THE NEW PUBLIC HEALTH Stephen R Leeder 7 March 2005 James Cook University, Townsville Introduction All of us here today are public health enthusiasts. If we weren’t we would be….
Improvements in Public Health
Between 1840 and 1900 living conditions in towns improved. How did the work of government, local councils and individuals bring this about? In this essay I will discuss the conditions in towns between 1840 and 1900 and the improvements in Public health since 1840. While doing this I will link reasons together to achieve my final conclusion. I will begin with an explanation of living conditions in towns and cities in the early 19th century. Living in the early 19th Century was very tough for most people. At least 80% were working class.
Houses where small and over crowded allowing diseases to spread easily. The air was polluted, poor and environment unhealthy because the people did not know about the causes and consequences of pollution. For example, coal burning from houses and factories was polluting the environment, but it was the main source of fuel. The environment was not just damaged by coal burning and the resulting sulphur dioxide and carbon dioxide, it was also unbearable because of the terrible smell and insanitary living conditions.
The smell was caused by the lack of sewerage system, public toilets (as only rich people could afford a toilet in the house), dirty water; unhygienic disposal of waste and the fact that cleaning methods were inadequate – no reliable products. The filth was particularly bad in the Soho district of London. In the late summer of 1854 there was a sudden outbreak of cholera. Dr John Snow quoted that it was “the most terrible outbreak of cholera which ever occurred in the kingdom. ” Over the first 3 days of September 127 people died that lived on or near Broad Street.
In some parts of the city the mortality rate was just 12. 8%. Nobody knew were it came from. The city stunk of human waste and the river Thames was a sewer. As the city grew the waste was increasing. When there was heavy rain the basements were flooded. This meant that people living in the basement and the rest of the house were in contact with raw sewerage and this would also attract disease and vermin and spread infections. Everyone wanted a clean fresh city where they could breathe clean air, drink and wash in clean water and live and keep their belongings in clean houses.
I believe that people’s ignorance to the effects of their actions and the fact that they had no alternatives had a big impact on the living conditions in the early 19th century. This is because many people were so poor and uneducated; they had no choice but to live in these conditions. This was particularly relevant in London and main industrialised towns and cities where people moved from the country because many were losing their jobs. This was because the invention of machinery on work and therefore forced people to evacuate to bigger cities with more work needed.
In the country they may only have been able to get seasonal work in the fields and they dreamt of a better life in the city where there was more regular work available in the factories. They needed to live in the bigger towns to have the opportunity to earn money in factories and workhouses. As London was rapidly growing, the health conditions got worse. Streets were filled with rubbish and dead animals and never cleaned. Street cleaners only clean roads with people living there who could afford to pay their wages.
The fact that there was little public services for example there was no national health services and you had to pay for the health services, there was no clean running water, poor structured houses full of people, filth and germs round every corner and the fact that the homeless children and even some adults, as seen in the cartoon bellow, where rolling around in the waste on the streets. The picture is a cartoon drawn at a time when the government believed that looking after the poor, the old and the sick was the job of individuals and their families.
They also believed in individualism and self help believing that if the government did too much for people they would become weak and dependent. This was named laissez faire. This is French for do little or nothing. It was there duty to make laws and deal with wars, but not to ‘babysit’ the community. At the end of the 19th century, the city life was improving little by little. New laws, such as the 1875 Artisan’s Dwelling Act, meant that better housing was being built. It was an act of the parliament designed by Richard Cross, Home Secretary.
The Act made the owners give their slums to the council so they could demolish the areas of slum housing to be redeveloped by commercial builders with low interest. The Artisans Dwelling Act of 1885 was considered one of most significant acts of the Prime Minister, Benjamin Disraeli’s presidency. The improvements to public heath brought real benefits. By this time cities had facilities to meet all kinds of interests, from dance halls to chapels. People joined together in a wide range of clubs and societies. There were nearly 700,000 allotments by 1881.
Allotment holders held competitions for flowers and vegetables. Enthusiasts, usually men, took time to trouble over breeding birds such as pigeons or canaries. Choirs were very popular, usually as part of church or chapel life. Many played in brass bands, often sponsored by a factory-owner. By the end of the century, cycling had become a popular hobby with both sexes. Thousands began to spend their Saturday watching sport. Various kinds of football had been popular for centuries. They were crude rough games, with few rules. Now people lived in clean houses and apartments.
In Birmingham Joseph Chamberlain made calls for slum clearance, improved housing, municipalisation of public utilities and higher taxes for the rich. He was elected as mayor of Birmingham in 1876. The middle class of Birmingham adored chamberlain. They all voted for what he fought for. He soon became Prime Minister William Ewart Gladstone’s lieutenant in the House of Commons and later in 1882 was appointed president of the Board of Trade in Gladstone’s second ministry. The Municipal Corporations Act of 1835 was an act of Parliament that rehabilitated local government. It split the country into districts.
Each district was responsible for running local services such as housing and education. They had commissioners to be in charge of each local council. The royal commission had eighteen members, two members for each district. A new law was made so middle class people were aloud to participate in the local council. They had annual elections each year, were a third of the council members up for election. They also elected aldermen to be part of the council with a six year term. Towns were divided into smaller areas were they had a local person to represent them on the local council.
As previously highlighted in the early 19th century overcrowding, poverty, dirty environment and insanitary housing lead to disease. In 1843 Edwin Chadwick argued that poverty was caused by disease and that by curing diseases poverty would be reduced. Joseph Bazelgette who designed the sewage system, made sure that the flow of foul water and underground rivers was diverted along new sewers and taken the sewage treatment works and then pumped into Tidal Thames where it would be carried out to sea rather than stay in the previous “open sewer” of the Thames.
His design was so good it has stood up to increases in volume of raw sewage. In 1848 the cholera epidemic spurred the government into action through public health measures followed by health measures for individuals. Many people thought cholera was air bourn but John Snow thought it entered the body through the mouth. He investigated a cholera outbreak in 1854 and carefully plotted all cases on a map of Soho where the outbreak occurred. He managed to identify a water pump as the source of the disease. When he removed the handle the causes of cholera immediately declined.
It took another six years before this theory was more widely accepted. John Snow also made development in anaesthetics and made them safer and more effective for use on humans. Public health measures included: – The public health of 1888 gave all towns the right to employ a public health officer. – In 1853 public vaccinations against small pox were made compulsory. – In 1854 influence by Florence Nightingale and other campaigners, hospital hygiene was improved and hospitals became much cleaner places, helping to prevent the spread of disease.
The 1875 Public Health Act required the clearance off slums, the installation of sewers, clean water supplies and better environment to live in. This was very successful as public health improved and local councils competed to be the best public health provider. This lead to the individual health measures introduced in the early 20th century e. g. free school meals in 1906, medical examinations for all children in 1907. Old age pensions introduced and in 1911 National Insurance (free medical treatment for workers. During the 19th century knowledge about the ways bodies work increased. William Beaumont (1822) studied the digestive system. Theodor Schwann (1858) realised that animal tissues were made of cells. Henry Gray (1858) wrote Grays anatomy and people started to have a broad knowledge of how their bodies worked. Louis Pasteur discussed that germs can cause disease rather that’s the previous theory of spontaneous generation where diseases cause germs. This also led to the pasteurisation of milk.
Robert Kock studied bacteria further and identified bacteria specific to the diseases septicaemia, TB and cholera and others discovered the bacteria that caused typhoid pneumonia and the plague. Patrick Manson 1879 discovered that diseases could be spread by vectors such as flies. Charles Chamberlain (1884) discovered viruses. Therefore understanding of disease was improving rapidly and there were some inventions that helped the treatment of disease also, e. g. multi lens microscope (Lister 1826) kymograph to measure pulse (1847 Ludwig) and x-rays (Roentgen 1895).
At the beginning of the 19th century doctors would only provide comfort but by the end they could treat diseases and heal some patients with surgery. I believe the living conditions between 1840 and 1900 did improve. The government and local councils brought this about by clearing slums and areas of bad, dirty housing, supporting improvements in biology knowledge cleaning up sewers and improving local government, encouraging people to help themselves and no longer accepting poverty as something that can not be dealt with.