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Response to Review of Insanitary City: Henry Littlejohn and the Condition of Edinburgh

It is gratifying to read that Tom Crook recognises the depth of primary research that lies behind our analysis and interpretation of public health in Edinburgh and the early career of Sir Henry Littlejohn. He also generously comments on our efforts to convey ‘a full sense of the dizzying multiplicity of local factors and forces that go into the making and reception of just one historical document’. We are grateful, too, for his compliments on the visual aspect of Insanitary City, and just to add to this positive reception of the physical product, for our part we are pleased that Carnegie Publishing have been able to publish our work at one-third of the price suggested by three university presses. Had Dr Crook’s review appeared in a conventional printed journal we would be inclined to accept his generally favourable assessment, and leave it at that. But being invited to respond we would like to challenge Crook’s objection to our claim that Littlejohn’s 1865 Report was ‘fundamentally different’ from reports by English medical officers. Though Cook described this as ‘a minor gripe’, were it true it would be quite a serious criticism.

The sub-title to Insanitary City is deeply significant: ‘The Condition of Edinburgh’ reaches far beyond drains, sewers, and epidemics to include employment, poverty, social policy, religious perspectives, public administration, interment, occupational health, local politics, social topography, and the roles of builders and landlords in constructing the Insanitary City. This integrated and comprehensive approach to the public’s health characterised Littlejohn’s deeply researched empiricism and it is why we regard it as ‘fundamentally different’ – significantly different would be too weak.

Dr Crook’s choice of Gavin and Kay to represent sanitarians writing in England who anticipated Littlejohn’s approach is unfortunate. Neither was a municipal medical officer answerable to political masters and subject to local social, economic and religious contexts. Nor were Simon’s ‘lustrous’ team of medics at the Board of Health directly concerned for the practical constraints of civic administration; their Reports in the 1860s were overwhelmingly about vaccination, epidemics, and sanitation, as were those of the early English Medical Officers of Health appointed under the Public Health Act, 1848 (section 40) where the Chadwickian preoccupation with drains and water quality dominated. We have never denied that the diagnoses, or indeed many of the remedies and strategies, of the sanitary reformers of the 1840s (which themselves had antecedents) were taken up and applied in Edinburgh by Littlejohn. Indeed much of our story, as one of the chapter titles itself indicates, is about ‘Littlejohn’s inheritance’ and how he had to deal with earlier systems and opinions.

The exceptionalism we attribute to Littlejohn is based also on a comparison with the tardiness, and often reluctance, of English provincial cities to appoint Medical Officers of Health. Many only appointed these officials in the late 1860s, often on a part-time basis; others prevaricated until they were ultimately obliged to do so by the terms of the Public Health Act, 1872. Of course there were many able medical officers in the 1850s serving local Boards of Health, but they had limited powers and were not officials of incorporated boroughs. The few full-time medical officers who were appointed mostly limited their brief reports to an enumeration of the location and causes of mortality. Even the pioneering W. H. Duncan, appointed in 1847 as Medical Officer of Health for Liverpool, with the largest population under his jurisdiction, presented annual reports from 1852 to 1862 that occupied less than a single newspaper column, and were little more than statistical compilations with occasional animated discussion of his statistical methodology.

Crook comments that we may have been ‘referring solely to the Scottish context’. No: we are quite clear that Littlejohn’s approach diverged from that of the early MOHs in England and Wales, and indeed from the outset our work grew from an irritation at the number of works on public health in ‘Britain’ (names available on application) which fail to mention Scotland, a fact that is all the more surprising since so many of the early sanitary reformers were either Scottish, or trained in Scotland, or both. The bases of our claims for Littlejohn’s ‘fundamentally different’ Report are threefold: firstly, his comprehensive and politically canny approach to public health, something largely detected in his prose – lucid, generous-spirited but sharp and powerful when attacking the vested interests that stood in the way of the welfare of the citizenry; secondly, his primary emphasis on morbidity rather than mortality, such that by lifting individuals out of poor health their life, and their families’, was enriched; and thirdly, his use of deeply-researched and corroborated evidence far beyond the superficiality of published vital statistics, and the simple enumeration of insanitary indicators. Our main concern was to understand better the inner dynamics of the 19th-century city, and our dissection of Littlejohn’s Report was just one means to do so. So the book is more than ‘a celebration of Littlejohn’s achievements’ and we reaffirm that the Report captured a ‘fundamentally different’ approach to the public’s health.

On another point, just for clarification, comparison with Michael Flinn’s magisterial commentary on the Chadwick Report is a fine compliment, especially to one of his former students. However Crook’s attempt to locate Insanitary City alongside Leicester University Press’ ‘Victorian Library’ series simply does not stand up, however distinguished the reputation of the authors in that series. Anthony King’s contribution to Godwin’s Town Swamps, which Crook cites, has an 18-page introduction yet Laxton and Rodger have written 110,000 words along with 88 illustrations and several entirely new maps to explore the complexity of public health provision in a national and international setting. A glance at the Index confirms the reach of Insanitary City.