Focusing on the 1851 International Sanitary Conference, this dissertation analyses an
important episode in the international regulation of health, trade, passengers, and
cargo in a period of epidemic crisis. It argues that a group of diplomats and
physicians appointed to represent 12 European nations instituted a new international
forum that extended – and occasionally rivalled – national and local agencies for
epidemic governance. Together, delegates endeavoured to establish a common
sanitary policy in Europe and in the Orient. By creating shared surveillance and
judicial mechanisms – while standardising definitions and practices – delegates
aimed to engineer the flow of people, vessels, cargo, and diseases in the
Mediterranean region. As a transnational forum, the Conference was a platform
where doctors and diplomats reinterpreted models of public health and sanitary
administration while creating institutions that challenged conventional concepts of
borders, national policy, and state sovereignty. As a multinational event, the
Conference marked the unprecedented transition from local, national and, bilateral
public health policies into a coherent transnational project for the governance of
epidemics.
The dissertation is based on extensive research conducted in hitherto largely
unexplored medical, diplomatic, and national collections in Britain, France, Italy,
Portugal, Spain, and the United States of America. Sources ranging from diplomatic
correspondence to medical publications and personal diaries, tie together multiple
national and professional perspectives while untangling a diversity of personal and
state agendas that fundamentally shaped the foundation of international public health
mechanisms and contributed towards the crystallisation of medical concepts.
Chapter one demonstrates how economic and political concerns about the impact of
quarantine on international trade led to calls for international regulation and the
standardization of quarantine practices in the Mediterranean region. Drawing on
medical reports, pamphlets and diplomatic correspondence, the chapter exposes the
multitude of quarantine practices in the Mediterranean region and a growing international demand for prophylactic reform. These exchanges, it is shown,
culminated with the organization of the 1851 International Sanitary Conference in
Paris.
Chapter two argues that the Conference challenged previous diplomatic and medical
protocols by including two professional groups in the process of regulating
international public health. The lack of precedent allowed diplomatic and medical
delegates to establish new rules for the conduct of the conference, which gave them a
relatively high level of autonomy from the states they represented.
Chapter three focuses on the problems of constructing a shared aetiological
classification and regulating quarantine practices. It shows that, although doctors
gained progressive control over the Conference, ultimately diplomatic agendas
shaped the final outcome. In addition, it demonstrates that, rather than defending the
elimination of quarantines, liberal states supported the continuation of quarantine
practice in the Mediterranean; albeit that they managed to severely limit its operation
in practice.
Finally, chapter four examines how European and Oriental sanitary institutions were
uniformly redesigned and new international judicial mechanisms created. These
measures variously affected the sovereignty of the participating states by limiting
their independent capacity to set national epidemic policies. However, the chapter
argues that these negotiations took the shape of sovereignty bargains: by loosening
control over specific elements of their sovereignty, states managed to advance their
political, economic and sanitary agendas.
By looking at the International Sanitary Conference of 1851, this dissertation shows
how the foundations of international public health had consequences not only for the
control of epidemic diseases and the circulation of goods and people in the
Mediterranean region, but also for the authority and status of the nation states. By
doing so, it reveals that international public health governance resulted from the
amalgamation of a particular configuration of expert and diplomatic struggles and
compromises. Moreover, the dissertation shifts the traditional local and national
focus in the history of medicine to a wider and international context where local and
national traditions struggled to produce coherent discourses and practices