Public health in the Victorian era is a sharp contrast to what public health is today, majorly due to the healthcare practices and general public health sanitation conditions. The Victorian era refers to the period in the reign of Queen Victoria from June 20 1837 to her demise on January 22, 1901. This period was characterized by rapid economic and industrial growth but was also performing poorly in terms of healthcare and sanitation, due to the high mortality rates resulting from diseases. As the urban population grew exponentially, more houses were built in close proximity to each other without proper sewers or clean water supply. The public health issues that came up led to the action of various health reformists who championed the enactment of changes in public health, whose benefits are still enjoyed to date. This article highlights the contributions of Edwin Chadwick, Florence Nightingale, and John Snow as the proprietors of public health reforms and sanitary practices. The article also outlines the prevalent public health issues in this period.
The Victorian era was characterized by a fast growth of the urban population, largely due to the industrial revolution and railway boom, which created a high demand for constant labor. It was difficult to keep up with the growing population and with time, sanitation levels deteriorated partly due to the inability to dispose of sewage properly and partly due to the lack of clean water supply for the residents, states Arnold-Forster (2020). Water sources also were severely contaminated by the sewage. Living in close quarters also meant that it was easier to spread infections from one individual to another. Evidently, poor living conditions correlated with poor sanitation, and a social reformer called Edwin Chadwick was appointed to be in the Poor Law Commission to investigate the sanitary states and formulate recommendations for improving such.
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Edwin Chadwick is considered to be one of the greatest reformers of public health during the Victorian era since he deduced a link between poor living conditions and diseases. As stated by Small (2020), Chadwick argued that impoverished laborers could not work properly due to ailments from poor sanitation, especially since the cholera epidemic killed many people. He made this claim to persuade government intervention and recommended the government provide clean water and improve drainage systems. Thus, the major achievement of Chadwick as a Sanitation Commissioner was his idea that the laborers could not attain their full potential in expanding the industries because of their poverty and poor health, thus it would be important to improve their living standards for the benefit of the nation.
Due to the deteriorating sanitary conditions and the emergent public health issues in the Victorian era, there occurred an outbreak of cholera in 1854 that devastated the population due to poor hygienic conditions. The disease also spread quickly because people were staying close to each other, thus a lot of contacts. A physician named John Snow undertook a systematic study of the origin and spread of cholera, helping him be later known as the father of epidemiology (Vineis, 2018). It was initially believed that cholera spread through inhalation of miasma or contaminated air, but Snow's examination of patients pointed to symptoms related to gastrointestinal infection. He argued that the disease was thus not spread by contaminated air, but rather through consuming contaminated water and food. Otherwise, patients would have manifested pulmonary symptoms.
John Snow's contribution to epidemiology was developing a systematic way of tracking down the origin of an epidemic and mapping out its spread by tracing the patients' infection history. His pioneering investigation of the source of the cholera outbreak pointed to water as the key source of the epidemic, and he demonstrated this by removing the Broad Street pump handle to stop people from drawing water. The prevalence of cholera in the days that followed dropped significantly, confirming his theory. His pioneering demonstration led to reforms in public health in that the government developed better sewage drainage systems and also focused on water purification in major cities and towns, and this contributed to the reduction in the effects of the scourge in the following decades.
Another major contributor to the reformation of public health was Florence Nightingale, who pioneered modern nursing, helping elevate it from an unprofessional practice to a highly-skilled and recognized medical occupation. The effects of her contributions were majorly felt during the Crimean War, where she was stationed in Scutari to nurse wounded and ill soldiers (Pattison, Deaton, McCabe, et al., 2022). During her time, most hospitals operated in unsanitary conditions, and the lack of antiseptics caused a lot of cases of reinfection in the hospitals. Also, the hospitals were often overcrowded, patients used unwashed beddings and ate indecent food. Nightingale made it her obligation to provide sanitary conditions by cleaning the hospitals, washing patients' beddings, and providing proper food for the patients. This led to a drastic decline in soldiers' mortality, as most of them were initially dying due to infections. The actions of Nightingale have since been adopted as the standard practice of nursing. She championed reforms that made it possible for patients to receive proper treatment in sanitary conditions, also completely eliminating the instances of getting infected by some diseases in the process.
Diseases were the major cause of mortality in the Victorian era, largely due to poor sanitary conditions both at home and in the hospitals, and the laxity to enforce various health policies that would ensure proper handling of infections. Some of the common infections in this period were cholera and typhoid, which were primarily caused by poor sanitation, as well as a general lack of knowledge on the transmission of the diseases (Pattison, Deaton, McCabe, et al., 2022). Edwin Chadwick deduced that poor living conditions translated to poor sanitation, and this led to the prevalence of cholera outbreaks among the poor individuals who also provided the labor force for the industries. To ensure steady economic growth, the issue of sanitation had to be addressed through improving drainage systems and provision of clean water. John Snow attempted to establish the cause of cholera and its epidemiology, and his systematic study of the disease pioneered a new way of tracking epidemics from their epicenter, how they spread, and how they can be contained. Nightingale, in her contribution to public health reforms, made it clear that a clean environment is necessary for the speedy recovery of a patient and to avoid the possibility of reinfection.
In conclusion, public health has made tremendous strides since the Victorian era which lasted from the mid-1800s to the early 1900s. In this period, technological advances were still minute, and applications such as microscopy had not been discovered yet. Thus, the field of medicine was lagging behind and disease containment was hard since there was no consensus on the origin of a disease. For instance, people in the Victorian era believed that cholera was caused by miasma, thus people were not keen on improving their sanitation which would have otherwise effectively helped in reducing the dangers of the epidemic. The mentioned pioneers of public health, Edwin Chadwick, Florence Nightingale, and John Snow, helped bring reforms to the public health sector and changed the outlook of epidemics and other diseases. These applications are still relevant to this day's public health system.
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