A BRIEF HISTORY OF PUBLIC HEALTH
By Tim Lambert
Early Public Health
In the ancient world public health was often surprisingly advanced. Stone age farmers lived in a village at Skara Brae in the Orkney islands. Some of their stone huts had drains built under them and some houses had cubicles over the drains. They may have been inside toilets.
In the Indus Valley civilisation (c.2,600-1,900 BC) streets were built on a grid pattern and networks of sewers were dug under them. Toilets were flushed with water.
On the island of Crete the Minoan civilisation flourished from 2,000 to 1,600 BC. They too built drainage systems, which also took sewage. Toilets were flushed with water.
The Romansalso built sewers to collect rainwater and sewage. (They even had a goddess of sewers called Cloacina!). Wealthy people had their own toilets but the Romans also built public lavatories. Despite the public lavatories many people still went in the street.
The Romans also built aqueducts to bring water into towns.
After the fall of the Western Roman Empire in the 5th century AD sophisticated plumbing disappeared from Europe for centuries. In Saxon times toilets were simply pits in the ground with wooden seats over them. (For ordinary people that remained the case for centuries afterwards).
There were public lavatories in the Middle Ages and the 16th century. For instance we know there was one over the River Fleet at London. However public lavatories were rare at that time. Often people went wherever they could. In 1547 people were forbidden to go in the courtyards of royal palaces so presumably it must have been a real nuisance.
In the Middle Ages the church ran the only hospitals. (Although often the only thing they could do was offer food and shelter). In many towns monks and nuns cared for the sick as best they could.
Furthermore outside many towns were leper 'hospitals' (really just hostels as nothing could be done for the patients). Leprosy was a dreadful skin disease. Anyone who caught it was an outcast. They had to wear clothes that covered their whole body. They also had to ring a bell or a wooden clacker to warn people they were coming. Fortunately leprosy grew less common in the 15th century and it died out in Britain in the 16th century.
In the Middle Ages only monasteries had sanitation. Streams provided clean water. Dirty water was used to clear toilets, which were in a separate room. Monks also had a room called a laver where they washed their hands before meals.
At Portchester Castle in the 12th century monks built stone chutes leading to the sea. When the tide went in and out it would flush away the sewage.
Toilets at Portchester Castle
However for most people sanitation was non-existent. In castles the toilet was simply a long passage built into the thickness of the walls. Often it emptied into the castle moat. Despite the lack of public health many towns had public bath-houses were you could pay to have a bath.
In the 18th century conditions in most towns improved (at least for the well off). Bodies of men called Improvement Commissioners or Paving Commissioners were formed with powers to pave, clean and light the streets (with oil lamps). Meanwhile several hospitals were founded in London in the 18th century including Westminster (1720), Guys (1724), St Georges (1733), London (1740) and Middlesex (1745).However despite some improvements 18th century towns would seem dirty and crowded to us.
In 1775 Alexander Cumming was granted a patent for a flushing lavatory. Joseph Brahmah made a better design in 1778.
However flushing toilets were a luxury at first and they did not become common till the late 19th century. Also popular in the 19th century were earth closets. An earth closet was a box of granulated clay over a pan. When you pulled lever clay covered the contents of the pan. In rural areas flushing lavatories did not replace earth closets until the early 20th century.
A toilet bowl from Weald and Downland Museum
Modern Public Health
In the early 19th century working class homes often did not have their own toilet and had to share one. Sometimes you had to queue to use it.
Even in the late 19th century inside toilets were a luxury. Working class homes almost always had outside lavatories. About 1900 some houses were built for skilled workers with bathrooms and inside toilets. However it was decades before inside toilets became universal.
The first modern public lavatory, with flushing toilets opened in London in 1852.
From the late 18th century the industrial revolution transformed Britain. Many villages or small market towns rapidly grew into industrial cities. However, although most towns gained gas light in other ways conditions were appalling. They were dirty, overcrowded and unsanitary. Lack of building regulations meant poor peoples houses were often hovels. Not surprisingly British towns suffered outbreaks of cholera in 1832 and in 1848. However conditions in Victorian towns gradually improved.
There were outbreaks of cholera in London and other towns in 1831, 1848-49 and finally in 1866. In 1859 work began on building a system of sewers for the whole city but it was not complete till 1875. After that deaths from disease fell drastically. Other towns also built networks of sewers. In 1865-70 Portsmouth council built sewers. In 1875 a bylaw stated that any house within 100 feet of a main sewer must be connected to it. However not all towns were so keen to build sewers. Many people in Chichester were reluctant to build a network of drains and sewers because of the expense. They were finally built in 1893-96.
In the 18th century a piped water supply was available in many towns - for those who could afford it. Water was pumped along elm pipes. In the 19th century local councils took over the water supply from private companies. People began to use sand filters and chlorination so the water supply became much cleaner. In the early 19th century most people obtained water from wells but in the late 19th century piped water became much more common.
In the 18th century people took baths in portable tubs. However bathrooms were very rare. But from the mid 19th century the middle class began to have them. In the 20th century the working class began to have bathrooms. Also gas made it much easier to heat water for washing. Bathrooms and running hot water made it much easier to keep clean.
Furthermore in the 19th century public parks were laid out in many towns. Before the industrial revolution parks were not necessary as towns were very small and anybody could easily walk out into the countryside. As towns and cities grew much larger they provided a very useful place for fresh air and exercise. Local councils also began to take responsibility for collecting refuse. Manchester council took that responsibility as early as 1845. Also in the 19th century hospitals were founded in towns and cities across Britain.
Another source of ill health in the early 19th century was overcrowding. At that time houses for poor people were often built back-to-back. They were literally joined one to another with the back of one house joining the back of another. Fortunately in the 1840s town councils banned the building of new back-to-backs. In the late 19th century living standards rose steadily and ordinary people began to live in houses with more rooms. Less overcrowding was an important factor in making people healthier.
Meanwhile in 1796 a doctor named Edward Jenner (1749-1823) realised that milkmaids who caught cowpox were immune to smallpox. He invented vaccination. (Its name is derived from the Latin word for cow, Vacca). The patient was cut then matter from a cowpox pustule was introduced. The patient gained immunity to smallpox. In the late 19th century and the early 20th century it became possible to vaccinate people against many infectious diseases, which greatly improved public health.
Louis Pasteur invented a way of sterilising liquids by heating them (called pasteurisation). It was first used for wine (in 1864) and later for milk.
In the 19th century adulteration of food was common. Cheap substances were added to food and drink e.g. water was added to milk. Food adulteration could literally be lethal. Calcium sulphate was added to peppermints. In 1858 a sweetmaker in Bradford sent somebody to obtain some from a druggist. However by mistake the druggists assistant picked up some arsenic thinking it was calcium sulphate. The arsenic was added to the sweets. As a result 200 people became seriously ill and 20 died. In Britain food adulteration was eventually controlled by the Sale of Food and Drugs Act 1875 and the Food Adulteration Act 1899.
Public health was transformed in Britain between the mid 19th century and the mid 20th century and today people are much healthier than they were.
A History of Washing
A History of Life Expectancy
A History of Medicine
A History of the Population of England
A History of Firefighting
Last revised 2012