Urbanization, Industrialization and Population: Mobilizing for the Public’s Health-Jesse Geisler

Jesse Geisler

August 29, 12

Seminar III

With Professor Oppenheimer

Urbanization, Industrialization and Population: Mobilizing for the Public’s Health

            This week’s readings focused on the ill health effects wrought by rapid industrialization. All of the readings suggest that the main determinant of disease is one’s socio-economic status. Frederick Engels quotes evidence showing that poorly kept streets, those in which the most obvious sanitary conditions were ignored, had rates of mortality four times those of richer neighborhoods (Engels). The readings do not patronize the poor and imply that they are dirty from ignorance, or lacking in bourgeoisie etiquette and hygiene. They suggest instead that the working class poor at that time, the “proletariat,” were thrust into a position of radically changing economic, political, and class interactions that led to crippling conditions of squalor and destitution. With these conditions came epidemics, specifically cholera. The devastating effects of such diseases became symbolic of the cost of unprecedented, unregulated, and uncontrolled industrial growth (Porter D).

In the book Civilization and the State by Porter D, he explores the physical conditions working class people in 19^th century England endured daily and their connection to disease. Porter also chronicles some of the symptoms and nature of cholera and typhus. Porter cites sources claiming that in the first half of the 19^th century epidemics and infant mortality were the number one causes of death. He also states or assumes that the majority of English urban poor were well fed enough to be above the level of malnutrition at which the integrity of ones immune system is compromised, and susceptibility to diseases common. Therefore death from starvation/famine was not so much an ill of 19^th century England, however the quality of food and exposure to contaminants may have compounded citizens susceptibility to disease. After 1870 deaths from infectious diseases declined abruptly due to improved sanitation and temporary school closings in districts with infected children (Porter D).

The book also explores differing opinions regarding how best to respond to epidemics. Some researchers at that time were what were called “contagionists,” believing that human-to-human contact was the sole source of disease and those afflicted must be immediately segregated. Anti-contagionists believed diseases were present in the environment, some belching from the bowels of the earth, and opinions varied as to why they infected some and not others. Many believed morality was linked to a weak constitution, and therefore sinners were more susceptible to epidemics. Anti-contagionists also pointed out that the problem with the theory that disease traveled only by human-to-human contact was that the same epidemic could break out in geographically distant isolated pockets. Moreover, another significant problem with contagionism was the political climate at that time. Quarintine practices used since medieval times—closed down public meeting places and sealed off cities and towns—which were ordinances enforced by the military, caused outrage in newer generations more in tune with social unrest.

This lead to civil disobedience and the murder of bureaucrats and doctors throughout Europe. Doctors were targeted because of their use of cadavers for research, and rumors circulated that cholera was a plot hatched by medical professionals who wanted more bodies to dissect. A central question that Porter raises is whether or not disease causes social unrest or if social unrest and the fragmentation of society create conditions ripe for disease. Porter does not draw a conclusion but essentially notes that the two situations may not be mutually exclusive, and a distinction regarding causation may be difficult. However Porter states that urban stress—conditions he defines as “hardship from political and economic conflict, strikes and lockouts, and homelessness and overcrowding resulting from slum clearance”—does consistently seem to precede the outbreak of a dangerous epidemic such as typhus or cholera.

Porter describes the symptoms of cholera as such: it begins with violent vomiting and diarrhea, which quickly leads to severe dehydration and pale bluesh tint of the skin that characterizes the disease. This is followed by debilitating cramps and muscular spasms, which lead quickly to death. Research seems to show the acidity or alkalinity of ones stomach can effect survival rates, and this is corroborated by alcoholics susceptibility to the disease—alcoholism is associated with a high PH stomach. Today when adequate resources are available cholera is no longer considered a deadly disease and can be treated with high doses of a potent antibiotic cocktail. It is now understood that the disease is transmitted primarily through feces, which explained the rampant spread in London slums. English country traditions regarding waste disposal involved essentially pooling all waste and runoff into a cesspit. However when this practice was employed in the vastly overcrowded slums of London, the cesspits became overrun swamps that almost invariably contaminated nearby drinking water. This lead to the rapid spread of the disease.

The cholera bacterium, if it survives the acidic conditions of the stomach, lodges itself in the walls of the small intestine and produces cell byproducts that are toxic to its host. This leads to the symptoms of vomiting and diarrhea. Typhus, the other major killer in 19^th century England, uses lice as a host. When the victim is bit by lice, and the resulting welts are scratched, the typhus bacterium enter through the open sore quickly infecting the person. Today typhus can also be treated with antibiotics, but in 19^th century England it was often deadly. Porter sinisterly notes that sometimes outbreaks of these deadly diseases were hidden and responses delayed because of public officials or private interest groups fears of the effects quarantine would have on revenue streams.

The devastation of these epidemics lead to the creation of public health systems. Initially, The expansion of Britain’s public health system was justified partly by the belief that conditions of society would effect the market health of the economy and in turn greater British society—namely the wealthy class, those with the power to yea or nay such public health campaigns. Therefore investing in the health of the lower classes was worthy because not doing so would essentially be bad for business (Porter D).

This belief was backed partly by the calculation by state architects that a surefire way to reduce the cost of the poor on the state was to ensure the health of the urban poor’s “breadwinners” (Porter D). As Engels noted in his The Conditions of the Working Class in England, the primary worker in a family was always the one most likely to be afflicted by a disease, and also the one a family could least afford to lose. This was probably because of stress on the job and exposure to more people and contaminants at work. Although Porter acknowledges that some held the view that government apathy was the cause of overcrowded slums and squalor, he does not like Engels entirely blame the government.

Tied into the vast overcrowding of the slums and subsistence level living that made death from famine unlikely but death from epidemics related to overcrowding common was the allowance system. The allowance system allocated enough money to poor families to supplement their wages just to subsistence levels in accordance with the price of bread (Porter D). Intense overcrowding in urban environments led to extreme situations of filth—animal and human waste, excrement, and refuse—that seeped into water supplies causing illness. The unbearable stench associated with such urban environments at that time likely led to the numerous theories of atmospheric contagions that randomly and intermittently spewed out of the earth to infect sinful townspeople.

However many within the British elite believed the allowance program was smothering the free market economy and increasing the price of labor, by dulling the “fear of hunger” in the poor. Still others believed the epidemics were necessary to curb wild population growth that if continued to grow unchecked would threaten industry and lead to instability (Porter D).

Edwin Chadwick and Dr. Henry Rumsey both became pioneers in English public health by creating reports that criticized the current state of affairs. Chadwick’s report essentially documented the terrible living conditions and complete disregard for sanitary practices in most of the slums. Chadwick, similarly to Engels, noted that the chronic diseases affecting the working class from infancy never allowed a generation to get truly ahead, leading to a chronic cycle of subsistence living. He essentially tied the elimination of poverty to proper healthcare. Rumsey published a report bemoaning the fact that the English General Board of Health was run by bureaucrats with zero medical knowledge and no advice from doctors. This in many ways is the beginning of an ongoing argument to this day between public health officials and doctors as to who should advise who and how the two professions should interact. As Porter stated, “Rumsey noted that preventive and palliative (treating symptoms not underlying causes) care needed to be integrated in some way” (Porter D). Another important figure within public health was Dr. William Farr, who pioneered the International Classification of Diseases (ICD) system. Farr also created many public health systems, and developed a national statistics initiative to aid doctors with data collection. Farr’s extensive implementation of statistics changed healthcare and social sciences (Eyler J).

Engel’s take on the abhorrent conditions in slums leading to epidemics is different from Porter’s in that he places specific blame on the government. He states that the government’s attitude towards slums and the squalor that proletariat Britain’s dwell in is one of such indifference that it constitutes manslaughter. Engels believes that the sheer density of people living in London leads to a lack of oxygen and that “carbonic acid gas” engineered by industry is spewed into the streets and because of the oppressive and cramped building style hovers close to the ground endangering peoples lungs. Again Engels as with many other critics of living conditions and their effect on health believed that much of the ills associated with city life came from unclean air. In fact he often mentions the stench associated with London, and as with others correlates it to ill health—not entirely without basis, as foul smells often indicate the presence of something harmful. In relation to Chadwick’s perception of the correlation between poverty and healthcare Engels notes the chronic illnesses beginning in children bring a perpetuating “enfeeblement upon the entire race of workers” (Engels).

Engels emphasizes indigestion as a constant ailment plaguing the working man, the result of old or contaminated food. Workers complain constantly of dull aching stomach pains in addition to their bleak environment, all of which they blunt with alcohol, a meager comfort that only compounds their ailments. He also addresses the rampant phenomenon of quack medicine, that is, various pills or elixirs that promise the world to the working class but do nothing but rob them of their menial pay or poison further bodies wracked with ills (Engels).

The thrust of Engel’s paper The Conditions of the Working Class in England seems to imply that the “property holding classes” have vested interest in sustaining and maintaining this state of affairs for the purpose of cheap labor, and are responsible for the sky high mortality rates among the working poor (Engels). Engels also addresses the education system in Britain for the poor, stating that it is essentially useless and staffed by unknowledgeable people and zero counseling or advice for upward mobility. The Conditions of the Working Class in England is filled with vivid descriptions and accusatory political rhetoric and serves its point. One cannot help but feel that the working classes are caught within a vicious cycle out of their control leaving them subject to the bacterial and viral ravages of nature.