Is air pollution an overlooked element in the mortality decline?


‘Sheffield’, Harper’s Magazine, 1884

At the economic history society conference in April 2016 I attended a panel entitled Social Infrastructure featuring papers from Nicola Tynan (Dickinson College), and colleagues on ‘Who should own and control urban water systems? Disease and the municipalisation of private waterworks in nineteenth-century England’ and Bernard Harris & Andrew Hinde Public works loans, social intervention and mortality change in England and Wales, 1850-1914. Both papers were more or less concerned with the role of urban infrastructure in the mortality decline, provoking a heated discussion from an audience with a fair smattering of urban historians who challenged the findings of the two research teams. In particular, there was a call for less aggregate data and more specific case studies to allow us to understand the factors that may be influencing investment decisions and social and health change.

This session came to mind when I was preparing a recent presentation on Pollution and Public Health in early twentieth century urban England. The paper built on an article I published a few years ago on tackling pollution in Middlesbrough, extending that research by the inclusion of data on Leeds and Sheffield. Given their key roles in the industrial revolution of iron, coal and cloth, smoke was an everyday reality in these towns, a symbol of work, progress and prosperity. Yet it is apparent that historians – concerned with water-borne diseases and sanitation – have paid little attention to what was, by the 1880s, a more deadly public health problem. This is a strange situation, for as historians like Simon Szreter have noted, a key flaw in the McKeown argument is the rising mortality from non-tubercular respiratory diseases like pneumonia and bronchitis just as the old killers like typhoid were in decline. So this post will consider why air pollution has not attracted the attention of historians of public health.

First off we need to prove there was a link. Interestingly, for much of the 19th century Medical Officers of Health (MOHs) were reluctant to make an explicit link. Even in the most smoke blighted cities – like the iron and steel towns of Middlesbrough and Sheffield – council officials treaded carefully for fear of upsetting powerful local interests. Thus, in 1899 the newly appointed MOH for Middlesbrough, Dr Dingle, satisfied himself with a quote from Dr Harvey Littlejohn’s recent comments on smoke in Sheffield which he condemned for:

  1. Its power for conducing fogs and rain.
  2. Its power in shutting out sunlight and depriving us of certain qualities of light.
  3. By depositing smuts and rendering houses dirty, thus causing an unnecessary expenditure of labour and soap.
  4. Separation of the classes.
  5. Destruction of natural and architectural beauties

Yes this was skirting round the issues for even a cursory reading of the mortality figures for Middlesbrough raised the strong prospect of a causal link between smoke and respiratory diseases. By 1910 the MOH, along with external Local Government Board Inspectors, was admitting that 400 tons of ash a year were probably at least predisposing causes for chest related mortality twice the national average.

image (1)

Doyle, ‘Managing and Contesting Industrial Pollution in Middlesbrough’, Northern History, (2010)

Certainly by the late 1920s municipal medics were more willing to make the link. At the meeting of the Royal Sanitary Institute in Sheffield in December 1929 the assembled group discussed Smoke. Local politicians, representatives of gas and electricity concerns and a slew of MOHs, including the influential Dr Veitch Clark of Manchester and Dr Johnstone Jervis of Leeds, made demonstrable links between smoke and increased mortality and morbidity. Indeed Veitch Clark illustrated his insistence that ‘the evidence against smoke as a factor in the production of ill-health, disease, and defective development is overwhelming’ with ‘paintings of the lung…which demonstrated the way in which smoke pollution reached the innermost organs of the body’ [‘Congress at Sheffield’, Journal of the Royal Sanitary Institute, L.6 (1929) Sadly these illustrations were not included in the article.]

So why haven’t historians taken the problem seriously. First, there were few legislative instruments for public health officers to deploy. The main legislative tool was the 1875 Public Health Act which permitted councils to produce by-laws to regulate smoke pollution in some industries – although metal making was one of those exempt. When a new act entered the statute book in 1926 it was widely regarded as ineffective, a victim of business lobbying which actually eased some of the more restrictive by-laws. Under both pieces of legislation the process of bringing a prosecution was cumbersome and rarely effective.

More significantly, tackling smoke pollution didn’t require any capital expenditure on the part of the Council. There was no heroic engineering solution. Rather the task was labour intensive and deeply unromantic, with Sanitary Inspectors spending hours on end observing chimneys to see if they exceeded the local maximum number of minutes of black smoke in an hour – usually 5-6 but as high as 10 minutes in Middlesbrough and just 3 in Leeds. In the mid-1920s the inspectors of Leeds watched over 6,000 chimney in the year or more than twenty a day. If they caught a boiler offending they rarely opted to prosecute, choosing persuasion and education over the full force of the law. As Dr Clinch MOH for West Ham explained in 1929:

Briefly, the only method by which the local authority can abolish the black smoke of the boiler furnace is one of friendly cooperation with both owners and men, coupled with legal action if they are so foolish as to resist any other method.

Moreover, the engineering solutions that existed lay with the owners – technology like the mechanical stoker – which would only be adopted when the economic benefits outweighed the cost of pollution. There is much evidence to suggest this did happen as industrial air pollution fell sharply from the 1880s through to the 1930s as steam power was replaced by gas or electricity, smokeless coke was deployed or new technologies acquired. So on the face of it public health departments couldn’t even take direct credit for the improvements secured!

Hunslet Brit from Air

Hunslet, in South Leeds – note the large number of domestic chimneys

In part that was because the smoke was still there – generated now by the domestic coal fire. Dr Jervis, MOH for Leeds, felt more than 60% of atmospheric pollution was caused by the household grate, with he and his colleagues lining up to condemn the coal fire ‘fetish’ while accepting ‘the average Britisher will be a long time before he is prepared to sacrifice his open grate’ (Cllr Asbury, chair of the Sheffield Health Committee, 1929). Once again the public health department had few options beyond urging the population to switch to smokeless alternatives, like gas or electricity or take the expense and inconvenience of the newly created smokeless coke which few were keen to try. Propaganda in Health Week may convert a few but the reality was over one third of urban homes did not have electricity by 1938, many more could only access gas if their landlord was willing while in most of the industrial areas coal remained cheap and plentiful until the Second World War.

Finally health officials had to face what might be called the banal disamenity of smoke. On the one hand belching chimneys were seen by townsfolk as a sign of work and affluence – as the mayor of Middlesbrough asserted in 1888 ‘we are proud of our smoke’. This made it very difficult for council officials to pursue polluting businesses and often when they did they found magistrates reluctant to prosecute. But of equal importance was public acquiescence in  the continuation of the smokey gloom with ‘air and light…habitually.. forgotten…because our supply of both in urban communities is so bad. I suppose, that we have become blind to it.’ (Cllr Asbury)

Faced with these problems it is little surprise that the professionals and politicians at city hall chose to move either the people or the problem. They built their new estates (usually) at some remove from the worst industrial areas while supporting the zoning of industry. In both these they were aided by businesses choosing new sites outside the city for transport or cost reasons – as happened with the movement of the main iron and steel works out of Middlesbrough between the wars – and by private builders erecting their new estates in smoke free suburbs invariably to the south and west of the cities. Moreover, new houses were often equipped with gas and electricity and few, if any, coal fires – Leeds council restricting their own council houses to one coal fire per household! Ultimately the big the final push to major reform came in 1952 when a smog descended on London (metropolitan concerns determining national policy). Smokeless Zone legislation followed and the public – faced with the cost of Coalite – abandoned their coal fires.

As we can see, historians seeking greater understanding of the processes by which the mortality decline was effected in late nineteenth and early twentieth century Britain should pay much more attention to the role of air pollution and especially the deleterious impact of black smoke. But identifying its causes and effects and charting the course of the long and arduous war of attrition fought by the municipal authorities will require close attention to the local archives not just the returns of government departments or the legislation they promoted.



Research Assistant (3 Posts) – Modern History of Health or Medicine: Central Europe

University of Huddersfield – School of Music, Humanities & Media

V0029776 An ornate doorway into a large stone building used as a disp Credit: Wellcome Library, London. Wellcome Images An ornate doorway into a large stone building used as a dispensary in Prague. Photograph. By: Zikmund ReachPublished:  -  Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0

V0029776 An ornate doorway into a large stone building used as a dispensary

Fixed term appointments for 6 months, 1.0 FTE

Three full time Research Assistants are required for the project European Healthcare before Welfare States under the direction of Professor Barry Doyle. You will work within the Centre for Health Histories (CHH) to undertake secondary and primary research into the provision of healthcare in one of Poland, Czechoslovakia or Hungary between the wars. The Research Assistants will focus on the following priorities:

  • Undertake a desk based literature review of current work in English and other languages in the field of interwar healthcare in one of Poland, Hungary or Czechoslovakia 1900-1940.
  • Undertake up to two months field work in archives and libraries in one of Poland, Hungary or Czech Republic/Slovakia.
  • Support the development of an international network around the theme of European Healthcare before Welfare States.
  • Along with the project Principal Investigator, develop partnerships with non-academic partners.
  • Work with the Principal Investigator and other Research Assistants to mount an international workshop in December 2016.
  • Produce a report of fieldwork and present findings to a workshop.
  • Contribute to a collective article with the Principal Investigator and other Research Assistants on sources and methods for the study of healthcare in the region between the wars.

With a good Honours degree and an MA in modern health or social history of Central Europe, you will also have fluency in one or (more) of Polish, Czech, Slovakian or Magyar.

For informal discussions please contact the Principal Investigator, Professor Barry Doyle 01484 471625: Email

For further details about this post and to make an application, visit

Job Ref: R2392
Working for Equal Opportunities.Closing date: 06 June 2016
Interview date: 30 June 2016

Innovative University. Inspiring Employer

Image credit: Wellcome Library, London. Wellcome Images
An ornate doorway into a large stone building used as a dispensary in Prague. Photograph.
By: Zikmund ReachPublished: –
Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0

Postdoctoral Research Associate in Modern Social/Health History

L0044863 Willis's cigarettes card Credit: Wellcome Library, London. Wellcome Images A man with his arm in a sling - a triangular bandage for the shoulder. 1913 Triangular bandage for the shoulder / W.D. & H.O. Wills (Firm) Published: [1913] Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0

L0044863 Willis’s cigarettes card 1913
Credit: Wellcome Library, 

We are looking to recruit a Research Assistant for 12 months Full Time for an AHRC funded project based at the University of Hull.

The successful candidate will work on a project entitled ‘Crossing Boundaries: The History of First Aid in Britain and France, 1909-1989’. The post is based at the University of Hull, working with the Principal Investigator, Dr Rosemary Wall. However, the Postdoctoral Research Associate (PDRA) will also benefit from the mentorship of the Co-Investigator, Professor Barry Doyle, at the University of Huddersfield, and the project team will meet together at least once every six weeks.

With a PhD in History, History of Medicine or a cognate discipline, the successful candidate will have reading knowledge of French, and will ideally be experienced in oral history research.

Research will include visiting archives and libraries in Paris and two other French cities, as well as archives in Britain.

The role requires understanding of twentieth-century social history as the PDRA will research and co-author at least one journal article on the impact of war and society on the policy, knowledge and practice of first aid.

The PDRA will also have the opportunity to propose and write a single-authored journal article which directly expands the goals of the project.

In addition, the PDRA will assist with:

  • Oral history research and transcription
  •  recording and transcribing witness seminars to which current and past practitioners and policy makers will contribute
  • co-organising engagement events such as a project conference and a forum,
  • writing several blog posts for the project website.
Reference:  FA0162
Campus:  Hull
Faculty/Area:  Faculty of Arts and Social Sciences
Department:  History
Salary:  £32,600 to £37,768 per annum
Post Type:  Full Time
Closing Date:  Sunday 08 May 2016

For further details of the post and how to apply go to

For further details of the project:

Follow us on twitter @FirstAidHistory

Beauty and the Hospital in History: Call for Papers

International Network for the History of Hospitals
Malta, 6–8 April 2017
Hosted by the Mediterranean Institute at the University of Malta, and the University of Warwick

INHH pics


Beauty, and its perceived absence or loss, has been a part of hospital experiences, therapies, and
planning throughout history. This conference aims to shed new light onto the history of beauty and
health by exploring the subjective concepts of beauty, ‘normality’, and their opposites within and
around the hospital.
This eleventh INHH conference will consider the relationship between beauty and the hospital in
history through an examination of five key themes: (1) the arts and the hospital; (2) landscape and
environment; (3) restoring beauty; (4) patient and staff experiences; and (5) beauty and the senses.
Below are more details about the themes the conference will address, along with related questions.
These themes and questions are by no means exhaustive, however, and we encourage the submission
of abstracts that discuss other aspects of beauty and the hospital in history in innovative ways.

Key Themes and Questions to be Explored:

1. The Arts and the Hospital:

  • How has the beauty of the arts been perceived to affect encounters within the hospital,
    been promoted by hospital patrons, or been used as a healing therapy in the hospital?

    •  Examples: Music, painting/s, festivities, crafts, creativity, architecture

2. Landscape and Environment:

  • How has the beauty of a landscape or environment — or its absence — shaped the choice
    of location for hospitals, and why?

    • Example: A medieval or colonial leprosy hospital situated in a beautiful landscape
      for its therapeutic value
      o Example: Asylums, isolation hospitals, or prison hospitals intentionally located in
      marginal, inaccessible or ‘ugly’ spaces, both urban and rural, and the consequences
      this was perceived to have on the health of patients
  • How have landscape and environment been adapted to affect hospital therapies and

    • Example: Hospital gardens
  • How did ancient ideas about the influence of environmental conditions upon health
    affect hospital care in the medieval and early modern periods?

3. Restoring Beauty:

  • Who decides what is beautiful or aesthetic, and whether and how that beauty should be
    restored? What strategies have been used in hospitals to restore or enhance that beauty,
    be it physical, mental, or emotional?

    • Example: Cosmetic surgery, prosthetics
    • Example: Psychotherapy to restore the perceived beauty of the mind
  • What happens when beauty or health cannot be fully restored? How have such
    therapies been depicted?

    • Example: Palliative care aimed at lessening suffering or alleviating the effects of
      ‘ugliness’; depictions of such care in before and after photographs, textbooks, and
      publicity material

4. Patient and Staff Experiences:

  • How have patients and staff experienced beauty or ugliness in hospitals? How and why
    has their access to beauty been encouraged or restricted?

    • Example: Hospital gardens for the use of patients only
    • Example: The isolation of patients in ‘ugly’ spaces as punishment
    • Example: The most beautiful spaces in a hospital compound restricted for the
      accommodation of European or white staff and patients
  • How was daily life in the hospital informed by the desire to create a beautiful order
    structuring the resident community?

    • Example: Ordinances and regulations inspired by religious or imperial precepts that
      guided daily life in residential hospitals

5. Beauty and the Senses:

  • How can we understand beauty — or its perceived absence — through the senses of
    smell, touch, sight, taste, and hearing? How has the hospital been a place for the care,
    enhancement, or experience of the beauty of these senses?

    • Example: Disgust surrounding ugly smells in hospitals; strategies to silence or
      shroud unsightly patients and practices
    • Example: The preferential hospitalisation of patients considered damaged in terms
      of their senses, e.g. the predominance of in-patients with a loss of nerve sensation
      in their hands and feet in colonial leprosy settlements

The Advisory Board of the INHH, as organisers of this conference, wish to invite proposals for 20
minute papers which address the conference theme. Potential contributors are asked to bear in mind
that engagement with the theme of beauty and the hospital will be a key criterion in determining
which papers are accepted onto the programme.

Abstracts should be a maximum of 300 words in length, in English and accompanied by a brief self
biography of no more than 200 words. Proposals should be sent to by
15 May 2016. As with previous INHH conferences, it is intended that an edited volume of the
conference papers will be published. Submissions are particularly encouraged from researchers who
have not previously given a paper at an INHH conference.

Upon provision of full receipts, we hope to be able to support attendance at this conference,
particularly for postgraduates and early career researchers. Speakers will be asked to make use of
alternative sources of funding where these are available.

Any queries may be directed to

Crossing Boundaries: The History of First Aid in Britain and France, 1909-1989



Dr Rosemary Wall, Lecturer in Global History, Department of History, University of Hull, has been awarded an Arts and Humanities Research Council Early-Career Grant of £200,000, with co-investigator and mentor, Professor Barry Doyle, Centre for Health Histories, University of Huddersfield.

First aid is a broad term encompassing activities from applying a sticking plaster, to preparing for and managing the effects of war. In this new study Wall and Doyle will focus on the initial treatment of minor injuries and techniques for basic life support undertaken by people other than recognized medical professionals. The project begins in 1909, when Voluntary Aid Detachments (including auxiliary nurses) were established by the British Red Cross, and ends by examining the influence of the Cold War on our knowledge of first aid. A major focus for the research will be the first aid activity and the diffusion of first aid knowledge conducted by the British Red Cross and other organisations such as St John’s Ambulance.

They will test the typicality of the British experience by examining of the development of first aid in France. French healthcare and voluntary associations developed in different ways to those in England. There has, for example, been a more prominent, and controversial, role for religious organisations, a greater level of state intervention in the oversight of first aid providers and a set of priorities strongly influenced by the experience of war and invasion. Moreover, the centrality of contributory insurance and the freedom of doctors from state employment may have shaped the continuing role of first aid within the French system.

Wall and Doyle’s project will move beyond professional, institutional care to focus on the history of the personal, voluntary and communitarian forms of healthcare generally known as first aid. They feel that an understanding of the trajectory of non-institutional treatment across the twentieth century, and in particular the effect of freely available universal health provision on the willingness of the public to self-treat minor injuries, can help to illuminate the boundaries of state provision, individual responsibility and voluntary action in the era of welfare states. Moreover, tracing the fate of first aid provides an opportunity to inform responses to the current crisis in the British National Health Service, especially recent heavy demands on GP surgeries and accident and emergency departments.

The grant begins on 1 March 2016 and runs to 31 August 2018. Wall and Doyle will shortly be recruiting a post-doctoral researcher to assist with the project, who will particularly focus on the research which will be undertaken in France and on oral history. As well as writing publications, the team will be working on a variety of policy and public engagement activities.

Story originally published on

Voices of Madness Conference CFP

Voices of Madness

Centre for Health Histories, University of Huddersfield

15th- 16th Sept 2016

Voices image

In the thirty years since Roy Porter called on historians to lower their gaze so that they might better understand patient-doctor roles in the past, historians have sought to place the voices of previously, silent, marginalised and disenfranchised individuals at the heart of their analyses. Contemporaneously, the development of service user groups and patient consultations have become an important feature of the debates and planning related to current approaches to prevention, care and treatment. The aim of this conference is to further explore and reveal how the voices of people with experience of mental illness have been recorded and expressed. We hope to consider recent developments in these areas with a view to facilitating an interdisciplinary discourse around historical perspectives of mental health and illness.

The organisers invite proposals for twenty minute papers or panels, workshops, and roundtables of ninety minutes on the themes of voices of madness and mental ill health under headings including but not limited to:

• Oral history and testimony
• Community care
• Institutional histories
• The role of informal carers
• The growth of the mental health professions
• Mental ill health and the voice(s) of adolescents and children
• Museums and ‘heritage’
• Literature (fiction and non-fiction)
• Language of madness (if not covered by ‘heritage’)
• Dissenting voices
• Appropriation/advocacy
• Patient and community participation
• Absent voices
• Art
• Stigma
• Self expression

For more information contact Dr Rob Ellis (, Dr Sarah Kendal ( or Dr Steven Taylor ( To submit a paper proposal (250 words maximum) or express an interest, please contact Steve Taylor by 14 March 2015. We hope to offer some bursaries for postgraduate and early career researchers.

European Healthcare before Welfare States


The ‘Hospital for Businessmen’, Prague


The Centre for Health Histories at the University of Huddersfield (formerly the Centre for the History of Public Health and Medicine CHPHM) has been awarded almost £90,000 by the University research Fund for a project designed to enhance the international research and profile of the Centre. The Centre, led by professor Barry Doyle, includes Dr Lindsey Dodd, Dr Rebecca Gill, Dr Rob Ellis, Dr Alex von Lunen, research students Andrew Holroyde and Sarah Taylor and recent appointment as Centre Research Assistant, Dr Steve Taylor.

The project will develop the international elements of the Centre through three inter-linked activities:

1. A research network of UK, European and North American scholars to meet in two focused workshops in 2016 and 2017 to discuss national and transnational themes in healthcare before welfare states.
2. A focused pilot project to collect data on health care systems in Poland, Hungary and Czechoslovakia to build knowledge in an area with little published research in either local languages or English.
3. The appointment of 3 visiting professors on short term placements in Huddersfield to develop projects, co-write for international journals and prepare funding bids.

Work Package 1
A research network of UK, European, North American and Australasian scholars to meet in two focused workshops in 2016 and 2017 to discuss national and transnational themes in healthcare before welfare states.
We propose to hold one workshop on Hospital Provision in Europe and North America, 1880-1950 and a second on Treating Mental Health before the Welfare State.

Work package 2
A focused pilot project to collect data on health care systems in Poland, Hungary and Czechoslovakia.

The aim of this element of the project is to identify a primary source base to explore how hospital provision was established, managed and funded in the successor states of East Central Europe (Poland, Czechoslovakia and Hungary) created in 1918. It will examine these developments from a ground up approach to explore the practical process of building health care provision at a local level. It will seek to locate suitable source material to undertake local case studies of hospital services.

The project will use international comparison across three countries and will open up opportunities to examine healthcare in diverse economic, social and political situations. It will draw on Doyle’s comparative work on Anglo-French hospital services which utilised urban case studies to assess the day-to-day operation of healthcare before welfare states. Healthcare provision in the three nations chosen for this project Poland, Czechoslovakia and Hungary has received limited attention from historians. Much of the English language work has focused on the activities of the Rockefeller Foundation, between 1918-25, while studies of early national health policy have concentrated on links between eugenics and local services. Local studies of provision remain rare.

We will conduct literature reviews, archival scoping and the collection of some pilot data with the help of research assistants with high-level competence in Czech, Polish and Hungarian respectively. After an initial period reviewing literature and identifying appropriate collections, the RAs will spend up to two months in their respective countries exploring archival sources, undertaking initial data collection and meeting with potential collaborators and project partners. The research visit will include a period in the capital identifying national records, print sources and medical journals and some time in a provincial centre scoping local archival material such as hospital records, local authority material, newspapers. In the final two months they will write up reports to include assessment of the scope and quality of archival material, the problems and possibilities offered by the source base and the initial pilot data collected. This material will be presented in a plenary workshop involving ten-fifteen academics interested in interwar health care provision in a European context. There will also be a co-authored article on the findings of the project for submission to a major medical history journal.

We hope the project will make a significant contribution to the history of health care provision by opening up local records in East-Central Europe for researchers and by placing hospital development in these countries in a Europe wide context. In particular, we will view these developments from the ground up examining the practical process of building health care provision at a local level. Integrating East Central Europe into the history of European hospitals will challenge existing paradigms based on the relatively wealthy, urban and politically stable states of western Europe that currently dominate the historiography and offer an opportunity to explore the role of health care in national identity formation.

Work Package 3
The appointment of 3 visiting professors on short-term placements in Huddersfield to develop projects, co-write for international journals and prepare funding bids. Opportunities may exist for reciprocal or complementary visits.

The visiting professors will: work on their own research, supported by colleagues in the Centre for Health Histories; present their research at Huddersfield and other institutions; provide advice and mentoring to staff and students associated with the Centre, especially around applying for non-UK funding, research strategies and environments in Europe and North America, opportunities for collaboration and reciprocal visiting roles; develop joint funding bids with colleagues in the Centre; co-author articles/co-edit books or special issues with Centre staff and students.

We are looking forward to developing this project, mounting the workshops and working with our project partners, including Professor Petr Svobodny of Charles University. It is intended to set up a web presence for the European Healthcare before Welfare States Network, with a blog and to explore both academic and non-academic outputs including information for governments and think tanks across. Europe.