The Making of a Social Disease

Reviewed by: The Making of a Social Disease: Tuberculosis in Nineteenth-Century France Robert A. Nye David S. Barnes. The Making of a Social Disease: Tuberculosis in Nineteenth-Century France. Berkeley and Los Angeles: University of California Press, 1995. xiv + 305 pp. Ill. $42.00. This book makes a notable contribution to the growing literature on medical thinking as a cultural or ideological system. In this instance David S. Barnes explores the history of tuberculosis in late-nineteenth-century France as an aspect of the wider history of cultural and political crisis in that nation, plagued as it was by a host of debilitating social and biological “pathologies” and faced with a powerful external threat in newly united Germany. Tuberculosis was the greatest and most puzzling danger to French health, and so it provoked, Barnes argues, more emotional response and concern than any other threat to the [End Page 528] “race.” Barnes limits himself here to an analysis of the public and professional discourse that considered the causes and possible prevention of the disease, because this dimension of the debate impinged most directly on other issues of contemporary ideological concern. Barnes follows these debates in great detail over the period 1880–1914, but he begins his study with chapters that pass in review the earlier cultural history of tuberculosis as a symbol of individual suffering and a source of aesthetic and religious redemption. He then outlines the contagionist/environmentalist debate that preceded the rise of germ theory and Robert Koch’s isolation of the tubercle bacillus in 1882, and concludes, surprisingly, that germ theory, far from breathing new vigor into a discredited contagionism, simply inspired more concern about the environmental circumstances in which the bacillus reaped the greatest number of victims. This search for environing causes was partly the result of a deeply rooted style of etiological thinking that generally marked French thought, but it was inspired also by the reasoning that since the bacillus seemed more or less ubiquitous, then individual constitution or circumstance must provide the key to who became ill and who did not. According to Barnes, a rather one-sided debate emerged over the exact nature of this etiology. The majority “official” view piggybacked on ancient ecological notions that the disease struck down those who lived or worked in dark, overcrowded, airless spaces, as indicated by demographic data linking mortality and population density. Left-wing physicians and syndicalist theorists held the minority opinion that physical overwork and malnutrition were the truly damaging aspects of the environment, and they coupled this argument with demands for the eight-hour day and higher wages. Their liberal and “solidarist” opponents balked at the far-reaching implications of such an argument and supported the far less expensive and less threatening option of domestic sanitary reform and more salubrious housing. Barnes shows how these arguments played out in Paris and in Le Havre, the northern port that suffered the highest rate of tuberculosis deaths in France. He concludes that in this case, as in so many other matters, the French political and hygiene establishments chose collective rhetorical and moral appeals rather than any root-and-branch experiments in public welfare, and he contrasts this national style of dealing with the dread disease with British individualism and German state interventionism. Barnes hopes his account of the history of tuberculosis will provide support for the view that in the years before the discovery of an inoculation treatment, an improvement in living and working standards had far more effect on bringing down the mortality rates of tuberculosis than did hygienic intervention. In the end, I think, his cultural history of the disease cannot actually decide that question, but he does very effectively illuminate the ways in which tuberculosis served as a powerful metaphor grafted by Frenchmen onto issues that fundamentally divided them, while simultaneously reminding them of the common fate they shared. Robert A. Nye Oregon State University Copyright © 1996 The Johns Hopkins University Press

Cultural history · Economic history · Environmental ethics · Germ theory of disease · Ideology · Political science · Politics · Social science · Sociology · Symbol (formal) · Tuberculosis · Classics · Gender Studies · Historical Psychiatry and Medical Practices · History · History of Medicine Studies · History of Science and Medicine · Law · Medicine · Philosophy