How Did Public Health in the 19Th Century Change? What Is Germ

A Revolution in Medicine C1800-1900

How did public health in the 19th century change? What is germ theory? What can you see? What guesses can you make about the effects this will have on the health of people in Britain? Houses close to Pollution coming pollution as lack of from factories transport for travel Several families living in one house

Overcrowded housing that Long was built working quickly and not hours in very well dangerous factories

Drinking water still polluted by sewers Poor ventilation in Lack of fresh food houses and factories in cities What is public health?

The health of the population as a whole, especially as the subject of government regulation and support. FACTORS FOR CHANGE There are 7 key factors. We will use these to discover change over time. Sometimes these factors HELP, sometimes they HINDER change.

HOW could each FACTOR create change? . WAR SUPERSTITION AND RELIGION Sometimes medical procedures or hygiene were The setting up of medical schools and universities in medieval times where usually by religious improved as a result of lessons learnt in war such as groups but this helped further knowledge. hygiene in the Crimean War.

GOVERNMENT COMMUNICATION SCIENCE AND TECHNOLOGY Inventors developing things such the microscope in Some governments have insisted on change e.g. the Inventions such as William Caxton’s printing the Netherlands in the 1590s has allowed Liberals and their reforms or Labour and the NHS. press has allowed new ideas about medicine medical and hygiene to be spread fast. developments.

INDIVIDUALS CHANCE

Some people have pushed through ideas which seemed crazy to many people such as Edward Jenner and Sometimes medical and health improvements have his smallpox vaccination. been stumbled upon by accident e.g. Fleming’s discovery of penicillin. Population statistics

Population in UK 1750 1900 7 Million 37 Million

People living in towns 1750 1900 13% 87% Life expectancy Living conditions Illnesses/accidents

• Victorians were good at collecting • Social surveys showed that whole • Young boys were forced to clean data. In Bethnal Green, London, families lived in one room, or in chimneys and came into contact 1842, rich people lived on average cellars liable to flooding. with gas and soot. Percivall Pott, an to 45, whereas labourers lived until • Children shared beds. English surgeon, identified scrotal they were just 16. • Toilets and water pumps were cancer as a problem for these boys. • In Manchester 57% shared by many families. • Young girls in match making of children died • In 1847, 40 people shared one factories suffered from Phossy-jaw before their room in Liverpool. caused by fumes from the 5th birthday. • People lived phosphorous. The jaw would be in back to eaten away, or glow in the dark, it We have already back housing. also caused brain damage. • No rubbish • Coal miners had pneumoconiosis, a collections . lung disease caused by inhaling dust. looked at this and • Textile factory machinery had no Food quality guards so arms were often caught in for all of these • No regulations. Problems machines. • Bakers added powdered chalk to There was no flour to make more money. compensation • Milk was watered down then in or chance of reasons, the added chalk powder to make it further work. white again. • William Luby saw a man mix brown paint with candle wax when Industrial government had making chocolate, he also saw men sweeping up sugar from the floor to make toffee. Towns to act to improve

The Great Stink Contagious diseases public health in • In 1858 parliament had to leave London because the • Contagious disease was no respecter of wealth. exceptionally dry weather had combined with a build • In 1861 Prince Albert died of typhoid caught from the up of human and industrial waste. Without rain to sewers of Windsor Castle . the 19th century. wash it into the Thames it started to fester. • Other diseases such as; typhoid, typhus, diarrhoea, • Charles Dickens called the Thames a “deadly sewer” smallpox, tuberculosis, scarlet fever, whooping cough, and the fumes were terrible. measles and chickenpox all spread rapidly. • At this time many • Rickets was common, Known as the “English disease” still believed that was a crippling bone disease common in children. It bad air (miasma) was caused by a lack of calcium and fresh air and caused disease. sunlight. A clear indicator of malnutrition. • Cholera was the biggest killer with epidemics7 in 1831- 32, 1848, 1854 and 1866. The Cholera

Cholera led to huge changes in the approach to public health in cities and towns. There were epidemics in 1831-32, 1848, 1854 and 1866. At the time nobody knew what caused it or how Cholera arrived in GB to cure it. In 131, 50,000 died. Sickness, diarrhoea, skin and nails blackened and the coma and in 1831. The death. People still thought that it was caused by miasma. symptoms were horrific UK deaths from Cholera John Snow and the discovery of the causes of Cholera and it spread quickly through overcrowded 1831-32 50,000 John Snow had a surgery in London. 1848 60,000 In 1849 he published a book arguing that cholera and filthy towns, killing 1854 20,000 was spread by dirty water rather than bad air. at an alarming pace. Medical opinion laughed at him and ignored him. In the first 10 days of the 1854 outbreak 700 people The cholera outbreak died in his locality. Snow mapped the locations of the deaths and found that they of 1848 was the worse all had one thing in common, water from a pump in Broad Street. and became an agent He also noticed that men in a nearby brewery who drank beer of change as people had not caught cholera. He got permission to remove the pump handle so that people demanded that had to go elsewhere. Immediately the disease in the area stopped. something be done. It was discovered that a cess pit less than one metre from the pump was leaking into the water supplies. The government was Careful scientific investigation had helped to find the cause of forced to act. cholera, long before germ theory was published. Snow’s discoveries helped to influence the Public Health Act of 1875 Public Health Acts and Sanitary Act of 1866. were introduced to improve living 8 conditions and health. Victorian Public Health What was cholera and why did it lead to Who as John Snow and what did he What did people first think of Snow’s What did Farr and Southwood Smith do? change? argue? Why did he argue this? ideas and why? How did this change and what did his ideas result in?

Why is Bazalgette important? Why is Edwin Chadwick important? Why is Dr Barnardo significant? What did the 1848 Public Health Act say? Think about the link he made between What was the problem with it? poor living conditionUse and disease. the info and fill in the top line on Snow. You can then review the work of Farr, Southwood Smith, Chadwick, Bazalgette and Barnado.

What did the Acts of 1866 and the Why were political parties thinking they What did the 1875 Public Health Act say Challenge Housing Act of 1875 say? needed to intervene in public health in and what was it a breakthrough? Was the role of the government of the 1867? individual more important in the improvement of public health? Victorian Public Health

What was cholera and why did it lead to Who as John Snow and what did he What did people first think of Snow’s What did Farr and Southwood Smith do? change? argue? Why did he argue this? ideas and why? How did this change and what did his ideas result in?

Why is Bazalgette important? Why is Edwin Chadwick important? Think Why is Dr Barnardo significant? What did the 1848 Public Health Act say? about the link he made between poor What was the problem with it? living condition and disease.

Improvements in Public Health – Key Individuals

Many people didn’t want government help when it came to improving conditions. A lot of people followed the idea of laissez-faire which meant that the government didn’t get involved with living and working conditions. There had been poor laws in Britain since Tudor times with each parish looking after its own poor.

Farr and • William Farr helped make births, deaths and marriages registers compulsory in 1837 Southwood Smith which meant that the government could now have accurate numbers. • Thomas Southwood Smith was appointed physician to the London Fever Hospital in 1824. This allowed him to study diseases caused by poverty and the papers that he published on public health provided examples and data to support the work of Edwin Chadwick.

Edwin Chadwick • He was secretary to the poor Law Commissioners from 1834 and he used statistical evidence to explore the link between ill-health and poverty. • He wrote the 1842, Report on the Sanitary Conditions of the Labouring Population which made the link between poor living conditions, disease and life expectancy. He, along with Southwood Smith, were the driving force behind the setting up of Health of Towns Association in 1844 and part of what became known as the “Clean Party”. • The “Clean Party” were those pushing for government action to improve conditions in towns. The “Dirty Party” were those who opposed it, mainly due to the costs involved, and the wealthy, who paid higher taxes, didn’t want change as it was expensive.

Dr Barnardo and • Thomas Barnardo trained as a doctor, in London, in 1866. “Ragged School” • He was appalled at the poverty he saw in the East End. • He set up the “Ragged School” where hungry children were given cheap breakfast and in times of unemployment meals were served too. • There were evening classes and Sunday Schools. • Wood-Chopping Brigade, a City Messenger’s Brigade, to help boys find work and a Factory Girls’ Club and Institute to support girls. • At school they were taught the skills to become a maid or servant and they were helped to find work locally at Bryant and May’s match factory or the Tate and Lyle Sugar refinery. • He also set up a series of homes for children with the slogan “No destitute child ever turned away”. • There was “Fresh Air Fund” and a “Children’s Country Holiday Fund” to provide escape for the poor children. • There were also schemes to send boys to Canada or Australia as farm workers. • The aim was to provide a better life. 12 Improvements to Public Health – the Government Takes Action- FINALLY!

1848 Public Health Act • This Act created the Central Board of Health. • It was prompted by the cholera epidemic of 1848. • It allowed local councils to improve conditions in their towns if they wished and they were prepared to pay for it. • They could force towns with high death rates to take action over water supplies and sewage, and appoint a Medical officer for Health. • It also encouraged local Boards of Health to be set up. • It inspected lodgings houses and checked food which was offered for sale. • It was a start, but by 1872 only 50 councils had a Medical Officer of Health. • Some towns, like Leeds, improved but many didn’t.

1858 Bazalgette’s Sewers • The government turned to Joseph Bazalgette to make plans for a series of underground tunnels to remove human waste from 1 million homes in London. It would use gravity and natural slopes make sewage flow to the sea. A pump would release the sewage at high tide and the Thames would do the rest. He built 83 miles of sewers which removed 420 million gallons of sewage a day. The sewers were finished in 1866 and cholera never returned to London.

1866 Sanitary Act • This made local authorities responsible for sewers, water and street cleaning and for the removal or improvement of slum dwellings.

1875 Housing Act • Gives local authorities power to buy up and redevelop slum areas . • Councils could knock down bad housing and replace it.

1875 Public Health Act • This was the real breakthrough Act which had more power. • Local councils were forced to provide clean water, appoint Medical Officers of Health and Sanitary Inspectors. • It brought together a range of Acts covering sewerage and drains, water supply, housing and disease. • Sanitary Officers looked after slaughterhouses to prevent contaminated food being sold. • Local authorities were ordered to cover sewers, keep them in good condition, supply fresh water, collect rubbish and provide street lighting.

1875 Food and Drugs Act • Regulated food and medicine.

The great clean-up was happening. In 1868 there were 716 deaths from typhus in London, in 1885 just 28 and by 1900 there were none. Flush toilets were now used in better off households, Pear’s soap became cheap and widely available,13 helping people and clothes stay clean. Also, compulsory vaccination against smallpox was introduced in 1852/3. Victorian Public Health

Fill in the rest of the sheet.

For example Explain two ways in which public health in towns in the Middle Ages and public health in towns in the 19th century were similar. Explain your answer with reference to both times.’ 8 marks.

Question 3 Compare ____ with ____. In what ways were they similar? 8 marks • You will be given TWO similar events in different periods to compare. 10 minutes • Write THREE similarities in separate paragraphs , with examples. • Similarities should be based on CAUSES, DEVELOPMENTS, CONSEQUENCES. • Key words to be used: ‘similarly’, ‘equally’, ‘likewise’. • Conclusion: What is the most obvious similarity?

How was it proved that germs caused disease? Germ theory

Louis Pasteur A French Chemist What theories did people have about the causes of disease until this point?

In the 1860s, a new science of bacteriology (study of microbes) helped scientists to understand the real cause of disease and infection. History Dictionary

Microbe - tiny organisms that include bacteria. Sepsis - poison. Antiseptic - chemical applied to a wound to stop growth of microbes that cause disease. Also applied to surgical instruments. Spontaneous generation v Germ Theory

● Spontaneous generation = rotting material causes We now know that an infection is germs ie microbes were the invasion of the body by caused by the disease rather microbes and that different than the other way round. microbes can cause different Assumption that all diseases. But, before we realised microbes were the same. this, scientists thought that, when a ● Germ theory = germs in the person was weak, sepsis started in air cause disease the wound and caused infection. They mistook infections for chemical reactions and didn’t realise that infections were caused by living organisms. How did Jenner discover his germ theory? Swan-necked flask experiment - Pasteur used this experiment to show how liquids go off when exposed to the air; his work was published in 1861 and proved that bacteria was the real reason that things decayed (went off). Germs did not come alive on their own. This was Pasteur’s germ theory. Why is Pasteur important? • At first Pasteur’s idea didn’t have much impact and most doctors continued to believe in the theory of spontaneous generation. • However, germ theory was a major breakthrough; Pasteur was the first to discover the link between germs and disease. He saw that microbes in the air caused disease and if they could be identified, vaccines could be developed to target specific diseases. Pasteur was a chemist who worked with food and drink and it was the work of other surgeons and doctors like Robert Koch and Joseph Lister who got his work accepted. • Pasteur is also very important in the development of vaccination - germ theory paved the way for vaccines to made in the laboratory. • Pasteur started work on this with chicken cholera in 1879. He experimented by injecting chickens with an old culture of bacteria in the lab. The chickens were ill but didn’t die and they became immune to chicken cholera. This reinforced the work of Jenner ie that weak forms of a disease could help people to develop immunity to that disease. • In 1881, Pasteur began to experiment with a vaccine for anthrax and in 1885 for rabies. • Pasteur took a risk with the rabies vaccine - he injected the vaccine that he had created in the lab into a young boy bitten by a rabid dog: the boy survived. The first trial of a man made vaccine had been a success. • The role of the individual and science and technology is important here eg none of this new research would have been possible without the development of microscopes which allowed scientists to see bacteria. At around the same time, other inventions like the stethoscope, thermometer and x ray machines started to be used. These made a difference as to how diseases were treated too.

Key marking

Email your answer to the question on the next slide to: [email protected] [email protected] Source A A cartoon called ‘Koch as the new St George’. From an English newspaper in the 1880s. It shows Koch conquering the bacteria responsible for tuberculosis,

Study Source A. How useful is Source A to a historian studying the importance of Robert Koch? 8 marks Content, Provenance, Contect

• Useful as from an English newspaper and even though Koch is German it acknowledges his achievement - shows his fame had spread along with he importance of his work.

• Useful as compares Koch to a national saint - emphasises the importance of his work in fighting disease.

• Useful as shows how important Koch’s work was in defeating dreaded diseases like tuberculosis which is shown as a snake. Symbolically, it shows how Koch’s microscope has shed light • Useful as shows people understood how Koch made his discoveries (understanding) upon the dark (unknown) origins of tuberculosis. by identifying his tools ie microscope. • Contextual knowledge - microscopes becoming much more effective and facilitated the work of scientists and doctors like Koch. Week 8 Model answer: Explain the significance of Edward Jenner (8 marks)

Jenner is very significant to the development of medicine because he created the idea of vaccination in the late 1700s. He was a country doctor who noticed that milkmaids did not contract smallpox which was a deadly disease extremely common at the time. He believed that the milkmaids were immune to smallpox because they were getting a mild dose of the disease in the form of cowpox. This idea was potentially very significant to the development of medicine however, Jenner had to prove that his theory was correct. Being a student of John Hunter, Jenner knew that experimentation to test his ideas and observation of patients was extremely important. Therefore Jenner experimented on a young boy named James Phipps who had not contracted either cowpox or smallpox. Phipps was injected with the pus from the sores of a milkmaid who had cowpox and he went on to actually develop cowpox. When he had recovered, Jenner inoculated Phipps with smallpox but nothing happened. It seemed that Jenner's theory was correct -if you had a dose of a disease in a more mild but related strain, you would develop immunity to both. To check the accuracy of his theory, Jenner inoculated Phipps with smallpox again and again, Phipps did not develop the disease. Therefore, Jenner knew that a dose of cowpox prevented a person catching the much more severe version of the disease; smallpox. The problem was that Jenner couldn't prove how his idea worked. Vaccination is extremely important to the development of medicine but in the short term, it was not as important as it could have been as many opposed the idea. This can be attributed to a number of reasons; the church was still very influential and believed that illness was a punishment for sin, it was therefore against putting an animal virus into a human in order for them to avoid their punishment; people were not prepared to trust theories that couldn't be explained; in a London smallpox hospital, William Woodville and George Pearson were testing Jenner's theory but they didn't know that their equipment was contaminated and some of their patients died leading them to conclude that vaccination didn't work; an Anti Vaccination League was set up and there were some physicians who charged a lot of money for inoculation and thought that vaccination threatened their livelihood and so they were against it.

Some years later, Jenner's idea started to become more popular and therefore its significance to the development of medicine was greater. People started to realise that vaccination worked and in 1840, vaccination started to be provided by the government, in 1842, vaccination was made compulsory but this was rarely enforced. However, in 1872, the fact that vaccination was compulsory started to be enforced and there were no more smallpox epidemics. In 1980, smallpox was declared eradicated from the world and this shows that, in the long term, Jenner's idea was vital to the development of medicine. Many more vaccinations for more diseases, eg measles, whooping cough and tuberculosis, have been developed since Jenner's discovery which again demonstrates Jenner's importance to medical progress in the long term. Week 9 Model answer: How useful is this source to a historian studying public health problems in cities? The source is useful to a historian studying public health problems because it shows the awful conditions in London and the filth of the River Thames.

In the source, it shows a a filthy man who represents the river Thames. This is useful to a historian because it shows how appalling the conditions of the River Thames was in the 19th century. This was because everyone disposed of human waste in the River Thames and this lead to health problems (and contributed to the cholera epidemics) and also lead to The Great Stink in 1858. The title “London Bathing Season” is useful to a historian because it teaches them that people used to use the water from the Thames to bathe and this gives them an understanding of how the filthy and contaminated water caused disease (although this was not a known cause at the time) and shows why the public health was so poor.

In addition, there is also a little boy who is covered in soot and dirt in the source. This is useful because it demonstrates how poor the living conditions were at the time, especially for children, who were vulnerable to disease and illnesses. Next to the boy, is a chimney brush which tells the historian he is a chimney sweep . This is useful because it shows that children being chimney sweeps was a common job and shows that there was no protection for children against labour or to protect their health. This demonstrates to a historian how awful public health was because children were often forced to work from a young age because they were poor, homeless or orphans and they were often made to do hard labour. Children who were chimney sweeps would be exposed to a lot of soot which when they breathed in caused respiratory issues. This is useful to a historian because it shows that lots of children suffered from really poor public health and how there were no laws or rules in place to maintain the public health.

There are also lots of dead animals in the street and the boy is holding his nose referring to the stink emitted by the waste. This is useful to a historian because it teaches them about the Great Stink in 1858. This was when the hot weather of the summer in 1858 lead to a drop in the water levels in the River Thames. The drop lead to bacteria growing in the waste and it produced such an awful smell it affected large parts of London and even stopped Parliament form meeting. This is useful because it shows how awful public health was because waste was not disposed of well and lead to massive problems. The dead animals and waste in the street also symbolise that the streets were in awful conditions and people often through their waste into the streets and because towns were overcrowded and full of waste diseases spread easily and quickly through people, epitomising how poor public health was.