NB. Philanthropist – Someone who helps others out of a sense of duty and wants nothing in return.

1. How far did individuals and philanthropists make a difference to Public health between 1800 and 1914? NB. Philanthropist – Someone who helps others out of a sense of duty and wants nothing in return.

2. The First Big Public Health Problem Unsanitary Filthy living conditions including rubbish on the streets, bad water, overcrowding and no sewers • What do all these images have in common?

3. Edwin Chadwick bad bad living conditions • In 1842 Edwin Chadwick wrote a report on the on the Sanitary conditions of the labouring population of great Britain. • The report was based on evidence gathered by doctors interviewing poor people by questionnaire in all the major cities of Britain over a two year period. • 10000 copies of his report were given away for free to politicians, journalists and other important people. • The report showed the poor lived in terrible conditions in cities and were likely to die much earlier than people who lived in the country or who were richer. • For example in Leeds a gentleman might live on average to 44 and a labourer to just 19. • Chadwick did not know about germs and blamed disease on the unsanitary conditions and miasma theory (the theory that bad air spread disease).

4. Chadwick’s report findings and recommendations

5. Did Chadwick’s report help? • Chadwick’s report was the first scientific survey of its kind and gained lots of publicity.… • BUT the government was ‘laissez-faire’ and felt it was not their job to tell people how to live their lives. • Many better off people also (wrongly) felt that the poor were responsible for the bad living conditions so it was their own fault so they could sort it. • Other people did not want their taxes to increase. • Therefore there was little immediate change because people and the government did not want to help. Key fact. The government did not bring in a public health act to clean up cities until 1848. This was partly due Chadwick’s report and the publicity it gained BUT it was also because there were many outbreaks of cholera that claimed thousands of lives in areas with unsanitary poor living conditions!

6. Cholera and John Snow • In 1831 there were 50000 Cholera Deaths. • Further big outbreaks took place in 1832, 1848, 1853 and 1866. • No one knew what caused Cholera but most people blamed miasma – an infectious mist given off by human waste and rotting rubbish. • In 1854 a doctor called John Snow realised through careful research and a surevy of deaths that 700 deaths from Cholera all took place among people using the Broad street water pump – he took off the handle and the deaths stopped! • Dr Snow then worked out the pump’s water had been contaminated with human waste. He had proved that Cholera was spread through water and suggested ‘white spots’ in the water spread the illness not miasma (bad smells). • After 1860 when Pasteur discovered the germ theory it became clear that John Snow had spotted Cholera germs – the white spots - under his microscope. Key fact Despite his discovery showing the dangers of bad water it took years of pressure before the government acted through the 1866 Sanitary Act that forced towns to provide clean water and sewers.

7. The Great stink and Sir Henry Bazalgette • In 1858 the Great Stink was caused by a heat wave that made all the human waste and rubbish in the river Thames smell so bad that parliament had to close. • This smell, Chadwick’s report and Snow’s finding about Cholera finally persuaded the MPS to have sewers built in London. • Bazalgette designed and built a network of sewers with massive pumps that collected sewage from nearly 1,000,000 homes and pushed it out to sea. They used 318 million bricks, moved 420 million gallons of sewage a day, were 83 miles long and took until 1866 to complete. Key fact Cholera never returned to London after 1866 and this helped prove that the Sanitary Act of 1866 (all towns should have sewers and clean water) was a very good idea!

8. The second Big problem - Poverty • Chadwick’s report showed that the poor had a lower life expectancy in 1848. • The Salvation Army and other charities started to help the poor and raise publicity about poverty from 1875. • Army recruitment for the Boer War in 1899 showed nearly 25% of men were unfit for service due to poor health and diet (many had ricketts and brittle bones from malnutrition – inadequate food) • Charles Booth and his team published reports based on surveys of over 4000 people between 1889 and 1903 called Life and labour of the people of London. This showed 31% of Londoners lived below the poverty line and that the main cause was low wages and poor health – things the poor could not do anything about! • Seebohm Rowntree was a confectioner and quaker who carried out studies into poverty. He read Booth’s reprts and applied them to York. He showed that in York. He found that 10% of people in York lived in Primary Poverty (inadequate food, clothing and shelter) and secondary poverty (barely enough food, clothing and shelter). Key Fact. All the above helped to draw attention to the issue of poverty in Britain but it was not until 1906 -1911 that the Liberal Reforms led to significant help for the poor.

9. The third Big problem - Housing • Over crowded and poor quality housing and slum areas spread disease. • Men like Cadbury built model villages like Bourneville in Birmingham for their workers. These had good quality housing, with good sanitation, parks, doctors surgeries, schools and other amenities. • In some cities whole areas were rebuilt to be model townships such as Port Sunlight in Liverpool. • The Artisans Dwelling Act of 1875 allowed councils forcibly purchase and knock down slums. • Joseph Chamberlain used the Artisans dwelling Act to clear slums and rebuild Birmingham as a much healthier city BUT not all the people who lived in the slums were rehomed leading to criticism of his policies.

10. How far did individuals and philanthropists make a difference to Public health between 1800 and 1914?