Tuesday, 24 January 2017

Public health

Sir Edwin Chadwick (1800-90)
Public Domain

Dirt and disease

It was in the 1830s and 1840s that the links between dirt and disease were conclusively established, though ignorance of bacteriology meant that the reasons for the link remained unknown. Dr James Kay (later Sir James Kay-Shuttleworth) established that typhus was a major killer in areas of poor hygiene.

Knowledge about the state of towns was greatly enhanced by the establishment of the civic registration of births, marriages and deaths in 1837. The first Registrar-General was a London doctor, William Farr, and one of his earliest decisions was to require doctors to cite cause of death. In 1838 Farr published a table of deaths which showed that deaths from fevers, smallpox, consumption, pneumonia stood at 8-9 per thousand in the rural counties while in Lancashire and Middlesex they were 18 and 29 respectively.

Public health legislation was the biggest breach in the dyke of laissez-faire ideology. The state had to have a role.

In 1831 Britain was in the grip of a cholera epidemic, which entered Sunderland from the Baltic. Between 1832 and 1846 only two pieces of central legislation were passed on specific aspects of public health:
  1. The Cholera Act (1832) enabled the Privy Council to make orders for the prevention of cholera provided that any expense incurred should be defrayed out of money raised for the relief of the poor by the parishes and townships. Powers lapsed at the end of 1834.
  2. The Vaccination Act (1840) made inoculation illegal and provided vaccination free of charge on the poor rates.
In 1842 Chadwick, now converted to state intervention, published his famous Report on the Sanitary Conditions of the Labouring Classes. His findings were confirmed by two reports in 1844 and 1845 published by the Health of Towns Commission. These led to the growth of a new type of social science based on epidemiology and to a new interest in public health. Chadwick wrongly held to the miasma theory that was widely held before the development of the science of bacteriology. Like most of his contemporaries, he believed that disease was due to
‘pollution of the air by the retention of ordures and refuse’
However he was right to stress the importance of hygiene and to lay down detailed plans for sewers.

Huge difficulties still lay in the way of an integrated plan for public health. The most important of these was localism– the belief that central intervention was a form of dictatorship.

A second problem was the proliferation of contending agencies for refuge collection, water supply, drainage &c, many of which remained in private hands.

The third problem was the reluctance of middle-class ratepayers to pay for services.

The Public Health Act of 1848 established a General Board of Health to furnish guidance and aid in sanitary matters to local authorities, whose earlier efforts had been impeded by lack of a central authority. The board had authority to establish local boards of health and to investigate sanitary conditions in particular districts.

Two Victorian heroes

'John Snow',  Licensed under CC BY 4.0 v
ia Wikimedia Commons
For the physician John Snow's discovery of the link between cholera and polluted water see here. Snow  has been hailed as the founding father of epidemiology.

There is a fascinating discussion on the discovery of the cholera bacillus here. The discovery was a European, not a purely British, achievement.

The 'Great Stink' of 1858 was a sign of how polluted the Thames had become. For Joseph Bazalgette's work in constructing sewers see here and here. Bazalgette and Snow have to be ranked among the greatest benefactors of humanity. They are heroes who deserve to be better known.
The Octagon, Crossness Pumping Station
Licensed under Creative Commons


  1. The state gradually became more interventionist and took on new responsibilities to regulate work conditions and lay down the rules for public health.
  2. However, many of the new measures were piecemeal. Most workers were not protected by legislation and vested interests stood in the way of a systematic reform of public health.

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