Chapter One
A Tale of Three Cities
Ecology and Demography
From their inception under the Victorian Public Health Acts, English public health campaigns were often lofty in their goals. Local histories show how these goals manifested in practice. English towns and cities often followed “different and asymmetrical paths” towards environmental and sanitary reforms since the age of Chadwick.
1Luckin, “Pollution in the City,” 214. Local ecologies, economics, and politics influenced these asymmetrical paths.
2Sheard and Power, “Body and City,” 1–2. To highlight the importance of place, we will spend the next two chapters considering the urban-environmental histories of Birmingham, Liverpool, and Manchester, and the ways in which local ecological and demographic factors influenced the development of public health in these three cities. Before systems of public health could shift from the macro level of city streets to the micro level of the English working-class home, Medical Officers of Health in these three cities first had to establish themselves and their professional responsibility for promoting public health to improve the living conditions of English town-dwellers.
Children’s health was not necessarily a specific target of the first wave of public health reforms, however, which focused on mass sanitary reform in crowded, polluted cities. The first wave of public health focused on the containment of hazards that contributed to poor health and fitness, such as the removal of cesspools that contributed to epidemics of cholera, or smoke and pollution that greatly increased the number of cases of respiratory illnesses (tuberculosis, bronchitis, and pneumonia) that accounted for over a quarter of all deaths in nineteenth-century Britain.
3Eisenbud, Environment, Technology and Health, 46; Thorsheim, “Green Space and Class in Imperial London,” 26. On ecological hazards to human health see also Mosley, The Chimney of the World; McEvoy, “Working Environments”; and Sellers, Hazards of the Job. Sanitary reforms tended
to impact the health of adults faster than children, though, revealing, by the 1880s, an unresolved challenge for public health: alarmingly high rates of infant mortality and a danger of the urban penalty threatening children.
4Luckin and Mooney, “Urban History and Historical Epidemiology,” 37–38. As I will argue throughout this book, the modes of public health that were most impactful in protecting children’s health required more intimate and individualized interventions, which began to emerge in the last decades of the Victorian era and which complemented the larger, city-wide sanitary systems. To set the scene, though, let us first consider how and why the three “urban behemoths” undertook city-wide sanitary reforms, laying a foundation for further public health reforms that followed.