Contagion: Disease, Government, and the "Social Question" in Nineteenth Century France (review)

This relatively brief but remarkably dense study aspires, as its sub-title indicates, to go well beyond a conventional history of public health in 19th-century France. Andrew Aisenberg sees the response to contagion by medical scientists and other technical experts and government authorities as critical, indeed constitutive of the most important social issue facing the Third Republic, namely how new demands for state interventions on behalf of society as a whole might be reconciled with traditional Republican values of individual liberty.

Although this familiar theme pervades literature on the 19th-century hygiene movement in France and elsewhere, Aisenberg’s originality lies in the ambitiousness of a contextualization that privileges a domain that typically receives little attention in social, much less, political histories of the Third Republic. Further, he demonstrates the diverse, often competing constituencies within each of the main groups of actors, whether hygienists, clinicians, public administrators, or legislators. Finally, as if matters were not already sufficiently complex, Aisenberg insists on deep interactions by which the formation of scientific knowledge and political ideology construct each other.

Of the five chapters that chronologically span the period from Villermé’s pioneering epidemiological (but legislatively unproductive) study of cholera in the 1830s to the enactment of a public health law in 1902, two contrasting chapters (amounting to more than half of the text proper) dealing with medical epistemology and hygienic action respectively, are innovative and insightful. Chapter 3, “The Debate over Contagion, 1860–1902” reviews in depth and with nuance the revolution in thinking about the causes of infectious diseases brought about by Pasteur’s germ theory. Building upon work in sociology of science, Aisenberg shows that many clinicians and hygienists, most of whom accepted the new microbial etiology, nonetheless disagreed with the Pasteurian emphasis on external causes or “morbid exteriority” to the neglect of other key determinants within the human organism or peculiar to its social environment, such as housing and nutrition. Conflicting positions within and outside the Academy of Medicine had important policy implications influencing whether one, for example, supported the vast sewage project for Paris begun by Haussmann (and favored by engineers and some medical men) or opposed it with Pasteur and other hygienists.

Chapter 5, “Hygienic Observation and the Remaking of Police Regulation”, draws on rich archival sources to show how, beginning in the 1880s and despite the absense of enabling legislation, an alliance between a network of neighborhood health officers and police authorities investigated the dwellings of families suspected of harboring infectious diseases. By focusing on le foyer (the household and neighborhood), the enquêtes of the hygienic detectives privileged the welfare of society over the sanctity of the private dwelling or even the immediate medical needs of the sick individual. No doubt, this represented an important shift in Republican values, and Aisenberg rightly prizes the significance of the textured eye-witness reports of arrondissement doctors over the still-reticent public health legislation of 1902. Nevertheless, we are dealing here with an impoverished Parisian population living in rented apartments, a group whose “liberty” of property tended to fall well short of that of their social superiors. On the bourgoisie and contagion, Aisenberg is silent. Nor does he consider how the problematic of state intervention played out with tuberculosis and venereal disease, manifestly contagious scourges of the Third Republic where physicians tended to protect the “professional secrets” of their middle class clients.

This study is flawed by other silences and inaccuracies. Relatively obscure figures are selected for detailed analysis while prominent personalities, Adrien Proust for example, Faculty professor of hygiene, are missing. At times the chronology is confused, with contributions long before or after Pasteur inserted into the context of the debate on germ theory. Repeated mistranslation of French words is disconcerting, and a generally graceful writing style is at other times excessively convoluted, even cryptic.

Clearly, Aisenberg has not written a synthesis on the question of contagion and the hygienic movement in France...