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Social History of Medicine 1999 12(2):227-269; doi:10.1093/shm/12.2.227
© 1999 by Society for the Social History of Medicine
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Patient Pathways: Solving the Problem of Institutional Mortality in London during the later Nineteenth Century

GRAHAM MOONEY*, BILL LUCKIN*,{dagger} and ANDREA TANNER*

*Centre for Metropolitan History, University of London Senate House, Malet St, London WC1E 7HU, UK.
{dagger} Humanities, Bolton Institute Chadwick Campus, Bolton BL2 1JW, UK.

This paper confronts a major problem in relation to the metropolitan and urban mortality declines in Britain during the later nineteenth century: the extent to which cause-specific death rates at district level were distorted by an official failure to redistribute deaths occurring in institutions back to ‘normal’ place of residence. Describing and analysing the manner in which hospital and infirmary provision in the capital during this period determined the geographical incidence of mortality, the article develops methodologies that bring the researcher progressively closer to more accurate spatial facts of demographic and epidemiological experience. Devoting separate sections to general voluntary and fever hospitals as well as to institutions administered by the Metropolitan Asylums Board, the paper also engages with similar problems in relation to workhouses and Poor Law infirmaries. By way of conclusion, it shows that, far from generating demographically trivial results, the process of redistribution radically revises the epidemiological history of London in the crucial years between the 1860s and the mid-1880s and provides a dataset that will allow controlled interrogation of the metropolitan mortality decline during this period.

Keywords: London; hospitals; Poor Law infirmaries; Metropolitan Asylums Board; mortality; patients


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R. Woods
Medical and Demographic History: Inseparable?
Soc Hist Med, December 1, 2007; 20(3): 483 - 503.
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