Duncan challenged the commonly held conception that it was the fault of the poor themselves that they became ill, he viewed social poverty as the cause, not individuals and looked to things like improving housing and sanitation to help the situation.
Housing in Liverpool was dark, poorly ventilated, damp and overcrowded, with no provision for human or other waste. Liverpool had not only the worst type of cellar dwelling, but also a larger proportion of its inhabitants living in cellars than any other town. The population living in court housing generally made use of privies and it was common practice to dispose of the contents by spreading them over the courts, so many of the cellar dwellers were frequently knee deep in sewage. In 1822 a commission of sewers was established and over the next 20 years built 30 miles of sewers, but these were for surface water drainage only, houses did not connect to their drains. In 1840 Dr Duncan was one of the numerous medical practitioners who submitted reports – including the Report on the Sanitary State of the Labouring Classes in Liverpool as evidence to
Edwin Chadwick’s
Poor Law Commission. His evidence is given in vol 2, 31st August 1840, where Duncan remarked, “There can be little doubt that the causes of the unusual prevalence of this disease in Liverpool are to be found principally in the condition of the dwellings of the labouring classes, who are almost exclusively its victims; but partly also in some circumstances connected with the habits of the poor. With regard to their dwellings I would point out as the principal circumstances affecting the health of the poor: • Imperfect ventilation • Want of places of deposit for vegetable and animal refuse • Imperfect drainage and sewerage • Imperfect system of scavenging and cleansing The circumstances derived from their habits most prejudicial to their health I conceive to be: • Their tendency to congregate in too large numbers under the same roof etc. • Want of cleanliness • Indisposition to be removed to the hospital when ill with fever". In 1843 Dr Duncan gave two lectures to the Literary and Philosophical Society – On The Physical Causes Of The High Rate of Mortality in Liverpool. The lecture was also published as a pamphlet which had an immediate effect upon the Council, who realised that something had to be done.Council Minutes 2nd August 1843 ‘…they have been deeply impressed by the novel and appalling statements made in a pamphlet recently published by their respected and able Townsman Dr W H Duncan by which it appears that Liverpool so far away from one of the healthiest as they had thought is actually the most unhealthy town in England owing to the extreme density in which the lower classes of its population are crowded together in confined Courts and Cellars constructed without due regard to ventilation and drainage and without adequate arrangements for the removal of filth.’His lecture and pamphlet effectively inspired the Council to compile and pass the Liverpool Sanitary Act 1846, which in turn, acknowledged that a medical person was needed to tackle the many complex issues. Duncan used statistics compiled by
William Farr to demonstrate that the average age of death in the rural communities of
Rutland and
Wiltshire was 36.5 years, while in
Liverpool it was 19.5 years. In the absence of all but the most rudimentary vital statistics, Duncan collected data comparing sickness absence rates between the wealthy and the less wealthy neighbourhoods - an early example of inequalities in health research. == The Liverpool Sanitary Act 1846 ==