A temporary Board of Health was set up that advised local governments to set up their own Boards of Health to issue advice to people. Some towns and cities implemented the advice but others did not. Councils were often uncertain if they could enforce the measures put forward by the Board of Health.
In 1831 John Snow had fought a cholera outbreak in Newcastle. He became convinced that cholera was a water-borne disease and in 1849 he published ‘On the mode of communication of cholera’. Unfortunately this remained just a theory. Whilst working as a general practitioner in Soho, he was convinced the source was a pump on Broad Street. Once the authorities had locked the pump the number of deaths fell dramatically. Snow supported his theory with evidence. People who had drank from the pump but did not live in the area all died and an entire workforce of a nearby brewery, who were supplied with free beer all remained free of cholera. However, the establishment still insisted that the impure waters participated in the atmospheric infection of the air.
In 1856, John Simon found that residents of Lambeth and Southwark had significantly different death rates. This was because Lambeth got its water from up river and Southwark got its water from near a sewer outlet. However, it was another 10 years before the establishment accepted that cholera was a water-borne disease. It was not until 1870 that Snow’s theory received universal acclaim and Simon finally abandoned the miasmic theory.
James Kay was one of the first people to demonstrate the connection between dirt and disease. His report, ‘The Moral and Physical Conditions of the Working Classes Employed in the Cotton Manufacture of Manchester’, had a tremendous affect on people’s attitudes towards public health. Kay reported that disease was more common in poorly ventilated narrow streets with poor quality housing. The widely held belief was that dirty living led to dirty habits.
Edwin Chadwick responsible for collecting information on the connection between environment and disease. Chadwick and his team set to work in various parts of London and the results mirrored those found by Kay. More importantly the report had official sanction.
James Graham requested a report covering the whole country to be made ready by 1842 but the Poor Law commissioners refused to allow it to be published because it criticised the water companies, the medical profession and local administration. Chadwick eventually had the report published under his own name in 1842. The report was named ‘ The Sanitary Conditions of the Labouring Population.’ Chadwick had attacked the inadequacy of existing water supplies, drainage and sewerage systems, pointed the finger at the vested interests that stood in the way and had stressed the connection between overcrowding, epidemics and death.
Graham set up a Royal Commission on the Health of Towns. This was to investigate more fully the legislative and financial side of Chadwick’s recommendations. The first report, ‘Report of The Royal Commission into the Sanitary Condition of Large Towns and Populous Districts’ was published in 1844 and it upheld Chadwick’s findings. The second report in 1845 had clear legislative proposals in relation to sanitation administration, inspection and management. However, the public remained uninterested.
The Liverpool Sanitary Act was passed in 1846. It was different to the other acts because the Liverpool authorities had specifically asked for it. However the acts were there if local authorities wanted to take advantage of them.
In 1848 a General Board of Health was set up which reported directly to Parliament. Local authorities were allowed to set up local health boards that were to manage sewers and drains, water supply and refuse disposal. But this Act was permissive rather than mandatory. It only applied where people wanted it but before the Act could be passed, at least 10% of those rated for poor relief had to petition for it.
The response to the 1848 Public Health Act was initially slow. The second cholera outbreak in Britain consumed most of the time and resources of the General Board of Health. By 1850, 192 towns had applied for the new public health regulations but only 32 had it applied to them. During the next three years a further 92 petitions were received and the number of towns succeeding had risen to 182.
In Lancashire barely a fifth of its population lived under a public health board. Of the 187 major towns nearly a third had no public health authority at all. Even when boards were set up it was often people with the same vested interests running them. Raw sewage still ended up in the water supply as toilets drained into the nearest river.
The 1848 Public Health Act failed because the medical knowledge was unclear. The mixture of private Acts caused confusion amongst the public and the engineering required was expensive. Despite all its failings the Act did demonstrate that the government was prepared to get involved in supporting the needy and vulnerable.
A decade later, the General Board of Health was abolished. Instead a Local Government Act Office was created and the Privy Council set up a medical department. The decade that had passed since the 1848 Act had clearly demonstrated the need for greater powers. The Local Government Act Office allocated the loans given for public works. It was the Central Government that played a direct role and became involved in the administration of public health.
A key mover behind the 1866 Sanitary Act was John Simon. Unlike Chadwick, Simon worked with people. He used existing law to aid him when he face opposition but relied mainly on his persuasive powers. Simon argued that discretional action was no longer enough and that compulsory powers were needed. Local boards became responsible for removal of nuisances to public health and if the local authorities failed to act, the central government intervened and charged the local authority for any work that was carried out.
For the first time, compulsion was a significant element for an Act of Parliament dealing with public health. The state could now compel local authorities to act. It is from this point on that the state actively directed the public health reform.
The 1875 Public Health Act made sure medical officers and sanitary inspectors were made mandatory for every authority. It ensured that all aspects of health, sewers and drains, water supply, housing and disease were now being improved and would eventually become the health system we know today.