The Registrar General’s report on the English cholera epidemic of 1848–1849 compared the arrival of the disease to that of an invasion of “a foreign army”.[1] Epidemics and pandemics threaten the security of states. Governments, central and local, must take action, and this often changes the way that they govern in the future. This essay discusses the ways in which plague, cholera, smallpox, and influenza affected the development of the British government and, thereby, the structures of the records at The National Archives.
Plague
Throughout 1665 and 1666 London was gripped by the most serious outbreak of the plague since the Black Death of 1348. More than 65,000 people lost their lives (15% of the city’s population) and many fled, including King Charles II, who moved his court to Oxford in autumn 1665. Plague is a bacterial infection passed to humans by infected fleas living on small animals like rats, and sometimes through the exchange of infected bodily fluids. While the symptoms of the disease were well enough understood in early modern London—flu-like symptoms and “Swellings or Risings under the Ears or Arm-pits, or upon the Groynes; Blains, Carbuncles, or little Spots, either on the Breast or back”[2]—its cause and transmission were not. The predominant theory of disease transmission in Britain and most of Europe at this point was the “miasma theory”. This postulated that disease was transmitted by bad smells, which poisoned the air and infected people. It would remain the dominant theory until the “bacteriological revolution” of the late nineteenth century.[3]
Charles II’s government made attempts to control the spread of plague. It published Rules and Orders…for Prevention of the Spreading of the Infection of the Plague on 11 May 1666. These rules and orders mandated that no “stranger” was to enter a town unless they had a certificate of health. There were to be no public gatherings. Fires should be put in public places “to correct the Air”, and no unwholesome or smelly food should be sold. The plague dead were to be buried at special sites, their bodies covered with lime and their graves not opened for at least a year. Monthly fasts and twice weekly public prayers were to be held, “by which means God may be inclined to remove his severe hand both from amongst you and us”.
The most important measure listed, however, was a strict regime of quarantine and isolation. Those believed to have the plague were to be removed to “pest-houses” (rudimentary isolation hospitals). Their homes were to be marked with a red cross on the door and the non-infected household members shut up for forty days, with warders providing “necessaries”. Quarantine, a concept derived from the Venetian word quarantena, meaning “forty days”, was a long-standing response to epidemic disease in Europe and across the world. It became a British practice rather late, in the sixteenth century, but was firmly established by the reign of Charles II as a way of dealing with plague.[4]
These regulations were issued as a proclamation (central government had no minister or department for health). The rules were addressed to “Justices of Peace, Mayors, Bayliffs, and other Officers”, local officials who were responsible for the actual governance of most people’s lives. Medical care was a private matter, except when parish authorities provided relief to the poor in the form of some provision to the destitute or incapacitated.[5] What interventions central government did make were via decree, proclamation, circular letter, guidance, and occasionally statute. They did not “put boots on the ground” in the fight against the plague. Quarantine was demanded in homes and ports, but the government made no special provision for the local officials to enact it. As a result, there are few records of the delivery of these public health measures in The National Archives beyond petitions and court cases brought by those affected by them. For example, in May 1777 the Custom House of London informed the Privy Council that a reward of £100 had been offered for the capture of sailors on the Cupid who had breached quarantine and absconded from the ship on its return from a plague-affected part of Italy.[6] In 1713 merchants from the Baltic petitioned the Council for their ships not to be subjected to quarantine as their cities were free of plague.[7] In 1588, moreover, tax commissioners in Lincolnshire explained that they had not carried out an assessment of parts of the county because the plague had been “so great and violent” there.[8] These records all shed light on the political, social, and economic impact of epidemic disease. Yet they also illustrate the remove at which central government was involved in them.
What is also notable is that, with the exception of the court records, these records are found in a relatively unsorted and unregistered series of documents. In the correspondence of the Secretaries of State and other officials in the State Papers (SP) collections and the papers of the Privy Council (PC), we find documents relating to plague next to letters and papers about all other aspects of government business. A box or a bound volume of papers in this period is likely to be made up of all the papers received or created by these offices and officers in a period, in vaguely chronological order. This reflects the organisation of government business and records—there were no discrete areas of business or filing relating to disease and health.
Cholera
Cholera is a diarrheal infection spread by the ingestion of water or food contaminated with the bacterium Vibrio cholerae. Contamination is usually via the faeces of an infected person. Cholera was endemic to the Indian subcontinent until the early nineteenth century. It was spread due to increased global trade with Europe. The second cholera pandemic began in 1829 in India and the disease arrived in England via Russia and central Europe. It was carried by sailors who docked in Sunderland, where the first case was observed in October 1831. It would kill over 31,000 people by the summer of 1832.[9] A surgeon in nearby Gateshead described the awful symptoms of the disease experienced by Henry Sibbeth, a 39-year-old sailor:
He became attacked with sudden purging and extreme coldness. A surgeon attended him at nine in the morning; the eyes were then sunken; the countenance had assumed the deathly character, and was changed to a blue colour; the pulse could scarcely be felt, was seventy in number; the tongue was cold; the extremities cramped; and he had considerable pain in the epigastric region…He died at twelve o’clock the same morning, retaining his senses to the last.[10]
In mid-1831, as cholera made its steady progress westward towards the British Isles, there was still no central government agency to deal with disease or health. Yet the conception of the state’s role in people’s lives and health was by this point changing. In Britain, the influence of late-Enlightenment thought and research not only led to advances in medical knowledge and a recognition of the environmental causes of disease (although the miasma theory still predominated), but also to the dissemination of these findings to non-technical audiences. Moreover, there was a desire to measure and to quantify the country’s population and its health and so improve it. This moral imperative led to calls for the reform of local government and the expansion of central government’s involvement in health.[11]
In June 1831 the Privy Council established a consultative Board of Health. Initially, it collated reports of the symptoms, treatment, and control of cholera in Russia and elsewhere, disseminating them to local officials and doctors. With cholera’s arrival in Britain in October, the Board published model sanitary regulations to deal with cholera in the London Gazette. It
recommended that in every town and village, commencing with those on the coast, there should be established a local board of health, to consist of the Chief and other Magistrates, the Clergyman of the parish, two or more Physicians or Medical Practitioners, and three or more of the principal inhabitants.[12]
The local boards, particularly their medical men, were to keep in contact with the Consultative Board and report details of any cholera cases in their area, how such cases were treated, and how they were ultimately resolved. Boards were duly established around the country.
In November 1831, as the crisis deepened, the Consultative Board was officially constituted as the Central Board of Health. In February 1832 Parliament passed the Prevention of Cholera Act, which widened the powers of the Central Board. It could now pass regulations on sanitation and the internment of victims by Order in Council (a legislative decree). Magistrates were also instructed to fine those who broke regulations, and local boards were to report cases, treatment, and deaths. Consequently, the Central Board collected a vast amount of manuscript statistics on the incidence of cholera. It also oversaw the quarantine of ships.[13]
The records of the Central Board take the form of Privy Council records related to plague in the seventeenth century—boxes of loose, unbound papers, letters, and printed material, in roughly chronological order, often folded and docketed with a précis of its sender and contents on the back for office use. The Central Board was, however, only ever a temporary body.
Writers, officials, and politicians concerned with better control of the environment, disease, and health began campaigning for sanitary reform. Edwin Chadwick, the divisive architect of the New Poor Law (1834), published his Report on the Sanitary Condition of the Labouring Population in 1842. Chadwick posed a simple formulation: filth caused epidemic diseases among the working classes and thereby made them less productive and obedient. Removing filth, via water supply and sewerage, would remove disease and produce docile and productive citizens. He envisioned this being realised by a centrally controlled system of laws, “uniform across the British Isles, to remedy these issues by sanitary policing, regulation on ventilation etc. and the delivery of sewerage and water supplies”.[14]
The Public Health Act of 1848, which allowed for the establishment of permanent Local Boards of Health, overseen by a General Board in Whitehall, created Britain’s first centrally supervised health bureaucracy. Local Boards had powers to levy rates and borrow money for sewerage and to make byelaws to regulate their environment and to control disease. Yet the General Board was powerless beyond disallowing spending and publishing negative reports about local sanitary conditions.
The records of the General Board are in The National Archives record series MH 13. We can begin to see more modern record management in these. A discrete government agency for public health had discrete records. Letters were bound up by place/district, with special volumes for inter-governmental correspondence and letters from abroad. Each one has a number signifying its entry in a registry (which does not survive) kept by the Board, which would be quoted by Local Boards to make sure that officials in London knew what they were referring to. The papers of the Home Office, which also took an interest in cholera, are similarly numbered, although on a different system.
The General Board also corresponded with the Foreign Office on overseas epidemics and other government departments, disseminating information on disease as the Central Board had. Britain’s imperial and military enterprises, and their record-keeping practices, such as the Royal Navy surgeons’ journals in the record series ADM 101, provided the British government with much information about the disease spread, control, and treatment of disease. The historian Jim Downs has argued that modern epidemiological practice was to an extent built on the backs of the soldiers, sailors, and enslaved people who were treated by these doctors.[15]
The General Board is generally seen as a failure, not least because Chadwick’s environmental prescription excluded medicine as part of the solution. Public health was, however, consolidated and made more compulsory in the late 1870s with increasing success, not least because of the involvement of clinicians, such as the Chief Medical Officer, first appointed in 1855. More sophisticated and mature regulation and control of cholera can be seen in documents from this period. As a result, epidemic cholera has not been seen in England since 1866.[16]
Smallpox
British approaches to public health in the mid-nineteenth century maintained the longstanding approach that central government made statute and set policy, but local government delivered it in a relatively permissive fashion. The exception was with smallpox. Smallpox was a viral infection characterised by fevers, vomiting, and a skin rash that turned into blisters. It was often fatal, particularly in young children, and could leave survivors scarred and disabled. An epidemic between 1837 and 1840 killed 42,000 people. It is was airborne disease—prolonged face-to-face contact with an infected person could lead to infection. It had long been treated by variolation, the injection of matter from an infected blister into another person’s skin. This produced a mild, localised infection, but immunity to further serious attacks. The practice dates (perhaps) from tenth century China. Generally, however, vaccination along these lines did not take place in Western Europe until the early eighteenth century.[17]
In the late eighteenth century, physician Edward Jenner developed a smallpox vaccine using cowpox, a similar but much less severe disease. The Vaccination Act 1840 offered the vaccine to anyone who wanted it for free. It was to be delivered by local Poor Law authorities, often mistrusted by the working classes. The National Archives holds records showing the efforts of authorities to convince people of the vaccination’s benefits. “Vaccination, if properly performed, effectually protects the Child from Small Pox”, as the vestry of Liverpool told its residents in an 1851 poster, which also asserted that the vaccine was “the only security against this dreadful malady”. The state was keen on citizens getting vaccinated. A ship’s surgeon journal from 1825 provides an account of the Navy Board providing vaccines so as to inoculate the children of families emigrating to Canada.[18]
With parliament convinced of the vaccine’s efficacy (the mortality rate from smallpox declined sharply after 1840), the Vaccination Act 1853 was passed. It mandated the compulsory vaccination of all infants before they were four months old, with penalties for parents who refused. It was an unprecedented intervention by government into people’s lives. People railed against compulsory vaccination. The records of the Home Office, which oversaw criminal justice, detail many of such cases. Charles Hayward, a Kent mechanic, refused to have his children vaccinated more than 29 times and was fined over £28, an enormous amount of money. Yet he was supported by the London Society for the Abolition of Compulsory Vaccination, who sought to make him a cause celebre, asking “what is the use of demonstrating the impotence of the law by the repetition of futile prosecutions?” The 1898 Vaccination Act abolished multiple penalties for refusal and also contained a clause allowing parents to object, legally, in conscience.[19]
Smallpox vaccination continued to be encouraged, and the efficacy of the vaccine (along with the reduction of its side effects) improved. By the late 1930s Britain was free from naturally occurring smallpox. By the end of the twentieth century it was eradicated globally. Prior to this, the records from The National Archives in this collection reflect not only the drive to increase vaccine take-up, but other attempts to mitigate against the disease via isolation (“smallpox hospitals”) and the usual quarantine of vessels. The bacteriological revolution and discovery of aseptic technique in the late nineteenth century increased the effectiveness of medicine and the state’s sponsorship of it.
Influenza
In 1919, the Ministry of Health was established “to concentrate the main health services in this country in a single department under a Minister of Health responsible to Parliament”. It allowed for disease control, hospitals, environmental health, and welfare to be brought under one umbrella. The Chief Medical Officer remarked that it demonstrated that “national health [was] of supreme and vital importance” to Parliament.
The Ministry of Health was, like previous government bodies, born of a pandemic: influenza. “There is little need for reminder that great epidemics, of the kind that determine history, are still with us”, the Chief Medical Officer remarked. The Ministry’s annual report of 1920 noted that the disease had claimed some 112,000 lives in 1918, more than ten times the toll for 1917, and 18% of the total deaths that year. Another 44,801 were killed by influenza in 1919.[20]
There were lessons to be learnt from the outbreak, the Chief Medical Officer remarked—about the nature of influenza, its spread, and with regard to central government’s approach to preventative medicine.[21] The first wave of the epidemic in 1918 had been comparatively mild. Influenza, unlike cholera, smallpox, and other epidemic diseases, was not a “notifiable disease”. Considered to be a seasonal virus that generally affected the old and infirm, local authorities were not liable to inform the central government of an outbreak.[22] Out of the over 3,500 reports and memoranda created by the medical departments of the Privy Council and Local Government Board (which would be subsumed into the Ministry of Health) only five related to influenza. All dated from the early 1890s, following a previous epidemic.[23] Influenza’s viral cause and airborne spread were not clearly understood by the local authorities. Indexes to Local Government Board correspondence from the period show many local authorities asking what should be done about the outbreak as the far more severe, second wave hit.[24]
Influenza had been observed in troops in Europe at the close of the First World War, and the British military again proved a vital testing ground for epidemiological practice. The government’s Medical Research Committee (founded in 1913) worked with army medical services to study the outbreak in 1918. Their intensive studies in military hospitals led to a much greater understanding of influenza’s causes and spread and was disseminated by a publication in 1919. It was the Committee that found that influenza was caused by a virus, not a bacterial infection.[25] Indeed, the presence of so many medical men in France for the war meant that the government had to try and deal with the shortage of clinicians at home during the pandemic.[26] Meanwhile, with central government guidance, local authorities took extensive public health action, such as closing public spaces, including schools, to prevent infection.
There was an acceptance on the part of government of the importance of a sustained involvement in disease control and medical research policy, spurred by the experience of the influenza pandemic. The Medical Research Committee became the Medical Research Council in 1919, with more money and powers. In May 1919 the Council recommended that the government establish standards for drugs and a national testing laboratory. Standardization of medical practice “can only be coherent and progressive if it springs from a centralised system of national research work” the Council said. This was a new departure in terms of how disease control and preventative medicine had been conducted in Britain for hundreds of years, i.e. locally.[27]
A laboratory was established. The Council was involved in vaccine research, including burgeoning attempts to synthesise an influenza vaccine in the 1930s. The Ministry of Health kept track of vaccine complications. The landmark Beveridge Report of 1942 called for further centralisation—a system of universal healthcare was required to defeat disease, its author argued. In 1948 the National Health Service was established. Local authorities maintained some independence, delivering many public health services, but it was centralised. This system was shaped by historical processes, not least Britain’s experiences of pandemics.
[1] William Farr, Report on the Mortality of Cholera in England, 1848–1849 (London: HMSO, 1852), i.
[2] London, The National Archives (TNA), SP 46/131, ff. 64–65, available at https://microform.digital/boa/documents/43099/sp-46131fo64-guidelines-for-halting-plague-spread-whitehalls-regulations-and-orders-may-11-1666#?xywh=-1051%2C-145%2C5325%2C2882.
[3] Gary S. de Krey, Restoration and Revolution in Britain (London: Bloomsbury, 2017), 65; John M. Last, “Miasma theory,” in A Dictionary of Public Health, ed. John M. Last (Oxford: Oxford University Press, 2007).
[4] TNA, SP 46/131, ff. 64–65, available at https://microform.digital/boa/documents/43099/sp-46131fo64-guidelines-for-halting-plague-spread-whitehalls-regulations-and-orders-may-11-1666#?xywh=-1051%2C-145%2C5325%2C2882.
[5] TNA, SP 46/131, ff. 64–65, available at https://microform.digital/boa/documents/43099/sp-46131fo64-guidelines-for-halting-plague-spread-whitehalls-regulations-and-orders-may-11-1666#?xywh=-1051%2C-145%2C5325%2C2882; Joanna Innes, Inferior Politics: Social Problems and Social Policies in Eighteenth-Century Britain (Oxford: Oxford University Press, 2009); Paul Slack, The English Poor Law 1531–1782 (Basingstoke: Macmillan, 1990), 22; Roy Porter, Disease Medicine and Society in England, 1550–1860 (Basingstoke: Macmillan, 1987), 22.
[6] TNA, PC 1/15/96, available at https://microform.digital/boa/documents/43111/73754-c46#?xywh=-3349%2C-265%2C9773%2C5288.
[7] TNA, PC 1/2/233, available at https://microform.digital/boa/documents/43112/pc-12233-petition-for-quarantine-exemption-eastland-merchants-appeal-referred-to-committee#?xywh=-1816%2C-141%2C5194%2C2811.
[8] TNA, E 179/382/9/6, available at https://microform.digital/boa/documents/43123/73754-c58#?xywh=-2950%2C-272%2C10042%2C5434.
[9] “Cholera Fact sheet,” World Health Organisation, accessed 27 July 2023, available at https://www.who.int/news-room/fact-sheets/detail/cholera; Kelly Less and Richard Dodgson, “Globalization and Cholera: Implications for Global Governance,” Global Governance 6, no. 2 (April–June 2000): 213–236, at 218–220; E. Ashworth Underwood, “The History of Cholera in Great Britain,” Proceedings of the Royal Society of Medicine 41 (November 1947):165–173, at 168.
[10] TNA, PC 1/109.
[11] Kyle Harper, Plagues Upon the Earth: Disease and the Course of Human History (Princeton NJ, Princeton University Press, 2021), 410–415; Dorothy Porter, Health, Civilization and the State: A History of Public Health from Ancient to Modern Times (London: Routledge, 1999), 63–66; Joanna Innes, “Central Government ‘Interference’: Changing Conceptions, Practices, and Concerns, c. 1700–1850,” in Civil Society in British History: Ideas, Identities, Institutions, ed. Joes Harris (Oxford: Oxford University Press, 2003), 39–60; Edward Higgs, The Information State in England: The Central Collection of Information on Citizens since 1500 (Basingstoke: Palgrave Macmillan, 2004), 65–69.
[12] The London Gazette, no. 18864, 25 Oct.1831, 2189–2192.
[13] TNA, PC 1/108, available at https://microform.digital/boa/documents/42962/pc-1108-cholera-statistics-for-great-britain-1831-1832#?xywh=-4966%2C-306%2C14148%2C6113; TNA, PC 1/111, available at https://microform.digital/boa/documents/42963/pc-1111-miscellaneous-london-cholera-statistics-1828-1832#?xywh=-2108%2C-282%2C10387%2C5621; TNA, PC 1/4397, available at https://microform.digital/boa/documents/42966/pc-14397-reports-of-trading-ships-under-quarantine#?xywh=-3463%2C-313%2C11540%2C6245.
[14] Christopher Hamlin, Public Health and Social Justice in the Age of Chadwick, Britain, 1800–1854 (New York, Cambridge University Press, 1997), 1–12; Edwin Chadwick, Report to 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 (London: Her Majesty's Stationery Office, 1842), 370–372. Chadwick papers and correspondence, including drafts of his Report have been digitised from the archives at University College London (UCL) and are contained in this collection. See UCL, CHADWICK/146-2181/1490; CHADWICK/146; CHADWICK/45; CHADWICK/67. For example, see https://microform.digital/boa/collections/125/pandemics-society-and-public-health-1517-1925/search?filters[query]=Chadwick&filters[className]=document&adminBarItems[0][type]=add&adminBarItems[0][title]=Add+Collection&adminBarItems[0][icon]=add_circle&adminBarItems[0][url]=https%3A%2F%2Fmicroform.digital%2Fboa%2Fnova%2Fresources%2Fcollections%2Fnew&adminBarItems[1][type]=all&adminBarItems[1][title]=All+Collections&adminBarItems[1][icon]=view_list&adminBarItems[1][url]=https%3A%2F%2Fmicroform.digital%2Fboa%2Fnova%2Fresources%2Fcollections%2F.
[15] Jim Downs, Maladies of Empire: How Colonialism, Slavery, and War Transformed Medicine (Cambridge, MA: The Belknap Press of Harvard University Press, 2021), 4–7 and 79–83.
[16] See TNA, MH 19/227, MH 19/228, MH 19/230, MH 19/277, and MH 19/278, available at https://microform.digital/boa/collections/125/pandemics-society-and-public-health-1517-1925/search?filters[query]=MH+19&filters[className]=document&adminBarItems[0][type]=add&adminBarItems[0][title]=Add+Collection&adminBarItems[0][icon]=add_circle&adminBarItems[0][url]=https%3A%2F%2Fmicroform.digital%2Fboa%2Fnova%2Fresources%2Fcollections%2Fnew&adminBarItems[1][type]=all&adminBarItems[1][title]=All+Collections&adminBarItems[1][icon]=view_list&adminBarItems[1][url]=https%3A%2F%2Fmicroform.digital%2Fboa%2Fnova%2Fresources%2Fcollections%2F.
[17] Harper, Plagues Upon the Earth, 406–410.
[18] Anthony S. Wohl, Endangered Lives: Public Health in Victorian Britain (Guildford: J M Dent and Sons, 1983),132–134; TNA, MH 12/5968/2, available at https://microform.digital/boa/documents/43038/mh-1259682-liverpool-smallpox-poster#?xywh=-6985%2C-467%2C19653%2C9321; TNA, ADM 101/76/2/2, available at https://microform.digital/boa/documents/43006/adm-1017622-voyage-medical-records-and-vaccination-journal-may-july-1825#?xywh=-2361%2C-185%2C6824%2C3693.
[19] F. B. Smith, The People’s Health, 1830–1910 (London: Croom Helm, 1979),156; TNA, HO 144/469/X9911, available at https://microform.digital/boa/documents/43013/ho-144469x9911-vaccination-refusal-by-charles-hayworth-ashford-kent-fined-27-times#?xywh=-2174%2C-298%2C11011%2C5958.
[20] Ministry of Health, First annual report of the Ministry of Health, 1919–1920, Cmd. 923, 1920, 49; Ministry of Health, Annual report of the Chief Medical Officer, 1919–1920, Cmd. 978 1920, 1.
[21] Ministry of Health, Annual report of the Chief Medical Officer, 1919–1920, Cmd. 978, 1920, 46–47.
[22] House of Commons Debate, 17 Dec. 1925, vol. 189, c. 1667.
[23] These papers are collected together in The National Archives record series MH 113. See https://discovery.nationalarchives.gov.uk/details/r/C10956.
[24] TNA, MH 60/22, Local Government Board, miscellaneous registers of correspondence, 1918–1919. The original letters that these records index do not survive.
[25] TNA, FD 4/36, available at https://microform.digital/boa/documents/42982/fd-436-studies-of-influenza-in-british-army-hospitals-in-france-1918; Michael Bresalier, “Uses of a Pandemic: Forging the Identities of Influenza and Virus Research in Interwar Britain,” Social History of Medicine 25, no. 2 (May 2012): 400–424.
[26] TNA, NATS 1/849, available at https://microform.digital/boa/documents/42995/73754-b22#?xywh=-2880%2C-233%2C8604%2C4656.
[27] TNA, FD 1/11, available at https://microform.digital/boa/documents/43012/fd-111-proposal-for-the-establishment-of-a-central-laboratory-for-vaccine-standardisation.