What obstacles faced the 19th century public health movement, and how far were they overcome?
What obstacles faced the 19th century public health movement, and how far were they overcome?
For the purpose of this essay I am going to debate on what obstacles faced the 19th century public health movement.
The Industrial Revolution was a set of developments that transformed British society from largely agricultural to overwhelmingly industrial system.
During the 19th century there was a rapid migration of rural workers to the new manufacturing towns. This was due to several factors - the loss of agricultural livelihoods with the enclosure of common land, the system of poor relief and the response to the introduction of the factory system. It led to unprecedented population growth. A rapidly expanding population fueled the growth of cities, but no concept of social responsibility for sanitation existed. Obtaining clean water and disposing of sewage and garbage were seen as individual rather then social problems. The living units at this time were known as tenements. These houses had very poor sanitation. Because of the bad sanitary conditions people were often sick. It meant that infectious diseases spread easily. Many of the most common diseases that were going around during this period of time was cholera, typhoid and typhus.
Little urgency was shown about all this problems until the appearance of cholera epidemic. Cholera is carried in infected water, but no one knew this for certain until the end of the 1860s. The first confirmed case of cholera in Britain occurred in September 1831. Over the next 30 years or so, Britain was invaded by four of the pandemics of cholera that had spread from Bengal since the early 19th century and suffered epidemics in 1831-1832, 1848-1849, 1853-1854 and 1866. Cholera was not as persistent or as frequent in its attacks as other infectious diseases but was remarkable for its high mortality rate and the speed at which it could kill.
Britain had known for some time that cholera was moving towards its national boundaries. Both the public and medical practitioners reacted to the arrival of cholera with sheer panic.
Before the 1860s, there were two main theories about the spread of disease in general and cholera in particular (both technically wrong)
The Contagionist Theory
People holding to this theory believed that disease was spread through contact with people who already had the sickness. It did not have any effect; because this theory would have led to the quarantining of whole houses, streets or even towns ...
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Britain had known for some time that cholera was moving towards its national boundaries. Both the public and medical practitioners reacted to the arrival of cholera with sheer panic.
Before the 1860s, there were two main theories about the spread of disease in general and cholera in particular (both technically wrong)
The Contagionist Theory
People holding to this theory believed that disease was spread through contact with people who already had the sickness. It did not have any effect; because this theory would have led to the quarantining of whole houses, streets or even towns and opponents pointed to the loss of trade, increase in poverty - and to the fact that not everyone in the same household caught the disease.
But this theory was increasingly challenged by the mismatists .The miasmatic theories of disease were led by Edwin Chadwick.
People holding to this theory believed that disease was carried by 'bad air' and that disease was carried on a 'miasma of filth'.
The provision of clean streets, well-ventilated housing, and effective sewage systems were the key to a healthy population. The miasmatic theory was very popular among medical men and the public alike. For Chadwick and his supporters, therefore, preventive measures for diseases such as cholera centred on overall sanitary improvements. There were considerable political advantages stemming from this viewpoint as well. It was assumed that cholera was airborne A few (notably Dr Southwood Smith of London) speculated that it was associated with contaminated water - some miasmists took this idea in and thought that the miasmas chemically affect the water. However, Snow did not accept this 'miasma' (bad air) theory, arguing that in fact entered the body through the mouth . The government policies and attitude did not help to overcome the serious health problems. The government had a 'laissez faire' attitude meaning they would not interfere with any social issues and did not involve themselves with the public. These were based on the ideas of the political economist Adam Smith, who advocated free trade. The government believed in individualism meaning people should fend for themselves and are only responsible for their own destiny in life. These attitudes prevented improvements in public health happening because the public began to have a general acceptance to filth and squalor and the government doing nothing about it. Furthermore because there was a lack any knowledge on infectious diseases people believed there was not much there could be done about the situation so generally accepted the hardship and squalor. The government had done little about the 'dirty' diseases that were common in all towns and which caused far more deaths than cholera. BUT cholera was different because it: was deadly and swift, created fear in a way that tuberculosis and typhoid did not. By the 1840's those assumptions were beginning to change. In 1842, Edwin Chadwick, published a report of his study of the health of the British labouring classes. He concluded that poor people lacked good health and had a shorter life expectancy. He argued that their poor health was caused by their physical living and working environments. Chadwick, like many people, believed that disease was caused by air pollution. His ideas on cleaning up towns were a step in the right direction but his conclusions were too general and did not address the specific causes of disease. However, he was the first major figure in public health and his work helped to make later reforms possible. The real breakthrough was the Public Health Act of 1848, which set up a Central Board of Health consisting of three members, one of whom was none other than Edwin Chadwick. Apart from the Central Board, there were Local Boards of Health which were given special powers and duties. The aim of the act was to improve the sanitary condition of towns and populous places in England and Wales by placing the supply of water, sewerage, drainage, cleansing and paving under a single local body. The act could be applied to any place in England and Wales except the City of London and some other areas in the Metropolis already under the control of sewer commissioners. The Act was passed by the incoming Liberal government, under Prime Minister Lord John Russell, in response to urges by Edwin Chadwick. The Central Board of Health, which lasted until 1854, was yet another failed attempt to improve the lives of the poor and were viewed with a deep distrust by most local health administrators. In 1871 the Central Board of Health was finally replaced by the Local Government Board, laying the foundations for the administrative mechanism of public health in the twentieth century. A year later, in 1872, a new Public Health Act passed full responsibility for rural sanitation over to Boards of Guardians. And then, in 1875, the British Isles saw the emergence of the Disraeli Public Health Act. The 1875 Act led to the transference of power from central to local government, even in the urban areas. Local authorities had to pay for all services, with the taxes now drawn from local ratepayers. Also included among the new responsibilities of local government, were the construction and maintenance of amenities - such as parks and public houses - and even special hospital isolation units for patients suffering from infectious diseases. So it has been clearly demonstrated that the government was keen to avoid taking action itself as far as public health was concerned.
From a social perspective, state intervention in public health can be regarded as a pragmatic response to social problems, that gradually led to a more interventionist state generally. From a Marxist point of view intervention happened more because it became necessary for the interest of capital as a whole, in order to make cities safe for capitalism to flourish, and to invest in the quality of labour as lost lives meant lost profits (Doyal, 1979, Turshen, 1989).
Whilst there were widespread social concerns about the conditions in which poor people lived, this was insufficient on its own to force the pace of change. It was only when taken in combination with powerful economic concerns about the need to have a healthy and therefore productive workforce that sanitary reform gathered pace. Public health reform moved ahead in 19th century England through a combination of broader political reform and specific policy legislation. The process of urban decentralisation was gradual, incorporating greater influence of an expanding electorate with an increase in authority of municipal bodies over public health matters.
Bibliography
Fraser, D. (1984), The Evolution of the British Welfare State, 2nd Edition, Basingstoke: Macmillan.
Blakemore, K, (1998), Social Policy: An Introduction, Buckingham: Open University Press.
Doyal, L. and Pennell, I. (1979) The political economy health, London: Pluto press.
Ermir Alicka
