Public Health (19th Century)

Edwin Chadwick

  • 1842 – Chadwick published his Report on the Sanitary Conditions of the Labouring Population of Great Britain about dreadful conditions people were living in
  • His conclusion was that it would be cheaper to spend local taxes on improving housing & hygiene instead of running workhouses
  • Main improvements suggested: provide access to clean water, remove sewage & rubbish from the streets
  • The government still had an attitude of laissez-faire (leave alone) which was the belief that government should not interfere in ordinary lives
  • Water companies feared any changes would reduce their profits
  • Middle-class tax payers didn’t see why their money should be spent on better living conditions for the poor who didn’t pay anything towards the improvements themselves
  • Very little was done as a result of his findings & suggestions until a bit later…

1848 Public Health Act

  • 1848 – Another major outbreak of cholera prompted the government to take action
  • Passed a Public Health Act of 1848 which set up a General Board of Health
  • Chadwick – was one of 3 commissioners on the board
  • Public Health Act told towns to: set up their own local Board of Health, appoint a local medical officer, organise the removal of rubbish, build a sewer system
  • However it was NOT COMPULSORY!!
  • Only a third of towns set up a board, even fewer appointed a medical officer, the General Board of Health was abolished in 1858
  • Overall, the act showed that the government were dealing with public health to a greater degree than before. However, much of this was a response to the threat of cholera and the repeated outbreaks

John Snow

  • In 1854 there was another outbreak of cholera
  • Dr John Snow investigated the theory that it was spread through water
  • He marked on a map all the deaths in one particular area of London’s Eastend
  • Discovered there was a clear concentration of deaths around a water pump on Broad Street
  • Snow had the handle removed so people couldn’t use the infected water
  • As a result the number of deaths fell dramatically
  • The impact of Snow’s investigation was that it helped people change their minds about Chadwick’s suggestion of providing clean water

Joseph Bazelgette

  • 1858 THE GREAT STINK Extremely hot weather meant that the level of the River Thames was exceptionally low and the consequent smell of exposed sewage was so great that parliament couldn’t meet
  • It convinced authorities that more public health reform necessary
  • Metropolitan Board of Works agreed to expensive ideas put forward by Joseph Bazalgette for a new sewer system in London
  • He designed a complex sewage system that took into account future population growth
  • 1300 miles of sewers, plus pumping stations
  • This shows that the Industrial Revolution caused public health problems BUT the increase in engineers also solved some problems too
  • Bazalgette’s sewers took 7 years to complete

1875 Public Health Act

What prompted further action?

  1. Snow’s work proved link between water and cholera
  2. Pasteur’s germ theory showed how disease spread and why hygiene was important
  3. Snow showed death rates varied according to water sources used by different water companies
  4. The Government started to collect statistics on births & deaths and they showed higher death rates in towns

Public Health Act 1875 – made local councils responsible for ensuring the following were provided:

–Clean water

–Public toilets

–Rubbish removal

–Sewers & drains

  • It MADE towns appoint Health & Sanitary Inspectors and a Medical Officer of Health
  • In the next 20 years local councils also became responsible for: checking the quality of food in shops, ensuring quality of new housing and enforcing laws against polluting rivers
  • Basic services such as water, lighting and paving were still run by private companies (not the government)
  • The act was COMPULSORY this time and ENFORCED


  • Doctors’ Qualifications: 1815Society of Apothecaries and Royal College of Surgeons introduced exams before doctors could set up practices
  • 1858 General Medical Act: a General Medical Council had to be set up & all qualified doctors had to be registered.
  • Doctors still not always respected as they still couldn’t cure much!
  • After germ theory – more emphasis on doctors using microscopes
  • Important medical schools started in Edinburgh, Oxford & London
  • Training no longer just reading the works of Galen – Observed experienced doctors, then went to work at a hospital under a more experienced doctor, then could volunteer to work at charity hospitals
  • As medical knowledge advanced, doctors divided into GPs/specialisms such as areas of body or specific disease – became known as consultants
  • Body snatchers increased due to need for human dissection