Mortality

Edward Higgs

Data on mortality were captured by the civil system for registering births, marriages and deaths set up in England and Wales under the provisions of the Registration Act, 1836 (6 & 7 Will. IV, c. 85) and the Registration (Suspension) Act, 1837 (6 & 7 Will. IV, c. 86). These acts established the modern system of civil registration to replace the parochial registration of baptisms, marriages and burials that had been established in the early sixteenth century. The whole of England and Wales was divided into registration districts based on the Poor Law Unions and registrars appointed to them. These local officers were to issue certificates of birth, marriage and death. They also sent copies of the certificates to the General Register Office (GRO), which created indexes of these and made them available to the public in a central site at Somerset House in London. A Registrar General for England and Wales was appointed to head the GRO, and to supervise the local registration system (Higgs, 2004, 1–90). A similar system was set up in Scotland in 1855.

The death certificate carried several pieces of information that were used to create various tables published by the GROs in both England and Wales, and Scotland, in their Annual and Decennial reports. These included: when and where the person died; their place of residence; their sex; their age; their occupation; and the cause of their death. The place of death was mainly used to allow data on the other variables to be displayed on a local basis as well as nationally. This caused some problems because increasingly people died in large hospitals, rather than where they lived, giving a false picture of the healthiness, or otherwise, of particular areas. The crude death rates for England and Wales in the tables in the Decennial report for 1891 to 1900, published in 1907, were 'approximately adjusted for deaths in institutions'. In his Annual report for 1908 the Registrar General for England and Wales maintained that in addition to the regular redistribution of deaths in London institutions, the 'mortality statistics relating to 75 other large towns and 142 smaller towns, as published in the quarterly returns and in the annual summary have been approximately corrected by the aid of special returns furnished to the Registrar General by the local registrars.' (Seventy-first annual report of the Registrar General, vii). The introduction of machine tabulation into the London GRO in 1911 allowed the routine shifting of deaths from hospitals to place of residence (Higgs, 2004, 173–5). This also allowed the GRO to introduce tables indicating the nature of the place where people died – private house, workhouse, or hospital.

But other headings of information took pride of place in the published tables. The crude numbers of death were converted into deaths per thousand population, and published for both the whole country and for localites. Population totals nationally and by area were derived from the decennial censuses, also administered by the GROs. This 'death rate' was used both to examine the impact of public health measures, and to identify the communities where mortality was most extreme. William Farr, the London GRO's medical statistician from 1839 to 1879, developed the concept of the mortality of 'Healthy Districts', which responsible local authorities should try to match. This was based on a set of 63 registration districts, mostly rural, which made up 10 percent of the national population, and had a crude death rate below 17 per thousand (Eyler, 71–2; Szreter, 439). This was used to shame local authorities into introducing sanitary reform. By combining death rates with other data, on population densities, or on the nature of housing, again derived from the censuses, it was possible to begin to analyse the causes of high mortality.

Data on the age and sex of the deceased was used to construct tables showing the differential rates of mortality for differing age groups and by gender. Such data were produced on both a national and a local basis. However, tabular data were not always published in exactly the same manner each year. Thus, in the nineteenth century the conventional age groups adopted in the Annual and Decennial reports were in quinquennia, such as 0–4, 5–9, 10–14, and so on. Only sometimes were ages at death broken down into single years – 0, 1, 2, 3, and 4, or even more occasionally into months under one year of age (Woods, 37). This creates difficulties for the study of infant mortality prior to the inception of much more detailed reporting on infant mortality in the Edwardian period.

When combined with data on the numbers of people in particular age groups from the decennial censuses, it was possible to work out age-specific mortality rates – mortality in the age group expressed as deaths per annum per thousand in that age group. These data could be used also to construct life tables, showing life expectancies at any age. These were useful for insurance companies wishing to set insurance premiums, and the desire to produce accurate actuarial aids lay behind much of the early history of statistical production within the English GRO (Higgs, 2004, 22–34). William Farr, the GRO's principle statistician and superintendent of statistics from 1842 to 1880, produced a number of such life tables in the Annual reports. Farr's first English Life Table appeared in the Fifth and Sixth annual report, based on national registration data for the census year 1841 (Fifth annual report of the Registrar General (1841), xii-xxxv, 161–78; Sixth annual report of the Registrar General (1842), 290–358). English Life Table Number Two appeared for each sex separately in the Twelfth and Twentieth annual reports, based on the census of 1841 and death registration for the years 1838 to 1844. His most important life table, Number Three, using data from the censuses of 1841 and 1851, and from death registration for 1838 to 1854, was published as a separate volume, entitled English life table, tables of lifetimes, annuities and premiums, in 1864 (Eyler, 66–80). Later life tables were produced by his successors.

The occupational data collected from the death certificates were also combined with occupational data from the censuses to give occupational death rates (e.g. General Register Office, Fourteenth annual report, xv-xxiii). It was hoped that this would enable citizens to avoid occupations which were particularly dangerous or unhealthy, such as mining or innkeeping (where the proximity of alcohol was an ever-present threat). The occupational data could also be combined with information on ages in order to create occupational life tables, which it was hoped would be of use to insurance companies and friendly societies seeking to insure their members in actuarially sound schemes (Higgs, 1991, 472–3).

Perhaps the most scientifically important data were those on the causes of death. The collection of this data enabled the GROs in England and Wales, and Scotland to study the diseases that affected differing localities, ages, genders and occupations, and how these patterns changed over time. But in order to make sense of these cause of death data it was necessary to place them in a classification system, which for causes of death is known as a 'nosology'. Given the constraints of the printed page, and the human powers of understanding, it was necessary to reduce the thousands of causes of death given in death certificates to a few hundred headings (Higgs, 2003). In 1845, the London GRO sent out standard medical certificates for doctors to fill in when certifying deaths, and encouraged them to use the terms in a 'statistical nosology' that was available from the Office (Seventh annual report of the Registrar General, 249–314). But even after the introduction of compulsory medical certification of deaths in 1874, there were still problems with the terminology used by medical practitioners. The Office had to resort to sending thousands of death certificates back to doctors in order to get them to provide replies that conformed to the models of disease causation implicit in its classifications (Hardy, 476). The nosology developed by the London GRO led to the creation of the modern International List of the Causes of Death.

REFERENCES

J. M. Eyler, Victorian Social Medicine: The Ideas and Methods of William Farr (London, 1979).

Fifth annual report of the Registrar General (1841) BPP 1843 XXI. (516) [View this document: Fifth annual report of the registrar-general]

Fourteenth annual report of the Registrar General (London, 1855). [View this document: Fourteenth annual report of the registrar-general (Registrar-general's edition)]

Anne Hardy, 'Death is the end of all disease: using the GRO cause of death statistics for 1837–1920,' Social History of Medicine, 7 (1994), 472–92.

Edward Higgs, 'Diseases, febrile poisons, and statistics: the census as a medical survey', Social History of Medicine, 4 (1991), 465–78.

Edward Higgs, 'The General Register Office and the tabulation of data, 1837–1939' in Martin Campbell Kelly, Mary Croarkin, John Fauvel and Raymond Flood, eds, From Sumer to the spreadsheets: the curious history of tables (Oxford: Oxford UP, 2003), 209–34.

Edward Higgs, Life, death and statistics: civil registration, censuses and the work of the General Register Office, 1837–1952 (Hatfield, 2004).

Seventh annual report of the Registrar General (1843–4), BPP 1846 XIX (727). [View this document: Seventh annual report of the registrar-general]

Seventy-first annual report of the Registrar General (1908), BPP 1909 XI (Cd.4961).[View this document: Seventy-first annual report of the registrar-general ]

Sixth annual report of the Registrar General (1842), BPP 1844 XIX (540). [View this document: Sixth annual report of the registrar-general]

Simon Szreter, 'The GRO and the public health movement in Britain 1837–1914', Social History of Medicine, 4 (1991), 454–62.

Robert Woods, The demography of Victorian England and Wales (Cambridge, 2000).