Professionalization in Public Health and the Measurement of Sanitary Progress in Nineteenth-Century England and Wales

Social History of Medicine

Volumn 10, Issue 1, 1997, Pages 53-78

  Mooney, Graham ^a  

^a UNIVERSITY OF LONDON   (United Kingdom)

Author keywords

General Register Office; Henry Letheby; London; Medical Officers of Health; Mortality rates; Professionalization; Public health

Indexed keywords

ARTICLE; HISTORY; MORTALITY; PROFESSIONAL PRACTICE; PUBLIC HEALTH; UNITED KINGDOM; VITAL STATISTICS;

GREAT BRITAIN; HISTORY, 19TH CENTURY; MORTALITY; PROFESSIONAL PRACTICE; PUBLIC HEALTH; VITAL STATISTICS;

EID: 0031113685     PISSN: 0951631X     EISSN: None     Source Type: Journal    
DOI: 10.1093/shm/10.1.53     Document Type: Article

References (187)

1. 49th Annual Report of the Registrar-General, 1886 (henceforth ARRG) (London, 1888), p. xx.
2. C. Law, 'The Growth of the Urban Population in England and Wales, 1801-1911', Transactions of the Institute of British Geographers, 41 (1967), 125-43. The percentage urban applies to towns of over 2,500 people.
3. G. Kearns, 'Cholera, Nuisances and Environmental Management in Islington, 1830-55', in W. Bynum and R. Porter (eds.) Living and Dying in London (Medical History Supplement No. 11) (London, 1991), pp. 94-125.
4. At 41 years in 1801, rural inhabitants enjoyed as much as an 11 year advantage in life expectation at birth compared to their urban counterparts. By 1911, this difference was much reduced, with life expectation being 51 years for urban dwellers and 55 years in the country: R. I. Woods, 'The Effect of Population Redistribution on the Level of Mortality in Nineteenth-Century England and Wales', Journal of Economic History, 45 (1985), 645-51. The figures for urban areas apply to places with populations over 100,000.
5. G. Kearns, 'The Urban Penalty and the Population History of England', in A. Brändström and L-G. Tedebrand (eds.) Society and Health During the Demographic Transition (Stockholm, 1988), pp. 213-35.
6. A. Hardy, The Epidemic Streets: Infectious Disease and the Rise of Preventive Medicine, 1856-1900 (Oxford, 1993). For a statement of the original arguments, see T. McKeown, The Modern Rise of Population (London, 1976).
7. A. Hardy, The Epidemic Streets: Infectious Disease and the Rise of Preventive Medicine, 1856-1900 (Oxford, 1993). For a statement of the original arguments, see T. McKeown, The Modern Rise of Population (London, 1976).
8. N. Humphreys (ed.) Vital Statistics: A Memorial Volume of Selections from the Reports and Writings of William Farr (London, 1885), p. 111.
9. See, for example, H. W. Rumsey, 'On Certain Deficiencies in Our Public Records of Mortality and Sickness, with Suggestions for an Improved and Extended National System of Registration', Transactions of the National Association for the Promotion of Social Science (1859), 574-84.
10. For previous work on this theme, see J. Eyler, Victorian Social Medicine. The Ideas and Methods of William Farr (Baltimore, 1979) and S. Szreter, 'The GRO and the Public Health Movement in Britain, 1837-1914', Social History of Medicine, 4 (1991), 435-63.
11. For previous work on this theme, see J. Eyler, Victorian Social Medicine. The Ideas and Methods of William Farr (Baltimore, 1979) and S. Szreter, 'The GRO and the Public Health Movement in Britain, 1837-1914', Social History of Medicine, 4 (1991), 435-63.
12. J. Snow, On the Mode of Communication of Cholera (London, 1855).
13. J. Snow, 'On the Comparative Mortality of Large Towns and Rural Districts, and the Causes by Which it is Influenced', Transactions of the Epidemiological Society of London (1855), 16-24.
14. Epidemiological Society of London, 'Objects of the Epidemiological Society', Transactions of the Epidemiological Society of London (1860-61), 2-7.
15. Eyler, Victorian Social Medicine, pp. 51-2.
16. W. Farr, 'Letter to the Registrar-General', First ARRG, 1838 (London, 1839), Appendix P, p. 76. The origins of Farr's urban/rural comparison lay in actuarial rather than sanitary science. See E. Higgs, 'A Cuckoo in the Nest? The Origins of Civil Registration and State Medical Statistics in England and Wales', Continuity and Change, 11 (1996), 127. Farr was appointed to the staff of the GRO in 1839, where he served successively as the Compiler of Abstracts and the Superintendent of the Statistical Department until his retirement in 1880. For a detailed history of his life and works, see Eyler, Victorian Social Medicine.
17. W. Farr, 'Letter to the Registrar-General', First ARRG, 1838 (London, 1839), Appendix P, p. 76. The origins of Farr's urban/rural comparison lay in actuarial rather than sanitary science. See E. Higgs, 'A Cuckoo in the Nest? The Origins of Civil Registration and State Medical Statistics in England and Wales', Continuity and Change, 11 (1996), 127. Farr was appointed to the staff of the GRO in 1839, where he served successively as the Compiler of Abstracts and the Superintendent of the Statistical Department until his retirement in 1880. For a detailed history of his life and works, see Eyler, Victorian Social Medicine.
18. W. Farr, 'Letter to the Registrar-General', First ARRG, 1838 (London, 1839), Appendix P, p. 76. The origins of Farr's urban/rural comparison lay in actuarial rather than sanitary science. See E. Higgs, 'A Cuckoo in the Nest? The Origins of Civil Registration and State Medical Statistics in England and Wales', Continuity and Change, 11 (1996), 127. Farr was appointed to the staff of the GRO in 1839, where he served successively as the Compiler of Abstracts and the Superintendent of the Statistical Department until his retirement in 1880. For a detailed history of his life and works, see Eyler, Victorian Social Medicine.
19. Szreter, 'The GRO', p. 436.
20. Eyler, Victorian Social Medicine, p. 141. See also, S. Szreter, Fertility, Class and Gender in Britain, 1860-1940 (Cambridge, 1996), pp. 89-91.
21. Eyler, Victorian Social Medicine, p. 141. See also, S. Szreter, Fertility, Class and Gender in Britain, 1860-1940 (Cambridge, 1996), pp. 89-91.
22. 11 & 12 Vict. CAP 63, An Act for Promoting the Public Health (31 August 1848).
23. Humphreys, Vital Statistics, p. 121.
24. Supplement to the 35th ARRG, 1872 (London, 1875), p. lviii.
25. 'Favourable' circumstances were defined as those in which classes of society such as the clergy -who had a life expectation at birth close to 50 years - lived. Ibid., p. 441, Appendix B.
26. Humphreys, Vital Statistics, pp. 150-2 and pp. 491-4. See also H. W. Rumsey, 'On the Value of Life Tables, National and Local, as Evidence of Sanitary Condition', Transactions of the Manchester Statistical Society (1866-67), 1-15. See Szreter, 'The GRO', footnote 17, p. 439, who notes that those districts with a crude death rate rounded down to 17 actually amounted to 62, but the addition of the 63rd lowest gave one tenth of the total number of RDs in England and Wales.
27. Humphreys, Vital Statistics, pp. 150-2 and pp. 491-4. See also H. W. Rumsey, 'On the Value of Life Tables, National and Local, as Evidence of Sanitary Condition', Transactions of the Manchester Statistical Society (1866-67), 1-15. See Szreter, 'The GRO', footnote 17, p. 439, who notes that those districts with a crude death rate rounded down to 17 actually amounted to 62, but the addition of the 63rd lowest gave one tenth of the total number of RDs in England and Wales.
28. Humphreys, Vital Statistics, pp. 150-2 and pp. 491-4. See also H. W. Rumsey, 'On the Value of Life Tables, National and Local, as Evidence of Sanitary Condition', Transactions of the Manchester Statistical Society (1866-67), 1-15. See Szreter, 'The GRO', footnote 17, p. 439, who notes that those districts with a crude death rate rounded down to 17 actually amounted to 62, but the addition of the 63rd lowest gave one tenth of the total number of RDs in England and Wales.
29. The Times (10 August 1863), p. 6.
30. Lancet, ii (1874), p. 633. The GRO's life tables were not even widely used for actuarial purposes. See Higgs, 'A Cuckoo in the Nest?', p. 128.
31. Lancet, ii (1874), p. 633. The GRO's life tables were not even widely used for actuarial purposes. See Higgs, 'A Cuckoo in the Nest?', p. 128.
32. N. Humphreys 'The Value of Death Rates as a Test of Sanitary Condition', Journal of the Statistical Society of London, 37 (1874), 437-77; and John Tripe's comments in the following discussion. At the time, Humphreys was Farr's deputy at the GRO.
33. N. Humphreys 'The Value of Death Rates as a Test of Sanitary Condition', Journal of the Statistical Society of London, 37 (1874), 437-77; and John Tripe's comments in the following discussion. At the time, Humphreys was Farr's deputy at the GRO.
34. A. Ransome and W. Royston, Remarks on Some of the Numerical Tats of the Health of Towns (Manchester, 1863), p. 2.
35. 'Special Issue: The General Register Office of England and Wales and the Public Health Movement 1837-1914, a Comparative Perspective', Social History of Medicine, 4 (1991); A. Hardy, '"Death is the Cure of All Diseases": Using the General Register Office Cause of Death Statistics for 1837-1920', Social History of Medicine, 7 (1994), 472-92; E. Higgs, 'The Statistical Big Bang of 1911: Ideology, Technological Innovation and the Production of Medical Statistics', Social History of Medicine, 9 (1996), 409-26.
36. 'Special Issue: The General Register Office of England and Wales and the Public Health Movement 1837-1914, a Comparative Perspective', Social History of Medicine, 4 (1991); A. Hardy, '"Death is the Cure of All Diseases": Using the General Register Office Cause of Death Statistics for 1837-1920', Social History of Medicine, 7 (1994), 472-92; E. Higgs, 'The Statistical Big Bang of 1911: Ideology, Technological Innovation and the Production of Medical Statistics', Social History of Medicine, 9 (1996), 409-26.
37. 'Special Issue: The General Register Office of England and Wales and the Public Health Movement 1837-1914, a Comparative Perspective', Social History of Medicine, 4 (1991); A. Hardy, '"Death is the Cure of All Diseases": Using the General Register Office Cause of Death Statistics for 1837-1920', Social History of Medicine, 7 (1994), 472-92; E. Higgs, 'The Statistical Big Bang of 1911: Ideology, Technological Innovation and the Production of Medical Statistics', Social History of Medicine, 9 (1996), 409-26.
38. E. Higgs, 'Disease, Febrile Poisons and Statistics: The Census as a Medical Survey, 1841-1911', Social History of Medicine, 4 (1991), 468.
39. Contemporary criticism of this method can be found in E. Willoughby, 'Figures, Facts and Fallacies', Sanitary Record, NS 6 (15 November 1884), 209-11.
40. Not all projections were as accurate as the London one. In three of the 17 largest provincial towns - Liverpool, Birmingham, and Hull - errors in the estimated populations produced crude mortality rates that were underestimated by 2.0, 2.1, and 2.1 per 1,000 respectively. In fact, the Registrar-General's Office was quite prepared to re-adjust the estimates if local authorities could provide sufficient evidence showing that they were obviously incorrect. In the decade 1861-70, revisions upon these grounds were made to the estimates for Leicester, Nottingham, Salford, Bradford, Leeds, and Hull: Humphreys, 'The Value of Death Rates', pp. 460-1.
41. L. Parkes, 'Death Rates as Tests of Healthiness', Sanitary Record, NS 9 (16 April 1888), 473-4.
42. Quoted in Eyler, Victorian Social Medicine, p. 195. Although critical of Farr, Rumsey was in fact a long-standing friend of Farr. On a quinqenmal census, see E. Higgs, 'The Struggle for the Occupational Census, 1841-1911', in R. MacLeod (ed.) Government and Expertise: Specialists, Administrators and Professionals, 1860-1919 (Cambridge, 1988), p. 84.
43. Quoted in Eyler, Victorian Social Medicine, p. 195. Although critical of Farr, Rumsey was in fact a long-standing friend of Farr. On a quinqenmal census, see E. Higgs, 'The Struggle for the Occupational Census, 1841-1911', in R. MacLeod (ed.) Government and Expertise: Specialists, Administrators and Professionals, 1860-1919 (Cambridge, 1988), p. 84.
44. W. Luckin, 'Death and Survival in the City: Approaches to the History of Disease', Urban History Yearbook (1980), p. 55; Hardy, '"Death is the Cure"', pp. 481-2; and W. Luckin and G. Mooney, 'Urban History and Historical Epidemiology: The Case of London between 1860 and 1920', Urban History (forthcoming, 1997).
45. W. Luckin, 'Death and Survival in the City: Approaches to the History of Disease', Urban History Yearbook (1980), p. 55; Hardy, '"Death is the Cure"', pp. 481-2; and W. Luckin and G. Mooney, 'Urban History and Historical Epidemiology: The Case of London between 1860 and 1920', Urban History (forthcoming, 1997).
46. W. Luckin, 'Death and Survival in the City: Approaches to the History of Disease', Urban History Yearbook (1980), p. 55; Hardy, '"Death is the Cure"', pp. 481-2; and W. Luckin and G. Mooney, 'Urban History and Historical Epidemiology: The Case of London between 1860 and 1920', Urban History (forthcoming, 1997).
47. During 1881 in Strand RD and London City RD (both in central London), 35 per cent and 42 per cent of all deaths occurred m institutions: N. Williams and G. Mooney, 'Infant Mortality in an "Age of Great Cities": London and the Provincial Towns Compared, c. 1840-1914', Continuity and Change, 9 (1994), p. 188.
48. Farr subtracted the population and the deaths in the hospitals from the population and deaths of the respective RDs in which the hospitals were located. Next, the hospital population and deaths at each age were redistributed evenly over all the RDs in London. See W. Farr, 'Letter to the Registrar-General', Ninth ARRG, 1846 (London, 1848), p. 160. Normally, however, the institutional death tables presented in each ARRG and the hospital populations given in the published tables of the decennial censuses were not broken down by age. This mathematical approach could therefore only be accurately performed in a census year, since the number of patients in London hospitals varied year-to-year The technique also reallocated the hospital deaths of a particular RD evenly across all the other RDs in the metropolis, thus underestimating the number of deaths to patients from those RDs immediately adjacent to that which contained the hospital. Institutional corrections for ten year totals of deaths appear in the decennial Supplements to the 25th ARRG, 1862 (London, 1864), 35th ARRG, and 45th ARRG, 1882 (London, 1885).
49. Farr subtracted the population and the deaths in the hospitals from the population and deaths of the respective RDs in which the hospitals were located. Next, the hospital population and deaths at each age were redistributed evenly over all the RDs in London. See W. Farr, 'Letter to the Registrar- General', Ninth ARRG, 1846 (London, 1848), p. 160. Normally, however, the institutional death tables presented in each ARRG and the hospital populations given in the published tables of the decennial censuses were not broken down by age. This mathematical approach could therefore only be accurately performed in a census year, since the number of patients in London hospitals varied year-to-year The technique also reallocated the hospital deaths of a particular RD evenly across all the other RDs in the metropolis, thus underestimating the number of deaths to patients from those RDs immediately adjacent to that which contained the hospital. Institutional corrections for ten year totals of deaths appear in the decennial Supplements to the 25th ARRG, 1862 (London, 1864), 35th ARRG, and 45th ARRG, 1882 (London, 1885).
50. In 1882, through consultation with Ogle and Humphreys at the GRO, the Society of Medical Officers of Health had already arranged for the metropolitan MOHs to receive a weekly list of deaths belonging to their districts occurring in institutions across London upon the payment of a small fee. Secretaries' Report, Transactions of the Society of Medical Officers of Health (Session 1882-83), p. 99. Similar corrections by the GRO for institutional deaths in other parts of the country awaited the compilation of special returns by local registrars. Meanwhile, the LGB tried to persuade MOHs to swap information on institutional deaths between themselves, although net 'exporters' of deaths were more enthusiastic about this than net 'importers', who saw the death rate in their district rise as a resuh: Higgs, 'The Statistical Big Bang of 1911', pp. 423-4.
51. In 1882, through consultation with Ogle and Humphreys at the GRO, the Society of Medical Officers of Health had already arranged for the metropolitan MOHs to receive a weekly list of deaths belonging to their districts occurring in institutions across London upon the payment of a small fee. Secretaries' Report, Transactions of the Society of Medical Officers of Health (Session 1882-83), p. 99. Similar corrections by the GRO for institutional deaths in other parts of the country awaited the compilation of special returns by local registrars. Meanwhile, the LGB tried to persuade MOHs to swap information on institutional deaths between themselves, although net 'exporters' of deaths were more enthusiastic about this than net 'importers', who saw the death rate in their district rise as a resuh: Higgs, 'The Statistical Big Bang of 1911', pp. 423-4.
52. 74th ARRG, 1911 (London, 1913), pp. vii-viii.
53. For the technicalities of this process, see E. Higgs, 'The Statistical Big Bang of 1911', pp. 424-5.
54. This course was taken, in large part, to avoid additional expense: G. Mooney, 'The Geography of Mortality Decline in Victorian London', (unpublished Ph.D. thesis, University of Liverpool, 1994), p. 52.
55. Rumsey, 'On Certain Deficiencies', pp. 575-6.
56. One study has shown, for example, that by including West Derby RD with the Liverpool RD -a truer reflection of that city's administrative geography - then the infant mortality rate for 'Liverpool' in the early 1870s falls by around 30 infant deaths per 1,000 live births to below 200 per 1,000: P. Laxton and N. Williams, 'Urbanisation and Infant Mortality in England: A Long Term Perspective and Review', in M. C. Nelson and J. Rogers (eds.) Urbanisation and the Epidemiologic Transition (Uppsala, 1989), p. 113. This definition problem has been given detailed treatment in N. Williams, 'Infant and Child Mortality in Urban Areas of Nineteenth-Century England and Wales: A Record Linkage Study', (unpublished Ph.D. thesis, University of Liverpool, 1989); and G. Kearns, 'Le Handicap Urbain et le Déclin de la Mortalité en Angleterre et au Pays de Galles 1851-1900', Annales de Démographie Historique, (1993), 75-105.
57. One study has shown, for example, that by including West Derby RD with the Liverpool RD - a truer reflection of that city's administrative geography - then the infant mortality rate for 'Liverpool' in the early 1870s falls by around 30 infant deaths per 1,000 live births to below 200 per 1,000: P. Laxton and N. Williams, 'Urbanisation and Infant Mortality in England: A Long Term Perspective and Review', in M. C. Nelson and J. Rogers (eds.) Urbanisation and the Epidemiologic Transition (Uppsala, 1989), p. 113. This definition problem has been given detailed treatment in N. Williams, 'Infant and Child Mortality in Urban Areas of Nineteenth-Century England and Wales: A Record Linkage Study', (unpublished Ph.D. thesis, University of Liverpool, 1989); and G. Kearns, 'Le Handicap Urbain et le Déclin de la Mortalité en Angleterre et au Pays de Galles 1851-1900', Annales de Démographie Historique, (1993), 75-105.
58. One study has shown, for example, that by including West Derby RD with the Liverpool RD - a truer reflection of that city's administrative geography - then the infant mortality rate for 'Liverpool' in the early 1870s falls by around 30 infant deaths per 1,000 live births to below 200 per 1,000: P. Laxton and N. Williams, 'Urbanisation and Infant Mortality in England: A Long Term Perspective and Review', in M. C. Nelson and J. Rogers (eds.) Urbanisation and the Epidemiologic Transition (Uppsala, 1989), p. 113. This definition problem has been given detailed treatment in N. Williams, 'Infant and Child Mortality in Urban Areas of Nineteenth-Century England and Wales: A Record Linkage Study', (unpublished Ph.D. thesis, University of Liverpool, 1989); and G. Kearns, 'Le Handicap Urbain et le Déclin de la Mortalité en Angleterre et au Pays de Galles 1851-1900', Annales de Démographie Historique, (1993), 75-105.
59. 71st ARRG, 1908 (London, 1909), p. vi.
60. 35 & 36 Vict. CAP 79, An Act to Amend the Law Relating to Public Health (10 August 1872), paragraph 6. The Urban Sanitary District was either a borough, an Improvement Act district or a Local Government District, each of which discharged the sanitary duties required by the Act. A summary of the legislation causing subsequent administrative reorganization relating to sanitary matters can be found in W. Frazer, A History of English Public Health, 1834-1939 (London, 1950), p. 212.
61. 35 & 36 Vict. CAP 79, An Act to Amend the Law Relating to Public Health (10 August 1872), paragraph 6. The Urban Sanitary District was either a borough, an Improvement Act district or a Local Government District, each of which discharged the sanitary duties required by the Act. A summary of the legislation causing subsequent administrative reorganization relating to sanitary matters can be found in W. Frazer, A History of English Public Health, 1834-1939 (London, 1950), p. 212.
62. Ibid.
63. 74th ARRG, p. viii. For a deeper exposition of this problem, see Higgs, 'The Statistical Big Bang of 1911', pp. 421-3.
64. 74th ARRG, p. viii. For a deeper exposition of this problem, see Higgs, 'The Statistical Big Bang of 1911', pp. 421-3.
65. 64th ARRG, 1901 (London, 1903), p. xvi.
66. On the decline of fertility, see M. S. Teitelbaum, The British Fertility Decline: Demographic Transition in the Crucible of the Industrial Revolution (Princeton, 1984) and R. I. Woods, 'Approaches to the Fertility Transition in Victorian England', Population Studies, 41 (1987), 283-311.
67. On the decline of fertility, see M. S. Teitelbaum, The British Fertility Decline: Demographic Transition in the Crucible of the Industrial Revolution (Princeton, 1984) and R. I. Woods, 'Approaches to the Fertility Transition in Victorian England', Population Studies, 41 (1987), 283-311.
68. For the decline in early childhood mortality, see R. I. Woods, P. A. Watterson and J. H. Woodward, 'The Causes of Rapid Infant Mortality Decline in England and Wales, 1861-1921 Part I', Population Studies, 42 (1988), 343-66, especially Figures 3 and 4. It is also likely that declining fertility rates would themselves have helped the reduction in mortality rates. See R. Reves, 'Declining Fertility in England and Wales as a Major Cause of the Twentieth Century Decline in Mortality: The Role of Changing Family Size and Age Structure in Infectious Disease Mortality in Infancy', American Journal of Epidemiology, 122 (1985), 112-26.
69. For the decline in early childhood mortality, see R. I. Woods, P. A. Watterson and J. H. Woodward, 'The Causes of Rapid Infant Mortality Decline in England and Wales, 1861-1921 Part I', Population Studies, 42 (1988), 343-66, especially Figures 3 and 4. It is also likely that declining fertility rates would themselves have helped the reduction in mortality rates. See R. Reves, 'Declining Fertility in England and Wales as a Major Cause of the Twentieth Century Decline in Mortality: The Role of Changing Family Size and Age Structure in Infectious Disease Mortality in Infancy', American Journal of Epidemiology, 122 (1985), 112-26.
70. The me, were 'indirectly' standardised to the England and Wales 1901 age and sex structure. For an explanation of this method, see 74th ARRG, pp. xxvii-xxviii.
71. Ibid.
72. T. Welton, 'The Effect of Migration Upon the Death Rates', Journal of the Statical Society of London, 38 (1875), 324-43.
73. Snow, 'On the Comparative Mortality.'
74. Welton, 'The Effect of Migrations', p. 326.
75. See D. Chadwick, 'Discussion on Mr. Humphreys' Paper', Journal of the Statistical Society of London, 37 (1875), 474; and S. Bourne, 'Discussion on Mr. Welton's Paper', Journal of the Statistical Society of London, 38 (1875), 338.
76. See D. Chadwick, 'Discussion on Mr. Humphreys' Paper', Journal of the Statistical Society of London, 37 (1875), 474; and S. Bourne, 'Discussion on Mr. Welton's Paper', Journal of the Statistical Society of London, 38 (1875), 338.
77. Humphreys, 'The Value of Death Rates', p. 463. See G. Kearns, 'Biology, Class and the Urban Penalty', in G. Kearns and C. Withers, Urbanising Britain. Essays on Class and Community in the Nineteenth Century (Cambridge, 1991), 12-30.
78. Humphreys, 'The Value of Death Rates', p. 463. See G. Kearns, 'Biology, Class and the Urban Penalty', in G. Kearns and C. Withers, Urbanising Britain. Essays on Class and Community in the Nineteenth Century (Cambridge, 1991), 12-30.
79. N. Humphreys, 'Sanitary Test-Value of the Death Rate', Transactions of the National Association for the Promotion of Social Science, (1884), pp. 493-4. For this later period, see R. Taaffe, 'Various Topics in Public Medicine', British Medical Journal, ii (1886), 316-19; and C. Paget, 'Some Values of Death Statistics', The Practitioner, 38 (1887), 67-80.
80. N. Humphreys, 'Sanitary Test-Value of the Death Rate', Transactions of the National Association for the Promotion of Social Science, (1884), pp. 493-4. For this later period, see R. Taaffe, 'Various Topics in Public Medicine', British Medical Journal, ii (1886), 316-19; and C. Paget, 'Some Values of Death Statistics', The Practitioner, 38 (1887), 67-80.
81. N. Humphreys, 'Sanitary Test-Value of the Death Rate', Transactions of the National Association for the Promotion of Social Science, (1884), pp. 493-4. For this later period, see R. Taaffe, 'Various Topics in Public Medicine', British Medical Journal, ii (1886), 316-19; and C. Paget, 'Some Values of Death Statistics', The Practitioner, 38 (1887), 67-80.
82. S. Guha, 'The Importance of Social Intervention in England's Mortality Decline: The Evidence Reviewed', Social History of Medicine, 7 (1994), p. 103.
83. Kearns, 'Biology' and S. Ryan Johansson, 'Sex and Death in Victorian England', in Martha Vicinus (ed.) A Widening Sphere (Bloomington, 1977), pp. 163-81.
84. Kearns, 'Biology' and S. Ryan Johansson, 'Sex and Death in Victorian England', in Martha Vicinus (ed.) A Widening Sphere (Bloomington, 1977), pp. 163-81.
85. Sir H. Beevor, 'The Declension of Phthisis', Lancet, i (1899), 1005-20 and W. H. Symons, 'Local Statistics', Public Health, 12 (1899-1900), 336-45, quoted in Hardy, The Epidemic Streets, p. 251.
86. Sir H. Beevor, 'The Declension of Phthisis', Lancet, i (1899), 1005-20 and W. H. Symons, 'Local Statistics', Public Health, 12 (1899-1900), 336-45, quoted in Hardy, The Epidemic Streets, p. 251.
87. Sir H. Beevor, 'The Declension of Phthisis', Lancet, i (1899), 1005-20 and W. H. Symons, 'Local Statistics', Public Health, 12 (1899-1900), 336-45, quoted in Hardy, The Epidemic Streets, p. 251.
88. S. Szreter, 'Mortality in England in the Eighteenth and Nineteenth Centuries: A Reply to Sumit Guha', Social History of Medicine, 7 (1994), 269-82.
89. C. Hamlin, A Science of Impurity: Water Analysis in Nineteenth-Century Britain (Berkeley and Los Angeles, 1990), pp. 178-211; and What Becomes of Pollution? Adversary Science and the Controversy on the Self-Purification of Rivers in Britain, 1850-1900 (New York and London, 1987), pp. 319-26. See also, W. Luckin, Pollution and Control: A Social History of the Thames in the Nineteenth Century (London, 1986), in which the Letheby versus Frankland confrontation pops up regularly.
90. C. Hamlin, A Science of Impurity: Water Analysis in Nineteenth-Century Britain (Berkeley and Los Angeles, 1990), pp. 178-211; and What Becomes of Pollution? Adversary Science and the Controversy on the Self-Purification of Rivers in Britain, 1850-1900 (New York and London, 1987), pp. 319-26. See also, W. Luckin, Pollution and Control: A Social History of the Thames in the Nineteenth Century (London, 1986), in which the Letheby versus Frankland confrontation pops up regularly.
91. C. Hamlin, A Science of Impurity: Water Analysis in Nineteenth-Century Britain (Berkeley and Los Angeles, 1990), pp. 178-211; and What Becomes of Pollution? Adversary Science and the Controversy on the Self-Purification of Rivers in Britain, 1850-1900 (New York and London, 1987), pp. 319-26. See also, W. Luckin, Pollution and Control: A Social History of the Thames in the Nineteenth Century (London, 1986), in which the Letheby versus Frankland confrontation pops up regularly.
92. 'Significance of Rates of Mortality', The Times (23 March 1870), p. 4.
93. Weekly Return of Births and Deaths in London and in Nineteen Other Large Towns of the United Kingdom, Number 12, 31 (Week-ending Saturday 26 March 1870), pp. 95-6.
94. 'Significance of Rates of Mortality', The Times (23 March 1870), p. 4.
95. Hamlin, A Science of Impurity, p. 192; Luckin, Pollution and Control, p. 39.
96. Hamlin, A Science of Impurity, p. 192; Luckin, Pollution and Control, p. 39.
97. H. Letheby, On the Estimation of the Sanitary Condition of Communities, and the Comparative Salubrity of Towns, Being an Address at a Meeting of the Society of Medical Officers of Health, October 17, 1874 (London, 1874) [Wellcome Unit for the History of Medicine Archive SMOH/A228]. The demographic critiques of Letheby and others, however, can hardly be described as novel. See W. Sargant, 'On Certain Results and Defects of the Reports of the Registrar-General', Journal of the Statistical Society of London, 27 (1864), 170-221 and H. W. Rumsey, 'On Certain Fallacies in Local Rates of Mortality', Transactions of the Manchester Statistical Society (1871-72), 17-39. Very early debates of these issues can be found in E. Chadwick, 'On the Best Modes of Representing Accurately, by Statistical Returns, the Duration of Life', Journal of the Statistical Society of London, 7 (1844), 1-40; and F. Neison, 'On a Method Recently Proposed for Conducting Inquiries into the Sanitary Condition of Various Districts', Journal of the Statistical Society of London, 7 (1844), 40-68.
98. H. Letheby, On the Estimation of the Sanitary Condition of Communities, and the Comparative Salubrity of Towns, Being an Address at a Meeting of the Society of Medical Officers of Health, October 17, 1874 (London, 1874) [Wellcome Unit for the History of Medicine Archive SMOH/A228]. The demographic critiques of Letheby and others, however, can hardly be described as novel. See W. Sargant, 'On Certain Results and Defects of the Reports of the Registrar-General', Journal of the Statistical Society of London, 27 (1864), 170-221 and H. W. Rumsey, 'On Certain Fallacies in Local Rates of Mortality', Transactions of the Manchester Statistical Society (1871-72), 17-39. Very early debates of these issues can be found in E. Chadwick, 'On the Best Modes of Representing Accurately, by Statistical Returns, the Duration of Life', Journal of the Statistical Society of London, 7 (1844), 1-40; and F. Neison, 'On a Method Recently Proposed for Conducting Inquiries into the Sanitary Condition of Various Districts', Journal of the Statistical Society of London, 7 (1844), 40-68.
99. H. Letheby, On the Estimation of the Sanitary Condition of Communities, and the Comparative Salubrity of Towns, Being an Address at a Meeting of the Society of Medical Officers of Health, October 17, 1874 (London, 1874) [Wellcome Unit for the History of Medicine Archive SMOH/A228]. The demographic critiques of Letheby and others, however, can hardly be described as novel. See W. Sargant, 'On Certain Results and Defects of the Reports of the Registrar-General', Journal of the Statistical Society of London, 27 (1864), 170-221 and H. W. Rumsey, 'On Certain Fallacies in Local Rates of Mortality', Transactions of the Manchester Statistical Society (1871-72), 17-39. Very early debates of these issues can be found in E. Chadwick, 'On the Best Modes of Representing Accurately, by Statistical Returns, the Duration of Life', Journal of the Statistical Society of London, 7 (1844), 1-40; and F. Neison, 'On a Method Recently Proposed for Conducting Inquiries into the Sanitary Condition of Various Districts', Journal of the Statistical Society of London, 7 (1844), 40-68.
100. H. Letheby, On the Estimation of the Sanitary Condition of Communities, and the Comparative Salubrity of Towns, Being an Address at a Meeting of the Society of Medical Officers of Health, October 17, 1874 (London, 1874) [Wellcome Unit for the History of Medicine Archive SMOH/A228]. The demographic critiques of Letheby and others, however, can hardly be described as novel. See W. Sargant, 'On Certain Results and Defects of the Reports of the Registrar-General', Journal of the Statistical Society of London, 27 (1864), 170-221 and H. W. Rumsey, 'On Certain Fallacies in Local Rates of Mortality', Transactions of the Manchester Statistical Society (1871-72), 17-39. Very early debates of these issues can be found in E. Chadwick, 'On the Best Modes of Representing Accurately, by Statistical Returns, the Duration of Life', Journal of the Statistical Society of London, 7 (1844), 1-40; and F. Neison, 'On a Method Recently Proposed for Conducting Inquiries into the Sanitary Condition of Various Districts', Journal of the Statistical Society of London, 7 (1844), 40-68.
101. H. Letheby, On the Estimation of the Sanitary Condition of Communities, and the Comparative Salubrity of Towns, Being an Address at a Meeting of the Society of Medical Officers of Health, October 17, 1874 (London, 1874) [Wellcome Unit for the History of Medicine Archive SMOH/A228]. The demographic critiques of Letheby and others, however, can hardly be described as novel. See W. Sargant, 'On Certain Results and Defects of the Reports of the Registrar-General', Journal of the Statistical Society of London, 27 (1864), 170-221 and H. W. Rumsey, 'On Certain Fallacies in Local Rates of Mortality', Transactions of the Manchester Statistical Society (1871-72), 17-39. Very early debates of these issues can be found in E. Chadwick, 'On the Best Modes of Representing Accurately, by Statistical Returns, the Duration of Life', Journal of the Statistical Society of London, 7 (1844), 1-40; and F. Neison, 'On a Method Recently Proposed for Conducting Inquiries into the Sanitary Condition of Various Districts', Journal of the Statistical Society of London, 7 (1844), 40-68.
102. J. Eyler, 'Mortality Statistics and Victorian Health Policy: Program and Criticism', Bulletin of the History of Medicine, 50 (1976), p. 349 and Szreter, 'The GRO', pp. 450-2.
103. J. Eyler, 'Mortality Statistics and Victorian Health Policy: Program and Criticism', Bulletin of the History of Medicine, 50 (1976), p. 349 and Szreter, 'The GRO', pp. 450-2.
104. 'Dr. Letheby on the Death Rates', British Medical Journal, ii (1874), 561-2.
105. Lancet, ii (1874), 632-34.
106. 'Dr. Letheby's Errors', Sanitary Record, 1 (31 October 1874), p. 310; See also, 'Public Health and the Local Death Rates', Sanitary Record, 1 (21 November 1874), 368-70; The Times (19 October 1874, p.11) reproduced extensive extracts of Letheby's speech for wider public consumption, although a full account can be found in a leader, 'Dr. Letheby on the Sanitary Condition of Communities and Salubrity of Towns', Sanitary Record, 1 (31 October 1874), 305-8.
107. 'Dr. Letheby's Errors', Sanitary Record, 1 (31 October 1874), p. 310; See also, 'Public Health and the Local Death Rates', Sanitary Record, 1 (21 November 1874), 368-70; The Times (19 October 1874, p.11) reproduced extensive extracts of Letheby's speech for wider public consumption, although a full account can be found in a leader, 'Dr. Letheby on the Sanitary Condition of Communities and Salubrity of Towns', Sanitary Record, 1 (31 October 1874), 305-8.
108. 'Dr. Letheby's Errors', Sanitary Record, 1 (31 October 1874), p. 310; See also, 'Public Health and the Local Death Rates', Sanitary Record, 1 (21 November 1874), 368-70; The Times (19 October 1874, p.11) reproduced extensive extracts of Letheby's speech for wider public consumption, although a full account can be found in a leader, 'Dr. Letheby on the Sanitary Condition of Communities and Salubrity of Towns', Sanitary Record, 1 (31 October 1874), 305-8.
109. 'Dr. Letheby's Errors', Sanitary Record, 1 (31 October 1874), p. 310; See also, 'Public Health and the Local Death Rates', Sanitary Record, 1 (21 November 1874), 368-70; The Times (19 October 1874, p.11) reproduced extensive extracts of Letheby's speech for wider public consumption, although a full account can be found in a leader, 'Dr. Letheby on the Sanitary Condition of Communities and Salubrity of Towns', Sanitary Record, 1 (31 October 1874), 305-8.
110. T. Hawksley, 'The Vital Statistics of the Registrar-General', Sanitary Record, 1 (31 October 1874), 308. Although the Sanitary Record names Hawksley as 'John' in the text, they give him the designatory letters C.E. and his entry in the journal's index appears as 'T. Hawksley'. I would therefore assume that the paper was given by the prominent civil engineer, Thomas Hawksley, who, like Letheby, complained against 'theoretical chemists' such as Franldand: Hamlin, A Science of Impurity, p. 192. Hamlin thankfully warns that '[r]eaders of sanitary literature should take care to distinguish [Thomas] Hawksley, M.D., from [Thomas] Hawksley, C.E.': Hamlin, What Becomes of Pollution? p. 137, footnote 119. This confusion also appears to have caught out the MOH Edmund Syson three yean later, when he named a 'Mr John Hawksley' as a fellow critic of the GRO: E. Syson, 'Vital Statistics', letter to the editor of the Sanitary Record, 7 (3 August 1877), 83.
111. T. Hawksley, 'The Vital Statistics of the Registrar-General', Sanitary Record, 1 (31 October 1874), 308. Although the Sanitary Record names Hawksley as 'John' in the text, they give him the designatory letters C.E. and his entry in the journal's index appears as 'T. Hawksley'. I would therefore assume that the paper was given by the prominent civil engineer, Thomas Hawksley, who, like Letheby, complained against 'theoretical chemists' such as Franldand: Hamlin, A Science of Impurity, p. 192. Hamlin thankfully warns that '[r]eaders of sanitary literature should take care to distinguish [Thomas] Hawksley, M.D., from [Thomas] Hawksley, C.E.': Hamlin, What Becomes of Pollution? p. 137, footnote 119. This confusion also appears to have caught out the MOH Edmund Syson three yean later, when he named a 'Mr John Hawksley' as a fellow critic of the GRO: E. Syson, 'Vital Statistics', letter to the editor of the Sanitary Record, 7 (3 August 1877), 83.
112. T. Hawksley, 'The Vital Statistics of the Registrar-General', Sanitary Record, 1 (31 October 1874), 308. Although the Sanitary Record names Hawksley as 'John' in the text, they give him the designatory letters C.E. and his entry in the journal's index appears as 'T. Hawksley'. I would therefore assume that the paper was given by the prominent civil engineer, Thomas Hawksley, who, like Letheby, complained against 'theoretical chemists' such as Franldand: Hamlin, A Science of Impurity, p. 192. Hamlin thankfully warns that '[r]eaders of sanitary literature should take care to distinguish [Thomas] Hawksley, M.D., from [Thomas] Hawksley, C.E.': Hamlin, What Becomes of Pollution? p. 137, footnote 119. This confusion also appears to have caught out the MOH Edmund Syson three yean later, when he named a 'Mr John Hawksley' as a fellow critic of the GRO: E. Syson, 'Vital Statistics', letter to the editor of the Sanitary Record, 7 (3 August 1877), 83.
113. T. Hawksley, 'The Vital Statistics of the Registrar-General', Sanitary Record, 1 (31 October 1874), 308. Although the Sanitary Record names Hawksley as 'John' in the text, they give him the designatory letters C.E. and his entry in the journal's index appears as 'T. Hawksley'. I would therefore assume that the paper was given by the prominent civil engineer, Thomas Hawksley, who, like Letheby, complained against 'theoretical chemists' such as Franldand: Hamlin, A Science of Impurity, p. 192. Hamlin thankfully warns that '[r]eaders of sanitary literature should take care to distinguish [Thomas] Hawksley, M.D., from [Thomas] Hawksley, C.E.': Hamlin, What Becomes of Pollution? p. 137, footnote 119. This confusion also appears to have caught out the MOH Edmund Syson three yean later, when he named a 'Mr John Hawksley' as a fellow critic of the GRO: E. Syson, 'Vital Statistics', letter to the editor of the Sanitary Record, 7 (3 August 1877), 83.
114. 'Dr. Letheby's Errors', Sanitary Record, p. 310. Tripe actually wrote to the Lancet 'in consequence of the very limited time allowed to me [Tripe] to discuss Dr. Letheby's paper': J. Tripe, The Value of Death Rates', letter to the editor of the Lancet, i (1875), 35. But the medical journals may have been harsh judges of Letheby in this instance, since documentary evidence in fact states that Letheby replied 'to the various opinions expressed during the discussion on this subject': J. Northcote Vinen and W. H. Corfield, Annual Report of the Society of Medical Officers of Health, 1874-75, p. 9 [Wellcome Unit for the History of Medicine Archive SMOH/AO]. It was, of course, customary for most journals of the time to print the ensuing discussions. Indeed, the accounts provided by Eyler and Szreter of Letheby's speech are not actually taken from the speech itself, but rather the Sanitary Record's reprint and those parts of it referred to in Humphreys, The Value of the Death Rates', and Letheby's response to this paper in the discussion.
115. 'Dr. Letheby's Errors', Sanitary Record, p. 310. Tripe actually wrote to the Lancet 'in consequence of the very limited time allowed to me [Tripe] to discuss Dr. Letheby's paper': J. Tripe, The Value of Death Rates', letter to the editor of the Lancet, i (1875), 35. But the medical journals may have been harsh judges of Letheby in this instance, since documentary evidence in fact states that Letheby replied 'to the various opinions expressed during the discussion on this subject': J. Northcote Vinen and W. H. Corfield, Annual Report of the Society of Medical Officers of Health, 1874-75, p. 9 [Wellcome Unit for the History of Medicine Archive SMOH/AO]. It was, of course, customary for most journals of the time to print the ensuing discussions. Indeed, the accounts provided by Eyler and Szreter of Letheby's speech are not actually taken from the speech itself, but rather the Sanitary Record's reprint and those parts of it referred to in Humphreys, The Value of the Death Rates', and Letheby's response to this paper in the discussion.
116. 'Dr. Letheby's Errors', Sanitary Record, p. 310. Tripe actually wrote to the Lancet 'in consequence of the very limited time allowed to me [Tripe] to discuss Dr. Letheby's paper': J. Tripe, The Value of Death Rates', letter to the editor of the Lancet, i (1875), 35. But the medical journals may have been harsh judges of Letheby in this instance, since documentary evidence in fact states that Letheby replied 'to the various opinions expressed during the discussion on this subject': J. Northcote Vinen and W. H. Corfield, Annual Report of the Society of Medical Officers of Health, 1874-75, p. 9 [Wellcome Unit for the History of Medicine Archive SMOH/AO]. It was, of course, customary for most journals of the time to print the ensuing discussions. Indeed, the accounts provided by Eyler and Szreter of Letheby's speech are not actually taken from the speech itself, but rather the Sanitary Record's reprint and those parts of it referred to in Humphreys, The Value of the Death Rates', and Letheby's response to this paper in the discussion.
117. 'Dr. Letheby's Errors', Sanitary Record, p. 311. See also, Lancet, ii (1874), 634.
118. 'Dr. Letheby's Errors', Sanitary Record, p. 311. See also, Lancet, ii (1874), 634.
119. Szreter, 'The GRO', p. 451.
120. Weekly Return of Births and Deaths in London and in Twenty Other Large Towns of the United Kingdom, Number 43, 35 (Week-ending Saturday 31 October 1874), pp. 357-8, which MOHs were urged to obtain by the Lancet, ii (1874), 633.
121. Weekly Return of Births and Deaths in London and in Twenty Other Large Towns of the United Kingdom, Number 43, 35 (Week-ending Saturday 31 October 1874), pp. 357-8, which MOHs were urged to obtain by the Lancet, ii (1874), 633.
122. Letheby himself had died one year earlier, on 29 March 1876.
123. E. Syson, 'Vital Statistics', p. 83.
124. N. Humphreys, 'Vital Statistics', letter to the editor of the Sanitary Record, 7 (17 August 1877), 116 Despite the restrained tone of Humphreys' communication, he couldn't resist a swipe at correcting Syson's mis-spelling and mis-titling of one of Letheby's alleged supporters, Mr. Sargant, whom Syson had named as Dr. Sargeant.
125. E. Seaton, Annual Report of the Medical Officer to the Vestry of the Parish of Chelsea, 1884, p. 156.
126. G. Mooney, '"A Tissue of the Most Flagrant Anomalies": Smallpox Vaccination and the Centralization of Sanitary Administration in Nineteenth-Century London', Medical History, 41 (forthcoming July, 1997).
127. H. Letheby, 'Discussion on Mr. Humphreys' Paper', Journal of the Statistical Society of London, 37 (1875), 473.
128. Although Lambert describes Letheby's Medical Officership at the City as both 'uninspired' and 'plodding', he ultimately concludes 'that . . . the City's general death rates . . . seldom equalled those of comparable slum areas elsewhere, was due entirely to sustained sanitary endeavour'. Letheby's record as a 'meticulous, patient administrator' reaped considerable benefits. A special lodging house inspector was appointed in 1857 and a full-time sanitary inspectorate of four in 1866. He expanded the rota system of house visitation developed by Simon which by the decade 1863-73 averaged 17,524 inspections and 3,624 orders: R. Lambert, Sir John Simon, 1816-1904 and English Social Administration (London, 1963), pp. 213-15. An interesting discussion on the compatibility of Letheby's analytical chemistry and his approach to local sanitary reform appears in C. Hamlin, Adversary Science and the Controversy on the Self-Purification of Rivers in Britain, 1850-1900 (New York and London, 1987), pp. 326-7.
129. Although Lambert describes Letheby's Medical Officership at the City as both 'uninspired' and 'plodding', he ultimately concludes 'that . . . the City's general death rates . . . seldom equalled those of comparable slum areas elsewhere, was due entirely to sustained sanitary endeavour'. Letheby's record as a 'meticulous, patient administrator' reaped considerable benefits. A special lodging house inspector was appointed in 1857 and a full-time sanitary inspectorate of four in 1866. He expanded the rota system of house visitation developed by Simon which by the decade 1863-73 averaged 17,524 inspections and 3,624 orders: R. Lambert, Sir John Simon, 1816-1904 and English Social Administration (London, 1963), pp. 213-15. An interesting discussion on the compatibility of Letheby's analytical chemistry and his approach to local sanitary reform appears in C. Hamlin, Adversary Science and the Controversy on the Self-Purification of Rivers in Britain, 1850-1900 (New York and London, 1987), pp. 326-7.
130. H. Letheby, 'Discussion on Mr. Humphreys' Paper', 473. Perhaps significantly, Letheby had resigned early in 1874 on the grounds of ill-health, The Times quoting a communication to the City Commission of Sewers requesting that 'the strain on his working powers must be relaxed': The Times (18 February 1874), p. 11.
131. H. Letheby, 'Discussion on Mr. Humphreys' Paper', 473. Perhaps significantly, Letheby had resigned early in 1874 on the grounds of ill-health, The Times quoting a communication to the City Commission of Sewers requesting that 'the strain on his working powers must be relaxed': The Times (18 February 1874), p. 11.
132. J. Tripe, 'The Sanitary Condition and Laws of Mediaeval and Modem London', Sanitary Record, NS 13 (15 November 1881), p. 180. This was Tripe's presidential address to the Society of Medical Officers of Health delivered in October 1881.
133. Seaton, Annual Report, 1884, p. 156.
134. S. J. Novak, 'Professionalism and Bureaucracy: English Doctors and the Victorian Public Health Administration', Journal of Social History, 6 (1973), p. 443.
135. C. Hamlin, 'State Medicine in Great Britain', in D. Porter (ed.) The History of Public Health and the Modern State (Amsterdam, 1994), p. 150.
136. Ibid., p. 151.
137. D. Porter, 'Stratification and its Discontents: Professionalisation and Conflict in the British Public Health Service, 1848-1914', in E. Fee and R. Acheson (eds.) A History of Education in Public Health: Health That Mocks the Doctors' Rules (Oxford, 1991), p. 113.
138. D. Porter, 'Stratification', p. 112. See also A. Hardy, 'Public Health and the Expert: The London Medical Officers of Health 1856-1900', in MacLeod (ed.) Government and Expertise, pp. 128-42.
139. D. Porter, 'Stratification', p. 112. See also A. Hardy, 'Public Health and the Expert: The London Medical Officers of Health 1856-1900', in MacLeod (ed.) Government and Expertise, pp. 128-42.
140. Letheby quoted in N. Humphreys, 'The Recent Decline in the English Death Rate and IB Effects Upon the Duration of Life', Journal of the Statistical Society of London, 46 (1883), 189. See also Letheby, On the Estimation, p. 14 and J. Tripe, 'The Sanitary Statistics of the Metropolis for the Ten Years, 1861-70', British Medical Journal, 11 (1873), 371-3.
141. Letheby quoted in N. Humphreys, 'The Recent Decline in the English Death Rate and IB Effects Upon the Duration of Life', Journal of the Statistical Society of London, 46 (1883), 189. See also Letheby, On the Estimation, p. 14 and J. Tripe, 'The Sanitary Statistics of the Metropolis for the Ten Years, 1861-70', British Medical Journal, 11 (1873), 371-3.
142. Letheby quoted in N. Humphreys, 'The Recent Decline in the English Death Rate and IB Effects Upon the Duration of Life', Journal of the Statistical Society of London, 46 (1883), 189. See also Letheby, On the Estimation, p. 14 and J. Tripe, 'The Sanitary Statistics of the Metropolis for the Ten Years, 1861-70', British Medical Journal, 11 (1873), 371-3.
143. Letheby, On the Estimation, p. 21. This speech was, of course, written at around the time the general decline in fertility was beginning but as yet awaited observation by contemporaries.
144. Ibid. It appears Letheby actually presented the Commission of Sewers with an ultimatum that they either provide him with extra staff to ease the burden of his workload, or he would tender his resignation. Whilst The Times reports that
145. Szreter, Fertility, pp. 94-5.
146. H. W. Rumsey, Public Health - The Right Use of Records Founded on Local Facts (London, 1860), reprinted in H. W. Rumsey, Essays and Papers on Some Fallacies of Statistics Concerning Life and Death, Health and Disease with Suggestions Towards an Improved System of Registration (London, 1875), p. 58.
147. H. W. Rumsey, Public Health - The Right Use of Records Founded on Local Facts (London, 1860), reprinted in H. W. Rumsey, Essays and Papers on Some Fallacies of Statistics Concerning Life and Death, Health and Disease with Suggestions Towards an Improved System of Registration (London, 1875), p. 58.
148. Higgs, 'Cuckoo in the Nest?', p. 123.
149. Letheby, On the Estimation, p. 30.
150. See, for example, M. A. Stoto, 'Setting Objectives for Preventable Mortality and Promoting Healthful Behaviours: Experience from the United States', in A. D. Lopez, G. Caselli and T. Valkonen (eds.) Adult Mortality in Developed Countries: From Description to Explanation (Oxford, 1995), pp. 327-46, and other essays in this volume.
151. Tripe, 'The Sanitary Statistics', p. 373 and 'The Sanitary Condition', p. 180.
152. Tripe, 'The Sanitary Statistics', p. 373 and 'The Sanitary Condition', p. 180.
153. Szreter, Fertility, p. 83. Farr had abandoned the analysis of infant mortality in the early years of the GRO because of the problems encountered in the registration of the precise age of infants. For further information on the GRO's expositions of infant mortality, see Szreter, Fertility, pp. 90-3 and Williams and Mooney 'Infant Mortality'.
154. Szreter, Fertility, p. 83. Farr had abandoned the analysis of infant mortality in the early years of the GRO because of the problems encountered in the registration of the precise age of infants. For further information on the GRO's expositions of infant mortality, see Szreter, Fertility, pp. 90-3 and Williams and Mooney 'Infant Mortality'.
155. Szreter, Fertility, p. 83. Farr had abandoned the analysis of infant mortality in the early years of the GRO because of the problems encountered in the registration of the precise age of infants. For further information on the GRO's expositions of infant mortality, see Szreter, Fertility, pp. 90-3 and Williams and Mooney 'Infant Mortality'.
156. Letheby, On the Estimation, p. 28. For example, an infant dying in the month of March - thus contributing to that year's IMR - may actually have been bom in the middle of the previous year.
157. G. Mooney, 'Did London Pass the "Sanitary Test"? Seasonal Infant Mortality in London, 1870-1914', Journal of Historical Geography, 9 (1994), 158-74.
158. M. Cullen, The Statistical Movement in Early Victorian Britain (Sussex, 1975), p. 43.
159. 28th ARRG, 1865 (London, 1867), p. lvii.
160. Taken from footnote (b) of the table 'London III', Eighth ARRG, 1845 (London, 1847), p. cxliii.
161. The City possessed 'what then existed nowhere else at national or local level: an accurate, prompt and even delicate instrument to guide subsequent operations': Lambert, Sir John Simon, p. 114.
162. E. Ballard, 'The Work of the Metropolitan Medical Officers of Health - Their Success and Their Difficulties', Transactions of the National Association for the Promotion of Social Science (1862), p. 657.
163. Ibid., pp. 657-8. This service, provided free of charge by the GRO, had become common practice almost immediately after the appointment of Simon as the first MOH for the City of London. See Lambert, Sir John Simon, pp. 114-15.
164. Ibid., pp. 657-8. This service, provided free of charge by the GRO, had become common practice almost immediately after the appointment of Simon as the first MOH for the City of London. See Lambert, Sir John Simon, pp. 114-15.
165. Ballard, 'The Work', p. 658.
166. Ibid., pp. 658-9.
167. Provincial examples of the use of the local registrars' and the centralised GRO's data can be found in F. Lewes, 'The GRO and the Provinces in the Nineteenth Century', Social History of Medicine, 4 (1991), 479-96.
168. The registrars outside London supplied their local sanitary authority (as defined by the Public Health Act, 1872) with a return of deaths upon request. They received an initial two pence for this, plus two more for every death entered on the return: 37 & 38 Vict. CAP 88, Births and Deaths Registration Act, 1874 (7 August 1874), paragraph 28.
169. The fact that provincial registrars were paid was a sore point for the metropolitan registrars. W. H. Butterfield, 'Weekly Returns', letter to the editor of the Lancet, ii (1874), 682.
170. The saga was monitored m numerous weekly editorials of the Sanitary Record between 24 October 1874 and 27 March 1875. The Registrar-General had initially asked the Society of Medical Officers of Health to bring the question of scaled payments before the local boards. The Society, not surprisingly, declined this offer, which was, in the words of one metropolitan MOH, an 'invidious task': T. Orme Dudfield, Annual Report on the Sanitary Condition of the Parish of St Mary Abbot's Kensington, 1874, p. 52.
171. Administration of the registration of births, deaths, and marriages came under the responsibility of the LGB through 34 & 35 Vict. CAP 70, The Local Government Board Act, 1871 (14 August 1871).
172. Lancet, i (1875), 447. The move was also criticised in the editorial, 'The Registrar-General and the London Vestries', Sanitary Record, 2 (27 March 1875), 213.
173. Lancet, i (1875), 447. The move was also criticised in the editorial, 'The Registrar-General and the London Vestries', Sanitary Record, 2 (27 March 1875), 213.
174. 'The Metropolitan Bills of Mortality', Sanitary Record, 1 (5 December 1874), 403. Although the provincial registrars received more than the amount proposed by the Registrar-General, the compilation of their returns was an additional, infrequent task. The Sanitary Record appears to have objected to the London registrars' claims, since the returns the MOHs received were copies of schedules which had to be prepared and sent to Somerset House anyway. Furthermore, the number of deaths they recorded, for which the Sanitary Record argued they received adequate remuneration, far exceeded the number registered by most provincial registrars. See, 'The Registrar-General and the London Vestries', Sanitary Record, 1 (24 October 1874), 294; and, 'The Registrar-General and the Weekly Returns of Mortality', Sanitary Record, 1 (7 November 1874), 330.
175. 'The Metropolitan Bills of Mortality', Sanitary Record, 1 (5 December 1874), 403. Although the provincial registrars received more than the amount proposed by the Registrar-General, the compilation of their returns was an additional, infrequent task. The Sanitary Record appears to have objected to the London registrars' claims, since the returns the MOHs received were copies of schedules which had to be prepared and sent to Somerset House anyway. Furthermore, the number of deaths they recorded, for which the Sanitary Record argued they received adequate remuneration, far exceeded the number registered by most provincial registrars. See, 'The Registrar-General and the London Vestries', Sanitary Record, 1 (24 October 1874), 294; and, 'The Registrar-General and the Weekly Returns of Mortality', Sanitary Record, 1 (7 November 1874), 330.
176. 'The Metropolitan Bills of Mortality', Sanitary Record, 1 (5 December 1874), 403. Although the provincial registrars received more than the amount proposed by the Registrar-General, the compilation of their returns was an additional, infrequent task. The Sanitary Record appears to have objected to the London registrars' claims, since the returns the MOHs received were copies of schedules which had to be prepared and sent to Somerset House anyway. Furthermore, the number of deaths they recorded, for which the Sanitary Record argued they received adequate remuneration, far exceeded the number registered by most provincial registrars. See, 'The Registrar-General and the London Vestries', Sanitary Record, 1 (24 October 1874), 294; and, 'The Registrar-General and the Weekly Returns of Mortality', Sanitary Record, 1 (7 November 1874), 330.
177. Frequently the local registrar was also a poor law officer. On this independence, see Higgs, 'The Statistical Big Bang of 1911', p. 422.
178. See, 'The Registrar-General and the London Vestries', Sanitary Record, 1 (24 October 1874), 294.
179. 'The Registrar-General and the London Vestries', Sanitary Record, 2 (27 March 1875), 213.
180. Lancet, i (1875), 447. Such arrangements had already existed in some districts. See Orme Dudfield, Annual Report, 1874, p. 52.
181. Lancet, i (1875), 447. Such arrangements had already existed in some districts. See Orme Dudfield, Annual Report, 1874, p. 52.
182. Ibid.
183. Such concerns also serve as a lesson for today's historical demographers to be cautious when using nineteenth-century mortality data, although they should not prove to be a blanket deterrent. Hardy, 'Death is the Cure', p. 491.
184. Rumsey, Essays and Papers, p. 57.
185. Supplement to the 55th ARRG, 1892 (London, 1895), pp. viii, xxxvi.
186. 74th ARRG, pp. xxvii-xxviii.
187. Humphreys, 'Vital Statistics', p. 116.