3.1-The Impetus For Public Health Reforms, 1780-1939 Flashcards
1
Q
What is public health?
A
Public Health is the act of looking after the wellbeing and health of
the population as whole (not necessarily just those living in poverty).
2
Q
Who is responsible for ‘public health’ in 2020? How
do you think this differed to previous years?
A
In 2020, national and local governments are responsible for public
health. In the past, this may have been local governments but the
responsibility also fell with philanthropists, charities/ volunteers and
the individuals themselves.
3
Q
Industrial and population changes from 1780-When was the overall population increase the most rapid in Britain?
A
The population increase in Britain was most
rapid during the height of the Industrial
Revolution (1781-1871).
4
Q
Why did the death rate fall?
A
The death rate fell due to improvements in
vaccines and soaps, a bigger quantity and
better quality of food and a bigger quantity
of textiles.
5
Q
Why did the birth rate increase?
A
The birth rate increased due to more people
surviving to adulthood and therefore an
increased marriage rate. There was also no
contraception!
6
Q
How did the distribution of
towns change?
A
By 1891, 72% people lived in towns
(compared to 33% at the beginning of the
1800s).
7
Q
What impact did the
increasing population have
on housing conditions?
A
The increasing population led to
overcrowding, as houses in cities could not
be built quickly enough and people also
had to live close to their workplace due to
lack of public transport. Living space was
often ‘adapted’, eg. cellar and attic
dwellings. New ‘back to back houses’ were
also built. Middle classes left towns/cities.
8
Q
What impact did the
increasing population have
on sanitary conditions?
A
Most housing lacked basic sanitation: no
drains, sewers or regular water supply. Privies
(outdoor toilets) were emptied into cesspits.
Water was expensive and owned by private
companies.
9
Q
What impact did the population
changes have on people’s lives?
A
🏠The rapid influx of people into towns and cities created poor housing. 🏠Back to back housing and cellar/attic dwellings were seen most frequently. Houses were typically built in a grid system. 🏠A huge number of families would occupy 1 house. 🏠Poorest lives in cellars/attics.
🏡Most housing lacked sewerage or drainage. Instead, they shared a privy. 🏡Cesspits were emptied by ‘night- soil men’. 🏡Houses also lacked a clean water supply. Instead, water was supplied by a communal pump. 🏡However, some middle classes did have access to flushing toilets and running water in their own homes.
10
Q
What was a privy? What was a cesspit?
A
Privy = communal toilet Cesspit = area where toilet waste would be put
11
Q
What were the 3 well-known industrial diseases?
A
Typhus
Typhoid
Tuberculosis
12
Q
What are the symptoms of typhus?
A
- Headache
- Diarrhoea
- Fever
- Nausea
- Vomiting
- Hypotension
13
Q
What are the causes of the disease, modern day and the 19th century understanding?
A
Modern understanding – Fleas/ lice/ bites
Early 19th century understanding – Miasma theory
14
Q
What are the treatments of typhus, modern and 19th century?
A
Modern - Hygiene, insect
repellent, antibiotics
Early 19th C – Try to
improve sanitation
15
Q
Name some history of epidemics of typhus in 19th century Britain
A
1837
1839
1847 – 10,000 people killed in
North West
16
Q
What are the symptoms of typhoid?
A
- Headache and body pain
- Loss of appetite and weight loss
- Dry cough
- Sweating
- Abdominal pain
- Swelling in abdomen
- Diarrhoea or constipation
- Itching or rashes
17
Q
What are the causes of typhoid, modern and 19th century understanding?
A
Modern understanding – Contaminated food
and water
Early 19th century understanding – Miasma theory
18
Q
What are the treatments for typhoid, modern and 19th century?
A
Modern - Hygiene,
vaccination
Early 19th century – Try to
improve sanitation
19
Q
Name some history of typhoid epidemics in 19th century Britain
A
Throughout 1800s
1897-8: Epidemic in
Maidstone, Kent kills
2000 people
20
Q
What are the symptoms of tuberculosis?
A
• a persistent cough that lasts more than 3 weeks and usually brings up phlegm, which may be bloody • weight loss • night sweats • high temperature • tiredness and fatigue • loss of appetite • swellings in the neck
21
Q
What are the causes of tuberculosis, modern and 19th century understanding?
A
Modern understanding – Bacteria
Early 19th C understanding – Miasma theory
22
Q
What are the treatments of tuberculosis, modern and 19th century ideas:
A
Modern – antibiotics &
vaccination
Early 19th century-Try to
improve sanitation,
quarantine/ isolation
(in Sanatoriums)
23
Q
Name some history of tuberculosis epidemics in 19th century Britain
A
40% of all deaths in Britain’s
cities due to TB
24
Q
When was the cholera epidemic and what caused it?
A
1832
Cholera epidemics had a profound effect upon the public. This was because of the high
percentage of fatalities amongst those contracting the disease (40-60%) and because of the
speed with which cholera could strike.
25
What were the cholera riots?
There were 30 recorded ‘cholera riots’ in towns and cities throughout Britain. In Liverpool, there
were 8 street riots between May and June 1832. The rioters were protesting against the medical
men; they believed that some doctors were murdering cholera patients so that they could use their
bodies for dissection. In Exeter, rioters objected to the burial of cholera victims in local graveyards.
Victims were being buried hastily, possibly before they were dead, and without proper religious
ceremony. Pressure amongst people and politicians for reform was intense.
26
What was the governments reaction? What advice did they provide?
Although the central government had done nothing about the endemic fevers and ‘dirty’ diseases
that were common amongst all classes in large towns, cholera was different. The government had
to take action. In 1831, the government sent two medical commissioners to Russia, where there
had been an outbreak of cholera. A Board of Health was quickly set up. The Board of Health
advised local government areas to set up their own Boards of Health. It suggested that these local
boards should include magistrates, a clergyman, some householders and one or more medical
men. These local boards reported on the food, clothing and bedding of the poor, the ventilation of
their dwellings, the number of people per room and the ways in which they kept clean and their
behaviour. It also issued advice.
🤢Houses were to be whitewashed and limed. All infected furniture and clothing was to be
fumigated.
🤢People with cholera were to be put in strict quarantine.
🤢Food and flannel clothing were to be distributed to the poor.
🤢Temporary fever hospitals were to be set up.
27
What were some of the drawbacks?
However, this advice was not the law. Legality became a problem – What legal right did the
boards have to insist that people co-operate with them? In 1832, temporary ‘Cholera Acts’ were
passed to allow local authorities to enforce some measures. Even so, local action was haphazard.
Local Boards of Health were disbanded.
28
What were the theories about what caused cholera?
The problem with cholera is that it had no known cure.
💧The contagionist theory suggested that cholera was spread by contact with local victims.
This was disputed becasued not everyone in the same household fell ill.
💧The miasmic theory suggested that cholera was spread by infected air. Treatment involved
the removal of heaps of excrement.
💧Patent medicines grew and multiplied in number. All claimed to cure cholera.
💧Prayer was recommended by all the main Christian churches.
It was not until the 1850s, with the proof that cholera was water-borne, did treatment of cholera
epidemics change.
29
What Report was created in 1832? Who created it? How did it create an impetus for public health reform?
1832
The moral and physical conditions of the working classes of Manchester
Dr James Kay
Reason for report- cholera epidemic
Board set up and by Kay (secretary) and it co-ordinated the works if the city’s 14 district boards
Kay visited each area and recorded the conditions- formed the basis of a very detailed report
Looked at a specific group of working people
Found connection between dirt and disease and that dirt and diet affected the health of working people
Also looked at moral conditions of the poor
Believed ‘dirty living’ led to ‘dirty habits’
Important for information and motivation for later reformers and investigations
30
What Report was created in 1842? Who was the key individual in its creation? How did it create an impetus for public health reform?
1842
Report on the sanitary condition if the labouring population of Great Britain
Edwin Chadwick
It was requested by poor law commissioners which was headed by Chadwick, initially was just to focus on London
1839 Sir James Graham (Home Secretary) asked House of Lords did ut to be extended and cover diseases among the labouring classes throughout the country not just London
3 volumes- 2 volumes of local reports from all over the U.K. (based on questionnaires sent to local boards of guardians), third- conclusions and proposals going forward
Poor law commission refused to publish-criticised water companies, named names, medical profession, local administration... had to publish whole thing in 1842 under his own name and expense
It was significant because....
📝attacked the inadequacy of existing water supplies, drainage and sewerage systems
📝Linked public health and poor law
📝pointed the finger at vested interests that stood in the way of improvement
📝stressed the connection between these rested interests, overcrowding, epidemics and death
Main=demonstrated connection between disease and environment
Reaction....
😡➡️🙂Anger to wholehearted acceptance
😈Sir James Graham was reluctant to act on findings and conclusions
😎Set up Royal Commission on the Health Of Towns-investigated more fully the legislative and financial sides of recommendations- Graham
🤓Chadwick- write a report in burial practices and gave official and unofficial briefings to Royal Commission at Graham’s request
31
What Report was created in 1844? Who was the key individual involved? How did it create an impetus for public health reform?
1844
Report of the Royal Commission into the sanitary condition of large towns and populous districts
Duke of Buccleuch
Based off Chadwick’s report
Royal commission into the health of towns members used
Geologist, chemist, expert on land drainage (also a cotton mill manager), engineers used
Questionnaires sent to 50 towns with highest annual death rates
Commissions made visits to worst areas as well
2 reports were created:
1) upheld Chadwick’s findings, out of 50 towns, 42 had bad drainage and 30 poor water supplies
2) 1845- contained proposals for future legislation and memorandum from Chadwick
Recommended that....
1) Central Government give extensive powers to inspect and supervise local sanitary work
2) local sanitary districts be up with authority over drainage, sewage, paving...
3) local sanitary districts be given powers to raise money for sanitary schemes through local rates
32
What Report was created in 1845? Who was the key individual involved? How did it create an impetus for public health reform?
1845
Report of the Bradford Woolcombers sanatorium Committee
Bradford Woolcombers
Result if industrial revolution, used existing ‘vacant’ living space and then built new dwellings eg:cellars, attics fill with families and used as workplaces
Eg: West Yorkshire- Bradford, more than 10,000 Woolcombers living and working in their own dwellings
Conditions were appalling, average age of death of a Woolcombers was 14 years
In 1845m Bradford Woolcombers formed a protective society and appointed own ‘ sanitary committee’ to report living conditions
(Put pressure on government to act)
33
What were the overall limitations of the reports and why?
Many of the recommendations of the report stayed as recommendations and proposals, only a few endorsed or researched further eg: Sir James Graham’s reluctance
A lot of them based on questionnaires, only a few who actually visited affected areas like Chadwick or Kay
Selective about areas eg: Duke of Buccleuch’s report only sent questionnaires to towns with highest annual death rates and originally Chadwick’s report only focused on London, had to appeal to go to different areas
Some once the research had been done didn’t like the reality and criticisms of things like local administrators or medical professionals meaning eg: Edwin’s Chadwick’s report was refused to be published by the commission
```
Focused on specific groups of people like the working class
Some only helped local areas eg: 1845 report, local sanitary districts given powers to raise money for sanitary schemes through LOCAL rates which would have varied- not all initiatives effective
```
34
Technology- give some facts about flushing toilets 🚽
Used since Neolithic times
Industrial Revolution made it more widespread
1775, Alexander Cummings invested the s-trap preventing foul air coming up from the sewer
Joseph Bramain- float value system for a cistern, built first, practical, workable, flush toilet
George Jennings- business manufacturing toilets, by 1861 employing 97% of men outside Bournemouth. Also improved the water closet, valves, drain traps
In 1875- Thomas William Twyford developed first ‘wash out’ water closet, improved flushing rim and outlet
In 1888 got grant to re-fill toilet pan with small amount of clean water
35
Why did flushing toilets improve public health? 🚽
Waste being disposed of more efficiently and hygienically
No longer being dumped into cesspits and having to be taken out by hand
36
Name some facts on sewerage:💩
Hard to convince to make changes, believe in strong held miasma theory therefore putting waste into a river seemed efficient
In 1842 a system of flushing gates to control the flow of liquids through the sewers was invented by John Roe
Not until 1870s and 80s that this was combined with hydraulic pumps to ensure a constant flow of water and make them virtually self-flushing
Still problem of where sewerage was to be placed especially as more known about the transmission of disease
Didn’t come till 1912 when scientists at Manchester university developed a sewage treatment of activated sludge, where the sewerage was biologically treated to make it safe
37
Why did a system of sewerage improve public health?💩
Sewage being disposed of more hygienically eg: not piled up on loans or rivers which were also used as water sources
Also made systems more effective eg: before had inadequate connections between sewers of different sizes...
38
Name some facts about water supply: 💦
For most of the 19th century controlled by private companies
1802- Lambeth Waterworks replaced wooden pipes with iron ones
1822- Southwark water company extracted water from the River Thames using steam engines to pump it to a cistern at the top of an 18 metre high tower, then piped to customers
1829- Chelsea Waterworks company- sand filtration system to purify water from the River Thames
39
How did water supply improve public health? 💦
Built reservoirs which enabled reliable supply of water to be pumped to houses
DIDN’T- don’t know about water-bourne diseases and so water was still extracted from rivers populated by industrial and faecal waste
More clean water filtration systems and more regular supply
40
Name 3 key points for these new technologies: (remember printed off answer sheet with it summarised)
1) flushing toilets:
🚽The invention of the s-trap was significant in its development
🚽George Jennings set up a business out if it
🚽By the end of the 1950s, building rules required all new homes to be fitted with one of them
2)Sewerage:
💩Before 19th century didn’t really exist
💩Engineer John Roe helped to control my flow of liquid
💩In the 1870s hydraulic pumps helped
3)Water supply
💦most of the 19th century, private companies were responsible for it
💦In the early 1800s main source was River Thames
💦Treated regularly especially with new knowledge that diseases can be water-bourne
41
Name some changes in social attitudes- authors
Charles Dickens, Elizabeth Gaskell, Arnold Bennett were all authors who had changed attitudes. This is because...
- Revealed working class living conditions
- More accessible
- Chimed with the findings of Henry Mayhew
- Covered many areas eg: Yorkshire, Lancashire, London...
- Example-1848, “Mary Barton” by Elizabeth Gaskell
42
Name some changes in social attitudes-National and local newspapers
Reported local outbreaks of diseases like scarlet fever
Example-local, ‘Leeds Mercury’
Made connections between living conditions and disease
National (greatest impact) eg: The Times, campaigned in response to the ‘Great Stink’ of 1858- more influence
43
Changes in social attitudes- artists:
Paintings and engravings of rural and urban poor
Weakness- rural usually shown as idyllic
Urban- realistic eg: Sir Luke Fildes
Attracted attention eg: Dickens
44
Changes in social attitudes- doctors, parishes and country councils
Produced statistical evidence
Connection between population density and overcrowding, death and disease
45
Changes in social attitudes- scientific knowledge
More known about water borne and sanitation related diseases
More public awareness
Encouraged Emergence of health and sanitation committees- pressured government
Eg: 1844 Health of Towns Association established
Branches- not just capital
Propaganda campaign- Public health legislation
Gave public lectures, published and distributed pamphlets, weekly sheet of facts and figures
46
Changes in social attitude- Government
Set up Royal Commission
Reports were made eg: State of Large Towns and Populous Districts 1844
47
Changes in economic attitudes- awareness:
Factory managers, mill owners, bankers, treasury officials- all becoming aware of cost of reforms and cost of not undertaking reform
48
Changing economic attitudes- calculations:
Cost of PHR calculated against the cost of losing a productive worker to a ‘dirty disease’
49
Changes in economic attitudes- maintenance:
Cost to nation of the poor law was escalating- having to maintain workhouses and pay for relief, when compared against cost of PHR saw a reduced poor rate as a result of good drains and clean water. People also more likely to vote if meant reduction in rates and taxes
50
Cost of economic attitudes-not liked
Not liked- some sections of society laying for all, initial cost fell upon householder. Landlords pressured persuaded to water supplies but increased rent cost- paupers couldn’t afford
Local authorities stepped in and took responsibility- paid for those in catchment area
Slow
Economic and political imperatives altered the minds and attitudes of those in power to bring about change
51
Changing economic attitudes-workforce
A fit workforce was more persuasive than any moral imperative
If improved workforce, reluctance outweighed
52
Changing economic attitudes-war
Second Boer War (1899-1902) encouraged reform further
53
Changing economic attitudes- Government
Gradual
| - impacted the role of the central government
54
Summary- why did change occur?
Clear that change only occurs when....
- growing awareness of the nature of a situation
- impact of new discoveries
- increasing readiness of the authorities
- combination of knowledge, understanding and determination
- organic process
- Public pressure on government
- spread-public,press, parliament
55
What Act came about in 1848?
Public Health Act
56
Which individual played an important role in the creation of the PHA?
Edwin Chadwick, a social reformer
57
Was this individuals’ argument social or economic?
Chadwick’s argument was economic. He was convinced that if the health of the poor were improved, it would mean less people seeking poor relief as a lot of it was given to families of men who had died infectious diseases. Therefore, money spent in improving public health was cost effective saving money in the long term
58
What did the individual think were the most important steps to improving the Public Health Act?
Improved drainage and provision of sewers
The removal of all refuse from houses, streets and roads
Provision of clean drinking water
The appointment of a medical officer for each town
59
What did the act establish?
The Public Health Act of 1848 was passed (after another severe outbreak of cholera in 1848). It established a Central Board of Health
60
Where were the Local Boards of Health to be set up?
Where the death rate was above 23 per 1000
61
What are the successes of the Public Health Act of 1848?
Sunderland is an example of one of the towns that used the powers offered by the Act, the co-operation watched the Bill’s progress through Parliament
Marks a change in attitude
Had a key individual who was influential- Edwin Chadwick
Improved living conditions eg: clean drinking water
More cost effective long term
62
What were the failures of the Public Health Act of 1848?
Provided a framework that could be used by local authorities but did not compel action
Limitations to the Central Board of Health eg: limited powers and no money. The boroughs like Sunderland that already had a co-operation would assume responsibility for drainage, water supplies, paving...
Loans paid back through poor rates
Had restrictions eg:only Boards of Health set up where the death rate was above 23 per 1000
63
Summary of Chadwick from other modules- key points:
Edwin Chadwick was one of the architects of the 1834 Poor Law, which was based on the principle of less eligibility where the provision of poor relief was so unpleasant it would put off the most desperate. Whilst working as secretary to the poor law commissioners he investigated the issue if sanitation amongst the poor. In 1842 he published ‘ The Sanitary Condition if the Labouring Population of Great Britain’ , laying the costs of publication himself as the poor law commissioners did not want to be associated with the report.
64
Who was Sir John Simon?
1816-1904
Founder of the Health of Towns Association in 1844
Chief medical officer for health to the Privy Council in 1858
Initially (before the germ theory) supported the miasma theory but unlike Chadwick he changed his mind
Changed public health from being a political matter to ken founded on scientific investigation and analysis
Helped bring about Sanitary Act of 1866 and public health Act of 1875
1887 received knighthood for contribution to public health
65
Key governmental legislation: what did ‘The Local Government Act 1858’ and ‘Public Health Act 1858’ say?
As a consequence of these acts, 568 towns began implement public health reforms in just 10 year period
Local Boards of Health were given the powers to take preventative action and appoint officials. There was a gradual acceptance that local boards would be best to make decisions regarding public health
A country-wide medical department was set up under the Privy Council. They directly corresponded with local boards to advise on public health measures
The General Board of Health was abolished. This was due, in part, to the fact that Chadwick was becoming increasingly disliked
66
Key government legislation- What was ‘The Sanitary Act of 1866’?
John Simone became the first medical officer of health, in charge of Privy Council medical department
This act made local authorities responsible for the removal of ‘nuisances’
This Act was compulsory. For the first time, Towns and local areas all had to make Sanitary measures
Local authorities were given the power to improve or demolish slum dwellings
67
Key government legislation- what was ‘The Public Health Act’ 1875?
Local authorities were given powers to lay sewers and rains, build baths and other public health conveniences
This act said that every part of the country had to have a public health authority
Every part of the country had to have at least 1 medical officer and 1 sanitary inspector
This Act consolidated and extended a range of previous legislation
The Act was a turning point in the regulation of house building. Standards were set
68
Key government legislation- what was ‘The Public Health Act 1936’
By 1935, 80% of the population of England and Wales was supplied with water by their local authorities
Control over slaughterhouses and food adulteration was added to local authorities responsibilities
The provision of a clean water supply with the combination of an effective sewerage system represented a major breakthrough in public health
69
Overall why did pressure for change to legislation increase in the 1860s and 70s?
Compulsion from Act of Parliament (enforced)
More supervision on local authorities and state intervened
Individuals such as John Simon
Old Boards and Committee’s abolished and new more effective ones were put into place eg:new Local Government Act Office
In 1867, the Parliamentary Reform Act gave the vote to the working men therefore politicians had to pay attention to their problems which included public health issues
3rd cholera epidemic (1865-66) in which 20,000 people died
In 1865 Louis Pasteur (1822-95) proved conclusively that germs caused disease and were not caused by it
In 1869, a Royal Commission in public health was set up revealed conditions in towns were better than when Chadwick conducted his investigations 30 years earlier
In 1871, Local Government Board was set up. Consolidated functions eg: Local Government Act Office, the Registar- General’s Office, the medical department of the Privy Council and the poor law Board. President was usually a member of the cabinet- influential
Every part of the country in 1875 had a public health authority
70
MORE INFORMATION:
LOOK AT GKT- GOOD SUMMARY!
LOOK AT ANSWER SHEETS IN NOTES !
LOOK IN GOODNOTES !
