Food As Medicine: Diet, Diabetes Management, and the Patient in Twentieth Century Britain

Abstract

In classic accounts of the development of modern medicine in Europe and North America, the sick person is often portrayed as having a history of disappearance with the rise of the objectified body of the modern patient. To this account, sociologists and historians of medicine have added another for the period after 1950, in which the patient as subjective person “reappears” in medical discourse. However, despite histories of practice and identity revising narratives of disappearance, the patient’s reappearance has largely escaped further assessment. Using an analysis of dietary management in twentieth-century British diabetes care, this article challenges accounts of this reappearance in three ways. Firstly, it argues that discursive interest in the social and psychological aspects of care emerged earlier than suggested. Secondly, it grounds such interest in reconfigured institutional arrangements that were initially designed to rationalize care and improve efficiency. Finally, it argues that patients regularly exceeded the efforts of even an expanded management regime to normalize and regulate life. Food planning, preparation, and consumption continued to sit at the nexus of competing demands that mediated medical efforts to cultivate governable selves and bodies.

Half the battle is fought in the kitchen: convalescence and cookery in 1920s and 1930s Britain

“…Scientists differed on the importance of vitamins: John Plimmer was, for example, at odds with John Boyd Orr over the importance of vitamins in 1919 although the latter was to change his position dramatically later in this period (Kamminga 2000). Elsewhere, the dietary management of diabetes changed only slowly after insulin was more widely available in the 1920s as clinical experience was gained to reassure those continuing to prescribe weight-reducing diets that higher carbohydrate levels were safe (Moore 2018). From the present day, it is easy to underestimate the difficulty new ideas -and their dietetic ramifications -had in becoming accepted wisdom, taught as such, and manifest as everyday clinical practice (Stark 2018).…”

Introduction

“…Instead, they have described their artistic endeavours as establishing calm and transcendence, and some even exceed their recommended drug dosage to enhance their experiences. 79 Contributions to this volume, then, have taken a diverse set of approaches to the question of self and balance, as well as issues of agency and regulation. Nonetheless, a common thread through all the chapters, often (though not always) drawn from a Foucauldian-inspired literature, is an understanding that subjectivities oriented to balance were produced relationally.…”

Chronicity and the care team in Britain’s New Jerusalem

“…13 Patients, moreover, approached their prescriptions in similar ways, adjusting diets according to different priorities and structural constraints. 14 The continued emphasis on laboratory oversight into the 1940s meant that elite hospital doctors (and many GPs) believed the ongoing supervision of patients was best provided through specialist outpatient clinics. 15 These institutions combined the laboratory equipment and expertise considered necessary for high standards of care in a complex condition.…”