Account for the Development of Public Health Reforms in the 19th Century and Assess Their Role in Improving the Population’s Health by the Early 20th Century BY Hanoi 65 The 19th Century was the century of the industrial revolution. There were numerous developments in scientific fields, including Physics, Chemistry, Biology and Mathematics alongside the invention of useable electricity and steel production. These all led to the growth of railways and steam ships as a means of transportation, and improved methods of communication.
These developments led to a sharp xplosion of new factories hoping to utilise the new technology and knowledge in order to make products faster and more cheaply than ever before. At the same time as these advances were being made the population of Britain doubled in the first half of the nineteenth century, with a fourfold or even eightfold increase in the populations of some urban areas (Alcock, Daly, Griggs, 2008) During this period of rapid technological advancement the number of Jobs available in towns and cities grew exponentially, leading to towns and cities becoming over-crowded with workers flocking to them in order to find work.
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Often the people who would traditionally have been working on the land were drawn to the towns and cities to take advantage of the opportunities that were being presented to them there. It has been suggested that, at the beginning of the century, around 80% of people lived in rural areas and worked on the land as farmers or within their homes to make cloth from cotton or to spin wool to be made into clothes; by the middle of the century, it is estimated that over 50% of the population lived in industrial towns and cities. In the first 50 years of the nineteenth century, for example, the population of Birmingham grew from 71 ,OOO o 233,000, of Glasgow from 77,000 to 345,000, of Liverpool from 82,000 to 376,000 and of Manchester from 75,000 to 303,000″ (Alcock,Daly,Griggs,2008) Small areas of habitation grew quickly until they grew into the major cities. Birmingham and Sheffield became famous for their manufacturing trades.
London, Liverpool and Bristol grew because of the docks, railways and canals that enabled goods to be exported. The unprecedented numbers of people moving to, and indeed creating these towns and cities meant that housing solutions needed to be found very quickly; to this end some factory owners built accommodation for their workers, hese would be built close to the factories so that the workers could easily be called to work by the factory bell, as most workers did not have their own clocks.
As the factory owners were motivated primarily by profit, and tended to view workers as Just another resource accommodation was often constructed to the lowest possible standard. “Salford, once more important than Manchester, was then the leading town of the surrounding district to which it still gives its name, Salford Hundred. Hence it is that an old and therefore very unwholesome, dirty, and ruinous locality is ouses could be extremely basic with communal toilets and without running water, and with no arrangements made for the disposal of human waste. Over-crowded, ill-drained, badly-ventilated, and miserable abodes which line the narrow lanes and filthy alleys abounding in most large town”‘ (Roberts, 1855) With the numbers of people moving to the towns and cities there could not be enough houses built to cope with demand; in these cases people would be forced to live in cellars and other unsuitable dwellings, often alongside other families and even animals. “It often appens that a whole Irish family is crowded into one bed; often a heap of filthy straw or quilts of old sacking cover all in an indiscriminate heap, where all alike are degraded by want, stolidity, and wretchedness.
Often the inspectors found, in a single house, two families in two rooms. All slept in one, and used the other as a kitchen and dining-room in common. Often more than one family lived in a single damp cellar, in whose pestilent atmosphere twelve to sixteen persons were crowded together. To these and other sources of disease must be added that pigs were kept, nd other disgusting things of the most revolting kind were found. (Engels, 1844) Although the boom in housing created problems with the removal of human waste, however this had been a feature of urbanised areas for some time before the industrial revolution; as Samuel Pepys recorded in a diary entry for 20th October 1660, “Going down to my cellar… I put my feet into a great heap of turds, by which I find that Mr Turners house of office is full and comes into my cellar” (Halliday, 2007) With the problem of waste disposal and over-crowding in squalid conditions came he inevitable increase in diseases. In one place we found a whole street following the course of a ditch, because in this way deeper cellars could be secured without the cost of digging, cellars not for storing wares or rubbish, but for dwellings for human beings. Not one house of this street escaped the cholera. ” (Engels, 1844) There had always been disease in the towns and cities, however, with the increased population it spread faster than at any other time, and there seemed no way to halt its progress. There were many diseases that flourished in these environments, ncluding Influenza, Tuberculosis, Typhoid, Typhus, and the most feared at the time, Cholera. Again, the repeated visitations of cholera, typhus, smallpox, and other epidemics have shown the British bourgeois the urgent necessity of sanitation in his towns and cities, if he wishes to save himself and family from falling victims to such diseases. ” (Engels, 1844) During this century, medical science advanced at hitherto unprecedented speed, and more people than at any other time entered the medical profession, “In the first half of the century the medical world was raising the xpectation that treatment of the body could become as exact a science as knowledge of the body.
Throughout the land, much money and energy was being devoted to medical care and its study. Between 1801 and 1850 more university- educated men entered the profession in Great Britain (over eight thousand) than in all of previous history. ” (Haley 1978) However, there was still a lot to be learned about the nature of disease, and the causes of epidemics were poorly understood. The theory of miasma (the belief that disease was spread by smell and foul air) was still popular as an explanation of how diseases were spread.
Cholera was greatly feared being a water-borne disease, attacked all, notably the middle classes with their better water supplies and struck fear into the hearts of the governors, local and national”. The response to the outbreak of infectious disease varied from town to town, however police in Manchester responded to one outbreak of Cholera, by evacuating and disinfecting the area. “The first court below Ducie Bridge, known as Allen’s Court, was in such a state at the time of the cholera that the sanitary police ordered it evacuated, swept, and disinfected with chloride of lime. ” (Engels, 1844)
Towards the end of the century, Britain was involved in conflicts around the world in order to defend her empire from the emerging powerhouses of Japan and Germany who were keen to forge their own empires and trading routes. In 1899 conflict erupted between the British and the Boers, being the South African descendents of Dutch settlers. The Boer army turned out to be well prepared, well trained and provided with enough food and provisions to defend themselves for three years, whilst the British, having believed that the war would be quickly over, were nowhere near as well-prepared.
The Boer war highlighted a serious problem for the forces, specifically that the recruits being called upon to defend the nation, being largely drawn from poverty-stricken areas where the conditions discussed above were rife, were often weak and of poor health. “At that time, it became apparent that there were serious problems with public health in Britain: up to 40% of recruits in Britain were unfit for military service, suffering from medical problems such as rickets and other poverty-related illnesses. 80% of men presenting for service in the Boer War were found by the Army Medical Corps to be physically unfit to fght. wrww. forces- war-records. co. uk) The realisation that the population had become too weak to defend the nation, alongside the increasingly common outbreaks of disease arising from cramped, unsanitary living conditions of workers led to the Report of the Interdepartmental Committee into Physical Deterioration in 1904, which called for changes to be made to ensure the nation’s health did not deteriorate further than it already had. In the 1906 general election the Liberal Party gained power after an extensive period of Conservative government and immediately embarked on a series f Acts to improve the health of the nation.
These included the provision of free school meals in 1906, health checks for school children in 1907, the Notification of Births Act in 1907 to allow midwives to ensure that newborn babies were being fed and cared for correctly and the Children’s Act of 1908, which was designed to keep orphans out of prisons and set up children’s homes for them. By focusing primarily on the health of children, they were working to improve the health of the next generation, thus ensuring a steady supply of fit and healthy individuals who could be called upon to defend the nation, if necessary.
The Labour Exchange Act of 1909 and the National Insurance Act of 1911. were the first that the nation had seen that tried to tackle the problem of unemployment and ill health. The Labour Exchange Act sought to bring together those people who were looking for work with those who needed workers. The National Insurance Act was split into two stages, firstly giving people a right to medical treatment and sick pay in return for a payment each week out of their wages, and secondly giving people the right to unemployment pay for up worker before claiming it.
There are differing theories about the effectiveness of hese reforms in improving the health of the population at the end of the 19th century and the beginning of the 20th century. What cannot be denied, however, is that the death rate fell in this period, from ’22. 6 deaths per 1000 in England and Wales in 1860 to only 14. 4 per 1000 by 1905′ (Gascoigne, S, 2012) Thomas McKeown, in his book the Modern Rise in Population (1976) looked at the detailed death records that were kept for Britain at the time of the reforms to assess their effect on the recorded deaths.
He concluded, after extensive research, that the improvements to he nation’s health during the period 1850-1914 was as a result of ‘a steady rise in living standards and the associated rise in average nutritional intake’ (McKeown, 1976) which was a secondary result of the reforms as people were able to support themselves whilst out of work and were able to move quickly from Job to Job, no longer subject to the fluctuations of business which may have previously led to a dependency on a poor law that could no longer support them. The dark shadow of the Malthusian philosophy has passed away, and no view of the ultimate scheme of things would now be accepted under which multitudes of men and women are oomed by inevitable law to struggle for existence so severe as necessarily to cripple or destroy the higher parts of their nature. ” (Dorling, D, 2002) McKeown’s conclusions were questioned by Simon Szreter who wished to discover if the link between the death rate falling and the public health reform was solely due to the better diet and living standards that were available, or it there was another cause.
Szreter started out by analysing the relationship between diseases, with particular attention to the fact that once infected with a disease a person is more susceptible to catching other iseases. Szreter also suggests that it may be a case of the statistics being misreported that led to the reduction, as opposed to the medical and sociological advances that were occurring.
In conclusion, there were many factors that that led to the development of public health reforms during the 19th Century; of these the most prominent were the rapid influx of people into the cities and towns leading to the rapid development of often unsuitable living arrangements, a polluted water supply, inadequate drainage and waste disposal; all of which contributed to the high levels f squalor experienced by those who lived there.
This in turn led to outbreaks of diseases, which worried the government as diseases such as cholera seemed to infect regardless of class. The threat from disease combined with the lack of suitable soldiers to protect Britain’s empire from emerging states such as Germany spurred the Government into action and brought about the public health reforms in the 19th Century.
The effectiveness of these reforms is still under debate, with academics trying to establish what was the primary reason for the death rate falling between 860 and 1905; the debate appears to be between those who believe it was the advances in medical knowledge of nutrition, cleanliness and the causes and treatment of disease and those who believe it was the public health reforms that were introduced because of the pressing need for intervention to prevent the poorest people becoming to enfeebled to work, thus becoming a load on the poor law.
The reason that the health of the population increased into the early 20th Century seems to be a combination of public health reform and rapid increase in have a welfare state and NHS which are the em. y of the world.