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Public health and social justice in the age of Chadwick: Britain, 1800–1854

Public health and social justice in the age of Chadwick: Britain, 1800–1854 Essay Reviews such an unappetising farrago of sloppily pedestrian and plodding, myopic mani- composed, confused, and confusing writing festations of historians earnestly working their that-perhaps appropriately-they threaten to way through internal memoranda and hospital drive the reader to distraction. records that might better have been left to Even leaving to one side its often clumsy moulder in a decent obscurity; and then there and soporific prose and focusing solely on the are yet other portions of the volume which scholarly value of the text, one confronts a real stitch together poorly documented, slipshod, curate's egg of a book. Here is a volume which and even factually unreliable representations of purports to provide a definitive history of one the events they purport to discuss. Taken as a of the major psychiatric institutions of the whole, and in the context of the explosion of Western world, but achieves that lofty goal interest in the history of psychiatry over the only intermittently. Portions of the text, as I past quarter-century, The history of Bethlem have suggested, are first-rate, thoroughly must be regarded as a major disappointment. researched and genuinely original; others are Edwin Chadwick Revisited ANNE HARDY* Christopher Hamlin, Public health and read it. It says something of the power of this social in the justice age of Chadwick: Britain, image, and of the fresh fields available to, and 1800-1854, Cambridge of History Medicine diverse interests of, the young discipline of series, Cambridge University Press, 1998, medical history, that there has been no pp. vii, 368, £40.00, $64.95 (0-521-58363-2). established corner in Chadwick studies, that no revisionist hand should have laid hold on the Edwin Chadwick bestrides the history of myth in forty-odd years. Yet as presented by public health, the near-mythic founder of the Finer and Lewis, the Chadwickian public sanitized city who sits, together with John health story now has an old-fashioned air-it is Snow the founder of and Lord top-down characteristic of its epidemiology history, period, Lister the founder of modern surgery, in the of modernization as a unquestioning desirable English Trinity of Victorian uncritical of progressive good, contemporary rhetoric, medicine. Difficult, doctor-hating and incurious of the wider cultural context within bloody- minded, inspired by Benthamite ideals and which the creation of public took health place. impassioned by the of and To a later of still excited recycling sewage by generation scholars, egg-shaped sewers, Chadwick's by the concepts of construct and popular image contest, has been well established older it lacks and However by histories, contingency, edge depth. notably Sammy Finer's and R A social historians resist the wilder biography rightly many Lewis's of his study contribution to public shores of post-modern interpretation, these both in health, published 1952. The very title methods, judiciously used, have an undoubted of 1988 value in the historian to set self Anthony Brundage's study, Englands assisting aside, "Prussian so to endorse and in our of the minister", appeared enriching understanding past. the legend that it almost seemed to Modern revisionism often unnecessary appears negative, almost opportunistic, in the sense that it *Anne Hardy, Wellcome Institute for the History of diminishes the or eminence of an significance London. Medicine, 255 Essay Reviews historically prominent figure by reviewing ruling classes at this period. Whatever other evidence critically, or by reconstructing cultural motives Chadwick may have had in his career and intellectual contexts: F B Smith's essay on as a civil servant, he was certainly aware of the Florence Nightingale, and Gerald Geison's political contexts of his activities. study of Pasteur stand as examples here. As the A great deal of water has thus passed in of since Finer notorious creator of public health England, beneath the bridges scholarship Chadwick seems an obvious candidate for the and Lewis described Edwin Chadwick's same treatment. However, Chadwick's contributions to English society and established personality is well known to have been flawed, his legend, and as the 150th anniversary of the so disillusion on that score is likely to be less first Public Health Act occurred in 1998, a intense, and he was a genuinely important reassessment of Edwin Chadwick's figure: not an independent operator but a civil contribution to the creation of public health is servant, he was involved not only with timely. It is probably fortunate for Chadwick, sanitation but also with the New Poor Law, and and certainly fortunate for historians interested his career and activities form part of a pattern in health, government and urbanization in the of administrative growth at a period of nineteenth century, that this reassessment has No undertaken as a serious enormous social and political uncertainty. been scholarly role in the modern in its one could deny Chadwick's founding enterprise. Entirely approach, yet Whatever else written in language remarkably free of jargon, of modern public health. an active so articulate in its presentation of the new Chadwick was, he was undeniably in a historical as to be accessible to the participant significant process. conceptual history of an most unregenerate traditionalist, Christopher The concept early nineteenth-century "revolution in was introduced Hamlin's Public health and social in the government" by justice in and it has sets a standard for Oliver MacDonagh 1958, long age of Chadwick been that the health is histories of medicine and recognized public story modernising science, Both text and footnotes to an integral part of that wider administrative society. testify of response to a newly urbanizing society. extensive and reflective exploration relevant Chadwick's work as a civil servant is nineteenth-century literature. Hamlin can be illustrative of the processes of nineteenth- ponderous ("Let us set this drama in motion", century government. Moreover, the p. 84), and the texture of his writing, with administrative revolution of which public health considered accounts of, for example, differing was so much a part took place within a highly contemporary perspectives on the nature of fragile political context, which scholarship has diseases (pp. 58-61) or Southwood Smith's done much to illuminate since the publication views on contagion and predisposition of E P Thompson's classic The making of the (pp. 114-19) may at times try the stamina of English working class in 1963. Post-war historians from non-medical sub-disciplines, depression and the emergence of a cyclical but for those interested in the hows and whys, pattern of economic growth and slump; and possible alternatives, of history, these are with the stuff which of the growing political consciousness, through understanding insurrections and revolutions in France and is made. past elsewhere, culminating in the Year of As regards Chadwick, the central thesis of Revolutions in 1848; Reform Act agitation, Hamlin's book is straightforward: Chadwick's and Chartism Corn Law Repealers at home; all passion for sanitation was born of expediency, made the between and to divert medical and years 1815 1850 years of political attention from special political sensitivity which touched all the failure of the New Poor Law and from actions taken or contemplated by government poverty as a cause of disease, and it developed whether or Whig Tory. Political rights and by expediency, because Chadwick was social justice, and their achievement without struggling to safeguard his career. Beyond the were critical revolution, preoccupations for the biographical corrective, however, Hamlin is 256 Essay Reviews with deeper issues: with the Public Health Act and the demise of the concerned of how broadly "public health" was to General Board. Central to this account is the question way in which Chadwick's sanitary idea be defined (a question posed by William over time, not only in its content, Coleman for France in Death is a social changed which was gradually reduced to the integrated disease [1982]), and with that of the power model, but also in its intention: relations embodied in sanitary works, as raised sewage/water tactic for the benefit of the by Michel Foucault in another modern from a diversionary punish to a political weapon for the historiographical classic, Discipline and Poor Law Board, and the stabilizing of (c. 1977). Because of Chadwick's career needs, diffusing of revolution a model for urban improvement and the whole focus of public health reform in society, to to an engine of England was shifted from the social to the capitalist enterprise, and finally In Chadwick's hands, environmental, from people to structures, from administrative growth. idea of health was no static ideal for poverty to water and sewers, and the the public as human condition, but a tool of construction of "public health" pertaining improving the and of survival. When theory at essentially to the latter firmly established. opportunity and Because Chadwick was a systematic, last was put into practise proved career tumbled; but so principled reformer, he was determined on impractical, Chadwick's central control in enforcing his particular effective had been his labours that the idea health vision of sanitary progress, and thereby raised itself survived to dominate the public the demon of tension between central and local programme for the rest of the century. which relations in so Beyond the central story, Hamlin's government complicated of social policy for the remainder discussions of both the background and the many aspects of the at least. sequels of Chadwick's work are arresting. The century The book falls into three parts, and describes pre-history of medical debates over the causes The first two of disease, with William Alison's emphasis on also three processes. chapters relationship of the cardinal significance of poverty and explore the pre-Chadwickian to the social issues of the destitution, is a powerful representation of the medicine great to the Chadwickian alternative health" concept which period, alternatives "public and the failure of the medical Chadwick so defeated. When it comes solution, signally to take a role in to the practical impact of profession up leading considering health. The central section Chadwick's sanitary vision, Hamlin's interest questions of public on his in the of science and technology of the book focuses Chadwick, history of him to see the it presented successful challenging contemporary enables problems of disease in for the who were supposed to medical opinion on the causation agents and his accommodate and the grand the years between 1832 1845, implement idea of In its mature form, in the construction and definition of the sanitary strategy. trace the Chadwick's ideal involved a complete sanitation. The final chapters 1840s, health was of combined sanitation-constant water processes by which public system and the house sewerage by pipe translated into an urban question supplies, drainage, treatment, profitable sewage middle class enlisted in support of it, and by sewers, sewage the were The was and which the towns and engineers recycling. system integral alienated from Chadwick and the Board of inseparable-and innovative, cumbersome, later sections of the and threatening. It imposed new Health. Throughout the expensive the forces which towards and standards and new technologies (high pressure book, operated the of the sanitary ethos as water systems, water carriage, sewage against enshrining on local authorities who had the dominant health strategy of the treatment plants) public set from the often been local Victorian period are carefully out, quietly improving for of 1842 environments in their own way many years. making of the Sanitary Report through to discover that- Health of the Towns Commission to the They were appalled now the 257 Essay Reviews according to Chadwick-they had been succeeded in establishing his sanitary model wasting money, endangering life and health not because his arguments were good, or his or his case for sanitation and betraying their ratepayers. In Chadwick's evidence persuasive, his overwhelmingly perceived as a real solution to insistence on imposing particular sanitary not the problem of disease and the financial costs model on England's towns lies the key only of disease upon the state. Chadwick succeeded to the friction between the local authorities and own because he because he the centre, but to Chadwick's downfall. fought dirty, urban resistance to intervention misrepresented evidence, selected suggestive Growing cases, suppressed views he did not share, from Chadwick's Board of Health was supported by the defection of the new juggled statistics and applied "science" or also from Chadwick's superstition as seemed most appropriate in engineering profession his The agenda. As Hamlin notes, the engineers arguing case. 1842 Sanitary Report a document intended to advance "shared Chadwick's goal of well drained towns was political and to ensure the Poor Law but had different ideas about design, expertise, Chadwick's career "there the and the social role of the engineer"(p. 305). In Commission's survival: was barest part these differences lay in approaches pretence of a general induction, much less of a towards the construction of sewers, should they testing of alternate hypotheses" (p. 163). At be large or small, sewers or pipes; in part they bottom, this book is about authority, and how it lay in competing ideas about professional is achieved; about how arguments are integrity. For Chadwick, integrity lay in constructed and adapted, how they can be adopting a principle and sticking to it through made to win a case independent of intrinsic hell and to like the merit, and how, in the end, their advocates can high water; engineers Thomas who had incomes to be undermined by the process of translating young Hawksley, make and careers to build, it lay in building theory into practice even while the policies trust among a clientele: the engineer had to introduced as a result of the arguments survive. himself to his clients' fears Chadwick's agenda for sanitary reform adapt requirements, and financial resources to build a defined the identity of "public health", and set working relationship in which they trusted him to look the pattern for the urban response to social after their interests: only so could client-base improvement for the rest of the century. A and a career be secured in the hundred and fifty years later the popular image long-term. is towards the of "public health" remains to a large extent that Hamlin quietly sympathetic and so of drains, sewers and water supplies; other engineers; obviously refreshingly towards the local administrative authorities kinds of health action-immunization public whose characters Chadwick so successfully programmes, sickness benefits, infant blackened to welfare-tend to be designated "preventive posterity. It is no part of Hamlin's intention in writing medicine" or "welfare". This fragmentation this to diminish Chadwick's historical dates back to the choices Chadwick to book made, or to his character and his denial of destitution as a cause of stature, vilify reputation. disease, Indeed, as previously observed, Chadwick's to his concern with the potential for revolution, character was clearly unsatisfactory enough for to his Poor-Law focus on the public aspects of the health Both Chadwick and his no one to suffer much disillusion at the problem. revelation of further It is clear that were quirks. Sanitary Report investigators principally Hamlin's intention here is to contextualize and interested in the health of working men. to explain Chadwick's extraordinary career; he Women, children, babies, the aged-the does not deny his subject's energy, his integrity politically disenfranchised, the economically of his his the even principle, organizational abilities, marginal, vulnerable, the future central in and the human importance creating forging capital-were discounted, although identity of modern public health. But he does too would benefit from they sanitary incontrovertibly show that Chadwick improvement, because they were the 258 Essay Reviews range of very different motivations, and was as responsibility of the men. The exclusion of the much a response to political change as it was particular problems of these social groups and social demonstrates the extent to which the driving to urban growth. Public health the motivations of Chadwick's reforms have been justice is a masterly analysis of of the classic history misinterpreted in the past: here was no construction and creation public health, as well as generous or considered response to the social of nineteenth-century nineteenth-century injustices of an urbanizing society, no adaption of the context of early to changing conditions, only the narrow vision government which made that construction of reformers responding to one particular set of possible. It deserves to be widely influential, In this sense, Hamlin's work but the continuing strength of the legends of preoccupations. the Chadwick but also Florence Nightingale, Joseph Lister and corrects not just legend, determinist view of Alexander Fleming still testify to the difficulty MacDonagh's essentially reform: with which such revolutionary reassessments early nineteenth-century government more an accidental than a from academe to the classroom and that process was progress involved a far thence into popular culture. unified elite response, greater http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Medical History Pubmed Central

Public health and social justice in the age of Chadwick: Britain, 1800–1854

Medical History , Volume 43 (2) – Apr 1, 1999

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Abstract

Essay Reviews such an unappetising farrago of sloppily pedestrian and plodding, myopic mani- composed, confused, and confusing writing festations of historians earnestly working their that-perhaps appropriately-they threaten to way through internal memoranda and hospital drive the reader to distraction. records that might better have been left to Even leaving to one side its often clumsy moulder in a decent obscurity; and then there and soporific prose and focusing solely on the are yet other portions of the volume which scholarly value of the text, one confronts a real stitch together poorly documented, slipshod, curate's egg of a book. Here is a volume which and even factually unreliable representations of purports to provide a definitive history of one the events they purport to discuss. Taken as a of the major psychiatric institutions of the whole, and in the context of the explosion of Western world, but achieves that lofty goal interest in the history of psychiatry over the only intermittently. Portions of the text, as I past quarter-century, The history of Bethlem have suggested, are first-rate, thoroughly must be regarded as a major disappointment. researched and genuinely original; others are Edwin Chadwick Revisited ANNE HARDY* Christopher Hamlin, Public health and read it. It says something of the power of this social in the justice age of Chadwick: Britain, image, and of the fresh fields available to, and 1800-1854, Cambridge of History Medicine diverse interests of, the young discipline of series, Cambridge University Press, 1998, medical history, that there has been no pp. vii, 368, £40.00, $64.95 (0-521-58363-2). established corner in Chadwick studies, that no revisionist hand should have laid hold on the Edwin Chadwick bestrides the history of myth in forty-odd years. Yet as presented by public health, the near-mythic founder of the Finer and Lewis, the Chadwickian public sanitized city who sits, together with John health story now has an old-fashioned air-it is Snow the founder of and Lord top-down characteristic of its epidemiology history, period, Lister the founder of modern surgery, in the of modernization as a unquestioning desirable English Trinity of Victorian uncritical of progressive good, contemporary rhetoric, medicine. Difficult, doctor-hating and incurious of the wider cultural context within bloody- minded, inspired by Benthamite ideals and which the creation of public took health place. impassioned by the of and To a later of still excited recycling sewage by generation scholars, egg-shaped sewers, Chadwick's by the concepts of construct and popular image contest, has been well established older it lacks and However by histories, contingency, edge depth. notably Sammy Finer's and R A social historians resist the wilder biography rightly many Lewis's of his study contribution to public shores of post-modern interpretation, these both in health, published 1952. The very title methods, judiciously used, have an undoubted of 1988 value in the historian to set self Anthony Brundage's study, Englands assisting aside, "Prussian so to endorse and in our of the minister", appeared enriching understanding past. the legend that it almost seemed to Modern revisionism often unnecessary appears negative, almost opportunistic, in the sense that it *Anne Hardy, Wellcome Institute for the History of diminishes the or eminence of an significance London. Medicine, 255 Essay Reviews historically prominent figure by reviewing ruling classes at this period. Whatever other evidence critically, or by reconstructing cultural motives Chadwick may have had in his career and intellectual contexts: F B Smith's essay on as a civil servant, he was certainly aware of the Florence Nightingale, and Gerald Geison's political contexts of his activities. study of Pasteur stand as examples here. As the A great deal of water has thus passed in of since Finer notorious creator of public health England, beneath the bridges scholarship Chadwick seems an obvious candidate for the and Lewis described Edwin Chadwick's same treatment. However, Chadwick's contributions to English society and established personality is well known to have been flawed, his legend, and as the 150th anniversary of the so disillusion on that score is likely to be less first Public Health Act occurred in 1998, a intense, and he was a genuinely important reassessment of Edwin Chadwick's figure: not an independent operator but a civil contribution to the creation of public health is servant, he was involved not only with timely. It is probably fortunate for Chadwick, sanitation but also with the New Poor Law, and and certainly fortunate for historians interested his career and activities form part of a pattern in health, government and urbanization in the of administrative growth at a period of nineteenth century, that this reassessment has No undertaken as a serious enormous social and political uncertainty. been scholarly role in the modern in its one could deny Chadwick's founding enterprise. Entirely approach, yet Whatever else written in language remarkably free of jargon, of modern public health. an active so articulate in its presentation of the new Chadwick was, he was undeniably in a historical as to be accessible to the participant significant process. conceptual history of an most unregenerate traditionalist, Christopher The concept early nineteenth-century "revolution in was introduced Hamlin's Public health and social in the government" by justice in and it has sets a standard for Oliver MacDonagh 1958, long age of Chadwick been that the health is histories of medicine and recognized public story modernising science, Both text and footnotes to an integral part of that wider administrative society. testify of response to a newly urbanizing society. extensive and reflective exploration relevant Chadwick's work as a civil servant is nineteenth-century literature. Hamlin can be illustrative of the processes of nineteenth- ponderous ("Let us set this drama in motion", century government. Moreover, the p. 84), and the texture of his writing, with administrative revolution of which public health considered accounts of, for example, differing was so much a part took place within a highly contemporary perspectives on the nature of fragile political context, which scholarship has diseases (pp. 58-61) or Southwood Smith's done much to illuminate since the publication views on contagion and predisposition of E P Thompson's classic The making of the (pp. 114-19) may at times try the stamina of English working class in 1963. Post-war historians from non-medical sub-disciplines, depression and the emergence of a cyclical but for those interested in the hows and whys, pattern of economic growth and slump; and possible alternatives, of history, these are with the stuff which of the growing political consciousness, through understanding insurrections and revolutions in France and is made. past elsewhere, culminating in the Year of As regards Chadwick, the central thesis of Revolutions in 1848; Reform Act agitation, Hamlin's book is straightforward: Chadwick's and Chartism Corn Law Repealers at home; all passion for sanitation was born of expediency, made the between and to divert medical and years 1815 1850 years of political attention from special political sensitivity which touched all the failure of the New Poor Law and from actions taken or contemplated by government poverty as a cause of disease, and it developed whether or Whig Tory. Political rights and by expediency, because Chadwick was social justice, and their achievement without struggling to safeguard his career. Beyond the were critical revolution, preoccupations for the biographical corrective, however, Hamlin is 256 Essay Reviews with deeper issues: with the Public Health Act and the demise of the concerned of how broadly "public health" was to General Board. Central to this account is the question way in which Chadwick's sanitary idea be defined (a question posed by William over time, not only in its content, Coleman for France in Death is a social changed which was gradually reduced to the integrated disease [1982]), and with that of the power model, but also in its intention: relations embodied in sanitary works, as raised sewage/water tactic for the benefit of the by Michel Foucault in another modern from a diversionary punish to a political weapon for the historiographical classic, Discipline and Poor Law Board, and the stabilizing of (c. 1977). Because of Chadwick's career needs, diffusing of revolution a model for urban improvement and the whole focus of public health reform in society, to to an engine of England was shifted from the social to the capitalist enterprise, and finally In Chadwick's hands, environmental, from people to structures, from administrative growth. idea of health was no static ideal for poverty to water and sewers, and the the public as human condition, but a tool of construction of "public health" pertaining improving the and of survival. When theory at essentially to the latter firmly established. opportunity and Because Chadwick was a systematic, last was put into practise proved career tumbled; but so principled reformer, he was determined on impractical, Chadwick's central control in enforcing his particular effective had been his labours that the idea health vision of sanitary progress, and thereby raised itself survived to dominate the public the demon of tension between central and local programme for the rest of the century. which relations in so Beyond the central story, Hamlin's government complicated of social policy for the remainder discussions of both the background and the many aspects of the at least. sequels of Chadwick's work are arresting. The century The book falls into three parts, and describes pre-history of medical debates over the causes The first two of disease, with William Alison's emphasis on also three processes. chapters relationship of the cardinal significance of poverty and explore the pre-Chadwickian to the social issues of the destitution, is a powerful representation of the medicine great to the Chadwickian alternative health" concept which period, alternatives "public and the failure of the medical Chadwick so defeated. When it comes solution, signally to take a role in to the practical impact of profession up leading considering health. The central section Chadwick's sanitary vision, Hamlin's interest questions of public on his in the of science and technology of the book focuses Chadwick, history of him to see the it presented successful challenging contemporary enables problems of disease in for the who were supposed to medical opinion on the causation agents and his accommodate and the grand the years between 1832 1845, implement idea of In its mature form, in the construction and definition of the sanitary strategy. trace the Chadwick's ideal involved a complete sanitation. The final chapters 1840s, health was of combined sanitation-constant water processes by which public system and the house sewerage by pipe translated into an urban question supplies, drainage, treatment, profitable sewage middle class enlisted in support of it, and by sewers, sewage the were The was and which the towns and engineers recycling. system integral alienated from Chadwick and the Board of inseparable-and innovative, cumbersome, later sections of the and threatening. It imposed new Health. Throughout the expensive the forces which towards and standards and new technologies (high pressure book, operated the of the sanitary ethos as water systems, water carriage, sewage against enshrining on local authorities who had the dominant health strategy of the treatment plants) public set from the often been local Victorian period are carefully out, quietly improving for of 1842 environments in their own way many years. making of the Sanitary Report through to discover that- Health of the Towns Commission to the They were appalled now the 257 Essay Reviews according to Chadwick-they had been succeeded in establishing his sanitary model wasting money, endangering life and health not because his arguments were good, or his or his case for sanitation and betraying their ratepayers. In Chadwick's evidence persuasive, his overwhelmingly perceived as a real solution to insistence on imposing particular sanitary not the problem of disease and the financial costs model on England's towns lies the key only of disease upon the state. Chadwick succeeded to the friction between the local authorities and own because he because he the centre, but to Chadwick's downfall. fought dirty, urban resistance to intervention misrepresented evidence, selected suggestive Growing cases, suppressed views he did not share, from Chadwick's Board of Health was supported by the defection of the new juggled statistics and applied "science" or also from Chadwick's superstition as seemed most appropriate in engineering profession his The agenda. As Hamlin notes, the engineers arguing case. 1842 Sanitary Report a document intended to advance "shared Chadwick's goal of well drained towns was political and to ensure the Poor Law but had different ideas about design, expertise, Chadwick's career "there the and the social role of the engineer"(p. 305). In Commission's survival: was barest part these differences lay in approaches pretence of a general induction, much less of a towards the construction of sewers, should they testing of alternate hypotheses" (p. 163). At be large or small, sewers or pipes; in part they bottom, this book is about authority, and how it lay in competing ideas about professional is achieved; about how arguments are integrity. For Chadwick, integrity lay in constructed and adapted, how they can be adopting a principle and sticking to it through made to win a case independent of intrinsic hell and to like the merit, and how, in the end, their advocates can high water; engineers Thomas who had incomes to be undermined by the process of translating young Hawksley, make and careers to build, it lay in building theory into practice even while the policies trust among a clientele: the engineer had to introduced as a result of the arguments survive. himself to his clients' fears Chadwick's agenda for sanitary reform adapt requirements, and financial resources to build a defined the identity of "public health", and set working relationship in which they trusted him to look the pattern for the urban response to social after their interests: only so could client-base improvement for the rest of the century. A and a career be secured in the hundred and fifty years later the popular image long-term. is towards the of "public health" remains to a large extent that Hamlin quietly sympathetic and so of drains, sewers and water supplies; other engineers; obviously refreshingly towards the local administrative authorities kinds of health action-immunization public whose characters Chadwick so successfully programmes, sickness benefits, infant blackened to welfare-tend to be designated "preventive posterity. It is no part of Hamlin's intention in writing medicine" or "welfare". This fragmentation this to diminish Chadwick's historical dates back to the choices Chadwick to book made, or to his character and his denial of destitution as a cause of stature, vilify reputation. disease, Indeed, as previously observed, Chadwick's to his concern with the potential for revolution, character was clearly unsatisfactory enough for to his Poor-Law focus on the public aspects of the health Both Chadwick and his no one to suffer much disillusion at the problem. revelation of further It is clear that were quirks. Sanitary Report investigators principally Hamlin's intention here is to contextualize and interested in the health of working men. to explain Chadwick's extraordinary career; he Women, children, babies, the aged-the does not deny his subject's energy, his integrity politically disenfranchised, the economically of his his the even principle, organizational abilities, marginal, vulnerable, the future central in and the human importance creating forging capital-were discounted, although identity of modern public health. But he does too would benefit from they sanitary incontrovertibly show that Chadwick improvement, because they were the 258 Essay Reviews range of very different motivations, and was as responsibility of the men. The exclusion of the much a response to political change as it was particular problems of these social groups and social demonstrates the extent to which the driving to urban growth. Public health the motivations of Chadwick's reforms have been justice is a masterly analysis of of the classic history misinterpreted in the past: here was no construction and creation public health, as well as generous or considered response to the social of nineteenth-century nineteenth-century injustices of an urbanizing society, no adaption of the context of early to changing conditions, only the narrow vision government which made that construction of reformers responding to one particular set of possible. It deserves to be widely influential, In this sense, Hamlin's work but the continuing strength of the legends of preoccupations. the Chadwick but also Florence Nightingale, Joseph Lister and corrects not just legend, determinist view of Alexander Fleming still testify to the difficulty MacDonagh's essentially reform: with which such revolutionary reassessments early nineteenth-century government more an accidental than a from academe to the classroom and that process was progress involved a far thence into popular culture. unified elite response, greater

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Medical HistoryPubmed Central

Published: Apr 1, 1999

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