This book promises much but ultimately rather disappoints, largely because of its tendency to lose focus, sprawling into this of that side-avenue. Partly this must be due to a lack of clarity as to what the book is about — an impression strongly reinforced by the book’s afterword which does much to illuminate the intentions and the author.
Is this a narrative history? An analytic investigation of the of public health provision, focusing especially on the 1892 epidemic? A wide-ranging overview of Hamburg society and the mentality of its dominant classes, a marxist-influenced study of class tension and conflict or …? The author does not seem to be sure. The result is rather a mish-mash.
At some points we seem to be investigating the political and social reasons for Hamburg’s poor public health outcomes, in particular the constant fighting between the different ‘fractions of capital’ (in particular the merchant/lawyer senators and the property-owners) over the provision of public goods, at others having a detailed description of working class living conditions, and at another a history of medical approaches to cholera and other diseases in the 19th century, and at another describing in detail how the ‘dominant’ classes used charitable support both in general, and after the 1892 epidemic, to exercise social and moral ‘control’.
Of course, it is possible these different approaches and angles could have been woven together to produce a single rich and compelling whole. But this is not so. To take the main focus of the book — which I take to be the Cholera epidemic of 1892 together with its causes and outcomes. By the time I had finished the more than 700 pages I was still unsure as to what, in Professor Evan’s view, were the main reasons for Hamburg’s terrible performance in comparison with other German (or European) cities. To pick just a few of the possible ones:
- The failure to develop sand-filtration for the public water supply. Was this in turn due to:
- The form of the Citizens’ Assembly, in particular the ability of the property owners to block improvements that might result in reductions in their profits.
- Early investment in a new water system which then made it relatively more costly to upgrade later (Hamburg was one of the first cities in Germany to develop an external resevoir).
- Ideological opposition (see next items)
- The ideological commitment of Hamburg’s ruling groups to ‘Trade’ and ‘Laissez Faire’
- Reinforced, perhaps, by direct self-interest in the case of ship-owners and others for whom quarantine meant serious disturbance to their work or enterprise
- The inefficient governance structures (in particular the operation and make-up of the Senate and Burgomaster)
- Hamburg’s governance compared particularly poorly with the more efficient, though also more, authoritarian action of the Imperial government (particularly that of the Imperial Health Office and Koch).
- Continuing support in medical circles (and in administrative positions) for ‘miasmatist’ rather than ‘contagionist’ theories of disease (especially in relation to Cholera)
- The inadequate living conditions of the poor especially in the ‘Alley Quarters’.
- Incorrect medical treatment either due to lack of medical knowledge or incompetence.
- The (in)ability of different socio-economic groups to follow the medical instructions provided — whether because of wealth (e.g. ‘rich': able to have their servant boil all their water, ‘poor': unable to resist the fruit which is suddenly cheaply available because normally denied it), literacy (can one read the instructions distributed), respect for ‘authority’, etc.
One would not expect to have a single explanation put forward but it would be useful to have some indication of which of these items were the more important, particularly where different reasons are substitutes not complements. For example, at several points Evans appears to indicate that the water-supply was the single biggest determinant of death by far (he cites a particularly illuminating comparison of a set of apartments that drew its water from two different sources). But if this is so then almost all of the focus should be on the water-supply question and why this public good was not present in Hamburg when it was elsewhere. No doubt, in answering this, one will be lead onto many of the other items as secondary causes but it an important step will have been made in stratifying, and thereby clarifying, the analysis. Furthermore, from this perspective an explicit comparative analysis with other localities becomes essential. While Evans does perform this to some extent, it is largely in terms of the behaviour of the localities in 1892 (e.g. re. imposition of quarantine) rather than the more important investigation of why those localities had sand filtration while Hamburg did not — in particular why had they found the political will to provide this important public good while Hamburg had not? In particular, why were the property-owners in Bremen, Berlin and elsewhere not able to block these same kinds of public infrastructure projects?
Once lead down this route the reader must be increasingly concerned about the weight, and attention, Evans focuses upon socio-ideological explanations (made particularly noticeable by the frequent intrusion of Marxist historiographical language and approach — an influence made explicit in the afterword). As Evans acknowledges in respect of most other disease outcomes Hamburg did little worse than elsewhere in Germany. If this is so how much does the 1892 epidemic really tell us about the society and politics of Hamburg (and vice-versa)? Perhaps if Hamburg had not invested early in its water supply, it would have had an ‘out-of-date’ one by 1892? Perhaps if Veresman had been Burgomaster more rapid and effective steps would have been taken early on that would have dramatically reduced the impact? Perhaps if Hamburg had been more authoritarian (rather than more democratic) the Senate would have been able to improve the water-supply earlier?
This brings me on to my final comment. The contemporary relevance of the book is emphasized in several places, for example on the back-jacket text and in several of the blurbs — Gordon Craig’s NYRB review extract quoted on the cover reads “… about the contemporary relevance of this book there can be no question”. Of course, we should allow for the fact that this was published in 1987 when the AIDS epidemic was receiving very widespread attention. But one does need to ask exactly what one does learn from this book regarding public health? That we should invest in public goods projects? That it is good for medical science to be accurate and correct? That one should respond rapidly to an outbreak of a contagious disease?
Surely the answer to all of these is yes. The devil, of course, is in the detail. how do we trade off the benefits of rapid and sharp response, which is likely to involve sharply restricting movement of persons and goods, against the costs of such restrictions both socially and commercially? What institutional structures will result in adequate investment in public goods and rapid response to public concerns? Are there tensions between responsiveness to concerns (e.g. via full representative government!) and effectiveness in action (which might necessitate a single executive office with significant power and autonomy)? Finally, if the answers to these questions are reasonably obvious (e.g. its Democracy stupid!) then what prevents a polity, whether today or in the 19th century, from acting in the correct way? (Answer: entrenched powers and vested interests — but how did these come into being and how are they overcome?).
The test then of Evans’ book is whether it supplies us with interesting answers to these, more nuanced, questions. In this regard the book, I feel, comes up short. Without a comparative analysis at the social, and more importantly, political level in other German (or European) cities how can we know whether Hamburg’s terrible experience was the result of a common generalizable pattern or mere historical accident?
In sum this an interesting book albeit a little lengthy and heavy-going in places. Confused as to its structure and purpose it largely fails to deliver on its promise to answer the main question posed on its jacket: “Why were nearly 10000 people killed in six weeks in Hamburg while most of Europe was left almost unscathed?” As such it is also limited in the light it can throw on public health problems today. Nevertheless the reader will have been left with a wide-ranging coverage of a whole variety of 19th century topics, most significantly the two items explicitly mentioned in the title: Hamburg and Cholera.