Andrew R. Aisenberg
California, Stanford University Press, 1999, ISBN: 9780804733953; 252pp.
Royal Holloway and Bedford New College, University of London
Date accessed: 4 December, 2013
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. His 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 Haussmanns 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 Corbins 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) had in helping the poor cope.
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 reg ulate 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 i nextricably 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 debat es, 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 relational. Professor Pilbeam has chosen not to consider this theoretical approach, instead reducing it to the status of "stylistic obscurity." In its place, she associa tes 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. Professo r 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 t hem 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 poli tics 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 expressi on 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 ex teriorizing (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 cap acities of government as the pre-eminent consequence of the attempt to comes 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 vi ews 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 scient ific 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 wh at constitutes society as something that is always involved in concerns about contagion.