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  • The Great Nation in Decline: Sex, Modernity and Health Crises in Revolutionary France c. 1750-1850
  • Dora B. Weiner
Sean M. Quinlan . The Great Nation in Decline: Sex, Modernity and Health Crises in Revolutionary France c. 1750–1850. The History of Medicine in Context. Hampshire, U.K.: Ashgate, 2007. xi + 265 pp. $99.95 (978-0-7546-6098-9).

This book has as many themes as its title has topics, but its most impressive message is that physicians played a prominent role in the political and socioeconomic life of France over the one hundred years that frame the Revolution. The recurrent phrases "doctors argued" (p. 5), "physicians saw" (p. 94), and "doctors turned away" (p. 12) indicate that Quinlan has read so widely in the primary sources, including the archival sources, that he believes that he can speak for medical opinion in France during a whole century. He cites or quotes at least one hundred doctors.

The task is daunting, and Quinlan is well aware of this, as he attempts to identify and discuss a large variety of issues related to his overall topic: the perceived "degeneration" of France, from the Enlightenment to the era of Koch and Pasteur. [End Page 203] To complicate his task, he finds changing definitions of the term "degeneration" in successive medical dictionaries (p. 116) beginning with religious meanings and ending with precise scientific criteria. He tries to accommodate these variations.

In chapter 1, "A Medical Diagnosis of a Social Crisis," Quinlan finds high infant morbidity and mortality and lascivious living among the aristocracy as the major indications of "degeneration" castigated by medical critics. "Nervous disease" and "vapors" were favorite culprits.

In chapter 2, "Depopulation and Institutional Response," he analyzes the innovative and creative work of the Royal Society of Medicine under the guidance of Vicq d'Azyr, applauded by lay leaders like Turgot and philosophers like Condorcet (p. 21). He elevates "depopulation" into the central "health crisis" of the late Enlightenment even though the Society's mandate was much broader and included fighting epidemics and epizootics. Here, I believe, is the major common theme in which the anxieties and efforts of successive generations of doctors coalesce: those of the Society, of colonial doctors anxious about the survival of Europeans in the Caribbean (chap. 3, "Colonial Bodies and Hygiene in the Antilles"), and of the Restoration hygienists: the problem of contagious diseases of epidemic proportions. With the introduction of Jennerian vaccination, the prevention of contagious epidemic diseases moved to center stage of the medical effort. Quinlan does not discuss vaccination or Jenner.

And so Quinlan, having explored the "Uncertain Territory and Fragmented Agendas" of the Restoration (chapter 5), moves up to a brilliant, well-documented and convincing analysis of the "health crisis" of the July Monarchy caused by the cholera epidemic. He appropriately credits the preparatory work of the chemists, pharmacists, and "hygienists" of the 1820s. Their research established the scientific evidence that the poor lived in decaying portions of Paris, in dilapidated housing, and worked in factories and shops that ruined their health. (Quinlan does not, I believe, sufficiently credit the Consulate or Bonaparte's minister of internal affairs, the physician Jean Antoine Chaptal, for setting up the Hospital Council and the Public Health Council of the Seine Department in 1801 and 1802, respectively, and creating the Midwifery School at Port Royal in 1802: chapter 4, "Doctors, Regeneration and the Revolutionary Crucible.")

What comes as an unexpected indictment of responsibility for the murderous living conditions that caused abnormally high morbidity and mortality among the laboring class was their condemnation as a "dangerous class" by the (bourgeois) medical establishment. Their misery and decline, it appeared, was their own fault. In chapter 6, "From Cholera to Degeneration, 1832–1852," Quinlan analyzes the major health crisis of the time, the cholera epidemic of the 1830s, and attempts to clinch the argument for "The Great Nation in Decline." Is the argument convincing? In the conclusion, "Degeneration and Regeneration after 1850," he attempts to reassure us.

This book is the kind of monograph that has won a noteworthy niche for Ashgate's History of Medicine in Context series. It raises a very specific issue still of pressing...

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