The Rise And Fall (And Rise?) Of Epidemic Diseases

12.10.05

19th Century urbanisation:
• Stimulated by industrialisation.
• Unplanned, rapid building.
• Primitive sanitary services - privies, cesspits, private water suppliers.

Demographic crisis:
• Crude death rates over 40/1000 in 1840s.
• State forced to provide basic welfare.
• REACTIVE NOT PROACTIVE.

Cholera:
• Symptoms - severe diarrhoea etc.
• Miasmatic theory of disease.
• All social classes at risk - no effective treatment.
• 1832 - 21,882 deaths.
• 1848-9 - 55,201 deaths.

Public fear of disease:
• Liverpool was one of the unhealthiest places in Britain.
• Liverpool - 8 cholera riots in 1832 - anti-medical profession (1832 = Burke and Hare and Anatomy Act = supply of bodies for anatomy classes).
• 1847 - typhus fever epidemic in Liverpool.

Sanitary response to cholera:
• Short-term responses - temporary Boards of Health.
• Temporary public cleansing.
• Edwin Chadwick - sanitarian.
• Liverpool Sanatory Act 1846.
• Public Health Staff - Medical Officers of Health - Dr Duncan first (Liverpool) 1847.

Bacteriology:
• Robert Koch.
• Louis Pasteur.
• Joseph Lister.
• Tuberculosis bacillus identified in 1882.
• Discovery of cholera vibrio in 1884.

Supremacy of science over sanitarianism:
• Miasmatic, contagious, anti-contagious theories replaced by germ theory.
• COMPULSORY public health.
• By 1880s, most urban areas had sanitary infrastructure - public piper water supply, sewer system etc.

'Personal prevention':
• Decline in epidemic diseases.
• New focus on chronic health problems.
• Tuberculosis, STDs, cancer, heart disease.
• Concern with national deterioration - 'degeneration' - eugenics.
• Development of an individual 'moralising' framework for disease.

1918-19 Influenza pandemic:
• Killed 30 million worldwide in less than 6 months.
• No effective vaccine or treatment.

Inter-war health crises:
• Who is responsible for disease surveillance?
• Conflict between Ministries of Health and wider medical profession.
• Worldwide economic depression.
• Lack of resources.
• Diphtheria scandal.

Post World War II disease regime:
• Culmination of transition from epidemic infectious diseases to chronic health problems.
• NHS 1948 - political priority for curative MEDICAL services.

1970s - the New Public Health
• Low public health status.
• Who has the communicable disease skills?

Conclusion?
• How do we define 'epidemic'?
• Does it matter?
• Are epidemics useful?
• Put pressure on systems.
• Generate demands for change.