In The Filth Disease: Typhoid Fever and the Practices of Epidemiology in Victorian England, Jacob Steere-Williams draws attention to the prototypical filth disease, one that was nominalized as such by professionals who developed systematic ways of understanding the frequency and distribution of disease amongst populations. Typhoid, Steere-Williams contends, shaped the science, practice, profession, rhetoric, and culture of British epidemiology during the latter half of the nineteenth century.

Steere-Williams opens the introduction to The Filth Disease with reference to John Simon's near-eponymic The Filth-Diseases and Their Prevention (1874), wherein Simon begins his widely read monograph by centralizing the model filth disease. Steere-Williams shows, however, how typhoid was not singularly Simon's rhetorical, performative, and material point of articulation. It was a critical node among the national public health apparatus that he helped usher in. In the first chapter, “A Royal Thanksgiving,” Steere-Williams focuses on Prince Albert Edward's prolonged bout of typhoid fever, which drew connections between illness experienced by individuals, practitioners, and Victorian culture at large (31). The decade following the prince's spectacular convalescence was “the most prolific period in English epidemiology” (26), in part due to the effort to source the cause of the prince's attack. In detailing these investigations, Steere-Williams highlights how sewer gas, as a theorized medium of transmission, helped catalyze the epidemiological gaze. The particular debates surrounding this etiological mode were “anything but an antiqued view of miasma theory” (67).

Chapter 2 transitions congruently from aerial to waterborne transmission. The waterborne theory, Steere-Williams contends, marked the inefficient infrastructures of waste removal and waterworks. From 1865 to 1880, the waterborne theory occasioned specific outbreak investigations that provided “a testing ground for a number of qualitative and quantitative epidemiological methods, such as experimentation, case tracing, interviewing, statistical analysis, and visual strategies such as making diagrams and maps” (79), forming what one practitioner called “via exclusionis, the favourite method” (quoted in 122) among inspectors at the Medical Department. In this period, epidemiologists would performatively command public health recommendations, ignoring, often deliberately, the still burgeoning applications of bacteriology and chemistry to public health fieldwork and policy.

In chapter 3, “Nature's Not-So-Perfect Food,” Steere-Williams details the entanglements of milk-borne theories of typhoid transmission. Epidemiological episodes that followed through the early 1870s brought to light the fact that the “health of the urban middle class—the principle drinkers of cow's milk—very much depended on complicated food pathways and sanitary habits of rural farmers” (27). As epidemiological investigations continued to become systematized and gained rhetorical power, centralized inspectors at the Medical Department had to interact with local officials and institutions. Ultimately, the milk-borne hypothesis and outbreaks raised “new questions about epidemiological, chemical, and veterinary expertise; about the culpability of milk sellers, dairymen, and farmers; and about the imaginary geopolitical lines between urban, suburban, and rural food pathways” (131).

Steere-Williams explains how epidemiological field work began to come to some terms with bacteriology in chapter 4, “Soils, Stools, and Saprophytes.” Epidemiologists at the Medical Department “cautiously engaged the new sciences of bacteriology in the 1880s and 1890s, particularly after the discovery of B. typhosus” (176). Even in the wake of this discovery, epidemiologists held fast their recently established qualitative and quantitative methods. The viability of animate microbial agents to epidemiological investigation hinged upon the typhoid bacillus's ability to persist outside the human body. The integration of laboratory and outbreak investigation became possible with soil-based research, “the crucial testing ground in the 1890s,” which drew attention to the “sporadic but persistent outbreaks of waterborne typhoid” (177). In the age of bacteriology, water, like milk, became a fluid, proximate medium which the ultimate causal agent—the bacterium—inhabited.

In the final chapter, Steere-Williams extends the microbially muddied gaze from English soil to English soldiers and their imperial milieus. “Typhoid in the Tropics” documents how enteric fever thwarted colonial efforts and the public health infrastructure it required, especially in theaters such as the South African War. In this chapter, Steere-Williams attends to the new level of public consciousness of the disease and the complicated relationship between British epidemiology and the longer history of military medicine. Steere-Williams proceeds by drawing into sharp relief the racialized discourse surrounding disease transmission in an increasingly globalized world. Field investigations continued to face challenges, especially given the long-standing typhoid denialism that “narrowed the gaze of an earlier generation of British military medics, especially in India, to focus on white European male bodies, ignoring and rejecting the filth disease in indigenous bodies” (269). The Filth Disease concludes with a timely discussion of the afterlife of Victorian epidemiology in which we learn how certain histories of epidemiology come to be remembered within the discipline while others do not. As epidemiological methods began to change nearing the mid-twentieth century, so, too, did the way in which epidemiologist wrote about their own history (274).

As a whole, Steere-Williams convincingly documents the uneven developments in the culture of epidemiology. The organizing logic around mediums of transmission makes this case especially clear. This detailed and expansive monograph should be required reading for historians of public health and epidemiology. Scholars of British studies working on histories of empire, state and municipal relations, infrastructure, and professionalization will find The Filth Disease to be a valuable resource. While British constructions of masculinity is not a central focus of this study, scholars working in area might also find the cultural context of typhoid and the men against death of particular interest. The book's focus on medium of transmission and discussion of epidemiology's historiography would also be generative for the current inquiries into the history of droplet and aerosol transmission theories in the wake of COVID-19. Ideally, The Filth Disease should inform future authors of textbooks focused on introductions to epidemiology and public health.

Readers will not find neither discrete stories of contagion, miasma, and microbes nor mythologized histories of John Snow. What they will find, however, is a nuanced case study of developing chains of evidence, hallmarks of outbreak investigation, and rhetorical performances of Victorian epidemiology.