L’expérimentation humaine: Discours et pratiques en France 1900–1940 (review)

Christian Bonah does not quite fulfill the promise of his title, in the sense that he does not cover the whole field of human experimentation in France in the first half of the twentieth century, but he finally provides far more than that by adopting a long-term and often comparative perspective and by bringing visibility to a long-ignored reality (the phrase “human experimentation” is rarely used by medical doctors).

Although Bonah recalls that human experimentation can be tracked back to antiquity, he shows how it exploded in Europe in Claude Bernard’s time. The emphasis was then put on the importance of establishing physiological laws specific to humans, with a continuity hypothesized between the normal and the pathological (the Broussais principle). Simultaneously, doctors were seized with a frenzy for testing all kinds of therapies, mainly but not exclusively in hospital wards.

This epidemic of experimentation did not pass unnoticed, even if legal suits against doctors remained exceptional. To explore the reactions of the public, Bonah turns to literature and theater. He borrows from French medical theses defended around the turn of the century to document the fears and defiance of the population toward scientists, who were viewed as apprentice sorcerers.

The central piece of the book, and its most original part, is the description of two episodes in France: BCG (Bacillus Calmette-Guérin) studies conducted on children between 1921 and 1927 and among colonial soldiers between 1924 and 1940. Bonah relies on the plentiful archives of the army and the Pasteur Institute to dissect the complex practices that are usually hidden from those who keep to the reading of scientific papers. In so doing, he provides an interesting retrospect on the history of BCG at a time when recommendations for its use are at stake (mass immunization versus vaccination of children at risk, the search for a better alternative vaccine, genetic engineering, and so on).

The BCG vaccine is controversial even today. Although it has long been part of the UNICEF strategy for children (Extended Immunization Program), some countries, such as the United States, have never adopted it.

Bonah provides a fascinating description of the dissemination of BCG in France after its introduction by Albert Calmette in Paris in 1921. Bonah does not anachronistically blame Calmette for not applying the criteria of randomized trials with control groups. They were not standardized before the mass trial of polio vaccine planned by Francis in the United States in 1954. But Bonah shows a Calmette insensitive to the arguments of the British statistician, Major Greenwood, and entrenched in his intimate conviction about his vaccine. To critics of his sampling and homogenization procedures, Calmette responded by invoking the social restraints complicating the march of the study, silencing his adversaries by advocating the urgent need of the vaccine. But the evaluation of the actual risk was precisely the point contested by the statisticians.

The second BCG episode took place in the army under the aegis of the Pasteur Institute. Despite several rapidly evolving cases of tuberculosis (attributed to infections contracted in the country of origin), the study concluded that BCG was safe. Although one would expect that a military frame would guarantee strict follow-up protocols, Bonah describes faulty procedures and soldiers fooling supervisors, but he also shows military doctors who were reluctant to have their troops treated as guinea pigs and who were, ultimately, more concerned than their civilian peers about the ethics of consent.

Christian Bonah does not completely succeed in clarifying all of the steps of the tortuous progression of research ethics in France, or in disentangling all of the factors shaping its specificities. He uses too lavishly the vocabulary of crises and revolutions and finds some difficulty in correlating the main shifts in legislation and jurisprudence with social and political events. Bonah’s outstanding contribution to the history of science is his ethnographical treatment of medical...