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Logo of medhistThe Wellcome Trust Centre of the History of Medicine (UCL)Medical History
 
Med Hist. 2016 April; 60(2): 287–289.
PMCID: PMC4847400
Reviewed by Paul V. Dutton

Dana Simmons,  Vital Minimum: Need, Science & Politics in Modern France ( Chicago, IL, and London:  University of Chicago Press,  2015), pp. 243, $45.00, hardback, ISBN: 13:978-0-226-25156-1. 

‘To posit a need is always a political act’ (p.1). So begins Dana Simmons’s incisive tour of ‘the parameters of human possibility’ (p. 2). Simmons’s broad scope is paired with a deep analysis of myriad primary sources from eighteenth through mid-twentieth-century France. We hear directly from leading agronomists, chemists, doctors, anthropologists, economists, sociologists, amateur data gatherers, union leaders and technocrats, all of whom were grappling with new scientific knowledge, political upheaval wrought by the French Revolution and the subsequent rise of industrial capitalism, which together laid waste to feudal customs governing human need.

Simmons understates the book’s achievement and undersells its potentially broad appeal when she humbly declares, ‘my argument is that a science of human needs undergirded the modern wage economy and the welfare state’ (p. 5) This reviewer happened to be simultaneously reading Michael Marmot’s The Status Syndrome and came to imagine a wonderful dialogue between the renowned epidemiologist Marmot and the historian Simmons.1 Both rely on economist Amartya Sen to further their cases in fascinating ways. And both are deeply concerned with nothing less than individual and social well-being in the modern era. Interest in Simmons’s Vital Minimum should extend well beyond historians to include scholars of public health, economics and social policy. The book asks big questions about equality and inequality and provides historically grounded answers that illuminate pressing contemporary debates.

Simmons’s book is composed of seven short body chapters, arranged chronologically, but constructed around themes. The first two chapters describe early to mid-eighteenth-century attempts to define human need in the wake of the French revolution of 1789. At the forefront were agronomists, whose field bridged the life sciences, natural sciences, and social policy. Simmons focuses on the work of Jean-Baptiste Boussingault and Jean-Baptiste Dumas. We learn about Boussingault’s 205-day imprisonment of two pigs, his precise measurements of their ingestion and excretion, and how the agronomist’s findings were promulgated into models for managing scarce resources, not only on the farm but also for workers’ basic needs. It must be remembered that poverty in the mid-nineteenth century was commonly perceived as a disease. Thus, the search for scientific remedies seemed only natural to researchers and political leaders alike.

In the subsequent chapter Simmons takes up the late nineteenth-century social survey. Just as the balance scale had proved indispensable to agronomists’ earlier work to devise a minimum ration in hopes of preventing poverty, social surveys were similarly employed in search of the ‘vital minimum’. Without doubt, notes Simmons, social surveys served as ‘a foundational technology of the welfare state’ but their creation and deployment were dominated by two opposing ideologies (p. 55). The first sought to divide the population into ‘immutable social-medical types’. The second, authored by socialist economists and workers’ associations ‘favored a language of transformation and progress’ (p. 56).

Indeed, a debate over the very nature of the vital minimum and to whom it should apply endured from the Third Republic (1871–1940), through the wartime regime based in Vichy (1940–1944) as well as the Gaullist Liberation government and the Fourth Republic (1944–1958). What components should it include? Should it apply to individuals? To women? Or should its goal be more racial-eugenic and pronatalist, and therefore be aimed at certain kinds of families, the larger the better? And what of its mutability? Should the vital minimum be modified in the face of societal change? And, if so, who should determine these modifications? Chapters 5–8 show us that all of these questions received varying answers between the late nineteenth and mid-twentieth century.

During the siege of Paris by Prussian forces in the winter of 1870–1871 only male ‘citizen-defenders’ (p. 79) were deemed eligible for food rations. Others – women, children and the indigent – were designated ‘useless mouths’ and were to rely on charity. This same terminology returned during the Second World War when Vichy leaders once again identified ‘useless mouths’ in the construction of welfare policy. The vital minimum should protect ‘blood, flesh, nationhood, race, and bodily health’ (p. 123). Architects and perpetrators of the contemporary Nazi racial hygiene programme employed similar language as they murdered many thousands. Never did such a programme exist in France, but Simmons demonstrates that Vichy’s contribution to the development of a vital minimum varied only in degree from its Third Republic predecessor. ‘The twentieth-century European welfare state was as much a racial-hygienic regime as a social-democratic one. Welfare logics and technologies passed from right to left and reached a historical apotheosis in the authoritarian regimes of the mid twentieth century.’ (p.117)

The final body chapter takes up the post-war debate over the minimum wage. The French state attempted to mediate the conflict between employers and unions by championing the prowess of its statistical experts and technocrats, but to no avail. In the immediate post-war moment union leaders held the political high cards in French society. Too many employers had collaborated with the wartime Vichy regime or directly with the Nazi government in Berlin. In 1946, the government ceded to workers’ demands, creating a state-enforced minimum wage. By 1951, sixty-five per cent of French workers lived on it. Even if the minimum wage did not survive the 1950s, the growth of the associated welfare state – health and disability insurance, family allowances and retirement pensions – served a similar purpose, ‘to regulate the distribution of material wealth and well-being’ (p. 162).

Simmons has not written another history of the French welfare state. Rather she has dashed down the welfare-state history curtains to reveal a historical window into human need in complex societies. Vital Minimum provides an explanation of need that immeasurably improves our understanding of the welfare state’s past and our ability to speculate on its future.

Footnotes

1.Marmot Michael, The Status Syndrome: How Social Standing Affects Our Health and Longevity (New York: Henry Holt, 2005).


Articles from Medical History are provided here courtesy of Cambridge University Press