THE SOCIAL HISTORY OF MEDICINE

The social history of medicine, like most social history, is primarily a development of the last two decades, and arose out of the same congruence of interests which have transformed economic and labour history into social history in that period. The older tradition of the history of medicine, which it has by no means displaced, saw the discipline as essentially inward-looking. This was a doctor-oriented version of medicine, justifying medical history as an illumination of the internal history of the profession or of the discovery or development of technical medical procedures. It assumed a Whig framework of progress towards ever-superior forms of knowledge or organisation, culminating in the state of medical practice at the present day. It therefore had a strongly biographical emphasis; the lives of the ‘great men’ of medicine filled the shelves of the medical history sections. The scientific basis of medical practice was seen as a series of discoveries and of contributions or advances towards present understanding; the analysis of medical institutions was in terms of celebratory histories concentrating on internal milestones of development. ‘The need for a knowledge of the origin and growth of one's profession is surely self-evident’, said Sir Douglas Guthrie in his Presidential address to the History of Medicine section of the Royal Society of Medicine in 1957, ‘it is obvious that history supplies an essential basis for medicine. It gives us ideals to follow, inspirations for our work and hope for the future.’The ‘graph of medical progress’ could, he considered, be depicted as ‘an ever-mounting curve’.

In the chapter on ‘Social Movements’ in Volume 12 of the old Cambridge Modern History published in 1910, Sidney Webb predicted that one of the main characteristics of twentieth-century society would be that it would consist only of government and of private citizens. As democratic rights were extended and as public authorities acquired increasingly extensive powers over social and economic affairs, the great ramshackle mass of private, pluralistic and voluntary institutions that had constituted the fabric of past societies would be progressively displaced by a streamlined, simplified, rationalised two-way relationship between the individual and the state. Seventy years later a distinguished American political scientist, Samuel Beer, diagnosed the relationship between British government and society in the latter half of the twentieth century in diametrically opposite terms: government had acquired greater powers and citizens had acquired greater democratic rights, but these trends had been accompanied by a proliferation of pluralistic interest groups unprecedented in British history. The upshot was that both government and individuals were in many ways more impotent than they had been under the traditional, restricted, imperfectly democratic system that had prevailed earlier in the century.

Curiously enough, though apparently the antithesis of each other, both the predictions of Sidney Webb and the historical diagnosis of Professor Beer contain important elements of historical truth. They both capture genuine elements in the immensely complex and continually changing relationship between British government and society in the twentieth century. This pattern of change to a certain extent reflects global rather than purely national history – the pressures of war, industrialisation, ideological dissent and demographic growth that have remodelled government institutions in all advanced countries.

‘There are many ways of regarding the house’, warned The Builder in 1881, ‘and most of them, it must be confessed, are prosaic.’ This caution is salutary, but it may be that a concentration on two of the many possible approaches to the history of housing may avoid the perils of tedium. One is the relationship between design and society, between the physical form of housing and the social life it contains. The individual house could relate to the external environment in a variety of forms, with the threshold between private and public space drawn at different points and with more or less emphasis. The physical structure of the house might be articulated in a number of ways, with the internal space used in a more or less specialised or undifferentiated manner. The second theme is the relationships which emerged from the ownership, management and occupation of housing. It is wrong to view houses merely as a collection of inert bricks and mortar, for they involved conflict over the distribution of income and resources between landlord and tenant, rates and rents, private enterprise and public initiatives. The outcome could affect not only the daily lives of residents, determining the amount they paid for accommodation and the terms on which it was held, but could also impinge on social structure and political debate. The emergence of a nation of owner-occupiers has very different social and political implications from a nation of tenants, and it is necessary both to explain how this change occurred, and to assess the consequences.

The theme of this chapter is the manner in which Government influenced the lives of citizens of England and Wales, their behaviour and conditions of life according to which principles and with what effects. A central assumption – widely shared for a substantial portion of the period, most fully developed in the ideas and actions of Peel and Gladstone, though with earlier roots, and most dominant from the 1840s to the 1870s – was that the government's role was at most strictly limited, that it not only should not but could not determine the structure and working of society. Rather its role was to provide a firmly established and clearly understood framework within which society could very largely run itself.

Even in the mid-Victorian period the reality of government action did not wholly match this ideal, but it was widely enough shared at all social levels for government transgression of it long to require justification against challenges. It had distinctive institutional effects. In contrast with most other societies of the period in England and Wales, many of the functions performed by central government elsewhere were, throughout the period, performed by groups of self-governing citizens either on an elective, but unpaid, official basis, as in the various institutions of local government, or through voluntary associations. Though Britain certainly possessed highly effective central government institutions, unlike other European countries she did not develop in the nineteenth century a strong bureaucratic stratum with powerful interests of its own, a strong set of popular expectations of the role of the state or a sense of popular identification with it.

If Britain was the first industrial and urban nation, it was also, for much of the period between 1750 and 1950, a remarkably religious one. During the first century of industrialisation the social relevance of religion actually increased, and the churches played a major role in both the public and the private spheres. Religion provides one of the keys to the history of the age.

Given Christianity's ancient origins, that may seem surprising: was not a traditional faith bound to wither away in a period of rapid modernisation? And since the two main churches, the Church of England and the Church of Scotland, had been integral parts of the pre-1832 ‘old regime’, were they not also bound to decline in an age of liberal and democratic political reform?

Similar questions were posed about the churches in all the advanced European countries. But Britain's answers were different. For while the established churches in Britain were comparable to those in Europe, there was also, as in America, an array of competing independent denominations. The combination of European quasi-monopoly and American ‘free market’ gave British religious life much of its distinctive character.

In the event the churches thrived on competition and for much of the period responded to social and political change with considerable success. During the Victorian religious ‘boom’ their influence, for better or worse, was greater than it had been since the seventeenth century; like America in more recent times, Victorian Britain shows that a modernising society can be religious.

INTRODUCTION

The reality of London has never been easy to grasp – the character of this vast city has been shrouded in uncertainty and ambiguity and much has depended on the perspective of the observer. Most obviously, there have been the contradictions arising from London's various, overlapping spatial contexts – London has operated and has been experienced at sub-metropolitan, metropolitan, regional, national and international levels. Each of these arenas has generated a particular ‘London view’, and much of London's history since 1750 can be seen as a series of conflicts arising from the associated interests and tensions. Yet despite its ‘chinese box’ character, a fundamental feature of London has been its stability and continuity.

The basis of London's orderliness has, paradoxically, been its continued dynamism, driven by a particular type of physical and economic growth that permitted both interdependence and autonomy. The two centuries between 1750 and 1950 can be regarded as the benchmarks of this inherently stable, though expansionist era for London – after 1950, changed economic and political conditions accentuated the fragility of London, forcing previously hidden and unresolved contradictions in metropolitan life to the centre of the social and political stage.

The prism through which London is viewed in what follows is that of the impact of the metropolis on the Home Counties – that is, its expansion from the old core cities of London and Westminster, through Middlesex, and later Surrey, Essex, Kent and Hertfordshire. The nature of that impact, its causes and consequences cannot, however, be comprehensively assessed.

Education is best defined as the ‘methodical socialisation of the young generation’. Thus family and kinship networks, apprenticeships, patterns of child employment all have a part to play in the educative process, alongside any provision of a formal or semi-formal kind for schooling. It would be impossible to treat all of these adequately in one chapter; and indeed family, kinship and work are all themselves subjects for separate extended treatment. This chapter will therefore focus primarily on the development of provision for formal schooling, but not to the exclusion of all other aspects of the process. For one of the chapter's most important themes is the rise of formal schooling. In 1750 this was a relatively insignificant and brief part of the educative process and one not necessarily encountered by all children. By 1950 it was central and it was what most people, adults and children alike, meant when they spoke of education.

1750–1850

In England in the seventeenth, eighteenth and early nineteenth centuries, the vast mass of the population did not see the basic skills of reading, writing and arithmetic as an integrated package – the 3Rs – and one to be acquired in a formal institutional setting, as a prelude to economic activity. These skills were seen as discrete, reading far outweighing the other two in importance. If acquired at all, they were acquired – and offered by teachers – in sequence: reading before writing, writing before arithmetic.

No country on earth can lay claim to a greater philanthropic tradition than Great Britain. Until the twentieth century philanthropy was widely believed to be the most wholesome and reliable remedy for the nation's ills, a view that is not without adherents today. For every affliction, individual or social, physical or spiritual, the charitable pharmacopoeia has a prescription or at least a palliative. Disease, old age and immorality are perennial problems. Others come and go with the elements or the trade cycle. Others still fall out of fashion or disappear because of medical or technological advance. Little is heard nowadays of cholera victims, chimney sweeps or thirsty horses in the metropolis, yet they all aroused public concern in the nineteenth century. Such causes have given way to those in tune with changed conditions, some of which would amaze, indeed alarm, past philanthropists. What would William Wilberforce or Lord Shaftesbury make of modern voluntary societies in aid of gay rights or family planning? Would they join the National Trust (1895), a charity in receipt of government grants, one of whose purposes is the preservation of country houses emptied of a paternalist aristocracy and gentry? Few subjects bring out so well the differences between ourselves and our ancestors.

As befits a nation in which philanthropists are ubiquitous, enormous sums have been contributed, representing a massive redistribution of wealth. But while financial records exist for many charities, it is impossible to measure the overall sums contributed to philanthropy in a single year or to compare the percentage of national income redistributed at different periods.

When in 1837, in the pages of his first periodical, Master Humphrey's Clock, Charles Dickens celebrated the doings of the Mudfog Association, with all its little formalities, its concern for rules, and its sense of importance and purpose, he was recording one of the most pervasive, diffuse and amorphous social developments of the past 200 years. The creation of formal voluntary associations was not new in his generation but what was new was the increase in their number, variety and public importance which took place, especially after 1780. That increase was to continue for many decades. The basis of that growth was in the adult male urban middle classes, but this adaptable and flexible form of social institution could never and was never limited to this group.

As society became more complex, those with power, those with no power and above all those with slender fragments of power which they sought to defend and extend began to organise themselves in a variety of specific ways. A whole new series of words came into common use in the English language, often changing or adding to their meaning – the association, the society, the chairman, the agenda, the membership, the rules and constitution and the annual report. After the mid-eighteenth century voluntary organisations appeared in increasing numbers. Their defining characteristics were minimal, a set of rules, a declared purpose and a membership defined by some formal act of joining. These organisations acted independently of the family, household, neighbourhood, firm or work group.

The Arabic translation movement begins among non-Arabs, non-Muslims, neo-Muslims or heretical Muslims, as one phase of a much larger process at the interface between cultures. The Greek to Syriac translating which preceded and accompanied the translation of Greek works into Arabic is another phase of the same larger process.1 A salient aspect of this great meeting of eastern and western civilizations is the Hellenization of Islam. For all the centres of intellectual activity in western Asia during the formative period of Islamic civilization – the surviving Christian centres of medical, logical, historical and Biblical learning at Edessa, Nisibin, and Qinnasrīn, the Talmudic academies of Sura and Pumpeditha, the medical centre of Jundīshāpūr, the pagan astronomical and astrological centre at Ḥarrān, the fire temples of Magian Persia, the Buddhist centres of Balkh, and the Indian observatories of Ujjain – exhibit traditions of learning centuries old and deeply imbued with the spirit of Hellenism and with detailed knowledge of the Greek sciences and arts, often studied in the original texts, or (for us even more important) in translation or adaptation.

The new Islamic civilization which presided over the dissolution of the Sasanid Persian empire and effectively sealed the “lower tier” of former Byzantine provinces against Byzantine political control, which absorbed large numbers of Jewish, Christian, pagan and Magian converts and imposed the terms for coexistence with the unconverted, was not and by the very nature of its success could not be so radically creative or destructive as to exclude all that it found in the new-won lands.

Abū Yūsuf Yaʿqūb b. Isḥāq al-Kindī (c. 180–250/795–865) flourished in particular in the reign of al-Muʿtaṣim (reigned 218–27/833–42). It is said that he served as tutor to the caliph's son Aḥmad, to whom some of his writings are dedicated. Others are dedicated to the caliph himself. Most are short didactic pieces of strictly limited scope. A few dozen survive, some in Latin or Hebrew translation. Many more titles are recorded by the bibliographers, covering an enormous range of subjects. Al-Kindī wrote on questions of mathematics, logic, physics, psychology, metaphysics and ethics, but also on perfumes, drugs, foods, precious stones, musical instruments, swords, bees and pigeons. He wrote against the false claims of the alchemists, the atomism of the mutakallimūn, the dualism of the Manichaeans, and the trinitarian dogma of the Christians. He supported astrology, calculated the duration of the Arab empire, and speculated on the causes of natural phenomena such as comets, earthquakes, tides or the colour of the sky. He also took an interest in distant countries and ancient nations, collecting information on Socrates (whom he confused with Diogenes the Cynic), the Ḥarranians and the rites of India. A similar range of topics was later covered by al-Kindī's pupil Aḥmad b. al-Ṭayyib al-Sarakhsī, tutor and boon-companion of the caliph al-Muʿtaḍid (reigned 279–89/892–902). No doubt al-Kindī, too, had played the part of a cultured polymath who, wearing his learning lightly, strove to captivate, divert and instruct a courtly public.

Unlike the changes which Muslim names frequently underwent in the Latin West, the last name of Abā Naṣr Muḥammad b. Muḥammad b. Tarkhān b. Awzalugh (or Uzlugh) al-Fārābī was barely altered, and it is as “Alfarabi” that it has been common to refer to him. Al-Fārābī's name, however, may be the only constant on which to seize at the moment, as contemporary scholarship challenges previous assessments of his work. Al-Fārābī appears increasingly as a disarmingly subtle thinker, an individualist with a civic conscience, a man who attempted to reconcile Plato and Aristotle, philosophy and theology, Athens and Mecca.1 The syntheses attempted, however, are neither facile nor dogmatic, and proceed from a predominantly philosophical standpoint. The exact nature of al-Fārābī's philosophical credo, moreover, is still being questioned.

The question is complicated by the lack of a sure chronology for al-Fārābī's many compositions, and an equal ignorance of the particular circumstances which prompted each work in a given genre: the motivation, purpose and intended audience. With few sure criteria of a biographical or stylistic sort to assist them, scholars are forced to choose between differing statements and emphases in related texts, and even within the same text, to determine al-Fārābī's genuine convictions. Moreover, the work of Leo Strauss, Muhsin Mahdi and others has drawn attention to the likelihood that al-Fārābī deliberately shielded essential elements of his convictions from the eyes of the uncritical reader.