the extension of inoculation against smallpox in the last third of the eighteenth century. All of these have been criticized. The
‘gin’ argument seems to have lapsed though the impact of this essentially urban vice on a predominantly rural society has
been overestimated. Town conditions may have improved in some areas but not for the bulk of the population. There is little
to indicate that improvements in standards of public health or personal hygiene contributed significantly to declining
mortality. Changes in the death rate can be explained in both economic and non-economic terms. A rise in real income may
reduce death rates by raising individual food consumption, or by increasing the funds available to public authorities for public
health services or better housing. Changes in dietary patterns or land tenure can produce similar results without changing real
income. The introduction of the potato, especially into Ireland and Highland Scotland, may have had this effect. Rising standards
of nutrition have been seen as the single most significant cause of declining mortality rates since the mid-eighteenth century.
Falling Irish death rates have been seen as due, wholly or partially, to the introduction of the potato. In Scotland rising real
wages enabled people to eat better, a situation assisted by improvements in marketing food supplies. In England, too, rising
standards of nutrition have been given considerable credit for the decline in mortality. But the evidence for changes in diet is
notoriously difficult to interpret.
The most important reason for the varying decline in mortality—the reduction in deaths from infectious diseases both
endemic and epidemic —has also been criticized. In 1955 two medical historians, McKeown and Brown, challenged the
prevailing views on the demographic impact of medical improvements. But Michael Flinn stated that ‘It may be that
epidemiology rather than economics may explain some of the fluctuations in mortality…’.
5
Tranter suggests that the reduction in mortality was the result, first, of forces which were independent of improvements
made by people to their own condition and environment and, secondly, of influences over which people did have control.
6
Human resistance to disease as well as the replacement of the black by the brown rat led to plague ceasing to influence
mortality. The natural virulence of the large number of infectious diseases seems to have been reduced between the mid-
eighteenth and mid-nineteenth centuries, though urban expansion saw a resurgence of water-borne diseases, especially
cholera, ‘the new plague’.
There may well have been pathological reasons for this but falling death rates were primarily the result of individuals’
efforts to improve their conditions. In the eighteenth and early nineteenth centuries there was an impressive increase in
facilities for medical assistance. The number of voluntary general and specialist hospitals and dispensaries funded by private
charity and providing free treatment and medicine was expanded. In Ireland seven voluntary hospitals were opened in Dublin
between 1718 and 1773. By 1804 there was at least one general infirmary in each county and, by 1845, 632 dispensaries. In
Scotland a similar process was evident. In England 33 voluntary hospitals were founded between 1720 and 1800 and dispensaries
were treating over 50,000 patients a year in the London area by 1800. The extent to which the new medical services
contributed to the decline in death rates depended on whether they treated illnesses prominent among the main causes of death
and whether the treatments were effective. Medical advance was as much the result of guesswork as scientific knowledge and
surgical techniques were conservative. It was the introduction of inoculation and vaccination against smallpox and the
increasing practice of isolating victims of infectious diseases that made the greatest contribution to declining death rates.
Immunization against smallpox was introduced into England in the early eighteenth century, but became common only after
the 1760s as a result of safer methods of inoculation pioneered by the Sutton family. By the early nineteenth century
inoculation, together with Edward Jenner’s new technique of vaccination, provided effective methods for combating the
major killer disease of the eighteenth century. Even before vaccination was made compulsory in 1852—it was not legally
enforceable until 1871—there had been a considerable reduction in the risk of smallpox as a cause of death. In 1750 smallpox
accounted for about 16 per cent of all deaths but only 1–2 per cent by the mid-nineteenth century.
There is little consensus on the causes of falling death rates.
7
In 1970 M.W.Flinn wrote that ‘The problem of explaining the
decline of mortality…remains largely unsolved.’ Fifteen years later N.Tranter said that The only safe conclusion that can be
reached about the rise in life expectancy…is that its causes were diverse…. For the period between the mid-eighteenth and
mid-nineteenth centuries the degree of uncertainty is still greater.’
Birth rates
The birth rate measures the number of births per thousand of the population over a given period of time (usually a year). Such
a rate is the function of three main variables: the ratio of births to women of child-bearing age; the ratio of women of child-
bearing age to the total population; and the proportion of women of child-bearing age who marry. Fertility, by contrast, is
defined as the physiological ability of men to impregnate and of women to conceive and bear healthy children. Until the
1950s the view that population expanded in the eighteenth century as a result of the reduction of the death rate was not
seriously challenged. Recently, the belief that rising fertility was the major element in Britain’s demographic growth has
found persuasive support.
Fertility in pre-industrial societies was overwhelmingly marital. Changes in the age of marriage therefore had an important
impact on the birth rate. Connell suggested that falling age of marriage and thus rising fertility was chiefly responsible for the
SOCIETY AND ECONOMY IN MODERN BRITAIN 1700–1850 23