Prevention of Disease in the 18th & 19th Century (Edexcel GCSE History)

Improvements in Disease Prevention in the 19th Century - Timeline & Summary

The conditions in towns and cities made the prevention of disease impossible. During the Industrial Revolution many people migrated from the countryside to industrial towns to find work. This population boom was unmanageable. Back-to-back housing for workers was dangerous and unhygienic. The buildings had little ventilation. Multiple households shared one communal toilet that often overflowed. Water came from neighbourhood water pumps, increasing the chance of contamination.

Campaigners like Edwin Chadwick petitioned the government to step in. He proved that the life expectancy of the poor population in cities was much lower than people in the countryside. The average life expectancy was 39 years old. The government did not believe it was their responsibility to look after the health of the nation. This attitude began to change in the 19th century.

In 1832, the government passed the Great Reform Act which extended the right to vote to more men than ever before. The government felt a bigger pressure to drop their laissez-faire attitude. They wanted to ensure they received votes from the newly enfranchised.

The cholera epidemic in 1854 and the Second Reform Act in 1867 forced the government to intervene further. The 1875 Public Health Act meant that local authorities had to provide clean water and sewage disposal. Failure to comply resulted in a fine. This transformed conditions in cities and increased life expectancy to 47 years old. Instances of epidemics were fewer and less severe. Disease prevention significantly progressed through a combination of vaccination and government intervention

Jenner & Vaccinations

Smallpox in the 18th Century

• Smallpox is an illness which causes a fever and pus-filled rashes across the body

• The disease was incredibly dangerous, killing as many as 30% of victims

  • Most of these were children

  • The worst epidemic in Britain was in 1796 when 3,548 people died

• Before Germ Theory, people did not understand what caused smallpox

  • Scientists had noticed those who had a mild case of smallpox never caught it again

• A method to prevent smallpox was inoculation

  • An inoculator would rub pus from a smallpox scab into a cut on the patient or crush a scab for the patient to snort up their nose

• Inoculation caused many problems:

  • Inoculation was expensive so many could not pay for their services

    • Inoculators became extremely wealthy

  • Some patients died of the inoculation process 

• Edward Jenner, having experienced the inoculation process as a child, believed there was a better way to prevent smallpox

  • He had gathered over 1000 cases where inoculation had failed to prevent smallpox

Jenner and Vaccinations

• Jenner noticed that dairymaids did not catch smallpox during epidemics

  • He regularly treated the maids for cowpox

  • The disease caused similar blistering to the skin as smallpox but was not deadly

• Jenner decided to test the link between smallpox and cowpox

  • In 1796, Jenner gave a young boy called James Phipps cowpox

  • Six weeks later, he infected James with smallpox

    • He did not catch the disease

  • He published his findings in 1798 in An Enquiry into the Causes and Effects of the Variola Vaccinae

    • The term ‘vaccination’ comes from the Latin ‘vacca’ for cow

Reactions to the New Vaccination

Government Reaction

• The British government preferred vaccination to inoculation

  • It was much safer

  • It was cheaper because people did not need to go into quarantine

• The government took steps to change public opinion of vaccination

  • In 1840, it became illegal to inoculate

    • The government paid for children's smallpox vaccination from taxes

  • In 1852, the government made smallpox vaccination compulsory for children up to 3 months old

  • In 1871, doctors received payment for vaccinating people against smallpox

  • In 1872, the government fined those who refused to vaccinate their children

The Impact of the Smallpox Vaccine

The Development of Vaccines

• Inspired by Jenner’s work, Louis Pasteur began to look into the possibility of vaccination

• He discovered that he would need to identify the germs causing a specific disease to be able to vaccinate against it

  • This went against Jenner’s approach of observation and human experimentation

• In 1879, Pasteur worked on a vaccine for chicken cholera 

• During the work he:

  • Identified the germ causing the disease

  • Produced a weaker version of the disease

  • Treated his patient with the weaker version

• Pasteur proved that treating animals with a weaker version of chicken cholera protected the animals from catching it later

• Pasteur later used this method to create vaccines for other diseases

  • He provided vaccines for anthrax and rabies, both of which impact animals more than humans

• Pasteur did not understand the science behind why his method of vaccination worked

  • He was unaware that a weaker version of a disease encourages the immune system to create antibodies

  • These antibodies then fight off the disease if the patient catches it again

• Koch’s work on discovering the microbes that caused disease also influenced vaccine creation

  • Emil von Behring used Koch’s research to create vaccines for tetanus and diphtheria

Government Action to Improve Public Health

• Edwin Chadwick wrote a report in 1842 called Report on the Sanitary Conditions of the Labouring Classes

  • Chadwick proved a connection between life expectancy and living standards

  • People living in cities died much younger than those living in the countryside

  • Chadwick:

    • Concluded this was due to the filthy conditions of cities

    • Campaigned for the government to make local authorities clean up their towns and cities

    • Advised setting up boards of health, responsible for clearing sewage and providing fresh water

  • The government did not believe differences in life expectancy were enough evidence to act on

• After John Snow and Pasteur’s work on cholera, there was more proof that clean water was vital for health

• After their work the government began to act

The Public Health Act of 1875

• The government introduced a Public Health Act in 1848

  • It encouraged cities to set up boards of health and provide clean water

  • It was not compulsory for local authorities to follow the act

    • This limited the impact the Act had on the health of the nation

• The government passed the second Public Health Act in 1875

• This act made it compulsory for local authorities to:

  • Provide clean water

  • Dispose of waste properly to avoid polluting drinking water

  • Build public toilets

  • Hire a public officer of health to monitor where epidemics of disease occurred

  • Build new houses with better ventilation and check lodging houses were safe

  • Provide parks for exercise

• A local authority who broke the terms of the Act would pay a fine

• By the end of the 19th century, the government had abandoned their laissez faire attitude

  • They acknowledged that it was the government’s responsibility to protect the health of the nation