What can the Third World learn from the health improvements of Victorian Britain?

I n 1904 (some three years after the Victorian era had come to a close), Sir George Clarke KCMG, late Secretary to the Colonial Defence Committee, wrote to the editor of the Times: ‘‘The bacteriologists have made our flesh creep. We have been taught to expect ptomains in food, bacilli in the running brooks, and germs in everything’’. He continued: ‘‘We know the elaborate precautions taken in all wellmanaged hospitals to avert septic conditions’’. And he ended his letter: ‘‘We must either modify the germ theory of disease, or ... regard the dust [my italics] of a great city, with hospitals and diseased persons in its midst, much more seriously than has been our custom hitherto.’’ Clarke was thus highlighting the fact that the (urban) environment in London was heavily contaminated; this had been the case in Victorian Britain, and remains the case in all Third World countries—where even today, nearly 50% of deaths are caused by infectious disease. Prior to the development of the ‘‘germ theory’’ (by, among others, Pasteur, Koch, and Lister) and many years before the introduction of antibiotics, enormous advances in human health in Britain had taken place in the Victorian era (that is, 1837–1901). These resulted first and foremost from improvements in the prevailing infrastructure in our rapidly increasing urban conurbations. A major early protagonist for an improvement in the standard of living conditions was Thomas Southwood Smith (1788–1861)–the ‘‘father of sanitary reform’’. Initially trained for the dissenting Christian ministry, Smith was appointed at the age of 36 years as physician to the London Fever Hospital. Other prominent names in disease prevention at that time were: Neil Arnott (1788–1874) and James Kay, later Sir James Kay–Shuttleworth (1804–77). Factors in the spread of epidemic disease (which in Smith’s opinion all had a telluric origin) were: confinement within a limited space, overcrowding, and decay of vegetable/animal material— which contaminated the atmosphere (the ‘‘miasmatic’’ theory of disease was still dominant). In 1839 (two years after Victoria came to the throne), it was Smith who was largely instrumental in forming the Health of Towns Association. In 1848, he was appointed as the sole medical representative on the General Board of Health where he had a close liaison with the lawyer Sir Edwin Chadwick (1800–90).