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This autumn marks the 150th anniversary of the Public Health Act for England and Wales, the beginning of a commitment to proactive, rather than a reactive, public health. The act began a series of legislative measures extending through the Victorian era and into this century in which the state became guarantor of standards of health and environmental quality and provided means for local units of government to make the structural changes to meet those standards.That public action can substantially improve the health of the general population now seems obvious, and it also seems obvious that public authorities owe their citizens that improvement. Both were controversial in the 1830s and 1840s. For centuries European governments had reacted to epidemics with decrees. With medical boards to advise them, they set their military forces to protecting borders and ports, whitewashed towns, fumigated dwellings, and burnt bedding. The threat of unusual disease prompted these reactions, and they were relaxed when the epidemics passed.1 Normal disease-infant mortality of more than 50% in inner city wards, annual mortality of over 30/1000 in some towns-prompted no such reactions.Unless we are familiar with some of the cities of the developing world, most of us are probably unable to fathom the enormity of the unplanned urbanisation of the 19th century: roughly 3 million people (slightly over 30%) were urban in 1801 in England and Wales, compared with 28.5 million (almost 80%) in 1901. Growth rates in some textile boom towns, like Bradford from 1811 to 1831, exceeded 60% per decade; this despite the fact that towns were acting as a sink for human life. In Liverpool average life expectancy by class ranged from 15 years for the unemployed or poor to 35 years for the well to do. [2][3][4][5][6] Yet that growth was accompanied, if belatedly, by an urban sanitary revolution. Many of us are its beneficiaries. To facilitate the building of sanitary systems, especially water supplies and sewerage, was the main purpose of the 1848 act, but it also established local and central units of government that would take responsibility for health, at least for those aspects affected by the built environment. It represented a commitment to the long term, to be made not by sanitarian boffins in Whitehall but by more or less ordinary (though usually upper middle class) townsmen who were suddenly to be given powers to obtain 30 year mortgages for these networks of pipes. Acknowledging a need for public health: the great sanitary inquiriesAmong the hardest of a historian's jobs is to understand how people move from hope for a different future to practical actions that secure it. In public health, fear had a large part. So too did ambition and perseverance.Edwin Chadwick was the widely hated architect and enforcer of the new poor law of 1834. Its principle was to make the conditions under which public relief could be given so unpleasant that most would refuse to request it. 7 Ever under pressure to cut costs, Chadwick began to focus on the causes of...
This autumn marks the 150th anniversary of the Public Health Act for England and Wales, the beginning of a commitment to proactive, rather than a reactive, public health. The act began a series of legislative measures extending through the Victorian era and into this century in which the state became guarantor of standards of health and environmental quality and provided means for local units of government to make the structural changes to meet those standards.That public action can substantially improve the health of the general population now seems obvious, and it also seems obvious that public authorities owe their citizens that improvement. Both were controversial in the 1830s and 1840s. For centuries European governments had reacted to epidemics with decrees. With medical boards to advise them, they set their military forces to protecting borders and ports, whitewashed towns, fumigated dwellings, and burnt bedding. The threat of unusual disease prompted these reactions, and they were relaxed when the epidemics passed.1 Normal disease-infant mortality of more than 50% in inner city wards, annual mortality of over 30/1000 in some towns-prompted no such reactions.Unless we are familiar with some of the cities of the developing world, most of us are probably unable to fathom the enormity of the unplanned urbanisation of the 19th century: roughly 3 million people (slightly over 30%) were urban in 1801 in England and Wales, compared with 28.5 million (almost 80%) in 1901. Growth rates in some textile boom towns, like Bradford from 1811 to 1831, exceeded 60% per decade; this despite the fact that towns were acting as a sink for human life. In Liverpool average life expectancy by class ranged from 15 years for the unemployed or poor to 35 years for the well to do. [2][3][4][5][6] Yet that growth was accompanied, if belatedly, by an urban sanitary revolution. Many of us are its beneficiaries. To facilitate the building of sanitary systems, especially water supplies and sewerage, was the main purpose of the 1848 act, but it also established local and central units of government that would take responsibility for health, at least for those aspects affected by the built environment. It represented a commitment to the long term, to be made not by sanitarian boffins in Whitehall but by more or less ordinary (though usually upper middle class) townsmen who were suddenly to be given powers to obtain 30 year mortgages for these networks of pipes. Acknowledging a need for public health: the great sanitary inquiriesAmong the hardest of a historian's jobs is to understand how people move from hope for a different future to practical actions that secure it. In public health, fear had a large part. So too did ambition and perseverance.Edwin Chadwick was the widely hated architect and enforcer of the new poor law of 1834. Its principle was to make the conditions under which public relief could be given so unpleasant that most would refuse to request it. 7 Ever under pressure to cut costs, Chadwick began to focus on the causes of...
In 1959, cytologic studies demonstrated that Down syndrome was associated with a nondisjunction now known as trisomy 21. Twenty years earlier (1932-39), at least three writers conjectured, independently of one another, that Down syndrome might be a form of nondisjunction: Petrus J. Waardenburg (1932), Adrien Bleyer (1934), and G. Fanconi (1938). In separate papers, Raymond Turpin (1937), Walter E. Southwick (1939), and Lionel S. Penrose (1939) also proposed that Down syndrome could be a chromosomal anomaly, but without specifying nondisjunction. However, these conjectures were largely ignored by contemporary medical writers. This essay (1) explores the background and context of early conjectures that Down syndrome is a form of nondisjunction, (2) provides some possible reasons why these conjectures were not given greater credence, and (3) traces early efforts to assimilate Down syndrome and other genetic disorders to what Robert Koch called the etiologic standpoint.
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