Public Health

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Public Health

• Features of Public Health Through the Ages

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Contents Page
What is Public Health?
PREHISTORY
THE EGYPTIANS (6000BC to 30BC)
MINOANS (2000BC to 1380BC)
THE GREEKS (800BC-338BC)
THE ROMANS (510 BC to 478AD)
The Middle Ages (476AD to circa 1450AD)
RENAISSANCE Circa 1450 to Circa 1650
INDUSTRIALISATION AND ENLIGHTENMENT (1700-1900)
MODERN WORLD 1900 onwards
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What is Public Health?

• Public Health is about the general well-being of
  the people.
• This topic therefore considers any measures taken
  that improved the general health of the people.

WATER SUPPLY
SEWERS
HOSPITALS
VACCINATIONS
BATHS
INNOCULATIONS
LEGISLATION
HEALTH INSURANCE
WHERE TO BUILD
PENSIONS
WASTE DISPOSAL
HOUSING
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POLLUTION CONTROLS
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PREHISTORY

• No Public Health Measures
• Nomadic Peoples
• No Governments
• Very Small Population
• No pollution

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THE EGYPTIANS (6000BC to 30BC)

• Believed in keeping clean for Religious reasons
  particularly priests
• Developed Mosquito Nets probably for comfort
  not to prevent Malaria
• Some wealthy people had baths that drained into
  large jars
• Toilets waste went into removable jars

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Summary

• Some measures that helped keep people healthy
• NOT for Health reasons
• Water was probably considered too valuable to be
  used to sluice away waste

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MINOANS (2000BC to 1380BC)

• Modern day Crete
• Elaborate water supply and drainage
• Ensured water supply during hot summers
• Collected Rain water in plaster lined tanks
• Sewers flushed out by Rainwater
• Toilets flushed with jugs of water

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THE GREEKS(800BC-338BC)

• Regimen
• Healthy life style
• Washing thoroughly
• Exercise
• Diet what to eat and drink and when
• Had to be rich to follow regimen thoroughly
• More general advice given to the poor

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THE ROMANS (510 BC to 478AD)

• Responsibility of Government to look after its
  citizens
• Strong believers in Public Health
• Strong Government
• Good system of Taxation
• Technical Knowledge
• Strong Army to keep control

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Key Features

• Planned Settlements kept them away from marshes
  and swamps believed they were poisonous
• Water supply aqueducts huge constructions to
  supply water to towns up to 173 million litres
  a day
• Most water went to public baths and street
  fountains

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• Baths social event people went frequently
  some free, some made a small charge
• Public lavatories social event sponge on a
  stick
• Larger towns had sewers to take human waste away

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Roman Army

• Had to keep the army healthy
• Medici soldiers trained to deal with
  battlefield injuries
• Valetudinaria military hospitals
• Army camp sites chosen carefully didnt stay in
  one place too long polluted water and smell of
  excrement.
• Exercise
• Good clothing

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Romans in Britain

• Roman Public Health introduced into Britain
• Not always used e.g. public bath house in
  Exeter torn down in AD85

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Did it work?

• Sewers close to the surface could lead to
  unpleasant smells and disease
• Roman baths could be a hotbed for disease if
  not kept clean

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The Middle Ages (476AD to circa 1450AD)

• Role of Government changed
• Did not look after welfare of the people
• Collapse of economy no common currency, People
  were poorer
• Only the clergy were literate

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Key Features

• The Rich kept most of the Roman ideas
• e.g. washing, bathing in wooden tubs, lavatories
  or privies, some sort of fresh water supply
• Monasteries built near running water-Some had
  piped water baths 5 or 6 times a year
  communal lavatories
• Poor in the Countryside fresh water supplies
  e.g. streams bathed in rivers and streams
  enough space to get rid of waste

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Medieval Towns

• National governments did not see public health as
  their responsibility
• Public lavatories provided by Rich on a
  charitable basis
• Most town houses had privies
• Cess pits under toilets not flushed away
• Rakiers employed to clean pits
• People living on higher floors used public
  toilets or threw waste out of the window!

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Town Councils

• As towns got bigger councils took more action
• London Council employed Rakiers
• Trades (E.g. Butchers) ordered to dispose of
  waste
• Supplies of fresh water in London, Exeter,
  Southampton and Bristol by 14th Century

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Black Death

• 1347 Bubonic Plague arrives in Messina
• Spread along trade routes of Europe
• One third of population died
• Symptoms None for 3 days then boils on
  neck/armpit, fever, vomiting,red blotches,
  delirium
• 3 to 5 days to die after symptoms appear

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How does it spread?

• Micro Organism Yersinia Pestis
• Carried by rats
• Infects humans by flea bites
• Can turn into pneumonic plague spread from
  person to person by coughing

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Medieval Theories of Causes

• Jews
• Foul stench from dead bodies
• Punishment sent by god for sinning
• Astrology alignment of planets 1345 Saturn,
  Jupiter and Mars were in line caused people
  with bad digestion to catch the plague

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Some Medieval Treatments

• Burning Jews, Taking Jewish property, Baptising
  Jews,
• No-one allowed in and out of cities
• No used clothing allowed in
• Dead to be buried in deep pits in coffins
• Flagellants whip themselves

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RENAISSANCECirca 1450 to Circa 1650

• Continued in a similar vein to the Middle Ages
• Slow improvements in towns as they grow in size
• Little to no National Government Action

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The Great Plague 1665

• Plague did not disappear in Europe after the
  Black Death
• In 1665 there was an outbreak in London of
  Epidemic proportions

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Theories

• Still a common belief amongst the people that
  there was a religious cause
• Educated People begin to believe there are
  rational causes carelessness of the people,
  and their greediness in receiving infected goods
  in their houses

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Responses

• Infected houses marked by searchers with a
  red cross and boarded up to stop infection.
• No one allowed to leave infected house unless
  to go to a pest house (a special plague
  hospital)
• Watchmen to make sure no one escapes

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• Essential food supplied by council for poor
  locked in infected houses
• Dead to be buried at night
• Stray dogs to be killed
• No animals in the city

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Were these measures effective?

• Concept of quarantine could have worked but
  healthy people were locked in as well
• Stray dogs used to keep rats down so killing them
  was detrimental
• Searchers and clergy spread the plague from house
  to house

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Britain slow to act!

• Europe brought in better measures earlier
• Quarantined victims away from the healthy
• Restricted movement between towns
• Developed protective clothing
• Established Isolation hospitals

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Great Fire 1666

• Probably did not cleanse the city
• Plague effected poor areas
• Fire destroyed wealthy areas
• Plague probably stopped because of stricter
  Quarantine laws in Europe

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INDUSTRIALISATION AND ENLIGHTENMENT (1700-1900)

• Start of big changes in Public Health
• Rational Thought
• Improved economy more wealth for some people
• Educated people believed it was their duty to God
  to improve the lives of the poor

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Medical Societies and Hospitals

• Doctors and surgeons better trained
• Medical Societies interested in developing ways
  of treating the sick
• More hospitals built and old hospitals replaced

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Growth of Towns

• Towns grew rapidly in this period.
• In 1750 80 of population lived in the country
• By 1901 80 (of a much bigger population) lived
  in towns
• This rapid growth led to huge public health
  problems.

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Problems in the towns!

• Poorly built hoses
• Overcrowding
• Low pay for working class poor nutrition
• Lack of sewage systems
• Poor working conditions exhaustion
• Lack of piped water.

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Life Expectancy in Towns

• Working Class 17yrs
• Middle Class 20yrs
• Upper Class 38yrs
• NB INFANT MORTALITY
• Life Expectancy in country almost double

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Cholera

• First recorded in India 400BC
• Caused by microbe
• Spread by drinking water polluted by excrement or
  vomit of cholera victims
• Diarrhoea and Vomiting causes death by fluid loss

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Cholera in Britain

• Arrived 1831
• No one understood the cause
• Early explanations disturbances in the
  atmosphere, sinning against god, Doctors
  treatments
• Early treatments Blood letting, Heat
• None successful

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Doctor Snow to the rescue!

• Noticed brewery workers didnt catch cholera
• Theorised that they didnt drink the water
• Persuaded to get the authorities to remove the
  handle of a water pump in Broad Street, London
• Epidemic stopped.

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New Public Health Measures

• Cholera outbreak forced Government to act
• Initially worked on prevention
• Cures not possible until 1865 and discovery of
  germ theory.

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First Steps

• Boards of Health set up in towns to prevent
  disease Many closed down after an outbreak was
  stopped
• 1835 Municipal Corporations Act Set up
  elected town councils that could raise taxes to
  pay for lighting, pavements, fresh water supplies
  and sewage disposal.

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Edwin Chadwick

• 1838 An investigation into Londons poor health
  carried out results led to a National survey
  conducted by Edwin Chadwick
• 1842 Chadwick Publishes report.
• Recommended Arterial water supply and sewer
  pipes made of glazed pottery for towns,
  cemeteries on the edge of towns and a medical
  officer to record cause of death, Councils to
  borrow money to pay

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1848 Public Health Act

• Based on Chadwicks report
• National Board of Health to be set up for 5 years
  and towns to set up own Boards of Health
• Great resistance
• Still not the Governments business
• Many towns refused to set up a board
• Central Board closed in 1858

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More Pressure on Government

• In the late 19th Century the Government was
  forced to make more action because
• 1866 another Cholera epidemic
• Many people believed dirty water caused Cholera
• 1871 - More People given the vote demand change

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By 1875 Government Legislation forced Local
Authorities to

• Provide street lighting
• Provide Clean water
• Provide sewage disposal
• Provide public parks
• Improve quality of housing
• Provide public toilets
• Ensure clean food
• Inspect lodging hoses
• Appoint Medical Officers

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Philanthropists

• Wealthy Individuals who want to help others
• George Peabody provided money for better
  quality housing
• Octavia Hill worked on projects to build
  healthier houses

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Edward Jenner

• Introduced Vaccination as a way of preventing
  Small Pox
• Infected people with cow pox to help them build
  up a resistance to small pox
• Great resistance at first!
• Others had tried similar experiments but had not
  proved it scientifically or published their work.

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Florence Nightingale

• Revolutionised Nursing
• Gained influence after her work as a nurse in the
  Crimean War
• Set up Nurses training
• Influenced how Hospitals are organised into wards

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MODERN WORLD1900 onwards

• Further improvements in Public Health
• At the turn of the century there were not enough
  men healthy enough to fight in the Boer War
• 2 out 5 who volunteered were unfit
• Trade Unions were formed and put pressure on the
  Government for better working conditions
• Labour Party created to fight for rights of
  working man

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Charles Booth

• 1889 published a report on poverty in London
  35 found to be living in real poverty
• Published another 17 volumes between 1891 and
  1903
• Suggested that Old age Pensions should be
  introduced

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David Lloyd George

• Liberal Politician
• 1908 introduced the first Old Age Pension
• 1911- National Insurance for working Men

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Seebohm Rowntree

• 1901- Published his research into poverty in
  Britain 25 of population living in Poverty
• Continued to research poverty
• He believed that healthy, and well-fed workers
  were efficient workers

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Early 20th Century Legislation

• 1906 Education (Provision of Meals) Act Free
  School Meals for the Poor
• 1908 Old Age Pensions Act
• - 50p a week paid to over 70s
• 1911 National Insurance Act
• - Sick workers allowed to draw benefit if they
  earned under 160 a year

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Legislation continued

• 1919 Housing Act
• - Gave Local Authorities the finances to
  provide homes fit for heroes
• 1930 Housing Act
• - Slums cleared in large towns and cities
  local authorities had to provide council
  housing for those who lost their homes.

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NHS

• Created in 1948
• Supposed to be free and care for people from
  cradle to the grave
• Soon found to be very expensive
• Some charges for care introduced in 1950

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Problems facing NHS

• Funding
• New treatments available
• More people to look after aging population
• Waiting Lists
• Hospital wards sometimes forced to close

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World Health Organisation

• Set up in 1948 with the aim help all peoples to
  reach highest level of health
• In 1967 set about eradicating Small Pox from the
  Planet
• In 1980 Small Pox wiped out

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