A review of The Perfect Food and the Filth Disease: Milk, Typhoid Fever, and the Science of State Medicine in Victorian Britain, 1850-1900, by Jacob Steere-Williams.
This dissertation focuses on the risk of infectious disease spreading to Victorian milk drinkers, particularly typhoid fever. The author, Jacob Steere-Williams, sees this as a test of the idea that it was specific problems of disease and sanitation that textured the public health response of the second half of the nineteenth century. On the one hand this was a matter of environmental governance, but a great deal also depended on the institutional and individual performances of pathologists, chemists, epidemiologists and bacteriologists. We therefore have here a thesis that is far more than a story of milk. It is a valuable social history of the medical and sanitary context of this commodity.
The findings of the research are reported in five chapters. Chapter 1 proposes a link between the anti-adulteration thinking of the 1850s and notions that some diseases might be milk-borne. Scientific food analysis is introduced through the work of Arthur Hill (A.H.) Hassall for the Lancet’s Analytical Sanitary Commission and a distinction is made between the methods of microscopy and chemistry. There are also some preliminary remarks about the MacDonagh model of administrative organization in nineteenth-century Britain and how this provides a starting point for understanding the construction of social problems of the period.
The in-depth treatment of typhoid begins in Chapter 2. Here Steere-Williams helpfully reminds us that the etiology and epidemiology of fevers were contested in Britain over many decades, particularly in the period 1860 to 1900. Distinctions between typhoid and typhus had begun to emerge in pathological anatomy in the 1820s and 1830s but their diagnosis remained uncertain for a further 50 to 60 years. For instance, the Registrar General made no nosological distinction until 1869.
The author claims that “typhoid was the pre-eminent ‘filth disease’ of the Victorian period” (p. 13) and it “remained at the center of public health discourses throughout the nineteenth century” (p. 14). Outbreaks of the disease were most intense around 1860 to 1880 and epidemiological investigation played an important part in identifying patterns, including the unexpected finding that wealthy families were most susceptible. It makes sense therefore to look in detail at the activities of researchers such as William Jenner, Alexander Stewart, William Budd, and Charles Murchison. The point is to trace the rise of the epidemiology of water-borne disease and to see the science playing out through the varied institutional agency of the Epidemiological Society of London, the Association of Medical Officers of Health, and the Medical Department of the Privy Council (later Local Government Board).
Chapter 3 looks at the application to milk in the 1870s of theories of water-borne disease. This always seemed likely since cow’s milk is on average 88% water but it took a number of high-profile examples of epidemiological fieldwork to find proof. Two case studies chosen are both from London: Islington in 1871, where the Medical Officer of Health was Edward Ballard, and St Marylebone in 1873, where the investigator was John Netten Ratcliffe, an Inspector for the Medical Department of the Local Government Board.
Chapter 4 leaves typhoid and returns to milk adulteration. It explores the difficulty of deciding upon the authentic composition of milk, with the following uncertainty of defining milk that has been fraudulently tampered with. There is a discussion of the Sale of Food and Drugs Acts (1875) and the conflict about authority and expertise that erupted between the government chemists in London and the analysts employed by local authorities. This made the identification and prevention and food adulteration problematic. The discussion of dairy practices and legislation is continued into Chapter 5, where it is suggested that looking at a corporate context is valuable. The Aylesbury Dairy Company is an example of best practice with regard to the production and sale of high quality milk, supervised by a team of full-time health officers, veterinarians, public analysts, and sanitary engineers.
Overall, the thesis has two main strengths. First, it takes “a critical lens to nineteenth century professional demarcations in science [and] allows historians to shift their analysis to scientific practices” (p. 331). This enables a rebuttal of the usual assumption that “epidemiological methods, practices, and theories were quickly overtaken by bacteriology starting in the 1870s” (p. 329). The author is able to show that “epidemiology was at the center of public health practice in the second half of the nineteenth century, and that British public health authorities remained committed to scientific evidence about disease causation based on rural and urban field research” (p.329). Second, the focus on typhoid adds to existing knowledge and hints at ways that further work on local epidemiological investigation will provide us with a more nuanced and contingent understanding of public health expertise. Readers interested in the disease should also see Jacob Steere-Williams’ article in the Journal of the History of Medicine and Allied Sciences (Jacob Steere-Williams, “The Perfect Food and the Filth Disease: Milk-born Typhoid and Epidemiological Practice in Late Victorian Britain” in Journal of the History of Medicine and Allied Sciences 65, 2010, pp. 514-545).
Local Government Board, Privy Council, and Government Laboratory. The National Archives, Kew
Society of Medical Officers of Health. Wellcome Library and Archives, London
Papers of John Simon, Charles Murchison and A.P. Stewart. Royal College of Physicians, London
William Budd Papers. London School of Hygiene and Tropical Medicine, London
Edward Ballard Papers. Islington Record Office, London
Papers of Pathological Society of London and Epidemiological Society. Royal Society of Medicine, London
University of Minnesota. 2011. 366pp. Primary Advisor: John Eyler.
Image: J. Campbell Cory, The Cartoonist’s Art (1920)