The People’s Health 1250-Present

Skills Booklet

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Revision Checklist Periods Content

Medieval Britainc.1250–c.1500

The characteristic features of medieval Britain: an overview Living conditions: housing, food, clean water and waste.Responses to the Black Death: beliefs and actionsApproaches to public health in late-medieval towns and monasteries

Early ModernBritainc.1500–c.1750

Cultural, social and economic change including the growth of towns: an overviewChanging living conditions: housing, food, clean water and wasteResponses to outbreaks of plague including national plague orders and localreactionsThe impact of local and national government on public health including measuresto improve the urban environment and the government response to the gincraze, 1660–1751

Industrial Britain,c.1750–c.1900

Industrialisation, the growth of major cities and political change: an overviewUrban living conditions in the early nineteenth century: housing, food, cleanwater and wasteResponses to cholera epidemicsPublic health reform in the nineteenth century including the Public Health Actsand local initiatives

Britain sincec. 1900

Economic, political, social and cultural change: an overviewLiving conditions and lifestyles: housing, food, air quality and inactivityResponses to Spanish Influenza and AIDSGrowing government involvement in public health including pollution controls,anti-smoking initiatives and the promotion of healthy lifestyles

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Key word Definition

Antibiotics Group of drugs used to treat infections caused by bacteriaApothecaries ChemistsBronchitis A disease that makes breathing difficultCess pit A pit or chamber used for collecting human excrement

Conduit A small fountain or water pipeEpidemic A disease that affects a large number of people at the same time

Ergotism A terrible human disease caused by fungus growing on cropsFactor Something that plays a part in causing an event or developmentFaeces Excrement, solid human wasteFamine Desperate shortage of foodFlagellants People who whip themselves or others e.g. to try to avoid getting the plagueFour humours Four liquids that make up the human body, according to ancient Greek doctorsGongfermer Person who cleans out cesspitsHazard Something that presents a riskImmunise Helping bodies resist infectious diseasesIndustrialisation The development of industry, involving the growth of factories and citiesInfluenza A disease that involves a fever, caused by a virusLaissez-faire Allowing people to look after their own affairs without government involvementLatrine Toilet without any flushing systemMalnourished Underfed or the failure to eat enough healthy foodsMiasma An invisible mist that was once thought to cause diseasesMicrobe Tiny living creature that causes disease, too small to be seen by the eyePesthouses Buildings outside the city walls where plague victims were made to stay

Plague A disease that first appeared in England as the Black Death in 1348Public Health Measures taken by governments and other authorities to look after people’s

healthQuarantine Being kept away from other people for a period of time to prevent the spread of a

diseaseRaker Street CleanerRickets A disease that involves the softening of the bonesSanitary Inspector Official who had to check that standards of hygiene were kept especially in

shopsSecular Non-religious; to do with human affairs without any involvement of God or the

ChurchSewerage A system for draining away waste including human excrement and urineSlums Dirty and overcrowded housingSmog Dense fog mixed with fumes from cars or factoriesTanner Person who treats animal skins to make leatherUrbanisation The rapid growth of towns or citiesWater-borne diseases

Diseases that are spread by microbes living in water e.g. cholera

Welfare State System by which a government takes responsibility for the health and well-being of the people

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Key People: Medieval Britain Key People: Early Modern Britain

Key People: Industrial Britain

Key People: Modern Britain

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Edward I in 1301 ordered the authorities in York to clear the filth from its streets and introduce new rules to keep the town clean.

Elizabeth I ordered the printing of plague orders which had to be enforced at times of the plague.

Louis Pasteur in 1861 he made a discovery that harmful germs could enter the human body, grow fast and cause disease.

Edwin Chadwick wrote the Report on the Sanitary Condition of the Labouring Population which helped influence the Public Health Act 1848.

John Snow in 1854 linked cholera to infected water by removing a water pump handle in Broad Street.

Joseph Bazelgette between 1858 and 1865 built 1300 miles of sewers across London.

Dr Niven was Manchester’s Medical Officer in 1918 at the time of the Spanish Flu. He wrote a very thorough report on the flu and made a list of actions the city should take in response to the epidemic.

Filippo Pacini an Italian doctor in 1854 discovered the comma-shaped organism which caused cholera and published a scientific paper to explain his discovery.

Princess Diana in 1987 visited an AIDS clinic and shook the hands of someone suffering from AIDS. This action helped reassure people that AIDS could not be passed on by simple contact.

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How to answer the Exam Questions

9 Mark Questions - e.g. Write a clear and organised summary that analyses people’s living conditions in the Middle Ages. Support your summary with examples (9 marks)

Skill: You must demonstrate the skill of using second order concepts: causation and consequence, similarity/differences and significance

Command Words to use:

Similarity/differences: Similarly... Likewise. Alternatively. .In contrast..

On the contrary.. Although. Instead… However…

Timing/Layou t : Two paragraphs in 10 minutes

Write a clear and organised summary that analyses people’s living conditions in the Middle Ages. Support your summary with examples (9 marks)

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Living conditions in the Middle Ages were different depending on who you were and where you lived. In the countryside, the Lord of the Manor would live in a much larger house than the peasants who worked on his land. There was also difference between the types of houses peasants lived in. For some, their homes were basic huts with walls woven from sticks and covered in mud. Others lived in timber framed houses which were larger. These timber framed houses would keep a fire burning which could make the house quite smoky but provided warmth and a way of cooking (commonly pottage, a thick soup). Peasants had meat and bread to eat, the smoke from the fire would be used to preserve the meat. However, whilst there were many similarities there were also a number of differences between life in the countryside and life in towns. Houses in towns were very different from the countryside as they were larger and only rich people could afford them. Often, the top floors would jut out to make more space in the house which meant the streets underneath would be very dark. Very few houses in the centre of towns had gardens but further out gardens were common and often had flowers to purify the air as well as growing vegetables to eat. The diets of people in the towns and countryside were very similar, however, there was more variety available to people in the towns due to the presence of the market. In towns water would be available from a wider variety of sources than in the countryside. As well as rivers and streams there would often be a conduit in the centre of the market square as well as water sellers going door to door. As this comparison has shown, medieval living conditions varied depending on factors such as wealth and location.

Command words

Examples

Consequence/significance: As a result.. This led to.. Consequently.. This meant that.. This caused… This was significant because …

10 Mark Questions - e.g. What was the impact of changes in living conditions and lifestyles in the twentieth century? Support your answer with examples. (10 marks)

Skill: You must demonstrate the skill of using second order concepts: causation, consequence and significance

Use the PEE (Point, Evidence, Explain) structure for each paragraph

Timing/Layou t : Two/three paragraphs in 15 minutes

What was the impact of changes in living conditions and lifestyles in the twentieth century? Support your answer with examples. (10 marks)

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Command Words to use:

There were many changes to diet in the twentieth century. At the beginning of the century reports by individuals such as Booth and Rowntree highlighted the effects of a poor diet on children. This resulted in the 1906 School Meals Act, which was so successful that by 1914 158,000 children were benefiting from it. During both the First and Second World Wars diet also improved as a result of rationing. As a result of rationing, people were not able to eat as much meat and were encouraged to eat more fruit and vegetables as they could be grown in this country. Nutritionists say that these changes meant that during the war the health of the population was the best it had been, although the introduction of free milk at school shows there were still some issues to be addressed.

Towards the end of the twentieth century the quality of food people chose to eat deteriorated as people started to eat more processed foods such as ready meals and crisps which have a high level of sugar and fat. Also people started to eat a lot more sweets and chocolate which has a high level of fat and sugar. These changes in diet have led to health problems such as more people with diabetes and higher levels of obesity. This in turn has led to government campaigns to promote active lifestyles and healthier eating, for example the government has encouraged people to eat five portions of fruit or vegetables each day. These campaigns have made people more aware of the issue.

Another big change in the twentieth century has been the care given to children in respect of both their living conditions and lifestyles. The disparity between the condition of richer and poorer children was highlighted by recruitment for the Boer War (children from wealthy families were significantly taller) and reports by social reformers. The Liberal reforms did much to help children, for example by making neglect of children illegal, and also making it illegal to sell cigarettes to children under 16. However, the poor condition of children evacuated during the Second World War showed that more still needed to be done. The creation of the NHS out of the Beveridge Report meant that children were cared for even before birth through the maternity services available, and immediately afterwards through health visitors who could check on the welfare of infants. The NHS also provides free healthcare, dental care and eye checks throughout childhood. As a result, the infant mortality rate is now extremely low, and life expectancy is still increasing. This shows that all of these changes have had a dramatic effect on people’s health, making the NHS the most important change since it has a direct effect on everyone.

Point Evidence Explanation

Consequence/significance: As a result.. This led to.. Consequently..

This meant that.. This caused… This was significant because …

18 Mark Questions - e.g. New technology has been the most important factor in improvements to public health in Britain’. How far do you agree with this statement? Give reasons for your answer. (18 marks)

Skill: You must demonstrate the skill of using second order concepts: causation, consequence and significance to reach a judgement that shows the two sides to the argument

Use the PEE (Point, Evidence, and Explain) structure for each paragraph

This meant that.. This caused… This was significant because However…

REMEMBER TO USE THE WORDS OF THE QUESTION AND FORM AN ARGUMENT

Timing/Layou t : Two sides written with a PEE structure for each paragraph.

Paragraph 1 – agree, Paragraph 2 – disagree.

A conclusion that reaches a decision – agree or disagree with the statement and why. 30 minutes

It can be argued that new technology has indeed been the most important factor in improvements to public health. Developments such as the printing press in the fifteenth century enabled information to be spread more quickly and accurately for example the Plague Orders of 1578. The development of microscopes was vital in enabling Louis Pasteur to develop germ theory which finally proved what caused illness, thereby also proving the importance of cleanliness and public health. Other technological developments in the Industrial period were also significant in improving public health, most notably the development of the sewer systems pioneered by Joseph Bazalgette in London. In the modern era technology has enabled the use of media to raise awareness on issues to do with public health such as anti-smoking and healthy eating campaigns. However, had it not been for the government commissioning these works, technology could have not have had this impact. Therefore, arguably, the role of government is more important with respect to the sewer system than the development of technology.

On the other hand, it can be argued that there are other factors which played a more important role in improving public health. Throughout all the time periods government has had a significant impact on public health, on both a local and national level. Examples include the Plague Orders, Public Health Acts as well as a raft of other legislation at the end of the nineteenth century, Liberal Welfare reforms, NHS and AIDS awareness campaigns. The Public Health Act of 1875 was a turning point in England as it was the first time that the government made it compulsory for councils to clean up their towns, thereby improving living conditions. For example, the appointments of medical officers and local authorities taking responsibility for sewers and water supplies. The NHS is another significant event in the improvement of public health because, for the first time, everybody in the country had access to trained doctors. This meant that the very poor had the same access and entitlement as the rich, and, as a result, life expectancy has improved dramatically. Combined with this, the growth of democracy, particularly during the nineteenth century with

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Command Words to use:

Agrees with reasons Consequence/significance explained

Disagrees with reasons Conclusion

Consequence/significance: As a result.. This led to.. Consequently..

the 1867 Second Reform Act, meant that there was increasing pressure for reform and the government had to respond to this. Additionally, a change in attitudes also played a role in improving public health. Since the Middle Ages there has been a shift away from the reliance of religion as an explanation and treatment of illness and people became more accepting of new, scientific ideas such as Pasteur’s germ theory.

In conclusion, whilst new technology has played an incredibly important role in improving public health, such as development of microscopes and the sewer system, by itself it cannot be considered the most important factor. Without the role of other factors such as government new technology would not have been able to have such a big impact. For example, the new sewer system only came about because of intervention by the government. Therefore, whilst it clearly played a significant role in improving public health, I disagree that by itself it was the most important factor.

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Middle Ages Exam Questions

How did authorities impact health in the Middle Ages? Support your answer with examples (10 marks)

Paragraph 1: Monasteries

One way that monasteries impacted health in the medieval period was…………………………………………..

………………………………………………………………………………………………………………………………………………………….

This impacted health because…………………………………………………………………………………………………………..

…………………………………………………………………………………………………………………………………………………………

Paragraph 2: Town Authorities

One way that town authorities impacted health in the medieval period was……………………………………

………………………………………………………………………………………………………………………………………………………….

This impacted health because……………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………………………………….

Paragraph 3: London

Finally, the national government impacted health in London by……………………………………………………..

This impacted health because…………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………………………………….

Why did people’s attempts to stop the plague in the Middle Ages have limited impact? Support your answer with examples (10 marks)

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Write an explanation of how living conditions in late medieval England contributed to poor public health. Give examples in your answer. (10 marks)

‘In Medieval Britain there was no concept of public health.’ How far do you agree with this statement? Give reasons for your answer. (18 marks)

I disagree that there was no concept of public health in the Middle Ages, but I also think that it varied according to who you were and where you lived. Public health in the monasteries was good, but in the towns was not so good.

The monasteries had very good ideas of public health, similar to the Romans before them. Washing and hygiene were a daily and important part of the life of a monk, and the buildings show that. Most monasteries were built near rivers so they had a fresh supply of clean water both for washing and for food preparation. All monasteries had a lavatorium, and the monks used this to wash daily before having a meal. In addition, separate reredorters or toilets were built next to a stream or river, removing all waste from the area in which they lived. All of this meant that the monks had a very high standard of public health and so means that the statement is wrong. Public health in villages was also not too bad, as the population in these areas was not very high. This meant that the issues in towns of polluted water and waste on the streets were not a problem in the villages, and so their standards of public health were good.

I do agree, however, that the standards of public health in the towns were not very good. The two biggest problems were access to fresh water, and removal of waste such as sewage. Part of the problem was that the government did not consider the cleanliness of towns to be its responsibility, and only really acted when there was an epidemic such as the Black Death. Another problem was that since there was no understanding of the cause of disease, there was also no understanding that having waste on the streets or polluted water was a problem. In some medieval towns there were gutters on the streets, and communal privies, but the waste from both of these ran straight into the river, polluting it. In some towns archaeologists have found huge waste piles on the corners of the streets, showing that the shopkeepers and people living in the towns would throw their rubbish straight onto the street making the problem worse. This shows that in the towns of Medieval Britain, there was little concept of public health.

Overall, therefore I agree that there was little concept of public health in the towns during the Middle Ages, but I think it is wrong to include everyone in that statement. Instead I think it depended on where you lived and how rich you were. Monasteries were very clean, and castles also had means of providing clean water and getting rid of sewage. Richer people bathed more often as well. It was the poorer people who lived closely together in the towns who had a poor standard of public health, although even then there were some towns such as Exeter which had both public toilets and piped supplies of clean water. The statement therefore is correct to an extent, but only for a certain part of the population in Medieval Britain.

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Early Modern Britain Exam QuestionsWrite a clear and organised summary that analyses the government response to the gin craze of 1660–1751. Support your summary with examples. (9 marks)

The government response to the gin craze was inconsistent, in that initially it was the government itself which encouraged the increased distilling of gin in Britain. Since Britain was at war with France, the government was keen to reduce the import of French brandy, and there was also a surplus of grain at the time, and so the government passed laws which meant that importing spirits became more expensive, but also that anyone in Britain could now distil gin. This obviously had a huge effect as there was a sudden rise in the amount of cheap gin available for people to buy, so the amount of gin drunk increased tremendously. Within a couple of years there were 7,000 shops selling gin, so it can be seen that it was the government that was responsible for the craze in the first place.

As the consumption of gin increased (Londoners were drinking an average of 2 gallons of gin a week), the government became concerned about the problems this was causing in terms of drunkenness and crime. As a result, its policy changed to one of trying to limit the amount of gin available through eight separate Gin Acts. Attempts to make gin too expensive to buy in 1736 by increasing the tax on gin sales failed as gin sales went underground, but people were still able to buy it. The most effective government response came in 1751 when the Gin Act was introduced which meant that distillers could only sell to respectable larger merchants. This meant that gin could only be bought from inns and taverns, preventing the sale of cheap gin on the streets, thereby making it less available and too expensive for many people to buy. This Act coincided with problems in the economy and lower wages, resulting in a natural decline as well. The 1751 Act is considered to be the most effective response to the gin craze, and within a few years it had finished.

Write a clear and organised summary that analyses people’s response to the plague in the early modern period. Support your answer with examples (9 marks)

Write a clear and organised summary that analyses people’s living conditions in the early modern period. Support your answer with examples (9 marks)

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How did local and national government impact people’s health in the early modern period? Support your answer with examples (10 marks)

Paragraph 1: Local Government

One way that the local government impacted health in the early modern period was…………………….

………………………………………………………………………………………………………………………

This impacted health because…………………………………………………………………………………..

………………………………………………………………………………………………………………………

Paragraph 2: National Government on Plague

One way that the national government impacted health was……………………………………………….

………………………………………………………………………………………………………………………

This impacted health because…………………………………………………………………………………..

………………………………………………………………………………………………………………………

Paragraph 3: National Government on Gin

Finally, the national government impacted health by…………………………………………………………

………………………………………………………………………………………………………………………

This impacted health because………………………………………………………………………………….

………………………………………………………………………………………………………………………

How far do you agree that the government in the early modern period made more effort to protect people’s health than in the medieval period? Give reasons for your answer (18 marks)

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Industrial Britain Exam QuestionsWrite a clear and organised summary that analyses government attempts to improve public health in Industrial Britain. Support your answer with examples (9 marks)

Introduction

During the industrial period a variety of measures were put in place to improve public health.

Paragraph 1 National government

One way that the national government attempted to improve public health was…………………………..

………………………………………………………………………………………………………………………

This impacted health because…………………………………………………………………………………..

………………………………………………………………………………………………………………………

This attempt to improve public health was successful/unsuccessful because……………………………..

………………………………………………………………………………………………………………………

Paragraph 2 Local government

One way that the local government attempted to improve public health was……………………………..

………………………………………………………………………………………………………………………

This impacted health because…………………………………………………………………………………

………………………………………………………………………………………………………………………

This attempt to improve public health was successful/unsuccessful because……………………………..

………………………………………………………………………………………………………………………

Write a clear and organised summary that analyses local and national government responses to cholera in the Industrial period. Support your answer with examples (9 marks)

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Write a clear and organised summary that analyses people’s living conditions in the Industrial period. Support your answer with examples (9 marks)

Why do you think that attitudes to public health changed in the period 1750–1900? (10 marks)

At the beginning of this period, the attitude that many people and the government had towards public health was one of laissez-faire. This meant that the government should not get involved in the lives of the population, as they would then not learn how to help themselves. By the end of the nineteenth century this had changed, and the government was becoming more involved in helping those in poverty through measures such as the Public Health Acts. This change happened partly because the situation in cities became much worse, but also through the work of individuals like Chadwick, Snow and Pasteur.

There were many individuals who changed the way people thought about public health. John Snow was the first as he managed to prove that cholera was spread though water. By taking the handle off the Broad Street water pump, he not only managed to control that particular outbreak of cholera, but because he showed it was spread through the water it now became important to provide everyone with clean fresh water in order to prevent further outbreaks. John Snow was only able to say that cholera was spread through water, but he was not able to prove what was causing it until Pasteur developed his germ theory. Pasteur was able to prove that disease is linked to germs, and this is one of the most important reasons why people’s attitudes changed. The germ theory proved that the appalling conditions people were living in were causing diseases such as tuberculosis and cholera, and that therefore improvements needed to be made to prevent overcrowding and poor sanitation in the slums that existed in many cities.

Another reason why attitudes to public health changed is because the situation in the towns and cities became so bad that it was difficult to ignore. Industrialisation meant that by 1900 80% of the population lived in towns, most of which had grown incredibly quickly and with little planning. The rapid growth led to the development of slums where overcrowding, poor sanitation and high death rates were common. The situation became so bad that it could not be ignored. Reports into living conditions and cartoons such as ‘At the Court of King Cholera’ were published and also meant that it was difficult to ignore the situation. This led to the government becoming more involved in public health through its Public Health Act, and the Artisans Dwelling Act.

I think that the most important reason for the change in attitude to public health was a combination of both the worsening situation and the work of individuals. The appalling conditions and high mortality rate in cities meant that people realised that something had to be done, but it was the work of Snow, Pasteur and others who proved that the high incidence of disease was not the fault of

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the people who lived in the slums, but rather of the slums themselves. This meant that there had to be change in the form of government intervention to ensure these improvements happened.

The work of Edwin Chadwick was the most important factor in improving the health of towns in the nineteenth century. How far do you agree with this statement? Give reasons for your answer (18 marks)

One side of the argument is: The other side of the argument is:

Evidence I could use for this argument:

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2.

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Evidence I could use for this argument:

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Conclusion:

The most important improvements to public health in Britain happened between 1750-1900.’ How far do you agree with this statement? Give reasons for your answer. (18 marks) N.B This type of question expects you to talk about at least one other time period.

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Britain since 1900 Exam Questions

Write a clear and organised summary that analyses people’s living conditions in the Modern period. Support your answer with examples (9 marks)

Why was the response to the AIDS crisis in 1982-1987 more successful than the response to the Spanish influenza epidemic in 1918-1919? Support your answer with examples (10 marks)

How far do you agree that the most important changes in public health in Britain took place in the twentieth century? Give reasons for your answer (18 marks) N.B This type of question expects you to talk about at least one other time period

For several reasons it can be argued that the most important changes to public health in Britain took place in the twentieth century. The period 1900-2000 was one of really significant change across nearly all aspects of life – health being no exception. The Liberal Welfare reforms at the start of the century were the ground work for the welfare state. Lloyd George’s National Insurance Act and Old Age Pensions had a positive impact on the lives of the working poor, not to mention the improvement of children’s health due to the introduction of free school meals. These first steps were enhanced by the 1919 Housing Act which created Council Houses which had to meet new standards in space, water supply and drainage, these positive steps helped bring an end to the slums of the nineteenth century and improve the quality of life of the poor. As the century progressed the introduction of the NHS in 1948 is further evidence of really important change to public health. Now everyone, irrespective of wealth or status, had access to fully qualified healthcare. Not only that, but the government became increasingly involved in health issues such as smoking which has served to increase life expectancy. However, despite the progress made during the twentieth century change was often slow to come about and a lot of the government initiatives faced huge opposition. Several of the Liberal Welfare reforms were deeply unpopular, for example the National Insurance Act which employers thought went too far and the workers not far enough. Not only this but it can be argued that none of these improvements to public health would have been possible had it not been for groundwork laid in the nineteenth century.

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Whilst the first half of the nineteenth century was undoubtedly one of a laissez faire attitude by the government key events and people brought this to an end. Due to the work of Edwin Chadwick, a Royal commission was formed to investigate water supplies. Dr John Snow proved that cholera was water-borne in 1854 (although it was not universally accepted immediately) and Joseph Bazalgette designed London’s sewer system which had a dramatic impact on the quality of water in the capital. Had this essential work on improving the water supplies not taken place, the lives of the poor especially would have continued to remain threatened by disease. The impact of this work cannot be underestimated and had it not taken place the improvements in drainage and water supply introduced by the Housing Act of 1919 could not have taken place. Further evidence that the most important changes in public health did not happen in the twentieth century was the work of Louis Pasteur in proving germ theory. This was a pivotal turning point in public health as the cause of illness was understood and could, therefore, be prevented and treated. Additionally, during the nineteenth century, the role of government was crucial in bringing about improvements to public health. The Public Health Act of 1875 finally brought about compulsory improvements that had a significant impact on the lives of the working poor such as clean water supplies, sewer systems, rubbish collection etc. By the end of the nineteenth century both local and national government were spending vast amounts of money on providing clean water in towns. Clearly, without this government intervention in the nineteenth century, there would have been no platform for further improvements in the twentieth century.

In conclusion, I disagree that the most important changes to public health took place in the twentieth century. Whilst there were really significant improvements made, notably the Liberal Welfare reforms and the NHS, I would argue that this wouldn’t have been possible had the groundwork not been laid during the nineteenth century. The improved water supplies, sewage systems, and government regulations for new housing had a direct impact on the lives of the working classes. Together with changing attitudes and a shift away from miasma thanks to Pasteur’s germ theory the cause of illness could be understood and combatted which was the key to improving public health.

How far do you agree that the most effective response to epidemics was in the twentieth century? (18 marks) ) N.B This type of question expects you to talk about at least one other time period

One side of the argument is: The other side of the argument is:

Evidence I could use for this argument:

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Evidence I could use for this argument:

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Conclusion:

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‘Beliefs, attitudes and values have been the most important factors in responses to public health.’ How far do you agree with this statement? Give reasons for your answer. (18 marks)

(Only got 15 marks because there was no attempt to explain which of the factors is more important, and so the answer does not reach Level 6.)

I believe that beliefs, attitudes and values have been very important in the responses to public health, and there are many examples of this.

In the Middle Ages, religion was very important to people, and there was little understanding of disease. This meant that when the Black Death struck, people did not understand the cause, and therefore how to react to it. Their religious beliefs led many to believe that it was a punishment from God, and therefore they prayed, or became flagellants in order to prevent themselves catching it. Others felt that astrology was the cause of disease. These supernatural beliefs had a negative effect on responses to public health as they did not look for natural causes.

An attitude that also had a negative effect on responses to public health was that of laissez-faire. This was widely held and meant that successive governments refused to become involved as they believed that they should not interfere in people’s lives. This resulted in the appalling conditions developing in the slums of the new cities, with the resulting high death rates and epidemics. Even when legislation was introduced it was not compulsory, and therefore had a limited effect. During the twentieth century, however, reports by Booth and Rowntree were one of the reasons why this attitude changed, and this resulted in the Liberal social reforms and increased government involvement in responses to public health. It can be seen, therefore, that attitudes were important, both in terms of laissez-faire and also interventionism.

Another belief that affected public health was the belief in miasma — that bad smells cause disease, and even though it was wrong, it did have some good results. Due to miasma, in times of plague or other epidemics, the government tried to clean up the streets to try to prevent the spread of disease. This is why during the Plague, waste from houses was carried away each day and also everyone had to clean the street outside their homes. This would have helped, as it prevented the conditions that encouraged the rats. The belief in miasma was also beneficial in the nineteenth century, as people recognised that outbreaks of cholera were happening in areas with stagnant and bad smelling water, and Chadwick believed that disease was caused by miasma. This meant that the Public Health Act of 1848 attempted to clean up towns and cities to improve the smell, which had a positive effect on health.

There were other factors that were important in the responses to public health, one of which was urbanisation. During the Middle Ages, the higher population living in towns and cities such as London and York meant that gaining access to clean water and disposing of rubbish and sewage became a big problem. Attempts to clean up the streets happened sporadically, and usually when there was an outbreak of disease such as the Black Death. Unfortunately, measures such as the employment of rakers to remove sewage, or forcing butchers to dispose of the carcasses of animals were not effective as the waste was put into nearby rivers, contaminating the water supply. Ineffective measures were also used during the Plague, when all cats and dogs in London had to be killed, thereby allowing for the increase in the number of rats. In addition, these public health measures in the towns and cities were not consistent, and often lapsed at the end of an epidemic.

The biggest impact of urbanisation on public health occurred in the nineteenth century with the rapid growth of industrial areas. This led to overcrowding and extremely poor living conditions. Cholera, typhoid and typhus became common, and spread rapidly through the slums. It was this urbanisation that forced the government to become more involved in public health, since the problem was on such a large scale. The building of sewers, provision of clean water and bath houses were all a result of this, and this government intervention has continued into the twentieth century. New towns such as Stevenage have been built which have been carefully designed to maximise benefits to public health through the provision of parks for example.

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One mark Questions

a) Name one threat to people’s health in medieval towns. [1]

b) Name one threat to people’s health in medieval villages. [1]

c) Give one example of what people in the Middle Ages thought caused the Black Death. [1]

d) Give one example of what people in the middle ages did to try and treat the Black Death. [1]

e) Name one threat to people’s health in early modern towns. [1]

f) Name one law that was passed by the government in response to the gin craze. [1]

g) What year were the Plague Orders introduced? [1]

h) Give one example of how local authorities tried to combat the plague. [1]

i) Give one example of a law passed to improve public health in the nineteenth century [1]

j) Name one reformer in the Industrial period. [1]

k) What year did the ‘Great Stink’ hit London? [1]

l) Who was in charge of building London’s new sewer system in the nineteenth century? [1]

m) Give one example of a government response to AIDS [1]

n) Give one example of a government response to the Spanish Influenza [1]

o) What year was the NHS set up? [1]

p) Give one example of how the government tried to reduce smoking in the modern period [1]

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