Morley: City chaos, contagion, Chadwick, and social justice 63 Figure 2. Very ill! An early 1800s illustra- tion (artist unknown) depicting the wide- spread suffering of the working classes. The gaunt individual is drinking tea to help repel an illness. Conventional medicine was unaffordable to the poor at that time. the mid-1830s, recognized the cultural con- flict within modern Manchester’s existence [6]: “... humanity attains its most complete development and its most brutish; here civ- ilization works its miracles, and here civi- lized man is turned back almost into a savage.” Such a description of city life, though, was not exclusive to Manchester. Large- sized British cities such as Birmingham, Liverpool, and Nottingham also inspired metaphors far than poetic due to their seem- ingly indescribable squalor. Yet to return to Manchester, Dr. James Kay-Shuttleworth [7] identified that its slum districts were very much like those in other cities. They con- sisted of poorly built houses, a deficiency of ventilation and toilets, unpaved narrow streets, mud, and stomach-turning stenches due to the presence of decaying refuse and sewerage. In such conditions, ill health was observably endemic [8]. British cities had, it seemed under the aegis of economic tran- sition, metamorphosed into epidemiological time bombs, environments greatly lacking in humanity and justice, particularly for the poor (Figure 2). HEALTH REFORM AND THE 1830S: THE CONTEXT The previous section has outlined how industrialization was acknowledged in early 1800s Britain to have instigated great ad- vances while it simultaneously wrought up- heaval that consequently appertained to the extensive presence of “4 Ds” [9]: dirt, dis- ease, deprivation, and death. In light of this situation, the British were the first to appre- ciate the taxonomy of disparate existence within an industrial framework, and cities as the seats of cultural change were the sites where this modern nomenclature, and the profundity of the dark tone to modern life, was most evident. Accordingly, some cities earned dishonorable monikers. Glasgow, the self-proclaimed “Second City of the Em- pire,” was so ravaged by violent crime, poverty, filth, and disease that it became stigmatized as a “Mean City” [10]. Liver- pool, a city with a death rate of almost 35 per 1,000 people in 1841, was given the un- enviable title of “The Most Unhealthy Town in England” [11], while London was branded “The Big Smoke” [12] and “Venice of Drains” [13], due to its impure air and overflowing sewers. The poet Percy Shelley went one step further and wrote in the play Peter Bell the Third: “Hell is a city much like London” [14]. In order to appreciate the existence and spread of the 4 Ds and the distress of indus- trial city living, a number of the features of evolving British urban culture need refer- encing. For example, such a miserable situ- ation did not develop, per se, as a result of the unparalleled speed of urbanization but occurred, among other things, due to a low wage economy that asphyxiated working people’s ability to compete in the housing market and a lack of governmental willing- ness to tackle urban problems head on be- cause of the pervasive laissez-faire principle that promoted non-interventionist convic-