The role of morbidity in the mortality decline of the nineteenth century: Evidence from the military population at Gibraltar 1818-1899

Journal of the History of Medicine and Allied Sciences

Volumn 60, Issue 1, 2005, Pages 73-95

  Padiak, Janet ^a  

^a NONE

Author keywords

Colonial health; Decline of mortality; Gibraltar; Military medicine; Morbidity; Soldiers; Victorian British army

Indexed keywords

ADULT; ARTICLE; ETHNOLOGY; GIBRALTAR; HISTORY; HUMAN; MALE; MIDDLE AGED; MILITARY MEDICINE; MORBIDITY; MORTALITY; SOLDIER; STATISTICS; UNITED KINGDOM;

ADULT; GIBRALTAR; GREAT BRITAIN; HISTORY, 19TH CENTURY; HUMANS; MALE; MIDDLE AGED; MILITARY MEDICINE; MILITARY PERSONNEL; MORBIDITY; MORTALITY;

EID: 11144284909     PISSN: 00225045     EISSN: None     Source Type: Journal    
DOI: 10.1093/jhmas/jri003     Document Type: Article

References (103)

1. Léon-Cléry Vacher, "On the Decline of the Mortality Rate and the Increase of the Average Life Span since the End of the Last Century," 1886, reprinted in Pop. Dev. Rev., 1979, 3, 163-70; G. B. Longstaff, "The Recent Decline in the English Death Rate Considered in Connection with the Causes of Death," J. Royal Stat. Soc., 1884, 47, 221-49.
2. Léon-Cléry Vacher, "On the Decline of the Mortality Rate and the Increase of the Average Life Span since the End of the Last Century," 1886, reprinted in Pop. Dev. Rev., 1979, 3, 163-70; G. B. Longstaff, "The Recent Decline in the English Death Rate Considered in Connection with the Causes of Death," J. Royal Stat. Soc., 1884, 47, 221-49.
3. Léon-Cléry Vacher, "On the Decline of the Mortality Rate and the Increase of the Average Life Span since the End of the Last Century," 1886, reprinted in Pop. Dev. Rev., 1979, 3, 163-70; G. B. Longstaff, "The Recent Decline in the English Death Rate Considered in Connection with the Causes of Death," J. Royal Stat. Soc., 1884, 47, 221-49.
4. Thomas McKeown and R. G. Brown, "Medical Evidence Related to English Population Changes in the Eighteenth Century," Pop. Stud., 1955, 9, 119-41; Odin W. Anderson, "Age-Specific Mortality in Selected Western European Countries with Particular Emphasis on the Nineteenth Century: Observations and Implications," Bull. Hist. Med., 1955, 29, 239-53.
5. Thomas McKeown and R. G. Brown, "Medical Evidence Related to English Population Changes in the Eighteenth Century," Pop. Stud., 1955, 9, 119-41; Odin W. Anderson, "Age-Specific Mortality in Selected Western European Countries with Particular Emphasis on the Nineteenth Century: Observations and Implications," Bull. Hist. Med., 1955, 29, 239-53.
6. George Alter and James C. Riley, "Frailty, Sickness and Death: Models of Morbidity and Mortality in Historical Populations," Pop. Stud., 1989, 43, 25-45; R. S. Schofield and D. Reher, The Decline of Mortality in Europe, ed. R. S. Schofield, D. Reher, and A. Bideau (Oxford: Clarendon Press, 1991), pp. 1-17.
7. George Alter and James C. Riley, "Frailty, Sickness and Death: Models of Morbidity and Mortality in Historical Populations," Pop. Stud., 1989, 43, 25-45; R. S. Schofield and D. Reher, The Decline of Mortality in Europe, ed. R. S. Schofield, D. Reher, and A. Bideau (Oxford: Clarendon Press, 1991), pp. 1-17.
8. Vacher, "On the Decline of the Mortality Rate"; Longstaff, "The Recent Decline in the English Death Rate."
9. Vacher, "On the Decline of the Mortality Rate"; Longstaff, "The Recent Decline in the English Death Rate."
10. McKeown and Brown, "Medical Evidence"; Thomas McKeown, The Modern Rise of Population (New York: Blackwell, 1977); Schofield and Reher, The Decline of Mortality in Europe.
11. McKeown and Brown, "Medical Evidence"; Thomas McKeown, The Modern Rise of Population (New York: Blackwell, 1977); Schofield and Reher, The Decline of Mortality in Europe.
12. McKeown and Brown, "Medical Evidence"; Thomas McKeown, The Modern Rise of Population (New York: Blackwell, 1977); Schofield and Reher, The Decline of Mortality in Europe.
13. Simon Szreter, "The Importance of Social Intervention in Britain's Mortality Decline c. 1850-1914: A Re-interpretation of the Role of Public Health," Soc. Hist. Med., 1993, 1, 1-37.
14. Sumit Guha, "The Importance of Social Intervention in England's Mortality Decline: The Evidence Reviewed," Soc. Hist. Med., 1994, 7, 89-113.
15. For example, Milton Lewis, "Sanitation, Intestinal Infections and Infant Mortality in Late Victorian Sydney," Med. Hist., 1979, 23, 325-38; L. A. Sawchuk, S. D. A. Burke, and Janet Padiak, "A Matter of Privilege: Infant Mortality in the Garrison Town of Gibraltar, 1870-1899," J. Family Hist., 2002, 27, 399-429.
16. For example, Milton Lewis, "Sanitation, Intestinal Infections and Infant Mortality in Late Victorian Sydney," Med. Hist., 1979, 23, 325-38; L. A. Sawchuk, S. D. A. Burke, and Janet Padiak, "A Matter of Privilege: Infant Mortality in the Garrison Town of Gibraltar, 1870-1899," J. Family Hist., 2002, 27, 399-429.
17. Anne Hardy, Epidemic Streets: Infectious Diseases and the Rise of Preventative Medicine, 1856-1900 (Oxford: Clarendon Press, 1993).
18. Szreter, "The Importance of Social Intervention"; John Landers, "Historical Epidemiology and the Structural Analysis of Mortality," Health Trans. Rev., 1992, 2, 47-70; Stephen J. Kunitz, "Speculations on the European Mortality Decline," Econ. Hist. Rev., 1983, 36, 349-64; Schofield and Reher, The Decline of Mortality in Europe.
19. Szreter, "The Importance of Social Intervention"; John Landers, "Historical Epidemiology and the Structural Analysis of Mortality," Health Trans. Rev., 1992, 2, 47-70; Stephen J. Kunitz, "Speculations on the European Mortality Decline," Econ. Hist. Rev., 1983, 36, 349-64; Schofield and Reher, The Decline of Mortality in Europe.
20. Szreter, "The Importance of Social Intervention"; John Landers, "Historical Epidemiology and the Structural Analysis of Mortality," Health Trans. Rev., 1992, 2, 47-70; Stephen J. Kunitz, "Speculations on the European Mortality Decline," Econ. Hist. Rev., 1983, 36, 349-64; Schofield and Reher, The Decline of Mortality in Europe.
21. Szreter, "The Importance of Social Intervention"; John Landers, "Historical Epidemiology and the Structural Analysis of Mortality," Health Trans. Rev., 1992, 2, 47-70; Stephen J. Kunitz, "Speculations on the European Mortality Decline," Econ. Hist. Rev., 1983, 36, 349-64; Schofield and Reher, The Decline of Mortality in Europe.
22. James C. Riley, "Ill Health during the Mortality Decline: The Friendly Societies' Experience," Bull. Hist. Med., 1987, 61, 563-88; James C. Riley, Sick Not Dead: The Health of British Working Men during the Mortality Decline (Baltimore, Md.: Johns Hopkins University Press, 1997); Alter and Riley, "Frailty, Sickness and Death."
23. James C. Riley, "Ill Health during the Mortality Decline: The Friendly Societies' Experience," Bull. Hist. Med., 1987, 61, 563-88; James C. Riley, Sick Not Dead: The Health of British Working Men during the Mortality Decline (Baltimore, Md.: Johns Hopkins University Press, 1997); Alter and Riley, "Frailty, Sickness and Death."
24. James C. Riley, "Ill Health during the Mortality Decline: The Friendly Societies' Experience," Bull. Hist. Med., 1987, 61, 563-88; James C. Riley, Sick Not Dead: The Health of British Working Men during the Mortality Decline (Baltimore, Md.: Johns Hopkins University Press, 1997); Alter and Riley, "Frailty, Sickness and Death."
25. Alter and Riley, "Frailty, Sickness and Death."
26. I b i d.
27. James C. Riley, "Why Sickness and Death Rates Do Not Move Parallel to One Another over Time," Soc. Hist. Med., 1999, 12, 101-24.
28. Alan R. Skelley, The Victorian Army at Home: The Recruitment and Terms of the Recruitment and Terms and Conditions of the British Regular, 1859-1899 (London: Croom Helm, 1977).
29. Philip D. Curtin, Death by Migration: Europe's Encounter with the Tropical World in the Nineteenth Century (Cambridge: Cambridge University Press, 1989).
30. Skelley, The Victorian Army at Home.
31. L. A. Sawchuk, Deadly Visitations in Dark Times (Gibraltar: Aquila Press, 2001); A. M. Tulloch, "On the Mortality among Her Majesty's Troops Serving in the Colonies during the Years 1844 and 1845," J. Royal Stat. Soc., 1847, 10, 252-59; Curtin, Death by Migration.
32. L. A. Sawchuk, Deadly Visitations in Dark Times (Gibraltar: Aquila Press, 2001); A. M. Tulloch, "On the Mortality among Her Majesty's Troops Serving in the Colonies during the Years 1844 and 1845," J. Royal Stat. Soc., 1847, 10, 252-59; Curtin, Death by Migration.
33. L. A. Sawchuk, Deadly Visitations in Dark Times (Gibraltar: Aquila Press, 2001); A. M. Tulloch, "On the Mortality among Her Majesty's Troops Serving in the Colonies during the Years 1844 and 1845," J. Royal Stat. Soc., 1847, 10, 252-59; Curtin, Death by Migration.
34. Sawchuk, Deadly Visitations.
35. Average ages were reported by D. Gillkrest, Annual Report of the Health of the Garrison of Gibraltar 1833, British Public Records Office file (hereafter PRO) WO 334 10; D. Halahan, Annual Report for the Military Year Ending 31st March 1848, PRO WO 334 16.
36. Average ages were reported by D. Gillkrest, Annual Report of the Health of the Garrison of Gibraltar 1833, British Public Records Office file (hereafter PRO) WO 334 10; D. Halahan, Annual Report for the Military Year Ending 31st March 1848, PRO WO 334 16.
37. Data from Lisa McNeil, "Chi-Square Analysis of the Gibraltar Military Population," unpublished manuscript, 1997. Soldiers under eighteen years of age were considered boys and were given lighter duties.
38. "Statistical Report on the Sickness, Mortality and Invaliding among the Troops in the West Indies," Parliamentary Papers, 1838, 46, 129; "Army Medical and Statistical Report for 1890," Parliamentary Papers, 1891, 52, 297.
39. "Statistical Report on the Sickness, Mortality and Invaliding among the Troops in the West Indies," Parliamentary Papers, 1838, 46, 129; "Army Medical and Statistical Report for 1890," Parliamentary Papers, 1891, 52, 297.
40. "Statistical Report," 129.
41. John Grant, Annual Report of the 79th Regiment of Foot for the Military Year Ending 31st March 1848, PRO WO 334 16.
42. Halahan, Annual Report.
43. Confidential memorandum, PRO WO 43 1259.
44. Gwyn Harries-Jenkins, The Army in Victorian Society (Toronto: University of Toronto Press, 1977).
45. Report upon the Soldiers' Home, Gibraltar (Gibraltar: Garrison Library Press, 1861); Ken Hendrickson, "A Kinder, Gentler British Army: Mid-Victorian Experiments in the Management of Army Vice at Gibraltar and Aldershot," War & Society, 1996, 14, 21-33.
46. Report upon the Soldiers' Home, Gibraltar (Gibraltar: Garrison Library Press, 1861); Ken Hendrickson, "A Kinder, Gentler British Army: Mid-Victorian Experiments in the Management of Army Vice at Gibraltar and Aldershot," War & Society, 1996, 14, 21-33.
47. I b i d.
48. Peter Lovegrove, Not Least in the Crusade: A Short History of the Royal Army Medical Corps (Aldershot: Gale and Polden, 1951).
49. Although several works on military medicine exist - such as Richard A. Gabriel and Karen S. Metz, A History of Military Mediane, 2 vols. (London: Greenwood Press, 1992); Fielding Garrison, Notes on the History of Military Medicine (Washington, D.C.: Association of Military Surgeons, 1922); Neil Candie, A History of the Army Medical Department, 2 vols. (Edinburgh: Churchill Livingstone, 1974) - none detail military medical care during this period.
50. Although several works on military medicine exist - such as Richard A. Gabriel and Karen S. Metz, A History of Military Mediane, 2 vols. (London: Greenwood Press, 1992); Fielding Garrison, Notes on the History of Military Medicine (Washington, D.C.: Association of Military Surgeons, 1922); Neil Candie, A History of the Army Medical Department, 2 vols. (Edinburgh: Churchill Livingstone, 1974) - none detail military medical care during this period.
51. Although several works on military medicine exist - such as Richard A. Gabriel and Karen S. Metz, A History of Military Mediane, 2 vols. (London: Greenwood Press, 1992); Fielding Garrison, Notes on the History of Military Medicine (Washington, D.C.: Association of Military Surgeons, 1922); Neil Candie, A History of the Army Medical Department, 2 vols. (Edinburgh: Churchill Livingstone, 1974) - none detail military medical care during this period.
52. Report of Medical Officer for Gibraltar Half Yearly Returns July-December, 1819, PRO WO 334 I.
53. I b i d.
54. Peter H. Niebyl, "The English Bloodletting Revolution or Modern Medicine before 1850," Bull. Hist. Med., 1977, 51, 464-83; Robert Jackson, An Outline of the History and Cure of Fever Endemic and Contagious (Edinburgh: Mundell and Son, 1798).
55. Peter H. Niebyl, "The English Bloodletting Revolution or Modern Medicine before 1850," Bull. Hist. Med., 1977, 51, 464-83; Robert Jackson, An Outline of the History and Cure of Fever Endemic and Contagious (Edinburgh: Mundell and Son, 1798).
56. Norbert Hirschhorn, Robert G. Feldman, and Ian A. Greaves, "Abraham Lincoln's Blue Pills: Did Our 16th President Suffer from Mercury Poisoning?" Persp. Biol. Med., 2001, 44, 315-32.
57. Thomas Moore, Annual Report of the 11th Regiment, 1819, PRO WO 334 1, p. 1; Henry West, Half Yearly Report of the 27th Regiment, 1819, PRO WO 334 1, p. 2.
58. Thomas Moore, Annual Report of the 11th Regiment, 1819, PRO WO 334 1, p. 1; Henry West, Half Yearly Report of the 27th Regiment, 1819, PRO WO 334 1, p. 2.
59. Dr. Gillkrest, Annual Report of the Health of the Garrison of Gibraltar, 1833, PRO WO 334 10; West, Half Yearly Report.
60. Dr. Gillkrest, Annual Report of the Health of the Garrison of Gibraltar, 1833, PRO WO 334 10; West, Half Yearly Report.
61. D. Thomas, Annual Report of the Health of the 5th Regiment, 1833, PRO WO 334 10; James Brady, Report of the 26th Regiment at Gibraltar, 1819, PRO WO 334 1, p. 2; Peter Samond, Annual Report of the Health of the Kings Royal Rifle Brigade, 1833, PRO WO 334 10.
62. D. Thomas, Annual Report of the Health of the 5th Regiment, 1833, PRO WO 334 10; James Brady, Report of the 26th Regiment at Gibraltar, 1819, PRO WO 334 1, p. 2; Peter Samond, Annual Report of the Health of the Kings Royal Rifle Brigade, 1833, PRO WO 334 10.
63. D. Thomas, Annual Report of the Health of the 5th Regiment, 1833, PRO WO 334 10; James Brady, Report of the 26th Regiment at Gibraltar, 1819, PRO WO 334 1, p. 2; Peter Samond, Annual Report of the Health of the Kings Royal Rifle Brigade, 1833, PRO WO 334 10.
64. Samond, Annual Report.
65. I b i d.
66. Ibid; H. Mostyn, Annual Medical Report of the 47th Regiment, 1835, PRO WO 334 12.
67. Ibid; H. Mostyn, Annual Medical Report of the 47th Regiment, 1835, PRO WO 334 12.
68. Grigor Stewart, Annual Report, 1835, PRO WO 334 12.
69. M. Ryder, Annual Report of the 56th Regiment, 1848, PRO WO 334 16.
70. Halahan, Annual Report; John Grant, Annual Report of the 79th Regiment of Foot, 1848, PRO WO 334 16.
71. Halahan, Annual Report; John Grant, Annual Report of the 79th Regiment of Foot, 1848, PRO WO 334 16.
72. Ibid, p. 20.
73. Lovegrove, Not Least in the Crusade.
74. M. Connely, Annual Report of the Health of the Royal Artillery and Royal Engineers, 1861, PRO WO 334 26, p. 17.
75. Patrick Kilgenny, Medical Report of the 13th Light Infantry, 1869, PRO WO 334 62; Hirschhorn, Feldman, and Greaves, "Abraham Lincoln's Blue Pills."
76. Patrick Kilgenny, Medical Report of the 13th Light Infantry, 1869, PRO WO 334 62; Hirschhorn, Feldman, and Greaves, "Abraham Lincoln's Blue Pills."
77. L. Manche, Annual Report of the Royal Malta Artillery, 1889, PRO WO 334 91.
78. "Army Medical and Statistical Report," Parliamentary Papers, 1897, 54, 543.
79. Lovegrove, Not Least in the Crusade.
80. Report of Medical Transactions and Prevailing Diseases to Accompany the Annual Return of Sick and Wounded on the Station Hospital, Gibraltar, 1889, PRO WO 334 91.
81. Alan C. Swedlund and George J. Armelagos, eds., Disease in Populations in Transition: Anthropological and Epidemiological Perspectives (New York: Bergin and Harvey, 1990), pp. 1-15.
82. Christopher J. L. Murray and Lincoln C. Chen, "Understanding Morbidity Change," Pop. Dev. Rev., 1992, 18, 481-503.
83. I b i d.
84. Riley, "Ill Health during the Mortality Decline"; Murray and Chen, "Understanding Morbidity Change."
85. Riley, "Ill Health during the Mortality Decline"; Murray and Chen, "Understanding Morbidity Change."
86. For an example of anthropologists and economists, see R. H. Steckel, P. W. Sciulli, and J. C. Rose, "A Health Index from Skeletal Remains," in The Backbone of History: Health and Nutrition in the Western Hemisphere, ed. R. H. Steckel and J. C. Rose (Cambridge: Cambridge University Press, 2002), pp. 61-93; for anthropologists and sociologists, see L. A. Sawchuk, J. D. Purcell, and Janet Padiak, "Quantifying the Colonized/Colonist Relationship: Suicide as a Proxy Measure for Population Stress," Curr. Anthropol., 2004, 4;, 118-24; and for population and international studies, see S. Becker and R. E. Black, "A Model of Child Morbidity, Mortality and Health Interventions," Pop. Dev. Rev., 1996, 22, 431-56.
87. For an example of anthropologists and economists, see R. H. Steckel, P. W. Sciulli, and J. C. Rose, "A Health Index from Skeletal Remains," in The Backbone of History: Health and Nutrition in the Western Hemisphere, ed. R. H. Steckel and J. C. Rose (Cambridge: Cambridge University Press, 2002), pp. 61-93; for anthropologists and sociologists, see L. A. Sawchuk, J. D. Purcell, and Janet Padiak, "Quantifying the Colonized/Colonist Relationship: Suicide as a Proxy Measure for Population Stress," Curr. Anthropol., 2004, 4;, 118-24; and for population and international studies, see S. Becker and R. E. Black, "A Model of Child Morbidity, Mortality and Health Interventions," Pop. Dev. Rev., 1996, 22, 431-56.
88. For an example of anthropologists and economists, see R. H. Steckel, P. W. Sciulli, and J. C. Rose, "A Health Index from Skeletal Remains," in The Backbone of History: Health and Nutrition in the Western Hemisphere, ed. R. H. Steckel and J. C. Rose (Cambridge: Cambridge University Press, 2002), pp. 61-93; for anthropologists and sociologists, see L. A. Sawchuk, J. D. Purcell, and Janet Padiak, "Quantifying the Colonized/Colonist Relationship: Suicide as a Proxy Measure for Population Stress," Curr. Anthropol., 2004, 4;, 118-24; and for population and international studies, see S. Becker and R. E. Black, "A Model of Child Morbidity, Mortality and Health Interventions," Pop. Dev. Rev., 1996, 22, 431-56.
89. The duration of each illness event was recorded by the surgeons and averages were published.
90. "Standing Orders in the Garrison of Gibraltar, established by H. R. H. the Duke of Kent, 1803," extracts reprinted in the J. Army Hist. Res., 1921, 2, 86-89, 124-29, 181-84.
91. "Married Soldiers," Med. Press Circular, 1868, 392-94.
92. Michael Baldwin, Annual Report of the Health of the 53rd Regiment, 1830, PRO WO 334 10, suspects that ophthalmia was produced by the introduction of lime into soldiers' eyes.
93. For concealment, see William Brimell, Annual Report, Dominica, 1830, PRO WO 334 6; and H. Mostyn, Annual Medical Report of the 47th Regiment. Robert Scott, Annual Report on the Prevailing Diseases, St Lucia, 1830, PRO WO 334 6, tells of both malingering and concealment.
94. For concealment, see William Brimell, Annual Report, Dominica, 1830, PRO WO 334 6; and H. Mostyn, Annual Medical Report of the 47th Regiment. Robert Scott, Annual Report on the Prevailing Diseases, St Lucia, 1830, PRO WO 334 6, tells of both malingering and concealment.
95. For concealment, see William Brimell, Annual Report, Dominica, 1830, PRO WO 334 6; and H. Mostyn, Annual Medical Report of the 47th Regiment. Robert Scott, Annual Report on the Prevailing Diseases, St Lucia, 1830, PRO WO 334 6, tells of both malingering and concealment.
96. For example, J. Rogers, "Reporting Causes of Death in Sweden, 1750-1950," J. Hist. Med., 1999, 54, 190-209; Y. Landry and R. Lessard, "Causes of Death in Seventeenth-and Eighteenth-Century Québec as Recorded in Parish Registers," Hist. Methods, 1996, 29, 49-57; McKeown, The Modern Rise of Population.
97. For example, J. Rogers, "Reporting Causes of Death in Sweden, 1750-1950," J. Hist. Med., 1999, 54, 190-209; Y. Landry and R. Lessard, "Causes of Death in Seventeenth-and Eighteenth-Century Québec as Recorded in Parish Registers," Hist. Methods, 1996, 29, 49-57; McKeown, The Modern Rise of Population.
98. For example, J. Rogers, "Reporting Causes of Death in Sweden, 1750-1950," J. Hist. Med., 1999, 54, 190-209; Y. Landry and R. Lessard, "Causes of Death in Seventeenth-and Eighteenth-Century Québec as Recorded in Parish Registers," Hist. Methods, 1996, 29, 49-57; McKeown, The Modern Rise of Population.
99. The methodology for data processing has been described in Janet Padiak, "Integration of Specificity Variation in Cause of Death Analysis," Hist. Methods (forthcoming).
100. The decade of the 18205 covers the period from 1818 to 1829, the 18405 from 1840 to 1847, and the 1860s from 1859 to 1869. The remainder are true decades.
101. This methodology is detailed by Landers, "Historical Epidemiology";
102. M. Flinn, The European Demographic System (Brighton, U.K.: Harvester Press, 1981), describes the definition of a crisis as mortality 50 percent higher than usual.
103. Denis Gibbs, "The Demon of Dyspepsia: Some Nineteenth-Century Perceptions of Disordered Digestion," in Gastroenterology in Britain, ed. W. F. Bynum (London: Wellcome Institute for the History of Medicine, 1997).