Impetus for Public Health Reform

Question 1

What was the population like before the industrial revolution?

Answer 1

Mostly rural. Little public health.
No sewers or clean water,
Disease outbreaks weren’t huge problems dut to sparse population.

Question 2

How did the changing population distribution affect public health?

Answer 2

Increasing population density so disease could spread more easily. Increasing size of the population meant that there weren’t enough resources (overcrowding etc.) so disease could spread.

Question 3

How did housing affect public health?

Answer 3

Many lived in overcrowded houses with poor ventilation and outdoor toilets. The overcrowding meant disease could spread easily. Homes were often near factories which led to smog and pollution causing breathing difficulties.

Question 4

How did sanitation affect public heatlh?

Answer 4

No drainage or sewerage which meant water borne diseases could spread easily.
Outdoor toilets weren’t emptied regularly which meant flies would bring disease. Waste would be put into streams and rivers where ‘clean’ water came from.
Poor water supply, often many would drink from the same pump so if a disease was in the water everyone in an area would be affected.

Question 5

How did dead people affect public health?

Answer 5

Grave diggers could get smallpox from the bodies. Disrupted graves could contaminate the soil and then the water leading to the spread of disease.
In London, 50,000 bodies were added to 200 acres of land.
Increasing dead meant harder to bury meant more disease meant more dead.
1850s prohibition of the majority of burials within the city limits

Question 6

Why was cholera a problem?

Answer 6

1831 - killed 31,000. 1848 - 62,000. 1853 - 20,000.
Spreads through food and water and can live on it for 2 weeks.
Flies would get the disease from the excrement of victims and then spread it to others.
There was no known cure and it wasn’t known how it spread as people in the same household wouldn’t all necessarily be infected.

Question 7

What is miasma theory?

Answer 7

The idea that illness lives in ‘bad air’, idea from the middle ages and people weren’t accepting of other ideas (like germ theory).

Question 8

How did the changing population effect the death and birth rate?

Answer 8

Death rate full due to better medicines (smallpox vaccine), better food and food supply, production of soap, production of cotton that was cheap and easy to wash
Birth rate rose due to fewer deaths meant more people could have children.

Question 9

How did civil registration effect the birth and death rate?

Answer 9

Introduced in 1837 it meant that it was known how many people were being born and dying rather than just guessing based of rich people.

Question 10

How much did London and Leeds grown in the 1800s.

Answer 10

London - 1801 - 775,000. 1871 - 3,254,000
Leeds - 1801 - 24,000. 1871 - 259,000

Question 11

What was germ theory?

Answer 11

Development of the microscope (Lister invented the 1,000x magnification) meant that micro-organisms could be observed in rotting material. There were two ideas: micro-organisms were attracted to decaying matter or that decaying matter made micro-organisms.
Pasteur proved that micro-organisms lived in the air in 1860, many people didn’t believe this until Koch proved it in the 1880s.

Question 12

What were the cholera riots?

Answer 12

The fear that cholera caused led to 30 recorded riots across Britain. They were worst in Liverpool.
The rioters weren’t protesting against the disease but against the doctors as they thought they were being killed in hospitals. There was some truth to this as 33 bodies were found at the dock to be shipped to Scotland for dissection.

Question 13

How did the government respond to the Cholera riots?

Answer 13

Created the Board of Health. Houses were whitewashed and limed. People with cholera were quarantined. Fever hospitals created. A variety of useless remedies suggested.
Didn’t know what caused cholera so struggled to prevent it.
Legality was a problem as the boards couldn’t force people to isolate or co-operate with them.
Religious organisations recommended prayer.

Question 14

What did James Kay’s report on public health say and do?

Answer 14

Written 1832 it looked at a cholera outbreak in Manchester. He linked poor housing, dirt, and poor diet with disease.
Helped set the scene for later investigations and reports.
He wanted the legislative authority to intervene to help prevent the spread of disease.

Question 15

What did Edwin Chadwick’s report on sanitary conditions say and do?

Answer 15

Written 1842 it criticised water companies, the medical profession, and local administrations.
He said that there were inadequate water supplies, drainage and sewer systems.
Link public health and the poor law.
Blamed those with vested interests for getting in the way of reform.
Connected overcrowding, epidemic, and death.
Reactions to it ranged from anger to acceptance.
The Royal Commission on the Health of Towns was created based on Chadwick’s recommendations.
He was sent then to do reports on burials.

Question 16

What did the Royal Commission’s report on the sanitary conditions of large towns and districts say and do?

Answer 16

Written 1844, of the 50 towns studied, 42 had poor drainage, upheld Chadwick’s findings.
Recommended that the government be given power to supervise local sanitary work and for sanitary districts to be created.

Question 17

What did the Bradford Woolcombers Sanatory Committee find and what did it cause?

Answer 17

Many people in Bradford lived together. Said that the filth was indescribable.
Attics and cellars were used as workplaces.
10,000 woolcombers lived in cellars with a life expectancy of 14.
Wanted to bring about reform but it didn’t lead to anything tangible.

Question 18

How did the invention of flushing toilets affect public health?

Answer 18

In 1775, Alexander Cummings invented the S-trap which sealed off the toilet bowls and prevent foul air from coming out. Joseph Bramah then combined this with a float valve system to build a practical flushing toilet.
George Jennings established a toilet manufacturing business outside Bournemouth in 1856. Twyford then improved this and sold the first wash-out toilet in the 1880s.
Working toilets became a building code in the 1850s in all new builds - this meant that predominately middle-class people had a toilet.
The poor wouldn’t have been able to afford a toilet or have the required drainage for one. So generally the public health of the working class wouldn’t have changed that much and that is where most of the public health problems arose.

Question 19

How did the creation of a sewer system affect public health?

Answer 19

Before the implementation of sewers waste was disposed into rivers and the sea which was were ‘fresh’ water would come from.
John Roe invented a system in 1842 which controlled the flow through sewers making them more efficient. In the 1870s sewers were fitted with hydraulic pumps to ensure a constant flow of sewage. . They were still however put into rivers and the sea. Some cities attempted to treat the water before it went back into the water supply but it wasn’t until 1912 when a team at Manchester University discovered a way to treat sewage to make it biologically safe.
The sewage systems meant that waste wasn’t becoming abundant in people’s living areas but toilets that didn’t flush weren’t emptied as regularly as they should have been which meant that disease could spread. The waste going into the water meant that people who were drinking it risked becoming ill with water-borne diseases like cholera.

Question 20

How did changing water supply affect public health?

Answer 20

For most of the 1800s it was managed by private companies and they often didn’t take advantage of new technology as it didn’t make them any profit.
In 1802 the Lambeth Waterworks expanded its supply to Kennington and replaced its wooden pipes with iron ones.
1829 - Chelsea Waterworks became the first to use a sand filtration system to purify water from the Thames.
The supply might have been good but the water was still relatively dirty.

Question 21

What was the Representation of the People Act?

Answer 21

Passed 1832
Redistributed seats in parliament to give towns in the Midlands and North more MPs.
Didn’t directly effect public health but meant there was more representation in parliament
Many MPs wanted to keep taxes low and the reforms cost.

Question 22

What was the Municipal Corporations Act?

Answer 22

Passed 1835
Stopped the systen of closed corporations where councillors would re-elect themselves.
They were elected by male taxpayers whichvmeant they were more accountable so more likely to promise reform.
Local councils could takr charge of paving, sewerage, street cleaning, and drainage.
Had to pass a privatr Act to do this and it cost money and some less populated councils couldn’t afford it.

Question 23

What was the Nuisance Removal Act 1846?

Answer 23

Allowed people to be prosecuted for unwholesome homes, accumulations of filth, cesspits etc.
Only applied if councils wanted it to.

Question 24

What was the Baths and Washhouses Act?

Answer 24

Passed 1846.
Enabled local authorities to provide baths and washhouses using public funds.
Allowed people to clean themselves who otherwise wouldn’t have been able to.
Councils had to want to provide these, they weren’t required to.

Question 25

What was the Towns Improvement Clauses Act?

Answer 25

Passed 1847.
Defined the rights of towns to lay water supply and drainage schemes and to control nuisances. Legalised the drainage of sewage into waterways and allowed its sale for agricultural use.
This meant that the waste of diseased people was put into water that many drunk and on food that was eaten, leading to disease spreading.

Question 26

What was the Public Health Act 1848?

Answer 26

Created the General Board of Health which reported to parliament.
Local authorities were encouraged to create their own boards and they could if 10% of the ratepayers requested one or if the death rate was greater than 23 per 1000.
Local boards could appoint a medical officer who was paid with taxes.
Local boards managed sewers, drains, wells, slaughterhouses, refuse, sewage, burial grounds, parks, and public baths.
The Act was permissive and didn’t have to apply everywhere. (Was implemented in 182 towns).
The Act demonstrate that the government was prepared to do something to tackle public health. The Act generated pressure for further reform.

Question 27

Why was their opposition to public health reform?

Answer 27

Improvement costs money, many rich people didn’t want their money to spent on helping the poor. There would be little benefit for themselves.
Many people thought the government was encroaching on individual liberty by making them remove dung heaps and whitewashing a slaughterhouse etc.
Companies with a vested interest wouldn’t agree to something which costs them a profit.
Civil engineering problems weren’t always understand by the local boards.

Question 28

What were the Local Government Act and the Public Health Act 1858?

Answer 28

Both passed 1858.
The General Board of Health abolished and their powers were given to the Local Government Act office.
A medical department of the Privy Council created.
Local boards given powers to take preventative action and appoint officials.
The 10 years since the last Public Health Act allowed people to become more accepting to the reform. 568 towns created boards and began to implement reforms.

Question 29

What was the Sanitary Act 1866?

Answer 29

Sanitary powers granted to individual local boards of health under the Public Health Act 1848 were made available to all boards, Local authorities requires to remove nuisances to public health and if they didn’t then the central government could charge them.
Nuisance extended to mean domestic properties and included overcrowding.
Local authorities could improve or demolish slums.
This was the first compulsory act and the local authorities had to implement the reform.

Question 30

In the 1860s why was the pressure for public health reform?

Answer 30

The 1867 Parliamentary Reform Act have the vote to working class men and so their problems had to be given attention.
Third cholera epidemic in 1865-66 killing 20,000
In 1865 Pasteur proved that germs caused disease and not caused by disease.
1869 Royal Commission on public health created which revealed that conditions hadn’t improved in 30 years.

Question 31

What was the Public Health Act 1875?

Answer 31

Most comprehensive legislation to date. Codified and consolidated previous laws.
Every part of the country had to have a public health authority.
Every authority had to have at least 1 medical officer and 1 sanitary inspector.
Local authorities given wide powers to lay sewers, drains, build reservoirs, parks, public baths and other local conveniences.
Government now completely committed to the provision of public health, no longer laissez faire.
The Act also was a turning point for housing regulations and sanitary authorities could make by-laws that controlled building standards.

Question 32

What was the Public Health Act 1939?

Answer 32

Consolidated previous legislation. Addressed sanitation, nuisances and offensive trades, baths and washhouses.
Local authorities continued to be in control of water supply and sewerage.

Question 33

How did writer’s influence public health reform?

Answer 33

Charles Dickens and Elizabeth Gaskell wrote about poverty in London and Manchester.
This likely influenced the literal middle class and potentially the illiterate middle and lower classes if they could attend readings. Can’t be directly linked to any reform but it helped create an atmosphere for reform and pressurise local authorities.

Question 34

How did newspapers influence public health reform?

Answer 34

Papers like Leeds Mercury reported on local outbreaks and some linked this to poor living standards.
Influenced the literate readers and the government who are held accountable by the press.
Helped create growing awareness of the need for reform, people take news as gospel so if they read a paper which says reform is needed they will likely agree.
In 1858 following the ‘great stink’ The Times headed a campaign to build sewerage in London.

Question 35

How did artists influence public health reform?

Answer 35

Artists like Gustav Fore showed the situation of the urban poor, and changed the attitudes of writers like Dickens. Helped create awareness for the problems the poor faced. Unlike written pieces, the illiterate people could see and understand art and could be influenced by it.
Dore’s work was a huge commercial success and helped pressure authorities.

Question 36

How did doctors influence public health reform?

Answer 36

In 1892 the Medical Officer of Health for London published a report linking overcrowding and disease.
Statistical information influences other scientists and medical professionals. Helped show the importance of overcrowding over morality.
Didn’t change everyone’s mind but it did help show a link.
Evidence used in reports put pressure on the government. Chadwick’s report influenced the Public Health Act 1848.

Question 37

How did science influence public health reform?

Answer 37

Discovery in 1854 by John Snow that dirty water caused cholera and Germ Theory by Pasteur in 1867.
Increased public awareness for the need for clean sewage and water supply.
The increase in awareness didn’t mean that attitudes had changed and many ignored Germ Theory.
Discoveries pressured the government (Creation of the Royal Commissions and passing legislation).

Question 38

How did Royal Commissions influence public health reform?

Answer 38

They were set up by the government so they are likely to listen to them.
The commissions recognised that environmental factors caused ill health and not morals.
Shows the shift from laisse-faire approach to a more interventionalist approach.
The commissions helped influence legislation like the Public Health Act 1848.

Question 39

How did economics influence public health reform?

Answer 39

It was cheaper for business owners to invers in reform then it was to lose a worker. Changed the opinion of those who owned businesses like mills and factories.
Business owners began to realise that good conditions made workers healthier meaning less money had to be used for the Poor Rate.
People in positions of power changing their minds that it was unnecessary and a waste of tax-payers’ money.