by Jeremy Black
Yet it is important not to exaggerate the degree and pace of improvement. Poor housing, low incomes and crowded hospitals remained a threat to public health. In 1866, 43 per cent of Newcastle’s population was still living in dwellings of only one or two rooms; in 1885, 30.6 per cent. In 1911, 12.8 per cent of Scotland’s dwellings still had only one room, and in 1918, 45 per cent of Scotland’s population still lived at a housing density of more than two people per room. Disease, moreover, continued to hit hard. Gastro-intestinal disorders linked to inadequate water and sewerage systems were responsible for Bradford’s very high infant morality rates in the late nineteenth century, and for comparable problems in crowded parts of Newcastle and elsewhere.
More generally, the supply of fresh cow’s milk became badly infected in the 1880s and 1890s, leading to a serious increase in diarrhoea in inner cities in hot weather and a rise in infant mortality in the 1890s, especially as the practice of breast-feeding decreased. The extent to which applied knowledge and government action were seen as important is apparent from the three Royal Commissions that focused on the transmission of tuberculosis to humans via milk.
Death rates, especially due to the infectious diseases of early childhood, such as measles and scarlet fever, were higher in urban areas, so the redistribution of the population through migration to the cities delayed the decline in national mortality. Yet, serious public health problems also existed in small towns and rural areas. Rural poverty, the impact of the agricultural depression, opposition to the interference of central government, and the preference for traditional practices (including inaction), could be a potent mix. Reports revealed that the Somerset town of Bruton had inadequate sewerage disposal and a lack of clean water in the 1870s and 1880s, but a reluctance to spend money ensured that plans to alleviate the situation were delayed; although the sewerage system was finally improved, Bruton did not construct a water supply system in the Victorian period.
Furthermore, industrial activity and developments led to increased or new sources of pollution. In Sunderland, where shipbuilding brought good jobs and a large percentage of workers owned their houses, life took place under a thick layer of coal dust, which was definitely detrimental to health. The sky was smoke-blackened. More generally, gas-works produced coal-gas tar which drained into rivers, polluting them.
Public Health, Poverty and Reform
Working conditions were frequently grim. Industries such as steel were ‘sweated’ and created a workforce whose leisure centred on the company pub where men could rehydrate, sometimes with four quarts (4.5 litres) a day paid for by the employer. In addition, poor ventilation, a problem in mines, helped the build-up of gas, leading to explosions. The average annual death rate from fatal accidents per 1,000 workers underground in 1875–93 was 2.09 for coal miners, 2.34 for Cleveland ironworkers and 3.23 for Ffestiniog slate miners. In 1878, 189 men and boys were killed by an underground gas explosion at Wood Pit in Haydock, Lancashire.
Mining was physically punishing as well as dangerous. The records of Welsh troops discharged on medical grounds in the First World War indicated the strains of pre-war work: colliers were found to be suffering from hernias and poorly mended broken bones. Miners’ health was also affected by dust particles. Other production processes were also dangerous. The manufacture of matches from yellow phosphorous, a task employing many women, contributed to jaundice, psoriasis, chronic diarrhoea and phosphorous rotted jaw. Trawling for fish was another dangerous occupation with many deaths.
Legislation regulating conditions of employment still left work both long and arduous. The Acts of 1847 and 1850 reduced the hours women and thirteen- to eighteen-year-olds could work in the textile industry, but only to ten hours daily. In 1907, however, there were still 5,000 children under thirteen working half-time in the Bradford worsted industry.
Furthermore, the decision to tackle public health essentially through engineering projects directed by administrators ensured that alternative responses, such as measures to alleviate poverty, were sidetracked. The focus was on sewerage systems and clean water, and not on securing the supply of food and work or income at levels sufficient to lessen the impact of disease. If the bulk of the working population faced difficult circumstances, the situation was even worse for those who were more ‘marginal’ to the economy or to society’s moral framework. Henry Stuart, who reported on East Anglian poor relief in 1834, found three main groups of inmates in the often miserable parish workhouses: the old and infirm, orphaned and illegitimate children, and unmarried pregnant women; the last a group that was generally treated harshly, far more so than the men responsible. Aside from scandals in individual workhouses, the situation in many was bleak. In Wimborne, beds had to be shared, meat was provided only once a week, there were no vegetables other than potatoes until 1849, husbands and wives were segregated, and unmarried mothers had to wear distinctive clothes. In general, expenditure was severely controlled, discipline was harsh, and the stigma attached to dependent poverty grew.
The Poor Law Amendment Act of 1834 had introduced national guidelines in place of the former, more varied, parish-based system, but the uniform workhouse system that it sought to create and that lasted into the twentieth century was not generous to its inmates. Outdoor relief was abolished for the able-bodied, who instead were obliged to enter the workhouse where they were to be treated no better than the conditions that could be expected outside in order to deter all bar the very destitute from being a charge on the community. Bastardy and indigent marriage and parenthood were to be discouraged. The system was overseen by the Poor Law Commissioners in London. The legislation was strongly resisted by the Anti-Poor Law movement, and outdoor relief continued into the 1870s.
The prioritization of public health accorded with the importance given it by the reforming middle classes and their priorities helped ensure that there were steadily greater attempts to create a legislative framework for reform. In place of a reliance on self-help and the efforts of local communities, there was a stress on institutional provision and national standards. The Factory Acts of 1860 and 1874 regulated conditions of employment, the Metaliferous Mines Acts of 1872 and 1875 sought better working conditions underground, including by improving ventilation, and the Miners Regulation Act of 1908 limited the number of hours that miners could spend underground.
Attempts were also made to improve and regulate society, especially the cities, which seemed particularly troubling, with their rapid growth and lack of established social controls. The County and Borough Police Act of 1856 made the formation of paid police forces obligatory. Policing sought to bring order and decorum to the streets. Moreover, in 1854, pubs in England were forced to close at midnight on Saturday and, except for Sunday lunch and evening, not to reopen until 4 a.m. on Monday. Complete Sunday closing was enforced in Scotland from 1853 and in Wales from 1881. Drinking was also affected by the 1869 Wine and Beerhouse Act and the 1872 Licensing Act. As pubs were central to working-class communal experience, and alcohol lessened inhibitions, these charges were very much part of a more controlled society; although self-regulation was also a key theme.
Social Assumptions
It was no longer a case of change affecting society, politics, the economy and culture. Instead, change became integral to their structures, and, in part, their ethos. Social criticism became more common. Under the heading ‘The Lord Lieutenant and the North Devon Railway’, Trewman’s Exeter Flying Post of 3 January 1856 reported at length a clash between the mores of aristocratic society and the notion of public responsibility:
Express trains will not do the bidding of Lords Lieutenant. Railways are not managed as are coaches; – the times of arrival and departure, as advertised, are kept as regularly as possible; and a railway superintendent would as soon think of keeping a train back to accommodate a peer of the realm as he would of sending off a train too soon to baulk a director. Lord Fortescue, however, seems to think that in his case exceptions ought to be made to the rule which go
verns all railway companies. It was his misfortune to be in the down express from Bristol last Saturday afternoon week, which did not happen to reach Taunton until after the time it was due at Exeter. The North Devon train is advertised to leave the station at 3.30, – half an hour after the arrival of the express. The superintendent having ascertained by telegraph that the express was much behind its time, started the North Devon train at 3.45.
Fortescue complained about the failure to delay the latter, despite the large number of passengers on it, leading the paper to ask, ‘Does Lord Fortescue mean to say that these should have been detained an hour and a half to suit his Lordship’s convenience?’ Thus, the broad acres around the ancestral Fortescue seat at Castle Hill in north Devon provided scant guarantee against the reality and criticism of a new world. There was also potent criticism in the fictional world. In his novel Bleak House (1852–3), Charles Dickens not only indicated the coldness of law and Church, but also society, in the haughty personages of Sir Leicester Dedlock – ‘his family is as old as the hills and infinitely more respectable’ – and his wife, who are revealed as concealing a guilty secret. Such accounts served to identify and criticize an entire class.
Yet, although the world of the 1850s had democratic aspects, it was very much a nation that was to be guided by moral conduct. Paternalistic and evangelical concern about Christian welfare lay behind much pressure for reform, rather than egalitarianism. These values were noted in the 11 July 1855 issue of Chudleigh’s Weekly Express which praised the situation under which ‘the children of our poorer brethren here receive a sound religious and moral education’. Education was certainly seen as a key goal. Under the heading ‘Popular Education’, the Western Times of 25 January 1851 declared:
We have only space to refer to the satisfactory report of the meeting held at the Guildhall, to establish public libraries. We should prefer seeing a more direct effort to promote the education of the destitute youth and children of the city, but we receive the conclusions of the meeting as an admission of the public duty to provide a means of education for that class of society whose means do not enable it to educate its offspring.
Paternalism was linked to social order, so that in the late nineteenth century those who killed a social superior were punished more severely than the opposite, while working-class killers were more likely to be executed than their social ‘betters’.
Change challenged all institutions and was unsettling for much of the population. The varied manifestations of this unease included hostility to immigrants, which was more of an issue towards the close of the century, and a wider disquiet about the state of the nation, not least the extent of urban poverty and the social problems associated with it. This concern encouraged social analysis, led to calls for public action and promoted charitable missions.
The plight of poor children moved crusading philanthropists such as Thomas Barnardo (1845–1905) who, in 1867, founded the East End [of London] Juvenile Mission, the basis of what later became ‘Dr Barnardo’s Homes’ for destitute children. From 1882, he sent some children to Canada for resettlement. Similarly, in 1869, the Reverend Thomas Stephenson (1839–1912) established near Waterloo Road, London, a refuge for destitute children, the basis of the National Children’s Home. In Whitechapel, in the East End, in 1865, William Booth (1829–1912) and his wife Catherine launched the ‘Christian Mission to the Heathen of our Own Country’ and, thirteen years later, this became the Salvation Army. Initially focused on spiritual salvation, the Salvation Army’s mission also became directed at social reform. Wilson Carlile (1847–1942), an Anglican curate in Kensington, matched this by launching the Church Army in 1882, again linking evangelism and social welfare. Temperance was a key theme of the moral rearmers. Emma Cons (1838–1912), who owned the Old Vic (formerly the Royal Coburg Theatre and then the Royal Victoria) from 1881 until 1912, provided decent and moral entertainment on temperance lines.
The motives of crusading philanthropists have been queried in recent decades, but, however much philanthropy could serve the interests of the donors’ spiritual well-being, curiosity and even personal aggrandizement, there was a drive both to offer relieving improvement and, in understanding the plight of the poor, to provide a more nuanced appreciation of the social environment. Yet, the moral panics about the plight of the poor that crusading philanthropy and journalism inspired, were, to a degree, replicated by unease about the willingness of philanthropists to compromise class and gender assumptions and roles in their charitable work. Their focus was on the East End, which became more orderly as a result of the major effort for public improvement.
The Pressure for Improvement
Educational expansion and reform were part of this process of public improvement. They also reflected the range and energy of Victorian philanthropy. Mason Science College, which eventually became part of the University of Birmingham established in 1900, was founded in 1880 by Sir Josiah Mason (1795–1881), a self-educated manufacturer of split-rings and steel pen-nibs. He spent part of his fortune on local orphans as well as on his new foundation, which was designed to be especially useful for local industries. Men such as Martin set the self-conscious tone of much of urban Victorian Britain. Their views and wealth were a tremendous stimulus to the process of improvement.
As government became more activist and regulatory, so the goal of politics increasingly became seizing the opportunity to push though policy, as much as office-holding for personal profit and prestige; ideology rather than interest. Linked to this, the nature of power within society was now discussed to a greater extent than a century earlier. The expanding middle class, which, unlike its counterpart in the late twentieth century, worked for the private rather than the public sector, expected power and status. In pursuit of its interests and views, the Victorian middle class, like its later counterpart, was dubious of established institutions and practices that did not seem reformist or useful. Deference was eroded and reconceptualized, as middle-class views and wealth stimulated a demand for, and a process of, civic and moral improvement that was central to the movement for reform, with government action increasingly seen as a substitute for the resort to religious faith. This movement was directed as much against the habits of the poor as those of the Establishment and inherited privilege. Rational organization, meritocratic conduct and moral purpose were the goals.
It would be misleading to see change as arising only due to reforming Liberal and, from 1924, Labour governments. Instead, as earlier in the late nineteenth century, and again, in part, as an aspect of the interplay between remedies linked to the state, voluntary bodies and individuals, there was a widespread and continuous commitment to reform. Thus, the Midwives Act of 1902, passed by a Conservative government, and the Maternity and Child Welfare Act of 1918, passed by the Coalition, improved infant and maternal health care and encouraged a sense of public responsibility. The Midwives Act improved the registration and quality of midwives, and this measure has been linked to a fairly steep decline in infant mortality after a peak in 1900.
By 1914, a basic national network of infant and child welfare centres had been created. Health-visiting was expanding. Educational authorities had been made responsible for the medical inspection of schoolchildren. Isolation, tuberculosis, smallpox and maternity hospitals and sanatoria were established by local authorities, elements of the process by which social welfare was linked to a growing institutionalization of society, which also led to the construction of schools, workhouses and asylums.
Medical Advances
Far from unconstrained capitalism, this was increasingly a regulated society. In his novel When the Sleeper Awakes (1899), H.G. Wells felt able to look forward 200 years to a world where disease had been vanquished, and there was enough food, a misleading utopia but one that cast light on what seemed possible at the time. Improved diet, thanks in part to a significant fall in food prices, had already played an important role in the decline in mortality rates, which in Newcastle fell from 30.1 to 19.1 pe
r thousand between 1872 and 1900. Medical advances, not least the replacement of the ‘miasma’ theory of disease by that of ‘germs’, helped, although mortality contrasts between registration districts persisted and there was a noticeable, although not invariable, relationship between life expectancy and population density, and thus poverty.
Medical knowledge and care improved in the early decades of the century. For example, the use, from the mid-1920s, of insulin, discovered in 1922, enabled diabetics to live. The increased distribution in the inter-war years (1918–39) of vitamins, which had been discovered earlier in the century, as well as the establishment of antenatal screening, were important in health, as were improvements to the milk supply through the introduction of milk depots and the provision of free pasteurized milk.
Inter-war medical advances included immunization against diphtheria and tetanus, improved blood transfusion techniques (which owed much to the experience of the First World War), the use of gamma globulin against measles, and the first sulphonamide drugs which, although later outclassed by antibiotics, had a major impact, especially on streptococcal infections, and were widely seen as miracle drugs. The Poor Law infirmaries and, from 1929, the municipal hospitals, offered free care; and the specialist hospitals had long offered care at a price that artisan and lower-middle-class families could well afford.
Yet, there were still major problems with public health, poor housing and medical provision in the inter-war years, even before the major crisis caused by the Depression of the 1930s. Much of the population did not benefit fully from medical advances, and health indicators continued to be closely related to socio-economic factors. Tuberculosis remained serious, especially among the urban poor, although death rates had a steady downward trend from about 1870. Hospital provision varied greatly across the country.
