Edwin Chadwick Biography (1800-1890)

lawyer, public health reformer

Although trained as a lawyer, Edwin Chadwick earned a place in the history ofmedicine by encouraging government involvement in health promotion. Reformsintroduced during his short-lived public health career included improved sewers and water supply systems needed to accommodate population growth associated with England's Industrial Revolution.

Born in 1800 near Manchester, England, Chadwick moved with his parents to London at the age of 10. There, after studying classical and modern languages, he helped finance his legal training by writing essays for newspapers, including one about life assurance for the Westminster Review that attractedconsiderable attention.

From that beginning, Chadwick developed what became known as the "sanitary idea," assuring health by creating central and local government agencies to regulate nuisances and provide for clean water and removal of sewage. Rejectingthe widely held belief that poor health was largely a matter of fate, he argued that disease arose from correctable environmental causes.

Chadwick's philosophy of health reform was heavily influenced by the utilitarian lawyer Jeremy Bentham, for whom he worked as an aide before becoming a lawyer himself. Bentham believed that all reforms should be based on "the greatest happiness of the greatest number."

Chadwick's sanitation initiatives were rooted in the now discredited belief that disease was caused by unpleasant odors (miasmas) from trash and sewers. Nonetheless, after his reforms were introduced, mortality rates in England decreased and life expectancy increased.

Chadwick's self-flushing sewers, lined with glazed brick, remained in use into the final years of the twentieth century. Prior to his environmental initiatives, English sewers collected surface water and waste in underground receptacles but did not carry it away. For this reason, sewage often decomposed into foul-smelling gases that Chadwick believed caused illness.

In addition, sewers of the day had to be cleaned manually, a job that Chadwick considered inhumane. He proposed building smaller diameter, egg-shaped sewer pipes that could be flushed with pressurized water. Liquid wastes could thus be removed to the countryside to be used as fertilizer. Instead of the existing jumble of individually designed cesspools, Chadwick's sewers were builtas an engineered, citywide system.

Chadwick also sponsored legislation requiring government registration of births, deaths, and marriages. Those records, previously maintained by the church, were useful for tracking epidemics and other causes of death. Chadwick correlated such vital statistics with data about living conditions to identify possible factors in disease causation. Florence Nightingale provided him with statistics for this work and enthusiastically promoted Chadwick's sanitation proposals. In turn, Chadwick lobbied for sanitary commissioners to ensure thehealth of soldiers fighting in the Crimea, as Nightingale was setting up hernursing service there.

In addition, Chadwick pushed for government health inspectors, better-ventilated and less-crowded housing, wider streets, workplace health and safety legislation, increased use of indoor plumbing, and limits on the employment of children in factories.

His best-known writing is his Inquiry into the Sanitary Conditions of theLabouring Population of Great Britain, a massive survey published in 1842that vividly described "open sewers, stagnant pools of liquid refuse, insanitary privies, and the stench of underventilated, overcrowded tenements," comparing the urban environments in London, Glasgow, Manchester, Birmingham, Leeds, and other large centers.

To implement recommendations from this report, Chadwick led the campaign forEngland's first Public Health Act. It nonetheless took the cholera epidemic of 1847 in which 10,000 Londoners die to persuade Parliament to finally pass the legislation the following year.

Chadwick's reforms were met with fear and distrust. He encountered oppositionfrom political foes who balked at centralized government and the cost of hispublic works projects, as well as engineers who disagreed with his sewer designs and doctors who objected to a nonphysician being responsible for publichealth. Chadwick's formal career in public health lasted only from 1848 to 1854, when the unpopularity of his reforms forced him and other members of London's Board of Health to resign. They were replaced by a new health-promotionbureaucracy made up of doctors.

Despite this less-than-noble end to his formal career in public health, Chadwick continued to write extensively about health-related issues. A two-volume,summarized compilation of his writings was published in 1887 under the titleThe Health of Nations.

In 1889, Chadwick's contributions to public health were recognized by Queen Victoria, who knighted him as one of the first civilian Knight Commanders of the Most Honourable Order of the Bath (KCB).

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