HEALTH PROMOTION

19th V 20th century health

19th century

20th century

Health Promotion
COMPARISON OF THE 19TH CENTURY
AND THE 20TH CENTURY REPORT

Amanda Robinson
Contents
Introduction...........................................................................................................................................2
19th century health.................................................................................................................................2
Health care.............................................................................................................................................2
Public health policies in the 19th century...............................................................................................2
Diseases.................................................................................................................................................3
Diphtheria..............................................................................................................................................3
Cholera..................................................................................................................................................4
20th century health.................................................................................................................................5
The emergence of the NHS....................................................................................................................5
The Black report....................................................................................................................................6
Diseases.................................................................................................................................................6
HIV........................................................................................................................................................6
Cancer...................................................................................................................................................7
Conclusion.............................................................................................................................................8
Bibliography..........................................................................................................................................9

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 Health promotion

19th century v 20th century

Report

Introduction
A report has been commissioned to compare the 19th and 20th centuries; the author will look
at the health care systems of the two centuries. The author will also look at some
communicable and non-communicable diseases from the two centuries. Lastly the author will
look at the some policies and medical breakthroughs that helped shape that century.

WHO divine healthcare as, not the main absence of disease, but the total physical,
mental and social well-being, (Thrower, 1996)

19th century health

Health care
Health care in the 19th century was poor due the lack of knowledge and the socio-economic
conditions. The 19th century saw frequent outbreaks of infectious diseases caused by the
living conditions or lack of knowledge. Major epidemics were seen throughout the 19th
century. These epidemics include cholera, influenza, typhus and typhoid, tuberculosis was a
major problem in the early 19th century also. There was a decline in diseases such as
diphtheria, and small pox which had been common during the 18thcentury. This was virtually
eradicated due to the introduction of a vaccine. The 19th century due to the lack of knowledge
of treatments and disease prevention, saw hundreds and thousands dying of many preventable
diseases.
Throughout most of the century, doctors can be said to have been conceptually
helpless about the cause and treatment of the disease.  [ CITATION vic02 \l 2057 ]

Public health policies in the 19th century

Edwin Chadwick (1842): His report on the sanitary condition of the labouring population of
Great Britain. It revealed a series of problems arising from the rapid growth of industrial
towns. The main elements of the report were as follows:

 Lack of sanitation
 Poor and substandard housing and overcrowding
 . The poor having to rely on public water pumps.
 Serious outbreaks of infectious diseases for example the cholera outbreak of 1831-32

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Public health act of 1875: R A Cross ensured local authorities to take responsibility for the
following:

 Drainage and sewage disposal

 Adequate water supplies for all
 The removal of nuisance burials
 Notification of infectious diseases
 The destruction of any contaminated foods
This act ensured an effective system of public health; it had been described as the most
important act of parliament of that century.

The 19th century saw great strides in medical science, significant discoveries were made, in
medical and biological science. Joseph Lister in in 1869 developed the first steps in surgical
medicine. The use of carbolic acid (phenol) this helped pave the way for antiseptic surgical
procedures. Louis Pasteur discovered germ theory; his discovery was a major breakthrough in
the study of bacteria and viruses. He discovered that major diseases like cholera and Spanish
influenza were as a result of bacterium and viruses. The mid 1800 saw the invention of the
stethoscope this significantly changed how diseases like tuberculosis were diagnosed and
treat.

Diseases

Diphtheria

Diphtheria was once one of the most dreaded diseases, with frequent large-scale outbreaks.
From 1735-1740, a diphtheria epidemic in the New England colonies was said to have killed
as much as 80% of the children under 10 years of age in some towns. In 1920s there were an
estimated 100,000 to 200,000 cases a year of diphtheria in the United States, with 13,000 to
15,000 deaths. Children represented the large majority of cases and fatalities.[ CITATION
dip05 \l 2057 ]

Diphtheria was one of the most common childhood diseases in the 19th century, it was known
as an upper respiratory illness. Its symptoms include a sore throat, a low grade fever, and a
thick membrane formed on the throat. The child would have some difficulties in breathing
and be weak bodily. In some cases the disease would weaken the child’s heart leading to
death. In 1920s America an estimated 100,000 – 200,000 cases were reported each year, and
around 15,000 deaths.

German scientist Robert Koch (1882) carried out studies of Diphtheria, he found that the
disease was caused by the bacillus bacteria. He found traces of the bacterium in the patient’s
throat; he believed it affected the person’s heart. Koch found that the diphtheria bacteria
produced a poisonous toxin. This would then travel through the blood, and eventually
damaging the heart. Koch in 1890 together with Erich Wernicke, they developed one of the

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first serums against diphtheria. The first successful treatment on a human patient was a child
in 1891 in Germany.
Diphtheria unlike diseases like cholera which hit mostly the poor areas, diphtheria hit anyone
in the population .The disease hit the British royal family in the late 19th century, the daughter
of queen Victoria, princess Alice of hesse died of the disease. She contracted it after nursing
her own children who were suffering from the disease. Queen Victoria’s granddaughter also
died from the disease.

Cholera

Unlike diphtheria cholera hit only the poor population due to poor and substandard living
and working conditions. The first cholera outbreak was reported to have been in the northeast
of England in 1831. This was in the north eastern town of Sunderland; from there it travelled
to Scotland, before traveling southward to London. Before the end of this epidemic 52,000
lives would be lost. It would be some time before a link between contaminated water and
cholera would be discovered.
The symptoms of cholera where frightening they included: Diarrhoea which would increase
with intensity. A severe thirst followed by dehydration. This would then be accompanied by
pain in the limbs, muscles and the stomach. The skin would change colour to a bluish grey;
the victims of this disease would die a very painful death.

. The disease was unlike anything then known. One doctor recalled: "Our other
plagues were home-bred, and part of ourselves, as it were; we had a habit of looking
at them with a fatal indifference, indeed, inasmuch as it led us to believe that they
could be effectually subdued,[ CITATION vic02 \l 2057 ]

A breakthrough in the fight against cholera came in the form of John Snow he was said to be
the father of modern epidemiology. He went on to discover the cause of cholera; Snow
discovered that a water pump in Broad Street (1854), London was responsible for the
epidemic. Snow used the newly emerging technologies in microbiology and death certificates
to trace the spread of the cholera outbreak. He traced it to the water pump and ultimately to
water contaminated by sewage.

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20th century health
The 20th century saw a dramatic decrease in communicable diseases such as TB, measles,
cholera, and smallpox. Most were eradicated in westernized countries while others like
measles were controlled by the introduction of vaccines. In 1986 the MMR vaccine was
created, as triple vaccine to help eradicate measles, mumps, and rubella. There has been some
controversy with this vaccine; some people believe it had caused autism in children. Theses
unproven reports lead to parents refusing the vaccine. This then lead to a rise in diseases,
such as measles. While the 20th century saw the eradication of a number of communicable
diseases. The 20th century also saw a rise in non-communicable diseases such as heart disease
and cancers.

The emergence of the NHS

The Beveridge report (1944) was commissioned by parliament on the best ways to help those
on low incomes. Its main aims were to put in place the following measures:

 All working age people to pay a contribution from their wages

 In return benefits would be paid to the sick or unemployed
 Retired people and widows helped

The Second World War provided a step towards a better, healthier society; it resulted in the
Beverage report of 1942. This had five main aims to help overcome, want, disease,
ignorance, squalor and idleness. This was the establishment of the welfare state by a post war
labour government. The main component of this was as follows:

 A national health service to provide free health care for all, nationalized hospitals.
 Child allowances
 A new national insurance scheme for all adults, to provide sickness, unemployment,
maternity benefit for all and pensions for the over 60s.
 The national assistance act (to provide help for those not already covered e.g.
unmarried mothers and the handicapped.
 The national industrial injuries act

The NHS was the first of its kind to be implemented by a government and even today it
remains unique.

Labour set up a welfare state based on the principle of universality: the services
provided by the state should be provided for rich and poor alike, since services
provided for the poor alone would be second rate. [ CITATION mic01 \l 2057 ]

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The Black report
The Black report was published in 1980 by the DHSS the purpose of the report was address
health inequalities. The report stated that overall health had improved since the introduction
of the NHS; however it found widespread inequalities in health. This was largely due to the
socio-economic status of the population. The report showed that there were class differences
within healthcare and in the distrobution of medical services. It stated that there were higher
rates of infant mortality, and premature death in the poorer areas.

Diseases

HIV
HIV stands for Human Immunodeficiency Virus; the virus infects and destroys the immune
system, making them more vulnerable to other diseases such as cancers and infections. A
person who has contracted HIV will show no symptoms for a long time, sometimes up to ten
years or more. However after some time has passed the persons immune system will stop
working, and will need the assistance of some anti HIV drugs to control the disease.

AIDS

AIDS like HIV is short for Acquired Immune Deficiency syndrome. This not one disease but
is a term used to describe a point when the persons immune system is too damaged by the
HIV to work efficiently. A person does not actually die from AIDS but they die from other
diseases, such as cancers or pneumonia, as a direct result of a weakened immune system.

The disease AIDS which is caused by the HIV virus was first discovered by doctors in 1985,
however they also discovered it had been around for a number of years before that. The
disease was jointly discovered by Dr Robert Gallo and Dr Luc Montagnier.

Theories are not lacking for the origin of HIV. There was, some years ago, a strong
belief that accidental contamination of the cell lines used for the production of the
vaccine against polio may have led to a virus "jumping" from animals to man, but this
was later disproved.

[ CITATION San08 \l 2057 ]

HIV and AIDS has become one of the most serious infectious diseases in the 20th century. It
first it was thought to only be contracted by homosexual men, but later studies confirmed
both homosexual and heterosexual people have contracted the disease. However cases of HIV
are still higher in homosexual men.

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In the UK HIV remains the fastest growing serious epidemic to date, people have the disease
but do not know they have it .HIV can also be spread by the sharing of infected needles
through illegal drug use, and the passing on of the infection by mother to baby as well as by
sexual contact. There are currently about 83,000 people living with HIV in the UK alone.
Worldwide there have been around 18,000 deaths due to HIV and AIDS since the 1980s.

For people living with HIV in the UK, the development of effective anti-HIV drugs
means they can stay healthier for longer. The UK government has also made public
commitments to tackling HIV in developing countries.
[ CITATION tru09 \l 2057 ]

Cancer
Cancer is caused when cells in that particular part of the body begins to grow out of control,
all cancers begin with out of control abnormal cells. Cancer cells differ from normal cells
while normal cells grow and die. Cancer cells continue to grow and produce new abnormal
cells. Normal cells within the body become cancerous cells due to damage within the cell’s
DNA. In cancer cells the damaged DNA id not repaired as normal. They go on producing
abnormal cells that can spread to other cells or organs within the body.
Most cancers from into tumours these tumours replace normal body tissue; however some
cancers such as leukaemia evolve within the blood and blood forming organs. The process
called metastasis happen when cancer cells travel to other parts of the body via the lymph
vessels within our bodies. There are many different types of cancer some examples include
lung cancer, breast cancer, prostate cancer, and bowel cancer.
Not all cancers work the same within the body. Lung cancer and breast cancer act very
differently within the body, they increase at different rates, and only respond to certain
treatments.
Epidemiologists continue their search for factors that cause cancer (like tobacco use,
obesity, ultraviolet radiation) as well as those offering protection against cancer
(such as physical activity and a healthy diet). This research provides evidence to
guide public health recommendations and regulations.[CITATION the09 \l 2057 ]

Cancer prevention is all about screening healthy people to ensure to early detection of
abnormal cells. These tests include breast and cervical cancer screening; studies show that an
increased success rate of beating cancer is archived if these cells are detected early. The first
cancer screening test was called the Pap test; it was developed by George Papanicolaou
(1923). He went on to recognize its potential for detecting cervical cancer, in the 1960s the
test was promoted for use. Since that time it has been widely used and continues to help save
lives. Since the test become common deaths by cervical cancer have decreased by 70%.

Conclusion
Within this conclusion I plan to compare the two centuries for differences or similarities
within the health care systems.

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The public health actions and control of infectious diseases in the 20th century came about as
the result of discoveries made in the 19th century. Examples include the discovery by Louis
Pasteur (1860) discovered that certain germs or bacteria were the cause of disease. Before
this doctors believed that it was the disease that caused the bacteria, the theory of
spontaneous generation. Within this time RTH Laennec (1816) invented the microscope,
which helped in the treatment of tuberculosis, and other diseases such as cholera and
diphtheria.

In the 19th century health care was mostly focused upon cure rather than prevention due to the
lack of knowledge in causes of ill health. . In the 19th century diseases spread among the
population because of poor sanitation and poor housing. The poor citizens lived in squalor
and overcrowded dwellings. These conditions helped disease rip through many parts of the
poorer sections of the city. Research has been says that more people have perished due to
preventable diseases such as cholera and measles, and then have died in all the world wars.
The 20th century however with the help of inventions and discoveries, shifted its focus to
health prevention. This is where the birth of health promotion and its subsequent models
came about.

In the 19th century steps were made to a better health and lifestyle of its population with the
polices by influential people such as Chadwick, the poor law amendment act and the health
care act of 1875. The 20th century saw the emergence of the NHS which significantly changed
the face of British health and welfare. Providing better health care, good safe housing and
benefits that needed them. A major campaign like the HIV and AIDS campaign was massive
at the time. This helped to educate shock and change behaviours of the population with
regard to sexual health.

There was a great deal of major lessons learned from ignorance and actions in the 19th
century, that helped shape the 20th century. These lessons have helped to change and improve
health care worldwide. Consequently in the 21st century our health care today is shaped by
what we learned in both the 19th and 20th centuries.

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