An Atlas of Victorian Mortality (review)

Robert Woods and Nicola Shelton. An Atlas of Victorian Mortality. Liverpool: Liverpool University Press, 1997. 165 pp. Ill. £30.00 (casebound), £15.00 (paperbound).

As historians know, and physicians are beginning to remember, disease and mortality are socially distributed: the poor live shorter, less-healthy lives. In the heyday of Humboldtian medicine, physicians believed that diseases were rooted in place as well as in social condition. Cholera and tuberculosis showed a partiality for particular districts, streets, and even houses; inhabitants of the fens and marshlands lived unhealthier, briefer lives than those on the highland cliffs.

Robert Woods and Nicola Shelton are analytical cartographers: they use maps to explain as well as to describe the changing mortality of late Victorian England (1860-1900). Relying on the Decennial Supplements of the Registrars General, they chart mortality patterns for the 641 registration districts that made up the statistical nation (England and Wales). Dozens of maps vividly portray how mortality was distributed in space and over time. Three introductory chapters provide valuable instruction to historians about the limitations of Victorian vital statistics. Five chapters analyze the experience of specific demographic groups--infants, children, young adults, the aged, women--exploring both regional variation and change over time. Here we learn about the changing contributions made by measles, scarlet fever, whooping cough, smallpox, and the diarrhea-dysentery complex to Victorian mortality. Three other chapters are given over to tuberculosis, maternal mortality, and violent death, and two summary chapters round out the book.

The authors are preoccupied by the McKeown thesis and its critics: were nineteenth-century improvements in mortality due to improvements in living standards and nutrition (McKeown), or to the public health movement (critics)? As Woods and Shelton rightly argue, it is time to move on from such simple alternatives: variations in mortality (for specific groups and from specific diseases) provide a more useful entry point into the complexities of mortality change. Yet the authors do more to depict complexity than to explain it. Most of the analytical discussions are fragmentary, and many are inconclusive. Woods and Shelton devote considerable attention to examining aspects of the urban-rural mortality divide, only to conclude that there was an urban penalty for much of the nineteenth century. Their efforts might have been better spent exploring the differences between kinds of towns (or rural regions).

This remains, nonetheless, a work of considerable value to historians: the authors provide a series of snapshots of how specific mortalities were distributed over the whole of England. A glance at any map lets you place the well-worn examples of Manchester or London's East End in context, whether you are interested in infants, women, or the temporal and geographic vagaries of smallpox or scarlet fever. Some findings are unremarkable. Thanks to Robert Woods's earlier work, we already know that reductions in infant mortality lagged well behind improvements in child or adult health in these decades. No surprise, either, that infant mortality was high in the northern industrial towns (Manchester, Liverpool, Birmingham, and Sheffield), but it is interesting to know that high infant mortality persisted as well in older commercial centers (e.g., Plymouth and Exeter) and in the rural fens of southeast England. Such observations sustain the authors' contention that the paths to higher mortality were multicausal. Tuberculosis, intriguingly, is not especially high in the overcrowded towns of the industrial north, but rather in the rural districts of East Anglia and the northern Pennines, and, less surprisingly, in the Welsh coalfields.

The Atlas is full of unexplored observations: why did early childhood mortality in London remain high when it receded dramatically elsewhere? Why did maternal mortality in western England appear to worsen over time? Woods and Shelton leave the task of exploring such specific regional patterns to economic and public health historians. It would be helpful to have a CD version of the Atlas--modeled on the recent contemporary Atlas of United States Mortality, ¹ which offers both...