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A Brief Introduction to
Edwin Chadwick's Report on the Sanitary Condition of the Labouring Population of G.T. Britain
In
1842, when he published his
Report on the Sanitary Condition of the Labouring Population of G.T. Britain, Chadwick was working to relieve
poverty and bring sanitary and
public health reform to greater
fruition. In contrast to the later work of
W. M. Alison and
Lemuel Shattuck, he cited
environmental factors as the cause of poverty, which he believed was in turn the root of widespread
disease. To fully understand this
concerning the
relationships between
environment,
people, and
disease, it is important to consider the
context in which it was
conceived.
Recognizing Chadwick's motivation for writing this report and the audience for whom he was writing it is essential to understanding its meaning in the greater historical context. At the time of his work, Chadwick was "serving on a commission to get people off the
British dole," and was therefore sensitized to, if not driven by, the "need
for men to work harder." This occupational motivation and set of peers, almost certainly, had an effect on his report. It is not unlikely that this is the reason that his methods and support, as described in his report, rely heavily on observation and interview skewed towards the causes and effects of economic status.
Similarly, the beliefs and ideas on which he builds his work are consistent with those of his peers. For example his perception of the human body as a "nervous body" which is given only a set amount of energy that can be depleted by poor conditions and misuse is the fundamental link that allows him to connect poverty to disease. Similarly, Chadwick's theme, about the medical profession being sufficient only to treat and not prevent disease, is simply a validation of public health reform. That is, this tenet is particularly important to Chadwick because it justifies his own occupation as a public health reformer.
With this context in mind, Chadwick's account of the 1834 cholera outbreak amidst the "crowds of ignorant, terrified, and savage people" who were the cause of fear "for the safety of Paris-of honest people and their property," clearly illustrates his belief that poverty leads to disease. Furthermore, he attributes this poverty to environmental factors (in this case, the "filth left defective cleansing," and the "chiffoniers" who were a "class of bone-pickers, mid-rakers, people living on the produce of dung-heaps" and the like). This tenet that it is not the poverty, but the conditions in which some of the poor live is unusually progressive and epitomizes Chadwick's report which even goes so far as to say that problems are due to the poor, not just poor Irish (which is practically the antithesis of Lemeul Shattuck's later model of the relation between people, environment, and disease). Chadwick goes on to cite Dr. Speer's account of the correlation between "filth" and "fever" (rather than poverty and fever) in Dublin.
W. P. Alison, one of Chadwick's contemporaries, refuted Chadwick's environment leads to poverty leads to disease
paradigm, suggesting that poverty results in poor conditions, which in turn facilitate the spread of disease. One of the fundamental differences between the two
paradigms was that Alison's suggested the appropriate course of action was to help the poor, while Chadwick's suggested that the solution was to help everyone by improving conditions. In addition to criticisms about their rival's methodology (Alison pointing out that Chadwick relied on data and work gathered by others, while Chadwick whined that Alison's research was restricted to the Edinburgh Dispensary), the rivals provided substantial support for their arguments. Alison cited cemeteries and specific situations that had conditions, especially smells, which were horrible, but did not result in disease. On the other hand, Chadwick provides evidence in the form of interviews that expose how poor conditions have affected the moral, economic and physical status of those subjected to them.
In his account of the interview with Thomas Brownlow, Chadwick exposes the "excessive heat and closeness" as well as the poor ventilation which "had a very depressing effect on the energies" and lead men to drink gin, beer, or some other alcoholic beverage several times a day "as a stimulant". This drinking, smoking and use of snuff (which seemed necessary to endure the conditions) was somewhat costly, workers couldn't save any of their wages, and eventually many of them died of "consumption". The interview goes on to discuss the productivity of a tailor under those conditions and determines that one would be willing to work much longer given less-crowded, better ventilated places to work. Furthermore, one freed from the "nervous exhaustion" (this is a reference to the idea of the nervous body as described above) due to such conditions would be able to work significantly more efficiently and with less use of "stimulants."
This correlation between immoral and unsanitary behavior and living conditions, and the concept of social Darwinism was further illustrated in Chadwick's description of female servants who were very clean and healthy (meaning morally, socially and physically) before marrying and moving to live in disgusting conditions. After their move, they lost much of their health and all of their cleanliness. When returned to better conditions, one of the women managed to recover "to a good degree," but not completely. Further inspection of other situations like "the internal condition of the dwelling on …general condition," the "sickness and death constantly present in the crowded and unwholesome districts," the "prostration of education and moral habits of Scottish labourers
which is attributable to the surrounding physical circumstances," the "poorIrish", and various others all support his environment based
paradigm.
While Chadwick's environment-then-poverty-then-disease model of the relationships between people, disease, and conditions is clearly not universally accepted, it was supported by evidence (primarily in the form of interviews), and is clearly the product of its context and a continuation of the tradition of sanitary reform. As such it serves not only as a point along the historical line, but a landmark example that embodies the changing thought about public health reform and more generally the relationship between patients, bodies, disease, and treatment.
Works Cited
Chadwick, Edwin. Report on the Sanitary Condition of the Labouring Population of G.T. Britiain. M. W. Flinn (ed.) Edinburgh: Edinburgh University Press, 1842.
Alison, Dr. W. P. Observations on the Generation of Fever. as part of "British Parliamentary Papers" Irish University Press, 1842-3.
Kavey, Allison. Discussions of The History of Modern Medicine.
Baltimore: The
Johns Hopkins University. Spring 2001.
Marks, Prof. Harry. In lectures on The History of Modern Medicine.
Baltimore: The
Johns Hopkins University. Spring 2001.
Also search results from www.everything2.com on the meaning and history of various terms.