A Revolution In Medicine: Improvements In Public Health

Question 1

Why were Britain’s towns so dirty during the 19th century?

Answer 1

• the towns grew very quickly in the first 50 years of the 1800s.
• As population grew the health of the people living on towns grew worse.
• People had flocked to towns to get new jobs in the new factories.
• Since s single factory could employ 100s of people rows of houses were build near the factors ‘back to back’- very crowded.
• all houses were crowded with 5+ people living in a small room.

Question 2

What was disease like in the early 1800s?

Answer 2

People did not have much medical knowledge and no one had yet proven that germs and dirt causes disease. Even when doctors eventually proved a connection between dirty water and cholera many councils were slow to do anything about the over flowing privies an pd drains.

Question 3

Throughout the 1800s how did dirty water have an impact on the public health in towns?

Answer 3

In towns like Leeds there wears no underground sewer system to remove waste safely. Mostly there were narrow gutters that ran through the middle of streets and yards to take away waste that people through out their windows. However this often got blocked by rubbish and leaves so waste lay stinking for months.

-in Leeds clean water was in short supply and its collection was a daily chore for many women. As a result of this, most people only took a bath once a week and the whole family had to use the same bath water.

Question 4

How did housing in the 1800s affect the public health in towns?

Answer 4

Houses in Leeds we’re built with very few windows because they were ‘back to back’. Most had 2 rooms - one for cooking and washing and one for sleeping and living. These who could not afford this had to rent the underground cellars of other people’s houses. These were damp and dark and often crowded.

Question 5

What affects did the lack of maintenance of privies have in the public health in towns in the 1800s?

Answer 5

The privies and the cesspits were not connected to sewers so the waste just collected underground. From time to time night soilmen cleaned them out and sold the waste to farmers. However, sometimes this did not happen for months and they were left to overflow. This overflow even went near the crake pipes of the communal water pump.

In the yard ps the smell was often terrible. This was sometimes from the waste but often it came from the privies. These were communal toilets which poorer families had to share, they were a wooden shell which was open at the front and at the back with a hole that connected to the cell out beneath the yard.

Question 6

What were diseases like in the 19th century in towns?

Answer 6

There were many deadly diseases and most of these struck cited like Leeds. This is because the city centres were over crowded and dirty.

In Leeds in 1832, there was the first cholera epidemic. Within a few months almost 700 people had died from this. By the time the epidemic ended a year later almost 31,000 people had died.

This was not only disease feared in the 1800s. TB, typhoid, scarlet fever and Measles killed 10s of thousands of people in the 30s and 40s.

Question 7

Why were city centres so crowded and how did this worsen public health?

Answer 7

In the 1800s many people moved into towns and cities from the countryside for work in the new factories, that had opened. These workers needed to live near as possible to towns and coteries developed around these factories. Houses for the poor workers were hurt and were crowded together (builders could make more profit) on a narrow street. Each house only had 1-2 rooms. Because of the crowded living conditions disease spread quickly.

Question 8

Why was their a lack of drinking/clean water in places like Leeds in the 1800s and how did this affect public health?

Answer 8

People back in the 1800s did not know that dirty water could kill them. They could not afford to but clean water from the town centre so they were forced to drink unclean water that they either collected from the pump, river or after it rained.

Councils in the 19th century did not have to provide basic services like water pipes. There were very few people who had clean water piped to their houses. Many had to queue in their yards to use the communal pump or carried it in buckets from the river.

Question 9

When did cholera arrive in Britain for the first time?

Answer 9

Arrived in 1831 and killed 50,000 people.

Question 10

What were the symptoms of cholera?

Answer 10

• victims were violent sick and suffered from painful diarrhoea.
• their skin and nails turned black just before the victim fell into a coma and died.
• cemeteries had to be closed because they were too full.

Question 11

When did further cholera outbreaks happen during the 19 century?

Answer 11

1831, 37,38,48,54

Question 12

What was the main effect cholera had on improving public health?

Answer 12

Cholera outbreaks encouraged the reform movement and then eventually government legislation to improve public health.

Question 13

What did Edwin Chadwick conclude from his report when he was commissioned to investigate the living conditions of the poor in 1842 during the cholera outbreak?

Answer 13

• there was an urgent need to improve the living conditions of the poor as their life style was linked to their health.
• workers weren’t as productive of they were unwell and took more days off so this ultimately costed the nation. (This was during the industrial revolution so industry was very important)

Question 14

Who was Edwin Chadwick?

Answer 14

He was a lawyer and social reformer. He helped contribute to the development of the public’s health reforms during the mid 1800s.

Question 15

What did Chadwick so immediately after publishing his report to help the poor and what opposition did he face?

Answer 15

He said helping the poor would benefit the nation. He implemented boards of health to clean the streets and provide clean water.
MPs were horrified as they didn’t want to spend government money on such issues. They believed in Laiseez Faire’.

Question 16

What happened in 1848 which forced parliament to invest in public health reforms?

Answer 16

Cholera struck again in 1848, killing 14,000+. Parliament was forced to create the Public Health Act, with Chadwick as chairman. He helped to make the streets cleaner.

Question 17

What did Chadwick believe caused cholera and other diseases and what did he instruct people to do South their waste?

Answer 17

He believed in miasma, disease spread by bad smelling air, this made the cholera outbreak worse. He ordered all people to throw their waste into the Thames, which then polluted clean water.

Question 18

Who was John Snow and what did he claim about the cause of cholera?

Answer 18

In 1849 he published a book claiming water was the cause of cholera. People who believe in miasma water angry. He proved his theory through collecting evidence and observation.

Question 19

How did John Snow prove his theory that dirty water was the cause of cholera?

Answer 19

In 1854 700 people died from cholera in Broad ST, London. He found 3 pieces of evidence to prove his theory:
1-when he removed the water handle, taking away access to water, no one else died.
2-a lady from another part of town ordered her sergeants to bring her water from that specific tap in broad ST and she died of cholera like the others in that area.
3-no one had died from the pub across the street because they had all been drinking beer instead of water.

He used a hypothesis, research, evidence and observation to rove his theory.

Question 20

What was the role of Edwin Chadwick in encouraging public health reforms?

Answer 20

• due to the chorea epidemic the government had to act. By 1840 Chadwick had began a national investigation by sending out doctors to most major towns and cities. 1842 he published his report on the Sanitary Conditions of the Labouring Population.
• he believed cholera was linked to poverty and dirty streets and by cleaning streets and helping labouring population it would benefit the nation as they would need less time off.
• HIS WORK INSPIRED THE SANITARY REFORM MOVEMENT. He said parliament should pass a legislation to improve sewage disposal and water supplies.

Question 21

What did the Sanitary Reform Movement do to encourage public health reforms?

Answer 21

• Chadwick’s report made people aware of the sanitary conditions of the labouring population.
• supporters of the reform became known as the ‘clean part’
• in 1844 The Health of Towns Association was set up to campaign for better living conditions.
• Local branches of the Association were set up across the country. Each produced evidence of filthy streets, lack of clean supplies of clean water and inadequate sewage facilities.
• the Association called for an Act of parliament.

Question 22

What changes did Edwin Chadwick want to introduce and why?

Answer 22

• wanted to improve living conditions of the poor as their lifestyle linked to their health.
• if workers were ill they didn’t work as well and too more time off, costing the nation. This was during the industrial revolution so this would have been an important factor to the ‘laissez faire’ government.
• he wanted to help poor to benefit nation in the long run. Implemented boards of health to clean the streets and provide clean water.

Question 23

What was in Chadwick’s report ‘The Sanitary Conditions of the Labouring Popualtion’ which he published in 1842?

Answer 23

• disease caused by miasma and this is common all over country.
• miasma caused by rooting animals and vegetables, by damp filth and overcrowded houses. If these improved death rates would fall.
• a medical officer should be appointed to take charge in each district.
• more people are killed by filth and bad ventilation each year than war.
• People cannot develop clean habits until they have clean water.
• the poor conditions produce a population that doesn’t live long, poor and is brutal and rough.

Question 24

What were some of the step forwards to improve public health after Chadwick’s report was published after 1842?

Answer 24

• the 1848 Public Health Act set up a Central Board of Health in London to sit for 5 years.
• the health boards had the power to improve water supply and sewage disposals. They took over from private companies and individuals.
• in 1848 the Public Health Act also provisioned for the setting up of Local Boards of Health in towns. Provided 10% of what the rate payers had agreed.

Question 25

What were some of the step backwards in improving public health after Chadwick’s report was published after 1842?

Answer 25

• under the Act, local health boards were set up in only 182 towns (there were 4000+ towns in England). This meant sewage disposal and water supplies were improved in only some places.
• in 1848 those who applied the Central Board of Health in London, were able to bring it to and end.
• In 1848 the Act was not compulsory. It was not fully applied across the whole country and brought limited improvements.

Question 26

What was introduced into parliament in 1847 to improve public health which many opposed?

Answer 26

In 1847 the Public Health Bill was introduced into parliament. It was strongly opposed by a group of MPs called the ‘Dirty Party’. They believed in Laissez Faire and argued it was not governments responsibility to clean up towns. However when cholera broke out again in 1848 the Bill was passed by parliament and became the first Public Health Act.

Question 27

What was the great stink?

Answer 27

London in 1858 was a dirty overcrowded city. The Thames was overflowing with raw sewage and the unusually hot weather (during the summer) encouraged bacteria to thrive.

Question 28

What were some of the reasons for the great stink?

Answer 28

The Thames was a dumping ground for human sewage, household rubbish, horse dung, slaughterhouse waste and chemicals from factories, as well as being used for washing clothes and cooking. This caused ab awful smell.

Sometimes raw sewage would trickle out the pumps that pulled the water out from under the ground.

The sewers linked to 4 massive pumping stations (2 on each side of the Thames). At high tide Bazalgette’s pumps 420 millions gallons of sewage a day into the Thames, from where it flowed into the sea with the river.

Question 29

What did the government do in reaction to the Great Stink?

Answer 29

The stench from the Thames along with Snow’s new evidence about cholera caused alarm. MPs turned to a man called Joseph Bazalgette to save their city.

Question 30

What did Bazalgette do to solve the problem of the great stink?

Answer 30

He was an engineer. He was given £3 million and told to start building sewers immediately. The project was a massive one, involving 83 miles of brick-lined sewers using a total 318 million bricks.

His sewers were finished in 1866 and when fully operational cholera never returned to London. Parliament soon started to improve public health.

Question 31

How bad was the smell from the Thames during the Great Stink?

Answer 31

The smell was so powerful that business in the House of Commons was suspended while members decided whether to move up rove to Hampton Court.

Plans were made to evacuate the law courts to either Oxford or St Albans.

Question 32

How did new voters later in the 1800s improve public health?

Answer 32

In 1867 working class men had been forced Ben the right to vote. This meant that MPs were more likely to take notice of the needs of people in their towns, who were the main victims of poor public health. A great percentage of the population was the labouring class.

Question 33

How did scientific later in the 1800s improve public health?

Answer 33

Pasteur’s Germ Theory has finally proved the link between dirt and disease. His discoveries influenced many scientists and slowly public health improved.

Question 34

How did the weakening of the laissez faire Government later in the 1800s improve public health?

Answer 34

As a result of all the changes in Public Health Acts (etc) the government saw it could no longer leave important public health measures to individuals or councils. They realised it was in everyone’s interest to force towns to clean up.

Question 35

How did education later in the 1800s improve public health?

Answer 35

From 1870 every local authority had to set up a school. Health education was taught and improved literacy made it possible for people to read pamphlets giving advice drainage, ventilation, diet, personal cleanliness, care of children and care if the sick.

Question 36

How did influencial cities later in the 1800s improve public health

Answer 36

E.g Leeds, a major industrial town had up until 1866 taken very little action. Then in 1866 (after another cholera outbreak) they appointed their very first Medical Officer of Health. In the same year a pressure group was formed to force the council to act. It was backed by the local newspaper which publicly blamed the council for 2000 unnecessary deaths in Leeds each year.

• in 1870 there was a court order to prevent seated being pumped into the river which they drew water from.
• in 1874 it had its first sewage purification works. Other town and cities soon started to make similar changes.

Question 37

What were the positive impacts of public health reforms in the 19th century?

Answer 37

• in 1866 the Sanitary Act made local councils responsible for sewers, water and street cleaning; each town was to have a health inspector. In 1876 the government then passes laws against pollution in rivers.
• other measures were taken by the government later in the 1800s:
  1852: compulsory vaccinations.
  1858: regulation of of doctors qualifications.
  1889: isolation hospitals were introduced for infectious diseases.

Question 38

What did the second Public Health Act do in 1875?

Answer 38

In 1875 the second Act was passed. It brought together all the previous laws under one act. Councils were now compelled to provide street lightning p, clean water, drainage and sewage disposal and employ medical inspectors.

Question 39

What factors show limited impact on the Public Health Reforms in the 19th century?

Answer 39

Despite the Government taking many measures to improve public health, it was a slow process. When Charles Booth investigates the East End of London in 1889 he found many people still living in appalling conditions of poverty and ill health.

In 1875 the Artisan’s Dwelling Act was passed. Councils were given the power to buy an area of slum housing, knock them down and build better housing. Few councils took this opportunity which meant people still lived in cramp houses in slum conditions.