Exclusions: Practicing Prejudice in French Law and Medicine, 1920–1945 by Julie Fette (review)

The quest to control practice by unqualified individuals and defend against encroachment by neighboring occupations has long been a standard topic in the history of the professions. Julie Fette’s study adds to a growing body of literature that addresses another kind of boundary maintenance: excluding or discriminating against particular groups who seek or have already received professional training. Although other scholars have considered aspects of her subject, this book stands out by systematically comparing the development of exclusion in two French professions, and it provides new information on how the process worked in practice. Fette analyzes the role of students, professionals, and governments and the motives behind exclusion, including not just the prejudices invoked in the book’s subtitle, but also economic protectionism and “professional identity formation” (1). Targets included women, foreigners, naturalized citizens, and Jews. The last three categories dominate the account. The obstacles that women encountered, which Fette has dealt with elsewhere (“Pride and Prejudice in the Professions: Women Doctors and Lawyers in Third Republic France,” J. Women’s Hist., 2007, 19, 60–86), receive only limited attention.

Since this review will focus on medicine, it should be noted in passing that the French legal and medical professions generally moved on parallel tracks. The major difference was that in addition to a university degree, membership in a local bar was required to practice law. Medicine lacked a corporate organization until the creation of the Ordre de Médecins in 1940.

The book begins with a chapter on the nineteenth-century background. In the 1880s, a movement emerged in the professions to exclude foreigners, which led to legal restrictions starting in 1892. The medical practice law adopted in that year abolished recognition of foreign diplomas. A new degree intended for foreigners created in 1897, the doctorat d’université, provided essentially the same training as the doctorat d’état but did not confer the right to practice in France.

The bulk of the study deals with the 1920s and 1930s, the last two decades of the Third Republic and the authoritarian Vichy Regime (1940–44), which succeeded it after France fell to the Germans and in key respects built on the exclusionist policies of its predecessor. Several factors conspired to promote exclusionism during the interwar period. They included a reaction against a law adopted in 1927, which reduced the residency requirement for naturalization from ten years to three, and against a decree issued the following year, which made it easier to convert a university doctorate into a state degree. The economic challenges of the Depression encouraged protectionism, and the influx of refugees from Nazi Germany and the Spanish Civil War, some of them well educated, added to the perception of overcrowding. A law adopted in 1933, sponsored by Senator Raymond Armbruster, a former army doctor, required new physicians to possess a state doctorate and French nationality. The Cousin-Nast law of 1935 imposed further limitations on naturalized citizens who received a French medical doctorate. Under this law, those who had not performed military service would have a waiting period before they could begin to practice, and they were subject to a still longer delay before they could receive a government appointment. The legislature did not, however, adopt a 1934 proposal to address the perceived overcrowding of the profession by limiting admission to medical school. Many physicians opposed this proposal, in part because it called for the Ministry of Education to set the number of available places, and they feared a growing intrusion of the state into the medical field.

In the summer of 1940, the newly installed Vichy Regime expelled French citizens born of foreign fathers from the professions. The government reviewed applications for citizenship submitted since 1927 and “denaturalized” individuals deemed incapable of assimilating into French society. It also adopted the first in a series of anti-Semitic measures, the result of French policy...