Mortality, public health and medical improvement in Glasgow 1855-1911

Abstract

In the mid-1950's McKeown and Brown advanced a controversial thesis concerning the effectiveness of medical measures available in the eighteenth century. Hitherto it had been widely believed that the rise of population in England and Wales in the eighteenth century had been the result of a fall in mortality partly due to medical improvements such as the growth of hospitals and advances in medical knowledge, a view that had been put forward by Griffith in the 1920's . McKeown and Brown argued that hospitals probably did more harm than good and that contemporary medical treatment with the possible exception of inooculation and vaccination against smallpox, was of little value. They pointed out that surgery, before the introduction of anaesthesia. and antisepsis, was very unsafe and the results of surgical procedures very poor; that in the field of midwifery the introduction of institutional confinements carried greater risks than home deliveries; and that few of the drugs then available were of therapeutic value. They concluded that eighteenth century population growth was not caused by a rise in the birth rate but by a reduction in the death rate probably caused by a decline in the incidence of infectious diseases due primarily to improvements in living conditions and to a lesser extent to changes in the virulence of certain diseases. In a later paper McKeown and Record extended the analysis to 1900 and concluded that the decline in mortality in the second half of the nineteenth century was largely due to improvements in the standard of living, particularly to improvements in diet; hygienic changes introduced by the sanitary reformers accounted for the decline of typhus, typhoid and the diarrhoeal diseases, while changes in virulence of the causative organism accountfor the decline of scarlet fever. They suggested that medical treatment in the nineteenth century had an insignificant impact on mortality; the only effective prophylaxis available was for smallpox and this was responsible for only a small part of the decline in the death rate These conclusions have been questioned; Razzell has argued that the introduction of inoculation against smallpox in the eighteenth century was a major factor contributing to the decline in mortality and Sigsworth, Cherry, and Woodward have stressed from studies of individual hospitals that conditions in voluntary hospitals were better than McKeown and Brown had suggested,, particularly in the late eighteenth and early nineteenth century, that surgical mortality was not as high and that a high proportion of patients were discharged "cured" or relieved". The object of this study is to test McKeown's thesis at the 16cal level by considering the relationship between mortality and hospital, medical, and public health provision in Glasgow 1855-1911. Unlike McKeown's studies, use has been made of detailed local sources relating to the hospital, public health and other medical institutions in the city. Minutes and reports of voluntary hospitals and dispensaries have been examined as well as minutes of committees of two of the Glasgow poorhouses and reports and minutes of the committee of health, the sanitary department and the infectious disease hospitals. Mortality rates in Victorian Glasgow were exceedingly high but they did fall in the period under consideration; despite the evident gross poverty and poor living conditions a considerable saving of life was achieved in the second half of the nineteenth century. This study attempts to identify the major diseases contributing to the mortality decline in Glasgow and in Scotland and to discover how the mortality experience of a large industrial city like Glasgow differed from the national pattern.