Decline of Infant Mortality in England and Wales, 1871-1948 : a Medical Conundrum; Vaccination Registers, 1871-1913

This study aimed to provide a more individual, micro-level appreciation of infant mortality data. Previously, the focus of these data had been aggregative, at a fairly high level of aggregation - the country, county registration district. To that end, a team of research students at the Open University has examined vaccination registers at the sub-registration district level for 22 such districts.<br> In 1853 vaccination was made compulsory and in 1871 legislation was introduced requiring all poor law unions to appoint vaccination officers and to set up a system of registration; this system, with only minor alterations, lasted until 1948. Under the 1871 Act, vaccination officers took over all the functions of the local registrars except for giving parents the statutory notice of compulsory vaccination. The vaccination registrar recorded the following: (i) the registration number in the civil birth register; (ii) date of birth; (iii) place of birth; (iv) name of child; (v) sex; (vi) name of father, or if illegitimate, mother; (vii) occupation of father or if illegitimate, mother; (viii) date of notice to vaccinate given to parent; (ix) date of successful vaccination, postponement or insusceptibility to vaccination; (x) name of medical man who signed the certificate; (xi) date of death of any child who died before vaccination; (xii) reference number in vaccination officer's report book on problem cases. From the monthly information on infant deaths, the vaccination officer compiled an infant death register on children dying under the age of one year.<br> Medical historians have begun to recognise the historical importance of the compulsory provisions of Victorian vaccination legislation, which entailed the growth of a complex administrative structure necessary for its implementation. This can been seen as a forerunner of the Welfare State, particularly as regards the development of the public health movement.<br> It is generally agreed that civil registration had reached a high standard of reliability by 1872, and as the vaccination birth registers and infant death registers are copies of the civil registers for the period 1872-1948, they constitute an unrivalled source of information on infant mortality for the period.