Paper 3 Breadth 2

Question 1

How was the 1848 Public Health act significant in public health reform?

Answer 1

• was the first govt involvement in reforming public health
• set up local Boards of Health- 1850 32 boards set up, 1853 182 set up
• allowed wide ranging powers of some towns e.g Rochdale reduced air pollution and water pollution

Question 2

How was the 1848 Public Health act limited in public health reform?

Answer 2

• permissive- Boards only set up if 10% of ratepayers agreed e.g Lancashire had 2.5 million people but only 1/5 lived under the Board of Health
• corrupt- some towns got them just to keep the status quo and save money
• just local govt not central so some areas didn’t have Boards of Health

Question 3

How important were others acts compared to the 1848 Public Health act?

Answer 3

• 1837 Registration of births, deaths etc.- didn’t have as much impact but showed statistics of number of people dying from cholera, forced govt to act
• 1847 Towns Improvement Clauses Act- actually made public health worse by contaminating rivers
• 1858 Public Health act- central govt involved- more national instead of local BUT still permissive like 1848 act
• 1875 Public Health act + 1866 Sanitary act- arguably more important as it was compulsory, national and local authorities were given power
• 1936 Public Health act- most important as it was compulsory, national and consolidated previous legislation

Question 4

What were initiatives to improve public health BEFORE 1848?

Answer 4

• local people gave short-term change e.g formation of Manchester Board of Health 1795 by Thomas Percival and John Ferriar- was only short-term, not many people ad passion to improve public health and was not done by govt
• private acts of Parliament- individual towns applied for localised acts to deal with street cleaning etc- was not the whole country, just separate towns
• 1835 Municipial Corporations Act- democratisation of local councils, more people could vote for their local council- led to demand for private acts

Question 5

What were problems with public health provision BEFORE 1848?

Answer 5

• provision was piecemeal- different towns did different things and provisi4on was not the same across the UK
• localised- not whole of UK
• no central govt involvement- by local people and local council
• corruption and localised oligarchies (groups in power who don’t want to give power to anyone else, rich did not want to pay for poor relief)
• using private acts of Parliament was costly and lengthy

Question 6

How did local govt IMPROVE public health? (housing)

Answer 6

problem with local housing before:
- better quality housing was more expensive and so house builders charged more for sale/rent
could be solved by: forcing landowners to sell for cheaper OR govt housing

local govt initiatives to improve building of housing:
- Private Improvement Acts- laws to improve housing in their own towns e.g Metropolitan Building Act 1844 (London)- all houses within 30ft of a sewer HAD to be connected to it

• 1875 Public Health Act- unified and clearly outlined housing requirements e.g width of streets, height of houses and drainage

initiatives to improve existing housing:
1. 1851 and 1853 Common Lodgings Acts- all lodging houses were to be registered and inspected by the police

2. 1855 Nuisances Removal Act- overcrowded houses were defined as a ‘nuisance’ and were liable to fines and prosecution
3. 1866 Sanitary Act- restricted use of cellars as places of habitation
4. 1868 Artisans’ and Labourers’ dwellings act- local councils could force landlords to repair houses and if the landlord failed to do so, the council could demolish it, further act in 1875 enabled councils to deal with districts rather than individual houses

1900-1939:

• 1919 Housing Act- gave govt subsidies to build new houses
• in the 1920s subsidies built good quality housing BUT 2/3 of houses were sold to wealthy owners, not poor people

Question 7

What were some LIMITATIONS to local govt initiatives?

Answer 7

new housing:
- only applied to newly built houses

• powerful, wealthy people tried to stop laws e.g avoiding housing requirements
• no inspectors to investigate and enforce laws- permissive so didn’t really help

existing housing:
- permissive acts- councils were not forced to deal with unsanitary houses or demolish them

• Birmingham and Joseph Chamberlain- massive slum clearance but no plan to deal with homeless tenants who then moved to new slums, 1890 and 1909 councils were forced to rehouse some slum residents

problems in 1900-1939:

• WW1 ended slum clearance- people went to fight in the war
• rising prices made cheap, good quality housing impossible
• 1939- only 50% of houses had access to hot water and a fixed bath

Question 8

How did local initiatives provide housing for the poor?

Answer 8

Peabody Estate: Peabody Donation Fund was founded which provided dwellings (flats) for the poor in London

• contained water closets, baths and laundry facilities
• larger estates were built in other areas- in 1882 there were 14,600 in 3,500 dwellings, by 1939 there were 33,000 people

Saltaire: wealthy mill owner Titus Salt moves his factory and his workers out of filth and pollution
- built a village, Saltaire, with a new mill, houses and a school
BUT (negative)- had strict rules- no pubs, workers not allowed to join unions and weren’t allowed to hag washing out on Sundays

Octavia Hill Housing Association: Octavia Hill bought run-down cottages and renovated them, cleaned and decorated them and linked them to sewers
- they were rented for a low price to poor people, female rent-collectors checked tenants’ habits

Garden Cities: Ebenezer Howard had a theory that people should live in harmony with nature
- Letchworth was the first garden city with plenty of space, light and fresh air

Port Sunlight Village: William Lever built a site for workers for his soap-making factory
- in 1899 and 1914 800 houses were built
- had a hospital, schools and a concert hall
BUT (negative) also had strict rules of behaviour

Question 9

How did vaccinations IMPROVE health of the public 1780-1930?

Answer 9

• 1808 National Vaccine Establishment- used a govt grant to promote vaccination, until 1830s vaccination was only used by the wealthy due to cost
• 1840 Vaccination act- anybody could be vaccinated free of charge by Poor Law medical officers
• 1853 Vaccination act- obligatory for parents to have their children vaccinated for smallpox within 3 months of birth, if they didn’t comply they were fined £1 which went towards the poor rate
• 1871 Vaccination act- obligatory for local health boards to have vaccination officers who imposed fines of 25 shillings to parents who refused to have their children vaccinated and imprisonment if they did not pay the fine
• 1898 Smallpox act- insertion of the ‘conscience clause’ which made it difficult to get life insurance, to rent a room or to get a job without a vaccination certificate

Question 10

What were LIMITATIONS of vaccinations in improving health of the public 178-1930?

Answer 10

• 1840 Vaccination act was permissive, Poor Law was the only represented national administrative network and Poor Law officers were the only widely-available administrators
• 1853 act- was compulsory which made vaccination more common BUT it was administered in a haphazard way
• after 1871 act the anti-vaccination movement was formed- people feared central govt interference, there were religious objections against impurities in blood, held demonstrations in different towns and cities, Leicester anti-vaccination league formed in 1869
• thousands of unvaccinated babies by 1900, in 1898 26.6% of babies were unvaccinated

Question 11

How did medical officers IMPROVE health of the public 1780-1930?

Answer 11

• medical officers were paid professional advisors working with local councils to deal with public health, 1848 Public Health Act established them but this was advisory, 1875 Public Health Act made medical officers compulsory
  importances: provided notification of diseases- would identify and act upon outbreaks of diseases in the community
• could investigate and enforce suitable housing
• enforced good sanitation
• high status doctors raised the importance of medical officers e.g Dr William Henry Duncan was a famous medical professional, John Simon was London’s medical officer and top advisor to govt

Question 12

What were LIMITATIONS of medical officers in improving health of the public 178-1930?

Answer 12

• rate payers wanted low taxes, medical officers were expensive to employ/their recommendations were too expensive so some places did not have them
• council members were also rate payers and wanted low taxes as well
• council members wanted to spend money on things like town halls rather than on drains and medical officers
• not all places had medical officers e.g Manchester didn’t until 1868
• Wolverhampton didn’t have a full-time medical officer until 1921
• 1875- only 50 medical officers, were poorly paid and local council could sack them at any point

BUT end of 1800s, council members were elected and would be more likely to get elected if they had a medical officer- shows their importance

Question 13

How did provision for children IMPROVE health of the public 1780-1930?

Answer 13

1. Education (Provision of Meals) Act 1906- people feared poor physical conditions of children to be recruited into the army, 1904 report showed poor physical condition of army recruits in the 2nd Boer War- urged medical inspection and feeding of children in education
   - act allowed local authorities to use public money to provide free school meals for children
   - act made it clear that children receiving free school meals were not regarded as paupers, it introduced a break from state help being only through the Poor Law system
2. 1907 Education (Administrative Provisions) Act- set up a school medical service run by local authorities- Sir Robert Morant, secretary of Board of Education, suggested they put in this legislation and was anxious of what reports would show
   - medical department was established within the Board of Education
   - Morant issued directives to local authorities and the service was regulated and authorised to provide treatment as well as inspection
   success: 2300 doctors and 5300 school nurses with 1650 school clinics providing treatment by 1935
   HOWEVER Board of Education urged local authorities to appoint local medical officer as their school medical officer but some authorities ignore this and appointed separate ones
3. 1908 Children and Young person’s act: brought in after serious lobbying by the NSPCC
   - consolidated several older acts to protect children
   - children were made ‘protected persons’ which made it possible to prosecute their parents for neglect or cruelty
   - Poor Law authorities were made responsible for visiting and supervising children who suffered neglect or cruelty
   - Nursing and private children’s homes were to be registered and inspected
   - children under 14 years old were not allowed into pubs
   - shopkeepers were forbidden from selling cigarettes to children under 16
   - juvenile court set up to separate children from adult offenders
   success: children were seen and protected by the state for the first time since the beginning of the 20th century, children no longer suffered due to their parents- their health and welfare was protected

Question 14

How did TB and sanitoria IMPROVE health of the public 1780-1930?

Answer 14

• TB- infectious disease caused by bacteria, spread through sneezing/coughing in crowded conditions, killed half the people who were infected by it, estimated cause for 1/3 of all deaths in the 1800s- indicates poor housing, transferred from cows to people by unpasteurised milk

attempts to stop it:
- local initiatives from places e.g Oldham- gave leaflets to houses detailing how TB spread, Brighton gave advice to spit into bowls which were regularly washed

national initiatives:
- 1922 pasteurisation of milk for human consumption, 1934 pasteurised milk to be given to all school children, 1937 3.2 million children had free milk

treatments of TB:

1. Sanitoria- in the countryside, had fresh air, sunlight, good food and rest, 84 sanitoria in 1911, 500 by 1930
2. surgery- on organs affected by TB, 1/6 of all surgeries were for TB

• in 1946 there was a vaccination for TB and it was eradicated

Question 15

What were LIMITATIONS of TB and sanitoria in improving health of the public 178-1930?

Answer 15

• some first attempts at stopping TB were just local not national so not everywhere had them, no overall strategy and was piecemeal

Question 16

What was positive impact of the work of Joseph Bazalgette in improving public health?

Answer 16

what was it like before?

• Metropolitan Commission of Sewers was ordered to close cesspits and house drains were to be connected to sewers which were emptied into the River Thames- added to the death rate in the 1848-49 cholera epidemic
• there were no fish in the Thames and it was very unhygienic which contributed to disease like cholera and typhoid

what did they do and when?
- drew up a plan where sewage was channeled through miles of street sewers into a series of larger intercepting sewers, large sewers would be at the tidal part of the Thames and would sweep sewage out to sea, involved over 2000km of sewers linked to 4 big pumping stations

• pumping stations carried the untreated sewage to treatment plants rather than dumping it into the river
• he designed large egg shaped tunnels which rarely got blocked
• started with the densest areas of the population, calculated how much sewage each person would generate and then doubled it- accounted for growth in population
• whole system was opened in 1865

reaction:

• 1858 Great Stink- River Thames was overflowing and hot weather encouraged bacteria to thrive, the smell was so powerful that business in the House of Commons was suspended- led to a campaign of change run by the Times newspaper
• 1858 Metropolis Local Management Amendment act passed- gave the Metripolitan board work permission to improve the drainage in London and to prevent sewage passing into the River Thames, Bazalgette could begin work due to this

Question 17

What was positive impact of the work of Edwin Chadwick in improving public health?

Answer 17

what was it like before?
- Chadwick was part of the Royal Commission, miasma theory was prevalent

what did he do?
- commissioned report of Sanitary Conditions of the Labouring Population 1842- concluded that overcrowding, poor ventilation and inadequate water supply caused disease

• Chadwick’s 1842 report led to Public Health Act 1848- positive impact because it directly improved public health HOWEVER act was permissive and cause of disease was not known, most people on the commission believed in miasma theory

Question 18

What were NEGATIVES to Edwin Chadwick’s work in improving public health?

Answer 18

• Chadwick’s personality wasn’t liked due to his impatience and arrogance
• House of Commons only agreed to renew Board’s mandate if Chadwick was no longer a commissioner

Question 19

What was positive impact of the work of John Snow in improving public health?

Answer 19

what was it like before?
- people believed in miasma theory, massive cholera outbreaks in 1831-32 (32,000 deaths), 1848-49 (62,000 deaths), 1852-53, 1866-67

what did they do and when?

• was suspicious of a pump in Broad Street spreading cholera
• made a study of the area around the pump- 7 workmen living outside the area died from drinking the pump’s water, 530 people lived near the pump but got water from a different source and only 5 died, a woman who used to live in the area had her water delivered specially and died even though her neighbours didn’t
• 1870 Snow’s breakthrough received universal acclaim and John Simon abandoned the miasma theory

Question 20

What were NEGATIVES to John Snow’s work in improving public health?

Answer 20

reaction:
- limited- John Simon made a larger study covering 500,000 Londoners- took away from Snow’s study because Simon’s was more reliable

• took 14 years for medical establishment to accept cholera as a water-borne disease because they believed in the miasma theory and still believed it to be caused by poor conditions and overcrowding

Question 21

What was positive impact of the work of Marie Stopes in improving public health?

Answer 21

what was it like before?

• no info given about birth control methods
• maternity and child welfare clinics weren’t allowed to give advice on birth control, even when mother’s life was at risk
• middle and upper class families had fewer children as they could afford access to private clinics- not the same for w.c families
• women’s magazines had advice about contraception in discreetly-names section ‘women’s ailments’

what she did:
- wrote bestselling book (40,000 copies) called ‘Married Love’

• opened a mother’s clinic in London in 1921- free clinic which gave contraceptive advice
• network of clinics were gradually built up- in 1939 there were clinics in Leeds, Aberdeen, Belfast and Cardiff

reaction:
- debate with Halliday Sutherland (leader of anti-contraception organisation) he failed to turned up and Stopes sued him for defamation- brought the issue of birth control to the public

• helped individual couples and opened up the whole debate of birth control

Question 22

What were NEGATIVES to Marie Stopes’ work in improving public health?

Answer 22

• Catholic Church was very opposed to her- in 1920 Stopes addressed the Lambeth Conference (meeting of bishops) and gave them the message that sexual intercourse was not just for procreation
• medical professionals were divided- her husband Humphrey Roe offered to set up a clinic in St Mary’s hospital in Manchester but he was denied

Question 23

What was positive impact of the work of Edward Jenner in improving public health?

Answer 23

what was it like before?

• smallpox affected a lot of people
• innoculation had been happening before- taking a weak version of a disease and putting it into someone else, sometimes this wouldn’t work properly and people would sometimes die

what did he do?
- discovered cowpox gave immunity to smallpox- 1796 he took pus from a milkmaid who had cowpox and gave it to a boy, then gave smallpox to the boy and he was fine, he did this 23 more times and everyone was fine- proved vaccinations could work

reaction:

• published his findings by himself in 1798
• was given £30,000 by Parliament to set up a vaccination clinic

Question 24

What were NEGATIVES to Edward Jenner’s work in improving public health?

Answer 24

reaction:
- Royal Society refused to publish Jenner’s findings and he was a local doctor and not high status

• received criticism from anti-vaccination groups e.g Leicester Anti-Vaccination League- limited his work as he received backlash