19th Century Britain - Public Health

Britain in the 19^th Century

What were the main public health problems of the mid-19^th century and how successful were the attempts to solve them?

Britain has come on an impressively long way since the 19^th century in relation to public health. The society with live in in this day is an absolute luxury compared to what the people of the 19^th century had to endure. The industrial revolution of Britain was an incredible time of history that benefited British society, and is without a doubt one of the most important periods of time regarding socialisation as it is today. However, the industrialisation of Britain did not run completely smoothly, and there were many problems and obstacles that occurred throughout that time. One of those being the impact it had on public health.

Due to the industrialisation of Britain, a rapid growth of the population occurred. Major cities, such as Liverpool and Manchester doubled in size during the 1820s, with both cities growing by at least forty six percent.  (Nevell, 2011) Thousands upon thousands of people moved to small market towns and cathedral cities. The Irish famine of 1845 and 1852 contributed to a gigantic increase of immigration from the Irish into Britain, which caused population to sour even more. For example, Liverpool’s parish of West Derby saw a population rise of 140,000 people, during 1801 to 1851 alone. This massive rise of people in small, urban areas undoubtedly caused many problems that many people were not prepared to see happen, such as diseases, death and smell. (Rees, 2001)

Overcrowding became normality for most urban areas. Singled roomed buildings could house over ten grown men at a time, who all had to endure extremely cramped and filthy conditions. Large houses were bought out and divided into as many small living spaces as possible by landlords and builders out for a fast profit. Grown men were literally squeezed into the tightest of spaces possible, such as the cellars and attics. A report by the Bradford Woolcombers Protective Society in 1845 describes the overcrowding circumstances:

“A great many Woolcombers reside in this court. It is a perfect nuisance. There are a number of cellars in it utterly unfit for human dwellings. No drainage whatever. The visitors (those compiling the report) cannot find words to express their horror of the filth, stench and misery which abounds in this locality, and were unable to bear the overpowering effluvia which emanates from a common sewer which runs from the Unitarian Chapel beneath the houses.” (Rees, 2001)

This quote from the report is an effective way of showing us an insight into the horrific conditions the working class had to endure. Due to the copious amount of people living together, these buildings, nicknamed ‘rookeries’, became an unimaginable breeding ground for lice and, what the Victorians named, ‘filth diseases.’

Although the overcrowding was incredibly uncomfortable and dirty for the people, it was the poor sanitations of the buildings and the lack of services to the houses that caused diabolical problems. During the first half of the nineteenth century, most working class houses lacked clean water supplies, sewages and drains. The privies, or toilets as we would call them now, were usually situated outside in courtyards and alleyways, with many people using it throughout the day. The waste was then emptied into cesspits.

Although the working class were stuck using filthy shared privies outside, some more wealthy families and the middle class had the luxury of their own private and flushing privies. However, the waste was still flushed into their cellars or closed sewers and had to be physically emptied, thus still contributing towards the cesspits. In large, heavily populated areas of the cities, sewage heaps built up to 35,000 tonnes in the middle of the areas, which as you can imagine, caused extremely dirty conditions and unpleasant smells. (Pedley, 2001)

The poor and working classes were hit harder with the conditions. Industrial workers had to move close to the factories and mills that they were working in, due to an absence of affordable public transport. The poorer areas had to make do with a significant lack of water and poorer conditions because of that, as it was extremely expensive (it’s supply provided by private water companies after a big profit) and used for important and practical parts of home life such as drinking, cooking and washing.  As a result of that, they had to suffer with the only available water being from public standpipes. People would queue for hours with their saucepans and buckets in the hope of stocking up with as much water as they could afford once the water supply was switched on by the water company. The unfortunate people who were just far too poor to afford the water charges would either take what they could from local streams and wells or just simply did not bother. The middle classes were able to move away from the dirty cities, beyond the pollution, and were also able to afford piped water pumped straight to their houses in which they could store huge quantities of the water in cisterns.

The great plague epidemic of 1665-6 was undoubtedly a horrific break out, however it was the last major disease attack on Britain until the public health diseases and illnesses broke out. Typhoid, diphtheria, tuberculosis, scarlet fever, measles and influenza were common, serious illnesses that caused vast problems and devastation across Britain. (Macraild, 2003) Smallpox was a serious issue in 1837-40, causing over 12,000 people to die in 1840 alone, and left many people petrified of a recurrence of the disease. Diarrhoea was common, and poor living conditions and hygiene caused body lice to attach on to people, which spread typhus fever and caused 10,000 deaths in 1847 in just north-west England alone. (Rees, 2001)

One of the most prolific diseases that effected the population of Britain was cholera. An epidemic outbreak of cholera broke out in Sunderland in October 1831 and spread across the whole country, causing 32,000 fatalities. Following such a distressing time, yet another outbreak attacked Britain in 1849, this time claiming the lives of 53,000, a dramatic increase from the previous epidemic. Cholera, nicknamed ‘King Cholera,’ also struck Britain a further two times. Although the main causes of cholera was not known, it was assumed poor sanitary conditions were a problematic cause of the disease. (Pedley, 2001)

The most common theory for explaining disease during that time was the miasmatic theory. This theory included that diseases and illnesses were spread through bad air, which surfaced from decayed organic matter. Dr. William Farr, who was a firm believer in the miasmatic theory and was an employee at the government’s General Register Office, proclaimed that soil at low elevations, such as near the Thames riverbank, contained organic matter that produced a lot of mismata, thus resulting in a rising amount of bad air circulating London.

The miasmatic theory was conflicted by physician John Snow. He didn’t believe that cholera was spread by bad air, instead insisting that it was spread by germs, which entered through the body via the mouth. His evidence which caused him to believe the theory was that he had treated many patients with cholera yet failed to catch the poisonous disease himself. He published his theories in ‘On The Mode Of Communication Of Cholera,’ an essay from 1849, and included this extract:

“It used to be generally assumed, that if cholera were a catching or communicable disease, it must spread by effluvia given off from the patient into the surrounding air, and inhaled by others into the lungs.  This assumption led to very conflicting opinions respecting the disease.  A little reflection shows, however, that we have no right thus to limit the way in which a disease may be propagated, for the communicable diseases of which we have a correct knowledge spread in very different manners.  The itch, and certain other diseases of the skin, are propagated in one way; syphilis, in another way; and intestinal worms in a third way, quite distinct from either of the others.” (Snow, 1855)

The head medical officer of London, Dr. John Simon, clearly understood John Snow’s theory. He wrote a summary of the idea, stating “(Epidemiology, 2014)However, Dr. Simon was reported as claiming the theory as ‘peculiar’ and continued to question the relevance of germs to the cholera outbreak like many others. John Snow then proceeded to try and prove his theory, by tracing the cause back to a particular water pump, situated on Broad Street. In addition, he also noted that the workers of the local brewery to the street never drank the water, only beer, and hadn’t ever caught cholera, as well as a local widow, who had the water from Broad Street pump delivered to her home, whom died of cholera yet her neighbours did not. Dr. Simon also conducted his own research. He carried out a study of 500,000 south Londoners in 1856. He compared two different water companies, Lambeth Water Company and Southwark Water Company, and the death toll of their customers. Lambeth Water Company took water from a place called Ditton, which is further up the river from London, and their death rate during the 1854 epidemic was 37 per 1000 people.  Southwark Water Company, however, took their water from a place in Battersea close to an outflowing sewer, and their death rate was 130 per 1000 customers. (Rees, 2001)

Despite John Snow’s correct and accurate findings of the causes of cholera, and Dr. Simon’s curiosity in the theory, the idea that cholera was spread by germs was still disputed by other professionals, due to the miasmatic theory still reigning as the leading belief of cholera. It was not until 1870 that John Snow’s findings were considered accurate, which, unfortunately, was 8 years after his death.

One of the important reforms to help tackle the issue with the diverse problems of Britain’s public health was the 1948 Public Health Act. Edwin Chadwick played an important part in the act, who was previously one of the main contributors towards the 1834 Poor Law. The Poor Law was created as a means to encourage people to work hard, take homelessness and beggars off the streets and inevitably reduce the money lost whilst looking after the poor. The poor were put into workhouses, and worked for the benefits of being clothed, fed, housed and educated, all within the workhouses. Conditions in the workhouses were purposely tough to try and deter as many people from relying on the government for a means of living, and only attracting the most desperate.

In 1838, due to a further two episodes of typhoid epidemics, Edwin Chadwick, as secretary of the Poor Law Act, was appointed to start an enquiry into the sanitation of the cities by the Poor Law commissioners. He published a report, ‘The Sanitary Conditions of the Labouring Population,’ which focused on an urgency to improve the living conditions of the working class for the sake of their efficiency to work. He stated that improvements to public health would benefit the economy and society, as more people would be able to work sufficiently. Chadwick was known to be quite difficult to work with, due to his harsh and humourless personality. He was extremely assertive, making enemies both in and out of parliament with his forceful nature. Chadwick was a strict individual who would settle for nothing but what he deemed appropriate.

Chadwick’s findings from his report were at first ignored, but in 1848 the Whig Home Secretary Lord Morpeth introduced the Public Health Act of 1848. This introduced a regular management of sewers, drains and slaughterhouses, sewerage systems, public baths and burial grounds, the ability of local authorities to set up local boards of health, A General Board of Health which regularly reported to parliament and an opportunity for local boards of health to levy local rates and buy land to finance projects.

There were both strengths and weaknesses to the Public Health Act, due to it being permissive. There was barely any opposition to it, as it was only applied in areas that the local people requested, areas in which people were suffering from poverty and piecemeal implementation meant that those who were in doubt of the act’s liability could view its positive effects on their own towns. However, the act didn’t apply to Scotland, London city or it’s City Sewers Act, nor could it apply to any town that had less than 23 per 1000 death rate.

The Public Health Act of 1848 inevitably didn’t start off too well, as a second cholera epidemic hit Britain almost immediately after it was started. Although, once the outbreak calmed down the General Board of Health was able to prioritise and focus their attention to it. By 1853, there were 284 towns who petitioned for new public health regulations to be applied, and in 182 of these towns the Act was carried out. That was considered a positive impact of the act. The Act, however, was not a complete success. Only 400,000 people out of 2.5 million in Lancashire were protected by an act from the public health board. Only 29 major towns in England and Wales had power over draining and cleansing and 62 had no public health authority at all. (Rees, 2001)

Public health in Britain generally didn’t have a significant improvement that would majorly impact society until the summer of 1858, in which an overbearing and nauseating smell emulated from the River Thames due to a particularly scorching hot season of weather. It was prolifically known as ‘The Great Stink.’ The increasing population of London played heavy on the Thames water, with all people and factories using it as a means to dump waste and as a clean water source. The issue of cleanliness with the Thames was first noticed in the 1600s, but due to a lack of knowledge on how to solve the problem, it was continued to be used in such extreme ways. By the 19^th century, the river had been abused for far too long, with added pressure due to the new flushing toilet systems. Such copious amounts of pollution and waste had accumulated in the river that it was known to be the filthiest river in the world, with the waste literally cooking in the heat of the summer.

The members of parliament found the stench equally revolting as the ordinary citizens, but at first tried to improvise ways to improve the situation, as opposed to completely fleeing the building. They doused curtains surrounding the building in chloride and lime, which ultimately didn’t make a difference. They considered moving the government from the Westminster area, yet this idea was quickly dismissed. After a while, with no significant improvements, members of parliament were reportedly seen fleeing the building as fast as possible, with handkerchiefs held up to their noses, whilst shouting and complaining loudly about the dire stench the river was omitting. (Lemon, 2014)

The Great Stink was finally proving to be too vulgar for the important members of government, who then finally decided that the time had arrived to change the situation. They also realised that by moving from the houses of Parliament to a different location, the situation would continue to worsen and affect the normal members of society. Also, an English chemist named Michael Faraday was incredibly vocal about his support of a Thames reform. He created intense pressure on the government, by sending a letter to The Times newspaper entitled, ‘Observations on the Filth of the Thames,’ which included his findings of throwing pieces of paper into the river, which disappeared almost immediately in the ‘pale brown fluid.’ He also stated that, ‘if we neglect this subject, we cannot expect to do so with impunity; nor ought we to be surprised if, ere many years are over, a hot season give us sad proof of the folly of our carelessness.’ (Lemon, 2014)

A bill was created, and a reformation of the Thames went underway. The Metropolitan Board of Works was given £3 million in the desperate hope that they could sort out the issue. Chief engineer, Joseph Bazalgette, was selected to tackle the task. He proceeded to design and construct a productive sewer system, which consisted of five giant sewers that measured 82 miles, and could handle 400 million gallons of waste. Two were situated in the south of the river, and a further three were built in the north of the river, which all connected with existing pumps and sewers that kept the flow of sewage productively going. The construction of this sewer system was highly significant, making it the biggest civil engineering project in the world currently at that time, and was completed in 1870. The size and shape of the sewers changed the shape of the River Thames, which shows the considerable job carried out by Bazalgette, and the previous water gates can still be seen, situated at their original points in the river. In addition, embankments were also created alongside the river as an additional way of helping the problem.

Analysing the incredible struggles the public of 19^th century Britain had to endure regarding health, hygiene, sanitation, disease and death is a fascinating way of realising how far we have come as a society. The laws and regulations we have now for health and safety seem like a basic human right, but after learning our history you can see it was an ongoing battle for those people, and something we should never take for granted. The city of London and the River Thames is full of underlying history that is fascinating, and we should always remember how far and productive we have become as a society.

Sources

Epidemiology, D. o. (2014, March 9th). Competing theories of cholera. Retrieved from UCLA, department of epidemiology: http://www.ph.ucla.edu/epi/snow/choleratheories.html

Lemon, J. (2014, March 9th). The Great Stink. Retrieved from Cholera And The Thames: http://www.choleraandthethames.co.uk/cholera-in-london/the-great-stink/

Macraild, J. B. (2003). Nineteenth-Century Britain. London: Palgrave MacMillan.

Nevell, D. M. (2011). Living in the Industrial City. International Journal for Historical Archaeology , 2.

Pedley, M. C. (2001). Britain 1815-51: Protest and Reform. Heinemann.

Rees, R. (2001). Poverty and Public Health 1815 -1948. London: Heinemann Educational Publishers.

Snow, J. (1855). On the Mode of Communication of Cholera. On the Mode of Communication of Cholera, 3. Retrieved from http://www.ph.ucla.edu/epi/snow/snowbook_a1.html.