Public Health

• The ancient Egyptians believed in keeping clean. It seems that their concern with cleanliness was more to do with religion and comfort than with health. The fact that priests washed more often than other people suggests a religious connection to their washing practices. The Egyptian development of mosquito nets was more to do with comfort than the knowledge of the illnesses that mosquitos can carry. But, whatever their reasons, their attitude to cleanliness helped them to keep healthy. Shaven heads were normal, for both men and women. Clothes were changed regularly.
• Despite their sophisticated water drainage system for growing crops, the Egyptians do not seem to have developed a drainage system for their toilets. Only well-off people had bathrooms and the baths were just shallow troughs with a drainage pipe leading to a large jar. Toilets were more common, but these were just stone seats over a large removale jar. Perhaps this shows that water was too valuable to be wasted in deep baths or in sluicing away sewage, which could be carried to the fields by slaves and used as manure.
• The Egyptains drink from cups of bronze which they clean daily - everyone, without exception. They wear linen clothes which they make a special point of continually washing. Their priests shave their whole bodies every third day to guard against lice and other unpleasant things. Twice a day and every night these priests wash in cold water.

• 'Regimen' was a word the Greeks used a lot when they discussed health. It covered all aspects of people's lives - what they ate or drank, how much they slept, how much exercise they took, what they did as a job and so on.Everything was taken into account.The modern word 'lifestyle'
• The idea of a regimen for a healthy life was not new. The Greeks had always believed that eating and drinking well helped people to keep healthy. Exercise and keeping clean were also important parts of Greek life. Many of the Hippocratic books set out exactly what should be eaten, drunk or avoided for perfect health and when meals should be taken. They also outlined the best forms and amount of exercise to take. Following all the books' advice about hygiene, eating and exercise would have filled a normal day. Doctors seem to have realised that these were ideal measures which only the rich would be able to take and they gave more general advice for ordinary working people who had limited time and money to spend on their regimen.
• Advising people to follow a healthy regimen helped to prevent a disease. However, the Greeks did not take more public measures to prevent disease in their populations such as building sewers or creating clean water supplies for their cities.

For the Romans, prevention was better than cure. However, before they could prevent illness, they had to decide what caused it. The Romans were a practical people and they learnt much from observation. One of the things they observed was that people who leaved near marshes and swamps tended to get ill, and often die, from the disease we now call malaria. Was there a connection between the swamps and the illness? The first solution was to build a temple to Febris, the goddess of fever, in the largest swamp near Rome. If you believe in supernatural causes and cures for disease, this is an obvious thing to do. However, over time, the Romans must have noticed that just as many people were dying as before. The next measure they took to try to solve the problem was to drain the swamps. The fewer swamps there were near Rome, the less malaria there would be.It worked.This shows two important things about Roman public health:

• It could only work within the Romans' understanding of the causes of disease. However, sharp observation and common sense got them a long way. They realised that the swamp was part of the problem and took action while not knowing the way in which malaria is spread by mosquitoes. The Romans often solved problems in this empirical way, acting on what they knew was happening rather than waiting to know exactly why it was happening.

• The Romans were willing to tackle large engineering projects in order to solve problems. Draining the swamps around Rome cannot have been cheap or easy, but the Romans had the willpower, resources and technology to do it.

Their empirical observations suggested to the Romans that a number of things were likely to cause disease: bad smells or 'bad air', bad water, swamps and marshes, being near sewage and not keeping clean.

They therefore took all these things into account when choosing a site for a new house, town or military camp. They also worked hard to get rid of these problems in the great towns and cities they had already built.

These ideas about preventing disease were tied to another Roman concern, always to have a strong army. Two things followed from this. The first was that army camps and barracks must always follow the ideas, to keep their soldiers healthy. The second was that, as the army depended on being able to recruit healthy new soldiers, disease should be prevented in the whole population. The government paid for public doctors and hospitals where the poor were treated. Measures like this, for the whole community, not just a few people, are called 'public health'.

• The Romans used their engineering skills to bring pure water into their towns. There were 14 aqueducts, bringing 1350 million litres of fresh water per day into Rome. The water ran through brick and stone channels. The Romans had no system for pumping water, so the whole course of the channel had to run gently downwards. This meant that most channels started in the nearest hills or mountains. Aqueducts were built to carry the channels across valleys, while sometimes tunnels had to be cut through hills. When the water reached the city, it was used for many purposes. It was not only Rome that had a complicated and expensive water system. Rome's system was copied in all the main towns of the empire.
• Public toilets were a common feature in Roman towns and cities. The toilet seats were like stone benches with holes in, around the edge of the room. Underneath was a channel where water was constantly running, to wash the waste out of the building. Instead of toilet paper, people used a sponge on a stick, which could be cleaned in another channel of clean water running in the floor in front of the benches. There were no separate cubicles, as in modern toilets, and people could sit and chat; it was a social time.

• Taking a bath was a social occasion too. A visit to the public baths could include a warm bath, a hot bath, time in a steam room, a swim, time in the exercise yard or the gymnasium, a massage, resting and chatting to friends, and a cold bath; and all this at a very low cost. The actual cleaning of the body was done by scraping sweat and dirt off the skin with a strigil. At some times bathing was mixed, but usually men and women either had separate public bath houses to go to or they went at separate opening times to the one public bath house. Many rich people had their own private bath complexes. The prices at the public baths were kept very low, so that the poor could afford to use them.

The Romans provided piped water, public baths, toilets and sewage systems for their towns. This made it easier for people to follow the advice that most doctors gave about keeping clean. People did not want to live in dirty conditions. But in the Middle Ages, without government provision of any of these facilities, especially running water, cleanliness was a privilege of the rich.

Ordinary townspeople found it hard to obtain clean water for cooking, brewing and washing. Each town was run by a corporation of rich men from the town. They had to decide how much sanitation to provide and how to raise the money to do it.

People put their household rubbish and sewage onto the street or into a nearby river. Sometimes houses shared a cesspit, or had privies built out over a stream, which should have washed the sewage away. This simply delayed the problem. Cesspits needed to be emptied or they overflowed. Streams often got choked with sewage and became little better than open sewers.

Some corporations knew that it was not healthy to have rubbish and sewage in the streets. They also knew that the river water was not healthy. They passed by-laws to try to stop people throwing rubbish and sewage onto the street - but these were hard to enforce. Little was done unless there was a serious outbreak of disease in the town. Then the corporation would clear the streets and collect and burn the rubbish. Concern about public health was sporadic and only came to a head with the horror at the huge numbers who died in the plague epidemic of 1348.

Monasteries were often rich, even if, individually, the monks were supposed to be poor. They had their own drainage and water supply systems installed in the monasteries. If their monastery was near a river, they could take the water from there. If not, they had to have more complicated systems. The water system at Canterbury Cathedral (a monastery) was very complicated. The water was piped through five settling tanks, to purify it. It could then be used to wash, cook and brew beer. Dirty water was used to clear the toilets which were housed in a separate building. One of the monks was in charge of making sure the laver (the place where the monks washed their hands and faces) was clean and always had clean towels. He was also in charge of supplying clean sheets.

Some hospitals for the sick were set up by the Church, including St Bartholomew's Hospital in London. Although never as rich as the larger monasteries, they were given money and usually had effective sanitation. There were only a few of them at this time, but those that existed were highly thought of by the public. They provided nursing, clean and quiet conditions, food, warmth and sometimes surgery and medicine. Not all hospitals had doctors or surgeons - some were only for the care, not the treatment, of the sick.

Living conditions in 19th century Britain are appaling. Many people live in new industrial towns, which have grown fast as they attract people looking for work in the factories. New houses have been built quickly to accommodate the extra people. These houses are overcrowded, with poor sanitation. People need to live near their place of work, because there is no cheap public transport. Terraces of back-to-back houses often house as many landlords make a quick profit. the back-to-back houses often house as many as 20 people in one room upstairs and one room downstairs. Reports on living conditions in the towns have found houses with five families crammed under one roof. The worst houses are in courts - enclosed passageways with houses built all around them. An open drain running through the middle of the court is often blocked with rubbish and sewage. Toilets are outside the houses and shared. There may be only one or two toilets for all the families in the courts.

Public health in British towns is desperately poor. In Manchester, in the 1840s, 57 per cent of children die before the age of five. Typhus and typhoid flourish, and diarrhoea can also be a killer disease, especially when there is no regular supply of clean water. These diseases spread as a result of the dirt and rubbish. Tuberculosis, scarlet fever, whooping cough and measles are also common diseases, but no one really understands what causes them.

After the 1875 Public Health Act, town councils had to appoint inspectors and a medical officer of health. Councils began to lay sewers and drains, build reservoirs, parks, swimming baths and public conveniences. The Artisans' Dwelling Act of 1875 laid down laws about the standard of housing.

Today, Environmental Health Departments deal with refuse disposal, pollution of air and water, noise pollution, food inspection, pest control, slum clearance and the provision of a range of health services. This does not mean that all the problems of the past have been solved. For example, one community in Glasgow needs more than £187 million to bring slum homes up to standard. In July 2008 a detailed study of 131 typical tenement properties in Govanhill, Glasgow, found that even carrying out essential repairs would cost an average of £80,000 per home - and there are hundreds more just like them. However, unlike in the 19th century, council officials are aware of the problems. A council spokesperson said:

Slum housing is just not tolerable in the 21st century and is the root cause of many of the problems we've got here. What has made it worse is the overcrowding in many privately rented flats. People new to the area have been squeezed into flats; many have Victorian conditions including cockroaches, rats, bed bugs, leaking roofs, no proper heating.

Public health reform was slow to happen. However, Chadwick's 1842 report did spark off a fierce debate about cleaning up the towns. Supporters of reform became known as the 'Clean Party'. In 1844 the Health of Towns Association was founded to campaign for healthier living conditions. Local branches of the association were set up across the country. Each produced evidence of filthy streets, lack of sewage facilities and inadequate supplies of fresh water. The association called for an Act of Parliament.

In 1847 a Public Health Bill was finally introduced to Parliament. It was strongly opposed by a group of MPs who were nicknamed the 'Dirty Party'. They believed in laissez-faire and argued that it was not the government's responsibility to clean up the towns. Furthermore, cleaning up the towns would cost too much and make the government too powerful. The poor were often looked down on and it was thought that they should try to help themselves. The poor did not have votes, so why should the wealthy try to help? Although Chadwick's report clearly showed that there was a connection between dirty living conditions and disease, no one knew exactly what caused these diseases.

Then, in 1848, cholera struck again and MPs voted in favour of the Bill, which became the first Public Health Act.

• Chadwick believed that all laws should be useful and efficient. He first worked as a lawyer.
• 1832 Became a civil servant when he helped to investigate the Poor Laws.
• 1838 Was given permission to enquire into the living conditions of the poor in the East End of London.
• 1840 Began a national investigation into living conditions, which led to his Report on the Sanitary Condition of the Labouring Population of Great Britain in 1842. The report revealed terrible conditions in the towns and shocked the nation. Chadwick argued that if the towns were cleaner, there would be less disease and people would not need to take time off work. As a result, fewer people would need poor relief and this would save the ratepayers money. His work inspired the sanitary reform movement.
• Chadwick said that Parliament should pass legislation to improve sewage disposal and water supplies. Although he was hard-working and intelligent, Chadwick could often be argumentative and tactless. He was 'pensioned off' by the government in 1854.

• Born in York. At the age of 14, he was apprenticed to a surgeon in Newcastle-upon-Tyne.
• 1833 Saw his first cases of cholera when working at Killingworth Colliery.
• 1838 Travelled to London and qualified as a member of the Royal College of Surgeons. He then set up a medical practice in Soho. One of his most famous acts was to administer chloroform to Queen Victoria to ease the pain of childbirth.
• 1848 During the outbreak of cholera in London he spent a great deal of time investigating the causes of the disease. He discovered that, in one area, the people who caught cholera drank water that came from the Thames. In the same area, some people took their water from a pump using fresh spring water and they did not catch cholera. He set out his ideas that the disease was transmitted through water, not through the air, but not everyone accepted his view.
• 1854 In September he found that victims of cholera in Broad Street, London, all used water from the same local pump. He removed the handle of the pump and the disease disappeared. This was further proof that water was responsible for the spread of cholera.

• Born in 1838. Her parents and grandparents were involved in charity work, so she naturally joined in.
• 1853 Started to work with a group of women called the Ladies' Guild. She taught in a ragged school, the first instance of her working with the poor. By 1858 she and her sister had set up their own school. Working in poor areas, she saw the appalling housing conditions of the poor and began to plan how they could be improved.
• 1865 Raised enough money to buy the leases of three houses. She repaired them, collected the rent regularly and got to know the tenants. She made sure that tenants didn't take in lodgers, which could lead to overcrowding and the spread of infection. She got rid of the bad tenants and improved the homes for the remaining tenants, who then looked after the houses. Octavia's scheme was a success. Her tenants cared for their homes and paid the rent on time. This quickly paid off the costs of improvements. Everyone was better-off.
• Soon, many people were paying Octavia to manage their properties for them. With the money she made from this, she bought more houses for the poor. People began to think that she talked a lot of sense about how to help the poor. She campaigned for better conditions for the poor right up to her death in 1912.