Thames Water, the authority responsible forLondon’s water and sewage system, is currently building a massive new ‘Super Sewer’ known as “Tideway”. Approximately 25km in length and due for completion in 2024, this project is being undertaken to prevent the release of thousands of tons of untreated sewage into the River Thames on a daily basis. This contemporary, complex and sometimes controversial civil engineering project is a reminder of the birth of London’s sewage system, designed by Joseph Bazalgette, born two centuries ago last month.

Portrait of Sir Joseph Bazalgette. Credit: Wellcome Collection. CC BY.

161 years ago Victorian MPs were busy arguing and prevaricating over the cost and necessity (or not) of building and funding a proper purpose-built sewer system, designed by Bazalgette. They rapidly ceased all opposition to the project during the long hot summer of 1858 when low tides meant that huge quantities of untreated sewage that normally ran into the Thames were deposited on the river’s foreshores. The resulting appalling smell became known as “The Great Stink”. Believing, as most did at that time, that bad smells spread disease, MPs had to hang sheets soaked in carbolic against the windows in the Palace of Westminster to stop the suffocating stench. Before finally leaving The House ‘en masse’ the MPs quickly voted in the necessary funding for Joseph Bazalgette’s brilliantly conceived sewer system. It consisted of “intercepting sewers”, pumping stations and treatment works that are still being used today thanks to the high quality brick-lined tunnels and the use of durable Portland cement.

Civil engineering: construction drawings for the Thames Embankment. Coloured drawing, 1865, after Sir J. Bazalgette. Credit: Wellcome Collection. CC BY.

Bazalgette was a brilliant engineer, who started his career working on various railway projects. He was responsible not only for the London Sewer System but also for the Thames Embankment, and numerous major roads in London such as Shaftesbury Avenue and Northumberland Avenue. He strengthened or rebuilt 12 bridges over the Thames and freed them from tolls. He also engineered the Blackwall Tunnel and the Woolwich Ferry, and important parks such as Clissold Park, Finsbury Park and Victoria Park “the green lung of East London”.

However, it is Bazalgette’s sewer system for which he is probably most famous. He designed it anticipating a population increase in London from 2 million to 4 million – extremely far-sighted for the time. Given that the current population of London is approximately 8.5 million, no wonder a ‘Super Sewer’ is needed to provide for the increased strain on the system. More important than saving Londoners from a further ‘Great Stink’, Bazalgette’s work played a critical role in saving the lives of many thousands from deadly water-borne infections such as cholera. For this, he deserves to be remembered.

Further Reading

• Stephen Halliday,The Great Stink of London: Sir Joseph Bazalgette and the Cleansing of the Victorian Metropolis(Sutton Publishing: Gloucestershire, 1999).
• ‘Tideway – Reconnecting London with the River Thames,’ accessed 30/3/19, available at: https://www.tideway.london.
• ‘Thames Water,’ accessed 30/3/19, available at: https://www.thameswater.co.uk/

Hermione Pool

‘That men do not learn very much from the lessons of history is the most important of all lessons that history has to teach’– Aldous Huxley

The Flint Water Crisis, which started in 2014 and is still on-going, is a contemporary example of where lessons from history have been ignored.  Briefly, the authorities in Flint, Michigan, decided to replace the water supply from Lake Huron with the less expensive water from the Flint River. Unfortunately, the Flint River was heavily polluted and this led to Legionnaire’s disease and lead poisoning among residents using the water supplied by lead pipes. Of particular concern is the expert opinion that almost 9,000 Flint children are at risk of developmental difficulties and long-term conditions due to lead poisoning. The authorities have been heavily criticised for not testing the safety of the Flint river water in advance and for the delays in both accepting that there was a problem, and in implementing the changes necessary to supply safe water. The crisis has sparked intense political and media debate and several prosecutions are pending.

Image 1: Gums and tongue from a case of lead poisoning. Credit: St Bartholomew’s Hospital Archives & Museum, Wellcome Collection.

In the nineteenth century, several reports of lead poisoning secondary to lead pipes in Britain and the USA appeared in the medical literature and the popular press. The problem in Britain was widespread but particularly evident in Yorkshire, Lancashire and Scotland. In Sheffield, the problem was first reported in 1885 by the Medical Officer of Health and was traced to the water from one reservoir that corroded lead supply pipes and lead-lined cisterns, hence contaminating the domestic water supply. The resistant Sheffield Water Company only agreed to add lime to the water after a public inquiry in 1890. Of even greater concern is the shocking 120 year delay in accepting that lead poisoning in Glasgow was due to a combination of the water supply from Loch Katrine and lead supply pipes.

Could the Flint water crisis happen again? Yes, sadly it could, and the words of Huxley resonate strongly here. But, if we listen to the lessons of history, and learn from them, such needless harm can be prevented.

Further Reading

• Anna Clark, ‘Nothing to worry about. The water is fine,’ The Guardian.17^thJuly 2018, accessed 24/1/19. Available at: https://www.theguardian.com/news/2018/jul/03/nothing-to-worry-about-the-water-is-fine-how-flint-michigan-poisoned-its-people.
• Mona Hanna-Attisha et al, ‘Elevated Blood Lead Levels in Children Associated with the Flint Drinking Water Crisis: A Spatial Analysis of Risk and Public Health Response,’ Am J Public Health.Feb 2016.106(2): 283-90.

Mike Collins

As a junior doctor possessing two X chromosomes, it is easy to applaud the achievements of Elizabeth Garrett Anderson (1836-1917), widely revered as the first British female doctor. It is infinitely harder to establish exactly how she succeeded and to quantify the relevance of this extraordinary woman who died just over 100 years ago. Can we still learn from her example, or has too much time passed to draw significant parallels in today’s modern world?

Image 1: Elizabeth Garrett as a young woman, Wellcome Images

Elizabeth Garrett Anderson wrote to a friend in 1864: ‘My strength lies in the extra amount of daring which I have as a family endowment. All Garretts have it.’ EGA did have ‘daring’, and she wasn’t scared to do things differently. She is frequently referred to as ‘a pioneer’, and with just cause: EGA was the first woman to qualify in Britain to practice medicine, the first woman to qualify as a doctor of medicine in France, the founder of the first hospital staffed by women, the first female member of the British Medical Association (BMA), the first female Dean of a British medical school, the first female mayor in Britain; the list goes on. EGA’s nature as ‘the first’ engendered two conditions: one, that the medical profession as a whole had not expected, nor prepared, for the possibility of a female attempting admission to their ranks; and two, that any doors that remained open within the medical profession were swiftly slammed shut soon after EGA had passed through them. The permission for women to take the Licentiate of the Society of Apothecaries (LSA) examinations to obtain a medical degree, and admission of females to the BMA may be cited as examples here. Consequently, EGA’s nature as a ‘pioneer’ conferred a significant advantage, and it was initially harder, as opposed to easier, for women to qualify as doctors after Elizabeth Garrett Anderson had succeeded.

Image 2: Elizabeth Garrett Anderson, Wellcome Images

Not only did EGA have an unwavering belief in herself and her ability to become a doctor but she put her career first: this was unprecedented in mid-Victorian Britain. She married comparatively late, at the age of 34, despite the average age of contemporary females entering matrimony being just 23 years in 1871. Importantly, marriage took place only after she had successfully completed her studies to become a fully qualified doctor. She had previously declined an offer of marriage in 1865 from her sister Millicent’s future husband, the MP Henry Fawcett. Even after becoming engaged to James Skelton Anderson, she worried that this might jeopardise her career as a doctor and her fight for women’s suffrage: ‘I believe I should almost die of the sense of something akin to guilt, if I found myself, three years hence, really out of the medical field’. This excerpt clearly demonstrates an immense sense of duty. EGA felt herself carrying the weight of the future of women’s rights on her shoulders, and this was constantly in the forefront of her mind.

Elizabeth Garrett Anderson changed the course of women in medicine indefinitely, and more broadly, had an integral role in promoting the women’s suffrage movement on a national scale. Women today can identify with EGA given that she mastered the ability of the ‘modern woman’ to ‘have it all’ – with both a successful career and a fulfilling family life. In 1871, The Lancet proposed ‘if [Elizabeth Garrett Anderson] succeeds in combining the two functions of mistress of a household and medical practitioner, she will have performed a feat unprecedented in professional history, and added another notable incident to this annus mirabilis’.

Quod erat demonstrandum.

Further reading:

• Glynn, J. (2008). ‘The Pioneering Garretts – Breaking barriers for women’, Hambledon Continuum, London.
• Garrett Anderson, L. (2016). ‘Elizabeth Garrett Anderson 1836-1917’, Cambridge University Press.

Lucy Havard