Cholera and Nation: Doctoring the Social Body in Victorian England (review)

Do not approach this book if you are seeking a beginner's guide to cholera. To its credit, the work brings together a great deal of knowledge and bibliographical information and is written in a reasonably concise style. It is certainly interesting. It does, however, require some background knowledge on the part of the reader. Gilbert weaves together contemporary and subsequent accounts of cholera in nineteenth-century Britain while demonstrating how the disease was portrayed in creative literature. The book never quite escapes the obvious difficulty of thereby existing in two halves, but the author must be applauded for a valiant effort to combine historical and literary analyses. The concluding liberal outpouring could perhaps have been omitted, and some of the material regarding gender and race might require a greater leap of imagination than many readers are willing to perform. But where judgments might be questioned, evidence is usually presented. Overall, the scholarship is sound; its findings are well set out and, in their way, make an original contribution.

The book starts with a useful introduction and erudite, succinctly argued early chapters. Cholera visited Britain in four principal epidemics between 1831 and 1866 and, as is discussed, was used by doctors, clergymen, sanitary reformers, and political figures to further their interests and to validate their own opinions. Medical officers did well from fear of the disease, which seized the Victorian imagination for a few reasons: there had been no great epidemics since the plague of the late seventeenth century, cholera had a sudden and unpleasant nature, and the incidence of mortality was, in some locations, as high as 50 percent. Its exact cause remained unknown until the 1880s, although the obvious association with impure water, abysmal personal hygiene, and bad sanitation provided ammunition for those in public life eager to push forward controversial health legislation and expensive municipal works. Indeed, it was the uncertainty surrounding cholera that provided so much scope for speculation. A range of causes, encompassing most forms of human degradation, could be advanced. Divine wrath was also cited as both visiting a necessary punishment and providing a warning for future moral improvement.

In the meantime, a spectrum of digestive ailments and bowel disorders might all qualify as cholera's many supposed varieties, and with the medical practitioners usually paid by local health boards per loosely defined case, there was no incentive for diagnostic precision. Though largely oblivious to the manoeuvrings of professional men, the poor—who suffered most—were instinctively distrustful. Suspicion about doctors and intrusive officials continued in Britain beyond the last cholera outbreak; some people even believed that the medical authorities were spreading disease, to provide corpses for anatomy classes or to keep down pauper numbers. Ironically, for all the publicity and anxiety that surrounded it, cholera was not the worst agent of death in nineteenth-century Britain: smallpox and typhus were both common and devastating, and tuberculosis was the nation's most relentless killer. British towns and cities in the early and mid-nineteenth century were accustomed to disease. Cholera was dramatic while it raged. However, its effects on local authorities and public opinion were often short-lived, and, as health reformers argued, its dangers too frequently forgotten. The author could perhaps have reminded readers of that more often.

How representative of nineteenth-century values and attitudes were the writings of the clergymen, medics, reformers, and novelists to whom Gilbert refers? In fairness, she concedes the following point: history tends to remember those who shouted loudest. Furthermore, medical science and public sentiment moved on from the early 1830s to the mid-1860s: as Gilbert acknowledges, the response to each of the four cholera epidemics was not the same. This study is thus tempered with a good dose of historical common sense. Although there is already a large bibliography on nineteenth-century cholera, space can gladly be found for this well-produced addition.