Public health (cholera)

• public health issue: industrialisation


  industrial revolution- 18th-19th century, factories built
• public health issue: urbanisation

  people moved from rural areas to cities as factories offered employment. pop of Manchester in 1750 = 17,000. pop of Manchester in 1850 = 300,000+
• public health issue: low quality housing


  back to back housing, courts. factory owners build them as quickly and cheaply as possible- no insulation or toilets. no building regulations from gov
• public health issue: overcrowding


  several families in 1 house. each could afford to rent only one room (cellar=cheapest). slums consisted of courts. no water supply
• public health issue: poor sanitation

  no clean running water or toilets. toilets shared by whole street. surface drainage only. waste thrown into cesspits which leaked/overflowed. night soil men emptied them irregularly/rarely. river (source of water) was often contaminated by a leaking cesspit
• public health issues: working conditions

  cotton workers- brown lung disease. chimney sweeps- cancer from soot
• public health issues: diet

  sand in sugar, sawdust in flour, lead carbonate & copper arsonate in sweets
• public health issue: poverty


  only the middle & upper classes could afford medical care from doctors
• lack of knowledge


  germ theory only proved in 1861 and did not have a huge impact on public health immediately afterwards. some clean ups but no knowledge about clean water
• Victorian attitudes


  Laissez faire- the idea that the government's job is to keep law and order not keep people healthy. prejudice towards poor people that it is their own fault and not the upper class' responsibility
• rates


  public health improvements would lead to higher rates which property owners would have to pay. these improvements would benefit those living in poverty who did not have to pay rates
• private companies


  9 different water companies in London. government regulations would hit their profits
• the vote


  the working class could not vote so laws were passed in the interest of those who did not pay them
• cholera in Britain


  1831- first outbreak in Sunderland. 1832- first epidemic, 6000+ die. by the end of 1832 21,000 people have died. 66% mortality rate
• reaction to cholera: miasma

  burned tar in the streets and added lime to the sewers
• reactions to cholera: religious


  government imposed national day of fasting and humiliation in 1832
• reactions to cholera: prevention


  isolation and quarantine. constables on outskirts of towns, cholera hospitals and cholera burial grounds
• reactions to cholera: treatments

  mustard, tobacco enemas, opium, champagne
• civil servant Edwin Chadwick


  Report on the Sanitary Conditions of the Poor (1842). believed terrible living conditions caused miasma so towns should be cleaned up. asked Parliament to pass legislation to improve sewage disposal & water supplies. supporters=clean party, opponents=dirty party- laissez faire & taxes
• 1848 public health act


  gov decided to pass act after hearing of cholera spreading through Europe in 1847. consisted of a national board of health being set up, improvements in some towns to water supply & sewerage, taxes to pay for improvements, medical health officers could be appointed in necessary
• issues with 1848 public health act

  no money or authority (not forced to pay higher taxes). no national plan
• John Snow- water companies

  Southwark & Vauxhall water company got water from downstream of sewage pipes. Lambeth was upstream. Snow ran chemical analysis on water from each company- S & V = 4 times salt than L. 38/44 deaths from S & V's water.
• John Snow- Broad Street Pump


  London 1830- 2/3 lived in a slum, 40 to a house, 8 to a room. 1854- Snow interviewed victims/families & was told pain began in stomach so believed it was ingested. 600 dead in 1st 2 weeks. plotted deaths on map (Voronoi diagram)- linked them to B.S pump. workhouse = in vicinity of pump but had its own so unaffected! pump = 3 feet from cesspit. authorities removed pump handle & epidemic ended
• impact of Snow's work on Britain

  1855- General Board of Health reported on the 1854 epidemic. published images (one of B.S water and one of New River Company water- area unaffected by cholera). B.S water was cleaner (magnified by 100). Board of Health was implying dirty water does not result in cholera
• Snow's impact internationally


  1874- international sanitary conference- 21 governments voted unanimously that miasma is the cause of cholera & that it is airborn
• the great stink


  1858 June high 20s. hottest summer on record. heat worsened smell of river. MPs driven from house of commons & debates terminated (curtains were coated in chloride of lime). 12 million cubic feet of human waste was flowing into Thames daily. Act of Parliament (made in 16 days) gave £3 mill to board of works
• Joseph Bazalgette


  chief engineer to Metropolitan Board of Works. biggest project of 19th century. £3 mill. lay a herringbore system of sewers collecting waste from all over London. waste dumped at high tide and swept out to North sea
• Louis Pasteur's contribution


  1860s- proving germs cause disease & decay. his work backs up Snow's. people are more willing to pay taxes for public health reforms
• Bazalgette's sewer timeline


  1866- 4th epidemic in East London, this area was not yet connected to the sewerage system. 1875- sewerage system is completed. 1892- cholera epidemic in Germany but does not break out in London as drinking water no longer contains waste.
• 1867 Reform Act


  doubled the electorate in England and Wales from 1 to 2 million men. working class now allowed to vote meaning they could have a say in national issues such as clean water which would effect the entire country
• 1875 Public Health Act


  compulsory for local councils to improve sewers & drainage, provide fresh water and appoint Medical Officers. also improved standards of housing, shortened the working hours for women & children in factories and stopped the pollution of rivers
• Robert Koch's contribution


  1883- successfully isolated bacteria in Indian epidemic. 1895- members of his lab developed a vaccine. 1884- findings rejected by gov
• positives of Snow's work

  it was correct, could lead to improvements in clean water supplies and sewerage systems, developed epidemiology (Veronoi diagram), saved lives of people of B.S, wrote up findings (presented them to House of Commons committee)
• limitations of Snow's work


  it was ignored, no short term improvements (treatment or prevention), needed contribution of other individuals like Pasteur to be believed, gov acted on the Great Stink not Snow's work, Bazalgette brought end to cholera not Snow