Epidemic disease was by no means a new experience for Uppingham. The town had suffered plague in 1840, 1848 and 1850, and there appears to have been a small outbreak two years later, followed by a major and more documented one in 1853–4. The Stamford Mercury reported in December 1854 that ‘the filth from the backyards which in most cases flows in to the open channels in the public street will scarcely be tolerated in any other decent market town’. However, the paper had also carried reports four months earlier of

In many ways this early skirmish between the RSA and local community serves as a symbolic event for the two decades before the 1875 epidemic, which was a period in which the RSA struggled to balance a local desire for improvement with fears about both its cost and the practical implications for householders. The LGB and its predecessors had numerous dealings with the RSA in this period – confirming the perception of people in Oakham in the 1860s that Uppingham's guardians were more proactive in sanitary reform than their own.

In Uppingham the concerns – and the desire for improvement – soon reemerged. In 1857 churchwarden William Compton, who had a house in the High Street and a wine and spirit shop in the marketplace, complained about the state of the drainage. As a result there was an enquiry, and the Nuisance Removal Committee commissioned a survey of drainage options, which resulted a year later in the main sewer being laid along the northern part of the town at cost of £750.