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Liverpool Medical Officers of Health 1805 - 1924

William Henry Duncan 1805-1863

In 1846 Liverpool became the first city in the world to appoint a Medical Officer of Health when it appointed Dr William Henry Duncan (1805-1863) to this position, which he took up on 1st January 1847. Duncan had been born in Liverpool and studied at Edinburgh University. At that time in Liverpool many of the poor lived in overcrowded court houses or cellars, the overcrowding having been exacerbated by the large influx of Irish immigrants following the potato famine.

Dr. William Henry Duncan was born in Seel St in 1805. his former home later became The Blue Angel nightclub.  He graduated as Dr. of Medicine in 1829 at Edinburgh and returned to Liverpool where his work as a General Practitioner took him into the poorest quarters of the city.  He quickly came to realize that it was no coincidence that the greater part of his patients lived in slum conditions and until those conditions altered then his efforts were negligible.  The authorities at the time held the ludicrous theory which  equated the health of the city to the wealth of the city and as that was booming then all was well.  It was Duncan's great achievement to draw the authorities attention to the plight of the thousands of slum dwellers which was accomplished with the use of pamphlets and lectures.  He also warned of the epidemics which were bound to arise.  His efforts and those of other like-minded philanthropists in the city led to action in Parliament, resulting in Duncan's appointment as the first Medical Officer of Health in the country in 1846, a massive task which would occupy him for the rest of his life. At the time of Duncan's appointment, the number of Irish immigrants was increasing daily and a conservative estimate placed a number of 80,000 remaining in the city, most of them crammed into the courts.  There were several occasions when no less than 40 people were found to be inhabiting one of the cellar rooms previously mentioned.  Three years later and Duncan's forecast of an epidemic came true with an outbreak of Asiatic cholera in 1849.  Hundreds died daily and although it was no consolation to Duncan to be proven right the outbreak triggered the beginning of he end of life in the courts and drew the attention of the authorities as nothing else could to the plight of the people living in them. Although they were still working on the basis of the Miasma Theory the authorities at last began to draw up some basic plans for rubbish removal and sanitation.

Dr William Stewart Trench 1863 - 1876

Dr William Stewart Trench was Medical Officer for Health in Liverpool from 1863 until 1876. Dr William Stewart Trench is a name unknown to most people, even to those who have studied medicine and public health in nineteenth-century Liverpool. He was the successor to Dr William Henry Duncan, who was Britain’s first Medical Officer of Health in Liverpool. The late Bill Shankly, the legendary manager of Liverpool FC, is remembered for saying that ‘first is everything, second is nowhere’ – albeit referring to football – but the quotation is equally appropriate for Dr Trench.  Trench was born in 1809 at his father’s plantation of Machnie in Clarendon, Jamaica. His father, William Power Trench, was a planter and a Member of the Assembly, the son of Rev. William Trench, Archdeacon of Kilfenora in Ireland and nephew of the first Earl of Clancarty. All of the children of William Power Trench and Janet Stewart Trench were given the opportunity to receive higher education in Britain and William Stewart Trench settled on a career in the medical profession. He studied medicine at the University of Edinburgh in the late 1820s.

Following the sudden death of Dr Duncan in 1863, the Health Committee of Liverpool had the duty of electing a successor to the post of Medical Officer of Health. On 1 July 1863, the Borough of Liverpool’s ‘Proceedings of the Council’ records the outline of the position with a salary of £750 per annum. Dr Trench was one of three candidates, the other two being Dr Gee, physician to the Workhouse, and Mr John Taylor, Surgeon. Dr Gee was the favourite for the post, having been granted a high testimonial by the parish Vestry and the Workhouse committee, but following three rounds of voting of the Council members Dr Trench emerged as the winner with twenty-seven votes. Dr Gee received nineteen votes and for Mr Taylor, no votes. The outcome was met with a lot of opposition.

Dr Trench was a man who had not had a great deal of experience in dealing with the masses. His practice was in Rodney Street, a better part of town which even today is the focus of private medicine, whereas Duncan had also been physician to the South Dispensary which had brought him into contact with the poor. Life was a terrible ordeal for these people who were forced to live in the overcrowded, disease-ridden, filthy parts of Liverpool. In 1863, the year of Trench’s appointment, the mortality rate was thirty-three per thousand, higher than any year since 1849. Yet there had been no epidemic of cholera or other infectious disease to which it could be ascribed. In this year some 895,851 people were supplied with relief by the parish Vestry, an average of 17,228 per week. Conditions were worst in the central areas of Liverpool. Trench noted that the attention of the Health Committee was always occupied with problems like ‘the number of poor, especially of Irish and other destitute immigrants, promiscuously collected in certain squalid localities; filth and penury pent up in airless dwellings’. Overcrowding and ill-ventilated courts and alleys were common and the construction and position of middens and cesspools were all risk factors that led to infection. Infectious (known by Trench as zymotic) diseases were the first to be examined by Trench as these were the most likely to become epidemic. During the previous ten years to 1862, they had caused 25.9 per cent of the deaths in the borough but in the year of 1863 they were responsible for 29.4 per cent. Typhus fever and diarrhoea were ranked first, followed by whooping cough and scarlatina, their prevalence being due to the overcrowding and lack of isolation of the sick. Typhus fever invariably broke out in the streets, courts and alleys where there was inadequate ventilation, bad drains, middens and overcrowding. Smallpox, diphtheria and phthisis were the other main causes of mortality. 

In November 1863 Dr Trench published a report on Defects in the Present Midden System and Improvements Required. He detailed arrangements for the disposal of the refuse of the town and the major problems of the privies, - shared insanitary convenience - and middens, some of which were built beneath, or close to, sleeping and inhabited apartments and had to be emptied via the passages and rooms of the houses. Other types of middens were ‘tunnel middens’ which, being unobserved by the Inspector of Nuisances, were never brought before the notice of the Health Committee. Some of the tunnel middens were 160 foot long, six foot four inches high and three foot wide, and rested on the walls of people’s homes and within a few inches of their beds. Trench considered that the question of improving the sanitary conditions of the houses of the poor should be one in which the whole town should be interested.  "Infection does not confine itself to the areas of the poor, but migrates and ‘finds victims among the children and families of the rich" he said. On 9 December 1864, Trench submitted his Report on Indigence (Poverty) as a cause of the Epidemic Typhus to the Health Committee. Due to the problems Liverpool had had with typhus fever, the Council accepted the proposals of the Health Committee to demolish a number of houses in some streets in order to allow ventilation to the court housing. Between July 1863 and December 1867, 8283 insanitary shared privies, with no proper plumbing or sanitation, had been certified for conversion to WCs Some fifty thousand inhabitants had benefited from these conversions in the years between 1863 and 1866. The last Annual Report written by Trench was in 1875, when he reported the death rate for the Borough being 27.5 per thousand – an improvement on the previous year – and the average age of death as twenty-six years.  By mid 1876 Trench could no longer continue his work, weakened by ill health exacerbated by his busy job. After fourteen years as Medical Officer of Health for Liverpool, he died suddenly in December 1877, aged sixty-eight.

Dr John Stopford Taylor 1877-1893

John Stopford Taylor was born in 1821 in Sheffield. He trained in Sheffield and at St Bartholemew’s Hospital in London. He gained his MD from Aberdeen University in 1853. He began medical practice in Liverpool in 1846, working as honorary Medical Officer to St Anne’s Dispensary and to the Eye and Ear Hospital.  Stopford Taylor played an active part in Liverpool politics from 1864, when he was elected as a Conservative Councillor. He served as Deputy and Chair of the Council’s Health Committee, while his predecessor Dr Trench was Medical Officer of Health. Stopford Taylor replaced Trench as Medical Officer of Health, a post he then held for the next sixteen years.  This period witnessed a consolidation in public health progress in Liverpool. National legislation imposed tighter control on buildings and sanitary services, while allowing for the expansion of other public health activities such as public baths and wash-houses and related municipal ventures. By 1892 Liverpool had finally secured a sufficient and safe water supply from the Vrynwy reservoir in North Wales. There was also an ambitious programme of slum clearance and new housing. The Council employed more public health staff, including a Borough Analyst from 1872 (to sample food and drink) and health visitors were appointed from 1897. This sustained period of sanitary reform contributed to a reduction in epidemic infectious diseases such as cholera, typhus and typhoid, and an increase in life expectancy in Liverpool. All this was achieved within a rapidly expanding urban population (from 443,938 in 1861 to 856,483 in 1931).  The politicisation of public health becomes most apparent at the time of the change in government in 1893 from Conservative to Liberal. Stopford Taylor found that the simultaneous shift in power in Liverpool made his position as Medical Officer of Health virtually untenable. Shortly after the change in leadership, he was required by the Council to resign his post ‘having regard to advancing years and increasing duties’. He was seventy-two, and undoubtedly the workload of the Medical Officer of Health had increased considerably during his sixteen years in office, but the manner of his departure was unfortunate. He died in 1901 at the age of eighty.

Dr Edward William Hope 1894-1924

Edward William Hope was born on 8 August 1856, the son of Robert Wallis Hope of the War Office, a Deputy Surveyor of Ordnance. His father’s occupation could have had an indirect influence on Hope’s approach to public health as a career, for his father had been involved in the detailed mapping of large towns. After preparatory education in Brighton, Hope was educated at the Royal School of Mines in Jermyn Street, London. Like two of his Medical Officer of Health predecessors in Liverpool, Hope attended Edinburgh University where he graduated MBCM (1878), BSc (1881) and MD (1882).

Dr Edward William Hope was Assistant Medical Officer of Health for the City and Port of Liverpool between 1883 and 1894, and Medical Officer of Health from 1894 until his retirement in 1924. The year 1883 was to mark the beginning of a new era in the realm of public health in Liverpool. Typhus had broken out again in the city and
confidence in the Medical Officer of Health, Dr John Stopford Taylor was at a low ebb. The Liverpool Daily Post had published a series of articles enlightening the general public to the filth, disease, poverty and other problems of the slums arising from the iniquities of the casual labour system associated with the docks. A special Commission consisting of a City Councillor, a prominent local  physician and a reporter of the Liverpool Daily Post was asked to submit a report on the conditions which were prevalent in the poorest quarters of the city.  The Report was entitled ‘Squalid Liverpool’.

In 1883 a special committee called the Insanitary Property Committee under the Chairmanship of Sir Arthur Forwood, was appointed by the City Council to deal with dwellings which were unfit for human habitation. The Committee was aided in its work by commercial requirements which led to house clearances, partly to make way for the increasing demand for warehouses, railway lines and other commercial properties.  The City Council resolved on 27 March 1883 to appoint an Assistant Medical Officer of Health to assist Stopford Taylor in the sanitary inspection of the City, more particularly with reference to infectious diseases. By virtue of his office he would be a Medical Officer of Health in all but name, his duties strictly defined by the Local Government Board. The post could be seen as a preparation for the role of a future Medical Officer of Health.  In May 1883 the post of Assistant Medical Officer of Health was advertised nationally. There were twenty-six applicants for the post. Six were short-listed and Hope, the successful candidate, was appointed in May 1883, aged twenty-six.

Between June 1883 to December 1884 Hope made one thousand eight hundred and thirty entries in his day book. Most of this period seems to have been allotted to work with very little time for leisure. It was a very hard schedule, an arduous and demanding role for a young doctor. They supply information about the courts, cellars, insanitary housing; whether the house is sub-let; the poverty; the slothfulness or drunkenness of families; the cleanliness and thrift of others; the deaths and diseased corpses; the Irish ‘wakes’. He noted the personal and domestic hygiene, the nationality, the number of children, the lack of fuel, food, clothing and beds and bedding. The dirt and smells are recorded with such clarity that one can almost smell the stench of the hovels. Hope also recorded the source of the report, such as a priest, a teacher or school attendance officer, and whether a patient was sent on a voluntary basis or not to the isolation wards of the Workhouse Hospitals at Mill Road, Netherfield Road or Brownlow Hill. He was carrying out a role similar to that of a General Practitioner on call, but in addition he was acting as an investigator of environmental conditions as well as an organiser of medical and social agencies such as hospitals. Hope’s comments on his visits illuminate all kinds of contextual factors: insanitary conditions of the dwellings; the poverty and wretchedness of children and mothers. He was not afraid to criticise doctors or parents. But he praised the more sensible who made provision for sickness through medical clubs. He advocated breast-feeding to address the problem of contaminated milk fed to babies by ignorant’ mothers. He also noted cases of child abuse and those suffering from syphilis. Eighteen ninety-four was to be a turning point in Hope’s career, when he was promoted to the post of Medical Officer of Health for the Port and City of Liverpool. While he held this position he was required, ‘to reside within the City and devote his whole time to the duties of the office’. In 1899 Hope eventually married the twenty-six year old beauty, Charlotte Rennie Bowring, a member of one of the wealthiest and most influential families in Liverpool, who were sailing ship owners and insurance
brokers. By the time Hope was fifty-four years old he was fast approaching almost a quarter of a century in the service of Liverpool’s public health. However, he continued to press for greater recognition both at home and abroad. With the growth of the city the number of inspectors and work staff had increased enormously, from sixty-two in 1894 to 470 by 1923. In 1912 Hope delivered a detailed paper at the International Congress on Tuberculosis held in Rome. A few months later he presided at the fourth Annual Conference of the National Association for the Prevention of Consumption and Other Forms of Tuberculosis at Milton Hall, Manchester. Although TB dispensaries and sanatoria had been in existence for many years, the post of  Tuberculosis Officer was a new idea, and Hope initiated a Tuberculosis Scheme for Liverpool. Nineteen twenty-four was the final year of Hope’s term of office, although he was to continue his Professorship for a few more years. In June, as his retirement neared, Hope addressed the Congress of the Royal Institute of Public Health (of which he was President) at Bordeaux in France. For his work in public health the French government conferred upon him the Order of Officier de l’Instruction Publique, a final international recognition for his work.

Hope continued writing in his retirement, still taking an active interest in public health. His book, Health at the Gateway, published in 1934, is a testament to his life’s work in public health in Liverpool. He died at Caldy, Wirral, aged ninety-five in 1951.

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