Disease and Public Health by pptfiles


									Medicine, Disease and Society in Britain, 1750 - 1950

            Disease and Public

                           Lecture 10
 Lecture Themes and Outline
• Disease, mortality and demography
   – McKeown thesis
   – More recent interpretations

• Three diseases prevalent in c18th and c19th
  demonstrating varying degrees of state intervention
  with varying degrees of success (though also many
  more e.g. measles, typhus, influenza, typhoid)
   – Smallpox – inoculation, vaccination, protests
   – TB/phthisis – nutrition vs state intervention
   – Cholera – widespread public health reforms,
 Disease, mortality and demography
• Epidemic = prevalent in waves, short-
  term; attacks populations
• Endemic = regularly or usually found
  among the population.
• Pandemic = global outbreak of
  disease in limited time period.
• 1836 Registration Act – compulsory
  for births and deaths to be registered.
          McKeown thesis
• Challenged the assumption that
  improvements in medicine directly
  accounted for population growth – aside
  from vaccination
• Falling death rates from disease,
  particularly childhood disease, were due to
  better nutrition and living standards and
  public health rather than immunisation.
• Work responded to by Simon Szreter and
  Anne Hardy
• Smallpox endemic and epidemic – only
  arena where significant decline in death
  rates due to direct medical intervention up
  until late c19th.
• Inoculation – Lady Mary Wortley
  Montague (1720 son inoculated in
• Vaccination – Dr Edward Jenner, 1790s
Edward Jenner (1749-1823)

           Vaccination developed in 1796.
           Observed that milkmaids and stockmen
           rarely developed smallpox.

           Inoculated James Phipps with cowpox and
           6 weeks later with smallpox – proved
           immunity to smallpox.

           Pamphlet An Inquiry into the Causes and
           Effects of Variola Vaccinae (1798)
Jenner vaccinating James Phipps
Cartoon by James Gillray: Vaccination against
Smallpox using Cowpox serum, 1802, engraving-hand
• Major killer in the C19th.
• 1839 TB was responsible for 17.6% of all
  deaths in England and Wales.
• In the early C20th it remained the most
  prominent chronic illness – 75,000 deaths
  per year.
• Spread through close personal contact –
  important to remove sufferers from their
c. 1930
       Cholera Outbreaks
• 1826 – second global pandemic,
  travelled from Asia

• 1831-2 - first hits Britain
• 1848-9 – second British epidemic
• 1853-4
• 1865-6
Blue stage of girl who died from cholera in
            Sunderland, 1832
Thomas Shapter, The History of the
    Cholera in Exeter (1832)
  The inadequate water supply combined with
  the deficiency of drainage, is of itself
  sufficient evidence, that the necessary
  accommodation for the daily usages of the
  population must have been very limited...
  they speak of dwellings occupied by from
  five to fifteen families huddled together in
  dirty rooms with every offensive
  accompaniment; slaughter-houses in the
  Butcher Row, with their putrid heaps of offal;
  of pigs in large numbers kept throughout the
  city...poultry kept in confined cellars and
  outhouses; of dung heaps everywhere
Cholera Map of Exeter, 1832
Map of Bethnal Green showing the ‘cholera mist’
Water supply Bethnal Green
Lodging Houses
Cholera deaths in England 1849
Edwin Chadwick (1800-1890)
               1842, Report on the Sanitary
               Condition of the Working
               Population of Great Britain.

               Emphasised the need for experts
               to be employed by government
               and believed the role of the
               state should be regulatory rather
               than directive.

               His report cited disease as a
               major cause of poverty –
               reduced earning capacity of
               the working classes.
      John Snow (1813-1858)
• j
                   1855 ‘On the Mode of
                   Communication of

                   Argued that cholera
                   was ‘water-borne’ and
                   not just based on
                   miasmas and
                   insanitary conditions.
Snow’s map of Broad Street

                 Soho district in London.
                 Called the ‘cholera
                 field’ by Snow.

                 Over 500 people died
                 in 10 days from 1 to 10
                 September 1854. Snow
                 linked the deaths to the
                 source of water.
‘King Cholera’
Monster Soup: Thames Water
     Public Health Legislation
• 1848 Public Health Act
• 1855,1860 and 1863 Nuisance Removal
• 1866 Sanitary Act
• 1872 Public Health Act
• 1875 Public Health Act
• 1889 Infectious Diseases Notification
• Actions against epidemics greatly reduced
  the numbers of deaths from diseases such as
  cholera and smallpox.

• Sanitary reform saved lives and improved
  living conditions.

• Public health reform was delivered unevenly
  across the population – poorer classes often
  last to receive it.

• Implementation of reform was affected by
  the concerns of central and local
  government – financial, social and legal.

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