The urban penalty: Towns and mortality in nineteenth-century Norway

Continuity and Change

Volumn 15, Issue 2, 2000, Pages 331-350

  Hubbard, William H ^a  

^a UNIVERSITY OF BERGEN   (Norway)

Author keywords

[No Author keywords available]

Indexed keywords

DEMOGRAPHIC HISTORY; MORTALITY; NINETEENTH CENTURY; PUBLIC HEALTH; RURAL-URBAN COMPARISON;

NORWAY;

EID: 0033795610     PISSN: 02684160     EISSN: None     Source Type: Journal    
DOI: 10.1017/S0268416099003549     Document Type: Article

References (43)

1. R. Schofield and D. Reher, 'The decline of mortality in Europe', in R. Schofield, D. Reher, and A. Bideau eds., The decline of mortality in Europe (Oxford, 1991), 1-17, here p. 2.
2. The most recent survey of Norwegian research in historical demography is William H. Hubbard, 'Historical demography', in William H. Hubbard et al. eds., Making a historical culture: Historiography in Norway (Oslo, 1995), 311-24.
3. 'Mortality in urban areas is customarily higher than in rural districts', quoted in Eilert Sundt, Om dodligheden i Norge: bidrag til Kundskab om Folkets Kaar (Oslo, 1855; reprinted 1975).
4. Robert I. Woods, 'Public health and public hygiene: the urban environment in the late nineteenth and early twentieth centuries', in Schofield et al., Decline of mortality, 233-47, and Simon Szreter, 'Economic growth, disruption, deprivation, disease and death: on the importance of the politics of public health for development', Population and Development Review 23 (1997), 693-728.
5. Robert I. Woods, 'Public health and public hygiene: the urban environment in the late nineteenth and early twentieth centuries', in Schofield et al., Decline of mortality, 233-47, and Simon Szreter, 'Economic growth, disruption, deprivation, disease and death: on the importance of the politics of public health for development', Population and Development Review 23 (1997), 693-728.
6. The computational method was derived from Gerry Kearns, 'Biology, class and the urban penalty', in G. Kearns and C. W. J. Withers eds., Urbanising Britain: essays on class and community in the nineteenth century (Cambridge, 1991), 12-30.
7. See the Umeå 1999 conference paper by Sam Willner on gender and mortality in nineteenth-century Sweden (proceedings forthcoming) and Willner's recent doctoral dissertation at the University of Linköping Det svaga könetl Kön och vuxendödlighet i 1800-talets Svergige (The weaker sex? Gender and adult mortality in nineteenth-century Sweden), Linköping Studies in Arts and Science, 203 (Linköping, 1999).
8. The crucial contribution of urban mortality to the overall mortality decline has been underscored especially in respect to Great Britain and Germany. See for example Gerry Kearns, 'The urban penalty and the population history of England', in A. Brandström and L.-G. Tedebrand eds., Society, health and population during the demographic transition (Stockholm, 1988), 213-36, here p. 223: 'A central feature of any explanation of mortality changes over the nineteenth century must be an account of the near removal of the urban penalty.' And see Richard M. Smith, 'Demography and medicine', in W. F. Bynum and R. Porter eds., Companion Encyclopedia of the History of Medicine (London, 1993), 1663-1692, here p. 1685: 'a very substantial part of the late nineteenth-century mortality decline was connected to the way in which the mortality gradient between urban and rural places was narrowed.' Most recently see Jörg Vögele, Urban mortality change in Britain and Germany, 1870-1910, Liverpool Studies in European Population, 5 (Liverpool, 1998).
9. The crucial contribution of urban mortality to the overall mortality decline has been underscored especially in respect to Great Britain and Germany. See for example Gerry Kearns, 'The urban penalty and the population history of England', in A. Brandström and L.-G. Tedebrand eds., Society, health and population during the demographic transition (Stockholm, 1988), 213-36, here p. 223: 'A central feature of any explanation of mortality changes over the nineteenth century must be an account of the near removal of the urban penalty.' And see Richard M. Smith, 'Demography and medicine', in W. F. Bynum and R. Porter eds., Companion Encyclopedia of the History of Medicine (London, 1993), 1663-1692, here p. 1685: 'a very substantial part of the late nineteenth-century mortality decline was connected to the way in which the mortality gradient between urban and rural places was narrowed.' Most recently see Jörg Vögele, Urban mortality change in Britain and Germany, 1870-1910, Liverpool Studies in European Population, 5 (Liverpool, 1998).
10. The crucial contribution of urban mortality to the overall mortality decline has been underscored especially in respect to Great Britain and Germany. See for example Gerry Kearns, 'The urban penalty and the population history of England', in A. Brandström and L.-G. Tedebrand eds., Society, health and population during the demographic transition (Stockholm, 1988), 213-36, here p. 223: 'A central feature of any explanation of mortality changes over the nineteenth century must be an account of the near removal of the urban penalty.' And see Richard M. Smith, 'Demography and medicine', in W. F. Bynum and R. Porter eds., Companion Encyclopedia of the History of Medicine (London, 1993), 1663-1692, here p. 1685: 'a very substantial part of the late nineteenth-century mortality decline was connected to the way in which the mortality gradient between urban and rural places was narrowed.' Most recently see Jörg Vögele, Urban mortality change in Britain and Germany, 1870-1910, Liverpool Studies in European Population, 5 (Liverpool, 1998).
11. Simon Szreter, 'The importance of social intervention in Britain's mortality decline c. 1850-1914: a re-interpretation of the role of public health', Social History of Medicine 1 (1988), 1-37, here p. 7.
12. That is, the number of corpses attached a cause of death related to the total number of deaths officially registered. A doctor-certified cause of death was not generally mandatory until the 1890s but several cities had included this requirement in the first municipal health codes adopted in the 1860s and 1870s. In the 1890s the requirement was incorporated into revised codes for most medical districts, and by 1900 doctor-certified cause of death was reported for some 80 per cent of all deaths in the country - rural and urban. See Julie E. Backer, Dodligheten og dens årsaker i Norge 1856-1955, Samfunnsokonomiske studier, 10 (Oslo, 1961), 36-41, and the individual health by-laws published in the country's medical reports (Beretning om Sundhedstilstanden og Medicinalforholdene i Aaret ...) in the publication series Norwegian Official Statistics (Norsk offisielle statistikk, hereafter NOS). The completeness of morbidity data is impossible to determine because its registration is a function of the public's use of doctors. Numerous comments in reports of the Medical Officers of Health indicate that they were not confident that the rural data were a true picture and even the urban data, where more doctors were available, were not always a complete record of disease outbreaks. See Riksarkiv, kat. 1263/30, Medisinalinnberetninger, Stavanger Amt, Haugesund Lasgedistrikt.
13. The category 'epidemic diseases' includes here all contagious disease except pulmonary tuberculosis.
14. Kristiania's Chief Medical Officer of Health, Hjalmar Berner, recognized the prior decline of TB mortality but praised the new legislation strongly as a contribution to the disease's eventual elimination; see Hjalmar Berner, 'Medicinisk Statistik fra Kristiania: Foredrag ved den tekniske og hygiæniske kongres i Kjobenhavn 24de-27de juni 1903', Beretning fra Kristiania sundhedskommision 1902 (Kristiania, 1903), 41-57. On the treatment of TB in Norway after 1900, see Ida Blom, Feberens ville rose: tre omsorgssystemer i tuberkulosearbeidet 1900-1960 (Bergen, 1998).
15. Kristiania's Chief Medical Officer of Health, Hjalmar Berner, recognized the prior decline of TB mortality but praised the new legislation strongly as a contribution to the disease's eventual elimination; see Hjalmar Berner, 'Medicinisk Statistik fra Kristiania: Foredrag ved den tekniske og hygiæniske kongres i Kjobenhavn 24de-27de juni 1903', Beretning fra Kristiania sundhedskommision 1902 (Kristiania, 1903), 41-57. On the treatment of TB in Norway after 1900, see Ida Blom, Feberens ville rose: tre omsorgssystemer i tuberkulosearbeidet 1900-1960 (Bergen, 1998).
16. According to the city's Medical Officer of Health, the number of deaths due to epidemic diseases was higher in 1887, both absolutely and relatively, than in any year since the cholera epidemic of 1853; see Beretning om Sundhedstilstanden og Medicinalforholdene i Aaret 1887, NOS series III, vol. 95.
17. See Simon Szreter and Graham Mooney, 'Urbanization, mortality, and the standard of living debate: new estimates of the expectation of life at birth in nineteenth-century British cities', Economic History Review 51 (1998), 84-112.
18. For a critical evaluation of McKeown's interpretation of tuberculosis and causes of death generally, see especially Szreter, 'The importance of social intervention', and Anne Hardy, The epidemic streets: infectious diseases and the rise of preventive medicine, 1856-1900 (Oxford, 1983).
19. For a critical evaluation of McKeown's interpretation of tuberculosis and causes of death generally, see especially Szreter, 'The importance of social intervention', and Anne Hardy, The epidemic streets: infectious diseases and the rise of preventive medicine, 1856-1900 (Oxford, 1983).
20. See Robert I. Woods and P. R. Andrew Hinde, 'Mortality in Victorian England: models and patterns', Journal of Interdisciplinary History 18 (1987), 27-54, and Robert I. Woods and John Woodward, ' Mortality, poverty and the environment,' in R. Woods and J. Woodward eds., Urban disease and mortality in nineteenth-century England, (London, 1984), 19-36. The use of cause-of-death statistics over time is fraught with difficulties; as Günter B. Risse reminds us, almost all elements of the collection of cause-of-death data - ecology of disease, definitions of disease and death, as well as the administrative organization of death records-are steadily shifting, making comparisons uncertain; see Günter B. Risse, 'Cause of death as a historical problem' Continuity and Change 12 (1997), 175-88.
21. See Robert I. Woods and P. R. Andrew Hinde, 'Mortality in Victorian England: models and patterns', Journal of Interdisciplinary History 18 (1987), 27-54, and Robert I. Woods and John Woodward, ' Mortality, poverty and the environment,' in R. Woods and J. Woodward eds., Urban disease and mortality in nineteenth-century England, (London, 1984), 19-36. The use of cause-of-death statistics over time is fraught with difficulties; as Günter B. Risse reminds us, almost all elements of the collection of cause-of-death data - ecology of disease, definitions of disease and death, as well as the administrative organization of death records-are steadily shifting, making comparisons uncertain; see Günter B. Risse, 'Cause of death as a historical problem' Continuity and Change 12 (1997), 175-88.
22. See Robert I. Woods and P. R. Andrew Hinde, 'Mortality in Victorian England: models and patterns', Journal of Interdisciplinary History 18 (1987), 27-54, and Robert I. Woods and John Woodward, ' Mortality, poverty and the environment,' in R. Woods and J. Woodward eds., Urban disease and mortality in nineteenth-century England, (London, 1984), 19-36. The use of cause-of-death statistics over time is fraught with difficulties; as Günter B. Risse reminds us, almost all elements of the collection of cause-of-death data - ecology of disease, definitions of disease and death, as well as the administrative organization of death records-are steadily shifting, making comparisons uncertain; see Günter B. Risse, 'Cause of death as a historical problem' Continuity and Change 12 (1997), 175-88.
23. Peter M. Holst, 'Om skarlagensfeberens optreden i Norge i årene 1879-1919', NOS series VII, vol. 152, Appendix, 91*-134*. Between 1880 and 1910 the doctor-reported number of cases of scarlet fever in Norway declined by half - from 4-5 per thousand population to ca. 2 per thousand - and case mortality dropped from 10-12 per cent to 1-2 per cent. Holst comments, 'This change cannot be due to improved medical treatment of the disease, for almost everywhere the treatment is the same as before: isolation and disinfection.' He thus concludes that the character of the disease must have changed.
24. 'Lov om sundhetskommissioner og om foranstaltninger i anledning av epidemiske og smittsomme sygdommer' ('Law on Health Commissions and on Measures relating to Epidemic and Contagious Diseases'), 16 May 1860, paragraph 3: 'Kommissionen skal ha sin opmerksomhet henvendt paa stedets sundhetsforhold, og hvad derpaa kan ha indflydelse ... ' ('The commission shall focus its attentions on the health conditions of the locality and on whatever can affect them ...').
25. 'Lov om sundhetskommissioner og om foranstaltninger i anledning av epidemiske og smittsomme sygdommer' ('Law on Health Commissions and on Measures relating to Epidemic and Contagious Diseases'), 16 May 1860, paragraph 3: 'Kommissionen skal ha sin opmerksomhet henvendt paa stedets sundhetsforhold, og hvad derpaa kan ha indflydelse ... ' ('The commission shall focus its attentions on the health conditions of the locality and on whatever can affect them ...').
26. On these two approaches, see Gerry Kearns, 'Zivilis og Hygaeia: urban public health and the epidemiologic transition', in Richard Lawton ed., The rise and fall of great cities (London, 1989), 96-124. Norwegian cities were relatively spared by cholera, but there occurred major epidemics in Bergen and Oslo in the early 1850s and the fear of contagion was always present in the country's port cities.
27. For contemporary surveys of public health interventions see Martin Geirsvold, 'Bergens sundhetsvæsen', in C. Geelmuyden and H. Schetelig eds., Bergen 1814-1914, vol. 1 (Bergen, 1914), 499-538, and 'Sundhets-og sykevæsen', in Beretning om Kristiania Kommune for Aarene 1887-1911 (Kristiania, 1914), 100-57. More distanced but less detailed treatments can be found in recent histories of the two cities: Egil Ertresvaag, Et bysamfunn i utvikling 1800-1920, Bergen bys historie, vol. 3 (Bergen and Oslo, 1982), Knut Kjeldstadli, Den delte byen, fra 1900 til 1948, Oslo bys historie, vol. 4 (Oslo, 1990), and Jan Eivind Myhre, Hovedstaden Christiania, fra 1814 til 1900, Oslo bys historie, vol. 3 (Oslo, 1990).
28. For contemporary surveys of public health interventions see Martin Geirsvold, 'Bergens sundhetsvæsen', in C. Geelmuyden and H. Schetelig eds., Bergen 1814-1914, vol. 1 (Bergen, 1914), 499-538, and 'Sundhets-og sykevæsen', in Beretning om Kristiania Kommune for Aarene 1887-1911 (Kristiania, 1914), 100-57. More distanced but less detailed treatments can be found in recent histories of the two cities: Egil Ertresvaag, Et bysamfunn i utvikling 1800-1920, Bergen bys historie, vol. 3 (Bergen and Oslo, 1982), Knut Kjeldstadli, Den delte byen, fra 1900 til 1948, Oslo bys historie, vol. 4 (Oslo, 1990), and Jan Eivind Myhre, Hovedstaden Christiania, fra 1814 til 1900, Oslo bys historie, vol. 3 (Oslo, 1990).
29. For contemporary surveys of public health interventions see Martin Geirsvold, 'Bergens sundhetsvæsen', in C. Geelmuyden and H. Schetelig eds., Bergen 1814-1914, vol. 1 (Bergen, 1914), 499-538, and 'Sundhets-og sykevæsen', in Beretning om Kristiania Kommune for Aarene 1887-1911 (Kristiania, 1914), 100-57. More distanced but less detailed treatments can be found in recent histories of the two cities: Egil Ertresvaag, Et bysamfunn i utvikling 1800-1920, Bergen bys historie, vol. 3 (Bergen and Oslo, 1982), Knut Kjeldstadli, Den delte byen, fra 1900 til 1948, Oslo bys historie, vol. 4 (Oslo, 1990), and Jan Eivind Myhre, Hovedstaden Christiania, fra 1814 til 1900, Oslo bys historie, vol. 3 (Oslo, 1990).
30. For contemporary surveys of public health interventions see Martin Geirsvold, 'Bergens sundhetsvæsen', in C. Geelmuyden and H. Schetelig eds., Bergen 1814-1914, vol. 1 (Bergen, 1914), 499-538, and 'Sundhets-og sykevæsen', in Beretning om Kristiania Kommune for Aarene 1887-1911 (Kristiania, 1914), 100-57. More distanced but less detailed treatments can be found in recent histories of the two cities: Egil Ertresvaag, Et bysamfunn i utvikling 1800-1920, Bergen bys historie, vol. 3 (Bergen and Oslo, 1982), Knut Kjeldstadli, Den delte byen, fra 1900 til 1948, Oslo bys historie, vol. 4 (Oslo, 1990), and Jan Eivind Myhre, Hovedstaden Christiania, fra 1814 til 1900, Oslo bys historie, vol. 3 (Oslo, 1990).
31. For contemporary surveys of public health interventions see Martin Geirsvold, 'Bergens sundhetsvæsen', in C. Geelmuyden and H. Schetelig eds., Bergen 1814-1914, vol. 1 (Bergen, 1914), 499-538, and 'Sundhets-og sykevæsen', in Beretning om Kristiania Kommune for Aarene 1887-1911 (Kristiania, 1914), 100-57. More distanced but less detailed treatments can be found in recent histories of the two cities: Egil Ertresvaag, Et bysamfunn i utvikling 1800-1920, Bergen bys historie, vol. 3 (Bergen and Oslo, 1982), Knut Kjeldstadli, Den delte byen, fra 1900 til 1948, Oslo bys historie, vol. 4 (Oslo, 1990), and Jan Eivind Myhre, Hovedstaden Christiania, fra 1814 til 1900, Oslo bys historie, vol. 3 (Oslo, 1990).
32. Axel Holst, 'To utkast til nye bygningslover', Tidsskriff for Den Norske Lageforening 14 (1894), 12-13. Holst was Norway's first professor of bacteriology and hygiene. See also Thomas M. Legge, Public health in European capitals (London, 1896), 145-55. Legge was a Medical Inspector of Factories in Britain; he held up Stockholm's communally administered bucket system of night soil disposal as a model. The introduction of water closets in both Kristiania/Oslo and Bergen was hampered by problems in establishing a secure system of drainage in difficult terrain. The technical problems were not completely solved before the 1920s, after which the installation of water closets spread rapidly in both cities. See Kjeldstadli, Den delte byen, 311-13. An informative history of waste disposal in Kristiania/Oslo is Inge Torstenson, Fra Nattmann til Renholdsverk: Avfall og renovasjon i Oslo gjennom tusen år (Oslo, 1997). An equivalent book on conditions in Bergen is more anecdotal: O. Segadal, 100 år for en ren by: Renovasjonsvirksomheten i Bergen fra 1881 til 1981 (Bergen, 1981). The struggle between health authorities and town council over the implementation of more hygienic methods in waste removal was not unique to Kristiania. In Trondheim, Norway's third largest city, cesspools remained dominant until 1920, even though the city's health commission had regularly and strongly recommended their prohibition and replacement since the 1880s. Rolf Danielsen, 'En exempelles fremgang' 1880-1920, Trondheims historie 997-1997, vol. 4 (Oslo, 1997), 317.
33. Axel Holst, 'To utkast til nye bygningslover', Tidsskriff for Den Norske Lageforening 14 (1894), 12-13. Holst was Norway's first professor of bacteriology and hygiene. See also Thomas M. Legge, Public health in European capitals (London, 1896), 145-55. Legge was a Medical Inspector of Factories in Britain; he held up Stockholm's communally administered bucket system of night soil disposal as a model. The introduction of water closets in both Kristiania/Oslo and Bergen was hampered by problems in establishing a secure system of drainage in difficult terrain. The technical problems were not completely solved before the 1920s, after which the installation of water closets spread rapidly in both cities. See Kjeldstadli, Den delte byen, 311-13. An informative history of waste disposal in Kristiania/Oslo is Inge Torstenson, Fra Nattmann til Renholdsverk: Avfall og renovasjon i Oslo gjennom tusen år (Oslo, 1997). An equivalent book on conditions in Bergen is more anecdotal: O. Segadal, 100 år for en ren by: Renovasjonsvirksomheten i Bergen fra 1881 til 1981 (Bergen, 1981). The struggle between health authorities and town council over the implementation of more hygienic methods in waste removal was not unique to Kristiania. In Trondheim, Norway's third largest city, cesspools remained dominant until 1920, even though the city's health commission had regularly and strongly recommended their prohibition and replacement since the 1880s. Rolf Danielsen, 'En exempelles fremgang' 1880-1920, Trondheims historie 997-1997, vol. 4 (Oslo, 1997), 317.
34. Axel Holst, 'To utkast til nye bygningslover', Tidsskriff for Den Norske Lageforening 14 (1894), 12-13. Holst was Norway's first professor of bacteriology and hygiene. See also Thomas M. Legge, Public health in European capitals (London, 1896), 145-55. Legge was a Medical Inspector of Factories in Britain; he held up Stockholm's communally administered bucket system of night soil disposal as a model. The introduction of water closets in both Kristiania/Oslo and Bergen was hampered by problems in establishing a secure system of drainage in difficult terrain. The technical problems were not completely solved before the 1920s, after which the installation of water closets spread rapidly in both cities. See Kjeldstadli, Den delte byen, 311-13. An informative history of waste disposal in Kristiania/Oslo is Inge Torstenson, Fra Nattmann til Renholdsverk: Avfall og renovasjon i Oslo gjennom tusen år (Oslo, 1997). An equivalent book on conditions in Bergen is more anecdotal: O. Segadal, 100 år for en ren by: Renovasjonsvirksomheten i Bergen fra 1881 til 1981 (Bergen, 1981). The struggle between health authorities and town council over the implementation of more hygienic methods in waste removal was not unique to Kristiania. In Trondheim, Norway's third largest city, cesspools remained dominant until 1920, even though the city's health commission had regularly and strongly recommended their prohibition and replacement since the 1880s. Rolf Danielsen, 'En exempelles fremgang' 1880-1920, Trondheims historie 997-1997, vol. 4 (Oslo, 1997), 317.
35. Axel Holst, 'To utkast til nye bygningslover', Tidsskriff for Den Norske Lageforening 14 (1894), 12-13. Holst was Norway's first professor of bacteriology and hygiene. See also Thomas M. Legge, Public health in European capitals (London, 1896), 145-55. Legge was a Medical Inspector of Factories in Britain; he held up Stockholm's communally administered bucket system of night soil disposal as a model. The introduction of water closets in both Kristiania/Oslo and Bergen was hampered by problems in establishing a secure system of drainage in difficult terrain. The technical problems were not completely solved before the 1920s, after which the installation of water closets spread rapidly in both cities. See Kjeldstadli, Den delte byen, 311-13. An informative history of waste disposal in Kristiania/Oslo is Inge Torstenson, Fra Nattmann til Renholdsverk: Avfall og renovasjon i Oslo gjennom tusen år (Oslo, 1997). An equivalent book on conditions in Bergen is more anecdotal: O. Segadal, 100 år for en ren by: Renovasjonsvirksomheten i Bergen fra 1881 til 1981 (Bergen, 1981). The struggle between health authorities and town council over the implementation of more hygienic methods in waste removal was not unique to Kristiania. In Trondheim, Norway's third largest city, cesspools remained dominant until 1920, even though the city's health commission had regularly and strongly recommended their prohibition and replacement since the 1880s. Rolf Danielsen, 'En exempelles fremgang' 1880-1920, Trondheims historie 997-1997, vol. 4 (Oslo, 1997), 317.
36. Axel Holst, 'To utkast til nye bygningslover', Tidsskriff for Den Norske Lageforening 14 (1894), 12-13. Holst was Norway's first professor of bacteriology and hygiene. See also Thomas M. Legge, Public health in European capitals (London, 1896), 145-55. Legge was a Medical Inspector of Factories in Britain; he held up Stockholm's communally administered bucket system of night soil disposal as a model. The introduction of water closets in both Kristiania/Oslo and Bergen was hampered by problems in establishing a secure system of drainage in difficult terrain. The technical problems were not completely solved before the 1920s, after which the installation of water closets spread rapidly in both cities. See Kjeldstadli, Den delte byen, 311-13. An informative history of waste disposal in Kristiania/Oslo is Inge Torstenson, Fra Nattmann til Renholdsverk: Avfall og renovasjon i Oslo gjennom tusen år (Oslo, 1997). An equivalent book on conditions in Bergen is more anecdotal: O. Segadal, 100 år for en ren by: Renovasjonsvirksomheten i Bergen fra 1881 til 1981 (Bergen, 1981). The struggle between health authorities and town council over the implementation of more hygienic methods in waste removal was not unique to Kristiania. In Trondheim, Norway's third largest city, cesspools remained dominant until 1920, even though the city's health commission had regularly and strongly recommended their prohibition and replacement since the 1880s. Rolf Danielsen, 'En exempelles fremgang' 1880-1920, Trondheims historie 997-1997, vol. 4 (Oslo, 1997), 317.
37. Axel Holst, 'To utkast til nye bygningslover', Tidsskriff for Den Norske Lageforening 14 (1894), 12-13. Holst was Norway's first professor of bacteriology and hygiene. See also Thomas M. Legge, Public health in European capitals (London, 1896), 145-55. Legge was a Medical Inspector of Factories in Britain; he held up Stockholm's communally administered bucket system of night soil disposal as a model. The introduction of water closets in both Kristiania/Oslo and Bergen was hampered by problems in establishing a secure system of drainage in difficult terrain. The technical problems were not completely solved before the 1920s, after which the installation of water closets spread rapidly in both cities. See Kjeldstadli, Den delte byen, 311-13. An informative history of waste disposal in Kristiania/Oslo is Inge Torstenson, Fra Nattmann til Renholdsverk: Avfall og renovasjon i Oslo gjennom tusen år (Oslo, 1997). An equivalent book on conditions in Bergen is more anecdotal: O. Segadal, 100 år for en ren by: Renovasjonsvirksomheten i Bergen fra 1881 til 1981 (Bergen, 1981). The struggle between health authorities and town council over the implementation of more hygienic methods in waste removal was not unique to Kristiania. In Trondheim, Norway's third largest city, cesspools remained dominant until 1920, even though the city's health commission had regularly and strongly recommended their prohibition and replacement since the 1880s. Rolf Danielsen, 'En exempelles fremgang' 1880-1920, Trondheims historie 997-1997, vol. 4 (Oslo, 1997), 317.
38. Geirsvold, 'Bergens sundhetsvæsen', 523.
39. Holst and the director of the state hospital (Rikshospitalet), M. Greve, were especially active in Kristiania; Klaus Hanssen, one of the two authors of the national tuberculosis law, was the most prominent campaigner in Bergen.
40. Beretning fra Kristiania sundhetskommision 1899 (Kristiania, 1900) 38-9; Kjeldstadli, Den delte byen, 156.
41. Beretning fra Kristiania sundhetskommision 1899 (Kristiania, 1900) 38-9; Kjeldstadli, Den delte byen, 156.
42. In 1999 the Ministry of Health commissioned a two-volume history of public health in Norway under the general editorship of Professor Øyvind Larsen, University of Oslo.
43. Roy Porter, Disease medicine and society in England, 1550-1860 (2nd edn, Cambridge, 1993), 58.