4 research outputs found
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Cholera as a 'sanitary test' of British cities, 1831-1866.
The malign contribution of northern industrial cities to the stagnation of national life expectancy over the period 1820-1870 forms part of one of the most long-running debates in English economic history, regarding the impact of early industrialisation on living standards. The deteriorating quality of urban water supplies often features in these arguments as the key driver of worsening mortality in this period. Here we use mortality reported from cholera in the epidemic years 1831-1832 and 1848-1849 as an indicator of the extent of sewage contamination of water in English and Welsh towns in this period. Surprisingly, the geography of reported mortality did not indicate that northern manufacturing and industrial towns were especially deficient in this respect. However, logistic regression analyses identified a number of risk factors for high cholera mortality, including location on coal-bearing strata, which was a feature of many industrial towns. Notably, however, textile-manufacturing towns, although often located in coal-rich districts, were associated with low levels of cholera mortality, and high population growth rates did not influence the risk of cholera. Reductions in cholera mortality after 1849 raise the possibility of widespread improvements in water quality after mid-century, rather earlier than is often assumed. However, in contrast to cholera, infant and diarrhoeal mortality remained high especially in northern towns until at least 1900. Several lines of evidence suggest that infants were relatively protected from waterborne diseases such as cholera and typhoid, and therefore did not benefit greatly from improvements in water quality. We conclude (1) that any worsening of water quality in urban areas c.1800-1850 was not confined to newÍ› or rapidly growing industrial or manufacturing towns; and (2) infants probably rarely drank untreated water, so high infant or diarrhoeal mortality rates should not be read as indicators of poor water quality, in the English context
The geography of smallpox in England before vaccination: A conundrum resolved.
Smallpox is regarded as an ancient and lethal disease of humans, however very little is known about the prevalence and impact of smallpox before the advent of vaccination (c.1800). Here we use evidence from English burial records covering the period 1650-1799 to confirm a striking geography to smallpox patterns. Smallpox apparently circulated as a childhood disease in northern England and Sweden, even where population densities were low and settlement patterns dispersed. However, smallpox was a relatively rare epidemic disease in southern England outside the largest cities, despite its commercialised economy and the growing spatial interconnectedness of its settlements. We investigated a number of factors hypothesised to influence the regional circulation of smallpox, including exposure to naturally occurring orthopox viruses, settlement patterns, and deliberate preventative measures. We concluded that transmission was controlled in southern England by local practices of avoidance and mass inoculation that arose in the seventeenth and eighteenth centuries. Avoidance measures included isolation of victims in pest houses and private homes, as well as cancellation of markets and other public gatherings, and pre-dated the widespread use of inoculation. The historical pattern of smallpox in England supports phylogenetic evidence for a relatively recent origin of the variola strains that circulated in the twentieth century, and provides evidence for the efficacy of preventative strategies complementary to immunisation
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Infant-feeding practices and infant survival by familial wealth in London, 1752-1812.
Anecdotal evidence indicates that high-status women in England generally did not breastfeed their children in the seventeenth and early eighteenth centuries. Metropolitan families of varied social status also often sent their children out of London for wet-nursing. However, anecdotal sources and rural burial registers also suggest that these practices declined rapidly from the mid-eighteenth century, and were replaced by a culture of maternal breastfeeding in all social classes. These changes in infant-feeding practices have been argued to explain much of the dramatic improvement in infant mortality rates in London in this period. Here we used quantitative evidence from a partial family reconstitution of the London parish of St. Martin in the Fields to test these claims. Using birth interval analysis to infer breastfeeding patterns in families by four categories of wealth, we found that birth intervals were close to the national average in pauper and poor families, but much shorter in wealthier families, in the period 1752-74. We also found evidence that many infants especially in wealthier families were missing from observation, consistent with high levels of rural wet-nursing. Both these phenomena declined between 1775 and 1812, suggesting a convergence in breastfeeding practices to the national norm. We used event history analysis, with corrections to aggregate rates for missing infants, to compare mortality rates over time and by wealth category. We found that infant mortality was initially higher in wealthier families, but declined in all groups over the period 1752-1812. We conclude that increases in maternal breastfeeding were probably important in improving survival of infants from wealthier families, however changes in breastfeeding patterns were insufficient to account for the ubiquitous improvements in mortality of urban-born infants in this period