Public health versus private practice: The contested development of compulsory infectious disease notification in late-nineteenth-century Britain

Bulletin of the History of Medicine

Volumn 73, Issue 2, 1999, Pages 238-267

  Mooney, Graham ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; CONFIDENTIALITY; HEALTH CARE AND PUBLIC HEALTH; HISTORY; HUMAN; INFECTION CONTROL; LEGAL ASPECT; PRIVATE PRACTICE; PUBLIC HEALTH; UNITED KINGDOM;

HEALTH CARE AND PUBLIC HEALTH;

CONFIDENTIALITY; DISEASE NOTIFICATION; ENGLAND; HISTORY, 19TH CENTURY; HUMANS; PRIVATE PRACTICE; PUBLIC HEALTH; WALES;

EID: 0033142832     PISSN: 00075140     EISSN: None     Source Type: Journal    
DOI: 10.1353/bhm.1999.0087     Document Type: Article

References (174)

1. The contemporaneous term "disease notification" will be adopted throughout this paper, as opposed to "disease registration" or the more recent term "surveillance." The usage of other modern terms such as "public health surveillance," "epidemiological surveillance," and "monitoring" is discussed in S. Declich and A. O. Carter, "Public Health Surveillance: Historical Origins, Methods and Evaluation," Bull. World Health Org., 1994, 72(2): 285-304.
2. John Eyler's recent study of Arthur Newsholme's medical officership in Brighton and his tenure on the Local Government Board deals with a number of aspects of notification: John M. Eyler, Sir Arthur Newsholme and State Medicine, 1885-1935 (Cambridge: Cambridge University Press, 1997). See also Anne Hardy, The Epidemic Streets: Infectious Disease and the Rise of Preventive Medicine, 1856-1900 (Oxford: Clarendon Press, 1993).
3. John Eyler's recent study of Arthur Newsholme's medical officership in Brighton and his tenure on the Local Government Board deals with a number of aspects of notification: John M. Eyler, Sir Arthur Newsholme and State Medicine, 1885-1935 (Cambridge: Cambridge University Press, 1997). See also Anne Hardy, The Epidemic Streets: Infectious Disease and the Rise of Preventive Medicine, 1856-1900 (Oxford: Clarendon Press, 1993).
4. This would also explain why the origins of disease notification have become intimately connected with William Farr, who in 1837 became the first Compiler of Abstracts in the newly established General Register office of England and Wales. See Alexander D. Langmuir, "William Farr: Founder of Modern Concepts of Surveillance," Internal. J. Epidemiol., 1976, 5: 13-18; John M. Eyler, Victorian Social Medicine: The Ideas and Methods of William Fair (Baltimore: Johns Hopkins University Press, 1979).
5. This would also explain why the origins of disease notification have become intimately connected with William Farr, who in 1837 became the first Compiler of Abstracts in the newly established General Register office of England and Wales. See Alexander D. Langmuir, "William Farr: Founder of Modern Concepts of Surveillance," Internal. J. Epidemiol., 1976, 5: 13-18; John M. Eyler, Victorian Social Medicine: The Ideas and Methods of William Fair (Baltimore: Johns Hopkins University Press, 1979).
6. See, for example, Christopher Hamlin, "Muddling in Bumbledom: On the Enormity of Large Sanitary Improvements in Four British Towns, 1855-85," Victorian Studies, 1988, 32: 55-83.
7. On the calls for sickness registration in the mid- and late nineteenth century, see A. H. T. Robb-Smith, "A History of the College's Nomenclature of Diseases: Its Reception," J. Roy. Coll. Physicians London, 1969-70, 4: 5-26, see especially pp. 7-8; Arthur Newsholme, "A National System of Notification of Sickness," Pub. Health, 1895-96, 8: 106-8.
8. On the calls for sickness registration in the mid- and late nineteenth century, see A. H. T. Robb-Smith, "A History of the College's Nomenclature of Diseases: Its Reception," J. Roy. Coll. Physicians London, 1969-70, 4: 5-26, see especially pp. 7-8; Arthur Newsholme, "A National System of Notification of Sickness," Pub. Health, 1895-96, 8: 106-8.
9. Dorothy Porter and Roy Porter, "The Enforcement of Health: The British Debate," in Aids: The Burdens of History, ed. Elizabeth Fee and Daniel M. Fox (Berkeley: University of California Press, 1988), pp. 97-120; quotation on p. 108. See also John M. Eyler, "Scarlet Fever and Confinement: The Edwardian Debate over Isolation Hospitals," Bull. Hist. Med., 1987, 61: 1-24.
10. Dorothy Porter and Roy Porter, "The Enforcement of Health: The British Debate," in Aids: The Burdens of History, ed. Elizabeth Fee and Daniel M. Fox (Berkeley: University of California Press, 1988), pp. 97-120; quotation on p. 108. See also John M. Eyler, "Scarlet Fever and Confinement: The Edwardian Debate over Isolation Hospitals," Bull. Hist. Med., 1987, 61: 1-24.
11. Porter and Porter, "The Enforcement of Health" (n. 6), p. 109.
12. See James C. Riley, Sick, Not Dead: The Health of British Workingmen during the Mortality Decline (London: Johns Hopkins University Press, 1997), pp. 99-104.
13. Statutes of the Realm (henceforth Statutes), 14 and 15 Vict. c. 28, 1851.
14. Ibid., 16 and 17 Vict. c. 41, 1853.
15. Ibid., 29 and 30 Vict. c. 40, 1866.
16. "Contagious Patients," Sanitary Rec., 1874, 1: 201. The defendant, Emily Burge, was nurse to a household for whom Mary Ann Robinson, the infected person, was a general servant. The journey was being made in order to admit the patient to the London Fever Hospital on Liverpool Road in Islington.
17. "Infected Clothing," Sanitary Rec., 1877, 7: 351-52.
18. Miles Ogborn, "Law and Discipline in Nineteenth-Century English State Formation: The Contagious Diseases Acts of 1864, 1866 and 1869," J. Hist. Sociol., 1993, 6: 28-55. See also Francis B. Smith, "The Contagious Diseases Acts Reconsidered," Soc. Hist. Med., 1990, 3: 197-215.
19. Miles Ogborn, "Law and Discipline in Nineteenth-Century English State Formation: The Contagious Diseases Acts of 1864, 1866 and 1869," J. Hist. Sociol., 1993, 6: 28-55. See also Francis B. Smith, "The Contagious Diseases Acts Reconsidered," Soc. Hist. Med., 1990, 3: 197-215.
20. Ogborn, "Law and Discipline" (n. 14), p. 43.
21. For the surveillance of whole populations and the medical problematization of normality in the twentieth century, see David Armstrong, "The Rise of Surveillance Medicine," Sociol. Health Illness, 1995, 17: 393-404.
22. Individual citizens, local officials, and central governmental bodies (e.g., the General Board of Health) were sources of pressure for the implementation of local sanitary measures. Although central government would frequently alert local authorities directly to some public health threats, their role was more influential through the press and official reports. See Gerry Kearns, "Cholera, Nuisances and Environmental Management in Islington, 1830-55," in Living and Dying in London, ed. William Bynum and Roy Porter, Medical History, suppl. 11 (London: Wellcome Institute for the History of Medicine, 1991), pp. 94-125, see especially pp. 104-9. Notwithstanding the intrusion of these groups, the possibility for the concealment of disease remained high.
23. Statutes (n. 9), 29 Vict. c. 40, 1866.
24. See, for example, Thomas O. Dudfield, 25th Annual Report on the Sanitary Condition of the Parish of St. Mary Abbots, Kensington, 1880 (held at the Kensington Public Library), p. 47.
25. Eyler, "Scarlet Fever" (n. 6), pp. 1-2. See also John V. Pickstone, Medicine and Industrial Society: A History of Hospital Development in Manchester and Its Region, 1752-1946 (Manchester: Manchester University Press, 1985), pp. 170-71.
26. Eyler, "Scarlet Fever" (n. 6), pp. 1-2. See also John V. Pickstone, Medicine and Industrial Society: A History of Hospital Development in Manchester and Its Region, 1752-1946 (Manchester: Manchester University Press, 1985), pp. 170-71.
27. Pickstone, Medicine (n. 20), p. 26; Edward Ballard, "The Work of the Metropolitan Medical Officers of Health - Their Successes and Their Difficulties," Trans. Assoc. Promot. Soc. Sci., 1862, pp. 657-66.
28. Pickstone, Medicine (n. 20), p. 26; Edward Ballard, "The Work of the Metropolitan Medical Officers of Health - Their Successes and Their Difficulties," Trans. Assoc. Promot. Soc. Sci., 1862, pp. 657-66.
29. Graham Mooney, "The Prevention and Control of Infectious Childhood Diseases in Late Nineteenth- and Early Twentieth-Century London: The Case of Diphtheria and Measles," in Questioni di popolazione in Europa: Una prospettiva geografica, ed. Maria Luisa Gentileschi and Russell King (Bologna: Pàtron Editore, 1996), pp. 255-71, see especially pp. 257-59. Eyler's biography of Newsholme demonstrates how a Medical Officer might use the information garnered by notification not only to roll back the boundaries of epidemiology but also to nurture an ambitious career: Eyler, Sir Arthur Newsholme (n. 2), esp. chaps. 2 and 4.
30. Graham Mooney, "The Prevention and Control of Infectious Childhood Diseases in Late Nineteenth- and Early Twentieth-Century London: The Case of Diphtheria and Measles," in Questioni di popolazione in Europa: Una prospettiva geografica, ed. Maria Luisa Gentileschi and Russell King (Bologna: Pàtron Editore, 1996), pp. 255-71, see especially pp. 257-59. Eyler's biography of Newsholme demonstrates how a Medical Officer might use the information garnered by notification not only to roll back the boundaries of epidemiology but also to nurture an ambitious career: Eyler, Sir Arthur Newsholme (n. 2), esp. chaps. 2 and 4.
31. House of Commons, "Return of Infectious Diseases Notification," Parliamentary Papers [henceforth PP], 1882, Local Government Board, 27 April 1882, vol. 57, pp. 587-648, quotation on pp. 628-29.
32. The Huddersfield Water Works and Improvement Act of 1876 had a clause enforcing notification, but only in cases where there was "inadequate" domestic accommodation for isolation of the case: "Compulsory Information of Infectious Diseases," Sanitary Rec., 1878, 8: 25.
33. "The Compulsory Notification of Infectious Disease," Sanitary Rec., 1877, 7: 287-88.
34. For a full list of these towns, see "The Notification of Infectious Diseases," Sanitary Rec., 1884, n.s., 6: 17-18.
35. Commons, "Report from the Select Committee on Police and Sanitary Regulations," PP, 1882, Select Committee on Police and Sanitary Regulations, 9 June 1882, vol. 12, pp. 345-382, quotation on p. 346.
36. Ibid., appendix 1.
37. Commons, "A Bill for the Better Notification of Infectious Diseases," PP, 1881, Infectious Diseases Notification, 27 July 1881, vol. 2, pp. 367-69; "Bill to Provide for the Better Notification of Infectious Diseases," PP, 1882, Infectious Diseases Notification, 10 February 1882, vol. 2, pp. 509-11; "Bill to Provide for the Better Notification of Infectious Diseases," PP, 1883, Infectious Diseases Notification, 21 February 1883, vol. 6, pp. 287-90.
38. Commons, "A Bill for the Better Notification of Infectious Diseases," PP, 1881, Infectious Diseases Notification, 27 July 1881, vol. 2, pp. 367-69; "Bill to Provide for the Better Notification of Infectious Diseases," PP, 1882, Infectious Diseases Notification, 10 February 1882, vol. 2, pp. 509-11; "Bill to Provide for the Better Notification of Infectious Diseases," PP, 1883, Infectious Diseases Notification, 21 February 1883, vol. 6, pp. 287-90.
39. Commons, "A Bill for the Better Notification of Infectious Diseases," PP, 1881, Infectious Diseases Notification, 27 July 1881, vol. 2, pp. 367-69; "Bill to Provide for the Better Notification of Infectious Diseases," PP, 1882, Infectious Diseases Notification, 10 February 1882, vol. 2, pp. 509-11; "Bill to Provide for the Better Notification of Infectious Diseases," PP, 1883, Infectious Diseases Notification, 21 February 1883, vol. 6, pp. 287-90.
40. "Mr. Dodson on Sanitary Legislation," Brit. Med. J., 7 May 1881, pp. 727-28; quotation on p. 727. See also Dudfield, 25th Annual Report, 1880 (n. 19), p. 57. Even when the value of notification was recognized, the objection of the public to the location of infectious disease hospitals had to be taken into the political consideration: Thomas O. Dudfield, 27th Annual Report on the Sanitary Condition of the Parish of St. Mary Abbots, Kensington, 1882 (held at the Kensington Public Library), p. 68. On the connection between disease notification and hospital provision, see Eyler, "Scarlet Fever" (n. 6).
41. "Mr. Dodson on Sanitary Legislation," Brit. Med. J., 7 May 1881, pp. 727-28; quotation on p. 727. See also Dudfield, 25th Annual Report, 1880 (n. 19), p. 57. Even when the value of notification was recognized, the objection of the public to the location of infectious disease hospitals had to be taken into the political consideration: Thomas O. Dudfield, 27th Annual Report on the Sanitary Condition of the Parish of St. Mary Abbots, Kensington, 1882 (held at the Kensington Public Library), p. 68. On the connection between disease notification and hospital provision, see Eyler, "Scarlet Fever" (n. 6).
42. "Mr. Dodson on Sanitary Legislation," Brit. Med. J., 7 May 1881, pp. 727-28; quotation on p. 727. See also Dudfield, 25th Annual Report, 1880 (n. 19), p. 57. Even when the value of notification was recognized, the objection of the public to the location of infectious disease hospitals had to be taken into the political consideration: Thomas O. Dudfield, 27th Annual Report on the Sanitary Condition of the Parish of St. Mary Abbots, Kensington, 1882 (held at the Kensington Public Library), p. 68. On the connection between disease notification and hospital provision, see Eyler, "Scarlet Fever" (n. 6).
43. "Mr. Dodson on Sanitary Legislation," Brit. Med. J., 7 May 1881, pp. 727-28; quotation on p. 727. See also Dudfield, 25th Annual Report, 1880 (n. 19), p. 57. Even when the value of notification was recognized, the objection of the public to the location of infectious disease hospitals had to be taken into the political consideration: Thomas O. Dudfield, 27th Annual Report on the Sanitary Condition of the Parish of St. Mary Abbots, Kensington, 1882 (held at the Kensington Public Library), p. 68. On the connection between disease notification and hospital provision, see Eyler, "Scarlet Fever" (n. 6).
44. Times (London), 31 January 1888, p. 7.
45. Commons, "Special Report from the Select Committee on Police and Sanitary Regulations," PP, 1888, Select Committee on Police and Sanitary Regulations, 26 July 1888, vol. 15, pp. 1-22, p. 3.
46. Statutes (n. 9), 52 and 53 Vict. c. 72, 1889. One Sanitary Record editorial suggested that the permissiveness rendered the legislation a "rather tardy step in the direction of sanitary perfection" ("The Compulsory Notification of Infectious Diseases Bill," Sanitary Rec., 1889, n.s., 11: 58). The Act's compulsory clauses regarding London were later consolidated under 54 & 55 Vict. c. 76.
47. Statutes (n. 9), 52 and 53 Vict. c. 72, 1889. One Sanitary Record editorial suggested that the permissiveness rendered the legislation a "rather tardy step in the direction of sanitary perfection" ("The Compulsory Notification of Infectious Diseases Bill," Sanitary Rec., 1889, n.s., 11: 58). The Act's compulsory clauses regarding London were later consolidated under 54 & 55 Vict. c. 76.
48. Hansard Parliamentary Debates, Commons, 3d ser., vol. 338 (1889), Mr. Ritchie (president of LGB), cols. 1819-20; and Mr. Long, cols. 1830-31. Countering allegations made by J. Rowlands (Finsbury East, London) that by singling out London in this way the LGB did not regard Londoners "as having sufficient intelligence to put in force the powers" of the Bill (col. 1825), Long noted that half of the London vestries had petitioned the House in favor of the Bill becoming law (cols. 1830-31).
49. Statutes (n. 9), 62 and 63 Vict. c. 8, 1899.
50. Commons, "Special Report from the Select Committee on Police and Sanitary Regulations Bills," PP, 1890, Select Committee on Police and Sanitary Regulations, 23 July 1890, vol. 17, pp. 7-54.
51. Mooney, "Prevention and Control" (n. 22), fig. 3.
52. British Medical Association, Parliamentary Bills Committee Minute Book, 1888-95, 1 August 1889, p. 27 (henceforth BMA, PBCMB).
53. John Livy, "The Notification of Infectious Diseases," letter to Brit. Med. J., 12 August 1882, pp. 291-92; quotation on p. 292. However, one representative of the London-based Vigilance Association for the Defence of Personal Rights "strongly protested against any [such] interference with the private arrangements of the people of this country" (Miss Downing, in the discussion of papers relating to the topic, "A System of Compulsory Notification of Infectious Diseases . . . ?" Trans. Assoc. Promot. Soc. Sci., 1881, pp. 556-70; quotation on p. 565).
54. John Livy, "The Notification of Infectious Diseases," letter to Brit. Med. J., 12 August 1882, pp. 291-92; quotation on p. 292. However, one representative of the London-based Vigilance Association for the Defence of Personal Rights "strongly protested against any [such] interference with the private arrangements of the people of this country" (Miss Downing, in the discussion of papers relating to the topic, "A System of Compulsory Notification of Infectious Diseases . . . ?" Trans. Assoc. Promot. Soc. Sci., 1881, pp. 556-70; quotation on p. 565).
55. Pivotal to this episode is the organization of the local medical profession under the auspices of the Liverpool Medical Institution, which had been in existence since the late 1830s. See John A. Shepherd, A History of the Liverpool Medical Institution (Liverpool: Liverpool Medical Institution, 1979), pp. 102-6. The clauses proposed a payment of 2/6 to the practitioner for each certificate issued.
56. Liverpool Medical Institution (LMI), Minutes of the Ordinary Meetings of the Liverpool Medical Institution, 43d sess., 20 October 1881 (held at the LMI). Reginald Harrison was president of the LMI at the time.
57. Ibid., Letter from Town Clerk to Reginald Harrison, 21 October 1881. With more than 180 members in the early 1880s, the LMI might be said to represent the spectrum of medical opinion of the 400 or so physicians living within ten miles of Liverpool city center (figures taken from Shepherd, History [n. 40], p. 142).
58. Ibid., Letter from Town Clerk to Reginald Harrison, 21 October 1881. With more than 180 members in the early 1880s, the LMI might be said to represent the spectrum of medical opinion of the 400 or so physicians living within ten miles of Liverpool city center (figures taken from Shepherd, History [n. 40], p. 142).
59. LMI, Minutes (n. 41), Circular from Edgar A. Browne, 21 October 1881.
60. Ibid., 3 November 1881. There were eighty members and associates present on that evening. Shepherd quotes sixty as a typical attendance figure for an ordinary meeting: Shepherd, History (n. 40), p. 149.
61. Ibid., 3 November 1881. There were eighty members and associates present on that evening. Shepherd quotes sixty as a typical attendance figure for an ordinary meeting: Shepherd, History (n. 40), p. 149.
62. City of Liverpool Health Committee Minute Book, October 1881-March 1882 (henceforth Health Committee Minutes), 10 November 1881, p. 96, Liverpool Central Library (LCL) 352 MIN/HEA II 1/34. A letter was read from Dr. Arthur Ransome, chair of the BMA's Registration of Disease Committee, which approved notification as long as compulsion fell upon the householder and not the medical attendant.
63. Ibid., 17 November 1881, p. 143.
64. Liverpool Mercury, 25 November 1881, p. 8.
65. LMI, Minutes (n. 41), 43d sess., Letter from Dr. E. Sheldon to the president of the LMI, 1 December 1881.
66. Health Committee Minutes, October 1881-March 1882 (n. 45), 1 December 1881, pp. 234-39; Liverpool Mercury, 2 December 1881, p. 7.
67. Health Committee Minutes, October 1881-March 1882 (n. 45), 1 December 1881, pp. 234-39; Liverpool Mercury, 2 December 1881, p. 7.
68. Liverpool Mercury, 25 August 1882, p. 8.
69. Special Correspondent, "Liverpool: The Notification of Infectious Diseases," Brit. Med. J., 23 September 1882, p. 598-99. A lawyer by profession, in the 1860s Forwood had founded the Atlas Steamship Company that traded between New York and the West Indies. This connection might account for his journey to America. The local conservative leader, he had served as mayor of the Council in 1877-78 and later became Member of Parliament for the Ormskirk Division of Lancashire. The reasons for his strenuous support of disease notification are not clear. Forwood's biographical details are taken from Frederic Boase, Modern English Biography, vol. 5 (Truro: Newton and Worth, 1912), p. 331.
70. Special Correspondent, "Liverpool: The Notification of Infectious Diseases," Brit. Med. J., 23 September 1882, p. 598-99. A lawyer by profession, in the 1860s Forwood had founded the Atlas Steamship Company that traded between New York and the West Indies. This connection might account for his journey to America. The local conservative leader, he had served as mayor of the Council in 1877-78 and later became Member of Parliament for the Ormskirk Division of Lancashire. The reasons for his strenuous support of disease notification are not clear. Forwood's biographical details are taken from Frederic Boase, Modern English Biography, vol. 5 (Truro: Newton and Worth, 1912), p. 331.
71. Health Committee Minutes, August 1882-February 1883, 31 August 1882, p. 43, LCL 352 MIN/HEA II 1/36.
72. Liverpool Mercury, 1 September 1882, p. 6. Forwood apologized for the hurried nature of his action, but argued that unless the Council were empowered by the Committee at its September meeting, then nothing could be done for a further twelve months. The Liverpool Mercury argued that McDiarmid and Smith's amendment was of "no practical value," suggesting that, "between the disinclination of the medical profession and the confessed uselessness of trying to obtain notification from householders, the Health Committee finds itself powerless for the time being" (ibid., p. 5).
73. Liverpool Mercury, 1 September 1882, p. 6. Forwood apologized for the hurried nature of his action, but argued that unless the Council were empowered by the Committee at its September meeting, then nothing could be done for a further twelve months. The Liverpool Mercury argued that McDiarmid and Smith's amendment was of "no practical value," suggesting that, "between the disinclination of the medical profession and the confessed uselessness of trying to obtain notification from householders, the Health Committee finds itself powerless for the time being" (ibid., p. 5).
74. Health Committee Minutes, August 1882-February 1883 (n. 52), 31 August 1882, p. 43.
75. Health Committee Minutes, August 1882-February 1883 (n. 52), 7 September 1882, p. 83. The LMI minute book does not have any reference to the meeting held on 4 September, but fortunately the memorandum is pasted into the Health Committee minutes. The suggestions included enforcing notification upon the medical officers of dispensaries, making notification optional for private practitioners, and various other measures compelling lodging-house keepers, educational authorities, and businesses to notify in order to restrict the spread of disease in sublet houses, schools, dairies and cowsheds. See also the letter from William Carter in the Liverpool Mercury, 12 September 1882, p. 8.
76. Health Committee Minutes, August 1882-February 1883 (n. 52), 7 September 1882, p. 83. The LMI minute book does not have any reference to the meeting held on 4 September, but fortunately the memorandum is pasted into the Health Committee minutes. The suggestions included enforcing notification upon the medical officers of dispensaries, making notification optional for private practitioners, and various other measures compelling lodging-house keepers, educational authorities, and businesses to notify in order to restrict the spread of disease in sublet houses, schools, dairies and cowsheds. See also the letter from William Carter in the Liverpool Mercury, 12 September 1882, p. 8.
77. Reports of the actual number of signatures vary slightly, from 258 in the British Medical Journal (Special Correspondent, "Liverpool" [n. 51], p. 598.) to Stephens's figure of 263 (Liverpool Mercury, 1 September 1882, p. 6). The proportion of Liverpool's medical community that this represented was also disputed, Forwood stating that the latter totaled 401; drawing his figures from the medical register, Hamilton reduced this estimate to 350, 60 of whom were either retired, dentists, or ships' surgeons: see Liverpool Mercury, 7 September 1882, p. 3.
78. Reports of the actual number of signatures vary slightly, from 258 in the British Medical Journal (Special Correspondent, "Liverpool" [n. 51], p. 598.) to Stephens's figure of 263 (Liverpool Mercury, 1 September 1882, p. 6). The proportion of Liverpool's medical community that this represented was also disputed, Forwood stating that the latter totaled 401; drawing his figures from the medical register, Hamilton reduced this estimate to 350, 60 of whom were either retired, dentists, or ships' surgeons: see Liverpool Mercury, 7 September 1882, p. 3.
79. Reports of the actual number of signatures vary slightly, from 258 in the British Medical Journal (Special Correspondent, "Liverpool" [n. 51], p. 598.) to Stephens's figure of 263 (Liverpool Mercury, 1 September 1882, p. 6). The proportion of Liverpool's medical community that this represented was also disputed, Forwood stating that the latter totaled 401; drawing his figures from the medical register, Hamilton reduced this estimate to 350, 60 of whom were either retired, dentists, or ships' surgeons: see Liverpool Mercury, 7 September 1882, p. 3.
80. This correspondence with twenty-four towns in England, Wales, and Scotland, twenty-three of which had notification in operation, was reprinted in City of Liverpool Health Committee, Notification of Infectious Diseases: Circular Addressed by the Chairman of the Health Committee to the Mayors of the Boroughs, and the Chairmen of the Local Board Districts in Which Notification of Infectious Disease Is Compulsory, and the Replies Thereto (Liverpool: Greenwood, 1882).
81. Forwood, Hamilton, and Hughes visited Blackburn, Bolton, Edinburgh, and Greenock, while Stephens, Bligh, Grindley, and the MOH Stopford Taylor went to Huddersfield, Leicester, Nottingham, and Warrington.
82. City of Liverpool Medical Officer of Health, Notification of Infectious Diseases: Report of the Medical Officer of Health upon the Suggestions Adopted at a Meeting of the Medical Profession, Held on the 4th September, 1882 (Liverpool: Greenwood, 1882); City of Liverpool Health Committee, Notification of Infectious Diseases: Evidence Taken by the Deputations Appointed by the Health Committee (Liverpool: Greenwood, 1882). Hamilton, not surprisingly, was keen to emphasize the objections of local general practitioners, and in his own submission to the Health Committee he recounted personal interviews conducted with physicians in Greenock who had not been invited to meet the deputations: see Health Committee Minutes, August 1882-February 1883 (n. 52), 28 September 1882, p. 202.
83. City of Liverpool Medical Officer of Health, Notification of Infectious Diseases: Report of the Medical Officer of Health upon the Suggestions Adopted at a Meeting of the Medical Profession, Held on the 4th September, 1882 (Liverpool: Greenwood, 1882); City of Liverpool Health Committee, Notification of Infectious Diseases: Evidence Taken by the Deputations Appointed by the Health Committee (Liverpool: Greenwood, 1882). Hamilton, not surprisingly, was keen to emphasize the objections of local general practitioners, and in his own submission to the Health Committee he recounted personal interviews conducted with physicians in Greenock who had not been invited to meet the deputations: see Health Committee Minutes, August 1882-February 1883 (n. 52), 28 September 1882, p. 202.
84. City of Liverpool Medical Officer of Health, Notification of Infectious Diseases: Report of the Medical Officer of Health upon the Suggestions Adopted at a Meeting of the Medical Profession, Held on the 4th September, 1882 (Liverpool: Greenwood, 1882); City of Liverpool Health Committee, Notification of Infectious Diseases: Evidence Taken by the Deputations Appointed by the Health Committee (Liverpool: Greenwood, 1882). Hamilton, not surprisingly, was keen to emphasize the objections of local general practitioners, and in his own submission to the Health Committee he recounted personal interviews conducted with physicians in Greenock who had not been invited to meet the deputations: see Health Committee Minutes, August 1882-February 1883 (n. 52), 28 September 1882, p. 202.
85. Health Committee Minutes, August 1882-February 1883 (n. 52), 11 October 1882, p. 263.
86. The LMI endorsed with only minor amendments the notification certificate submitted to them by MOH Stopford Taylor: LMI, Minutes (n. 41), 51st sess., 7 November 1889.
87. The power of an organized local profession was well recognized elsewhere. In Edinburgh, where there were a number of medical societies and two medical colleges, the MOH confirmed that it was "a most sensitive community here, and if any medical grievance was brought before the local authority they would see to it at once"; he was at pains to stress that his employers instructed him to "have no unnecessary collision with the medical profession" (City of Liverpool, Evidence [n. 59], Edinburgh Deputation, Dr. Littlejohn, Q[uestions] 246 and 289).
88. Liverpool Mercury, 18 October 1882, p. 5.
89. "Report of the Committee on the Registration of Disease," Brit. Med. J., 16 August 1879, pp. 256-57. These reports were doubtless penned by Arthur Ransome, chair of that Committee.
90. At the time of the Liverpool dispute in 1881, William Carter alleged that at one recent annual meeting of the BMA where the model clauses were drawn up, there were only ten members present, and none at all from the north of England: Liverpool Mercury, 25 November 1881, p. 8.
91. "Report of Committee on Registration of Disease," Brit. Med. J., 18 August 1877, pp. 222-23. Registration of disease had also been advocated by the Manchester and Salford Sanitary Association in 1872, and by the Joint Committee of the British Medical and Social Science Associations after governmental arrangements to register disease in Poor Law practice had been deemed "imperfect and unsatisfactory" ("Report of the Committee on Registration of Diseases," Brit. Med. J., 12 August 1876, pp. 211-12).
92. "Report of Committee on Registration of Disease," Brit. Med. J., 18 August 1877, pp. 222-23. Registration of disease had also been advocated by the Manchester and Salford Sanitary Association in 1872, and by the Joint Committee of the British Medical and Social Science Associations after governmental arrangements to register disease in Poor Law practice had been deemed "imperfect and unsatisfactory" ("Report of the Committee on Registration of Diseases," Brit. Med. J., 12 August 1876, pp. 211-12).
93. "Registration of Infectious Diseases," Brit. Med. J., 28 February 1880, p. 340; Dudfield, 25th Annual Report, 1880 (n. 19), p. 57.
94. "Registration of Infectious Diseases," Brit. Med. J., 28 February 1880, p. 340; Dudfield, 25th Annual Report, 1880 (n. 19), p. 57.
95. BMA, PBCMB, 1875-87, 30 April 1885, p. 169.
96. The mayor of Bolton, Thomas Glashier, openly acknowledged that while the inclusion of notification in its 1877 Act was not deliberately kept secret, "it did not come prominently before them [the local medical profession], and therefore we got the clause without any opposition" (City of Liverpool, Evidence [n. 59], Bolton Deputation, T. Glashier, Q 4). Even though the town had applied for notification powers, the Huddersfield town clerk made it clear to the deputation that the model clauses for dual notification were inserted into their 1880 Act by the Parliamentary Select Committee without the local authority having sought compulsion for the medical profession: ibid., Huddersfield Deputation, Q 245-49.
97. The mayor of Bolton, Thomas Glashier, openly acknowledged that while the inclusion of notification in its 1877 Act was not deliberately kept secret, "it did not come prominently before them [the local medical profession], and therefore we got the clause without any opposition" (City of Liverpool, Evidence [n. 59], Bolton Deputation, T. Glashier, Q 4). Even though the town had applied for notification powers, the Huddersfield town clerk made it clear to the deputation that the model clauses for dual notification were inserted into their 1880 Act by the Parliamentary Select Committee without the local authority having sought compulsion for the medical profession: ibid., Huddersfield Deputation, Q 245-49.
98. Dr. Leslie Jones, at a special meeting of the Lancashire and Cheshire Branch of the BMA, quoted in "Notification of Infectious Diseases," Brit. Med. J., 4 March 1882, pp. 318-22; quotation on p. 319. Henry Hall, mayor of Blackpool and chair of its Health Committee, frankly conceded that "the protests of these [medical] gentlemen, their unaccountable susceptibilities, and their letters to the papers, were all quietly ignored by the Committee" (City of Liverpool, Circular [n. 57], p. 15).
99. Dr. Leslie Jones, at a special meeting of the Lancashire and Cheshire Branch of the BMA, quoted in "Notification of Infectious Diseases," Brit. Med. J., 4 March 1882, pp. 318-22; quotation on p. 319. Henry Hall, mayor of Blackpool and chair of its Health Committee, frankly conceded that "the protests of these [medical] gentlemen, their unaccountable susceptibilities, and their letters to the papers, were all quietly ignored by the Committee" (City of Liverpool, Circular [n. 57], p. 15).
100. "Return of Infectious Diseases Notification" (n. 23). Most local authorities had publicized the proposed amendments - if not in the local press, then at least by a Parliamentary notice of the bill. They alleged that these met with little or no outcry from the local medical profession, although such biased evidence should be treated with caution. The replies were solicited from each local authority by John Lambert, secretary to the LGB, at almost the same time that Forwood was seeking information for the City of Liverpool Health Committee.
101. "Notification of Infectious Diseases," Sanitary Rec., 1882, n.s., 3: 376.
102. City of Liverpool, Evidence (n. 59), Huddersfield Deputation, Joseph Batley (town clerk), Q 228, and Dr. Rhodes, Q 335-39. Although the proposed legislation was publicized in the local newspapers, Rhodes told the Liverpool deputation that the Town Council had refused to meet with the profession.
103. The first of these was Ernest Hart, "Special Report by the Chairman of the Parliamentary Bills Committee on the Progress of Legislation with Regard to the Notification to Sanitary Authorities of the Occurrence of Cases of Infectious Diseases," in BMA, PBCMB, 1875-87, 7 November 1879, pp. 93-115.
104. In 1887 the Committee requested £25 to pay for the services of a clerk to examine the contents of local sanitary bills: ibid., 25 February 1887, p. 210.
105. Hart chaired the Parliamentary Bills Committee for twenty-five years until 1897; coupled with his long-term editorship of the British Medical Journal, he was able to coordinate and influence medical opinion on a range of issues most effectively. See Peter Bartrip, Themselves Writ Large: The British Medical Association 1832-1966 (London: BMJ Publishing Group, 1996), p. 125.
106. Hart chaired the Parliamentary Bills Committee for twenty-five years until 1897; coupled with his long-term editorship of the British Medical Journal, he was able to coordinate and influence medical opinion on a range of issues most effectively. See Peter Bartrip, Themselves Writ Large: The British Medical Association 1832-1966 (London: BMJ Publishing Group, 1996), p. 125.
107. The six towns were Ramsgate, Eastbourne, Wigan, Sonthport, Mossley, and Hastings. Of the other two towns, no changes to the clauses were anticipated in Wakefield, and the Parliamentary Bills Committee ratified a motion regretting that "the profession in Sunderland have not more energetically opposed" dual notification (BMA, PBCMB, 1875-87, 18 February 1885, p. 142). As well as persuading the Brighton Health Committee to receive a deputation, Hart even put the medical profession there in contact with William Carter of Liverpool during their successful attempt to block the Brighton compulsory notification clauses: ibid., 30 April 1885, p. 169. Notable failures did occur, notwithstanding strong support. The profession in Leicester were unable to halt that city's legislation passing through the House of Lords, despite advertising in the pages of the Lancet for financial assistance: ibid., pp. 84-86.
108. The six towns were Ramsgate, Eastbourne, Wigan, Sonthport, Mossley, and Hastings. Of the other two towns, no changes to the clauses were anticipated in Wakefield, and the Parliamentary Bills Committee ratified a motion regretting that "the profession in Sunderland have not more energetically opposed" dual notification (BMA, PBCMB, 1875-87, 18 February 1885, p. 142). As well as persuading the Brighton Health Committee to receive a deputation, Hart even put the medical profession there in contact with William Carter of Liverpool during their successful attempt to block the Brighton compulsory notification clauses: ibid., 30 April 1885, p. 169. Notable failures did occur, notwithstanding strong support. The profession in Leicester were unable to halt that city's legislation passing through the House of Lords, despite advertising in the pages of the Lancet for financial assistance: ibid., pp. 84-86.
109. The six towns were Ramsgate, Eastbourne, Wigan, Sonthport, Mossley, and Hastings. Of the other two towns, no changes to the clauses were anticipated in Wakefield, and the Parliamentary Bills Committee ratified a motion regretting that "the profession in Sunderland have not more energetically opposed" dual notification (BMA, PBCMB, 1875-87, 18 February 1885, p. 142). As well as persuading the Brighton Health Committee to receive a deputation, Hart even put the medical profession there in contact with William Carter of Liverpool during their successful attempt to block the Brighton compulsory notification clauses: ibid., 30 April 1885, p. 169. Notable failures did occur, notwithstanding strong support. The profession in Leicester were unable to halt that city's legislation passing through the House of Lords, despite advertising in the pages of the Lancet for financial assistance: ibid., pp. 84-86.
110. City of Liverpool, Evidence (n. 59), Bolton Deputation, Mr. Scowcroft (town clerk), Q 315; Edinburgh Deputation, Dr. Littlejohn (MOH), Q 269-70.
111. Ibid., Greenock Deputation, Dr. Wallace (MOH), Q 315. Even though Greenock operated a system of householder notification the MOH listed other sources of notification, such as the house surgeon at the Infirmary, sanitary officers, School Board officers, registrars of births, deaths, and marriages, a few medical practitioners, inspectors of the poor, quarantine officers, ships' officers, and the neighbors of infected households.
112. William Carter, "Is the Compulsory Notification of Infectious Disease by Medical Men Practically Useful?" Brit. Med. J., 16 September 1882, pp. 507-13, see especially p. 509, and the contributions of Dr. Whittle, Dr. Houghton, and Mr. G. Brown to the subsequent discussion. Carter, lecturer at University College Liverpool and physician to Liverpool's Royal Southern Hospital, was a member of the LMI deputation to the city's Health Committee in November 1881; see Frederick W. Lowndes, "The Medical Profession in Liverpool, and the Notification of Infectious Diseases," Sanitary Rec., 1882, n.s., 3: 323-34.
113. William Carter, "Is the Compulsory Notification of Infectious Disease by Medical Men Practically Useful?" Brit. Med. J., 16 September 1882, pp. 507-13, see especially p. 509, and the contributions of Dr. Whittle, Dr. Houghton, and Mr. G. Brown to the subsequent discussion. Carter, lecturer at University College Liverpool and physician to Liverpool's Royal Southern Hospital, was a member of the LMI deputation to the city's Health Committee in November 1881; see Frederick W. Lowndes, "The Medical Profession in Liverpool, and the Notification of Infectious Diseases," Sanitary Rec., 1882, n.s., 3: 323-34.
114. City of Liverpool, Evidence (n. 59), Warrington Deputation, Dr. Sherratt, Q 165.
115. Claims were made that general practitioners already betrayed the confidence of patients by giving a medical certificate of cause of death - but, considering the chain of events that could befall patients and their families after notification, death certification and disease notification were hardly comparable, and the medical profession easily rebuffed such points. See Livy, "Notification" (n. 39), p. 292; John F.J. Sykes, "On Organisation and Administration of Infectious Diseases," Sanitary Rec., 1886, n.s., 8: 159.
116. Claims were made that general practitioners already betrayed the confidence of patients by giving a medical certificate of cause of death - but, considering the chain of events that could befall patients and their families after notification, death certification and disease notification were hardly comparable, and the medical profession easily rebuffed such points. See Livy, "Notification" (n. 39), p. 292; John F.J. Sykes, "On Organisation and Administration of Infectious Diseases," Sanitary Rec., 1886, n.s., 8: 159.
117. Alexander Macara, "Confidentiality - A Decrepit Concept?" J. Roy. Soc. Med., 1984, 77: 577-84.
118. Sykes, "On Organisation" (n. 81), p. 159.
119. Cornelius B. Fox, "Why Should the Existing Worthless System of Registering Sickness Be Longer Perpetuated?" Sanitary Rec., 1877, 7: 406. Fox was an Essex MOH, and this seems to have been an uncommon viewpoint for a preventive sanitarian to hold. He did, however, qualify it by saying that "unfortunately, no scheme has yet or ever can be devised for preventing one man from injuring his neighbor which does not involve some deterring or compelling evidence" (ibid.). For examples of more conventional MOH opinion, see the various contributions to two discussions at the annual meetings of the Social Science Association: "A System of Compulsory Notification of Infectious Diseases . . . ?" and "What Are the Advantages of a System of Notification of Infectious Diseases . . . ?" Trans. Assoc. Promot. Soc. Sci., 1882, pp. 465-78.
120. Cornelius B. Fox, "Why Should the Existing Worthless System of Registering Sickness Be Longer Perpetuated?" Sanitary Rec., 1877, 7: 406. Fox was an Essex MOH, and this seems to have been an uncommon viewpoint for a preventive sanitarian to hold. He did, however, qualify it by saying that "unfortunately, no scheme has yet or ever can be devised for preventing one man from injuring his neighbor which does not involve some deterring or compelling evidence" (ibid.). For examples of more conventional MOH opinion, see the various contributions to two discussions at the annual meetings of the Social Science Association: "A System of Compulsory Notification of Infectious Diseases . . . ?" and "What Are the Advantages of a System of Notification of Infectious Diseases . . . ?" Trans. Assoc. Promot. Soc. Sci., 1882, pp. 465-78.
121. Cornelius B. Fox, "Why Should the Existing Worthless System of Registering Sickness Be Longer Perpetuated?" Sanitary Rec., 1877, 7: 406. Fox was an Essex MOH, and this seems to have been an uncommon viewpoint for a preventive sanitarian to hold. He did, however, qualify it by saying that "unfortunately, no scheme has yet or ever can be devised for preventing one man from injuring his neighbor which does not involve some deterring or compelling evidence" (ibid.). For examples of more conventional MOH opinion, see the various contributions to two discussions at the annual meetings of the Social Science Association: "A System of Compulsory Notification of Infectious Diseases . . . ?" and "What Are the Advantages of a System of Notification of Infectious Diseases . . . ?" Trans. Assoc. Promot. Soc. Sci., 1882, pp. 465-78.
122. Livy, "Notification" (n. 39), pp. 291-92.
123. "Report of the Committee on the Registration of Disease" (n. 64), p. 256.
124. City of Liverpool, Circular (n. 57), p. 16.
125. Alfred Hill, "The Notification of Infectious Disease: Its Importance and Its Difficulties," Sanitary Rec., 1884, n.s., 6: 43.
126. "The Compulsory Notification of Infectious Diseases," Sanitary Rec., 1882, n.s., 3: 334.
127. Dr. Fitzpatrick, quoted in "Notification of Infectious Diseases" (n. 70), p. 319. Two shillings and sixpence was the usual amount a local authority paid to the physician for a notification certificate. It would seem that 2/6 was the typical basic fee a physician would charge for a visit (excluding medicine) to patients with a house rental of less than £50 per annum in the late 1870s. Many low-paid workers were covered by club contributions, and physicians were heavily reliant upon the larger fees from a relatively small group of upper-and middle-class patients, who might have expected to pay anything up to 10/0. According to Anne Digby, about half of all single-handed general practices had a gross annual income of between £400 and £799 in the late 1870s; on the complex nature of the medical market, see Anne Digby, Making a Medical Living: Doctors and Patients in the English Market for Medicine, 1720-1911 (Cambridge: Cambridge University Press, 1994), chap. 5.
128. Dr. Fitzpatrick, quoted in "Notification of Infectious Diseases" (n. 70), p. 319. Two shillings and sixpence was the usual amount a local authority paid to the physician for a notification certificate. It would seem that 2/6 was the typical basic fee a physician would charge for a visit (excluding medicine) to patients with a house rental of less than £50 per annum in the late 1870s. Many low-paid workers were covered by club contributions, and physicians were heavily reliant upon the larger fees from a relatively small group of upper-and middle-class patients, who might have expected to pay anything up to 10/0. According to Anne Digby, about half of all single-handed general practices had a gross annual income of between £400 and £799 in the late 1870s; on the complex nature of the medical market, see Anne Digby, Making a Medical Living: Doctors and Patients in the English Market for Medicine, 1720-1911 (Cambridge: Cambridge University Press, 1994), chap. 5.
129. Dr. E. Haughton, discussion of Carter, "Compulsory Notification" (n. 79), p. 509.
130. Carter, ibid., p. 508.
131. William T. G. Woodforde, "Amendments Required in the Notification Act, 1889," Pub. Health, 1897-98, 10: 43-44. Woodforde may have pointed to a case in London where tobacconist and beer-seller Albert Rice was fined 20s and costs, or one month's imprisonment, when he failed to give notice that his wife was suffering from smallpox; his reason for not doing so, he pleaded, was the fact that it would cause a loss of trade. In the event, Rice unwittingly swapped the possible ignominy of a prison cell for that of a hospital bed: while in the process of giving evidence against the defendant, the MOH (Dr. Hill) observed that Rice was suffering from smallpox in its papular stages, and he was subsequently removed to hospital. See "The Notification of Small-pox Cases," Pub. Health, 1894-95, 7: 79-80. Although anecdotal incidents such as this cannot alone be deployed as convincing foundation for Woodforde's argument for concealment, Rice's removal to hospital at least serves as a useful reminder of the power of the authorities in such cases.
132. William T. G. Woodforde, "Amendments Required in the Notification Act, 1889," Pub. Health, 1897-98, 10: 43-44. Woodforde may have pointed to a case in London where tobacconist and beer-seller Albert Rice was fined 20s and costs, or one month's imprisonment, when he failed to give notice that his wife was suffering from smallpox; his reason for not doing so, he pleaded, was the fact that it would cause a loss of trade. In the event, Rice unwittingly swapped the possible ignominy of a prison cell for that of a hospital bed: while in the process of giving evidence against the defendant, the MOH (Dr. Hill) observed that Rice was suffering from smallpox in its papular stages, and he was subsequently removed to hospital. See "The Notification of Small-pox Cases," Pub. Health, 1894-95, 7: 79-80. Although anecdotal incidents such as this cannot alone be deployed as convincing foundation for Woodforde's argument for concealment, Rice's removal to hospital at least serves as a useful reminder of the power of the authorities in such cases.
133. Hart, "Special Report" (n. 74).
134. M. Jeanne Peterson, The Medical Profession in Mid-Victorian London (Berkeley: University of California Press, 1978); Ivan Waddington, The Medical Profession in the Industrial Revolution (Dublin: Gill and MacMillan, 1984).
135. M. Jeanne Peterson, The Medical Profession in Mid-Victorian London (Berkeley: University of California Press, 1978); Ivan Waddington, The Medical Profession in the Industrial Revolution (Dublin: Gill and MacMillan, 1984).
136. Hart, "Special Report" (n. 74).
137. "Reasons Why the BMA Objects to the Penal Clauses against Medical Men as Proposed by the Infectious Diseases Notification Bill, 1888," in BMA, PBCMB, 1888-95, 27 April 1888, pp. 3-4, quotation on p. 4.
138. William Carter, quoted in "Notification of Infectious Diseases" (n. 70), p. 318. Dr. Cort, a general practitioner in Blackburn, was adamant that "the medical man is as competent to see proper disinfectants used as any other medical man" (City of Liverpool, Evidence [n. 59], Blackburn Deputation, Dr. Cort, Q127).
139. William Carter, quoted in "Notification of Infectious Diseases" (n. 70), p. 318. Dr. Cort, a general practitioner in Blackburn, was adamant that "the medical man is as competent to see proper disinfectants used as any other medical man" (City of Liverpool, Evidence [n. 59], Blackburn Deputation, Dr. Cort, Q127).
140. One thing sure to irk some general practitioners even more than an inspection by the MOH was an inspection by a member of his non-medically qualified staff: City of Liverpool, Evidence (n. 59), Blackburn Deputation, Dr. Garstang, Q 187.
141. Alfred Carpenter, "The Right of the State to Enforce Notification and the Best Method of Doing It," Sanitary Rec., 1884, n.s., 6: 50.
142. Ibid.
143. Roy Porter, Disease, Medicine and Society in England 1550-1860 (London: Macmillan Education, 1987), p. 54.
144. The breakdown was as follows: eight MOHs had private practice, seven were disallowed it, and in eight cases the MOH's position was not stated. The town clerk at Jarrow qualified his belief that the "medical practitioners of the town are in one accord with the efficiency and practibility [sic]" of notification with a postscripted statement that "the difficulties my Corporation are experiencing in the working of the Act are caused by our officer [i.e., MOH] being engaged in private practice. The medical practitioners are strongly opposed to him being permitted to practice in addition to his official duties" (City of Liverpool, Circular [n. 57], p. 44). While virtually all of the replies - which were penned by either the mayor, the town clerk, the MOH, or all three - favored notification, the objection of the local practitioners was candidly admitted, although the nature of their objections was not always elaborated upon.
145. Dorothy Porter, "Stratification and Its Discontents: Professionalisation and Conflict in the British Public Health Service, 1848-1914," in A History of Education in Public Health: Health That Mocks the Doctors' Rules, ed. Elizabeth Fee and Roy M. Acheson (Oxford: Oxford University Press, 1991), pp. 86-89.
146. Hill, "Notification" (n. 88), p. 45.
147. Ibid.
148. City of Liverpool, Evidence (n. 59), Edinburgh Deputation, Dr. Littlejohn, Q 294.
149. City of Liverpool, Circular (n. 57), p. 24. See also Porter, "Stratification" (n. 104), pp. 91-92, 96.
150. City of Liverpool, Circular (n. 57), p. 24. See also Porter, "Stratification" (n. 104), pp. 91-92, 96.
151. The Diploma in Public Health became a requirement of MOH employment from 1888, while "the license to specialise in 'preventive' rather than 'curative' medicine was," Dorothy Porter has argued, "the basis of a new professionalism among community physicians" (Porter, "Stratification" [n. 104], pp. 99-100). See also Graham Mooney, "Professionalization in Public Health and the Measurement of Sanitary Progress in Nineteenth-Century England and Wales," Soc. Hist. Med., 1997, 10: 53-78.
152. The Diploma in Public Health became a requirement of MOH employment from 1888, while "the license to specialise in 'preventive' rather than 'curative' medicine was," Dorothy Porter has argued, "the basis of a new professionalism among community physicians" (Porter, "Stratification" [n. 104], pp. 99-100). See also Graham Mooney, "Professionalization in Public Health and the Measurement of Sanitary Progress in Nineteenth-Century England and Wales," Soc. Hist. Med., 1997, 10: 53-78.
153. Cited in Gerry Kearns, "Tuberculosis and the Medicalisation of British Society, 1880-1920," in Coping with Sickness: Historical Aspects of Health Care in a European Perspective, ed. John Woodward and Robert Jūtte (Sheffield: European Association for the History of Medicine and Health Publications, 1995), pp. 147-70; quotations on p. 153. Kearns goes on to argue that it was not until the early twentieth century, with the introduction of compulsory tuberculosis notification and the expansion of state-funded services for tubercular patients, that general practitioners fully began to realize the potential compatibility of their mode of individualistic health care with state medicine.
154. Dr. E. Whittle, discussion of Carter, "Compulsory Notification?" (n. 79), p. 509.
155. City of Liverpool, Evidence (n. 59), Warrington Deputation, Dr. Sherratt, Q 139.
156. Ibid., Huddersfield Deputation, Dr. Rhodes, Q 347.
157. Ibid., Blackburn Deputation, Dr. Morley, Q 208.
158. Ibid., Dr. Stevenson (MOH), Q 152.
159. On the nineteenth-century categorization of physicians' fees into occupational- or housing-tenure-related categories, see Digby, Making a Medical Living (n. 90), pp. 148-55.
160. William Carter, "Some Results of Recent Sanitary Legislation, with Suggestions as to Its Safe Extension," Proc. Lit. Philos. Soc. Liverpool, 1886-87, 41: 36.
161. Liberal Rev., 9 September 1882, p. 11.
162. City of Liverpool, Evidence (n. 59), Edinburgh Deputation, Dr. Littlejohn, Q 220.
163. Ibid., Q 264-65.
164. The charge for hospital admission in Warrington had been 15s: ibid., Warrington Deputation, Q 93-100; Huddersfield Deputation, Dr. Rhodes, Q 356.
165. That these deterrents operated are partly borne out by the evidence that in those towns where there was no infectious disease hospital to be removed to, the working classes showed little compunction in calling for the MOH to make a domestic inspection. See ibid., Blackburn Deputation, Q 133-37.
166. Porter, "Stratification" (n. 104); Mooney, "Professionalization" (n. 109); Anne Hardy, "Public Health and the Expert: The London Medical Officers of Health, 1856-1900," in Government and Expertise: Specialists, Administrators and Professionals, 1860-1919, ed. Roy M. MacLeod (Cambridge: Cambridge University Press, 1988), pp. 128-42.
167. Porter, "Stratification" (n. 104); Mooney, "Professionalization" (n. 109); Anne Hardy, "Public Health and the Expert: The London Medical Officers of Health, 1856-1900," in Government and Expertise: Specialists, Administrators and Professionals, 1860-1919, ed. Roy M. MacLeod (Cambridge: Cambridge University Press, 1988), pp. 128-42.
168. Porter, "Stratification" (n. 104); Mooney, "Professionalization" (n. 109); Anne Hardy, "Public Health and the Expert: The London Medical Officers of Health, 1856-1900," in Government and Expertise: Specialists, Administrators and Professionals, 1860-1919, ed. Roy M. MacLeod (Cambridge: Cambridge University Press, 1988), pp. 128-42.
169. City of Liverpool, Evidence (n. 59), Edinburgh Deputation, Dr. Littlejohn, Q 260.
170. Commons, "Special Report from the Select Committee on Police and Sanitary Regulations," PP, 1886, Select Committee on Police and Sanitary Regulations, 2 June 1886, vol. 11, pp. 249-68, p. 252.
171. Ibid.
172. Newsholme, "National System" (n. 5), p. 107.
173. Mooney, "Prevention and Control" (n. 22). See also Dorothy Porter, "'Enemies of the Race': Biologism, Environmentalism, and Public Health in Victorian England," Victorian Studies, 1991, 34: 159-78.
174. Mooney, "Prevention and Control" (n. 22). See also Dorothy Porter, "'Enemies of the Race': Biologism, Environmentalism, and Public Health in Victorian England," Victorian Studies, 1991, 34: 159-78.