“In the subject-matter of Preventive Medicine … Enteric Fever, with the diseases which are allied to it in mode of origin, must necessarily, I think, stand as first topic.” Thus began John Simon’s most influential report as Victorian Britain’s leading health authority. Titled Filth-Diseases and Their Prevention, named after the nineteenth century’s most enigmatic infectious disease, typhoid fever, the report was first issued in 1874 as a supplement to Simon’s annual report as medical officer of the local government board. Filth Diseases laid out a striking vision for British public health, whereby the incidence of typhoid stood as a litmus test for the health of a particular area. And a particular kind of epidemiology, outbreak investigation, was the central weapon in preventing the disease through local sanitary surveillance. This book takes its title, The Filth Disease, from Simon’s well-known report. Its subject is how overlapping and sometimes conflicting cultures of typhoid—popular, scientific, and political—dominated public health debates in Victorian Britain.

John Simon was the longest-serving chief medical officer in British history. He led centralized public health activities for twenty-one years, from 1855 to 1876, overseeing the health of the people of England and Wales and influencing a number of landmark health acts, including the Sanitary Act of 1866 and the Public Health Acts of 1872 and 1875. Together the acts compelled local authorities to provide municipal sanitation systems and to hire a medical officer of health (MOH). The acts also established a national sanitary surveillance system led by Simon and his team of inspectors at the Medical Department. A surgeon and pathologist by training, holding a long-term post at St. Thomas’s Hospital, Simon broke into public health as the City of London’s first MOH, a position he held from 1848 to 1855. There he saw firsthand the grim realities of urban environmental degradation wrought by the Industrial Revolution. In his nearly decade-long trial by fire in the unprecedented role of the MOH, Simon called for wide-ranging reforms in water supply, sewerage, housing, cemeteries, and food adulteration, first publishing reports in the Times, and then in 1854 having them collated and sold separately as Reports Relating to the Sanitary Condition of the City of London. In 1855 Simon accepted an offer from Benjamin Hall to lead the General Board of Health, replacing the outspoken and obstinate barrister Edwin Chadwick.