Auld reekie?

In the first of two blogs, LHSA Archivist Louise has been looking at the fight for clean air in Auld Reekie... 

Auld Reekie has long been a name for Edinburgh – its earliest written use was in 1715. In spoken word the phrase goes back even further. It means “Old Smokey” in Scots, referring to the black, dense pollution from coal and wood fires that shrouded the skies and became the main view of the city. 

But how did the city's (infamous) atmosphere affect the population's health? To find out, I've taken a closer look at two collections we hold here in LHSA: evidence from the Royal Victoria Dispensary, Hospital and Tuberculosis Trust to see how clean air was important in clinical care, and reports from the Public Health Department of the City of Edinburgh, to find out about measures to prevent disease by reducing atmospheric pollution. Because I started my survey around 1900, I thought it was worth looking at where public attitudes towards air pollution had got to by that time. 

Complaints about air quality were recorded as far back as 13th century London when coal started to be used, and the first environmental law was passed soon after. But the issue of pollution from smoke really came to the front of public consciousness in the nineteenth century with mass industrialization. Pressure groups were formed, like Manchester’s Association for the Prevention of Smoke (1842). Later, Public Health Acts saw smoke from factories defined as a possible nuisance for local authorities to act on (1875). 

In 1898, the Coal Smoke Abatement Society was founded to raise awareness about the harm to health and the environment from chimneys in cities. Its lobbying led to the introduction of significant public health legislation, of more later. So by the 1900s, the ills of pollution were becoming more and more evident, and there’s relevance for our local area here too. The head of the Coal Smoke Abatement Society popularized the word “smog” in 1909, when he described a particularly bad episode of coal smoke combining with fog that affected both Glasgow and Edinburgh, causing a rise of 1000 in the annual death rate. 

View from Edinburgh Castle, 1914 (University of Edinburgh Heritage Collections)

Access to fresh air was seen as essential to good health in clinical settings, too. In the 1860s, Florence Nightingale advocated for large open-plan wards where dirt could not hide and long windows let in light and air. The Royal Infirmary of Edinburgh opened on its third site in 1879 in a building influenced by Nightingale’s ideas on design. 

Surgical Ward, Royal Infirmary of Edinburgh, 1930s

Hospitals were also planned with balconies, and beds were often placed outside, as in this image of Elsie Inglis Memorial Maternity Hospital, which opened in 1925.

Patients at Elsie Inglis Memorial Maternity Hospital, 1920s

Good, clean air was seen as particularly important in the fight to prevent infectious disease, notably tuberculosis. In 1887, Edinburgh physician Robert Philip opened the world’s first TB dispensary in Edinburgh’s old town. This free-of-charge pharmacy and health centre was the first step in a disease monitoring system: patients would be identified at the dispensary, advice and medicine were given, contacts could be traced, and nurse visits arranged. 

Home visit from a Royal Victoria Dispensary nurse, 1900s

When specialist facilities opened, patients could be sent for further treatment depending on their symptoms. More serious cases would be sent to a specialist pavilion in Edinburgh’s main infectious diseases hospital, the City Hospital. Early onset cases would be sent to a sanitorium (the Royal Victoria Hospital), and from there could progress to more active rehabilitation in a “farm colony”, where bodies would be strengthened by work outside in the fields. This system was quickly known as the “Edinburgh Scheme” and adopted around the world. The scheme was not about curing TB, but prevention and rehabilitation. 

Diagram of the "Edinburgh Scheme", 1900s.

Although it was known that TB was spread by a bacterial infection by the 1880s, the disease was seen as more prevalent in people living in crowded conditions without natural light and clean air. Fresh air was said to aid recovery and reduce cross infection. Wards in new infectious disease hospitals were purpose built to be spacious, with large windows looking onto treatment sites away from the city centre: taking infectious individuals away from a wider population, but also providing a less polluted environment (see ward in City Hospital here, which opened in 1903). 

Ward in the new City Hospital, 1903

Open shelters for patients were built in the grounds of hospitals, activities like school and exercise drill took place outside, and images from the farm colonies show recovering men and women working methodically in the country air. 

Revolving shelter, City Hospital, 1903.

But what about efforts to change the wider environment to reduce illness in the first place? To find this out, I looked inside Edinburgh’s annual Medical Officer of Health reports. These snapshots of the city’s population provided essential statistics on birth, death and disease, and were usually divided into three sections: one on more medical and social interventions (such as treatment of infectious disease, health visiting, and mother and children’s services), one from the veterinary department (who would inspect abattoirs, meat and milk), and another on the work of the Sanitary Department (like inspecting shops, housing and factories and making sure food was safe). But when I went through the reports for the 1900s and 1910s, I was a bit surprised about what I found. 

Concerns about clean air were rarely expressed. Smoke issues were the remit of the Sanitary Department. But the main hazards they investigated were obstructed vents trapping smoke from fires inside the home. 

Extract from City of Edinburgh Medical Officer of Health report, 1924.

Around the 1920s, though, things begin to change with a key piece of legislation. I'll pick up from here next month. In the meantime, if you would like to find out more about Edinburgh's history of public health, you can access our collection of Medical Officer of Health reports here.