Humans were once granted three decades or so on earth before shuffling off. But for the past quarter of a millennium, we’ve been living ever longer. Today, 30 is the age when rehearsal stops and serious life begins, but — historically speaking — we’re in extra time. Since the early 1800s in western Europe, for each day that passes, life expectancy increases by another five hours.
The ways we die now are different too. This Mortal Coil is not a history of death itself, but rather an account of its causes. Told in five acts like a Shakespearean tragedy, Andrew Doig’s book considers our vulnerabilities and vices, from typhoid to tobacco. Since humans moved into closer quarters with each other and set about farming animals 10,000 years ago, we have contracted diseases that were never native to our species: plague, smallpox and malaria, among many others. This was, in certain respects, a big mistake. In the 14th century, the Black Death killed up to 60 per cent of the European population. But with advances in sanitation, vaccines and then antibiotics, infectious diseases have appeared to recede while non-communicable killers, such as heart attack and stroke, have soared. We evolved in an environment of food scarcity, but now sugary, salty and fatty snacks are an arm’s length away.
Doig, a professor of biochemistry at the University of Manchester, takes the major causes of death in turn and gives us reasons to be cheerful. We’re therapeutically armed against most infections; smoking has dropped considerably since Richard Doll established a causal link with lung cancer in 1950; cars have become safer; genetic diseases can be screened before birth; and even cardiovascular-related deaths have halved in England since 2001. This sweep of the past includes victorious landmarks, from John Snow’s identification of the Broad Street pump water supply as a source of cholera in 19th-century London, to Edward Jenner’s 1796 experiment with a milkmaid whose cowpox pustules were sampled to create one of the world’s earliest vaccines.
It’s a compelling story that is made admirably accessible. While Doig does discuss social factors that contributed to these successes, science is the hero. Complex processes are elegantly explained, from chromosomal abnormalities to how mutations in DNA lead to cancer. Doig brings energy to the unpromising subject of disease classification, the foundation of modern epidemiology. His writing shows particular sensitivity when telling the history of the Samaritans phone line, set up by a Church of England curate in the 1950s, which has improved suicide rates in Britain and beyond.
But This Mortal Coil is also a story with striking omissions. Doig’s history welcomes the gore and horror of the “searchers of the dead”, women who would traipse through parishes in the 16th century checking corpses to determine what killed them, yet seems squeamish about more recent contentions around our exits and entrances. Miscarriages are discussed but abortions are not. Doig does not mention the Holocaust. HIV/Aids is a passing remark. There is no word on eugenics or euthanasia.
The thornier, uglier realities of medical technologies and potential pitfalls of progress are glossed over. Philosophical and practical thresholds of death, which are increasingly contested in the UK — namely, should doctors assist to end patients’ lives? — are not included either. Of course, no book with such an ambitious scope can be comprehensive, but neither should it turn away from these critical debates.
The book is optimistic about longevity, though this remains unlikely for many people in many places who are still dying from infectious diseases, which have not gone away and are getting worse due to antibiotic resistance. Focusing on lifespan downplays the importance of “healthspan”, the years when we consider our body and mind to be working well. Perhaps before another scientific revolution, our ageing population needs greater social dignity and practical support, without which those hard-won final years gifted by modern medicine are burdened by invalidity and invisibility.
This Mortal Coil: A History of Death by Andrew Doig, Bloomsbury, £25, 384 pages
Kate Womersley is an NHS doctor and researcher
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