Major Contributors to Public Health Studies

Public health is the study of preventing disease, extending life expectancy, promoting the dignity of human life by education, and improving lifestyle choices. Public health involves the entire community: government, private sector, and citizens. Public health, and its related discipline, epidemiology, also involves analysis and disease modeling. To understand the foundation of public health, one must identify key figures and their contributions to the field. Some of these key contributors are John Snow, Edwin Chadwick, and William Henry Duncan. John Snow is considered the father of epidemiology. Edwin Chadwick is considered the father of public health and William Henry Duncan was the first medical health officer in Britain. When these men were alive in the Victorian era, the industrial revolution was happening, which is the time period where great progressions in urbanization and invention occurred. But along with these progressions, “dirt, disease, deprivation, and death” became prevalent (Morley, 2007). These men identified the poor sanitation and poor health standards in day-to-day living as risk factors. The purpose of this paper is to highlight the lives of each of these men, to address their contributions to public health, and to illustrate how their discoveries affect the population today.

 The father of epidemiology is John Snow. John Snow was born on March 15, 1813 in York, England (Vachon, n.d., & Hempel, 2013). When he was 14 years old, he began an apprenticeship under a surgeon, Dr. William Hardcastle (Vachon, n.d. & Hempel, 2013). During this time, his attention to detail was accentuated and developed. In 1831, a cholera outbreak occurred in London. John Snow was sent by Hardcastle to assist miners, who were infected with cholera; all treatments were ineffective (Vachon, n.d. & Donaldson, 2002).  By studying the miners, Snow disagreed with the popular “miasma” theory at this time, which was assuming that cholera was spread through the air (Vachon, n.d.).  In 1837, Snow passed the Royal College of Surgeons and the Society of Apothecaries exams. He obtained a degree in medicine from the University of London in 1844 (Vachon, n.d.). In 1849, he became licensed as specialist in the Royal College of Physicians of London (Hempel, 2013). Between 1848 and 1854, frequent outbreaks of cholera occurred; thus, Snow began studying the trends of cholera outbreaks (Vachon, n.d. & C.D.C, n.d.). In 1854, he investigated the Soho area cholera outbreak and determined the Broad Street water pump was the primary cause of the outbreak (Vachon, n.d. & CDC, n.d.). Once he addressed the problem by removing the pump handle, cholera began to diminish in the Soho area (Vachon, n.d. &CDC, n.d.). Snow died of a heart attack on June 16, 1858.

During his lifetime, and in the legacy he left after his death, John Snow’s major contribution to public health is his discovery of the transmission of cholera; but, his theory of transmission that cholera was spread through digestion was a major disagreement at this time. He conducted an epidemiology study called the “Grand Experiment”(Hempel, 2013 & CDC, n.d.). Because of this experiment, he was deemed the father of epidemiology. There are two aspects to this experiment: the first aspect analyzes a previous study indicating that cholera was spread through water and the second aspect was spot mapping people’s location to the water pump during the outbreak of cholera in 1854 (CDC, n.d., . During Snow’s life, the “miasma” theory was the major belief, which means that cholera was spread through poisonous fumes, meaning that it was airborne (Hempel, 2013). Snow proved his theory that cholera was not airborne but spread through the body during the epidemic in 1831(Vauchon, n.d. & C.D.C, n.d.). While taking care of minters, Snow observed that there were no open sewers or swamps in the area; therefore, “miasmas” theory was unlikely (Vauchon, n.d.). He formulated that cholera was spread by germs but was uncertain how the spread occurred (Vauchon, n.d.).

From 1849 to 1853, Snow continued to gather data on cholera (Vauchon, n.d.). During this time period, two water companies were drawing water into London: Southwark and Vauxhall Water and Lambeth Company.  Both companies were taking water from the same source until ***, when the Lambeth company switched water sources to a clean water source outside the city. He notated the deaths of people from cholera, where they got their drinking water, and which company (CDC, n.d.). He discovered after Lambeth switched water supplies tp the upstream Thames River, the death ratio between companies was 71:5 deaths (Vachon, n.d.). The switch to the water supplied improved life expectancy (CDC, n.d.). He concluded that the water source from the sewage was the main cause of death for the first part of his “Grand Experiment” (Vauchon, n.d. & CDC, n.d.).

In the second experiment, Snow began mapping where people drew water and became infected with cholera. From the Center of Disease Control, John Snow’s map is indicated below describing his thought process:

(CDC, n.d.). Based off this spot map, he determined that the Broad Street pump was the cause of cholera because one pump was too far to draw sources from and the second  was deemed disgusting to take water (CDC, n.d.). In 1854, he proposed that the handle be removed. He removed the handle and cholera cases decreased significantly (CDC, n.d. & Vachon, n.d.). Through his research, he determined where the first case of cholera started based off his studies (Vachon, n.d.). In 1855, he published a follow-up commission report, which contained all the statistics of his research (CDC, n.d).

His contributions to epidemiology introduced the world to spot mapping, which is still used today. His theory on germs and cholera was confirmed by Louis Pasteur many years after Snow died (Vachon, n.d.). He is also the pioneer of anesthetics by testing doses of ether and chloroform on animals and on humans, which was used on Queen Victoria’s when she birthed her son, Leopold (Vachon, n.d. &Hempel, 2013). Overall, John Snow’s contributions are being the father of epidemiology, tracing cholera outbreak to water supply and initiating public intervention caused by arising problems. His research applies to the world today because for example, while researching for this project, many recent articles were citing his impact to their particular study and many studies and galas honor his name and contribution. His legacy is continued daily because his methods for conducting experiments are imitated for evaluation and identifying risk factors in epidemiology.

Another contributor to the field of global health is Edwin Chadwick. He was born in Manchester in 1800. In general, he was a brilliant student and continued his studies with private tutors (Bloy, 2002). In 1828, he wrote an article called Westminster Review that imposed the idea of sanitation that he carried through for the remaining of his career (Bloy, 2002 & UCLA, 2001). Chadwick is a lawyer and his underlying belief was that science can be used to improve the lives of people. After 1832, he was offered a job on the Poor Law Commission and was promoted the year afterward due to his implementation policies to assist the poor (Bloy, 2002 & Morley, 2007). For example, he led the act called the Ten Hour Act, which reduces children’s working hours(Bloy, 2002). Other acts he implemented were restricting liquors, providing health recreation for people, and ensuring employers are being held accountable for accidents at work (Bloy, 2002 & UCLA, 2001). He was employed by Parliament in the 1840s as a civil servant by the Poor Law Commission, where he investigated the living conditions of the poor.

 In 1842, he wrote an assessment called 1842 Report on the Sanitary Conditions, where he concluded that poverty and illness were caused by the poor living conditions, not laziness (Bloy, 2002 & Morley, 2007). This report shocked public opinion and met opposition, specifically from the wealthy. Opinion shifted about his report when many citizens died of cholera in the 1848 epidemic (Bloy, 2002). After this event, Chadwick was named the first director of the General Board of Health by the government (UCLA, 2001). The purpose of this position from the government is to assign a qualified medical practitioner to an area, to intervene on health issues and to improve for the example, the sanitation of an area (UCLA, 2001).  Chadwick retired from the public commissioner post in 1854, and stayed involved in the community, such as improving sanitation and farm drainage (Bloy, 2002). For example, Chadwick developed a plan that assists the drainage for sewage and rainwater in the community (Bloy, 200). This plan was carried out by the army sanitary commission in 1871. Chadwick died on July 6, 1890.

Edwin Chadwick contributed to public health through his involvement in policy, especially the Poor Law of 1834, Public Health Act of 1848, and the 1842 Report on Sanitary and Commission (Morley, 2007 & Susser, n.d.).  The Poor Law of 1834 is a document that imposes harsher laws on the poor to use government resources as a last resort (Susser, n.d.). Chadwick’s involvement was creating the document, but he strongly opposed the outcome because it was harsh (Morley, 2007). The next major influence he had on public health is through his commission piece in 1842, where he identified that both the poor and wealthy where living poorly (Morley, 2007 & Susser, n.d.). To improve public health, his three recommendations were removing of waste, implementing of a better sewage system paired with running water and nominating a qualified medical officer to each area to monitor improvement (Developments, 2018). He confronted his opposition on this commission report until 1848 because the outbreak of cholera proved his commission thoughts were correct (UCLA, 2001). In 1848 with the passing of the Public Health Act, Chadwick was able to expand his impact on the general population through government because this document acknowledges that government will be involvement in public health initiatives (Morley, 2007).  Overall, Chadwick identified the need for public sewage systems and was an advocate for the community. Chadwick represents what it means to fight for justice today and the importance of implementing policies that affect a population for good. 

Chadwick’s impact is evident because he believed that the government should assist in improving the common good. His knowledge, although opposed many times, is well respected because he was elected to many committees (UCLA, 2001 & Bloy, 2002). Through this time, Chadwick insisted government involvement because with healthier people, the government would have to support less people(Susser, n.d. & Developments, 2018). He insisted on a multidisciplinary effect, such as working together to deliver clean water to people’s home, so that overall, the life expectancy of the people and the lives of the people can improve (Developments, 2018). Chadwick insisted that the health administration will pave the way for regulation, trade, and sanitation (Developments 2018). Because of Chadwick’s work, more laws eventually were passed to improve the general environment, such as the 1846 The Nuisances Removal Act, allowing landlords to be prosecuted for poor sanitation in their tenant homes (Brief, 2015). Overall, Chadwick was a social reformer. He assisted with sanitation and public health, and promoted decision making to those with expertise during the Victorian era to improve the overall health. These actions affect public health today because policy change impacts an entire population for the better or worst. His legacy promotes the involvement of government to improve population health. For example, the CDC( Centers of Disease and Control), for example, promotes health of the US citizens and responds to outbreaks.

 William Henry Duncan is the final contributor referred to public health. He was born in 1805 in Liverpool, England (Duncan, 2004). He attended medical school at Edinburgh University and earned his degree in 1829 (Halliday 2003, Ashton, 2006, &  Duncan, 2004). During this time, Edinburgh University was the only university to have a health management section (Halliday, 2003). He practiced in the Liverpool Infirmary and assisted with the outbreak of cholera in Liverpool in 1832 and several other outbreaks afterward (Halliday, 2003 & Duncan,2004). While working as a doctor, Duncan advocated to improve the living conditions of his patients, specifically homes should not be built without toilets (Halliday, 2003). In 1846 because of Duncan’s influence, the Liverpool Town Council passed the Act for the Improvement of Sewerage and Drainage of the Borough of Liverpool and For Making Further Provisions for the Sanatory Regulation, which implemented standards for home construction (Halliday, 2003). Homes must be built with drains, privies, and no cellars (Halliday, 2003). Because of this act and advocacy, Duncan was appointment as Liverpool’s and England’s Medical Officer of Health on January 1, 1847 until 1863 (Halliday 2003, Donaldson, 2002, &, Duncan, 2004). As an acting officer, he established that overcrowding, poor sanitation, and ground floors are the breeding ground for rapid disease spread (Ashton, 2006 & Halliday, 2003).  This thought was confirmed when the Irish were moving to Liverpool and living in these unsanitary conditions (Halliday, 2003). Throughout the epidemics, the general board and town council placed Duncan in charge of allocating resources.

 William Henry Duncan lead an impact on his community through advocating for his patients, identifying key factors of poor living, and involving the government. When Duncan was alive, Liverpool was not as developed as London, such as sewage systems (Halliday, 2003). As an example, in his research, he identified that life expectancy in Liverpool was 19.5 years; whereas, in rural Wiltshire the life expectancy was 36.5 years, which creates the image of how Liverpool was not developed (Halliday, 2003). As a doctor, Duncan saw the poor living conditions of his patients; therefore, he became an advocate for the community and wanted to increase life expectancy of the people (Halliday 2003). For example, he fought for better home structure because many people were living in cellars that were in the sewers, which is unsanitary (Ashton, 2006). He believed his patients should have sanitation in their homes and water. Once he was promoted to medical officer, he was able to implement more policies through the government for a positive effect on the poor (Halliday, 2003). His main focus of advocacy was sanitation, but he faced two challenges. The first challenge was the difficulty to care for patients with lack of understanding of the disease (Donaldson, 2002). The second challenge is lack of any direction in hospitals as well as nurses and doctors employed (Donaldson, 2002). Additionally, Duncan was able to organize hospitals at times of crisis (Donaldson, 2002).

 He contributed to public health by becoming the first medical officer of health in England, improving the health of the people, involving the government for public health administration and highlighting effects of overcrowding and poor sanitation with consequences of disease development and death. His work impacts today because he gives the example of what does it mean to be leader in government to cause change. He highlights the importance of good living conditions that even in the world today are not always met. Lastly, he is a model for example in lectures to show that using good health services instituted by the government that can improve public health.

 In order to appreciate public health today, one must dig into key people for the foundation of public health, who are John Snow, Edwin Chadwick and William Henry Duncan. John Snow is the father of epidemiology. He laid out the groundworks for the transmission of cholera, illustrated the methods of epidemiology, and introduced public intervention. Edwin Chadwick is a social reformer, who is claimed by some to be the founder of public health, began government involvement in the lives of people and the policy change. William Henry Duncan was a physician who identified that disease is linked to poverty, poor sanitation and overcrowding, and he paved the way for public health administration. Each of these men with their individual contribution to public health influenced how we live in the world today and how we continue to progress for years to come based off their methods. 

References:

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• A Brief History of Public Health (2015). Boston University of Public Health. Retrieved from http://sphweb.bumc.bu.edu/otlt/MPHModules/PH/PublicHealthHistory/publichealthhistory7.html
• Bloy, Marjie (2002). Edwin Chadwick (1800-1899). Retrieved from http://www.victorianweb.org/history/chad1.html
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• Halliday, Stephen (2003). Duncan of Liverpool: Britain’s first medical officer. Journal of Medical Biography, 11(3), 142-149. Doi: https://doi.org/10.1177/096777200301100307
• Hempel,Sandra. John Snow. (2013). The Lancet. 381, 1269-1270. Retrieved from https://www.thelancet.com/action/showPdf?pii=S0140-6736%2813%2960830-2
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• Susser, Ezra; Michaeline, Bresnahan. Origins of Epidemiology. Columbia University and University Epidemiology of Brain Disorders Department, New York. Retrieved From http://www.columbia.edu/itc/hs/pubhealth/p8462/misc/Susser_Bresnahan.pdf
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