Leisure Settings: Bourgeois Culture, Medicine, and the Spa in Modern France (review)

Douglas Peter Mackaman. Leisure Settings: Bourgeois Culture, Medicine, and the Spa in Modern France. Chicago: University of Chicago Press, 1998. xi + 219 pp. Ill. $46.00 (cloth), $18.00 (paperbound); £36.75 (cloth), £14.50 (paperbound).

As the title may imply, the primary focus of this book is the formation of bourgeois social identity, not hydrotherapy per se. But if varieties of medical theory and practice are not accentuated by Douglas Mackaman, the professional identities of physicians and the economics of medicine certainly are. Taking his cue from the works of Michel Foucault and Alain Corbin, Mackaman is intrigued with the notion that physicians were influential in shaping bourgeois values and norms. Like Foucault and Corbin, he is wary of the oppressive nature of medical authority and likens certain forms of hydrotherapy to torture. But he seeks to go beyond Corbin by looking at the issue of human agency in the economic and developmental construction of beaches or, in his case, spas.

Mackaman is interested in physicians as entrepreneurs, and in the relationship between medicine and profit-seeking in a capitalistic economy. He focuses on the nineteenth century, when an ambitious group of physicians emerged who saw in spas vast potential for their personal profit. These spa physicians assumed more than strictly medical functions as they invested in spas, designed their interiors, determined their administration, and led literary campaigns to popularize them. In the process of promoting spas as productive places for the bourgeoisie to spend its leisure, in contrast to the festive excesses of the people or the frivolous and sexual overtones of the aristocracy, these spa physicians blurred the roles of doctor and host, patient and guest. Traditionally places where invalids sought relief of pain, spas emerged in the nineteenth century as sites where holiday-makers pursued pleasure. Whereas the medicalization of spas had proved an effective marketing device at mid-century, by the end of the nineteenth century increasing numbers of tourists avoided treatment altogether. Promotional literature proclaiming the social as well as physical benefits to be gained by spending three weeks at a spa was supplanted by caricatures in which hydrotherapy was dressed down and the bourgeoisie undressed, revealing the charlatan or fraud behind the image.

Throughout his study, Mackaman avoids confrontational language or an excessively moralizing tone, but he raises significant questions regarding capitalism and medicine. What is the driving force in determining patient care? Is medicine compromised by too close a concern for profits? In documenting the development of spas over the course of the nineteenth century, Mackaman suggests that reforms were prompted as much by the pursuit of profits as by medical principles. In response to women's complaints about a lack of decency at spas, spa administrators devised a new architecture that emphasized private rather than public bathing and segregated curists by class and gender. Hospitals emerged where indigent invalids could take their cure apart from the leisured classes.

Although Mackaman expresses no doubt that needy bathers received better medical care in the hospitals, he notes that it was common knowledge that segregated spas were more profitable. In like manner, he suggests that "hygiene" became a code word for class consciousness. Hygienic bathing facilities did not just boast rows and rows of white tiles: they were clearly classed, discreet, and private. Similarly, spa administrators' concern with time discipline would prove as beneficial to physicians' pocketbooks as to their patients' health.

One of the worst compromises between capitalism and care apparently came when spa physicians overtly urged their patients to abstain from excessive eating, drinking, and partying, while covertly creating spas as sites of pleasure, complete with casinos. Another came when traditional physicians were presumably paid to endorse spas and enhance profits.

Though limited in focus, this is a thoughtful and well-researched book. Short shrift is given to the history of spas in...