Epidemics Laid Low. A History of What Happened in Rich Countries

Abstract

Patrice Bourdelais is one of France's leading historians of demographic change and public health medicine. This introductory text is organised on a broadly chronological basis into seven thematic chapters. The first deals with the plague era and the Italian city-states' attempts to exclude the diseased from their precincts. This is followed by a chapter on the rise of post-Enlightenment nation-states with such great powers that they could now successfully prevent plague from moving across large extents of territory. In chapter 3, the nineteenth century sees a turn-away from the strict barrier methods of border quarantines with their commerce-inhibiting inconvenience and the rise of the free trade strategy of permeable borders accompanied by strict surveillance, inspection and isolation of sick persons, along with the disinfection, and if necessary destruction, of their property. In the ‘English system’ of chapter 4 this goes alongside Edwin Chadwick's determination to redefine the wage-labourers' poverty, which facilitated early capitalists' accumulation of wealth, into the problem of urban dirt. This could be cleansed away by sanitarians and capital investment in running water and sewers. In Britain, Chadwick's politically anodyne interpretation ruled the roost at mid-century, while in France the Hygenists' analysis was politically more radical. Yet, as Bourdelais notes in chapter 5, while the French Hygienists produced research publications, the British passed national public health legislation. But much of this was enabling, not compulsory legislation. By the beginning of the twentieth century, the life expectancy of an urban citizen was dependent less on the legislation of national government and rather more on the practical policies of local municipal government, regardless of whether the context was England or France (or Germany or the USA for that matter). The final two chapters detail the rise of the technology of modern population immunization, from its origins in smallpox inoculation and then vaccination, as the technique which has truly laid low epidemics of infectious disease in the advanced west. At the same time, it is noted that, without a range of expensive ‘organisational underpinnings’, such technology cannot alone save lives, as the recent health reversals from different causes – in each case – in the ex-Soviet states and in sub-Saharan Africa both demonstrate.