Climate, Medicine, and Peruvian Health Resorts

Mark Carey, “Climate, Medicine, and Peruvian Health Resorts,” Science, Technology, and Human Values 39, no. 6 (2014): 795-818.

Carey tells the story of Jauja, a health resort developed in mid-nineteenth century Peru. He argues that, through the veil of medico-scientific (and more specifically, climatological) discourse, physicians and other authority figures advocated for the development of the resort for economic, political, racialized, and local cultural reasons. Carey holds the science and medicine to be almost entirely socially constructed, and as such it serves as a lens through which to view the real motivations and influences that affected the development of the region.
I’m not quite as hard of a social constructionist as Carey, and while I will incorporate culturally-produced climates, I believe the science/medicine to be a little bit more independently operated than his argument would have it.

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Inventing Caribbean Climates

Mark Carey, “Inventing Caribbean Climates: How Science, Medicine and Tourism Changed Tropical Weather from Deadly to Healthy,” Osiris 26, no. 1 (2011): 129-141.

In this piece, Carey traces changing European and North American perceptions of Caribbean climates from 1750-1950. He argues that these understandings were not shaped only by the climactic science; rather, they were constructed around multiple considerations, including “…environmental conditions, knowledge systems, social relations, politics, and economics.” (129) Carey understands these ideas, then, to be culturally constructed and argues, in line with most recent studies on climate, for the cultural construction of climate.

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Foucault: The Birth of the Clinic

Foucault’s is a history (if we can call it that) of discourse — of the way people talked about the body, particularly in its diseased state, and the way they’ve understood the doctor and the patient himself in relation to the disease.

« …commenter, c’est admettre par définition un excès du signifie sur le signifiant, un reste nécessairement non formule de la pensée que le langage a laisse dans l’ombre, résidu qui en est l’essence elle-même, poussée hors de son secret; mais commenter suppose aussi que ce non-parle dort dans la parole, et que, par une surabondance propre au signifiant, on peut en l’interrogeant faire parler un contenu qui n’était pas explicitement signifie. »

To comment on something is to assume that the ultimate meaning of what you’re getting at is more important than what you’re saying — that there’s something more, something left in the shadows of your words. I think Foucault is laying the foundations for the kind of work he will do in the rest of the book here, asserting that if we can read through the way that doctors talk about the body, the patient, the disease, and themselves in relation to it, we can understand at a deeper, more complex level how they saw and understood these concepts.

This is a history of reading between the lines, of seeing what was not explicitly stated and looking underneath for larger take-aways. I’m unsure how I feel about this, because it doesn’t seem to be based in anything tangible. It feels farfetched and difficult to substantiate, problems that Foucault does resolve, in my mind, in the remainder of the text.

I think it has the potential to be very powerful, though, and I love that Foucault states he is not arguing that this epistemic change in the late 18th century was doctors/scientists suddenly waking up and seeing what had really been there all along — rather, that a new kind of science (by which I mean what was considered scientific) emerged, and through its lenses, scientists and doctors saw different things. They were looking for different things.This way of looking at things, I think, is something a lot of historians of science don’t like. It’s the ultimate critique to the progress narrative and to positivism, to viewing the history of science, technology, and medicine as the story of how scientists eventually “got it right.”

Espaces et Classes

Primary (disease), secondary (disease + individual), tertiary (disease + individual + health infrastructure, or « l’ensemble des gestes par lesquels la maladie, dans une société, est cernée, médicalement investie, isolée, repartie dans des régions privilégiées et closes, ou distribuée a travers des milieux de guérison, aménages pour être favorables »). Big changes took place in the tertiary.

Une Conscience Politique

Begins by talking about epidemics, exploring how they were understood and why the concept of contagion was largely unimportant.

« On a discute beaucoup et longuement, et maintenant encore, pour savoir si les médecins du 18ieme siècle en avaient saisi la caractère contagieux, et s’ils avaient pose le problème de l’agent de leur transmission. Oiseuse question… »

Details growing « conscience collective » of medicine, as observations around France were being collectivized and disseminated through medical infrastructure.

« Le lieu où se forme le savoir, ce n’est plus ce jardin pathologique où Dieu avait distribue les espèces, c’est une conscience médicale généralisée, diffuse dans l’espace et dans le temps, ouverte et mobile, liée à chaque existence individuelle, mais bien à la vie collective de la nation, toujours éveillée sur le domaine indéfini où le mal trahit, sous ses aspects divers, sa grande forme massive. »

Discusses change in the doctor’s role being reinstituting an individual, idiosyncratic “normal” to, in the 19th century onwards, adhering to a common, popular normal as the standard for health.

Importance of the concept of healing the state — health as something the entire nation should be concerned about.

Le  Champ Libre

Account of the debates surround the reformation of medical education during the French Revolution;

Hospitals should be abolished; they shouldn’t be needed in the ideal state, because everyone will be healthy. They end up becoming the new “natural” place for disease, though, replacing the family.

Arguments over whether education/medical field should be regulated.

The Old Age of the Clinic

“Before it became a corpus of knowledge, the clinic was a universal relationship of mankind with itself; the age of absolute happiness for medicine. And the decline began when writing and secrecy were introduced, that is, the concentration of this knowledge in a privileged group, and the dissociation of the immediate relationship, which had neither obstacle nor limits between Gaze and Speech: what was known was no longer communicated to others but put to practical use once it had passed through esotericism of knowledge.”

Theory vs. seeing — to what extent do our theories dictate what we see? (“When Hippocrates had reduced medicine to a system, observation was abandoned and philosophy was introduced into medicine.”)

I’ve felt this way about learning history a lot. If I read so much theory, it’s going to change the way I do history. It’s going to change the way I read sources, the way that I understand them, and the way that I relate them to contemporaneous and modern-day situations and ideas. Is this less pure? Or merely substituting someone else’s bias for my own?

Details how the clinic is different from a hospital, one being that, while in a hospital, “one is dealing with individuals who might suffer from one disease or another,” in the clinic, “one is dealing with diseases that happen to be afflicting this or that patient: what is present is the disease itself, in the body that is appropriate to it, which is not that of the patient, but that of its truth.”

The Lesson of the Hospitals

Clinical hospitals became a space where “truth teaches itself… offers itself to the gaze of both the experienced observer and the naive apprentice; for both there is only one language…”

They made possible “the immediate communication of teaching within the concrete field of experience… effac[ing] dogmatic language as an essential stage in the transmission of truth.” (68)

Interesting, although I’d still argue there was a lot going on with medical language at this time. Someone didn’t just walk in and know how to talk about the body. The body still wasn’t speaking for itself.

“What makes medicine, thus understood, a corpus of knowledge of use to all citizens is its immediate relationship with nature; instead of being, like the old Faculty, the locus of an esoteric, bookish corpus of knowledge, the new school would be ‘the temple of nature’; there one would learn not what the old masters thought they knew, but that form of truth open to all that is manifested in everyday practice…” (70)

Signs and Cases

Begins by discussing similarities and differences between natural history and this new brand of medicine; continuing conversation distinguishing classificatory medicine and clinical medicine. Instead of just classifying everything by their differences and similarities, clinical medicine embodied “a gaze… not bound by the narrow grid of structure (form, arrangement, number, size), but that could and should grasp colors, variations, tiny anomalies… it must make it possible to outline chance sand risks; it was calculating.” (89)

Discusses signs and symptoms — actually kind of defines something for once — and the changing amount of space between what was a signifier and what was signified. Symptoms, instead of being a sign of something, become themselves part of the whole of the disease.

Fascinating discussion of the rising importance of statistics in medicine (WISH THERE WAS MORE SUBSTANTIAL EVIDENCE), which “gave the clinical field a new structure in which the individual in question was not so much a sick person as the endlessly reproducible pathological fact to be found in all patients suffering in a similar way; in which the plurality of observations was no longer simply a contradiction or confirmation, but a progressive, theoretically endless convergence…” (97) “The only normative observer is the totality of observers…’Several observers never see the same fact in an identical way, unless nature has really presented it to them in the same way.’” (102)

Seeing and Knowing

Difference between experimentation and observation

“The observing gaze manifests its virtues only in a double silence: the relative silence of theories, imaginings, and whatever serves as an obstacle to the sensible immediate; and the absolute silence of all language that is anterior to that of the visible.” (108)

The setting of the hospital is important, permitting “pathological events to be reduced to the homogenous; the hospital domain is no doubt not pure transparency to truth, but the refraction that is proper to make possible, through its constancy, the analysis of truth.” (110)

“…by saying what one sees, one integrates it spontaneously into knowledge…” (114)

This is a really important point for Foucault, I think. He’s writing about discourse as a way of knowing. How we put into language what we see is how we construct knowledge.

Long-winded analogy between disease and languages:

“Disease, like the word, is deprived of being, but, like the word, it is endowed with a configuration.” (119) – nominalistic (denies the existence of universals and abstract objects, but affirms the existence of general or abstract terms and predicates)

Open Up a Few Corpses

Argues that the histories of anatomy that posit dissection was not common until the mid-19th century are false, constructed to explain why pathological anatomy (the correlation of lesions with symptoms) wasn’t a thing earlier.

Historical narratives constructed as “retrospective justifications.”

The People’s Car

The People’s Car: A Global History of the Volkswagen Beetle, Bernhard Rieger

         As someone quite illiterate insofar as the history of technology is concerned, I thought this book did an excellent job of elucidating through example just how ingrained in a society’s beliefs, prejudices, and self-perceptions technologies are, and equally important, how easily the same technologies can adapt to new socio-cultural environments. Technologies can be overtly used — like the VW Beetle was by the Nazi regime — to further political, social, or economic goals or ideologies, but the purposeful instillation of technological ethos is not the only way that a technology can acquire social meaning. The beetle’s adaptation to cultural environments outside of Germany (and even inside of West Germany, a quite different landscape from the one of its conception) proves that technologies can acquire meanings far beyond those instilled in them by their developers. Author Bernhard Rieger cleverly displays the nuances and complicated patterns of societies’ relationships with technologies, demonstrating that neither technological determinism nor the social construction of technology paint a full picture of the way that a technology interacts with a population. Instead, as evidenced by the effects the bug had on society and the way that society in turn shaped the bug, a reciprocal relationship emerges in which society and technology converse and enact changes in one another.

The book showed how technologies can be an avenue through which political entities proliferate (radio) and reinforce their ideologies; the VW Beetle in its promotion by the Nazi party was meant to “demonstrate how the emerging ‘people’s community’ would raise the average German’s living standard.” (58-59) Things can be said, ideas made manifest, through the use of commodities. In Rieger’s words; “Material objects often acquire profound personal and collective significance because they make the ‘abstract… concrete, closer to lived experience.'” (6) Hitler was able to make his ideologies concrete by enacting technological policies that put his beliefs about the ideal society into action. In a way, the technologies spoke back — and said something about the realities of human nature — when his laissez-faire Highway Code backfired. Perhaps, if he had listened when the human-technology conglomerate (men driving cars) spoke, he would have found that is worldview (and what he wanted for Germany) was untenable.

After WWII, the bug was in a precarious situation in occupied West Germany. Rieger’s account of how it bounced back, in no small part due to its revamped and heavily revised cultural aura, offers the first example of how a technology can adapt to different socio-cultural environments. In order to remain culturally attractive, the bug had to shed its Nazi origin story; like the society that surrounded it, it was viewed as a victim of the Third Reich. Its paramount success in the otherwise dire post-war economy served as a beacon of hope for Germans. Where the Nazis had failed, the Federal Republic had finally provided a long forgotten promise of providing the average German a vehicle. This drastic reworking of VW’s actual history goes to show that technologies evolve and adapt with the populations they were created to serve and are not static historical factors. They can also play a role, as they had in the 1930s and 1940s, in establishing and reinforcing cultural identities. Battered Germans looked at the success of the beetle and saw an economically viable, competitive Germany in their future, if they would only work hard like those in Wolfsburg had.

The latter half of the book is what makes Rieger’s history “global”; in it, he outlines the bugs’ donning of a few other cultural robes. The Nazi origins of the car tended to be too much of an obstacle to the British constituency, displaying limits to the beetle’s techno-cultural adaptability. In America, by contrast, after initial hurdles the Volkswagen became very popular. As part of a new society, however, it took on a very different identity. Instead of the hearty “people’s car,” the standard-setter it had been in Germany, the bug adopted a distinctly unorthodox and counter-culture ethos in the American market, which was dominated by much larger, domineering vehicles. In Mexico, the beetle — or vochito — adopted yet another cultural ethos. Again, its simple yet reliable engineering proved advantageous; Mexicans identified the car as “tough” and “thick-skinned,” “capable of handing both actual and metaphorical bumps in the road,” like its hardy clientele. (283)

Rieger employs a somewhat elementary version of gender analysis, commenting occasionally on how the culture surrounding the car differed for men and women. A lot more could have been done here, but at 335 pages, the book was already quite hefty. Another mild complaint I had was that it seems a bit much to call a book that covers Germany, the United Kingdom, America, and Mexico, “global,” but again, including more would have made Rieger’s book a monolithic project and read. This begs the question, however, of what exactly “global” means to historians — because if it means only four countries, three of which are western European, that seems problematic.

I came away from the book with a far deeper understanding of the way that, to borrow from Dr. Heyck, technology and society reinvent one another over and over again. While the appearance of the bug — because it was such a large part of its draw — remained more or less the same, its cultural meaning was constantly being reworked, just as the societies in which it found itself developed unique and varied ideas of what it meant to them. The car’s reentrance into the automobile market in the 1990s speaks to how powerful and long lasting these associations can be. Additionally, Rieger’s explanations of why the VW caught on (or didn’t) displayed just how important international politics and economics are to technological adoption and adaptation. Far from being static entities only reflective of their designers’ technological goals, technologies can tell historians a lot about the worlds they were produced from and used within.