Health and Medicine in Britain since 1860 (review)

Anne Hardy. Health and Medicine in Britain since 1860. Social History in Perspective. New York: Palgrave, St. Martin's Press, 2001. xi + 220 pp. $65.00 (0-333-60010-X).

Writing general works of synthesis is an impossible task: striking the balance between possible topics requires the judgment of Solomon. New major works appear just when a draft is finished. Alternatively, major work does not exist when one wishes it did; some areas are inexplicably neglected. In addition, if one is working on periods of history leading into the present day, then historical assessment is truly a movable feast. In my case, a change of government meant that many existing health structures were changed and replaced, most inconveniently for my nearly finished text.

Anne Hardy has undoubtedly encountered many of these problems in writing her survey history of the past 140 years. Her book is sensibly divided chronologically into five major chapters: one deals with the nineteenth century and the turn-of-the-century years, while four deal with the twentieth century. Hardy mentions her audience of medical students in the intercalated B.Sc. degree at University College London, and this is clearly the type of audience for whom she is writing. She has set herself the task of providing a mix of "historical fact" along with a judicious leavening of the latest historical interpretations and debates, where these exist. Students wanting "basic facts"—for example, dates of the arrival of the stethoscope and the thermometer—can find this information (p. 23). But some of the debates are also there: if one looks up "Webster, Charles" in the index, for example, one finds reference to the debates around the "healthy or hungry?" 1930s—although not to those around consensus and the coming of the NHS.

The book's focus is the relationship between medicine and health: both at the personal level, in terms of the relationship between patient and doctor, and at the community level, in what is generally termed public health. It therefore covers the changing demographic background—the growth of the urban/rural divide in the nineteenth century, or the rise in the proportion of the elderly in the population after the Second World War. There is valuable information throughout the book on changes in medical technology, in equipment, but also on medical advances like the improved medical understanding of the identities and characteristics of different diseases, and when these were established. Hardy is concerned to outline the connections between medical advance and industrial development, so that the rise of the pharmaceutical industry in the twentieth century is given full weight. Because of her own research interests, nutrition and food-related aspects of health receive valuable prominence.

The state of public health in the nineteenth century—the deficiencies of water and sewage disposal, and the problem of industrial disease in the nineteenth century—always of interest to students beginning work in the history of medicine, is graphically described, and the book ranges widely over the subsequent late-nineteenth-century "discovery of poverty," the rise of state involvement in the provision of medical care, and the economic, male breadwinner priorities that determined it. A particular strength are the two chapters on the First and Second World Wars, which focus on the impact on the civilian population as well as on the troops. That on the 1939-45 war deals with the health impact of the movement of population; infectious disease (meningitis made a reappearance); the impact of air raids; and the state of the nation's food. Rationing and the British Restaurant are given due attention.

The postwar years are more difficult to write about, and the content here is sometimes uneven. The "Doctors' Charter" of 1966 is not mentioned, although it was arguably more important in raising the status of general practice than pay deals in the 1950s, which are included in the text (p. 143). Women's smoking was...