Continue to The Partial SolutionChapter 9: Epilogue
by R. J. Morris
in Cholera 1832 -- The Social Response to An Epidemic, 1976.
The Public Health Acts of 1848
As cholera approached Britain in the summer of 1848, two important public health acts were passed through Parliament, the Public Health Act itself and the Nuisance Removal and Contagious Diseases Act. The first created a General Board of Health with powers to initiate and assist local sanitary reform projects. The second gave the General Board power to issue orders and instructions, but only on the authority and after an order from the Privy Council. The passage of these Acts was often linked to fears of the approaching cholera. The debates in Parliament do not suggest that the link was important. True, when the Commons were considering amendments from the Lords, Morpeth [Lord Morpeth, a close ally of Edwin Cadwick, appointed Chair of the Royal Commission which recommended and crafted the Metropolitan Sewers Act of 1848, then became Chair of the newly formed Metropolitan Sewers Commission] treated them to a reading of the cholera death toll from Russia, but it was unlikely that this convinced anyone not already attracted to the Bill. Some even suggested that cholera was too dangerous to be tackled through such a complex and contentious measure, and suggested that the simpler 1832 Act was more appropriate. When Morpeth introduced the Bill in February 1848, he told the House,
I do not wish to lay any material stress upon the possible approach of cholera... it is far from any temporary evil, any transient visitation against which our legislation is now called upon to provide. It is the abiding host of disease, the endemic not the epidemic pestilence, the permanent overhanging mist of infection, the slaughter doubling its ravages on our bloodiest fields of conflict, that we are now summoned to grapple with.
If the 1848 Acts can be attributed to any one disease, that disease must be typhus, for it was the one most frequently mentioned in the debates and in the decade of parliamentary reports which preceded the two Acts. The approach of cholera did not prevent the House of Commons using all possible means to delay the Bill and stripping the General Board of all its major powers in the name of protecting the localities from central power. The fear of cholera had a marginal effect in reducing delays in late summer 1848. The Bishop of London withdrew amendments in the Lords designed to strengthen the Bill because he felt that delay in the face of cholera was irresponsible. Thus the approach of cholera weakened the Bill because it rushed the health reformers without forcing the hand of anti-centralizers like Colonel Sibthorpe. Fear of cholera did nothing to hurry the government into producing measures which filled the gaps in public health legislation left by the Act -- in the introduction of measures for London, for Scotland, or for the prohibition of interment in overcrowded city graveyards. The real cholera act of 1848 was the Nuisance Removal and Disease Prevention Act which went through with commendable dispatch largely because its major principles had been agreed during the passage of a temporary Act the previous year.[21]
Throughout 1849, the administrative burden of cholera was met by the General Board of Health. The Board, created by the 1848 Act, consisted of a Minister, Viscount Morpeth, an unpaid member, Lord Ashley and a paid member, Edwin Chadwick. The last two together with their two medical inspectors, Grainger and Sutherland, did most of the work during the epidemic.[22] They were active, powerless, derided and largely ineffective. The Public Health Act itself was of little value to them -- the intended gains of this Act were long-term, setting up local boards of health with plans for drainage, sewerage and water supply. The General Board was constituted on 22 September, a few days before the first cases of cholera were announced. 'We have indeed toiled unceasingly, and not as mere officials but with earnestness and feeling', wrote Ashley at the end of the epidemic, but earnestness and good feeling were not enough.[23] They issued instructions and regulations and sent their medical inspectors into the field, but found that the temporary powers granted to them by the Privy Council under the Diseases Prevention Act enabled them to help the willing but not to coerce the unwilling. In Sheffield (1856 map: upper right), cleansing and early medical aid was thorough and deaths were reduced to 46. Dumfries needed a visit from Dr Sutherland before action was taken, but the London parishes were made of sterner stuff and resisted all attempts to persuade them to take extra measures until the middle of September when some of the worst hit began house-to-house visitation.[24] The General Board got little help and attention from leading members of the governing classes. Whilst cholera spread in London, the Queen was in the Highlands, the Prime Minister deerstalking and the Archbishop relaxing in the Lake District. In many ways the structure of local government was less appropriate than it had been in 1832. Then ad hoc committees had been formed and, once endowed with power, had acted quite well within the limitations of their knowledge. In 1848 and 1849 the task was given to the local Boards of Guardians whose natural habits were to restrict spending and then limit it to relief rather than preventive measures.[25] Despite the cleansing and house-to-house visitations which the General Board felt had saved many lives, it was probably more ineffective in its own terms than the Central Board had been, and equally ineffective in real terms.
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