Trends in Morbidity and Mortality

By Skye Coronel

The life of George McDonald, a 19th-century writer, was greatly affected by tuberculosis. His mother died of pulmonary tuberculosis, while he survived various bouts of the disease himself. His fourteen-year-old half-sister Isabella, his father, and his brother all died from the disease in a span of about 4 years. Four of George’s children died later in his life (Brownell). Clearly tuberculosis could have a very big impact on a person’s life. However, this is only one story of the effects of tuberculosis on an individual.

This disease was of epidemic proportions, particularly in England. Because of the rapid spread and progression of tuberculosis, researchers in the nineteenth century worked to determine what aspects of a person’s lifestyle or environment resulted in an increased susceptibility to tuberculosis. They determined that unsanitary conditions, “immoral living, alcohol and tobacco consumption, along with various developmental crises in the host’s physical well-being such as puberty or childbirth” (Johnston). According to James Collins, the decline in tuberculosis mortality in England and Wales was related to “improved nutrition, reduction in exposure to infectious and parasitic diseases, and medical measures” and each of these factors was the dominant influence in certain time periods (Collins).

Even though researchers determined there were ways to prevent the contracting of this disease, tuberculosis still caused 1 out of 8 deaths in England in 1901 (Acton). Autopsies from London and other major cities indicated almost 100% of the population experienced tuberculosis at some point in their lives (Johnston). In 1941, the number of deaths caused by tuberculosis peaked. After classifying deaths from tuberculosis into pulmonary and non-pulmonary tuberculosis, death rates began to differ. According to the table below from a Medical Officer of Health report from 1946, the rate of deaths caused by pulmonary tuberculosis and tuberculosis as a whole began decreasing from the 1930s to 1946 while no clear pattern for non-pulmonary tuberculosis death rates was evident (Heston and Isleworth 1946).

Graph displaying data table showing descending pulmonary and total tuberculosis death rate trend from Heston and Isleworth 1947 per 100,000 population table
Table from the Wellcome Library website showing tuberculosis death rates in Heston and Isleworth from 1930-1947.

Treatment for pulmonary tuberculosis, streptomycin, was discovered and made available after 1947 (Collins). According to the table found in the London County Council 1958 document below, both death rates for pulmonary and non-pulmonary tuberculosis decreased from 1949 to 1958 (London County Council 1958).

Graph illustrating the data below from the London
County Council 1958
document with a descending trend of pulmonary tuberculosis annual death rates per 1,000 living
Table from the Wellcome Library website London County Council 1958 document showing statutory notifications and death rates from 1949-1958

Interestingly, pulmonary tuberculosis was more prevalent in London in 1949 when comparing the rates of civilian deaths from pulmonary and non-pulmonary tuberculosis in London and the entire country of England. This is due to the larger population density of the city of London in comparison to the rest of the country. This allows for easier transmission of this often air borne disease among individuals. Occupations involving the release of particles into the air, such as “textile mill laborers, masons, pottery factory operatives, and metal grinders” increase the likelihood of inflammation of one’s lungs and an increased risk of contracting tuberculosis (Johnston). The factories in big cities like London also contributed to the spread of this disease because stress and exhausting physical work increases an individual’s risk of contracting tuberculosis (Johnston). The non-pulmonary tuberculosis death rate was higher in England and Wales. The specific death rates can be seen in the table below.

Table from the Wellcome Library website London County Council 1949 document showing the difference in rates of death from pulmonary and non-pulmonary tuberculosis out of 1,000 deaths for London and the whole country of England

Some of these trends in mortality can be explained by external factors such as “better case-finding and increased chronicity of lung tuberculosis” (London County Council 1950). Other trends demonstrate the spread of non-pulmonary tuberculosis infections through impure milk supplies in London and the improvement in said milk supplies resulting in a corresponding decrease in non-pulmonary tuberculosis cases and deaths (London County Council 1950).

Tuberculosis not only affected individuals all over England, but also people of all age groups. According to the table below, most individuals died from pulmonary tuberculosis between the ages of 25-45 years old.

Table from the Wellcome Library website Croydon 1946 document showing the ages individuals died from pulmonary tuberculosis

Although the table above does not show many children were affected by pulmonary tuberculosis from 1938-1946, in 1930, researchers carefully studied over 140 children who were discharged from treatment for pulmonary tuberculosis. Thirteen of the children died from pulmonary tuberculosis and, after post-mortem examination, were found in various conditions. One had “deposits throughout the right lung and at left apex” while others experienced miliary tuberculosis, pleurisy, meningitis, pleural effusion, and many other ailments (London County Council 1936). Most young children affected by tuberculosis were afflicted with tuberculous meningitis mostly due to transmission from bovine to humans in the home (London County Council 1950).

Tuberculosis was rampant in individuals of all ages throughout England during the 20th century. Impure milk supplies in London, the high population density in cities, and the professions of individuals in these cities aided in the spread of this deadly disease. Improved sanitation, research, and medical knowledge helped gradually reduce the mortality and morbidity rates.

References

Primary Sources:

Medical Officer of Health for Acton. Acton 1901. Wellcome Trust, 2019. Accessed October 22, 2019.

Medical Officer of Health for Heston and Isleworth. Heston and Isleworth 1946. Wellcome Trust, 2019. Accessed October 22, 2019.

Medical Officer of Health for Heston and Isleworth. Heston and Isleworth 1947. Wellcome Trust, 2019. Accessed October 22, 2019.

Medical Officer of Health for Croydon. Croydon 1946. Wellcome Trust, 2019. Accessed October 22, 2019.

Medical Officer of Health for London County Council. London County Council 1936. Wellcome Trust, 2019. Accessed October 22, 2019.

Medical Officer of Health for London County Council. London County Council 1949. Wellcome Trust, 2019. Accessed October 22, 2019.

Medical Officer of Health for London County Council. London County Council 1950. Wellcome Trust, 2019. Accessed October 22, 2019.

Medical Officer of Health for London County Council. London County Council 1958. Wellcome Trust, 2019. Accessed October 22, 2019.

Secondary Sources:

Brownell, Robert. “The Dark Shadow“: Consumption (tuberculosis) in the families of nineteenth-century writers. Last modified 2013.

Tuberculosis. Cambridge University Press, 2008.

Collins, James. “The Contribution of Medical Measures to the Decline of Mortality from Respiratory Tuberculosis: An Age period-cohort Model.” Demography 19, no. 3 (1982): 409-27.