Intended for healthcare professionals

It's Good To Talk

The midwife, the coincidence, and the hypothesis

BMJ 2003; 327 doi: (Published 18 December 2003) Cite this as: BMJ 2003;327:1428
  1. David Barker, professor (
  1. 1University of Southampton, Developmental Origins of Health and Disease Centre, Princess Anne Hospital, Southampton SO16 5YA

    Finding an archive of health records is one thing—and being able to talk your way into accessing them may depend on coincidence

    Development of the hypothesis that adverse conditions in utero and during infancy increase the risk of cardiovascular disease in later life required epidemiological studies of a kind never undertaken before. It was necessary to find records of birth weight and living conditions during infancy for people born at least 60 years ago and to link these to their current cardiovascular health. After a search lasting several years, a large collection of records came to light in Hertfordshire. The existence of this collection was due to the foresight of one midwife, Ethel Margaret Burnside. Getting access to the records, however, was down to a fortunate coincidence, and the subsequent research probably would not be possible today.

    Hertfordshire records

    At the beginning of the 20th century, there was widespread concern about the physical deterioration of the British people. One in 10 infants died before they were a year old, and many of those who survived reached adult life in poor health. During 1902, reports in the national press claimed that up to two thirds of the young men who volunteered to fight in the Boer War in South Africa (1899 to 1902) had been rejected because of unsatisfactory physique. An interdepartmental committee set up in 1903 drew a shocking picture of the nation's children—malnourished, poorly housed, and deprived. Moreover, the birth rate was falling. The medical officer of health for Hertfordshire at around this time stated:

    Hertfordshire does less than forty out of the fifty-five counties to perpetuate the national stock; for England and Wales the birth-rate has for thirty-three years been steadily declining, only two Continental countries (Belgium and France) having lower birth-rates, while that for Japan is increasing and is …

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