Sunday, April 05, 2020

Friedrich Engels, the English working class, and incipient social epidemiology

Friedrich Engels’ act of socialist sublimation on behalf of value-laden and principled social scientific description and causal explanation: “’I forsook the company and the dinner-parties, the port-wine and champagne of the middle classes, and devoted my leisure-hours almost exclusively to intercourse with plain working men,’ he explained.” 

Engels’ The Condition of the Working Class in England (1845) was written during his 1842–44 stay in Manchester, the city at the heart of the Industrial Revolution in Europe, and “compiled from Engels’ own observations and detailed contemporary reports. After their first meeting in 1844, Karl Marx read and was profoundly impressed by the book.”

“[Engels] shows, for example, that in large industrial cities such as Manchester and Liverpool, mortality from disease (such as smallpox, measles, scarlet fever and whooping cough) was four times that in the surrounding countryside, and mortality from convulsions was ten times as high. The overall death-rate in Manchester and Liverpool was significantly higher than the national average (1 in 32.72, 1 in 31.90 and even 1 in 29.90, compared with 1 in 45 or 46).” 

First, consider the description immediately below of what we now term “social epidemiology”1 from Richard W. Miller’s Fact and Method: Explanation, Confirmation and Reality in the Natural and Social Sciences (1987). The reference to 19th century Manchester immediately reminded me of Friedrich Engels’ “classic indictment” of this rapidly industrializing city in The Condition of the Working Class in England, hence our discussion of the book follows thereafter.

“In the organized pursuit of explanation, practical concerns may…dictate choice of a standard causal pattern. In the early nineteenth century, many investigators had come to explain the prevalence of certain diseases in certain places as due to filth and overcrowding. For example, the prevalence of tuberculosis in urban slums was understood this way. In these explanations, the microbial agent was not, of course, described. But the causal factors mentioned were actual causes of the prevalence of some of those diseases. If Manchester had not been filthy and overcrowded, tuberculosis would not have been prevalent. On the purely scientific dimension, acceptance of accurate environmental explanations probably did not encourage as many causal ascriptions as would a standard requiring explanation of why some victims of filth and overcrowding became tubercular, some not. Those who pressed the latter question were to lead the great advances of the germ theory. But in a practical way, the environmental explanations did a superior job, encouraging more important causal accounts. Guided by those accounts, sanitary measures produced dramatic reductions in tuberculosis and other diseases, more dramatic, in fact, than the germ theory has yielded. A perspicacious investigator might have argued, ‘We know that some specific and varied accompaniment of filth and overcrowding is crucial, since not every child in the Manchester slums is tubercular. But we should accept explanations of the prevalence of disease which appeal to living conditions. For they accurately, if vaguely, describe relevant causal factors, and give us the means to control the prevalence of disease.”2 

Sridhar Venkatapuram summarizes the limitations of the prevailing biomedical (or bio-statistical) model of epidemiology, the model we’ve heard references to during the coronavirus (COVID-19) pandemic, although some journalists, medical experts, and astute observers have noted the differential toll the virus is taking on poorer and more vulnerable communities and groups (an example of the last being those incarcerated in jails and prisons), thus (inadvertently?) highlighting the constraints of that model:

“Three specific limitations of the prevailing model of disease aetiology are often at the centre of debates about the ‘paradigm crisis’ in epidemiology. These include its level of analysis, its inability to recognize distribution patterns, and its partially informed recommendations for policy. The current model, which evolved from the late-nineteenth-century germ theory of disease, recognizes three categories of causal factors. These factors include biological endowments, behaviours and external exposures to harmful substances or ‘agents.’ The resulting limitation of this model is that it operates only a single level, at the individual level, and expresses a form of explanatory individualism. Short causal pathways confined to the human body are studied, while the model precludes recognizing and supra-individual level factors or social processes as part of the longer causal chain in the production of disease. As a result, the model studies individuals in a vacuum and disconnected from other individuals; it is only focused on what happens on and within the skin of individuals.

Furthermore, populations are understood as just a collection of individuals with no emergent properties. Therefore, public or population health is just the summation of the health of individuals. An individual, proximate factor analysis is restricted in recognizing the longer causal pathways to disease in individuals and restricted in recognizing the causal factors of disease distribution in population. 

The second limitation of the model is that it can only recognize certain patterns of distribution of disease and mortality across human beings. Because it can only group individuals according to biological features, behaviours, or external exposures, it has no internal source of information of grouping individuals by any other characteristics, namely, social characteristics. Grouping individuals according to social characteristics in this model would be seen as unscientific and political. Thus, the inability to group individuals according to social features precludes the models inability to analyse the possible causal impact of social conditions. [….] Epidemiology is interested in what causes diseases in human beings as organisms, not why disease is distributed unevenly in historically contingent and culturally specific social groups. The concern over distribution appears to be ‘normative,’ as it is about inequality, while the search for causation in individuals is seen to be scientific. [….]

The third limitation of the current model is that an explanatory model with restricted explanatory power and the limited capacity to recognize distribution patterns will prescribe only partially informed—and consequently incompletely effective—health policies.”3 [emphasis added]  
The apparent contradiction or conflict between the “normative” concern over distribution and the “scientific” search for causation in and among individuals rests on a false dichotomy insofar as it fails to respect four interdependent principles from the American philosopher, E.A. Singer, Jr. (1873 – 1954), according to Hilary Putnam:
  1. Knowledge of facts presupposes knowledge of theories.
  2. Knowledge of theories presupposes knowledge of facts.
  3. Knowledge of facts presupposes knowledge of values.
  4. Knowledge of values presupposes knowledge of facts.
Or, as Putnam himself put it in Reason, Truth and History (Cambridge University Press, 1981), “every fact is value loaded and every one of our values loads some facts,” the argument for which was later filled out in Putnam’s The Collapse of the Fact/Value Dichotomy and Other Essays (Harvard University Press, 2002).4

Miller Fact and Method  

In an article in The Guardian over ten years ago, Tristam Hunt5 wrote: 

In the spring of 1863, toiling away at Das Kapital in the reading room of the British Museum, Karl Marx read again Friedrich Engels’s classic indictment of industrial Manchester, The Condition of the Working Class in England. He immediately wrote to his friend to re-congratulate him on a work of steely fury: ‘What power, what incisiveness and what passion drove you to work in those days. That was a time when you were never worried by academic scholarly reservations! Those were the days when you made the reader feel that your theories would become hard facts if not tomorrow then at any rate on the day after.’ 

Today, the power, incisiveness and passion of Engels's polemic remain undiminished. Far more so than Charles Dickens’s Hard Times, Benjamin Disraeli’s Sybil, or Thomas Carlyle’s Past and Present, Engels’s The Condition of the Working Class is the defining text of the British industrial experience. And, 150 years on, it speaks to our age with painful prescience—not only in its critique of the instability of the free market and the structural inequalities of British society, but in its unrivalled depiction of the inhumanity of capitalism. With Brazil, Russia, India and China experiencing just the kind of breakneck economic growth that transformed British society in the 1800s—villages turning into cities, peasants swapping fields for factories, and mass exploitation grinding out higher GDP—Engels’s polemic resonates with terrifying force. 

The young Engels had in fact been sent to Manchester in 1842 precisely to rid him of radical sentiments. His father, a conservative textile manufacturer from the Rhineland, had been increasingly concerned about the circle of Young Hegelians Engels had been associating with in Berlin. Instead of dutifully performing his military service, he had succumbed to the beer rooms and lecture halls of Berlin University where the philosophies of Hegel, Ludwig Feuerbach and David Strauss were debated with boozy gusto. All of which led him to abandon his Protestant faith for Feuerbach’s religion of humanity, before then falling in with the ‘communist rabbi’ Moses Hess who taught him that modern capitalism was just as dehumanising a force as Christianity. The solution, Hess suggested, was socialism: the abolition of private property and an end to the alienating effects of the money economy. And in the march toward socialism, England—where the industrial revolution had left a deep chasm between rich and poor and where the proletariat was most advanced—would provide the social kindling of revolution. Engels looked to use his two years in the north-west to marshal the material evidence he needed 

From 1842-44, he worked during the day at the Ermen & Engels mill in Salford, before plunging after hours into the Manchester underworld. ‘I forsook the company and the dinner-parties, the port-wine and champagne of the middle classes, and devoted my leisure-hours almost exclusively to intercourse with plain working men,’ he explained. He visited Owenite Halls of Science, spent time with Chartists, watched a brickmakers’ riot, and with his Irish lover Mary Burns sought out the human detritus of capitalist society. He found it on the south side of the city, just off Oxford Road, where some of Manchester’s 40,000 Irish immigrants huddled. Burns’s confreres were the most exploited, lowly paid and abused of all the city’s residents: ‘The race that lives in these ruinous cottages, behind broken windows, mended with oilskin, sprung doors, and rotten door-posts, or in dark, wet cellars, in measureless filth and stench, in this atmosphere penned in as if with a purpose, this race must really have reached the lowest stage of humanity.’ 

Engels was relentless in charting the ‘social war’ waged by the middle class on the operatives of the industrial city. Workplaces—mills, mines, factories, farms—resembled crime scenes. ‘Women made unfit for childbearing, children deformed, men enfeebled, limbs crushed, whole generations wrecked, afflicted with disease and infirmity, purely to fill the purses of the bourgeoisie.’ He was inflamed by the Manchester middle classes. ‘I once went into Manchester with a bourgeois, and spoke to him of ... the frightful condition of the working people’s quarters, and asserted that I had never seen so ill-built a city. The man listened quietly to the end, and said at the corner where we parted: “And yet there is a great deal of money made here; good morning, sir.”’ 

Behind Manchester’s ‘planless, knotted chaos of houses’ there was a brutal logic to the urban form: ‘Cottonopolis’ was zoned along class lines to ensure that the rich never caught sight of what they had done to the poor. Manchester’s ‘money aristocracy’ lived in the ‘breezy heights’ of Cheetham Hill and Broughton and travelled along Deansgate into town ‘without ever seeing that they are in the midst of the grimy misery that lurks to the right and the left.’ Engels understood that the city's spatial dynamics—its streets, houses, factories, and warehouses—were expressions of social and political power. The struggle between bourgeois and proletariat was tangible in street design, transport system and planning process. 

Engels wrote Condition of the Working Class back home in Barmen, under the stern glare of his parents; it was first published in Leipzig in 1845. As such it formed part of a broader continental literature detailing the effects of advanced industrial growth on social conditions. Engels aimed the work at the Prussian bourgeoisie in the hope that such a stark depiction would lead them to choose socialism rather than Manchester’s free-market fundamentalism. [….] 

The book now takes on a dimension beyond its obvious historical importance as a work of Victorian reportage and insight into the genesis of Marxism. In one of the largest mass migrations in history, some 120 million Chinese peasants have, since 1980, made their way from the country to the city, and to read accounts of contemporary urban China is to be thrown straight back into the cityscape of Engels. Cancer rates soar along polluted waterways; rivers turn black with industrial effluent; water is unsafe to drink; acid rain strips forests; some 300,000 die prematurely each year from air pollution; a generation of children is being brought up with high levels of lead poisoning. As China assumes the mantel of ‘workshop of the world,’ the special economic zones of Guangdong and Shanghai appear eerily reminiscent of 1840s Manchester and Glasgow. Compare and contrast, as the scholar Ching Kwan Lee has done, Engels’s account of employment conditions in 1840s Manchester—‘In the cotton and flax spinning mills there are many rooms in which the air is filled with fluff and dust .... The usual consequences of inhaling factory dust are the spitting of blood, heavy, noisy breathing, pains in the chest, coughing and sleeplessness .... Accidents occur to operatives who work in rooms crammed full of machinery’—with an account of working life by a Chinese migrant worker in Shenzhen in 2000: ‘There is no fixed work schedule. A 12-hour workday is [the] minimum. Our legs are always hurting. There is no place to sit on the shop floor. The machines do not stop during our lunch breaks. Three workers in a group will just take turns eating, one at a time ... The shop floor is filled with thick dust. Our bodies become black working day and night indoors. When I get off from work and spit, it’s all black.’ [….] 

… [I]n the developed world, much of Engels’s analysis of the urban form reads as a telling critique of the gentrification programmes which entail the demolition of working-class neighbourhoods and curtailing the informal space of the city. Of course, the language has changed: policy-makers talk now of ‘sink estates’ rather than ‘slums,’ of ‘worklessness’ rather than ‘the residuum’ and in Britain the forces of progress come in the guise of ‘New Deal for Communities’ or ‘Housing Market Renewal Funds.’ Even Engels’s adopted city has not been unaffected. While Manchester’s revitalised city-centre glistens, Moss Side and Garton have somehow failed to prosper. 

The Condition of the Working Class in England is far more than the work of an angry young man confronting the iniquities of industrial capitalism. It is a brilliant polemic by a sensationally gifted 24-year-old applying German philosophy to existing conditions with a sure eye on the revolution to come. As the experiment of 20th-century state communism recedes into memory, like Marx we can at last return to The Condition of the Working Class and appreciate the work on its own terms. To do so is to discover in its economic critique of unfettered markets, condemnation of capitalism's social injustices, angry reportage, and analysis of politics, poverty, feminism and urbanism all the power, passion and incisiveness which Marx rightly heralded.” 

This is in general agreement with the judgement rendered at the end of Eric Hobsbawm’s characteristically perceptive chapter on Engels’ study (one of a handful the latter penned) in How to Change the World: Reflections on Marx and Marxism (2011): 

“The truth is that Engels’ book remains today, as it was in 1845, by far the best single book on the working class of the period. Subsequent historians have regarded and continue to regard it as such, except for a recent group of critics, motivated by ideological dislike. It is not the last word on the subject, for 125 years of research have added to our knowledge of working class conditions, especially in the areas in with which Engels had no close personal acquaintance. It is a book of its time. But nothing can take its place in the library of every nineteenth-century historian and everyone interested in the working-class movement. It remains an in indispensable work and a landmark in the fight for the emancipation of humanity.”6 

In conclusion, we might view Engels’ The Condition of the Working Class not only as a pioneering and perhaps matchless historical examination of the English working class, but a work of incipient social epidemiology as well, in other words, an historically-informed, value-laden, and principled social scientific description and causal explanation of poor health, sickness, and mortality rates among members of the working class under the inhumane conditions of capitalist industrialization.

Health justice

  1. See, for example, Lisa F. Berkman, Ichiro Kawachi, and M. Maria Glymour, eds., Social Epidemiology (Oxford University Press, 2nd ed., 2014). For an excellent introduction to same, one which relies on the “capabilities approach” to social justice pioneered by Amartya Sen and Martha Nussbaum, please see Sridhar Venkatapuram’s Health Justice: An Argument from the Capabilities Approach (2011). As Venkatapuram explains, social epidemiology transcends, while incorporating, conventional biomedical (bio-statistical) epidemiology.
  2. Richard W. Miller, Fact and Method: Explanation, Confirmation and Reality in the Natural and Social Sciences (Princeton University Press, 1987): 94.
  3. Sridhar Venkatapuram, Health Justice: An Argument from the Capabilities Approach (Polity Press, 2011): 75-77.
  4. For the role of normative principles and values in science, I’ll cite just three of a number of possible titles in the relevant literature that I’ve found helpful: Philip Kitcher’s Science, Truth, and Democracy (Oxford University Press, 2001) and Science in a Democratic Society (Prometheus Books, 2011), and Andrew Sayer’s Why Things Matter to People: Social Science, Values and Ethical Life (Cambridge University Press, 2011).
  5. Tristam Hunt, “War of the Words,” The Guardian, 8 May 2009.
  6. Eric Hobsbawm, How to Change the World: Reflections on Marx and Marxism (Yale University Press, 2011): 89-100.


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