Coventry's periodic rapid growth outstripped its sanitation systems: overcrowded, poor living conditions combined with ineffective sewerage, drainage and refuse disposal systems lead to frequent epidemics and a high death toll. When the Commissioners on the State of Large Towns investigated Coventry in 1843 they found that there was no Act or regulation in force regarding drainage or sewerage, and an inquiry under the Public Health Act of 1848 lead to the city council being established as the local Board of Health in 1849 with associated powers, and the first Medical Officer of Health was appointed in 1874.