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History in Focus

the guide to historical resources • Issue 3: Medical History •

Medical History

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Author's response


Contagion: Disease Government and the 'Social Question' in Nineteenth-Century France

by Andrew R. Aisenberg
Stanford University Press , 1999

Professor Pam Pilbeam

Professor Pilbeam's review accurately alludes to the salient themes contained in my book: conflicting theories of contagion in the nineteenth century, the relationship of understandings of contagion to the political problem of how to understand and regulate poverty, and the professionalization of hygienists. What is missing in the review, however, and what is crucial to the engagement with the fields of modern French social history and the history of medicine that is at the centre of this book, is the characterization of the relationship among these themes.

I have adopted a discursive approach, mainly informed by the work of Michel Foucault, to understand this relationship. By discursive, I mean to demonstrate how scientific debates about the transmission of contagious disease in industrial society were inextricably shaped by political debates about how to conceive the role of the state "government" in addressing the problems associated with industrialization and urbanization: poverty, unemployment, and social conflict. Viewed as a product of these debates, contagion cannot be reduced to a pathological entity against which government reacts, or as a form of scientific knowledge that informs or justifies government intervention. Rather, contagion and the capacities and interests that define government as a moralizing and socializing force in industrial society come into being together, or are relational. Professor Pilbeam has chosen not to consider this theoretical approach, instead reducing it to the status of "stylistic obscurity". In its place, she associates my book with a more accepted approach, explicitly rejected in my introduction, that brings together social control and medical progress arguments. Before the emergence of true medical (Pasteurian) science, so this line of reasoning goes, public health officials linked the transmission of disease to the lives of the working poor as a way of defending the bourgeois interests of industrialists and politicians against the militant claims of workers for state recognition of their "social rights". According to this interpretative approach, what makes Pasteurian science possible at the end of the nineteenth century is the separation of political interests and scientific knowledge about disease, or the demarcation of political and scientific spheres. Professor Pilbeam's acceptance of such an approach is suggested in her comments that I am writing about "holier-than-thou prosperous social commentators" and "conflicts between engineers and doctors that had more to do with the careers of individuals than science".

While discussions about the relevance of discursive analysis and the work of Michel Foucault to historical writing and explanation are far reaching and thus extend beyond the scope of my book and its review, I do feel it appropriate to defend both of them in regard to interpreting the important position of contagion in nineteenth-century debates about the "social question". A discursive analysis makes possible a reinterpretation of the "social question" that was at the centre of French society and politics for most of the nineteenth century. Historians as different in approach as William Sewell and Giovanna Procacci have suggested that we cannot explain the government response to social conflict and suffering in nineteenth-century France as an expression of bourgeois interest. A discursive understanding of contagion reveals that what was at stake in government intervention in the social question was neither the creation of a docile workforce nor the ideological obfuscation of the contradiction between claims of universal liberty and social inequality. Rather, through their understandings of contagion, hygienists articulated the problem of industrial society as a conflict between liberty and sociability, and they attempted to redress that conflict by exteriorizing (through scientific knowledge and regulation of disease) "sociability" from the conflict-ridden category of individual rights. In this way, a discursive understanding of contagion enables us to grasp the development of the moral and social capacities of government as the pre-eminent consequence of the attempt to come to terms with the emergence of social inequality and militancy in a free industrial society.

The contribution of a discursive approach to the field of nineteenth-century medical history is no less promising. For too long, and despite the important work of scholars like Roger Cooter and Bruno Latour, we have accepted the interpretation which views progress in knowledge about disease as a function of the separation of the fields of science and politics. Such a demarcation, however, does not clarify the contentious discussions that followed in the wake of Pasteur's discoveries. These discussions had less to do with the continuing influence of backward, old-fashioned, ideologically-informed doctors who resisted the inevitable march of medical progress than with the centrality of conflicting political visions of society and its regulation to scientific understandings of disease. To accord such a prominent position to politics is not to debunk the effectiveness or truth of medical science. Rather, it acknowledges the political question, central to liberal industrializing societies like France, of what constitutes society as something that is always involved in concerns about contagion.

November 1999

Original Review

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