Sean M Quinlan, The great nation in decline: sex, modernity and health crises in revolutionary France c. 1750–1850, The History of Medicine in Context, Aldershot, Ashgate, 2007, pp. xi, 265, £55.00 (hardback 978-0-7546-6098-9).

Abstract

The central aim of this book—to rewrite, and to some extent redefine, the history of French hygiene between 1750 and 1850—should be welcomed by all historians of French medicine. Even William Coleman, who acutely observed both the “bourgeois medical doctrine” of the 1750s and the public health movement of the nineteenth century, never linked these two hygienic projects. Quinlan, by contrast, makes an ambitious attempt to demonstrate the continuities in hygienic writings over this period: they were a forum for middling medical practitioners to critique both their social superiors and inferiors, and they increasingly addressed the effects of industrialization upon the urban poor, explaining away its adverse consequences by a variety of naturalizing strategies, culminating in theories of heredity. Quinlan divides the period into three: an Old Regime phase which rested on meliorist models and portrayed nervous diseases as evidence of the decline of civilization; a Revolutionary phase characterized by Utopian programmes for achieving social and political harmony through hygiene; and, lastly, a more pessimistic phase, lasting from 1804 until the 1848 revolution, underpinned by an appeal to statistics and concerned to cure, cleanse and decriminalize the working class. Methodologically speaking, Quinlan asserts, “this study has moved beyond sociological explanations of medical power and the social constructionism associated with the new cultural history”. This claim is supported by a second assertion: to have shown that doctors exercised their public roles by means other than a blatantly “unified ideological front”, instead working in collaboration with a range of public authorities and “patients” to accomplish certain social, moral and political agendas (pp. 217–18). It is here that Quinlan’s argument falls down, for me, since this dimension—the relationship of doctors to the formation of public authority over French bodies—is one of the least well-supported parts of the book. There is little attempt to show whether the books discussed actually had any outcomes in terms of changes in public policy, by whom they were read and for whom they were written, and how significant their authors may be said to have been in the process of medically reforming the French public. For example, in presenting Charles-Augustin Vandermonde’s essay on the perfection of the human species as a foundational work in the hygienic programme of the Old Regime, he passes over the fact that this book fell far short of the success achieved by comparable works such as Michel Procope’s Art de faire des garcons, nor does he mention that Vandermonde died aged just thirty-five—six years after publishing his essay—having held no public position whatsoever. The attention to the circumstances of production and consumption of books which characterizes the cultural history of medicine is precisely what would be required here to demonstrate that works like this actually affected the public practice of medicine. This weakness pervades the book, which at no point shows degenerationist concerns implemented in actual programmes for the medical governance of the public. One linking strand throughout the period is the notion of degeneration, for which various physiological models were advanced. Throughout, Quinlan uses the term “degeneracy” as the translation for the French degeneration. For the later nineteenth century, the term is perhaps apt, evoking as it does a systematic interest in forms of deviance and decadence and in hereditary social “vices”, such as alcoholism. However, in his eagerness to represent degeneration as a concern which began within medicine, Quinlan fails to do justice to other forms of use, such as animal breeding and horticulture, a central resource for natural historical models of degeneration. Other elements of the hygienic programme were also older than Quinlan imagines: critiques of the adverse effects of civilization may be found in Jansenist medical writings and even in medieval works.