3.2 Changes in public health Flashcards
(109 cards)
1
Q
How was parliamentry legislation at first?
A
tentative, with permissive acts that could be accessed should local authorities wish to do so
2
Q
When did government become committed to public health (PH) and when were acts dealing with Public Health compulsory?
A
Early years of the 20th century. Clean water and effectice sanitation were no longer optional
3
Q
Was central or local gov more powerful?
A
Central gov could legislate for public health, but it was in the localities that it was implemented; when central gov was permissive, a local council could decide to spend money on civic buildings rather than on drains; even PH acts had to be implented by local councils
4
Q
Why was there a slow change to local and central involvement in public health?
A
Unprecedented population growth in the 19th century
5
Q
If local gov had more prominent intervention, did this mean that local authoroties ignored the issue of public health?
A
No. Pioneering work was done in certain towns and cities by individual medics and admins
6
Q
Who was behind the formation of the Manchester Board of Health in 1795?
A
Thomas Perceval and John Ferriar.
7
Q
Who published reports in Scotland on public health in the early 19th century that prompted authorities to act?
A
Robert Graham, Robert Cowan and James Cleland
8
Q
Problems with Scottish reports?
A
Piecemeal and initaives were only local. Due to diff local admin w/ diff ppl and diff priorities, public health schemes wld collapse
9
Q
What else was piecemeal?
A
Private Acts of Parliament secured by local authorities relating to PH.
10
Q
How many Acts of Parliamnent did London operate under?
A
In London, there were 300 diff bodies w/ an interest in PH and these operated under 250 Acts of Parliament
11
Q
How many paving baords did St Pancras have?
A
The London parish had 16 paving boards, responsible for paving the streets of the parish under 29 Acts of Parliament
12
Q
What went wrong with St Pancras and the many Acts of Parliament?
A
Admin nightmare and repeated throughout Britain i.e in Lancashire and Exeter. These allowed commissioners to be elected by ratepayers to deal w/ specific problems depicted by the Acts
13
Q
What was Vested interests?
A
The ppl more likely to support a measure if they will benefit frm the measure; they were night soil men to clergy and owners of water companies who were either paid off or represented on the improvement committees themselves.
14
Q
What did Leeds and Manchester do when taking advantage of their new status under the Municipal Corporations Act?
A
The Municipal Corporations Act 1835 meant that both towns assumed control of paving, sewerage, street cleaning, and draining. However, they still needed a private Act of Parliament to help them do it, and it was not cheap.
15
Q
What happened when Liverpool obtained a Sanitary Act in 1846?
A
The Sanitary Act made the corporation a health authority and empowered it to appoint a medical officer of health. Thus, the town council was given power to carry out improvements to sewerage, drainage, and water supply.
16
Q
Who was the first medical officer of health in Britain?
A
WH Duncan (appointed by Liverpol town council)
17
Q
What overshadowed the immediate implementation of the 1848 PH Act?
A
Second cholera outbreak that hit Britain. Plus, it was easy for the Act to be undermined so its effectiveness was patchy
18
Q
Three successes of the PH Act 1848?
A
Start of 1850 = 192 towns asked for the new ph regulations to be applied & the Act had been applied to 32 of them; by 1853= this rose to 284 petitions & there were 182 towns where the Act was applied; there were town councils that took the Act further through private Acts of Parliament that gave them more sweeping powers
19
Q
Three failures of the PH Act 1848?
A
- Lancashire = only 40k of its 2.5 mil ppl were living under some sort of PH board. 2. Of the 187 major towns in the UK, only 29 had the powers of draining & cleansing; 30 had absolutely no powers over PH because powers were in the hands of independent commissionders; 62 had no PH authority whatsover. 3. Local boards of health (BOH) were often j the existing town corporation under a diff guise, so movved slowly, hesistantly, and cautiously.
20
Q
Why did the PH act od 1848 not have that much impact compared to the Poor Law Amendment Act 1834?
A
public and gov were not convinved that order needed to be brought into the private Acts relating to PH, no existing structure that cld be reformed; med knowledge was not giving clear msgs, vested interests in water companies, local commissioners scared of losing their job
21
Q
How was the PH act of 1848 a turning point?
A
Marked the start of the state’s intervention in PH, and the start of the termination of the need for private Acts of parliament to deliver PH for those whom councils were responsible for. In the years to 1939, increased understanding abt the causes, transmission, and prevention of disease, the pioneering work of individuals and willingness of authorities to support PH initiatives meant PH improved.
22
Q
What did the health of the poor and vulnerable rely on?
A
Provision of good quality & cheap housing. Clean water supply, sewerage systemm, and knowledge abt disease transmission meant nothing if the poor lived in overcrowded conditions
23
Q
What towns and cities inserted clauses into their own Improvement Acts that let them control buildings, sewerage connections, and cellar dwellings?
A
Leeds & Liverpool in 1842, Manchester in 1844/45, Nottingham and St Helens in 1845, London Metropolitan Building Act 1844 ( all newly constructed buildings within 30 feet of a common sewer to be connected to it.)
24
Q
Problems with giving city authorities control?
A
Giving control was not the same as the authority acting; w/o a building inspectorate, 100s of new buildings didn’t conform to the supposed regulations implemented.
25
What did the Local Gov Act 1858 do?
Set out model by-laws & 10 yrs later = 568 towns used them.
26
Problems w/ Local Gov Act 1858?
Although building regulations were available in the 1860s, their impact was not so good. Vested interests fought them thru local courts; localities developed their own variants, and problems w/ enforcement. PH Act of 1975 that clearly set out the powers of local authorities were in regards to building regulations. So bcuz of the firmness & clarity of the PH act, local gov laid down by-laws in 1877 like systems of drainage, building height, and street width.
27
Other building regulations implemented that would expedite the effect on PH?
1) The Common Lodgings House Act 1851 & 53 made all lodgings registered and inspected by cops; however, rarely enforced and badly drafted. 2) A Nuisances Removal Act 1855 empowered authorities to combat overcrowding as a nuisance w/ fines etc. 3) The Sanitary Act 1866 placed limitations on using cellars for occupation 4) The Artisans and Labourers' Dwellings Act 1868 gave local councils the power to force a landlord to repair an insanitary hse. 5) The Artisans' and Labourers' Dwellings Improvement Act 1875 gave local councils the power to clear whole districts, not j hses.
28
What did Brimingham's mayor (Joseph Chamberlain) do?
The last two acts were permissive. Chamberlain started a huge slum clearance programme; town council bought slum houses to replace them w/ law courts and shopping centre
29
What did PM Lloyd George promise WW1 soldiers?
that they'll return to a land 'fit for heroes' (in relation to house building)
30
Problems in 1918?
rise in the cost of building materials slowed any rebuilding programs + poor workers cldnt afford hses
31
What was the Housing Act 1919?
gov subsidies given to local councils & private builders to enable them to build affordable housing for ppl on low incomes. Called council houses; had waiting lists
32
What happened 11 yrs after 1919?
Gov offered councils a special slum clearance subsidy to encourage councils to pull down slums; was not good as in 1933 councils asked to prep 5 yr program to remove slums
33
What was housing like by 1939?
Most houses in towns and cities had piped water and were connected to a sewerage system. Only 50% had a hot water tap and a fixed bath.
34
What did George Peabody do for housing?
He founded Peabody Donation Fund to provide model dwellings for the London poor. First block of flats opened in Spitalfields in 1864 with toilets, baths and laundry facilities. Larger estates were built in e.g. Westminster. By 1882, the Trust was housing more than 14,600 people in 3500 dwellings; 1939= 8k dwellings & 33k ppl
35
What did Titus Salt do for housing?
Bradford mill owner. In 1850s moved his factory & its workers into purpose-built village of Saltaire. Had mill, houses, school, park, alms-houses, hospital. BUT Strict rules (e.g. no union joining
36
What did Octavia Hill do for housing?
Bought run-down artisans' cottages, renovated them. Let them out at low rents to poor ppl. Mid 1870s had 3k tenants. Worked w team of women rent collectors. Believer in self-help and self-sufficiency for poor
37
What did Ebenezer Howard do?
Wrote 'To-Morrow: A peaceful Path to Real Reform' in 1898. Developed theory that ppl should live in harmony w nature in towns where there was lots of green space. Started garden city movement. E.g. Letchworth built - 1st garden city
38
What did William Lever do?
New site for his soap making business & new model village for his workers. 1899-1914: 800 houses were built at Port Sunlight w allotments, cottage hospital, schools, concert hall, open-air swimming pool, church. Introduced welfare schemes & provided entertainment
39
How many people did the 1837-40 Smallpox epidemic kill?
42,000
40
What was done to combat Smallpox (apart frm vaccine as there alr was one but sm anti vaxxers)?
1) Permissive Vaccination Act 1840: vaccine available to everyone free of charge, Poor Law medical officers gave it out 2) Compulsory Vaccination Act 1853: obligatory for parents to vaccinate their children w/in 3 months of birth. If failed to comply = £1 fine, money went towards the poor rate
41
How many people did the 2nd smallpox epidemic kill (1870-73)?
44,000
42
What was done to combat Smallpox epidemic pt2?
Compulsory Vaccination Act 1871: obligatory for local health boards to appoint vaccination officers & imposed fines of 25 shillings on parents who refused to have their child vaccinated.
43
What opposition was there to the smallpox vaccine?
rights of individual, fear of central government intervention in local gov, religious objections
44
Eg of anti-vax movement?
Leicester = deaths frm smallpox fell w/o vaccines; infected ppl & contacts were quarantined; disinfected hses of quartiners & burning their clothes/bedding; 1869 Leicester Anti-Vaccination League formed to carry out campaign against central gov's compulsion
45
How were anti-vax fears reduced?
1898 insertion of a 'conscience clause' in the Smallpox Act; end of yr = 203,143 exemption certificates issued. Lancashire parents accounted for 1/3 of apps, Leicester parents requested 28,524 certificates for bbys
46
What was the negative side of having an exemption certificate?
It was difficult to get life insurance, rent a room, or get a job without a vaccination certificate.
47
How many babies were unvaccinated in 1875?
3.8% which rose to 26.6% by 1898
48
What did the public anger towards vaccines show?
That gov initiatives & scientific discoveries werent enough; co-operation of local gov officials, local docs & medical officers were needed
49
Why were some local councils unwilling to appoint medical officers?
They were expensive + 'unseen'. Most town councillors were elected on the promise of keeping rates low, so tension b/w low rates and raising money for sanitation
50
When did Leicester appoint two medical officers of health?
1846. The effectiveness of PH locally depended on the medical officer of health
51
Who did Liverpool appoint and when?
Dr Duncan in 1847. He was seen as the ideal model for other towns to follow, not Leicester's officers
52
What did Dr Duncan do?
His work provided a model for other cities and towns to follow. He was a physician, respected lecturer in medicine and his interest in public health showed other towns that it must be important.
53
Who did London appoint as a medical officer of health?
John Simon; he and Duncan helped provide evidence for importance of the medical officer role
54
When did Leeds appoint a medical officer of health?
1868 (considered late)
55
When was having a medical officer of health made compulsory?
Public Health Act 1875; however, only 50 med officers of health holding full-time positions in UK. End of 1800s = PH became more accepted and it was a clear issue that needed commitment
56
What did the Local Government Act of 1888 say about medical officers of health?
All medical officers of health in districts with a population of over 50,000 had to be qualified doctors holding a diploma in sanitary science, state medicine, or public health. Med officers had low pay so they had to do additional work to earn $; also job uncertainty/no stability
57
What is TB?
Largest 19th century killer (possibly accounted for 1/3 of all deaths frm disease); an infectious respiratory disease caused by bacteria. Attacked the lungs of an infected person. transmitted through coughs or sneezes and also transmitted in infected cows' milk.
58
What are some examples of the actions taken to stop TB's spread?
Oldham = medical officer ordered leafleting all houses, said TB was transmitted in the spit of an infected person. Spitting in public spaces & railway carriages was forbidden. Advised burning all handkerchiefs. Brighton had similar leaflets, urged people to only spit in bowls provided
59
What year did the Ministry of Health order pasteurization of milk to prevent spread of TB from cattles to humans?
1922 (had to be locally admin'ed tho). These actions on a local basis brought home how simple and achievable it was to help stop TB spread (using ventilation, space, piped water and sewerage)
60
When was an act passed making pasturised milk free/subsidised for school kids?
1934
61
By 1937, how many children received school milk?
3.2 million (for free or at 1/2d for one-third of a pint)
62
What was seen as the most effective 'cure' for TB in the years to 1939?
fresh air, sunlight, good food & rest. Sanatoria: by 1911 there were 84 providing 11k beds. By 1930 there were 500 providing 25k beds
63
What was the Education (Provision of Meals) Act 1906?
Local authorities could use public money to provide free school meals for children of needy parents. Made clear that parents' of children who took advantage of free meals weren't paupers. This is cuz of fears that children were unfit to sustain the Imperial army
64
What was the Education (Administrative Provisions) Act 1907?
Set up school medical services (BOE emphasised importance of the co-ordination of med work & other branches of PH; urged all local edu authorities to appoint same med officer of health and schl med officer). By 1935 there were 2300 doctors and 5300 school nurses. 1650 school clinics provided medical treatments.
65
What did the Children and Young Persons' Act 1908 do?
Made children protected, this meant persons and parents could be prosecuted for neglect and cruelty. Poor Law authorities visited & supervised kids who suffered frm cruelty. Nursing and private children's homes had to be registered and inspected. Pub owners were forbidden to let children under 14 into pubs. Children under 16 weren't allowed to buy cigarettes. Juvenile courts and remand homes set up to separate children from adult offenders.
66
What was Edward Jenner's significance (1749-1823)?
Discovered the vaccine for smallpox. The vaccine wasn't initially accepted so had to publish his findings at his own expense & called his technique vaccination. 100+ Drs signed letter supporting him, so parliament gave £30k to establish vaccination clinic
67
How many ppl did smallpox kill under E Jenner's time?
10% of the population; rose to 20% in towns where poor living conditions and overcrowding enabled the infection to spread easily. Accounted for 1/3 of children deaths.
68
What was inoculation?
Giving someone a mild dose of a disease to help boost immunity. It was hit/miss as sometimes the inoculated person wld develop a disfiguring version of the disease and die
69
Why did Jenner become interested in vaccination?
He had heard stories about how cowpox could prevent people from getting smallpox, so he wanted to investigate this.
70
How did Edward Jenner discover the smallpox vaccine in his 1796 experiment?
Sarah Nelmes (dairymaid) consulted Jenner because she'd caught cowpox from Blossom the cow. He took pus from her blisters & rubbed it onto scratches of James Phipps (8yr old son of his gardener), who developed mild fever. Several months later he inoculated James with smallpox matter and no disease followed. Jenner repeated the experiment with 23 different patients and none of them caught smallpox. This showed that cowpox gave immunity against smallpox.
71
Where did Edward Jenner submit his findings to and why did they refuse to publish them?
To the Royal Society. Refused to publish them because he was a country doctor, cowpox unheard of, Jenner couldn't explain why his experimentation worked
72
What was Edwin Chadwick's significance (1800-90)?
When working for the Poor Law Commission, he made the connection between poor public health & pauperism (typhus 1837-38 led to an inc in poverty relief applicants). He was one of the 1st commissioners on the General BoH. but he was unpopular therefore was forced to resign. Innovative administrator
73
What led to Chadwick's commissioning of his report/investigation/enquiry?
Due to Typhus epidemic, East Poor Law guardians spent money from the poor rates on removing filth from the streets and prosecuting negligent landlords. Chadwick defended this expenditure
74
Who did Chadwick choose for his enquiry?
Neil Arnott - A ship's surgeon for the East India Company. He had an interest in improving seamen's health and had made considerable progress in identifying connections between 'exotic' diseases like cholera.
James Kay - He had worked among the poor and reported on the poor in Manchester.
Southwood Smith - He had worked for over 10 years at the London Fever Hospital and as a physician to the Eastern Dispensary and the Jews' hospital in Whitechapel.
75
What did Chadwick's initial reports from London demonstrate?
They stated that although sanitary improvements would be expensive, the cost of pauperism from inaction would be higher. In areas inhibited by thousands of people, healthy conditions couldn't be achieved. It also concluded that personal habits of people weren't as significant in causing disease as overcrowding, poor ventilation, an inadequate water supply and a lack of proper refuse control.
76
Was Chadwick's report accepted?
No. The Tories of 1842 rejected it by using a delaying tactic -- setting up a Royal Commission, which received regular briefings from Chadwick w/ stats. The Commission's report, published in 1844, maintained Chadwick's findings
77
When was the Report on the Sanitary Condition of the Labouring Population of Great Britain published?
1842. The 1848 Pub Health Act was passed due to Chadwick's report + the Royal Commission's report
78
Thus, what was Chadwick appointed as?
He was appointed as one of the General Board of Health's sanitary commissioners.
79
What did Chadwick do?
He recommended egg-shaped earthenware pipes to carry sewage and banned shallow drinking wells, this meant there was less contaminated drinking water.
80
When did Chadwick agree to resign?
1854 as the general BOH wasnt well liked abd its imperious & directives were resented (due to Chadwick's impatience)
81
How did Chadwick's work continue?
He was awarded a pension of £1000 a year and so he continued to give voluntary advice on all issues sanitation and health. In January 1884, he was appointed the first president of the Association of Sanitary Inspectors and received a knighthood in the following year.
82
What was John Snow's significance (1813-58)?
Discovered cholera was water-borne. Initially, no one accepted his findings until John Simon's study. Broad Street Pump
83
When were the four cholera epidemics in Britain?
1) 1831-1832 - 32,000 deaths.
2) 1848-1849 - 62,000 deaths.
3) 1853-1854 - 20,000 deaths.
4) 1866-1867 - 14,000 deaths.
84
How did John Snow discover cholera was water-borne?
Cholera outbreak in Frith Street in Soho, London. suspicions fell upon Broad Street pump. He persuaded authorities to shut it down. Deaths fell. To make it scientific so it wld be accepted, Snow did a detailed report of the deaths in the area during the 1853-54 cholera epidemic. Anecdotal evidence: a widow (who lived in area before) had large bottle of water from broad street pump delivered because she liked the taste - she died. 7 workmen who lived outside area but drank their water died, 18/200 factory workers who got their water from Broad Street pump died, 535 inmates in workhouse near broad street, got their water frm somewhere else, but 5 died
85
What problems did John Snow have?
Even after Snow's theory w/ anecdotes, he had problems with making the scientific and medical communities believe there was a link between contaminated water and cholera. The idea that cholera was water-borne was ref to as 'Dr Snow's Theory'
86
What was John Simon's study (a medical officer of health) on (that supported Snow's findings)?
Covered 500k south Londoners. Published in 1856. Showed customers of Lambeth water Company had death rate of 37 per 1k in 1854 cholera epidemic WHEREAS Southwark H2O Company had 130 per 1k dead. Lambeth = water from up river from London, Southwark = water from outflowing sewer in Battersea (supported Snow's findings of water-borne cholera)
87
How long did it take for the medical establishment to accept that cholera was a water-borne disease?
Another 14 years. It was not until 1870 that Snow's breakthrough was universally acclaimed. Thus, Privy Council abandoned miasmic theory of disease
88
What was Joseph Bazalgette's significance (1819-91)?
Drew up plans in which large sewers took waste far to the east of London where it could be pumped into tidal part of River Thames and be swept out to sea. Members of Board & its boss locked in arguments w/ Joseph about money until summer 1858. Combined idas and tech.
89
Explain London Local Government.
It was chaotic, with various different specialist authorities and improvement commissions having authority over different streets or even parts of streets. All of these bodies had to agree to provide services, making PH initiatives impossible to implement.
90
What happened in 1837?
There was an attempt to set up a London-wide elected authority to provide and administer services, but it was defeated by the vested interests of wealthy districts Marylebone and Westminster.
91
What happened in 1854 and 1855?
1854= attempts to raionalise the admin of london. The Royal Commission of London proposed dividing into 7 boroughs each represented on a Metrpolitan Body of Works (role = secure the efficient maintenance of the sewer system). The boroughs proposal was eradicated, but the Met Body of Works was set up in 1855
92
When did the Metropolitan Body of Works appoint Bazalgette as chief engineer?
1856
93
What was Balzagette's plan?
London's sewage was channelled through miles of street sewers into a series of larger intercepting sewers. These large sewers took the waste far to the east of London where it could be pumped into the tidal part of the River Thames. However, there were money arguments until summer 1858
94
What was the 'Great Stink' of 1858?
Summer 1858 was v hot. Thames was overflowing with raw sewage & warm weather encouraged bacteria to thrive smell was so powerful that business in House of Commons was suspended. MPs debated the issue
95
When could Bazalgette begin work in response to the Great Stink? What did it involve?
July 1858. 2000 km of interconnecting brick lined sewers linked to 4 massive pumping stations. Redesigned Thames so that it housed huge final sewers connecting the smaller ones w/ the pumping stations, which were made to carry the untreated sewage to treatment plants rather than dumping it in the river of the sea. Balzagette designed large, brick-lined shaped sewer tunnels that rarely got blocked.When calculating size of sewers = densest population, calculated amount of sewerage each person would generate then x2
96
How many resources were used in building Joseph's sewers?
318 million bricks and 670,000 cubic metres of concrete. Opened in 1865 by Prince
97
What was Marie Stopes' significance (1880-1958)?
Wrote 'Married Love' (publishers refused to publish it because there was a chapter on contraception). Humphrey Verdon Roe published it, 2k copies, became her husband later --> 400k copies by 1924. Condensed Wise Parenthood to 16 pages & gave out to working class for free. Opened Mother's Clinic in Holloway in March 1921
98
What were the attitudes of authorities in 1906-08?
Didn't wanna give info on birth control and limiting fam size , but helped poor kids
99
What happened to Elizabeth Daniels in 1922?
She was dismissed from her post as health visitor in London as she gave advice about birth control.
100
Why did middle-class and upper class families tend to have less children than working class families?
They could afford private clinics where information was given on contraception was available.
101
What were the main methods of birth control for poorer families?
Abstention (Not having sex), Coitus Interruptus (Withdrawal Method) and induced abortion. Until abortion was legal in 1967
102
Name a magazine that advice about contraceptives
cheap women's magazines, sections would be called 'women's ailments', shows that there was a demand for this info; however, it was risky & open to fraudsters
103
What was her book Married Love about?
Published in 1918 and gave practical advice. After divorce in 1913, Stopes wrote a book on how she thought marriage shld work. Talked abt effective contraception and was expliict on married sex, so publishers denied publishing it as it was 'controversial'. Finally, Humphrey Verdon Roe published it. Although 'Married Love' was aimed at middle class, she distributed leaflets for working class
104
When did Stopes and her husband Roe open a Mother's clinic in Holloway?
March 1921. It was free and provided advice about contraception (the diff methods and how to use them). In 1925, the clinic moved to Tottenham Court Road and was v popular. By 1939 there were three clinics in Leeds, Belfast, Cardiff and Aberdeen.
105
Who was Dr Halliday Sutherland?
Secretary of the League of National Life (anti-contraception, mainly Catholic organisation). Wrote 'Birth Control: A statement of Christian Doctrine Against the Neo Malthusians' in 1922.
106
What was the situation between Stopes and Sunderland?
Sunderland was critical of Stopes work. Stopes tried to sue him, but lost. However, the case did bring the issue of birth control to the attention of the public. The number visiting Stopes clinics doubled.
107
Who supported birth control?
Dr Killick in Leicester and Dr George Jones
108
Who opposed birth control?
Catholic Church. Stopes message to the bishops that sex was not only for creating kids but also for pleasure my husband and wife was received in silence
109
Overall, why was there a clear improvementin PH b/w 1780 and 1939?
Three factors: inventiveness & determination of individuals; the drive of local authorities to improve the lot of ppl for whom they were responsible for; and the move of central gov frm laissez-faire to active involvement in the lives of citizens. All three existed in combination and worked tgt
