Public health in Lincolnshire in the 19th Century—1

Public health in Lincolnshire in the 19th Century—1

PUBLIC HEALTH Public Health in Lincolnshire in the 19th Century 1 By E. GILLETT, B.A., Staff" Tutor, University of Hull, and Archivist to the Count...

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PUBLIC

HEALTH

Public Health in Lincolnshire in the 19th Century 1 By E. GILLETT, B.A.,

Staff" Tutor, University of Hull, and Archivist to the County Borough of Grimsby, and J. D. HUGHES, M.A.,

Staff Tutor, University of Sheffield of health set up in Louth, Lincoln, and Grimsby had no successors, among members of the medical profession and others there was growing interest in public health and the opinion that collective action in sanitary matters could limit the spread of epidemic diseases. Yet although the occasional catastrophic visitation might arouse public opinion for a time, the framework of the poor law made such opinion ineffective and encouraged all but the few to fall back into the old ways of parochialism, and the petty politics of farmers. Improvement faced the double obstacle of the practice and spirit of the poor law on the one hand, and the legacy of the past--ignorance, superstition, and even o p i u m - on the other.

r

history of public health in 19th Century England has usually been written in terms of the " great wen and of the insanitary state and high death rates of the rapidly growing industrial towns. The rural areas, on the other hand, have more generally escaped the attention of the historian of public health, and the tendency has sometimes been to mention them as a contrast to the morbidity of the towns I. But even cursory reading in Blue Books of the ,evidence of witnesses from the rural counties is enough to suggest that the villages had problems of public health which, however much they might differ in scale from those of the larger towns, were very similar in character. Indeed, in some respects, particularly in the control of working conditions the rural areas--which meant agriculture and small trades-lagged a generation behind the towns. Moreover, in some areas special features aggravated the public health problem, for instance in the marsh areas the combined problems of drainage and water supply, opium addiction and women's field labour. These special problems were particularly to be found in Lincolnshire.

I

P a r i s h A d m i n i s t r a t i o n a n d the L a w o f S e t t l e m e n t

At the opening of the 19th century the machinery for t h e regulation of public health in Lincolnshire differed hardly at all from that which existed at the end of the Middle Ages. Here, as in so many other matters, the parish was the unit of administration. If the parish officers were active, and if the parishioners saw fit to make bye-laws relating to public health, something might be done. Scotter, for instance, as early as 1586 was attempting to regulate dunghills and the burial of dead cattle. Grimsby throughout the 16th century had many and detailed regulations concerning unwholesome victuals, the cleansing of watercourses and open sewers, and the disposal of butchers' and fishmongers' offal. A more detailed examination of court-leet verdicts would no doubt provide many parallel instances. But at the best of times there was much laxity in the enforcement of by-laws. At the worst, the by-laws might say nothing at all about public health. At the opening of the era of modern public health legislation we have, in Lincolnshire, little more than the concept that certain situations might constitute a " nuisance," and that if the " nuisance" became intolerable the parish might proceed against those responsible.

A Long History of Disease

This article is an attempt to show public health problems a n d development in a county which contained no very large towns or industries, where the villages and small market towns set the pattern. Because of its geographical situation Lincolnshire had a long history of endemic disease. Bede's account of a miracle of St. Oswald at Bardney makes it clear that malaria existed in the fenland of his day. After 1800 the remaining marshes, such as the East and West Fens to the north of Boston, disappeared rapidly in face of improved drainage and the use of the steam engine for pumping, and mfilaria declined. But as the fens disappeared, the growth of steam navigation and later the railways increased the danger of infection being brought in from a distance. Thus in 1831 the most strenuous attempts Were made to quarantine all vessels bound for Grimsby and Boston from ports where cholera existed ; but cholera came just the same, from Hull, Doneaster, or Sunderland, it would seem. From this time we might date the beginning of an awakening in public health administration. For although the temporary local boards

Inadequacies of Parochial Administration

To the inadequacies of parochial administration in tackling public health must be added the deadening effect of the whole character and administration of the poor law. In this respect it is hardly necessary to distinguish between the old and the new po~r law. True, the latter represented the first step in reaching beyond the inadequate unit of the parish. But its entire principle and practice were deterrent, and concerned with the relief not the prevention of poverty. The guardians, in the rural areas almost always farmers, were interested above all in rate economies. Unfortunately, since the Board of Guardians was the only effective local administrative body, it was given by successive Acts a series of public health functions, such as nuiiance removal and small-pox

x E.g., J. L. & B. Hammond, Age of the Chartists, at the end of the chapter on " The State of the Towns" : ~' One fact must always be borne in mind in any attempt to picture the lives of the new industrial populations ; they were in the main country folk . . with their roots in fields and not in streets or court " (p. 104). And earlier : " The towns were the homes o f . . . men and women 9 . . accustomed to the peace and beauty of nature, shut up in slum and alley " (p. 28). But the country-folk, although they may have worked in the fields, lived in streets, courts and alleys not unlike (as we shall see) those of the new towns. The Hammonds' point is very relevant when discussing the town-dweller's deprivation of " playgrounds " but is hardly true as a contrast in housing conditions. 34

November 1955 s a n i t a r y gospel f o u n d converts. A t M e s s i n g h a m , a r o u n d 1820, A r c h d e a c o n Bayley f o u n d his flock as obstinate in the p r o t e c t i o n of t h e i r nuisances as in p u r s u i t of ancient village quarrels. T h e m o r e he attacked n u i s a n c e s the faster they left the established church. The A r c h d e a c o n was, for his time, s o m e t h i n g of a n exception in his interest in village cleanliness, b u t by 1870 we find t h e A r c h d e a c o n of L i n c o l n p r e a c h i n g a c a t h e d r a l s e r m o n which " was a sanitary s e r m o n in every sense o f the w o r d ' 6 . W e h e a r of t h e Earl of H a r r o w b y b u i l d i n g a village sewer, of a l a n d o w n e r at Sudb r o o k e offering bricks for a sewer if the villagers would build it (they refused). B u t in t h e m a i n it was t h e physicians a n d surgeons, as we should expect, w h o s h o w e d the greatest c o n c e r n ' . T h e average of professional skill was p e r h a p s n o t very high. A t Spilsby a q u a c k w h o described himself as Thorn.as Allen, M.D., practised w i t h i m p u n i t y for several years, t h o u g h his medical t r a i n i n g was limited to his experience as a n e r r a n d boy at t h e Leicester infirmary. P e r h a p s the fact t h a t h e was eventually p r o s e c u t e d by the Society of A p o t h e c a r i e s shows t h a t s t a n d a r d s were rising. In an emergency, however, m a n y preferred to get a horse-doctor, or, if they believed t h a t they h a d b e e n b i t t e n by a m a d dog, to go to the h u n t s m a n at Brocklesby.

v a c c i n a t i o n , w h i c h inevitably were u n w e l c o m e (since they might involve some expense) a n d neglected. This " save the r a t e s " a p p r o a c h to public health was carried over into the B o a r d s o f H e a l t h and, later, Local G o v e r n m e n t , quite a p a r t f r o m persisting a m o n g the B o a r d s o f G u a r d i a n s . This by itself would h a v e b e e n sufficient h a n d i c a p for r u r a l public health, b u t in a d d i t i o n the w o r k i n g of t h e law o f s e t t l e m e n t t e n d e d everywhere to lower the s t a n d a r d s of r u r a l housing. U n t i l 18652 relief was given only by t h e parish w h e r e a n individual h a s his " s e t t l e m e n t , " a n d the parish raised t h e rate to c o v e r the cost. A n y o n e w h o b e c a m e a p a u p e r in a parish o t h e r t h a n t h a t o f his settlement could be r e m o v e d to his place o f settlement, o r his p a r i s h o f settlement w o u l d p a y the bill for the relief given w i t h o u t the p a u p e r actually b e i n g r e m o v e d . B u t the law o f settlement was complex a n d u n c e r t a i n a n d ted to f r e q u e n t disputes at law between parishes in t h e a t t e m p t to p r o v e a settlement ~. Since a n y r u r a l l a b o u r e r was a p o t e n t i a l p a u p e r , w h e r e the l a n d o f a p a r i s h was in the h a n d s of one or a few l a n d o w n e r s they c o u l d reduce t h e p o o r rates by c r e a t i n g a " c l o s e " village, i.e., by p r e v e n t i n g a n y labourers living in the parish. This o f t e n i n v o l v e d the d e s t r u c t i o n o f cottages. T h e process received even m o r e impetus after 1846 when, as a sop to the l a n d l o r d s ' , a n A c t was passed p r e v e n t i n g t h e p a r i s h r e m o v i n g a n y p a u p e r to his p a r i s h of settlement w h o h a d b e e n r e s i d e n t for five years. This gave t h e l a n d l o r d even m o r e incentive to r e m o v e all l a b o u r e r s f r o m the parishes w h e r e h e held land, since the reduction of his p o o r rates as a c o n s e q u e n c e b e c a m e the m o r e certain. T h e labourers m o r e a n d m o r e were c r o w d e d into the cottages of t h e " o p e n " villages, which b a d h o u s i n g a n d over-crowding m a d e centres o f ill-health a n d disease. I t was a n artificially created public h e a l t h p r o b l e m which d o m i n a t e d r u r a l life in m a n y areas. T h u s the p o o r law was the b a n e of public health in the r u r a l areas b o t h f o r the a p p r o a c h to public h e a l t h a d m i n i s t r a t i o n t h a t it e n g e n d e r e d , a n d for t h e m a j o r p r o b l e m of r u r a l h o u s i n g c o n d i t i o n s which it h a d created.

Rising Prestige of Medicine Nevertheless, t h e effects o f medical progress were felt, a n d we m a y suppose t h a t the rising prestige of medicine gradually modified the prevailing attitude to sanitary problems. T h e earliest o p e r a t i o n u n d e r a n anaesthetic in t h e county a p p e a r s to h a v e b e e n p e r f o r m e d by a D r . N o r r i s w h o p e r f o r m e d several at Spalding in the second week o f January, 1847, assisted by a surgeon n a m e d Vise. His example was followed a t P a r t n e y b y Mr. Thimbleby, a Spilsby surgeon, o n F e b r u a r y 10th, 1847. I n M a r c h , however, a w o m a n died u n d e r a n e t h e r a n a e s t h e t i c at G r a n t h a m , a n d progress was r e t a r d e d for a while. B u t within a year a druggist at Laceby was using c h l o r o f o r m in killing a pig. T h e effectiveness of the medical profession, at any rate in t h e first h a l f o f the century, m a y b e assessed in the p o p u l a r a t t i t u d e to small-pox vaccination. I n this county, m o r e p e r h a p s t h a n most, the believers in the small-pox i n o c u l a t i o n f o u g h t a long battle. It is n o t yet k n o w n a t w h a t period in t h e 18th C e n t u r y the m e t h o d of i n o c u l a t i o n b e c a m e established in Lincolnshire ; b u t it is q u i t e clear t h a t it r e m a i n e d p o p u l a r long after the effectiveness o f v a c c i n a t i o n h a d b e e n demonstrated.

The Medical Profession P o p u l a r beliefs a b o u t hygiene were a m i x t u r e of sympathetic magic, witchcraft, a n d a leavening o f Wesley's househ o l d medicine 5, a n d it was a m o n g - t h e u p p e r classes t h a t the 2 The Union Chargeability Act of 1865 was the major reform, since by creating a uniform rate for the whole Union it removed the reason for clearing labourers from a parish to reduce the rate burden. a ,, By the variety of successive statutory restrictions introduced into the law of settlement and removal, that law, by 1834, had greatly increased in complexity and uncertainty. Speaking of settlements, in a comparatively simple state of the statute law, Dr. Burn had said, in 1764, ' It has been the work of an age to ascertain the law respecting them '." R. Pashley, Pauperism and PoorLaws, 1852, p. 266. This much neglected work is an admirable and lucid source for the study of the operation of the law of settlement. * Sir Robert Peel announced his intention of making this change in the law of settlement at the same time as he announced his intention of repealing the corn laws. Up till 1846 and the statute 9 & 10 Vlct. c.66, the manufacturing towns had been able to put the burden of relieving unemployment on the backs of the parishes in which their workers had settlement, which generally meant the rural parishes. The change in the law meant a heavy increase in town poor rates, at Norwich by s a year, at Leeds b y s But similarly in the rural areas themselves, the rate burden on the " d o s e " parishes was reduced, on the " o p e n " parishes - increased. Cf. R. Pashley, op. cit., pp. 274-287. 5 And, of course, patent medicines. A Gainsborough bookseller

in 1783 advertised for sale, among other "'genuine medicines," Daffy's Elixir, Godfrey's Cordial (these were opium mixtures), Ormskirk Medicine for the Bite of a Mad Dog, Pike's Ointment for the Itch, Dr. Ward's Emetic, or Sack Drop, and Dr. Ward's Liquid Sweat! Popular ideas of medicine were also applied to animals, of course. A Crowle yeoman farmer's diary for 1777 contained as recipe " for a cow that has got a cold "' : " Take of anaseads ld. ; of fower of Brunston -~d. ; of Liquorice Powder ~-d. ; of Jinson 89 ; of Diepenta 89 ; half a pound of treakel, one handful of wormwood and a handful of Herbegress both boild in a quart of Ale." We cannot help feeling that this would have done something to the cow's cold. 6 For Messingham see Archdeacon Stonehouse, " Visitation of the Archdeaconry of Stow, 1845." For the sermon, 2rid Report, Royal Sanitary Commission. Minutes of Evidence, 1871, llI, pp. 140-7. Evidence of W. J. Mantle. County poll books show that those who had votes (mostly surgeons) were often Tories, but more often they gave one vote to the Whig, the other usually to the Tory candidate, and only rarely to the more radical Whig. 35

PUBLIC HEALTH In 1816 R. Bellingham, a surgeon at B o u r n e , c o m m e n t e d o n the dangers o f i n o c u l a t i o n : - " T h e small-pox appeared in a single individual here early in the last spring. Before it was even generalry known that the smallpox existed in the town the source of contagion had been multiplied by inoculation among the poorer and least informed classes. The chief argument in favour of this wanton extension was that it was of a very mild and harmless sort, and that it was impossible to have it at a better time. Several died with all the advantages of preparation, inoculation and medical attendance; and a still greater number without these advantages. The intercourse with the circumjacent towns and villages soon propagated this mild and harmless disorder in each direction-8. As the epidemic spread, q u a c k s t h r o v e o n the d e m a n d for inoculation. T h e r e was o n e w h o h a d n e v e r seen a lancet until he set u p as a n inoculator. A year o r so later this class o f m e n were described as " the fag ends o f the medical a n d surgical p r o f e s s i o n s - - a l s o shoe makers, tailors, weavers a n d even r a t c a t c h e r s ' 9 . This was in Kesteven. T h e worst c o n s e q u e n c e was t h a t " by the frightful a n d false reports of these m e n the lower class of persons are entirely set against the c o w p o c k " (i.e., vaccination). T h e d e m a n d for inoculation was, in fact, so strong t h a t some practitioners reverted to t h e m o r e p o p u l a r m e t h o d . T y s o n West, a n A l f o r d Surgeon, r e p u d i a t e d v a c c i n a t i o n a n d r e c o m m e n d e d inoculation 10. A t Horncastle, J o h n W a r d , also a s u r g e o n declared himself similarly a n d said t h a t h e k n e w of 600 to 800 people, inoculated within a few miles of his residence, with only o n e death. H e h a s t e n e d to a d d t h a t the victim was n o t o n e of his p a t i e n t s n.

to successive V a c c i n a t i o n Acts. F r o m 1842, vaccination at the public cost could be claimed from local authorities in any parish. N o t until 1853 was t h e v a c c i n a t i o n o f c h i l d r e n within four m o n t h s o f b i r t h m a d e c o m p u l s o r y , a n d l a t e r still the Privy Council f r a m e d regulations for securing d u e qualification o f t h o s e w h o were c o n t r a c t e d with by t h e guardians, after c o m p l a i n t s o f the u n s a t i s f a c t o r y way in w h i c h vaccination was b e i n g performed. Yet in 1862 w h e n a r e p o r t o n v a c c i n a t i o n in Lincolnshire was m a d e to the M e d i c a l Officer of the Privy Council it stated : - " The quality of the Vaccination in Lincolnshire, more especially of the unions in the Fen district and in Great Grimsby, was very bad indeed, more especially in Great Grimsby. Here small-pox had been smouldering for three to four years:"lL A t G r i m s b y , indeed, t h e r e were 20 small-pox deaths in 1860, a n d G a i n s b o r o u g h h a d h a d a n e p i d e m i c in the w i n t e r o f 1858-59. T h e r e was small-pox at G r a n t h a m in 1861. Persistence o f Small-pox T h e persistence o f some small-pox is u n d e r s t a n d a b l e , n o t only because o f the p o o r quality o f t h e vaccination, b u t in the light of t h e evidence given of neglect o n the p a r t of local authorities. T h e registrar o f v a c c i n a t i o n s for Caistor U n i o n was f o u n d n o t to h a v e k e p t his register for a year, at B o s t o n n o t since 1855, a n d at G o s b e r t o n (in S p a l d i n g U n i o n ) t h e register h a d n o t b e e n kept since 1854. T h e duty which t h e Compulsory Vaccination Act imposed on Guardians of " giving f r o m time t o time d u e notice of t h e m e a n s p r o v i d e d for o b t a i n i n g v a c c i n a t i o n " to all t h e local p o p u l a c e h a d b e e n " almost universally neglected." N o public notice h a d ever b e e n given by t h e authorities o f Caistor, G a i n s b o r o u g h , Brigg, H o l b e a c h , S p a l d i n g a n d S t a m f o r d U n i o n s . The T a b l e given in this 1862 r e p o r t showing t h e state of vaccinat i o n o f children t h r o u g h o u t Lincolnshire is m o s t revealing 1~. T h e percentage well vaccinated varies between 4.6 at B r i g g to 6.8 at Boston, a n d 24.1 at Sleaford. T h e percentage n o t vaccinated a t all r a n g e d b e t w e e n 8.8 at G r a n t h a m a n d 17.5 at Horncastle. I n m a n y o f the districts visited there were children m a r k e d with small-pox, 2, 8 ~o o f t h o s e e x a m i n e d a t G r i m s b y , 2.3 at Stamford, a n d 1.4 at G a i n s b o r o u g h . T h e p r o p o r t i o n o f infants registered as v a c c i n a t e d per 100 registered births, w h e r e it is given, is relatively tow particularly in the F e n U n i o n s . T h e two reasons given for the low a p p a r e n t rate o f public v a c c i n a t i o n (as low as 25 % at Horncastle) a r e

Working Class and Inoculation T h e evidence p o i n t s to t h e working classes as t h e m o s t tenacious believers in inoculation, t h o u g h it m u s t b e e m p h a s i s e d t h a t little is k n o w n a b o u t t h e attitude of t h e m o r e privileged groups. T h o s e w h o could n o t afford t h e cost o f i n o c u l a t i o n t e n d e d to accept deliberate infection b y a reputedly mild case as a substitute 12. T h e r e are h i n t s t h a t this k i n d o f t h i n g was n o t very different f r o m infanticide. " H u m a n i t a s , " writing to t h e S t a m f o r d M e r c u r y in 1816 a b o u t a n epidemic at G r i m s b y d e p l o r e d the " delusion u n d e r w h i c h t h e lower orders of t h e c o m m u n i t y l a b o u r ,,a3. H e implies t h a t t h e i r hostility to vaccination h a d a sinister side, a n d a l t h o u g h they s p o k e o f the e p i d e m i c as a visitation o f D i v i n e Providence, " n a t u r a l affection seems to b e a b s o r b e d in this deadly fanaticism, w h i c h d e p o p u l a t e s the place a n d causes all r a t i o n a l p e o p l e to suspect t h a t t h e r e is s o m e t h i n g m o r e in this species of o b d u r a c y t h a n a p r e t e n d e d r e s i g n a t i o n to the will o f h e a v e n . " T h e c o n q u e s t of this scourge ~ o f small-pox owed m u c h

15 Fifth Report o f the Medical Officer to the Privy Council, 1862. 16 Ibid. The findings for some representative areas in Lincolnshire were as follows : - Infants % vaccinated No. % % 9/ooun- marked per P.L.U. exam- well badly vaccinby 100 district ined vaccin- vaccin- ated smallregisated ated pox tered births

8Lincoln, Rutland and Stamford Mercury, Mar. 8th, 1816. 9 Ibid., Apr. 30th, 1824. a~ Feb. 13th, 1818. 11 Ibid., Aug. 28th, 1818. 13 In 1835 a Grantham surgeon complained that the disease was being spread by the deliberate exposure of infected patients as well as by inoculation. As late as 1862 a nonconformist clergyman in the Isle of Axholme could recollect a recent instance of a woman who was anxious that her children should have small-pox before harvest and who arranged for them to take turns at sleeping in an infected nightshirt. is Lincoln, Rutland and Stamford Mercury, Nov. 1st, 1816. ~ This is well expressed by T. Eminson in his Epidemic Pneumonia at Scotter and Neighbourhood published in 1892 : " Small-pox was once an extremely common and fatal disease in the neighbourhood ; all of us over 35 can remember ' old standards ' whose faces bore evidence of the terrible nature of this loathsome disease.'"

Boston .. Grimsby . Gainsborough" Brigg.. Grantham Horncastle Lincoln Louth Sleaford Spalding Stamford 36

986 569 409 239 1,075 531 962 462 174 254 473

6.8 7.2 14.1 4.6 17.8 14.5 11.0 9.9 24.1 11.6 20.9

20.5 14.9 26.6 15.0 20.3 20.1 17.6 19.0 19.0 20.6 28.1

15.3 12.4 11.9 15.0 8.8 17.5 14.8 13.8 10.3 14.7 14.7

0.8

2.8 1.4 -0.7 0.01(sic) 0.9 0.2 -0.3 2.3

53.4 58.7 50.0 25.5 47. 7 37.5 36,9

N o v e m b e r 1955 A t first sight, the figures of d e a t h rates in Lincolnshire in this period m a y suggest some superiority of c o n d i t i o n s to t h o s e prevailing elsewhere 21. F o r t h e Lincolnshire d e a t h rate was r a t h e r below t h a t for the c o u n t r y as a whole, a n d was t e n d i n g to fall slightly, f r o m 19.5 per 1,000 (1851-60) to 19.1 (1861-70) a n d 18.5 (1871-80), wh~-reas in the country, as a whole the crude d e a t h rate fell m o r e slowly ~1". But the n a t i o n a l average was swollen by t h e high death rates of the big towns where disease spread rapidly, whereas in the m o r e isolated r u r a l areas the spread of disease was m o r e restricted. Significantly, few U n i o n s with a d e a t h rate exceeding t h a t of the worst parts of Lincolnshire were p r e d o m i n a n t l y rural.

the interference of non-certifying v a c c i n a t o r s a n d the high rate o f infant mortality. T h e latter was particularly noticeable in the Fens, as we shall notice later in this article. Nevertheless, this g r a d u a l c o n q u e s t o f small-pox is o n e of the m o s t i m p o r t a n t i m p r o v e m e n t s in Lincolnshire public h e a l t h in the first h a l f of the 19th Century. T h e other, the decline of malaria, was the b y - p r o d u c t of i m p r o v e d drainage. W h e n A r t h u r Y o u n g visited Lincolnshire in 1799, he could already note : " In the north-west . . . . Agues were formerly c o m m o n l y k n o w n u p o n the T r e n t a n d H u m b e r s i d e ; at p r e s e n t they are rare "JT. Surprisingly, he went o n to say : "' N o t h i n g h a s b e e n effected on this side o f the H u m b e r to which it c a n b e a t t r i b u t e d . " Yet in his r e p o r t he m e n t i o n s several i m p o r t a n t enclosures in this area, all o f which involved extensive i m p r o v e m e n t s in drainage. In the great enclosure o f the Isle o f A x h o l m e c o m m o n s a l o n e over s was s p e n t o n new d r a i n a g e works. I n this p a r t o f t h e c o u n t y some m a l a r i a persisted until a b o u t 1830 b u t after t h a t was rarely f o u n d , p r o b a b l y due to t h e c o m p l e t i o n of enclosure a n d i m p r o v e m e n t of the low-lying l a n d in the 1830s, a n d the installation o f s t e a m engines for p u m p i n g , t h e first of w h i c h was installed at B e l t o n in 1834 aS. I n t h e Fens, a l t h o u g h m a l a r i a was said to h a v e declined greatly it still persisted in t h e Spalding area. I n 1826 a local d o c t o r ' s b o o k s t h e r e s h o w e d 300 cases o f " a g u e , " a n d it was p r e v a l e n t again in t h e following year. T h e r e was also a n increase in 1857-59. I n 1863 a r e p o r t o n t h e subject stated, " i n t e r m i t t e n t a n d r e m i t t e n t fevers are still f r e q u e n t a r o u n d Spalding t h o u g h described as m u c h less severe t h a n f o r m e r l y . . . . A t the N a t i o n a l School . . . o f 75 boys p r e s e n t at the time of m y visit, 11 stated t h a t they h a d h a d ague at some p e r i o d -19

The Healthiest Districts I n the decade 1841-50 the healthiest p a r t s of the c o u n t y were Spilsby, Caistor, B o u r n e a n d G r a n t h a m Unions, with a d e a t h rate of 18 per 1,000. T h e villages here were for t h e m o s t p a r t o n high ground 9 G r i m s b y ( p a r t o f Caistor U n i o n ) with a d e a t h r a t e of 19 p e r 1,000 was t h e n one o f t h e 24 healthiest t o w n s in E n g l a n d a n d Wales, b u t its r a p i d g r o w t h after 1850 was to bring with it rising d e a t h rates. Horncastlr Brigg, Sleaford a n d S t a m f o r d U n i o n s r a n k e d next with a d e a t h rate o f 19 per 1,000, a n d these c o n t a i n e d m u c h o f t h e recently d r a i n e d malarial marshes o f the county 9 H o l b e a c h a n d B o s t o n U n i o n s , ~ntirely in t h e fens, h a d a d e a t h r a t e o f 21 p e r 1,000. T h e rate was t h e same in t h e Lincoln U n i o n , largely b e c a u s e o f the u n h e a l t h y state o f t h e city, a n d in t h e L o u t h U n i o n which included m a n y o f t h e o v e r c r o w d e d villages o f t h e Lindsey marsh. T h e Spalding U n i o n , entirely in the fenland, a n d the G a i n s b o r o u g h U n i o n , affected b y epidemics in G a i n s b o r o u g h itself, were t h e least h e a l t h y in t h e c o u n t y with a m o r t a l i t y of 22 p e r 1,00025. I f we seek c o m p a r i s o n s between d e a t h rates in t h e c o u n t y a n d t h o s e to b e f o u n d elsewhere, we find t h a t a d e a t h r a t e such as t h a t in Spalding U n i o n was as high as industrial t o w n s such as Huddersfield a n d Keighley. L i n c o l n (23 p e r 1,000) was n o b e t t e r t h a n Wakefield. B o s t o n a n d L o u t h ~3 (24 per 1,000) r a n k e d with Clerkenwell, St. Pancras, Barnsley a n d R o c h d a l e . T h e r e were only six t o w n s in t h e c o u n t r y w i t h a d e a t h rate h i g h e r t h a n t h a t o f G a i n s b o r o u g h .

Overcoming Small-pox and Malaria Nevertheless, t h e occurrence o f cases o f small-pox a n d m a l a r i a in L i n c o l n s h i r e in t h e 1860s s h o u l d n o t o b s c u r e t h e f a c t t h a t these t w o diseases, w h i c h h a d b e e n extremely wides p r e a d in L i n c o l n s h i r e a n d devastating in their effects, were b y t h e n largely overcome. T h e i r r e d u c t i o n was t h e m a i n a d v a n c e in h e a l t h c o n d i t i o n s in the first h a l f o f the century. B u t in 1869-71 t h e severe epidemic o f small-p0x t h a t swept G r i m s b y - - s o m e 1,000 cases with 244 deaths~~ for t h e last time o n this scale the terrible n a t u r e of the disease, a n d t h e penalty o f neglect. T h e neglect t h a t h a d such d i s a s t r o u s effects c o n c e r n e d riot only v a c c i n a t i o n b u t t h e g e n e r a l s a n i t a r y state o f the town, a n d it is to this m a j o r subject o f the s a n i t a r y state of the t o w n s in the c o u n t y t h a t we m u s t t u r n to u n d e r s t a n d the prevailing c o n d i t i o n s o f public h e a l t h in the m i d d l e decades o f t h e century.

21 The use of crude death rates to compare the healthiness of different areas is open to the objection that they depend upon the age structure of the population. However, we do not think this significantly affects the general pattern shown in Lincolnshire. The major qualification to be borne in mind is that there was substantial " emigration " from the country districts, both out of the country to industrial districts and a b r o a d - - a n d within the county, to the towns. This would tend to make the age structure in the villages more " elderly." An age specific death rate might afford more exact comparisons ; but e.g. infant mortality rates in Lincolnshire were influenced by special features which do not directly reflect the general " healthiness " or otherwise of the area but rather conditions of work which bore hardest upon "field f a r i n g " women (cf. our later analysis of infant mortality rates), 9 2~a ,, Tested by the available statistics, the standard of health up to the passing of the Public Health Act, 1875, does not appear to have improved, in spite of the expenditure . . . upon sanitation during the two preceding decades," W. M. Frazer, History o f English Public Health (1950). p. 127. The crude death rate is there given as 22.7 for 1851-55, and 22.0 for 1871-75. 23 Report of Select Committee on Public Health Bill, 1855, pp. 205-8. ~3 But the Louth figure would have been considerably better if deaths in the Union Workhouse had been excluded.

1T A. Young. General View of the Agriculture of Lincolnshire (1799). la A report on Axholme in 1859 (Second Report of the Medical Officer to Privy Council) st;ll mentioned the existence of malaria, b u t rather curiously declared, " ague occasionally attacks the Irish immigrants, but never occurs among the residents." This suggestion of its more serious effect on outsiders recalls the account of a writer in the Universal Magazine of 1773 who conversed with a man who had had nine wives ; " the Fen men were accustomed t o seek their wives in the upland country, selecting those who had a little money ; and as living in the Fens was certain death to ~trangers during the fever season, many of the Fen men thus contrived to accumulate a good deal of money." (S. Smiles, Lives of the Engineers Rennie, p. 242). xa Fifth Report of the Medical Officer to Privy Council. ~o Grimsby Observer, Nov. 15th, 1871. 37

PUBLIC H E A L T H O n t h e whole, these' figures indicate accurately e n o u g h the unfaVourable state o f the towns in L i n c o l n s h i r e . I f t h e figures for G a i n s b o r o u g h were particularly raised b y a series o f epidemics, the features common-~ to all t h e epidemics r e p o r t e d o n in t h e c o u n t y p o i n t b a c k to t h e general s a n i t a r y state o f b o t h t o w n s a n d villages. T h e m o s t c o m m o n features f o u n d associated w i t h epidemics in L i n c o l n s h i r e c a n be s u m m a r i s e d as the following : Severe o v e r c r o w d i n g ; d a m p , ill-ventilated cottages ; b a d drainage, especially in the m a r s h a r e a s ; i n s a n i t a r y disposal of s e w a g e ; lack o f Uncont a m i n a t e d w a t e r supply ; a n d t h e existence o f m i g r a t o r y workers, especially Irish, livii~g in the w o r s t possible conditions ~'. Such elements were to b e f o u n d a b u n d a n t l y in Lincolnshire. T h e s e prevailing a n d persistent c o n d i t i o n s of b a d s a n i t a t i o n a n d h o u s i n g n a t u r a l l y h a d their c o u n t e r p a r t from t i m e to t i m e in violent ep demics c o n c e n t r a t e d in t h e m o s t u n w h o l e s o m e parts.

g o o d quality." Indeed, h e is r e p o r t e d to have said t h a t the water was so i m p u r e t h a t h e f o u n d E p s o m salts in it " o u t of his o w n s h o p . " Samples of the well water, a n d o f p i p e d water supplied to p a r t of Brigg were sent to a n analyst w h o c o n d e m n e d t h e well water as wholly unfit for d o m e s t i c use. H e r e p o r t e d t h a t t h e w a t e r w o r k s supply was far superior, t h o u g h n o t so pure as desirable. A m a j o r i t y o f t h e G u a r d i a n s , however, p r e f e r r e d to use their o w n j u d g m e n t . A subc o m m i t t e e solemnly tasted b o t h waters a n d declared t h e i r preference f o r t h e well water. A t this stage, one o f the G u a r d i a n s , Mr. E d w a r d Peacock o f B o t t e s f o r d ~,, b e g a n to write to the Press 28, in t h e h o p e o f forcing the m a j o r i t y o f the G u a r d i a n s to give way.

The Sanitary State of the Towns

T h e B o a r d o f G u a r d i a n s reversed its earlier decision, and Peacock n o t e d t h a t t h e r e was n o w a disposition a m o n g t h e G u a r d i a n s to b l a m e the Medical Officer for n o t h a v i n g pressed t h e m a t t e r earlier. T h e depressing picture o f c o n d i t i o n s in Brigg is reinforced by t h e c o m m e n t s o n it m a d e in a r e p o r t for t h e M e d i c a l Officer to t h e Privy C o u n c i l o n " A g u e s i n M a r s h D i s t r i c t s , " in 1863. Brigg h a d scarcely a n y ague at this date, b u t : " General sanitary condition of the town extremely bad. The town lies low and there is no drainage worth mentioning 9 I visited the town with Mr. Moxon, Union Surgeon and saw several cases of typhoid fever in some filthy courts on east side of town. In one of these there was only one privy for 11 houses. On the west side a low lying portion known as ' t h e R o o k e r y ' was one of the filthiest places I ever saw ,,39.

" There is a cesspool," he wrote, " within about six feet of the well, and into this water used in washing, urine from the bedrooms and other noxious matters flow in great abundance. Moreover, the privies are so near as to aid contamination . . . . The soil is a mixture of loam, sand and gravel, through which water easily finds its way."

Typical c o n d i t i o n s to b e f o u n d in t h e c o u n t r y t o w n s o f L i n c o l n s h i r e c a n b e illustrated f r o m the e x a m p l e o f Brigg. This small b u t growing m a r k e t t o w n in t h e n o r t h o f t h e c o u n t y was b o t h a small m a n u f a c t u r i n g c e n t r e 2~ a n d a n " o p e n " village supplying l a b o u r to n e i g h b o u r i n g parishes. I n 1842 t h e District M . O . o f t h e Brigg P o o r L a w U n i o n sent in a rel:ort to the c c r r m i t t e e investigating the s a n i t a r y c o n d i t i o n o f the p o p u l a t i o n , w h i c h sets the scene : - " Fever has been very prevalent, a few years since during the hot weather in a range of paupers' houses, situated upon a drain, called the town drain, situated very near the centre of the town of Brig~. which is never to my knowledge cleared out, and is during the summer a complete mass of animal and vegetable decomposition ; we have no public o r private authority for interfering. Near this are many pigsties, close to the houses ; all of which are never noticed, merely because fever has not been prevalent these few years but should our summers become unusually hot, I am convinced fever must be very common. " A n o t h e r observation 1 wish to make, is the very common occurrence of tramps bringing the small-pox to our town ; they arrive at the ~odging houses (where they are without scruple taken in) almost at the height of the complaint, and this occurs repeatedly so that our town is never long free from the small-pox ,,~6. Actually, t h e r e was ia p r i v a t e a u t h o r i t y w h i c h was able to t a k e action against s o m e evils the C o u r t L e e t j u r y o f W r a w b y manor. T h e Stamford Mercury ( S e p t e m b e r 10th, 1852) r e p o r t e d from Brigg : - " It seems that the ooor Irish tenantry have returned to wallowing in their filth ; for on Tuesday the 7th inst. several of this description were summoned and fined for the abominably filthy and fever-breeding condition of their abodes. To give an account of the Irish locality 9 . would be really disgusting." I n 1855, we find t h e U n i o n Medical Officer c o m p l a i n i n g t h a t t h e well w a t e r o f the w o r k h o u s e at Brigg was " n o t o f

T h e r e p o r t goes o n to m e n t i o n t h a t " t h e R o o k e r y " had " n o k n o w n satisfactory s u p p l y o f w a t e r '" a n d t h a t t h e r e was f r e q u e n t t y p h o i d there. But, as if t h a t were n o t e n o u g h , : " T h e sanitary committee, formed of members of the Board of Guardians, are said to be opposed to any improvement, and to direct the inspector of nuisances not to report any case unless complained of-80

Attitude of the Sanitary Authorities R e p o r t s o n o t h e r c o u n t r y t o w n s in L i n c o l n s h i r e in these middle decades suggest h o w general were t h e worst features of public h e a l t h f o u n d in Brigg. Passivity o f local a u t h o r i t i e s in t h e face o f s u c h evils was n o t c o n f i n e d to Brigg. F r o m the same r e p o r t o n " a g u e s " f r o m w h i c h we h a v e q u o t e d , we learn t h a t at B a r t o n - o n - H u m b e r , " T h e Local B o a r d o f ~ Peacock was primarily a scholar and antiquary, with a creditable record of publications in Archaeologia and of texts edited for the early English Text Society. It is interesting to note that in his Glossary of the Words used in the Wapentakes of Manley and Corringham (1877), he includes the word " nuisancer," meaning an inspector of nuisances. To illustrate its use he quotes a villager who said of another that he let his family " drink stuff that's no better than seep from a manure hill. He wants real bad to have the nuisancer down on him." He also quotes a man who spoke of the " nuisancer always coming and rooting about. Fevers wouldn't come if they wasn't sent." 38Lincoln, Rutland and Stamford Mercury, Aug. 31st and September 7th, 1855. 39 Sixth Report of the Medical Officer to the Privy Council. The report on " A g u e s " was made by a Dr. Whitley. 3o It was not until 1866 that the Sanitary Act of that year compelled local authorities to inspect their districts and suppress nuisances.

2~ Another feature worth noting in Lincolnshire epidemics was the rapid transmission of diseases along the Humber and Trent side, along which there was very extensive trade and passenger traffic. The parlous state of sanitation in Hull, which was the main port for all this traffic, led to severe epidemics there which spread into Lincolnshire. 35 White's Directory for Lincolnshire, 1842, which caLs Brigg " a neat, well built, and thriving market town "estimates its population then at 2,300, mostly within the area of the " town and Chapelry of B r i g g " in Wrawby parish, but spread into three other parishes. Brigg had several corn mills, steam mills, and malt kilns, two roperies and two tap, yards, an ironfoundry, a ship-building yard, a sail manufactory, and a worsted manufactory. 36Local Reports on the Sanitary Condition of the Labouring Population of England and Wales, 1842. p. 156. 38

November 1955 Health, c o m p o s e d chiefly o f farmers, h a v e n o by-iaws a n d shirk i n q u i r y . " A S u p e r i n t e n d i n g Inspector, u n d e r t h e 1846 Public H e a l t h Act, r e p o r t i n g o n H o l b e a c h in 1851, concluded, " I a m compelled to a d d H o l b e a c h to t h e list o f places in which t h e Public H e a l t h A c t h a s l o n g b e e n in o p e r a t i o n w i t h o u t a n y t h i n g h a v i n g b e e n d o n e to i m p r o v e t h e sanitary c o n d i t i o n of t h e i n h a b i t a n t s ,,a~. B u t L i n c o l n itself provides t h e most extreme example of w h a t o n e m i g h t call a n antisanitary party. I n 1848 the citizens refused to a d o p t t h e Public H e a l t h Act. I n 1849 a rewort o n the state o f the t o w n emphasised the deficient drainage. S o m e privies a n d waterclosets discharged themselves into small c o v e r e d drains, which h a d t h e i r outlets in open c h a n n e l s in t h e street. I n 1863 Dr. W h i t l e y declared t h a t n o t h i n g h a d b e e n d o n e for t h e i m p r o v e m e n t o f the t o w n since 1849, a n d t h a t t h e increase o f p o p u l a t i o n h a d increased t h e evils m e n t i o n e d . H e wrote : " T h e general sanitary c o n d i t i o n of Lincoln is very bad. I was i n f o r m e d t h a t t h e ' s a n i t a r y c o m m i t t e e , ' f o r m e d o f m e m b e r s o f t h e T o w n Council, object to raise m o n e y f o r d r a i n a g e p u r p o s e s ,,3~.

a n d despite a t y p h o i d epidemic, t h e T o w n Council h a d " t h r o u g h the action o f a m i n o r i t y o f t h e i r body, declined to avail themselves of the a d v a n t a g e s w h i c h the a d o p t i o n o f the Local G o v e r n m e n t Act would give t h e m ,,~4 Again, Brigg was typical in its w r e t c h e d w a t e r supply. In m a n y cases it was n o t until late in the c e n t u r y t h a t efficient w a t e r works were set up. Before t h e n t h e water supply available was often appalling. A t G a i n s b o r o u g h , in the 1840s, the t o w n was said to be b a d l y off for water " o w i n g to the b a d m a n a g e m e n t o f the w a t e r w o r k s , which are a complete burlesque o n m a c h i n e r y a n d the spirit of the age -3 ~. T h e m a c h i n e r y was w o r k e d with a single h o r s e a n d a b o y h a l f asleep to drive it. N o a d d i t i o n a l piping h a d been laid d o w n for 20 years, a n d t h r e e - q u a r t e r s o f the populace h a d to get t h e i r w a t e r by draw-buckets f r o m the Trent. T w e n t y years later n o t h i n g h a d c h a n g e d : - " The water supply is partly from the river above the town, being raised by horse-power about low-water, avd partly from wells. Much rain water is used even for cooking ,,a6. A t G r a n t h a m at the same time t h e w a t e r c o m p a n y was, d u r i n g the winter, mixing spring w a t e r with river water " o f t e n turbid and undrinkable .... T h e river w a t e r was t a k e n f r o m the W i t h a m a mile a b o v e the town, a n d two o r t h r e e miles a b o v e t h e source o f supply, the river receives a p o r t i o n of the d r a i n a g e o f a village." B u t the t y p h o i d epidemic " b r o k e out, a n d was m o s t fatal at a place called the W h a r f t h e i n h a b i t a n t s o f which used for d r i n k i n g a n d o t h e r p u r p o s e s w a t e r derived f r o m a n e i g h b o u r i n g c a n a l - 3 7 . T h u s , the existence of a w a t e r works was n o g u a r a n t e e of r e a s o n a b l y p u r e water.

The Anti-Sanitary Party I n 1865 w h e n the Public H e a l t h A c t was. a d o p t e d , the councillors w h o h a d v o t e d for the a d o p t i o n were defeated a t the N o v e m b e r elections. T h e leader o f t h e anti-sanitary party, w h o were mostly liberals a n d retired t r a d e s m e n w h o h a d invested in jerry-building, was a local n e w s p a p e r proprietor. T h e agitation o n the o t h e r side was started b y Vr J. Mantle, Esq., w h o drew a t t e n t i o n to o u t b r e a k s o f fever a t S c o t h e r n (within L i n c o l n U n i o n ) w h e r e t h e w a t e r c o u l d b e smelt several yards f r o m the p u m p ; B a r d n e y , where the sewer was b l o c k e d ; a n d I n g h a m w h e r e 52 o u t o f 54 cases o f fever were t r a c e d to o n e p u m p . T h e G u a r d i a n s a p p o i n t e d a committee, o f w h i c h h e b e c a m e c h a i r m a n , a n d he gave evidence before t h e R o y a l Sanitary C o m m i s s i o n in 1870. Because o f his efforts for sanitary i m p r o v e m e n t a t t e m p t s were m a d e to u n s e a t h i m f r o m the B o a r d o f G u a r d i a n s 33. A p a r t f r o m t h e unwillingness of local authorities to act, t h e r e was sometimes difficulty in finding o u t which a u t h o r i t y did b e a r responsibility. A r e p o r t o n a fever o u t b r e a k at G r a n t h a m in 1864 stated t h a t " sewage . . . seems to be u n d e r t h e a u t h o r i t y o f n o one. T h e T o w n Council of t h e municipal b o r o u g h h a s n o control over t h e sewers, n e i t h e r h a v e the B o a r d o f G u a r d i a n s , n o r the Sanitary C o m m i t t e e s of Spittlegate a n d Little G o n e r b y . " I n a d d i t i o n t h e r e were t h r e e different h i g h w a y authorities. Yet in this situation,

Dubious Water Supply B u t for t h o s e n o t c o n n e c t e d to a w a t e r works, the supply was e v e n m o r e dubious. N o t only p o l l u t e d rivers a n d canals, b u t even a n agricultural d r a i n (at Spalding), a n d railway ballast pits 3s (at Lincoln) were the source. E v e n where w a t e r w o r k s existed, t h e r e were large n u m b e r s o f wells in use in t h e towns, m a n y of t h e m m o r e or less c o n t a m i n a t e d . T h i s was true of L i n c o l n a n d G r i m s b y w h e r e only a q u a r t e r o f t h e houses in 1871 were supplied f r o m the w a t e r works, a n d t h e r e were o v e r 300 private wells. O f G r i m s b y ' s wells D r . H o m e in his r e p o r t ~ declared : - " The water in most of the private wells of Grimsby is very exposed to contamination from fluids draining into i t ; this is rendered unavoidable in consequence of the confined space in which house-drains, pigsties, cess-pits and other sources of pollution are crowded near the well. The definite instances which might be adduced in illustration of this statement are so numerous that selection is difficult."

31Lincoln, Rutland and Stamford Mercury, Aug. 22nd, 1851. The Inspector metations 10 cottages draining into a stagnant ditch filled with " dead animals and refuse of the most revolting description," and quotes a statement that nearly two-thirds of the population of Holbeach died before reaching the maturity. ~ Sixth Report o f the Medical Officer to Privy Council. 33 Second Report, Royal Sanitary Commission. Minutes o f Evidence, pp. 140-147. Mantle characterised the Guardians from the rural parishes as " tenant farmers sent from little villages with one object of keeping rates down." Where Guardians were more careless of the ratepayer, it was not necessarily in the interests of public health. The Louth Guardians in 1857 settled wine merchants bills of s several months after the Poor Law Board had censured them for lavishness with medical extras, " nearly every case receiving" (we wonder if they did ?) '" either wine, brandy, gin, ale or tobacco." In 1861 the Louth Guardians were equally obstinate in face of the Board's complaints of excessive infant mortality in the workhouse. (Louth Union. Guardians' minutes.)

34 Seventh Report o f the Medical Officer to Privy Council. a~ Stow, History o f Gainsborough, 1842 edition. 36 Sixth Report o f the Medical Officer to Privy Council. Although the local board of health took over the water company in 1871, the source of water continued to be the Trent until 1888. 37 Seventh Report o f thg Medical Officer to Privy Council. This privilege they shared with Goole, in Yorkshire, where the water supply was " partly from wells, partly from the c a n a l " (Sixth Report). a8 Report o f the Medical Officer o f the Local Government Board, 1886. At Holbeach in the 1860s most of the water supply camc from pits (Sixth Report o f the Medical Officer to Privy Council). and only " a few of the better houses have wells." ~9 Report to the Medical Officer o f Local Government Board, 1871. Quoted from the Grimsby Observer of Jan. 10th, 1872. 39

PUBLIC HEALTH Barton-on-Humber, 1859 : " The cesspools are in the worst possible condition. The practice prevails of keeping their contents for long periods for agricultural purposes, to suit the convenience of the farmers. They are all above ground, and usually about 6 feet square, and frequently several are contained in the yard of one house ,,42

T h e " definite i n s t a n c e s " which Dr. H o r n e gave were o f t h e sort t h a t do n o t m a k e pleasant reading. B u t e n o u g h evidence has been given to show the universality o f a n i m p u r e supply of w a t e r in t h e t o w n s of 19th c e n t u r y Lincolnshire. W e c a n best illustrate this by noticing t h e way in which the exception was s p o k e n of : " T h e general sanitary c o n d i t i o n of B o u r n e a p p e a r e d unusually g o o d as t h e r e is a good a n d extensive system o f d r a i n a g e available for nightsoil . . . . T h e r e is a n a m p l e supply o f h a r d water . . . laid o n in the t o w n -40. ,, Uniasually g o o d " because it h a d an a m p l e w a t e r supply, a n d a n effective system o f drainage. W e c a n a p p r e ciate t h e justness o f the c o m m e n t as far as the w a t e r supply is c o n c e r n e d . It is n o less true o f t o w n drainage.

Grhnsby, 1871 : In the majority of the houses " nightsoil and ashes are received into boxes, the contents of which are removed periodically . . . . The carts discharge at a depot in the W. Marsh, at a place onequarter of a mile from the nearest houses ; the accumulations remain there until the contractor is able to dispose of them . . . . The sewage of the whole borough is discharged at a point nearly one-third of a mile from low water mark-43 Boston, 1886 : '" Systematic sewering on W. side of River Witham discharging into tidal water. On east side, old drains failing into an old ratriddled irregular sewer (once the " Bar-ditch ") connected at both ends with the Witham, or into a stagnant canal, " Bargate Drain," causing nuisance. Excrement r~moval mostly very offensive brick privy pits only emptied when full and ccmp'ained of. About 500 ash-closets drained into sewers and empaed weekly by public scavenger. A few W.Cs. ,,44.

Drainage of the Towns T o w n d r a i n a g e a n d disposal o f sewerage were a l m o s t e v e r y w h e r e a s t a n d i n g incitement to disease. B u t we c a n distinguish stages in development. T h e d e v e l o p m e n t in m o s t Lincolnshire t o w n s was n o t from n o d r a i n a g e (cesspools a n d r e m o v a l of nightsoil in carts) t o effective d r a i n a g e ; t h e r e was a t r a n s i t i o n p e r i o d in w h i c h d r a i n a g e was i n t r o d u c e d b u t was so imperfect in c h a r a c t e r as often to create a new source o f disease. I n general primitive d r a i n a g e a n d v a u l t privies, ash-closets a n d cesspools, existed side b y side u n t i l late in the century. T h e y seem to h a v e rivalled each o t h e r .in offensiveness. W e select some example f r o m different t o w n s at different dates : - -

R e p o r t s o n various L i n c o l n s h i r e t o w n s , a p a r t f r o m t h e examples given, m a k e it clear t h a t t h e d r a i n a g e i n t r o d u c e d into towns, or a d d e d to older systems o f drainage, at this p e r i o d was deficient in so far as t h e drains were generally u n t r a p p e d , u n v e n t i l a t e d a n d unflushed. A t G r a n t h a m t h e drains were t h o u g h t to b e the m a i n s o u r c e o f t h e epidemic in 1864. There, t h e drains in the p o o r e r quarters, a n d private drains, were described as " c o m m o n l y u n t r a p p e d a n d t h e sewers generally imperfect . . . m o r e o r less o f t h e n a t u r e of e l o n g a t e d cesspools -4 ~.

Starnford, 1842 : The severity of typhoid had been much increased by local causes, " particularly such as yards densely populated, ill ventilated, and where filth accumulated for the want of public convenience for its deposit: many of such yards have cesspools covered over with open grating ,,~1.

(To be continued) 4~ Second Report o f the Medical Officer to Privy Council. 43 Report to the Medical Officer o f the Local Government Board. 44 Report to the Medical Officer o f the Local Government Board, pp. 138-9. 4~ Seventh Report o f the Medical Officer to the Privy Council.

4o Sixth Report o f the Medical Officer to Privy Council. Report on Agues. 41 Report by Stamford Medical Officer. Local Reports of 1842 Sanitary Committee.

Dental Health in the Maternity and Child Welfare Field therefore, seem logical t o devote a certain a m o u n t of time a n d m o n e y to try to p r e v e n t dental disease. A t the p r e s e n t time t h e r e were a d d i t i o n a l factors. T h e d e n t a l profession was practically fully o c c u p i e d a n d yet was p r o v i d i n g t r e a t m e n t for a p p r o x i m a t e l y o n l y one-fifth o f the p o p u l a t i o n . T h e rate o f r e c r u i t m e n t to the profession a n d the wastage due to d e a t h o r r e t i r e m e n t were such t h a t the n u m b e r o f d e n t a l s u r g e o n s in this c o u n t r y seemed likely to decline considerably. F u r t h e r m o r e , since the e n d of rationing, c a r b o h y d r a t e s of all forms, b u t particularly sweets a n d biscuits, h a d b e c o m e m u c h m o r e readily obtainable, with a c o n s e q u e n t m a r k e d increase in d e n t a l caries. I n Staffordshire in 1947, w h e n r a t i o n i n g still applied, o f the five-year-old c h i l d r e n e n t e r i n g school, 38.9 % h a d s o u n d teeth, while t h e n u m b e r with f o u r or m o r e decayed teeth was 2 2 . 3 % . I n 1953 w h e n r a t i o n i n g of c a r b o h y d r a t e s h a d d i s a p p e a r e d t h e n u m b e r with s o u n d teeth h a d d r o p p e d to 2 1 . 3 % a n d the n u m b e r with four o r m o r e decayed t e e t h h a d risen to 50.6 %.

E T H O D S o f p r e v e n t i n g dental caries b y education, inspection a n d regulation o f the fluoride c o n t e n t of d r i n k i n g w a t e r were described in p a p e r s r e a d a t a j o i n t meeting of the D e n t a l a n d M a t e r n i t y a n d C h i l d Welfare G r o u p s o f the Society of Medical Officers o f H e a l t h , held at the L o n d o n School o f Hygiene a n d Tropical Medicine. T h e subject was " D e n t a l H e a l t h in t h e M a t e r n i t y a n d Child Welfare F i e l d . " T h e r e were 45 m e m b e r s a n d visitors present, a n d t h e President o f the M a t e r n i t y a n d C h i l d Welfare G r o u p , Dr. H i l d a Davis, was in the chair. T h e r e were two speakers f r o m e a c h group. Dr. Eileen Ring, Senior A d m i n i s t r a t i v e M e d i c a l Officer, B i r m i n g h a m , w h o s p o k e first, p o i n t e d o u t t h a t d e n t a l decay affected a b o u t 98 % o f the p o p u l a t i o n . I t was n o t a d r a m a t i c disease b u t was t h e cause o f m u c h pain, suffering a n d general ill-health. I f e v e r y b o d y w h o n e e d e d t r e a t m e n t were to receive it the cost in t e r m s o f m o n e y a n d m a n - p o w e r w o u l d p r o b a b l y b e m o r e t h a n t h e c o u n t r y c o u l d afford. It would,

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