While most Americans want easier access to the past century's medical advances, a small minority question established therapies such as childhood vaccinations, which save scores of lives each year. It's frustrating to consider how their choices might shorten the lives of others. If one thing puts my mind at ease, it's knowing that this tension isn't new. Most pills and inoculations were developed in the 20th century, but the tradition of challenging the medical establishment is much older. In a way, it shows that a democracy is healthy.
Madison author Erika Janik explores this contrarian custom -- and the enduring desire to control one's own health -- in her new book, Marketplace of the Marvelous: The Strange Origins of Modern Medicine. Along the way, she uncovers thrilling stories about people who developed odd medical therapies in the 19th century, and how some of these treatments led to wisdom we now consider commonsense: Drink eight glasses of water daily, exercise regularly and bathe at least every now and then. Even the quacks have something valuable to teach us.
Trained as both a historian and a journalist, Janik, 33, has created a book that's likely to find a place in college classrooms as well as the bookshelves of readers who enjoy strange stories about our country's past. It's the fifth book she's written but her first for Beacon, a major independent press whose works are distributed by Random House. Her earlier books, including Odd Wisconsin, concentrate on regional history, for the most part, and many of her other stories appear on Wisconsin Public Radio, where she is a producer.
In a Marvelous excerpt The Atlantic published recently, Janik details how phrenology -- a practice that involves measuring the skull and "strengthening" specific areas of the brain to improve one's personality -- spawned terms such as "highbrow" while fueling the public's interest in studying the mind scientifically.
"Why do we act the way we do? What determines the patterns of our behavior? How can we be better people? Every generation seeks answers to these questions," Janik writes. Phrenology was a popular way to answer these questions in the 1800s. Today we have psychiatry, neurology and even "brain-strengthening" games such as the ones Lumosity sells. Meanwhile, self-help books share exercises for controlling anger, managing anxiety and improving concentration.
Snake oil and quacks
From the get-go, Janik hoped Marketplace of the Marvelous could be both a trade title and an academic one.
"People often think history is going to be dry reading, especially when they remember memorizing names and dates in school," Janik says. "But history is the stories of people like you and me. We can relate to these people and learn from them."
The idea for Marvelous sprang from a question Janik's husband, a neurologist, posed nearly six years ago, and it took her four years to research and write the book. The question was about Wisconsin's Reinhardt brothers, a pair of quacks who made a fortune selling remedies for "sexual dysfunction." Janik couldn't answer it, so she decided to learn more about 19th-century medicine and pseudoscience. Luckily, the UW's Ebling Library is a treasure trove of documents about the history of healing. Janik supplemented these materials with a month-long trip to the University of Rochester. Here she sought assistance from a librarian specializing in medical history, and the themes of Marvelous began to emerge.
"I was reading tons of source materials and writing down things I was noticing," Janik says. "I kept coming back to 'We still do this today.' Soon I knew I could tell this story by picking out some of the [19th-century] therapies that had the most impact. I thought about which ones have traces in politics, literature and religion, which ones had their own schools, and which ones you hear doctors complaining about."
Though Janik built Marvelous from historical accounts, the book reads like a set of stories, with colorful characters who come alive on the page.
"I really wanted to have a person be the first face of each therapy I introduced," she says. "I wanted these characters to seem real to the reader, so I looked for physical details to help people picture them and words they spoke or wrote to help people hear them. That can help you understand why someone would have thought the way they did."
While searching for connections between topics like homeopathy and hypnosis, Janik concluded that 19th-century people weren't suckers, despite the vast quantities of snake oil being sold.
"There were very good reasons they thought the way they did, and I think they were well intentioned in making guesses. It's just that they didn't know some of the things we know today, like how human contact and insects can spread disease," she says.
Janik stresses that there are still many knowledge gaps in modern medicine, and that this uncertainty makes many people uncomfortable. Plus, it can be hard to accept that a diagnosis sometimes comes with an unpleasant treatment. Less daunting options are appealing, even if they're not very effective.
"If some treatments taste better or don't cost as much, people are going to try them," she says.
On the flip side are people who find mainstream treatments too mild. Janik points to hydropathy, a healing system centered on cold water, lots of it. Patients were advised to drink it and bathe in it, often for long periods of time. Janik says this is one of the weirdest treatments she came across, but also one of the most useful, in that it helped regular bathing go from a radical practice to a common one.
"I try to imagine what your skin would look like after 18 hours of drinking and bathing, and people often did it for weeks on end, even when it was cold outside," she says.
Though this method of healing seems mad in the context of modern medicine, Janik says she can understand why 19th-century people trusted its underlying principle, that sickness -- from physical ailments to social, cultural and spiritual ills -- can be flushed from the body.
Historian as standup comedian
Janik's career path was uncertain for a period of time. Raised in Seattle, she recalls being interested in writing from a young age. A high school teacher praised her prose and encouraged her to major in English in college.
"I didn't think I'd major in history, even though every book I opened over Christmas break was a history book, and many family vacations were visits to historical sites," Janik says with a laugh.
Eventually she realized what she was missing and came to the UW to pursue a Ph.D. in colonial women's history. She felt her writing becoming too academic, so she enrolled in the journalism master's program.
"I needed to figure out how not to write like an academic, and I wanted to restructure how I think about things in order to reach more people," she says.
Since completing that degree, Janik has been on a leave of absence from her history program. It's been nine years, and she doesn't seem to be looking back. And she's definitely been reaching people through WPR programs like Wisconsin Life and history-themed talks at libraries across the state.
These audiences have had much to teach her, too.
"When I tell stories during talks, it's almost like being a standup comedian," she says. "I pay attention to which part the audience laughed at or asked questions about. This is great for figuring out where to start a story and what things to leave out."
The female practitioner
One thing Janik makes sure to leave in is female history-makers. She used Marketplace of the Marvelous to highlight several ways women have shaped medicine.
Janik was surprised to learn that alternative medicine was the second most popular career choice for women in the late 1800s, after teaching. Women became hydrotherapists, chiropractors, herbalists and more, and medical doctors were almost always men. These male doctors soon took over some tasks women had done for centuries, such as delivering babies. Distrust for the medical establishment grew as the power shifted.
"Even Elizabeth Blackwell, the first female doctor in the U.S., was admitted to medical school as a kind of joke," Janik says. "She was harassed throughout her career, and women still weren't allowed to study at very many medical schools."
Meanwhile, alternative-medicine practitioners knew that a health crisis was happening. Women weren't getting the treatment they needed because of social mores: They were uncomfortable being examined by male doctors, their families disapproved of it, or the doctors themselves were unwilling to do it.
"Alternative medicine had a genuine interest in giving women business opportunities and ways to improve their own health," Janik says.
Though most women didn't have an M.D. to show for their expertise, they gained something just as valuable: their patients' trust.
As Janik notes in Marketplace of the Marvelous: "Whomever people trusted with their lives and well-being earned the title 'doctor.'"