The Rise and Fall of Anticontagionism in France

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Articles
The Rise and Fall of

Anticontagionism in France*
Abstract. This article re-examines the anticontagionist controversy in nine-

teenth-century France. Erwin Ackerknecht attributed the discrediting of conta-
gion theory to political opposition to quarantines and the rise of social medi-
cine. Later scholars argue that he exaggerated the opposition between conta-
gionists and anticontagionists. I argue that French doctors were genuinely di-
vided on questions of knowledge and practice. Disease by disease, they battled
it out. Anticontagionistsgained the upper hand in the 1820s and 1830s, only to
relinquish it again in the 1840s as contagionistsrevised their theories to be more
progressive and tracked down evidence to which the Academy of Medicine
lent its authority. At that point the majority of physicians rallied around to an
attenuated theory of transmission and support for qyarantines.
Resume. Cet article rkxamine la controverse anticontagionniste au XIXe
sikle en France. Erwin Ackerknecht a attribu6 le distrait de la thhrie de la
contagion 1l'opposition politi ue aux quarantaines ainsi qu'8 la mont6e d'une
9,
m6decine sociale. Plus tard des istoriens ont avanc6 qu'il avait exaged I'opposi-
tion entre contagionnistes et anticontagionnistes. Je soutiens qu'en France, les
medecins 6taient v6ritablernent divis6s sur les questions de savoir et de pratique.
' Ils en dkbattirent rnaladk par maladie. Les anticontagionnistesprirent le dessus
dans les a n n h vingt et trente mais ce fut pour c6der 1 nouveau la place dam les
a n n h quarante, lorsque les contagionnistes r6vidrent leurs th6ories pour etre
plus progressistes et dtkouvrirent des faits nouveaux que lfAcad6miede M6de-
cine appuya de son autorit6. Ace moment 18, la majorit6 des m6decinsse rallihent
1m e thkrie plus nuan& sur la transmission et au soutiendes quarantaines.
Around the turn of the nineteenth century, many doctors began to think
that traditional principles and practices of contagion were exaggerated.
E. A. Heaman, Department of History, University of Toronto,Toronto,Ontario M5S 1Al.
CBMH/BCHM / Volume 12: 1995 / p. 3-25

Contagion, as defined by Fracastoro in the sixteenth century, was the
transmission of the same disease from a sick person to a healthy one by
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means of self-perpetuatingagents or entities of disease-germs-which

resided in bodily fluids and must be alive because they could repro-
duce. They could also spread by means of clothing, linen, and other
goods. This clearly failed to explain diseases like yellow fever, which is
carried by mosquitoes; or those which spread in water including chol-
era and typhoid; or bubonic plague and typhus, carried by vermin.
Filth theory, which had long coexisted with contagion, became an
argument against it. Its proponents blamed such local causes as
swamps and sewers.l Now a group of self-styled "anticontagionists"
announced that these local causes were sufficient to explain epidemics;
there was no reason to invoke contagion as well. There was no conta-
gion but only continuous generation. And, they argued, contagionist
practices like quarantines actually made things worse. Quarantines
kept people in the insalubrious area, exposed to the causes. If they were
dispersed, the disease would not spread but would disappear. Quaran-
tines should be replaced with hygienic measures such as better sewage
and swamp drainage.
Erwin Ackerknecht has argued that the medical profession durin
the nineteenth century converted wholesale to anticontagionism. Q
Moreover, he suggests, because evidence for and against contagion was
evenly balanced, doctors became anticontagionists because they op-
posed quarantines. They allied themselves with merchants who com-
plained that quarantines hampered commerce, and with liberals who
opposed the expensive bureaucracy needed to maintain these arbitrary
and "draconian" police measures. Doctors declared non-contagious
those diseases affected by quarantines: yellow fever, the plague, and
cholera. Other diseases were less controversial.
Ackerknecht's theory has come under attack. Margaret Pelling claims
that he exaggerated the strength of English antic~ntagionism.~ Christo-
l
pher Hamlin, building on her work, argues that contagionism and an-
ticontagionism were neither incompatible nor essentially ~ p p o s e d . ~
The real quarrel, he explains, was over predisposing versus immediate
causes of disease. My own work leads me to conclude that Acker-
knecht's account is inadequate but not entirely wrong-headed. Acker-
knecht did overestimate the strength of anticontagionism: many of his
anticontagionists actually argued for morbific transmission. Typical is
N. P. Gilbert describing an 1802epidemic:
La fievre jaune n'est pas contagieuse. [. . .l Cependant on ne peut se dissimuler
qu'une maladie aussi grave et d'un caractere putride et gangreneux, ne puisse
se porter par communication de l'air r6spir6, ou par le contact des effets
impr6gn6s de ces miasmes sur les homme~.~
The Rise and Fall of Anticontagionism in France
Nevertheless, these "transmissionists" called themselves anticontagion-

ists, choosing to define themselves in opposition to contagionism. Dis-
taste for quarantines was an important motive. Franqois Delaporte

denigrates Ackerknecht's appeal to "high politics" as a "rather naive
mixture of psychologism and soci~logism."~ But clearly the range of
possible responses to epidemic disease informed the debate over
causes: R. G. Collingwood has argued that in medicine we identify as a
cause precisely what we can act upon.' In the eighteenth century, this
was bodies and objects, but by the nineteenth century, visions of social
regeneration by means of hygienic reform expanded the scope of the
controversy. The extent to which the state could or should regiment
people, their possessions, and their environment, was a political prob-
lem. And in times of political turbulence, the medical controversies also
grew heated. The anticmtagionist controversy coincided with a series
of political upheavals in France, from the late-eighteenth to the mid-
nineteenth century. Anticontagionists won allegiance from "transmis-
sionists" like Gilbert because their program of social and hygienic re-
form suited political sensibilities. However, as Ann F. La Berge has
pointed out, if Ackerknecht's anticontagionists were defiantly liberal,
hygienists were confirmed statists? This tension contributed to the
eventual collapse of anticontagionism.
In short, before turning to alternative theories to explain anticonta-
gionism's success? we should examine the relationship between
theories as to how epidemic diseases propagated and how they should
be arrested. No such survey of French opinion exists. The two best re-
cent studies, by Delaportelo and William Coleman,ll examine isolated
outbreaks of individual diseases. Both see trammissionism as a new so-
lution to the controversy, one that emerged in 1832 during the cholera
epidemic (Delaporte) and after midsentury during yellow fever epi-
demics (Coleman).I will argue that transmissionism was as old as anti-
contagionism itself, and only became a solutionbecause the political cli-
l
mate changed and quarantines were made more acceptable. A close
reading of the labored reasoning and vocabulary employed can per-
form the modest but useful task of correctly identifying positions that
not only Ackerknecht but even Delaporte mistake^,'^ and which should
be a first step in theorizing French anticontagionism.
THE RISE
French anticontagionism began in 1793 when Jean Deveze, fleeing an
uprising in Saint-Dominguearrived in Philadelphia just as yellow fever
broke out. D e v h adopted the anticontagionism already prevalent
among American doctors, which he propounded in France until his
death in 1829.13He was aghast at the epidemic devastation, which con-
tagionist sanitary measures seemed only to reinforce. Community life
halted as people fled from contact with one another and particularly
from doctors. They abandoned friends and kin, or saw them forcibly re-
moved to isolation camps, to die alone amongst dying strangers.
Dev&zelsaccount evoked that of a Boccaccio, or a Thucydides, who had
made the plague of Athens an abiding metaphor for social and moral
anarchy. Epidemics were an affront to all human and divine order. In
The Plague, Camus remarked, "no one will ever be free so long as there
are pestilences." Heir of the French Revolution, Dev&zeset about liber-
ating mankind from that other despot, epidemicity.
Dev&zeurged a return to normalcy and order. He insisted that yellow
fever was neither contagious nor fatal: fear alone, with its effects, ren-
dered the disease harmful. Properly treated, a yellow fever epidemic
would be no worse than a rash of winter colds.14Doctors should quell
fear by declaring the disease non-contagious and replace cruel meas-
ures of sanitary police with beneficial public health improvements.
Another witness to the American epidemic, Louis Valentin, also
watched yellow fever destroy a French campaign to Santo Domingo in
1802. With fellow military physicians Victor Bally and Gilbert, he de-
nounced the excesses of contagionism,but also admitted that yellow fe-
ver could transmit itself by means of miasmata emanating from the sick.
Regarding quarantines, the three believed, until port towns could be
made more salubrious, "La prudence et la crainte prescrivent ces me-
sures, et la raison les consacre."15 Many junior health officers returned
from the expedition to write dissertations about the epidemic.16Some
pronounced yellow fever communicable and cohtagious; some, like
Gilbert, commu-nicable and non-contagious, and some, with Deveze,
denied any form of transmission.
Meanwhile, yellow fever invaded Spain in 1800. A team from the
Montpellier Faculty of Medicine declared the disease contagious and
advocated quarantines." Their verdict was challenged by F. P. B. Blin,
l
who qualified his anticontagionism with the remark
Je dois prbvenir qu'en refusant B la maladie de Cadix le caract&recontagieux,
proprement dit, je n'ai point prktendu que cette fi&vre,une fois rbpandue chez
un grand nombre de sujets, n'ait pu, c o m e la fi&vredes prisons, celle des
camps et des h&pitaux,se communiquer B beaucoup de personnes sains, par la
contagion qu'un si grand nombre de rnalades B du occasioner dans l'at-
mosph&re.18
These accounts introduced a lasting ambiguity into the meaning of
"contagion." Reports on the plague, which devastated Napoleon's
troops in Egypt in 1798, deepened the confusion. Chief medical officers,
R. D. Desgenettes and J. D. Larrey, contagionists both, believed that fear
enhanced susceptibility, and they calmed the troops by announcing
The Rise and Fall of Anticontagionism in France 7
that the disease decimating them was neither contagious nor the
plague.19 Desgenettes publicly inoculated himself with bubonic pus,

though he carefully chose a convalescent as the donor. While these two
contagionists denied transmission, two transrnissionists, J. F. X. Pugnet
and Pierre Assalani, denied contagion. Assalani believed the plague
a d d only spread in proximity to its local causes:
One may contract, in my opinion, this disease, when the causes which produce
itshall by degrees have impaired the health, and predisposed the body to take
omdiiased action: I will then admit, that if a person be exposed to breathe the
infected air in the chamber of a patient, or should he stay too long in the same
atmosphere, he will runa great risk of contracting the prevailing malady.20
Assalani blamed contagionism for the neglect of patients, and the quar-
antines which retained him in Damietta, again in Cairo, then in Malta,
and finally in Marseilles. He sent his memoir to the Paris Faculty of
Medicine Society, which praised the attempt to calm people but
warned, "it is no less important not to lull into a false security the solici-
tude of g~vernments."~~ The Society adopted the same position in 1805
regarding a memoir by Antoine Dalmas which argued that yellow fever
was "epidemo-contagious" inside a focus, but could not be transported
into FranceF2
A third source of anticontagionism was the typhus epidemics which
devastated the Grande Amzke, prison camps, and a besieged Paris. All
agreed that typhus spontaneously appeared where people were
crowded together in filthy conditions. Anticontagionists claimed that
transmission occurred not by means of a germ but because the ill be-
came part of the cause: "Chacun des individus affect& tend accroitre
le nombre des victimes, en augmentent la cause de l'infection dont il de-
vient lui-m&meun nouveau foyer."23 So typhus, unlike smallpox, was
only transmissible where crowds and squalor prevailed. The epidemic
cause might travel, as when the army trekked typhus across Europe, but
I
could not leave its causal f w s . If one dispersed the crowd, the cause
would disappear. Quarantines and sanitary cordons only perpetuated
epidemics, which were best cornbatted with evacuation and hygienic
reform of the conditions that were clearly much more to blame than in-
dividual transmission.
m h u s (which virtually disappeared from France) became the para-
digmatic epidemic disease, even though everyone admitted it was com-
municable, even Dev&zeand later radicals F. J. V. Broussais" and Nico-
las C h e r ~ i nMany
. ~ ~ "anticontagionists," like Blin, declared yellow fe-
ver (a.k.a. American typhus), the plague (African typhus), or later chol-
era (Indian typhus), to be non-contagious but still transmissible in the
fashion of (European) typhusF6 Transmissionism became assimilated
with anticontagionism. In a widely quoted series of articles, J. B. Nac-
quart admitted "infection" was a form of contagion, but stated it was
"peu philosophique" to associate the two because they provoked differ-

ent response^.^' Whereas contagionists provided formulas for coping
with epidemics, anticontagionists and transmissionists sought the con-
quest of epidemicity. They wanted to break the link between social ca-
tastrophe and epidemic, to purge the latter of its Thucydidean over-
tones, by making it the business of public health reform.
In 1816F. J. V. Broussais complicated matters. Broussais was an inter-
nalist, more concerned with the process of disease within the body than
with its external propagation, but his "physiological" theories had anti-
contagionist implications. He denounced contagionism's ontology:
diseases were not entities, but gastro-intestinal irritations and inflam-
mation~.Disease was imbalance, and differed from health only in de-
gree, not kind. As there was no such thing asa disease, there could be no
self-perpetuating and specific agent of disease.28Broussais' .doctrine
gripped the Paris school for two decades. He gave anticontagionism
theoretical sophisticationand a new political slant, for he was a political
radical and critic of the reactionary Bourbon government restored to
power in 1814.
Broussais' influence should not, however, be exaggerated. His stu-
dents were primarily interested in gastroenteritis (typhoid) or they
sought to disprove the existence of a virus causing syphilis or rabies
(which, they admitted, did spread via bodily fluids). And because
Broussais believed miasmatic poisoning a cause of irritation, he and his
disciples admitted infectious transmission between individual^.^^
In short, anticontagionism had begun to penetrate the French medi-
cal profession, but it was ambiguous and often heavily qualified. A
handful of radical anticontagionists denied transmission of any sort.
A larger number of physicians admitted transmission but identified
themselves as anticontagionists. All denounced sequestrationmeasures
taken inside epidemic foci as useless and pernicious. Though critical of
I
quarantines, few yet advocated their immediate abolition for yellow fe-
ver and the plague: these were prudent and although inconvenient, not
openly harmful. Any constituted body which spoke ex cathedra between
1800 and 1826 adopted a position admitting transmission or contagion,
or at least that quarantines were prudent: this included the Montpellier
Faculty in 1800, another Spanish Commission led by Bally in 1804, the
Paris Faculty of Medicine in 1804,1805, and 1817, and two more Span-
ish commissions in 1819 and 1821. Finally, in 1825 the Academy of Sci-
ence and the Academy of Medicine (created in 1820 to advise the gov-
ernment on medical matters) were consulted regarding the expediency
of importing the goods of plague victims into the Marseilles lazaretto
for experimentation.Both declared the risks too great.30
By the mid-1820s, however, the controversy had begun to grow

heated over the question of quarantines. When yellow fever brdke out
in Spain in 1819, the Restoration government hastily erected quaran-
tines and sent Etienne Pariset to Spain to assess the threat to France.
With Andre Mazet, he composed a firmly contagionist reporta3'In 1821
the disease reached Barcelona, and Pariset and Mazet were sent off
again, accompanied by Victor Bally and Andrb Fran~ois,both of whom
had declared the Santo Domingo epidemic non-contagious, but had be-
come converted to contagionism. To forestall criticism, the Minister of
the Interior adjoined an anticontagionist, J. A. Rochoux. Rochoux soon
fell out with the others and abandoned the commission leaving the rest
(except Mazet, who died of the fever) to report that epidemic invasion
was imminent and strict sanitary measures were needed?2 The govern-
ment, anticipating Pariset's conclusion, had erected a cordon sanitaire
and passed a bill to establish a national system of quarantines and laza-
rettos. This law of 3 March 1822 guided French sanitary policy for the
rest of the century.33 Among its authors were Desgenettes, Pariset,
Bally, and Deveze who published a lonely protest against the commis-
sion's The law enacted strong-arm measures to prevent the im-
portation of "pestilential" diseases: yellow fever, the plague, and ty-
phus. It also provided for internal measures applicable within France,
but these were neither enforced nor enf~rceable.~~ Of particular note: it
centralized initiativein decidingwhen and how to apply quarantines; it
called for the constructionof new lazarettos; and it prescribed the death
penalty for evasion.
The new law generated considerable resentment. Local authorities
bridled at the Parisian intrusion into their affairs. Merchants chafed at
the costly obstacles it imposed upon commercial traffic. Liberals feared
that the government might level this formidable police apparatus
against its political enemies. Finally, anticontagionists protested on be-
half of till those needlessly oppressed by the law, and their arguments
l
that quarantines served no useful purpose fuelled the criticism from
other quarters. Liberals' worst fears seemed realized when in 1823 the
French government transformed the sanitary cordon into an army to in-
vade Spain and quash a revolution. Moreover, the government re-
warded the Barcelona Commissionerswith honors and pensions. How-
ever, as Delaporte has remarked, the government probably did not es-
pouse contagionism simply to upset merchants and liberals.36Consid-
erable evidence existed to suggest a need for sanitary measures, and the
general public, imbued with an age-old fear of contagion, demanded
them. It seems more likely that the government became sensitive to po-
litically inspired criticism of its sanitary policies, and so came to view
even the medical arguments against contagion with a jaundiced eye?'
The Pariset Commission, which had done little actual research, was
quickly discredited. Local and foreign doctors denounced it, among
them Rochoux and Simon Lassis, who declared yellow fever, like ty-
phus, communicablebut neither contagious nor imp~rtable.~~ Matthieu
Audouard, sent to Barcelona by the Minister of War, argued that the fe-
ver ("nautical typhus") was transmissible and importable, aboard the
slave traders he blamed for its genesis.39Finally, Nicolas Chervin, anti-
contagionist extraordinaire, erupted onto the scene. He was a radical of
the Devkze stamp, whose 1812 medical dissertation had proclaimed so-
ciety's ability to overcome even biological li~nitations.~~ Chervin then
applied this principle to epidemic disease. He believed it could be con-
quered outright through social reform, beginning with quarantine re-
peal. He spent years in the United States gathering evidence to prove
yellow fever non-~ontagious,4~ and now rushed to Spain, where he
obtained enough information to demolish the scientific credibility of
Pariset's account. Chervin returned to France and demanded the Depu-
ties stop building new lazarettos for yellow fever. His petition, with 839
notarized documents, was sent to the Academy of Medicine. The Acad-
emy named a special commission, which in 1827gave its report. As one
journalist remarked, the choice was between
des h o m e s qui soutiennent par de faibles argumens et des preuves inexactes
une opinion par une autorite qui paye cherement leurs services, opinion
que la plupart d'entre eux ont combattue l'bpoque oil elle &it moins profi-
table, et un h o m e qui, seul ap&s de longs et penibles voyages, muni de docu-
mens authentiques et nombreux, vient proclamer une doctrine qui ne lui rap-
porte que des dbagremenset des tracasseries."
Reporter Godefroi Coutanceau concluded that the documents merited
very serious governmental attention and were "de nature ii motiver
l'ajournement des etablissements ~anitaires."~~
Pariset and the Minister of the Interior, Courbikre, had the report
I s ~ p p r e s s e dCourbikre
.~~ told the Academy that sanitary measures were
none of its business. A rurnor warned that "le Gouvemement sera
mecontent si l'Academie adopte les conclusions de la Commission [. ..]
que le Gouvernement n'enverra plus rien ii YAcadtlmie de Medecine
et sladressera ii llAcademie des S~iences."~~ Another anticipated a
purge.46Some scoffed but others remembered that the Faculty of Medi-
cine had been purged of its liberal professors in 1822;" nor were they
unaware that a proposed "re-organization" of the over-large and un-
wieldy Medical Academy was in the air.48The Academy chose to sub-
mit to the government's terms, and only Desgenettes and anticonta-
gionist J. B. de Louyer-Villermay protested, the latter exclaiming with
disgust "11Acad6miedoit donner ses avis, et non rendre des services."49
After a peremptory discussion, the Academy voted the conclusion:
La commission B la presque unanimit6 pense que les documens de M. Chervin

(en admettent come exact les faits qu'ils contiennent) m6ritent l'attention la
plus serieuse, qu'ils augmentent consid6rablement la masse des observations

en faveur de l'opinion de la non contagion de la fievre jaune, et qu'ils pour-
raient concourir puissamment A 6tablir en principe cette non contagion si, dans
l'&t actuel de la science, cette questionpouvait etre r6s0lue.~~
Coutanceau deleted the reference to quarantines and even to govern-
mental interest. Emphasis that the commission had taken the docu-
ments at face value and that science could not resolve the issue diluted
the obvious anticontagionist sympathies.
Chervin had not proved yellow fever non-contagious, as even his
friends outside the Academy admitted?l He did prove that the govern-
ment's rationale for erecting new yellow fever lazarettos was scientifi-
cally and politically suspect. One consequencewas that the Deputies re-
fused further funding for lazarettos.
In 1832, after the July Revolution, the Academy elected Chervin to its
membership. He became its expert on yellow fever and, until his death
in 1843, dominated any discussion of it while Pariset and Bally sat in
silence. There remained considerable unease with his radical anti-
contagionism: an epidemic in Gibraltar in 1829 occurred in the almost
entire lack of local causes, and Chervin, clinging to his swamp theory,
had to blame four centimetres of water in cart tra~ks.5~But as the Acad-
emy feared to re-open formal debate, the government was left with the
initiative in sanitary policy. The %ourgeois monarchy" of LouiS-
Philippe took liberal and commercial interests rather more to heart than
had its predecessor and, in 1845, abolished all quarantines for yellow fe-
ver .53
The yellow fever controversy was indeed about quarantines. Cholera
was less straightforward. Endemic to India, in 1817 cholera began to
spread outward. When it invaded Eastern Europe in 1830, France sent
four commissions to observe the disease in Poland and Russia, two of
' them sponsored by the Academies of Sciences and of Medicine. The
Academy of Medicine provisionally declared the disease not essentially
contagious, but able to become so, and advised the government to take
both sanitary and hygienic measures.54The July Monarchy had already
done so, following the advice of a retired naval captain, A. Moreau de
Jonnes.% In June 1831 cholera was added to the list of importable
diseases, and in August an ordinance created sanitary Intendances to
set up quarantines. Across Europe all sorts of sanitary and hygienic
measures were taken, all in vain, for the cholera advanced relentlessly,
and in March 1832 descended upon Paris. In April the government
suppressed the Intendances and invited them to transform themselves
into health councils.
The epidemic was cata~trophic.~~ In Paris alone, 18,000 died. Medical
remedies proved as futile as had the quarantines. Worse, the calamity
signalled the breakdown of public order. The well-to-do fled or, en-
sconced in their homes, escaped relatively unscathed, with the notable
exception of President Casimir Perier. The poor died in droves, and
they rose in anger against the middle classes they believed were poison-
ing them. Riots erupted into near revolution as the barricades went up
again, and the government only suppressed the uprising with diffi-
culty. Louis Chevalier has remarked that this epidemic truly opened
bourgeois eyes to the spectre of the Parisian masses?'
Doctors, critics of the Bourbon monarchy, supported the July Monar-
chy, and joined in the campaign to re-establish order. They urged sobri-
ety, avoiding "debilitating passion^,"^^ and declared the disease non-
contagious. Like Desgenettes in Africa, even contagionistsjoined with
anticontagionists and transmissionists to declare publicly that the dis-
ease was not contagious, though they might privately admit reserva-
t i o n ~ ?But
~ Paris contained few contagionists. Evidence of non-
transmission, particularly in hospital wards, abounded, while the first
case in an area often had no contact with cholerics. Many self-inocula-
tions failed. Any instance of transmission was blamed on epidemic
causes. Some, like Rochoux, denied miasmatic transmission and de-
clared cholera no more contagious than a broken leg.60Others believed
it communicable where epidemic, and that armies and caravans had
formed mobile epidemic foci, transporting the disease across Europe.
These transmissionists joined anticontagionists in pronouncing the ut-
ter bankruptcy of quarantine measures and the need for fundamental
hygienic and even social reform. One widely read Russian, Jaehnichan,
denounced contagion, admitted miasmatic transmission, but declared
quarantines useless unless everyone could stop breathing.61P. A. Prost,
one of the few to believe in animalcular contagion, published a ringing
address to governments: "c'est eux qu'il appartient d'opposer au
l
Cholkra une digue qu'aucun cordon, le plus sanitaire meme, ne peut
remplacer. C'est le sort des populations qu'il faut ameli~rer."~~
Quarantines were more than "inutile," ubiquitous though the term
became. The Academy heard horror stories of the misery that they
caused. One commissioner reported:
Toutes les precautions qu'on a prises n'ont pu en garantir le Prusse; elles sont
plus nuisibles qu'utiles. Le lazaret de Berlin est fort malsain; les quarantenaires
y sont trop entasds' et le &@me est rnauvais; les factionnaires qui en gardent
les approches ont ordre de tirer sur ceux qui chercheraient I etablir des cornmu-
nications, et ils s'en acquittentavec un horrible exactit~de.~~
This was a liberal's nightmare. Quarantines and cordons, already un-
fashionable, associated with repression, and of dubious efficacy, clearly
added to the horror of the epidemic. The Academy's Commission urged

French authorities to imitate the Moscow health council, which
par une conduite toujours calme, prudente et courageuse, a su pr&erver Mos-

cou d'un fleau plus redoutable encore que le cholQa-morbus; nous voulons
parler des emeutes populaires qui ont constarnment accompagne les mesures
que l'on a cru repressivesde la contagion.64
The antiquarantine movement paralleled the movement for penal re-
form that Michel Foucault has described in Discipline and Punish. Re-
formers sought to replace the overt use of force by the state with unos-
tentatious disciplinary techniques. These would serve not as extraordi-
nary measures, but as a "generalizable mode of f~nctioning."~~ Like the
Panopticon, they would replace repression with progressive reforms
which would extend the medical gaze into society.
In 1832, amidst the most devastating epidemic in memory, anticonta-
gionism made sense. It provided an agenda for coping with the medical
and social catastrophe, which contagionism failed to do. But if the epi-
demic discredited contagionism, it also dealt a serious blow to environ-
mental and social etiologies. Neither provided sufficient cause for the
epidemic: neither could explain why, suddenly, the disease catapulted
around the world, striking the most diverse areas, as abruptly to sub-
side again.66Delaporte has shown how the Parisian epidemic replaced
environmentalism with new concern for urban ~onditions.~~ The Seine
departmental report on the epidemic dismissed topographical and cli-
matic causes, to concentrate on filth, poverty, and irnm~rality.~~ Yet
these could not alone explain the epidemic. And as R ~ c h o u xand ~ ~the
departmental report70 ruefully admitted, people living in debauchery
or near insalubrious establishments ofteli remained embarrassingly
healthy.
The leaders of the public health movement were not greatly per-
turbed by this: they found more than enough to interest them in what
I the disease had had to say about social etiology. L. R. Villerme and L. F.
Benoisten de Chateauneuf used the epidemic to reveal the s ualor that
S
flourished in Paris, and ignored the problem of transmission. Anticon-
tagionists felt more deeply their ignorance of the epidemic's general
cause and blamed electricity in the air, or copper filings, gases, or
ozone.n As the medical profession became won over to the new social
medicine, thanks largely to the epidemic and to anticontagionist propa-
ganda, anticontagionists themselves moved restlessly on. The anti-
contagionist alliance began to fragment.
THE FALL
Cholera heightened concern for epidemics in France. These had been

largely rural and ignored by Parisians. Rural doctors were more likely
to be contagionists because they could better trace an epidemic where
population was sparse. In 1832 a number of provincial practitioners de-
clared cholera importable, earning only the disdain of ParisiansT3How-
ever, as techniques to gather information improved, rural epidemiol-
ogy could no longer be ignored, and contributed to the collapse of an-
ticontagionism.
In the late eighteenth century, the Academy of Medicine's forerun-
ner, the Royal Society of Medicine, had begun to collect reports by state-
subsidized rural epidemics doctorsT4It hoped to compile a medical to-
pography for all France. Reports piled up after the Society, as a corpo-
rate body, was abolished during the Revolution. The Academy, incor-
porated in 1820, inherited its archives and its task of collating epidemio-
logical information. It created an Epidemics Commission which began
to report regularly in 1833.75Its foremost concern was typhoid, which
will here speak for endemo-epidemics generally.
Parisians almost unanimously believed typhoid non-contagious,
though they still disputed whether it was a gastro-enteritis or a typhus.
An important work by P. C. A. Louis in 1829 pronounced it typhus, but
made no mention of transmission in its catalogue of causesT6Provincial
physicians disagreed. Pierre Bretonneau of Tours, who first identified
typhoid as a distinct disease, believed it as contagious as smallpox."
Pupils Armand Trousseau and Alfred Velpeau carried his views to
Paris, while a growing number of able provincial clinicians published
detailed accounts of contagious typhoid epidemic^.'^ Emblematic was
Bretonneau's account of an epidemic at the military school in La F k h e
in 1826. Students were dismissed, whereupon 29 fell ill upon reaching
their homes, and 8passed the disease on to their families.
Sceptical Parisians blamed misdiagnosis, but slowly the weight of ev-
l
idence turned the tide. The Epidemics Commission of the Medical
Academy was one important means of publicizing rural findings. An-
other was an Academy prize in 1837, awarded to an essay which
marshalled all the evidence available to prove typhus and typhoid iden-
tical, contagious, and importable. The author, E. Gaultier de Claubry,
soon entered the Academy and dominated the Epidemics Commission
until 1853.79In 1841, Louis converted to contagionism. Discussion of ty-
phoid in the Academy continued to stall over problems of diagnosis,
but another prize contest in 1849 overcame this. Of the 17 entries, 13
declared typhoid transmissible. But, remarked C. M. Gibert, when he
announced the verdict, the spectre of contagion need no longer inspire
fear because simple precautions could control it: "Dieu merci! et crestla
un progr&sdont nous pouvons nous glorifier, nous avons su nous af-

franchir des terreurs et des prkautions outr4es qu'inspiraient A nos de-
vanciers les maladies contagieu~es!"~~

Experience with typhoid showed that even one person could trans-
mit the disease outside an epidemic focus and cause a new epidemic.
Even if that person did not carry a germ but, in the manner of typhus,
recreated the disease in the atmosphere around him or her, the result
was still importation. Anticontagionists who had identified yellow fe-
ver, cholera, and the plague with typhus, were hoist by their own pe-
tard. Typhus could m longer serve as an emblem of non-contagioy
epidemicity. Instead, typhoid became a model for epidemiology, as the
notion of an individual human focus was applied to other diseases. At
the same time, the importance of local conditions was upheld. All were
struck by the squalor and poverty of the French countryside, graphi-
cally described by local doctors. However, the permanent, banal pres-
ence of typhoid epidemics in France tended gradually to reduce reform-
ing zeal to an equally banal level. One early reporter for the Commis-
sion, transmissionist P. A. Piorry, called upon the medical profession
and the government to declare war on po~erty.~' Later reporters found
they could scarcely persuade authorities to remove cemeteries or dry
swamps. Gaultier de Claubry, was reduced to listing specific, obnox-
ious dungheaps and cemeteries in particular communes.82So where an
epidemic had lifted the gaze of a Devgze upward to embrace all society,
it narrowed the gaze of Gaultier de Claubry and his successors to focus
upon the minutiae of rural life. The problem was transformed from one
of political and philosophical principles to the efficient exercise of a
state-supported public health network.83As epidemicity and contagion
were reduced to practical details, they lost their symbolic meanings and
became less incompatible. 'Zf.phoid best illustrates this shift because
quarantines were not at issue, but the same process occurred with re-
gard to the "fatal trinity."
I The plague was anticontagionism's first casualty. In fact, few ever
openly declared the plague non-contagious, and fewer still believed
quarantines could be safely aboli~hed.~~ French interest in the disease
long remained tepid, notwithstanding a trip by Pariset to observe it in
Egypt in 1828.Pariset branded it contagious, but he appropriated an-
ticontagionism's optimism, promising that if French civilization were
extended into Africa, the plague could be overcome.85The goal was no
longer social renaissance, but imperialism. Another Egyptian epidemic
in 1835 provoked a sharp exchange among contagionist and anticonta-
gionist French doctors.86Once again, however, quarantines, and specif-
ically their duration, sparked controversy in France.
In 1834 England had established a steamship line between Alexan-
dria and So~thampton.~' France quickly created its own Alexandria-
Marseilles run. Each country imposed 20-day quarantines. Because the
French could make the shorter trip in half the 15-16days it took the Eng-
lish, France monopolized traffic. In 1841 England reduced quarantines
to 14 days, to begin the date of the ship's departure and to recommence
if anyone died suspiciously en route. English quarantines now existed
in name only. Austria and-theSlav states followed suit. One could now
reach France most quickly travelling via England or overland. France
was in a quandary. Its economic interests were seriously threatened.
But with only eight days between Alexandria and Marseilles (whose In-
tendance was notoriously contagionist), the government hesitated to
abolish its quarantines.
Transmissionist L. R. Aubert-Roche suggested a solution. He asserted
that during the previous 124years the plague had never broken out in a
French lazaretto without first appearing aboard ship and that its incu-
bation period never exceeded eight days. French quarantines should be
reduced to eight days beginning with the ship's departure, that is, be all
but a b o l i ~ h e dAubert
. ~ ~ provided a means to sanitary reform in the ab-
sence of consensus over contagion.
Aubert-Roche sent this argument to the Academies of Medicine and
of Sciences. Neither felt competent to verify the claim. In the Academy
of Medicine, contagionists and anticontagionists clashed, but discus-
sions went around in circles. Pressure upon the government and its
medical authority, the Academy, mounted. In August of 1844, during
yet another inconclusive dispute, N. P. Adelon, one of the architects of
the 1827compromise, cried "Enough!" He suggested that the Academy
form a special plague commission, to decide the problem for once and
for all?9 An 11-man Plague Commission spent the next 18 months pro-
ducing an exhaustive analysis of anything ever written on the disease.
Among the historical, geographical, clinical, and etiological conclusions
was the claim that the plague was not contagious, for nothing proved it
I
could spread by touch, clothing, merchandise, or inoculation. But it was
communicable when epidemic: individuals could transmit it one to an-
other by means of exuded or exhaled miasmata. It could spread inside
an epidemic focus or outside.* Reporter Clovis Ren6 Prus produced four
recent examples taken from the Marseilles lazaretto whereby sailors from
Egypt with the plague passed it on to attendants. However, Aubert-
Roche was correct: the plague had an incubation period of eight days. The
practical conclusions followed: Prus advocated quarantines of 8 to 10
days from the start of the voyage, and the posting of French sanitary phy-
sicians to suspect ports such as Alexandria. These would provide ships
with a bill of health and perform epidemiologicalinquiries.
After eight months of debate over the report, the Academy adopted
the conclusions?1 Prus' only significantconcession was to delete the ref-
erence to quarantine duration so as to avert a reoccurrence of the Acad-

emy's earlier humiliation. The Minister of Commerce, though initially
hostile to the report?2 agreed to impose 10-day quarantines (soon re-
duced to eight days) and post sanitary doctors in Alexandria, Constan-
tinople, Smyrna, Beirut, Damascus, and Cairo.
Prus proved transmission and importation outside the epidemic fo-
cus. When Rochoux insisted that the plague was really a form of typhus,
and so dispersal of the ill, not sequestration, was indicated, Prus, who
also likened the plague to typhus, retorted that transmission was, after
all, transmission. Whether or not dispersal might work, lazarettos had
worked, successfully snuffing out the plague on French soil. Prus rup-
tured the alliance between anticontagionism and transmissionisrn and
joined the latter, not to contagionism per se, but to a "better-safe-than-
sorry" position which supported quarantines. It helped, of course, that
these quarantines would be nominal.
Where Chervin had denounced the monies spent on quarantines as
much as their pernicious effects, Prus encouraged further government
investment in the sanitary doctors. This shift reflected the public health
ideal of an alliance between the state and the medical profession, which
had grown under the bourgeois Orleanist rnonar~hy?~ Now, sanitary
measures were situated within the public health paradigm. Quaran-
tines, lazarettos, and sanitary doctors would function as outposts of
French hygiene, extending the medical gaze even into darkest Africa.
They appeared in the same light as the network of epidemics doctors
and public health councils that the Academy and hygienists sought to
disseminate throughout France. This pragmatic neocontagionist pro-
gram more nearly corresponded to midtentury principles of reform
than the earlier radicalism of a Deveze or a Chervin.
Newer anticontagionist theories were equally irrelevant. Reasoning
l that insalubrity and poverty could not alone cause an epidemic,
Antoine Clot-Bey blamed all epidemics on an unknown atmospheric
agent. w h u s was never epidemic because people and insalubrity
caused it: "on ne peut donc dire que parce que le typhus atteindra un
grand nombre d'individus, il constituera une kpidbmie, pas plus qu'un
grand nombre d'individus bless& aprb une bataille ne constitue une
bpidkmie de The plague was epidemic, not a typhus, so hy-
gienic reforms would have no influence over it. Clot's theory was medi-
cally and socially irrelevant and it reveals the bankruptcy of anticonta-
gionist theory at mid-century.
The long, passionate plague debate was anticontagion's last stand.
When French physicians later agreed that cholera and yellow fever
were transmissible and importable and so necessitated quarantines,
they would do so with little dispute. Nonetheless, formal consensus
took many years to emerge.

Scarcely had the academicians finished discussing the plague when
cholera reappeared. This time France did not erect quarantines, and
again the disease descended. French physicians had afforded the ques-
tion of cholera's transmission little attention since 1832. In the Acad-
emy, only Bally, Pariset, and Nacquart half-heartedly objected as Ro-
choux, Chervin, and Charles Londe denounced contagion and "ces ef-
frayantes et burlesques q~arantaines."~~ Now, however, contagionism
was given new life as rural epidemics reports began to arrive at the
Academy. At least 37 described the importation and successive trans-
mission of the disease, as opposed to 18 which denied this or blamed
electri~ity?~ Academicians adjourned discussion until a commission
could verify the data. As the reporter, Jules GuCrin, found the rural re-
ports convincing, a return to transmissionism seemed likely. GuCrin
never presented his report. He complained that, fearful of a contagion-
ist verdict, the government refused him access to its records:
on allhgua 11inopportunitc5d'une telle dc5marche; on pretendit que toute recher-
che sur la contagion n'aurait d'autre dsultat que de jeter l'alarme parmi les
populations, et on refusa de nouveau, mais non sans exprimer ouvertement
combien l'on voyait avec rhpugnance que l'Acad4mie s'occuplt de-lacontagion
du ~ h o l h r a . ~ ~
Following the uprising of June 1848, the new republic feared popular
unrest. At the same time, the government forestalled criticism by pro-
moting public health reforms and by re-introducing for cholera the sort
of nominal quarantines that Prus had advocated for the plague.
In 1854 cholera returned. The Academy was inundated by reports
from the provinces, most of which documented importation and trans-
mission. It heard these in stony silence. Even the presence of the epi-
l
demic passed unremarked. The Imperial government discouraged
mention of the epidemic, and a cloak of silence descended over
France.98Not until 1865, the year of the next invasion, did the Academy
hear a report on cholera.99This highly statistical account of epidemics to
1850 asserted that the disease was spread primarily by people. No dis-
cussion ensued. In 1869, another report on more recent epidemics sec-
onded its conclusions: cholera was transmissible, and both sanitary and
hygienic measures were needed.loODiscussion began only in 1873, after
the fall of the Empire. Henceforth, cholera became the business of the
Epidemics Commission. Cholera joined the list of endo-epidemic
diseases to be combatted with public health measures, including quar-
antines. Already in 1865, at an international sanitary conference, offi-
cials had agreed upon a standard of quarantine^.'^'
Yellow fever anticontagionism died a speedier death. In 1857 the

Academy as much as admitted that the disease had been imported onto
French soil,'02 and in 1861 it applauded the importationist account of an

epidemic at the port of St. Nazaire presented to it by Franqois Miilier, the
gpvernment sanitary inspector.lo3 The French government had not
awaited the Academy's verdict but re-introduced quarantines using its
own sanitary bureaucracy. The Prus report, with its argument for nomi-
nal quarantines, had introduced a principle which the government in-
dependently applied to yellow fever and cholera as well as the plague.
Prus and Aubert-Roche proved that the government did not need scien-
tific consensus on the nature or occurrence of contagion to formulate
sanitary policy. This principle complemented another advanced by tra-
ditional anticontagion, neocontagion, and hygiene theories alike,
namely, that social etiologies were insufficient but certainly necessary
causes for epidemics. The result was that the government gradqally
equipped itself with a centralized hierarchy of sanitary and hygienic
personnel which did not need justification from theories of either conta-
gion or anticontagion. This program was not the radical utopian vision
of yore. With the establishment of the bourgeois July Monarchy, liberal-
ism became more conservative, and its reform program was redesigned
to support and no longer to challenge existing authority.lo4
As quarantines were assimilated with public health organization,
they were no longer the object of political partisanship. Instead doctors
and administrators together pursued a larger political program, that of
extending a public health grid through France and beyond, which
would permit them to peer into and reform the public and private lives
of French men and women. Thus, though doctors became more conta-
gionist than the government, this was not translated into the political
opposition seen under the Bourbons. Though Aubert-Roche led the
mob attack on the Tuileries in 1848 and was the leading critic of Orlean-
ist sanitary policy, he sought only to modify not abolish quarantines,
1 and the medical estaWshment refused to follow him even that far with-
out compelling evidence. As they had done with typhoid, doctors
quietly negotiated compromises, which recognized transmission and
importation. Isolated anticontagionist arguments were heard for dec-
ades longer, but anticontagionism was a spent force.
OF ANTICONTAGIONISM
If there was one essential difference between anticontagionists and con-
tagionists, it was that the former discovered the idea of an epidemic
first. Anticontagionists were not interested in contagion per se: rather
than rabies or smallpox or tuberculosis, they studied epidemic disease,
and they defined "epidemic" as synonymous with "anticontagious."
They had a more holistic approach to epidemics than did contagionists
who, by reducing the epidemic to one case of individual transmission
after another, missed the forest for all the trees. Anticontagionists stud-
ied epidemics as an urban, community experience, and they prescribed
reforms to create a new society free from the threat of epidemics.
The dream of liberating humanity from pestilence foundered. Out-
breaks of typhus-the model of a non-contagious and epidemic dis-
ease-taught that sociabilityitself, in concentrated form, was patholog-
ical.lo5Epidemicity could no more be eradicated than could society
itself. It could only be repressed, by regulating social behavior. Here an-
ticontagionists and hygienists parted company. After the July Revolu-
tion, as relations between doctors and the state became4ess adversarial,
hygienists insinuated themselves into the emerging medical bureauc-
racy and addressed the nineteenth-century problem of taming the pop-
ulace rather than the executive. Neo-contagionist theories lent them-
selves to this public health regime that extended the medical gaze into
urban slums, the countryside, and overseas, without hampering the
free flow of persons and goods. The turning point in the controversy
over contagion coincided with the hygiene laws of 1848, described by
La Berge as "the culmination" of the public health movement in France
which established hygiene councils across France.lo6
With the development of a public health apparatus, an analytical epi-
demiology emerged. Observers of epidemics decomposed these social
and medical events to their smallest common unit: the sick individual.
Anticontagionists, because they refused to truck in individuals, could
not conceive of one person becoming an epidemic focus and transport-
ing a disease from one area to another. Anticontagionists placed agency
in the environment; contagionists responded that individuals caused
environment.'("
Medical knowledge and organization evolved considerably during
the controversy. By insisting on close study of environmental patho-
l gens, anticontagionistsand hygienists greatly improved techniques for
gathering information, which pointed toward infectious transmission
from person to person. Establishing the transmission of the plague and
typhoid was a significant accomplishment and one of the first impor-
tant acts of the Academy of Medicine. Scattered evidence had existed all
along, but to be widely accepted required a national body to air it pub-
licly and certify its accuracy."@
The tale of anticontagionism seems to follow a classic dialectical pat-
tern. Anticontagionism emerged in reaction to the exaggerations of con-
tagionist principles and practices, which it combatted with equally ex-
aggerated claims and promises. Eventually a juste-milieu replaced both:
a scientific compromise upon infectious transmission and a practical
compromise upon rationalized quarantines. But this compromise was

only possible because the French medical field had been profoundly al-
tered in the meantime. By mid-century the anticontagionist movement

was without leaders or direction and undermined by its accomplish-
ments. As the anticontagionist utopia became ever more elusive, the
means to it had become itself the end. The doctrine of transmission re-
placed anticontagionism as that most suited to mid-century social, eco-
nomic, political, and medical realities.
NOTES
* I would like to thank the Hannah Institute for the History of Medicine, which funded
this study, and my supervisor, George Weisz, for his patience and encouragement.I
am grateful to the librarians at the Osler Library, McGill University, for the use of
their rich collection. I would also like to thank the two anonymous readers for their
helpful suggestions.
1 James Riley, The Eighteenth-Century Campaign to Amid Disease (Hampshire: Macmil-
lan, 1987).
2 Erwin H. Ackerknecht, "Anticontagionism between 1821 and 1867," Bulletin of the
History ofMedicine, 22 (1948):562-93.
3 Margaret Pelling, Cholera, Fever and English Medicine, 1825-1865 (Oxford: Oxford Uni-
versity Press, 1978).
4 Christopher Hamlin, "Predisposing Causes and Public Health in Early Nineteenth-
CenturyMedical Thought," Social History of Medicine, 5 (1992): 43-70.
5 N. P. Gilbert, Histoire mkdicale de l'armkefranpise d Saint-Domingue, en l'an dix (Paris:
Gabon, 1803), p. 94-96.
6 Fransois Delaporte, Disease and Cimlization: The Cholera in Paris, 1832, translated by
Arthur Goldhammer(Cambridge: MIT Press, 1986), p. 147.
7 R. G. Collingwood, "Causation in Practical Natural Science," An Essay on Metaphys-
ics (Oxford: Clarendon Press, 1940), p. 296-312. He instances a car which stops on a
steep hill: to be told that the top is further from the earth's centre than the bottom and
more power is needed to ascend is only helpful "if I had been a person who could
flatten out hillsby stampingon them." In this case, the cause must be mechanical.
8 Ann F. La Berge, Mission and Method: The Early Nineteenth-Century French Public
Health Movement (Cambridge: CambridgeUniversity Press, 1992), p. 1-6 and 97.
9 La Berge, following Roger Cooter, arguesthat anticontagionistsblamed atmospheric
influences because these were "hard to study'' which "opened the way for expert in-
terpretation" (Missibn and Method, p. 95-98, and Roger Cooter, "Anticontagionism
and History's Medical Record," in P. Wright and A. Treacher, eds., The Problem of
Medical Knowledge [Edinburgh: Edinburgh University Press, 19831, p. 87-108). As yet
no study has tested this hypothesis.
10 Delaporte, Disease a d Civilimtion.
11 William Coleman, Yellow Fever in the North: The Methods of Early Epidemiology
(Madison: Universityof Wisconsin Press, 1982).
12 Delaporte argues that J. A. Rochoux became a supporter "of physiological medicine
because it alone had treated the question of infection in a systematic way" (Disease
and Civilization, p. 137). In 1832, Rochoux was more anticontagionistthan the physi-
ologists: see below.
13 Jean Devhze, An Inquiry into and Obsemtion upon the Causes and Effects of the Epidemic
Disease (Philadelphia:Parent, 1794), and Dissertation sur 1aPvre jaune, Medical The-
sis (Paris, 1804).
14 Devhze, Dissertation, p. 10. Simon Lassis later remarked similarly: "En m e mot, m e
ville atteinte d'une bpidbmie, au lieu de devenir le thbatre de ces dksashes qui ont si-
p a l 6 tant d'autres maladies kpidemiques, ne differait en rien d'une ville saine, si ce
n'est pas par la p&sence des malades, qui alors seraient beaucoup moins nombreux,
et en genbral beaucoup moins gravement affect&, que sous le systeme de la conta-

gion" (Causesdes maladies $idkniques [Paris:C o m p h jeune, 18221,p. 333).
15 Deveze, Dissertation,and L. N. Vanould, Dissertatwn sur lafievre jaune, Medical Thesis
(Paris, 1808),p. 20.
16 Collectwn des theses soutenues d la Facultt de Mtdecine de Paris (Paris: Didot, 1796-1835,
and Rignoux, l838-l85O), held at the Osler Library, McGill University, Montreal.
17 F.-C. Caizergues,Mtmoiresur la contagion de lafi&urejaune(Montpellier:Picot, 1817).
18 In L. B. Guyton Moweau, Traitt des moyens de d&infecter l'air, de prhenir la contagion,
et d'en arrtter les pmgres, 2d ed. (Paris:Bernard, 1802),p. 322.
19 R. Desgenettes, Histoire mtdicale de l'armte dd'Orient(Paris: Croullebois, 1802), and
J. D. Larrey,Mtmoires de chirurgie militaire et campagnes (Paris:J. Smith, 1812).
20 P. Assalani, Observations on the Disease Called The Plague, translated by Adam Neale
(London: J. Mawman, 1804), p. 22. On Pugnet: Bulletin de Z'Acadkmie royale de Mtde-
cine, 11(1846-47): 1473.
21 Assalani, Observations,p. 184202.
22 A. Dalmas,Recherches historiques et mtdicales sur lafitbrejaune (Paris:Marchant, 1805).
23 A. Bourdeau, L1t!pidhieparmi les prisonniers de guerrefranpis b Dartmoor, Medical
Thesis (Paris, 1815),p. 6.
24 F. J. V. Broussais, Examen de la doctrine mtdicale g&&alement ndoptte (Paris: Gabon,
1816),p. 109and 146-47.
25 Nicolas Chewin, Examen des nouvelles opinions de M. le docteur Lassis, concernant le
@re jaune (Paris:Pinard, 1829),p. 5-6.
26 G. Andral, "lf.phus," Dictwnnaire de mtdecine (1828): 1-10. Other important ex-
amples,cited elsewhere, includeJ. A. Rochoux, Simon Lassis, and Charles Roche.
27 J. B. Nacquart, "Contact," "Contagion," "Infection," and "Epid6mie," Dictwnnaire
des sciences mtdicales (Paris:Panoucke, 1812-18).
28 Broussais, Examen de la doctrine;E. H. Ackerknecht, "Broussais or a Forgotten Medi-
cal Revolution," Bulletin of the History of Medicine, 27 (1953): 320-43; and Jean-
Fransois Braunstein, Broussais et le mattrialisme: Mtdecine et philosophic nu X I 2 s2cle
(Paris:MeridiensKlincksieck, 1986).
29 P. J. V. Broussais, Le choltra-morbus $idtmique, o b s d et trait6 selon la m6thode phy-
swlogique (Paris: Lachevardihre, 1832), p. 13. Among his leading disciples, see P. G.
Boisseau, l'kaitt du cholkra morbus considtrt sous le rapport ddical et administratif
(Paris: J.B. Baillibre, 1832); R. H. J. Scoutetten, Histoire rn6di.de et topographique du
chol6ra-morbus (Metz: S. Lamort, 1831);and L. Charles Roche, "llphus," Dictwnnaire
de mtdecine et de chirurgie pratiques (Paris: Mequignm-Marvis,1836).
30 Academie royale des Sciences (G. Dupuytren, reporter), Rapportfait dans les stances
des 26 septembre, 7 et 21 novembre sur une Mtmoire de M. Costa (Paris: Firmin Didot,
1826), and Archives gh&ales de mtdecine (AGM),10(1826):126-29.
31 Etienne Pariset and And& Mazet, Obsemtwns sur laj2urejaune faites b Cadix, en 1819
(Paris:Audot, 1820).
32 Victor Bally, And& Fran~ois,and Etienne Pariset, Histoire m6dicnle de laji&urejaune ob-
servte en Espagne (Paris:Imprimkrie royale, 1823).
33 George Sussman, "From Yellow Fever to Cholera: A Study of French Government
Policy, Medical Professionalism and Popular Movements in the Epidemic Crises of
the Restoration and the July Monarchy," PhD thesis, Yale University, 1971; Lean-
Pran~oisHoffman, LA peste b Barcelone, en marge de l'histoire politique et litttraire de la
France sous la Restauratwn (Paris: PUP, 1964); and Uon Colin, "Quarantaines," Dic-
tionnaire encycloedique des sciences mtdicales,3,1(1878).
34 Jean Devhze, Mknoire au roi en son conseil de ministres et au chambres, ou protestation
contre le travail de la commission sanitaire centrale du royaume (Park Baillard, 1821).
Members are listed in La Berge,Misswn and Method, p. 3%
35 Henri Meyer,La ltgislation sur la police sanitaire (Paris: F. Pichon, 1885).
36 Delaporte, Disease and Civilization, p. 144.
37 This point was made by GeorgeWeisz.
38 In Charles Maclean, Evils of Quarantine Laws and Non-existence of Pestilent Contagion

(London:R. Taylor, 1824).
39 AGM, 12 (1826): 311-13, and I. C. de Fermon, "Sur ia fievrejaune," Journal de physiolo-
gie eq&imentale et pathologique, 8 (1828).
40 Nicolas Chewin, Recherches mldico-philosophiques sur les causes physiques de la poly-
gamie dans les pays chauds, Medical Thesis (Paris, 1812).
41 J. Marifred Wasserman and Virginia Kay Mayfield, "Nicolas Chewin's Yellow Fever
Survey, 1820-22,"Journal of the Histoy of Medicine and Allied Sciences, 26 (1971):40-51.
42 F. Ratier, review of Eugene Sulpicy, Les contagionistes rt?futds par eux-m&nes,AGM, 16
(1828):310.
43 AGM, 14(1827):444.
44 Nicolas Chewin,Examen des principes de l'administration en matitre sanitaire (Paris:Fir-
rnin Didot, 1827),and de Fermon, "Sur la fievrejaune."
45 AGM, 14(1827): 12.
M Chewin,Examen des principes de l'administration, p. xi.
47 P. Menetrier, "Le centenaire de la suppression de la Paculte de Mtidecine de Paris,"
Bulletin de la sodtlfranpise de l'histoire de la mldecine, 16(1922):441-45.
48 AGM, 12(1826):648-49.
49 Chewin,Examen des principes de l'administration, p. xviii.
50 AGM, 16(1828):297.
51 AGM, 22 (1830):437-38.
52 Colernan, Yellow Fever in the North.
53 E. F. Dubois &Amiens, "Notice historique sur M. Chervin," Mlmoires de l'Acadlmie
myale de Mldecine, 11(1846):p. 57.
54 Acadtimie royale de Mtidecine (P. J. Double, reporter), Rapport sur le chollra-morbus
(Paris:Imprimtirieroyale, 1831).
55 Annales d1hygi?nepublique et de mldecine llgale, 6 (1831):231-40.
56 Louis Chevalier, Le choltra, la w e m h e &idhie du X1F sitcle (La Roche-SW-Yvon:
Imprimtirie cen&alede l'Ouest,'1958); ~ e i a ~ o r tDisease
e, and civilization; Patrice Bor-
delais and Jean-Yves Raulot, Une pew bleue: Histoire du choltra en France 1832-1855
(Paris: Payot, 1987); and J. Picquemal, "Le choltira de 1832 et la mbdicale,"
Thales, 10(1959):29-73.
Louis Chevalier, Laboring Classes and Dangerous Classes in Paris in the First Half of the
Nineteenth Centuy, translated by Frank Jellinak, 2d ed.(1958; New York: H. Fertig,
1973).
Acadtimie royale de Mbdecine (F. J. Double, reporter), Rapport et instruction pratique
sur le chollra-morbus (Paris:J. B. Baillibre, 1832),p. 16.
The Hbtel-Dieu and Pit% hospitals declared cholera non-contagious, though each
harbored contagionists, including Victor Pally, Auguste Chomel, Joseph Recamier,
and Alfred Velpeau. The latter published his reservations: "Du choka bpidtimique
de Paris," AGM, 29 (1832):219-20.
Rochoux, "Mesures sanitaires," Dictwnnaire de mddecine, 2d ed., 19 (1839), p. 622.
Dr. Jaehnichan, Quelques rt?Jexions sur le chollra-morbus (Moscow: Auguste Semen,
1831),p. 11,27-28.
Prost, naif6 du choltra-morbus (Paris Courcier, 1832),p. 292.
Revue mddicale,4 (1831):321.
Revue mddicale,4 (1831):501.
Michel Foucault, Discipline and Punish: The Birth of the Prison, translated by
A. Sheridan-Smith (New York: Vintage, 1979),p. 305.
S. Normand de la Tranchade, De Ja nature du chollra-morbus sporadique, Medical The-
sis (Paris, 1842),p. 63.
Delaporte, Disease and Civilization.
68 L.-F. Benoisten de Chateauneuf, reporter, Rapport sur la marche et les gets du chol&a-
morbus duns Paris et les communes rurales du Dkpartement de la Seine (Paris, 1834).
69 J. A. Rochoux, "Notice sur le cholera-morbusen general, et en particulier sur d u i de

BicBtre," AGM, 30 (1832):336.
70 Benoisten de Chateauneuf,Rapport sur la marche.
71 Benoisten de Chateauneuf,Rapport sur la marche; L. R. Villermb, "Note sur les ravages
du cholera-morbusdans les maisons garnies de Paris," Annales d'hygih publique, 11
(1834): 385-409: and "Des epidemics sous les rapports de l'hygiene publique, de la
statistiquemedicale et de l'economie politique," Annales d'hygiEne publique, 9 (1833):
5-58. See also William Coleman, Death Is a Social Disease: Public Health and Political
Economy in Early Industrial France (Madison: University of W ~ o n s i nPress, 1982),
p. 293.
72 This was commonly remarked in medical dissertations.
73 A. B. Frizon, Coup d'oeil sur les divers opinions imises concernant les causes productrices
de cholira-morbus ipidimique (Marseilles: Achard, 1836).
74 Caroline Hannaway, "Medicine, Public Welfare and the State in Eighteenth-Century
Prance: The Sock!# royale de Midecine of Paris (1776-1793)," PhD thesis, Johns Hop-
kins University, 1974.
75 Reportswere published in the Academy's amualMimoires.
76 P. C. A. Louis, Recherches anatomiques, pathologiques, et thdrapeutiques sur la maladie
connue sous les noms de@w typhoide, 2d ad.(1829; Paris: Baillibre, 1841).
77 Pierre Bretonneau, "Notice sur la contagion de la dothinent&ie, lue B 1'Academie
royale de Medecine," AGM, 21 (1829):57-78.
78 Esprit Gendron, "Dothinenteries observb aux environs de Chateau-du-Loi,"
AGM, 20 (1829): 185-211 and 361-85, and Franqois Leuret, "Memoire sur la
dothinenterite obsewk Nancy au commencement de Y a n k 1828," AGM, 18
(1828): 161-96.Othersare listed in A. J. B. Rotureau, Quels sont les causes et le traitement
de laji&vreadynamique,Medical Thesis (Paris, 1843).
79 C. E. S. Gaultier de Claubry, "M6moire en dponse B cette question: Faire connaftre
les analogies et les di&rences qui existent entre le typhus et la fievre typhoide dans
l'etat actuel de la science,"Mt?moires,7 (1838):1-184.
80 "Rapport general sur les prix, lu dam la dance publique annuelle du 11d b m b r e
1 8 4 9 , " ~ i r e s ,15(1850): wotiii.
81 P. A. Piony, "Extrait du Rapport sur les epidemics qui ont &gne en France de 1830B
1836," Mhoires, 6 (1837): 1-24, and "Rapport de la Commission des +idhies sur les
maladies epidemiques qui ont dgn6 en Prance en 1836,1837 et 1838," Mimoires, 7
(1838): 141-56.
82 Gaultier de Claubry, "Rapport sur les 6piddmies de 1849," W i r e s , 16(1852): 21-67.
83 Giovama Procacci, "Governing Poverty: Sources of the Social Question in Nine-
teenth-Century France," in Jan Goldstein, ed., Foucault and the Writing ofHistory (Ox-
ford: Blackwell, 1994),pp. 206-19, and Gouvemer la mis8re: La question sock&en France
1789-1848 (Paris:Editionsdu Seuil, 1993).
84 AGM, 9 (1825):134.
85 Etienne Pariset, Mhoire sur les causes de la peste et sur les moyens de la ditruire (Paris:
Crochard, lW ) , p. 72.
86 Notably between Antoine Clot-Bey, De la peste 0bserv.h en Egypte (Paris: Fortin, Mas-
son et Cie., 1840), and A. P. Bulard de Meru, La peste orientale (Paris: M e t jeune et
Lab& 1839).
87 P.-N. Hamont, "Note sur les quarantaines," Bulletin, 9 (1843-44):237-48.
88 Bulletin de Z'Acadimie royale de Midecine, 6 (1840-41): 787-95, and C. R. Prus, Rapport d
l'Acad6mie royale de Mhfecine sur la peste et les parnntines (Paris: J. B. Baillih, 1846),
p. 573-75.
89 Bulletin, 9 (1843-44): 1099.
90 C. R. Prus, reporter, "Rapport de la pate et des quarantaines," Bulletin, l1 (1845-46):
545-870.
The Rise and Fall of Anticontagionism in France
Bulletin, 11( 1 W 6 ) a n d 12(1846-47),passim.
AGM, 4 1 1 (1846):111-12.
La Berge,Mission and Method.

Bulletin, 16(1850-51):885-89, and Clot-Bey,De &I peste.
CharlesLonde, Bulletin, 2 (1837-38):797, and 7 (1841):29-30.
These are all the positions ascertainablein the Bulletin.
Bulletin, 15(1859-50): 1023.
Bordelaisand Raulot, Une peur bleue, p. 210-14.
Paul Briquet, reporter, "Rapport sur les 6pid6mies de cholera-morbus qui ont dgne
de 1817B 1850," Mhoires, 28 (1867-68):56-271.
J. Barth, "Rapport sur les epidemics du chol6ra morbus qui ont r e p 6 en Prance pen-
dant les ann&s 1854et 1865,Mt?moires, 30 (1871-73):299-422.
Neville M. Goodman, International Health Organizations and Their Work, 2d ed. (Edin-
burgh: ChurchillLivingston, 1971).
Bulletin, 22 (1856-57):889-904.
Pranqois Melier, "Relation de la fievre jaune survenue B Saint-Nazaire en 1861,"
Mhoires, 26 (1863-64): 1-228; Bulletin, 28 (1862-63): 646-1039; and Coleman, Yellow
F e w in the North, p. 59-138.
Pierre Rosenvallon,Le moment Guizot (Paris: Gallimard, 1985).
The typhus epidemics anticipated and probably informed Broussais' physiological
theory concerning the identity of the normal and the pathological. See Georges
Canguilhem, O n the Normal and the Pathological, translated by Carolyn R. Pawcett
(Dordrecht: D. Reidel, 1978), and Michel Poucault, The Birth of the Clinic: AndrchaeoE
ogy of Medical Perception, translated by A. M. Sheridan Smith (New York Pantheon,
1973).
La Berge,Misswn and Method, p. 310.
On agency and environment see Kenneth Burke, A Grammar of Motives (Berkeley:
University of California Press, 1969).
On the Academy, see George Weisz, The Medical Mandarins: The French Academy of
Medicine in the Nineteenth and Early k t i e t h Centuries (NewYork: Oxford University
Press, 1995).

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3 - Saturday, May 21, 2022 10:48:33 AM - IP Address:2001:8a0:e02d:1901:b92c:993:b95:667c

The Rise and Fall of

Abstract. This article re-examines the anticontagionist controversy in nine-

CBMH/BCHM / Volume 12: 1995 / p. 3-25

means of self-perpetuatingagents or entities of disease-germs-which

Nevertheless, these "transmissionists" called themselves anticontagion-

taste for quarantines was an important motive. Franqois Delaporte

plague.19 Desgenettes publicly inoculated himself with bubonic pus,

"peu philosophique" to associate the two because they provoked differ-

By the mid-1820s, however, the controversy had begun to grow

La commission B la presque unanimit6 pense que les documens de M. Chervin

plus serieuse, qu'ils augmentent consid6rablement la masse des observations

added to the horror of the epidemic. The Academy's Commission urged

par une conduite toujours calme, prudente et courageuse, a su pr&erver Mos-

Cholera heightened concern for epidemics in France. These had been

un progr&sdont nous pouvons nous glorifier, nous avons su nous af-

vanciers les maladies contagieu~es!"~~

erence to quarantine duration so as to avert a reoccurrence of the Acad-

took many years to emerge.

Yellow fever anticontagionism died a speedier death. In 1857 the

French soil,'02 and in 1861 it applauded the importationist account of an

compromise upon rationalized quarantines. But this compromise was

tered in the meantime. By mid-century the anticontagionist movement

et en genbral beaucoup moins gravement affect&, que sous le systeme de la conta-

38 In Charles Maclean, Evils of Quarantine Laws and Non-existence of Pestilent Contagion

69 J. A. Rochoux, "Notice sur le cholera-morbusen general, et en particulier sur d u i de

La Berge,Mission and Method.

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