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Public health in the 19th century

An introduction

It is difficult to exaggerate the appalling conditions in which so many people lived during the century of the industrial revolution and the impact these conditions had on the health and life expectancy of individuals. In 1842 in Manchester, for example, a member of the gentry or professional had a life expectancy of 38 years, whereas that of a worker was only 17 years. Outside the manufacturing centres, this rose to 52 years in Rutland for a member of the professional class, and 38 for a craftsperson or farm labourer (Peter Wood, Poverty and the Workhouse in Victorian Britain, Alan Sutton, 1991, p. 21). The strong link between mortality and poverty is demonstrated by infant mortality numbers: the rate for the upper and middle classes was 76 per 1000 births, but for the unskilled labouring class 153 per 1000 births (Wood, p. 21).

Roy Porter, in his excellent medical history, paints a vivid picture of the kind of life the working classes led in 19th century Britain and the industrialising world:

"For millions, entire lives - albeit often very short ones - were passed in new industrial cities of dreadful night with an all too typical socio-pathology: foul housing, often in flooded cellars, gross overcrowding, atmospheric and water-supply pollution, overflowing cesspools, contaminated pumps; poverty, hunger, fatigue and abjection everywhere. Such conditions, comparable to today's Third World shanty towns or refugee camps, bred rampant sickness of every kind. Appalling neo-natal, infant and child mortality accompanied the abomination of child labour in mines and factories; life expectations were exceedingly low - often under twenty years among the working classes - and everywhere sickness precipitated family breakdown, pauperisation and social crisis. The squalor of the slums was exposed time and again by social reformers, novelists, newsmen, and clergymen appalled to find hell at the heart of civilization." (Roy Porter, The Greatest Benefit to Mankind: A Medical History of Humanity from Antiquity to the Present, Harper Collins, 1997, p. 399)

The Poor Law was not working and workhouse infirmaries were overflowing. [For more information on the Poor Law, click here] Until the first quarter of the 19th century most forms of public medical assistance were voluntary, provided mainly by charitable organisations, idealistic doctors and clergymen, Quaker business-men and other non-conformists. It was not until the outbreaks of large-scale infectious diseases in the 1830s, such as cholera and typhus, that the government and local councils started paying attention to the appalling conditions in the slums and the grave risks posed by the overcrowding in substandard housing, by contaminated wells, lack of a sewage system etc.

The solutions to these problems seem obvious to us, we must however keep in mind what attitudes were prevalent among the class of people who had the power to bring about change. Firstly, the pathological cause of infectious diseases was not known, that means that viruses and bacteria had not yet been discovered. It took decades of observation for people to draw the conclusion that those who lived in filthy, overcrowded, damp houses with a bad water supply were more often ill than people who lived in less deprived conditions. But even establishing such links did not bring about instant change.

The major stumbling block was a philosophical/political one. The interpretation of the role of government in the early part of the 19th century did not allow for much social legislation, because people saw any attempt to improve the situation by interfering with employment practices or by raising taxes to help the poor as an assault on personal freedom and the free market economy. It is only in the last 150 years that the government has increasingly taken on responsibility for new areas such as health, education and social services. This means that until then the government did not think its role was to help the individual. For example, if you were severely injured working in a mine or factory, the employer was not bound to help in any way, by keeping your job open for you, for instance, nor was there any disability benefit available. (Of course, there was also no Health and Safety legislation) In the absence of a National Health Service you had to pay for the doctor yourself and if you and your family could not afford that you just died. It is not surprising therefore that in some parts of Britain life expectancy was 20!

We tend to associate abject poverty during the 19th century with large cities, such as London and Manchester. However, many of the problems Roy Porter mentions, such as gross overcrowding, foul housing, water-supply pollution, overflowing cesspools and contaminated pumps and the resulting disease also applied to Hereford and other market towns in the county. By studying the remains of the built environment, such as housing, and by looking at the written sources you can gain an idea of the scale of the problem in your area.

Among other areas, 19th century archaeology looks at the homes, sewage systems, hospitals and other public institutions which had such an effect on people's standard of living. In other sections of these pages we will look at some of these topics to help us gain an understanding of public health in Herefordshire in the 19th century.

[Original author: Toria Forsyth-Moser, 2004]