Intrusive Interventions: Public Health, Domestic Space, and Infectious Disease Surveillance in England, 1840–1914 by Graham Mooney (review)

In the conclusion to Intrusive Interventions, Graham Mooney claims that "infectious disease control had changed a lot in the forty years or so following the Royal Sanitary Commission at the end of the 1860s, and only partly because the diseases themselves came to be scientifically and popularly understood as 'infectious' and amenable to 'control.' From practically a standing start, isolation hospitals became a common sight in the urban landscape … Roving teams of municipal disinfectors competed with fever ambulances for street space. And young working-children not only went to school as a matter of course; they were also routinely sent home from it for health reasons" (180). Mooney's book seeks to chart this increasing intervention by the state and its mandated public health authorities into the homes and lives of its citizens, particularly its newly enfranchised working-class citizenry. However, as the first sentence of this quotation suggests, Mooney does not see this increased intervention as simply the result of scientific developments, a "natural" response to germ theory and its emphasis upon the infectivity of the individual. Rather, taking his lead from Michael Worboys' Spreading Germs (2000), Mooney acknowledges the complexity and diversity of disease theory in the years preceding the widespread acceptance of germ theory and suggests that "the basic tools of surveillance were put in place well before their bacteriological logic was 'scientifically' proven" (8). Moreover, he also demonstrates how infectious disease surveillance and intervention was politically contentious and stood in ambiguous relation to later nineteenth century notions of the liberal state.

Mooney's book opens with an excellent introduction, which situates his work within a complex historiography, not only of public health but also the post-Joycean literature on liberalism, surveillance, and governmentality. The main body of the work is divided into two parts. The first of these is entitled "Making Infectious Disease Surveillance" and explores the contested origins of disease notification. Chapter one considers the various attempts to collect reliable statistics on the sick poor and the model provided by early, experimental, and often localized systems of surveillance, such as that initiated by the Manchester and Salford Sanitary Association or that of Newcastle. Meanwhile, chapter two explores the legislative dimensions of disease notification and the frequent resistance of groups such as radical liberals to measures that might have granted increased authority to a medical profession already implicated in such controversial and "coercive" laws as the 1853 Vaccination Act and the Contagious Diseases Acts of 1864–1869. Drawing on the experience of Liverpool, Nottingham, Birmingham, and Leicester, Mooney demonstrates how the success of disease notification in the years before the national Infectious Disease (Notification) Acts of 1889 and 1899 was heavily dependent upon local political circumstance.

Part two of Intrusive Interventions is entitled "Spaces of Risk and Opportunity" and examines the various domains within which the state-mandated agents of public health increasingly operated. Chapter three explores the role of isolation hospitals and the degree of compulsion required to get working families to acquiesce to having members of their family, including children, taken into institutional care. Mooney takes issue with the official line that the working classes gradually came to accept their duty to the health of the community, suggesting that the "legally enforceable weapon of compulsion [always] lurked ominously in the background" (81). He also provides some fascinating material on the ways in which isolation hospitals sought to keep visitors at arm's length, including publishing regular, coded updates about patients' conditions in the local press. Chapter four, meanwhile, considers the space of the school and demonstrates how the School Medical Service monitored the health of working-class children, barred them from attending if they had an infectious disease, and through the system of "following up," increasingly opened up the domestic sphere to scrutiny. Chapter five deals with the issue of disinfection and domestic space. Mooney suggests that, during the course of the...