A Body Worth Defending: Immunity, Biopolitics, and the Apotheosis of the Modern Body 9780822391111

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A Body Worth Defending

ed cohen

A Body Worth Defending immunit y, biopolitics, and the apotheosis of the modern body

Duke University Press  Durham and London  2009

© 2009 by Duke University Press All rights reserved Printed in the United States of America on acid-free paper ∞ Designed by C. H. Westmoreland Typeset in Arno with Aller display by Achorn International, Inc. Earlier versions of the first parts of chapters 1 and 2 appeared in Literature and Medicine 22, no. 2 (2002), and Theory, Culture and Society 25, no. 3 (2008), respectively. A different incarnation of the conclusion lives in Social Text 26, no. 1 (2008). Library of Congress Cataloging-in-Publication Data Cohen, Ed A body worth defending : immunity, biopolitics, and the apotheosis of the modern body / Ed Cohen. p. cm. Includes bibliographical references and index. isbn 978-0-8223-4518-3 (cloth : alk. paper) isbn 978-0-8223-4535-0 (pbk. : alk. paper) 1. Immunity.  2. Human body.  3. Biopolitics. 4. Medicine—History.  I. Title. qr185.2.c64 2009 616.07'9—dc22  2009022399

L’chaim: to life

Contents Acknowledgments  ix Opening Up a Few Concepts: Introductory Ruminations  1 1 Living Before and Beyond the Law, or A Reasonable Organism

Defends Itself  32 2 A Body Worth Having, or A System of Natural Governance  68 3 A Policy called Milieu, or The Human Organism’s Vital Space  130 4 Incorporating Immunity, or The Defensive Poetics of Modern

Medicine  206 Conclusion: Immune Communities, Common Immunities  269 Notes  283 Bibliography  323 Index  359

Acknowledgments

“A meshwork of selfless selves”: this is how Francisco Varela describes organisms, but it applies just as well to this book—which is another way to say that it lives in me. After more than a decade of thinking and writing, the debts I owe exceed the words I’ve written. First and foremost, my purest and most heartfelt gratitude goes to my “framily”—my friends who are my family: Ellen Bruno, Rebecca Mark, Caroline Streeter, Ardele Lis­ ter, Michael Lighty, Josie Saldana, Annie Janowitz, Maria Damon, Sally Rappeport, Jenny McKnight, Siddhisambava, Jean Franco, Jane Wagner, Tina Defelciantonio, Ira Livingston, Vicki Robinson, Jenny Brier, David Kazanjian, David Eng, Mary Pratt, and Renato Rosaldo. This book’s very existence bespeaks the gifts and genius of my therapist, Carol Joyce, who sustained a positive maternal transference and helped me realize myself (or my “self ”). Egregious gratitude goes to the teachers and guides who inspire me: Emilie Conrad, Susan Harper, Jackie Dennis, Rachel Remen, Philip Brooks, and Mayla Riley. My father, despite his best intentions, taught me that scientific explanations do not always make sense, an insight which incites this intellectual undertaking. For their largesse in using

 

acknowledgments

their good names to endorse this project, I bow respectfully to Lisa Lowe and Liz Grosz—and to Ken Wissoker for heeding their advice. To those who read some if not all of the many, many bits and pieces of this project over the years and encouraged me to persevere, I requite their kindness and sagacity: Julie Livingston, Joan Scott, Bonnie Smith, Alfred Tauber, Anne Marie Moulin, Ann Cvetkovitch, Rita Charon, Sander Gilman, Chris Newfield, Teemu Reskola, Priscilla Wald, and Evelyn Hammonds. To Livia Tenser, I owe kudos for all things classical. For helping me to recover from the traumas inflicted by my former department and reminding me that I still have a few worthwhile ideas from time to time, deep appreciation to my posse in Women’s and Gender Studies at Rutgers: Barbara Balliet, Ethel Brooks, Cheryl Clarke, Harriet Davidson, Carlos Decena, Judy Gerson, Mary Gossy, Mary Hawkesworth, Nancy Hewitt, Jasbir Puar, and the indefatigable Joanna Regulska. Thanks also to the 2006–7 IRW (Institute for Research on Women) seminar for their feedback on the introduction and to all the others who have graciously listened to me work through this material over the last decade. The well-named Laura Ferris-Helper indeed was an exemplary helper in the arduous editorial undertaking. The anonymous readers for Duke both supported and improved the earlier manuscript; I hope the final product honors their vision of its potential. Andy Mazzaschi undertook the grueling task of indexing with aplomb and deserves much more than I could pay him. All the folks at Duke Press—Mandy Earley, Pam Morrison, Cherie Westmoreland, Katie Courtland, and Amanda Sharp—made the production process a pleasure which bespeaks both their prowess and their congeniality. Susette Min deployed her curatorial genius to find the brilliant cover image that graces this book, and I am deeply indebted for this suggestion. The image is by the late Robert Flack and I am honored that his brother and father have allowed me to use it here. Part of Flack’s Empowerment series, created in the wake of discovering he was seropositive for HIV, Anatomical Garden both visually and conceptually augments my project in ways that I could only dream were possible. The VisualAIDS archive and its curator Nelson Santos generously made the image available and this book would not be the same without their help. Google Book Search deserves major props for making incredibly obscure eighteenth-century and nineteenth-century texts accessible and word-searchable from the comfort of my living room. Finally, to everything growing in my garden, to all the trees in Prospect Park, and to the memory of Mr. Boo, I offer the roots of my heart for giving me ground while I was learning to write this.

A Body Worth Defending

The proper task of a history of thought . . . : to define the conditions in which human beings “problematize” what they are, what they do, and the world in which they live. —michel foucault, The Use of Pleasure

In this culture, medical thought is fully engaged in the philosophical status of man.—michel foucault, The Birth of the Clinic Science projects are civics projects; they remake citizens. —donna haraway, Modest_Witness@Second_Millennium.FemaleMan©_ Meets_OncoMouseTM The choice of explanations in medicine is always a choice of values. —lawrence kirmayer, “Mind and Body as Metaphors”

Opening Up a Few Concepts Introductory Ruminations

The Vital Matter of Defense

In his memoirs, Élie Metchnikoff fondly recalls the mundane events which precipitated his discovery in 1881 of immunity as a form of biological self-defense: One day when the whole family had gone to a circus to see some extraordinary performing apes, I remained alone with my microscope, observing the life in the mobile cells of a transparent star-fish larva, when a new thought suddenly flashed across my brain. It struck me that similar cells might serve in the defense of the organism against intruders. . . . I said to myself that if my supposition was true, a splinter introduced into the body of a star fish larva, devoid of blood vessels or a nervous system, should soon be surrounded by mobile cells as is to be observed in a man who runs a splinter into his finger. This was no sooner said than done. There was a small garden to our dwelling . . . [and] I fetched from it a few rose thorns and introduced them at once under the skin of the beautiful star-fish larvae as transparent as water.

 

Introductory Ruminations I was too excited to sleep that night in the expectation of the results of my experiment, and very early the next morning I ascertained that it had fully succeeded.1

From this humble conjunction of a starfish larva, a thorn, and a microscope, Élie Metchnikoff deduces an entirely new way to perceive how organisms coexist and thereby ushers biological “immunity” into the world as an organismic form of “defense.” 2 With his family off seeing “some extraordinary performing apes,” the scientist alone with his instrument has an epiphany: “How does the organism defend itself from intruders?” he wonders, for obviously, in a case of “intrusion,” any response must be a “defense.” Aha, he thinks, perhaps the mobile cells that I am observing can mobilize themselves against such an incursion. Metchnikoff decides to test his hypothesis by enacting this scenario. Identifying with and as an intruder, he pierces the “skin of the beautiful star-fish larvae as transparent as water.” In doing so, he imagines that he models a form of aggression which he assumes to be entirely natural (as if he himself constitutes a force of nature), thereby providing a classic example of what the philosopher G. E. M. Anscombe calls action under the form of description.3 In other words, by construing his experimental protocol as an intrusion, Metchnikoff enacts it as such and then reasons that, however the larva reacts, this reaction represents the intrusive catalyst’s logical antithesis. Observing the experimental subject the next morning, he witnesses the fragment of the rose thorn engulfed by large amoeboid cells, apparently attempting to decompose it. He then recognizes—or in fact re-cognizes—this cellular decomposition as a characteristically protective process. With this flash of insight, Metchnikoff conceives a definitive and defensive way to understand how organisms coexist in environments replete with others of different sizes and scales. Certainly, many of us believe that Metchnikoff ’s understanding transparently describes the way living things are, or at least the way they should be. Over the last one hundred years or so, the idea of immunity has passed from Metchnikoff ’s lab into our self-understanding, so that today we take for granted many assumptions on which this understanding leans. For example, most of us who rely on biomedical treatments such as vaccinations or antibiotics accept the idea that our immune systems ought to defend us against illnesses (even as we are also increasingly aware that they do not always live up to this promise). And while few of us have any deep understanding of its complexities, we generally presume that the immune

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system represents the front line in our incessant battle with the hostile forces of disease. Despite our ready acceptance, however, immunity is not a natural choice of images for our ability to live as organisms among other organisms of various sizes and scales—nor is defense, for that matter. Instead, both terms derive from the ways that Western legal and political thinking accounts for the complex, difficult, and at times violent manner that humans live among other humans. Only later, much later, are they applied to the animate world more generally—including that part of the animate world we call “human.” Modern presumptions about personhood and collectivity saturate both immunity and defense. Each offers a different strategy for accommodating the frictions and tensions (if not outright contradictions) between the singular and the multiple, the one and the many, that characterize modern political formations. Indeed, both immunity and defense play central roles in framing what we now understand as liberal or democratic governance, and hence they deeply inform our economic and political horizons. So how do these complex and critical concepts end up in biomedicine anyway? And what biopolitical effects do they induce when they migrate from politics and law into the cellular matter that we call “the body”? Even as we go for vaccinations, take antibiotics, try to avoid the things to which we are allergic, have our white blood cell counts checked, or listen to news reports about aids, sars, or avian flu, most of us remain ignorant of a basic historical fact: biological immunity as we know it does not exist until the late nineteenth century. Nor, for that matter, does the idea that organisms defend themselves at the cellular and molecular levels. For nearly two thousand years, immunity, a legal concept first conjured in ancient Rome, has functioned almost exclusively as a political and juridical term—and a profoundly important and historically overdetermined one at that. “Self-defense” also originates as a political concept, albeit a much newer one, emerging only 350 years ago in the course of the English Civil War, when Thomas Hobbes defines it as the first “natural right.” One hundred and twenty-five years ago, biomedicine fuses these two incredibly difficult, powerful, and yet very different (if not incongruous) political ideas into one, creating “immunity-as-defense.” It then transplants this new biopolitical hybrid into the living human body. We have not been the same since. When science transfigures immunity in the 1880s and 1890s by equating it with defense, defense is acknowledged for the first time as a capacity of the living organism. This acknowledgment radically changes not just

 

Introductory Ruminations

how we imagine our bodies as living organisms but also how we imagine what it means to be an organism living among other organisms and what it means to be a human living among other humans. Moreover, immunity’s new incarnation emerges as the avatar of a scientific practice that profoundly transforms how we conceive and address both illness and healing. Indeed, immunity’s acceptance as a robust biological concept fundamentally changes the embodiment of these essential human experiences. Today we fight diseases both individually and collectively. We declare war on cancer and aids. We visualize white blood cells destroying tumors. We imagine that we are fighting off a cold. We kill the germs that cause bad breath. What we no longer do (lest we incur the stigma of being terribly “New Age”) is consider that we might harbor a capacity to heal. Following Metchnikoff ’s declaration that the “battle” between white blood cells and microbes “represents the healing power of nature,” defense quickly replaces healing as medicine’s scientifically approved ethos.4 Before this replacement, for people all over the globe and throughout most of recorded history, “healing” bodies forth the organism’s natural propensity, albeit a propensity that also needs human support and encouragement. From antiquity until the mid-nineteenth century, almost all cultures recognize that nature exercises a curative power in the organism, a power which medicine at best emulates or enhances. The Galenic and Hippocratic traditions (the prevailing philosophies of healing in the West) know this force as vis medicatrix naturae, the healing power of nature.5 According to this worldview, healing manifests the organism’s natural elasticity: it incorporates the organism’s most expansive relations to the world, embracing the forces that animate the cosmos as a whole. Those seeking to facilitate the healing process attempt (at best) to encourage nature’s course by redressing the micro- and macrocosmic imbalances that keep symptomatic crises from resolving favorably. Within such healing frameworks, organisms incorporate and inexorably rely on the elements that constitute the world in which they live. Illnesses result from imbalances among these constitutive elements, whereas health emerges from restoring inner and outer harmony. Therefore natural healing expresses the immersion of living beings in the universe and affirms their fundamental connection to the matrix from which they arise and to which they will one day return. By the end of the nineteenth century, however, the vis medicatrix naturae falls out of favor among Western bioscientists. Deemed unduly vitalistic by scientific medicine’s increasingly reductionist paradigms (which

Introductory Ruminations 



pursue biochemical explanations for biological processes), “healing” becomes a more and more anachronistic notion. Instead, bracketing healing as an improperly fuzzy premise, scientific medicine embraces a highly complex, if not paradoxical, legal rubric—or even, perhaps, legal ruse. Though we do not always fully appreciate it, immunity is somewhat of a trickster. Within the juridico-political domain, immunity operates by defining lawful exceptions to the law precisely in order to maintain that the law applies universally and therefore without exception. In other words, since the law declares that its exceptions always already derive from it, such exceptions do not trouble its jurisdiction.6 Historically this declaration proves useful, since realpolitik often frustrates desires for juridical purity. Immunity (in its nonbiological valence) thus lubricates the ineluctable friction between law and politics. It allows the exigencies of politics to rub up against the formalities of the law without causing them to warp and turn back on themselves. Biomedicine embraces this lawful conundrum (i.e., that exceptions prove the rule) to incorporate “defense” as properly “natural” and thereby anoint it as a natural property. This metaphoric substitution supports scientific medicine, since it restricts the complex, contradictory, and yet entirely necessary intimacy of organism and environment to a single salient type of engagement: aggression/response. With the advent of biological immunity, medicine localizes the ability to recover from or to avoid disease in the specific actions of our cells and molecules (specificity constituting another of biomedicine’s hallmarks).7 This specific activity quickly supersedes the less specific notion of healing as a more appropriately scientific concept. Furthermore, it imagines the individual organism as the space within which a cellular struggle for survival (a.k.a. disease) takes place, and conversely defines a specific microbial agent as the hostile cause against which the organism must wage its relentless war with death. While the germ emerges as both a biological and a political agent in the decade or so before immunity realizes its defensive capacity, immunity-as-defense retrospectively lends germ theory some of its legal force, helping it achieve the status of natural law. Before Metchnikoff ’s realization, the germ’s vicissitudes remain obscure. If germs actually cause disease, then why do they cause disease in some people and animals and not in others? Moreover, if these disease-causing germs are omnipresent, then how do we stay alive in such a relentlessly hostile environment? Immunity helps us reconcile ourselves to the fateful microbes. It provides us with the wherewithal to keep these ubiquitous,

 

Introductory Ruminations

invisible, life-threatening others at bay. Medicine then allies itself with this self-protective force, seeing its own actions as a mirror image. Instead of evoking the organism’s essential connection to the world in which it lives, immunity refigures medicine as a powerful weapon in the body’s necessary struggle to defend itself from its life-threatening context. Yet if this struggle represents such a natural condition, why do medicine and biology rely so explicitly on political and juridical concepts to make sense of it? If the ways that organisms coexist evince our political and juridical precepts so immediately, does this mean that medicine after immunity constitutes politics by other means? In the first half of the nineteenth century, the military theorist Karl von Clausewitz offered his famous formulation: “War is nothing but a continuation of political intercourse with a mixture of other means.” In the second half of the twentieth century, Michel Foucault reverses the syntax to ask: “Should we . . . say that politics is war pursued by other means?” to which he responds: “It is one of the essential traits of Western societies that the force relationships which for a long time had found expression in war, in every form of warfare, gradually became invested in the order of political power.”8 Immunity strangely grafts or inoculates both military and political potentials into human biology as an entangled mode of explanation. In fact, immunity offers a peculiar hybrid of military, political, and biological thinking that “naturally” negates the distinctions among these realms. Rendering biological immunity as an organism’s active process of defense, scientific medicine deftly fuses a bellicose ideology (which sees environmental challenge as a hostile attack) with a political notion of legal exception (which nevertheless affirms the law’s universal applicability). Through this potent conceptual alchemy, biological immunity insinuates itself at and as the intersection of two disparate, if not opposed, ways of organizing human interactions: war and law. To the extent that the law seeks to preempt war’s violence (albeit by mobilizing its own violence) and to the extent that declarations of war seek to define violence’s legal extent (albeit within their own jurisdiction), the two seem counterpoised.9 Hence not only do immunity as legal exemption and immunity as defense not necessarily correspond; they do not even necessarily coexist. Strictly speaking, where immunity exists there is no need of defense and where defending occurs there is no immunity. Nevertheless, the bioscientific appropriation of immunity collapses both these possibilities to describe how a complex organism maintains its vitality while living in a world where some of its fellow organisms (viral, bacterial, parasitic, and human)

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potentially threaten its well-being and aliveness. As a consequence of this incongruous and yet largely unnoticed fusion, the “immune” organism becomes a biopolitical life form through and through.

The “Nature” of the “Modern Body”

As its subtitle suggests, using the lens of immunity, this book focuses on how medicine makes “the body” “modern” and reflects on the biopolitics this modern turn in medicine engenders. In other words, it ruminates on how medicine modernizes us by incarnating a theoretical practice that simultaneously—if unconsciously—defines humans as organisms and as political actors and in so doing incorporates biopolitics as one of our consummately modern dimensions. At the center of this rumination appears a virtual node that we might call the “modern body.” While we often take the body to represent what is most natural about us, or indeed suppose that our bodies manifest our “nature” itself, this presumption assumes far more and far less than is the case.10 Instead both our bodies and our selves have undergone profound historical changes—changes both giving rise to, and ensuing directly from, immunity’s biomedical apotheosis. As more and less than a natural phenomenon, the modernized body arises as an artifact of intense human interest and investment. Informed by a confluence of finance capital, philosophical reflection, and scientific theory, not to mention military formations, colonial relations, religious reformations, technological developments, kinship dynamics, industrial processes, educational regimes, health care protocols, among many other factors, the modern body aspires to localize human beings within an epidermal frontier that distinguishes the person from the world for the duration which we call a life. If we think of Mikhail Bakhtin’s “grotesque body”—a body radically open to the world both temporally and spatially, simultaneously eating, shitting, fucking, dancing, laughing, groaning, giving birth, falling ill, and dying11—as an icon for a nonmodern or premodern body, then by contrast the modern body proffers a proper body, a proprietary body, a body whose well-bounded property grounds the legal and political rights of what C. B. Macpherson famously named “possessive individualism.”12 For all its salience as a political, economic, philosophical, and even psychological phenomenon, however, until the end of the nineteenth century the modern body does not exist, strictly speaking, as a biological body.

 

Introductory Ruminations

Or to put it more accurately, until the end of the nineteenth century, the modern individual’s atomized body does not accord with prevailing scientific theories that apprehend living organisms as contiguous with, rather than fundamentally distinct from, their lifeworlds. Indeed, this book holds that only with the advent of biological immunity does a monadic modern body fully achieve its scientific and defensive apotheosis. To appreciate this individualizing transubstantiation, A Body Worth Defending traces the body’s modern vicissitudes as they unfold from the middle of the seventeenth century to the end of the nineteenth century to consider how they end up in our cells and tissues, as well as in our imaginations and institutions. After the advent of immunity-as-defense, bioscience affirms that living entails a ceaseless problem of boundary maintenance. Less modern ideas about living beings ensconce organisms in a material world whose vital elements form—and whose fluxes and flows inform—their aliveness.13 With immunity as its avatar, modern biomedical dogma holds to the contrary that as organisms we vitally depend on a perpetual engagement against the world to maintain our integrity or indeed our selves. However, this agonistic presumption does not entirely accord with biological thinking about how organisms coexist in shared ecologies, sometimes with great mutual benefit, sometimes pacifically, sometimes indifferently, and sometimes deleteriously. Instead, modern bioscience’s investment in the self-interiorizing and defensive organism betrays its unacknowledged debt to modern philosophies of personhood.14 Immunity incarnates ideas about human being culled from modern politics, economics, law, philosophy, and science, which then belatedly achieve scientific status when immunity inoculates them into the living organism and thereby validates them as essentially “natural.” Although it takes immunity-as-self-defense as its nominal subject, this book only partially traces the specific developments in biology and medicine that precede and condition immunity’s biomedical coming-of-age. It does not exhaustively analyze immunity’s complex invocations from the eighteenth century through the late nineteenth, when the term appears with accelerating frequency to describe a general empirical observation that disease affects different people differently.15 Nor does it seek to address or contest the historiographies of biology, medicine, and technology on which my argument extensively draws. Instead, A Body Worth De­ fending engages immunity’s migration from politics and law into the domains of medicine and science as a complex of thinking about modern

Introductory Ruminations 



bodies which percolates through political, legal, philosophical, economic, administrative, governmental, scientific, and medical discourses. As this complex unfolds, beginning in Europe around 1650, its manifestations mutually inform and modify each other. Together they turn over—and indeed overturn—the pre- or nonmodern ground in which theocentric feudal hierarchies planted their ensouled human forms, thereby clearing and fertilizing the terrain where the hybridized seeds of modern individualism come to flourish. Indeed, within modernity (or however else we might conceive it) the attachment of the person to the body supersedes its attachment to the soul. Concomitantly, the distinct personal statuses of body and soul denominate distinct political ontologies.16 Modernity births the modern body, and the modern body makes modernity matter. Obviously, the meanings that accrue to the terms “modern” and “modernity” are myriad and complex. Tomes devoted to defining and describing modernity and the modern fill not inconsiderable shelf space in libraries around the world. Some treatments define these concepts historically, some philosophically, some technologically, some religiously, some economically, some politically, some geographically, some sexually, some racially, some globally, and many all of the above. Yet all these diverse readings share an underlying sense that modernity refers to living relations in and of time. As its etymology suggests, “modernity” (from the classical Latin adverb modo meaning “just now”) connotes a punctual immersion in the present which syncopates the eschatological time frame espoused by premodern Christianity. Insofar as modernity designates a historical period (whatever the exact chronological parameters ascribed to it), it does so precisely by reimagining time as historical, that is, as a human index of change. Michael Hardt and Antonio Negri have recently characterized this shift, at once conceptual and material, as “revolutionary immanence.”17 Among its many other effects, such radical immanence opens the possibility for rooting human being—and human beings—both spatially and temporally in the localized domain that we call the body. In fact, we might characterize the transformations that European modernity incorporates by saying that they enable the essential metonym for the person to morph from immortal soul to mortal body. Altering the criteria for, and claims to, personhood, this metonymic shift contributes to destabilizing the religiously ordained (soul-based) hierarchies that characterized premodern European social formations. The immanent human body provides a temporal and spatial locus for biopolitical agency and therefore helps inaugurate a new political economy of modern personhood: one

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in which differences among and between people (e.g., race, sex, gender, class, age, etc.) appear as attributes of bodies rather than the gradations of souls.18 In this reading, modernity’s ordinance becomes secular not because it abjures the spirit but rather because it orients human experience around a living temporality that resides in the world. From the Latin saeculum, meaning the ordinary lifetime of the human species, a lifetime, a generation, or an age, modern secularity (like modernity itself) originally designates a situatedness in time in a specifically embodied way. The opposite of secular, then, is not religious but eschatological. As the lived dynamics of human embodiment begin to define human agency, they underwrite both political contestation (e.g., theories of natural rights) and economic transformation (e.g., wage labor). Mary Poovey identifies arguments from and about secular “human nature” as mediating epistemologically between premodern investments in a providential order and modern social institutions.19 This book adopts a similar mapping to Poovey’s but analyzes the modern nature of human nature in the changing biological and medical perceptions about the human organism itself. In other words, it traces modernity’s genealogy through changing ideas about the nature of the human, especially as the human organism increasingly imagines and lives itself as a biological phenomenon separate and distinct from an environment that only subsequently seems to surround or even oppose it. In this regard, modernity marks a passage from the encompassing “passibility” that Timothy Reiss attributes to premodern and nonmodern subjectivities, where personhood accrues from “a sense of being embedded in and acted on by . . . the material world and [by] immediate biological, familial and social ambiances, as well as the soul’s (or ‘animate’) and cosmic, spiritual and divine life.” 20 Modernity might thus appear as an ensemble of practices that literally incorporates—or incarnates—a historical paradox: modernity produces and reproduces humans as both natural and cultural, biological and social, empirical and transcendental, finite and infinite, insofar as it conjures the body as a hybrid biopolitical formation which we must have in order to be a person. Given the vast array of possible meanings, the next section adumbrates how modernity and the modern circulate in this book by considering two distinct and compelling interpretations, the first provided by Bruno Latour, the second by Michel Foucault. Hopefully this will help to clarify what it means to say that biological immunity makes the body modern.

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11

A Short History of Biopolitics

In a concise and polemical text provocatively titled We Have Never Been Modern, Bruno Latour offers a surprising and compelling analysis of the putatively modern. He does so by disclosing a set of epistemological assumptions that underwrite the modern’s material successes even as they contradict its ostensible premises. Extrapolating from Steven Shapin and Simon Schaffer’s exploration of how modernity’s advent in England transforms science and politics into overlapping and co-constituting domains,21 Latour initially posits what he calls the “Modern Constitution” as supposing two distinct and yet inextricable beliefs: “It is not men who make Nature; Nature has always existed and has always been there; we are only discovering its secrets” and “Human beings, and only human beings, are the ones who construct society and freely determine their own destiny.” 22 Disarticulating nature from humans, and humans from nature, frees political and scientific thinking from the impacted dynamics that feudal and early modern relations between nature and man suppose (as well as those of premodern cultures more generally). 23 Each now becomes available for critical reflection and rearticulation. Yet, as Latour demonstrates, these conditions remain insufficient in and of themselves, since they actually contradict each other, and so “the moderns” offer additional constraints: “But these two guarantees are contradictory, not only mutually but internally, since each plays simultaneously on transcendence and immanence. . . . Are they lying? Deceiving themselves? No, for they add a third constitutional guarantee: there shall exist a complete separation between the natural world (constructed, nevertheless, by man) and the social world (sustained, nevertheless, by things).” 24 This condition, constituting what Latour calls “purification,” informs the modern by disaggregating the very elements from which modernity creates itself. It binds—and blinds—modernity to its unstable epistemological and ontological foundations by secreting them below the thresholds of visibility and intelligibility. Taken together, these constitutional “guarantees” enable the moderns to mobilize resources, ideas, objects, and relations in ways heretofore unimaginable, via what Latour calls “networks.” These new mobile possibilities not only infect modernity’s famous self-conceit that it radically breaks with the past (i.e., that it completely severs its ties both with tradition and with traditional cultures) but also enable modernity to propel itself forward through time. In so doing, it appears to relentlessly reanimate these

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very temporal and geopolitical ruptures within its unceasingly “productive” capacities. [The moderns] are going to be able to make Nature intervene at every point in the fabrication of their societies while they go right on attributing to Nature its radical transcendence; they are going to be able to become the only actors in their political destiny, while they go right on making their society hold together by mobilizing nature. On the one hand, the transcendence of nature will not prevent its social immanence; on the other, the immanence of the social will not prevent the Leviathan from remaining transcendent. We must admit that this is a rather neat construction that makes it possible to do everything without being limited by anything. It is not surprising then that this Constitution should have made it possible, as people used to say, to “liberate productive forces.” (32)

By productively liberating itself from the past, modernity liberates the present for the future. Yet the neatness of this temporal bifurcation rests on the messiness of the conceptual matter that underwrites this progressive narrative. If nature transcends and intervenes, society self-creates and naturalizes. Causality appears everywhere and nowhere at once. The fungible categories which underwrite the Modern Constitution and make it so productive concomitantly give rise to a plethora of justifications, many of which manifestly contradict each other. For such justifications to appear noncontradictory, or “rational,” and therefore politically and philosophically valid, some form of mediation must materially buttress the foundational divisions supporting the modern (nature-society, transcendent-immanent, subject-object, nonhuman-human, secular­religious, traditional-modern, etc). The Modern Constitution achieves this support, according to Latour, by outsourcing such contradictions to what he calls “hybrids.” Hybrids form material networks that bind up “nonhuman nature” and “human culture” while disappearing below, beneath, or beyond modernity’s epistemological and ontological threshold, almost as if they exist in and as the world itself. Explaining how this immanent hybridity ubiquitously prevails and yet remains largely undetected, Latour offers another modern guarantee, the guarantee of guarantees: “There shall exist a total separation between the work of hybrids and the work of purification” (31). In other words, hybrids “work” precisely insofar as their work remains immune from the radical, or indeed ontological, bifurcation that modernity presumes. To return to our main example, by borrowing on its explicitly juridicopolitical legacy and then claiming to describe nature itself, biological im-

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13

munity succinctly illustrates how hybrids conjoin society and nature while occluding the fact that they do so (also explaining why immunity performs such important work for modern medicine, or even why it makes medicine thoroughly modern). By playing the opposition between nature and politics against the excluded middle, modern ways of explaining the world propose distinctions that biopolitical hybrids (such as biological immunity) should obviously undermine, since their manifest social nature should confound the society-nature divide. However, because hybrids appear constitutionally innocent of any such intention, and because they must be constitutionally exempt from consideration for the Modern Constitution to remain effective, they perform their imaginary work unremarked and unchallenged. In so doing, these hybrids secret(e) their values in everyday forms, shaping how we imaginatively and materially make sense of our lives, without revealing either the stakes involved or the possibility that other options might exist. Hybrids underwrite our conceptual mapping of the world while themselves remaining “invisible, unthinkable, unrepresentable” (34). In so doing, they make the (contradictory) logic of such mappings almost impossible to discern. We think we are doing one thing while we are also doing otherwise at the same time. This double-thinking permits modernity to breech the limits that it declares inviolate: “The critical power of the moderns lies in this double language: they can mobilize Nature at the heart of social relationships, even as they leave Nature infinitely remote from human beings; they are free to make and unmake their society, even as they render its laws ineluctable, necessary and absolute” (37). Hybrids underwrite the modern double bind even as they belie it. Materializing concrete instances of nondifferentiation, their nonappearance or nonintelligibility enables modernity to exist as such. Or to put it slightly differently, highlighting their appearance and their intelligibility makes us realize that “we have never been modern”—or, at least, realize that modernity is not all that it is cracked up to be, or perhaps, simply, that modernity is always already cracked: “Here on the left, are the things themselves; there, on the right, is there free society of speaking, thinking subjects values and signs. Everything happens in the middle, everything passes between the two, everything happens by way of mediation, translation and networks, but this space does not exist, it has no place. It is the unthinkable, the unconscious of the moderns” (37). Littered with hybrids, the modern unconscious reveals the traces of the contending forces which inform the social nature that we are. Yet because

14 

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they lurk beneath the level of our conscious reflection—at least insofar as we “are modern”—these hybrids also conceal these very forces from us. This book interrogates one such hybrid, “immunity-as-defense,” to meditate on the thoroughly political dimensions of the putatively biological substrate that we call “the body” (itself another hybrid, if not a hybrid of hybrids, as we will see in chapters 2 and 3). Biological immunity and the body mirror each other, each reflecting the other as both natural ground and raison d’être. Immunity takes on the responsibility for maintain­ ing the integrity of the body, while the body’s putative singularity creates a constitutive vulnerability against which immunity must relentlessly defend it. Silently invoking its juridico-political legacy to supplement this natural insufficiency (while conversely naturalizing its unappreciated juridico-political valence), immunity throws itself into the breach between nature and society as a good hybrid should. The longer I work on this project, the less I understand why it seems obvious to us to use a complex legal and political concept to describe how we coexist as organisms. Taken at face value, immunity has little to recommend it as an organismic possibility; indeed, once called to our attention, it seems hard not to notice that the trope only works as catachresis. 25 But what troubles me more than this patently improper character is the fact that despite how transparently immunity functions as a biopolitical hybrid and how obviously its “political nature” hides in plain sight, no one gives this hybrid strangeness the slightest regard. Every day immunity is invoked countless times as an unproblematic facet of reality, that is, as “fact”: labs are run on this fact, inoculations and antibiotics are prescribed according to this fact, pharmaceutical corporations invest in this fact, governments plan and implement policies predicated on this fact, NGOs and international and supranational organizations organize and distribute resources based on this fact. Immunity’s utility is indisputable. Yet as a consummate hybrid, it contradicts itself on many levels and then enfolds its contradictions within itself. A Body Worth Defending considers immunity as an apotheosis of both modern medicine and the modern body because immunity defensively renders the organism distinct from the vital contexts in which it necessarily exists, locating both nature and culture inside it. This diremption hollows out the lifeworld, defining the organism as a defensible interior which needs to protect itself ceaselessly from a hostile exterior. In so doing, immunity-as-defense naturalizes premises avowed by an earlier political modernization, one that anoints the individual—along with its

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15

now essential metonym, the body—as the natural social atom. If these entangled hybrids form the basis for modern political theory and modern biomedicine respectively, they do so as instances of what Foucault famously named “biopolitics.” Indeed, rubbing Latour up against Foucault (and thereby offering what I hope could provide a useful if  not pleasurable frisson for both), we might say biopolitics names a “hybrid domain,” or a domain of hybridization. It makes visible and intelligible relations of force which, on the one hand, seek to distinguish biology and politics epistemologically and ontologically and, on the other, endeavor to mobilize “life” as a vital resource for, and target of, power. Biopolitics (along with its fraternal twin, “biopower”) has proved one of the most infectious as well as most elliptical elements of Foucault’s conceptual legacy.26 Despite their renowned elusiveness, biopolitics and biopower have engaged and continue to engage the interests of many contemporary thinkers, who recognize that the concepts evoke something which seems distinctly characteristic about the modern world (at least in its Euro-American incarnations).27 Alluding to a pervasive engagement with, or entanglement in, “life itself,” biopolitics bespeaks a palpable sense that power has operated for the last two hundred or so years in part by creating, manipulating, managing, promoting, enhancing, and investing in a “zone of indistinction” (to appropriate Agamben’s idiom) between nature and culture which we all too unproblematically call “the body.” If both the life of the body and the quantum of life realized within bodily aggregations known as “populations” emerge as political concerns in Europe during the late seventeenth century and the eighteenth, we might say that they do so as hybrids which entrain the nature that humans incorporate within the politics that we enact. In other words, following Foucault, biopolitics seems to gesture toward an unremarked elision between nature and culture both in what we name as “human” and in ensembles of living human beings. Moreover, biopolitics reveals this hybrid formation as a highly potent domain, or as a domain whose potency derives from the biopolitical indistinction it motivates. Within the ambit of the modern, then, “the life” of human beings and of human collectivities emerges more and more as a paramount subject-object of political concern. Foucault situates this emergence within a historical shift occurring from roughly the middle of the seventeenth century onward—in other words, within the ambit of modernity construed as a historical horizon. Though he does not precisely characterize it this way, Foucault’s biopolitical thinking emplots “the body” as a life-form that takes place within

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the historical transformations that modernize us (if we ever become so). This problematic clearly appears in the lectures he gives at the Collège de France in 1976–77, titled Society Must Be Defended, where he considers the problem of political sovereignty in part by situating Hobbes’s political philosophy in the context of the English Civil War and its Cromwellian aftermath (1649–60). The next year’s lectures, Securité, territoire, population (1977–78), expand this historical project, situating biopolitics in the aftermath of the Thirty Years’ War as a “governmental” supplement to sovereignty per se. If (as we will consider in chapters 1 and 2) internecine violence and bloodshed in England leads modern political thinkers like Hobbes and Locke to invest in sovereignty and the rule of law as a means of civil pacification, Continental thinkers and rulers at the same time rely more and more on extralegal strategies to keep the peace both within and between nations. To apprehend this difference, we should recall that unlike the domestic and fraternal unrest which seized England, across the Channel, on the Continent, the most fearful violence ensues from conflicts that are not just civil but also regional, not just internecine but also international. Preceding and overlapping the English Civil War, the Thirty Years’ War (1618–48) brings unrelenting death and devastation to many parts of Europe. This enduring period of military, political, and religious conflict not only results in widespread human mortality and morbidity but also visits ecological destruction, agricultural ruin, and economic collapse upon vast swaths of the region. While the war’s lengthy and convoluted dynamics cannot be summarized succinctly here, the complex alliances and enmities that underlie these three decades of violent discord can roughly be parsed into the opposition between the Habsburg dynasty, which ruled the Holy Roman Empire (now much of Germany, Austria, Switzerland, the Czech Republic, Slovakia, Hungary, and northern and central Italy), as well as Spain, against the combined opposition of the rulers of France, Sweden, Denmark, and Holland. Furthermore, this international backdrop also provides the setting for more internal struggles within and between the many Germanic principalities, bishoprics, electorates, dukedoms, cities, and estates which variously and alternately ally themselves with the larger powers. Overlaying, or underlying (depending on your interpretation), these military maneuvers are religious divergences between Calvinism, Lutheranism, and Catholicism which orchestrate the byzantine play of forces and counterforces that characterize this extended and extensive era of bellicosity. Needless to say, given the widespread involvement and

Introductory Ruminations 

17

deeply felt justifications, the conclusion of these animosities, culminating in 1648 with the Peace of Westphalia, radically recasts the future of European states. Yet, even more importantly for our purposes, the Thirty Years’ War also leaves in its wake a radically new mode of valuing human life. For in contrast to the English situation, where (as we will find in chapter 2) the political worth of human bodies bespeaks a legal and economic valuation predicated on the individual’s abstraction from the lifeworld and its generalized vulnerability to death, the conclusion of these widespread and deadly hostilities on the Continent sees the value of the living human body politically affirmed as a vital defense against an imminent potential for generalized war in Europe. In the aftermath of the Thirty Years’ War, living itself becomes politically invested as a vital state of war preparedness. The biopolitics that crystallizes during the eighteenth and nineteenth centuries (and ultimately congeals within immunity-as-defense) is catalyzed by the Thirty Years’ War and the Peace of Westphalia. In particular, Foucault intimates that resolving the violent conflicts among the warring European states gives rise to an extralegal political order which, in contradistinction to the English case, does not invoke natural law or natural rights to pacify the region. This new order creates modern Europe, establishing a “geographic region of multiple States, without unity and with unevenness between the small and the large, having a relation of utilization, colonization and domination to the rest of the world. . . . Voila, that’s what Europe is.”28 Within this uneven geographic domain, organized violence and death are used and deployed as political resources both within and between states. According to the new equilibrating calculus of Europe, wars which had previously been thought—and fought—as rivalries among princes and been justified through competing claims to jurisdiction (war as litigation by other means) now come to function as a means of ensuring peace: “The first instrument of this precarious, fragile and provisional universal peace, which took the appearance of a balance and an equilibrium among a plurality of States . . . is war. That is to say, henceforth, one is going to be able to wage war, or better, one must wage war precisely in order to maintain this equilibrium.” 29 Enlisting war as the primary resource for a general economy of peace implies two corollaries: the need for permanent diplomatic missions (and spies) serving to gauge and regulate the use of war, which Foucault describes as “a permanent apparatus [dispositif ] of relations between States, an apparatus of relations which are neither an imperial unity nor an ecclesiastical universality. . . . a veritable society of nations” (310); and the need

18 

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for a permanent military apparatus comprising professional military personnel, a structured and permanent army, a military infrastructure (fortresses, equipment, roads, communications, etc.), and specific military knowledges (tactics, strategies, intelligence, etc.). After the devastating era of the Thirty Years’ War and the ambitious peace it provokes, Foucault suggests that war enters modern politics as both a deadly and a vital instrument: “War is no longer another face of the activities of humans. War is going to be, from this moment on, the implementation of a certain number of means that politics has defined and of which the military is one of its fundamental and constitutive dimensions” (313). Two hundred years later, considering humans as living organisms, immunity-as-defense finally brings this war home. Amid Europe’s paradoxical domain of permanently bellicose peacefulness, biopolitics emerges as a resource both for war and for its prevention. To avert excessive violent death, biopolitics augments the forces of life; in the name of a pacific life, it invokes the belligerent specters of war. This Janus-faced regime incorporates within itself the very violence against which it contends, establishing war as the political ground for affirming the lives on which, and in whose name, it acts. In the final part of La volonté de savoir, titled “Right of Death and Power over Life,” Foucault maps this new domain across two axes: the “disciplines: an anatamo-politics of the human body” and “regulatory controls: a bio-politics of the population.” 30 The first of these he explicates at length in Discipline and Punish, where not coincidentally the tactical organization of military forces provides one of the paramount examples of how disciplines inform “docile bodies.” Remarking on the efficacy of the Prussian army’s new training regimes under Frederick I (who invests heavily in militarily “balancing” European relations), Foucault comments: Through this technique of subjection [assujettissement] a new object was being formed; slowly, it superseded the mechanical body—the body composed of solids and assigned movements, the image of which had for so long haunted those who dreamt of disciplinary perfection. This new object is the natural body, the bearer of forces and the locus of a life [siège d’une durée]; it is the body capable of specified operations, which have their order, their stages, their internal conditions, their constituting elements. The body, in becoming the target for new mechanisms of power, offers itself up to new forms of knowledge. Body of exercise, rather than of speculative physics; body manipulated by authority, rather than imbued with animal spirits; body of useful training [dressage] and not of

Introductory Ruminations 

19

rational mechanics, but in which, by which even, a number of natural requirements and functional constraints will reveal themselves. 31

Formed through a “technique of subjectification” and target for “new mechanisms of power,” the “natural body” clearly does not manifest “na­ ture” in an unmediated or ontological sense. Rather, constituted by and for strategic exigencies, the natural body serves as the political locus within which vital forces endure. Indeed, as Foucault notes elsewhere, given the massive new investments in permanent armies which require extensive training of troops to carry out military operations (e.g., efficiently using equipment, moving in synchronous patterns, obeying chains of command, etc.), the endurance of the life force trained in this manner becomes an object of great political and economic interest.32 The political and military concern with and for the natural body, then, imbues this body with its na­ ture. Or, retracing Foucault’s precise thinking, “natural requirements and functional constraints will reveal themselves” in, or even through, the na­ tural body by way of the “new forms of knowledge” to which it, as the “target for new mechanisms of power,” must “offer itself up.” In light of this contrapuntal formulation, we discern in Foucault’s natural body one of Latour’s network of social-natural hybrids that shore up the Modern Constitution, since its nature is thoroughly political. The military investment in the natural body bespeaks the potent effects that the new political economies of war manifest for the living human being. In modern Europe, war provides a forceful terrain where the value of human life is realized—both individually and collectively. If Hobbes characterizes the “state of nature” as one of “Warre of every one against every one,” Foucault suggests that on the modern political battlefield, individuals do not so much contend against one another individually as much as they are conscripted within national formations which channel their vital potentials toward strategic ends. In other words, as Julian Reid argues, Foucault suggests that the ends of war transform the living human organism into a resource for national defense: The strategic stakes of the military endeavors of modern states reside not simply in the clash of forces that distinguishes combat but in preparing for conflict, in disciplining the life of bodies that constitute organized military forces. War is fought for political order not among states, or on territorial battlefields where military forces clash, but on the terrain of the human body. It is the order that life assumes within the human body that is at stake, Foucault argues, in the struggles to discipline the human body.33

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Within this disciplinary formulation, we discern the first premonitions of modern biomedicine’s avatar, immunity-as-defense. For the disciplines, “life” appears “ordered” within “the body” as a resource for, and a condition of, war preparedness. This is the case not only within the military per se but also within the domains where (as we will discern in chapter 2) disciplinary techniques applied to living bodies seek to augment the vital forces of the nation itself (e.g., the factory, the school, the hospital, etc.). By the end of the nineteenth century, when immunity emerges as a robust medical and scientific concept, it thoroughly naturalizes the military model as the basis for organismic function. As if materializing the disciplinary investment in the natural body, the immunological framework establishes war—at the level of cells and molecules—as the condition of life itself (the topic of chapter 4). Indeed, we might even say that the disciplinary formation of the natural body bespeaks the escalating incorporation of war in the mundane ways that we live.34 Moreover, this political investment constitutes human life, both individually and collectively, as a valuable asset and increasingly construes living processes themselves as resources for the state in its ongoing struggle to balance its forces against those of the other states with which it coincides (chapters 1, 2, and 3 consider this dynamic for England, Germany, and France respectively). Appearing after the disciplines, biopolitics emerges in the eighteenth century as a regulatory ensemble that both constitutes and conditions a new aggregate form of life: population. One of a series of modern abstractions that hypostatize the regularities of collective living and discern quasi-natural laws within them (e.g., the economy, society, human nature),35 population conceives the individual lives of national subjects as units belonging to a more encompassing vital domain which the state now recognizes as a valuable resource for its own ends. This overinvestment in life at the levels of the natural body (discipline) and of the population (biopolitics) constitutes the new regime that Foucault names “biopower.” The old power over death that symbolized sovereign power is now carefully overlaid [recouvert] by the administration of bodies and the calculated management of life. During the classical age, there is a rapid development of diverse disciplines—universities, secondary schools, barracks, workshops; in the field of political practices and economic observations, there also appear the problems of birth, longevity, public health, housing, and migration. Hence there is an explosion of numerous and diverse techniques for achieving the subjectifica-

Introductory Ruminations 

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tion [assujettissement] of bodies and the control of population. Thus, an era of “bio-power” commences.36

The era of biopower might serve as another name for modernity, since, as Foucault puts it, it marks the “threshold of biological modernity.” 37 Here human life appears at and as the intersection of two different but interlocking apparatuses that simultaneously individualize and bind people together: “The setting up, in the course of the classical age, of this great duplex technology [technologie à double face]—anatomical and biological, individualizing and specifying, turned toward the performances of bodies and regarding the processes of life—characterizes a power whose highest function henceforth is perhaps no longer to kill but to invest life through and through.”38 “Life” augments death as the primary instrument of power because it can be hailed both singularly and collectively, at the level of the organism and the species, as performance and as process, as biology and economics. Life does not then specify the unmediated immanence of a distinctly and properly natural domain that precedes or exceeds social determination, only subsequently entering human relations by way of “cultivation” or “culture.”39 Rather, life specifies an object of administration and subjectification that constitutes the processes of human living as a thoroughly hybrid domain. Targeting the world-transforming potential manifest by living human being (including, of course, its capacity to labor),40 biopower appreciates life by recognizing in it an exploitable natural resource rather than simply wielding death or diminishment as sovereign power does. Yet it is precisely this appreciation (in both its economic and aesthetic senses) that isolates living potential in the body and in collections of bodies in the first place. Moreover, as Foucault emphasizes, the two principal techniques of biopower converge not just conceptually but materially and effectively on and in these bodies (and bodies of bodies) through their administration and subjectification: “In fact, their articulation will not happen at the level of speculative discourse but in the form of concrete arrangements [agencements concretes] which will constitute the great technology of power in the nineteenth century.”41 Biopower encompasses a domain of hybrid networks that knit together biological processes, disciplinary technologies, individualized organisms, biopolitical apparatuses, and populations, among others, and in so doing affirms the value of human life. Among its many palpable consequences, this life-affirming power recasts the role of the state, changing its raison d’être from that of a saver

22 

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of souls to a governor of bodies. If in premodern Europe the rationale that political theology provides for divinely anointed monarchs affirms their salvific responsibility for their subjects’ souls—that is to say, their primary concern for their subjects’ eternal life, rather than their temporal existence—then the rationale provided by political philosophy for modern sovereignty shifts this locus of concern from the afterlife to this life, if not to “life” itself. As Foucault describes it, this shift from soul to body has, since the eighteenth century, swallowed us whole. Deflecting its concern from soul to body, the modern state’s “somatocracy” organizes new forms of governance that envelop the lives of its subjects in their allencompassing embrace.42 Watching over us from cradle to grave, medicine serves as one of the most consummate somatocratic forces and concomitantly garners great power and authority (not to mention income) for its efforts. When it conceives immunity as its physiological doppelgänger in the last decades of the nineteenth century, medicine naturalizes this governmental project by proxy. According to the new bioscientific doxa, the organism’s own cells now seem to engage in the very warlike actions that the modern state itself enlists to protect its subjects’ lives as its most vital asset. Thus, A Body Worth Defending argues, by relegating defense to the organism’s interior, modern medicine transforms the body into the apotheosis of the modern.

Genealogical Rumination, or Foucault in Slow Motion

By now I’m sure you realize that the work of Michel Foucault lives at the heart of this project. From the beginning of his career, Foucault addresses medicine as a knowledge formation that tangibly informs human experience.43 While Foucault’s early writings have had a widespread (if not always enthusiastic) reception in the history of medicine, medical sociology, and medical anthropology, thus far his later interests and methodologies have had less impact on studies of biomedicine.44 Moreover, how reflecting on biomedicine might reciprocally illuminate biopower and biopolitics remains largely unexplored. A Body Worth Defending seeks to redress these gaps in our appreciation both of Foucault’s own writings and of how they might link modern medicine more closely to biopolitical effects and contexts. In so doing, it foregrounds how one avatar of modern biomedicine, immunity-as-defense, metaphorically crosses from politics to nature and back and forth again, and offers a meditation on what, following Emily Martin, we might call “immunophilosophy.”45

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Each of the book’s four chapters elucidates the knowledge, imagination, ethics, politics, and values that precipitate immunity’s modern biological incarnation to illuminate how modern medicine defensively anoints the “modern body” as its most sacred icon. This project is at once historical and philosophical; or, to be more precise, it is genealogical. Genealogy refers to an interpretative process inaugurated by Friedrich Nietzsche and adapted by Foucault, which Foucault famously described as a “history of the present.”46 For Foucault, genealogy considers the past as an immediacy whose immanence in the present derives neither from its inevitability nor from its determinacy.47 Rather, genealogy understands that the presentation of the past, that is, the realization of “pastness” in and as “presentness,” emerges from fragmentary and often random convergences whose accreted effects nonetheless confront us as “real.” Such genealogical endeavors seek to uncover the chance combinations and conjunctions, intersections and collisions, productive coalescings and violent rendings, that give rise to the ways we realize our lives now. Ge­ nealogy’s basic premise holds that the world is much more virtual and much more mutable than it presents itself. In genealogy we disclose contingencies secreted within phenomena which propose themselves to us as the essential dimensions of our world. Through this disclosure, genealogy hopes to glimpse instabilities where we often see inevitabilities, to imagine possibilities where we resign ourselves to necessities, and thus to learn to think and live otherwise than we supposed imaginable heretofore. Disturbing the foundational certainties ascribed to the body, genealogy opens life to history by considering contingencies which the body hides. Though Foucault still retains his own attachment to the body (for this nominal formulation persists despite its problematization), he locates genealogy’s concern at and as “the articulation of body and history.”48 Genealogy, according to Foucault, decomposes the body’s “nature”—and thus any pretense to its “being” (as) an immutable, inevitable, transhistorical, or immanent truth—revealing what, following Latour, we might call the body’s “hybridity.” Insofar as genealogy discloses the body as hybrid, it enables us to consider how the historical unfoldings that we take (and mistake) as its contours, or even its “defenses,” appear self-evident as its and our most vital matter. In Foucault’s terms, such “eventualization” is “a matter of shaking this false self evidence, of demonstrating its precariousness, of making visible, not its arbitrariness but its complex interconnections with a vast multiplicity of historical processes, many of them of a very recent date.”49

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Genealogy therefore offers a fruitful framework through which to consider immunity’s transubstantiation into a biological function at the end of the nineteenth century. When science adopts the juridico-political metaphor as a robust concept, it radically redefines the truth of the body as both substantially distinct from, and opposed to, the world in which it exists. However, this scientific affirmation necessarily obscures not only the conditions of its own coming-into-being but also occludes all competing frameworks, which it concomitantly disqualifies as un- or prescientific. For this reason, a genealogy of immunity necessarily partakes of Foucault’s more general genealogical goal to destabilize and decenter scientific discourse’s self-authorizing and self-validating truth claims. As Foucault remarks: “Genealogies are quite specifically antisciences. . . . They are about the insurrection of knowledges. . . . Genealogy has to fight the power­effects characteristic of any discourse that is regarded as scientific.” 50 An antiscientific or genealogical approach to immunity does not, however, seek to contest its truth or effectiveness but seeks to discern how the concept congeals within itself the interests and assumptions of a wider, nonscientific ambit as science to disqualify as nonscience what Foucault calls “subjugated” knowledges. The contemporary idiom that regards healing modalities that do not unquestioningly affirm the immunological paradigm as “alternative,” “complementary,” or “supplemental” (e.g., acupuncture, osteopathy, homeopathy, etc.) illustrates precisely how such disqualification works. Placing immunity at the center of truth, as the most truth-full concept, bioscience displaces other possible understandings from the domain of “the true.” While they may offer empirical verification (and hence be eligible for insurance reimbursement), these “supplements” remain nonetheless excluded from proper bioscientific legitimacy. They might work, but they are not “true.” A genealogy of immunity highlights how motivated and yet nondetermined combinations of political, economic, sociological, philosophical, diplomatic, and biological events precipitate immunity as a robust bioscientific explanation while simultaneously rendering other healing possibilities less than, or not yet, scientific. If the goals of genealogy are antiscientific, its process is rumination. In On the Genealogy of Morals, where Nietzsche both describes and deploys genealogy simultaneously as a historical method and as a form of interpretation, he plays on the bovine resonance of this image quite explicitly: “To be sure, one thing is necessary above all if one is to practice reading as an art in this way, something that has been unlearned most thoroughly nowadays . . . something for which one almost has to be a cow and in any

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case not a ‘modern man’: rumination.”51 Counterpoised to the habits of “modern man,” genealogical rumination not only approaches matters as if from a nonhuman, cowlike perspective but advances by way of slow, careful digestion. In this book, it proceeds by lingering over numerous distinct events and disjoint concepts with no necessary or predictable correspondence that “a body worth defending” accretes. Moreover, this immunological rumination ruminates in turn on Foucault’s biopolitical idiom itself, lingering over numerous texts and insights that Foucault invokes in his writings to break down their often gnomic significance into more digestible bits. The body of this book repeatedly limns the terrain of Foucault’s writings (especially the less well-known, more recently published lectures he gave at the Collège de France between 1975 and 1978) and asks how they illuminate our investments in biomedicine and human bodies more generally. As a result, the argument continually circles around and returns to topics often familiar to Foucault’s readers; however, in doing so, it expands on and extends the Foucauldian reference by dwelling on and with texts and issues that Foucault himself often passes over quickly while making his points. Addressing Foucault in slow motion, then, not only elucidates the significance of Foucault’s work but also interrogates the biopolitical dimensions of modern medicine as an instrument of biopower itself. These entwined undertakings form the conceptual armature of A Body Worth Defending, binding its diverse genealogical considerations together within a contrapuntal play of theoretical and historical inquiry. In considering immunity as the biomedical apotheosis of the modern body, A Body Worth Defending evokes three recurrent motifs: one addresses the history of a concept (how does immunity migrate from politics and law into medicine?); one reflects on the emergence of a political ontology (how does the body come to ground modern notions of political, legal, economic, and biological personhood?); one interrogates the theoretical hope that Foucault’s writings continue to inspire today (how do biopolitics and biopower inform contemporary thinking about living human being both in its singularity and its collectivity?). Braided together, these three lines of inquiry ruminate on a basic question about how modern personhood comes to conceive itself as fundamentally, if not biologically, defensive. To put it crudely, my main goal is to understand how and why those of us who live within the ambit of modern medicine (defined in this case by the acceptance of biological immunity as a foundational precept) so readily accept the notion that to endure as living organisms, we must actively and relentlessly fend off the predations of

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the very world that sustains us. Or, even more crudely put, I am trying to comprehend how and why we unreflectively believe that as embodied beings we are essentially and necessarily—i.e., “naturally”—distinct from the lifeworlds within which we materially arise and on which we materially depend for our existence. In other words: how did we come to believe that as living beings, “the body” separates us from each other and from the world rather than connects us?

To Defend or Not to Defend? That Is the Question

Of course, biomedicine no longer holds that immunity simply defends the organism—even if defense remains one of immunity’s most rudimentary and most radical valences. In the middle of the twentieth century, immunology transforms itself into the “science of self/nonself discrimination,” as Macfarlane Burnet proposes.52 “Self-nonself discrimination” arises within immunology to account for evidence that immune activity can paradoxically defend against the host organism’s own tissues—or at least destroy them. This autoreactivity, or autoimmunity, confounds an immune paradigm predicated on host-invader relations, which imagines the immune target as foreign. To make sense of autoimmunity while still retaining its basic defensive orientation, immunology evokes a more nuanced explanation, which Burnet provides: “When Macfarlane Burnet initiated the modern preoccupation with the self/nonself dichotomy, it was to explain the apparent paradox of why we all do not succumb to autoimmune disease.”53 Or, as the editors of an issue of Seminars in Immunology (2000) devoted to contemporary immune theories polemically affirm: “Everyone agrees that a biodestructive defense mechanism must make some kind of self-nonself discrimination.” 54 While not everyone actually agrees (as we will see in a moment), nonetheless immunity’s defensive implication does pass over into the organism’s self-constitution. For most immunologists, “self ” implies “as opposed to nonself,” and “discriminate” supplements “defend.” However, this lexical transition does not render defense immunologically obsolete. Rather, it recasts immunity as a productive rather than a negative activity, affirming the self as both self-constituting and self­defending (self-constituting because self-defending, self-defending because self-constituting). As Scott Podolsky and Alfred Tauber observe: “The organismic view of immune function focused on the processes of

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self-nonself discrimination and the general regulatory basis by which to model them; the main question is how the body distinguishes between friend (self) and foe (nonself).”55 The analogy “self is to nonself as friend is to foe” reveals the immunological self-relation as decisively political. Indeed, the opposition of friend to foe has defined the poles of Western politics ever since there first was a polis.56 Moreover, despite Burnet’s ecological interests in how biological organisms coexist, his self-nonself model recapitulates immunity’s underlying defensiveness as intrinsic to the individual organism, projecting its politics into the living being as a vital condition.57 Thus, while self-nonself seems to displace defense as immunity’s raison d’être, it actually pushes it even deeper into the organism, to the level of ontogeny if not ontology. Throughout the twentieth century, immunology nuances its sense of defense. In the late 1950s, Burnet adapts his self-nonself theory to Niels Jerne’s “selection theory,” precipitating “clonal selection theory.”58 With many adjustments and complexifications, this theory still largely obtains—albeit in a more postmodern vein. Hence, while some immune theorists do propose alternate possibilities, at the beginning of the third millennium venerable scientists like R. E. Langman and M. Cohn still categorically claim: We assume without further justification that the immune system is a biodestructive defense mechanism that normally functions to destroy and rid both intracellular and extracellular pathogens without destroying or seriously impairing the host. . . . In fact, we would go so far as to make this the definition of an immune system: Any biodestructive defense mechanism that makes somatically selected self-nonself discrimination is an immune system. 59

For Langman and Cohn, defense still constitutes the sine qua non of immunity, and self-nonself maps the terrain across which (or within which) this defensive encounter transpires. Immunity may necessitate more complex reconnaissance to accomplish its essential mission, but the defensive imperative remains much the same. Even when a renegade theorist like Irun Cohen attempts to move beyond clonal selection and self-nonself to introduce a “dialogic” or “cognitive” paradigm, he proffers similarly defensive tropes: The immune system is the guardian of our chemical individuality; it is a system that eliminates parasitic bacteria and viruses, a system that rejects foreign cells and tissues, a system that can destroy tumor cells arising from our own bodies.

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By deciding what macro molecules and cells are allowed residence within us, the immune system establishes the molecular borders of each person. In defending the individual, the immune system defines cellular individuality. The immune system has earned a reputation, justly, for its role as protector of the body against foreign invaders. However, the immune system is not only a department of defense, it also functions as a department of internal welfare. The immune system is an unsung hero of maintenance and reconstruction.60

Here Cohen highlights defense’s inability to account for all the processes encompassed by immunity (as opposed to Langman and Cohn). To redress this limitation, his cognitive model seeks to appreciate ways that immune function enhances “body maintenance.”61 Yet, in figuring what this entails, Cohen evokes the specter of “internal welfare,” the exact image that governing discourses at the end of the eighteenth century and the beginning of the nineteenth employed to explain medicine’s value for the state as a supplement to its defense (mentioned earlier and discussed at length in chapters 2 and 3). Thus, in rectifying the politico-historical limits of one metaphor, Cohen unwittingly conjures the limits of its historical confrere. Moreover, when he does so, he imagines the immune system as a form of “homeland security” avant la lettre, even foreseeing its policing of residence and border crossings. One of the few immunologists who explicitly abjure defense is Polly Matzinger. In fact, her “danger” model provokes quite defensive defenses of defense.62 Matzinger’s theory addresses a range of phenomena for which defense-oriented immunology cannot account, including, among others, autoimmunity; transplant rejection; why tumors are not rejected; why mothers do not reject fetuses; why we can go through puberty, maternity, and aging without rejecting ourselves; why we do not defend against commensal bacteria and viruses (e.g., the bacteria in our guts without which we are dead meat); and graft-versus-host disease. Positing a “two-signal” paradigm (immune responses require two separate effector signals, one of which indicates proximate tissue damage or death), Matzinger underscores the embedded metaphors that inform immune theories: For half a century we have studied immunity from the point of view of various forms of snsd [self-nonself discrimination] models in which immunity is controlled by the adaptive immune system, an army of lymphocytes patrolling the body for any kind of foreign invader. Recently there has been a shift to include the cells and molecules of the innate immune system, an army of cells and molecules patrolling the body for a subset of foreign invaders that are ancient enemies. . . .

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Perhaps it is time to stop running a cold war with our environment? The Danger model does not allow an army to control immunity. It expands the definition of the innate immune system to include the extended, highly interactive family of bodily tissues. It allows for a flexible system that adapts to a changing self while launching immune responses to dangerous pathogens. It also allows us to live without maintaining a rigid sterility that segregates us from the environment. We become a habitat, welcoming the presence of useful commensal organisms and allowing the passage of harmless opportunistic ones. With such an immune system we live in harmony with our external and internal environment.63

In distinguishing her ideas from immunology’s earlier defensive paradigms, Matzinger not only highlights their militaristic implications but also stresses that they represent the body as a defensible and defended boundary. Far from an ideological critique, Matzinger’s concerns about immunology’s inability to negotiate a number of empirical impasses lead her to question its implied vision of the human organism. However, the terms of her questioning also reveal the values that immune theories incarnate. Apart from its ability to encompass heretofore contradictory data (certainly not conclusively established), Matzinger’s danger model discloses the modern body that immune discourse incarnates. Her sense that immune paradigms conduct “a cold war with our environment,” which does not represent the natural and hence inevitable order, allows her to posit a more pacific, and dare I say “communal,” world. (Community is the ety­ mological opposite of immunity, as chapter 1 reveals.) In so doing, she invokes a concept, harmony, that fell out of Western biomedicine in the late nineteenth century when immunity replaced “natural healing” (the vis medicatrix naturae) as a scientifically endorsed concept. By predicating this harmonious possibility on danger as an alternative to defense, Matzinger suggests that defending incorporates unwarranted scientific assumptions about how organisms (human and not) coexist in shared environments. Moreover, as her rhetoric intimates, these unwarranted scientific assumptions both depend on and realize unwarranted political consequences which deleteriously affect organisms (human and not). Matzinger’s danger model then proposes that the body might actually, empirically, scientifically, and medically be a nonmodern body, a welcoming habitat, and conversely that the defended, self-defining modern body might itself constitute a source of danger. A Body Worth Defending provides some of the back story for how modern medicine constitutes the modern body and asks how immunity

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(which no one in immunology ever questions as an appropriate metaphor, unlike defense) makes this constitution make sense. It tracks how the human organism loses its natural harmony with the environment to achieve its new modern apotheosis. Long before this possibility exists biologically—unthinkable until the middle of the nineteenth century—it lives politically, legally, and economically in the wake of seventeenth- and eighteenth-century Europe’s violent turn from feudal hierarchies and absolute monarchies. Chapter 1, “Living Before and Beyond the Law, or A Reasonable Organism Defends Itself,” introduces the historical provenance of immunity and defense and situates them in relation to ideas about natural law that shape modern politics and modern science. Chapter 2, “A Body Worth Having, or A System of Natural Governance,” considers how the two axes of biopower, the anatamo-politics of bodies and the biopolitics of population, inform modern ideas about the body and personhood, not only giving rise to new legal, political, philosophical, and economic subjects but also enabling medicine to incorporate these new subjectivities as its political rationale. Chapter 3, “A Policy Called Milieu, or The Human Organism’s Vital Space,” focuses on the coin­cident revolutions in French politics and medicine and explores how nineteenthcentury medico-politics, or public hygiene, envisions humans as vitally situated beings. It then examines how bioscientific epistemology inverts this vision when Claude Bernard introduces the concept of milieu intérieur and thereby legitimates laboratory experiment as the privileged locus for biological truth. Chapter 4, “Incorporating Immunity, or The Defensive Poetics of Modern Medicine,” brings together the political and medical valences preceding immunity’s defensive incarnation, especially evident in humoral medicine’s interpretations of infectious diseases and in the international military, economic, and political strategies to disrupt them. Against this background, it reveals how bacteriology’s equation of microbes with invaders—a metonymy derived from the metaphoric representation of epidemics (especially cholera) as invasions—leads to Metchnikoff ’s countercoup of imagining phagocytes as defending the organism against these invaders. From this biopolitical conjunction, immunity-as-defense arises as the apotheosis of the modern body. Modern medicine appears at the end of the eighteenth century and the beginning of the nineteenth as an explicitly hybrid domain, as a biopolitical domain, which publicly declares its indifference to the modern distinctions between nature and society insofar as they equally impinge on living human being. Across the next two centuries, this ongoing incarnation of

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politics in nature and nature in politics marks medicine as one of our most powerful governing institutions. Indeed, we might entertain the possibility that the power of modern medicine lies not only—or even especially—in its curative capacities but also in its ability to finesse the terms of the Modern Constitution. Proliferating an amazing array of biopolitical hybrids, modern medicine deflects our ability to consider how the care and governance of our bodies import political values into our putatively “natural” processes. In so doing, medicine secret(e)s its political import within the tissues, cells, and molecules of our flesh, where we would not usually think to look for it. It turns us into modern bodies. By interrogating the ways that immunity comes to matter as an intimate and necessary element of our living, A Body Worth Defending considers the biopolitics of modern medicine as a matter worth rethinking. Indeed, it tries to suggest that such a rethinking might actually lead us to imagine new ways of living, both singularly and together, which might be more healing than those that modern medicine currently offers us. Today immunity informs us deeply: as organisms, as individuals, as citizens, as peoples, and as a species. In the wake of immunology, we no longer just live our politics, but our politics literally live in us. Conversely, the world in which we live has been recast according to this new “natural” order such that overtly political acts of violence and aggression can be interpreted immunologically, as George W. Bush did when he described the events of September 11, 2001, to a joint session of the U.S. Congress by declaring: “Our nation has been put on notice: we are not immune from attack.”64 Yet despite how immersed we are in immunological understandings and how deeply immunological effects reside in us, we remain largely ignorant of the processes through which this infectious concept has come to have such a purchase on our lives. In recovering a bit of this history, then, A Body Worth Defending recalls some of the decisions about how we construe the world that this concept accretes—and hence implicitly invokes—whenever biological immunity serves as a transparent representation of our vital nature.

The scientist is possessed by the sense of universal causation. . . . His religious feeling takes the form of a rapturous amazement at the harmony of natural law which reveals an intelligence of such superiority.—albert einstein, The World as I See It

1. Living Before and Beyond the Law, or A Reasonable Organism Defends Itself Figures of Science

First published in 1898, H. G. Wells’s The War of the Worlds introduces a staple of twentieth-century science fiction: the alien invasion. In this seminal narrative, a colonizing force from Mars lands on our planet and within days easily humbles the combined military powers of the world’s civilized nations, leaving only death and destruction in its wake. Nothing seems capable of stopping the Martians until one day they suddenly die, vanquished by microorganisms in the earth’s atmosphere to which humans have long since become resistant: The Martians—dead!—slain by the putrefactive and disease bacteria against which their systems were unprepared . . . slain after all man’s devices had failed, by the humblest things that God in his wisdom has put upon this earth. For so it had come about, as indeed I and many other men might have foreseen had not terror and disaster blinded our minds. These germs of disease have taken their

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toll of humanity since the beginning of things—taken toll of our prehuman ancestors since life began here. But by virtue of this natural selection of our kind we have developed resisting power; to no germs do we succumb without a struggle, and to many—those that cause putrefaction in dead matter, for instance—our living frames are altogether immune.1

One hundred years later, in 1998, the makers of The X-Files movie (based on the popular Fox TV show) imagine a somewhat different scenario of alien invasion. Seeking to colonize Earth, aliens conspire with a secret cabal of quisling humans to propagate a virus that uses human bodies as hosts to gestate an invasion force destined to claim the planet. FBI agent Fox Mulder defeats the aliens (but only temporarily, we learn in the following television season) after he procures a weak vaccine against the virus from one of the aliens’ human co-conspirators and then braves the aliens’ headquarters—which also turns out to be their spaceship—under the ice of Antarctic, where he inoculates his partner (and possible love interest) Dana Scully, who is being held in cryogenic stasis after having been infected by the microbial agents of xenogenesis. This single injection causes an immediate, cataclysmic immune reaction to cascade throughout the entire biotech apparatus that sustains the colonization project, thereby causing all hell to break loose in the alien stronghold and forcing them to flee the planet. A hundred years after germs to which humans are immune save the planet from aliens, it is now the immune system that saves humanity from alien germs, or from the germs of aliens. In the interval between The War of the Worlds and the X-Files movie, biological immunity captures the Western imagination. Figured as a mode of organismic defense, immunity has permeated popular understanding in more and more intimate ways during the last one hundred years. Indeed, in its most general usage, it now signifies a mode of boundary maintenance that characterizes a diverse range of possible actors from bodies to nations to the planet itself. Needless to say, these popular examples neither participate in nor represent bioscientific reflections on immunity. Nevertheless they do mark a graphic transition in immunity’s ability to describe how human organisms coexist in environments populated by multiple aliens—some terrestrial, some not—which may challenge our being both as singular organisms and as a species. Today, with its reputation paradoxically enhanced by multiple, well-publicized challenges to its capacities (e.g., aids, sars, and avian flu), biological immunity bodies forth an infectious metaphor that circulates equally within scientific and nonscientific discourses. Yet before achieving this contagious circulation,

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it initially travels some distance from the domains of law and politics to embody a biological concept in the first place. Those of us who live within the province of Western medical practice incorporate immunity both in our tissues and in our minds. Most of us who rely on allopathic medicine as our primary means of health care now materially embody immunological doctrine (via vaccines, inoculations, antibiotics, etc.).2 That is to say, we have been biochemically altered at the cellular, molecular, and perhaps even subatomic levels by the powerful consequences of this transformative image. Furthermore, we not only recognize ourselves through the frame of biological immunity (e.g., believing that we have an immune system or that our bodies defend themselves against pathogens) but also hold that immunity tells us something fundamentally true about our experiences of illness and health. In so doing, we make immunity matter. Clearly, popular perceptions of immunity do not adequately reflect how bioscience uses the concept. Indeed, the state of immunological knowledge unfolds so rapidly (especially in relation to new fields like computational immunology or genetic ontology) that even experts might find it difficult to encompass.3 Yet, as misinformed or misconstrued as they might be, popular representations of biological immunity do reveal something important about the imaginary work enacted by their scientific twin. As the cosmologist Lee Smolin suggests, within scientific knowledge, a recursion occurs between theory and metaphor. The validity of a scientific theory does not—and cannot—exhaust the general significance of the metaphors around which it turns: Apart from its use to predict the results of experiments, a good scientific theory may function as a metaphor that captures and expresses what we think is essential in the world. We must be able to separate the question of the empirical validity of a theory from the ethical and spiritual implications of its central metaphor; they are not the same thing, even if the metaphor may gain authority from the success of the theory while it in turn shapes our understanding of the theory’s meaning.4

Here Smolin foregrounds the necessary interplay between metaphorical and theoretical uses of scientific concepts. Metaphor and theory exist symbiotically. The emergent properties of a knowledge formation crystallize around their conceptual seeds. By precipitating unarticulated possibilities percolating through the scientific apparatus and then decisively framing them in newly recognizable forms, the theoretical deployments of metaphor and the metaphorical uses of theory organize the imaginary

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work of experimentation and research. Changes in scientific paradigms often represent changes in the metaphors used to describe what we take to be “real,” as Michael Arbib and Mary Hesse note: “Scientific revolutions are, in fact, metaphoric revolutions, and theoretical explanations should be seen as metaphoric redescription of the domain of phenomena.”5 The Nobel Prize–winning novelist and linguist J. M. Coetzee describes the process succinctly: “One of the chief ways in which science creates new terminology to cover new fields of knowledge is by importing words from elsewhere, giving them a new sense, i.e. by metaphor (Greek metaphero, ‘to carry over’).”6 Metaphors shape the way science works by attracting and organizing “interest” and thereby focusing action.7 Moreover, they engender collectivities of agents who act in their name and thus provide the basis on which humans work in concert to change the world.8 Indeed, we might conjecture that the more successful a concept is theoretically, the more powerfully it performs metaphorically—and vice versa. Consider, for example, that many of the concepts which modern physics advances, like gravity, relativity, uncertainty, and chaos, function simultaneously as theoretical and metaphorical tropes. In all these cases, the concepts perform metaphorical work not only in their nonscientific manifestations but, more importantly, in their scientific ones. Indeed, their imaginary valence is what makes them so useful to science in the first place. Take just the oldest (and yet perhaps still least understood) of these: gravity. As often as we may have been regaled with the tale of an apple landing on a professor’s head—a tale which Newton promoted to legitimate his claim to the discovery—Newton did not discover gravity per se. Rather, gravitas names an ancient concept that encompasses the material, emotional, and moral senses of weightiness, heaviness, and significance. Thus Newton’s theory appropriates the historical and rhetorical accretions of gravitas to affirm a verifiable correspondence between a mathematical construct and the observed patterns of the material world. Through this metaphorical appropriation, Newton rhetorically links the mathematical and the material, facilitating imaginary passage back and forth between realms that might otherwise remain incomparable.9 The metaphor provides a crucial element of the theory. The theory’s meaning and its central metaphor inextricably intertwine precisely because they make the world “make sense,” in a most material fashion, in new and compelling ways. Not all that surprising, I suppose, since this transformational capacity defines metaphor wherever and whenever it happens. In the specific case of immunity, the legal concept predates its biomedical appropriation by at least two thousand years. Originally posited within

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Roman law, immunity rises to scientific comprehension only after Pasteur’s triumphant vaccination experiments at the end of the nineteenth century. Yet as Anne Marie Moulin reminds us, even in such a manifestly scientific context, “the resulting immunity was an obscure image, a poetic borrowing.”10 Of course, this kind of “poetic” appropriation is hardly uncommon and probably not troubling, unless we choose to ignore that it might mean something. The point is not to take issue with bioscience’s use of poesis. To the contrary, we need to appreciate much more palpably the imaginary work that metaphor performs in and as science. The scientific and poetic dimensions of bioscience are not only not opposed; they create each other. All this really means is that like poetry, bioscience is an imaginative activity. However, since bioscience, unlike poetry, has a deep investment in guaranteeing the “truth” of its concepts, it often hesitates to acknowledge, let alone interrogate, this kinship. Never one to ignore unacknowledged conceptual investments, Jacques Derrida meditates on precisely this troubling yet transforming affinity between metaphor and concept in bioscience in the concluding section of “White Mythology” (his famous consideration of “metaphor in the text of philosophy”). Here Derrida reads Gaston Bachelard’s La formation de l’esprit scientifique as suggesting that “metaphor does not appear . . . either simply or necessarily to constitute an obstacle to scientific or philosophical knowledge.”11 Derrida thus invokes Bachelard’s sense that the metaphoric “obstacle” acts as a “counter-thought” (contre-pensée) within scientific rationality, simultaneously manifesting what Bachelard characterizes as science’s “risk” and its “result”(succes).12 As Derrida remarks: [The] epistemological ambivalence of metaphor, which always provokes, retards, follows the movement of the concept, perhaps finds its chosen field in the life sciences, which demand that one adapt an unceasing critique of teleological judgment. In this field the animistic or (technical, social, cultural) analogy is as at home as possible. Where else might one be so tempted to take the metaphor for the concept? And what more urgent task for epistemology and for the critical history of the sciences, than to distinguish between the word, the metaphoric vehicle, the thing and the concept?13

For Derrida, bioscience provides an exemplary instance of the ambivalence—or, dare I say, différance—that metaphor introduces in “truthful” reflection generally. Within the life sciences, Derrida discloses metaphor lurking in its native habitat: metaphor seems, after all, to encompass a process of the living, if not actually a living process. Nevertheless Derrida also recognizes the danger that metaphor poses for bioscience: the

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danger—or anxiety—that the scientist might “go native.” To foreclose this anxious logic, he suggests, we need to avoid recapitulating the classic opposition between empirical reductionism, on the one hand, and what he calls “a fantastic ideology of truth,” on the other. Instead he proposes a new interplay between epistemological and metaphorical effects by reanimating the living metaphor in bioscience. To achieve such a metaphoric renaissance, however, we first need to discern how metaphor informs what we come to know as the vital processes we call “life.” We must, as Derrida exhorts us, “take the risk of a continuity between metaphor and concept, as between animal and man, instinct and knowledge.”14 In reflecting on this risk, which is obviously not born(e) without some cost, Derrida pursues a project initiated in Nietzsche’s famous meditation on metaphor, “On Truth and Lie in an Extramoral Sense.” It is, of course, not coincidental (since Nietzsche specifically questions how science arrives at its “true” representations) that at the same moment when bioscientists affirm the metaphor of immunity’s credibility as a biological truth, Nietzsche depicts all such truth as the forgetting of metaphor: What therefore is truth? A mobile army of metaphors, metonymies, anthropomorphisms: in short a sum of human relations which become poetically and rhetorically intensified, metamorphosed, adorned, and after long usage seem to a nation fixed, canonic and binding; truths are illusions of which one has forgotten they are illusions; worn out metaphors which have become powerless to affect the senses; coins with their images effaced and now no longer of account as coins but merely metal.15

Interrogating truth’s “binding” attributes, Nietzsche proliferates metaphors to foreground the very imaginative activity that those who traffic in truths necessarily obscure. For Nietzsche, the rhetorical force of metaphor underlies all human knowledge about the world because metaphor informs how humans imaginatively engage in the world. Indeed, metaphor performs itself as knowledge—becomes knowledge—by enabling humans to make the world’s otherness familiar. It thereby allows us to transform the world in its and our image. Nietzsche suggests that only in and through metaphor do humans participate in the world as humans: our “humanness” itself perhaps only names a metaphorical effect. Thus he recalls our attention to the rhetorical and poetical transformations which crystallize as truth to affirm the constitutive quality of human agency: creativity. It is unlikely that anyone would argue that bioscience is not creative activity. However, if it relegates metaphor merely to an instrument, bioscientific discourse can all too readily forget the creative work that metaphor

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activates within it. In a simple sense, the desire to know with certainty demands that we tame metaphor’s creative propensities. Left to its own devices, metaphor would roam freely within the gap between the familiar and the unfamiliar. In its most generative mood, metaphor remains inherently unstable and untamed: its very generativity feeds on a wild instability that nourishes new understandings and meanings. Unfortunately, as Nietzsche intimates, when knowledge recognizes and uses metaphor univocally as truth, this creative instability implodes, rendering meanings static and fixed. Any perturbations that metaphor’s unfamiliar incarnations might provoke are contained by the verification processes that establish its “real” correspondences. This semantic containment is undoubtedly productive, helping figural uses of language circulate promiscuously. Like the worn coins that Nietz­ sche invokes or, to deploy another economic image, like the interchangeable parts of a manufactured commodity, it enables them to be taken up and used wherever they appear. The “true” metaphor, now widely accepted at face value and hence “recognized” (or re-cognized) as a token of the real, then fetishistically organizes discourse around itself, allowing the world to appear as if created in its image. Moreover, its participation in this creation remains neglected in direct proportion to how much it changes the world. That is why the metaphors we live by are usually those that we no longer even recognize as metaphors. 16 To escape from this hall of mirrors, as Nietzsche admonishes us, we need to resist our willful amnesia and instead attend more closely to the polished surfaces on which our metaphors reflect true. Recognizing and appreciating the transformational force of metaphor, both within science and within the world, means considering how metaphor matters, not merely as an instrumental manipulation of the world but also as a new way of living in the world.

Remetaphorizing Immunity

Of course, biomedicine does acknowledge that it metaphorically appropriates immunity for scientific purposes. If you look at many immunology textbooks published in the last twenty years, you often find a sentence or two at the outset stating that medicine borrows the concept of immunity from legal discourse and that the word originates etymologically from Latin. However, this ritualized invocation then has no relevance for the ensuing hundreds of pages of detailed information about the biochemical patterns of immune response.17 Consider one of the more elaborate

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examples: the opening paragraphs of Stewart Sell’s Immunology, Immunopathology, and Immunity illustrate the preferred technique of historical and etymological citation: The human organism, from the time of conception, must maintain its integrity in the face of a changing and often threatening environment. Our bodies have many physiological mechanisms that permit us to adjust to basic variables such as temperature, supply of food and water, and physical injury. In addition, we must defend ourselves against invasion and colonization by foreign organisms. This defensive ability is called immunity. Immunity comes from the Latin word immunitas and means “protection from.” In legal terms, immunity means that an immune person is not subject to certain laws (e.g., diplomatic immunity) or is exempt from certain duties (e.g., not required to serve in the armed forces). In medical terms immunity means protection from certain diseases, particularly infectious diseases.18

Leaving aside the questionable etymology that Sell invokes (as we will see, immunitas does not mean “protection from”), his account actually covers over the very imaginary work that it seems to invoke. Sandwiching immunity’s metaphorical derivation between two statements of biomedical faith disguises the transformational force that the figure supplies. Furthermore, the restricted etymology, appended to a list of major biomedical assumptions, implies that immunity’s etymological history offers a logical coda to the premises of medical rationality. Sell’s putative description thus also serves as a prescription that makes the legal concept, immunity, “naturally” coincide with the human organism’s most basic functions. Since he is writing a medical textbook, Sell invokes the legal and political senses of immunity as if they were themselves unproblematic (already known and knowable). He then purports to derive biological immunity through a weak analogy to these trouble-free meanings. The rhetorical strategy here is apotropaic: it wards off the infectious power of recognizing the trope as a trope. The imaginative labor implicit in Moulin’s characterization of immunity as an “obscure image, a poetic borrowing,” disap­ pears in Sell’s account. Instead of recognizing (let alone appreciating) metaphor’s force as a medical technology, the passage applies a sort of etymological determinism where its (supposed) juridico-political significance proleptically anticipates the biomedical concept. In other words, Sell acknowledges metaphor as transformational, but only insofar as it ac­ cedes to medical knowledge as its foreordained truth. Hidden within this conflation of metaphor’s transformative and instrumental uses (characteristic not just of Sell’s textbook but of almost every

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bioscientific treatment of immunity) lies a serious conundrum: To what extent does biomedicine’s investment in determinism as its privileged epistemology diminish metaphor’s significance? For medicine to claim authority as a scientific practice (i.e., one that presupposes linking antecedent causes with recognizable effects), must it renounce metaphor as a creative resource? And if so, what happens when we begin to reanimate the metaphoricity of this biopolitical hybrid called immunity? Could we begin to recognize some of the imaginary work that metaphor performs in its bioscientific incarnations? And would this allow us to appreciate the transformations it brings to bear on the worlds in which we live? To address these questions, we might need to remember precisely what we forget when the metaphor “immunity” functions as biomedical truth. In other words, we might need to reclaim some of the metaphor’s history to apprehend what remains unknown when immunity serves as a conceptual basis for bioscientific practice. Here is one version of this story: For two millennia, immunity refers almost exclusively to privileges and entitlements conferred on individuals or collectivities that exempt them from political obligations and responsibilities. Immunity from prosecution, military service, taxation, legal culpability, or financial indemnity occurs when the law formally sets aside its supposedly universal obligations for particular subjects or groups of subjects. In so doing, legal immunity simultaneously introduces and seeks to contain a deeply disturbing political problem: can the law apply both universally and partially? Indeed, the granting of immunity inscribes a legal paradox: it puts into abeyance, for some citizen-subjects, the general regulatory constraints supposedly incumbent on all citizen-subjects. Indeed, by identifying and constituting particular legal exceptions to the law, immunity negatively affirms the incumbency of the very obligations which it specifically sets aside. Moreover, it does so despite and because it presumes that these same constraints incorporate individual subjects as citizens in the first place (i.e., if it does not presume the constraints as necessary, then it would not need formal exemptions). Thus immunity seems paradoxically to contain the troubling distinctions among “all,” “some,” and “one” that both define and disturb the political domain by foregrounding the exceptions which prove the rule. The standard etymology of the word “immunity” crystallizes this productive yet paradoxical turn. Immunity derives from the Latin (im + munis), where the root munis (from which we also derive our contemporary word “municipal”) gestures toward responsibility for “shared duties, charges, or services” (OED). In its original Roman usage, munus signi-

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fies a range of possible social practices and obligations: service, function, duty, gift, favor, kindness, tax; public entertainment, gladiatorial show, tribute (to the dead), rite, sacrifice, public office.19 Munera are the specific practices that define Roman citizens’ public burden and are therefore required of them as citizens (i.e., the munera confer citizenship by hailing the subject as a citizen of Rome). Through this bond of requirement, Roman citizens affirm their place not only geographically but also politically as Romans. Our contemporary use of the word “municipal” in its dominant sense still foregrounds the constituting force of such practices and obligations. It both identifies them as a kind of power internal to a local authority (i.e., municipal jurisdiction allows civic self-government but not foreign relations) and reciprocally denominates them as the rights and responsibilities accorded to members of such a locality. In Roman law, where the concept first appears, “municipal” denotes a non-Roman person vested with the rights and privileges of citizenship, while municipium denominates a city (often at the periphery of the empire) whose nonslave, nonfemale denizens acquire the rights and privileges of Roman citizens.20 Municipia develop in the fourth century bce to resolve the political, legal, and military complexities that ensue when Roman jurisdiction expands outside the perimeters of Rome. As A. N. Sherwin-White remarks in The Roman Citizenship, during this period “certain customs which a man had originally shared through his status as a Latin [Latinus, dweller in the plain: i.e., belonging to a certain village] began to be regarded as privileges dependent upon residence within the territory of a given state, or as a corollary of duties performed within that state. These privileges could be shared with, or withheld from, a neighbor.”21 By modulating the legal and political status of the inhabitants of previously existing towns encompassed within the sphere of Roman military power, authorities sought to bind these subject peoples to Rome through links of loyalty and interest.22 Simply, they made them “Romans,” albeit of a qualified sort. They thereby introduced the possibility of conceiving citizenship as polyvalent: the central state could correlate local participation with civic rights while modifying these rights and obligations by establishing a limited geopolitical relation to Rome. 23 This possibility has had far-reaching effects, underlying, for example, the American understanding of republican governance with its distinction among federal, state, and local jurisdictions.24 Within Roman law, the establishment of municipia both acknowledges and seeks to resolve the tensions among geographic localizations, political boundaries, and citizenship. In particular, it legally reinscribes the (male,

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nonslave) inhabitants of preexisting yet heretofore alien jurisdictions within an imperial power’s domain. Recognition as a political subject of Rome depends on this remapping: it subjects these new citizens to the rights and responsibilities enjoined by the state and thereby transforms them into its legal subjects while simultaneously, to gain their loyalty, “returning” to them the local political authority that they have heretofore exercised. Municipal status thus collectively confers citizenship on incorporated (and often defeated) cities by transforming their (male, nonslave) inhabitants’ geopolitical otherness and subsuming them within the overarching demands and obligations incumbent on all Roman citizensubjects. First among these obligations is the requirement that they contribute to the well-being of the state with their bodies, with their taxes, or with both. Yet this political recognition takes place outside the boundaries that define autochthonous belonging (i.e., the idea that being Roman derives from being a native in and of the land that is Rome) on which the Romans previously based their citizenship.25 Hence it implicitly reveals the fictional nature of all Roman citizen-subjects. For if non-Romans can legally become Roman citizens (albeit with some limitations and constraints) while maintaining their political relation to the non-Roman localities in which they reside, then how can Roman citizenship “naturally” derive from the embodied localization that defines Rome? The confirmation of Roman citizenship on such municipal subjects thus unwittingly betrays the imaginary work underlying the alignment of place, belonging, and political allegiance that constitutes citizen-subjects more generally. If municipal history evokes the productive and reproductive localizations that territorialize subjects as citizens, then immunity historically reveals the contingency of some, if not all, of the collective practices that putatively found both the sociality and the locality of the state. Immunity reveals the contradiction which subtends this understanding, since those who are immune are both bound and not bound by their subjection. Indeed, immunity as a legal and political category confirms Giorgio Agamben’s observation that the state “is not founded on a social bond, of which it would be the expression, but rather on the dissolution, the unbinding it prohibits.”26 Here Agamben makes the apparently counterintuitive point, at least from the perspective of the dominant political logic, that the state does not represent a coherent or preexistent collectivity. Instead he holds that the state uses its power to negate the forces within a collectivity that work against its cohesion. In this sense, immunity constitutes a quintes-

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sential manifestation of state power: Immunity suspends the binding of particular duties and responsibilities while maintaining the inviolability of the social bond. It negates the dissolution that threatens when supposedly constitutive obligations go unfulfilled by legally reattaching those exempted as immune. Thus immunity uses exceptions to the law to demonstrate that the law remains without exception. Significantly for my purposes, then, there also exists a classification of municipia that designates cities lying outside the Italian peninsula discharged from the payments of tribute expected from other municipal subjects. Denominated civitates liberae et immunes, these cities are defined as being both “free” and “immune,” where the former quality usually— though not always—implies the latter.27 However, the freedom accorded to civitates liberae et immunes constitutes a perplexing form of citizenship. Politically and militarily hailed by Rome, dwellers in these municipia are interpellated within its imaginary domain; however, they are simulta­ neously excluded (if their local governors concur) from the obligations in­ cumbent on citizens who live “in” Rome. In this instance, immunity literalizes the political imaginary as a material effect by distinguishing it from the obligations which purport to attach the citizen to the state. Hence the paradox of immunity makes visible what Étienne Balibar has, in a different context, described as an “alchemy” that “singularizes each citizen. . . . at the same time as it unifies the ‘moral’ body of the citizens.” 28 Since immunity sets aside the particular obligations to which citizenship subjects an individual without dissolving citizenship itself, it reveals a surplus of attachment, a kind of “magic,” if you will, in excess of these obligations that overdetermines the citizen-subject’s conscription by the state. 29 Thus immunity negatively reveals the imaginary marking—and making—of citizens as subjects and distinguishes this subjection from any particular obligations to which it subjects citizens. Conversely, however, immunity’s etymological antonym, “community,” affirmatively transforms this negative condition. Denoting obligations or responsibilities performed with others, whether within a state formation or not, community can refer both to a “municipal corporation” and to a sharing “in common” without specific regard to the province of the state, as in “communication” or “communion” (OED).30 Four centuries after Rome begins granting some municipia immunity, the early Christian usage of “community” also opposes itself to the political designation (munus); however, in this case community signifies the transcendent citizenship of those reborn in Christ. The “surprising” injunction stipulated in Matthew

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22:21 to “render unto Caesar that which is Caesar’s—and unto God what belongs to God” not only discriminates among temporal and transcenden­ tal responsibilities but also sorts modes of subjection. It therefore specifies the kinds of subjects that Christian community engenders. One can be immune before Caesar, but no one can be immune before God (not even his own son). The emperor Constantine first brings immunity and community together in the fourth century ce when he relieves Christian clerics from se­ cular munera so that they can devote themselves to divine worship.31 Hence, within the late Roman Empire, Christian community paradoxically offers a limited immunity from the obligations (munera) that constitute the political responsibility of the Roman citizen-subject. This torsion inaugurates a complex negotiation between religious and political authority—between church and state—that will unfold well into the modern period. Immunity’s new ability to mediate between political and religious claims expands when communal obligations begin to supersede municipal ones. As Hannah Arendt observes in The Human Condition: “After the downfall of the Roman Empire it was the Catholic Church that offered men a substitute for the citizenship which had formerly been the prerogative of municipal government. . . . It was always an essentially otherworldly concern which kept the community of believers together.” 32 Following on this substitution, immunity’s legal and political role swells as church authorities increasingly seek to ensure their sovereignty against the claims made by secular rulers and conversely as secular rulers increasingly seek church support to ground their authority. While this brief overview cannot consider immunity’s complex unfolding, the category proves critical to Western notions of subjectivity and statehood from late antiquity onward. Early modern monarchs seeking to shore up their kingship often grant lands and immunity to churchmen in exchange for their prayers for the stability of the realm.33 Such grants protect church properties from incursions by royal agents or recuse them from submission to legal proceedings while conversely confirming the landholders’ positive responsibilities for imposing peace and order within their jurisdictions. For example, augmenting its authority by patronizing churches to which it grants immunity, the Carolingian dynasty permits certain bishoprics the right to their own law and custom and thus to create their own self-governing communities.34 This formula for immunity becomes a model for other, nonecclesiastical grants of property which guarantee the immunist a freedom to exercise jurisdiction within the

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boundaries of the property granted (e.g., certain lords and nobles can as­ sume the right to collect fees that would otherwise go to the king). In these early modern cases, property itself carries immunity—much like the Roman civitates liberae et immunes—not the individuals who retain the property. However, by the twelfth century, immunity’s meanings begin to migrate, metonymically applying to the landholders and residents of immune domains as well as to the land itself. When rights claims begin to derive from the notion that an individual owns his or her body as his or her property (as we will see in chapter 2), the notion of immunity is abstracted to include individual citizen-subjects as well. This abstraction accelerates across the modern period—and indeed continues today, as the recent claims to immunity for overt acts of violence and murder by private military companies employed in Iraq by the U.S. State Department, like Blackwater Worldwide, make troublingly clear. Throughout the preponderance of its two-thousand-year history, then, immunity has no “natural” significance whatsoever, serving exclusively as a legal and political concept, and a complicated and dynamic one at that. Since the late Roman Empire, immunity negotiates complex legal relations among individuals in the West, specifying both the necessity for, and the limits on, mutual obligations that map the relational space which we call “the political.” For almost two millennia, immunity has organized our sense of how we live together by designating those exceptions to the collective responsibilities that seem to define the political rule. Still today, politics marshals immunity to define the parameters of international law in a world increasingly marked by the economic permeability of national dominions. Immunity’s province, then, has not only historically been political; it has actively served—and continues to serve—to circumscribe the domain of human action that legally constitutes “the political.”

Creatures of the Law

If immunity places you beyond the law, it is also always a matter of the law. Sometimes, however, immunity also proposes a law of matter—living matter, that is. Biological immunity circumscribes living beings within the law in a concrete way. To say that organisms require immunity to survive implies not only that they conform to the laws of nature in a general sense but also that their complex physiologies correspond to the nuances of the law in their innermost workings. Undoubtedly the idea that our bodies obey

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natural laws seems common sense to us. Think of the ubiquitous example given in the recent “science wars” polemics: whether or not we believe that science represents the truth about the world, when we jump off a balcony, our bodies obey the law of gravity.35 In this example, our subjection to natural law appears self-evident because its empirical consequences appear inescapable (though we have collectively figured out how to compensate for, if not defy, the law of gravity on a regular basis, as we do each time we take an elevator or an airplane). Certainly the case of gravity seems incontrovertible: human beings live within a domain governed by the laws of nature whether we believe that such laws exist or not. The idea that our physiologies manifest lawful patterns represents a somewhat different proposition, however. Invoking the juridical paradigm of paradigms (“the law”) to describe organismic processes suggests that “our nature” enacts the same kind of rationality that underwrites our systems of social regulation. To say that biological processes unfold strictly according to natural laws supposes that normative constraints, imposed by the physical necessities of our world, “govern” the ongoing events which substantiate our aliveness and regulate all our cellular and molecular activities. Moreover, it assumes that recognizable and assignable relations of responsibility exist among these sequential and consequential events, such that some cause others that follow them. Thus it implies that all the minutiae of our life processes unfold systematically according to a noncontradictory logic both accessible to, and inscribed in, human reason. Indeed, it all too often presumes that human knowledge—even if not yet exhaustive—could ultimately encompass all the living complexities that animate our bodies (at least once we identify the regularities that subtend them). Yet if immunity proposes (or imposes) a legal order to (or on) our living nature, what do we mean exactly when we imagine that our biological existence conforms to natural laws? Scientific medicine holds that biological processes appear lawful because they incorporate the same fundamental characteristics which all (known) matter displays. This reductionist principle assumes that bioscience can analyze living phenomena in the same terms that chemistry and physics use to parse the world.36 For its purposes, then, bioscience defines living matter as nothing more, and nothing less, than a concatenation of physico-chemical reactions localized in time and space. In so doing, it presumes that the universe occurs in “layers” (a word etymologically related to “law”) such that the “lower,” more foundational levels act as inviolable constraints on each “higher” order. 37 Thus,

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for true-believing reductionists, science can describe even as complex and dynamic a phenomenon as “evolution,” which seeks to account historically for the diversity of all living beings, solely in biochemical terms. Richard Dawkins does exactly that in his exposition of the “selfish gene”: he ascribes the aggregate effects of terrestrial organisms, including the aggregations called human cultures (and hence medicine and bioscience themselves?), to underlying biochemical events precipitated by a crystalline molecule that we now know as dna.38 This biomolecular presumption subsequently forms the basis for the polemical schools of thought called sociobiology and evolutionary psychology, which explain all social and psychic dynamics within and between humans as effects of “gene expression.” Needless to say, these radically reductionist theories raise the hackles of some of our species who resent, or at least resist, the imputation that our lives are lived in molecular enthrallment. Numerous critics have disputed the assumptions underlying such biomolecular (a.k.a. genetic) determinism, illustrating how they function as both biological and political ideology.39 However, except for these challenges to the political impli­ cations entailed by the biochemical determination of individual or collective human behavior, biochemical reductionism itself remains largely uncontested as the basic principle of explanation in the life sciences. 40 Before reductionism assumed this unquestioned dominion over Western medical thinking during the last half of the nineteenth century and the first half of the twentieth, however, numerous scientists and nonscientists alike affirmed a more holistic principle called “vitalism.” 41 Simply put, vitalism holds that while living beings may encompass the same materiality as the rest of the physical world, they also incorporate an irreducible force or principle not present in inanimate matter. While some of the many forms of vitalism derived from philosophical, metaphysical, or theological premises, others proceeded empirically, driven by the inability to localize the continuity of life (either ontogenetically or phylogenetically) in the inner workings of matter. Some even consider the great nineteenthcentury French experimentalist Claude Bernard (discussed at length in chapter 3) a vitalist for holding that while physico-chemical reactions may account for the metabolic activities through which life transpires and hence expires (he identified these reactions with death), they do not explain the ongoing creative or synthetic processes that support life either within the individual or between generations.42 Bernard’s experimental attitude toward vitalism demonstrates that a commitment both to physico-chemical analysis and to determinism—for which his Introduction

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à l’étude de la médicine expérimentale (1865) provides the first definite epistemological statement—does not trump an appreciation for what he perceives as the nonreducible aspects of living organisms. Despite vitalism’s resilience as an explanatory framework for biological experimentation, its plausibility as a scientific premise nevertheless provoked intense scrutiny and opposition throughout the nineteenth century. As biology and medicine eagerly applied new developments in chemistry and physics, they repeatedly discovered phenomena that challenged vitalism’s basic suppositions. For example, when chemists began to manufacture organic compounds from inorganic components in the 1830s, they undermined the ontological specificity of organic matter and instead proposed an unbroken continuity between the inanimate and the animate. Later in the century, investigators applied the principle of the conservation of energy to the complexities of animal respiration, thereby encompassing living processes within the basic laws of physics.43 Darwin’s theory of evolution—along with Lyell’s earlier work on geology and Cuvier’s work on comparative anatomy—could also imply that life was not a special case but unfolded from more basic physico-chemical phenomena that preceded it. These, along with many other important discoveries, including insights about the composition of molecules, the effects of electricity, and the uniformity of the universe’s elemental constituents, increasingly undermined vitalism’s insistence that there was more to life than matter. Although vitalism remained a plausible scientific option even into the first decades of the twentieth century, it rapidly lost much of its persuasive force. By the time that Watson and Crick analyzed dna’s molecular structure in the 1950s, demonstrating the biochemical underpinnings of genetic inheritance, vitalism seemed evacuated of all its scientific, if not “rational,” credibility.44 For most contemporary biomedicine, vitalism constitutes a dead issue.45 Instead, today’s bioscience assumes that physico-chemical reactions can account for pretty much everything we need to know about the processes of life. Not surprisingly, immune discourse actively participates in this antivitalist cause. By investing in a material activity localized either in cells (phagocytes) or in molecules (antibody-antigen reactions), late-nineteenth-century immunology exorcizes the specters of vitalism that haunted the idea of healing. Indeed, immunology’s enthusiastic investment in biochemical reductionism led it to devote itself almost single-mindedly to analyzing the biochemical events underlying specific antibody-antigen reactions throughout the first half of the twentieth century. As a consequence, it largely ignored the biological dynamics of cel-

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lular immunity from which it first emerged (i.e., Metchnikoff ’s “phagocytosis”), which have become so interesting to immunology since then.46 Instead immunology so effectively promoted biomolecular specificity as its main object of interest that this paradigm became an overarching frame for much biomedical theorization during the period. For example, as Lily Kay illustrates, before the adoption of information as a compelling bioscientific metaphor (precipitated after World War II by cybernetics), specificity, specifically derived from immunology, pervaded most thinking about genetic inheritance.47 Thus the case of immunity, rather than simply applying reductionism as a bioscientific premise, instead provides one of its exemplary instances. Furthermore, by borrowing against its ancient juridico-political capital, immunity makes the “lawfulness” of such biochemical reductionism seem entirely natural.

On the Natural Properties of the Law and the Legal Properties of Nature

While we have entertained the idea that matter behaves lawfully for a few centuries, the adoption of immunity as a vital function at the end of the nineteenth century brings animate matter into the penumbra of the law in a dramatically new way. Indeed, we might say—and not just rhetorically—that immunity makes the law matter for biology and consequently makes biology a matter of law. Endowed with a rich juridical and political inheritance, immunity metaphorically carries over the legal logic that historically animates it into biological texts and contexts where it now circulates freely. As we will consider in chapter 4, when scientific medicine incorporates biological immunity as a robust concept to explain the success of Pasteur’s vaccination experiments in the early 1880s, it retroactively, if surreptitiously, confers the status of natural law on germ theory. Until immunity legalizes the microbe as the causal agent of disease from which immunity implicitly exempts an organism (thus negatively anointing it as the hostile entity against which an organism must defend itself), germ theory contended with a number of competing theories of disease causality.48 Moreover, as Nancy Tomes and John Harley Warner remind us: “There was no ‘germ theory of disease’ transcendent over time, but rather many different germ theories of specific diseases being debated in specific communities, times and places.”49 When immunity invests the microorganism as a biomedical and biopolitical agent whose “aggression” conjures up a countervailing “legal” reaction within the organism, it

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figuratively bestows physiological legitimacy—or indeed lawfulness—on the tenets and values of germ theory. By characterizing as “immunity” an organismic dynamic that disrupts the link between pathogen and illness (presumed by germ theory), the biomedical imagination reciprocally ordains the continuity between pathogen and illness as a matter of (natural) law. Of course, you may have noticed a slippage in this train of thought between two different uses of “the law”: one political, the other scientific. This is neither a mistake nor a rhetorical sleight of hand. Rather, it marks the conceptual innovation that makes immunity both so useful to bioscience and so central to contemporary ideas about how we live in the world.50 By finessing the distinctions among natural law’s different valences, biological immunity weaves together politics and science and thus manifests its own biopolitical hybridity (in Latour’s sense). As a hybrid that incorporates what we could call “social nature” (to hijack Donna Haraway’s term), biological immunity fuses two distinct traditions of natural law to affirm the lawfulness of life itself. 51 On the one hand, given its juridical legacy, it evokes a sense of natural law that finds a foundational authority for social regulation in moral precepts given by “human nature.” In this theory, derived from medieval Christian theology, the nature of the world and the nature of humans (as given by God) dictate regulative principles for behavior, which the law then codifies. According to this view, since reason defines the attribute most “natural” to humans (again because ordained by God), law incorporates human reason as a normative frame. As Thomas Aquinas put it: “The rule and the measure of human acts is reason, which is the first principle of human acts.” 52 Or as William Blackstone, the great codifier of English law, opined: This law of nature, being coeval with mankind and dictated by God himself, is of course superior in obligation to any other. It is binding all over the globe, in all countries and at all times; no human laws are of any validity if contrary to this; and such of them as are valid derive all their force, and all their authority, mediately or immediately, from this original.53

On the other hand, as a medical framework, biological immunity also invokes the scientific sense of natural law. This legal idiom refers either to statements that descriptively characterize the material uniformity and regularity of the world or to principles that prescriptively govern its manifestations. Today philosophers of science debate the epistemological status of the laws of nature, trying to adjudicate between laws as statements about the way the world is (description) and laws as statements about the way the world must be (prescription). However, the presumption under-

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lying both positions holds that “law” normalizes matter (in the statistical as well as sociological senses) and thereby makes matter intelligible to human reason. Thus, whether science invokes natural law to describe how the world is or how it should be, it implicitly affirms that humans can rationally understand the world because reason constitutes the basis both for nature and for human nature. To understand how biological immunity enfolds these political and scientific valences of natural law, we need to briefly consider why the metaphor “law” applies to nature in the first place. Natural law emerged during the Renaissance as a way of characterizing the regularities of the physical world. Although manifold (and much disputed) complexities led to this conceptual innovation, scholars generally agree that the axiom that matter behaves lawfully marks the threshold of scientific thinking.54 Associated variously with Roger Bacon (c. 1220–92), Copernicus (1473–1543), Kepler (1571–1630), Galileo (1564–1642), Descartes (1596–1650), and Newton (1643–1727), among others, the idea that fixed laws order the material world radically transformed both the notion of law and the notion of nature. In one derivation, the application of legal form to physical matter incorporated a Judeo-Christian presumption that God’s divine authority (i.e., his law) guarantees the rational ordering of the universe, so that natural laws obtain prescriptively as well as descriptively.55 According to some historians of science, this metaphorical use of law first appeared during the transition from feudalism, when monarchs increasingly centralized their political authority through the rule of law.56 For these interpreters, the temporal legitimation of monarchical power reiterates claims about how divine authority governs nature and thereby defines its laws. In a competing historical account, law characterizes natural phenomena not because it manifests divine authority per se but because semantically the Latin use of lex (law) merged with regula (rule or guideline). It thereby refers not just to political or juridical regulation but also to practices governed by custom or principle.57 The use of law to characterize material regularities, then, supposes a socially normative rather than a theological force, where the law’s authority derives from its iterability rather than its inevitability. Whatever its genealogy, when law appears to regulate matter, it carries with it a few important assumptions about how the world organizes itself. Paramount among these reigns the notion that insofar as nature operates according to fixed laws, it behaves rationally. The implication here is twofold. On the one hand, nature’s “reasons” correspond to human reason such that natural order makes itself accessible to our analysis; on the other

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hand, the laws that “govern” nature affirm the intrinsic logic of the world as rational, that is, noncontradictory. By defining the world’s structure through a principle of order and judgment that both derives from and gives shape to human social relations, modern science upholds the world as knowable in human terms—even if God first gives them to us. Moreover, by appropriating the law, whether secular or divine, modern science defines such knowability (and “know-ability”) as universal, intelligible, measurable, and predictable. These assumptions radically refigure the interplay between law and nature, enabling law to define the natural order whether that order is material or political. Thus, in the turn of phrase that Francis Bacon attributes to James I: “Kings rule by their laws as God did by the laws of nature.”58 Whether or not the first of the Stuarts ever actually uttered this telling aphorism, its attribution reveals the explicit turning back of nature onto and into politics that Latour elucidates. The analogy between the king’s laws of the realm and God’s laws of nature performs a critical function for the sovereign: it implies that the force that makes monarchical law legitimate, and hence enforceable, evinces the same degree of necessity as the divine laws which regulate the material world. In making this comparison, the temporal sovereign elides, or literally hides, the violence that undergirds his legal jurisdiction. Indeed, politics inevitably naturalizes such violence, making its immanence into the basis for the law’s authority. Jacques Derrida meditates on this paradox in his essay “Force of Law: The ‘Mystical Foundation of Authority.’ ” Here he argues that the law always contains a violence that it also contains. In other words, for the rule of law to contain (rein in) violence and thereby pacify social relations, it must also contain (hold) a violence that enables it to reign. As Derrida remarks: Applicability, “enforceability,” is not an exterior or secondary possibility that may or may not be added as a supplement to law. It is the force essentially implied in the very concept of justice as law (droit). . . . There are, to be sure, laws that are not enforced, but there is no law without enforceability, and no applicability or enforceability of the law without force, whether this force be direct or indirect, physical or symbolic, exterior or interior, brutal or subtly discursive and hermeneutic, coercive or regulative, and so forth. 59

Derrida’s violent disclosure here reveals that social order, like all order (according to the Second Law of Thermodynamics), comes at a cost. Governance requires force. In the political domain, this imposition of force

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often imaginatively appears at (or as) an original moment, located somewhere in the past, where violence institutes a new legal jurisdiction. For example, the mythic understanding of political revolution often defines it as a violent overturning that inaugurates a new, more just, and lawful society. Yet as Derrida reminds us: “This founding or revolutionary moment of law, is in law, an instance of non-law.”60 Thus, he suggests, the law’s foundations contradict themselves, making them “mystical,” precisely because they incorporate what must constitutively remain outside the law as the law’s inaugural moment. The law then appears noncontradictory, and hence rational, only to the extent that it disavows its contradictory dependence on nonlawful violence as its raison d’être.61 As we will see, this disavowed violence rebounds into “the law”—both political and biological—through a defensive logic which presupposes both that human life transpires within an inevitably hostile ambience and that it must incessantly protect itself from this “natural” danger. In light of Derrida’s insights about the law, we can discern a similarity in the way the law betrays itself both in social relations and in material processes. The political and scientific uses of natural law both stem from theological interpretations (mostly Christian) that derive the order of the world from God’s authority. The transformations of European legal thinking between the fifteenth and seventeenth centuries incorporate these new understandings about God’s systematic presence on Earth. As we will see in chapter 2, fundamental legal doctrines that we continue to affirm today, especially habeas corpus, appear within the horizon of the violent European exploration and exploitation of Africa, Asia, and the Americas,62 as well as after Luther’s protests against the Roman Church, and the bloody and extensive religious and political wars that followed, including the English Civil War. At this volatile historical juncture, the exponents of legal theology seek to establish a secure, or indeed “natural,” foundation for both religious and temporal power, while the proponents of science seek to establish the lawfulness of nature itself.63 Thus, from the seventeenth century onward, natural law appears to secure order both in the realm and in the world.

The Legal Defense of Property

Pursuing this natural legal imperative, the early modern theorists of rights, like Grotius, Selden, Hobbes, and Locke, extrapolate from Christian polemics about God’s and man’s dominion on Earth.64 Property forms one of

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their main theoretical concerns, since its legal status inscribes the human appropriation, use, and control of the natural world. In these juridicotheological disputes about property—which once again turn on the opposition between description and prescription—religious and political authorities both negotiate and legitimate their respective claims to earthly power. Richard Tuck traces the modern transformation of nature into property to controversies arising within the Roman Church in the late thirteenth century and the early fourteenth. According to Tuck, disagreements between Dominicans and Franciscans concerning the appropriateness of apostolic property (Dominicans) versus apostolic poverty (Franciscans) gave rise to rival theories concerning the nature of property itself. While the Franciscans opposed the church’s acquisitive impulses, holding that, in the words of Duns Scotus, “the use of things, following right reason, is allowed to men in so far as it conduces to harmony, peaceful intercourse and necessary sustenance,”65 the Dominicans who occupied the Papal See demurred. In rebutting the Franciscans’ early communalism, Pope John XXII affirmed that “God’s dominium over the earth was conceptually the same as man’s dominium over his possessions.”66 In equating humans’ proprietary interests with God’s possession and command over the earth, the church’s advocates effectively established a new proprietary principle. In legitimating their own right to hold and transfer property, church authorities asserted that humans’ place in the world conceptually mirrors that of God. In so doing, they introduced the notion that dominium or property not only describes God’s possessive relation to all his creation but also transfers this proprietary claim of global proportions to his creature-of-choice: “[Property] is not a phenomenon of social intercourse, still less of civil law: it was a basic fact about human beings, on which their social and political relations had to be posited.”67 While first conceived during the medieval period, this juridico-theological naturalization of property produces some of modernity’s most enduring principles; our relations to the world, to each other, and to ourselves all travel through its ambit. Obviously property’s vast legal and philosophical history exceeds our concerns here. However, we need to consider one of its important, though little noticed, consequences for a moment to grasp a fundamental issue that immunity’s biological incarnation presumes. If property supposes dominium and dominium implies control, then loss of control means loss of property. To retain property as property requires a defense against its loss. In the mid-seventeenth century, when natural law construes the body as a human possession, that is, as personal property, it mandates bodily defense as a possessive

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imperative that politically safeguards the person as a person. Thus, at least two centuries before bioscience conjures immunity to describe how the (human) organism defends itself, self-defense already appears as a foundational principle of natural law. In its original juridico-political context, the doctrine of self-defense literally and naturally establishes the individual as the paramount form of personhood. It locates the person in a body constituted as its own property—that is, in a body “owned” by “the self.” It thereby determines the self as a kind of owner of itself, or at least as a being that relates to itself as a form of property. Consequently, to remain itself, it must defend itself from the appropriative violence of others.68 Self-defense first emerges, then, as a juridico-political precept which affirms an “innate impulsion to keep going” common to all physical processes, so that any violent attempt to interrupt this impulsion naturally evokes its opposite.69 Until Metchnikoff conjures “defense” in the early 1880s to name the cellular events he identifies as immunity, self-defense remains an exclusively political doctrine. Before his innovative use of this concept, no physiological meaning for organic “defense” exists. Natural law initially enjoins self-defense on the individual as a political matter. Only two centuries later does it enter by analogy the nature of living matter. The classic discussion of this political principle appears during the midseventeenth century in the writings of Thomas Hobbes. While not immediately addressed to the Canon Law debates briefly touched on earlier, Hobbes elaborates on the proprietary logic developed in these polemics.70 From Hobbes’s perspective, self-possession describes a fundamental form of self-relation. As he writes in Leviathan (1651): “Of things held in propriety, those that are dearest to a man are his own life & limbs.” 71 The idea that our lives and bodies are “things held in propriety” radically reimagines the nature of human existence.72 It introduces the idea that the immanence of human existence cleaves between proprietor and property. No longer does the human organism live its immersion in the sensuous world either as a play between contiguity and contingency or as a gift from God. Rather, the person now emerges as a duality that relates to itself, by way of a legally recognized relation called property, as the owner of itself. In this formulation, to be a person means, first and foremost, to have a body, where the “being” of the person resides (literally) in the “having” of the body. As I discuss at length in chapter 2, John Locke explicitly draws out the implications of this conclusion in his famous statement in Two Treatises of Government: “Every Man has a Property in his own Person. This no Body has any right to but himself.”73

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Like his contemporary René Descartes, Hobbes comprehends human bodies as objects that incorporate basic physical or mechanical principles. In the opening chapters of Leviathan, Hobbes derives all attributes of human experience from the physics of “bodies” (meaning objects that have mass and motion). He then insists that the complexities of human actions resolve into simpler elements, themselves immediately governed by the laws of nature.74 When a Body is once in motion, it moveth (unless something els hinder it) eternally; and whatsoever hindreth it, cannot in an instant, but in time, and by degree quite extinguish it: And as wee see in the water, though the wind cease, the waves give not over rowling for a long time after; so also happeneth in that motion which is made in the internall parts of a man, then, when he Sees, Dreams, &c.75

For Hobbes, all human behavior analytically reduces to a concatenation of forces and effects which play through and on material assemblages of sense organs, nerves, muscles, imagination, memory, and reason. As C. B. Macpherson affirms: “This was Hobbes’s striking scientific hypothesis. All human actions could be resolved into elementary motions of body and mind which the scientist could recombine in a way that would explain everything.”76 Hobbes systematically derives all human actions and volitions from this material premise and then deduces as a first principle what he calls the “Right of Nature”: “the Liberty each man hath, to use his own power, as he will himselfe, for the preservation of his own Nature; that is to say his own Life; and consequently, of doing any thing, which in his Judgement, and Reason, hee shall conceive to be the aptest means thereunto.” 77 The preservation of one’s own “Nature,” which Hobbes identifies here with one’s own “Life,” frames a putatively “reasonable” political (and perhaps biopolitical) imperative. Moreover, it grounds the legal status of the contractual relations which, for Hobbes, give rise to “the Commonwealth.” Life, conceived both as a locus of vitality which resists death and as the enduring procession (and possession) of the human organism, defines the nature beneath all political aggregations. Hence politics is a kind of physics. As Hobbes avers in Philosophicall Rudiments concerning Government and Society, insofar as humans live, a vital inertia physically and politically impels them to resist death: For every man is desirous of what is good for him, and shuns what is evill, but chiefly the chiefest of naturall evills, which is Death; and this he doth, by a cer-

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tain impulsion of nature, no lesse then that whereby a Stone moves downward: It is therefore neither absurd, nor reprehensible; neither against the dictates of true reason for a man to use all his endeavours to preserve and defend his Body, and the Members thereof from death and sorrowes. . . . Therefore the first foundation of naturall Right is this, That every man as much as in him lies endeavour to protect his life and members.78

Like the natural law which inexorably guides the downward movement of a stone (which Newton will in the near future call gravity), there obtains by analogy a natural law that leads humans away from death. Impelled by this lawful inertia, there exists the “naturall Right” to “protect his life and members,” that is, “to preserve and defend his Body.” Thus in Leviathan Hobbes defines as “a Law of Nature” “a Precept, or a generall Rule, found out by Reason, by which a man is forbidden to do that, which is destructive of his life, or taketh away the means of preserving the same; and to omit, that, by which he thinketh it may be best preserved.”79 Combining these premises, Hobbes proclaims “the Fundamentall Law of Nature”: “The first branch of which Rule . . . is, to seek peace and follow it. The Second, the summe of the Right of Nature; which is, By all means we can, to defend our selves.”80 By identifying life as nature’s fundamental attribute in humans and by then affirming the continuity of that life in the same body as the essential (a.k.a. natural) self-relation, Hobbes transforms the human body’s preservation into the natural locus of political subjectivity.81 When Hobbes imagines “body” as a discrete, movable mass (as does his intellectual hero Galileo), he generalizes physical properties ascribed to the inanimate world, applying them to the animate human body. He thereby grounds a political physics on the “reasonable” obligation that the body conserve its living momentum. In this scenario, the human body relinquishes its immersion in its life context—including other living humans—and presents itself as a moving and movable mass that bears life. The vital qualities that animate this atomized subject remain secondary. The connections to the world that make life possible and the coexistence with other living beings that makes life livable initially disappear. Instead Hobbes “naturally” renders the living human being singular in its struggle against death. Connection to the world and to other humans reappears only then through this struggle against death, especially with other humans, who readily put each other to death in their efforts to preserve their own lives. To explain this assumption’s inevitability, Hobbes inserts between his initial declaration of the “Law of Nature” and his subsequent statement

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of its “First Fundamentall” form a link that justifies this specific application of the more general principle: “The condition of Man . . . is of Warre of every one against every one.”82 With this bellicose aphorism, Hobbes reduces the complex potentialities and vulnerabilities engendered by coexistence among human organisms to incessant battle. War provides the model for relating socially, politically, and economically, because it “naturally” ensues from the inertial characteristics (of bodies and motion) which ground Hobbes’s political physics. Moreover, war defines the prevailing pattern of interactions among humans, who are now conceptually atomized as individuals insofar as they possess their own bodies. Over the next two centuries, politics and economics invest in this besieged physical (though not yet biological) body as the vital basis for human collectivity (as we will discover in chapter 2). Subsequently it is extrapolated as a general principle which describes not just human interaction but also the organic world itself (as chapters 2 and 3 suggest). Thus, as we will discover in chapter 4, two hundred years after Hobbes, a zoologist like Metchnikoff can unreflectively incorporate this biopolitical framework to describe the interactions among humans and microbes as a champs de bataille, a field of battle, without anyone noticing the metaphor’s embedded political assumptions. Indeed, this conceptual possibility seems prefigured—if not predestined—by Hobbes’s own formulation, since war for Hobbes describes not an event but an environment. As Foucault points out in his reading of Leviathan: “[In Hobbes] we are not at war; we are in what Hobbes specifically calls a state of war.”83 Hobbes’s original description makes the point explicit: Warre, consisteth not in battell only, or the act of fighting; but in a tract of time, wherein the Will to contend by Battell is sufficiently known; and thereof the notion of Time is to be considered in the nature of Warre; as it is in the nature of Weather. For as the nature of Foule weather lyeth not in a showre or two of rain; but in an inclination thereto of many days together: So the nature of War, consisteth not in actuall fighting; but in the known disposition thereto, during the time there is no assurance to the contrary.84

Hobbes construes war as the climate within which human relations unfold. As his meteorological analogy indicates, war appears as a natural element that impinges on human development. This construal then characterizes human dynamics primarily through the potential for violence and death that war incorporates. Indeed, Hobbes’s generalization of war metaphorically invokes imminent death at the hands of other humans

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as the ambience in which humans live. Not coincidentally, this insight brings us to another famous aphorism, appearing just a bit farther down the same page: “Whatsoever therefore is consequent to a time of Warre. . . . Worst of all [is] continual feare, and danger of violent death; And the life of man, solitary, poor, nasty, brutish, and short” (186 [62]). Life appears only negatively here as that which resists its own negation. In its natural habitat, human life possesses no positive attributes. Hobbes rhetorically emphasizes this constitutive negativity by elaborating a long list of everything it lacks: In such a condition, there is no place for Industry; because the fruit thereof is uncertain; and consequently no Culture of the Earth; no Navigation; nor use of the Commodities that may be imported by Sea; no commodious Building; no Instruments of moving, and removing such things as require much Force; no Knowledge of the face of the Earth; no account of Time; no Arts; no Letters; no Society. (186 [62])

In its own natural realm, living matter accrues no interest. Human existence has no intrinsic worth as a life-form, since this life perpetually exposes it to death—either its own or that of others which it inflicts: “the condition of meer Nature which is a condition of Warre of every man against every man” (196 [68]). Only in a polity or commonwealth where citizens find shelter from the bellicose environment which naturally befalls them do they reap the “fruits” of “industry,” “culture of the earth,” “navigation,” “commodities,” and so on. Only collective governance (or acquiescence to a sovereign power, as Hobbes avers) modulates the multiplicity of singular combative wills. By their individual submission to a central power, it overwhelms them all. In other words, Hobbes defines sovereign power’s positive function as negating the negative effects that naturally devolve when humans follow the intrinsic and belligerent movements impelled by their own natural inertia. This negative formulation provides the (negative) basis for Hobbes’s quintessential definition of liberty: “By liberty is understood, according to the proper signification of the word, the absence of externall Impediments” (189 [64]). Or as he reframes it later, “Libertie, or Immunitie from the service of the Commonwealth” (266 [110]). Here immunity receives a new inflection under the sign of liberty. Drawn from its early modern extension to the denizens of immune domains, immunity now appears as a negative form of freedom. Immunity gestures toward a “free” space carved out from the sphere of obligation entailed by the commonwealth,

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an obligation incurred in exchange for the commonwealth’s protection against—or negation of—the state of nature’s life-negating effects. Indeed, Hobbes redoubles this negative assessment precisely by confining “Libertie” exclusively to the sovereign—whose existence alone mitigates nature’s fatal flaws—since no “particular man” can claim such immunity as a right whether “a Commonwealth be Monarchiall, or Popular” (266 [110]). From the late seventeenth century on, immunity circulates within this spiral of negativity. Its political applications henceforth denote the space of freedom as a place beyond the law, a conceptual domain cut from within the law by the specific negation of its jurisdiction. There is no affirmative or positive content to liberty defined as “the absence of externall Impediments,” or “immunitie from the service of the Commonwealth,” no specification of what Foucault will come to describe as “practices of freedom.” Rather, Hobbes’s sense of immunity denotes the mitigating of an impingement that itself provides a bulwark against the incessant tides of violence and death which characterize unrestrained human nature. Hobbes’s apposition “Libertie, or Immunitie” directs us to an important aspect of modern subjectivity and modern embodiment which immunity’s medical conscription will biologize two hundred years down the road. According to a contemporary of Hobbes, the philosopher Baruch Spinoza, since its earliest incarnations modern philosophy imagines human beings as what Spinoza calls “a kingdom within a kingdom.” Most writers on the emotions and on human conduct seem to be treating rather of matters outside nature than of natural phenomena following nature’s general laws. They appear to conceive man to be situated in nature as a kingdom within a kingdom: for they believe that he disturbs rather than follows nature’s order, that he has absolute control over his actions, and that he is determined solely by himself.85

This passage, which appears as the preface to book 3 of The Ethics (1677), alerts us to a collapse between the laws of nature and the laws of nations that imbues Hobbes’s political physics. As Warren Montag reflects, Spinoza’s telling use of this regal metaphor reveals how “an entire philosophical tradition has confused laws of nature, which describe what necessarily exists, with social laws which prescribe how things ought to be, but may not, and physical power with legal power.”86 Similarly, when Hobbes affirms self-defense as a natural right, he conflates the natural law which he describes as material necessity (entrained in the physical interactions of bodies and motion) with the prescriptive force that he desires his juridico-

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political formula to contain. Thus we glimpse how “kingdoms within kingdoms” unwittingly betray control fantasies. With respect to humans, this fantastic conflation also paradoxically reduces the natural to the political. While he adduces his principles “geo­ metrically” from “bodies and motion,” for Hobbes, the primary laws impinging on humans derive not immediately from the natural world but mediately from the political. Indeed, Hobbes’s “Fundamentall Law of Nature” specifically aims to rein in the violence that naturally inheres in “meer Nature.” Conversely, Hobbes’s kingdom within a kingdom, or perhaps “law within a law,” fabulates a juridico-political order as constant and inevitable as the material universe. Spinoza’s critique of this juridicopolitical idealism reminds us that human beings—like all beings, animate and inanimate—always already exist as bodies among other bodies, matter swimming in a sea of matter. Yet when modern politics imagines itself as distinct from nature, as determining its own order (as Latour suggests), it construes itself not as a part of, but rather as apart from—or even opposed to—the natural world in which it lives. When bioscience recruits immunity at the end of the nineteenth century to describe the abilities of—and the presumed necessity for—organisms to “defend themselves” against the pathogenic microbes that live around and within them, it turns this quintessentially modern trope back into animate nature. In other words, it identifies a hybrid legal and political mechanism, immunity-as-defense, as the natural basis for the endurance of living organisms. Conceived as a biological function, immunity-as-defense thus metaphorically affirms the organism as a literal kingdom within a kingdom: the juridical force it ascribes to, and inscribes in, the natural laws of biology seems to offer the organism sovereignty over its own (natural) existence.

The Fortress Body

In the penultimate chapter of Leviathan, “Of Darkness from Vain Philoso­ phy and Fabulous Traditions,” Hobbes offers a materialist rebuttal to theo­ political investments in “Abstract Essences and Spiritual Forms”: The World (I mean not the Earthly onely, that denominated the Lovers of it Worldly men, but the Universe, that is the whole masse of all things that are) is Corporeall, that is to say, Body; and hath the dimensions of Magnitude, namely Length, Bredth, and Depth: also every part of Body, is likewise Body, and hath the like dimensions; and consequently every part of the Universe, is Body, and

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that which is not Body, is no part of the Universe: And because the Universe is All, that which is no part of it, is Nothing; and consequently no where.87

Hobbes affirms “the Universe” as “Body” to disqualify political appeals to “incorporeal substance” (which he thought an oxymoronic formula).88 In doing so, he wants to mitigate the divisive role he believes religion plays in the state when it divides citizens’ loyalty between the sovereign and the priesthood.89 This bodily presumption grounds Hobbes’s political ontology and locates natural law within the laws of (physical) nature.90 Short-circuiting the distinction between the laws of nature and natural law, Hobbes aspires to an unassailable and immutable political rationality owing no debt to the “insubstantial” reasons proffered by political theology and therefore invulnerable to (or, we might say, “immune from”) the kind of upheaval and violence which forced him to flee England for France during the English Civil War.91 Hobbes desires political philosophy to serve the commonwealth as geometry serves science: by establishing a logic through which the “laws of motion” become both recognizable and intelligible. Yet by abstractly grounding natural law in this way, Hobbes incorporates the very violence which Derrida avers the law contains as the law’s raison d’être. Not surprisingly, this “Corporeall” perspective provokes accusations that, despite his professed allegiance to God, Hobbes’s bodily materialism conceals, or rather reveals, a covert atheism. The theological implications of Hobbes’s ideas, among others, so trouble even as esteemed a scientific figure as Robert Boyle (who also opposed Hobbes on points of science and politics) that in a codicil to his will he endows the Boyle lectures “for proving the Christian religion against notorious infidels.” 92 However, given such overt Christian hostility to the Hobbesian worldview, what does surprise (much more so than any aspersions cast upon his faith) is that the first person to adapt the notion of “self-defense” to a medical context, thereby foreshadowing what we now call immunity, is the most iconic and bombastic incarnation of the American Protestant, Cotton Mather. Mather’s role in importing the practice of inoculation (or variolization, as it was then known)93 into the Massachusetts Bay Colony has been much discussed ever since he first advocated the practice during a smallpox epidemic in 1721.94 Long interested in science generally and medicine specifically—about which he had read widely since his days as a precocious Harvard undergraduate95—Mather learns of this prophylactic technique from two very different sources: the first European reports published in the

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Philosophical Transactions of the Royal Society (1714–16) and the testimony of slaves who had undergone the practice in Africa. 96 When smallpox appears in Boston in the spring of 1721, Mather vigorously promotes the new procedure and enlists a sympathetic physician, Zabdiel Boylston, in his campaign to stop the spread of infection. Although Boylston turns out to be the only doctor to heed Mather’s call, he eventually inoculates 242 people during the eight-month crisis.97 However, Mather and Boylston quickly run athwart the only Boston physician to have actually taken a medical degree, William Douglass. Douglass not only opposes variolization on medical grounds (he believes it spreads infection rather than mitigates it) but also vociferously objects to Mather’s endorsement itself, which Douglass views as an untrained divine’s encroachment on the doctor’s professional turf. The rancorous dissention between Mather, Boylston, and their largely religious supporters, and Douglass and his medical cohort soon spills over into the municipal arena. In the controversy, the practice’s efficacy and safety provoke intense public concern and political struggle. Eventually the Boston selectmen and justices side with Douglass and force Boylston to cease inoculating without their specific consent. 98 Certainly the inoculation controversy reveals much about the politics of medicine and religion in colonial America. Moreover, it illustrates how from the early eighteenth century onward, discourses about nature, society, and God openly coincide in framing public reactions to epidemic disease, thereby marking such medical interventions as what Latour terms “hybrid networks.” With inoculation, Western medicine introduces the first prophylactic procedure that promises to diminish the epidemic risk that haunts human aggregations. As we will see throughout this book, medico-political responses to epidemics—especially to smallpox in the eighteenth and nineteenth centuries (addressed in chapters 2 and 3) and cholera in the mid- to late nineteenth century (addressed in chapters 3 and 4)—provide frequent occasions to negotiate the play between politics and nature (and sometimes God). Concomitantly they reveal the ways that medicine increasingly legitimates its protocols in terms of political values and outcomes to extend its own power and expertise. Through this hybrid process, medicine begins to supplant religion as an authoritative basis for making political decisions about the public good (especially after the French Revolution, as we will discover in chapter 3). When theories about epidemics simultaneously involve scientific, medical, political, and religious concerns, they locate medicine at the interstices of these domains and thereby invest its privileged subject-object, the human body, with their overdetermined values.

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Mather’s own innovative theory about how variolization circumvents smallpox (an issue I return to at length in chapter 2) surfaces in the wake of, and in reaction to, the inoculation controversy. This theoretical framing appears in The Angel of Bethesda (1724), one of the first systematic medical treatises written in the Americas.99 Though never published in his lifetime (and not, in fact, until well into the twentieth century), Mather’s manuscript nevertheless provides an early example of how defense can figure as a healing modality of the human organism. Therefore, while this text in no way influences later interpretations of how organisms respond to disease, it does illustrate how such a defensive rendering imaginatively coalesces at least a century and a half before it achieves its scientific apotheosis. Mather’s proleptic endorsement of organismic defense demonstrates something quite simple: if the idea precedes the evidence, then the evidence does not produce the idea (as Metchnikoff and his followers assume). In The Angel of Bethesda, Mather passionately advocates inoculation by hypothesizing about why the practice is both sound and warranted. In so doing, he celebrates inoculation’s simultaneously prophylactic and political value. Given this explicitly medico-political agenda, Mather introduces a telling medical formulation that anticipates biological immunity’s emergence at the intersection of juridico-political and biomedical thinking: Mather portrays the human organism as an embattled fortress, besieged on all sides by the forces of illness, and he describes his new prophylactic procedure as a strategic, if cunning, form of self-defense.100 The defensive figuration of the fortress body derives from Mather’s interest in “a New theory of many Diseases,” as the subtitle to chapter 7 of The Angel of Bethesda frames it. Here Mather offers an incipient version of what a century and a half later will reappear as germ theory.101 Mather starts small—literally. Owning one of colonial New England’s few microscopes (and obviously entranced by what he sees through it), Mather portrays the magnified world as a teeming, if looming, environment: Every Part of Matter is Peopled. Every Green Leaf swarms with Inhabitants. The Surfaces of Animals are covered with other Animals. Yea, the most Solid Bodies, even Marble itself, have innumerable Cells, which are crouded with imperceptible Inmates. As there are Infinite Numbers of these, which Microscopes bring to our View, so there may be inconceivable Myriads yett Smaller than these which no glasses have yett reach’d unto. The Animals that are much more than Thousands of times Less than the finest Grain of Sand, have their Motions; and so, their Muscles, their Tendons, their Fibres, their Blood, and the Eggs wherein

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their Propagation is carried on. The Eggs of these Insects (and why not the living Insects too!) may insinuate themselves by the Air, and with our Ailments, yea, thro’ the Pores of our skin; and soon gett into the Juices of our Bodies. They may be convey’d into our Fluids, with the Nourishment which we received, even before we were born; and may ly dormant until the Vessels are grown more capable of bringing them into their Figure and Vigour for Operations.102

Clearly Mather finds the plenitude that appears within the scope of his enhanced gaze ominous. His choice of verbs (“swarms,” “covered,” “crouded,” “insinuate”) underscores the potential danger that the miniscule multitudes manifest. The very necessities we require provide conduits through which “inconceivable Myriads” can undo us. Even before birth, the hardly visible world impinges on the human organism and threatens to compromise our borders. Amid this microscopic profusion, human life appears terribly, terribly vulnerable. Filled with anxiety about this microcosmic plethora, Mather imagines the convergence among living beings of vastly different scales as not only dangerous but openly hostile: “And Vast Numbers of these Animals keeping together, may at once make such Invasions, as to render Diseases Epidemical; which those particularly are, that are called, Pestilential.”103 He then extends this invasive trope by explicitly representing the “Vast Numbers of these Animals” as an “unseen Army” against whose incursions only God prevails: How much does our Life ly at the mercy of our God! How much do we walk thro’ unseen Armies of Numberless Things, ready to Sieze and Prey upon us! A Walk, like a Running of the Deadly Garloup, which was of old called a passing thro’ the Brick-kiln! What Unknown Armies has the Holy One, wherein to chastise, and Even destroy, the Rebellious Children of men? Millions of Billions of Trillions of Invisible Velites! Of Sinful men they say, Our father, Shall We Smite Them? On His order, they do it Immediately; they do it Effectually.104

As H. G. Wells’s narrator does two centuries later, Mather identifies the militarized might of these “unseen” and “unknown” mites “ready to Sieze and Prey upon us” as the scourge of God. Yet whether or not they are doing God’s bidding, the “Armies of Numberless Things” constitute a hostile ambience though which we travel, unaware of the dangers that beset us.105 Mather figures the ambient world as an antagonistic environment, and the antagonism derives not just from other humans (as Hobbes dreads) but from “Millions of Billions of Trillions of Invisible Velites” (“Velites: light armed soldiers employed as skirmishers by the Roman armies” [OED]).

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Personifying the agents of microscopic invasions as foreign military forces, Mather translates Hobbes’s fears about personal property (including the person as property) in the state of nature into the organism: “Where an Invader hath no more to feare, than an other mans single power; if one plant, sow, build, or possesse a convenient Seat, others may probably be expected to come prepared with forces united, to dispossesse, and deprive him, not only of the fruit of his labour, but also of his life, or liberty.”106 Mather’s identification of smallpox as invasion resituates such natural threats on a new scale—one both more ubiquitous and less human than Hobbes conjures. Mather’s portrayal of epidemics as violent military incursions concomitantly imagines the organism’s resistance to such threats as a fending off or as a defending. Over the next century and a half, the trope of invasion proliferates in medico-political discussions of epidemics in Europe. Especially after 1832, when cholera “from India” besieges most European nations, invasion encompasses (even while masking) epi­ demics’ inextricably biological and political stakes. Metchnikoff then explicitly turns this biopolitical conceit inward—into the body itself— and scientifically validates immunity-as-defense as the organism’s active response to such small-scale invasions by bacteria and other microbes. Mather, however, writing 150 years before this validation, does not yet draw out the implications of his metaphor. Instead, with his threatening and bellicose image, he offers a defensive theory of disease prevention to affirm inoculation as a simultaneously providential and political practice. While Mather devotes most of his discussion to elaborating the “Way of Proceeding in the practice,” he begins it with an extended analogy that theoretically elucidates the technique. Addressing the reader as a political ally (i.e., not of the anti-inoculation camp), Mather underscores their shared assumptions to unite them against their common enemy: Behold, the Enemy at once gott into the very Center of the Citadel: And the Invaded party must be very Strong indeed, if it can struggle with him, and after all Entirely Expel and Conquer him. Whereas, the Miasmas of the Small-Pox being admitted in the Way of Inoculation, their Approaches are made only by the Outerworks of the Citadel, and at Considerable Distance from the Center of it. The Enemy, tis true, getts in so far as to make Some Spoil, yea, so much as to satisfy him, and leaves no Prey in the Body of the Patient, for him ever afterwards to seize upon. But the Vital Powers kept so clear from his Assaults, that they can manage the Combats bravely and, tho’ not without a Surrender of those Humours in the Blood, which the Invader makes a Seizure on, they oblige

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him to march out the same way he came in, and are sure of never being troubled with him any more.107

Here Mather combines a humoral depletion theory with a defense of the fortress body to picture how variolization works. Likening the body to a “citadel” at whose front gate the “venemous Miasmas” of smallpox normally lay siege, Mather imagines inoculation as a preemptive strike. If the physician introduces the seeds of contagion by way of a secondary forti­ fication not critical to the organism’s integrity, Mather suggests, then the enemy’s appropriative gusto exhausts itself by depleting “the prey” which it covets, causing only a minor loss of humoral wealth. By relinquishing the part of its property which makes it desirable for “the Invader [to] make a Seizure on,” the inoculated body frees itself from future life-threatening attacks on its fortifications through a project of strategic impoverishment. Needless to say, both the logic and the metaphors in this account remain fuzzy. Nevertheless the biological analogy, grounded in a proprietary understanding of individuality, seems clear. Mather introduces an image of the body as a kind of property whose vital resources are strategically alienable—in the same way, for example, that wage labor begins to be understood at exactly this historical moment (as I discuss in chapter 2). Thus Mather (like Hobbes) characterizes modern embodiment as an essentially defensive posture through which the fortress body fends off the marauding tendencies of hostile enemies which would attempt to seize its vital properties for their own ends. That Mather seems to anticipate the rudiments of immunity-as-defense more than 150 years before Metchnikoff “scientifically” articulates it does not attest either to Mather’s prescience or to his clairvoyance. Rather, it suggests that biological immunity appears only belatedly within a political domain which had long since conceived such defensive modes of embodiment. Moreover, it indicates that when biomedicine does confer scientific legitimacy on the trope of immunity-as-defense, it retroactively naturalizes such defensive presumptions by repurposing these juridicopolitical concepts as intrinsic to the human organism. In chapter 2, I extend this biopolitical genealogy of immunity to explore why “having” “a body” that “defends itself” makes sense to us by considering how human organisms come to be valued philosophically, medically, politically, and economically as “bodies worth having” in the first place.

Is the body the vessel which holds the true self locked within it? Is the skin the frontier between inside and outside? What in man is the capsule, and what the encapsulated? —norbert elias, The History of Manners

2. A Body Worth Having, or A System of Natural Governance As the discussion of Cotton Mather at the end of chapter 1 indicates, fearing that variolization might not only not prevent smallpox but actually precipitate an epidemic, eighteenth-century politicians and physicians often opposed the practice. Conversely, to counter such medico-political opposition, inoculation’s advocates (especially in England) seek ways to legitimate it in simultaneously medical and political terms. This double legitimation requires them to create new forms of knowledge—or at least to promote new means of creating what counts as knowledge—about the practice. Through new modes of evaluation, they hope to convince medical practitioners (and concomitantly the healthy people they plan to inoculate) of the technique’s safety and to sway the officials who must politically endorse its use. Those who favor variolization therefore affirm modulating vulnerability as a “rational” option so that, despite its inevitably uncertain outcomes, people will submit to it. Fortunately for vari­ olization’s champions, modern political and economic thinking in En­

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gland already presupposes strategically adjusting the human organism’s vulnerability to death. Indeed, as we saw in chapter 1, Hobbes’s bio-logic (anticipating Adam Smith’s, as we will see later) holds that political relations themselves obtain only because they assuage the individual’s natural insufficiencies or weaknesses—especially its capacity to be killed. Drawing on this same bio-logical assumption, eighteenth-century physicians who promote inoculation foreground the positive ratio of risk to outcome. Hence they claim that vulnerability to smallpox will actually diminish on the whole if particular individuals expose themselves to the risk of infection under controlled circumstances. In these terms, if lesser risk now avoids greater risk later and if collective advantage trumps individual jeopardy, variolization recommends itself. The apogee of this risk calculus occurs in the 1790s when Edward Jenner forgoes variolization (using live smallpox) in favor of what he names “vaccination” (using infectious matter from cowpox). Through this substitution, he achieves the prophylactic ends that variolization intends with little or no apparent risk. Jenner’s innovation no doubt significantly improves the chances of harmlessly preventing smallpox. However, we fully apprehend its significance only if we consider how earlier attempts to avert smallpox made such risk calculable. In other words, we need to appreciate how Jenner’s discovery of vaccination leans on a historical process that enfolds the value of human life within the ambit of calculation. Furthermore, since Pasteur explicitly capitalizes on this calculating triumph (honorifically calling his own protocol “vaccination” in tribute to Jenner), its biologic presages the appearance of immunity-as-defense nearly a century later. I swerve away from the consideration of smallpox prevention, then, to elucidate the life calculus that it radically incorporates. In other words, I will adumbrate the political and economic gestation of the modern body as a prelude to considering how modern medicine then incorporates “it.” To this end, I take up two crucial changes which transpire during the seventeenth and eighteenth centuries that significantly reevaluate human lives as embodied processes. First, I contemplate how, in the context of the English Civil War, the body accrues value as the legal possession of an individual citizen-subject whose ownership of it grounds both political rights and economic relations. Concomitantly, this proprietary assessment assumes that political and economic relations envelop the living human organism primarily because it is vulnerable to injury and death. Second, I reflect on how, in the wake of the Thirty Years’ War in Europe, government concerns itself more and more with aggregates of living

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bodies (in the form of “populations”) on whose well-being, or indeed “happiness,” the security of the state seems to depend (as Foucault intimates). This political and economic focus on the lives of subjects emphasizes the human organism’s capacity to flourish and grow, given the appropriate conditions and resources, as a vital asset for the state. Together these two distinct reassessments of the body—both of which, not coincidentally, emerge following incredibly violent and deadly conflicts—radically revise the political and economic value accorded to humans as living organisms. Unwittingly incorporating these distinctly violent histories, their convergence then augurs self-defense’s apotheosis as a “natural” (i.e., biological) capacity.

The Body Is Not a Defensible Boundary

To conceive a body worth defending, we must first constitute a body worth having (which was, after all, Hobbes’s insight about the natural right to selfdefense discussed in chapter 1). Yet when we consider the worth of bodies as possessions, they become rather different beings than when they live as organisms in the world. Indeed, to constitute the body as a knowable and ownable object requires quite a bit of conceptual and material violence, as well as a modicum of legal fiction. When John Locke avows in The Sec­ ond Treatise on Government (1689) that “every Man has a Property in his own Person. This no Body has any right to but himself,” he establishes a philosophical axiom that affirms the rights of citizens.1 From the Lockean perspective, we enter the political domain as owners of our bodies and the labor of those bodies, and no one can take this property-in-ourselves from us without due process of law. Indeed, according to Locke, the right to own property itself derives from this fundamental proprietary self-relation: “though the things of nature are given in common, yet man, by being master of himself, and proprietor of his own person, and the actions or labour of it, had still in himself the great foundation of property.” 2 Our legal and economic notions of individualism and individual rights (such as the right to property) rest on the premise that, as embodied persons, we possess ourselves. It seems a simple-enough formula: to be a person means to have a body.3 Starting from this proprietary premise, we derive the most basic concepts that organize our political and economic lives. For example, our prevailing notions of freedom, on the one hand, and wage labor, on the other, both owe their significance to Locke’s semi-

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nal formulation. These concepts saturate our understanding about how we live both as humans among other humans and as organisms in the world. Indeed, the imaginary equivalence between being a person and having a body has long since passed over into our daily lives, so that “having a body” now makes us known to ourselves in immediate and intimate ways. Quite likely, this being/having-a-body formula feels familiar enough to most of us who live within the ambit of Western political rationality, or indeed Western political ontology.4 Taking care of our bodies has become the cultural equivalent of maintaining our capital. The body represents a kind of property that we invest in—psychically and financially—because it gives us back to ourselves. We can exercise it, we can liposuction it, we can work it, we can neglect it, because it is ours to control. Conversely whatever we do (or do not do) with and to it seems to tell us something profoundly true about who we are. If our bodies are fit and “well defined,” we seem healthy, energetic, and productive; if our bodies are under­ exercised and overweight, we are self-loathing, lazy, and depressed. But what exactly do we mean when we say: “I have a body”? Who or what is this “I” that “has” “a body” anyway? And how and why does this having, this possessing, of a body confer legal and psychological personhood on us? Is distinguishing between the notions of “being an organism,” or even “being alive,” and “having a body” just semantics? Or are there pragmatic, biopolitical consequences to the ways we construe our vitality and embodiment? Furthermore, does such bodily possession necessarily define a mode of “self-ownership”? Can thinking about the body as a (or even the) matter of self-possession tell us something about how personhood informs our lives? After all, what is the nature of the body if we can possess it? And does this proprietary way of thinking exhaust the possibilities for imagining what it means to be an organism, a person, a citizen, or a human? Consider for a moment a rather different way of conceiving embodied personhood: translating the worldview of her native people, the Okanagan First Nations (an indigenous people who claim descent from the lands of western Canada now called British Columbia) for a nonnative readership, Jeanette Armstrong, a member of the traditional council of the Penticton Indian band, lyrically describes the Okanagan understanding of “physical self,” one of the four “capacities of the self.” Okanagans teach that the body is the Earth itself. Our flesh, our blood, and bones are Earth-body; in all cycles in which Earth moves, so does our body. We

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are everything that surrounds us, including the vast forces that we only glimpse. If we cannot continue as an individual life form, we dissipate back into the larger self. Our body-mind is extremely knowledgeable in that way. As Okanagans we say the body is sacred. It is the core of our being, which permits the rest of the self to be. It is the great gift of our existence. Our word for body literally means “the land-dreaming capacity.”5

Armstrong translates the Okanagan embodied sense to accent characteristics that diverge from the dominant Western understanding of “having a body.” “Body,” for the Okanagan, derives from and participates in the being (and well-being) of the planet. In this cosmological ontology, we are, literally and materially, pieces of earth. “Body” names a capacity, not an object: it evokes a set of potentialities which endure only so long as they remain viable, or perhaps “dreaming.” “Individual” refers neither to an intrinsic quality of personhood nor to a way of being a person but rather specifies a contingent and temporary form of aliveness. “Body” does not denominate a possession that we have but rather embraces “the great gift of our existence” which we receive—perhaps with gratitude—for a limited time. Lest you think that I am romantically appropriating the Okanagan worldview for my own purposes, let me assure you that this critical assessment does not emerge only within the nonmodern domains conceived by indigenous personhood. It also appears within contemporary thinking about the consummately Western, high-tech provinces of bioscience. The biological theorist Dorian Sagan, for example, elaborates the politics implied by the recent bioscientific insight that organisms evolve not just by competition and “survival of the fittest” but also by cooperation and symbiosis. In this project, he draws on the germinal insights of Lynn Margulis, an evolutionary biologist and bacteriologist who radically recasts the history of cellular life, claiming that all nucleated cells represent the successful fusion of two or more bacterial lineages.6 Sagan describes the multicellular organisms that arise from such bacterial blending as “chimeras” and notes: The human body is an architectonic compilation of millions of agencies of chimerical cells. . . . These cells themselves appear to represent the latter-day result, the fearful symmetry, of microbal communities so consolidated, so tightly organized, that they have been selected together, one for all and all for one, as societies in the shape of organisms. . . . The body can no longer be seen as single and unitary. It is multiple, even if orchestrated by vicissitudes and harmony

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over evolutionary time. We are all multiple beings. . . . The body is not one self but a fiction of a self built from a mass of interacting selves. A body’s capacities are literally the result of what it incorporates; the self is not only corporal but corporate.7

Sagan refigures the unit of analysis on which we found our self-conceit. Underscoring the biological complexity that multicellular organisms necessarily incorporate, he calls attention to the fiction we invoke when we apprehend the body as a singularity that naturalizes our status as individuals. Our much vaunted oneness, our indivisible individuality, he suggests, lives in our imaginations, not in our cells. Eschewing this imaginary unity, he instead recommends we disrupt this modern worldview and embrace a nonmodern perspective (which he labels “medieval-microcosmic”) that incorporates a fundamentally different political ontology: “We are metametazoans, metazoans whose industrial pollutants, ecological impact, and telecommunications have not only altered the shape of life on Earth but forced us to recognize the environment of life as a totality with shared destiny, as a single, integrated, sensitive and sensing system.”8 Like Donna Haraway, who proposes the “promise of monsters” as a critical ontology to destabilize human agency’s anthrocentric hubris,9 Sagan challenges our economic, epistemological, psychological, and political investments in a monadic organism. He thus troubles the body as the metonym for the kind of person who can be interpellated as a qualified subject. The body (imagined as a kind of being that can be “had”) unconsciously and unwittingly gives shape to modern forms of subjectivity and belonging. Moreover, it does so by situating the modern way of being human within this bodily fiction as if this somatic conceit provides the human’s “natural” home. Beginning our discussion of the modern body with these two examples, which, following Latour, we might call “nonmodern” personhood, reminds us that no necessity or inevitability underlies our commitment to having a body. Indeed, if we reflect for a moment on what we actually refer to when we say “the body” or “my body”—as in “my body is totally out of shape” or “I wish that my body looked like one of those models in the magazines”—we might find that, rather than manifesting a thinglike substantiality, or well-defined appropriability, corporeal being unfolds temporally as a concatenation of biomolecular transformations of matter and energy localized in space. This time-space localization forms both what we call “a body” and what we call “a life.” Moreover, such a life-form

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can exist only in contexts that sustain its aliveness, a context dependence that disturbs any essential distinctions between the body and the environment.10 Therefore we might argue that our common understanding of the body as both formally discrete and politically, socially, and psychologically fundamental poses something of a paradox: How are evanescent, contingent, and continuous processes construed as separate and distinct “individuals”?11 And why do we invest so much in separation and distinction anyway? Obviously such reflections on embodiment’s context-dependent transitivity do not necessarily impugn the body-as-property formula per se. To imagine the sameness of the body, let alone to imagine the body as a thing, a possession, or a kind of property, requires another conceptual leap: it circumscribes the body within a well-defined perimeter. This boundary condition underlies all acts of appropriation, since for property to exist at all, it must be defined. The unbounded or the infinite cannot be owned as such. The basic difference between an expanse of the earth’s surface and a “piece of property” inheres in the imaginary (and yet oh so material) work that both delimits the “piece” as a coherent, separable part and assigns its immanent potential to an owner. Boundaries that define land as property do not emerge from the land itself. Rather, they enter the world through human decisions (in the etymological sense of violent cuts) that render parts of the planet’s particularity “ownable” by conceptually dividing them, both spatially and temporally, from the continuous unfoldings and enfoldings of planetary processes.12 For something (or some thing) to be someone’s (or some one’s) property, the boundary drawn around it must be defensible. In owning property, in making it sensible and tangible as our “own,” we lay claim to it though a duration of time. Property ownership entails a disposition that makes us agents or subjects in relation to whatever we possess for however long we possess it. The Western history of property affirms that it constitutes a form of dominion and that dominion manifests a force or power which resists and repels all opposing forces or powers within its domain (as noted in chapter 1). This investment in property-as-domination underlies Hobbes’s assertion that self-defense forms the first Right of Nature. If a boundary does not contain the domain within which this force or power, this agency or subjectivity, can freely act, then the property’s distinctiveness disappears. Applying this proprietary principle to the body assumes that the absence of well-defined boundaries results in either death or servitude (which, as

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Orlando Patterson argues, constitutes a form of “social death”).13 Conversely, transcending bodily boundaries purports to induce ecstasy or communion. In any case, troubling the bounded body troubles the self ’s consonance, sometimes fearfully, sometimes pleasurably, sometimes pleasurably because fearfully, sometimes fearfully because pleasurably. However, if transcendence maintains bodily distinction while overcoming (or negating) the separation it implies, breaching the body’s physical boundaries appears only as threatening, if not life-threatening. Hence it must be resisted, even at great cost, since the exclusivity of property ownership forecloses the possibility of peaceful coexistence. Thus we find, underlying the logic which takes (or mistakes) the human body for a kind of property, the assumption that the body forms a defensible boundary. Indeed, Cotton Mather’s image of the body as a citadel might easily serve as an icon for this defensive form of vitality. Such proprietary and defensive assumptions take us far from the Okanagan belief that “the body is the Earth itself.” Yet these assumptions are where biological immunity lives—and where we live—insofar as we live “in” our bodies. But bodies are never naturally property any more than land is. That they become so (or at least that some of us believe them to have become so) indicates that a complex process of definition and appropriation has transpired. Biological immunity emerges from, or even culminates, this process while also concealing it from our awareness. For by transforming self-defense from a legal and political instrument into an organismic capacity, immunity both presupposes and naturalizes the notion that the self has the body that it defends.

Habeas Corpus, or Embodying a Ground to Stand On

During the seventeenth century, western Europe is a fairly tumultuous place to live, to say the least. Religious and political conflict embroils much of the continent in wars of one sort or another for most of the period. Colonialism, as well as new state policies designed to capitalize on resources flowing in (or expropriated) from Africa, Asia, and the Americas, give rise both to new forms of conflict between European nations and to new conflicts within them. The gradual disaggregation of feudal relations between people and land challenges traditional notions not only of social relations among people but of personhood itself. New classes of citizens begin to benefit from the circulation of wealth and to achieve greater

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social and geographic mobility. Religious dissent, especially in new sects of Protestantism, shifts perceptions about God’s place in human lives and hence about the place of humans in the world. These shifts in religious perspective also support challenges to the political legitimacy of monarchs who claim their authority by divine right. Religiously motivated conceptions of royal prerogative become increasingly untenable in contexts where God’s immanence appeals to all. Thus the rationality of states transfers from political theology to political philosophy, challenging if not reimagining traditional organizations of power and control. The shifts throughout Europe are neither synchronous or homogeneous and indeed take quite divergent paths (as we will see in the cases of England, France, and the German states). Yet the processes of political, economic, religious, philosophical, and social change uniformly spark thoroughgoing reappraisals of how the world organizes itself. Indeed, the names of the thinkers associated with this period (Descartes, Galileo, Leibniz, Newton, Spinoza, Hobbes, Locke, etc.) serve as a convenient shorthand for such radical revisioning. Certainly, this summary does little justice to the complex events unfolding during the 1600s and early 1700s; nevertheless, it does gesture toward the horizon within which the body replaces the soul as political subjectivity’s foundation. England provides the primal scene for this profound imaginary transformation. Here, in the bloody crucible of civil war and revolution—from one king’s beheading, to another’s expulsion, to the subsequent importation of a third—new theories of political allegiance and subjectivity coalesce which continue to underwrite political and economic thinking about personhood even today. One of the most enduring theoretical icons is Thomas Hobbes’s Leviathan, which imagines a new secular political realm that no longer needs or wants the divine to sanctify its aims (as mentioned in chapter 1). This secularization of the state or “commonwealth” reverberates throughout the era’s political and philosophical mutations.14 By imagining that national cohesion derives not from God but from “reason” and “natural law” (albeit both given by God), Hobbes refigures the “body politic” as material and immanent rather than immaterial and transcendent. Changing the political bedrock from theology to philosophy, from soul to body, proves radical, for it recasts politics as a matter of human rationality and thus for human intervention and change (despite Hobbes’s intention to found a polity invulnerable to upheavals). Before the mid-seventeenth century, European monarchs claimed, and were largely understood, to derive their authority and sovereignty from

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divine dispensation. As a consequence, earthly power organized itself vertically, from the top down, flowing from the godhead onto the crowned heads (by way of the angels and other disembodied beings) and from there down to the various anointed potentates, nobility, gentry, and so on, down to the lowliest peasants, women, animals, and plants. This explicitly hierarchal ranking, which Arthur Lovejoy describes as “the great chain of being,” definitively ordered one’s soul according to the “degree” of one’s birth.15 Within this hierarchical ordering, the monarch had an exemplary provenance, for he (or more rarely she) embodied not just the divinely anointed sovereign but as such also the nation, its territory, and its people itself.16 Avowing that it, and only it, could bind up and fuse an aggregation of human singularities coinciding within the same temporal and spatial domain, the absolute monarch gave its life over to the nation. Or, to put it slightly differently, absolute monarchy held that insofar as the nation coheres politically and legally, it “lives” in and through the monarch’s body, as if manifesting a species of juridico-political parasitism (thus raising the question of which was really the host and which the parasite). This national—and nationalizing—incarnation of the crowned prince (who was, needless to say, also mortal) as the body politic birthed what Ernst Kantorowicz denominates “the king’s two bodies.”17 According to this peculiar dualistic doctrine, the coincidence between the nation’s “body” and the monarch’s divinely anointed, personal body provided a kind of theopolitical glue that transubstantiated merely coexisting human singularities into a geopolitical whole. Within this political theology, the sacred body of the nation cohabited with and in the mortal body of the sovereign for as long as the monarch’s body lived.18 Though the monarch’s mortality might seem to belie this bodily coincidence, elaborate rituals organized around princely succession offered material and religious support to sustain the monarch’s essential duplicity. Hence the nation’s materialization in and as the absolute monarch supposed the nation as an abstraction whose incarnation the crowned prince incorporated, body and soul. One of the many consequences of this two-body doctrine was that everything in the nation (land, dwellings, movable wealth, people, livestock, etc.) belonged to the monarch inasmuch as it ultimately belonged to the crowned head’s “corporate body.”19 God may have granted the monarch this proprietary interest as part of his divine investment, but historical precedent secured the privilege as well.20 Certainly the monarch made specific delegations of parts of the realm, so that land, dwellings, wealth, people, and animals were granted to families and individuals who then held their title. However, these subjects and their holdings ultimately

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remained subject to royal prerogative (through, for example, taxation, secondment, forced loans, arbitrary imprisonment, punishment, and even execution) and thus not immune from arbitrary seizure or destruction. James I declared the principle succinctly before the Houses of Parliament in 1609 when he avowed: “For to Emperors, or Kings that are Monarchs, their subjects bodies and goods are due for their defense and maintenance.”21 Framed by the theory of divine ordination, the king’s claim was extensive and knew few proprietary bounds, not even the bounds of subject lives. Thus, as Foucault so graphically characterizes it, within this constellation of power, the monarch effectively exercised the right “to take life or let live.” 22 Different monarchs with different understandings of prerogative imposed more or less on subjects and properties, “bodies and goods.” Yet the potential assertions of royal prerogative, however benign, always ran athwart the citizen’s experiences of freedom. During the seventeenth century, the descendants of James I—to whom, as you might recall from chapter 1, Bacon attributed the aphorism “Kings rule by their laws as God did by the laws of nature”—take an aggressive, if not in fact “absolutist,” perspective on their prerogative. Indeed, the Stuart monarchs understand the absoluteness of their rule as naturally resulting from their unique and sovereign ability to (metaphysically and politically) transform legislation passed by Parliament into law.23 As a consequence, they often understand themselves to be the law, or even above the law, which is a more contentious proposition altogether. As things turned out, however, this absolute investment in their paramount legal status did not do much for their longevity either as monarchs or as people. The execution of Charles I and the expulsion of James II punctuate a century during which various challenges to royal power occur in the name of diverse religious, political, economic, and social interests. In the midst of this period of unsettled authority, and to mitigate the excesses of royal power which repeatedly catalyzed popular opposition to the crown, the English parliament redefines some of the most fundamental principles of governing. Perhaps the most enduring of these changes is the Habeas Corpus Act of 1679 (Act 31 Chas. II. c. 2). Passed during the reign of Charles II (the monarch restored to power in 1660 after the Cromwellian interregnum that followed the beheading of his father, Charles I, in 1649), the Habeas Corpus Act installs a limit on royal or state prerogative that attempts to rein in executive authority even today.24 While the basic principle which the act affirms (i.e., that the monarch, though sovereign, is bound by natural and

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common law) had been implicit in English jurisprudence since the Magna Carta (1215), in practice things were not always so clear. 25 Monarchs could circumvent writs of habeas corpus by various legal maneuvers, including assertions that the crown held powers of discretionary imprisonment, which seems to call the very principle into question. 26 The central claim of the Habeas Corpus Act is quite simple: the sovereign cannot imprison people unless it can show that it has a lawful reason to do so. To ensure this legal protection against unlawful incarceration, a prisoner can obtain a writ of habeas corpus ad subjiciendum, which the responsible authorities must answer by bringing the detained person before a court where the case for detention can be heard. 27 As the act states: That wheresoever any person or persons shall bring any habeas corpus directed unto any sheriff or sheriffs, gaoler, minister, or other person whatsoever, for any person in his or their custody . . . the said officer or officers, his or their underofficers or deputies, shall within three days after the service thereof . . . bring or cause to be brought the body of the party so committed or restrained, into or before the lord chancellor, or lord keeper of that great seal of England for the time being, or the judges, or the barons of the said court from which the said writ shall issue.28

The presentation of “the body of the party so committed or restrained” in court establishes a limit on the executive function of government. The legal formulation habeas corpus ad subjiciendum addresses itself (albeit deferentially in the present subjunctive) to the crown’s representative or agent as a competing claim to legal subjection. Literally habeas corpus ad subjiciendum translates as “You may/should have the body for submitting.”29 This “submitting” renders “the body” as a legal bound on the monarch’s power over its subjects. Upon receiving a valid writ, whosoever has it must present “the body of the party” in court to allow the court to exercise its legal jurisdiction, thereby affirming the law’s jurisdiction per se. Under this doctrine, “the body” constitutes both a natural and legal metonym for “the person.” Concomitantly, this metonymy founds a “natural” or “immanent” basis for resisting royal prerogative’s divine and transcendent assertions.30 In other words, countering the monarch’s spiritually ordained power over “bodies and goods,” “the body of the party” forms a material impediment, providing a ground on which citizen-subjects can stake their claim to due process of law. Under the auspices of the Habeas Corpus Act, which formalized the application of the principle as universal (except when suspended), 31 “the

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body” legally counterpoises itself to monarchal violence.32 The specification of “the body” in lieu of “the person”—and thus literally and legally as the place of the person—nominates the body as the matter which opposes the spirit that imbues the crown with its discretionary force. It thus establishes a countervailing philosophical basis, or even an ontological foundation, for rights claims in a nature that the body then represents in and for the person. In the late seventeenth century, Parliament incorporates the body within the law as a political stratagem that accords subjects a natural ground, creating a new “Body of Law.” Shifting the political opposition to the monarch’s legal authority from the theological to the mundane, the Habeas Corpus Act grounds the legal rights of subjects, and the rights of subjects to due legal process, in their living matter as such. This shift conceptually detaches the body from the realm, heretofore conceived as coextensive with the monarch’s (and hence God’s) authority, and redefines it as a legally separable or indeed separate entity. To resist or subvert political theology’s sovereign declarations necessitates a reorientation of the human life context. So long as it hails them, the life of the soul (subject to eternal damnation) haunts those who might oppose sovereign powers which assert such divine ordination. The life of the organism suggests an alternate locus operandi for politically countering divine monarchs and subsequently for politics itself. When the body emerges as a legal referent, born under the threat of royal violence, it affirms the subject’s natural distinction from a political domain within which monarchs freely execute unchecked violence. The body enters politics, then, not merely as a vital or biological phenomenon but as a legal fiction that stands opposite the corporate body of the monarch. Thus it bodies forth a new political ontology. Only following its juridico-political “birth” can citizens claim rights on the basis of a nature which “the body” represents in and for the subject. Conversely, this ontological representation figures the living human body as personifying the modern political subject. When evoked in response to a writ of habeas corpus, the body produced (in both senses) in the courtroom in lieu of the person, that is, as the legal place of the person, offers a material antidote to the soul, whose eternal disposition political theology conjures to render the person subject to the sovereign’s absolute authority. Of course, this political formulation concurs with an economic one that both precipitates and supports it. In the late seventeenth century, the body is conceptually torn from the world and from the kingdom, both politically and economically. In other words (Locke’s word, actually), it is

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removed from “the state in which nature had left it” by a labor that mingles with it and transforms it from bare nature into personal property. The body arises then as a legal and philosophical metonym for the person precisely insofar as it grounds personhood materially and thereby serves as a counterpoint to divine legitimations of sovereign authority. This material person, or personified matter, provides a fulcrum to prize apart the theological edifice of monarchal absolutism by reappropriating the corporeality abjected by Christianity. In this sense, we might say that modern political philosophy actually resurrects the body to disrupt the transcendental foundations claimed by sovereign authority. Certainly in early modern England, it made a lot of sense to invest (in) the body as the living location of personhood and to conceive it as the kind of property that guarantees the right to own property, as Locke did. Yet as valuable as this material metonym has been for grounding the individualizing tenets of modern political thought, it remains a reaction formation to sovereign violence and as such unwittingly recontains this same violence within itself. As bodies we are violently torn from the world’s embrace and belatedly return to it as property owners of ourselves. However, we might consider that “a body worth having” both bears (and bares) the traces of the very sovereign violence to which it serves as a legal and political remedy. The body, born out of a strategic legal and political decision (once again with its etymological emphasis on cutting and rending), unwittingly conserves the trauma of its violent inception.

Immanent Life, or On Personifying a Rightful Body

Determining the body as the legal location of the person radically re­ imagines both the ontological and political basis for personhood. While this legal incarnation itself does not cause these changes, it provides a frame through which people can incorporate them. However, once this political ontology displaces the soul as a person’s essential attribute, once the body constitutes the legal metonym for the person, how does the embodied subject understand and live such corporeal personhood as a vital possibility? How does the new political and legal figure become palpable and not just conceptual? How does “the body” make sense as the place of personhood—epistemologically, psychologically, and economically? Two key elements of modern personhood help make the personified body plausible: psychological interiority and wage labor. Needless to say, the

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two also intertwine. Wage labor imagines a person bifurcated between a laboring and a labor-owning self. Since labor-owning self “possesses” the laboring self, it can contractually alienate itself from its laboring capacity for durations of time in exchange for remuneration (i.e., wages). Such corporeal self-possession concomitantly posits a dualistic psychology, since the laboring and labor-owning self fractures along its immanent and abstracting potentials. If the reflective self can delegate the bodily self according to its contractual interests, then this identification proposes the reflective self as a delegating agent. Thus the modern person paradoxically emerges as an embodied subject only insofar as it simultaneously incorporates legal and political, economic and psychological, abstractions. Perhaps the most significant reflection on these conundrums of incorporated personhood appears a decade and a half after the passage of the Habeas Corpus Act, when John Locke publishes the second edition of his Essay concerning Human Understanding (1694).33 Here Locke appends a new chapter, “Identity and Diversity,” in part to disrupt the political and philosophical effects entailed by the theological equation of “person” with “soul.”34 For Locke, the category of soul presents a basic problem for knowledge, as the soul is constitutively unknowable. Such unknowability vexes him, since, as Adriana Cavarero suggests, his project foregounds what a person is rather than who a person is; hence his thinking requires the epistemological possibility of defining this “whatness.” 35 Whether the soul is immortal or not, or indivisible or not, according to Locke, exceeds the purview of human understanding and hence cannot provide an adequate foundation for personhood. Invoking the example of resurrection,36 Locke avers: The body, as well as the soul, goes to the making of a man. And thus we be able, without any difficulty, to conceive the same person at the resurrection, though in a body not exactly in make or parts the same which he had here,—the same consciousness going along with the same soul that inhabits it. But yet the soul alone, in that change of bodies, would scarce to anyone but to him that makes the soul of man, be enough to make the same man. (27:15) 37

As evidence for this claim, Locke offers the example of “the soul of a prince, carrying with it the consciousness of the prince’s past life,” that “enter[s] and inform[s] the body of a cobbler.” In this case, Locke concludes that the soul cannot make the person, since “the soul, with all its princely thoughts about it would not make another man: but he would be the same cobbler to every one besides himself.” As the example itself indicates, Locke’s con-

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cern lies in the social and political domains rather than the theological. Soul may be enough to identify a person “to him that makes the soul of man,” but not to anyone, and certainly not to any body, else. Posing the problem this way, Locke underscores the moral and legal consequences of human actions insofar as they apply to human agents. Indeed, he explicitly states that “ ‘person’ is a forensic term . . . appropriating actions and their merit; and so belongs only to intelligent agents, capable of a law, and happiness and misery” (27:26). In the wake of Locke’s analysis, “personhood” characterizes a legal, moral, ethical, and psychological subject. Indeed, as Charles Taylor argues, that Locke postulates a “punctual self ” as the reasoning agent behind human action “helps explain why we think of ourselves as ‘selves’ today.”38 However, while Locke’s formulation certainly fuses the thinking of ourselves with the being of our “selves,” this thinking being (or as he says, “thinking thing”) cannot be functionally disembodied, unlike Descartes supposed before him. It does not come as a big surprise that Locke attaches more philosophical significance to the living body than Descartes. 39 After all, Locke’s first training is in medicine. Moreover, he serves as an assistant to, and becomes a close friend of, one of the seventeenth century’s greatest physicians and advocates of the Hippocratic tradition, Thomas Sydenham.40 Indeed, throughout his career Locke maintains an abiding interest in medical matters—and in the (literal) matter of medicine— as his ongoing efforts to record meteorological data and correlate it with health and illness testify.41 Furthermore, Locke’s own delicate health may account for his greater appreciation of bodily matters in questions of personhood.42 No doubt Locke does foreground consciousness as essential to personhood. However, this consciousness itself presupposes a sensuous, if not embodied, immanence in the world: We must consider what a person stands for;—which I think, is an intelligent being, that has reason and reflection and can consider itself as itself, the same thinking thing, in different times and places; which it does only by that consciousness which is inseparable from thinking, and, as it seems to me, essential to it: it being impossible for any one to perceive without perceiving that he does perceive. When we see, hear, smell, taste, feel, meditate, or will anything, we know that we do so. Thus it is always as to our present sensations and perceptions: and by this every one is to himself that which he calls self:—it not being considered in this case, whether the same self be continued in the same or divers substances. (27:9)

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In this famous passage, Locke imagines consciousness as that which presents and represents a person to its self. Yet since Locke also carefully discriminates between thinking and consciousness per se, he explicitly differentiates his understanding from Descartes’s cogito (in which thinking appears as self-evident to itself and thus as necessary and sufficient evidence for “the self ”). Interposing consciousness as the “inseparable” and “essential” companion of thinking, Locke affirms that the matter of selfhood—in both senses—rests on and in “our present sensations and perceptions” and that only “by this every one is to himself that which he calls self.” Thus Locke indicates that consciousness must exist in a sensuous and perceptive medium, although he brackets the question of whether this conscious self-presence depends on “the same or divers substances.” Needless to say, this sensuous underpinning follows from Locke’s famous theory that knowledge arises from sensation, which he defines as the “great source of most of the ideas we have, depending wholly upon our senses” (1:3). Despite this logical precondition, however, Locke’s recognition of consciousness’s sensuous self-knowledge remains a bit murky. Something still seems to be missing here—a lurking missing something on whose back, it turns out, he builds the edifice of consciousness. Immediately preceding Locke’s reflections on consciousness and personal identity, he introduces a different figure who mysteriously disappears as soon as he conjures “the person” as his discussion’s hero. This supporting character, whose work sustains consciousness’s leading role, much as the slave sustains the master, or more pertinently as the wage laborer enriches the capitalist, Locke calls “the same man.” In a section titled “The Identity of Man,” Locke posits this figure as the accreted effect of embodiment: The identity of the same man consists . . . in nothing but a participation of the same continued life, by constantly fleeting particles of matter, in succession vitally united to the same organized body. He that shall place the identity of man in anything else, but, like that of other animals, in one fitly organized body, taken in any one instant, and from thence continued, under one organization of life, in several successively fleeting particles of matter united to it, will find it hard to make an embryo, one of years, mad and sober, the same man by any supposition, that will not make it possible for Seth, Ismael, Socrates, Pilate, St. Austin, and Caesar Borgia, to be the same man. For if the identity of the soul alone makes the same man; and there be nothing in the nature of matter why the same individual spirit may not be united to different bodies, it will be possible

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that those men, living in distant ages, and of different tempers, may have been the same man: which way of speaking must be from a very strange use of the word man, applied to an idea out of which body and shape are excluded. (27:6)

The identity Locke posits here as a formal self-relation surreptitiously introduces a new figure into his argument. Hypostatizing the “same organized body,” “the same man” accretes to itself “constantly fleeting particles of matter in succession vitally united” and thereby establishes the “participation of the same organized life.” This embodied identity performs more than a modicum of conceptual work. To begin with, the sameness of “the same body” affirms a continuity in the face of difference, or an identity in the face of diversity, as Locke’s chapter title indicates. The comparison of two instances of “the same body” across time affirms an identity (its sameness) precisely insofar as the twice-mentioned “constantly fleeting particles of matter” (its diversity) lose all significance. The “one fitly organized body” that defines the identity of both man and animal plays a crucial role, since its continuity “under one organization of life” binds up the temporal discontinuities which continually disrupt its material “sameness.” In other words, “the same body” evokes a theoretical fiction that incorporates a contradiction (sameness-in-diversity) which Locke then rectifies by personifying it as “the same man.” The sameness of man as both an idea and a figure provides the bridge across which “the person” enters Locke’s text. In this sense, “the same man” conceptually and rhetorically personifies “the same body,” a prosopopoeia that then collapses into “the person” as the privileged framework for human self-understanding. Indeed, this unremarked personification, or impersonation, enables us to experience ourselves individually as embodied beings. In the first instance, Locke’s elision of the “same body” and the “same man” as the substrates, or even the precipitates, of the “same person” renders “having a body” psychologically plausible. While most commentators focus on how Locke foregrounds consciousness as constituting personhood, few recognize a back-formation that supports this possibility. For ownership of the body to bestow personhood’s juridico-political ground (as Locke argues in The Second Treatise), it must also function conceptually and sensually as a mode of living. Locke accomplishes this vital task by annexing consciousness, as the constituent form of selfhood, to “the same body.” He then defines “the same body” as the locus within which, or through which, this consciousness literally and materially lives. Yet in so doing, Locke also produces a liminal or

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indeed ghostly figure, “the same man,” who incorporates “the same body” by retro­fitting this body with a consciousness that makes it known to itself (“When we see, hear, smell, taste, feel, meditate, or will anything, we know that we do so” [27:9; italics mine]). Weirdly, this personified body/man manifests a strange and yet hauntingly familiar doubleness. Heretofore personal duplicity had characterized only reigning monarchs, whose “two bodies” incorporated the territorial principle of sovereignty in the body of a living—and hence mortal—person. Locke’s new philosophy instead generalizes this doubleness as a constituent condition of all persons insofar as they also constitute political and legal subjects. The idea of the “king’s two bodies” which Kantorowicz discerns in early modern political theology therefore presages the self-doubling that infects Locke’s same man / same person articulation. Indeed, Locke makes the bifurcated subject immanent rather than transcendent by inoculating it into personhood’s legal and psychological incarnation. Lockean personhood then provides a general and generalizable condition for human identity. Though the chapter “Identity and Diversity” first appears as an addition to An Essay concerning Human Understanding (an ostensibly epistemological rather than political text), it helpfully elucidates Locke’s earlier assertion that the laboring body establishes the principle of property. When Locke expounds in The Second Treatise of Government that “though the earth, and all inferior creatures, be common to all men, yet every man has a property in his own person: this no body has any right to but himself. The labour of his body, and the work of his hands, we may say, are properly his,” he accords a doubleness to the laboring subject which he conceptually elaborates when he discusses the “personified man.” The laborer exists in an objectified relation to his labor, which he “owns” as his own: “labour being the unquestionable property of the labourer.” By reifying this bodily activity (labor) as an ownable resource that belongs as “unquestionable property” to an agent performing this action (the laborer), Locke invokes another identity-in-diversity. The transforming work that labor “is” necessarily manifests a difference in the world, a difference that the body literally makes.43 Yet the relation of ownership binds this world-changing temporal process (labor) back to the laborer through a material medium which labor itself transforms: “Whatsoever then he removes out of the state that nature hath provided, and left it in, he hath mixed his labour with, and joined to it something that is his own, and thereby makes it his property.” Labor returns to the laborer as his own property through a belabored nature. Property becomes property only after an infusion of bodily ac-

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tivity that extracts it (or as Locke declares, “frees it”) from the “state” in which “nature” previously “left” it. This logic anticipates An Essay concern­ ing Human Understanding’s “same body” that binds up “constantly fleeting particles of matter” and thereby grounds the “sameness” of “the same man.” Labor, a temporally extended process, acquires self-consistency by coalescing in a body; however, this body then disappears when labor appears as the property of the laborer who personifies it. In this formulation, the body from which the labor proceeds (“the labor of his body and the work of his hands”) vanishes, subsumed on the one hand into the objects of the labor it performs, and on the other into the laborer who owns these efforts. Thus the body metonymically collapses on the one hand into its world-transforming activities and on the other into the political and legal agent who takes possession of whatever these activities produce. Locke’s property-owning, property-creating person fundamentally refigures the living, laboring human being by constituting self-difference (labor/laborer) as a form of identity (property). Moreover, it makes this identity-in-diversity thinkable and livable by personifying the body as “the laborer.” Yet the personification negates the specific difference that the body is. Locke does not value the human being’s corporeal locus as an immanent realization of difference-producing agency, or even as a vital process that situates the person in a life context from which it emerges and on which it depends. Instead he reimagines this human potentiality as a kind of property (labor) owned by its personification (laborer), which in turn makes the principle of property itself plausible as a way of dividing up the world. Conversely this proprietary formulation, which distinguishes between labor and laborer, founds a legal self-relation of self-ownership that in turn defines both legal and economic rights as forms of proprietary investment. Only following such a conceptual convolution does the notion that labor is intrinsically alienable and that it therefore can be contrac­ tually alienated emerge as a credible way to organize human relations. To this convolution, we owe both the realization of wage labor as a general economic condition and the idea that a person’s worth can be specified by the amount of money which the body’s labor commands.

Protecting Living Being, or The Matter of Police

Thus far, we have been considering the birth of the modern body, that is, how the human organism incorporates modern political philosophy as a mode of legal and economic subjectification. Through this

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renaissance, the human organism is reconceived as a form of property. This living property then defines the citizen-subject who owns it as an individual possessing certain essential rights, including self-ownership and self-defense. Needless to say, this formulation offers profound theoretical and material resources for political and economic change. Indeed, it facilitates and expedites the transition from absolute monarchy and feudal obligation into what will eventually become our modern forms of governance and capitalist forms of social and economic relation. Yet, as noted earlier, a corollary of these incorporated rights and relations has gone largely unremarked. To live as body-possessing legal subjects, we must first radically abstract ourselves from the lifeworld within which we exist and define ourselves as distinct from the material contexts that make our lives viable. In light of this rumination, we might describe the modern body as a form of violence that we do to the world—and that is done to us, both individually and collectively—to contain a violence that the world contains. Indeed, this is part of Spinoza’s insight (mentioned in chapter 1) when he characterizes modern philosophy’s assessments of the human condition as a “kingdom within a kingdom,” that is, as an imaginary domain of sovereignty conceptually carved out from the material universe to sustain the illusion that we are self-sustaining. In other words, the modern body that we believe we have comes into being during the seventeenth century as a legal and economic fiction to oppose the violence that absolute monarchs and feudal hierarchies regularly inflicted on their subjects. Paradoxically, to contain such violence, that is, to limit or circumvent its infliction on vulnerable and suffering subject bodies, the political theorists who offer this conceptual (or perhaps imaginary) resource preemptively incorporate this same violence within the person. Their theories suppose that political violence always already happens, thereby redefining it as a natural condition that rends the person from the world. Such conceptual violence defines a radically new political ontology of personhood that marks the modern subject as a “possessive individual.”44 Moreover, it predicates this political ontology on a legal order that unwittingly contains the violence that it seeks to contain. As the previous section illustrated, Locke’s overlapping political, philosophical, psychological, and economic valuations of personhood derive from this basic investment in law as political containment policy, simultaneously guaranteeing property rights and individual rights. In this regard, he follows his countryman Thomas Hobbes, who also seeks in natural law

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a reasonable rather than a spiritual basis for social cohesion through the political constraint of violence. Writing during the bloody unfolding of the English Civil War, Hobbes invests his desire for peace and well-being in natural law. As we saw in chapter 1, Hobbes establishes self-defense as the first natural right by defining the body as a physical and hence natural locus for legal and political personhood. For Hobbes, the security of the commonwealth rests in the sovereign’s power, a power that derives from subjects ceding to the sovereign some portion of their natural rights to achieve a greater good: freedom from unchecked violence and the “Warre of every one against every one.” This Hobbesian idiom grounds social relations not in a natural aptitude or propensity for cooperation, the existence of which he denies, but rather in the desire for “either Gain or Glory.” As Hobbes succinctly puts it: “We must therefore resolve that the Originall of all great, and lasting Societies, consisted not in the mutuall good will men had towards each other, but in the mutuall fear they had of each other.” 45 But whence does this socially constitutive “mutuall fear” come? Hobbes answers this question logically: first he defines “this word Fear [as] a certain foresight of future evill” (1.1.2); then he admonishes his readers to “consider how brittle the frame of our humane body is, (which perishing, all its strength, vigour and wisdome itselfe perisheth with it)” (1.1.3); and hence he concludes: “Every man is desirous of what is good for him, and shuns what is evill, but chiefly the chiefest of naturall evills, which is Death” (1.1.7). Fear of death as a “foresight of evill” predicates Hobbes’s political philosophy on the living body’s vulnerability. For Hobbes, the living human organism exists politically only insofar as its “brittle frame” subjects people to violence and death. 46 As Sheldon Wolin observes: “Hobbesian society was sustained by the institutionalization and perpet­ uation of fear. . . . According to Hobbes the desire for self-preservation was basic in the sense of being a response to the threat of violent death. Self-preservation was thus closely bound to man’s physical integrity.”47 Foucault extends Wolin’s assessment, noting that this emotional premise underwrites Hobbes’s entire theory of sovereignty: “It is fear, the renunciation of fear and the renunciation of the risk of death. It is this that introduces us into the order of sovereignty and into a juridical regime: that of absolute power. . . . Sovereignty is always shaped from below, and by those who are afraid.”48 Although universalizing the fear of death might initially seem incontrovertible—and thus an adequate basis for political theory—it does, alas, import a few nonuniversal assumptions. On the one hand, it explicitly

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secularizes human experience and reduces aliveness to the finitude of the vulnerable body, thereby abandoning religious doctrines that see death as an opportunity to transcend this vale of tears and be (reborn) with God, as so many martyrs, Christian and non-Christian, were—and are—apt to do. (The contemporary experience of suicide bombing, for example, might provoke us to reconsider just how firm a political foundation the fear of death actually provides.)49 On the other hand, it reduces the political relevance of living itself to the threat and fear of nonliving, thereby negating any of the human organism’s potentially non-death-oriented, vital qualities, rendering them politically inessential (which was Spinoza’s critique).50 In other words, Hobbes’s political theory establishes the finitude and vulnerability of the living organism as the proximate basis for all social relations; conversely, it defines the violence which human organisms inflict on and receive from each other as the catalyst that quickens societies into being. Opposing this “natural” (i.e., inevitable) violence and vulnerability, Hobbes hopes the political defenses of natural law and natural right will redress the equally natural and fear-inducing human disposition to inflict death and destruction on other humans. Amid the civil upheaval that marked Hobbes’s early adulthood, where fellow citizens might easily pose the greatest threat to one’s life, a desire for law to pacify the realm seems reasonable enough.51 Indeed, Hobbes makes his fear of his historical situation explicit in the first paragraph of Leviathan, in which he draws an extended analogy between the human body and “the great LEVIATHAN called a COMMONWEALTH, or STATE,” and then defines “sedition” as equivalent to “sickness” and “civil war” to “death.” Through these analogies, Hobbes characterizes contemporary political and religious conflicts in terms of the dangers and risks they pose simultaneously to the polity’s well-being and to the people who live within it. Hobbes’s main theoretical and philosophical insight thus conflates political turmoil, violence, and death, to which he counterposes “equity and laws” and “business” as “artificial reason and will” and “salus populi (the people’s safety)” respectively. In this text and context, then, law and business appear as the quasi-natural healing forces of the state’s “artificial body.” Yet this investment in law does not provide the only political strategy for pacification during the period (as Foucault’s account of modern Europe’s emergence suggests). In the wake of the devastating regional conflicts of the Thirty Years’ War, Europe emerges as a multiplicity of states coexisting according to a principle of territorial equilibrium, founded on

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the permanent possibility of hostility among them. Thus, across the En­ glish Channel, war, not law, contains the violence that it seeks to contain. This investment in war as a guarantee of peace has its costs, however, especially for the three hundred or so smaller German states carved out of the Holy Roman Empire. As they increasingly assert their own autonomy (after radical reduction in the Austrian sphere of influence designed by the Peace of Westphalia), each of these states must now partake in the reason of state implied by the militarized peace of the new Europe. Yet unlike the larger states which already have a military infrastructure and a base of tax revenues to support it (however diminished or overextended), the smaller German states need both to establish their security apparatus and to figure out how to pay for it.52 The ruinous effects that three decades of war had inflicted on their peoples and territories made this fiscal proposition even more challenging. Erik Reinert describes the profound consequences of the Thirty Years’ War on the German states: The Thirty Years’ War had indeed left Germany an “economic wasteland.” The long war and the presence of foreign troops had created a massive destruction throughout German principalities, cities had been destroyed and thousands of villages burnt. On top of this, wide-scale deforestation in order to export wood made the countryside reflect the conditions of the cities. The agricultural base of the region had been largely destroyed, causing famines that added to the mounting death-toll. It has been estimated that between half and two-thirds of the German population died during the war and its immediate aftermath, an incredible 12–13 million dead. Lawlessness disrupted trade between city and country, forced recruitments lead [sic] to a scarcity of workers, and lack of capital, falling prices of agricultural products and agricultural land, heavy taxation, frequent payments of customs duties in international trade, debasement of coinage, loss of law and security, and rampant vagrancy were just some of the many factors that came together to dismantle German economy and society. 53

As small, war-torn states negotiate their place in the new militarized European equilibrium, they must cultivate internal resources to establish external security. To accomplish this taxing goal, they develop a new theory of statecraft called cameralism.54 Responding to the pressing financial needs of princes, cameralism emphasizes the internal regulation of the state’s subjects as the ultimate embodiment of its wealth.55 As Mack Walker puts it, cameralism “address[es] the workings of the society the prince governed and the total relations of everybody’s productive activities.” 56

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The word “cameralism” itself derives from the German translation Kam­ mer or Cammer of the Greek and Latin camera (room), signifying initially the prince’s residence and then by metonymy the place from which the state is administered. The project of cameralism encompasses the state’s entire domain and all its inhabitants, not as singular citizens but as an aggregate whose collective life activities it channels, directs, augments, enhances, organizes, and dedicates to the “happiness” of the state. As Albion Small put it: “The salient fact about cameralistic civic theory was its fundamental assumption of the paramount value of the collective interests, or in other words the subordination of the individual to the interests of the community.”57 The individual’s subordination to the collective reiterates the earlier claims of absolute monarchs over their subjects, but to new ends: the ends and the “reasons” of the state. Whereas political theology predicated the prince’s legitimacy on an obligation to the spiritual salvation of his or her subjects, the new theories of statecraft envision the subject as a means of salvation for the state. Marc Raeff underscores this fundamental revaluation, arguing that cameralism “helped foster a new view of man’s condition and nature, a secular attitude that judged individuals by their worth as productive members of society,” thereby affirming “the conviction that life is not only sacred but also a valuable asset not to be wasted.”58 The state’s assessment of and investment in these collective living assets give rise to a new biopolitical agent: population. For if the state’s well-being rests on its subjects not as individuals but as “productive members of society,” then human life’s social value appreciates not singularly but in aggregate. Population specifies this aggregation through an abstraction that encompasses the multiple singularities of living beings. It represents people not in their distinctiveness but only as they constitute elements of a larger “body,” whose essential characteristics it extrapolates from information accumulated about each and every one of the assembled constituents. Population thus gestures simultaneously toward an assemblage of living beings coexisting within a defined domain and toward an object of analysis whose vital regularities (birth, death, morbidity, impoverishment, occupation, etc.) it analyzes statistically. Indeed, although attempts to describe the resources of a region had recently begun to appear elsewhere (e.g., William Petty’s assessment of Ireland for the conquering English army), the notion of “statistics” itself first appears as an effect of cameralism, accounting for the state’s assets insofar as they inhere in its population.59

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If population defines both the state’s most vital resource and a domain of vital knowledge, then population organization and management—that is, governance—constitute the state’s most urgent responsibility. Within cameralist theory such population management is known as “police.”60 Translated from the Greek and Latin politia, the German Polizei (also written Pollicey, Pollicei, Policey, Policei, Pollizey, and Polluzey) first entered theories of government in the late fifteenth century to encompass “all areas of the common good that were not, or only partially, comprehended by the concepts of ‘right’ and ‘peace.’ . . . The concept Polizei comprehends Commonality itself.”61 As Gerhard Oestreich explains, the notion of police develops during this period as an extralegal prerogative that rulers arrogate to themselves in the name of order: “Its aim was to produce a well-ordered civic or territorial community. This conception of ‘police’ soon gave rise to the claim on the part of the ruling authorities to a general competence in the combating of all social disorders for which law and custom did not provide a remedy.”62 Oestreich comments that as populations increase and as the structuring dynamics of feudal life attenuate, police serves as a new instrument of social cohesion and regulation: “Greater social complexity brought a greater deployment of authority. People had to be ‘coached,’ as it were, for the tasks created by more populous society and the claims it made on its citizens. The concept of ‘police’ covered the authority which the ruler arrogated to himself to issue new commands and prohibitions.”63 Over the course of the next century, cameralism expands both the term and its purview, coining the new concept Polizeiwis­ senschaft (science, knowledge, scholarship of police) to encompass “the detailed conditions for the institution and/or maintenance of order and in consequence . . . the objective of State itself and the forms of State activity requisite for the establishment of order.”64 It is important to stress here that Polizei specifies a “non-juridical form of regulation.”65 In other words, its project encompasses citizens not only as legal subjects of a sovereign ruler but also as residents living within the state’s domain (living being the operative word). Citizens thus figure both as vital resources for the state and as objects of the state’s epistemological, political, and economic concern. In 1756, summing up the police’s charge, the great cameralist Johann Heinrich von Justi makes these intersecting investments explicit: “We must consolidate and augment, through the wisdom of its regulations, the internal power of the state; and since this power consists not only in the Republic in general, and in each of the members who constitute it, but also in the faculties and talents of those

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that belong to it, it follows that the police must concern themselves with these means and make them serve the public welfare. And they can only obtain this result through the knowledge they have of these different assets.”66 According to von Justi’s logic, “public welfare” as the subject and object of police “concern” “consolidate[s] and augment[s]” the “power of the state” by articulating “the Republic” and “those that belong to it” and harnessing their “faculties and talents.” Hence Polizei necessarily covers a vast range of diverse interests, practices, and information that mark the state’s investment in its people as its vital “assets.”67 The anonymous author of an early-eighteenth-century treatise on the topic, Entwurff einer wohleingerichteten Policey (Blueprint for a WellArranged Police) (1718), gives a succinct overview of the project: The Policey has to do with the internal and external condition of the state. The internal condition consists in a vigorous society, namely (1) in a vigorous growth of the inhabitants, partly in a joyous life, both of the soul, namely (2) in a religious worship, (3) in virtuous conduct, and (4) praiseworthy education; and of the body, in its sustenance, and satisfaction, through (5) abundance of necessary, useful, and superfluous means-of-life, (6) robust health, (7) peaceful security. The external condition consists (8) in the good order of the people, things, and places, and (9) in a convenience ornamentation of city and country. 68

As this blueprint underscores, Polizei focuses on the vital or “vigorous” (from Latin, meaning “liveliness,” “activity,” “force,” or “animate”) aspects of the social, in other words on the living qua living-in-society. While not ignoring the spiritual dimension that motivated earlier justifications of princely authority, Polizeiwissenschaft also underscores the political salience of material, earthly, embodied, secular life both as something that can be qualified (“joyous”) and as something that requires support (“means-of-life”). In fact, by reinterpreting the soul’s needs in terms of not only religious worship but also “virtuous conduct” and “praiseworthy education,” the mission of Polizei translates the sovereign’s spiritual obligations to his subjects into material supports for the state.69 Thus “body” and “soul” now appear as vital assets that the state must cultivate to promote its own “happiness” and well-being, which, von Justi avows, defines its highest aim: “Hence follows the first and universal principle, namely: all the governmental activities of the state must be so ordered that by means of them the happiness of the state may be promoted.” 70 The practical exigencies of human living enter into the purview of statecraft as they tend to support or undermine the state’s paramount imperative: its own survival. This emphasis on the state’s responsibility to itself

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also transforms the objectives of state interventions, as Marc Raeff suggests: “The traditional mandate of government (i.e., rulership) shifted from the passive duty of preserving justice to the active, dynamic task of fostering the productive energies of society and providing the appropriate institutional frameworks for it.”71 In this context, the active work of police as a state instrument consists in establishing a social and material ambience in which population can flourish. In 1731 Justus Christoph Dithmar explains this dynamic project in his text on Polizeiwissenschaft (based on lectures at the University of Frankfurt, where he occupies one of cameralism’s first academic chairs): [Polizeiwissenschaft] teaches how the internal and external nature [Wessen] of a state is to be maintained with a view to general happiness, in good condition and order, and accordingly that the supreme magistracy of the country must have a care that their subjects shall not only be kept in good numbers, God-fearing, Christian, honorable and healthy [in] life and conduct, and that their support and surplus of temporal goods shall be promoted by flourishing rural and town occupation; but also that a land shall be improved with well-laid-out cities, country districts and towns, and all kept in a good condition.72

Here the project of Polizeiwissenschaft explicitly correlates the “internal and external nature of a state” with the population’s “general happiness,” an abstraction that refers not to the felicitous experience of all subjects but to the ways the state can use individual felicity to its own ends.73 The supreme magistracy’s mandate is framed as “having a care” both for the quantity (“good numbers”) and quality (“honorable and healthy [in] life and conduct”) of its subjects. Moreover, this care-full mandate concerns not just the lives of the subjects as living organisms per se but also the social contexts or milieus within which this living transpires. Indeed, the use of the botanical trope “flourishing” as the standard for evaluating social projects reveals a more general political valuation of “growth” as a living resource.74 Frederick II, the monarch of Prussia, invokes this efflorescent valuation in his famous refutation of Machiavelli (1740): “The interest of a prince is thus to populate a country and to make it flourish [le rendre florissant].”75 Following the same political and economic logic of luxuriant growth, the cameralist Georg Heinrich Zinke, author of Cameralisten Bibliothek (1751), writes: The source of the ready means of a ruler is to be found not merely in land and people, with all their interconnections, but rather in a land and a people placed

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in a constantly flourishing condition of their means of livelihood. Hence follows the principle: A prince who would better establish, maintain, and preserve his ready means, must devote all his effort to put his land and people in a constantly flourishing condition, of gaining a means of livelihood, and must thus secure for them increasing prosperity.76

Enjoining the ruler to accept a new principle of government rooted in a flourishing land and people, Zinke proposes a direct political investment in the living contexts of the prince’s subjects to “establish, maintain, and preserve his ready means.” In other words, Zinke exhorts the sovereign to attend to the vital material processes through which the state’s subjects live, their “means of liveliness,” to augment and increase the state’s resources and revenues. This new political appreciation for living expresses the presumption of Polizeiwissenschaft that “the ruling prince [must] control the conduct and affairs of his subjects for the maintenance of the community” so that, according to Dithmar, “Policey may rightly be called the life and soul of a state.”77 Within the new equilibrating force field of Europe, Polizei necessarily concerns itself with the citizen’s life and conditions of life insofar as this liveliness contributes not only to the state’s well-being in and of itself but moreover to its security in relation to other states. Hence Kottenkamp, in a 1747 pamphlet on the topic, offers a maxim: “A prince must always put himself in such a condition as compared with his neighbor that he is at least his equal in resources, or, if that is impossible, that the inequality may be off-set by alliances and arrangements, so that he need not fear destruction or subjugation by his neighbor.”78 This comparative calculus of resources determines their value in terms of how they further the state’s ultimate interest: the ability to resist destruction or subjugation by neighboring states. Since resource parity among states deters military aggression, these resources manifest their value by preempting the exercise of violence toward the state by other states. Insofar as Polizei concerns itself with population as the font of such resources, it addresses human life as a matter—if not the vital matter—of state security, as the Austrian cameralist Joseph von Sonnenfeld makes explicit in his Grundsätze der Polizey, Handlung, und Finanz (Fundamentals of Police, Administration, and Finance) (1787): “Polizeiwissenschaft is concerned with the principles according to which internal security is founded and maintained.” 79 Within this security calculus, health appears as a political good precisely by enhancing the citizen’s productive potential for the state and hence

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against all its looming adversaries. Indeed, whatever positive potential the health of a population might specify in and of itself collapses into the logistical advantages that accrue to it within the militarized equilibrium of Europe. Following this logic, von Justi in his Staatswirtschaft (1758) explicitly admonishes the prince to consider his subjects’ collective health as a preparation for war: “A wise ruler will seriously consider the point of view of population before entering into war. He will especially encourage all means of diminishing sickness and that of preventing plague.”80 The military view of population understands health primarily by way of its negation (“sickness” and “plague”) and strategically promotes the negation of this negation. Ameliorating the bodily ills that could precede or follow a state’s military initiatives falls within the sovereign’s resource assessments vis-à-vis the resource potential of neighboring adversaries (and, as Foucault suggests, within the European equilibrium all neighbors are always already potential adversaries). In other words, with respect to its value as either a military deterrent or an asset, the population’s health represents a political good not intrinsically but conditionally. Whether considered defensively or offensively, then, as a police matter, health of the population serves as a form of war preparedness.

Medicalizing Police, Policing Medicine

More than just a mode of military preparation, however, health also manifests the state’s larger investment in its population. In fact, questions of health and illness become so critical in the second half of the eighteenth century that they give rise to a new domain of political interest: “medical police” (Medizinischepolizei). While the population’s general well-being already falls within Polizei’s concern, the explicit emphasis on medicine as an official means, or as a governing agent, refocuses the policing project. Medical police aligns Polizei with medical expertise and medical experts rather than with the cameralist administrators who dominated it heretofore. If cameralists ground their political claims in their extensive knowledge about population, the region, its resources, their utility for industry and export, et cetera, medical police focuses more explicitly on population’s vital dimensions (public health, occupational safety, food, sanitation, dwellings, disposal of corpses, regulation of health practitioners, elimination of quacks, building of hospitals, and marriage and procreation, including all the vicissitudes thereof: fertility, sterility, prostitution,

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unwed mothers, masturbation, etc.). “Medical police” thus designates a new political conjunction between physicians and the state which increasingly legitimates physicians’ authority as experts about the population’s general well-being, or “happiness,” as living organisms. As a result, medical expertise begins to assume some of religion’s salvific responsibilities. Expanding medicine’s purview from individual bodies to population’s aggregate body precipitates a decisive change in the social status and stature of medicine. For the first time, medicine asserts a special role in matters of state by virtue of its superior knowledge about the human body qua vital being. Of course, physicians had performed public functions before. In times of plague, for example, officials enlisted physicians in establishing quarantines to limit the spread of disease. Physicians also accompanied armies in their campaigns and so served the state in their professional capacity. Or monarchs could conscript physicians to perform special services, as when William Petty, physician general of Cromwell’s invasion force, evaluated Ireland’s resources for its new colonial masters.81 However, apart from personally attending princes, until the eighteenth century the physician’s primary state function was juridical. As Mary Lindemann describes, though, with the advent of medical police, the role played in Germany by the district medical officer, or physicus, evolves from legal to governmental: In the late seventeenth and early eighteenth centuries, the tasks assigned to the physicus were still primarily forensic: “The physicus is a physician appointed by the authorities who in special medical instances that come to court must render his opinion [on them].” Indeed, another common name for the physicus was Medicus forensis. By the end of the [eighteenth] century, the description of the physicus had expanded: “he was to see that all the rules of medical police were properly observed.”82

Medical police affirms medicine’s presumed authority over the processes and vulnerabilities that characterize the living human body. As a consequence, it expands medicine’s governing concerns beyond the individual and the forensic to include social, political, and economic factors that inform population’s vitality.83 Conversely, cameralism’s political investment in population allows the state to endorse medicine as social expertise. In fact, by regarding human life as a vital political asset (in addition to whatever spiritual dimensions it manifests), cameralism makes it possible for physicians to rival, if not to eclipse, church officials as political actors.84

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No figure personifies medical police more thoroughly than Johann Peter Frank. His monumental six-volume opus System einer vollständigen medicinischen Policey (A System of Complete Medical Police) (1779–1819) decisively establishes the field’s centrality to state interests. During the last decades of the eighteenth century and the first decades of the nineteenth, the popularity of Frank’s texts increasingly unites the concerns of medicine and the concerns of the state within medical publications and pedagogy. Moreover, their success encourages others to translate the tenets of medical police into official legislation as, for example, in Franz Anton Mai’s wide-ranging proposal to the government of the Palatinate in 1800, Entwurf einer Gesetzgebung über die wichtigsten Gegenstände der medizinischen Polizei (Draft of a Law on the Most Important Objects of Medical Police).85 Frank’s career trajectory illustrates the political transformations in medical authority that transpire during the eighteenth century: Beginning as a country doctor in the mid-1760s, he rises first to district medical officer (a physicus), then to the margrave of Baden-Baden’s physician-in-ordinary, and subsequently the prince-bishop of Speyer’s personal physician. In Speyer he begins to implement his ideas about medical police and writes his magnum opus’s first three volumes (1779, 1780, and 1783). Impelled by their success, Frank assumes the professorship in clinical medicine at Göttingen (1784) but soon moves to a more prestigious post in Pavia (1785). Shortly after his arrival, Emperor Joseph II visits and takes an active interest in the hospital that he directs. A year later Frank is appointed Protophysicus and director general of public health in Austrian Lombardy, merging his administrative and medical interests. After Joseph’s death (1790), Frank continues his role under the new emperor, Leopold II, until Leopold dies (1792) and Franz II succeeds him. However, court intrigue and Franz’s indifference undermine Frank’s project, and so he leaves Austria for Russia, where Czar Alexander I appoints him director of the Medicosurgical Academy in St. Petersburg (1795). After three years Frank once again succumbs to court intrigue, returning to Vienna, where a few years later Napoleon (after occupying the city in 1809) invites Frank to become his personal physician. Frank respectfully declines and for the rest of his life remains outside state service. Succinctly summarizing his contributions, Erna Lensky comments: “Frank taught the monarchs that the greatest wealth of a state lies in its subjects, who should be as numerous, healthy, and productive as possible; that it is possible to maintain this precious ‘fortune’ and through rational hygienic measures to increase it,

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if the power of the state would be combined with the knowledge of the physician.”86 Affirming healthy population as a living asset, Frank contends that the state requires medical expertise to preserve and augment its “fortune” relative to other states. In Medical Police’s first volume, the opening sentences make this case immediately and directly: The internal security of the state is the subject of general police science. A very considerable part of this science is to apply certain principles for the health care of people living in society, and of those animals that they need for their work and their sustenance. Thereby the conditions under which the population live are improved so that the people can enjoy with pleasure and for a long time the advantages which social life really offers them. . . . Medical police, like all police science, is an art of defense, a model of protection of people and their animal helpers against the deleterious consequences of dwelling together in large numbers, but especially of promoting their physical well-being so that the people will succumb as late as possible to their eventual fate from the many physical illnesses to which they are subject.87

Elaborating this “art of defense” in six volumes over the next thirty years, Frank details the challenges that medically trained personnel confront in the state’s service (if not employment). Frank specifies this project as “health care for the people living in society,” highlighting living as a social attribute. This “health care” attends not just to the ills which beset individ­ ual subjects but to the state more generally: that is, to the well-being of “the people” as a whole. Yet health itself ultimately constitutes just a precondition for Frank, who clearly defines medical police’s ultimate concern: “so that the people can enjoy with pleasure and for a long time the advantages which social life really offers them.” This emphasis broadens cameralism’s affirmative and qualitative valuation of population. For medical police, life constitutes a necessary but not sufficient condition for the state. Underlying and motivating these vital concerns, Frank identifies the need “to calculate the value of a person and the advantages of the population” (13). This advantage-value calculus frames the discourse of medical police. It explicitly defines human “value” as not only calculable per se but calculable precisely with respect to the “advantage of population.” These calculations in turn reveal the physician’s significance for the state, disclosing a political obligation “to acquaint persons in authority in human society with the necessities of the nature of their subjects and with the causes of their physical ills, not to leave out anything that may have a bear-

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ing on the detailed knowledge of important subjects” (5). Here Frank’s rhetoric both asserts medicine’s centrality to governmental practice and identifies how it derives authority from such expertise. On the one hand, he commands physicians to serve the state by developing knowledge practices that inform sovereigns about the “nature of their subjects”; on the other, he defines these “necessities of the[ir] nature . . . and the causes of their physical ills” as medicine’s proper bailiwick. By defining medical understanding as the kind of “detailed knowledge of important subjects” which the state requires, he thus appropriates some of the state’s authority for medicine itself. This potential for reciprocal enhancement between medicine and the state explicitly shapes Frank’s undertaking: “I was proud enough to think that the broad field which I opened to myself was one in which the influence of medical science on the well-being of the states would attain a new splendor if my diligence were blessed and that physicians would cease to be regarded as men who are only more or less successful in making others healthy in the republic” (4). In Frank’s estimation, medicine’s police obligations entail not just health and illness but all social relations. Its concern for the “general health of a state” must be ongoing and preventive, since population “has its incidents and stubborn diseases, like the body of an individual citizen” (7). Foregrounding the constant need for medical attention, Frank names “public health” among other state priorities: Nowadays, endeavors are made to make various useful improvements in economic and other matters. But they concern only the wealth of a country and of its rulers. . . . What is there above health? all people ask, and experience shows that nothing is treated more wastefully than health. And yet, in most countries, very few measures have been taken, although they could be expected to be among the duties of the authorities. One hardly sees anybody other than physicians take care of the noble jewel of public health, until a deadly epidemic raises its head: then everybody who wants to seem somebody shouts about the tardiness of the police. On the other hand, the police then expends more vain efforts and spends more money in one week in order to provide relief than would have been necessary to prevent the disease by prudent regulations. (5–6)

Frank defines health as a different and more fundamental kind of wealth which the state must guard and preserve. Moreover, health does not simply follow from treating disease once it appears but rather requires ongoing, preemptive efforts. Belated recognition results in economic and human waste. Physicians acting individually cannot, according to Frank,

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protect the “noble jewel of public health”; instead authorities must defend the state’s most precious resources. Ultimately, Frank implies, medical police must help the state appreciate its citizens as living beings vulnerable to death and disease and encourage it to invest in their lives to defend and augment itself. Frank’s political perspective abjures Hobbes’s theory that sovereign au­ thority rationally derives from negating the negative consequences that “naturally” impinge on human lives. Frank argues instead that “common sense” reveals an affirmative basis for subjection to sovereign power, which resides in “enjoy[ing] the advantages of social life” (202). These advantages derive from “the great advantage realized if people who are already here are preserved and made happy” (202). Of course, Frank does not neglect medicine’s ameliorative efforts to assuage individual illness and suffering. However, he recognizes eighteenth-century medicine’s limited ability to intervene successfully at the level of the individual. Hence he attends to illness’s aggregate effects, which he believes are more amenable to modification: Even those who despise medicine, pay homage to that part of it which teaches how to maintain health and prevent illness. . . . To tell the truth, it is less because of their luck in treating human illnesses but because of the useful warnings and instructions which skilled physicians usually give for the sake of maintaining health and preventing disease. It is either the physician alone, or upon his request the state itself who prevents the possible or very likely impending physical ills that concern private or public health. (290)

Here in the opening chapter of Medical Affairs (the final volume of Medi­ cal Police), Frank admits the physician’s limited effectiveness “in treating human illnesses” to highlight medicine’s ability—which “cannot be reasonably doubted by anybody”—to intervene prophylactically. Medicine best serves state interests by acting preemptively before illnesses manifest. In other words, medicine should proactively embrace the value of health rather than waiting to negate its negation when disease appears (where it does not have much “luck” anyway). This political imperative to encourage health rather than defeat disease underlies Frank’s prolific advocacy of medical police. He realizes medicine’s potential to value human lives not just abstractly (e.g., through demographic assessments intended for economic, military, or political planning) but materially and concretely. Thus Frank affirms medicine as a simultaneously private and public undertaking.

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Frank elucidates this affirmation’s political import in a speech titled “The People’s Misery: Mother of Diseases” (1790).88 Addressing the University of Pavia’s medical graduating class (whose training he supervised) and drawing on his extensive surveys of region (undertaken as protophys­ icus and director general of public health), he exhorts his audience to accept the connection implied in his title: that is, poverty constitutes a health issue. Or to put it another way: citizens’ lives are too valuable to waste.89 He opens with a rhetorical gambit that Rousseau might have admired: “Why is it that a vast amount of illness originates in the very society inaugurated in order to enjoy a safer life, after having lived primitively in the woods? The people who roved through endless forests, deprived of permanent homes, undoubtedly suffered many discomforts, but I am convinced that their diseases were very different and considerably fewer than ours.”90 After this historical framing, he proceeds to the heart of his argument, “the extreme misery of the people saps the stamina of the most useful citizens and prostrates them with poisonous breath” (89–90), and admonishes those in authority not to neglect this social fact: Let the rulers, if they can, keep away from the borders the deadly contagion of threatening diseases! Let them place all over the provinces men distinguished in the science of medicine and surgery! Let them build hospitals and administer them more auspiciously! Let them pass regulations for the inspection of pharmacies and let them apply many other measures for the citizens’ health—but let them overlook only one thing, namely, the necessity of removing the richest sources of diseases, the extreme misery of the people, and you will hardly see any benefits from public health legislation. (90)

Assessing the possibilities on which public health legislation draws, Frank discloses the logic of a bad investment. Despite all of the state’s other attempts to defend the “citizens’ health,” if it does not attend to immiseration as a cause of disease, then it risks throwing good money after bad. Ironically troping on the notion that the health of the population constitutes the wealth of the state—what in Medical Police he called “the noble jewel of public health”—he characterizes “the extreme misery of the people” as “the richest sources of disease.” This richness reverses the value-advantage calculation that medical police advances (remember his injunction “to calculate the value of a person and the advantages of the population”) and suggests that medical police use (apparently) nonmedical means to medical ends.

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To illustrate how social inequality undermines state security, Frank explicitly plays on the metaphors of growth and efflorescence that characterize the discourse of Polizei more generally: “The extreme poverty of the people, just as it is the most fertile mother of crimes, in the same way corrupts the products of generation at the root” (91). In conditions of extreme poverty, population, the font of the state’s wealth, does not flourish, but its antithesis does. Poverty breeds—it is a “fertile mother”—and yet unnaturally “corrupts the products of generation,” that is, destroys the natural resource embodied within the life of the “most useful section of the population.” The state then ignores its citizens’ economic suffering at its own peril: After all the land has been divided among the powerful and the rich, there is hardly any difference left between the common people and the very beast of burden except that beasts precede and pull the plow, while men guide and follow. When the people live in such a slavish condition and are excluded from any property right of citizens, shall we perhaps expect them to be more attached to the country than the domestic animals which, as they see, are hardly less esteemed? Shall we expect them to raise their emaciated arms with equal power in defense of the hearth that holds no fire for them? (92)

Overtly connecting the state’s defense and the population’s misery, Frank emphasizes the logic that drives medical police. As medical authority, it evinces a deep investment in life, epistemologically, professionally, personally, and politically. However, this investment does not accrue interest simply because human life—or more specifically the life that citizens embody—represents an intrinsic good. Instead medical police authorizes itself by declaring its interest as the state’s interest. It values the life of the population as a fund on which the state can draw. In the European context, where each state determines its own wellbeing or happiness by considering itself as potentially, if not inevitably, opposed to all other states, this living value emerges negatively as a form of defense.91 Of course, medical police, like Polizei more generally, does appreciate the political utility of the life-form it construes as “population.” Indeed, Polizei provides one of the most powerful technologies supporting the governmental regime that Foucault named “biopower” (as discussed in the introduction). However, as Frank’s rhetoric makes overt, this biopolitical investment affirms life—it literally incorporates the lives of citizens—not just to encourage their growth or well-being. Rather, it seeks to secure them as living resources for the state against the destruction and devastation of war.

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A Vulnerable Population, or Healing Becomes Political Economy

Eight years after Frank addresses the graduating class of physicians at the University of Pavia, Thomas Robert Malthus publishes the first edition of An Essay on the Principle of Population (1798), his famously dark prognostication about expanding numbers of poor citizens. Virtually inverting Frank’s position, Malthus characterizes poverty and population not as ameliorable conditions that demand state intervention but as inevitabilities that threaten political and economic stability. Indeed, he concludes as a purely logical or mathematical extrapolation from what he declares “the fixed laws of our nature” that “no possible form of society could prevent the almost constant action of misery upon a great part of mankind.”92 Believing that “misery” necessarily and naturally afflicts a substantial proportion of the nation, Malthus opposes assistance to the indigent, holding that such beneficence exacerbates the very problems it seeks to redress.93 Instead he asserts that indigence, homelessness, hunger, and disease require economic explanations which conceive those living in poverty primarily as human labor whose income (and hence value) fluctuates according to the ratio between availability and demand. In this analysis, the experiences of privation that poverty inflicts on the nation and its citizens disappear. Instead poverty simply represents an oversupply of labor, a problem whose only redress depends on “checks” that are either “positive” (deadly) or “preventive” (prophylactic). As Malthus succinctly opines: “All these checks may be fairly resolved into misery and vice.” 94 Unlike Frank, a physician by training and vocation, Malthus is a minister with philosophical and mathematical inclinations. Thus he happily reduces the complex factors that support humans as living organisms (which Frank valiantly struggles to encompass in the six lengthy volumes of Medical Police) to a few variables and equations. Initially publishing his Essay to debunk the optimistic idealism espoused by his contemporaries William Godwin and the Marquis de Condorcet (who both believe in continuous human improvement or even perfection), Malthus proposes a “natural” paradox that be believes will reveal such thinking as hopelessly naive.95 To this end, Malthus grounds his pessimistic, or “melancholy,” assessment in what he sees as nature’s immutable demands (albeit demands instituted by God): I think I may fairly make two postulata. First, That food is necessary to the existence of man.

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Secondly, That the passion between the sexes is necessary and will remain nearly in its present state. These two laws, ever since we have had any knowledge of mankind, appear to have been fixed laws of our nature, and as we have not hitherto seen any alteration in them, we have no right to conclude that they will ever cease to be what they are now, without an immediate act of power in that Being who first arranged the system of the universe, and for the advantage of his creatures, still executes according to fixed laws, all its various operations.96

In constructing this natural (theological) model, Malthus focuses on two attributes he assumes as absolute: food and sex. While his assumptions might initially seem incontestable, these “necessities” do not actually operate with the same degree of constraint. The first, food, involves the individual organism’s vital endurance: deprived of food for a sufficient amount of time, the living being dies. The second, “the passion between the sexes,” specifies another kind of necessity, since as far as we know, no one dies for lack of it. While today we might apprehend sexual necessity as a species imperative, this possibility does not concern Malthus, who has no fear for humanity’s perpetuation (especially since he worries about over­ population). Instead his passionate requirement constitutes a necessity because its felt bodily experience impels men (and he does mean men, primarily of the working class) to disregard more rational assessments of their best interests. As Malthus blithely comments: A truth may be brought home to his conviction as a rational being, though he may determine to act contrary to it as a compound being. The cravings of hunger, the love of liquor, and the desire of possessing a beautiful woman will urge men to actions, of the fatal consequences of which, to the general interests of society, they are perfectly well convinced, even at the time they commit them. Remove bodily cravings, and they would not hesitate a moment in determining against such actions.97

Malthus defines the necessary “passion between the sexes” not as a vital condition whose absence negates life but as “bodily cravings” that override “the general interests of society.” Moreover, this “fatal” necessity has other deleterious consequences. Since Malthus’s concern with sexual passion (or “the desire of possessing a beautiful woman”) lies not with the passion itself, its manifestations, its motivations, or its machinations, he most fears its possible outcome: more offspring. The “passion between the

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sexes” thus enters his equations only insofar as it increases birthrates and thus informs population, the collective biopolitical phenomenon which occupies his attention.98 Malthus’s analysis of population renders the living processes it encompasses abstract. The two and only two necessities that he admits form mortal limits, not vital requirements. Food constitutes a relevant variable for Malthus because its lack is deadly, “passion between the sexes” because more offspring demand more food (whose unavailability then produces more death). Hence he does not positively value food for the nourishment it provides but only considers it negatively via the lack its deprivation occasions. Concomitantly, he does not value sex positively as passion, pleasure, or even procreative event but views it negatively as effective cause of too many hungry mouths or unemployed bodies. This melancholy evaluation understands the human organism as essentially and radically vulnerable to a world in which work constitutes its only affirmative capacity. In other words, for Malthus, the living beings that population gathers within its penumbra matter only insofar as they are both vulnerable to death and able to labor—and where the demand for (or want of ) labor determines their exposure to death. All the positive concerns that Frank elaborates and worries over as contributing to the health and happiness of the people, and thus to the nation’s well-being, vanish for Malthus. Instead he reads human embodiment negatively as a potential source of political and economic disaster. Of course, Malthus does recognize health as a relevant phenomenon, as his preemptive response to an imaginary critic indicates: “I do not mean to enter into a philosophical discussion of what constitutes the proper happiness of man; but shall merely consider two universally acknowledged ingredients, health, and the command of the necessaries and conveniences of life.”99 Yet while acknowledging that the “proper happiness of man” minimally includes “health,” the resources which support and encourage this “universally acknowledged ingredient” do not enter his thinking beyond his two postulated necessities.100 Instead Malthus represents health as a political consideration belonging not to the living assets embodied in and as citizens but to political economy conceived as population’s regulatory agent. Later editions of the Essay make this political arrogation of health explicit by invoking the vis medatrix naturae (the “healing power of nature” familiar to Hippocratic, Galenic, and humoral medicine, mentioned in my introduction); however, they do so as a poli­t­ ical, rather than a vital, force. Indeed, Malthus strategically recruits this

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ancient medical precept to explain how the living organism’s vital potential paradoxically threatens—rather than ameliorates—its own collective political and economic well-being. Traditionally, the vis medicatrix naturae holds that organisms intrinsically seek to balance inner and outer forces and that when they experience imbalances they evince a natural tendency to restore harmony, a tendency which medical practices seek to augment and facilitate. Malthus, however, translates the vis medicatrix from naturae to reipublicae. In other words, he locates the balancing forces that maintain vital well-being not in the organism or in the material world but in the state’s political economy. With this trope, Malthus proposes an analogy between organism and political economy that supposes that population regulates itself according to fixed natural tendencies. He thus imagines population as a biopolitical hybrid (in Latour’s sense) and concomitantly reimagines health as economic rather than a bodily condition: The desire of bettering our condition, and the fear of making it worse, like the vis medicatrix naturae in physics, is the vis medicatrix reipublicae in politics, and is continually counteracting the disorders arising from narrow human institutions. In spite of the prejudices in favour of population, and the direct encouragements to marriage from the poor-laws, it operates as a preventive check to increase; and happy for this country is it, that it does so.101

And further: Universally, the practice of mankind on the subject of marriage has been much superior to their theories; and however frequent may have been the declamations on the duty of entering into this state, and the advantage of early unions to prevent vice, each individual has practically found it necessary to consider of the means of supporting a family, before he ventured to take so important a step. That great vis medicatrix reipublicae, the desire of bettering our condition, and the fear of making it worse, has been constantly in action, and has been constantly directing people into the right road, in spite of all the declamations which tended to lead them aside. Owing to this powerful spring of health in every state, which is nothing more than an inference from the general course of the laws of nature, irresistibly forced on each man’s attention, the prudential check to marriage has increased in Europe; and it cannot be unreasonable to conclude that it will still make further advances. If this take place without any marked and decided increase of a vicious intercourse with the sex, the happiness of society will evidently be promoted by it.102

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Here Malthus transposes the vis medicatrix from nature to politics. When he attributes “health” to the state rather than to its citizens, he radically refigures the vital matter of both health and state. According to his calculus, the “powerful spring of health in every state” follows from “the general course of the laws of nature” because they regulate individual (male) awareness and thus modulate “each man’s” sexual behaviors. Hence health reduces to a political and economic outcome that obtains when men modulate their (potentially) procreative activities. Consequently and conversely, the state’s healthy existence fulfills these natural laws when it “continually counteract[s] the disorders arising from narrow human institutions.” The state’s governing capacity apparently flows directly from this quasinatural potential, analogous to the natural force of healing, which operates through and on the material world, including living human matter. By short-circuiting the distinction between nature and political economy, Malthus’s Essay recasts a supposedly implacable moral and economic principle (“the desire of bettering our condition, and the fear of making it worse”) as a natural tendency. Then, since healing already represents such an accepted, albeit inexplicable tendency, it uses healing by analogy to adumbrate how this new principle obtains and thereby appropriates healing’s transformational agency for political and economic ends. However, this translation of the vis medicatrix naturae seems fairly curious, if not actually untenable. It radically restricts the healing locus of nature, finding it in the political and economic activities of citizens acting as rational and moral agents, rather than in the entanglements of living beings and the lifeworld. So why did it make sense for Malthus to conscript such an expansive concept, which had grounded medical philosophy for thousands of years, to theorize the state’s political and economic well-being in this way? To apprehend Malthus’s conceptual and rhetorical choice, we need to regress a quarter of a century to consider how Adam Smith paves the way for Malthus’s vital calculus.103 In Smith’s writings, the chiasma between nature and political economy, which Malthus exploits, first appears to explain the lawlike quality of market forces. By positing economic relations as a collective supplement to the human organism’s natural insufficiencies (much as Hobbes derived political relations from its natural vulnerabilities), Smith anticipates the healthy outcomes of economic activities. Thus, at the same moment that Frank, in the German context, proclaims medical police’s political and economic utility—arguing both that medical

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police functions as political economy by other means and that it should deploy political and economic means to healing ends—Smith proposes the converse for England. If the human organism’s limitations undermine the individual’s ability to satisfy its bodily needs, thereby compromising its vitality and well-being, then according to Smith, political economy’s collective agency can ameliorate this imbalance and hence function naturally as a political kind of healing. In other words, instead of affirming medical police, Smith proposes police as a form of economic medicine. Like Malthus, Smith holds that a basic, quasi-natural postulate guides human behavior and hence serves as the basis for economic relations. However, unlike Malthus, Smith does not concern himself immediately with the living organism’s necessities. Instead he describes supposedly inevitable patterns of human activity determined by “the natural effort which every man is continually making to better his own condition.”104 Or, as he more fulsomely describes it in An Inquiry into the Nature and Causes of the Wealth of Nations (1776): The desire of bettering our condition, a desire which, though generally calm and dispassionate, comes with us from the womb, and never leaves us til we go into the grave. In the whole interval which separates those two moments, there is scarce perhaps a single instant in which any man is so perfectly and completely satisfied with his situation as to be without any wish of alteration or improvement of any kind. An augmentation of fortune is the means by which the greater part of men propose and wish to better their condition.105

Smith’s founding explanation for economic activity obviously prefigures Malthus’s “great vis medicatrix reipublicae” (i.e., “the desire of bettering our condition, and the fear of making it worse,” an implied if unacknowledged citation of Smith). Characterizing the “desire of bettering our condition” as something that precedes birth and exceeds death, Smith inscribes this relentless desire in the temporal (i.e., “secular”) matrix of embodied human life. He then asserts that “the greater part of men” seek to satisfy this desire by an “augmentation of their fortune,” thereby establishing the economy as the domain within which this desire (virtually coextensive with human life) finds its preferred appeasement. Indeed, by linking this innate desire to the impetus for human labor, Smith seems to channel the natural vitality of the human organism into the economic as its proper domain. Discussing wage labor and the effects of wages on workers’ industriousness (“Where wages are high, accordingly, we shall always find the work-

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men more active, diligent, and expeditious, than where they are low”), Smith comments: “A plentiful subsistence increases the bodily strength of the labourer, and the comfortable hope of bettering his condition, and of ending his days perhaps in ease and plenty, animates him to exert that strength to the utmost.”106 In a rare acknowledgment, Smith admits that human labor derives from and depends on “bodily” exigencies such as “subsistence” (a term that informs debates about poverty during the French Revolution, as we will discover in chapter 3). In so doing, Smith recognizes a material (if not physiological) connection between “plentiful subsistence” and “bodily strength” similar to that found in medical police. Yet instead of conceding that health, happiness, and pleasure depend on this connection, Smith immediately imagines this embodied potential as tending toward “the comfortable hope of bettering his condition,” thereby annexing it for his economic idyll (“ease and plenty”). Indeed, insofar as the “natural effort” toward “bettering his condition” organizes Smith’s entire “system of natural liberty,” it underlies all labor and exchange relations. Through this putatively natural impulse, Smith reconciles the disparate if not opposing goals of individuals and collectives. Moreover, he claims that the interests of individuals will naturally regulate the characteristics of collectives. The uniform, constant, and uninterrupted effort of every man to better his condition, the principle from which public and national, as well as private opulence is originally derived, is frequently powerful enough to maintain the natural progress of things towards improvement, in spite both of the extravagance of government and of the greatest errors of administration. Like the unknown prin­ ciple of animal life, it frequently restores health and vigour to the constitution, in spite, not only of the disease, but of the absurd prescriptions of the doctor.107

Likening the implacable imperative toward economic improvement to the vis medicatrix naturae, Smith introduces a slippage between nature and political economy that Malthus later crystallizes as vis medicatrix reipu­ blicae (thereby making Smith’s implied analogy overt). The “unknown principle of animal life” provides Smith with both a concept and an image that enables him to explain the economy as a self-regulating system. Moreover, it allows him to criticize the state interventions proposed by mercantilism and cameralism (“the extravagance of government and of the greatest errors of administration”) by comparing them to the futile cures and nostrums proffered by eighteenth-century physicians.108 In other

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words, the healing metaphor allows Smith both to naturalize his economic theory and to suggest that although regulated by an unknown mechanism—whether “unknown principle of animal life” or the infamous “invisible hand”—economic relations can “restore health and vigour” just as organisms do.109 With this effective and yet secreted catachresis, the abstract “national body” subsumes and eclipses the living attributes of the individual bodies it comprises. Though at first glance this abstraction might seem similar to the cameralist analysis of population, it actually inverts cameralism’s appreciation of individual subjects as vital assets, and public health as a “noble jewel.” Thus while Smith’s discussion of wage labor employs the same botanical tropes regularly used by medical police, it only does so by negating them: But poverty, though it does not prevent the generation, is extremely unfavourable to the rearing of children. The tender plant is produced, but in so cold a soil, and so severe a climate, it soon withers and dies. . . . This great mortality, however, will every where be found chiefly among the children of the common people, who cannot afford to tend them with the same care as those of better station. Though their marriages are generally more fruitful than those of people of fashion, a smaller proportion of their children arrive at maturity. Every species of animals naturally multiplies in proportion to the means of their subsistence, and no species can ever multiply beyond it. But in civilized society it is only among the inferior ranks of people that the scantiness of subsistence can set limits to the further multiplication of the human species; and it can do so in no other way than by destroying a great part of the children which their fruitful marriages produce.110

If cameralist discourses of police, especially medical police, invoke botanical metaphors (flourishing, blooming, etc.) to emphasize that people thrive under conditions which support and sustain them, Smith’s invocation works to the opposite end.111 He highlights the “tender plant’s” vulnerability to a hostile climate and thereby suggests that poverty constitutes an environmental or meteorological, and therefore natural, condition. His ironic concluding remark disparages “fruitful marriage” among the poor because their undernourished offspring too often wither and die on the vine. Furthermore, since poverty sets bodily “limits” on “the inferior ranks of people,” they seem more like “animals” than “those of better station” precisely because their economic conditions disproportionately expose them as living organisms to death.

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The Wealth of Nations does not explicitly account for this vital vulnerability. However, the explanation did appear a decade earlier in the Lectures on Jurisprudence (1762–63), where Smith first formulated his most famous postulates. In a lecture titled simply “Police” (March 23, 1763), Smith clearly articulates his assumptions about the political value of human life—assumptions which animate his entire economic theory, though he never again makes them quite so visible. Invoking the rubric that informs cameralist theory and practice, Smith gives “police” a particularly British inflection. The concept of police existed in Britain since the sixteenth century, as it had throughout Europe (we will consider its French incarnation in chapter 3); however, it never achieved the robustness that it did elsewhere. Constrained by English liberalism’s concern for individual and economic freedom, police there linked the internal security of the state more narrowly to the protection and improvement of property and exchange relations.112 As Patrick Carroll notes, Smith’s interest in police defines this overtly political (or, to use Foucault’s idiom, “governmental”) project commercially precisely to reimagine it as ancillary to the market: “Smith’s approach to police, directed at commerce rather than health, expresses the concerns of the emerging field of liberal political economy which he sought to shape. . . . Arguing from the principle that ‘dependency’ is the greatest corrupting force upon ‘mankind,’ Smith posited the establishment of commerce and manufactures as ‘the best police for preventing crimes.’ ‘Free trade’ economics was not opposed to police, it was a particular policy of police.”113 Smith’s opening remarks on the subject subsume police within political economy or perhaps even constitute “the economic” as police by other means: Police, the word, has been borrowed by the English immediately from the French, tho it is originally derived from the Greek politeia signifying policy, politicks, or the regulation of government in generall. It is now however generally confind to the regulation of the inferior parts of it. It comprehends in generall three things: the attention paid by the public to the cleanliness of the roads, streets, etc; 2d, security; and thirdly, cheapness and plenty, which is the constant source of it.114

As opposed to the expansive German understanding, Smith’s estimation of police restricts its purview and instruments considerably. After addressing the task of cleaning the roadways, which receives scant attention (though it will prove essential to the sanitary movement in nineteenth-century

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Britain, as we will see in chapter 4), he states that police’s second main concern is “security,” which he conceives primarily as law enforcement: “The security of the people is the object of the second branch of police, that is, the preventing of all crimes and disturbances which may interrupt the intercourse and destroy the peace of society by any violent attacks. In generall the best means of bringing about this desirable end is the rigorous, severe, and exemplary execution of the laws of the state.”115 Unlike the cameralists, Smith does not understand “the security of the people” to encompass and depend on the myriad eventualities that impinge on and shape citizens’ vital experiences. Rather, Smith defines security as an antidote to social violence and vividly imagines this remedy as the effective application of a counterviolence which the law contains. In other words, just as Hobbes and Locke do before him, Smith invests in law as a violent system that secures the “intercourse and peace of society,” which for him effectively coincides with prosperous economic relations.116 However, when he addresses police’s third task (“the proper means of introducing plenty and abundance into the country, that is, cheapness of goods of all sorts”), which encompasses and ensures the second (security), Smith explicitly articulates his views about the natural condition of human beings as living organisms: In order to consider the means proper to produce opulence [Smith uses “opulence” in the Lectures where “wealth” often appears in his later texts] it will be proper to consider what opulence and plenty consist in, or what are those things which ought to abound in a nation. To this it will also be previously necessary to consider what are the naturall wants and demands of mankind. Man has received from the bounty of nature, reason and ingenuity, art, and contrivance, and capacity of improvement far superior to that which she has bestowed on any of the other animalls, but is at the same time in a much more helpless and destitute condition with regard to the support and comfort of his life. All other animalls find their food in the state they desire it, and that which is best suited to their severall natures, and few other necessities do they stand in need of. But man, of a more delicate frame and more feeble constitution, meets with nothing so adapted to his use that it does not stand in need of improvement and preparation to fit it for his use.117

Now we discover the bio-logic supporting Smith’s entire economic theory and, as a consequence, that of those who follow him (such as Malthus and many later liberal, and even neoliberal, political economists). Because he seeks to elucidate “the means proper to produce opulence,” Smith first

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stipulates the “naturall wants and demands of mankind.” These natural (or bodily) requirements, Smith suggests, derive from the unique situation of humans compared to “all other animals.” Whereas other animals have the capacity to fulfill their desires immediately, consuming food “best suited to their severall natures,” humans, being “of a more delicate frame and more feeble constitution,” must transform what they consume by adapting it to their weakness. Unlike other animals, who experience a natural adequation between their vital requirements and the contexts in which they live, humans exist “in a much more helpless and destitute condition.” Indeed, humans evince a natural vulnerability that bifurcates what they organically need and what the world provides—a bifurcation that they rectify by using what they have “received from the bounty of nature, reason and ingenuity, art, and contrivance, and capacity of improvement.” Smith emphasizes humans’ natural incapacity by further describing their “feeble and puny stomach[s],” their “tender and delicate frame[s],” their “tender skins,” ul­ timately summarizing all these “natural” insufficiencies as “the natural feebleness of [their] frame.”118 Humans’ original vulnerability as living organisms, then, entails two critical consequences: first, it forces humans to labor to transform the world as it appears into a domain adapted to their feebleness and incapacity; and second, it requires them to join together to supplement their “natural” inadequacies, such that they can collectively satisfy the needs and desires which they individually cannot meet. 119 According to Smith, then, the human reaction to a constitutive (“natural”) incapacity catalyzes the collective transformations of labor, which then establishes the “nature” of the economy.120 Smith’s emphasis on the human organism’s constitutional feebleness and his depiction of labor as its antidote enable him to imagine the economic as a quasi-natural domain—and hence subject to natural laws. For Smith, the economy is natural because it manifests supplemental capacities which humans receive from “the bounty of nature” to augment our incapacity to survive in the material world as it presents itself to us. Indeed, Smith’s economic thinking binds both the human organism’s vitality and the lifeworld within which the human exists precisely because he holds that as organisms we lack the ability to remain alive unless we materially transform our conditions of existence. While this view affirms the intrinsic, or even natural, sociality of humans as a species, it also coopts this sociality (or nature) for the economic as its inevitable human destiny. Like Hobbes, who predicates social and political relations on the

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human organism’s natural exposure to violence and death, Smith derives his political and economic vision from a radical vulnerability that he sees as essentially human. Smith’s notion that “the natural feebleness of his frame” motivates human development (and thereby impels both labor and civilization) renders the human organism’s weakness as its most characteristic and compelling quality. Hence economic and political relations exist for Smith to modulate such natural limitations and mitigate the risks which human beings inherit as living organisms. With Smith and Malthus, the modern body, as an individual and vulnerable locus, achieves its first biopolitical incarnation. In fact, Smith’s political and economic vision inspires Malthus to treat population as an entangled problem of biology and political economy. Assuming that nature works through political economy to naturally supplement the human body’s limitations, both thinkers invoke an analogy to the vis medicatrix naturae to make political economy’s “natural” effects intelligible. In so doing, they refigure both the meaning and the domain of healing. This same political and economic bio-logic also redounds onto and into medicine when it seeks to address the natural vulnerabilities that populations incorporate. Returning now to our earlier discussions of smallpox, we discover how eighteenth-century medicine draws on these bio-logical assumptions of political economy to legitimate (and thereby promote) new prophylactic technologies aimed at circumventing the risks posed by the dread disease.

Risking Vulnerability: Variolization, Vaccination, and the Biopolitical (E)valuation of Smallpox

If Johann Peter Frank represents the eighteenth century’s most prominent proponent of medical police, Edward Jenner undoubtedly epitomizes its most renowned innovator of medical practice. Indeed, we might sche­ matically consider Frank and Jenner as personifying two distinct medical rationales.121 If Frank champions a medical project that simultaneously encompasses the individual citizen’s entire life as well as the lives of all citizens as a whole, Jenner offers a singularizing protocol that endeavors to alter a specific disease’s effects on particular individuals. Moreover, Frank’s political commitment to enlisting medicine on the state’s behalf, coupled with his skepticism about safeguarding—let alone enhancing—the people’s health solely by treating diseases, subordinates specific treatments

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(of which Jenner’s was by far the most spectacularly successful) to medical police’s broader and more urgent goal: a flourishing and thriving population. Conversely, Jenner’s interests and commitments betray no overt philosophical or political project; instead, after he successfully disseminates his initial results, for the rest of his career he simply gathers more empirical evidence to confirm his vaccine’s certainty and safety. (In his own humble reflection on his achievements, he describes himself as “vaccine clerk to the whole world.”)122 Yet although he does not claim a broader theoretical or political agenda, Jenner’s project nevertheless implicitly proposes an individual and individualizing medical perspective. He attends solely to the singular context from which a specific infection arises and within which he hopes to modulate its effects—even if he ultimately aspires to propagate such modulations throughout the “whole world.” The opposition between, and interplay of, the medical modes personified by Frank and Jenner persist throughout the nineteenth century. Despite the enthusiastic acclaim Jenner’s vaccine inspires, for much of the period the broader, more inclusive aims of medical police prevail. Throughout much of the nineteenth century, vaccination remains the only empirically verified, specific treatment. Medical police, on the other hand, morphs into expansive public health, public hygiene, and sanitary movements that frame national and international policies about epidemic and infectious diseases (considered at length in chapters 3 and 4). However, this balance radically reverses beginning in the early 1880s, when Pasteur triumphantly reprises and revises vaccination in its post-Jennerian incarnation, a triumph which Metchnikoff then compellingly explains when he theorizes immunity-as-self-defense. Together these entwined empirical and theoretical innovations of the 1880s will decisively precipitate medical thinking and medical politics in an individualizing, and indeed individualist, direction, ensuring that Jenner’s legacy ultimately eclipses Frank’s entirely. During the eighty years before Pasteur’s and Metchnikoff’s breakthroughs, Jenner’s achievement exceeds that of all other medical innovations. Indeed, it provides the consummate model for successful medical innovation, which is why Pasteur chooses to name his own protocol “vaccination” in tribute. Jenner’s achievement is twofold: he offers the means to mitigate an illness whose virulence continually announces itself (both through the mortality it inflicts and through the scars it leaves on its survivors), and he augurs a new and heretofore unheard-of medical possibility (a safe and reliable means to prevent a specific disease). 123

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He achieves these ends simply by substituting the infectious matter of cowpox for smallpox in the inoculation procedure, thereby transforming variolization (from variola, medical Latin for smallpox) into vaccination (from vacca, Latin for cow). The immediate reactions evince skepticism (the Royal Society rejects his initial report in 1796 as “incredible”) if not outright hostility (especially from those who have professional and financial interests in variolization). However, within a few years, Jenner’s technique garners enough support to legitimate both its effectiveness and his reputation. At the beginning of the nineteenth century, vaccination marks a spectacular turning point for medicine in terms of material effects and popular expectations. Moreover, when those concerned with public health embrace vaccination, they suggest that medicine can effectively localize its protocols around the individual body to produce aggregate results within the population as a whole.124 A near contemporary of Malthus, Edward Jenner (1749–1823) begins his career as a rural surgeon and doctor. In this setting, he adapts an empirical observation familiar to those who work in dairies, that those who have contracted cowpox less frequently contract smallpox, into the basis for a relatively safe prophylactic technique. Using largely harmless infectious matter from cows, Jenner demonstrates that inoculating people with it reduces their vulnerability to the much more serious illness. Jenner’s vaccination technique obviously develops from variolization using live matter from smallpox pustules (discussed in chapter 1). In fact, as a child at boarding school, Jenner suffered this practice and found it fearsome if not cruel. Moreover, in his early years as a doctor, Jenner himself performed variolizations, following a regimen that required patients to prepare with two weeks of rest and special diet to ensure their greatest possible health at the point of infection. When he changes the source material which he engrafts, however, Jenner critically revises and simplifies the earlier protocol and radically reduces the risks associated with it. Since opposition to variolization often derived from the not unjustified concern that it actually led to the same disease with the same virulence as the one it proposed to mitigate, Jenner’s introduction of another, less-threatening possibility facilitates its acceptance. Yet Jenner does not provide a totally new technique for smallpox prevention, since the actual method for inoculating the infectious matter remains much the same. His radical innovation results entirely from the way cowpox diminishes the risk associated with the preventive protocol compared to contracting smallpox itself, either “naturally” or through variolization.

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As a practicing physician, Jenner is an empiricist and not a theorist. Therefore he primarily seeks to document and not to explain his technique’s efficacy. In Vaccination against Smallpox: An Inquiry into the Causes and Effects of the Variolae Vaccinae, or Cow-Pox (1798), he offers a compendium of cases, which he updates over each of the next several years, to record his experimental results. Largely abjuring analytic inference, Jenner does tentatively broach a vague conclusion in a 1799 supplement: The very general investigation that is now taking place chiefly through inoculation . . . must soon place the vaccine disease in its just point of view. The results of all my trials with the virus on human subjects has been uniform. In every instance the patient who has felt its influence, has completely lost the susceptibility for the variolous contagion.125

In this passage, a rare synthetic statement, Jenner invokes vaccination’s nebulous “influence” to account for decreased “susceptibility” to “variolous contagion.” Obviously he does not call on the figure of the fortress body which Cotton Mather conjured, nor does he propose any comparable explanation for why his vaccine works. Instead, given his belief that smallpox derives from an undue “familiarization . . . with a great number of animals [e.g., dogs, cats, cows, hogs, sheep, and horses] which may not have been intended for his associates,”126 Jenner deploys a fuzzy environmentalist terminology to cautiously clarify his results. Vaccination, according to Jenner, recapitulates the disease-inducing proximity between humans and animals, a condition of boundary confusion that signals “the deviation of man from the stage in which he was originally placed by nature.”127 By controlling the manner and the direction in which the infectious matter circulates, vaccination ameliorates this deviation. It substitutes the lesser risk of cowpox for the greater risk of smallpox. Not unlike Adam Smith’s investment in political economy as a strategic modification of natural vulnerabilities, Jenner’s vaccine seeks to redress a natural human risk by manipulating nature directly to circumscribe it. This same problem of risk attends all eighteenth-century attempts to preempt or allay smallpox. Indeed, Jenner’s success at the end of the century has as much to do with how medicine makes sense of risk as with risk reduction itself. To enhance the acceptance of such preventative protocols, medicine introduces epistemological strategies that testify to the certainty of its claims. In the absence of such “certain knowledge,” opponents can easily dismiss medicine’s putative promises. Thus (as we saw in chapter 1) the selectmen and justices of Boston vociferously oppose

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Cotton Mather and his associate Zabdiel Boylston in 1721, partly because they fear that variolization might actually increase incidents of, and mortality from, the disease rather than curtail them. The history of smallpox prevention therefore also entails a history of the techniques used to make truth claims about its effects. For example, in London during the same year that Mather and Boylston try in vain to persuade Boston’s officials, perhaps the first clinical trial in European history attempts to establish variolization’s safety as a prophylactic procedure. Under the auspices of the Prince and Princess of Wales, court physicians inoculate three male and three female prisoners in Newgate prison with smallpox in August 1721.128 All except one (who had previously suffered from the illness) show slight symptoms of the disease but soon recover and, receiving pardons, are released from prison the following month.129 In a weird twist of historical causality, then, the first experiment known to assess a medical protocol gives rise to both legal and biological immunity. In the years immediately following these initial forays into smallpox prevention, increasing interest in variolization leads to reflections on how to evaluate its results.130 Two empirical issues plague variolization: whether attempts to preempt smallpox by introducing matter from the pustules of those already infected actually induce the same illness under more controlled conditions (thereby mitigating further and more virulent occurrences), and whether the technique actually provokes less-severe symptoms than the “naturally occurring” version.131 Seeking to assuage such doubts by ascertaining the practice’s reliability, Thomas Nettleton, a provincial doctor (who like Boylston comes under attack for inoculating people in his community), writes to James Jurin, the secretary of the Royal Society, on June 16, 1722, suggesting a new way to settle such arguments. His letter appears in the Philosophical Transactions of the Royal Society: Sir, I doubt not but when you have collected a sufficient Number of Observations for it, you will be able to demonstrate, That the Hazard in this Method is very inconsiderable, in proportion to that in the ordinary way by accidental Contagion, so small, that it ought not to deter any Body from making use of it. In order to satisfy myself, what proportion the number of those who die of the Smallpox, might bear to the number that is seized with the Distemper, in the natural way, I have made some enquiry hereabouts, and I shall take the freedom to transmit the Accounts to you, because I believe you may depend upon their being taken with sufficient care and impartiality.132

With this recommendation, Nettleton introduces the idea that numerically assessing variolization will endorse the procedure as a strategically effec-

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tive modulation of natural vulnerability. He compares the proportion of those who die from smallpox after inoculation to those “seized with the Distemper, in the natural way,” to determine “the Hazard in this Method.” This comparison then constitutes the basis for evaluating his confidence in the practice. To validate the new protocol, Nettleton mathematically defines a ratio of risk between “accidental Contagion” and induced forms of the illness. Assuming that accidental contagion exceeds the induced variety, this proportional relationship then stands in for the positive effects which variolization achieves. Furthermore, by characterizing infection “in the ordinary way” as “accidental,” Nettleton presumes that variolization forms a purposeful means of risk control with “very inconsiderable” “hazard” “in proportion.” Thus he endorses the procedure as decreasing human vulnerability to smallpox: by deliberately inducing the risk of infection, he claims to confer a (hopefully) less dangerous form of the potentially deadly illness so that those inoculated “will always be secure from any danger of it.”133 In so doing, he offers mathematical proof to promote variolization as a calculated risk that assuages a natural human liability. Catalyzed by Nettleton’s suggestion, Jurin himself, using his resources as the secretary of the Royal Society, begins in 1723 to compile and publish information “concerning the comparative Danger of the Inoculated and Natural Smallpox”—including reports by Cotton Mather and Boylston— attempting to estimate “the hazard of dying of the inoculated smallpox.”134 To discern this risk potential, Jurin first seeks to form an Estimate of the Hazard, which all Mankind, one with another, are under of dying of the natural Smallpox, that, by comparing this with the Hazard of Inoculation, the Publick may be enabled to form a Judgment, whether or no the Practice of Inoculation tends to the Preservation of Mankind, by lessening the Danger to which they are otherwise liable. (216)

As Jurin proclaims, the ground of comparison that will determine the “estimate of hazard” is “the Danger to which they [Mankind] are otherwise liable.” Postulating smallpox as an index of natural danger, medicine can invest in inoculation as a means of  lessening a constitutive vulnerability—a vulnerability that it makes intelligible as a ratio of risk. Thus, assessing the mortality tables from the late seventeenth century and the early eighteenth, Jurin argues: It can never be known, whether or no any particular Person, be one of those, that are to have the Smallpox; his Hazard of dying of that Distemper, being made up of the Hazard of having it, and the Hazard of dying of it, if he has it. (221)

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Jurin extrapolates the “Hazard of dying of that Distemper” that constitutes “the Danger to which they are otherwise liable” by compounding two risk ratios: “the Hazard of having it, and the Hazard of dying of it, if he has it.” He then calculates these compound ratios and juxtaposes the result to the rates that follow from inoculation under different circumstances, concluding: That of all the Children that are born, there will, some time or other, die of the Smallpox, one in fourteen. That of Persons of All Ages taken ill of the Natural Smallpox, there will die of that Distemper, one in five or six, or two in eleven. That of persons of all Ages inoculated, without regard to the healthiness or Unhealthiness of the Subject, as was practiced in New England [by Cotton Mather and Zabdiel Boylston], there will die one in sixty. That of persons inoculated with the same Caution in the choice of Subjects, as has been used by the several Operators one with another, here in England (if we allow in the two disputed Cases abovemention’d, that the persons died of the inoculated Smallpox) there will die one in ninety one. But if those two Persons be allowed to have died of other Accidents or Diseases then we shall have reason to think, as far as any Judgement can be made from all our own Experience here in England, that none at all will die of Inoculation, provided that proper caution be used. (224)

These numbers circulate widely and appear in numerous debates and discussions of variolization in Europe and North America throughout the eighteenth century.135 Moreover, Jurin’s estimates provide the first known example of using a proportional calculation to affirm the efficacy of, and necessity for, a new medical intervention. As deployed by those who seek to promulgate inoculation, his ratios provide mathematical indexes that stand for the usefulness and safety of a technique that, while always bearing risk within it, also seeks to mitigate a more threatening and deadly susceptibility. Hence Jurin’s analysis not only endorses the procedure itself but also, as a means of endorsement, provides a way to recognize and evaluate the procedure’s consequences. Variolization, then, involves two distinct and yet deeply entangled innovations: as a preventative medical technique, it also spurs an important new mode of medical verification.136 If physicians and their patients do not believe that their own interests require the practice, then it will certainly have no purchase. Since variolization’s advocates want to ex-

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pose vulnerable individuals to smallpox under controlled circumstances to modulate susceptibility to it, they seek to demonstrate convincingly that the technique safely and significantly reduces risk. But what would count as convincing evidence of safe risk reduction, especially considering the overwhelming fear associated with smallpox? Apparently numbers and comparisons between numbers provide the key: those who support inoculation strategically enlist comparative numerical analysis as their most persuasive form of evidence. But why did enumerated comparisons offer such an appealing certainty? In part, this reliance on numerical interpretation resonates with trends in eighteenth-century scientific and social knowledge, where mathematization increasingly provides both a metaphor for rationality and an element of rational decision making. The mathematization of knowledge about the world bespeaks an increasing epistemological investment in the notion that material processes, both natural and social, operate according to fixed natural laws determining recognizable if not predictable regularities (as discussed in chapter 1). Marshaling mathematical understanding to support variolization therefore suggests not only that such regularities exist beneath the patently risky practice but that medicine can elicit them with predictable success. If mathematical precepts more and more act as a universal language, still the application of mathematics to natural phenomena constitutes a metaphoric crossing between two incommensurate realms (as, for example, in Newton’s discussion of gravity mentioned in chapter 1). Metaphorically speaking, the abstract regularities of mathematical relations appear to correspond to—or indeed to represent—the material regularities of the physical world. In a similar fashion, numbers, especially comparisons between numbers, make imaginable the ratio between variolization’s physical effects on those who receive inoculations and smallpox’s effects on those who do not. In so doing, such numbers influence how people will live with each other and with smallpox in the future. Deploying this numerical method to render variolization’s positive effects visible and intelligible, its promoters seek for the first time to encompass the complex organic processes which medicine addresses within enumeration’s abstract regularities. Moreover, by mobilizing these ratios as metaphors for the protocol’s success, they implicitly invoke an intrinsic scale of numerical evaluation (e.g., the value of 0 is less than 1 is less than 2, etc.); hence it appears as if the numbers (or ratios) themselves naturally justify the effects for which they stand. Nevertheless, despite this reliance on enumerated arguments, variolization’s physical effects still remain subject

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to volatile debate (especially in France, as we will see) precisely because as metaphors, numbers do not actually resolve the value conflicts which debates about the practice introduce. Although numbers may seem to account for living human processes, purporting simply to reveal us as we really are, their significance—and hence their persuasive force—always derives from the implied values on which they lean. In England, numerical arguments for variolization are comprehensible, if not acceptable, because they accord with political and economic investments in the body as a form of personal property which requires protection and defense—as Hobbes claimed. Moreover, like Adam Smith’s understanding that the economy systematically modulates the natural vulnerabilities which feeble human organisms incorporate, variolization can appear as a strategic investment that reconciles individual liability with collective well-being. Hence, though both medical and religious objections to the practice persist, the practice itself gathers momentum. For example, by 1745 inoculation is made compulsory for all children at the newly instituted Foundling Hospital in London, and a Smallpox and Inoculation Hospital is established in the capital city. Inoculation quickly becomes available throughout the country, and proof of inoculation, or of having survived smallpox, often serves a condition of employment for domestic servants or hospital staff. In 1755, after an epidemic in 1752 and in response to French critics of the English practice (about which more in a moment), fellows of the Royal College of Physicians give inoculation their imprimatur, declaring “that in their Opinion the Ob­­jections made at first to it have been refuted by experience, and that it is more generally esteemed and Practiced in England than ever, and that they Judge it to be a practice of the utmost benefit to mankind.” 137 During the eighteenth century, then, variolization proves itself in England not just by materially reducing the mortality and morbidity associated with smallpox but also by engendering a new way to know its material effects. If by the mid-eighteenth century the English incline to accept both variolization and the new knowledge that legitimates it, in France the practice not only receives little enthusiasm but faces considerable hostility and disavowal.138 Although Genevieve Miller explains variolization’s chilly reception by the French as belonging to a “general resistance to new English intellectual ideas,” the reasons for “French conservatism” are probably both more complex and more diffuse. In part, as Miller suggests, the French adhere to an environmentalist notion of disease causality (as we will see

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in chapter 3), implying that treatments originating in a different climate would not have the same efficacy in France.139 Also, the Roman Church still oversees the practice of medicine in France, and hence the church’s theological objections hold more institutional sway there.140 Moreover, during the ancien régime the French legacy of police (which, as we will consider in chapter 3, involves similar political investments in population’s health and well-being as those in Germany) informs medical ideology; thus they evince less interest in risk than the English or their colonial subjects.141 Be that as it may, within this more hostile context, variolization’s French proponents arduously endeavor to spell out the compelling logic of comparative risk assessment to an audience they perceive as not yet enlightened enough to grasp it.142 As a result, in these French debates about variolization, we discern even more clearly than in England the epistemological and political stakes entangled in the practice of variolization and the production of verifiable knowledge about it. The most vocal French enthusiast for variolization is the mathematician and naturalist Charles-Marie de La Condamine. Already widely renowned in France as the leader of an ill-fated expedition to Peru (to test Newton’s hypothesis about the shape of the Earth by measuring an arc of a meridian of longitude) as well as an explorer of the Amazon (he recounts his adventures in Journal du voyage fait par l’ordre du roi à l’equateur [1751]), La Condamine addresses the Académie Royale des Sciences, to which he belongs, in April 1754 and exhorts them to encourage smallpox inoculation. After a highly enthusiastic public reception, his lecture quickly appears as a monograph, Mémoire sur l’inoculation de la petit vériole.143 After comprehensively surveying variolization’s history, including Mather’s and Boylston’s experiences in New England and Jurin’s in London, as well as reports from missionaries in China and South America, and accounts of inoculating slaves in Carolina and the poor in England, La Condamine describes various methods to prepare patients and to introduce the infectious matter. Having laid this empirical foundation, he then counters the objections which impede variolization’s acceptance in France. Initially he outlines his case by anecdotally juxtaposing variolization and naturally occurring smallpox: What comparison can be made between a premeditated disease and one contracted by chance, on a journey, in the army [where La Condamine himself had contracted smallpox], in critical circumstances, and especially for women in a time of epidemy, which multiplies accidents, which transports the seat of the

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inflammation in the internal parts of a body, perhaps exhausted by watching or fatigue? How great is the difference between a disease which is expected, and one that surprises, dismays, and fear alone may make mortal, or, appearing with equivocal symptoms, may lead into error the ablest physicians? (16)

The terms that La Condamine juxtaposes underscore the force of his rhetorical questions: “premeditated” versus “chance,” “expected” versus “surprises” or “dismays.” Like his English counterparts, then, La Condamine endorses variolization as an intentional means to control a random natural threat which relentlessly highlights the human organism’s radical and constitutive vulnerabilities. However, “fear alone” does not suffice to recommend variolization, so La Condamine also logically accounts for the procedure’s risks: It is granted that it is the duty of everyone to avoid the dangers life may be threatened with; but what becomes of this obligation when the danger is inevitable? It is evidently converted into that of lessening the danger as much as possible; but the risque of having some time or other the small-pox, and perhaps dying of it, is inevitable in regard to him who has never had it; therefore inoculation is a sure means of diminishing, in a great degree, this danger. (24)

Here La Condamine makes a critical conversion: within a context where “danger is inevitable,” he asserts, the “duty . . . to avoid the dangers life may be threatened with” translates into “that of lessening the danger as much as possible.” By proposing that “the risque of having some time or other the small-pox, and perhaps dying of it is inevitable in regards to him who has never had it,” La Condamine affirms this absolute vulnerability as the decisive factor that transforms an obligation to avoid danger into an obligation to diminish it: Such is the fate of humanity: Upwards of a third of those who are born, are destined to die, in the first year of their life, by incurable diseases, or at least unknown: Escaped from this first danger, the risque of dying of the small-pox becomes inevitable to them; it sheds its influence on the whole course of life, and in every instant of time increases; it is a forced lottery wherein we find ourselves concerned in spite of us: each of us has a ticket in it, and the longer it delays in coming out of the wheel the danger augments. What is done by the practice of inoculation? The conditions of the lottery are changed; the number of fatal tickets is diminished. (25)

La Condamine’s conceit makes his case. “The fate of humanity” endures under the wheel of chance. Life, like a lottery, has no predictable out-

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comes, no sureties, only probabilities. “In letting nature act,” vulnerability befalls us. Yet the lottery of life does not permit us to enter or leave the game at will. The death that smallpox encompasses entrains and perhaps entrances us: “It is a forced lottery wherein we find ourselves concerned in spite of us.” If we avoid death’s initial pass and survive the first year of life, then smallpox becomes the fate that looms before us: “It sheds its influence on the whole course of life, and in every instant of time increases.” The specter of smallpox haunts humanity. Each seeming escape only portends an even more certain rendezvous with “a risque [we] cannot make void.” In such circumstances, where only “the certainty of danger” obtains, diminution of risk offers the only rational possibility—though, alas, it itself entails a risk. Yet despite the real danger, inoculation to induce the “artificial smallpox,” according to La Condamine, provides the only hope of diminishing smallpox’s threat, which otherwise remains a surety. La Condamine’s impassioned rhetoric affectively seeks to persuade his audience that reason requires them to acknowledge they have no choice but to gamble. He invokes the lottery as a familiar example of probabilistic action and then emotionally engages the fears of a negative outcome to make the idea of a lesser risk more palatable. Certainly La Condamine’s interest in rallying his listeners and readers to the cause of inoculation accounts for much of his rhetorical zeal. However, beneath this persuasive engagement also lies an interest in legitimating probabilistic reasoning as a valid ground for deciding when the rational organism’s natural vulnerability makes risk taking particularly onerous. As Ian Hacking and Lorrain Daston demonstrate, probabilistic frameworks emerged from the late seventeenth century onward and became increasingly effective and accepted for understanding a range of aleatory phenomena.144 Indeed, La Condamine’s metaphoric invocation serves as the immediate precursor to, and catalyst for, Daniel Bernoulli’s Essai d’une nouvelle analyse de la mortalité causée par la petite variole, & des avantages de l’inoculation pour la prévenir (1760), the first systematic application of probability to medical intervention.145 Bernoulli’s treatise in turn provokes a highly critical reply by his nemesis, the mathematician, philosopher, and coeditor of the Encyclopédie Jean le Rond d’Alembert. D’Alembert’s text in turn sparks a critique of his critique by the Encyclopédie’s other editor, Denis Diderot, who objects to his erstwhile collaborator’s mathematics and his politics. In all these cases, analyzing the medical procedure’s probabilities and hazards requires mathematically correlating individual risks to collective

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outcomes. To determine variolization’s value, then, its exponents regularize smallpox’s lottery-like nature by statistically normalizing its individual occurrences across a population. In so doing, they assimilate the individual lives into which smallpox erupts into an abstract living ensemble whose vital regularities they mathematically translate from chance into knowledge. These eighteenth-century controversies about variolization adumbrate the political regime which Foucault names biopower. The polemics about how to assess the value of smallpox inoculation relative to its discernible risks reveal the entanglements between particular human organisms and abstract political aggregates. Variolization requires individuals to submit to risks, including disease and perhaps death, to forestall greater risks of mortality both for themselves and for the populations of which they constitute units. It thereby folds together the two dimensions that Foucault described as the “anatamo-politics of the human body” and the “biopolitics of populations” which “constituted the two poles around which the organization of power over life was deployed.”146 If Mather’s fortress body or Locke’s “same man” represents one pole and Frank’s medical police the other, then we can understand why eighteenth-century medicine begins to constitute a form of politics by other means: it maps these frameworks onto each other and suggests that doing so is entirely natural. Over the course of the next century, medicine will develop its investments in both these perspectives. It will affirm its political authority and expertise by developing public health as one of its proper domains while also increasingly localizing its concerns within the individual organism’s interiority. The tensions and torsions between these different, if not opposing, ideologies disclose nineteenth-century medicine’s hybrid articulations of nature and politics. Indeed, precisely because medicine makes these articulations seem not only possible but natural, Foucault emphasizes medicine’s efficacy as a simultaneously political and economic technology: The capitalism which develops at the end of the eighteenth century and at the beginning of the nineteenth century, had first socialized a primary object, the body, in its capacity as a productive force, as a work force. The control of society over individuals does not execute itself only by conscience or ideology, but also in the body and with the body. For capitalist society, bio-politics mattered before everything, the biological, the somatic, the corporeal. The body is a biopolitical reality; medicine is a bio-political strategy.147

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Chapters 3 and 4 next illuminate the development of the modern body as biopolitical reality. By reflecting on medicine’s increasingly strategic role, they situate the immunity-as-self-defense within the bodily nexus that makes biopower matter. In other words, they cast bioscience’s discovery of immunity as an organism’s defensive capability as the apotheosis of the modern body.

One of the essential characteristics of modern biopolitics (which will continue to increase in our century) is its constant need to redefine the threshold in life that distinguishes and separates what is inside from what is outside. —giorgio agamben, Homo Sacer

3. A Policy Called Milieu, or The Human Organism’s Vital Space

At the beginning of the nineteenth century, French responses to epidemic and infectious disease turn around the relation between poverty and public health. Seventy years later French bioscience turns one more time to promote the monadic organism as the primary locus of life—and hence of medical interest. This chapter takes up these turns in turn, ruminating on how politics and science coalesce in French biomedical thinking during the eighteenth and nineteenth centuries. France provides a critical juncture for this convergence because both its politics and its science prove revolutionary during the period. Indeed, the politics deeply inform the science. French revolutionary politics—especially the politics of poverty and health care—fold together individualism (from English liberalism) and collectivism (from the French legacy of “police” as well as from the German influence of “medical police”). This paradoxical enfolding not only catalyzes ongoing political struggles within nineteenth-century France but informs how French medicine interprets health and illness

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as well. Historians of medicine (especially Erwin Ackerknecht, Georges Canguilhem, and Michel Foucault) have documented how nineteenthcentury French biologists, physicians, philosophers, and politicians modernize medicine by reimagining both its subjects and its objects. This chapter extends their insights by thinking these bioscientific developments in tandem with the historical, political, philosophical, biological, and economic tensions that arise within, and cut across, public health in France. Public health—or public hygiene, as it will come to be called—actually emerges from the fierce heat of the Revolution, offering new ways to consider and hence to address the living contexts that French citizens materially incorporate. Here, smelted in a historical cauldron fueled by political, legal, economic, and military conflict, the two life-forms considered in chapter 2 (i.e., the politico-economic individual and the nation-state’s population) coalesce. During the revolutionary conflagration, the individualizing and proprietary metonymy between person and body, which characterizes English liberalism, melds with the ancien régime’s interest in “police,” which like its German counterpart holds population as a vital asset (though, as we will see, appreciating this living resource in somewhat different terms). The resulting republican alloy casts the national collective as an amalgam of individuals whose living being materially and ideologically precipitates their “fraternity.” However, if this historical process molds the antinomies that characterize French bourgeois liberalism, public health and hygiene solidify them. To take just the most obvious example, when epidemic diseases such as smallpox and cholera (to name just those I will discuss here) infect individual subjects, they threaten the population as a whole; thus, preempting or limiting such contagions necessarily activates the tensions between individuals and populations. Over the next century, health and illness catalyze numerous biopolitical events that engage—and transform—the Revolution’s contradictory suppositions about personhood making medicine political and politics medical. To introduce these biopolitical engagements—and transformations— chapter 3 begins with the ancien régime’s investments in police, which situate health and well-being primarily within an environmentalist and collectivist ethos (in part predicated on Hippocratism’s resurgence in eighteenth-century medicine). It then considers how the French Revolution, when it overthrows the monarchy, paradoxically reabsorbs this “absolutist” legacy as a counterpoint to the same individual freedoms and rights proclaimed in the Declaration des droits de l’homme et du

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citoyen. Confronting poverty and its mortal consequences as vital problems which immediately threaten their political undertaking, the revolutionaries quickly invoke the premises that police previously affirmed, but to new republican ends. Following the revolutionary era, the interplay between individualist and collectivist concerns consistently appears throughout French thinking about public health and hygiene. These governmental discourses interpret the insalubrious contexts within which citizens live as challenging their individual health and well-being and thus as threatening the nation as a whole. Conceiving environment—or milieu—as simultaneously social and natural, political and biological, public hygiene actively addresses both individuals and populations as living phenomena. Given this ambient perspective, the concept of milieu circulates widely during the period, functioning simultaneously as a material, natural, biological, sociological, philosophical, and political paradigm. As its promiscuous usage suggests, milieu constitutes another hybrid (in the sense that Latour gives it), simultaneously uniting phenomena that represent themselves as either political or natural. Milieu can denote both social contexts and biological situations; moreover, it can represent social contexts as biological situations and vice versa. Yet it also maintains that the social and the biological form distinct modes of being and causality. As we will discover, the social and the biological may coincide within milieu, but they are not the same. Milieu thereby purports to maintain the sanctity of the political-natural distinction which its own complex existence belies. Given this labile capacity, milieu not surprisingly performs powerful imaginary work for medical science, for politics, and for the relations between them. It enables them to assume their dependence even while asserting their autonomy. Furthermore, it enables public hygiene to represent the social conditions of disease as “true” medical problems, that is, until Claude Bernard explicitly appropriates and inverts this powerful hybrid. Conjuring the concept of milieu intérieur, Bernard radically transforms medical epistemology and investigation in the 1860s, ushering in the era of laboratory-based experimentation and research within which we still live. Turning the outside in, milieu intérieur scientifically recasts the organism’s most salient environment as existing within it, rather than imagining the organism as primarily existing within its environment. Bernard thereby breaks with the Hippocratic imagination that dominates eighteenthand nineteenth-century medicine, and entirely redefines medicine’s object—as well as its subject. Indeed, milieu intérieur actively contests

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public health and hygiene’s investment in population as medicine’s appropriate focus and instead designates singular individuals as its proper concern. Physiologically, philosophically, and politically distinguishing the individual organism from the world in which it lives, Bernard’s concept therefore makes it possible to imagine a new organismic function: an internal defense against an actively and relentlessly hostile external world. It thus provides a direct and potent precursor for immunity’s biomedical apotheosis.

A Prick of the Needle, or How Vaccination Inoculates Biopolitics into French Life

When François Alexandre Frédéric, duc de la Rochefoucauld-Liancourt, returns from exile in 1799, in the wake of the Napoleonic coup, he brings with him an enthusiasm for vaccination. Having actively participated in the initial, “liberal” years of the French Revolution, RochefoucauldLiancourt had fled France in 1792, when the Revolution’s radical turn made him too vulnerable to its increasing violence. He spent the intervening years traveling through the United States and England, where on his homeward trip he learned of Jenner’s new prophylactic technique. As soon as Rochefoucauld-Liancourt safely takes up residence again in his native land, he launches himself back into civic life with the same reforming zeal that characterized his public persona both before and during the revolutionary period. To this end, promoting vaccination on a national scale proves the ideal cause for his postrevolutionary political renaissance. He harnesses the new protocol’s empirical success to a political effort to ameliorate smallpox’s individual and aggregate effects, thereby inaugurating a national campaign which combines the ancien régime’s charitable ethos with a liberal republican affirmation of citizens’ “right to health.”1 Indeed, as we will see later, Rochefoucauld-Liancourt helped articulate this right itself when, during the Revolution’s early phase, he presided over the Constituent Assembly’s Comité de Mendicité, which affirmed: “Public beneficence [bienfaisance publique] must thus see to ameliorating these misfortunes, diminishing their substance, and drying up their source; it owes to the sick who are indigent prompt, free, certain, and complete relief [secours].”2 Rochefoucauld-Liancourt’s attraction to vaccination as an instrument of public health, then, judiciously updates his revolutionary legacy for the Napoleonic era.

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Rochefoucauld-Liancourt did not introduce vaccination to France, for news of Jenner’s vaccine preceded his arrival in Paris. The new procedure’s first notice appeared in Bibliothèque Brittannique in October 1798, followed by the first French translation of Jenner’s Inquiry in 1800.3 Moreover, officials had already expressed interest in vaccination, and in 1799 the minister of the interior requested a review of a text on variolization that explicitly referred to Jenner’s innovation. By early 1800, Philippe Pinel, the famous director of the infamous Hôpital de Salpêtrière, instituted vaccination’s first trials in a clinic previously established by the École de Médecine to promote variolization.4 However, Rochefoucauld-Liancourt, seeing beyond these introductory gestures, quickly discerns the expansive public health potential that vaccination presents. Taking up a subscription among France’s leading citizens (including Charles François Lebrun, one of the new government’s three consuls; Lucien Bonaparte, minister of the interior and Napoleon’s brother; Charles Maurice de Talleyrand, minister of foreign affairs; and Nicholas Frochot, prefect of the Department of the Seine), Rochefoucauld-Liancourt establishes the Comité Medical pour l’Inoculation de la Vaccine (usually referred to as the Comité Central de Vaccine).5 For the next twenty years, until the Academie de Medicine commandeers its function in 1820, the Comité Central supervises the development and organization of a national vaccination program. Vaccination’s introduction into France illustrates the complex interplay of governmental and individual responsibility that characterizes public health policies in revolutionary and postrevolutionary France. Drawing on the ancien régime’s legacy of charity, as channeled through republican liberalism’s economic and political strategies, vaccination efforts in the early nineteenth century anticipate the entangled collectivist and individualist imperatives which mark French public health and hygiene throughout the century. Casting vaccination as promoting national interests, the Comité envisions—and soon establishes—a system of vaccination centers in each of France’s departments. These centers then provide local sites for disseminating the live vaccine. Thus the Comité relentlessly circulates information about, expertise in, and justifications for vaccination, along with the material means to implement it. This material support also necessarily includes propagating the vaccine itself in human hosts—often orphans or other wards of the state—whose own prophylactic infections in turn provide infectious matter for further rounds of inoculations.6 In other words, the Comité Central de Vaccine simultaneously disseminates the idea of vaccination as a public value and the matter of the vaccine, which

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transforms the idea into a reality. By manipulating the vulnerability and risk latent in an aggregation of unvaccinated individuals, the Comité Central hopes to (re)produce a population (which they envision as national in scope) less susceptible to smallpox’s debilitating if not deadly effects. The Comité Central’s vision clearly constitutes a governmental concern and therefore interests both the state and its leaders. For example, Napoleon himself will give the cause great symbolic support when he has his son, the King of Rome, vaccinated soon after his birth in 1811. In fact, the minister of the interior, Jean Antoine Chaptal, endorses the Comité’s 1803 Rapport, “applauding” the project and recommending its emulation throughout France. Furthermore, Chaptal proposes to introduce vaccination in public schools and foundling homes, promises to recommend it to the minister for war, and exhorts “fathers of families [to] imitate the example of the government and hasten the destruction of a scourge which so greatly ravages the population.”7 Yet although government publicly sanctions the Comité Central’s project, it does not fund it. As Pierre Darmon acidly observes: “Animated by an inordinate pretension that it proclaimed with aplomb from the beginning of the nineteenth century, the superior authorities ordered the national extirpation of smallpox with the intimate conviction that an operation of this expansiveness must and should be conducted successfully in the absence of all financial support.”8 Instead, throughout the Consulate (1799–1804), Empire (1804–14), and Bourbon Restoration (1814–30), the state relies on a privately financed institution that works through and with local governmental agents to promote vaccination. This reliance exemplifies the complex and overlapping political, legal, economic, medical, moral, and social investments in the life and health of France’s citizens. For while affirming vaccination’s importance as a national project, the state nevertheless structurally and financially distinguishes its own vital interests from those of the living human beings that constitute its subjects. This distinction effectively bifurcates French citizen-subjects into an individual legal and economic subject on the one hand and a vulnerable living citizen on the other. Indeed, the citizen’s vital response to vaccination (which modifies its susceptibility to smallpox infection, benefiting both political-economic subjects and the sovereign nation that subjectifies them) incorporates a new form of being and living together. Since vaccination’s national value depends on inoculating enough people to disrupt an epidemic, the “vaccinary” imagination sociopolitically hails

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France’s citizens as both subject and object of medical concern and intervention. Jenner’s technique affords direct access to the vital, and hence vulnerable, potential latent in the population’s living mass. Furthermore, it does so precisely by using the human organism’s responsiveness to the vaccine not only to decrease individual susceptibility to smallpox but also to create more vaccine to use on other individuals to decrease their susceptibility and thereby create more vaccine, and so on. The collective value of a vaccinated population contrasts markedly with economic and political appraisals which emphasize individual singularity (e.g., Smith’s and Malthus’s). The living nexus whose infectability a national vaccination campaign seeks to modulate represents a new way to imagine and address citizens apart from (or in addition to) their interpellation as economic and political subjects. This collective potential, imaginatively and materially inscribed within the new medical technology, can then appear within an increasing array of governing concerns. It is important to emphasize, following Foucault, that governing concerns are not necessarily state concerns. Instead of receiving state funding, early vaccination efforts in France rely on philanthropic interest and investment, revealing French liberalism’s contradictory interplay of social and individual agencies. As Giovanna Procacci argues, nineteenth-century French philanthropy finesses the tensions between citizenship as a form of national and social belonging and individualism as an economic and political ideology. This philanthropic ethic revises and replaces the impulses that inspired eighteenth-century charity (especially under church auspices), altering the social and political implications of such dependent relations: The charitable attitude interpreted distress [la misere] as an individual case, and interested itself in the poor individual to symbolically confirm the power and the singularity of the rich. In the hands of nineteenth-century philanthropists, the moral element aims, on the contrary, to determine the effective conditions of an organic sociality. . . . Philanthropic techniques do not pursue an individual solution, but aim to introduce a social effect [un effet de socialité] in a situation judged asocial.9

The Comité Central’s philanthropic investment relies on individual donations by some of France’s most illustrious citizens—not the state— to address and to redress the social effects of an illness whose existence heretofore “asocially” appeared as a natural or religious phenomenon. In other words, the Comité’s philanthropic campaign (albeit operating under governmental imprimatur) assuages the political contradictions that

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liberal governance confronts when epidemic disease impinges on both individuals and populations. The Comité Central de Vaccine resolves this contradictory situation by absolving the state of responsibility for imposing vaccination on its citizens, even as it and some of its major officials in their capacity as private citizens actively support and facilitate the Comité’s designs. By displacing individual and collective responsibility for vaccination from the state onto the social domain, in which philanthropists act on behalf of the public interest, the Comité Central de Vaccine models how public health responds to individual illness over the next century. Conversely, responses to epidemic illnesses, along with the medical mappings on which they lean, politically and economically inform dynamics between individuals and collectivities during the same period. In so doing, they bear the traces of the specific history from which they emerge, as Matthew Ramsey describes: Far from subordinating the individual relentlessly to the public interest, France was one of the countries in which classic liberalism was most pervasive and lasted longest. . . . [Yet] the development of public health in France reflected the contradictory legacy of the French Revolution; its deeper roots lay in the Old Regime, in the efforts of the Bourbon monarchy to inject the state into the business of promoting the health and welfare of the king’s subjects.10

As chapter 2 makes clear, “the business of promoting the health and welfare of the king’s subjects” refers explicitly to the state’s investments in police. Because the revolutionary project takes up these older imperatives, even as it rejects and revises their raison d’être, the French inflections of police between the reigns of Louis XIV and Louis XVI percolate through public health and hygiene in the nineteenth century. By chronologically detouring through the French dynamics of police, then, we can clarify how revolutionary tensions between a collectivist investment in population and economic and political individualism (adapted from En­ gland) will play out in the medical and hygienic theories of the nineteenth century.

Police Work, or The Labor of Population

As in England and the German states, the mid-seventeenth century sees a decisive shift in France’s governing policy. While French and German princes share an investment in police as an instrument of state power,

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France at the time of the Treaty of Westphalia bears slight resemblance to the German states at the same time. Having disrupted both the Habsburgs’ theopolitical fantasy of a unified Holy Roman Empire and its geopolitical land-lock around France, France supersedes Spain as Europe’s greatest power. Yet France is also in the middle of a civil war, called the Fronde, sparked in part by the costs of the Thirty Years’ War, as well as by the crown’s exacting fiscal demands on the nobility and its increasingly imperious attitude.11 Unlike in England, where the king loses his head and the crown succumbs during the Cromwellian interregnum, the French Regency holds onto power, and Louis XIV takes the reins of his reign in 1661. He then consolidates his power to preempt any further challenges to his sovereignty.12 Thus, rather than redefining the monarch’s legal and political relations to his subjects (as the Civil War and Glorious Revolution had in England), the Fronde engenders a more centralized and administratively consolidated monarchy, personified by and in the Sun King himself. Given Louis XIV’s personal and political ambitions, the notion of police provides a primary tool of state power. Inheriting the costs of the Thirty Years’ War and further encumbered by a large and often unwieldy military on which he relies to wage numerous wars, not to mention his ambitious personal projects (for which Versailles provides an excellent icon), Louis depends heavily on his ability to extract resources from his subjects.13 Indeed, he understands this as his métier, remarking in his Mémoires (a pedagogical text written for his heir) that an intelligent king “finds the means of profiting from whatever they [his subjects] have that is good.”14 In this regard, Louis has a gift; he uses administrative centralization to consolidate both political and economic power. Establishing his court as the center of French politics, he forces nobles to orbit around his every bodily movement (literally). Louis not only unifies all state power in himself (serving as his own prime minister from Mazarin’s death in 1661 to his own in 1715) but also reorganizes the dynamics between local feudal authorities and the crown, consolidating a nationwide network to gather and report information to him. To this end, Louis establishes a new office, Lieutenant générale de Police de Paris, in 1667, which supervenes on the city’s feudal assemblage of more than fifty distinct ecclesiastical, municipal, and seigniorial authorities.15 The royal ordinance establishing the position clearly defines its charge, specifying that “police consists in ensuring public and individual peace, ridding the city of that which causes disorders, procuring abundance, and enabling each to live according to his condition.”16 While ap-

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pearing to distinguish between public and individual interests, the royal charge actually uses police to link them. It thereby adumbrates how police fuses these two distinct (and not easily reconcilable) ways to value human lives. Indeed, as Foucault remarks, police resolves the difference between individual and public by incorporating the singular body of the subject within the “social body” of the collective.17 Thus police materially and administratively recognizes the complexity that humans manifest as living bodies which are simultaneously biological and political. Louis XIV’s investment in police demonstrates how politics increasingly focuses its interests in and on the vital conditions that enable a sovereign’s subjects to live and serve as assets for the crown. Over the next four decades, under the auspices of the first two Lieutenants géné­ ra­les de Police de Paris, Nicholas La Reynie (1667–97) and Marc-René d’Argenson (1697–1718), police responsibilities increasingly encompass municipal life. Furthermore, the office’s success leads to its establishment in the realm’s other major municipalities by 1699. The growing capaciousness of police responsibility inspires the monumental Traité de la Police (1705–19), a series of volumes compiled by Nicholas Delamare (a Parisian Conseiller-Commissiares directly appointed by the king and overseen by the Lieutenant générale de police). In this magisterial undertaking, which Foucault describes as “the great charter of police function in the Classical period,”18 Delamare codifies and clarifies the domain within which police operates in early-eighteenth-century France. While many of Delamare’s topics also appear in works by German cameralists, Delamare frames their significance somewhat differently. His twelve volumes consider (in order) police itself, religion, morals, health, food, buildings and roads, public peace, science and the liberal arts, commerce, manufacture and the mechanical arts, servants, domestics and workers, and lastly poverty. This compendious list maps how police conceptually and materially intervenes in the lives of French subjects. Meticulously working their way through police responsibilities, the volumes terminate with poverty, almost as if it provides a punctuation mark that binds the others up and gives them meaning. Circumventing poverty then serves as the end for all the other concerns and thereby provides their overarching rationale.19 In France, the project of police conceptually derives from the sovereign’s theopolitical obligation to his subjects’ salvation (discussed in chapter 2). Given this overarching pastoral function, Delamare devotes the first three books of his opus to introducing the history of police and then specifying its moral and religious dimensions—which, as the minion of a most

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Catholic monarch, he not surprisingly defines as the “primary concerns of police.”20 Having provided this theopolitical frame for his exposition, Delamare then turns in the third and forth volumes to health and nutrition. When he addresses health in the third volume (“Health then which is the first and most desirable of bodily goods, precedes here all others of this nature”),21 Delamare invokes a classical Hippocratic view emphasizing the environmental factors that support or undermine physical well-being. Invoking “the Ancients,” Delamare defines police’s health concerns as accommodating the living organism to its environment to support its wellbeing and to ameliorate its ills. His categories—airs, waters, foods—along with regulating remedies and physicians’ qualifications, situate health in a simultaneously natural and social nexus. Police modulates these factors insofar as they impinge directly on “bodily well-being” (biens corporels). Finally, Delamare emphatically affirms that police “vigilance” becomes “incomparably more necessary” when the “general” effects of epidemic illness turn the object of concern from an individual to an aggregate. Policing health, according to Delamare’s social and environmentalist perspective, entails providing clean water and air, regulating wastes, modifying insalubrious areas (swamps, cemeteries, slaughterhouses, tanneries, etc.), curtailing dangerous cures, and eliminating unqualified healers. Moreover, police responsibility encompasses a much more vexing problem, the provisioning and distribution of food: that is, ensuring the adequacy of the supply, the quality of the product, the honesty of the sale, the validity of the measures, the cleanliness of the production, the means of distribution, the location and regulation of the markets, the hoarding of surpluses. With food supply, police confronts the economic and political demands and risks entailed in maintaining citizens as living beings. As Steven Kaplan notes: “Police was the means by which government sought to assure the subsistence of the people.” 22 Together food and health—and understanding food as an element of health—demand the most significant police interventions. For the king’s subjects to labor productively and thus for the monarch to extract value from them, they need sufficient provisions and protections to work (if not, as the German cameralists believed, to thrive). Police then bears the responsibility for rendering royal subjects a labor force by augmenting their life force. 23 If, as Emma Rothschild writes, “the organization of commerce and the organization of government were intertwined, in late eighteenth-century Europe, in all the details of ordinary life,” then police represents a particularly entangled aspect of this organization. 24 Police intervenes in and

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organizes the flows of resources, wastes, elements, animals, and humans that together incarnate municipal life. Needless to say, such interventions require diverse techniques, some legal, some administrative, some financial, some structural, and many all of these at once. Policing therefore extends the domains across which, and the means through which, the lives of French subjects attract increasing scrutiny and control. Arlette Farge argues: “This uninterrupted production of ordinances, this excess of legislation bears in fact on things of little weight, of slight detail: it is the field of the real, regulated moment by moment with infinite precision. . . . All the interventions of police modify not only spaces but social actors themselves.” 25 The regulatory zeal codified in a spate of new police ordinances (823 between 1730 and 1763) bespeaks the growing desire to administer quotidian patterns and details to govern the social relations materialized within them.26 The article titled “Police” in Diderot and d’Alembert’s Encyclopédie (1765) testifies to how police folds politics and government together. Written by the jurist Antoine Gaspar Boucher d’Argis, the article explicitly relies on Delamare’s prior framing, describing police by naming (in exact order) the topics of each of Delamare’s volumes. However, writing a half century after Delamare, Boucher d’Argis also clarifies the form of governing that police inspires and specifies its particular provenance. Situating police within an overarching history stretching from Mosaic Law through the Greeks and Romans to the history of France, the essay opens with an anthropological narrative largely consistent with Rousseau’s. Segueing from a brief etymology, Boucher d’Argis stresses the juridico-political conundrum to which police attends. He begins with a basic contradiction: if humans first assemble to create a “comfortable and peaceful life” (la vie commode & tranquille), then why has this goal not only not been achieved but its “contrary . . . all but come to pass”? 27 This situation obtains, he claims, because individual wills run athwart the general good. “Mistakes,” “self-love,” “passions” increase when humans gather (compared to some mythic time of dispersal) and then subvert, if not invert, the reasons they coalesced in the first place. Law remediates this social paradox, and the “good” easily incorporate its “rules of conduct,” since their “nature” affords them an “equity” the wicked lack. Without this inner “natural” compulsion, the law must compel nonconforming miscreants to behave appropriately—or at least to appear to do so. Hence, Boucher d’Argis concludes, the law bifurcates itself into two incommensurate domains: that which attends to the general will and that which concerns individuals.

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Throughout this exposition, Boucher d’Argis emphasizes the tension between the individual and the collective which necessitates police. For him, police restores the original impulse from which societies derive. It forcefully corrects those who do not naturally incorporate appropriate conduct and informs their actions. If laws derive from quasi-natural “rules of conduct,” then police (though administratively endowed by the sovereign’s force of law) applies itself outside or beyond or even before the law by attaching itself directly to actions and their regulation. Though Boucher d’Argis does not pursue its implications, his logic frames the legacy that public health and hygiene inherit from police. For if police’s imperative derives from the negative consequences that ensue when humans aggregate politically—consequences which contradict the original reasons for this political aggregation—then it must recalibrate individual actions to mitigate their collectively deleterious effects.

How to Know the Health of a Population

Police concern with population reaches its apogee in Moheau’s Recherches et considerations sur la population de la France (1778).28 In this work, which French demographers view as inaugurating their discipline, Moheau extends and elaborates the general reflections on the economic, social, moral, and vital effects of collective living that appear throughout the Encyclopédie (including Boucher d’Argis’s entry on police).29 While questions about population had attracted mercantilists and physiocrats—especially in their debates about the basis for national power and wealth (e.g., agriculture versus industry)—Moheau’s book attempts the first systematic analysis based on empirical data (mostly from police sources). Moreover, it frames this analysis philosophically by negating the individual’s significance: Man thus seen naked and stripped of all the prerogatives and distinctions that social conventions have introduced leads to the sentiment of natural equality: for all individuals the same needs, the same pleasures. The only real enjoyments for sovereigns are the same that they share with the least of their subjects. Same beginning, same end, a cradle, a grave. One of the most eloquent lessons of morality consists in the sight of this innumerable multitude of human beings which cover one part of the surface of the globe, of this long succession of generations which follow each other, pushing themselves forward, extinguishing themselves, reproducing themselves.

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The tiny space that the most important men occupy in the order of times and places, the tiny influence that the most memorable actions have on the centuries that follow them and on foreign nations, all thus reveals the weakness, the nothingness [le néant] of the individuals that compose the human species. . . . But consider men as a mass, that is when our being reclaims a character of dignity.30

Moheau’s emotional evocation leads him to a new appreciation of human worth. He first considers human beings “naked and stripped” to evoke biological commonality (“same needs, same pleasures”) as “natural equality”: “Same beginning, same end, a cradle, a grave.” (As the next section shows, this biological equalization, whose political import Moheau clearly appreciates, reappears during the French Revolution as the natural basis for the rights of man.)31 Figuratively reducing the individual to bare life, Moheau then describes history’s vital flow as negating any one person’s or event’s significance, no matter how seemingly important or memorable. Confronted by this “nothingness of the individual,” however, humanity ultimately redeems itself from insignificance not particularly but generally, not singularly but as a “mass.” Population incorporates this mass’s living materiality as both a vital resource and an existential value. In the chapter “Value of the Population in a State,” Moheau elucidates these political and economic implications. He initially argues that labor performed by the sovereign’s subjects founds the state’s wealth: If there are some Princes whose hearts are closed to the cry of nature, if vain homage has enabled them to forget that their subjects are their fellow creatures [semblables], and often their superiors in terms of character, morals, spirit, and knowledge, they must at least observe that man is simultaneously the last term and the instrument of all forms of production; and only considering him as a being with a price, he is the most precious treasure of a Sovereign. Within this financial frame, man is the principle of all riches.32

Here Moheau invokes nature not only to disrupt the metaphysical pretensions of closed-hearted monarchs (should any exist) but also to affirm that human labor constitutes both the subject and object of “production.” Human productive capacity, he declares, embodies both the “most precious treasure of a Sovereign” and “the principle of all riches.” Yet more than an individual capability, this potential combines with all others, and together they define political economy’s value nexus. The intrinsic and relative forces of States consist principally in the population, and singularly in the number of individuals who can handle a spade, guide a

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plow, work at a trade, carry arms, and finally reproduce themselves: such is the basis of the power of a nation.33

Admonishing those advising the king that his strength and wealth consist in human relations, not in material infrastructures, Moheau equates the “intrinsic and relative force of States” with collective productive and reproductive capacity. He then personifies this capacity as “the number of individuals” capable of performing transformative, economically essential tasks. Since individuals exist here as a “number,” Moheau seems to value population by imagining it as primarily a labor force which vitally incorporates the nation’s wealth and power. Writing during Turgot’s brief tenure as comptroller general (when Turgot seeks with limited success to reform France’s political economy along physiocratic principles), Moheau clearly hopes to guide the nation. Indeed, as Marie-Noelle Bourguet suggests, Moheau’s text comprises both a “political manifesto and an administrative manual,” simultaneously proffering “a theory of man, the premises of a comprehensive science of society, and a program of government.”34 To augment the state, Moheau outlines how individuals must live in order for people to live together profitably. He first addresses the material conditions of human life (air, water, food, sleep, etc.), following the same Hippocratic perspective that Delamare invokes, before taking on social dynamics (religion, government, law, marriage, morals, luxury, war, etc.). Combining these two sets of vital issues, his analysis culminates in the work’s penultimate chapter, “Some Establishments and Rules of Police Useful to Population,” with a paean to public medicine: Independent of curative methods, there is a preservative Medicine, enhancing the general police, and essential to the conservation of the public health [la santé publique]: it is in this science that Aristotle and Pythagoras, and many other great philosophers, have instructed us; it is that which was professed by our ancestors, the Gauls, the Druids, who were Physicians, Priests and Magistrates all at once; more believed, more developed in France for almost the last century, this science has perhaps been the unknown cause of the cessation of a multitude of mortal illnesses which afflicted pervious centuries, and of which some have disappeared and others have been less frequent. 35

After a pointed critique of private medicine, which may “destroy more men than it saves,” Moheau lauds “preservative Medicine,” which operates “independent of curative methods,” and situates it within “general police”

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insofar as it acts on population. He then invokes “Aristotle and Pythagoras,” along with “our ancestors, the Gauls, the Druids,” as precursors for this “science,” describing it as at once philosophical, medical, religious, and governmental. This overdetermined characterization privileges “public health,” since it invokes all aspects of the subjects’ lives (intellectual, corporeal, spiritual, and political). Attributing an “unknown” curative agency to the preemptive science, Moheau underscores its positive effect on population by diminishing or eliminating certain “mortal illnesses.” In light of Moheau’s assessment—especially his distinction between “curative” and “preventative” medicines—we see how police attends to health by addressing the multiple dangers and vulnerabilities encountered when humans live together. One index of this attention appears in the new valence that hygiene increasingly takes on. Until the last decades of the eighteenth century, hygiene refers almost exclusively to modulations of individual behavior aimed at either maintaining health or ameliorating illness. For example, the Encyclopédie’s long entry on hygiene (1765) invokes the Hippocratic and Galenic principles supporting the “part of medical science which can be the most advantageous to the human species” without ever suggesting that it has a political or public valence.36 Moreover, as Dorinda Outram argues, eighteenth-century hygiene focuses bourgeois self-concern, such that the individual’s vital interest in health becomes a self-investment.37 This individualizing investment, which hygienic technique, or “regime,” seeks to enhance, transforms the bourgeois body into a kind of moral (if not yet legal and economic) property. It provides the emerging middle class with a concrete object of self-concern and a locus for self-actualizing activity. However, this singularizing technology also finds itself increasingly collectivized, as hygiene comes to characterize not just bourgeois self-interest but also the state’s investment in population’s aggregate vitality. During the last decades of the eighteenth century, this new hygienic possibility emerges as a more and more critical element of police’s health concerns. Over the next century, it both realizes Moheau’s notion of “preventative medicine” and transforms medicine’s domain per se. Foucault describes this transformation concisely: In a more precise and localized fashion, the necessities of hygiene call for an intervention by medical authority on those privileged places of illness: prisons, ships, harbor installations, general hospitals [hospitaux généraux] where vagabonds, beggars, and the disabled encounter each other, hospitals themselves

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whose medical setting is insufficient most of the time, and which exacerbate or complicate patients’ illnesses when they do not spread pathological germs to the outside. . . . Medicine as a general technique of health, more than as a treatment for illnesses or an art of cures, occupies a more and more important place in the administrative structures and in this machinery of power, which does not cease in the course of the eighteenth century to expand and assert itself. 38

Hygiene as a matter of political import requires medical knowledge not just about individuals but also about the collective body that these individuals engender when they coexist. Needless to say, this expansive ambition includes a multitude of details and relations whose interconnections it must consider to address, if not redress, the population’s health. Moreover, these regulatory aims require making such details and relations visible and intelligible to modify them to desired ends. Medicine realizes this political desire by conceiving it as a technical problem. 39 The Société Royale de Médecine, founded in 1778, epitomizes this technological approach.40 Until its founding, French medicine operated under a corporate model, as had many occupations during the late medieval and early modern periods.41 The profession’s quasi-monopolistic organization, financially and institutionally invested in its own centrality, often not surprisingly resisted new theories and practices (especially in Paris, where, for example, the most eminent faculté ruled against variolization, as mentioned in chapter 2).42 In 1774, however, the situation decisively shifts when a persistent cattle plague, or rinderpest, threatens animals that not only provide meat and milk but also supply power for cultivation. To address the dangerous situation, Turgot asks a medical commissioner to investigate the problem and suggest possible courses of action. This request results in the culling of both diseased animals and those that had come in contact with them. In the costly wake of the rinderpest epizootic, Turgot realizes that for the state to respond expeditiously to similar threats in the future, it needs more adequate information. To this end, he distributes questionnaires to state officials throughout the country, requesting data about human and animal diseases in each of their localities over the previous three years, to be compiled centrally in Paris. However, for these responses to serve any useful purpose, they need archiving and interpreting. Thus in 1776 a royal decree authorizes the Commission de Médecine à Paris pour tenir une correspondance avec les Médecines de province, pour tout ce qui peut etre relatif aux Maladies épidemique & épizootique (Paris Medical Commission to undertake a correspondence

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with physicians in the provinces concerning everything pertaining to epidemic and epizootic diseases). Organized under the leadership of the king’s first physician, Joseph Lassone, and with Félix Vicq d’A zur at its helm, the commission has several charges: to situate epidemics and epizootics in a national perspective; to disseminate information about the clinical signs, diagnostic techniques, and remedies for these illnesses; and to make isolated outbreaks of illness visible more generally. To generate such new knowledge, the commission (under the direct auspices of the comptroller general) establishes a network of local physicians to gather comprehensive details about health and illness in every region. They report to the crown’s agent (intendant) of their area, who in turn forwards their findings to Paris. Conversely, regional authorities must dispatch medical knowledge and personnel to localities whenever clustered outbreaks of illnesses appear. In 1778 the commission evolves into the Société Royale de Médecine, a more comprehensive organization whose charge no longer focuses exclusively on epidemics and epizootics but includes the nation’s “state of health” generally.43 The Société’s new scope reveals the Hippocratic ethos which underlies its activities. Since, according to this perspective, health and illness involve the complex interplay of topographical, meteorological, environmental, nutritive, sanitary, and personal variables, the Société commences compiling data about and assessing the dynamics among all these factors. Caroline Hannaway summarizes the Société’s ambitions: “It wanted to complete its project of building up a medical map to illuminate the relationship of climate, geography and disease in every area of France.”44 To this end, in addition to physicians, its informants include local officials, veterinarians, village priests, landowners, and lay people. Disseminating a comprehensive questionnaire, the Société guides their data gathering, asking them to observe medical topography (geographic and geological details, including water supplies, housing conditions, numbers of people, arrangements of hospitals and cemeteries, organization of social classes, habits, etc.), climate (meteorological patterns and variations), diet, and incidence of disease. Moreover, it standardizes the instruments to gather such data (thermometers, barometers, hygrometers, etc.) and institutes reporting protocols to ensure consistent results. By mapping health and illness onto the nation’s vital contexts, by defining the knowledge relevant to such a mapping, and by assembling the apparatus and the agents to achieve it, the Société reimagines health’s conceptual and material domain. After the Société’s comprehensive project to render health and

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illness visible and intelligible as geopolitical phenomena, medicine can no longer exclusively localize the isolated individual. Instead medicine now emerges as a biopolitical technology that mobilizes an array of resources, including, among others, humans, animals, elements, resources, wastes, technologies, transports, places, knowledges, interpretations, authorities, and values. Before the Société dissolves in 1793 (since it is the Société Royale, it ends with the monarchy), it produces, in conjunction with its more than one thousand correspondents, a monumental archive.45 This archive recasts scientific reflection on health and illness as an applied practice designed to transform the collective lives of individual citizens in the name of the public good. The Société’s documents enable medicine not only to reimagine health and illness but also to address them differently. Rather than basing medical practice on theoretical premises that merely postulate how environments affect individuals, the Société amasses detailed information, collected throughout the nation, and derives correspondences to indicate how significant these effects are and how they might be modified. This new technology of knowledge production transforms Hippocrat­ ism from a medical theory into an applied political strategy. Underscoring the Hippocratic premises invoked by earlier doctrines of police (as mentioned earlier), the Société translates this strategic framework into a state investment in its subject’s lives. In the last decades of the ancien régime, then, medical theory informs political thinking and practice, and conversely political strategy transforms medical thinking and practice. Moreover, this interpenetration of politics and medicine redefines the biopolitical significance of human life both collectively and individually. Thus, on the cusp of the French Revolution, the political imagination of medicine and the medical imagination of politics intersect. Moreover, they inaugurate a new way to value human lives that locates health and illness at its epicenter.

Incorporating the Rights of Man, or Making a Vital Revolution

The new political value of human life makes its revolutionary debut in the first sentence of the first article of La déclaration des droits de l’homme et du citoyen: “Les hommes naissent et demeurent libres et égaux en droits” (Men are born and remain free and equal in rights). With its first verb (naitre, to be born), the body of this renowned text, which the National

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Assembly delivers into the world on August 26, 1789, conceptually and materially attaches itself to the living human body. The issue of birth (i.e., the free and rights-bearing men “issued” by birth) emerges here precisely as an issue of birth­, since to be—let alone remain—“free and equal in rights,” one must first be born. But why do men remain “free and equal in rights” only insofar as they are born so? Or to put it slightly differently, why does birth become a political as well as biological threshold for free and rights-bearing citizens? To address these questions, consider for a moment the stirring affirmation pronounced in another famous revolutionary document (one that in fact directly influences the Declaration of the Rights of Man): the Declaration of Independence of the United States.46 There, in a passage that also grounds the political being of citizens, the document invokes somewhat different “self-evident truths”: “That all men are created equal; that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty, and the Pursuit of Happiness.” Note that a critical difference interposes between the American “are created” and the French “are born.” Certainly, both documents claim a “natural” basis for the political principles that justify revolutionary transformation, and both identify these bases as “original.” Yet those American citizens created by their Creator and those French citizens who are born do not manifest their nature or their origins in quite the same way. Not merely a semantic distinction, “are created” and “are born” posit different natural constitutions for individual political subjects. Indeed, they constitute individuals as both natural and political subjects differently. The declaration of July 4, 1776, invokes the same formal principles and the same formal body that the English legal and economic individual incarnates, defined by habeas corpus on the one hand and wage labor on the other (as discussed in chapter 2). “Created” ex nihilo by “their Creator,” the Declaration of Independence’s rights-asserting subjects—the “we” who “hold these truths to be self-evident”—announce a formal principle that conceptually structures their juridico-political claim. This claim in turn legitimates the violent overthrow of a colonial power to found a new sovereign one. Thus, while the rhetoric naming the rights bestowed by the Creator (the political trinity “life, liberty, and the pursuit of happiness”) certainly holds them as natural rights, this is an abstract nature, not a living one. Indeed, as if emphasizing the point, the right to “life” only follows from this abstractly “equal” creation as one of its “endowments,” rather than preconditioning it.47

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The French Declaration of the Rights of Man, however, derives rights from birth as a natural event that individualizes human life as such.48 In other words, birth confers freedom and equal rights on all individuals because as embodied beings all humans equally must be born. In one sense, then, “equality of birth” simply means that since all men are equally born, the threshold of birth establishes their political status as both natural and universal. Conversely, and more subtly, the freedom and equality that this birth installs incarnate in a living body which is born. The nature that establishes the philosophical and political bedrock for the French rightsbearing man and citizen hence inheres in a living being. Unfortunately, a paradox ensues as a corollary to this premise, since the citizen-subject’s proclaimed individuality immediately runs athwart the vital connections that living beings manifest.49 Consequently, an irreducible tension appears between the individual subject and the national citizen—a tension that, not surprisingly, often surfaces within political concerns about bodily health and well-being (as my earlier discussion of the Comité Central de Vaccine suggests). The comparison of the American and French declarations illuminates the different ways that modern politics construes the modern body. The French gesture, even if rhetorical, foregrounds the citizen’s birth—and hence life—as a political event. Concomitantly, it considers maintaining such life a political responsibility, as stressed by the second verb of the Déclaration’s first article (demeurer, meaning “remain” or “continue,” but also connoting “to live, reside, dwell, or lodge”). As its idiom discloses, the Déclaration naturally attaches the freedom and rights of French citizens to their conditions of living. Hence the political concerns about health and well-being that plague the Revolution (to which the next section turns) seem doubly inscribed in the first sentence of the document that proclaims the revolutionary project itself. Taken together these two initial verbs, which both hail the citizen and declare “his” rights, divulge that the French Revolution’s vital logic recasts politics as an effect of life itself. Founding rights in and at the citizen’s birth, the Déclaration incorporates a tension between the rights-bearing individual’s singularity and the vital contexts within which such individuals live. While as legal, political, and economic subjects, individuals might inhabit the abstract dimensions that equality supposes (and hopes to impose), as living citizens they necessarily coexist with each other, as well as with other living and nonliving beings, in complex circumstances that render their abstract singularity moot. When events such as famines, epidemics, wars, and natu-

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ral disasters threaten such vital coexistence, the tensions between these two valences of personhood often materialize as biopolitical problems. To reconcile their diverging perspectives and thereby redress mortality and morbidity, which is at once individual and collective, the notion of the “general interest” intercedes. Representing health and illness as matters of general interest resolves the friction between individual and collective. It politically propagates the lifeworld’s “generality” as that in which humans (and other living beings) collectively bear a vital interest, and it thereby collectivizes them. As Giovanna Procacci explains: “ ‘The general interest’ . . . simultaneously represents the principle of the unity of individuals in the social body and that of the subordination of their individual interests. All production of political reality takes place, under the Revolution, with a double purpose: to constitute the individual and the Nation at the same time.”50 Needless to say, this tension endures throughout the next century as different forms of French government grapple repeatedly with its implications.51 The Revolution’s recurrent attention to health and medicine inaugurates this political strain when it seeks to reconcile citizens’ bodily being with their well-being.52 Since the vital problems that afflict French subjects now also threaten the living locus that makes them citizens, the state’s responsibility for sustaining individual lives reappears as a “right to subsistence” (as the next section documents). This political investment in subsistence diverges radically both from Thomas Hobbes’s claim that political collectivity arises to mitigate how vulnerable the “brittle [human] frame” is to death (especially violent death) and from Adam Smith’s idea that political economy necessarily and naturally supplements our “delicate frame” and “feeble constitution.” Instead the French citizen’s vital being—its capacity to be born and to remain free and equal in rights—both localizes its national belonging and grounds its political and economic value. This natural articulation of national personhood, which explicitly disrupts the ancien régime’s sacralized hierarchies, establishes instead an internal torsion between individuality and collectivity.53 By representing “general will” as embodying the national collective (heretofore theologically incorporated in the monarch’s corporate and corporeal body), the Revolution both posits and produces a new personification to unify the nation into a vital whole. In this process, the citizen’s life, the literal and material issue of its birth (naitre), bound up in a living context where it necessarily dwells (demeurer), takes on new value. It paradoxically incarnates the general will as a particular and universal manifestation.

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When the French Revolution imports English liberalism’s political and economic principles into a historical context where a theologically legitimated monarchy heretofore used police to govern its vital assets, it precipitates a confluence of contradictory effects. On the one hand, the Déclaration des droits de l’homme et du citoyen begins by affirming an individual citizen, legally and politically incarnate in a body that is born and remains free and equal in rights, and concludes by avowing that property is an “inviolable and sacred right.” On the other hand, it also addresses itself directly to the “all the members of the social body,” defines its overarching purpose as helping citizens to “tend always to maintenance of the constitution and to the well-being of all [au bonheur de tous],” and locates the principle of sovereignty “essentially” in the nation. Indeed, these divergent declarations make the difference between homme and citoyen palpable by distinguishing between two distinct, and sometimes competing, modes of living. In other words, they bifurcate the national citizen-subject by inscribing conflicting values and interests within it. These internal conflicts emerge most clearly when the lives and well­b eing of individuals or groups make unequal demands on collective national resources. In such cases, fractures within the social body often appear to erupt within individual (suffering) bodies that the state must contain lest the nation and its citizen-subjects split apart at the seams. Foremost among these containment strategies, public health and hygiene seek to rectify the irreducible gap between the individual body and the social body, between individual property and le bonheur de tous, all in the interest of the sovereign nation itself. In fact, they emerge from the French Revolution as new ways to think the politics of life as simultaneously an individual and a collective process.

A Revolution in Subsistence, or The Comité pour l’Extinction de la Mendicité Rethinks Health and Illness

The months following the Déclaration provide ample opportunity for its contradictory objectives to reveal themselves. The Revolution foments social upheaval which both follows upon and exacerbates economic distress in the cities and in the countryside.54 The harsh winter of 1789–90 creates even more suffering. The conditions of the poor and unemployed in Paris provoke both outpourings of concern and fears of uprisings (as had occurred the previous year after bad harvests). Public subscriptions

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attempt to alleviate the most immediate hardship, and the mayor of Paris petitions the National Constituent Assembly for assistance. In response, on January 23, 1790, the Assembly creates a new committee to determine how to distribute money contributed for relief and how to determine “the means to provide for [subvenir] the indigent.”55 Under the duc de la Roche­ foucauld-Liancourt’s presidency, the Comité pour l’Extinction de la Mendicité deliberates throughout the Assembly’s existence (ending on September 30, 1791, when Louis XVI accepts the new constitution).56 It investigates the living conditions of the poor and indigent and considers ways to ameliorate them, forwarding regular reports to the Assembly. Its recommendations include proposals to assist the unemployed, the chronically poor, the sick, the disabled, the blind-deaf, foundlings, pregnant women, the aged, and those confined to hospitals, prisons, and so on. In addition to, and by way of, these specific concerns, it also conceives a new philosophy of social assistance consonant with the Revolution’s agenda. The Comité de Mendicité rejects the charitable intentions professed by the ancien régime. Instead it translates the theologically legitimated monarch’s police concerns into the state’s rational responsibility toward its citizens.57 In this regard, the Comité participates in the Revolution’s larger efforts to reimagine the domain of governance itself. Insofar as the monarchy’s police rationale encompassed its imperative to uphold the true religion (to which Delamare devoted his Traité’s second volume and defined as one of its “primary concerns”) and insofar as it relied on religious instruments to fulfill its aims (e.g., on alms giving to alleviate poverty or on religious orders to run hospitals), this monarchical raison falls within the mode of govermentality that Foucault describes as “the pastoral” (as does its German counterpart discussed in chapter 2).58 Such governmental rationality channels the monarch’s spiritual demands into a care-taking concern for its subjects’ lives, thereby using salvific obligation to legitimate the sovereign’s social, political, and economic interventions. Given that it abjures such theological legitimation, the National Constituent Assembly cannot invoke this religious means either to justify or to effect its responses to social and economic distress. To mold the state’s ameliorative imperatives to the Revolution’s ends, then, it needs new ways both to apprehend the nation’s interests in maintaining its citizens’ lives and, conversely, to specify the citizen’s entitlement to partake in the nation’s resources. The Comité pour l’Extinction de la Mendicité forwards to the Assembly a series of texts that pragmatically and conceptually sketch such a

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revolutionary approach to indigent citizens’ bodily needs. In the opening sentences of its Plan du travail (which sets forth the project for its Rapport), the Comité simultaneously acknowledges the Assembly’s paramount goal, dedicates its own charge to this goal, and defines its project as essential to the overall success.59 It conflates the nation’s “true grandeur” with “genuine national prosperity,” thereby seamlessly displacing the realization of political ends onto economic means.60 It then naturalizes this slippage by metaphorically describing such prosperity as “born of the happiness of each individual,” echoing the first article of the Déclaration while reversing its causal relations. Since the nation’s well-being, or its “grandeur,” “is born” from each individual’s vital condition, it owes it to itself—literally—not to neglect its duties to each of them. It then expands this “sacred obligation” by comparing and indeed equating the protection the state affords the “property of the rich” to the protection it must provide for “the subsistence of the poor.” (As we will see in a moment, this “sacred obligation” translates in a few paragraphs into a “sacred debt.”) Not coincidentally, supporting this comparison we find the same proprietary notion that Locke established as the basis for wage labor (discussed in chapter 2). In other words, since the bodies of the poor constitute their only property, the state must legally protect them as it does the noncorporeal property of the wealthy.61 After the prologue, the Plan explicates the “principal bases of [the Comité’s] deliberations.” In an expository tour de force, it boldly introduces a new right into the revolutionary agenda: All men have the right to their subsistence. This fundamental truth of all society, which imperiously claims a place in the Declaration of the Rights of Man, it seemed to the Comité, must be the base of all laws, of all political institutions, which propose to appease mendicity. Thus, each man having the right to his subsistence, society must provide for the subsistence of all those members who might lack it. . . . [A] duty which must never be disgraced, neither by the name nor by the character of charity [aumone] . . . it is for society a sacred and inviolable debt.62

Nothing seems clearer: the “right to subsistence” defines a “fundamental truth of all society.” Not only a “strict and indispensable duty,” it also names a “sacred and inviolable debt.” Conceiving subsistence as a right, the Comité insists that the “lack” experienced by any individual demands social and political “assistance.” Defining this assistance as a duty, it rejects the “name . . . [and] the character of charity” as a “disgrace.” Moreover,

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the metaphoric extrapolation of “debt” from “duty” marks the shift from a moral to an economic register, implying that economics provides the new justification for collective responsibility. However, beneath these affirmations lurks a murkier problem: Why is this right, this duty, this debt, construed in terms of “subsistence”? How does subsistence modulate the vital economy within which the “sacred and inviolable debt” obtains? What assumptions does subsistence impose as a right? Using subsistence to denominate legitimate claims on the nation’s resources evokes a complex history of thinking about bodily need in relation to political and economic values. Compared to the German investment in a “flourishing” population (discussed in chapter 2), or Delamare’s affirmation of “the most perfect happiness” (discussed earlier in this chapter), or even le bonheur de tous proclaimed by the Declaration of the Rights of Man, subsistence provides a particular and purposefully limited way to frame the new right’s announcement. The Dictionnaire de l’Academie française (1762) gives the primary meanings of “subsist” as “to exist, to still exist, to continue to be,” but also includes as alternate senses “to remain in force and vigor” (demeurer en force & en vigeur) and “to live and to be maintained fittingly in a certain state.” The resonance between demeurer and subsister thus directly links the “right to subsistence” to the first article of The Rights of Man. However, philology alone does not account for the new right’s nominal form. During the seventeenth century, subsistence means not only “to continue to exist” in a general sense but also “to keep alive” (se maintenir en vie) or “to provide for one’s needs” (pourvoir à ses besoins). In the eighteenth century, it extends (in the plural) to maintaining an army and refers in economics (for example, in Quesnay’s Tableau economique [1766]) to produce or commodities necessary to maintain life. Subsistance recurs repeatedly throughout the Encyclopédie (at least 343 times), most often in relation to agriculture, commerce, taxation, population, and the military. Therefore, with subsistence, the Comité specifically deploys a familiar political and economic concept to define a minimal threshold that enables the national subject to remain (demeurer) a citizen “free and equal in rights” by continuing to live (subsister). Since subsistence specifies a vital minimum, it also immediately intersects with health and illness. The right to subsistence exists as a political prerogative precisely because its lack diminishes vital capacities, especially the capacity to work. Furthermore, the Comité defines indigence itself as a form of social illness: “Poverty is a malady inherent in all great soci­ ties: a good Constitution, a wise administration can diminish its intensity,

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but nothing, unfortunately, can radically destroy it” (315). To describe poverty as an endemic malady metaphorically naturalizes it, transforming it from an economic into a quasi-biological phenomenon. With this rhetorical figure, the ancien régime’s theological justifications for charity morph into a civic responsibility, since political responses to indigence can now appear as a type of social medicine. No longer does the biblical stipulation “For the poor always ye have with you” ( John 12:8) guide the politics of relief; instead poverty itself forms an ineradicable social condition that requires relentless treatment. Transferring concern for the poor from a religious to a medical framework inaugurates revolutionary shifts in pastoral authority that ultimately proclaim medicine a secular ministry (as we will see in the next section). Construing poverty as a malady, the Comité figuratively conflates an effect with a cause: if poverty’s deprivations diminish bodily well-being and induce ill-health, then illness offers a visible metonym for the economic destitution that provokes it. More than a simple metonymy, however, poverty’s depiction as a social malady, as a social disease, suggests that poverty diminishes the nation’s vitality insofar as it diminishes the aliveness of impoverished individuals. But how does this vital diminution deleteriously affect the social body? What signs make this political disease visible? Labor betrays the critical symptoms here: the ability or inability to work distinguishes health from illness, both individually and collectively. Extending the idea that poverty constitutes a social illness, the Comité proposes work as its effective cure, naming it the “principal remedy for indigence” (316). According to this basic principle, the ability to work establishes an individual’s obligation to work; conversely, the inability to work establishes the state’s obligation to the individual (317). Yet more than just dividing up the domain of misery, this obligatory logic also revalues the bodies of those living in poverty. For if poverty constitutes an endemic social malady, then those whose bodies can but do not work now incorporate a form of social pathology, while only those who cannot work owing to natural (bodily) pathology deserve aid. The text denominates these naturalized divisions among the poor unequivocally. Thus, first division.—The true [véritables] poor, that is to say, those who, without property and without resources, want to earn their subsistence by work; those whom age does not yet allow, or whom it no longer allows, to work; and finally those who are condemned to an enduring inactivity by the nature of their infirmities, or to a temporary inactivity due to passing maladies.

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Second division.—The bad/vicious [mauvais] poor, that is to say those who, known under the name of professional beggars or vagabonds, refuse all work, disturb the public order, are a scourge [un fleau] to society and call for just severity. (317)

According to the Comité’s schema, those who “refuse all work” do not deserve aid not only because they are “bad,” “vicious,” and even “evil” (all possible translations of mauvais) but also because they disrupt political relations and constitute a social “scourge.” Indeed, with this embedded religious metaphor—adapted from “scourge [ fleau] of God”63—the Comité subtly retools the theological premises which underwrite the ancien régime’s charitable impulses to the revolutionary project. Encompassing illness and debility within the horizon of work, the Comité clearly delineates their political significance: individual experiences of bodily suffering and incapacity constitute remediable political events when they impinge on an individual’s ability to contribute to, or indeed labor for, the collective good. The Comité underscores this political calculus in a later section of the Rapport titled “Secours aux malades” (Aid to the Sick): It is, without doubt and with great reason, misfortune which arouses the attention of society to the conditions born from the state of illness in the man who subsists only by his hands. The type of work to which he devotes himself, the hardships which crush him, the habitual state of distress in which he lives, render his illnesses, his injuries, his infirmities more frequent. Misfortune arises from his illness, from the destruction of his resources by the impossibility of working, and from the misery in which the absolute lack of salary plunges his family. . . . Public beneficence [bienfaisance publique] must thus see to ameliorating these misfortunes, diminishing their substance, and drying up their source; it owes to the sick who are indigent prompt, free, certain, and complete relief [secours].64

This passage elaborates the internal connections between poverty and illness that animate public health and hygiene over the next century. The Rapport frames the political response to “misfortune” (which both results from and causes illness) as a matter of “general interest.” It defines work as that which “merit[s]” assistance because through it society incurs a debt which it repays by providing “prompt, free, certain, and complete relief.” The political bonds that labor engenders thus justify using collective resources to ameliorate the suffering of those who can or will work, or

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who have worked. In this sense, the bodily transformation of life force into labor force (which the logic of police also incarnated) determines the citizen’s political responsibility: “If one who exists has the right to say to society: Make me live [Faites-moi vivre], society equally has the right to respond to him: Give me your work.”65 This life-work equation establishes a political axiom that links the citizen’s individual body to the nation’s social body though the transformational labor that the vital organism can perform. Hence it predicates the value of the citizen’s life on its bodily capacity to augment the collective materiality from which the “general interest” ensues—and on which it depends. Within this conceptual frame, individual illness and debility represent significant political problems not because the state has a political, moral, or religious responsibility for the people’s well-being but because illness and debility materially diminish the population’s collective vitality and thereby afflict the whole social body. Although the constitution did not incorporate any of the Comité de Mendicité’s concrete proposals (the Assembly refers these issues to its successor), the Comité’s vital logic nevertheless frames the political imagination of health and illness over the next century—albeit not continuously.66 This is not to say they had no contemporary impact. Indeed, the Comité’s ideas and language reappear almost exactly in the revised Déclaration des droits de l’homme et du citoyen (1793): “Public assistance [les secours publiques] is a sacred debt. Society owes subsistence to unfortunate citizens, whether by procuring work for them or by assuring the means to exist for those unable to work.”67 This new thinking also transforms republican ideas about health and social welfare into elements of a defense policy, as Colin Jones explains: The armed struggle against ancien régime Europe transformed bienfaisance from a laudable virtue into an urgent political desideratum. The provision of radical social welfare policies on the lines of the Comité de Mendicité became an integral part of the programme of social radicalism introduced by the Jacobins and endorsed by the Convention with the aim of securing mass support for the hardpressed infant Republic.68

In this sense, the Comité’s perspective immediately informs the Revolution’s complex political and military agenda. However, after the end of the Terror, with the war going better, with their cash flows severely limited, and with their radical zeal attenuated, the Thermidorean and Directorial regimes forgo this commitment to the Comité de Mendicité’s wideranging approach. Matthew Ramsey describes the turn: “Following the

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fall of Robespierre in the summer of 1794, as the Convention steered the Republic in a more moderate direction, it turned away from the principle of la bienfaisance nationale towards a less statist model of assistance.”69 Instead they increase local assistance through a network of municipal or district comités de bienfaisance which assume greater responsibility for the poor and the infirm.70 Nationally the Thermidorean and Directorial governments focus instead on medicine much more narrowly. They concern themselves primarily with the functioning of hospitals, with the regulation and teaching of medicine, with providing medical aid to the military, and with circumventing epidemics. These medical issues, especially the controversies about regulating medical expertise and training, persist from the beginning of the Revolution to its end. In The Birth of the Clinic, Foucault initially tracks medicine’s legislative vicissitudes during the Revolution’s early years, examining the numerous policies for deregulating medicine, which inspire what he names the “Free Field.” These include abolishing all medical corporations, societies, academies, and faculties; nationalizing hospital properties and funds; “dehospitalizing” care for the sick and indigent; and legitimating diverse nonmedical health practitioners. According to Foucault, these political strategies revise “the very meaning of the medical profession” and redress “the privileged character of the experience it defines.” 71 After considering these early attacks on “corporate” medicine, Foucault then analyzes how, after Robespierre’s fall on the ninth of Thermidor, the Republic changes tack. In reaction both to the problems that ill-trained or untrained practitioners create among the civilian population and to the army’s dire need for competent medical officers, Thermidorian, Directory, and Consulate officials attempt to reconstitute a “qualified” medical profession by reintroducing medical education and training. Thus they establish new medical schools, new medical curricula, new examination structures, and new hierarchies of practitioners (doctors—now understood to include surgeons—pharmacists, midwives, and health officers) to replace the ones previously abolished.72 For Foucault, these legislative vicissitudes lead to the hospital’s resurrection as a site where medical practice, medical knowledge, and medical training converge on the impoverished citizen’s body.73 If the collective interest underwrites medical care for the poor, it does so only as an investment in its own vital well-being. Given Foucault’s desire to trace how the modern medical gaze focalizes within this institutional and discursive nexus, his analysis foregrounds how physiological medicine emerges from

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this revolutionary conjuncture. The hospital clinic facilitates this emergence because it provides a “neutral domain” which abstracts the diseased citizen from illness’s “natural environment.” 74 As this institutional abstraction suggests, physiological medicine’s revolutionary inception once again realizes the tension between individual and collective: by deploying collective means (medicine, the hospital, public assistance), the clinic singularizes the individual body as the site within which medicine locates and identifies disease. Foucault then demonstrates how this paradox leads medicine to reimagine the living body itself in relation to collective manifestations of disease: “[Disease] is no longer a pathological species inserting itself into the body wherever possible; it is the body itself that has become ill.”75 If, as Foucault argues, physiological medicine singularizes the diseased body, does access to medical care conversely oblige the indigent citizen to submit to this singularizing subjectivization to “earn” the “right” to medical care? Does the needy subject, in exchange for the “right” to “prompt, free, certain, and complete relief,” have to offer its suffering body to the clinical gaze for the nation’s good? Indeed, such a biopolitical obligation follows, Foucault suggests, by virtue of the subtle right that resides in the fact that no one is alone, the poor man less so than others, since he can obtain assistance only through the mediation of the rich. Since disease can be cured only if others intervene with their knowledge, their resources, their pity, since a patient can be cured only in society, it is just that the illness of some should be transformed into the experience of others.76

Here Foucault elaborates the conditions that inform the revolutionary politics of medical intervention: the vital connections implied in the “subtle right” to medical care highlight the living contexts within which citizenship matters. Moreover, the amelioration of disease reveals that biopolitical connections trouble the ideological commitment to the individual as an autonomous (political, legal, economic) agent. In the wake of the Revolution, medicine more and more provides a means to subjectify citizens, to produce citizens as subjects. Increasingly, the state calls on medicine to offer remedies for numerous social problems which directly affect citizens as living organisms, including those that involve disease, housing, food, water, medical care, and so on.77 In this service, medicine begins to encompass many of the projects that Johann Peter Frank defined as falling within the purview of medical police.

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Indeed, Frank’s work explicitly inspires French public hygiene during the first decades of the nineteenth century. However, more than just mobilizing collective resources to ameliorate circumstances that diminish the individual citizen’s vital capacities, medicine also begins to advance techniques that alter the citizen’s self-relation as a subject. To some extent, the life-work equation established by the Comité pour l’Extinction de la Mendicité already negatively anticipates this possibility: predicating access to health care and assistance on incapacity (but not unwillingness) to work, medicine assumes responsibility both for assuaging temporary debility among those able to work (to return them to work) and for legitimating the “validity” of those chronically or permanently infirm (who cannot work). Medicine thus biologically supplements political economy to maximize the population’s productive capacities as a labor force. As significant as this supplemental responsibility might be, however, medicine also aspires to function directly as a biopolitical force, capable of modulating the citizen’s behavior qua citizen. By shoring up the human being’s nature as a living organism, medical science advances itself as essential social knowledge both of the individual and of the collective—or even as a social knowledge that links the individual to the collective.

Medical Ideology: The Nature of Cabanis

The figure who makes this critical transition most explicit is the ideologue Pierre-Jean-Georges Cabanis. Physician, philosopher, and politician, Cabanis plays a complex role during the revolutionary era, including helping Napoleon to engineer the coup of 18 Brumaire.78 While Cabanis’s influence during the period exceeds my consideration here, his role as a politically and philosophically inclined physician (and a medically and philosophically inclined politician) directly shapes how public health and hygiene catapult from the Revolution into the nineteenth century. Famous—and, to some, infamous—for a materialist psychology that predicates human mental and emotional capability on physiological capacity (epitomized by his claim that the brain “digests” sensations and “secretes” thought),79 Cabanis hopes to found a veritable “SCIENCE OF MAN” (his capitalization) to unify “physiology, analysis of ideas, and ethics.”80 This political, philosophical, and biological materialism leans on his unabashed enthusiasm for the Hippocratic corpus as the basis for medical practice. Cabanis’s physiological explanation for the Hippocratic

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assumptions on which eighteenth-century police relied (as discussed earlier) constitutes one of his main contributions to medicine—especially to public hygiene. Elucidating Cabanis’s ambition for the “science of man,” Sergio Moravia clarifies the biological underpinning for Cabanis’s psychoethico-politico-medical project: “If man is in his structure essentially a physical organism, the study of his being and his moral behavior has to be based on the study of everything that conditions and influences such a materiality.”81 Predicating the link between personal and political on human nature, Cabanis holds the living organism as the vital ground that unites the individual with the collective. Moreover, he sees medicine as the biopolitical groundskeeper. In reports written for the Hospitals Committee for the Department of Paris (convened in 1791), Cabanis begins to elaborate his political philosophy of medical care.82 Composed between 1791 and 1793 (but only published in 1803 as Quelques principes et quelques vues sur les secours publique), these essays address the same political situation that the Comité pour l’Extinction de la Mendicité also confronts. Like the Comité, Cabanis hopes to reconcile his political commitment to liberal individualism with a belief in the nation’s obligation to provide social and medical assistance. As a doctor, he founds this compromise between individual and society not only in the Revolution’s political precepts but also in the human organism’s natural functions: The existence of man is not isolated and solitary. Nature has made him a sociable being [etre sociable]: it has rendered society necessary to complement his life; it only creates him to be born and live in society. The length of his infancy, his needs (so often out of all proportion to his energies) and, more than all the rest, the innumerable advantages of coexistence with beings of his species, which all his experience shows and makes him feel, dispel from him all ideas of separating himself from them: they attach him invincibly to the social condition which creates his happiness, or at least without which he can only have suffering and deprivation.83

Society constitutes the “natural” human condition, it forms the “necessary complement to [our] life,” Cabanis claims, because as organisms humans cannot live (well) entirely by ourselves. Our physiology demands both that we receive nurturance during our early motor incapacity and that others augment our limited forces to meet our excessive needs. With this initial framing, Cabanis critically deviates from Adam Smith—whose work he read and, like his fellow ideologues, often found salutary. Cabanis

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qualifies society not just as supplementary to human feebleness, merely compensating for our deficiencies, as Smith held, but also as complemen­ tary to human life, enhancing our ability to meet our (exorbitant) needs. In other words, Cabanis, unlike Smith, imagines being together as a natural human condition, rather than a belated compensation for natural weakness. However, Cabanis still (negatively) recognizes a tension between the individual and the social: though society’s positive experiences and advantages “dispel all ideas of separating . . . from them,” nevertheless, he implies, this idea must arise relentlessly to be just as relentlessly dismissed. Moreover, if social benefits “attach” humans “invincibly to the social condition,” this attachment also casts a negative shadow as the suffering and privation that nonattachment portends. When confronted by such suffering in others, the “natural” sociality incorporated in our “sensibility” (a physiological capacity that determines, for Cabanis, our living per se) evokes “shared affections” which move us to help each other: At the sight of suffering or misery, human feelings are affected [entrailles humanines s’emeuvent]: a prompt return to ourselves acquaints us, by the misfortunes [maux] we have witnessed, with those that we can experience. A vivid sentiment [sentiment vif ] links us to these agonies, in some way, as if they were ours personally. We have the need to share them by our compassion, to sweeten them with our assistance. Here is the principle of welfare [bienfaisance].84

Cabanis’s “compassionate” logic derives from a physiological capacity to feel others’ feelings. His idiom locates this capacity in our guts, which move themselves in the face of misery and suffering. He stresses this “sentiment” as a “living” capacity (the primary sense of vif ) which contradicts individualism’s possessive assumptions: it is “as if they were ours personally.”85 With this “as if,” Cabanis renders the absolute distinction among individuals conditional and reveals sentiment’s links as society’s natural dimension. These vivid and living sentiments weave together the very individuals whose experiences vary according to “the errors of fate and laws.”86 In fact, Cabanis imagines the natural social connections among individuals extending beyond every national and political distinction whatsoever, even to the expanse of the species itself (2.5). Conversely, and more paradoxically, however, he declares that the “social body” interrupts sentiment’s global extension to localize individuals within nations, which then isolate their “own” interests as their highest good. From this sentimental

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tension follows Cabanis’s explanation for social welfare: “Political humanity embraces all of society: national charity [l’aumone nationale] especially has in sight the public utility that prescribes it. Hence, without brushing aside individual misfortunes, of which it must without a doubt sweeten the bitterness, its principal object is the maintenance of the peace, wellbeing and good order in general” (2.5). While Cabanis admits that political rationality motivates bienfaisance (“This is not only an obligation; it is a veritable calculus of interest” [2.4]), he also relates it to the human organism’s prepolitical nature. Hence Cabanis accords medicine a special biopolitical role insofar as medicine’s raison d’être directly addresses the citizen-subject’s corporeal ground. Cabanis introduces his synthetic political vision for medicine in his historical and philosophical reflection Coup d’oeil sur les révolutions et sur la réforme de la medicine, written during (1795) but published after (1804) the Revolution. Instigated by Dominique Joseph Garat, a fellow ideologue and minister of public education, Coup d’oeil initially recounts the legislative debates about reintroducing and restructuring medical education (in which Cabanis, needless to say, participates actively).87 He then elaborates and updates his Hippocratic principles to encompass contemporary epistemological paradigms and portrays medicine as a unique scientific project, distinct from, but drawing on, the physical sciences. Finally, advocating the hospitalization of medical education, Cabanis holds that the hospital provides the only setting where the poor can receive consistent care (due to numerous observers tracking their progress) and where medical knowledge can advance rapidly and effectively (due to the numerous cases the hospital staff can compare and analyze).88 Within this plan for medicine’s future, Cabanis locates hygiene as its centerpiece precisely because it links physiology and morality, bodies and actions: Hygiene teaches the means to conserve health. It is not only an essential part of medicine; it is also a no less important part of morality. Morality is in effect the art of life: how could this art be complete, without knowledge of the changes that can challenge the subject on whom it practices and the means capable of producing these changes? Hygiene, and as a consequence also certain succinct notions of physiology and anatomy, must enter into all systems of education. In order to extract the most useful part of our intellectual faculties, in order to direct our inclinations and our desires towards the ends most advantageous to our happiness, it is absolutely necessary to adapt all our physical habits to our type of work, to the moral dispositions that we would like to cultivate in ourselves:

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and often a good regimen [bon régime] suffices to restore order to our ideas and to regulate our passions.89

When Cabanis promotes hygiene as a technique of both health and morality, he implicitly asserts a vital connection between them. Health encompasses not just physical but also moral well-being because physical well-being can engender moral well-being, because moral behavior can induce bodily and mental health, and because immoral behavior can lead to physical degradation. In other words, Cabanis understands human materiality as entailing intellectual, psychological, emotional, ethical, and political consequences. Hygiene addresses itself to this materiality to modulate our living processes toward “order[ed]” and “regulate[d]” ends which conform to “our type of work” and “the moral dispositions we would like to cultivate in ourselves.” Thus it proposes “regimen” as a subjectifying technology that can reconcile individual and social interests. Furthermore, when Cabanis defines morality as “the art of life” and identifies hygiene as one of its essential techniques, he entwines its biological and political significance: attending to physiology, hygiene serves the art of life; informing how physiology gets directed, it serves the art of life. Invoking “life” as hygiene’s subject and object, Cabanis reveals hygiene as an exemplary practice. Since it can “naturally” govern how human organisms live together, biologically, morally, and politically, it establishes politics as a “natural” human domain. Given this biopolitical entanglement, Cabanis segues without hesitation from regimen as a psycho-physical, politico-moral technology to his underlying Hippocratic premises. Quickly summarizing the multiple and interacting effects that air, water, soil, food, work, local dispositions, and so on induce both individually and on the “character proper to each nation,”90 he then affirms the inventive potential of “man, who although in appearance the most feeble animal, is at bottom the strongest,” to adapt to even the most challenging contexts. However, although this inventiveness enables humans to dwell in vastly different habitats by shaping natural settings to their specific needs, in doing so, they are shaped as much as they shape. Indeed, studying this reciprocal action between organism and environment constitutes Cabanis’s expansive “science of man.” Deeply appreciating social behavior’s complex materiality, Cabanis offers a technique to improve (or perhaps “perfect”) not just society but the species as a whole. One must not, without doubt, limit oneself to the history of foodstuffs, to the exposition of their nature, to the determination of their effects: it is necessary

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moreover to indicate the chains of impressions, ideas, appetites, or inclinations which can entail their use; it is necessary to appreciate each type of life, with respect to its influence on habitual dispositions of the system, on those of each organ, on its faculties and functions. . . . In a word, by embracing the physical and the moral at the same time; in indicating the relations and the means by which they act upon one another, one must aspire to make this knowledge, once it has been well verified, serve to perfect all individuals. And let us even recall here, what I have remarked upon elsewhere: the constant observation of centuries attests that the physical dispositions transmit themselves from parents to children: some facts are certain, other analogies have great weight, and these along with the collected laws of animal economy, lead us to believe at least that certain moral dispositions propagate themselves equally by means of generation. One must therefore cast one’s vision still further, in tracing the rules of regimen; it is to the general perfection of the human species that it must aspire.91

The utopian grandiosity of Cabanis’s aspiration (which seems to portend eugenics in all its most frightening glory) might give one pause. Nevertheless it also indicates why Cabanis focuses his political vision on medicine and hygiene. If human activity and need depend on context, if circumstances inform the values that people embody, if even the organs and the vital systems inflect how humans coexist, then by attending to these vital variables, medicine is necessarily and immediately political. Moreover, extrapolating from the Hippocratic emphasis on regime and environment, Cabanis aspires for medicine to intervene in developing individuals, political collectives, and the species. Hygiene serves the nation by focusing medicine not just on alleviating the ills to which flesh is heir but also on enhancing this fleshly capacity itself. It defines the individual as a locus of political, moral, and biological intervention because individuals always exist among other individuals, each reciprocally affecting (and infecting) others politically, morally, and biologically, within and across generations. By elucidating the “rules of regimen,” hygiene proposes a comprehensive pedagogy of citizenship. In Cabanis’s estimation, then, hygiene provides an all-encompassing technology capable of refiguring the entire biopolitical domain. Its expansive aims hold unlimited promise: It is undoubtedly possible, through a wisely combined and consistently followed plan of life, to act to a fairly high degree on the habits of the constitution. It is consequently possible to improve the particular nature of each individual; and this goal, so worthy of the attention of the moralist and the philanthropist,

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relates to the research of the physiologist and the keen physician. But as one can usefully modify each temperament, taken separately, likewise, one can in a much more extensive, much more profound manner influence the species itself by acting uninterruptedly according to a uniform system on the successive generations. Hygiene would be doing very little now if it limited itself to drawing up the rules applicable to the different circumstances in which each man in isolation may find himself. It must dare much more; it must consider the human species as an individual whose physical education has been entrusted to it, and it must consider that the indefinite duration of his existence makes him capable of constantly coming closer and closer to a perfect type, of which his initial state did not even give an idea—it is necessary, in a word, for hygiene to aspire to perfect human nature in general.92

This passage introduces the conclusion to the sixth memoir of Cabanis’s magnum opus On the Relations between the Physical and Moral Aspects of Man, titled “On the Influence of the Temperaments on the Formation of Moral Ideas and Affection.” Here, fusing his physiological and Hippocratic sympathies into a capacious affirmation of hygiene, Cabanis directs medical attention away from the individual; instead he represents the individual as an epiphenomenon of larger political and biological imperatives. Paradoxically redefining the species as an individual “whose physical education has been entrusted to” hygiene, Cabanis negates the “particular nature” of each person, whose habits it can “to a fairly high degree” act on and modulate. In other words, by “acting uninterruptedly according to a uniform system on the successive generations,” hygiene aspires to transform the collectives of which individuals constitute “natural” units, and as such to improve the greater “individual.” Because medicine, personified by “the physiologist and the keen physician,” attends to the actual matter of this nature, it plays an unparalleled role in this utopian project. Its hybrid perspective, physical and moral, biological and political, individual and collective, transcends these antinomies—or even negates political distinctions altogether—and providentially “aspire[s] to perfect human nature in general.” Given this ambitious aspiration, Cabanis not surprisingly envisions medicine as a “sacred” calling. In a series of lectures given at the newly reconvened Paris School of Medicine in 1797, Cabanis exhorts the future physician to consider the breadth and depth of his obligation: In some respects the profession of medicine is a type of ministry [une espèce de sacerdoce]; in others, a true magistrature. . . .

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One can consider the physician with respect to his patients, with respect to society as a whole, with respect to science. He owes to his patients all his care and consolations. It is not enough that he know how to prescribe [medicamenter]; it is necessary that he know how to heal [guérir], and for that he needs to know [connaitre] the effects of exterior moral impressions no less than those of remedies and foods. It is necessary that he be initiated in all the secrets of the human heart, and that he understand this great art in order to move it by way of the filaments of hope and to bring calm to a troubled imagination. The physician owes society a frank and generous explanation of all his discoveries, the wise and patriotic employment of his talents, and all the means of influence that his profession gives him. . . . On certain occasions, this influence, which adheres to the nature of his ministry, can have very extended general effects, can become a veritable public force [puissance publique]. Finally, as we have just said, his obligations to science have a religious and sacred character.93

Cabanis’s idealist exhortation illustrates the new role that medicine hopes to occupy as it passes into the nineteenth century and reveals the coordinates that map this new medical terrain. Arising at the intersection of science, politics, and religion, medicine in Cabanis’s estimation becomes the incarnation, if not the apotheosis, of Latour’s “modern constitution.” If medicine can rectify the distinctions between nature, society, and God that purportedly found the modern worldview, distinctions that the French Revolution radically affirms, it incorporates “a veritable public force” indeed. The ills that medicine seeks to treat may be physical, but their effects are also psychological, emotional, moral, political, and spiritual. Distinguishing between “prescribing” [medicamenter] and “healing” [ guérir], Cabanis directs medical attention to “exterior moral impressions no less than those of remedies and foods.” Simultaneously physiological, psychological, and spiritual, medicine thus serves as a comprehensive “science of man” which the physician should profess “religiously.” 94 In Cabanis’s pregnant phrase, the physician’s “influence” “adheres to the nature of his ministry,” implying that medicine functions both as a ministry of nature and a natural ministry. Incarnating the natural, the social, and the divine, Cabanis’s medicine strives to heal not just the suffering individual but the suffering that individuation itself inflicts on the social body—an aggregate which heretofore, under sovereign monarchs, also constituted a sacred body. In other words, Cabanis’s vision of medicine, which holds doctors to both sacerdotal and governmental obligations, anoints modern medicine as a pastoral calling according to the gospel of science. This vocational doctrine, which revalues medicine epistemologi-

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cally, professionally, and politically, situates medicine immediately in a social milieu. Moreover, it inspires professionals who heed public hygiene’s call to anoint milieu itself as the quasi-sacred space within which they can finesse, assuage, rectify, and refine the antinomies between individual and collective.

The Milieu of Public Hygiene

This capacious sense of public hygiene receives its first official incarnation in 1802, during the Napoleonic Consulate, when the Conseil de salubrité de la ville de Paris et du département de la Seine convenes under the auspices of the Prefet de Police de Paris.95 Like its predecessor, the Lieutenant générale de police, the Prefecture of Police concerns itself with public health, public safety, and the preservation of law and order.96 Founded as a consulting body to this newly reinstated police authority, the Paris Health Council somewhat modestly begins with only four members, who consider food and water, epidemics and epizootics, occupational health and safety, and prison conditions. By 1815, however, both its charge and its membership expand to include eleven members (several of them Cabanis’s friends and colleagues),97 who report on conditions relating to “epidemics, markets, rivers, cemeteries, slaughterhouses and slaughteryards, dumps, dissection rooms, and public baths,” in addition to “compil[ing] medical statistics and mortality tables, and conduct[ing] research on the sanitary reform of public places, industrial processes, and secret remedies,” while seeking the “elimination of quackery” and trying to “determin[e] . . . the best methods of heating and lighting.” 98 Although this ambitious agenda provides ample opportunity for diagnosing the health problems of Paris—or even for taking “Paris itself as a patient whose vital signs, circulation, nutrition, sanitary habits, and growth need critical attention,” as Dora Weiner and Michael Sauter intimate99—the council has no enforcement powers. Needless to say, the lack of authority frustrates its members, since they have to report directly to the prefect of Police, who implements only those recommendations he sees fit. The council’s numerous proposals thus meet with varying degrees of success under different prefects. Yet lack of enforcement is not the only obstacle to the council’s efficacy. Even its more successful undertakings, such as overseeing dangerous trades, often run athwart its members internal conflicts about their obligations: “Good liberals, they feared

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restrictions on the freedom of industry even for public health reasons, believing that wealth was essential to health.”100 However, despite these structural and ideological limitations, at the dawn of the nineteenth century the Paris Health Council successfully grafts the revolutionary strain of public health onto a police agenda derived from the ancien régime, and thereby bears public hygiene’s first institutional fruit. Over the next thirty years, Lyon (1822), Marseille (1825), Nantes (1828), Lille (1828), Troyes (1830), Rouen (1831), and Bordeaux (1831) will all emulate the Paris Health Council’s model. In the wake of the 1832 cholera epidemic, even more municipal councils appear, so that by 1848, when the Second Republic reorganizes them into a nationwide system, more than sixty-five exist.101 Moreover, the hygienic perspective incorporated by this model itself coalesces into a recognizable epistemological framework, inspiring a new professional forum, the Annales d’hygiène publique et de médecine légal, inaugurated in 1829, largely by active members of the Paris Health Council. Indeed, within the first decades of the nineteenth century, the prerevolutionary understanding of hygiene as a singular and singularizing technique—or regime, intended to enhance, preserve, or recover individual health—metamorphoses into a social and political technology aimed at augmenting the well-being and ameliorating the suffering of populations, especially in urban contexts. Concomitantly, the physician can now aspire to encompass this expan­ sive sense of hygiene (adumbrated by Cabanis) as Pierre Sebastian Thouvenel’s 1806 medical thesis Sur les devoirs publique du médecin (On the Public Duties of the Physician) illustrates: It is thus very important for the happiness of all [le bonheur de tous] that he [man] be placed under the sacred power [puissance sacrée] of the physician; that he arise, eat and dress according to his advice, and the systems according to which he must be governed, educated, rectified [corriger], etc., should be set out by him, as well as the causes which can change or modify him—because who more than a doctor is suited [propre] to fulfill such a function, he who has made a profound study of the nature and the laws of his physical and moral organization?102

While Thouvenel’s idealistic discourse no doubt contains some youthful enthusiasm and hubris, it nevertheless illustrates the complex synthesis that hygiene, now conceived as a thoroughly medical and social practice, attempts to realize. Invoking the very phrase that appears in the Déclaration des droits de l’homme et du citoyen (“le bonheur de tous”) in conjunction

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with the pastoral idiom that legitimated the ancien régime (“puissance sacrée”), Thouvenel explicitly claims this authority for postrevolutionary medicine. In fact, his rhetorical question (“because who more than the doctor is suited . . . ?”) actually foregrounds his appropriation, since before the Revolution the answer might easily have been “a priest.” Espousing a naturalistic ontology that conscripts the theological language which monarchal power previously invoked to justify its rule, Thouvenel conceives medicine as a secular priesthood to affirm its political and professional agendas.103 Thouvenel hence ascribes to the physician’s “sacred power” the ability to regulate not only the individual’s personal regime (waking, eating, dressing) but also his social demeanor. Possessing knowledge of “the nature of the laws of [man’s] moral and physical organization,” the physician must design the “systems according to which [man] must be governed, educated, rectified, etc.” In other words, by connecting the knowledge of human nature (conceived as simultaneously biological and psychological) to the systems that govern and regulate human conduct, hygienic medicine seeks to modify and channel individual actions to social and political ends. As public hygiene aspires to rectify the individual and the collective, it reveals its investment in medicine as an authorized and authorizing knowledge of the human body. An excellent index of this transformation appears in the famous entry on hygiene written by Jean-Noel Hallé (in conjunction with Pierre-Hubert Nysten) published in the Dictionnaire des sciences médicales (1818).104 At the time, Hallé is the dean of the hygiene movement. He began his career as a hygienist under the ancien régime and even participated in the Société Royale de Médecine. Later, during the Revolution, he was named to the first ever chair in hygiene, created when the École de Medicine was established in Paris in 1794. Given this historical formation, he espoused a classically Hippocratic position which focused primarily on the dynamics between individual and environment. Adapting for the postrevolutionary context an article that Hallé wrote in 1780 for the Encyclopédie methodique, Hallé and Nysten reprise and update Hallé’s earlier position by defining the new “public” role they call on hygiene to play: “The knowledge concerning the laws, mores, and police of people relative to hygiene constitutes public hygiene.”105 Hygiene’s new incarnation not only enlarges the field’s application but also substantially transforms both the subjects and objects of its concerns. Public hygiene must now encompass the individual subject-object of traditional hygiene within the political domain.

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This political morphing of hygiene into public hygiene clearly incites a fair amount of enthusiasm—if not celebration—in the authors, since it inspires their unprecedented break in an otherwise staid reference-book presentation to lyrically and literally address the subjects of the new discipline: O inhabitants of towns: It is for you that such sacrifices are made! And moreover it is around you that all the solicitudes of governments gather to dispel [écarter] all harmful influences; it is for you especially public ways are cared for and cleaned, it is for you that magnificent and salubrious walkways are prepared . . . it is even more for you that artfully constructed sewers, more habitable than the shacks of the poor, are dug and that canals destined to carry clear water are erected at great cost. Whether you owe their construction to the vigilance of your magistrates, or to the active industry of your fellow citizens, it is around you that public hygiene is truly studied and put into action.106

The apostrophe that introduces this passage marks the domain of public hygiene as an especially urban affair. This municipal focus follows from the perception, first enounced during the eighteenth century and expanded during the nineteenth, that aggregate living proves especially risky for human life. Describing the urban landscape as a context requiring social, political, and economic intervention, Hallé and Nysten situate the urban addressee in an implicitly dangerous environment where governmental solicitude must disperse “harmful influences.” The numerous public works undertaken on behalf of the urban dweller (works largely aimed at regulating flows of people, goods, necessities, and wastes through the cityscape) attempt to redress the negative effects of having to share the same space with many others. Public hygiene therefore names a knowledge/practice that undertakes to regulate this spatialized dynamic by reimagining the city as a vital domain whose complex materiality inextricably informs the living conditions of its inhabitants. As Foucault remarks: “It is a medicine of the milieu of existence.”107 Needless to say, this material complexity obliges public hygiene to treat the dependent relations among humans, objects, and other living beings which define the urban as such, as Hallé and Nysten’s conclusion reveals: We have proposed the study of man himself as the subject of hygiene; that of the things necessary to his existence, whether placed outside of him or emanating from within him as the matter of hygiene; finally, the determination of the use of these things, directed according to his needs, towards the conservation of his

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health and his existence constitutes the regime, that is to say the rules, of hygiene or hygiene properly speaking. These three orders of consideration would be applied to man taken in isolation and individually as the subject of private hygiene [hygiene privé]; to men gathered together, that is to say considered collectively or to societies, as the subject of public hygiene. One follows them insofar as health, either individual or public, finds itself interested or menaced, whether by causes properly dependent on men’s constitution and the organization of societies; whether by the nature of things which are destined to satisfy our needs in the individual or public order; whether finally by forgetting the measures and the rules that conserve the health of the private man and the common salubrity [salubrité commune] in the social order. Thus the complete study of hygiene tends to the study of pathology and individual treatment, as well as that of endemics and epidemics and of the police sanitaire in its largest sense and its last details.108

To elucidate hygiene’s comprehensive project, Hallé and Nysten explicitly map the three axes of its concern: subject, matter, and regime. The text’s indeterminate invocation of “matter”—simultaneously substance and concern—underscores the lingering conceptual ambiguity. Because hygiene concerns the human being as matter living among other matter (as Spinoza might have done), it cuts across the political, philosophical, and psychological distinctions that individualism seeks to establish when it defines the body as the locus of the person (see chapter 2). Hygiene recognizes not only that individuals do not and cannot form singularities because they must live together in the material world, but also that this nonsingularity actually provokes pubic hygiene in the first place. However, since it also exists with a broadly liberal worldview in which the individual provides a template for juridico-political subjectivity, hygiene must finesse this radical ontological premise. Hence Hallé and Nysten’s list of either-or formulations reiterates this profound conceptual ambivalence: Hygiene is private or public, individual or collective, natural or social, singular or common. Yet, as Hallé and Nysten’s last paragraph demonstrates, all these “ors” really signify “ands,” since the “complete study of hygiene” binds up all these possibilities at once. Within the hygienic perspective, the putative political disjunction “either/or” dwells in tension with the medical conjunction “both/and.” For hygiene to function publicly, it must apply itself to the very conditions that complicate its private applications, because in

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such collective circumstances, private applications alone do not suffice. In other words, although it grows from the bourgeois investment in hygiene as a personal technology, public hygiene foregrounds the contradiction between the individual and the collective because it discloses how personal hygiene fails to ameliorate the symptoms occasioned by aggregate living. Thus the “matter” of public hygiene—in both senses—belies the singularity of its subject and conceives its object (the “common salubrity”) as coexisting with and codetermining the “health of private man.” Nevertheless, given its political and historical context, public hygiene must still maintain the individual as a locus of both pathological investigation and treatment. Caught within this liberal paradox, advocates of public hygiene in postrevolutionary France work to reconcile the individualism that informs legal and economic subjectivity with the statist imperatives that police maintains toward citizens.109 In this regard, Hallé and Nysten explicitly acknowledge their intellectual debt to Johann Peter Frank and call for an even wider appreciation of Frank’s works in France: “Finally, an important part of public hygiene, medical police, includes an important work begun but not yet completed by the venerable J. P. Frank, a work that we hope someone will translate into French.”110 Similarly, the introductory essay in the first issue of the Annales d’Hygiène Publique (1829) also lauds Frank’s work: “In 1778 A Complete Treatise on Public Hygiene [Traité complete d’hygiène publique] by Jean-Pierre Frank appeared. To this illustrious physician belongs the glory of having first opened the path by drawing up in a body of doctrine [un corps de doctrine] all the known specialties which compose the science with which he concerns himself. This immense work imparted a great impulse to the scientific culture of public hygiene.”111 While subtly alluding to the doctrinal (and hence quasi-religious?) quality of Frank’s scientific writings, the Annales also boldly mistranslates the actual rubric within which Frank encompasses this doctrine (remember that the title of Frank’s work was System einer vollständigen medicinischen Polizey—literally A System of Complete Medical Police), framing it instead as a treatise about “hygiène publique.” The Annales thus surreptitiously collapses the difference between “medical police” and “public hygiene” even as it bestows on Frank “the glory of having first opened the path.” With this unremarked elision—hiding behind a mistranslation that critically revises Frank’s title in light of its own project—the Annales d’Hygiène Publique reveals how much the hygienic project explicitly identifies itself

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with Frank’s expansive, pastoral model.112 However, if we recall their lateeighteenth-century uses, which were not synonymous, the substitution of “hygiene” for “police” also suggests that the Annales uses the individualizing ethos of hygiene to mitigate the collectivizing implications of police, thereby incorporating, even while disguising, the tensions between them. Conversely, the mistranslation also underscores the movement away from the earlier sense of medical police, construed as a religiously ordained royal prerogative, toward a secular medical philosophy which claims natural rather than theological grounds for its political authority. Although it emerges first under Napoleon and then develops under the Restoration monarchs, Louis XVIII and Charles X, all of whom reinvest in police to shore up their sovereign power (with the last two also reasserting the monarchy’s theological underpinnings as well), public hygiene does not follow Frank in directing its concerns to these sovereigns as medical police had. Public hygienists do not, for example, admonish their rulers to value population as a vital asset or to invest in the people’s “happiness” as a means of defending the state. Instead public hygiene now addresses the emerging professions, especially medical, administrative, and journalistic, that establish themselves more and more as public authorities during the period.113 Public hygiene speaks about empirical conditions that impinge on collective living when the nation manifests as a natural or political aggregate and not a god-given unity. In other words, as a political discourse, public hygiene takes as its subject matter (or subject/matter) the challenges which human coexistence engenders, and imagines them as natural rather than theological issues. Hence public hygiene asserts itself as “a secular religion,” which usurps political theology’s claim to bind individual subjects into collectives, by affirming citizens’ lives (and not their souls) as the natural ground of politics itself.114 When medicine aspires to a ministerial role, as Cabanis, Thouvenel, and many others advocate, it offers its all-embracing material concern for human well-being as the basis for its sacerdotal desire. If public hygiene contains the secular-religious antinomy which this desire introduces, it does so by positing a political ontology that displaces religion entirely, identifying its own overarching biopolitical concerns as those that matter most both to individuals and to collectives. The “Prospectus” which introduces the first issue of  the Annales d’Hygiène Publique (1829) wastes no time in making this case, as its opening sentences illustrate:

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Medicine does not only have for its object the study and cure of illnesses, it also has intimate connections [rapports intimes] with social organization; sometimes it aids the legislator in drawing up laws, often it enlightens the magistrate on their application, and, with the administration, it always watches over the public health. Thus applied to the needs of society, this part of our knowledge constitutes public hygiene and legal medicine.115

Immediately moving beyond illness as medicine’s proper domain, the Annales expansively lays claim to social and political power. It “intimately” affixes its subject/matter to the apparatuses of the state—legislative, executive, and juridical—which it reciprocally charges with “watch[ing] over public health.” Invoking the concept of the “needs of society” to create a subtle indistinction between politics and nature—“need” functioning indiscriminately here as both biological and social requirement—it affirms its own significance as a public medical discourse. Using the concept of public health as a political ligature, the forward-looking prospectus seeks to remake government in its own image. This inaugural manifesto then stakes out as much political and conceptual territory as it can.116 It situates public hygiene at the intersection of biological, moral, and political economies and defines this intersection as the social itself. Its purview encompasses all that pertains to the vital aggregation of human beings precisely insofar as their living together calls their living itself into question. Building on its claim to privileged knowledge about the physical aspects of human life, it metonymically extends this claim to the physical spaces in which such life transpires or indeed expires. It then extrapolates from these physiologically rooted concerns to moral ones, implicitly drawing on Cabanis’s understanding that morality depends on physiology as its material foundation. Through this move, it aligns itself—and medical reflection more generally—with philosophy and law as regulatory discourses which seek to govern (in both senses) human behavior.117 Reciprocally, social deviations reappear as social pathologies, literally social “infirmities” or “maladies,” whose correction it refigures as a form of “healing.” Moreover, it asserts that the success of such political “cures” will derive their greatest success when predicated on the natural matter that organizes human life per se. Thus physiology and hygiene serve to enlighten the “science of government” by providing the “science” on which “government” can base its regulation of “men united in society.” This regulatory vision animates public hygiene’s reflections on political dynamics by applying the epistemological frameworks of contempo-

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rary medical science—or, at least, the epistemological frameworks that attempt to render medicine “scientific” in the first place—to the social domain. William Coleman represents this epistemological intervention acutely: As Paris medicine, under the influence of Bichat and Corvisart, moved away from reliance on disease symptoms alone and sought out a more secure basis for diagnosis in pathological changes in the human body itself, so public health investigation began to shift away from mere description of phenomena to the pursuit of the underlying relations, or the supposed causes, of those phenomena. No longer content with what was immediately apparent, the hygienist began to create a social pathology, one which sought palpable evidence of social dysfunction and which at first was expressed principally in the language of economics. It was concluded, moreover, that social disruption is not something radically new or utterly different, an external agent which, coming from without, caused one or another of society’s ills. The upset was, as French pathologists were coming to insist, within the organism itself, be this the living body or society at large. Dysfunction was due to aberrations in the very structure and nature of the body or society.118

When medicine conceives a homology between relations within the living body and relations within the social body, it supposes a causal nexus that requires it to expand its analysis from the individual to the collective. By defining “social ills” as “pathologies,” it projects its assumptions about organic norms onto social dynamics and concomitantly affirms the possibility of isolating, if not curing, their intrinsic causes. This symptomatic interpretation of public dysfunction—which defines a social “symptom” as “dysfunction” in the first place—conceives “causes” as commensurate with “functions” and sees them operating within the same political space. Or to put it slightly differently, the homology advanced by public hygiene between social and biological bodies implicitly proposes a material indistinction between them such that neither exists outside the other. For public hygiene, then, all that matters is always already within its purview.

Cholera Takes Place, or The Social Space of Disease

Ironically, a major test of this ontology of biopolitical interiority appears to come from without. “Invading” from afar—from India, traveling by way of the Middle East and eastern Europe, and finally “jumping” from

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England to France—the cholera epidemic of 1832 provides an effective catalyst for refining and expanding public hygiene’s purchase. Two years after the July Revolution (which deposed the ultraconservative Bourbon king Charles X and replaced him with the relatively liberal Orleanist monarch Louis-Philippe), cholera suddenly appears, and its rapid dissemination and high mortality rate provoke medico-political debate from the moment it occurs—and even before. Confounding the Royal Academy of Medicine’s expectations that France’s geopolitical advantages and its “hygienic situation” would spare it from the “scourge,”119 the first fatalities are diagnosed in Paris on March 26, and within six months more than 18,400 people die.120 Cholera remaps both political and medical understandings of epidemic disease, which come to see it as—at least in part—socially induced.121 (Political and medical debates about cholera’s etiology persist through the end of the nineteenth century, as I discuss at length in chapter 4.) If on the one hand impoverished citizens quickly discern a Malthusian plot to diminish their numbers, then on the other hand the middle and upper classes envision a threatening transformation of the city itself.122 Catherine Kudlick, troping on the title of an epic play written by Eugène Roch in response to the epidemic, Paris malade (1832), comments: Paris malade, then, signaled bourgeois Parisians’ understanding that a complete and literal fusion of the diseased urban and human bodies had occurred. . . . Paris suffered from a kind of internal imbalance rather than from externally imposed conditions of geography and climate; the city was plagued by forces of its own making. Implicit in this view was a moral judgment: not only was the capital becoming sick, but this sickness was part of the very fabric of urban existence and resulted from human activity rather than mysterious natural forces.123

Conflating the urban landscape with the domain of disease, cholera pro­ jects pathology into the cityscape itself. For the city to fall ill (and not just its inhabitants), the social space must seem coextensive with the lives that coexist within it. The urban context thus vitally informs its denizens’ living processes, and this context-dependent living now encompasses health and disease. Responses to the deadly epidemic do not address “mysterious natural forces” which serially affect unrelated individuals, but rather posit a collective biopolitical danger. Or to reverse the causal connections, when public hygiene engages cholera’s urban contexts, it construes the epidemic politically and biologically because the city provides the vital ground where its citizens dwell (demeurer) and from which they derive their subsistence.

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If cholera infects Paris as well as its citizens, then with regard to infection, Paris and its citizens constitute two sides of the same problem. Cholera makes this equivalence thinkable because contemporary causal theories have difficulty explaining its emergence and rapid proliferation. At the time, “contagionism” and “anticontagionism” (or “contagionism” and “infectionism”) constitute the two dominant paradigms for epidemic disease—with the divergence between them disclosing alternative mappings of the urban.124 Put schematically: for contagionists, a specific, albeit unknown, catalytic agent must pass from individual to individual in order for the disease to percolate through the city, while for anticontagionists, an emanation, usually atmospheric, arises locally (though sometimes possessing the ability to travel from place to place) to infect those who dwell within its ambience. For contagionists, the city appears as a serial relay of bodies across which contagion’s vectors migrate; for anticontagionists, urban space defines infection’s foyer.125 From our present perspective, we might assume that the contagionists and the anticontagionists are as different as day and night—or at least as different as “scientific” and “deluded.” However, this presentist assumption obscures both positions’ political investments, since neither commanded empirical verification and both admitted to vast unknowns. During the period, some diseases, such as smallpox, along with venereal disease and measles, are commonly accepted as “contagious” rather than infectious (hence the willingness of anticontagionists to promote vaccination prophylactically). Conversely, many contagionists admit that environmental and climatological factors enhance or diminish contagious potential, giving rise to what Erwin Ackerknecht refers to as “contingent contagionism.”126 In any case, the debate itself participates in a larger negotiation concerning the politics of vital space in which public hygiene necessarily intervenes.127 Furthermore, these different perspectives on governmental and medical intervention—or governmental as medical intervention and medical as governmental intervention—disagree about the subjects and objects of both political and medical concern, as François Delaporte notes: “For the infection [anticontagion] theory treated population, whereas the contagion theory dealt with individuals.”128 Both contagionism and anticontagionism are old forms of explanation that cycle through numerous incarnations, especially after the sixteenth century.129 Contagionism predominates in medical thinking about epidemics, especially plague, until the end of the eighteenth century. Since the contagionists hold that epidemic diseases agglomerate essentially individual cases across an indefinite spatial domain, as a corollary, they

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propose that disrupting epidemics requires regulating the movements of people and goods, especially through quarantines, sequestration, and cordons sanitaires. Conceived largely as defensive disruptions, these strategies attempt to preempt the catalysts for epidemics by imposing material limitations on an otherwise abstract space (characterized as that through which movement literally “takes place”) to protect national borders from an influx of contagion (especially by sea). In cases where epidemics arise despite such attempts, contagionist protocols try to divide the national space into distinct regions by establishing internal boundaries which can similarly be monitored and controlled. Such technologies of segregation, developed primarily in response to the plague, instate a military model of surveillance and control as the paramount form of vital protection.130 They imagine political, economic, and biological space as coalescing in intrinsically distinguishable, geopolitical regions, bounded by containable perimeters which allow an increasingly fine grid of control to disrupt contagious movement. By the first decades of the nineteenth century, these ideas no longer dominate medical thinking about epidemics—especially as the incidence of such epidemics seems to wane. Although the French government does, after the yellow fever outbreak in Spain of 1821, create a national agency to address epidemics (primarily plague, yellow fever, and cholera) that explicitly invokes contagionist principles, the theory’s persuasiveness nonetheless steadily diminishes.131 Indeed, after the Spanish epidemic, which contagionist protocols failed to prevent, Nicholas Chervin relentlessly campaigns to convince both the French government and the Royal Academy of Medicine that contagionist interpretations had been mistaken—a position the Academy affirms in 1828, much to the government’s official chagrin.132 When yellow fever reappears in Gibraltar a few months later, a French commission, including Chervin as one of its three members, hastens to consider the outbreak. While the official report avoids taking sides, Chervin’s own report, published after this mission, unabashedly champions an infectionist model that derives yellow fever from atmospheric causes: “The infectionists hold . . . that yellow fever originates in an altered, vitiated, or contaminated atmosphere. The exhalations generated by decomposing vegetable or animal substances, being encouraged by a high temperature and by a distinctive atmospheric situation and by other causes of which we are ignorant, are the responsible agents.”133 Chervin’s explanation clearly embraces public hygiene’s subtending Hippocratic ethos. While public hygiene itself does not prioritize epidemics over other social ills, Chervin’s polemic against

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contagionism mobilizes a causal logic (including unknown causes) that resonates with public hygiene’s epistemology. Given the impossibility of proving the causal connections among an infinite number of unknowns, Chervin cannot debunk contagionism absolutely. Yet by successfully discrediting contagionism as inadequate to explain the yellow fever epidemics, he provides strong conceptual support for public hygiene’s Hippocrat­ ism more generally. When cholera appears in France three years later, anticontagionism and public hygiene quickly dominate official discussions, first about how to prevent the epidemic and subsequently about how the preventive efforts fail. In 1831, with cholera encroaching on all sides, French government officials seek advice from medical authorities, especially the Academy of Medicine, as to the proper course of action. Several different commissions, made up of Academy members who take largely anti­contagionist positions, recommend establishing health councils at the borders of neigh­ boring countries where cholera has already appeared to warn about potential incursions and possibly to circumvent them.134 Though expressing little faith in these strategies, the commissions do not oppose already established protocols for quarantining ships and setting up cordons sanitaires; however, they do reject sequestering citizens if the epidemic evades these blockages—which, of course, it does. As a result of these recommendations, the government quickly upgrades health agencies along the coast, sets up quarantine facilities, and improves roadsteads for ships. In Paris, it establishes an integrated network of local, district, and municipal committees to track the “salubrité publique.”135 These committees, comprising local doctors, pharmacists, chemists, and other citoyens honorables, conduct detailed assessments of each quartier and are “especially to visit individual houses; to ascertain the condition of sewers, plumbing, wells, cesspools; to observe [suveiller] schools, eating establishments, nurseries and health centers. . . . They must also pay attention to landlords, food-producers, tanners, bathing attendants, meatpreparers, rag-pickers, and finally, to work-places of all types, susceptible to becoming noxious by bad management or by the odors that they exhale.”136 Clearly directed by public hygiene’s basic precepts, these “generous citizens” must “carefully note all causes of insalubrity which appeared to them and bring them to the attention of the administration, who [will] give the necessary orders to make them promptly disappear.”137 The government also sets up local health centers to attend to those who succumb to the disease and authorizes temporary hospitals. Furthermore, the government publishes and disseminates instructions populaires to advise

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citizens how to guard their own health, avoid compromising behaviors, and maintain the healthfulness of both domestic and public spaces— combining the protocols of personal and public hygiene.138 Yet none of this makes much difference. Within six months after the initial cases appear, more than eighteen thousand Parisians die, and then the disease just as mysteriously abates. In the aftermath of this devastating event, the government establishes another commission to assess what went wrong. This group of officials, including the two foremost hygienists, Louis-René Villermé and Jean Baptiste Parent-Duchatalet, plus a number of government functionaries, produces the monumental Rapport sur la marche et les éffets du cholera-morbus dans Paris (1834).139 At its most basic level, the report offers a detailed reflection on the information gathered about mortality and morbidity during the epidemic. Emulating a strategy that Villermé introduced several years earlier, the commission analyzes the mortality statistics in relation to a series of “natural” variables that traditional Hippocratic explanations suggested as most pertinent: sex and age, temperature, place, elevation, humidity of the ground.140 To these they add a number of social variables, considering density of population, professions, influences of the workplace, prisons, the military, and finally insalubrious lodgings. After finding no consistent correlations between death rates and the first set of “natural” factors, the report proceeds to the second social set, where consistencies begin to reveal themselves. Density of population turns out to be the first and most significant factor. There where a wretched [misérable] population found itself encumbered in dirty, cramped lodgings, there also the epidemic multiplied its victims. In order to specify this fact, it was definitely not enough, as was seen, to look at the level of the arrondissements, the quartiers, the streets. It was necessary to penetrate as far as the habitations to determine the influence of the terrain, in order then to arrive at the level of the street, because according to the different conditions of the locality, the illness often only strikes one quartier of an arrondissement in four, and in this quartier only some streets, and in these streets only some houses. Their incremental mortality [mortalité partielle], although very high, would find itself effaced in the general mortality, and its real intensity would then remain unknown if one limited oneself to looking only at the larger divisions of the city. It is here that the explanations promised by the committee come to situate themselves naturally, and that it must make its thought known in its entirety to

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its readers, who already no doubt have some inkling of it. In seeing that the epidemic sometimes ravaged elevated places, at the same time that it saved places lower down and sometimes on the contrary raged though the latter and spared the first, or even showed itself equally fatal in entirely different localities; in observing these frequent contradictions, these continual variations of relations, the commission was not able to refrain from supposing in this type of disorder which it encountered everywhere, the existence of a catalyst [élèment de perturbation] also present everywhere, and from believing that this element could only be that of the population, always united to all [toujours uni à tout], and complicating all the results, in which it enters as a value relative to the kind of individuals [l’espece d’individus] that it represents, to their occupation [genre de vie—literally “type of life” or “way of life”], to their ability to subsist [aisance] more or less great, to their living together [rapproachment] more or less dense [serré].141

In this passage the Rapport fundamentally revises public hygiene’s Hippocratic precepts. Using statistical techniques, the commission begins by eliminating factors that do not correspond to its data’s mortality patterns. They first analyze elements that should influence the disease according to a strict Hippocratic environmentalism (e.g., airs, waters, places, constitutions), but this analysis yields only contradictions. Since they hold that a rational (i.e., noncontradictory) explanation exists despite the informational “disorder . . . encountered everywhere,” they posit an under­ lying élèment de perturbation whose existence they seek. To disclose this unknown, they reimagine the city space itself: they eschew geographic and social mappings which follow its political divisions (arrondissements, quartiers, streets, etc.) and focus instead on the city as a habitable space. Starting from the ground up, they seek a lurking cause that transforms the city from a vital to a morbid environment. This focus then allows them to see something new. If the cityscape does not merely include distinct “natural” features that impinge on individuals localized within it, if it does not separate people along geopolitical boundaries but instead inevitably and inexorably connects them, then the mortality rates no longer appear contradictory. Instead they appear entirely comprehensible. Pursuing their new analysis, the commission finds that the “promised explanations” present themselves “naturally,” and the “natural” explanation is eminently social. Population, that paramount object of eighteenthcentury police concern, reemerges here as a ubiquitous causal element, “united to all,” suffusing the urban space and transforming its relations.

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However, population no longer represents the aggregate vitality incar­ nate in a people which exists as the state’s vital asset, as eighteenthcentury sovereigns imagined it. Instead population now manifests a “relative value” that “complicates” an analysis of the city by modulating “viability” or “habitability” according to the “kind of individuals” it encompasses, their “type of life,”142 their ability to subsist “more or less great,” and their density. Population thus marks the city as what François Delaporte calls a “living space.”143 This vital spatialization recognizes life as a spatial as well as temporal phe­nomenon (or even as a phenomenon whose spatial relations modulate its temporal continuity). Furthermore, it localizes human beings not merely within a living body but also in a social dimension which redefines its natural parameters. Nature no longer acts on the organism in a strictly Hippocratic sense, that is, as the result of an ontological indifference between constitutive elements seeking a fundamental harmony. Instead the “vital space” that population inhabits now imagines living organisms projecting themselves outside themselves, as literally and materially living beyond themselves, extending themselves into the hybrid biopolitical urban domain where they must subsist—or die. Thus, as Delaporte avers: “Living space, in other words, is a causal space.”144 For the commission, then, population lives—and dies—in space: It has been impossible for the commission not to believe that there exists a certain type of population [espèce de population], like a certain kind of place [nature de lieux], which favors the development of cholera, rendering it more intense and its effects more deadly. It [the commission] even adds that the agreement of these two causes appears to its eyes much more fearsome than the variations of temperature, the direction of winds, the exposure of the sun, and its higher or lower elevation, of dryness or humidity (which it is necessary not to confuse with that of habitation and which it does not always bring about).145

Here the Rapport specifically discounts classic Hippocratic factors (airs, waters, places) as not consistently accounting for their data’s mortality patterns. Instead it foregrounds the connection between the vital qualities manifest by a localized aggregation of living human beings and the “nature” of the locale within which they aggregate.146 It then affirms this correlation as causal, or in any event consistent. Indeed, the Rapport introduces an apparent indistinguishability between population and place, so that population’s impacts seem to override the putatively natural characteristics of place.

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Places that are the most opposed are led, with respect to their losses, to an almost common likelihood, when the population there is also the same, because there it finds itself with the same conditions of existence [conditions d’existence].147

Mobilizing the concept of  “conditions of existence” to encompass the qualities localized by—or within?—an ensemble of people living together, the Rapport troubles the distinctions between “natural” and “social,” between individual and collective, and between specific and general.148 Moreover, “conditions” underscores how the entanglement of natural and social elements actually determines human coexistence.149 Indeed, the great biologist Georges Cuvier had already invoked the concept of “conditions” to explain the inextricable interconnection between organisms and environments, especially as environments impinge on and shape the function of organisms.150 By invoking this fungible concept, the Rapport conceives mortality and illness as effects of the overdetermined causes which envelop human existence. However, perhaps as significant as “conditions of existence” (a phrase which, though telling, appears only once or twice in the Rapport) might be the reiteration of a humble prepositional phrase, “au milieu de,” which haunts the document, conjuring cholera’s ineffable and yet ineluctable effects. Take one example that occurs two paragraphs after “conditions of existence”: “The scourge spreads rapidly throughout [au milieu de] these people packed together [entassés]”;151 or one from the introduction: “The terrible scourge has left absolutely no evidence of the secret in its heart; it withdraws and takes it with it, leaving shocking gaps within [au milieu des] the populations that it has ravaged, and the fear of its return after the fright of having seen it” (12). Or consider another from the Rapport’s conclusion: “There the inhabitants accord with [sont en rapport avec] the habitation [demeure]. . . . The fetid miasmas spread throughout [au milieu de] these hideous garrets, where often a space of less than six square feet serves as shelter for an entire family” (194). Numerous other instances occur, but the point remains much the same: reiterating this phrase, “au milieu de,” the Rapport syntactically emphasizes that humans live situated lives within permeable contexts from which they become, if not indistinguishable, then at least inseparable. In fact, in its final résumé, the Rapport explicitly raises this syntactical implication to the level of concept: It is a truth of all times, of all places, a truth that it is necessary to repeat without cease because if one ceases it may be forgotten: there exists between man and all

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that surrounds him [tout ce qui l’entoure], secret ties, mysterious relations whose influence on him is continual and profound. Favorable, this influence adds to physical and moral forces, it develops them and conserves them; harmful, then it alters them, negates them, kills them. (195)

This rousing philosophical exhortation leaps out from a primarily pragmatic conclusion calling for better housing and living conditions (e.g., more salubrious dwellings and neighborhoods, with abundant airflow, sunshine, clean water, etc.). Within these policy recommendations—and remembering the etymological link between “policy” and “police”—resonates the same Hippocratic ethic that motivates both the ancien régime’s police concerns as well as the ambitions of revolutionary and post­ revolutionary hygiene. Yet, dramatically breaking from these more quotidian proposals, the Rapport also emphatically evokes as a “truth of all times, [and] of all places,” the fundamental interconnection between “man and all that surrounds him.” Acknowledging that this interconnectedness realizes “mysterious relations,” the Rapport nevertheless insists that its “influence” is “continual and profound.” Moreover, more curiously, it claims that it must incessantly reiterate this truth which otherwise “may be forgotten.” While the Rapport does not explain why this tendency to forget should continually threaten such a compelling truth—not to mention a truth whose consequences for good or ill are so tangible—we might conjecture that the threat ensues from individualism’s tendency to discount vital contexts as significant political and biological factors. Indeed, individualism makes sense (using the idiom’s both physical and conceptual inflections) only if the “secret ties, mysterious relations” “between man and all that surrounds him” are “forgotten.” While the Rapport obviously cannot and does not offer an explicit critique of individualism, it does recognize the contradictions that arise when individuals succumb to epidemic illnesses, which negate not only their individuality but also their lives. It calls on the government to redress the egregious circumstances that disproportionately expose some French citizens to disease and death—or even, using William Coleman’s poignant phrase, that reveal “death is a social disease.” The Rapport therefore relentlessly underscores how citizens living “au milieu de,” in the midst of, such insalubrious surroundings are at greater risk than others living “au milieu de” circumstances whose “influence” affected them more beneficently.152 In other words, as this innocuous prepositional phrase intimates, the Rapport suggests that “milieu” articulates individuals to collectives, collectives to spaces, spaces to social relations, and social

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relations to political dynamics, all of which encompass the lives of citizensubjects.153 Or to invert this formulation, we could say that, in the Rapport, we begin to discern how milieu comes to define a vital locus within which citizen-subjects live.

The Milieu of Milieu

To contemporary readers of the Rapport sur la marche et les éffets du choleramorbus dans Paris, “milieu” might also have had another, explicitly political resonance. On January 30, 1831, in response to a populist proclamation by the village of Gaillac, Louis-Philippe I, the newly crowned “king of the French,” declared: “We will seek to remain in a happy medium [juste milieu], equally removed from the excesses of popular power and from the abuses of royal power.”154 Employed by a “bourgeois monarch” to explain his ruling morality, this bon mot henceforth provides his presumptive logo. Indeed, by underscoring his self-avowed moderation, “juste milieu” rhetorically crystallizes Louis-Philippe’s desire to redress the preceding forty years of political extremes and to reestablish the monarchy on a sound middle path. Unfortunately for him and his royalist supporters, their milieu does not actually turn out to be quite so just, and following his persistently decreasing popularity, Louis-Philippe eventually abdicates in 1848, leading to the Second Republic, which soon leads to the Second Empire. Whatever the justness of Louis-Philippe’s invocation, his idiomatic conscription of “juste milieu” (itself a Renaissance translation of a classical ethical ideal, the “golden mean”) bespeaks a semantic trajectory that leads from classical ethics and aesthetics, by way of eighteenth-century physics, to biology and medicine and from there to the nascent domain of social science. Reflecting on milieu’s peregrinations from antiquity through the nineteenth century, Leo Spitzer describes how the idea evolves from “an essentially geometrical reference: the midpoint determined by two extremes” into a complex concept that encompasses diverse space-time localizations.155 The crucial transition occurs, according to Spitzer, in 1749, when Madam du Chatelet chooses the word “milieu” to render Newton’s notion of “medium” in her translation of his Philosophiae Naturalis Principia Mathematica. Embracing this new usage, d’Alembert’s entry on “milieu” in the Éncyclopedie (1765) locates the term within “mechanical philosophy” and defines it as “a material space across which a body travels in its movement, or in general, a material space in which a body is placed

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whether it moves or not.” Then, extrapolating from this relational definition, for which “ether” and “air” serve as primary illustrations, d’Alembert offers a third, proleptically biological, example: “Water is the milieu in which fish live and move.”156 Segueing from instances that use “milieu” to denote a spatial domain—or an extensiveness through which movement literally “takes place”—d’Alembert’s final image makes milieu matter differently by making it matter in the first place. It conceives milieu not as movement’s corollary, not as an emptiness through which a body’s incremental displacements unfold, but rather as a “material space” or indeed as a vital space, the medium within which fish live and move. By extending Newton’s mechanical principle to living organisms, then, d’Alembert radically shifts the significance that “milieu” carries: it now refers not just to the coexistence of matter and space but also to the coincidence of organism and lifeworld. Given such Newtonian inflections, “milieu” mutates during the late eighteenth century from a relational or geometric designation connoting “betweenness” into a substantial signifier that evokes “situatedness.”157 Buffon, the late eighteenth century’s great naturalist, adopts this dynamic material sense to characterize the nexus constituted by organisms and the worlds in which they live.158 Fusing milieu’s new Newtonian significance with the Hippocratic perception that “airs, waters, and places” evince vital consequences (which also explains the Société Royale de Médecine’s efforts to correlate climate, geography, and disease, at exactly the same moment), Buffon delineates a new, properly biological relation between the organism and its material context.159 Buffon’s student, Lamarck, in turn extends this relation to evolutionary development, arguing that organisms relentlessly modify themselves to survive in changing milieus.160 Thus, by the first decades of the nineteenth century, “milieu” accounts not only for the ways that, as vital processes, organisms “take place” in the world both materially and biologically but also for the changes these organisms manifest to remain alive, changes which, according to Lamarck, they can even transmit to their offspring. Since it proves so capacious, milieu circulates widely during the period among thinkers of different temperaments, proclivities, and styles. In addition to the new science of biology (which Lamarck is among the first to name), milieu enters not only politics (in Louis-Philippe’s idiom) but also literature, history, philosophy, anthropology, and sociology—though at the time these distinctions are not so clear-cut.161 A year after the Rapport sur la marche et les éffets du cholera-morbus appears, Auguste Comte’s

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Cours de philosophy positive gives milieu its most explicit and substantial theorization. In the fortieth lesson, “Considérations philosophiques sur l’ensemble de la science biologique,” written in January 1836, Comte turns to biology to explain the “positive” basis for his analysis of human relations. He invokes milieu to describe “one of the two inseparable elements whose harmony necessarily constitutes the general idea of life”: “Such a harmony between the living being and the corresponding milieu obviously characterizes the fundamental condition of life.”162 Comte’s harmonious vision appears within an extended critique of Xavier Bichat’s renowned motto “Life is the ensemble of functions that resist death.”163 Rejecting this dualistic framing as pitting life against the world, Comte asks: “Why not allow for cooperation [concours] as well as antagonism? The state of life would be very viciously characterized by this imaginary independence with respect to the general laws of ambient nature, by this fantastic opposition with the ensemble of exterior actions.”164 Comte foregrounds what he considers most problematic about Bichat’s vitalism: the “imaginary” or “fantastic” attempt to define life as an “independent” phenomenon. Instead he emphatically affirms: The mode of existence of living bodies is, on the contrary, clearly characterized by an extremely strict dependence on exterior influences, whether because it requires the determinant cooperation of a multiplicity of diverse actions, or because of the special degree of intensity of each one of these. . . . The higher one rises in the organic hierarchy, the more, in general, this dependence necessarily increases due to the greater complication that the system of the conditions of existence [conditions d’existence] experiences insofar as the functions develop and diversify themselves more and more. . . . The organism in raising itself thus reacts at the same time more and more on the ambient system to modify it in its favor. One must, in order to avoid all exaggeration on this subject, distinguish therefore between the multiplicity of exterior actions and the normal limits of their intensity. If, according to the first point of view, the living organism insofar as it raises itself becomes incontestably more and more dependent on the corresponding milieu, it depends however less and less on the second aspect: that is to say, that its existence demands a more complex ensemble of exterior circumstances, but that it is compatible with more extensive limits of variation of each influence. . . . Nevertheless, whatever the importance of this general correlation, one obviously cannot infer from it any argument supporting the idea of a supposed fundamental independence [une prétendue indépendence fondamentale] of living bodies towards the exterior world, since, when the dependence is less in one sense, it is necessarily more complete in another.165

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Here Comte specifies the philosophical implications that his biological theory holds for human experience. He avows that living organisms maintain an “extremely strict dependence on exterior influences” and that the “higher” the organism appears in the “organic hierarchy”—with humans undoubtedly at the top of the heap—the more strictly dependent they become. Invoking Cuvier’s notion of “conditions of existence,” Comte expands Cuvier’s strictly relational notion into a “system.”166 This systematic formulation (which according to Comte follows from and even permits greater functional diversification) not only determines rank in the organic hierarchy but also informs an organism’s abilities to modify its milieu. As he affirms: “We have recognized, in effect, that the idea of life constantly supposes the necessary correlation of two indispensable elements, an appropriate organism and a suitable [convenable] milieu. It is the reciprocal action of these two elements from which inevitably result all the diverse vital phenomena.”167 For Comte, this vital reciprocity between organism and milieu constitutes life itself. Thus, as Chris McClellen remarks: “It is then with the conditions relative to the milieu that the law governed world of inorganic bodies is brought to bear on life and vital function. . . . Those [conditions] relative to the milieu are dynamic conditions always determined by the interaction of the organism with external influences, and they are the focus of physiological study.”168 Milieu allows Comte to nuance Cuvier’s conditions of existence to include the paradoxical human ability to transform the very circumstances on which we “strictly depend.” In other words, milieu heralds a flexible, vital domain in which the higher, that is, human, organism does not neglect its dependence on the material world—does not fool itself into believing in a “supposed fundamental independence”— while still retaining the dynamic capacity to change the world. Therefore, with milieu, Comte surreptitiously introduces an unremarked indistinction between social and natural—at least in the case of “superior” or human organisms—and milieu bespeaks this enfolded social nature. In Comte’s text, milieu provides the paradoxical and yet essential crux for philosophical reflection because “the study of man and that of the exterior world necessarily constitute the double and eternal subject of all our philosophical ideas.”169 We might even say that milieu philosophically represents this eternal duplicity by encompassing it within and as one subject. Returning to the Rapport sur la marche et les éffets du cholera-morbus (which appeared the preceding year) with Comte’s reflections in mind, we see that when it uses “conditions of existence”—or semantically reiterates “au milieu de”—to figure those “secret ties [and] mysterious relations

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whose influence on [man] is continual and profound,” it participates in a broader epistemological endeavor to locate the human organism’s social life in the natural world. These coeval adaptations of Cuvier’s conditions of existence recognize that how humans live together profoundly informs the contexts where this living takes place. If, following Foucault, we understand that “by conditions of existence, Cuvier means the meeting [affrontement] of two ensembles: on the one hand, the ensemble of correlations which are physiologically compatible with each other; on the other hand the milieu in which it lives,”170 then we notice that in both the Rapport and Comte’s Cours, milieu comes to include the effects of physiology, effects that now appear to return to the organism from the outside in. This reciprocal interaction helps explain why the aggregate “nature” produced by urban assemblages of people living together directly impinges on their viability both as organisms and as citizens. For the hygienists, the 1832 cholera epidemic makes this recursive dynamic visible and intelligible because it statistically correlates the harmful consequences of insalubrious and overcrowded dwellings with marked increases in mortality. In other words, it illustrates how the social conditions of living together can deleteriously modify the vital processes of life itself. Hence milieu evokes the consequences—both for good and for ill—that accrue to, in Comte’s terms, humans’ “greater aptitude to affect the ambient system.” When milieu and its confrere, conditions of existence, circulate through governmental and theoretical thinking about “the human situation” (in both figural and literal senses), they divulge the complex imaginary work required to consider humans simultaneously as biological and social beings. Or, fusing Latour’s and Foucault’s idioms, we might say that milieu offers a hybrid which entrains nature and society by casting humans as manifestly biopolitical beings. It exposes both how their social relations call their biological existence into question and how their biological relations call their social existence into play.

Overturning Hippocrates, or How Claude Bernard Interiorizes Exteriority

Considering this overdetermined significance, it makes sense that perhaps the most powerful and transformative concept of nineteenth-century bioscience, milieu intérieur, turns on milieu so explicitly. Introduced in the 1850s and 1860s by Claude Bernard, the term “milieu intérieur” opens the living organism up to laboratory exploration (quite literally, since it

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justifies vivisection as a valid path to biological knowledge). In so doing, it underwrites all subsequent bioscientific experimentation up to and in­ cluding those of today’s biotech industries—an achievement so consequential that Georges Canguilhem unabashedly names Bernard “the Newton of the living organism.”171 Or as Henri Bergson opined: “The laboratory sciences, those which follow experiment in all its sinuosities without ever losing contact with it, date from the XIXth century. To these more concrete forms of research Claude Bernard was to bring the formula of their method, as Descartes once did to the abstract sciences of matter.”172 Bernard’s milieu intérieur names a new theoretical and material space that appears when experimenter, laboratory, instruments, and experimental organisms coincide. Downplaying what he calls the milieu cosmique extérieur, Bernard identifies, defines, and materializes a more “determined and determinable” milieu which he holds to be the real locus of scientific interest: “The milieu intérieur created by the organism is special to each living being. But it is the true milieu physiologique, it is that which the physiologist and the physician must study and know, because it is by its mediation [intermédiaire] that they can act on the histological elements which are the only effective agents of the phenomena of life.”173 Here Bernard simultaneously claims that milieu intérieur defines the “true” locus of life (since the interactions between the organism and the milieu extérieur only occur through its mediation) and that milieu intérieur reveals “true” knowledge about life (since within it experimenters and practitioners “can act on the histological elements which are the only effective agents of the phenomena of life”). In other words, milieu intérieur makes life available to science by isolating life’s truth within itself and thereby constituting the real domain from which true knowledge about life emerges. Or, as he avers, experimental medicine must especially consider “a milieu intérieur which is the real theater [théatre réel] of all physiological actions, pathological and therapeutic.”174 When Bernard introduces both the concept and the term “milieu intérieur” into biological thinking, he radically breaks with prevailing medical perceptions of the organism. He also legitimates the laboratory as the privileged space from which truth emerges, and concomitantly anoints experiment as scientific medicine’s avatar, investing it with a status and promise never before imagined. Based on this dual intervention, at once epistemological and technological, Canguilhem credits Bernard with performing a “historical rupture which inaugurates modern medicine in

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the idea of experimental medicine as a declaration of war on Hippocratic medicine.”175 If, as Canguilhem claims, modern medicine actually begins with Bernard, it probably does so more precisely according to Latour’s sense of “the modern.” Whereas French public hygiene (following Cabanis) increasingly entangles social and natural existence, as a thoroughly modern scientist, Bernard rejects this entanglement, decrying Cabanis’s ideas as “the sum of all the positions that experimental medicine means to attack.”176 Overturning Hippocratism’s assumed continuity between organism and vital context, Bernard instead radically distinguishes the natural organism from the social environment. However, even as he posits this radical distinction, he creates a new hybrid, milieu intérieur, which enfolds the nature-society opposition within itself. Moreover, Canguilhem’s contention that Bernard proclaims “a declaration of war on Hippocratic medicine” is not mere rhetoric: it describes a project that not only envisions medicine as armed combat but acclaims vivisection as its royal road to knowledge. Enlisting this death-dealing technique as a “weapon” (his term, as we will soon see), Bernard mobilizes death to focus medical science on the singular organism, to manipulate, “master” (maitriser), and even “conquer” its vital functions and thereby modify, if not save, its life.177 Troping on a series of characteristically modern oppositions— nature-politics, inside-outside, life-death—Bernard refuses the Hippocratic dynamism which embeds the organism in a lifeworld, or in a living world, as its condition of possibility. Instead he turns it upside down and outside in. As Bernard himself is the first to admit—or to claim credit for—this aggressive anti-Hippocratic fantasy, this willful attempt to turn Hippocratism outside in, derives from and depends on milieu intérieur. Old-fashioned science [science antique] could only conceive the milieu extérieur; but it is necessary in order to found experimental biological science [la science biologique expérimentale] to conceive moreover a milieu intérieur. I believe I have first explained this idea clearly and have insisted on it in order to better understand the application of experimentation to living beings.178

This claim’s seeming simplicity and self-evidence belie its radicality. By bifurcating the concept of milieu into an outside and an inside, Bernard reconceives the organism’s material and vital space. This decision—in the etymological sense of a violent cutting—actually distinguishes the organism from the world and situates it within a new théatre réel. This internal rendering of milieu clearly conflicts with Comte’s understanding,

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and intentionally so.179 If, as Comte avers, the organism’s milieu is fundamentally in the world, then all true knowledge about it must derive from how organism and milieu interact. Within this epistemological frame, laboratory experimentation on living beings makes little sense. Since the laboratory is not the milieu in which organisms actually live—and, in fact, more likely represents the milieu in which they will die—it cannot yield accurate information about them. Thus Comte (like Cuvier before him) dismisses experimentation as inadequate for producing true knowledge about living organisms.180 Conversely, following his mentor, the physiologist François Magendie, Bernard not only relies on live dissection but justifies it epistemologically. Paul Hirst describes Bernard’s justification: “The reproduction and variation of this milieu intérieur provide the experimental basis on which the conditions of the existence of life are determined.”181 Or as Alan Wasserstein comments: “The internal milieu was the metaphoric space where the new science was situated: where the physico-chemical ‘conditions’ of life were modified, where experimental intervention took place.”182 In part, milieu intérieur achieves such epistemological significance because it enables Bernard to restrict the salient causal domain within which life occurs and therefore to ground experimental procedures on “determinism”: “For the physiologist, if he can descend into the milieu intérieur of the living machine, he finds there an absolute determinism which must become for him the real basis of the science of the living body.”183 While Bernard’s determinism (which he distinguishes from Leibniz’s) explicitly founds the scientificity of experimental physiology, a full consideration exceeds my purposes here.184 Nevertheless it does bear noticing that by linking determinism and milieu intérieur, Bernard not only establishes experimental physiology as a new theoretical and scientific paradigm but also secures for it the institutional authority and privilege belonging to a successful disciplinary formation.185 That Bernard’s disciplinary undertaking succeeds is indisputable, as today’s highly profitable global biotech apparatus amply testifies. However, supporting this stupendous bioscientific success, milieu intérieur bears within it political and philosophical assumptions whose significance rarely comes to light. At the least, the experimental imaginary defined by milieu intérieur contains the bio-logic that underlies and underwrites modern medicine’s corporeal atomism. After Bernard’s critical innovation, biomedical interest scientifically turns away from complex ecological interpretations of disease and healing (upheld by both the Hippocratic tradition and the hygienic movement) toward the laboratory, where a

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new artifact, the experimental animal, takes up residence. As lab animals increasingly model living systems, Bernard’s assumptions proliferate in turn. Indeed, the human organism corporealized by contemporary bioscience directly descends from Bernard’s biopolitically constructed laboratory animal-artifact. First formulated as an ad hoc proposition in a series of lectures at the Sorbonne (1854), milieu intérieur recurs persistently in Bernard’s writings until his death (1878).186 In its earliest presentation, to posit a break with humoralism, milieu intérieur adapts a residual humoralist understanding of blood as life’s essential medium. Since a complex organism’s internal elements no longer directly contact the environment from which the organism must derive sustenance, Bernard reasons that an “artifice” must mediate this separation: “That artifice is circulation; the blood is the environment.”187 This initial “internal-environmentalist” formulation provides a rough theory which allows Bernard to claim that physiological determinants trump environmental variables in experiments on animals. Working through and elaborating this idea, by 1857 Bernard argues that if the living body necessarily relies on the surrounding environment, its own internal milieu nevertheless effectively contains it: That sort of independence which the organism possesses in the milieu extérieur derives from the fact that in the living being the tissues are in fact withdrawn [soustraits] from direct external influences, and are protected [protégés] by a veritable milieu intérieur, which is constituted in particular by the fluids circulating in the body. That independence, moreover, becomes greater the more elevated [plus élevé] the organism is in the scale of organization, that is, the more completely protective an internal environment it possesses. . . . With regard to man and warm blooded animals, the independence of the milieu extérieur and of the milieu intérieur is such that one can consider these beings as living in their own organic milieu.188

Claiming that the “living tissues are in fact withdrawn from direct external influence,” Bernard avers that these “subtracted” tissues “are protected” from what, before this claim, would have constituted the world on which they depend. Furthermore, this withdrawal and protection engender a new perception of the “more elevated” animal’s existence: that is, its natural “independence” (the very concept, remember, that Comte rejects). Transposing this patently political concept onto nature, Bernard births another of the modern hybrids to which Latour alerts us. Indeed, Bernard’s focus on the “elevated” animal’s independence from the environment marks a critical—and biopolitical—turn in medical discourse. For as the

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contemporary evolutionary biologists Dorion Sagan and Lynn Margulis remind us: “Independence is a political, not a scientific, term.”189 By transplanting political philosophy into his scientific theory and then ignoring the imaginary work it performs, Bernard directly overturns the hygienists’ belief that the social environment forms the human organism’s life context. Instead, by way of an almost oxymoronic rubric, milieu intérieur, Bernard inverts the topological relations of inside and outside, such that the organism’s interior now serves as a determining context that effectively isolates it from the lifeworld, which now only secondarily environs it. Recognizing the concept’s internal tensions, Fredrick Holmes characterizes Bernard’s concept as “contradictory,” claiming: Bernard never analyzed the new shades of meaning he unfolded as he continued from year to year to discuss the milieu intérieur. But it seems evident that the double role he now attributed to the blood, as at once an intermediary and a barrier between the tissues and the outside world, was the feature that gave his idea such original and powerful insight into biological organization as he extended its application to other kinds of physiological problems. Yet there was a difficulty hidden in this formulation, for in a sense the two roles as he then envisioned them were contradictory. How can the internal environment transmit the conditions of the external environment to the tissues if at the same time it isolates the tissues from them?190

While agreeing with Holmes’s assessment, we can also extrapolate from it. If, following Latour, we recognize this hybrid contradiction not as under­ mining milieu intérieur’s effectiveness but as actually enabling it, then we glimpse how it maps political attributions such as independence and freedom into and onto the organism’s nature. Moreover, we discern that Bernard’s bioscientific formulation verges on the political theory of possessive individualism, since in Bernard’s formative depiction, the highest (i.e., human) animal’s independence leans on the “more completely protective an internal environment it possesses.” Biologically incorporating “protective possession,” milieu intérieur conjoins the political and the natural even as it holds them radically separate. “Subtracted” and “protected” from the lifeworld, the living organism becomes, in Bernard’s view, biologically “free.” In this protective formulation, we see, on the one hand, the shadow of Hobbes’s political definition of self-defense as the first natural right and, on the other, a harbinger of Metchnikoff ’s bioscientific definition of immunity as the organism’s natural defense. In both regards, we could

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consider how Bernard’s concept enables him to finesse the distinctions between politics and biology even as he proclaims that the two domains remain radically distinct. While historians of medicine tend to downplay Bernard’s political allegiances, alluding at best to his “mild conservatism,”191 we should not forget that Bernard’s conceptualization of milieu intérieur almost exactly coincides with the rise of Louis-Napoléon and the Second Empire. Nor should we dismiss the public favor that the emperor bestows on Bernard, including ultimately naming him to the Senate. Furthermore, we might consider that the Second Empire, with its contradictory combination of economic liberalism and authoritarian control, also sees the radical reconstruction of Paris’s urban milieu.192 Yet despite the temptation to read such contemporary influences into Bernard’s writing, we do not even need them to perceive the political foundation on which milieu intérieur rises. As he develops his idea on ostensibly scientific grounds, Bernard more and more openly resorts to manifestly political terms to explicate its significance. Consider a few examples. In notes titled “Plan de l’introduction,” in which he sketches his ideas for Introduction à l’étude de la médecine expérimentale, he writes: “In sum, when one wants to ascertain the influence of cosmic conditions on bodies animate or inanimate, it is necessary that these external conditions alter the active bodies themselves. But, in warm-blooded animals, these influences do not act. This enables these animals to conserve an independence and a perfect liberty in the midst of [au milieu de] other bodies which are enchained to terrestrial conditions.”193 Once again “independence and perfect liberty” purport to describe a warm-blooded organism’s natural condition in relation to the “influence of cosmic conditions.” However, the terms that Bernard employs to conjure this natural nondependence clearly have other significance for him, as Introduction’s final words—the famous book’s semantic punctuation—make perfectly evident: “The independence and liberty of spirit . . . will always be the essential conditions of all human progress.”194 As this rhetorical crescendo intimates, Bernard’s biological recourse to “independence,” “liberty,” and “freedom” leans on their political and philosophical valences. Ignoring Comte’s admonition against “the idea of a supposed fundamental independence,” Bernard assumes the political and philosophical ideals espoused by Comte’s individualist nemesis, Victor Cousin, for whom “individual liberty . . . was inseparable from the doctrine of the freedom of the human spirit.”195 Indeed, it might not be implausible that Bernard’s milieu intérieur not only rejects Comte’s inextricable relation

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between milieu and conditions of existence but also directly translates Cousin’s individualism into physiology.196 If on the one hand Bernard embraces philosophical and political individualism as a biological truth that milieu intérieur embodies, then on the other he also deduces this political philosophy from nature itself. He envisions “independence and liberty” of the (human) organism and “independence and liberty” of the (human) spirit as deeply entwined: Intelligence only accompanies complex organisms and it is like a flame which results from the entire organic ensemble and which enlightens [éclaire] the organism; we do not even create our own liberty. We are fatally free, that is to say, in a necessary manner. . . . It is a property of our organism of which we avail ourselves. But we are not free to impede [empecher] our free will [libre arbitre] to act any more than we can impede any other function that the body accomplishes according to its laws. We are not free to not be free: we believe ourselves free as we believe that we live.197

This paradoxical formulation represents Bernard’s attempt to avoid the conundrum that his epistemological determinism raises for spontaneous human creativity.198 He offers his insight about “fatal freedom” as the human organism’s natural and hence “necessary” state to reconcile his foundational bioscientific principle with the political and economic precepts of bourgeois individualism. In so doing, he injects this tenet of bourgeois political economy into the organism’s tissues and sees it operating there just as other “functions” which the body “accomplishes according to its laws.” By embedding politics in “our organism,” Bernard both conforms us to these political principles and affirms them as manifesting natural law. To the extent that the organism’s natural independence and liberty derive from the milieu intérieur, then milieu intérieur represents the bourgeois individual’s proper nature, or indeed its natural property. Bernard does not limit his biopolitical vision to singular individuals, however. Instead he follows his insights to their logical medico-political conclusions. In another set of notes for the Introduction, he affirms: “Thus, the autonomy of the organic element is the autonomy of the in­ dividual in society. There is simultaneously dependence and liberty, as in nature there is simultaneously unity and variety of the type that one can say: all is relative, all is variable and determined. Voila the only absolute principle.”199 This triumphantly paradoxical “absolute,” which purports to describe the functional congruence among anatomical elements, each pursuing its own “autonomous” aim, also wonderfully encapsulates the

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Second Empire’s fusion of laissez-faire economics and political authoritarianism.200 The initial analogy between the “autonomy” of organic elements and the “individual in society” already imbues the comparison with political import: the notion of autonomy (from the Greek for “having or making one’s own laws,” i.e., self-governing) does not designate a natural phenomenon, nor obviously does the “individual in society.” Nevertheless Bernard uses both concepts to figure the (putatively) natural phenomenon he explicates, and thereby carries over into biological thinking the very political contexts that he nominally eschews when he defines milieu intérieur as the “true milieu physiologique.” Conversely (as we saw earlier), when Bernard metaphorizes the “individual in society” as naturally “autonomous” as “the organic element,” he naturalizes the individual as a biological monad once again. Given their ubiquity in his biological theory, Bernard obviously regards his own political presuppositions as positive formulations, whose invocations remain unproblematic. He happily mobilizes political analogies to characterize almost all the major scientific concepts on which he relies. Thus, describing the organism at the end of Leçons sur les phénomènes de la vie, Bernard employs the following conceit without hesitation: Let us represent the complex living being, animal or plant, as a city having its special character which distinguishes it from all others. The inhabitants of this city represent the anatomical elements of the organism; all these inhabitants live the same, feed themselves, breathe in the same manner and possess the same general faculties, those of man. But each has his métier, or his skill, or his aptitudes, or talents, according to which he participates in social life and on which he depends. The mason, the baker, the butcher, the worker, the manufacturer, furnish different products, and the more varied, more numerous, and more nuanced the society on which they act, the higher the degree of development. Such is the complex organism. The organism, like society, is constructed in such a fashion that the conditions of elementary or individual life are respected there, its conditions being the same for all; but, at the same time each member depends, in a certain way, by its function and for its function, on the place that it occupies in the organism, in the social group. 201

Here, in his last series of lectures, Bernard reflects on how to “represent” a “complex living being” and finds that the city provides him an apposite image. We should not fail to appreciate a certain irony in this choice, since the city, as represented through public hygiene’s Hippocratic lens, constitutes the very object that Bernard intends milieu intérieur to supersede.

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The irony redoubles when Bernard evokes the city not as a bounded material space, not as an agglomeration of structures, thoroughfares, residences, and resources (we should not forget that Georges-Eugène Haussmann was, after all, Bernard’s contemporary), but rather as a living set of human relationships, a political and economic milieu, differentiated, as he indicates, by “the law of the division of labor.” 202 Evoking the urban milieu as a complex political economy, organized according to the most famous law of capitalist accumulation, Bernard applies this political and economic complexity to the organism to elucidate its structural function. In its innermost processes, then, the “higher” (i.e., human) organism morphologically echoes—or is isomorphic with—the political and economic dynamics of “highly developed” societies (e.g., nineteenth-century France). Indeed, this resonance determines their level of development in the first place. Reciprocally, these natural processes, by virtue of their successful organic function, provide proof that societies structured according to these same organizational principles naturally evince “higher development.” Society, by which Bernard obviously means French bourgeois society, “respects” individual people, living under conditions that are “the same for all,” just as the organism “respects” its “elements”—and vice versa. By the end of the passage, the oscillation between the social and the natural becomes radical, so that in the final clause they become literally interchangeable. Thus, while Bernard’s epistemological determinism obtains only because milieu intérieur distinguishes a “natural” interiority from a political exteriority (including and constituting public hygiene), the organism it incarnates actually contains the very politics it purports to exclude precisely to exclude them.203 Not only does Bernard elide the distinction between biological and social representations, then, but they each serve to reinforce the subtending political premise which views society as an agglomeration of autonomous individuals “organically” related through political economy’s division of labor. Furthermore, this premise itself rests on a biological claim that the individual is the natural unit of analysis, a claim shored up by affirming milieu intérieur as the “real” and “true” locus of human life. Hence we see how Bernard’s bio-logic, which percolates through and explains his scientific claims, leads him to reject the Hippocratism that public hygiene adopts after Cabanis and instead to declare the individual as the real locus for medical intervention: “For the physician this is a very important thing. It is the individual with whom he always concerns himself. For the doctor there is absolutely no human type, human species, he is the physician of

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an individual who is placed in particular conditions [conditions particulières].”204 Or, as he avows elsewhere: Medicine must act on individuals. It is not destined to act on collectivities or people. . . . In reality, one only acts on individuals. Collectives are entrained in currents upon which we can have no effect. These are general actions which are beyond us. It is the same with epidemics and epizootics. One can act on the individual who presents oidium, plague or cholera; but one cannot act on the general cause of plague, cholera, etc., etc. 205

Bernard clearly breaks with the subject-object of public hygiene and offers a competing, singularizing agenda for scientific medicine. Population no longer figures, for him, as a legitimate object of medical concern. Instead he extols the individual as the paramount subject and object of medical knowledge and practice because only the individual appears to him susceptible to being effectively acted on by way of the milieu intérieur (recall his comment cited earlier: “It is that which the physiologist and the physician must study and know, because it is by its mediation [intermédiaire] that they can act on the histological elements which are the only effective agents of the phenomena of life”). Nevertheless Bernard’s assertion that “in reality one only acts on individuals” also seems precariously tautological, since he has already defined the milieu intérieur as the true ground of “the real.” Caught within this vortex of self-fulfilling realization, he dismisses the notion, sacred to the hygienists, that “general causes” can be modified; significantly, however, he does not claim that they do not exist. Instead he predicates the future of medicine on the assertion that only individuals should exist for medicine, implying that all other concerns are either ineffective or illusory. Taking the individual as the medical subject par excellence, Bernard advocates refiguring medicine and medical science in the individual’s image. Having defined milieu intérieur as the real and true locus of human life, he imagines a new medicine that will arise from this foundation: The knowledge of experimental physiology will lead to the preservation [l’entretien] of health, the perfecting of the race, the art of enabling men to live for a long time, as Bacon desired. Experimental pathology, founded on physiology, will lead to preventative hygiene and medicine, which must be one of the most important aspects of medicine. In effect the mechanism of the production of diseases being known, it will only have to prevent this mechanism from realizing itself [s’accomplir] in removing [éloignanat] the conditions which give rise to it.

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Finally, experimental therapeutics will lead to the cure [guérison] of illnesses by the influences that one will be able to effect on the diseased organism or by the new conditions in which it will be placed. Thus, these three sciences will comprise the complete definition of medicine: preserve health, prevent or cure illness.206

Experimental physiology, experimental pathology, experimental therapeutics: herein lies Bernard’s new vision for scientific medicine. Annexing the agendas previously claimed by public hygiene to redefine hygiene itself, Bernard offers experimental medicine, predicated on the hybrid milieu intérieur, as a putatively nonpolitical, scientific domain that totalizes medicine’s knowledge and practice. In so doing, he implies, it can ac­complish all that public hygiene promised but failed to fulfill—since if pub­lic hygiene had succeeded, a new (not public?) hygiene founded on ex­perimental medicine would not be needed. Encompassing basic hygienic precepts within his own framework, as the reiteration of the key terms “conditions” and “influences” indicates, Bernard turns away from the social world and toward the experimental laboratory to establish medicine as an effective theoretical practice that will “act on individuals,” not on “collectivities and people.” Dismissing nonexperimental forms of medicine as “ideal, impossible, utopian,” Bernard proposes experimental medicine as a more pragmatic, more effective, more forceful corrective: The experimental physician thus possesses weapons [armes] with which he must act; he only has one thing to do, that is to leave the empirical methods that he has used until now and manage to provide scientific bases for therapy. In a word, he has the weapons, he only has to learn from science to utilize them. We were not pursuing therefore a chimerical aim in wishing to found experimental medicine. In wishing to determine with the aid of modifications (poisons) the laws of the phenomena of life, we attack [attaquons] the problem of therapeutics directly.207

In this telling passage, Bernard makes the violence that subtends his new medical vision overt. Conceiving medical treatments as weapons, Bernard proposes a new militarized version of medicine that, paraphrasing Clausewitz’s mantra about war, we can understand as “politics by other means.” Metaphorically girding his loins, Bernard goes beyond just rejecting Hippocratism’s “passivity” to refigure medicine as belligerence in the name of health. Furthermore, this is certainly not an entirely natural process, for the “attack” that Bernard proposes embraces poisons as biochemical

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weapons. Bernard is hardly the first to understand the relation between “poison” and “cure,” as Derrida’s reading of the pharmakon in Plato illustrates.208 However, Bernard may be the first to consider the medical use of “poison” as an element of a healing armament. In any case, with Bernard’s openly militarized perspective, we definitely understand why Canguilhem can describe Bernard as effecting a “historical rupture which inaugurates modern medicine in the idea of experimental medicine as a declaration of war on Hippocratic medicine.” Moreover, we begin to foresee how med­ icine’s self-proclaimed belligerence can, following Metchnikoff ’s extrapolation, be mapped onto the organism itself as its own militarized form of self-defense. At the end of his life, long since celebrated as a scientist (in 1854 a chair of general physiology was founded for him at the Sorbonne, in 1858 he was elected to the Collège de France, and in 1868 he was called to a seat in the Académie Française), as a national figure (in 1869, by special decree, he entered the Senate), and as a public hero (he was the first scientist ever to receive an official state funeral),209 Bernard announces the implications of his own position, enthusiastically affirming: By the physico-chemical sciences, man proceeds to the conquest of brute nature, of dead nature: all the earth sciences whose object can be attained are nothing other than the rational exercise of the domination of man over the world. In this is physiology like the other sciences? Can science which studies the phenomena of life pretend to master them? Does it intend to subjugate living nature as dead nature has been subjected? We do not hesitate to answer in the affirmative. Physiology must therefore be an active and conquering science in the manner of physics and chemistry.210

In this passage, which summarizes his attitude after a lifetime of laboratory experiments on living creatures, Bernard hails his science as an instrument of domination not just over the natural world (which has been the desire, after all, since Bacon) but over the material nature that we are. In Principes de médicine expérimentale, an unpublished manuscript intended to culminate the project he initiates in the Introduction à l’étude de la médicine expérimentale, Bernard puts it even more pithily: “The idea of experimental medicine is the idea of all sciences. To dominate living nature scientifically, to conquer it for the benefit of man: such is the fundamental idea of the experimental physician.” 211 Or as he phrases it even more emphatically at the end of the same manuscript: “The purpose of physiology and experimental medicine must never be lost from view: To conquer living nature;

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to act on the phenomena of life, to regulate them, to modify them.”212 While heretofore neither medicine nor science, let alone the nascent “medical science,” aspire to anything more than supporting and encouraging the organism in its own healing processes (as Hippocratic ethics espouse), Bernard dramatically rejects this “passive” attitude in favor of an unabashedly aggressive one. Canguilhem underscores this dramatic change: “Hippocratism is a naturalism; the medicine of observation is passive, contemplative, descriptive as a natural science. Experimental medicine is a conquering science.” And just in case we missed the point, he adds: “The idea of experimental medicine, the scientific domination of living nature, is hippocratism reversed.” 213 There is one final turn to this agonistic logic, which anticipates and perhaps motivates Metchnikoff ’s decision to construe as “defensive” the phagocytic activity he evokes when he pierces the skin of “the beautiful starfish larva as transparent as water.” At the beginning of the last lecture published in Bernard’s last book, Leçons sur les phénomènes de la vie (the same lecture in which he provides the analogy between the organism and the city), he undertakes at the end of his career and at the end of his life to provide a definition of life itself. Implicitly evoking and critiquing Bichat’s formula (“Life is the ensemble of forces that resist death”)—the same formula that Comte evoked and critiqued in his fortieth lesson (discussed earlier)—Bernard acknowledges the occluded contradiction that milieu intérieur contains to move beyond it to vital phenomena themselves: In constant life, the being appears free, liberated [affranchi] from the exterior cosmic conditions, and the vital manifestations seem to be only dependent upon [tributaries de] interior conditions. This appearance . . . is only an illusion, and it is particularly in the mechanism [mécanisme] of constant or free life that strict relations between the two orders of conditions show themselves in the most characteristic manner. Life being, for us, the result of a conflict between the exterior world and the organism.214

Finally acknowledging what he has heretofore obscured, Bernard admits that the “freedom and independence” which he repeatedly attributes to the milieu intérieur only constitute a “seeming,” an “appearance,” and “illusion.” Indeed, he now claims that rather than a vital independence, founded on a “dependence upon interior conditions,” living beings are not only in “strict relation” but actually in “conflict” with the “exterior world.” With this bellicose vision, Bernard revises Bichat’s idea that life resists death (i.e., that

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death provides the limit against which and within which life defines itself) to claim that life is the perpetual conflict between “the exterior world and the organism.” This formulation of an eternal vital conflict, mapped onto a distinction between interior and exterior, makes it possible to imagine that the living organism manifests a physiological process that repels the incursions of the world around it. In other words, Bernard’s concept of life establishes a theoretical basis not just for affirming the organism’s singularity—however fragile and precarious—but also for conceiving defense as one of its vital functions. After Pasteur and Metchnikoff, this defensive concept evolves into the biological idea of immunity.

The proper milieu of humans is not situated in the universal milieu like contents in a container. A center does not dissolve itself in its environment. A living being [un vivant] is not reduced to an intersection of influences. Thus, the insufficiency of all biology which, by complete submission to the physico-chemical sciences, would like to eliminate from its domain all consideration of meaning [sens]. A meaning, from the biological and physiological point of view, is an appreciation of values with re­ spect to a need.—georges canguilhem, “Le vivant et son milieu” In the definition of living things, therefore, the determination of the weapons for attack or for defense has necessarily been taken as [the determination] of that whereby they preserve themselves vis-à-vis other particulars.—g. w. f. hegel, The Jena System

4. Incorporating Immunity, or The Defensive Poetics of Modern Medicine

Citing Immunity, or Humoral Description

Until 1883, when Élie Metchnikoff definitively links immunity to host defense, neither “immunity” nor “defense” refers to physiological functions. Before Metchnikoff ’s linkage, when medical discourse employed “immunity,” it did so only descriptively to encompass the empirical observation that different people can embody disease differently: that is, sometimes some people get ill when others do not; sometimes some people get more ill than others; some places seem to harbor illness more frequently than others do; some groups of people seem more inclined to get some illnesses than others; and so on. Though by no means an authorized element of the medical lexicon, for the first eighty years of the nineteenth century, when “immunity” appears, it simply refers to the people, places, and groups that manifest illness less often or less severely than others. However, this reference does not reveal anything intrinsic about such differences, because

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according to the prevailing humoral system of medicine, illnesses (and health) incarnate dynamics among elements, qualities, and humors. Thus, while immunity might express a recognition that differences occur between the ways illnesses affect individuals, groups, or places, it does not explain in humoral terms how or why these differences exist. Of course, the recognition of such differences itself bespeaks the empirical orientation of medical thinking at the time. When confronted by epidemics, for example, such differences often appeared more clearly, especially since amid generalized illness, those who had previously experienced the same disease might not succumb to it again (though what made illnesses the “same” was far from certain). As my previous chapters illustrate, smallpox first reveals this potential and inspires both variolization and vaccination as attempts to modulate human susceptibility to it. After Jenner convincingly demonstrates that he can limit the risk entailed in making people less vulnerable to smallpox—raising the hope that eventually medicine might safely mitigate other illnesses as well—variable susceptibility to disease begins to crystallize more distinctly as a conceptual possibility in its own right. During the first decades of the nineteenth century, immunity appears with increasing frequency to signify this hopedfor concept-in-formation. Yet until Metchnikoff provides a satisfactory explanation for why this possibility might exist, immunity remains an exclusively descriptive signifier. Before Metchnikoff ’s revision, then, when immunity appears in medical texts, it explicitly borrows against its juridico-political inheritance— especially in reference to epidemics. According to immunity’s metaphoric tenor, nature acts precisely as a political sovereign does, affirming its jurisdiction by defining those whom it exempts from its laws.1 Indeed, if we remember that Foucault characterizes the political sovereign as the one who bears the “right to take life or let live,” then immunity in both its political and medical valences evinces such a sovereign power.2 This metaphoric usage makes medical sense because immunity weaves together the relation between juridical and scientific notions of natural law (as we saw in chapter 1) and thereby discloses the hybrid biological and political effects that epidemics necessarily incarnate. The very word “epidemic” (among the people) derives from the Greek demos, meaning a geopolitical district (as opposed to “epizootic,” derived from zoon, meaning nonpolitical animal life), thereby indicating that a disease’s “epidemic” quality inheres in its political import. If “epi-demics” presuppose that illness carries significance as a political form of life, then defining immunity as exemption

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from such epidemic illnesses concomitantly frames it within this same bio-logic. Consider one of the earliest medical citations of immunity, which not surprisingly appears amid a discussion of variolization. In the final install­ ment of his monumental Commentaries upon Boerhaave’s Aphorisms concerning the Knowledge and Cure of Diseases (1772), Gerard van Swieten as­ sesses whether the current understanding warrants inoculation with live smallpox. This assessment culminates van Swieten’s multivolume opus, which provides the most authoritative compendium of mid- and lateeighteenth-century medical knowledge. Spawning numerous European printings and translations throughout the period, the Commentaries, in a brief citation, introduces “immunity” in terms that reappear almost exactly in medical definitions over a century later.3 The volume dealing with small­ pox sets out van Swieten’s brief at great length. He meticulously details the various arguments for and against variolization and evaluates them in light of his humoral interpretation of smallpox. In this context, immunity appears only tangentially as an improvisatory effort to name the supposed resistance that those who previously experienced smallpox manifest to reinfection. Near the beginning of several hundred pages of analysis, van Swieten avers: “This disorder is generally epidemical, beginning early in the spring, increasing in the summer, abating in autumn, ceasing almost entirely the following winter; to return again in the spring, and reign again in the same order.”4 Van Swieten explains smallpox’s “epidemical” nature via a characteristically humoral assessment of its seasonal variation. Given humoralism’s environmental orientation, this cyclical interpretation places the illness—and its victims—in the natural world along with everything else under the heavens. Yet van Swieten also significantly, if unremarkably, deploys the political verb “reign” alongside this natural pattern to characterize smallpox’s widespread and recurrent dominion.5 Defining “epidemic” as a “popular distemper,” he locates smallpox’s epidemic quality in the generalized effects it imposes on the “numbers of people” over whom it “reigns.”6 This enumerative criterion establishes smallpox as a threat not just to individuals but moreover to aggregates, or “populations,” where the ultimate significance of singular cases derives from their concatenation. Thus the argument for or against inoculation turns on the collective or numerical effects it induces rather than on the particular outcomes of singular examples. In this regard, van Swieten’s analysis falls within both the cameralist appreciation of population as a state’s vital asset and the

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statistical assessments of variolization’s individual risk (as discussed in chapter 2). Nearly fifty years after Cotton Mather conjured his defensive explanation to support inoculating with live smallpox, van Swieten deploys the word “immunity” without any defensive connotations whatsoever while articulating his doubts about the procedure. He recounts an exchange with an “old woman, past sixty,” who laughs when he diagnoses her illness as smallpox because as a child she slept and ate with her siblings while they suffered from the disease, and yet she never contracted it: And then concluding she never should, [because she] had since attended, with equal immunity, many laboring under the same disease. I know very well, that there are some (though few) of such idiosyncrasy, that, though a thousand times exposed to the contagion, they have never been infected with it. . . . This, however, I believe, that no man, who has not already had the disorder, can ever promise himself an entire immunity from it, although he never experienced any injury from being frequently exposed to it.7

Immunity appears here in an anecdote illustrating an old woman’s misapprehension about her supposed exemption from smallpox, for indeed she does manifest it despite “being frequently exposed to it.” For this reason, van Swieten characterizes her supposed state of “immunity” as an “idiosyncrasy” and then uses this parable to forewarn those who might invoke “hereditary immunity,” since only those who actually experience the illness can expect “entire immunity.” “Idiosyncrasy” signals van Swieten’s adherence to a classic humoral perspective. Following Galen, who defined krasis as a blending, combining, or mixing of humors, elements, and qualities that determine a general disposition or temperament,8 van Swieten uses “idiosyncrasy” to designate the particular compounds that make individuals individual: Upon its being observed, that the health of each particular man contained something singular and peculiar to himself; and at the same time that different bodies were as different from each other, both in solids and fluids, though all equally in health; this singular constitution of each particular body, wherein it differed from another equally healthy, was termed its idiosyncrasy.9

When van Swieten counterpoises idiosyncrasy to immunity, then, he reveals humoral medicine’s trouble in apprehending the empirical effects induced by smallpox and inoculation. Indeed, van Swieten’s recourse to immunity in this context discloses the limits of humoralism’s ability to

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make sense of smallpox (or variolization) as a singular or particular blending, that is, as an idiosyncrasy, since the phenomenon it seeks to encompass represents a general or collective effect. To redress this limitation, van Swieten draws on another lawful paradigm, jurisprudence. This usage might work because it reinforces the idea of epidemics as “reigning” diseases (i.e., immunity unconsciously references smallpox’s dominion as a “natural” sovereign), although van Swieten never actually explains the connection. In any event, van Swieten’s immunity serves exclusively as description, not concept. He never comments on, elaborates, or defines the term, and (with two marginal exceptions) he never repeats it in the text’s remaining several hundred pages.10 Moreover, even in this instance, the concept does not seem essential to either his point or his story, since when he returns to the same example at the end of the book, he does not cite immunity at all.11 In fact, in the one instance where he theoretically addresses inoculation’s prophylactic potential (which he doubts), he reiterates the idea of idiosyncrasy but does not mention immunity at all.12 Despite how elliptically he treats the term, almost one hundred years later, when “immunity” enters medical dictionaries, little seems to have changed.13 For example, though absent from the first eleven editions, when “immunity” appears in the twelfth edition of the Dictionnaire de médecine, de chirurgie, de pharmacie, des sciences accessoires et de l’art vétérinaire (1865), it involves almost the exact terms van Swieten used a century earlier: “conditions which enable some people to escape from a reigning illness.”14 The Dictionnaire’s next revision (1873) provides a slight elaboration, making the correspondence even more exact: “idiosyncratic conditions which enable some people to escape a reigning illness.”15 The sixteenth edition (1886) again alters the definition slightly: “conditions which enable some people to escape a reigning illness, because of idiosyncrasy, acclimatization, or inoculation.”16 The seventeenth edition (1893) finally alludes to the conceptual and practical developments provoked in the 1880s by Pasteur and Metchnikoff, yet still retains van Swieten’s original terms: Conditions which allow some people to escape a reigning illness, because of idiosyncrasies, age, constitution, acclimatization, or inoculation. Some illnesses (small-pox, typhoid fever, syphilis) only strike the same person once, to which this first attack confers immunity, or if they recur again they remain briefly. Upon this fact rests the principle of inoculations destined to assure morbid im-

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munity, probably due to a dynamic modification that the vaccine produces in the cells of the organism and which remains for some time.17

Within this conceptual progression, immunity appears repeatedly as an unspecified, and indeed unknown, set of conditions that permits some people to “escape” from the epidemic influence of a “reigning illness.” Ini­ tially, “escape” might seem to comport logically with the trope “reign,” implying that within a given jurisdiction a sovereign force (of illness, of nature) rules, and therefore to avoid this rule, one must flee its domain. However, the idiom actually contradicts immunity’s juridico-political sense. Immunity defines legal exceptions to the law precisely in order to obviate the need for escape (thereby maintaining the law’s supposed universality). Furthermore, the notion of escape almost completely opposes the notion of defense, which after Metchnikoff ’s theorization comes to define immunity’s biological nature. Though immunity appears with more and more frequency in medical discourse throughout the nineteenth century (in part because Jenner’s vaccine inspires hope for other disease-preventing protocols), its use remains purely descriptive and in fact extremely vague.18 After a slow diffusion during the nineteenth century’s first three decades, medical literature increasingly cites immunity throughout the 1830s and 1840s to characterize variable responses to illness, especially the tendency to not contract infectious illnesses a second time (smallpox still offers the key example, but the idiom also extends to cholera, measles, plague, influenza, consumption, syphilis, yellow fever, croup, etc.). Moreover, “immunity” begins to refer quite haphazardly and figuratively to the nonrecurrence of a wide array of noninfectious illnesses and conditions (tumors, hemorrhoids, rickets, paroxysms, epilepsy, etc.). By extension it starts to designate differential susceptibilities to illnesses across geographic and racial distinctions (“comparative immunity”), especially in accounts of the European colonization of Africa and Asia.19 Concomitantly, its variations serve as biological indexes for racial difference as, for example, when Charles Darwin cites the work of Dr. W. C. Wells, claiming that “negroes and mulattoes enjoy an immunity from certain tropical diseases.” 20 Or, even more fulsomely, we find in Dechambre’s Dictionnaire encyclopédique des sciences médicales: “Each race has its immunities: and if we have, among others, an inaptitude to contract sleeping sickness in the same climate where blacks [négres] are stricken, for their part, the Bechuanas and the Bakouins . . . are exempt from all biliary stones and cancers, and for the most part they

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share with the beasts [brutes] the happy privilege of not contracting constitutional syphilis.” 21 As all these incommensurable instances suggest, immunity’s inconsistency does not clarify thinking about illness and health during the period. Rather, it rubs up against the basic humoral premise that predisposition to disease depends on a peculiar admixture of elements, qualities, and humors as these modulate and are modulated by the organism’s dynamic responsiveness to climate, food, rest, and environmental factors (e.g., miasmas, swamps, foul air, decomposing organic matter, etc.).22 As long as immunity nonsystematically names a complex of empirical observations about illness’s occurrence or nonoccurrence, and as long as humoral explanations prevail as medicine’s dominant theoretical style, little explicit reflection occurs on why something like immunity should exist—or not exist, as the case may be. One of the few examples I have found, an essay by George Day (a fellow of the Royal College of Physicians) appearing in 1849 in the Edinburgh Medical and Surgical Journal, argues against the idea of immunity. Day asserts in explicitly humoral terms that the “morbific element or principle, at all times existing, and probably operating more or less steadily, however imperceptibly, constitutes that essence or condition on which, extending through all periods of life, external causes or agents act in inducing diseases, and which at different periods of life being acted upon, or itself reacting in different modes, impresses on the diseases of each period their peculiar characteristics.”23 In making this assertion, Day cites Philip Charles Hartmann of the University of Vienna: If the human body were adequate either to repel or to overcome all these agents, which threaten its health, it would give access neither to hurtful force nor to disease. But as this immunity is not enjoyed by beings living on the earth, which possess only limited powers of resistance or subjugation, the result is that these bodies are able to subject external agents only of a certain degree and kind. The living body, accordingly, when exposed to the influence of external agents, necessarily yielding to this influence, may be made to deviate from the normal condition, and be subjected to disease, in consequence of the efforts it makes to resist the influence of these agents.24

Deeply qualifying the possibility of immunity, this depiction eerily anticipates almost exactly in reverse the terms that Metchnikoff will use to define immunity as defense three decades later. Since, as Day explains, the “morbific element” manifests due to individual idiosyncrasy and endures throughout “all periods of life,” the potential for illness exists “essentially,”

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even if its realization only follows conditionally from the actual interactions between organism and environment. Following from this bio-logic, something like immunity makes limited (if any) sense as an organism’s activity, since it imagines a systematic possibility at odds with humoral medicine’s specific and conjunctural explanations. 25 Given immunity’s basic incompatibility with humoral precepts, the only sustained attempt to elucidate its humoral plausibility of which I know appears in a thesis written in 1852 by André-Thérèse Chrestien while applying for the chair of clinical medicine at the Faculté de Médecine de Montpellier.26 Titled De l’immunité et de la susceptibilité morbides au point de vue de la clinique médicale (On Morbid Immunity and Susceptibility from the Clinical Point of View), the text not surprisingly follows the humoralist and explicitly vitalist ideology associated with the faculty where Chrestien seeks employment.27 His treatise considers “morbid immunity” as a clinical concept, first by theoretically juxtaposing it to its conceptual antithesis, “morbid susceptibility,” and then by assessing the implications that both concepts have for medical practice. From the outset, Chrestien offers his exposition as a polemic against a rising tide of biomedical reductionisms and submits both immunity and susceptibility as proof of vitalism’s vitality: Man is far from being able to be assimilated to a machine essentially subject to the laws of physics; and his actions, whether healthy or morbid, are far from being the consequence of chemical reactions. There is, in effect, in him a spontaneity that he relinquishes only in becoming a cadaver, and that reveals itself in the most positive manner by the faculty which he often has of resisting the causes of illness which surround [environnent] him on all sides.28

Chrestien’s opening salvo alludes to the classical Galenic and Hippocratic notion of the vis medicatrix naturae. It depicts the healing power of nature not only as essential to humans but as incarnating a “spontaneity” whose absence renders the living organism a corpse. Chrestien avers that, before becoming a cadaver, the organism reveals this vital spontaneity in its “most positive manner” as resistance to illness. Moreover, he adapts this vitalist notion to the contemporary idea that the causes of illness are environmental (i.e., that they arise in and from the milieu, as addressed in chapter 3), evoking the possibility—though not the inevitability—of “resisting” these “morbid” causes. To ground this claim, Chrestien (like Day) introduces the humoral axiom that disease involves an interplay of internal and external causes: “For man to fall ill, in effect, it is not enough . . . that he has around him the

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causes of illness, but it is necessary that he also has within him a disposition favoring these causes; because the experience of all times demonstrates that these causes act much less because of their activity than by the receptivity of the animal economy, a receptivity without which they remain powerless” (6). Here the “receptivity of the animal economy” serves as an active principle which enables external morbid “causes” to act causally in the first place. Locating the effective “activity” of such surrounding factors in an actively receptive “disposition,” which confers their power on them, Chrestien conversely defines immunity as the lack of this disposition or “susceptibility” (9). In this sense, immunity bears no particular positive or substantial import; it does not represent an active engagement of the organism, let alone an active defense, merely denoting the failure to be affected by illnesses when “others have contracted them in the midst of [au milieu de] the same apparent circumstances, or even in conditions supposedly less favorable to the development of these illnesses” (9). In other words, immunity serves here as a descriptive recognition that environmental catalysts lack efficacy if a “certain capacity or disposition” of the human body to fall ill does not realize itself. In Chrestien’s text, immunity negatively upholds the humoral premise that susceptibility to illness is essential and universal: it reconciles this premise with the fact that only some people succumb to the “morbific action” of “contagious matter and of contagion itself,” while other, more “privileged individuals” do not (11). Susceptibility, then, manifests a nonprivileged state, an ordinary, ongoing, quotidian state, in which the individual realizes itself as capable of being acted on—or more specifically, of receiving into itself that which is not itself, and thereby being modified as a “self.” The sixth edition of the Dictionnaire de l’Académie française (1832–35) makes this involution evident when it defines “susceptible” as “Capable of receiving certain qualities, certain modifications. Spoken of as much in the physical as moral sense. . . . Used generally of persons to signify one who is easy to wound, who takes offense easily.”29 Morbid susceptibility, in Chrestien’s sense, reveals the individual’s co-implication in the world, since the individual, by taking in that which is not properly its own (the contagious “cause”), opens itself not just to being wounded and offended but to becoming ill and dying. Yet it is only by and through this openness, this receptivity, that the individual lives. Hence Chrestien’s long exposition of morbid susceptibility traverses canonical factors familiar to the Galenic corpus (heredity, age, temperament, constitution, idiosyncrasy, sex, passions) as well as the “circumstances which surround

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man” (air, climate, food, clothes, habitation, profession, emotion), factors which paradoxically represent the conditions of possibility both of health and of disease. Immunity conversely appears to rectify this paradox by affirming that nonreceptivity (to disease) can coexist with receptivity (to health-inducing forces) under certain “privileged,” albeit unknown, circumstances. Following this train of thought, Chrestien concludes that immunity’s only clinical relevance is preemptive: “Considered from this point of view [of clinical medicine], morbid immunity only appears of interest, properly speaking, through the light it has already thrown and that it will be able to shed later on prophylaxis.”30 Not surprisingly, this assertion serves as a prologue to a lengthy consideration of vaccination. Though Chrestien admits vaccination’s efficacy in preventing smallpox, he ultimately questions it as a means of decreasing mortality. From Chrestien’s humoral perspective, when vaccination alters the inherent predisposition to contract smallpox (which he accepts empirically), it then makes susceptibility to other illnesses more likely. Also he wonders about vaccination’s limited success and about the need for revaccination. Finally, while acknowledging that the achievements of vaccination “would suggest the idea to inoculate for all contagious illnesses, which, especially when they become epidemic, are truly desolating,”31 he cautions against this extrapolation as being highly risky and hence unwarranted. Chrestien’s cautions about immunity’s limited medical value underscore his basic presupposition that immunity does not manifest an active capacity of the organism but rather negatively affirms the organism’s basic vitality: In considering morbid immunity and susceptibility, it is evident that the human body has in itself not only forces which preside over the play of its organs, but also a principle by virtue of which it struggles [lutte] with more or less success against exterior agents and against certain circumstances in which it finds itself.32

Chrestien’s text illustrates the indeterminacy that immunity bodies forth in the mid-nineteenth century before the combined insights of Koch, Pasteur, and Metchnikoff will recast the concept in a more active direction. While acknowledging that immunity denominates a form of  “exemption,” a “faculty to not contract certain illnesses,” Chrestien subordinates this faculty to a more general “force of resistance more or less inherent in life.” This principle in turn specifies not just a play of particular organs but also

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the situation of the organism as a whole vis-à-vis the “circumstances in which it finds itself.” On the last page of his text, Chrestien introduces the notion that “struggle against” qualifies this engagement. Just as Bernard will almost twenty-five years later, Chrestien ends his exposition by addressing his analysis to the contemporary understanding that the organism-milieu dyad is both inextricable and agonistic. As we saw in chapter 3, the nineteenth-century hygiene movement repeatedly insists that the milieu which encompasses living human beings impresses either beneficent or deleterious conditions on them that inform their health and well-being. Thinking within a similar humoral paradigm, Chrestien also understands the material impressions that surroundings have on human lives as catalysts for (if not causes of ) health and disease. However, by positing the opposition between morbid immunity and morbid susceptibility as playing on the presence or absence of a vital principle virtually synonymous with life itself, Chrestien’s text unwittingly anticipates immunity’s future, almost thirty years hence, as an active function that maintains life by struggling against the germs of disease. Until that day, however, immunity continues to provide only a descriptive metaphor, whose meaning-effects remain circumscribed within medicine’s struggle to think the organism apart from—or indeed in opposition to—its milieu.

Conferring Immunity, or Nations Defending Themselves Together

Beyond the limits of humoral description, another reason that immunity did not come into its own in medical thinking until the last decades of the nineteenth century is that infectious illness itself occupied so much conceptual, practical, and political space. Epidemics are rife throughout Europe during much of the nineteenth century, among them smallpox, typhus, typhoid, influenza, measles, yellow fever, scarlet fever, dysentery, and, of course, cholera. Given such pestilential prevalence, attention not surprisingly focuses primarily on discerning illness’s patterns and circumscribing its causes rather than theorizing the exceptions to its “reign.” Moreover, disease causality itself does not appear a straightforward or unambiguous concept, as Christopher Hamlin explains: Depending on context, the question of “what is the cause of the disease” might mean any of the following: (1) “what is the cause of this person (rather than

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another person) taking the disease now?” (2) “what is the cause of the course the disease has taken in this person, e.g., why is it fatal to one person and not to another?” (3) “what is the cause for the existence of a general epidemic at this time and this place, i.e., what is the cause of the beginning of the epidemic?” (4) “what is the cause of the spread of this epidemic?” 33

If a disease’s cause includes the supposition that its effects can manifest themselves differentially, then the idea that some individuals, groups, or places might evince immunity to them seems merely to reiterate this differential notion of cause itself (insofar as immunity describes such differences). Thus, as we saw in Chrestien’s exposition, immunity appears— when it appears—in mid-nineteenth-century medical discourse not as the organism’s active engagement with or against the world but only negatively as the absence of “susceptibility,” or of what Hamlin refers to as “predisposing causes.” Immunity retains this constitutive ambiguity, or indeed negativity, until Metchnikoff actively redefines the term in the 1880s. Nevertheless, immunity’s descriptive instances raise complex questions both about disease causality and about the social and political values embedded in medical thinking about epidemics. When these two valences converge, it enables immunity to provide an index both for the political value of medicine and for the medical inscriptions of politics. The most significant medicopolitical convergence appears during the international deliberations among European nations about the cholera pandemics that plague Europe during the period (1830–32, 1847–49, 1853–54, 1865–66, 1873, 1884, 1892–93).34 More than any other biopolitical phenomenon, these highly visible and terrifying outbreaks provoke widespread critical reflection among phy­sicians, politicians, and public health officials on the epidemics’ entangled social, economic, and biological consequences. Thus, at the moment Chres­tien elucidates the metaphoric import of the juridicopolitical term “immunity” for medical discourse,35 the most literal juridicopolitical reflections on illness concern how to limit cholera’s terrifying spread across national, regional, and local borders. Beginning in 1851, when the first International Sanitary Conference opens in Paris, a series of multinational conferences convene at regular intervals to discuss and debate various ways to contain epidemic disease. From the outset, their primary point of contention concerns whether to require quarantines, if so in what form, if not why not, and concomitantly to assess what other, less restrictive means might stem the tides of cholera.

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Conferences meet in 1851 (Paris), 1859 (Paris), 1866 (Constantinople), 1874 (Vienna), 1885 (Rome), 1892 (Rome), 1893 (Dresden), 1894 (Paris), 1897 (Rome), 1903 (Paris), and 1911 (Paris). At the third conference, in 1866, immunity makes its first medico-political appearance to accommodate an explicitly defensive strategy—although in this case a defense conceived not at the level of the organism but at the level of nation-states and commercial interests. Indeed, immunity arises in these deliberations primarily as a way to explain why some places and people might need more defending than others, and hence why such defensive strategies need not be uniform across the globe. Immunity’s 1866 debut on the medico-diplomatic stage occurs, then, within an official consideration of cholera’s causes, whether or not they are transmissible, and if so how they should be circumscribed. At this time (more than thirty years after the 1832 epidemic introduced Europe to the disease), popular, political, and medical opinion holds that cholera erupts in India and migrates by way of the Middle or Near East, before inundating Europe proper. Thus cholera consistently shows up in both everyday representations and medico-diplomatic deliberations as an invasion. However, given the participants’ different economic, political, and medical interests, fears of—and thus preferred responses to—cholera’s invasive potential vary considerably. The opposition between nations seeking quarantines as necessary protections and nations refusing quarantines as unwarranted disruptions of trade initially seems irreconcilable. In this contentious medico-political context, immunity offers a middle way: it finesses the contradiction that cholera might be communicable and—given its nonpredictable consequences—acknowledges that it does not always need to be treated as such (i.e., to warrant quarantine). The negotiations about how different nations with different political, economic, and biological interests might best defend themselves against cholera’s invasions thus turn on introducing immunity as a compromise formation into their deliberations. However, immunity does not immediately suggest itself as the appropriate strategic solution. First the conflict about quarantine has to unfold. At the two International Sanitary Conferences in Paris (1851, 1859) preceding Constantinople, the gatherings do not devote themselves exclusively to cholera but also include plague and yellow fever within the quarantine debates. Yet, given the immediacy of cholera’s threat (epidemic outbreaks occur in 1847–49 and 1853–54), it soon completely overshadows the other diseases, which recede as active dangers.36 As we saw in chapter

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3, traditional quarantines and cordons sanitaires failed to contain the 1832 epidemic, thereby diminishing their credibility and undermining faith in cholera’s contagiousness. During the twenty-year period between the first cholera epidemic in Europe and the 1851 conference, anticontagionism trumped contagionism (see chapter 3) and endorsed social, political, and economic strategies to preempt further outbreaks (though without excluding more “contagionistic” methods of boundary maintenance). The Rapport sur la marche et les éffets du cholera-morbus dans Paris provided a prototype for such preemptive protocols when it redirected medical concern about the human milieu from the elemental to the social environment. If cholera’s highest mortality and morbidity statistically correlate with social, economic, and political factors, then public hygiene must address these variables to ameliorate the disease. Based on this presumption, some nations, especially Britain, actively oppose extending quarantine to cholera and seek instead to elucidate new prophylactic possibilities against epidemics. In part, Britain’s influence at the first International Sanitary Conference derives from its undisputed leadership in casting sanitation as a preventative regime. If French public hygiene proffers the most theoretically developed form of anti-contagionism, the English sanitary version constitutes its most ambitious realization. Inspired in part by the innovative French investigations (especially by their use of statistical analyses), 37 the English public health movement nevertheless eschewed the French focus on sociopolitical variables, instead maintaining an ideological commitment to economic and political liberalism.38 As a result, English public health brackets socioeconomic conditions (primarily poverty and unemployment) and relies instead on cleaning up “filth.” By reducing questions about how social environments affect human lives to “salubrity” or “insalubrity,” the English sanitary movement establishes waste management and sanitary regulation as the state’s primary means to circumvent epidemics.39 Edwin Chadwick, famed English spokesman for sanitary reform and author of the Poor Law Report (1834), personifies the English approach. In fact, Chadwick so successfully equates public health with sanitary improvement that this equivalence not only guides domestic health policy but also informs his nation’s international policy on cholera prevention for the rest of the century. Evolving out of his earlier work on the Poor Law, Chadwick’s Report on the Sanitary Condition of the Labouring Population of Great Britain (1843) provides the classic formulation of this

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position.40 In this text, Chadwick introduces “filth” as a simultaneously social and natural issue—as literally and materially a biopolitical issue, insofar as it issues from humans who live both politically and biologically. For Chadwick, filth’s quasi-natural valence reconciles the belief that market forces ought to regulate economic relations, with the obvious problem that destitution statistically increases disease (and, consequently, claims on the state for poor relief). To maintain the idea that political economy’s laws are as natural as those of disease (rather than refuted by them), Chadwick proposes an alternate “natural” explanation for the mortality and morbidity of the poor. If filth, not poverty, really causes disease, then the state can still hold the poor responsible for their own economic condition as individuals, even while it intervenes to remove environmental contamination to ensure that as individuals they are more able to work more often. Thus, as Christopher Hamlin succinctly concludes: “The need was for an alternative to destitution as a cause of disease, and the main merit of the view that the causes of disease were environmental was simply that it was a viable alternative to the view that they were economic.”41 Chadwick’s perspective is by no means universal. In fact, he encounters strong opposition, especially from medical practitioners who intimately experience the link between destitution, malnutrition, and disease. However, his ability to proselytize for the sanitary project enables him to promote it officially over all rivals. In particular, Chadwick’s ability to reconcile the tension between private property rights and the costs that cholera and other epidemics imposed on the nation enables him to sell public health to a Parliament that primarily represents property owners.42 Since sanitary reform addresses a major economic contradiction in the Poor Law (i.e., the connection between disease and poverty increases demands for state assistance), it shores up liberal capitalism’s “good faith” belief that market forces are natural and thus ought to regulate social relations. Accordingly, Chadwick’s environmental reductionism provides the conceptual basis both for the passage of the 1848 Public Health Act and for a new state-endorsed theory of disease. The dominance of Chadwick’s medical politics—or political medicine—has been widely recognized. For the rest of the nineteenth century, English public health almost exclusively addresses sanitation and water supply. Of course, these factors do promote health and well-being and certainly deserve praise from contemporary commentators in other countries where the debates about sewage and clean water will continue for decades after England embraces sanitation.43 Yet England’s sanitary

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commitment also betrays its investment in policies, both domestic and international, that minimize state interference with private commercial interests and require individuals to sustain themselves economically. These policies descend from the seventeenth- and eighteenth-century idea that the human body provides a metonym for the person (discussed in chap­ ter 2). Since, in this thinking, the individual human organism constitutes the property of the person that it bodies forth, these proprietary individuals retain responsibility for their own health and well-being. Only when living together produces unhealthy effluents which diminish their ability to work productively—and thereby to sustain themselves economically and biologically—does the state incur an obligation to ameliorate such disease-inducing conditions. Thus the English sanitary movement sanctifies the individual as a legal and economic atom while holding politics responsible for the risks entailed by collective living. It thereby realizes Adam Smith’s basic beliefs about the nature of political economy, including his belief that limited police demands include “attention paid by the public to the cleanliness of the roads, streets” (see chapter 2). The liberalism underpinning English sanitary health policy—and consequently its official theories of disease—proves a main point of conten­ tion at all the International Sanitary Conferences, where the British assiduously fend off or modify all measures which potentially threaten trade (especially quarantine). As a result, beginning with the first conference in Paris (1851) and persisting through the 1890s, the British counterpoise their economic and commercial interests to those of international health, much to the other participants’ dismay. For example, reflecting on the proceedings of the 1866 conference, the French representative Antoine Fauvel depicts the British position as the conference’s major impediment: We think, in addition, that the principal obstacle to the general adoption of an identical system of quarantine against cholera comes less from the divergence of opinion on the efficaciousness of these practical measures, than from the fact that all countries do not have equal interest in protecting themselves from the illness, or even more that, in certain countries restrictive measures are considered as more detrimental to general interests than the harms caused by cholera itself. Thus is the opinion of England.44

Indeed, the English hold so tenaciously to this opinion that even after Koch proclaims the bacterial etiology of cholera, they publish an “Official Refutation of Dr. Robert Koch’s Theory of Cholera and Commas”

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(1886) to support their investment in sanitation as a viable alternative to quarantine.45 Espousing their faith in sanitary measures to repel epidemics, the En­ glish representatives to the 1851 conference consistently refuse calls issued by the delegates from nations bordering the Mediterranean (Greece, Spain, Tuscany, the Papal States, and the Two Sicilies) to extend quarantine to include cholera.46 Although technically quarantine still remained legally available in England as a preventive measure, its existence, let alone its use, had proved contentious for decades.47 In fact, although the regulations were invoked in 1845 when cholera once again loomed, they were withdrawn in 1848 on the recommendation of the newly authorized General Board of Health, which issued its first Report on Quarantine in the following year (with Chadwick among the coauthors).48 Largely eschewing theoretical considerations of disease causality in favor of assessing methods of prevention (i.e., sanitation), the board’s report nevertheless endorses the notion that “medical opinion throughout the world has swung away from the doctrine of specific contagion towards a ‘terrestroaerial’ causation.”49 This endorsement in turn grounds what comes to be known as “the English system” for prevention, which will consistently be opposed to quarantine for the next fifty years. The English protocol, which Peter Baldwin dubs “neo-quarantinism,” combines sanitary surveillance (including house-to-house visitations to inquire about bowel movements and toilet facilities), disease notification of local authorities, isolation of the ill, medical tracking of travelers, detention of ships for observation, and the disinfection of people, goods, and dwellings. It thereby redefines the locus for disease prevention from the nation’s borders to its interior.50 Whereas quarantines and cordons sanitaires rely on the geopolitical demarcations of national sovereignty to define pestilential invasion, the new English system distributes these limits among the population as a whole: “Quarantine was in effect both moderated and broadened, the entire nation turned into a lazaretto without walls.”51 Incorporating elements of what Foucault called “disciplinary individualism,” the English sanitary model distinguishes individuals as potential nodes of biopolitical disorder while concomitantly binding them together as belonging to a population vulnerable to disease. 52 Thus the individual body, as a vulnerable atom of population, now comes to serve as the locus where the nation defends itself against epidemics. The English faith in sanitary measures as individualizing and disciplinary means of national protection informs the nation’s domestic and in-

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ternational health policies for at least the next forty years. Shifting the defensive perimeter from the nation’s boundaries to the body’s boundary, the English system replaces quarantines and other trade-disturbing tactics with sanitary surveillance, augmented by the inspection, isolation, and disinfection of affected individuals and ships. Conversely, the sanitary ideal consolidates the state’s biopolitical investment in citizens’ bodies, as Mary Poovey argues: “In the 1830s and 1840s, this dense network of interdependent theories, technologies, and political disputes about [sanitary] policy simultaneously reorganized individuals’ relations to their own and their neighbors’ bodies and constituted the conditions of possibility for the formation of the social domain and of the professionalized, bureaucratized apparatuses of inspection, regulation, and enforcement that we call the modern state.”53 By the century’s end, this double-edged English strategy succeeds in consolidating the principles of international health and commerce, as Baldwin notes: “The doctrines of liberalism had now been extended to public health, much to the profit of commerce and navigation. . . . By ensuring effective sanitary reform within each nation, controls imposed at the borders could be, if not abolished, at least moderated. Sanitation at home meant neo-quarantinism abroad.”54 The 1851 International Sanitary Conference in Paris marks the beginning of this liberalizing process, although it implemented no agreement about how to control cholera. Comprising a physician and a diplomat from each participating nation (Austro-Hungary, France, Great Britain, Greece, the Papal States, Portugal, Russia, Sardinia, the Two Sicilies, Spain, Turkey, and Tuscany), the conference convenes to consider whether to standardize quarantine protocols for plague, yellow fever, and cholera. Almost immediately the inclusion of cholera along with the other previously quarantine-worthy illnesses (plague and yellow fever) sparks objections from the Austrian representatives, whose government insists that they exclude cholera from the discussion. According to the Austrian experience, quarantine and cordons sanitaires clearly failed to inhibit cholera’s occurrence,55 and cholera therefore should not fall within deliberations about standardizing quarantine—a position the English delegates support. Given the issue’s divisiveness, before addressing the topic in open session, the conference appoints a separate commission to consider whether or not quarantines work in cases of cholera. In its official report, the committee holds that cholera is “capable of importation . . . progressing in its invasions like epidemics in general, breaking like a storm over the countries it awaits.” However, since cholera

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did not move directly from one country to the next, “we conclude that quarantines can do nothing against cholera and that when they are employed the illness, passing beneath all the barriers raised against it, arrives or arises in the country, if it hasn’t already found itself there.”56 If the report represents the committee’s collective agreement, it also substantially reiterates the English delegation’s position, which rejects quarantine throughout the proceedings. While equivocating about whether cholera is contagious, the committee nevertheless upholds quarantine’s uselessness—if not counterproductiveness—against cholera’s invasions. It explicitly juxtaposes the commercial costs of restricting trade and travel to the (supposed) lack of benefits that accrue from policing national borders. Instead it shifts the locus of attention and prevention to insalubrious ships and homes, where it locates the “real cause and true force of the formation of illnesses.” In so doing, however, the committee complicates the notion of cholera’s invasiveness, which “isolation, sequestration, or absence of complete contact” seek to halt. If invasion imagines cholera’s violently incursive quality and underscores its hostile transitivity, then rooting the illness in foreseeable and preventable locales seems to belie this intrusive hallmark. In other words, the hygienic principle assumes an intrinsic and indeed pervasive “invade-ability” as the condition of possibility for its preemptive protocols. More pointedly, it implies that each human body provides a vulnerable locus for (national) invasion and that national defense must therefore also act locally at the level of the living organism. For diplomatic reasons, the committee’s report does not carry the day. At the emphatic insistence of the Mediterranean countries, the conference adjourns after formally extending quarantine restrictions to cholera. However, this putative victory is mostly pyrrhic, since the documents produced by the conference remained unratified (except by Sardinia) and so in practice little changed.57 Yet, as Norman Howard-Jones observes, this lack of change did not mean that nothing had changed at all: “The fact that the conference took place established the principle that health protection was a proper subject for international consultations even though international health cooperation was for many years limited to defensive quarantine measures.”58 At the least, considering epidemic disease a matter for international diplomacy revises the relation between the military and medical valences of the terms “invasion” and “defense.” Heretofore, defending against cholera’s invasions had figured primarily as metaphor, gesturing toward somatic vulnerabilities, loss of lives, disruptions of eco-

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nomic relations, and threats to national security. After the first International Sanitary Conference, these metaphoric implications take on a more literal status. Incursions of disease would now be considered in much the same way as incursions of armies, as matters about which nation-states negotiate according to their economic and security interests, and against which they deploy military and naval forces. Indeed, through the diplomatic process, cholera epidemics overtly emerge as biopolitical hybrids (in Latour’s sense), conjoining nature and politics as matters of international concern. Furthermore, applying international protocols to epidemic “invasions” literalizes the politics embedded in this metaphor and underscores the extent to which medicine now serves as a political—and diplomatic—discourse in its own right. At the second International Sanitary Conference in 1859, limited to dip­ lomats only without medical participants (to preempt disputes about medical theory), the same nations reconvene to reconsider the 1851 documents. Largely encountering the same obstacles, they reach an even less conclusive outcome.59 However, at the 1866 conference in Constantinople, where immunity surfaces as a biopolitical antidote to the plaguing international disputes about quarantine, the diplomatic situation changes dramatically. At this historical juncture, medical thinking about cholera does an about-face and reembraces infectious causes to explain its deadly incursions. In part the change reflects historical contingency: not only has cholera just transited Europe—and continues to loom menacingly on the horizon—but the increasing speeds and changing modes of transportation (railroads and steamships) make it easier to track the disease’s perilous movements.60 Paradoxically, however, the same improvements in transportation that make cholera’s contagiousness less contestable also undermine the feasibility of traditional quarantine protocols. Given shorter transit times, ships would have to stay in quarantine for longer periods to allow standard containment measures to work. However, extending prophylactic detention periods exacerbates quarantine’s economic and political undesirability even as the medical basis for its effectiveness seems more sure.61 Given these conflicting empirical constraints, medical explanation emerges at the expanded Constantinople gathering as a political instrument that shapes how nations diplomatically address one another’s aims.62 Moreover, since different arguments about disease causality manifestly bolster different national interests, contagionism’s resurgence demands new political strategies from those who oppose its quarantine-friendly

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implications. These demands catalyze the strategic importance of the “English system” (which Baldwin calls “neo-quarantinism”), and the 1866 conference serves as its laboratory. Combining elements of both containment and sanitation, or redeploying containment as a fail-safe for sanitation, the neo-quarantine protocols of “inspection, isolation, and disinfection promised to reconcile those erstwhile enemies, public hygiene and safety in one corner, trade, commerce, and unrestricted peregrination in the other.”63 Yet this reconciliation among enemies, erstwhile or not, did not happen automatically. Fortunately, then, immunity both justifies and realizes its promise. The opening of the 1866 conference’s official French exposé, written by the French delegate Antoine Fauvel, simultaneously reveals the conference’s main focus and its main anxiety: “The invasion of cholera in 1865 surprised Europe in the middle of a profound quietude. . . . Coming from outside, [it] taught Europe that, thanks to the rapidity of the means of communication, a new route was opened for Indian cholera to traverse the Red Sea and Egypt, whether the malady originally came from India, or whether it has its birth in the midst of the vexing [ facheuses] conditions periodically created by the pilgrimage to Mecca.”64 From the outset, the document casts cholera as a problem of unexpected violation, in particular the violation of Europe from the colonial East: In 1865 Europe had been caught off guard; resting on its sanitary laurels, Europe complacently allowed itself to succumb to a devastating onslaught from Asia.65 Responding to these anxieties, the French delegates immediately make a dramatic and contentious motion to head off the looming threat, personified by Muslim pilgrims. The French propose that should cholera appear among those bound for Mecca, European nations will interrupt all communication with the ports of Arabia and the Egyptian littoral. In addition to whatever racial and religious presumptions the proposition enfolds (clearly there are many), it anxiously anticipates that increasing transportation speeds presage the collapse of national boundaries, disrupting geographic distinctions between inside and outside. Coupled with the rediscovered belief in cholera’s contagiousness, this fear of temporal proximity with formerly distant lands exemplifies the new geopolitical situation and conversely demonstrates the disease’s new biopolitical salience. From its opening moments, then, the 1866 conference engages cholera’s hybrid status as at once a biological, political, economic, and military event. Repeatedly underscoring cholera’s invasive quality, the focus on India, Egypt, and Mecca as staging sites not only establishes racial, eth-

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nic, and religious difference as intrinsic to the disease’s progress—and peril—but also legitimates a defensive imperative to disrupt it: [A] single weak point in the defense against an enemy as subtle as cholera suffices in order to lose the benefits of more general [sanitary] measures for all of Europe. If on either the Asian or European sides of the Mediterranean basin a coast lacks adequate surveillance, or an unfaithful [infidèle] or negligent agent allows some compromise, the entire economy of your defensive system is ruined. . . . By establishing an obstacle to prevent cholera from leaving Egypt, the European governments have decided to disrupt all maritime communication with it by means of a blockade during the duration of a cholera epidemic. Then let us see what happens.66

Or as the Archives Diplomatiques summarizes the proposal: War ships will converge to assure the execution of the prescribed measures; they will be the police of the sea, and exercise as exacting a surveillance as possible in order to prevent all clandestine departure.67

In this medico-diplomatic context, the literal and figural notions of defense fuse as the European powers determine to fend off their metaphoric enemy (cholera) by military means (blockade). This determination addresses cholera by targeting the human agents who appear to convey it. Positing them as legitimate objects for international military action, it also materially reimagines the kind of “subtle enemy” that cholera represents. Of course, quarantines and cordons sanitaires had been enforced by violent means before. Historically quarantine violations were not uncommonly subject to military enforcement and summary execution.68 For example, during much of the eighteenth and nineteenth centuries, Austria maintained an almost thousand-mile-long military border that also served as a medical cordon.69 However, the European agreement to define cholera as a collective enemy represents the disease as a new kind of “natural” enemy that “subtly” abets Europe’s political and religious enemies—as the double valence of “agents infidèle” intimates. Conversely, representing cholera as an international threat reveals how political, economic, and biological processes deeply intertwine within problems of health. Incorporating medical theories about disease causality and prevention, domestic and international responses to cholera force European powers to engage each other militarily, politically, and economically.70 Displacing the political and the economic onto the sanitary defines the sanitary as a form of political economy (as the case of England demonstrates). It also

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illustrates how preventing epidemic disease enables European powers to contest each other’s colonial and commercial desires diplomatically and militarily. Within this dense biopolitical nexus, immunity first appears as a conceptual expedient that helps lubricate the friction among competing medical and diplomatic aims. Indeed, immunity’s indeterminacy as a simultaneously medical and juridico-political concept enables medical theory to apply itself to juridico-political ends. Immunity’s international debut takes place as the diplomatic gathering begins to entertain medical explanations for cholera’s dissemination to adjudicate among the conflicting strategies proposed to contain it. To this end, the conference designates a committee of the medical delegates to consider cholera’s “origin, endemicity, transmissibility, and propagation” and to provide a scientific basis for further deliberations.71 The topic of origin turns out to mean not the epidemic’s etiological cause but rather the place from which it issues forth. Thus the initial question to occupy the delegates concerns cholera in India (identified as this “origin”) and how it propagates itself beyond the subcontinent.72 The committee then asserts its first causal theory, not surprisingly blaming the Indian people: The importance of Indian pilgrimages, of these periodic agglomerations which bring together up to a million people at a time, could not escape the conference. It has been led to consider as without doubt that these agglomerations, where all the conditions of insalubrity are combined, are the most powerful of all the causes which favor the development and expansion of epidemics of cholera in India. They are the sources [ foyers] of both the disease’s reinforcement and propagation.73

Evoking “agglomerations” as cholera’s “most powerful” cause, the committee discloses its intense anxiety about the massing of individuals. Certainly convocations of Hindu and Muslim pilgrims touch the delegates’ prejudices, since they vividly imagine them as undifferentiated, dirty, peri­ patetic, disorderly, and hence terribly dangerous. However, beneath such phobic characterizations lies a more general fear of deindividualization itself. Hence the proceedings will affirm as a basic law of the disease that “all human agglomerations constitute a condition favoring the extension of cholera among them, and the rapidity of the epidemic’s evolution is proportionate to the concentration of the mass” (17). Within such dangerous agglomerations, the vital differences among the human elements massed together then determines the epidemic’s destructive force:

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The violence of the epidemic in such cases is—independent of influence of bad hygienic conditions—much greater when the individuals composing the agglomeration have remained until then free [vierges] of the choleric influence. That is to say, individuals who have just suffered the influence of a choleric source [ foyer cholérique] enjoy for a certain time a relative immunity which neutralizes for them the troublesome effects of the agglomeration. (28)

With this first invocation, immunity introduces distinctions where no distinctions ought naturally to apply. In other words, having just defined “all human agglomerations” as lawfully subject to choleric influences “proportionate to the concentration of the mass,” the committee acknowledges that other differences which nullify this law also exist. In this case, then, it chooses its metaphor well, since immunity’s juridicopolitical valence works precisely by naming legal exceptions to the law to maintain the fiction that the law is universal and therefore without exception. Here, however, they also qualify the notion of immunity, making it “relative.” While this framing might seem to anticipate what we would now call “acquired immunity” (which the committee’s report later calls it, “immunité acquise”), the text actually defines immunity not with respect to cholera per se but with respect to the “troublesome effects of the agglomeration.” Hence “relative immunity” merely differentiates among individuals within the agglomerated mass as more or less threatening to each other. Even in this new figuration, however, immunity still resonates with its other, more familiar juridico-political valence, the “reign of disease,” as the proposition’s corollary indicates: “When cholera rages with more violence through an agglomerated mass, it is good to disperse all agglomerations where cholera reigns” (29). Having introduced agglomeration as cholera’s source, the committee turns to hygiene as a contributing factor (considering the traditional Galenic categories: food, water, air, and soil, plus, of course, sanitation) before directly engaging the question: “How to understand immunity with respect to cholera?” (224). Fifteen years after Chrestien provided a humoral explanation for immunity as the negation of “morbid susceptibility,” the International Sanitary Conference proffers a different justification for medically appropriating the concept: The Conference, after having thus studied and illuminated (as much as the acquired facts permit) all the circumstances capable of favoring the development and the propagation of cholera, wanted to take account of the conditions that, on the contrary, make numbers of individuals and even localities appear refractory [réfractaires] to its development.

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This immunity, which one wrongly invokes as an argument against the transmissibility of cholera, only proves that this illness, like many others that are eminently transmissible, is not fatally communicated by the fact that an individual is placed in contact with the morbific principle. (29)

The committee makes no attempt here to explain what immunity is or how it works. Immunity still remains a descriptive rubric which simply names variations in the effects produced by “contact with the morbific principle.” However, in this medico-diplomatic context, immunity also carries other meanings. First, immunity appears in opposition to “circumstances capable of favoring the development and the propagation of cholera” as the “conditions” that render both individuals and locales “refractory to its development.” The choice of “refractory” as the substantive qualifier once again implicitly draws on immunity’s juridico-political past: the primary meaning of refractaire during the period was “rebellious” or “disobedient,” with the primary dictionary example being “Refractaire aux ordres du roi” (disobedient to the orders of the king).74 No doubt immunity’s play on illness as a quasi-natural sovereign (also embedded in “reign”) subtends in this formulation and reaffirms the epidemic’s biopolitical status. Moreover, by accounting for exceptions (which might “wrongly” suggest that variable effects confirm cholera’s noncontagiousness) in manifestly juridical terms, the trope represents cholera’s contagiousness as a lawful process. Yet if immunity works rhetorically to shore up cholera’s contagiousness in the face of seemingly contrary evidence, it has still not crystallized into a well-defined concept and so enables several other interpretive gambits as well. A second usage foreshadows the forceful sense that immunity finally achieves fifteen years later in Metchnikoff ’s decisive formulation. Referring to “the resistance that certain countries, certain localities and the preponderance of individuals oppose to [cholera’s] development,” the committee asserts: It is to this resistance, however exceedingly variable, that we give the name immunity. It supposes that the locality which enjoyed it has resisted the importation of cholera and that the individual who has been exposed to contact with the illness remains unharmed [resté indemne], as does, for example, a doctor in the middle of an epidemic locale.75

While this notion of resistance might seem more resonant with contemporary ideas about immunity as a biological capacity, in context both re­

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sistance and immunity operate as agentless agencies evinced by both places and people. Furthermore, such resistance primarily denotes chol­ era’s nonmanifestation, even if it obliquely connotes that some (unknown) force actively resists its diffusion. The correspondence between these valences arises only inferentially, from the simple observation that not everyone dies from the disease: “If all such illnesses were transmitted simply by the fact that they are transmissible and that one had been exposed to the contagion, the human species would have disappeared from the surface of the globe a long time ago.”76 Immunity, then, names a resistance to transmissible disease not because there exists any coherent explanation for what resistance might entail or even where or how it occurs (in places? in races? in populations? in aggregations? in weather patterns? in individuals?) but because it follows logically from the fact that epidemic illness has not (yet) rendered the human species extinct. Actually, the committee supposes that immunity primarily inheres in places. To some extent, this supposition recapitulates immunity’s juridicopolitical history, which first applied to cities, then to territories and church domains, and only subsequently—and by metonymy—to people who lived in these domains, before being abstracted as a legal possibility in its own right. This recapitulation leans in part on an ancient theory, revived in 1546 by Girolamo Fracastoro, On Contagion and Contagious Diseases, which likened disease’s catalysts to seeds and the sites where disease flourishes (places and people) to fertile ground.77 Versions of this theory propagated themselves widely in the mid-nineteenth century in part because they accommodated both contagionist and anti-contagionist readings. The analogy comparing disease etiology to germination—which culminates in germ theory—had long suggested an explanation for why some people do not contract an illness at the same time and place that others do. According to this botanical way of thinking, people or places with less native nutrition for the seeds of disease remain healthy, while conversely illnesses bloom where these seeds find adequate nourishment.78 Here is the version that the committee expounds: The principle of all transmissible illness only regenerates itself under certain conditions without which it is sterile. Just as a seed thrown at random on the ground does not suffice to reproduce the plant which produces it; it needs to find all the conditions favorable to its germination. Without doubt all morbific principles [principles morbifiques] do not have the same degree of exigency, but the necessity of an organism favorable to the regenerative evolution of a

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morbific principle is no less fundamental to the doctrine of the transmission of diseases.79

In this medico-diplomatic context, the seed-ground theory takes on new salience. It provides not just a way to account for disease (or the lack thereof) but also to negotiate among different nations’ strategic responses to it. As the conference tries to reconcile the anti-contagionism underlying the English sanitary ideal with the resurgent contagionist demand for quarantine issued by a number of Continental nations, the seed-ground theory underwrites a medico-diplomatic compromise between quarantine and sanitation that renders neo-quarantinism both plausible and possible. Drawing on this germinal explanation, which apprehends disease as simultaneously contagious and environmental, the committee considers immunity first—and especially—as an environmental condition. Enumerating specific examples of nations, regions, cities, and towns that appear to have avoided cholera while others around them lie “besieged” (assiégée), the committee once again enlists immunity to vindicate contagionism in the face of what might seem clear evidence for anti-contagionism: Does this fact, and many other analogous ones, prove that cholera is not transmissible? Not at all. It only proves that there are certain localities, like individuals, who enjoy a certain immunity against the transmission, immunity which, for the localities, can be complete or partial, permanent or temporary. We say temporary because there are some examples which show a locality which resisted at a certain time and had been invaded at another and vice versa.80

Immunity performs a lot of imaginary work here. Like a good negotiator, it reconciles opposites and makes them both seem valid. “Complete or partial, permanent or temporary,” immunity explains why the same place at different times can exhibit antithetical responses to cholera: once invaded, now resistant, and vice versa. In this labile formulation, immunity enables cholera to call forth multiple prophylactic responses, all of which can claim to found themselves on fact. Indeed, immunity’s main rhetorical advantage seems to lie in its ability to explain away data that might other­ wise suggest that “cholera is not transmissible” (as the pro-quarantine side requires) while acknowledging that transmissibility varies according to particular locales (as the anti-quarantine side insists). From this ambivalent formulation follows the committee’s pragmatic endorsement of neo-quarantinism as an international response to cholera:

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This immunity, as a general rule, when regarded closely, can be linked to good hygienic conditions existing in these localities, or to notable improvements which have operated there for a little while. The relative immunity answers those who are too inclined to commend the safety [salut] of nations against cholera exclusively to quarantine measures. It proves, not that these are useless—far from that—but that measures of hygiene are necessary complements to them.81

Associating immunity with “good hygienic conditions,” whether “existing” (implying they occur naturally) or because of “notable improvements” (implying they result from sanitary commitments), the committee diplomatically casts the concept as “conditional” in the most literal sense. Relative immunity’s constitutive indeterminacy does not not endorse quarantine, though it might insinuate that quarantine alone does not suffice for national defense. Conversely, it also supports those who advance “measures of hygiene” as “necessary complements” to boundary maintenance, even while intimating that as complements these too lack something essential. By artfully equivocating between these options, the committee associates immunity with national safety, but not by insisting that national borders define geopolitical thresholds. It also avers that sanitary improvements can afford localities degrees of “safety” (at least after they operate for a while), yet still recognizes that policing geopolitical perimeters also supports localist policies. Needless to say, rather than offering a well-defined medical concept, immunity operates here as a diplomatic compromise. After engaging immunity’s geopolitical valence, the committee turns to immunity’s individual significance, which appears both subsequent and secondary to its geopolitical consideration.82 The committee quickly indicates, without much evidence or specification, that for individuals immunity varies widely, that “complete immunity . . . is not the rule,” and that immunity, either complete or incomplete, may be only temporary. Though they do not conjecture how such immunity might occur, as Chrestien does they link it to an unnamed vital force: “Immunity against cholera is thus definitely proportionate to the vital resistance [résistance vitale] of individuals and it varies with it” (228). Nevertheless they do affirm that immunity follows epidemics and that individuals can “acquire” it: “There is moreover a temporary immunity that remains after an epidemic has recently passed through” (228). However, the committee’s main interest in individual immunity associates it with “adjuvant causes” which arise directly from the environment:

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Immunity against cholera results from all the conditions contrary to the adjuvant causes, i.e., good hygienic conditions, and its influence is such that if one could succeed in generalizing these good conditions, and by that reduce cholera to the proportion it attains among the wealthy classes and populations, its passages would be of little consequence. The Committee thus recognizes that in opposition to the transmissibility of cholera, there exists in healthy people a resistance capable of neutralizing the influence of the toxic agent, and this resistance, weakened among the destitute [populations misérables] and among individuals exhausted for whatever cause, can, by the progress of well-being and by good hygienic measures, be generalized to the point of rendering cholera hardly dangerous. But unfortunately we are far from being there, and that is why measures of isolation are, and will yet be, necessary for a long time. We must acknowledge that cholera, even while transmissible, does not fatally attack all individuals exposed to its influence; that a well-regulated life and good hygienic conditions are almost certain guarantees against its effects; and that it prefers to rage through unhealthy [malsaines] localities, among populations exhausted by misery, and on individuals already consumed by illnesses or excesses. (230–31)

The committee’s exposition limns immunity’s contradictory contours. Not yet a biological attribute, individual immunity instead derives from “good hygienic conditions.” Intimating that good hygiene follows wealth, even so the committee denies the direct link between class and health (as Chadwick would insist) by asserting that “good conditions” themselves would render cholera harmless—or at least as harmless as the wealthy find it. Though the committee holds that among “healthy people” a natural “resistance” opposes cholera’s “toxic agent,” still immunity varies according to both socioeconomic status and personal behavior. More relative than the English sanitary model might strictly hold (because it includes destitution and “populations exhausted by misery”), and so probably closer to French public hygiene, the report nonetheless carefully balances sanitary conditions, sociopolitical effects, and individual acts or attributes as all antithetical to the “almost certain guarantees” promised by a “well-regulated life and good hygienic conditions.” As the name that encompasses those effects almost certainly guaranteed by a properly regulated and sanitized life, “immunity” assigns the possibility of not contracting cholera an explicitly normative spin. However, “far from being” realized, “the progress of well-being and . . . good hygienic measures” remains woefully limited. Thus immunity does

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not promise enough protection, and hence “measures of isolation are, and will yet be, necessary for a long time.” This begrudging affirmation of restrictive protocols does not necessarily entail quarantine (which remains unnamed) but clearly does not exclude it, either. Instead, in the committee’s hands, immunity justifies almost any intervention a nation wishes to make—or to forgo—as its final, artfully ambiguous conclusion (which passes unanimously) demonstrates: “From the point of view of epidemic development, immunity is the corrective to transmissibility, and in relation to prophylaxis, it puts in motion the proper means to restrain the malady’s ravages” (231). As the conference will conclude, these prophylactic means can include sanitary improvement, inspection, tracking, confinement, quarantine, and even naval blockades. Immunity sets them all in motion by bringing its juridico-political past to the conference table and thereby enabling diplomats and doctors to agree that, as an epidemic illness, cholera simultaneously engages biological, economic, political, and military interests. Extrapolating from this overinterested nexus of concerns, the notion that immunity constitutes an organism’s defense against microbial intrusion will both simplify and focus the biopolitical picture by at last providing immunity with a properly biological explanation.

Germs of an Idea: Pettenkofer, Pasteur, and Koch

So how does immunity migrate from this medico-diplomatic context, where it adjudicates between national preferences for defending against cholera’s invasions, to the interior of the human organism, where it defends the individual against the germs that cause disease? What enables a descriptive concept, characterizing nonsusceptibility to contagion and referring more often to places than to people, to morph into a fundamental physiological process? Moreover, how does the notion of “defense” transcend its juridico-political and geopolitical past to assume its biomedical future? To answer these questions, we need to consider developments in scientific thinking about disease during the 1860s, 1870s, and 1880s and their relations to the politics of public health. The drama takes place primarily in Germany and France, although its denouement unfolds in the Italian seaside lab of a Russian zoologist (who as a result ends up, a few years hence, in a new biotech institute in Paris, greatly annoying his German rivals). Within this European theater, immunity finally achieves its starring role.

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Needless to say, much happens in Europe during this period that exceeds our purview. In France, Louis-Napoléon occupies the imperial throne until (after his capture by the Germans during the Franco-Prussian War) the Third Republic deposes him in 1870 and, after an initial monarchial interlude, steers France toward bourgeois liberal democracy. To the east, Bismarck revives the German imperial legacy (invading France to popularize Prussia’s direct control over the thirty-nine German kingdoms, duchies, grand duchies, principalities, and free Hanseatic cities) and establishes a Reich which endures until World War I. In both countries (and around the world), industrial capitalism consolidates its dominance and precipitates rapid demographic, technological, environmental, and social transformation. While these events do not determine the medical theories that emerge from the two countries, they do inform the sense of rivalry between their respective scientific communities. Moreover, they affect how the nations apply different medical theories to domestic and international health policies.83 For example, in Germany, responses to epidemic and infectious diseases enable the Imperial Chancery to impose uniform regulations on the empire’s federated states, to mandate smallpox vaccination, and even to establish the rudiments of state-supported health insurance.84 In France, despite the Third Republic’s commitment to liberal individualism and aversion to state-sponsored health care, Pasteurianism refocuses public hygiene on limiting the spread of microbes, thereby justifying public outlays for clean water and sewage and reanimating public hygiene itself.85 In the years after the 1866 International Sanitary Conference, Max Pettenkofer dominates German political thinking about disease. Though no longer remembered among the famous German progenitors of contemporary bioscience (Liebig, Muller, Henle, Cohnheim, Cohn, and, of course, Robert Koch), at the time Pettenkofer designs official German responses to infectious disease, much as Chadwick had in England. Also, like Chadwick, Pettenkofer’s influence extends beyond national borders to international sanitary policy.86 Unlike Chadwick, however, Pettenkofer trained as a physician and, before his role in public health, achieved renown as a wide-ranging and practical scientist (like Pasteur, he had considerable intellectual and economic success as a chemist before his biomedical turn). Hence his interest in sanitary protocols and his rejection of traditional quarantine carry a professional authority that eluded the English bureaucrat. For example, at Pettenkofer’s personal request to the king, Bavarian universities establish hygiene as an academic discipline in

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1865, requiring it on medical examinations (a provision extended to the entire German empire in 1883).87 Pettenkofer subsequently holds the first chair in hygiene at the University of Munich and then, after he declines to head the Imperial Bureau of Health in Berlin, establishes the Institute for Hygiene in Munich, from which he oversees the city’s sanitary redevelopment. Despite remaining in Bavaria, he still exercises considerable influence throughout Germany, acting as scientific advisor to the Imperial Bureau of Health and in 1883 cofounding the Archiv für Hygiene. Furthermore, Pettenkofer presides over the Cholera Commission for the German Empire (until the bacteriologist Robert Koch succeeds him in the mid-1880s, as discussed hereafter). Though Pettenkofer’s power wanes as bacteriology’s waxes, he remains influential in public health both nationally and internationally through the beginning of the twentieth century. In many respects, Pettenkofer’s ideas about cholera approximate those proposed at the 1866 International Sanitary Conference—no great coincidence, since the conference cites Pettenkofer’s theory repeatedly.88 In Pettenkofer’s view, cholera epidemics arise when a specific catalyst or seed (Cholerakeim), favorable local and seasonal conditions, and individual predispositions converge. He maintains that for the “germ” (keim) of cholera (either endemic or transmissible) to flourish, the soil must provide exactly the correct moisture to “ripen” it into a virulent form. Thus Pettenkofer’s Boden Theorie (soil theory) proposes a rather literal version of the seed-ground theory that the 1866 conference adopts.89 Based on this germinal idea, Pettenkofer actively opposes quarantine: “A restriction of traffic to such an extent that Cholera could not be spread by it, would be a far greater calamity than the disease itself, and the bloodiest wars would be waged to remove the restriction if once imposed.”90 By 1873, he persuades the resistant imperial government in Berlin to relax controls on movements across its internal borders (both by rivers and on land) and to rely on sanitary prophylaxis, especially “keeping the soil free from impurities,” to control cholera instead.91 For the next thirty-five years, Pettenkofer faithfully proselytizes this multicausal etiology.92 As Chadwick did before him, Pettenkofer advocates sanitary improvement and public health as preventative precautions rather than controlling borders and policing boundaries. However, if Chadwick’s sanitary ideal bespoke England’s economic individualism and sought to reconcile this political ideology with the state’s expenses for disease among the poor, Pettenkofer’s sanitary mission combines a liberal commitment to limited state intervention with the imperial legacy of medical police. In

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two public lectures he gives in Munich in 1873, titled “The Value of Health to a City,” Pettenkofer articulates this economic bio-logic to convince his fellow citizens to fund public sanitation: Since the value of our life depends on what we accomplish and our accomplishments depend on our ability to work, the value of health to each individual is obvious. Today, however, I would like to draw your attention particularly to the fact that each individual derives advantage, not only from his own health but just as much, and sometimes even more, from the health of other people, of his fellowmen. . . . [A] community, a city, performs not only an act of humanity when it makes provisions for the healing of illness and for improving the citizens’ health, but at the same time it creates and invests a capital that yields dividends.93

Pettenkofer’s political and economic perspective equates human “value” and “accomplishment.” In this equation, the “value of health” appears both obvious and instrumental because its lack undermines the individual’s productive capacity. Informed by this liberal individualism, Pettenkofer construes health as “advantageous,” fusing biological and economic values “naturally” in the same body. However, since Pettenkofer’s rhetoric aims to justify public expenditure to maintain such personal capital, he complicates this individualist valuation by giving it a collectivist spin. Drawing on the German heritage of medical police (discussed in chap­ ter 2), Pettenkofer redefines health not just as an individual’s personal possession, but also as communal property. Like Frank before him, Petten­ kofer argues that the people’s health “advantageously” redounds to the collective as a vital asset. Yet since he appeals rhetorically to his fellow citizens—and not to the monarch, as Frank had—Pettenkofer revises his argument in explicitly capitalist terms: expenditures on sanitation and public health constitute wise “capital investments” and “yield dividends.” Or as he reiterates in his conclusion: “There is no better investment for money than in institutions for the preservation and improvement of  health” (609). This communal commitment posits “a community, a city” as a public corporation (literally a “body of persons”) whose accumulative imperative appreciates healthy individuals primarily as profitable resources. Individual health promises good value for money because healthy individuals make good money for others. Despite this manifestly capitalist translation, however, Pettenkofer also voices the same defensive concerns that motivated the previous century’s cameralist investment in medical police: “It will not be necessary for me to prove that in the peaceful

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struggle for existence, health has no less value than in the war fought by soldiers” (490). Predicating the obviousness of this maxim on Prussia’s recent victory over the less health-minded French (he boasts that “we Germans have acquired our laurels at a comparatively low cost” [490]), Pettenkofer accommodates the individualist tenets of bourgeois political economy to the new imperial ethos by casting them in military guise. Just as “the people’s misery” led Frank in the late eighteenth century to admonish the sovereign to attend to public health if he wished his subjects to defend his domain, so eighty years later Pettenkofer exhorts his fellow imperial citizens to attend to their own collective health in the “peaceful struggle for existence” by reminding them of the empire’s latest military triumph. While the Prussians may have claimed victory in this battle because of their superior health, Pettenkofer implies, if they neglect to maintain their superior capital investment, the results could have turned out otherwise. At the same time, on the other side of the Rhine (where this potential enemy lurks), Pettenkofer’s much-better-remembered coeval Louis Pasteur also undertakes his initial forays into bioscience. Yet if the largely forgotten Pettenkofer espouses a politically and economically informed, multifactorial etiology that emphasizes cholera’s environmental determinants, we remember Pasteur for disseminating a monocausal germ theory—and a biopolitical individualism—that we still popularly embrace. Although their divergent reputations might simply seem to reflect each theory’s validity (or lack thereof ), these divergences also bespeak the distinct biomedical interests embedded in the theories. Whereas Pettenkofer’s Boden Theorie espouses a complex imperial individualism that embeds the human organism in a biopolitical ecology, Pasteur’s germ theory restricts these biosocial determinants to a single vector, the microbe, and, following Claude Bernard, conceives the relevant ecology within individual organism, in its milieu intérieur. Like Pettenkofer, Pasteur’s reputation precedes his entree into the study of disease. In the 1840s and 1850s, Pasteur had already made his mark on chemistry with his work in crystallography, demonstrating that organic molecules polarize light asymmetrically.94 Following this auspicious launch to his career, he turned his attention to fermentation, which he recognized as an organic rather than a strictly chemical process. In his Mémoire sur la fermentation appelée lactique (1857), Pasteur first anticipates his “germ theory,” correlating fermentation with the digestive activity of a specific microorganism (yeast) which he “sows” (seme, i.e., like a

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seed) to isolate and purify it.95 Then, in 1864, nearly twenty years before he will spectacularly recast the biotechnology of disease at Pouilly-leFort (where, in 1881, he experimentally validates his vaccine for anthrax), Pasteur achieves both scientific and popular renown by publicly refuting “spontaneous generation.” Debunking the notion that animate beings can arise from inanimate matter, Pasteur extrapolates from his thinking about fermentation to affirm that life comes only from life. He thereby reciprocally reinforces his claim that microbes cause fermentation rather than result from it (as some critics hypothesized). Though initially this formulation bears no relation to theories of disease, it ultimately proves decisive in transforming them and renders environmental theories—like Pettenkofer’s—increasingly anachronistic. In many popular histories of science, Pasteur’s debunking of spontaneous generation and his concomitant advocacy of germ theory serve as victories for empirical validation (based on rigorous experimental protocols) over metaphysical speculation (based on less-rigorous, and therefore falsifiable, techniques). In this view, the scientific stakes in the polemic primarily concern experimental methodology and whether (or not) living organisms can arise from inorganic matter. To the latter question, Pasteur responds decisively in the negative with his legendary credo “For life is the germ, and the germ is life.”96 Whatever its experimental merits, however, Pasteur’s public advocacy of germ theory also constitutes both a political and a polemical intervention against spontaneous generation. This rubric, encompassing centuries of speculation about life’s material origins, proposes that “some living entities may arise suddenly by chance from matter independently of any parent.”97 Under certain auspicious circumstances, its proponents hold, inanimate matter transforms itself and begins to generate the (unknown) qualities inherent in life. Pasteur invokes germ theory to discredit this transformationist idea, especially as represented by Félix-Archimède Pouchet’s Heterogenesis, or A Treatise on Spontaneous Generation (1859).98 Instead he asserts a radical discontinuity between organic and inorganic matter (a distinctly vitalist contention, as discussed in chapter 1). Not surprisingly, then, beyond the ostensibly scientific issues, the controversy’s ideological stakes also involve both theology and politics, as well as the relations between the two. Indeed, while disputing issues of science, Pasteur does not hesitate to make their political and theological import clear. Though Pouchet always insists on his theory’s Christian piety and doctrinal conformity, spontaneous generation still provokes high anxi-

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ety among the Second Empire’s theistically minded supporters. Since it potentially disturbs the clear ontological boundary between the animate and inanimate, some opponents (whose concerns Pasteur champions) interpret heterogenesis as endorsing radical change not only as a material possibility but perhaps as a natural one. Indeed, for some nineteenthcentury scientists, spontaneous generation implies that it is not just possible but natural for the qualities of matter to transform profoundly (from inanimate to animate), and thus it secret(e)s the germs of revolution. Given this troubling interpretation, by the middle of the nineteenth century, spontaneous generation transcends its status as a bioscientific theory and becomes associated with atheism, materialism, anti-monarchialism, and communism—and not entirely without reason.99 To take just one tendentious example combining all these associations, the renowned geol­ ogist and anthropologist Jacques Bouchet de Perthes, in his book De la génération spontanée: Avons-nous eu père et mere? (Spontaneous Generation: Have We Had Fathers and Mothers?) (1861) argues that hetero­genesis calls into question the inheritance of property, imperial power, and even the authority of the pope.100 Such radical potential so completely offends Pasteur that he imagines it as something like a materialist Trojan horse. In a celebrated soiree at the Sorbonne, where first he utters his famous “germinal” credo on the evening of April 7, 1864, Pasteur also exhorts his audience (which includes luminaries such as Alexandre Dumas, George Sand, and Princess Mathilde Bonaparte) to resist such outrages. What a victory, gentlemen, for materialism if it can affirm that it rests upon a fact established by evidence that matter organizes itself, taking on life itself; matter which already has within it all the known forces! . . . Ah, if we could add to it this other force called life, and life changing its manifestations according to our experiments, what would be more natural than to deify it, this life? What need to have recourse to the idea of a primordial creation, before whose mystery we must kneel? Of what good, the idea of a creative God [un Dieu créateur]?101

Collapsing heterogenesis and materialism with great rhetorical flourish, Pasteur evinces horror at the notion that experimental fact might endorse such a repellent doctrine. If life is sui generis, then matter would be literally omnipotent. For Pasteur, life’s continuity bespeaks continuity with a creative God, but the threat of discontinuity threatens the Dieu créateur itself. Interpellating his listeners as fellow believers, Pasteur implicitly underscores his political commitments to Louis-Napoléon’s reign and

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to those in the Catholic Church who support it. As Gerald Geison demonstrates, Pasteur hardly concealed his political allegiances.102 Like his friend and mentor Claude Bernard, Pasteur cultivates the emperor’s patronage, and Louis-Napoléon personally intervenes to secure funds for Pasteur’s lab at the École Normale Supérieure. The emperor also, in 1868, recognizes both Pasteur’s loyalty and his service to the nation, promoting him to a Commander of the Imperial Order of the Legion of Honor. Thus, even if Pasteur’s objections to spontaneous generation derive from experimental evidence, he nonetheless applies these objections to affirm his religious and political loyalties. Moreover, as the popular journalistic responses to Pasteur’s exhortations make patently clear, Pasteur’s auditors readily discern—and openly debate—these theological and political implications.103 Pasteur’s celebration of the germ as the “agent” of life (which he soon transforms into “author” of disease) emerges therefore within an engaged social and historical context. Moreover, germ theory appears here as a defensive formulation, albeit one founded on experimental results, intended to impugn the transformative multifactorial causality that underwrites both spontaneous generation’s premises and public hygiene’s promises. Applying his germinal credo, Pasteur forges a dynamic biochemical and biopolitical project that percolates through his subsequent experiments on fermentation in milk, vinegar, wine, and beer; disease in silkworms; and most famously bacterial and viral infections (avian cholera, anthrax, and rabies) in chickens, sheep, goats, cows, dogs, monkeys, and humans. Throughout these experimental engagements with disease, which engross him until his death in 1895, Pasteur couples the intellectual insights of bacteriology (i.e., that specific microorganisms cause pathological patterns known as infectious diseases) to his own work on fermentation’s biogenic process. He thereby revises his favorite abstraction, “the germ [is] the agent of life,” to encompass the “germs” of pathogenesis.104 Drawing on a well-known analogy (derived from humoral medicine) between fermentation and disease, Pasteur infers that microorganisms cause infectious disease just as yeast causes fermentation. Presuming that a biotic agent catalyzes the chemical changes that transform organic matter from one qualitative state to another, Pasteur reasons that the biochemical transformations known as disease must also require a biotic agent.105 Hence, in Pasteur’s bio-logic, the living germ that converts smashed grapes into vintage wine provides the analogue for the deadly germ that transforms living bodies into putrefying corpses.106 As Geison remarks: “The

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germ theory of fermentation virtually implied a germ theory of disease as well.”107 With this implication, Pasteur recasts both infectious diseases and the living hosts in which these pathogenic germs flourish. As Pasteur hones this theoretical linkage throughout the 1860s and 1870s, back across the Rhine, his German counterpart (and soon-to-be rival) Robert Koch launches his own investigations into the relations between bacteria and pathology. Koch, an obscure district physician in Polish Prussia a generation younger than Pasteur, enters the bacteriological fray in 1876 by correlating a specific bacteria with anthrax (as the French physician Casimir Davaine had previously suggested, albeit inconclusively).108 Developing experimental techniques that enable him both to cultivate the bacteria and to render it visible, Koch first recognizes the bacteria’s endospore as an alternate form of the same organism. By identifying this heretofore unrecognized moment in anthrax’s life cycle, he explains why some observers failed to find the bacteria in animals diagnosed with the disease, and conversely why blood with no visible bacteria could induce the illness (both phenomena had served to undermine Davaine’s claim). With these results, Koch significantly strengthens the empirical correspondence between the bacteria and the illness, even if he does not precisely prove their causal connection (Pasteur contentiously takes credit for this proof the next year).109 With the backing of German bioscience’s reigning figures, Ferdinand Cohn (director of the Institute of Plant Physiology) and Julius Cohnheim (director of the Institute of Pathology), Koch quickly establishes himself as a laboratory virtuoso whose work radically alters modern thinking about both bacteria and disease. Whether or not he proved the cause of anthrax first, Koch’s essay convincingly argues that bacteria act as “parasites” and infected animals as “hosts.” He thereby figures the microbes he studies as literally “eating off ” the larger organisms from which he isolates them.110 Though he does not speculate on how these parasites deleteriously affect their host, he implicitly represents pathology as occurring when organisms of different scales compete for nutrients. Thus for Koch, etiology refers not to the diseased organism’s physiological processes but to how the uninvited microscopic hordes ravage it. Conversely, he predicts that illness will occur wherever and whenever these miniscule scavengers appear—as his famous postulates affirm.111 Unhindered by a lack of explanation for why bacteria and disease coincide, Koch immediately expands his purview, comparing anthrax’s etiology to cholera’s and typhoid’s. Then, to bolster his own idea about the dormancy of bacterial spores, he criticizes Pettenkofer’s claims

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about cholera’s noncontagiousness (initiating a virulent rivalry between them) and attributes all three diseases to a “living contagium” (not unlike Pettenkofer’s Cholerakeim except without the need for environmental transformation). Analogizing ruminant and human illnesses, Koch argues that animal experiments will reveal the etiology of human pathologies and perhaps even portend a time when science can prevent them: “Only then will it be possible to determine the essence of the infectious diseases, which have horribly devastated the human race, and to find reliable means of protecting ourselves against them.”112 With this prophylactic speculation, Koch not so subtly repudiates Pettenkofer’s sanitary protocols (indeed, he will soon endorse the very quarantines that Pettenkofer abjures) and inaugurates a bacteriological program that quickly catapults him to national and international fame. Riding the acclaim his anthrax essay receives, Koch expands bacteriology’s inquiry. He next takes up wound infection, a problem which preoccupies bacteriology in the 1870s after Pasteur’s ideas about fermentation reanimate a long-standing comparison between such infections and organic decay.113 Here Koch reiterates his notion that pathological processes result from parasitic infestation, though more hesitantly: “One can assume that human infected wound diseases will be proved to be parasitic when investigated by these improved methods.”114 Affirming that a contagium animatum catalyzes these infections, Koch proposes what he considers his “most important result,” that specific bacteria cause specific diseases: “Each distinct bacterial form corresponds to a specific disease. This form always remains the same, however often the disease is transferred from one animal to another.”115 Pronouncing bacterial species immutable, Koch explicitly challenges the ideas of Carl Nägeli (who argued for the fungibility of microbes, and indeed of nature itself) and implicitly rejects the notion that Pettenkofer’s Cholerakeim varies according to available groundwater (thus necessitating sanitary prophylaxis).116 Bacterial specificity, for Koch, therefore directly contests both the science and the politics of disease. Unquestionably, Koch’s theory of specific causality radically transforms biomedical theory and practice, distinguishing it both from earlier humoral theories and from most non-European healing traditions. Correlating an ontological understanding of disease with an ontological interpretation of specific cause—or fusing the former with the latter as a disease’s “essence”—Koch introduces the hallmark of modern biomedical theory and practice: specificity. However, specificity’s corollary remains less well known. When Koch asserts a “specific” conjunction between bacteria and

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disease, he assumes that the host organism provides no more, and no less, than an exemplary and self-isolating medium for bacterial growth: “The animal body is an excellent apparatus for pure cultivation.”117 In other words, for Koch, the experimental animal’s milieu intérieur serves as an “apparatus” for “cultivating” the (micro)organisms which most interest him. While Koch notoriously opposes Pasteur on many bioscientific issues, in this regard they agree. Pasteur, a chemist who investigates micro­ organisms’ biochemical effects, also lacks much interest in the host organism—except as the medium of bacterial growth. In fact, Bruno Latour foregrounds this trait as characterizing both Pasteur and those who adopt his ideas: The internal individual agents of pathology were of less concern to [the Pasteurian] than they were to a physician, but he could use symptoms to understand the patient’s body as a culture medium. The internal machinery of the body was of less interest to him than to a physiologist, but he was able to use it to understand the dazzling progress of the microbe in its economy.118

Pasteur and the “Pasteurians” fetishize the microbe as disease’s “agent” or “auteur” and then try to manipulate its pathogenic force by “culturing” it in less virulent forms.119 Construing the diseased organism as a milieu de culture (an explicit Pasteurian spin on Bernard’s milieu intérieur),120 Pasteur imagines diseases as ecological disturbances produced by pathogenic agents within an organic “culture.” However, Pasteur does not much concern himself with how disease affects the animals on which he experiments. Instead he considers the microbial vectors that propagate and trans­ mit disease to mitigate the pathogenic effects produced and reproduced by their growth. When Pasteur does reflect on disease processes, he assesses how micro­ organisms transform the experimental organism’s enclosed “animal economy.” If this sounds reminiscent of Claude Bernard’s milieu intérieur, it should. To say that Pasteur knew Bernard’s work vastly understates the case. The men became acquainted in 1859, when Bernard presided as a judge for the Academie des Science’s Montyon Prize in experimental physiology (Bernard’s bailiwick), which Pasteur won. After this, Pasteur audited two of Bernard’s courses: the first during the spring of 1860 at the Sorbonne and the second during the academic year 1862–63 at the Collège de France (Pasteur kept meticulous notes on both sets of lectures, which he later cites).121 The second of these courses, on “experimental medicine,”

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served as the testing ground for Bernard’s Introduction à l’étude de la médecine expérimentale, where milieu intérieur got its first rigorous explication (see chapter 3). Then, during the debate about spontaneous generation, Bernard served on the Academie des Sciences’ 1862 prize commission to determine “who by well-conducted experiments throws new light on the question of  so-called spontaneous generation,” which, hardly surprisingly, Pasteur won.122 In 1865, Bernard and Pasteur, along with the chemist Henri Sainte-Claire Deville, made up a government-appointed committee to investigate the reigning cholera epidemic (the same epidemic to which the 1866 International Sanitary Conference responded).123 This appointment constituted Pasteur’s first foray into exploring human illness. Given his interest in airborne germs (his basis for refuting Pouchet), the men filtered the ventilation system in the Lariboisière hospital, hoping to isolate a causal germ. Also, given Bernard’s interest in blood as milieu intérieur’s first form, they took blood samples and subjected them to chemical anal­ ysis. Though none of the experiments proved conclusive, Pasteur never­ theless experienced Bernard’s epistemological approach to biological experimentation firsthand. Since Pasteur had no biological training, this hands-on tutorial augmented the theoretical insight he gained by attending Bernard’s lectures and informed all of Pasteur’s subsequent work on pathogenic germs. In “Sur les maladies virulentes et en particulier sur la maladie appellée vulgairement cholera des poules,” a paper on avian cholera presented in 1880 to the Academie des Sciences, Pasteur clearly frames his results in Bernardian terms. In this essay, where he first reports his attempts to manipulate pathogenic virulence through inoculation (and then unabashedly compares his innovation to Jenner’s), he abstracts the animals he inoculates from their environments, both materially and imaginatively. Pasteur brackets the avian lifeworld (including the fact that avian cholera did not generally pose much threat to chickens) to represent these living organisms as enclosed ecologies for bacterial development. He describes how he inoculates his experimental subjects with virulent germs and then describes their effect on the dying chicken as a struggle for scarce resources in the milieu intérieur. By the acts of its nutrition, the microbe produces the gravity of illness and leads to death. One can easily comprehend it. The microbe, for example, is aerobic; it absorbs great quantities of oxygen and it burns many of the elements [principes] of its culture medium [milieu de culture].124

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Pasteur’s explanation leans on the seed-ground analogy that underwrote humoral theories of disease causality. The aerobic microbe requires oxygen to flourish; the bird’s body provides the needed nutritive resource. As it lives, the microbe consumes this “element,” which in this case asphyxiates the chicken. However, in animals inoculated with attenuated microbes (as we will see in a moment), it renders them “sterile” for more virulent forms of the same germ. To create this correlation, Pasteur interprets the disease he induces by identifying the animal with the lab equipment itself. He not only reduces the chicken’s living metabolism to a feathered milieu de culture but relegates the chicken’s life to its status as experimental subject. In this restricted ecology, it makes sense to see disease as the consequence of asphyxiating microbes, since only the microbe (and Pasteur, of course) has any agency in the scenario. Yet by including the mise-en-scène, we glimpse what Pasteur brackets: the sociohistorical frame in which he creates the illness that he induces by inoculating a chicken with a virulent bacterial strain which he “cultures” precisely to kill it. Since for Pasteur the scarce resources which the microbes deplete appear only as artifacts of his experiment, the disease’s host remains largely insignificant—with one significant exception. An experimental organism and a milieu de culture differ, according to Pasteur, because in the organism the microbes compete for available nutrients: “In an artificial milieu de culture, no obstacle to its multiplication; in the body, on the contrary, it ceaselessly struggles [lutte] with the cells of the organs which, also aerobic, stand ready to seize the oxygen.”125 Here Pasteur introduces an internal struggle for resources that recapitulates Malthus’s perspective (remember “the perpetual struggle for room and food” discussed in chapter 2); however, he relocates it within the individual organism itself. Indeed, except for this struggle, Pasteur considers the experimental animal to be virtually the same as a piece of lab equipment. Moreover, the reason an experimental animal gets sick and a piece of equipment does not depends entirely on this competitive dynamic. In other words, for Pasteur, disease occurs when microorganisms compete with an animal for its living property (which sustains it, or we might say which is “proper” to it) in a milieu that provides the animal no additional sustenance—a philosophy that accords quite nicely with liberal individualism, both Pasteur’s and the Third Republic’s. Extending this bio-logic, Pasteur believes that when he inoculates an animal with attenuated strains of “disease-causing” bacteria (whose virulence he manipulates in the laboratory), he preemptively modifies its

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milieu de culture, making it less hospitable to more virulent, naturally occurring strains. The condition of the existence and multiplication of microbes—the cause of virulent illnesses—is that they find in the inoculated organism or the culture medium [milieu de culture] where they are introduced elements for their nutrition; the proof is that if one filters the chicken bouillon which served to cultivate the microbe of avian cholera, this bouillon becomes improper for a new culture of the same organism, whereas it can still serve to cultivate other microbes, anthrax bacteria, for example. Why? Because, in all probability, the first culture exhausted the elements necessary for the life, the multiplication of the microbe of avian cholera, and not those necessary for the bacteria. If this happened in my test tubes, couldn’t it equally happen in the animal organism, in the human body?126

This statement provides Pasteur’s most explicit hypothesis about why inoculation might work. He compares inoculation to bacteria in a culture medium, whose exponential growth ends when the population depletes necessary nutrients (a microcosmic version of Malthus’s tendency/limit problem, discussed in chapter 2). Without these nutritive elements, the pathogenic agent cannot grow. Thus to inhibit disease in living organisms requires a strategic depletion of vulnerable resources, to make the host less “hospitable” for the parasite. Here Pasteur revises Pettenkofer’s Boden Theorie, which holds that the seeds of illness need environmental ripening (in the soil) to manifest their virulence. Instead he construes the living organism’s milieu intérieur as the significant ecology, where the presence or absence of bacteriologically desirable nutrients determines the microbe’s pathogenic threat. According to Pasteur’s thinking, even if a bacteria’s virulence can vary either in the lab or in the world,127 the individual organism provides the salient environment for medical reflection. Furthermore, preventive health protocols must incorporate this individual, and individualizing, fact (as we will soon see). From our post-Pasteurian perspective, which conflates vaccination, inoculation, and immunization, we might expect Pasteur to invoke immunity here as a form of host defense. Yet while he does know and use the word “immunity,” he does not make this conceptual leap. In his first essay on avian cholera, Pasteur almost exclusively uses “the absence of recidivism” or “nonrecidivism,” rather than immunity, to refer to the dynamic he investigates. The two sentences that cite “immunity” do so only referring to Jenner’s vaccine. In this text, which some historians of medi-

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cine evoke as immunology’s inaugural event, Pasteur does not emphasize immunity at all. Instead asserting that “the fact of the nonrecidivism of virulent illnesses seems general,” Pasteur focuses on how his inoculations induce such a “nonrecidivistic character.”128 This idiom draws on the metaphor récidive, a legal term meaning repeating a crime or moral transgression, that at least since the sixteenth century also connoted a relapse, a fall back, into illness (thus illustrating the long history of comprehending crime as disease and disease as crime).129 The juridical metaphor’s medical valence proliferates throughout the eighteenth and nineteenth centuries, and its popular application to illness underscores the political and philosophical values embedded in medical concepts.130 Social science borrows recidivism during the first half of the nineteenth century to encompass social pathology, especially in the statistical analysis of “delinquent” populations.131 By the time Pasteur appropriates it, recidivism’s entwining of social and biological pathologies makes it a particularly useful trope to naturalize the biopolitical consequences of infectious disease. Pasteur’s preference for “nonrecidivism” over “immunity” echoes Chrestien’s earlier humoral understanding of immunity as a lack of susceptibility. In 1880 the nonrecurrence of disease still does not imply an active physiological process but rather represents for Pasteur something of a nonevent. His inoculations work, he suggests, not because the organism defends itself against a microbial invader but because the parasite renders itself “inoffensive” to the host when it can no longer “cultivate itself ” (se cultiver): “Isn’t this the image that is observed when a microscopic organism appears inoffensive [se montre inoffensive] for a species of animal into which it is inoculated? It is inoffensive because it does not develop [ne se développe pas] in the animal’s body or its development does not reach the organs essential to life.”132 If we consider the terms of Pasteur’s statement, a number of assumptions reveal themselves: first, Pasteur imagines the microscopic organism as self-acting, as his string of reflexive verbs indicates; second, when he foregrounds the microbe’s inoffensiveness, he negatively alludes to its potentially offensive force; third, the inoculated species remains passive throughout the process. Since this emphasis on microbial activity predicates disease on a “virulent agent, a living being,” it represents “disease’s recurrence or its nonrecurrence” as decided ultimately by the germ (6.298). Before Metchnikoff refigures the term in 1883, Pasteur consistently pre­ fers the now forgotten notion of nonrecidivism over the still current and highly prized scientific concept of immunity. So much so, that by

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the spring of 1881, in another paper presented to the Academie des Sciences, “On the Possibility of Rendering Sheep Refractory to Anthrax by the Method of Preventive Inoculations,” he favors the eponymous “refractory” and articulates a “general law of the nonrecidivism of virulent illnesses” (“la loi générale de la non-récedive des maladies virulents”) (6.339) but does not even mention immunity until the conclusion: “Now that the question of doctrine is settled, the most important practical question to elucidate is that of the possibility of creating anthrax immunity [l’immunité charbonneuse]” (6.342). In this statement, we notice that while “nonrecidivism” constitutes a general phenomenon, or even a law, and “refractory” designates the generic possibility rendered by the method of inoculation, immunity serves only as a specific appellation—immunity to anthrax. As Anne Marie Moulin underscores: “Pasteurian medicine doesn’t rely upon theoretical hypotheses concerning immunity, but on an empirical program of immunization which appeals to the attenuation of microorganisms.”133 “Immunity,” then, may gesture toward a favorable outcome of the Pasteurian enterprise, but it certainly does not motivate it. Similarly, immunity does not figure prominently in Robert Koch’s labs either, since there bacterial specificity reigns supreme. However, because Koch focuses so intently on bacteria, correlating their growth and development with different diseases, he adds a critical dimension to immunity’s genealogy that Pasteur does not. Instead of considering how to render microbes inoffensive, Koch sees parasitic pathogens as directly offensive and thereby anticipates that host organisms might naturally need to defend against them. When Koch turns in 1882 to one of the nineteenth century’s greatest scourges, tuberculosis, he refigures the microbes he previously identified as “parasites” as “invaders” for the first time. Indeed, he describes his inquiry in precisely these terms: “The first goal of the investigation was to exhibit certain parasitic forms that were foreign to the body and that cause disease,” so he undertakes “to prove that tuberculosis is caused by the invasion of bacilli, and that it is a parasitic disease caused by the multiplication and growth of bacilli.”134 Koch’s description here echoes the fused military and political idioms used to describe cholera epidemics at exactly the same moment. Claiming that bacterial foreign invaders cause disease, he metonymically conflates the metaphoric depiction of epidemics as invasions with the microbial activities he observes under the microscope. If infectious diseases seem to act geopolitically as invasive events (as international consensus on cholera holds), then

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bacteria themselves—which he considers to cause such diseases—must constitute an invading force per se. In part, this militarized ethos pervades the German context within which Koch works. Imperial public health policy explicitly constitutes a defensive undertaking that equates citizens’ well-being with national military strength (as Pettenkofer intimates). Manifesting this ideology, Koch’s appointment as senior medical officer to the Imperial Bureau of Health in 1880 involves both civil and military appointments, and he rises quickly through both ranks.135 Pauline Mazumdar argues that “Koch’s tremendous power was due in part to Koch’s close connection to the Prussian state and its military arm.”136 In fact, he organizes his lab work itself as a quasi-military campaign against his Pasteurian rivals (which, as Mazumdar points out, recapitulates Koch’s experience as a military officer against France during the Franco-Prussian War).137 Moreover, within this historical horizon, germ theory itself effortlessly morphs into a quasi­militaristic paradigm, engaging what Koch’s mentor, Julius Cohn, in 1874 calls “invisible enemies in the air” in the hope that “not far into the future . . . the high command of our physicians and hygienists will find the means to defend our health and life against those invisible enemies that surround us in earth, water, the skies.”138 In this defensive struggle, Koch not only proves himself one of the world’s greatest strategists but, by linking the organisms he magnifies to the broader geopolitical context, actually assumes the “high command”—and not surprisingly cholera provides the occasion for his coup. The story of how Koch correlates the waterborne comma bacillus with cholera appears as a dramatic turning point in many progressive narratives of modern medicine (most famously Paul de Kruif ’s Microbe Hunters).139 Usually told as a race between Pasteur’s protégés and Koch and his minions, the plot involves the nationalistic competition between the two rival lab chiefs to identify the cause of a cholera outbreak in Egypt in the summer of 1883. When neither party succeeds, the French retreat to Paris after one of their investigators dies from the still-unidentified cause. Undeterred (and encouraged by the German imperial authorities), Koch, however, proceeds to India, where he successfully links the bacteria to the disease by tracking its passage through a public water source. Koch’s success did not consist in discovering the bacillus (that honor went to Filippo Pacini in 1854) or in associating it with cholera but rather, as William Coleman puts it, in “gathering the information required to form a persuasive causal statement regarding the role of the vibrio in inducing

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the disease.”140 To some extent, as K. Codell Carter suggests, this persuasive achievement leans on a causal premise that bespeaks Koch’s investment in public health as medicine’s highest value. Underscoring the distinction between “sufficient” and “necessary” causes, Carter notes that whereas pathologists might see death as the culmination of disease, and “causes of death are always sufficient causes. . . . For treating and preventing disease, causal necessity is all that really matters.”141 Given that Koch’s investigative charge comes from the Imperial Health Office, his prioritizing of causal necessity seems self-evident. Nevertheless the implications of this causal determination prove pivotal for reimagining German public health’s tactical agenda. Returning home to national accolades (and an increase in both civil and military ranks), Koch quickly capitalizes on his experimental success by extrapolating his findings to public hygiene. At the 1884 Cholera Conference in Berlin, he announces his causal claim: “The cholera process and the comma bacillus stand in direct connection to one another, and I see in this relationship nothing other than that the comma bacillus causes the cholera process. The bacillus precedes the disease and it produces the disease.”142 The policy implications attending Koch’s statement are clear. Contrary to Pettenkofer’s Boden Theorie, a bacillus alone serves as both necessary and sufficient to explain the presence of cholera. Hence Pettenkofer’s advocacy of sanitary reform and local hygiene does not make sense, since the bacteria need no soil ripening to unleash their lethal fury. Instead, strict quarantine and disinfection provide the only rational prophylaxis against cholera.143 Appointed in the same year to the Cholera Commission for the German Empire (until then dominated by Pettenkofer), Koch quickly disseminates his new ideas. He institutes courses for physicians under its auspices and in the following year becomes full professor of hygiene at the University of Berlin, from which he further promulgates his theory. From his position in the Imperial Bureau of Health, he incites the central government to impose regulatory control over the empire’s constituent states, concomitantly providing the opportunity for the central government to consolidate its imperial authority locally. In short order, he displaces Pettenkofer as the state’s ranking health authority, and his bacterial agent replaces Pettenkofer’s multifactorial etiology as the ruling medical paradigm. Koch’s assumption into the Prussian state and academic hierarchies signals a fundamental shift in the relation between theories of disease and polices of health, as Richard Evans concludes:

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The miasmatist model, as even the most cursory examination of the cholera monographs of Pettenkofer and his school quickly reveals . . . gave the central role in cholera prevention to the generalists in the broad, interdisciplinary field of social hygiene—in fact men such as Pettenkofer himself. Bacteriology removed it from them and gave it to highly specialized laboratory scientists like Koch. The civil authorities once more took up quarantine, isolation, and disinfection as the chief weapons in the fight against cholera, but where this had formerly been a kind of traditional administrative reflex in the face of any major epidemic disease, it now assumed the guise of a systematic war against an identifiable enemy carried out under the clear direction and supervision of specialist medical scientists.144

Evans’s assessment of the shift from Pettenkofer’s to Koch’s theories metaphorically emphasizes bacteriology’s bellicose and military investments. However, this is not just metaphor. Koch’s bacteriological project proclaims the possibility of defending the nation against invisible but deadly enemies. Rhetorically evoking microbes as enemy agents not only authorizes reimposing quarantines and other strategies to control microbial movements but also allows Koch to reimagine medicine itself as a quasimilitary practice: It may be possible, given a bacterial infectious disease, to master the microscopic yet previously uncontrollable invaders within the human body. . . . Allow me, therefore, to conclude this lecture with the wish that the strengths of all nations may be measured in this field of labor and in war against the smallest but most dangerous enemies of the human race, and that in this struggle, for the good of all humanity, the success of each nation may repeatedly surpass that of the others.145

With this hortatory finale to his keynote speech before the International Medical Conference in Berlin in August 1890, Koch translates the tropes of invasion and enemy, which had characterized the International Sanitary Conference’s discussions of cholera twenty-five years earlier, from the geopolitical domain into the individual body. If bacteria stand as an invasive disease’s cause, Koch avers, then by metonymy the bacteria must invade; however, such diseases no longer invade nations but individuals, or rather they invade nations by invading individuals. Moreover, he privileges this biological atom (as opposed to population) as the relevant biopolitical and biomedical target for health policy and practice, both nationally and internationally. According the microbe almost “uncontrollable” agency

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(or even depicting it as what, in our current political moment, we might call a “nonstate combatant,” i.e., a terrorist), Koch hails “all nations” to heed his admonition and to reorganize their “war” efforts according to his strategic assessment. This bellicose vision represents disease as a natural war among species of vastly different sizes and scales. Furthermore, it implies that the individual human organism constitutes the battlefield on which this war transpires—an image that Élie Metchnikoff then naturalizes by defining immunity as host defense.

Redefining Defense, or Metchnikoff Resignifies Immunity

Both Pasteur and Koch predicate public health policy on the assumption that microorganisms cause pathogenesis.146 However, to do so, they bracket how infected organisms themselves enter into complex ecological interactions with microscopic beings. As Bruno Latour argues in The Pasteurization of France, Pasteur—and we can also add Koch—introduces the germ as a simultaneously biological and political agent. Given the triumphal proclamations that heralded its arrival, the germ’s biopolitical significance quickly percolates through both scientific and popular imaginaries.147 Despite the risk that they might lose their authority by doing so (as Pettenkofer’s example indicates), advocates of public hygiene, seeking contagious disease’s environmental determinants, enthusiastically embrace the germ’s infectious power. Needless to say, the germ rapidly displaces public health’s earlier reliance on multiple causal factors; henceforth the infected organism’s living conditions will appear less relevant, except insofar as they facilitate or inhibit the transmission of pathogenic microbes. With this new agent, which Latour dubs “the cultivatedmicrobe-whose-virulence-they-varied,” a new biopolitics of bodies, subjects, diseases, economies, and interests coalesces. Yet more than just linking multiple levels of organic and social matter, germ theory also defines the organism’s (supposedly) passive interior as the space where a political and economic struggle for survival takes place.148 Like Claude Bernard before them, Pasteur and Koch reject the notion that socioeconomic factors significantly impinge on the health of populations. Instead they isolate infectious disease’s true locus within the singular organism’s epidermal envelope. In so doing, they reimagine the domains of nature and society, nature saturating the organism, society enveloping and containing it. Bracketing the life circumstances into which

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infectious diseases erupt, the new medical science therefore “naturally” privileges microbes over and against both the biopolitical conditions which might render organisms vulnerable to infection and the biopolitical relations which might enable those so infected to heal. Soon after its apparent triumph, however, questions begin to surface that confound the germcentric analysis: How do infected organisms participate in disease processes? How do afflicted organisms survive an infectious illness? How do inoculated (or recuperated) subjects maintain their resistance to reinfection? These questions especially vex Pasteur. From the mid-1880s onward, other researchers repeatedly challenge his expansive claims for—not to mention his financial, personal, and professional investments in—vaccination by demonstrating, for example, that dead bacteria can serve as effective vaccines (Salmon and Smith) or that induced resistance can occur even in the absence of bacteria (von Behring and Kitasato). These problems plague those who advocate the new Pasteurian biotechnologies because even though the Pasteurian project remains primarily empirical, nevertheless its biomedical and biotechnical profitability requires it to justify its applications. Unfortunately, in Pasteur’s hands, immunity does not provide a robust enough trope to legitimate either his comprehensive research program or the magnificent edifice he erects in his own name (the Institut Pasteur).149 Thus Pasteur the empiricist imports Élie Metchnikoff and his phagocytes, the leading players in a field that soon becomes known as immunology, to account for how his bacterial attenuation techniques work, thereby enabling him to capitalize on the immunity he claims they induce. A Russian zoologist with an abiding interest in comparative invertebrate embryology, Metchnikoff achieves international renown during the 1880s for first recognizing immunity as an organismic activity. Trained in Russia during the 1860s, between 1870 and 1882 Metchnikoff taught zoology and comparative anatomy at Novorossisk University in Odessa. Though national circumstances might suggest his peripherality to the main axis of bacteriological debate, Metchnikoff enthusiastically engaged biological developments in France, Germany, and England.150 For example, his research in the 1870s polemically contested both Darwin’s and Haeckel’s evolutionary narratives, and during the mid-1880s he headed the Odessa Bacteriological Station, which produced versions of Pasteur’s anti­ rabies vaccine. In his primary field, comparative embryology, Metch­nikoff adopts a genealogical perspective on the evolutionary development of organismic function.151 His interest in how structures adapt to new

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exigencies leads him to argue that the changing biological meanings of organic forms reveal their evolutionary developments. Thus, as a biologist, he considers the living organism to be a nexus of historical forces which constantly transform themselves in relation both to other organisms and to the environments in which they coexist. Though in his later years he sees himself as a Darwinian partisan, in his earliest writings Metchnikoff reflected critically on Darwin’s theory, publishing his first critique of Darwin in 1863. Like many other Russian thinkers during the period, Metchnikoff appreciated the new evolutionary paradigm from England but found Darwin’s reliance on Malthus both politically and scientifically suspect (if not betraying a certain English self-interest).152 He rejected the idea that a “struggle for existence” occurs primarily among members of the same species, which he took as an unwarranted Malthusian assumption, as well as the idea that evolution proceeds primarily by adaptation to environmental circumstances. Instead Metchnikoff proposed that the active relations among different species and with the world play a significant part in evolutionary transformations. As Alfred Tauber and Leon Chernyak argue, for Metchnikoff “the ‘real’ struggle takes place between individuals of different species, either as they compete for sustenance or in their respective encounters with abiotic environments.”153 Applying this appreciation for interspecies dynamics, Metchnikoff also studied parasitic relations as exemplifying interspecies struggle. In his essay “Illness of the Larvae of the Beet Weevil” (1879), he even proposed a form of biological pesticide against these crop-­damaging insects (using the fungus muscardine) based on the “conclusion that lower parasitic organisms are actually the most powerful enemies of animals and therefore can be used to relieve man of harmful insects.”154 At this point in his career, Metchnikoff had not yet turned his attention to how Pasteur’s and Koch’s favorite parasites (i.e., bacteria) also constitute “the most powerful enemies of animals,” nor had he begun to imagine how organisms defend against such enemies. Yet by posing parasitism in evolutionary terms, he opened the question of bacteria as parasites to new biological consideration. Combining his evolutionary thinking with his insights about parasitehost relations, in the 1880s Metchnikoff turns to the phenomenon he names “phagocytosis.” Referring to the activities of certain amoeboid cells that he calls “phagocytes” (or “eating cells”) capable of encompassing and degrading both microorganisms and cellular detritus in the milieu inté­ rieur, Metchnikoff understands their activity as incarnating a cellular strug-

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gle for survival. Metchnikoff ’s theory proposes a novel and indeed radical application of evolutionary insights: rather than identifying evolution with the struggle between individual organisms for limited environmental resources (i.e., natural selection), he concludes that the organism itself embodies a struggle between different cellular aspects of its own development (ontogenesis). Seeing the organism as an interplay of complementary and contradictory cellular aspects permits Metchnikoff to include intracellular digestion within the ontogeny of multicelled organisms. For example, in considering the way tadpoles grow into mature frogs, Metchnikoff observes that intracellular digestion enables a maturing frog to delete and reabsorb the effete cells which constituted its tadpole tail into its soon-to-be tailless body.155 As Tauber remarks: “[Metchnikoff] viewed ontogenetic development as a struggle of embryonic components, where the organism appears as a foreigner to itself. Its identity must be established during ontogenesis partly as a result of that struggle.”156 From this embryological insight, Metchnikoff apprehends phagocytosis as a general phenomenon through which organisms regulate the contradictory forces of competing developmental imperatives. In other words, he holds that organisms must continually reestablish and reiterate the cellular ensembles they incarnate. Since microbial cells can also enter into such ensembles, phagocytes also regulate their cellular matter. Hence Metchnikoff includes among the phagocyte’s primary functions not only transmuting cells that “degenerate” in the course of organismic function or development but also what he first calls organismic “prophylaxis” and later “immunity.” Metchnikoff introduces his theory of immunity as a specific kind of phagocytosis, viewing intracellular digestion in metazoa as the paradigmatic example of “host defense.” He thereby proffers a concept that radically transforms scientific medicine’s biopolitical maps. Thanks to Metchnikoff ’s innovation, bioscience now imagines the host organism as a materially localized entity, inscribed within a recognizable frontier, whose immunity appears within the furthest limit of its ability to defend against a marauding parasite’s invasive forces. By positing immunity as manifesting a more general organismic response (itself evolutionarily conserved from the intracellular digestion of single-celled organisms), Metchnikoff redefines both what an organism “is” and how it maintains its integrity within its life context. More importantly, he conceives the organism in terms of its life context, which allows him to transform an almost entirely descriptive concept into the robust basis for a “theoretically articulated experimental research

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program”: immunology.157 Metchnikoff ’s immunity offers biomedicine a way to account for what Claude Bernard deemed the organism’s “freedom and independence” (see chapter 3) through an activity that produces and reproduces its localized integrity. Avoiding Pasteur’s problematic explanation for microbiotic nonrecidivism, Metchnikoff instead recasts the issue by portraying it as an organismic process. Needless to say, Pasteur enthusiastically grants his imprimatur to Metchnikoff and his phagocytes: he provides a French home for the Russian embryologist under the auspices of his newly constructed research facility (where Metchnikoff remains ensconced until his death) and publishes an essay by Metchnikoff in the inaugural volume of the institute’s Annals. Metchnikoff soon emerges as one of the institute’s leading theoretical lights, serving both as laboratory director and as a department head, and teaches his ideas each year as part of Emile Roux’s famous lecture course on bacteriology (which promulgates the official Pasteurian doctrine widely).158 In short, Pasteur publicly annexes Metchnikoff’s insights for his own inoculation-vaccinationimmunization regime—a win-win situation if there ever was one. Metchnikoff first develops the bio-logic subtending his translation of immunity-as-host-defense in a series of three papers he publishes in 1883 and 1884. In the first, “Researches on the Intracellular Digestion of Invertebrates,” he meditates on intracellular digestion’s evolutionary trajectory from “colonial monads,” which manifest “no kind of division of labor,” to organisms with more complex animal economies.159 Focusing initially on Plumularia (a variety of coelenterate), he describes their cuplike nematocalyces as “organs whose chief function is prophylactic; they eat up necrotic parts of the colony, and also continually explore the organs in their vicinity, to render harmless by devouring them any injurious bodies which may be present” (93). With this ascription of a “prophylactic” function to the hydroid “colony,” Metchnikoff metaphorically adapts one of public health’s major premises to the organic world. Construing the cohabiting Plumularia as a quasi-political entity, he interprets their activities in overtly biopolitical terms. Until now, prophylaxis refers exclusively to human actions intended to prevent disease. In other words, it names a kind of medicine (as we have seen, it appears in the eighteenth century to characterize variolization and develops in the nineteenth century in relation to public hygiene and especially cholera prevention). Here Metchnikoff alters its connotations by ascribing this preventive agency to the cells of a simple sea animal, which he then extends by analogy to complex physiology. Indeed, from this ascription, he infers the notion that

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organisms actively establish and maintain their integrity at the cellular level. Moving on to consider more complex animals, Metchnikoff observes: “It has been shown that one of the functions of amoeboid mesoderm cells is to eat up those parts of the organism which have become useless, and also any foreign bodies which may have pierced through the ectoderm; or, if it be not possible to eat up such bodies, to surround and isolate them” (102). Isolating and destroying both its own “useless” elements and “any foreign bodies” that “pierce” its ectodermal envelope, these phagocytes model the organism’s protective engagement with bacteria at the very historical moment that these microbes increasingly represent the causes of disease: “We may then consider that bacteria are habitually ingested by mesoderm cells, when they make their appearance in the organism;—a fact which obviously increases the prophylactic importance of these cells” (106). This consideration introduces Metchnikoff ’s notion that organismic prophylaxis includes a cellular struggle against bacteria, but as he cautions, “the victory was not, however, all on one side” (106). While he does not elaborate the insight in this essay, he clearly identifies his main theoretical opponent. Directly criticizing “Koch’s opinion that bacteria force themselves into the white corpuscles in order to multiply there,” Metchnikoff contests Koch’s exclusive focus on bacterial agency (citing the tuberculosis essay where Koch first characterizes bacteria as a parasitic “invasion”). Thus when Metchnikoff concludes that “the power of intracellular ingestion and absorption is used as a protection against harmful bodies arising within an organism on reaching it from without,” he implicitly counterpoises his theory to Koch’s exclusive focus on invasive bacteria in thinking about disease.160 Metchnikoff ’s first overt discussion of phagocytosis and disease appears in the following year in an article entitled “A Yeast Disease of Daphnia: A Contribution to the Theory of the Struggle of Phagocytes against Pathogens.”161 Analyzing an infection of water fleas, Metchnikoff begins his discussion by extrapolating from Koch’s depiction of tuberculosis as bacterial invasion (which he cites again later in the article) and develops it into a full-blown war scenario: “Hardly has a spore appeared in the body cavity when one or several blood cells attach themselves to the spore and the battle against the invader begins” (189–90). The escalation from invasion to battle represents Metchnikoff ’s insight that in the disease process agency does not simply reside with microbes (in this case a yeast and its spores). Personifying blood cells as “attackers,” he avers that “the blood

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cells do not remain passive, however, towards the invasion” (191). Refusing the host organism’s implied passivity, evident in both Koch and Pasteur, Metchnikoff recasts the blood cells themselves as aggressive rather than docile. Moreover, Metchnikoff inverts Koch’s characterization of bacteria as hostile “enemies,” reflecting their imputed aggression back onto the supposed aggressors themselves: “It is evident that spores in the body cavity are attacked by blood cells and probably killed or disintegrated. Thus, the function of the blood cells is to protect the body against infectious agents” (190–91). If microbial vectors associated with infection appear as “agents,” then the organism’s cells serve as counteragents: attack begets attack, and thus battles ensue: “From this study one can see that infection and disease of our Daphnia constitute a battle between two types of living forms, the fungus and the phagocyte” (193). However, more than just a form of microscopic warfare (which Metchnikoff envisions as an evolutionary unfolding), the interspecies battle also transvalues the ancient idea of healing itself: “The phagocyte has preserved the original function of intracellular feeding and, by this means, is the destroyer of the parasite. The phagocyte therefore represents the healing power of nature” (193). Until Metchnikoff ’s refiguration, the “healing power of nature,” the vis medicatrix naturae, names the ways that organisms harmonize themselves in and with their environment. Now Metchnikoff radically reimagines this process not as harmonizing or balancing but as fighting against, devouring, destroying, attacking, and battling: “When one accepts the concept that phagocytes fight directly against pathogens, it becomes understandable that inflammation is a defensive mechanism against bacterial invasion” (195). This succinct explanation follows from Metchnikoff ’s critique of Koch’s essays on wound infection and tuberculosis. Disagreeing with Koch’s exclusive emphasis on parasites as destructive agents (with hosts only appearing as more or less susceptible to their destructive force), Metchnikoff reanimates the organism. However, he does so by supposing that if, as Koch intimates, the microbe represents a hostile force, then the organism must marshal an equal and opposite reaction, a “defense.” As we saw earlier, Koch’s metaphor of bacteria as invaders resonates with the mid-nineteenth-century understanding of cholera as an invasive force. If bacteria cause this invasive disease, then by metonymy the bacteria must invade. Conversely, where invaders appear, defenders must follow, and so by another metonymy phagocytes must defend—an insight Metchnikoff articulates in the same year that Koch so famously links the comma bacillus to cholera. The final twist arrives at the end of Metchnikoff ’s text, where

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he finally establishes the possibility toward which his new interpretation of healing tends: “It can therefore be hoped that these considerations may elucidate the obscure phenomenon of immunity and vaccination by analogy with the study of cellular digestion” (195). Metchnikoff offers a provisional account for why this might happen in his essay “Concerning the Relationship between Phagocytes and Anthrax Bacilli,” which once again takes on Koch. Here Metchnikoff actually repeats—albeit with a difference—the famous anthrax experiment which first brought Koch to international attention to disprove Koch’s notion that the anthrax bacilli act on the phagocyte, “forcing the cell open and liberating themselves,” and not vice versa.162 Instead Metchnikoff inverts this relation, characterizing the “insatiable leucocyte” as the aggressor, and with sarcastic understatement comments: “I assume that the bacteria which have been devoured by the leucocytes find themselves in an environment which is unfavorable for their further development” (763). After describing how he verifies this observation, Metchnikoff considers how the experiment works with attenuated bacteria and finds much the same results, leading to a broader theoretical reflection: “After it had been established that attenuated bacteria are devoured, I had to take up the question whether the immunity which is produced by prophylactic injections is brought about by the fact that the phagocytes after repeated engulfing of the vaccine finally become accustomed to devour the virulent organisms and to kill them” (766). In this first iteration of his theory, he tellingly reverts to the medical meaning of “prophylactic” to evoke how Pasteur’s attenuation technique might activate the phagocytes’ “healing” agency. Prophylaxis (human) begets prophylaxis (organismic). Much like Koch’s metonymic use of invasion, then, cellular prophylaxis metonymically recapitulates within the organism the prophylactic actions of humans in the world. However, in this case, prophylactic success results not from avoiding engagement with the pathogenic cause but by incorporating it: “Immunity is not dependent on the blood as a fluid in the humoral sense but rather on the action of living cells in the cellular-pathological sense. . . . I believe that the evidence can be reduced to the gradual accustoming of the phagocytes to the uptake of substances which they otherwise avoid. . . . Immunity is due to the engulfing functions of certain phagocytes which have gradually become accustomed to these organisms” (767). Given this digestive hypothesis, which supposes not only that phagocytes materially (if lethally) embrace microbial pathogens but also that immunity in fact

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bespeaks an increasing cellular intimacy with “substances they otherwise avoid,” Metchnikoff ’s concluding statement about his notion of immunity brings together his digestive and defensive thinking: If we now summarize the relationship between phagocytes and bacteria the conclusion can be drawn that a battle rages between the two, which ends in favor of the phagocyte when they are enabled to devour the greater part of the bacteria, while the bacteria emerge victorious if the phagocytes cannot attack them. The attenuation of bacteria or the strengthening of the phagocytes (for example through preventive injections) increases the chances of victory by the phagocytes. (770)

More than just betraying a mixed metaphor, Metchnikoff ’s inconsistent figuration illustrates that his bellicose representation of phagocytosis follows not from observing how phagocytes act but from a critical rebuttal of Koch’s invasion tropes. If Metchnikoff observes a process of incorporation and decomposition, which seems to recapitulate the digestive function of single-celled organisms, he might plausibly characterize it as “devouring.” If he conceives this devouring as a sanitary cleansing or disinfection in the name of the organism’s self-healing, then he might plausibly construe it as “prophylaxis.” However, the only apparent reason that he recognizes what phagocytes do as “battling” or “attacking” seems to follow from his polemic against Koch’s bacterial imagery. Phagocytes and bacteria enter the world—or at least the lab—as opposing forces, intractably locked in a fight to the death. To the victor goes the prize: the life of the multicelled organism. Championing phagocytosis as the quintessential example of how organisms defend themselves qua organisms, Metchnikoff becomes the leading proponent of “cellular immunity,” for which he receives a Nobel Prize in 1909 (along with Paul Ehrlich, who champions an opposing yet equally defensive framework, “humoral immunity”). Over the next two decades, Metchnikoff systematizes his immunological insights, both consolidating and expanding his undertaking. For example, in his Lectures on the Comparative Pathology of Inflammation, given at the Pasteur Institute in 1891, Metchnikoff begins to consider phagocytosis’s underlying assumptions: If we examine the organization of an animal or a plant, we find that their most characteristic features are their organs of attack and defense. The carapace of the crayfish, the shell of mollusks and the teeth of vertebrates, as well as many other organs, are so many means of protection to these animals in their perpetual

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warfare. . . . Now from active aggression to infection there is but a short step. . . . Since zoological research takes cognizance of the phenomena of attack and defense, it should likewise include infection and resistance, which are really in close connection with the former.163

In less than a decade, Metchnikoff ’s defensive idiom escalates from a particular to a highly general phenomenon. Certainly the notion that “the most characteristic features” of any organism, animal or plant, are “their organs of attack or defense” constitutes an ideological presumption. Moreover, the conceptual “step[s]” from “perpetual warfare” to “active aggression” to “infection” may be short, but they are also precipitous. Yet the imaginary equivalence drawn between “attack and defense” and “infection and resistance” serves as the logical crux for the metaphors that found immunological discourse, metaphors that remain foundational throughout much of the twentieth century. Certainly, phagocytosis represents an engagement through which meta­ cellular organisms negotiate their paradoxical localizations—localizations which demand both their openness to and containment from the world in which they arise. However, Metchnikoff claims more than this when he elaborates immunity as a robust metaphor by explicitly conflating resistance, defense, struggle, and healing: [The] constancy of the inflammatory reaction in natural immunity is one of the best proofs of the accuracy of the view that inflammation is a phenomenon useful to the animal organism, especially in its struggle against microbal invasion. . . . This phenomenon really constitutes a healing reaction of the organism.164

Once again characterizing phagocytosis as a “healing reaction,” Metchnikoff conflates the defensive tropes he uses to comprehend the organism’s “inflammatory reaction” with the organism’s active environmental engagement. Like the “carapace of the crayfish, the shell of mollusks and the teeth of vertebrates,” phagocytes stand between the individual organism and the world that might invade it. Yet they defend from within. Metchnikoff declares the cellular struggle that he imputes to the microscopic subjects he observes as immunity itself. From this fertile metaphoric mix, immunity emerges as a bioscientific description of the “active struggle against bacteria” and thus supersedes healing as a general explanation for organismic processes.165 As he hones his theory, Metchnikoff reassesses Darwin’s evolutionary “struggle for survival” between individual organisms—a struggle

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borrowed from Malthus. However, Metchnikoff incorporates the organism’s struggle for survival within it as the active basis for its own continuity as an organism. These phenomena [of phagocytosis] do not come under the heading of the struggle for existence in the strictly Darwinian sense (i.e., competition for the survival of the fittest among individuals of the same species), yet they are all more or less directly connected with the struggle for survival that is always going on between the representatives of the different orders of living beings.166

Metchnikoff uses immune function to nuance Darwin’s agonistic rubric. Indeed, he greatly expands the premise that life entails constant struggle, eventually characterizing the organism itself as a perpetual war zone, “le champs de bataille.”167 He thereby literalizes his bellicose understanding of immunity as organismic defense: “The theory of phagocytosis, based on the study of the struggle of the organism against microbes and of inflammation as a special case of this struggle, can serve also to facilitate the explanation of the extraordinary phenomena of immunity, whether natural or acquired.”168 However, if Darwin identified the struggle for survival as the engine of phylogenic history (in which death culls the “unfit” and leaves the “fit” to propagate), Metchnikoff incorporates this struggle to explain ontogenetic history (in which the organism seeks to forestall this culling at the cellular level). Metchnikoff ’s ontogenetic perspective foregrounds the individual organism as bioscience’s most vital site. The individual’s struggle for survival not only informs a species’ future but also incorporates adaptive dynamics between species. Since the chief cause of inflammation—infection—must be considered as a struggle between two organisms, the parasite and its host, and since this struggle brings about adaptations on both sides, we must admit that the organism has elaborated means to defend itself against its aggressors. . . . It is the phagocytes which war against the aggressor by devouring, englobing, and digesting it.169

This belligerent characterization of organismic existence seems to amplify the Hobbesian “war of all against all” at a cellular level. The phagocytes constitute the first line of defense in a world replete with aggressors, and the struggle for existence now plays out within the organism. Certainly Metchnikoff was not the first person to conceive of infection in terms of invasion or healing in terms of defense.170 As we saw in chapter 2, these tropes already enabled Cotton Mather to imagine the process of vari-

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olization nearly a century and a half earlier. Nevertheless by transforming this heretofore figurative understanding into an organismic function and locating it in a particular group of cells which then act as its agents, Metchnikoff corporealizes immunity as a primarily defensive engagement and thereby occludes the multiple nondefensive healing possibilities that an organism may manifest. Moreover, he insinuates this defense solely within the individual organism and thereby obscures the collective possibilities for healing that groups of organisms—especially human organisms—may manifest. Since this individualist presumption underwrites Metchnikoff ’s biomedical perspective, his hostility to public hygiene and sanitation does not come as a surprise. In fact, on this he and Koch agree: science has eclipsed Pettenkofer and his sanitary school. In 1887 at the Second Pirogov Conference in Moscow—a gathering of Russia’s community medicine establishment dedicated to sanitary reform and social hygiene—Metchnikoff vociferously attacks any suggestion that vaccination might not live up to its claims.171 He goes head-to-head with Friedrich Erismann, a student of Pettenkofer’s and dean of Russian sanitary science, denouncing Erismann’s position as anachronistic and incompetent. Conversely, affirming that “the human hosts of their microbes lived in particular social conditions which had themselves been linked to the prevalence of disease,” Erismann defends his ideas against those like Metchnikoff and Koch who would isolate the individual organism.172 Though Erismann’s attack effectively ostracizes Metchnikoff from Russian medicine, pushing him toward Pasteur’s much more congenial pastures, it nevertheless provides only a rear-guard response. Metchnikoff leaves the field behind. In The New Hygiene (1907), a series of three lectures on the prevention of infectious diseases given in London as the Harben Lectures of the Royal Institute of Public Health, Metchnikoff appropriates and revises public hygiene in a thoroughly private way. In the first lecture, “The Hygiene of Tissues,” Metchnikoff claims that “as soon as we had discovered the pathogenic microbes, an effective fight against many diseases became possible” (i.e., he sees all prior efforts as ineffective), and furthermore “it is the phagocytes which deliver us from our enemies.”173 Here Metchnikoff recasts the object of public medicine in light of his own defensive and aggressive tropes. Whereas forty years earlier, the International Sanitary Conferences imagined their defensive strategies (including actual military ones) by figuring cholera as an invading force, Metchnikoff (like Koch) imagines the bacteria causally associated with infectious disease as invading

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agents and consequently situates defense within the organism itself. However, while the earlier defensive protocols involved recognizably political or even armed responses—and “defense” itself underscored these means—the “new hygiene” relocates politics and violence within the human body. As a consequence, it thoroughly redefines the hygienic project: “The principle of this hygiene consists in increasing the number and activity of phagocytes. . . . We may rejoice that the foundation stone of the hygiene of the tissues—i.e., the thesis that the phagocytes are our arms of defense against infective germs—has at last been generally accepted.” 174 If at the beginning of the nineteenth century, hygiene bespeaks a political commitment to the individual citizen’s well-being as a member of a population (considered a vital asset for the state, as discussed in chapters 2 and 3), at the close of the century it begins to be ensconced within the individual itself. Throughout the intervening years, public hygiene foregrounds the prophylactic possibility—or at least the hope—of preventing epidemic illnesses. Depending on national context, the attempts to realize this possibility might include medical, economic, administrative, sanitary, police, and military means; however, in all instances, they assume an overtly political engagement by governments on their subjects’ behalf. Cholera’s exemplary status illustrates how public health recognizes and addresses epidemics as biopolitical events and inspires a rethinking of biopolitical boundaries. If the frontiers of a state no longer serve as sufficient to safeguard against deadly intruders, then its boundaries must contract around its vulnerable population and each body at risk within it. Such political redefinition redraws geopolitical maps, displacing questions of inside and outside from territories to bodies, a mapping that seamlessly meshed with Bernard’s notion of milieu intérieur. Indeed, Bernard provides an epistemology that naturalizes this restriction of political milieu to the proximate organism itself at the exact historical moment when repeated international attempts to contain cholera highlight the disease’s biopolitical status. They subject it to deliberations among competing nations, who then use these deliberations to advance their own economic, political, military, and social interests. In this historical nexus, immunity emerges as an efficient biopolitical hybrid that enables different nations to justify their divergent investments as natural choices. For while immunity might describe the differences among individual responses to contagious contexts, or more usually differences among these contexts themselves, it does not yet indicate how or why individual organisms manifest pathology—or not.

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Following the insights of bacteriology, predicated on Bernard’s isolation of the milieu intérieur as “true milieu physiologique,” this immune scenario radically changes. Bacteriology localizes infectious disease within the individual organism as an effect of invading microbes. Pasteur then successfully modifies microbial virulence and thereby reduces the organism’s vulnerability to pathogenic symptoms, conferring what he considers either “nonrecidivism” or “immunity.” Why this happens, however, remains obscure until Metchnikoff hypothesizes that multicelled organisms, conserving intracellular digestion from single-celled organisms, defend themselves from invading bacteria by devouring them. This microscopic battle (which he also represents as the healing force of nature) serves as the organism’s personal prophylactic protocol, situating hygiene within the organism’s tissues themselves. As a consequence, defense takes on the individualist implications that Hobbes first gave it two hundred years earlier when he declared it “true reason for a man to use all his endeavours to preserve and defend his Body, and the Members thereof from death and sorrowes” (see chapters 1 and 2); but it now does so as a biological fact. Until Metchnikoff, the matter of defense had never resided within the organism. When Hobbes argues that self-defense constitutes a law of nature, he means this in a juridico-political, not a biological or even biopolitical, way. Metchnikoff fully naturalizes this precept, making the body the apotheosis of political reason. Admittedly, he does not do this intentionally. However, the bio-logic that he deploys to make sense of phagocytosis incarnates these assumptions within its scientific perspectives. Knitting together more than two centuries of thinking about human bodies as simultaneously political and biological phenomena, Metchnikoff ’s immune theory imaginatively and materially remakes the living human organism. In its wake, new bioscientific technologies proliferate that transform us through and through: vaccinations, inoculations, antibiotics, antibody tests, genetic medicines, and even the public health campaigns which mobilize them all, seek to diminish our vulnerability as beings who necessarily coexist with microscopic others that may harm us. Yet diminishing vulnerability does not necessarily mean defending. What makes this metaphoric equivalence seem so natural to us are the political axioms that we take for granted when we think this way. By forgetting that self-defense first emerges as a political right, we fail to recognize that when immunity biologizes this precept, it does not offer us the only way to imagine illness and healing. Instead, Metchnikoff ’s fusing of immunity-as-defense with the vis

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medicatrix naturae buries our political assumptions deep within us—in our cells and molecules and subatomic particles. His new sense of immunity as an organismic activity naturally renders the modern body a political and biological atom—a political atom because a biological one, and a biological atom because a political one. Individualism previously incorporated this assumption as a political and economic truth; immunology after Metchnikoff finds the truth of this truth within our living matter. It thereby makes us truly bodies worth defending at last.

When biomedicine speaks the truth it also speaks morals. —didier fassin, When Bodies Remember It doesn’t matter if you are hiv-positive or negative. The world has aids. And if you give a shit about the world you have it too. —adam levin, AidSafari

Conclusion Immune Communities, Common Immunities

This book ends where immunology begins. In the decades after Metchnikoff introduces immunity-as-defense, the concept takes on a life of its own. Soon his German rivals, especially Paul Erlich, appropriate Metchnikoff ’s rubric but reject his cellular orientation. They redirect the study of immunity toward biochemistry and adapt Koch’s idea of specificity to molecules, presaging the antigen-antibody reactions that preoccupy immunology for much of the twentieth century.1 Exploiting dyes used to stain bacteria for microscopic analysis, they also begin to experiment with chemical means to ameliorate illnesses, foreshadowing antibiotic treatments. Not surprisingly, immunology starts to turn a profit. Almost as soon as Pasteur validates his vaccines, he markets them. His antirabies vaccine inspires great enthusiasm, and he licenses labs, like the one Metchnikoff briefly runs in Odessa, to produce it. (Koch too tries to capitalize on his experimental success but fails rather spectacularly when Tuberculin, his supposed treatment for tuberculosis, proves ineffective; nevertheless the infectious desire for profit thrives.)2 Pasteur also dispatches minions around the globe to investigate the bacterial sources of “colonial” diseases

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in the hope of producing—and selling—vaccines for them.3 Since his scientific and commercial interests complement France’s colonial ambitions, this project flourishes. As Latour succinctly comments: “The politicomilitary role given to the biologist was explicitly claimed by the Pasteurians.”4 Moreover, immunity’s fusion of defensive and political concepts makes this role seem entirely natural. Within Metchnikoff ’s lifetime, the bioscientific enterprise which his innovation underwrites explodes into a global biotech industry. While this story’s details deserve careful analysis, they exceed this book’s undertaking.5 However, a reflection on one recent example precipitated by these events might provide a fitting conclusion to our thinking about immunity, biopolitics, and the apotheosis of the modern body. Since 2000 the government of South Africa has been alternately condemned, reviled, excoriated, chastised, denounced, and ridiculed for failing to endorse and implement nationwide distribution of antiretroviral therapy (art) for people with hiv/aids. At the International aids Conference held in Toronto in August 2006, the South African president Thabo Mbeki and health minister Manto Tshabalala-Msimang were regularly personified as recalcitrant and ignorant, if not pernicious and murderous, for their reluctance to affirm unambiguously that “hiv causes aids. Antiretrovirals are the only medications currently available that alleviate the consequences of hiv infection” (so read the open letter to Mbeki calling for TshabalalaMsimang’s dismissal, signed by more than eighty of the world’s leading aids experts).6 The outgoing United Nations special envoy for hiv/aids in Africa, Stephen Lewis, made his moral outrage explicit: “The government has a lot to atone for. I’m of the opinion that they can never achieve redemption. . . . I know that what it is doing is wrong, immoral, indefensible.”7 Though the South African government has altered its position over the past several years and now offers art, as well as postnatal drug protocols for infants born to mothers with hiv/aids, it does not provide universal coverage. This uneven availability leads many of Mbeki’s critics, both within South Africa and around the world, to insist that it betrays his continued refusal to acknowledge a basic, universal, incontrovertible, scientifically affirmed fact: that hiv is the singular “cause” of aids. To many in the developed North, and in South Africa as well, Mbeki’s pronouncements about hiv/aids represent “lunacy,” while conversely those who speak in science’s name are objective, reasonable, and sane. However, this opposition belies the complexities involved in bringing knowledge to bear on something as difficult and tragic as the aids pandemic. If antiretroviral treatments seem incontrovertible to those who

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espouse biomedicine’s universality, the contradictory results both of these specific treatments and of biomedicine more generally in the South Afri­ can context trouble such claims. Analyzing this nexus of politics, histories, and persons, Didier Fassin discloses the “social logics” that underlie Mbeki’s much-reviled positions. In Fassin’s brilliant book, When Bodies Remember, he argues that Mbeki’s perspective does not look quite so idio­syncratic or anomalous within South Africa as many commentators might believe. Rather, Fassin shows that it falls within a range of plausible regional interpretations that do not automatically accord truth to biomedicine’s claims. Fassin, a physician, sociologist, and anthropologist, was until 2003, vice president of Médecins sans Frontieres (Doctors without Borders), so his concerns and experience afford him complex knowledges about hiv/ aids. Situating its South African history within apartheid’s legacy, Fassin argues that bioscience’s framing of the epidemic might warrant some South African skepticism—given how biomedicine and public health in fact helped to shore up the apartheid regime. Moreover, the country’s challenging economic and social circumstances, where unemployment, inadequate food and housing, and violence dramatically impinge on people’s lives (causing more deaths each year than aids), make questions of health and illness less comprehensible solely in terms of biochemical causality and treatment. Hence the scientists who signed the open letter to President Mbeki asserting that “antiretrovirals are the only medications currently available that alleviate the consequences of hiv infection” may not sufficiently recognize that all the “consequences of hiv infection” do not occur at the cellular or molecular levels. In fact, these cells and molecules also exist within a larger biosocial world where causes are not only viral. Biomedicine limits knowledge about hiv/aids by affirming that individuals constitute the central if not exclusive locus of concern. As we have learned, since the middle of the nineteenth century when Claude Bernard first justified using experimental data to explain how organisms live, milieu intérieur has legitimated laboratory-based research protocols, including those of immunology and virology. Conversely, his claim that “medicine must act on individuals. It is not destined to act on collectivities or people” increasingly defines its overtly political corollary.8 Opposing the individual to the collective, Bernard bifurcated the living world into inner and outer milieus, each subject to distinct causes (only the inner milieu being responsive to medical intervention). Following this epistemological breakthrough, biochemical reductionism has more and more restricted

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medical and health concerns to the singular individual’s isolated body. The medical anthropologist Margaret Lock succinctly notes: Efforts to reduce suffering have habitually focused on the control and repair of individual bodies. The social origins of suffering and distress, including poverty and discrimination, even if fleetingly recognized, are set aside, while effort is expended in controlling disease and averting death through biomedical manipulations.9

Lock continues: It is now apparent in most corners of the world, except perhaps in the heart of the Leviathan, that science, and in particular biomedicine, has come to be thought of by many as one form of neo-imperialism. In an era of struggles to create and recreate cultural identities and establish grounds of cultural difference, the self-conscious possession of scientific knowledge, or, alternately, its repudiation as inauthentic or culturally inappropriate, is explicitly made use of to establish local power bases and authority. The production and circulation of technologies are, therefore, not only far from autonomous but, on the contrary, incite and foster culturally infused political activity.10

Biomedical knowledges and technologies, Lock suggests, also import the underlying political, ethical, and moral assumptions that they unconsciously incarnate. In this case, the lurking axiom holds that the individual forms the natural biopolitical atom. However, this culturally and historically ordained form of personhood, which this book has explored at length, does not in fact exhaust how humans have thought, and do think, about either their vitality or their relations.11 Other ways of imagining humanness lead to other models of care and treatment, as, for example, traditional Chinese medicine or Ayurvedic medicine or even the history of humoral medicine illustrate. Resisting biomedical explanations and protocols, then, does not necessarily indicate “wrong, immoral, [or] indefensible” ideas, as Stephen Lewis opines, but may reveal a fundamental value conflict that bioscience obscures when it declares its own universal validity. Indeed, such conflicts about biomedical interpretations might reveal unacknowledged cultural and political limitations which bioscience secret(e)s within its truth claims about hiv/aids—limitations that inhibit its ability to redress the complexities which exist in South Africa and elsewhere. Pragmatically and conceptually, Fassin suggests, biochemical reductionism and individualism may not explain how hiv/aids lives in South Africa:

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Since the beginning of the pandemic, the focus of discourse and policies throughout the world solely on the medical aspects of the illness, and since the beginning of the South African controversy, solely on the availability of drugs, has made the social issues (both carried and revealed by aids) practically inexpressible. Of course a number of opposition critics have conceded that poverty is certainly a serious problem, that if one were taking anti-retroviral drugs, one should be able to eat—it was hardly possible to do otherwise than admit it— but rare were those willing to draw the conclusion, both about what happened yesterday and about what is happening today.12

From Fassin’s perspective, focusing on getting “drugs into bodies” (as the famous act up slogan in the United States put it) may not by itself ameliorate the health problems encompassed by the rubric “hiv/aids.” This does not mean that antiretroviral therapies do not provide amazing results for people who have the resources to acquire and take them safely. Undoubtedly, providing ARTs more widely is laudable, as is pressuring the pharmaceutical industry to make the treatments affordable. The discrepancy between access to pharmaceuticals both within Africa and around the globe bespeaks a massively unjust and inequitable distribution of resources, which contributes to huge differential distributions of suffering and immiseration. Yet by naturalizing these biochemical protocols as the only effective means to redress the consequences of hiv/aids, biomedicine devalues alternate understandings which might locate hiv/aids not just within suffering and vulnerable human bodies but within the biosocial domain more generally. Taking a position complementary to Fassin’s in her book Neoliberalism and aids Crisis in Sub-Saharan Africa, Colleen O’Manique calls attention to the “ontological monism” of aids policies in sub-Saharan Africa at the levels of both treatment and prevention: “The institutional response to aids in ssa remains focused on the autonomous individual who is to be ‘empowered’ to protect herself or himself from infection, or cope with imminent death in the absence of treatment.”13 In O’Manique’s view, this restricted—and restrictive—concern bespeaks neoliberalism’s economic imperatives, which dictate both national health policies and international efforts to redress the pandemic within Africa: Neoliberalism is largely consistent with the biomedical construction of aids, which reduces the aids pandemic to its individual clinical and behavioral dimensions. In effect, what is erased or obscured are the material conditions which allow the virus to thrive, the broader factors that condition access to treatment, and the day to day realities of affected households where the tangible

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impacts are felt. . . . One effect of biomedicine’s hegemony is depoliticizing disease; removing the understanding of disease from its social context and placing it back into the individual body.14

While enthusiastically concurring with O’Manique’s assessment from the point of view of political economy, I cannot entirely endorse her sense that the “effect of biomedicine’s hegemony is a depoliticizing of disease.” Nor do I completely agree with her corollary assertion: “The problem rests not with biomedicine per se.” As I have been arguing, the issue with biomedicine is not that it makes politics extrinsic to its theory and practice but that it incorporates a specific, modern politics within itself as if it were naturally true. This incorporation takes place not just through industrial development of drugs and treatments or their profitable distribution through capitalism’s market mechanisms. In fact, modern biomedicine embeds modern political ideology when it represents the singular, epidermally bound organism which defends itself against a relentlessly pathogenic environment as a universal fact. Thus the consistency between neoliberalism and the biomedical construction of hiv/aids which O’Manique discerns does not betray accident or coincidence. It actually reveals how biomedicine continually incarnates the assumptions of classic political and economic liberalism as biological or even natural phenomena. Modern biomedicine makes the modern body true. Neoliberalism then recapitulates these supposedly natural assumptions both through its economic and political effects and through the biomedicine it proffers as the most credible treatment option not just for hiv/aids but for manifold health problems around the world. In particular, the bioscientific paradigm of immunity, which, after all, lies at the center of hiv/aids, does not transparently reveal the material processes of the living organism as it coexists with other living beings in shared environments. Instead, as we have found, immunity (which existed as a powerful juridical and political concept for two thousand years before medicine applied the idea to vital contexts) construes the individual as a natural unit and thereby renders the social and political milieu within which this individual necessarily lives medically extrinsic or epiphenomenal. When the bioscientific imagination of hiv/aids enfolds this individualizing and self-isolating framework as an essential truth, or as a “natural fact,” it prescribes what it claims to describe, realizing the juridico-political assumptions that it unreflectively incorporates. To a large

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extent, my project in this book extrapolates from Paul Farmer’s observation that “a critical epistemology of emerging infectious diseases is still in the early stages of development. A key task of this endeavor is to take our existing conceptual frameworks and ask, what is obscured in this way of conceptualizing disease? What is brought into relief?”15 A Body Worth Defending examines how biomedicine conceptualizes disease more generally insofar as it takes immunity to define the organism’s natural response. Taking the modern body as its subject and object—and in the process actualizing it—biomedicine relegates knowing to the milieu intérieur and epistemologically disclaims responsibility for what lies outside. However, many health concerns trouble this inside-outside distinction. The human inside lives in the outside, and the outside affects the inside socially, physically, emotionally, and biochemically. When biomedicine divides up these domains of responsibility, it maps its political ideals onto the world. Obviously these divisive ideals do not reflect how the world materially exists. However, they make sense of the world and thereby make the world what it is for us. Conversely, by incarnating the modern body as our nature, biomedicine makes us who we are. As the controversy about hiv/aids in South Africa suggests, conflicts about medical truths conceal conflicts of values. By attending to its history more closely, we can illuminate what is at stake in how biomedicine makes its truths “true.” The fracas began with Mbeki’s address to the Thirteenth International aids Conference in July 2000, which precipitated an immediate global furor. Indeed, even before Mbeki had spoken a single word, the anticipation that he might question the bioscientifically endorsed credo that hiv causes aids led over five thousand scientists worldwide to sign the Durban Declaration, categorically reaffirming “the scientific evidence that hiv is the sole cause of aids.”16 In his speech, however, Mbeki never actually denied the correlation between hiv and aids, though he did acknowledge that he and members of his government harbored reservations about it. Instead he foregrounded other causally salient factors that bioscience’s investment in hiv as the sole cause of aids obscures: “poverty, suffering, social disadvantage, and inequity.”17 While the leading aids researchers also acknowledged that poverty, deprivation, and social and economic injustice foster the devastating spread of aids in Africa, they nevertheless emphatically insisted that when questions of causality arise, only hiv can be named. Mbeki, on the other hand, invoked a more expansive understanding of cause: “The world’s biggest killer and the greatest cause of ill health and suffering across the globe, including

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South Africa, is extreme poverty.” Then he expressed the moral and ethical import of this causal invocation: “Is there more that all of us should do together, assuming that in a world driven by a value system based on financial profit and individual material reward, the notion of solidarity remains a valid precept governing human behavior!” Mbeki had barely ceased speaking when the horrified chorus of bioscience arose en masse as if to drown him out. The condemnations were ubiquitous, persistent, impassioned, and self-righteous. Mbeki’s detractors did not just lament his benightedness; they reviled him as both a scientific idiot and a political horror. Not only had Mbeki broken faith with biomedicine’s precepts, but he verged on apostasy by entertaining scientists (like the infamous Peter Duesberg) who held the hiv/aids linkage to be less than absolute.18 However, the openly hostile and affective opposition to Mbeki suggests that something else might motivate these critical responses besides alerting the public to his wrongheadedness (along with whatever significance it might have for South African health policy). Whatever understandings the South African president’s position relies on, official science seemed to say, they lie outside “the truth.” Therefore they must be violently repulsed as threatening “monsters on the prowl” (as Michel Foucault named the epistemological outliers that lurk beyond verifiable knowledge’s borders).19 Mbeki’s comments were not just erroneous, for errors at least would be subject to verification and falsification. Rather, they overturned the very ground of truth which science proclaims as fact and on which it founds its authority. For the spokespersons of science, then, Mbeki’s claims were not just risible, they were threatening. Nothing illustrates this rhetorical strategy more clearly than a remark made by the Oxford-trained president of South Africa’s Medical Research Council (and former Mbeki ally) William Makgoba: “The sad part is, he’s trying to politicize scientific facts and that’s what the Nazis did.” 20 The inflammatory “Nazi” invocation here alerts us that this controversy involves more than science. Clearly, by playing the Nazi card, Makgoba intends to trump Mbeki, with no further discussion needed. Yet still we might wonder, if the scientific facts possess so much certainty and if these facts are indeed so apolitical, why does the scientific community respond so defensively? Obviously no one disputes that the aids epidemic engages political concerns. Even the most cursory reflections on the global distribution of hiv/aids and the measures taken (or not taken) to ameliorate the pandemic reveal the complex political and economic challenges that shape how care and prevention operate. Furthermore, the highly con-

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tested bioscientific discovery and naming of hiv itself, as well as the ensuing pharmacological investments and profits derived from focusing on this retroviral agent, also plainly indicate that both politics and economics animate the hiv/aids articulation. However, while accepting that aids might involve politics, what incenses the bioscientific community is the suggestion that their own scientific explanations for hiv/aids might themselves be directly political. Consider how the Durban Declaration’s signatories affirm the scientific facts. In their statement, they repeatedly invoke their right to speak authoritatively about hiv/aids. They cite an archive of documentation (produced by what some now refer to as the “aids industry”) to affirm their assertion that “hiv is the sole cause of the aids epidemic.” None­ theless they also feel obliged to acknowledge that “limited resources and the crushing burden of poverty in many parts of the world constitute formidable challenges to the control of hiv infection.” After this vague gesture toward the biopolitical world in which hiv/aids lives, they nevertheless conclude: “To tackle the disease everyone must first understand that hiv is the enemy.” While they might have imagined that this statement represents an indisputable, scientific assessment of the situation, it actually does not. Instead, their rhetorical characterization of hiv as “the enemy” explicitly reveals the politics deeply embedded in their putatively nonpolitical position. For the language of friend and enemy in no way derives from the matter of the world; it does not describe the unfolding of biochemical processes according to immutable natural laws; it does not constitute an unmediated representation of an essential physical truth; rather, the trope of friend and enemy has circumscribed Western politics since Aristotle.21 In fact, it has provided a canonical framework for defining “the political” as such ever since there first was a polis. More important for my purposes, it has also underwritten the bioscientific investment in immunity as a biological form of self-defense for the last one hundred years. By identifying hiv as “the enemy,” bioscientific representatives who signed the Durban Declaration construed aids in terms of a thoroughly biopolitical investment in immunity—the “I” in both hiv and aids— which first emerged as the organism’s defensive capacity at the end of the nineteenth century. Since then medicine has implicitly divided up the life world into “friend” or “enemy” camps, effectively defining the human organism as what Élie Metchnikoff called “le champs de bataille,” the field of battle.22 Today the bellicose spirit of vital warfare inflects—and infects—modern medicine’s prevailing ethos in numerous respects. As

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Donna Haraway and Emily Martin observe, within the contemporary biomedical framework, the human organism appears as a defended frontier, bound within an epidermal envelope that establishes the limits of a self, which is both exposed to and opposed to microbial “others” who threaten to negate its existence.23 Insofar as the so-called war on aids paradoxically marshals, and indeed radically expands, the resources of immune discourse against an infectious agent which lays waste to the very defensive capabilities ascribed to immunity itself, it redoubles a biopolitical commitment to this individualizing perspective by excluding the human organism’s vital contexts from its purview. When Thabo Mbeki questions the premise that the Durban Declaration categorically affirms, namely, that hiv is the sole cause of aids, he touches on the implicit yet unacknowledged biopolitics that immune discourse secret(e)s within the juridico-political metaphors around which it forms itself. Moreover, Mbeki calls attention to the limits that biomedical causality imports when it tries to encompass the historical events we now know as aids: “One of the questions I have asked is—are safe sex, condoms and anti-retroviral drugs a sufficient response to the health catastrophe we face?” The question of sufficiency seems critical here: Mbeki does not say that hiv has no agency; rather, he intimates that focusing on hiv as a cause of aids may be (scientifically) necessary but not (politically) sufficient.24 Yet in response to this suggestion, biomedical experts vociferously, if not aggressively, insist not only that hiv provides a sufficient condition but that claiming otherwise would be both scientifically invalid and politically naive. However, Mbeki is not so naive as all that, either politically or scientifically. Listen to how he characterizes the “health crisis of enormous proportions” that confronts Africa, a crisis that includes but is not totalized by hiv/aids, a crisis that encompasses numerous other infectious diseases and environmental conditions which often coexist with and exacerbate the suffering of people living with hiv/aids: One of the consequences of this [health] crisis is the deeply disturbing phenomenon of the collapse of immune systems among millions of our people, such that their bodies have no natural defense against attacks by many viruses and bacteria. . . . It seems to me that every living African, whether in good or ill health, is prey to many enemies of health that would interact one upon the other in many ways, within one human body. And thus I came to conclude that we have a desperate and pressing need to wage a war on all fronts and realize the human right of all our people to good health.

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Here Mbeki appropriates immune discourse’s bellicose tropes to highlight the very politics that this discourse denies. He invokes the standard biomedical explanation of infectious disease (viruses and bacteria are “attacking” disease agents, as Koch first intimated) but does so precisely to emphasize its biopolitical limitations. The immune system’s “natural defenses” cannot be “natural”—in the sense of immutable or inexorable, and therefore immune to political exigency—if they are also historically contingent and vary according to the circumstances in which the bodies they are supposed to defend live. By rendering immunity’s natural defenses historical and contingent, Mbeki disturbs the putatively apolitical nature to which immunology, and bioscience more generally, “objectively” lay claim as their epistemological or even ontological ground. He then turns the immunological invocation of disease as enemy upon itself (remember the Durban Declaration’s affirmation that “hiv is the enemy”), suggesting that there are “many enemies of health,” all of which entail physiological consequences, even if not all of them have strictly biological causes. Finally, he returns the metaphor of war to the domain of politics, where he uses it not to describe how the immune system functions within the organism but how political relations could mitigate the multiple biological, social, and economic factors that persistently impinge on the health and well-being of “every living African.” Fassin locates Mbeki’s perspective within a way of thinking about African identity that foregrounds its specific history (precolonial, colonial, and postcolonial) as essential to imagining its future. Conversely, those who affirm bioscientific truths aspire to shape this future through putatively ahistorical principles, whether biomedical or neoliberal. The tension between these two competing perspectives, Fassin suggests, reveals an implicit critique, such that Mbeki’s invocations of Africanness also uncover the values incorporated within bioscientific (or even neoliberal) universals: On the one hand, [this opposition] is about the distribution of power in the world, in particular the huge inequalities that can be translated in terms of quantity and quality of life. That is what Thabo Mbeki is saying when he denounces the global imbalance, the plundering of the African continent, the undue profits of the pharmaceutical industry. On the other hand, the conflict is about the universal order of knowledge, in particular, the validity of unanimously accepted explanations and solutions. That is what the president is saying when he rejects the viral theory and sexual transmission in favor of poverty as the explanation for the epidemic.25

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If we view the controversy over Mbeki’s perspectives on hiv/aids in light of Fassin’s analysis, we discern social and historical logics that make his position not only comprehensible but critical. Mbeki not only challenges the political, economic, and epistemological assumptions that bioscience brings to bear in making truth claims about the aids epidemic; he demonstrates that these epistemological claims also contain political and economic ones. Surely this insight could have significant consequences for how hiv/aids is addressed in South Africa and around the world. For insofar as it troubles the ontological and epistemological grounds on which biomedicine founds its exclusive claims to “alleviate the consequences of hiv infection” (as the scientists’ open letter to Mbeki put it), it may open up other as yet unused or underused ideas and resources, which might then both alter what “consequences” count as consequential and offer different ways to address them. At the least it might help reframe the ways the subjects and objects of concern—whether viruses and drugs, individuals and collectives, housing and food, money and resources, laboratories and clinics, policies and politics, birth and death, immunity and community—are conceived when we speak about hiv/aids. Since I am not in any position to speculate about what different possibilities might emerge from the local, national, transnational, or even global contexts where these concerns actually live, I would not presume to suggest what forms such reconceptualization might take in South Africa or anywhere else. So instead let me close by merely noting that Mbeki’s implicit critique also points to a more general conflation which biomedi­ cal understanding incorporates and imports when it assumes that its paradigms speak for nature itself. When bioscience takes immunity-as­defense to describe the natural condition of possibility for how organisms of different sizes and scale coexist, it “forgets” that these concepts emerge out of a long history of political and legal thinking that unfolds primarily across the history of Europe and North America, from the Roman Empire to the current war in Iraq.26 Recalling the contingency of this framework, Mbeki’s challenge to hiv/aids discourse troubles immunology’s contention that the very processes which allow us to heal from illness also condemn us to live in a permanent state of internal war. Furthermore, it prompts us to remember not only that as organisms we live together, but also that because we must modulate our openness—both to other humans and to the other others with whom we coexist—we can never not also remain vulnerable to them without killing ourselves. As Donna Haraway so eloquently puts it: “Life is a window of vulnerability. It seems a mistake to close it.” 27

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How might Haraway’s venerable and vulnerable insight make the world we live in a little different? When in the early 1880s Élie Metchnikoff characterizes a form of organismic activity as “defense,” he gives the term “immunity” its modern biomedical valence. Imagine what might have happened if he had not been so focused on either the individual organism as a milieu intérieur or the dynamics of aggression and response which underwrote his political ontology, evolutionary worldview, and laboratory experiments. He might then have described the dynamics through which complex organisms systematically mediate their relations with the others with whom they must concur by using immunity’s etymological opposite, “community,” since community foregrounds the co-constitutive dynamics of living.28 Imagine what might have happened if “community” had achieved the same biological status that immunity did. How differently might we live in the world imagining that our “commune systems” mediated our living relations with and in the world? How might we experience ourselves as organisms if we imagined that coexistence rather than self-defense provides the basis for our well-being? How might we have organized our care for the ill and our systems of healing, or indeed our entire political and economic relations, if we imagined that our ability to respond to corporeal challenge engages our ability to commune with others? Might biological community enable us to appreciate healing not just as a biomolecular phenomenon but also as a political, ethical, and material value? Might it encourage us to ask, along with Thabo Mbeki, “Is there more that all of us should do together, assuming that in a world driven by a value system based on financial profit and individual material reward, the notion of solidarity remains a valid precept governing human behavior”? A silly thought experiment, perhaps. Nevertheless it does suggest that there may be more to immunity than we currently know, or are indeed even capable of knowing, so long as we remain infected by the biopolitical perspectives that it defensively defines as the apotheosis of the modern body.

Notes

Introductory Ruminations

1. Metchnikoff, Souvenirs, 97 (italics mine). 2. The work of Alfred Tauber and his colleagues provides the starting point for my reflections on immunity. See Tauber and Chernyak, Metchnikoff and the Origins; Tauber, The Immune Self; and Podolsky and Tauber, The Generation of Diversity. Also formative for my thinking is Moulin, La dernier langage. The best general history of immunology is Silverstein, A History of Immunology. See also Napier, The Age of Immunology. For a treatment that focuses on German bacteriology as the crucible from which Paul Ehrlich’s thinking about immunity emerges (but which slights Metchnikoff), see Mazumdar, Species and Specificity. 3. Anscombe, Intention, 84–85. 4. Metchnikoff, “Daphnia,” 193. 5. Neuburger, The Doctrine. 6. Esposito, in Bios, gestures toward a similar understanding, though his engagement with immunity—both legal and biological—remains largely philosophical rather than historical. 7. Kay demonstrates in Who Wrote how immunology’s privileging of specificity provided the template for the first models of genetic inheritance. 8. Foucault, La volonté de savoir. Unless otherwise noted, quotations are taken

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unmodified from the English translation, The History of Sexuality, vol. 1: An Introduction. 9. In Foucault, Deleuze argues that “Foucault shows that the law is now no more a state of peace than the result of a successful war: it is war itself, the strategy of this war in action” (30). 10. R. Williams, “Problems,” 67–85. 11. Bakhtin, Rabelais and His World. See also Stallybrass, Politics and Poetics. 12. Macpherson, Political Theory. 13. Contemporary (or dare I say “postmodern”) theories centering on biotech, often following Deleuze, also embrace such fluid potentials. However, they seem to think this embrace represents an ontological shift precipitated by new biotechnologies (e.g., Massumi, Parables; Thacker, Biomedia and Global Genome; Clough, “Affective Turn”). This book suggests instead that the modern body coalesces as a biological possibility only in the late nineteenth century by historically incarnating a modern ontology from which these newer political ontologies then differ (and defer). 14. Tauber’s Immune Self elucidates how immune discourse engages philosophy’s positing of selfhood over the last several centuries. 15. Chapter 4 addresses this usage and considers key moments in its development. My comments about immunity’s descriptive valence derive from considering more than four hundred examples in English and French, between 1750 and 1890, thanks to the genius of Google books. Obviously not an exhaustive or systematic archive, this word-searchable database nonetheless provides access to more documents than anyone has used to consider immunity’s significance before. While counterexamples may exist (though I have not found any), the vast preponderance of instances confirm my claim. Try it yourself and see. 16. Like Hacking’s Historical Ontology, this book seeks to understand the vicissitudes of human “being” in light of Foucault’s genealogical undertakings. It differs in my focus on the historical grounding of modern political ontology in the body. 17. Hardt and Negri, Empire, 70–74. 18. With regard to sexual difference, Laqueur describes this shift by noting that at the end of the eighteenth century, “a biology of hierarchy grounded in a metaphysically prior ‘great chain of being’ gave way to a biology of incommensurability” (“Orgasm,” 24). In Society Must Be Defended, Foucault describes the coeval emergence of biological racism (254–58). 19. Poovey, “Liberal Civil Subject.” 20. Riess, Mirages of Selfe, 2. 21. Shapin and Schaffer, Leviathan and the Air-Pump. 22. Latour, We Have Never Been Modern, 30. 23. Ibid., 98–100. Latour argues that the disjunction modernity supposes between nature, society, and God gives rise to a series of corollaries including the temporal bifurcation between “traditional” and “modern,” and the geopolitical mapping of this temporal schema onto other cultures taking the form “premodern” versus “modern,” or succinctly “Them” versus “Us.” In this sense, his argument ac-

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cords with Chakrabarty, Provincializing Europe, about the Eurocentrism of modern historiography. 24. Latour, We Have Never Been Modern, 31. 25. “Catachresis,” according to the OED, means the “improper use of words; application of a term to a thing which it does not properly denote; abuse or perversion of a trope or metaphor.” 26. Foucault frequently, if somewhat vaguely, uses the terms “biopolitics” and “biopower” during the mid-1970s, most famously in the concluding section to La volonté de savoir (1976) and in the title to his lectures of 1978–79 at the Collège de France, Naissance de la biopolitique. The less-well-remarked “biohistory” also shows up in the last part of La volonté de savoir as a counterpart to biopower, but much less commonly elsewhere. One important exception that is significant for our purposes occurs in a lecture given in Brazil in 1974: “There appears then a new dimension of medical possibilities that I will call the question of bio-history. The doctor and the biologist henceforth no longer work at the level of the individual and its descent, but begin to work at the level of life itself and its fundamental events. We find ourselves in bio-history and it behaves as a very important element” (“Crise de la médicine,” in Dits et écrits, 48). 27. Some might dispute Foucault’s periodization as Agamben’s Homo Sacer does (for my critique of Agamben’s critique of Foucault, see E. Cohen, “A Body Worth Having”) or his Eurocentrism, as Mbembe does in “Necropolitics.” However, few if any deny that biopolitics and biopower poignantly describe a potent characteristic of the world as we know it. 28. Foucault, Securité, territoire, population, 306. On Europe’s self-conceit as a universal historical process with respect to the rest of the globe, see Chakrabarty, Provincializing Europe. 29. Ibid., 308. 30. Foucault, La volonté de savoir, 183 [139]; page numbers in brackets refer to the English translation, The History of Sexuality, vol. 1: An Introduction. 31. Foucault, Discipline and Punish, 155 [157] (translation modified). 32. Foucault, “Les mailles du pouvoir,” in Dits et écrits, 188. 33. Reid, “Life Struggles,” 129–30. 34. The continuation of this dynamic in the nineteenth and twentieth centuries gives rise to what Paul Virilio calls “pure war,” as a totalizing social mobilization through and for war. Virilio, Pure War. 35. Poovey, “The Liberal Civil Subject.” 36. Foucault, La volonté de savoir, 183–84 [139–40] (translation modified). 37. Ibid., 188 [143] (translation modified). 38. Ibid., 183 [139] (translation modified). 39. The history of these concepts indicates that they derive by analogy from agriculture, where human manipulation of the earth transforms an immanent potential into a resource. See R. Williams, Keywords, 48–50, 76–82. 40. See Virno’s discussion of “labor-power” as embodied potential in A Grammar of the Multitude, 81–84.

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41. Foucault, La volonté de savoir, 185 [140] (translation modified). 42. Foucault, Crise de la médicine, in Dits et écrits, 43. 43. In his first two books, Folie et déraison, and La naissance de la clinic, Foucault directly considers the formative role that medical knowledge and institutions play in the constitution of “modern man.” Over the next twenty years, medicine continues to occupy Foucault’s interest both directly (for example, in Les machines à guérir, the work on hospitals which he coedits in 1979, or in the lectures on health care he gives in Brazil) and indirectly (as in the way medicine functions in La vo­ lonté de savior to inform the apparatus of sexuality), though these later studies have received much less attention among scholars of medicine. See Foucault, “La politique,” 7–18; Foucault, “Crise de la médicine,” in Dits et écrits; Foucault, La naissance de la biopolitique; and Foucault, “L’incorporation de l’hôpital dans la technologie moderne,” in Dits et écrits. 44. Somewhat redressing this aporia are Petersen and Bunton, Foucault, Health, and Medicine; and Jones and Porter, Reassessing Foucault. Also, numerous recent works extend Foucault’s inquiry, such as Rabinow, Making pcr and A Machine to Make the Future; Rose, Politics of Life Itself; Hacking, Rewriting the Soul; Franklin, Embodied Progress and Dolly Mixtures; Fassin, When Bodies Remember; and Sunder Rajan, Biocapital, among others. 45. The term “immunophilosophy” was coined by the anthropologist Emily Martin in her groundbreaking book Flexible Bodies, 91–112. 46. Foucault, Discipline and Punish, 31. 47. Foucault discusses genealogy in numerous texts. One succinct formulation appears in “What Is Critique?” (Lotringer and Hochroth, The Politics of Truth), where he states: “Genealogy, that is, something that attempts to restore the conditions for the appearance of a singularity born out multiple determining elements of which it is not the product, but rather the effect. A process of making it intelligible but with the clear understanding that this does not function according to any principle of closure. . . . Therefore schematically speaking, we have perpetual mobility, essential fragility or rather the complex interplay between what replicates the same process and what transforms it” (57–58). 48. Foucault, “Nietzsche, Genealogy, History,” 147–48. 49. Foucault, “The Impossible Prison,” 277. 50. Foucault, Society Must Be Defended, 9. 51. Nietzsche, On the Genealogy of Morals, 23. 52. Burnet, Self and Not-Self, vii; Tauber, “The Elusive Immune Self.” For a detailed reflection on Burnet’s legacy, see Podolsky and Tauber, The Generation of Diversity. 53. Silverstein, “There Is Only,” 177. 54. Langman and Cohn, “Editorial Introduction,” 159. 55. Ibid. Critiquing “self/nonself ” as the basis for immunological function, Pradeu and Carosella, in “The Self Model,” propose “continuity” and “(strong) discontinuity” as a more adequate to explain the empirical data about immune response.

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56. In The Politics of Friendship, Derrida offers an extended meditation on Aris­ totle’s formulation of this problem. 57. Burnet, Biological Aspects, 23–24. 58. Jerne, “Natural-Selection”; Burnet, “Modification of Jerne’s Theory.” 59. Langman and Cohn, “Minimal Model,” 190. 60. Irun Cohen, Tending Adam’s, 5. 61. Irun Cohen, “Discrimination,” 215. 62. See Anderson and Matzinger, “Danger,” for the three rounds of defense and response in Seminars in Immunology (2000). Also see the following works by Matzinger: “Danger Model in Its Historical Context”; “Danger Model: A Renewed Sense”; “Innate Sense of Danger”; “Innate Sense of Difference”; “Tolerance, Danger.” 63. Matzinger, “Danger Model in Its Historical Context,” 8. 64. See the full text of Bush’s address “A Nation Challenged,” New York Times, September 21, 2001. William Safire introduced this trope in his New York Times oped piece on September 12, 2001, when he asked: “What are we doing to protect our skies, to develop innate immunity and multivalent vaccines, and to carry the war to the enemy?” There is more than a slight bit of irony in this usage, since in the months preceding the events of September 11, 2001, the U.S. government had been seeking to abrogate the treaty founding the World Criminal Court and was threatening not to participate in any United Nations peacekeeping missions unless U.S. soldiers received “immunity” from un jurisdiction. See Crossette, “War Crimes”; Schmemann, “U.S. Links Peacekeeping”; Richardson, “America’s Interest”; and Alvarez, “Bush Faces.” Almost as if ghosting this political mobilization of immune discourse by the Bush administration, Jacques Derrida uses the metaphor “autoimmunity” to meditate on 9/11 as the return, or turning back, of a political violence that the United States thought to defend itself against with its violent interventions elsewhere—especially in the name of “democracy.” See Derrida, Rogues. Also see the long interview “Autoimmunity.” On Derrida’s use of the trope of autoimmunity, see Haddad, “Derrida and Democracy”; and Esposito, Bios. From the perspective developed here, Derrida’s use of autoimmunity proves somewhat problematic. It neither takes into account the internal tensions between politics and law realized within the juridical trope “immunity” itself nor notices that medical discourse then unwittingly adopts and grafts them onto liberalism’s endorsement of self-defense as the first natural right. Thus the reprisal of immunity’s genealogy in autoimmunity remains unrecognized by Derrida.

1. Living Before and Beyond the Law

1. Wells, War of the Worlds, 187. 2. In contexts where biomedicine is less dominant but not unknown, the metaphoric effects of biological immunity are more complex, as the cross-cultural analy­ ses of medical anthropology illustrate. See the conclusion to this book for an

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account that considers how immunological discourse produces conflicting effects in the discourses about AIDS in South Africa. 3. See, for example, Delves and Roitt, “Advances”; Chien and Shearer, “Advances”; Dinakarpandian, Lee, and Chitra, “Applications of Medical Informatics”; Chan and Kepler, “Computational Immunology.” 4. Smolin, Life of the Cosmos, 145. 5. Arbib and Hesse, The Construction of Reality, 156. 6. Coetzee, “Newton and the Ideal,” 10. 7. Isabelle Stengers discusses the notion of “interest” from the Latin interesse, “to be situated between,” as the basis for the collective action which defines science in Power and Invention, 83–84. Also see Bachelard’s earlier use of interest (interet) to describe what he characterizes as the “affective base” (la base affective) of scientific thought (Formation, 7). 8. Stengers makes the point succinctly: “Material, electron, vacuum do not receive an ‘operational’ definition, as if it were simply enough to decide to subject them to an operation; rather, they become that on which we are now able to operate, and it is this ‘we’ that is decisive, the creation of a collectivity with which matter, electron, or the vacuum will now make history. It is from the political definition of this collectivity that epistemological terms such as objectivity or theory take on meaning” (Power and Invention, 94). 9. This strategy was controversial even in Newton’s day, as the objections of Leibniz and Huygens make clear. Newton himself recognized that “figurative” uses of language mediated between—or, to use his words, “artificially adapted”—mathematics and the world but saw this as a problem introduced by having to communicate to lay readers. For an excellent introduction to the question of metaphor in Newton’s theory of gravity, see Coetzee, “Newton and the Ideal,” 3–13. See also I. B. Cohen, “Newton’s Discovery of Gravity.” 10. Moulin, Le dernier langage, 36. See also Moulin’s assertion that “the Pasteurian program rested more on a metaphor that on a concept. Immunity figured only as a ‘concept in waiting’ to use Canguilhem’s expression, whose content remained to be defined.” Moulin, “La métaphore vaccine,” 139. 11. Derrida, “White Mythology,” 259. 12. Bachelard, Formation, 17. 13. Derrida, “White Mythology,” 261. 14. Ibid., 262–23. 15. Nietzsche, Philosophy and Truth, 92. 16. Lakoff and Johnson’s Metaphors We Live By plays on this same idea. 17. See, for example, the false etymology provided in Roitt, Essential Immunology: “It is these defense mechanisms which can establish a state of  immunity against infection (Latin immunitas, freedom from) and whose operation provides the basis for the delightful subject called ‘Immunology’ ” (1). Or in Rao, Introduction to Immunology: “The word ‘immune’ (Lt: immunis meaning exempt) implies freedom from a burden: an organism which develops immunity to a specific infecting agent will remain free of infection by that agent life long” (1). See also Golub, Immunol-

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ogy: A Synthesis, 2; Klein, Immunology, 14; Todd and Spickett, Immunology, 3; Sell, Immunology, Immunopathology, and Immunity, 3. 18. Sell, Immunology, Immunopathology, and Immunity, 3. 19. Related words are mundo (to clean); mundus (clean, neat, elegant); mundus (world, universe); munero/munerior (to give, present); munimentum (for­ tification, protection, defenses); munio (to fortify, defend, protect, also to build a road); munitio (fortifying, defense works, bridging, fortification); munus, muneris (service, office, function, duty, gift). Thanks to Sara Warner for her Latin expertise. 20. Obviously the particulars of Roman citizenship are much more complex than such a statement indicates—especially as they change during the movement from empire to republic and beyond. For a general outline of the qualifications of citizenship with respect to municipia, see Tellegen-Couperus, Short History of Roman Law, 29–37; Crook, Law and Life of Rome, 36–47; Heitland, Last Words, 11–57; and Abbott and Johnson, Municipal Administration, 3–9, 39–53. 21. Sherwin-White, The Roman Citizenship, 32. 22. Abbott and Johnson, Municipal Administration, 8. 23. Greenidge, Legal Procedures of Cicero’s Time, 99. 24. Sherwin-White, The Roman Citizenship, 57–58. 25. On autochthony as the foundational fiction of “fraternal” notions of citizenship (as in the Roman myth of Romulus and Remus), see Derrida, The Politics of Friendship. 26. Agamben, Coming Community, 86. Esposito provides an alternative derivation of what he calls the “paradigm of immunization” (Bios, 45–77). 27. Abbott and Johnson, Municipal Administration, 40. 28. Balibar, “Citizen Subject,” 47. Balibar is describing the action of “election” in the wake of the French Revolution. Nevertheless the “alchemical” dimension inheres, I believe, in how the concept conserves the contradictions of political subjects while acting on them, which is also the case for immunity. Chapter 3 takes up the question of postrevolutionary French citizenship at length to characterize the horizon within which biological immunity appears. 29. On the nonrational, magical efficacy of the state, see Taussig, Magic of the State. 30. An alternative but weaker derivation of common, commune, community, communion, communication is com + unis, meaning “together one.” Corlett’s Community without Unity, explores the lineage of these alternate etymologies—as well as the contradictions they engender—in the history of political theorizing about community. 31. Grubbs, Law and Family, 25. Later Grubbs notes: “Many subjects who were liable to curial munera sought refuge from their municipal responsibilities in the service of the church” (137). 32. Arendt, The Human Condition, 34. 33. Rosenwein, Negotiating Space; Harding, Medieval Law. 34. Harding, Medieval Law, 15.

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35. The “science wars” polemics have been compiled in a number of sources. See, for example, Editors of Lingua Franca, The Sokal Hoax; Labinger and Collins, One Culture; Sokal and Bricmont, Fashionable Nonsense; Koretge, House Built on Sand. For an excellent critique of the use of gravity as an exemplar case in these polemics, see I. Livingston, Between Science, 146–59. 36. Alas, biological reductionism too often neglects to notice that contempo­ rary biomedical theories by and large take classical physics as their ground and do not incorporate contemporary understandings of matter and energy derived from relativity or quantum mechanics. Thus while contemporary physics advances different notions of natural law based in probabilistic thinking and uncertainty, we need not take account of them here. For a consideration of scientific medicine’s disregard of contemporary physics, see Dossey, Space, Time, and Medicine. 37. The etymology of the English word “law” derives from the Old Icelandic lag, meaning in the singular “layer stratum,” “share in an undertaking,” “partnership,” “fixed market price,” “set tune,” et cetera, and in the plural having the collective sense “law” (OED). See Livingston, Between Literature, 148. 38. Dawkins, The Selfish Gene. The theoretical biologist Stuart A. Kauffman takes the reductionist premise even further, suggesting in At Home in the Universe that the mathematics of combinations can account for the emergence of life on our planet: “The spontaneous emergence of self-sustaining webs is so natural and so robust that it is even deeper than the specific chemistry that happens to exist on earth; it is rooted in mathematics itself ” (60). For an excellent critique of Dawkins’s logic, see Latour, “Human Social Origins,” 169–87. 39. For a powerful and trenchant analysis of the limits of sociobiology, see Lewontin, Biology as Ideology. For a more detailed and philosophical version, see Levins and Lewontin, The Dialectical Biologist. See also Keller, Refiguring Life and Century of the Gene. 40. For a fun and funny biological critique of genetic determinism, see Sapolsky, Monkeyluv. 41. For a survey of the many schools of vitalism since antiquity, see Wheeler, Vitalism; and Driesch, History and Theory of Vitalism. For a contemporary assessment, see Canguilhem, “La connaissance de la vie,” 83–100; for an excellent assessment of Canguilhem’s idea about vitalism, see Greco, “On Vitality of Vitalism,” 15–27. See also Benton, “Vitalism in Nineteenth-Century Scientific Thought,” 17–48; Lenoir, Strategy of Life; Wuketits, “Organisms,” 3–28; Haller, “Great Biologic Problem,” 81–88; Federspil, “Nature of Life,” 337–43. On the complex history of vitalism in the late eighteenth century and the early nineteenth, see Rey, Naissance et développement. 42. Bernard, Leçons, 29. In Creative Evolution (238–48), Henri Bergson addresses Bernard’s vitalism in his discussion of Bernard’s scientific philosophy: “He seeks less to define life than to define the science of life” (243). On the controversies about Bernard’s vitalism, see Normandin, “Claude Bernard,” 495–528. 43. Coleman, Biology, 118–59.

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44. In a review of Watson’s DNA, written to commemorate the fiftieth anniversary of the decoding of DNA’s molecular structure, Coyne succinctly summarizes the effect of this famous discovery: “Darwin showed that simple, natural processes could explain the diversity of life on earth, while Watson and Crick finally demolished the view that there is more to life than chemical interactions” (“Doing Acid”). For an interesting reflection on the current attitude toward vitalism, see Gupta, “Victim of Truth,” 677. 45. On the ongoing vitality of vitalism, see Fraser, Inventive Life. 46. On the history of immunology’s biochemical focus, see Silverstein, A History of Immunology. 47. Kay, “Spaces of Specificity,” in Who Wrote, 38–72. 48. See chapters 3 and 4. See also Worboys, Spreading Germs; and Latour, The Pasteurization of France. 49. Tomes and Warner, “Introduction to Special Issue,” 10. 50. In a more limited sense, the Darwinian notion of inheritance, on which immunity indirectly relies, performs a similar elision between the biological and political valences of a legal concept. However, inheritance does not perform the same kind of conceptual work for evolutionary theory, since it retains its metaphorical status as descriptive rather than instrumental for bioscientific practice. Indeed, until the gene emerged as the hypothetical medium of inheritance, biological heredity appeared more a matter of animal husbandry than legal delegation of property, as Darwin’s famous discussion in On the Origin of Species demonstrates. 51. Haraway, “Promise of Monsters.” 52. Aquinas, On Law, Morality, and Politics. 53. Blackstone, Commentaries, 41. Contemporary theories of natural law dispense with the theological frame but maintain some version of the normative moral force of these earlier doctrines. See, for example, Finnis, Natural Law; and Fuller, Morality of Law. 54. Zilsel, “Genesis of Concept,” 245–79; Needham, “Human Laws,” 3–32; Milton, “Origin and Development,” 173–98; Ruby, “Origins,” 341–59; Milton, “Laws of Nature,” 680–710. 55. Zilsel, “Genesis of Concept”; Needham, “Human Laws”; Milton, “Origin and Development”; Milton, “Laws of Nature.” 56. Zilsel, “Genesis of Concept”; Needham, “Human Laws.” 57. Ruby, “Origins.” 58. Quoted in Milton, “Laws of Nature,” 684. 59. Derrida, “Force of Law,” 5–6. 60. Ibid., 36. 61. In “Nietzsche, Genealogy, History” (151), Foucault makes a similar point in a somewhat more Nietzschean vein. 62. See Arneil, “John Locke,” 588–603. 63. Bellomo, Common Legal Past, 227. 64. For an excellent introduction to this history see Tuck, Natural Rights Theories. There is a huge literature on natural law and its political effects in the West. See

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also Haakonssen, “Divine/Natural Law”; and Arneil, “John Locke.” On the ecclesiastical context for this debate, see Leff, Heresy, 51–255. 65. Quoted in Tuck, Natural Rights Theories, 21. 66. Ibid., 22. 67. Ibid., 24. 68. I am deeply indebted to the germinal analysis of this relation in Macpherson, Political Theory. 69. Macpherson, “Introduction,” 28. 70. On Hobbes’s relation to canonical versions of natural law, see Bobbio,  Tho­mas Hobbes; Braybrooke, Natural Law Modernized, 90–124. 71. Hobbes, Leviathan, 382–83 [179]; pages in brackets refer to the first edition (1651). As Macpherson discusses at length in Political Theory (197–220), Locke takes up this proprietary formulation and inscribes it as the basis for his theory of governance. 72. Though complexly intertwined, “property” and “propriety” often appeared interchangeably in the seventeenth century, as Schochet demonstrates in “Guards and Fences” (378). 73. Locke, Two Treatises of Government, 2.27. 74. Hobbes’s “scientific” approach derived from his reading of Galileo, whom he visited in Florence during the 1630s. 75. Hobbes, Leviathan, 88 [4–5]. 76. Macpherson, “Introduction,” 29. 77. Hobbes, Leviathan, 189 [64]. 78. Hobbes, Philosophicall Rudiments, 1.vii (original italics). 79. Hobbes, Leviathan, 189 [64]. On the complex possibilities of Hobbes’s understanding, see Gauthier, “Hobbes: The Laws of Nature,” 258–84. 80. Hobbes, Leviathan, 190 [64]. 81. In We Have Never Been Modern, Latour adumbrates the strategic role that this naturalization of politics performs for Hobbes: “Civil Wars will rage as long as there exist supernatural entities that citizens feel they have a right to petition when they are persecuted by authorities of this lower world. The loyalty of the old medieval society—to God and King—is no longer possible if all people can petition God directly, or designate their own King. Hobbes wanted to wipe the slate clean of all appeals to entities higher than civil authority. He wanted to rediscover Catholic unity while at the same time closing off any access to divine transcendence” (19). 82. Hobbes, Leviathan, 189 [64]. 83. Foucault, Society Must Be Defended, 92. 84. Hobbes, Leviathan, 185–86 [62]. 85. Spinoza, The Ethics. 86. Montag, Bodies, Masses, Power, 37. 87. Hobbes, Leviathan, 689 [371]. 88. Hobbes explains his idiomatic use of body on p. 428 [208]. 89. On Hobbes’s political ontology, see Shapin and Schaffer, Leviathan and the Air-Pump, 80–109.

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90. Needless to say, Hobbes’s notion of natural law is not only much more complex but also framed within a political theology that still derives “natural law” from God, but a God who is “the author of nature” (Leviathan, 394 [185–86]). For a detailed discussion of these complex issues, see Gauthier, “Hobbes: Laws of Nature,” 258–84. 91. In Behemoth, Hobbes’s last work, conceived as an extended reflection on the consequences of civil war, he makes this point explicit in part 1: “Besides, you cannot doubt but that they, who in the pulpit did animate the people to take arms in the defense of the then Parliament, alleged Scripture, that is, the word of God for it. If it be lawful then for subjects to resist the King, when he commands anything that is against the Scripture, that is, contrary to the command of God, and to be judge of the meaning of the Scripture, it is impossible that the life of any King, or the peace of any Christian kingdom, can be long secure.” See Montag, Bodies, Masses, Power, 51. 92. For the definitive assessment of the Hobbes and Boyle engagement, see Shapin and Schaffer, Leviathan and the Air-Pump. 93. Variolization entails “grafting” infectious matter from a smallpox pustule into a cut opened on the limbs of a person not yet afflicted (the word “inoculation” derives from the Latin for plant graft). Histories of medicine usually note the introduction of inoculation against smallpox in England during the early eighteenth century as initiating modern immunological practice in the West. Chinese and Islamic schools of medicine, on the other hand, appear to have used it for much longer. The first European accounts on the subject—which Mather reads—were by an Italian and a Greek physician corresponding from Constantinople: Timonius, “Account, or History,” 72–82; Pylarinum, “Nova et Tuta,” 393–99. Credit often goes to Lady Wortley Montagu, wife of the English ambassador to Constantinople, who learned of the prophylactic practice from Islamic medicine. Nevertheless, as Silverstein indicates, by the beginning of the eighteenth century information about the non-Western practices of inoculation already circulate through Western scientific literature (25–28). Silverstein notes that much of this literature appears as communications from Europeans who were either in the employ of English corporations (the East India Company) or the foreign service. 94. The literature on Mather and inoculation is copious. See, for example, Beall and Shryock, Cotton Mather; Blake, “Inoculation Controversy,” 489–56; Van de Wetering, “Reconsideration of Inoculation,” 46–67; Minardi, “Boston Inoculation Controversy.” 95. Mather’s interest in the natural philosophy of the seventeenth century is conspicuous in his tome The Christian Philosopher (1721); see the excellent introduction. See also Jeske, “Cotton Mather,” 583–94. 96. Minardi discusses these dual contexts at length. See Mather, The Angel of Bethesda, 10. 97. Blake, “Inoculation Controversy,” 497. 98. With mixed metaphors flying, Douglass gloats over this in the May 21, 1722, edition of the New England Courant: “Last January Inoculation made a Sort of Exit,

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like the Infatuation Thirty Years ago, after several had fallen Victims to the mistaken notions of Dr. M——r and several other learned Clerks concerning Witchcraft. But finding Inoculation in this Town, like the Serpents in Summer, beginning to crawl about again the last Week, it was in time, and effectually crushed in the Bud, by the Justices, Select-Men, and the unanimous Vote of a general Town-Meeting” (Blake, “Inoculation Controversy,” 497). 99. In the introduction to The Angel of Bethesda, Gordon Jones describes the context and the history of Mather’s manuscript. See also Beall and Shryock, Cotton Mather; and I. B. Cohen, Cotton Mather. 100. In The Christian Philosopher (1721), completed just three years before The Angel of Bethesda, Mather uses a different architectural image to figure the body: a “Holy Temple” (237–38). 101. While derived from an ancient doctrine, the seeds of germ theory are resown in 1546 by Girolomo Frascotoro in De Contagionibus et Contagiosis Morbis et Earum Curatione (On Contagion and Contagious Diseases). See Nutton, “Seeds.” 102. Mather, The Angel of Bethesda, 43–44. 103. Ibid., 44. 104. Ibid., 47. 105. Especially if we are one of the abject sinners, which, according to Calvinist doctrine, we could never know. 106. Hobbes, Leviathan, 184 [61]. 107. Mather, The Angel of Bethesda, 112.

2. A Body Worth Having

1. Locke, Two Treatises of Government, vol. 2, sec. 27. 2. Ibid., vol. 2, sec. 44. 3. Since the middle of the nineteenth century, there has also been another “disembodied” form of legal person, that is, the corporation. It is hardly coincidental that this noncorporeal legal subject, constituted entirely to facilitate the possession and transference of property, nominally affirms its similarity to the embodied person. 4. The discourse of psychoanalysis—especially in its recent feminist and Lacanian incarnations—extensively engages this being-having dynamic through considerations of “being-having the phallus.” See, for example, Lacan, Ecrits, 281–91; Borch-Jacobsen, Lacan, 43–71; and Butler, “The Lesbian Phallus,” 57–92. 5. Armstrong, “Sharing One Skin,” 463–64. 6. See Margulis, Origin of Eukaryotic Cells; Margulis, Symbiosis in Cell Evolution; Margulis and Sagan, Origins of Sex; Margulis and Sagan, Slanted Truths; and Margulis and Sagan, Acquiring Genomes. 7. Sagan, “Metametazoa,” 368–70 (italics mine). 8. Ibid., 380. 9. Haraway, “The Promise of Monsters.”

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10. For excellent critiques of the Darwinian notions of “fitness” as “adaptation to an environment” and an explanation for the coevolution of the organismenvironment dyad, see Lewontin, Biology as Ideology; and Sapolsky, Monkeyluv. 11. On the paradox of individuation as a form of selfhood, see Simondon, “Genesis of the Individual.” 12. The precariousness of this imaginary-yet-real decision is well known to owners of coastal property, where the uncontainable and often uncontained processes of ocean and weather can erase the most well-defined, and defended, property lines. Recent planetary history has underscored this vulnerability as the effects of Cyclone Nargis in Burma, Hurricane Katrina in the Gulf of Mexico, and the 2004 tsunami in the Indian Ocean illustrate. 13. On slavery as social death, see Patterson, Slavery and Social Death. 14. Lilla, Stillborn God. 15. Lovejoy, Great Chain of Being. On Lovejoy’s notion of hierarchy and its correspondence to medieval notions of hierarchy, see Mahoney, “Lovejoy and Hierarchy.” 16. Foucault, Society Must Be Defended, 217–18. 17. Kantorowicz, The King’s Two Bodies. On Kantorowicz’s paradigm, see Agamben, Homo Sacer, 91–103. 18. See, for example, Forset, Comparative Discourse. For a genealogy of the metaphor “body politic” that underwrites this theopolitical paradigm, see Hale, Body Politic. 19. On the body-head distinction, see Cavarero, Stately Bodies, 99–120. 20. Foucault, Society Must Be Defended, 102. 21. James I, “A Speech to the Lords and Commons of the Parliament at WhiteHall, on Wednesday the XXI of March, Anno. 1609,” quoted by Glenn Burgess, “Divine Right of Kings Reconsidered,” 848. 22. Foucault, History of Sexuality, vol. 1, 136. 23. Daly, “Idea of Absolute Monarchy.” 24. Habeas corpus continues to propose a limiting principle on improper uses of executive authority to incarcerate people, as illustrated by its recent invocation in cases of individuals detained after September 11 or of prisoners held by the U.S. military at Guantanamo. See Butler, Precarious Life, 50–100. 25. Section 39 of the Magna Carta, which King John I assented to under duress at Runnymede in 1215, reads: “No freeman shall be taken or imprisoned or disseised or exiled or in any way destroyed, nor will we go upon him nor send upon him, except by lawful judgment of his peers or by the law of the land.” 26. See, for example, Guy, “Origins of the Petition”; and Reeve, “Legal Status.” 27. The form of habeas corpus that appeared by the thirteenth century did not have either the effect or the intent of the modern notion. Initially used to negotiate the competing jurisdictions of different courts, only during the late Tudor period did habeas corpus begin to challenge discretionary imprisonment. See Sharpe, Law of Habeas Corpus. The act, in various versions, was introduced repeatedly between 1668 and 1679 before its final passage. See H. Nutting, “Most Wholesome Law.”

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28. http://www.constitution.org/eng/habcorpa.htm (accessed June 5, 2008). 29. Thanks to Livia Tenzer for her Latin expertise. 30. On the significance of the “plane of immanence” for the critical articulation of modernity, see Hardt and Negri, Empire, 70–74. 31. On the suspension of habeas corpus, see Crawford, “Suspension.” On the state of exception more generally, see Agamben, Homo Sacer. 32. Theories of violence and statehood often derive the early modern establishment of the state and religion as two distinct domains (or powers) from the state’s consolidation of its monopoly on the legitimate use of violence. For an excellent survey and critique of this literature, see Cavanaugh, “Fire Strong Enough.” 33. Philosophers have argued about Locke’s ideas since he published them. In the eighteenth century, Leibniz’s New Essays concerning Human Understanding and Hume’s Treatise of Human Nature refuted various aspects of Locke’s theory of personal identity. More recently Parfit’s Reasons and Persons has unleashed a philosophical riot for and against the “neo-Lockean” perspective. For the tenor of these polemics, see Atkins, “Personal Identity”; and Noonan, “Animalism versus Lockeanism.” 34. Locke added the chapter to the second edition at the instigation of William Molyneux, who suggested that Locke include a discussion of the principium individuationis. Locke acknowledges his fulfillment of Molyneux’s request in a letter to him in August 1693. See Allison, “Locke’s Theory,” 41–42. 35. Cavarero, “Who Engenders Politics?” 97. 36. Christian theology had debated the body’s status for several hundred years. See Bynum, Resurrection of the Body; Vidal, “Brains, Bodies.” 37. There are numerous editions of Locke’s An Essay concerning Human Understanding. By convention all references are indicated by chapter and paragraph and follow the quotation in the text. The citations here are all from book 2, “Of Ideas.” 38. Taylor, Sources of the Self, 174. 39. This does not mean that Descartes had no regard for the living organism or that he had no appreciation for personhood’s corporeality. In his last work, Passions of the Soul, and in his correspondence with Princess Elizabeth regarding the passions, as well as in the posthumously published Description of the Human Body, he explicates the materiality of human life and especially how the passions compound both body and mind. See Cook, “Body and Passions,” 25–48. On Descartes’s relation to contemporary medical thought and his own health, see Shapin, “Descartes the Doctor,” 131–54. See also Gorham, “Mind-Body Dualism,” 211–34; R. Carter, Descartes’ Medical Philosophy; Londeboom, Descartes and Medicine. 40. Coleman, “Significance,” 711–31; G. Meynell, “Database,” 473–86; SanchezGonzalez, “Medicine,” 675–95; Romanell, John Locke and Medicine; Dewhurst, John Locke. 41. Dewhurst, “Review of John Locke’s Research,” 317–40. 42. On Locke’s health, see Internet Encyclopedia, s.v. “John Locke”; and Stanford Encyclopedia, s.v. “John Locke.”

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43. See Virno’s discussion of “labor-power” as embodied potential in Grammar of the Multitude, 81–84. 44. Macpherson, Political Theory. 45. Hobbes, Philosophical Rudiments, book 1, chap. 1, § 3 (hereafter 1.1.3). 46. In Communitas, Esposito eloquently characterizes the Hobbesian perspective: “That which men have in common—which assimilates them one to another more than all other attributes [propriété]—would be the generalized fact that they are killable. Any man can kill any other. This is what Hobbes reads in the somber profundities of the community. This is how he interprets the indecipherable law. The communitas carries within itself the gift of death” (28). 47. Wolin, Politics and Vision, 293–94. 48. Foucault, Society Must Be Defended, 95–96. 49. Mbembe, “Necropolitics,” 11–40. 50. See Lazzeri, Droit, pouvoir, et liberté; and Montag, Bodies, Masses, Power. 51. On the violent movements and religious factions of the period, see Hill, Century of Revolution. Hobbes himself acknowledges fear as central to his political rationality: “So that man which looks too far before him, in the care of future time, hath his heart all the day long, gnawed on by feare of death, poverty or other clamity; and has no repose, nor pause of his anxiety, but in sleep” (Leviathan, 169). In a short prose autobiography, A Life of Thomas Hobbes, which he translates into a Latin poem, Hobbes literally identifies fear as his twin: My Native place I’m not asham’d to own; Th’ill Times, and Ills born with me, I bemoan: For Fame had rumour’d, that a Fleet at Sea Wou’d cause our Nation Castrophe; And hereupon it was my Mother Dear Did bring forth Twins at once, both Me and Fear. For this, my Countried Foes I e’r did hate, With calm peace and My Muse associate. (2) 52. On the transformations in military institutions and the development of standing armies after the Thirty Years’ War, see Oestreich, Neostoicism , 221–40. 53. Reinert, “Brief Introduction,” 22. 54. On cameralism, see Raeff, “Well-Ordered Police State,” 1221–43; Raeff, WellOrdered Police State; Tribe, “Cameralism and Science,” 263–84; Tribe, Governing Economy; Walker, “Rights and Functions”; Braun, “Economic Theory,” 301–22. For translations of the cameralist writings, see Small, The Cameralists. 55. Cameralism often appears as a continental translation of mercantilism. However, mercantilism seeks to enhance the prosperity of the state primarily through economic regulation (bullionism, import substitution, tariffs, etc.), whereas cameralism governs people’s lives. 56. Walker, “Rights and Functions,” 236. Such total administration entails developing both theoretical and practical knowledge. See Wakenfield, “Books, Bureaus,” 311–20.

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57. Small, The Cameralists, 16. 58. Raeff, Well-Ordered Police State, 144–45 (italics mine). 59. For a discussion of these early quantifiers, see Rosen, “Medical Care,” 159–75. On statistics more generally, see Hacking, The Taming of Chance; and Poovey, History of the Modern Fact. On the reciprocal dynamic between population as an object of knowledge and statistics as a knowledge resource for sovereigns, see Foucault, Sécurité, territoire, population, 280. The OED remarks that the term “statistics” was first “used by Martin Schmeizel (professor at Jena, died 1747) for a course of lectures on the constitutions, resources, and policy of the various States of the world. The German statistik was used as a name for this department of knowledge by G. Achenwall in his Vorbereitung zur Staatswissenschaft (1748); the context shows that he did not regard the term as novel.” Hacking attributes an earlier usage to Gottfried Achenwall referring to “remarkable facts about the state” (24). 60. Caillé, “L’age classique,” 271–80. 61. Knemeyer, “Poliezi,” 172–73. 62. Oestreich, Neostoicism, 156. 63. Ibid., 157. 64. Knemeyer, “Poliezi,” 173. 65. Tribe, “Cameralism and Science,” 266. 66. Justi, Éléments généraux de police, 20. 67. Napoli, “La discourse de la police,” 281–92. Napoli comments that “the essential end [of police] is to envision the means to establish order in all the domains of life” (282; italics mine). 68. Quoted in Small, The Cameralists, 34. 69. Senellart, “La science de la police,” 473–84. 70. Heinrich von Justi, Staatswirthshaft, quoted in Small, The Cameralists, 310. 71. Raeff, “Well-Ordered Police State,” 126. 72. Quoted in Small, The Cameralists, 226–27. 73. Small describes this principle in The Cameralists (324). Foucault, in Sécurité, territoire, population (334), also comments on the political project of “happiness.” Polizeiwissenchaft’s notion of “happiness” differs markedly from that operating in the Anglo-American context, where it forms one pole of an associationalist psychology which holds that humans seek pleasure and avoid pain. Derived from Locke and Hume, this premise gives rise both to the Utilitarian calculus of “the greatest happiness of the greatest number” and to the Declaration of Independence’s affirmation of the “right to life, liberty, and the pursuit of happiness.” See D. Porter, Health, Civilization, 58–61. 74. As the OED indicates, the first meaning of “flourish” is “to blossom, thrive,” from the Latin floresco, “to begin to blossom.” This usage leans on Aristotle’s formulation: “Now it is evident that the form of government is best in which every man, whosoever he is, can act best and live happily” (Politics, book 7, part 2). Or, as a more recent translation puts it: “It is evident that the best politeia is that according to which anyone whatsoever might do best and live a flourishing life.” 75. Frédéric II, L’Anti-Machiavel, 200.

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76. Quoted in Small, The Cameralists, 252 (original italics). 77. Ibid., 228. 78. Ibid., 262. 79. Quoted in Tribe, “Cameralism and Science,” 275. 80. Quoted in Small, The Cameralists, 343. 81. Petty, Political Anatomy. 82. Lindemann, Health and Healing, 77. 83. Carroll, “Medical Police,” 461–94. 84. D. Porter, Health, Civilization, 53. 85. On the context and dissemination of Frank’s texts, see Rosen, “Cameralism,” and “The Fate of the Concept of Medical Police, 1780–1890,” 120–58, both in From Medical Police. On the relation of Frank and Mai, see Kroeger, Concept of Social Medicine, 8. 86. Lensky, “Introduction,” ix. 87. Frank, System of Complete Medical Police, 12. 88. Frank, “The People’s Misery,” 81–100. 89. In “The Politics of Health” (166–82), Foucault recognizes Frank’s intervention as exemplary of the increasing political importance of medicine in the eighteenth century. 90. Frank, “The People’s Misery,” 89. Presciently, Frank anticipates the contemporary understanding of how human illnesses evolved as a result of settled agrarian communities (in which microorganisms and viruses easily cross between species) and urbanization (in which human pathogens easily circulate among humans). 91. Foucault, Naissance de la clinique, 9. 92. Malthus, On Population, 8, 17. Unless otherwise specified, all quotations are from the first edition. 93. Moreover, Malthus holds that such misery reflects God’s intention to mitigate the equally natural tendencies to indolence and sloth: “Consider man as he really is, inert, sluggish and adverse from labour, unless compelled by necessity” (131). See Winch, “Malthus versus Condorcet Revisited,” 52; and Simons, “T. R. Malthus,” 60–75. 94. Malthus, On Population, 38. In subsequent editions, Malthus lightens up enough to include “moral restraint” under preventive checks: “Of the preventive checks, the restraint from marriage which is not followed by irregular gratifications may properly be termed moral restraint” (160). 95. See Winch, Malthus, 16–32; S. Levin, “Malthus and the Idea,” 92–108; LeMahieu, “Malthus and the Theology,” 467–74; and Santurri, “Theodicy and Social Policy,” 315–30. 96. Malthus, On Population, 8. 97. Ibid., 92. 98. Nicholson notes: “Population in Malthus’s text is a code word for sex: the result (population) stands metonymically for the cause (sex)” (“Eleventh Commandment,” 412). 99. Malthus, On Population, 109.

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100. The word “health” appears in just eighteen paragraphs of the Essay’s first edition, most commonly as an adjective (“healthy” or “unhealthy”) describing some aspect of working-class life. Malthus barely entertains how these purely descriptive terms apply. The one extended consideration occurs in an imaginary dialogue with Godwin about what effects the life of the mind has on the body: “The man who takes his temperate meals and his bodily exercise, with scrupulous regularity, will generally be found more healthy, than the man who, very deeply engaged in intellectual pursuits, often forgets for a time these bodily cravings” (86). 101. Malthus, On Population, 370. 102. Ibid., 589. 103. “The most important argument that I shall adduce is certainly not new. The principles on which it depends have been explained in part by Hume, and more at large by Dr. Adam Smith” (Malthus, On Population, 7). 104. A. Smith, Wealth of Nations, 638 (italics mine). 105. Ibid., 324. 106. Ibid., 81. 107. Ibid., 326 (italics mine). 108. Smith elaborates this critical analogy between mercantilism and quackery on p. 638. 109. Packham, “Physiology of Political Economy,” 477. 110. A. Smith, Wealth of Nations, 79. 111. The word “flourish” appears in only eighteen paragraphs of Wealth of Nations, and not once does it refer to living conditions. Most often Smith uses “flourish” to describe various forms of “commerce and manufactures” (862). 112. In Naissance de la biopolitique (288), Foucault reflects on Smith’s political economy as a direct critique of mercantilist and cameralist doctrines of police. 113. Carroll, “Medical Police,” 468. See also Andrew, Philanthropy and Police; White, “Medical Police,” 407–22; Cook, “Policing the Health,” 1–33. 114. A. Smith, “Lectures on Jurisprudence,” 331. 115. Ibid. 116. A cornerstone of liberal political economy and hence a critique of the mercantilist and cameralist theories which precede it, Wealth of Nations posits that a “system of natural liberty” governs more effectively than police regulations imposed by a sovereign. With the exception of spending on public works, Smith defines the sovereign’s function primarily as exercising violence to restrain violence (Wealth of Nations, 651). 117. A. Smith, “Lectures on Jurisprudence,” 334. 118. Ibid., 334, 335, 340. 119. Smith also holds that the capacity to work together for individual and collective well-being distinguishes humans not only from “all other animals,” which do not need such supplemental effort, but also from “savages,” who remain animal-like by failing to comprehend the value added by the division of labor (“Lectures on Jurisprudence,” 340). 120. Ibid., 338.

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121. The distinction between these rationales diminishes when Frank and his followers enthusiastically embrace Jenner’s protocol for their own purposes. See Frank, Medical Police (291), where he muses retrospectively about his career and remembers his endorsement of Jenner’s method as one of his finest moments. 122. Baron, Life of Edward Jenner, 53. 123. The literature on smallpox is copious. See, for example, Glynn and Glynn, Life and Death of Smallpox; Carrell, The Speckled Monster; Tucker, Scourge; J. R. Smith, Speckled Monster; Hopkins, Princes and Peasants; Shurkin, Invisible Fire; Razzel, Conquest of Smallpox. The best comprehensive account of smallpox in the eighteenth century remains Miller, Adoption of Inoculation. 124. On nineteenth-century vaccination and antivaccination campaigns, see MacLeod, “Law, Medicine,” 107–211; Porter and Porter, “Politics of Prevention,” 231–52; Durback, Bodily Matters. 125. Jenner, Vaccination against Smallpox, 73–74. 126. Ibid., 13. Jenner believes that smallpox and cowpox both derive from an infection of horses called “grease,” which causes inflammation and swelling in the heel. Contagion and infection occur when a human agent, “not paying due attention to cleanliness” after attending an ailing horse, then touches a cow’s udders, engendering cowpox. How Jenner imagines the relation between cowpox and smallpox remains obscure. 127. Identifying the “unnatural” domestication of animals, Jenner anticipates current theories about the evolution of human diseases. See R. Porter, Greatest Benefit, 14–44. 128. Silverstein and Miller, “Royal Experiment,” 437–47. 129. Historians of medicine obsess about the so-called Royal Experiment and the role of Lady Mary Wortley Montagu, wife of the British ambassador to Constantinople from 1716 to 1718, in transmitting knowledge about variolization to En­ gland. Miller’s Adoption of Inoculation complicates such anecdotal histories, contextualizing the numerous eighteenth-century experiments (including the Newgate trial and Mather’s and Boylston’s efforts) within the numerous smallpox epidemics that threatened England and its American colonies during the era. 130. As indicated in chapter 1, versions of the technique previously existed in Africa, Asia, and the Middle East. The European and North American discussions considered here are thus somewhat belated. 131. In addition to these material questions, variolization also provoked theological arguments about whether God intended smallpox to afflict those who contracted it and therefore whether the divine plan forbade attempts to forestall it. Miller describes sermons preached in London against variolization (Adoption of Inoculation, 100–11). 132. Nettleton, “A letter from the same Learned,” 50–51. 133. Nettleton, “Part of a letter from Dr. Nettleton,” 211. 134. Jurin, “A Letter to the Learned Dr. Caleb Cotes-Worth,” 214–15. Jurin continued to compile and update his reports based on information submitted to him as secretary to the Royal Society until he resigned this position in 1727.

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135. Miller, Adoption of Inoculation, 121. 136. The entanglement between the technique and the mode of verification it occasioned continues to inform both medical practices (such as vaccinations) and the scientific and political considerations of their value. The recent publication of a translation of Daniel Bernoulli’s Essai d’une nouvelle analyse de la mortalité causée par la petite veriole (1760) in Reviews in Medical Virology makes this link explicitly. See Bernoulli, “An Attempt,” 275–88. 137. Quoted in Miller, Adoption of Inoculation, 170. 138. Miller provides a detailed account of the French struggles over variolization throughout the eighteenth century (Adoption of Inoculation, 172–240). See also Rowbotham, “The ‘Philosophes,’ ” 265–90; and Emch-Dériaz, “Inoculation Justifée,” 65–72. 139. Miller, Adoption of Inoculation, 207. 140. Rowbotham describes the controversy generated in 1763 when the avocat général du roi au parlement ordered both the Faculty of Medicine and the Faculty of Theology at the Sorbonne “to examine the question of whether inoculation was harmful or useful to the human race, whether it was contrary to religion, whether it should be permitted, forbidden or tolerated” (“The ‘Philosophes,’ ” 271). 141. Rosen, “Mercantilism and Health Policy,” 201–19. 142. Lipkowitz, “Physicians’ Dilemma,” 2329–30. 143. The Mémoire was widely circulated and translated. I cite from a 1773 American translation, La Condamine’s The History of Inoculation. 144. See Hacking, Emergence of Probability; Daston, Classical Probability; Hald, History of Probability; Krüger, Daston, and Heidelberger, Probabilistic Revolution. 145. Bernoulli explicitly commends his text to La Condamine to refute variolization’s adversaries (“An Attempt,” 275). 146. Foucault, History of Sexuality, vol. 1, 139. 147. Foucault, “La naissance de la médicine sociale,” 210.

3. A Policy Called Milieu

1. The phrase “right to health” derives from Weiner, “Le droit de l’homme à la santé.” 2. Bloch and Tuetey, Procès-verbaux et rapports, 391. 3. See Dunbar, “Introduction of the Practice”; E. Meynell, “French Reactions”; Bercé, Le chaudron; and Darmon, La longue traque. 4. Darmon details the various trials and the vicissitudes of vaccination’s introduction. 5. Comité Central de Vaccine, Rapport du Comité, 6. 6. Diffusing and maintaining an active and effective vaccine proves difficult, since the vaccine has to be conserved and transferred from one human to another. Vaccinators overcome the difficulty by conscripting orphans and indigents—as well as indigenous colonial subjects—as living hosts. Darmon, La longue traque,

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208–9, maps the vaccine’s diffusion and rates of efficacy in different departments of France. 7. Comité Central de Vaccine, Rapport du Comité, vi. 8. Darmon, La longue traque, 263. 9. Procacci, Gouverner la misère, 176 (original italics). 10. Ramsey, “Public Health in France,” 45. 11. See Doolin, The Frond; Moote, Revolt of the Judges; Ranum, The Fronde; Carrier, Le labyrinthe de l’état. 12. Parker, “Sovereignty, Absolutism.” 13. Lynn, “How War Fed War.” Lynn notes that the French army during the Thirty Years’ War was already the largest it had ever been but that it doubled under Louis XIV. Paying for this force—which Louis did not always accomplish—led to major economic, political, and agricultural difficulties. See also Mousnier, Institutions of France (xv–xvi). 14. Quoted in Jay Smith, “Our Sovereign’s Gaze,” 410. 15. P. Riley, “Police and the Search”; A. Williams, “Police and Public Welfare”; and Daniel Gordon, Citizens without Sovereignty, 9–24. 16. Quoted in Hervé, “L’ordre a Paris,” 210. 17. Foucault, “Politique de la santé,” 10. 18. Foucault, “The Politics of Health,” 170. Unlike the German literature on police, produced by a cadre of professional and academic writers who devote themselves to elucidating cameralism as both policy and practice, France does not develop as reflective an archive. Delamare’s remains the eighteenth century’s most exhaustive treatment, and it testifies both to his personal experience as a royal functionary and to his interest in justifying his position’s value. 19. Schwartz, Policing the Poor, 4. 20. Delamare, Traité de la police, n.p. (the preface from which I quote is unpaginated). For an overview of how religion informs French citizenship, see Merrick, “Conscience and Citizenship,” 48–70. 21. Delamare, Traité de la police, n.p. 22. Kaplan, Bread, Politics, 11. 23. For a consideration of a range of  texts addressing the economic interests, see Rosen, “Mercantilism,” 201–19. 24. Rothschild, Economic Sentiments, 72. 25. Farge, “L’espace Parisien,” 119–20. 26. Hervé, “L’ordre a Paris,” 185–214. 27. Boucher d’Argis, “Police.” 28. Moheau, Recherches et considerations. On the controversy about the authorship of this text as well as for its context, see Chevalier, “Préface a Moheau”; Speng­ ler, “Moheau”; Brian, “L’âge d’or de l’arithmétique.” Significantly, Recherches appears just two years after Adam Smith’s Wealth of Nations. 29. Fage, “Les doctrines de population.” 30. Moheau, Recherches et considerations, 50 [3–4]; brackets refer to pagination of the first edition.

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31. See Moheau, Recherches et considerations, 51 [6], where he dramatically addresses the monarch directly on this point. 32. Ibid., 55 [10–11]. 33. Ibid., 58–59 [17]. 34. Bourguet, “De la population.” 35. Moheau, Recherches et considerations, 202 [145]. 36. Coleman, “Health and Hygiene.” 37. Outram, Body and the French Revolution, 48. 38. Foucault, “Politique de la santé,” 13–14. 39. Baker, Inventing the French Revolution, 153–66. Baker argues that science, and technology more generally, are mobilized ideologically to legitimate royal policy during the period. 40. This account relies on the following sources: Hannaway, “Société Royale de Médecine”; H. Mitchell, “Rationality and Control”; H. Mitchell, “Politics in the Service”; Meyer, “L’enquet de l’Academie”; Peter, “Un enquete de la Société Royale”; and Foucault, Birth of the Clinic, 22–37. 41. Bullough, Development of Medicine; Ramsey, Professional and Popular, 17–70; Léonard, La médicine entre les savoirs. On the “corporate model,” see Goldstein, Console and Classify, 8–40. 42. Rowbotham, “The ‘Philosophes.’ ” 43. H. Mitchell, “Rationality and Control,” 88. 44. Hannaway, “Société Royale de Médecine,” 267. 45. Directed by Emmanuel Le Roy Ladurie, Annales historians have assessed the archive by computer. See Desaive, Médicins, climat, et épidémies. 46. Bourne, “American Constitution”; Marienstras and Wulf, “French Translations”; Crocker, “Le Bill of Rights”; Marshall, “Les droits de l’homme.” 47. Compounding this interpretation, the etymology of the verb “endow,” according to the OED, derives from “endower,” meaning to provide a dowry for a bride or to provide dower for a widow. In either case, the notion of the “endowment” of rights certainly does not appear as coincident with the life of the individual subject but rather as bestowed (patriarchally) in the event of, or as a condition for, a transformation in kinship status. 48. Guilbert-Sledziewski, “Quel droits,” 173. 49. Of course, full political rights actually redound only to (some) men. On the legacy of sexual distinctions carried within the “rights of man,” see Scott, Only Paradoxes. 50. Procacci, Gouverner la misère, 79. 51. Indeed, it endures today, in new and even more vivid terms. See, for example Fassin, “Biopolitics of Otherness.” 52. It also potentially elucidates the Terror’s fatal frenzy, since death provides a political antidote to the birth that incarnates those citizens whose lives (seemingly) threaten the nation’s existence. For two recent treatments of the Terror, see Scurr, Fatal Purity; and Andress, The Terror. 53. Baker, “Representation,” 477.

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54. On tension between political and economic imperatives, see F. Gauthier, “1789–1795: La libéralisme economique.” 55. Bloch and Tuetey, Procès-verbaux et rapports, x. 56. Weiner, in “Le droit de l’homme à la santé,” provides an account of the committee’s internal politics, including the breakaway by some of its physicians to form a new Comité de Santé devoted to the “salubrité publique” and especially to regulating the medical profession. See also Trenard, “Les projets des constituants.” 57. Weiner, Citizen-Patient, 8. 58. The pastoral, according to Foucault, specifies a mode of regulating personal conduct through a logic of spiritual subjection which the devotional practices of the early Christian church incorporate. This pastoral mode shapes the understanding of diverse forms of regulation including God’s regulation of nature, the monarch’s regulation of subjects, the priest’s regulation of the parish, and the father’s regulation of the family. Foucault elaborates his thinking about the pastoral in Sécurité, territoire, population, 119–38, 168–93, 232–59. Foucault also addresses the importance of the pastoral in “Omnes et Singulatim,” and in “Sexualité et pouvoir,” in Dits et écrits, 3, 552–570. 59. Bloch and Tuetey, Procès-verbaux et rapports, 309. 60. Du Boff, “Economic Thought,” 434–51. Du Boff sees the report as “the repository of the most refined French economic thought of the period” (446). 61. Emmanuel Joseph Sieyès’s incendiary pamphlet Qu’est-ce que le tiers état? initially forges this connection. See Zarka, “La notion,” 63. 62. Bloch and Tuetey, Procès-verbaux et rapports, 310. 63. Fleau means a whip or flail and, according to the Dictionnaire de l’Académie française (1762, 1798), provides a shorthand for the “scourge of God,” as in “plague, war, and famine are the three scourges [fleaux] of God.” 64. Bloch and Tuetey, Procès-verbaux et rapports, 391. 65. Ibid., 327. 66. On the Comité de Mendicité’s ambivalent legacy, see Thuillier, “L’Influence,” 549–59. 67. Constitution of the Year One, Article 21. 68. C. Jones, “Picking Up the Pieces,” 57. 69. Ramsey, “Poor Relief,” 288. 70. Woloch, “From Charity to Welfare,” 779–812. 71. Foucault, Birth of the Clinic, 78. 72. On the reconceptualization of the field of practitioners, see Crossland, “Officiers de Santé.” 73. Hospital conditions engendered shocking reports and critiques during the years leading up to the Revolution (most famously Tenon’s Mémoires sur les hospitaux [1788]). Thus the hospital inevitably focused the Revolution’s political concerns about health and illness. See Imbert, Le droit hospitalier de la Revolution et de l’Empire and Le Droit Hospitalier de l’Ancien Regime. 74. Foucault, Birth of the Clinic, 109. 75. Ibid., 136.

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76. Ibid., 84. 77. Sournia, “L’idée de Police.” 78. Staum, Cabanis; Role, Georges Cabanis; Moravia, “Introduction,” vii–xxxiii. 79. Cabanis, Relations, 1.116. 80. Ibid., 1.33. 81. Moravia, “Introduction,” xxxii. 82. On the political nexus from which the Hospital Committee emerges and to which it addresses itself, see Staum, Cabanis, 132–46. 83. Cabanis, Oeuvres philosophiques, 2.3. 84. Ibid., 2.3–4. 85. Cabanis’s theory of sentiment shows his familiarity with Smith’s Theory of Moral Sentiment, whose seventh edition his sister-in-law Sophie de Gouchy (Condorcet’s widow) translates and to which she appends eight letters most likely addressed to Cabanis (see Forget, “Cultivating Sympathy”). While Smith uses the same category to explain why and how concatenations of individual interests can realize the general good, he invests much more explicitly in the individual’s essential and foundational singularity. Thus he restrains and qualifies the social effect of affect, as his famous first sentence indicates: “How selfish soever man may be supposed, there are evidently some principles in his nature, which interest him in the fortunes of others, and render their happiness necessary to him, though he derives nothing from it, except the pleasure of seeing it” (1.1.1). Moreover, Smith’s sympathy is not immediate or personally felt (like Cabanis’s) but mediated and imaginary (1.1.2), not vivid and linking but copied and solipsistic, not gut moving but conceived in “fancy”: “the source of our fellow-feeling for the misery of others, that it is by changing places in fancy with the sufferer, that we come either to conceive or to be affected by what he feels” (1.1.4). 86. Cabanis, Oeuvres philosophiques, 2.3–4. 87. On Coup d’oeil’s context, see Staum, Cabanis, 150–55. 88. In Birth of the Clinic, Foucault’s analysis returns repeatedly to Cabanis. For the specific account of Cabanis’s influence on medical epistemology, see pp. 116–23. 89. Cabanis, Oeuvres philosophiques, 2.221. 90. Ibid., 2.223. 91. Ibid., 2.224–25. 92. Cabanis, Relations, 1.308. 93. Cabanis, Oeuvres philosophiques, 2.317. 94. Cabanis had held medicine as a quasi-sacred calling since his own entry into the profession, as his rather infelicitous poem “Serment d’un médecin, pronouncé le jour de sa réception, en 1783, dans des écoles située en face d’une église, et près d’un hopital” indicates. Cabanis, Oeuvres philosophiques, 2.300–302. 95. Established under the Consulate (Law of 12 Messidor An VIII, June 30, 1800), the Prefet de Police reprises the duties and responsibilities of the Lieutenant générale de police during the ancien régime. Weiner, “Public Health”; La Berge, “Paris Health Council”; La Berge, Mission and Method, 113–47; Ramsey, “Poor Relief,” 289–98.

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96. Unlike its predecessor, it shares its authority with the Prefect of the Seine, whose duties include public works (e.g., water supply, sewer construction, roads and bridges, etc). This bifurcation responds to Paris’s role in fomenting the Revolution and reflects Napoleon’s desire to preempt any such possibility during his reign. See O’Brien, “Urban Growth.” 97. E. Williams, Physical and the Moral, 113. 98. La Berge, Mission and Method, 116. 99. Weiner and Sauter, “City of Paris,” 40. 100. La Berge, Mission and Method, 125. 101. Léonard, La médecine, 150–51. 102. Touvenel, Sur les devoirs, 13, quoted in Ackerknecht, “Hygiene in France,” 123–24. 103. Jacyna, “Medical Science.” 104. Hallé and Nysten, “Hygiène.” This monumental compendium published between 1812 and 1822, eventually comprising sixty volumes, had a strong affinity for hygienic matters, since three members of its editorial board also belonged to the Paris Health Council, and six of them would sit on the editorial board that founded the Annales d’hygiène publique. See Weiner, “Public Health,” 281. 105. Hallé and Nysten, “Hygiène,” 510. 106. Ibid., 550. 107. Foucault, “La naissance,” 222. 108. Hallé and Nysten, “Hygiène,” 608–9. 109. La Berge, Mission and Method, xii. 110. Hallé and Nysten, “Hygiène,” 604. No translation of Frank’s magnum opus was undertaken during the period, though it had already begun to be translated in Italian in 1807. Two other volumes of Frank’s did appear in French: Traité de médecine practique (1817) and Traité sur la manière d’enlever sainement les enfants, fondé sur les principes de médecine et du physique (1798). 111. Marc, “Introduction,” xix–xx. 112. Ackerknecht, in “Hygiene in France,” notes Frank’s influence on a number of hygienists associated with the Annales, including Fodéré and Marc. 113. Kudlick, Cholera, 65–103. 114. La Berge, Mission and Method, 41–42. 115. “Prospectus,” v. 116. Ibid., vi–vii. All quotes in this paragraph refer to this citation. 117. This perspective characterizes the public hygiene project throughout the nineteenth century. See, for example, Tardieu, Dictionnaire d’hygiène: “The material conditions of life exercise on the moral dispositions of man an influence so evident, so direct, that the efforts of a well-constituted society must constantly tend to ameliorate the physical condition [l’état physique] of the greatest number of its members” (I, iii). 118. Coleman, Death Is a Social Disease, 21. 119. Delaporte cites F.-J. Double, Rapport sur le cholera-morbus, lu à l’Académie Royale de Médecine le 13 septembre 1831 (Disease and Civilization, 15).

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120. Benoiston de Chateauneuf, Rapport sur la marche, 188. 121. For example, see Chevalier, Le choléra; Delaporte, Disease; Bourdelais and Raulot, Une peur bleue; Kudlick, Cholera. Numerous monographs extensively consider the epidemic; see, for example, Aisenberg, Contagion, 21–26; Coleman, Death Is a Social Disease, 171–78; La Berge, Mission and Method. 122. Delaporte, Disease, 47–72. 123. Kudlick, Cholera, 38–39. 124. On these terms and this opposition, see Ackerknecht, “Anticontagionism.” Ackerknecht’s essay provoked various critiques, most forcefully that of Pelling, Cholera, Fever. Pelling in turn has been forcefully criticized; see Cooter, “Anticontagionism.” The entire polemic is revisited in Coleman, “What Was Epidemiology?” in Yellow Fever in the North, 173–94. For the contagionist-infectionist divide specifically in relation to the 1832 cholera epidemic in Paris, see Delaporte, Disease, 139–200. 125. The Dictionnaire de l’Académie française, 6th ed. (1832–35), defines foyer as “the foyer of a contagious disease: the place where it inflicts its greatest ravages, or where it first appears and from which spreads later.” 126. Ackerknecht, “Anticontagionism,” 576. 127. Kudlick, Cholera, 76. 128. Delaporte, Disease, 169. 129. Ackerknecht, “Anticontagionism,” 564–65, provides a history of the doctrines. See also J. Riley, Eighteenth-Century Campaign. Chapter 4 considers the relation of contagionism to quarantine at length. 130. Foucault, “La naissance de la médicine sociale,” 217–19. See also BarretKriegel, “Les demeures,” 75–143. 131. La Berge, Mission and Method, 89–98; Coleman, Yellow Fever, 25–55. 132. Chervin was a French physician who had extensive experience with yellow fever as a result of his travels through the southeastern regions of the United States and throughout the Caribbean. Ackerkneckt, “Anticontagionism,” 57–575; Coleman, Yellow Fever, 25–55. 133. Chervin, Examen de nouvelles opinions, 5–6. Quoted in Coleman, Yellow Fever, 43. 134. Delaporte, Disease, 14–45, provides a detailed account of the lead-up to the epidemic. 135. Benoiston de Chateauneuf, Rapport sur la marche, 14–19, describes these arrangements. 136. Ibid., 15. 137. Ibid., 16–17. 138. Kudlick, Cholera, 105–14. 139. Coleman, Death, 172. 140. Villermé analyzed information generated by Villot in “Rapport fait par M. Villermé.” On Villermé’s introduction of statistical techniques, see Coleman, Death, 124–238.

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141. Benoiston de Chateauneuf, Rapport sur la marche, 120–21. 142. Idiomatically this refers to their occupation. The sixth edition of the Dictionnaire de l’Académie française (1832–35) glosses genre de vie as “spoken also with respect to the different occupations and professions of life: to choose an occupation, to apply oneself to a profession” (2:933). In English we might say, the work they perform “for a living,” or today their “way of life.” 143. Delaporte, Disease, 84. 144. Ibid., 86. 145. Benoiston de Chateauneuf, Rapport sur la marche, 124–25. 146. Espèce, according to the sixth edition of Dictionnaire de l’Académie française (1832–35), connotes “sort” or “quality” especially within a larger grouping—hence genus and species. 147. Benoiston de Chateauneuf, Rapport sur la marche, 123. 148. On the Rapport’s use of “conditions of existence,” see Aisenberg, Contagion, 24. 149. The first three entries for “condition” in the sixth edition of the Dictionnaire de l’Académie française (1835) emphasize this interconnectedness: “Condition: The nature, state, or quality of a thing or a person. . . . Condition also signifies the state of a person with respect to his birth (in this sense used ordinarily with the preposition ‘de’). . . . Condition moreover signifies the Profession, the state of which one is” (1:370). 150. Cuvier introduces “conditions of existence” as a fundamental concept of comparative anatomy. See, for example, Discours sur les révolutions, where he gives the example of carnivores to explain the idea. Cuvier employs the concept “conditions” to articulate the individual animal with the species even while distinguishing between them. As “conditions” vary from “general” to “particular,” they induce physiological changes that modulate the singular organism which nonetheless remain true to the “regime” of its species. These two kinds of variation—organismic and environmental—overlap, and their intersection defines the vital dynamism of speciation. See Foucault, “La situation de Cuvier dans l’histoire de la biologie,” in Dits et écrits, 2.77. 151. Benoiston de Chateauneuf, Rapport sur la marche, 124. 152. Coleman describes the ethos of Villermé, the Rapport’s principal analyst: “Poverty meant risk, undue exposure to all the hazards of life; and the poor thus exposed succumbed” (Death, 179). 153. Blandine Barret-Kriegel offers a similar observation: “The commission begins to suppose: misery [la misère] behind illness, society behind the environment, habitat behind the citizen” (“Les demeures,” 119). 154. Cited in Antonetti, Louis-Philippe, 645. 155. Spitzer, “Milieu and Ambiance,” 169. Spitzer notes that at the end of the nineteenth century, Maxwell’s introduction of “field” supersedes the Newtonian sense of milieu at least in physics. In medicine, in part because of the lasting influence of Bernard’s milieu intérieur, this was not the case. On modern medicine’s continued

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reliance on concepts derived from eighteenth-century Newtonian physics, see Dossey, Space, Time. 156. Diderot, Encyclopédie, 10:509. 157. Canguilhem, “Le vivant et son milieu,” in La conaissance de la vie, 130. 158. Ibid., 131–32. 159. Rabinow, French Modern, 131. 160. Jordanova, Lamarck. 161. Étienne Geoffroy Saint-Hilaire (biology), Honoré de Balzac (literature), and Hippolyte Taine (history), among others, invoke milieu. 162. Comte, Cours, 676. 163. Bichat, Recherches physiologiques, 2. 164. Comte, Cours, 677. 165. Ibid., 678. 166. Comte attends the course in “general physiology,” given by Cuvier’s erstwhile protégé Henri de Blainville, from 1829 to 1832. See Comte’s footnote describing his attendance and its influence on his thinking. Comte, Cours, 665. 167. Comte, Cours, 682. In a footnote to the word “milieu,” Comte belatedly acknowledges his heretofore unacknowledged invocation of the term. 168. McClellen, “Legacy of Georges Cuvier,” 23. 169. Comte, Cours, 665. 170. Foucault, “La situation de Cuvier,” in Dits et écrits, 2.77. 171. Canguilhem, Études, 149. 172. Bergson, Creative Evolution, 238. 173. Bernard, Introduction, 119. 174. Bernard, Principes, 11. 175. Canguilhem, Études, 131. 176. Ibid., 131. 177. Bernard, Leçons, 378. 178. Bernard, Introduction, 118. 179. While preparing to write the Introduction, Bernard read and took copious notes on Comte’s Cours. See Olmstead and Olmstead, Claude Bernard, 141–42. While writing the Introduction, Bernard also read a history of philosophy translated by Comte’s individualist antagonist Victor Cousin, whose position, as we will see, is much closer to Bernard’s own. Comte and Cousin represent antithetical approaches to thinking about human existence: whereas Comte’s positivism famously situates humans in society and in the material world, Cousin espouses a philosophy that localizes human subjects in a psychical interiority he called “le moi.” On the divergence between Comte and Cousin, see Simon, “Two Cultures.” 180. Comte, Cours, 692. 181. Hirst, Durkheim, Bernard, 63. 182. Wasserstein, “Death and the Internal Milieu,” 319. 183. Bernard, Introduction, 123. See also Sullivan, “Reconsidering the Wisdom.” 184. Needless to say, Bernard spends much time explaining and justifying the concept which he summarily introduces as follows:

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THERE IS AN ABSOLUTE DETERMINISM IN THE CONDITIONS OF EXISTENCE OF NATURAL PHENOMENA, FOR LIVING BODIES AS WELL AS FOR INANIMATE ONES [LES CORPS BRUTS]. It is necessary to admit as an experimental axiom that with regard to living beings as well as inanimate ones that the conditions of existence of all phenomena are determined in an absolute manner. Whoever would say in other words that the condition of a phenomenon once known and fulfilled, the phenomenon must reproduce itself always and necessarily, at the will of the experimenter. The negation of this proposition would not be anything other than the negation of science itself. (Introduction, 109) 185. Coleman, “Cognitive Basis,” 50. 186. For a comprehensive archival description of the concept’s emergence and development in Bernard’s oeuvre, see the works of Holmes: “Claude Bernard,” “Milieu Interieur,” “Origins of the Concept,” and “La Signification.” For a more recent work, see Grmek, Legs de Claude Bernard. 187. Bernard, “Course de physiologie générale de la Faculté des sciences,” Moni­ teur de Hospitaux (1854), quoted in Holmes, “Origins,” 184. 188. Bernard, “Leçons sur les propriétès physiologiques et les altérations patho­ logiques des liquides de l’organisme” (1859), quoted in Grmek, Legs de Claude Bernard, 135. 189. Margulis and Sagan, What Is Life? 26. The entire quote amplifies the significance of the Bernardian legacy in contemporary bioscience: “Most writers of biology texts imply that an organism exists apart from its environment, and that the environment is a static, unliving backdrop. Organic beings and environment, however, interweave. . . . Independence is a political, not a scientific term.” 190. Holmes, “Origins,” 187. 191. Olmstead and Olmstead, Bernard, 71. 192. Haussmann’s myriad projects (a number of which include basic elements demanded by hygienists, notably sewers, water, wider roadways, more air and light, etc.) respond in part to the 1848 cholera epidemic, one of the precipitating causes of the 1848 revolution that leads to the Second Republic. Three years later, when the Second Empire seeks to prevent further public uprisings, Haussmann’s famous projects, which seek both to remove some of the major complaints (by providing clear water, sewage, better housing, wider thoroughfares with more light and circulation of air, etc.) and to break up urban centers of revolutionary dissent (by tearing them down in the service of these goals), provide a pragmatic means to this end. See Harvey, Paris, Capital of Modernity. 193. Manuscript from Collège de France, quoted in Grmek, Legs de Claude Bernard, 152. 194. Bernard, Introduction, 312. 195. Simon, “Two Cultures,” 46. 196. Cousin’s individualism posits le moi as an interiorized rejoinder to what Goldstein calls “the sensationalists’ fixation of the external environment” (Postrevolutionary Self, 137), and public hygiene incorporates many of the same assump-

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tions about the external environment. Cousin posits the moi as an essential condition of personhood that results from “voluntarily inserting oneself into this entirely interior world” (Cousin, quoted in Goldstein, Post-revolutionary Self, 160). While Cousin’s philosophy invokes a psychic, not a physiological, interiority, the parallels with Bernard’s milieu intérieur seem worth considering. 197. Bernard, Principes, 206–7. 198. Bernard incorporates “freedom” as a biological principle in response to criticisms of “physiological determinism.” For Bernard, physiological determinism provides the basis on which an antivitalist experimental bioscience—or indeed any physical science—can rely. Hence he argues that “the psychic world absolutely does not dispense with [ne se passe point] the physicochemical world” (Leçons, 61), which leads him to his philosophical conclusion: There is necessarily a determinism for moral liberty; that is to say, an ensemble of anatomical and physicochemical conditions which permit it to exist. We affirm this fact and say that the manifestations of the soul, far from escaping physicochemical determinism, find themselves strictly subject [assujetties] to it and never escape it, whatever appearances to the contrary. Determinism, in a word, far from being the negation of moral liberty is on the contrary its necessary condition, as of all other vital manifestations. (Leçons, 61–62) And in a footnote to this passage, he continues: Freedom cannot be indeterminism. In the doctrine of physiological determinism, man is forcibly free. (Leçons, 62) 199. Manuscript quoted in Grmek, Legs de Claude Bernard, 160. 200. Hazareesingh, From Subject to Citizen. 201. Bernard, Leçons, 356–57 (original italics). The conceit continues over several pages and even includes a description of organs: “These organs are in the living body like, in an advanced society, manufacturing or industrial concerns which furnish different members of this society with the means to clothe themselves, to warm themselves, to feed themselves and to enlighten themselves” (358). 202. Ibid., 357. 203. In “Reconsidering the Wisdom,” Sullivan notices a similar paradoxical structure with respect to the biological interpretation of Bernard’s paradigm: “Bernard, in essence, duplicates the dialectic of inner and outer according to which organismic processes are determined. Before Bernard, ‘inner’ was simply inside the organism and ‘outer’ its inorganic environment. To preserve the organism as both determined and free, Bernard splits the interior of the organism into inner and outer again. . . . The brilliance of the concept lies in this ambiguity: the internal environment is both inside and outside the organism” (499–500). With regard to our discussion here, we might reverse this formulation and say also that the external environment, including the political context, is both inside and outside the organism. 204. Bernard, Principes, 142. 205. Ibid., 76–77.

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206. Ibid., 137. 207. Ibid., 123. 208. Derrida, “Plato’s Pharmacy,” in Dissemination, 61–172. 209. On Bernard’s life, see Olmstead and Olmstead, Claude Bernard. 210. Bernard, Leçons, 378. 211. Bernard, Principes, 106 (original italics). 212. Ibid., 285 (original italics). 213. Canguilhem, “L’Idée a médecine experimentale selon Claude Bernard,” in Etudes, 131, 132. 214. Bernard, Leçons, 346.

4. Incorporating Immunity

1. This idiom echoes Carl Schmitt’s “state of exception” in Political Theology. 2. Foucault, La volonté de savoir, 178 [136]; bracketed page number refers to page in the English translation, The History of Sexuality, vol. 1: An Introduction. 3. No doubt this lasting influence derives as much from van Swieten’s political and professional stature as from his scientific insight and authority. Personal physician to the Habsburg empress Maria Theresa, as well as director of the court library and subsequently chairman and director of the medical faculty of the University of Vienna, van Swieten obviously understands smallpox’s political import (like Johann Peter Frank soon thereafter). However (unlike Frank), van Swieten’s concern lies not with the bodies of the empress’s subjects generally but with those of her family particularly. Primarily addressing himself to their safety, his objections to variolization reflect the potential dangers posed to this regal cohort by the procedure’s risk (as discussed in chapter 2). Despite van Swieten’s obvious caution, the empress nevertheless did come down with smallpox in 1767, but she survived and seemed not to hold it against him. On van Swieten’s career, see Brechka, Gerard van Swieten; Kidd and Modlin, “Van Swieten”; Frederiks, “Inflammation of the Mind.” 4. Van Swieten, Commentaries, 15.5. 5. This verb appears at a number of other points in the text to characterize the active quality, if not the sovereign force, of an epidemic. See van Swieten, Commentaries, 15.5, 84, 91, 260. The same idiom appears in the prospectus for the first volume of Histoire et mémoires de la Société Royale de Médecine (1779). 6. Ibid., 15.6. 7. Ibid., 15.12. 8. Eukrasis signified a healthy or balanced blending, and dyscrasia an imbalance or disease. Idio- means “own, private, personal, or distinct.” See Galen, On Diseases and Symptoms, 135. See also Arika, Passions and Tempers, 8. 9. Van Swieten, Commentaries, 1:97. 10. In the almost three-hundred-page text, he invokes the word just two other times, once to describe how a clergyman whom van Swieten knew attributed his “immunity from this dreadful scourge” when visiting parishioners afflicted with

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smallpox to the putative effects of a bean (15.70). The other occurs near the end of the volume when he admonishes physicians to use caution in promising their “patients or their friends, perfect immunity with regard to that point about which many are more concerned than about any other” (15.247). 11. Van Swieten, Commentaries, 15.265. 12. Ibid., 15.96. 13. While evidence from these popular and frequently reprinted dictionaries does not necessarily represent the vanguard of medical theorization, it does illustrate the ways that immunity diffuses through medical discourse as what Ludwik Fleck called “vademecum science,” that is, “simplified, lucid, apodictic science,” where instead of  “constraining proofs . . . the word has already become flesh.” Fleck, Genesis and Development, 112, 117. 14. Littré, Nysten, and Robin, Dictionnaire de médecine, 12th ed., 772. 15. Littré and Robin, Dictionnaire de médecine, 13th ed., 784. 16. Littré, Dictionnaire de médecine, 16th ed., 814. 17. Littré, Dictionnaire de médecine, 17th ed., 814. 18. These remarks rely on more than four hundred examples found in English and French, between 1750 and 1890, thanks to Google’s book database. The searchable database makes it easy to access these citations simply by Googling, for example, “immunity” and “disease”—or “immunity” and any specific disease—during the period. Feel free to check these assertions yourself. 19. Too numerous to track here, the instances generally follow the formula presented in Dechambre, Dictionnaire encyclopédique, vol. 1: “But the Negro [le nègre] enjoys almost total immunity for yellow fever” (291); or “The Jews, according to Boudin,” have enjoyed a remarkable immunity to the plague” (677). 20. Darwin, Origin of Species, 4th ed., xv. 21. Dechambre, Dictionnaire encyclopédique, 752. On the “physiological immunities of race,” see W. Anderson, “Immunities of Empire.” 22. Stelmack and Stalikas, “Galen.” 23. Day, “Practical Treatise.” 24. Ibid., 465. 25. Another royal fellow (and physician extraordinary to the queen), Henry Holland, provides a different metaphorical logic for immunity’s medical usage. In the chapter titled “On Diseases Commonly Occurring but Once in a Life” in Medical Notes and Reflections, he states: “The change from complete liability to immunity is not always perfected at once, but admits of great modification under the causes creating it; or as may be more explicitly stated, from the variations in the state of the body in which the liability consists” (412). Immunity here follows from its opposition to the implied legal frame of bodily liability. 26. I owe this reference to Anne Marie Moulin, who cites it in Le dernier langage, 22–24. 27. On Montpellier as a center of humoral and vitalist thought, see Han, “Le programme.”

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28. Chrestien, De l’immunité, 2. 29. Académie Française, Dictionnaire de L’Académie française, 2.801. 30. Chrestien, De l’immunité, 51 (original italics). 31. Ibid., 65. 32. Ibid., 115, 121. 33. Hamlin, “Predisposing Causes,” 52. 34. R. Evans, Death in Hamburg, 472. 35. Chrestien, De l’immunité, 115, explicitly acknowledges this “borrowing” by asserting a faulty etymology, establishing a pattern that continues even today (as chapter 1 illustrates). 36. Howard-Jones, “The Scientific Background”; “Review of ‘Procès-Verbaux’ ”; Baldwin, Contagion, 127. 37. La Berge, “Edwin Chadwick.” 38. The literature on the English public health movement is extensive. Good places to begin are Hamlin, Public Health; Dean, Constitution of Poverty; Wohl, Endangered Lives; F. Smith, People’s Health; Eyler, Victorian Social Medicine; Pelling, Cholera, Fever; Haley, Healthy Body. 39. The differences between French and English public hygiene recapitulate the eighteenth-century differences in their notions of police. Recall that whereas the French affirmed a comprehensive police project (as discussed in chapter 3), the first English police priority was, in Adam Smith’s words, the “attention paid by the public to the cleanliness of the roads, streets” (as discussed in chapter 2). 40. Chadwick, Report on the Sanitary Condition. Chadwick has been a much eulogized and reviled figure in the history of public health. See Brundage, England’s “Prussian Minister”; R. Lewis, Edwin Chadwick; Finer, Life and Times. Hamlin’s Public Health provides the most complete and compelling account. 41. Hamlin, “Edwin Chadwick.” See also Hamlin, “Could You Starve.” 42. Kearns, “Private Property.” 43. On French sewage debates, see Shapiro, “Private Rights.” 44. Fauvel, Choléra, 54. 45. “The Official Refutation.” See Ogawa, “Uneasy Bedfellows.” 46. Baldwin, Contagion, 213. Howard-Jones, “Scientific Background,” provides a detailed summary of the proceedings. 47. During the debates preceding the 1825 revision of English quarantine law, significant opposition arose both from anti-contagionists and from commercial interests who balked at the interference with their business. Though the law was reauthorized, the length of quarantine (traditionally forty days) and the penalties for violation (traditionally death) were reduced. The law remained on the books until 1896, though it was barely used for most of the nineteenth century. See Mullett, “Century of English”; McDonald, “History of Quarantine”; Luckin, “Final Catastrophe”; Hardy, “Cholera, Quarantine.” 48. General Board of Health, Report on Quarantine. 49. McDonald, “History of Quarantine,” 32.

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50. Baldwin, Contagion, 141. 51. Ibid., 188. 52. Foucault, Discipline and Punish, 189–90. 53. Poovey, Making a Social Body, 115–16. 54. Baldwin, Contagion, 191. 55. See Rothenberg, “Austrian Sanitary Cordon.” 56. The report, delivered by the French inspector general for sanitary services, François Mélier, appears in Tardieu, Dictionnaire d’hygiène publique, 303–5. 57. In France, the conference did spur the promulgation of a new sanitary decree in 1853 that extended quarantine to cholera. See Coleman, Yellow Fever, 95–96. 58. Howard-Jones, “Scientific Background,” 166. 59. Ibid., 170–71. 60. See for example, “Review of ‘Procès-Verbaux,’ ” 118. 61. Baldwin, Contagion, 140. 62. The attending nations include Austro-Hungary, Belgium, Denmark, Egypt, France, Great Britain, Greece, Holland, Italy (Sardinia, the Two Sicilies, and Tuscany), the Papal States, Persia, Portugal, Prussia, Russia, Serbia, Spain, Sweden, Switzerland, and Turkey. 63. Baldwin, Contagion, 141. 64. Fauvel, Choléra, 1–2. The proceedings were disseminated in a number of forms. In addition to the Procès-verbaux, the French delegate Antoine Fauvel produced an official exposé for the emperor (Fauvel, Choléra). The U.S. Congress authorized a translation of the section on cholera’s transmissibility: Report to the International Sanitary Conference. Also, a redaction appears in Archives Diplomatiques 3 ( July–September 1868): 1183–1210. 65. The literature debating contagion frequently distinguishes between cholera nostras, supposedly endemic to Europe, and Asiatic cholera, which “invades” it. 66. Fauvel, Choléra, 552–53. 67. Archives Diplomatiques, 1200. 68. In Discipline and Punish, Foucault underscores the violent order that traditional quarantine protocols against the plague enforce: “The plague stricken town provided an exceptional disciplinary model: perfect, but absolutely violent; to the disease that brought death, power opposed its perpetual threat of death; life inside it was reduced to its simplest expressions; it was, against the power of death, the meticulous exercise of the sword” (207). 69. Rothenberg, “Austrian Sanitary Cordon.” 70. This becomes increasingly clear over the next few decades as theories of disease causality and prevention run athwart changing commercial and colonial interests in the Mediterranean. The opening of the Suez Canal compounds this dynamic, especially after the British assume a major interest in 1875 and then again after 1888 when they undertake to protect the now “neutral” zone. In addition, the Germans, whose colonial possessions are limited compared to France and Britain, try to use the international conferences to limit the advantages of their rivals. See Baldwin, Contagion, 201–43.

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71. Fauvel, Choléra, 12. 72. Ibid., 13–14. On the consequences of the conference for British colonial policy in India, see Arnold, Colonizing the Body, 186–99. 73. Fauvel, Choléra, 17. 74. Académie Française, Dictionnaire de L’Académie française, 2.595. 75. Fauvel, Choléra, 224. 76. Ibid., 225. 77. Nutton, “Seeds of Disease.” 78. Silverstein, A History of Immunology, 1–23. 79. Fauvel, Choléra, 225. 80. Ibid., 227. 81. Ibid., 228. 82. However, even in recognizing this turn, it negatively indicates the implicit order of precedence: “That which concerns the fact of the immunity of individuals plunged into a choleric center [foyer cholerique] is not less worthy of attention than that with respect to locales” (Fauvel, Choléra, 228). 83. For a comparison of German and French health politics, see A. Mitchell, “Bourgeois Liberalism,” 346–64. For an overview of how political context shapes public health policies, see Ramsey, “Public Health in France,” 62–86; and Weindling, “Public Health in Germany,” 119–28. 84. R. Evans, Death in Hamburg, 240; Huerkamp, “History of Smallpox Vaccination,” 617–35; Hennock, “Urban Sanitary Movement.” 85. In The Great Stink of Paris, Barnes summarizes the Third Republic’s ideology: “For the positivist republicans of France, however, large-scale state intervention in any area of social life (with the notable exception of education) was anathema. Remedies for social problems lay in the self-made revitalization of the individual citizen, encouraged and perhaps initiated by the state, and made possible through an amelioration of the milieu in which that citizen lived and worked” (63). See also Ramsey, “Public Health in France,” 77. On the reciprocal relation between Pasteurianism and public hygiene, see Latour, The Pasteurization of France. 86. After the 1874 International Sanitary Conference in Vienna, Thomas White­side translates Pettenkofer’s Cholera: How to Prevent and Resist It in “recognition of the importance of so many of Professor von Pettenkofer’s opinions by most of the delegates at this great international scientific gathering.” Pettenkofer, Cholera, 5. 87. For Pettenkofer’s biography, see Edgar Erskine Hume, Max von Pettenkofer; and A. Evans, “Pettenkofer Revisited.” 88. See, for example, Fauvel, Choléra, 33, 158, 181, 182, 220, 221, 222, 238, 280, 387, 389, 506. 89. See Whiteside’s introduction to Pettenkofer, Cholera, 22. 90. Pettenkofer, Cholera, 27. 91. R. Evans, Death in Hamburg, 262–63. 92. His loyal students continued to affirm this principle after his suicide in 1901. See Howard-Jones, “Gelsenkirchen Typhoid Epidemic.”

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93. Pettenkofer, “Value of Health,” 487–88. 94. The bibliography on Pasteur is—like his life—monumental. One place to begin would be with the biographies: Geison, Private Science; and Debré, Louis Pas­ teur. See also Dagognet, Méthodes et doctrine; and Dagognet, Pasteur sans la légende. 95. Pasteur, Oeuvres, 1.3–13. For a reading of this text, see Latour, “Pasteur on Lactic Acid Yeast.” 96. Pasteur, Oeuvres, 2.342. 97. Farley, Spontaneous Generation, 1. 98. Pouchet, Hétérogenie. On the Pouchet-Pasteur controversy, which has generated its own controversy, see Farley and Geison, “Science, Politics”; Farley, Spontaneous Generation; Roll-Hansen, “Experimental Method”; Geison, Private Science, 110–42; and Gálvez, “Role of the French Academy.” 99. Farley, Spontaneous Generation, 92–120. See also Geison, Private Science, 110– 42; and R. Porter, Greatest Benefit, 428–61. 100. Perthes, De la génération spontanée. See Debré, Louis Pasteur, 171. 101. Pasteur, Oeuvres, 2.333. 102. Geison, Private Science, 110–42. 103. For a sampling of the journalistic debates, see Debré, Louis Pasteur, 160–72. 104. Pasteur justifies this category confusion in “Physiological Theory of Fermentation,” 88. 105. For an explanation of this bio-logic, see Pasteur, “Sur les maladies virulentes, et en particulaier sur la maladie appelée vulgairement choléra des poules,” in Oeuvres, 6.291–312. 106. Pasteur, Oeuvres, 3.481. 107. Geison, Private Science, 36. 108. Koch, “Etiology of Anthrax,” 1–18. 109. Pasteur, “Étude sur la maladie charbonneuse,” in Oeuvres, 6.164–71. See also K. Carter, “The Koch-Pasteur Dispute.” 110. “Parasite” (para + sito) comes from the classical Latin translation of the Greek for “one who eats at the table of another” (OED). On Koch’s innovations in imaging and representation, see Schlich, “Linking Cause.” 111. K. Codell Carter suggests in “The Development of Pasteur’s Concept” that Koch honed his postulates in response to his disagreement with Pasteur about anthrax’s causality. 112. Koch, “Etiology of Anthrax,” 16. 113. Koch, “Investigations of the Etiology.” On bacteriological interest in wound infection, see K. Carter, “Ignaz Semmelweis.” 114. Koch, “Investigations of the Etiology,” 48. 115. Ibid., 49. 116. Mazumdar, Species and Specificity, 1–103. 117. Koch, “Investigations of the Etiology,” 51. 118. Latour, The Pasteurization of France, 103. 119. On the “variability of virulence” as the critical element of Pasteur’s experimental project, see Mendelsohn, “Like All That Lives.”

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319

120. Moulin makes a similar point: “Claude Bernard introduced the internal ocean (la mer intérieure). The technique of bacterial culture furnished a metaphor, the organism as a milieu de culture” (Le dernier langage, 36). 121. Debré, Louis Pasteur, 346–51. 122. Geison, Private Science, 125. 123. Debré, Louis Pasteur, 301. 124. Pasteur, Oeuvres, 6.310. 125. Ibid., 6.308. 126. Ibid., 6.295. 127. Mendelsohn argues that Pasteur’s reliance on “variable virulence” demonstrates that his project incorporates “the relationship of a variable biological property, virulence, to environmental and host milieux” (“Like All That Lives,” 11). Thus Mendelsohn concludes: “In fact the Pastorians’ virulence-based disease theory came closer to environmental and even anticontagionist epidemiology since the Enlightenment than to the new world of circulating dangerous germs revealed by investigators like Pasteur himself or the traditional contagionist doctrines that he is usually taken to have vindicated” (11). While variable virulence does seem to invert Pettenkofer’s notion that the Cholerkeim must ripen in the soil (for Pasteur, exposure to oxygen in the air can diminish virulence), the difference lies in how they imagine “environmental and host milieux.” For Pettenkofer, the human organism, as both biological and economic being, lives in a sociopolitical environment whose material conditions inform the germ’s virulence, whereas for Pasteur, the microbe, as biological and political agent whose virulence may vary, moves between the milieu extérieur and the milieu intérieur, both conceived as natural environments. 128. Pasteur, Oeuvres, 6.294, 6.299. 129. Dyche’s Dictionnaire universel defines récidive as “relapse, second fall, whether into illness or fault” (310). This usage becomes so commonplace that Roubaud, in Nouveau synonymes francois (36–37), distinguishes between “relapse” (rechute) and “recidive,” attributing “relapse” to “Medicine and Morals” (“a sick person [un malade] or a sinner has a relapse”) and “recidive” to “Jurisprudence and Penal Law” (“a guilty person or a delinquent [has] a recidive”). The same distinction pertains in the nineteenth century. See, for example, Guizot, Dictionnaire universel, 261. 130. The Google books database contains hundreds of examples illustrating this use of “recidive” throughout the eighteenth and nineteenth centuries. In the last decades of the nineteenth century, recidive and immunité begin to overlap. 131. Hacking, “Making Up People.” 132. Pasteur, Oeuvres, 6.295. 133. Moulin, Le dernier langage, 47. 134. Koch, “Etiology of Tuberculosis,” 84, 87. 135. Mazumdar, Species and Specificity, 82. 136. Ibid., 82. 137. Ibid., 76–77. 138. Quoted in Gradmann, “Invisible Enemies,” 16.

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139. De Kruif, Microbe Hunters. On the errors in this famous account, see Howard-Jones, “Choleranomolies.” For a more historical medical historiography, see Coleman, “Koch’s Comma Bacillus.” 140. Coleman, “Koch’s Comma Bacillus,” 327. 141. K. Carter, “Disease Causation,” 537, 543. 142. Coleman, “Koch’s Comma Bacillus,” 337. 143. R. Evans, Death in Hamburg, 264–75. 144. Ibid., 271. 145. Koch, “On Bacteriological Research,” 186. 146. See, for example, Pasteur’s testimony before the Conseil d’Hygiéne Publique et de Salubrité on March 9, 1888. Pasteur, Oeuvres, 7.125. 147. Bucchi, “Public Science.” On the popularization of germ theory as a gendered and gendering process, see Tomes, Gospel of Germs. 148. Latour, The Pasteurization of France, 104. 149. On the institute’s complex financing, see Löey, “On Hybridizations.” 150. On the bacteriological developments in Russia during the period, see Hutchinson, “Tsarist Russia.” 151. Tauber and Chernyak, Metchnikoff and the Origins of Immunology, 25–67. 152. Todes, Darwin without Malthus. 153. Tauber and Chernyak, Metchnikoff and the Origins of Immunology, 92. 154. Quoted in Todes, Darwin without Malthus, 92. 155. Metchnikoff, “La lutte pour l’existence.” 156. Tauber, The Immune Self, 21. 157. Tauber and Chernyak, Metchnikoff and the Origins of Immunology, 148. 158. Mendelsohn, “Like All That Lives,” 12. 159. Metchnikoff, “Researches on the Intracellular Digestion,” 90. (This is the English translation of the 1883 German version.) 160. Ibid., 111. The implied opposition perhaps provides at least a partial expla­ nation for why Koch and his colleagues did not embrace Metchnikoff and his phago­ cytes very enthusiastically. Tauber and Chernyak, Metchnikoff and the Origins of Immunology, 135–53. 161. Metchnikoff, “Yeast Disease of Daphnia.” The original appeared in Archiv für pathologische Anatomie und Physiologie 96 (1884): 178–93. 162. Metchnikoff, “Concerning the Relationship,” 761. Originally published in Virchow’s Archiv für pathologischen Anatomie 97 (1884): 502–6. 163. Metchnikoff, Lectures on the Comparative Pathology, 2–3. 164. Metchnikoff, Immunity in Infective Diseases, 176. 165. Metchnikoff, “Sur la lutte des cellules,” 326. 166. Metchnikoff, Lectures on the Comparative Pathology, 28. 167. Metchnikoff, “Sur la lutte des cellules,” 328. 168. Ibid., 333–34. 169. Metchnikoff, Lectures on the Comparative Pathology, 108–9. 170. On the history of defensive metaphors in Western medicine, see Rather, “On the Source and Development.”

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321

171. Hutchinson, “Tsarist Russia,” 428–29. 172. Ibid., 430. 173. Metchnikoff, New Hygiene, 2, 14. 174. Ibid., 34–35.

Conclusion

1. See Silverstein, A History of Immunology; Moulin, Dernier langage; Mazumdar, Species and Specificity. 2. Gradmann, “Robert Koch”; Lenoir, “Magic Bullet.” 3. See Moulin, “Patriarchal Science”; Moulin and Guénel, “L’Institut Pasteur”; Guénel, “Creation”; Laberge, “Les Instituts Pasteur”; Pelis, “Prophet for Profit.” 4. Latour, The Pasteurization of France, 142. 5. For examples addressing the study of colonial medicine, see MacLeod and Lewis, Disease, Medicine; Arnold, Imperial Medicine; Arnold, Colonizing the Body; Arnold, Science, Technology; W. Anderson, Colonial Pathologies. 6. “Letter to South Africa’s President Thabo Mbeki,” www.aidstruth.org/letterto-mbeki.php (accessed August 1, 2007). 7. S. Lewis, “Remarks.” 8. Bernard, Pensées: Notes detaches, 76–77. 9. Lock, “Displacing Suffering,” 210. 10. Ibid., 211. 11. For a wonderful example of the process by which such thinking changes in southern Africa, see J. Livingston, Debility and the Moral Imagination. 12. Fassin, When Bodies Remember, 189. 13. O’Manique, Neoliberalism, 4. 14. Ibid., 5–6. 15. Farmer, Infections and Inequalities, 40. 16. The text of the Durban Declaration was published in Nature 406, no. 6791 ( July 6, 2000): 15–16. 17. The text of Mbeki’s speech can be found at www.virusmyth.net/aids/news/ durbspmbeki.htm (accessed August 1, 2007). All further references will be to this site. 18. Jon Cohen opines: “Not only is Mbeki publicly flirting with scientifically discredited ideas about the cause of AIDS, but a leading skeptic of HIV ’s role in the disease has been invited to serve on a panel to discuss how South Africa should deal with the crisis” (“AIDS Researchers,” 590). 19. Foucault, “Discourse on Language,” 223–24. 20. See, for example, J. Cohen, “A Research Renaissance,” 2169; and Chaisson, “World AIDS.” 21. Derrida, The Politics of Friendship. 22. Metchnikoff, “Sur la lutte des cellules.” 23. Haraway, “Bio-Politics”; E. Martin, Flexible Bodies.

322 

notes to conclusion

24. On the confusion between “causes” and “agents” in bioscience, see Lewontin, “Causes and Their Effects,” in Biology as Ideology, 39–58. 25. Fassin, When Bodies Remember, 253. 26. As I write this in June 2008, the Iraqi and U.S. governments have reached an impasse about whether contractors (like Blackwater International) will remain immune from prosecution for acts of violence committed in Iraq, thereby threat­ ening the future of the U.S. occupation. 27. Haraway, “Bio-Politics,” 224. 28. Indeed, late-nineteenth-century bioscience contained an alternative— though nondominant—explanation that accounted for evolution through cooperation and mutuality, not through competition and the struggle for survival. See Sapp, Evolution.

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Index

Academy of Medicine (France), 178, 180, 181 Ackerknecht, Erwin, 131, 179, 308 n. 124 ACT UP, 273 Africanness, 279 Agamben, Giorgio, 15, 42, 285 n. 27 Aggression, 203–4; immunity and, 2, 260, 281; of microbes, 49, 261, 264. See also War Agriculture, 285 n. 39 AIDS, 3, 4; South African response to, 270–80, 288 n. 2, 321 n. 18 Alien invasion, 32–33 Allopathic medicine, 34 America: rights in, 149–50; variolization in, 62–67 Anatamo-politics. See Discipline Animals: experimentation on, 194–95; human and, 119 Anscombe, G. E. M., 2 Anthrax, 243, 244, 250, 261, 318 n. 111 Anthropology, medical, 287–88 n. 2 Anticontagionism, 179–81, 219, 232, 308 n. 124, 315 n. 47, 319 n. 127

Antiretroviral therapy, 270, 271, 273, 274 Apartheid, 271 Aquinas, Thomas, 50 Arbib, Michael, 35 Arendt, Hannah, 44 Aristotle, 144, 145 Armstrong, Jeanette, 71–72 ART, 270, 271, 273, 274 Atheism, 62, 241 Attack, disease as, 259–60, 262–63, 279. See also War Authoritarianism, 197, 198 Autochthony, 289 n. 25 Autoimmunity, 26–29; Derrida’s use of, 287 n. 64 Autonomy: of individual, 273–74; of organism, 199–201. See also Independence Ayurvedic medicine, 272 Bachelard, Gaston, 36, 288 n. 7 Bacon, Francis, 52, 78, 201, 203 Bacon, Roger, 51 Bacteria, 32–33, 72–73; as cause of disease, 221–22, 240–45, 247–49, 251–54,

360 

index

Bacteria (cont.) 259–62, 265–66, 279; as invasion, 250– 51, 257, 260–62, 266–67, 278; specificity of, 5, 49, 244–45, 250, 269, 283 n. 7 Bacteriology, 30, 242, 244, 248, 253, 258, 267 Baker, Keith Michael, 304 n. 39 Bakhtin, Mikhail, 7 Baldwin, Peter, 222, 223 Balibar, Étienne, 43, 289 n. 28 Bare life, 143 Barnes, David, 317 n. 85 Bergson, Henri, 192, 290 n. 42 Bernard, Claude: Comte and, 310 n. 179; determinism and, 310–311 n. 184, 312 n. 196, 312 n. 198; milieu intérieur and, 30, 132–33, 191–205, 216, 239, 245–46, 254, 258, 266–67, 271, 311 n. 189, 312 n. 203; vitalism of, 47, 290 n. 42 Bernoulli, Daniel, 302 n. 136 Bichat, Xavier, 177, 189, 204–5 Biohistory, 285 n. 26 Biology, 61, 189, 199; as political, 6, 15, 267–68; vitalism versus, 48. See also Medicine Biomedicine. See Medicine Biopolitics: critiques of, 285 n. 27; epidemics and, 178, 217, 225, 228, 230, 266; health and, 148, 239; history of, 15–22; immunity as, 50, 228, 242, 254, 258, 270, 277–79, 281; medicine and, 131–32, 162, 164, 166–67, 220, 222, 223; milieu intérieur and, 195–96, 198; organism as, 7, 49; personhood and, 151, 177, 266; population and, 92, 116, 128, 184. See also Population Biopower, 15, 20–21, 30, 104, 285 n. 26; medicine and, 22, 25, 128 Biotechnology, 194, 270, 284 n. 13 Birth, rights and, 148–50, 152, 304 n. 52 Bismarck, Otto von, 236 Blackstone, William, 50 Blackwater International, 44, 322 n. 26 Blainville, Henri de, 310 n. 166 Blood cells. See Phagocytes Body, 3, 171, 312 n. 201; capitalism and, 71, 111, 145; disease and, 160, 212, 245, 247–48, 253; environment and,

26, 189, 194, 195, 197, 271–72, 278; as fortress, 64, 66, 67, 75, 128; as historical, 7, 23–24; individual and, 14–15, 21, 73–74, 81–82, 149–50, 152, 221, 238, 268, 296 n. 39; in law, 79–80, 295 n. 3; mind and, 300 n. 103; nation and, 158, 223–24, 253, 266; nonmodern conceptions of, 71–74; social, 139, 151–52, 156, 158, 163–64, 177; soul and, 9–10, 21–22, 76, 82–83; state and, 20, 77, 94, 98, 151, 164; as temple, 294 n. 100 Body-as-property: alternatives to, 70–74; boundaries and, 74–75; individual and, 55, 71, 74, 85–86, 124, 145; labor and, 67, 81–82, 87, 154; rights and, 7, 56–57, 69, 88 Bonaparte, Mathilde, 241 Borders: of nation, 180, 217, 223–24, 226, 233, 266; of organism, 8, 33, 65, 223, 233, 266, 278; property and, 74–75 Botany, 95, 112, 231–32 Boucher d’Argis, Antoine Gaspar, 141, 142 Bourguet, Marie-Noelle, 144 Boyle, Robert, 62 Boylston, Zabdiel, 63, 120–22, 125 Buffon, Georges-Louis Leclerc, Comte de, 188 Burnet, Macfarlane, 26, 27 Bush, George W., 31, 287 n. 64 Cabanis, Pierre-Jean-Georges: Bernard versus, 193, 200; on hygiene, 161–70, 175, 176, 193, 306 n. 88, 306 n. 94; theory of sentiment, 163, 306 n. 85; Calvinism, 16, 294 n. 105 Cameralism: definition of, 91–93, 297 n. 55; police and, 94–98, 111–14, 139, 140, 208–9, 238–39, 300 n. 112, 303 n. 18 Cancer, 4 Canguilhem, Georges, 131, 192–93, 203, 204, 288 n. 10 Capitalism, 220, 236; AIDS policy and, 273–74, 276, 279–81; body and, 71, 88, 200; medicine and, 239, 269–70, 274. See also Labor; Political economy Carroll, Patrick, 113 Carter, K. Codell, 252, 318 n. 111

index  Catachresis, 285 n. 25 Catholic Church, 44, 53–54, 125, 242, 292 n. 81 Causality, 12. See also Disease causality Cavarero, Adriana, 82 Chadwick, Edwin, 219, 220, 222, 234, 236, 237 Chakrabarty, Dipesh, 284–85 n. 23 Chaptal, Jean Antoine, 135 Charity, 134, 136–37, 153, 156, 164 Charles I, 78 Charles II, 78 Charles X, 175, 178 Chernyak, Leon, 256 Chervin, Nicholas, 180, 181, 308 n. 132 Chinese medicine, 272 Cholera: germ theory and, 224, 226, 237, 239, 243–44, 248, 251, 252, 260, 265–66, 308 n. 124; immunity and, 66, 218, 228–34, 317 n. 82; milieu and, 185–86, 201; public medicine and, 131, 170, 177–78, 181–82, 217, 219, 221–24, 311 n. 192; types of, 316 n. 65 Cholera Commission for the German Empire, 237, 252 Chrestien, André-Thèrése, 213–17, 229, 233, 249, 315 n. 35 Christianity. See Religion Citizenship: French, 135–37, 150–52, 158, 289 n. 28, 317 n. 85; medicine and, 160, 164, 181–82; Roman, 41–43, 289 n. 20, 289 n. 25 City: epidemic and, 178–79, 182–83, 238; immunity and, 231; as milieu, 197; organism as, 199–200. See also Munera Class, economic, 145, 234, 254–55. See also Poverty Clausewitz, Karl von, 6, 202 Coetzee, J. M., 35 Cohen, Irun, 27–28 Cohen, Jon, 321 n. 18 Cohn, Ferdinand, 243 Cohn, Julius, 251 Cohn, M., 27, 28 Cohnheim, Julius, 243 Coleman, William, 177, 186, 251–52, 309 n. 152

361

Collective: health of, 131–32, 147–48, 229; individual and, 92, 111, 124, 130–32, 134–37, 141–42, 148, 151, 152, 156–57, 161–64, 167, 170–71, 173–75, 177, 185, 202, 271–72, 300 n. 119; life as, 142–43, 173, 185, 191, 201. See also Population Colonialism, 53, 75, 211; disease and, 226–28, 269–70, 302 n. 6, 316 n. 70 Comité Central de Vaccine, 134–37, 150 Comité de Santé, 305 n. 56 Comité pour l’Extinction de la Mendicité, 153–58, 161–62 Commission de Médecine à Paris, 146–47 Commonwealth, 56, 59–60, 62. See also State Communalism, 54 Community, 43–44, 281, 289 n. 30, 297 n. 46 Comte, Auguste, 188–98, 204, 310 nn. 166–67, 310 n. 179 “Condition,” 309 n. 149, 309 n. 50 Congress, U.S., 31, 316 n. 64 Consciousness, 83–86 Conseil de salubrité de la ville de Paris, 169 Constantine, 44 “Contagionism,” 179–81, 219, 232, 308 n. 124, 315 n. 47, 319 n. 127 Cooperation, 72, 189, 322 n. 26 Copernicus, Nicolaus, 51 Corvisart, Jean-Nicolas, 177 Cousin, Victor, 197–98, 310 n. 179, 311–12 n. 196 Cowpox, 118–19, 301 n. 126 Coyne, Jerry, 291 n. 44 Crick, Francis, 48, 291 n. 44 Cromwell, Oliver, 78, 98, 138 Culture, 12, 14–15, 21 Cuvier, Georges, 48, 185, 190–91, 194, 309 n. 150, 310 nn. 166 D’Alembert, Jean le Rond, 127, 141, 187–88 Danger: immunity modeled as, 28–29; posed to life, 65, 121, 126 Darmon, Pierre, 135 Darwin, Charles, 48, 211, 255–56, 263–64, 291 n. 44, 295 n. 10

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Daston, Lorrain, 127 Davaine, Casimir, 243 Dawkins, Richard, 47, 290 n. 38 Day, George, 212–13 Death, 16; life and, 189, 204–5, 297 n. 51; organism’s vulnerability to, 56–59, 68–69, 89–90, 115–16, 193, 297 n. 46; population and, 18, 112, 184–86; power over, 20–21 Declaration of Independence (United States), 149–50, 298 n. 73 Declaration of the Rights of Man, 148–50, 152, 154–55 Defense: against disease, 224–25, 227, 251, 254; immunity as, 2–10, 14–15, 20–22, 26–31, 34, 61, 66–69, 206, 209, 217–18, 235, 256–69, 277–81, 286 n. 55, 287 n. 64; medical police and, 100, 104; organism and, 6, 19, 64, 67, 204–5; property and, 54–57, 74–75 de Kruif, Paul, 251 Delamare, Nicholas, 139–41, 153, 155, 303 n. 18 Delaporte, François, 179, 184 Deleuze, Gilles, 284 n. 9, 284 n. 13 Democracy, 287 n. 64 Demography, 102, 142 Derrida, Jacques, 36, 37, 52, 53, 203, 287 n. 56, 287 n. 64 Descartes, René, 51, 56, 76, 83, 84, 192, 296 n. 39 Determinism, 39–40, 47–48, 194, 198, 200, 290 n. 40, 310–11 n. 184, 312 n. 198, 312 n. 203 Development, 200 Deville, Henri Sainte-Claire, 246 Diagnosis, 177, 209 Diderot, Denis, 141 Difference, 9–10, 86–87; in response to disease, 8, 116–17, 206–14, 226–27, 266 Digestion, 257, 261, 262, 267 Diplomacy, 17, 224, 225, 227–28, 232–33 Discipline, 18–20, 30, 128, 222 Disease: differences in response to, 8, 116–17, 206–14, 226–27, 231, 266; germ theory and, 242–44; as invasion, 30, 39, 64–66, 218, 222–26, 235, 250, 253–54, 259–66; milieu and, 160, 201,

216; as social, 101–5, 118–19, 130–32, 147–50, 156, 176–79, 183, 186, 217–18, 220, 271; war against, 4, 254 Disease causality, 216–17, 222, 316 n. 70; environment and, 124, 177, 179, 247, 253; HIV/AIDS and, 270–71, 275–80, 321 n. 18; immunity and, 225–26, 228; microbes as agents of, 49, 239, 242–48, 251–55, 259–61, 265–66, 318 n. 111. See also Germ theory Disposition, 214 Dithmar, Justus Christoph, 95, 96 Diversity, 83–86 Divine right, 22, 50–52, 76–81 DNA, 47, 48, 291 n. 44 Doctors without Borders, 271 Douglass, William, 63, 293–94 n. 98 Du Chatelet, Madame, 187 Duesberg, Peter, 276 Dumas, Alexandre, 241 Duns Scotus, John, 54 Durban Declaration, 275, 277, 278, 279 Dyscrasia, 313 n. 8 École Normale Supérieure, 242 Economy, 135, 198, 238; body and health and, 80–81, 108–16, 124, 136; police and, 113, 140–41; state intervention in, 221. See also Political economy Egypt, 226–27, 251 Ehrlich, Paul, 262, 269 Einstein, Albert, 32 Endowment, notion of, 304 n. 47 Enemy, 66–67, 227, 253, 277, 279 England: body in, 76, 81; cholera in, 178; liberalism of, 113–14, 131, 152, 219, 221, 223; public health in, 124, 219–23, 226, 315 n. 38 English Civil War, 3, 16, 53, 62, 69, 76, 89, 138 Environmentalism, 124–25, 131, 183 Environment/organism relation: as antagonistic, 57–66, 115, 203–5, 263, 278; body-as-property and, 70–74; immunity’s effect on, 2–6, 25–29, 30, 212–16, 232, 263, 266–67, 271, 274–75, 278–81; medicine and, 132, 140, 166, 179, 183, 185–88, 195, 239, 246–48,

index  254–55, 311 n. 189, 311–12 n. 196, 312 n. 203, 319 n. 127; modernity and, 8, 10, 14–15; rights and, 150–51. See also Milieu Epidemic: immunity and, 211, 214–18, 228–31, 234–35, 266, 317 n. 82; as invasion, 30, 66, 218, 222–26, 250–51; milieu and, 185–86, 200–201; nation and, 178, 217–28, 230, 232–37, 250–54, 266; public health and, 117, 131, 177–83, 191, 219, 226, 228, 234, 313 n. 5; as term, 207–8; variolization and, 63, 68, 301 n. 129 Epistemology: of medicine, 30, 36, 40, 132, 168–69, 266; of public hygiene, 176–77 Equality, 149–50, 152 Erismann, Friedrich, 265 Esposito, Roberto, 283 n. 6, 297 n. 46 Eugenics, 166 Eukrasis, 313 n. 8 Eurocentrism, 285 n. 23, 285 n. 27 Europe, 75–76, 90–91, 96–97, 236; cholera and, 226–28; modern, 9, 16–17, 19, 22 Evans, Richard, 252–53 Evolution, 47–48, 188, 255–57, 290 n. 38, 291 n. 50, 295 n. 10; as cooperation, 322 n. 26; as struggle, 257, 260, 263–64 Evolutionary biology, 72–73 Experimental medicine, 120; germ theory and, 242–43, 247; milieu intérieur and, 191–95, 201–3, 245–46, 271–72, 311 n. 184, 312 n. 198; public hygiene versus, 253; as science, 203–4 Facts, 14, 276 Faculté de Médecine de Montpellier, 213 Farge, Arlette, 141 Farmer, Paul, 275 Fassin, Didier, 271–73, 279–80 Fauvel, Antoine, 221, 226, 316 n. 62 Fear, 59, 75, 89–90, 126, 297 n. 51 Fermentation, 242 Feudalism, 9, 11, 30, 51, 75, 88, 93, 138 Field, milieu versus, 309 n. 155 Filth, 219–20 Fleck, Ludwik, 314 n. 13

363

“Flourishing,” 95–96, 112, 155, 298 n. 74, 300 n. 111 Food, 105, 107, 140 Foucault, Michel, 24–25; on biopolitics, 6, 15–18, 70, 191, 285 nn. 26–27; on biopower, 20–22, 104, 128, 285 n. 26, 285 n. 27; on discipline, 18–19, 222; on Europe, 90; on genealogy, 22–24, 284 n. 16, 286 n. 47; on governmentality, 113, 136, 153; on Hobbes, 58, 89; on medicine, 22, 131, 145, 159–60, 172, 276, 286 n. 43, 286 n. 44, 299 n. 89; on pastoral power, 153, 305 n. 56; on police, 139; on quarantine, 316 n. 68; on sovereign power, 78; on war, 283 n. 9 Fracastoro, Girolamo, 231 France, 200, 270; charity in, 134, 136–37, 153, 156, 164; cholera in, 178, 181; citizenship in, 135–37; inoculation debates in, 124–25, 136–37; liberalism in, 131, 133–34, 135–37, 150, 152, 197, 219, 289 n. 28, 317 n. 85; medicine in, 130–31, 134, 146, 219, 315 n. 38; police in, 137–42, 303 n. 18 Frank, Johann Peter, 99–110, 116–17, 160–61, 174–75, 238, 299 n. 89, 299 n. 90, 301 n. 121, 307 n. 110 Franz II, 99 Frederick II, 95 Freedom, 78, 149–50; of organism, 196– 98, 204–5, 258, 312 n. 198, 312 n. 203 Free will, 198 French Revolution: liberalism and, 130–32, 133, 143, 151, 289 n. 28; medicine and, 137, 148, 158–60, 162–63, 168, 170, 186, 305 n. 73; poverty and, 111, 131–132, 152–54 Fronde (French Civil War), 138 Galen, 4, 145, 209, 213, 229 Galileo, 51, 76 Garat, Dominique Joseph, 164 Geison, Gerald, 242, 243 Gender, 184 n. 18 Genealogy, 23–25, 284 n. 16, 286 n. 47 General interest, 151, 157 Genetics, 47, 267, 290 n. 38, 291 n. 44, 291 n. 50

364 

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Germany: cameralism in, 91–92, 139, 140; military of, 251; police in, 93–105, 110, 113, 130, 137–38, 238–39, 303 n. 18; sanitation in, 236–40, 251–52 Germ theory, 239–43, 294 n. 101, 319 n. 127; as defensive, 242–43, 250–51; immunity and, 49–50, 231–32, 235, 249–50, 259–60; milieu intérieur and, 244–48; precursor to, 64–65; public health and, 252–55, 265 God, 54, 149, 241; rationality and, 50– 52, 76 Godwin, William, 105, 300 n. 100 Google Books, 284 n. 15, 314 n. 18, 319 n. 130 Gouchy, Sophie de, 306 n. 85 Governmentality, 22, 113, 136–37, 153, 176–77 Gravity, 35, 57, 290 n. 35 Great chain of being, 77 Grotius, Hugo, 53 Habeas Corpus Act, 53, 78–82, 295 n. 24, 295 n. 27 Habsburgs, 16, 138, 313 n. 3 Hacking, Ian, 127, 284 n. 16 Haeckel, Ernst, 255 Hallé, Jean-Noel, 171–72, 174, 307 n. 104 Hamlin, Christopher, 217, 220 Hannaway, Caroline, 147 Happiness, 70, 92–95, 97, 102, 107, 154–55, 170, 175, 298 n. 73 Haraway, Donna, 50, 73, 278, 280–81 Hardt, Michael, 9 Hartmann, Philip Charles, 212 Haussmann, Georges-Eugène, 200, 311 n. 192 Healing: immunity versus, 4–5, 29, 213, 255, 260–63, 267–68, 280–81; milieu intérieur and, 202–4; as political, 107–12, 116, 176 Health: collective, 147–48, 174, 177; economics and, 23, 103–9, 156–57, 170, 221, 300 n. 104; in French Revolution, 147–51; immunity and, 212, 215, 281; individual and, 173–74, 221, 238–39; milieu and, 140, 147, 201–2, 216, 271, 275, 278–79; morality and, 164–66; right to, 133, 302 n. 1; state and, 96–97,

100–103, 107, 131, 135, 137, 140, 147, 155–58, 236–39 Heredity, 209, 291 n. 50 Hesse, Mary, 35 Heterogenesis, 240–42 Hierarchy: of organisms, 189–90, 200, 284 n. 18; religious, 9, 77 Hippocratism: immunity and, 213; milieu and, 132, 188, 192, 203–4; public medicine and, 140, 145, 147–48, 164–67, 171, 180–86, 199–202 Hirst, Paul, 194 History, 9, 285 n. 28; biohistory, 285 n. 26; evolution and, 256, 264; gene­ alogy versus, 23; of medicine, 197, 240, 293 n. 93, 301 n. 129 HIV. See AIDS Hobbes, Thomas, 54–67, 69, 70, 74, 76, 88–90, 102, 109, 114–16, 124, 151, 196, 264, 267, 292 n. 71, 292 n. 81, 293 n. 90, 293 n. 91, 297 n. 51 Holland, Henry, 314 n. 25 Holmes, Frederick, 196 Holy Roman Empire, 16, 91, 138 Homeland security, 28 Hospitals, 159–60, 305 n. 73 Howard-Jones, Norman, 224 Humans, 37, 50–51, 54, 141, 143, 173, 238; animals versus, 119; as economic, 110–11, 114; as natural and social, 10–14, 57, 190–91, 203–4, 272, 300 n. 119; as species, 163–66 Hume, David, 296 n. 33, 298, n. 73, 300 n. 103 Humoralism, 107, 229; immunity and, 10, 207–10, 212–16, 247, 249, 261–62, 272; milieu intérieur and, 195; variolization and, 67 Hurricane Katrina, 295 n. 12 Huygens, Christiaan, 288 n. 9 Hybrid: body as, 19, 23; epidemic as, 225–26; hygiene as, 167; immunity as, 50, 207, 266; life as, 21; medicine and, 31, 128; milieu and, 132, 191, 195–96; modernity and, 12–15; population as, 108, 184; variolization as, 63 Hygiene, 132–33, 137, 145–46, 160–69, 236–37; immunity and, 233–34,

index  265–67; milieu and, 169–73, 200–202, 216 See also Public hygiene Identity, 83–87, 257, 279, 296 n. 33 Idiosyncrasy, 209–10 Illness. See Disease Immanence, transcendence versus, 10, 12 Immunity: as defense, 2–10, 14–15, 20–22, 26–31, 34, 61, 66–69, 206, 209, 217–18, 235, 256–69, 277–81, 286 n. 55, 287 n. 64; epidemic and, 211, 214–18, 226–35, 266, 317 n. 82; as hybrid, 12–13, 50, 266; inoculation and, 208, 248, 255, 261; law and, 3, 5, 14, 35–36, 40–46, 49–50, 59–60, 120, 210, 249–50, 291 n. 50, 314 n. 25; organism and, 54, 196, 206–17, 233–35, 255–58, 267, 274–75; as term, 39–42, 210–12, 284 n. 15, 288 n. 10, 288–89 n. 17, 313–14 n. 10, 314 n. 13, 314 n. 18 Immunology, 48, 271, 279, 280, 283 n. 7; contemporary, 26–31, 38–39; origins of, 248–49, 257–58, 262–63, 267, 269; textbooks on, 38–39 Imperial Bureau of Health (Germany) , 237, 251, 252 Incarceration, 79, 225, 295 n. 24, 295 n. 27 Independence of organism, 195–98, 204–5, 258, 311 n. 189 India, as source of cholera, 66, 177, 218, 226–28, 251 Individual, 113, 164; body and, 7, 8, 14–15, 55, 71, 74, 85–86; as economic, 136, 221; health and, 228–29, 230, 238, 239, 265–68, 278, 280; medicine as addressed to, 117–18, 128, 143–145, 147–48, 168–69, 173, 175, 199–201, 209, 222–23, 248, 253–54, 266, 271–74, 280–81, 311–12 n. 196; milieu and, 186, 197–202; nonmodern concteptions of, 71–74; population and, 131, 135, 142–43; rights and, 88–89, 149–50, 304 n. 47; species and, 264, 309 n. 150. See also Collective Individualism, possessive, 7, 88, 196. See also Body-as-property “Infectionism,” 179–81, 219, 232, 308 n. 124, 315 n. 47, 319 n. 127

365

Influenza, 216 Information, 49 Inheritance, 291 n. 50 Inoculation. See Vaccination; Variolization Inside/outside, 196, 226, 275, 312 n. 203. See also Milieu intérieur Institute of Pathology (Germany), 243 Institute of Plant Physiology (Germany), 243 Institut Pasteur, 255, 258, 262 Intelligence, 198 Interiority, 81–82, 128, 177, 196, 200–201, 310 n. 179. See also Milieu intérieur International AIDS Conference (2000), 270, 275 International health policy, 217–28, 232–33, 236–37, 250–51 International Sanitary Conferences, 217–18, 221, 223–24, 225, 229, 236, 253, 265, 316 n. 64, 317 n. 86 Invasion: alien, 32–33; epidemic as, 30, 218, 222–26; microbes as, 39, 65–66, 235, 250–51, 253–54, 259–66 Iraq war, 280, 322 n. 26 Islamic medicine, 293 n. 93 James I, 52, 78 James II, 78 Jenner, Edward, 69, 116–18, 134, 136, 207, 211, 246, 248, 301 n. 121, 301, n. 126 Jerne, Niels, 27 John I, 295 n. 25 John XXII, 54 Jones, Colin, 158 Jones, Gordon, 294 n. 99 Joseph II, 99 July Revolution, 178 Jurin, James, 120–22, 125, 301 n. 134 Justi, Johann Heinrich von, 93–94, 97 Kantorowicz, Ernst, 77, 86 Kaplan, Steven, 140 Kauffman, Stuart A., 290 n. 38 Kay, Lily, 49, 283 n. 7 Kepler, Johannes, 51 Knowledge: mathematization of, 123–24; medical, 68, 119–20, 146, 161, 194, 272, 276; scientific, 24, 34–38, 288 n. 8; sensational, 84. See also Epistemology

366 

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Koch, Robert, 215, 221–22, 243–45, 250–52, 256–62, 265, 269, 279, 318 n. 111, 320 n. 160 Kottenkamp, Christian Friedrich 96 Kudlick, Catherine, 178 Labor, 105, 143–44, 154, 200; body and, 10, 70–71, 80–82, 86–87, 110–12; human and, 115, 300 n. 119; illness and, 156–57, 161, 221 Laboratory medicine. See Experimental medicine Lacan, Jacques, 294 n. 3 La Condamine, Charles-Marie de, 125, 127 Lamarck, Jean-Baptiste, 188 Land, 45, 71–74, 77 Langman, R. E., 27, 28 Laqueur, Thomas, 284 n. 18 La Reynie, Nicholas, 139 Lariboisière hospital, 246 Lassone, Joseph, 147 Latour, Bruno, 19, 23, 50, 52, 61, 63, 73, 132, 168, 191, 195, 196, 225, 254; on Hobbes, 292 n. 81; on modernity, 10–15, 284–85 n. 23; on Pasteur, 270 Law: as applying to organism, 45–46, 49–50; body in, 78–80, 88, 294 n. 3; epidemic and, 229, 315 n. 47; immunity and, 3, 5–6, 14, 35–46, 120, 210–11, 229–30, 249, 314 n. 25; police and, 114, 142; social and, 141, 176; as term, 290 n. 37; violence of, 52–53, 62, 114, 284 n. 9. See also Natural law Lebrun, Charles François, 134 Leibniz, Gottfried, 76, 288 n. 9, 296 n. 33 Lensk, Erna, 99 Leopold II, 99 Lewis, Stephen, 270, 272 Liberalism: individual/collective and, 113, 131, 133, 136–37, 151–52, 162, 173–74, 197, 219, 236, 238, 300 n. 116; medicine and, 136–37, 169–70, 173–74, 220–21, 223, 237, 274, 287 n. 64 Liberty: of organism, 59–60, 197–98, 312 n. 198; political economy and, 300 n. 116

Life: bare, 143; as calculable, 69; collective, 142–43, 175; investment by power or state, 15, 18–22, 92, 96–97, 100, 113, 139, 144, 148–49, 158, 184–86; labor and, 157–58, 161; medicine and, 47–48, 176, 207–8, 215, 240–42, 247–48; milieu and, 130, 189–90, 192–95, 200–205; vulnerability of, 56–59, 106–107, 126–27, 280–81 Lindeman, Mary, 98 Livingston, Ira, 290 n. 35 Livingston, Julie, 321 n. 11 Lock, Margaret, 272 Locke, John, 5, 16, 53, 76, 114, 296 n. 33; body-as-property and, 55, 70–71, 81–88, 128, 154 Louis XIV, 138, 303 n. 13 Louis XVI, 153 Louis XVIII, 175 Louis-Napoléon, 197, 236, 241–42 Louis-Philippe, 178, 187–88 Lovejoy, Arthur, 77, 295 n. 12 Luther, Martin, 53 Lutheranism, 16, 53 Lyell, Charles, 48 Lynn, John, 303 n. 13 Machiavelli, Niccolò, 95 Macpherson, C. B., 7, 56, 292 n. 71 Magendie, François, 194 Magna Carta, 79, 295 n. 25 Mai, Franz Anton, 99 Makgoba, William, 276 Malthus, Thomas Robert, 105–11, 114, 116, 118, 136, 178, 247, 248, 299 n. 93, 299 n. 94, 300 n. 100, 300 n. 103; evolution and, 256, 263–64 Margulis, Lynn, 72, 196, 311 n. 189 Maria Theresa, 313 n. 3 Marriage, 108, 112 Martin, Emily, 22, 278 Mather, Cotton, 62–67, 75, 119–22, 125, 173, 209, 264–65, 293 n. 93, 293 n. 95, 294 n. 100 Matter, 46–48, 51, 173–74, 188, 240–41 Matzinger, Polly, 28–29 Maxwell, James Clerk, 309–10 n. 155 Mazumdar, Pauline, 251

index  Mbeki, Thabo, 270–71, 275–81, 321 n. 18 McClellen, Chris, 190 Measles, 179, 211, 216 Mecca, 226 Médecins sans Frontieres, 271 Medical police, 97–105, 109–12, 116–18, 130, 160–61; public health and, 117, 174–75, 237–39 Medical Research Council (South Africa), 276 Medicine: economy and, 156, 164; epidemics and, 147–48, 207–12, 216–18, 225–28, 252–55; healing and, 4–5, 29; immunity as affecting, 6–8, 20, 22, 26, 34, 257–58, 264, 287–88 n. 2, 311 n. 189; individual and, 117–18, 145–48, 159–62, 166–69, 177, 200–202, 248, 265–67, 271–73, 280–81; inoculation and, 63, 67, 116–24, 127–28, 136; metaphors in, 35–40; milieu and, 132–33, 170–71, 192–94, 202–4; modernity and, 7, 13, 31, 130–31, 166–69, 192, 203–4, 244–45, 251, 275, 286 n. 43; police and, 101–3, 110, 140, 144–46; religion and, 97, 175; state and, 98–100, 103, 119–20, 176, 270–80; vitalism and, 46–49 Medium, 187 Mélier, François, 316 n. 56 Mendelsohn, J. Andrew, 319 n. 127 Mercantilism, 111–12, 297 n. 55, 300 n. 112 Metaphor: in science, 34–40, 288 n. 9; in statistics, 123–24 Metchnikoff, Élie, 30, 49, 55, 58, 64, 66–67, 117, 196, 203–5, 210–12, 215, 217, 230, 254, 320 n. 160; immunityas-defense and, 1–5, 206–7, 249, 255–70, 277–78, 281 Miasma, 79, 185, 212, 253 Microbes. See Bacteria Milieu: de culture, 245, 247–48, 319 n. 120; field versus, 309 n. 155; epidemic and, 185–86, 200–201, 219; organism and, 189–91, 214, 216, 319 n. 127; public hygiene and, 169–73, 185–87, 219, 274; as term, 132, 187–89, 310 n. 167. See also Milieu intérieur Milieu intérieur, 132–33, 191–94; germ theory and, 239, 245–47, 248, 256, 267;

367

modern body and, 275, 281; organism and, 194–201, 204, 266 Military, 18–20, 45, 91, 97–98, 303 n. 13; disease and metaphors of, 29, 65–66, 180, 202, 224–28, 250–51, 253, 265; population and, 97 Miller, Genevieve, 124 Modern, 3, 8–13, 19–21, 31, 60–61, 284–85 n. 23; medicine as, 14–15, 23–25, 30–31, 193, 203, 274, 286 n. 43 Modern body, 73–74, 87–88, 150, 284 n. 13; biopolitics and, 15–16, 116; immunity and, 14–15, 23, 29–30, 267–68, 270, 281; medicine and, 23, 69, 274–75; as term, 7–10 Modern Constitution, 11–14, 19, 31, 168 Moheau, Jean Baptiste, 142–45, 303 n. 28 Molyneux, William, 296 n. 34 Monarchs: health of people and, 92, 96– 100, 131–32, 137–40, 143–44, 151–53, 168, 238; religion and, 22, 44, 50–52, 76–81, 171, 292 n. 81, 293 n. 91; violence of; 79–80, 88. See also Sovereignty Montag, Warren, 60 Montagu, Mary Wortley, 293 n. 93, 301 n. 129 Morality, 299 n. 94; health and, 164–66, 168, 176 Moravia, Sergio, 162 Morbidity: epidemic and, 151, 178, 182, 191; immunity and, 213–14 Moulin, Anne Marie, 36, 39, 250, 288 n. 10, 319 n. 120 Munera, 40–44, 289 n. 19, 289 n. 31 Muslims, 226 Nägeli, Carl, 244 Napoleon I, 99, 133, 135, 161, 175, 307 n. 96 Napoleonic Consulate, 135, 159, 169, 306 n. 95 Nation: body and, 77, 112, 152, 158, 223– 24, 233, 253, 266; borders of, 180, 217, 223–24, 226, 233, 266;epidemic and, 178, 217–28, 226, 230, 232–37, 250–54, 266; health and, 19–20, 107, 131–32, 135, 144, 147, 151–55, 160, 162–64; natural law and, 60–61, 76

368 

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National Constituent Assembly (France), 153 Natural law, 50–62, 88–90, 293 n. 90; economy and, 109, 115–16, 220; nation and, 76, 109; organism and, 45–46, 50, 59, 61, 123–24, 171, 197–98, 207, 267, 277, 290 n. 36 Natural right, 149; self-defense as, 2–3, 54–60, 70, 74, 88–90, 196, 267, 287 n.64 Nature: body as, 7, 14–15; economy and, 11, 106, 143–44, 220; as healing, 4, 260, 267; medicine and, 168, 202–4, 280; modernity and, 3, 11–13, 61, 284–85 n. 23; politics and, 61, 63, 108–9, 128, 176, 198, 227, 292 n. 81; as property, 54; social and, 132, 162–65, 177, 182–83, 185–86, 191, 193, 199–200, 202, 220, 254–55; as sovereign, 207; state of, 19, 58–60, 66, 80–81, 86 Nazis, 276 Negri, Antonio, 9 Neoliberalism, 273–74, 279–80 Nettleton, Thomas, 120–121 Newton, Isaac, 35, 51, 76, 187, 188, 288 n. 9, 309–10 n. 155 Nietzsche, Friedrich, 23–25, 37 Nobel Prize, 262 Nonrecidivism, 249–50, 258, 267, 319 n. 130 Numbers, value of, 123–24 Nysten, Pierre-Hubert, 171–72, 173, 174 Oestreich, Gerhard, 93 Okanagan First Nations, 71–72, 75 O’Manique, Colleen, 273–74 Ontogenesis, 47, 257, 264 Organism: as city, 199–200; germs and, 238–40, 243–50, 247; hierarchy of, 190, 200; immunity’s effect on, 1–8, 14, 18, 20, 22, 26–29, 39, 45–46, 49–50, 211–18, 234, 254–68, 274–75, 280–81; individual/collective and, 162, 165, 177, 184–85; milieu and, 130, 132–33, 188–205, 216, 239, 247–48, 319 n. 120; nonimmunological defense and, 54–56, 58, 64–67, 88–90, 196–97, 202–3; political economy and, 107–12,

114–16. See also Environment/organism relation Outram, Dorinda, 145 Outside/inside, 196, 226, 275, 312 n. 203. See also Milieu intérieur Pacini, Filippo, 251 Parasites, 318 n. 110; bacteria as, 243, 248–50, 256, 257, 260, 264 Parent-Duchatelet, Jean Baptiste, 182 Paris, 178, 181–82, 197, 307 n. 96 Paris Health Council, 170 Paris School of Medicine, 167 Parliament (British), 78, 80, 220 Pasteur, Louis, 35, 49, 69, 117, 205, 210, 215, 236, 239, 240–51, 254, 256, 258, 265, 269, 270, 288 n. 10, 318 n. 111, 319 n. 127 Pasteur Institute, 255, 258, 262 Pastoral power, 153, 174–75, 305 n. 56 Pathogens. See Bacteria; Germ theory Patterson, Orlando, 74–75 Peace, 17–18, 91, 93 Peace of Westphalia, 17, 91, 138 Pelling, Margaret, 308 n. 124 Personhood, 75–76, 88, 89, 150–51; body and, 25, 54–55, 70–73, 75, 79–87, 131, 221, 296 n. 39, 312 n. 196; modern, 3, 7–10 Perthes, Jacques Bouchet de, 241 Pettenkofer, Max, 236–240, 243–44, 248, 251–54, 265, 317 n. 86, 319 n. 127 Petty, William, 92, 98 Phagocytes, 256–64, 266–67, 320 n. 160 Phallus, 294 n. 3 Pharmaceutical industry, 273, 274, 279 Pharmikon, 203 Philosophy, 176; milieu and, 187–90, 195–96, 197–99; modern, 60–61; politi­ cal, 15, 53–54, 22, 62, 76, 81, 87–88, 199 Physicians: hygiene and, 167–68, 170–71; milieu intérieur and, 192, 200–201; state and, 98–102; as warriors, 202–3, 251 Physics, 290 n. 36 Physiocrats, 142, 144 Physiology, 159–60, 167, 176, 190, 194, 196, 198, 245, 310 n. 166; milieu intérieur and, 201–3, 298, 312 n. 198

index  Pilgrimages, 226, 228 Pinel, Philippe, 134 Pirogov Conference, 265 Place, immunity and, 231, 233 Plague, 97, 98, 179, 201, 218, 223, 314 n. 19, 316 n. 68 Plato, 203 Podolsky, Scott, 26–27 Poesis, 36 Poison, 202–3 Police, 93–98, 125, 131–32, 137–42, 144– 48, 152–53, 298 n. 73, 300 n. 116, 303 n. 18, 315 n. 38; economy and, 110–14; medical, 97–105, 109–12, 116­–18, 130, 160–61; public hygiene and, 137, 162, 169–75 Political economy, 300 n. 116; health and, 220–21, 273–74; life and, 107–16, 119; milieu intérieur and, 197–200; public health and, 143–44, 151–52, 227–28, 161 Politics: medicine as, 172, 175–76, 271–72, 274–80; milieu and, 187–88, 197–201; as “natural” domain, 165; organism and, 5–6, 15, 40, 45, 150, 163–64, 196–98, 254, 267–68; police and, 141 Poor Law, 220 Poovey, Mary, 10, 223 Population: biopolitics and, 15, 18–21, 30, 128; epidemic and, 181–86, 208–9, 222–23, 231, 234, 266; hygiene and, 144–46, 175, 266; individual versus, 131, 135, 142–43, 222, 253–54, 266; inoculation and, 118, 128, 135–37, 147, 208–9; police and, 69–70, 92–104, 116–17, 125, 131, 139–42; political economy and; 105–8, 112, 116, 143–45, 158–61; public health and, 131–33, 170, 266 Possessive individualism, 7, 88, 196. See also Body-as-property Postmodernism, 284 n. 13 Pouchet, Félix-Archimède, 240, 246 Poverty: AIDS and, 272, 275–80; health/ illness and, 103–5, 130, 155–57, 219–20; police and, 132, 139, 152–54 Prefet de Police de Paris, 169, 306 n. 95 Probability, 127–28

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Procacci, Giovanna, 136, 151 Property, 74–75, 54–55, 220, 238; as immune, 44–45; of monarch, 77–78; organism as, 67; rights and, 7, 55, 70, 113, 152. See also Body-as-property Psychoanalysis, 294 n. 3 Public health: biopower and, 20; germ theory and, 235–37, 252, 254, 258, 266–67; individual/collective and, 128, 132, 136–37, 152; military and, 251; police and, 97, 99–103, 112, 117, 131, 142–44, 169, 170; population and, 112, 132–33, 145, 146; poverty and, 157, 169–70; sanitation and, 219–20; South African, 271, 276, 278; vaccination and, 133–37 Public Health Act, 220 Public hygiene: economy and, 169–70; epidemic and, 117, 177–82, 219, 226, 234; germ theory and, 242, 252, 254, 265–66; individual/collective and, 131–32, 161–69, 171, 173–77, 185–87, 307 n. 104, 312 n. 196; milieu and, 193, 199–203, 216; police and, 142, 315 n. 38; population and, 145, 182–84; as urban, 172, 178, 183, 198 Public works, 172 Pythagoras, 144, 145 Quarantine, 98, 316 n. 68; germ theory and, 244, 252–53; nation and, 180–81, 217–27, 232–37, 315 n. 47 Race, 211–12, 226–28, 271, 314 n. 19 Raeff, Marc, 92, 95 Ramsey, Matthew, 137, 158–59 Rationality: epidemics as, 183; God and, 50–51, 76; natural law and, 46, 52–53; organism as, 127; of science, 48, 203; statistics and, 123–24 Ratios, 121–22 Recidivism, 248–50, 258, 267, 319 n. 130 Reductionism, 47–49, 213, 271–73, 290 n. 36, 290 n. 38 Regimen, 165–66, 173 Reid, Julian, 19 Reign of Terror, 158, 304 n. 52 Reinert, Erik, 91 Reiss, Timothy, 10

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Religion: community and, 43–44; medicine and, 63, 97–98, 124, 153, 156–57, 168, 170–71, 175, 240–42, 301 n. 131; modernity and, 9–10, 12, 16; natural law and, 50–53, 90, 106, 291 n. 53, 293 n. 90, 293 n. 91; property and, 54–55; state and, 44, 62, 76–81, 86, 92, 94, 139–40, 151–53, 292 n. 81, 296 n. 32, 305 n. 56 Renaissance, 51 Resistance, immunity as, 230–31, 234 Revolution, 53, 160, 161–63 Right, 53–54, 143, 207, 304 n. 47; body and, 56–57, 69, 81, 86–89, 148–52, 154–55, 304 n. 52; to health, 133, 160, 302 n. 1; of property, 7, 55, 70, 113, 152; to sustinence, 151, 154–55. See also Natural right Rinderpest, 146 Risk: collective life and, 140, 172, 186–87, 221, 266; in Hobbes, 89–90; inoculation and, 63, 69, 118–23, 126–128, 134–35, 207, 209, 215, 313 n. 3; knowledge and, 36–37; political economy and, 116, 309 n. 152 Robespierre, Maximilien, 159 Roch, Eugene, 178 Rochefoucauld-Liancourt, François Alexandre Frédéric, duc de la, 133, 134, 153 Rome, law in, 3, 35–36, 40–42, 44–45, 141, 289 n. 20, 289 n. 25 Rothschild, Emma, 140 Rousseau, Jean-Jacques, 141 Roux, Emile, 258 Rowbotham, Arnold, 302 n. 138 Royal Academy of Medicine (France), 178, 180 Royal Experiment, 301 n. 129 Royal Institute of Public Health (London), 265 Rumination, 24–25 Sacred debt, 154–55, 158 Safire, William, 287 n. 64 Sagan, Dorion, 72–73, 196, 311 n. 189 Sand, George, 241 Sanitation: epidemic and, 217–28, 237–38; germ theory and, 244, 252–53,

262, 265–66; immunity and, 228–35; police and, 113–14, 117 Sauter, Michael, 169 Scarlet fever, 216 Schaffer, Simon, 11 Schmitt, Carl, 313 n. 1 School, 135 Science, 52, 272, 276, 288 n. 7, 290 n. 35; genealogy versus, 24; medicine as, 161–62, 165, 168, 176–77, 192–194, 202–4, 254–55, 265; metaphor in, 24, 34–38 Second Empire (France), 187, 197, 198–99, 241, 311 n. 192 Secularism, 10, 12, 52, 76, 89–90, 92, 94, 110, 156, 171, 175, 292 n. 81 Security, 28, 89, 91, 225; police and, 96–97, 100, 104, 113–14 Seed-ground theory, 231–32, 237, 247 Selden, John, 53 Self-defense: as natural right, 2–3, 54–60, 70, 74, 88–90, 196, 267, 287 n. 64; organism and, 26–27, 61–62, 64, 70, 75, 88–90, 117, 129, 196, 203, 277. See also Defense Self-nonself discrimination, 26–29, 286 n. 55 Sell, Stewart, 29 Sensation, 83–85 Sentiment, Cabanis on, 163–64, 306 n. 85 September 11, 2001, 31, 287 n. 64, 295 n. 24 Sex, 105–8, 299 n. 98 Shapin, Steven, 11 Sherwin-White, A. N., 41 Sieyès, Emmanuel Joseph, 305 n. 56 Silverstein, Arthur, 293 n. 93 Slavery, 42 Small, Albion, 92 Smallpox: immunity and, 208–11, 215; inoculation and, 62–67, 68–69, 118–28, 133–36, 207, 209, 215, 236, 293 n. 93, 301 n. 126, 301 n. 129, 313 n. 3; public health and, 131, 179 Smith, Adam, 69, 109–116, 119, 124, 136, 151, 162–63, 300 n. 103, 300 n. 111, 300 n. 112, 300 n. 116, 300 n. 119, 306 n. 85 Smolin, Lee, 34

index  Social: law and, 141; medicine and, 63, 170–71; modernity and, 11–13, 284–85 n. 23; natural and, 132, 162–65, 177, 182–83, 185–86, 191, 193, 199–200, 202, 220, 254–55; pathology as, 177 Social science, 187, 249 Société Royale de Médecine, 144–48, 171, 188 Sociobiology, 290 n. 39 Sonnenfeld, Joseph von, 96 Sorbonne, 195, 203, 241, 302 n. 140 Soul: body and, 9–10, 21–22, 76, 81–85; police and, 94, 96; public hygiene and, 175; sovereign and, 77, 80, 312 n. 198 South Africa, 270–80, 288 n. 2, 321 n. 18 Sovereignty, 16, 44, 152; disease as, 207–12, 216, 230, 313 n. 5; natural law and, 52, 59–60, 62; organism and, 61, 86; police and, 93–97, 101–2, 139, 175, 184, 239, 300 n. 116; power in, 20–21, 59–60, 78, 80–81, 89, 102, 187; religion and, 22, 50–52, 76–81, 153 Space: milieu and, 187–88, 192; population and, 179–80, 183–85 Spain, 180 Species, 106, 163–67, 256, 264, 309 n. 150 Specificity of bacteria, 5, 49, 244–45, 250, 269, 283 n. 7 Spinoza, Baruch, 60, 61, 76, 88, 173 Spitzer, Leo, 187, 309–10 n. 155 Spontaneous generation, 240–42, 246 Starfish, 1–2, 204 State: epidemic and, 219–23; investment in life and health, 17–22, 69–70, 92–104, 108–9, 113–14, 116, 133–138, 143–48, 154–58, 175–76, 181–84, 208–9, 223, 236–38, 266, 317 n. 85; legal immunity and, 40–44; political economy and, 90–92, 107–9, 111–12, 221; religion and, 62, 76, 78–79, 90, 296 n. 32; war and, 90–91 State of nature, 58–60, 66, 80–81, 86 Statistics, 92, 121–24, 127–28, 182–83, 219–20, 249, 298 n. 59 Stengers, Isabelle, 288 nn. 7–8 Struggle, 256–57, 263–64 Subject, citizen versus, 150, 152, 160, 173

371

Subjectification: body and, 19–21, 44, 87–88; medicine and, 160–61, 168–69 Subsistence, 111, 140, 151, 154–58 Suez Canal, 316 n. 70 Sullivan, Mark D., 312 n. 203 Surveillance, 180, 222–23 Susceptibility, 213–17, 229 Sydenham, Thomas, 83 Syphilis, 210, 211, 212 Talleyrand, Charles Maurice de, 134 Tauber, Alfred, 26–27, 256, 257, 283 n. 2 Taylor, Charles, 83 Tenzer, Livia, 296 n. 29 Terror, Reign of, 158, 304 n. 52 Terrorism, 254 Theology: monarchy and, 76–77, 80, 86, 92, 151–52, 175, 293 n. 90; natural law and, 50–53, 106, 291 n. 53; property in, 54–55 Theory, 34–36, 288 n. 8 Third Republic (France), 236, 247, 317 n. 85 Thirty Years’ War, 16–18, 69–70, 90–91, 138, 303 n. 13 Thouvenel, Pierre Sebastian, 170–71 Tomes, Nancy, 49 Tradition, modernity versus, 11–12, 284–85 n. 23 Transcendence, immanence versus, 10, 12 Treaty of Westphalia, 138 Truth, 24, 36–37, 71, 275–78 Tshabalala-Msimang, Manto, 270 Tsunami, 295 n. 12 Tuberculosis, 250, 259, 260, 269 Tuck, Richard, 54 Turgot, Anne-Robert-Jacques, 144, 146 Typhoid, 210, 216, 243 United Nations, 270, 287 n. 64 United States: rights in, 149–50; variolization in, 62–67 University of Berlin, 252 University of Munich, 237 University of Vienna, 212 Urban context: disease and, 172, 178–79, 182, 191, 238, 299 n. 90; milieu and, 191, 200 Utilitarianism, 298 n. 73

372 

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Vaccination, 69, 117–19, 301 n. 126, 302–3 n. 6; immunity and, 2, 3, 34, 36, 49, 207, 210–11, 215, 248–49, 255, 258, 261, 265, 267, 269–70, 287 n. 64; public health and, 133–37, 236 Value of life, 113, 148–49, 158, 238; of numbers, 124 Van Swieten, Gerard, 208–10, 313 n. 3 Variolization, 293 n. 93; immunity and, 67, 207–10, 258, 264–65; risk and, 62–63, 68–69, 119–28, 313 n. 3; vaccination and, 117–119, 134 Venereal disease, 179 Vicq d’Azur, Félix, 147 Villermé, Louis-René, 182, 309 n. 152 Violence: biopolitics and, 18; body and, 79–81, 88–89, 266; of law, 6, 52–53, 62, 90, 287 n. 64, 296 n. 32; medicine and, 202–3, 266, 271; as natural law, 31, 55, 58–62, 89–91, 114–16, 300 n. 116 Virilio, Paul, 285 n. 34 Virulence, 248, 254, 267, 319 n. 127 Viruses, 271, 279 Vis medicatrix naturae, 29, 107–11, 116, 213, 260, 267–68 Vitalism, 47–49, 189, 213, 240, 290 nn. 41–42, 291 n. 44, 312 n. 198 Vivisection, 192–93 Vulnerability, 280–81; immunity and, 14, 17, 248, 254–55, 267; inoculation and, 118, 119, 121, 123–24, 126–127, 134–36, 207; in political philosophy, 56–59, 62, 65, 89–90, 151, 297 n. 46; popula-

tion as, 98, 106–7, 112, 115–16, 145, 222, 224, 266 Wage labor, 10, 67, 70–71, 80–82, 86–87, 110–12 Walker, Mack, 91 War: against disease, 4, 253–54, 278–79; life and, 19–20, 22, 69, 97, 104, 204–5, 238–39; as means to peace, 17–19, 91; medicine as, 202–3; natural law and, 57–59, 62, 89–90, 284 n. 9, 292 n. 81, 293 n. 91; within organism, 6, 259–64, 267, 277–80, 287 n. 64; pure, 285 n. 34. See also Invasion Warner, John Harley, 49 Warner, Sara, 289 n. 19 Wasserstein, Alan, 194 Water, 251 Watson, James, 48, 291 n. 44 Wealth, 99–101, 103–4, 143–44, 170 Weapons, 202–3 Weiner, Dora, 169 Welfare, 94, 158, 163–64 Wells, H. G., 32–33, 65 Wells, W. C., 211 Wolin, Sheldon, 89 World War II, 49 X-Files, 3 Yeast, 242 Yellow fever, 180, 216, 218, 223, 308 n. 132 Zinke, Georg Heinrich, 95–96

Ed Cohen teaches cultural studies and directs the Graduate Pro­gram in Women’s and Gender Studies at Rutgers University, New Brunswick. He is the author of Talk on the Wild Side: Towards a Genealogy of a Discourse on Male Sexualities (1993).