Thursday, 7 April 2016

Expectancy of life?

[Warning: this post contains quotes from a 1914 textbook using terms which are today highly offensive]

Earlier this week, I took a rare trip to our university library (a sad indictment of current academic life in itself), and found there a copy of “Mental Deficiency (Amentia)”, the 1914 second edition of a clinical textbook by Alfred Tredgold, one of the principal architects of eugenics for people with learning disabilities in the UK. This textbook was immensely influential, and ran through several editions over a number of years.

In this post I don’t want to offer any general observations on this book, as historians and social theorists have done a much better job of this than I could. As I was going through some of it (I couldn’t face reading it cover to cover as I was feeling distinctly nauseous), I noticed a relatively short section on mortality, including some data. Although the information is limited, it gives a point of comparison between then (around 1910) and recent information from the Confidential Inquiry ( ) roughly a century later.

In the table below is information for the median age of death (the age at which half of a group of people will have died) for people with learning disabilities (from Tredgold for 1910 and the Confidential Inquiry for 2010), compared to the general population (the source for this is the quite brilliant Office for National Statistics website ).

1910 (ish)
Median age of death
People with learning disabilities
15-19 years
64 years
General population
61 years
82 years

What can we learn from this?

  • First, the median age of death for people with learning disabilities a century ago was 15-19 years – 15-19 years – a full 44 years younger than the general population.
  • Second, over a century the median age of death for people with learning disabilities has increased hugely, by roughly 47 years, to 64 years.
  • Third, although the gap in median age of death has reduced over the past century, the median age of death of people with learning disabilities is still a full 18 years younger than the general population. If these trends were to continue (and this is wildly simplistic for all sorts of reasons), equality in age of death between people with learning disabilities and the general population would be achieved by 2080 (when the median age of death would be, erm, 96 years…).

Why do I think it’s worth writing a post about this? Well, here’s what Alfred Tredgold had to say about mortality in his 1914 textbook (page 149):

“The physical welfare of the ament of to-day is the subject of far more care and attention than was the case a few generations back. Then many perished who, under present conditions, would have survived; and there can be no doubt than modern medical and surgical practice, together with advances in preventive medicine, have diminished the mortality rate, not only of the fit, but of the unfit also. Nevertheless, the vitality of aments as a class is decidedly inferior to, and their expectation of life still remains appreciably less than, that of the ordinary population.”

Remember, he was writing this at a time when half of people with learning disabilities were dying before reaching the age of 20. From a medical professional, this is a self-fulfilling expectancy of a shortened life - would he have expected, demanded, worked strenuously to find out why people were dying (in his book he reports data showing that the most common cause of death for people with learning disabilities was tuberculosis at an astonishing 40%, but focuses his attention on the ‘nervous system’ as the most important factor implicated in people’s deaths)? 

Would he have thought all the resources of a health service should be put at the service of people with learning disabilities, as they should be for everyone else? Would he have predicted (or thought desirable) an increase of almost 50 years in the median age of death of people with learning disabilities over the next century?

My last thought for this blog is that, with some changes in terminology, that 1914 quote could just as easily be uttered by some medical practitioners today, and indeed can be seen in some of the NHS Board papers that @GeorgeJulian has been investigating. The circle of inaction is completely sealed – there’s no need to investigate why people with learning disabilities are dying younger, and do anything about it, because they die younger. Shorter life expectancy is just that – an expectancy that life will be short, by those who are in the best position to do something about it.


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