Thomas McKeown

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...

Medical evidence related to English population changes in the eighteenth century.

Abstract In a recent communication1 Professor Habakkuk has raised doubts about the acceptability of the traditional view which attributes the increase in the population of England during the eighteenth century to a fall in the death rate. He is unable to accept Griffiths2 suggestion that medical measures introduced during that century had a substantial effect on the death rate, and considers the statistical evidence that mortality declined unreliable. These conclusions led Habakkuk to re-examine the possibility that an increase in the birth rate was the more important cause of the rise in population, and he suggests that “the acceleration of population growth in the late eighteenth century was to a very large extent the result of a high birth rate, and that in turn was the result of the economic developments”.3 His reason for preferring this interpretation is not merely that the traditional view is unacceptable; he is also impressed by evidence of the significance of the birth rate in the growth of popul...

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 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.

Observations on All Births (23,970) in Birmingham, 1947

The short clinical histories and the diagrams show that a distinct remission occurred in at least five out of six polycythaemic patients in response to the oral aiministration of /3-naphthyl-di-2-chloroethylamine for periods varying from a few weeks up to a few months. At first we were cautious with the dosage; 500-600 mg. might be given daily to start with for a few months, after which the dose should be reduced. An attempt was made to keep two patients stable on a small continuous dose (200 mg. daily), so far with good result. We have also seen a fall in the leucocyte values during the treatment; in one case a fall to as low as 1,200 leucocytes pzr c.mm. occurred, but a spontaneous and rapid rise set in 12-14 days after the drug was discontinued. It appears from this and what was earlier stated that the substance is a potential bone-marrow poison inherent in which is the risk of damage to the bone marrow, with aplastic anaemia or perhaps rather granulocytosis as a result. It is therefore necessary that these patients should be carefully and constantly followed with blood counts during treatment. As is known, polycythaemia is in itself a relatively benign disease and usually the patients have a fairly long expectation of life (cf. Dameshek (l950) and VIdebaek (1950), amongst whose groups of patients there were several with a history of over 20 years), and therefore emphasis must be placed on caution during the treatment.

Observations on the Medical Condition of Men in the Seventh Decade

Chute, A. L., and Bain, H. W. (1956). Ibid., 74. 994. Duncan, L. J. P., Baird. J. D., and Dunlop, D. M. (1956). BrIt. med. J., 2. 433. Engleson, G., and Lehmann, 0. (1956). Lancet, 2, 786. Hunt, J. A., Oakley, W., and Lawrence, R. D. (1956). Brit. med. J., 2, 445. McKenzie, J. M., Marshall, P. B., Stowers, J. M., and Hunter, R. B. (1956). Ibid., 2, 448. Murray. I., and Wang, I. (1956). Ibid., 2. 452. Walker, 0., Leese, W. L. B.. and Nabarro, J. D. N. (1956). Ibid., 2, 451. Wolff. F. W., Stewart, G. A., Crowley, M. F., and Bloom. A. (1956). Ibid., 2, 440. Wrenshall, 0. A., and Best, C. H. (1956). Canad. med. Ass. J., 74, 968. Young, F. G. (1956). Brit. med. J., 2. 431.

Fertility mortality and causes of death: an examination of issues related to the modern rise of population

Summary This paper attempts to remove some sources of misunderstanding of the interpretation of the growth of population outlined in The Modern Rise of Population, particularly the lack of attention given to increased fertility and the emphasis on the importance of nutrition. On the first point, it is shown that whatever assumptions are made about fertility and mortality in the pre-registration period, the reduction of the death rate was undoubtedly the predominant influence during the past three centuries. On the second point, it is noted that there is no direct evidence of improvement in nutrition during the eighteenth and early nineteenth centuries. The case for its significance, which is circumstantial, is threefold: this explanation is consistent with present-day experience of infectious diseases; it accounts for the growth of population in many countries at about the same time and, when extended to include improved hygiene and limitation of numbers, it attributes the decline of infections to modific...

Prenatal and Early Postnatal Influences on Measured Intelligence

In larger mammals natural selection has led to reduction of litter size and prolongation of the period of gestation. Even in human pregnancy, which is normally single, gestation is prolonged beyond the time when the growth of most fetuses can be fully supported. This conclusion is based on comparison of prenatal and postnatal growth rates. The lengthening of pregnancy may be related to the selective advantages of maturity at birth, particularly, in man, the development of immunity to infectious disease. Verbal reasoning scores recorded in the 11-plus examination provide no evidence that the retarded prenatal growth associated with prolongation of gestation affects measured intelligence. There are considerable score differences in a general population of births in relation to birth weight and duration of gestation; but, like the larger differences related to maternal age and order of birth, they are not found in sibs. Still more suggestive is the finding that twins raised singly from birth have scores higher than twins raised together and little lower than those of single births. This indicates that even the pronounced retardation of fetal growth which occurs in twin pregnancy has little effect on verbal reasoning, the large differences between twins and single births being due to postnatal experience.

A Scheme for the Care of the Aged and Chronic Sick

Formerly it was laid down as a cardinal principle that operation should be considered only after a full course of medical treatment had been tried and failed. Such a standpoint can no longer be maintained. On the one hand, few patients can now afford the time and cost of a full course of medical treatment, involving as it does a lengthy period of rest in bed with a prolonged convalescence, on a diet which, to be adequate, must prove quite expensive. On the other hand, operative treatment is far less of a hazard than formerly. Owing largely to improvements in anaesthesia and in medical care before and after operation, the risk to life is now very small, while with a proper selection of cases there is a strong prospect of speedy convalescence and quick return to full health and strength. In considering the advisability of operation, attention must be given to the duration and severity of the symptoms, to the economic disablement they cause, and to the presence or probability of complications such as haemorrhage and pyloric stenosis. In gastric ulcer the question of malignancy also arises. Ulcers in the prepyloric region are especially dangerous. In this area the diagnosis between benign and malignant ulcers is by no means easy, whether based on clinical or radiological criteria or on gastroscopic examination, and, even though benign at the time of examination, such an ulcer is liable to malignant change. Though it is now agreed that the frequency of this development is not high, nevertheless it is sufficient to demand consideration. In suspicious cases operation should be advised at once, while even in cases of undoubted benignity operation should be advised if complete healing has not been achieved within a few months. The treatment of the bleeding peptic ulcer is too big a problem to consider here, but it will be agreed that a history of previous haemorrhages must always weigh the scales in favour of operation. Pyloric stenosis also, though sometimes capable of a good deal of relief by medical measures, is usually to be regarded as a clear indication for operation. In uncomplicated cases the decision to operate should be based on the severity of the symptoms, and it must be borne in mind that the best results are generally to be expected in patients with a long history and much pain. Among other criteria nocturnal pain and deep boring pain penetrating to the back are regarded as indications for surgical treatment.

The Next Forty Years in Public Health.

Abstract In this article an attempt is made to assess the major health problems of the second half of the twentieth century in developed countries, the methods appropriate to these problems, and the pattern of medical services necessary to deal with them. From an examination of mortality and morbidity trends it is suggested that the most important problems are likely to be the mortality, malformation and disability established before birth, mental illness, and the disease and disability associated with ageing. Reasons are given for doubting whether control of breeding, the method which has contributed greatly to the improvement of plants and other animals, can be expected to be effective in the case of man, and hence reliance must continue to be placed on modifications of the environment to which achievement hitherto has been entirely due. The methods likely to be significant are: an extension of measures already in use for control ofthe physical environment; discovery and application of knowledge concern...