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5 - The spectrum of death, disease and medical care

Published online by Cambridge University Press:  18 December 2009

Mary J. Dobson
Affiliation:
University of Oxford
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Summary

I propose therefore, in imitation of the geographers, to spread out and to review, in one general chart, the enormous host of diseases which disgorge their virulence over the earth, and, with frightful rapacity, wage incessant hostilities with mankind.

(Black, 1788, p.56)

AIRS, WATERS AND PLACES – LOCAL VARIATIONS IN MORTALITY AND THE SEARCH FOR EXPLANATIONS

The topographers who traversed the English countryside, the physicians who visited the sick, the vicars and parishioners who experienced or watched the toll of disease and dying in their local parishes were acutely aware that life's chances varied according to place. Their perceptions, their descriptions and their crude attempts to quantify such observations have now been matched against our more refined mortality statistics (Figure 5.1). Levels of mortality did vary dramatically across the topographical divides of south-east England and they varied according to the ‘airs’ and ‘waters’ of different ‘places’ in ways that had been clearly recognised since the sixteenth century (Figure 1.1). Some places were notoriously unhealthy, their mortality levels exceptionally high. Other places were refreshingly healthy and their death rates remarkably low. Our statistical analysis shows that infant mortality rates could reach over 300 per 1,000 in one place and remain below 100 per 1,000 in another. Life expectancies at birth may have ranged from 20s to 30s in some parts of the south-east English countryside and, yet, elsewhere, have exceeded forty or even fifty years by the early nineteenth century (Figure 5.1 and Tables 4.1 to 4.6). Autumn could prove unusually mortal to the unhealthy environments and, yet, remain favourable to others (Figure 4.10).

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Publisher: Cambridge University Press
Print publication year: 1997

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