- Roads to Health: Infrastructure and Urban Wellbeing in Later Medieval Italy by Guy Geltner
In the midst of a global SARS-CoV-2 pandemic, comparisons to historical pandemics come up frequently. Will as many die as in the 1918 influenza pandemic? Will it lead to changes in health regimes like regular mask wearing? Will a vaccine get SARS-CoV-2 under control similar to other flu vaccines? The basic assumption of many is that public health crises such as the Great Stink of London in 1858 or [End Page 116] the Black Death, which raged across Europe from 1347 to 1351, are watershed events that affected not only the health of individuals but also approaches to public health.
Bucking this trend, Guy Geltner’s Roads to Health puts to rest the idea that the Black Death revolutionized public health in Italy. As he deftly proves, Italian urban communities had already issued and enforced public health measures before the wave of disease hit in 1348. Geltner argues that scholars have previously thought of the plague as the instigator of public health measures because they were looking for health in the wrong place: instead of focusing on the establishment of public health offices, we should be looking in the streets.
Roads to Health focuses on the officials in charge of roads as key public health workers in the 1200s and 1300s. Through case studies of the Italian cities of Lucca, Bologna, and Pinerolo, Geltner shows how road officials were delegated responsibilities that we today would lump under health and sanitation: keeping waste off the streets and gutters flowing, ensuring clean marketplaces and food for sale, and maintaining latrines and water supplies. A lack of modern medical understanding did not mean that medieval communities lacked concepts of health and wellbeing. Medieval public health was “a dynamic and historically contingent set of legal prohibitions, disciplining practices, and subtle insinuations designed to improve health outcomes at the population level” (p. 12).
In the introduction, Geltner lays out his book as a study of biopower. While Foucault had understood biopower as an eighteenth-century development, Geltner pushes the idea back to medieval city-states whose “governments’ and other agents’ quest for authority and control meant aligning their prerogatives with certain forms of health promotion” (p. 17). Biopower in action leads him to propose the concept “healthscaping,” defined as “the physical, social, legal, administrative, and political process of providing urban environments with the means to promote residents’ health, safety, and wellbeing” (p. 20). With the combination of biopower and healthscaping as the theoretical framework, the actions of road officials can be understood as actions promoting health, which in turn promote the government.
After demonstrating the breadth of Italian urban statutes dealing with public health in chapter 1, the next chapters take up case studies of three Italian cities. Lucca’s viarii, the local roads and works official, had a mandate to keep the city clean, including fining those who blocked streets or waterways and those who polluted water sources. The viarii’s task was explicitly connected to “the wellbeing and health of the people and the city of Lucca” (p. 71) in the 1321 statutes, leaving no doubt that the government was deliberately healthscaping pre-plague Lucca. Similar statements are found for his other case studies in Bologna and Pinerolo. In addition to statutes, which have been the standard go-to sources for medieval sanitation scholarship, Geltner mobilizes financial and official inquest records to expose the work of the roads officials like Bologna’s fango as preventative urban health measures. The level of detailed analysis of the records of the viarii, fango, and camparii is impressive and gives readers a much fuller picture of healthscaping in action than statutes alone provide. [End Page 117]
In chapter 5, Geltner zooms out his view to medieval Europe and touches upon world developments. The chapter feels somewhat tacked on to the core study of the Italian cities as a freestanding essay on premodern health and sanitation...