Note: When Dalrymple’s long-running BMJ column ended in 2012, he had a backlog of around 50 or 60 unpublished pieces, and he kindly gave them to us to post here at Skeptical Doctor. We are posting one each Wednesday to coincide with the schedule of his old BMJ column. We hope you enjoy them.

Could it be, I wonder, that Mr Micawber derived his great dictum about happiness and misery from having read Edwin Chadwick’s Report to Her Majesty’s Principal Secretary of State for the Home Department from the Poor Law Commissioners, on an Inquiry into the Sanitary Condition of the Labouring Population of Great Britain of 1842, only five years before the publication of David Copperfield?

Dickens, after all, read such literature, and on pages 139 and 140 would have seen a tabulated comparison of those who lived providently and improvidently:

William Haynes, of Oakamoore (wire drawer), wages £1 per week; he has a wife and five children; he is in debt, and his family is shamefully neglected.

John Hammonds, of Woodhead (collier), wages 18s. per week; has six children to support; he is a steady man and saving money.

This great book is, to me at any rate, inexhaustibly fascinating. Chadwick was a barrister, not a doctor, and though most of his information came from doctors (unpaid for their work, incidentally) he had no exaggerated respect for their wisdom or understanding. Pages 148, for example, are headed Irrelevancy of Controversy on the Generation of Fever, as against Practical Means of Prevention. Contagion or infection, it was all the same to him; he was the Deng Xiao Ping of public health, to whom it mattered not whether the cat was black or white, so long as it caught mice. A note of impatience and exasperation creeps in:

The medical controversy as to the causes of fever; as to whether it is caused by filth and vitiated atmosphere, or whether the state of the atmosphere is a predisposing cause to the reception of the fever, or the means of propagating that disease, which has really some superior, independent, or specific cause, does not appear to be one that for practical purposes needs to be considered, except that its effect is prejudicial in diverting attention from the practical means of prevention.

And he quotes from an episode from a French report about the small town of Prades (through which, as it happens, I have often passed) in the Ariège, which suffered a disastrous epidemic:

The physicians of Ariège, in order to prove that the disease was not contagious, and to re-assure the inhabitants, lay in the beds from which the invalids had been removed.

Arguing for sanitary reform, Chadwick points out the advances made in the navy. In 1779 one in eight employed on ships died in a year; from 1830 to 1836, it was one in 72. This improvement he attributed to sanitary measures, even though he quotes the case of the expedition of HMS Centurion in which, a hundred years earlier, 200 of 400 men were lost to scurvy. It is interesting to note that although in the latter years lemon juice was by Chadwick’s time in general use, it was still uncertain in 1842 as to whether it, or better conditions in general, was responsible for the prevention of scurvy.

The book contains sanitary maps of Leeds and Bethnal Green of great beauty: were it not vandalism to do so, I would tear them out and frame them. And Chadwick provides illustrations of workmen’s housing, infinitely better, aesthetically-speaking, than almost anything built for the last hundred years. If there is one thing that has not improved, it is architecture.