Mortality in England in the eighteenth and the nineteenth centuries: a reply to Sumit Guha.

In the last issue of Social History of Medicine, Sumit Guha published a critique of the thesis presented in Szreter (1988), which argued that an increasing weight and diversity of social interventions were primarily responsible for the reduction in Britain's mortality achieved from the 1870s. Previoiusly neglected and harmful urban, factory, and eventually even home environments were improved, as both political and social as well as scientific approaches gradually changed, albeit in a locally diversified manner. Guha's critique is shown to be fundamentally misguided because it is premissed on the assumption that the disease ecologies of eighteenth- and of nineteenth-century England were essentially comparable. This ignores important recent research in the historical epidemiology and demography of seventeenth- and eighteenth-century England. In conclusion, it is suggested that some of the information presented by Guha in fact further supports the plausibility of the interpretation in Szreter (1988), rather than the McKeown thesis.