Epidemic – Diseases that struck the Black Country

by Nadia Awal, BCLM Researcher

“Looking back to those early days in my life, it seems to me that the attitude of people to this disease was very different from what it is today. Now, if a case is reported, there is a hue and cry, and many people endeavour to track down the source of the disease and any possible contacts. In the old days people seemed to accept it as just one of the things that had to be endured. One either got over it, or died, and that was that.”

 – J. Cartwright, writing in 1970 about the smallpox epidemic of c. 1894, Blackcountryman

Epidemics of the 19th and 20th centuries caused many deaths in the Black Country. Poor sanitation, crowded living conditions, and lack of vaccinations were some of the reasons that disease spread in the area. Read on to find out about some of the diseases that impacted the Black Country, the reasons they spread, and how individuals, towns and government strived to tackle them.


Cholera and the Dudley board of health

Cholera was arguably the most terrifying of all the 19th century epidemics and affected rich and poor alike. It caused more deaths more quickly than any other epidemic disease in the 19th century. A horrific disease, it’s caused by the ingestion of contaminated food or water, and can kill within hours. Vomiting and diarrhoea leads to severe dehydration, through the loss of litres of water (sometimes up to 20 litres a day!) If left untreated, the mortality rate is around 50-60%.

Cholera hit the Black Country in 1832. It is thought that it was brought to the region by a canal boatman that travelled from Liverpool (where the disease was rife) to Tipton. The community stood very little chance in preventing its devastating impact as there was no real understanding of what caused the disease to spread (whilst there was some awareness of a link between poor hygiene and illness, it wasn’t until 1854 that Dr John Snow confirmed the link between contaminated water and cholera). With no National Health Service, families had to rely on charity and the kindness of strangers (or otherwise, just accept their fate).

Because there were so many cholera-related deaths, towns in the Black Country and beyond started running out of places to bury people. For example, in 1832 the Dudley Board of Health issued a notice stating that all persons who died from Cholera had to be buried in Netherton rather than Dudley.

The outbreak had a particularly tragic impact in Bilston, as entire families were wiped out. The town received aid from across the country, including the Royal Family. Eventually the spread started to decline in Bilston, but by this point over 3,000 residents had been infected, over 700 died, and 450 children were left orphaned. 

Whilst cholera is not so common nowadays, it still kills an estimated 21,000-143,000 people across the world per year. It is most closely linked to places with inadequate access to sanitary water, such as slums or refugee camps.


Believed to have existed for at least 3,000 years, smallpox is a viral disease which causes high fever, tiredness and a rash. The spots fill with fluid, then pus, and eventually fall off. Up to 30% of patients would die from the disease.

Edward Jenner discovered a cure for smallpox in 1796. He realised that cowpox was similar to smallpox, so injecting cowpox could protect a person from getting smallpox.  In 1853 the law made it compulsory to vaccinate children against smallpox within the first 3 months of their life. However, certain people were against vaccinations, as there were doubts about their effectiveness and safety, and they objected on religious and political grounds. In the late 19th century, thousands of people took to the streets across the country to demonstrate against vaccinations, and anti-vaccination leagues were formed.

There were several smallpox outbreaks in the Black Country in the 1800s. In Walsall, Anglican nun and nurse Sister Dora realised that patients needed to be isolated to prevent the disease from spreading. When she arrived in Walsall in 1865, the town was hit by smallpox; many of the patients could not be moved to the hospital and as such she performed home visits. Sister Dora soon caught smallpox from an outpatient and was confined to her room.  In 1875, when there was another smallpox outbreak, she convinced the Town Council to create an isolation hospital (it was located at the rather unfortunately named Deadman’s Lane). She consequently took leave from her post at Cottage Hospital to care for smallpox patients for six months. Sister Dora understood the importance of cleanliness in the treatment of disease. When she arrived at Deadman’s Lane, she noted the distinctive smell of smallpox (a greasy, putrid smell). The first thing she did was prepare water to clean the patients. The next day she sent a list of demands to the Town Hall, which included: disinfectant, flea-powder, bars of soap and scrubbing brushes. During the epidemic she visited over 12,000 smallpox patients at their homes, putting herself at great risk. There were concerns that this could lead to Sister Dora’s death; she reportedly said: “Then I should have died in the course of duty and no one can die better than that.”

One account by J. Cartwright describes how, in c.1894, the smallpox outbreak was of such proportions in Quarry Bank that the local authority had to act. There was not an appropriate isolation hospital nearby, so Army tents were hired and placed in a field at Merry Hill. When a new case was identified, a horse-drawn cab would arrive at the house, and the patient would be wrapped in a blanket and assisted into the cab to be taken to the tents. One night, there was a horrendous storm. Many of the tents were blown down, leaving patients exposed to the elements. One man, who lived nearby, struggled home in his night attire and later died.  Whilst the epidemic did not last long, the people of Quarry Bank were determined that it would not happen again. A hospital was built soon after, a corrugated-iron structure, ready for any future outbreaks. It was used for a few cases of diphtheria and other contagious diseases, but ultimately there were not enough cases to justify its upkeep and so it was dismantled. Future cases were taken to nearby Kingswinford where a more permanent building had been erected.

Smallpox was one of the most destructive diseases in human history and caused millions of deaths. In the 1960s the World Health Organization launched an eradication plan; the last known case was in Somalia in 1977 and by 1980 it was declared eradicated.


Diphtheria is a fatal disease which affects the nose and throat, and sometimes the skin. It can lead to weakness, a sore throat, fever and swollen glands. If it affects the skin, it can cause open sores and ulcers. In its advanced stages, the disease can damage your heart, kidneys and nervous system. In some cases, the symptoms are mild or non-existent, and people may spread the infection inadvertently. 

In 1940, diphtheria became the first vaccine of the bacteriological age to be offered to British children nationally for free. There was a government push to encourage parents to get their children vaccinated. In the mid-twentieth century posters were created which depicted babies with unnerving straplines such as ‘Diphtheria Costs Lives’ and ‘Diphtheria is Deadly’.

The vaccination programme led to a significant reduction in cases, from over 46,000 in 1940 to just 962 in 1950. Medical authorities saw this as a success but were aware of the risk of parents not immunising their children because it looked like diphtheria was no longer such a concern, which may lead to a deadly increase in cases.   

The authorities’ fears were appeared to be proved correct. In 1950 there was a sudden decline in child immunisation, and the Ministry of Health felt that the problem was apathy. In Coseley in 1951, an outbreak led to 66 cases. Comparatively, during the same year Wolverhampton had 5 cases and Dudley 11 (during the first two quarters of the year). Despite a consequent immunisation campaign there were a further 58 cases from 1952-3. In 1953, Coseley accounted for almost a third of all cases in England for that year. According to the Chief Medical Officer’s report for 1953:

“In Coseley, as elsewhere in the country, it was found in most instances the parents of unimmunised young children had no objection to the procedure. They were merely indolent and quite apathetic concerning the matter … Later, when the child could be immunised at school, without any inconvenience, they readily consented. Nevertheless, there was the odd instance of the obdurate parent who could not be persuaded to have his children protected, even though other members of the household had contracted the disease. In several instances in recent years, in Coseley and elsewhere, this refusal has brought tragic consequences – the child not only contracting the disease but succumbing to it.”

The Chief Medical Officer’s tone places blame on Coseley parents and apathy. However, there is an argument that parents did not know how to interpret some of the information they were receiving from government. Local Alderman George Newham said of parents who had fears about vaccination: “They haven’t been educated…We are still having to teach them.”

There are still cases on Diphtheria in the world, in particular in countries where vaccination rates are low. However, diphtheria is now rare in the United Kingdom and other countries with robust immunisation programmes because individuals are vaccinated at a young age.