What did nineteenth-century Madras and Quebec have in common? Both were within the empire, although that might be said of many towns and cities of the world. Both had to confront cholera and other epidemics whereby the limits of medical knowledge would be sorely tested and all the problems facing public health reform laid bare. Yet this was also true of Britain and across most of Europe too. The shared identity of the two settlements rests essentially with the manner in which Michael Zeheter contrasts their reactions to the onset of disease. His book occasionally loses the reader amid the wealth of detail provided; furthermore, throughout the work attention switches between the histories of the two cities, treating each as separate studies while attempting to draw out the differing contexts within which local officials had to work. Madras and Quebec varied enormously in terms of size, climate, population and culture. Madras was a sprawling and predominantly Indian city, which had gown rapidly since the late eighteenth century and which contained a population of approximately 400,000 by 1871. Quebec was a town of largely European settlement; in the early 1840s its French and English speaking citizens numbered only about 45,000. But if the logic for this comparative study is not immediately apparent, careful scholarship certainly justifies the work, and the author’s broad thesis, that public health continuously and permanently contributed to the formation of the state and the stabilization of colonial rule, is worthy of such meticulous investigation. Dense as the prose appears sometimes, this is research the way it used to be. Nineteenth-century cholera is a well-covered area of medical history. The origins of the disease, disputes about predisposition, the struggle to contain epidemics, and long-running disputes within the medical profession over the role of public sanitation all feature in a vast and growing literature. But, as Zeheter makes plain, whenever and wherever an epidemic struck the response was as likely to be influenced by political considerations as by the availability of scientific knowledge. At what point should public authorities declare an epidemic and be seen to be taking measures which might either cause undue alarm or, conversely, give rise to questions about why preventative steps had not been taken earlier? Could individual liberties be overridden for perceptions of communal advantage? And where was the money for large-scale building and infrastructure projects to come from? In Madras, such matters were complicated further by constraints on the control of a native population. Yet while mishandling cultural or religious sensitivities risked disorder and potentially a challenge to the regime, allowing disease to run out of control with the loss of many lives risked the charge of governmental incompetence. Public health began to emerge as a yardstick for colonial legitimacy and as a domain where political officials, medical officers and inexperienced civil engineers were frequently at odds. As in Britain from the 1830s onwards, public health was seldom free from either political values or political consequences. By the late nineteenth century Quebec had a significant degree of popular political representation that increased the pressure for municipal improvement. Madras lacked similar forms of governance; even so, the process of urban reform gathered pace after the 1857 Mutiny. In Madras, of course, outbreaks of cholera and plague would always be ascribed to local origin and their causes more likely judged to be beyond the control of medical officers. Quebec was different. Cholera came with the thousands of migrants entering Canada each year and news of an epidemic in Britain or the United States always gave cause for concern. Yet Quebec lived by shipping. Quarantine damaged its economy and was, in any case, difficult to enforce. In both cities, however, when action was needed, the measures taken were similar and mirrored those implemented in Britain. Boards of Health were established, while fumigation, nuisance removal, better water supply and drainage schemes were all eventually undertaken. It was commonly accepted that sanitation held the key, at least until the rise of bacteriology towards the end of the nineteenth century and links between disease and specific micro-organisms confirmed. Zeheter handles all these issues with an evident authority. In doing so, his work deserves to be regarded as a serious contribution to the wider fields of imperial medicine and imperial administration. © The Author 2017. Published by Oxford University Press on behalf of the Society for the Social History of Medicine.
Social History of Medicine – Oxford University Press
Published: Feb 1, 2018
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