As the nineteenth century progressed there was a growing call to keep abreast of and address the health of the nation. The United Kingdom was an imperial power and industrial powerhouse and there were serious concerns with regard to maintaining a large and healthy workforce. There were real fears that Britain could lag behind the rising economies of Germany and the United States.
With the 'first modern census' of 1841, census-taking in the UK came into its own. The decennial census enabled government, social administrators, doctors and statisticians to gather much-needed data. This impacted developments in town planning, public sanitation and housing. The combination of civil birth, marriage and death records records (plus schools and poor law boards) with census data proved influential in both government policy and social reform.
Britain was the home of the Industrial Revolution and continual growth gave rise to unhealthy and often perilous living conditions in overpopulated urban areas. The bringing together of civil death records (available since 1837) and census data could determine the deaths per 1,000 population. Mortality and morbidity could now be traced over time and by area. For example, in 1841 it was reported that 'of 100,000 children born in Liverpool, only 44,797 live to the age of 20,...' Unhealthy areas and occupations were now revealed.
Starting in 1848, a two-year cholera outbreak claimed over 53,000 lives. In the first year a Public Health Act was passed. The Act established a Central Board of Health. Its goals were to improve sewer drainage, remove refuse from houses, streets and roads, provide cleaner drinking water and make sure every town had a medical officer.
William Farr, c.1850. Superintendent of the Statistical Department (from 1842),
Assistant Commissioner for the census (1851 and 1861) and Commissioner (1871).
William Farr (1808-1883), an epidemiologist and statistician, joined the General Register Office for England and Wales (GRO) in 1839 as the first complier of scientific abstracts. In 1837, after only four years of marriage, he had lost his first wife to tuberculosis (TB). Farr, who remained with the GRO until retiring in 1879, was instrumental in the scientific utilization of the censuses during his long tenure. He was Assistant Commissioner for the 1851 census and worked with the first Registrar General, Thomas Henry Lister, on its design to forward demography aimed at public health. In 1871 Farr served as Commissioner. He is now regarded as one of the founders of medical statistics and along with John Snow - another famed epidemiologist - and Florence Nightingale (with whom Farr had a working friendship), employed census data for public health.
In 1851 the first infirmity questions were posed in a new column headed: 'Whether Blind, or Deaf, or Dumb'. In 1871 this was revised to four choices, namely: '1. Deaf-and-Dumb '2. Blind' 3. Imbecile or Idiot 4. Lunatic'. In 1891 it dropped to three, with 'Lunatic' joining no.3. In 1891 it was revised yet again to: '(1) Deaf and Dumb (2) Blind (3) Lunatic (4) Imbecile, Feeble-minded'.
With the less derogatory 'Feeble-minded' replacing 'Idiot', the number of individuals recorded rose markedly; no doubt dementia was now included. In 1911 the head was asked to write down at what age the 'affliction' began. Unsurprisingly, given the absence of precise definitions - for example, was 'Blind' totally blind or partially-sighted? - some individuals added additional information.
Despite its inclusion, many householders were often reluctant to complete the infirmity section. There was a natural reluctance to admit that family members had mental or physical disabilities. As a result the infirmity column across all the censuses must be treated with caution. The infirmity column was dropped in 1921.
In 1853 an Act of Parliament made smallpox vaccination compulsory - the 1851 census having identified that one in every 979 people were blind.
1854 saw the Broad Street cholera outbreak in London, which killed 616 people. June 1866 marked the final outbreak, this time in overcrowded East London - it claimed 5,596 lives. It occurred just as the city was completing construction of its major sewage and water treatment systems - the East End section was not quite complete.
On 1 June 1861, The Tewkesbury Register and Agricultural Gazette asserted: 'The Census reveals to us that the rural population of England is either at a stand-still or in process of diminution. This is in itself a serious matter, it is a reduction in the thews and sinews of the country, the class from which our soldiers and sailors are drawn. It is a well-established fact that a town population is physically inferior to that of the country, and therefore the loss of a thousand in a rural district holding 15,000 is poorly compensated by an increase to the same extent or to a larger one in the debilitated frames and pallid countenances of Rochdale or Nottingham.'
The year leading up to the 1871 census saw another outbreak of infectious disease, this time a scarlet fever epidemic. The census reports were the first to make use of the recently initiated sanitary districts, created by the Public Health Acts of 1874 and 1875. They were divided into urban and rural sanitary districts. Sanitary authorities oversaw sewers, drinking water, slums and street-cleaning in each district.
In 1881 census officials noted an alarming rise in individuals being reported as 'Deaf-and-Dumb'. On enquiry, it emerged that some enumerators had erroneously recorded non-verbal babies as such.
1879 had witnessed the first Habitual Drunkards Act (allowing authorities to establish retreats for inebriates, though payment by the 'inmate' was required) and teetotalism showed a notable increase in 1881. This is evident through the recording of teetotal institutions, such as temperance halls. Homes for Inebriates, run by the Salvation Army, housed alcoholics and addicts of morphine or opium/laudanum.
In 1885 the Housing of the Working Classes Act was passed, as part of the Public Health Acts.
The Local Government Board was granted the power to force local authorities to shut down unhealthy houses, making landlords personally liable for their tenants' health, and the Act also made it illegal for landlords to let property which was below elementary sanitary standard
As the century reached its end concerns about public health extended to military strength; a third of volunteers for the Boer War (1899-1902) were rejected as physically unfit. As a consequence, improving infant welfare became a prime concern. 1906 saw the The Education (Provision of Meals) Act, which aimed to provide free school meals for working class children.
The 1911 Insurance Act led to the introduction of a contributory medical and unemployment insurance for workers.
Bernard Mallet (1859-1932) was appointed Registrar General in 1909. His interest in the then popular pseudo-science of eugenics influenced his decision to add questions regarding birth numbers within marriage. Consequently, the 1911 census became known as the 'Fertility Census'. In the 'Particulars to Marriage' section, the following enquiry was made of each married woman:
'Completed years the present Marriage has lasted. If less than one year write "under one."'
Then under a heading 'Children born alive to present Marriage. (If no children born alive write "None" in column 7).' there were three sub-columns:
'Total Children Born Alive.'
'Children still Living.'
'Children who have Died.'
These major additions was prompted by concern regarding a falling birth rate, general health amongst the population and a rise in emigration.
Eugenic theories found favour with some key social reformers, who feared breeding amongst certain sections of society, namely the poor, criminal, disabled or chronically ill. They also feared what were termed 'Foreign invaders' or 'undesirable immigrants', who might taint 'Anglo-Saxon' Britain.
Eugenicists proposed that the working classes were reproducing more than the middle classes. Admittedly, the subsequent Fertility of Marriage report (not published until 1923) revealed that the average family had 2.8 children, with the number increasing amongst the working class, though the five-class classification system used to analyse the data has been called into question.
Bernard Mallet continued his eugenic crusade well after retiring from the GRO, publishing such papers as 'Is England in danger of racial decline?', and 'Registration in relation to eugenics'.
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