Childhood, Illness and Disease
Lecture 5 From Cradle to Grave
Topics
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Lecture: covers the 19th and 20th centuries
Smallpox and anti-vaccination
Brief introduction to public health
Infectious diseases – children’s diseases
(measles)
• Infectious disease hospitals
Seminar:
• Advice to parents – management of children’s
health in home
• Psychologisation of childhood
Disease, mortality and the state
• Disease impacts on populations, but also economy, state
and cultural beliefs and practices.
• State involvement in public health and disease regulation –
includes quarantine, vaccination, public health measures,
establishment of infectious disease hospitals.
• Much positive (there is an improvement narrative here),
but also marks state interference in individual rights with
regard to health – and often involves compulsion.
• Epidemic = prevalent in waves, short-term; attacks
populations indiscriminately.
• Endemic = regularly or usually found among the
population.
• Pandemic = global outbreak of disease in limited time
period.
• 1836 Registration Act – compulsory for births and deaths to
be registered.
Smallpox
• Smallpox – major killer, and children very
vulnerable. Viral sickness – spread by droplet
infection. Also caused male infertility as well as
high mortality, so major check on population.
• Smallpox endemic and epidemic – vaccination
only arena where significant decline in death
rates due to direct medical intervention up until
late 19th century (McKeown thesis).
• Inoculation – Lady Mary Wortley Montague (1720
son inoculated in Constantinople).
• Vaccination – Dr Edward Jenner, 1790s.
Edward Jenner (1749-1823)
Vaccination developed in 1796.
Observed that milkmaids and
stockmen rarely developed
smallpox.
Inoculated James Phipps with
cowpox and 6 weeks later with
smallpox – proved immunity to
smallpox. Remarkable feat of
empirical medicine.
Pamphlet An Inquiry into the
Causes and Effects of Variola
Vaccinae (1798). 1801 100,000
people vaccinated. National
Vaccine Establishment 1808.
Vaccination implementation
• 1840 Vaccination Act –
first move into state
medicine
• Further legislation 1850s,
1860s
• 1853 Act vaccination of
infants compulsory before
age of 3 months
• Public Vaccinators 187071; fine of 25s if parents
refused to vaccinate
children
• Children refused
admission to school if not
vaccinated
Anti-vaccination
• Many of poor opposed
vaccination – objected to
compulsion, association
with Poor Law and to
procedure itself.
• Anti-Vaccination League
1866 – ‘conscientious
objectors’. Campaigns in
many town e.g. Leicester,
Dewsbury, Brighton.
• However, opposition died
down and vaccination
widely introduced. Last
major outbreak smallpox
1902-03, and 1907 repeal of
compulsory vaccination.
Public Health
Edwin Chadwick (1800-1890)
1842, Report on the Sanitary
Condition of the Working
Population of Great Britain.
Emphasised the need for experts
to be employed by government
and believed the role of the
state should be regulatory rather
than directive.
His report cited disease as a
major cause of poverty –
reduced earning capacity of
the working classes. Broke
ground in relating sickness and
poverty.
John Snow (1813-1858) and cholera
• j
• Cholera outbreaks 183132, 1848-49, 1853-54 and
1865-66
• 1855 ‘On the Mode of
Communication of
Cholera’
• Argued that cholera
water borne rather than
being based on miasmas
and insanitary conditions
Snow’s map of Broad Street
Soho district in London.
Called the ‘cholera field’
by Snow.
Over 500 people died in
10 days from 1 to 10
September 1854. Snow
linked the deaths to the
source of water.
Marked of shift from idea
of ‘miasmas’ causing
disease to ‘germ theory’
Public Health Legislation
Cholera short-term impact, but tended to spur governments
into action.
1831 Central Board of Health created – local boards set up in
many towns
Increasing Recognition state responsibility to respond to
public health problems caused by rapid growth of towns
1848 Public Health Act – piped water, removal of nuisances,
and local boards of health (permissive)
1855,1860 and 1863 Nuisance Removal Acts
1866 Sanitary Act – Sanitary Inspectors appointed to removal
nuisances and to review housing (compulsive)
1872 Public Health Act – appointment of MOHs compulsory –
marked rise of preventive medicine
1875 Public Health Act – councils compelled to build sewers
and supply clean water
1889 Infectious Diseases Notification Act
Anthony Wohl, Endangered Lives (1983).
Children’s diseases
• Children particularly
vulnerable to smallpox,
measles, scarlet fever,
diphtheria, whooping cough,
croup, infantile diarrhoea and
also bronchitis and pneumonia
• Causes of death under 5,
1848-55
• Measles 44,003
• Scarlet fever 72,056
• Whooping cough 58,254
• Diarrhoea 76,660
• Pneumonia 107,831
• Registrar-General’s Office,
1857
Notification of infectious diseases
• Calls for system of notification and isolation from
1860s (John Simon)
• Small number of towns set up infectious disease
hospitals – 1883 34 towns
• Infectious Disease Notification Act (1889) – notification
of infectious disease compulsory London, optional
elsewhere, but quickly adopted by local authorities –
by 1891 555 urban and 373 rural sanitary districts
(growing acceptance of germ theory)
• Also inspired by awareness after Education Act 1870
that infectious disease conveyed by school children
might become more widespread – in crowded
classrooms, diseases like measles and scarlet fever
more common
Infectious disease (isolation) hospitals
• Built on tradition of providing
fever hospitals during the 18th
and 19th centuries largely to
treat typhus (charitable).
Workhouses also treated fever
cases
• Provision of special hospitals
slow – opposition by local
inhabitants, funding
limitations (borough hospitals,
so local government
responsibility)
• Isolation Hospital Act 1893 –
county councils enabled to
provide hospitals
• Provision remained poor –
costly, and patients hated
compulsion
• Ca
Responses to disease and isolation hospitals
• Poor understood contagious diseases, fatalistic about
them. Terrified by smallpox, TB; other diseases, like
measles, seen as ‘ordinary childhood disease’, even
though death rate high.
• 1904 smallpox epidemic ‘There was a plague of
smallpox. On Moor Park they had to put marquees and
tents up and they had to put the children in there with
smallpox… They were dying like flies. Every Friday night
we would look in the paper and it took a great toll of
children in them days did the plague’
Lucinda Beier, For their Own Good (2008), collection of
oral histories – Barrow, Preston and Lancaster
Isolation hospitals
• Average stay 40 days or 6 weeks.
• Great reluctance on part of working class to admit children
– complete isolation from family
• 1898 MOH Barrow observed ‘It is impossible to get the
consent of parents amongst the working classes to the
removal of their children to hospital’. MOH Preston,
however, argued in 1909 that ‘invariably even the very
youngest soon settle down to their new surroundings,
enjoy the company of other children and benefit by the
more careful nursing, better food, and purer air than, in the
case of the majority, they would enjoy in their own homes’.
The hospital was made as attractive as possible to
overcome parents’ reluctance to allow children ‘to enter an
institution of a bright, cheerful, and ornamental character.
It does much to remove the prejudice and opposition
generally shown against the erection of an Isolation
Hospital…’
Measles
• Deadly viral disease, spread by droplet infection or touch
• Peaks in summer and high case fatality in midwinter when
associated with coughs and influenza – reached epidemic
levels in many years
• Disease of poor – due to proximity of overcrowding
• F.B. Smith claims parents ‘stoical’ about measles – though
tried various kinds of domestic and patent remedies;
doctors struggled to treat it effectively
• Sanitary reform and isolation made little difference
• Broke out in schools – e.g. epidemics Coventry 1886, 1889
and 1894, but schools reluctant to inform authorities
• 1915 became notifiable disease following major epidemic –
1916 rate fell dramatically
• However, improved standard of living, improvements in
education and housing, and good nursing care could
improve survival rates
• See Anne Hardy, Epidemic Streets (1993).
Tuberculosis
• Major killer in the 19th century (endemic)
• 1839 TB was responsible for 17.6% of all deaths in England
and Wales
• 1848-55 largest single cause of death – 354,542
• In the early 20th century it remained the most prominent
chronic illness – 75,000 deaths per year
• Widely thought to be hereditary in 19th century and
associated with bad working and living conditions and vice
• Spread through close personal contact – important to
remove sufferers from their environment – TB sanatoria
and open-air school movement (1907)
• Shift to preventative approaches – health education also
important
• By 1950 death from TB greatly reduced – better hygiene
and nutrition and housing most likely cause, as well as use
of antibiotics
Sanatoria
Open-air schools
• To combat TB, but also to encourage hygiene,
fresh air, healthful practices more broadly
Polio
• Around 1900 epidemics of
polio appeared in Europe
and N. America
• Major outbreaks around
period of 2nd WW
• Salk and then Sabin
vaccination introduced mid
to late 1950s
Household and advice
• Also health initiatives in home – working-class
homes targeted by well-to-do visitors, and then
public health officials (health visitors, district
nurses, MOHs, sanitary inspectors) who
instructed on hygiene and domestic management
and management of illness
• ‘Domestic quarantine’ supplemented isolation
hospitals
• Parents increasing influenced by advice literature
– e.g. Pye Henry Chavasse and Thomas Bull
• And increasingly exposed to multiple sources of
professional advice via school, local/public health
authority
Nursing at home
• Parents own ideas on health – ‘strong’ and
‘delicate’ children – e.g. use of laxatives, patent
remedies, strengthening medicines, bolstered by
family and neighbours
• ‘To kill the germs and to make it easier for
breathing, pull the blinds downs if we had
measles so that we didn’t get the light in our
eyes. And on the whole she used to nurse us
through; I’ve had goose grease on my throat, that
was supposed to be good; I’ve had sulfur and
they put it in a white clay pipe and blow it down…
Liquorice sticks and cod-liver oil and malt and
Scott’s Emulsion…’
• Mrs Peel, born 1921 Barrow
Patent remedies
Conclusions
• Late 19th and 20th saw decline in diseases and diseases of
childhood, though some like TB and measles persistent
(major epidemic of measles e.g. in 2ndWW). By 2ndWW,
however, former killers, like measles and whooping cough,
minor childhood diseases.
• Initial decline largely due to major public health
interventions, but then into 20th century increasingly
associated with improved housing, diet and nursing care.
• By 2ndWW children immunised against many diseases,
including smallpox, diphtheria, whooping cough and polio;
antibiotics effective against TB and scarlet fever.
• Fighting disease involved considerable state intervention
e.g. vaccination, public health reform, regulation of housing
and compulsory notification of infectious disease – most
accepted as public good.
• However, also involved notification, surveillance, isolation,
disinfection and education.
Debate continues