Poor Law versus Public Health: Diphtheria, Sanitary Reform, and the ‘Crusade’ against Outdoor Relief, 1870–1900

Abstract

This article focuses on several high-profile, rural diphtheria epidemics of the later nineteenth century to explore the links between public health reform and disease control, and the changing character of the Poor Law. It explains that a Poor Law retrenchment policy, dubbed by contemporaries as the 'crusade' against outdoor relief, dominated Local Government Board (hereafter LGB) spending policies. The policy had a profound impact on all areas of local government administration. Notably, it exposed the fact that there were many over-lapping personnel, sitting as both Poor Law and sanitary officials. Holding joint offices compromised objectivity. It also encouraged administrators to cut local taxation ruthlessly. Doctors, the poor, and the LGB Medical Department objected strongly to the fact that too much financial power was delegated to self-interested ratepayers. In particular, urgently needed sanitary reform was frustrated. Large-scale investment was needed to improve drinking water, sewage supplies, and support research into preventive medicine, but few ratepayers were prepared to foot the bill, unless compelled to do so. This situation was further exacerbated by the permissive, rather than statutory, nature of public health legislation. Curiously, both historians of medicine and the Poor Law have under-estimated the extent to which the 'crusade' ethos dominated national and regional government spending. This article shows that studying rural diphtheria outbreaks can begin to uncover the degree of central government collaboration with ratepayers for Poor Law cost-cutting reasons, to the detriment of national public health reform in late Victorian England.