continued from History of Public Health(part 4)
THE ENLIGHTENMENT AND SANITARY REFORM
The Enlightenment (the period from 1750 until the mid–nineteenth century) was characterized by unprecedented industrial, social, and political developments, and the resulting societal impacts were immense, culminating in the Industrial Revolution. It was in Germany that the first major contribution of the period to public health occurred. Between 1779 and 1816, Johann Peter Frank, a leading clinician, medical educator, and hospital administrator, published a six-volume treatise, System of a Complete Medical Policy, in which he proposed a sweeping scheme of governmental regulations and programs to protect the population against disease and to promote health. His proposals covered the entire life span from birth to death. The actions that he advocated ranged from measures of personal hygiene and medical care to environmental regulation and social engineering.
Meanwhile, in England, Jeremy Bentham (1748–1832) was enunciating a similar humanitarian social philosophy and consequent political reform. InIntroduction to the Principles of Morals and Legislation (1789), Bentham argued, among other ideas, that society should be organized for the greatest benefit for the greatest number (Utilitarianism). In hisConstitutional Code (1830), Bentham proposed radical new legislation dealing with such issues as prison reform, the establishment of aministry of health, birth control, and a variety of sanitary measures.
Implementing these concepts in the mid–nineteenth century fell to Bentham's disciples, particularly Edwin Chadwick. Chadwick had been secretary of England's Poor Law Commission, established in 1834 to effectuate the New Poor Law, and was aware of the pervading interaction of disease and poverty. Thus, when the Commission undertook a special study in 1839 of the prevalence and causation of preventable diseases, particularly of the working poor, Chadwick took the lead. The resulting publication, General Report on the Sanitary Condition of the Labouring Population of Great Britain (1842), is considered one of the most important documents of modern public health.
Chadwick documented the status of housing of the working population, the lack of sewerage and adequate supplies of water, the unhygienic circumstances of places of work, the life expectancy of various social classes, the economic impact of unsanitary conditions, and the evidence for the beneficial health effects of preventive measures. As a result, sewerage, potable and plentiful water supplies, refuse disposal, proper ventilation of residences and places of work, supervision of public works by qualified professionals, and legislative authorization of measures to obtain these results were put forward.
Chadwick's report was widely circulated and carefully considered. In the United States, it stimulated a similar survey based on more sophisticated survey methods and with more comprehensive recommendations. The Report of a General Plan for the Promotion of Public and Personal Health (1850), authored by the organizer and first president of the American Statistical Association, Lemuel Shattuck, put forward fifty recommendations (many still worthy of implementation but not yet realized) and a model state public health law. Although both of these reports impacted national and local legislation, their more enduring effect was to define the purview and establish the organizational framework of the field of public health in the late nineteenth and early twentieth centuries.
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