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Endeavour
Vol. 35 No. 2–3
The pasteurized state: milk, health and the
government of risk
Elizabeth Cullen Dunn*
University of Colorado at Boulder, Geography and International Affairs, CB 260 Guggenheim, Boulder, CO 80309, United States
In the late 1940s, Florence Sabin, a retired professor of
medicine, returned to her home in Colorado to launch a
massive public health campaign. Seeing ‘‘filthy milk’’ as
an important vector of disease, she struggled not only to
mandate pasteurization, but to create a state government that was capable of regulating the milk industry. In
the process, she brought managerialism into public
health by fighting against the political machines and
introducing Robert McNamara’s systems analysis into
government for the first time. Sabin’s innovation, which
united business, government and public health in new
ways, transformed the way that public health is managed even today.
National Statuary Hall, located in the US Capitol building
in Washington, is a pantheon of notable Americans. While
most states are represented by famous men of heroic
stature gazing off into the future, Colorado’s statue is a
surprising contrast: a plump, middle aged woman in a
shapeless dress and sensible shoes seated at a lab bench.
Yet, despite her unassuming posture, Florence Rena Sabin
(1871–1953) was one of the most important reformers of
public health in the postwar era. Using milkborne disease
as the nexus of industry, government and health, Sabin
organized a grassroots campaign for pasteurization that
broke the back of machine politics. But Sabin created not
just pasteurized milk, but a pasteurized state, one purified
of both political and microbial contamination. By agitating
for a set of health reforms that came to be known as the
Sabin Bills, and by breaking the machine politics that had
long controlled the state of Colorado, Sabin blended the
drive for public health with techniques of corporate management in order to create new forms of physical security
for the citizenry. Using systems analysis, a new form of
industrial management brought to the Ford Motor Company by Robert McNamara, Sabin placed the notion of
biosecurity – or the protection of the population from
biological threats – at the heart of political power. In doing
so, she changed the way state and municipal government
operated, reshaped industry and created the possibility of
new ways of governing health more than 60 years later.
What is at stake in Sabin’s story is a form of political
power often misrecognized as new and ominous. In recent
years, social scientists such as Foucault [14] and Rose [19]
have argued that people in modern societies are forced to
constantly monitor themselves, discipline themselves and
§
This paper was written with the invaluable assistance of Joshua Perdue. Thanks
also to Michele Rivkin-Fish, Julie Guthman, Wendy Wolford, Joe Bryan and Emily Yeh.
*Tel.: +1 303 492 5388.Dunn, E.C. ([email protected])
Available online 12 August 2011
www.sciencedirect.com
manage their own health and biological life. Braun [3],
however, argues that there is a second relationship
between health and politics that shapes modern life: the
idea that people are constantly vulnerable to germs, pollutants and contamination that they cannot control. No
matter how diligently people watch their diets, exercise
and take other precautions, there are risks to their health
they cannot control. These hazards, often, come from business: from the toxic wastes and contaminated products
that are the products of commerce not properly regulated.
Animal-borne diseases are the classic case of the unpredictable hazards of modern life: as Bernard Vallat, the
Director General of the World Organization for Animal
Health, put it, we live in the ‘‘great biological cauldron of
the twenty-first century’’ (Vallat cited in [3, p. 8]).
As Florence Sabin’s struggle against milkborne disease
shows, though, the problem of ungovernable disease-causing microbes is hardly new (see also [1]). But urbanization,
increasing commercialization of the food supply and the
concentration of milk production created new vulnerabilities to disease, ones that could no longer be managed by
individuals acting on their own. To combat these new risks,
Sabin introduced one of the most important ideas underlying the management of public health: that to combat the
risks posed by the commercialization of the food system,
the state could adopt the same bureaucratic management
techniques that capitalist businesses did in order to manage the circulation of germs and regulate public health.
Looking at the way Sabin managed to transfer ideas of
business management into public health shows not only
how public health became a problem of government, or the
rationale for new government bureaucracies, but how the
health of the population became something that could be
managed and administered in the same ways as a for-profit
business.
Creating the truth
In 1944, Florence Sabin had just retired from a long career.
The first tenured female professor at the Johns Hopkins
School of Medicine, she later became the first woman to
head a department at the Rockefeller Institutes of Medicine. Returning home to her native Colorado, Governor
John Vivian soon named her as the chair of the Health
Subcommittee of his Postwar Planning Commission.
Vivian selected Sabin not because he thought she would
lead a reform effort, but because he thought that as a ‘‘quiet
retired M.D.’’, she would ‘‘upset no applecarts’’ [18]. But she
soon upset applecarts all over the state of Colorado by
merging Progressive Era ideas of public health with new
modes of industrial management.
0160-9327/$ – see front matter ß 2011 Elsevier Ltd. All rights reserved. doi:10.1016/j.endeavour.2011.06.004
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As the monument to her in National Statuary Hall
suggests, Sabin’s quest to reform health is usually portrayed as a hero’s quest. In popular accounts, she is shown
crisscrossing the state under perilous conditions in order to
educate the people of Colorado about the need for change:
Last November, she was scheduled to speak at the
little town of Sterling, 125 mountainous miles from
her Denver home. At daybreak, Herb Moe [the executive secretary of the Sabin Committee] ‘phoned to
say that there were eight inches of snow on the
mountain passes and why didn’t they call it off.
Her answer was, ‘‘Meet me at nine. . .and don’t forget
your rubbers.’’
By the time they reached the foothills, the State
Highway Patrol was broadcasting warnings to all
cars to get off the roads. ‘There she sat,’’ Moe relates
admiringly, ‘‘with a shawl tied over her head, like a
quiet little old grandmother on her way down the
street to tea. It was 1:30, with snow near our hubcaps,
before we reached Brush. ‘‘Thirty miles to go’’, I said,
making a last try at getting out of it.
‘‘Well,’’ she answered, ‘‘we’ve still got 30 minutes.
Let’s make it’’ [18, p. 3].
This story and others like it are probably more apocryphal than true. (For one thing, Sterling and Brush are not
in the mountains, but more than a hundred miles away on
the Eastern Plains.) However, the image of an aging and
vulnerable woman on a mission to warn the public of
hidden dangers was integral to Sabin’s myth during the
time she was campaigning for legal reforms. Stories of her
travels around the state emphasized how her inexplicably
magnetic personality (inexplicable because of her age and
lack of beauty) brought people to demand reform. This
image of a democratic call for health reform was carefully
created by Sabin herself, who edited her own accounts to
emphasize her belief that the general public was thirsting
for the information she gave them. On manuscript copy of
an essay recounting her reform campaign, Sabin carefully
crossed out a long paragraph detailing the organizational
efforts of her committee, and substituted instead one that
made it seem as if the demand for government intervention
in public health had emerged spontaneously from towns
across the state:
One of our legislators has put it in one sentence. He
said, ‘‘This time, we, the legislators, know before
hand that we had to pass the Health Laws.’’ This
can mean only one thing: that the people of Colorado
had willed it so [22, p. 3].
So ends Sabin’s tale of reform: ‘‘the people had willed it
so’’. In a story that echoes the dominant narratives of
revolutionary advance that have become associated with
a Pasteurian history of science more generally [16, p. 13],
Sabin’s own narrative represents the passage of the health
reform laws as the inevitable result of the population’s will
towards progress.
The real story, however, was much more complex. Sabin
began her crusade to eliminate reservoirs of disease by
using statistical analysis, a technique pioneered on the
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Figure 1. Statue of Florence Sabin at National Statuary Hall.
Courtesy of the Sophia Smith Collection, Smith College.
East Coast during the Progressive Era, as a means of
making disease and a population simultaneously visible.
Although Sabin’s letters show that she had already decided
on the targets of her intervention a priori, she began by
commissioning a study by Dr. Carl Buck of the American
Public Health Association that ‘‘revealed’’ supposedly unappreciated levels of disease in Colorado by quantifying
them and comparing them to rates of disease in other
areas. According to Buck and Sabin, 47 states had lower
rates of scarlet fever, 44 had lower rates of tuberculosis, 43
had lower rates of diarrhea and enteritis and so on [21],
http://profiles.nlm.nih.gov/RR/Views/Exhibit/documents/
colorado.html. She argued that between 1941 and 1946,
over 8245 deaths in Colorado ‘‘could have been prevented,
had the knowledge that we already have concerning preventative medicine and health protection been universally
applied throughout the state’’ (http://profiles.nlm.nih.gov/
RR/Views/Exhibit/documents/colorado.html [4,21, p. 1]).
She took as her target diseases typhoid fever and bovine
tuberculosis, which she argued were both milkborne
(Figs. 1–4).
Raw milk was, of course, the quintessential target of
Progressive public health reform. In 1945, Colorado was at
least 20 years behind New York and Wisconsin, where
‘‘milk wars’’ had already led to mandatory pasteurization,
the industrialization of the dairy business and the transfer
of ideologies of perfection from the religious domain into
the hand of technical experts and social reformers (see [13,
Chapter 4]). However, neither the social nor the economic
transformations of milksheds further east had taken place
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Figure 2. Sabin at Hobart and William Smith Colleges.
Courtesy of the Sophia Smith Collection, Smith College.
in Colorado. Milksheds were still served almost entirely by
small dairy farms most of which delivered milk directly to
consumers. The beginnings of market consolidation in the
milkshed were evident, though, and this gave Sabin a place
from which to launch her campaign. Larger dairies and
bottlers such as Royal Crest and Meadow Gold (which was
part of the industrial dairy conglomerate Borden’s) began
to focus on processing milk from local dairymen rather
than on maintaining their own herds. They developed their
own assembly-line bottling plants complete with industrial
pasteurization equipment onsite. They were far from controlling the market, however. The Denver milkshed
remained highly fragmented, with small-scale producers
continuing to compete with the larger bottlers. Thus,
despite the nationwide trend towards pasteurizing milk,
many consumers both in Denver and in other Colorado
towns were still drinking raw milk from family farms in
1946, over 50 years after pasteurization was invented and
over 22 years after pasteurization was recommended in the
federal government’s Standard Milk Ordinance of 1924 (cf.
[13, p. 77]).
Sabin used this ostensible backwardness in the milk
industry to build grassroots support for her reforms. Her
phenomenal success at this came from her ability to
submerge her own emphasis on government reform within milk as a highly gendered symbolic substance and to
convince women in particular of the existent dangers to
public health. As she travelled the state, she used the
standard Progressive Era political technique of stirring
up maternal outrage at the specter of filth and disease in a
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fluid that was supposed to be white, perfect, health-giving
and pure (see [13], see also [2]). As her biographer, Maisel
[18] writes, ‘‘When Dr. Sabin talks of babies made sick by
tainted milk, mothers feel that she is talking of their
own babies’’. She presented rates of disease adjacent to
calls for ‘‘improved sanitation and standards of milk and
dairy products’’ to imply – though she never claimed
outright – that unpasteurized milk from Colorado’s
small-scale dairies was linked to tuberculosis and typhoid
fever. In one instance, Sabin writes that women in one
county responded to her presentation by saying ‘‘that they
could see so much dirt in the milk that they did not use it
at all’’.
Her assertion that milk was killing people was probably
as inaccurate as the tales of her heroic travels. Indeed,
given that Denver had no water treatment plant and that
raw sewage was dumped into the Platte River, water was a
much more likely source of illness. But by pointing the
finger at milk, Sabin reestablished the notion of unpredictable risk at the heart of all germ panics: the idea of an
unseen and potentially devastating force beyond the control of individual citizens or consumers. Sabin’s discursive
construction of milk, in which children were made vulnerable to a microbial force their mothers could not control,
laid the groundwork for a new kind of subjectivity, one
in which individuals appeared as precarious bodies
enmeshed in circuits of economic and political exchanges,
eternally at the brink of disaster (see [3]).
The way Sabin constructed risks to health marked a
fundamental break with Progressive Era health reformers. Unlike the early Progressives, Sabin did not argue
that individuals or household cleanliness and organization were responsible for health or illness. Nor did she
prescribe improved practices of self-care and domestic
practice as the Progressives did (cf. [24,25]). Sabin’s argument was clearly meant to lead to one conclusion: the
problem was industry, not individuals. Because risk
was systemic and beyond the individual, she argued, only
the state could stave off catastrophic infection. What made
Sabin’s argument about biosecurity transformative,
though, was not just the linkage between germs and
government, but the way she linked it to managerialism.
For the state to regulate both health and commerce,
according to Sabin, required not just government management of industry, but the industrial management of government. Sabin argued that to purify the body, the state
must sanitize the milk and to sanitize the milk, the state
must clean up the industry, but most important of all, to
clean up the industry, the state had to use the tools of
industry to purify itself. While certainly sympathetic to
the ways capitalist businesses ran, Sabin’s argument did
not rely on a naı̈ve faith in the virtues of an unregulated
market. Rather, Sabin tapped into one of the most potent
ideas of the postwar era: the belief that ‘‘the future is the
belief of calculated decisions made in the present’’ rather
than of unseen and unknowable events. She believed in
managerialism and planning [15].
In the early postwar era, the efficacy of planning was
becoming an article of faith in everything from Keynesian
economic policy and American corporate management to
Soviet industrial management. By creating a study that
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Figure 3. Delivery trucks at Gold Seal Dairies, ca. 1930.
Photograph by Harry Mellon Rhoads. Courtesy of Denver Public Library, Western History Collection, call number RH-1193.
quantified incidences of disease and tabulate them in gridlike form, Sabin coupled the classic progressive arguments
that disease was rampant and that the government could
enact technical means to prevent it. But more importantly,
she pioneered a new way of looking at disease, one that tied
new knowledge about vulnerabilities to a managerialist
ethos that saw planning as the means of constituting
security for a population (Dupuis, 2002, p. 66, [15, p.
35]) [10,20]. As James Scott says, these were images of
state power that were ‘‘uncritical, unskeptical and thus
unscientifically optimistic about the possibilities for comprehensive planning’’ [23, p. 4]. This emphasis on comprehensive planning meant that Sabin was of course
interested in a large number of diseases, most of which
were not milkborne. But more importantly, it meant that
rather than merely focusing on eradicating disease vectors,
as Progressives did, she was focused on transforming the
entire system that produced disease, including the structure of industry and the structure of the state that regulated it.
The Sabin Bills, as the laws Florence Sabin campaigned
for came to be known, thus had surprisingly little to do with
milk, or indeed, with disease vectors at all. Indeed, of the
eight bills, only the first three were aimed directly at the
prevention or treatment of disease. There was a bill to
increase the number of hospital beds for TB sufferers, one
to increase the per-diem payment to hospitals for the care
of indigent TB patients, and a bill that proposed the testing
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of dairy cattle for Bang’s Disease. The next three were
squarely aimed at expanding the medical apparatus. One
was for appropriations for the health department, the next
funded the construction of new hospitals and the third
allocated money for the medical school, where new public
health experts were to be trained.
The last two bills, though, were the most important.
They marked a massive change in the administrative and
spatial organization of state government and promised to
create a new form of public health politics by recognizing
the state as a bundle of regulatory forces rather than as
single entity, and at controlling that bundle by placing
experts in strategic locations. One bill, explicitly labelled
the ‘‘State Reorganization Bill’’, created an independent
Department of Public Health that was supervised not by
the governor of Colorado, but by a Board of Health made up
of medical experts. The State Reorganization Bill banned
political appointments for other public health positions by
removing them from the civil service, and required the
director of the new Colorado Department of Health and the
Environment to have academic credentials in medicine or
public health. A second bill, which created county and city–
county health departments, aimed at extending systemic
state control of health to smaller and smaller spaces,
including not only dairy barns and other industrial spaces,
but into the micro-spaces of domestic lives. Sabin’s heroic
quest for health thus aimed at creating a form of biopolitics
in which managers and experts, acting on behalf of the
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Figure 4. Free milk at Rude Park Community Center, ca. 1940.
Courtesy of Denver Public Library, Western History Collection, call number X-19848.
state, could both posit the vulnerable body and begin work
on it. Although the reforms these bills instituted seem
commonsensical today, in the political context of the late
1940s, they were not at all obvious. They demanded dramatic changes in politics and industry, proposed a radically
new form of governance and opened up new spaces within
which governance could operate.
The technocratic regulation of industry
The pasteurization of milk would seem to be an unproblematic improvement. In the best technocratic tradition,
the notion of pasteurization defines a problem and proposes a technological solution all in one moment. But
pasteurization was controversial in Colorado not on scientific grounds, but on economic and political ones, precisely
because under Sabin’s reforms, making milk sanitary required ‘‘cleaning up’’ the industry through government
regulation. Pasteurization became a thin cover for stateled industry consolidation, since under Sabin’s reforms,
authorities came to believe that eliminating milkborne
disease required having fewer, more economically prosperous firms that were easier to regulate.
Drives for consolidation under the guise of public health
protection had a long history in Colorado. In 1926, for
example, the city of Denver’s injunction against the sale
of unpasteurized milk to prevent typhoid fever was overtly
a battle over market share between the small-scale dairy
farmers and the rapidly consolidating bottling industry,
arbitrated by state and municipal government using public
health regulations. Arguing that no cases of typhoid had
been traced to milk, several raw milk dealers declared
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openly that the ordinance reflected ‘‘an organized attempt
of certain milk dealers to ‘squeeze out’ the smaller men,
most of whom were dealers in raw milk’’, and said the
‘‘order would prejudice the public against their product in
favor of the pasteurized dealers, taking away their market
and completely ruining their business’’ (Denver Post [8]).
The city eventually permanently mandated pasteurization
within city limits in 1931, in what the Denver Post described this as a victory by the municipal government
against the city’s raw milk dealers (Denver Post [9]). But
the struggle between small-scale raw milk dairies and the
rapidly consolidating pasteurizers continued sub rosa.
Small dairies were still finding a way to circumvent the
large-scale pasteurizers and sell raw milk and they were
perfectly free to do so in most towns outside Denver, which
they did even during and after World War II.
One reason Colorado lagged behind the East in mandating pasteurization was that the milk industry had long
been intimately linked to the personalistic patronage relations of machine politics. The government’s infrastructure
and the municipal government’s ability to monitor, inspect
and control production were at that time a function not of
technocratic, science-based governmentality, but of the ties
among elites that dominated local government in Denver.
In 1937, before Sabin’s return to Colorado, the city’s Chief
Milk Inspector told the Rocky Mountain News that many of
the 25 milk stations in or near Denver were able to sell milk
that was ‘‘unfit for human consumption’’ because Governor
Teller Ammons, Mayor Ben Stapleton and their notorious
political machine were constantly engaging in political
interference in the inspection process and depriving the
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Health Department of resources in order to further the
business interests of their cronies (Rocky Mountain News,
July 19, 1937).
When Sabin emerged on the scene in 1944, public health
was still wrapped up in a system of governance that
regulated economic circulation through cronyism and
thought of political power not in terms of technocratic
regulation, but in terms of personalistic ties. The system
linking milk, government and public health was what
Tania [17] might call a ‘‘contingent lash-up’’: a loose alliance of state agencies, individual politicians and various
dairies that sometimes collaborated but more often opposed one another. Sabin’s political program was based
on the assertion that because cronyism drove out expertise,
the state could not identify risk or regulate production, and
therefore could not provide security for citizen-consumers.
Germ panic was thus transformed into a kind of state
panic, in which the presence of illness in the population
indicated that the state itself had a disease. Sabin, playing
the role of doctor rather than politician, offered what she
called ‘‘modern’’ or ‘‘professional’’ health management as a
remedy. Proper management, she argued, could purify
milk not just by pasteurizing it, but by dismantling the
political machines that stood in the way of pasteurization.
Here, expert management promised to provide a more
durable basis for regulatory power, one that embodied
itself in procedures, objects and principles rather than in
individuals and their personalistic networks.
Sabin embedded her struggle against machine politics
in a battle over expert knowledge. She strove to dramatically change the definition of ‘‘competent authorities’’ who
could issue truth claims about health by arguing that
competence meant the ability to manage on the basis of
science. As the Buck Report – which was drawn up with
considerable input from Sabin – put it,
The most important weakness in state public health
organization is that at present public health is a
division of the executive branch of government under
the direct control of the governor. The health of the
people in any state is altogether too important to
place it in State Government in a position to be so
completely susceptible to political machinations and
maneuvering. . . Public health must be completely
freed from political interference and permitted to
develop and progress on a sound scientific basis [4,
p. 8].
Sabin began by backing the secretary of the Division of
Public Health, Dr. Roy Cleere, in an overt war against
Mayor Benjamin Stapleton’s political machine. The Stapleton machine had run Denver politics on the basis of
political cronyism for over 23 years. But in 1937, Cleere
attempted to hire additional sanitation officers to inspect
milk and milk products. This sparked a battle between him
and Stapleton’s Civil Service Commission, which, as the
engine of the patronage system, refused to give out government jobs on the basis of technical competence rather
than as rewards for political favors. When Dr. Cleere
refused to hire a milk inspector nominated by Stapleton
on the grounds that the nominee was grossly unqualified,
the Civil Service Commission responded to Dr. Cleere’s
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refusal by withholding pay from the entire Division of
Public Health (Health in Colorado [7]). This opened a
full-scale war between a newly coalescing group of technocratically inclined self-proclaimed ‘‘modernizers’’, and
the Stapleton machine.
Sabin joined Cleere in battle by demanding that expertise be institutionalized. In her State Reorganization Bill,
Sabin created a new State Department of Public Health
removed from the direct supervision of the state governor
and set up a Board of Health as its executive. Requirements for the makeup of the Board were meant to ensure
that its composition would be technocratic rather than
based on political favors. The State Reorganization Bill
also banned political appointments for public health positions by removing them from the civil service, and required
the director of the new Colorado Department of Health and
the Environment to have academic credentials in medicine
or public health. In doing so, she sought to extend the
supposed value-neutrality of science into a public health
system funded and regulated by the state.
The next step in purifying politics was to use health
reform as a means of installing technocrats in the political
offices currently occupied by the Stapleton machine. Sabin
helped two young politicians, Quigg Newton and Lee
Knause, neither of whom had a party affiliation, use the
lack of enforcement of sanitary measures in the dairy
industry as a key criticism against Stapleton and Ammons.
Sabin wrote,
Two years ago the State Government in Colorado
had only one interest in its Division of Public Health;
namely, that it was one more place in which to try to
force political appointments. Moreover, the Denver
city machine had a remarkably successful record in
defeating health bills in the legislature. The machine
had only to pass the word down the line to kill health
bills, and they were killed. Now, what a change!
There is a new Governor who campaigned for good
government and specifically for a health program,
and is enthusiastically carrying out his pledges. An
election in Denver brought into office a new
Mayor. . .who understands the fundamental principles of the movement; he wants, just as eagerly as
informed citizens, a modern, professional staffed
health department. . .No wonder Coloradans walk
on air and talk of health to match their mountains!
They have won the decisive battles of their campaign
and now have only to get on with the business of
public health in Colorado [22, p. 1311].
Sabin’s drive for governmental reform thus hinged on
the idea of pasteurizing the state itself, purifying it of
politics and instead installing expert managers who could
rule on the basis of science and rationality. The physical
security of the population was based on simultaneously
inserting health into politics, by managing the population
and its environment as a means of controlling public health,
and, at the same time, making this new form of state power
appear to be apolitical by calling it ‘‘management’’. Health,
politics and industrial management were gathered around
the powerless bodies of the potentially infected. But the
triple displacement of health into politics, politics into
industrial management and industrial management into
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health created a new kind of person in society: the manager
as sovereign. Rather than putting the burden of managing
their own health on citizens and relying on the market to
give them what they needed to preserve their own bodies,
Sabin’s managerialism made public health the responsibility of a new managerial class.
New strategies of management
The set of strategies for intervening in collective existence
in the name of health and life did not end by simply
installing unaffiliated politicians in office, by making scientists into bureaucrats or by creating a regulatory environment in which profit could be reaped. Sabin’s reforms
aimed not just at inserting medical expertise into the state,
but at bringing a new set of managerial practices from
industry into the state regulation of health. What Sabin
did was to introduce systems analysis, the suite of management tools developed by Robert McNamara, the president of the Ford Motor Company and later the Secretary of
Defense under Kennedy, into government by way of public
health.
McNamara had developed systems analysis in the Army, where he and ten other officers staffed a small unit
called ‘‘Statistical Control’’ during World War II. Picking
up on the Taylorist principle of management by measurement, McNamara’s so called ‘‘Whiz Kids’’ began a program
of measuring things in the Army that had never been
measured before: numbers of aircraft per hangar, spare
parts per base, gallons of fuel per bomb that reached target
and so on. At war’s end, McNamara and the Statistical
Control group went to the Ford Motor Company, where
systems analysis soon replaced familial corporatism. At
Ford, the Whiz Kids took their ‘‘management by numbers’’
philosophy and developed planning tools such as organizational charts, production schedules and capital forecasts.
While these seemingly innocuous bureaucratic tools are
now commonplace in almost any organization today, in
1945 they were radical. Management was being done not
on the basis of intuition or on personal relationships, but on
the basis of cold, hard numbers and formalized plans.
McNamara, of course, later became famous for ‘‘modernizing’’ government agencies in just the same way he had
Ford, including the Department of Defense and the World
Bank.
Sabin never called McNamara’s management style
‘‘systems analysis’’. She referred to it using the terms
‘‘modern’’ and ‘‘professional’’. But what she clearly sought
to do was to bring the emerging management styles of
corporate America into the realm of statecraft – something
she did even before McNamara tried to do the same thing
by applying the tools he used at Ford to the Department of
Defense. She had already used statistics to define the
problem, and then posited a complex network of state,
dairy industry and household relationships as the ‘‘system’’ in which regulation should operate. In the logic of
mid-century management, the next logical step was not to
chase microbes, but to create a new institutional structure
that could regulate at ever finer scales. The texts of the
laws, and the structures of governance they envision show
that Sabin’s idea of ‘‘modern’’ managerial structures was
essentially the same one taking place in American corwww.sciencedirect.com
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porations in the 1940s and 1950s. The archetypical model
for this kind of corporate transformation was General
Motors, which, under the guidance of Alfred Sloan,
brought together a wide group of independent car manufacturers and brands into a single firm [5]. Robert McNamara, a graduate of the Harvard Business School, brought
the Sloanist management model to Ford Motors, where it
replaced familial corporatism. McNamara later became
famous for ‘‘modernizing’’ government agencies along the
same way, including the Department of Defense and the
World Bank. At the time of Sabin’s campaign, then, porous
boundaries between corporate management and state
governance were already being built in other American
sites. Sabin’s innovation was to link the body, industry and
the state in a complex formation that rendered public
health into a Sloanist apparatus that constituted a new
form of sovereignty.
The Sloanist or McNamarist model required a complex
multi-unit structure organized in a line-and-staff chain of
command, with both a centrally located headquarters and
a number of field units placed close to the site of production
or regulation, and within which a set of technologicallyinclined professional managers organized transactions
among the units. Sabin’s calls for a ‘‘professional’’ and
depoliticized technocratic managerial staff echo transformations in large capitalist firms, in which claims to scientific knowledge by professional managers came to replace
the personalistic ties among entrepreneurial family members and business partners [5]. In industry, according to
Chandler, this kind of structure allowed the visible hand of
management to partially supplant the invisible hand of the
market. In public health, it allowed the visible hand of
government experts to supplant both the market and
medicine, blending Pasteurian ideas about the eradication
of microbes with Sloanist ideas about management in ways
that made regulation the primary site on which a new form
of sovereignty could be constructed.
Sabin’s State Reorganization Bill put forth the idea of a
‘‘modern’’ institutional structure inside the Department of
Public Health that almost completely replicated the lineand-staff model first put forth at General Motors and later
brought by McNamara to Ford. McNamara’s model required a complex multi-unit structure with both a centrally
located headquarters and a number of field units placed
close to the site of production or regulation, and within
which a set of technologically inclined professional managers organized transactions among the units. In industry,
this kind of structure supposedly allowed the visible hand
of management to partially supplant the invisible hand of
the market. Sabin believed that this structure could create
health security by allowing her apolitical technocrats to
‘‘see’’ more effectively into small towns and communities by
placing the structures of public health closer to them and to
deploy new health-promoting strategies across space and
at ever-smaller scales. By authorizing multiple-county,
county, and city–county health departments supervised
by the State Department of Health, the Sabin Bills
aimed to change the scale of public health provision and
to permit direct contact between the Department and
individual citizens. By virtue of their local knowledge
and social connections with the surrounding community,
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Endeavour Vol. 35 No. 2–3
these county departments were supposed to be more able to
effectively penetrate, monitor, and shape the goings-on at
the local level.
The goal was to bring science-based technocratic regulation to tiny and heretofore hard-to-reach places like
dairy barns, obstetrical clinics, family homes and public
schools. Indeed, in the first two years after the Sabin
Laws were passed, a host of stepped-up enforcement
procedures enabled the county health departments to
enter into spaces where it had not been before. First,
the microspaces of the milk commodity chain were opened
to new scrutiny and measurement, including dairy barns,
milking parlors and pasteurizing plants. In addition to
‘educational’ visits from public health officials and educational meetings held by sanitarians to 156 pasteurizing
plants, the Department of Health’s laboratory now began,
for the first time, to systematically measure milk quality
by taking somatic cell plate counts on milk samples from
the pasteurizers.
The systems approach allowed the newly reorganized
public health system to follow the milk commodity chain
and penetrate new social spaces. Schools were one new
arena that the reorganized Health Department entered.
The state’s Nutrition Consultant followed pasteurized
milk into the school systems to ensure that schoolchildren
were being given milk to drink as a way of improving
nutrition. But soon, the Nutrition Consultant was working
with school districts to develop school lunch menus, and
then conducting regular sanitary inspections of schools’
food-handling procedures. Likewise, the state also began to
track individuals’ health-related performance. Within a
year after the passage of the Sabin Laws, county health
departments began penetrating private homes, as they
adopted the casework method and sent public health
nurses to inspect new mothers’ knowledge about appropriate diets for children (which of course, included copious
quantities of milk), housekeeping skills, childrearing techniques. Just as the state’s laboratory was now tracking the
bacteriological counts of individual processors’ samples in
order to see which plants were in need of supervision and
consultation, so too did the state create health history
forms and vaccination forms to keep track of children’s
immunizations.
As the state took on the responsibility for tracking and
supervising children’s health, it also began to X-ray college
students so that local health departments could locate
tuberculosis sufferers and supervise treatment. The newly
reformed Health Department even penetrated the intimate spaces of the body in order to apply technocratic
management. Between 1948 and 1950, the state Department of Health launched a campaign that used educational
tent shows at county fairs and rodeos to identify potential
patients at county fairs and rodeos, test their blood for
venereal disease, and if needed, begin the administration
of procaine penicillin (Colorado State Health Department
[6, pp. 10–14]).
This was a massive expansion of government. As new
kinds of risk were identified and brought under managerial
control, Colorado’s public health became visible in
ways that it never had before. Public health had become
a fundamental problem, the measurement of citizens’
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illnesses had become a fundamental technique of governance, and the management of public health had become
the fundamental basis of state expansion into new parts of
social life.
Conclusion
The management of public health has been a problem of
government for a very long time. But Florence Sabin’s
campaign to eradicate milkborne illness marked the beginning of a huge transformation in how states sought to
protect the wellbeing of their citizens. Sabin’s great innovation was to bring managerialism into government. By
using McNamara’s systems analysis and other techniques
of business management to protect the food supply, she
brought economy, health and politics together in a new way
that allowed the state to defend the population as a whole
from forces that were invisible, unpredictable and uncontrollable by individuals acting alone. Although her fusion
of capitalist managerialism and government was pioneering, it was rapidly replicated in other parts of government,
and not just by McNamara himself, who brought systems
analysis to the Department of Defense. Today, the management techniques and bureaucratic forms first developed by McNamara and brought to public health by Sabin
are still – even in this technologically advanced age – used
by states in the quest to protect populations from circulating threats. They saturate everything from the USDA’s
attempts to regulate food safety [11] to USAID contractors’
attempts to provide humanitarian relief [12]. They are the
mundane architecture that even now brings together economies, commodities, bodies and germs into forms that can
be monitored and regulated by the state. They allow
government to manage new places – from dairy barns
and mines to preschools to refugee camps. In doing so,
they shape not only large industrial systems (like entire
agrofood systems), but also the everyday behaviors of
citizens.
References
1 Atkins, Peter (2007) Fear of Animal Foods: A Century of Zoonotics.
Appetite 51, pp. 18–21
2 Bobrow-Strain, Aaron (2008) White Bread Biopolitics: Purity, Health
and the Triumph of Industrial Baking. Cultural Geographies 15, pp.
19–40
3 Braun, Bruce (2007) Biopolitics and the Molecularization of Life.
Cultural Geographies 14, pp. 6–28
4 Buck, Carl E. (1946) Colorado’s Public Health Needs and How To Meet
Them
5 Chandler, Alfred (1977) The Visible Hand: The Managerial Revolution
in American Business, Harvard University Press, (Cambridge)
6 Colorado Department of Public Health (CDPH) (1949) Toward a Long
and Healthful Life: Report of the Colorado State Department of Public
Health. CDPHE archives
7 Colorado Department of Health (1969) Health in Colorado: the First
One Hundred Years. CDPHE archives
8 Denver Post (March 7, 1926) Dealers in Raw Milk Ordered to
Pasteurize
9 Denver Post (October 20, 1938) Griffenhagen Survey Assails Dairying
Laws
10 Duffy, John (1990) The Sanitarians: A History of American Public
Health, University of Illinois Press, (Urbana)
11 Dunn, Elizabeth Cullen (2007) Escherichia coli, Corporate Discipline,
and the Failure of Audit. Space and Polity 11, pp. 35–53
12 Dunn, Elizabeth Cullen (2012) The Chaos of Humanitarianism:
Adhocracy in the Republic of Georgia. Humanity 3. (2), in press
Feature
Endeavour
Vol. 35 No. 2–3
13 Dupuis, E. Melanie (2002) Nature’s Perfect Food, New York University
Press, (New York)
14 Foucault, Michel (2009) Security, Territory, Population: Lectures at the
College de France, Picador, (New York)
15 Lakoff, Andrew (2008) From Population to Vital System: National
Security and the Changing Object of Public Health, Biosecurity
Interventions: Global Heath and Security in Question (Andrew
Lakoff and Stephen J. Collier, Eds.), Columbia University Press,
(New York), pp. 33-60
16 Latour, Bruno (1988) The Pasteurization of France, Harvard
University Press, (Cambridge)
17 Li, Tania (2007) The Will to Improve: Governmentality Development
and the Practice of Politics, Duke University Press, (Chapel Hill)
18 Maisel, Albert (1947) Colorado’s Little Dynamo. Reader’s Digest
p. 49
www.sciencedirect.com
115
19 Rose, Nikolas (2001) The Politics of Life Itself. Theory, Culture and
Society 18, pp. 1–30
20 Rosen, George (1958) A History of Public Health, MD Publications,
(New York)
21 Sabin, Florence (1946) Basic Health Needs of Colorado
22 Sabin, Florence R. (1947) The People Win for Public Health in
Colorado. American Journal of Public Health 37 (10), pp. 1311–1316
23 Scott, James C. (1998) Seeing Like a State: How Certain Schemes to
Improve the Human Condition Have Failed, Yale University Press,
(New Haven)
24 Tomes, Nancy (2000) The Making of a Germ Panic, Then and Now.
American Journal of Public Health 90 (2), pp. 191–198
25 Tomes, Nancy (2003) The Private Side of Public Health: Sanitary
Science, Domestic Hygeine, and the Germ Theory, 1870–1900. The
Bulletin of the History of Medicine 64 (4), pp. 509–539