3.2- How effective were government and individual Inititiaves at Improving Public Health, C1780-1939

Question 1

What is an initiative?

Answer 1

To put forward an idea/ proposal to improve something (government usually introduce)

Question 2

Who was Joseph Chamberlain?

Answer 2

1836-1914

Radical social reformer

Embarked on a massive slum clearance programme in Birmingham, built housing for the poor, set up free public libraries, art galleries, took gas, water and sewerage systems into control of the city council

Little regard for aristocracy believing they should pay for their privileges

1895 became colonial secretary in Salisbury’s conservative- unionist government where he supported expansion in Africa

MP for Birmingham in 1876

Question 3

What government initiative was set up for local government action? Successes and failures?

Answer 3

Local government was more prominent in dealing with public health than national government in the 19th C

✅Local authorities could pass their own public acts of parliament to improve public health-London issued 300 such laws
✅Liverpool, Leeds and Manchester also good examples

❌Town improvement committees were seen as corrupt- oligarchies and vested interests

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Question 4

What housing initiative was set up? What was it successes and failures?

Answer 4

A connection had been made in the early 19th C between poor housing and disease
Lack of sanitation was a problem in most houses

✅Some twins and cities had introduced Acts about the quality of housing eg: Leeds and Liverpool
✅Public health Act of 1875 was successful at clarifying building regs for local Govs
✅Numerous acts passed between 1851-1875
✅Birmingham began a huge slum clearance programme

❌Legislation was passed but the new buildings did not necessarily conform
❌Laws difficult to enforce
❌There were vested interests
❌Legislation primarily concerned with new houses only
❌Artisans and labourers Dwellings Acts were permissive
❌Some people were actually made homeless because of slum clearance

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Question 5

What vaccinations initiative was set up? What were the successes and failures?

Answer 5

• Created by Jenner in the 1790s
• Vaccines were optional for all until some legislation in mid-1800s
• Smallpox

✅1808 a government grant promoted vaccination- National Vaccine Establishment
✅1840-Vaccines offered free of charge via Poor Law staff
✅1853- parents had to have children vaccinated or they were fined
✅1871- Local health Boards would fine parents and threat of prison

❌Vaccination was expensive- used by upper classes
❌Lots of opposition- anti-vaccine movement
❌The Leicester method (quarantine and isolation) grew in popularity instead
❌200,000 exemption certificates issued by 1898
❌Demonstrates that government initiatives were not enough to improve public health
❌Legislation only applied to children

Question 6

What medical officers of health initiative was set up?

Answer 6

• The Public Health Act Of 1875 made it compulsory for all local authorities it appoint someone in charge of public health- this person was known as a medical officer of health
• Medical officers were usually trained as doctors or surgeons

✅Liverpool’s medical officer of health, William Henry Duncan appt in 1847 was seen as exemplary John Simon in London also very successful
✅Compulsory medical officers from 1875
✅After 1888 medical officers had be fully qualified
✅Public health became the ‘norm’ in local government and elections

❌Most local councillors chosen because promised to keep public health rates low middle class councillors were not convinced about spending taxpayers money on public health
❌Medical officers poorly paid and so it was often a second job
❌1875 legislation was poorly implemented

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Question 7

What TB and sanatoria government initiative was set up? What was it successes and failures?

Answer 7

• TB was the biggest killer of the 19th century. It spread rapidly because of poor housing conditions and overcrowding in industrial cities
• Local officers of health took some immediate action eg: leaflets issuing advice to prevent spitting

✅Local officers of health were able to convince people how simple steps could prevent poor public health
✅Central government ordered the pasteurisation of milk in 1922.Further acts made this widely available to school children
✅Sanatoria (places of isolation) were set up- by 1930 there were 500

❌Antibiotic cures for TB did not come until after the Second World War
❌Surgery for the effects of TB was still frequent requirement
❌Local medical officers took on the responsibility a lot more than national government (national government only really for children with TB)

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Question 8

What government initiatives were made for children? Successes and failures?

Answer 8

• The Education (provisional of meals Act) 1904-allowed Local authorities to use public money to provide free school meals for the children of needy parents
• the Education Act 1907 set up a school medical service
• Children and young persons act 1908- protected children from neglect and cruelty

✅Established the principle that the state could take on the role of a parent (and that children were not seen as paupers)
✅A medical dept was set up for children, and administration by local authorities . This led to improvements in other areas of public health
✅Children became a priority for public health. Attitudes no longer related to the immorality of their parents

❌Local government took on the responsibility rather than national government (although the decisions did come from national government)
❌Difficult therefore to impose in some areas

Question 9

Who was Margaret McMillan?

Answer 9

(1860-1931)

• representative of the ILP for the Bradford School Board, elected as only women member in 1894
• Fought long and hard for the health and welfare of the children of the poor
• first baths were installed
• Dr James Kerr, Margaret persuaded the school Board to institute medical inspections, set up a school clinic and establish a system whereby children were given free school meals
• The Bradford initiative was one of many instituted by Margaret

Question 10

What was significant about the town of Rochdale?

Answer 10

• Prosperous town in the South Pennines
• Flourishing woollen mills, silk manufacturers, bleachers and dyers, buy the cotton industry was dominant
• first co-operative society founded there in 1844
• increasing prosperity throughout 19th century was reflected in its governance
• became a parliamentary borough

Good example to use!!

Question 11

Implementing the public health Act 1848:

Answer 11

• Many ways the act could could be avoided or undermined so its implementation and therefore effectiveness was patchy
• Act was overshadowed by second cholera outbreak-only when this died down could focus its whole attention on more general public health issues
• didn’t have the same impact as 1834 poor law amendment act-Public and government were not convinced
• no existing structure that could be reformed, medical knowledge was not giving clear messages, vested interests eg: water companies remained strong
• sanitary engineering was expensive
• marked the beginning of the states intervention in public health matters
• 1939 increased understanding- the pioneering work of individuals and increasing willingness of local authorities meant during this period, public health improved massively eg:housing

Question 12

What were the successes of the public health Act of 1848?

Answer 12

• in 1850 192 towns asked for new public health regulations to be applied and the act had been applied to 32 of them
• by 1853 this had risen to 284 petitions and there 182 towns where the act had been applied
• Town councils that took the act even further and through private acts of parliament obtained more sweeping powers

Question 13

What were the failures of the public health of 1848?

Answer 13

• Towns like Rochdale were rare or have to be put in perspective eg: vested interests and reluctance by many local authorities
• In Lancashire only 400,000 of it’s 2.5 million people were living under some sort of public health Board
• of the 187 major towns in England and Wales only 29 had powers of draining and cleansing in the hands of one Board, 30 had absolutely no powers over public health (in hands of independent commissioners), 62 had no public health authority whatsoever.
• local boards of health were frequently simply the existing town co-operation under a different guise. Therefore governed by the same vested interests and moved in the same slow and cautious way- hesitancy was reluctance to spend money and ignorance of sanitary engineering needed put for a minority they were constrained by pre-1848 private improvement acts
• eg: lavatories flushed into sewers that emptied into the nearest watercourse from which drinking water was taken

Question 14

Successes and failures of local government rather than the national government:(table)

Answer 14

+Passed their own public acts eg: London, Liverpool, Leeds and Manchester
+Local Government took action on housing eg: Birmingham slums
+Local medical officers of health appointed
+Sanatoria set up
-Town improvement committees were seen as corrupt- oligarchies and vested interests

Question 15

What were the successes and failures of the national government against the local government?

Answer 15

+Numerous housing acts passed between 1851-1875
+Government support for vaccinations, including funding
+Made medical officers compulsory
+TB support for children
+State responsibility- attitudes
-laws difficult for enforcement, permissive etc

Question 16

Who was Edward Jenner?

Answer 16

1749-1823

• smallpox killed 10% of the population rising to 20% in towns- overcrowding
• In children, smallpox accounted for 1/3rd of all deaths
• 1773 EJ was a local doctor in Berkeley Gloucestershire
• Studied as a surgeon in London, 1788 was made a fellow of the Royal Society

Question 17

What did Edward Jenner do?

Answer 17

• Jenner aimed for probe that someone who had been infected with cowpox could not catch smallpox
• Before Edward Jenner they used a process known as variolisation to try and stop the spread of disease. The early inoculation meant they gave a small amount of smallpox to a healthy individual in hope they would develop a mild form of smallpox and be protected from the disease. But some had a severe and disfiguring version of the disease and died-people were desperate
• 1796 Sarah Nelmes consulted Jenner about the cowpox myth of curing/preventing smallpox. To test it he took some of gender pus from Sarah’s blisters and gave it to James Phipps a small boy. He developed a fever but recovered quickly. This established cowpox could be passed from human to human. To see if the cowpox bad given Phipps immunity from smallpox Jenner variolated him- didn’t get smallpox
• Tested this with 23 patients- nine got smallpox, found cowpox gave immunity to smallpox

Question 18

What was his significance for public health?

Answer 18

• found cowpox have immunity to smallpox and developed a vaccination for it
• over 100 leading London doctors signed a letter supporting his research and declaring their intention to vaccinate
• parliament voted him £30,000 to establish a vaccination clinic
• Jenner supplied doctors around the world with cowpox material to provide a vaccine safely and without contamination- developed a technique
• participated in conferences and learned discussions about the nature of immunity

Question 19

What are the drawbacks of Jenner’s contribution to public health:

Answer 19

• At first the Royal Society refused to publish his results (country doctors- not professional)
• Jenner couldn’t explain how and why his experimentation worked
• some reluctance to use the vaccine as they made an income from variolation
• Jenner published his results at his own expense in 1798- ‘An enquiry into the causes and effects of Variola Vaccinae’ , known by the name of cowpox

Question 20

Who was Edwin Chadwick?

Answer 20

1800-90

• associated with the poor law reform and with public health reform
• persuaded and bullied government to invest in public health reform
• limited finances wrote for ‘Westminster Review’ usually about scientific principles that could be applied to various areas of government. Jeremy Bentham Chadwick literary secretary saw this. Bentham’s belief in the doctrine of utility drove Chadwick to a professional life

Question 21

What did Chadwick do?

Answer 21

-Made the connection between poor public health and disease
-typhus epidemic (1837-38) meant more apply for poor relief. Led to the commissioning of- ‘Report on the Sanitary Condition of the Labouring Population of Great Britain’
-set up an enquiry, chose three doctors:
🥼Neil Arnott: ship’s surgeon, identified connections between ‘exotic’ diseases like cholera and sanitation
🥼James Kay- reported on the poor in Manchester
🥼Southwood Smith- London Fever Hospital- physician
-drew conclusions and made some convincing arguments eg:no matter how expensive sanitary improvements would be, the cost of pauperism as a result of inaction would be even higher, established that healthy conditions could not be achieved with overcrowding, poor ventilation, inadequate water supply…= resulted in the ‘Report on the Sanitary Condition of the Labouring population of Great Britain’-1842
-Chadwick did briefings in the Royal Commission set up by the government with both anecdotal and statistical evidence- commission report (1844) upheld Chadwick’s findings
-meant the Public Health Act 1848 was passed by Parliament
-set up a general board of health whereby Chadwick was appointed as one of the sanitary commissioners

Question 22

What was significant about his contribution to public health?

Answer 22

• Raised awareness through making key enquiries and through published reports and works
• Led to the setting up of Boards like the General Board of Health and legislation like the 1848 Public Health Act
• made key connections eg: poor public health and disease which led to changes eg: through GBH clean water went to all dwellings, pipes were used to carry water, abolished shallow drinking wells, built sewerage systems (where waste only went to farm land as fertiliser)
• awarded a pension of £1000 a year and continued to give voluntary advice in all sides about health and sanitation
• In 1884 he was appointed the first president of the Association of Sanitary inspectors
• received a knighthood

Question 23

What were the drawbacks of Chadwick’s contribution to public health?

Answer 23

• GBH ans him were not liked seen as arrogant and impatient
• Agreed to design in 1854 and House of Commons only agreed to renew the Board’s mandate if Chadwick was no longer a commissioner
• Tory government in 1842 rejected Chadwick’s report- ‘report on the Sanitary Condition of the Labouring population of Great Britain’
• GBH was resented by localities due to his impatience with reform
• Took a long time, a lot of his advice was ignored/ overlooked

Question 24

Who was John snow?

Answer 24

1813-1858

• cholera had spread from India via trade routes to Europe
• cholera had 4 big epidemics:
  1) 1831-32=32,000 deaths
  2) 1848-49=62,000 deaths
  3) 1853-54=20,000 deaths
  4) 1866-67=14,000 deaths
• 1831 Snow had fought the cholera outbreak in Newcastle- convinced cholera was water-borne
• retiring nature + long hold miasmic theory by doctors, surgeons, administrations and the public stopped him from acting

Question 25

What did Snow do?

Answer 25

-in the 3rd epidemic (1853 outbreak)- soho, London. The local pump was known to taste impure-persuaded authorities to lock pump handle and users to go elsewhere- the number of deaths fell dramatically

• made connection of falling soho death rate and closing down of Broad Street pump- medical community accepted it
• Snow did study during 1853-54 eg:house to house interviews, observation and research gathering more evidence. Used evidence to support his theory eg: A widow that used to live in soho had a bottle of Broad Street pump water delivered of her Hampstead home, she died of cholera and none of her neighbours caught the disease
• John Simon corroborated snow’s findings with his own (medical office of health for the city of London)- much more large scale covered 500,000 south Londoners, published 1856. He compared customers from different water companies
• in 1870 John Snow had a breakthrough making the knowledge that cholera was water-borne universal- miasma theory disregarded

Question 26

How was Snow significant to public health?

Answer 26

• saved thousands of lives eg:removing Broad Street Pump and proving it was waterborne
• found connection between water and cholera- most people believed in the miasma theory
• raised awareness-John Simon also carrying out research and corroborating his findings
• detailed research-could support theory with evidence and was very thorough eg: going house to house

Question 27

What are the drawbacks of John’s Simon contribution to public health?

Answer 27

• Medical establishment was not impressed by his research, idea that cholera was water-borne was referred to as ‘Dr Snow’s theory’
• although John Simon also showed interest and conducted supporting research he originally wanted to disprove Snow’s theory believing the cause was miasma
• took another 14 years after Snow and Simon’s studies were accepted and that it was a water-borne disease was proven (1870)- slow
• Reluctance to act from the start and government’s failure to act lead to more cholera outbreaks and deaths

Question 28

Who was Joseph Bazalgette?

Answer 28

1819-1891

• Bazalgette was appointed chief engineer in 1856 by the new metropolitan Board of Works which consisted of 45 nominees from the principal local authorities in London
• Bazalgette provided the technology to put theories into action like John Snow’s study on water-borne diseases
• drew up a comprehensive plan where London’s sewerage was channeled through miles of street sewers into a series of larger inception sewers. These large sewers took the waste far right the east if kind in where it could be pumped to the tidal part of the River Thames and swept far out to sea
• the plans were good but the metropolitan Board of Works were reluctant about acting producing fruitless arguments mostly about money until 1858 and the ‘Great Stink’.

Question 29

What did Bazalgette do?

Answer 29

• Drew up plans for London’s sewerage
• Bazalgette project was massive involving 2000km of interconnecting brick-lined sewers linked to 4 massive pumping stations, two in each side of the Thames
• Bazalgette large brick-lined sewer tunnels rather than the narrower pipes favoured by Chadwick- good decision as they rarely got blocked
• Bazalgette started with the densest areas of the population, calculated the amount of sewerage each person would generate and doubled it. 318 million bricks and 670,000 cubic metres on concrete were used

Question 30

What was Bazalgette significance to public health?

Answer 30

• The whole sewerage system was opened by Edward, Prince of Wales in 1865 thus giving it the Royal seal of approval
• It was significant due to the chaotic situation before leading to the ‘Great Stink’- London’s local government was controlled by various different specialist authorities and improvement commissions. This made an public health initiatives virtually impossible to implement
• in 1837 an attempt was made to set up a London wide elected authority but it was defeated by vested interests
• A metropolitan Board of Works was set up in 1855 but ut was short lived and it’s only marked ‘success’ was the order for cesspits to be closed
• This meant that bad sewerage systems lead to dirty diseases like typhoid
• the great stink encouraged bacteria to thrive. The smell was so bad the House of Commons was suspended. It lead to a vociferous campaign for change
• in 1858 the Metropolis Local management Amendment Act was passed giving the Metropolitan Board of works permission to act= not directly as a result if Bazalgette but his work was significant to public health and gave the government a way to do it

Question 31

What are the drawbacks of Bazalgette contribution to public health?

Answer 31

• not instigator for change just provided a way to do it
• took a long time to force government to act, only act 1858 ‘Great Stink’ was change made
• Bad management and communication in London’s local government
• expensive- huge project

Question 32

Who was Marie Stopes ?

Answer 32

-stopes had a major contribution to public health which was to provide information and practical advice about limiting family size
-this was needed as…
➡️1906-08 parliament concerned itself with the welfare of children, and passed legislation regarding meals and medical treatment for poor children, but birth control methods was not touched upon due to the opposition from Anglican and Catholic Churches
➡️This lead to huge numbers of poor children especially amongst the working class, families of 12 or 14 were not uncommon
➡️Nurses were forbid to give advice in birth control eg: 1922 Elizabeth Daniels was dismissed
➡️led to overcrowded poor housing and family struggles to feed, clothe and provide for children
➡️upper class and private clinics where they could get advice and get contraception but the poorer families had traditional methods of birth control
➡️Abstention
➡️Use of coitus interrupt us (withdrawal method)
➡️induced abortion-illegal until 1967
➡️Safe period in woman’s cycle
➡️Dangerous and risky- opened stage you to all kinds of quacks and fraudsters
➡️Demand for information, had some cheap women’s magazines eg: ‘women’s Ailments’, new contraceptive appliances, ‘women only’ lectures

Question 33

What did Stope do?

Answer 33

• provided straightforward, detailed, practical advice
• write a book in marnage and use of effective contraceptive. Strongly opposed abortion and believed family size should be limited
• Humphrey Verdon Roe (Philanthropist) published ‘married love’-immediate success, sold over 2000 copies and over 40,000 copies by 1924
• ‘Marie Stopes’ became the household name
• married love was aimed at middle class so was ‘Wise Parenthood: A book for Married People’, made a condensed ‘Wise Parenthood’ for poor- distributed free of charge
• Due to the large scale demand for advice Stope’s opened her own mother’s clinic in north London- 1921
• Was fun by midwives, visiting doctors- gave face to face contraceptive advice and taught mothers how to use contraception
• Stopes gradually built your a network of clinics across Britain, and by 1939 there were clinics in Leeds, Aberdeen, Belfast and Cardiff

Question 34

What was Marrie Stopes significance to public health?

Answer 34

• helped married couples limit the size of their families, either directly by visiting clinics or indirectly by opening up the subject of birth control to public debate
• produced books, gave advice, raised awareness eg: in court trail between stopes and Sutherland
• provided spaces for women and for conversations took take place- more choice then before eg: induced abortions- dangerous
• 1920-Stopes addressed Lambeth Conference (a meeting of Anglican bishops) message was received in silence (x) but still listened
• Dr. C Killick (medical officer of health for Leicester) was a strong supporter of birth control. So was Dr George Jones (worked in West End Hospital for women-London) who said it was even more important in the case of unmarried women- contraception should be offered to them

Question 35

What were the drawbacks of Marie stopes contribution to public health?

Answer 35

• her original manuscript for ‘married love’ was rejected/ refused to publish
• opposition from the church (Anglican and Catholic)
• 1922 Dr Halliday Sutherland (secretary of the league of national life)set up an anti-contraception organisations and wrote ‘Birth control:A statement if Christian Doctrine agonist the Neo Malthusians’ in retaliation to stopes
• Sutherland made defamatory attacks on Stopes, she sued hum for libel-went to court and although jury and judge favoured Stopes the House of Lords were in favour of Sutherland. Hit stope financially but increased the number of clients visiting her clinics (doubled)
• Divide in medical profession
• 1917 Humphrey Roe tried to endow a birth control clinic at St Mary’s Hospital (Manchester) and was declined even though he proposed all patients should be married and no abortions were to take place
• Her mission to extent knowledge and understanding of birth control could have more to do with her eugenic concerns than a desire to improve the lot of the poor (enthusiastic supporter of the science of eugenics, believed could improve the quality of the race by controlling fertility of certain groups and classes)-1921 Fellow of the Eugenics society and in her book ‘Radiant Motherhood’ it stated those unfit fir parenthood eg: disabled should be sterilised

Question 36

Conclusion- what was the reason for an impetus for public health reform?

Answer 36

• unique combination of 4 factors (successes from 1780-1939):
  1) Inventiveness
  2) Determination of individuals
  3) Drive of local authorities to improve lives for people, whom they had responsibility
  4) move of central government from laissez-faire to active involvement in the lives of citizens

Question 37

Who was more effective- individuals or government? Why could you say individuals?

Answer 37

• increased the demand for public health initiated (got public support) and helped implement them
• made proposals for the government eg: Edward Jenner and his vaccination
• Made direct changes eg: General Board of Health or John Snow removing Broad Street Pump

Question 38

Who was more effective- individuals or government? Why could you say government?

Answer 38

• passed legislation like Public Health Act 1848
• Started Royal enquiries eg: Royal commission which researched into the poor and disease
• could enforce it/ make it compulsory
• access to infrastructure and money for change

Question 39

What became a ‘national obsession’ in 19th. Century Britain?

Answer 39

• drains and sewers
• abused ones they had eg: putting rubbish in the drains… in 1800 London didn’t rely on sewers- weren’t seen as important

Question 40

What was the ‘great catalyst’ that ended the use of cesspits?

Answer 40

• the introduction of the water closet
• were some other contributing factors eg: volume of foul material, poorly maintained eg: overflowed, complaints against nightmen…

Question 41

When was the ‘first great public health scandal’ related to sewerage and what happened?

Answer 41

• occurred in 1827
• triggered by a pamphlet sortent by John Wright (editor of Hansard)
• entitled ‘The Dolphin, or Grand Junction Nuisance; proving that Seven Thousand Families in Westminster and its suburbs are supplied with water in a state offensive field the sight, disgusting to the imagination, and destructive to health’
• It said that the Grand Junction Water Works Company was drawing water from the Thames and pumping it out by steam engine which was within yards of the outfall of a major sewer
• It said it was not filtered before being distributed which was usually to the aristocratic West End
• this meant the elite were paying for diluted excrement for drinking, cooing and laundering
• Wright’s motivation being rival water companies
• The grand junction company denied it but was true
• created an unprecedented public outcry due time the promised of fresh water
• most knew water was to some degree dirty but the proximity of water and sewer pipes was significant
• Public meetings started at Willis’s rooms- St James’ meetings and piétinions set up and a parliamentary commission was convened. In 1828 produced a lengthy report but a lack of conclusions were drawn, only a few outcomes one being a government sponsored survey on alternative water sources by civil engineer Thomas Redford but nothing concrete
• some water companies did take steps eg: filtration schemes, built new reservoirs…
• Wright’s campaign represents a lost opportunity to prevent pollution of the Thames which grew worse as the century progressed
• Mainly due to lack of scientific or medical evidence- didn’t know consequences of dirty water. No science linking water to particular diseases
• some reviews condemned wright to stirring up ‘hydrophobia’ or minimised the issue, the Grand Junction Company even made counterclaims eg: once matter settled it was pure

Question 42

Why was there a ‘hysteria atmosphere’ in London during 1831 and how had the government responded?

Answer 42

• The Asiatic cholera epidemic which was in Eastern Europe and the Baltic ports- scared of it coming to England- alarming symptoms
• source of origins and transmission were unknown
• hysteria created with daily reports in the press and rising death toll
• Named cholera morbus
• Theories being created everywhere, medical profession was in dissray
• Government tried to calm panic…
  1) Maritime Quarantine
  2) Restriction on trade
  3) Reconstituted the central Board of Health. Had people who practical experience in epidemics eg: William Russel and David Barry
  4) Also established ‘local boards of health’ that would report back to the central board eg: could employ inspectors to monitor outbreaks

Question 43

Why was government action in 1831 criticised?

Answer 43

• doctors implication was clear- poor urgently needed help and support- ‘individual and charitable exertion’ such as standard food, clothing, accommodation and sanitation
• Government criticised for creating a culture of dependency eg: proving soup kitchens, cleaned drains and privies, more ventilation, health inspectors….

Question 44

What were the most common problems identified by written reports in the city?

Answer 44

• the refusal of dustman to clear waste from slums.
• the authorities put up posters listing their contracts and requirements
• another massive problem was the state of the privy by poor people- ignored by landlords, never emptied, shared between tenants… water-closets- unknown= filthy conditions was the norm
• made connection to plumping meant rising surges of filth in heavy rainfall
• ideas of public cleansing vanished with the decrease in epidemic outbreaks

Question 45

What were the main reasons for ‘inaction’ against cholera?

Answer 45

• things such as the Central Board of Health was a temporary affair. They had no order to add beyond the immediate crisis
• changes required compliance from existing local authorities and the general public
• problems from Irish immigrants- insisted on holding lengthily wakes for their dead- infected corpses remained in the home. Boards of Health wanted a swift burial- created tensions + near riots
• local Boards of health could not form basis of a permanent organisation eg: paid off people like the watermen
• Not political desire for permanence. A lot of politicians saw interference as incompatible with the freedoms of the English nation
• money- no one wanted to add to the already high price of poor rates especially by making things permanent eg: The Lambeth Vestry dissolved its local board of health when the board demanded £200 to set up a cholera hospital
• scepticism about medical professions motives eg: in local board system doctors could suddenly find employment in the slums with decent salaries
• scepticism about the practical need for any further action- the long wait for cholera to arrive in the metropolis and heightened fears by the press meant expectations weren’t met eg: most of the disease was clustered in poorest parts of the city- seen as a disease of the poor. There was few famous casualties in the metropolis- most thought if it returned could just avoid certain parts of the city

Question 46

What is surprising about the cholera epidemic of 1832?

Answer 46

• the savages of cholera did not mean long lasting sanitary improvements eg: neglected cesspools and dusting returned to be a private matter
• epidemic of 1832 revealed the incapability if sewers to clear surface water and remove excrement- in some districts- didn’t exist

Question 47

Who saw sewer rates as an ‘unnecessary expense’?

Answer 47

-local authorities
-sewer commissioners
-landlords
-parishes
-commissions ⭐️
= All reluctant about using money + effort it would require - big project

Question 48

What happened in 1834 regarding sewers?

Answer 48

• lots of petitions to the government for cleaning the sewers eg: Dr Peter Fulling who stated that typhus cases had come from houses with untrapped drains
• Timothy Bramah testified to the foul- smelling drains.
• George Watkins claimed the sewers depreciated the value of his property
• lots hinted that the failure to act meant cholera will return
• no-one said however it was the ‘cause’ of the disease- uncertainty about cause and effect- same thing which ruined John Wright’s campaign
• continued scepticism eg: none of men employed to clean the sewers caught the disease
• Did make some conclusions eg: prospect of a ‘central Board’ to manage London’s sewers, sewer commissioners should take action

Question 49

Why were John Martin’s designs for sewers ignored?

Answer 49

• inspired Joseph Bazalgette
• Martin lacked the technical expertise and experience it would require
• seemed quixotic/ too idealistic in his pursuit of ‘Thames Improvement’-eccentric
• cost
• Family associations eg: mad, his brother Jonathan set fire to York minister in 1829, had no political influence
• didn’t cause a public outcry despite his plans being visually appealing
• no followers in a pamphlet produced in 1836 offering Martin support-only considered it, showed desperation

Question 50

Which man was responsible for changing government attitudes towards public health in the 1840s and how did he come to be involved in public health?

Answer 50

• Edwin Chadwick
• under his influence most victorians come to understand the need for improved sanitation which was essential for the future well-being of the nation
• became involved in public health due to Jeremy Bentham- worked as his secretary and shared his enthusiasm for accumulating facts and statistics
• started off in poor law but did not work well with other colleagues who were less progressive, he sought for a new purpose/ angle to let out his reforming zeal-public health. A lot of people hated the changes he was making and as public health did not fall under the poor law commission, nor did it belong to any government or medical body it was the best way for Chadwick to get involved- the concept barely existed

Question 51

What did Chadwick demonstrate was the ‘fundamental problem in the east end’?

Answer 51

• he argued (Chadwick) it was not poor health but money. Epidemics meant good working men were not working putting a burden on the parish
• made it obvious that it was possible to remove the causes of disease
• Chadwick continued to lobby commissioners and when they didn’t listen went to the Bishop of London- Home Office agreed for a written report- became nation’s sanitary investigator
• Benthamite ideals also addressed damaging claims of the starving poor rather than grim horrors of the workhouse
• Accusations under New Poor Law threatened to undermine model of ‘lesser eligibility’ and make it morally unpalatable
• Chadwick focus on ‘removable causes’ provided a scapegoat for suffering in the slums

Question 52

What most impressed Victorian readers about Chadwick’s 1842 report and what were his overall conclusions?

Answer 52

-shocking but it was the depth and breadth of information that impressed Victorian readers. They could no longer blame it on a minority
-Poor drainage, lack of ventilation, open sewers and filthy houses were affecting lives across the nation
-presented the problem and solution:
➡️Epidemic disease was caused by miasma
➡️poverty was not the cause of disease but the result
➡️solution-removed miasmic film from streets and homes
➡️improve sewerage eg: replace cesspools with WCs connected to main drainage
➡️constant supply of water
➡️recycling of waterborne sewage- pipe into the countryside and sold as liquid manure= not new but combined to produce a single entity

Question 53

Who were the only serious opponents to Chadwick’s report and why?

Answer 53

• opponents came from the capital’s commissions of sewers- trespassed on their domain
• The Westminster commission was angry as they had built 20,000 feet of improved sewers since 1800 = other sewer authorities supported this stand
• Richard Kelsey (surveyor of the City of London) declared he had been injured by the report’s claims especially since no other metropolitan local authority had been singled out
• the commissioners of sewers feared Chadwick-thought (and did) want their destruction

Question 54

Why was Chadwick’s report not put into action straight away?

Answer 54

• the theory had been done but solutions asked further questions eg: the difference between districts, disagreements amongst engineers, surveyors about design, water- lay in the hands of commercial interests, streets managed by parish vestries, boards, trust and commissions= no central authority existed and local authorities were hostile (as shown by true new poor law) about ‘centralisation’.
• Put a government commission in place to review Chadwick’s recommendations and assess practicability

Question 55

Why did Chadwick re-gain popularity in the late 1840s?

Answer 55

• Had become a ‘totemic figure’- leading light in ‘sanitary movement’ that transcended politics
• ‘An inquiry into the Sanitary Condition of the Labouring Population of Great Britain’ left a lasting impression
• Support for Chadwick’s designed were emphasised with public meetings, pamphlets, speeches and debates-all in favour of his sanitary reforms
• Helped by his friends such as Thomas Southwood Smith

Question 56

Which companies consistently opposed Chadwick’s proposals for water reforms and why?

Answer 56

• London vestries were hostile to Chadwick’s centralising agenda and feared for their own future.
• Internal disputes began in the MCS
• Their was a clash of egos between Leslie (West End Vestryman) and Henry Austin brought in to calm the situation between Leslie and Philips. Proposed two different plans, other technical arguments in sewer pipes, the cost of rival projects, viability of sewage as manure…

Question 57

Why by 1854 had Chadwick ‘failed’?

Answer 57

• General Board of Health’s ended
• faced hostility eg: from Sir Benjamin Hall
• All government appointees saw Chadwick and his works as an abomination
• Hall attacked Chadwick accusing him of incompetence, self-interest and corruption
• All the wealthy engineers, trading companies… Hall administered a parliamentary coup de gracê meaning his career as a public servant was over
• Still no London-wide system of sewerage
• no single authority for water
• no commitment to a constant supply of water
• no scheme for utilising sewage as manure
• Health of Towns Association-abolished
• By 1854 ‘The Metropolitan Sanitary Commissioners’ held no public meetings, produced only the occasional petition’
• Questionable management of the MCS
• Impracticalities eg: tunnels vs pipes

Question 58

What were Chadwick’s greatest successes?

Answer 58

-commissioned the first ordnance Survey Map of London
-persuaded many to modernise their cesspools and houses eg: introducing drainpipes and water closets
-by 1850s cesspools were all but extinct in central London
-new legislation eg: 1844 Building Act, Metropolitan Sewers Act of 1848, The Nuisances Removal Acts of 1848 and 1849
-more intervention by local authorities and make full use of powers
-not just engineering works but perhaps one of the greatest- promotion of sanitary ideals making improved sewerage seem imperative
-up to an extent:
➡️sufferings of the poor
➡️dogmatic insistence of miasmatic cause of disease
➡️stubbornness to change methods
➡️time waste eg: investigating sewage manure which never became a viable economic proposition
-BUT:
➡️provided solutions to problems which troubled many reformers of the 1820s and 1830s
➡️Great measure of Chadwick’s success does not just lie in the number of de were flushed or cesspools filled but the fact that no-one abandoned sanitary reform of the metropolis AFTER Chadwick was dethroned

Question 59

What are the problems with London’s sewers today?

Answer 59

• John Bazalgette allowed me population of 4 million in his calculations as full capacity. This was double the number of inhabitants in London when the sewers were built but London’s population has doubled again to 8 million. Therefore, over the next decade sewerage will once again become a great metropolitan engineering project. Unlike in the past it has not been delayed by modern-day ‘commissioners’ but local and environmental pressure groups
• Also as John Martin and Edwin Chadwick had once proposed a lot of sewage manure is recycled and undergoes anaerobic digestion creating biogas which is burnt to generate electricity. Though still not for a profit.

Question 60

Extra details from L.Jackson ‘Dirty Old London’ chapters 3 and 4

Answer 60

In booklet, lockdown week 12