Progress in the Mid-19th Century: Nightingale, Chadwick, Snow and Simpson » Chadwick and the Public Health Act of 1848

Life in the industrial towns

In the early 19th century Britain's towns grew very fast, because people moved to work in the new factories. By 1851 more than half the population lived in towns. Builders put up cheap housing as quickly as they could, and nobody planned how the towns would cope. Three problems made towns dangerous places for the poor.

Deadly diseases such as typhoid and cholera spread easily in these conditions. At this time people did not know that germs caused disease. The usual belief was in miasma, the idea that disease was spread by bad smells from rotting matter. The filth was real, but the smell was not the cause.

Key terms:

• Public health: the health of the whole community, and the actions taken to protect it, such as clean water and sewers.
• Cesspit: a pit in the ground where human waste was collected.
• Sewer: an underground pipe that carries waste away.
• Board of Health: a group of officials in charge of public health. The 1848 Act set up one for the whole country (the General Board) and allowed towns to set up their own (local boards).
• Medical officer of health: a doctor appointed by a town to look after its public health.

Edwin Chadwick and the 1842 report

Edwin Chadwick was a lawyer who worked for the government on the Poor Law. He saw that when workers fell sick and died, their families could not support themselves, and the town then had to pay for their poor relief. Chadwick argued that preventing disease would be cheaper than paying for its results.

In 1842 he published his report on the sanitary condition of the labouring population of Great Britain. It was based on evidence collected from towns across the country. It made three main points:

• People in poor, dirty districts died much younger. In the report's figures for Manchester, the average age of death for professional people was about 38, but for labourers it was only about 17.
• Disease was caused by filth. Chadwick believed in miasma, so he blamed the smells from rotting rubbish and waste.
• The cure was to clean up the towns, which he called the 'sanitary idea'. He wanted piped fresh water, sewers to wash waste away, and regular removal of rubbish. All of it should be run by officials who were paid to do the job.

Chadwick was wrong about miasma, but his plan to clean up towns would still have cut disease. The report also did something new: it used facts and figures to show that dirt, poverty and early death were linked, and it made many people in power face the problem.

The Public Health Act (1848)

Chadwick's report did not bring action at once. Many people still believed in laissez-faire, and clean water and sewers would cost money. Then, in 1848, news spread that a new cholera epidemic was moving across Europe towards Britain. Fear of the disease helped push Parliament to act, and it passed the Public Health Act in 1848. The Act:

• set up a General Board of Health in London, with Chadwick as one of its three members;
• allowed a local board of health to be set up in any town where the death rate was above 23 deaths per 1,000 people, or where one tenth of the ratepayers asked for one;
• gave local boards the power to improve water supplies, sewers, rubbish removal and burial grounds, and to appoint a medical officer of health.

Why the Act achieved little

The Act was a start, because for the first time the government accepted some responsibility for public health. But it did not change much. The main reasons were:

There was also a third problem. Nobody yet knew the real cause of disease, so even the improvements that were made did not target it. Chadwick himself made enemies by trying to force changes through, and in 1854 he lost his post, and the General Board was abolished a few years later, in 1858.

Change and continuity

What changed: the government now accepted that it had some part to play in public health, and a law existed that allowed towns to clean up.

What stayed the same: most towns stayed dirty, because the Act was voluntary and many towns did little. Nobody understood the real causes of disease, and laissez-faire attitudes remained strong. Stronger action had to wait until the Public Health Act of 1875.

Exam-style question

Explain TWO causes of the limited success of the Public Health Act (1848). [8 marks]