Name:
Public Health revision 1350 to the
present day.
Key areas to cover:
 Public Health from 1350–1750: The problems.
 Public Health 1350–1850: Government action.
 Public Health 1750-1900: Cholera and Chadwick.
 Public Health 1850-1900: Government action.
 Public Health 1900-1948: Welfare State
 Public Health 1948 to present day: prevention and education.
 Factors affecting Public Health 1350 to present day.
London scenes from the Plague 1665.

What methods can you see being used in
these pictures to stop the spread of the
Plague?
1
Research the following events and say how they affected
Public Health.
Date Century
1600’s
17th
1665
17th
Event
Growth of towns.
Plague in London.
1750
Tax on gin.
1831
Cholera
1842
Chadwick’s report
1854
John Snow
1861
Pasteur germ
theory
Link to Public Health.
2
1865
Bazalgette
1880
Vaccines
developed
1905
Liberal reforms
1948
NHS
1970s
Healthy living
campaigns
2009
Vaccination again
cervical cancer
3
Keywords: match up the key word to the correct definition.
By-law
The idea that government should not
interfere too much with industry and
private business.
Chamber Pot
The situation where someone who may
have an infectious disease is isolated from
people to stop it spreading.
Laissez-Fair
A law made by a town’s local authority that
affects only that town.
Public health provision
Quarantine
Welfare state
Workhouse
The coordination and provision by the
government of all matters affecting the
health of the people.
A potty that was kept in a room or
chamber, for people who needed the toilet
and did not want to go outside to the
toilet.
An institution where people could go if
they could not support themselves; they
would be expected to work in return for
their food.
Health provision for the whole community,
such as fresh water, sewers and access to
health care.
4
Medieval Public Health:
 Medieval towns did not have systems of sewers or water pipes like
Rome had. Medieval towns were probably filthy. Garbage and human
waste was thrown into the streets. Houses were made of wood,
mud and dung.
 Rats, lice and fleas flourished in the rushes strewn over the clay
floors of people's houses (often changed only once a year).
However, we can't conclude that Medieval people were personally
filthy, or careless of their health:
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The doctor Alderotti advised people to stretch their limbs, wash
their face, clean their teeth and exercise.
Guy de Chauliac (the Pope's doctor) realised the importance of a
good diet, and that a poor diet made people more vulnerable to
the plague.
Monasteries developed comprehensive systems of public health,
including fresh running water, wash rooms, flush latrines with
running sewers, clean towels and a compulsory bath four times a
year.
Nobles took regular baths (perhaps two a year).
Towns had bath houses (which were also restaurants and
brothels).
People realised that a room next to a privy was unhealthy, and
towns paid 'gongfermers' to clear out the cess pits.
Medieval kings passed laws requiring people to keep the streets
clean.
During the time of the plague many towns developed quarantine
laws, and boarded up the houses of infected people. People with
leprosy, likewise, were confined to lazar houses (a place for
people with infectious diseases).
During the Middle Ages the first hospitals were built since
Roman times (eg St Bart's in London).
5
Key Public Health Problems were:
 How to get clean water?
 Chamber pots and water closets.

Questions:
1) Why was the water of such poor quality and why did it make people
ill?
2) What did people drink instead of water and how did this cause
problems?
3) How did chamber pots cause Public Health problems in Medieval
towns?
4) Why were water closets a problem for Medieval people?
5) What was a gongfermers job and why were they introduced?
6
Public Health 1350-1850: Government action.
Dealing with the Plague: local authorities were under pressure to stop
the spread of the plague. So what did they do???????
A
B
D
E
C
F
1) Use the picture clues and write down what the local authorise did the stop the plague
from spreading.
2) Now you need to say how they thought each of these factors helped stop the plague
from spreading and did any of the actually work?
A)
B)
C)
7
D)
E)
F)
COMPULSORY VACCINATION.
The government made vaccination compulsory in
1852, but it was not strictly enforced until 1871
when an Act of Parliament forced local authorise
to register everyone who was vaccinated – only
then did the number of deaths for smallpox drop
dramatically.
Questions:
1) Why were public Health issues more serious in towns
than in villages in the countryside?
This picture titled ‘Gin Lane’ was painted in 1751 by
William Hogarth. It warns of the Gangers of gin.
The government passed laws that made gin
more expensive. This was to try and improve
standard of health among the poor but also
because the government was concerned about
the effect on the economy if people were too
drunk to work.
ANSWERS: A) Banning crowds
B) Killing cats and dogs
2) Why do you think central government did not raise
taxes or pass new laws to improve Public Health more
often?
3) How far did compulsory vaccination and the tax on gin
show the government taking new, preventive role in
Medicine?
c) Burning barrels of tar D) Collecting dead bodies
E) Locking up
F) Fasting and praying
8
Public Health 1750-1900: Cholera and Chadwick
1) What is the Industrial revolution?
2) How did the Industrial revolution affect Public Health?
An engraving of London in early 19th Century showing the crowded
and unhygienic conditions in which most people lived.
3) What does this source show you about people living
conditions in the 19th century?
Chadwick’s role in improving public health:
 Published the results of his survey of housing conditions in towns called, The sanitary Conditions of the
Labouring population.
 Suggested it would be cheaper to improve housing and hygiene rather than pay for workhouses.
 Also access to clean water, remove sewage and rubbish was suggested.
 He has much opposition due to a laissez-faire attitude, water companies thought they would lose money
and the Middle class would have to pay for these changes through taxes and therefore did not think that
their money should be used for this purpose.
Government action:
 The Public Health Act 1848 set up a General Board of Health, with Chadwick as one of the three
commissioners.
 It allowed towns to set up their own Board of Health, appoint local medical officer, organise rubbish removal
and build a sewer system.
 But this was not enforced. Only one-third set up a Board of Health and fewer appointed a medical officer.
 This act was only temporary so in 1854 the commissioners had to resign and the General Board of Health
was abolished in 1858.
 Chadwick was not appointed to any other official position.
 Chadwick’s report highlighted the issues and laid the basis for reform.
What part did Edwin Chadwick play in bringing about changes in public health provision?
Explain your answer.
(9 marks)
9
Level 1 (1-3 marks): Answers offers a simple description of something Chadwick did.
Level 2 (4-6 marks): Answer describes some of Chadwick’s work and it includes specific information.
Level 2 (7-9 marks): Answer gives a detailed account of Chadwick’s work and shows that he had a limited impact.
The best answers will explore his work in the context of other developments.
PLAN your answer here and then have a go and answer it:
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Public Health 1850-1900: Government action.
Dr John Snow’s investigation:
What did John Snow discover? How did this help public health?
The ‘Great Stink’ 1858: What was the great stink? How did it lead to public
health changes?
Local councils take action:
Act
Key terms
1866 Sanitary Act
All towns had to appoint inspectors to check water supplies and drainage.
1875 Artisans Dwelling Act
Local authorities were given the power to buy and demolish slum housing.
1875 Public Health Act
Towns had to appoint Health Inspectors and Sanitary Inspectors; local
authorities were given powers to enforce regulations on water supplies and
sanitation.
1878 Public Health Act
This consolidated existing laws.
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Public health 1900-1948: The foundation of the Welfare State.
Access to health care: Surveys showing how difficult it was for the poor to afford decent
housing and food were carried out by Charles Booth and Seebohm Rowntree. Then, when
Britain was involved in the Boer War in South Africa in 1899-1902, a third of volunteers for
the army had to be turned down because they were not medically fit. This shocked many
politicians and made them decide to take action.
The beginnings of the Welfare State in the early 20 century: Liberal government was
elected in 1905 began to pass laws that they hoped would improve health among the poor.
1911 National Insurance Act
Free treatments and medicines, limited sick
pay and unemployment support for some
workers.
1908 Old Age Pension Act
To stop the elderly going into workhouses
1907 School medical Service and health
visitors
This was to check the health of young
people.
1906 Free school meals
This was for the poorest children
1902 Midwives Act
All midwives have to be trained and
registered.
There were still problems of epidemics and that woman and children were not covered by
national Insurance scheme and so they could not afford treatment from a doctor. The
average life expectancy had increased by 1931 to 58 for men and 63 for women. The
government was also bringing in further help by:
- Medical inspections in secondary schools
- Free milk for poor primary school children (introduced in 1934)
- Health clinics gave vaccinations and sold cheap baby food
- Many hospitals brought under the control of local authorities
Effects of the Second World War:
1) How did children being evacuated help bring around change in public health?
2) Rationing encouraged poor people to eat more vegetable. How would this help improve
health?
12
Public Health 1948 to present day: Prevention and education.
1) The National Health Service was set up in 1848 how did that help improve public health
for all?
Now the government now enforce preventive public health such as giving free vaccinations
to stop polio and cervical cancer. Can you think of any other preventive measure the
government take?
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Health education:
When it comes to light that certain things such as smoking, obesity and binge drinking are
bad for our health the government embark on communication to educated people of the
dangerous. They use messages on products, posters and television campaigns to raise
awareness.
Jamie Oliver’s campaign for healthy food led the government to act. Why do you
think Jamie’s action lead to the government to change food in school and how does
this link to public health?
Public Health and private companies.
How are private companies taking over the role of Public Health?
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Factors affecting Public Health 1350 to present day.
The two key agents of change are Technology and Key Individuals.
1)Technology
This has help with the development of sewers created by Bazalgette and the
construction work needed to build the underground sewer system for London
and the complexity of the planning and engineering that went into the system.
Technology was used in 19th century to pump water into the towns and cities.
This would have been imposable to do before the technological advancement of
the industrial Revolution. Technology also helped improve living conditions with
heating, hot water and electric lighting.
2) Key Individuals and they did to help Public Health. Match up what each
person did.
Individuals
Contribution
Chadwick
Showed the link between Cholera and water.
John Snow
Used statistics to analyse the problem.
William Farr and Snow
Drew attention to poor living conditions.
Pasteur
Suggested the government should improve
public health.
Beveridge report 1942
Showed that disease was spread by microbes.
New Labour government
Put pressure of doctors to join NHS and
helped launch it in 1948.
Bevan Minster for health
Elected in 1945 accepted these
recommendations by Beveridge and began to
plan NHS.
Why were living conditions in industrial towns so unhealthy in the early 19th
century? (9 marks)
PLAN: Now think about what you need to include the answer this question and jot it
down and then have a go and write an answer.
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How different was the public health provision in the 19th and 20th centuries? (16m)
 In 1875 a Public Health Act was passed
 In 1941 a vaccination programme against diphtheria was introduced
 In 1948 the NHS was set up
15
PLAN: Now think about what you need to include the answer this question and jot it down and
then have a go and write an answer.
My Plan:
Explain 1848 PH Act (Chadwick’s improvements) which was not enforced, then 1875 PH Act which
was important but government focused on preventing disease not improving people’s lives.
20th century further acts passed to help people’s life with health care, children’s health in schools.
Then NHS set up access for all.
Conclusion – 20th century on bigger scale and covered more areas than the 19th century,
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How important was the role played by Edwin Chadwrick in impoving puclic health services in
towns in the 19th century (16m)
PLAN:
 Explain the importance of Chadwick’s report. Links his finding to specific changes
 Explain the limitations of what Chadwick did.
 Evaluate the role played by other individuals. John Snow and Bazalgette.
 Evaluate the role played by other factors Pasteur discovery, great stink.
 Conclusion – reach overall judgement, do you agree with the statement did he play the main
role or were other factors more important?
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