The Link Between Destitution and Disease- Megan Low

In the midst of the British Industrial Revolution, demand for labor sparked a march of opportunistic proletariats into industrial areas, with rapid urbanization leading to less than adequate living conditions for the working poor. Those higher up on the food chain, the economically stable British bourgeoisie, sought to keep populations impoverished for cheap labor. But this want created a cycle of malaise: the central and prevailing idea of this week’s assigned texts seems to incarnate a direct correlation between socio-economic status and health, specifically in that the poorer and more destitute an individual the more susceptible to illness he would be. That being said, a clash of theories regarding the cause of disease served to help sustain the economic status quo, and thus keep populations in conditions that contributed to their poor health.

As F. Engels points out in The Conditions of the Working Class in England, rapid urbanization had adverse outcomes, such as cramped living areas, lack of infrastructure such as ventilation and drainage, and unsanitary conditions. Along with bad diet, these factors led to poor health for the poor working class. And because the poor barely had enough funds for subsistence, they could not afford actual doctors. As such, the proletariat was to rely on quack medicine, most of which caused more harm than good. According to a study by Dr. P.H. Holland in Manchester, the mortality rate of the third class (the poorest) was 78% greater than the first class (the richest) in a grouping of streets. This statistic points to the poor’s susceptibility to disease, which is greater than the rich.

Victorian sentiments powered the British bourgeoisie’s view of the poor, especially in a moral way; the upper class saw those capable yet unwilling to work as the gunk on the bottom of a shoe, and condemned pauperism. The English New Poor Law, which reduced the group mentioned previously to an inferior race, served as a harsh deterrent for such behavior. The problem was that it did not allow for relief outside of workhouses, places where the out of work may find shelter and food. The industrial north of Britain experienced cyclical unemployment from sporadic recessions, but unemployed workers were unwilling to enter the workhouses.

As such, it could be said that the New Poor Law failed in its vision of reducing the number of poor. But Edwin Chadwick, chief commissioner of the Poor Law Commission, refused to accept the inadequacy of the statute. His obsession with the miasmatic theory of disease causation (in which agents of disease are created by decaying organic material) exists as a last but feeble attempt to pin disease on social factors, rather than economic factors. Chadwick and followers blamed illness purely on unsanitary environment disregarding the multitude of other factors such as poor diet and incapacitating working conditions.

However, men of medicine often prescribed food for ailing patients. This decision was fueled by money: doctors had to pay for medicine out of their own pockets but food was covered by medical unions (Mutton Medicine). Chadwick and the Poor Law Commission saw this action as preposterous, believing that hunger drove the poor to work, so by prescribing food the doctors were encouraging pauperism. Also, the PLC’s goal was to link disease to filth and not destitution. The act of prescribing food alluded to a relationship between an aspect of destitution (poor diet) and fever. British bourgeoisie supported Chadwick’s belief, because a continuous flow of cheap labor equated to higher profitability.

The PLC quickly clamped down on any contrasting information regarding its organization and used intimidation to extend their funding. For example it forbid people with medical credentials from Scotland and Ireland passage into English medical unions. This was because Scots wanted support from the English poor law establishment in creating a foundation for similar systems in Scotland; doing so however revealed contradictions in the English New Poor Law. That these conflicting studies were to be taken as fact would render the deterrent practice (in which the poor are left hungry so they would work and not be a drain on society) as unreliable and worthless. With that, it was not until Chadwick stepped down and John Simon took the position that science and not just speculation was used in public health reform.