3.1 Impetus for public health reforms Flashcards
(96 cards)
1
Q
What was the population growth as a result of the Industrial Revolution?
A
grew from 13 million to over 31 million between 1781 and 1871, and by 1939 it was nearly 48 million
2
Q
Industrialisation impact on towns and cities
A
it created work in factories, mills and foundries, and people flocked into the rapidly growing towns and cities to take advantage of new job opportunities, which forced many to crowd together, living in substandard housing with little supply of clean water or adequate sanitation
3
Q
when was the most rapid population increased in Britain?
A
1811 and 1841
4
Q
Why did death rate fall during industrialisation?
A
- vaccine for smallpox
- agriculture producing higher quality food in high quantity
- textile industry produced cotton cloth that was cheap and easy to buy
5
Q
Birth rate rose due to
A
- lower death rate means more people grew up to have babies
- more babies living in adulthood meant that their generation would have more babies
6
Q
Marriage rate rose due to
A
- farmers didn’t have live-in servants, so it was easier for men and women to start a life
- earlier marriages before contraception meant more babies
7
Q
how did the distribution of population change?
A
in 1801, only 33% of the population lived in towns, and was increased to 50% in 1851 and 72% in 1891
-by 1900 4/5 British citizens were urban dwellers
8
Q
when was civil registration introduced?
A
1837
9
Q
what did civil registration do?
A
there was civil registration of births, death and marriages, which revealed a young, fertile and actively reproducing population in most urban centres
could have pressured the government into implementing reforms to tackle overcrowding problems
epidemics of cholera, smallpox and scarlet fever were recorded and their rate and geographical distribution were analysed by statisticians and used by those pushing for reform in public health
10
Q
why did urban growth cause public health problems?
A
the rate of urban growth was too fast
11
Q
How much did the population grow between 1800 and 1871?
A
775 thousand to around 3000 thousand
12
Q
How did population growth affect living conditions?
A
the influx of people led to a catastrophic effect on existing housing and sanitation provision, resulting in ‘filth diseases’ like typhoid, tuberculosis, cholera
13
Q
How did Industrial Revolution exacerbate housing problems?
A
Bad housing had always been a problem in medieval London, but IR led to widespread, dense overcrowding
14
Q
As a result of overcrowding, what did urban communities do to the existing ‘living’ spaces?
A
They used them up and adapted them to build new dwellings
15
Q
What were cellars and attics used as?
A
used as workspaces by working people and their families
16
Q
Due to industrial revolution, where did working class people live close to?
A
close to factories and mills with polluted air due to the lack of public transport
17
Q
Where did the middle class live during IR
A
they moved out from the industrialising cities
18
Q
What did most housing in the 19th century lack?
A
drainage, sewerage and regular water supply
19
Q
How was human waste treated?
A
they were collected in cesspits and collected by ‘night-soil men’ and sold to farmers
20
Q
Even with flushing in middle-class houses, what happened to the waste?
A
still had to be physically emptied
21
Q
Was water supply available/ accessible?
A
no, it was in short supply and was expensive, water supply was usually controlled by vested interests (private water companies)
22
Q
Where did water companies get water from?
A
either from underground reservoirs, or from local rivers
23
Q
Middle-class people would have water piped to their house, how did the poorer people obtain water?
A
they would queue to buy water when the water company turned on the supply, but most of the time, people were too poor to even buy water so they would just take water from local streams or rivers
24
Q
In the first half of the 19th century, what did overcrowding lead to? (before Germ Theory)
A
the growing numbers of epidemics and disease
25
What disease did the overcrowding issue in houses with lack of water supply cause?
Typhus fever, there were two outbreaks in 1837 and 1839 and in 1847, the outbreak killed 10,000 people in Northwest England
26
What were some diseases that caused a lot of deaths?
Influenza, scarlet fever, tuberculosis, typhoid
27
How many cholera epidemics were there and when did they happen?
4, 1831-32, 1848-49, 1853-54 and 1866
28
How many deaths did the first cholera epidemic result in?
31,000
29
How many deaths did the second cholera epidemic result in?
62,000
30
in the 19th century, which two were the main theories of causes of disease?
miasma and germ theory
31
What is miasma theory?
the idea that diseases are caused by bad air, they thought that miasma, a poisonous gas, was spreading disease through the air
32
Why did the miasma theory made sense to the people?
since industrialisation led to filthy, foul-smelling areas in more cities, and it was these areas that had to highest rates of death due to epidemics and disease
33
How did people solve public health problems during industrialisation based on the miasma theory?
clean cities up, improve housing and sanitation
34
Who developed microscropes?
Joseph Lister in 1830
35
Who developed the germ theory first?
Louis Pasteur in 1860
36
What was Pasteur's Germ Theory?
that micro-organisms exist in the air and were not created by decaying materials, and that different micro-organisms can can cause disease in humans
37
Did people accept Pasteur's Germ Theory?
no, many still believed in miasma theory
38
Which other scientists was able to prove the Germ Theory?
Robert Koch in later 19th century, where he and his team were able to prove that germs caused disease
39
Why did the cholera epidemic cause more fear among the public and legislators?
- high percentages of fatalities (40%-60%)
| - the speed with which cholera could strike
40
How many 'cholera-phobia' riots were there due to fear of the disease?
30, in towns like Birmingham, Bristol, Liverpool etc.
41
What were the Liverpool riots about?
they were rioting against local medical men, who were believed to have murdered cholera victims in order to perform dissection
42
What was the Exeter riot about?
protested against authorities' regulations for the disposal of cholera-infected corpses and their belongings, as well as burying victims in local graveyards
43
What was the political/ social situation like during the riots against cholera?
there were political and social unrests in 1831-32, where pressure amongst people and politicians for reform of parliament was intense
44
What did the government do in response to the cholera outbreak?
they sent 2 medial commissioners in 1831 to Russia (where there was an outbreak too), and set up temporary board of health
45
When was the temporary Board of Health set up?
1831
46
What kind of members made up of Board of Health?
4 fellows of Royal College of Physicians, medical commissioner, civil servants...
47
What was the role of Board of Health?
- advise local government to set up their own boards of health, and appoint inspectors to report on food, housing, bedding
- issued advice, e.g. quarantining, whitewashing houses, provide food and clothing for the poor, temporary fever hospitals
- suggested variety of remedies- e.g. rub castor oil, leeching, bathing
48
What was the significance of the set up of Board of Health?
showed that central government was recognising the importance of cleanliness, adequate clothing and food in improving public health
49
Why was the temporary Board of Health ineffective?
- many cities were frightened by the advance of cholera to set up their own local boards of health
- number of cases that were reported by local boards were given to central boards for information gathering rather than looking for disease prevention/ cure
- hospitals were set up in some areas, and some areas adopted quarantine regime, but the lack of firm knowledge regarding disease meant that many of the measures were just hit or miss affairs
50
Did the temporary Board of Health have any legal rights? How did this impacts it effectiveness
No, it didn’t have any legal right, and individuals were not compelled to have their own houses limed without any legislations in place
- temporary ‘cholera act’ in 1832, to allow local authorities to enforce some measures and finance them from poor rates, but local action was still haphazard, and the local boards of health were only temporary, they disbanded after the 1st cholera had died down
51
Were there any cure for cholera during early 19th century?
No, many people tried avoidance rather than attempt prevention or a cure, most of them fled, or used remedies and preventatives
52
What were some examples of preventative remedies in the early 19th century?
- contagionist theory- cholera was spread by contact with victims- suggested quarantine
- miasma theory- removal of heaps of excrement
- use of patent medicine - which worked for many
- prayer- churches believed that cholera was a punishment for lax and immoral behaviour, so they had to repent
53
Due to lack of scientific knowledge/ proof for causes of disease, how did the government deal with the 2nd cholera epidemic?
the same happened, set up temporary boards of health which disbanded after epidemics, it was only in the 1850s, where scientific advancements allowed more understanding of diseases
54
Except for the will of parliament and the acceptance of the public, what was also important in order for changes to public health to be incentivised?
technological knowledge and practical ability to undertake such reforms
55
Who invented the S-trap? When was it invented? What is it
1775, Alexander Cummings
| - it seals the toilet bowl to prevent foul air from coming out from the sewer
56
Who combined Cummings’s invention with a float valve system for a cistern? What did he invent
Joseph Bramah, he built the first practical, workable flush toilet
57
When was South-Western Pottery opened? What did it manufacture
1856 by George Jennings, it manufactured toilets (water closets) with sanitary ware
58
Were water closets popular?
yes, South-Western Pottery was employing 97 men and 18 boys by 1861, which shows the immense popularity of water closets, particularly among middle classes
59
by the end of 1850s what did the buildings require all new-build homes (usually the middle class) to have?
water closets
60
Who developed and sold the first ‘wash out’ trap water closet? When was it developed?
Thomas William Twyford in 1875
61
What was the impact of Twyford’s development?
In 1888, he was granted a patent where the toilet pan was refilled with small quantity of clean water to improve flushing, and this has remained the standard water closet throughout the late 19th and early 20th century
62
Why was the disposal of waste into rivers an ideal system to removal of waste?
Because it was a cheap and easy solution, and given the prevalence of the belief in the miasma theory of the spread of disease, the washing away of bad air through the river seemed ideal
63
What were the problems of the sewer system in late 19th century before the development of sewerages?
the sewerage had rough walls, and the inadequate connection of sewers, intermittent volumes of water and inadequate slopes meant solids accumulated and only heavy storms would flush them clean
64
What did John Roe do in 1842?
he invented a system of flushing gates to control the flow of liquids, and cast iron gates were fixed in the sewers so that it will only be opened when there is sufficient accumulation of water-borne sewerage behind them to allow the force of water to flush the waste away
65
When did sewers become self-flushing?
1870s and 1880s
66
What did the construction of an effective sewerage system involve?
the production of millions of bricks and tonnes of cement, with transport infrastructure to deliver them to where they were needed
67
What were the limitations of the advancements made in the sewerage system?
the problem of what should be flushed in the sewers, since discharging untreated sewage into the the natural water system was a problem (with the increased understanding about the transmission of disease)
68
What was done to treat the waste in sewers before they were discharged? When did a breakthrough come that improve the sewage treatment system?
Some cities attempted to treat the waste by adding sedimentation system to their sewers. A breakthrough came in 1912 when scientists developed the sewage treatment system of activated sludge, where the sewage was biologically treated to make it safe
69
Which two supplies were in the hands of private companies for the most of the 19th century?
water supply and sewerage
70
What was the drawback of having water supply and provision of sewerage be in the hands of private companies?
since whether or not companies took advantage of new technologies depended much on shareholders, who were guided by the need to make good profit on their investment
71
What were some examples of private companies investing in modernising and using the latest equipments?
- 1802, Lambeth Waterworks replaced its wooden pipes to cast iron ones
- 1822, the Southwark Water Company extracted water from River Thames using stream engines to pump it to a cistern at the top of an 18-metre-high tower before being piped to customers
- 1838, Grand Junction Waterworks Company built a pumping station near Kew Bridge on the River Thames to house 3 steam pumps, and water was taken from the middle of the river and pumped into filtering reservoirs and a 61-metre high water tower that used gravity feed to supply the area
72
What was a major problems despite having companies building reservoirs to enable reliable supply of water?
water from rivers were polluted by industrial and faecal waste, and there was a lack of knowledge that disease could be water-borne
73
How did novelists help change attitudes towards public health in the early 19th century?
Charles Dickens and Elizabeth Gaskell created vivid pen-pictures of working-class living conditions in mid-Victorian Britain, Dickens focused on London, with first-hand experience of poverty
74
How did novelists help change attitudes towards public health in the early 20th century?
-George Orwell in 1937 documented the bleak living conditions of many working-class people in Yorkshire and Lancashire
75
How did national and local newspapers help change attitudes towards public health?
- by reporting on public health matters non-favourably
- local outbreaks of scarlet fever and typhoid were reported with connections made between poor living conditions and diseases
- ‘The Times’ newspaper headed a campaign for effective sewerage of London as a result of the ‘Great Stink’ on 1858
76
How did artists help change attitudes towards public health?
- they created paintings and engraving of the rural and urban poor, usually incorporating street scenes and interiors
- helped influence novelists to write about the urban poor and destitute (e.g. Dickens was a great admirer of Sir Luke Fildes, who created engraving of London’s streets)
77
Why weren’t artworks impactful in changing attitudes towards public health?
because artworks were usually brought and hung on middle-class walls for their sentimental value, having the rural poor presented as romantic idylls, rather than motivating them to take action to improve public health
78
Doctors, parishes and county council started doing__ that allowed the production of statistical evidence to illustrate the connection between population density and overcrowding, and death and disease
they improved their record-keeping facilities
79
What did the report by the Medical Officer of Health in London in 1892 reveal?
that as percentage of total population overcrowded rises, the death rates rises as well
80
What did the increasing scientific knowledge and understanding about the causes of water-borne and sanitation-related diseases lead to?
Increased public awareness about the need for clean water, sewerage and drainage in general and encouraged the emergence of Health and Sanitation Committees to pressurise councils and the government to take action
81
When was the Health of Towns Association established? What was its roles?
1844, it aimed to carry out a propaganda campaigns or public health legislation, and members would give public lectures, publish and distribute informative pamphlets and produce a weekly sheet of facts and figures
82
When was an example of a Royal Commission that was set up in 1843 to investigate the living conditions of the poor and authorise a range of investigations during the period?
Royal Commission for Enquiry into the State of Large Towns and Populous Districts
83
What was another factor that played a huge rule in changing the attitude of public health reforms? (except for scientific knowledge, artists and novelists)
Economic imperatives, the cost of not undertaking reforms
84
How did the lack of public reform affect the workforce?
The cost of losing a productive worker to one of the ‘dirty’ diseases
85
How did the Poor Law put more strain on the costs?
- the costs of maintaining workhouses and paying of relief rose
- instead, there was a reduction of poor rates after providing good drains and clean water, so the reduction of taxes and rates gave them an incentive to carry out reforms
86
Who was paying for clean water and drains? How was this an incentive to carry out reforms
Usually the householders, the middle class pay for clean water and drains. Landlords also had to pay for clean water and drainage, which meant that they had to raise the rent to cover the costs. However, the poor was not able to pay for it, which will throw more of them into pauperism. As a result, the local authorities should take control responsibility for the public health of the local area instead to break this cycle
87
In 1780, did government involve in social policy? Who did they think was responsible for public health and why?
Their involvement was minimal, they thought that parishes were responsible for public health, since the idea of laissez faire was prevalent at that time
88
What did the Representation of the People Act 1832 do?
Allowed greater representation from the growing industrial towns of the Midlands and the North
89
Was the Representation of the People Act 1832 impactful on public health reform?
No, even though in theory, more attention on p.h. reform would be given due to wider representation, middle-class representation, who wanted to keep rates low, was more important for MPs, meaning that sanitary reform was not prioritised. They still thought that p.h. reforms should be the business of local authorities rather than parliament
90
What did the Municipal Corporations Act 1835 do?
Borough councils were to be elected by male ratepayers for a three-year term in office instead of having them re-appoint themselves yearly.
- stated that councils could assume control of paving, sewerage, street cleaning and drainage in their areas
91
Was Municipal Corporations Act 1835 impactful on public health?
In theory, the fact that councils were elected by ratepayers meant that the more progressive councils would want to focus on public health reforms, but in practice, it was not the case.
- councils' control of paving, sewerage etc. required an Act of Parliament, which was expensive
- showed that central government showed little interest in public health, it was the town councils' affair rather than gov.
92
What was the impact of the 1844 Report of the Royal Commission into the Sanitary Condition of Large Towns and Populous Districts?
It was a mid-century assessment of the sanitary condition of Britain, and immediately after it was published, some minor legislation on public health were implemented
93
What legislations were implemented after the 1844 Report of the Royal Commission?
- 1846-- series of Nuisance Removal Acts, which enabled justices to prosecute anyone responsible for 'nuisances'
- Baths and Washhouses Act 1846-- enabled local authorities to provide baths and washhouses out of public money
- 1847- Towns Improvement Clauses Act- right of towns to lay water supplies and drainage schemes and to control nuisances, legalised discharge of sewage into rivers and seas
94
Why was there continued opposition to public health provision in the 1850s and 1860s? (6)
- issues varies in importance from place to place, and local priorities changed over time- so lack of universal implementation
- cost of improvement schemes- property owners didn't want to pay more tax to provide for their neighbours that did not benefit them at all
- government encroaching on their individual liberties by requiring them to e.g. whitewash a slaughterhouse
- vested interests unlikely to vote for measures that would reduce profits
- civil engineering problems and water supply schemes were not understood by local boards of health- led to delay/ implementation of inappropriate schemes
- Chadwick- angered many due to his bullying tactics
95
During late 19th century, what were the pressures for further change? (5)
- 1867- Parliamentary Reform Act gave the vote to working men in towns, so politicians had to listen to their problems
- third cholera epidemic in 1865-1866 (20,000 deaths)
- 1865- Pasteur proved that germs caused disease
- 1869- Royal Commission of p.h. set up, which revealed the poor conditions in towns
- 1871- Local Government Board set up
96
What was the role of the Local Government Board?
it consolidated the functions of the Local Government Act Office, the Registrar-General's Office and medical department of the Privy Council and Poor Law Board- centralisation of power
