Five days of coal smoke
This counter is a slow disease of the lungs. The week that makes the harm visible was over in five days.
This counter is chronic lung disease, rounded to 4 million deaths a year. Most of that is the illness in which the airways narrow and the lung is slowly destroyed, usually called COPD. Asthma is in the same slot. Pneumonia is not. Pneumonia is an infection, and it is counted on the card above this one.
The story that makes the harm visible happened too fast to be that chronic disease. It is still the right story, because it shows what air does when a city breathes it together.
Five days
From 5 to 9 December 1952, London, in England, sat under a lid of cold air. Coal smoke from house fires, power stations and factories had nowhere to go. Visibility fell to a few yards. People who were well found it hard to breathe. People who were already ill started to die. At the time, the deaths did not look like a single event. They looked like a bad week of pneumonia and heart disease, which is how they were certified. The excess only became obvious once the registrations were added up.
A Ministry of Health committee later compared those weeks with the weeks before, and with the same weeks in earlier years. Their best estimate was about 4,000 more deaths than usual, inside a range of roughly 3,500 to 4,000. That figure is the one that entered the official record, and it counts the days of the smog and the stretch immediately after.
It misses the tail. In 2001, Michelle Bell and Devra Davis reworked the mortality through February 1953 and estimated about 12,000 excess deaths from December through February, from the acute days and from effects that persisted. The government had floated influenza as the explanation for the later deaths. A 2004 paper by Bell, Davis and Tony Fletcher tested that and found flu could account for only a fraction, unless the epidemic had been far more severe than the one doctors actually saw that winter. Both numbers belong in the account. Four thousand is what was agreed at the time, for the peak. Twelve thousand is a later estimate of the longer wound. Neither is a count of named victims.
Both cards
The deaths were not only lung deaths. Hospital admissions rose for heart disease as well as for respiratory disease. The same air lands on the cardiovascular counter. A piece about the smog that files every body under “lungs” is filing them in the wrong drawer.
The Clean Air Act was passed in 1956. Towns could declare areas where household smoke was controlled, and dark smoke from industry was restricted. Coal fires did not vanish in a year. A further Act followed in 1968. The pea-souper became a memory. The chronic disease did not.
The fifty years
COPD's main cause, in countries that kept the habit, is smoking. The doctors Doll and Hill followed, already described in the cancer piece, were also dying of this. Where people cook on wood, dung or coal inside the house, that smoke does a similar job, slowly, and mostly to people who never bought a packet of cigarettes. The London week is what the harm looks like when the dose arrives in five days instead of fifty years. The counter is the fifty years.
This is not health advice. It is a story about a population statistic. It says nothing about any one person's risk. If you have concerns about your health, speak to a doctor.
Sources
- The Greater London Authority's account of the Ministry of Health estimate, about 4,000 deaths.
- Bell and Davis, 2001, the reassessment that put the longer toll at about 12,000.
- Bell, Davis and Fletcher, 2004, on why influenza does not explain the later deaths.
- The Clean Air Act 1956.
- The annual figure used on the counter is the Ledger's own rounding, set out on the methodology page.