London's Pulse: Medical Officer of Health reports 1848-1972

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City of London 1969

[Report of the Medical Officer of Health for Port of London]

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produced diseases. Florence Nightingale and Chadwick held to this theory throughout their lives.
John Simon dismissed Henle's theory as unproven and he considered the phenomena of infectious
diseases to be essentially chemical. He found it impossible to accept John Snow's theories and
his empirical proof of the water borne contagion of cholera though he was aware of the dangers
of impure water: he was scrupulously careful in evaluating evidence and was not open to be
convinced easily. In the late I870's Simon was able finally to accept specific contagion as the
cause of infection. He declared "the true cause of each metabolic contagion must either be or
must essentially include a specific living organism able to multiply its kind". He tended if anything
from now on to overstress the germ theory of disease.
On 12th June 1849 Simon had to report to the Court of Common Council that cholera had
struck in some of the dirty, fly infested haunts of the East London district.
I will deviate at this point to mention how interested Monckton Copeman was in flies as
carriers of infection and what an ally he would have been for Simon. Copeman made ingenious
attempts to record scientific observations of flies at different places as comparable as possible.
He set up observation centres and fly-collecting stations. The latter were in most cases private
houses. It was necessary to obtain the co-operation of the occupiers. In this connection he states
that experience in London has shown that no difficulty is experienced in this respect. The centres
were places selected where large quantities of house refuse or stable manure was deposited,
in investigations conducted in London during the previous two years, all operations were carried
out with as much uniformity as possible. Criteria for uniformity were enunciated by him with regard
to selection of collecting stations. These criteria had regard to a ground floor location, fairlylighred,
preferably with sunny aspect, neither specially clean nor dirty, not done up within the previous
6 months, not near other accumulations of refuse or manure, nor in the vicinity of shopswnere
articles of food were sold, and so on. He gave details of the fly traps to be used and one recommended
for uniformity of use was a fly paper known as "The Fly Cemetery" coatedwith a specially
tenacious "honey-gum". Directions as to the use of the fly paper were given and where and how it
should be hung. A scheme for the collection of fly papers at regular intervals of 24,48 antj 72 hours
and arrangements for replacement was instituted. Counting of flies after sorting and so on was described,
as well as curves plotted of catches and comparisons made with curves representing incidence
of deaths from epidemic enteritis and enteric fever. A method of marking flies is described.
This was used to facilitate the accumulation of accurate information regarding range of flight of
flies vertically and horizontal ly. "Spot" maps of the centres on which were super-imposed locations
by means of dots of houses invaded by epidemic enteritis or enteric fever respectively were made.
Metereological Data as to the air and soil temperature, rainfall, direction and force of the wind,
duration of bright sunshine, persistence of rainy weather were kept. If a species of fly trapped was
unknown this was elucidated by arrangement with the British Museum Natural History, South
Monckton Copeman also carried out an interesting study in an endeavour to answer thequestion
"do flies hibernate?"
As far as flies and cholera were concerned Sir John Simon insisted that his inspectorate
was entirely insufficient in this emergency and that the establishment should be immediately
enlarged. The police also should help by inspecting every house in the poorer areas of the City
and report on a special form each nuisance that they found. Simon attended daily at Guildhall
with the Clerk issuing orders to abate the statutory nuisances. 30 citizens had already died from
cholera in the last week of June. The Court had trebled the nuisance inspectorate and during the
summer enforced the works that Simon had ordered. The clearance of a vast amount of removable
filth undoubtedly reduced opportunities for contact spread of the disease. He had urged on the
Board of Guardians to prepare for the epidemic by adopting the measures advocated by the General
Board of Health. This included the provision of cholera wards and places of refuge for evacuees
from cholera infected houses, mortuaries and medical relief of the poor. The method of house
visitation was to be instituted in the poorer areas in order to find out and treat any premonitory
diarrohoeal symptoms of cholera. The Court of Common Council established in July a special
health committee of 12 members with powers to spend sums in medical relief. Deaths increased
in the last weeks of July from 30 to 39 and then leapt to 68.
Simon insisted that the sewers should be incessantly flushed into the River and that the
sewage strewn docks and mudbanks of the Thames should be cleansed. Sewer flushing into the
river aggravated the epidemic. After a lull in early August the cholera suddenly became water
borne. There were 82 deaths in the week ending 18th August and 100 in that ending September 1st.
In the Metropolis at large nearly 2,000 people a week were dying by the end of the month. The
headline of the Times appeared "We must cleanse or perish". The large London Hospitals were
packed with cases of cholera and had to close their doors to sufferers seekingadmission. On
3rd September the Health Committee finally agreed and allowed the M.O. to set up a hospital and
provide medical assistance to the Poor Law M.Os. out of the City's own funds. We see Simon's
co-ordination of preventive and curative action by appointing 10 Assistant M.Os. to help the Poor
Law doctors. However the Court of Common Council failed to ratify the Committee's action when
they met on 7th September so that the Hospital project was not approved and Simon had to dismiss
his medical assistants. In this week over 94 people had died of cholera in the City — 2,200 in the