Chapter Four
Cantlie’s Crisis Revisited
From the South African War to 1904
So far, we have focused on how alarmingly high infant mortality rates across large English cities influenced the growth of municipal public health in the late nineteenth century. By the year 1900, roughly a third of the British population was living in large, gloomy cities, suffering the effects of the urban penalty (deplorable living conditions, inadequate diets, and frequent exposure to environmental and pathogenic health hazards). As a result, if James Cantlie was to be believed, they were experiencing “physical degeneration.”
1Mosley, The Chimney of the World, 103. But localized concerns of the Medical Officers of Health alone did not necessarily capture serious national attention. Rather, it would take a national medical crisis to draw broader attention to the importance of preventative public health. The Second Anglo-Boer War (1899–1902) created just such a crisis, and its legacy serves as an important inflection point in our story.
The legacy of a war that occurred in the imperial periphery, far from the three municipalities at the center of this story, was critical in shaping the expansion of urban public health at home in England for two reasons. First, the conflict revived James Cantlie’s concerns about “degeneration” and brought them back into the foreground of public health. Second, the alarming medical data that emerged from the war forced Parliament to conduct a national review of the state of the nation’s physical health. The results of this review were released in 1904, and they were shocking. But the ensuing report also included important recommendations for enhanced public health in large towns and extended commentary on the importance of protecting children’s health to ensure the healthy future of the British Empire. Thus, unpacking the legacies of the Second Anglo-Boer War is critical to considering how and why the scope of public health widened further in the first decade of the twentieth century, as the epicenter of public health began to slowly shift upward from cities to national administration.