Social Reform: 1750-1950 – Public Health
From 1750 to 1950, Britain was characterised by sweeping changes which permanently impacted the day to day lives of the people. The social conditions caused by rapid population growth and an increasingly urbanised society shaped a period of vast governmental reform. Perhaps one of the most poignant filters through which these changes can be seen is public health.
During and after the Industrial Revolution, Britain was characterised by a migration of poor rural people from the countryside into the cities. This phenomenon became known as urbanisation, and vastly effected society. These people came to the cities looking for work in the new factories, often leaving what were fairly poor standards of living in the countryside and encountering equally poor or worse conditions in the cities upon arriving, as cities in general were totally unequipped for the rapidly increasing population. Housing was usually near to the polluted air of the factories and often owned by the factory owner. These houses were usually built rapidly, with cheap materials, back to back. Owners often built as many houses as possible within the available area to house the workers, leaving these areas dark, confined and with very poor ventilation (Tonge and Quincey, 1985, pp 12-14). Families would often live in one room or in cellars as space dwindled and the lack of external space meant that human waste, decaying plant and animal matter and refuse littered the streets, often in large piles. During heavy rain, surface water could mix with these materials, flood cellar dwellings and poison public water supplies. The lack of proper drains and sewers facilities increased these problems, as did the unwillingness of owners to pipe in fresh water or connect housing to drainage and sewerage (Reid cited in Tonge and Quincey, 1985, pp 5-7). Families often dealt with financial pressure by taking on lodgers or relatives to assist with rent, compounding the overcrowding. The poor conditions in housing and factories, lack of proper nutrition, lack of adequate washing facilities and the extremely long strenuous hours worked by the labouring poor meant that they were more susceptible to sickness and environmentally spread diseases such as typhus and cholera (Thompson, 1990, pp 369-370).
Towns and cities of this era were divided into several subgroups. There were those who were characterised by familial wealth, there were the labouring rural poor which now found their way into the cities, and there were also semi skilled workers whose positions were becoming challenged by new technological advances which allowed unskilled women and children to be taken on as cheap labour. There was also an emerging middle class, which through industrialisation suddenly had the opportunity to create private wealth. Social mobility was becoming more common, but the rift between the extreme poor and the rest of society meant that most of those who lived in relative comfort did not actually know what the living conditions were like for the poor until light was shed on the subject (May, 1996, p.57).
Industrial era Britain was also characterised by great social inequality. Voting rights were tied to property qualifications which meant that the poor had no say in their working and living conditions. The government was characterised by its laissez faire philosophy, mainly seen as a source of law and order rather than an entity to improve the welfare of its people:
… the State ought to confine itself to what regards the State … namely its magistracy; its revenue; its military force by sea and land … in a word … to the public peace, to the public safety, to the public order, to the prosperity… (Burke cited in Tonge and Quincey, 1985, p.17).
However, things slowly began to change. The French Revolution in 1789 illustrated to extent to which things could go wrong for the ruling classes if the working classes were unhappy. The first attempt at placating the working classes was passed by the Conservative government lead by Henry Addington. The first Factory Act – also known as the Health and Morals of Apprentices Act – imposed limits on working days for children of certain ages, mandated education for younger children and addressed issues such as proper ventilation and sleeping conditions for workers. Addington’s government also awarded funds to Edward Jenner to continue his efforts toward obtaining a viable smallpox vaccine, but the 1802 Factory Act was largely unenforced and ignored, making little headway into improving the health and welfare of the poor (May, 1996, p.76). By the time the Earl of Liverpool lead the Conservatives as Prime Minister in 1812, the working class were beginning to call for their own voices to be heard. The movement for unionisation/combination was gaining strength, leading to political unrest and bloodshed in incidents such as the Peterloo Massacre. Trade Unions were legalised by the Conservative government, but fell far short of the demands of the people. As the population continued to increase and the conditions in the cities for the poor became worse, the Reform Act of 1832 took centre stage in the political arena, winning the leadership of the government for the Liberal, Earl Grey. While not directly impacting upon the conditions for workers, the act lowered the requirements for voters, extending the right to vote to 7 percent of the adult population and illustrating the power of the public voice (BBC – History – British History in depth: Prime Ministers and Politics Timeline, no date).
It was at around this time that the serious problems of poor sanitation in the cities were brought to public attention. In 1831, cholera came to Britain. Starting in Sunderland and working its way across the country, it had killed over 21 thousand people by the end of 1832 (Tonge and Quincey, 1985, p.37). The medical establishment at the time was unregulated and largely based on limited training from apprenticeship. They mistakenly thought that germs were the result of disease rather than the cause of it and treatments often did more harm than good, resulting in a public fear of the profession. At the time of the first cholera outbreak there were two main schools of thought as to how the disease spread. The first were the miasmatists, who thought that disease spread by poisonous air and bad smells. The second group were the contagionists, who believed that it spread through contact (Tonge and Quincey, 1985, pp 19-20). The Miasmatists were by far the majority, and despite their misunderstanding of the causes of the urban diseases, they often did some measure of good in combating them. For example, their attempts to diminish the bad smells through sewering and drains would have helped minimise water contamination and flooding of cellar dwellings.
There were some attempts to clean up cities after the first outbreak, but the person who really galvanised the nation in the cause was Edwin Chadwick. In 1832 the Prime Minister Earl Grey commissioned an enquiry into the effectiveness of the Poor Laws and Chadwick was to play an instrumental part, writing around a third of the finished report, which was published in 1834. As a result of the report, the Poor Law Amendment Act was passed, which did little to improve conditions for the poor and in fact abolished certain measures of poor relief, which earned Chadwick enemies. He had, however, proven himself to the Liberal government, and was asked to carry out an enquiry into sanitation in London after influenza and typhoid outbreaks. His report was published in 1842 during Sir Robert Peel’s Conservative government. The emotive language used in Chadwick’s reports echoed popular writers such as Dickens and Gaskell but also appealed to the Utilitarian love of facts and figures and when Peel’s government refused to take action based Chadwick’s recommendations, the Health of Towns pressure group was formed to persuade them to reconsider (Spartacus Educational, no date).
It wasn’t until Lord John Russell and his new Liberal government took power that Chadwick’s findings were used. Following fear of a cholera outbreak, the Whig Act of 1848 was passed. It created a General Board of Health – of which Chadwick was one of three members – and called for the creation of Local Boards of Health where town councils did not exist (Briggs, 2000, p.288). Despite plenty of ideas regarding clean water, sewage and water closets, Chadwick had amassed many enemies and his attempts at change were successfully defeated by landowners and others with vested interests and laissez faire philosophies:
… [Chadwick] was determined that the British world should be clean and live a century, but on one condition only – that they consented to purchase the real patent Chadwickian soap, the Chadwickian officially-gathered soft water and the true impermeable telescopic earthware pipes, and when they did die, were interred by his official undertakers in the Chadwickian necropolis (Engineers and Officials cited in Tonge and Quincey, 1985, p.42).
Despite another cholera outbreak in 1853, the General Board of Health was disbanded after Chadwick agreed to retire in order to protect his existing reforms (Spartacus Educational, no date). Medical matters were returned to the control of the Privy Council, which appointed Sir John Simon as its Chief Medical Officer (Tonge and Quincey, 1985, p.43). Meanwhile, science had made a breakthrough. John Snow, a doctor in Soho, had serious doubts about the miasmatists theory of the spread of cholera. He had experienced breakouts, and believed that cholera was passed by contaminated water supplies. He effectively proved this during the 1848 outbreak, implicating a single pump. Among other findings, he recommended boiling drinking water. His ideas were first published in 1849 but were largely ignored due to the powerful influence of the miasmatists. A later, much more detailed edition of his work was published in 1855, but he died in 1858, never having received any recognition for his efforts (Tonge and Quincey, 1985, p.47). Simon, though, successfully continued to work in his role as Chief Medical Officer, diverting public funds into research on diseases such as typhoid and smallpox. Scientific advances had also vastly improved medicine. The stethoscope appeared, improvements were made in microscopes in order to observe the mico-organisms which Pasteur had discovered in the 1850s, antiseptic surgical procedures were pioneered, and anaesthetics were introduced. Medicine was starting to take its steps firmly into science, just as Britain started to cast off its laissez faire past and venture into collectivism (Robinson, 2009).
The Public Health Act of 1875 introduced legislation to regulate conditions which allowed diseases such as cholera to spread. It eventually led to reforms in the construction of housing and called for all new housing built to include sewage, running water and an internal drainage system (Robinson, 2009). The old mindset of the law and order state was gone, replaced by the idea that the state had a responsibility to account for the welfare of its citizens. Along with the Conservative Reform Acts of 1867, which extended the right to vote to 1.5 million more men, and the Liberal Reform and Redistribution Act of 1884/1885, which extended the vote to 6 million more men, the social welfare of common people had much improved. It was still an issue, however, in the public mind. The writings of Booth and Rowntree gave insight into poverty within society, with concepts such as the ‘poverty cycle’ and the ‘poverty line’ taking shape at around the turn of the century. Another example of this appetite for reform was the report into the conditions of the Boer War recruits. The findings revealed an embarrassing amount of poverty related illness, severely impacting the numbers suitable for military service (May, 1996 pp 336-338).
Although many acts were passed after the turn of the century, the most significant in terms of public health was the National Insurance Act of 1911, which was championed through Parliament by David Lloyd George, who had a working class background and had a personal history with disease. The act set aside money weekly from the worker, the employer and the state in order to provide medical treatment for workers, but was by no means a unified system of healthcare. The reforms during this period are seen by some as the beginnings of the welfare state but by others just an attempt to protect the capitalist system from competition abroad and socialism (May, 1996 pp 343-345).
This idea of protecting the system can also be seen in the aftermath of the first world war. The war had left over a million men injured seriously and hundreds of thousands dead, but it had strengthened the relatively new Labour party. Fear of revolution, pressure from this new Labour threat, and a desire to see Britain improved to make all of the sacrifice worthwhile saw the Liberals in control and committed to reform with David Lloyd George as their leader. The vote was extended again, this time to all men over 21 and all women over 30, who eventually received the same voting status as men in 1928. Also introduced in 1919 was the eight-hour work day, dramatically improving the health and welfare of workers (May, 1996 p.364). The Housing Act of 1919 was also introduced, introducing the first council houses. While it improved the health problems associated with overcrowding, it failed to address the housing needs of the unemployed and truly poor. However, further changes in legislation throughout the 1920s by the Labour and Conservative parties cemented the role of council houses within the nation’s collectivist identity (May, 1996 p.393).
The Second World War was a time of great hardship for Britain, and the hospitals were stretched to their limits. The Emergency Hospital Service was created in 1938. The role of this service was initially constructed for air raid casualties, but eventually extended to other types of patients. William Beveridge emerged during the war as an important figure, compared to the likes of Bentham. His Beveridge Report was published in 1942, in which he proposed a unified system of social welfare, encompassing ideas such as a national health service and social insurance (May, 1996 p.406). It was by using the basis of these proposals that Labour came to power in 1945 following the end of the war. While a complete transformation of society never happened and the years following the war were difficult, Britain had introduced the welfare state.
It is clear, therefore, that vast social change occurred from 1750 to 1950 and that public health was at the heart of it. The lens of public health demonstrates not only the vast change in societal ideology, but the impact that the issues surrounding public health had upon the political decisions. The movement of the public’s ideas about the role of government and the government’s shift from an individualist law and order state to a collectivist welfare state are perfectly illustrated by the vast change within the issue of public health.
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Bibliography
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