This essay describes the evolving state of British health in the nineteenth century and considers how Livingstone’s perceptions of this health influenced his understanding of Africa and his writings.
British Health in the Nineteenth Century Top ⤴
The practice and understanding of medicine profoundly changed during the years of Livingstone's life (1813-1873). These changes grew out of the massive restructuring of British society that followed the industrial revolution of the late eighteenth and early nineteenth century. Throughout the nineteenth century, British people moved from town to country, while the British economy and labor force moved from agriculture to industry and commerce.
Although in Africa for much of his adult life, Livingstone's letters bear testimony to these transformations, notably in so far as they affected London. When Livingstone first visited London in 1838 it was already a massive metropolis; not an industrial city but a thriving port, the centre of a rapidly expanding empire, in whose growth and administration Livingstone was to play a part.
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But in 1838 London was full of overcrowded, unpoliced, disease-ridden slums. The "Great Wen," as it was known, might have seemed an anarchic, terrifying place (although perhaps not to someone who had studied in Glasgow). Indeed many missionary societies considered working at home, arguing that reclaiming the "savage" inhabitants of these slums for Christianity was as important as converting the "savages" of Africa or India.
The massive growth of towns and cities in Britain after the industrial revolution had produced terrible problems of public health. People living in overcrowded slums with insufficient and contaminated water and heaps of human and animal refuse piled around them were subject to endemic diseases such as small-pox, tuberculosis, typhoid, and dysentery, but also to murderous epidemics, especially cholera which swept through Britain in 1832, 1848, and 1854.
Diagram of cholera deaths in England during 1849. Copyright Wellcome Library, London. Creative Commons Attribution 4.0 International
Doctors and others commonly described the disease-producing conditions of the British slum as similar to the swamps of Africa. The healthiness or otherwise of the air in both places was frequently commented on. Malarias (mal-aria) and miasmas – bad airs – were widely regarded as the cause of epidemic disease, whether they arose from decomposing vegetation in the jungle or rotting waste in the streets of St. Giles (a notoriously dirty and dangerous London parish).
Livingstone's writings are steeped in implicit and explicit comparisons of the health of British towns with Africa. When he talks of a place on the Zambesi being like a cesspit, it was possibly London or Glasgow to which he was comparing it. However, Livingstone's letters, which were written over a period of more than thirty years, do not all strike the same tone. His earliest letters are those of an eager young missionary who had seen the degradation and heathenism of Glasgow and London and might be said to be devoted to making individual conversions.
Steel engraving: 1851 Great Exhibition, Crystal Palace. Copyright Wellcome Library, London. Creative Commons Attribution 4.0 International
Transformations in British Health at Mid Century Top ⤴
By the time of Livingstone's second return from Africa in 1864 the city had begun to change. The heyday of Victorian stability and prosperity had arrived. The Great Exhibition of 1851, as had been hoped, inaugurated a new era. Wealth began to flow to the middle classes and also to many working-class families (the very poor and paupers were a different matter). Relative stability reigned; the threat of rioting, revolution even, had diminished. Government had become more centralized and was passing bills on health, working hours and education. A modern civil service was being created. A network of railways was unifying the nation. The great public works era – notably in the provision of fresh water and the removal of sewage – had begun.
In the West End of London, fashionable and prestigious scientific and medical societies flourished that encouraged the professionalization of medicine and science. Most important for Livingstone was the Royal Geographical Society (RGS). Founded in 1830, the early years of this institution were undistinguished, but by mid century it had become an important centre for promoting exploration and imperial science. It is not surprising then that Livingstone looked to it for patronage and approval, and the RGS, in turn, sought its share of credit for Livingstone's work. It is not hard to imagine that Livingstone saw in the transformation of London some of the possibilities that science, technology, trade, and good British governance might bring to Africa.
The ‘Livingstone’ medicine chest, named after David Livingstone and made by Burroughs, Wellcome & Co, who often provided medicine chests to expeditions free of charge for publicity. Copyright Wellcome Library, London. Creative Commons Attribution 4.0 International
Livingstone’s correspondence from the 1860s is that of a man who had seen the benefits of trade, science, and reform, especially in public health. Although the civilizing influence of Christianity is strong in them, there is also a highly developed sense of the health of the people as whole being an essential constituent of prosperity, happiness and salvation. Health in this case, he saw as conditioned in part by the environment, whether natural or managed.
Medical Practice in Mid-Victorian Britain Top ⤴
Medicine, too, would have looked considerably different to Livingstone between 1838 and 1864. Bedside medicine – treating the sick person – changed profoundly in these years. When Livingstone was a young doctor, the patient's history was the key to diagnosis and management, as it had been for two millennia in the West. By the time he was a mature practitioner, physical examination aided by instruments was expected of every medical man.
In 1840 some still thought of the stethoscope, invented in 1816, as a toy. By 1865 its use was mandatory. A whole host of other instruments were also at the physician's disposal: for ears and eyes, the auroscope and ophthalmoscope could be used; the laryngoscope for the throat and, although modesty still surrounded its use, the vaginal speculum was deemed necessary for examination in women's diseases. The most modern practitioner might also have a microscope to examine the blood and urine. Drug therapy, though, changed little.
A cholera patient experimenting with remedies, by Robert Cruikshank. Copyright Wellcome Library, London. Creative Commons Attribution 4.0 International
Surgery, however, had been transformed. While Livingstone was in Africa, ether and chloroform anaesthesia had been introduced, in 1846 and 1847 respectively. Surgical intervention, although largely confined to bones and soft tissues, had become amazingly ambitious and intricate by the mid 1860s. Exceptionally, the abdomen was now being opened for the removal of ovarian tumours.
Surgical deaths in the great hospitals, however, had increased considerably but Livingstone would have been well aware of the claims made by surgeons that science would solve this problem. Shortly after he returned to Africa in 1865, controversy would break out over Joseph Lister's antiseptic treatment based, he said, on Louis Pasteur's germ theory. Modern germ theory was not established until after Livingstone's death.
Science and the Rise of the Medical Profession Top ⤴
In Livingstone's lifetime, science at the bedside, in the laboratory and in the community was increasingly seen as a potent force in medicine. In retrospect, any claim made at the time that science helped the patient is a shaky one. What matters here are two consequences of the importance that the Victorians ascribed to science in medicine. First, the Victorians saw medicine, using science, as a tool for transforming people's lives and having the capacity to do so not only in Britain but also in the colonies – just as science and technology in general could.
Second, this image of science in medicine raised the status of the medical profession. What was once an elite vocation for the few was becoming a respectable middle-class occupation for the many. If Britain and the Empire were to thrive, doctors proclaimed, they could be its backbone (engineers and chemists said much the same thing). And, indeed, doctors and other professionals were eventually churned out in their thousands to serve in the colonies.
Further Reading Top ⤴
Bonner, Thomas N. 1995. Becoming a Physician, Medical Education in Great Britain, France, Germany and the United States, 1750-1794. New York: Oxford University Press.
Bynum, W.F. 1994. Science and the Practice of Medicine in the Nineteenth Century. Cambridge: Cambridge University Press.
Bynum, W.F., Anne Hardy, Stephen Jacyna, Christopher Lawrence, and E.M. Tansy. 2006. The Western Medical Tradition, 1800 to 2000. Cambridge: Cambridge University Press.
Cunningham, Andrew, and Perry Williams, eds. 1992. The Laboratory Revolution in Medicine. Cambridge: Cambridge University Press.
Digby, Anne. 1994. Making a Medical Living, Doctors and Patients in the English Market for Medicine, 1720-1911. Cambridge: Cambridge University Press.
Hardy, Anne. 2001. Health and Medicine in Britain since 1860. Basingstoke: Palgrave.
Lawrence, Christopher. 1994. Medicine in the Making of Modern Britain, 1700-1920. London: Routledge.
Risse, Guenter B. 1999. Mending Bodies, Saving Souls. New York: Oxford University Press.
Smith, F.B. 1993. The People’s Health, 1830-1910. London: Gregg Revivals.
Wangensteen, Owen H., and Sarah D. Wangensteen. 1978. The Rise of Surgery, from Empiric Craft to Scientific Discipline. Folkestone, Kent: Dawsons.