Breadth 2: Changes in Public Health

Question 1

What indicates changing attitudes to PH from c.1780-1939?

Answer 1

Increasingly progressive parliamentary legislation.

Question 2

What were problems with the fact that reform was localised before 1848?

Answer 2

PAOP were expensive so only the most progressive councils sought them.
Depended on the work of particular individuals but self-perpetuating oligarchies (complained of in the 1830s) prevented progressive people from coming to power. Vested interests could prevail.
PAOP - individual people for individual aspects of PH: inefficient and uncoordinated.

Question 3

Some local initiatives?

Answer 3

1795 - John Ferriar and Thomas Perceval bring about the Manchester BOH.
Early 19th century - John Cleland, Robert Graham and Robert Cowan in Scotland write a report on PH which encourages change there.

Question 4

Private Acts of Parliament

Answer 4

LONDON - 300 PH boards work under 250 PAOP. Includes 16 paving boards working under 29 PAOP at the parish of St. Pancras.

St. Helens, Lancashire - ‘Lighting with Gas the Town of St. Helens’ (1831-32)
Exeter - ‘Act for better paving, lighting, watching, cleansing and otherwise improving the City of Exeter’ (1831-32).

Question 5

Which cities brought about measures under the 1835 Municipal Corporations Act?

Answer 5

Leeds and Manchester

Question 6

When was the Sanitary Act of Liverpool and what did it do?

Answer 6

1846 - It saw the town council becoming an official health authority and Dr. William Harvey Duncan becoming Britain’s first MOH. He was a good example: genuinely interested in PH and very respectable as a physician at Liverpool Infirmary and professor in medical jurisprudence at the medical school of the Royal Institution.

Question 7

What were the successes of implementing the 1848 Public Health Act?

Answer 7

Rochdale Improvement Act (1853) was particularly progressive: set road width legislation [30ft carriage road; 10ft non-carriage road]; allowed commissioners to remove, improve or set regulations of use at public privies, and made the release of smoke or steam into streets a crime punishable with a 40 shilling fine.
1850 - requested in 192, in place in 32.
1853 - requested in 284, in place in 182.
Watershed for change which marked a beginning to an end of the need for PAOP to bring about PH legislation; making it more accessible to all.

Question 8

What were the problems which arose in implementing the 1848 Public Health Act?

Answer 8

16% of people in Lancashire lived under no PH authority. Of the 187 major towns and cities of England and Wales, 15.5% had the duties of drainage and cleansing on one board, 16% relied on independent commissioners and 33.2% were without any PH authority altogether.
Rochdale was very progressive; other places undermined or avoided the legislation.
Fear of too much intervention after years of Laissez Faire: 1858, The Times “there is nothing a man hates more than to be cleaned up against his own will”.
Vested interests prevailed because it was normally just the existing town corporation under a different guise. Might avoid due to financial concerns or the perceived adequacy of pre-1848 legislation. E.g. Leeds due to 1835 Municipal Corporations - no MOH until 1866.
Cholera outbreak of 1847-49 was a distraction.

Question 9

Why was housing legislation significant?

Answer 9

The poor couldn’t afford the facilities so were more susceptible to Victorian filth diseases. Access to facilities would mean that diseases would prove less prevalent.

Significant also in considering the extent to which housing conditions were poor. Friedrich Engels in The Condition of the Working Class in England (1844) refers to the “dirty, old, tumble-down” houses of Manchester, whilst James Kay in his ‘The Moral and Physical Condition of the Working Classes of Manchester’ (1835) outlined that the Fever Hospital of Manchester had informed him that typhus prevails solely in areas where houses were like so.

Question 10

Legislation to improve new buildings

Answer 10

Housing Acts (allowed local councils to take control of building regulations, sewerage connections and cellar dwellings.
1844 - City of Leeds Housing Act; Metropolitan Building Act (homes within 30ft of sewers in London must be connected)
1844/45 - City of Manchester Housing Act
1845 - Town of St. Helens Housing Act; City of Nottingham Housing Act
1846 - City of Newcastle Housing Act; Town of Burnley Housing Act

1853 Rochdale Improvement Act
1858 - Local Government Act - model building regulations in place in 568 cities by 1868. 1875 PH Act and 1877 standard by-laws.

Question 11

Legislation to improve existing buildings

Answer 11

1851-53 - Common Lodgings Act - all homes registered with police and regularly inspected; but poorly administered.
1855 - Nuisances Removal Act - permissive act empowering local governments to deal with overcrowding within petty courts.
1866 - Sanitary Act - applied limitations to the use of cellar dwellings. Cause of 14 year, 2 month life expectancy in Bradford (1845).
1868 - Torren’s Act - council can order a landlord to fix an unhealthy home, or else buy it up and destroy it.
1875 - Cross’ Act - council can do as above but whole districts at once. Yet not compulsory to rehouse 50% until 1909 (1890 London) so slums prevailed. E.g. Birmingham, 1873-77, Chamberlain…4 acres of slums and workshops become law courts and a shopping centre!

Question 12

Housing legislation after WWI

Answer 12

1918 - slowed down despite David Lloyd George’s promises. Building materials costly.
1919 - Housing Act - subsidies for council houses.
1930 - slum-removal subsidies.
1933 - 5-year slum removal plans.
1939 - most in homes with running water, just 50% have hot water/fixed bath.

1919-39 - 2/3 of homes sold to owner-occupiers: lack of cheap homes to rent.

Question 13

What laws did the government enforce to encourage vaccination?

Answer 13

1798 - A Report into the Causes and Effects of the Variola Vaccinae
1808 - National Vaccine Establishment to encourage vaccination. Yet limited by poverty/anti-V.
1840 - Vaccination Act [permissive] - accessible free via Poor Law Commissioners; limited availability.
1853 - Vaccination Act [compulsory] - £1 fine if a child under 3 months isn’t vaccinated.
1867 - Age extended to 14 years.
1871 - Vaccination Act [compulsory] - fine increased by 5 shillings; imprisonment for those that failed to pay it.

Question 14

Why did people oppose vaccination?

Answer 14

Religious objections of local clergy (‘playing God’; animal disease); cow disease concerns; miasma; too much centralisation.

Question 15

What was the nature of the anti-vaccination movement?

Answer 15

Anti Vaccination League set up in Leicester, where the ‘Leicester method’ of compulsory quarantining was pioneered then launched in Bolton and Huddersfield.
1885 - Leicester hosts an anti-vaccination gathering - 50+ towns.

Question 16

How did the government respond to the anti-vaccination movement?

Answer 16

1898 conscience clause allowed for exemption certificates if the individual was willing to risk reduced access to jobs, homes and insurance. 203,104 exemption certificates in 1898 (1/3 Leicester).

1871-1898 - 22.8% decrease in kids being vaccinated. But herd immunity.

Question 17

How significant was TB in the 19th century?

Answer 17

The most prevalent disease in the 19th century, causing c.1/3 of disease-related deaths.
Hard to measure as it was commonly confused with bronchitis.

Question 18

Over what period did TB death rates halve?

Answer 18

1851-1910

Question 19

What did MOH do to deal with TB?

Answer 19

Oldham - Banned spitting on railways and in public places; distributed leaflets; fumigated hankies and disinfected homes.

Brighton - distributed pamphlets encouraging people to use spitting bowls, and to empty them before the spit dried.

Question 20

How many sanatoria were there?

Answer 20

In 1911 there were 84 sanatoria with 8,000 beds. In 1930, 500 sanatoria were providing 50,000 beds. Yet some WC breadwinners avoided them as they couldn’t afford to not work for many months.

Question 21

When did the Ministry of Health start pasteurising milk and why?

Answer 21

1922, to prevent the transmission of bovine tuberculosis from cows to humans.

Question 22

When did the government start encouraging local councils to offer free/subsidised milk to kids in schools and what was the scale on which it was carried out?

Answer 22

1934 - government encourages councils

1937 - 3.2 million kids receive free or subsidised milk (1/2d for 1/3 pint).

Question 23

What did the 19th century Factory Acts do?

Answer 23

Legislated for the working hours and working conditions of working children.

Question 24

What were local governments doing at the start of the 20th century?

Answer 24

Opening clean milk depots, appointing health visitors, advising poor parents and feeding poor school kids.

Question 25

Who brought about reforms for early children in the 20th century?

Answer 25

Liberal governments of 1905-1915

Question 26

What did the Education Act (Provision of Meals Act) of 1906 do?

Answer 26

Encouraged by MP William Wilson (Labour) and his private member’s bill and what was outlined by the Report of the Interdepartmental Committee on Physical Deterioration (1904).

Allowed state to intervene within the upbringing of children without the same taint of pauperism sen with the 1834 Poor Law Amendment Act.

Question 27

What did the Education Act (Administrative Provisions Act) of 1907 do?

Answer 27

Largely under the influence of Sir Robert Morant as permanent secretary of the Board of Education, local school medical services were to be set up. He ensured that the inspection be linked to treatment by issuing relevant directives and circulars.

1912 - school clinics and grants to fund these.

By late 1930s, most authorities followed Morant’s advice that they appoint their local medical officer of health as the school medical inspector to coordinate this aspect of public health with others.

By 1935, 2,300 doctors and 5,300 nurses work within 1,650 school clinics.

Question 28

What did Margaret McMillan do in Bradford?

Answer 28

As representative of the Independent Labour Party on the Bradford School Board from 1894, she was able to campaign for the health of children so as to maximise their potential to learn. She established baths in schools, starting with Wapping Road School. She also worked with Dr. James Kerr (Bradford school medical officer) to bring about medical inspections, a school clinic and free school meals in Bradford.

Question 29

What did the Children and Young Persons’ Act of 1908 do?

Answer 29

It was inspired by NSPCC lobbying and increased the rights of children in Britain.

They were made ‘protected persons’ who could not be abused. Abused children had to be visited and supervised by Poor Law authorities. Their nursing and care homes would be registered and inspected.

They were banned from pubs when under 14 and from cigarettes when under 16.

New juvenile courts and remand homes were set up so that delinquent youths would be treated separately to their adult counterparts.

Question 30

Why was smallpox a significant disease?

Answer 30

10% death rate or 20% in urban areas.

It accounted for 1/3 deaths amongst youths.

Question 31

What was inoculation?

Answer 31

This was a process which Lady Mary Wortley Montagu brought home from Turkey when living there with her husband, the British ambassador to Turkey.

A small amount of smallpox pus would be applied to an incision made upon the arm of a healthy person. It was hoped they’d become immune as a result. Yet it was a hit-and-miss affair due to the risk of actual infection.

Question 32

What did Jenner do?

Answer 32

In 1773, he launched an investigation into the efficacy of cowpox as a means of preventing smallpox.

He carried out his experiment on James Phipps in May 1796. He carried it out on 23 other people and noted his conclusions within ‘An Enquiry into the Causes and Effects of Variola Vaccinae, known by the name of cowpox’ (1798), after the Royal Society refused to publish his findings.

Question 33

How did people respond to ‘An Enquiry into the Causes and Effects of Variola Vaccinae, known by the name of cowpox’ (1798)?

Answer 33

100 leading London doctors signed a letter supporting his research and declaring that they’d use the technique.

£30,000 government funding allowed hum to set up a London-based vaccination clinic.

Question 34

What was Chadwick’s early job role upon having graduated from the law school at The Temple in London?

Answer 34

He wrote essays on how science could be applied to government practice within the Westminster Review. This got him in touch with John Stuart Mill, Jeremy Bentham, Neil Arnott and James-Kay Shuttleworth.

Question 35

What philosophy was Chadwick’s ideology based on?

Answer 35

Bentham’s Principle of Utility. [utilitarianism].

Question 36

What did Chadwick do?

Answer 36

Inspired by his experiences as Poor Law Commissioner he set up an enquiry into working class living conditions across England.

He chose 3 doctors to help him; 3 doctors that he thought would share his ideology so bring about the results he wanted. These were:

Neil Arnott - former ship surgeon for the East India Company, who linked cholera with poor sanitation.

James Kay - Doctor in Manchester who published ‘The Moral and Physical Condition of the Labouring Population of Manchester’ (1832).

Southwood Smith - worked for 10 years at London Fever Hospital (typhus!), then at the Eastern Dispensary and Whitechapel Jew’s Hospital.

The Report on the Sanitary Condition of the Labouring Population of Great Britain was written in 1842. He concluded that it would be more economically efficient to provide for paupers than to ignore matters.

Question 37

What shocking life expectancies did the Report on the Sanitary Condition of the Labouring Population of Great Britain (1842) outline?

Answer 37

Professional - 42.8 years

Trade - 29.8 years

Labourers - 23.2 years

Question 38

How did the Tory government respond to Chadwick’s report?

Answer 38

Set up a Royal Commission, which published a report in 1844 which upheld the findings of Chadwick.

Question 39

What was Chadwick’s role in the General Board of Health (1848)?

Answer 39

He worked as a sanitary commissioner of the General Board of Health. He managed to introduce a new sewage and drainage system whereby glazed, egg-shaped earthenware pipes and shallow drinking wells would be installed.

Yet he was forced to resign in 1854 because people hated his impatience and bullying tactics. Otherwise, the House of Commons wouldn’t renew the mandate of the General Health Board.

Question 40

What did Chadwick contribute to public health after his retirement in 1854?

Answer 40

He continued to volunteer advice on sanitation and public health.

January 1884 - he works as first president of the Association of Sanitary Inspectors.

He was knighted in 1885.

Question 41

When did Dr John Snow start to believe that cholera might be waterborne?

Answer 41

In 1831, when it came to Britain from India for the first time. Yet miasma theory prevailed and he was too reclined in himself to assert his views too powerfully.

It came from what he saw when dealing with the cholera outbreak at Killingworth Colliery, Newcastle.

Question 42

When did Snow actually act upon his suppositions in an effective way?

Answer 42

In response to the cholera epidemic of 1853 -54, at which point he was working at a GP on Frith Street, Soho.

Through extensive research - which included observation and house-to-house interviews - he was able to create a map dotting out cholera deaths in the area. It was found that most were circled around the Broad Street pump. He accompanied it with ‘On the Mode of Communication of Cholera’ (1855) which offered anecdotal evidence. E.g. 7 workers who sourced water from the pump when working there died.
Out of the 535 workhouse residents who lived near Broad Street but sourced their water elsewhere, 5 died.

Question 43

What did Dr John Simon do with Dr John Snow’s findings?

Answer 43

He extended the study in 1856 to 500,000 south Londoners and was able to conclude that the source of water chose by each particular water company would determine whether there was infection.

Lambeth Water Company got its water from Ditton, which was up-river from polluted London, so the death rate was 37 per 1,000.

Southwark Water Company got its water from water infected by an overflowing sewer near Battersea, and so the death rate was 130 per 1,000.

Question 44

When did the medical establishment actually accept that cholera was a waterborne disease, therefore rejecting miasma?

Answer 44

1870