The English revolution in social medicine, 1889-1911
The dissertation examines the development of preventive medicine between 1889-1911. It discusses the rise of expertise in prevention during this period and the consolidation of experts into a professional body. In this context the career histories of medical officers of health in London have been analysed to provide a basis for insight into the social structure of the profession. The prosopography of metropolitan officers demonstrated a broad spectrum of recruitment from the medical profession and the way in which patterns of recruitment changed over time. The level of specialisation in preventive medicine has been examined through a history of the development of the Diploma in Public Health. The courses and qualifying examinations undertaken by medical officers of health revealed the way in which training was linked to professionalisation through occupational monopoly. The association representing the interests of medical officers of health, their own Society, was Investigated through its recorded minutes of Council and Committees from the year it was first amalgamated into a national body, 1889, up to the date of the National Insurance Act in 1911. Here the aims and goals of the profession were set against their achievements and failures with regard to the new patterns of health care provision emerging during this period. This context of achievement and failure has been contrasted with an examination of the 'preventive ideal', as it was generated from within the community of preventive medical associations, of which the Society of Medical Officers of Health was one member. The interaction and exchange of ideas between these associations, including that with the Society, was traced through their journals and publications. Finally, the theoretical and practical knowledge which supported the development of technical expertise in preventive medicine is discussed through an analysis of hygiene text-books, available as instruction texts for diploma courses. Bearing in mind that It has been suggested by some historians that a revolution in social medicine took place in England during the 19th-Century, the thesis argues that this proposition needs to be re-examined historically. It suggests that an assumption that a revolution began and ended in the conventional realms of central and local politics would be unfounded. Alternatively, it suggests that the process of transition took place in the realm of the politics of expertise, linked to the rise of professionalism and changes in conceptual technology. It is hoped that this re-examination will allow the reader to re-address the question what is social medicine and when or if a revolution, even a typically English one, occurred.