With the introduction of General Registration from July 1837 it was possible to gather statistics on mortality for the whole of England and Wales. Edwin Chadwick (1800-1890) drew on this information to write his celebrated report. It helped the passage of the Public Health Act (1848) and the establishment of a Board of Health, of which Chadwick served as a commissioner until it was abolished in 1854. Here are the key conclusions:
"After as careful an examination of the evidence collected as I have been enabled to make, I beg leave to recapitulate the chief conclusions which that evidence appears to me to establish.
First, as to the extent and operation of the evils which are the subject of this inquiry:-
That the various forms of epidemic, endemic, and other disease caused, or aggravated, or propagated chiefly amongst the labouring classes by atmospheric impurities produced by decomposing animal and vegetable substances, by damp and filth, and close and overcrowded dwellings prevail amongst the population in every part of the kingdom, whether dwelling in separate houses, in rural villages, in small towns, in the larger towns - as they have been found to prevail in the lowest districts of the metropolis.
That such disease, wherever its attacks are frequent, is always found in connexion with the physical circumstances above specified, and that where those circumstances are removed by drainage, proper cleansing, better ventilation, and other means of diminishing atmospheric impurity, the frequency and intensity of such disease is abated; and where the removal of the noxious agencies appears to be complete, such disease almost entirely disappears.
That high prosperity in respect to employment and wages, and various and abundant food, have afforded to the labouring classes no exemptions from attacks of epidemic disease, which have been as frequent and as fatal in periods of commercial and manufacturing prosperity as in any others.
That the formation of all habits of cleanliness is obstructed by defective supplies of water.
That the annual loss of life from filth and bad ventilation are greater than the loss from death or wounds in any wars in which the country has been engaged in modern times.
That of the 43,000 cases of widowhood, and 112,000 cases of destitute orphanage relieved from the poor rates in England and Wales alone, it appears that the greatest proportion of deaths of the heads of families occurred from the above specified and other removable causes; that their ages were under 45 years; that is to say, 13 years below the natural probabilities of life as shown by the experience of the whole population of Sweden.
That the public loss from the premature deaths of the heads of families is greater than can be represented by any enumeration of the pecuniary burdens consequent upon their sickness and death.
That, measuring the loss of working ability amongst large classes by the instances of gain, even from incomplete arrangements for the removal of noxious influences from places of work or from abodes, that this loss cannot be less than eight or ten years.
That the ravages of epidemics and other diseases do not diminish but tend to increase the pressure of population.
That in the districts where the mortality is greatest the births are not only sufficient to replace the numbers removed by death, but to add to the population.
That the younger population, bred up under noxious physical agencies, is inferior in physical organisation and general health to a population preserved from the presence of such agencies. That the population so exposed is less susceptible of moral influences, and the effects of education are more transient than with a healthy population.
That these adverse circumstances tend to produce an adult population short-lived, improvident, reckless, and intemperate, and with habitual avidity for sensual gratifications.
That these habits lead to the abandonment of all the conveniences and decencies of life, and especially lead to the overcrowding of their homes, which is destructive to the morality as well as the health of large classes of both sexes.
That defective town cleansing fosters habits of the most abject degradation and tends to the demoralisation of large numbers of human beings, who subsist by means of what they find amidst the noxious filth accumulated in neglected streets and bye-places.
That the expenses of local public works are in general unequally and unfairly assessed, oppressively and uneconomically collected, by separate collections, wastefully expended in separate and inefficient operations by unskilled and practically irresponsible officers.
That the existing law for the protection of the public health and the constitutional machinery for reclaiming its execution, such as the Courts Leet, have fallen into desuetude, and are in the state indicated by the prevalence of the evils they were intended to prevent.
Secondly. As to the means by which the present sanitary condition of the labouring classes may be improved: -
The primary and most important measures, and at the same time the most practicable, and within the recognised province of public administration, are drainage, the removal of all refuse of habitations, streets, and roads, and the improvement of the supplies of water. That the chief obstacles to the immediate removal of decomposing refuse of towns and habitations have been the expense and annoyance of the hand labour and cartage requisite for the purpose.
That this expense may be reduced to one-twentieth or to one-thirtieth, or rendered inconsiderable, by the use of water and self-acting means of removal by improved and cheaper sewers and drains.
That refuse when thus held in suspension in water may be most cheaply and innoxiously conveyed to any distance out of towns, and also in the best form for productive use, and that the loss and injury by the pollution of natural streams may be avoided.
That for all these purposes, as well as for domestic use, better supplies of water are absolutely necessary.
That for successful and economical drainage the adoption of geological areas as the basis of operations is requisite.
That appropriate scientific arrangements for public drainage would afford important facilities for private land- drainage, which is important for the health as well as sustenance of the labouring classes.
That the expense of public drainage, of supplies of water laid on in houses, and of means of improved cleansing would be a pecuniary gain, by diminishing the existing charges attendant on sickness and premature mortality.
That for the protection of the labouring classes and of the ratepayers against inefficiency and waste in all new structural arrangements for the protection of the public health, and to ensure public confidence that the expenditure will be beneficial, securities should be taken that all new local public works are devised and conducted by responsible officers qualified by the possession of the science and skill of civil engineers.
That the oppressiveness and injustice of levies for the whole immediate outlay on such works upon persons who have only short interests in the benefits may be avoided by care in spreading the expense over periods coincident with the benefits.
That by appropriate arrangements, 10 or 15 per cent on the ordinary outlay for drainage might be saved, which on an estimate of the expense of the necessary structural alterations of one-third only of the existing tenements would be a saving of one million and a half sterling, besides the reduction of the future expenses of management.
That for the prevention of the disease occasioned by defective ventilation and other causes of impurity in places of work and other places where large numbers are assembled, and for the general promotion of the means necessary to prevent disease, that it would be good economy to appoint a district medical officer independent of private practice, and with the securities of special qualifications and responsibilities to initiate sanitary measures and reclaim the execution of the law.
That by the combinations of all these arrangements, it is probable that the full ensurable period of life indicated by the Swedish tables; that is, an increase of 13 years at least, may be extended to the whole of the labouring classes.
That the attainment of these and the other collateral advantages of reducing existing charges and expenditure are within the power of the legislature, and are dependent mainly on the securities taken for the application of practical science, skill, and economy in the direction of local public works.
And that the removal of noxious physical circumstances, and the promotion of civic, household, and personal cleanliness, are necessary to the improvement of the moral condition of the population; for that sound morality and refinement in manners and health are not long found co-existent with filthy habits amongst any class of the community."