In 1988 I argued that a careful reappraisal of the nineteenth-century historical epidemiological evidence, which Professor Thomas McKeown derived from the Registrar-General's decennial supplements, showed that it did not, after all, support the view that he had championed. I demonstrated that for the purposes of the argument McKeown was making, it was invalid to combine together all the airborne infectious diseases as a single category as evidence in favor of the principal conclusion that McKeown drew, that rising living standards and per capita nutritional intake was the single most important source of falling mortality in nineteenth-century Britain. I then argued for an alternative thesis, which emphasized the importance of social intervention, mainly in the form of a steadily increasing momentum, from the late 1860s onwards, in the range and penetration of public health and preventive measures, including (but not synonymous with) municipal sanitation. Although the exact timing and character of these increasing interventions were influenced by much local government mediation and negotiation, by the Edwardian period even the inhabitants of the working-class home itself, and not merely the streets outside, were subject to public health efforts and were fast becoming aware of a new appreciation of the health implications of different forms of behavior.

The plausibility of this reinterpretation depended critically on placing McKeown's epidemiological evidence for the Victorian period, valuable as it is, within the context of the most important other relevant historical information available, regarding Britain's demographic, economic, social, and political history.