“Heroes of the Battle for sanitary reform”

Historians have recognised that the appointment of the Medical Officer of Health (MOH) was integral in confronting public and environmental health concerns prevalent in Victorian England and were essential in preventing the spread of infectious diseases in the latter half of the nineteenth century.[2] MOH were central to the control of the local public health bureaucracy.[3] The newly established duties appointed to the Medical Officers of Health by local governments were ever-increasing in this period.[4] Bernard Harris states that, the only way to eradicate the ‘evils of poverty’ was to introduce major sanitary reform.[5] In the second half of the nineteenth century water food borne diseases were reduced in half as an impact of sanitary intervention by the state; there was a 44% decline in air-borne diseases due to improvements in diet as a result of the interventions of the Medical Officers of Health.[6] With the ‘rise in infectious diseases’ within towns and cities, the mid-nineteenth century saw a need for more governmental involvement in public health for the first time. [7]

Unlike the twenty-first century where there is a public health framework in place for all and awareness of the causes of infectious diseases the mid-nineteenth century was another story. It was a period ridden in cholera epidemics, small pox and high mortality rates, with the average age of death being twenty-nine in urban areas within the 1840s; In combination with a lack of clear understanding of ‘the propagation of communicable disease’ and no ‘surveillance system to monitor’ these diseases public health became a detrimental problem for Britain.[8] The idea of microorganisms causing disease meant that the government had to introduce alternative methods to ‘combat different sources of infection’. It was also recognised that sanitary reform could only go so far in improving the standards of public health.[9] The Social Science Association suggested that public health law allowed for local authorities to appoint Medical Officers of Health and reorganise internal management into one succinct body who’s focus was ‘to cause local authorities to do their duty’.[10]

W.G Willoughby, the Medical Officer of Health for Eastbourne states that,

“We are required to inform ourselves respecting “all influences affecting injuriously the public health,” to study the etiology of” diseases within the district,” to keep ourselves informed of the “conditions injurious to health,” and “to advise the Sanitary Authority on all matters affecting the health of the district.”[11]

Willoughby articulates that the MOH’s key responsibilities were to determine preventative measures in order to stop the spread of disease as opposed to implementing treatments.[12] In addition to this, Medical Officers of Health ‘spearheaded the Victorian struggle against infectious diseases’, suggesting that they were focused on taking preventative action which would eventually lead to the ‘epidemic streets’ being eradicated.[13]

Medical Officers of Health were instructed to create a report on their specified districts in order to inform the Local board of Health of the issues present; these annual reports outlined the sanitary problems within the districts, as well as including tables and graphs which outlined serious public health problems, such as the number of deaths from epidemic diseases and subsequently the improvements which have been made following the last report.[14]It’s often perceived by historians that MOH produced complacent and monotonous reports and have therefore arguably become propagandists.[15] However, these reports are crucial in providing physical evidence of how public health and the understandings around the causes of infectious diseases evolved throughout the nineteenth-century and even up until modern day.[16] They are integral in showing the unprecedented need for more governmental involvement in public health within the mid-nineteenth century.[17] Roberts states that,

‘In England, where I think the office was first instituted, or at any rate first fully and efficiently developed, the part played by them is of first-rate importance. Upon them is laid, practically, the whole duty of the local administration of the laws relating to public health, and their powers are varied and ample’.[18]

In order to explore how Medical officers of Health were perceived as “Heroes of the Battle for sanitary reform”, the following subsections will be explored,  Danger in the Sewers – Danger in the Drains , Exporting Excellence, A Matter of Mortality – Death and Disease in the Slum, Dora the Slum Explorer and Through the looking-glass – Disposing of the Dead.

[1] Welshman, J. “The Medical Officer of Health in England and Wales” 1900-1974 Watchdog or Lapdog Journal of Public Health and Medicine 19:4 (1997) Page 443

[2] Welshman, J. “The Medical Officer of Health in England and Wales” 1900-1974 Watchdog or Lapdog Journal of Public Health and Medicine 19:4 (1997) Page 443

[3] Goldman, L. Science, Reform and Politics in Victorian Britain. The Social Science Association 1857-1886 (New York: Cambridge University Press 2002) Page 187

[4] Willoughby, W, G. Presidential Address delivered to the Society of Medical Officers of Health on October 14th, 1910. Public Health Journal Available online: https://www.publichealthjrnl.com/article/S0033-3506(10)80018-6/abstract Accessed on 04/11/2018

[5] Harris, B., The Origins Of The British Welfare State: Society, State And Social Welfare In England And Wales, 1800-1945 (Houndmills, Basingstoke, Hampshire: Palgrave Macmillan, 2003) p. 107

[6] Harris, B. The Origins of the Welfare state, Social welfare in England and Wales 1800-1945 (Basingstoke: MacMillan 2004) Page 104

[7] Welshman, John, “The Medical Officer of Health in England and Wales, 1900-1974”, Journal of Public Health Medicine, 19:4 (1997), p. 443.

[8] Page Alan, ‘Sir John Simon: a role model for public health practice?’ in Stewart, Jill, Pioneers in Public Health, p. 24.

[9] Harris, B., The Origins Of The British Welfare State, p. 111

[10] Goldman, L., Science, Reform And Politics In Victorian Britain: The Social Science Association, 1857-1886 (Cambridge: Cambridge University Press, 2007), p. 188

[11] Willoughby, W, G. Presidential Address delivered to the Society of Medical Officers of Health on October 14th, 1910. Public Health Journal Volume 24 Available online: https://www.publichealthjrnl.com/article/S0033-3506(10)80018-6/abstract Accessed on: 04/11/2018

[12] Willoughby, W, G. Presidential Address delivered to the Society of Medical Officers of Health on October 14th, 1910. Public Health Journal Available online: https://www.publichealthjrnl.com/article/S0033-3506(10)80018-6/abstract Accessed on 04/11/2018

[13] Harris, B., The Origins Of The British Welfare State, p. 114

[14] Welcome Library. London’s Pulse: Medical Officer of Health reports 1848-1972 A new kind of Medical Professional (2018) Welcome Trust. Available at: https://wellcomelibrary.org/moh/about-the-reports/new-kind-of-medical-proffesional/ Accessed on: 15/11/2018

[15] Roberts, F, The Responsibilities of Medical Health Officers, The Public Health Journal, Vol. 11, No. 8 (AUGUST, 1920), pp. 348-352, Published by: Canadian Public Health Association, https://www.jstor.org/stable/41972589 page 5

[16] Welshman, J. “The Medical Officer of Health in England and Wales” 1900-1974 Watchdog or Lapdog Journal of Public Health and Medicine 19:4 (1997) Page 444

[17] Welcome Library. London’s Pulse: Medical Officer of Health reports 1848-1972 A new kind of Medical Professional (2018) Welcome Trust. Available at: https://wellcomelibrary.org/moh/about-the-reports/new-kind-of-medical-proffesional/ Accessed on: 15/11/2018

[18] Roberts, F, The Responsibilities of Medical Health Officers, The Public Health Journal, Vol. 11, No. 8 (AUGUST, 1920), pp. 348-352, Published by: Canadian Public Health Association, https://www.jstor.org/stable/41972589 page 5

Illustrations of Clark’s Cottages, Woodford Bridge, now demolished. MOH report for Wanstead and Woodford 1949. Image in: Report of the Medical Officer of Health for Wanstead and Woodford Available online: https://wellcomelibrary.org/moh/report/b1987862x#?c=0&m=0&s=0&cv=0&z=-1.8367%2C-0.2369%2C4.6518%2C1.8159