19th & 20th Century Public Health

Question 0

How did the governments response to public health at the start of the 19th century impact on people?

Answer 0

Only rich men were allowed to vote in 1920, and they had good living conditions. Poor people couldn’t vote.
Laissez-faire attitude- poor people had no help in solving these social problems.

Question 1

What were some of the dangers to health caused by rapid industrialisation?

Answer 1

No public transport so people lived close to their place of work, leading to many low quality houses being quickly built.
Smoke from coal-fired factories filled the air.
Houses were close together without running water or toilets.
Diseases spread quickly in overcrowded slums.
Life expectancy in towns lower than in the countryside.

Question 2

When did the three cholera epidemics in London take place?

Answer 2

1832
1849
1854

Question 3

Who was Edwin Chadwick?

Answer 3

A civil servant who worked for the poor law commission in the 1830s and 1840s. He became a member of the National Board of Health in 1848.

Question 4

What was Edwin Chadwick’s main weakness when it came to putting across his ideas about public health?

Answer 4

He did not know how to get other people on his side.

He was argumentative, arrogant and rude.

Question 5

What did Chadwick believe to be the cause of disease?

Answer 5

Miasmas, or ‘bad air’.

He did not accept Pasteur’s germ theory.

Question 6

What did Chadwick’s ‘Report into the Sanitary Conditions of the Labouring Population of Great Britain’ involve?

Answer 6

Poor people live in dirty, overcrowded conditions that cause a hued amount of illness. This makes them too sick to work and so poorer still, leading to other people having to pay higher taxes to help the poor.

Question 7

What was Chadwick’s suggested solution to the problem of people falling ill and needing time off work?

Answer 7

Improving drainage and sewers, removing waste from streets, providing clean water supplies and appointing medical officers.

Question 8

What did Chadwick’s recommendations lead to in 1848?

Answer 8

The first Public Health Act

Question 9

What did the Public Health Act of 1848 entail?

Answer 9

A national Board of Health was set up.
In towns with high death rates the government could force the local council to make public health improvements.
Local councils were encouraged to collect taxes for improvements if they had the support of local rate-payers.
Councils were allowed to appoint medical officers of health to oversee public health.

Question 10

What opposition was there to the first public health act?

Answer 10

Taxpayers did not want to have to pay taxes even though it meant lower taxes in the long run.
The rich had a laissez-faire attitude to the poor.
Some people did not like the interference of the government.

Question 11

How many towns set up local Boards of Health after the 1848 Public Health Act?

Answer 11

103

Question 12

When was the National Board of Health abolished?

Answer 12

In 1854, only 6 years after it was set up to oversee reforms.

Question 13

Who was John Snow?

Answer 13

A pioneer in sugery as well as in public health, improving medical methods and using detailed evidence to challenge old theories.
He did not believe in miasma.

Question 14

What did John Snow publish in 1849 to prove that cholera is spread through water, not through bad air?

Answer 14

On the Mode of Communication of Cholera

Question 15

How was Snow able to prove that cholera is spread though water in 1854?

Answer 15

The handle of the Broad Street water pump, near to his surgery, was removed, stopping people getting water from the pump. There were no more deaths, and it was later discovered that there was a cesspool a metre away from the pump that was leaking into the drinking water.

Question 16

Why was Snow’s evidence still not enough to publish a new Public Health Act?

Answer 16

Pasteur had not yet published his germ theory.

Question 17

What was the Great Stink?

Answer 17

The summer of 1858, in which it was very hot and the smell from the river Thames grew worse and worse, the worst smells being at the Houses of Parliament.
An effective, more modern sewer system was built but this still did not lead to improvements throughout the whole of the country.

Question 18

When did Pasteur publish his germ theory?

Answer 18

1861

Question 19

When did working class men get the vote?

Answer 19

1867

Question 20

How did the fact that working class men gained the vote impact on the government?

Answer 20

If politicians wanted to win elections they would have to promise laws that won the votes of all the classes.
Many new laws were passed that were designed to improve the lives of ordinary people.

Question 21

What did the Public Health Act of 1875 entail?

Answer 21

Made it compulsory for local councils to improve sewers and drainage, provide fresh water supplies, and to appoint medical officers and sanitary inspectors to inspect public health facilities. Towns can charge taxes to do this.

Question 22

What other laws followed the 1875 Public Health Act?

Answer 22

Housing standards improved.
Pollution of rivers used for drinking water stopped.
Working hours in factories for women and children shortened.
Illegal to add ingredients to food that made unhealthy.
Education made compulsory.

Question 23

Why did the government decide to make public health compulsory in 1875?

Answer 23

Rich people died of cholera so politicians took it seriously.
Poor people got the vote in 1867, so looking after poor people became a vote winner.
The germ theory proved there was a point to cleaning away dirt.

Question 24

What evidence is there to suggest that Edwin Chadwick had a limited impact on improving public health?

Answer 24

His 1842 report did not lead to immediate reform.
His personality antagonised people and did not win support for his cause.
The 1848 Act did not force councils to reform public health.
Other individuals like WILLIAM FARR linked dirt and disease. His reports on dirty towns shamed some towns into improving conditions.

Question 25

What role did William Farr play in 19th century public health?

Answer 25

After 1837 all births, deaths and
marriages had to be registered and
William Farr used this information to
build an accurate picture of where the death rate was highest and what people died of. This proved the link between high death-rate and unhealthy living conditions. His statistics shamed some towns into improving local public health conditions. Therefore Farr’s evidence also put pressure on local and national government to make changes.

Question 26

What had life expectancy risen to by 1900?

Answer 26

46 for men.

50 for women.

Question 27

Why were public health conditions so bad at the beginning of the 19th century?

Answer 27

Laissez-faire government.
Slums as people had to live close to work, diseases spread quickly.
Poor working conditions- no regulations.
Houses built without planning and very close together with no fresh water, toilets, etc.
Cause of disease unknown
Cholera epidemics that affected the rich as well as the poor.
Smoke from coal-fired factories filled the air.

Question 28

What factors aside from Chadwick helped public health to improve in the later 1900s?

Answer 28

Improved technology
Germ theory
Government intervention

Question 29

What factors in technology allowed the Great Clean Up to take place?

Answer 29

Bazalgette a Sewers
Lavatories
Soap

Question 30

Who was Joseph Bazalgette and how did he contribute to public health?

Answer 30

The chief engineer of the London Board of Works established in 1856.
He designed and supervised the building of a new sewer system after the Great Stink. This incorporated more than 1000 miles of sewers, built with new materials like Portland cement.
The sewers were now oval tunnels instead of circular ones. This made the sewers self-cleaning.
He mapped the flow and tides of the Thames and connected the system so that the tides carried away the waste and so that at high tide, sewage could be carried out to sea with the help of pumping stations.

Question 31

How long did the Bazalgette sewers take to complete?

Answer 31

10 years

Question 32

How did new lavatories help to improve public health?

Answer 32

They flushed away waste into sewers which prevented people from dumping it on to streets or into rivers.
Public toilets had to be provided in towns through the 1875 Public Heath Act.

Question 33

When did the government take tax off of soap?

Answer 33

1853

This meant that more people were able to afford it and so the spread of disease was prevented.

Question 34

What two reports published at the end of the 1800s highlighted the links between poverty and ill-health and shocked the nation?

Answer 34

Charles Booth surveyed poverty in London; Seebohm Rowntree carried out a similar study in York.
These showed that 1/3 of families did not have enough money to pay for their housing, clothes and food. Many were working but earned only very low wages. The sick, unemployed and elderly received no help from the national government no matter how poor they were.

Question 35

When was a new Liberal government elected?

Answer 35

1906

Question 36

Describe some of the reforms made by the Liberal government.

Answer 36

1902- compulsory training for midwives.
1906- free school meals.
1907- births notified to local Medical Officer of Health. A health visitor visited each new mother.
1907- school medical checks by nurses or doctors.
1907- Workers Compensation Act for injuries at work.
1908- old-age pensions for over 70s.
1908- Children’s Charter (punishments for child cruelty and children sent to borstals instead of adult prisons).
1908- maximum 8-hour day for miners.
1909- back-to-back housing banned. Regulations enforced higher standards of house building.
1909- labour exchanges set up.
1911- weekly half day holiday for all shop workers.
1911- Parliament Act (pay for MPs so working men could stand for election).
1912- school clinics to provide children with free medical treatment.

Question 37

What did the school for mothers that opened in 1907 teach?

Answer 37

The importance of hygiene and the dangers of diarrhoea for infants.
How flies spread disease from privies and rubbish in streets.
That breast feeding was better than bottle feeding.
That good mothering was a duty to be performed for King and Country.

Question 38

When was the National Insurance Act introduced?

Answer 38

1911

Question 39

What did the National Insurance Act involve?

Answer 39

Workers, employers and the government were required to pay into a sickness fund. The aim was to give workers medical help and sick pay if they could not work through illness in exchange for 4d a week.
They would receive 10 shillings a week for up to 26 weeks and free medical care. This was paid out of the sickness fund.

Question 40

What were the limitations of the National Insurance Act?

Answer 40

Many people were left out of the scheme: 
Most women and all children
The unemployed
The elderly
People with long-lasting illnesses

Question 41

What was a feature of the 1919 Housing Act?

Answer 41

Local councils had to provide good homes for working people to rent, as after WW1 the government had promised ‘Homes fit for Heroes’.
250,000 new homes were built.
In the 1930s, many old, unhealthy sulk houses were cleared and another 700,000 new houses were built.

Question 42

How were developments in the 1930s not all that they seemed?

Answer 42

Medical care was harder to find which was very expensive.
Unemployment rose to over 3 million and these were left outside of the NI scheme.
People in jobs could not afford to keep up with NI payments and couldn’t get free medical help.
In towns where unemployment was high, the death rate of children under 1 was rising.

Question 47

How did the Second World War change attitudes towards public health?

Answer 47

> Many died at home during bombing raids and people felt that everyone should have the chance to good health care, not just the wealthy.
The Middle-class families who town children were evacuated to were shocked at the condition of these children who were dirty, unhealthy and undernourished.
After all the sacrifices, people wanted a better future, including better health care.
During the war many people got free health care to keep them fit for the war effort.

Question 48

What was the Beveridge Report?

Answer 48

In 1942, the national coalition government asked a leading civil servant, Sir William Beveridge, to write a report on what should be done to improve peoples lives.

Question 49

What recommendations did Beveridge make in his report?

Answer 49

Setting up an NHS, free to everyone and paid for by taxes. Doctors, nurses and other medical workers would become government employees instead of charging the sick to create their wages.

Everyone in work would pay NATIONAL INSURANCE out of their wages. This would pay benefits (sick pay, oaps, unemployment lay, etc.) to everyone whether they were working or not.

Question 50

How did people react to the Beveridge Report?

Answer 50

Mostly by ENTHUSIASM:
People queued outside shops to buy their own copy and 600,000 copies were sold.

There was also some OPPOSITION

Question 51

What opposition was there to the NHS?

Answer 51

> Doctors were afraid they would lose their freedom and be unable to treat private patients who paid fees.
Some believed that the poor and sick were poor because of laziness, so didn’t think they should be helped.
Some thought that people would grow lazy if they got ‘something for nothing’ and so they wouldn’t bother working.
Local councils and charities objected to the government taking over control of hospitals from them.

Question 52

How did the government overcome opposition from doctors?

Answer 52

They agreed that doctors could continue to treat patients privately and charge them fees as well as work for the NHS.

Question 53

Who was the Minister for Health when the NHS was introduced?

Answer 53

Aneurin Bevan

Question 54

When was the National Health Service introduced?

Answer 54

July 1948

Question 55

How many people had never seen a doctor before 1948 because they could not afford to do so?

Answer 55

8 million

Question 56

What types of services did the NHS provide?

Answer 56

The nationalisation of hospitals.
the creation of health centres.
The better distribution of doctors around the country.
A new salary structure for doctors.
New and improved hospital equipment.
A new building program begins to replace some out-of-date hospitals.
Single-issue health-care campaigns begin – for example, against smoking, or promoting a healthy diet.
‘Working for Patients’ produced by the government proposes changes to the NHS with the introduction of competition between hospitals.
Hospitals allowed
to become trusts. GPs allowed to become fund holders buying services from hospitals and other providers.

Question 57

What impact did the NHS have on life expectancies?

Answer 57

The percentage of people dying at 65+ years rose from 42% in 1919 to 81% in 1992.
The number of women dying during or shortly after childbirth was also reduced.

Question 58

When was the Nuisance Removal Act passed?

Answer 58

1855- illegal to overcrowd

Question 59

When was the Factory Act passed?

Answer 59

1864- unhealthy factory conditions illegal.

Question 60

What three acts were passed in 1875?

Answer 60

Public Health Act
Artisans Dwelling Act (landlords must keep houses in good condition).
Food and Drugs Act

Question 61

What act was passed in 1876?

Answer 61

River Pollution Prevention Act

Question 62

When was a law passed to demolish slum housing?

Answer 62

1868

Question 63

Who became mayor of Birmingham in 1873 and what did he do?

Answer 63

Joseph chamberlain

He had transformed the city by the 1890s: he bought the companies that provided water and gas light and providing them all for the city. He took advantage of the Artisans Dwelling Act to clear large areas of slums and created a new city centre.

Question 64

Which two industrial families helped to improve conditions for workers?

Answer 64

The Cadbury family- built a model town called Bournville which had decent, well built houses and amenities.

The Levers- built a model village at Port Sunlight in the north West, containing an art gallery to ensure that employees were educated.

Question 65

What helped to reveal the need for social reform in the 20th century?

Answer 65

• Reports of Booth and Rowntree.
• In the Boer War in 1901, two-thirds of unhealthy men were turned down. Germany had already made social reforms (eg. Sickness insurance) and their army was strong and growing.
• Trade unions and the Labour Party were gaining power: the liberal party needed worker votes.
• ‘Gas and water socialism’ like that shown in Birmingham had proved that reform could work.
• New Liberalism: emphasised that the government should address social problems. Lloyd George and other MPs were keen to improve lives.

Question 66

What happened in June 1866?

Answer 66

In London(June 1866), a localized epidemic in the East End claimed 5,596 lives, just as the city was completing construction of its major sewage and water treatment systems (see London sewerage system); the East End section was not quite complete. William Farr, using the work of John Snow, et al., as to contaminated drinking water being the likely source of the disease, relatively quickly identified the East London Water Company as the source of the contaminated water. Quick action prevented further deaths.

Question 67

What was the average age of death for a male in the 1850s?

Answer 67

26

Question 68

What did Bismarck introduce in Germany?

Answer 68

Old age pensions
Accident insurance
Medical care

This worried Britain

Question 69

What did Seebohm Rowntree publish in 1901?

Answer 69

Poverty, A Study of Town Life

Question 70

What was introduced in 1834?

Answer 70

The Poor Relief Act

If you wanted poor relief you had to go and live and work at a workhouse.

Question 71

How did workhouses reveal need to fro reform in the late 19th century?

Answer 71

They were VERY overcrowded and made people more ill.
They were not helping people to get back to work.
Families were often split apart.
Large groups of people were opposing them as barbaric.

Question 72

What were the limitations to free school meals?

Answer 72

By 1914 less than half of local authorities had no school meals service.

Question 72

What were the limitations to the Old Age Pension Act?

Answer 72

Various exemptions were included:

• People had to be British and have lived in UK for 20 years
• People had to have not been imprisoned in last 10 years
• People had to have not avoided work
• People had to have avoided detention under Inebriates Act in last 10 years
• Many pensioners had no birth certificates and could not prove age

Question 73

What were the limitations to the national insurance act for unemployed people?

Answer 73

• Worker had to register at Labour Exchange to receive benefit
• If dismissed for conduct, no benefit paid

Question 74

What were the limitations to the national insurance act?

Answer 74

Medical treatments were only for the wage earner and not his family.
The amount poor people had to pay in return for the dole was high and the benefits were not enough for a family to live off.

Question 75

What were the limitations to labour exchanges?

Answer 75

The jobs were mostly temporary; the government did not create new jobs.