Medicine and the industrial revolution

• Industrialisation: From 1750, there was a movement of people from rural to urban areas due to the Industrial Revolution. Goods were being made in factories powered by steam, instead of in peoples’ homes. People needed to move to where there was work, and this was in the new factories in urban areas. This led to towns and cities growing quickly in size.
• Industrialisation: The population of London in 1801 was 1,090,078 and in 1901 this had increased to 5,567,591.
• Housing and sanitation: Factory owners often built cheap houses for their workers. Back-to-back terraced housing was common, with families living in a single room. There was a lack of clean running water, proper sanitation and sewage systems. Toilets were normally shared between several houses.
• Housing and sanitation: Water came from pumps in the street with water supplied from a river that was often heavily polluted. Cracked pipes could also lead to contamination of the water with human waste from cesspits. If there was an outbreak of a disease, it would spread rapidly due to overcrowding and poor sanitation.
• Air pollution: Huge amounts of coal were being burned to power new factories and mills in towns and cities. Air pollution caused significant damage to health, as a thick smog hung over towns and cities where people had moved to in order to live and work. It caused breathing difficulties and led to many deaths as it damaged people’s lungs.
• Disease: Cholera - first arrived in England in 1831 and caused an outbreak that killed around 50,000 people. It was spread by contaminated water or food. It caused diarrhoea and vomiting, which often led to severe dehydration and death. There were further cholera epidemics in 1848, 1854 and 1866.
• Disease: Typhoid - was also spread by contaminated food or water. It caused a high temperature and fatigue, and could also be fatal.
• Edwin Chadwick: A lawyer who wanted to reform the conditions poor people lived in. He carried out research into the living conditions in different parts of the country. This work was put together in his Report on the Sanitary Conditions of the Labouring Population of Great Britain in 1842. The report highlighted the impact of public health conditions and wealth on life expectancy.
• Edwin Chadwick: Found that labourers who lived in northern towns and cities, such as Bolton, Liverpool and Manchester, had a life expectancy of just 15-19 years. In contrast, people living in rural northern areas, such as Rutland, and who worked in a professional trade had a life expectancy of 52 years.
• Edwin Chadwick: The idea that the government should be involved in public health was rare in the 19th century. Many people accepted this laissez-faire attitude and did not want the government interfering in their lives. This view is reflected in a letter sent to The Times newspaper in 1852. It helps to explain why there was a reluctance from the government to make public health reforms compulsory.
• Public health act (1848): The government responded to Chadwick’s report and passed a Public Health Act. The act set up a Central Board of Health to oversee the improvement of public health.
• Public health act (1848): Local authorities could set up a local board of health to oversee public health. If an area had a mortality rate higher than 23 per 1,000 people, the local authority had to set up a board.
• Public health act (1848): The local board of health could then raise taxes to pay for clean water supplies and new sewerage systems.
• Public health act (1848): The act was limited in that there was little funding and the local boards of health were usually not compulsory. However, it was an important first step in the government taking action to improve public health.
• Discovering the cause of Cholera: John Snow was a physician who was working in London during the cholera outbreak in 1854. He did not believe miasma theory was responsible for the outbreak of cholera in 1854. Therefore, he carried out an investigation to try to establish the cause of the outbreak.
• John Snow's investigation:

  • Focused on cholera cases in Soho, London.
  • Snow plotted all the places where people had died from cholera.
  • From the map, he was able to work out that they had all drunk water from the same pump on Broad Street.
  • It is believed that the drinking water was contaminated by sewage leaking into the water supply from a nearby cesspit.
• John Snow's investigation:

  • Snow knew that none of the workers at a local brewery had been taken ill with cholera.
  • The people who worked at the brewery had been drinking beer, rather than water from the pump.
  • Snow persuaded the local council to remove the handle from the pump so it could not be used.
  • Cases of cholera in the area stopped as people were forced to go to other pumps for their water.
• Significance of Snow's work: Snow’s investigation proved that cholera was a waterborne disease. This was an important step forward in disproving the miasma theory. However, Snow could not explain that there were germs in the water that were causing the illness. Therefore, many people continued to believe that cholera was caused by miasma. It was not until Louis Pasteur’s germ theory that there was evidence to further support Snow’s work.
• Significance of Snow's work: Led to further public health reforms. Action was taken to provide people across the country with a clean water supply.
• The great stink: The summer of 1858 was warm and dry. As a result, the water level of the River Thames dropped. This meant the sewage and waste that were being dumped in the river were no longer being quickly washed away.
• The great stink: Due to remaining sewage he resulting smell was awful and became such a problem that the Houses of Parliament were closed. Miasma theory was still widely believed. As a result, people cleaned the walls of their homes with chloride of lime to take away the smell.
• John Bazalgette: As a result of the Great Stink, the government invested in the construction of a new sewerage system for London. This was designed by Joseph Bazalgette. The new system was designed in 1858 and completed in 1875. The system was built in response to the Great Stink. However, it also resulted in the end of significant cholera outbreaks in London.
• Public Health act (1875): Following John Snow’s work on cholera and Louis Pasteur’s publication of germ theory, there was conclusive proof that cleaning up towns and cities would improve the health of the people who lived in them. There was now clear evidence that if public health systems were improved, lives would be saved. This marked a move away from a laissez-faire attitude.
• Public Health act (1875): In 1875, Prime Minister Benjamin Disraeli’s government passed a second Public Health Act. This went further than the act of 1848. It said that local authorities had to provide clean water supplies, build sewerage systems and appoint a medical officer.
• Disraeli introduced more reforms:

  • The 1875 Artisans' and Labourers' Dwellings Improvement Act brought in new standards for housing quality.
  • The 1875 Sale of Food and Drugs Act tightened laws around food labelling.
  • The 1876 Rivers Pollution Prevention Act aimed to clean up rivers and the water supply.
• Charles Booth: In 1889, the social reformer Charles Booth decided to investigate the levels of poverty in London. He produced a colour-coded map that showed the divide between wealthier and poorer areas of the city.
• Charles Booth: Booth found that 35 per cent of people lived in extreme poverty, even though many of them had full-time jobs. This number was much higher than people had previously believed. It showed that despite the reforms of public health in 1875-1876, more still needed to be done.