Questions about infirmities

Edward Higgs

The General Register Office (GRO) was set up in 1837 to administer the civil system for registering births, marriages and deaths in England and Wales. Although this system was originally intended to underpin property rights via recording lines of descent, the registration of deaths also recorded the causes of death, and the GRO developed a Statistical Department dedicated to the production of medical and demographic statistics. The GRO was at the forefront of the nineteenth-century public health movement, using death data to shame local authorities into undertaking sanitary reform, and contributing to the development of medical science. The GRO's chief medical statistician from 1839 to 1879, Dr William Farr, was the greatest medical statistician of his time (Eyler; Higgs, 2004, 1–89; Szreter). Compulsory civil registration was introduced into Scotland in 1855, and was administered by a Scottish GRO that had medical functions similar to those of the GRO in London.

From 1841 the GRO was also responsible for taking the decennial census, and from 1861, when the Scottish GRO took over the enumeration north of the border, in England and Wales alone. In many ways the census enumeration was part of the Offices' medical project since the population of administrative units was necessary to calculate deaths per 1,000 population, the key measurement of health. The data collected on population density, and the family formation and migration that determined it, was used to develop 'laws' linking mortality to the crowding of people into the cities. Even occupation data could be used to examine the effects of particular types of work on mortality (Higgs, 1991).

These medical concerns also explain why from 1851 onwards data were collected on medical disabilities. In that year householders were asked to state in the final column of the household schedule they had to fill out if members of their household were deaf and dumb, or blind. The same question was asked in 1861 but 'from birth' was to be added if the condition was congenital. From 1871 householders were to indicate, in addition, if members of the household were imbeciles, idiots or lunatics. In 1891 'from childhood' was substituted for 'from birth', and 'feeble-minded' for 'idiot' (Higgs, 1989, 121–6). In 1911 householders had to record if the member of the household was 'totally' blind, deaf, or deaf and dumb, as well as the former mental disabilities, and state the age as which the person 'became afflicted' (Census of England and Wales, 1911, General report 257–8). Similar changes of nomenclature can also be found in the Scottish censuses.

The data collected on medical disabilities were given extensive analysis in the published Census reports, but the changing instructions to the householders and census enumerators indicate that there were doubts about the quality of the information supplied. The main problem was that householders were often unwilling to admit that their children or relatives had medical or mental disabilities. In the case of very young children, parents may have been unaware of any such medical issues. For example, enquiries undertaken at the time showed that many people who were about to be admitted to mental hospitals were not recorded as having any illness or disability. When 'feeble-minded' was substituted for 'idiot' in 1901, the numbers recorded as having a mental disability rose markedly. This was put down to the fact that the use of the former term was much less pejorative than that of the latter (Higgs, 1989, 75).

Another problem was confusion over the exact nature of the data required. Householders were being asked to give information about medical disabilities without any precise definitions. In the case of the blind, until 1911 no indication was given as to whether a person had to be totally blind to be included, or whether a partial lack of sight could be enumerated. Similarly, until 1911 the census asked for information on those who were deaf and dumb, but people put down relatives who were deaf, and those who could not speak whilst still being able to hear. It is difficult to know exactly what householders understood by such terms as 'idiot', 'imbecile', 'feebleminded' and 'lunatic', especially since the medical profession was also unsure as to the exact definitions. The degree of confusion these issues created can be seen from the insertion of information regarding afflictions other than those required – in one case the illnesses suffered by the inmates of an entire cottage hospital (Higgs, 1989, 75).

Such problems explain why the final column of the householders' schedules was usually left blank. This omission was carried over into the census enumerator's books into which the enumerators, prior to 1901, copied the household schedules for dispatch to the census authorities in Edinburgh and London. However, the census clerks who abstracted data from these manuscript returns often used the final column for ticks, or other marks, to show that they had dealt with the information on birthplaces in the penultimate column.

Eventually the GROs in London and Edinburgh decided that the quality of the data collected did not justify the trouble of collecting and analysing it, and the question on medical disabilities were dropped in 1921 to make room for other enquiries. As the 1921 General report for England and Wales put it, the question on infirmities had been omitted, 'in view of the generally recognised fact that reliable information upon these subjects cannot be expected in returns made by or on behalf of the individuals afflicted' (Census of England and Wales 1921, General report, 2).

REFERENCES

Census of England and Wales, 1911, General report with appendices BPP 1917–18 XXXV. [View this document: General report, England and Wales, 1911]

John M. Eyler, Victorian social medicine. The ideas and methods of William Farr (London, 1979).

Census of England and Wales 1921, General report with appendices (London: HMSO, 1927).

Edward Higgs, Making sense of the census. The manuscript returns for England and Wales, 1801–1901 (London, 1989).

Edward Higgs, 'Diseases, febrile poisons, and statistics: the census as a medical survey', Social History of Medicine, 4 (1991), 465–78.

Edward Higgs, Life, death and statistics: civil registration, censuses and the work of the General Register Office, 1837–1952 (Hatfield, 2004).

Simon Szreter, 'The GRO and the public health movement in Britain 1837–1914', Social History of Medicine, 4 (1991), 454–62.