At least ten mills were in operation in Accrington in the early nineteenth century. Terraced housing for the industrial workers was built along new streets and in squares; a few higher status developments, such as Bank Terrace, were also built at this time. By the middle of the century overcrowded living conditions had given rise to major sanitation problems. Many people were living in cramped courts with inadequate drainage, and it was not uncommon for pigs and other animals to be kept in the town. The arrival of the railway in 1848, connecting Accrington with Blackburn, Burnley and Manchester, was a stimulus for further industrial and residential development. More new streets were laid out throughout the second half of the nineteenth century. Housing build after about 1860 tended to differ from the earlier housing, being generally of better quality and built in longer, more standardised terraces on streets laid out to an orderly grid plan. The town grew as a centre for the textiles industry, but in the later nineteenth and early twentieth century it also became a world-renowned centre for engineering including the NORI brick, used in the foundations of the Blackpool Tower. The NORI brick was also exported from Hyndburn to America in 1931 to be used in the foundations of the 1,454ft Empire State Building because they were the densest and strongest in the world.
Accrington grew rapidly from the late eighteenth century onwards as a result of the industrial revolution. The population grew from 3266 in 1811 to 10,374 by 1851 and 40,000 by 1898. As a result of the population boom the town centre was established with many shops being concentrated around the Church Street area of Accrington and along Abbey Road. Abbey Street, Blackburn Street, Blackburn Road, Oak Street and Warner Street had become major shopping streets by the middle of the century, and Burnley Road by 1878. Shops had become more widespread and far more diverse by the end of the century, and those constructed at this time were usually purpose-built. Accrington may have had only two taverns at the start of the nineteenth century, but had fourteen public houses and 27 beer houses by 1850, and in just 18 years that number had risen to 44 public houses and 36 beer houses.
Many new churches were built in Accrington in the nineteenth century, particularly by the Nonconformists who made up a high proportion of the immigrants moving into the town seeking work. These immigrants established schools as well as churches, as did both the Roman Catholics and the Anglicans. A technical school was built in the town in 1894-5. The earliest public building in Accrington was a courthouse, built in 1835 and demolished in the 1930s. The Peel Institution was built in 1857-8 and fulfilled various functions before becoming the Town Hall in 1878.
However, on the 28th of February 1898 the town cottage hospital was officially opened by the Mayor Alderman Lee, the first choice was Lord Derby, but he was away on a tour of Egypt. The story had started four years previously when the Mayor Mr Haywood called a meeting to discuss the idea of a hospital based in Accrington; the idea was fully backed by the Accrington Observers editor. Previously patents had to travel all the way to Blackburn and to Manchester before the Blackburn Royal Infirmary was built. The first building contained sixteen beds and cost £7,700 which is equivalent to £684,000 in modern day money. However, the Mayor Alderman Heywood thought that ten beds would be more than sufficient with a capital of £3,000, equivalent to £266,000. The cottage hospital was constructed by local builders Ramsbottom and Sons of Whalley Road. The town clerk Mr Aitken was made honorary secretary of the cottage hospital funds, interestingly the three streets that surround the hospital are named Aitken, Ramsbottom and Haywood.