HIST 249 Lecture Notes - Lecture 14: Health Promotion, Cell Theory, Lemuel Shattuck
History of Public Health
•
Textbook reading:
o Deborah Brunton: “Dealing with Disease in Populations: Public Health, 1830-
1880”
• Assignment #2
o Next class: workshop for assignment #2
o Secondary literature added
o Librarian coming
o In the assignment - make it clear why you are using it, what's important? What does
it add?
o Evaluating the source you found
o Why is this a good example of secondary literature
• Classic public health - 19th century
• Facts, development
• Readings - how to write history
• What is public health? - definition
• When societies collectively organize to protect against health dangers in populations
• Not about individuals
• About populations, groups
1. Epidemic diseases
2. Diseases related to social conditions, poverty
3. About protecting the public - dangerous practices & behaviours
• Public health is also often driven by non-medical interests but often produces
medicalized responses
• Medicalization
• Relationships b/t public health & clinical medicine (individual) is historically complex
& tense (different from one another)
• Discussions about what is preferred
• There have been measures in history about what constitutes public health
• Public health administrations
• Appear during epidemics
• Italy
• 17th & 17th century
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2
• Public health really develops in the 18th century
• Rise & emergence of state & administration that take control of health
• Replace fatalism
• Absolut monarchies
• Have the idea that the strength of a nation is determined by the size of its
population (need people for army & workforce)
• Need for information about populations
• Mercantilism
• Cameralism - healthy finances of the state
• Centralized power & bureaucratic intervention - do something about health,
need for whats going on
• Standing armies
• Based on the faith in progress of the Enlightenment
• State police
• Medical police
• General approach to health problems of populations
• Includes all aspects of hygiene and public health
• (EX) Sexual hygiene, child welfare, prostitution, clean water
• Compulsory vaccinations
• Industrialization & Health
1. Rapid, massive urbanization
• Overcrowding
• Little infrastructure
• Human, animal waste
• Air / water pollution
• This was all addressed by the public health
• (EX) London - surrounding areas came into the city, city doesn’t have adequate
housing & infrastructures
2. Industrial accidents & illnesses
• Area of public health - Epidemics
• Incentive to infest in public health (epidemics & large # of people dying)
• Visible & scary
1. Cholera
• Several outbreaks in Britain 1832 etc.
• Was a new disease
• A little bit like HIV / AIDS in the 1980's
• Symptoms: intense vomiting, water diarrhea, abdominal pain, cramps
• Had occurred locally
• India, far East
• Started spreading in 1817
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3
• Moved West
• Awful disease, quick spread
• Could be well in the morning & dead in the night
• If you survived the first 42 hours often survived but most people didn’t
• Dehydration
• Skin - blue tint
• "Blue stage of cholera"
• Doctors were helpless
• Mortality of victims got worse
• The poor suffered most - working class, slums were hit the hardest
• Conspiracy theories & tension in the air around this
• Cholera - spread more by area than by class, some cities were harder hit than
others
• No one knew why this was the case
• The main explanation of the spread of cholera - the idea of miasma (disease as
filth)
• This idea was challenged by doctors
• John Snow doctor
• Broad street pump
• Cholera outbreak of 1854
• Specific water disease
• Something in the water that causes the disease, didn’t believe it was a
miasma disease
• Mapped out the cases of cholera in his own neighbourhood in London
• There was a single contaminated well on Broad street - thought to be the
source of cholera for that neighbourhood
• Raw sewage that would come back up…
• The workers of the local brewery who only drank beer, did not get cholera
• Therefore he thought it was the pump
• Focus on the water supply
• Something morbid matter in the water
• Supply of clean water - was important
• Investigations of diseases - arise at similar conclusions about water
• Helped sanitation in Britain
• Disease causes:
• Environment as the direct cause (filth, dirt)
• And an unknown agent of contagion (water)
• Cause of disease was wide spread
• Changes / developments were not always so clear cut as they appeared in
retrospect
• Seed (agent) vs. soil (hosts body - most important)
• Pre-disposition or the presence of the infectious agent
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Document Summary
1880 : deborah brunton: dealing with disease in populations: public health, 1830, assignment #2, next class: workshop for assignment #2, secondary literature added, librarian coming. & tense (different from one another: discussions about what is preferred, there have been measures in history about what constitutes public health, public health administrations, appear during epidemics, 17th & 17th century. Little infrastructure: overcrowding, human, animal waste, air / water pollution, this was all addressed by the public health (ex) london - surrounding areas came into the city, city doesn"t have adequate housing & infrastructures. Industrial accidents & illnesses: area of public health - epidemics. 3: cholera - incentive to invest in public health, britain, first industrialized nation. Lay > medical: went from lawyers and lay people, change, end of this - public health was completely in the hands of trained & professional doctors, edwin chadwick.
