Public Health and Social Justice in the Age of Chadwick: Britain, 1800-1854 (review)

Christopher Hamlin. Public Health and Social Justice in the Age of Chadwick: Britain, 1800-1854. Cambridge History of Medicine. Cambridge: Cambridge University Press, 1998. vii + 368 pp. Ill. $64.95.

There is no shortage of historical works on Edwin Chadwick and his role in the public health movement. A list of only the most important of the last half-century would have to include S. E. Finer's Life and Times of Sir Edwin Chadwick (1952), R. A. Lewis's Edwin Chadwick and the Public Health Movement, 1832-1854 (1952), M. W. Flinn's long introduction to the 1965 reprint of Chadwick's Sanitary Report of 1842 (1965), two chapters in Margaret Pelling's Cholera, Fever, and English Medicine, 1825-1865 (1978), and Anthony Brundage's England's "Prussian Minister": Edwin Chadwick and the Politics of Government Growth, 1832-1854 (1988). Christopher Hamlin's book offers some new information, but its main claim to attention is a fresh interpretation. Hamlin pushes back the origin of Chadwick's interest in health from 1838, the date the Poor Law Commission sponsored an investigation of fever in East London, to the middle thirties, when Chadwick felt obliged, we are told, to defend the New Poor Law against two threats from the physicians to the principle of least eligibility. First, medical men insisted on considering privation a cause of disease; hence, Chadwick's prescription for life in the workhouse at a level of existence below that obtainable by work on the outside might be considered not only unjust, but life-threatening. Second, some Poor Law medical officers prescribed food as medical necessaries, a practice that drove up the cost of relief and undermined the strategy of deterrence. Chadwick was thus led into a quarrel with the physicians, particularly W. P. Alison of Edinburgh, about whether lack of food, exposure to cold, exhaustion, and overwork were causes of fever. His determination to prove the physicians wrong led Chadwick to insist that disease was produced by remediable physical conditions incidental to the working life of the industrial working classes, and eventually to champion a simple miasmatic explanation of disease and the narrow preventive strategy of drains and sewers.

Hamlin thus locates the origins of the Sanitary Movement in the highly charged discussions of the condition of the working classes in the age of the Chartists. The cause of disease thus becomes an intensely political question: "Even the most innocuous sanitary undertakings might be proxies of class conflict" (p. 299). The focus of the book changes with Chadwick's career and the nation's politics. We have a detailed review of the Sanitary Report and of the accounts of local observers found in the Supplemental Report. Hamlin also provides a fuller and more credible discussion of Chadwick's conflict with the civil engineers over the design and construction of urban water and sewage systems than has previously been available.

The book is well organized and written in lively prose. It is an argumentative account that makes some sweeping assertions and invites debate. In short, it is engaging and stimulating. These advantages, however, have costs. One is a narrow perspective. Hamlin chooses to omit some aspects of Chadwick's career and some central features of early Victorian public health that we might expect to find discussed: police reform, the reform of urban burial practices, the struggle over London's water supply, and, most remarkably, cholera. The second price is the lack of even-handedness in dealing with Chadwick's disputes. Chadwick and his small cadre of advisors have their evidence, motives, even their integrity questioned at every turn. Chadwick is not allowed to express shock at the water shortage in working-class districts, or to notice the inconvenience this causes families. The appearance of concern with the individual is "disingenuous," we are told, because Chadwick's concern was really "capital...