Edwin Chadwick Saved More Lives than All Vaccination Programmes

Dr Vernon Coleman MB ChB DSc

Drug companies and the medical establishment often claim that they, and they alone, were responsible for controlling the spread of infectious diseases in the 19th century. Indeed, drug companies and the medical establishment often claim that they are responsible for the increase in life expectation. The drug companies, of course, claim that big killer diseases were controlled by vaccination programmes.

None of these claims is true.

Look, for example, at cholera – once a major killer.

Cholera, became important in Europe only during the nineteenth century. As trade with the East continued to expand, the cholera bacteria were transmitted from central India to China, Japan and Asiatic Russia, reaching Poland, Austria, Germany and Scandinavia by about 1829. During the next few years, cholera travelled slowly but persistently across the whole of Europe. The natural history of the disease in Britain was typical of its progress in most European countries.

When cholera first arrived in Britain in 1831, it found an ideal environment: no large town had water safe to drink, and most of the rivers were polluted. The growing population in most towns crowded into the tiny back-to-back houses, and the average two-roomed house often had twenty people crammed into it, all using unhygienic privies which frequently overflowed into the yards and streets. The better-off families might have had fewer problems with their sewage disposal, but they had to take their fresh water supplies from the same polluted sources as everyone else. The lessons which had been learned had been long since forgotten, and the modern, growing towns were all run on exactly the same lines as medieval villages.

The cholera epidemic of 1831 obliged the authorities to consider what could be done to improve the general state of public health. Although the poor, who suffered more from cholera than the rich, sometimes claimed that the disease was due to deliberate poisoning, and the religious insisted that cholera was a punishment for immoral behaviour, most observers seemed to recognise that the epidemic was related in some way to the poor water supplies and sewerage facilities. However, since this theory was not the official view (which was still hanging onto the miasma theory) most practitioners kept quiet.

Of the many men who struggled to do something to improve the quality of public health care in Britain, one of the first and most far-sighted was the civil servant, lawyer and journalist Edwin Chadwick, whose ideas and innovations influenced events in America as well as Europe.

Dismayed by the number of people killed by the cholera epidemic, Chadwick, who had been invited by the Government to help with Poor Law Reform, argued that proper sanitation facilities would not only improve the quality of life but also be of value in economic terms. This deliberate equation of good health and economic strength was not a new philosophy, as it had already been put forward in the seventeenth century by Sir William Petty.

But, whereas Petty’s arguments had gone more or less unnoticed, Chadwick’s did not. The changing political climate in Britain in the early part of the nineteenth century, which had accompanied the drive for equality initiated by the working people as they became better off and better educated, meant that there was a genuine need for change. Since more working-class people now had political power, politicians were under more pressure to do something about the foul conditions in which the town dwellers usually lived.

Chadwick prepared and studied maps which showed where the worst death rates due to disease occurred. His figures showed that the average age at death was forty-three for gentlemen, thirty for tradesmen and twenty-two for labourers crowded together in the cities, and on the basis of these statistics concluded that disease was spread by atmospheric pollution caused by over­ crowding, poor water supplies, bad drainage and dirty towns. In his report entitled A Report of an inquiry into the Sanitary Conditions of the Labouring Population of Great Britain, which was published in 1842, Chadwick suggested that a circulatory system be used in towns and cities to supply water and remove waste products, showing that the authorities would actually save money by building proper facilities. A water board expert for the Trent River Water Works showed that, whereas when water supplied at high pressure tended to burst the traditional bored elm trunks, it did no damage at all to iron pipes, while a surveyor to the Holborn Sewers Commission produced evidence showing that narrow-bore drains which had smooth inside walls, cleaned themselves when water closets were used. Agreeing that it would cost money to build pumps to supply fresh water to town dwellers and to provide sewer pipes of the type he recommended, Chadwick suggested that sewage could be processed and sold to farms as valuable fertiliser.

Chadwick’s recommendations were incorporated into a Public Health Act in 1848 and, although not all his ideas were accepted (it was cheaper to import Chilean guano as a fertiliser than to treat human sewage for the purpose), he made a great contribution to the quality of life in Britain.

Almost alone, Chadwick provided the initial impetus which eventually gave us clean streets, clean water supplies and sewage disposal facilities. There can be absolutely no doubt that Ernest Chadwick has in the last century and a half saved far more lives than the entire international pharmaceutical industry.

The proposals put forward in the 1848 Act were given additional impetus by the second major epidemic of cholera, which began that year and proved to be the most widespread of the four outbreaks of cholera to affect Britain. In London alone the 1848-9 outbreak was responsible for the deaths of nearly fifteen thousand people; slightly more than six out of every thousand people died from the disease.

As a result of social pressures and the work of men like Chadwick and Dr John Snow, by the middle of the nineteenth century the taming had begun of the major killers: smallpox, cholera and tuberculosis. Many more people would die before the diseases could be described as under control, but there is no doubt that the devastation they had wrought during the latter part of the eighteenth century was being neutralised. Tuberculosis and cholera were soon to be brought under control by improvements in living conditions and standards of public hygiene while smallpox was controlled by a program of quarantine.

Taken from `The Story of Medicine’ by Vernon Coleman

Copyright Vernon Coleman February 2022

`The Story of Medicine’ by Vernon Coleman is available as a paperback and an eBook.