January 19, 2007
A sewer is the best medicine, poll declares
David Rose
* Sanitation voted top medical advance
* But doctors backed anaesthesia
The London cholera epidemic of 1854 killed around 10,000 people. Before sewers were widespread British cities, which were the largest in the world in the 1800s, were stinking cesspits where cholera epidemics were common.
Sewage disposal and clean water supplies, among other aspects of sanitation, were chosen over 15 key medical advances named in an international poll by the British Medical Journal (BMJ).
A shortlist of 15 discoveries was narrowed down to antibiotics, anaesthesia, vaccines, DNA and sanitation before the winner was announced yesterday at an awards ceremony held in London, where leading doctors and scientists championed each milestone.
Doctors and members of the public, who were among the 11,000 voters, were divided on which discovery they considered most significant.
Sanitation eventually won with a total of 1,795 votes. However, medical professionals rated anaesthesia as more important, while the public voted for antibiotics — which came second overall with 1,642 votes.
Professor Johan Mackenbach, of Erasmus University Medical Centre, in Rotterdam, who put forward the case for sanitation, said yesterday: “The general lesson, which still holds, is that passive protection against health hazards is often the best way to improve population health.”
In the 18th century, infectious diseases led to huge numbers of deaths, including those from cholera, tuberculosis, diphtheria, measles, smallpox and typhoid, he said.
Anne Hardy, a medical historian from University College London, said that sanitation had provided the key building block for public health.
The creation of sewerage systems by Victorian engineers, while not a medical milestone in the strictest sense, worked alongside doctors to change attitudes towards hygiene and health. In an informal debate at the British Medical Association chaired by Jon Snow, the broadcaster, other doctors disputed the result of the poll.
John Burn, Professor of Clinical Genetics at the University of Newcastle, who championed the discovery of DNA as the greatest breakthrough, said that the poll “could look very silly in 50 years time”.
He said that the discovery in 1953 by James Watson and the late Francis Crick, underpinned the development of modern medicines such as the hepatitis C vaccine and the breast cancer drug Herceptin.
A “tsunami” of discoveries in genetic medicine — including stem-cell research and analysis of the human genome — could soon eclipse all other medical achievements, Professor Burn said.
But Adam Hart-Davis, author and presenter of the BBC series What the Victorians Did for Us, told The Times that sanitation was a deserving winner.
“Contamination of drinking water is still the single biggest killer in the world and it always has been,” he said. “As such, the humble lavatory is the greatest device ever invented in medical history.”
Salutary facts - Stinky Victorians
The London Cholera Epidemic of 1854 (or the Broad Street Pump epidemic) started from a water pump in Broad Street. That pump, which was public, free and previously considered a safe source of drinking water, drew from a well beneath Golden Square, home to some of London's poorest and most overcrowded people. In the last week of August 1854, many residents of Golden Square suddenly took sick and began dying. Their symptoms included upset stomach, vomiting, gut cramps, diarrhea and racking thirst. Whatever the cause, it was fast - fast to kill (sometimes within 12 hours of onset) and fast in spreading to new victims.
The previous cholera epidemic in London in the 1830s killed 7,500 people in just 2 years.
Authorities at the times, not as advanced as we are at medicine and science, thought the disease was carried by bad "miasmas" in Britain's incredibly polluted air, which was made that way by its mighty manufacturing industry.
Waterborne disease, through inadequate sanitation and hygiene, is responsible for about 80 per cent of all sickness in the world, killing around 14,000 people each day
Until the 1830s, about HALF the children born in British towns did not live to the age of FIVE because of disease carried by sewage present in drinking water
In studies of a water pump on Broad Street, London, John Snow found that cholera was a waterborne disease. During the epidemic of 1853-54, more than 10,000 people died of the cholera
Edwin Chadwick’s report The Sanitary Condition of the Laboring Population (1842) called for sewers rinsed by water. This resulted in water being pumped to homes for the first time. Previously Londoner got their drinking water from places like the Thames - which was also used as a toilet and a dumping area of industrial waste.
As a result of sewer systems built by the Victorians, the infant mortality rate decreased to about 1 per cent over the next 100 years. In countries such as Bangladesh it is still as high as 12 per cent
The first patent for a flushing water-closet was taken out by Englishman Alexander Cumming in 1775, and his sliding-valve device was improved by Joseph Bramah in 1778
Source: Water Partners International, BMJ, Thunder, Flush & Thomas Crapper by Adam Hart-Davis (Michael O'Mara Books)
timeosnline.co.uk
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