Mission and Method: The Early Nineteenth-Century French Public Health Movement (review)

The study of the history of French public health owes a great deal to Ann La Berge. When she carried out the research for her dissertation in the early 1970s, there existed little secondary literature and nothing of significance on the formative years of the public health movement beyond the article by Erwin Ackerknecht, published in this journal in 1948, that had inspired her work. ¹ Her boldly synoptic thesis, completed in 1974 (“Public Health in France and the French Public Health Movement, 1815–1848,” University of Tennessee), and a series of pioneering articles that followed, laid a foundation for subsequent studies by other historians. The present volume, which incorporates the secondary literature that has emerged in the last two decades and draws on an additional year’s research in France, is most welcome.

The book is a mine of information on the leading figures who defined the French public health program under the Bourbon Restoration and July Monarchy; on the institutions that attempted to implement it; and on the major problems addressed by the hygienists, ranging from fundamental questions of sanitation to the surveillance of industry and of trades and occupations affecting public health. Apart from smallpox and cholera, La Berge suggests, the French hygienists showed relatively little interest in epidemics and in the debates on their etiology. They focused, rather, on the environmental and social factors contributing to endemic disease; in particular, they underscored the correlation between poverty and high levels of morbidity and mortality. Although their program was in part a response to the new challenges posed by the growth of cities and industry, La Berge notes that they tended to reject the view that industry itself seriously compromised the health of the working classes; on the contrary, they welcomed economic development, expecting that it would promote health by increasing prosperity.

These detailed discussions underpin a framing argument in which La Berge presents Villermé, Parent-Duchâtelet, and company as a self-conscious community committed to developing hygiene as a scientific but socially aware discipline founded on empirical investigation and the use of statistics; she considers them the progenitors of the modern field of public health, while at the same time recognizably and distinctively French. She points out their influence not only on later developments in France but also on Edwin Chadwick and the British public health movement. The British, however, rejected the French emphasis on social factors and focused much more narrowly on sanitary reform. For La Berge, moreover, the French context, with its “centralized, national bureaucracy” (p. 318), helped shape an essentially statist approach to the implementation of public health programs, better suited to the Continent than to England or America—though she prefers to see liberalism and statism as elements in a dialectic rather than as mutually exclusive alternatives.

Any ambitious work of synthesis will invite objections about topics not considered and approaches not taken. By focusing on the leaders of a movement and their program, La Berge inevitably has less space to devote to implementation at the local level in the provinces; she barely raises the question of rural public health. Had she given more attention to the problem of writing the hygienists’ program into legislation and the difficulty of enforcing it, she might have stated more emphatically what she acknowledges intermittently in her text—the inhibiting effects of “the predominant liberal ideology” (p. 149), local custom, and sheer inertia on state intervention, and the strength of the liberal strain within the public health movement itself. Then there is the paradox, never really addressed, that the “statist” model in many respects developed more successfully in England than in France, its seeming natural home. But to demand these things would be to ask for a different book than the one that the author undertook to write; in her ambition to provide a point of departure for further studies of the history of French public health, she...