In the beginning there was paradise: “Life was without evils, hard toil and grievous disease.” But all changed, according to the poet, “thousands of miseries now roam among men that bring evils to the mortals.”  (Hesiod 700 BC)

Painted Garden, Villa of Livia, Prima Porta, Italy, 39 BCE.
                                             Painted Garden, Villa of Livia, Prima Porta, Italy, 39 BCE.

 Yet by the mid- eighteenth century many intellectuals shared the belief that humankind was about to enter a ‘’Golden Age” one of indefinite progress. This new era would be led by science and characterized by new technological developments and advances in industry. Erasmus Darwin, an English physician, saw these forces as providing humans with all the necessities to master nature, conquer disease and even disarm death itself. Writing just before his suicide in 1794, the Marquis de Condorcet also envisaged modernization, particularly the impact it would have on the people’s health, as creating social regeneration. “The average length of human life will be increased, and a stronger physical constitution will be ensured.” These visions of optimism would soon be crushed by those holding a very different view.

 According to the Revd. Thomas Malthus only danger and suffering lay ahead. In An Essay on the Principle of Population as it Affects the Future Improvement of Society (1798) he argued that material progress would led to inexorable population growth resulting in too little resources for too many people. From Malthus’s viewpoint, the consequences of this would be devastating: endemic famine, conflict and disease. In later editions of his work, the parson suggested the only way out of this dystopian would be “moral restraint”. Many have criticized Malthus’s philosophy as doom–mongering with potentially extreme consequences. However, Malthus argued social as well as personal action would be necessary to prevent mass calamity. One of the more palatable methods of prevention he suggested was the adoption of universal public health initiatives.    

 Public health is about maintaining health and preventing or controlling disease. In Britain, the movement began in the nineteenth century, but the system was constructed on earlier socio – political and medical structures concerned with managing disease epidemics. Central Government’s creation of a modern public health system was in direct response to the rapid industrialization and urbanization that created unprecedented levels of poverty and disease.

A series of cholera pandemics, which first hit Britain in 1831, is commonly viewed as the primary catalyst but – as this article will discuss – the movement was always about social control and disease control in equal measure.

The Plight of the Urban Poor

The Slums of London by Gustave Everett
The Slums of London by Gustave Dore.

 From about 1750 to 1900 Britain’s population rose by 300% from around 6 to 18 million. By the1880s 80% of the country’s inhabitants were urban dwellers, with two out of three workers employed in manufacturing or linked occupations.   

Similar patterns were repeated in other European cities, but nowhere experienced such large-scale population growth as London. The first official census of 1801, recorded 800,000 living in the Capital, by 1901 this figure escalated to include a further 6 million, London became the largest and wealthiest city in the West and probably the world, but for the majority of Londoners survival in the ‘golden city’, came at a deadly cost.

The nineteenth century was self-consciously an age of improvement, but it was also haunted by the social question of the plight of the rural and urban poor. The poor had always been ubiquitous in Britain, but industrialization made their predicament more acute.   

It is impossible to measure the percentage of people living in London who fell below the poverty threshold, but if surviving institutional records and contemporary accounts are anything to go by it would seem that poverty was rife.

In the early nineteenth century there were a range of solutions on offer to help manage short-term hardship; some religious, some medical and some philanthropic. Along with voluntary organizations local authorities administered a system of ‘outdoor’ relief to their indigenous poor. 

The Old Poor Law had been established during the Tudor period but by the 1800s the statute was deemed inadequate to meet the demands of a society undergoing rapid transformation – creating more people requiring support. Also, many nineteenth century contemporaries argued that the traditional methods were a waste of taxpayers’ money as it only encouraged idleness and immorality amongst the poor. 

In 1832 Parliament set up a Poor Law Commission to amend the system. Edwin Chadwick was educated in law and served as the secretary to utilitarian philosopher Jeremy Bentham. Chadwick’s advocacy of a strict, scientific centralized bureaucracy earned him the position of the leading architect in the Poor Law Amendment Act. It also earned him the position as the most detested man in England especially by the poor themselves.

The Court of King Cholera

The New Poor Law of 1834 functioned as the mechanism for poor relief in Britain until its abolition in 1929. It introduced the workhouse system as a ‘final solution’ to elevate want and waste. Administering the new scheme soon confronted Chadwick with the link between poverty and disease. His observations were not particularly novel at the time; for centuries it had been noted that sickness and disease almost exclusively reigned among poorer communities where the population was denser and overcrowded living conditions and malnutrition were prevalent. He noticed that a large proportion of workhouse inmates were either chronically sick or disabled, to such an extent that special workhouse infirmaries had to be established at more public expense.

Chadwick closely monitored the situation and concluded that it was not entirely people’s fecklessness that created the high demands on poor relief: ill health had affected the individuals’ ability to work. His findings did not totally reverse the theory shared by many of his supporters, that the poor were poor because of their own wrongful doings, but in 1837, Chadwick appointed three doctors to investigate the London districts with highest typhus mortality. Their reports revealed the grim reality of some of the Capital’s worst affected areas.


Berridge, Virginia, Martin Gorsky & Alex Mold. 2011. Public Health in History. McGraw-Hill Education.

Halliday, Stephen. 1999. The Great Stink of London: Sir Joseph Bazalgette and the Cleansing of the Victorian Metropolis. The History Press.

Hamlin, Christopher. 1996. ‘Edwin Chadwick, “Mutton Medicine,” and the Fever Question’, Bulletin on the History of Medicine 70:2.

Hamlin, Chris (1998).  Public Health and Social Justice in the Age of Chadwick: Britain, 1800-1854. Cambridge University Press. 

Porter, Dorothy. 1999. Health, Civilization and the State: a history of public health from ancient to modern times. Routledge.

Porter, Roy. 1994. London a Social History. Penguin.

Porter, Roy. 1997. The Greatest Benefit to Mankind. W. W. Norton. 

To cite this post : Julie Mathias, “ The Foundations of  Modern Public Health: The ‘Body’ and the Environment in Nineteenth Century London”, Curious Histories (blog on, April 5th, 2020. [On line]

Julie Mathias is the Head of Learning at the Old Operating Theatre Museum and Herb Garret. Her role includes convening the schools programs for students studying the “Medicine Through Time” series and related subjects. As a social historian Julie is interested in the history of ‘ordinary’ peoples’ experiences of health, illness, and death, and how investigating this fascinating phenomena enriches our present day understanding of our own bodies.

Twitter: @JulieMathias11

The Foundations of Modern Public Health: The ‘Body’ and the Environment in Nineteenth Century London