Urban growth: Disease in the Victorian city

It was unhealthy to live in Victorian cities, though chances of illness and premature death varied considerably depending on who you were, where you lived, how much you earned and how well you were fed. Social class mattered. Not all towns had equally high mortality rates and death rates in the countryside could match those in middle class suburban areas of cities[1].

Contemporary opinion was most concerned about infectious diseases even those more people died from 'other causes' than from all infectious diseases combined. Such diseases as typhus and influenza were both endemic and epidemic: they killed large numbers of both rural and urban dwellers but affected the young and malnourished of the urban slums. Smallpox became less important, in part because of the vaccination developed by Edward Jenner in the 1790s. Typhus fever was endemic in London and epidemics occurred in all towns in 1817-19, 1826-27 and 1831-2. Influenza epidemics occurred in 1803 and 1831. As towns grew, polluted water became an increasingly pressing problem and was the cause of many diseases from infantile diarrhoea and typhoid fever and especially cholera.

1. Infectious diseases were spatially concentrated: deaths from tuberculosis, typhus and cholera focused mainly on inner-city slum districts.
2. The main nineteenth century killer of adults was tuberculosis. Few families were not touched by the effects of TB and even in 1900 it was responsible for around 10 per cent of all deaths nationally, despite a significant decline from 1850. Spread by a bacillus through droplet infection from coughs or saliva, tuberculosis is not highly contagious but its spread is encouraged by a combination of poverty, malnutrition and overcrowded living conditions. Though not immune, the middle classes were better able to withstand tuberculosis than the poor, malnourished working class.
3. Typhus and typhoid fever were not separately diagnosed until 1869. They have completely different methods of transmission. Typhus, spread by body lice mainly to adults, is encouraged by poor living conditions. Endemic in the nineteenth century, it became epidemic during economic depressions and poverty crises and was strongly associated with poor residential areas. In contrast, typhoid fever was spread by a bacillus contained in sewage-contaminated water, milk or food and is directly related to poor sanitation and hygiene. It could be spread through the water supply to all parts of a town, but inner-city areas were most likely to be hit hardest.
4. Contaminated water and food also spread cholera, but unlike typhoid it occurred only in specific epidemics introduced from Europe in 1831-2, 1848-9, 1853-4 and 1866 and was not otherwise present in Britain. Epidemic mortality could be high in affected areas but in general it was much less important than other infectious diseases. However, cholera did attract considerable public attention both because of its high mortality rate and the fact that it struck all classes, though as with typhoid fever it was the poor who suffered most.
5. Children were particularly vulnerable to most infectious diseases, but especially from the effects of diarrhoea and dysentery, diphtheria, whooping cough, scarlet fever and measles. Infant mortality remained high and by the end of the nineteenth century still accounted for a quarter of all mortality.

What was the impact of such high rates of infectious disease? Death was only one, and not necessarily the most important, of the many effects of disease. For a poor family struggling to pay rent and buy food, illness [whether fatal or not] imposed additional strains: medical bills to pay; medicines to buy; extra heating costs; and the problem of childcare if the mother was taken ill. If the primary wage earner was off work the crisis would be more acute as not only did outgoings rise but incomes also fell. Short-term crises were met by pawning clothes, borrowing from kin and raising short-term loans. Prolonged illness increased costs and reduced income to such an extent that it could cause or increased malnutrition for the whole family, leading to further illness or to eviction for non-payment of rent. Families might then have to move to inferior accommodation or to be separated from one another in the workhouse. There is little doubt that the high level and concentration of infectious disease was a significant extra burden for working class families in the Victorian city.

In certain respects the health of the urban population began to improve as a result of a number of changes occurring after 1890.

• The Public Health Act 1890, though it did not introduce many new principles, was more effective than previous legislation in ensuring that towns took responsibility for the basic provision of pure water supply and proper sanitary conditions.  The Housing Act 1890 placed emphasis on slum clearance, a programme that was only really beginning to have an effect by 1914.
• The development of town planning began to stress environmental considerations that influenced the layout of some suburban developments and created a healthier environment. This only had an effect if individuals were able to move from the inner-city areas to the new garden suburbs.
• Advances in medical knowledge and technology began to make real inroads into diseases that had been barely understood in 1830.
• The development of a state welfare policy towards health created a buffer that prevented some of the worst impacts of disease in family life. The impact of the embryonic welfare state was patchy before 1914. In 1911 Lloyd George introduced the first national medical insurance scheme that was intended, in part, to replace schemes previously run by individual friendly societies.
• General increases in standards of living and especially improvements in diet and nutrition throughout most of the population led to greater resistance to disease and lower mortality.

There had been some improvement in the quality of life for those living in urban communities between 1830 and 1914. However, the major determinant of health was still social class: the working class as a whole were less healthy than the middle class.

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[1] On health see G.M. Howe Man, environment and disease in Britain, Penguin, 1976 and R. Woods and J. Woodward (eds.) Urban disease and mortality in nineteenth-century England, Batsford, 1984. F.B. Smith The People's Health 1830-1910, Croom Helm, 1979 is a valuable study of social problems and the limited resources of nineteenth century medicine.

Urban growth: Governing towns

History, as A.J.P. Taylor reminded us, gets 'thicker' as it approaches modern times[1]:'There are more people, more events, and more is written about them.'  Social history gets particularly ‘thick’ because more attention is paid to the lives of ordinary people, more of them were literate and more join the debate. There is a flood of evidence for urban conditions in this period -- reports, Blue Books, surveys, memoranda, diaries, books[2]. So what were urban conditions like in the 1830s? In what ways did those conditions change in the next eighty years and why?

Urban planning and administration

By the 1830s the administrative and electoral map of Britain was at odds with demographic and economic facts. The antiquated legal structure of local government created three major sets of problems for urban government:

1. Urban status was often unrelated to contemporary size and function. Major cities, such as Manchester and the east Lancashire cotton towns and the Black Country industrial centres, were without formal status. Manchester and Birmingham, for example, were unincorporated[3] in the eighteenth century and, in theory, controlled by the county. Although they gained control over their own affairs through local Improvement Acts the system did not lend itself to effective local government. Unincorporated industrial towns had no direct representation in Parliament and found it difficult to petition for change. In contrast many decayed towns had parliamentary representation, for example the rotten borough of Old Sarum, or had a handful of inhabitants in the 'pocket' of aristocratic landowners retained borough status. London's metropolitan area of some eight-mile radius from St Paul’s had a population of 1.75 million in 1831 but lacked a coherent overall administrative structure.
2. Even where urban administrations were in place in large towns, as in Incorporated Boroughs as at Liverpool, Bristol, Newcastle and Kingston upon Hull, their urban built-up areas were often tightly restricted in terms of continuing expansion. Incorporated towns also varied greatly in the way in which local government was organised. 'Closed' corporations like Leeds, Liverpool, Coventry, Bath and Leicester were often run by a small oligarchy appointed for life.
3. This led to the third problem. What effective control was there of a range of issues -- physical, environmental, health, economic and social -- that often affected areas outside existing corporation boundaries? Thus, although London's parish vestries sought to provide better sanitation and health their efforts lacked integration. Despite the work of Improvement Commissioners in larger English cities, there were severe limitations to the range of their activities.

Under these circumstances it is not surprising that local government was slow to respond to the increasingly serious problems of urban life until after 1835.

Between the 1830s and 1890s urban and local government was restructured twice and there was significant legislation by the state on specific urban problems, together with a restructuring of the franchise and of parliamentary and civic representation.

1. Parliamentary franchise was widened in 1832, 1867 and 1884-5. This created a more equal relationship between parliamentary representation and property ownership and population size and increased the urban voice in national affairs. The 1832 Reform Act, in very broad terms, gave the vote to urban middle class property owners. The 1867 Reform Act extended this to the urban working classes and the 1884 Reform Act did the same to the rural working classes.
2. The Municipal Corporations Act 1835, and parallel legislation in Scotland in 1833 and 1834, laid the basis for municipal planning and control over a wide range of issues and recognised the true administrative map of urban Britain by giving full urban status to many unincorporated towns. Some, like Manchester, Birmingham and Sheffield, were already very large indeed; others such as Bradford, Bolton, Huddersfield, Wolverhampton and Brighton were growing rapidly. They also allowed the incorporation of adjacent townships over which urban development had spread, as reflected in the considerable boundary extensions of Liverpool and Leeds and of Glasgow in the 1830s.
3. The 1835 Act did not solve the problem of integrated urban government. Intervention through bye-laws in key issues -- health and sanitation, housing, public amenities, poverty -- was either piecemeal or, as in the case of the Poor Law and the provision of compulsory state education [made over to local government in 1919 and 1902 respectively] was reserved for central government. When new administrative divisions were established they were often out of tune with the times. For example, the reformed Poor Law of 1834 created a framework of 624 Unions focused on old market towns and regional centres, a pre-industrial pattern of functional regionalism that had to be constantly adjusted to meet the changing population distribution.

By the 1860s there was a growing recognition that urban administration needed to be more coherent if it was to implement legislation on health, housing and sanitation. In 1855 the Metropolitan Management Act [following the Royal Commission of 1854] attempted to created an integrated government for London by reorganising the previously haphazard structure into a Metropolitan Board to control sewage, highways, lighting and health in London's 36 Registration Districts with an 1861 population of 2.8 million.

Elsewhere, despite the addition of 554 new urban areas between 1848 and 1868 in England and Wales, confusion remained. A Royal Commission to investigate local government was set up in 1869 and its Second Report began the transition to the Acts of 1888 and 1894 that established the late nineteenth and early twentieth century framework of local government. The Public Health Act 1872 created an administrative framework of Urban and Rural Sanitary Districts under the Local Government Board set up the previous year. The Local Government Act 1875 and the Municipal Corporations Acts 1882 defined the principles and functions of a new system of urban administration. However, the Commissioners of the Board set up under the Local Government Boundaries Act 1887 and the decisions made under the Local Government Acts of 1888 and 1894 determined its geography. These Acts recognised that the needs of large towns could best be met by integrating all the functions of local government within all-purpose administrations of 63 Counties and 61 County Boroughs. London became an Administrative County incorporating its 41 Metropolitan Board Areas. In 1894 the remaining urban areas were consolidated into Municipal Boroughs and Urban Districts each with a range of powers but subordinate to their Administrative Counties for education, police and fire and some other services.

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[1] A.J.P. Taylor English History 1914-1945, OUP, 1965, page 729.

[2] On  urban  conditions and the problems of public health  see  A.S. Wohl Endangered Lives: Public Health in Victorian Britain, Methuen, 1985 and  his The  eternal slum: housing and social policy  in  Victorian London, Edward Arnold, 1986. J. Walvin English Urban Life 1776-1851, Hutchinson, 1984 is an excellent, readable study on the early years of the period. D. Fraser (ed.) Municipal reform and the Industrial city, Leicester University Press, 1982 contains useful case studies. On cholera see N. Longmate King Cholera, Hamish Hamilton, 1966, R.J. Morris Cholera, 1832, Croom  Helm, 1976  and  M. Pelling Cholera, Fever and English Medicine 1825-1865, OUP,  1977.  Royston Lambert Sir John Simon 1816-1904, MacGibbon & Kee, 1963 is excellent for the end of the period.  R. Porter Disease, Medicine and Society in England 1550-1860,  Macmillan, 2^nd. ed., 1993 contains some useful ideas in its final chapters. F. Mort Dangerous Sexualities: Medico-Moral Politics in England since 1830,  Routledge, 1987, 2^nd ed., 1999 examines the impact of disease on perceptions of women. F.B. Smith The People's Health 1830-1910, Croom Helm, 1979 is a valuable study of social problems and the limited resources of nineteenth century medicine.

[3] There was an important distinction between incorporated and unincorporated towns. Incorporated towns or boroughs had received charters, often in the Middle Ages, which gave them certain rights. In particular they were run by elected corporations. Unincorporated towns were still run by the parish or by the old feudal leet courts.