Health and Social Conditions: The Case of John Hudson

A central tenet of syndemic theory is that diseases do not exist in a social vacuum nor solely within the bodies of those they inflict, and thus their transmission and impact is never merely a biological process. Ultimately, social factors, like poverty, racism, sexism, ostracism, and structural violence may be of far greater importance in the extent of disease spread and the toll taken in human well-being than the nature of pathogens or the bodily systems they infect. As a result of such factors and the resulting interactions among pathogens or other health conditions, the total burden of disease is far greater among those subjected to structural disadvantage compared to populations that are not so encumbered resulting in significant disparities in both social suffering and years of life lost.

These points are illustrated in an important historic epidemiological case. In his speech before the Policy Interpretation Network on Children’s Health held in Amsterdam in 2003, Peter Van den Hazel, an environmental health physician, called attention to this case through his account of the life of John Hudson, a nine year old boy living in London during the 1780s. Illiterate and orphaned, John avoided starvation by working as a chimney sweep. At the time, unskilled child laborers like John had a life expectancy of about 19 years, with a multiplicity of diseases and other health conditions, including malnutrition, exposure to the elements, overwork, and mistreatment, claiming the lives of the children of the urban poor. As a sweep, John’s job was to crawl up into a chimney and scrape the layers of heavy black soot from the inside walls, replace any mortar that became dislodged, and fix cracks in the brickwork. Like other sweeps, his hands and face were badly lacerated from the sharp corners of the brick. Moreover, sweeps regularly would become trapped in the narrower flues or fall to their deaths. In addition, sweeps suffered heavily from a variety of occupational hazards, including asthma, inflammation of the eyes, malformed spines and legs, and tuberculosis, and many suffocated to death. In no small part, such diseases were a byproduct of the most profitable segment of a mastersweep’s business, extinguishing flue fires. To put out such fires, young sweeps like John would be ordered to climb up a chimney until they reached and could put out the fire. Additionally, in 1776 Percival Pott, a London physician, reported on the high incidence of scrotal cancer in young chimney sweeps, one of the first published cases linking socioeconomic status and occupational and environmental health, and, from the perspective syndemics theory, one of the first accounts of an occupational syndemic.

Of note, against all odds, John did not fall victim to the usual causes of death among sweeps. Rather, in October 1783, he was caught breaking into a London home with several friends and stealing some items of clothing and a gun. He only avoided a death sentence because he was charged with breaking and entering rather than burglary. He was sent to the infamous Newgate Prison, then transferred to a prison ship and sent to Australia, along with 50 other children and a number of convicts. He arrived in Australia at age 13. The last official record of John is an Australian government report indicating he received 50 lashes for being outside his prison hut at nine o’clock, a sad but appropriate ending for a story on the social origins of ill health and social suffering.