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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
Smallpox
Edward Jenner (1749-1823)
Cartoon by James Gillray on vaccination against Smallpox using Cowpox serum,
1802., Engraving-hand colour
“It is often assumed that vaccination measures were
the means by which the disease was brought under
control. This assumption is founded on ignorance of
the real limitations of vaccination measures, and
undervalues the crucial contribution of associated
preventive practices in reducing the incidence and
mortality from the disease. Although vaccination
was the tool which permitted the eradication of
smallpox, the simple availability of vaccination
would never have resulted in the eradication of the
disease. In the evolution of the methods by which
vaccination was made effective, the British
smallpox experience, and that of London in
particular, is of central importance”
Anne Hardy, The Epidemic Streets (1993): 111
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.
See Christopher
Hamlin 1998 for more
details
John Snow (1813-1858)
Snow’s map of Broad Street
‘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
Success of public health reforms and state
intervention? Links to mortality decline
Varied from disease to disease:
• Smallpox – first effective medical intervention, state
interference, but also opposition, importance of
social factors, vaccination just the tool
• TB – state invention after disease had reached it’s
peak. Improved nutrition and living standards
usually seen as cause of decline, but still debated
• Cholera – linked with the first wide scale sanitary
and public health reform. Widespread state
intervention, which was reactionary. Largely
successful
Others? E.g. Measles – decline not the result of sanitary
reform but raised living standards, nutrition
‘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.