Sanitation Reform: How the Industrial Cities Learned to Manage Waste

The sanitation reform movement was one of the most important public health reforms of the nineteenth century.

The Sanitation Problem in the Industrial Cities

The industrial cities faced a serious sanitation problem. The rapid growth of the cities had outstripped the capacity of the existing waste disposal systems, and the result was the accumulation of filth in the streets, the rivers, and the cellars of the new urban housing. The article on housing conditions describes the conditions in which the working class lived.

The waste disposal systems of the time were woefully inadequate. The cesspools, which collected human waste, were often poorly maintained, and they overflowed into the streets and the rivers during heavy rain. The open sewers, which carried the overflow from the cesspools, discharged into the rivers, which were also the source of drinking water for many cities.

Edwin Chadwick and the Sanitation Movement

The sanitation reform movement was led by Edwin Chadwick (1800-1890), a social reformer who served as secretary to the Poor Law Commission. Chadwick was a tireless advocate of public health reform, and he used his position to gather evidence about the conditions in the industrial cities and to press for legislative action.

Joseph Bazalgette and the London Sewerage System

The most ambitious sanitation project of the nineteenth century was the building of the London sewerage system, designed by the engineer Joseph Bazalgette (1819-1891). The system, which was built between 1858 and 1875, was a major feat of engineering, and it transformed the sanitation of the British capital.

The Effects of the Sanitation Reforms

The sanitation reforms of the nineteenth century had a dramatic effect on the health of the urban population. The death rates in the industrial cities fell sharply in the second half of the nineteenth century, and life expectancy rose correspondingly. The improvement was due to a combination of factors, including the better sanitation, the cleaner water, the improved housing, and the better nutrition of the working class.

The Continuing Question

The unresolved historical question about the sanitation reforms is the one that has been raised in the cholera-outbreaks article: were they effective because they removed the bad air (the miasma theory), or because they cleaned up the water supply (the contagion theory)? The traditional answer, going back to Edwin Chadwick’s Report on the Sanitary Condition of the Labouring Population of Great Britain (1842) and given its modern form in the work of Anthony Wohl, is that the reforms were a triumph of the miasma theory: the disease was caused by the bad air of the slums, and the response (sewers, clean water, slum clearance) was the right response. The revisionist answer, given its most forceful form in the work of medical historian Christopher Hamlin, is that the miasma theory was wrong, and that the cholera outbreaks were water-borne, and that the public health reforms of the 1840s-1870s worked not because they removed the bad air but because they cleaned up the water supply. The interesting current question, raised in Simon Szreter’s Health and Wealth (2005) and developed in the recent literature on the political economy of public health, is why the British state acted on the miasma theory when John Snow had already identified the water-borne mechanism, and why the germ theory of disease (Robert Koch, 1884) was the necessary condition for the post-1860 acceleration of public-health reform. The honest answer, given the historical evidence, is probably: the miasma theory was politically useful because it provided a rationale for sanitary reform that did not require the medical profession to take responsibility for water quality, and the germ theory, when it finally arrived, made the rationale more robust but did not change the actual interventions very much.

Selected Sources

Simon Szreter, Health and Wealth: Studies in History and Policy (2005).
Anthony S. Wohl, Endangered Lives: Public Health in Victorian Britain (1983).
John Snow, On the Mode of Communication of Cholera (1849).
Christopher Hamlin, Public Health and Social Justice in the Age of Chadwick (1998).