Brian Altonen, MPH, MS

Additional Notes

The tempest of success that Acland’s work on cholera brought to medicine and in particular the study of poverty and health defined his next two important writings in the field.  Sanitation was Acland main focus as an epidemiologist, in particular the study of epidemiology as it related to health at home and health in the community.  Acland’s next important works included his writing of sanitation and the need to improve upon the water supply.  This was also a topic heavily reviewed and focused upon by most other famous epidemiologists for the time.  Acland mentions a little of this in the introduction to one of his next books, entitled

A portion of this movement would later be heavily responsible for the slow reduction and at time elimination of unhealthy environmental settings, such as marshlands, swamps, and other ecological settings that more than a century later led to a reversal in this public health decision.  Medical geography had everything to do with our philosophy for the disease in the mid 1800s, and was the reason we became so focused on the pastoral way of living, converting moist fields into productive croplands and plantations, and marshes into drier, inhabitable lands.

Acland had the following to state about this important part of  ecological medicine history, an example of just how much of a role topography and climate were now playing in the field of disease prevention.

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The nature of the sanitation problems at hand in the new systems design for treating human waste were defined well in this following letter written to  Acland by Voelcker.  The details about the usefulness of human waste, including urine, in industries and tasks related to gardening would come up repeated for decades to come as an important public health and waste management issue, with special qualities when it came to providing more cost effective processes to programs attempting to manage the issue of poverty and unhealthy living environments.

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Dr. Acland’s work facilitated our understanding of human waste in terms of its literal chemical and biological contents, its behavior in natural and manmade settings, its impacts on the local ecology, its impacts upon our health, its potential use as a natural resource, and its potential as a source for many diseases.  Whereas yellow fever was the disease needed for us to develop more effective quarantine practices and disease diagnostics and prevention procedures, cholera further enhanced what we were learning about properly diagnosing a disease, differentiating it from its similars, and then developing a better understanding of its relationship with both place and people.

Yellow fever, in spite of all the arguments out there and differences in opinion as to its cause, was mostly a fever of the air, ‘mal aeros” or the miasma and effluvium.  Cholera on the other hand was a consequence of mostly human behaviors, resulting in poor sanitation and sometimes greater disease susceptibility due to poverty.  Cholera defined whether or not people were susceptible to disease patterns, not environmental settings.  That change in reasoning facilitated the conversion of the miasma theory and its various environmental and theoretical derivatives into the zymotic theory for disease popularized by William Farr.  Zymosis in turn made it possible for a much smaller change to ensue as the germ theory was converted into the bacterial theory for diseases.  Acland’s work played an important role in this change in disease theory philosophy.

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Health, Work and Play

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Perhaps the most important book ever written on the health of the poor during the mid-19th century was Health, Work and Play by  Henry Acland, published in 1857.  This book focused on the social inequality making its way through much of Great Britain during the first half of the nineteenth century, since the first major writing on this public health issue by Malthus in 1797 and republished several times more over the next ten years.

A book review published in Mechanical Magazine

Great Britain was well into the industrial revolution when poverty began to take its its toll in large numbers within more heavily populated parts of the urban settings.  Malthus’s prediction for poverty and starvation for populations that became too large was just a small piece of the puzzle that had to be solved as medicine continued to strive towards better understanding diseases and epidemics, and what enabled each of these to behave in the ways they did.   Some of the physicians realized that the governmental infrastructure running the county needed to be adequately trained and ready to better deal with any more events like the cholera epidemics of 1828-1832 and 1848 to 1853.  Government had to provide the finances needed to engage in whatever was needed to prevent the next generation of plagues or cholera episodes from taking large numbers of lives within the working class.

As each decade passed during the first half of the nineteenth century, it seemed as though each decade experienced one or more of holy tests as foretold by the Bible, at least according to some religious leaders.  Sir Henry W. Acland was in fact one such leader well trained in both religion and medicine.  If anyone in the medical field during this time was familiar with the teachings of the Bible with regards to the Wrath of God and the philosophical reasoning behind why diseases and poverty happens, it was Sir Acland.

During Acland’s childhood a number of interesting political and medical science events took place that exposed Acland as a young boy to whatever stimuli were needed for him to become one of the strongest advocates for the poor once he grew up.  Malthus’s book was first published in 1797, more than fifteen years before Henry Acland was born.  We expect one of two things to happen to such a book published.  either it becomes very popular and its meaning and purpose continue for decades to come, enough so that Acland learned about it as he grew up between the years of 1815 and 1830.  Alternatively, Acland may have grown up knowing very little about the heritage behind many of the legal actions that took place during his first decades of life.  Events related to the Woolen Law, the Corn Law, and the various laws written specifically to deal with the poor families and kids who were orphaned may have had little influence upon Acland, weren’t the need for such still underway during his childhood years.

Henry Acland was raised by parents who experienced these impact that population growth had on the national economy and the changes in lifestyle to be engaged in by both farmers and urban families.  There were always poor neighborhoods with poor families and such, with churches and community services out there to attend to their needs, and financial support coming from government official most of the time.  During the 1820s, this was less the case than years prior, and when the first Asiatic cholera epidemic struck Great Britain 1819, the argument began which blamed the lifestyles impoverished people lived, not an potential public health cause, only cultural cause.

At this stage in population development in Western Europe, it was not unusual for a population to demonstrate a direct relationship between age and likelihood of dying the following year.  The Age-Gender population pyramid for this time was very much triangular in form, with numerous medical problems taking their toll on the youngest generation, one year after another, exerting its greatest impacts on the youngest kids, but slowly loosing that power as one got older.  There wasn’t that strange increase in deaths followed by a second reduction in deaths so common to modern populations.  As you got older, and managed to survive, your survival was a sign of your ability to manage the various stresses your environment was forcing you to face. As a kid you went through the deadly childhood diseases, followed by events with numerous recurring epidemics borne by infectious diseases and a few well known animalcules that at times took a life or two–the tapeworms, flukes, and various forms of pestilence carried by rodents, fleas, ticks and flies.  If you made it through this early stage in life, learning how to effectively practice personal hygiene both on the body and in your living space, your next environmental exposures came as a result of your first years as an apprentice, exposing your self to various chemicals and work related processes that managed to impact your eyes, hair, air passages, mouth, hands and arms, feet and ankles, motor strengths, ability to concentrate and to focus, to read instructions, to learn to be ambidexterious and a hard worker.

Little of these skills matched those of Henry as he went through his childhood schooling.  As a child of a family serving Royalty, he had some advantages sent his way when he was very young, allowing him to choose that path many kids take in their teens, to go to some form of advanced schooling.  Henry Acland received religious training and learned to relate skills in religion with those of a good politician while serving and working at the Christian Church.  After several years at what had become coloquially known as ‘Ch.Ch.’, he  began to impact the types of education to be made available at Ch.Ch. for future generations.  We were now into the natural sciences by now in terms of the miniscule, those elements of nature not easily seen by the naked eye.

To Acland, two important aspects of nature and science were once unclear to younger generations.  The first was how those much smaller parts of nature looked to us and how marvellous or romantic they could seem at times to writers and natural philosophers.   The second was the inner makings of the human body, its anatomy and physiology.  Medical doctors learned all about this as a part of their teachings, young children learned about it in books, through art, drawings and pictures.  Acland was about to change this routine way of teaching this important increasingly important aspect of biology and people.  By the time he graduated from Ch. Ch., he was ready to push for some dissection courses to be taught to kids, not adults, and where else might these classes be held, than the labs and classrooms funded for and operated by Ch. Ch.

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History had already influenced churches like Ch. Ch. with regard to the importance of understanding the body and how it operated, how it was made by God, Nature, whomever and whatever.  Some religious followers and leaders were a bit more open about the process of gazing into the product of life, something that could only be explained as a product of the Creator.  The complexity of the body prevented us from every knowing the secrets to life up until now.  Was it possible for us to better understand life and the processes of living within a body by studying its parts and their complex organization.  To strong religious leaders like Acland, this would have simply made us wiser about life, opened our minds up more to the concept that nature did not create these objects as machines with a spirit through natural events alone.  Some other forces had to be involved.

So, as Acland worked to promote the first dissection labs as a part of the schooling provided by Ch. Ch., other applications of this knowledge came to bear with time.  We were pretty much stabilized in our understanding of the life process by this time.   The controversies which the first evolutionist developed in the decades prior had come to full fruition, as evolutionists and creationists constantly exchanged their leads in having the people believe them more than their competitor.  People needed to believe that they “knew” science as well as God’s Plans along the way, basing these conclusions on not only what was written in the Book, or books, but also by what we could see in nature.

The first generation of Erasmus Darwinian evolution had peaked and fully matured, being supplements in the 1820s by several writers, and furthered intellectually by the teachings of scientists researching the natural selection process during its earliest stated, like ____  Lamarck.  So the argument no longer focused on whether this was true or not, just the big question ‘what is going to happen next?’

Just when nature seemed to be stable for a moment, when age and health and disease seemed to be somewhat linear in their patterns of change, with health and age and longevity all factors that seemed to feed back and forth to each other.  As one got older, one became more likely to die, and in the end there were very few who made it to their octagenarian years.  What was it that made them survive had been the focus of many scientists since the mid 1820s onward.  During the 1830s, as well learned more about sciences in general, along with the science of living and life, we also came to a better understanding of  all the inner and outer workings of nature, and the human body.  Acland turned the 1840s into a year when we honored this wisdom of nature and fed it by the spoonful, or bookfull, to anyone taking classes who had the desire to learn.

In the midst of this transition of science from primitive natural science and a young natural philosopher’s world, to a maturing natural and biological science filled with numerous specialties, too much for one to learn in a lifetime it now seemed, a major epidemic struck the world and became pandemic–killing people in Western Europe as it migrated from India and the Middle East westward through France, Spain, the Netherlands, and across the Strait to England and Great Britain.  Just prior to 1820, this disease that was then known simply as another form of cholera, struck portions of Europe just west of India, but never made its way to great Britain.  In the early 1830s, it made its way to the isolated islands defining Great Britain, and changed the population pyramid considerably as numerous deaths ensued.

Following the early 1830s cholera epidemic was the Irish Potato Blight that impacted mostly the northern parts of Great Britain.  This had a significant, most fatal effect on the farming communities that filled Ireland, extinguishing local families and greatly reducing whatever stores and services these rural towns provided for their Mother Country.  To religious leader Acland, this may have been interpreted as a statement of just how much social inequality was beginning to play a role in peoples’ health and longevity as well as the same for the given culture.

In the 1850s, Acland took a series of moves parallel with those of several other medical leaders interested in dealing with the social inequality issue.  The blame for disease was shifting away from the focus on nature, and back to the focus on people and most importantly, the way they live–their sanitation practices.  A decade or two prior, sanitation was a concern, but the focus for preventing and treating illness focused on the person, his or her body, its ability to withstand the various acts of nature that often took lives, and the strengths and ability of nature itself/herself to take a life.  Weather, climate, topography, environmental parts such as rotting plant and animal parts, the miasm ejected from the “bowels” and unhealthy soils of the earth, were all considered capable of causing illness.  The work of people focused on cleanliness and sanitary practices changed this externally and then internally focused philosophy and discipline into one that looks at the internal self first, and the behaviors that resulted in the appearances and make-up of your external environment.  Some of the blame for disease was still placed upon nature, but a lot of blame also went to individuals and their ability or inability to change whatever unhealthy living practices there were engaged in.

Acland’s focus on the poor and their needs viewed the poor as people in need of change, and perhaps the means to assist them in implementing these changes.  Acland proved that such a need existed by showing that businesses and companies taking advantage of the poor were responsible for some of the worst of these pathogenic institutional, industrial behaviors found throughout various low income population settings.

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The following is pulled from Acland’s book recommending young students prior to selecting a career in life learn anatomy and physiology.  It is an example of a religious leader promoting the basic idea of knowing and learning science in order to better understand the products of the Creator.  Even though religious and medicine never fully got along since science introduced the first philosophies counter to traditional Christian ideas of Creation, new steps like the above were routinely take as time passed.

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Introduction to book (Link):