Introduction

Programs of agrarian reform have continued to be used either to bring about change or sometimes to slow it down, depending on whether such programs were introduced after a major upheaval in society or as a preventive against it. Economic development and modernization have been used as justifications for introducing reform programs, on the assumption that reform facilitates these processes, but the actual contribution of reform to development and modernization is not obvious nor easily measured because of the variety of approaches utilized in evaluating the effects. Furthermore, only the rudiments of a theory of agrarian reform have been formulated in the literature. To a large extent, agrarian reform programs have been pragmatically oriented, aimed at short-term political goals, or viewed as problem-solving mechanisms in the day-to-day affairs of the state. One may go farther by suggesting that reform programs have often been used to inhibit change. In that role reform serves as a pacifier, and only minimum change would be brought about—just enough to avoid an upheaval or to stabilize the relations between reformers and potential beneficiaries. By the time such a weakness, if it may be considered that, has been discovered, another potion of reform would be introduced to keep the lid on the dormant restlessness of its potential beneficiaries.

A decade ago, most African states had proclaimed their commitment to centralized planning and administration. At the end of European rule, African leaders saw their countries as poor and malintegrated, but with great potential. That potential could be realized, they thought, only through firm central direction. Scarce resources, including capital and technology, had to be coordinated effectively and managed carefully. The few skilled personnel had to be located at key points. And the divisive tendencies of regional, religious, and ethnic differences had to be constrained by a centralized, national authority.

Most of the literature concerning traditional African medical practice has dealt with aspects often deemed ‘irrational,’ such as the role of priests, shrines, magic and religious ritual. M. J. Field's work demonstrates convincingly that these aspects of medical treatment in Ghana are essential in mitigating and curing psychosomatic illnesses as well as controlling neuroses. The emphasis on religious and psychological methods of treatment, however, can often lead to less perceptive conclusions, such as those of U.S. doctors visiting Ghana in 1960 who stated flatly that traditional medical practices there consist solely of ‘ignorance and superstition’ and that ‘witchdoctor … medicine man and native doctor are synonymous terms.

The eighteenth-century medical view of the peasantry offers clues to a series of problems. This essay will treat one of them, namely the processes by which the French medical community in the declining years of the ancien régime and the early years of the Revolutionary period came to justify proposals for intervention in a rural society generally hostile to its claims and suspicious of its motives. The theme of the present study is an exploration of how the ideology of rationality and control, which was being developed in the learned world of the eighteenth century, was reinforced by a group within it that was gaining prestige and searching for means to enhance its professional status and power.Since the demands of such an inquiry are rather large, many of the related questions which it raises, such as the nature of medical knowledge, the contemporary disputes in medical philosophy, and the movement of change from one form of medicine to another, will be touched on only insofar as they have direct relevance to the major need to clarify the medical contribution to the development of the new ideology. In my present conceptualization of the problem, I am concerned to show that there was a close interaction between medical knowledge and the social values of the members of the medical trade, even if there existed no conscious direction of the elements connecting the two, and in spite of the difficulties there are in establishing the precise links mediating intellectual products and their social configurations.

The geographical distribution of separatist movements in the world today is, and always has been, highly skewed. At any point in history such movements arise only in particular states, and—within these states—only in particular regions. One task of a general theory of separatism is to account for this skewed geographical distribution. Mr. Sloan seems to think that the answer to this problem is ‘imperialism’, tout court. He apparently believes that any region subject to dependent development is likely to spawn separatist movements (hence his discussion of Vermont). According to Mr. Sloan ethnicity has no causal status in a theory of separatism. Thus, to pay it heed is to mistake an effect for a cause.

Michael Hechter does not respond to the basic issue of whether or not a social scientist, in seeking to demonstrate that ethnic rebellion in an internal periphery of an industrialized nation can be explained only in terms of ‘internal colonialism,’ ought first of all to equip himself with some adequate and explicit theory of imperialism itself. Rather than deal directly with the specific criticisms which follow from his neglect of such an approach, Hechter contents himself with the dismissal of a proposition—attributed in his first paragraph, without citation, to me—the simplistically fallacious character of which I never doubted or denied.