Public Health

What is Public Health?

http://www.bbc.co.uk/scotland/learning/bitesize/standard/history/1830_1930/public_health_rev1.shtml

• The filthy overcrowded conditions in which so many people lived made sure that Cholera spread quickly.

• Contact with human excrement and flies which had been in contact with human excrement was inevitable. The worst source of Cholera was dirty water.

• Cholera attacked with terrible suddeness and victims could die within a few hours, or after a few days of violent pain and diarrhoea.

• Where it was waterborne whole streets and areas were affected, entire households could die.

• There was no effective treatment and one in two of those infected died. It was terrifying because they did not understand that it was waterborne, - it just seemed to move and jump from one area to another at random.

• Cholera was not the only danger - Typhus was almost as bad.

• The huge increase in population meant cesspools were constantly overflowing, often because emptying them was very expensive. some were even completely open.

• In Whitechapel, London, that there were no sewers so was, 'the filthiest place you can imagine'. In Manchester, it was normal to empty raw sewage into the rivers.

• While the overcrowded poor were in the most danger the middle classes were also in danger, from Cholera and Typhus because it was caught through dirty water.

Housing ProblemsHousing Problems Diseases caused

Poor sanitation – drainage cesspools, no running water

Cholera

Shared toilets

Dirty stairs, and so on Typhus, diphtheria

Open sewers and middens

Typhus

Rats & vermin Typhus & typhoid

Poor diet TB

Overcrowding TB & typhus

Improvements to housingYear Changes

1833 Scottish Municipal Reform – this allowed rate payers to vote for local councillors and, as a result, some corrupt councils were replaced by those willing to improve towns.

1835 The Municipal Corporation Act – this allows councils in England to improve lighting, sanitation & street paving – it still did nothing for slums

1855 Removal of Nuisances Act – this allowed compulsory council purchase of slums

1875 Public Health Act meant many houses had water and sewers

1875 Artisans’ Dwelling Act – councils were given the power to pull down slums and build new houses, but cost was a problem

1909 Housing and Town Planning Act – local authorities could prepare town planning schemes

1919 Addison’s Act was passed to make “Homes for Heroes” but funding ran out in 1921

1924 Wheatley Housing Act – council houses were built with electricity, gardens and indoor toilets

1930 Green Woods Housing Act – further large-scale clearance in slums

Housing and healthCholera epidemics:

Year Deaths1831 32,0001848 62,0001854 20,0001866 14,000

• 1842 Edwin Chadwick- “Report on the Sanitary Conditions of the Labouring Population of Great Britain”

• Argued that government could improve people’s lives by bringing about reform

• Recommended: “The most important things needed are drains, removing rubbish from streets, and purer water. There should be improved sewers and drains, and a medical officer of health should be put in charge of each district”

Public Health Act 1848

• A board to set up local health boards was established

• A central board was set up to make recommendations to the local boards

• Act not successful:– boards had no real power– Too few boards set up

• 1858 abolished

• Investigated cholera outbreak in London

• Linked cholera with contaminated water

Dr John Snow, 1854

Cholera in Scotland

• Dundee, (page 60)

• Glasgow (page 61 & 62)

Public measuresThe first public health measures were based upon the idea that

miasmas (bad smells) caused disease. Although the idea was wrong, the measures against the miasmas involved a greater focus on cleanliness, and this improved public health.

Further measures included: • In 1848 the first Public Health Act caused the setting up of a

Board of Health, and gave towns the right to appoint a Medical Officer of Health.

• In 1853 vaccination against smallpox was made compulsory. • In 1854 improvements in hospital hygiene were introduced

(thanks in large part to Florence Nightingale). • In 1875 a Public Health Act enforced laws about slum clearance,

provision of sewers and clean water, and the removal of nuisances.

The benefits of these measures soon became clear, and by the late 19th century local councils were competing with each other to provide the best public health.

Public Health Act 1875

• Local authorities had to appoint a Medical Officer

• Authorities had to:– Cover & maintain sewers properly– Provide clean water– Pave and clean the streets

• Local officers were appointed to check up on slaughterhouses and take responsibility to make sure that contaminated food was properly destroyed.

Other factors which improved health

• Better diet – due to better transport, fresh food reached the cities

• Cheap new materials – soap and disinfectant reduced infections

• Cheap cotton clothes – these were easy to clean and launder.

• Better medicines and hospitals

Developments in medical knowledge helped: Year Discovery

1847 James Young Simpson discovered chloroform and its uses

1864 Louis Pasteur discovered germs

1867 Joseph Lister used antiseptics in surgery

1882 Robert Koch discovered the germs that caused TB & cholera

1895 X-rays were invented by William Roentgen

1906 Calmette and Guerlin worked on a cure for TB

1928 Alexander Fleming discovered penicillin

Individual measures• When the Boer War revealed that half the population

were unfit for military service, the government accepted that it had to pass laws to improve the situation of the individual poor:

• In 1906 local councils were told to provide free school meals for poor children.

• In 1907 school medical examinations were ordered for all children (among these examinations were those of the 'nitty nurse').

• In 1908 Old-age pensions were introduced.

• In 1911 National Insurance (free medical treatment for workers who fell ill) was introduced.