City Chaos, Contagion, Chadwick, and Social Justice
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YALE JOURNAL OF BIOLOGY AND MEDICINE 80 (2007), pp.61-72. Copyright © 2007. ARTS & HUMANITIES City Chaos, Contagion, Chadwick, and Social Justice 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.