Medical statistics and sources
Migration and health – are census returns an accurate reflection of health risks? A view
from Belfast, 1911.
With the release of the 1911 census of England and Wales, which includes answers to
questions concerning the birth and survival of children, historians will be keen to ask
whether ‘where a family stayed’ or ’the socio-economic class to which a family belonged’
had a greater impact on their children’s survival chances. However if families were highly
mobile, can we be sure that ‘where they stayed’ on census night was where they were
residing when their children were exposed to factors leading to their death? This paper will
examine the already available census returns of 1911 Belfast, Northern Ireland, and in
conjunction with 1901 census returns and contemporary street directories, will assess the
rates of ‘persistence’ amongst married couples within a selection of neighbourhoods over
the 1901-11 decade. ‘Environmental’ issues within each neighbourhood will then be
considered, looking at housing quality, the availability of wells, the socio-economic
composition of the inhabitants, and the presence of industrial and commercial premises
amongst the available housing. In conclusion the paper will ask if certain types of
neighbourhood ‘import the unhealthy’, rather than causing ill health amongst their
inhabitants.
Eilidh Garrett (History Faculty, University of Cambridge)
Alice Reid (Cambridge Group for the History of Population & Social Structure,
Department of Geography, University of Cambridge)
‘A most foul and putrid mass’
Archival and unprinted sources for nineteenth century public health which tell us what was
happening on the ground can be difficult to find, to collate and to interpret. This is due to
the complex and often reactionary administrative nature of nineteenth century local and
national government. However, with the introduction of the Public Health and Local
Government Acts passed between 1848 and 1871, a clearer, more systematic approach to
the provision and administration of public health generated an enormous amount of
government correspondence, which is contained within the various Ministry of Health
records held at The National Archives. This paper will discuss how this poorly catalogued,
and thus currently underused documentation, reveals not only the way in which government
was implementing this legislation, but more interestingly, the responses and realities of its
implementation across the country. From graphic descriptions of the sanitary conditions in
various streets, through to furious outbursts against what is perceived as a ‘nanny state’,
these papers are essential for historians looking at the health of the nation, the city and the
village. Through individual letters from those in both urban and rural environments, it is
possible to uncover a wealth of information ‘from the bottom’.
Sarah Hutton
Modern Domestic Records Specialist
Advice and Records Knowledge Department (ARK)
The National Archives
Institutionalizing Complementary and Alternative Medicine at the National Institutes of
Health
Writing about the early history of the Office of Alternative Medicine (OAM) at the National
Institutes of Health at the close of the twentieth century in 1998, James Harvey Young
echoed the call of skeptics and alarmists for a sound scientific evaluation of unproven and
allegedly hazardous therapies in the medical marketplace. Young identified a wide range of
critics who portrayed the OAM as an undiscriminating advocate of unconventional medicine
and condemned its entire mission as outrageous and theoretically misguided. At the same
time, however, amidst ongoing controversy, Congress tripled its allocation and upgraded the
OAM to the National Center for Complementary and Alternative Medicine (NCCAM) in 1999,
in order to bring scientific rigor to studies of marginalized and unconventional approaches to
health and healing.
In this paper I revisit Young’s evaluation of the OAM and offer my own analysis of the next
ten years of NCCAM history based on published and archival materials. The four strategic
goals established by NCCAM’s first five-year plan demonstrated a commitment to
overcoming the historical impasse between critics and cheerleaders of complementary and
alternative medicine (CAM) by establishing a research base, training investigators, facilitating
integration between unconventional and conventional practitioners, and building an
outreach program for public and professional groups. In the last five years, the Center has
dramatically expanded the CAM research profile and the level of funding for CAM research
while training hundreds of new CAM researchers. While the Congressional appropriations
for NCCAM have increased dramatically, from less than $20 million in 1998 to more than
$120 million in 2008, NCCAM continues to face harsh criticism for both the nature of its
work and the results of the research it funds. Given these criticisms I use the occasion of the
recent ten year anniversary of NCCAM to evaluate how effectively it has carried out its
Congressional mandate to identify, investigate, and validate complementary and alternative
treatment modalities and systems. This is part of a larger project that seeks to apply a
stakeholder and boundary-formation framework to the history of CAM in American society
more broadly, in order to illustrate the factors involved in reshaping the dynamic and
complex relationships between mainstream and CAM practitioners and patients over the
past two decades. In this study, I also seek to engage the widely held belief that consumers
often choose alternative therapies because they are more congruent with their own values,
beliefs, and philosophical orientations toward health and life.
Eric Boyle
Office of NIH History
Dewitt Stetten Postdoctoral Fellow
Dying to Get Out the Asylum
Mortality and Madness in Four Victorian Mental Hospitals, c. 1841-1891
This paper examines the mortality regime of the Victorian mental hospital. In particular, it
analyses the cause of death data of over 5,000 patients who were admitted to (and
ultimately died in) the four principal lunatic asylums in the province of Ontario (Canada),
from 1841 to 1901. The results present the alleged cause of death (in broad categories) as
well as the trends of age at death, revealing the impact of tuberculosis and syphilis within
the institutional environment. Standardizing for age, the data suggest that there was a
steady increase in life chances of those entering the mental hospital over the six decades
under study, one that became more pronounced amongst women patients over time. The
paper concludes by placing the rise in expected age of death within the context of the
decline of mortality in the late nineteenth-century Anglo-American world and the
contemporary (as well as historical) debates over the social and medical role played by
lunatic asylum.
*David Wright holds the Hannah Chair in the History of Medicine at McMaster University,
Hamilton, Canada. He is the author and co-editor of seven books on the history of mental
health and psychiatry, including Down Syndrome: A History (Oxford University Press, 2011).