Social Reform and Public Health – Florence Fassih

During the nineteenth century, there was an increase in the understanding and exploration of health and disease within Britain. The outbreak of diseases that affected the entire country, such as cholera, was one of the many aspects that spurred the influx in men and women examining the living conditions of the nation’s people, particularly in the ever-expanding cities. The formation of the slums has long been associated with the ‘uprooting’ and moving into the cities and urban areas in search of better work or livelihood.[1] There was a clear segregation between those living in the slum and those who were apparently of a more civilized class, and this led to separate social worlds and styles of living.[2] The slums of London were notorious for being extremely filthy, dirty and degrading ghettos that were developing because of a dramatic increase in the city’s population. In the last decades of the nineteenth century, the population of the capital reached four million, creating a high demand for cheap housing.[3] The immense rate that the slums were continuously growing caused many to believe that change and action must take place, otherwise the slums would affect London life for everyone; these social reformers demanded that action take place in order to save those living within the slum and London itself.

Dudley Street, Seven Dials, from ‘London: A Pilgrimage’, 1872, by Gustave Dore. [14]

In 1842, Edwin Chadwick published a Report on the Sanitary Conditions of the Labouring Population, within which he emphasized the lack of sanitary conditions a large number of the population were living in. Here he describes the state of Petticoat Lane, Whitechapel, London:

It is not without misgiving I address myself to the task of picturing the wretchedness and misery in this notorious pestilences-breathing lane, and the incredibly numerous alleys, courts, and yards diverging from each other on either side, (extending into Spitalfields,) teeming with pollutions to an extent which beggars all description.Thousands of human beings are here cooped up, filthy in habits, debased in morals, oppressed with want, abandoned and reckless – because without hope of relief- the proper subjects of disease and death engendered by the foulness which taints the air they breathe, the food they eat, the water they drink, covers the ground they walk on, ever clinging to them in close companionship with their persons, their clothing, their bed and their board. Mostly ruinous and dilapidated, the dwellings are without a single redeeming quality, no ventilation! No drainage! Tenanted chiefly by Jews and Irish of the lowest class; the eye seeks in vain for an “oasis in the desert”, an element of health amid this scene of squalid poverty and dirt. In festering hillocks at the entrance, or strewn upon the surface of these alleys, lie vast quantities of putrifying animal and excrementitious matter, gradually liquefying by admixture with the foul water from the dwellings, some portion perchance wending its noisome course to a distant gully, and escaping there, but more usually remaining to form a stagnant pool, ankle deep, exhaling into the air.[4]

Chadwick had compiled a great amount of scrupulous research for his final works over a period of three years.[5] He argued that the dirty and unsanitary conditions people were living in directly correlated with mass illness and unless there was reform within the century it would cease to end. Chadwick highlighted that the very worse conditions are inhabited ‘chiefly by Jews and Irish of the lowest class’, which is slightly surprising because Charles Booth argued that of the 60-70,000 Jews in the city, ninety per cent were living in the East End, and managed to climb the social scale, therefore bettering their conditions. Due to the rise in the number of immigrants and the jealousy many felt toward those who were successful, racism and anti-semitism began to flourish.[6] The East End was the most notorious slum of London and often referred to as “darkest London”.[7]

The ultimate result of Chadwick’s presentation of the Report was the Public Health Act of 1848, which meant that the government was charged with a number of responsibilities for safeguarding the health of the population.[8] This, according to M.W. Flinn, was not the outcome Chadwick and many other reformers had hoped for.[9] He argued that poverty was not to blame for the diseases, but rather it was a result of disease and concluded that the solution to the problems associated with disease was the removal of filth from the streets and homes. Although such demands were not essentially new, the press, people and politicians were impressed with the Report.[10]

Since the last few decades of the eighteenth century, there had been speculation from doctors about the relationship between disease and filth and poor ventilation. This was a matter the government took seriously, especially after the cholera and typhus epidemics of the 1830s. Chadwick’s report encouraged such ideas and fears and, in the 1840s, the campaign for sanitary reforms began to build momentum.[11]

Court for King Cholera, illustration from Punch Magazine, 25th September 1852. [15]
Chadwick was not alone in his quest to fix the problems of unsanitary Britain. Other reformers also wrote and examined the conditions of the population. James Phillips Kay, had previously produced a pamphlet on the moral and physical conditions of Manchester’s working class in 1832, in which he argued that the state of the streets in which people lived directly affected the health of its inhabitants.[12] Kay explained what was wrong with the conditions and what he believed to be the reason for such widespread disease:

‘Sporadic cases of typhus chiefly appear in those which are narrow, ill ventilated, unpaved, or which contain heaps of refuse, or stagnant pools. The confined air and noxious exhalations, which abound in such places, depress the health of the people, and on this account contagious diseases are also most rapidly propagated there.’ [13]

England had experienced a number of epidemics throughout the centuries, including the plague, cholera and small pox. All of them had caused fear to spread throughout the country. Such fear led to numerous developments in the medical understanding surrounding disease and illness; the demand for cures and prevention of such diseases were inevitable. The public health of London during the nineteenth century was a common cause for concern; the advancements within the medical spectrum had since the eighteenth century, been developing in a number of ways. There were new sources of medicine, new understanding of how to operate and prescribe medication. Toward the end of the nineteenth century, there were also a number of committees established to specifically oversee the state of hospitals, and the general welfare and health system of the country. The developments in new drugs that became available for doctors to use in order to stop or prevent disease began to prosper during the nineteenth century. For example, in 1822, after several years of extensive research and experimentation, Louis Pasteur had successfully the formulated a vaccine for anthrax.

Despite the vast amount of pressure from social reformers and doctors campaigning for change in ill kempt and overcrowded slums of the city, by the closing of the nineteenth century London still had vast mazes of slum districts where poor health continued to flourish. London was still a city full of dirt and disease.

Florence Fassih


[1] Ward, David, ‘The Victorian Slum: An Enduring Myth?’, Annals Association of American Geographers, 66.2 (1976), p.323.

[2] Ward, ‘The Victorian Slum’, p.323.

[3] Slums and Slumming in Late-Victorian London. Available Online:, Date Accessed: 15th November, 2015.

[4] Chadwick, Edwin, Report on the Sanitary Conditions of the Labouring Population in 1842. Available online:

[5] Chadwick, Edwin, Flinn, M. W. (ed.), Report on the sanitary condition of the labouring population of Great Britain, 1842 (Edinburgh: Edinburgh University Press, 1965), p.1.

[6] Haggard, R.F., ‘Jack the Ripper as the Threat of Outcast London’, in Willis, M. and Warwick, A. (eds.) Jack the Ripper: Media, Culture and History (Manchester: Manchester University Press, 2007), p.198,199.

[7] Slums and Slumming in Late-Victorian London, Available Online:, Date Accessed: 15th November, 2015.

[8] Chadwick, Reports on the Sanitary, p.1.

[9] Chadwick, Reports on the Sanitary, p.1.

[10] Jackson, Lee, Dirty Old London: The Victorian Fight Against Filth (London: Yale University Press, 2014), p.76,77.

[11] Marriot, John, Beyond the Tower: A History of East London (New Haven: Yale University Press, 2011), p.131.

[12] Kay, James, The Moral and Physical Condition of the Working Classes Employed in the Cotton Manufacture in Manchester (1832), Available Online:, Date Accessed: 28th September, 2015.

[13] Kay, James, The Moral and Physical Condition of the Working Classes Employed in the Cotton Manufacture in Manchester (1832), Available Online:, Date Accessed: 28th September, 2015.

[14] A Court for King Cholera, illustration from Punch, 25th September 1852.

[15]Gustave, Dore Dudley Street, Seven Dials, from ‘London: A Pilgrimage’, Engraving 1872, Museum of London, London.