At the start of the Revolution, Claude Chappe was a young physicist who performed several experiments with electricity, of which the results were published in the Journal de Physique. In , he defined a new technical project: He was to try several solutions: The first message which he transmitted, during his first experiment in the Sarthe on 2 March , a year before presenting his thesis to the Assembly, was as follows: The National Assembly will reward experiments which are useful to the public'.
In the petition which he presented on 22 March to the Legislative Assembly, Claude Chappe insisted that his system be put to use: Two years later 31 August , several months after the first telegraph line had been installed, the use imagined by Chappe was to become a reality:. Surrender was at six o'clock this morning. Later in the session, the chairman read out the following note by Chappe: We shall note that it was with regard to military news that Chappe's project to govern in 'almost real time' materialized.
On 12 March , the representative of the Convention in Belgium asked for a regular service of dispatch riders to be organized, so as to have continual contact with the armies. The only use he mentioned was military. These two reports also insisted on the reliability of Chappe's system and on its capacity to ensure the confidentiality of correspondence.
Chappe, the Convention, the Committee of Public Safety, saw telegraphs, before all else, as instruments of war.
Chappe succeeded where others had failed, by making use of the demand from National Defence. Indeed, he enjoyed constant support from the Committe of Public Safety in expropriation, requisitioning of equipment, etc. However, it was not the first time in the history of the eighteenth century that France was at war. Guillaume Amontons developed his system during the Augsburg League war, and the political authorities took no interest in it.
I think that in fact the decision to construct the system was not purely military. In a letter addressed to Lakanal by Chappe, and written after the first experiment carried out in front of the Convention members, the latter said of his project's opponents: The establishment of the telegraph is, in effect, the best answer to those publicists who think that France is too spread out to form a Republic. The telegraph shortens distances and in a way unites a huge nation on one single point.
Invention distances between places disappear in a sense This use of the telegraph to ensure national coherence was described by Rabaut-Pommier by the image of instant national mobilization: Chappe's innovation was in keeping with an ideological context which went well beyond the targeted uses military and political of the device. The Revolution was the period of restructuring the national domain.
From July the time when Chappe started to think about his system the National Assembly debated a new administrative partitioning of France. Either way, it was a question of putting an end to regional peculiarities and enforcing national unity by creating divisions based on spatial and demographic equality. Finally, a partitioning which mainly took natural borders into account was adopted at the beginning of The unity of this homogeneous space had to be constantly strengthened.
The telegraph was well suited to these dynamics of spatial coherence. We can thus understand the dispatch published by Le Moniteur Universel of 6 January indicating that, thanks to work undertaken by Chappe, Strasbourg could communicate with Paris in thirty-six minutes. It was signed 'Chappe, engineer-geographer'; what could seem to be a misprint geographer for telegrapher was in fact a lapsus which well illustrated the fact that Chappe's system was part of a reorganization of the national domain. The telegraph harmonized with revolutionary rhetoric, but also had a symbolic existence on an architectural level.
The dispatch from Strasbourg shows us that 'the telegraphic machine was to replace the cathedral bell-tower'. As for its installation on the roof of the Tuileries, Rabaut- Pommier tells us that 'these constructions will add to the external decoration of the National Palace. But to celebrate the cult of Reason, science was transformed into magic without any hesitation! The more symbolic than functional aspect of Chappe's machine had been noted by the German scholar Bergstrasser, the author of several works on the telegraph: They take advantage of this to attract the attention of Europe and so to imperceptibly attain their object1.
In the second version of his report, Laka- nal defined the telegraph as follows: A rapid messenger of thought, it seems to rival its speed Laka- nal, Chappe had moreover at first wanted to call his machine a tachygraph 'who writes fast'. In his report to the Assembly, as in those of Romme and La- kanal, the rapidity of transmission was one of the main points of the argument, and very precise transmission times were quoted. For Rabaut-Pommier, 'a decree could be transmitted to the ends of the Republic half an hour after being issued, proclaimed forthwith and executed the same day', and thus at any point of the nation, the same events could be lived at the same moments.
Bonaparte was one of the first to understand the political value of this new medium. The Legislative Corps has just been transferred to Saint-Cloud by virtue of artcles and of the Constitution; the General Bonaparte is named commander of the armed forces of Paris. Two days later, Chappe submitted a new dispatch to the Consuls: The Legislative Corps has named a three-member Consulat to replace the Directoire The Consuls had the following sentence added: This new telegraphic time, which permitted an almost instantaneous dissemination of information, was in keeping with the revolution of time which the members of the National Convention, and particularly Romme the main author of this reform of the First French Republic wanted to undertake.
It was precisely at the moment when Romme was preparing his report on the telegraph that he chaired a working group on the reform of the calendar with the cooperation of scientists like Lagrange and Monge. These aspects of reform are well known. What is less well known is the desire to introduce a rational division of time: This reform of the calendar was linked to that of weights and measures, although the principle of the latter reform was accepted by the Constituent Assembly. Tou have undertaken', declared Romme during the presentation of his project, 'one of the most important operations for the progress of the arts and human minds and which could only succeed in a time of revolution.
That is, making diversity, incoherence and inexactitude of weights and measures which continually hinder industry and trade, disappear; and taking, even for measuring the ground, the unique and invariable type of all new measures. The arts and history, for which time is a necessary element or instrument, also require new measures of duration, similarly rid of the errors which credulity and superstitious routine conveyed from centuries of ignorance through to us' Romme, Different objects were measured with different measures; some were in paces, others in cubits or in feet.
Certain measures had no physical objectivity, and land was measured according to the number of days' work in Bourges, for example, an acre was equivalent to sixteen days. Furthermore, measures varied from one parish to another. At certain markets two or three systems of. Royal authorities repeatedly tried, in vain, to unify the system of weights and measures. In fact, local metrological particularism was part and parcel of the privileges of the nobility who could always take advantage of it to increase taxes, generally paid in kind. Metrological unification was a significant claim in registers of grievances, but it was only with the upheaval of the revolution that this was to be realized.
The demands in the registers of grievances were for an end to the metrological arbitrary and for local unification. The academics responsible for implementing this reform and particularly Condorcet wanted to give it a universal character, a natural base. Condorcet, as secretary of the Academy of Sciences, wrote in his report to the National Assembly in March The Academy has tried to exclude any arbitrary condition, anything which could hint of the influence of a particular French interest or a national bias.
In short, it wished that if the principles and details of this operation were to be passed to posterity, it would be impossible to guess by which nation it had been ordained and executed8. Under the Convention, reform, like the telegraph, seemed intended primarily to strengthen national unity. Condorcet, Romme, Laka- nal, but also Arbogast and Daunou the two commissaires responsible with Laka- nal for supervising Chappe's first experiments were the authors of such projects.
His hydraulic comparison was possibly inspired by a machine he had to evaluate for the Committee of Public Education but, whatever the case, this model of diffusion by relays is exactly that of the telegraph. All these reforms to space, time, systems of measures, had the same justification: The universal vocation of the Revolution.
The project of a universal language developed by Condorcet was fairly close to that of Leibniz. It was amatter of discovering the intellectual operations at the base of all reasoning. Parallel to this logician's thought, other revolutionary intellectuals wanted to construct an artificial universal language, an Esperanto before its time.
Delournel, for example, presented to the Convention in a 'universal language project'. These themes were adopted by an intellectual movement called the ideologists Daunou was one of them , which was dominant at the time of the Directoire and the Consulat Some of them considered changing the language. This project 'did not only seek to determine the common foundations of all languages; [it] was also animated by the dream of finding the lost universal language whose restoration would ensure perfect communication, the true base of.
These universal language Utopias are the reflection of the concrete difficulties which the revolutionaries experienced in trying to get their political message across. In the face of such linguistic fragmentation, a means of communication had to be found to constitute a public sphere. The knowledge I have of the country surrounding me made me think of translating, into the most common language out of all the jargon of its inhabitants, the blessed Declaration of Human Rights Gazier, '. Such projects for a universal language soon proved to be impracticable.
Reforms envisaged were rather relative to vocabulary and spelling. A principle for the multiplication of words was being sought. It was thus a question of rationalizing the construction of vocabulary. Furthermore, the reform of spelling, like that of weights and measures, was to allow for the definition of a rational system; to note in a univocal fashion the sounds of words, and to standardize the. Like the reform of weights and measures, which Talleyrand had imagined in could be led jointly with England so as to be truly universal, and which became national and Jacobin, the universal language became the diffusion of French across the Republic as a whole.
The 'Republican language', 'universal' in the nation, founded on the grammaticization of the French language, appeared explicitly as the expression of popular sover- eignty, as the condition of 'communication', of citizens between themselves and with the State, in the debates of assemblies, the reports of commissions, the laws, and in the organization of the new school system. This philosopher wanted to introduce a new method of reasoning founded on formulae similar to those used in algebra The telegraph thus only writes languages which are already formulated; but its language becomes almost universal, in that it indicates combinations of numbers instead of words, and that the manner of expressing these numbers is generally known and can be applied to the words which compose all dictionaries.
His aim is not to find a language which is easy to learn without a dictionary Leibniz's expression in his letter to M. All these Utopian conceptions of space, time and communication were produced not only by the intelligentsia and politicians but also by unknown persons who sent letters to the Convention or the Committee of Public Education. Some of this literature is still accessible today in the national archives.
From to , we can count one invention project per year for a long-distance communication system. But my intention in this chapter is not to write a technical history of telegraphic inventions, but a history of the representations of the technology. These inventors-amateurs are of interest to me because of their discourse. Favre discovered a system which permitted 'the transmission in a few seconds of a mind's image sic from one end of the Republic to another', but he was careful not to reveal his method8.
A 'citizen of Angely- Boutonne' sent two notes, one on the telegraph, the other on 'Directions on the French Calendar', preceded by 'Reflection on chronology in relation to the people's freedom'. To illustrate his phonetic writing, he took the example of the republican calendar. All these scholarly or spontaneous representations of space, time, measurement systems, and communication, constitute the mentality in which Chappe was able to develop his innovation.
Chappe was not content to convince just the military lobby of the Convention, and his project was taken over by Romme and Lakanal not only because it was reliable it was not unique in this , but because it was in keeping with this new perception of space. Chappe's advantage over Amontons was that he proposed a project which corresponded to the mentality of his era.
The Birth of Long Distance Communication. Semaphore Telegraphs in Europe (1790-1840)
Let us try to look further at this idea of correspondence between a technology and mentalities. The semaphore telegraph did not correspond to any significant technological development. It was situated in a technical paradigm which had been stabilized for the preceding two centuries. One could thus consider at one level that we are dealing with a latent innovation which the movement of ideas resulting from the Revolution had made possible. In his account to the Legislative Assembly, he stated: The most difficult obstacle to conquer will be the spirit of prevention, with which creators of projects are normally received.
I would never have been able to get beyond the fear of being associated with them, had I not been supported by the persuasion that every French citizen owes to his country, now more than ever, the tribute which he believes will be useful to it.
It is up to the legislators to stop the clamours of ignorance or the agitation of curiosity; it is for the National Convention to encourage the arts and sciences. Diffusion of the telegraph was largely related to that of the republican calendar and the metric system. These three novelties seem to have resulted from the Revolution. Their zones of diffusion were to evolve with the movements of the French armies, and the telegraph was to be extended towards northern Italy Turin- Milan-Venice then Trieste and Flanders Antwerp-Amsterdam and Brussels.
Diffusion of Chappe's telegraph was essentially linked to the extension of the Republic. It was only implanted in those territories annexed by France and in certain sister republics. Kula noted that in other European countries, conquered later by Napoleon, it was not republics but kingdoms which were created, and no attempt was made to introduce the metric system. The republican calendar was abandoned in , after twelve years.
In retrospect, it may seem quite reasonable that the most purely ideological reform did not survive the Revolution, but we should not forget that, as W. Kula demonstrated so well, there was considerable resistance to the metric system. If the registers of grievances requested the unification of weights and measures, it was more a question of harmonization on a local level than ere-. The reason for the calendar's failure was clearly explained by Baczko.
Whilst there existed considerable diversity of weights and measures, the Christian world had unified its measurement of time on the Gregorian calendar. The need for universality was thus far less obvious. Similarly the English who had unified their system of measures were hardly interested in the metric system.
It was finally to be adopted in Italy, in Germany, and in Russia along with the Gregorian calendar at the time of the revolution. This makes one think of the May slogan 'Let us indulge in wishful thinking'1. That intensity of desire, that force of social imagination, was one of the conditions for the birth of the telegraph.
It was common to Chappe and the other inventors of the telegraph. If Chappe triumphed over the others because of the reliability of his system, he did not hesitate to use ideological arguments to fight his most serious competitors. The Chappe brothers worked not only on the technical side to their invention, but also on the social and political. During his retirement, Abraham Chappe, in , drew to the notice of the Minister of the Interior the necessity to lay the legal foundations of the telegraphic monopoly.
Use of the telegraph. There was of course a discrepancy between the social imagination of the telegraph and its effective uses. Rabaut- Pommier declared in The author of this fortunate invention has already used it to warn of storms9. In , Chappe suggested to the Directoire using the telegraph for transmitting exchange rates and announcing the arrival of ships in ports.
In , under the Consulat, he renewed his proposition by extending it to the diffusion of national lottery results and the transmission of an official information bulletin approved by the First Consul. Only the lottery project was accepted. Several historians see in this the refusal by the State to open its communication networks to the private sector. It was not the only reason; these projects necessitated the extension of the network. Reasons for the failure of attempts to extend use of the telegraph are rather to be found in the lack of demand.
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The industrial revolution was still in its infancy in France, and the demand for rapid transmission of industrial and commercial information limited. During the Revolution and the Empire, uses of the telegraph were essentially military, under the Restauration they were rather for the police. Abraham Chappe described in a letter of the role of the telegraph after the Empire: This communication verifies all administrative reports, it gives more unity of action When the government has to be ready to defend itself against the attack of parties, when each minute must be effeciently used The construction of lines was most often related to a specific request linked to events.
The first Paris-Lille line was built under the Convention for communicating with the army in the North. The Directoire requested the installation of the Strasbourg line to be able to communicate with its plenipotentiaries during the Rastadt congress. Napoleon, to improve his communication with Italy, wanted to build the Lyons-Milan line in fifteen days. After the Russian campaign he also requested the urgent construction of a Strasbourg- Mayence line. Under the Restauration a Paris-Bayonne line was similarly built in preparation for the Spanish expedition of Such principles for building the network did not allow for an effective response to the development of the militaro-police demand.
The Lyons-Toulon line was to be built only in The British Admiralty built telegraphic lines between London and four coastal ports in and In , these lines were closed. Similarly, in the Netherlands a telegraph was built in during the Belgian war of independence, and was closed as soon as the war ended. The installation of a permanent transmission device for the needs of the State was only developed later - but not in France.
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Britain installed a network of semaphores in the 's for the Admiralty's needs. It is interesting to note that, having closed the lines which served during the Napoleonic wars and having declared in to Ronalds, an inventor of the electric telegraph, 'that telegraphs of whatever nature they may be, are completely useless9', the Admiralty had a new semaphore system built to cover the same areas Deal, Portsmouth and Plymouth with slightly different alignments.
Some historians like Jeffrey Kieve were surprised by the lack of insight of the Admiralty who did not seize upon the possibilities offered at that time by the electric telegraph. We think that on the. It was only in the s that the other European states built telegraphic links. In , Russia established a line between St. In Spain, a real network was installed: These networks were however short-lived. The English network was to be replaced by the electric telegraph in , whilst on the continent the transformation was to take place later, in the.
The law text produced by the Senate's Commission on Social Affairs and adopted by a majority of the Senate in October see Table 2 was intended to accomplish 3 things: It accomplished this purpose in the Assembly by forcing the adoption of its own, weak version of the law, and in the Senate, by blocking a vote on the Senate's strong version of the law. Of what use is Parliament? Parliament no longer exists!
The arguments advanced by both government and Parliament throughout the debate leading up to the demise of the government's legislative project and of the AM in December were almost wholly economic: The aims of this project were to bolster the fortunes of the French pharmaceutical industry; increase its competitiveness in Europe and globally; and, at the same time, keep pharmaceutical prices under control. Given the government's economic aims, any suggestion that an agency independent of its control would have a deciding role in pricing or marketing decisions was anathema: The effect of the blood crisis was to upend these calculations.
Blood donations in France were voluntary, unpaid, and anonymous. At the time of which we write, the French blood system was highly fragmented, consisting of close to independent blood transfusion centers: In practice, oversight was minimal. Like a clap of thunder in the sky of good health and medical progress, the entire society found itself caught in the winds of panic, traumatized, disoriented in relation to its most constant beacons. There was a profound loss of confidence in health officials, but also in physicians, in all those in the health system perceived as no longer capable of guaranteeing the public's health.
Located in Paris, it was the most influential and prestigious of those centers, actively engaged in both the scientific and industrial ie, fractionation aspects of the blood system. The doctors on its executive committee were the elite of France's blood transfusion system, specialists in hematology with important hospital appointments. Critically, the Paris blood bank advised the government on blood matters and had the sole authority to import blood products from outside of France. Its power within the French blood system far outweighed that of the single staff member devoted to blood affairs within the Ministry of Health.
Reflecting a few months after Casteret's publication on the impact of her revelations, 2 prominent French medical journalists wrote: The discovery that this idealized system did not protect against HIV was, of course, particularly brutal. There is a long and complicated backstory the most immediately relevant elements of that story are outlined in Table 4. The health catastrophe—HIV contamination of the blood supply leading to the massive infection of hemophiliacs—unrolled in France largely out of the public eye.
The majority of infections occurred prior to the institution in of blood screening and the heat treatment of blood products. Further, rates of HIV infection from blood products were not higher in France than in other developed countries. Knowledge of the health catastrophe spread gradually in the period between and , primarily through the agency of militant infected hemophiliacs to whom HIV infections and deaths among their number were increasingly visible.
Condensed Chronology of Blood Affair in France a. The immediate sequelae of this event are shown in Table 4. Hearings before this commission as well as the trial of those prominent officials all of whom were physicians indicted in the spring of continued well into The principal architect of Fassin's legitimizing discourse—the locale where the discourse was framed and action strategies were developed—was the ministerial cabinet of Bernard Kouchner, minister of health from April through March Elections scheduled for March were expected to drive the socialists out of power, and there was intense pressure on Kouchner and his cabinet to accomplish a great deal in a short time, in particular to orchestrate a strong and highly visible response to what the government now perceived as a social and political crisis: Upon their arrival in April , the young men and women of Kouchner's cabinet his cabinet director was barely 30 were plunged into what they recall as a scene of chaos: The administrative services were not on top of this.
Framing this state of affairs as an unprecedented opportunity not only for reform on a grand scale but also to add to the stature of the health ministry in general and of their minister in particular was the work of Kouchner's cabinet. In an early memo outlining a ministerial program for the coming months, his cabinet director wrote to Kouchner: In this quintessential act of institutional entrepreneurship, the director laid down a program to remake public health in France and employed less than subtle flattery to convince his boss of its merits.
Embedded in these texts was a sense of betrayal on multiple levels: What we thought was pure—a Frenchman's blood—is now discovered to be dangerous; what we thought was sacred—a transfusion system built on republican solidarity—is now discovered to be profaned by the intrusion of filthy lucre; the medical profession whom we trusted is now discovered to have feet of clay.
Anger at the medical profession, as reflected in contemporary journalistic accounts as well as in the substantial literature on the blood affair and its sequelae, extended well beyond blood bankers. Physicians with high public profiles who had reassured the public that blood was safe, health officials now under indictment, and doctors who had failed to warn their patients were all tarred with the brush of complicity in the blood scandal.
One of its principal authors recollected: For me that was the [blood] contamination, the undesirable effects of medicinal drugs, nosocomial infections, medical accidents, all the risks that were produced by the health system itself [a conception that extended well beyond the immediate problem presented by the blood system]. But even within the ministry, the people who dealt with hospitals or with health insurance were condescending toward those concerned with public health.
Public health was viewed as not serious: Nor did symbolic and institutional construction follow one another in linear fashion; they were interwoven, with institution building sometimes preceding symbolic framing and sometimes following it: The immediate political priority for the cabinet was reform of the blood system: We couldn't leave this bazaar. Work on this plan—and the meanings that its implementation was intended to convey—are reflected in multiple archived cabinet notes and memos dated from April through September Many industrialized countries reorganized their blood systems in the wake of HIV contamination of the blood supply.
Although the AM had been officially buried in December , it lived on in the hearts and minds of parliamentarians see Table 3. As noted earlier, members of parliament raised the issue with Kouchner at every opportunity in public debate. Kouchner and his team appeared supremely disinterested. The government's bill to reform the French blood system was introduced in the National Assembly on November 26, see Table 3.
The AM was mentioned in debate on this bill merely as a thorn in the side of certain deputies, and of Kouchner, who continued to patiently acknowledge its nonexistence: We may regret it, but that's the way it is. We frame our discussion around the 2 questions posed in the introduction: What is for some people a radical event may appear to others as a date for lunch.
These qualities do not inhere in the event itself; they are attributions that make sense within a particular historical, political, and cultural framework. Not only was that mythology discredited by evidence of systemic venality, but doctors—including the managers of the blood system, physicians who treated hemophiliacs and gave blood transfusions, and the National Academy of Medicine—were portrayed in the media and perceived by their patients as at best ignorant and lacking foresight and at worst as actively and even criminally deceptive.
Attributions of meaning do not happen in a vacuum; they are made by interested parties with agendas of their own. Their success was, in several respects, counterintuitive. They cannot, however, explain the further evolution of that crisis into a vehicle for public health institutional reform. Essential to that process was not only a very different category of actors, but also a uniquely French political institution: The clap of thunder that brought the blood affair to public attention in the spring of came about through the agency of militant hemophiliacs and the few journalists who listened to them.
Once on the public agenda and—more significantly—embraced by the government in power as an affair of state, resolution of the political problem this affair represented became a matter for the health ministerial cabinet, acting essentially behind the scenes in the name of, and solely beholden to, its minister. The central place of this issue on the health ministerial agenda is documented not only in the oral history interviews cited earlier, but also by an examination of Kouchner's daily diary FNA: Their form —exercise of institutional power in the name of the minister—was wholly consistent with the traditional character of French cabinets, reflecting a political culture that privileges central government power and construes that power as exercised in the public interest.
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The latter point is well documented in our interviews and in the secondary literature. The crisis simultaneously made cabinet action imperative and silenced potentially competitive voices. A brief comparison with the United States will further highlight the contingencies that shaped the drama of contaminated blood as it played out in France. This is despite the considerable overlap both in the key actors in each country eg, blood bankers, government health officials, legislators, militant hemophiliacs and in many of the issues at stake.
The IOM report, as well as scholarly 56 , 57 and popular 58 writing, all point to one or more institutional failures parallel to those identified in France, including delay in implementation of measures to protect the blood supply, financial and other conflicts of interest among the various actors involved, and questionable relationships between the regulators and the regulated. We propose several reasons why HIV infection of the blood supply did not become a political crisis in the United States. First, and perhaps of most importance in accounting for differences between the 2 countries, is that the health care system in the United States was not identified with the state.
Crisis and Change: The Making of a French FDA
Disorder —as in the case of the blood crisis—will almost by definition be blamed on the state. The American state did not orchestrate, and was not perceived as orchestrating, that country's blood supply. Second, the aura surrounding the blood system in France—the symbolism of voluntary blood donation as a reflection of French national identity, solidarity, and patriotism—did not and has never existed in the United States. The distinction between paid and unpaid donors—almost of biblical proportions in France—had little meaning in the United States where it was institutionalized in the bifurcated American blood system.
In the IOM's executive summary and recommendations, this distinction was never mentioned. Unraveling the relative importance of each element in limiting escalation of the affair in the United States and amplifying it in France is beyond the scope of this article.
We would emphasize, however, that the relatively robust public health infrastructure in the United States as compared with France 3 , 4 both increased the former's capacity to manage however imperfectly the public health crisis created by HIV infection of the blood supply and also created fewer incentives to catalyze reform by wholesale denunciation of existing structures. The deployment of crisis as a path to institutional reform is not unique to France. Carpenter describes in detail the iatrogenic disease crisis that led in to the modern FDA; the parallels in trajectory ie, revival of stalled legislation, crisis framing, and entrepreneurial action to the French case over 40 years later are striking.
The authors acknowledge with gratitude the material and intellectual support of the Columbia Population Research Center Grant No. Disaster and the Reinvention of Public Health in France. Conflict of Interest Disclosures: No conflicts were reported. The authors are grateful for the invaluable intellectual sustenance over many years from colleagues in the Department of Sociomedical Sciences at Columbia University. We further acknowledge with grateful thanks the willingness of French actors in the drama we describe to sit often for several hours to answer our many questions.
And last but not least, we thank the staff of the French National Archives in Fontainebleau and in Paris for their willingness to move mountains of boxes and their patience with our many questions. National Center for Biotechnology Information , U. Journal List Milbank Q v. Published online Sep Author information Copyright and License information Disclaimer. In that spirit, this manuscript presents a detailed case study of public health policy transformation in France in the early s.
It casts light on processes of policy change in a political and cultural environment very different from that of the United States, showing how the public health policy process is shaped by multiple contingencies of history, ideology, and politics. More specifically, we describe the transformation of a disease catastrophe into a political crisis and the deployment of that crisis to precipitate reform of the French public health system. Methods This paper is based on detailed analysis of primary documents eg, archived French health ministry papers, recorded parliamentary debates, government reports, newspaper articles and oral history interviews covering a period from to Findings Policy entrepreneurs positioned to frame adverse events and seize opportunities are key to public health policy reform.
Conclusions Actors positioned to shape public health policy need to have a detailed understanding of the circumstances that facilitate or impede policy reform. France, drug and narcotic control, public health, health care reform. Table 1 Primary Texts. Charles and Missoffe d. Open in a separate window. Pharmaceutical Regulation in France The production of medicines in France before World War II was in many respects a cottage industry, rooted in the 19th century when pharmacists compounded drugs in the backrooms of their many small shops.
Budgets, Medicines, and the EU The French government in the late s was confronted with major challenges on multiple fronts. Repeats earlier financial and competitive arguments. Emphasis on division's insufficient resources to carry out responsibilities in domain of drug approval. Argues for amendment to blood law incorporating AM. Amendment will be proposed by Senator Claude Huriet. PM says insufficient control of AM by the state.
Consignment to the Ash Heap The government's reservations about the agency model advocated in the Weber report are clear from memos and meeting notes recorded in the spring of , immediately following the report's submission. French Public Health Administration DGS publishes circular directed to all the transfusion centers in France recommending that blood donors with specified risk factors be excluded. This circular is largely ignored by blood banks. June 19 Prime minister announces obligatory blood screening for HIV.
July French government approves Abbott blood screening test. Letter to prime minister on behalf of organized hemophiliacs demands attention to their plight. Ongoing efforts by ministerial cabinet to limit both publicity about and scope of response to hemophiliacs. June 1 Director of Paris blood bank resigns. June Director of Paris blood bank and two other blood system officials are indicted. Enter Kouchner The principal architect of Fassin's legitimizing discourse—the locale where the discourse was framed and action strategies were developed—was the ministerial cabinet of Bernard Kouchner, minister of health from April through March Discussion We frame our discussion around the 2 questions posed in the introduction: From Crisis to Reform The clap of thunder that brought the blood affair to public attention in the spring of came about through the agency of militant hemophiliacs and the few journalists who listened to them.
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