Unit 3.1 Impetus for Public Health Flashcards
What is public health?
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.
What were 5 reasons why many people died at a young age?
- Extreme high pollution - many factories - bad quality of health
- Cholera, many industrial diseases spread by dirt and waste - 1848-49 - 62,000 cholera death - 4 cholera epidemics in each decade
- Overpopulation - rife disease - when people got ill, it spread to others easily
- Around 55% was the death rate per 100 total births from maternal mortality
- Shared homes - bad quality housing - no kitchens - back to back housing - damp houses- badly fitted windows - communal privies - water supply contaminated by cesspits
Who died due to cholera? When?
Maria Woolf - died in London in 1849 - she was 32
What happened to the population? What happened in cities? What did this mean? Why?
-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
What happened to the death rate? Why? How many babies died before their 5th b day in??
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
What happened to the birth rate? Why?
Birth rate rose:
-fewer died when young meant more people in twenties and thirties to have more babies
What happened to the marriage rate? Why?
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)
What was the population of the UK that lived in towns in 1801, 1891, 1900?
-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
What was civil registration and when was it introduced? Who advocated for public heath reform? What did he do?
-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
What 3 categories did population change have on the lives of people?
- Homes
- Cesspits
- Disease
What impact did population change have on homes?
-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
What impact did population change have on cesspits?
-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.
What impact did population change have on disease?
-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
What 4 industrial diseases were rife?
- Tuberculosis - TB
- Cholera
- Typhus
- Typhoid
What are symptoms of tuberculosis? Actual cause of illness? Believed cause of illness? Treatments?
-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
What are symptoms of typhus? Actual cause of illness? Believed cause of illness? Treatments then and now?
-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
What are symptoms of typhoid? Actual cause of illness? Believed cause of illness? Treatments then and now?
-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
History of epidemics of tuberculosis?
-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
History of epidemics of typhus in Britain?
-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
History of epidemics of typhoid in Britain?
-16,000 yearly cases between 1838-1842 in London alone
-1882 - outbreak in wales - 42 people died in Bangor
Why did cholera epidemics have a great impact on the public?
-the high percentage of Fatalities amongst those contracting the disease (40-60%) and because of the speed with which it could strike
What were the cholera riots?
-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
What was gov reaction to cholera riots?
-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
What advice was published by the Board of Health?
-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
What was the issue with the recommendations provided by the board of health?
-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
What theories were there about what caused cholera?
-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.
What did victorians invent? What did Bazalgette specifically develop>
-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
Which hospital attempted to get rid of typhus? How? What did parliament do in 1819? What did they do in 1853?
-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
What were key issues in industrial areas that led to poor health?
-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
What did district boards do? Inequalities in this? What did London County Council do? When?
-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
Beliefs about illness pre 1800s?
-People believed God sent an epidemic/plague/illness when society or some people were being sinful.
-People believed that the bad smells from the towns infected people and made them ill. Public health reformers argued that cleaning up the environment would stop epidemics.
-The widest-held belief was that people were ill because their Four Humours were out of balance. The Four Humours were known as: blood, yellow bile, phlegm and black bile. People believed a person became ill when the humours were out of balance e.g. there was too much or too little of one type of humour.
-The supernatural world was used by some to explain unexpected and sudden disease and illness. They believed that the human body and the planets were made up of the same 4 elements (earth, fire, air and water). For the body to operate well, all 4 elements had to be in harmony with no imbalances.
Beliefs about illness post 1800s?
-Public health reformers argued that cleaning up the environment would stop epidemics.
-Bacteria, or germs, were the real cause of medical infections; infections were a biological, not chemical process. This was known as the Germ Theory.
-An infection is the invasion of the body by microbes (very tiny organisms which include bacteria); different microbes cause different diseases
-Some insisted that objects which frequently caused wounds, eg. bullets, were laced with poison and therefore caused the body to become infected.
What were the 4 reports that created an impetus for public health reform?
- The moral and physical conditions of the working classes of Manchester
- Report on the Sanitary Condition of the Labouring Population of Great Britain (Chadwick Report)
- Report of the Royal Commission into the Sanitary Condition of Large Towns and Populous Districts
- Report of the Bradford Woolcombers Sanatory Committee
When was the moral and physical conditions of the working classes of Manchester report? Who led it?
Created in 1832
Dr James Kay led it
How did the moral and physical conditions of the working classes of Manchester report create an impetus for public health reform?
-Cholera arrived in Manchester on 17th May 1832 and as a result a board of health was set up - Kay as its secretary
-board was to co-ordinate the work of the city’s 14 districts board
-Kay personally visited each area to investigate conditions there which formed the basis of his report
-one of the first detailed reports on the condition of a specific group of working people
-one of the first individuals to make the connection between dirt and disease
-believed that ‘dirty living’ led to ‘dirty habits’ - motivated other reforms
When was the report on the sanitary condition of the labouring population of Great Britain (Chadwick Report)? Who led it?
Created in 1842
Led by Edwin Chadwick
How did the report on the sanitary condition of the labouring population of Great Britain (Chadwick Report) create an impetus for public health reform?
-focused on London - small report
-was requested by the Poor Law commissioners and carried out under Edwin Chadwick
-in 1839 Sir James Graham (home secretary) asked that an enquiry be extended to cover the issue of disease amongst the labouring classes throughout the whole country
-Chadwick’s report was in three volumes (two being reports from all of bases on questionnaires sent to local boards of guardians and the third volume containing his own conclusions and proposals
-the poor law commissioners refused to allow it to be published as it criticised water companies, the medical profession and local administration
-eventually in july 1842 Chadwick had the while report published under his own name at his own expense
-set up Royal commission on the Health of Towns to investigate recommendations
-public health and poor law linked
When was the report of the royal commission into the sanitary conditions of large towns and populous districts? Who led it?
Created in 1844
Led by Edwin Chadwick
How did the report of the royal commission into the sanitary condition of large towns and populous districts create an impetus for public health reform?
-Royal Commission into the Health of Towns were drawn from those who knew what they were talking about - e.g. Duke of Buccleuch
-Questionnaires sent to 50 towns with highest death rates
-42 towns had bad drainage and 30 had poor water supplies
Recommendations:
-Central gov should be given more power to inspect and supervise sanitary work
-Local sanitary districts should be set up - authority over sewage
-Local sanitary districts must have powers to raise money for sanitary schemes in local rates
When was the report of the Bradford Woolcombers Sanatory Committee?
Created in 1845
How did the report of the Bradford Woolcombers Sanatory Committee create an impetus for public health reform?
-Responded to increasing populations due to Industrial Revolution - Used up and adapted vacant living space & Built new dwellings
-Cellars and attics filed with people and their fams (lived and worked here) e.g. 1840s - more than 10,000 woolcombers living and working in own dwellings
-Average age of death of a woolcomber was 14 years
-Report formed a protective society and appointed ‘Sanatory Committee’ to improve living conditions - e.g. Nelson Court - mentioned this in the report talking about bad living conditions like dampness and bad smell and sewage
3 technological advancements that impacted public health in the 19th century?
- Flushing toilets
- Sewage
- Water supply
What was used for waste pre flushing toilets? What event impacted their creation? When was the s-trap created, what was the impact of this?
-Water to flush away human waste into rivers - used since Neolithic times
-Industrial Revolution, and the advances in technology meant that the flushing toilet became a feature of many people’s lives
-1775, with the invention of the S-trap by Alexander Cummings - sealed the toilet bowl, preventing foul air coming up from the sewer
The growth of what enabled who to establish a business manufacturing toilets? How did flushing toilets create employment? What did this show? When was a patent granted and its impact?
-Growing urbanisation and the growth of a sewerage system, especially in London, enabled George Jennings to establish a business manufacturing toilets (known as water closets) and accompanying sanitary ware
-South-Western Pottery was opened outside Bournemouth in 1856 and, by 1861, was employing 97 men and 18 boys, indicative of the immense popularity of these new water closets, particularly among the middle classes
-Jennings was granted a patent in 1852 for his invention of an improved water closet - improved the construction of valves and drain traps
What policy changed the relationship between housing and water closets? Who created the trap water closet? Long term impact? Failures of flushing toilet?
-By the end of the 1850s, building codes required all new-build homes (predominantly for the middle class) to be equipped with a water closet
-Thomas William Twyford who, in 1875, developed and sold the first ‘wash out’ trap water closet that proved immensely popular
-This remained the standard water closet throughout the late 19th and early 20th centuries - small quantity of clean water refilled the toilet pan
-Inaccessible to working classes
-Led to build up of waste
Original method of sewage disposal? How did this change? Why?
-Human and industrial waste piled up on land, and rivers offered an easy and cheap solution to the problem of disposal - without the need for the expense of installing and maintaining pumps, and they eventually emptied into the sea - didnt carry waste efficiently
-public health requirements not to allow piles of filth to accumulate, local authorities were reluctant to move away from the traditional method of disposal
-miasma theory of the spread of disease throughout most of the 19th century, a quick and apparently efficient removal of waste into the river system seemed ideal
What was the first example of a sewage system in the 19th century? By who and when? Developments by Bazalgette? What came along with the construction of a sewage system? When was a sewage treatment system developed?
-A system of flushing gates to control the flow of liquids through the sewers was invented by the engineer John Roe in 1842
-1870s and 1880s - self-flushing sewers by Bazalgette
-Construction of an effective sewerage system involved, too, the production of millions of bricks and tonnes of cement, as well as a transport infrastructure to deliver them to where they were needed
-1912 when scientists at Manchester University made sewage biologically treated to make it safe
Who controlled water supply? When did the Lambeth waterworks use cast iron pipes? When did Chelsea waterworks company use sand filtration system, what was the impact of this? When were pumping stations built by the Thames?
-It was in the hands of private companies for most of the 19th century - profit not health
-In 1802, the Lambeth Waterworks expanded its operations to supply Kennington and replaced its wooden pipes with cast iron ones
-In 1829, the Chelsea Waterworks Company became the first in the country to install a sand filtration system to purify the water taken from the River Thames - more hygienic
-In 1838, the Grand Junction Waterworks Company built a pumping station by the Thames, housing three steam pumps
What is there evidence of in relation to water supply in late 19th century? Negatives of where water was extracted from? What was not known at the time which had an impact on further change?
-As the century progressed, more and more water companies built reservoirs to enable a reliable supply of water to be pumped to houses
-water companies in London and elsewhere extracted drinking water from rivers that were themselves polluted by industrial and faecal waste
-Further change had to wait until the knowledge that disease could be water-borne was combined with the science of removing impurities and the will of the people and the government that this should be done
Why did attitudes to public health change in 1780-1939?
-Between the years 1780-1939 there was an increasing desire for change regarding public health.
-Increasing population, cholera epidemics, new technologies and government reports had all contributed to a desire for change.
-Changing attitudes predominantly fell into two categories: social attitudes and economic attitudes
Alderman
People who work for local governments or councils
Who played an important role in PHA 1848? What was his argument?
-Edwin Chadwick played an important role in the creation of the Public Health Act
-his argument was economic, not social, as he was convinced that if the health of the poor was improve, less people would seek relief, more poor rleief would be given to families of men who died of infectious disease - cost effective
Recommendations of Chadwick as part of PHA 1848?
-Chadwick though that the most important steps to improving the Public Health Act were: improved drainage and provision of sewers, the removal of all refuse from houses streets and roads, the provision of clean drinking water, and the appointment of a medical officer for each town
What 2 things did the PHA 1848 establish? Examples? In what circumstances?
-The Act established a Central Board of Health, but this had limited powers and no money. Those boroughs that had already formed a Corporation, such as Sunderland, assumed responsibility for drainage, water supplies, removal of nuisances and paving. Loans could be made for public health infrastructure which were paid back from the rates
-Local Boards of Health were to be set up where the death rate was above 23 per 1000, if 10% of taxpayer wanted it
Limitations to the PHA 1848?
-Political conflict of interests
-Not compulsory
-Permissive Act - did not apply everywhere, eg London (who had its own Acts). Therefore not as effective as Poor Law Amendment Act.
-Provided a framework but did not compel action - only enforced in area that met the death rate criteria
-Not required to take on further public health considerations, eg. parks
-Improvements cost money (local taxes): This was an area of resentment.
-Vested interests (for eg the director of local water companies) were usually represented in local boards of health - Unlikely to vote for measures that would reduce their company’s profit.
-Chadwick himself was disliked: angered many, seen as a bully.
-Of the 187 major towns in England and Wales, 62 had no public health authority whatsoever.
Successes of the PHA 1848?
-Less cholera due to increased sewage control
-High death rate
-End of Laissez faire era
-Edwin Chadwick - working in both public health and poor law
-Chadwick’s economic arguments are convincing; get people on side
-Shows the gov are prepared to do something. Marked the beginning of state intervention, ending of laissez-faire attitude.
-Led to pressure for further reform.
-Local Boards of Health in certain areas (very successful eg Sunderland); little or no opposition as appeal to local needs.
-1850 - 192 towns asked for public health regulations to be applied.
What were the 5 government acts passed in the 19th and 20th centuries?
- Public Health Act 1848
- The Local Government Act 1858 and the Public Health Act 1858
- Sanitary Act 1866
- Public Health Act 1875
- Public Health Act 1936
Key information on the Local Government Act 1858 and the Public Health Act 1858?
-As a consequence of these acts, 568 towns began implementing public health reforms in just a 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
-The General Board of Health was abolished, This was due, in part, to the fact that Chadwick was becoming increasingly disliked
-A country-wide medical department was set up under the Privy Council: They directly corresponded with local boards to advise on public health measures
What was the significance of the Factory Act of 1833 in public health?
it aimed to reduce work hours and improve conditions in factories
Which year did John Snow conduct his famous cholera investigation in Soho?
1854
