2 - Life, sickness and death

Summary

By the end of the nineteenth century, mortality rates for all except infants had been in decline for several decades: the overall death rate dropped from 21.8 per 1,000 in 1868 to 18.1 in 1888 and to 14.8 in 1908. Diseases such as phthisis (pulmonary tuberculosis or ‘consumption’), typhoid, cholera, smallpox, measles, diphtheria and diseases of the circulatory system were still common, especially among the populous urban working classes, yet fatalities from these diseases had dropped dramatically since the mid-Victorian period. Shifting paradigms of contagion combined with enhanced public health legislation improved attempts to quarantine infectious disease: the homes of the dead and diseased were stripped, disinfected and lime-washed; individuals could be removed to hospital on warrant; and medical officers could instigate the closure of shops and schools thought to harbour germs. Access to the hospital also expanded in this period, especially among the lower classes, whilst the transfer of some poor law medical facilities to the control of the Local Government Board in 1871 encouraged a degree of reform and modernisation in health services. Medical insurance had long been available through friendly societies but the introduction of National Insurance in 1911 formalised a fragmented culture of putting money aside for welfare purposes.

Nonetheless, access to healthcare during this period remained uneven. Insurance schemes may have increased access to medical care but subscription was biased towards families with steady incomes and the health of the male breadwinner.