Abstract
This paper provides an examination into some of the most enduring debates regarding tuberculosis mortality during the nineteenth century: those related to gender, geographic and temporal variations. We use populations reconstructed from individual census and civil register data for the period 1861 to 1901, comparing a growing urban area with a declining rural area, both with around 20,000 inhabitants in 1861. Our analysis shows that among young adults tuberculosis was linked to excess female mortality in the urban area and excess male mortality in the rural area. We demonstrate that in the town textile workers of both genders had particularly high mortality from tuberculosis, and that the only reason for higher overall female mortality was the predominance of young women in the textile labour force. We show that the age and gender-specific pattern of mortality in the rural area is consistent with higher male than female out-migration together with return migration of those who had contracted the disease elsewhere and needed care during their lengthy illness. We argue that the observed patterns are difficult to reconcile with the ‘bargaining-nutrition’ account of gendered patterns in tuberculosis mortality, and that they provide little support for nutrition as a key influence on the disease. However, our findings do reinforce Andrew Hinde’s recent argument that geographical patterns in sex-specific tuberculosis mortality rates were largely determined by migration patterns, and we discuss the implications of this for our understanding of the decline of the disease over the late nineteenth century.
Highlights
Tuberculosis was perhaps the most important, and arguably the most interesting and controversial, disease in the late nineteenth century
The geographical patterns are far from clear-cut, with some rural areas having a strong male disadvantage, and other authors have suggested that high rural tuberculosis rates might be due to the return migration of those who had contracted the disease in urban places (Cronje, 1984; Hinde, 2015)
In this paper we have explored age and sex differentials in mortality in both an urban and a rural community in late nineteenth century Scotland and demonstrated that factors quite divorced from the disease environment can have a marked impact on mortality differentials between certain groups
Summary
Tuberculosis was perhaps the most important, and arguably the most interesting and controversial, disease in the late nineteenth century. The arguments focus on differentials in tuberculosis mortality between women and men, on urban-rural and other geographical patterns, and on the underlying reasons for the decline in mortality in the late nineteenth century. The best-known position is that of McNay, Humphries and Klasen (2005), who argue that higher female tuberculosis rates were due to the weaker bargaining position of females within their households, resulting in lower nutrition among women This debate is connected to geographical patterns in tuberculosis mortality, as the female disadvantage in mortality from the disease was noticeable in many agricultural areas of Britain where female labour may have been less well valued than male.
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