By what stages did the state begin to take over responsibility for public health between 1848 and 1875?

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Previous to the 1848 Public Health Act, Britain had taken the laissez-faire attitude towards the public health reform. This continued to be the way until the government took over the responsibility for public health.

The improvement in public health always posed problems for those intent on developing it. There had to be appropriate technical skills, knowledge of sanitary engineering, medical knowledge about the cause of disease and the willingness of the public, local authorities and Parliament to legislate and up hold that legislation. People believed that diseases were caused by poisonous vapours in the air and the miasma theory had held sway for several hundreds of years.

Between 1801 and 1851 the population of Britain had doubled and it had doubled again by the beginning of the 20th century. It was not so much the fact of urban growth that created public health problems but the rate of urban growth.

The influx of thousands of people into small market towns and cities had a catastrophic effect on the existing housing and sanitation provisions. Rapid industrialisation and urbanisation had created many poor, filthy and foul-smelling neighbourhoods. Cellars and attics were being filled with working people and their families and were also being used as workplaces. Most houses lacked drainage, sewerage and a regular water supply. Privies were usually outside and were emptied into cesspits where filth would just lay in huge dunghills. Water was in short supply and was very expensive. Knowledge of the cause of disease at this time was poor. People were still under the impression that disease was carried and transmitted by bad air.

The first outbreak of cholera in Britain was in 1831 and it killed 32,000 people. The number of deaths rose to 62,000 in the second attack in 1848. In 1853 the third outbreak claimed 20,000 lives and the fourth epidemic, sixteen years later in 1866 claimed 14,000 lives. The cholera epidemics had a profound effect upon the public. This was because of the high percentage of fatalities and the speed with which cholera could strike. Cholera had forced the government into action because it was deadly, it was swift and it had the capacity to create fear in the population.

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A temporary Board of Health was set up that advised local governments to set up their own Boards of Health to issue advice to people. Some towns and cities implemented the advice but others did not. Councils were often uncertain if they could enforce the measures put forward by the Board of Health.

In 1831 John Snow had fought a cholera outbreak in Newcastle. He became convinced that cholera was a water-borne disease and in 1849 he published ‘On the mode of communication of cholera’. Unfortunately this remained just a theory. Whilst working as a general practitioner in Soho, he ...

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