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The failure of expertise: public health policy in Britain during the 1918-19 influenza epidemic.

This article attempts to account for the paradox that Britain, with one of the most highly developed public health establishments of the period, mounted one of the least effective responses to the influenza epidemic of 1918-19. The episode is located in the context of the Great War, the evolution of the medical profession, and official public health policy. Motivated primarily by concern for their recently-acquired status, medical professionals and public health administrators deprecated the virulence of the epidemic and counselled the public to ignore its ravages. Only at the local level of administration, and at the initiative of lay members of public health committees, was there pragmatic attention to the acute social problems created by the epidemic. Faced with institutional obstacles and scarce resources, these efforts had little real impact but in their underlying assumptions were the only effective response to influenza in Britain in 1918-19, with health professionals playing a passive, or even obstructionist, role. The deficiencies of Britain's epidemic policy are accountable not in spite of, but because of a well-established and self-consciously scientific medical profession and public health establishment.