Reviewed by Mustafa Emre Gunaydi (Iowa State University)
Published on H-Environment (May, 2021)
Commissioned by Daniella McCahey (Texas Tech University)
While medical historians of the late twentieth and early twenty-first centuries have built a diverse and increasingly dynamic literature tracking and revising the histories of plague, cholera, smallpox, syphilis, influenza, and AIDS in different temporalities and socio-spatial contexts, fewer scholars have been intrepid enough to consider “disease” from a more holistic, even global perspective. Is disease an embedded part of civilization? This question is big and open-ended. Nevertheless, Henry E. Sigerist (1891-1957), a well-known medical historian of his time, ambitiously tried to present the combined histories of disease and culture in Civilization and Disease. First published by Cornell University Press in 1943 and reprinted by the original publisher in 2018 with the addition of a foreword by Elizabeth Fee, the book is a kind of a medical equivalent to Arnold J. Toynbee’s civilization-spanning magnum opus, A Study of History (1934), or as something of a precursor to William H. McNeill’s Plagues and Peoples (1976).
Sigerist was born in Paris in 1891 and immigrated to the United States after receiving an invitation from Johns Hopkins University to become the director of the Institute of the History of Medicine in 1932. He was a politically active leftist during his academic career in the US. He spent years supporting universal health care across the country through his many talks, interviews, lectures, and the great collection of his books, articles, and essays. He was interested in the Soviet model of medical care and believed that individualized medical practices resulted from “primitive science and technology.” From his perspective, modern knowledge and medical technologies made a universal health care system both possible and necessary. It “was but one step in this inevitable historical progression.”
Civilization and Disease attempts to convey the ambiguous relationship between civilization and disease in the history of “human progression.” While doing this, Sigerist broke civilization into its constitutive elements, ranging from economics, culture, law, religion, philosophy, and science to art, literature, and music, and scrutinized their reciprocal relationship with the disease to demonstrate the development of medicine in these spheres of life. Unlike most of his contemporary colleagues, he did not pursue a narrative that presents civilization as an antidote to human incapacity against disease. Instead, Sigerist aimed to highlight the agential capacities of both culture and disease in mutually preparing their conditions and shaping their futures.
Chapters 1 and 2 discuss the side effects of civilization in the form of diseases. Without limiting himself only to the post-industrial world, Sigerist illuminated how “civilization has often produced conditions detrimental to health” (p. 4). Societal norms that forced women to wear small shoes and the corset in the late medieval period caused severe health problems, such as ingrown nails and respiration and digestion problems. Occupational diseases, either resulting from excessive labor or poor working conditions, also exhausted human bodies and made them vulnerable to infections. The Industrial Revolution that was followed by the processes of excessive urbanization and infrastructural collapse exacerbated bodily vulnerability and mainly affected “the unskilled laborer and his family” (pp. 55-56). Therefore, disease started to be associated with the lower classes in the industrialized world.
In chapters 3, 4, and 5, Sigerist also paid attention to the role of disease in shaping societal relations. He focused on segregation, exclusion, and quarantine practices, imposed on patients suffering from diseases like leprosy, plague, or syphilis. He also uniquely showed that the effects of disease on human bodies and their resonance in society changed over time. While syphilis was recognized as a disease with sexual character in the late Middle Ages, it “did not involve any moral reprobation” (p. 76). However, the rise of the middle class in the nineteenth century resulted in syphilis’s increasingly moralizing association with sexual licentiousness and the decay of family values. In chapter 5, Sigerist also evaluated the transformative power of catastrophic diseases in the forms of pandemics and epidemics by focusing on well-known examples in the history of Western civilization, such as the plague of Justinian, the Black Death, and malaria epidemics in ancient Greece, as well as in the nineteenth century.
Chapters 6, 7, and 8 provide a genealogy of the evolution of medicine from ancient times to the twentieth century. While chapter 6 focuses on the historical role of religion, myth, and tradition in dealing with diseases, the next chapter turns to the secularization of medical practices and the emergence of humoral theory in ancient Greece and its subsequent adoption by medical practitioners of the late Middle Ages in the West. In chapter 8, Sigerist highlighted the role of modern anatomy and technological advancements in medicine and pharmacology that paved the way for modern medicine.
Chapter 9 analyzes the role of disease in literature and pays more attention to the movement of naturalism and naturalist writers. Naturalist writers provided detailed descriptions of disease symptoms as different from writers in other literary schools that were interested in the effects of diseases on their protagonists’ lives. In chapter 10, Sigerist constructed an interesting connection between disease, artists, and medicine. Disease has always inspired artists and became one of their major themes. Thus, in turn, Sigerist underscored the unsung role that artists played in the development of medical practices. He established a direct connection between the rise of anatomical knowledge in human history and the role of artists’ crafts in the forms of illustrations, drawings, handicrafts, or sculptures. Sigerist asserted that “the rise of anatomy would have been impossible without the cooperation of artists” (p. 206). In chapter 11, he focused on the relationship between music and disease. He specifically concentrated on the therapeutical uses of music to treat disease symptoms and the case of tarantism in Apulia, Italy.
In many respects, Civilization and Disease has naturally been superseded by more recent developments in the historiography. Therefore, it carries some characteristics of its period and has now been well criticized by revisionist historiography for decades. Sigerist’s historical perspective is evolutionary and progressive. His depiction of human civilization is almost limited to American and Western European histories. Women’s role as actors with their own agency in his imagined civilizational progression is also ignored.
Nevertheless, Sigerist’s advocacy for universal health care makes his work still relevant today. Civilization and Disease was reprinted in an atmosphere in which right-wing obstruction of state-sponsored health care remained a key battleground in American politics. The Trump administration put “Obamacare” (the 2010 Affordable Care Act) under sustained attack and was able to make some changes to it with an executive order in 2017. Fee, the foreword’s author in the reprinted version, is also a supporter of Sigerist’s medical reform politics and the initiator of Sigerist Circle within the American Public Health Association. Combined with the dire stakes of the political landscape at the time, Fee’s career provides an important context for the reprinting of Sigerist’s work roughly three-quarters of a century after its original publication.
Civilization and Disease’s reevaluation of past pandemics and advocacy for universal health care has also taken on new significance when considered alongside the devastating effects of the COVID-19 pandemic’s impact on both American and wider global infrastructures of the welfare state. The current pandemic decisively proved that privatized medical systems featuring weaker public health messaging and infrastructures are deeply vulnerable to global health crises. Civilization and Disease was reprinted just before the pandemic, but it perfectly overlaps with the troubling new questions raised by COVID-19. How can states and societies better prepare for and manage the rising tide of risks posed by emerging pathogens and pandemics in a globalized world made evermore vulnerable by our changing climate?
. Elizabeth Fee, “The Pleasures and Perils of Prophetic Advocacy: Henry E. Sigerist and the Politics of Medical Reform,” American Journal of Public Health 86, no. 11 (1996): 1637.
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Mustafa Emre Gunaydi. Review of Sigerist, Henry E., Civilization and Disease.
H-Environment, H-Net Reviews.
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