EHJ March 2005, pages 12-14

Sir James Crichton Browne was the longest serving president in the CIEH's history. Mary Corran, author of a forthcoming book on the Victorian campaigner, looks at the public health issues that exercised him 100 years ago

Sir James Crichton Browne, was a surprising choice to be made the fifth president of the Sanitary Inspectors' Association, the forerunner of the CIEH, in 1901. Although he espoused many public health causes, ranging from nutrition and sanitation to the risk of balloon travel spreading disease, he was primarily a medical man, more psychiatrist than sanitary inspector. An early neurologist, he started his career in the world of the lunatic asylum. He first worked at the Scottish asylum, Crichton Royal, near Dumfries, where his father was medical superintendent. Then he moved to Wakefield, the vast English pauper asylum. Here he spent 10 years as medical superintendent where poor drainage and water quality plagued his years at the asylum, increasing mortality and the spread of disease.

In 1876, Crichton Browne moved to London, entering private practice, and becoming a major figure on the capital's intellectual and social scene. Despite initially remaining committed to neurology, more and more Crichton Browne entered public life, pronouncing on the ills of the day including tuberculosis and what was later found to be a form of tertiary syphilis.

Preventing TB was the subject he chose for his first address to the Sanitary Institute, in Liverpool, in 1894. After a scientific discussion of causes, infections, bacilli, and the effects of air, food, and heredity, he told his audience: "An eminent scientific friend... says that whenever he attends a lecture on bacilli he has a creeping sensation all over him and feels like a horrid old stilton cheese." He prophetically claimed that the subject of bacilli, or bacteria, would occupy science for years to come.

Seven years later Crichton Browne, who had since been knighted, became president of the Sanitary Inspectors' Association. At his inaugural speech he talked about the London smallpox epidemic, and the need for vaccination - a favourite topic of his. Unfortunately, his second year as president was marred with tragedy. While representing the association at an International Congress of Hygiene in Belgium, his wife, Lady Crichton Browne died very suddenly.

Sir James's addresses ranged broadly over the 20 years of his presidency. He publicly espoused many causes. Not least drains, light, air, and the development of garden suburbs. He had a reputation of being a highly entertaining speaker and his subjects would range from the merits of food hygiene to the right of sanitary inspectors to receive "fair tenure" and pensions. In 1908, his annual address to the Sanitary Inspectors' Association in Liverpool concerned the ravages of alcohol on the city's population, and the "brutish carelessness it induces when taken in excess". He was, however, not in favour of total temperance, pointing out that prohibition in the United States had dramatically increased sales of drugs, particularly opium.

Housing was one of his pet themes, in particular the recent construction of homes for the poor, and the quality of the plaster used. He claimed that inferior plaster and cheap wallpaper harboured "vermin and fleas", breeding grounds for disease. He also worried about the dangers to seaside visitors from poor lodgings where there was "an insufficiency of space in bed chambers, of ventilation, and even structural repairs." Adulteration of food, such as milk and meat, was another of his fears, warning of the dangers of chloroform in sweets.

He was also on the alert for new threats. Balloons and planes, he believed, could bring in infectious disease from abroad. Dust from cars also posed a threat to health. On a trip to address the sanitary inspectors in Llandudno, he noticed as he was approaching the seaside town "as far as the highways were concerned, a change for the worse". He saw laying tar-macadam as the best way to stem this potential disease vector. "Analysis of the road dust suggested not only nuisance but also pathogenic germs responsible for cases of conjunctivitis, of oral sepsis lockjaw," he told the association.

Domestic hygiene also interested him. At the Sanitary Inspectors' Conference in 1910, he enthused about the "fish diet". There was no "slumdom" in the ocean, no crowding as was inimical to growth or vigour, "for the finest fish were found in the most thickly populated areas... well-to-do fish made it a rule to have an annual change of water,' like their human counterparts."

When Crichton Browne spoke he would often express his anxieties about the physical deterioration of the British race. "Luxury had its degenerates as well as poverty, but poverty was the wholesale degenerator," he would tell his audiences. Sanitation and good housing, he believed, would be the nation's salvation. In 1911, at the annual Sanitary Inspectors' dinner in London, at the Trocadero, he congratulated the group on now having 1,300 members, as against only 524 10 years before, and remarked that they were: "the first line of defence against disease".

In addition to his presidency of the Sanitary Inspectors' Association, Crichton Browne had many other roles. He had been made director the company Bovril as well as being president or vice president of many influential bodies. These included the Royal Institute, the Royal British Nurses' Association, the Scottish Universities Commission and many societies associated with epileptics and asylums. He was also a founder member of the Eugenics Education Committee, which propounded - among other theories - the importance of sensible breeding, a view commonly held at the time. National deterioration in the form of susceptibility to disease was of great concern to Crichton Browne. He was also worried about the competitive industrial position of Britain compared to the US and Germany. As early as 1890 he had produced a pamphlet on handcraft - referring specifically to workshop training, and the importance of such racially inherited talents.

He also had strong views on love believing in the "love match," rather than marriages due to rank, social influence, ambition, or money. Unions, he claimed, between people of the same race who were mutually attracted to each other were more likely to produce "vigorous and healthy" offspring than those that "had allied themselves in cold blood from mercenary or sordid motives". Marriages based on "natural forces... were, perhaps, more far-sighted in the future of race improvement than we were with our best scientific spectacles."

By 1915 his thoughts turned to war. He believed the country had been saved by sanitation keeping men of fighting age and troops healthy. "It was said that of the men who offered themselves during the first year of the war one million were rejected for defects of one kind or another. These men were all born from 18 to 40 years ago in the bad old insanitary days." Rejections on account of physical or mental defects were proportionately much higher in Germany, Austria and Russia. Sickness in the field, he claimed, also proved the importance of sanitation. "We had lost nearly half a million men, killed, wounded and missing, but if matters had been as they had during the South African war, we should have lost more than a million men from sickness," he said. Both of his grandsons died in the First World War.

With the close of the war, Sir James saw the possibility of training up members of the Voluntary Aid Detachments, set up to provide medical support during times of war, in health work. The problem, he claimed was finding a way to turn the half trained body of women into that "well-trained army of sanitary inspectors and health visitors which, as a nation, we must aim at securing." The problem was education. The National Health Society had set up courses of lectures for helping women to qualify, providing scope for girls who became interested in such work during their period of service. Crichton Browne, no advocate of women's suffrage, was, however, forward in his concern for the development of what was to become the National Health Service. As early as the 1880s he was advocating free milk and medical treatment for board school children. He also recommended fluoride in drinking water.

Venereal disease, he acknowledged, was a delicate subject. But he believed he would be culpable if he did not alert sanitary inspectors to the public health risk. It is "a secret poison that had until recently been allowed to circulate freely," he told them. "Slaying our people, undermining their manhood and producing widespread invalidism and industrial incapacity." The establishment had failed to stop its spread "because of ignorance and negligence and ecclesiastical prejudice and short-sighted morality". Chastity and marital fidelity had failed. A form of disinfection was needed so that "those who perversely and blindly insist on satisfying their appetites in a depraved way, may protect themselves, and would not, then, communicate the diseases to unoffending women". In September 1921, a pamphlet on VD, mostly taken from Sir James' speeches, was produced by the Times despite moral objections.

Ill health forced Crichton Browne to resign as president of the SIA in 1922. Despite being 82, however, he did not withdraw from public life but continued to write on issues such as food and vermin, often published in The Times and campaigned over housing improvements, vaccinations, bread reform, TB prevention, educational reform, and much more. Crichton Browne was a man who enjoyed being at the centre of a good argument, and often wrote most passionately when in opposition, with no qualms about the use of invective. He was a serious man, who took the health of the nation as a whole very much to heart, and fought tirelessly for those improvements, sanitary, or otherwise, in which he believed