A baby born this morning can expect to live to celebrate his or her 80th birthday. And there is every chance that most of those years will be free from disease, disability and pain.
There may not be a pill for every ill — yet — but our lives at the start of the 21st century are longer, healthier and more comfortable than ever before. We may worry about our health today, obsessing over every niggle, bump, ache or itch, but at the dawn of the 20th century, life was constant anxiety from birth to death. And often not many years separated those two events. A child born a century ago was more than likely dead by the age of 50.
Take a typical family in 1905: their lives described in detail in the British Medical Journal of February that year. The Greenbaums — mum, dad and six children — were living in four rooms of a six-room house which they shared with another family in Stepney, East London. Certainly not well-off by our standards (few families of eight cram into four rooms today) they would have counted themselves lucky compared with most of their contemporaries. Mr Greenbaum had a job as a tailor’s presser out in the country from semi-rural Stepney and their home was in good condition and clean.
But prospects for the Greenbaums took a tragic dive at the beginning of 1905 when Dad came home ill from his job. With no state sick pay, Mr Greenbaum’s illness meant no income. But the family had probably joined one of the many local friendly societies which paid sickness benefit when members fell ill. By the end of the 19th century, more than four million families in England and Wales had signed up with a friendly society, They would have been paying a quarterly fee of anything from three to ten shillings (15 to 50p) — a prototype of the National Insurance scheme that would follow in 1911.
The alternatives, they knew, were measly — poor-relief handouts from the parish at best, the workhouse at worst. In the London of 1905, more than 77,000 people were incarcerated in workhouses — state-run homes for people who had no income — and 49,000 more were dependent on poor-relief handouts, out of a population of 4.5 million.
Worse was to come for the Greenbaums. Just five days after Dad took to his bed, the family’s 12-year-old daughter fell sick with the same headache, vomiting and fever. She was lucky enough to be seen at the nearby London Hospital, most probably in its spanking new outpatients’ department opened two years earlier by King Edward VII. As one of the capital’s prestigious charity hospitals, the London provided free treatment — but only to the select few deemed “ deserving poor”.
Admission was by letter of recommendation from an upstanding benefactor, usually an employer or someone who had contributed large amounts of money to the hospital. The doors were firmly shut to “undeserving” paupers who didn’t work and were consigned to the largely inferior workhouse infirmaries. People with an infectious or chronic disease and mental illness were also barred. Edwardians could have been forgiven for thinking it easier to gain an audience with their King than the London Hospital’s consultants.
No better for her privileged access, the feverish Greenbaum daughter returned home to the care of Dr Crawford, the local GP. Six years before the National Insurance Act brought free medical care, the family would have paid for this treatment.
But when Dr Crawford diagnosed typhoid (which was incorrect and later amended to typhus fever — an unrelated condition with a similar name), the girl was forcibly removed to the East London fever hospital, the Homerton. Fever hospitals kept patients in isolation and prevented the diseases from spreading, but there was no treatment available.
Set up under statutory regulations to provide isolation for the ubiquitous victims of infectious diseases, the fever hospitals were at least free. Two more of the Greenbaum children soon followed with the same alarming symptoms of chills, rash, headaches, vomiting. Mr Greenbaum had most probably brought back the body-lice which spread the disease from his job in the countryside.
Today typhus fever is prevented with vaccination and treated with antibiotics and is rare in the UK. In 1905, there was little that anyone could do to help to cure typhus or the whole gamut of contagious illnesses that still stalked Britain.
At the start of the 20th century, huge strides had been made towards defeating infectious diseases. The swathe of Victorian public health measures, providing better housing, cleaner water and effective sewerage systems, had tamed most of the epidemics which had previously been responsible for killing millions each year. By 1905, cholera had been virtually eradicated while the death toll from smallpox, typhoid, typhus fever, scarlet fever and diphtheria had fallen dramatically.
But for all the scientific progress and Victorian vision, immense public health problems persisted. In 1905, contamination of the water supply to Lincoln led to a typhoid epidemic which killed more than 60 people, prompting The Times to condemn city authorities for their “past neglect” (see below). Huge numbers of babies were dying from contaminated milk. Schools regularly closed through outbreaks of measles, whooping cough and scarlet fever. And in the first week of August 1905, 1,507 people died from infectious diseases in the principal English towns.
In East London, the Greenbaum family was lucky. All survived their brush with typhus fever without undue effect. But Dr Crawford was less fortunate. He died a few weeks later, a victim of the disease that he had tried to treat.
It’s not known whether the Greenbaums were among the masses the following year who gave the Liberal Government a landslide victory, leading to a bounty of reforms. These brought free GP care, sickness pay, unemployment benefit, pensions, school meals and school medical examinations. But the likelihood is that the Greenbaums would have gone to their graves by the time another landslide election victory brought a free National Health Service in 1948.
Wendy Moore is the award-winning author of The Knife Man: The Extraordinary Life and Times of John Hunter, Father of Modern Surgery, published by Bantam Press, £18.99
TYPHOID FEVER AT LINCOLN
An extract from The Times of Thursday, February 23, 1905, about the Lincoln typhoid outbreak in which 60 people died
“The city of Lincoln is in serious trouble, from which it will have great difficulty in extricating itself. For two months it has been suffering from the severest epidemic outbreak of typhoid fever experienced in England since that which occured in Maidstone in 1897. . . some of the attendant circumstances at Lincoln make the present case more difficult to deal with. Before discussing them, however, it will be best to state the bare facts of the outbreak. Lincoln is a prosperous manufacturing market and residential town with a population of around 50,000. It enjoys a low death-rate . . .”
HEALTHY DEVELOPMENTS
by Nigel Hawkes and Tom Hirst
Before 1905 Scientific medicine had begun to emerge before 1905 but still had a long way to go:
1796 Edward Jenner developed the first vaccine, against smallpox.
1842 The anaesthetic ether transformed surgery, giving surgeons more time and patients less pain.
1859 The London sewerage system was begun, transforming public health. The last outbreak of cholera in the capital was in 1866, when the system was virtually complete.
1865 Louis Pasteur suggested that diseases are caused by germs.
1870 Joseph Lister used the antiseptic carbolic acid to sterilise wounds, greatly reducing infection after operations.
1895 X-rays discovered by Wilhelm Roentgen.
1899 Aspirin, the first modern medicine, appears.
After 1905 Progress accellerated as understanding improved and drug discovery became formalised:
1907 First blood transfusion with proper blood typing carried out.
1910 Paul Ehrlich introduced Salvarsan, a cure for syphilis, and the world’s first blockbuster drug.
1921 The role played by insulin in diabetes discovered.
1923-28 Vaccines against diphtheria, pertussis, TB and tetanus developed.
1928 Alexander Fleming discovered that the mould Penicillium notatum could kill bacteria — but penicillin, the first antibiotic, was not produced until the 1940s. Antibiotics almost eliminated infectious disease.
1949 First artifical lens implanted in the eye, by Harold Ridley.
1953 Francis Crick and James Watson show that DNA, the material of the genes, has a double-helix structure.
1955 First polio vaccine introduced by Jonas Salk, later overtaken by Albert Sabin’s oral vaccine. Half a century later, polio is on the verge of elimination.
1960 Birth-control Pill wins approval from the US Food and Drug Administration.
1963 First successful kidney transplant, followed in 1967 by the first heart transplant.
1972 CT scanner developed by Godfrey Hounsfield at EMI.
1977 Mankind eliminated a disease — smallpox — for the first time.
1978 Louise Brown, the first IVF baby, was born in Oldham, Lancashire
2003 Human genome sequence read for the first time, providing a new means of understanding disease and developing medicines.
