ian morley. city chaos, contagion, chadwick, and social justice

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YALE JOURNAL OF BIOLOGYAND MEDICINE 80 (2007), pp.61-72.Copyright © 2007.

ARTS & HUMANITIES

City Chaos, Contagion, Chadwick,and Social Justice

Ian Morley

Department of History, Chinese University of Hong Kong

In 1842, a civil servant, Edwin Chad-wick, published at his own expense The Re-port from the Poor Law Commissioners onan Inquiry into the Sanitary Conditions ofthe Laboring Population of Great Britain,which outlined in detail the wretched socialand environmental conditions within theworld’s first industrial society. The Chad-wick Report, the first such national investi-gation of its kind, highlighted a number ofnow widely accepted phenomena concern-ing economic development, urbanizationand health within industrial settlements.For its time, the report was a monumentalstep toward accepting and then dealingwith the social costs of economic progress.In short, the Chadwick Report establishedthat material progress did not equate interalia to a universal improvement in urbanhealth. Instead, it revealed howmodern cir-cumstances had the ability to establish ahealth schism between social groups. Sowith such a backdrop in mind, this articleassesses the role of Edwin Chadwick andhis 1842 sanitary report in the lead-in to thePublic Health Act (1848), a legislative at-tempt to bestow social and health equity inBritain, and examines the wider social andmedical context within which the world’s

first modern system of public healthemerged. Demonstrating how the sanitarymovement was formed and how miasmicmedical notions influenced the form of the1848Act, this paper will appraise a varietyof factors that helped shape the evolutionof epidemiology within what was theworld’s first industrial and urban society inthe 1830s and 1840s, including the realiza-tion that societal advancement did not cre-ate health benefits for all.

BACKGROUND

At the end of the 18th century, whenthe initial stages of industrialization wereunder way, the British population was esti-mated to be less than 10 million people, ofwhich about 30 percent of the populaceresided in urban communities. By 1841 [1],immediately before Edwin Chadwick pub-lished his Report from the Poor Law Com-missioners on an Inquiry into the SanitaryConditions of the Laboring Population ofGreat Britain (hereafter known as theChadwick Report), the quantity of urbandwellers was approaching 50 percent of thenation’s population total, and a number ofbroad developments had been noted aboutthe size, appearance, density, heterogeneity,

To whom all correspondence should be addressed: Ian Morley, Department of History, Chi-nese University of Hong Kong, Shatin NT, Hong Kong SAR; Tele:+852-2609-7116; E-mail:[email protected].

Figure 1. George Cruikshank’s 1829 cartoon London Going Out of Town or The March ofBricks and Mortar! depicted the city’s outward expansion.

Morley: City chaos, contagion, Chadwick, and social justice62

and complexity of urban places. These ob-served changes included the appearance ofsometimes monumental factories, the con-struction of grand town halls, and hithertoopen areas at the urban fringe being replacedby multitudes of high density back-to-backterraces [2].Although this phenomenon wasnationally observable, the tendency to eataway fields was most pronounced at London(see Figure 1), along with provincial placeslike Birmingham, Glasgow, Leeds, Liver-pool, Manchester, and Bradford, a settle-ment described as being “one of those townswhich have practically grown up during themodern manufacturing era” [3].

While numerous people were in awe ofthe transformations instigated by the Indus-trial Revolution, some members of society,particularly writers and medical practition-ers, questioned what effects the industrialage was having upon the public. Not onlywere “diseases of civilization” such as tu-berculosis noted as having a much morewidespread incidence than in previoustimes, the growth of “localities of pauperi-sation” [4], that is, quarters deficient in hy-giene yet filled with slums andmanifestations of poverty, drew aghast de-pictions of contemporary working class lifeand produced disquiet among medical pro-

fessionals like James Kay-Shuttleworth, aManchester physician, and Robert Baker, asurgeon in Leeds, about the well-being ofurban citizens. Likewise, other grave uncer-tainties had arisen. Crime, for example, wasperceived to have increased, as had prosti-tution, levels of drinking, destitution, andovercrowding. Accordingly, a new depth ofconcern was manufactured about the natureof British cities, the direction society washeading, and the potential volatility of theindustrial age. As Robert Vaughan assertedin The Age of Great Cities: “If any nation isto be lost or saved by the character of itsgreat cities, our own is that nation” [5].

As previously noted, early 1800sBritain contained contrasting illustrations ofurban life. On the one hand, communitiesemerged, containing impressive architec-tural creations that articulated civic prideand entrepreneurial confidence; yet concur-rently within the very same environments, ahellish situation characterized by grime andhardship was produced. Indeed, the dissim-ilarity of this modern existence, the best andworst of Britain’s unfolding urban civiliza-tion, was arguably best eulogized by anoverseas visitor to “The Workshop of theWorld”: Manchester. The French politicalthinker Alexis de Tocqueville, a sightseer in

the mid-1830s, recognized the cultural con-flict within modern Manchester’s existence[6]:

“... humanity attains its most completedevelopment and its most brutish; here civ-ilization works its miracles, and here civi-lized man is turned back almost into asavage.”

Such a description of city life, though,was not exclusive to Manchester. Large-sized British cities such as Birmingham,Liverpool, and Nottingham also inspiredmetaphors far than poetic due to their seem-ingly indescribable squalor. Yet to return toManchester, Dr. James Kay-Shuttleworth [7]identified that its slum districts were verymuch like those in other cities. They con-sisted of poorly built houses, a deficiency ofventilation and toilets, unpaved narrowstreets, mud, and stomach-turning stenchesdue to the presence of decaying refuse andsewerage. In such conditions, ill health wasobservably endemic [8]. British cities had,it seemed under the aegis of economic tran-

sition, metamorphosed into epidemiologicaltime bombs, environments greatly lacking inhumanity and justice, particularly for thepoor (Figure 2).

HEALTH REFORM AND THE 1830S:THE CONTEXT

The previous section has outlined howindustrialization was acknowledged in early1800s Britain to have instigated great ad-vances while it simultaneously wrought up-heaval that consequently appertained to theextensive presence of “4 Ds” [9]: dirt, dis-ease, deprivation, and death. In light of thissituation, the British were the first to appre-ciate the taxonomy of disparate existencewithin an industrial framework, and cities asthe seats of cultural change were the siteswhere this modern nomenclature, and theprofundity of the dark tone to modern life,was most evident. Accordingly, some citiesearned dishonorable monikers. Glasgow, theself-proclaimed “Second City of the Em-pire,” was so ravaged by violent crime,poverty, filth, and disease that it becamestigmatized as a “Mean City” [10]. Liver-pool, a city with a death rate of almost 35per 1,000 people in 1841, was given the un-enviable title of “The Most Unhealthy Townin England” [11], while London wasbranded “The Big Smoke” [12] and “Veniceof Drains” [13], due to its impure air andoverflowing sewers. The poet Percy Shelleywent one step further and wrote in the playPeter Bell the Third: “Hell is a city muchlike London” [14].

In order to appreciate the existence andspread of the 4 Ds and the distress of indus-trial city living, a number of the features ofevolving British urban culture need refer-encing. For example, such a miserable situ-ation did not develop, per se, as a result ofthe unparalleled speed of urbanization butoccurred, among other things, due to a lowwage economy that asphyxiated workingpeople’s ability to compete in the housingmarket and a lack of governmental willing-ness to tackle urban problems head on be-cause of the pervasive laissez-faire principlethat promoted non-interventionist convic-

Figure 2. Very ill! An early 1800s illustra-tion (artist unknown) depicting the wide-spread suffering of the working classes.The gaunt individual is drinking tea to helprepel an illness. Conventional medicinewas unaffordable to the poor at that time.

Morley: City chaos, contagion, Chadwick, and social justice 63

Figure 3. A late 1820s view of London’s water: “Monster Soup commonly called ThamesWater, being a correct representation of that precious stuff doled out to us!”


tions. To compound the precarious situationopportunists, such as local merchants andshopkeepers, lawyers, farmers, landowners,and others with available capital, attemptedto exploit urban growth for the purpose ofacquiring financial gain. To maximize prof-its, unqualified builders (i.e., available la-borers) were paid to rapidly constructback-to-back terraces, a small housing formlacking in basic utilities like clean water andsewers but erected solely as a machine tomanufacture rent [15]. Even if nearby watersupplies did exist, they were commonly in-termittent in supply, far from hygienic or fitfor human consumption due to seweragecontaminating local rivers, wells and springs(Figure 3). To illustrate this point, water ex-aminations in Nottingham on average hadalmost 45 grams of solid effluent for everygallon of water assessed. Such a finding wasclearly insupportable on humanitariangrounds, and to comprehend how the Britishshaped a strategy to manage such problems,a number of developments need to be expli-cated.

To begin with, a number of social-med-ical reports were composed in the 1830s

that emphasized the shocking reality ofurban life, in particular the vast daily vol-ume of waste produced and impure waterconsumed. Inspired by Thomas SouthwoodSmith’s Treatise of Fever in 1830, latermanuscripts such as those by James Kay-Shuttleworth and William Farr presenteddetails of living that offered a passage of so-cial discovery to the largely ignorant middleclasses and disclosed a direct correlation be-tween impoverishment, the slum environ-ment, and endemic fever. Strengtheningsocial and medical debates about diseaseand the state of urban environments, suchindividuals, through applying statisticalanalysis, also developed rational models re-garding the origin and propagation ofurban-based illness [16]. In due course, thisallowed a body of progressive professionalsto come forward, broadening British epi-demiological thinking by incorporating newconceptual medical and demographic no-tions, and through empirical investigationrebuffing many existing hypotheses aboutthe distribution of disease. Significantly,too, they put forward “facts” pertaining tosociety’s condition which:

Figure 4. Louis-Léopold Boilley’s Consultation de Médicine 1760 (left) and Consultation deMédicine 1823 (right, published mid-1820s). In pre-revolution France, the doctors are shownto be old and dazed. In the later era, the doctors are shown in a prime of life and using a sci-entific approach to the study of health.


1. Acted as crude indicators of mate-rial progress;

2. Drew attention to unforeseen prob-lem areas such as poor housing, crime, andavoidable ill-health and mortality; and

3. Intertwined health with psychologyand morality.

Consequently, the overall health debatecalled attention to a surfeit of potential phys-ical and moral predisposing determinants.

Armed with its “facts,” the medicalcommunity, in effect, granted a caveat thatportended to a bleak future. The view pre-sented by modern medical practitioners andstatisticians, despite their limited scientificknowledge, was unmistakable: Urban soci-ety was ailing and in need of improvement[17]. The British city was a setting con-firmed as unsafe to one’s health.

Complementing the aforesaid socialand medical state of affairs in Britain wasthe rise and influence of new journals, de-scribed later, and French medical research[18]. Although French medical practices(Figure 4) had an effect at institutions suchas the London Fever Hospital before the

1820s, their impact extended by the 1830sinto offering original treatment techniques,innovative ways to classify and distinguishone ailment from another, and bestowingnew physiological, anatomical, and pharma-cological information. Notably, such med-ical dissemination had important qualities.It imparted a promise of better health for alland offered a new consciousness of the bodyto the phlegmatic middle classes.

Also of importance were the works ofFrench physicians like Louis René Villermé,whose groundbreaking work in Paris verifieda correlation between poverty, poor health,and high rates of mortality, and periodicalslike Annales d’Hygiène Publique etMédicine Lègale (Chronicles of Public Hy-giene and Legal Medicine), which providedfurther fuel to the vigorous debate about thephysical and moral condition of cities. In thismilieu, French research reinforced Britishsuspicions associated with the materializa-tion of economic growth and urbanization.The human cost of society’s unmanagedurban development was unmistakable [19].

Notable developments occurred inBritain as well. In 1834, the Statistical Soci-

Figure 5. George Cruikshank’s Cholera Consultation (1832) illustrates the ineffective anddishonest nature of health authorities. In the image, a board member is offering a toast: “Maywe preserve our health by bleeding the country.”


ety of London (SSL) was founded with thepurposeful objective of collecting and classi-fying particulars “illustrative of the presentcondition and prospects of society.” From itsinception, the SSLorganized working groupsto explore serious social concerns, and from1838, when the Journal of the Statistical So-ciety of Londonwas introduced, the SSLpro-vided an outlet for medical practitioners tofurther consider the causes and conduct ofdisease. Consequently, the SSL’s periodicalgave medical statisticians armed with datafrom the General Register Office (opened1837) the opportunity to contribute to exist-ing debates, propose new health hypotheses,and offer pieces of evidence that supple-mented notes in existing journals such as TheLancet (founded in 1823) about the health ofmodern society. Overall, such analysis veri-fied the profits of civilization’s progress forthe well-to-do who resided in salubrious sub-urban districts. They were shown to havebeen granted an apparent gain in their healthlevels, although it was noted to have occurredat the expense of suppressing a healthful ex-istence for the working population [20].

Attention must be placed also on thesurfacing of sweeping occurrences of dis-

ease in the 1830s.Although outbreaks of, forexample, influenza, typhoid, typhus, andconsumption were rife before 1830 and wereso ubiquitous that the urban history of earlyindustrial Britain was said to be the historyof typhus and consumption [21], the 1830sdemonstrated two new disease experiences.First, the impact of infirmity increased, asrevealed by the tens of thousands who annu-ally died of infectious disease. In cities suchas Birmingham and Bristol, the death rateper thousand people rose from 14.6 to 27.2,and 16.9 to 31 [22]. So widespread was thepresence of disease by about 1840 that theaverage lifespan was just 26 years if some-one lived in a settlement of 100,000 peopleor more [23]. However, the second point ofnote was the arrival of cholera.

Although common illnesses like whoop-ing cough, scarlet fever, smallpox, dysentery,diphtheria, scrofula, measles, typhoid, typhus,or influenza took many lives, it took an epi-demic in the early 1830s caused by a disease ofoverseas origin — cholera — to instigate anew dynamic to urban living and the subjectof health [24]. Rapidly attaining an infamousstatus, a repute transpiring from its seeminglyarbitrarymanifestations, its virulence, ravaging

Figure 6. A sketch fromthe early 1830s of a vic-tim of cholera in Sunder-land (source: WellcomeLibrary, London).


talent for killing quickly, and agonizingly,cholera prompting municipalities to formBoards of Health — later shown to be ineptand corrupt (Figure 5). Nonetheless, choleraalso inspired themedical community to furtherventure into the slums to comprehend its na-ture, e.g., Dr. Thomas Shapter who mappedcholera deaths in Exeter, in so doing position-ing contagionists against miasmatists as ofconjecture on its causes and diffusion [25].

Manufacturing unimaginable terror inBritain after its appearance in 1831 in Sunder-land [26], cholera, like many other illnesses,paid scant respect to social class boundaries(Figure 6). When coupled with its ability todefy conventional medicine, it engineered un-paralleled fear. The disease, a frighteningsilent spectacle, was unlike anything knownbefore it. It was a psychological sledgeham-mer to material progress [27] and all the per-ceived benefits of modernity. With its air ofmystery, defiance, and with such minimal ex-planation as to its cause, cholera recalled thememory of the Middle Ages’ plagues. Itshocked society like no other illness had donein recent times and generated everything fromgeneral unease to riots. In light of the rise ofstatistical analysis and contemporary ways ofthinking about the social nature of disease,cholera became a compelling propagandist forurban betterment, andwarranted both politicalstability and social justice.

THE POOR LAW, EDWIN CHADWICK,SOCIAL MEDICINE, AND THE CITY

Prior to the 1840s, the decade withinwhich British public health as a profession

and municipal endeavor emerged, a smallnumber of characters were central in helpingto identify the factors that affected the healthand illness of urban populations, expandingthe theoretical framework of disease causa-tion, and engaging medicine with the politi-cal economy of capitalist Britain. Some ofthese individuals, like William Farr, havebeen mentioned already in this paper, but akey player in the meshing of medicine withthe moral and political economy of Britainwas Edwin Chadwick.While it is not neces-sary to discuss in detail every aspect ofChadwick’s life or all principles that shapedhis thinking, some facets of his charactermust nonetheless be considered.

Chadwick’s entry into discussions onthe related “Condition of England Ques-tion,” namely the expansive dialogue onproblems such as poor housing and a lack ofurban hygiene, stemmed from his work withthe Poor Law Board. Even though at facevalue, the Poor Law, with its brutal work-house regime and the issue of epidemiology,may appear to be two opposing faces of so-cial welfare, it was through Chadwick’s ap-preciation of the need to promote economicgrowth and maintain social order that hisideology on health and well-being devel-oped. For that reason, some pertinent re-marks are necessary with regard toChadwick’s position within the 1832 RoyalCommission into the Operation of the PoorLaws, a body putting forth Benthamite rec-ommendations that led to the passing of thePoor LawAmendment Act in 1834.

The constraints constructed into thePoor Law system, deterrents to stop all but

the neediest in society from claiming help,should be recognized at this point as beinga governmental scheme not against poorpeople, per se, but as an apparatus hostile tothe activities and conducts of the poor,whom the Poor Law administrators consid-ered socially iniquitous. It was thought thatby implementing a welfare structure thatsought at its core to encourage the dimin-ishment of bad habits like evading work(because of idleness or ill health) and so theneed to claim relief, society at large wouldbe known to improve itself. In this manner,the management of poverty through theamended Poor Law combined social, moral,and economics judgments. Impoverishmentand disease were viewed as the end resultof immoral habits as much as in the pres-ence of miasma. Implemented at a timewhen numerous reports by medical practi-tioners were increasingly highlighting theunion between poverty and infirmity [28],the Poor Law Commissioners deduced thatas much as Poor Relief lessened suffering, itwas not sufficient in itself to end penury. Tothis end, it was essential on economicgrounds that measures were enforced to pre-vent ill health in order for laborers toachieve their work and salary potential inthe free market. In other words, it was im-perative to root out the causes of disease soworkers could better contribute to the na-tional industrial machine. Accordingly, asstudies into the daily lives of the workingclass were necessary, interest in etiologywas roused, and public health measures pur-sued. In 1838, Chadwick commissionedrenowned medical practitioners James Kayand Neil Arnott (see Figure 7) to investigatethe “physical causes of fever … whichmight be prevented by proper sanitarymeasures” in London. This was a responseto an upsurge of illness but also was a skill-ful political maneuver to deflect critical at-tention that the Poor Law and destitutionwere primary causes of disease. Irrespectiveof reasons, the intention of the commissionwas weighty. Emphasis now was placedonto the roots of disease and issues of san-itation. Attention also was placed upon pre-ventive measures, something described in

1840 by the Select Committee on the Healthof Towns as being imperative for reasons ofinstigating justice for the poor and, rathermeaningfully, sustaining the protection ofproperty and security of the rich [29]. Inshort, the Poor Law Commission was chan-neling the focus of the formative publichealth movement in Britain, defining itsconcerns and delineating its interests.

To appreciate further Edwin Chadwick’sunfolding approach to the subject of publichealth and the creation of a paradigm from1842 to deal with poor urban health, it is notnecessary to dwell so much on the limitedscientific understanding of the early 1800s[29], but it is necessary to try to grasp theprofundity of doctrinal, cultural, and socialturmoil that economic growth had instigatedprior. Of course, in as much as the narrowscientific base of the 1830s was crucial as tohow disease was managed in Britain and didlead miasmatists, that is individuals whoconsidered disease to be caused by “bad air,”like Chadwick, to undertake urban better-ment albeit for the wrong reasons, it is alsovital to understand how the broader era inwhich these people lived and its influenceupon how those interested in urban health af-fairs thought.

Figure 7. British public health pioneers. Top(from left): Edwin Chadwick and Sir JamesKay-Shuttleworth. Bottom: Neil Arnott.



HISTORIOGRAPHY,THE 1842 REPORT AND BEYOND

Although a great deal of medical histo-riography has emphasized the significanceof the onset of public health as a professionand a municipal activity, much criticism ofthe role of miasmatists in light of their erro-neous scientific erudition has meant thatmany basic cultural facts have been neg-lected. This paper, therefore, is an opportu-nity to redress this situation somewhat. As acase in point, it is easy to forget how theBritish were a nation of people placed withinthe setting of rapid cultural transition, themanifestations of which had a sense of speedand intensity never before seen, plus new so-cial dynamics and relations. British bureau-crats like Edwin Chadwick, an individualcharged with dealing with the massive socialissue of welfare and impoverishment, notonly attempted to solve grave social matterswithout the advantage of entrenched empiri-cism, but also faced the double difficulty ofpreemptively building an administrative ap-paratus in order to manage processes of cul-tural change that had no foreseeable ending.Thus, the Chadwick Report should be ac-knowledged as not only being a survey ofthe social and environmental condition of alarge number of towns and cities, but an actto create public health policy. It was a multi-purpose endeavor to understand and managecities in accord with prevalent social andeconomic principles and a rational theoriza-tion of the behavior of contagion. It was ameans to encourage the cleaning up of urbanenvironments so as to make people healthier,but it was also the result of an adroit bureau-cratic politicization of public health beliefs,a gambit to guarantee future political action.

There is little reason to deny that theChadwick Report was a groundbreakingpiece of research. Its effect was to bring to-gether formerly isolated health and sanitarystrands, therefore reinforcing the need forlegislation to deal with health issues. Its un-dertaking was based on a rational reaction tourban problems and the presence of factorslike the advent of political machinations as-sociated with “dangerous classes,” a socialgroup seen as a derivative of bad sanitation.

Consequently, better hygiene was needed tocounteract the threat of insurrection. But ifprevention was the key to public health, onwhat was it to be precisely defined? Chad-wick’s 1842 report proposed an explanation.

To be succinct, the Chadwick Report, agraphic exposé of “the extent and operationof the evils” that contributed to the spread ofdisease in urban communities and “the meansby which the present sanitary condition of thelaboring classes may be improved,” was amilestone in social history and the quest forpublic sanitary reform. Through the attentiveapplication of descriptive environmental ac-counts and statistical analysis, Chadwick’sfindings were overwhelming to even the mostnon-interventionist.As he put it, Britain’s direurban environments and the ill health ithelped promulgate was akin to a war that waskillingmore every year than anymilitary con-flict in which Britain had ever been involved.His report was a dogma of facts summarizingin startlingly simple yet hard-hitting terms aphysiology of poverty and immorality cen-tered both on muck and the loss of malebreadwinners. Together, they were shown tohave created 43,000 new widows and112,000 new orphans per annum; an exten-sive loss of working ability due to poorhealth; and the poor in places like East Lon-don were dying at an average age of 29 yearsless than the wealthy.

Of equally significant, yet frequentlyunderestimated note, was the Chadwick Re-port’s masterful control of language toprompt political persuasion. To illustrate thispoint, Chadwick undoubtedly realized thatto achieve the end of instigating urban bet-terment, great value was to be obtained byfocusing on matters of engineering, e.g., re-lating to aspects of health. Therefore, bydealing with matters of a range of urban andmoral conditions, Chadwick could promotehis public health agenda. In this way, notonly could he instigate municipal interest ina variety of matters relating to urban healthand improvement, but what’s more, he wasable to navigate around what were previouslitigious matters relating to public health,such as questions of need and cost relating tothe implementation of drainage systems.

Presenting the 1842 report as one onsanitation, a novel scientific and social field,Chadwick put forth a highly developed doc-ument in which he discussed air, sewers,dung heaps, water, the built environment,and people and argued that the problems re-garding each one were obstacles to the im-provement of others. In turn, an argumentwas put forth that improvements to sewers,for example, could positively improve mat-ters of water or housing, and in so doingserve as a catalyst to improve the structureof urban society. Environmental determinismwas a defense for legal intervention, sug-gested Chadwick. To sit back and do nothingfor whatever reason was insupportable. Cor-relating poorly planned environments withbad health and/or people’s immoral behavior,Chadwick presented an argument that wasdifficult for his critics to dismantle by mak-ing at the core of his case the ability of drainsand clean water to improve morality. Sanita-tion, he proclaimed, would defuse rowdinessand decadence and make once “dangerousclasses” compliant. It would make societymore secure as well as improve health. Withhis confidence in society’s ability to furtheradvance itself, Chadwick recommended cer-tain methods to allow urbanization to correctthe wrongs it had helped produce earlier. Inthis way, urbanization, once the root of work-ing class burdens, was to now be controlledand so be its own antidote.

To allude for a second time to the issueof Chadwick’s detractors, they attempted tostop any public health implementation post-1842 by adhering to a line of reasoningabout the dangers of having increased cen-tral government intervention. In a way, thiswas a result of the nature of Chadwick’s re-port and its factual rather than judgmentalperspective and avoidance of contentious is-sues like the running of the economy. Thusto argue against the report’s particularswould have been injudicious. Instead, toweaken Chadwick’s case, critics focused onother issues, namely public health’s bureau-cracy and its fiscal cost. Both were vehe-mently attacked. Critics compared its centralbureaucracy with problems in autocraticFrance. Chadwick’s report thus was not able

to acquire legal fruition until 1848, when asuitable legal balance between local and na-tional governmental interests was found.With the passing of the Public Health Act,for the first time the industrial world pro-vided a proactive system of public healthand required local governments, which be-came local health authorities, to guaranteeminimum environmental standards [31].

Shaped by miasmic medical notions,i.e., disease was associated with noxiousodors, impure air, and poor sanitation, the1848 Public Health Act, though permissive,was a breakthrough in health culture [32]. Itpurveyed a new tradition of well-being inwhich health was a fundamental instrumentof local democracy. To ward off disparage-ment about heightened bureaucracy, publichealth was to be not defined by central gov-ernment but rather by municipal govern-ments that would implement schemes givenlocal needs and circumstances (though cer-tain minimum standards regarding financialand technical configurations were enforce-able from Westminster). Even those politi-cians most resistant to the call for publichealth, due to its perception with autocracy,were overcome as local autonomy wasmaintained, albeit with central governmentgiven the right to guarantee certain mini-mum standards.Any settlement with a deathrate exceeding 23 per 1,000 of the popula-tion had to immediately form a localizedBoard of Health as did one at the request of10 percent of the ratepayers. The provisionof paved streets, clean water supplies, andsewage disposal was an imperative as wasthe introducing of rulings to new privatelybuilt housing that had to be constructed inaccord with minimum structural standardsand minimum amounts of light, air, andspace. Taking a long-term approach to bet-terment, the act was a precursor to the assur-ance to bring more social justice to thosehindered by the social and economic cir-cumstances instigated by the Industrial Rev-olution [33]. As R.A. Slaney MP remarkedin the parliamentary debates leading up tothe passing of the 1848Act, public health atits core was not about kindness but was acall for fairness: “If they did not protect that

70 Morley: City chaos, contagion, Chadwick, and social justice

property [health, well-being], did they do thepoor man justice?” [34]

CONCLUSIONFrom the early 1800s onward, the

British were faced with understanding andmanaging two phenomenon associated withthe Industrial Revolution. The first was anextraordinary level of urban problems fol-lowing the rapid growth of existing townsand cities from the late 1700s. Then, asmuch as industrialization’s onset was as-sumed to provide an upward trend in thecondition of society, the British had to ac-cept by the 1830s that this notion wasflawed, as evidence provided by the medicalcommunity was starting to prove. As a con-sequence, the British had to redefine theirorthodoxy on material progress and fully ap-preciate that differences one had in terms oflife expectation and health from birth wasmanifest within the industrial social milieu.However, to comprehend and then managethis situation was far from straightforward.Legal, scientific, moral, economic, and po-litical concerns all had to be meshed into acoherent strategy before problems of healthand housing, for instance, could be tackleddirectly. Moreover, to activate any politicalstrategy required a superlative sanitary tech-nocrat, someone of pragmatism and politicalknow-how, as well as some degree of sani-tary understanding. In the case of early1800s Britain, thankfully, a number of indi-viduals of vision did step forward and pro-vided rational perspectives and solutions tothe “Condition of England Question.”

Central to the British process of dealingwith the malformed nature of urban societyin light of industrial change and rapid urban-ization was Edwin Chadwick, who from theearly 1830s initiated mechanisms and inves-tigations to improve the health of the popu-lation. Coping with an enormouslychallenging task, Chadwick, by 1848, hadlaid down basic principles for improvingpublic health in Britain, organized municipalgovernments into acting as centrally account-able health authorities, and promoted a moreeffective provision for improving sanitary

conditions that meant, for example, all newhouses and streets had to be built to certainstructural criterion. Thanks to Chadwick’spolitical influence, public health proponentswere able to establish it as an entrenched re-sponsibility of local and national governmentin Britain, just as it did in subsequent years inother societies. Importantly, too, due to thebroad nature of Chadwick’s sanitary reportin 1842, a view was borne that poor healthwas affected by a variety of causative factors,even if these were somewhat contestablegiven limited contemporary scientific knowl-edge. Even so, the formative national publichealth framework constructed in 1848 wasable to embrace a plethora of dynamics con-sidered as having a negative impact on peo-ple’s moral and physical well-being.

To conclude, although the chronologicalframe presented by this paper is limited, mas-sive transformationswith regard to urban think-ingweremade in the 1830s and 1840s that stillecho today. The British attitude toward publichealth, albeit far from perfect, encouraged theperspective that all citizens regardless of class,occupation, or place of residence, must betreated equally. Today, just as then, this is un-derstood to form social justice. Apartheid ofhealthwas considered to be intolerable. Thanksto evidence provided by medical practitioners,British bureaucrats took actions that were toculminate in the implementation of legal appa-ratus to assure improved health.Although con-cerns about public health persisted, in part dueto the magnitude of problems formed by un-controlled rapid urban growth, subsequentsocio-medical reports after 1848 and newhous-ing erected under sanitary legislation confirmedthe benefits of public health in negating thewell-being risks introduced by industrializa-tion. Health, as a basic necessity and humanright, was confirmed as being fundamental tothe success of any economy and society as awhole. If the legacy of Chadwick and his peerswas nothing else, it was this.And all industrialsocieties after Britain have to be thankful to thefounding of this tenet.REFERENCES1. The Office of Population Censuses and Sur-

veys. Census 1831-1841. London: HMSO;1841.

71Morley: City chaos, contagion, Chadwick, and social justice


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ian morley. city chaos, contagion, chadwick, and social justice

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