Key dates in the Sociological history and development of Great Britian



[ index of subjects ] [ dates for Stoke-on-Trent]

Key dates Health and Nursing 
Great Britain 1000 - 1899



1106 (?1173) Foundation of the Priory near the church of St Mary Overie, Southwark, which became St Thomas’ Hospital.

c.1123 Foundation of St Bartholomew’s Hospital. See 1546.


c 1225 Acts passed dealing with the repair of sewers and control of nuisances.

1281 City of London Regulation prohibited pigs wandering in the streets, and a further Regulation in 1297 required the removal of pigsties from the streets.

1283 City of London Regulation prohibited tallow-melting in the streets and further Regulations the scouring of furs (1310), flaying of dead horses (1311) and solder melting (1371).


1309 City of London Regulation prohibited the casting of filth from houses into the streets and lanes of the City. People "ought to have it carried to the Thames or elsewhere out of town".

1315 Severe floods and poor harvests were followed by famine; recurred in 1316 and in 1317.

1344 Royal Ordinance decreed that lepers should leave the City of London and "betake themselves to places in the country".

1348-50 Black Death pandemic. In England it reached a peak in July 1349 and recurred in 1361 and 1368; between a third and a half of the population died, the total falling from about 4.7

1357 Royal Order required that no rubbish or filth should be thrown or put into the rivers of Thames and Flete; all such rubbish must be taken out of the City of London by cart (ref. Simon, Sanitary Institutions, p.40).

1371 Royal Order forbade the slaughtering of oxen, sheep and swine in the City of London.

1388 The first English Sanitary Act dealt with offal and slaughter houses; prohibited the casting of animal filth and refuse into rivers or ditches, and "corrupting of the Air".


1427 Commission of Sewers Act to remedy and prevent flooding.

Enactment in the Scottish Parliament meeting in Perth restricted the movement of lepers in cities.

1467 Beverley (Yorks) passed a rule forbidding the building of any more kilns because of the stink and badness of the air, and the detriment of fruit trees

c.1486 Publication of the first book concerned with preventive practices to be written in English. “Here begynneth a litil boke the which traytied and rehearsed many gode things necessarie for the pestilence”. Attributed to Canutus.

1496 Syphilis spreads through Europe. In 1497 Aberdeen passed a statute to segregate women infected with syphilis.

1499 Plague returned; at least 20,000 deaths in England.


1505/6 Incorporation of the Barber Surgeons of Edinburgh.

1511 Physicians and Surgeons Act limited medical practice to those who had been examined. In the City of London and for seven miles around, the examination was to be conducted by the Bishop of London or the Dean of St Paul’s Cathedral, with the assistance of four physicians or surgeons. For the rest of England the examination was to be conducted by the bishop of each diocese in a similar manner. Oxford and Cambridge universities retained their rights to issue licences to practice.

1513 Plague epidemic. The City of London issued regulations to control it.

1518 Royal College of Physicians of London founded through the granting of a charter by Henry VIII to oversee the practice of medicine within a seven mile radius of the City by licensing recognised physicians. The first president was Thomas Linacre (1460-1524).

1530-40 Suppression of the monasteries. Until this time the almshouses and hospitals of the Church dispensed charity to those who could not benefit from the help given by the craft guilds to their sick or aged members. When the State was forced to intervene, the parishes under the supervision of the justices of peace (in turn under the surveillance of the Privy Council) were made the agencies for the collection of voluntary (at first) alms and their distribution. Later, London levied the first compulsory poor rate and organised a system for poor relief through four institutions - Christ’s Hospital for children (1552), St Bartholomew’s and St Thomas Hospitals for the sick and Bridewell for the able-bodied destitute (1553). Other cities developed their own local schemes.

1532/3 Act authorised the raising of a rate for the destruction of vermin. Another Act provided for the appointment of Commissioners of Sewers with powers to tax and distrain, and to inspect and construct sewers.

1540 Union of the Guild of Barber Surgeons and the Fellowship of Surgeons combined to form the Communality (Company) of Barbers and Surgeons of London, following an Act which declared that surgeons should no longer be barbers, and that barbers should restrict their surgery to drawing teeth. The Company was given the monopoly of teaching anatomy and surgery and the right to “take yearly four condemned persons for Anatomies”.

1542 The Physicians and Surgeons Act of 1511 amended to permit every person “having knowledge and experiences of the Nature of Herbs, Roots and Waters” to treat external wounds, sores, diseases and maladies, and medicines for stone, strangury or agues”. This was necessary because “for the most Part of the Persons of the said Craft of Surgeons have small Cunning, yet they will take great Sums of Money, and do little therefore, and by reason thereof they do oftentimes impair and hurt their Patients, rather than do them good”


1563 Severe epidemics of bubonic plague in London and other cities. It has been estimated that in the City of London, (population of 93,000) 17,000 people died.


1571 Further legislation concerning the maintenance of sewers and control of nuisances

1575 Plague epidemic.

1586 Severe famine.

1589-93 Outbreaks of plague in various cities.

1593 An Act for the Necessary Relief of Soldiers and Mariners stated that “Every parish shall be charged with a sum weekly towards the relief of sick hurt, maimed soldiers and mariners”. Amending acts raising the amounts to be collected were passed in 1597 and 1601.

1594-98 Intermittent famines, some associated with typhus and dysentery (“bloody flux”). “People were starving and dying in our streets and in our fields for lack of bread”.


1603-10 Intermittent epidemics of bubonic plague in various cities; power was given in 1604 to mayors, bailiffs and justices to order people to stay indoors and to take other measures.

1617 Society of Apothecaries formed by the separation of apothecaries from grocers. The apothecaries were granted the exclusive privilege of selling drugs and of compounding medicines.

1625 Epidemic of plague caused an estimated 20,000 deaths in 11 weeks.

1636 Epidemic of plague.

1665 Great Plague Epidemic,

1689 Dr Hugh Chamberlen (court physician and accoucheur) submitted a “Proposal for the Better Securing of Health” suggesting that medical treatment should be available to “all sick, poor or rich ... for a small yearly certain sum assessed upon each house”, and, “that the laws already in being may be revised, which provide against the sale of unwholesome food; that bread may be well baked; beer well brewed, and houses and streets well cleaned from dirt and filth; all these being common causes of diseases and death”.

1697 First dispensary opened in the premises of the Royal College of Physicians in Warwick Lane, where the poor were oven free consultation and advice, and prescribed drugs dispensed from a special stock. Branches were opened later in other parts of the City. Closed in 1725.

Daniel Defoe (1660-1731, journalist and novelist) proposed that the insurance principle should be applied to the social problems of the poor, including disability pensions and medical and institutional care.

Eighteenth Century

England at the start of the century was still mainly a land of hamlets and villages with the majority of the population living in the south. The population probably numbered about five and a half million.

In the towns, houses, including the cellars, were desperately overcrowded; there were no sanitary systems, and streets were unpaved and filthy. In the early part of the century) only about one child in four, born in London, survived.

During the century transport between towns improved, mills and factories were built; and, as towns developed, dispensaries, general hospitals, hospitals for special groups of patients, and charity schools were founded in London and in provincial towns. By the end of the century ideas of state intervention in public health matters were emerging, and concern was expressed about the conduct of asylums (madhouses) and the treatment of prisoners.

1745 Company of Surgeons formed, and separated from the Barbers.

Removal of the ban on private dissection of human bodies led to the rise of private schools of medicine and the introduction of anatomy classes.


1769 Dispensary for sick children of the poor opened in Red Lion Square by George Armstrong (1719-1789, physician and author of “An Essay on the Diseases Most Fatal to Infants, 1767); later moved to Soho Square, closed in 1781. Seamen’s Hospital, London, opened.

1773 An Act for the better Regulation of Lying-in Hospitals, and other Places appropriated for the charitable Reception of pregnant Women; and also to provide for the Settlement of Bastard Children, born in such Hospitals and Places.

1774 Act for Regulating Private Madhouses followed the report of a Select Committee of the House of Commons (1763) and introduced licensing, in London by Commissioners elected by the Royal College of Physicians, and elsewhere by justices at Quarter Sessions. The Act had many weaknesses, not least that the Commissioners had no power to revoke licences on the grounds of ill-treatment or neglect of patients.

Westminster General Dispensary opened in Gerrard Street, Soho, and provided medical, surgical and midwifery services to the local poor for the next 182 years - until 1956.

John Howard (1726-90, philanthropist and prison reformer) described to the House of Commons the appalling conditions in British prisons. His name and work are perpetuated by the Howard League for Penal Reform.


1793 Registration of Friendly Societies. Many of the Societies provided medical attention to their subscribing members.

1796 A voluntary Board of Health formed at Manchester on the advice of Thomas Percival (1740-1804, local medical practitioner) who had studied outbreaks of infectious diseases in the city and the cotton mills; the Board received reports from Percival and John Femar (1761-1815, physician at the Manchester Infirmary) on the social and occupational causes of disease.

York Retreat founded by the Society of Friends for the humane treatment of mental patients on the lines advocated by William Tuke (1732-1822, tea and coffee merchant and Quaker in York).


1808 County Asylums Act for “the better Care and Maintenance of Lunatics being Paupers or Criminals” enabled counties to construct asylums for the insane.

1827 Select Committee appointed to consider the state of pauper lunatics from the metropolitan parishes.

1828 County Asylums Act was largely a consolidating act. It introduced standard records which were to be forwarded by justices of the peace to the Home Department, and the Secretary of State acquired powers to send inspectors to any asylum.

Care and Treatment of Insane Persons Act (The Madhouse Act) set up the Metropolitan Commission in Lunacy and charged the Commissioners with the duty of inspecting private asylums in London, previously the responsibility of the Royal College of Physicians.

1831 A Consultative Board of Health set up, composed of the President and five fellows of the Royal College of Physicians, the Superintendent-General of Quarantine, the Director-General of the Army Medical Department, the Comptroller of the Navy, the Medical Commissioner of the Victualling Office and two non-medical civil servants. The Board issued a series of recommendations in the form of Sanitary Regulations. Later in the year it was replaced by a Central Board of Health which called for the establishment of local boards of health composed of one or more magistrates, a clergyman, a number of substantial householders and one or more medical men. The local boards were to appoint district inspectors to report on the food, clothing and bedding of the poor, the ventilation and sanitation of their dwellings, space, means of cleanliness and their habits of temperance; houses were to be whitewashed. The Boards were to endeavour to remedy, by every means which individual and public charitable exertion can supply, such deficiencies as may be found. Over 1,200 local boards were established by Orders in Council, many continued after 1832 when the Central Board was disbanded.

1832 Cholera Act and Cholera (Scotland) Act enabled the Privy Council to make orders for the prevention of cholera provided that any expense incurred should be defrayed out of money raised for the relief of the poor by the parishes and townships. Powers lapsed at the end of 1834.

Insane Persons and Asylums Act transferred the inspectorate of the Metropolitan Commissioners to the Lord Chancellor, but left the county asylums under the supervision of the Secretary of State.

1838 Report by Dr Neil Arnott (1788-1874) and Dr James Kay and another by Dr Southwood Smith exposed the extent of preventable disease and the dreadful living conditions under which people existed in Manchester and London respectively.

1840 Vaccination Act made free vaccination available as a charge on the poor rates. Vaccination was, thereby, the first free health service provided through legislation on a national scale and available to all.

1840 Report of the Select Committee on the Health of the Towns (chairman, RA Slaney 1792-1862) exposed squalid conditions in many industrial areas and recommended the institution of district boards of health: “The principal duty and object of these boards of health would be precautionary and preventive, to turn the public attention to the causes of illness, and to suggest means by which the sources of contagion might be removed.”

“Observations on the Management of the Poor in Scotland and Its Effects on the Health of the Great Towns”, by WP Alison (1790-1859, successively professor of medical jurisprudence, physiology and medicine in Edinburgh), published. Alison favoured the contagion theory of disease and focused attention on destitution as the chief cause of misery, overcrowding and disease.

1841 Vaccination Act declared that vaccination should not be considered as “parochial relief” and that no person shall by reason of vaccination be deprived of any right or privilege or be subject to any disqualification whatsoever.

Association of Medical Officers of Asylums and Hospitals for the Insane formed. In 1865 the name was changed to the Medico-Psychological Association (in 1925 became Royal) and in 1971 it became the Royal College of Psychiatrists.

1842 Lunatic Asylums Act gave power to the Metropolitan Commissioners (see 1828) to inspect, twice yearly, all asylums and madhouses in the country whatever their legal status.

Report of the Sanitary Condition of the Labouring Population of Great Britain published. Written by Edwin Chadwick, the report detailed grossly insanitary conditions and related these to the incidence of diseases and deaths; and contrasted the life expectancy in the different social classes. It established the association between squalor, lack of sanitation and overcrowding to endemic and epidemic diseases. The report recommended sanitary engineering and extending the duties and training of district medical officers. “The wants, however, which it is a duty to represent and repeat, as the most immediate and pressing, for the relief of the labouring population, are those of drainage, cleansing, and the exercise of the business of an engineer, connected with the commissions of sewers, to which the service of a board of health would be auxiliary”. “A medical man who is restricted to the observation of only one establishment may be said to be excluded from an efficient knowledge even of that one. Medical men so restricted are generally found to possess an accurate knowledge of the morbid appearances, or of the effects among the people of the one establishment, but they are frequently found to be destitute of any knowledge of the pervading cause in which they are themselves enveloped, and have by familiarity lost the perception of it”.

Chadwick’s report led to the Royal Commission for Inquiry into the State of Large Towns and Populous Districts set up in 1843.

Report on the Sanitary Condition of the Labouring Population of Scotland published.

A General Medical Order providing guidance for the establishment of a comprehensive medical system for “the poor” received widespread opposition from Boards of Guardians.

1844 Interim Report of the Royal Commission on the State of Large Towns and Populous Distincts (Health of the Towns Commission), was published.

Report of the Metropolitan Commissioners in Lunacy (chairman, Lord Ashley, 1801 -85,
later Lord Shaftesbury), criticised the management of asylums; called for a uniform system of inspection by a statutory authority; reform of certification; and separate accommodation for incurable pauper lunatics so that the asylums could concentrate on the treatment of curable cases.

Reports of the Select Committee on Poor Law Medical Relief (chairman, Lord Ashley)
outlined a comprehensive picture of current practice; opposed the requirement for a relieving officer to determine need and eligibility for medical attention; and favoured direct access to a medical officer. No change followed the report.

The Health of the Towns Association established (11 December) for the purpose of
diffusing among the people the information obtained by recent inquiries as to the physical and moral evils arising from existing insanitary conditions and to “substitute health for disease, cleanliness for filth, order for disorder, economy for waste, prevention for palliation, justice for charity, enlightened self-interest for ignorant selfishness and to bring to the poorest and meanest - Air, Water, Light”.



1845 Lunatics (Care and Treatment) Act and Regulation of Asylums Act improved the procedure for certification; and set up a Board of Commissioners (chairman, Lord Ashley) to inspect and supervise asylums and other places where mentally ill people were cared for.

1845 Final Report of the Health of the Towns Commission (see 1844) published. It
recommended the creation of a new government department and that the arrangements for drainage, paving, cleansing and water supply should come under one administration in each locality. The Report deplored the extent of overcrowding; called for a central inspectorate of housing; and recommended that local authorities should be able to demand that landlords clean and repair properties dangerous to public health. The Report led to the Public Health Act 1848.

The Select Committee on Smoke Prevention, appointed in 1843, reported. For the first
time serious attention was given to air pollution.

1846 Removal of Nuisances and Prevention of Epidemic Diseases Act set out procedures for the more speedy removal of nuisances when certified as such by two
medical practitioners; and empowered the Privy Council to make regulations for the prevention of contagious diseases.

Improvement of the Sewerage and Drainage of Liverpool Act, known as the Liverpool Sanatory (sic) Act, was the first comprehensive sanitary act in Great Britain. It gave authority for a “medical officer of health” to be appointed: “It shall be lawful for the said
Council to appoint, subject to the approval of one of Her Majesty’ Secretaries of State, a legally qualified medical practitioner of skill and experience to inspect and report periodically on the sanitary state of the said borough, to ascertain the existence of diseases, more especially of epidemics increasing the rate of mortality, and to point out the existence of any nuisances or other local causes which are likely to originate and maintain such diseases, and injuriously affect inhabitants of the said borough , and so to point out the most efficacious means for checking and preventing the spread of such diseases and such person shall be called the Medical Officer of Health for the Borough of Liverpool.”

Public Baths and Wash-houses Act enabled local authorities to providethese amenities.

1847 Cholera epidemics in London and elsewhere. Typhus epidemic in Scotland.
Towns Improvement Act consolidated provisions for adoption in private acts for paving, drainage, cleansing, lighting and general improvement of towns. Similar acts were passed containing model clauses for the police, water and cemeteries.


1848 Major cholera epidemic with about 60,000 deaths, about 14,000 in London.
Influenza pandemic; there were about 50,000 deaths in London alone.

Public Health Act created a new central department, the General Board of Health, under a nominated president, and provided for local boards of health to be set up; in municipal boroughs these were to be the town councils, elsewhere they were to be special boards elected by the rate payers on the same footing as the election of boards of guardians. Each board of health was empowered to appoint a surveyor, an inspector of nuisances, a treasurer, a clerk and an “officer of health” who had to be a legally qualified medical practitioner. The appointment of the officer of health and his removal was subject to the
approval of the General Board of Health. The act contained numerous sanitary clauses
including the cleansing of sewers, sanitation of houses, supervision of lodging houses and slaughter- houses, and maintenance of pavements.

The General Board had no system and no powers to enforce effective local action where the clauses of the act were not adopted locally.
This is the first act in which the term “public health” appears. The act did not cover London or Scotland; London operated under the Metropolitan Commission of Sewers Act

Nuisances Removal and Diseases Prevention Act legislated in regard to the removal of nuisances and the prevention of epidemic diseases in places where the Public Health Act was not in force, and gave power for the Poor Law Commissioners to compel guardians to execute regulations and directions of the General Board of Health.

Metropolitan Commission of Sewers Act established the Commission in regard to London except for the City which operated under its own City Sewers Act

Spreading of Contagious or Infectious Disorders among Sheep, Cattle and other Animals Act introduced penalties for exposing for sale meat unfit for human
consumption, and gave powers for the destruction of such meat. Regulations to be made by the Privy Council.

1849 Cholera epidemic reached its peak in the week ending 15th September, when 3,183 deaths were reported in London.

Nuisances Removal and Diseases Prevention Act extended the powers of the 1848 Public Health Act and the previous act and brought the state of burial grounds under the supervision of the inspectors of nuisances.

1851 The General Board of Health issued a statement of the duties of “officers of health”. These included “giving instructions and directions for the removal or prevention of causes of disease common to several persons, and also for the prevention or removal of causes of disease to individuals, where those causes come within the province of local administration under the Public Health Act”. The officers were required to report quarterly to the General Board of Health on the nature and amount of sickness and death which had prevailed in their areas during the quarter, and annually to provide more details about the nature, location and rates of sickness and death, and possible future action for preventing identified causes.

Analytical Sanitary Commission established by The Lancet to investigate the adulteration of food and drink. Reports were published in The Lancet during the next four years.

Mount Street medical school, Manchester, became the medical department of Owens
College, soon to be Manchester University.

The Hospital for Sick Children, Great Ormond Street, London, founded, inspired by Dr
Charles West.

1853 Vaccination Act introduced compulsory vaccination for all infants within four months of birth, but contained no powers of enforcement. Responsibility was with
the poor law guardians.

Three Lunacy Acts regulated proceedings under the Commissioners of Lunacy; amended the 1845 Act in regard to the procedures of certification and licensing; and consolidated and amended the law for the provision and regulation of lunatic asylums and for the maintenance and care of pauper lunatics in England.

Common Lodging Houses Act required all such houses to be registered and gave powers for the removal of persons with fever, infectious or contagious disease to hospital or infirmary.

Smoke Nuisance Abatement (Metropolis) Act empowered the Home Office to appoint an inspector, to work in consultation with the metropolitan police, to abate nuisance from the smoke of furnaces in the Metropolis and from steam vessels above London

1855 Influenza pandemic.

Nuisances Removal and Diseases Prevention Act consolidated the Acts of 1846 and 1848; enlarged the definition of nuisances; dealt with the sale of meat unfit for human consumption; and with offensive trades. The act made obligatory the employment of one or more "sanitary inspectors" (previously inspectors of nuisances) by each authority or jointly with other authorities; defined their powers of entry; introduced the concept of overcrowding as being dangerous or prejudicial to health; and authorised the Privy Council to declare the act in force in any part of England affected by or threatened with any formidable epidemic of contagious disease, and thereby for the General Board of Health to issue regulations for house-to-house inspections, provision of medicines and interment of the dead.

First report on occupational mortality published by the Registrar General.

"The Great Stink" of London, caused by the sewage pollution of the Thames 1855

Nuisances Removal (Scotland) Act dealt with the removal of nuisances, control of epidemics and the inspection of common lodging houses.

Poor Law Medical Reform Association formed with Richard Griffin (1806-1869,an outstanding leader in the campaign to reform the Poor Law medical services) as the first chairman. The Medical Faculty of Durham University established.

"Recherches sur la Putrefaction" published, in which Louis Pasteur (1822-1895, French chemist) postulated a "germ theory" of fermentation and putrefaction.

1857 Lunacy (Scotland) Act established the General Board of Commissioners in Lunacy for Scotland, which took over duties from the Board of Supervision. The act laid down conditions for certification and, unlike the English acts, provided powers to keep a patient under observation for six months without certification and to board out harmless lunatics with private persons.

Smoke Nuisance (Scotland) Abatement Act attempted to abate nuisance arising from the smoke from furnaces in Scotland.

"British Medical Journal" first published

1858 Public Health Act ended the General Board of Health and transferred its medical duties with some other important duties to the Privy Council, and some of its duties to the Home Office. John Simon (see 1848) was appointed medical officer to the Privy Council. The act authorised the Privy Council to make enquiries into any aspect of public health in any area, and empowered its medical officer to report to the Council. During the subsequent years Simon put in hand numerous investigations of wide scope and scientific integrity. These included field studies of diseases causing excessive mortality, involving social surveys of housing, nutrition and child care; the effects of industry on health; and investigations of epidemics. In this work Simon had a team of medical men of outstanding abilities; eight of them became fellows of the Royal Society, five censors of the Royal College of Physicians of London, and three deans of London medical schools.

Workhouse Visiting Society formed with William Cowper (1811-88, later Lord Mount-Temple) as president and Louisa Twining as secretary.

1859 "Notes on Hospitals", by Florence Nightingale (see 1854), published. She demonstrated that the high rate of mortality, then invariable in large hospitals, was preventable. "It may seem a strange principle to enunciate as the very first requirement in a hospital that it should do the sick no harm. It is quite necessary nevertheless to lay down such a principle, because the actual mortality in hospitals, especially those of large crowded cities, is very much higher than any calculation founded on the mortality of the same class of patient treated out of hospital would lead us to expect." She drafted model hospital statistical forms which would enable the relative mortality and the relative frequency of diseases and injuries among hospital patients to be ascertained. She found statistics "more enlivening than a novel" and loved to "bite on a hard fact". Later in the year Miss Nightingale’s "Notes on Nursing" was published; it was intended to make women who had charge of the health of their children and members of their household think how to nurse" and to adopt habits of hygiene.

The first "cottage hospital" opened at Cranleigh in Surrey; gradually other small hospitals were built in small towns in rural areas and in the suburbs of large towns.

The first "home" or "district" nurse appointed in Liverpool.

1860 Pressure mounted to reform Poor Law Medical Relief and a Medical Relief Bill was presented to Parliament, but rejected. The Poor Law Board issued "Consolidated Orders Respecting Medical Relief".

Select Committee on Lunatics received substantial evidence of wrongful detention and abuse of patients, but its recommendations were not acted on.

1861 Local Government Act (1858) Amendment Act amended the 1858 act, by requiring local authorities to purify sewerage before discharging it into natural waterways.


Publication for the Workhouse Visiting Society of "A Plea for the Destitute Incurable" by Frances Power Cobbe (1822-1904). The plea was that the chronic sick should be separated from other inmates of the workhouses and be given extra comforts. There were about 80,000 people in the category of "destitute incurable" in the institutions. A petition to the House of Commons included signatures from leading physicians and surgeons of London hospitals who agreed that such people should not be kept for more than a brief period in any hospital established for the cure of the sick.

Nurses were appointed for the first time to the staff of a Poor Law hospital (Liverpool) and Agnes Jones (1832-68) was appointed the first superintendent.

1862 Lunacy Acts Amendment Act set out conditions and regulations for the establishment, management and inspection of county asylums.

Lunacy in Scotland Act regulated the care and treatment of lunatics, and the provision and maintenance of lunatic asylums in Scotland.

Lunacy Regulation Act amended the 1853 act in respect of the proof of insanity and disposal of the property of lunatics.

House of Lords Select Committee on Injury from Noxious Vapours called for an inspectorate free from local control. See Alkali Act 1863.

Manchester and Salford Ladies Health Society appointed the first "health visitors", being women of the working class, to visit the poorer people and teach them the rules of health and child care.

1863 Public Works (Manufacturing Districts) Act enabled large towns to obtain loans from the Public Works Loan Commission for sanitary works.

Alkali Act empowered the appointment of a chief inspector (Robert Smith, 1817-84, chemist) with four assistant inspectors. Smith developed acceptance of inspection by showing manufacturers how to turn wasteful pollution into profitable by-products.

Nuisances Removal Act amended the 1855 act; dealt with the seizure and destruction of unsound meat intended for human consumption.

Vaccination (Scotland) Act made vaccination of infants compulsory

International Red Cross founded by Jean-Henri Dunant (1828-1910, Swiss humanitarian). "Sick and wounded soldiers will be collected and cared for irrespective of nationality" (see Pringle, 1752).

1864 Contagious Diseases Act attempted to control venereal diseases by the compulsory medical examination of "common prostitutes" in garrison towns and ten miles around. The act was amended and extended in 1869.

In 1869 Mrs Josephine Butler (1828- 1906), with the support of Florence Nightingale, founded the Ladies National Association for the Repeal of the Contagious Diseases Acts on the grounds that they were unfair and one-sided, ignoring the role of men in the spread of the diseases. Nightingale considered the acts ineffective and advocated more support for the wives and children of soldiers and sailors and the provision at barracks of rest-rooms and leisure activities. The acts were suspended in 1883 and repealed in 1886.

1864 A Royal Commission was set up on the Prevention of River Pollution. It met intermittently over the next nine years. Its Third Report stated that serious pollution arose from the growth of the population and from the introduction of sewerage systems following the 1848 Public Health Act. The Report called for a central authority and an increase in River Boards.

Louis Pasteur showed that infections were caused by micro-organisms.

"A Manual of Practical Hygiene" by EA Parkes (1819-76, first professor of military hygiene) was published. The book was the first important treatise on hygiene.

1865 Sewerage Utilisation Act created sewer authorities; gave town councils and other health authorities powers to dispose of sewerage for agricultural purposes; and to take proceedings against persons polluting rivers.

Start of the main drainage scheme for London.

The Lancet set up a Commission to Inquire into the State of Workhouse Infirmaries. The Commission published reports in successive issues of The Lancet including a general report and detailed accounts of individual infirmaries.

Joseph Lister (later Lord, 1827-1912, surgeon in Edinburgh and later in London at King’s College Hospital) first used carbolic spray in surgery. The results were published in The Lancet in 1867.

1866 Sanitary Act required local authorities to undertake sanitary regulation; set out general powers for the provision of sewage disposal and supply of water, and the abatement of nuisances; made overcrowding of residences illegal; introduced penalties for persons suffering from dangerous infectious diseases who endangered others in public places; and gave powers to authorities to provide hospitals or contract for the use of hospitals or parts thereof. Simon was largely responsible for drafting the act; he considered that the act "represented such a stride of advance as virtually to begin a new era".

Cattle Plague Prevention Act amended the law relating to contagious and infectious diseases in cattle and other animals. A further Act amended the 1848 Act, and another act gave inspectors powers to order the slaughter of diseased animals.

Last great cholera epidemic in London ended.

1867 Metropolitan Poor Act provided for the establishment of hospitals (with nursing staff) for the sick, infirm, insane and other classes of the poor; of dispensaries; and for the distribution over the metropolis of the charge for poor relief. This act led to the establishment of the Metropolitan Asylums Board.

Poor Law Amendment Act made the Poor Law Board permanent; amended administrative details of previous acts; and applied the principles of the Metropolitan Poor Act to the rest of the country, thus enabling boards of guardians to establish infirmaries for the treatment of the sick poor separate from the workhouses.

Public Health (Scotland) Act consolidated previous legislation relating to nuisances, sewers, water supplies, common lodging houses and prevention of diseases; and permitted the appointment of medical officers of health and the levy of a general rate for public health purposes. Only a few authorities appointed MOsH.

Vaccination Act consolidated and amended previous acts; made vaccination compulsory for all infants; set out procedures for the registration of successful vaccinations, and the appointment and payment of public vaccinators; prohibited the inoculation of any person with "variolous matter"; and made the boards of guardians responsible for the administration of the act.

Sewage Utilisation Act widened the powers of authorities to dispose of sewage.

1868 Sanitary Act amended administrative details of the 1866 act, and enlarged the powers of the sewer authorities in relation to house drainage, privies and removal of house refuse.

Artisans and Labourers Dwelling Act (Torrens Act) empowered local authorities to compel owners to demolish or repair insanitary dwellings, and to keep their properties in a habitable state. This was the first national legislation to tackle slum dwellings, although action was limited by legal procedures and the high compensation involved. Previously some action had been taken under local acts.

Pharmacy Act limited the sale of opium to qualified pharmacists and legally registered chemists, and amended the 1852 act.

Following representations from the British Medical Association the General Medical Council appointed a State Medicine Committee "to inquire into the proper steps to be taken, if any, for granting Diplomas or Certificates of proficiency in State Medicine and for recording the same in the Medical Register".

State Medicine became one of the four subjects accepted for the MD degree by Cambridge University.

1869 The Lancet advocated the creation of a state medical service with a ministry of health.

1870 Sanitary Act augmented the powers of the 1866 and 1868 acts regarding the removal of persons suffering from contagious diseases.

The Poor Law Board raised in its annual report the possibility of establishing a system of free medical advice for all wage-earners; in the words of the report, to consider "how far it may be advisable, in a sanitary or social point of view, to extend gratuitous medical relief beyond the actual pauper classes generally".

The National Society for the Sick and Wounded in War (later the British Red Cross Society) founded.

From 1870 to 1873 there were widespread outbreaks of smallpox. About 44,000 people in England, 10,000 of them in London, died from the disease. There was also an influenza pandemic during 1870.

1872 Public Health Act established urban and rural sanitary authorities and set out their duties which included the appointment of a medical officer of health (being a legally qualified medical practitioner) and an inspector of nuisances. The act gave power to the Local Government Board to constitute designated sanitary authorities as port sanitary authorities.

Adulteration of Food, Drink and Drugs Act strengthened and extended the 1860 Act.


Infant Life Protection Act required any person who took in for reward two or more children under one year of age for more than 24 hours to be registered by the local authority.

The London Obstetrical Society introduced examinations and a diploma for midwives who could demonstrate a minimum standard of competence.

The Local Government Board issued a memorandum setting out the duties of medical officers of health.

1873 Report of the Select Committee on Noxious Businesses.

Introduction of the "Hospital Sunday Collection" which was an annual collection for hospitals held on a Sunday in June.

Birmingham appointed its first medical officer of health.

1874 Alkali Act (1863) Amendment Act set a volumetric standard of permitted pollution from hydrochloric acid; and extended inspections.

Public Health Act declared that rural sanitary district authorities were the same bodies as the boards of guardians of unions or parishes within which such authorities acted; increased the powers of enforcement of the Local Government Board particularly in respect of water supplies; and brought infected milk within the category of "nuisance".

Hospital Saturday Fund began. Money was collected from working men on pay day (Saturday) and paid to hospitals establishing a right to treatment.

1874 Foundation of the Cremation Society by Sir Henry Thompson (1820-1904, professor of surgery at University College, London) and others.

The first human cremation took place in 1885 at the Society’s crematorium at Woking, Surrey.

London School of Medicine for Women founded.

1875 Public Health Act consolidated and amended previous acts (national and local) relating to public health. The act was divided into eleven parts and contained 343 sections dealing with the responsible authorities, sanitary provisions, local government districts and their procedures and the Local Government Board. The act provided a code of sanitary law concerned with the supply of wholesome water; prevention of pollution of water; removal of sewerage; housing standards; regulation of streets; inspection of food; control of nuisances; prevention and control of epidemic diseases; and burial. The act empowered local authorities to provide hospitals and charge patients (except paupers), and to provide medicines and medical assistance to their poorer inhabitants. It removed the five year restriction on the appointments of medical officers of health.

The act did not apply to the London metropolis, or to Scotland. The act remained the Magna Carta of public health until 1936.

1876 Rivers Pollution Act prohibited the disposal of solid matter, liquid or solid sewage, or drainage from mines and factories into streams; but stated that the Local Government Board shall not sanction any such control in districts which are areas of manufacturing industries, unless satisfied that no material injury will be inflicted on such industries

1877 Public Health (Water) Act simplified the process for municipalities to purchase private waterworks; and required rural sanitary authorities to ensure that every occupied dwelling house had within a reasonable distance an available and sufficient supply of wholesome water.

Dentists Act provided for the registration of dentists and restricted the use of the term "dentist", and gave powers to the General Medical Council to register dentists.

Royal Commission on Noxious Vapours, called for more inspectors with increased powers, and the extension of the Alkali Acts to all noxious works, despite witnesses arguing that noxious vapours were the inevitable and unalterable cost of national prosperity.


Charles Drysdale, senior physician to the Metropolitan Free Hospital, warned against the use of tobacco. He pointed to "the enormous consumption of tobacco in all European states", estimating that £15,000,000 was spent annually in Great Britain on tobacco, and concluded "that the use of tobacco is one of the most evident of all the retrograde influences of our time" (The Times, 25th. September).

1879 Compulsory notification of infectious diseases introduced in Edinburgh.

1880 British Dental Association formed.

In February 3,376 deaths were recorded in London, the highest number for any week during the previous 40 years since civil registration was introduced, except for two weeks during cholera epidemics in 1849 and 1854. The excess was attributed to the recent fog (British Medical Journal, Feb. 14th. page 254).

1883 Diseases Prevention (Metropolis) Act improved the provisions for the isolation and treatment of persons suffering from infectious diseases in the metropolis; and legalised admission to poor law hospitals without any criteria of poor relief.


1885 William McEwen (1848-1924, surgeon, Glasgow) removed a glioma from the brain of a man aged 25 years, and so initiated brain surgery.

L Pasteur (see 1856) administered attenuated rabies vaccine.

1886 Idiots Act provided for the care, education, and training of mentally subnormal people; and required the registration and inspection of the institutions and hospitals concerned.

1887 Select Committee on Smoke Nuisances considered that fog in London had increased significantly during the preceding years, and that fog was as lethal as any epidemic.

1888 Local Government Act created county and county borough councils, elected by ratepayers, to take over from the justices of the peace in rural areas the duties of rating, licensing, asylums, police, highways and weights and measures. Gave women, if unmarried and otherwise eligible, the right to vote for county and county borough councillors; permitted county councils to appoint medical officers of health, and made the holding of a registrable diploma of public health (or equivalent) compulsory for medical officers of health in districts with populations of 50,000 or more.

1889 Public Health (Amendment) Act contained sections on a number of sanitary and safety matters including the prevention of danger from telegraph wires, disposal of chemical refuse, safety of building sites and of places of public resort and pleasure grounds.

Infectious Disease (Prevention) Act empowered medical officers of health to inspect dairies and to prohibit the supply of milk; to order the compulsory cleansing of premises and disinfection of public conveyances; and other measures.

1894 Diseases of Animals Act consolidated the acts of 1873 and 1893; restricted the movement of, and introduced compensation for the slaughter of animals suffering from cattle plague, foot and mouth disease, pleuro-pneumonia or swine fever.

1895 X-rays discovered by WK Rontgen (1845-1923, German physicist).

1897 In this year of Queen Victoria’s Diamond Jubilee, an editorial in “Public Health” stated “of all the achievements of the Victorian Era ... history will find none worthier of record than the efforts made to ameliorate the lives of the poor, to curb the ravages of disease, and to secure for all pure air, food, and water, all of which are connotated by the term ‘sanitation’”. (Public Health, IX, 10, January, 1897, page 286).

1898 Vaccination Act introduced a “conscientious objection” clause, enabling parents to be excused the compulsory vaccination of their children.

1899 Coal Smoke Abatement Society founded in London.

Aspirin introduced by Bayer.

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