Health, Medicine, and Society in Victorian England (review)

The history of health, medicine, and society in Victorian England has been well explored in monographs and textbooks for some thirty years but still attracts study. As scholarship moves on, new syntheses have their merits, and Mary Wilson Carpenter's volume is no exception. Carpenter takes a literary and gendered approach to the topic, drawing extensively on fiction, poetry, memoirs, diaries, and letters for contemporary illustration and emphasizing issues around women and class. The book is clearly and engagingly written, intended as an introduction for students or a general readership. Those working in this period of English medical history will find much that is familiar, as Carpenter covers professional relationships, infectious diseases, and women. Two chapters on deafness and blindness offer a perceptive and more original contribution to the wider field. Nonetheless the organization of the book is somewhat curious. The introductory chapter on practitioners and patients is followed by four chapters on the most significant (in one sense or another) infectious diseases—cholera, tuberculosis, smallpox, and syphilis. Deafness and blindness follow, and a chapter on women concludes the volume.

The heavy emphasis on the major infectious diseases is perhaps understandable, given cholera's high public profile and the deaths and damaging sequelae associated with the other three. Yet it does make the book feel lopsided. Given the emphasis on women, it seems curious not to have had a chapter on children. Although high rates of infant mortality and childhood infections are touched on, the continual concern and anxiety that many if not most Victorian women would have experienced about sick and dying children would have been worth exploring. The miseries of whooping cough, measles, scarlet fever, and rheumatic fever, their often unfortunate sequelae of organ damage, and the trauma of diphtheria, as well as rickets, constant diarrhea and ear and chest infections, were an integral part of women's experience of health and medicine in Victorian England. This is a domestic dimension of illness that has all but disappeared from modern Western societies, and it would have been worth drawing the attention of readers to these many ills that often made life burdensome but did not kill.

A second omission from this book, which may trouble some readers, is that of insanity, or "psychiatric and neurological disorders" (p. 6), as Carpenter calls them. She explains this omission in her intelligent introduction as resulting from her belief that they are not among the most representative problems of nineteenth-century medicine and society, as fit into a "reasonably short and comprehensive history of an extremely complex subject" (p. 6). Nor was cholera representative, it might be argued. Its scare value was great, but mortality was not overall of the first order, and the four epidemics that England experienced to 1866 were of a significantly diminishing order of scale and geographical spread. Madness has, however, been a very strong strand of inquiry in the social history of medicine, and its omission plays down a notable source of ill health, medical endeavor, and social concern. The recent publication of Akihito Suzuki's Madness at Home (2006) opened up the problems that insanity caused in ordinary domestic life, while depression is known to have been prevalent among both men and women. In view of the centrality of mental discomfort and distress in the twenty-first century, an account of how such problems were understood and managed in the nineteenth century would have added a valuable dimension to this book. Mental distress, like childhood illness, was an integral part of daily life for many English families. As a historian of infections myself, I may be overcompensating in another direction, but it does seem to me that the balance and perspective of Carpenter's book would have benefited from less attention to the great infections and more to the less spectacular but trying afflictions experienced by nineteenth-century households.