19th Century Public Health

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The Industrial Revolution - Problems

The Problems

  • The industrial towns were growing at alarming rates
  • There were no regulations to control:
    • House buildings, so shoddy houses were built and many were too close together (back to back, or around a shared courtyard)
    • Road Laying, so weren't even made in the 1st place
    • Water Supply, therefore the water became contaminated very quickly
    • Sewage removal, wasn’t any therefore it began to pile up
    • Population size, so overcrowding was a huge problem
    • Food quality, so most were malnourished
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The Industrial Revolution - Effect on Health

The Effect on Health

  • Due to malnourishment people were too weak to fight off disease and were very prone to it
  • Damp and overcrowding led to the widespread of very infectious diseases
  • Endemics such as typhoid, typhus and tuberculosis were frequent killers
  • Epidemic diseases like cholera caused huge loss of life and scared people more than the endemic ones
  • The average mortality rate in towns fell:
    • The average mortality rate for working class people was just 17
    • The average mortality rate for upper class people was only 38
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The Industrial Revolution - Why Wasn't Anything Do

Why Wasn't Anything Done?

  • The key belief of the government was laissez-faire (leave it alone)
  • Most people also agreed with this belief and didn't want them to get involved with the lives of the citizens
  • The rich, and therefore those who had a vote didn't want any new schemes being made as it would come out of their pockets in the form of taxes
  • Some people believed that they should fend for themselves to avoid becoming dependant on others (Self help was a key Victorian idea)
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Edwin Chadwick - What Did He Do?

What Did He Do?

  • By 1830 the government had finally realised that something ought to happen about public health
  • Edwin Chadwick was given the job to investigate the living conditions in East London in 1838 - This was extended to the whole country by 1842
  • He then publish his 'Report on the sanitary conditions of the Labouring population of Great Britain', and it was here that he published his ideas about the link between disease and poor living conditions
  • His findings were backed up the work of Dr Southwood Smith, who in 1838, found over 14,000 cases of fever among the poor
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Edwin Chadwick - What Did His Report Say?

What Did His Report Say?

  • Chadwick's exact words were "Epidemic diseases are caused by decaying animals and vegetable substances, by damp and filth, and close overcrowding dwellings"
  • He also said that "The annual loss of life from filth and bad ventilation is greater than the loss from death or wounds in many wars in modern times"
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Edwin Chadwick - What Did He Propose?

What Did He Propose?

  • Chadwick's ideas were practical ones:
    • Build drains from houses to main sewers
    • Remove the sewage through glazed pipes, which wouldn't leak
    • Sell the sewage to farmers as fertiliser
    • Improve the water supplies
    • Build the cemeteries on the edge of town
    • Each town should have a body responsible for public health
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Edwin Chadwick - What Response Did He Get?

What Response Did He Get?

  • Chadwick's ideas were opposed as many old ideas such as cost, laissez faire and self help surfaced
  • The government decided to conduct a separate enquiry and came back with the same conclusion as Chadwick
  • So in 1847 a public health bill was introduced to parliament
    • The MPs who headed it up were nicknamed 'The Dirty Party'
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Edwin Chadwick - What Happened To Him?

What Happened to Chadwick?

  • After the failure of the 1848 Public Health Act he tried to impose his ideas on local boards, and because of this created bad feelings with the medical profession by ignoring their role in people's health
  • The central board of health was shut down in 1852, and in the same year Chadwick lost his job
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1848 Public Health Act - How Did it Get Passed?

How Did it Get Passed?

  • William Farr used death certificates to collate statistical evidence linking disease with filth
  • Chadwick won many over with his argument that death and illness was actually costing the nation in lost work and productivity
  • Chadwick also proposed that towns should borrow money for Public Health Schemes and pay them back in 30 years in the form of local rates
  • Cholera returned in 1848 and scared people into action
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1848 Public Health Act - What Did it Say?

What Did The Public Health Act Say?

  • A central board of health in London was to sit for 5 years
  • Local boards of health could be set up if 10% of rate payers agreed, and these local boards:
    • Could improve water supply and sewage disposal systems
    • Took over from private companies and individuals
    • Rates could be levied to pay for schemes
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1848 Public Health Act - Did it Work?

Did it Work?

  • Only 184 places set up local boards of health
  • However the law wasn't compulsory so many towns didn't bother
  • 'The Times' newspaper stated "We prefer to take our chances of Cholera and the rest than be bullied into health'
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Important Factors that Contributed to Public Healt


  • Cholera epidemics during 1854 and 1866 frightened the authorities
  • John Snow proved the link between Cholera and dirty water in 1854

Germ Theory

  • In 1864 Pasteur's germ theory was accepted and published, and this became the widespread belief about what caused disease


  • Statics, like Chadwick's linked poor living conditions with disease and death
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Important Factors that Contributed to Public Healt

Medical Officer

  • In 1858 Sir John Simon, a surgeon was appointed, by the government, to be the first Medical Officer of Health
  • Simon did the following:
    • Pushed for preventative measures, for example efficient sewers and clean water supply
    • Pushed for curative measures, and therefore was accepted more by Doctors
    • Persuaded the government to set up the 'Royal Sanitary Commission' which made recommendations which led to the 1872 and 1875 Public Health Acts
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Other Acts

How was the 1848 Public Health Act Improved upon?

  • 1858 Public Health Act - Allowed Towns to set up Boards of Health without central interference
  • 1866 Sanitary Act - Each town had to appoint sanitary inspectors
  • 1872 Public Health Act - Divided the country into 'Sanitary Areas' which were all overseen by a Medical Officer of Health
  • 1875 Artisans Dwelling Act - Local Authorities were given permission to buy up slum houses, knock them down, and then build new houses
  • 1876 Artisans Dwelling Act - Compelled Local Authorities to provide housing with fresh water and sewerage
  • 1890 Housing of The Working Class Act - Strengthened the power of Local Authorities to build areas of new housing (council houses)
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1875 Public Health Act - What Was It?

  • The 1875 encompassed all the previous acts (up to 1872) and added a few extra laws:
    • Made local authorities appoint a medical inspector
    • Made local authorities provide clean water, street lamps, drainage and sewage disposal 
  • So this meant the councils were in responsible for:
    • Clean Water
    • Sewage Disposal
    • Improved Housing
    • Inspection of Lodging Houses
    • Food Inspection
    • Public Parks
    • Public Toilets
    • Street Lighting
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1875 Public Health Act - Change of Attitude

Change of Attitudes

  • The government were expected to act in matters of health
  • Laissez Faire was destroyed
  • Move towards compulsory legislation
  • Pressure groups were set up to push for more reform
  • Individuals pushed for better housing
  • Joseph Rowntree built model houses for working class citizens
  • People began to be educated about health
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1875 Public Health Act - Did it Work?

Did it Work?

  • Up to a point they did
  • However towards the end of the C19th several studies showed that there were a lot of problems:
    • Charles Booth proved that at least 30% of Londoners were living in poverty
    • Rowntree Studied the poor in York and found that more than 25% were living in poverty
    • 40% of the recruits for the Boer War were found to be medically unfit
  • All these statistics came to a surprise to those who had carried out the reforms
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