FACT SHEET 5

Public Health

Public health was a major concern in the 1830s and 1840s. Edwin Chadwick (responsible for the New Poor Law in 1834) headed the Report on the Sanitary Conditions of the Labouring Population of Great Britain in 1842. This led to a Royal Commission on the Health of Towns and eventually in 1848 the Public Health Act was passed. Towns were able to set up Local Boards of Health and appoint a Medical Officer of Health. Oxford set up a Local Board of Health with Town and Gown representatives in 1864 and a Medical Officer of Health was appointed in May 1872. The Medical Officer of Health, accountable to the Local Board, had the responsibility for overseeing public health. An Inspector of Nuisances (a power inherited from the Commissioners in 1771) and a Sanitary Inspector worked with the Medical Officer of Health to improve sanitary conditions. (See Memorial to Lee Turner (B21), described in the 1881 census as 'Surveyor and Inspector of Nuisances.')

The inspectors investigated homes and property in the community and reported to the Nuisances Committee and the Sanitary Committee respectively. There were limited sanitary facilities in many homes, some owned by landlords and others owned privately. Public Nuisances Reports go back to the 1860s and report on defective drains, blocked toilets, deficient water supply to toilet, inappropriate keeping of animals and homes without a toilet. The Sanitary Committee Minutes report from 1889 on the houses in east Oxford with inadequate water closets and drainage. Other complaints included overcrowding, keeping swine (which was against a bye-law) and accumulation of manure. Schools were also inspected and on occasions the local schools were reported for inadequate toilet facilities. When an Inspector reported a complaint the persons responsible for the property had a set amount of time to rectify the problem. If this was not carried out further action was taken by the inspector, but some people could not afford to sort out the problem.

Robin Hood/Ss Mary & John School

Log book: Extracts

1878

Whooping Cough, flu, colds and chilblains a constant problem

1888

September
Typhoid fever present lots of children ill especially in the Babies Room

1889

March 1st
Measles proving quite an epidemic in the district, closed school for three weeks. Four scholars have died.

November 21st
Still a great deal of sickness among the children. Three of them having died almost suddenly since the date of the examination

1895

Medical Officer of Health closed school (for almost three weeks) because of the increase in the number of scarlet fever cases.

1918

October
School closed for three weeks, influenza epidemic

Sanitation

Cholera epidemics in the early part of the nineteenth century played a large part in generating the need for more attention to public health. The Paving Commissioners (set up in 1771) were the official body dealing with the 1832 cholera epidemic, and the Oxford Paving Act 1835 laid down laws addressing some aspects of public health, such as the banning of cattle slaughter in the street. But because the water supply was owned by a private company the Commissioners had no control over this. In fact the city pumped water direct from the river to comparatively few customers; most people were reliant on wells and local pumps for water. In 1848, Dr Ormerod, a Commissioner who was also a surgeon at the Radcliffe Infirmary, wrote a report The Sanitory Condition of Oxford. Dr Ormerod linked the large open drains full of decomposing mess with the high mortality rate. The most affected areas in the city were St Ebbes, St Thomas' and St Clements. Members of the public also made many complaints about the filthy state of the sewers, cesspools and drains. Filth and sewage from the slum areas in the centre of the city were being emptied into the Thames just above the waterworks site at Folly Bridge. Further investigations and surveys demonstrated that the water supply and sewerage system needed to be improved. New sites and systems were suggested but rejected due to the high costs involved. Some action was taken by building new sewers and a committee was set up in 1854 to investigate another sewerage system. This committee recommended the inclusion of outlying suburbs such as St Clements and Cowley in the sanitary responsibilities of the city. The Local Board from 1864 did take in these suburbs and introduced a new main drainage system between 1873 and 1880; by 1884, most Oxford homes had at least shared access to piped water from the City waterworks.

By this time east Oxford was rapidly developing with mixed housing. Houses ranged from large buildings, particularly along the Iffley Road, to small artisans cottages in the poorer areas. Included in the Census of 1881 for this area are college servants, blacksmiths, whitesmiths, tailors, a laundress, bookbinders, an annuitant, butchers, a carpenter, an inspector of nuisances and clerks. Although the houses were relatively newly built, the area around Sidney Street, Percy Street and Magdalen Road, known as the Robin Hood district, was particularly poor.

Area with a concentration of children's graves 1880s-1920s

Infectious Diseases

Infectious diseases were very common in the nineteenth century and many were fatal, particularly for infants and children. The Medical Officer of Health in Oxford, together with other public health officials, worked to prevent and isolate cases of infectious disease, and reported monthly on disease and disease control. There were cholera epidemics in the city in 1832, 1849 and 1854. Local doctors identified polluted water, inadequate sanitation, poverty and over-crowding as contributory factors in the spread of the disease (see Dr Ormerod's report, above). Smallpox was also a very serious disease of the time. There were four outbreaks of the disease in Oxford - in 1839, 1844/5, 1854/5 and 1871. The first Vaccination Act, passed in 1840, granted the Poor Law Guardians the power to contract a medical practitioner to carry out vaccinations free of charge. A further Act in 1853 made vaccination compulsory. In Oxford the uptake of vaccination was considered to be low amongst poor families. The Infectious Disease (Notification) Act 1899 made notification of prescribed diseases compulsory.

In 1892 there were outbreaks of diptheria and scarlet fever in the city. The Medical Officer of Health reported that out of the 450 deaths, 80 came from the Cowley St John area. Ss Mary and John burial records for this year indicate that 76 children were buried in the churchyard. The following year the number increased - 109 people in the area died out of a total of 434 in the city. Amongst these were at least another 65 children who are buried in the churchyard. (See children's graves F57 - F192). A temporary hospital had been established as a result of the 1870 smallpox epidemic and a permanent isolation hospital was built at Coldharbour in Abingdon Road in 1885 (which later became Rivermead Rehabilitation Hospital). Burial records show that from 1892 several children buried in the churchyard, some as young as eight months, had been at the isolation hospital before their death. Adults also used the isolation hospital; see for example D102 about which the Burial Register mentions 'leprious from Isolation Hospital.'

Illnesses in the Robin Hood School such as typhoid fever, scarlet fever, diphtheria and whooping cough, are recorded in the log books and children were sent home for 'blisters.' The parish magazine published a cure for diphtheria in March 1885:

The following cure for diphtheria should be universally known for it is believed that it scarcely fails to succeed:-

One teaspoonful of powdered sulphur in a wineglass of water, gargle frequently with it, allowing a little to go down the throat, and hold it in the throat also.

If the case is too far gone to be able to gargle, put a teaspoonful of sulphur on a red hot coal, inhale the smoke. Go on doing this till a passage is made, then swallow a little and hold it in the throat as before directed. If this treatment is persevered in, the sulphur never fails to burn away the fungus.

Maternity services

There was a high death rate amongst mothers and babies in the nineteenth century. See F115 (children) and D225 (mother). Most women would have had their babies at home with little support and, although some local women practised as midwives, they had no formal training. Some very poor women may have had their babies in the workhouse. The Medical Officer of Health reported on several cases of puerperal fever in Cowley St John from 1891 to 1896. A Lying-in Charity existed in Oxford and Father Benson introduced a local Lying-in Club in 1867: mothers paid a regular amount during their pregnancy and received a loan of baby linen for a month after the birth of the baby. Membership of the Cutler Boulter Dispensary (see below) also provided medical care for pregnant mothers.

Attempts to improve maternity care began to be made at the beginning of the twentieth century when the Midwives Act was introduced in 1902. Midwives then had to be regulated and trained, although there were still concerns about the high mortality. A maternity department was opened in 1921 at the Radcliffe Infirmary. During the following years there was a national concern about the inadequate services for ante-natal care for mothers. This led to more services in Oxford, including the building of the Nuffield Maternity Home and additional maternity beds at Cowley Road Hospital (this became a Public Assistance Institution in 1930). Ante-natal clinics were also held at the Cowley Road Hospital. A municipal midwifery service was running in the city in 1944. After the war, when the National Health Service was established in 1948, a new maternity ward was opened at the Churchill Hospital.

Child health

A voluntary organisation, the Sanitary Aid Association, was established in 1902 to improve sanitary and housing conditions and general health in the city. An off shoot of this Association was the Infant Welfare Association (later known as the Health Committee) set up in 1905 to educate poor mothers in child care to help protect children from diseases. Volunteers would visit new mothers in poor areas and advise them. The scheme was started in St Clements. An Inspector of Midwives was appointed in 1902, a link between the public health department and the voluntary sector. This appointment arose out of the increasing amount of lady sanitary inspectors who were the first health visitors. Amongst some of the projects the Association set up were classes for mothers on child health and baby weighing clinics. From 1909, east Oxford babies could be weighed at the Cutler-Boulter Dispensary in Marston Street.

A school medical officer was appointed in Oxford in 1903. Four years later under the Education Act it became compulsory to have a school medical officer. Children were screened for infectious diseases at schools. The Medical Officer of Health had recorded that often parents had let their children mix with others when infected with a disease. Teachers were asked to report cases of infection at schools to the Medical Officer of Health who would then take the necessary course of action to prevent any disease spreading. Tests had been developed to diagnose diseases such as diphtheria, scarlet fever, enteric fever and tuberculosis. Children were also screened for head lice, hearing or sight problems and dental decay. Older residents remember going to a clinic at the workhouse site on Cowley Road for dental treatment; and others remember going to child health clinics at the local school, on the site where Boots now stands on Cowley Road.

General Health Care

Residents in the area could visit a local doctor if they could afford the fees. Others may have joined the Cutler Boulter Provident Dispensary. For a weekly sum (the amount depended on how many family members were to be covered) medical consultation and treatment could be given. From 1891 a dispensary with medical officers in attendance was held at 7 Cowley Road. The dispensary moved to Marston Street in July 1892. If a person was too ill to attend the dispensary a home visit could be made. For people who could not afford the subscriptions for the Dispensary, Poor Law Medical Officers were available. There were also Friendly Societies that provided cover for workers and their families, but not everybody could afford the weekly rates.

When a person had to go to hospital, the Radcliffe Infirmary would take acute cases but not chronically sick people. These cases would usually go to the workhouse infirmary. Infectious cases would go to the isolation hospital. Once the NHS came into effect in 1948 health care became available free to everybody, and general practitioners' surgeries and other health services developed in the area.

Detail of children's graves

Cemeteries

After the cholera epidemic in 1831 a survey of cemetery provision by the Board of Health discovered that most church graveyards were almost full. As the city was expanding there was need for more graveyard space. There were discussions and disagreements in the council on where the cemeteries should be. Ss Mary & John Churchyard was consecrated in 1878. Land was bought from Christ Church for a public cemetery at Rose Hill in 1889 and also from the Dean and Chapter of Westminster for land in North Oxford. Botley cemetery was purchased in 1890 from the Earl of Abingdon.

From the early eighteenth century to the middle of the nineteenth century there was also an issue around the active trade of 'body snatching' from graves and morgues in operation. The corpses were used for dissection by medical students to learn about anatomy. The Anatomy Act of 1832 outlawed this practice, but if bodies not claimed by relatives they were allowed to be used by the medical schools. These were usually poor people who could not afford a funeral, and those who lived in public institutions such as the workhouse and asylums. Many people were scared of a pauper funeral as they were worried what would happen to their body after they had died.

Sources

Medical Officer of Health Reports

Sanitary Committee Reports

Nuisance Committee Reports

Sanitary Aid Committee Annual Reports

Cutler Boulter Provident Dispensary Reports

VA Butler, Social Conditions in Oxford, Sidgewick &Jackson, London, (1912).

A Bourdillon, A Survey of the Social Services in the Oxford District II Local Administration in a Changing Area (Oxford: OUP, 1940).

Websites

www.chronology.org.uk

Further reading

Public Health in Oxfordshire: the past, (Oxfordshire Health Authority, 1998)

E Burrough, Unity in Diversity: The Short Life of the United Oxford Hospitals (Privately published, 1978).

Joan Lane, A Social History of Medicine, Health, Healing and Disease in England, 1750-1950 (London: Routledge, 2001).

Jessie Parfit, The Health of a City: Oxford (Oxford: The Amate Press, 1987).

A Robb-Smith, A Short History of the Radcliffe Infirmary (Church Army Press for United Oxford Hospitals, 1970)


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