R. G. Record

Reasons for the decline of mortality in england and wales during the nineteenth century

Summary Five diseases or disease groups accounted for almost the whole of the reduction in mortality between 1851–60 and 1891–1900: tuberculosis (all forms), 47.2 per cent; typhus, enteric fever and simple continued fever, 22.9 per cent; scarlet fever, 20.3 per cent; diarrhoea, dysentery and cholera, 8.9 per cent; and smallpox, 6.1 per cent. In order of their relative Importance the Influences responsible for the decline were: (a) a rising standard of living, of which the most significant feature was improved diet (responsible mainly for the decline of tuberculosis, and less certainly, and to a lesser extent, of typhus); (b) the hygienic changes introduced by the sanitary reformers (responsible for the decline of the typhus-typhoid and cholera groups); and (c) a favourable trend In the relationship between infectious agent and human host (which accounted for the decline of mortality from scarlet fever, and may have contributed to that from tuberculosis, typhus and cholera). The effect of therapy was restr...

An interpretation of the decline of mortality in England and Wales during the twentieth century.

Summary National mortality statistics were analysed to assess the contribution made by different causes of death to the decline of mortality between 1901 and 1971. Reduced mortality from infectious diseases accounted for about three-quarters of the decrease. The main influence was considered to be improved nutrition, particularly in the case of airborne infections. Reduced exposure to microorganisms, especially those causing gastro-intestinal disease, also played a significant part. Immunization and therapy made only a small contribution. The fall in mortality from noninfectious conditions, accounting for one-quarter of the total decline, owed a good deal to specific medical measures but was also influenced considerably by general improvements in the standard of living, particularly in respect in respect of infant feeding and care.

An investigation of the difference in measured intelligence between twins and single births

Mean V.R. (verbal reasoning) scores recorded in the eleven‐plus examination for Birmingham multiple births in the years 1950‐57 were 95‐7 for 2164 twins and 91‐6 for 33 triplets. The mean for 48,913 single children born in the years 1950‐54 was 100‐1.

An interpretation of the modern rise of population in Europe

Abstract This paper has two aims. One is to outline an interpretation of the modern rise of population, based on the experience of England and Wales. This interpretation1 was derived from investigations of population growth in the eighteenth2 and nineteenth centuries3 undertaken, it seems to us in restrospect, in the wrong order. The other aim is to examine the credibility of the interpretation in the light of the different circumstances which existed in four other European countries: Sweden, France, Ireland and Hungary. These countries were chosen because they differ considerably from England and Wales and from one another in such important respects as the period and rate of population growth, the levels of birth rate and death rate and the timing of agricultural and industrial development. It is an exacting test of an hypothesis to enquire whether it can be accepted, if necessary with modifications and reservations, under such different conditions.

The relation of measured intelligence to birth order and maternal age

This article examines the relationhip of verbal reasoning scores recorded for 48913 Birminghan children born in 1950-1954 to birth order and maternal age. It is shown that the scores are negatively correlated with sibship size and positively with maternal age. It is concluded that the association of measured intelligence with maternal age and birth order in a general population of children is determined mainly by differences between rather than within families. Therefore the negative correlation between sibship size and intelligence cannot be attributed substantially to variation in intelligence according to birth order or maternal age within sibships. The population was divided according to occupation of fathers into 3 social groups. Since distribution of children by mothers age and birth order is a distribution by social class the relation of scores to the 2 variables in a population of births is largely a reflection of the social class difference.

The relation of measured intelligence to birth weight and duration of gestation

There have been two main approaches to investigation of the relation of birth weight to intelligence. In one, birth weights of children of low intelligence are compared with those of children of average or high intelligence. Where the comparison has been between children in ordinary schools, as in Ascher & Roberts’s study (1949) in primary, grammar and secondary schools, birth weight differences have usually been unimpressive or absent ; but among the subnormal, mean birth weight appears to be reduced and the reduction is present even after exclusion of those whose low intelligence is associated with physical abnormalities (Barker, 1966). The more usual approach has been to measure the intelligence of children of different birth weights. Numbers investigated by this procedure are, as a rule, rather small and the methods of analysis sometimes make it difficult to assess the results. However, the general conclusion which has been reached is that when children with physical abnormalities-such as blindness, deafness and cerebral palsy-are excluded, the intelligence of the remaining children of low birth weight is about normal (McDonald, 1964). In children of very low weights, however, intelligence appears to be reduced (Drillien, 1964). The relation of intelligence to duration of gestation is even less well established, but the contemporary viewpoint is probably summarized in Baird’s conclusion (1959) that ‘there is no clear indication that within wide limits premature expulsion from the uterus does the foetus any serious harm ’. The data used in the present investigation were described in a preceding paper (Record, McKeown & Edwards, 1969). Briefly, they are derived from observations on all (86,630) Birmingham live births in the period 1 January 1950 to 1 September 1954. Verbal reasoning scores from the results of the eleven-plus examinations were matched for 50,172 children and birth weight and duration of gestation (estimated to the nearest week from the first day of the last menstrual period) were available from obstetric records for 41,534 single births.

Congenital Malformations of the Central Nervous System : II—Maternal Reproductive History and Familial Incidence

In a previous communication (Record and McKeown, 1949) we described an investigation of 930 consecutive malformations of the central nervous system certified as the causes of stillbirths or of first year deaths in the City of Birmingham in the years 1940-1947. Certain data were available for all these malformations in the Maternity and Child Welfare Departments records; additional information was obtained by home visits from 742 mothers of 755t of the 930 malformations, and from a control group of 742 mothers of 757 of the 892 infants born free from malformation, selected by taking every two hundredth name from the registers of live births and stillbirths for the same years. For a fuller discussion of the material and for an account of the procedure followed in classification of the malformations, we refer the reader to the earlier paper. The most interesting observations so far recorded in this inquiry concerned the association of age and parity of the mother with the risk of birth of a central nervous malformation. We now make use of the information obtained by field inquiry to compare the malformation series and the control series in respect of the reproductive history of the mother, and the familial incidence of malformations of the central nervous system.

FOETAL AND INFANT MORTALITY IN MULTIPLE PREGNANCY

INTRODUCTION IT is well established that risk of stillbirth is greater for twins than for single births, and greater for triplets than for twins. Using national statistics, Yerushalmy and Sheerar (1940), Strandskov and Ondina (1947), and Lowe and Record (1951) showed that the stillbirth rate is inversely related to the number of foetuses in the uterus, and many workers have recorded high stillbirth rates in twins born in hospital (Neuhauser, 1914; Marinoff, 1926; Takahashi, 1934; McClure, 1937; Gernez and Omez, 1938; Hirst, 1939; Munnell and Taylor, 1946; Vermelin and Ribon, 1948). Mortality rates of multiple live births are less reliable. National statistics are not published in a form suitable for calculation of neonatal or infant mortality rates for multiple births, and available data are derived mainly from hospital experience. Few direct comparisons have been made between twin and single births; in general, recorded twin neonatal mortality rates appear to be high (Neuhauser, 1914; Marinoff, 1926; Takahashi, 1934; Hirst, 1939; Potter and Crunden, 1941; Potter and Fuller, 1949). There are no satisfactory records of subsequent mortaIity in twin and single births which survive until the end of the first month. So far as we are aware, the only information about mortality in liveborn triplets was provided by Fisher (1928), who reported that after 146 triplet deliveries, 39 per cent of male and 46 per cent of female infants were alive at 64 years. We know of no data on liveborn quadruplets. The higher mortality of twins than of single births has been variously ascribed to toxaemia, 47 1 crowding in the uterus, complications of delivery, and prematurity. (1) Toxaemia is a more frequent complication of twin pregnancies than of single pregnancies (Guttmacher, 1939; Potter and Crunden, 1941; Munnell and Taylor, 1946; Vermelin and Ribon, 1948), but there is little direct evidence that it contributes to the higher mortality of twins. Indeed figures quoted by Strandskov and Ondina (1947) suggest that toxaemia is not responsible for the discrepancy between mortality rates of twin and single births. (2) Crowding in the uterus is regarded by Newman (1940) as the main cause of high prenatal mortality in twins. The deaths of some monozygous twins are undoubtedly due to circulatory imbalance resulting from the placental anastomosis (Price, 1950); foetal mortality is higher for twins of like sex than for twins of unlike sex (Yerushalmy and Sheerar, 1940; Lowe and Record, 1951), and for monochorial twins than for bichorial twins (Vermelin and Ribon, 1948). The observation that monochorial twin pregnancies terminate at an earlier stage than bichorial pregnancies also has a bearing on this problem (Colloridi, 1935; Mazzullo, 1948). (3) Complications of delivery. Munnell and Taylor (1946) reported an increased incidence in multiple births of uterine inertia, hydramnios, prolapse of the cord, and placenta praevia. It is commonly believed that these and other complications (premature separation of a normally situated placenta, malpresentation) are more frequent in twin deliveries, but it is not certain to what extent they are responsible for the in-

Evidence of post-natal environmental influence in the aetiology of infantile pyloric stenosis.

The fact that the risk of infantile pyloric stenosis is related to position in family suggests that the environment influences the incidence of the disease, since there is no reason to suppose that inherited differences are affected by birth order, while examples of both pre-natal and post-natal environmental effects associated with birth order are well known (McKeown, MacMahon and Record, 1951a and b). The observation that size of the pyloric tumour is highly correlated with age at operation (McKeown et al., 1951c) supports the view that the tumour develops after birth, but does not, of course, exclude the possibility that the environmental influence (suggested by the association of incidence with birth rank) is exerted before birth. The present communication provides evidence that this environmental effect is post-natal by showing first that immediately after birth the disease is equally common in all birth ranks (it is not until about the third week that the incidence in firstborn is significantly raised), and secondly that symptoms appear earlier in domiciliary than in hospital births.

Congenital Pyloric Stenosis: An Investigation of 578 Cases

In the case of pyloric stenosis, the collection of this information now raises no insuperable difficulty, and if knowledge (of such matters as the association of the malformation with maternal age and birth rank) is still incomplete, it is because inquiries have usually been based on hospital births for which the population of related births is unknown. In the present investigation we have attempted to overcome this difficulty by the following methods: (1) A series of Birmingham children with pyloric stenosis has been assembled by examination of the records of all Birmingham hospitals which admit children, for the 10-year period 1940-49. f (It was, of course, necessary to exclude children whose homes were not in Birmingham.) The series can be regarded as complete in so far as