William Henry Duncan 1805-1863

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.
Sources
Liverpool Central Library
Liverpool Records Office
Liverpool University
Liverpool Health Committee Minutes
Robert F Edwards
Robert F Edwards