History Public Health 1800-1914 (Paper 2)


Medicine in 1800

  • causes of disease was still unknown
  • operations performed were still basic, performed in filthy conditions
  • public health wasn't much better than in the MIddle Ages

Brilliant Individuals: Pasteur (1861), Koch, Simpson, Lister, Fleming

Urbanisation: many people were crammed into small towns, infected water and dirty surroudnings made disease spread rapidly

Government: disinterested in individual lives - if people became ill or were unhealthy it was their problem to deal with alone

Science: links between micro-organisms and diseases made 

Industry: money put into research of drugs to cure diseases

Communications: faster trains, newspapers and telegrams allowed doctors to share ideas

Wars: eg. Crimean War (19th century) improved nursing standards

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Pasteur (germ theory)


1857-64: a brewing company asked P to investigate why one vat of alcohol was going bad, he discovered it was because one micro-organism was growing faster than others. He thought germs were causing the problem. He heated the liquid (pasteurisation), killing the germs.

1860-64: P devised a series of experiments to prove his germ theory. Was ale to convince other scientists that his theory was correct.

1865: P guessed that if germs could make liquids turn sour they could also cause disease in living organisms. Was able to prove that micro-organisms caused a disease in silk worms.

GERM THEORY (findings):

  • prevention vaccines
  • antiseptics (stopping infection)
  • treatments - chemical drugs
  • dirt=disease/importance of hygiene
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Development of penecillin (1928-1945)


  • 1928: Alexander Fleming discovered a mould growing in a discarded dish. The mould had killed surrounding bacteria. Wrote a paper on his discovery.


  • 1939: Howard Florey and Ernst Chain began to experiment with penecillin at Oxford
  • 1940: team experimented with 8 mice, injecting all with deadly germs and 4 with penecillin. Was proven effective against the infection
  • 1941: first human trial, penecillin was effective but ran out before man was fully cured


  • 1941: Florey and Heatley tried to interest USA companies in the mass production of penecillin
  • Dec 1941: Pearl Harbour - USA entered WW2. After this the USA gov. supported mass production. Gave $80mil. to fund research
  • 1943: successful trial on a war wound in N. Africa
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Ignaz Semmelweiss 1847

  • problem: deaths of healthy women after childbirth on wards that were treated by medical students, not midwives
  • he noticed the medical students didn't wash their hands before delivering babies, even after dissecting dead bodies
  • he introduced the idea of washing hands after dealing with the dead, using chloride of lime solution. This idea was not taken up

Joseph Lister 1867-69

  • used carbolic spray in operations
  • ideas were gradually accepted, germ theory made it easier for him to explain why his theory worked
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Public Health reform (19th century)

Cholera: new disease, killed people quickly. Epidemics in 1831-2, 1848 and 1865 forced gov. to act in order to prevent thousands of deaths each time

William Farr: recorded births, deaths etc. and recorded where death rate was highest and what people died of

Edwin Chadwick: wrote chunky cholera reprt in 1842, proved life expectancy was lower in city than in country. Challenged 'laissez-faire' attitude. Pressured gov. to pass British PH Act in 1848

John Snow: plotted cholera cases on a mao, identified a water pump in Broad Street as the source

Jospeh Bazalgette:  made sewer system in London, finished by 1875 

Germ Theory: Pasteur developed it in 1861, helped Koch identify cholera micro-organism

Political Reform: working class men given the vote. MPs had to make changes to their PH policies in order to gain their vote and be elected, as working class men in towns were most at risk from catching disease, therefore they wanted help with preventing it 

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Early 19th century living conditions/opposition to


  • cramped, poorly constructed, damp housing. Sometimes 10 people to a room
  • dirty, polluted water, either from puddles or rivers. Water pumps probably polluted
  • no sewers, sewage left in piles on the street and collected once a year, otherwise dumped in rivers/streams which polluted water supply
  • steam trains and factories polluted air
  • no drainage, puddles of rainwater left in street, which combined with the sewage
  • no rubbish collection


  • many believed that the gov. shouldn't interfere with individual lives (laissez-faire attitude)
  • middle/upper classes ignored inner city conditions, hated the idea of rates and taxes being increased to improve living conditions for the poor
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1848 First Public Health Act and 1875 Second Publi


  • central and local Boards of Health
  • wasn't very successful because it didn't force towns to take action
  • in 1854, when threat of cholera had passed, central Board of Health was closed


  • laid down in detail what each local/town council had to do
  • had to provide: clean water, proper drainage, sewage disposal
  • had to appoint a Medical Officer of Health 
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Charles Booth and Seebohn Rowntree (Welfare State)

  • carried out surveys in York that tried to understand the lives of the poor, and decide whether poverty was being exaggerated
  • their findings shocked them and the rest of Britain
  • nearly one in three people in cities lived below the poverty line, and ill, old or unemployed people could do nothing to help themselves
  • they advised the gov. to take action such as introduce an old age pension
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Welfare State (gov. looking after their citizens f


  • National efficiency: Boer War 1899-1901 - 40% of recruits were found to be medically unfit
  • Social awareness: Charles Booth and Seebohn Rowntree
  • Political advantage: working class men could vote and Liberals wanted to be elected, so they looked at policies to help prevent poverty
  • Education (provision of meals) 1906 - meals were provided at schools which were compulsory, and were free for those who could not afford them
  • Old Age Pensions Act 1908 - weekly state pensions were introduced for 'deserving' men and women over 70 years old BUT the amount they got was below the standard of living
  • National Insurance Act 1911 (part 1) - state health insurance was provided for low paid workers, sickness benefit was also granted if they were off work BUT it only covered the wage-earners not their families (part 2) - state unemployment insurance was given to those made unemployed in certian trades eg. ship building BUT was only available for unstable trades
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How did WW1 and WW2 help to progress surgery?

Blood transfusions: in 1901 the different blood types were discovered. After years of on-the-spot donors and erratic success, doctors realised that blood coould be separated. Cells were then kept in ice and diluted when needed

Fighting infection: aspetic surgery was done in all hospitals. It was difficult to prevent battlefield wounds getting infected, therefore infected tissue was removed and soaked in saline solution. New techniques to mend broken bones were developed

Plastic surgery: skin grafting techniques were improved. in WW1 surgeons performed 11,000+ plastic surgery operations, and WW2 resulted in many more cases of burns

X-rays: 1895 - Wilheim Rontgen experimented with cathode rays and discovered X-rays. Hospitals installed them within 6 months of publish (Dec1985). X-rays improved removal of bullets and shrapnel from soldiers

Did they hinder development? gov. put more money into war (army, machinery etc) so there wasn't much left for scientific research or technology advances

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