Whether more doctors inevitably meant better health is another question. Until fairly recently it was customary to assume, without going very deeply into details, that it did. Indeed, the common interpretations of the demographic changes of the eighteenth and early nineteenth century depended very largely on this assumption. Recently, however, some disbelief has been cast on this assumption. McKeown and Brown, in a now famous article, insist that there were no medical advances in the eighteenth century likely to reduce the death rate more than marginally; that all surgery in that period was highly lethal, so that the more surgery there was, the higher would mortality become; that institutional confinement was associated with far higher maternal death rates than was domiciliary confinement on account of the higher risk of puerperal infection, so that the spread of lying-in hospitals involved an increase rather than a reduction of the death rate; and that the eighteenth- and early nineteenth-century hospitals spread infection, thus increasing a patient's prospect of dying from a disease other than the one he entered a hospital to have cured. They quote with approval Florence Nightingale's dictum that the first requirement of a hospital was 'that it should do the sick no harm,' and conclude that 'the chief indictment of hospital work at this period is not that it did no good, but that it positively did harm.' It followed that not until the basic principles of bacteriology were understood (a development of the last quarter of the nineteenth century) could any reduction of the death rate through the work of doctors and hospitals be expected. [Source: E. W. Flynn?]

Last modified 1989