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

Abstract

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 restricted to smallpox and hence had only a trivial effect on the total reduction of the death rate. Reasons for the rise of population In the pre-registration years are discussed in the light of these conclusions. Neither therapy nor sanitary reform made any significant contribution, and It is suggested that the marked and sustained rise In population before 1850 cannot plausibly be attributed solely to a fortuitous shift In the relationship between infectious organisms and the human host. We conclude that, whether more importance Is attached to the birth rate or the death rate, the most significant Influence until 1850 (indeed until 1870) was a rising standard of living.