The pandemic, a total political fact

It is impossible to read the book of Nicolas Cadet on the cholera of 1832 in Sarthe without having in mind the recent Pandemic of Covid, which Marie Gaille and Philippe Terral designated as “ A total social fact ». By concentrating his investigation into this department, the historian gives us a perception of the relationship between localized cases and the global phenomenon which, by definition, characterizes a pandemic.

The approach consists in analyzing this relationship and in grasping how the situation of a department reveals all the components of a crisis which goes far beyond it and is expressed as much in each individual as in society. Beyond the health and medical aspects, the disease is also a revealing of the characteristics of the social body. If Cadet notes the cyclicity of epidemics and the interest of a rapprochement with the recent health crisis, it is not a question of carrying out a comparison between these two situations of two centuries.

The brutality of the disease

In 1832, the Sarthe was spared ? Only the historical survey, based on archives, can provide an answer, but three factors make this evaluation difficult: the disease is new, therefore not recognized ; The counts are easier in metropolitan areas than in a rural department like the Sarthe ; The authorities mask reality to avoid any panic, fear being sometimes considered as a cause predisposing to the disease.

Certain factors explain that the Sarthe was relatively spared: it is a territory of bocage with a dispersed habitat, the department is characterized by low economic exchanges and, finally, the local authorities have been able to be reactive and the prophylactic measures have been effective. However, the department did not escape the brutality of the wave of the disease resurging in the summer of 1834 until the winter of 1835.

Cadet questions the state of preparation of the medical profession which is then in full upheaval both in terms of concepts and the training of doctors. In 1832, in the Sarthe, 145 graduate practitioners must face the disease, including 56 medical doctors, 14 doctors in surgery and 75 health officers, for a total population of 457,362 inhabitants. In addition, this medical profession is very heterogeneous in terms of training and practice and the health system, including hospitals, is very poorly prepared in the face of cholera. This situation is aggravated by imbalances in the districts.

Since the circulars of 1805 and 1813, the Minister of the Interior designates, on the proposal of the prefect, a referring doctor responsible for containing and combating epidemics in each district. At the country’s scale, from the 1820s, measures of quarantine and disinfection were imposed on ships from possibly infected territories.

It is a question of defending the national territory against the invasion of the disease and, therefore, a martial vocabulary is essential. Cadet uses it to designate and consider that it is “ of a real defensive strategy “Or the establishment of” defense lines ». But, despite many measures, France is not ready to “ face an invisible enemy “And it is necessary” miasma ».

Epidemic diseases and contagious diseases

From 1831, in Sarthe as everywhere in France, we followed in the press the advance of cholera in Europe. The scourge is quickly instrumentalized and power is accused of being the cause or not knowing how to protect the population. It remains to explain biologically the disease, and two types of opinion are distinguished according to Cadet.

The proponents of the biological and organic causes believe that the disease is due to disturbances of the organism or to the “ cholera miasma ». This is how the pharmacist Charles Le Maout thinks to identify microscopic corpuscles which would spread through the wind and penetrate into the body by the airways. Transifying by air, these corpuscles would be transmitted between individuals. The other camp advocates an environmentalist thesis which claims that the disease is caused by the disturbances of the middle due, for example, to volcanic eruptions, with mineral gases from the soil or, for example, at the level of the Seine !

At the start of XIX^e A century, it is the theory of miasmas which is most adopted by doctors. The disease would therefore result from emanations escaping from the sick body or decaying and contaminating healthy bodies. Cadet summarizes the widespread design at the time: “ The air communicates death, the effluve is threatening, its stagnation, its fetity, carrying the death. »»

He also underlines the distinction between what we then consider as epidemic diseases linked to the environmental disturbances and contagious diseases which are transmitted from one individual to another and can turn into epidemic. This theory “ contagionist »Remains very fought in the case of cholera.

Politically, epidemic theory avoids panic movements, while the extent of the disease in Paris should play in favor of contagion. If the direct material cause of the disease is then very difficult, if not impossible to identify, strengthens the idea that the upper classes must take charge of the fate of the working and poorest classes, easily incriminated.

Impotence

Faced with the disease, it is necessary to organize and Cadet dissects the process on the scale of the department. The Ministry of the Interior and the Royal Academy of Medicine centralize the information raised from the territories from the doctors, following a chain composed by the mayors, the Committees of Boroughs, the sub-prefects, to the central health commission of the chief town of department. On a global scale, the international cooperation of doctors is not overlooked, especially during the second pandemic.

The 100,000 victims show the ineffectiveness of the system, particularly due to communication difficulties. The excess of notes that overwhelm the health officials leads the Minister to ask for synthetic synoptic tables, but this intervention turns out to be too late. Furthermore, there is harmful competition between the medical profession and the authorities, the latter trying to undermine the severity of illness.

If the system implemented is ultimately ineffective to treat the disease, Cadet underlines that it was a “ formidable means of investigation and control of the company “For the July monarchy, capable, which is to show” To the opinion that the government attaches importance to the fight against the scourge and does not intend to abandon the people. Around the fight against miasmas establishes an awareness of hygiene rules to avoid unhealthiness in all places, these being imprints of moral reasons and imposed on the poorest classes. The fact remains that the acquired habits vanished quickly.

In terms of treatments, medicine remains very helpless by having only leeches, blades, herbal teas and the sweaty. However, large medical figures are trying to impose their methods. François Broussais considers that cholera is a very acute gastroenteritis and advocates anti-inflammatory treatment with the application of leeches. François Magendie says that it is an anemia of the organism characterized by a drop in tone and that it is therefore necessary to fight against cooling and stimulate the organism.

Faced with different therapeutic methods, patients doubt the effectiveness of medicine which, as cadet emphasizes, only mobilizes remedies and little drugs. Faced with this helplessness, and above all confronted with the lack of doctors, the populations tend to turn to the “ empirical », A diversity of characters who provide care of official medicine.

From Sarthe to Mayotte

At a time when these lines are written, France is undergoing a new attack on cholera – far from the metropolis, in Mayotte, but as in 1832 it was nonetheless a total social fact. It is possible to compare the case of Sarthe and this French department. The first analogy would be the progression of the disease in the most disadvantaged social categories, in particular populations deprived of running water. Beyond that, it should be noted that the biology of the disease, as well as the conditions favorable to its development, are today well known.

However, the efforts of health professionals currently present in the field and armed with a vaccine suffice to curb this epidemic (or the following), if it is not considered a total political fact ? This epidemic, at the cost of the dead and the sufferings it generates, reminds us that tackling misery, a fortiori Thousands of kilometers from Paris, is an issue that goes beyond political policy, always a decay, and on the contrary requires a deep commitment.

Nicolas Cadet’s work helps us to question such emergence in our present. It offers us the possibility of a documented historical observation confirming that health is not an individual fact, but also a social and political fact. According to him, health disasters are exposed to society. This is why it is necessary to scrutinize them with the greatest attention.