In The Healthy Body and Victorian Culture, Bruce Haley asserts that the Victorians were concerned with health over almost all, if not all, other issues. The following passages are excerpted from his book:

Nothing occupies a nation's mind with the subject of health like a general contagion. In the 1830s and the 1840s there were three massive waves of contagious disease: the first, from 1831 to 1833, included two influenza epidemics and the initial appearance of cholera; the second, from 1836 to 1842, encompassed major epidemics of influenza, typhus, typhoid, and cholera. As F. H. Garrison has observed, epidemic eruptions in the eighteenth century had been "more scattered and isolated" than theretofore; and in the early decades of the nineteenth century there had been a marked decline in such illnesses as diphtheria and influenza. Smallpox, the scourge of the eighteenth century, appeared to be controllable by the new practice of vaccination. Then, in the mid-twenties, England saw serious outbursts of smallpox and typhus, anticipating the pestilential turbulence of the next two decades.

The first outbreak of Asiatic cholera in Britain was at Sunderland on the Durham coast during the Autumn of 1831. From there the disease made its way northward into Scotland and southward toward London. Before it had run its course it claimed 52,000 lives. From its point of origin in Bengal it had taken five years to cross Europe, so that when it reached the course of Durham, British doctors were well aware of its nature, if not its cause.

The progress of the illness in a cholera victim was a frightening spectacle: two or three died of diarrhoea which increased in intensity and became accompanied by painful retching; thirst and dehydration; sever pain in the limbs, stomach, and abdominal muscles; a change skin hue to a sort of bluish-grey. The disease was unlike anything then known. One doctor recalled: "Our other plagues were home-bred, and part of ourselves, as it were; we had a habit of looking at them with a fatal indifference, indeed, inasmuch as it led us to believe that they could be effectually subdued. But the cholera was something outlandish, unknown, monstrous; its tremendous ravages, so long foreseen and feared, so little to be explained, its insidious march over whole continents, its apparent defiance of all the known and conventional precautions against the spread of epidemic disease, invested it with a mystery and a terror which thoroughly took hold of the public mind, and seemed to recall the memory of the great epidemics of the middle ages."

The cholera subsided as enigmatically as it had flourished, but in the meantime another sort of devastation had taken hold. The previous June, following a particularly rainy spring, Britain was visited by the first of eight serious influenza epidemics in the space of sixteen years. In those days the disease was often fatal, and even when it did not kill, it left its victims weakened in their defenses against other diseases. Burials in London doubled during the first week of the 1833 outbreak; in one two-week period they quadrupled. Whereas cholera, spread by contaminated water, affected mainly the poorer neighbourhoods, influenza was limited by no economic or geographic boundaries. Large numbers of public officials, especially in the Bank of England, died from it, as did many theater people.

At that time the term "fever" encompassed a number of different diseases, among them cholera and influenza. In the 1830s the "new fever," typhus, was isolated. During its worst outbreak, in 1837-38, most of the deaths from fever in London were attributed to typhus, and new cases averaged about sixteen thousand in England in each of the next four years. This happened to coincide with one of the worst smallpox contagions, which killed tens of thousands, mainly infants and children. Scarlet fever, or scarlatina as it was then called, was responsible for nearly twenty thousand deaths in 1840 alone.

Although mortality rates for specific diseases were not compiled for England and Wales between 1842 and 1846, we know that during this period there was a considerable decline in epidemics. It has been surmised that one reason was the expansion of railroad building, with the consequent increase in wage levels and a better standard of living. A hot, dry summer in 1846, however, was followed by a serious outbreak of typhoid in the fall of that year. Enteric fever, as it was then called, is a water-borne disease like cholera and tends to flourish when people are not particular about the source of their drinking water.* That same year, as the potato famine struck Ireland, a virulent form of typhus appeared, cutting down large numbers of even well-to-do families. As Irish workers moved to cities like Liverpool and Glasgow the "Irish fever" moved with them. By 1847 the contagion, not all of it connected with immigration, had spread throughout England and Wales, accounting for over thirty thousand deaths. As had happened a decade earlier, typhus occurred simultaneously with a severe influenza epidemic, one which carried off almost thirteen thousand. There was also a widespread dysentery, and as if all this were not enough, cholera returned in the autumn of 1848, assailing especially those parts of the island hardest hit by typhus and leaving about as many dead as it had in 1831. This was the epidemic which took the lives of one-fifth of the thousand children housed at the institution for the poor at Tooting.

Diseases like cholera, typhus, typhoid, and influenza were more or less endemic at the time, erupting into epidemics when the right climatic conditions coincided with periods of economic distress. The frequency of concurrent epidemics gave rise to the belief that one sort of disease brought on another; indeed, it was widely believed that influenza was an early stage of cholera. There were other contagions, however, which yearly killed thousands without becoming epidemic. Taken together, measles and "hooping cough" accounted for fifty thousand deaths in England and Wales between 1838 and 1840, and about a quarter of all deaths during this general period have been attributed to tuberculosis or consumption.

It is not hard to see why the idea of disease had such an impact in the last century. In his Report on the Sanitary Condition of the Labouring Population of Gt. Britain, Edwin Chadwick included figures to show that in 1839 for every person who died of old age or violence, eight died of specific diseases. This helps explain why during the second and third decades of the nineteenth century nearly one infant in three in England failed to reach the age of five.

Generally throughout the 1830s and the 1840s trade was off and food prices were high. The poorer classes, being underfed, were less resistant to contagion. Also, during the more catastrophic years the weather was extremely variable, with heavy rains following prolonged droughts. Population, especially in the Midlands and in some seaport cities and towns, was growing rapidly without a concurrent expansion in new housing. Crowding contributed to the relatively fast spread of disease in these places. The Registrar General reported in 1841 that while mean life expectancy in Surrey was forty-five years, it was only thirty-seven in expectancy in London and twenty-six in Liverpool. The average age of "labourers, mechanics, and servants", at times of death was only fifteen. Mortality figures for crowded districts like Shoreditch, Whitechapel, and Bermondsey were typically half again or twice as high as those for middle-class areas of London.

Such statistics as these not only made Britons aware of the magnitude of disease in their own time, but served as effective weapons for sanitary reformers when they brought their case before Parliament. Two reports by the Poor Law Commission in 1838, one by Dr. Southwood Smith, the other by Drs. Neil Arnott and J. P. Kay (later Kay-Shuttleworth), outlined causes and probable means of preventing communicable disease in poverty areas like London's Bethnal Green and Whitechapel. Chadwick's Report broadened the scope of inquiry geographically, as did a Royal Commission document in 1845 on the Health of Towns and Populus Places. What we learn from these and other sources gives a depressing picture of early Victorian hygiene.

During the first decades of Victoria's reign, baths were virtually unknown in the poorer districts and uncommon anywhere. Most households of all economic classes still used "privy-pails"; water closets were rare. Sewers had flat bottoms, and because drains were made out of stone, seepage was considerable. If, as was often the case in towns, streets were unpaved, they might remain ankle-deep in mud for weeks. For new middle-class homes in the growing manufacturing towns, elevated sites were usually chosen, with the result that sewage filtered or flowed down into the lower areas where the laboring populations dwelt. Some towns had special drainage problems. In Leeds the Aire River, fouled by the town's refuse, flooded periodically, sending noxious waters into the ground floors and basements of the low-lying houses.

As Chadwick later recalled, the new dwellings of the middle-class families were scarcely healthier, for the bricks tended to preserve moisture. Even picturesque old country houses often had a dungeonlike dampness, as an visitor could observe: "If he enters the house he finds the basement steaming with water-vapour; walls constantly bedewed with moisture, cellars coated with fungus and mould; drawing rooms and dining rooms always, except in the very heat of summer, oppressive from moisture; bedrooms, the windows of which are, in winter, so frosted on their inner surface, from condensation of water in the air of the room, that all day they are coated with ice."

In some districts of London and the great towns the supply of water was irregular. Typically, a neighbourhood of twenty or thirty families on a particular square or street would draw their water from a singly pump two or three times a week. Sometimes, finding the pump not working, they were forced to reuse the same water. When a local supply became contaminated the results could be disastrous. In Soho's St. Anne's parish, for example, the faeces of an infant stricken with cholera washed down into the water reserve from which the local pump drew, and almost all those using the pump were infected. Millbank Prison, taking its water from the sewage-polluted Thames, suffered greatly during every epidemic of water-borne disease.

The Public Health Bill, passed in 1848 because of the efforts of reformers like Smith and Chadwick, empowered a central authority to set up local boards whose duty was to see that new homes had proper drainage and that local water supplies were dependable. The boards were also authorized to regulate the disposal of wastes and to supervise the construction of burial grounds. Simply bringing this last problem to public attention was a great service: the New Bunhill Fields burying ground in the Borough, less than an acre in size, was at that time the depository of over fifteen hundred bodies a year, though Chadwick estimated that only one hundred and ten could be "neutralized" per acre of ground. When more room was needed, the older skeletons and coffins were incinerated. The graveyard of St. Martin's, Ludgate, had long since filled, and hundreds more were interred in church vaults; the resulting stench drove the regular worshippers from service.

Since it was widely believed that disease was generated spontaneously from filth (pythogenesis) and transmitted by noxious invisible gas or miasma, there was much alarm over the "Great Stink" of 1858 and 1859. The Thames had become so polluted with waste as to be almost unbearable during summer months. People refused to use the river-steamers and would walk miles to avoid crossing one of the city bridges. Parliament could carry on its business only by hanging disinfectant-soaked cloths over the windows. It should have been a blow to the theory of pythogenesis when no outbreak of fever ensued from this monstrous stench. As late as 1873, however, William Budd could reluctantly report in his important book on typhoid that "organic matter, and especially sewage in a state of decomposition, without any relation to antecedent fever, is still generally supposed to be the most fertile source."

Throughout most of the century, doctors can be said to have been conceptually helpless about the cause and treatment of the disease. A glance at the contents of a typical volume of the Lancet (1849) tells the melancholy story: "On the Advantage of Copious Bleeding in Inflammatory Diseases"; "Report of a Case of Cholera Treated by Transfusion"; "Treatment of Cholera by Small and Repeated Doses of Calomel"; "On the Employment of Embrocations and Injections of Strong Liquid Ammonia in the Collapse Stage of Cholera." One title begins promisingly, "On the Production of Cholera by Insufficient Drainage", but continues, "with Remarks on the Hypothesis of an Altered Electrical State of the Atmosphere."

No doubt the resistance to the theory of polluted water as a source of infection contributed to the steady prevalence of typhoid in the second half of the century as well as to the high mortality rates from cholera in epidemics as late as 1854 or 1865-6. The general cleaning up of the cities and towns, however, produced a marked reduction in deaths from typhus, a disease, we now know, transmitted by lice. Although a systematic control of contagious disease had to await the introduction of preventive inoculation in the eighties and nineties, after mid-century the general health of the country measurably improved. In the 1850s and 1860s there came into common use such diagnostic aids as the stethoscope, the ophthalmoscope, and the short clinical thermometer. Meanwhile the employment of general anaesthesia and antiseptic surgery was reducing considerably the number of hospital deaths.

Improved hygiene, diagnosis, and treatment in the past century have given people a certain emotional security even in the face of serious disease. Throughout much of the Victorian period, however, with both the causes and the patterns of disease very much matters of speculation, it was difficult ever to feel comfortable about one's state of health. The behaviour of the sever contagions of the time had a special way of intensifying anxiety. They would appear, then perhaps subside for a month or two, only to reappear in the same locality or somewhere else. Also, the individual sufferer had no way of predicting the outcome of the disease in his own case. Influenza patients, observed the London Medical Gazette during the 1833 epidemic, "might linger for the space of two or three weeks and then get up well, or they might die in the same number of days." Just as frightening was the uncertain progress of typhoid. For the first week the victim would feel listless and suffer headaches, insomnia, and feverishness. His temperature would gradually increase over this period, though fluctuating between morning and evening hours. His stomach would be painful and distended. Probably he would have diarrhoea and perhaps red patches on his skin. Typically there would be an intensification of these symptoms for a few weeks. In most cases the patient would recover, but convalescence might take additional weeks. Depending on the severity of the attack, however, and the patient's ability to resist, he might die from exhaustion, internal haemorrhaging, or ulceration of the intestine.

The beginnings of such a disease as typhoid were so mild and gradual as to be subjectively indistinguishable from, say, a cold or a moderate case of influenza, of from any number of nonfatal complaints. Deficiency diseases, both glandular and dietary, were but dimly understood in those days. Proper diagnosis and effective treatment of goitre, diabetes, and the various vitamin deficiencies belong to the twentieth century, as is true with allergies, many of which must also have imitated the early symptoms of acute diseases. Thousands of sufferers from eczema, hives, or asthma not only were given superficial relief but were ignorant of the nature of their maladies.

The number of unknowing victims of chronic food poisoning must also have been great. Mineral poisons were often introduced into food and water form bottle stoppers, water pipes, wall paints, or equipment used to process food and beverages. Moreover, the deliberate adulteration of food was a common and, until 1860, virtually unrestricted practice. For example, because of the Englishman's dislike for brown bread, bakers regularly whitened their flour with alum. Conditions for the processing and sale of foods were unsanitary. An 1863 report to the Privy Council stated that one-fifth of the meat sold came from diseased cattle. In 1860 the first pure-food act was passed, but, as was often the case in these early regulatory measures, it provided no mandatory system of enforcement. In 1872 another act was passed, this time considerably strengthening penalties and inspection procedures. But in the meantime, and throughout most of the nineteenth century, Britons had little protection against unwholesome food and drink. We can only guess at how many tons of adulterated tea, rancid butter, and polluted meat were sold and consumed monthly throughout the kingdom.

Whenever Parliament debated some labor-reform bill, Victorians were reminded that the Industrial Revolution had brought as an unwelcome by-product the proliferation of occupational diseases. Testimony from medical investigators and workers alike included gruesome stories of "black-spittle" among miners, of grinder's rot and potter's asthma. Those looking into conditions among milliners and dressmakers found much higher than average rates of anaemia, deteriorating vision, and various lung diseases caused by breathing dust and fine particles of fiber. In many places of work, ten to twelve hours a day standing or sitting in one spot, often in an unnatural positions, damaged the spine, the digestion, and the circulation.

With the prevalence of these occupational ailments, as well as of contagions, deficiency diseases, and food poisonings, George Henry Lewe's remark that "few of us, after thirty, can boast of robust health" is understandable. Their correspondence reveals that many prominent Victorians were constantly afflicted. --Bruce Haley. The Healthy Body and Victorian Culture. Cambridge, Mass.: Harvard University Press, 1978.

What sort of insight does this information yield into the Victorian period, which was obviously a time of both medical progress and intense human suffering and physical pain?

Could it help to explain certain elegies, or a prevalence for grieving or ruminations on death, in poetry?


Victorian Web Public Health

Last modified 11 October 2002