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No. 71 Swiss Pioneers in Science and Medicine |
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E. Wolff Maximilian Bircher-Benner counts among the best-known and most influential Swiss physicians of the 20th century. But how did he influence medicine? Discovering a disease? Inventing a new and effective therapy? No, his influence was quite different. His most visible impact was beyond medicine: it was on menu cards, shop shelves and breakfast buffets all over the world, where his Birchermüesli, müesli, müsli, muesli, museli (or however it is differently spelled around the globe) changed dietary habits of millions and millions. Next to cheese and mountains, muesli (which means 'little mush') counts among the best-known things attributed to Switzerland. Today, a 'muesli' is commonly understood to be a mixture of basic ingredients like cereals, milk or yoghurt and some fruit – dried or fresh. It is typical modern food. It is convenient, for a quick breakfast or snack, made from ready-made cereal mixtures bought in the supermarket. It is also a very modern dish since it can be made for individual interests and tastes: for sportspeople, for children, for organic food devotees or gourmets. Muesli remains popular today largely because it tastes like a healthy option. Bircher-Benner was neither a chef nor a marketing consultant for a food manufacturer. In the beginning, muesli was quite different – its recipe, its image, its purpose, its consumers, and even its name. Bircher-Benner named his creation Apfeldiätspeise (apple dietary dish). Its most crucial ingredients were Bircher-Benner's dietary ideas.
At the end of the 19th century he studied medicine at the University of Zürich. After the first years of his medical practice, Bircher-Benner converted to naturopathy and temperance and focused more and more on the importance of nutrition for a healthy life. However, he was definitely not a pioneer in this respect. It was a time when naturopathic ideas were gaining popularity, in parallel with and as a reaction to developments in such fields as bacteriology, surgery and laboratory research. Vegetarianism was the antithesis of the prevailing Justus von Liebig theory of protein (which practically meant: meat) as being crucial for healthy nutrition. Bircher-Benner radicalized vegetarian ideas to the propagation of uncooked food: the more both healthy and ill people would eat raw food the more their state of health would be stabilized. He was not the first to do this but he became the most famous of what in German is called a Rohkostapostel (an apostle of raw food) – with all the ironic undertones of this term. Fresh Thinking Raw food is not everybody's favourite. Bircher-Benner's aim was to create a raw dish that both contained the most important foods and was attractive to eat – even for the toothless. So muesli's most important ingredient was absolutely fresh grated apple. In the 1940s, when muesli had developed to be a Swiss national dish, one of Bircher-Benner's sons, Ralph, complained about restaurants still serving in the evening muesli that had been made in the morning. The grated apple had to be mixed with some oat flakes and sweetened condensed milk, a very popular Swiss diary product of that time and still available today. Finally, lemon juice and chopped nuts were added. The original muesli would not have won a food beauty contest, but even to a sceptical muesli-eater the taste would have been respectable. Today, a typical dietician would argue for the health value of the original muesli on the grounds of its vitamins, low calories and cholesterol and high fiber content. Not so Bircher-Benner. Among his arguments one was prominent: in his eyes, raw food contained a high level of energy taken from solar light. This energy was lost by cooking or having been digested by animals. This is why, for Bircher-Benner, meat was of especially minor value: in his eyes it had lost its energy twice – once when the animal digested the plant and once when the animal's meat was being cooked. When Bircher-Benner presented his ideas to his non-sectarian Zürich colleagues, he more or less lost his reputation as a serious academic. It was not until the late 1920s and 1930s that he achieved broad popularity and became an authority in nutrition and healthy living in unconventional medicine circles of the time. For Bircher-Benner, muesli was not a convenient breakfast dish or something swallowed for a hurried lunch between appointments. It was part of a strictly fixed health regime and a structured daily schedule. Muesli was meant to be served as a starter for every menu. Breakfast, lunch and dinner were part of a tight timetable of healthy living. According to Bircher-Benner's regime, which was called Ordnungstherapie (order therapy), one had to get up at 6 am and take a stroll before breakfast. One should stay out in fresh air working or strolling as much as possible during the day and avoid indulgences like coffee, alcohol or tobacco. At 9 pm one should go to bed and turn down the light at 9.30 – at the latest. A regime like that had to be exercised and internalized. For this purpose Bircher-Benner founded a sanatorium in which the patients were under supervision more or less the whole day. In 1904 he moved his facility to a new building on the famous Zürichberg, on a paradise-like piece of land with a marvellous view over Lake Zürich to the Swiss Alps. Soon patients flooded his Sanatorium Lebendige Kraft (Vital Force Sanatorium), hoping to get rid of their neurasthenia, obesity, constipation or depression. The Lebendige Kraft became one of the most renowned places for healthy living in early 20th century Europe, and a growing number of celebrities and wealthy people stayed there. Guests included art celebrities like Yehudi Menuhin and politicians like Sir Stafford Cripps, Habib Bourgiba and Golda Meir. Thomas Mann, German literate and later Nobel Prize laureate, took his cure at the sanatorium in 1909 and in a letter he named it a 'Hygienisches Zuchthaus' (which could be translated as 'health jail'). However, patients subjected themselves to the therapy regime completely voluntarily. Bircher-Benner's sanatorium did not stand alone, it was a part of an early multimedia popular health movement. This consisted of an idea, a simple message (raw food) that could be identified with a popular person (Bircher-Benner) and a symbolic practice (eating muesli). It had a concrete center (the sanatorium) and was publicized through various media: a popular monthly journal (Der Wendepunkt), brochures that sold over 100,000 copies, self-help books and exhibits. Health campaigns in later decades – Jane Fonda's workout, for example – were in principle based on a similar concept. Years before the rise of the Lebendige Kraft in Zürich, in the United States a sanatorium with a similar reputation could be found. The American Seventh-Day Adventist physician John Harvey Kellogg (1852-1943) had much in common with Bircher-Benner – except the idea of raw food, as can be seen by the cornflakes developed by him and his brother. Kellogg's sanatorium in Battle Creek, Michigan, was also meant to internalize what its founder saw as a healthy life: vegetarian diet, asceticism, exercise – and enemas to clean the bowels. T.C. Boyle immortalized Kellogg's ascetic sanatorium in his novel The Road to Wellville. What the Lebendige Kraft and Kellogg's sanatorium have in common is that they both were places where patients were trained to conduct a strict regime, constantly practicing self-control and focusing on the health of their body and mind. This phenomenon is still seen in today's wellness practices, where it is commonly described as 'healthism'. As today, Bircher-Benner's numerous patients were practicing healthism without any compulsion from outside but nevertheless influenced by the presence of a higher authority, personified in Dr. Senior, as Bircher-Benner was called inside the Lebendige Kraft. The French sociologist and philosopher Michel Foucault described this phenomenon as 'governmentality', and saw it as a crucial factor in making modern societies work. Medicine in the Media Age To conclude: in which way did the Swiss physician Maximilian Bircher-Benner have an influence on medicine? It was not his somehow weird theory of nutritional energy from solar light, which had never been broadly accepted. Even if he promoted an ideal dietary plan that has some similarities to the ones of today, there is no direct line between the two, since he promoted raw food for partly different reasons. His nutritional eponym in the German-speaking world – Birchermüesli – is less and less known, while muesli's recipe and image have substantially moved away from the original form. However, Bircher-Benner, like John Harvey Kellogg and others, had a remarkable influence on medicine in a broader sense. His ideas of Ordnungstherapie, with its strict health regime, his internationally renowned sanatorium to practice this regime and a multifaced set of mass media to promote it established an early and well-known platform of modern popular health practices, for better or for worse. Remember this the next time you bite into an apple instead of a steak. This article is based on research funded by the Swiss National Science Foundation. Further Reading Melzer J, Melchart D, Saller R: "Entwicklung der Ordnungstherapie durch Bircher-Benner in der Naturheilkunde im 20. Jahrhundert". Forschende Komplementärmedizin und Klassische Naturheilkunde 2004;11:293-303. Meyer-Renschhausen E, Wirz A: Dietetics, health reform and social order. Vegetarianism as a moral physiology: the example of Maximilian Bircher-Benner (1867–1939). Medical History 1999;43:323-341. Wirz A: Die Moral auf dem Teller dargestellt an Leben und Werk von Max Bircher-Benner und John Harvey Kellog. Zürich, Chronos, 1993. Wolff E (ed): Lebendige Kraft. Max Bircher-Benner und sein Sanatorium im historischen Kontext. Baden, hier + jetzt, 2010. Wolff E: Moderne Diätetik als präventive Selbsttechnologie: Zum Verhältnis von heteronomer und autonomer Selbstdisziplinierung zwischen Lebensreformbewegung und heutigem Gesundheitsboom; in Lengwiler E, Madarasz J (eds): Das präventive Selbst. Eine Kulturgeschichte moderner Gesundheitspolitik. Bielefeld, Transcript, 2010, pp 169-201. Related Reading  Gazette No 68: Eating Your Way to Happiness: Chocolate, Brain Metabolism, and Mood  Eberhard Wolff University of Zürich Dr Wolff is a medical historian and cultural anthropologist at the universities of Zürich and Basel. |
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