The history of health care in Mittenälvsborg – then, now and afterwards

The period until about 1800 can be denoted as a time when the Swedish economy was in a bad state. The population was then entirely dependent on agriculture. The majority lived on the margin and were extremely sensitive to reverses in the form of wars and poor weather that often resulted in crop failure and a year of famine. Deficiencies in industry, hygiene and the residential environment made people susceptible to various diseases and epidemics. This period can therefore be called the era of epidemics and famines. These factors caused considerable increases in mortality. The mortality was about 30 per 1000 inhabitants with peaks in the middle of the 1700s of 55 per 1000, and in the beginning of 1800s of 40 per 1000.

The period 1800-1920 was characterized by the epidemics and famine's still being in the picture. Smallpox, dysentery, cholera and typhus ocurrred at longer and irregular intervals during most of the 1800s, but the trend was clear. The mortality peaks were no longer so high or so common. The improvement in people’s health was clearly demonstrated in medical statistics. Between the 1800 and 1920 the average life expectancy increased in Sweden from 37 to 60 years. Women lived on average somewhat longer than the men.
The growth towards a longer average length of life was the same to both sexes.
An important underlying explanation was that mortality earnestly begun to fall during the first decades of the twentieth century.
This was the beginning of a trend against increased length of life.

At the beginning of the nineteenth century, the infant mortality (i.e. mortality in the first year of life) was still very high. In the years around 1820 one baby in four died in Sweden, but a hundred years later, fewer than one in ten died. During this period, the infant mortality accounted for much of the total mortality. At the start of the 1800s, there was a large difference in mortality town and countryside. Depending on population density and sanitary, economic and social circumstances, mortality was substantially higher in the towns compared with the countryside. However. during the 1800s the towns developed better sanitation. It was also in the towns that the medical organisation was first built up. This was reflected in a strongly falling mortality in towns. Although the mortality also decreased in the countryside, it took place more slowly, accounting for people surviving longer in the towns than in the countryside.

The above-mentioned factors contributed to a reduced the risk of epidemics. In the years around 1900, those big epidemics, as had earlier hit Sweden, had substantially played out their role. However, tuberculosis was not yet under control. Certain, more sporadic epidemics would also become more prominent, such as the Spanish influenza pandemic in 1918, and poliomyelitis on many occasions in the 1900s. To sum up, the period 1800 to 1920 can therefore be called the “era of diminishing epidemics”. A popular movement against tuberculosis was started and the first sanatoria were built as a private initiative at the start of 1900s, with the county council later taking responsibility.

The end of the 1800s and the beginning of the 1900s saw great developments in knowledge about causes of disease and thereby also their treatment. The midwives' numbers were increased as was their knowledge. Vaccination against smallpox was successful. The number of district doctors increased at a slow rate and were relieved of much administrative work when the first medical officers of health took these on. The politicians better informed about how the society could be helped to avoid the epidemics, and what could contribute to improving the public health as above mentioned.