PART III
Manufacturing Health
Will Kellogg’s cereal factory: the packing room, circa 1920 Credit 67
9
The San’s Operations
BIOLOGIC LIVING ASIDE, there was a great deal of surgery going on at the San and Dr. Kellogg performed most of those operations. In his earliest days of running the Sanitarium, the young doctor hired moonlighting surgeons from Detroit, Chicago, and Ann Arbor to perform surgery in Battle Creek. John, used to far better outcomes at Bellevue Hospital, was appalled by his hired surgeons’ skyrocketing mortality rates. Equally discouraging was the paucity of follow-up care delivered by these per diem blades, who typically beat a fast track out of town shortly after the last stitch was sewn into place. On too many late nights, Dr. Kellogg frantically called these surgeons back to the San’s operating rooms to amputate patients’ limbs or remove more diseased tissue because the hastily performed procedures went awry with postoperative infections.
Beyond the desire to ameliorate complication rates, John quickly grasped that the fees generated by outside operators represented a lost cash bonanza for the San. By establishing an in-house surgical service, the extra income would help raise the San’s bottom line, rather than paying off the proceeds to the outside surgical contractors. Consequently, Dr. Kellogg revised his initial plans to conduct a medical practice that did not include cutting into living human flesh. But because he had no formal training in this delicate craft, he had to learn how to perform surgery all the while he was building and expanding the San, maintaining his ever-growing roster of patients, lecturing around the country, and producing a long written record of his ideas and work.
Dr. Kellogg operating on a patient at the American Medical Missionary College. In the viewing gallery is a rapt audience of student nurses. Credit 68
Such “postgraduate work” was no easy task. Nearly a decade into his career as a surgeon, he remained anxious about every procedure he performed and once told Ellen White that he relied upon God’s will to tolerate the sight of blood and the anguish of cutting into a living human being.1 To satisfy his perfectionism, in the 1880s Dr. Kellogg began a thorough study of surgical techniques by making a series of observational trips to Europe’s leading hospitals in Vienna, Paris, London, and Edinburgh, where many of the world’s operative masters plied their trade.2 Every time John returned from Europe, he came back loaded with techniques he wanted to replicate in the San’s suite of white-tiled, well-ventilated, and sky-lit operating rooms. Above all, it was John’s attention to detail, his systematic review of the latest surgical journals, and his constant practice of new methods that made the San’s operating rooms hum with efficiency.3
—
IN 1888, FOR EXAMPLE, Dr. Kellogg visited the Vienna General Hospital (Allgemaines Krankenhaus), the leading institution of its kind in the world. Instead of currying favor with a young Jewish neurologist named Sigmund Freud, whose psychoanalytic musings on hysteria would have seemed odd, indeed, to the son of an Adventist broom maker, John spent his days in the operating theater of Theodor Billroth, a pioneer in abdominal surgery.
In the days before antacids and other pharmacological wonders relieved gastroesophageal reflux and “acid indigestion,” stomach and intestinal ulcers were commonplace occurrences among many men and women. The pain brought on by a gastric ulcer is so difficult to bear because it feels as if sharp nails are scratching the inner surface of one’s stomach. This pain is especially intense after consuming a meal, which stimulates the stomach to secrete loads of scorching hydrochloric acid, further irritating the ulcerated, raw sore. There also existed the very real risk of that ulcer eroding the stomach or intestinal wall so that it perforates entirely through, much like the blow-out of a tire. Such medical emergencies often ended in a bloody, painful death.
To correct these ills, Dr. Billroth devised a series of operations in which large portions of the stomach were entirely removed. This drastic solution obviated the immediate harm of a perforated ulcer but it disrupted one’s digestive process long after the surgical wound healed. John was astute enough to know these were procedures he needed to learn, even if he used them only as a last therapeutic resort. The great Billroth was too busy to give John the personal attention he craved but the surgeon’s first assistant, Anton Wolfer, privately tutored him on mastering the technique, in return for a healthy stack of Austrian kroners.4
Dr. Kellogg also studied under a world-famous gynecological surgeon named Lawson Tait at the University of Birmingham in Great Britain. Women suffering from what were delicately referred to as “female problems,” including vaginal tears from childbirth, sexually transmitted diseases often unwittingly contracted from straying husbands, painful uterine fibroids, prolapsing uteruses, ectopic pregnancies, and ovarian, uterine, and cervical tumors, frequently came to the San seeking help. Hence, John was always on the lookout for improved methods to handle such problems. In 1889, when he first visited Birmingham, Dr. Tait was on an unprecedented surgical roll of completing 116 successive operations without a single infection or complication. This was a phenomenal accomplishment in an era where 10 to 20 percent of all surgical procedures ended in death.5 The number becomes even more striking given Tait’s initial opposition to the germ theory of disease and Dr. Joseph Lister’s doctrine of surgical antisepsis, wherein all instruments and the surgical wounds were sprayed with the antiseptic carbolic acid to kill the germs in the operating room and the surgical wound. Nevertheless, Dr. Tait was hardly the dinosaur some medical historians have claimed him to be. He strongly believed in the importance of operating in a scrupulously clean environment, one that today might be classified as “aseptic” or germ-free conditions, even as he eschewed and vigorously debated Lister’s harsher chemical approach.6 Like a surgical sponge, Dr. Kellogg absorbed Dr. Tait’s emphasis on operative skill and sanitary precautions. On the same trip, John spent a month at the Samaritan Free Hospital for Women in London observing several Listerian gynecological surgeons practice their craft, so that he might acquaint himself with their techniques, as well.
Incidentally, Lawson Tait’s successful operative record was one he substantially increased in the years that followed. The surgeon did have a rather keen competitor in the United States, however, who performed 165 successive operations using the Tait techniques without a single postoperative infection: his name was John Harvey Kellogg.7 In an era before aseptic surgery and sterile rubber gloves became the gold standard, this record of success is a superb testimony to Dr. Kellogg’s operative skills.8
At London’s famed St. Bart’s Hospital in 1907, and again in 1911, Dr. Kellogg studied under Sir William Arbuthnot Lane, one of Great Britain’s most prominent gastrointestinal surgeons. Lane, like Dr. Kellogg, was fascinated by the now discarded disease entity known as autointoxication, which was thought to have resulted from chronic constipation. The theory behind this malady was that the poisons emanating from the retained stool (and undigested, putrifying foodstuffs, such as meat) caused problems ranging from anxiety and neurasthenia to depression, chemical imbalances, and far worse. Lane’s savage cure was removal of most of the colon, a procedure Dr. Kellogg found too drastic for his taste.9
—
BACK IN BATTLE CREEK, John began each operation by leading his surgical team in prayer, often before the patient was put under the anesthetic. Several patients commented on how much they appreciated this devout touch. John told his patients after they recovered that kneeling in prayer before operating calmed his apprehensions.10 Always knowing how to play on the doctor’s insecurities, Ellen White declared that she had a vision where “heavenly beings” guided Dr. Kellogg as he surgically ventured into the human body. With the passage of time, the doctor grew resentful of such comments, fearing that patients might expect too much from him and, perhaps more pragmatically, diminish the respect of his secular colleagues who routinely took full credit for their own surgical successes.11
In fact, Dr. Kellogg took great pride in
his dexterity with the scalpels and forceps he routinely manipulated. The doctor modestly attributed these skills to his being a “delicate child” who often stayed indoors with his mother while she taught him to sew. It will also be recalled that as a boy working in his father’s broom factory, he was among the best workers at sorting the broomcorn and making brooms. Yet a more cogent reason John was so good at stitching up wounds was that he practiced the craft during any free moment he could find. On many of the long train rides he took for his lectures, meetings, hospital visits, and weekly stints at the Chicago Mission, John would put aside the latest manuscript he was composing to practice making tiny incisions on rough pieces of cloth and elegantly sew them back together. Dr. Kellogg was also quite handy with pen, ink, and paper and often drew his own surgical illustrations to accompany the reports he wrote on the procedures he conducted. Sketching, he insisted, was an important part of his skill building because “the hand is trained to follow the eye,” a critical skill for any surgeon.12
Many of his surgical colleagues admired his abilities in the operating room. For example, Howard Kelly, the famed gynecological surgeon at Johns Hopkins Hospital and a devoutly evangelical Christian, often visited Battle Creek and assisted John in the San’s operating suite. Kelly was said to have “tears in his eyes when he watched” Dr. Kellogg perform surgery. At several public gatherings over the years, Dr. Kelly stated, “John Harvey Kellogg [was] the most skillful surgeon [I] ever saw operate.”13 In recognition of his skills, John was nominated and elected to the prestigious and highly exclusive American College of Surgeons in 1914, only one year after it was founded.
Similarly, Dr. Charles Mayo, of the eponymous Mayo Brothers Clinic, once examined a patient and observed, “I see that Dr. Kellogg has operated on you.” The patient confirmed Mayo’s assessment and then asked incredulously, “How could you have known who had done the operation?” Dr. Charlie was said to have replied, “That’s easy. The scar is small and neat, just like a signature.”14 Dr. Kellogg befriended both Mayo brothers and made many a pilgrimage to their famous surgical clinic in tiny, cold Rochester, Minnesota. A colleague later complained that the Battle Creek Sanitarium did not develop into an enduring Mayo Brothers–type enterprise because John refused to departmentalize and build up specialists and let them run their own practices. “[He] insisted on doing it all himself. [He] was something of an exhibitionist.”15 His biographer, Richard Schwarz, was even more blunt: “loathing self-seeking, John was always concerned lest some colleague or relative try to use association with him for personal advancement. The suspicion often led Kellogg to appear sharp and critical and undoubtedly kept many of his associates from becoming really friendly with him.”16
—
ONE OF JOHN’S GREATEST CONTRIBUTIONS to modern surgery, even if he never received due credit for it, was insisting that his surgical patients engage in moving about as soon as possible after the operation. The standard of care at this time was the exact opposite and most surgical patients were strictly confined to a hospital bed for several days to weeks at a time. Today, we know that many of these recumbent patients developed thrombi, or blood clots, which have the power to break off into emboli and clog the arteries wherever they lodge, including the brain, heart, and lungs, often ending in serious disability or death. Many patients also developed bacterial pneumonia as a result of lying too long in bed and breathing in too shallow a manner, allowing mucus and infectious microbes to take root in their chests. Not so on Dr. Kellogg’s postoperative ward. Although he stuck to the notion of postoperative bed rest, he ordered his recuperating patients to perform a series of graded physical and deep-breathing exercises while in bed, on the day after surgery and every day thereafter while in the hospital. Today, early ambulation and breathing exercises are a basic (and vital) premise for recovery from nearly every surgical procedure.17
Unlike many surgeons of his day, Dr. Kellogg insisted on keeping his patients well hydrated. He encouraged them to drink several large glasses of water before going under the knife and administered water enemas immediately after an operation, while the patient was still anesthetized. Given the high risk of surgical shock from the abrupt loss of body fluids, especially in the years before intravenous fluids were developed, Dr. Kellogg’s devotion to “hydrotherapy” likely had a beneficial impact. Another way he mitigated the risk of surgical shock was by inventing an operating table heated with hot water, so as to keep the patient as warm as possible during the procedure. Afterward, he surrounded the patient’s body with warm sandbags.18
Dr. Kellogg did not quit the operating room until he was eighty-four and performed more than 22,500 operative procedures. During most of his career, he spent two to three days a week in the operating room. On an average day, he performed about twenty-five procedures over an eight- to ten-hour period, many involving the removal of hemorrhoids, ovaries, gall bladders, and appendixes. Most of the surgical fees John generated over this period were donated to the Sanitarium or earmarked for his latest medical crusade rather than lining his pocket.19 In the first half of 1905 alone, for example, he billed more than $27,000 (or $562,000 in 2016). Approximately one third to one half of the operations he performed were on patients who could not afford surgery and who were not charged for his services. In a surgical version of Robin Hood, John often charged fees as high as $1,000 on a rich man so that he could afford to operate on a poor one for free.20
Dr. Kellogg (left) operating on his 75th birthday, February 26, 1927 Credit 69
—
ODDLY, Dr. Kellogg insisted on dominating all of the gynecological work rather than “assigning it to lady doctors.”21 Over the years, he performed thousands of such procedures with great care and success. One of the most frequent reasons he took a woman into the operating room was for “external and internal massage of the womb.” Dr. Kellogg describes this method in his 1883 textbook, Ladies Guide in Health and Disease: Girlhood, Maidenhood, Wifehood, Motherhood:
This new application of massage has won many brilliant successes in the hands of skillful operators. There are three modifications of the treatment; external, internal, and the two combined. Only external massage can be properly employed by untrained persons. The operation consists in grasping the uterus between the two hands, first compressing it and then applying a rolling motion. This should be alternated every minute or two with an upward movement applied with both hands in such a manner as to lift the womb from the pelvis. To facilitate the treatment, the patient should lie with the hips elevated upon a pillow or cushion. The movements should be applied with care and great gentleness at first, and no violence should ever be employed.
The womb massage sessions lasted for ten to thirty minutes and were administered twice a day. The women submitting to them became so exhausted from the sensation that they typically required a half hour’s rest, “in a horizontal position…after the conclusion of the treatment.”22 Few women complained and many returned for more such treatments over the years, suggesting that there was some amount of pleasure, or, at least, a modicum of strangely positive gain involved in submitting to Dr. Kellogg’s healing hands.
At this late date, it is difficult for even the most intrepid medical historian to decipher just what exactly Dr. Kellogg was treating with pelvic massages. Unorthodox to the extreme, there developed much talk and intense curiosity about the practice in Battle Creek and beyond. In 1961, John’s longtime colleague, Dr. William Sadler, mused about how the pelvic massages might give rise to suspicions regarding Dr. Kellogg’s relations with his female patients, but ever faithful to his mentor, Dr. Sadler insisted that John “was above reproach in all his attitudes toward women.”23
—
DURING THE TWENTY-TWO YEARS Will Kellogg handled and managed the San’s more mundane operations in the laundry, greenhouse, vegetable farm, gymnasium, treatment facilities, dining room, grounds, and bathhouses, he made certain that the proverbial trains always ran on time. Will created and supervised all of the San’s policies
and procedures, other than the medical ones laid down by the doctor. He was also the reliably trustworthy keeper of the San’s many secrets, including the occasional sexual peccadilloes of the medical staff, as evidenced by a diary entry he recorded on May 5, 1884:
I run acrost [sic] a letter from a Miss S to Dr. [J.H.] in which she confessed that Dr. F. had seduced her [,] had her for his mistrest [sic] for quite a while [.] loved her better than his wife [.] knocked her up and performed an abortion on her of a four months kid.24
Above all, the San served as Will’s business school and it was there where he learned to run a big complex organization with lots of people, machinery, specialized facilities, and activities that required his constant attention and upkeep. It is unclear if Will ever read the entirety of Frederick Winslow Taylor’s influential book The Principles of Scientific Management, but he certainly read abridged magazine article accounts of it. Taylor was the famous engineer who “conducted time and motion studies during the 1880s and 1890s to reformulate and systematize industrial work tasks” for maximum output by workers supervised by foremen and executives.25 From his earliest years working at the San, Will was fascinated by record-keeping systems and other newly developed means to make his business run more smoothly. Years later, he made scientific management a touchstone of his cereal business. As such, he frequently consulted with experts on the latest developments in advertising, marketing, and mass production.26
The Kelloggs Page 23