City Chaos, Contagion, Chadwick, and Social Justice

ARTS & HUMANITIES

Ian Morley

Department of History, Chinese University of Hong Kong

In 1842, a civil servant, Edwin Chad - first modern system of public health wick, published at his own expense The Re - emerged. Demonstrating how the sanitary port from the Poor Law Commissioners on movement was formed and how miasmic an Inquiry into the Sanitary Conditions of medical notions influenced the form of the the Laboring Population of Great Britain , 1848 Act, this paper will appraise a variety which outlined in detail the wretched social of factors that helped shape the evolution and environmental conditions within the of epidemiology within what was the world’s first industrial society. The Chad - world’s first industrial and urban society in wick Report, the first such national investi - the 1830s and 1840s, including the realiza - gation of its kind, highlighted a number of tion that societal advancement did not cre - now widely accepted phenomena concern - ate health benefits for all. ing economic development, urbanization and health within industrial settlements. BACKGROUND For its time, the report was a monumental At the end of the 18th century, when step toward accepting and then dealing the initial stages of industrialization were with the social costs of economic progress. under way, the British population was esti - In short, the Chadwick Report established mated to be less than 10 million people, of that material progress did not equate inter which about 30 percent of the populace alia to a universal improvement in urban resided in urban communities. By 1841 [1], health. Instead, it revealed how modern cir - immediately before Edwin Chadwick pub - cumstances had the ability to establish a lished his Report from the Poor Law Com - health schism between social groups. So missioners on an Inquiry into the Sanitary with such a backdrop in mind, this article Conditions of the Laboring Population of assesses the role of Edwin Chadwick and Great Britain (hereafter known as the his 1842 sanitary report in the lead-in to the Chadwick Report), the quantity of urban Public Health Act (1848), a legislative at - dwellers was approaching 50 percent of the tempt to bestow social and health equity in nation’s population total, and a number of Britain, and examines the wider social and broad developments had been noted about medical context within which the world’s the 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].

61 62 Morley: City chaos, contagion, Chadwick, and social justice

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

and complexity of urban places. These ob - fessionals like James Kay-Shuttleworth, a served changes included the appearance of Manchester physician, and Robert Baker, a sometimes monumental factories, the con - surgeon in Leeds, about the well-being of struction of grand town halls, and hitherto urban citizens. Likewise, other grave uncer - open areas at the urban fringe being replaced tainties had arisen. Crime, for example, was by multitudes of high density back-to-back perceived to have increased, as had prosti - terraces [2]. Although this phenomenon was tution, levels of drinking, destitution, and nationally observable, the tendency to eat overcrowding. Accordingly, a new depth of away fields was most pronounced at London concern was manufactured about the nature (see Figure 1), along with provincial places of British cities, the direction society was like Birmingham, Glasgow, Leeds, Liver - heading, and the potential volatility of the pool, Manchester, and Bradford, a settle - industrial age. As Robert Vaughan asserted ment described as being “one of those towns in The Age of Great Cities : “If any nation is which have practically grown up during the to be lost or saved by the character of its modern manufacturing era” [3]. great cities, our own is that nation” [5]. While numerous people were in awe of As previously noted, early 1800s the transformations instigated by the Indus - Britain contained contrasting illustrations of trial Revolution, some members of society, urban life. On the one hand, communities particularly writers and medical practition - emerged, containing impressive architec - ers, questioned what effects the industrial tural creations that articulated civic pride age was having upon the public. Not only and entrepreneurial confidence; yet concur - were “diseases of civilization” such as tu - rently within the very same environments, a berculosis noted as having a much more hellish situation characterized by grime and widespread incidence than in previous hardship was produced. Indeed, the dissim - times, the growth of “localities of pauperi - ilarity of this modern existence, the best and sation” [4], that is, quarters deficient in hy - worst of Britain’s unfolding urban civiliza - giene yet filled with slums and tion, was arguably best eulogized by an manifestations of poverty, drew aghast de - overseas visitor to “The Workshop of the pictions of contemporary working class life World”: Manchester. The French political and produced disquiet among medical pro - thinker Alexis de Tocqueville, a sightseer in Morley: City chaos, contagion, Chadwick, and social justice 63

sition, metamorphosed into epidemiological time bombs, environments greatly lacking in humanity and justice, particularly for the poor (Figure 2).

HEALTH REFORM AND THE 1830 S: THE CONTEXT The previous section has outlined how industrialization was acknowledged in early 1800s Britain to have instigated great ad - vances while it simultaneously wrought up - heaval that consequently appertained to the extensive presence of “4 Ds” [9]: dirt, dis - ease, deprivation, and death. In light of this situation, the British were the first to appre - ciate the taxonomy of disparate existence within an industrial framework, and cities as the seats of cultural change were the sites Figure 2 . Very ill! An early 1800s illustra - tion (artist unknown) depicting the wide - where this modern nomenclature, and the spread suffering of the working classes. profundity of the dark tone to modern life, The gaunt individual is drinking tea to help was most evident. Accordingly, some cities repel an illness. Conventional medicine earned dishonorable monikers. Glasgow, the was unaffordable to the poor at that time. self-proclaimed “Second City of the Em - pire,” was so ravaged by violent crime, the mid-1830s, recognized the cultural con - poverty, filth, and disease that it became flict within modern Manchester’s existence stigmatized as a “Mean City” [10]. Liver - [6]: pool, a city with a death rate of almost 35 per 1,000 people in 1841, was given the un - “... humanity attains its most complete enviable title of “The Most Unhealthy Town development and its most brutish; here civ - in England” [11], while London was ilization works its miracles, and here civi - branded “The Big Smoke” [12] and “Venice lized man is turned back almost into a of Drains” [13], due to its impure air and savage.” overflowing sewers. The poet Percy Shelley went one step further and wrote in the play Such a description of city life, though, Peter Bell the Third : “Hell is a city much was not exclusive to Manchester. Large- like London” [14]. sized British cities such as Birmingham, In order to appreciate the existence and Liverpool, and Nottingham also inspired spread of the 4 Ds and the distress of indus - metaphors far than poetic due to their seem - trial city living, a number of the features of ingly indescribable squalor. Yet to return to evolving British urban culture need refer - Manchester, Dr. James Kay-Shuttleworth [7] encing. For example, such a miserable situ - identified that its slum districts were very ation did not develop, per se, as a result of much like those in other cities. They con - the unparalleled speed of urbanization but sisted of poorly built houses, a deficiency of occurred, among other things, due to a low ventilation and toilets, unpaved narrow wage economy that asphyxiated working streets, mud, and stomach-turning stenches people’s ability to compete in the housing due to the presence of decaying refuse and market and a lack of governmental willing - sewerage. In such conditions, ill health was ness to tackle urban problems head on be - observably endemic [8]. British cities had, cause of the pervasive laissez-faire principle it seemed under the aegis of economic tran - that promoted non-interventionist convic - 64 Morley: City chaos, contagion, Chadwick, and social justice

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

tions. To compound the precarious situation that emphasized the shocking reality of opportunists, such as local merchants and urban life, in particular the vast daily vol - shopkeepers, lawyers, farmers, landowners, ume of waste produced and impure water and others with available capital, attempted consumed. Inspired by Thomas Southwood to exploit urban growth for the purpose of Smith’s Treatise of Fever in 1830, later acquiring financial gain. To maximize prof - manuscripts such as those by James Kay- its, unqualified builders (i.e., available la - Shuttleworth and William Farr presented borers) were paid to rapidly construct details of living that offered a passage of so - back-to-back terraces, a small housing form cial discovery to the largely ignorant middle lacking in basic utilities like clean water and classes and disclosed a direct correlation be - sewers but erected solely as a machine to tween impoverishment, the slum environ - manufacture rent [15]. Even if nearby water ment, and endemic fever. Strengthening supplies did exist, they were commonly in - social and medical debates about disease termittent in supply, far from hygienic or fit and the state of urban environments, such for human consumption due to sewerage individuals, through applying statistical contaminating local rivers, wells and springs analysis, also developed rational models re - (Figure 3). To illustrate this point, water ex - garding the origin and propagation of aminations in Nottingham on average had urban-based illness [16]. In due course, this almost 45 grams of solid effluent for every allowed a body of progressive professionals gallon of water assessed. Such a finding was to come forward, broadening British epi - clearly insupportable on humanitarian demiological thinking by incorporating new grounds, and to comprehend how the British conceptual medical and demographic no - shaped a strategy to manage such problems, tions, and through empirical investigation a number of developments need to be expli - rebuffing many existing hypotheses about cated. the distribution of disease. Significantly, To begin with, a number of social-med - too, they put forward “facts” pertaining to ical reports were composed in the 1830s society’s condition which: Morley: City chaos, contagion, Chadwick, and social justice 65

Figure 4 . Louis-Léopold Boilley’s Consultation de Médicine 1760 (left) and Consultation de Médicine 1823 (right, published mid-1820s). In pre-revolution France, the doctors are shown to 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 - 1820s, their impact extended by the 1830s rial progress; into offering original treatment techniques, 2. Drew attention to unforeseen prob - innovative ways to classify and distinguish lem areas such as poor housing, crime, and one ailment from another, and bestowing avoidable ill-health and mortality; and new physiological, anatomical, and pharma - 3. Intertwined health with psychology cological information. Notably, such med - and morality. ical dissemination had important qualities. It imparted a promise of better health for all Consequently, the overall health debate and offered a new consciousness of the body called attention to a surfeit of potential phys - to the phlegmatic middle classes. ical and moral predisposing determinants. Also of importance were the works of Armed with its “facts,” the medical French physicians like Louis René Villermé, community, in effect, granted a caveat that whose groundbreaking work in Paris verified portended to a bleak future. The view pre - a correlation between poverty, poor health, sented by modern medical practitioners and and high rates of mortality, and periodicals statisticians, despite their limited scientific like Annales d’Hygiène Publique et knowledge, was unmistakable: Urban soci - Médicine Lègale (Chronicles of Public Hy - ety was ailing and in need of improvement giene and Legal Medicine), which provided [17]. The British city was a setting con - further fuel to the vigorous debate about the firmed as unsafe to one’s health. physical and moral condition of cities. In this Complementing the aforesaid social milieu, French research reinforced British and medical state of affairs in Britain was suspicions associated with the materializa - the rise and influence of new journals, de - tion of economic growth and urbanization. scribed later, and French medical research The human cost of society’s unmanaged [18]. Although French medical practices urban development was unmistakable [19]. (Figure 4) had an effect at institutions such Notable developments occurred in as the London Fever Hospital before the Britain as well. In 1834, the Statistical Soci - 66 Morley: City chaos, contagion, Chadwick, and social justice

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

ety of London (SSL) was founded with the ease in the 1830s. Although outbreaks of, for purposeful objective of collecting and classi - example, influenza, typhoid, typhus, and fying particulars “illustrative of the present consumption were rife before 1830 and were condition and prospects of society.” From its so ubiquitous that the urban history of early inception, the SSL organized working groups industrial Britain was said to be the history to explore serious social concerns, and from of typhus and consumption [21], the 1830s 1838, when the Journal of the Statistical So - demonstrated two new disease experiences. ciety of London was introduced, the SSL pro - First, the impact of infirmity increased, as vided an outlet for medical practitioners to revealed by the tens of thousands who annu - further consider the causes and conduct of ally died of infectious disease. In cities such disease. Consequently, the SSL’s periodical as Birmingham and Bristol, the death rate gave medical statisticians armed with data per thousand people rose from 14.6 to 27.2, from the General Register Office (opened and 16.9 to 31 [22]. So widespread was the 1837) the opportunity to contribute to exist - presence of disease by about 1840 that the ing debates, propose new health hypotheses, average lifespan was just 26 years if some - and offer pieces of evidence that supple - one lived in a settlement of 100,000 people mented notes in existing journals such as The or more [23]. However, the second point of Lancet (founded in 1823) about the health of note was the arrival of cholera. modern society. Overall, such analysis veri - Although common illnesses like whoop - fied the profits of civilization’s progress for ing cough, scarlet fever, smallpox, dysentery, the well-to-do who resided in salubrious sub - diphtheria, scrofula, measles, typhoid, typhus, urban districts. They were shown to have or influenza took many lives, it took an epi - been granted an apparent gain in their health demic in the early 1830s caused by a disease of levels, although it was noted to have occurred overseas origin — cholera — to instigate a at the expense of suppressing a healthful ex - new dynamic to urban living and the subject istence for the working population [20]. of health [24]. Rapidly attaining an infamous Attention must be placed also on the status, a repute transpiring from its seemingly surfacing of sweeping occurrences of dis - arbitrary manifestations, its virulence, ravaging Morley: City chaos, contagion, Chadwick, and social justice 67

Figure 6. A sketch from the early 1830s of a vic - tim of cholera in Sunder - land (source: Wellcome Library, London).

talent for killing quickly, and agonizingly, and municipal endeavor emerged, a small cholera prompting municipalities to form number of characters were central in helping Boards of Health — later shown to be inept to identify the factors that affected the health and corrupt (Figure 5). Nonetheless, cholera and illness of urban populations, expanding also inspired the medical community to further the theoretical framework of disease causa - venture into the slums to comprehend its na - tion, and engaging medicine with the politi - ture, e.g., Dr. Thomas Shapter who mapped cal economy of capitalist Britain. Some of cholera deaths in Exeter, in so doing position - these individuals, like William Farr, have ing contagionists against miasmatists as of been mentioned already in this paper, but a conjecture on its causes and diffusion [25]. key player in the meshing of medicine with Manufacturing unimaginable terror in the moral and political economy of Britain Britain after its appearance in 1831 in Sunder - was Edwin Chadwick. While it is not neces - land [26], cholera, like many other illnesses, sary to discuss in detail every aspect of paid scant respect to social class boundaries Chadwick’s life or all principles that shaped (Figure 6). When coupled with its ability to his thinking, some facets of his character defy conventional medicine, it engineered un - must nonetheless be considered. paralleled fear. The disease, a frightening Chadwick’s entry into discussions on silent spectacle, was unlike anything known the related “Condition of England Ques - before it. It was a psychological sledgeham - tion,” namely the expansive dialogue on mer to material progress [27] and all the per - problems such as poor housing and a lack of ceived benefits of modernity. With its air of urban hygiene, stemmed from his work with mystery, defiance, and with such minimal ex - the Poor Law Board. Even though at face planation as to its cause, cholera recalled the value, the Poor Law, with its brutal work - memory of the Middle Ages’ plagues. It house regime and the issue of epidemiology, shocked society like no other illness had done may appear to be two opposing faces of so - in recent times and generated everything from cial welfare, it was through Chadwick’s ap - general unease to riots. In light of the rise of preciation of the need to promote economic statistical analysis and contemporary ways of growth and maintain social order that his thinking about the social nature of disease, ideology on health and well-being devel - cholera became a compelling propagandist for oped. For that reason, some pertinent re - urban betterment, and warranted both political marks are necessary with regard to stability and social justice. Chadwick’s position within the 1832 Royal Commission into the Operation of the Poor Laws, a body putting forth Benthamite rec - THE POOR LAW, EDWIN CHADWICK, ommendations that led to the passing of the SOCIAL MEDICINE, AND THE CITY Poor Law Amendment Act in 1834. Prior to the 1840s, the decade within The constraints constructed into the which British public health as a profession Poor Law system, deterrents to stop all but 68 Morley: City chaos, contagion, Chadwick, and social justice

the neediest in society from claiming help, should be recognized at this point as being a governmental scheme not against poor people, per se, but as an apparatus hostile to the activities and conducts of the poor, whom the Poor Law administrators consid - ered socially iniquitous. It was thought that by implementing a welfare structure that sought at its core to encourage the dimin - ishment of bad habits like evading work (because of idleness or ill health) and so the need to claim relief, society at large would be known to improve itself. In this manner, the management of poverty through the amended Poor Law combined social, moral, and economics judgments. Impoverishment and disease were viewed as the end result of immoral habits as much as in the pres - ence of miasma. Implemented at a time Figure 7. British public health pioneers. Top when numerous reports by medical practi - (from left): Edwin Chadwick and Sir James tioners were increasingly highlighting the Kay-Shuttleworth. Bottom: Neil Arnott. union between poverty and infirmity [28], the Poor Law Commissioners deduced that 1840 by the Select Committee on the Health as much as Poor Relief lessened suffering, it of Towns as being imperative for reasons of was not sufficient in itself to end penury. To instigating justice for the poor and, rather this end, it was essential on economic meaningfully, sustaining the protection of grounds that measures were enforced to pre - property and security of the rich [29]. In vent ill health in order for laborers to short, the Poor Law Commission was chan - achieve their work and salary potential in neling the focus of the formative public the free market. In other words, it was im - health movement in Britain, defining its perative to root out the causes of disease so concerns and delineating its interests. workers could better contribute to the na - To appreciate further Edwin Chadwick’s tional industrial machine. Accordingly, as unfolding approach to the subject of public studies into the daily lives of the working health and the creation of a paradigm from class were necessary, interest in etiology 1842 to deal with poor urban health, it is not was roused, and public health measures pur - necessary to dwell so much on the limited sued. In 1838, Chadwick commissioned scientific understanding of the early 1800s renowned medical practitioners James Kay [29], but it is necessary to try to grasp the and Neil Arnott (see Figure 7) to investigate profundity of doctrinal, cultural, and social the “physical causes of fever … which turmoil that economic growth had instigated might be prevented by proper sanitary prior. Of course, in as much as the narrow measures” in London. This was a response scientific base of the 1830s was crucial as to to an upsurge of illness but also was a skill - how disease was managed in Britain and did ful political maneuver to deflect critical at - lead miasmatists, that is individuals who tention that the Poor Law and destitution considered disease to be caused by “bad air,” were primary causes of disease. Irrespective like Chadwick, to undertake urban better - of reasons, the intention of the commission ment albeit for the wrong reasons, it is also was weighty. Emphasis now was placed vital to understand how the broader era in onto the roots of disease and issues of san - which these people lived and its influence itation. Attention also was placed upon pre - upon how those interested in urban health af - ventive measures, something described in fairs thought. Morley: City chaos, contagion, Chadwick, and social justice 69

HISTORIOGRAPHY, Consequently, better hygiene was needed to THE 1842 REPORT AND BEYOND counteract the threat of insurrection. But if Although a great deal of medical histo - prevention was the key to public health, on riography has emphasized the significance what was it to be precisely defined? Chad - of the onset of public health as a profession wick’s 1842 report proposed an explanation. and a municipal activity, much criticism of To be succinct, the Chadwick Report, a the role of miasmatists in light of their erro - graphic exposé of “the extent and operation neous scientific erudition has meant that of the evils” that contributed to the spread of many basic cultural facts have been neg - disease in urban communities and “the means lected. This paper, therefore, is an opportu - by which the present sanitary condition of the nity to redress this situation somewhat. As a laboring classes may be improved,” was a case in point, it is easy to forget how the milestone in social history and the quest for British were a nation of people placed within public sanitary reform. Through the attentive the setting of rapid cultural transition, the application of descriptive environmental ac - manifestations of which had a sense of speed counts and statistical analysis, Chadwick’s and intensity never before seen, plus new so - findings were overwhelming to even the most cial dynamics and relations. British bureau - non-interventionist. As he put it, Britain’s dire crats like Edwin Chadwick, an individual urban environments and the ill health it charged with dealing with the massive social helped promulgate was akin to a war that was issue of welfare and impoverishment, not killing more every year than any military con - only attempted to solve grave social matters flict in which Britain had ever been involved. without the advantage of entrenched empiri - His report was a dogma of facts summarizing cism, but also faced the double difficulty of in startlingly simple yet hard-hitting terms a preemptively building an administrative ap - physiology of poverty and immorality cen - paratus in order to manage processes of cul - tered both on muck and the loss of male tural change that had no foreseeable ending. breadwinners. Together, they were shown to Thus, the Chadwick Report should be ac - have created 43,000 new widows and knowledged as not only being a survey of 112,000 new orphans per annum; an exten - the social and environmental condition of a sive loss of working ability due to poor large number of towns and cities, but an act health; and the poor in places like East Lon - to create public health policy. It was a multi- don were dying at an average age of 29 years purpose endeavor to understand and manage less than the wealthy. cities in accord with prevalent social and Of equally significant, yet frequently economic principles and a rational theoriza - underestimated note, was the Chadwick Re - tion of the behavior of contagion. It was a port’s masterful control of language to means to encourage the cleaning up of urban prompt political persuasion. To illustrate this environments so as to make people healthier, point, Chadwick undoubtedly realized that but it was also the result of an adroit bureau - to achieve the end of instigating urban bet - cratic politicization of public health beliefs, terment, great value was to be obtained by a gambit to guarantee future political action. focusing on matters of engineering, e.g., re - There is little reason to deny that the lating to aspects of health. Therefore, by Chadwick Report was a groundbreaking dealing with matters of a range of urban and piece of research. Its effect was to bring to - moral conditions, Chadwick could promote gether formerly isolated health and sanitary his public health agenda. In this way, not strands, therefore reinforcing the need for only could he instigate municipal interest in legislation to deal with health issues. Its un - a variety of matters relating to urban health dertaking was based on a rational reaction to and improvement, but what’s more, he was urban problems and the presence of factors able to navigate around what were previous like the advent of political machinations as - litigious matters relating to public health, sociated with “dangerous classes,” a social such as questions of need and cost relating to group seen as a derivative of bad sanitation. the implementation of drainage systems. 70 Morley: City chaos, contagion, Chadwick, and social justice

Presenting the 1842 report as one on to acquire legal fruition until 1848, when a sanitation, a novel scientific and social field, suitable legal balance between local and na - Chadwick put forth a highly developed doc - tional governmental interests was found. ument in which he discussed air, sewers, With the passing of the Public Health Act, dung heaps, water, the built environment, for the first time the industrial world pro - and people and argued that the problems re - vided a proactive system of public health garding each one were obstacles to the im - and required local governments, which be - provement of others. In turn, an argument came local health authorities, to guarantee was put forth that improvements to sewers, minimum environmental standards [31]. for example, could positively improve mat - Shaped by miasmic medical notions, ters of water or housing, and in so doing i.e., disease was associated with noxious serve as a catalyst to improve the structure odors, impure air, and poor sanitation, the of urban society. Environmental determinism 1848 Public Health Act, though permissive, was a defense for legal intervention, sug - was a breakthrough in health culture [32]. It gested Chadwick. To sit back and do nothing purveyed a new tradition of well-being in for whatever reason was insupportable. Cor - which health was a fundamental instrument relating poorly planned environments with of local democracy. To ward off disparage - bad health and/or people’s immoral behavior, ment about heightened bureaucracy, public Chadwick presented an argument that was health was to be not defined by central gov - difficult for his critics to dismantle by mak - ernment but rather by municipal govern - ing at the core of his case the ability of drains ments that would implement schemes given and clean water to improve morality. Sanita - local needs and circumstances (though cer - tion, he proclaimed, would defuse rowdiness tain minimum standards regarding financial and decadence and make once “dangerous and technical configurations were enforce - classes” compliant. It would make society able from Westminster). Even those politi - more secure as well as improve health. With cians most resistant to the call for public his confidence in society’s ability to further health, due to its perception with autocracy, advance itself, Chadwick recommended cer - were overcome as local autonomy was tain methods to allow urbanization to correct maintained, albeit with central government the wrongs it had helped produce earlier. In given the right to guarantee certain mini - this way, urbanization, once the root of work - mum standards. Any settlement with a death ing class burdens, was to now be controlled rate exceeding 23 per 1,000 of the popula - and so be its own antidote. tion had to immediately form a localized To allude for a second time to the issue Board of Health as did one at the request of of Chadwick’s detractors, they attempted to 10 percent of the ratepayers. The provision stop any public health implementation post- of paved streets, clean water supplies, and 1842 by adhering to a line of reasoning sewage disposal was an imperative as was about the dangers of having increased cen - the introducing of rulings to new privately tral government intervention. In a way, this built housing that had to be constructed in was a result of the nature of Chadwick’s re - accord with minimum structural standards port and its factual rather than judgmental and minimum amounts of light, air, and perspective and avoidance of contentious is - space. Taking a long-term approach to bet - sues like the running of the economy. Thus terment, the act was a precursor to the assur - to argue against the report’s particulars ance to bring more social justice to those would have been injudicious. Instead, to hindered by the social and economic cir - weaken Chadwick’s case, critics focused on cumstances instigated by the Industrial Rev - other issues, namely public health’s bureau - olution [33]. As R.A. Slaney MP remarked cracy and its fiscal cost. Both were vehe - in the parliamentary debates leading up to mently attacked. Critics compared its central the passing of the 1848 Act, public health at bureaucracy with problems in autocratic its core was not about kindness but was a France. Chadwick’s report thus was not able call for fairness: “If they did not protect that Morley: City chaos, contagion, Chadwick, and social justice 71

property [health, well-being], did they do the conditions that meant, for example, all new poor man justice?” [34] houses and streets had to be built to certain structural criterion. Thanks to Chadwick’s political influence, public health proponents CONCLUSION were able to establish it as an entrenched re - From the early 1800s onward, the sponsibility of local and national government British were faced with understanding and in Britain, just as it did in subsequent years in managing two phenomenon associated with other societies. Importantly, too, due to the the Industrial Revolution. The first was an broad nature of Chadwick’s sanitary report extraordinary level of urban problems fol - in 1842, a view was borne that poor health lowing the rapid growth of existing towns was affected by a variety of causative factors, and cities from the late 1700s. Then, as even if these were somewhat contestable much as industrialization’s onset was as - given limited contemporary scientific knowl - sumed to provide an upward trend in the edge. Even so, the formative national public condition of society, the British had to ac - health framework constructed in 1848 was cept by the 1830s that this notion was able to embrace a plethora of dynamics con - flawed, as evidence provided by the medical sidered as having a negative impact on peo - community was starting to prove. As a con - ple’s moral and physical well-being. sequence, the British had to redefine their To conclude, although the chronological orthodoxy on material progress and fully ap - frame presented by this paper is limited, mas - preciate that differences one had in terms of sive transformations with regard to urban think - life expectation and health from birth was ing were made in the 1830s and 1840s that still manifest within the industrial social milieu. echo today. The British attitude toward public However, to comprehend and then manage health, albeit far from perfect, encouraged the this situation was far from straightforward. perspective that all citizens regardless of class, Legal, scientific, moral, economic, and po - occupation, or place of residence, must be litical concerns all had to be meshed into a treated equally. Today, just as then, this is un - coherent strategy before problems of health derstood to form social justice. Apartheid of and housing, for instance, could be tackled health was considered to be intolerable. Thanks directly. Moreover, to activate any political to evidence provided by medical practitioners, strategy required a superlative sanitary tech - British bureaucrats took actions that were to nocrat, someone of pragmatism and political culminate in the implementation of legal appa - know-how, as well as some degree of sani - ratus to assure improved health. Although con - tary understanding. In the case of early cerns about public health persisted, in part due 1800s Britain, thankfully, a number of indi - to the magnitude of problems formed by un - viduals of vision did step forward and pro - controlled rapid urban growth, subsequent vided rational perspectives and solutions to socio-medical reports after 1848 and new hous - the “Condition of England Question.” ing erected under sanitary legislation confirmed Central to the British process of dealing the benefits of public health in negating the with the malformed nature of urban society well-being risks introduced by industrializa - in light of industrial change and rapid urban - tion. Health, as a basic necessity and human ization was Edwin Chadwick, who from the right, was confirmed as being fundamental to early 1830s initiated mechanisms and inves - the success of any economy and society as a tigations to improve the health of the popu - whole. If the legacy of Chadwick and his peers lation. Coping with an enormously was nothing else, it was this. And all industrial challenging task, Chadwick, by 1848, had societies after Britain have to be thankful to the laid down basic principles for improving founding of this tenet. public health in Britain, organized municipal REFERENCES governments into acting as centrally account - 1. The Office of Population Censuses and Sur - able health authorities, and promoted a more veys. Census 1831-1841. London: HMSO; effective provision for improving sanitary 1841. 72 Morley: City chaos, contagion, Chadwick, and social justice

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