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Public Health:background

By our standards, health in the Nineteenth Century was very bad indeed, although one should beware of 'reading history backwards' - that is, making judgements about the past from a modern perspective. London's death rate was very high at 35.3 per 1,000. The infant mortality rate was also high: 437 per 1,000 children born, died before they reached the age of 2.

Epidemics were common. Although the plague virtually disappeared in 1666, outbreaks of typhus (also known as gaol fever) were frequent and smallpox epidemics broke out regularly, killing 1 in 9 victims. Medical provision was very basic (again, by our standards). No anaesthetics existed; surgery was primitive; hospitals were few and depended for funding on charity, and often were in poor condition.

There was no satisfactory Medical Register until 1858. The Eighteenth Century was the age of the 'quack', the apothecary with his patent cure-alls, and the barber-surgeon. There were no antiseptics or proper understanding of the cause of diseases.

Urbanisation added cholera to the list of epidemics in 1831 and exacerbated the problem, but thereby attracted attention and offered an incentive for a solution (as with popular political movements).

Eighteenth Century doctors

Some prominent men emerged as medical pioneers:

• John Hunter (1728-93) helped make surgery a science by careful collection and analysis of specimens. He was a Scot.
• William Smellie (1697-1733) trained midwives.
• Edward Jenner (1749-1823) in 1793 introduced the idea of vaccination against smallpox.

Industrial helps to health

Aids were slow to come before the acceleration of the railway age of 1830 onwards. Also there was little direct government aid - it was the age of internal laissez-faire

• cotton clothing was most important because it replaced wool as the fabric of clothing. It could be washed easily and did not harbour lice.
• the chemical industry grew, especially in the production of soap and detergents. Later, antiseptics were made available.
• bricks helped in the building of better houses. It was more difficult for vermin to live undetected in brick built houses
• the enclosure movement provided better food.
• improved transport allowed for better distribution of food and manufactures.

The Nineteenth Century Crisis

1815-1850 was the worst period of unhealthy urbanisation and the Industrial Revolution created the urban problem with its various health hazards.. This period was the rapid increase of crowded towns, bad drainage, inadequate clean water supplies, bad or non-existent cleansing and an accumulation of filth. In October 1831, cholera arrived in Britain. It was Asiatic in origin but in England it became the new scourge. It was a water-carried disease, but this was only suspected rather than understood. It was a classless killer, so - because cholera killed rich and poor alike - it stimulated a massive campaign for public hygiene. The emphasis was upon prevention, since any cure was impossible before knowledge of its cause.

Long working hours, female and child labour helped to impair mental health while towns crippled physical health, but the industrial revolution provided better health in the long run because of the developments in science. The myth that ill-health came with the industrial revolution is just that: a myth. The collectivisation of urbanisation simply drew attention to the appaling health standards of people in England. Population soared during the worst period of industrial development, but life expectancy fell:

Average age of death in 1842

The population of the industrial towns was younger; the infant mortality rate fell.

The urban problem was one of the FIRST to be created and one of the LAST to be faced because of:

• the French Wars
• laissez-faire attitudes
• inadequate administrative machinery
• inadequate medical knowledge
• Robert Owen being more of a 'clean-up' environmentalist
• social prejudice and lack of education
• no civil service

18th Century Advances

1. little government activity beyond the 1751 Gin Act
2. 150 hospitals founded, all dependent on charity
3. medical skills were few
4. the industrial revolution eventually provided some indirect solutions to health problems, but these had little impact before railways

Early 19th Century

Despite nearly four hundred Improvement Acts between 1800 and 1840 this was the worst period of urbanisation evils: Dickensian England. After 1831, CHOLERA became the new, classless killer.

The emphasis was still on the prevention of disease. Surgery was still crude and 33% of all patients died on the operating table.

N.B.

1. not until the 1850s did cures feature in medicine.
2. lack of knowledge meant government remained uncommitted. The cartoon The Use of Adulteration illustrates one of the problems faced by the working classes.
3. public health was a feature of the Benthamite Utilitarian movement. Edwin Chadwick was a disciple of Bentham.
4. it was difficult to persuade 'John Bull' to become 'John Citizen' as Punch noted in 1850:

Edwin Chadwick became a friend, disciple and secretary to Bentham. He was appointed to the Poor Law Commission through the influence of Nassau Senior. Chadwick served on a number of Commissions dealing with social and administrative questions between 1834 and 1847. He was knighted in 1889. Chadwick was a Utilitarian in action.