Over the decades, and often imperceptibly, every home, street and workplace was shaped by the work of Medical Officers of Health (MOHs). In their reports we find unexpected angles on histories as diverse as work and empire. Port reports of attempts to track and contain plague outbreaks reconstruct the movements of ships and their cargoes across the globe, and in doing so they vividly convey London's position at the centre of a world trading system.
It is in discussions of bylaws on the disposal of dead horse carcasses or on the creation of manure and refuse sites that we can track the gradual cleaning of the streets; and it is in the testing and removal of contaminated milk by sanitary inspectors as much as in the growth of sanatoria and vaccination that we can understand the decline of tuberculosis.
In the 1860s around a third of all deaths were from infectious disease; this had declined to a quarter by 1911, and to under 4% by 1951.
While the Corporation of the City of London remained largely independent in its working, the rest of the metropolis was organised by parishes run by their vestries. In 1855 these were brought under the overview of the Metropolitan Board of Works, the nearest thing the capital had to an overseeing body until it was superseded by the London County Council in 1888. In 1900 the vestries ceded their powers to larger metropolitan boroughs. Before World War II, painstaking enumerations of children inadequately clothed and shod, infested with head lice, scabies and impetigo, and suffering from uncorrected squints or physical disabilities reveal how poverty was inscribed on the bodies of London's poorest. Over time, open sewers, contaminated water, damp bedrooms infested with bugs, tuberculosis-infected milk and high infant mortality rates became less common, largely disappearing by the 1970s.
If the reports chart the decline of some issues, they also track the rise of others – heart diseases and cancer gained relentless prominence from the interwar period. After 1945, the expanded place of social services in the lives of Londoners is reflected in the number of committees and services dealing with "juvenile delinquents", "maladjusted children", "problem families" and indeed "potential problem families".
Often the lives of London's women are revealed in the MOH reports in the starkest terms: maternal mortality rates, which remained stubbornly high into the 1930s, were perhaps the most visible indicator. But, by looking for example at numbers of people per room, infant mortality rates, deaths from infectious disease, and the percentage of women with profound dental decay or children with rickets, it is not hard to gain an insight into how poor nutrition, scarce resources and slum housing shaped millions of women's everyday existence.
We also see the changing lives of women in the different ways in which they appear as medical professionals in MOH reports. At first completely absent, they have their first mention as nurses in 1856 - though not yet as part of the public health profession, but rather lumped in with domestic servants in a consideration of different occupational death rates. Gradually, however, they slip into the pages, as nurses, handywomen and midwives, then medical assistants, and finally Assistant MOHs and even full MOHs. We also see the creation of the roles of health visitor, school nurse and social worker - professions dominated by women.
If MOH reports are able to give unique insights into the changes and developments in London life and that of the nation, they are no less equipped to reveal the continuities. Infant and maternal mortality rates may have decreased, yet the depressing fact revealed in MOH reports is that poor Londoners continued to be far unhealthier, live in unsatisfactory or overcrowded housing and be more vulnerable to occupational illnesses than the rich. Slum housing and health inequalities across the capital in the early 1970s were still a stark reminder that there was much work left to be done. That they had narrowed so much was in no small part due to the relentless work of the Medical Officers of Health.
Find Out More
- The Wellcome Library has lots of information about London in its archive collections – see our Local History subject guides for details.
- The Charles Booth Online Archive contains the original records from Booth's survey into life and labour in London, dating from 1886 to 1903, including maps!
- London Metropolitan Archives (LMA) holds a diverse collection of archives, records, images, films and maps that can help researchers in all aspects of London's history.
- Most of the current London boroughs have public archives services. See the ARCHON directory list of repositories in London for details.
- Porter, R. London: a social history. London: Hamish Hamilton; 1994. Available in the Wellcome Library.