Building for Health

John Evelyn, living quietly at Sayes Court beside the Deptford naval dockyard in London, ensconced in his library, was all too aware of what lay beyond his walls. He wrote on many topics but on one he was unusually short and to the point. With Fumifugium (1661), he hoped to catch the eye of King Charles II. Evelyn’s topic was sea-coal smoke, which hung everywhere from Whitehall to the Thames estuary, damaging ‘the health and felicity of so many’. Framing his pamphlet as a metaphor for the monarchy’s clean start, Evelyn argued for urgent environmental action with ‘REMEDIES humbly proposed’. Incredibly, his text remained in print until 1972, under the imprint of the National Society for Clean Air.  

A boatful of peeled onions, one of the sillier solutions then current, might not do much to waft away pollution and infection, but Evelyn’s own suggestion of encircling the city, its riverside works and overcrowded houses, with a ‘green belt’ of plots and hedges of scented plants to be activated when trodden down or cut, was an enchanting idea from an expert gardener. 

Only five years later, London, and much of the country, was devastated by the plague. But the real crisis lay far ahead, with industrialization. As Jane Austen (writing in 1815) pointed out in her novel Emma: ‘In London it is always a sickly season. Nobody is healthy in London, nobody can be.’ Fortunately, all was well for Emma’s family, since ‘the neighbourhood of Brunswick Square is very different’ and they had taken a healthy dose of sea air at South End (sic) to be on the safe side. Where the middle classes gathered, then as now, nothing was untoward. Elsewhere, often little more than a street away, as commissioners into the city’s dire public health situation in the 1840s heard, ‘the spirit of commercialism recked […] little of the physical condition and circumstances of those upon whom […] it depended’. The poor were being mown down by deadly waves of contagion, in particular cholera and smallpox. 

A handsome frontage on Liverpool Road in Islington marks the former London Fever Hospital, which opened on this site in 1848. Having already relocated and expanded twice since its foundation in 1802, the new hospital had 200 beds to meet the demands of the latest, and worst yet, cholera outbreak. Now, it serves as a picture-postcard facade to a 1980s housing development. 

For all such charitable fever hospitals, no one knew where these diseases began nor how to counter them. The favourite notion was miasma – airborne infection – a theory no better than a boatload of onions. During the cholera epidemic of 1854, a Soho-based doctor, John Snow, realized that drinking water contaminated by sewage caused the disease, but it took many years to act on his observation. Cometh the hour – the Great Stink of 1858, when a particularly hot summer exacerbated the smell of raw sewage in the River Thames – cometh the engineer, Joseph Bazalgette. 

The Metropolitan Board of Works drove Bazalgette’s massive structural reorganization through, under and around London. Embankments and newly aligned roads, super sewers and water culverts were inserted – many there to this day. But the temples of this new religion were the outlying pumping stations. Few were more splendid than the Grade I listed Crossness Pumping station in Bexley or Abbey Mills in West Ham. Their exuberant, colourful interiors reflected the excitement of the revolution in health that they heralded. 

On the streets of east and central London, improvements such as whitewashed walls, glazed windows, fresh water, sanitation and green space (or even a window box) all played their part in bringing health to the city. For 19th-century housing reformer Octavia Hill, this was best achieved by managing existing buildings and enhancing the quality of tenants’ lives. Larger scale improvements came with the many blocks built in the late 19th century by charitable housing trusts such as Peabody, Waterlow and Guinness. Facilities extended to a scullery and a toilet but, for most of the poor depending on the vagaries of casual work, conditions remained atrocious. 

At every turn, this history offers grim reminders of the present situation. The exceptionally high COVID-19 rate in the poorest London boroughs can be attributed to many of the same causes – the gig economy, rapacious landlords leading to desperate overcrowding and, always, a lack of decent social housing. In the 1890s, the London County Council stepped in on a completely new scale, commissioning the architects’ department to design immense estates such as Boundary Street in Shoreditch and Millbank – the latter a series of Arts and Crafts blocks close to Tate Britain. The Right to Buy scheme – introduced under former Prime Minister Margaret Thatcher in 1980 to enable social-housing tenants to purchase their homes –  adversely impacted the affordable housing stock, drove up rental costs and made both estates desirable addresses for owner-occupiers. 

One disease continued to scythe inexorably through the population in the 20th century: tuberculosis. Around 1900, it was the cause of one in every eight deaths. In the 1880s, Hill published an analysis of open space around London and, unsurprisingly, the wealthier north and west of the city were far better served than the east and south. In the very centre, however, there was a forgotten resource: small, disused burial grounds, which were redesigned and reopened as pocket parks or ‘open-air sitting rooms’ (as Hill called them). Further afield, the energetic men and women of the Commons Preservation Society had been fighting enclosure since 1865 and secured immense open spaces such as Epping Forest, accessible from east London by train, bicycle, bus and tram – or even in a cart or charabanc on a workers’ beanfeast. 

Tuberculosis was very susceptible to fresh air and sunshine, and soon spawned its own interwar architecture of light and air. White, modernist and reassuringly functional, sanitoria were widely built in northern Europe, most notably in Finland. Only antibiotics would prove more effective. But, a progressive welfare agenda in impoverished London boroughs also led to several integrated clinics and the Finsbury Health Centre (1935–38), designed by Berthold Lubetkin and described, in a lovely phrase, as a ‘megaphone for health’. These ventures were developed as part of a new postwar welfare system, the National Health Service, launched in 1948. The architecture conveyed modernity and, in action, suggested a cure to the city’s ills. 

We are still encouraged to pursue outdoor activities for our health and Londoners have benefitted from some exemplary recent additions to the city’s open spaces: the Green Bridge in Mile End (2000), the Queen Elizabeth Olympic Park (2012), reclaimed spaces with water features at Somerset House (Edmond J. Safra Fountain Court, 2000) and Kings Cross (Granary Square, 2013), and, across London, a renewed emphasis on walking and bicycling. But let’s not forget the families still living in Victorian-era squalor across the city, the people whose jobs are dependent on whim and those who do not have a home at all. The things that shamed us in 2019 are the miasma that poisons the air in 2020. 

_{Main image: Crossness works, view of engine house. Photograph: © Hulton-Deutsch Collection/Corbis via Getty Images}