Life was cheap in the 19th century – in the 1840s, the average age of death in England, France and the US was 45. There were huge health divides within countries, however, as, for example, the average age of death for working-class men in urban, industrial Manchester, was just 17, while it was 38 in rural areas such as Rutland. The middle classes fared much better than labourers in both town and country, although there were still large inequalities, with average life expectancies for men of 38 in Manchester and 52 in Rutland. These divides were similar in other industrial countries like the US where life expectancies were 15 years higher in rural areas of New England than in the large cities of Boston, New York, and Philadelphia. Compare that to average life expectancies in wealthy countries today, where most people can expect to exceed 75 years. So, in the 19th and early 20th century, it was remarkably easy to die – indeed, surviving childhood was quite an achievement, as over a third of children died before the age of nine. Life was ‘nasty, brutish and short’.

This chapter provides the historical context to health divides by examining life and death in the 19th century. It starts by examining the industrial revolution and how it shaped the disease environment in the 19th century, the time of Queen Victoria, Napoleon and Abraham Lincoln. It then examines the main causes of death and disease in wealthy countries in the industrial age – the time of epidemics when infectious diseases such as cholera, typhus, smallpox, typhoid or tuberculosis claimed millions of lives. It then outlines the key health divides of the period: between the North and South of England, between rural and urban areas and between rich and poor areas of towns and cities. It also examines the changing nature of death and disease from the end of the 19th century onwards, including the emergence of the welfare state in the 20th century.

In the court of King Cholera

This section examines death and disease during the industrial revolution of the 19th century, outlining the nature of the industrial revolution itself, its impact on the population and on public health.