Between states, philanthropic societies, and the Red Cross: managing dead bodies and the crossroads of “P rogres s” , 1856-1889

. This paper examines the debates and controversies around the hygienic management of corpses having arisen in Europe since the 1850s and, most particularly, during the next three decades on various international medical and health congresses. The main debates revolved around the so-called “ rational burial of the dead ” . The issue comprised varied matters, namely, provisions to regulate the establishment of cemeteries in the green areas round the towns; use of effective chemical disinfectants; diagnosis of “ rea l” versus “ apparen t” death; procedures for the identification of dead bodies; alternative systems to burial, and so on. shocking photographs of coffins piled up in makeshift morgues set up in garages, ice rinks, and heated truck trailers; and even of open mass graves dug on old quarantine islands or on the green belts outside towns. This paper examines the debates and controversies around a number of issues regarding the hygienic management of corpses having arisen in Europe since the 1850s and, most


Introduction
The global pandemic of Covid-19 has brought to our lives an overwhelming experience of illness and mass death, unprecedented for the vast majority of us. With the exception of various dramatic circumstances of convergence between war and epidemic disease during the first half of the 20th century, we must go back to the influenza pandemic of the biennium 1918-1919 to come across a condition of similar epidemiological and clinical features. Luckily, its direct mortality toll is by no means expected to come close to reaching the figures of that pandemic. Much more fearsome, nevertheless, is the impact of Covid-19 on a global scale in the most disparate areas (health, social, economic, political, cultural), including indirect mortality due to delays in attention to other health demands, collapse of health systems, and undernourishment and hunger as a result of shortages and increased extreme poverty.
Throughout the first semester of 2020, the Covid-19 outbreak has provided to the media all over the world, to the headlines of television news and the daily press, striking images of makeshift field hospitals in all sorts of locations, of hospital ships, and of convalescent or quarantine centres set up in hotels and hostels, which evoke those associated to the "Spanish flu" pandemic of a century ago. Moreover, we have been exposed to unusual and shocking photographs of coffins piled up in makeshift morgues set up in garages, ice rinks, and heated truck trailers; and even of open mass graves dug on old quarantine islands or on the green belts outside towns. This paper examines the debates and controversies around a number of issues regarding the hygienic management of corpses having arisen in Europe since the 1850s and, most particularly, during the next three decades on various international medical and health congresses. They include several international conferences of relief societies (Paris 1867; Berlin 1869; Geneva 1884; Paris 1889), the first International Congress on Hygiene, Rescue and Social Economy (Brussels 1876), the seventh International Medical Congress (London 1881), and the fourth International Congress on Hygiene and Demography (Geneva 1882).

The controversy over the abolition of cemeteries in the 1850s
Despite being routinely out of focus, the management of dead bodies in the event of mass deaths began to be addressed as a prominent health and social problem in Europe and North America from the mid-19th century, if not before. The earliest debates emerged in the civil sphere as a controversyprompted by the high mortality caused by the third cholera pandemic of 1846-1860over the suppression of cemeteries and the use of cremation as an alternative to the inhumation of corpses. Far from vanishing, during the subsequent decades this controversy led to a generalisation of the debates about cremation and the proliferation all over Europe of associations of hygienists in favour of it as the most suitable way for burial.
One of those controversies broke out in late 1856 within Catholic circles both French and Belgian because of an article published at the influential Paris magazine La Presse by Alexandre Bonneau (1820-1890), one of its editors, who asked for the suppression of cemeteries and for reintroducing cremation as the suitable way of burial. [1] The controversy spread rapidly across Europe. By way of example, only a few months later, the Spanish army physician Nicasio Landa (1830-1891) echoed its arguments in a rather long article published at the Madrid medical journal La España Médica in which he also made his point about the issue. [2] 3 The debate on the management of corpses in times of peace and war, at international medical and sanitary conferences However, the focus of attention soon shifted toward the management of corpses in military conflicts as a result of the impact caused by the American Civil War and the great European wars of the period (Crimean War, Italian Wars of Independence and Franco-Prussian War, mostly). Indeed, their catastrophic effects in terms of mortality were at both the origin of profound reforms in the national army health services, and the rise of the international association for the relief of sick and wounded soldiers in campaign, soon better known as the Red Cross. Specifically, the national relief organizations that were members of the Red Cross did not take long to claim the management of the bodies of victims of wars and other catastrophic situations as one of their tasks. They did so for both hygienic and humanitarian reasons.
During the pre-bacteriological era, when miasmatic theories were preponderant to explain the origin and transmission of infectious diseases, hygienists had focused their activities on disinfecting and eliminating bad odours from battlefields and other spaces occupied with corpses. Later, when the bacteriological theory became a part of their hygienic views, they aimed for a comprehensive sanitation of all these spaces.
In parallel, the spread of liberalism led to the emergence of the individual as a citizen whose inalienable rights should be protected in life and after death, in peace as in war. Hence, humanitarian organizations debated to extend their functions from the tasks of alleviating the suffering of wounded and sick combatants, to those of identifying and burying bodies with dignity as well as of informing the relatives about their whereabouts, both while they were looked after by them, and in the event of death. The main debates regarding the hygienic management of corpses revolved around the socalled "rational burial of the dead". The issue included a great deal of varied matters, namely, provisions to regulate the establishment of cemeteries in the green areas around the towns; use of effective chemical disinfectants; diagnosis of "real" versus "apparent" death to minimize the risk of hasty burials; procedures for the identification of dead bodies; alternative systems to burial (cremation, desiccation, confinement in cement); combustible materials for a more efficient cremation; and the question of the burial of animals (horses, in particular).
Yet, the medical and hygienic aspects of the debates cannot hide the cultural and social challenges that doctors and hygienists participating in those international meetings had to face. If they indeed strove to agree with each other on the possible scientific-technical solutions (as demanded by the spirit of the meetings at the time), they tried as much not to betray their own worldviews. In a matter as emotional as that of the corpses of human beings, they unavoidably had to counterbalance scientific progressthe incarnation of the humanitarian, of the extensible to all humanitywith the particular beliefs and feelings, different for each popular cultural tradition.
From this perspective, the debates in this period can be seen as revolving around three key aspects: a) identifying the dead bodies, because they represent the individual; b) handling the corpses, because hygiene demands it; c) and attending to the bereaved, so that they could mourn and honour the memory of their dead. The different standpoints from which the participants in international meetings contemplated each of these aspects ranged from the extremes of Judeo-Christian religions' practitioners, who demanded the need to care for the soul of the deceased and to honour their remains; to that of convinced materialists, who considered that the fate of organic matter was its conversion into inorganic elements to restart the cycle of life. One of the most vehement was the Belgian physician and socialist leader César de Paepe (1841-1890), who believed that progress itself threatened to hinder the advancement of Medicine and Anatomy since, as welfare spread to larger sections of society, doctors would be left with no other corpses to be studied than those of "people so poor and wretched that neither their family nor their friends would claim them". Being persuaded that the real evil to be extirpated was pauperism and supporting cremation as "the most rational solution" for burials, De Paepe advocated generalising autopsies and eliminating corpses by cremation, saving only those parts that could be useful for science, namely organs with anomalies whose observation may contribute to the progress of anatomy and physiology, or skulls for studying anthropological and phrenological series. [3] All debates were also tinged by a fundamental question about limits: whether respect for the living or respect for the dead should prevail -an issue most frequently raised with the question of "to what extent beliefs and feelings can be a limit to the scientific progress". These were some opinions: Comte François Van der Straten-Ponthoz (1816-1907), vicepresident of the Belgian Société Centrale d'Agriculture: "Why change today what has been practiced, without real inconvenience, for centuries, what suits our beliefs, our feelings of respect for the dead?" 1 . Eugène Bouchut (1818-1891), professor at Paris Faculty of Medicine and specialist in paediatrics : "The day it becomes necessary to go to a railway station to get to a cemetery, that day we will have lost the cult of the dead, which is not a superstitious cult" 2 ; Henri Bergé (1835-1911), member of the Belgian House of Representatives and professor at Brussels Faculty of Medicine: "Feelings have been put forward in favour of the preservation of cemeteries. Gentlemen, when hygienic measures are discussed, feelings are out of place. They can, nevertheless, be taken into account. But they must not be exaggerated and, above all, distinctions should not be made between the various classes of society. However, I argue that in the present state of things, feelings are just respected for those who have the means to pay […] I argue that if feelings are to have importance, they must have it for everyone, without distinction of race, caste or fortune […] Alas, if you adopt progress in relation to the living and to everything related to the needs of life, adopt it as well in relation to the dead and try that these cause the least inconvenience to the living" 3 [3].
Unsurprisingly, none of these issues was settled in any of the conferences. The only consensus, that the scientifically most hygienic procedure for burials was the cremation of the corpses, while becoming a shared scientific truth, remained nevertheless unacceptable as a unanimous recommendation to be implemented. Controversies made it also impossible to come up with any generalizable and shared solution for marking the clothes and even the bodies of the military in order to make possible the subsequent identification of their corpses. Perhaps the most striking aspect of debates was precisely the kind of prejudices that could interfere in the search for solutions. Thus, the disgust the majority felt when hearing how, in 1884, at the third International Conference of Red Cross Societies, Sir John Furley (1836-1919) and the American Joseph Sheldon (1828-1911) 4none of them a doctor, but juristsdefended the previous identification of the combatants by means of tattoos, was expressed with the argument that the body could not be abused in life.
[4] Other proposed solutions, such as identification medals, could become useless in practice because, as expressed by the Prussian military surgeon Ernst Julius Gurlt (1825-1899), the "soldiers of the lower classes" believed in the devil's intervention in wars, so they often threw or exchanged their medals to confuse him when he went after them. The application of techno-scientific progress had to be measured against these realities. [4] As to how to handle the corpses, everyone agreed on the urgent need to sanitise the battlefields to protect both local health and agriculture, but not all had the same scientific conviction as to the unhealthiness of cemeteries. For example, Bouchut believed that "hospitals are more dangerous than cemeteries" (les hôpitaux sont plus dangereux que les cimetières) [3] Not even everyone agreed on how to "disinfect" the corpses, nor all were willing to endorse solutions that meant destroying them, though they did not make proposals as to how to proceed with them if they were not destroyed. Again, in almost all debates, what mostly hindered scientific consensus were beliefs, feelings and ideological positions. Horror led to the rejection of proposals such as the industrial use of the saponification of corpses. Moreover, delirium led to the proposal of cementing the corpses into prisms stackable in large pyramids that, allegedly, could at the same time avoid infections from putrefaction and honour the dead in great monuments taking up little space and locatable within towns. Honouring the dead, yes, included the exception of desperate times, desperate measures: after 3  a great battle, as during a devastating epidemic, incinerating the corpses made sense, though it could not be assumed as a regular practice.
Participants in international congressesmostly, well-off liberals with a Judeo-Christian backgroundwere precisely facing the crossroads of "Progress". The French physician and politician Louis Laussedat (1809-1878) clearly proclaimed the dilemma: "Those of us who cultivate Science do not renounce having feelings nor do we aim to harm the beliefs of others. Yet, those things related to feelings cannot be our only motive in the world. It is necessary to recognise that the noblest feelings are lost when they give up relying on science, when its lights do not illuminate them. It is necessary to pay tribute to science and follow its laws for the benefit of humanity" 5 . [3]