Contagion and the State in Europe, 1830-1930 (review)

Peter Baldwin. Contagion and the State in Europe, 1830–1930. Cambridge, Cambridge University Press, 1999. xiv, 581 pp. $69.95.

This book investigates the determinants of national prophylactic strategies across Europe during a century bounded by the first invasion of cholera and the passing of significant venereal disease legislation in Germany. Peter Baldwin seeks to challenge the widely held, reductionist belief that “it was not the nature of the disease which specified how it would be prevented and limited, but the kind of political regime under epidemic attack”(p. 13). Thus, in the past it has been argued that liberal democracies such as Great Britain favored sanitary environmentalist solutions, while conservative states such as Sweden preferred the stringencies of quarantine. Although this strand of thought is associated primarily with the work of Erwin Ackerknecht, Baldwin collates a substantial corpus of writing by other authors that have broadly accepted this viewpoint, consciously or otherwise. In its place, and to his credit, he presents a more complicated explanatory history, which grants a role not only to the nature of political regimes but also to a much wider set of social, medical, and geographic factors. Baldwin also seeks to turn the fundamental Ackerknechtian premise on its head by asking whether it was not that politics shaped preventative response, but that public health shaped politics.

Divided into sections that deal with individual diseases, the evidential substance of Baldwin’s argument lies in detailed accounts of the development of public health systems to combat cholera (two chapters), smallpox and syphilis in France, Germany, Great Britain, and Sweden. Intermittent examples are also drawn from other European nations, not least Russia and the Baltic states. It is impossible here to indicate in sufficient detail the remarkable depth of Baldwin’s descriptive ocean. Not least—although I write mainly from the British viewpoint—he appears to have read more or less every significant contemporary periodical article, parliamentary debate, government report, and official correspondence relevant to the diseases concerned. Undoubtedly the book will become a valuable source of information for scholars in this field, whatever country they are interested in.

Toward the end of his long journey, Baldwin admits gracefully, if not sheepishly, that “although differences in political systems did not cause prophylactic variations, they are roughly correlated with them” (p. 557). By this stage, however, the reader has discovered that each nation state under scrutiny was adaptive, to a lesser or greater extent, depending on the nature of the disease in question. In the face of arguments that quarantine was disastrous in economic and trading terms, as the ravages of cholera receded, and as opinions on etiology shifted, authoritarian European regimes gradually began to shed the most draconian aspects of that system. At the opposite end of the political scale, more liberal environmentalist states donned armor of containment: surveillance, disinfection, isolation and/or removal to hospital, and therapy. Baldwin argues that geo-epidemiology (that is, a country’s physical position in relation to the spatial chronology of an epidemic), international trade, the mass movement of people, the emergence of bacteriology, and cumulative experience in dealing with epidemic threats were as important for these gradual transformations as the political complexion of the regimes that oversaw them. This is all perfectly sensible stuff, at least to the mind of this medical historian-cum-historical geographer. But one wonders if 600 pages were required to bring the reader to such an obvious conclusion?

The more interesting question, and one that Baldwin also poses but answers less satisfactorily, is whether these dynamics determined the nature of the political systems themselves. He coins the appropriate term “neoquarantinist” to describe the panoply of measures that served to control epidemiological outbreaks as opposed to preventing their occurrence altogether. The emergence of these adaptive strategies is crucial to Baldwin’s interpretation of the post-cholera period, and one cannot dispute the emphasis he...