A half century later: recollections of the London fog. (Guest Editorials).

It is important to recognize that all environmental events occur in some specific context, and this was particularly true of the 1952 London Disaster. During World War II London suffered 30,000 civilian casualties in the bombardments from the air, first from aircraft, then from flying bombs, and finally from the V2 missiles. Famed for fogs since the days of Charles Dickens, people largely took London's fogs for granted.

When I arrived at Bart's Hospital on 10 December 1952, everything was normal for that time of year. Our wards at that time of year always had a number of cases of advanced chronic obstructive pulmonary disease, many in outright heart failure. A recent BBC documentary, "The Great Fog" (first shown 28 September 1999), recalled a coroner at the time remarking that the morgues were full. For those of us directly working in the hospitals, the elevated mortality was not widely realized.

By the mid-twentieth century, the population included a high number of people at high risk from lung disease, like those in our emphysema clinic. Cigarette smoking in men was nearly universal and had risen greatly during the stress of war. This must have contributed to the high mortality, which rose immediately during this episode, when many of the victims died very quickly. We knew why the fog affected smokers so drastically: Because ventilation distribution within the lungs of a smoker was usually seriously impaired, high exposure to polluted air could induce acute bronchiolitis that might quickly be fatal.

The media expressed public outrage at the attitude (largely inertia) of the government during the weeks after the event, and Harold MacMillan, Minister of Housing, finally agreed to appoint a committee to advise on the question. He told his cabinet colleagues that it was very unlikely that anything useful would come of this, but it might assuage the public concern ("The Great Fog"). The questions asked in the House of Commons and the discussions there show how little interest there was in identifying the harmful constituents present in the fog (see Hansard, United Kingdom Parliament).

We have only recently learned that Britain's economic situation in 1952 was extremely tenuous; for this reason, low-quality, high-sulfur coal was being burned in London to permit the export of the more valuable low-residue, low-sulfur coal. Thus, the economic situation contributed indirectly to the degree of pollution.

The medical profession did not take a leading role in the quest for cleaner air. When I worked as a clinical assistant at the Brompton Hospital in 1953, we had a printed sheet to give to new asthma patients, which advised that if the patient woke up at night with an attack, he or she should get out of bed, open the bedroom window, and take large breaths of the night air. It did not say that the next thing the patient should do was to call for an ambulance. It was not until 1980 that we knew that asthmatics were especially sensitive to sulfur dioxide.

Contrary to MacMillan's expectations that nothing would happen, the committee process he began led to clean air legislation in many different countries. Although both Pittsburgh, Pennsylvania, and St. Louis, Missouri, had passed city ordinances against air pollution from coal smoke before 1952, it was the London disaster that compelled governments to act. This is why the London Disaster of 1952 should be commemorated; the many efforts to limit ambient air pollution that have occurred in the past 50 years are the proper memorial to those who were its unheralded victims.

David V. Bates
Professor and Dean Emeritus
University of British Vancouver, School of Medicine
Vancouver, British Columbia, Canada
E-mail: [e-mail]

David Bates worked at St. Bartholomew's Hospital in London (1948-1956) and at McGill University in Montreal (1956-1972). He was the Dean of the Faculty of Medicine at the University of British Columbia from 1972 to 1977; he retired in 1987. He is a Fellow of the Royal Society of Canada, and received the Trudeau Gold medal from the American Thoracic Society in 1993.