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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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