PHP&S - Changes In Public Health

Question 1

Overview

Answer 1

Government initiatives:
- public health acts
- liberal government reforms
Contributions of:
- Edward Jenner
- Edwin Chadwick
- John Snow
- Jospeh Bazalgette
- Marier Stopes
Changes in Public Health
- discovery of the cause of cholera
- improvements in public health and sanitation
- introduction of vaccine
- introduction of birth control clinics

Question 2

Vaccinations

Answer 2

Unlike today, the government during the early 19th century believed that is was not their responsibility to improve the living and working conditions of the people
The wealthy segment of the population often blames the poor for their own conditions
This attitude is called laissez-faire
However, before the end of the 20th century, improvements in public health and hygiene in the UK were rapid
Between 1906 and 1914, the Liberal Government abandoned the idea of laissez-faire and intervened on improving public health

Question 3

Brief timeline of vaccinations

Answer 3

1796 - Edward Jenner’s breakthrough using cowpox lesions to create a vaccine for smallpox
1836 - Edward Ballard introduced a more potent vaccine for smallpox
1853 - the Vaccination Act made smallpox vaccination compulsory in the first three months of infants
1879 - Louis Pasteur developed a vaccine for cholera
1896 - a typhoid vaccine was introduced to British troops by Almroth Wright
1923 - a new type of diphtheria vaccine was developed by Alexander Glenny and Barbara Hopkins’s
1933 - The Medical Council developed a new flu vaccine

Question 4

Vaccination Acts

Answer 4

1840 :
- variolation was made illegal
- optional vaccination was free of charge
1853:
- infants were required to be vaccinated within three of four months of birth
- parents who refused to get their child vaccinated had to pay a penalty
1867:
- poor law guardians sent a notice of vaccination within seven days of a brith
- infants needed to be vaccinated within three months
- inoculation of people with smallpox was punishable by a month of imprisonment
1898:
- this modified but did not supersede the previous acts
- cumulative penalties were removed for conscience objectors
- non vaccination required a certificate of exemption

Before the 1840 Vaccination Act, charitable institutions and the Poor Law authorities provided a vaccination service
In 1834, the revised Poor Law and the 1836 Registration Act had laid the foundations for a public vaccination service
Vaccination in England was only made compulsory in 1853
The new law involved local registrars of births, marriages and deaths
Despite the attempts at vaccination, over 23,000 people died of smallpox in 1871

Question 5

Opposition to vaccines

Answer 5

According to historian Kristin Hussey, conscientious objectors of the smallpox vaccine came from a variety of angels including religious, sanitary, scientific and political
It was also suggested that a third of doctors in Britain in 1841 were unqualified
An 1848 medical book listed diseased parents, wet feet, sedentary habits and night airs as common causes of disease
In 1869, the Leicester Anti-Vaccination League was formed
Instead of vaccination, the city’s method was to identity cases of smallpox, isolate the patient, quarantine the family and burn their belongings
This became known as the ‘Leicester method’
By 1884, about 3,000 parents/guardians had been prosecuted for non-vaccination in Leicester

Question 6

Smallpox

Answer 6

Between 1870 and 1874, a smallpox epidemic occurred in Europe
It was believed that the epidemic began in London and Liverpool before the end of 1870
In 1871, about 9.84% of deaths in London were due to smallpox
Smallpox outbreaks:
1796 - London and the British Iskes
1816-1819 - Nottinghamshire, Staffordshire, East Anglia, London, Canterbury
1825-1826 - Newcastle and Canterbury
1837-1840 - Wales up to Lancashire
1871-1872 - British Isles
1901-1902 - British Isles

Question 7

Public health act 1848

Answer 7

The act gave local authorities the power to:
- provide a clean water supply
- implement drainage and refuse collection
- appoint medical officers of health and sanitary inspectors
As the act was not compulsory, a General Board of Health was set up to encourage councils to ppt
Funding was given to councils over and above ratepayers to implement improvements
Due to limited funding, those boroughs with an existing corporation took on the responsibility to improving drainage, the water supply and paving
The act provided a structure for local authorities but failed to compel all, especially those without a corporation, to take action
The 1848 public health act was the first attempt of the British government to improve public health

Question 8

1858 public health act

Answer 8

The act gave local boards the power to:
- remove obstruction and nuisance in the street
- prevent fire
- provided public bathing houses
- remove dangerous buildings
- improve the streets
On the 1 September 1858, the 1848 act was replaced by the Local Government Act
Aside from the abolition of the General Board of Health, responsibilities were shared by the Secretary of State of the Home Department and the Privy Council
Moreover, additional powers were given to all local boards
In 1873, local boards peaked at 721
Before the passage of the Public Health Act in 1875, laws related to public health were contained in a series of statues including the Disease Prevention Acts, Nuisances Removal Acts, Local Government Acts and Sanitary Acts
Some were re-enacted in 1875, but many were repealed

Question 9

1875 public health act

Answer 9

The act gave local authorities the power to:
- take control of water supplies
- purchase, repair or create sewers
- regulate cellars and lodging houses
- establish by-laws for controlling new streets
In 1875, Benjamin Disraeli’s Conservative government introduced a law that would consolidate all existing laws into one
This laws established and name local authorises as rural and urban sanitary authorities that would replace the local boards of health established in 1848
These sanitary authorities were given jurisdiction over the newly created urban and rural sanitary districts in order to provide clean water, dispose of all sewage and refuse, and ensure that only safe food was sold
While earlier acts were still enforced in London until 1891, the Public Health Act of 1875 was not originally extended to the metropolis
The central body created under this act remained until 1919 when the Ministry of Health superseded the Local government Board

Question 10

Response to the act

Answer 10

In responses to the act, rural and urban sanitary districts were established in England and Wales in 1875, followed by Ireland in 1878
Urban sanitary districts were places in towns with existing local government bodies
Meanwhile, rural sanitary districts were applied to areas of poor law Unions
Sanitary authorities were responsible for matters related to public health, including access to drinking water, maintenance of sewers and streets and clearing of slum housing
In 1875, about 225 boroughs and 575 local government districts were designated as urban sanitary districts

Question 11

Additional laws passed to improve public health and hygiene in the 19th century

Answer 11

Artisan Dweling Act of 1875, which granted councils the power to clear slums and build better homes
Sale of Food and Drugs Act of 1876 banned the use of harmful substances in food, like chalk (in flour)
In 1876, laws against the pollution of rivers were passed
The Education Act of 1870 made schooling compulsory. Aside from improving literacy, some schools included health education in their curriculum
Laws on improving working conditions were also introduced in the late 19th century

Question 12

Influential people in TB treatment

Answer 12

The initial years of Industrialisation in England were characterised by squalor and poverty, which became an optimal environment for the spread of TB
In the early 19th century, TB caused one in four deaths
In 1840, George Baddingotn, a British pulmonary specialist, published his essay “On the Treatment and Cure of Pulmonary Consumption”
This led to the introduction of sanatoria, especially for TB patients
In his essay, he advocated dry frost air, exercise and a healthy diet
His work have heavily criticised by reviewers in the Lancet
By 1854, after recovering from TB in the Himalayas, Herman Bremerton, a German Physician, was the first to introduce a sanatorium for the treatment of TB
With good nutrition, fresh air and isolation, Brehmer’s sanatorium became the common treatment for TB in Europe
George Bodington opened a sanatorium in Sutton Coldfield in 1836, which later was converted in an asylum
The first TB sanatorium known a the “Brehmersche Heilanstalt für Lungenkranke” was opened by Brehmer in Görbersdorf, Silesia
By 1869, it had treated 958 patients
Robert Koch discovered M Tuberculosis in 1882
By 1895, Wilhelm Konrad Röntgen had discovered x-rays
Based on Louis Pasteur’s principles, Calmetter and Camille Guérin developed a vaccine against TB

Question 13

Timeline of TB sanatoria in Britain

Answer 13

Broomhill Hosptial, 1876: when it opened, it catered for patients suffering from TB, cancer and other incurable diseases at the time
Victoria Dispensary for Consumption and Diseases of the Chest, 1887: the royal Victoria hospital was founded in 1894, followed by the Polton Farm Colony in 1910 and the Royal Victoria Tuberculosis trust in 1914
Gartloch Hospital, 1896: built by the city of Glasgow district lunacy board, it was a psychiatric hosptial that added a 50-bed TB sanitarium in 1902
Ruchill Hospital, 1900: in 1915, bed for TB patients were added
Sidlaw Hospital, 1902: donated by the Earl of Airlie, a sanatorium for TB patients was opened in the Sidlaw Hills outside Dundee
Lanfine Hospital, 1904: TB patients were added
Robroyston Hosptial, 1908: mainly built as a municipal smallpox and TB hospital
East Fortune Hospital, 1922: a naval airship station was converted into a hospital for TB patients

On 5 October 1907, the Stannington Sanatorium became the first purpose-built children’s TB sanatorium in Britain
Located in Northumberland, it was built by a local charity, the Poor Children’s Holiday Association, or PCHA
From 50 bed in 1907, it was able to expand its capacity to 310 with help of donations

Question 14

Liberal government reforms, 1906-1908

Answer 14

The 1906 General Election returned a Liberal Government
Between 1906 and 1914, liberal welfare reforms were introduced by the majority, the Liberal Party
Reforms included management of poverty and support for the elderly, sick and unemployed

Question 15

Improvements of Children’s welfare

Answer 15

In 1906, free school meals were introduced
This allowed educational authorities to provide free meals to children
On a local basis, about half of all educational institutions followed the scheme
By 1914, as estimated 14 million meals were given to children
In 1907, free medical tests were given to children
Similar to free meals, this scheme was managed by local authorities
In 1908, the Children and Young Persons Act was passed as part of the Liberal Party’s reform package
Also known as the Children’s Charter, this act established juvenile courts
Moreover, the registration of foster parents was also introduced to protect children from abuse

Question 16

Elderly Care

Answer 16

In 1908, the Old Age Pensions Act was passed, which provided minimal financial support to poor elderly people aged 70 or above
The pension per week was between 1 and 5 shillings
Before the outbreak of WW1, about 1 million people were recipients of a pension
However, eligibility to receive pension was limited to:
- British citizens who had lived in the UK for 20 years
- those with clear criminal records in the last 10 years
- those with proof of age through a birth certificate

Instead of social welfare agencies or the Poor Law, the scheme was administered by the Post Office
On 31 December 1908, a total of 596,038 pensions had been approved
Of those 338,948 were from England (Excluding Monmouthshire), while Wales granted 21,956, Scotland 64,750 and Ireland 170,365

Question 17

Edward Jenner

Answer 17

(1749-1823)
In early times, variolation was used to prevent the spread of smallpox
It is a process of giving smallpox sores or pustules to people who had never had smallpox
However, as the person developed the symptoms, there was a high risk of death
It was only in 1796 that English physician Edward Jenner observed that milkmaids who were exposed to cowpox did not contract smallpox
He then variolated his gardener’s son with cowpox pus
After months of observation, the child never developed smallpox
Despite opposition, further research and experiments gave way to the development of a vaccine against smallpox
(Important to note that immunisation was already being practised in medicine by the time Jenner invented the smallpox vaccine)
Lady Mary Montagu has first hand seen inoculation on a visit to Turkey
She introduced the practise to Britain
However, these procedure, although standard practise, involved serious risk including that the inoculated person would become carriers of the disease and transfer it to those around them
They were also very expensive
During those times, vaccinations were seen as dangerous, especially as doctors often used infected and non-sterile needles
After he was rejected by the Royal Society, Jenner published his findings on his own and named his technique vaccination (“vacca” being the Lat5in word for cow) to distinguish it from the commonly used method of inoculation

Impressed by Jenner, the British Parliament gave him £30,000 to open a new vaccination clinic in London
Not only did Jenner help revolutionise and really kick-start research and practise in medicine, but his reach was global and not just national
In 1803, American doctors began using his ideas
Meanwhile, in 1805 even Napoleon demanded that his soldiers be vaccinated
Jenner’s diocese had made a huge contribution to public health, by introducing not only a lasting immunisation methods but also a cost-efficient one

Widespread immunity, which began with this single discovery by Jenner, eventually helped eradicate smallpox entirely by 1979
In 1802, Jenner was elected as an honour army member of the American Academy of Arts and Sciences as well a a foreign member of the Royal Swedish Academy of Sciences in 1806
Finally, in 1853, after a deadly smallpox epidemic has once again claimed many lives, the UK government passes the Vaccination Act
The new law requires that everyone got vaccinated against smallpox
It made vaccination not only compulsory but also free
Until the mid 19th century, despite this breakthrough, many people believed that smallpox was causes by miasma
Jenner’s work was supported by french scientist Louis Pasture, who claimed hat vaccination could prevent certain type of diseases

Question 18

Edwin Chadwick

Answer 18

Born in Longsight, Manchester, young Edwin Chadwick was exposed to liberal political and social ideas because of his father
At the age of 18, he apprenticed in a law office
While studying law, he befriends John Stuart Mill and Jeremy Bentham, who was exposed him to social reforms
Before his reforms in sanitation, Chadwick worked at the Royal Commission
In 1832, he was appointed to inquire into the implementation of the Poor Law
Along with Nassau William Senior, Chadwick drafted a report to reform the old law in 1834
In the same year, he was appointed secretary of the Poor Law commissioner
In 1838, a typhus epidemic broke out
In response, Chadwick convinced the Poor Law Board to conduct an inquiry
For the first time in British history, doctors were commissioned to Carry out the inquiry to detect what caused the population’s ill health
The survey began in 1839 and was published in 1842 with the title “report on the sanitary conditions of the labouring population of Great Britain”
Different areas around Britain were surveyed
In his data, Chadwick compared compared counties such as Rutland, Leeds, Liverpool, Manchester and Bolton
It generally suggested that the terrible conditions caused disease and poverty
What were the recommendations for industrial towns?:
- organised drainage and refuse collection
- provide a pure water supply
- appoint a medical health officer
- suggested ratepayers would save money in the long-term by improving the health of the poor

Question 19

John Snow

Answer 19

Born into a working-class family in North Street, York, England, in 1813
He lived in one of the poorest areas of the city
At the age of 14, John Snow became a medical apprentice in the area of Newcastle
In 1832, while serving as a surgeon-apothecary apprentice, he encountered the first cholera epidemic in Killingworth
Together with Thomas Micheal Greenhow, he conducted research on England’s cholera epidemics in the 1830s
A sceptic of miasma theory, Snow studies the transmission of cholera
He discounted that bad air caused diseases such as the bubonic plague and cholera
In his essay “on the mode of communication of cholera” published in 1849, Snow identified the role of water supply
In 1850, the Epidemiological Society of London, of which Snow became a founding member, as formed in response to the 1849 cholera outbreak

According the Snow’s investigations, foul water and not foul air was the main way that cholera was spread
To support the first edition of his book, he conducted 2 studies during the 1854 cholera epidemic
He focused on the Soho outbreak, specifically around the pump in Broad Street, where about 600 people died
Using government-death registration and house-to-house inquiries, Snow reached the pump
At that time, drinking water from the well had an open sewer nearby since many houses were not yet connected to the central sewage system
Snow argued that people who drank water from he well contracted cholera
Employees of the nearby brewery who drank more beer than water were essentially immune from cholera
Moreover, an overcrowded nearby with its own well infected only a few
In Snow’s 1848 work, he incriminated water companies in Lambeth, Southwark and Vauxhall for servicing south London with contaminated water
Before 1854, the Lambeth company got its water from Thames Dutton instead of the Thames in Central London
Along with epidemiologist William Farr, Snow revealed that households using water from the Southwark and Vauxhall company were more likely to die from choelra
Based on his observations, Snow used the term ‘organised matter’ as the causative agent of choelra
His studies concluded that this agent was a living organism because of its ability to reproduce
Snow was not aware of the breath thought study of Italian microscopist Filipino Pacini who described the the comma-shaped bacillus, which caused cholera in an 1854 outbreak in Florence
By the time Louis Pasteur and Robert knock shed light on the cause of diseases through germ theory, Snow had died

Question 20

Joseph Bazalgette

Answer 20

Born in 1819 in Enfield, London, he was a 19th century English civil engineer who was credited for solving the Great Stink in 1858
Bazalgette served as the chief engineer of London’s Metropolitan Board of Workers between 1856 and 1889
In 1847, London’s Metropolitan Commission of Sewers ordered all houses to empty their sewers into the River Thames, which resulted in a cholera epidemic in 1848 and 1849
In 1849, Bazalgette was appointed assistant surveyor to the London’s Metropolitan Commission of Sewers
By 1852, he took over as engineer
The following year, another cholera epidemic killed about 10,738 people
In response to the Great Stink, Parliament agreed to fund Bazalgette’s proposal of a grand sewage system for central London
They believed that the idea of having an enclosed sewer would eliminate the miasma
In 1875, he was knighted
He also also elected President of the Institution of Civil Engineers in 1883
Aside from the sewage system, he also worked on several roads, bridges and embankments
The work of Bazalgette resulted in the building of large new embankments along the River Thames that encased sewer pipes
It also provided an underground tube line which removed open sewer as from the streets of London
In addition to Victoria, Bazalgette also designed the Albert and Chelsea embankments
In 1865, Edward, Prince of Wales officially opened the new sewage system
Construction continued until it was completed in 1875
The foresight Bazalgette had to use quality materials means that the Victorian brick-lined tunnels are still present in London’s sewer system
Instead of narrow-bore pipes, which could cater to the population of the 1850s, Bazalgette’s insisted on large tunnels that successfully accommodated the doubling population of London

Question 21

Marie Stopes

Answer 21

Born in 1880 in Surrey, England, Marie Charlotte Carmichael Stopes founded the first instructional clinic for contraception in the UK
Before being a known control pioneer, Stopes was a paleobotanist
The failure of her first marriage to Reginald Gates and the expense of the annulment process led her to pursue advocacies about marriage, sex and childbirth
She argued that birth control was a means for women to protect themselves from physical strain of excessive childbearing
Despite medical and religious opposition, Stopes and her second husband Humphrey Verdon Roe founded a brith control clinic in the Holloway district of London
In 1918, she published “Married love and wife parenthood: a book for married people”
By 1923, she has written “Contraception: its theory, history and practise”
The family planning clinic provided low-income women with free contrastive advice and sold them contraceptives
The clinic in Holloway water later moved to Whitfield Street
Many considered Stopes a controversial historical figure
In Married Love, she provided a detailed account of the sexual relationships between men and women, which was taboo at the time
Meanwhile, Wise Parenthood was a manual on birth control
She promoted the ‘gold pin’ or ‘spring’ methods, which other considered an abortifacient
The mothers clinic advised birth control options such as the cervical cap, coitus interruputus (pull-out method) and spermicides
Other clinics were opened in Leeds (1934), Aberdeen (1934), Belfast (1936), Cardiff (1937) and Swansea (1943)
After hearing some intimate sexual details, the court granted Stopes’ annulment on the ground of non-consummation
According to the works of June Rose and Richard Soloway, Stripes was an elitist and idealist who was obsessed with a perfect societ
Soloway argued in his 1996 lecture that Stopes’ general interest in birth control was driven by her eugenic concerns and the impending ‘racial darkness’ from the poor
From 1912, Stopes was a member of the Eugenics Education Society
She became a life fellow in 1921
At the time, public figures such as Havelock Ellis (physician), George Bernard Shaw (playwright), Cyril Burt (geneticist) and Ellen Wilkinson (Labour Party politician) were known eugenicists

Along with Stopes’ introduction of brith control in the UK, she was heavily criticised for advocating eugenics
In her 1934 interview with the Australian Women’s Weekly, she expressed her view on mixed race
The interview revealed her belief that all half-castes should be sterilised at birth
In August 1939, hoping that her poems would be distributed in brith control clinics in Germany, she sent of copy of her “Love Song for Young Lovers” to Adolf Hitler
Her connection to Hitler ended when the Nazi leader closed birth control clinics in Germany