Preliminary Programme

The general shift from acute infectious to chronic degenerative diseases during late 19th and early 20th centuries marked the beginning of what Abdel Omran described in 1971 as the "epidemiological transition." Subsequent declines in mortality over this same period ushered in an era of rising life expectancies that continue to define the modern period. Understanding the factors that gave rise to this transitional period is often obscured by the lack of common historical criterion during this period for diagnosing disease and identifying cause of death. This paper analyzes late 19th and early 20th century trends in disease and cause-of-death classification by examining the influence of emergent nosologies on North American medical nomenclature. Using recorded literal causes of death in Northampton and Holyoke Massachusetts, 1850-1912, we focus on changing cause-of-death reporting throughout this period and examine certain terminological shifts leading up and subsequent to the first International Classification of Disease in 1900. The Bertillon Classification of Causes of Death was the forerunner to the 1900 International Classification of Disease, released in the United States at the International Statistical Institute in Chicago in 1893. The American Public Health Association recommended the adoption of the Bertillon Classification in 1898 along with suggested decennial revisions, which (under a variety of titles) were published by the U.S. federal government soon after discussions of the international Bertillon Commission. We examine the sociopolitical, cultural and institutional underpinnings that propelled this etiological shift and provide a qualitative and quantitative analysis of the classificatory systems that codified this understanding. (Show less)

Between the 1848-49 New York City cholera epidemic and the London outbreak of 1854, Holyoke, Massachusetts, was planned and built as a model industrial city on the banks of the Connecticut River. Sewers drawing human waste away from habitations and discharging into an extensive power canal system were an integral part of the initial tenement house construction. The toxic miasmas of the industrial class would be swept away, limiting disease amongst operatives and their families, and providing additional protection for the managerial classes living on the higher river terraces. An open reservoir of water pumped from the River was gravity fed to the tenements and factories, with no provision for its purity. By the 1866 London epidemic - so influential in convincing public health officers and medical men that cholera was indeed water-borne - the inadequacies of Holyoke's system were already apparent. After a slow start due to the Panic of 1857, Holyoke's growth was accelerating. Many inhabitants did not live in the tenements - an extensive squatter city had grown up next to the River, and some speculative housing was being built as well. Mortality was increasing alarmingly, especially among young children.

Public health interventions based on miasmatic theories that were focused on noxious air identified the urban poor as both the most vulnerable and the most dangerous segment of the population - the source of bad air as well as the ones to suffer the most from its effects. On the other hand, there was a growing sense that mitigation of the threat posed by and to the industrial poor by their waste was an obligation of society through government. Concurrently, the Massachusetts Board of Health was shifting its notion of personal responsibility for learning and following the “natural laws” of hygiene, to becoming much more proactive as an empowered authority to pass laws and enforce them. The need for sewers was recognized first. The realization that clean water is also vital dawned more slowly. Did changes in causes of death for gastro-intestinal disease and/or in the categories of GI diseases precede installation of sewers and water systems? Were people given different GI causes based on their conceptual category (e.g., the urban poor of Holyoke; the Round Hill neighborhood of Northampton)? Did such relationships between category and cause change from the timing of sewer systems to the timing of better water supplies? We explore these questions using detailed death records and supporting histories from the period 1850 to 1912 from Holyoke and Northampton, Massachusetts. (Show less)

The use of social categories in public health research is no novelty. In varying forms and to varying degrees social categories has been used in efforts to explain possible relationships between social position and health status throughout the western public health research communities, since at least the 19th century onwards. The historically changing concepts of humanity, society, population and various subdivisions of these categories into others such as race, ethnicity, class, occupation groups etc. has, at a very profound level, been a part of this research. Through public health research the infused meaning of categories such as these has had a long range of consequences for both the individual and society as a whole. Within a Danish context the question of how and why certain categories have been adapted by and used in public health research is still largely unanswered.
In an approach inspired by R. Kosellecks Begriffsgeschichte this paper aims at analysing examples of change and continuity in the use of social categories in public health research. The examples are taken form research articles published in three leading Danish medical journals from 1900 – 1950. Analysing these examples, attention will be drawn to some of the significant developments within the political, economical, academic and social areas constituting the socio-historical context of the categorization processes. (Show less)