Death registration and mortality trends in Australia 1856–1906 By Michael Willem de Looper A thesis submitted for the degree of Doctor of Philosophy of The Australian National University May 2014 Declaration This thesis is the original work of the author carried out during Ph.D. candidature in the Demography and Social Research Program of the Australian Demographic and Social Research Institute at the Australian National University. Michael de Looper 28 May 2014 ii Acknowledgements First and foremost, I would like to express my grateful thanks to Heather Booth, Rebecca Kippen, Len Smith and Ching Choi for their guidance throughout the course of this thesis. I appreciate your knowledge and wisdom. I am deeply indebted to the staff of the following libraries for their assistance in locating sources: the National Library of Australia, the Menzies Library at the Australian National University, the State Library of New South Wales, the Fisher Library at the University of Sydney, the Royal Australian College of General Practitioners library, the Australian Bureau of Statistics library in Canberra and the Bibliothèque nationale de France in Paris. Thanks to Rasmus Hoffmann and Caspar Looman from Erasmus University, Rotterdam, for their advice on mortality turning points, and for sharing their R program. I also thank Romola Davenport from the Cambridge Group for the History of Population and Social Structure for her insights on the decline of tuberculosis mortality. Christy, to you goes my love and appreciation for your forbearance and support over these eight years. S. D. G. iii Abstract Analyses of national mortality data in Australia generally do not examine the period before the formation of the Commonwealth Bureau of Census and Statistics in 1905. Yet detailed information on death and its causes is available from the beginning of civil registration in the colonies in the mid-nineteenth century, and in the case of Tasmania, as far back as 1838. By 1856, all colonies had enacted legislation for the compulsory registration of births, deaths and marriages. Between 1856 and 1906, more than 1.75 million deaths were registered in Australia. Annual summaries or ‘abstracts’ of mortality were published by colonial Registrars and Statists, containing information on age, sex and causes of death. Although not without methodological problems, these abstracts can be compiled to allow for the examination of the course of all-cause and cause- specific mortality in Australia, a period of great epidemiological change. The age-standardised rate of all-cause mortality peaked at around 2,000 per 100,000 population in 1860—a year of fearsome epidemics. An important turning point occurred in 1885, after which mortality declined steadily and with less annual variation. The death rate fell from 1,600 in 1885 to under 1,000 in 1906, a fall of one-third over two decades. Life expectancy at birth rose from 43 years for males and 46 for females in the 1850s, to 47 and 51 in the 1880s, and 54 and 58 in the 1900s. More than half of the improvement was contributed by the reduction of under-5 mortality. Two key components were declines in infant iv deaths from gastrointestinal infections, and in tuberculosis mortality among young adults. Cause-of-death data allow for the measurement of epidemiological transition— the replacement of infectious diseases by chronic diseases over time as mortality declined. Although there were changes in the contribution of specific causes of death such as gastrointestinal infections and tuberculosis, the relative contribution to total mortality of communicable diseases, non-communicable diseases and injuries remained largely unchanged. To that end, there was little evidence of epidemiological transition during the period. With scientific medicine largely absent, social and environmental factors—the conditions in which people live, grow, work and age—emerge as important determinants of mortality during this period. Deaths graded by occupation and by a socioeconomic index of area reveal a social gradient. Degradation of the physical environment through urbanisation and public health improvements in the form of clean water and sanitation were key determinants of mortality. v vi Contents Declaration ........................................................................................................................ ii Acknowledgements........................................................................................................... iii Abstract ............................................................................................................................ iv Contents .......................................................................................................................... vii 1 Introduction ........................................................................................................... 1 2 Registering deaths .............................................................................................. 21 3 Colonial mortality data and its quality............................................................ 51 4 All-cause mortality, 1856–1906 ......................................................................... 83 5 Registering and classifying causes of death.................................................. 113 6 Cause-specific mortality, 1856–1906 .............................................................. 145 7 Mortality in transition ...................................................................................... 199 8 Social and environmental determinants of mortality.................................. 263 9 Conclusion ......................................................................................................... 295 Appendix 1: Methods and conventions......................................................................... 303 Appendix 2: Registrars-General and Government Statisticians .................................. 315 Appendix 3: Health and medical administrators .......................................................... 318 Appendix 4: Nosologies used in colonial Australia ...................................................... 322 Appendix 5: Constructing a Socioeconomic Index for colonial Melbourne.................. 335 Bibliography .................................................................................................................. 341 vii viii Chapter 1 Introduction Historical demography has described many of the striking changes in mortality which began in the latter part of the nineteenth century in the countries of western Europe and in their ‘offshoots’ in other regions of the world. In countries such as England, France, Germany, Sweden and the United States, the diminishing of the ‘crisis mortality’ of the eighteenth century—when epidemic diseases caused widespread loss of life with great annual variability in death rates—was followed by a period of stabilisation in the nineteenth. Much of the nineteenth century was characterised by deaths from endemic infectious diseases, and a slowing of gains in life expectancy (Schofield & Reher, 1991). In the last decades of the century however, mortality rates again declined sharply. In England, the unfolding of the Industrial Revolution during 1830–75 was accompanied by a stagnant death rate before a further decline commenced around 1875 (Szreter, 2004). Life expectancy at birth for males rose from 41.4 years in 1871–80 to 48.5 in 1910–10, and for females from 44.6 to 52.4 (Woods & Hinde, 1987). In France, there was little change in the forty years following 1845, the death rate only resuming its decline towards the end of the 1880s (Vallin, 1991). The crude death rate in Germany declined from 28 per thousand in 1871–75 to 18 in 1911–15, while the expectation of life at birth rose from 37.0 to 49.0 years (Haines & Kintner, 2000). In Sweden, all sexes and age groups 1 benefited from ‘a substantial mortality decline during the second half of the nineteenth century parallel to the rapid industrialisation of the country’ (Sundlin & Willner, 2009). In the United States city of Philadelphia life expectancy at birth rose from 39.6 in 1870 to 45.8 in 1900, with the age- standardised death rate over the same period declining from 21 per thousand to 17, a phenomenon repeated in other major urban centres including New York, Chicago and Baltimore (Condran & Cheney, 1982). Stolnitz (1955) observed that the modern rise in western life chances first became marked late in the century. National increases in life expectancy at birth in the half century since the 1890s had almost doubled the gains of the preceding half century. The initiation of substantial gains in life expectancy before the 1890s occurred among the countries of western Europe and in Canada, the United States, Australia and New Zealand (Riley, 2005). The course of death rates in these countries suggested that the end of the nineteenth century, and more particularly the 1880s ‘appear to mark the beginning of a new mortality regime’ where the variability of epidemic disease and crisis mortality was reduced, so that these ‘chance factors no longer play as large a part as they did previously’ (Vallin, 1991). This period between 1850 and 1900 has attracted widespread attention from demographers, epidemiologists, economists, historians and other students of social change. Not only did mortality decline to unprecedented low levels in many western countries in the last decades of the Victorian era, but fertility and family size also fell, with improved