What: Medicine and Health in the Countryside from the Middle Ages to the Present /
Where: Blaise Pascal University (Clermont-Ferrand 2, France)
When: October 14-16, 2015
Deadline for submissions: 1 October 2015
Popularized not only by Balzac’s novel, but also well into the mid-twentieth century by a variety of exceptional characters, such as Doctor Maurice Delort, the “snow doctor” from Vic-sur-Cère in the Cantal region, country doctors have often appeared as atypical, sometimes heroic figures, underscoring the ancient lack of medical care in rural areas. The oft denounced “medical deserts” have recently come once again to the attention of the public with the publication of the Health Ministry’s proposed “Health Pact” in the fall of 2013. In reality, however, the insufficient medical presence in the countryside is neither new nor uniform. When studied over the long term, it is possible to put into perspective the social and geographical rationales at work in the relations between the medical milieu and the rural population, as well as between government and rural areas. One of the goals of contemporary public health programs has been to increase government health care for rural populations, not only to reinforce control over rural communities, but also in an effort first to increase their productivity and finally to guarantee a relative equality between different regions and populations. Yet the profound redefinition of the purposes and organization of rural areas over time has confused the issue and modified several times, sometimes brutally, the ways in which public health policies have been applied to the countryside. How and by whom have rural populations been healed over the centuries? What efforts were made to fight against disease in rural areas? What were the goals, either declared or hidden, of public health policies? What can current political actors learn from the historical record? These are the questions which this conference will seek to answer.
Medicine, as a highly organized scholarly discipline, appears at first glance to be an urban affair. This is the dominate perspective that has evolved not only from commonly perceived notions but from the history of medicine. The presence of medical institutions (universities, medical schools, European hospitals since the medieval period, and so forth) as well as that of officially designated doctors has created a strong unifying criterion useful to an understanding of the balance between various regions at different periods of time. In this view, advances in medical knowledge were gradually diffused from cities to outlying regions and populations. An approach based primarily on the study of institutions has necessarily led to this assessment since it is based on the perspectives that doctors themselves have developed and on positions that they have sought to defend against various forms of competition.
Nonetheless, the reality of public health issues does not strictly conform to the idea that urban medicine has imposed a hegemonic and continuous domination. The goal of this conference is to demonstrate that throughout history medical realities other than the urban experience have existed, and that the interactions between city and countryside have not been one-directional. Medical knowledge is of diverse nature and origin. Rural areas have participated in a variety of ways to its accumulation, either through medical interventions and observations, or through their contributions to pharmacopoeia. A wide and changing variety of medical practitioners have also long been part of rural medicine: bone-setters, “quacks” practicing various acts or selling remedies without any oversight, country surgeons, matrons, Ladies of Charity, local leaders who played an important role in the diffusion of knowledge, nineteenth century medical officials, as well as members of the medical profession called to the countryside for individual consultations or sent from urban hospitals to deal with an epidemic, and finally, especially in the contemporary period, medical providers present in rural areas. All of these individuals and groups have participated in various ways to provide healthcare to rural populations, either in competition or in harmony depending on the time and place. Although the increasing therapeutic efficiency of conventional medicine since the late nineteenth century has shifted definitions of quackery, the differences between urban and rural medicine still deserve specific attention as the relationships of rural populations with the medical community contain specific characteristics due not only to rural sociology but also to geographical constraints.
In addition to exploring medical practices, this conference will revisit the health of rural populations, a classic topic that nonetheless has received little attention in the last thirty years. While historical demography and scholarship focusing on the social history of public health prospered in the 1960s and 1970s, especially with the very promising insights into the history of eighteenth and nineteenth century western France (Jean-Pierre Goubert, François Lebrun, Jacques Léonard), since the 1980s, studies of the health of rural people have declined not only in French scholarship, but in Europe in general, especially in terms of comparative studies. Has this been the consequence of the improvement in public health that may have given government as well as the medical community the impression of having attained their ambitious goals of winning the battle of good health for all? Without a doubt, yet the appearance of new pathologies (or the discovery of hidden pathologies stemming from use of toxic products) and the still enormous problems of world public health have revived interest in questioning the efficiency of medical programs. The most recent studies on welfare and public health not only in France but elsewhere in Europe, especially in England and in Italy (for example, Mathieu Arnoux and Gilles Poster-Vinay, Samantha Williams), as well as studies of colonial medicine and the health of colonial populations (for example, James L.A. Webb, Claire Fredj) demonstrate the advantages of a global and comparative approach that resituates specific populations in a global environment, rather than simply in regions through which new populations and knowledge flow. Similarly, advances in medical anthropology have deepened understandings of the various pathologies from which people have suffered and which have affected both urban and rural areas, hence providing insight into much earlier periods of time.
The goal of this conference is to understand better the health and medical situation in rural areas in France, as well as across Europe and its colonies, all the while challenging the processes of medicalization at work and the very concept of medicalization. It seeks especially to analyze medical practices as well as knowledge, their flows and networks as well as institutions, in a dynamic perspective from the medieval period to the present. Special attention will be paid not only to the legacy of the past but also to paradigm changes in order to bring to light the ways in which the contemporary organization of rural medicine has been constructed and what we may learn from the choices made in different historical periods.
Discussion will center on three themes:
1°) The Health of Rural Populations in Terms of their Specific Environments
Have there been or are there still differences in the nature and intensity of urban and rural pathologies? Can we compare rural and urban hygiene? The image of rural public health is paradoxical and has varied over time. Often perceived as a site of resistance to the modernization of medical and sanitary systems, the countryside has also been considered as far removed from specifically urban forms of insalubrity (artisan and industrial), as well as from the most virulent centers of epidemics. At the same time, the concepts and methods of Hippocratic medicine, a model that was used and reinterpreted until the middle of the nineteenth century and has maintained its heuristic value, invite an assessment of the relationships between health and environment in terms of living space. Over and beyond miasmatic theories and the relatively well known example of medical constitutions, it is possible to measure the impacts of the environment (for instance, in zones defined as humid, arid, coastal, mountainous, etc.). Furthermore, the pollution of soil and water by chemical fertilizers and pesticides has become since the nineteenth century a major issue, with an impact on farm workers as well as on rural populations in general. Non-agricultural rural activities such as mineral exploitation have also had consequences on health. Moving beyond representations, it is necessary to study the sanitary and epidemiological realities of rural health issues.
2°) Relations between Rural Populations and Health Providers
What are the characteristics of health providers? How are country doctors represented? How have health providers established links between the city and the countryside? What relationships exist between doctors and various other health providers, as well as between doctors and the populations under their care? These questions create the opportunity to examine the multiple configurations of knowledge and power that spring from the myriad sanitary interventions and forms of health care provided in rural areas. Some therapeutic innovations may encounter resistance, while other therapies with no scientifically proven efficiency may be well accepted. Especially in the countryside, the medical corps emerged from a discourse condemning quackery and outmoded methods remaining in use among rural populations. An analysis of the nature of the social demand for medicine can provide significant information about the organization of rural societies, the degree to which they are open to outside influences, and their contribution to sanitary debates extending beyond the rural world. Rural societies have never been homogenous, either in space or time. Their participation in the development of public health programs deserves exploration in order to tease out the nuances between political goals and public health campaigns imposed by higher authorities. The sanitary and medical facilities located in the countryside are in this way signs of rural dynamism and are more or less numerous and visible over time. They may include sites of worship of protective divinities or saints, small hospices, as well as in the modern countryside, nursing homes and medical clinics.
3°) Medical Practice and Knowledge in the Countryside
Rural populations have also participated in the constitution of medical knowledge and the separation between healthy and unhealthy practices. From a medical-sanitary perspective, the study of rural populations provides a key to the reading of representations of the relationship between the natural and non-natural. The medical theories formulated in Antiquity, especially those developed around the work of Hippocrates and Galen, constitute a reflection on the power of nature. For scholarly medicine, the observation of phenomena that occur in rural areas is all the more necessary as they take place far from the perturbations created by urban life. The idea of nature has much evolved and it is useful to question the impact of the shifts in the vision of the countryside referred to in scholarly medicine to understand what medical science expects from the rural world. In a more concrete manner, we will address in particular the harvest and cultivation of various substances derived from botanical, zoological, and mineral elements. Traditional books of remedies and botanical knowledge are sources for analysis, as well as the present-day demand for phytosanitary procedures and organic products. From what substances are remedies made? What are their production cycles and how are they commercialized? Questions may also address the models provided by veterinary medicine for the treatment of human beings. The accumulation of knowledge in the rural areas of Europe and the world has played an important role in advancing various treatments. Popular experience has nourished empirical observations, sometimes transforming them (a phenomenon encouraged by the creation and development of medicinal chemistry), but also sometimes leading to their rejection. This is demonstrated by the current fascination with therapies considered as natural and derived from ancestral rural practices, with an additional basis in scientific research as well as a strong commercial response to the great social popularity of the back to nature movement. A fruitful exploration would address the role of rural areas as reservoirs of medicinal resources and knowledge exploited on a large scale and creating cultural, scientific, and economic changes that have transformed medical practices.
This conference is of interest not only to historians but also to other scholars and individuals who using the framework of the social sciences investigate questions of medicine and health in the countryside. Insights on the present time are also welcome. Participants are invited to focus on both European and colonial topics to promote a comparative approach. Paper proposals must include each author’s name, home institution, and address; a title; a 3,000 to 5,000 character abstract; and a few key words. Submissions must be made before January 10, 2015, and should be sent to the following two addresses:
Jonathan Barry, University of Exeter
Marie Bolton, Université Blaise Pascal (Clermont-Ferrand 2), CHEC (EA 1001)
Isabelle von Bueltzingsloewen, Université Lumière Lyon 2, LARHRA (UMR 5190)
Didier Foucault, Université Toulouse II-Le Mirail, FRAMESPA (UMR 5136)
Patrick Fournier, Université Blaise Pascal (Clermont-Ferrand 2), CHEC (EA 1001)
Claire Fredj, Université Paris Ouest Nanterre La Défense, IDHE (UMR 8533)
Stéphane Frioux, Université Lumière Lyon 2, LARHRA (UMR 5190)
David Gentilcore, University of Leicester
Claude Grimmer, Université Blaise Pascal (Clermont-Ferrand 2), CHEC (EA 1001)
Laurence Moulinier-Brogi, Université Lumière Lyon 2, CIHAM (UMR 5648)
Marilyn Nicoud, Université d’Avignon, CIHAM (UMR 5648)
Christelle Rabier, EHESS, Centre Norbert Elias (UMR 8562)
Laurent Rieutort, Université Blaise Pascal (Clermont-Ferrand), CERAMAC (EA 997)