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The early Medical Officers of Health of Nottingham 1873-1929 by Dr Denise Amos

Until recently little was recorded about these three men, Edward Seaton, Sir Arthur Whitelegge and Philip Boobbyer, who were at the vanguard of public health in Nottingham. It is a sad fact that in Robert Mellors' 1924 book, Men of Nottingham and Nottinghamshire, which has a foreword describing it as "a record of those who in some way were distinguished for usefulness to others", none of the three men are given a mention. However, new material is emerging and this piece gives an overview of their appointments, sets them in the period and offers a description of each man.

Background

The background to their appointment is complex and long. The post of a Medical Officer of Health (MoH) had been urged as early as 1845 by men such as Edwin Chadwick and influential journals such as the Lancet. Few authorities chose to appoint a MOH until compelled after the Public Health Act 1872. The Public Health Act of 1848 was the culmination of a long campaign in which Chadwick’s Report of the Sanitary Conditions and the agitation of the Health of Towns Act and two reports 1844/1845 and Royal Commission on Health of Towns were the impetus for change. It was a significant piece of legislation in the nineteenth century as it marked the first clear acceptance by the state of a responsibility for the health of people but its one weakness was the permissive option of appointing a Medical Officer of Health.  The Act also provided for the creation of local boards of health that were empowered to appoint a legally qualified medical practitioner or member of the medical profession as an MOH. Progress was slow and many local boards did not take up this initiative and those that did provided only temporary solutions to deal with a local epidemic.

There is some dispute as to who the first MOH was; it is generally accepted that Dr William Henry Duncan of Liverpool in 1847 was the first but Leicester appointed two Medical Officers in1846; the other notable exception was the City of London’s appointment of Sir John Simon. Other large provincial towns, including Nottingham appeared to be in no great hurry.

The Royal Sanitary Commission Report in 1871 led to the Local Government Act by which the central machinery of health administration was reorganized and a new department was created to be called the Local Government Board. The public health service was no longer to be the poor relation of other organs of government, and now possessed its own Minister.  The Public Health Act, 1872, consolidated the law relating to sanitation and public health and reviewed the need for legislative change. The appointment of a MOH was finally mandatory, as was the appointment of nuisance inspectors for all local sanitary authorities throughout England and Wales.

It is ironic that in 1929 when Dr Boobbyer retired from his post as Medical Officer of Health after serving for 40 years, the same year saw the introduction of the Local Government Act, possibly one of the landmarks in the history of public health. One of the most important features of this act was the union, under the Medical Officer of Health, of preventative and curative medicine. It enabled the MOH to increase the work of the Personal Health Services as well as continuing work in the public health arena.  The old Poor Law hospitals had been one area where difficulty had been experienced by the MOH and until 1929 they were often out of reach of the MOH and his department in terms of administrative machinery.

Edward Cox Seaton (MoH, 1873-1884)

Edward Cox Seaton, MOH 1873-1884Edward Cox Seaton (MoH, 1873-1884).

Nottingham Corporation failed to take up the opportunity in 1847 of appointing an MOH, but was obliged to make the appointment in 1872. The proposed duties were set out in nineteen points, including the systematic inspection of the district, the discovery, causes and origins of disease, and the role of advisor to the town council and health committee on all matters regarding health. The Council decided to decline the grants offered by the Local Government Board and  paid for the officer’s salary from funds.

 Edward Cox Seaton M D (Medical Doctor) London, F RCP (Fellow of the Royal College of Physicians) was born 3 August 1847, the son of Edward Cator Seaton, MOH to the Privy Council and Local Government Board and was educated at Tonbridge School and St Thomas’s Hospital, graduating as M.B. in 1870. He was appointed on a salary of £400 in 1873 which was good compared with other towns; although Liverpool and Leeds paid £750 and £500 respectively, in Lincoln it was £15 and Southampton £150. Seaton’s employment was on the understanding that it was solely to “the service of the committee for the purposes of the Sanitary Act 1866, vaccination and other such duties”.

There had been no systematic survey of the town for over a quarter of a century, since the 1844/5 Commission into the state of Towns and Populous Places, so when Seaton took over from the Sanitary Committee, he joined forces with the borough engineer, M.O. Tarbotton, to compile a thorough survey of Nottingham. Seaton set out the problems and how he proposed to address them.  Each borough ward was examined individually, noting the population both numerically and by gender; the number of houses and character. A short description of each area was provided. The remainder of the report examined various aspects of the town including housing accommodation and overcrowding, the effect of having a greater young female population within the town and  death rates, including infant mortality and the distribution of infectious diseases, especially Phthisis. The report constituted a comprehensive piece of investigative work. What Seaton found was that in certain areas of the town the number of deaths, particularly those from infectious diseases was very much higher than in others. The two main killers were typhoid fever, an “eminently preventable disease” and phthisis. In his first Annual Report of the same year he drew attention to the existence of much insanitary housing, both in the centre of the town and the suburbs.

Seaton was not afraid to voice concerns about the problems within the towns, even if this meant crossing swords with other authorities. In his opinion none of the wells sunk around the town were fit to provide drinking water, but he was unable to say how much of the population derived their drinking water from these wells because the Water Works Company refused grant him the information with regard to distribution. He also believed that those involved in the framing of the Enclosure Act of 1845 had misjudged the housing market and as a result the new houses were priced at an unaffordable rent for the people who were most in need of improved housing. One of his first tasks was to do something about the severe housing problem in the town, which still had over 8,000 back-to-back dwellings. The 1875 Artisan’s and Labourer’s Dwellings Act gave Seaton the scope to condemn two areas of particularly poor quality housing; Darker’s Court, Broad Marsh and St. Ann’ Alley, Glasshouse Street.

One of the key jobs of the MOH was to investigate and restrict the spread of disease and in 1877 Seaton produced a pamphlet entitled, How to prevent the spread of fever in which he singled out the diseases Scarlet fever, Typhoid and Smallpox. He noted that the sanitary authorities could do much by providing hospitals, disinfection and removal of cases to hospital, but that this action remained comparatively useless, unless supplemented by the intelligent co-operation of the individual. In short this meant the immediate isolation of the patient to a hospital. With the extent of insanitary, cramped housing within the old town and the danger of epidemic, Seaton needed to reduce the limit of infection as much as possible. Using the Improvement Act 1878 Nottingham became the first town to adopt a Local Act for the notification of infectious disease. These moves were not always  popular and  Seaton’s decision encountered hostile criticism from a number of the town’s doctors, who maintained that the danger of infection was greater inside the hospitals than in domestic homes.

In 1874 Seaton successfully applied to the council to engage in a physician’s practice at the General Hospital, alongside his role as Medical Officer. He felt that for an MOH to be excluded from private practice was detrimental to his work in the field of public heath. The Health Committee recommended his salary be increased to £600 with £50 for travelling expenses. This appears to have been quite generous as many MOH were expected to pay for their own means of transport, including paying for their own gig, and staff which could have cost up to £100 annually. The full Council felt that this was too generous and refused to pay.

A decade after his appointment Seaton produced an Annual Report (1882) which reflected on the period of his office and combined both factual statistics and recommendations for improvements. One such was the Report to the Health Committee on measures required to improve Narrow Marsh, a notoriously, densely populated district of Nottingham, with an estimated population of 317 persons per acre. In the report he showed the connection between poor housing, the spread of infectious diseases, and the local death rates. He went on to evaluate the effect of implementing the relevant Housing Acts. Throughout his reports Seaton is shown to be a man who approached his work earnestly. He not only suggested where the problems were, but ways in which they could be alleviated.

In view of this he certainly felt that he was worth more than he was being paid. In 1883 again the question arose over a salary increase to which he and the Health Committee felt, quite justifiably, he was entitled.  The Health Committee recommended that his salary should be increased by one-third taking it up to £800 and £200 of that would come from government aid set out in the Public Health Act 1875. Unfortunately the Council refused the increase and Seaton resigned his post.

 Seaton married Florence Waggett in 1875. Although it is generally believed that he resigned in 1884 as a result of the conflict over his salary, Florence died on 22 February 1884, and this may have had some influence in his decision. He took up the post of MOH in Chelsea, remarried, and had a daughter and a long and varied career in public health until his death in 1915.

Sir (Benjamin) Arthur Whitelegge (MoH, 1884 - 1889)

Sir (Benjamin) Arthur Whitelegge (MoH, 1884 - 1889).Sir (Benjamin) Arthur Whitelegge (MoH, 1884 - 1889).

Nottingham was able to attract another very well qualified person, Benjamin Arthur Whitelegge, M D, M R C S and Diploma in Public Health (Cambridge). Whitelegge had considerable experience with infectious diseases in hospitals in London and Sheffield and the diploma in Public Health was the first to be formally registered as a medical degree. He was also executive officer to the Mansion House Council on the Dwellings of the Poor, London, giving him added experience with which to tackle the  housing problem in Nottingham.

Whitelegge began his term of office by addressing the problem of infectious disease, vaccination and the need for an isolation hospital. He wrote in the Lancet that the practice of compulsory notification of infectious disease had attained a reduction in the ratio of deaths to known cases. But notification and isolation alone could not be completely adequate. A three-pronged attack was needed, with the third strand being vaccination. On 14 November 1885 the Nottingham Medico-Chirurgical Society passed a resolution that the only way in which smallpox could be eradicated was by vaccination being universally adopted.

In June 1885 the Corporation of Nottingham decided to purchase 126 acres of land outside of the town at Bagthorpe, for the building of a new infectious diseases hospital. In his Annual Report of 1885 Whitelegge wrote that, in the new hospital, provision would be made for smallpox, scarlet fever, enteric fever and diphtheria patients, but not measles or whooping cough. Bagthorpe hospital was built and opened in 1891.

During his period of office,  Whitelegge periodically wrote on the subject of Scarlet Fever in the Lancet.  He was a member of the Nottingham Medico-Chirurgical Society and was Secretary between 1886-7. He was held in high esteem and at the Annual Dinner of the Society a memorial was signed by 81 members of the profession in Nottingham. In 1889 he left Nottingham to take up a similar post in the West Riding of Yorkshire. Soon after he went to the West Riding he produced his book Hygiene and Public Health, which ran to at least 17 editions. In 1896 he became the second Chief Inspector of Factories and Workshops. He was appointed CB in 1902 and KCB in 1911. He was married to Fanny Marian, daughter of the painter, John Callcott Horsley, R.A.

Philip Boobbyer (MoH, 1889-1929)

Philip Boobbyer (MoH, 1889-1929)Philip Boobbyer (MoH, 1889-1929).

Whitelegge was replaced by Philip Boobbyer, MRCS and LSA, who had been MOH for the Basford Rural Sanitary District of Nottingham since 1884. Boobbyer, was a religious man and a member of the Plymouth brethren and he set out as a crusader against the grim conditions in Nottingham. He was dismissive of people he called ‘nomads and derelicts’, and believed tramps to be at best a burden on charity, and at worst a source of deadly danger.

As both Seaton and Whitelegge were only in their post for relatively short periods it was left to Boobbyer to develop the public and personal health system in the city fully. He was able to do this with the acquisition of new knowledge of scientific research, for example Boobbyer became involved in the epidemiology of respiratory tuberculosis (phthisis) and child health care, which had been given only perfunctory mention in the reports of his predecessors.

He was appointed on a salary of £500 p.a., plus £50 for travelling expenses. In 1894, the Health Committee felt that as the duties of the Medical Officer had grown considerably, largely to the increasing work of the Epidemic Hospital, for which the organization for both staff and work was carried out by the Medical Officer, his salary should be increased by £100. This was further increased by £100 in 1898 because of the even greater demand on the MOH’s responsibilities. The workload now included the inspection of factories and workshops and dairies and milk shops. The council reports for 1898 comment on the ‘great zeal and conspicuous ability and courteous manner” with which Boobbyer carried out his tasks.

When Boobbyer began his work, as Seaton and Whitelegge before him, he focused his efforts on the most desperate health factors he deemed urgent. His initial focus was on waste removal. The pail closet system, which was the main form of excrement removal in Nottingham, had been adopted as long ago as 1868.

The link between the spread of enteric fever and the continued use of pail closets was something that Boobbyer fought against until 1919. The Corporation of Nottingham was averse to funding the wholesale introduction of water closets, but on 1 July, 1895 the council adopted a recommendation that the pail-closet system should no longer be recognised and that water-carriage was the way forward, even though it would take some time to implement.

Boobbyer demonstrated how typhoid had rapidly diminished in other large towns where water closets had been introduced. For Boobbyer the most convincing evidence was the Local Government Report, which showed that Leicester, a town with a similar population and characteristics, including the manufacture of textiles, in contrast to Nottingham, had begun to phase out pail closets and to replace them with water closets in the 1890s. It had a 45%decline in typhoid fever as a result.

Boobyer regularly repeated these calls for water closets in his Annual Reports and wrote two articles which appeared in the influential journal, Public Health, emphasizing his concerns. The use of pail closets in Nottingham remained a thorn in the side of Boobbyer, but it was to be an outside influence which finally spurred the council into changing its policy. The 1920 Enquiry convened after the rejection of an extension application by the Nottingham Corporation revealed a catalogue of failures on their part in its statutory responsibilities towards sewage disposal.

Boobbyer’s other major achievements were in tackling respiratory tuberculosis and in reducing infant mortality. Both were serious killers, but little had been done to tackle the problems they posed because of a lack of knowledge and a department with few resources. During the nineteenth century tuberculosis, in all forms, was the leading killer. Respiratory tuberculosis, also known as phthisis, affected the adult population, being most lethal in early adulthood, from the age of 15 to 35 years. For the first three-quarters of the nineteenth century tuberculosis was believed to be hereditary, but with the identification of the tubercle bacillus by Robert Koch in 1882, a more scientific approach was adopted in fighting the disease.

Boobbyer’s interest in the high rates of phthisis in Nottingham, led him to monitor its incidence between 1907 and 1915, by measuring the fatalities within houses of various rentals. Boobbyer associated the location of phthisis with the abundance of poor quality housing in Nottingham and these surveys backed up his beliefs as the highest number of deaths from the disease occurred in houses of rents under 6shillings per week; as the rents increased the number of deaths declined.

Having made the connection between tuberculosis in the poorer districts Boobbyer began a campaign of education and preventative work. Part of the education process lay in the notification of the disease and this was given a boost in 1898 with the foundation of National Association for the Prevention of Tuberculosis with HRH the Prince of Wales as its patron.

For the Victorians the improved sanitary conditions which had positively affected the general death-rates were apparently having little effect on the most vulnerable sector of the population, infants. At the end of the nineteenth century infant mortality was on the increase.  Once again Boobbyer focused on the problem of excrement removal and the high incidence of diarrhoea in young babies in the poorer districts of the city. Although it was impossible to state categorically that there was a connection all the evidence pointed to a link between the two. Once again the comparison with Leicester highlighted the problem. Nottingham had excessive incidence of diarrhoea where over half the city was served by pail closets, Leicester, on the other hand, had begun to adopt the water closet far more rapidly and the results were apparent in a reduction in diarrhoeal deaths. It was not just the survival of pail closets which had a bearing on infant mortality, but it was certainly important.

As a way of trying to educate the mothers in feeding and caring for their infants properly, Boobbyer set up a Mothers and Babies Welcome on Howard Street which was situated in one of the poorer areas of Nottingham. In the beginning this was run on a voluntary basis, but it later formed the basis of child welfare clinics in the city. From around 1914 infant mortality began to decrease both nationally and in Nottingham for a variety of reasons; such as by improved housing conditions, waste disposal and the accessibility of the Mothers and Babies Welcome clinics where women could receive guidance in child care from trained professionals.

During his long career Boobbyer was a member of the Nottingham Medico-Chirurgical Society. He was Secretary between 1887 and 1892, President in 1907-08 and Vice President from 1908-10. During this time he regularly gave papers to the Society on subjects such as smallpox typhoid fever and phthisis. After 40 years of outstanding service, Boobbyer retired from the post in 1929, leaving the Health Department considerably larger and more efficient. When he took over  there were between 30 and 40 employees, when he left there were 220 and the department’s annual expenditure had risen from £28,000 to £121,000. He left the department with a pathological department, a maternity and child welfare department as well as a hostel for unmarried mothers, a VD clinic and clinics dealing with tuberculosis. He received great praise upon his retirement and following his death in January 1930 his burial service was attended by leading civic dignitaries of Nottingham.

Work specifically relating to these men are listed in the data structure which follows. However there are a number of books which are more general studies of Public Health and the work of the Medical Officer of Health.