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?


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 the History of 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.