Public Health and Politics in the Age of Reform: Cholera, the State and the Royal Navy in Victorian Britain (review)

The scope of this volume is narrower than its title suggests: it deals with Plymouth and its environs in the years leading up to the cholera epidemic of 1848–49. These two years were significant with regard to the intersection of local and national in English public health: the epidemic followed passage of the great 1848 Public Health Act, but came before the local boards of health to administer it could be established in towns that wished to adopt it (many did not). Central governmental response relied on the Nuisances Removal Acts (which required local implementation), and on advising temporary local boards of health, which intersected in complicated ways with existing units of government. On these latter, there was little evidence of an "age of reform": Plymouth's corporation had been reformed under the 1835 Municipal Corporations Act, but parishes, improvement commissions, and boards of Poor Law guardians, acting under a mix of local and general acts of Parliament, still did much of the governing. Their jurisdictions and responsibilities were often unclear and incoherent and sometimes riven by inherent conflicts of interest. Notwithstanding overlapping memberships, their relations with one another were characterized more by squabbles for power than by a coordinated provision of public services.

Where Plymouth differed from other English towns was in the prominent presence of the navy. Naval health concerns and institutions interpenetrated with those of the town. Sailors' dependents made up a significant portion of the pauper population. Cholera threatened the navy, too, and at least in some cases, its hospitals, surgeons, and disinfectants supplemented (or superseded, or interfered with) the responses of public bodies. As David McLean notes, the progressiveness of early nineteenth-century British naval hygiene has often been underrecognized in the history of public health. Yet despite the insights of Lind, Trotter, and Blane, and a premium on command and coordination, the navy too was rife with conflicting agendas and bickering and difficult personalities. Much of McLean's story is of the relations—with each other and with units of local government—of Sir William Burnett, the navy's chief medical administrator, and inventor of a zinc chloride disinfectant whose efficacy he decided to test in south Devon's slums during the epidemic; William Rae, his appointee as naval medical inspector (administrator) of the hospitals at Plymouth; John Toup Nicolas, governor of the Plymouth naval base; and Andrew McClure, a naval assistant surgeon who did much of the public health work in the towns. Overall, the success of the navy's interventions is not clear: relative to the nation as a whole, the Plymouth area had a high cholera mortality.

Although McLean occasionally alludes to the experiences of other English and Scottish towns, and to the futile attempts of Whitehall bureaucrats from the Poor Law Board (Edward Gulson) or from the General Board of Health (Edwin Chadwick, Gavin Milroy) to manage things, the book never consistently transcends local history to locate its stories in a broader context. Chapters 2 and 3—on local government and on naval medicine, respectively—are able surveys, but the focus in introduction and in conclusion is never clear. In my view, fixation on the local needs no apology, though it does need more explanation. McLean has depicted a Dickensian world: a rich mess of motives, customs, relationships, and old grudges that dominate the response to a public crisis. He reminds us that whatever Parliament might do, much of the action in nineteenth-century English public health was at the periphery.

The book is not easy to use. One often finds oneself lost—geographically, chronologically, or institutionally. Maps, appendices, and a more accurate index would have helped. The range of sources used is impressive, though the fact that Plymouth-Devonport had only one newspaper, and that a radical one, should warrant caution. By no means is this a newspaper-based...