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Medicine
· A quick review of public health from prehistoric times to the 19th century
· Early nomadic tribes had no need for public health, as they were constantly on the move.
· Early civilizations in (Mohenjo Daro, India) had basic public health systems
· Roman public health systems depends on army (Cloacae Maxima)
· They had drainage systems, fresh water and regulation of aqueducts (Pont du guard)
· Sack of Rome : Public health systems fall into disrepair
· Middle ages is crowded, open sewage
· The Middle ages had little regulation.
· Monasteries are the only exception, they are kept clean to please God.
· Few significant improvements by the 19th century (1665 is the great plague :)…read more

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Public Health ­The Hazards
· Industrialization meant that the housing became even more cramped and that it became even darker and dingier.
· Open sewage and polluted drinking water.
· Factories released coal and dust fumes, which did not help the public health situation
· The workers in these factories were severely malnourished.
· Read the little match girl ­ to get a sense of the poverty associated with that time!
· Cholera epidemics (1831-1832), (1848-1849), (1853-1854) and (1866)
· The great stink (1858)
· The middle class were in their beautiful villas, in the country side, they were not bothered about the working
class!!!…read more

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Factors-Why was nothing done???
· 1) Government elected by the wealthy (till 1867 only the middle class could vote). They do not live with the working class, they don't have
to suffer what the w/c (working class= w/c) have to suffer and so they don't care
· Government has a laissez faire attitude, which basically means leave it alone,
· Middle class self help (they don't like taxes)
· The middle class think that people are poor because they are lazy.
· The w/c worked in work houses.
· Key factors
· The rich are not interested in the poor
· Lack of knowledge (pre 1861 there was no knowledge on the causes of disease or on germs)…read more

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Why did change occur?
· In 1867 the working class got the chance to vote
· As a result in order for their party to win they must also appeal to the w/c.
· This then means that the government finally starts to understand the dreadful problems in the towns of the w/c. 7
· There is also growing awareness of the problems from the help of people like Edwin Chadwick and John Snow.
· Edwin Chadwick
· - Investigates poor cities. Report in 1842 poor people in towns live half as long as those in the countryside.
· Then John Snow:
· - Proves that cholera is spread by H2O, he uses a map to show cholera spread from a dirty water pump.
· Also the w/c finally become more educated. So they can explain their views
· 1861-Germ theory
· Cholera is a classless killer it affect the w/c and the rich
· Success in pioneering cities.…read more

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What changed?
· 1860's Bazelgette builds huge sewers network for London
· This then led to other cities following.
· 1875- public health act (compulsory)
· - Appoint local medical officers
· - Responsibility of local council to clean sewage.
· - New houses must have toilets.
· BUT!!!
· Still there was work to be done... The population was not healthy still
· 40% of the population were still unfit to fight in the Boer war. (1899-1901), as they seemed unfit to be in the army.
· No cheap health care or support for the poor
· Slums were still there, only new houses had public health systems.
· Hospitals still not available to all
· 20th century leads to NHS.
· Most of the problems are not resolved yet, until the twentieth century.
· Initially 9/10 of the doctors opposed the NHS since they stood to loose money and didn't want the change, extra work and the
government controlling them.…read more

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