Public Health in the 19th Century

Big Picture

• To understand the roles of individuals

• To understand how the Government changed their attitude

• To understand the link between living conditions and health

So, what were the problems?

• Industrial towns were growing at a massive rate

• There was no central regulation over:

• Sewerage removal

• Water supply

• Road laying

• Hose building

The result ?

• Badly built and houses were close together – often back to back.

• Roads were unmade.

• Due to low wages people could not afford good housing or decent food.

• Mass overcrowding.

• Sewerage piled up.

• As a result water was contaminated.

The Effect on Health

• People were more prone to disease due to malnourishment.

• Damp conditions meant that disease spread quickly.• Endemic diseases like typhus, typhoid & TB were regular

killers.• Epidemic killers like cholera caused huge loss of life and,

to the people at the time, were more shocking than the endemic diseases.

• The average age of death was falling !• In 1842 in Manchester, if you were working class, the

average age was 17 !

Why did nobody do anything?

• At the time the belief was:

• Laissez Faire

• The Government felt it was not right for them to be involved in the lives of citizens.

• The rich new that it would be them that would have to pay for the poor if any new health schemes came into action.

What happened?

• By 1830 people began to think that something needed to be done.

• Edwin Chadwick was given the role of looking at living conditions in East London in 1838. By 1840 this had been extended to the whole country.

• In 1842 he published his report, ‘Report on the sanitary conditions of the labouring population of Great Britain.’

Quotes from report

• “Epidemic diseases are caused by decaying animals and vegetable substances, by damp and filth, and close and overcrowded dwellings.”

• “The annual loss of life from filth and bad ventilation is greater than the loss from death and wounds in any wars in modern times.”

What were Chadwick’s recommendations?

• His ideas were all very practical:

• Build drains to get rid of sewage into sewers.

• Remove the sewage through a glazed pipe so it would not leak.

• Improve water supplies.

• Each town should have a body that is held responsible for the health of that town.

Did people like his ideas?

• Chadwick was a rude, tactless and abrasive man so although his ideas were sensible he put people’s back up and not many people liked him.

• Arguments about cost and laissez faire kept coming up (remember self help was a key Victorian idea)

• In 1844 the Government did its own enquiry and it came to the same conclusions as Chadwick.

• In 1847 a public health act was passed.

How was the 1848 act passed when people didn't initially agree with Chadwick?

• William Farr used death certificates to prove that it was the filth that was causing death.

• Chadwick used the argument of lost productivity to win people over.

• In 1848 cholera returned and scared people into action.

What did the health act say?

• It was the first time a central board of health was set up.

• This could go to local level if 10% of the rate payers agreed. They had power to:

• Improve water and sewerage systems

• Raise the funds via tax to pay for the improvements

That sounds great – but did it work?

• It should have worked but the law was not compulsory so many did not bother (184 towns did however).

• The Times said in 1854, “We prefer to take our chance of cholera and the rest than be bullied into health.”

What happened to Chadwick?

• He tried to impose his ideas on health by force. This didn’t work and it all backfired.

• He ignored the medical profession and their role in peoples health.

• In 1854 the central board of health was shut down (that’s just 6 years after it started!)

• Chadwick was also removed from his post.

So the Health Boards were shut down – then what?

• In 1854 and 1866 there were cholera outbreaks that scared the authorities.

• John Snow proved the link between water and cholera and Louis Pasteur proved that disease is caused by germs.

• They had to do something…but what?

Sir John Simon

• Sir John Simon became the first medical officer of health.

• He was able to push preventative measures – sewers, clean water etc.

• As a surgeon he also pushed for medical methods so his ideas were accepted more readily than Chadwick.

• The Government set up a Royal Sanitary Commission and because of their intervention the Government introduced health acts in 1872 and 1875

Is there more? Yes !

• Along there way there were more health acts but in 1875 councils became respoonsible by law for the health and sanitation of their area of control with inspectors to make sure it was being done.

• Water supply• Sewerage• Better housing• Parks• Public toilets• Street lighting

But I don’t know why Chadwick is even on this Powerpoint. He did nothing !

• Not true. Although he was not a doctor or scientist he paved the way for better public health.

• If it wasn’t for Chadwick and his report public health would not be as good as it is now.