The dreadful and declining quality of the urban environment in the 1830s and 1840s is an appropriate starting point for any discussion of Victorian towns and cities. It was at this time that the state of towns was recognised as a problem that could be ignored no longer. Concern about the health of the burgeoning urban population began to crystallise in 1838 when three reports written for the Poor Law Commissioners by doctors Neil Arnott, James Kay and Thomas Southwood Smith ‘most emphatically fixed the blame for the spread of disease on squalid urban conditions’. Then in 1842 Edwin Chadwick, secretary to the Poor Law Commission, published his Report on the Sanitary Condition of the Labouring Population of Great Britain, which has been described as a ‘magisterial, comprehensive and horrendous indictment of social conditions in Britain’. This was a decisive moment in the theory and practice of public health, for it gave a great boost to the notion that disease could be prevented as well as cured. Chadwick was an administrator, not a medical man or an engineer, but he became the leading advocate of the prevention of ill health by engineering techniques, specifically the provision of a constant supply of water piped directly into houses, and a comprehensive network of drains and sewers to remove domestic waste. The adoption and implementation of these principles was to have a profound and enduring impact on the health and wellbeing of the people of Britain.

Public health is also a good starting point in terms of the four propositions outlined in Chapter 1. First, the crisis demonstrated beyond doubt the importance of the urban environment and in particular the inadequacies of the physical infrastructure in relation to two absolutely basic requirements, water and sanitation. Second, each town had its own specific circumstances: some had good and abundant supplies of water, while others did not; some places were naturally easier to drain. In addition, the existing arrangements varied from place to place, and the politics of reform were subject to local factors. Third, the people of each town were responsible for deciding what to do in their circumstances, and paying for it, but they were given a great deal of guidance, initially from the General Board of Health in London.