Andrew Doig - This Mortal Coil - A History Of Death (Bloomsbury, 2022) ***

Andrew Doig is Professor of Biochemistry at the University of Manchester. He studied Natural Science and Chemistry at the University of Cambridge, and Biochemistry at Stanford University Medical School. He became a lecturer in Manchester in 1994, where he has been ever since. In "This Mortal Coil", he gives an overview of how disease resulting in death impacted society throughout the ages. It is not about how people perceived death or how the concept of death changed throughout history. The subtitle would have been more accurate if it had been "The History of Medicine". 

The book's title comes from the famous Hamlet speech of "To Be or Not To Be", “What dreames may come, When we haue shufflel'd off this mortall coile, Must giue vs pawse.”

Doig is a scientist, not a historian, but that shows more in the second part of the book. The first part gives overviews of what people died from, based on the first epidemiological data, however basic they may have been, and with the sometimes impossible challenge to understand what the actual disease was in today's jargon. He also gives an overview of how the science evolved, how disease was looked upon, but also the first breakthroughs in medicine itself. The essence of the following story was known to me, but not with this much detail. 

"In 1796 a milkmaid called Sarah Nelmes came to Edward Jenner, a country doctor from Gloucestershire, with a rash on her right hand. Sarah told Jenner that one of her Gloucester cows called Blossom had recently been infected with cowpox. Jenner knew that milkmaids often developed blisters on their hands after working with cow udders that were infected with cowpox. Sarah had most pustules on the part of her hand that handled Blossom's udder.6 It was widely believed that milkmaids never got smallpox due to exposure to cowpox, but Jenner resolved to test the old wives' tale directly. He extracted some pus from the blisters on Sarah's hands, which he proceeded to inject into eight-year-old James Phipps, the son of his gardener, giving him a mild case of cowpox. Phipps was then deliberately injected with smallpox on multiple occasions. Fortunately, he was unharmed. 

Jenner followed up this promising result on a hundred other children and himself, again with complete success. In 1798, Jenner published his findings in a book entitled An Inquiry into the Causes and Effects of Variolae Vaccinae6 and named his procedure 'vaccination', after the Latin word for cow: vacca."

Vaccination became a major advance in the decrease of mortality, together with better hygiene and sanitation.  

As another striking example of the progress we made, he also explains how the Chamberlen family kept their invention of the forceps a secret, despite the fact that it saved the lives of many babies and their mothers during childbirth. One interesting story about hygiene in this context is the death rate in the two maternities in Vienna in 1846, one led by physicians, the other by midwives. The former had a 10% death rate, the latter only 4%. The explanation was that the physicians training their students also performed autopsies in between deliveries, without washing hands or sterilising equipment. 

He also emphasises other important factors such as nutrition and the necessary intake of nutrients for cognition, growth and avoiding diseases. Many diseases could be prevented and treated globally by very cheap solutions that are currently not high on the public health agenda. This is not only the case in developing countries, but in my personal opinion also very much the case in our current medical practice even in the richest countries. 

He also expands on the value of the scientific method, with James Lind doing control studies to compare the nutrition of sailors who suffered from scurvy and those who didn't, or John Snow who did one of the first epidemiological studies on cholera in London. 

The book ends with the big health challenges of our time, including the latest high level insights into medical science and its possible solutions. 

Doig's book is well-written, educational and entertaining at the same time.