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Ann LA BERGE (Blackburg, USA) A 17 THE EARLY NINETEENTH CENTURY FRENCH PUBLIC HEALTH MOVEMENT In his pioneer article published in 1948 Erwin Ackerknecht surveyed the French hygienic literature from 1815 to 1848 and concluded that the French were the leaders in public health in the early nineteenth century (1). Since that time a number of historians have investigated various aspects of French public health history. But no one has adequately described and analyzed the early nineteenth century French public health movement. The purpose of this paper is to do just that. I shall describe the movement, analyze its leadership, organization and goals, and discuss some of its achievements (2). The early nineteenth century French public health movement was a movement by a group of physicians, pharmacists-chemists, and administrators to bring about public health reforms in France, primarily in the cities, in order to lower mortality and morbidity rates and to improve the quality of life. The movement clustered around and was propagated by the Paris health council and the society of the Annales d'hygiène publique et de médecine légale. Nearly all the leading hygienists were members of the Paris health council or one of the provincial health councils. Most of the leading hygienists were founders, editors, and/or contributors to the Annales d'hygiène publique, the organ of the public health movement. Many of the leading hygienists were members of the Royal Academy of Medicine, the Royal Academy of Sciences and/or the Academy of Political and Moral Sciences. In these academies and in local medical societies during the early nineteenth century public health issues were debated and public health reforms were urged. The leading early nineteenth century public hygienists included : in Paris, the physicians Halle, Villermé, Parent-Duchâtelet, Esquirol, Marc, Kéraudren, Levy, Guérard, Pariset, Bousquet, Piorry, Mêlier ; and in the provinces, Fodéré in Stras- bourg, Thouvenin in Lille, Marchant in Bordeaux, Pigeotte in Troyes, and Mon- falcon, Polinière, and Terme in Lyon. Leading chemists and pharmacists included Labarraque, Pelletier, DArcet, Barruel, Chevallier, and Gaultier de Claubry ; other leading hygienists were the veterinarians Huzard junior and senior, the statistician Benoiston de Chateauneuf, and the administrator Trébuchet. To set the chronological limits of the movement, the decades from 1820 to 1840 included the most important early nineteenth century public health events and developments : the founding of the Royal Academy of Médecine with public health goals in 1820 ; the publication of L. R. Villermés's statistical work in the 1820s ; the publication between 1821 and 1836 of all the hygienic works of A. J. B. Parent-Duchâtelet ; the founding of the Annales d'hygiène publique in 1829 ; the cholera epidemic of 1832-35 a n d the beginning of the reform of the quarantine system ; the development by the 1830s of the Paris health council into 46
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Page 1: THE EARLY NINETEENTH CENTURY FRENCH PUBLIC HEALTH ...

Ann LA BERGE (Blackburg, USA)

A 17

THE EARLY NINETEENTH CENTURY FRENCH PUBLIC HEALTH MOVEMENT

I n h is p ionee r a r t i c le pub l i shed in 1948 E r w i n A c k e r k n e c h t su rveyed t h e F r e n c h hygienic l i t e r a t u r e f rom 1815 to 1848 a n d conc luded t h a t t he F r e n c h w e r e the l eade r s in pub l i c h e a l t h in t h e ear ly n i n e t e e n t h c e n t u r y (1). S ince t h a t t i m e a n u m b e r of h i s to r i ans have inves t iga ted va r ious aspec t s of F r e n c h public h e a l t h h i s to ry . Bu t no o n e h a s a d e q u a t e l y desc r ibed a n d ana lyzed t h e ea r ly n i n e t e e n t h c e n t u r y F r e n c h pub l i c h e a l t h m o v e m e n t . The p u r p o s e of th i s p a p e r is t o do j u s t that. I shal l desc r ibe t h e m o v e m e n t , ana lyze i ts l eade r sh ip , o rgan iza t ion a n d goals , a n d d i scuss s o m e of i t s a c h i e v e m e n t s (2).

The ear ly n i n e t e e n t h c e n t u r y F r e n c h pub l i c h e a l t h m o v e m e n t w a s a m o v e m e n t by a g r o u p of phys ic ians , p h a r m a c i s t s - c h e m i s t s , a n d a d m i n i s t r a t o r s to b r i n g a b o u t pub l ic h e a l t h r e f o r m s in F rance , p r i m a r i l y in t h e ci t ies , in o r d e r to l ower m o r t a l i t y a n d m o r b i d i t y r a t e s and to i m p r o v e t h e qua l i ty of life. T h e m o v e m e n t c lu s t e r ed a r o u n d a n d w a s p r o p a g a t e d by the Pa r i s h e a l t h counci l a n d t h e socie ty of t h e Annales d'hygiène publique et de médecine légale. N ea r l y all t h e l ead ing hygien is t s w e r e m e m b e r s of t he Par i s h e a l t h counci l o r one of t h e p rov inc ia l h e a l t h counci ls . Mos t of t h e leading hygien is t s w e r e founde r s , ed i to r s , a n d / o r c o n t r i b u t o r s to t h e Annales d'hygiène publique, t h e o r g a n of t h e pub l i c h e a l t h m o v e m e n t . M a n y of t he leading hygien is t s w e r e m e m b e r s of t h e Royal A c a d e m y of Medic ine , t h e Royal Academy of Sciences a n d / o r t h e Academy of Pol i t ical a n d Mora l Sciences . I n t hese a c a d e m i e s a n d in local m e d i c a l societ ies d u r i n g t h e ea r ly n i n e t e e n t h c e n t u r y pub l i c h e a l t h i ssues w e r e d e b a t e d a n d pub l i c h e a l t h r e f o r m s w e r e u rged .

The l ead ing ea r ly n i n e t e e n t h c e n t u r y pub l i c hygien is t s i nc luded : in Pa r i s , t h e phys ic i ans Hal le , Vi l le rmé, Paren t -Duchâ te le t , Esqu i ro l , Marc , K é r a u d r e n , Levy, G u é r a r d , Par i se t , B o u s q u e t , P ior ry , Mêlier ; a n d in t h e p rov inces , F o d é r é in S t r a s ­b o u r g , Thouven in in Lille, M a r c h a n t in B o r d e a u x , P igeo t t e in Troyes , a n d Mon-falcon, Pol in ière , a n d T e r m e in Lyon. Lead ing c h e m i s t s a n d p h a r m a c i s t s i nc luded L a b a r r a q u e , Pel le t ier , D A r c e t , B a r r u e l , Cheval l ier , a n d Gaul t i e r de C laub ry ; o t h e r l ead ing hygien is t s w e r e t h e v e t e r i n a r i a n s H u z a r d j u n i o r a n d senior , t h e s t a t i s t i c i an Beno i s ton de Chateauneuf , a n d t h e a d m i n i s t r a t o r T r é b u c h e t .

To set t he chrono log ica l l imi t s of t he m o v e m e n t , t h e decades f r o m 1820 to 1840 inc luded the m o s t i m p o r t a n t ear ly n i n e t e e n t h c e n t u r y pub l i c h e a l t h even t s a n d d e v e l o p m e n t s : t he founding of t h e Royal A c a d e m y of Médec ine w i t h pub l i c h e a l t h goals in 1820 ; t he pub l i ca t i on of L. R. Vi l le rmés ' s s t a t i s t i ca l w o r k in t h e 1820s ; t h e pub l i ca t i on b e t w e e n 1821 a n d 1836 of all t h e hygien ic w o r k s of A. J . B . Pa ren t -Duchâ te l e t ; t h e founding of t h e Annales d'hygiène publique in 1829 ; t h e cho l e r a ep idemic of 1832-35 a n d t h e beg inn ing of t h e r e f o r m of t h e q u a r a n t i n e s y s t e m ; t h e d e v e l o p m e n t by t h e 1830s of t h e Pa r i s h e a l t h counci l i n t o

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t h e p r e e m i n e n t pub l i c h e a l t h a u t h o r i t y in F r a n c e ; a n d t h e d e v e l o p m e n t of pub l i c hygiene a s a scientif ic d isc ipl ine .

The F r e n c h pub l i c h e a l t h m o v e m e n t w a s a n ind igenous m o v e m e n t . I d e a s of p u b l i c h e a l t h h a d b e e n c u r r e n t in F r a n c e f rom t h e l a s t q u a r t e r of t h e e i g h t e e n t h cen tu ry , exempl i f ied by t h e pub l i c h e a l t h goals a n d ac t iv i t ies of t h e Royal Socie ty of Medic ine a n d the H e a l t h C o m m i t t e e of t h e Na t iona l Cons t i t uen t Assembly , a s Caro l ine H a n n a w a y a n d D o r a We ine r h a v e s h o w n (3). By t h e 1820s t h e F r e n c h h a d a wel l -es tabl i shed t r a d i t i o n of i n t e r e s t in pub l i c h e a l t h d a t i n g b a c k s o m e fifty yea r s .

The F r e n c h pub l i c h e a l t h m o v e m e n t w a s quasi-official. Wi th t h e excep t ion of t he Annales d'hygiène publique, t h e i n s t i t u t i ons t h r o u g h w h i c h t h e hyg ien i s t s w o r k e d , such as t h e h e a l t h counci l s , n a t i o n a l a c a d e m i e s , a n d vacc ine c o m m i s s i o n s w e r e g o v e r n m e n t sponso red . I n add i t ion , m o s t hygien is t s h e l d official pos i t i ons — a t t he hosp i t a l s , in t h e p r i s o n sys t em, o n vacc ine c o m m i s s i o n s , a t t h e m e d i c a l facul t ies a n d profess iona l schools . S o m e of t h e l ead ing hyg ien i s t s he ld admin i s ­t r a t i v e p o s t s in t h e m u n i c i p a l a n d d e p a r t m e n t a l a d m i n i s t r a t i o n s . Serv ing o n t h e h e a l t h counci l s , ho ld ing official p o s t s , p a r t i c i p a t i n g in the g o v e r n m e n t - s p o n s o r e d academies , t h e lead ing pub l i c hygien is t s w e r e m e m b e r s of t h e « E s t a b l i s h m e n t ».

The F r e n c h pub l i c h e a l t h m o v e m e n t w a s a n a t i o n w i d e m o v e m e n t . Though m u c h of t h e l e a d e r s h i p a n d o rgan iza t ion w a s Par i s i an , in m a j o r F r e n c h ci t ies such as N a n t e s , Lille, Lyon, B o r d e a u x , Marsei l le , Troyes , a n d S t r a s b o u r g local hyg ien is t s w o r k e d for a n d advoca t ed pub l i c h e a l t h r e fo rm. Espec ia l ly n o t e w o r t h y w a s the very ac t ive g r o u p of Lyonna i s phys ic ian-hygienis t s (5).

The F r e n c h pub l i c h e a l t h m o v e m e n t w a s in te rd i sc ip l ina ry . T h o u g h a m a j o r i t y of t h e leading hygien is t s w e r e phys ic ians , a s izeable m i n o r i t y w e r e p h a r a m i s t s -chemis t s , a n d i m p o r t a n t c o n t r i b u t i o n s w e r e m a d e b y v e t e r i n a r i a n s , a r ch i t e c t s , eng ineers , a n d a d m i n i s t r a t o r s .

The m e d i c a l p ro fess ion p layed a n i m p o r t a n t ro le in the F r e n c h pub l i c h e a l t h m o v e m e n t . The invo lvement of t h e med ica l p ro fess ion in pub l i c h e a l t h m a t t e r s d a t e d f rom t h e e igh teen th c e n t u r y a n d t h e Royal Socie ty of Medic ine . A l though t h e Royal Socie ty of Medic ine d id n o t speak for t h e m e d i c a l p ro fess ion as a whole , it d id r e p r e s e n t one r e fo rm i s t e l e m e n t of t h e p rofess ion (6). In t h e ea r ly n i n e t e e n t h cen tu ry , before t h e c r ea t ion of h e a t h counci ls , local m e d i c a l societ ies of ten se rved as adv i so ry b o a r d s in pub l i c h e a l t h m a t t e r s . Medica l societ ies w i t h i n t h e facul t ies of med i c ine adv i sed t h e n a t i o n a l g o v e r n m e n t on pub l i c h e a l t h conce rns un t i l t h e found ing of t h e Roya l Academy of Medic ine in 1820 (7). The Royal A c a d e m y of Medic ine w a s f o u n d e d w i t h pub l i c h e a l t h goals a s t h e successor to t h e Royal Socie ty of Medic ine . The four p e r m a n e n t c o m m i s s i o n s of t h e A c a d e m y w e r e pub l i c hea l th - re la ted (8). The Royal Academy of Medic ine se rved as a p r i nc ipa l f o r u m for d i scuss ion a n d d e b a t e a n d also h e l p e d s h a p e n a t i o n a l pol icy on pub l i c h e a l t h m a t t e r s .

T h e t w o l eade r s of t h e pub l i c h e a l t h m o v e m e n t a n d t h e m o s t inf luent ial of t h e pub l i c hygien is t s w e r e Drs . Vi l l e rmé a n d Paren t -Duchâ te le t . N e i t h e r of t h e m ever cons ide red h imsel f t h e l e ade r of t h e m o v e m e n t , however . R a t h e r , l e a d e r s h i p w a s a lways a t t r i b u t e d t o g r o u p s : to t h e Par i s h e a l t h counci l a n d to t h e socie ty of t h e Annales d'hygiène publique. These g r o u p s p r o v i d e d b o t h t h e l e a d e r s h i p a n d o rgan iza t ion of t h e pub l i c h e a l t h m o v e m e n t .

M u c h of t h e act iv i ty of t he m o v e m e n t w a s c h a n n e l e d t h r o u g h t h e Pa r i s hea l th counci l , w h i c h func t ioned as a n adv i so ry b o a r d to t h e p re fec t of pol ice, t h e official in c h a r g e of pub l i c h e a l t h for Pa r i s . I n t h e p rov inces d e p a r t m e n t a l h e a l t h counci l s adv i sed t h e p re fec t s in pub l i c h e a l t h m a t t e r s . N ea r l y all t h e l ead ing pub l i c hygien is t s w e r e m e m b e r s of t h e Pa r i s h e a l t h counci l o r o n e of t h e p ro ­vincia l h e a l t h counci l s (9).

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Lead ing hyg ien i s t s w e r e founde r s , ed i to r s , a n d f r equen t c o n t r i b u t o r s t o t h e Annales d'hygiène publique, f o u n d e d in 1829 a s t h e o r g a n of t h e p u b l i c h e a l t h m o v e m e n t . Hyg ien i s t s p u b l i s h e d n u m e r o u s a r t i c les a n d t r e a t i s e s o n al l a s p e c t s of pub l i c hea l th . M o s t of t h e s e w o r k s a p p e a r e d in o n e f o r m o r a n o t h e r i n t h e Annales. T h e Annales d'hygiène publique w a s t h e m a i n s o u r c e of pub l i c i ty for t h e pub l i c h e a l t h m o v e m e n t a n d gave t h e m o v e m e n t i t s visibi l i ty.

F r e n c h hyg ien i s t s h a d b o t h specific a d m i n i s t r a t i v e a n d legislat ive goals . On t h e local level they a d v o c a t e d a d m i n i s t r a t i v e r e f o r m s s u c h a s h o u s i n g r e g u l a t i o n s , i m p r o v e m e n t of s ewerage s y s t e m s a n d w a t e r suppl ies , a n d fac to ry r egu l a t i ons . On t h e n a t i o n a l level t hey u r g e d legis lat ive r e f o r m s : a n a t i o n a l pub l i c h e a l t h l a w se t t i ng u p a n a t i o n w i d e s y s t e m of h e a l t h counci l s a n d t h e r e f o r m of t h e q u a r a n t i n e s y s t e m . Vi l l e rmé c h a m p i o n e d a chi ld l a b o r l aw a n d a civil r e g i s t r a t i o n ac t . Pa ren t -Duchâ t e l e t u r g e d a n a t i o n a l l a w regu la t ing p r o s t i t u t i o n . These r e f o r m s w e r e closely r e l a t e d to o t h e r goals of t h e pub l i c hyg ien i s t s .

F r e n c h hygien is t s w a n t e d t o convince t h e g o v e r n m e n t t o accep t a n d i m p l e m e n t t h e i r definit ion of pub l i c hea l t h . They conceived of pub l i c h e a l t h ve ry b r o a d l y . Publ ic h e a l t h w a s a l l -encompass ing ; eve ry th ing w a s in i ts d o m a i n . Hyg ien i s t s w a n t e d t o r ep l ace t h e o lde r n a r r o w view of pub l i c hea l th , w h i c h h a d b e e n t h e p r o t e c t i o n of t h e n a t i o n f rom i m p o r t e d ep idemics w i t h th i s n e w e r view. If successful , t h e n t h e q u a r a n t i n e s y s t e m could b e r e f o r m e d a n d t h e g o v e r n m e n t could m o v e i n t o o t h e r publ ic h e a t h a r e a s w h i c h t h e hygien is t s cons ide red cri­t ica l , such a s s a n i t a r y a n d socia l r e f o r m .

The Pa r i s h e a l t h counci l e m b o d i e d th i s n e w e r a p p r o a c h to pub l i c hea l th . I n o r d e r to e x t e n d t h e benefi ts of t h i s i n s t i t u t i o n hygien is t s ca l led for a n a t i o n w i d e s y s t e m of h e a l t h counci l s . They a lso u r g e d t h a t t h e s e counci l s b e inves ted w i t h t h e i r o w n p o w e r so t h a t pub l i c h e a l t h w o u l d b e in t h e h a n d s of p ro fess iona l e x p e r t s , t h e pub l i c hygien is t s , r a t h e r t h a n in the h a n d s of e lec ted o r a p p o i n t e d officials.

I n o r d e r to c la im profess iona l expe r t i s e hyg ien i s t s h a d to h a v e p rofess iona l s t and ing . The re fo re one of t he i r p r i nc ipa l goals w a s t h e e s t a b l i s h m e n t of pub l i c hyg iene as a scientific d isc ip l ine . Hyg ien i s t s s o u g h t t o define a n d de l imi t pub l i c hyg iene a s a d isc ipl ine a n d to app ly w h a t they u n d e r s t o o d as t h e scientific m e t h o d to t h e s t u d y of pub l i c hygiene .

By 1848 hyg ien i s t s h a d ach ieved s o m e of t he i r goals a n d h a d m a d e i m p o r t a n t c o n t r i b u t i o n s t o pub l i c hea l t h . The i r a c h i e v e m e n t s i nc luded t h e t r a n s f o r m a t i o n of t h e Pa r i s h e a l t h counci l i n t o t h e lead ing pub l i c h e a l t h a u t h o r i t y in t h e Wes t b y t h e 1830s ; t h e found ing a n d c o n t i n u e d pub l i c a t i o n of t h e p ro fess iona l j o u r n a l t h e Annales d'hygiène publique ; t h e r e f o r m of t h e q u a r a n t i n e s y s t e m ; t h e q u a r a n ­t i ne s y s t e m ; t h e p a s s a g e of a chi ld l a b o r l aw in 1841 ; t h e p a s s a g e of a l a w in 1848 es t ab l i sh ing a n a t i o n w i d e n e t w o r k of h e a l t h counci l s ; t h e e s t a b l i s h m e n t of t h e scientif ic d isc ipl ine of pub l i c hyg iene ; m a j o r t heo re t i ca l c o n t r i b u t i o n s , a n d n u m e r o u s p r ac t i c a l s a n i t a r y r e f o r m s .

P e r h a p s t h e t w o m o s t i m p o r t a n t c o n t r i b u t i o n s of t h e F r e n c h pub l i c h e a l t h m o v e m e n t w e r e t h e d e v e l o p m e n t of pub l i c hyg iene a s a scientif ic d isc ip l ine a n d t h e h e a l t h counci l mode l . T h e ear ly n i n e t e e n t h c e n t u r y F r e n c h pub l i c hygien is t s e s t ab l i shed t h e disc ipl ine of pub l i c hygiene on a « scient if ic » bas i s . By scientif ic , t hey m e a n t t h e u s e of f i r s t h a n d obse rva t ion , e x p e r i m e n t a t i o n , a n d t h e n u m e r i c a l m e t h o d to inves t iga te a n d solve pub l i c h e a l t h p r o b l e m s . Ref lec t ing t h e u r g e of t h e age t o t u r n every a r e a of social inves t iga t ion i n t o a « sc ience », t h e hyg ien i s t s t r a n s f o r m e d pub l i c hyg iene f rom a n « a r m c h a i r p h i l o s o p h y » i n t o a n e w science w i t h i t s f ounda t ion in s t a t i s t i c s (10). Cen t r a l t o t h e d e v e l o p m e n t of pub l i c hyg iene a s a scientif ic d isc ipl ine w a s t h e Annales d'hygiène publique. I n t h e i r se lec t ion of m a t e r i a l t h e f o u n d e r s a n d e d i t o r s of t h e j o u r n a l se t t h e l imi t s of p u b l i c hyg iene a n d d e m o n s t r a t e d i ts a p p r o p r i a t e me thodo logy .

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T h e in s t i t u t i ona l e m b o d i m e n t of t h e scientif ic d isc ipl ine of pub l i c hyg iene w a s t h e h e a l t h counci l . By t h e 1830s t h e Pa r i s h e a l t h counci l h a d b e c o m e t h e m o d e l for o t h e r h e a l t h counci l s b o t h in F r a n c e a n d a b r o a d . W h a t w a s n e w a b o u t t he Pa r i s counci l w a s n o t t h a t of a n adv i sory b o a r d of hea l t h . These h a d b e e n i n s t i t u t e d in t i m e s of m e d i c a l e m e r g e n c y a t l eas t a s fa r b a c k as the s ix t een th cen tu ry . W h e n t h e e m e r g e n c y w a s over , t he se b o a r d s w e r e d i s b a n d e d . T h e P a r i s h e a l t h counci l w a s a p e r m a n e n t b o a r d of t echn ica l e x p e r t s set u p t o deal w i t h day- today p r o b l e m s involving any a spec t of t he pub l i c hea l th . T h e success of t h e Pa r i s counci l led to t h e e s t a b l i s h m e n t in t h e 1820s a n d 1830s in a n u m b e r of F r e n c h ci t ies of h e a l t h counci l s b a s e d on t h e P a r i s m o d e l . The Pa r i s counci l w a s a lso t h e m o d e l u s e d in 1848 w h e n a n a t i o n a l l aw se t u p a n a t i o n w i d e n e t w o r k of h e a l t h counci l s . I n add i t ion , t he Par i s m o d e l w a s cop ied in the n e w Belgian n a t i o n in t h e mid-1830s w h e n h e a l t h counci l s w e r e e s t a b l i s h e d on a n a t i o n w i d e b a s i s a n d in 1847 w h e n the K i n g d o m of S a r d i n i a i n s t i t u t e d a s y s t e m of h e a l t h counc i l s .

I n the final analys is , t h e ex t en t a n d type of hygien ic l i t e r a t u r e , t h e n u m e r o u s act iv i t ies of t h e pub l i c hygien is t s , t h e pub l i c h e a l t h i n s t i t u t i ons , t h e p ro fes s iona l j o u r n a l of t h e m o v e m e n t , t h e theo re t i ca l a n d p r ac t i c a l c o n t r i b u t i o n s all a t t e s t t o F r e n c h l e a d e r s h i p in pub l i c h e a l t h in t h e decades b e t w e e n 1820 a n d 1840. I n t e r m s of a c t u a l pub l i c h e a l t h r e f o r m s , b o t h a d m i n i s t r a t i v e a n d legislat ive, s ignif icant a c c o m p l i s h m e n t s w e r e m a d e . B u t i t s e e m s to m e t h a t t h e g r e a t e s t c o n t r i b u t i o n of t he ear ly n i n e t e e n t h c e n t u r y F r e n c h pub l i c hyg ien i s t s w a s theore t i ca l . They e s t ab l i shed a n e w definit ion of pub l i c h e a l t h for t h e age a n d founded t h e m o d e r n disc ipl ine of pub l i c hygiene .

N O T E S

(1) Erwin Ackerknecht , « Hygiene in France, 1815 - 1848, » Bull. Hist. Med., 1948, 22 : 117 - 155. (2) The principal sources for the conc lus ions I have reached here are the Annales d'hygiène

publique, 1829 - I860, the pr inted and manuscr ip t reports of the Paris hea l th counci l and all the provincial heal th counc i l s , the hygienic wri t ings of major and minor hygienis t s , p u b l i s h e d reports and m i n u t e s of the relevant academies , archival sources pertaining t o publ ic heal th in the National Archives , Paris, and in the departmental archives where hea l th counci l s w e r e located, and the munic ipa l archives of Lyon.

(3) Caroline Hannaway , « The Soc ié té Royale de Médecine and Ep idemics in the Ancien Reg ime , » Bull. Hist. Med., 1972, 45 : 257 - 273 ; Dora B. Weiner, « Le Droit de l ' H o m m e à la Santé : une bel le idée devant l 'Assemblée const i tuante : 1790 - 1791, » Clio Medica, 1970, 5 : 208 - 223.

(4) Terme and Prunel le w e r e mayors of Lyon ; Trébuchet w a s head of the sanitary office at the Prefecture of Pol ice in Paris .

(5) Terme, Prunel le , Sainte-Marie, Bottex , Monfalcon, Pol inière, Pointe. (6) Hannaway, « The Soc ié té Royale de Médec ine . » (7) S u c h as the Soc ié té de l 'Ecole de Médec ine of the Paris Faculty. (8) The permanent c o m m i s s i o n s w e r e : the vaccine c o m m i s s i o n , the ep idemic c o m m i s s i o n , the

mineral w a t e r c o m m i s s i o n , and the secret remedy c o m m i s s i o n . (9) Dora Weiner, « Public Hea l th Under N a p o l e o n : the Consei l de Salubri té de Paris , 1802 - 1815, »

Clio Medica, 1974, 9 : 271 - 284 ; Ann Fowler La Berge , « The Paris Heal th Council , 1802 - 1848, » Bull. Hist. Med., 1975, 49 : 339 - 352.

(10) Parent-Duchâtelet spoke of hygienic theories as be ing cons truc ted « dans le s i l ence du cabinet . » I have used the t erm « armchair ph i losophy » to descr ibe Parent's att i tude. See Parent-Duchâtelet , « Mémoire sur les débardeurs de la vi l le de Paris , » Hygiène publique, 2 vo l s . (Paris : Bai l l ière , 1836), II : 640.

(11) Ambroise Tardieu, « Introduct ion » to the second edit ion of Dictionnaire d'hygiène publique et de salubrité, 4 vo l s . (Paris : Bai l l ière , 1862), I : VII - X .

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