History midterm

Biomedicine Lectures: Epidemics

I. Hygiene

- By 1832 some attempts were made to prevent epidemics, but moving slaughter-houses and cemeteries to the outskirts of towns.

- Hospitals were better designed larger, cleaner and offered a healthier diet to its patients.

II. Cholera Epidemics on Northern Europe from 1817-1823, 1826-1827, 1841-1859, 1863-1875, and 181-1896. Then again in 1899-1916.

- in 1872 a Local Government Board was formed in Villerme.

It was known as Asiatic Cholera (Cholera morbis, Cholera nostrum)

- There was still a concentration on ‘filth’ as the cause. Disease is related to the habits of the poor.

1) relates to disorder

2) a specific contributor to disease

Report of the General Board of Health: loose stools were related to cholera, as a precursor it advised that people who had diarrhea should report to the medical doctors as though they had cholera.

- ‘Premonitory diarrhea’ led to ‘cholera’. For the authorities there was an intellectual connection between these two. The poor for them were like animals, if they did not experience violent diarrhea then they would not make the connection themselves.

1892, Robert Koch is quoted saying “Gentlemen, I thin I cannot be in Europe,” after witnessing a Hamburg under a cholera outbreak (the water system there had spread cholera along the Elbe River).

- In Europe, civility (modern habits) is related to purity and protection against cholera. Only those “uncivilized places” that cannot reason are subject to cholera.

Some historians now contend that cholera may have been exacerbated by modernization and new transportation systems.

- In 1848, after the development of canals there were multiple loci for cholera outbreaks.

- Improvements in commerce brought disease.

What did the “poor” think of this?

- They thought that the doctors or other authorities were inflicting this on them. Hospitals were only for the poor, who tried to avoid them as much as possible.

- One example was when a military boat of the coast of Georgia—sailors were put on an island to contain the cholera outbreak—the healthy people had to be forced at gunpoint to carry the sick to the hospital.

Richard Evans, in his book Death in Hamburg: Society and Politics in the Cholera Years, 1830-1910 noted that the poor were more likely to catch cholera—the rich were less likely because they could and would leave town and avoid the water--but once you catch it the mortality rate is the same for everyone.

Dr. John Snow (1813-1858) recognized that women of childbearing age—because they were the primary caretakers and they came in more contact with the sick—had higher mortality that the sick (Graph of mortality rate for men and women during epidemics: Men are out and about so get it earlier in the epidemic, but women get it later and more of them get it.)

Doctors – Health councils existed rarely and when they did (as in Paris) they had very little power-they did not make ultimate decisions, but rather only gave advice.

- After 1848, medical officers of health gain more power and an order cleaning up of areas, and of moving around (of people)—but they could do this only after a cholera outbreak was announced. Thus a conflict of interest arose—since they were paid by city/town officials who did not want to lose business by announcing the outbreaks.

Health officials focused on certain places in the town: tanneries, lodgings.

They advised – don't get drunk, don’t over exert yourself,

There were few quarantines in the 1830s. In the 1860s, these are improved and more effective.