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Diagnostic Spaces

Workhouse, Hospital, and Home in Mid-Victorian London

Published online by Cambridge University Press:  04 January 2016

Graham Mooney
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Abstract

For nine weeks during the 1866 cholera epidemic, the registrar general for England and Wales published details of more than 13,000 deaths in London. Although the names of the deceased and the informant were withheld, all other information available from the death certificate was reproduced in the capital city's Weekly Returns, including registration district and subdistrict, precise address (house number and street, or institution), sex, age (sometimes down to hours for infants), occupation, cause(s) of death, and duration of final illness. Since historians’ access to original death certificates in England and Wales is restricted, this source presents an opportunity to analyze systematically the practice of cause of death certification in the middle of the nineteenth century, albeit during a period of mortality crisis. Variability of diagnostic “depth”—that is, the listing of multiple causes and duration of final illness—is considered for three major causes: cholera, diarrhea, and respiratory tuberculosis. Deaths in workhouses and general hospitals were chronically underdocumented compared to home deaths. This finding supports the notion that the institutionalization of sickness in the nineteenth century was accompanied by a loss of the “patient narrative” and also points to the entrenchment of institutional cultures of record keeping and administration.

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Type
Special Section: Complexities of Nineteenth-Century Cause-of-Death Nomenclatures
Information
Social Science History , Volume 33 , Issue 3 , Fall 2009, pp. 357 - 390
Copyright
Copyright © Social Science History Association 2009 

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References

Alter, George C., and Carmichael, Ann G. (1999) “Classifying the dead: Toward a history of the registration of causes of death.” Journal of the History of Medicine and Allied Sciences 54: 114–32.Google Scholar
Alter, George C., and Carmichael, Ann G. (2000) “Reflections on the classification of causes of death.” Continuity and Change 12: 169–73.Google Scholar
Anderton, Douglas L., and Leonard, Susan Hautaniemi (2004) “Grammars of death: An analysis of nineteenth-century literal causes of death from the age of miasmas to germ theory.” Social Science History 28: 111–43.Google Scholar
Anonymous (1865) “Metropolitan infirmaries: St. Leonard's, Shoreditch.” Lancet 86: 131–33.Google Scholar
Anonymous (1866a) “Cholera in the metropolitan hospitals.” Lancet 88: 204–7.Google Scholar
Anonymous (1866b) “Cholera in the metropolitan hospitals.” Lancet 88: 182–84.Google Scholar
Anonymous (1866c) “Cholera in the metropolitan hospitals.” Lancet 88: 148–50.Google Scholar
Anonymous (1866d) “Cholera in the metropolitan hospitals.” Lancet 88: 121–23.Google Scholar
Anonymous (1866e) “Cholera in the metropolitan hospitals.” Lancet 88: 93.Google Scholar
Anonymous (1866f) “King's College Hospital: Cases of cholera.” Lancet 88: 547.Google Scholar
Anonymous (1866g) “Metropolitan infirmaries. No. XI: Lambeth infirmary.” Lancet 87: 178–80.Google Scholar
Anonymous (1866h) “Metropolitan infirmaries: No. XII: St. Margaret's and St. John's, Westminster.” Lancet 87: 376–78.Google Scholar
Anonymous (1866i) “The cholera: Mansion House Relief Committee.” Times, October 9.Google Scholar
Anonymous (1866j) “The cholera: Daily return of deaths from cholera and diarrhoea in London.” Times, October 17.Google Scholar
Anstie, Francis E. (1865–66) “Workhouse infirmary reform.” MacMillan's Magazine 13: 477–83.Google Scholar
Barnes, Robert (1855) “A register of the cases of disease observed at the London and Metropolitan Free Hospitals during the month of August, 1855; with clinical remarks on the etiology and characters of the current diseases, and on the importance of publishing a periodical register of prevailing diseases.” Lancet 66: 211–16.Google Scholar
Blane, Gilbert (1813) “Observations on the comparative prevalence, mortality, and treatment of different diseases; illustrated by abstracts of cases which occurred to the author at St. Thomas's Hospital, and in his private practice, embracing a period of twenty years.” Medico-Chirurgical Transactions 4: 89–142.Google Scholar
Bowker, Geoffrey C., and Star, Susan L. (1999) Sorting Things Out: Classification and Its Consequences. Cambridge, MA: MIT Press.Google Scholar
Brand, Jeanne L. (1965) Doctors and the State: The British Medical Profession and Government Action in Public Health, 1870–1912. Baltimore: Johns Hopkins University Press.Google Scholar
Bryder, Linda (1996) “‘Not always one and the same thing’: The registration of tuberculosis deaths in Britain, 1900–1950.” Social History of Medicine 9: 253–66.Google Scholar
Bynum, William F. (2006) “The rise of science in medicine, 1850–1913,” in William F. Bynum, Anne Hardy, Stephen Jacyna, Christopher Lawrence, and E. M. Tansey, The Western Medical Tradition, 1800 to 2000. Cambridge: Cambridge University Press: 111–239.Google Scholar
Cameron, Hector M., and Euphemia, McGoogan (1981) “A prospective study of 1,152 hospital autopsies: I. Inaccuracies in death certification.” Journal of Pathology 133: 273–83.Google Scholar
Clark-Kennedy, Archibald E. (1963) The London: A Study in the Voluntary Hospital System. Vol. 2, The Second Hundred Years, 1840–1948. London: Pitman Medical.Google Scholar
Cohen, Joachim, Johan, Bilsen, Peter, Hooft, Patrick, Deboosere, van der Wal, Gerrit, and Luc, Deliens (2006) “Dying at home or in an institution: Using death certificates to explore the factors associated with place of death.” Health Policy 78: 319–29.Google Scholar
Committee for Scientific Inquiries (1855) “Report in relation to cholera epidemic of 1854.” British Parliamentary Papers, 1854–55: XXI.1 (Cd. 1980).Google Scholar
Coupland, Sidney (1880a) “Clinical lecture on a case of typhus fever, part 1.” Lancet 115: 157–58.Google Scholar
Coupland, Sidney (1880b) “Clinical lecture on a case of typhus fever, part 2.” Lancet 115: 197–99.Google Scholar
Crowther, M. Anne (1982) The Workhouse System, 1834–1929: The History of an English Social Institution. Athens: University of Georgia Press.Google Scholar
Cullen, Michael J. (1974) “The making of the Civil Registration Act of 1836.” Journal of Ecclesiastical History 25: 39–59.Google Scholar
Davey Smith, George (2002) “Commentary: Behind the Broad Street pump; Aetiology, epidemiology, and prevention of cholera in mid-19th century Britain.” International Journal of Epidemiology 31: 920–32.Google Scholar
Digby, Anne (1994) Making a Medical Living: Doctors and Patients in the English Market for Medicine, 1720–1911. Cambridge: Cambridge University Press.Google Scholar
Dodier, Nicolas (1994) “Expert medical decisions in occupational medicine: A sociological analysis of medical judgment.” Sociology of Health and Illness 16: 489–514.Google Scholar
Driver, Felix (1993) Power and Pauperism: The Workhouse System, 1834–1884. Cambridge: Cambridge University Press.Google Scholar
Evans, Richard J. (1992) “Epidemics and revolutions: Cholera in nineteenth-century Europe,” in Ranger, Terence O. and Paul, Slack (eds.) Epidemics and Ideas: Essays on the Historical Perception of Pestilence. Cambridge: Cambridge University Press: 149–73.Google Scholar
Eyler, John M. (1979) Victorian Social Medicine: The Ideas and Methods of William Farr. Baltimore: Johns Hopkins University Press.Google Scholar
Farnall, Harry Burrard (1866) “Report of H. B. Farnall, poor law inspector, on infirmary wards of metropolitan workhouses.” British Parliamentary Papers, 1866: LXI.389 (Cd. 387).Google Scholar
Farr, William (1868) “Report on the cholera epidemic of 1866 in England.” British Parliamentary Papers, 1866–67: XXXVII.1 (Cd. 4072).Google Scholar
Feudtner, Chris, Feinstein, James A., Marlon, Satchell, Huaqing, Zhao, and Kang, Tammy I. (2007) “Shifting place of death among children with complex chronic conditions in the United States, 1989–2003.” Journal of the American Medical Association 297: 2725–32.Google Scholar
Field, Marilyn J., Cassel, Christine K., and Institute of Medicine Committee on Care at the End of Life (1997) Approaching Death: Improving Care at the End of Life. Washington, DC: National Academy Press.Google Scholar
Fissell, Mary (1991) “The disappearance of the patient's narrative and the invention of hospital medicine,” in Roger, French and Andrew, Wear (eds.) British Medicine in an Age of Reform. London: Routledge: 92–109.Google Scholar
Flinn, Michael W. (1976) “Medical services under the new poor law,” in Derek, Fraser (ed.) The New Poor Law in the Nineteenth Century. New York: St. Martin's: 45–66.Google Scholar
Foster, Balthazar Walter (1893) “First and second reports from the Select Committee on Death Certification, together with the proceedings of the committee, minutes of evidence, appendix, and index.” British Parliamentary Papers, 1893–94: XI.195 (Cd. 373 and Cd. 402).Google Scholar
Foucault, Michel (1973) The Birth of the Clinic: An Archaeology of Medical Perception. New York: Pantheon.Google Scholar
General Register Office (1843) Registration of the Causes of Death: Regulations and a Statistical Nosology Comprising the Causes of Death, Classified and Alphabetically Arranged, with Notes and Observations, for the Use of Those Who Return the Causes of Death under 6 & 7 Will. IV, c. 86. London: Clowes.Google Scholar
General Register Office (1845) Registration of the Causes of Death: Circulars to Medical Practitioners, and to Registrars; A Statistical Nosology for the Use of Those Who Return the Causes of Death...; Circular to Coroners and a Classification of the Causes of Violent Deaths. London: Clowes.Google Scholar
General Register Office (1860) “Twenty-first annual report, 1858.” British Parliamentary Papers, 1860: XXIX.543 (Cd. 2712).Google Scholar
General Register Office (1866) Weekly Return of Births and Deaths in London and in Twelve Other Large Towns of the United Kingdom. Vol. 27, nos. 31–40.Google Scholar
Goldacre, Michael J., Roberts, Stephen E., and Myfanwy, Griffith (2003) “Multiple-cause coding of death from myocardial infarction: Population-based study of trends in death certificate data.” Journal of Public Health Medicine 25: 69–71.Google Scholar
Gomes, Barbara, and Higginson, Irene J. (2008) “Where people die (1974–2030): Past trends, future projections, and implications for care.” Palliative Medicine 22: 33–41.Google Scholar
Granshaw, Lindsay P. (1981) “St. Thomas's Hospital, London, 1850–1900.” PhD diss., Bryn Mawr College.Google Scholar
Granshaw, Lindsay P. (1992) “The rise of the modern hospital in Britain,” in Andrew Wear (ed.) Medicine in Society: Historical Essays. Cambridge: Cambridge University Press: 197–218.Google Scholar
Granshaw, Lindsay P., and Roy, Porter, eds. (1989) The Hospital in History. London: Routledge.Google Scholar
Green, David R. (1995) From Artisans to Paupers: Economic Change and Poverty in London, 1790–1870. Aldershot, U.K.: Ashgate.Google Scholar
Greenfield, W. S. (1875) “Medical Report 1874,” in John S. Bristowe, John Harley, and William W. Wagstaffe (eds.) St. Thomas's Hospital Reports, n.s., 6. London: Churchill: 307–28.Google Scholar
Guha, Sumit (1994) “The importance of social intervention in England's mortality decline: The evidence reviewed.” Social History of Medicine 7: 89–113.Google Scholar
Hardy, Anne (1988) “Diagnosis, death, and diet: The case of London, 1750–1909.” Journal of Interdisciplinary History 18: 387–402.Google Scholar
Hardy, Anne (1993) “Cholera, quarantine, and the English preventive system, 1850–1895.” Medical History 37: 250–69.Google Scholar
Hardy, Anne (1994) “Death is the cure of all diseases: Using the General Register Office cause of death statistics for 1837–1920.” Social History of Medicine 7: 472–92.Google Scholar
Heaman, Elsbeth A. (2003) St. Mary's: The History of a London Teaching Hospital. Montreal: McGill-Queen's University Press.Google Scholar
Hess, Volker (2005) “Standardizing body temperature: Quantification in hospitals and daily life, 1850–1900,” in Gérard, Jorland, Annick, Opinel, and George, Weisz (eds.) Body Counts: Medical Quantification in Historical and Sociological Perspective. Montreal: McGill-Queen's University Press: 109–26.Google Scholar
Higgs, Edward (2004) Life, Death, and Statistics: Civil Registration, Censuses, and the Work of the General Register Office, 1836–1952. Hatfield, U.K.: Local Population Studies.Google Scholar
Hodgkinson, Ruth G. (1967) The Origins of the National Health Service: The Medical Services of the New Poor Law, 1834–1871. Berkeley: University of California Press.Google Scholar
Hooper, Robert, and Guy, William A. (1858) Hooper's Physician's Vade Mecum: A Manual of the Principles and Practice of Physic, with an Outline of General Pathology, Therapeutics, and Hygiene. London: Renshaw, Whittaker.Google Scholar
Howlett, Edmund H. (1880) “A uniform system of registration of disease in hospitals.” Lancet 116: 30–31.Google Scholar
Jacyna, Stephen (2006) “Medicine in transformation, 1800–1849,” in William F. Bynum, Anne Hardy, Stephen Jacyna, Christopher Lawrence, and E. M. Tansey, The Western Medical Tradition, 1800 to 2000. Cambridge: Cambridge University Press: 11–101.Google Scholar
Jalland, Patricia (1996) Death in the Victorian Family. Oxford: Oxford University Press.Google Scholar
Jewson, N. D. (1976) “The disappearance of the sick-man from medical cosmology, 1770–1870.” Sociology 10: 225–44.Google Scholar
Laxton, Paul, and Naomi, Williams (1989) “Urbanization and infant mortality in England: A long term perspective and review,” in Nelson, Marie C. and John, Rogers (eds.) Urbanisation and the Epidemiologic Transition. Uppsala, Sweden: Uppsala University: 109–35.Google Scholar
Lewis, Milton J. (2007) Medicine and Care of the Dying: A Modern History. Oxford: Oxford University Press.Google Scholar
Livingstone, David N. (2003) Putting Science in Its Place: Geographies of Scientific Knowledge. Chicago: University of Chicago Press.Google Scholar
Loudon, Irvine (1981) “The origins and growth of the dispensary movement in England.” Bulletin of the History of Medicine 55: 322–42.Google Scholar
Luckin, Bill (1977) “The final catastrophe: Cholera in London, 1866.” Medical History 21: 32–42.Google Scholar
Luckin, Bill (1986) Pollution and Control: A Social History of the Thames in the Nineteenth Century. Bristol, U.K.: Hilger.Google Scholar
Maas, Ineke, and van Leeuwen, H. D.Marco (2005) “Total and relative endogamy by social origin: A first international comparison of changes in marriage choices during the nineteenth century.” International Review of Social History 50: 275–95.Google Scholar
Mackenbach, Johan P., Kunst, Anton E., Lautenbach, H., Oei, Y. B., and Bijlsma, F. (1997) “Competing causes of death: A death certificate study.” Journal of Clinical Epidemiology 50: 1069–77.Google Scholar
Mant, Jonathan, Sue, Wilson, Jayne, Parry, Pam, Bridge, Richard, Wilson, Will, Murdoch, Terry, Quirke, et al. (2006) “Clinicians didn't reliably distinguish between different causes of cardiac death using case histories.” Journal of Clinical Epidemiology 59: 862–67.Google Scholar
Maudsley, Gillian, and Williams, Evelyn M. (1993) “Death certification by house officers and general practitioners: Practice and performance.” Journal of Public Health Medicine 15: 192–201.Google Scholar
McCusker, Jane (1983) “Where cancer patients die: An epidemiologic study.” Public Health Reports 98: 170–76.Google Scholar
Merrington, W. R. (1976) University College Hospital and Its Medical School: A History. London: Heinemann.Google Scholar
Moinpour, Carol M., and Lincoln, Polissar (1989) “Factors affecting place of death of hospice and non-hospice cancer patients.” American Journal of Public Health 79: 1549–51.Google Scholar
Mooney, Graham, Bill, Luckin, and Andrea, Tanner (1999) “Patient pathways: Solving the problem of institutional mortality in London during the later nineteenth century.” Social History of Medicine 12: 227–69.Google Scholar
Moscucci, Ornella (2004) “Barnes, Robert (1817–1907),” in Oxford Dictionary of National Biography. Oxford: Oxford University Press, www.oxforddnb.com/view/article/30606.Google Scholar
Pelling, Margaret (1978) Cholera, Fever, and English Medicine, 1825–1865. Oxford: Oxford University Press.Google Scholar
Polissar, Lincoln, Severson, Richard K., and Brown, Norman K. (1987) “Factors affecting place of death in Washington State, 1968–1981.” Journal of Community Health 12: 40–55.Google Scholar
Porter, Roy (1985) “The patient's view: Doing medical history from below.” Theory and Society 14: 175–98.Google Scholar
Prior, Lindsay (1985) “Making sense of mortality.” Sociology of Health and Illness 7: 167–90.Google Scholar
Prior, Lindsay, and Mick, Bloor (1993) “Why people die: Social representations of death and its causes.” Science as Culture 16: 346–74.Google Scholar
Risse, Guenter B. (1999) Mending Bodies, Saving Souls: A History of Hospitals. New York: Oxford University Press.Google Scholar
Risse, Guenter B. (2000) “Cause of death as a historical problem.” Continuity and Change 12: 175–88.Google Scholar
Risse, Guenter B., and Warner, John H. (1992) “Reconstructing clinical activities: Patient records in medical history.” Social History of Medicine 5: 183–205.Google Scholar
Rivett, Geoffrey (1986) The Development of the London Hospital System, 1823–1982. London: King Edward's Hospital Fund.Google Scholar
Robb-Smith, A. H. T. (1968–69) “A history of the college's nomenclature of diseases: Its preparation.” Journal of the Royal College of Physicians of London 3: 341–58.Google Scholar
Rogers, Joseph (1889) Reminiscences of a workhouse medical officer, ed. Thorold Rogers. London: Unwin.Google Scholar
Rosenberg, Charles E. (1979) “The therapeutic revolution: Medicine, meaning, and social change in nineteenth-century America,” in Vogel, Morris J. and Rosenberg, Charles E. (eds.) The Therapeutic Revolution: Essays in the Social History of American Medicine. Philadelphia: University of Pennsylvania Press: 3–25.Google Scholar
Snow, John (1849) On the Mode of Communication of Cholera. London: Churchill.Google Scholar
Southall, Humphrey, and Eilidh, Garrett (1991) “Morbidity and mortality among early nineteenth century engineering workers.” Social History of Medicine 4: 231–53.Google Scholar
Stevens, Rosemary (2003) Medical Practice in Modern England: The Impact of Specialization and State Medicine. New Brunswick, NJ: Transaction.Google Scholar
Sturdy, Steve, and Roger, Cooter (1998) “Science, scientific management, and the transformation of medicine in Britain, c. 1870–1950.” History of Science 36: 421–66.Google Scholar
Sudnow, David (1967) Passing On: The Social Organization of Dying. Englewood Cliffs, NJ: Prentice-Hall.Google Scholar
Swift, Benjamin, and Kevin, West (2002) “Death certification: An audit of practice entering the twenty-first century.” Journal of Clinical Pathology 55: 275–79.Google Scholar
Szreter, Simon R. S. (1988) “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: 1–37.Google Scholar
Szreter, Simon R. S. (1994) “Mortality in England in the eighteenth and the nineteenth centuries: A reply to Sumit Guha.” Social History of Medicine 7: 269–82.Google Scholar
Tanner, Andrea (1998) “Thomas Orme Dudfield: The model medical officer of health.” Journal of Medical Biography 6: 79–85.Google Scholar
Times (1866) Editorial. October 10.Google Scholar
van Leeuwen, Marco H. D., Ineke, Maas, and Andrew, Miles (2002) HISCO: Historical International Standard Classification of Occupations. Louvain: Louvain University Press.Google Scholar
Waddington, Ivan (1973) “The role of the hospital in the development of modern medicine: A sociological analysis.” Sociology 7: 211–24.Google Scholar
Waddington, Keir (1998) “Unsuitable cases: The debate over outpatient admissions, the medical profession, and late-Victorian London hospitals.” Medical History 42: 26–46.Google Scholar
Wall, Melanie M., Jinzhou, Huang, John, Oswald, and Diane, McCullen (2005) “Factors associated with reporting multiple causes of death.” BMC Medical Research Methodology 5, www.biomedcentral.com/1471-2288/5/4.Google Scholar
Watson, Thomas (1867) “Report of committee to consider cubic space of metropolitan workhouses.” British Parliamentary Papers, 1867: LX.185 (Cd. 3786).Google Scholar
Weisz, George (2006) Divide and Conquer: A Comparative History of Medical Specialization. Oxford: Oxford University Press.Google Scholar
Williams, Naomi (1996) “The reporting and classification of causes of death in mid-nineteenth-century England: The example of Sheffield.” Historical Methods 29: 58–71.Google Scholar
Willshire, Dr. (1863) “Charing Cross Hospital: Substance of a clinical lecture upon a number of cases of typhus fever.” Lancet 81: 36–37.Google Scholar
Woods, Robert I. (2000) The Demography of Victorian England and Wales. Cambridge: Cambridge University Press.Google Scholar
Woods, Robert I., and Nicola, Shelton (1997) An Atlas of Victorian Mortality. Liverpool: Liverpool University Press.Google Scholar
Woods, Robert I., and Naomi, Williams (1995) “Must the gap widen before it can be narrowed? Long-term trends in social class mortality differentials.” Continuity and Change 10: 105–37.Google Scholar
Worboys, Michael (2000) Spreading Germs: Disease Theories and Medical Practice in Britain, 1865–1900. Cambridge: Cambridge University Press.Google Scholar