Thursday, 2 February 2017

The Swimming Baths?

When I was a kid people talked about going to "the baths" about as often as going to the "swimming pool". It always seemed kind of weird but pretty much everything adult was a mystery to me then. I am happy to say I finally solved that little mystery recently when I delved into The Great Filth by Stephen Halliday. 

While the Inquiry into Havelock North's Drinking Water was in recess I thought I would put the whole outbreak and the inquiry into some context. I knew that in the 19th century huge advances were made in public health but I had no idea of the detail. This book is a very readable primer on the various strands of improvement of disease prevention that took place then. The "War Against Disease" had two major strands: the purely medical involved vaccination, childbirth practices and antisepsis in hospitals; the public health stream involved cleaning up water supplies, removing rubbish and improving housing. It's the latter stream that is most relevant to the Inquiry.

You cannot underestimate what a game changer public health improvements were at that time.

During the 60 odd years of Queen Victoria's reign, life expectancy in Britain increased by a staggering 50%. Declines in infant mortality and deaths in hospital, and the eradication of smallpox were important factors as was a lift in nutrition. But, just as important were the great public sanitation improvements carried out by councils: improving the supply of drinking water, improving the removal of sewage and stormwater, providing bathing facilities, and demolishing unsanitary buildings.

Local government achieved something in the late 19th Century that was more important than all the inventions of the time: they made cities livable. Not in the ill-defined way that that word is used today but literally. Until the heroic age of sanitation cities were dangerous places where disease was rife. In fact all places where humans were jammed together in large numbers were dangerous. The enlisted men in the army and navy were much more likely to die from disease than enemy action. Likewise prisoners in London's notorious Newgate Prison had more to fear from "prison fever" than the hangman.

But, as councils built proper water supply systems, and pipes to remove sewage and stormwater, and removed rubbish from the streets the incidence of communicable disease declined significantly. This allowed cities to grow and to benefit from the bringing together of people and their businesses.

There must have been a real sense of mission in some councils. Many of these activities were encouraged by the Medical Officer of Health - who was a council employee in those days. In addition to the engineering works the MoH also oversaw the demolition of insanitary buildings and encouraged changes in city design to get noxious industries separated from people. Amongst other things councils built public bathing facilities so that people could wash if they had no access to proper water supplies. Quietly, over the years, those facilities have transformed into recreational swimming pools although they were known as "the baths" into modern times.

That sense of purpose is long gone and we have been flailing around for the last 30 years trying to define just what local government is for. We are probably still no closer to a compelling answer to match the triumph of the Victorian Age.

As the Havelock North Drinking Water Inquiry continues I will be looking to see whether this loss of purpose was a factor in the outbreak. It certainly let down everything that the great pioneers of public health fought for 150 years ago.

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