LECTURE OF THE MONTH Health services and the public health

Many modern public health practitioners become drawn to the origins of public health as a discipline, and turn their attention first to sources of local history within their jurisdiction. It was in this way that John Ashton’s curiosity was aroused, and he brought the story of William Henry Duncan to popular attention, inaugurating the Duncan Memorial Lecture Series. In fact, the career of John Snow, the Victorian public health pioneer, was of especial interest to the late Sidney Chave, who gave the 1st Duncan Memorial Lecture. Chave consulted original historical sources to unravel the events surrounding Snow’s part in combating the cholera outbreak in Golden Square, Soho, in 1854. Although John Snow (1813–1858) and William Duncan (1805–1863) were contemporaries, it is not known whether they ever met. Snow was born in York, and apprenticed as a surgeon in Newcastle upon Tyne. Apart from being one of the earliest anaesthetists, John Snow is famous for identifying the link between drinking water and cholera. He was able to persuade the guardians of the Parish of St James to remove the handle of the water pump in Broad Street, thereby hastening the decline of the cholera epidemic in that area, which had killed so many. The first officially recorded case of cholera in England was in Sunderland in October 1831, although it is possible that some of the deaths that occurred earlier in that year had been caused by Asiatic cholera. Cholera first appeared in Newcastle upon Tyne during December 1831. William Hardcastle deputed John Snow, his former apprentice, to go to Killingworth Colliery where there was a severe outbreak. Snow’s experience of cholera at Killingworth may have helped to formulate the ideas that led to his investigation and prevention of cholera in London 23 years later. The first outbreak of cholera in Liverpool was in 1832 when Duncan was physician to the South Dispensary. Later Duncan was to become the first Medical Officer of Health (1847–1863), and had to contend with several severe outbreaks of cholera in Liverpool. Edward Headlam Greenhow (1814–1888), a contemporary of Duncan’s and considered to be an authority on sanitary science, was involved in reporting on the sanitary state of the country to the Board of Health. He had thrown some discredit on the sanitary condition of Liverpool, and on the efforts made to improve it. In his annual report of 1860, Duncan pointed out the statistical inaccuracies in Greenhow’s work, and refuted the conclusions drawn from them. Although Duncan was a pioneer in the practice of sanitation in a large and rapidly expanding town, he faced two main difficulties: • the imperative to care for people who had diseases the causes of which were not fully understood; • the lack of any direct locus in the control of local hospitals, and doctors and nurses.