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History

ohn Harvey Kellogg; Surgeon, Inventor,utritionist (1852–1943)

a Scienya M Jackson, MD, Stanley J Dudrick, MD, FACS, Bauer E Sumpio, MD, PhD, FACS

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ohn Harvey Kellogg was elected to Fellowship in themerican College of Surgeons in 1914 as one of theriginal members, and he remained an active member ofhe College throughout his life. Not only was he anccomplished surgeon, but also a successful inventor,ealth advocate, educator, and food reformer. He per-ormed more than 22,000 surgical procedures during hisareer while contributing many inventions and innova-ions including promotion and marketing of peanututter, Bulgarian yogurt, meat substitutes, granola,reakfast cereals, and artificial milk derived from soy-eans.1,2 Toasted Corn Flakes became one of his mostamous cereal products. But his creativity was not lim-ted to foods. He also invented the electric blanket, a

ethanol nasal inhaler, tanning lights, surgical instru-ents, and exercise equipment.2 Like many surgeons, heas multitalented, and his creativity extended beyondis expert technical skills in the operating room. Johnellogg was a truly remarkable pioneer in both health

eform and nutrition, and ample evidence of his ingenu-ty and resourcefulness continues to exist beyond hisifetime (Fig. 1).

Kellogg was born in 1852 inTyrone, MI, and during hisouth, he moved with his family to Battle Creek, MI, wheree worked in his father’s broom factory. In 1872, the Sev-nth Day Adventists, who wished to attract an attendinghysician to the staff of their institution, offered to sponsoris education in exchange for his services after graduation.e initially attended the University of Michigan Medical

chool, but completed the requirements for his medicalegree at Bellevue Hospital Medical College in New Yorkity.2 Kellogg returned to Battle Creek and soon changed

he focus of “The Western Health Reform” institution ofhe Seventh Day Adventists from hydrotherapy to medicalnd surgical treatment (Fig. 2). Kellogg promoted his facil-

eceived April 16, 2004; Accepted May 12, 2004.rom the Department of Surgery, St Mary’s Hospital-affiliate of Yale Univer-ity (Jackson, Dudrick), Waterbury, CT; and Yale University School of Med-cine (Dudrick, Sumpio), New Haven, CT.orrespondence address: La Scienya Jackson, MD, 56 Franklin St, Waterbury,

iT06706.

8172004 by the American College of Surgeons

ublished by Elsevier Inc.

ty as a clean place where people could come to maintainellness and good health. Consistent with these goals, theord sanitarium evolved from the word sanitation.2 Origi-ally, the facility housed only 20 patients, but as it ex-anded, it was renamed the Battle Creek Sanitarium byellogg.2 At about this same time, Louis Pasteur also hadublicly proclaimed his germ theory, adding great impetuso “antiseptic surgery,” which Dr Kellogg strongly advocat-d.2 His beloved “San” is where he developed his surgicalractice and invented many of his products to help hisatients.

Dr Kellogg studied and trained with both Europeannd American surgeons. In 1889, he pursued portions ofis surgical training in London and Vienna, where hepent 5 months with Dr Lawson Tait, a surgeon whopecialized in gynecologic and abdominal surgery.1,2 Taitas well known internationally for having successfully

ompleted 116 successive operations without a singleatality.1,2 This was an exceptional feat during this pe-iod, when surgical procedures were accompanied by a5% to 20% mortality rate. Using Dr Tait’s techniques,r Kellogg would exceed this signal record 5 years later,

y performing 165 successive operations without anyortality.2 While in Vienna, Dr Kellogg also had the

pportunity to observe one of the greatest surgeons ofhe 19th century and the founder of modern gastricurgery, Dr Theodor Billroth. Dr Billroth’s assistant,nton Wolfler, provided Dr Kellogg with private in-

tructions while teaching him the surgical procedureserformed in Billroth’s clinic.2 Dr Kellogg traveled tourope several times during his lifetime, and the addi-

ional training he received there allowed him to updateis surgical skills and helped him advance his surgicalareer.

In America, Kellogg visited the Mayo Clinic inochester, MN, which was considered the premierenter for experimental surgery at that time. There heet the two founding physicians and surgeons of the

linic, Drs Charles and William Mayo.2 The Mayorothers observed Dr Kellogg’s surgical skill and were

mpressed with his technique (Fig. 3). Eventually, Dr

ISSN 1072-7515/04/$30.00doi:10.1016/j.jamcollsurg.2004.05.279

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818 Jackson et al John Harvey Kellogg J Am Coll Surg

ellogg focused his surgical interests on the gastroin-estinal tract, which enhanced his ability to concen-rate and advance his skills and allowed him to per-orm complicated procedures more efficiently andffectively.2 While traveling by train, he used the timeo practice his stitching technique on a piece of clothnd subsequently became well known for his smallnd precisely sutured incisions.2 This relativelynique feature of his surgical skill was not only no-iced and appreciated by his patients, but also by his

igure 1. John Harvey Kellogg in 1942 at age 90. (From the Battlereek Historical Society, with permission.)

igure 3. Dr Kellogg teaching in the operating room. (From the

Cattle Creek Historical Society, with permission.)

olleagues, who could often identify his work by thencision alone. He was a man admired by many of hisontemporary colleagues, including Dr Howard Aelly, the famous abdominal surgeon at John Hop-ins University.2 Dr Kellogg continued to practiceurgery well into his 80s, and his professional careerxtended over a period of 68 years.

Dr Kellogg was not only a gifted technical surgeon,ut he also invented many different surgical items in-luding surgical instruments and retractors. He designedn operating table that was heated by hot water, whichas used to prevent shock in patients undergoing long

urgical procedures.2 In addition, he placed warm sand-ags around his patients postoperatively. Dr Kellogg’soncept of biologic living played a role not only in ev-ryday living, but also in the care of his patients. Heelieved patients recovered more quickly if they avoided

igure 2. The Western Health Reform. (From the Battle Creek His-orical Society, with permission.)

igure 4. Exercising in front of the Sanitarium. (From the Battle

reek Historical Society, with permission.)

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819Vol. 199, No. 5, November 2004 Jackson et al John Harvey Kellogg

eat several days before surgery. Postoperatively, he al-ays encouraged his patients to drink plenty of fluids.fter operations were completed, most patients werelaced on bed rest for several weeks, but Dr Kelloggequired his patients to start passive exercises on the firstostoperative day and encouraged ambulation soonhereafter.2

Dr Kellogg gained additional recognition because ofis devotion to public health. One of his role models waseverend Sylvester Graham, a Presbyterian ministerho was a strong advocate of vegetarianism, which, in

he 19th century, was termed Grahamism. He preachedhat people should avoid meat, alcohol, tobacco, coffee,ea, and white bread. A fundamental component of hisietary philosophy was to use whole grain wheat flouror baking, and he later extended this conviction to theevelopment of graham crackers, which continue to re-ain popular today.At the Battle Creek Sanitarium, Dr Kellogg advocated

nd extended Graham’s philosophy. He provided his

igure 5. Sanitas Wheat Flakes. (From the Battle Creek Historicalociety, with permission.)

atients with a healthy atmosphere and assisted them w

ith their diets. His concept of “biological living” in-luded vegetarianism, aerobic exercise, drinking 8 to 10lasses of water a day, and abstinence from alcohol, to-acco, tea, and coffee1 (Fig. 4). His strong beliefs inegetarianism led him to invent meat substitutes. Pro-ose was an imitation of beefsteak, and nuttose was anmitation of veal. He also developed other practicalealth food products, such as coffee substitutes, soybeanerived milk, and peanut butter. Arguably, his greatestietary invention was wheat flakes (Fig. 5). Originally,he product was produced by crushing wheat betweeneavy rollers and baking the sheets of grain into flakes.2

his led to the development of a cereal called Granose in8953 (Fig. 6). Three years later Kellogg produced theirst corn flake, which was called Sanitas Corn Flakes.3

he flaked cereals would later become the force behindhe product known today as Kellogg’s Toasted Cornlakes (Fig. 7).Creating flake cereals considerably changed the

merican diet. Dr James Jackson, a Seventh Day Ad-entist, broke up sheets of graham crackers, rebaked

igure 6. Granose Flakes. (From the Battle Creek Historical Society,

ith permission.)

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820 Jackson et al John Harvey Kellogg J Am Coll Surg

hem and marketed the product as “Granula.” Drellogg did essentially the same thing and also called hisroduct “Granula.” When Dr Jackson subsequentlyued Dr Kellogg, Kellogg renamed his productGranola.” One of Dr Kellogg’s patients at the “San,”harles Post, who had undergone treatment there for aervous breakdown, decided after his recovery to enterhe cereal production business based on knowledge andxperience he acquired at Dr Kellogg’s institution (Fig.). In 1891, he marketed Post Toasties and Grape Nuts,nd years later, the Post Company and the Kellogg Com-any became arch rivals.4

William K Kellogg, John Harvey Kellogg’s brother,

igure 9. The Battle Creek Sanitarium. (From the Battle Creek

igure 7. The Kellogg factory. (From the Battle Creek Historicalociety, with permission.)

bistorical Society, with permission.)

ventually became the business manager and leadingroponent of the Kellogg Company. William changedhe “healthy cereal” to a more marketable item by addingugar to Sanitas Corn Flakes.5 Dr Kellogg obviously waspposed to this concept because of the potentially harm-ul effects, especially in diabetic patients. The brothersere eventually at odds over other decisions Williamade about the direction of the company and its prod-

ct line. Dr Kellogg later dissociated himself from theood business, and William K Kellogg’s signature wouldppear thereafter on the cereal cartons as the trademark,hich persists to this day.Dr Kellogg invented not only food and surgical prod-

cts, but other items as well. He was particularly inter-sted in measuring muscle strength and coordinationnd being able to standardize the function of the varioususcle groups in the body. After 10 years of investiga-

ion and innovation in this area, he perfected the uni-ersal dynamometer to accomplish his goals. His successith this novel ergometer was manifested by its adop-

ion by the Military Academy at West Point and by Yaleniversity into their physical education programs. In907, the Naval Academy purchased two of Kellogg’synamometers and used them to test every cadet whontered the Academy for the next quarter century.2

Dr Kellogg’s reputation continued to grow, as did theattle Creek Sanitarium. In 1885, it was the largest in-

titution of its kind and would continue to expand. In938, it sat on more than 27 acres of land and had 32

igure 8. The Kellogg laboratory. (From the Battle Creek Historicalociety, with permission.)

uildings. The rich and the famous flocked to the insti-

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821Vol. 199, No. 5, November 2004 Jackson et al John Harvey Kellogg

ution, where the basic teaching was how to stay well.mphasis was placed equally on both curative and pre-entive medicine (Fig. 9). Dr Kellogg referred to hisanitarium as “The University of Health,” not a hospital.is guests included Henry Ford, Harvey Firestone, JohnRockefeller, Thomas Edison, Amelia Earhart, Presi-

ent William Howard Taft, and several Nobel Prizeinners.2 To promote his concepts, he delivered more

han 5,000 public lectures, and by 1902, his staff grew to00 and his institution could accommodate more than,200 patients.

igure 10. John Harvey Kellogg and friend. (From the Battle Creekistorical Society, with permission.)

Measuring only 5 feet and 4 inches in height, Dr

ellogg was nonetheless conspicuous around the “San”n his all-white outfits with his white cockatoo sitting onis shoulder2 (Fig. 10). Although some may have con-idered him a quack, others believed that he was a ge-ius. Dr Kellogg regularly worked 15 hours a day, virtu-lly until his death at the age of 91 years. He neverersonally requested nor received any fees for his servicesnd was known especially for his generosity in treatingndigent patients. His income was derived primarilyrom his publications on nutrition and medicine. Heas a member of many organizations including themerican Association for the Advancement of Science,

he American College of Surgeons, and the Americanedical Association. Dr John Harvey Kellogg deserves

o be recognized and remembered not only as a dedi-ated and innovative physician and surgeon, but also asdevoted and inventive contributor to the maintenancend advancement of good health and optimal nutrition.e notably changed the American diet and the Ameri-

an way of life.

EFERENCES

. Fee E, Brown T. John Harvey Kellogg, MD: health reformer andantismoking crusader. Am J Public Health 2002;92:932–934.

. Schwarz R. John Harvey Kellogg, MD. Nashville: Southern Pub-lishing Association; 1970.

. Buchmeier J. Defense Logistics Information Service. The BattleCreek Sanitarium years (1903–1942), wellness for the individual.Available at http://www.dlis.dla.mil/federalcenter/sanyears.asp.Last accessed September 22, 2004.

. Zacharias P. Snap, crackle and profit—the story behind acereal empire. The Detroit News Online Addition, 1999.Available at http://info.detnews.com/history/story/index.cfm?id�146&category�business. Accessed July 28, 2004.

. Powell HB. The original has this signature WK Kellogg. Engle-

wood Cliffs, NJ: Prentice-Hall Inc, 1956.