publichealth-3 B

Transcriber:	Chen Li-Chen
Brief Bio:
Date finished:	04-06-2006
Proofreader:	Paula Trever
Brief Bio:
Date finished:	04-06-2006

The History of Public Health

Lecture 3: The Sanitary Idea

Part B

Hello, welcome back.  We're now going to look at the problems of urbanization and industrialization that gave rise to the sanitary idea and made the environmental clean-up campaigns that were so evident in the mid-19^th century imperative.  And I'd like to make the initial point-and again, this might seem obvious but is worth reemphasizing-that urbanization alters human environmental relationships.  The problems of public health are heightened by the organization-or the disorganization might be more accurate-of communities into towns and cities.  The same processes of capitalism that created the market economy, the factory, and the modern urban environment, also bring into being the health problems that make necessary the new means of disease prevention and health protection.  So, in other words, if you have new environments that are centered around urban areas, that are centered around the very dense congregation of people living together in very close quarters, these new environments create and prompt new responses to the health problems that they generate.  And the processes of industrialization and urbanization occurred across Europe, but they tended to be most concentrated in Great Britain in the period between 1750 and 1840. 

And as I have previously mentioned, the forces that resulted in urbanization, also produced specific disease environments.  And by this point, by the late 18^th and early 19^th century, it wasn't only epidemic outbreaks that brought about substantial public health reform and intervention, and we saw in the previous lecture, in relation to quarantine, how epidemic outbreaks might result in particular forms of public health intervention.  What we're more concerned about here in relation to the sanitary idea are endemic diseases, such as smallpox, typhoid, and chronic illnesses caused by malnutrition and poor living conditions that were so prevalent in the urban areas, the cities, and the towns of Western Europe in this late 18^th , early 19^th century period.  By the middle of the 19^th century, attention was beginning to be paid to the condition of the working class, particularly in France and Britain.  Urbanization, of course, was fueled by unprecedented levels of migration, and towns and cities grew in response not only to this migration but to very high levels of natural growth.  And current concerns were not necessarily related to humanitarian philosophies around the quality of life of the masses of the industrial workers, but rather to fears of the deteriorating work capacity by people weakened by ill-health and the looming threat of insurrection and revolution on the part of the working classes.  So disease environments were developed by urbanization and industrialization, but [they were] also environments that might foster insurrection and revolution.  So concerns about the health and disease of the working class population went hand in hand with concerns about the general social conditions of that working class population that made them potentially dangerous in terms of insurrection and revolution.  So ideas and concerns about environment and health have to be viewed within those wider social movements. 

And we can move on now to look at some of the patterns of urbanization that became so worrisome at the beginning of the 19^th century.  We can see from the table, some of the patterns of urbanization during this period.  One of the most striking statistics is, in 1801, there were no urban centers in England and Wales with population in excess of 100,000, other than London itself.  Within 60 years, more than 11 percent of the national population lived in towns and cities of above 100,000 people.  Similarly, the number of people who lived in urban centers between 20,000 and 100,000 had doubled.  And between 1801 and 1861, the population of London had increased from almost one million to two million.  So the percentage of national population living in the capital city was almost 14 percent by 1861.  These trends had a long-term effect.  In 1801, about 30 percent of the population of England and Wales could be considered urban.  In other words, about 30 percent of the total population lived in places that had a population of two-and-a-half thousand or more.  The rest of the population, about 70 percent, lived in rural areas.  By the end of the 19^th century, by 1901, those proportions had been completely reversed.  Seventy percent of the population, in 1901, in England and Wales, could be considered urban; thirty percent could be considered rural.  So it's not just the fact of urbanization itself that matters.  What also matters is the rapidity and the speed and the rate at which the urbanization takes place because, if the urbanization takes place at a rapid rate, then that poses particular sets of problems for the management of urban areas, for towns and cities, and for the provision of utilities, supplies, and amenities for that population.  And these are some of the basic problems that emerged during the industrial period, not only in Britain, but also across Western Europe and the United States. 

There was certainly a lack of planning in any sense. The rapid urban growth outpaced the rates at which houses could be built.  And there was virtually no planning of housing at all.  Manufacturers would erect factories in accordance with their production requirements, as opposed to the requirements of their workers, and as families and workers streamed to areas where their employment opportunities existed, speculative builders would run up housing on any land, usually marginal land, as we saw from the slide at the beginning of Section A.  This was usually marginal land that was available, as long as it was close to the prospective employment opportunities in the factories.  

The problems of urbanization, paradoxically, were also exacerbated by the process of suburbanization, and there's already evidence in the early 19^th century of suburbanization in British cities. In effect, as transport and communication networks improved, the wealthy were able to leave the overcrowded and environmentally deprived inner cities and buy for themselves, if you like, a rather more healthy lifestyle, on the suburban, almost rural, outskirts of the large cities.  And the effect that that would have is that wealth would be lost to the city areas, the rate base and the rate-raising potential for local authorities and cities would be reduced because the proportion of their population who were wealthy was becoming diminished. 

And there was a general lack of attention to the provision of sanitary facilities.  In the earlier part of our period, in the late 18th century, there tended to be a prevailing assumption that the various physical and social needs of inhabitants would almost automatically come into existence as the result of wealth creation.  And there was little interest in the sanitary facilities, unless they generated a profit.  Basic utilities, such as pure water supply in London for example, rested in the hands of private companies, and these private companies would only connect up a constant supply of water to those homes that could afford to pay for it.  Houses in poorer areas, not only lacked a constant supply of pure water, but they also suffered from infrequent and minimal sewage and garbage removal.  In one part of the northern English city, Manchester, there were two privies for every 250 people in the early 1840s.  A privy is basically a very rudimentary form of water closet. Instead of water closets or privies, there was sometimes a tub that would require emptying on a daily basis.  Again, in one part of Manchester in the 1840s, 7,000 people were supplied with just over 30 of these tubs for their daily sanitary requirements.  So you can imagine the environmental problems, this lack of sanitation and lack of amenities, presented for the population. 

And we can see from some of this information that's presented on two northern English cities, Manchester and Liverpool, how bad the situation could actually get.  And this data (?) was taken from 1840s again.  On the left hand side, you can see some information about cellar dwelling in Manchester. We can see in 1500 cellars in Manchester, three people per bed was the norm.  In 738, four people shared a bed. And in more than 280 cellars, as many as five people shared a bed.  In Liverpool, on the right hand side of the slide, 40,000 of the total population lived in cellars and 60,000 of the population lived in closed courts. And closed courts would effectively be rows of houses that were arranged in a square, and they would have one very narrow entrance that would provide access to all the houses in the square.  And generally, there would be 300 to 400 people living in a single closed court. And they would have to share amenities such as, maybe, one water pump-if they were lucky-and also any other sanitary amenities would have to be shared between that population of the closed court.  And you can see from the bottom section of that information on Liverpool, that the hundred thousand people in the city who lived in the cellars and the closed courts represents almost half of the population of Liverpool in the 1840s.  So very high proportions of city populations were living in very environmentally deprived conditions during this period.   So even though this slide shows a picture from London in 1901, the conditions that you can observe were very similar to the types of conditions that would be prevalent in closed courts and alleys and streets of places like Manchester and Liverpool in the 1840s. 

And it's not surprising that these rather shocking urban environmental conditions should translate into very high rates of mortality.  You can see here a list of crude death rates from some of the largest English cities.  And we can observe that there is some forms of urban crisis occurring in the 1830s and 1840s.  You can see from the rates that I've shown here, but particularly for the two cities of the previous slides, Liverpool and Manchester, that crude death rates in mid-1840s reached as high as mid 30s.  So 33 in Manchester, almost 34, and almost 35 per thousand population lives were being claimed in the 1840s.  So, in this section, we've highlighted some of the main environmental problems that arose due to the processes of urbanization and industrialization that gave rise to many of the central themes of the sanitary idea.  But it's also important to emphasize that, as well as the social processes, the sanitary idea has a range of philosophical and political impulses.  And it's to these impulses that we're going to turn in next section.