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Book and Media Reviews
January 6, 2010

Incurable and Intolerable: Chronic Disease and Slow Death in Nineteenth-Century France

JAMA. 2010;303(1):79-80. doi:10.1001/jama.2009.1950

In this insightful and erudite volume, Jason Szabo takes up the social, cultural, and medical history of terminal chronic illness in 19th-century France and charts the misery often hidden by a more extensive focus on the effects of epidemic infections. Szabo begins by unraveling the complex conceptual and practical conundrum posed to medicine and its scientific allies by incurable illness throughout the 19th century. The visceral debates between the vitalist-physiologist and inflammation theorist, Francois-Joseph-Victor Broussais, and the anatomist-pathologist and inventor of the stethoscope, René Laennec, and their disciples is well documented. Szabo concentrates, however, on their intellectual duel, expressed through mudslinging over tuberculosis and cancer. Here, Szabo draws out the effects of the contingent definition of incurability on the contentious issues of diathesis, disease, and therapeutic nihilism, which stalked the French medical profession throughout the period. Szabo then logs the convoluted exit from the deterministic constitutionalist theory of chronic diatheses to the reinvention of hope that opportunities still existed for successful therapeutic intervention. This was a difficult professional balance to strike, because medicine had no specifically targeted cures for the individualized diatheses asserted. Physicians, therefore, relied on constitutional inevitability to explain the death of patients that they were unable to prevent.

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