Stagnation or innovation? The work of the Local Government Board Medical Department between 1871 and 1919 and its impact on public health administration in England and Wales

Evans, Nicholas Charles (2022) Stagnation or innovation? The work of the Local Government Board Medical Department between 1871 and 1919 and its impact on public health administration in England and Wales. PhD thesis, Birkbeck, University of London.

Abstract

Despite occupying a central role in the structure of public health services in England and Wales for almost fifty years, the Local Government Board Medical Department has been considered by many historians to be too small, too overburdened and too lacking in authority to have any significant impact. With its parent organisation condemned as a backward-looking bastion of obstructive bureaucracy and encumbered by a historiography that is both patchy and fragmented, the Department has at best been dismissed as a well-meaning but ultimately ineffectual predecessor to the Ministry of Health which emerged from the reconstruction of post-Great War British government. This thesis challenges this view. Using a combination of thematic and chronological approaches and national and local archive sources, each of its five chapters explores different aspects of the Medical Department’s work. Case studies demonstrate the influence wielded by its staff through the process of inspection which formed the foundation of its engagement with its local authority clientele, as well as revealing the complex relationships that developed between local and national governments in the period. Close reading of annual and other reports has given insights into the thinking of Medical Officers and their staffs and shows the gradual emergence of the preventative approach which came to characterise the Department’s activities. Despite chronic shortages of manpower and the challenging contexts within which successive Medical Officers and their staffs had to work, the Local Government Board Medical Department exerted a major influence on British public health management. Identifying and promulgating good practice, driving up standards, contributing significantly to the international debate on public health matters and successfully defending the Britain of the pre-antibiotic era from endemic and epidemic infectious disease for nearly fifty years, the Department laid the foundations of British public health practice and management which endure to the present day.

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