Constantin Bărbulescu. România medicilor: Medici, ţărani şi igienă rurală în România de la 1860 la 1910. Societate şi civilizaţie Series. Bucharest: Editura Humanitas, 2015. 360 pp. $10.00 (paper), ISBN 978-973-50-4762-7.
Reviewed by Alex Drace-Francis (University of Amsterdam)
Published on H-Romania (January, 2017)
Commissioned by R. Chris Davis (Lone Star College - Kingwood)
The formation of a body of professional classes and institutions was one of the most significant consequences of the establishment of the Romanian state in the second half of the nineteenth century. Despite this, not enough detailed research has gone into understanding this process and its impact on society. Historians have studied the roots of their own profession assiduously, and there are some notable works on political elites and parties, intellectuals and ideologues, and other interest groups in the period from the Union of the Principalities to the outbreak of the Great War. However, the professions that had in many ways the greatest impact on social and economic life in Old Kingdom Romania—lawyers, soldiers, entrepreneurs, engineers, and doctors—have received comparatively less attention. This circumstance in itself renders Constantin Bărbulescu’s monograph of intrinsic interest.
Bărbulescu’s book is not an institutional history or prosopographic profile of the medical profession, although some information is provided on doctors’ intellectual formation and worldview, as well as a few portrait photographs. Rather, it takes a discursive approach, defined by the author as “social imagology,” meaning primarily an analysis of official reports compiled by medics on the state of health of the country’s rural population (p. 13). It provides, firstly, a survey of a body of documentation; secondly, an analysis of recurrent themes; and thirdly, an account of “medical cultures,” which focuses especially on modernizing medical legislation, and of its “impossible application.” The exposition concludes with a case study of incidents concerning two individuals from the year 1860.
The documentation includes reports published in the journal Monitorul Sanitar (1863-66); district practitioners’ (medici de plasă) reports, which became regularized following the Law of 1874; county medical officers’ (medici primari de judeţ) reports, instituted from 1885; reports of the Higher Sanitary Council, in theory obliged to report from 1874 but in practice not produced until 1886 onward; Health Inspections (Inspecţii sanitare) reports, again from 1885; reports of the Bucharest Health Service (Serviciul Sanitar al Capitalei), a fairly consistent series from 1868 onward; rural hospital doctors’ reports, from 1881; and reports of regimental doctors, published in the Revista Sanitară Militară from the 1890s. Bărbulescu then turns to the memoir literature, identifying a dozen authors (Victor Gomoiu, C. D. Severeanu, Vasile Bianu, Nicolae Kretzulescu, George Sabin, Ludovic Fialla, Nicolae Burghele, Dimitrie Gerota, Panaite Zosin, Ștefan Episcupescu, Zaharia Petrescu, and I. Bordea), whose writings he sees as falling into two categories, the biographical and the historical. Bărbulescu notes a tendency toward self-legitimation in texts of the latter category. In a particularly interesting reflective section, he considers the medics’ own view of their situation within the wider social world of the Old Kingdom.
In his thematic analysis, Bărbulescu attends, in turn, to the medics’ view of peasants’ bodily hygiene and clothing, housing and habitat, nutritional hygiene, alcoholism, pelagra, and demographic discourses in relation to ethnic degeneration. He makes a number of interesting observations on the origins, contexts, and consequences of the appearance of certain tropes at a given time. For instance, in respect to the critical attitudes toward peasant dwellings, he states that this was something that first appeared in foreign travel accounts of the Principalities and was then integrated into the national discourse. Meanwhile, in respect to the trope of “racial degeneration,” the accentuation (and willful divergence from reality) of statements on this topic are said to have been influenced by the prominence of the question of the civil status of Jews in the wake of the Congress of Berlin, where the Great Powers’ attempts to impose universal citizenship as a condition of Romanian independence brought the issue to the fore in public discourse (p. 274). Using ample quotations and comparisons interspersed with wry commentary, Bărbulescu demonstrates the degree to which the medics’ diagnoses of the social body were often logically inconsistent and alarmist, partly cleaving to their own cultural logic, partly influenced by conjunctural factors, such as those mentioned above.
In the third section, Bărbulescu analyzes two cases of healers of mental afflictions, both of whom attracted the attention of the authorities in the first months of the year 1860. Upon hearing of the work of a village “healer,” Marin Vărzaru of Vlaşca district (today part of Giurgiu county), who was said to have cured a number of villagers afflicted with mental turbulence after having been bitten by a rabid wolf, the minister of the interior, Ion Ghica, far from attempting to outlaw such unlicensed medical practices, actually commended Vărzaru’s methods and advocated their replication on a national level. Vărzaru received a reward of five hundred lei for his services to the community, although nobody was able to claim the smaller sum of six lei for the extirpation of the wolf—not even its ears or paws could be produced. Another healer of mental illnesses, Stoian Buruiană of Romanaţi county (today part of Olt county), was in the same year the subject of extensive investigations on the part of the medical authorities. Buruiană’s methods included fumigation, preparation of medicines from crushed beetles, distillations of herbs and weeds, and scarification of the tongue. While some questioned his methods and sought to discredit him, others (including priests) defended him and even appealed to his services. Buruiană was forbidden from practicing his craft on account of his general “ignorance,” although Bărbulescu doubts that this interdiction had any real effect. When, starting from 1862, the government attempted to establish a list of qualified doctors on more formal criteria, many traditional healers continued to practice, basing their authority on historical authorizations and attestations as well as references from local officials. Some were required to come to Bucharest and undertake demonstrations of their methods so that their efficacy could be attested. When this proved difficult to administer, protracted negotiations or extensions of permissions were necessary, although some healers transformed themselves almost overnight into respectable, authorized medical practitioners. We see through Bărbulescu’s account a process of incomplete or negotiated “medicalization,” understood as “a process of internal acculturation.” Although Bărbulescu sees peasant medical culture as “a separate entity from modern medical culture,” he acknowledges this “cultural barrier” “was not in fact that difficult to surmount” (p. 307). From a situation where medical power relations were “interwoven between the two cultures” of professionals and peasants, modernization and etatization led to attempts “to propagate the official medical culture and associated social practices through the entire social body” (pp. 301, 303).
The conclusion highlights several points. First, the image of the peasant produced in the reports is far more negative than present-day representations, and in sharp constrast with the image of the peasant as “the good Romanian,” already under construction in the period under study. Secondly, the medical profession failed to appreciate the cultural logic of peasant practices: “The doctors did not empathize with the peasants, and only very rarely did they attempt to understand their behaviour” (p. 333). Thirdly, this was a period in which both the peasants’ traditional culture and their economic predicament declined disastrously. Finally, modernization’s social effects combined with its representatives’ cognitive obtusity to create “a profoundly fractured society” divided into “two worlds” (p. 336; cf. p. 116).
These conclusions are hard to deny, and are in tune with those of social and economic historians studying the period after emancipation and political independence to the eve of the First World War. They provide insight into the attitudes of the emerging professional class and the paradoxes of knowledge-based governmental practices, which arguably drew a harder line between ruler and ruled than existed in traditional power relations. The argument echoes that made by Yanni Kotsonis about late nineteenth-century Russia, that it was not the peasants who were backward but the authorities’ modes of thinking about and dealing with them that made them so.
Overall, Bărbulescu’s work offers exceptional insight not only into the “medicalization” of Romanian society but also into the interrelation between discourses and adminstrative practices in the state-building project generally. It stands alongside other surveys of public discourse in this state- and nation-building phase of Romanian history, such as Mirela-Luminiţa Murgescu’s monograph on schoolbooks and national identity in a slightly earlier period. In fact, it may be said to go further than that as Bărbulescu not only provides a repertoire of topoi and motifs but also seeks to analyze their implementation and functionality in everyday situations in the Old Kingdom.
As noted, Bărbulescu understands medicalization as being “under construction” in the period under study. He also invokes peasant cultural practices when demonstrating inconsistencies in the medics’ discourse. Overall, however, peasant culture and identity appear in this book as rather fixed categories. It might be that this was a period not just of medicalization, but of “peasantization,” that is, the subsumption of various different categories of rural dweller under a single, objectified category, which had been less clearly defined before the agrarian legislation of 1864 and afterward. In other words, medical discourse did not merely portray peasants negatively in contrast to literary, folkloric, and other discourses, but may also have helped to consolidate a conception of them as a homogeneous, undifferentiated group. Most theories of cultural identity and alterity see the subject-object relation as mutually constitutive, and I suggest more attention might have been given to this issue. Otherwise I very much commend Bărbulescu’s book, which significantly advances our understanding of medical, governmental, and peasant practices in late nineteenth-century Romania. Like other books in the excellent Societate şi civilizaţie series in which it appears, it is attractively written and well produced: the provision of an index would improve the reader’s experience still further.
. The international context of the development of these discourses might have been emphasized a little more in the conclusion. For an ulterior study on the topos of racial degeneration which takes a more international approach, see Călin Cotoi, “Cholera, Health for All, Nation-Building and Racial Degeneration in Nineteenth-Century Romania,” East Central Europe 43, nos. 1-2 (2016): 161-187.
. See, for example, Philip Eidelberg, The Great Rumanian Peasant Revolt of 1907: Origins of a Modern Jacquerie (Leiden: Brill, 1974); Daniel Chirot, Social Change in a Peripheral Society: The Creation of a Balkan Colony (New York: Academic Press, 1976); Henri H. Stahl, Traditional Romanian Village Communities (Cambridge: Cambridge University Press, 1980); and Constanţa Vintilă-Ghiţulescu, Evgheniţi, ciocoii, mojici: Despre obrazele primei modernităţi româneşti, 1750-1860 (Bucharest: Humanitas, 2013), 326-327.
. Yanni Kotsonis, Making Peasants Backward: Agricultural Cooperatives and the Agrarian Question in Russia, 1861-1914 (Basingstoke: Macmillan Press, 1999).
. Mirela-Luminiţa Murgescu, Între “bunul creştin” şi “bravul român”: Rolul şcolii primare în construirea identităţii naţionale româneşti (1831-1878) (Iaşi: Editura A, 1999).
. See, for example, Michel De Certeau, “Writings and Histories,” in The Certeau Reader, ed. Graham Ward (Oxford: Blackwell Publishers, 2000), 25-26; and Johannes Fabian, Time and the Other: How Anthropology Makes ts Object (New York: Columbia University Press, 1983).
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Alex Drace-Francis. Review of Bărbulescu, Constantin, România medicilor: Medici, ţărani şi igienă rurală în România de la 1860 la 1910.
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