Britain offers to go to 15,000 cattle a week for the next five years to wipe out BSE more people have fallen ill with a stomach bug that's thought to have been caused by drinking contaminated water the number of suspected food poisoning cases in central Scotland has risen to one hundred and eighty one ninety one of these are confirmed why do governments make laws about things that affect our health today government controls the safety of the food we eat the water we drink and the houses we live in the government sees our health as an important part of its job but in the past government did not see health as their responsibility why did things change I wish it how do you feel on it it's just a seven she was fine at dawn she's sweating but she's cold this is what she's past it's right Susan look at it what what do you think in it you know what a drop to stop she's quitting there's nothing you tell my mom never speak to you um I have my goal going that banjee Whitney and I put her in her earth I'll put her in a box half-naked with the blankets left from the last one she goes in that band she's never coming back do you want me to stay just keep the kids out I don't mind the river just keep them out too it's over in the cellar of number 23 back irk streaks on Hana eight-year-old daughter of an unemployed Weaver was dying because of the cholera epidemic that had hit the poorest parts of the city we know about um because of a local doctor Henry Gault er he wrote a book about the cholera epidemic which GERD was a detailed picture of working life in Manchester in 1832 we had known the disease was coming it had swept across Europe like a like an enemy no army could hold back it was in London Belfast Liverpool Glasgow we knew it would not pass us by so two months ago our Board of Health inspected the poorest parts of the tongue and what we found there such scenes of Filth crowding disgusting habits drunkenness and in some districts such wretchedness Honda so much that when the report was finally published many of our more comfortable citizens said that we'd slurred the good name of the city painting a picture quite so grim as the epidemic spread Coulter plotted the first 200 cases on a map and he visited the families involved to question them to try to pin down the cause of the disease he knew that cholera affected poor people more than it's affecting rich people in back irk Street three days after the death of an Hannah he found a younger sister Margaret was sick - Margaret Hannah aged four very delicate half famished seized Monday July 23rd 7:00 a.m. I'm sorry to ask his questions at such a time you understand no she'd not been with her sister not when I was sick no it were too quick Margaret were out playing at the time then in the afternoon they came for her for an to go to the hospital told them it was for the best so Robert never saw her sister again no contact then has she eaten margaret husband's not were at least two months if I have food it goes to me eldest I gave van foraged the night before she went and buttermilk and now I see that were wasted Margaret said nothing nor one at this stage knew exactly what cause of cholera some people thought it was contagious he caught it from other people but people like Galt er had made the connection between cholera and the poor conditions in which these people live their lives the poor quality of the food they ate the overcrowded housing and the bad sanitation many of the streets gulped upon cholera victims it were streets of back-to-back houses many doctors believe these houses were the cause of diseases like cholera because they believed bad air was trapped in them in fact the real problem was the lack of running water Brens lavatories and refuse collection this house for instance number six Jordan Street it's blocked in from the side and the rear there's only one source of air and light the rubbish they have to carry through the house to the front but because the streets are so narrow the rubbish cars can't fit so the filth just sits there the distance here between two facing houses just 14 foot each house had just two rooms one up one down and the Sowers some of which were small as 12 foot by 14 the landlords rented out separately to make even more money I've seen whole families six seven eight sleeping on the floor no furniture in one cell the children half naked half starved the smells it's indescribable where is the Privy now my the bridge and how many people use it 80-100 what sort is it holding the ground or does it overhang the river and how often do they come up to take away the filth does it overflow the problem was that until 1830 in Manchester builders could build what they liked there were no building regulations workers were flooding in from the countryside to the towns and they needed somewhere to live the builders wanted to make maximum profits so they built back-to-backs to cram more and more people into less and less space these local maps show the speed of development in 1794 black oak street didn't exist the area was mainly fields over the next 40 years by 1831 the fields have become narrow streets and cords how long have you been here two month our our village will be in cleared they gave us free passage on the barge once it left to pull down our cottage did you know what to expect what did you find work Susan took me to the foreman I am lucky I've got small hands you know the spindles so you stayed here with Susan she as husband and the children it would not be right I am in lodgings across the way first it scared me not sleeping with strangers but now they don't seem to strange men and women no no it is a decent house oh not like summer mrs. Hopkins for seven men and women in the one room and not same zone in between you have done well throughout Britain over 31,000 people died in this cholera epidemic 900 of them in Manchester most of them lived in houses like this milk makes the stables slaughterhouses factories because there were no building regulations Builders workforce to provide sewers toilets or water supplies many poorer families had to collect water from canals or rivers people even stole water from private water pumps then used it so sparingly that it became even dirtier over 30 years later by 1867 it was accepted that the cholera germ was in the water something Henry gold sir never knew with his work helped to prove the link between disease and poor living conditions it seems to me when you examine the conditions of our working poor but the truly remarkable question is why so few should have died walk down back arrghh Street for instance and note how outside the very door number 23 in which house Ann and Margaret Hannah died the sewer bubbles up through the crumbling masonry flooding the street in a stinking mass of extra is this not the perfect soil in which disease would grow Frankie I can see no reason often considered why we should have escaped quite so lightly do any governments help to make us lead healthy lives this question was argued over for most of the 19th century some people believed that things would sort themselves out it was up to individuals to look after themselves others believed that the government had to take more control of health matters this drawing was made in 1840 and shows one person's view of life for poor children at the time the medical problems were serious in 1842 a report by Edwin Chadwick showed that death rates were extremely high the average life expectancy for the working classes in Manchester was 17 a rich person could expect to live twice as long Manchester had been one of the first places to bring in local act to improve things all streets are to be at least twenty four feet wide and paved and drained by their owners of course it didn't affect the many streets already built like back oak street it could only affect new building back to back housing was cheap to build because only one thing wall of brick separated any two houses in 1844 building back to backs was made illegal in Manchester but we know they were still being built ten years later this report was made by visiting inspectors from the Manchester and Salford sanitary Association they were looking at the street next backer Street there is new property at the top of Silver Street in no better condition the houses are newly built and back to back in these records the name of the order has been crossed through but we can still see it says the property belongs to alderman pilling alderman pilling was a member of the local council it looks as if someone was trying to prevent this information from being made public in 1848 the government responded to public and official pressure by passing a Public Health Act but most of its provisions were not compulsory so many councils didn't do anything magazines of the time printed cartoons like this one showing the local councillors as pigs ignoring the government's orders out of greed many of the middle class's believed that the poor people were responsible for the diseases they caught they didn't accept that the local councils should try to improve the health of the poor in 1853 Manchester Council tried to make it illegal to have people living in salad Wellings but the landlord's balls the measure this would mean closing nearly all the cellar dwellings and would cause many of us to lose a great deal of income some of us would be ruined also it would be very bad for the tenants as they would have nowhere else to live the landlords were right call slobs did cause problems around back Earth's Street some of the houses were demolished when the railway line came through is we can see from this map of 1839 the housing laughed got even more overcrowded this engraving was made by a Frenchman Gustave doré a who visited Britain in the 19th century and was amazed at the overcrowding he witnessed ten years after the demolitions in 18-49 the morning Chronicle sent a reporter to Manchester his report and these images give us some idea of the conditions the flicker of the candles showed grimy walls reaching with fetid damp which trickled in greasy drops down to the floor beds were huddled in every corner one man was too drunk to get rid of his trousers and the next seller slept two boys and a man one man was lying dressed and beside him a well-grown calf sitting up on another bed was an old man maudlin drunk the saliva running over his chin in one of the walls was a little Hollow six feet long too deep in one eye the death rates were as high as ever many people agreed that something had to be done the next 11 years with a time of much greater action on health reform in the later 19th century attitudes changed Britain became more wealthy through trade and industry it seemed possible to do more for the people Manchester finally appointed a medical officer of health in 1867 his name was John Lee he wanted to get rid of salad Wellings get rid of back to backs and get rid of midden privies we can see how successful he was by looking at the documents that still survived from that time the read books for Manchester tell us that sellers were still lived in in 1872 by 1873 all the dwellings are listed as houses people were no longer living in Salle's midden privies were literally holes in the ground the filth had to be dug out which made it very difficult to remove properly John Lee brought in a system of pale closets when people went to the toilets the West now went into a buckets beneath the sate which could be easily removed bad housing could not be cured so quickly these houses were still being lived in 1944 when this portal was taken but gradually houses were demolished throughout the later part of the nineteenth century all new streets had to be wide enough so that a cart could get access to the outside toilet in order to take the waste away in 1875 the second major Public Health Act was passed this time it was not voluntary all local authorities were legally obliged to bring in reforms the Act was enforced all local authorities in Britain had to appoint medical officers over the next 20 years housing water supplies and drainage improved but the reforms were not aimed at curing poverty disease and ill health continued to be major problems for the working classes there is very little film from the beginning of this century but this was shot in 1946 to show the Victorian conditions that still existed 75 years after the reform by the local authorities all over the country poverty meant that people had to carry on living in very unhealthy conditionings poverty also meant that people act cheap food tea bread and Marjorie with a man foods of the poor poor people could not afford to eat the kind of food that provided vitamins minerals and enough calories to protect them from illness keeping clean was still difficult where some 7,000 people are still living in some condition the effect of poverty on health was still very obvious council records show an increase in death rates amongst very young children in 1840 a hundred and forty four out of every 1000 babies had died by 1899 it had gone up to one hundred and sixty three babies in a thousand who died before the age of 1 by now watching people were beginning to get organized into groups which demanded changes there were many different political and workers groups one of these with the Women's cooperative guild the guild was set up in 1883 it was one of the first organized women's groups and fought for government action in health matters such as maternity care for pregnant women child care free school meals for the poor and cleaner streets and housing meetings were held all over the country this is what one member of the guild wrote we were taught about vaccinations and death rates one speaker told us about the public health laws and showed us how the water supply got polluted after this we sent up a list of questions to the local health committee the mayor wasn't very happy about us asking for information but in the end he was forced to answer our questions the British Empire also needed many more able bodied people the government wanted to send fixed healthy men to administer the Empire and the armed forces wanted to see health measures brought in because during the Boer War fought from 1899 to 1900 too many recruits had not been fit for service in Manchester for example and to 9,000 recruits only 1,000 were fit for service as a result of this concern a parliamentary report was published in 1904 this report asks the government to get rid of overcrowded housing control smoke pollution give school children regular medical inspections set up their nurseries for the children of working mothers and stop selling tobacco to children the massive concern from all sections of society meant that the 1906 Liberal government passed new laws the kinds of laws that had never been passed before to give poor people help 1906 school meals were provided for needy children 1907 schools had to give medicals to children all births had to be notified to the health visitor 1908 all their pensions were paired 1909 the building of back to back housing was banned across Britain when the hospice take charge you can really see how rotten these places are at the beginning of the 19th century there was little government interference in health matters by the beginning of the 20th there was a lot people began to accept that poverty might be the cause of disease they also began to accept that poor people could not be blamed for poverty today the government takes responsibility for the nation's help but the arguments about how much the government should interfere continue how much government intervention do we need to make us lean healthy lives war affects medicine in many ways it spreads disease it causes casualties it stops research and takes doctors and nurses away from civilians it also leads to new medical inventions and ways of working this program looks at surviving records from the first world war fought between 1914 and 1918 which resulted in 24 million casualties for soldiers and civilians did the war help or hinder medicine we work for the hours and hours without rest moving from stretcher to stretcher the overcrowding beggars belief between the stretches the walking wounded slump waiting patiently for their wounds to be dressed or for a shot of anti-tetanus sometimes a man on a stretcher vomits explosively spewing over himself and his neighbor's sometimes they die in their stretchers and we are so busy we don't discover them for hours in the First World War doctors and nurses were needed as never before for many men and women the war was an opportunity to practice as doctors nurses and ambulance drivers in the very worst conditions captain Lawrence Gamson was a medical officer in the Army Medical Corps he wrote a diary recording his experiences we work by candlelight the air is bad there is blood everywhere there is little water no running water of course dressing isn't filth Tyla we can do so little we just bandage them up and our cups of tea and give them painkillers a fest screaming there are so many wounded we hope you scrape the surface it was sometimes said the huge number of casualties from battles led to improvements in medicine especially in surgery this is what the official history written at the request of the British government said about it the number of battle casualties during the war gave the surgeons a great opportunity for surgical work and as the years went on the improvements in method and the skill acquired in dealing with wounds placed war surgery in a position which it had never occupied in the past for gansan's diary gives us a different view of how successful surgery was at the front sit down man you look terrible I'm fine five frontline medical officers like Gamson weren't there to carry out operations their job was to patch up casualties by bandaging as best they could before sending them back to surgical hospitals some of which were 20 miles behind the lines well away from the fighting but in many cases surgery will come too late look right you needed just a corporal Peters through to Jeanette Peters and some regular rocks and just lay there asking would he play again play football he's good surprisingly nimble for such a large map what I am cut away the dead flesh does nothing to stop the gangrene so we'll just send him back down the line by which time it'd be too late in the leg laughter go they could have sent it not now what was it um bullet went in the back of the thigh smash the bone at the front there's a hole three inches thick maggots swarming already can even get the poor stop a shot of tetanus without hurting your more than needles or so blunt I mean do not think they've suffered a life without us during with blunt needles get some sleep yes there's another push at over 600 four hours all right I'll wake you before the war surgeons have been practicing conservative surgery instead of removing limbs the carefully cut away at damage born and allowed the limb to heal so at least the patient didn't lose an arm or a leg but with such huge numbers of casualties the dirt and at first the lack of antiseptics at the front wounds quickly became septic amputations increased dramatically many of the official photographs that survived stress the excellence of the medical facilities but the private written sources offer another view nobody can ever imagine the fearful wounds these men have it is not like one sees on the lovely ambulance train arriving in Southampton with slightly wounded men if I told you some things that come in here you would be horrified and it's just as well that England has not seen yet these remains of what were right young men brought in to die in a few dreadful hours all the War Office felt the horrors of war had to be kept from the British public there was a great need to keep up morale at home to make people feel that the war was going well there was a highly organized system for dealing with casualties this plan from 1915 shows had casualties either Walt or were carried to field dressing stations they were then sent by horse ambulance or for the casualty clearing stations where doctors decided whether they needed to be sent to hospital or not this system only brought down when the number of casualties became too great as part of the system medical cards were introduced in the First World War this helped doctors to keep track of a patient's medical history it was a useful development which carried over into civilian life before this doctors didn't automatically pass on information about how patients had been treated now any doctor who came along could find out what the patient's medical history was without asking the patient for it it's often said that war leads the new inventions and treatments blood banks were developed as a response to war as war weapons grew more deadly more soldiers received serious injuries the pressure of casualties meant that army doctors needed vast amounts of blood to cope with the terrible injuries on the battlefield before the war a blood transfusion was only possible if the Dorner the person giving blood was on the spot the need to be able to store blood led to the introduction of sodium citrate which meant the blood could be stored and used without the dormer being left the war also made the search for new antiseptics more important we had never seen wounds become infected as they did in this soil they quickly developed gangrene which meant that the skin became grey and bubbled up it was made worse as the bullets often carried fragments of dirty cloth into the wounds the doctors were not expecting this problem the Boer War 15 years earlier had been fought on dry sandy soil in Africa but the wet muddy soil in France meant that the wounds became infected very very quickly Karel decking solution was a powerful new antiseptic which helped to clean out the wounds and stop infection spreading it helped to save many lives and limbs x-rays were not an innovation of the war they were invented in 1895 but they were widely used at the front to find bullets and examine injuries so many more people were trained to use x-rays because of the fighting one area that made major progress during the war was the diagnosis of mental illness it's affected many thousands of casualties including a high percentage of officers for the first time it was widely recognized exposure to the horrors of battle place terrible stress on soldiers shell-shocked became a major problem both to the army and to the medical profession Lawrence Gamson diary records a typical case Oh I was searching a shell hole for a body scratching around a couple of shells went over head and I saw them fall near two men from B company who were working in the open one man fell and the other was just a boy really he escaped and I sent him back to the dugout my stuff while I held on with a wounded man he was hurt quite badly shrapnel he lost a hand a lot of blood anyway later I thought the instance closed but that night I was called out to see the other one the boy he was alone in the shop and this is mafia Serrano suggest what this will help you sleep so first you'll be fine Ryan his name was everyone said he was normal I was up to scratch used to seeing people hit seeing his friends hit but this one isolated incident hood and a broken him he just nervous disorders had been treated before the war but the army didn't have much sympathy they believed to suffer a nervous complaint showed a lack of moral fiber army doctors like all officers are the duty to keep discipline what you seem to be saying is that if there's no blood there's no wound well I'm saying if someone helps the diagnosis yes I had a man came in this morning hoping his guts been it wound nah he say we should excuse from duty facial boys a coward Lawrence I don't know if he's a card or not I don't know all I know is that we've been going over the top every day and there's something brave we're not gonna win this war but whistle blows and boys like him stand sculpting on the fires death is windy as shark so you do your job you tell him pull yourself together and over you go I'm about concussion what about concussion oh bomb goes off they clear just no blood no shrapnel but somehow they're knocked off balance concussed do you think they're fit to fight except it's not always as simple as there and there isn't was a bomb that goes off just at that moment that's what makes it so difficult Donna so unsafe he's been here for months he's lived through bombardments advances retreats staffers old nails takes a machine gun post single handed this man is not windy and then one day he's be standing in that cook house and he is he's a sausage pop on the stove looks a bit like flesh and he starts to cry like a baby and he doesn't stop crying I'd like to think that that somehow is wounded I just don't think any of us understand how as the war progressed more and more cases of shell-shocked were reported 80,000 cases in all and it wasn't because of physical wounds rather soldiers and officers alike were being made sick by the surroundings by the sights sounds and experiences of trench warfare the War Office was so worried they tried to limit the damage in 1917 just before the Battle of Passchendaele they tried to ban the use of the words shall shock the medical officer will not record any diagnosis he will enter the letters n yd n not yet diagnosed nervous and will note any definitely known facts about the true origin or the previous history of the case in no circumstances whatever will the expression shell-shocked be used verbally or be recorded we have to call all our nervous patients either wounded or sick and all the time there's this pressure to call them sick because I'm either wounded we'll get a pension our judgment is always been questioned now you think you're a doctor it's your job to find out what's wrong and then some memo comes through and it dawns on you no it's not your jobs to close your eyes and parse them fit for duty but the war did help the study of mental illness because soldiers with nervous disorders were an embarrassment and bad for morale many were taken away from the frontline and cats in special counts after Passchendaele one camp was set up all the 5,000 man here the latitudes were basically unsympathetic some doctors did take the opportunity to study nervous disorders further as interest growth specialist hospitals were set up back in Britain this footage shows victims of shell shock being treated at Natalie Hospital in Southampton the treatment developed here were written up in The Lancet the included role play talking and the use of electric shocks to persuade the lens to work again our experiences show that prolonged re-education is unnecessary and we are now disappointed if complete recovery does not occur within 24 hours men are now fit to return to duty or to earn their living in civilian life in a few weeks instead of having to be invalided from the service the emphasis was still on finding a quick Kyra and not paying a pension many patients were shell-shocked were accused of malingering your cowardice the penalty for which could be death the boy Ryan now three days after the incident with the shell he was himself again seemed to be but then word came down the 1i there was to be a push and the bombardment started again to soften up gently before the boys went over the top and then all the noise and confusion Ryan just left he just walked away the next day after the push was over half his mates dead he was found five miles behind the line sitting with his feet in the ditch holding his rifle like a fishing rod when asked what he thought he was doing he said I'm waiting for a bite they put him in a lock-up and charged him with cowardice where are we what you mean where are we he soft tell me we've done he said when he gets back we can go to the Prague you want to come who Who am I who are you talking to Joe who's Joe your brother Joe Joe I was gone for sure some nights I'm not your brother want to come I've seen malingerers but I don't think I'm green I mean maybe one or two have slipped past me I don't know but this boy was not malingering he didn't know he left the battle let his mates and now he would tried and he found guilty he could be shot officially your sentence of death could be carried out without the approval of a medical officer as the army commander-in-chief Field Marshal Hague med clear what
