The Chief Medical Officer’s annual report has aroused fierce debate throughout its 150-year history, but the leaking of Sir Liam Donaldson's key concerns about alcohol consumption in this country – and the quick and co-ordinated government rebuttal – is a less palatable first.

While Sir Liam may have been measured in his criticism of those who appear to be playing political football with his proposals for public health reform, it is a situation that would have been neither expected nor tolerated by his 14 predecessors in the role.

The report has been the spur for considered debate in Parliament from the time of cholera and smallpox vaccination through to the ban on smoking in public places – initiating many an important review of policy.

When Sir John Simon, the first Chief Medical Officer, presented his report on the state of public health in England in 1858, it was designed not only to be a historical record of events but to inspire, instruct and urge action.

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

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The dominant issue of that year was the "Great Stink" of London, when foul smells from raw sewage flowing into the Thames combined with a particularly hot summer to cause a stench that threatened to overpower the city’s population. Such was its unpleasantness that Parliament and the law courts considered relocating outside the city. MPs in the House of Commons sat behind lime-soaked curtains, in an effort to keep the stench out, and voted enthusiastically for a Bill to fund a new sewage system for London.

Poor sanitation was a prominent issue in the first CMO’s report, as was the need for an improved national vaccination campaign against smallpox.

The report detailed a series of recent epidemics in England and highlighted variations in regional mortality levels. At the time, average life expectancy was 40, but a boy born in an inner city such as Liverpool could expect to live just 26 years.

Simon described an outbreak of cowpox in Wraysbury and an epidemic of typhoid and other "common filth fevers" in Windsor. He also called for better training of medical staff to improve vaccination rates, which – despite the Vaccination Act of 1853, which made it a legal requirement for all children to be immunised – were still patchy.

The CMO’s role grew out of the Government’s burgeoning interest in public health. A decade before Simon’s first report, in 1848, the first Public Health Act had been passed, establishing a General Board of Health to focus on sanitation and the environment. However, a need for medical expertise brought Simon, a surgeon at St Thomas’ Hospital to attention, and he was appointmed as the first Medical Officer of Health for London.

In 1855 Simon effectively became Chief Medical Officer to England after his appointment as Medical Officer to the General Board of Health, and then, after the board’s dissolution, adviser to the Privy Council. He established reviews of policy, including the national vaccination campaign.

Simon, the longest serving CMO to date, was in post for 21 years. Other public health pioneers included Sir George Newman (1919-1935), who wrote a powerful treatise on infant mortality, and Sir George Godber (1960 -1973), a key player in the foundation of the NHS. From the Great Stink onwards, none had seen their reports pre-empted by a Government slap-down such as the one Sir Liam’s proposals have received. A century and a half on, sanitation may have improved around London, but the spin of leaks and contrived rebuttals is now lending Westminster its own peculiar stench.

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