Brian Altonen, MPH, MS

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These maps, one of which is planned for reviewed on another page (not yet completed), are some of the first very detailed disease maps developed for the U.S.  They were produced 1874 by a Harvard physician, Sydney Carney, who began working for a life insurance company in New York City in 1870. 

The mapping of disease had this interesting spurt in popularity it developed in the 1870s due to the Fire and Life Insurance industry.    A rapid growth of this industry took place in the form of new companies formed following the Civil War.  Concerns about fire and the need for fire insurance developed due to industrialization.  In addition, the continued growth of the railroad industry did two things to impact insurance needs and cost.  Building the railways was a major occupation that attracted large numbers of potential employees, who in turn added to the growing field of occupational health.  It wasn’t unusual for a railroad company to have its own physician at hand for evaluating and investigating claims being made by employees injured due to work.

Insurance companies also served in the increasing number of life stock deaths that took place in the years to come.  Due to the free ranges that the rails passed through, it was not unusual for livestock to be stricken by these trains.   By the end of the century, owners of these animals were traditionally reimbursed for the loss of an animal, ranging from 5 to 20 dollars a head.  Investigators were employed to determine if such a pay out was required.

Insurance companies were focused on the cost for a given event in relation to the investments that needed to be made to cover those costs in the form of a claim.  They usually invested their money in other stable industries such as banking, the development of canals and canal companies, the addition of telegraph lines to a railway setting, the building of electricity and other utility related infrastructure needs such as dams, new equipment, mining operations, etc.  These actions formed what is known as the Golden Age for United States industries.

Source: Sharon Ann Murphy’s Life Insurance in the United States through World War I at EconomicHistory.net

A consequence of this rapid growth were numerous events that changed the way the insurance industry was managed and handled.  The Great Chicago Fire had an on the financial stability of this industry.  Insurance companies insuring the buildings, business and investments contained in cities like Chicago might have essentially gone bankrupt by the pay-offs they owed to customers, were it not for the events that took place due to the Chicago Fire of 1871.  By the end of the year in 1872,  there was the formation of an organization designed to meet these need known as an underwriter’s group.  The establishment of such a group naturally led to other avenues related to the industry to be more effectively researched.  This resulted in the addition of health related studies of people to better define the effects of health and likelihood for disease on a given individual’s life insurance program.

During the late 1850s and 1860s, William Farr’s epidemiological methods of evaluating disease rates in terms of age and place set the stage for the evaluation of population health as a standard insurance program responsibility.  Once he published his version of the mortality statistics used to predict life and death, it was only a matter of time before the insurance companies would implement this as a part of their risk assessment process for each individual to be covered.   For more than a century, actuarial statisticians working for these companies were developing and using numerous formulas for predicting the risk of death.  The earliest studies focused on simple death rates relative to birth rates, and the rates at which children successfully make it to and through adulthood.  Much of this information was well known and used as a part of any insurance program.  The fields of medical topography and climatology added a different perspective to this way of analyzing people’s lying and dying.   Such studies led to reviews of how an individual lives and where he/she moved to impact his/her overall longevity.  This merging of medical climatology and topography with the responsibilities of the insurance industries led to the production of some of the finest, most detailed population maps of disease produced in 1874 by Sydney Carney.

Source: 

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To better understand how this industry came to be, the following timeline of events for these two distinct industries is provided.  Prior to William Farr’s work, we see medicine and epidemiology, and the insurance industry developing along distinct paths.  Following Farr’s work on the same, in which a more scientific approach was taken to calculating the risk for death in relation to the current health status of individual people, the Fire and Life Insurance industry developed into a prototype for the current health insurance industry we have today.

The following is a chronology of events that correlate diseases and the risk of death or disease with climate, and how companies were able to use this approach to define a way to produce more useful actuarial information.

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A synopsis of the above events is as follows:

In 1742 and 1750, our ability to adapt to climate (Dr. John Tennant) and the effects of climate on longevity (Dr. Thomas Short) were defined in detail.  During the 1730s, a number of essays on epidemics were published detailing how endemic diseases where we live and epidemic diseases come about for a place or region.  These observations were used to define healthy and unhealthy living areas.  Over the next seventy five years, the effect of climate, ways of living, and our exposure to the environment were better documented and related to certain disease patterns.  Following a couple of decades of time spent differentiating these diseases some more, a better understanding of their differences and the causes and effects developed.  We used this information to also define a paradigm used to define the healthiness attached to living in certain places for certain conditions, versus living elsewhere for the others.  In 1829, Dr. George Farren summarized these findings and people’s interest in sanative or curing climates.  This practice of life improvement and disease prevention continued through the 1830s and 1840s, as more knowledge about the healthiness and lack of healthiness of certain climate and topographic settings was published.  During the 1850s, William Farr created his nosology of diseases, which was  followed by medical groups in his homelands in Great Britain as well as abroad in the United States.  Later on, his mathematical formulas for defining the probabilities of disease and death were developed (see Farr’s Report on the nomenclature and statistical classification of diseases for Statistical returns, 1856), and by 1857, Farr’s philosophy became the standard for most countries maintaining records of their population health.   A few years later, this methodology was supported further by Dr. William Aitkin in Chapters 2 and 3 of his The Science and Practice of Medicine, vol. 1, in 1863 (see also Edinburgh Medical Journal Book Review on Science and Practice of Medicine, 1863); this was followed by a republication of this work as a second edition in 1868.  During this time, the interest in establishing local and regional fire and life insurance industries took off, and so Farr’s philosophy on how to monitor and analyze disease patterns became the new standard for this field.

In 1871, the Prudential Assurance Company defined its way of interpreting diseases, using Farr’s nosology as follows.  It is identical to the nosology of disease defined by Farr and republished by Aitken:

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In August of 1877, Farr gave a presentation to The British Association at a meeting in Plymouth, where he presented a brief and succinct description of the benefits of his population statistics technique (see On Some Doctrines of Population).  In this lecture he spoke about the ways in which births and deaths relate, or don’t relate, and how events like war and starvation impact population and economic health.  He also amde comments about how sanitation is so very important to improving our chances for survival, and how poverty and inadequate care to children during their first years has a tremendous impact on populations in general, defining these behaviors as being ome the most regionally different behaviors and practices out there in need of interventions.  These statistics tell us how inadequate poor laws actually help to make an already unstable condition worse and a thriving city better, thereby increasing the inequality that exists between the rich and the poor and each of their health states.    For the most part, insurers, Insurance Agencies and the leaders of this field considered Farr’s work to be “scientific” or theoretical, yet they made ample use of his nosology for years to come.  Farr’s zymotic classification for diseases is found as well in the census documents of health and disease for the United States, for the period of 1850 to 1890.

In the tables that follow, the use of Farr’s method in England are presented.  In Tables XIV (2 pages), XV (1 p, 2 tables), XVI (4 p) and XVII (3 p) appearing at the end of this page, we are provided only with summary statistics.  Worth noting is that the five most prevalent diseases were, in descending order, Phthisis pulmonalis, Bronchitis, Scarlet Fever, Pneumonia, and Diarrhea/Dysentery/Cholera.

Table XVI details the number of deaths by disease for 10,000 deaths, for male and female.  This tells the statistician running the actuarial data, that if you die, your likelihood of dying for each of these given illnesses is defined on the table.  In turn, if you are known to be ill with a particular condition, it tells the statistician your likelihood for death compared with other conditions, including combinations of conditions for many of the diagnoses.  Using Farr’s nosology and formulas from 1864, an actuarial statistician could begin to determine your likelihood of being alive one year later.  This information was used to define your insurance payments for each consecutive payment you may need to make.

Methods to improve your likelihood of longer survival were detailed in an 1868 pamphlet on life and health, published on an accompanying page–Life and Death, or How to Secure Health and Avoid Sickness.

Since likelihoods for death at a given age were determined using this format, it naturally follows that this data can also be mapped.  The data provided below detail rates of death based upon townships or hamlets, fairly large regions.  The most impressive presentations of these results came as the disease maps produced by Sydney Carney in 1864, which are covered on another page.

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APPENDIX

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Example of Table with deaths by locations

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William Farr.  (A Biography and Dedication after his death.). 1883.  F.A.C.hare.

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