So Who Cares? Taking Livingston out of Africa

Bibliographic Data

ID3333974
AuthorsChristine Hamlin (0000-0003-2554-3995, University of Notre Dame, corresponding author), Christopher Hamlin
Year2020
Volume111
Issue4
Pages805-808
Publication date2020-12-02
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueIsis (JOURNAL)
Journal identifiersISSN: 0021-1753 • E-ISSN: 1545-6994
PublisherUniversity of Chicago Press (PUBLISHER • US)
DOI10.1086/712382
OpenAlexW3119372512
LanguageEN
Citations received1
References cited8

Previous articleNext article FreeSo Who Cares? Taking Livingston out of AfricaChristopher HamlinChristopher HamlinUniversity of Notre Dame Search for more articles by this author PDFPDF PLUSFull Text Add to favoritesDownload CitationTrack CitationsPermissionsReprints Share onFacebookTwitterLinked InRedditEmailQR Code SectionsMoreHistorians don’t have on-off switches. A studier of epidemics can’t help reading the present as a chronicle, supplementing book learning with the better evidence of “experience,” playing voyeur, herald, or fifth grader on a Magic Schoolbus adventure. But we already know the plot. We’ll expect the courageous and the outrageous, the hypocritical grab for exculpatory narrative.1 Yet experience may surprise and change us. I have been surprised by “fear” and by the profundity of my sorrow.2 Yet expression of either was unwelcome—weakness, I sensed; sorrow could be public only as anger.Usually the units of epidemic chroniclers are the outbreaks themselves and the disease agents. Persons are objects, often with binary status: survivors or not. Preparation fiascoes—tests, gowns, masks, ventilators—have made what Julie Livingston calls “microprocesses of care” unusually visible in the American COVID-19 epidemic. In Debility and the Moral Imagination in Botswana (2005), she is concerned with the “day-to-day reality of who cares”—who visits, cleans bedclothes, helps with bathing, shopping, communicating, with “wood or water ... clothes and food.”3 But she is concerned too with historians’ “epistemological and moral” practices; how we ask, answer, and narrate—other senses of “who cares” (pp. 1–2).Though the Tsawana do suffer from epidemics of polio, HIV-AIDS, and the compound and concentrated damage of mine work, these are not passing transgressions on normality but accepted parts of life. Yet atemporal does not mean ahistorical. Livingston’s work is historical in the ordinary senses of documenting a century of regional change—colonialism, missionaries, modes of work (lucrative, gendered, and involving migration), independence, NGOs, and biomedical health care—but also in its concern with changes in “personhood and self” and, as the “moral imagination” of her title indicates, its lamentation over lives “profoundly disrupted” from “bodily norms” that once were (p. 1).4Equally central is the title’s other term, “debility.” In Livingston’s book it provides the pathos that binds author to subjects: as an axis of interpretation and assessment and, between these, as a dynamic and an analytic as important as class or gender. She calls “debility” “one of the most fundamental human experiences.” Not only will bodies change and be differentially abled by age and circumstance, but identity (“personhood”), community (negotiation of care among family, community, and state), and culture (“moral imagination”) will be expressed in terms of debility. For many of her subjects, debility is an objective state of disability: “impairment, lack, or loss of certain bodily abilities.” Yet the concept goes beyond: first, in effacing the bureaucratic binary (i.e., the checking of “normal” or “disabled”); second, by adding breadth, to include “chronic illness, and senescence”; and third, by opening the door to the subjective. As both a state of, and a “profound challenge” to, “personhood,” it operates as a negation of the “agency” that is the darling of contemporary historians (pp. 1–5).Is Livingston’s perspective a part of the history of epidemics? Try replacing “debility” with “epidemics” in the three statements that open her conclusion (p. 234):• “The history of debility has drawn together changes to human bodies with shifting ideas and practices of care and personhood.”• “Debility illuminates how fundamental social, moral, and biological dynamics are grounded in experience as people struggle to marshal care and rework meanings and lives within and around bodies that are somehow impaired or different.”• “The relationships between bodies and persons, history and meaning-making are highlighted and transformed in the context of debility” (p. 234).I don’t think we can; I do think we should. “Debility,” “moral imagination,” and “personhood” have become central in the emerging field of disability studies. They have been marginal for historians of epidemics and public health and even, arguably, underappreciated in the social history of medicine.To see Livingston’s insights as exotic products unique to oral history and to her empathetic Marple-esque epistemology of learning to hear persons over cups of tea surrenders too much. Here I will apply Livingston’s agenda not directly to epidemic narratives but to the ambiguous enterprise of public health itself, operating at the interface between subjective and objective, communities and states, persons and populations. My target will be the ancient yet foundational literature I know best, a public health historiography grounded in the English industrial revolution. There social reform, socialism, liberalism, and social justice are seen to come together in sanitary reform. “Moral imagination” and “personhood” (implicitly) and “debility” (explicitly) do operate here but have been ignored, channeled, or coopted. Bringing Livingston out of Africa will help to expose political agendas, accidents of temporality, and contingencies of historiography.I have struggled with this issue from the microscopic to the macroscopic, from following Victorian “inspectors of nuisances” on their daily rounds to writing textbook chapters on the history of public health.5 Yet it has been hard to escape the iconic stature of sanitation, the revolution of water and sewers as the greatest gift of states to their citizens (for defenders of statist expertise) or of communities to themselves (for anarchist communitarians). Behind that historiography lay cholera, an existential threat often given a quasi-providential role as driver of such change, a problem generating its own deliverance. And yet the best-known history of cholera, Charles Rosenberg’s The Cholera Years, is more Livingstonesque: it chronicles the “moral imagination” with which Americans made this outrage intelligible. Theodicy trumps diarrhea.6For English history, the best-known appeal to a “moral imagination” is E. P. Thompson’s articulation of a “moral economy,” an implicit social contract invoked by working-class women in so-called food “riots.” “Rioting” involved taking what one needed and leaving behind the just price that tradition indicated. A broader “moral imagination” would loom large in the polar historiography that recorded the tragic change from precapitalism to cash nexus. Peter Laslett’s title, The World We Have Lost, echoes Livingston’s interviewees, remembering a time when it rained more (p. 22).7Thompson’s subjects were acting at what Livingston terms the “intersections of culture and somatic life” to secure health (p. 1). Yet, ironically, given the Marxist-materialist framework of industrial revolution historiography, somatic states were merely instrumental or illustrative. The primary form of personhood was intellectual, an accurate consciousness of class. Much of this came not from Karl Marx but from the studies of ascetic Protestantism of Max Weber and R. H. Tawney. Radicalism was rooted in sectarianism: struggle brought introspection, not debility. Yet Marx, too, would commodify personhood: the ever-lengthening workday turned health into capital.8 Debility—registering as nonpersonhood rather than a form of personhood—was the entropic outcome.Here contingencies matter. Had Capital been composed two decades earlier and in Dublin or Glasgow, Marx might have had a better sense of how central “debility” could be in linking conditions, care, and subjectivity. Particularly for practitioners with Scottish or Irish training, it was an integrative technical term and a foundation for structural critique that did not sacrifice the personhood of those on whose behalf the critique is made. The fever hospital, which restored debilitated persons, was the chief public health institution.9The public health (or “sanitary”) movement of the 1840s was a repudiation of that debility-based medicine. It recognized the moral imperative and revolutionary potential of a medicine in which disease came from debility and debility from social conditions and economic policies. As Marx would for the workplace, the sanitarians would objectify debility, translating personhood into infrastructure. The conductors of the great “blue book” social investigations that became the mark of responsible government after 1830 imposed their own “moral imagination” as a formulaic and dismissive ejaculation—“filth.” Protesting the designation (few did) meant confessing that one tolerated conditions “intolerable” for human beings, thus dehumanizing oneself. For the sanitarians, on the other hand, that very dehumanization mandated these gifts of universal personhood (in contemporary argot, it showed the necessity of “necessaries”—i.e., privies).10Yet, increasingly, the privy that wasn’t mattered more than the person who was. Wherever fixed supply was slow to respond to demand, the declamations translated as demands—“Hold it in” for excremental exposés; or even “Don’t be,” for dwelling overcrowding. One determinant of debility—insanitation—would displace others (e.g., work and food) and eliminate the use of “debility” as a legitimate expression of personhood, leaving it only for dotards and postpartum women or, through an exhaustion-delirium pathology, as a marker of insanity.11Historians were complicit in this objectification. Preoccupied with science—diagnostic and etiological specificity—medical historians lost track of debility (only recently has it returned as compromised immunity). Focused on ideology, policy, professionalization, and integration of health and welfare, public health historians often inadvertently invited invidious distinctions between Public Health and the public’s health. In a state’s-eye perspective, persons not only had problems; they were problems. And often, nineteenth-century English public health was not only template but telos: what public health shall be and how it shall get there.Here Livingston helps us question, recognize contingencies, explore counterfactuals, by recognizing a bottom-up “public health” through which communities impose health and moral order, sometimes tapping state power and expertise (p. 16). That invites a broadening of public health into social medicine and the finding of other icons: for example, in the German traditions explored by George Rosen and others in the late 1940s and in the person-centered regimes of Nightingale nursing, where sanitation was central but the unit of assessment was not the well-sewered street but the well-conditioned person.12 One might thus challenge the order of the standard scientific story—etiological theory to epidemiology to microbial agent. The statistical revolution that allowed sophisticated social epidemiology happened to occur after agent-centric epidemiology, yet not necessarily so: it was more a matter of creative application than novel mathematics.13What all this has do to with COVID-19 depends on what COVID is—on what is to be narrated. Historians should be wary in writing their own changing times. Since early spring, when I was first asked to write about it, what COVID was has changed repeatedly; and along with temporal (and geographic) differences are enormous differences in social situatedness, evident not only quantitatively—in mortality rates—but in qualities of vitality itself—in debility and grief, elements of Livingston’s “personhood.” For what we should see is the way that epidemics expose the endemic—the debilities and disabilities that persist for peoples in places. These may reduce to relative inability to avoid infections; in America, however, they have registered, sadly but not surprisingly, in terms of race and of racism.NotesChristopher Hamlin, a historian of science, technology, and medicine, is a professor in the Department of History and the Program in the History and Philosophy of Science at the University of Notre Dame. His recent books are More than Hot: A Short History of Fever (Johns Hopkins, 2014) and Global Forensic Cultures, edited with Ian Burney (Johns Hopkins, 2019). Department of History, University of Notre Dame, 434 Decio Hall, Notre Dame, Indiana 46556, USA; [email protected].1 As Charles Rosenberg notes, HIV-AIDs does not fit the pattern. See Charles E. Rosenberg, “What Is an Epidemic? AIDS in Historical Perspective,” Daedalus, 1989, 118(2):1–17.2 Plague-era historians have found this easier. See Jean Delumeau, La peur en Occident, XIVe–XVIIIe siècles: Une cité assiégée (Paris: Fayard, 1978), pp. 15–19.3 Julie Livingston, Debility and the Moral Imagination in Botswana (Bloomington: Indiana Univ. Press, 2005), p. 19. Subsequent references to this work are indicated in the text by page number.4 For a similar sensibility see Amy L. Fairchild, “The Polio Narratives: Dialogues with FDR,” Bulletin of the History of Medicine, 2001, 75:488–534.5 Christopher Hamlin, “Nuisances and Community in Mid-Victorian England: The Attractions of Inspection,” Social History, 2013, 38:346–379; and Hamlin, “The History and Development of Public Health in Developed Countries,” in Oxford Textbook of Public Health, 3 vols., ed. Roger Detels et al., 6th ed. (Oxford: Oxford Univ. Press, 2015), Vol. 1, Ch. 1.2.6 Christopher Hamlin, “‘Cholera Forcing’: The Myth of the Good Epidemic and the Coming of Good Water,” American Journal of Public Health, 2009, 99:1946–1954; and Charles E. Rosenberg, The Cholera Years: The United States in 1832, 1849, and 1866 (Chicago: Univ. Chicago Press, 1962).7 E. P. Thompson, “The Moral Economy of the English Crowd in the Eighteenth Century,” Past and Present, 1971, 50:76–136; and Peter Laslett, The World We Have Lost (London: Methuen, 1965). I explore these issues in Christopher Hamlin, “What Is Your Complaint? Health as Moral Economy in the Long Nineteenth Century,” in Progress and Pathology: Medicine and Culture in the Nineteenth Century, ed. Sally Shuttleworth, Melissa Dickson, and Emilie Taylor-Brown (Manchester: Manchester Univ. Press, 2020), pp. 295–327.8 Max Weber, The Protestant Ethic and the Spirit of Capitalism, trans. Talcott Parsons (New York: Scribner’s, 1930); R. H. Tawney, Religion and the Rise of Capitalism (Harmondsworth: Pelican, 1972); and Karl Marx, Capital, trans. Samuel Moore and Edward Aveling (New York: International, 1939), Vol. 1, Ch. 4.9 Christopher Hamlin, “William Pulteney Alison, the Scottish Philosophy, and the Making of a Political Medicine,” Journal of the History of Medicine and Allied Sciences, 2006, 61:144–186; and Hamlin, “Environment and Disease in Ireland,” in Environment, Health, and History, ed. Virginia Berridge and Martin Gorsky (London: Palgrave Macmillan, 2012), pp. 45–68.10 Christopher Hamlin, Public Health and Social Justice in the Age of Chadwick: Britain, 1800–1854 (Cambridge: Cambridge Univ. Press, 1998); and Hamlin, “The ‘Necessaries of Life’ in British Political Medicine, 1750–1850,” Journal of Consumer Policy, 2006, 29:373–397.11 Hilary Marland, Dangerous Motherhood: Insanity and Childbirth in Victorian Britain (New York: Palgrave Macmillan, 2004).12 George Rosen, “What Is Social Medicine: A Genetic Analysis of the Concept,” Bull. Hist. Med., 1947, 21:674–733. Complicating Rosen’s vision is Esther Fischer-Homberger, Medizin vor Gericht: Gerichtsmedizin von der Renaissance bis zur Aufklarung (Bern: Huber, 1983). On Nightingale see Lynn McDonald, ed., The Collected Works of Florence Nightingale, 16 vols., Vol. 6: Florence Nightingale on Public Health Care (Waterloo, Ont.: Wilfrid Laurier Univ. Press, 2001).13 Christopher Hamlin, “The History of Methods of Social Epidemiology to 1965,” in Methods in Social Epidemiology, ed. J. Michael Oakes and Jay S. Kaufman (San Francisco: Jossey-Bass, 2006), pp. 21–44. Previous articleNext article DetailsFiguresReferencesCited by Isis Volume 111, Number 4December 2020 Publication of the History of Science Society Article DOIhttps://doi.org/10.1086/712382 Views: 660 © 2020 by The History of Science Society. All rights reserved.PDF download Crossref reports no articles citing this article

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