‘No man’s land’: Rural / urban boundaries and public health

By Keir Waddington

Writing about the county of Glamorgan, Wales in 1894, the Western Mail noted, ‘No places ought to be more charming and healthful than our pretty villages; but some of them are sadly deceptive’. If reformers came to feel that they could tackle urban sanitary problems through structural reforms, on the surface ‘the rural’ did not fit within metropolitan narratives of sanitary intervention. Urban officials became increasingly adamant at the end of the nineteenth century that rural sanitation was inadequate as they highlighted the slow pace of reform. Although public health historians are now more sensitive to the local dimensions of reform, existing scholarship on rural sanitation has endorsed a similar narrative of backwardness to present public health as a modernizing force in the battle against disease and the uncivilized inhabitants of rural communities. As recent work on Canadian medical history demonstrates, medicine and public health were often practiced differently in rural areas to the city.[1] Rural practitioners frequently struggled to apply urban medical doctrines, but where exactly was ‘the rural’?

In my research on public health in Victorian and Edwardian rural Wales, this question of where the ‘rural’ is has presented a number of problems as existing definitions have proved inadequate for understanding rural public health. We might associated the ‘rural’ with the countryside or with agricultural areas, but my research is revealing how when it comes to health, medicine and public health, the boundaries between the rural and the urban were often mutable. As historians of medicine and public health, we need to be aware of these mutable boundaries if we are to avoid misreading the environments we are studying or associating the ‘rural’ with particular sets of values or structures imposed on them by outsiders.

Historians of medicine and science might turn to the growing literature on the “spatial turn” to understand the boundaries between rural and urban, which suggested how environment and landscape are mediated by cultural understandings. However, notwithstanding this literature and growing scholarship on the health problems that came to be associated with the rural in late-nineteenth century Europe, our existing definitions of the rural remain imprecise and often caught up with romanticized notions of the countryside or contemporary perceptions of backwardness, a view that has informed scholarship on rural health. Demographers have struggled with defining the ‘urban’ and the ‘rural’ between the census of 1851 and 1911, and how to approach areas which were rural in 1850 but urbanized by 1911. In Britain, distinctions between agrarian and industrial may have become more clear-cut after 1900, but rural areas were never just agricultural in nature or concentrated around the notion of the village or a nostalgic form of ‘traditional’ face-to-face community. Writing in 1914, the statistician Bowley set out some of the problems that have continued to concern historians and demographers when he noted:

rural population might be defined either from consideration of its density, or of its occupation, or from its position in the scheme of local administration; or it might be taken as the residual of the population of the Kingdom after that of a scheduled list of boroughs and towns has been abstracted.[2]

The lack of agreement over what the ‘rural’ was in the nineteenth century has ensured a range of definitions, all more or less unsatisfactory, that hamper us when trying to understand the nature of rural medicine or rural public health. Most quantitative or demographic measures utilize settlement size and population density, with more sophisticated work including the proportion of the workforce engaged in agricultural activities as pointing to an area’s rural nature. Such existing methods of categorization appear crude or subject to a nostalgic imagining of the rural as a response to modernization, while they fail to take account of the temporal dimension.

While James Winter argues that during the nineteenth century, ‘city and country managed to keep their distance and distinctiveness’ in Britain, William Cronon’s work on nineteenth-century Chicago suggests there was often no firm division between urban and rural environments.[3] Hence, it is often more useful to focus attention on the ways in which governments, local authorities, officials and local inhabitants perceived the rural in terms of medical or health policy. Public health legislation might provide one way of conceptualizing the ‘rural’, an approach favoured by Adna Weber in his 1899 study.[4] Responsibility for rural sanitation was grafted on to the unions created by the 1834 Poor Law Act and given concrete form by the creation of rural sanitary districts under the 1872 Public Health Act. Thinking strictly in terms of administrative boundaries is of course artificial and cumbersome, but contemporary debates about the public health responsibilities of rural districts are more instructive as they reveal how these areas were framed through an identity that was not solely geographical in nature. By the 1880s it was widely acknowledged that different standards had to apply to rural authorities because they worked in different contexts and had different and more limited powers. More interesting is how these debates point to the discursive formation of areas defined as rural, highlighting how contemporaries understood that while some districts might technically be urban they were in reality rural in character.



Aberdaron from Penysarn, People’s Collection Wales, http://www.peoplescollectionwales.co.uk/items/17868

Thinking about the rural as a discursive formation is a useful starting point. As the 1891 census noted about rural Wales, ‘a very considerable number of districts that are technically speaking urban, are in reality of thoroughly rural character’.[5] Distinctions between rural and industrial Wales were seldom obvious despite nearly 50 per cent of the population remaining rural in 1891 compared to 35 per cent nationally. While Wales beyond industrial Glamorganshire and Monmouthshire was often perceived as ‘a small country to which town life was completely alien’ and one dominated by farmstead-based communities, notions of ‘parish’, ‘village’, ‘rural’ and ‘urban’ were remarkably slippery and changed over time.[6] Numerous types of parish and village existed, and defining where the urban ended and the rural started is made more complex by the nature of urbanization, industrialization and in-migration.

The trap of thinking about village or town in medicine and public health, or what and where the rural / urban divide occurred, in simple terms can be illustrated by the following example. Writing in 1896, the medical officer for Bridgend Rural District Council explained how in the South Wales village of Tondu ‘surface slops and refuse are thrown anywhere so that the whole area is polluted’. This might be viewed as evidence of poor rural sanitation, with insanitary practices attributed to rural backwardness. Yet, although contemporaries referred to Tondu as a village, the Tondu ironworks and mines were a significant pocket of industrial production in mid-Glamorgan. Were conditions in Tondu a consequence of its rural location or a by-product of its industrial character? Considering local contexts rather than just topography, population size, density or contemporary terminology is vital, but when thinking about where the rural was it is also necessary to consider when the rural was. Ironworks and collieries, as seen in the case of Newbridge, could emerge in green-field sites, rapidly transforming rural landscapes into industrial ones, but industrialization was equally uneven: for example, while ironworks in upper Glamorgan grew in the 1840s and 1850s, the Aber Valley remained an almost completely rural landscape until the 1890s. As the medical officer for Gelligaer and Rhigos Rural District Council explained, some ‘remote rural district[s] plodding along contentedly on primitive lines’ could suddenly undergo a process of rapid transformation ‘into a bustling industrial center with… all the accomplishments of modern life’. In under a decade, previously isolated rural parishes could become distinctly urban settlements. How to do we account for such places that were rural in one decade and urban the next?

The nature of many urban settlements that grew up from the mid-nineteenth century further complicates any clear division between the urban and rural. In Glamorgan, contemporaries were aware that there were ‘few rural districts unaffected by mining and quarrying’, but as Borsay, Miskell and Roberts have explained, many of the coalfield settlements do not fit easily with existing models used by urban historians, especially as urbanization in Wales often resulted from the transformation of green field sites rather than from established urban centers.[7] Although their relatively small size did not preclude them from fulfilling urban functions, Welsh industrial communities and towns often had a ‘quasi-urban nature’ with strong links between them and their rural hinterlands. For example, the slate-quarrying towns of Gwynedd in North Wales had distinctly urban forms of culture, politics and social organization, but their inhabitants were intimately connected with agriculture. A similar pattern existed in South Wales where towns, such as Abercynon with a population of 10,000 in 1900, were described as having a strong rural character. The result was hybrid landscape of industry and agriculture in which many small and market towns in Wales were practically as much a part of the rural organization as the surrounding villages.

rhondda from the Rhigos

Rhondda Valley from the Rhigos

Thinking about urban – rural divides is made more complex by the interactions that existed between urban and rural areas, industry, agriculture and the landscape. Coal mining, as well as metal works and slate quarrying, scarred the rural landscape. As ‘the dark shadows of the valleys’ were, as one writer explained in 1893, ‘made darker by the grime of coal and dust of iron’, rural tenants ‘saw their lands encroached upon for works, tips… railways, housing’.[8] Ironworks and other industries became important sources of rural pollution, choking streams with refuse industry with Welsh rivers reported to be the most polluted in Britain. Mining both disrupted local water supplies and made them acidic, while mining and copper works ensured that, as one contemporary lamented, ‘crops of every description are injured, cattle suffer, and wool is made useless’. Urban responses to sewage and refuse disposal caused problems for rural districts. For example, Bangor dumped its household refuse on the foreshore of the Hirael, prompting complaints from local rural communities. Agricultural practices and how agricultural land was used equally posed a threat to urban health. Cattle and the manuring of fields polluted water supplies. Rural practices were perceived to be a threat to urban health following the 1882 typhoid outbreak in Bangor, which was blame on the rural pigsties, cowsheds, slaughterhouses and privies in the surrounding villages contaminating Bangor’s reservoirs. In response, urban authorities in the 1880s and 1890s became increasingly worried about rural communities as sources of contamination.

The same interconnections between rural and urban areas occurred in the administration of public health. Town and country were medically interdependent: where one started and the other ended was more subtle than the boundaries of Poor Law unions or sanitary districts. For example, Glamorgan saw the rapid expansion of new industrial towns and mining settlements, but much of the region continued to fall under the responsibility of rural sanitary districts. As coalfield settlements grew in size they sought urban powers, but many remained within rural authorities, a process made clear in Swansea Rural District Council, which contained twenty-two collieries by 1902. Individuals often considered borders as arbitrary and suburbanization further blurred boundaries. While this was particularly pronounced around Cardiff, it was not just an issue for industrial Glamorgan. Holywell, for example, had to seek the agreement of the surrounding rural authority when making any sanitary improvements.

Paradoxically, then, the more scholars turn to consider the important dynamics of medicine and public health in the rural, the more they may become aware of its porous and often indistinct boundaries, its elusive nature, as well as its conceptual and material interconnectedness with other spaces. Historians studying the rural ought to be wary of some of the pitfalls of their object of study, like simply mistaking the rural for the non-urban or the countryside, or being blind to the interdependence of rural areas with urban, industrial, and agricultural sites. Instead, setting aside traditional assumptions about the rural might open up routes of investigation into the rural’s multiplicity of meanings, its temporal dimensions, and its inseparability from other geographical categories.


Keir Waddington is Professor of History at Cardiff University. He is author of An Introduction to the Social History of Medicine (Basingstoke: Palgrave Macmillan, 2011), among many other publications. His current project focuses on rural public health in Victorian and Edwardian Wales. His most recent article, ‘In a country every way by nature favourable to health”: Landscape and Public Health in Victorian Rural Walesin the Canadian Bulletin of Medical History is available for free via Open Access.



[1] Megan J. Davies, “Mapping ‘Region’ in Canadian Medical History: The Case of British Columbia,” Canadian Bulletin of Medical History 17 (2009): 73-92.


[2] A.L. Bowley, “Rural Population in England and Wales: A Study of the Charges of Density, Occupation and Ages,” Journal of the Royal Statistical Society 127 (1914): 597.


[3] James Winter, Secure from Rash Assault: Sustaining the Victorian Environment (Berkeley: California University Press, 1999), 166; W. Cronon, Nature’s Metropolis: Chicago and the Great West (New York: Norton, 1991).


[4] A.F. Weber, The Growth of Cities in the Nineteenth Century: A Study in Statistics (1899).


[5] Report of the Royal Commission on Land in Wales and Monmouthshire (London, 1896), 47.


[6] Cited in P. Borsay, L. Miskell and O. Roberts, “Introduction: Wales, a new agenda for Urban History,” Urban History 32 (2005): 5


[7] Borsay, Miskell and Roberts, ‘Introduction: Wales, a new agenda for Urban History.”


[8] M. Trevelyan, Glimpses of Welsh Life and Character (1893), 120.


  1. David Harley

    A full survey of urban/rural public health should surely include birth.

    Throughout Europe from the early modern period until the early 20th century, in late Imperial and Soviet Russia, in India and other colonial and post-colonial countries to the present, there has been resistance to the arrival of professionally trained midwives. They were urban outsiders, and behaved like doctors rather than like the village birth attendants, who were and are either very helpful for days or very low status.

    Just as Irvine Loudon has compared the death rates in births attended by obstetricians and midwives, it would be interesting to know how perimortal death rates compared, something that can be determined wherever careful bureaucratic records have been kept, as in imperial Russia.


  2. Reblogged this on DailyHistory.org and commented:
    Keir Waddington has article on the urban/rural divide and its impact on public health in Wales. Waddington argues that scholars should avoid the traditional notion of rural when thinking about public health and “become aware of its porous and often indistinct boundaries, its elusive nature, as well it conceptual and material interconnectedness with other spaces.” Waddington’s article pairs nicely with Alun Whithey’s recent piece “Practising by Numbers” posted at regionalmedicalhumanities.


  3. David Harley

    It occurs to me that one could read the reports of Medical Officers of Health against the grain. Wherever they comment on “ignorance,” and describe its effects, it might be possible to use this as a door into a range of cultural phenomena and not just a lack of education and “modernization.” The rural “folk” knowledge of those arriving to take up industrial or ancillary work might well be used as a marker of the interpenetration of the rural and the urban, probably with generational and ethnic components.

    Culture and geography can be examined in fine detail, but so too can relative morbidity and mortality.

    Census reports provide evidence of age and place of birth. Causes of death, within the usual historical limits, and longevity can be mapped closely. It then becomes possible to include such environmental factors beyond the control of households as the use of middens, as opposed to “night soil,” and not just industrial pollution of air and water. Are the “ignorant” incomers actually more vulnerable to early death than the presumably acculturated locals?


  4. Pingback: Links: Crowdsourcing, reproductive tech, and more on Ebola | AmericanScience

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