Friday, June 16, 2017

What Internship Looks Like XXXIX: Reading in the Atrium

Sometimes internship looks like reading a book about food and hunger in 20th-century Germany while sitting in the warm sunshine of a hospital walkway atrium. Later on the agenda: lunch with the Narrative Medicine group and then primary care clinic in the afternoon.

P.s.--Go Penguins, Stanley Cup champions for the second year in a row!

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Tuesday, June 13, 2017

Book Review: Feeding the Nation Left a Sour Taste

In my last blog post, I described an academic study of hunger, food, and cultural racism in twentieth-century South Africa that is so prize-winningly good that it intimidated me as a writer. Let's just say that the next book I picked up engendered just the opposite feelings. For a book with a title like Feeding the Nation: Nutrition and Health in Britain before World War One (2010), I can't believe it wasn't on my radar before this spring. But Yuriko Akiyama's dissertation/first book seemed to promising that I went ahead and purchased it. Her argument is simple: cookery teachers, nurses, and other "educationists" (a British word I had to look up that means "educators") taught nineteenth- and early-twentieth-century Britons both nutrition and hygiene through lessons about food preparation and consumption. 




However, Akiyama conflates teaching with learning. This is pitched as a study of reception, but she offers precious little data about what the trainees thought of their lessons. I don't really fault her for that, because designing a reception study is hard (I know, I've tried); the answer is to frame your work as a discussion of other people's discussions, of what they wanted to convey. Unfortunately, she seems to take many of her primary sources at face value, blithely recounting their letters, speeches, and booklets. This may be one reason why the timeline of events in each chapter is so confusing: because each author rediscovered the importance of food for health in order to justify the importance of their particular program, it seems like the thread of the argument that cookery was recognized as important for the health of individuals and the nation is constantly being dropped and picked up again. She sometimes explains a particular idea as "now/suddenly/finally" being perceived as important once some reform has happened, which neglects the interest that had to exist beforehand to generate the political and social will for that reform. It also doesn't help that she argues for the importance of Florence Nightingale in the development of cookery and hygiene and then mentions at one point that real change required 30 years. In the long duree that's nothing, but in real time three decades an entire generation.

The other difficulty that arises from Akiyama taking her sources at face value is that she adopts their disapproving, reformist tone, especially toward the lower classes. Although she includes such important details as the fact that many poor Britons lived in hovels or tenements without private cooking facilities, she nevertheless makes comments about how uninformed and unhygienic they were. She confuses lack of knowledge with lack of will or ability, when there were manifest structural and institutional hindrances. This is important, because on the one hand she argues that the army taught every man to cook his own rations to ensure that nutrients would not be wasted by an inexperienced (non-British/foreign) cook, and then later she notes that the navy trained professional cooks so that all sailors could benefit from good, hygienic food. Somehow both are supposed to convey the same message about the importance of diet on health, when I suspect the army was mostly concerned about cost cutting. I will concede her one point though, which is that just because hygienic structures and routines have been created doesn't mean that individuals will absorb the lesson (I think of soldiers defecating outside of their tents because it's more convenient than going to the communal latrine).

The best part of the book is that she tried to cover a variety of sites: schools for cookery teachers, elementary schools, hospitals and nursing schools, training for soldiers and sailors. In this way she covers girls and boys, women and men. I wish she had spent more time on the recipes that were taught, rather than talking about the educational institutions, but then I would have written a different book. And maybe I will.

Monday, June 12, 2017

Starving on a Full Stomach: An Intellectual Feast for the Mind

Image result for starving on a full stomach wylieDo you remember that time in medical school when I pledged to read one book a month? Predictably, the streak didn't last very long, although in my defense, I had joined a year-long Bible study, in addition to reading many other, shorter things. Since then I have published the occasional book review, more out of a need to make me sit down and grapple with than because I think most of you want to know about any one of these books. Residency has kept me too busy to do much blogging, but I looked up the other day and realized I had read five books in the last three months, with 2-3 books scheduled for the rest of my current block of time off from clinic for research. I want to share two books with you that had opposite reactions on me.

The first book is Starving on a Full Stomach: Hunger and the Triumph of Cultural Racism in Modern South Africa (2001). It had been on my to-read list since before I presented a paper at a medical humanities conference in Johannesburg, South Africa, in 2013. Starving on a Full Stomach was Wylie's second book, and it has all the markings of the product of a mature scholar--namely, that it is so well written that it makes me doubt I will ever be able to publish anything half as good. Other scholars agree: it won the Melville J. Herskovits Prize from the African Studies Association in 2002.

Wylie uses arguments about food, hunger, and nutrition in the eastern part of South Africa to track the development of the cultural racism that buttressed the apartheid state for more than 40 years. (It was not biological racism, because scientists had shown that all human bodies were comparable; if Blacks and Whites had different life experiences, then this must be explainable by habits and beliefs = culture.) At first Europeans treated the mostly rural African population with paternalism, using the language of the patriarchal family to justify White rule over Black "children," just as native Chiefs had power over their tribes. However, colonial policies that enriched White miners and farmers at the expense of Black workers--such as artificially low wages, artificially high food prices, and crowded native "reserves"--put more and more impoverished Africans in the position of needing help that the government was unwilling to supply after World War II ended.

She argues that the apartheid state was "modern" in so far as it had scientific backing, such as the nutritionists and social scientists who claimed that Africans could not feed themselves and therefore--implicitly or explicitly--did not deserve political rights. As paternalism gave way to scientism (over-regard for scientific-sounding explanations), the apartheid government formed in 1948 no longer accepted any responsibility for Black health, envisioning separate "homelands," foodways, and "self-sufficient" socio-cultural spheres. One of their favorite hobby horses was that Africans were mismanaging their land and cattle, such they no longer produced enough food to nourish their families. This assertion conveniently ignored the fact that Blacks had been ejected from cities and crowded onto too little land for too many people (and cows). Even most of the politically moderate physicians and researchers examining the question of the nutritional health of native Africans described the problem as one of knowledge instead of one of structures of oppression. Finally, at the bitter end, when these scientistic explanations for Black poverty had lost their luster, the apartheid government justified its continued existence with naked power and brute force.

Things I learned:
  • Thomas Malthus predicted that a growing population would outstrip its food supply, leading to famine and a necessary reduction in the population. What he did not account for was the agricultural revolution that increased food production exponentially. While modern societies no longer suffer widespread famine, some of their members do experience hunger. Hunger in industrial capitalism is a problem of food maldistribution rather than one of insufficient food production.*

  • Europeans typically held a static view of African culture as "a food-sharing entity" and assumed that Africans preferred private gifts of food among each other to higher wages from their White employers. How conveeeeenient, as The Church Lady might say.

  • The word "famine" was thrown about a lot. Africans often thought of "starvation" as a synonym for "poverty," while Whites saw it as a description of Blacks' eternally helpless state. How mind-blowingly aggravating that the government never adopted any of the suggestions Blacks offered for their own betterment.

  • It was possible to be "starving on a full stomach" if the person had moved to town and replaced their milk, grain, and vegetable-heavy rural diet with processed foods and sugar. To want meat but not be able to afford it was another kind of hunger.

Look out for Part II of this series, a review of Feeding the Nation: Nutrition and Health in Britain before World War One (2010) by Yuriko Akiyama.


*I am now in the middle of Modern Hungers: Food and Power in Twentieth-Century Germany by Alice Weinreb; when I get to the last chapter, on obesity, I hope she talks about how an abundance of food encourages over-consumption, which in our health-conscious western culture typically leads to dieting = voluntary hunger.


Editor's Note: If you liked this post, Frau Doktor Doctor has previously reviewed a book about German measles and birth defects; a book of essays by historians of medicine who are also practicing physicians; and a number of audiobooks she listened to while driving around the Eastern United States for residency interviews.

Sunday, June 11, 2017

TSPGH: St. Paul's summer organ series

That's So Pittsburgh: an organ concert on a Sunday afternoon at St. Paul's Cathedral. What's unusual: getting to sit up in the organ loft to watch from 10 feet away. I've seen Dear Husband play the organ from closer, of course, but this was special as the drifting clouds outside changed the brightness of the sunlight streaming in trough the beautiful stained glass windows. Up here, not only do pipes jut overhead, but you can hear the sounds of the mechanical stops, and occasionally a large, deep pipe vibrates under foot.

Friday, June 2, 2017

Scotland: Highland Folk Museum


Our next AirBnB was down in Newtonmore, so after spending the middle of the day on Cairn Gorm Mountain, we stopped at the open-air museum on the edge of town. Entrance is free, but since it costs them 11 pounds per visitor to pay their actor-interpreters and keep up the grounds, we went ahead and donated 10 pounds each, plus 5 pounds for the guide book. The weather mostly held out for us as cool and gray, with only a smattering of light rain toward the end of our three-hour visit.

(A week's rations in Britain during WWII.)



The Highland Folk Museum is a mile-long stretch of land to which a number of old buildings have been brought. On one end is an animal farm, complete with nicer and shabbier farm houses. (See Dear Husband milking Bessie, above.) There's also a vehicle garage from the interwar period and a house that trebles as middle-class parlor, sweet shoppe, and post office. In the middle is a town c. 1930, with a school, a church, a tailor, a clockmaker, etc. The school was the very last place we stopped, shortly before closing time, and when the schoolmaster reprimanded us for being late, at first we thought he was playing his part, but really he wanted us to know that the place was closing! Our AirBnB hostess sometimes plays a schoolmarm there.


Above is the table in the little shepherd's hut; below is the stone paddock for sorting sheep brought in from the pasture for shearing, dipping, or other procedures.


Here's the counter of the little post office.


A short walk through the woods gets you to an eighteenth-century village of wattled dwellings with thatched roofs. The houses, barns, and drying kiln were sturdy structures, but the insides were dark and smokey. I readily understood what a dirty existence it must have been. There were two actors present while we were there, but the man didn't seem interested in conversation, and the woman ran off to intercept a couple who were trying to trespass onto neighboring land.



It was a neat experience. The 20th-century presentations looked pretty familiar to our American eyes, but the 1700s settlement was new and different. I'm glad we went, even though I hadn't been expecting to pay money for it.

Thursday, June 1, 2017

Scotland: Loch Ness & Urquhart Castle

On our last day in Scotland, I had planned for us to take a boat tour of Loch Ness and Urquhart Castle. We woke up that morning in Newtonmore, a good hour south of the Jacobite dock, and thanks to road construction and "Sunday drivers" (there's the phrase again!), we quite nearly missed the boat. Skidding into the gravel parking lot with mere minutes to spare, Dear Husband ran to the booth to pick up our tickets, while I grabbed a few things from the car. Between us we had two jackets, one hat, and one scarf, and it was half as much as we needed out on the blustery lake. Scottish weather had finally caught up with us, and we were not ready.


Nevertheless, we braved the wind and cold for the hour-long journey out to Urquhart Castle, a tourist trap if ever there was one.


First things first: no, we did not see the Loch Ness monster. Mostly we watched the water and steep hillsides, with gorse bushes, trees, a golf course, and sheep, while a very entertaining young Scotsman rolled his "r"s and chattered on the PA system about the loch (it's not a lake, it's a loch). Loch Ness is the UK's second largest lake by surface area and second deepest (to 754'), but it contains the largest volume of fresh water--more than the rest of the lakes in England and Wales combined. Below 100 feet, the water is a constant 44 degrees F; above that the temperature fluctuates but never gets cold enough to freeze over.




The tour company is named for the Jacobite Rebellion in the late 1600s, the failed attempt to put a Catholic monarch back on the English throne, after King James II was driven into exile in 1688. Clans living in the Scottish Highlands were some of his and his son "Bonny Prince Charlie"'s most ardent supporters.

Urquhart Castle is a ruin of Scottish wars for independence from England. Picts may have occupied the area in the late 500s. St. Columba, who converted the Scots to Christianity, is said to have talked down a loch monster who was trying to eat a servant about that time. The first medieval stone castle was built in the 1200s. Strategically situated on a promontory, it changed hands many times and was finally dynamited in 1692 by retreating Crown forces. We joined the throngs (3/4 German tourists?!?) in visiting the various "rooms" and waited our turn to climb the narrow winding staircase up Grant Tower (it wasn't all that great). A chapel existed for a few decades before the space was converted to weapons storage (go figure). Having seen everything, we bought sandwiches from the visitor center and spent a little bit of time looking at the exhibits before catching the last possible showing of the short documentary that ended with the screen being raised and the curtains opened to reveal the castle down the hill. They also have a working trebuchet on the grounds; no word on when they hold demonstrations.



On the way back it had begun to sprinkle. The boat was less crowded, so we sensibly decided to ride in the enclosed cabin. I wanted to try a spiked hot chocolate from the snack bar, but the cost was too dear, so I settled on a pair of Nessie stuffed animals as Christmas presents. Alas, neither of us remember to pee before we disembarked, so we spent ten minutes looking for a restroom before heading 3 hours to the airport and consequently didn't think to snap a photo of our vessel, so here's one from their website of the "Warrior" in all her glory, with the Highlands behind her.




If you want to read more about our trip to Scotland, check out this post about hiking Cairn Gorm Mountain, this one about death and dying in Victorian times, or the one about going to church with Queen E.