Reconstructing the mandates and activities of urban "healthscapers" between roughly 1250 and 1500, Roads to Health contends that preventive healthcare emerged from a steady concern for populations' wellbeing. It challenges the view of the Black Death, let alone the Industrial Revolution, as a unique trigger in public health history.
2019 | 320 pages | Cloth $65.00
History / Ecology/Environmental Studies / Medicine
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Table of Contents
A Note on Dates, Currencies, Wages, and Prices
Rome, 1306: A Prologue
Chapter 1. Roads to Health
Chapter 2. Lucca's Viarii
Chapter 3. Bologna's Fango Officials
Chapter 4. Piedmont's Camparii
Chapter 5. Healthscaping in Medieval Europe and the Premodern World
1. Fines to Be Imposed by Lucca's Roads Masters
2. Text and Translation of Vernacular Promulgations by Lucca's Roads Masters
List of Abbreviations
Rome, 1306: A Prologue
The eternal city had very mortal denizens. Even as the flood of pilgrims around the jubilee year of 1300 began to subside, easing crowdedness and pressure on scarce resources, Romans continued to face health risks on a routine basis. Across the hospital of Santo Spirito, for instance, on the main road leading to Saint Peter's Basilica, certain grounds belonging to the hospital had become an unruly wasteland, raising fears about local conditions. Deviant activities and filth strewn among the ruins—many complained—were polluting the air; the sights and odors were gravely damaging:
Near a public road that Roman citizens, both male and female, and numerous others use when approaching the boundaries of the basilica of the Prince of the Apostles . . . in empty lots, yards, and ruins, a large amount of squalor and fetid matter arrives daily due to inconsiderate littering, as well as hay and dung and other waste and filth. And ribalds thoughtlessly do fetid and repulsive things in that place, on account of which those passing along that road cannot travel without protection. Indeed, they see those men doing such foul things and through the damage and harm thereby incurred and the injury caused to people throughout the neighborhood, as well as to the confraternity members and the household of the said hospital, the air becomes corrupted and is corrupted; and infections arise, from which grave illnesses can ensue.To investigate the claims, the magistrates summoned what by then had become a staple organ of urban policing: the public works and roads masters (magistri hedificiorum Urbis et viarum). The outfit had a fixed-term, rotating leadership, as was common in cities across Italy. That year the office was headed by Giovanni de Cancellario, Lorenzo Giovanni Statio, and Matteo Cinthi de Rustici and served by a dedicated judge, Gregorio de Fuscis de Berta. Like their predecessors since at least 1227, these men were tasked with protecting Rome's infrastructure, both in and beyond the city's walls. In principle and in practice their remit included dealing with threats to public health stemming from the misuse of communal spaces or, as in this case, issuing from a private site. For, while there was no dispute that the field in question was owned by an independent religious entity and as such fell outside the magistri's jurisdiction, its neglect presented the officials with an opportunity to redefine a traditional boundary between private, corporate, and public spaces. To justify such an incursion, the magistri could have resorted to bringing criminal charges or else appealed to a possible economic setback. Instead, they chose to underscore the government's prerogative as the main entity responsible for the city's health.
Promoting hygiene at the population level through the upkeep of shared spaces and infrastructures is a staple of present-day healthscaping, the process of creating places where health can bloom. As a material aspect of communal prophylactics, however, healthscaping's roots run far deeper than medical historians and public-health professionals tend to think. For, even in its fourteenth-century modality, healthscaping dovetailed with a long-standing tradition of pious works such as founding hospitals, digging wells and building bridges, activities that for centuries beforehand were recognized as moral-prophylactic measures in their own right. These and other preventative interventions also constituted what some critical theorists have dubbed a biopolitical act. For by appropriating a health discourse to frame their stance, different stakeholders pushed against a spatial correlation between private property and the private, domestic, and corporate sphere from a new direction, enabling, for instance, public disciplinary power to expand into homes, production sites, and—as in the present case—religious compounds. It was no accident that the notary framing the Roman officials' arrival at the scene invoked two key vectors for disease transmission that had great purchase in Galenic medical theory, namely, ocular intromission and miasmatic odors. Indeed, it would have been difficult for officials to designate trash itself as what Mary Douglas famously termed "matter out of place" in a privately owned plot. Yet the visibility of foul matter and polluting actions from the main road, along with the stench these collectively generated and threatened to broadcast into the air, was sufficient grounds for entering the field legitimately and ordering its cleanup. The actions would be undertaken in the name of preserving public health, morality, and safety.
Seizing their chance, then, the works officials responded swiftly. They gathered their underlings—Jacopo Petri Piperi, a notary; Giovanni Leonardi and Leonardo Petri Angeli, masons; and Lorenzo Romani Muti, a lower-ranking official—and sent them to conduct a preliminary investigation, which included the inspection of the site and collection of eyewitness testimony. Once their subordinates were done, the magistri made their way to the plot in person and verified the basic facts of the case. Despite abundant proof of the hospital's responsibility and the field's ongoing neglect, the officials' conclusions and instructions were constructive and harm reductive rather than overtly punitive. Perhaps they believed in taking a mild approach, or else they feared overplaying their hand when it came to policing a private site, especially one belonging to a prominent charitable foundation. Either way, instead of identifying individual culprits or fining the hospital for its complicity in polluting the area, they simply asked the institution's governors to scour and enclose the vacant plot "so that ribalds and anyone else could not enter it and place any unsightly or fetid or filthy matter there, or allow any putridity to issue forth from the said ruins and into a public way." Reducing the health risks of miasma and intromission thus seems to have been the magistri's most urgent business, although even their modest demands sought simultaneously to reinforce behavioral norms regarding urban hygiene and the government's prerogative in enforcing them.
The intervention was legitimate, in other words, thanks to the officials' ability to convince residents that it benefited the city's health and the public good. Setting aside the biological consequences of the magistri's actions, the very notion that rulers of a medieval city cared about population health, much less formed organs to promote it and tied their political fate with those organs' perceived success, is rather striking. For it contrasts sharply with a prevailing modern view of premodern governments and urban residents as both medically ignorant and apathetic to communal health hazards. The social, cultural, and political roots of this view today can be traced to Euro-American imperial, colonial, and nationalist agendas, which publicized public health as a key accoutrement of civilized modernity. Yet, as this book will argue, such roots rarely reach much deeper. That is to say, they are hard to ground in medieval European or—more broadly—premodern sources.
In this sense 1306 Rome was typical. Numerous normative sources and documents of practice from that period, such as those produced by public-works officials across the peninsula, contradict a widely held interpretation of the historical development of public health. Roads to Health accordingly reconstructs one chapter in the history of these seemingly pedestrian interventions; situates them in their political, material, administrative, and medical-theoretical contexts; and traces how urban residents embraced and resisted them in several Italian cities. Beyond filling a particular lacuna, moreover, the illuminating of premodern preventative theories, policies, and practices is also an invitation to interrogate the hegemony of the modern or, conversely, what Kathleen Davis has dubbed "the simplex of the pre." For it spotlights how earlier societies engaged in healthscaping as a biopolitical and disciplinary project, and it demonstrates how its negotiation unfolded on and through an assemblage of physical infrastructures and their administration. Recognizing the presence of these dynamics, their complexity, diversity, and ubiquity, underscores the extent to which a prevailing construction of medieval (and, more broadly, premodern) civilizations reflects mostly what ideologues of Euro-American modernity imagined they were rejecting: an unsophisticated but ultimately seductive form of othering.