Public Health and Social Justice in the Age of Chadwick: Britain, 1800-1854 (review)

Hamlin’s scrupulous examination of Edwin Chadwick’s sanitation campaign attacks the determinist idea that Victorians constructed sewers and water supply systems as a direct and obvious response to pollution-induced disease. He argues instead that sanitation was a particular choice of diagnosis and remedy made for philosophical, moral, economic, and political reasons.

Hamlin demonstrates that Chadwick ignored medical reports showing that disease among Britain’s working classes arose from a variety of conditions—destitution; horrible housing; bad water and sewage; long working hours in dangerous, toxic workplaces; and little education or training. There was, says Hamlin, no clear way to move from this diagnosis to public policy: Liberal economic theory, real fear of the lower classes, and distrust of centralized government left only sanitation as a feasible target. Moreover, because the inquiry was generated from the operation of the Poor Law, which focused on indigent males, women’s and children’s problems did not enter into the calculations.

Chadwick’s 1842 Report on the Sanitary Condition of the Labouring Classes encoded “the moralizing and management of a desperate and unruly people” (213). Chadwick promised that systems of clean-water supply and sewerage would not only alleviate disease but actually reform lower-class manners, removing the dangers of Chartism. Sewer construction appealed to middle-class sentiments. Sewers improved the town, and could be built without actually dealing with the dangerous classes. Clean water would bring clean morals. The subjective misery of destitution was replaced by the objective language of dirt, stench, pipes, drains, and dwellings. Often spurious data and projections suggested extraordinarily far-reaching benefits: Sanitary reforms would pay for themselves in lower rates of crime, disease, and political agitation.

Having gained his point by way of two reports and the support of the Health of Towns Association, Chadwick sought to use the Board of Health created in 1848 to oversee the largely autonomous local authorities and dictate specifications of drainage works. He ran headlong into the maturing community of professional engineers. Used to working closely with local officials on projects of limited scope, the engineers rejected Chadwick’s all-encompassing systems, as well as his engineering pretensions. Yet, their construction of drainage and sewer systems physically enshrined Chadwick’s notion of “public health” as sanitation, to the exclusion of many other facets. Hamlin maintains that this narrow definition continues to skew debate and policy planning on public health today. He urges health practitioners and authorities to reconsider pre-Chadwickian approaches.

Hamlin’s close reading of the Report and related documents can grow tedious if taken in large doses, but his rich vocabulary, energetic pace, and trenchant insights make the book well worth studying. His mastery of the archival sources allows him to explore the complexities, uncertainties, and choices involved in the construction of policy. Long acquaintance with secondary literature allows him to comment on medical theories, statistical methods, class and gender prejudices, and bureaucratic infighting. The book succeeds as history, as social commentary, as a treatise on sanitation, and even as intellectual biography.