Clean and tidy

When Victoria ascended the throne in 1837 London was already the largest metropolis in the world with a population of nearly 2 million, but most of her subjects were still country-dwellers. By the end of the century London had grown sixfold, and 80% of Britons lived in towns or cities.

In large part the story of 19th-century England is the story of the city. Early Victorian cities struggled to manage themselves with a public infrastructure that had changed little since Elizabethan times. There was no regular income tax. The government's role in matters of sanitation, water supply or public health was barely recognised. While 15% of all children could expect to die before their first birthday, urban children were far worse off than their country cousins. Figures published in the Lancet in 1843 showed that the life expectancy of a labourer in rural Rutland was 38, while in Liverpool it was just 15.

The Great Filth is the latest of a recent spate of books that take dirt and disease as a starting point for the social history of the Victorian city. In particular, John Snow's revolutionary discovery in 1854 that cholera was spread not by air but by contaminated water has served as a foundation for several studies, most notably in Steven Johnson's excellent The Ghost Map

The Great Filth examines much of the same territory but views it through a wide-angle lens. Early in the book Stephen Halliday quotes the Health of Towns Association, established in 1844, whose founding principle was "to substitute health for disease, cleanliness for filth, order for disorder . . . and to bring to the poorest and meanest air, water and light". The association was short-lived but the "unsung heroes" who took up the cause ensured that, by 1901, cities were safer and healthier places in which to live. Scientists, doctors, midwives and engineers each merit a chapter.

While London inevitably dominates, the reach of Halliday's investigations extends to even more rapidly growing cities - Manchester, Glasgow and, in particular, Liverpool. His cast is consequently a large one, involving a wealth of engaging detail: the word "midwife", for example, was considered so vulgar that Louisa Hubbard, who campaigned tirelessly for the rights of women to education and employment, observed: "My dear, I wish there was another word for you; it would be so awkward if we used it just when the footman came in to put on coals." The book covers everything from Sir John Sutherland's claim that a crew of German seamen had contracted cholera from over-indulgence in plums, to the aside that the son of William Budd, the doctor who demonstrated that typhoid was carried by polluted water, was probably the model for Sherlock Holmes's Dr Watson.

This biographical approach, however, is also the book's critical flaw. By tackling the period as a series of separate, interconnecting stories Halliday gives himself fundamental structural difficulties. This is particularly problematic with regard to epidemics such as cholera, which preoccupied scientists, doctors and public servants alike. Often he is required to repeat himself or to refer the reader to points made elsewhere in the book.