It is over a year since restrictions, prompted by the Covid pandemic, were lifted in England. 2 years ago the country was still in the first national lockdown. Since the start of the pandemic, at the end of 2019, we have become used to terms such as SAGE, test and trace, regional tiers, lateral flow and PCR tests, face masks, lockdown, save the NHS, WFH, anti-vaxxers and ‘follow the science’ among others. We also learnt that the disease spread in overcrowded places, affected the elderly and those with underlying health conditions more than any other sections of the population and was more prevalent in some parts of the country than others.
Information about the pandemic was conveyed through a myriad of media outlets from the daily Downing Street conferences to social media platforms. The information was verbal and numeric with a concentration on data about the number of cases, hospitalisations and deaths and the regional variations in these figures. Up to April 2022 national data could still be seen on a daily basis on the BBC website and Greater Manchester figures were published in the MEN newspaper, even though the numbers in all categories had decreased significantly from the height of the pandemic. There is still a fear that variants of the current strain may make the numbers rise. The main hope of preventing a significant spread lies in the vaccination programme which has not only decreased the spread of the disease but has also decreased the severity leading to proportionately less hospitalisations and deaths than the number of cases. This pandemic has been played out on the world stage with different countries adopting differing strategies both for the treatment of the disease and how to cope with it in the next few years from most western countries who are adopting a policy of learning to live with the disease to the policy of negative Covid cases adopted by countries such as China.
The North West in particular was hard hit by the Covid pandemic partly because of the level of deprivation and health inequalities within the region. The city of Manchester, in particular, has been at the forefront of deprivation statistics for decades even though it has an international reputation for its business, sport, media, nightlife and universities. In 2005 for example the city had the lowest life expectancy for men in the country and the fourth highest for women and it ranked second in the deprivation league table nationally. Today the national life expectancy figures show that for both men and women Manchester is 2 1/2 years behind the average for the country. In February 2021 it was calculated that Greater Manchester had spent 297 out of the previous 324 days in lockdown, 92% of the time. See “The Quest for public health in Manchester” page 105 on stock in Manchester Libraries.
How does this picture compare with previous eras, what were the living conditions and how did the city cope with previous epidemics?
An interesting observation was made by Friedrich Engels in “The Condition of the Working Class in England” written in 1887:
“One day I walked with one of these middle-class gentlemen into Manchester. I spoke to him about the disgraceful slums and ….. the disgusting conditions of that part of town in which the factory workers lived. I declared that I had never seen so badly built a town in my life.” He remarked “and yet there is a great deal of money made here.”
This observation was made as the last remnants of a pandemic were dying out. This pandemic was not Covid nor indeed a newly identified strain of a disease but one which it is thought was around in 10,000 BC and this disease was smallpox. This 19th century pandemic started in 1870/1871 and lingered intermittently for about 15 years. Although the diseases were not the same and there are other differences, there are some significant features of the management of the disease which provide an interesting comparison 150 years apart. We can see this with evidence from the monthly reports of the local Public Officer of Health for the city of Manchester and by looking at the health infrastructure in the 1870s and theories about the spread of the disease and its treatment.
In the present day there is the Department of Health which has a strategic overview of the course of Covid and its management together with the management of the NHS, the delivery arm of the Health Service. The strategic management of the Covid epidemic was centralised in London with the government providing the policy which was then delivered at a local level. In the 19th century there was a Board of Health which had been established under the Public Health Act of 1848.
Public Health Act 1848 on Legislation.gov.uk
This act was devised by Edwin Chadwick, the social reformer, who had written the 1842 report into the sanitary conditions of the poor. The act was primarily about how to improve living conditions by the treatment of sewage and refuse. It also recommended the appointment of a Public Officer of Health (POH) for each local authority and delegated health strategy and development to a local level. Liverpool had already appointed a POH in 1847 and provided a model for the act. However, it was not compulsory and Manchester considered that the development of physical infrastructure was the most important part of this act and concentrated on building sewers and waterworks.
Manchester finally set up a Health Committee in 1867 and appointed its first POH in 1868. This was John Leigh who had been the POH in Rochdale. He reported monthly to the Health Committee and his reports provide a wealth of detail about the health of the citizens of the city and how the pandemic was managed locally.
The position of the POH was in its infancy when the smallpox pandemic arrived in the city. Smallpox epidemics had been experienced over hundreds of years and in 1796 an English doctor, Edward Jenner, produced the first vaccine against the disease. By the 1850s it had been recognised that the disease was most dangerous in children particularly those under 5 and in 1857 vaccination of babies was made compulsory and in 1867 a second vaccination was offered to children under 14. Smallpox vaccinations were compulsory for babies until 1948 and routinely given until 1971. Although the vaccinations were compulsory and all parents were given information about the vaccinations when they registered a birth, it was very difficult to monitor the uptake of the vaccine since there was no regulated health service to undertake this task.
Part 2 to follow – The provision of Health services in Manchester in 1870s
Part 3 to follow – A comparison of the strategies in dealing with the pandemic
This blog post was written for Archives+ by one of our volunteers.