The ‘Medicalisation’ of France

Dr Chris Pearson

Louis Pasteur (1822-1895)

‘Medical discourse infused all areas of French society from the bastions of science – the academies and research institutes – to newspapers, novels, and the theatre, to the daily lives of citizens as patients.’

La Berge and Fiengold, ‘Introduction,’ in La Berge and Fiengold (eds) French Medical Culture (1994), p. 3

“Positive” narrative of medicalization

• Focuses on spread of modern medicine at expense of “folk” or “traditional” practices

• Looks at doctor-patient ratios, medical training etc

• Medicalization as a positive forces – bringing progress, pushing back the boundaries of knowledge, increasing life expectancy

Foucauldian narrative of medicalization

• Medical language, ideas and techniques invade other disciplines and areas, such as politics

• Doctors portray themselves as experts and seek to control the patient – medicine as social control

• Political and social context informs medical practice (i.e. medicine not an objective science)

Lecture outline

• Expansion and professionalization of medicine throughout 19th century

• Foucauldian approach, focusing in particular on bio-medical ideas of national degeneration

Professionalization entails:• ‘creating self-regulating professional organizations

with formal control over group behaviour and ethics’• ‘eliminating competing groups’• ‘restricting group membership through high

licensing standards… [justifying] the profession’s claims to high quality and competence’

• ‘controlling educational institutions to further raise standards and restrict entry into the profession’

• ‘popularizing the notion that members of the profession were motivated by a service orientation rather than by concern for profit.’Weisz, ‘Politics of Medical Professionalization in France, 1845-48’

The ‘professionalization’ of

medicine • Revolutionary undermining of medical

regulation and teaching (as part of the attack on aristocratic, ancien régime privileges)

• Law of 19 Ventôse Year XI (or 10 March 1803) re-established the regulation of medical profession

• Law distinguished between doctors and health officers and limited legal medical practice to those with the training

Doctors and class

• Profession identity of doctors more important than class identities (see Zeldin)

• Doctors a distinct group within the bourgeoisie

• Doctors had relatively low status• But division amongst doctors:

Association générale des médicins de France (AGMF) v. the Syndicat

Doctors and republicanism

• Doctors – supposedly one of the public-spirited professions that would help France overcome social divisions

• 11% of deputies during the Third Republic were doctors

• Clemenceau had initially trained as a doctor

• Portrayed as battling against disease and clerical forces

Public health measures

During the Third Republic, ‘physician-legislators’ backed:

• Obligatory small-pox vaccine (1881)• Measures to purify the Seine through an

improved sewerage system (1888)• Sanitary inspections of housing (1897)• Law for the protection of Public Health

(1902)

See Jack Ellis, Physician-Legislators of France (1990)

‘A kitchen containing several box-beds, where the sick and well lie together, cluttered with various furniture items, pierced only by a door and a small window, serves at the same time as dining room and bedroom; the residents spend all night there, and often daytime as well, in a limited volume of air that circulates very little, so that the atmosphere is rapidly vitiated and exercises its deleterious action on anyone who breathes it and lives surrounded by it.’

1882 medical report quoted in Barnes, Great Stink of Paris (2006), 194

Questioning the narrative of progress

• ‘Sanitary-bacteriological synthesis’ (SBS) – long-standing ideas that filth caused disease mixed with germ theory

• History of medicine not one of seamless progress towards the truth

• Barnes, Great Stink of Paris (2006)

Michel Foucault (1926-1984)

Medicine as contingent and historical:

‘Medicine made its appearance as a clinical science in conditions which define, together with its historical possibility, the domain of its experience and the structure of its rationality.’

Foucault, Birth of the Clinic (2003 [1963]), p. xvii

Medicine doesn’t reflect reality, it reorganizes it:

‘The clinic – constantly praised for its empiricism, the modesty of its attention, and the care with which it silently lets things surface to the observing gaze without disturbing them with discourse – owe its real importance to the fact that it is a reorganization in depth, not only of medical discourse, but of the very possibility of a discourse about disease.’ Foucault, Birth of the Clinic (2003 [1963]), p.xxi

TB threatens France?

• TB ‘is a fearsome, advancing scourge that is gaining ground every day with no obstacles in its contagious path; one is justified in saying that in France, where the population is not growing [it] is more than a threat to individuals – it is truly a national peril.’

• 1901 report, quoted in Barnes, Making of a Social Disease (1995)

Heightened concerns over TB linked to wider political, social, and cultural anxieties about French decline at the end of the nineteenth century

‘As for the question of pauperism, of socialism, and of the struggle for life, the worker could be happier if he eliminated the cabaret and alcohol from his ordinary habits, substituting for them sobriety, thrift, good nourishment and refreshing sleep; poverty is in part nothing but the result of the loss of time, money, and health through alcoholism.’

Dr Thiron (1898), quoted in Barnes, Making of a Social Disease (1995)

‘All scientific knowledge is – and always has 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.’

Barnes, Making of a Social Disease (1995)

Benedict-Augustin Morel (1809–1873): Developed the influential theory of

degeneration

Signs of supposed national degeneration:

• Between 1872 and 1911 France population grew by 10%, Germany’s by 58%

• French per capita highest rates of alcohol consumption in Europe

• Increasing number of insane asylums and suicides (latter increased by 385%)

• Nye, ‘Culture of Sport,’ (1982), 54-5

Jean-Martin Charcot: from 1892 he held the chair for the study of nervous disorders at

the Salpêtière hospital, Paris

Max Nordau: publishes Degeneration in 1895

Adolphe Pinard- explored eugenics