Roseanne Zhao
Roy Zhao
Chicago, Illinois, United States

 

Alfred Salter and Joyce Wellcome Library, London, United Kingdom

Nestled on the south bank of the Thames, just east of Tower Bridge, lies the home of a poignant sculpture known as Doctor Salter’s Daydream. A life-sized sculpture of an elderly Dr. Salter rested on a bench fondly watching his young daughter, healthy once again, playing with her pet cat on the river wall. It stood as tribute to a physician who dedicated his life to fighting disease in the impoverished community of Bermondsey, a Southeast borough of London. Sadly, the sculpture of Dr. Salter was stolen in November 2011, presumably for scrap metal, and the sculptures of his daughter and her cat were temporarily taken into safekeeping. The theft prompted public outcry along with a campaign by local residents to raise funds to replace the statue.

So who was Dr. Salter, and what made him such an important and beloved figure?

 

A promising youth

Alfred Salter was born in Greenwich, UK, on June 16, 1873, the eldest of four children, to a family of modest means. He showed early promise in medicine, and at age sixteen, won a scholarship from the John Roan School that provided him the means to study at Guy’s Hospital in London. There Salter was an outstanding student who impressed his instructors with his endless energy, inquisitive mind, and photographic memory. With a crusading passion for service, Salter made medicine his mission. He sought to emulate great pioneers such as Joseph Lister, who had applied Pasteur’s germ theory to develop life-saving antiseptic procedures for surgery. He was equally inspired by his hero’s modest character, simple habits, and love for humanity¹.

By age twenty-two Salter had accumulated a long list of awards. By age twenty-four he had been appointed House Physician and Resident Obstetric Physician at Guy’s Hospital. Later that year, Salter was invited by Lister to take up the position of bacteriologist at the prestigious British Institute of Preventive Medicine, where he worked towards developing an anti-toxin serum to treat diphtheria. By the time he was twenty-five, his research was known throughout Europe.

Despite a promising future as a wealthy consultant or a great pioneer in medicine like Lister, Salter was conflicted. He had developed a keen interest in social justice, influenced by Edward Bellamy’s writings and H.M. Hyndman’s logical approach to Marxist theory². The poverty he encountered during his home visits to the slums of working-class Bermondsey spurred his desire for change.

 

Bermondsey’s call

At the time, Britain’s health was in a perilous state. The Industrial Revolution that had ushered in technological advancement also led to a dramatic shift in the urban landscape with significant consequences. Evocative snapshots of the times were captured by writers including Charles Dickens, Elizabeth Gaskell, and Friedrich Engels. Dickens’ novel Oliver Twist—featuring the notorious Bermondsey slum, Jacob’s Island—had offered a description, years earlier, of “dirt-besmeared walls and decaying foundations, every repulsive lineament of poverty, every loathsome indication of filth, rot, and garbage”³.

In cities, the combination of overcrowding, poor sanitation, and grinding poverty led to endemic smallpox, tuberculosis, and typhus; epidemics of cholera; and high mortality^4,5. For the majority of the population, healthcare was a matter of charity, but resources were never sufficient and many suffered illness without treatment. Good healthcare was accessible only by the privileged few.

While working at the Lister Institute, Salter went to live at Bermondsey Settlement—founded by the Methodist minister, John Scott Lidgett, in 1891 to advance the economic, social, and spiritual conditions of the community. In the absence of national health insurance, Salter started a Dividing Insurance Society to provide security during times of illness. He also met and fell in love with Ada Brown, a young social worker in the West London Mission. Dismayed by the unsanitary conditions, extreme poverty, and lack of basic amenities such as running water and heat, they dedicated their lives to helping the community.

Despite opposition from professional colleagues, Salter charged a low fee for his medical services and treated the poorest for free⁶. Through his compassion and dedication to his patients’ best interests, his practice expanded rapidly. Other doctors sharing his Christian Socialist values soon joined this philanthropic enterprise.

 

Turning to politics

Nevertheless Salter understood the limits of his individual effort as a physician. Under Lidgett’s influence, he joined the Liberal Party to campaign for better conditions, recognizing adequate nutrition, housing, and sanitation to be preventive medicines for the laboring poor⁷. He was elected to the Bermondsey Council in 1903 and to the London County Council in 1906. Later, he and Ada joined and became leading members of the Independent Labour Party, impressed by its ethical socialism and campaign for unemployment benefits, old age pensions, and school meals. In 1930 Salter also became a founding member of the Socialist Medical Association, which paved the way for the establishment of universal health care in 1948 under Britain’s National Health Service⁸.

Salter likewise spoke against the class basis in medical education, writing, “it has been recruited almost entirely from the upper middle classes with the result that its members have been more allied in sympathy with the privileged and governing classes,”⁹ and proposed that medical education be more accessible to all.

 

Losing their “little ray of sunshine”

Personal tragedy struck in June 1910.  Their eight-year-old daughter Joyce, well loved throughout the borough as “our little ray of sunshine,” caught scarlet fever for the third time and became seriously ill. Despite receiving the best care, she succumbed to the disease. This blow challenged the Salters’ core convictions, as they had avoided shielding Joyce from Bermondsey’s harsh environment as a matter of principle against class privilege. Although they never overcame their grief, they expressed their love for their daughter through a deepened affection for the children of Bermondsey and new sense of identity with the community¹⁰.

 

Bermondsey’s revolution: “there is no wealth but life”

In 1922 Alfred was elected as member of parliament for Bermondsey and Ada became its mayor, respectively. Despite numerous disappointments, the Salters and other pioneers of the Bermondsey Labour Council campaigned passionately to prevent unnecessary deaths and improve the health of their borough. Salter believed that there is no wealth but life, and alongside Ada, became a driving force behind what was later called Bermondsey’s Revolution.

They pushed to improve housing conditions and led the Council to build comprehensive municipal health centers. Bathing, dental, foot, antenatal, and infant welfare centers were established. Fairby Grange, their country house in Kent, with its twenty acres of gardens, fruit orchards, and woodlands was converted into a convalescent home for mothers and women recovering from operations¹¹. Alfred lamented “the curse and cruelty of ugliness” that “cut off the people from the chiefest means of natural grace,”¹² and a Beautification Committee led by Ada worked to fill every possible place in Bermondsey with flowers and trees.

Health education was emphasized by reaching out to the local masses through pamphlets, open-air lectures, and newly designed “cinemotor” vans that showed lanternslides and specially prepared films at street corners^13,14. The campaign targeted common conditions ranging from poor hygiene and infectious diseases, such as tuberculosis and venereal disease, to rickets, rheumatism, heart disease, and diabetes.

The Council also opened a solarium, the best alternative for treating tuberculosis before the discovery of antibiotics and particularly beneficial in the early stages of disease^15,16. Also, tuberculin testing was enforced. Although Mycobacterium tuberculosis and Mycobacterium bovis had each been identified by Robert Koch as the causative agents of tuberculosis in humans and cows, Koch and others did not believe that Mycobacterium bovis could be transmitted to humans. Controversy persisted for years despite the link between the drinking of raw milk to disease and infant mortality⁵. In the absence of comprehensive national legislation, tuberculin testing along with educational health campaigns reduced the incidence of tuberculosis acquired from bacterially contaminated milk.

As a result of these efforts, a dramatic improvement was seen in Bermondsey¹⁷. Within five years, the number of new tuberculosis cases fell by 29% and deaths by 15%. Infant mortality also plummeted. In 1922, the death rate amongst infants under one year of age was more than one in ten children; by 1927, it had fallen by 30% despite continued poverty and overcrowding. Maternal mortality became one of the lowest in London. Other places sought to emulate Bermondsey’s many successes.

 

Pacifist

Perhaps more than most, Salter recognized the human cost of war and advocated passionately against both World Wars. Amidst the social upheaval and emotional turmoil unmasked during World War One, he remained unapologetically outspoken, even in the face of reactionary backlash and vitriol from his own community. Salter campaigned determinedly to save the peace in the lead-up to World War Two and stave off what he viewed as the moral deterioration and evils associated with war. Bermondsey was heavily bombed and ravaged by fire during the Second World War, suffering great loss of life and damage to its infrastructure, much as Salter had predicted fourteen years earlier¹⁸.

 

The Salters’ legacy

After a lifelong career working tirelessly for his patients, constituents, and community, Salter died on August 24, 1945, at Guy’s Hospital, three years after Ada’s passing. At the end of his journey, he did not regret his sacrifices.

In November 2014, Southwark Council announced that it had raised the full amount needed to replace the stolen statue of Salter and also add the first-ever statue of Ada, along with security measures to ensure that the statues were not stolen again¹⁹. Together with the statues of Joyce and her cat, the four sculptures tell a truly human story, one of courageous integrity, passionate idealism, dedication to social justice, and commitment to improving the health of the community.

 

References

1. Brockway F. (1949). Bermondsey story: the life of Alfred Salter (p. 4).London: George Allen and Unwin.
2. Ibid., p. 6.
3. Dickens C. (1837). Oliver Twist. Chapter L.
4. Brown M. (2006). Making sense of modernity’s maladies: health and disease in the Industrial Revolution. Endeavor, 30(3), 108-112.
5. Dormandy T. (1999). The white death: a history of tuberculosis. London and Rio Grande: The Hambledon Press.
6. Ibid., Brockway, p. 24.
7. Ibid., pp. 19-20.
8. Stewart J. (1997). For a Healthy London: The Socialist Medical Association and the London County Council in the 1930s. Medical History, 42, 417-436.
9. Ibid., Brockway, p. 51.
10. Ibid., pp.43-45.
11. Ibid., p. 100.
12. Ibid., p. 89.
13. Ibid., pp. 170-171.
14. Pharkins. (2012, February 24). Here Comes Good Health! Retrieved from Wellcome Library website: http://blog.wellcomelibrary.org/2012/02/here-comes-good-health/
15. Ibid., Dormandy, p. 157.
16. Ibid., Brockway, pp. 96-100.
17. Ibid., pp. 100-102, 169.
18. Ibid., p. 137.
19. Southwark Council Latest News. (2014, November 25).  Long awaited Alfred Salter statue set to be unveiled in Bermondsey. Retrieved from http://www.southwark.gov.uk/news/article/1851/long_awaited_alfred_salter_statue_set_to_be_unveiled_in_bermondsey

 

---

 

ROSEANNE F. ZHAO, PhD, received her PhD in immunology and cell biology jointly between the National Institutes of Health (NIH) and the University of Cambridge, UK, where she was a NIH-Cambridge Biomedical Sciences Scholar. She is currently completing her medical training in the MD-PhD Program at the University of Chicago Pritzker School of Medicine.

ROY N. ZHAO is graduating from the University of Chicago, a prospective MD-PhD student.

 

Spring 2015  |  Sections  |  Physicians of Note