Bourdelais begins with responses to the plague, from Justinian to the Black Death. With the last major plague outbreak in France in 1720-1721, a quarantine was enforced by a powerful centralised state. The early modern period also brought changing perceptions of the body, increasing numbers of physicians and increasing control by medical schools, a decline in mortality, and the discoveries of inoculation and vaccination against smallpox.
When cholera arrived in the early 1830s there were powerful lobbies against restrictions on trade and movement, an increasing role for often discordant expert opinions, and popular unrest against coercive government measures. Traditional approaches to disease control were largely abandoned.
The "English System" pushed by Edwin Chadwick emphasized cleanliness and sanitation, while Louis-René Villermé found a link between mortality and poverty. New systems of quarantine were brought into force: Bourdelais looks at the imposition and costs of quarantine in the Eastern Mediterranean and the Middle East. And stigmatisation was used as a tool of social control, notably with venereal diseases and young mothers.
Other 19th century developments included moves towards sanitary reform, better hospital hygiene, and an understanding of nutrition. A case study is the 1879 introduction of a city health department in Le Havre, modelled on that of Brussels; it was often municipal governments that took the lead in health initiatives.
Bourdelais gives a history of vaccination from the 1820s into the 20th century, covering its extension from smallpox to other diseases and the continuing opposition to it. He also covers tuberculosis and the attempts to find a vaccine for it.
The 20th century saw some spectacular public health successes and changes: the rise of antibiotics, the apparent defeat of tuberculosis, an increase in demand for health care with rising affluence, and an increasing role for governments. But resistant bacteria, re-emerging diseases, AIDS, and basic health failures in the developing world cast a shadow over the century. The history of public health challenges and responses offers lessons for our current problems.
Epidemics Laid Low is patchy, covering scattered topics without much continuity. It is focused on France and more broadly on Western Europe, and only hints at the implications of this history for the developing world. And one drawback of a translation is that the references are mostly in French, which may complicate attempts to follow them up. It is an easy read, however, and contained a fair bit of material that was new to me, so I recommend it to anyone curious about the history of epidemics and public health.
March 2009
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