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History in Focus

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

Medical History

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Book Review

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

Andrew R. Aisenberg
Publisher: Stanford University Press , 1999

Reviewed by: Professor Pam Pilbeam

This book began life some years ago as a doctoral thesis, prepared under the direction of John Merriman. It is an investigation of conflicting nineteenth-century theories on contagion. Some experts thought that illness was brought in from outside society, particularly by immigrants, others that disease arose from within through a combination of physical and moral imperfections. The author focuses on how doctors and others interpreted the causes of disease, ranging from Villermé, Buret and Frégier in the 1830s and 1840s to Pasteur and almost forgotten health experts of the end of the century, such as Brouardel, Arnould, Kelsch and Léon Colin. Aisenberg's central theme is to explain how, in the last decades of the nineteenth century, republicans struggled to square the circle of defending individual liberty, while introducing sufficient government regulations to prevent the spread of disease. The question was far from philosophical and involved arguments among doctors who tended the sick, engineers who designed the not entirely satisfactory expensive new Parisian sewage system and the rival Paris prefect and prefect of police.

Enquiries into the social question in the 1830s began to build up pressure that governments should intervene in the organisation of social life to try to prevent the proliferation of diseases such as cholera. Subsequent scientific investigations reinforced this message. In 1831, before cholera actually hit France, a network of neighbourhood commissions, consisting of doctors, pharmacists, local officials and wealthy do-gooders were in place, ready to produce statistics and explanations, but, while they prepared endless lists of sick and dead, they were short on explanations and were helpless to contain the disease. In general the commissions were able to show a close correlation between poor housing, sanitation and poverty and the disease, although, as Aisenberg, and Catherine Kudlick, demonstrated (Cholera in Post-Revolutionary Paris (1996)), some extremely poor districts were barely touched. Like subsequent holier-than-thou prosperous social commentators, those who compiled the official report on the 1832 cholera were convinced that the disorderly and immoral poor were mostly likely to be justifiably struck down.

The problem of containing contagious diseases, whose causes were imperfectly understood before Pasteur, was addressed by the publication of reports such as those which are at the heart of this book, legislation, notably the law on Insalubrious Dwellings (1850) and the Public Health law (1902), the physical reconstruction of cities, especially Paris, and the development of systems of inspection under the Paris prefect of police. The author has praise for the Paris hygiene commissions which, before World War One, investigated unhealthy living conditions, but is less impressed by Haussmann's monolithic sewage system, which, amazingly, lacked the slope and water pressure to cope with the real stuff. In 1914 there were still over 14,000 cess-pits in the capital.

This volume takes up some of the themes of Alain Corbin's The Foul and the Fragrant, which was translated into English in 1986. It emphasises that the intellectual debate over contagion and the conflicts between engineers and doctors had more to do with the careers of individuals than science. Experts in the history of medicine will welcome the insights into the minds of nineteenth-century professionals. Apart from some stylistic obscurity, this volume is logically ordered and conveys its thesis effectively. Many dimensions of the perception of the causes of contagion remain to be investigated: how non-experts, such as journalists, playwrights and novelists interpreted the battle for health; how property-owners and their tenants reacted to inspection by the Paris prefect; to what extent radical doctors, in the tradition of Raspail, Buchez and Guépin, continued to provide free care for the poor in the fight against illness - and how they reacted to increasing state intervention; what contribution was made by mutual-aid societies and the popular healers Elizabeth Ackermann described (Health-Care in the Parisian Countryside (1990)) in helping the poor to cope.

November 1999

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