Municipal Medicine: Public Health in Twentieth-Century Britain, and: Body and City: Histories of Urban Public Health (review)

John Welshman correctly points out that local studies in public health administration have been neglected, and that this is especially regrettable because the implementation of policy since the nineteenth-century era of sanitary reform has been largely a matter for local authorities. His examination of public health in the Midlands' town of Leicester between 1900 and 1974 admirably begins to open up the political and social relations of municipal medicine and health care in twentieth-century Britain in a way that should stimulate far greater interest for future researchers.

Welshman reveals how national politics and central state rhetoric had to be interpreted within the political constraints of the particular structural and cultural characteristics of a local social system. The relatively affluent county borough of Leicester had been economically sustained by steadily expanding manufacturing industries such as the boot and shoe trade, which made it an attractive place for Commonwealth migrants in the 1960s. Throughout the twentieth century the diseases of poverty were perhaps less of a challenge for this local authority than for some of its neighboring sprawling conurbations, but it did have to confront postwar social conflicts such as race relations and the distribution of services. Leicester's social history offered opportunities for innovation and experimentation within public health practice, allowing the local department to navigate some transformations rather more successfully than others. For example, the Leicester health department was able to adapt and integrate emerging disciplines such as social work in an effective cooperative approach to care in the community for mental health patients and the elderly, family planning, and child health. Welshman contextualizes such developments clearly within the changing demographic, social, and political environment of Leicester's population, allowing a gratifyingly holistic picture of health, illness, and medical services in the community to emerge.

This history of public health in Leicester offers far more than just an analytical narrative of life in a single locality. Welshman uses the local study to explore much broader changes taking place in public health and medical service organization, and their ideological determinants. For example, he examines the mixed reception and variable influence of eugenics on local developments and tries to uncover how new intellectual movements, such as "social medicine," affected the Leicester scene. He tries not only to assess the extent to which Leicester's health department became an effective or ineffective public educator and mass communicator, but also to reveal how changing educational ideals, goals, beliefs, and metaphors were generated and pursued. Equally interesting is his analysis of how Leicester became a "laboratory" for some socio-medico investigators, and his evaluation of their interpretations.

There is a great deal to learn about the intellectual and ideological history of public health in this book, as well as about the politics and social relations of health care facing British communities in the twentieth century. Welshman challenges many historiographic assumptions with this local study and makes many innovative and provocative new arguments for the field to consider.

Reinforcing Welshman's point about the historiographic potential of local studies is the wonderfully innovative collection of essays edited by Sally Sheard and Helen Power, Body and City: Histories of Urban Public Health. The editors began with the familiar historical trope of the diseased city corrupting the civilizing process and invited historians with highly contrasting approaches to examine its cultural representations and material measure. The result is a stimulating collection of work that utilizes a wide range of methodologies to investigate dramatically contrasting subjects, from the historical anthropology of sacred and secular meanings to the quantitative...