Sir Arthur Newsholme and State Medicine, 1885-1935 (review)

Dr. Arthur Newsholme (1857–1943) was medical officer of health for Brighton from 1888 to 1908, and then chief medical officer for the Local Government Board (L.G.B.)—the person primarily responsible for public health in England and Wales—from 1908 to 1919. Thereafter he taught briefly at Johns Hopkins, traveled, and wrote extensively on health policy. Eyler examines Newsholme’s career as an administrator and policymaker, an epidemiologist, and, at the end of his career, an analyst of comparative state medicine. The years of Newsholme’s career, 1885–1935, saw a striking drop in mortality, still not well understood. Eyler is not so bold as to claim to account for that change, nor to credit it to Newsholme. He is interested instead in the uses made of legal powers, public sensibilities, and scientific techniques by an able and active public health officer, working first in local and then in central government, in tackling what seemed the most immediate health problems.

At Brighton, these problems were infant diarrhea, typhoid, pulmonary tuberculosis, scarlet fever, housing conditions, and slaughterhouse nuisances. There Eyler finds a reciprocal relationship between administration and epidemiology. Newsholme traced typhoid to contaminated shellfish, scarlet fever to bad milk. As a beneficiary of the new Diseases Notification Act and with an ample force of sanitary inspectors, he had vastly more data with which to make sense of differential disease incidence than did colleagues with only mortality figures and broad, mainly geographic, means of characterizing victims. Especially in comparison to earlier public health efforts and subsequent sensibilities, his administration is remarkable for its intrusiveness: in a town of 24,000 dwellings, Newsholme’s inspectors made as many as 13,000 home visits per year, sometimes badgering occupiers to reform their plumbing or refuse disposal, following up notifications of disease, and always on the lookout for incipient tuberculosis. Given that visits were concentrated on the class least likely to complain (and in which illness was most common), for some an inspector’s visit must have been a regular occurrence.

As with many of his contemporaries, Newsholme’s emphasis shifted from environment to person, and from climatic factors (like Max Pettenkofer’s groundwater hypotheses) to transmission routes. In part this reflected opportunities for action: improving health through better housing proved far more formidable than modifying behavior and isolating carriers. Sometimes contingency created opportunity and guided research: that Newsholme was also medical officer of the municipal sanitorium and the moving spirit behind a costly new isolation hospital focused his attention on the benefits of isolation, and led to studies that seemed to dissociate tuberculosis reduction from rising living standards, in favor of an explanation centering on the control of infection, chiefly through isolation.

Newsholme came to the L.G.B. as a protégé of the Webbs. He was to be the Fabian’s Fabian: the expert behind expert government. There his priorities were infant mortality, tuberculosis, and venereal disease—and, more broadly, the protection of a public health establishment from being either swamped by Lloyd George’s national insurance or dismantled by the war effort. Dominating his last years in the post was a squabble with George Newman, the nation’s chief school medical officer. What began as a turf fight came to reflect different conceptions of state medicine: one, Newsholme’s, in which a science of prevention guided an intrusive state in the production of health and well-being; another in which government underwrote benefits to the sick and to their physicians. Newsholme lost, and retired rather than work for Newman in the new Ministry of Health.

It is the pragmatism of the bureaucrat, manifest even in his epidemiology, that most clearly distinguishes Newsholme’s career from his better-known predecessors in the “great man” reading of British public health history: Edwin Chadwick and John Simon. If the growing corpus of public health law left Newsholme with more powers than his predecessors, it did not rescue him from politics or...