Eclectic Medicine, Liberal Politics: Cholera Crises and the Making of a Federal Health Policy in Switzerland, 1830–1886

Abstract In nineteenth-century Switzerland, the medicine and the politics of cholera were made together. Drawing on cantonal ordinances and the medical reports of Basel and Zurich, this article shows that Swiss authorities neither chose between contagionism and miasmatism nor followed a single doctrine, but acted on an evolving eclecticism that stabilised around Max von Pettenkofer’s seed-soil theory. That medical pluralism was the counterpart of a distinctively liberal and federal crisis politics. In place of cordons, the Tagsatzung improvised in the 1830s open traffic combined with federal financial compensation for affected cantons, eventually consolidated, after the 1867 Zurich crisis and the 1874 federal revision, in the federal Epidemics Law of 1886. The Swiss case thus invites a rereading of the Ackerknecht thesis on contagionism and liberalism. Beyond that rereading, the Swiss case opens a second question. A liberalism committed to individual freedom and a lean state had to convert that freedom into a collective, tax-funded responsibility for the health of all, and the costliest test of this conversion was the modern sewer. The conversion required, in turn, that the liberal night-watchman state of the 1830s reinvent itself as a tax-raising and provident state capable of mobilising the public investment that the Pettenkoferian sanitary programme demanded. Where direct-democratic rights of co-determination allowed propertied electorates to vote the expense down, as in Basel, the translation was slow and contested. The article shows, in conclusion, how the conjunction of three factors carried the translation through: the epidemic shock of 1867, the democratic mobilisation that followed, and a partial federalisation of the financing of epidemic response, anticipated in the Tagsatzung’s reimbursement decisions of 1837 and consolidated in the cost-sharing provisions of the federal Epidemics Law of 1886.