Urbanization and the urban mortality change in Imperial Germany.

This analysis assesses urban mortality change in Imperial Germany, when the country was going through a process of accelerated industrialization and urbanization. Urban mortality reached its peak after the middle of the century, thereafter urban mortality improved substantially. The largest cities, particularly in the highly industrialized western parts of the country, registered the strongest decline. A key element in this process was the reduction of mortality from gastrointestinal disorders, affecting almost exclusively infants. Therefore this analysis discusses the impact of selected public health strategies designed to fight high infant mortality rates. Special emphasis is placed on municipal milk supply and infant welfare centres.

Does infection affect amputation rate in chronic critical leg ischemia?

BACKGROUND: Aim was to analyze the association between local infection and amputation rate in patients with chronic critical limb ischemia (CLI) with or without successful revascularization. PATIENTS AND METHODS: We performed a retrospective analysis of 56 consecutive patients with 57 critically ischemic legs seen at the University Hospital Bern. Patients with CLI were selected if ischemic lesions and follow-up of more than 2 months were documented. Infection was suggested when 2 of the following criterion were present: temperature > 37 degrees C, C-reactive protein > 50 mg/L, leukocytes > 10 x 10(3)/microliter ("2 of 3" criterion), or a putrid secretion was documented ("secretion" criterion). RESULTS: In patients with successful revascularization (n = 39), there was a significant shift from 10.3% major to 33.3% minor amputations (Chi Square p value = 0.014) as compared to patients without or with failed revascularization (n = 18) with 44.4% and 11.1% (Chi Square p value = 0.008), respectively. An infection was suggested in 22 of 53 limbs (41.5%) according to the "2 of 3" criterion, and 30 of 57 limbs (52.6%) satisfying the "secretion" criterion. Both criteria, were significantly more common in patients undergoing amputation as compared to patients without amputation (p = 0.001). Multiple lesions were more common in patients with major amputations (p = 0.026). CONCLUSION: Successful revascularization effectively reduces major amputations and leads to healing of ischemic ulcers. Secondary foot infections are frequent. Infections are associated with a significantly higher rate of minor and major amputations, also in patients with successful revascularization, and should be treated adequately as well as in time with antibiotics.

[Differences between town and country and evolution of mortality in Germany during industrialization]. / Différences entre ville et campagne et évolution de la mortalité en Allemagne pendant l'industrialisation.

Traditionally cities and towns in historical Europe were perceived as being particularly unhealthy. Terms like 'le handicap urbain' or 'urban penalty' have been introduced in order to emphasize the high death rates in the fast-growing industrial towns of nineteenth century Europe, which significantly exceeded the average rates for rural areas or the whole country. A rising population density was ideal for the transmission of the prevailing infectious diseases. This paper assesses urban and rural mortality change in Imperial Germany, when the country was going through a process of accelerated industrialization and urbanization. It provides an analysis of changes in age-, sex- and disease-specific mortality in urban and rural Prussia. In general, urban mortality in Germany reached its peak after the middle of the century, thereafter urban mortality improved substantially in relative as well as in absolute terms, the gap between urban and rural mortality narrowed and finally disappeared entirely. The largest cities registered the strongest decline in mortality. Obviously they had the potential to overcome the threats of disease or death, and became forerunners of improved health conditions in modern industrialized societies. An analysis of the mechanisms of mortality change in an urban environment during industrialization in the late nineteenth and early twentieth centuries can therefore serve as a paradigm for conditions in highly urbanized industrial societies.

Urban infant mortality in Imperial Germany.

Infant mortality in Imperial Germany started to decline in urban areas from the 1870s onwards, whereas national rates did not decrease before the beginning of the twentieth century. Therefore, key explanatory factors determining the levels and trends of infant mortality are investigated in an urban context. These include the decline of birth rates, the legitimacy status of infants, feeding practices, environmental conditions, and economic growth. Through a rising living standard and by creating a health-preserving environment, urban populations lost their traditional disadvantage in survival chances. This went so far that even high risk factors, such as the abandonment of breastfeeding, could be counterbalanced. In this sense, a study of past urban health conditions functions as a paradigm for the situation in industrialized societies.