Unit 3.1 Impetus for Public Health

Question 1

What is public health?

Answer 1

The health of the population as a whole, especially as monitored, regulated and promoted by the state. It is the science and art of preventing disease, prolonging life and promoting human health through organised efforts and informed choices. It is about helping people to stay healthy and protecting them from threats to their health.

Question 2

What were 5 reasons why many people died at a young age?

Answer 2

1. Extreme high pollution - many factories - bad quality of health
2. Cholera, many industrial diseases spread by dirt and waste - 1848-49 - 62,000 cholera death - 4 cholera epidemics in each decade
3. Overpopulation - rife disease - when people got ill, it spread to others easily
4. Around 55% was the death rate per 100 total births from maternal mortality
5. Shared homes - bad quality housing - no kitchens - back to back housing - damp houses- badly fitted windows - communal privies - water supply contaminated by cesspits

Question 3

Who died due to cholera? When?

Answer 3

Maria Woolf - died in London in 1849 - she was 32

Question 4

What happened to the population? What happened in cities? What did this mean? Why?

Answer 4

-Population rose from 13 million to over 31 million between 1781 and 1871, and was 48 million in 1939
-Industrialisation created work in factories, mills and foundries and people flocked into the rapidly growing towns and cities to take advantage of job opportunities
-Meant that it was more crowded and lived in substandard housing with little by way of clean water

Question 5

What happened to the death rate? Why? How many babies died before their 5th b day in??

Answer 5

Death rate fall:
-medical industry produced vaccine that prevented smallpox
-agricultural industry produced better quality food
-chemical industry produced cheap soap
-textiles produced cotton cloth that was cheap and easy to use
-1840s - Manchester 57% of babies died before fifth birthday

Question 6

What happened to the birth rate? Why?

Answer 6

Birth rate rose:
-fewer died when young meant more people in twenties and thirties to have more babies

Question 7

What happened to the marriage rate? Why?

Answer 7

Marriage rate rose:
-farmers employed fewer servants so men and women labourer could begin life together and marry earlier
-in industrial areas unskilled workers were replaced by skilled who had to work 7 year apprenticeship (could marry with no job)

Question 8

What was the population of the UK that lived in towns in 1801, 1891, 1900?

Answer 8

-1801 - 33% of pop lived in towns, 72% by 1891
-1900 - 4/5 citizens were urban dwellers
-1801-1901 - 1mil to 6mil in pop in London - waste products multiplied

Question 9

What was civil registration and when was it introduced? Who advocated for public heath reform? What did he do?

Answer 9

-Civil registration introduced in 1837 which stopped parishes from having to record births, deaths and marriages which was difficult because of a moving population, they were then listed as legal documents - revealed a young and fertile population in urban areas so that meant the birth rate was higher than death rate
-William Farr advocated for public health reform and drew attention to wide variations in mortality - supported miasma (smells caused disease) - produced statsitcs - insisted doctors register cause of disease not just fact of the death

Question 10

What 3 categories did population change have on the lives of people?

Answer 10

1. Homes
2. Cesspits
3. Disease

Question 11

What impact did population change have on homes?

Answer 11

-The rapid influx of people into towns and cities created poor housing bad fitted windows, communal privy no kitchens
-Back to back housing and cellar/attic dwellings were seen most frequently. Somebody else’s house Houses were typically built in a grid system.
-A huge number of families would occupy 1 house.
-Poorest lives in cellars/attics - water would leak through - damp - bad for lungs - little ventilation

Question 12

What impact did population change have on cesspits?

Answer 12

-Most housing lacked sewerage or drainage. Instead, they shared a privy (communal toilet).
-Cesspits (area where toilet waste would be put) 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.

Question 13

What impact did population change have on disease?

Answer 13

-The rapid population migration and poor living conditions resulted in epidemics.
-There were typhus (water borne) epidemics in 1837 and 1839; an outbreak in 1847 killed 10,000 people.
-Also influenza, scarlet fever, TB and measles.
-Typhoid and diarrhoea were common.
-Cholera.
-Diphtheria.
-industrial diseases

Question 14

What 4 industrial diseases were rife?

Answer 14

1. Tuberculosis - TB
2. Cholera
3. Typhus
4. Typhoid

Question 15

What are symptoms of tuberculosis? Actual cause of illness? Believed cause of illness? Treatments?

Answer 15

-cough that lasts more than 3 weeks - can cough up mucus/ blood
-exhaustion
-High temp/night sweats
-chest pain

-bacterium: Mycobacterium tuberculosis - contagious

-miasma until Koch proved otherwise

-antibiotics for at least 6 months
-vaccination

Question 16

What are symptoms of typhus? Actual cause of illness? Believed cause of illness? Treatments then and now?

Answer 16

-Red rash
-Dry cough
-Headache
-Nausea and vomiting
-Joint and muscle pain

-Infected mites, fleas or lice

-Thought it was caused by hygiene or miasma

-Now:
Antibiotics
-Then:
Quarantine and isolation
Herbal remedies, blood letting

Question 17

What are symptoms of typhoid? Actual cause of illness? Believed cause of illness? Treatments then and now?

Answer 17

-Headache and high temp
-Extreme tiredness and fatigue
-Diarrhoea
-Lose appetite

-Cause: Bacteria - Salmonella Typhi - spread by contaminated water and food

-Believed causes: miasma (bad air)

-Current treatments: course of antibiotic medicine and vaccines

-Past treatments: bloodletting, opiates and ammonia

Question 18

History of epidemics of tuberculosis?

Answer 18

-Poor sanitation and living conditions meant that one in four deaths in Britain were caused by tuberculosis in the early 19th century
-There was an almost steady decline in the disease from 1912, as living and working conditions improved.
-17,000 in 1913, had fallen to around 5,000 in 1987

Question 19

History of epidemics of typhus in Britain?

Answer 19

-18th century
-Came from napoleonic wars etc
-Came from the great famine (Irish people fleeing to England)
-1847 - Typhus epidemic = 30,000 people in
England and Wales died of typhus fever

Question 20

History of epidemics of typhoid in Britain?

Answer 20

-16,000 yearly cases between 1838-1842 in London alone
-1882 - outbreak in wales - 42 people died in Bangor

Question 21

Why did cholera epidemics have a great impact on the public?

Answer 21

-the high percentage of Fatalities amongst those contracting the disease (40-60%) and because of the speed with which it could strike

Question 22

What were the cholera riots?

Answer 22

-There were 30 recorded ‘cholera Phobia’ 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 Dissections
-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

Question 23

What was gov reaction to cholera riots?

Answer 23

-In 1831, the government sent two medical Commissioners to Russia, where there had been an outbreak of cholera
-Board of Health was set up in 1831 - advised local government areas to set up their own Local Boards of Health - 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

Question 24

What advice was published by the Board of Health?

Answer 24

-Houses were to be whitewashed and lined - 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.
-gave advice in relation to to cholera and was made permanent in PHA 1848

Question 25

What was the issue with the recommendations provided by the board of health?

Answer 25

-legality – 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
-local action was haphazard. Local Boards of Health were temporary

Question 26

What theories were there about what caused cholera?

Answer 26

-The Contagionist theory suggested that cholera was spread by contact with local victims. This was disputed because 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 waterborne did treatment of cholera epidemics change.

Question 27

What did victorians invent? What did Bazalgette specifically develop>

Answer 27

-Victorians invented sanitary care - study of public health, dirt and disease - considered cleanliness as extremely important - increased funding in sewers (millions £)
-1860s - Bazalgette - engineer who came up with the concept of a sewage system under the Metropolitan Board of Works that replaced 8 Sewer Commission in 1800s - ‘the man who cleaned up London’ - built on miasmic theory

Question 28

Which hospital attempted to get rid of typhus? How? What did parliament do in 1819? What did they do in 1853?

Answer 28

-London Fever Hospital - attempted to organise cleaning of slums and get rid of typhus - 1801 - many dustmen refused as they were overcrowded and so much to clean
-1819 - parliament damned smoke from factories as a cause of public health
-1853 - legislation to reduce factory fires but 10s of thousands of coal fires were unchallenged by Parliament

Question 29

What were key issues in industrial areas that led to poor health?

Answer 29

-Air vitiated by smoke - fogs of soot sometimes - rising mortality from bronchitis and other pulmonary issue - nickname: ‘the smoke’
-demand for bricks dropped in mid 1820s, demand for dust lowered - filth increased as dustmen didnt clean as they didnt make a profit
-overcrowded slums
-no sewage control

Question 30

What did district boards do? Inequalities in this? What did London County Council do? When?

Answer 30

-District boards - cleaned slums - some local authorities more organised and wealthier than others - west end had more money for sanitary matters than the east
-London County Council in 1889 - sanitary interest and prosecuted local authorise for not collecting rubbish - new facilities for communal cleansing like public baths and public toilets - slum housing improved through model housing charities and other social housing schemes