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22.09.07 Geltner, Roads to Health

22.09.07 Geltner, Roads to Health

Guy Geltner’s book examines the efforts of Italian medieval municipal authorities to shape the built environment in ways that might promote wellbeing. The author employs a recent term, “healthscaping,” to define such practices and argues that they were extensively implemented. His aim is to counter widely held beliefs about medieval communities as apathetic and indifferent to appalling levels of public hygiene. He points to this as a historiographic bias about medieval societies that has proven impervious to numerous studies of the attempts to reduce health hazards in medieval towns and the rural areas subject to their jurisdiction. This modernist bias (shared by some medievalists) continues to attribute the emergence of public health measures to the wild urbanization spurred by eighteenth-century industrialization.

As studies on medieval communal hygiene have failed to correct this perception, Geltner adopts a new strategy. He investigates healthscaping in medieval Italian towns through extensive archival research but frames it as an expression of “biopolitics.” The term, coined by Michel Foucault who applied it to modernity, indicates processes whereby authorities monitor and regulate private settings and behaviors in the name of the public good. Viewing medieval communal preventative measures as manifestations of biopower, Geltner proposes, might cast them in a theoretical light that renders them pertinent to current concerns, finally dismantling entrenched perceptions about medieval hygienic ignorance.

Roads to Health focuses on Central and Northern Italy, one of the most urbanized regions of Europe. Three towns serve as case-studies: Lucca in Tuscany; Bologna, whose records are particularly abundant; and Pinerolo, a smaller center that is representative of its surrounding rural region in the Piedmont. For each town, Geltner examines the establishment of specially appointed health organs and the regulations they issued. These revolved around keeping public streets and waterways free of ordure by disposing of waste in sanitary ways, avoiding obstructions that might impede the flow of air or water, and regulating the activities of potentially polluting industries such as tanning and butchering. Preventative norms in the three centers are comparable, illuminating the existence of an articulated medieval legislative framework for public health.

Geltner examines not only urban code laws but also court records. The description of cases brought before the health officials, and the measures they took to remedy breaches to hygienic conditions, enriches the narrative. Above all, these examples demonstrate the extent to which norms were enforced. One component of the bias against medieval, and more broadly, premodern communities, concerns the assumption that, even when they were issued, public health statutes remained little more than wishful thinking--normative texts issued by ruling elites that bore little relationship to the reality of medieval environments and their (un)sanitary conditions.

Geltner’s study demonstrates instead the consistent enforcement of law codes. Frequently, municipal authorities called upon neighbors to report breaches of hygiene regulations so that they could be remedied, and the culprits fined. The concrete effectiveness of these sanitary measures is hard to assess, as the author admits, given that not all were based on what we now consider sound medical knowledge. In medieval towns, for example, not only offensive smells but also sights--of offal or human waste--were believed to be potential sources of contagion. But there can remain little doubt about the widespread promulgation of codes on communal health and their enforcement in accordance with the resources and knowledge that was available.

The extensive examination of archival records enables the author of Roads to Health to dismantle another myth, the belief that health boards were established and regulations issued only in the aftermath of the Black Death, the devastating plague that decimated European population in the middle of the fourteenth century, jolting authorities into action. Urban statutes and court records show instead that measures taken to preserve urban wellbeing were systematically implemented starting in the early thirteenth century. In the middle of the following century, Geltner convincingly argues, the Black Death only sharpened the attention paid to public health hazards, spurring officials to strengthen provisions that were already in place.

To consolidate his argument, the author situates the cases of Lucca, Bologna, and Pinerolo into a broader context. Relying on existing literature, he points to comparable communal health practices found across Europe, from Scandinavian countries to Mediterranean regions, from the provinces of the Byzantine Empire to the Islamicate. Far from being exceptional, the norms and practices that were implemented to monitor and enhance the salubriousness of the built environment and the health of its inhabitants in Italian towns were representative of an immense geographic territory.

The ubiquity of healthscaping efforts in Europe and around the Mediterranean is due in part to its roots in Greco-Roman antiquity. Geltner points to the authors of military and civil architecture treatises, such as Varro and Viruvius, who relied on Hippocratic principles to explain the need for selecting salubrious sites to prevent the spread of disease. For the establishment of both military camps or new towns, they stressed the importance of choosing well-ventilated areas distant from marshes and with an abundant supply of clean water. Similar prescriptions were observed and transmitted in monastic settings in early medieval centuries; they received newfound impetus when Galenic and Hippocratic texts were translated and augmented by Arab scholars, and continued though early modernity.

Lucidly, Geltner does not trace these ancient roots to posit later medieval towns as the antechamber of modernity: he is aware of the teleological trap. But resisting the teleology, he insightfully suggests, should not prevent us from identifying common ground between the later medieval period and eighteenth-century Europe. The demographic pressures exerted on urban areas during the first phase of industrialization can be usefully compared to those experienced in thirteenth- and fourteenth-century Europe when the processes of urbanization, particularly rapid in Central and Northern Italy, underlined the urgency of implementing public hygiene measures.

The structure of Roads to Health illustrates Geltner’s argument efficiently. Following a prologue, an introduction and introductory chapter, the three central sections (chapters two to four) examine archival records for each of the case-studies. The fifth chapter surveys the literature on other European and Mediterranean countries and outlines the roots of medieval health policies in Greco-Roman and early medieval treatises and texts. A short final chapter draws conclusions.

Geltner writes a vivid, convincing account of medieval healthscaping, illustrating its characteristics and capillary reach. Casting public health practices into a framework that views them as an instance of biopolitics is a new approach that might prove fruitful in dismantling long-held assumptions. Perhaps unavoidably, he encountered difficulties in implementing the new approach. The main one is that he can only suggest, not demonstrate, that health officials who enforced hygienic norms were attempting to impose a “disciplining gaze” on domestic settings or private behaviors. Further, what remains unarticulated in this as in other discussions about the assertion of biopolitical power is the extent to which such efforts were deliberate, or rather the collateral effect of a series of actions that were taken.

The author himself poses the question about how conscious health officials were that they were imposing their views about pollution, especially when the evidence seems to row in the other direction. The cases adjudicated by the health officials in Bologna, for example, reveal that while they canvassed the built environment broadly, they showed “a general reluctance to enter private abodes.” Also, they “did not single out one type of potentially polluting artisans […] preferring instead to attend to less-contested amenities such as Bologna’s waterways” (94). The author’s attempt to provide alternative interpretations of the data, suggesting that the officials mainly sought to legitimize their own right to enforce hygienic rules, is a bit torturous.

The parallel that the author suggests between medieval prophylaxis and the colonial enterprise is also problematic. Colonial powers sought to justify their seizures of land and resources with their supposedly civilizing mission--which included the establishment of health boards, advanced medical facilities, and higher levels of public hygiene. There is a fundamental difference with health officials in medieval towns, however, who sought to enforce sanitary norms in communities to which they themselves belonged. The prohibition, say, to toss human waste from windows onto the public street during daytime, when the presence of passersby was most likely, ensured that the officials as well should not be regaled with the contents of a chamber pot when walking down a street. Trying to argue that the reasons for enforcing such norms might not have been entirely laudable is an uphill battle.

Difficulties, however, are to be expected when new theoretical frameworks are proposed and Geltner takes on an ambitious historiographic project. Only future scholarly production will show whether his strategic attempt to frame medieval healthscaping as an exercise in biopolitics will finally transform the bias about medieval public health. What is clear is that the image that emerges from this compelling study is starkly different from the traditional view of medieval communities as weighed down by an apathetic indifference to sanitary conditions. Supported by extensive archival research and a clear narrative, Roads to Health is an important contribution not only to public health history but more broadly to the social and cultural history of medieval urban Europe.