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Disease and Public Health

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Medicine, Disease and Society in Britain, 1750 - 1950 Disease and Public Health Lecture 10 Lecture Themes and Outline Disease, mortality and demography McKeown thesis ... – PowerPoint PPT presentation

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Title: Disease and Public Health


1
Disease and Public Health
Medicine, Disease and Society in Britain, 1750 -
1950
  • Lecture 10

2
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,
    sanitation

3
Disease, mortality and demography
  • Epidemic prevalent in waves, short-term
    attacks populations indiscriminately.
  • Endemic regularly or usually found among the
    population.
  • Global outbreak of disease in limited time
    period.
  • 1836 Registration Act compulsory for births and
    deaths to be registered.

4
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

5
Smallpox
6
Smallpox
  • 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 Constantinople
  • Vaccination Dr Edward Jenner, 1790s

7
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)
8
Jenner vaccinating James Phipps
9
  • Cartoon by James Gillray on vaccination against
    Smallpox using Cowpox serum, 1802.,
    Engraving-hand colour

10
Tuberculosis
  • 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 environment.

11
c. 1930
12
Cholera Outbreaks
  • 1826 second global pandemic, travelled from
    Asia
  • 1831-2 - first hits Britain
  • 1848-9 second British epidemic
  • 1853-4
  • 1865-6

13
Blue stage of girl who died from cholera in
Sunderland, 1832
14
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
15
Cholera Map of Exeter, 1832
16
Map of Bethnal Green showing the cholera mist
1848-9
17
Water supply Bethnal Green
18
Lodging Houses
19
Cholera deaths in England 1849
20
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.
21
John Snow (1813-1858)
  • j

1855 On the Mode of Communication of Cholera.
Argued that cholera was water-borne and not
just based on miasmas and insanitary conditions.
22
Snows 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.
23
King Cholera
24
Monster Soup Thames Water
25
  • Public Health Legislation
  • 1848 Public Health Act
  • 1855,1860 and 1863 Nuisance Removal Acts
  • 1866 Sanitary Act
  • 1872 Public Health Act
  • 1875 Public Health Act
  • 1889 Infectious Diseases Notification Act

26
Conclusion
  • 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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