Poverty and Public Health Why was the urban population vulnerable to epidemic diseases in the first half

of the nineteenth century?

In 1800, little understanding of what caused disease, so deaths from preventable diseases common. Infant mortality was high one in seven children died before the age of one. Hygiene not understood lie and fleas common. Those in authority, especially in towns, recognised that disease was a problem and cleaned streets, provided communal water pumps and sewers to remove human waste. However, public health made worse by the rapid industrialisation of the late 18th and 19th centuries. In 1801, only 14 towns had more than 25,000 people, but in 1841 this had risen to 41. Towns and cities concentrated large numbers of people ion small space, making the spread of disease easier and putting considerable strain on existing public health provision.

How unhealthy was it to live in cities and why? Conditions varied depending on where you lived and what class you were in Contemporary opinion was most concerned about infectious diseases typhus and influenza killed large numbers of people both in rural and urban areas, but particularly affected the malnourished of the urban slums. Smallpox became less of a threat, partly because of the vaccination developed by Edward Jenner in the 1790s. Typhus and typhoid fever were common in London and epidemics occurred in all major towns in 1817-19, 1826-27, 1831-32, 1837 and 1846-47, coinciding with periods of economic slump and high unemployment. As towns grew, polluted water became a problem and was the cause of many diseases such as infantile diarrhoea, dysentery, typhoid fever and especially cholera (which was also spread by contaminated food). Whereas tuberculosis, typhus, and cholera was mainly centred in inner-city slum districts, cholera was more deeply feared because it sometimes spread to the middle- and upper-class areas.

What was the impact of such high rates of infectious diseases? Children were particularly vulnerable to disease, and by the end of the 29th century infant mortality counted for a quarter of all deaths. In Manchester 50 per cent of children died before they were five.

Death rates, already high in most towns, went up in the 1830s and 40s from about 19 per 1000 in 1831 to 22.4 in 1838 and over 25 in 1849, a cholera year. In 1831 in Bristol, death rate of 16.9 per 1000, rose to 31 by 1841. Marked differences in average age of death between professional, trade, and labouring populations in 1842 in Liverpool, 35, 22, and 15 respectively, compared to Rutlands 52, 41 and 38 years respectively. Death was only one of the effects for people struggling to pay rent and food, illness imposed additional costs (medical bills, medicines, extra heating, and if mother ill, childcare). Significant burden.

Why did housing and clean water pose problems? The influx of people working in towns created a housing crisis. Back-to-back houses, cellar dwellings and cheap, poorly built housing of various kinds constructed to house the new arrivals. Even so, supply could not keep up with demand and by 1830 many houses were multi-occupied, with families living in a single room or cellar without proper sanitation or water supply. In London, lodging houses were common and in the poorest district as many as 15 people would sleep in one room. In Liverpool in the 1840s, between 10 and 20 per cent of the population live in cellars. Contemporaries tended to focus on the horrors of urban living, but it was little different for the rural poor, where there were also slums. The main difference was the density of urban living. Living literally on top or beneath neighbours in multioccupied houses was a new experience for many. The major problem was that most new houses did not have adequate drainage, sewage, or a water supply. The water companies were unwilling to spend profits on cleaning rivers and springs and central and local government had yet to see providing clean water as one of their responsibilities. By late 1820s Thames were highly polluted, but water companies continued to praise the state of the river, profits outweighing public health. This culminated in great stink of 1858. The duke of Newcastle sounded the alarm in July 1857, warning that the river was like a vast sewer and unless something was done to purify it, it would engender dome frightful plague among the two and a half million who inhabited the metropolis. A year later, stories flying of men struck down with the stench and fatal diseases occurring as a result, and Parliament took action to bring Londons water under central control. This was paralleled in many industrial towns where rivers were invariably open sewers.