Population Trends: The Eighteenth Century and Earlier

The proper study of mankind is man.' In its early years angina pectoris was for the most part an affliction of middle-aged and elderly men, almost exclusively a complaint of the affluent and a "British disease".2 It was first reported in 1768 and became prevalent by the 1770s, a time when the population of England was growing rapidly and its expectation of life lengthening. It is therefore pertinent to examine the contribution of these demographic changes together with their wellsprings, magnitude and precise timing in relation to the emergence of angina. Differences in the extent to which the sexes and various age and social groups were affected need to be ascertained and explained if possible. Finally, any demographic explanation for the early geographical localizing of angina must be sought in a comparison of eighteenth-century population changes in England with those occurring elsewhere. Despite high death rates in infancy, childhood and early adult life, many people in earlier centuries did live to middle and even old age. This was the case as long ago as the Classical Era. As an example, some nineteen prominent ancient Greek writers and fifteen Roman historians whose years of birth and death are known with reasonable certainty lived to beyond the age of sixty (Table III.1).3 Longevity was not then the good fortune of the famous alone. W R Macdonell surveyed inscriptions on memorial monuments in ancient Rome and its empire in Hispania and Lusitania, the modern Spain and Portugal respectively, and in Africa, the Morocco, Algeria and Tunisia of today. He showed, inter alia, that the age at death of males and females as recorded on each epitaph was over sixty years in about 5 per cent of the Roman inscriptions, 20 per cent of the Iberian and 22 per cent of the African. The numbers cannot be considered typical of life expectancy in the Roman empire generally. There are discrepancies between the findings in the three areas. The inscriptions appear to refer exclusively to Roman citizens and personal slaves, and therefore they probably memorialize persons of means. The scant number of early ages at death that were recorded on the inscriptions suggest that children who died were rarely remembered in this way (Table III.2).4 The expectation of life in Roman times that Macdonell calculated is very low by