Contours of Death and Disease in Early Modern England

A generation ago, French annaliste history stimulated a number of fine regional studies of the health of populations, notably Jean-Pierre Goubert’s 1974 analysis of Brittany. Meanwhile, in England, the Cambridge “Pop” Group was mobilizing its massive study of parish registers, which was to bear fruit in E. A. Wrigley and R. S. Schofield’s The Population History of England, 1541–1871 (1981) and more recently in E. A. Wrigley, R. S. Davies, J. E. Oeppen, and R. S. Schofield’s English Population History from Family Reconstitution, 1580–1837 (1997). Those two traditions are triumphantly combined in Mary Dobson’s pioneering and definitive attempt at historical medical topography. Taking the counties of Sussex, Kent, and Essex—in that respect her book’s title is misleading: it should read not “England” but “South-East England”—Dobson (a geographer turned medical historian) makes full use of precise demographic data (scores of tables and graphs) to uncover and explain dramatic geographic differentials in health.

Burial:baptism discrepancies and other such indices reveal, Dobson shows, that certain natural environments were remarkably and consistently less healthy than others. In simple terms, it was all a matter of contours: high ground had the lowest morbidity, low ground the highest mortality. In this picture of “contours of death,” particularly unhealthy were the salt marshes and creeks typical of Romney Marsh, the Thames and Medway estuaries, and the Essex coast—a fact well known to contemporary topographical writers like Daniel Defoe (who blamed the “bad air”) and the pioneering student of population Dr. Thomas Short.

Today’s historical demographers have dwelt upon the “urban graveyard” phenomenon; what Dobson shows so well is that it would be a mistake to associate the countryside unequivocally with healthiness, for there were “rural graveyards” as well. At the same time, she demonstrates what an excellent “health record” could be enjoyed in the early modern period by certain upland expanses; far off the main roads, with a dry soil, fast-running streams, and ample wood for fuel, these consistently registered a noteworthy excess of baptisms over burials, and exceptional longevity.

Making admirable use of surviving medical records as well as parochial data, Dobson provides an expert analysis of the multiplicity of “fevers” that decimated the region, paying attention above all to “marsh fever” or “ague,” which she identifies (surely correctly) as benign tertian malaria. Recognizing the importance of climatic no less than geographic variations, she also shows that bitter winters produced severe mortality among the old, while sultry summers bred the enteric fevers that worsened infant deaths. Locals with a mind to their health should have opted to live above the 400-foot contour line; indeed, surviving evidence from letters and diaries reveals that they often did make such a choice.

While stressing how “topography—or some combination of altitude, natural drainage, soil and geology—seems to have had an overwhelming influence on mortality variations right across the landscapes of this corner of south-east England” (p. 144), Dobson is far from being a geographic determinist. She underscores social factors as well—patterns of migration and the role of wealth, class, and occupation in the gradients of sickness. She also provides a rich account of the medical resources of the region, while not claiming that these weighed very heavily in the balance of mortality (at least, not before the widespread uptake of the use of quinine against malaria in the nineteenth century). Rather, she submits that “civilization” was changing “nature”: especially after the mid-eighteenth century, the old fatal marshy areas were growing less hazardous, probably thanks to “improvement” in its widest sense—marsh reclamation, fen drainage, new field systems, straightened water courses, better housing, well-boring, and the like.

These findings raise fascinating questions respecting the interpretation of demographic change. To put it rather crudely, Wrigley and Schofield have argued that the population increase gaining ground in England after about 1740 owed...