Past Talks

Charles Dickens as 19th Century Social Reformer and Medical Observer

Date: 16th April 2018
Speaker: Professor Greg Stores

Charles Dickens as 19th Century Social Reformer and Medical Observer – Professor Gregory Stores - 16 April 2018 

Charles Dickens (1812-1870), well-known as a writer and actor, was keenly aware of social problems resulting from poverty and disease in 19th century society.  His interest extended to social destitution; conditions in workhouses, orphanages, prisons and hospitals; child labour; education and public health.

Social destitution stemmed from the large shift of population from the country to the towns in search of work.  During the period from 1800-1880, London’s population grew from 1 million to 4½ million with resulting slums, disease, lack of sanitation, unemployment and vagrancy. 

In early 19th medicine many pre-scientific notions persisted: diagnosis was vague and treatment primitive.  Disease arose from contaminated water, poor nutrition, lack of daylight and prolonged, intense physical activity.

“To be born and to have survived in the 1800s was a journey of great risk” Dickens

The 1848 Public Health Act was the first step on the road to improved public health. Later in the century, the Public Health Act of 1875 addressed the problems of poor urban living conditions.  Advances in medical training and innovation, and the discovery of germ theory, when men such as Pasteur, Lister and Koch were to the fore, improved Victorians’ lives.

Dickens’ approach to public health was influenced by his childhood experiences.  His father spent a period in a debtors’ prison and Dickens worked in a boot-blacking factory to help support the family.  

He suffered from insomnia and regularly walked the streets at night encountering “homelessness, drunkenness and vice on the streets”.  Visits to hospitals; reading The Lancet; discussions with doctors and his own health problems added to his knowledge of illness and its origins.  He was ahead of his time with regard to clinical enquiry, details of symptoms, and physical and mental examination.  Dickens’ detailed descriptions of his fictional characters’ conditions were based on real cases and included ailments only recently recognised by medical science at that time.

The pre-19th century Poor Law severely penalised vagrants and the jobless.  Dickens was prominent in campaigns against poverty and destitution.  He publicised the shortcomings of Poor Law reforms and promoted prevention and treatment of medical conditions.

The 1834 Poor Law Amendment Act established workhouses for the ‘undeserving poor’ – the elderly, the sick and orphans.  Dickens was among those who condemned the harsh regime.  Dickens worked with Angela Burdett-Coutts to established a home for fallen women, Urania Cottage, in Shepherds Bush and to support, so-called, ‘ragged schools’ for the very poor. 

Dickens’ concern for social problems and public health is reflected repeatedly in his novels.  Prison reform is covered in Oliver Twist, Little Dorrit and Great Expectations, whilst orphans Oliver Twist, Pip, Little Nell and Edwin Drood are well-known characters.  The education of the poor is examined in Nicholas Nickleby and public health reforms are described in Oliver Twist.  Appalled by child mortality in the 1850s, Dickens was an early supporter of Great Ormond Street Hospital, and he featured a disguised advertisement for the hospital in his last completed novel Our Mutual Friend.

Dickens suffered a stroke and died at his London home on 9 June 1870, aged 58 years, and was buried in Poet's Corner in Westminster Abbey.