The Filth Disease: Typhoid Fever and the Practices of Epidemiology in Victorian England, by Jacob Steere-Williams

Abstract

Reviewed by: The Filth Disease: Typhoid Fever and the Practices of Epidemiology in Victorian England by Jacob Steere-Williams Pamela K. Gilbert (bio) The Filth Disease: Typhoid Fever and the Practices of Epidemiology in Victorian England, by Jacob Steere-Williams; pp. xiii + 324. Rochester: University of Rochester Press, 2020, $99.00, $24.99 ebook, £80.00, £19.99 ebook. Typhoid fever, an enteric disease caused by Salmonella typhi and marked by fever, abdominal pain, and sometimes a rash with rose colored spots, was a mass killer throughout the nineteenth century and remains so in many places today. It spreads via the fecal-oral route, and humans are its only known host. As an endemic disease with periodic outbreaks, typhoid was one of many familiar killers in the first half of the nineteenth century, when the much less lethal (in absolute numbers) but unfamiliar cholera kickstarted the public health movement in Victorian England. By the later years of the mid-century, cholera was beginning to be well understood, and Britain was somewhat protected from its pandemic depredations. Typhoid, however, which spread by the same means, continued to loom large. It became, Jacob Steere-Williams argues, the "model disease" for the further development of public health, and it moved dramatically to center stage when Britain very nearly lost the Crown Prince to it in 1872 (8). This was particularly poignant as the Prince Consort was believed to have died of it the decade prior, in 1861. Steere-Williams's The Filth Disease: Typhoid Fever and the Practices of Epidemiology in Victorian England offers a careful and detailed discussion of typhoid and epidemiology from the late 1860s to 1901. Steere-Williams shows how, during this period, epidemiologists centered typhoid as both the greatest disease threat and as a "testing ground of state medicine" (7). Unsurprisingly, the disease resisted easy classification or remediation, in part because it was understood very differently by different scientists and also by the public. And, as we have seen again recently, epidemics tend to be tangled up in political and other narratives and interests, and the more central the disease is to public discussion, the higher the stakes of these entanglements. Alongside the narrative of a specific disease, Steere-Williams also tells an important story of how epidemiologists came to claim and define a field of knowledge and authority to speak for the public good. He focuses on epidemiology as practice—that is, in this period, mostly as the shoe-leather work of tracing particular outbreaks by the Medical Department and local Medical Officers. He also shows how the very different but interdependent contexts of urban and rural spread meant that rural Medical Officers were in a position to contribute knowledge in ways hitherto less valued. Finally, he charts the uneven rise of bacteriology and its slow and uneasy integration in the epidemiological framework, a development that would ultimately make twentieth-century epidemiology look very different than it did when the field came to prominence in the period he so ably covers here. Each chapter focuses on what Steere-Williams calls "a different medium" for transmission (26): air, water, milk, soil, and bodies. The book progresses roughly chronologically, from the miasmatic beliefs of the mid-Victorians to the geographical and racial emphases of late-Victorian empire. The time between the Prince Consort's death and the Crown Prince's near miss was dominated by the fear of airborne disease; because well-off people tended to have indoor plumbing, there was a particular panic around sewer gases. However, in this same decade, the kinds of work done on water contamination in prior [End Page 505] cholera epidemics paved the way for scientists to understand that the disease could be substantially waterborne. The next panic about vectors seized upon milk in an outbreak in Marylebone in 1873. Milk (often diluted with contaminated water) was advocated by doctors in the period as "nature's perfect food" (131). The outbreak was traced to the Dairy Reform Company, which marketed its milk as a healthful, clean product to well-off clients in urban areas with evocations of the bucolic English countryside. Here again, typhoid seemed to strike particularly at the wealthy and respectable in...