The earlier history I can only briefly mention, as we are chiefly concerned today with events since 1869. To understand these events, however, one must understand the forces which had been accumulating and increasing in power in earlier years, and which rendered possible the rapid public health progress experienced in the fourth quarter of the nineteenth and the first quarter—so far as it has passed—of the twentieth century.
Laissez Faire Economic Teaching
Historians in future generations will refer to the second half of the eighteenth and the first half of the nineteenth century as the period of unmitigated industrialism, of associated rapid increase of urban at the expense of rural life, and of the most extreme manifestation of laissez faire economic science. The older semi-paternal system of interference with the economic life of the people by King and Parliament, was replaced, under the influence of Adam Smith, Malthus, James Mill, and other teachers, by inaction based on the view that in old countries poverty is the natural and inevitable result of pressure of population on means of subsistence, and that any interference with freedom of competition in obtaining work or employing workers is useless or mischievous. A similar view found expression in President Jefferson’s dictum: that government is best which governs least; and until the middle of the nineteenth century these views were generally accepted and their influence was dominant.
It was assumed that given free competition, enlightened self-interest would incite effort and improvement, encourage self-reliance, and guarantee production and economy.
Under the conditions considered inevitable with such teaching, although great wealth accompanied the rapid industrial development after the Napoleonic wars, it was associated with unrelieved misery; for homeworkers and rural workers crowded into mean hovels in towns, paying exorbitant rents out of a miserable pittance of wages, and were exposed to the evils resulting from overcrowding, and from absence of adequate and satisfactory water supply, scavenging or drainage. By the year 1851 about half the population of England and Wales had become aggregated in towns; and it may be added that in 1911, less than one fourth of the population was left in rural districts. Urbanization in the earlier years meant dense overcrowding and insanitation; and that it is still an influence adverse to health may be gathered from the information given by the census of 1911, that over eight times as large a proportion of the urban as of the rural population live in one-roomed tenements, and nearly twice as large a proportion live in two-roomed tenements, while the proportion of one-roomed tenements in towns which are overcrowded (in the sense of having more than two persons to a room) in towns is seven times as great, and of two-roomed tenements is twice as great as in country districts.
Domestic misery was associated with commensurate industrial misery; overwork, in insanitary factories and workshops, regardless of the health of the “hands,” was the rule.
The displacement between 1760 and 1800 of domestic by factory manufacture represented a new phenomenon in the world’s history, a true industrial revolution. It was the parting of the ages; destined not only to change the life of the people of England from preponderantly outdoor to preponderantly indoor; and to bring for them for many years all the disadvantages of unregulated town life; but also, owing to the rapid development of better roads, of canals, and then of railroads and steamships to end forever the practical segregation in which countries, and even neighbouring communities, had previously lived.
It cannot be wondered at that under these circumstances the general death-rate was excessive, and epidemic disease spread with a rapidity and to an extent previously unknown.
The reaction against the laissez faire economic teaching began early, and it is in accordance with the fitness of things that the national conscience first rebelled. The earliest evidence of reform was legislation in 1802 on behalf of pauper children indentured to the overseers in textile factories; and there followed subsequent Factory and other Acts in 1819, in 1833, in 1844 and in 1847, which prohibited the factory employment of children under nine, limited the hours of labour of young persons and of women, and insisted on elementary sanitation in factories. Subsequent Factory and Mining Acts, followed by Shop Hours Acts and the Shop Seats’ Act, have completed a most valuable code of regulations prohibiting overwork, and securing a measure of protection against dangers to health and limb or eyesight during industrial employment. It is noteworthy that the first steps at improved sanitation, and to safeguard health by preventing overwork, were on the industrial plane. Factory inspectors preceded medical officers of health and sanitary inspectors appointed by local authorities.
Philanthropy was the motive power in initiating factory reform; in securing general sanitary reform, driving power was furnished by the double motive of economy and fear, caused by the inordinate expense of poor-law administration, the frequently recurring epidemics of “fever,” and the alarming occasional invasions of Asiatic cholera. The sacrifices of life from cholera were truly vicarious; for we owe it largely to these that our national system of vital statistics was initiated in 1837 and that serious efforts at sanitary reform were begun.