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14580 results in History of Medicine

Page 132 of 729

  • 11 - Cardiovascular Disease

  • Alexander Mercer, Independent researcher and the author of Disease, Mortality and Population in Transition: Epidemiological-Demographic Change in England Since the Eighteenth Century as Part of a Global Phenomenon
  • Book:
    Infections, Chronic Disease, and the Epidemiological Transition
    Published by:
    Boydell & Brewer
    Published online:
    14 March 2018
    Print publication:
    30 December 2014, pp 141-162

  • Summary

    The main focus in the next three chapters is on changes in death rates from major chronic diseases in the context of a greatly changed infectious disease environment. Although major epidemic diseases such as smallpox, typhus, typhoid, and cholera had ceased to cause high mortality and were largely eliminated from England by the end of the 19th century, many other acute infectious diseases of childhood and the chronic infectious disease tuberculosis remained prevalent. The main epidemic diseases of childhood and common respiratory and gastrointestinal infections continue to be prevalent today, although most are generally not life threatening in industrialized countries or case fatality is extremely low. Some of the acute infectious diseases convey immunity, and a specific immune response will occur whenever the microorganism is contracted throughout life. This might tend to be overlooked as the immune response prevents acute infection, although there can be biophysiological consequences that are potentially harmful, either in the short run or cumulatively. Many common viruses and bacteria are now known to be associated with particular forms of chronic disease, including the cardiovascular diseases considered in this chapter.

    Bearing in mind the dramatic reduction in death rates from major epidemic diseases that had already occurred by the 1870s, cardiovascular diseases became increasingly predominant as death rates from acute infectious diseases, tuberculosis, and respiratory diseases declined (fig. 11.1). Together with the increase in the death rate from cancer, this constitutes much of the shift in cause of death that has occurred in the epidemiological transition. Cardiovascular disease and other chronic diseases are more likely to occur at older ages, and their growing predominance was linked with increased longevity resulting from the decline in infectious disease death rates. A study of the transition in Italy recognized that the distinction between communicable and noncommunicable disease is not clear-cut as infections are involved in the pathogenesis of many chronic diseases. Evidence of association between microorganisms and chronic diseases previously regarded as noncommunicable, with causality established in some cases, clearly has implications for any theory of epidemiological transition.

  • 10 - Respiratory Diseases

  • Alexander Mercer, Independent researcher and the author of Disease, Mortality and Population in Transition: Epidemiological-Demographic Change in England Since the Eighteenth Century as Part of a Global Phenomenon
  • Book:
    Infections, Chronic Disease, and the Epidemiological Transition
    Published by:
    Boydell & Brewer
    Published online:
    14 March 2018
    Print publication:
    30 December 2014, pp 131-140

  • Summary

    The continuous decline in the period death rate from respiratory tuberculosis in the second half of the 19th century contrasts with an increase in the death rate from other respiratory diseases (mainly bronchitis and pneumonia) from the 1840s to the 1870s. The respiratory disease death rate then leveled off in the 1870s and 1880s until the influenza pandemic of 1889–91, which affected all age groups (figs. 10.1 and 10.2). Apart from this epidemic, the general trend over the period 1875–1915 reflects changes in the bronchitis death rate, which declined from the 1890s, while the long-term decline for pneumonia began around 1905 (figs. 10.3 and 10.4). Trends for subcategories are likely to have been affected to some extent by changes in classification of the primary cause of death. The trend in the respiratory disease death rate at ages 45–64 was relatively unaffected by transfer of recording from the “old age” and “ill-defined” categories, although there may have been some transfer of diagnosis from respiratory tuberculosis in the second half of the 19th century. Although the death rate among adults declined, the downturn in the death rate at all ages from the 1890s reflects a decline among young children (0–4 years) in particular (fig. 10.2). After the 1890s, the total respiratory disease death rates declined for males and females, apart from World War I years and in the major influenza pandemic of 1918 (fig. 10.1). After World War II, the death rate for females leveled off while that for males increased, most likely due to higher prevalence of cigarette smoking.

    A review of trends in death rates from respiratory disease in the 20th century focused on three categories because of changes in classification: asthma, pneumonia, and chronic obstructive pulmonary disease or COPD (chronic bronchitis, emphysema, bronchiectasis, bronchial catarrh, and other obstructive airway diseases). The COPD death rate at ages 15–74 declined steadily with a more rapid decline after the 1960s, which probably reflects the decline in cigarette smoking among older men. The risk of chronic respiratory disease is affected by smoking and other irritants, as well as recent severe acute respiratory infections; however, it is also partly determined by experiences earlier in life. The study found that the long-term trend in period mortality was superimposed on a declining trend over successive cohorts born in the second half of the 19th century.

  • 8 - Child Mortality

  • Alexander Mercer, Independent researcher and the author of Disease, Mortality and Population in Transition: Epidemiological-Demographic Change in England Since the Eighteenth Century as Part of a Global Phenomenon
  • Book:
    Infections, Chronic Disease, and the Epidemiological Transition
    Published by:
    Boydell & Brewer
    Published online:
    14 March 2018
    Print publication:
    30 December 2014, pp 101-117

  • Summary

    In the mid-19th century, about 60% of deaths among children aged 1–4 years were attributed to airborne infectious diseases and respiratory diseases that were mostly caused by microorganisms. Many of the airborne infectious diseases still common among unvaccinated children in Western countries were frequently fatal in the 19th century. As in developing countries today, children in large families with poor living conditions and inadequate nutrition, would have been at high risk of dying from a series of interrelated or concurrent airborne, respiratory, and other acute infectious diseases. The adverse effect of malnutrition on mortality risk from infectious diseases is well known, and malnutrition can itself be caused by infectious disease as a result of reduced food intake or impaired digestive mechanisms. The association of malnutrition with over half the cases of measles and diarrheal disease in developing countries reflects this two-way relationship. Both measles and whooping cough have independent epidemic cycles, reflecting sociodemographic factors, the immunity gained by survivors, and the time required for replenishment of the “pool of new susceptibles.” In the 19th century, the streptococcal disease scarlet fever usually occurred later in childhood, causing particularly high mortality at ages 1–4 years.

    Child Mortality Decline

    Although infant mortality contributed little to the decline in the overall death rate in the second half of the 19th century in England and Wales, a decline in the child (1–4 years) death rate contributed significantly. Among the childhood diseases, scarlet fever was the biggest arithmetic component of mortality decline, contributing -0.12 to each unit of change in the total death rate (all ages) between 1848–54 and 1901, and -0.04 between 1901 and 1951, while whooping cough contributed -0.02 and -0.03, and measles -0.01 and -0.03, respectively. There was a clear turning point in the child death rate in the mid-1860s, after which it declined consistently apart from fluctuations predominantly caused by scarlet fever epidemics (fig. 8.1).

    The main diseases that contributed to the decline in child mortality from the mid-1860s were scarlet fever, typhoid and other fevers, cholera and diarrheal diseases, tuberculosis, whooping cough, and smallpox.

  • Introduction

  • Alexander Mercer, Independent researcher and the author of Disease, Mortality and Population in Transition: Epidemiological-Demographic Change in England Since the Eighteenth Century as Part of a Global Phenomenon
  • Book:
    Infections, Chronic Disease, and the Epidemiological Transition
    Published by:
    Boydell & Brewer
    Published online:
    14 March 2018
    Print publication:
    30 December 2014, pp 1-7

  • Summary

    The decline in mortality from infectious diseases has been one of the most significant changes in human history leading to unprecedented increases in life expectancy. There is an expectation in industrialized countries that almost all children will grow up to adulthood and that most people will live at least eighty years despite the high incidence of chronic diseases. Heart disease, stroke, cancers, diabetes mellitus, ulcers, diseases of the kidneys and liver, and other chronic diseases cause much debility, long-term sickness, and “premature” death, which to some extent detracts from the sense of progress in health that has come with the control of infectious diseases. The epidemic diseases that caused high mortality in the 18th and 19th centuries generally resulted in acute short-term sickness, which was often fatal, particularly in the early years of life, while the major chronic infectious disease, tuberculosis, caused high mortality among adults. Infectious diseases restricted average life expectancy to 30–40 years in England and other European countries. A change in the predominant causes of morbidity and mortality from acute infectious diseases and tuberculosis to other chronic diseases among adults, concomitant with increasing life expectancy and a higher proportion of older people in the population, characterizes the epidemiological transition. This term distinguishes the process from Abdel Omran's original concept, “epidemiologic transition,” which included phases and models of change. Inadequate definition of disease categories, lack of consideration of disease etiology, and other aspects of Omran's theory have been criticized, and many refinements have been made. Nevertheless, the basic concept of epidemiological transition is widely accepted as a framework for analysis of long-term changes in disease and mortality.

    A major objective of this study is to review the emergence of chronic diseases, the now predominant causes of death in industrialized countries, in the context of dramatic changes in the infectious disease environment. The study focuses on the epidemiological transition that occurred in England from the 18th century onward. This is distinct from an earlier change in the predominant infectious diseases when humans first began to live in settled communities during the “Neolithic Revolution,” and a further phase of the global transition in which new infectious diseases have emerged and old ones have reemerged as a threat in recent decades, mostly as a result of human action.

  • 14 - Epidemiological Transition: A New Perspective

  • Alexander Mercer, Independent researcher and the author of Disease, Mortality and Population in Transition: Epidemiological-Demographic Change in England Since the Eighteenth Century as Part of a Global Phenomenon
  • Book:
    Infections, Chronic Disease, and the Epidemiological Transition
    Published by:
    Boydell & Brewer
    Published online:
    14 March 2018
    Print publication:
    30 December 2014, pp 203-222

  • Summary

    Changes in Disease, Mortality, and Life Expectancy

    Human beings have been adapting to invasive microorganisms contracted in different environments throughout their history, and long before the existence of microbes was known. The recent epidemiological transition has occurred very late in human history, along with urbanization and industrialization in the last three hundred years. Earlier changes in the predominant way of life exposed humans to new infectious diseases that challenged the immune system and people's ingenuity as they sought to avoid or prevent them. A transition in disease patterns occurred when microorganisms transferred to humans as a result of following herds of animals for food. Later, during the long period of the “Neolithic Revolution,” the development of crop cultivation enabled people to live in more settled communities alongside domesticated animals, thus increasing exposure to new infections. Living in villages and eventually towns led to infection with airborne, waterborne, and food-borne microorganisms that were able to adapt to humans as suitable hosts. Human settlement also resulted in new microbial hazards due to living in close proximity to animal and human waste, which could be more easily avoided in a nomadic way of life. Fecal contamination of water and food led to new waterborne and gastrointestinal infections. The increase in size of centers of population brought further changes in the infectious disease environment, with airborne viruses such as measles and smallpox causing regular epidemics among those with no immunity, or becoming endemic where populations were sufficiently large and concentrated. Infectious diseases spread as a result of migration from areas of high prevalence, via rural-urban migration, as a result of increasing contact between people in rural areas and towns, and through trade. Human beings had evolved for a very different way of life of hunting and gathering, and adaptation to a “modern” way of life is still far from complete.

    This study of changes in disease and mortality in England since the 17th century indicates the continuing importance of the infectious disease environment despite the dramatic decline in death rates from acute infectious diseases and tuberculosis, as many of the chronic diseases that have replaced them as the predominant causes of death have confirmed or suspected infectious etiology.

  • 4 - Mortality Decline, Food, and Population Growth: “Standard of Living” and Nutrition

  • Alexander Mercer, Independent researcher and the author of Disease, Mortality and Population in Transition: Epidemiological-Demographic Change in England Since the Eighteenth Century as Part of a Global Phenomenon
  • Book:
    Infections, Chronic Disease, and the Epidemiological Transition
    Published by:
    Boydell & Brewer
    Published online:
    14 March 2018
    Print publication:
    30 December 2014, pp 48-57

  • Summary

    Despite many limitations of the records showing cause of death and some degree of inaccuracy in the level of cause-specific mortality, the historical data indicate that infectious diseases predominated in the mid-18th century when overall mortality began to decline in England and other parts of Europe. Wrigley and Schofield's analysis of aggregated data from several hundred parishes in England confirmed the findings of earlier studies that mortality in England declined from the mid-18th century. All of the 11 severe mortality crises (30% above trend) occurred before 1750, and the last secondary crisis (20–30% above trend) was in 1762–63. After 1802–3 there were only two years in which mortality was more than 10% above the trend level, in 1846–47 and 1848–49. Figure 4.1 shows the dramatic change in the pattern of annual fluctuations in the crude death rate from the 1740s, and the greatly diminished spikes in annual mortality compared with earlier years. The death rate had generally been lower than the birthrate between 1540 and 1640, and population may have approached the limit that could be fed given the land available and the state of agricultural technology. Although there does not appear to have been an increase in subsistence crises, the increase in demand would have led to increased food prices, exacerbating poverty. From the 1740s, the more rapid population growth put further pressure on food supplies, which had to be increased just to maintain existing levels of average consumption per capita.

    Wrigley and Schofield found that short-term variations in mortality were determined by factors other than food supply and there was little correlation between food supply and mortality over the long run. Using their aggregate data, Fogel found that less than 10% of “crisis mortality” (50–100% above normal) in England between 1541 and 1871 was due to famines, and that the decline in mortality was not due primarily to a reduction in “crisis mortality,” whether caused by famines or not.

  • 1 - Background

  • Alexander Mercer, Independent researcher and the author of Disease, Mortality and Population in Transition: Epidemiological-Demographic Change in England Since the Eighteenth Century as Part of a Global Phenomenon
  • Book:
    Infections, Chronic Disease, and the Epidemiological Transition
    Published by:
    Boydell & Brewer
    Published online:
    14 March 2018
    Print publication:
    30 December 2014, pp 8-18

  • Summary

    The decline in mortality from the mid-18th century in England and other European countries and the more rapid growth in population that occurred up to the mid-20th century have been the subject of investigation and debate among historians, geographers, economists, demographers, and medical specialists. Attention has focused on the relative importance of different factors, such as treatment, care of the sick, measures to control and prevent infectious diseases, living conditions, “standard of living,” nutrition, and changes in the nature of some diseases. Historians and economists have considered the decline in mortality in the context of agricultural and industrial revolutions leading to improvements in food supplies and expansion of economic activity. Studies of the relationship between food supply and death rates in the period leading up to the mortality transition have indicated that many epidemic diseases caused spikes in mortality that were independent of the effects of famine and poor harvests. In earlier premodern times, changes in the infectious disease environment were linked with great transformations in the way of life of humans, particularly the development of agriculture and adaptation to living in settled communities. Eventually urbanization and large-scale migrations led to new ways of living in very different environments, while trade and changes in population size and density brought exposure to new pathogens, different infectious diseases, and changes in the immunological status of individuals and populations.

    Industrial development and economic growth in Western countries eventually brought many improvements in living conditions, but the concept of “standard of living” is too general to provide a satisfactory explanation for the decline in mortality and increased life expectancy. It reflects the values of particular sections of society, cultures, and historical periods and masks factors specific to the decline in mortality from particular diseases. It is clearly important to distinguish the specific changes in people's lives that contributed to improved survival chances. In the limited sense of people's own economic circumstances and access to food, shelter, and other basic needs, the concept of “standard of living” can generate hypotheses that are testable with reference to specific indicators.

  • 3 - A New Infectious Disease Environment

  • Alexander Mercer, Independent researcher and the author of Disease, Mortality and Population in Transition: Epidemiological-Demographic Change in England Since the Eighteenth Century as Part of a Global Phenomenon
  • Book:
    Infections, Chronic Disease, and the Epidemiological Transition
    Published by:
    Boydell & Brewer
    Published online:
    14 March 2018
    Print publication:
    30 December 2014, pp 34-47

  • Summary

    Human history has been marked by significant migrations and adaptation to new methods of survival, with consequences for the infectious disease environment, health, longevity, and population. This chapter briefly outlines evolutionary changes in the human condition that led to agriculture, the growth of towns, and exposure to new infections, and considers the infectious disease environment in England when the long-term decline in mortality began. The infectious diseases that contributed to high mortality in the 18th century and the relationship of mortality decline to population growth and food supply are a particular focus. Population increased despite adverse changes in the infectious disease environment, and survival was dependent on immune defenses as well as food supplies. The importance of immunity may be less obvious now that infectious diseases in Western countries are relatively mild and appear to cause few deaths, although immune responses to invasive microorganisms occur continuously throughout life, whether or not there is any discernible acute sickness. In some cases the immune response can become less efficient with age, while other microorganisms, or the immune response to them, can have adverse biophysiological consequences resulting in chronic disease.

    Although microorganisms causing some of the infectious diseases that were major killers in the 17th and 18th century are no longer prevalent in England, other common microorganisms continue to cause childhood epidemic diseases, respiratory infections, and gastrointestinal disorders. Some of these microorganisms are associated with chronic diseases that are now major causes of death. Although environmental, socioeconomic, lifestyle, and behaviorrelated risk factors contribute to the development of these diseases, common microorganisms have been confirmed as causal agents in some chronic diseases, while the involvement of infection in the underlying biophysiological processes in other chronic diseases is strongly suspected. Some chronic disorders have been linked with long-term effects of childhood infections or exposure to microorganisms during adult life, which will be considered in chapters 10–13 along with the issue of the criteria that can be applied to assess causality. At this stage, the possibility of infections being involved in chronic diseases can be borne in mind in considering evolutionary changes that have affected humans, their infectious disease environment, and their immune responses.

  • Preface

  • Alexander Mercer, Independent researcher and the author of Disease, Mortality and Population in Transition: Epidemiological-Demographic Change in England Since the Eighteenth Century as Part of a Global Phenomenon
  • Book:
    Infections, Chronic Disease, and the Epidemiological Transition
    Published by:
    Boydell & Brewer
    Published online:
    14 March 2018
    Print publication:
    30 December 2014, pp ix-xii

  • Summary

    Much has been written since the 1970s about the causes of the decline in mortality from infectious diseases, but far less about the emergence of chronic diseases. When Abdel Omran first referred to the change in predominant causes of death as an “epidemiologic transition,” academic studies tended to focus more on issues raised by Thomas McKeown in his influential book The Modern Rise of Population. McKeown's emphasis on improvements in the “standard of living” and nutrition as key determinants of increased life expectancy aroused considerable controversy, while Omran's “theory” of transition remained a basically descriptive framework for analysis of changes in disease and mortality. The epidemiological transition is ongoing globally, and constitutes a fundamental change in the human condition; as such, the phenomenon has both contemporary relevance and historical importance.

    One objective of this book is to review evidence from local, national, and international studies indicating that preventive measures and changes in behavior played a far greater role in mortality decline in England and globally than McKeown or Omran suggested. However, the aim is to go beyond the controversy over the relative importance of “human intervention” and “standard of living” as determinants of increased life expectancy. Assessment of changes in disease and mortality in England since the 18th century and their possible causes is fundamental to an understanding of how contemporary patterns of disease emerged. A very long-term perspective is particularly important as it encompasses the development of a preventive approach to disease in response to devastating epidemics of plague, smallpox, and typhus that laid the foundation for later health interventions. Records of cause-specific mortality available for England, with supporting data from other Western countries, form the basis of this review of the epidemiological transition and illustrate its main features—acute infectious diseases being superseded by chronic diseases as the predominant causes of death, a shift in age at death from childhood to older adult ages, increased life expectancy, and a larger, “aging” population.

    A central theme of the book is the interrelated nature of diseases, particularly the role of microbial infection in chronic diseases, which indicates there is another dimension to epidemiological transition. The original concept oversimplified the process, viewing it as the replacement of one group of distinct diseases (infectious) by another (“degenerative” or “noncommunicable”).

  • 2 - Theoretical Framework, Data, and Study Outline: The Concept of Epidemiological Transition

  • Alexander Mercer, Independent researcher and the author of Disease, Mortality and Population in Transition: Epidemiological-Demographic Change in England Since the Eighteenth Century as Part of a Global Phenomenon
  • Book:
    Infections, Chronic Disease, and the Epidemiological Transition
    Published by:
    Boydell & Brewer
    Published online:
    14 March 2018
    Print publication:
    30 December 2014, pp 19-33

  • Summary

    The original concept of “epidemiologic transition” outlined by Omran in 1971 focused attention on extremely important changes in cause of death. The infectious diseases that had caused very high mortality among children and adults in the past had been replaced as the main causes of death in industrialized countries by chronic diseases among adults assumed to be noninfectious in origin. There was much criticism of his concept as a “theory,” and it does appear simplistic in the light of subsequent findings about the etiology of chronic diseases. Patterns of disease, mortality, and life expectancy are more complex than a simple shift to predominantly chronic diseases as infectious disease mortality declined. Nevertheless, despite criticisms and revisions of the phases of “epidemiologic transition,” it has provided a framework for comparison of secular trends and profiles of disease in different populations. An objective of this study is to develop a perspective on historical changes in disease and mortality that goes beyond descriptive accounts of different phases of transition, takes into account disease etiology and the interrelationships between diseases, and contributes to an understanding of how contemporary patterns of disease have come about.

    Omran's first formulation of his theory consisted of five propositions, which can be summarized as follows:

  • 1. “Mortality is a fundamental factor in population dynamics.”

  • 2. “A long-term shift occurs in mortality and disease patterns whereby pandemics of infection are gradually displaced by degenerative and man-made diseases as the chief form of morbidity and primary cause of death.”

  • 3. “The most profound changes in health and disease patterns obtain among children and young women.”

  • 4. “The shifts in health and disease patterns that characterise the epidemiologic transition are closely associated with the demographic and socioeconomic transitions that constitute the modernisation complex.”

  • 5. There are three basic models of the “epidemiologic transition” corresponding to the experience of most Western countries, countries such as Japan where the transition was more rapid, and developing countries where the decline in mortality commenced more recently.

Page 132 of 729