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VVVVVVVVVVV 216 Conclusion Today we speak of chronic and/or degenerative diseases, and sufferers previously classified as incurable are now considered disabled, chronic, or terminally ill. There are no longer any Homes for Incurables in Boston, Philadelphia, and Brooklyn; “reputedly incurable” is also a forgotten notion. Yet despite changes in vocabulary, the related issues of prognosis and disease trajectory are as significant today as they were a century and a half ago. Importantly, many of the developments that make “being incurable” what it is today trace their origins to the nineteenth century. During that period, physicians wielded new forms of knowledge, new technologies, and new skills that allowed them to diagnose and, in some cases, treat illnesses more effectively. Thanks to these and other developments , physicians came to enjoy a newfound measure of prestige and authority. This process gained momentum in the twentieth century, as various breakthroughs dramatically improved medicine’s ability to cure and to transform disease, mostly for the better. Indeed, one needs look no further than the discovery of antibiotics for tuberculosis to appreciate scientific medicine’s dramatic impact on human health and experience. Yet the emergence of AIDS and drug-resistant tuberculosis vividly demonstrates that both disease ecology and (in)curability remain nearly as contingent and unstable today as they were in the past. Health outcomes are not random events. Just as in the nineteenth century, the incidence and prognosis of chronic disease is profoundly affected by socioeconomic and geopolitical factors. For millions in the developing world, AIDS remains incurable because of “how the world works.” For various reasons, life-saving drugs don’t reach the people that need them, cruelly exposing the limits of transnational justice and global solidarity. Of course even in affluent countries, many of the same CONCLUSION 217 issues play a role. Race, poverty, and access to care are not only important social determinants of health; they profoundly affect the evolution and prognosis of chronic disease. In the end, though biology and bad luck are important, (in)curability is also driven by income and education, as well as by the decisions that policy makers take on our behalf. The progressive secularization and professionalization of end-oflife care is another important historical development. Since the midnineteenth century, physicians, nurses, and other paid caregivers have assumed many of the roles previously filled by pastors, priests, nuns, and families. In the case of incurable illness, this process has been both uneven and problematic. Critics, both past and present, have used these disorders to draw attention to the therapeutic limits of modern medicine and to highlight the importance of adequately addressing patients’ emotional, existential, and spiritual concerns. Finally, new forms of sociopolitical activism came to the fore during the late nineteenth century, initiatives that culminated in the creation of the modern welfare state. In both France and elsewhere, state-sponsored programs progressively replaced private, religiously inspired efforts at assuaging incurables. Despite their cost and apparent wastefulness, such activities were no longer simply a moral or religious duty but a social and professional challenge that more agreed was worth the effort. Together, these developments contributed to the politicization and partial medicalization of incurable illness. By the early twentieth century, doctors and other decision makers viewed the treatment of chronic disease with a newfound optimism. Therapeutic innovations such as radiotherapy and hypodermic morphine allowed them to palliate suffering more effectively. At the same time, physicians and society at large increasingly recognized that many incurables required a level of care only available in institutions. In fact, as time went on, incurables from all social classes progressively turned to hospitals en masse. Twentieth-century medicine’s growing ambition and optimism also had an important spillover effect; incurables came to be seen as appropriate, eventually even desirable, subjects of scientific research. The magnitude of this medical and cultural shift is apparent if one considers the case of a leading incurable illness, cancer. In the first decades of the twentieth century, doctors and social reformers exuberantly launched campaigns across Europe and North America to improve its diagnosis and treatment. Joseph Recamier’s 1911 address to an international conference vividly illustrated an important aspect of this ambitious new ethos: “for patients afflicted with inoperable cancer, especially when it is ulcerated and necessitates dressing changes, relief during the last months is only possible through hospitalization. This hospitalization must differ from ordinary hospital services in that the rules must...

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