The first report into the health of the nation began with a disgusting smell, a stench so overpowering that it forced the Government to improve sanitary conditions in London and helped to usher in the modern age of public health.

One hundred and fifty years ago, the year after the “Great Stink”, when London was overwhelmed by the worst pong in its malodorous history, Sir John Simon, Britain’s first Chief Medical Officer, presented a report to Parliament on the “State of Public Health in England”.

Sir John reported on outbreaks of smallpox, epidemics of typhoid, other “common filth fevers” and problems with vaccination. Perhaps most important, he drew attention to the appalling sanitary conditions in London and the danger this posed to public health.

The previous year, a hot summer, the invention of the flush toilet (increasing the volume of water entering the sewerage system) and overflowing cesspits that sent raw effluvia into the Thames all combined to create a smell so revolting that MPs soaked the curtains of the House of Commons in lime to keep out the stench and considered moving to Hampton Court, as the Thames itself turned black.

Times Archive, 1859: Mr. Simon's report on the public health

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Only five years earlier the pioneering doctor John Snow had demonstrated that cholera was carried in sewage-infected drinking water.

The Great Stink and Sir John’s report convinced politicians to “take immediate measures for abating the dangerous nuisance caused by the noxious state of the Thames” with a Bill for overhauling the capital’s sewerage system.

Sir John, one of the great unsung heroes of public health reform, had become the City of London’s first medical officer in 1848 and he campaigned tirelessly to improve health by abolishing cesspools and city slaughterhouses, improving sewerage and purifying drinking water. “He drained the city and rendered it healthy,” wrote one contemporary.

Sir John’s annual reports led directly to the Sanitary Act of 1866, the first mandatory, universal and science-based public health law. He also investigated housing conditions, industrial workplaces, and hospitals: every Monday registrars provided him with the latest mortality reports, a weekly catalogue of death in the city.

In his first report, he drew attention to the need for a national vaccination campaign against smallpox and for efforts to control the outbreak of epidemics. He was particularly concerned by the wide variations in health and life expectancy in different parts of the country, at a time when cities were expanding rapidly. In the 1850s a man living in the rural town of Okehampton, Devon, could expect to live, on average, to 57; for men in the city of Liverpool, the average life expectancy was only 26. Sir John considered this grim disparity to be one of the essential points of his report.

His concerns about inadequate medical training, resistance to vaccination and inequalities of health all carry strong modern echoes.

Today the feared epidemics in Britain are not cholera or smallpox but HIV, West Nile virus and Sars, yet the role of the chief medical officer in drawing attention to the dangers and pushing for action has changed little since Sir John’s time.

One other aspect of public health has also remained constant over the past 150 years: politicians still tend to delay acting on public health issues until someone, or something, kicks up an almighty stink.

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