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Published by EH.NET (May 2004)
Andrea A. Rusnock, _Vital Accounts: Quantifying Health and Population in
Eighteenth-Century England and France_. Cambridge: Cambridge University
Press, 2002. xvii + 249 pp. $70 (hardback), ISBN: 0-521-80374-8.
Reviewed for EH.NET by Bernard Harris, Division of Sociology and Social
Policy, School of Social Science, University of Southampton, U.K.
In 1662, John Graunt published what has been called the first "recognisably
demographic" account of population change in his study of _Natural and
Political Observations upon the Bills of Mortality_,[1] and over the next
150 years, the rise of numbers, and especially tables, became a staple part
of the common currency of medical debate. However, as Andrea Rusnock, an
Assistant Professor of History at the University of Rhode Island, points
out, the growth of quantification was neither straightforward nor
inexorable, and the central aim of this book is to show how its progress
varied in the different institutional contexts of England (or Britain) and
France.
Although many of the broad outlines of Rusnock's story may have been told
before, the book's main strength is the meticulously-detailed
reconstruction of the particular ways in which these early quantifiers
developed their techniques in order to bring their findings to the
attention of a wider audience. She also succeeds particularly well in
conveying the optimistic and proactive spirit of her main protagonists,
which was reflected in their fervent belief that it was not only possible
to understand the workings of the world in numbers, but also to subject
"natural" phenomena to informed human intervention. This belief was
expressed with particular vigour by the Irish physician, William Black, in
his _Arithmetical and Medical Analysis of the Diseases and Mortality of the
Human Species_ in 1789: "I propose ... to ... reconnoitre more distinctly
our enemies arranged in hostile front ... to make the best disposition and
preparation for defence where the danger is apprehended, and the most
formidable assault to be sustained" (quoted on pp. 137-9 of Rusnock).
The main sections of the book are divided into three parts and seven
chapters, excluding the introduction and conclusion. The first substantive
chapter focuses on the work of Graunt and William Petty, and summarizes the
development of "political arithmetic" in England in the seventeenth
century. As Rusnock shows, the most characteristic feature of the work
carried out by these authors was their use of tables as a means of
summarizing information and presenting it in ways which might be helpful to
public debate, and the aim of the succeeding chapters is to show how their
hopes and aspirations were rewarded in the following century.
After completing this piece of seventeenth-century scene-setting, Rusnock
proceeds to a comparative analysis of the role played by quantification in
the eighteenth-century debate over smallpox inoculation. Inoculation was
imported into Europe from Turkey at the beginning of the eighteenth
century, but it spread much more rapidly in England and Wales than in other
parts of Europe, and Rusnock's account implies that this may have been
partly related to differences in the role of the medical profession and its
attitude to numbers.[2] In England, two of the leading students of the
efficacy of inoculation, John Arbuthnot and James Jurin, were
medically-trained individuals who were able to use quantitative methods to
demonstrate that individuals who contracted smallpox through inoculation
enjoyed much higher survival chances than individuals who contracted the
disease naturally, and they were able to use these insights to promote the
popularity of inoculation among their fellow-doctors and aristocratic
patients. By contrast, French doctors were much more hostile to
mathematical (or even arithmetical) demonstrations, and support for
inoculation was largely confined to public administrators, and it was not
until the final quarter of the eighteenth century that the practice began
to make much headway on the other side of the English Channel.
The second main section of the book focuses on the use of "medical
arithmetic" as a way of exploring the relationship between health (or
ill-health) and the geography of "airs, waters and places." Here again,
James Jurin was a key figure in gathering observations about the
relationship between mortality and various meteorological phenomena, such
as temperature and precipitation, in a range of different European
countries, but these investigations did not prompt the same divide between
Britain and France which was apparent during the debates over inoculation.
Rusnock does not devote a great deal of attention to the exploration of
these differences, but it is possible that the use of numerical arguments
caused less controversy in relation to environmental issues because it did
not encroach so directly on the physicians' area of therapeutic competence.
Nevertheless, this does perhaps indicate one area where the arguments in
the book might have been taken a stage further.
Although the book is primarily concerned with the eighteenth century, its
concerns can hardly be said to be confined to that century (and, indeed,
many of the debates which exercised contemporaries, such as the risks
associated with various forms of treatment, are ones which are strikingly
relevant today). This is particularly true of Chapter 6, which explores the
relationship between disease, mortality and the environment, and provides
the source for the quotation from William Black mentioned earlier. This
chapter is perhaps particularly interesting for the historian of a later
period because it provides clear evidence of the existence, half a century
before the emergence of a concerted movement for sanitary reform, of a
clear understanding of the unhealthy nature of urban environments. Here,
for example, is the Manchester physician, Thomas Percival, in 1775: "Great
towns are in a peculiar degree fatal to children. Half of all that are born
in London die under three, and in Manchester under five years of age;
whereas at Royton, a manufacturing township in the neighbourhood of
Manchester, the number of children dying under the age of three years is to
the number of children born as one to seven; and, at Eastham, a parish in
Cheshire, inhabited by farmers, the proportion is considerably less" (pp.
159-61). It is impossible to read these words and not be reminded,
irresistibly, of the data collected by Edwin Chadwick concerning the
average age at death of individuals in Manchester and Rutland in 1842.[3]
While much of the book is primarily concerned with the application of
numbers to the study of disease and mortality, the final part focuses
instead on the measurement of population itself. Rusnock frames her
discussion of this topic in the context of eighteenth-century beliefs in
mercantilism and the importance of population growth as an index of
national strength, but her account points once again to the importance of
national differences. These are particularly apparent in relation to the
means by which information about population size was obtained. In England,
it was left to private individuals to gather data and frame estimates
surrounding the number of people, whereas in France such data were gathered
by the state, and the main focus of scientific debate concerned not so much
the gathering of data, but the development of increasingly-sophisticated
means of analyzing them.
Although this book will be widely-used, and deservedly so, it is in some
ways rather narrowly-focused, and this may -- possibly -- reflect its
origins in a Princeton University Ph.D. thesis. As we have already seen,
its greatest strength lies in its meticulously- and even lovingly-detailed
reconstructions of the internal arguments of a range of seventeenth- and
eighteenth-century thinkers, but there are times when the close attention
to detail might have been supplemented by some additional attention to the
wider picture. This is perhaps particularly apparent in relation to three
important issues. In the first place, although Rusnock highlights the links
between writers such as Jurin and the Royal Society of London, she does not
discuss the extent to which they themselves derived the inspiration for
their new modes of thinking from developments in the natural sciences, even
though it is clear that they were well aware of these. Secondly, although
the author should be commended for her efforts to compare developments in
Britain and France, one sometimes feels that the reasons for both the
similarities and the differences between the two countries might have been
examined more fully. Finally, although Rusnock is undoubtedly alive to the
limitations as well as the strengths of this new quantitative discourse,
she could sometimes push her analysis of these limitations a little
further. As we have already seen, one of the many strengths of her book is
the way in which she highlights the work of men such as John Haygarth and
Thomas Percival in drawing attention to the sanitary hazards of
eighteenth-century urban life, but one does not get a strong sense of the
impact which these writers were able to exercise on a wider public. If the
arguments presented by these men were so compelling, why did it take
another sixty or seventy years for them to be converted into a national
campaign for public action?
Notes:1. Sheila Ryan Johansson, "When Numbers Began to Count for Health Policy: A Review
Essay," _Population and Development Review_ 29 (2003), 715-29, p. 715. 2. Inoculation also
spread less rapidly in other parts of the British Isles. See Deborah Brunton, "Smallpox
Inoculation and Demographic Trends in Eighteenth-Century Scotland," _Medical History_ 36
(1992), 403-29. 3. Michael Flinn, ed., _Report on the Sanitary Condition of the Labouring
Population of Great Britain, by Edwin Chadwick, 1842_, Edinburgh: Edinburgh University
Press, 1965, p. 223.
Bernard Harris is Reader in Social Policy in the Division of Sociology and
Social Policy, School of Social Science, University of Southampton, UK. He
has published extensively in the areas of anthropometric history, the
history of health and living standards, and the history of social policy.
His latest book, _The Origins of the British Welfare State: Social Welfare
in England and Wales, 1800-1945_, is due to be published by Palgrave
Macmillan in June 2004.
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2004). All EH.Net reviews are archived at http://www.eh.net/BookReview.
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