Written by Ailsa Fraser
‘Auld Reekie’ is one of Edinburgh’s best-known nicknames. For most of its existence, Edinburgh smelled awful. A crowded, unhygienic city for the poor and not always much better for the rich; it was rife with sickness, poverty, and misery. But today, it’s much cleaner (provided you’re not here during the fringe festival), with much better sanitation and public health. For that, we have many nineteenth-century public health reformers to thank. Most importantly, Edinburgh’s first Medical Officer of Health (MOH), Dr Henry Littlejohn.
Littlejohn was appointed in 1862. By then, the nineteenth century had already known a mess of public health issues. The population of Edinburgh doubled from sixty-eight thousand to one hundred and thirty-six thousand people between 1801 and 1831 alone; as urbanisation swept the country, twenty-two per cent of the Scottish population lived either in Glasgow, Edinburgh, Aberdeen, or Dundee by 1851. Tenement houses were cramped and poorly ventilated, with many families sharing one room and multiple buildings sharing an outdoor earth closet to excrete in. Water supplies were haphazard at best. Prior to 1818, inhabitants had their own wells, with enough water provided in rainy Scotland to let it run wasted down the street, but once the town leased a company to provide the water, there were significant shortages. This was especially damning when cholera struck Britain. Spread through contaminated food or water, it might not have killed as many people as fever, but the death it dealt, dehydration through diarrhoea, was traumatising to onlookers. Cholera riots broke out in Edinburgh in 1832 with a terrified public angry that the medical establishment was not doing more, and the city spent nineteen thousand pounds trying to address the 1832 epidemic alone.
With little piped water, it makes sense that the vast majority of residents—one hundred thousand—did not have water closets by 1847 to dispose of their sewage. Instead, there was an industry around collecting human waste for fertiliser for fields, a practice that appealed to health reformers like Edwin Chadwick as efficient, despite the narrow profit margins it offered. The fields around Holyrood would be irrigated with sewage-spiked water. Many contemporaries complained about the smell. But by 1873, when fifty-six thousand tons of excrement were being removed from the streets, it cost far more to pay the workers collecting the manure than the city actually received from the farmers who bought it. It did not help that the pail-and-pan system, meant to streamline the collection by serving the manure in pans, was messy to implement in practice, and many would just throw it into the streets.
There were, of course, attempts to reform the public health of the city. Doctors like William Alison, a doctor known for working closely with the poor to understand the source of their health problems, advocated for a reform of the poor laws that would address them. Similarly, he was a surveyor for and contributor to Chadwick’s Report on the Sanitary Conditions of the Labouring Poor, which sought to improve public health by addressing unclean environments around Britain. Previous theories of medicine had taught that illness was caused by an imbalance of humours within the body—an individual problem—but since the eighteenth century, miasma theory led doctors to wonder if one’s environment might impact one’s health. Chadwick’s assertion that sanitary conditions prevented illness was in line with many doctors’ beliefs, and from the publication of his report in 1831, it became a focus across all of Britain to improve public health.
It was in this context that Littlejohn was appointed MOH for Edinburgh in 1862, the first of a new position. Born into a family with a long history of public service, he had trained at the medical school where William Alison taught and had a similar approach to the prevention of disease in the poor. By1862, he was a highly respected doctor and had served as a Police Surgeon and provided medical references in criminal trials. There was significant public support for his appointment. The Scottish MOH had a strong position in local government—far stronger than previous health authorities had had—although his board was understaffed, and he had only three inspectors working for him. His appointment was only supposed to be temporary. He served for forty-six years.
Within two weeks of being appointed, Littlejohn drew up an assessment of the prevalence of smallpox within the city. He proved indefatigable. His crowning achievement was undoubtedly his 1865 Report on the Sanitary Conditions of Edinburgh, a detailed examination of cleanliness and potential causes for disease across Edinburgh, ranging from the quality of meat to sewage disposal, from ventilation in homes to overcrowding in graveyards. Reading his report, his familiarity with the landscape of Edinburgh is evident. He had to draw up a map of its sanitary districts from scratch, analyse how the distribution and density of housing built might impact the spread of disease, and productively compare the public health of Edinburgh to Glasgow despite Edinburgh’s idiosyncrasies. In particular, several times, he references interviewing members of the working class who lived in unsanitary conditions and cites their reasons for not doing more to keep clean, including problems with neighbours and landlords. Considering many reformers suggested that educating the poor on cleanliness would be enough, Littlejohn’s awareness of the structural difficulties facing people is striking. It demonstrates his attention to detail across Edinburgh.
What he found was appalling. His recommendations were clear. He tailored them each to the Old Town, the New Town, and the newer Southern Suburbs, all of which had different architectural and socioeconomic situations. The Southern Suburbs were largely fine but needed some attention; the New Town was suffering from poor drainage. However, it was the Old Town that needed the most reform, with the oldest and most cramped buildings. He recommended the closes should be paved and drained, water and gas should be introduced to poor accommodation, the stairs cleaned, and repairs made, and limitations on the number of people per apartment and house heights to lower overcrowding. Conscious of leaving people homeless, he recommended that people only be removed from accommodation once alternative accommodation had been found for them, vetted by him. The council leapt into action. Within three months, a five hundred thousand pounds improvement scheme had been approved.
The impact of Littlejohn’s reforms of Edinburgh, owing to the national interest in public health and the power vested in him as MOH, was significant. According to his own statistics, the death rate in Edinburgh dropped by 32.1 per cent between 1865 and 1883. Death rates in the worst affected districts fell most significantly, likely as a result of the decrease in overcrowding after the 1867 Edinburgh Improvement Act instituted on his watch. However, there were limits. The improvement scheme took twenty-two years to finish. And while 2,721 houses were demolished, only three hundred and forty new ones were built. Considering the population rose by a further thirty-six per cent in this time period, the housing crisis, therefore, remained. The project started in the 1860s to introduce water closets into homes did have some successes, with twenty-eight thousand homes installed with them in 1873, but only twenty per cent of houses worth less than five pounds had running water at all. In 1914, the year of Littlejohn’s death, most working-class residences shared a water closet—but at least they had access to one.
Littlejohn was one public health reformer in a century of them, and his predecessors—Chadwick, Alison, and others—contributed greatly to his work. It would not have been possible without the attention previously given to public health. But the impact he had was astounding. His report remains an enormously impressive feat of data collection, and his apt recommendations oversaw a staggering decline in Edinburgh’s death rate. In particular, his sensitivity to the socioeconomic factors of health, such as living conditions and the structural experience of the working class, enabled him to enact reforms in a way that would not hurt the poor further. Public health, simultaneously intimate and all-encompassing, was and is a complex issue to regulate and enforce. But the impact Littlejohn had in shaping Edinburgh into the city it is today was undeniable.
Bibliography
Chadwick, Edwin, and M. W. Flinn. Report on the Sanitary Conditions of the Labouring Population of Great Britain. Edinburgh: Edinburgh University Press, 1965.
Dingwall, Helen M. A History of Scottish Medicine. Edinburgh: Edinburgh University Press, 2003.
Flinn, M. W. “Introduction.” In Report on the Sanitary Conditions of the Labouring Population of Great Britain, edited by M. W. Flinn, 3-74. Edinburgh: Edinburgh University Press, 1965.
Laxton, Paul, and Richard Rodger. Insanitary City: Henry Littlejohn and the Condition of Edinburgh. Lancaster: Carnegie Publishing, 2013.
Littlejohn, Henry. “Report on the Sanitary Condition of Edinburgh.” In Insanitary City: Henry Littlejohn and the Condition of Edinburgh, edited by Paul Laxton and Richard Rodger, 228-433. Lancaster: Carnegie Publishing, 2013.
Morris, R. J. “Urbanisation and Scotland.” In People and Society in Scotland: Volume 2, 1830-1914, edited by W. Hamish Fraser and R. J. Morris, 73-102. Edinburgh: John Donald Publishers, 1990.
Pelling, Margaret. Cholera, Fever, and English Medicine, 1825-1865. Oxford: Oxford University Press, 1978.
Riley, James C. The Eighteenth-Century Campaign to Avoid Disease. London: Macmillan Press, 1987.
Smith, F. B. The People’s Health, 1830-1910. London: Billing and Sons Limited, 1979.
Wohl, Anthony S. Endangered Lives: Public Health in Victorian Britain. London: J. M. Dent & Sons, 1983.
Featured image credit: “Auld Reekie” by AJC1 is licensed under CC BY-SA 2.0.
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