Szreter S
St John's College, Cambridge, UK
Soc Hist Med. 1994 Aug;7(2):269-82. doi: 10.1093/shm/7.2.269.
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.
在《医学社会史》的上一期中，苏米特·古哈发表了对斯雷特（1988年）提出的论点的批判。斯雷特认为，社会干预措施的权重增加和多样性增加，是19世纪70年代以来英国死亡率下降的主要原因。随着政治、社会以及科学方法逐渐改变，尽管方式因地区而异，但此前被忽视且有害的城市、工厂乃至家庭环境都得到了改善。事实证明，古哈的批判从根本上就是错误的，因为它基于这样一种假设，即18世纪和19世纪英国的疾病生态基本相同。这忽视了近期在17世纪和18世纪英国历史流行病学和人口统计学方面的重要研究。总之，有人认为，古哈所呈现的一些信息实际上进一步支持了斯雷特（1988年）的解释的合理性，而非麦克基翁的论点。
