IN many ways, despite periodic visitations of bubonic plague, there was no real public health problem in pre-industrial England. London and the centres of some of the provincial market or cathedral towns contained cramped houses, but the vast majority of the population were spread thinly over the rural areas. It was the Industrial Revolution, accompanied by a massive shift in population from rural to urban areas, which created a public health problem. As with so many other social questions, it was the very concentration of people which caused the difficulty. It was only in the so-called ‘age of great cities’ that society needed that essential combination of preventive medicine, civil engineering and community administrative and legal resources known by the generic term ‘public health’.
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