Although the nineteenth century witnessed many improvements in therapeutic medicine, most medical historians have tended to accept the view that these improvements made only a small contribution to the decline of mortality. McKeown argued that approximately one-third of the overall decline in mortality during the second half of the nineteenth century was caused by a decline in the incidence of water- and food-borne diseases, which he attributed to the impact of Victorian sanitary intervention, and that approximately 44 per cent of mortality decline was associated with a reduction in the death rate from airborne diseases, which he attributed to improvements in diet and nutrition.1 This chapter explores the history of this debate, and examines the development of the campaign to improve public health from the late-eighteenth century onwards.
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