John Leech's cartoon in Punch, 23 (25 September 1852): 139), showing the association of cholera with squalor. A child stands on his head on top of a rubbish heap in the left-hand corner. An old woman scavenges from the heap, another child shows off his own find, and washing flutters in the breeze overhead. Credit: Wellcome Library, London. Many thanks to the Wellcome Library, London, which kindly allows images from its Digital Gallery to be used under this Creative Commons License for educational and non-commercial purposes. — Jacqueline Banerjee [Click on images to enlarge them.]
he alarming spread of COVID-19 has led some commentators to scour the past in search of lessons from previous pandemics, while others warn that we are seeing the first glimpses of a dystopian future, where contagious diseases regularly ravage sections of our over-populated planet. Such prophecies may strike fear deep into the hearts of many, but the history books can provide us with some hope for humanity in the form of the Victorians and their response to situations far worse than ours today.
Queen Victoria’s reign is often heralded as an era of towering achievements. Britain was the economic superpower of the age, its navy ‘ruled the waves’, the country accumulated the largest empire ever seen, and the many staggering engineering triumphs appear to symbolise the confidence of the period. Yet the nation’s pre-eminence came at a considerable cost. The rapid industrialisation and urbanisation that helped turn the country into the ‘workshop of the world’ also created conditions that were rife for spreading disease. As people flocked to the towns and cities for employment many ended up in overcrowded, damp and squalid housing that lacked basic sanitation, like running water (Wohl 1-9).
Some blamed the ‘artificial’ urban environment itself for causing the physical and moral degeneration of society (Hardy 39-46). In such settings it was simply impossible to self-isolate from the health hazards of the day, as thick black smoke clung to the air, the waterways were heavily contaminated by effluent, and sewage festered in the numerous cesspools and privy pits that dotted the landscape. Unsurprisingly, the ‘condition of England’ was much discussed and some saw the vast expanding metropolis of ‘outcast London’ as epitomising the country’s deprivation (Steinbach 92, Steadman Jones 1-15). Although the East End became particularly notorious, the situation was worse in many of the northern cities. Friedrich Engels was forced to concede that even his own bleak depiction of the desperate conditions in the old part of Manchester didn’t do justice to the ‘filth, ruin and unhabitableness’ that he witnessed (Tucker 434).
Diversity of diseases
Although there are still a number of illnesses that are feared in Britain today, they don’t come close to the cacophony of deadly contagions that circulated in the nineteenth century. The Victorians almost appeared to be under siege from wave after wave of epidemics that regularly wiped out whole swathes of the population. These affected rich and poor but, including members of the royal family, unlike the current outbreak, it was the young who were particularly vulnerable. In some of the industrial centres of the north, the infant mortality rate even sometimes reached one in every two births among certain sections of the working class. ‘Dirty diseases’ associated with squalor were endemic and one of the most common was typhus, which was also known as Irish or Gaol fever, as it often afflicted poorer immigrants and those in prison. An outbreak that began in 1848 caused the deaths of over 30,000 in England and Wales alone, while another threat was typhoid, which famously killed the Prince Consort, Albert, in 1861 (Haley 3-12).
Tuberculosis (‘the white plague’) was the most dangerous of them all, as the respiratory condition probably accounted for approximately a third of all fatal illnesses during this time. Scarlet fever was a considerable danger to children, while diphtheria (‘croup’ or ‘throat fever’) was terminal for a quarter of those who contracted it. Even smallpox, which some were inoculated against, caused over 40,000 fatalities between 1837 and 1840. A whole host of other conditions could often be terminal, such as measles, influenza, dysentery, and whooping cough – to say nothing of the serious risk of infection or the prevalence of venereal disease, rickets and scurvy. These were all bad enough, but it was the arrival of a new epidemic in Britain in the early 1830s that caused the greatest panic among the public: cholera (Haley 3-12).
Like the COVID-19 virus, cholera was a novel disease that caused widespread alarm as it swept across Europe from Asia. First recorded in India, one doctor branded it ‘outlandish, unknown, [and] monstrous’, as it could kill sufferers within hours of the symptoms. Likened to the black death, it not only produced nasty symptoms, including painful diarrhoea, retching, aching and the skin to become cold to the touch and blue in colour, but it also had a very high mortality rate (40-60% of those who contracted it). Furthermore, it seemed impervious to conventional methods for treating illnesses and it had the unnerving habit of appearing and disappearing seemingly without warning. The largest of the four massive epidemics in Britain began in 1848 and resulted in over 60,000 deaths (Sigsworth 69).
The situation sounds impossibly bleak, especially when you consider that not only were many Victorians undernourished and therefore lacking strong physical defences against illnesses, but the transmission of disease was not even understood. The prevailing wisdom was that sickness was spread through foul smelling air or ‘miasmas’ emanating from rotting flesh. Although the theory was misconceived, the focus on avoiding airborne disease did at least lead to some advances, such as medical facilities being well ventilated. It also meant, however, that the polluted waterways were not seen as a public health priority, or at least not until the infamous summer of 1858 and the terrible Great Stink.
Left: Faraday Giving His Card to Father Thames. Punch (21 July 1855). Right: Metropolitan Main Drainage: Present State of the Abbey Mills Pumping Station, West Ham. Illustrated London News (April 1867). [Click on images to enlarge them.]
Rivers had the dubious distinction of being both a source of drinking water and a convenient way of getting rid of all kinds of waste. The river Thames in London, for example, was described by The Oarsmen’s Guide to the Thames and Other Rivers (1857) as ‘the largest navigable sewer in the world’. The putrid water often produced a pungent stench during the warmer months, but this became unbearable in 1858, when a particularly hot summer created what became known as the ‘great stink’. Such was the public outcry that a vast new sewer network was commissioned for the capital. Overseen by Joseph Bazalgette, the incredible subterranean feat may well have saved more lives in London than many of the medical advances of the day. Indeed, the project came at a time when Victorians were beginning to realise the dangers of waterborne diseases (Wohl 233-56).
Three cartoons from the 1873 Fun about flush toilets, drains, and sewage: Left: The Drain Demon. — A Hard case. Middle: The Complete Builder, — (By One Who Has Been a Tenant) No. 4 The Cistern Lark. Right: The Complete Builder, — (By One Who Has Been a Tenant) No. 9 The Drains and Dusthole Witticism.
Left: Dr. John Snow. Middle: Fun magazine's cartoon about the Broad Street Pump, which John Snow discovered to have been "Death's Dispensary: Open to the Poor, Gratis, by Permission of the Parish," on 18 August 1866. Right: Snow’s Pioneering map.
An important breakthrough came in 1854, when John Snow conducted a landmark study that earned him the nickname of the ‘father of epidemiology’. After a deadly bout of cholera broke out in Soho, he meticulously researched where the deceased (and survivors) had drawn their water from. By marking the fatalities on a map, he indicated that a pump on Broad Street was the likely culprit and its decommissioning soon reduced the deaths in the area. Rigorous statistical and scientific surveys like Snow’s were highly characteristic of an age when the authorities sought to understand and improve the social and moral fabric of the nation. Nevertheless, it took time for his findings to be widely accepted, because there was still no conclusive scientific evidence to show how cholera was transmitted (Vinten-Johansen 283-339).
It was only over the course of the following decades that germ theory was developed and even though some disease-carrying microbes were identified from the 1870s onwards, it wasn’t until the twentieth century that cures were discovered for many of the deadly Victorian contagions. There were numerous other medical advances in the period too, such as the expansion and diversification of hospital care, the introduction of asepsis in wards, and better communication about diseases. The Lancet, for example, was launched in 1823 and became a respected medical journal that reported on the health issues of the day. There were also some cutting edge technological advances, such as a growing use of anaesthesia, especially after John Snow administered chloroform to Queen Victoria during the birth of two of her children in the 1850s, and the inventions of the X-ray and the cardiograph in 1895 and 1901 respectively (Steinbach 279-302).
Boards of health
Another major challenge for tackling disease was that the Victorians simply did not want or expect the central government to meddle too closely in their everyday lives. Any major public health project would not only impact people’s private property, but cost a considerable amount of money, which had to be funded by raising local taxes. Although many vested interests stood in the way of reform, as The Times claimed, paradoxically it was cholera that arguably ended up being the ‘best of all sanitary reformers’ (Lane 148). Temporary local Boards of Health had to be set up to prepare for its arrival and the disease was ruthless in exposing any flaws. Although the specialist advice given was decidedly mixed, with recommended treatments including bleeding with leeches and using plasters of turpentine, further epidemics (of various kinds) and a growing understanding of societal problems underlined the need for more action.
In 1848, a central Board of Health was established, led by the tireless and rather heavy-handed reformer Edwin Chadwick, who had already helped to identify a close connection between poverty and disease. Although it lacked power and the results were mixed, the Board helped many local councils address public health issues. Indeed, the late Victorian period saw a great increase in the power of the State, as it gradually became understood and more accepted that centralised solutions were needed for some of the most widespread and seemingly intractable problems of the day. A whole range of laws were introduced to try to improve public health, such as consolidating the power of local councils, so they could control, for example, the water supply, as well as dealing with wider issues such as the standard of housing and adulterated food. Indeed, improving the well-being of British citizens took on more of a national importance during the Boer War, when the authorities realised that many young men were simply unfit for military service (Royle 230-38).
Dealing with death
Although many people had what we would now call underlying health conditions, what is striking about the population in the nineteenth century is how they coped with crisis. While some have suggested the culture revelled in death, as shown by Queen Victoria’s protracted mourning of Albert, the reality was that mortality unsurprisingly loomed much larger in the consciousness of people than it does today. The number of fatalities shows us that many people were affected by tragedy, but it is the private accounts that really convey the personal impact caused by the loss of loved ones. Yet as well as illustrating the devastation, they also show a remarkable courage and stoicism in the face of death.
It was a highly religious age and many not only found hope and solace in churches and chapels, but were motivated to try to improve life for those around them. The strong influence of evangelical faith helped to foster a powerful social conscience among the population and produced a great era of philanthropy spearheaded by many remarkable reformers on the local and national stage. At a time when many mainstream jobs were closed off to them, these even included a number of notable women, such as Florence Nightingale, Louisa Twining, Octavia Hill and Elizabeth Fry, who battled against the odds to bring about key advances in nursing, poor law provision, housing and prisons respectively.
Many Victorians shared this sense of personal responsibility in an era when thrift, hard work and respectability were prized assets. The popularity of today’s motivational literature partly stems from Samuel Smiles’ hugely successful book Self-Help (1859), which urged citizens to take control of their own destinies by proactively bettering themselves. Having ‘character’ was also connected with cleanliness and many households duly invested a great deal of time and energy on chores such as scrubbing hearths, washing clothes and bathing bodies. We may struggle to appreciate how this was possible without modern innovations, but many had immense pride in the state of their domestic affairs. As the saying went, cleanliness was next to godliness or, as one German academic dismissively put it, ‘the English think soap is civilisation’ (Himmelfarb 35). Indeed, a strong work ethic in general was crucial in an era when many people relied on a great deal of ingenuity, good fortune, and wider support networks in order to survive.
By the end of the nineteenth century, the infant mortality rate remained stubbornly high, but the situation for adults was improving as life expectancy had increased. Although there is debate about how much this was the result of social reforms and how much it was connected with rising living standards in general, it is clear that a collective effort from both the government and individuals helped to transform society for the better. Considerable challenges remained, but the way the Victorians overcame adversity is testament to the human spirit. The hardships they faced may seem unbearable to us today, but they led to huge strides being made not only in improving the lives of ordinary citizens, but in developing one of the world’s most efficient healthcare systems, upon which our modern National Health Service was built. Perhaps that is the message of hope that history can bring to us in our current situation, as it shows that coming through some of the worst perils of the past has often helped humanity to forge stronger and brighter futures.
- Cholera: An Introduction
- Cholera and the Komma Bacillus of Koch
- John Snow and Waterborne Diseases
- Chadwick's Report on Sanitary Conditions
- Bibliography for Cholera, 1825-1917
- The Victorian Environment (homepage)
Haley, B. The Healthy Body and Victorian Culture. Harvard University Press, 1978.
Hardy, A. Health and Medicine in Britain since 1860. London: Palgrave, 2001.
Himmelfarb, Gertrude. The De-Moralization of Society. New York: Vintage, 1996.
Lane, J. A Social History of Medicine. London: Routledge, 2001.
Royle, E. Modern Britain: A Social History 1750-2011. London: Bloomsbury Academic, 2012.
Sigsworth, M. ‘Cholera in the Large Towns of West and East Ridings, 1848-1893’ (PhD thesis, Sheffield Hallam University, 1991)
Steadman Jones, G. Outcast London. London: Verso, 2013.
Steinbach, S. L. Understanding the Victorians. London: Routledge, 2017.
Thomas, Amanda J. Cholera: The Victorian Plague. Barnsley: Pen & Sword History, 2015. [Review by Keir Waddington, Professor of History, Cardiff University]
Tucker, R. C. The Marx-Engels Reader. New York: W. W. Norton and Company, 1972.
Vinten-Johansen, P. (et al). Cholera, Chloroform and the Science of Medicine: A Life of John Snow. Oxford: Oxford UP, 2013.
Wohl, Anthony. Endangered Lives. Cambridge: Harvard UP; London: J. M. Dent and Sons Ltd, 1983.
Last modified 19 January 2017