A HEALTH CENTURY
By E. ASHWORTH UNDERWOOD
AGLANCE at any dictionary of dates will show that the year 1848 was a period of revolution in many European countries. Though England was free from civil strife, there were wordy battles of great violence in both Houses at Westminster. The result in this country was also a revolution, a social revolution which has had a great effect on the health and comfort of the people. The rise of industrialism in the towns led to an urgent demand for cheap houses which was not beyond the ability of the jerry-builder to supply. But there were no authorities with the power to control these builders and to check the abuses to which they gage rise. The great cholera epidemics of 1831-32 caused a wave of fear to pass over the whole land. Though infected water was not at that time regarded as a cause, most medical observers were agreed that the disease was more prevalent and more fatal in the poorer districts.
Action, immediate and drastic, was required, but it was not forth- coming. Even sixteen years later the deplorable conditions of all manufacturing towns—including the metropolis itself—could be catalogued by official reporters literally ad nauseam. A distinguished surgeon, lecturing in 1847 on•behalf of the recently formed Health of Towns Association, said that the causes of the high mortality in towns could be traced to an excessive density of population, to want of ventilation, to defective paving, drainage and sewerage, to the filthy state of dwellings, to the concentration of unhealthy and putrescent emanations from narrow streets, courts and alleys, to crowded unhealthy workshops and to injurious occupations. From the royal palace downwards to the meanest hovel houses were very frequently built over cesspools, and the sewers were so old and badly constructed that they often polluted the wells. At about this period the directors of the Bank of England were invited by an anonymous .correspondent to meet him in the bullion room of the Bank, since
he said he had access to it. An appointment was made, and the horrified directors saw the man appearing from the floor of the room. He had walked from Dowgate along the old sewer. Conditions in the houses of the poor beggared description, with overcrowding, darkness, squalor and the all-pervading damp. In 1848 the Metro- politan Sanitary Commission recommended the cleansing and ventila- tion of houses as a preventive of cholera ; but they noted that the outside air might be so bad that the inhabitants had to keep the windows shut to exclude it.
It was against these conditions that the Public Health Act of 1848 was directed. The passing of the Act is being commemorated during the next few weeks by the "Health of the People Exhibition," at the Government Exhibition Site, Mount Royal, Marble Arch. This was the first of all the great public health Acts. It was the first step in our code of health legislation. The period between 1832 and 1848 gives an excellent example of the difficulties which sometimes encom- pass the obvious. Rent-profiteers were reaping a rich harvest, and the multitude of small authorities were jealous of their rights, and anxious about little beyond their personal privileges. A pioneer of integrity, courage and simple aim was required. In 1832 the man was already in the service of the Government, yet it was not until six years later that he really began to make himself felt in this field, and ten years of hard work were needed to achieve the passing of the necessary legislation. Edwin Chadwick came to his task through the medium of the Poor Law. The Poor Law Commissioners, of which Chadwick was the leading member, were concerned about the effects of preventable disease in causing pauperism. Their report of 1838 was buttressed by independent enquiries by three physicians of standing—Neil Arnott, James Phillips Kay and Southwood Smith. The public conscience was at last stirred. Chadwick's persistence led to the appointment of a Select Committee and later a Royal Corn- mission. The final result was the Public Health Act and the appoint- ment of a General Board of Health in 1848.
If anyone who is interested will glance through the sixty pages of this Act he will find tat it deals skilfully with a surprisingly wide range of abuses, nuisances, offensive trades, the maintenance of the sewers, the registration of common lodging houses and cellar dwel- lings. This does not complete the list. One would have expected the Board, armed with such powers, to make rapid work of the task before it. That it did not suggests that there was a weakness in the Act. Such was indeed the case. It was permissive and not obligatory, so that the Board could only force a local authority to adopt it after a tedious and expensive local enquiry This detect was remedied later—but only after eighteen years. The Board itself— Lord Carlisle, Lord Shaftesbury and Chadwick—was not a success. Chadwick tried to coerce where he should have persuaded. His belief in the ability of the Board to act as an executive authority was not shared by others.. In 1854 Chadwick passed from the official sphere, and a new Board of Health began to function on rather different lines. For fourteen years he had wielded quite exceptional influence. Armed with the statistical bullets of William Farr, he had attacked every stronghold fearlessly and with complete confidence in the justice of his cause.
For the City of London this year is also a centenary. The Corpora- tion is on Friday of this week commemorating the appointment of Sir John Simon as its first Medical Officer of Health. By a short head Liverpool was the first area in this country to appoint such an officer, in the person of William Henry Duncan. .Simon remained with London for seven years—until he was called to advise the Board of Health in a wider capacity. He served the Government as its chief medical officer for over twenty years, and when he resigned in 1876 the strenuous efforts which had been made by him and his colleagues were at last beginning to show a dividend in the form of a reduction of the death-rate. The City of London, for the health of which Simon accepted responsibility in 1848, was a very different place from what it is today. The resident population was 125,500, and the death-rate of 3o per xpoo living was nearly three times the lowest suburban mortality recorded by the Registrar- General for the same year. There had been few improvements in sanitation since the cholera of 1832. Later in the year 1848 cholera again broke out, and before it finally disappeared in November, 1849, it caused nearly five times as many deaths as it had accounted for at its first visit. This was the heritage to which Simon fell heir.
In later years, as principal medical officer to the Privy Council and the Local Government Board, Simon himself wrote many famous reports, and his colleagues were responsible for others which were issued with his authority. These later reports have perhaps overshadowed those which he wrote during his seven years with the City of London. Yet the London reports are classics of their kind. Simon had no guide to point the way, but in seven years he achieved miracles. There were no previous health reports to serve as examples, yet his first report reads as if it had behind it the traditions of fifty years of health administration. His attack on the evils of the time was an advance, on six points, against defective drain- age, polluted water-supplies, the regulation of offensive trades (pre- paratory to their complete exclusion from the City), the practice of burial in the vaults of churches, unfit houses and the unhealthy habits of those who dwelt in them. When he deft the City for Whitehall seven years after his appointment, rapid progress had been effected under all these heads. Simon could point with pride to the fact that, while cesspools were still very common in the houses of the great, they had been completely abolished through- out the whole of the square mile of the City. He had built up a regular system of inspection of houses, and he had laid the founda- tions of a sound system of collecting and utilising local statistics. In his campaign for the abolition of underground slaughter-houses and in other ways he showed a fearless disregard for the dictates of vested interests, and year after year he reverts in his reports to his conception of the duties of his Authority. Chadwick, Farr, Simon— these three men laid the sure foundations of English public health, which after a century of progress now seems about to enter on a phase of even closer association with the individual lives of the people.
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