3.5: Industrial Revolution

While smallpox continued to devastate indigenous and enslaved populations, one of the reasons many Europeans had immunity to it by this time, was due to a popular medical practice called variolation. This process involved gathering fluid from smallpox pustules of a currently infected person and inoculating the next person by rubbing the material into small scratches in the skin. The purpose was to cause a milder form of the disease in the recipient which would be far less deadly. Although the workings of the human immune system were not yet understood, the process worked for the most part, although it was still risky (Contributors to Wikimedia projects, Variolation, 2023d). In 1796, an English doctor named Edward Jenner discovered that cowpox infections could provide immunity against smallpox as well. This discovery led to the development of the first vaccine - which was eventually provided freely by the English government and adopted across Europe (Contributors to Wikimedia projects,Edward Jenner, 2023g). Due to worldwide vaccination efforts over the next two centuries, the World Health Organization declared smallpox completely eradicated in 1980 (Tulchinsky & Varavikova, 2014, p. 11). The eradication of smallpox is considered one of the greatest achievements of global public health efforts.

Along with the aforementioned effects of colonization, enslavement, and westward expansion on the spread of disease, now the consequences of the industrial revolution further exacerbated disease transmission and created new health concerns. Factory jobs often utilized dangerous machinery and had little oversight to occupational safety. These same jobs brought more people into cities with crowded living quarters. In the 1830’s, Edwin Chadwick, a British Lawyer, gathered data and demonstrated the correlation between poverty, poor living conditions, and disease. He also advocated for better sanitation to prevent the spread of infectious diseases. Chadwick and others began what historians refer to as the sanitary movement - public and private efforts to improve health by improving living conditions related to clean water, plumbing, and waste removal. This prompted cities to rebuild whole neighborhoods throughout Europe and North America (HIST 234 - Lecture 11 - The Sanitary Movement and the “Filth Theory of Disease,” n.d.).

These social determinants of health like poverty, environment, and education, have been recognized for centuries, and those who advocated for the remedies to health disparities were often considered politically radical. In 1848 there was a Typhus outbreak in a rural area among an ethnic Polish community. A young and politically active doctor, Rudolph Virchow, was tasked by the Prussian government with determining the cause of this outbreak. Although Virchow was notably obsessed with cellular pathology in his other work, he identified social, environmental and political factors as the causes of disease in his report on the Typhus outbreak. “Medicine is a social science, and politics nothing but medicine on a grand scale,” noted Virchow (Taylor & Rieger, 1985, p. 548). In his report, he advocated that diseases could be reduced with adequate employment and income, sufficient housing and sanitation, and proper nutrition. Although he disagreed with Louis Pastuer’s germ theory that bacteria were the cause of infectious diseases like typhus, we now recognize that both social-economic determinants and infectious pathogens are causal factors in outbreaks of communicable diseases. Virchow is perhaps most well-known for proposing the philosophy of health as a human right - a concept that can still seem revolutionary. A century later, it was one of the founding principles of the constitution of the World Health Organization (WHO): “The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.” (World Health Organization, n.d.-a).

In the early 1800s a cholera epidemic broke out in India and was soon transported to Europe and North America. In London, a young doctor by the name of John Snow began one of the first epidemiological surveillance projects in 1854. Through door-to-door interviews, Snow determined that the rates of cholera were higher in specific neighborhoods. He found that the homes with higher infection rates had been provided with water by one of the water supply companies, which had an intake valve in a particularly polluted section of the Thames river. Without understanding the microorganism that causes cholera (this would not be discovered for another 20 years), he gathered sufficient evidence to convince authorities to remove the handle of the Broad Street water pump. This effectively decreased the cholera cases in those homes, demonstrating that public health actions to benefit the community could be taken even without a complete causal explanation of the disease. Snow’s actions also assisted in the discovery of waterborne pathogens, reinforced the sanitation movement, and prompted filtration requirements for public water. A replica of the Broad Street pump stands to this day as a memorial of this feat of public health (Seabert et al., 2021, Tulchinsky & Varavikova, 2014).

Figure \(\PageIndex{1}\): Broad Street Pump. (Copyright; Jamzze, CC BY-SA 4.0, via Wikimedia Commons.)