where he often saw damaged lungs, and the publication of Edwin Chadwick's The Sanitary Condition of the Labouring Population in 1842 caused Leigh to take an interest in public health. From the 1840s, he proposed that the high incidence of respiratory disease in Manchester, compared to other areas of England, was due to the city's poor air quality and that this was largely attributable to the extensive use of coal as fuel in what was the first industrial city. Charles James Napier had described Manchester as "the chimney of the world" in 1839 and a near-contemporary study of deaths in the city between 1840-42 blamed "diseases of the windpipe and chest" as the major causes, accounting for nearly 30 per cent of all fatalities and blaming the smoke-filled air in particular for poor health among children. Leigh believed that the level of harmful particulates in the air needed to be reduced and he also thought it necessary to ensure better-quality food and better ventilation of homes. The tendency of city officials throughout the century was to rely on the goodwill of manufacturers to achieve improvements in air quality rather than the blunt instrument of prosecution. Although Leigh did not subscribe to a commonly held belief that smoke from burning coal had purifying properties, he did generally appear to accept the popular miasma theory as an explanation for transmission of diseases. The theory was that bad smells from rotting organic matter, excrement and similar were the cause of transmission, rather than the microbes that found a breeding-ground in such an environment. While germ theory was gaining ground as an alternate proposition, Leigh did not mention it in any of his annual reports until 1887 and even on that occasion he qualified his support. Leigh's position was not uncommon: during the period that he was active in civic life, policy both nationally and locally was influenced more by the miasma theory than germ theory and so concentrated more on matters relating to sanitation than, say, immunisation. It was the era of the Health of Towns Association, the first local boards of health and the reformist bodies such as the Manchester and Salford Sanitary Association and the Manchester Statistical Society, although the city elders of Manchester - a "self-perpetuating inner circle of big merchants, manufacturers and landlords", according to Platt - had been reluctant to accept early government initiatives such as the 1848