Diagnostic Spaces

Abstract

For nine weeks during the 1866 cholera epidemic, the registrar general for England and Wales published details of more than 13,000 deaths in London. Although the names of the deceased and the informant were withheld, all other information available from the death certificate was reproduced in the capital city's Weekly Returns, including registration district and subdistrict, precise address (house number and street, or institution), sex, age (sometimes down to hours for infants), occupation, cause(s) of death, and duration of final illness. Since historians’ access to original death certificates in England and Wales is restricted, this source presents an opportunity to analyze systematically the practice of cause of death certification in the middle of the nineteenth century, albeit during a period of mortality crisis. Variability of diagnostic “depth”—that is, the listing of multiple causes and duration of final illness—is considered for three major causes: cholera, diarrhea, and respiratory tuberculosis. Deaths in workhouses and general hospitals were chronically underdocumented compared to home deaths. This finding supports the notion that the institutionalization of sickness in the nineteenth century was accompanied by a loss of the “patient narrative” and also points to the entrenchment of institutional cultures of record keeping and administration.