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Death and the Metropolis offers a powerful analysis of demographic patterns in London over the 'long eighteenth century', concentrating on mortality but also including data on marital fertility, population structure and migration. The study is based on a variety of sources including weekly and annual Bills of Mortality, parish registers and Quaker vital registers, and employs the techniques of family reconstitution and aggregative analysis. The data are analysed within the framework of a structural model of mortality change comprising the proximate determinants of exposure to, and resistance against, infectious agents on the the part of populations. Within this framework a model is established describing the specific demographic and epidemiological characteristics of early modern metropolitan centres. The evidence indicates that mortality in London was much higher than in other settlements in England for most of the period, but declined steeply in the later eighteenth century. This apparently reflected changes in exposure to infections.
Fertility in animals reflects access to scarce resources, such as food and territory. In humans the situation is more complex. Patterns of breast feeding, contraception and ideas about age at marriage and desired family size all affect fertility. The relation between these and access to scarce resources such as housing and employment, via income, education and other factors that affect status, is explored. In this book, the gap between socio-ecology and population demography is bridged, by showing how animals and humans adjust their fertility to environmental conditions.
Rapid innovations and improvements in communication technologies have opened many new channels for health education and delivery, as well as disaster management. Theme 2 examined the role and applicability of these technologies to Disaster Medicine and Management and the various issues involved in their use.
Methods:
Details of the methods used are provided in the introductory paper. The chairs moderated all presentations and produced a summary that was presented to an assembly of all of the delegates. The chairs then presided over a workshop that resulted in the generation of a set Action Plans that then were reported to the collective group of all delegates.
Results:
Main points developed during the presentations and discussion included harnessing convergence, seeking interoperability, building partnerships and making it appropriate. This group identified four Principles of Action underlying its plan: (1) investigate possibilities, (2) identify stake-holders, (3) invite participation, and (4) involve discussants in activities.
Discussion:
Action plans were categorized into three areas that included “thinking globally, acting regionally”, forming a telehealth advisory group, and increasing corporate partnerships.
Conclusions:
Technology is opening many opportunities that have applications in disaster management. To optimize benefits, goals and standards must be agreed upon and implemented.
There has as yet, however, been little detailed research into the explicitly quantitative incidence of disease, or of specific infections, in the late eighteenth and nineteenth centuries.
(Luckin 1980: 54)
In the preceding sections we have considered the pattern of aggregate vital data from eighteenth-century London and tried to estimate the prevailing levels of fertility and mortality. The results generally bore out the ‘high potential’ interpretation of metropolitan epidemiology, but if we are to pursue this question any further we must move from a study of the ‘output’ variable – the medium-term level of mortality – to one of the ‘internal’ character of the regime itself. This involves a consideration of the intermediate mortality variables, their structure and inter-relationships, together with London's pathogenic load over our period.
The latter is, of course, crucial for the proximate explanation of mortality patterns in any population, but assumes prime importance when we consider relationships between metropolitan epidemiological regimes and those of their hinterlands. The HPM portrays the former as endemic reservoirs of infection – sources of epidemic crises in the hinterland – whose distinctive character reflects quantitative differences in the incidence of infections common to both metropolis and hinterland, rather than the action of diseases peculiar to the former. In particular, the model implies that excess urban mortality arose substantially from infections communicated from person to person, either directly or by the action of arthropod vectors.
The increased importance of the ‘Autumn diseases’ (see chapter 7) in the seasonality of mortality during the central decades of the eighteenth century coincides with the epidemics of ‘putrid sore throat’ described by a number of contemporary physicians. These appear to have been part of a regional pandemic which affected much of the Atlantic world from its appearance in New England in 1735–7 (Dobson 1989b: 282). As described by Creighton (1894: 698–9) it first struck England late in 1739, but was not associated with severe excess mortality until the outbreak of 1746, after which it continued throughout the 1750s before disappearing in the subsequent decade.
The exact nature of the condition remains obscure, but contemporary descriptions, such as that of Fothergill (quoted in Creighton 1894: 698–9), strongly suggest that it was a form of streptococcal throat infection. This possibility can be investigated to a limited degree using the cause-specific burial totals from the annual Bills of Mortality. Since the streptococci in question are also responsible for puerperal fever (Loudon 1987), the hypothesis would lead us to expect a closer relationship between maternal mortality and fever mortality (the cause of death series whose seasonality seems to have been most affected) during the decades 1730–59 than either before or after.
The results of a principal components analysis carried out on the correlation matrix of cause-specific CMRs (see below) lend some support to this hypothesis.