ABSTRACT
There is some dispute about when the Great Mortality Shift began. It was thought that the increase in longevity at birth began in the middle of the nineteenth century when public health efforts to clean the environment began, but there is a growing agreement that it started earlier. Because of uncertainty about birth and death records before the nineteenth century there is no widespread agreement about an exact start time. In many histories of medicine, the increase in longevity is claimed to have begun after the passage of the first Public Health Act of 1848 in England and is attributed to Edwin Chadwick, the father of public health. He found that highest mortality rate of infants and young children occurred in cities where sanitation was the poorest and the lowest rate was in rural areas with more clean water and less contaminated sewage. In the early and barbarous periods, the excessive mortality was accomplished by a prodigious fecundity.
