The birth and death rates in England and Wales are known with greater certainty after 1837, and the continued growth of the population was in part because of the excess of births over deaths and in part because of a continuing decline in mortality (McKeown & Record, 1962). By the mid-19th century, over half of the population of Britain could be classified as urban and there is clear evidence of a rising standard of living during the second half of the century, with rising real wages, a falling cost of living (Woods & Woodward, 1984) and a fall in food prices (Woodward, 1984). Imports of meat trebled between 1870 and 1890 and the imports of butter and margarine more than doubled between 1880 and 1890 (Cronje, 1984). However, there is no positive evidence to show that there was any increase in the heights or weights of school children; working-class diets were still composed principally of carbohydrates and any movement towards proteins was limited to small increases in the consumption of dairy products rather than meat (Oddy, 1982).

McKeown & Record (1962) concluded that the amelioration of the effects of infectious diseases made the predominant contribution to this decline in mortality in Britain in the 19th century and the following diseases had the most important effects:

1. Tuberculosis: the progressive improvement in the standard of living had the dominant influence, although some workers (Burnet, 1953) have suggested that the elimination of susceptible individuals must have had a profound influence on the history of the disease.

2. Typhus: the virtual elimination of typhus from England and Wales is attributed to an improvement in the standard of living.

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