Woods and Shelton have not only illuminated the Victorian morality experience; they have written a primer in descriptive epidemiology. In addition to the customary view of epidemiological change, Woods and Shelton show us the geographical variation in mortality and the extent to which that variation changed during the last half of the nineteenth century. [End Page 313]
The geography includes the 600 or so civil registration districts of England and Wales, emphasizing the importance of locality in the disease environments. The chapters about nosology and the quality of death registration provide excellent summaries of the implications for conducting any analysis of mortality change during a time when the understanding of disease processes and their culmination in death was undergoing so rapid a transition.
The heart of the book is the cartographical presentation of the Victorian mortality experience. It is a stunning mosaic of disease and death. Using an array of maps, charts, and tables as our guides, we are taken on an incredible journey of forty years across England and Wales, and through the city of London. We examine mortality at the age intervals of infants, young children, young adults, and the elderly and by gender differences. At the end, we know that “[w]here one lived in Victorian England critically affected not only one’s life chances, but also the manner in which death might occur” (142). Woods and Shelton call this conclusion “broad and apparently obvious.” Yet, reading the book, one is struck by how little consideration is routinely given elsewhere in the literature to characteristics of place as influences on mortality difference and change.
Finally, Woods and Shelton place their study in the context of the debate about the relative value of improving living standards (the emphasis on resistance) or the role of public health interventions (the emphasis on exposure) as explanations for the European mortality transition. Though recognizing the two as “falsely simple alternatives” (144), the authors incline their argument toward the emphasis on exposure. It is a chapter well worth reading.
Apart from errors in editing (there are far too many), there are one or two areas of substance with which to take issue. For one thing, the density factor plays such a central role in the exposition that one begins to wonder whether density really explains anything at all. After all, in an era of infectious disease, it might be said that the closer one lives to one’s neighbors, the greater the likelihood of “catching” their diseases. The trick is defining the etiology of the disease and its pathways of transmission. The book sets the stage for such an investigation.
A set of external causes emerged from the extraordinary relationship between population and environment in England and Wales in the late nineteenth century. Contrary to the tenor of the authors’ discussion, it does not seem inexplicable that infant mortality would rise in the 1890s as urban populations grew at accelerated rates, even with the efforts of the public health community to keep up. Rather, the continuing increase in infant mortality is likely explicable with archival research in urban sanitation records at the household level and the calculation of the exposure to risk of disease from the ratio of children to toilets.