The legislative story of British public health reform has often been told;but the moral mission to cleanse and save the nation emerged from a whole penumbra of health reformers stretching far beyond the public facade of Sanitarianism. They included the many millions of silent consumers whose private health care arrangements were already making their contribution to the new health industries—and to demographic statistics. In nineteenth-century Europe the average population growth rate was roughly 60-70 per cent;but in Britain the growth rate was nearer a staggering 140 per cent (from c.15.5 million in 1801 to 41.4 million by 1901). Town dwellers were 20 per cent of the UK population in 1801, 54 per cent in 1851, 80 per cent by 1901.1 In 1800 European public health philosophy was enlightened but barely off the drawing board; but the immediate problem facing Britain as its population grew so rapidly was the looming question of long-term health investment, above and beyond the norm. Who was going to pay for the necessary bricks and mortar, and water supplies? Ever since 1688, political pragmatism had ruled in British affairs. Legislation was tentative at first;but in the end the utilitarian (or mercantilist) economic arguments were decisive. No public investment—no sanitation, no cleansing, no civilizing process, no trade.
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