Transcript Disease and Public Health

Medicine, Disease and Society in Britain, 1750 - 1950
Disease and Public
Health
Lecture 11
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
– Smallpox – inoculation, vaccination, protests
– TB/phthisis – nutrition vs state intervention
– Cholera – widespread public health reforms:
sanitation
Disease, mortality and demography
• Epidemic = prevalent in waves;
attacks populations indiscriminately.
• Endemic = regularly or usually found
among the population.
• 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.
• Falling death rates from disease,
particularly childhood disease, were due to
better nutrition and living standards rather
than immunization.
Smallpox
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.
Cartoon by James Gillray on vaccination against Smallpox using Cowpox serum,
1802., Engraving-hand colour
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.
c. 1930
Cholera Outbreaks
• 1826 – second global pandemic,
travelled from Asia
• 1831-2 - first hits Britain
• 1849 – second British epidemic
• 1853-4
• 1865-6
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
Cholera’.
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’
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
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.
‘In order to re-create the epidemiological landscapes of the past
and track the routes and pathways of the world’s major
epidemics, we need to understand these dynamics in an
ever-changing natural and human world. The ecological and
biological chains of disease transmission – where and how
each epidemic is spread; the environmental parameters and
constraints – geographical and seasonal variations in the
natural and physical world; the demographic variables – the
density and age structure of a population needed to support
an epidemic disease, levels of contact and crowding, and the
prior immunological experiences of a community; the
multifactorial social, economic, domestic, and personal
factors that enter into the equation – standards of living, the
nutritional status of a host population, its level of domestic and
public hygiene, patterns of residence, occupation, and
migration – have each combined with a multitude of elusive
factors, from disease mutations to animal-human disease
transfers, to govern and determine the spread of each
epidemic disease and its global impact.’
Mary Dobson, ‘Epidemics and the Geography of Disease’, in
Irvine Loudon (ed.), Western Medicine: An Illustrated History
(Oxford: Oxford University Press, 1997), pp. 187-8.