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Sir John Simon’s Medical Officer of Health reports on the ‘Sanitary Condition of London’ , 1848-55

John Simon was the first Medical Officer of Health for the city of London. He was appointed in 1848 to deal with the threat of cholera and other public health issues. As a trained surgeon, he was dedicated to sanitary reform. His annual reports called for municipal action to eradicate slums, build new houses for the poor and improve the water supply. Simon's remained Medical Officer of Health for London until 1855, when the Government of the city established a corps of medical officers and offered him ythe head position, He was the first permanent medical advisor to the government.

Below are some extracts from Simon's annual reports. They highlight the main public health problems facing London in the 19th century and his suggestions as to how they might be tackled.



Starting then from the Registrars’ Returns, I invite you to inquire with me, how it has come to pass that, within the City of London, there have died in the last year twice as many persons as it seems necessary that there should die; and whence has arisen the apparent anomaly, that here-in the very focus of civilisation, where the resources of curative medicine are greatest, and all the appliances of charitable relief most effectual, still, notwithstanding these advantage, there has passed away irrevocably during the year so undue a proportion of human life. Let it not be imagined that the word ‘cholera’ is a sufficient answer to these questions, or that its mention can supersede the necessity for sanitary investigation. Let it, on the contrary, be observed that the epidemic which has visited us, extends its ravages only to localities previously and otherwise hostile to life; so that while all regions of the globe in succession are shadowed by its dark transit, the healthiest districts of each region remain utterly unharmed in presence of the pestilence. (1848-9, pp.6-7)

I would suggest to you that the presence of epidemic cholera, instead of serving to explain away the local inequalities of mortality, does in fact, only constitute a most important additional testimony to the salubrity or insalubrity of a district, and renders more evident a disparity of circumstances which was previously decided. The frightful phenomenon of a periodic pestilence belongs only to defective sanitary arrangements. (1848-9, p.7)

House Drainage

Now here is a removable cause of death. These gases, which so many thousands of persons are daily inhaling, do not, it is true, in their diluted condition, suddenly extinguish life; but, though in different concentration, they are identically the same in nature with that confined sewer-gas which on a recent occasion, at Pimlico, killed those who were exposed to it with the rapidity of a lightening stroke. In their diluted state, as they rise from so many cesspools, and taint the atmosphere of so many houses, they form a climate the most congenial for the multiplication of epidemic disorders, and operate beyond all known influences of their class in impairing the chances of life.(1848-9, p.13)

Water Supply

I consider the system of intermittent water supply to be radically bad; not only because it is a system of stint in what ought to be lavishly bestowed, but also because of the necessity which it creates that large and extensive receptacles should be provided, and because of the liability to contamination incurred by water which has to be retained often during a considerable period. In inspecting the courts and alleys of the City, one constantly sees butts for the reception of water, either public, or in the open yards of the houses, or sometimes in the cellars; and these butts, dirty, mouldering , and coverless; receiving soot and all other impurities from the air; absorbing stench from the adjacent cesspool; inviting filth from insects, vermin, sparrows, cats, and children; their contents often augmented through a rain water pipe by the washings of the roof, and every hour becoming fustier and more offensive (1848-9, p.23)

Social Condition of the Poor

The task of interfering in behalf of these classes, however insensible they may be of their own danger and frequent degradation, begins at length to be recognised as an obligation of society; and as such an interference may be fraught with the utmost advantage to sanitary progress (p. 58).

Simon’s then continues by offering suggestions such as; the registration and enforced inspection of houses in order to count the number of lodgers in each, issuing rules and regulations relating to hygiene and ventilation and within lodgings and the enactment of a penalty for those who offend against these. (n.b this was only to applied to lodging houses initially then extended to working class tenements)

Suggestions for Sanitary Organisation in the City

Having now enumerated the sanitary evils of the City, and the remedies which appear to my mind most appropriate for their removal, it becomes desirable that, in concluding, I should point out to you the organization which seems necessary to be adopted during the transition of the City from its present to a healthier state…The organization lies in one word; Inspection, Gentlemen; inspection of the most constant, most searching, most intelligent, and most trustworthy kind, is that which the provisional management of our sanitary affairs must essentially consist (p.70).

Another element to which I think it necessary to advert, in connexion with a future sanitary organization for the city, is this, - that some permanent arrangement should be made, by which the maintenance of exterior and interior cleanliness, the enforcement of scavengers duties, the suppression of nuisances, and the like, should be brought under habitual and systematic surveillance; one, by which all breaches of your present or future sanitary regulations may be quickly detected, and may be visited with their appropriate penalties as speedily and certain as possible. (p.77)


From a consideration of this former geography of the place, and from observation of the diseases which prevail there, I am led to think it highly probable, that some of its sanitary defects depends less on defective house-draining than on a still marshy undrained condition of the ground itself, and that these defects, including the liability to cholera, would be removed by an efficient application of subsoil drainage. (1850, p.32)