Friday, 9 October 2015

Towards a healthy city

In this week's blog, Archivist Louise learns how 'auld reekie' cleaned up from LHSA's public health collections:
You may have seen our recent social media promotion of a very special event at the Royal College of Surgeons of Edinburgh on 21st October celebrating 150 years of the ground-breaking 1865 work, Report on the Sanitary Conditions of Edinburgh, by the city’s first Medical Officer of Health, Henry Duncan Littlejohn (1826 – 1914). Ruth (LHSA Manager) and I are going along to the symposium, not only because the content will be fascinating and deals directly with our work, but also because we’re raiding the LHSA stores to take along some items for the afternoon to bring the history of public health in our city alive.

The symposium programme begins with a talk on the history of the development of public health in Edinburgh since Littlejohn’s 1865 report, followed by an account of the current health of the city delivered by NHS Lothian Director of Public Health, Professor Alison McCallum. The day finishes by discussing the legacy of Littlejohn’s work, and whether in 2165 (150 years from now), we will continue to capitalise on Littlejohn’s innovative legacy.

Luckily for everyone, I’m not a doctor, so cannot help with the city’s current ills, and I definitely can’t see into the future, but I can help to shed light on the history of public health changes in Edinburgh through LHSA collections. We’re taking along items that span the period from Littlejohn’s time until the developments in healthcare with the coming of the NHS, including images of nurseries and the school medical service in the 1940s, a letter-book describing insanitary houses in Leith in the early twentieth century and mementoes and memories of Littlejohn as a lecturer at the University of Edinburgh Medical School (Littlejohn was appointed to the Chair of Medical Jurisprudence at the University in 1897).

Henry Duncan Littlejohn was appointed Medical Officer of Health for the city in 1862, a post that he occupied until 1908. Born in Leith Street and educated at the University of Edinburgh Medical School (from which he graduated in 1847), Littlejohn was appointed as the city’s Police Surgeon in 1854.  Littlejohn’s career developed as he lectured at the Royal College of Surgeons of Edinburgh and appeared in the judiciary courts as a crown medical examiner. However the November 1861 tragedy in the High Street in which a tenement collapsed killing 35 people brought Edinburgh’s appalling housing and sanitary conditions for the poor into sharp relief. The Town Council put the appointment of a Medical Officer of Health to the vote and, by the narrowest of margins (only one vote), Littlejohn and his department began to transform birth, life and death in our city.

My favourite item from those I’ve chosen for the display is the Report on the Evolution and Development of Public Health in the City of Edinburgh from 1865 to 1919 (LHB16/2/1). Admittedly a bit of a mouthful, the report by John F Young details the progress in making Edinburgh a cleaner, happier and healthier city since Littlejohn’s 1865 report. Report on the Sanitary Conditions of Edinburgh was the result of painstaking work by Littlejohn and his sole clerk. It was based on data that they collected in 1863 on death rates, disease and housing conditions in 19 districts that Littlejohn defined in Edinburgh. The report also included recommendations on steps that could be taken to improve the poorest areas of the city, such as decreasing overcrowding, lowering the height of tenements, improving existing housing and creating space for more sanitary new houses and streets.
The Report on the Evolution and Development of Public Health in the City of Edinburgh from 1865 to 1919 takes a ‘then-and –now’ approach, comparing the conditions and immediate improvements made in the late nineteenth century with life for Edinburgh’s residents in 1919:

The first pages of Young's report comparing the nineteenth century conditions for those with infectious diseases in Canongate Poorhouse to the green fields and (then!) modern facilities at the City Hospital, opened with Littlejohn's help in 1903 (LHB16/2/1).

Young recounts the dire conditions described in Littlejohn’s 1863 research, such as a tenement called Middle Mealmarket without sink or WC yet housing 248 individuals, and that Edinburgh had 171 cow-byres located directly below human dwellings. He also traces the development of Edinburgh’s sanitary and living condition since Littlejohn’s appointment, particularly listing the legislation which came as a result of his work, such as the 1867 City Improvement Act (a slum clearance scheme), the 1889 Notification of Diseases Act (particularly important in being able to trace the impact of infectious diseases such as TB) and the City Act of 1891 which empowered authorities to removed healthy people from infected houses.

Indoor and outdoor case for TB patients at the City Hospital (LHB16/2/1).

The 1919 Report on the Evolution and Development of Public Health in the City of Edinburgh shows the growth of the Public Health Department from Littlejohn and his clerk in 1862 to a range of functions, including a public health group, a tuberculosis group (comprising infectious disease dispensaries, disinfecting stations and hospitals), food and drugs inspectors, a sanitary department, a VD scheme, a veterinary department (checking the conditions of animal husbandry and slaughter) and a child welfare department. Young’s report was written just as Edinburgh’s pioneering Maternity and Child Welfare Scheme was developed (on which I’ll be writing another blog shortly), a system of care prompted by the number of infant deaths attributed to premature birth and nursing conditions. This scheme was developed under Edinburgh’s second Medical Officer of Health, Dr A Maxwell Williamson, and the necessity of its foundation makes up a large section of Young’s survey:

Table showing deaths of children under five in Edinburgh by area, 1911 - 1915 (LHB16/2/1).

LHSA does not hold a physical copy of Littlejohn’s Report on the Sanitary Conditions of Edinburgh (although you can read a digitised copy here), but we do have an impressive collection from the Public Health Department. The collection covers Medical Officer of Health reports, photographs, as well as documents covering the main roles of the Public Health Department in sanitation, prevention of disease, housing and child welfare. Its potential as a research resource is huge. In fact, it’s currently a major source for a University of Edinburgh contribution to a collaborative public health research project, using the collection to map the lives of those born in Lothian in 1936.

There are still a few free tickets left for the 21st October Symposium on public health's history, present and future in Edinburgh, which you can sign up for here - so come and visit us to see some of LHSA's collections!

Public health on the move: a motorised ambulance and a disinfecting van in early twentieth century Edinburgh (LHB16/2/1). 

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