Enforced convergence: Political change and cause-of-death registration in the Hansestadt Bremen, 1860-1914

Continuity and Change

Volumn 12, Issue 2, 1997, Pages 221-246

  Leidinger, Barbara ^a   Lee, W Robert ^b   Marschalck, Peter ^c  

^a UNIVERSITY OF BREMEN   (Germany)

^b UNIVERSITY OF LIVERPOOL   (United Kingdom)

^c UNIVERSITY OF OSNABRÜCK   (Germany)

Author keywords

[No Author keywords available]

Indexed keywords

CAUSE OF DEATH; DOCUMENTARY SOURCE; MEDICAL GEOGRAPHY; METHODOLOGY; NINETEENTH CENTURY; POLITICAL CHANGE; REGISTRATION SYSTEM;

GERMANY, BREMEN;

EID: 0031401621     PISSN: 02684160     EISSN: None     Source Type: Journal    
DOI: 10.1017/S0268416097002968     Document Type: Review

References (77)

1. E. M. Hucko ed., The democratic tradition: four German constitutions (Leamington Spa, 1987); W. R. Lee and E. Rosenhaft eds., The state and social change in Germany, 1880-1980 (New York, Oxford and Munich, 1990); R. J. Evans, Death in Hamburg: society and politics in the cholera years, 1830-1910 (Oxford, 1987); H. Tjaden, Bremen und die Bremische Aerzteschaft seit dem Beginn des 19. Jahrhunderts (Bremen, 1932); P. Weindling, ' Mediane and modernisation : social history of German health and medicine', History of Science 24, 277-301; G. Kearns, W. R. Lee and J. Rogers, 'Urbanisierung und Professionalisierung als Bestimmungsfaktoren bei der Gestaltung des deutschen Gesundheitssystems im 19. Jahrhundert im internationalen Vergleich', in H.-G. Haupt and P. Marschalck eds., Städtische Bevölkerungsentwicklung in Deutschland im 19. Jahrhundert. Soziale und demographische Aspekte der Urbanisierung (St Katharinen, 1994), 258-281.
2. E. M. Hucko ed., The democratic tradition: four German constitutions (Leamington Spa, 1987); W. R. Lee and E. Rosenhaft eds., The state and social change in Germany, 1880-1980 (New York, Oxford and Munich, 1990); R. J. Evans, Death in Hamburg: society and politics in the cholera years, 1830-1910 (Oxford, 1987); H. Tjaden, Bremen und die Bremische Aerzteschaft seit dem Beginn des 19. Jahrhunderts (Bremen, 1932); P. Weindling, ' Mediane and modernisation : social history of German health and medicine', History of Science 24, 277-301; G. Kearns, W. R. Lee and J. Rogers, 'Urbanisierung und Professionalisierung als Bestimmungsfaktoren bei der Gestaltung des deutschen Gesundheitssystems im 19. Jahrhundert im internationalen Vergleich', in H.-G. Haupt and P. Marschalck eds., Städtische Bevölkerungsentwicklung in Deutschland im 19. Jahrhundert. Soziale und demographische Aspekte der Urbanisierung (St Katharinen, 1994), 258-281.
3. E. M. Hucko ed., The democratic tradition: four German constitutions (Leamington Spa, 1987); W. R. Lee and E. Rosenhaft eds., The state and social change in Germany, 1880-1980 (New York, Oxford and Munich, 1990); R. J. Evans, Death in Hamburg: society and politics in the cholera years, 1830-1910 (Oxford, 1987); H. Tjaden, Bremen und die Bremische Aerzteschaft seit dem Beginn des 19. Jahrhunderts (Bremen, 1932); P. Weindling, ' Mediane and modernisation : social history of German health and medicine', History of Science 24, 277-301; G. Kearns, W. R. Lee and J. Rogers, 'Urbanisierung und Professionalisierung als Bestimmungsfaktoren bei der Gestaltung des deutschen Gesundheitssystems im 19. Jahrhundert im internationalen Vergleich', in H.-G. Haupt and P. Marschalck eds., Städtische Bevölkerungsentwicklung in Deutschland im 19. Jahrhundert. Soziale und demographische Aspekte der Urbanisierung (St Katharinen, 1994), 258-281.
4. E. M. Hucko ed., The democratic tradition: four German constitutions (Leamington Spa, 1987); W. R. Lee and E. Rosenhaft eds., The state and social change in Germany, 1880-1980 (New York, Oxford and Munich, 1990); R. J. Evans, Death in Hamburg: society and politics in the cholera years, 1830-1910 (Oxford, 1987); H. Tjaden, Bremen und die Bremische Aerzteschaft seit dem Beginn des 19. Jahrhunderts (Bremen, 1932); P. Weindling, ' Mediane and modernisation : social history of German health and medicine', History of Science 24, 277-301; G. Kearns, W. R. Lee and J. Rogers, 'Urbanisierung und Professionalisierung als Bestimmungsfaktoren bei der Gestaltung des deutschen Gesundheitssystems im 19. Jahrhundert im internationalen Vergleich', in H.-G. Haupt and P. Marschalck eds., Städtische Bevölkerungsentwicklung in Deutschland im 19. Jahrhundert. Soziale und demographische Aspekte der Urbanisierung (St Katharinen, 1994), 258-281.
5. E. M. Hucko ed., The democratic tradition: four German constitutions (Leamington Spa, 1987); W. R. Lee and E. Rosenhaft eds., The state and social change in Germany, 1880-1980 (New York, Oxford and Munich, 1990); R. J. Evans, Death in Hamburg: society and politics in the cholera years, 1830-1910 (Oxford, 1987); H. Tjaden, Bremen und die Bremische Aerzteschaft seit dem Beginn des 19. Jahrhunderts (Bremen, 1932); P. Weindling, ' Mediane and modernisation : social history of German health and medicine', History of Science 24, 277-301; G. Kearns, W. R. Lee and J. Rogers, 'Urbanisierung und Professionalisierung als Bestimmungsfaktoren bei der Gestaltung des deutschen Gesundheitssystems im 19. Jahrhundert im internationalen Vergleich', in H.-G. Haupt and P. Marschalck eds., Städtische Bevölkerungsentwicklung in Deutschland im 19. Jahrhundert. Soziale und demographische Aspekte der Urbanisierung (St Katharinen, 1994), 258-281.
6. E. M. Hucko ed., The democratic tradition: four German constitutions (Leamington Spa, 1987); W. R. Lee and E. Rosenhaft eds., The state and social change in Germany, 1880-1980 (New York, Oxford and Munich, 1990); R. J. Evans, Death in Hamburg: society and politics in the cholera years, 1830-1910 (Oxford, 1987); H. Tjaden, Bremen und die Bremische Aerzteschaft seit dem Beginn des 19. Jahrhunderts (Bremen, 1932); P. Weindling, ' Mediane and modernisation : social history of German health and medicine', History of Science 24, 277-301; G. Kearns, W. R. Lee and J. Rogers, 'Urbanisierung und Professionalisierung als Bestimmungsfaktoren bei der Gestaltung des deutschen Gesundheitssystems im 19. Jahrhundert im internationalen Vergleich', in H.-G. Haupt and P. Marschalck eds., Städtische Bevölkerungsentwicklung in Deutschland im 19. Jahrhundert. Soziale und demographische Aspekte der Urbanisierung (St Katharinen, 1994), 258-281.
7. See the Medizinalordnung of 18 September 1871, in Gesetzblatt der freien Hansestadt Bremen 1871 (Bremen, 1872), 117 ff.
8. 'Ratsbeschluss, 15 July 1814, über die Verordnung über die Führung der Civilstandsregister'. This was confirmed on 30 May 1816 (Staatsarchiv Bremen (hereafter StAB) 2-D.20.C.1.).
9. The new heading was recorded in the revised version of the civil registers on 14 November 1834.
10. See the decree regarding the drawing up of the civil registers - 'Sterbe-Act', in Sammlung der Verordnung und Proclame des Senats der freyen Hansestadt Bremen im Jahre 1816 (Bremen, 1817), 65.
11. 'Gesetz betr. Civilstandsregister und Eheschliessung vom 17 November 1865', in StAB 2-D. 20.C.1.
12. Richard Boeckh, Die geschichtliche Entwicklung der amtlichen Statistik des preussischen Staates. Eine Festgabe für den internationalen Statistischen Congress in Berlin (Berlin, 1863), 5 ff.
13. A census was carried out every three years in the Customs Union states, but only to determine revenue distribution from customs receipts, and not to register causes of death.
14. Protocols of the Public Health Board, 17 November 1834, 4 December 1834 and 15 October/20 December 1839, in StAB 4, 21-3 and 2-S.7.a.10. a.3.
15. The reasons why the Medical Commission rejected the advice of the Public Health Board were made clear on 13 July 1857, when F. W. Beneke, a physician, asked about the possibilities of introducing uniform statistics on causes of death in all German states. It was then confirmed that the Medical Commission had rejected the introduction of such medical statistics on the grounds that the necessary prerequisites for such an approach were still lacking. These included an obligatory post-mortem examination, and the registration of causes of death by physicians, which could not be implemented in rural areas, or in the state of Bremen as a whole.
16. Data taken from the Municipal Hospital and Children's Hospital.
17. See various contemporary publications of medical statistics, in particular Friedrich Oesterlen, Handbuch der medizinischen Statistik (Tübingen, 1865), and Friedrich Prinzing, Handbuch der medizinischen Statistik (Jena, 1906).
18. See various contemporary publications of medical statistics, in particular Friedrich Oesterlen, Handbuch der medizinischen Statistik (Tübingen, 1865), and Friedrich Prinzing, Handbuch der medizinischen Statistik (Jena, 1906).
19. From 6 February 1875 onwards, as a result of the 'Reichsgesetz zur Beurkundung des Personenstands', the cause of death was no longer recorded in the official death registers.
20. Detailed information on the present state and reliability of cause-of-death statistics can be found in W. Müller and N. Nocter eds., Beitrag zur Abschätzung der Aussagekraft der amtlichen Todesursachenstatistik, Eine empirische Untersuchung zur Verbesserung der Validität, Schriftenreihe des Bundesministers für Jugend, Familie, Frauen und Gesundheit, Band 253 (Stuttgart, 1990).
21. The first publication of cause-of-death statistics for Berlin for the period 1816 to 1843 was undertaken by J. G. Hoffmann in 1843, as the Director of the Royal Statistical Bureau in Prussia; see Alfons Fischer, Geschichte des deutschen Gesundheitswesens, 2 vols. (Berlin, 1933), in particular Vol. 2, 421.
22. Verhandlungen zwischen dem Senate und der Bürgerschaft vom Jahre 1869 (Bremen, 1870), 182, 239-40.
23. The Provisorische Bureau für allgemeine Staats- und Städtestatistik was founded in 1861, following the creation of the Bureau für die Handelsstatistik in 1850. In 1867, both organizations were amalgamated under the leadership of Johann Frese; see Otto Fromme, '100 Jahre amtliche Statistik in Bremen', Statistische Mitteilungen 5, 1 (1950), 3-12. For an overview of the general development of Bremen's central administration, see Manfred Leist, 'Das Wachstum der Bremischen Behörden-Organisation in den letzten hundert Jahren, 1850-1950. Eine verwaltungswissenschaftliche Untersuchung auf Grund statistischer Unterlagen', (unpublished Law dissertation, Kiel, 1955). See also Marjatta Hietala, Services and urbanization at the turn of the century: the diffusion of innovations (Helsinki, 1987), 132, 134.
24. The Provisorische Bureau für allgemeine Staats- und Städtestatistik was founded in 1861, following the creation of the Bureau für die Handelsstatistik in 1850. In 1867, both organizations were amalgamated under the leadership of Johann Frese; see Otto Fromme, '100 Jahre amtliche Statistik in Bremen', Statistische Mitteilungen 5, 1 (1950), 3-12. For an overview of the general development of Bremen's central administration, see Manfred Leist, 'Das Wachstum der Bremischen Behörden-Organisation in den letzten hundert Jahren, 1850-1950. Eine verwaltungswissenschaftliche Untersuchung auf Grund statistischer Unterlagen', (unpublished Law dissertation, Kiel, 1955). See also Marjatta Hietala, Services and urbanization at the turn of the century: the diffusion of innovations (Helsinki, 1987), 132, 134.
25. The Provisorische Bureau für allgemeine Staats- und Städtestatistik was founded in 1861, following the creation of the Bureau für die Handelsstatistik in 1850. In 1867, both organizations were amalgamated under the leadership of Johann Frese; see Otto Fromme, '100 Jahre amtliche Statistik in Bremen', Statistische Mitteilungen 5, 1 (1950), 3-12. For an overview of the general development of Bremen's central administration, see Manfred Leist, 'Das Wachstum der Bremischen Behörden-Organisation in den letzten hundert Jahren, 1850-1950. Eine verwaltungswissenschaftliche Untersuchung auf Grund statistischer Unterlagen', (unpublished Law dissertation, Kiel, 1955). See also Marjatta Hietala, Services and urbanization at the turn of the century: the diffusion of innovations (Helsinki, 1987), 132, 134.
26. See the correspondence of the Public Health Board in February and March 1858 in StAB 2-S.7.a.1.a.1.
27. See the negotiations concerning the Medical Ordinance of 7 September 1866, in Verhandlungen zwischen dem Senate und der Bürgerschaft von Jahre 1866 (Bremen, 1867), 418 ff. A specific tax was to have been introduced to pay for introduction of post-mortem examinations in the rural areas.
28. StAB 4, 21-5. On 23 December 1871 the physicians Pauli and Focke were carrying out the training course.
29. See the complaints of the sanitary authorities in the third yearly report of 17 December 1875, which stated that the accuracy of mortality statistics in rural areas suffered from the doubtful accuracy of the determination of cause of death. The registration of cause of death would have to be undertaken by physicians, rather than laymen. See Verhandlungen zwischen dem Senate und der Bürgerschaft vom Jahre 1875 (Bremen, 1876), 585. Detailed information on instruction in the Hospital can be found in the report of the Public Health Board of 10 February 1878: StAB 4, 21-4.
30. In 1911 it was thought that there were sufficient physicians to carry out post-mortem examinations, even in rural areas. Finally in 1912 the Public Health Board supported this position, because of improvements in the accuracy of post-mortem examinations by physicians. However, because of the First World War, this issue was not raised again until 1920 in connection with a planned revision of the Medical Ordinance. The Public Health Board on this occasion repeated its earlier arguments of 1912 and pointed out that the shortage of physicians caused by the war was no longer a major problem. At the same time, a survey of rural physicians came to the same conclusion : StAB 4, 21-11 and 4, 21-187; Medical Ordinance of 17 December 1927, Gesetzblatt der freien Hansestadt Bremen 1927 (Bremen, 1928), 105.
31. The sanitary authorities included the Medical Commission of the Senate, the Public Health Board, and six elected members of the Bürgerschaft (citizens).
32. See the protocol of the Public Health Board of 5 May 1869 in StAB 4, 21-3. The Prussian cause-of-death classification had been drawn up in 1858 by the scientific Medical Deputation. It was initially applied in Berlin, but from 1861 throughout the whole of Prussia. The 76 causes of death were divided into ten main headings : stillbirth, weakness following birth (Lebenschwäche nach der Geburt), weakness of age (Altersschwäche), death through external violence, death during pregnancy and childbirth, inner acute illnesses, inner chronic illnesses, sudden illness, external illnesses (äussere Krankheiten), and unknown cause of death. See Boeckh, Die geschichtliche Entwicklung, 73.
33. According to the correspondence of Wilhelm Böhmert (later Director of the Bremen Statistical Bureau) of 24 November 1904, a cause-of-death classification scheme similar to that developed by Virchow had been used in the case of Bremen before 1892: see StAB 4, 21-566. Virchow, as a Stadtverordneter, or City Councillor, for Berlin, had created a classification scheme with 139 causes of death for the Berlin Statistical Bureau in 1873. It is uncertain whether this classification scheme was used in Bremen in 1873 for processing data from the previous year, or whether it was first used directly in 1876. See Fischer, Geschichte des deutschen Gesundheitswesens, Vol. 2, 555.
34. The scheme of 1872 was as follows: I. Infektionskrankheiten (infectious diseases), II. Vergiftungen (poisonings); III. Gewaltsamer Tod (violent death); IV. Störungen der Entwicklung und Ernährung (development and nutrition disturbances); V. Organische Krankheiten (organic diseases), (a) der Haut und Muskeln (of the skin and muscles), (b) der Knochen und Gelenke (of the bones and joints), (c) des Nervensystems und der Sinnesorgane (of the nervous system and sensory organs), (d) der Atmungsorgane (of the respiratory organs), (e) der Verdauungsapparate (of the digestive apparatus), (f) Harnkrankheiten (urinary diseases), (h) der Geschlechtskrankheiten (sexual diseases); and VI. Unbekannt (unknown) (Jahrbuch für die amtliche Statistik des Bremischen Staats, VI, Vol. 2, Zur allgemeinen Statistik des Jahres 1872 (Bremen, 1873).
35. From 1876 onwards there was almost certainly a partial adoption of elements of the Virchow classification scheme. The main and sub-headings were retained for many years.
36. The statistical analysis was carried out by the Imperial Statistical Office (founded in 1872), until this task was transferred to the Imperial Health Office, following its establishment in 1876. The year 1877 witnessed the publication of the first cause-of-death statistics, statistics on the number of doctors and medical personnel, and from 1887 onwards statistics on the number of general hospitals. See Gerhard Fürst, 'Wandlungen im Programm und in den Aufgaben der amtlichen Statistik in den letzten 100 Jahren', in Statistisches Bundesamt Berlin ed., Bevölkerung und Wirtschaft 1872-1972 (Stuttgart, 1972), 13-83, in particular p. 18.
37. The Imperial Health Office had only an advisory function. It was under the direct supervision of the Imperial Chancellor (Reichskanzler) and the Reichsamt des Inneren (Ministry of the Interior).
38. Some of the cause-of-death classification schemes were developed by individual doctors (such as Bertillon, Virchow, Flinzer, and Lackner), whereas other schemes were created by the bureaucracy; see Eugen Würzburger, 'Die Bearbeitung der Statistik der Bevölkerungsbewegung durch die Statistischen Ämter im Deutschen Reiche', Allgemeines Statistisches Archiv, Vol. 7 (1909), supplementary volume, 45 flf.
39. In 1874 the Commission appointed by the Federal Council designed a cause-of-death scheme based on that used by the army and consisting of 200 specific illnesses. This new classification scheme contained five main groups: Entwicklungskrankheiten (developmental diseases), Infektions- und allgemeine Krankheiten (infectious and general diseases), Localisierte Krankheiten (located diseases), Gewaltsame Todesarten (violent deaths), Unbekannte Todesursache (unknown causes of death) and within these were 82 subgroups. But this scheme was not made obligatory within the German Empire; see Emil Blenck, Das Königliche Statistisches Bureau im ersten Jahrhundert seines Bestehens 1805 bis 1905 (Berlin, 1905), 43. This system also probably incorporated elements of the Virchow scheme of 1873. Indeed, Virchow had already designed a classification of illnesses based on the diseases listed in the Prussian sanitary reports of 1863 for presentation to the International Congress of Statistics that was held in Berlin in the same year; see Fischer, Geschichte des deutschen Gesundheitswesens Vol. 2, 350, 348.
40. Blenck, Das Königliche Statistische Bureau, 43.
41. Fischer, Geschichte des deutschen Gesundheitswesens, 555.
42. Fürst, 'Wandlungen im Programm', 18. The demands of the Imperial Health Office addressed to the Bremen Senate Commission on Statistics on 14 October 1876 can be found in StAB 4, 57/4-6.
43. See Würzburger, 'Die Bearbeitungen der Statistik', 45. The classification scheme of 1892-1904 consisted of the following elements : 1. Diphtherie mit Kroup (diphtheria with croup), 2. Keuchhusten (whooping cough), 3. Scharlach (scarlet fever), 4. Masern (measles), 5. Typhus (typhus), 6. (a) seltenere gemeinfährliche Ansteckungskrankheiten (more rare, but dangerous infectious illnesses), (b) übertragbare Tierkrankheiten (contagious animal diseases), 7 (a) Lungentuberkulose (pulmonary tuberculosis), (b) TB anderer Organe (tuberculosis of other organs), 8. Lungenentzündung (pneumonia), 9. andere entzündliche Krankheiten der Atmungsorgane (other inflammatory diseases of the respiratory organs), 10. Magen - und Darmkatarrh (stomach and intestinal catarrh) / Atrophie der Kinder (atrophy of children), 11 (a) Kindbettfieber (puerperal fever), (b) andere Folgen der Geburt (other consequences of parturition), 12. Neubildung (neoplasms), 13. angeborene Lebenschwäche (congenital weakness), 14. Alterschwäche (decrepitude), 15. Verunglückungen (accidents), 16. Selbstmord (suicide), 17. sonstige benannte Krankheiten (other named diseases), 18. Todesursache nicht angegeben (cause of death unrecorded). In addition to these headings and subheadings, classification by age group was also introduced: (a) under 1, (b) 1-15, (c) 15-60, (d) over 60, (e) unknown.
44. Communication of the Ministry of the Interior, 14 May 1891 (StAB 3-M.1.d.8).
45. This was the reason for not recording cause of death in official death registers prior to 1892.
46. The Commission created to prepare medical statistics for the German Empire had supported the introduction of post-mortem examination as early as 1874. The Office of the Imperial Chancellor was accordingly asked to draw up appropriate legislation, but nothing came of this initiative. This was equally the case following a petition in favour of post-mortem examination submitted by the Association of German Life Insurers in 1880, and the request submitted by the Imperial Parliament in 1901 to the Chancellor. See Prinzing, Handbuch der medizinischen Statistik, 323.
47. Blenck, Das Königliche Statistische Bureau, 45.
48. Ibid.
49. The 1905 scheme consisted of the following elements: 1. angeborene Lebensschwäche im Monat (congenital debility in the first month of life), 2. Altersschwäche über 60 Jahre (decrepitude over 60 years of age), 3. (a) Kindbettfieber (puerperal fever), (b) andere Folgen der Geburt oder des Kindbetts (other consequences of birth or childbed), 4. Scharlach (scarlet fever), 5. Masern und Röteln (measles and German measles), 6. Diphtherie und Kroup (diphtheria and croup), 7. Keuchhusten (whooping cough), 8. Typhus (typhus), 9. übertragbare Tierkrankheiten (contagious animal diseases), 10. (a) Rose [Erysipel] (erysipelas), (b) andere Wundinfektionskrankheiten (other infected wound diseases), 11. (a) Tuberkulose der Lungen (pulmonary tuberculosis), (b) Tuberkulose anderer Organe (tuberculosis of other organs), 12. Lungenentzündung (pneumonia), 13. Influenza (influenza), 14. andere übertragbare Krankheiten (other contagious diseases), 15. andere Krankheiten der Atmungsorgane (other diseases of the respiratory organs), 16. Krankheiten der Kreislauforgane (diseases of the circulation system), 17. (a) Gehirnschlag (cerebral apoplexy), (b), andere Krankheiten des Nervensystems (other diseases of the nervous system), 18. (a) Magen- und Darmkatarrh (stomach and intestinal catarrh), Brechdurchfall (diarrhoea), (b) andere Krankheiten der Verdauungsorgane (other diseases of the digestive organs), 19. Krankheiten der Hautund Geschlechtsorgane (diseases of the skin and sexual organs), 20. (a) Krebs (cancer), (b) andere Neubildungen (other neoplasms), 21. (a) Selbstmord (suicide), (b) Mord (murder), Totschlag (manslaughter), Hinrichtung (execution), (c) Verunglückungen oder andere gewaltsame Einwirkung (accidents or other violent influences), 22. andere benannte Todesursachen (other named causes of death), 23. Todesursache nicht angegeben (cause of death unrecorded). See Würzburger, 'Die Bearbeitungen der Statistik', 46.
50. (a) Under 1; (b) 1-15; (c) 15-30; (d) 30-60; (e) 60-70; (f) over 70; (g) unknown age. See Würzburger, 'Die Bearbeitungen der Statistik'.
51. Prinzing, Handbuch der medizinischen Statistik, 330.
52. Würzburger,'Die Bearbeitungen der Statistik', 46.
53. Statistisches Bundesamt Wiesbaden ed., Bevölkerung und Wirtschaft, 117.
54. Boeckh, Die geschichtliche Entwicklung, 73.
55. Fischer, Geschichte des deutschen Gesundheitswesens, Vol. 2, 304 ff. The petition of February 1870 was from Wasserfuhr, Richter, Spiess, Varrentrapp, and Hobrecht (all were either doctors or members of the local council, except Baurat Hobrecht), together with 3,700 signatures from individuals in all the federal states, and representatives of some medical and hygiene associations. The objective was to secure the introduction of suitable institutions and laws regarding a public health service for the whole of Germany, based on the recommendations of the 43rd meeting of German scientists and doctors in Innsbruck in 1869. In March 1870 numerous other doctors, led by Zeulzer, the publisher of the Wochenblatt für medizinische Statistik und Epidemiologie, petitioned for the creation of a central Institute for Statistics in Berlin.
56. Fischer, Geschichte des deutschen Gesundheitswesens, Vol. 2, 306 ff.
57. Prinzing, Handbuch der medizinischen Statistik, 332.
58. See the report of the Public Health Board on behalf of the Medical Commission of July 1873 (StAB 3-M.1.d.1).
59. Walter Kohler, 'Quellen zur Statistik des Gesundheitswesens in Deutschland (1815-1938)', in Wolfram Fischer and Andreas Kunz eds., Grundlagen der Historischen Statistik von Deutschland: Quellen, Methoden, Forschungsziele (Opladen, 1991), 275-98.
60. See the correspondence between the Medical Commission, the sanitary authorities, the Senate Commission for Bremen Statistics, and the Statistical Bureau, 27.4.1877-28.6.1878 (StAB 4, 57/4-6).
61. Between 1834 and 1867 the population of all the states in the Customs Union had been counted. This meant that everyone was included who had their permanent place of residence within the designated area on the day in question. For the first time the census of 1867 was designed to establish the actual number of individuals present on the day in question. After 1871, only the second method of calculating total population was allowed.
62. See the communication of 26 March 1878 in StAB 4, 57/4-6 and 6, and the recommendation of the Deputation for Bremen Statistics to the Statistical Bureau, 28 June 1878, in StAB 4, 57/4-6.
63. Since the beginning of 1872, according to the head of the Statistical Bureau, it was usual to record weekly deaths in the statistical data, and also to publish them in newspapers in Bremen (StAB 3-M.1.d.1 and 4, 57/4-6).
64. See the communication of 27 May 1890 (StAB 3-M.1.d.8).
65. See the correspondence between the Public Health Board and the Imperial Health Office between 14 May 1891 and 2 December 1891 in StAB 3-M.1.d.8.
66. Moreover, the calculations of the Jahrbuch für Bremische Statistik continued to be based on the permanent resident population, presumably to facilitate comparisons with earlier data.
67. See the communication of Dr Wilhelm O. Focke with Dr Wilhelm Böhmert from 24.1.1901 in StAB 4, 21-566. In dealing with continuing problems relating to cause of death data, Böhmert cited the unreliability of the death certificates and the diagnostic problems created by general practitioners. 'Many descriptions do not allow a diagnosis of the actual cause of death, but simply record some symptom, or they have a completely unspecific and unreliable significance, as in the case of cholic, paralysis of the lung, stroke, etc. In private practice circumstances frequently prevent an exact observation, so that the actual cause (of death) remains unknown.' In contrast, Focke attributed a high statistical significance to diseases with a uniform causation, for example, scarlet fever, abdominal typhus, and tuberculosis.
68. See Böhmert's report of 24 November 1904 (StAB 4, 21-566).
69. Until this date at least two systems were used in Bremen: the Virchow scheme (until 1892), and the version of the Imperial Health Office. In other towns, classification schemes devised by other doctors were used, for example, the Finzer system (which had been adopted by many local authorities), or the Bertillon scheme (which was used both internationally and in the southern German states).
70. See the communication of Böhmert of 13 December 1904, in which he withdrew his objections without stating any reasons (StAB 4, 21-566).
71. See the decision of the Senate on 10 January 1905 in StAB 4, 21-566.
72. Jahrbuch für Bremische Statistik, 1906 (Bremen, 1906).
73. StAB 3-M.1.d.4.
74. See the correspondence between 7 October 1910 and 14 February 1911 in StAB 3-M. 1.d.1. The physicians and statisticians in Bremen agreed to the introduction of the 'mittleren Todesursachenverzeichnis' because it had already been in use in Bremen since 1909 and had been employed in the Jahrbuch für Bremische Statistik. It therefore did not present any significant changes to the existing cause-of-death classification scheme.
75. Boeckh, Die geschichtliche Entwicklung, 5.
76. H. Boldt, 'Federalism as an issue in the German Constitution of 1849 and 1871', in H. Wellenreuther, C. Schmurmann, and T. Krueger eds., German and American constitutional thought: contexts, interaction and historical realities (New York, Oxford and Munich, 1990).
77. Manfred Rauh, Föderalismus und Parlamentarismus im Wilhelminischen Reich (Düsseldorf, 1973).