Victorian nosology deciphered

The further we move back in time in pursuing the geography of life and death, the greater the number of questions and answers raised, and in the process the less clear both seem to be.

Moreover, both questions and answers multiply dramatically if we explore attitudes as well as analyse statistics. The first problem as far as statistics are concerned is their reliability, and chapter four of this atlas deals specifically with "the quality of death registration". There is one key date, 1837, by a coincidence the year of Queen Victoria's accession to the throne. Thereafter each registrar general was obliged to lay before Parliament an annual report. From the time of the 25th report, a decennial supplement was published also, and it is largely from the six decennial supplements, appearing from the 1850s to the 1900s, that the material is derived on which this atlas is based.

The registrars general were for the most part retired army officers or colonial civil servants, assisted by compilers of statistics or statistical superintendents, at least one of whom, William Parr, has survived as an "eminent Victorian''. Another individual who emerges from the statistics set out in the atlas is Sir Arthur Newsholme, who became principal medical officer to the Local Government Board. His work spans Victorian and welfare state structures, and is frequently quoted in the atlas.

A second problem the compilers faced was the changing state of medical knowledge. "Nosologics", attributers of causes of death, could be vague as well as wrong. There was no problem about the so-called "classical" infectious diseases of childhood, for these could be distinguished by parents as well as doctors. Other diseases, however, could complicate the tasks of the classifiers. Among babies and children up to the age of four and those over-65s, an undifferentiated category "Other Causes" was large enough to make comparisons difficult within the Victorian age as well as between that age and now. The fact that from 1871 onwards the word "system" began to be applied for the first time to causes of death actually increases the numbers of deaths listed under "Other Causes".

The authors note the change of classification by nosology without examining quite why it took place. What had previously been called diseases of brain, heart, lung, stomach, liver and kidneys were now called diseases of "the nervous, circulatory, respiratory, digestive and urinary systems". What was the medical significance of this? As far as tuberculosis was concerned, there were statistical and medical problems. The compilers of the atlas are circumspect on this and other issues.

An interesting sub-plot in this atlas is the interconnectedness of different diseases. Indeed, it is part of the final, if tentative, assessment set out in the last chapter, "Places and diseases", that the debate between Thomas McKeown and his critics on the causes of the Victorian decline in death rates has underplayed possible changes in diseases and the limitations to doctors' knowledge of them. This chapter is the most relevant for historians.

This careful, well-researched and beautifully produced atlas of death in Victorian England and Wales is a valuable contribution to social history.

Lord Briggs was formerly provost, Worcester College, Oxford.