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Medical Milestones

Sanitation: pragmatism works

BMJ 2007; 334 doi: (Published 04 January 2007) Cite this as: BMJ 2007;334:s17
  1. Johan P Mackenbach, professor of public health
  1. 1Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, Netherlands

    Despite erroneous theories of disease causation and the lack of an evidence base, new sewage disposal and water supply systems in the 1800s revolutionised public health in Europe

    At some time in the 1780s the Industrial Revolution began—firstly in Britain then in other European countries. Technical and commercial advances enabled European societies to break through their pre-industrial production ceiling, initiating the seemingly limitless multiplication of goods and services. Expanding industry attracted labourers and their families to towns and cities, which grew rapidly, at the expense of rural areas. In terms of economic output these transformations were an immense success; in terms of human wellbeing they were not. Unplanned urbanisation, appalling working conditions, and low wages led to a deterioration in the health of much of the population. In Britain, where these changes occurred first and most rapidly, average life expectancy at birth actually declined during the first half of the 19th century.1

    Infectious diseases exacted a huge toll in morbidity and mortality, among them tuberculosis, diphtheria, measles, smallpox, typhoid, and typhus, as well as the “enteric fevers,” whose causes were hotly disputed. We now know that dysentery is caused by ingesting food or water contaminated with faecal micro-organisms in environments where sanitation and access to clean water are inadequate. But at the time popular …

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