Roads to Health: Infrastructure and Urban Wellbeing in Later Medieval Italy by Guy Geltner (review)

In Roads to Health: Infrastructure and Urban Wellbeing in Later Medieval Italy, Guy Geltner challenges the received wisdom regarding public health in the pre-modern world that suggests early urban governments were, at worst, self-interested and indifferent to the health of their citizens or, at best, simply unable to understand the correlation between health and public policy, at least until the Industrial Revolution or possibly at the earliest as a reaction to the Black Death.

Geltner encourages the reader to reexamine these assumptions and their theoretical models as well as the selective evidence on which they are based. Using urban statutes and court and fiscal records from north and central Italy between 1250 and 1500, Geltner argues that civic authorities in these urban areas understood the need for promoting health and well-being among the citizenry as a means of maintaining political control. By considering both normative and descriptive sources, he is also suggesting that, in addition to being employed earlier than generally thought, communal health initiatives were also more effective than previously understood.

Geltner frames his study using Michel Foucault’s theory of biopolitics as applied to the eighteenth century (regulating private behaviors for the public good). Geltner employs the term “health-scaping” to the actions of urban governments which he defines as “the physical, social, legal, administrative, and political process of providing urban environments with the means to promote residents’ health” (p. 20). He argues that if one looks broadly at the policies of the medieval urban governments, including monitoring activities and regulating behavior in areas such as waste disposal, animal conduct, and proto-industrial waste, it is possible to see a conscious effort at health-scaping and the creation of preventative public policy that was consistently and effectively enforced well before the Industrial Revolution.

After a general introduction to the theoretical construct for his arguments and a consideration of the breadth of archival sources for public health regulation, the main body of the book outlines findings for three case-studies from Lucca, Bologna, and Pinerolo. The study primarily focuses on these cities’ roads officials, viarii, fango, and comparii, respectively, who were tasked with maintaining the infrastructure and policing communal activities along the public roads with regard to sanitation and safety. Geltner provides an exhaustive study of the statutes for the employment, regulation, and activity of these officials. Beyond prescriptive statutes, he also finds detailed records of assignments, building and labor expenses, violations, fines, and witness accounts, which testify to the commitment and effectiveness of the efforts of the officials.

Geltner’s last chapter suggests the possibility of applying his methodology even further chronologically and geographically, citing, for example, ancient Roman policy efforts and those of other non-western civilizations in order to “fundamentally alter the prevalent narrative of public-health history and thereby interrogate an entrenched paradigm of Euro-American modernity” (p. 144). While commendable, and opening many avenues for further exploration, some of the suggested analysis presents too great a methodological stretch for his argument. Also, Geltner’s focus on intentional efforts of the civic authorities in health-scaping overlooks the fact that this effort was also driven, in part, by popular communal demand. Individual citizens, tertiary religious orders, nascent private hospitals, and other civic constituents actively sought a civic response to communal need forcing the hand of civic authorities in many cases. These slight critiques do not detract from the overall importance of Geltner’s work, and Roads to Health is an important addition to the recent body of scholarship that is reassessing the evolution of health care and social assistance in urban areas of medieval Europe. In this highly readable study, Geltner successfully proves that health-scaping was indeed a civic value already fully entrenched in urban Italy in the high Middle Ages.