The “necessaries of life” in British political medicine, 1750–1850

At the beginning of the nineteenth century, the medical concept of “necessaries of life”—i.e., food, heat, clothing, and shelter—became controversial in Britain. The new domain of political economy, in both its Smithian and its Malthusian modes, challenged the view that necessity was either a measurable concept or a deliverable right. For the political economists, “necessity” was relative, a standard erected by class and culture. Many doctors and surgeons resisted that relativism, insisting that the fever epidemics they were responding to could be directly or indirectly attributed to the absence of such “necessaries.” The first half of the article reviews the distinct debates between doctors and economists on these issues in England, Scotland, and Ireland during the first half of the nineteenth century. By mid-century these so-called “necessaries” had largely been de-medicalized and transformed into the status of consumer commodities. The second half of the paper describes the quite different list of necessities that replaced them in public health campaigning and administration during the second half of the century.