The aim of the paper “The Determinants of Health from a Historical Perspective” is to evaluate Britain in the 19th century, which was undergoing all the classic symptoms of a society that has seen too much economic development too fast…
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But this favorable outcome.... had to be devised with the aid of medical science and fought for politically. It could only be achieved if the serious health challenges brought on by economic change, industrial wage labor, and urban living were met with the appropriate political resolution to implement far-reaching preventive health measures, requiring the deployment of substantial social and economic resources...."( Szreter ,1997)
In order to understand the health improvement and its causes it is necessary to look at the dismal situation in terms of disease, infant mortality, quality of food, filth in the surroundings and the work environment in 19th century Britain through a snapshot created from documented history:
The most life-threatening hazard facing city-dwelling Victorians is cholera, closely followed by typhoid fever and typhus. Four epidemics of cholera - in 1831/32, 1848/49, 1853/54 and 1866 - kill about 140,000 people, with more than 60,000 perishing in the second epidemic alone. ....In London, there are still open cesspools, and the sewers run straight into the Thames..... Urban workers are stunted in growth and afflicted by debilitating diseases such as rickets, tuberculosis and bronchitis. Long hours of toil and poor diet weakens their resistance. .....much of the food consumed by the working classes is adulterated by foreign substances, contaminated by chemicals or fouled by animal and human excrement. The infant mortality rates in the.... inner city rates were dramatically higher, 300 deaths per thousand on average .... Puerperal fever...was the main cause of death in childbirth during the 19th century....patients under a doctor's care have only a 50% chance of being better off than if they and their diseases had been left alone. ( McVeigh,2000)
This then, is the situation in which most of industrial Britain found itself in the beginning of the 19th century, and we first examine how developments in medicine and hygienic concepts facilitated improvements in health standards. To our 21st century perceptions, the answers must seem pretty simple: remove the filth and improve the sanitary and health services. But to the 19th century mindset, ideas on infection and sanitation and their relevance to health was yet to be established, and this is where the role of medicine came in. The role of sanitation in a disease like cholera was first commented on by a surgeon called John Snow.
John Snow......published in 1849 his opinion that cholera was spread by the pollution of drinking water by sewage......Snow's original publication received little official attention, the miasmatists being bent on campaigning vigorously against filth in general as a cause of 'poisoned air'. Two of the three persons most celebrated for their interest in health in Victorian times, Edwin Chadwick and Florence Nightingale, remained miasmatists all their lives. ..... Nevertheless, the realization of the miasmatists that cholera was at its worst in insanitary places led to widespread national protests against the evils of the open sewers, the defective drains, the foul ditches and the refuse-littered streets of the towns of the 1840s.(Seaman,1995)
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