Monday, 8 September 2014

Sanitising History

Radio 4's 'Thought for the Day' today (8/9/14) was by Rev Professor David Wilkinson, about ebola. You may want to listen to it yourself. [link here]

Wilkinson starts his talk by noting that the head of Medecins Sans Frontieres has criticised the 'lock down' planned in Sierra Leone, on the grounds that it will undermine trust and drive down notifications of the disease. Wilkinson agrees; and he makes - I assume very valid -  points about the failure of the existing market-driven system to produce a vaccine before this vast outbreak; and the need, in future, for partnerships between pharmaceutical companies, government and local health providers. He finishes with "As a Christian I want to join with many other voices in highlighting that in this we need a common concern and action for the poor."

All excellent; but Professor Wilkinson sandwiches a historical homily between these thoughts.

History, of course, must offer countless parallels. We might look, for instance, at cholera coming to England in 1831/32 - an equally terrifying plague and, at the time, infinity more unknowable than ebola is today. The Central Board of Health - the government's medical advisors - toyed with the idea of internal quarantine  but decided it was impracticable  - and, of course, an affront to the much-vaunted personal freedoms of the English. Do the inhabitants of Sierra Leone feel any different about being trapped in their homes?

Professor Wilkinson, however, refers  back to John Snow's famous epidemiological studies of cholera in the 1850s.

Here's what he says:
On this day, 160 years ago on the instruction of Dr John Snow, the handle of the pump on Broad Street in Soho was removed. Snow had argued that its water was the source of an outbreak of cholera that had killed over 500. This was not an easy argument to win. Christian reformer, the Earl of Shaftesbury had for some time failed to persuade the authorities that improving sanitation would minimise cholera outbreaks. Opponents objected to the cost, but also were convinced that cholera was caused by miasma, a mysterious kind of ‘bad air’.

 By careful investigation and plotting the locations of deaths, Snow was able to argue that the disease was spread by germs and the outbreak originated from raw sewage that had contaminated the pump water. But Snow did not do this alone. Henry Whitehead, an evangelical Anglican curate, lived in the impoverished area of the city, and although initially sceptical of Snow, through meticulous research became one of his most vocal and influential supporters in arguing for germ theory and action in the light of it. His faith motivated his sympathy for the poor, his commitment to live with them and led him to oppose the view that cholera was simply a consequence of laziness which led to poverty. Snow and Whitehead’s partnership gave birth to the science of epidemiology and significant improvements in public housing and sanitation.
The point seems to be that a combination of clear-thinking science (Snow) and Christian charity (exemplified by Shaftesbury and Whitehead) ultimately reformed public housing and sanitation.

No-one but a lunatic would deny that Christianity was a major driving force in Victorian social reform - perhaps the driving force - but the above story is just plain wrong.

I'll explain why:

1.  Shaftesbury, a devout Christian, was a leading 'sanitarian' and social reformer. He was also, famously, a devout miasmatist. Here he is speaking in *1859* ...

"Filth and miasma will, in some form or other, accomplish their work, and, like evil spirits, anxious only for destruction, if they cannot exstinguish the physical, will corrupt the moral life of many generations ..."

In other words, Snow's epidemiological proof of cholera - widely ridiculed and ignored in the 1850s - had little or nothing to do with Shaftesbury's already long-standing interest in sanitation, housing and social reform.

2. "Opponents objected to the cost, but also were convinced that cholera was caused by miasma" ... Yes, cost was a major concern in sanitary reform. For example, there was great unwillingness on the part of central government to foot the bill for sewer schemes in London, which had been on the drawing-board since the late-1840s. But almost everyone, on all sides of the debate, was a miasmatist.

Edwin Chadwick, the civil servant who had carved his own niche in the running of the country by describing the insanitary hell of its great towns and cities, was the great proponent of miasmatic theory. Shaftesbury was one of his great supporters. By the 1850s, miasmatic theory was everywhere, not the preserve of opponents to social improvement. Indeed, quite the opposite, the ardent proponents of improved sanitation were all miasmatists.

3. The claim that Snow and Whitehead's work ultimately drove change is just wrong, except in the longest possible of historical long lenses. Every major sanitary reform that actually took place in Victorian London - sewerage, parochial cemeteries, model housing - had its basis in Chadwick and Shaftesbury's sanitary agitation of the 1840s. And their great article of faith was - you guessed it - that bad air caused disease. Chadwick, moreover, was not a great man of faith - rather, a ruthless Benthamite utilitarian, also remembered for the cruel calculus of the New Poor Law.

It's fascinating how Snow's genius has made him a latter-day saint of rational scientific inquiry - and much deserved. But we need to remember that he had little actual impact on the health of the metropolis. I certainly do not wish to diminish the importance of religious faith to the sanitary reform movement - it's absolutely crucial - but the notion that a marvellous alliance of enlightened scientists and Christians improved Victorian London is simply erroneous. There was a good deal of trial, error and dismal failure; and almost universal belief in 'miasma' persisted throughout the century. Moreover, there was many a dedicated church-goer who explicitly objected to helping the poor with better housing or drains; others, tacitly, had a nice row or two of slum properties from which they collected a modest rent.

Apologies for the rant, but these are not obscure facts - so let's remember them.

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