Importancia de la viruela, gastroenteritis aguda y paludismo ... - Oulu

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Gastroenteric diseases show an upward trend during most of the period, and seem to
begin to loose importance towards the end of the study period, except for the decade
containing the famine years of 1833 and 1836. The Finnish population experienced,
during the study period, a sustained growth both in the number of inhabitants and in the
degree of urbanization. These two factors are most probably the explanation for the initial
growing tendency, but make it difficult to understand the decreasing tendency mentioned
for the last decades. On the other hand there were no conflicts or important crop failures
at a national level during these last decades of 1820 and 1840, that is, there were no
boosters of gastroenteritis.
This early downwards trend could reflect as well the beginning of a change in the field
of public health, even if the greatest changes in that area did not reach Finland until the
late 19th century (von Bonsdorff 1975). Some authors claim that the decrease might be
related to the campaigns for making the people aware of the benefits of breastfeeding
(Turpeinen 1979, Turpeinen & Kannisto 1997, Kannisto et al. 1999). Considering the
importance of gastroenteritis as a cause of death among children, this explanation might
have some importance.
Fig. 3. Percentage of deaths due to each of the three causes under study by decade.
Smallpox is perhaps the most interesting disease to analyze in the long run.
An initial upward trend can be seen during the first decades, followed by a gradual
decrease, starting approximately in the last years of the 18th century. This phenomenon is
extremely interesting because, even if the general decrease of smallpox in the wide sense
can be attributed to vaccination, this preventive measure was not introduced in Finland
until 1802 and became widespread only well after the Finnish War (Forsius 2004c,
Pitkänen et al. 1989). That means that the decrease of smallpox at the end of the 18th
century and beginning of 19th is due to other reasons than vaccination. This is a complex
phenomenon in which probably several factors are involved. Three of them can possibly
be: