Public Health in the Nineteenth Century: Why Did Central Government Accept Increasing, But Still Limited, Responsibility Between 1800 and 1875?

DURING the first half of the nineteenth century, the living conditions of the working classes in the British Isles were utterly appalling. Many primary sources dealing with the period in question highlight this disturbing fact beyond any doubt. Indeed, the inherent contradictions which occasionally permeate these documents seem to relate to the actual scale of misery involved, rather than to a disputation that such a problem existed in the first place.

The disposal of sewage and other waste had always been a problem amongst the urban population of these islands. Most people living in rural areas tended to bury their rubbish or dump it in isolated spots. However, this was just not feasible in an increasingly urbanised society and piles of decaying waste could regularly be seen in the streets and courtyards of the poorer areas, with their row-upon-row of back-to-back dwellings.

The supply of water was another serious hurdle during the early to middle nineteenth century, and many families were forced to share contaminated wells. The cholera epidemic of 1831, which had travelled westwards through Asia and across Europe until it first became manifest in Sunderland, had proved just how dangerous polluted water supplies could be. But, at the time, many leading doctors had wrongly diagnosed cholera as having been caused by atmospheric factors, rather than by liquid infection[1].

Several well-intentioned philanthropists made it their duty to expose these pitiful scenes of poverty and, as a result, a series of reports concerning the worsening conditions of the working peoples emerged from a variety of sources. As early as 1838 the Poor Law Commissioners published a report on the effect of epidemic diseases on the poor-rates of Bethnal Green and Whitechapel, in London[2]. Edwin Chadwick, a prominent campaigner for social justice and the general improvement of sanitary conditions within society as a whole, had gained several years of experience as Secretary to the Poor Law Commissions and this experience had contributed to his modified views on the causes of poverty[3]. The reasons behind the awful conditions of the time, according to Chadwick, were due to a lack of sanitation. This cannot be attributed to the fact that working class people were often considered filthy by nature, on the contrary, Chadwick realised that due to their extreme poverty these individuals were unable to afford the simple luxuries of cleanliness, and people were actually washing in and drinking from contaminated water supplies. In 1840, Edwin Chadwick had decided that enough was enough and set to work at his own request. By 1842 the Poor Law Commissioners finally published his report on the Sanitary Conditions of the Labouring Population of Great Britain. The report blamed atmospheric impurities produced by decomposing animal and vegetable substances, damp and filth, and close and overcrowded dwellings[4] for the spread of disease. Chadwick believed that the very lifestyle of the lower classes also contributed to the problem, and he paid special attention to their “habitual avidity for sensual gratifications”[5], which for the average Victorian appeared to suggest that there was a general lack of dignity and morality among such people.

Chadwick’s investigation into the causes of bad working conditions not only brought such problems to the ears of the more affluent members of society for the first time, it also stated the necessary measures which had to be undertaken in order to effectively improve the lives of the poor. These measures were far from simple, and included the implementation of adequate drainage and water systems. Chadwick also suggested that all refuse be removed from houses and streets to prevent further infestation and disease.

As Chadwick was compiling his report, several of his friends in the House of Commons were actively campaigning for a select committee to investigate health problems in the towns. Eventually Chadwick’s supporters were successful and a select committee was finally appointed, recommending a parliamentary act to regulate the construction of working dwellings. They also campaigned for a Sewerage Act, a Board of Health in every town to provide an adequate water supply, and the power to remove nuisances. In 1841, several bills found their way into Parliament and the committee sought to enforce these new regulations and several other amendments, such as restrictions on the building of houses too close together or streets that were considered to be too narrow. People were forced to live in close proximity to one another, due to the fact that they had to work extremely long hours and, therefore, needed to live as close as possible to their actual places of work. Chadwick soon realised that a major problem of overcrowding was bad ventilation, another indisputable cause of widespread disease and illness.

Unfortunately, before the relevant bills could become law there was a general election and a subsequent change in the political administration of the British Isles. In 1842 there were renewed attempts at social reform, but by this time a strong and growing opposition ensured that many of the proposed reforms were watered down and finally thrown out altogether. Such opposition had arisen since the scale of the changes being advocated were revealed by Chadwick’s report, and the economy was considered to be unable to withstand such a huge outpouring of funds. The committee’s plans were also thought to be fundamentally unworkable, due to the immense programme of intense physical construction that would have to be undertaken. Such construction would have included an attempt to build an underground sewage system beneath the crumbling houses and decaying streets, which, to give the government its due, would have meant demolishing whole areas and beginning from scratch. Not, of course, that the postponement of such plans should ever allow us to overlook the heartless greed of nineteenth-century Capitalism. Other problems included disputes between those private companies hoping to sell water and localised government which intended to provide free water for all. The committee protested at central government inaction and were eventually appeased by the promise of a new Government Health Bill. Predictably, however, the government was very reluctant to take on the responsibility itself and thus set up a Royal Commission on the Health of Towns instead. The committee issued a report in 1844, suggesting that the various aspects of public health should be in the hands of local administrators, although a government department should monitor the work of such administration. In other words, the government was keen to avoid centralisation and adopted the attitude that if enough people in each local area cared enough about the plight of its poorer citizens, then they would have to take action themselves. It is possible to make comparisons between the events of 1844 and the Poll Tax of 1991, when a similar situation resulted in the administration of the country’s centralised rating system being placed in the hands of local borough councils. National governments are rather fond of passing the buck and letting localised governments deal with both the implementation of centralised policies and the collection of taxes. However, by agreeing to oversee the local administrative procedures, the government of 1844 had buckled under pressure and was now on the slippery slope towards taking better and more effective action in the decades to follow.

Several years earlier there had been various other attempts to improve social conditions and among the pioneers of reform were the Improvement Commissions, set up by businessmen who had a vested interest in the health of their workforce. For the Capitalist entrepreneur, who was more concerned with making money than for the general wellbeing of the labouring classes, a healthy employee was the key to financial success and, therefore, was worth the investment. Another highly beneficial factor that helped to ensure that industry contributed to the raising of social standards, was that in order to make a profit it was necessary to attract customers, many of whom would be far more willing to visit a town with good sanitation than one which resembled a smelly, deprived cesspool of human misery and degradation. Although the Improvement Commissions had absolutely no control over housing, they did make a significant improvement to the lives of the poor. In Portsmouth, for example, the streets were kept extremely clean and in areas such as Manchester, the Improvement Commissions were responsible for policing, street lighting, piped water supplies and cleaning companies. But there was a catch. People had to pay for the services they received, and it was left up to local ratepayers to contribute to the basic funding of all such initiatives, although the Improvement Commissions themselves did provide the initial capital.

Other attempts to raise the standard of living included the Municipal Corporations Act of 1835, which was very similar to the Town Councils Act. In this case, local administrators could raise taxes to make ratepayers pay for services in their district. Unfortunately, however, this act was totally ineffective for the simple reason that Municipal Corporations did not have to be directly responsible or make any real effort to enforce bylaws. Once again, the government chose to relinquish all responsibility for the social welfare of the working classes and, as a result, very little changed.

The ineffectiveness of local control can best be demonstrated by taking one particular example. If the residents of a village were keen to prevent all forms of water pollution and made a strenuous effort to ensure that no waste found its way into their section of the river, their diligence will have been quite in vain if the residents of a nearby town were in the habit of dumping their own vast amounts of waste into the same river, so that it flowed downstream and fouled the water used by their neighbours. The blame, therefore, must lie with a government either too blind to recognise the obvious problems or too afraid to take responsibility lest it fail miserably and find itself seriously out of favour at the next general election.

In 1840 the government authorised Robert Peel to look into the matter of sanitation and poverty, with a commission being set up for this specific purpose. Peel was to eventually serialise his findings in what came to be known as the Blue Books. In 1845 some suggested that the Home Office act as a central health authority, but this caused quite a storm in Parliament and the Conservative government eventually fell to the Liberals before the issue could be resolved. But during this farcical charade of governmental inefficiency, the conditions of the working classes worsened considerably and among those campaigning for the rights of the workers at the time were famous writers such as Charles Dickens and the well-known columnist, Henry Mayhew, who catalogued the lives of the poor in the pages of The Morning Chronicle.

At last another compromise was agreed between the disparate factions and, as part of a solution offered to those people who argued that the Home Office was already far too overworked to deal with the problem (and others who believed that the Poor Law Commissioners had performed excellently in the past by forcing local authorities to function more efficiently), it was decided that a Central Board of Health be set up as soon as possible[6].

The real breakthrough came with the Public Health Act of 1848, which set up a Central Board of Health consisting of three members, one of whom was none other than Edwin Chadwick. Apart from the Central Board, there were Local Boards of Health which were given special powers and duties. These localised committees were similar in many respects to town councils, but there was a major difference between these and the old Municipal Corporations. Whilst the latter had no strict programme of implementation, the Boards of Health could actually be compelled to take action if, for example, the death rate for a particular district exceeded 23 in 1000 persons during the course of one year. Ratepayers could also petition their Local Board of Health and campaign for action, too, provided they constituted 1 in 10 of the local population.

The Central Board of Health, which lasted until 1854, was yet another failed attempt to improve the lives of the poor and were viewed with a deep distrust by most local health administrators[7]. Chadwick, in particular, was despised by many people for his overbearing attitude and lack of diplomacy. Beneath the prevailing influence of laissez-faire, Local Boards of Health were keen to retain their independence and the high hopes which many people had for the original concept were destined to come crashing down to earth with a bump. By placing final decisions in the hands of the Central Board, the government rendered the power of local authorities completely useless. Indeed, Local Boards of Health were even restricted from carrying out any supervision and inspection duties in their own areas, so the entire scheme was purely superficial. The government had succeeded in making local authorities responsible for decisions made by the centre.

As the Central Board of Health became more and more unpopular, Chadwick was removed from the committee and it was handed over to the Home Office and put under the control of a president, Sir Benjamin Hall. This arrangement was more acceptable to the local authorities and during the next fifteen years sanitation began to improve tremendously. The appointment of Sir John Simon as medical officer to the Board of Health was a major contributing factor and things seemed to be progressing steadily at long last, with additional acts of Parliament being passed to ensure that adequate sewerage and drainage systems were installed in many towns up and down the country.

In 1871 the Central Board of Health was finally replaced by the Local Government Board, laying the foundations for the administrative mechanism of public health in the twentieth century. A year later, in 1872, a new Public Health Act passed full responsibility for rural sanitation over to Boards of Guardians. And then, in 1875, the British Isles saw the emergence of the Disraeli Public Health Act. The 1875 Act led to the transference of power from central to local government, even in the urban areas. Local authorities had to pay for all services, with the taxes now drawn from local ratepayers. Also included among the new responsibilities of local government, were the construction and maintenance of amenities – such as parks and public houses – and even special hospital isolation units for patients suffering from infectious fevers and small-pox[8].

It has been clearly demonstrated that the government was keen to avoid taking action itself as far as public health was concerned. The fact that it was gradually forced to take some action, I believe, has more to do with its electoral status than with a genuine concern for social justice. Once the Westminster government realised that it was a disaster to attempt to restrict the powers of local government, it had to capitulate if real progress was to be made. In other words, the government had to relinquish central control and let the Local Government Boards determine precisely how money extracted from local ratepayers was to be allocated. Whilst the government was trying to retain overall power, it eventually realised that it was in its own best interests to admit defeat. The government’s stubborn refusal to decentralise proved to be the last remaining obstacle to national stability and social order.


1. Roy Porter; Independent Colour Supplement, 8th June, 1991.

2. Milton Briggs & Percy Jordan; Economic History of England (University Tutorial Press, 1967), p. 686.

3. Ibid.

4. Report from the Poor Law Commissioners of an enquiry into the Sanitary Conditions of the Labouring Population of Great Britain, 1842.

5. Ibid.

6. Briggs & Jordan, op. cit., p. 687.

7. Ibid.

8. Ibid., p. 689.

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