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About VIAF. Architecture, globalization, metropolisation : the process of globalization through the architectural landscape : cross-readings of Barcelona, Berlin and Roma.
Commerce et patrimoine dans les centres historiques vers un nouveau type d'espace de consommation. National imaginary and tourism imaginary in Costa Rica : tourism as territory and nation making. Patrimonialization of pre-Hispanic vestiges and recognition of indigenous peoples. The production of public space in Lyon, Lisbon and Louvain-la-Neuve : policies, processes and the construction of public space uses. Tourism and Euro-Mediterranean integration : what part do tourist companies play in developing tourism in Maghreb countries?.
Vers une modification de l'image de la cite d'habitat social? When tourism builds cathedrals : heritagization and touristification of Antoni Gaudi's architecture in Barcelona and Charles Rennie Mackintosh's architecture in Glasgow. A new wave of strikes beginning in and the formation of a unified Socialist party in intensified mutual class resentment and fear. Other equally acute anxieties were also at work in France at the turn of the century. The economic, military, and biological vitality of the nation itself appeared to be threatened by dangerous trends to which its neighbors seemed immune.
The German and British populations and therefore their pools of potential workers and soldiers were increasing rapidly. If this model of crisis was medical in nature, it served the thoroughly cultural aim of explaining to the French the origins of national decadence and the weaknesses of their population.
It is true, of course, that much of French history has been marked by anxiety and contentiousness; the entire nineteenth century in particular, with cataclysmic industrialization, urbanization, and revolutions, fits this description quite well. Both the perception and the reality of demographic decline added a new dimension to social fears that had been expressed in biological terms since the early nineteenth century.
French responses to tuberculosis cannot be understood outside of this political and cultural context. Birthrates, mortality, moral decay, political subversion, the filth and danger represented by the working classes in bourgeois eyes—tuberculosis allowed all these diverse and threatening themes to be assembled into a single coherent package. To be sure, the illness was not just a metaphor, not just a sign through which social relations or anxieties expressed themselves.
Real people got sick and died from tuberculosis, just as they are getting sick and dying today. That seemingly self-evident proposition must not be forgotten. However, neither should that truth mislead historians into a fruitless search for the single true explanation of those real deaths. Even if much more historical evidence were available regarding the incidence and causes of tuberculosis, it would still represent the inescapable biases, preoccupations, and blind spots of the society in which it was produced.
All scientific knowledge is—and has always been—conditioned by social factors. Industrialization, urbanization, class conflict, religious piety and charity, bourgeois sexual morality, demographic stagnation, military defeat, and international rivalry all contributed to the peculiar shape of the French understanding of tuberculosis. Ultimately, to write the history of tuberculosis in nineteenth-century France, one must write a history of nineteenth-century French society.
This particular social history, like all others, has biases and blind spots of its own. Epidemiology and public health figure more prominently in this study than medical practice per se. In medical terms, this is a history of etiology and prophylaxis rather than of therapeutics. Conceptions of the causes and prevention of tuberculosis are my chief concern here, insofar as they provide keys to the vital question, how does a society make sense of a widespread and deadly disease?
As a result of this preoccupation, the saga of medications and treatment regimens in the nineteenth century is given short shrift, as is that of the sanatorium largely the province of the elite, particularly during the period covered by this study , and the voice of the individual patient is rarely heard. While stories of the doctor-patient interaction and of hospitals and other medical institutions do reveal important aspects of social change, they are peripheral to this account of how the healthy in medicine, government, and elsewhere explained tuberculosis to each other and to the not-yet-sick in the rest of society.
Similarly, much of this study concerns the writings, teachings, and actions of influential men or committed propagandists; how the general population received their ideas must necessarily remain an open question. No simple method exists for determining the nature and extent of popular attitudes toward tuberculosis in nineteenth-century France. There are, however, scattered bits of evidence suggesting varying degrees of public receptivity to the agendas of medicine, government, philanthropy, and labor where tuberculosis was concerned.
This evidence is considered carefully here, but the resulting picture of popular perceptions is, unfortunately, a partial one at best. Chapter 2 suggests that during these same pre-germ theory years, outside the realm of medicine, a certain age-old ideal of womanhood took a distinctive nineteenth-century form, appropriating tuberculosis as a vehicle of redemptive suffering. Chapters 3 through 5, the heart of the book, detail the development of the dominant etiology in the late nineteenth century and its implementation in the War on Tuberculosis. Disgust at the deplorable state of working-class slum lodgings prompted an unprecedented surveillance effort notably in Paris and Le Havre , the casier sanitaire des maisons, which kept track of all buildings and apartment units whose occupants died of tuberculosis, so as to track down hotbeds of infection.
Chapter 4 analyzes this administrative strategy as well as the role of women as vectors in what was diagnosed as the dangerous domestic spread of tuberculosis. Chapter 5 traces the way in which, by medically associating alcoholism and syphilis with tuberculosis, doctors and hygienists were able to link deviant behavior and marginal classes with the perceived moral and demographic decline of the French nation.
What makes this Norman seaport a particularly salient case study is the convergence of these dramatically changing material conditions with the maturation of an activist group of city fathers led by the mayor and occasional cabinet minister , Jules Siegfried. Chapter 7 describes at length the origins and elaboration of a defiantly oppositional body of medical knowledge, which arose on the far left of French politics around the turn of the century.
While some socialists sought to represent a working-class point of view within the terms of debate of mainstream medicine, doctors and other militants associated with revolutionary syndicalism rejected those terms of debate. Questions of power, identity, and survival increasingly focused on the leading killer of the time, at once familiar and mysterious.
Throughout France, whether in medicine, politics, literature, or theology, knowledge of tuberculosis became valuable—and contested—terrain. Sudre, G. See also the thoughtful historical review by Barron H. There is already a vast and rapidly expanding literature on AIDS in cultural and historical perspective. Fox, eds. Even in the nineteenth century, anxiety over transmission of bovine tuberculosis to humans was less acute in France than it was, for example, in Great Britain or the United States. It has been estimated that in the days before widespread surveillance and regulation of milk and meat supplies, only 2 percent of all cases of pulmonary tuberculosis and 30 percent of nonpulmonary forms were attributable to bovine infection.
This would amount to less than 10 percent of all cases of tuberculosis. For epidemiological developments since the mids, see Sudre et al. Barnes et al. Ciesielski et al.
Utopies féministes et expérimentations urbaines on Apple Books
Snider, Jr. See, for example, William W. Stead and Joseph H. Fishman, ed. New York: McGraw-Hill, , ; for other relatively accessible medical overviews of tuberculosis, see A. Rich, The Pathogenesis of Tuberculosis, 2d ed. Springfield, Ill. Thomas, ; Paul T. Top, Sr. Wehrle, eds. Louis: C. Mosby, , chap. William Harris and John H. Hoeprich, ed. In these trials, the results of the placebo groups provide the figures for risk of disease in the general population.
For another extremely detailed epidemiological study, see J. Arthur M. Dannenberg, Jr. Tomashefski, Jr. For a partial response to this backlash, as far as nineteenth-century France is concerned, see David S. Some were medical doctors, and others were not, but they all concerned themselves primarily with the study and improvement of public health.
Paris: Adrien Egron, , —; P. Louis: Warren H. Emphasis added. Commission de la tuberculose, Moyens pratiques de combattre la propagation de la tuberculose Paris: Masson, Melun: Imprimerie administrative, — Robert A. Emphasis in original. Some of the best examples of this brand of history have come from Charles Rosenberg and his colleagues and students at the University of Pennsylvania. See, for example, Charles E. Rosenberg and Janet Golden, eds. Another recent book has applied this patient-centered perspective to the history of tuberculosis in the United States: Bates, Bargaining for Life.
A recent collection of essays representing this approach is Andrew Wear, ed. During the first half of the nineteenth century, France watched in fascination and horror as its capital showed every sign of imminent implosion. A city whose physical facilities had changed little in centuries saw its population double in less than thirty years. Another, larger city had overflowed into the unaltered framework of streets, mansions, houses and passageways…filling every nook and corner, making over the older dwellings of the nobility and gentry into workshops and lodging houses, erecting factories and stockpiles in gardens and courts where carriages had been moldering quietly away, packing the suddenly shrunken streets,…overloading the forgotten sewers, spreading litter and stench even into the adjacent countryside and besmirching the lovely sky of the Ile-de-France with [its] vast and universal exhalation.
This dread expressed itself in a sizable literature of concern over the transformation Paris was undergoing. In the picturesque literature of crime and poverty as well as in public health investigations, a tone of fascinated disgust infused all descriptions of the pathological city. Here is his description of the city at night. Bespattered carts draw up to the door of the sleeping houses to carry off every kind of filth. If you contemplate from the summit of Montmartre the congestion of houses piled up at every point of a vast horizon, what do you observe?.
In the historiography of medicine, the rise of germ theory is the great divide of the nineteenth century, in light of which all preceding and subsequent developments are interpreted. Where tuberculosis in France is concerned, the decisive dates have been and , when Villemin demonstrated the inoculability of the disease and when Koch identified the tubercle bacillus, respectively. However, several significant elements of the pre-germ theory etiology of tuberculosis survived intact through the late nineteenth century.
Among these elements are filth, stench, and overcrowding, all symptomatic of the underlying pathology of the city. Furthermore, the history of early-nineteenth-century medicine and public health includes some pivotal debates and revealing preoccupations underlying the search for the incidence and causes of tuberculosis. The first half of the nineteenth century was not a time of great innovation in the realm of etiology.
Historians have long regarded the Bourbon Restoration and the July Monarchy — as a crucial era in the development of French medicine and public health. The two most salient developments in early-nineteenth-century French knowledge about tuberculosis were 1 the shift from hereditary essentialism to contagionism in the etiology of tuberculosis and 2 the rise of various social epidemiologies of the disease in the emergent field of public health.
It should be emphasized that these two trends were not necessarily related to each other. Some have called the early nineteenth century the heyday of romantic medicine for other reasons, referring to the search for transcendent explanations and the tendency to speculative, idealistic, universal system building in opposition to rationalist empiricism.
Illness, in this view, arose spontaneously from internal causes and constitutional predisposition rather than from external causes, although external factors could influence the outcome of internal tendencies and predispositions. This last corollary would become quite significant when essentialist medicine confronted the unequal incidence of tuberculosis in French society. If the question of contagion may be regarded as highly dubious relative to tubercles, the same cannot be said of hereditary predisposition. Experience proves to all physicians that the children of consumptives are more frequently attacked by this disease than are other subjects.
Tuberculous phthisis has long been thought contagious, and it is still thought to be so by the common people, by magistrates, and by some doctors in certain countries, especially in the southern parts of Europe.
In France, at least, it does not seem to be [contagious]. The star of pathological anatomy was ascendant in French medicine, and most of its innovations concerned semiology and nosology: the symptoms and diagnosis of various disorders. The first edition, published in , contained none of this material on the causes of tuberculosis in its thousand-plus pages. In the ensuing years as will be seen below , epidemiological investigations associated with the early public health movement brought etiology and the social determinants of health under closer scrutiny.
Neither factor was innate, certainly, but both were widely portrayed in romantic and postromantic literature, among other genres as aspects of fate, intimately related to identity and individuality. Among other things, it explained why the disease was so common in cities and so rare in the countryside. It is perhaps to this reason alone that the frequency of pulmonary consumption in large cities must be attributed: there, men have more relations with each other, and so have cause for more frequent and profound sorrows; bad morals and poor conduct of all sorts are more common there and are often the cause of bitter regrets that cannot be consoled and that even time cannot soften.
It would be a mistake to confuse references in medical texts, however frequent, with a concerted social and political campaign aimed at stigmatizing certain groups and practices such as the one that arose later in the century through the association of alcoholism and syphilis with tuberculosis. Nevertheless, these references show that there was in the early nineteenth century a significant and established current of thought connecting perceived moral failings with physical illness.
They also prefigure later etiological debates in another respect. The same phrases recurred in the later leftist critique of capitalism and official medicine, in which overwork and low wages were seen as the principal causes of tuberculosis. Peter cited such factors explicitly, though few of his contemporaries followed suit.
Later polemics would revolve around whether the term meant a disease inherent in the lifestyle of the working classes or a disease determined by the dictates of industrial capitalism and wage labor. Moreover, the very notion of contagion added an inherently social dimension to the antituberculosis campaigns of the late nineteenth century. Simply put, social status conferred relative susceptibility to or immunity from disease.
The particulars of the poverty—mortality relationship or the specific social factors that contributed to tuberculosis were not fully explored in this period. Two of his projects in particular broke new ground for public health research: a series of articles around on mortality in Paris based on the Recherches statistiques published periodically beginning in by the prefecture of the Seine , and the two-volume monograph published in on conditions among textile workers.
Little of the subsequent work of the nineteenth-century hygienists would have been possible or plausible if this basic social connection had not been established. Their work inevitably reflected the preoccupations and prejudices of their milieu, and, viewed in retrospect, it contained numerous gaps and silences.
Although it is risky to criticize any work on the basis of what it does not say, such blind spots are noteworthy in several respects. The early hygienists held themselves to a high standard by their explicit claim to have enlarged the study of health and disease to encompass all of society. Taken together, the works published between and represent a manual in statistical interpretation as well as a methodical review of possible causes of insalubrity in the capital.
Population density received the most detailed attention, as it was widely believed to be a contributing cause of ill health. Still, on close inspection, no clear correlation emerged. Using a considerable array of tables and charts, he presented the data in various different ways.
Estimating or excluding deaths in hospitals, calculating average rental costs or percentage of untaxed rental housing units by arrondissement, the results were the same: the rank of arrondissements by mortality matched the inverse rank by wealth nearly exactly. This was as far as he wanted to go, and he readily admitted as much. But he never took the next step—the basis for so much of the later campaigns concerning tuberculosis—of relating the constituent elements of poverty to specific causes of death.
Nor could he bring himself, committed as he was to the principles of liberal political economy, to recommend remedial public action on the scale of the problems he described. The questions these hygienists asked—and did not ask—and their tentative answers shed some light on the attitudes of public health experts toward the rapidly changing social fabric in the early nineteenth century. Several studies focused on the occupational incidence of tuberculosis, most often seeking to determine if particular toxins or environmental influences could be shown to have deleterious health effects.
By reviewing many different types of occupations, this relentless hymn to the statistical method gives the impression of comprehensiveness while actually considering only the immediate impact of certain types of work on the chest and lungs. Lombard began by assembling data from five sources covering four cities: Paris, Geneva, Hamburg, and Vienna.
For each city, Lombard compiled a list of all professions specified for tuberculosis victims and ranked the professions by the number of tuberculosis victims belonging to each of them. He then did the same for all causes of death combined, and he compared the two rankings of professions.
Those that ranked lower on the tuberculosis list than on the overall list for most cities were considered to have negative correlations with the disease. For example, day laborers ranked very high on both the tuberculosis list and the general list for all cities, but because they ranked higher on the general list, they were classified as negative. In effect, the classification said nothing about the actual mortality of day laborers from tuberculosis the ratio of tuberculosis deaths to the total number of those workers in the population but suggested that they were more likely than workers in the positive category to die of causes other than tuberculosis.
Lombard considered this evidence that the occupation did not contribute to the disease. The first category, wealth and poverty, was quickly disposed of. Therefore, he concluded, muscular activity warded off tuberculosis and inactivity invited it. Lombard rejected the long-held belief that constant arm movement, vocal activity, and bent-over body position caused tuberculosis. Professions corresponding to these characteristics did not correlate uniformly in the positive category, so he deemed the effects of such activity negligible.
The most significant feature of all in professional life, though, was neither economic status nor muscular activity but air. Aqueous vapors were beneficial to workers, he determined, because professions exercised in humid environments showed negative tuberculosis correlations. Lombard found one of his strongest correlations to tuberculosis in the breakdown of professions by whether they were exercised indoors or outdoors. The elaboration of this concept marked a crucial step in the development of attitudes toward tuberculosis.
It manifested an attitude toward the physical environment that laid the groundwork for later etiological theories, including the linkage of unsanitary housing and other environmental factors to tuberculosis. A similar investigation in the same journal in took a slightly different approach to the same problem. Benoiston had long felt that certain causes commonly linked with tuberculosis needed to be verified, so he compiled information from the entry registers of four Paris hospitals covering the period — and noted the occupations of 1, tuberculosis patients.
Like Lombard, he grouped the occupations into categories—in this case, seven, based on the position of the body during work, the type of muscular activity involved, and particles or vapors to which workers were exposed. He then compared these ratios to the mortality rate from tuberculosis in the general population, to determine the relative susceptibility of workers in each category.
The way in which Benoiston chose to divide professions into categories predetermined to some extent the results of his investigation. No occupational conditions other than posture, muscle use, and particle or vapor exposure were considered. This characteristic of pre-germ theory miasmatism sought the causes of disease in spatial relations and the exposure of bodies to weather conditions, vapors, particles, and other environmental factors. In the case of tuberculosis, environmentalism and essentialism were by no means mutually exclusive.
In the course of his investigation, Benoiston noticed something that several other doctors and hygienists had pointed out but that none had truly analyzed: women died of tuberculosis at a significantly higher rate than men. His occupational categories caused him to comment on the different circumstances faced by women and men in various professions, and this discussion eventually led him into a full-fledged diagnosis of the fundamental pathology of women.
Benoiston had one simple and one complicated explanation for the over-representation of women among the victims of tuberculosis. A slightly different point of view emerged, however, when Benoiston remarked that occupational category 7—occupations necessitating a forward-leaning or bent over position of the body—exhibited an especially marked sex differential in tuberculosis mortality.
This innate weakness of women, gentle and unfortunate birthright of their sex [ triste et doux apanage de leur sexe ], which when they work alongside men exposes them to more than their share of dangers, this same weakness has another harmful result: it also condemns them to lesser earnings, and thereby to a state of poverty. In the final analysis, fatalism and moral condemnation share center stage. Simply by means of this brief didactic narrative,  Benoiston managed to equate biology with destiny and reduce the sexual differential in mortality to a moral question—prostitution.
In addition, he found tubercles in the lungs of two-thirds more women than men who had died of causes other than tuberculosis out of a sample divided evenly between the sexes. These figures and data he collected subsequently led Louis to conclude that women were 37 percent more likely than men to get tuberculosis. After establishing this differential based though it was on a fairly small sample , Louis addressed two factors traditionally thought to predispose women to tuberculosis.
The first culprit was tight clothing, particularly corsets, which were then in vogue among Parisian women. Corsets inhibited chest development, it was thought, and thus invited tuberculosis. Most of the consumptive women Louis treated, however, grew up in the countryside, working in the fields, and did not wear corsets until after their arrival in Paris, when their chests were already fully developed and corsets would have had little effect on the dimensions thereof. Moreover, tuberculosis was more common among females even during childhood, when corsets were not generally worn.
Louis therefore rejected the idea that tight clothing contributed to the onset of the disease. Louis seemed to be persuaded, however, by another characteristic traditionally thought to be associated with the incidence of tuberculosis. This is a classic expression of essentialist medical thought: women died of consumption more often than men because of their lymphatic nature. Neither contagionism nor any other particular etiology was a precondition for examining disease from a social viewpoint or for charting its ramifications through society.
While the rise of germ theory changed the language in which tuberculosis was depicted and oriented preventive strategies toward a focus on microbes, many of the constituent elements of the early-century essentialist etiologies of tuberculosis including heredity, overcrowding, filth, and vice maintained their status in the heyday of contagionism decades later. Around , the terms of discussion surrounding tuberculosis began to change; the old debates were engaged in a new way as they began to take on a different tone, and doctors aligned themselves on one side or another of a new controversy concerning the disease: contagion.
In that year, Jean-Antoine Villemin, a military physician, announced that he had succeeded in inoculating tuberculosis into laboratory rabbits. By injecting tuberculous matter from a human cadaver into the rabbits, Villemin had produced the disease in the animals. If true, inoculability implied, though it did not prove, contagiousness.
For decades, the controversial doctrine of contagionism—with the quarantines and other restrictions on commerce that it implied—had been anathema in established European medical circles and among liberals in general, as Ackerknecht pointed out in a now-classic article. Many doctors committed to the optimistic outlook of positivism viewed contagion as a prejudice that inspired fear among the populace, pitted citizen against citizen, and stigmatized the sick as enemies of the healthy.
His intervention in the controversy over the contagion of tuberculosis in the Academy of Medicine debate and in his contemporary writings deserves detailed scrutiny, because its often intriguing perspective and rationale were lost to history when it went down in ignominious defeat. It comes straight out of the Middle Ages. It is an animist doctrine of viruses, in which the specific agent is conceived of as a soul existing by itself. Today, more than a century after the triumph of germ theory, it may seem more than a little strange that an entrenched foe of one of the basic truths of modern medicine could pose as a fighter of medieval fantasy.
Pidoux was not alone, however, in this perception; he simply went further than most in ridiculing the contagionists and burning all bridges behind him. Few were actually new to the medical literature, but the way in which he set them forth in his impassioned speech to the academy was impressive in its comprehensiveness and its social perspective.
The first two categories corresponded roughly to social position: the poor and the rich, respectively. But Pidoux did not envision just another philanthropic project. In this case, the state would have to intervene. First of all, except for smallpox vaccination and temporary emergencies such as cholera epidemics, such associations involving state participation were not a commonly accepted public health strategy in the s, as they would be several decades later. Pidoux was one of the first to call for a government-sponsored fight against tuberculosis.
Furthermore, demanding public intervention on a collective scale was a peculiar stance for an anticontagionist dedicated to preserving medical essentialism and morbid spontaneity. As he took pains to point out, however, spontaneity was not incompatible with the influence of external causes, and it was these external causes that Pidoux sought to battle through collective action.
Let us believe, then, until there is proof to the contrary, that we are right…we partisans of the spontaneous degeneration of the organism under the influence of [various] causes that we are seeking out everywhere, in order to combat the disease at its roots. On the etiology of tuberculosis—bacteriologically speaking—Pidoux was wrong. Overwork, low wages, poor diet, fighting tuberculosis by fighting poverty—all fell by the wayside until resurrected much later by the political Left.
There is no indication that Pidoux was any kind of political radical, and in fact much of his writing on tuberculosis including his request that the clergy involve itself in the public campaign against the disease exhibits the prevailing medical moralism of his age.
Nevertheless, he prefigured in some ways the later leftist critique of tuberculosis, and his ultimate failure was by no means assured at the time of the contagion debate. Instead of overthrowing hereditarian essentialism, Pidoux attempted to modify it and expand on it, entering certain new variables into the etiological equation of tuberculosis. He seems to have been concerned with steering medicine into areas in which preventive strategies, public health, and the state could fruitfully intervene. That he failed—and that germ theory emerged triumphant— sured that his perspective would be forgotten.
Beginning in the s, however, the terms of discussion changed dramatically. Some habits survived from the essentialist era, including the adoption by bourgeois investigators of a disgusted and moralizing tone in describing the urban poor. These observers continued to look at the working class as if it were another species, filthy and brutish. But filth was henceforth dangerous in a new way, and the living conditions of the working class now contained the deadly menace of contagion. Furthermore, tuberculosis became not just a social disease but a national problem.
Old worries were expressed in a new vocabulary of microbes and degeneration. Rather, this period is remembered as the age of the consumptive literary heroine, whose illness and death were tragic yet beautiful, with both physical and spiritual dimensions. The significance of this phenomenon, which transcended medical knowledge and rendered it all but irrelevant, is the subject of the next chapter.
Erwin H. Ann F.
Coleman, Death Is a Social Disease, esp. For a discussion of the role of such narratives, which became staples of the War on Tuberculosis around the turn of the century, see chaps. Germ theory in its later, more developed form would argue that while the tubercle bacillus was most often introduced into the body through inhalation, the disease could subsequently take hold in any part of the body—though pulmonary localization was most common.
God has deigned to make me pass through many types of trials. In the late s, the legendary French actress Sarah Bernhardt captivated theatergoers in France and abroad as few performers have before or since. Her portrayal of Marguerite Gautier, the kind-hearted courtesan doomed to an untimely death from tuberculosis, epitomized to many of her admirers her brilliance on the stage.
Meanwhile, also in the autumn of , a young nun in the Carmelite convent of Lisieux was enacting her own death scene from tuberculosis—this one all too real, but no less staged. She continued to record her emotions right up until her death, after which the convent authorities decided to publish her writings as an autobiography, entitled Story of a Soul. Population report Population report Population report Subscribe to Population. Contact us. Subscribe to the e-alert.