history of public health in the United Kingdom

{{Further| English society#Georgian society: 1714–1837}}

The 18th century in Great Britain was a transitional period in public health, with advances but also persistent problems due to urbanisation, limited medical knowledge, and fragmented governance. There were early attempts to address sanitation, disease control, and urban planning, but these efforts were often constrained by prevailing scientific misconceptions and socioeconomic disparities. There was a struggle to manage rapid urban growth; miasma theory dominated health practices, quarantine and inoculation measures were implemented locally, and there was a gradual shift toward structural reforms influenced by catastrophic events like plagues and fires. These developments laid hesitant groundwork for the more systematic public health reforms of the Victorian era, in an era of industrialisation and densely populated cities.George Rosen, A history of public health (1958) pp.109–191. [https://archive.org/details/historyofpublich0000rose online]

With the onset of the Industrial Revolution and the rapid growth of overcrowded cities, living standards amongst the working population began to worsen, with cramped and highly unsanitary conditions. A severe long-term shortage of cheap housing led to the rapid growth of slums, and mortality rates began to rise alarmingly, almost doubling in Birmingham and Liverpool. Thomas Malthus warned of the dangers of overpopulation in 1798. His ideas, as well as those of Jeremy Bentham, became very influential in government circles in the early years of the 19th century. Public health started to improve in the late 18th century: a trend that was to continue over the next two centuries: a social evil was identified, private philanthropists brought attention to it, and changing public opinion led to government action.{{cite web|url=http://www.britannica.com/EBchecked/topic/482384/public-health/35547/National-developments-in-the-18th-and-19th-centuries|title=Public Health | vauthors = Rhodes P, Bryant JH |date = 20 May 2019 |publisher=Encyclopædia Britannica}}

The practice of medicine grew rapidly in the 18th century, as seen in the rapid growth in voluntary hospitals in England.{{cite book| vauthors = Carruthers GB, Carruthers LA |title=A History of Britain's Hospitals |date=2005|publisher=Book Guild Publishers|isbn=978-1-85776-905-0}} The acceptance of vaccination quickly followed the pioneering work of Edward Jenner in treating smallpox. James Lind's discovery of the causes of scurvy amongst sailors and its mitigation by eating fruit on lengthy voyages was published in 1754 and led to its adoption by the Royal Navy.{{cite journal | vauthors = Vale B | title = The Conquest of Scurvy in the Royal Navy 1793–1800: A Challenge to Current Orthodoxy | journal = The Mariner's Mirror | volume = 94 | issue = 2 | date = May 2008 | pages = 160–175 | doi = 10.1080/00253359.2008.10657052 }}

The broader public was also educated about health matters: in 1752 the British physician Sir John Pringle published Observations on the Diseases of the Army in Camp and Garrison, which pointed out the importance of adequate ventilation in the barracks and the provision of latrines for the soldiers.{{cite journal | vauthors = Selwyn S | title = Sir John Pringle: hospital reformer, moral philosopher and pioneer of antiseptics | journal = Medical History | volume = 10 | issue = 3 | pages = 266–274 | date = July 1966 | pmid = 5330009 | pmc = 1033606 | doi = 10.1017/s0025727300011133 | publication-date = July 1966 }}

{{Further|Infant mortality}}

Infant mortality in the United Kingdom greatly reduced between 1700 and 2025. Good national statistics begin in 1837; before then historians use local studies.Chris Galley, Infant Mortality in England, 1538-2000 (Local Population Studies Society. 2023), pp. 8-10. [http://www.localpopulationstudies.org.uk/the-journal/galley-infant-mortality/ online]

In the early 18th century, infant mortality rates were extremely high:

• 1700–1749: The infant mortality rate in London was 342 deaths per 1,000 live births.Romola Jane Davenport, "Infant-feeding practices and infant survival by familial wealth in London, 1752–1812." The History of the Family 24.1 (2019): 174-206. [e: https://doi.org/10.1080/1081602X.2019.1580601 online]
• 1700–1740: Nationally, infant mortality reached about 20% of all live-born infants.Romola J. Davenport, "Mortality, migration and epidemiological change in English cities, 1600–1870." International Journal of Paleopathology 34 (2021): 37-49. [https://pmc.ncbi.nlm.nih.gov/articles/PMC7611108/ online]

Tuberculosis was the main cause of death, especially in fast-growing urban areas where very bad sanitation and polluted water supplies spread germs to poor people. However, until professional medicine realised that germs caused infectious diseases, progress was limited. Between 1851 and 1910, tuberculosis caused about 4 million deaths in England and Wales alone, representing nearly a quarter of all deaths during this period.Helen Bynum, Spitting Blood: The history of tuberculosis (Oxford UP, 2015) p.110. John Frith, "History of tuberculosis. Part 1-phthisis, consumption and the white plague." Journal of Military and Veterans Health 22.2 (2014): 29-35. See also [https://www.valmcbeath.com/victorian-era-england-1837-1901/victorian-era-consumption/ "Victorian Era Consumption"]

Historians have developed estimates before 1837 for several localities. Finally in that year, the introduction of civil registration of births and deaths enabled the nationwide tracking of infant mortality by date, location and cause.E. A. Wrigley and E. Anthony. "How reliable is our knowledge of the demographic characteristics of the English population in the early modern period?." The Historical Journal 40.3 (1997): 571-595. DOI: https://doi.org/10.1017/S0018246X97007334

The 19th century saw substantial improvements in infant survival:

• 1800–1824: Infant mortality for Quakers in London fell to 151 deaths per 1,000 live births.Davenport (2019).
• 1837–1844: The national infant mortality rate was around 148 deaths per 1,000 live births.Chris Galley, "Infant Mortality in England, 1538-2000: Stability and the Beginnings of Change, 1837-1910." Local Population Studies 106 (2021). [http://www.localpopulationstudies.org.uk/wp-content/uploads/LPS-106-2021-GALLEY-pp.-98-209.pdf online]
• 1839–1844: There was a steady increase in the proportion of neonatal to infant deaths{{clarify|date=March 2025}}, possibly indicating improved registration practices.Galley (2021).
• 1870s: The Registrar General's office began regularly reporting infant mortality rates.

A series of laws passed by Parliament and affecting England and Wales marked a shift towards proactive public health measures. They concerned sanitation, disease prevention, and living conditions in urban areas, as well as national and local rules of oversight.W. M. Frazer, A history of English public health, 1834–1939 (1950) pp.31–112.Chris Day. "‘The Law of The Board of Health’ Rhetoric, Failure and Public Health in the English Periphery, c. 1848–1875." Family & Community History 26.3 (2023): 218-234. "Sanitary reform" was a common refrain of Conservative politicians in their landslide victory in 1874. Liberal politicians tended to ridicule it, but Disraeli had a broader vision of "sanitary", saying: "that phrase so little understood [included] most of the civilizing influences of humanity." What the voters really wanted, in Disraeli's opinion, was healthier conditions at home and at work, and across their towns.William Flavelle Moneypenny and George Earl Buckle, The Life of Benjamin Disraeli Earl of Beaconsfield (1929) volume, 2, p. 703.

• The Public Health Act 1848 established the General Board of Health and allowed local authorities to set up local boards of health. It empowered them to appoint a Medical Officer of Health (MOH) to take charge of local issues, especially sanitation. The law marked the beginning of active state involvement in public health matters.Martin Exner, "Edwin Chadwick and the Public Health Act 1848: Principal architect of sanitary reform." in Routledge Handbook of Water and Health (2015) pp. 699-705.C. Hamlin, and S. Sheard, "Revolutions in public health: 1848, and 1998" BMJ (1998) ;317(7158):587-91. doi: 10.1136/bmj.317.7158.587. PMID 9721121; PMCID: PMC1113797.
• The Vaccination Act 1853 made vaccination against smallpox compulsory for all infants under three months old, while the Vaccination Act 1867 extended compulsory vaccination to all children under the age of 14.Ro Jo Lambert, " A Victorian National Health Service: State Vaccination, 1855–71." The Historical Journal 5.1 (1962): 1-18. [https://www.jstor.org/stable/3020503 online]
• The Public Health Act 1875 consolidated the previous public health legislation.

{{Main|Child labour}}

Evangelical religious forces reflected Victorian morality by taking the lead in identifying the evils of child labour, and legislating against them. Their anger at the contradiction between the conditions on the ground for children of the poor and the middle-class notion of childhood as a time of innocence led to the first campaigns for the imposition of legal protection for children. Reformers attacked child labor from the 1830s onward. The campaign that led to the Factory Acts was spearheaded by rich philanthropists of the era, especially Anthony Ashley-Cooper, 7th Earl of Shaftesbury, who introduced bills in Parliament to mitigate the exploitation of children in the workplace. In 1833, he introduced the Ten Hours Act 1833, which provided that children working in the cotton and woollen mills must be aged nine or above; no person under the age of eighteen was to work more than ten hours a day or eight hours on a Saturday; and no one under twenty-five was to work nights.Georgina Battiscombe, Shaftesbury: A Biography of the Seventh Earl 1801–1885 (1988) pp. 88–91. The Factories Act 1844 said children 9–13 years could work for at most 9 hours a day, with a lunch break.{{cite book|last=Kelly|first=David|display-authors=etal|title=Business Law|url=https://books.google.com/books?id=wMhwAwAAQBAJ&pg=PA548|year=2014|publisher=Routledge|page=548|isbn=9781317935124}} Further legal interventions throughout the century increased the level of childhood protection, despite the resistance from the laissez-faire attitudes against government interference by factory owners. Parliament respected laissez-faire in the case of adult men, and there was minimal interference in the Victorian era.{{cite book|author1=C. J. Litzenberger|author2=Eileen Groth Lyon|title=The Human Tradition in Modern Britain|year=2006|publisher=Rowman & Littlefield|isbn=978-0-7425-3735-4|pages=142–43}}

Unemployed street children suffered too, as novelist Charles Dickens revealed to a large middle class audience the horrors of London street life.Amberyl Malkovich, Charles Dickens and the Victorian Child: Romanticizing and Socializing the Imperfect Child (2011)

In the first four decades of the 19th century alone, London's population doubled and even greater growth rates were recorded in the new industrial towns, such as Leeds and Manchester. From 1801 to 1851, the proportion of Englanders living in cities over 20,000 more than doubled from 17% to 38%.Rosen p 202.

This rapid urbanisation exacerbated the spread of disease in the large conurbations that built up around the factories. These settlements were cramped and primitive, with no organised sanitation. Disease was inevitable, and its incubation in these areas was encouraged by the poor lifestyle of the inhabitants. Not enough new housing was built, and people squeezed into small, dirty apartments, and drank dirty water. One result was high rates of tuberculosis, which became the leading cause of death.Romola J. Davenport, "Urbanization and mortality in Britain, c. 1800–50." Economic History Review 73.2 (2020): 455-485. [https://onlinelibrary.wiley.com/doi/pdf/10.1111/ehr.12964 online]

{{Further| History of Liverpool|History of housing in Liverpool}}

File:Court housing Liverpool.jpg

Very rapid migration came from rural England, and especially from Ireland during the famine years 1847–1852. This led to severe overcrowding and very poor sanitation. Housing in Liverpool was dark, poorly ventilated, damp and overcrowded, with no provision for human or horse waste. The people stuffed in tiny apartments used privies out back, and it was common practice to dispose of the contents by spreading them over the courts. As a result, many people waded in sewage. The cities faced several cholera outbreaks. Gerry Kearns, "Town Hall and Whitehall: sanitary intelligence in Liverpool, 1840–63." Body and City (Routledge, 2017) pp.. 89-108.

These hardships galvanised public health reforms and philanthropic efforts. Reformers led by William Rathbone worked tirelessly to improve healthcare and education. In 1822 a commission of sewers was established and over the next 20 years built 30 miles of sewers, but these were for surface water drainage only; houses did not connect to their drains.Bertie Dockerill, "Liverpool Corporation and the origins of municipal social housing, 1842–1890." Transactions of the Historic Society of Lancashire and Cheshire 165 (2016): 39-56. [https://www.researchgate.net/profile/Bertie-Dockerill/publication/321306377_Liverpool_Corporation_and_the_origins_of_municipal_social_housing_1842-1890/links/5a5fed00458515b4377b86d2/Liverpool-Corporation-and-the-origins-of-municipal-social-housing-1842-1890.pdf online]

William Henry Duncan (1805–1863) was Medical Officer of Health (1847–1863). He was the first Medical Officer anywhere in the UK. He worked energetically to upgrade the city's sanitation, especially in the face of overwhelming migration from Ireland during the great famine.{{Cite journal | last1 = Halliday | first1 = S. | title = Duncan of Liverpool: Britain's first Medical Officer | journal = Journal of Medical Biography | volume = 11 | issue = 3 | pages = 142–149 | year = 2003 | pmid = 12870037 | doi=10.1177/096777200301100307| s2cid = 21967666 }}

Edwin Chadwick (1800–1890) identified bad sanitation as a major threat to public health in crowded cities. He promoted major construction programs in urban sewers and water supplies . He pioneered the use of systematic surveys to identify all phases of a complex social problem, and pioneered the use of systematic long-term inspection programmes to make sure the reforms operated as planned.Robert B. Ekelund, and Edward O. Price, The Economics of Edwin Chadwick: Incentives Matter (Edward Elgar Publishing, 2012) pp.183-208. [https://archive.org/details/economicsofedwin0000ekel/page/n6/mode/1up online] Similar sanitation programs were developed by most major cities in Europe and North America.Daniel Gallardo‐Albarrán, "The global sanitary revolution in historical perspective." Journal of Economic Surveys (2024). pp 1-32. DOI: 10.1111/joes.12607 [https://onlinelibrary.wiley.com/doi/pdf/10.1111/joes.12607 online]

Following a serious outbreak of typhus in 1838, Chadwick convinced the Poor Law Board that an enquiry was urgently required. Chadwick sent questionnaires to every Poor Law Union, and talked to surveyors, builders, prison governors, police officers and factory inspectors to obtain additional data about the lives of the poor. He edited the information himself, and prepared it for publication in 1842 at his own expense. It became a best-seller. His Report on The Sanitary Condition of the Labouring Population of Great Britain caught the public imagination and was soon incorporated into English law.G. M. Binnie, Early Victorian Water Engineers (Thomas Telford, 1981) pp 4–5.S.E. Finer, The life and times of Sir Edwin Chadwick (1952) [https://books.google.com/books?hl=en&lr=&id=nOQcDQAAQBAJ see pp. 209-242].For the text of Report of Her Majesty's Principal Secretary of State for the Home Department, from the Poor Law Commissioners, on an Inquiry into the Sanitary Condition of the Labouring Population of Great Britain; with appendices see [https://archive.org/details/reporttohermaje01commgoog/page/n5/mode/1up online copy.].

Chadwick argued eight main points, emphasizing the absolute necessity of better water supplies and of a drainage system to remove waste, as ways to lower the death rate. He saw that every house needed a permanent water supply, rather than the intermittent supplies from standpipes that were often provided. He proposed each house would have a constant water supply, and privies would ensure that soil was discharged into egg-shaped sewers, to be carried away and spread on the land as manure, preventing rivers from becoming polluted. Chadwick understood that both water supply and drainage were important, since there had to be enough sewers to carry the waste away. Chadwick later helped to ensure that the Waterworks Clauses Act 1847 limited profits, and required them to provide a constant supply of wholesome water for houses, and a supply for cleansing sewers and watering streets.Binnie, pp=7-23.

{{main|1854 Broad Street cholera outbreak|History of cholera|1846–1860 cholera pandemic}}

Cholera was the main concern.Rebessa Stieva,  "Public Health Interventions in Historical Perspective: Cholera in Victorian London, 1849, 1854, and 1866" (PhD dissertation, McGill University (Canada) ProQuest Dissertations & Theses,  2023. 31078784). Officials knew that the disease had hit India hard in 1818 and was steadily progressing westward. There was no known cure, and about a third of the patients died. Doctors assumed it was caused by breathing "miasma"—mysterious air particles produced by rotting waste. Sanitation using sewers to move out all the waste was seen as the solution. Early on no one realized it was caused by a germ that passed through the water supply from person to person. The first case appeared in England in 1833. A quarantine was imposed on shipping in the seaports, much to the dismay of merchants and sailors. By 1832 there were 52,000 deaths, including 10,000 in Edinburgh and Glasgow alone. It focused on cities but not on social status; the victims represented every class of society. Local governments ordered whitewashing houses with chloride of lime or burning barrels of tar in the streets in order to dissipate the supposed miasma causing. the disease. The epidemics petered out, then reappeared every few years. Major cholera epidemics struck Britain in 1848–1849 with 70,000 deaths; 1853–1854 with 30,000 deaths; and 1866 with 18,000 deaths.David Taylor, Mastering economic and social history (1988) pp. 306–307.

Geoff Gill, "Cholera and the fight for public health reform in mid-Victorian England." Historian 66 (2000): 10+ [https://www.history.org.uk/files/download/531/1204285709/cholera_and_the_fight.pdf online]A popular history is Amanda J.Thomas, Cholera: the Victorian plague (2015) [https://www.google.com/books/edition/Cholera/sjk5CwAAQBAJ?hl=en&gbpv=1&dq=cholera+in+UK+Britain+england&pg=PA10&printsec=frontcover online]

File:John Snow memorial and pub.jpg

Chadwick was working on removing the waste and dirt as the solution, but the precise cause of the disease was not known until the work of John Snow in 1854.Roy Porter, The Greatest Benefit to Mankind: A Medical History of Humanity (1997) pp. 412–413. That year there was a severe outbreak of cholera in the upper class Soho district of London. It was part of the worldwide 1846–1860 cholera pandemic. It prompted Snow to map the homes of people who got sick in Soho and show they had all been drinking water that came from one neighborhood pump in Broad Street. Everyone breathed the same air, but only some people used that particular pump and only its users got sick. He deduced that germ-contaminated water was the source of all the cholera cases. Snow's maps were a powerful confirmation of the germ theory of disease, and explained how the germs spread. Doctors could now discard the old airborne "Miasma theory".{{Cite journal |last=Eyeler |first=William |date=July 2001 |title=The changing assessments of John Snow's and William Farr's Cholera Studies |journal=Sozial- und Präventivmedizin |doi=10.1007/BF01593177 |pmid=11582849 |volume=46 |issue=4 |pages=225–32 |s2cid=9549345 |doi-access=free}}Sandra Hempel, The Medical Detective: John Snow, Cholera, and the Mystery of the Broad Street Pump (Granta Books, 2006).

Snow's great discovery decisively influenced public health policies and quickly led to the construction of improved sanitation facilities. The term "focus of infection" started to be used to describe sites, such as one particular water pump in Broad Street that spread the cholera germs.George Rosen, A History of Public Health (1958) pp. 285–288,

{{Further|Water supply and sanitation in the United Kingdom#History}}

Sir Joseph Bazalgette was the Chief Engineer of London's Metropolitan Board of Works, 1856–1889. His major achievement was the creation of a sewerage system for central London, in response to the Great Stink of 1858. His solution in 1864–1875 was to construct a network of 82 miles (132 km) of enclosed underground brick main sewers to intercept sewage outflows, and 1,100 miles (1,800 km) of street sewers, to divert the raw sewage which flowed freely through the streets and thoroughfares of London to the river. His system proved instrumental in relieving the city of cholera epidemics, while beginning to clean the River Thames.Gordon Charles Cook, "Construction of London's Victorian sewers: the vital role of Joseph Bazalgette." Postgraduate Medical Journal 77.914 (2001): 802-804. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1742196/pdf/nihpp-rs4169007v1.pdf online]

Historians have been using quantitative models to estimate the impact of investment in sanitation and pure water supplies on health indicators. One study of 16 cities outside London indicates that for 1845–1884, the first round of sanitation investments were associated with sharp declines in infant and child mortality, and a 13% decline in overall mortality. However subsequent rounds of spending in the same cities gave a much smaller decline.Toke S. Aidt, Romola J. Davenport, and Felix Gray. "New perspectives on the contribution of sanitary investments to mortality decline in English cities, 1845–1909." Economic History Review 76.2 (2023): 624-660. [https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/ehr.13195 online] See also M. Alsan and C. Goldin, "Watersheds in child mortality: the role of effective water and sewerage infrastructure, 1880 to 1920" Journal of Political Economy 127 (2019), pp. 586–638 on the pattern in Massachusetts.

{{Further|Demographics of the Victorian era}}

19th-century Britain saw a huge population increase accompanied by rapid urbanisation stimulated by the Industrial Revolution.{{Cite book |last=Marriott |first=J. A. R. |title=Modern England: 1885–1945 |year=1948 |edition=4th |pages=166}} In the 1901 census, more than three out of every four people were classified as living in an urban area, compared to one in five a century earlier.{{Cite book |last=Chapman Sharpe |first=William |title=Victorian Britain An Encyclopedia |publisher=Routledge |year=2011 |isbn=9780415669726 |editor-last=Mitchell |editor-first=Sally |pages=162–164 |chapter=Cities}} Historian Richard A. Soloway wrote that "Great Britain had become the most urbanized country in the West."{{Cite book |last=Soloway |first=Richard A. |title=Victorian Britain An Encyclopedia |publisher=Routledge |year=2011 |isbn=9780415669726 |editor-last=Mitchell |editor-first=Sally |pages=617–618 |chapter=Population and demographics}} The rapid growth in the urban population included the new industrial and manufacturing cities, as well as service centres such as Edinburgh and London.{{Cite book |last=Theerman |first=Paul |title=Victorian Britain An Encyclopedia |publisher=9780415669726 |year=2011 |isbn=9780415669726 |editor-last=Mitchell |editor-first=Sally |pages=237–238 |chapter=Edinburgh}} Private renting from housing landlords was the dominant tenure. P. Kemp says this was usually of advantage to tenants.{{cite journal |last1=Kemp |first1=P. |year=1982 |title=Housing landlordism in late nineteenth-century Britain |journal=Environment and Planning A |volume=14 |issue=11 |pages=1437–1447 |doi=10.1068/a141437 |bibcode=1982EnPlA..14.1437K |s2cid=154957991}} Overcrowding was a major problem with seven or eight people frequently sleeping in a single room. Until at least the 1880s, sanitation was inadequate in areas such as water supply and disposal of sewage. This all had a negative effect on health, especially that of the impoverished young. For instance, of the babies born in Liverpool in 1851, only 45 per cent survived to age 20.{{Cite book |last=Cook |first=Bernard A. |title=Victorian Britain An Encyclopedia |publisher=Routledge |year=2011 |isbn=9780415669726 |editor-last=Mitchell |editor-first=Sally |pages=622–625 |chapter=Poverty}} Conditions were particularly bad in London, where the population rose sharply and poorly maintained, overcrowded dwellings became slum housing. Kellow Chesney wrote of the situation:{{Cite web |title=Poverty and Families in the Victorian Era |url=http://www.hiddenlives.org.uk/articles/poverty.html |access-date=2023-04-28 |website=www.hiddenlives.org.uk |language=en |archive-date=6 December 2008 |archive-url=https://web.archive.org/web/20081206083852/http://www.hiddenlives.org.uk/articles/poverty.html |url-status=live }}

{{Blockquote|text=Hideous slums, some of them acres wide, some no more than crannies of obscure misery, make up a substantial part of the metropolis... In big, once handsome houses, thirty or more people of all ages may inhabit a single room}}

Hunger and poor diet was a common aspect of life across the UK in the Victorian period, especially in the 1840s, but the mass starvation seen in the Great Famine in Ireland was unique.{{Cite book |last=Goodman |first=Ruth |title=How to be a Victorian |publisher=Penguin. |year=2013 |isbn=978-0-241-95834-6 |chapter=Chapter 6: Breakfast: Hunger}} Levels of poverty fell significantly during the 19th century from as much as two thirds of the population in 1800 to less than a third by 1901. However, 1890s studies suggested that almost 10% of the urban population lived in a state of desperation lacking the food necessary to maintain basic physical functions. Attitudes towards the poor were often unsympathetic and they were frequently blamed for their situation. In that spirit, the Poor Law Amendment Act 1834 had been deliberately designed to punish them and would remain the basis for welfare provision into the 20th century. While many people were prone to vices, not least alcoholism, historian Bernard A. Cook argues that the main reason for 19th century poverty was that typical wages for much of the population were simply too low. Barely enough to provide a subsistence living in good times, let alone save up for bad.

Improvements were made over time to housing along with the management of sewage and water, eventually giving the UK the most advanced system of public health protection anywhere in the world.{{Cite web |last=Robinson |first=Bruce |date=17 February 2011 |title=Victorian Medicine – From Fluke to Theory |url=http://www.bbc.co.uk/history/british/victorians/victorian_medicine_01.shtml |access-date=13 October 2020 |website=BBC History |archive-date=8 November 2020 |archive-url=https://web.archive.org/web/20201108110941/http://www.bbc.co.uk/history/british/victorians/victorian_medicine_01.shtml |url-status=live }} The quality and safety of household lighting improved over the period with oil lamps becoming the norm in the early 1860s, gas lighting in the 1890s and electric lights beginning to appear in the homes of the richest by the end of the period.{{Cite book |last=Loomis |first=Abigail A. |title=Victorian Britain An Encyclopedia |publisher=Routledge |year=2011 |isbn=9780415669726 |editor-last=Mitchell |editor-first=Sally |pages=452–453 |chapter=Lighting}} Medicine advanced rapidly during the 19th century and germ theory was developed for the first time. Doctors became more specialised and the number of hospitals grew. The overall number of deaths fell by about 20%. The life expectancy of women increased from around 42 to 55 and 40 to 56 for men. Very rapid urbanisation aided the spread of diseases, and squalid living conditions in many places exacerbated the problem. The population of England, Scotland and Wales grew rapidly during the 19th century.{{Cite web |last=Jefferies |first=Julie |year=2005 |title=The UK population: past, present and future |url=https://webarchive.nationalarchives.gov.uk/ukgwa/20060215211500/http://www.statistics.gov.uk/downloads/theme_compendia/fom2005/01_FOPM_Population.pdf |access-date=2023-04-29 |website=webarchive.nationalarchives.gov.uk |pages=3 to 4 |archive-date=29 April 2023 |archive-url=https://web.archive.org/web/20230429012738/https://webarchive.nationalarchives.gov.uk/ukgwa/20060215211500/http://www.statistics.gov.uk/downloads/theme_compendia/fom2005/01_FOPM_Population.pdf |url-status=live }} Various factors are considered contributary to this, such as the lack of a catastrophic pandemic or famine for the first time in history,{{cite journal |last=Szreter |first=Simon |year=1988 |title=The importance of social intervention in Britain's mortality decline c.1850–1914: A re-interpretation of the role of public health |journal=Social History of Medicine |volume=1 |pages=1–37 |doi=10.1093/shm/1.1.1 |s2cid=34704101}} {{Subscription required}} improved nutrition, and a lower overall mortality rate. Ireland's population shrank significantly, mostly due to emigration and the Great Famine.{{cite web |title=Ireland – Population Summary |url=http://homepage.tinet.ie/~cronews/geog/census/popcosum.html |url-status=live |archive-url=https://web.archive.org/web/20110728111229/http://homepage.tinet.ie/~cronews/geog/census/popcosum.html |archive-date=28 July 2011 |access-date=10 August 2010 |publisher=Homepage.tinet.ie}}

File:Slum in Glasgow, 1871.jpg|Slum area in Glasgow (1871)

File:Llanfyllin Workhouse - geograph.org.uk - 3098623.jpg|Buildings originally built as Llanfyllin workhouse, a state-funded home for the destitute which operated from 1838 to 1930{{cite web|title=Llanfyllin, Montgomeryshire|url=http://www.workhouses.org.uk/Llanfyllin/|access-date=30 May 2023|archive-date=7 May 2023|archive-url=https://web.archive.org/web/20230507044551/https://www.workhouses.org.uk/Llanfyllin/|url-status=live}}{{cite web|title=Llanfyllin and district – The Union Workhouse – A Victorian prison for the poor|url=http://history.powys.org.uk/school1/llanfyllin/workmenu.shtml|publisher=Victorian Powys|access-date=30 May 2023|archive-date=25 April 2023|archive-url=https://web.archive.org/web/20230425161039/http://history.powys.org.uk/school1/llanfyllin/workmenu.shtml|url-status=live}}

File:-Vignetted portrait, woman holding a baby- MET DP113912.jpg|Photograph of a mother and baby by Alfred Capel-Cure ({{Circa|1850s or 60s}})

{{Further|Edwardian era|Victorian era}}

Mortality declined steadily in urban England and Wales 1870–1917. Robert Millward and Frances N. Bell looked statistically at those factors in the physical environment (especially population density and overcrowding) that raised death rates directly, as well as indirect factors such as price and income movements that affected expenditures on sewers, water supplies, food, and medical staff. The statistical data show that increases in the incomes of households and increases in town tax revenues helped cause the decline of mortality.{{Cite journal |jstor = 41377834|title = Economic factors in the decline of mortality in late nineteenth century Britain|journal = European Review of Economic History|volume = 2|issue = 3|pages = 263–288|last1 = Millward|first1 = Robert|last2 = Bell|first2 = Frances N.|year = 1998|doi = 10.1017/S1361491698000124}}

The new money permitted higher spending on food, and also on a wide range of health-enhancing goods and services such as medical care. The major improvement in the physical environment was the quality of the housing stock, which rose faster than the population; its quality was increasingly regulated by central and local government. Infant mortality fell faster in England and Wales than in Scotland. Clive Lee argues that one factor was the continued overcrowding in Scotland's housing.Clive H. Lee, "Regional inequalities in infant mortality in Britain, 1861–1971: patterns and hypotheses." Population Studies 45.1 (1991): 55–65. During the First World War, infant mortality fell sharply across the country. J. M. Winter attributes this to the full employment and higher wages paid to war workers.J. M. Winter, "Aspects of the impact of the First World War on infant mortality in Britain." Journal of European Economic History 11.3 (1982): 713.

In 1901-1910, infant mortality became a focus of public health concerns, with more detailed reporting and analysis.See [https://www.nuffieldtrust.org.uk/resource/infant-and-neonatal-mortality "Stillbirths and neonatal and infant mortality" (Quality Watch, 2024)] The Midwives Act 1902 regulated midwifery, in order to ensure safer childbirth practices.Pamela Dale, and Kate Fisher. "Implementing the 1902 Midwives Act: assessing problems, developing services and creating a new role for a variety of female practitioners." Women's History Review 18.3 (2009): 427–452. [https://www.tandfonline.com/doi/pdf/10.1080/09612020902951580 online]

In 1800 hospitals were few in number. and played a small role in public health.. Their primary role was to pro provide free service to the poor. During the 19th century, the number and variety of hospitals grew dramatically. In the long run, the most important were the voluntary hospitals. By 1900 they had became the elite institutions. for the practice of the best medicine, using a new and much deeper understanding of disease based on the theory of germs.

{{Further|Hospital#Types}}

Britain had a great variety of hospitals in the 19th century.Brian Abel-Smith, The Hospitals 1800-1948: A Study in Social Administration in England and Wales (1964) is the standard scholarly history. See pp. 119-151. [https://archive.org/details/hospitals18001940000bria/page/n8/mode/1up online]J. Rogers Hollingsworth, A political economy of Medicine: Great Britain and the United States (Johns Hopkins, UP 1986) pp.6–64. [https://archive.org/details/politicaleconomy00holl/page/n5/mode/2up online] G. Barry Carruthers and Lesley A. Carruthers, A History of Britain's Hospitals and the Background to the Medical, Nursing and Allied Professions (Book Guild Publishing, 2005).

• Voluntary hospitals: There were around 1,000 voluntary hospitals, compared with the 3,000 or so public hospitals in the other categories. The voluntary hospitals were funded by fees and by charitable donations. They were managed by private organizations led by the local upper class. Although they provided some free or low-cost medical care to the poor, their emphasis was on the paying middle class family. They played a steadily expanding role as they came to dominate the healthcare system.Anne Borsay, " 'Persons of honour and reputation': the voluntary hospital in an age of corruption." Medical History 35.3 (1991): 281-294. [https://www.cambridge.org/core/services/aop-cambridge-core/content/view/15DBAD3B5DD4FFD5BCD6041DDF0E4718/S0025727300053795a.pdf/aoepersons_of_honour_and_reputationa_the_voluntary_hospital_in_an_age_of_corruption.pdfonline]Edward Cheetham, "Community and the Voluntary Hospitals in Derbyshire and Nottinghamshire, 1900-1946: Economy, Society, Culture" (PhD dissertation, Nottingham Trent University, 2020) [https://irep.ntu.ac.uk/id/eprint/42932/1/Thesis%20Edward%20Cheetham%20N0324194%20Complete%20(1).pdf online].

• Cottage hospital: These were small hospitals, typically accommodating around 12 patients. They were established in rural areas and were often run by local general practitioners (GPs). Cottage hospitals provided basic medical care and were more accessible to people living in the countryside.R.M.S. McConaghey. "The evolution of the cottage hospital." Medical History 11.2 (1967): 128-140. [https://scholar.google.com/scholar?output=instlink&q=info:3eK2YyDKRYYJ:scholar.google.com/&hl=en&as_sdt=0,27&scillfp=8185835067423620164&oi=lle online]

• Infirmaries: Larger hospitals located in towns and cities, the infirmaries provided both inpatient and outpatient services. An example is Leeds General Infirmary. Initially funded by charities, these hospitals were often crowded and had poor sanitary conditions. They played a central role in providing medical care to the urban population.Anne Borsay, Medicine and charity in Georgian Bath: A social history of the general infirmary, c. 1739-1830 (Routledge, 2019).

• Specialist hospitals: These hospitals focused on specific medical conditions or patient groups. For example, the Hospital for Sick Children, established in 1852, was dedicated to pediatric care. Katharina Boehm, “ ‘A Place for More than the Healing of Bodily Sickness’: Charles Dickens, the Social Mission of Nineteenth-Century Pediatrics, and the Great Ormond Street Hospital for Sick Children.” Victorian Review 35#1 (2009), pp. 153–74. [http://www.jstor.org/stable/27793709 online] Likewise others emerged from new specialties including fever hospitals; maternity hospitals; and incurable hospitals.Richard Kershaw, Special Hospitals: Their Origin, Development, and Relationship to Medical Education; Their Economic Aspects and Relative Freedom from Abuse (1909). [https://books.google.com/books?hl=en&lr=&id=-hwyAQAAMAAJ&oi=fnd&pg=PA7&dq=specialist+hospitals+UK+history&ots=74_CCV5Zsw&sig=bW-V6wMXKRIJ7ezDzfnEPeNWAKE online]

• Workhouse infirmaries: These were part of the notorious workhouse system and provided medical care to the poor and destitute. Conditions in workhouse infirmaries were often harsh, and the quality of care varied widely. They were intended to be a last resort for those who had no other means of support. Public outrage spurred reforms, including the Metropolitan Poor Act 1867, which mandated separate infirmaries for London’s sick poor. By the 1880s, many workhouses evolved into dedicated hospitals with trained nurses. Nevertheless, the negative reputation persisted well into the 20th century.Margaret Anne Crowther, The Workhouse System 1834-1929: The history of an English social institution (Routledge, 2016).

• Military and naval hospitals: Established near military bases or in strategic locations to care for military and naval personnel.Erin Elizabeth Spinney, "Naval and Military Nursing in the British Empire c. 1763-1830" (PhD dissertation, University of Saskatchewan, 2018) [https://harvest.usask.ca/bitstream/10388/8575/1/SPINNEY-DISSERTATION-2018.pdf online]

• Neighborhood dispensaries were established in many cities that provided outpatient care for the poor. They mostly closed by the early 20th century.Irvine D.L. Loudon, "The origins and growth of the dispensary movement in England." Bulletin of the History of Medicine 55.3 (1981): 322-342. [https://www.jstor.org/stable/44441381 online]

{{Main|Emergency Hospital Service}}

The different hospital types were all uncoordinated because they were run by scores of local and regional government authorities, all of them very narrowly focused. The confusion ended suddenly in 1939 when the government realized war was near and Germany had a superior air force that could bomb all British cities. Officials feared they would have vast numbers of civilian casualties needing medical care. One prediction made in 1937 warned German bombing would cause 600,000 civilian deaths and 1,200,000 in need of medical attention.Richard M Titmuss, Problems of Social Policy (1951) p. 13. By 1945 there were in fact 61,000 deaths and 86,000 seriously wounded.See [https://www.thesecondworldwar.org/western-front-1939-1940/battle-of-britain/the-blitz/the-victims "Blood and Tears" (Warmaster UK, 2025) online]

All the hospitals were put under the direction of the new Emergency Hospital Service. Civil defense was urgent, so backward facilities were quickly upgraded and a wide range of new programs were started. By 1944 authorities were pleased and surprised to discover that a unified, coordinated system was possible. Indeed, it now existed, it worked well, and it won widespread support from the public and from all interested parties. The stage was set for a post war radical reconstruction of national health services.Chares Webster, The National Health Service: A Political History (1998) pp.5–15. Cuthbert Lindsay Dunn, The Emergency Medical Services: England and Wales. Vol. 2 (HM Stationery Office, 1952) [https://books.google.com/books?hl=en&lr=&id=P1IYAAAAIAAJ&oi=fnd&pg=PA1&dq=%22+Emergency+Medical+Service%22+World+War+II+United+Kingdom.&ots=N2nC95gaZQ&sig=Ja2lzbhIL06mxD0I4czXvz-59F0 online]. Richard Titmuss Problems of Social Policy (1951) [https://archive.org/details/problems-of-social-policy online]

In the 18th century the voluntary hospital movement began to provide inpatient care thanks to philanthropic efforts. Donations from wealthy benefactors provided free care to the "deserving poor". In London, hospitals like St Bartholomew's Hospital and Guy's Hospital initially served as refuges for the indigent, operating under a paternalistic model where trustees—drawn from the local elite—oversaw governance. Patients who could afford it avoided them. Instead they used small facilities operated by their physician.James O. Robinson, "The Royal and Ancient Hospital of St Bartholomew (Founded 1123)" Journal of Medical Biography (1993). 1 (1): 23–30. doi:10.1177/096777209300100105. ISSN 0967-7720. PMID 11639207. S2CID 33070295.

Throughout the 19th century, as urban populations soared, rising operational costs and increasing patient demand increasingly strained local charitable funds. Local government started public hospitals in the major cities. For instance, outpatient admissions at Royal London Hospital surged from 900 in 1809 to over 150,000 by 1895, reflecting broader societal reliance on institutional care.Abel-Smith, p. 101. Some physicians and surgeons operated very small hospitals for their own paying patients. The needs for hospitals changed according to the needs of physicians and local governments, and the sharp decline of epidemics and communicable diseases. Financial pressures, social stratification, and evolving governance models likewise helped to reshape how medical care was delivered to the public in the 19th century. Abel-Smith, p. 90.

From the late 19th century to 1948 door-to-door solicitors signed up employed men to hospital contributory schemes which acted like insurance. They collected small weekly payments from members who in turn received free treatment from the participating hospital. Most prominent was the Hospital Saturday Fund (founded 1873). see "Hospital Saturday Fund " The Hospital (May 9, 1903) [https://pmc.ncbi.nlm.nih.gov/articles/PMC5203208/pdf/hosplond73339-0014.pdf online] These schemes, which by the 1930s enrolled over 10 million contributors nationally, allowed voluntary hospitals to offset costs while providing a guaranteed flow of patients. In cities like Birmingham and Liverpool, the Hospital Saving Association (HSA) funded up to 59% of voluntary hospital beds by 1948. These programs had support from labour unions, which previously had run their own schemes.Abel-Smith, pp. 135, 316, 386–395.H.W.B. Mellows, " Hospital Contributory Schemes," Charity Organisation Quarterly no. 7, 1923, pp. 123–27 [http://www.jstor.org/stable/44649099 online] Martin Gorsky, John Mohan, and Tim Willis, Mutualism and health care: British hospital contributory schemes in the twentieth century (Manchester U P, 2016) pp.1–10.

A representative program was the Tredegar Medical Aid Society in South Wales. There coal miner Aneurin Bevan joined and was pleased with the service it provided. When Bevan became Minister of Health in the Labour government of 1945, he used Tredegar as part of the model for the National Health Service that he created.Steve Thompson, "NHS was not solely modelled on a Welsh workmen’s medical society" The Conversation July 3, 2018 [https://theconversation.com/nhs-was-not-solely-modelled-on-a-welsh-workmens-medical-society-98024 online]

After 1948 all hospitals were nationalized and became components of the free National Health Service. Allen Daley, "British Hospitals as they were before 1948." British Medical Journal 2.5201 (1960): 758. Hospitals were microcosms of broader social struggles over the welfare state in Britain.Nick Hayes, "Did we really want a National Health Service? Hospitals, patients and public opinions before 1948." English Historical Review 127.526 (2012): 625–661. https://doi.org/10.1093/ehr/ces072 Their transformation from charitable endeavors to public institutions reflects shifting ideologies about poverty, responsibility, and the state’s role in welfare. While contributory schemes demonstrated the potential for working-class participation, they ultimately could not reconcile efficiency with equity—a lesson that informed the NHS’s founding. Kenneth Morgan,Labour in Power 1945–1951 (1984) pp. 151–163. [https://archive.org/details/labourinpower1940000morg/page/n6/mode/1up online] John Campbell, Nye Bevin and the Mirage of British socialism (1987) pp.165–185. Ben W Lewis, British planning and nationalization (1952) pp.187–225. [https://archive.org/details/britishplanningn00lewirich/page/n6/mode/1up online]

File:National-insurance-act-1911.jpg under David Lloyd George (right) boasts of passing the National Insurance Act 1911.]]

In Britain, the National Insurance Act 1911 included national social health insurance for medical care for sick, injured or disabled workers. When it went into effect in 1913 it covered one-third of the population—employed working class wage earners. In 1913, it covered 13 million workers using 15,000 doctors. Doctors were paid £.4.3 million. Coverage expanded somewhat steadily and by 1938 it reached 19 million workers; its 19,000 doctors were paid £9.2 million. Only active blue collar workers were covered, and not their families. Income of participating doctors went up steadily until they did almost as well as barristers.Anne Digby, and Nick Bosanquet, "Doctors and patients in an era of national health insurance and private practice, 1913-1938" Economic History Review (1988), 41#1, p.74–94, data on p, 76. [https://www.jstor.org/stable/2597333 online]

This system of health insurance continued in force until 1948. Then the National Health Service created a universal service, funded out of general taxation rather than on an insurance basis, and providing health services to all legal residents.{{cite book|last=Leathard|first=Audrey|year=2000|chapter=Health care in Britain: pre-war provision, 1900–1939|title=Health care provision: past, present, and into the 21st century|edition=2nd|location=Cheltenham|publisher=Stanley Thornes|pages=3–4|isbn=9780748733545|chapter-url=https://books.google.com/books?id=D2lVXWNQ7ZsC&pg=PA3}} Bentley B. Gilbert, The evolution of national insurance in Great Britain: The origins of the welfare state (1966) pp.400–447 [https://archive.org/details/evolutionofnatio0000unse online] Steven Cherry, "Before the National Health Service: Financing the Voluntary Hospitals, 1900–1939." Economic History Review 50.2 (1997): 305-326. [http://www.jstor.org/stable/2599062 online]

The number of nurses rose rapidly in the 20th century. According to the 1901 United Kingdom census, there were 64,000 women nurses, along with 5,000 men. Of the total, 12,500 were trained or registered. By 1921 there were 110,000 women and 12,000 men in nursing, 25,000 were trained or registered. By 1939 there were 160,000 nurses in all, of whom 60,000 were trained and registered.Steven Cherry, "Medicine and public health, 1900–1939" in Chris Wrigley, ed., A Companion to Early Twentieth Century Britain (2003) pp. 405–423, data at page 413.Brian Abel-Smith, A History of the Nursing Profession (1960) [https://archive.org/details/historyofnursing0000abel online]

The 20th century witnessed further declines in infant mortality:Wallis Taylor, "The changing pattern of mortality in England and Wales: I. Infant Mortality." British Journal of Preventive & Social Medicine 8.1 (1954): 1-9 {{PMID|13140835}} [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1058524/pdf/brjprevsmed00033-0005.pdf online] covers 1911-1950

• 1993: The infant mortality rate in England was 6.3 deaths per 1,000 live births.
• The current infant mortality rate for U.K. in 2025 is 3.2 deaths per 1000 live births, and the rate is declining at about 2% a year.See [https://www.macrotrends.net/global-metrics/countries/gbr/united-kingdom/infant-mortality-rate "U.K. Infant Mortality Rate 1950-2025"]

Historians emphasise that progress was not always linear. For example, there were periods of stagnation and even slight increases in infant mortality rates, particularly in urban areas during rapid industrialisation.[https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/childhoodinfantandperinatalmortalityinenglandandwales/2022 Census2021, "Child and infant mortality in England and Wales: 2022" (2024) ]

Multiple factors contributed to the overall decline in infant mortality:

• Advancets in citywide sanitation and public health measures.
• Improvements in infant care, particularly in antenatal and neonatal care.Galley (2023)
• Changes in breastfeeding practices and infant feeding methods.Davenport (2021).

In the 1920s government public health funding concentrated on upgrading public infrastructure and helping wounded war veterans. Meanwhile, a number of private philanthropies took roles in public health. They were not funded by the government and ranged from major international operations such as the Rockefeller Foundation, to membership groups like the Order of Saint John, to small local charities. Rockefeller sponsored training programs for visiting nurses. The others focused on individual needs at the neighborhood level, such as helping poor families with childbirth and child welfare and dealing with tuberculosis, or providing ambulance services to hospitals for victims of traffic accidents.Barry Doyle, "Voluntary organizations and the provision of health services in England and France, 1917–29." European Review of History: Revue européenne d'histoire 30.5 (2023): 791-811.

Since 1948, the great majority of health services have been an integral part of the National Health Service . It provides free medical care, even as heavy use causes longer and longer delays.Martin Gorsky, "The British National Health Service 1948–2008: a review of the historiography." Social History of Medicine 21.3 (2008): 437-460. Geoffrey Rivett, The history of the NHS (2025) [https://www.nuffieldtrust.org.uk/health-and-social-care-explained/the-history-of-the-nhs online]

• Health in the United Kingdom
• Health in England
• Health in Wales
• Health in Scotland
• Health in Northern Ireland
• UK Health Security Agency
• Healthcare in the United Kingdom
• Private healthcare in the United Kingdom
• British Society for the History of Medicine
• History of the National Health Service, since 1948
• History of nursing in the United Kingdom
• Water supply and sanitation in the United Kingdom
• Leaders
• Edward Jenner 1749-1823 , first vaccine
• Edwin Chadwick, 1800–1890
• William Henry Duncan (1805–1863), activist in Liverpool; the first Medical Officer of Health
• John Snow, 1813–1858
• John Simon (pathologist), 1816–1904
• Joseph Bazalgette, 1819–1891, built the sewerage system for London
• Florence Nightingale, 1820–1910, founded modern nursing
• Arthur Newsholme 1857–1943, local projects
• Aneurin Bevan 1897–1960, designed the National Health Service in 1940s
• Brian Abel-Smith,1926–1996, developed the economics of public health

• Abel-Smith, Brian. The Hospitals 1800–1948: A Study in Social Administration in England and Wales (1964) [https://archive.org/details/hospitals18001940000bria online]
• Abel-Smith, Brian. A History of the Nursing Profession (1960) [https://archive.org/details/historyofnursing0000abel online]
• Allan, P. and Jolley, M. Nursing, Midwifery and Health Visiting since 1900 (1982)
• Bell, Frances, and Robert Millward. "Public health expenditures and mortality in England and Wales, 1870–1914." Continuity and Change 13.2 (1998): 221-249.
• Berridge, Virginia. " Health and medicine" in The Cambridge Social History of Britain. 1750–1950: Volume 3 Social Agencies and Institutions, edited by F.M.L. Thomson, (Cambridge University Press. 1990) pp. 171–242.
• Berridge, Virginia. Health and Society in Britain since 1939 (1999)
• Borsay, Anne, and Peter Shapely (eds). Medicine, Charity and Mutual Aid: The Consumption of Health and Welfare in Britain, c.1550–1950 (2007)
• Brand. Jeanne L. Doctors and the state: the British medical profession and government action in public health, 1870-1912 (Johns Hopkins UP, 1965).
• Briggs, Asa. '"Cholera and Society in the Nineteenth Century" Past & Present, No. 19 (1961), pp. 76–96 [http://www.jstor.org/stable/649981 online]
• Carpenter, Mary Wilson. Health, Medicine, and Society in Victorian England (Bloomsbury, 2009)
• Davenport, Romola J. "Urbanization and mortality in Britain, c. 1800–50." Economic History Review 73.2 (2020): 455-485. [https://onlinelibrary.wiley.com/doi/pdf/10.1111/ehr.12964 online]
• *Digby, Anne, and Nick Bosanquet. "Doctors and patients in an era of national health insurance and private practice, 1913-1938" Economic History Review (1988), 41#1, p.74-94 https://doi.org/10.1111/j.1468-0289.1988.tb00456
• Donaldson, L. "The UK public health system: Change and constancy" Public Health (2008) 122, 1032e1034 doi:10.1016/j.puhe.2008.05.001

• Frazer. W.M. A history of English public health, 1834–1939 (1950). [https://archive.org/details/historyofenglish00wmfr/page/n7/mode/2up online copy of the book]; see also [https://www.cabidigitallibrary.org/doi/full/10.5555/19512700304 review of book]

• Guthrie, Douglas. A History Of Medicine (1945) [https://archive.org/details/in.ernet.dli.2015.81546 online]

• Hamlin, Christopher. Public health and social justice in the age of Chadwick: Britain, 1800–1854 (1998) [https://archive.org/details/publichealthsoci0000haml/page/n8/mode/1up online]
• Hamlin, Christopher. "Muddling in bumbledom: On the enormity of large sanitary improvements in four British towns, 1855–1885." Victorian Studies 32.1 (1988): 55-83. [https://www.academia.edu/download/101373669/muddling.pdf online]
• Hardy, Anne. Health and medicine in Britain since 1860 (2001)
• Harris, James Jeffrey. "Body Politics: A History of Public Health and Politics in Britain, 1885–1922" (PhD dissertation, The Ohio State University, 2017) [https://etd.ohiolink.edu/acprod/odb_etd/ws/send_file/send?accession=osu1510659104333359&disposition=inline online].
• Heggie, Vanessa. “Women Doctors and Lady Nurses: Class, Education, and the Professional Victorian Woman.” Bulletin of the History of Medicine 39#2 (2015), pp. 267–92. [https://www.jstor.org/stable/26309019 online]

• Hollingsworth, J. Rogers. A Political Economy of Medicine: Great Britain and the United States (Johns Hopkins UP, 1986), covers 1890 to 1970.

• Honigsbaum, Mark. "The Great Dread: Influenza in the United Kingdom in Peace and War, 1889-1919" (PhD Dissertation, Queen Mary, University of London, 2011); cultural history [https://qmro.qmul.ac.uk/xmlui/bitstream/handle/123456789/2421/HONIGSBAUMGreatDread2011.pdf?sequence=1&isAllowed=y online].

• Hunter, David et al. The Public Health System in England (Policy Press 2010) Online at Ebook Central

• Lewis, Barry S. and Joyce R. Gaufin. Mastering Public Health: Essential Skills for Effective Practice (Oxford UP, 2011), Highly detailed textbook based on UK.

• Longmate, Norman. King Cholera: The biography of a disease (1966), focus on UK epidemics
• McLean, David. Public Health and Politics in the Age of Reform: Cholera, the State and the Royal Navy in Victorian Britain (2006).
• Mosley, Stephen. The Chimney of the World: A History of Smoke Pollution in Victorian and Edwardian Manchester (2001).
• Nathanson, Constance A. Disease prevention as Social Change: The State, Society, and Public Health in the United States, France, Great Britain, and Canada (Russell Sage Foundation, 2007).
• Niemi, Marjaana. Public Health and Municipal Policy Making: Britain and Sweden, 1900–1940 (Ashgate, 2007)
• Porter, Roy. The Greatest Benefit to Mankind: A Medical History of Humanity (W.W. Norton, 1997) pp. 397–427.
• Porter, Roy, and Dorothy Porter. In sickness and in health: the British experience,1650–1850 (1988) [https://pmc.ncbi.nlm.nih.gov/articles/PMC1036074/pdf/medhist00055-0095.pdf online review of this book] how educated patients talked about personal health issues.
• Porter, Dorothy. Health, Civilization and the State: A History of Public Health from Ancient to Modern Times (1998), good coverage of the British record in ch. 8-9.
• Rosen, George A History of Public Health (1958). [https://archive.org/details/historyofpublich00rose/page/n6/mode/1up online], a standard scholarly history.
• Sheppard, Francis. London 1808-1870: The infernal wen (1971, reprint 2022) [https://www.google.com/books/edition/London_1808_1870/6IR3EAAAQBAJ?hl=en&gbpv=1&dq=sheppard+london+1808&pg=PR13&printsec=frontcover online], see pp 247–296..
• Siena, Kevin. "Moral Economy, Mixed Economy, and the Biohazardous Shaping of Health Infrastructure in Eighteenth-Century London." Eighteenth-Century Studies 58.1 (2024): 25-32.
• Sigsworth, Michael, and Michael Worboys. "The public's view of public health in mid-Victorian Britain." Urban History 21.2 (1994): 237–250. [https://www.cambridge.org/core/journals/urban-history/article/abs/publics-view-of-public-health-in-midvictorian-britain/99DACDB6503272A553D2F353AD16771C online]
• Skelton, Leona J. Sanitation in Urban Britain, 1560-1700 (Routledge, 2016)
• Smith, F. B. The People's health. 1830-1910 (1979).
• {{cite journal |last=Szreter |first=Simon |year=1988 |title=The importance of social intervention in Britain's mortality decline c.1850–1914: A re-interpretation of the role of public health |journal=Social History of Medicine |volume=1 |pages=1–37 |doi=10.1093/shm/1.1.1 |s2cid=34704101}}

• Taylor, David. Mastering economic and social history (1988) pp.301–331.
• Warren, Michael D. A chronology of state medicine, public health, welfare and related services in Britain 1066–1999 (2000) [https://archive.org/details/chronologyofstat0000warr/page/n2/mode/1up online]
• Webster, Charles. The National Health Service : a political history (2002) [https://archive.org/details/nationalhealthse0000websonline]
• Webster, Charles. Problems of health care : the National Health Service before 1957 (1988) [https://archive.org/details/problemsofhealth0000webs online]

• Winter, J.M. The Great War and the British People (1986), Wide ranging, scholarly study of the demography of the soldiers and the home front. [https://www.google.com/books/edition/The_Great_War_and_the_British_People/ddoOAQAAMAAJ?hl=en online]
• Wohl, Anthony S. Endangered lives: public health in Victorian Britain (1983) [https://archive.org/details/endangeredlivesp0000wohl_i0t2 online]
• Woods, Robert, and John Woodward. Urban Disease and Mortality in Nineteenth Century England (1984)
• Woodward, John, and David Richards, eds. Health Care and Popular Medicine in Nineteenth-Century England (Croom Helm, 1977)

{{Further|Dictionary of National Biography}}

• The Dictionary of National Biography is online for Wikipedia editors only at The Wikipedia Library
• Baly, M. (1986) Florence Nightingale and the Nursing Legacy, (1986)
• Bostridge, Mark. Florence Nightingale: The Making of an Icon (2008), a standard scholarly biography.
• Cohen, I. Bernard. "Florence Nightingale." Scientific American 250.3 (1984): 128-137. On her statistical methods. [https://accounts.smccd.edu/case/biol675/docs/nightingale.pdf online]
• Eyler, John M. Sir Arthur Newsholme and State Medicine, 1885-1935 (Cambridge University Press, 1997).
• Finer, S.E. The life and times of Sir Edwin Chadwick (1952).
• Lewis, R.A. Edwin Chadwick and the Public Health Movement 1832 – 1854 (1952) [https://archive.org/details/edwinchadwickpub0000rlew online]
• Royston, Lambert. Sir John Simon and English social administration (1963).

• Cherry, Steven. "Medicine and Public Health, 1900-1939" in A Companion to Early Twentieth-Century Britain ed. by Chris Wrigley, (Blackwell, 2003) pp. 405– 423.
• Gorsky, Martin "The British National Health Service 1948–2008: A Review of the Historiography" Social History of Medicine 21#3 (2008), pp. 437–460. [https://academic.oup.com/shm/article-pdf/21/3/437/4768909/hkn064.pdf online]

• Sheard Sally. "History Matters: The Critical Contribution of Historical Analysis to Contemporary Health Policy and Health Care" Health Care Analysis (2018) 26(2):140-154. doi: 10.1007/s10728-017-0348-4. PMID: 29063364; PMCID: PMC5899992.

• Sweet, Helen. "Establishing Connections, Restoring Relationships: Exploring the Historiography of Nursing in Britain," Gender and History, (2007) 19#3 pp. 565–580

• Webster, Charles. "Conflict and consensus: explaining the British health service." Twentieth Century British History 1.2 (1990): 115-151. https://doi.org/10.1093/tcbh/1.2.115

• Cole, G.D.H., and M.I. Cole. The Condition of Britain (1937) pp.81–111 on health statistics. [https://archive.org/details/in.ernet.dli.2015.524798/page/n1/mode/1up online]

• National Statistics: The health of adult Britain, 1841–1994 (1997) [https://archive.org/details/healthofadultbri0000unse/page/n2/mode/1up online]
• Schneider, Dona, and David E. Lilienfeld, eds. Public health: the development of a discipline. Vol. 1. (Rutgers University Press, 2008), long excerpts from key primary sources before 1920, UK and United States. [https://books.google.com/books?hl=en&lr=&id=4xv0scbWSAUC&oi=fnd&pg=PR9&dq=Schneider,+Dona,+and+David+E.+Lilienfeld&ots=j-GP3XunKj&sig=0SKekWocw8u5gK7nKY0CNp1kzZE excerpts]
• Public health: the development of a discipline. Vol. 2 Twentieth century challenges (2011), covers 1920 to 2010.

• Simon, John. English sanitary institutions, reviewed in their course of development, and in some of their political and social relations (1890) [https://archive.org/details/englishsanitaryi00simorich online]
• Statistical Abstract of the United Kingdom [https://archive.org/search.php?query=title%3A%28Statistical+abstract+of+the+United+Kingdom%29&sort=-date annual 1871–1908, online]
• Young G. M., and W. D. Handcock, eds. English Historical Documents: Volume XII(1) 1833–1874. (Oxford University Press 1970), pp. 751–828.

• [https://www.adph.org.uk/resources/175th-anniversary-timeline/ History of Public Health Timeline]
• [https://www.nuffieldtrust.org.uk/health-and-social-care-explained/the-history-of-the-nhs Online history of National Health Service by Geoffrey Rivett (2025) ]

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Category:History of health care in the United Kingdom

Category:Public health

Category:History of the United Kingdom by topic

Category:History of medicine