I2 - Health Inequalities - Disease

Author(s)

Fióna Gallagher (Dublin City University)

Keywords

Cholera, Disease, Ireland

Abstract

Cholera was once the biggest killer in Irish society. The 1832 Pandemic resulted in an estimated 50,000 deaths in Ireland, and Irish cities, provincial towns and villages bore the brunt of this predominantly urban disease. Frequently, death rates in Irish towns were higher than in large English cities. Urban centres with comparatively low populations such as Sligo, had a mortality rate equal to that of large urban areas in Europe. Relatively little analytical work has been done on this Irish epidemic; the morbidly and mortality rates have never been fully collated, mapped or analysed on a national basis. Newly-indexed papers at the National Archives let us hear contemporary voices from this period, not all of them official ones. Extensive numerical data recorded in the reports of contemporary newspapers allows a statistical approach to the study, as does the abstract of the 1841 census. This type of inter-disciplinary investigation forms part of the emerging fields of medical history, life- sciences and public health. This examination will, for the first time, chronicle and map the all-island extent of the 1832 epidemic, allowing for a nuanced look at how disease and fever had a significantly different impact and character in urban and rural areas. Comparative case studies of Irish provincial towns will enable an examination of the experience of the epidemic at this important tier of the urban structure in pre-Famine Ireland. The study will amass data to allow evaluation of the Irish epidemic against the experience of British and European urban areas, and encourage a re-evaluation of the nature of the Irish epidemic. The role of the district Cholera Boards will be scrutinised, assessing the effectiveness of their preventative measures and responses to the disease, and gauge if the experience gained in 1832 helped in the creation of future public health policies.

Author(s)

Katerina Chatzikonstantinou (University of Thessaly)

Keywords

Health Inequality, Sanatoria, Sanatoria

Abstract

Historically, hospital isolation practices have typically focused on the social and medical aspects, such as in the changing theories of disease. In the case of tuberculosis, commonly accepted as ‘social disease’, the perception that prevailed gradually by the turn of the 20th century, was that the stay of tuberculosis patients in sanatoriums was the most effective means of reducing the disease, as its treatment was systematized.

Two sanatorium cases in the city area of Athens, Greece, i.e. Sotiria, a sanatorium consisting of several buildings, and Melissia, a district hosting a number of sanatoria, endeavoured to offer ideal conditions for treatment. On the one hand, it could be argued that those conditions and the principles of hygiene represented a kind of utopia. The sanatoria functioned as a type of medical equipment, the ultimate example of healthy living and perception of ‘‘social hygiene’’ that gave structure to this healthy lifestyle, i.e. a mechanism for healing the physical body, but also for ‘‘advancing’’ the social body.

On the other hand, both cases of sanatoria functioned as vehicles for social cleansing, a kind of eugenics, where the purification was distilled on the urban level. The enclosure and isolation of a large number of patients, especially in the extensive space of Sotiria, offered an important environment for study, and experimentation, for the treatment of the disease. In the case of Melissia, the distance from the urban centre allowed for interplay between a place for recreation and advanced quality of life, and an environment of sordidness and aversion. While they were to be understood as ‘‘immune spaces’’ that allowed for the dissociation of the disease-producing and mentally-straining surroundings of the spoilt city, they paradoxically hosted its most ‘‘contaminated’’ elements. Hence the sanatorium grounds comprised a threshold of demarcation between health and illness, but also a boundary of relational social ordering. Those who comprised an exception from the norm were excluded from the city and confined in isolation within the parallel territory of the sanatorium. Social exclusion was expressed on an urban level, where health was the medium and distance became the restrictive, exclusionary space.

Author(s)

Celia Miralles Buil (University of Lisboa)

Keywords

Social and urban inequalities, Health, Historical GIS
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Abstract

This paper aims to study the urban impact of tuberculosis (TB) on Barcelona social topography during the 1930’s (before the Civil War).
More than any other disease, TB was, and still is today, strongly associated with social inequalities in cities. For this reason, TB found its place in the fight for social justice that agitated Barcelona in the 1930’s, and became a main issue for the newly elected Catalan Government in 1931.
The established relation between TB and urban misery drove the experts (physicians and public authorities) to focus on a particular group of individuals, who, because of their social and spatial characteristics, became the favoured object for health control.
This paper intends to resituate this group of individuals into the Barcelona socio-spatial frame. For this purpose, it looks at information regarding 5000 patients who were free-assisted by Barcelona public authorities between 1929 and 1936. Instead of explaining the TB distribution in the whole city, the paper rather analyses its unequal impact on the working-class city. Indeed, the assisted patients were mostly young male workers living in the most degraded neighbourhoods and had a lesser social integration in the city. By using Historical GIS, the paper investigates the social fragmentation of a working-class city at diverse geographical levels: neighbourhood, streets, building and house, with the aim of completing the works previously done regarding urban segregation in Barcelona (see Oyón JL, The split of the working-class city 2009).
Furthermore, the paper intends to demonstrate that TB was not only an indicator of socio-spatial inequality. It was also a factor that increased the social fragmentation of the city by worsening the precarious situation of many families. For instance, TB frequently prevented the patient from working, forcing his family to find other precarious solutions to survive, to move to a cheaper house, etc.
Finally, to complete the picture, the paper focuses on the inequality of medical treatment. While the doctors generally explained the differences of treatment by the patients’ pathologies, clinical reports clearly show that other factors (unhealthy urban environment, overcrowded houses, professions, gender etc.) were already considered.