Edwin Chadwick, "Mutton Medicine," and the Fever Question

Edwin Chadwick’s Report on the Sanitary Condition of the Labouring Population of 1842 is famous for launching the public health movement in Britain. It was the product of the so-called Sanitary (or Sanatory) Inquiry, an investigation begun in autumn 1839 by the Poor Law Commissioners (PLC), whose secretary Chadwick was. Using the rest of England and Wales as a laboratory, this investigation was designed to test a thesis about the environmental causes of fever developed in pilot studies in London done by Drs. Thomas Southwood Smith, J. P. Kay(-Shuttleworth), and Neil Arnott in May 1838. ¹ The work of Chadwick and these associates has been seen as reflecting a remarkable appreciation that the reform of social (and particularly of structural and environmental) conditions might prevent most infectious disease. It is seen as the manifesto of the desirability of a proactive rather than a reactive medicine, of prevention over cure. ²

The Commissioners explained their move into preventive medicine as part of their mission to lower the costs of poor relief. It had recently been discovered, they held, that dirt was the cause of disease. As disease was a common cause of dependency, it followed that “sanitary improvement” (removing dirt) could reduce disease and thus reduce the number of people requiring public aid. The inquiry would provide evidence to justify spending funds collected for poor relief on such sanitary improvement. As we know, its products were far-reaching. The environmental improvement it inspired probably did do much to diminish disease. Whether or not Chadwick’s approach really lowered welfare costs, the sort of environmental conditions he championed have become standard expectations in industrial societies on grounds of amenity as well as health. Chadwick’s move into public health has been seen as a major transition in his career, a move from poor-law disciplinarian and political economy zealot to benefactor of humanity. As to why he made the move, historians disagree: some suggest that he was finally settling into his true life’s work, others that he was seeking public work that would bring gratitude, not calumny. ³

In this article I will suggest that public health was less a new policy initiative than a response to a developing crisis in poor-law management. Of more immediate concern to Chadwick and the three Poor Law Commissioners than lowering costs through preventive medicine was the political emasculation of aspects of medical theory—and worse, of medical practice—that was undermining the new poor law, and that would lead ultimately to the abolition of the Commission in the wake of the Andover scandal of the mid-1840s. ⁴ The move into public health was more a rhetorical means of damage control than an expansion into a new and less stormy area of social betterment.

The troublesome aspects of medical theory and practice arose most markedly in connection with continued fever (a distinction between typhus and typhoid was only beginning to emerge during these years). This disease had been the focus of the pilot studies and was the initial focus of the Sanitary Inquiry. It was, in effect, the “battle ground” for fundamental questions of social policy during the 1830s and 1840s—years of social and political turmoil, and equally of innovative social policy in Britain. ⁵

As is well known, the sanitarians’ chief claim was that fever struck healthy people exposed to “insanitary” conditions, the most important of these being an atmosphere filled with emanations of decay. Embedded in this simple statement were at least five distinct claims bearing on key issues of fever etiology and prevention, which Chadwick and his followers would advance more or less explicitly. Claim 1 was that decaying filth was a cause of fever. Claim 2, stronger, was that decaying filth was either the true “exciting” cause of fever, or at least the only necessary cause. Claim 3, a hidden antithesis, was that a debilitated condition of the victim (in particular, one due to destitution) was not a cause, or at least not an important cause. Chadwick insisted that fever struck primarily healthy people (i...