Hodder Education History catalogue 2024 - Catalog - Page 88
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Healthcare in Britain,, 1848–1948
voluntary and the improvement in public health
which resulted from the act was therefore patchy.
Some progressive town councils built effective
sewerage systems and clean water supplies, but
others did not, often on grounds of cost.
Further laws, including the 1866 Sanitation
Act and the 1872 and 1875 Public Health Acts,
rectified the weaknesses in the 1848 Act and
carried forward the work which it had initiated.
The 1875 Act, for example, made action by local
authorities on building sewerage systems and clean
water supplies compulsory, rather than voluntary.
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1 Using the internet
and/or your history
textbooks, explain
clearly in your own
words what part the
following people played
in improvements in
public health:
a Edward Jenner
b Edwin Chadwick
c John Snow
d Louis Pasteur
e Robert Morant
f Sir William
Beveridge
g Aneurin Bevan
B
efore the nineteenth century, healthcare,
such as it was, was provided largely by
the church, particularly monasteries until
their dissolution in the 1530s, and charities. The
government’s role was limited to the most basic
provision for the sick poor through the Poor Law
established in Elizabeth I’s reign. In laws such
as the 1597 Act for Erecting Hospitals, wealthy
individuals were encouraged to give charitably to
fund hospitals.
There were signs in the early nineteenth
century that some degree of change was
coming. For example, the National Vaccination
Board was established in 1808 to encourage
vaccination, suggesting that advances in medical
understanding, such as the work of Edward
Jenner, were starting to influence government
policy.
The 1848 Public Health Act
The 1848 Public Health Act marked a step-change
in assigning a degree of responsibility for public
health to government bodies. The act was a direct
result of Edwin Chadwick’s ‘Report on the Sanitary
Condition of the Labouring Population of Great
Britain’, published 6 years earlier, which contained
clear evidence that poor sanitation was a major
cause of ill health and premature death. The
implication of this was that sanitation in towns
and cities needed to be improved and only the
government and local authorities could do this.
The 1848 Act created the General Board of
Health, a government body with responsibility
for improving public health. It also established a
network of elected local boards of health, whose
duties included the building and maintenance of
sewers, the provision of clean water supplies, the
inspection of lodging houses and slaughterhouses,
and the construction and maintenance of
pavements in the streets.
This was the first major act which embodied
the principle that the government had a duty
to exercise responsibility for public health
in an effective way. However, it had some
loopholes which limited its impact. Crucially,
the establishment of local boards of health was
24
Hindsight September 2023
The USSR’s transition
to socialism
Chris Read
An examination of the roles of
Lenin, Stalin and the New Economic
Policy in the USSR’s transition to
socialism between 1917 and 1929
EXAM LINKS
AQA 1H Tsarist and Communist Russia, 1855–1964
AQA 2N Revolution and dictatorship: Russia, 1917–53
Edexcel Paper 1, Option 1E Russia, 1917–91: from
Lenin to Yeltsin
Edexcel Paper 3, Option 38.1 The making of
modern Russia, 1855–1991
OCR Y249/Y219 Russia 1894–1941
OCR Y318 Russia and its rulers 1855–1964
WJEC Unit 3, Part 10 Changing leadership and
society in Russia c.1881–1989
D
ictatorships come in many guises. Often,
in modern times, they are simply seizures
of power by individuals and groups
intent on self-aggrandisement and enrichment,
kleptocracies aiming to turn a nation’s assets over
to its dictator and associates. Other dictatorships,
often associated with military takeovers, frequently
claim to be defending the nation against threats,
often supposedly from outside forces but more
realistically because the ruling elite feels threatened
by social movements demanding a share in
power and wealth. They are thus
defensive of an existing
ruling class.
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OCR (B) The people’s health, c.1250 to present
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Edexcel Medicine in Britain, c.1250–present
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AQA Britain: Health and the people c.1000 to the
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Aneurin Bevan,
Minister of Health,
visiting a young
patient in a hospital in
Lancashire in 1947
The Bolshevik dictatorship, however, belonged
to neither of these categories. For Lenin and the
tiny group of leaders who understood the deeper
purposes of Bolshevism, power was an instrument
to lead humanity towards emancipation. In
Marxist terms, which are at the root of Bolshevism,
humanity had been oppressed by class structures
from earliest times. The ruling class changed over
time from clan chiefs to feudal lords and then the
capitalist middle class. The enduring point was
that most of humanity was kept at the level of
hard manual labour, even slavery, in which they
were unable to reach their potential as human
beings. Their abilities and talents were repressed.
Humanity was deprived of immense potential. The
effect was, as the scientist Stephen Jay Gould puts
it in The Panda’s Thumb (1980), ‘I am, somehow,
less interested in the weight and convolutions of
Einstein’s brain than in the near certainty that
people of equal talent have lived and died in
cotton fields and sweatshops.’
Marxism, including Bolshevism, was driven
by the belief that it could retrieve this situation
for the benefit of everyone. After the overthrow
of class society, the real history of unfettered
humanity would begin. Bolshevism was a
dictatorship driven by its convictions. In that sense
it belonged to a third category of dictatorships
usually associated with certain types of religion.
It was a secular form of theocracy. It was akin to
today’s fundamentalist states and movements.
Implementation of the principles of faith was the
imperative.
For Lenin and the Bolsheviks, however, the
problem was that, while one might have a utopian
vision of a future society in which class has been
overcome, the path to reach that goal was not
mapped out. What should be done
to move in that direction?
How did one conduct the
transition from today to
tomorrow and beyond?
Flag of the USSR
28
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Modern History Review September 2023
This movement towards more government action
on public health was driven by two major factors.
One was reform of the electoral system, which
gave an increasing proportion of the population
the right to vote. This process had begun with
the Great Reform Act in 1832. The Second
Reform Act of 1867 extended the franchise to
most middle-class men and some of the working
class. Politicians like Gladstone and Disraeli had
to be attuned to the needs and concerns of this
much larger electorate if they wanted their votes,
including more action on public health, and the
acts of 1872 and 1875 were the immediate result.
Liberal reforms, 1906–14
There is a distinction to be drawn between a
measure to prevent disease and treating individual
cases. Undertaking large-scale works to build
sewers and water mains was vital to improving
public health, but still by 1900 there was no
form of medical treatment provided free by the
state, except for the basic health provision for
the inmates of workhouses. This was about to
change under the Liberal government elected by a
landslide victory in January 1906.
2 Study the cartoon
‘A Court for King
Cholera’: www.tinyurl.
com/5dpzaz3p. Pick out
three details from it and
explain how they might
have led to the spread of
cholera?
Germ theory
The other factor driving the move towards more
government action was the growing acceptance
of germ theory as the principal cause of many
diseases. The French pioneer microscopist, LouisDaniel Beauperthuy, had argued that infectious
diseases were caused by microorganisms as early
as 1838, but in Britain the work of John Snow was
more influential.
Snow was a doctor who investigated the cause
of an outbreak of cholera in Broad Street in
London which had resulted in more than 600
deaths in 1854. He concluded that the disease
was caused by microscopic cells which bred in
the lower intestines of the population and were
spread in water supplies polluted with sewage (in
this specific case, the Broad Street pump). More
detailed research by Louis Pasteur in France from
© Historic Images/Alamy Stock Photo
Source A
Expansion of the electorate
the 1850s onwards and Robert Koch in Germany
in the 1880s greatly increased understanding of
how bacteria caused many infectious diseases and
of effective measures which could help to reduce
their spread.
Source B
A Liberal Party poster published in 1911 shows David
Lloyd George, the minister responsible for the National
Insurance Act, with one of the patients the bill was
intended to help
25
www.hoddereducation.co.uk/hindsight
Transition strategies
Between coming to power in October 1917 and his
last major intervention in the revolution in 1921
before illness pushed him to the sidelines, Lenin
followed three distinct transition strategies. In 1917
he expressed an optimistic belief that, given their
freedom, workers and peasants, organised through
soviets, would be able to liberate themselves by
following their social and political instincts.
Some argue that this was a ruse by Lenin who
knew such a naive version of transition would fail,
but it won support for the seizure of power in the
name of the soviets, though, in reality, it was the
Bolshevik party that took power in the October
Revolution. This form of transition quickly
collapsed as the social actors – workers, peasants,
administrators, capitalists, civil servants – pursued
their own interests rather than the vague social
goals outlined by the party. The country began to
fall into chaos and the economy nose-dived.
Dictatorship
By spring 1918, Lenin turned to a new transition,
not based on free action by soviets but by, to
use his own phrase, ‘dictatorship’. In a change
of policy heralded in a complex but crucial
pamphlet entitled The Immediate Tasks of the Soviet
Government, Lenin laid down new principles.
Having won power, he argued, the next task was
to administer the country. This process would
require centralised managerial authority, the use
of the talents of former capitalist specialists with
essential military, technical and administrative
knowledge needed for society to function, and
a priority to defend the revolution in Russia
rather than engage in romantic quests to spread
‘world revolution’. Soviet Russia needed to be
strengthened politically, socially and economically,
to face inevitable attacks from the capitalist world.
In a complex moment in early 1918, the First
World War ended but civil wars began in the
lands of the former Russian Empire. Lenin’s
spring initiative had to be adapted quickly to the
new threat and the dictatorship became tighter.
Rights were suspended. Non-Bolshevik political
parties were suppressed. Formerly free institutions,
like trade unions and soviets, were incorporated
into a strict party- and state-centred hierarchy.
Democratic experiments with workers’ control
and a citizen army were abandoned in the name
of the necessity for central command. The market
economy was abolished or abolished itself under
the impact of hyperinflation. The system of money
collapsed almost entirely and barter and rationing
became crucial to survival.
Disastrously as it turned out, this led to forced
requisition of grain and other supplies from the
peasants. Naturally the peasants resisted. However,
www.hoddereducation.co.uk/historyreview
Portrait of Joseph Stalin,
c.1942
soviets Literally
‘councils’. In 1917 a vast
network of them were
set up by urban workers
and intellectuals and
much of the peasantry
© IanDagnall Computing/Alamy Stock Photo
Mark Rathbone
considers how government
responsibility for healthcare
in Britain increased
between 1848 and 1948
© Trinity Mirror/Mirrorpix/Alamy
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to define and promote
the interests of ordinary
people. Despite the
October Revolution
being supposedly based
on ‘all power to the
soviets’ it was the first
step in undermining free
soviets. They survived
until the end of the
system and country
(the USSR) that bear
like other groups who opposed these policies,
they kept their opposition within limits as the
civil wars raged because nobody wanted the antiBolshevik forces of the old regime to return.
However, as the Bolsheviks (who changed
their name to the Communist Party in 1918)
strengthened their hold on power, protests
from their own side multiplied into a crisis that
demonstrated the unsustainability of this second
path of transition. The peasantry had blocked
its progress and rebellions broke out in Western
Siberia, the province of Tambov and in the
Kronstadt naval base near Petrograd (now Saint
Petersburg). A new strategy was needed. It emerged
in the form of the New Economic Policy (NEP)
adopted in 1921.
The New Economic Policy
their name, but only as
instruments of Bolshevik
power.
October Revolution
(October 1917) A mass
popular revolution in
Russia that took power
from the Provisional
Government, which
had replaced tsarism,
but was quickly
subordinated by the
Bolsheviks who used
the popular revolution
as the launchpad for
their acquisition of state
power.
What was new about it? Above all it took major
steps back from the extensive state control of
what had become known as war communism.
Instead, the market was partially restored and the
authority of tsarist-trained specialists in many
fields was strengthened. NEP was widely hated
by party militants who referred to it as the New
Exploitation of the Proletariat. However, Lenin
believed that, by trial and error, they had found
the ideal mechanism for transition to socialism.
By gradually strengthening the public sector of
the economy they could weaken the capitalist
and market remnants inch by inch and win the
doubters over to the process of liberation to the
promised land of communism.
29
