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

Contagion and the State in Europe 1830-1930. By Peter Baldwin (New York, Cambridge University Press, 1999) 563 pp. $69.95

More than fifty years ago, Ackerknecht, the medical historian, argued in a seminal article that the adherence of European physicians to anticontagionist or contagionist explanations of contemporary epidemics (primarily of plague, yellow fever, and cholera) between 1821 and 1867 was shaped to a large extent by their political views. Anticontagionists, he said, "were known radical or liberals. The leading contagionists . . . were high ranking royal military or naval officers."¹ Liberal anticontagionists were concerned to protect the freedom of individuals and of commercial trading interests. Conservative contagionists were concerned with the rights of governments to intervene to protect the entire population. The alignment of political positions with theories concerning the causation of epidemics occurred, Ackerknecht argued, because contagionism and anticontagionism were evenly balanced in their explanatory power. "Under such conditions the accident of personal experience and temperament, and especially economic outlook and political loyalties will determine the decision" of which explanation to accept.²

Ackerknecht's article has either stimulated, or been the forerunner of, much subsequent work, some supportive and some critical. Baldwin's book is the most recent and surely the most encyclopedic, exhaustive, and exhausting. It deals with two broad issues. First, considering the German states, Sweden, Britain, and France during the period 1830 to 1930, did prevention policies with regard to cholera, smallpox, and syphilis correlate with prevailing political persuasions? Second, "to the extent that there are correlations here, what can we say about the direction of causality?" (35) Did political power shape preventive responses, or did the "prophylactic imperative help mold political regime and shape ideological traditions?" (36)

The preceding paragraph should give some indication of the sweep of this volume, both temporally and geographically. It should also make clear why a necessarily brief review can scarcely do justice to the complexity of the material presented. It must suffice to say that with regard to the first issue, Baldwin demonstrates convincingly that there was no simple correlation of the sort posited by Ackerknecht between political persuasion and prevention policies, either at the national level or among social classes and interest groups within nations.

With regard to the second issue, the evidence is less persuasive because the issue, as posed, is less clearly defined. Although it seems evident that within and across countries, experience and pre-existing policies shaped what happened subsequently with regard to prevention policies, it is not always obvious how learning across time and place occurred (by imitation or through central influence?), nor what role, if any, epidemiological and clinical evidence played in policymaking. It is also far from clear from what Baldwin has written that the "prophylactic imperative help[ed] mold political regime[s]."

A book of such size and scope poses an enormous challenge to the writer--how to distill an enormous mass of data into digestible form and at the same time present enough to demonstrate the rightness of the argument? This problem is dealt with unevenly. The two chapters on cholera are not totally successful; they are loaded with so many dates and places that they can scarcely be kept straight. The chapters on smallpox and syphilis are far more successful in this respect. Moreover, the writing is sometimes unnecessarily convoluted, and the author has an unnerving tendency to turn proper names into adjectives. Mozartian, Darwinian, Shakespearian are widely used terms, but Ackerknechtian? Lovejoyian? Eliasian? Chadwickian? Pettenkoferian? Kochian? Snowian? Frankian? Marshallian? This sounds like the membership list of an Armenian fraternal organization.

Despite the organizational and stylistic problems, this book is well worth the effort it takes to read. Though not abandoning the notion that prevention policies are partially shaped by political and economic interests, it gives a far more nuanced picture of the complex relationships between policies and interests than we have had before, and on a scale unmatched by previous...