Edwin Chadwick

Following a serious outbreak of typhus in 1838, Chadwick convinced the Poor Law Board that an enquiry was required, and this was initially carried out by his doctor friends Arnot and Southwood Smith, assisted by another doctor from Manchester, James Kay Shuttleworth. This was the first time in British history that doctors were employed to look at the conditions which might contribute to ill health in the population. Chadwick sent questionnaires to every Poor Law Union, and talked to surveyors, builders, prison governors, police officers and factory inspectors to obtain additional data about the lives of the poor. He edited the information himself, and prepared it for publication.[7] His Report on The Sanitary Condition of the Labouring Population of Great Britain,[8][9] begun in 1839 and published in 1842,[10] was researched and published at his own expense, and became the best-selling publication produced by the Stationery Office to date.[11] A supplementary report was also published in 1843.[12]

He employed John Roe, the surveyor for the district of Holborn and Finsbury who had invented the egg-shaped sewer, to conduct experiments on the most efficient ways to construct drains, the results of which were incorporated into the report, and the summary included eight points, including the absolute necessity of better water supplies and of a drainage system to remove waste, as ways to diminish premature mortality.[13] Evidence given by Dr Dyce Guthrie convinced Chadwick that every house should have a permanent water supply, rather than the intermittent supplies from standpipes that were often provided.[14] The report caught the public imagination, and the government had to set up a Royal Commission on the Health of Towns to consider the issues and recommend legislation.[15] Its chairman was the Duke of Baccleuch, and there were thirteen members, including the engineers Robert Stephenson and William Cubitt. Chadwick acted as secretary in an unofficial capacity, and seems to have dominated the proceedings.[16]

The Commission took evidence from Robert Thom, who had designed a water supply system for Greenock, Thomas Wicksteed, who was the engineer for the East London Waterworks Company, and Thomas Hawksley from the Trent Waterworks, Nottingham.[17] These confirmed his ideas about constant water supplies, and he developed a model which he called the "venous and arterial system." Each house would have a constant water supply, and water-closets would ensure that soil was discharged into egg-shaped sewers, to be carried away and spread on the land as manure, preventing rivers from becoming polluted.[18] Followed the publication of the commission's report, the Health of Towns Association was formed and various city-based branches were created.[19] Chadwick later helped to ensure that the Waterworks Clauses Act 1847 became law, to limit the profits that water supply companies could make to 10 per cent, and requiring them to comply with reasonable demands for water. This included a constant supply of wholesome water for houses, and a supply for cleansing sewers and watering streets.[20]

Chadwick wanted to see his ideas implemented over a wide area, and set about forming a company to supply water to towns, to ensure their drainage and cleansing, and to use the refuse for agricultural production. It was to have the grandiose title "The British, Colonial and Foreign Drainage, Water Supply and Towns Improvement Company", with an initial capital of £1 million, but it was the time of the Railway Mania, and he struggled to raise the finance against such competition. The company when it was eventually registered became the more modest Towns Improvement Company.[21] Railways continued to dominate the money market, and the company was wound up after just three years.[22] Chadwick understood that both water supply and drainage were important, since replacing earth-closets with water closets resulted in cesspools overflowing and making sanitary conditions worse, unless there were sewers to carry the waste away. This led to a rift forming between him and Hawksley, who had initially worked closely with him but who later took on water supply projects which did not include any requirement for drainage.[23]

Chadwick's report led to the Public Health Act 1848, which was the first instance of the British government taking responsibility for the health of its citizens.[10] It had been introduced by Lord Morpeth in 1847, with the aim or requiring every town to supply water to every house, which they could do by building their own waterworks or by liaising with water companies, and to undertake drainage, sewerage and street paving projects. Most of its grand aims were considerably watered down by the time it became law, but it established a Central Board of Health, whose members were Lord Morpeth, Lord Shaftesbury, and Chadwick. They were later joined by Southwood Smith, who acted as a medical advisor. Districts could pay for a survey from an inspector employed by the Board, and could then proceed without the need to obtain a costly local Act to authorise the work. Chadwick chose all of the inspectors himself, ensuring that they shared his views on glazed sewer pipes, constant water supply and arterial drainage. They worked enthusiastically, ensuring that districts considered comprehensive schemes for water supply, drainage and sewerage.[24]

Ratepayers in a district could request an inspector to attend if ten per cent of them signed a petition. The Board could also hold an enquiry if the death rate of a district exceeded 23 per 1000, but gauged the level of local feeling, and formed a local Board if there was support, and withdrew tactfully if there was opposition. By 1853, they had received requests for inspections from 284 towns, and 13 combined water supply, sewerage and drainage schemes had been completed under the legislation.[25] Relationships with engineers were not always easy, with J. M. Rendel calling Chadwick's ideas "sanitary humbug" and Robert Stephenson stating that he hated the ideas of pipes, rather than brick-built sewers. Even Joseph Bazalgette, who went on to design London's trunk sewer network, spoke out against glazed sewer pipes.[26] As time went by, there was growing opposition to what was seen as central control by the Board. The rift between Chadwick and Hawksley had become open hostility, and Hawksley made serious complaints against Chadwick and one of the Board's inspectors to a Select Committee of the House of Commons in 1853.[27] Opposition from engineers increased, and a "Private Enterprise Society" was formed by Hawksley and James Simpson, with the intent of bringing down the Board. Shaftsbury, Chadwick and Southwood Smith all had to resign in 1854, and the Board did not last for long afterwards. Chadwick lived to see his position vindicated when the Local Government Board was established in 1871, which led to the formation of the Ministry of Health. Since then, it has been widely acknowledged that public health is a matter of government responsibility, working through local authorities.[28]

In 1851, Chadwick made a recommendation that a single authority should take over the nine separate water supply companies that operated in London. Although this idea was rejected by the Government, the Metropolitan Water Supply Act 1852 forced the companies to move the intakes for their water to locations above Teddington weir, to filter water before it was used for domestic supply, to cover filtered water reservoirs, and to ensure that there was a constant water supply to all users by 1857. This was not achieved until 1899, and Chadwick's recommendation for a single authority was eventually implemented in 1902, with the formation of the Metropolitan Water Board.[29]

In 1852, Chadwick conversed with Lewis Llewelyn Dillwyn in relation to the construction of a sewerage system in Swansea.[30]

Chadwick's efforts were acknowledged by at least one health reformer of the day: Erasmus Wilson dedicated his 1854 book Healthy Skin to Chadwick "In admiration of his strenuous and indefatigable labours in the cause of Sanitary Reform".[31]

He corresponded with Florence Nightingale on methodology. He encouraged her to write up her research into the book Notes on Nursing. He promoted it among well placed intellectuals, making her more visible.[32]