University of Minnesota

Wartime Mortality and Pathology

Haqvin Malmros of Malmö and Lund, Sweden, was an internist in the classical mold, trained in the biochemistry of diseases and having a keen interest in nutrition and metabolism. In 1950, he published a report about the spectacular wartime changes in CVD deaths in Scandinavia (Malmros 1950). Others had made similar reports, recounted below, but Malmros made the important assumption that diagnostic custom and medical care changed little in Scandinavia during World War II; therefore, the dramatic downward trend in reported CVD mortality of the war years was probably real. And, he further assumed, if real, it was probably due to wartime privations, among which he postulated decreased dietary fat consumption. The sharp decrease in wartime consumption of meat and dairy fat was well documented.

Malmros’s report had an abrupt and wide influence. Ancel Keys, for example, immediately made contact and invited him on his early Mediterranean exploratory travels in 1952 and to a 1955 conference on atherosclerosis at his Minnesota laboratory. They became closer over time as their separate findings confirmed their diet-heart ideas.

Others in Europe found a similar wartime picture of falling cardiac mortality, including direct evidence of reduced arterial pathology as the war and its privations lingered on in Finland, Norway, Germany, and the Netherlands (Vartiainen and Kanerva 1947, Strom and Jensen 1951, Aschoff 1924, and Schornagel 1953). These independent reports, using different measures of the burden of vascular disease, indicated an unusually large, direct, and abrupt environmental impact on CVD death rates and, as well, on the fundamental arterial disease itself. These demonstrations of change, derived from different systems of vital statistics, the clinic, and pathology, served to heighten medical and public health awareness of the coronary epidemic. They pointed sharply to its mutability and hinted broadly at its causes.

We learned in our oral interviews made for this history that these dramatic findings of wartime and post-war variations in CVD events influenced powerfully those pioneers who had begun to explore the epidemiology of CVD, particularly Ancel Keys and Jerry Morris , and also enlightened those modern pathologists who had begun to compare population distributions of atherosclerosis, including the teams of Holman-McGill-Strong and of Wissler (Keys 1989, McGill 2001, Morris 2001, Strong 2001 and Wissler 2001). These observations led, as had the early Russian experimental findings, to a greatly renewed interest in the dietary and environmental influences on atherosclerosis. (Henry Blackburn)


Aschoff L. 1924, Lectures on Pathology. Hoeber, New York.

Ancel Keys, in an interview recorded by Richard Shekelle, 31 March 1989. History of Cardiovascular Epidemiology Archive, University of Minnesota.

Malmros, H. 1950, ‘The relation of nutrition to health: a statistical study of the effect of the war-time on arteriosclerosis, cardiosclerosis, tuberculosis and diabetes’. Acta Medica Scandinavica Supplementum, vol. 246, pp. 137-153.

McGill, Henry Jr., in an interview recorded by Darwin Labarthe, 21 March, 2001.
History of Cardiovascular Epidemiology Archive, University of Minnesota.

Morris, Jerry in an interview recorded by Henry Blackburn, 3 June, 2002.
History of Cardiovascular Epidemiology Archive, University of Minnesota.

Schornagel, H.E. 1953, ‘The connection between nutrition and mortality from
coronary sclerosis during and after World War II’. Documenta de Medicina Geographica et Tropica 5, 173-183.

Strom, A. and Jensen, R.A. 1951, ‘Mortality from circulatory diseases in Norway 1940-1945’. The Lancet 1, 126-129.

Strong, Jack in an interview recorded by Henry Blackburn, 19 April, 2001. History of Cardiovascular Epidemiology Archive, University of Minnesota.

Vartiainen I. and Kanerva K. 1947, ‘Arteriosclerosis and war-time’. Annales Medicinal Internal Fenniae, 36, 748-758.

Wissler, Robert in an interview recorded by Henry Blackburn, 15 February 2001. History of Cardiovascular Epidemiology Archive, University of Minnesota.