History of Medicine: Public Health

1) Roman Public Health
1. Despite no reasoning, the Romans understood cleanliness meant good health, which was vital for a strong army to control the empire
  1. What did they do to improve cleanliness?
    1. Aqueducts
      1. Clean and fresh water delivered straight to towns and available to all
    2. Public Baths
    3. Sewers
    4. Public Toilets (Latrines)
      1. Removes waste from human contact, reducing risk of infection
    5. Saunas and Steam Rooms
      1. Reducing risk of infection or spread of disease
    6. Public Fountains
  2. What were the limitations?
    1. People still had to carry water into their homes from wells/fountains
    2. Only the minority living in towns got it
    3. Only Roman Soldiers could use Latrines
      1. Everyone in a latrine used the same sponge
      2. Little rainfall meant disease spread easily
    4. The Public Baths were only cleaned once a week
      1. 5000 people used them every week!
  3. Why did it work so well?
    1. Romans collected taxes efficiently
    2. Slaves built the facilities to keep down costs
      1. During peace times, soldiers would also help building
    3. The Government controlled it all
3) 1350 - 1750 Problems
1. What were the existing problems?
  1. Rubbish including dead animals were left on the streets to rot
  2. Rivers were polluted meaning very little clean water
  3. Poor sanitation
  4. Sewage was thrown into streets
2. What happened as a result of poor public health?
  1. Outbreaks of disease
    1. The Black Death 1348-9
    2. The Great Plague 1665
      1. How did Government try to stop spread of disease?
        Reducing large crowds
        Closing theatres
        Large funerals banned
        Dogs and cats killed
        Carts to collect dead bodies
        Ordering days of fasting
        Boarded up houses for 28 days
        Ordering days of prayer
  2. Lots of death from infection
4) 1750 - 1900 Action
1. What did they do to improve public health?
  1. Making gin more expensive (1750)
    1. Improved health of poor people
    2. Improved the economy also
  2. Compulsory Smallpox Vaccine (1853)
    1. Dramatically reduced death by smallpox
  3. Public Health Act (1848)
    1. General Board of health
      1. Abolished in 1858
      2. Only a third of towns set it up
      3. Allowed for a medical officer in towns
2. Why wasn't more done?
  1. Most action was only on local authority level, not made by a national government
  2. People still thought God caused disease
  3. The link between dirt and disease was not discovered until 1861
  4. They didn't want taxes to be spent on something that (until 1861) hadn't been proven to reduce disease.
  5. Health was not seen as something that the Government should deal with
5) Public Health since 1900
1. NHS 1948
  1. During WW2, the importance of a healthy country was realised
    1. The NHS was set up by Aneurin Bevan, then the UK Health Minister
      1. The NHS, still today, gave everyone access to healthcare for free
2. Liberal Reforms
  1. Old Age Pensions Act 1908
  2. Free school meals 1906
  3. National Insurance Acts
    1. Money for seasonal unemployment (1912)
    2. Money for illness or injury (1911)
  4. School medical inspections 1907
    1. School Clinics 1912
  5. The Children's Act 1908
    1. Children under 14 not allowed into pubs
    2. Cigarettes not sold to children under 16
  6. Limited Success?
    1. Few people benefited from these changes at the time
3. Government Funding
  1. Advertisements
    1. 1980s AIDS Campaign
  2. Vaccinations
    1. Polio (1952)
    2. Cervical Cancer 2008
  3. Better waste disposal
  4. Clearing of slums in 1930s
  5. Hospitals coming under NHS ownserhip
  6. Reducing air and water pollution
    1. Clean Air Act 1956
  7. Environmental Health Officers
2) Medieval Public Health
1. Why did Roman Public Health disappear in Britain?
  1. Engineers returned to Rome
    1. No knowledge of building/fixing
  2. No central government to control it
  3. There wasn't enough money for it
  4. There were other priorities
    1. Food
    2. Defending Land
  5. People moved back to the countryside
  6. Civil War in Britain
2. What did they do to improve cleanliness?
  1. 1281: London authorities tried to ban pigs on the city streets
  2. 1347: Sanitary Act, trying to keep streets cleaner, people could be fined for dropping waste
  3. 1388: Parliament tried to improve water supplies
    1. Stopping excrement going into rivers
    2. New pipes or conduits into some cities and towns

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History of Medicine: Public Health

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