Sex differentials in phthisis mortality in England and Wales, 1861–1870

Abstract

In the mid-nineteenth century phthisis, or pulmonary tuberculosis, was the single most important cause of death in England and Wales. It was widely distributed geographically though some areas were worse affected than others. This paper explores aspects of the geography of phthisis mortality in England in the second half of the nineteenth century, with particular attention to the sex differential in mortality from this cause. Phthisis is often thought of as a disease of young women, and throughout much of England and Wales, especially in agricultural areas, women aged between 15 and 40 years were especially vulnerable. However the sex ratio of deaths from phthisis varied greatly from place to place and, in some places where phthisis was prevalent, men rather than young women were at the greatest risk of death. Phthisis mortality was sufficiently important that the geography of the overall sex differential in mortality was to a considerable extent determined by the geography of the sex differential in phthisis mortality. Where phthisis mortality disadvantaged females, the overall sex differential between male and female mortality was small or even negative; where phthisis mortality disadvantaged males, the overall sex differential was large. The paper then considers explanations of geographical variations in the sex differential in phthisis mortality. It is not clear that these are best explained by a ‘bargaining-nutrition’ account which holds that young women in poor households were especially vulnerable to mortality from phthisis because their weak intra-household bargaining position compromised their nutritional status. Other factors, such as the return migration to their native areas of out-migrants who became sick with the disease, and working conditions, especially for females, may have been more important. The final part of the paper considers the implications of the results for explanations of the decline of phthisis mortality between 1860 and 1900.