The MBW was created to deal with the main problem of governing London - the city had grown hugely but the local authorities that existed represented the villages that had been swallowed rather than the new city that existed. In 1850 there were over 300 different bodies with a role in governing London and directing its development as well as the local authorites of Kent, Middlesex and Surrey. The MBW was the first group with a remit covering the whole of London, it created numerous borough level bodies.
The MBW was not directly elected by the people of London, it was elected by the parish vestries, district boards and the City of London authorities. As the name suggests the Board was mainly concerned with infrastructure, the roads, bridges and sewers.
The notable achievements of the Board were 120 km of main and 1650 km of street sewers, built under the direction of the MBW's only chief engineer Joseph Bazalgette. From 1869 the MBW acquired all the private bridges crossing the River Thames and built new crossings including Tower Bridge, Victoria Bridge, rebuilding Battersea Bridge, Waterloo Bridge; the continuation of slum clearence creating Charing Cross Road, Garrick Street, Northumberland Avenue, Shaftesbury Avenue, and Southwark Street; and the creation of the three section Embankment from 1864. After the Education Act of 1870 the created School Board for London was part of the MBW. The Metropolitan Fire Brigade was created in 1865.
The Board was replaced by the London County Council in 1889, a genuine elected local government group.