Annales de démographie historique
Belin
I.S.B.N.2-7011-3435-8
232 pages
p. 131 à 167
doi: en cours
Veille sur la revue
Veille sur l'auteur
Belin
I.S.B.N.2-7011-3435-8
232 pages
p. 131 à 167
doi: en cours
Veille sur la revue
Veille sur l'auteur
Vous consultez
Varia
no 105 2003/1
Sickness, insurance and health: assessing trends in morbidity through friendly society records [*]
Claudia Edwards Department of Economic HistoryLondon School of EconomicsHoughton StreetLondon WC2A 2AE Martin Gorsky Department of History and War StudiesUniversity of WolverhamptonCastle ViewDudley DY1 3HR Bernard Harris Department of Sociology and SocialPolicyUniversity of SouthamptonHighfieldSouthampton SO17 1BJ Andrew Hinde Department of Social StatisticsUniversity of SouthamptonHighfieldSouthampton SO17 1BJ
During the last twenty years, social and demographic historians have used a variety of approaches to investigate the health of past generations. Whilst a great deal of effort has been devoted to the analysis of anthropometric indicators, a smaller number of historians have used friendly society records to investigate aspects of sickness and morbidity. This paper reports our own efforts to investigate the health experience of members of the Hampshire Friendly Society in the south of England. The paper presents new information regarding the effect of short-term factors, such as disease outbreaks and administrative changes, on the pattern of sickness claims; the relationship between age and morbidity; and the different headings under which sickness claims were submitted. The paper provides relatively little support for the view that age-specific morbidity increased during the late-nineteenth and early-twentieth centuries, but age-specific morbidity may have increased following the introduction of statutory health insurance in 1911. We are not yet in a position to say whether this reflected a change in the cause-specific nature of morbidity, or whether it was a "cultural" artefact, resulting from a change in sickness-related behaviour.
Depuis vingt ans, les spécialistes d’histoire sociale et d’histoire des populations ont employé bien des méthodes pour aborder le problème de la santé des générations passées. Tandis que de grands efforts étaient consacrés à l’analyse des indicateurs anthropométriques, une minorité d’historiens ont utilisé les registres des associations mutuelles pour mener des recherches sur divers aspects de la maladie et la morbidité. Dans cet article, nous présentons nos propres recherches sur la santé vécue des membres de la Hampshire Friendly Society, dans le sud de l’Angleterre. Sont abordés : l’effet de facteurs de court terme (épidémies, modification administrative) sur la fréquence des demandes d’aide pour cause de maladie ; les différentes titulatures auxquelles devaient se soumettre ces demandes ; les liens entre âge et morbidité. Cette recherche ne fournit qu’un faible soutien à l’idée que la morbidité à âge donné s’est renforcée entre la fin du xixe siècle et le tout début du xxe. Cependant il est possible que cela se soit produit suite à l’introduction de l’assurance obligatoire en 1911. À ce stade, il est encore impossible de dire si cette augmentation reflète un changement dans les causes de la morbidité ou s’il s’agit d’un effet « culturel » découlant d’une transformation des comportements face à la maladie.
During the nineteenth and twentieth centuries, a large number of working-class men (and a much smaller number of working-class women) sought to protect themselves against the financial risks of sickness and old age by joining friendly societies. Although these organisations have often been studied as cultural institutions and as providers of welfare services, researchers have also attempted to use the surviving records as sources for the study of health and morbidity. In this paper, we report our own efforts to investigate the health experience of individuals belonging to one particular friendly society, the Hampshire Friendly Society, in the south of England. We begin by setting out some of the empirical and conceptual issues associated with the derivation of morbidity trends from health insurance records. We shall then go on to present new findings regarding the effect of short-term factors, such as disease outbreaks and administrative changes, on the pattern of sickness claims; the relationship between age and morbidity; and the different headings under which claims were submitted.
In recent years, a number of writers have endeavoured to use friendly society data to investigate changes in the morbidity, as opposed to the mortality, of the British population. In 1991, Humphrey Southall and Eilidh Garrett published an extremely careful analysis of the relationship between the two types of health indicator among members of the Steam Engine Makers’ Society between 1836 and 1845. Their findings showed that the average duration of each period of sickness increased with age, and that there was a close relationship between the seasonal pattern of sickness claims and the seasonality of mortality, although they were unable to compare the causes of sickness claims with the causes of mortality (Southall and Garrett, 1991). However, the most influential and prolific writer in this area has been James Riley. He has published (along with George Alter) a stream of articles (see e.g. Alter and Riley, 1989; Riley and Alter, 1989, 1996; Riley, 1987a, 1987, 1999a, 1999b), as well as two substantial books (Riley, 1989, 1997), on the relationship between morbidity and mortality among friendly society members. His evidence was drawn principally from the two largest societies, the Manchester Unity of Oddfellows and the Ancient Order of Foresters, which together accounted for more than 26 per cent of all friendly society members (excluding the members of friendly “collecting” societies) in the United Kingdom at the end of the nineteenth century (Johnson, 1985, 50)
[1]. Riley’s findings have undoubtedly provided the benchmark for discussion of British morbidity trends, but critics have pointed to substantial conceptual and methodological difficulties.
One of the major problems is that whilst we may be able to be reasonably confident about the definition of death, it is much more difficult to frame an objective definition of either health or morbidity (Riley, 1987a). However, Riley has argued that the health insurance records of the British friendly societies may offer a way round this difficulty, because they provide an indicator of the time taken off work as a result of ill-health, and because all claims for compensation had to be validated by a medical practitioner (Riley, 1989, 5-6; 1997, 127). His most striking finding was that as mortality declined in England and Wales between 1870 and 1914, the health insurance records of the leading British friendly societies show that morbidity increased. He attributed this to the combined effects of beneficial medical attendance, “insult accumulation” (the body’s diminishing capacity to recover from disease, resulting from the cumulative effect of “unrepaired damage” left by illnesses suffered over the life course), and the greater frailty of individuals who might previously have succumbed to an outbreak of infectious disease (Alter and Riley, 1989, 26, 31; Riley and Alter, 1989, 208; Riley, 1989, 44, 47; 1997, 197; 1999b, 137).
In itself, the conclusion that morbidity increased as mortality declined may not seem particularly surprising; this is precisely what one might expect to happen if, as a result of the decline in mortality, the average age of the population increased. However, while Riley acknowledged that this increase in general morbidity was closely associated with age, he also argued that age-specific morbidity increased. This claim was reflected most strongly in Riley’s analysis of the records of the Ancient Order of Foresters in his book, Sick, not dead: the health of British workingmen during the mortality decline (Riley, 1997). In Figure 6.5 of Sick, not dead, Riley showed that the total number of “sick days” rose consistently in each age group (with the exception of men aged 50-54 in the 1890s) between 1872 and 1911. Figure 6.7 showed that the average number of “sick days” for an age-standardised population rose sharply between 1872 and circa 1885, and that by 1911, the average number of sick days had increased by more than fifty per cent (Riley, 1997, 164-6).
It is arguable that Riley’s findings raise four main areas for concern, both empirical and conceptual. One of the most important empirical questions concerns the methods which he used to demonstrate the increase in age-specific morbidity. His analysis was based not on the experience of individual members, but on the experience of the members of individual courts, or branches. One of the problems associated with this approach is that, as Riley himself acknowledged, the morbidity of each branch’s members was likely to be associated less closely with their average age than with the proportion of members in the higher age-brackets. In Sick, not dead, he attempted to control for this by looking not only at the average age of the members of each branch, but also at the age of the branch itself or, to put it another way, at the length of time which had elapsed since the branch was first founded. However, it is not clear how much additional information this control really provided. Riley himself argued that the average age of the members of each branch was quite closely correlated with the branch’s own age, and that “throughout the period under study […] courts gained one-third of a year in average age for each year that passed” (Riley, 1997, 295).
Riley also sought to control for age dispersion by introducing a variable which counted the net entries to each branch (i.e. entries of new members less “secessions” of existing members). In his debate with Herb Emery, he argued that secessions were not an important factor in the Ancient Order of Foresters (AOF), since the majority of those who joined the Society did so for life, and because the proportion of those who did secede declined anyway, from 4.7 per cent in the period 1872-6 to 3.1 per cent in the period 1907-11. However, it is important to note that when Riley investigated the rate of secession, he compared the number of individuals who seceded in a given year with the total number of members in that year, and not with the number of new joiners. This is an important distinction. If, as Riley’s own investigations suggested, most of those who seceded were men who had only recently joined the society, and if the number of new members was declining, then the number of those seceding, expressed as a percentage of the total membership, would also decline, but the percentage of members who were clustered at higher ages would continue to rise (Riley, 1997, 156-60, 294-301; 1998; Emery, 1998)
[2].
One of the most important aspects of Riley’s argument concerned the relationship between the incidence of sickness claims (i.e. the number of new claims being initiated) and their duration (i.e. the period of time for which they remained in force). In Sick, not dead, he argued that the main reason for the increase in sickness prevalence was an increase in the average duration of claims, and he used this argument to refute suggestions that the apparent increase in morbidity was the result of a lowering of the sickness threshold (i.e. the point at which people were willing to consider themselves ill) rather than a real increase in sickness experience (Riley, 1997, 198; 1999a, 107; Harris, 1999, 127). However, as he himself pointed out, the majority of AOF records only provided information about the number of members making claims and the total number of days on which they received sickness benefits in each calendar year, and this did not enable him to distinguish between separate claims submitted within the same year, or between single claims which spanned more than one year. This meant that it was very difficult to reach any firm conclusions about the relationship between incidence and duration for the AOF as a whole (Riley, 1997, 154, 172).
Although the majority of AOF records did not provide detailed information about individual claims, Riley was able to obtain this kind of information for the Abthorpe court in Northamptonshire, and he was subsequently able to supplement this with further information concerning the incidence and duration of sickness claims in Morcott (in the county of Rutland) and Ashbourne (in Derbyshire). However, whilst this information was undoubtedly useful, it did not provide unequivocal support for Riley’s original suggestions. In Morcott, both the incidence and the duration of sickness claims rose between 1779-1840 and 1841-1902; in Ashbourne, the incidence of sickness claims declined by 52 per cent between 1812-1862 and 1863-1914, whilst their duration rose by 6.3 per cent; and in Abthorpe itself, the incidence of cases declined by 17.5 per cent between 1863-1892 and 1893-1922, but their duration declined by 29 per cent. These variations not only help to highlight the variability in recorded sickness experience between different branches, but also the difficulty involved in deriving any firm conclusions about the pattern of sickness claims in the AOF as a whole (Riley, 1997, 173-4; 1999a, 116; see also Harris 1999, 129; Riley, 1999b, 136).
The problems associated with the need to distinguish between different sickness episodes are compounded by the lack of information about the precise nature of the conditions causing each claim to be lodged. In Sick, not dead, Riley acknowledged that even though the Foresters required claimants to obtain a medical certificate, they rarely kept a record of the condition which gave rise to a claim. However, Riley was able to obtain information about the nature of the sickness claims submitted by members of three individual friendly societies in Bristol, Abthorpe and Clun (Shropshire), between 1896 and 1919, and these data are reproduced in Table 1. If we ignore the fact that more than one-third of the total number of cases do not appear to be accounted for in the table at all, the most striking point is that nearly sixteen per cent of successful claims were associated with accidents, and that a further 13.5 per cent were categorised under the heading
“poorly-identified”. These figures provide a clear illustration of the difficulties involved in assuming that an increase in “sick time” is necessarily the same as an increase in general “morbidity”.
Tab. 1
Leading causes of sickness in three friendly societies, 1896-1919
Whilst much of the controversy surrounding Riley’s work has focused on matters of method and detail, it is arguable that the fiercest debates have taken place on a more conceptual level. At the heart of Riley’s argument is the claim that these data represent “real” sickness, and that they provide a consistent measure of health experience over time. This claim can be questioned both on the basis that the composition of the membership of the friendly societies may have changed over time, and on the basis that their members’ inclination or ability to submit sickness claims may have changed as a result of changing cultural norms, new administrative practices, the relative wealth of a society, an increased ability to support themselves if they took time off work, or because of changes in the labour market (Whiteside, 1987; Johansson, 1991; Woods, 1996, 22-3; Macnicol, 1998, 125-31; Harris, 1999)
[3]. Some of these claims are more difficult than others to test empirically, but they do highlight the need for more information about the constellation of factors which may have led friendly society members to increase either the number or the duration of sickness claims towards the end of the nineteenth century.
The Hampshire Friendly Society
Although Riley’s findings have been disputed, there can be little doubt about the significance of the issues he has raised, not only for the history of morbidity, but also for the history of social welfare more generally. We have therefore decided to try to test some of his arguments by comparing his findings with our own analysis of the records of the Hampshire Friendly Society. The attraction of this archive lies in the unusually detailed information it contains about individual sickness experience.
The Hampshire Friendly Society was founded in Romsey in 1824, and spread throughout the county during the remainder of the century
[4]. Unlike the societies which Riley has investigated, it was one of the so-called “county” or “patronised” societies, founded and administered on behalf of working people by honorary members “drawn from the leading gentlemen and clergy of the county” (Gosden, 1961, 52-3; Thick, 1990, 56)
[5]. Its principal purpose was to provide assurances against sickness and death, with a range of subscription rates and commensurate benefits to suit different income levels (see e.g. Hampshire Friendly Society, 1827, 11-18). When the Society was first set up, members were able to subscribe for sickness benefits (provided they were not engaged in hazardous occupations, in which case they would have to pay an additional premium); pensions; death benefits; and childhood endowments, which yielded a given sum of money when children reached their fourteenth or twenty-first birthdays (Hampshire Friendly Society, 1827, 6-10). During the greater part of the nineteenth century, it seems likely that the vast majority of members did subscribe for sickness pay, but during the early part of the twentieth century, an increasing proportion of new members appear to have registered for pensions or death benefits only. Nevertheless, by 1914 the Society still had more than 7,500 members who qualified for some form of sickness pay, and more than 10,000 assured members overall (see Table 2)
[6].
Tab. 2
Number of policies held by members of the Hampshire Friendly Society 1874-1919, including a comparison of the number of sickness benefit policies and the total number of members at the end of each year
Although there were many similarities between the pattern of recruitment to the Hampshire Friendly Society and that of other societies, there were also some differences, and these were only partly related to the occupational structure of the county in which it was based (Table 3). During the period between 1851 and 1911, the most common occupational category was simply “labourer” but, given that the vast majority of these men resided in agricultural districts, it seems reasonable to assume that they were members of the agricultural working class. The society also drew a significant proportion of its new recruits from the ranks of other men employed in agriculture, forestry and fishing; transport and communication; and “miscellaneous services
[7]”; and only a small proportion of new members were employed in industrial occupations, public administration or defence. These statistics suggest that the occupational composition of the men who joined the Hampshire Friendly Society was rather more heavily biased in favour of agricultural occupations than the county as a whole, or the rest of the friendly society movement (Lee, 1979, Part II; Gosden, 1961, 73-6; Neave, 1991). In 1899, the Society’s Actuary drew attention to this fact when he suggested that the members’ “favourable environment” in terms of residence and occupation conferred a “remarkable vitality […] in middle life and old age” when compared with the members of the Manchester Unity of Oddfellows (Hampshire and General Friendly Society, 1901b, 6).
Tab. 3
Occupations of men joining the Hampshire Friendly Society, 1851-1911
While its occupational composition was unusual, the age structure of the Hampshire Friendly Society seems to have undergone similar changes to that of the Ancient Order of Foresters, but possibly for different reasons. In Sick, not dead, Riley suggested that the average age of the Foresters increased because the influx of new members was insufficient to compensate for the ageing of existing members, but in the case of the Hampshire Friendly Society, the average age of the members also reflected the fact that an increasing proportion of those who did join tended to remain as members for longer periods. As we can see from Table 4, the proportion of new members who remained in membership for more than 25 years rose from 15 per cent (among those joining in 1851) to 31 per cent among those joining in 1891, and the proportion of new members who remained until death increased from 19 per cent to 34 per cent over the same period. These changes had a dramatic effect, not only on the average age of the Society’s members, but also on the proportion of members who were clustered at higher ages. During the period between 1884/89 and 1914/19, the average age of the Society’s members rose from 29.7 to 40.3, and the proportion of members aged 55 or over rose from 6.1 per cent to 22.5 per cent (Table 5).
Tab. 4
Hampshire Friendly Society: Length of membership, 1851, 1861, 1871, 1881 and 1891
Tab. 5
Age distributions of men belonging to the Hampshire Friendly Society assurance scheme, 1885-1919
The Hampshire Friendly Society was not a mutual society, in the sense represented by organisations such as the Ancient Order of Foresters or the Manchester Unity of Oddfellows, and this meant that it could not rely on the same kind of fraternal ethos and democratic organisation which enabled these organisations to protect themselves against improper claims. However, the Society sought to compensate for this by developing a systematic set of administrative procedures to guard against any potential (or perceived) abuse, and these enabled it to generate a remarkably rich set of published and unpublished records. We have used these to investigate both the incidence and the duration of the sickness claims submitted by its members. We have made particular use of the Society’s assurance ledgers, which contain information about the age, occupation and place of birth of all those who joined the Society from 1868 onwards, together with a record of the number of days on which they received sickness pay in each of the years for which they remained with the Society. We have supplemented these data with information from the Society’s Annual Reports and the Actuary’s Quinquennial Valuations, which include details of changes in the Society’s age structure, its rule changes, and the incidence and duration of the claims submitted under different headings for various years between 1875 and 1910. We have also attempted to construct an overview of changes in sickness experience over the whole of the period by using the summary information about the number of members, the number of days claimed, and the average number of days lost per member in the Annual Report for 1921 (Hampshire and General Friendly Society, 1922).
Although the Society published its own estimate of the average number of sick days per member per year in its 1921 report, these figures do need to be interpreted with care. As we have already seen, the Society offered a range of different membership schemes to its assured members, and not all of these members were eligible for sickness pay. However, the 1921 report only included information about the total number of assured members, and our knowledge of the actual number of members who were eligible for sickness pay is limited to a few years at the end of the 1870s, and to the figures reproduced by the Actuary in the Quinquennial Valuations. The second problem is that in 1887 the Society decided to count all weeks as though they only contained six days, and this led to a drop in the level of recorded sickness between 1888 and 1890. As a result of these problems, we have decided to produce three different estimates of the “true” level of sickness between 1868 and 1921. In Table 6, column 4 shows the Society’s own figures, which have probably been calculated by dividing the total number of sick days by an unpublished estimate of the total number of members who were eligible for sickness pay, and which reflect the change from a seven-day week to a six-day week from 1888 onwards
[8]. The figures in column 5 have been derived from the figures in column 4, but the figures for 1888 onwards have been recalculated to reflect the assumption that each week contained seven days of sickness rather than six. The figures in column 6 have been calculated by dividing the total number of sick days by the number of individuals who were known to be eligible for sick pay in the years for which these data exist. These figures have also been calculated on the basis of a constant seven-day week, and the figures for the years after 1888 generally lie between the figures in the other two columns.
Tab. 6
Number of assured members, annual amount of sickness, and average amount of sickness per assured member, in the Hampshire Friendly Society, 1868-1921
We can gain a better impression of the difference between the three sets of figures, and the overall trend in sickness claims, by looking at Figure 1. Although there are differences between the three series, the overall trend seems reasonably clear. All three sets of figures suggest that sickness rates rose between the 1870s and the mid-1880s, before reaching a peak in the early-1890s. They fell sharply between 1892 and 1894 and then remained fairly stationary for the remainder of the century. The average number of days claimed began to rise once more from around 1905 onwards, and then rose steeply during the years immediately prior to the First World War. There was then a small decline in the average number of days claimed between 1915 and 1921.
In considering these overall trends, it is important to note a number of caveats. In the first place, we have not yet said anything about the extent to which variations in the age structure of the Society may have influenced the overall trends. It is also worth noting that these figures do not enable us to say whether the same proportion of individuals was making more claims or longer claims, or whether the proportion of members making claims also rose. However, it is interesting that the broad trends which we have observed appear to conform quite closely to the trends which James Riley discovered in his analysis of the Foresters’ data. This does suggest that, despite all the idiosyncratic features of the Hampshire Friendly Society, an analysis of the factors which lay behind its members’ experience may provide a good test of the factors which lay behind Riley’s data.
Epidemiological and administrative influences
Although we are primarily interested in the long-term trends in sick rates, it is also important to recognise that these were also influenced by a number of more short-term factors, particularly during the 1890s. As we can see from Figure 1, there was an increase in the number of sick days per member in the early part of the decade, followed by a decline between 1892 and 1894, which meant that the number of sick days did not return to its former level before the beginning of the new century. These fluctuations reflect the impact of changes in the disease environment and in the administration of the Society’s rules for the administration and supervision of benefit claims.
Fig. 1
Sickness experience of members of the Hampshire Friendly Society, 1868-1921
The increase in the number of sick days in the early part of the 1890s coincided with a series of severe influenza outbreaks which swept through the whole of England and Wales between 1890 and 1892. We propose to return to this topic in section 4 of this paper, when we consider the causes of sick claims in more detail. However, for the present it will be sufficient to note that the Society drew attention to the importance of influenza in its Annual Reports for both 1890 and 1892, and in the second of these reports it estimated that nearly ten per cent of its members had been affected by the disease (Hampshire Friendly Society, 1891; 1893). In 1894, the Registrar-General for England and Wales revealed that the death rate from influenza and diseases of the respiratory system in the southern counties of England rose from 2.44 deaths per thousand living in 1889 to 3.17 in 1890, 3.69 in 1891 and 4.16 in 1892, when the disease was found to have been particularly virulent in rural areas (Parliamentary Papers, 1894, xv)
[9].
Although the Society recognised the extent to which the influenza epidemic had undoubtedly influenced the number of short-term claims (see also Table 7 below), it was also becoming increasingly concerned about the way in which “over-indulgent administration” (Hampshire Friendly Society, 1892a, 2) may have facilitated an increase in the proportion of long-term claims. During the 1880s, the Society had enjoyed a healthy financial surplus, and it had used this to lower contribution rates, and to enable members whose policies expired at the age of 65 or 70 to remain for life (Hampshire Friendly Society, 1888; 1889). However, when the Society’s Actuary came to write his Quinquennial Valuation for 1884-89, he pointed out that the proportion of sickness claims which lasted for more than six months was substantially higher than the equivalent figure for the Manchester Unity of Oddfellows, and suggested that a high proportion of the claims submitted by elderly members were not cases of genuine sickness at all, but really attempts to secure a pension “at the lowest rate of pay demandable” (Hampshire Friendly Society, 1892a, 2). The Actuary was also becoming increasingly suspicious of the claims submitted by some younger members. In 1899 he pointed to a tendency for those members who subscribed at higher rates, and who were therefore entitled to higher benefits, to make a disproportionately large number of claims. He concluded that “either […] additional liability from occupations or other causes attaches to the assurances of higher amount—which is not inherently probable although such extra liability may exist to some extent—or the substantial amount of the benefits tends to suppress the common incentive to […] return to working life after brief periods of sickness. In either case it is evidence that special attention should be directed to the claims for the higher benefits” (Hampshire and General Friendly Society, 1901b, 5).
Although we have been unable to undertake any independent investigation into the validity of these suspicions, they undoubtedly had some effect on the Society’s willingness to tighten the rules governing the payment of long-term benefits. In 1892, the Society decided to reduce the rate of benefit paid to members who had been off work for more than six months, and in 1893 it introduced a sick-visiting scheme, which was then extended in the following year (Hampshire Friendly Society, 1893; 1894; 1895). It is impossible to say whether these changes did have the effect of discouraging malingering, or whether they merely discouraged sick people from taking time off work which might have been used to achieve a more complete recovery, but the number and extent of long-term payments were significantly reduced. In his report for 1899, the Actuary commented approvingly: “Some part of the abatement is probably due to the general improvement which has characterised the experience of the friendly societies during the past five years […] but the greater part […] is undoubtedly attributable to the increased efficiency of supervision and the beneficial results of a reduction in benefit in long-continued cases.” (Hampshire and General Friendly Society, 1901b, 3)
Although the Society had succeeded in restoring its financial position by the end of the nineteenth century, it continued to emphasise the need for vigilance in the policing of benefit claims. In 1904 it resisted demands from some branches for the discontinuation of sick visiting, but in 1906 it agreed to relax the rules governing the payment of half-pay to those who had been off work for long periods (Hampshire and General Friendly Society, 1905; 1907). However, by 1909 it was beginning to express renewed concern over the payment of long-term benefit, and this concern intensified with the introduction of the statutory national health insurance scheme in 1911. In 1913, the Society suggested that this had encouraged society members to prolong their sickness claims because the combined value of the benefits they received from the Society and those they received under the government scheme meant that they could afford to remain off work for longer periods (Hampshire and General Friendly Society, 1910, 1913, 1914).
The relationship between age and morbidity
As the previous section has shown, the overall pattern of sickness claims among members of the Hampshire Friendly Society was sensitive to short-term changes in the disease environment and in the Society’s administrative practices, and it may have also reflected the impact of broader changes in the availability of welfare benefits in society as a whole. However, our earlier analysis also demonstrated that there was an underlying upward trend in the pattern of morbidity between 1868 and 1921, and this was similar to the kind of trend which James Riley identified in his analysis of the sickness records of the Ancient Order of Foresters. In Sick, not dead, Riley noted that both the incidence and the duration of sickness periods were strongly correlated with age, and this has led some critics to suggest that age itself may have been largely responsible for the trends he observed (Emery, 1998). Our data enable us to go further than Riley because we can examine the relationship between age and morbidity for particular cohorts of Hampshire Friendly Society members, and because we can also use the experience of different cohorts to measure the extent to which age-related morbidity itself increased.
Our results are based on information derived from the assurance ledgers which were kept by the Society from 1868 onwards, and we have used these to measure the number of days for which each of the individuals in our sample was able to claim sickness pay during every year in which they remained a member. During the period between 1868 and 1892, the Society only retained details of the amount of money paid to each member on account of sickness in each calendar year, and we have used this information, together with information about the different rates of benefit to which each member was entitled, to calculate the number of days for which benefits were paid. The second series of ledgers (from 1892 onwards) allowed us to calculate sickness totals more directly by adding the numbers of days claimed in each quarter of the year. In order to be able to compare the experience of different cohorts, we followed the membership careers of 197 men who joined the assurance scheme (and contracted for sickness benefit) in 1871, and 181 who joined between 1895 and 1899. In retrospect, it is possible that these periods were not ideal for our current purposes, because there was a significant time lag between the ages at which most people joined the Society and the ages at which they were most likely to be sick, but the samples do tell us something about the relationship between age and morbidity among Hampshire Friendly Society members, and the extent to which this changed across different cohorts.
Figures 2-4 show the proportion of individuals for each year of age who claimed benefits, the average duration of these benefits, and the number of days claimed per member. The data on sickness duration are based on the number of days claimed by each individual in each calendar year, and are therefore open to the same set of objections as the AOF data, but the graphs nevertheless provide a good indication of the overall relationship between age and morbidity. In the case of the 1871 cohort, there is some indication that both the incidence and the duration of sickness claims were higher among those aged 10-35 than they were among those aged 35-55, but they both rose sharply from the age of 55 onwards. There is less evidence of a dip in either the incidence or the duration of sick claims among those who joined between 1895 and 1899, but this group also shows a sharp increase in both the incidence and the duration of sick claims from the mid-50s onwards. There is some evidence to suggest that those people who joined in 1871 experienced higher levels of morbidity when they reached old age than those who joined the Society between 1895 and 1899, but the reasons for this are not entirely clear. It probably reflects the impact of changes in the eligibility for benefit of older members. This is the most likely explanation for the complete absence of any sickness payments to members of the 1895-9 cohort after they had reached the age of eighty.
Fig. 2
Incidence of claims among members who joined the Hampshire Friendly Society in 1871 and between 1895 and 1899
Fig. 3
Duration of claims among members who joined the Hampshire Friendly Society in 1871 and between 1895 and 1899
Fig. 4
Prevalence of claims among members who joined the Hampshire Friendly Society in 1871 and between 1895 and 1899
Although the numbers of men in these samples are small, the results nevertheless suggest that a large part of the general increase in morbidity among Hampshire Friendly Society members shown in Figure 3 can be explained by the changing age structure of the Society’s membership. As we have already seen, the average age of the Society’s members rose from 29.7 in the second half of the 1880s to 40.3 between 1915 and 1919, and the proportion of members aged 55 or over rose from 6.1 per cent to 22.5 per cent. In view of the clear association between age and morbidity, it seems equally clear that this increase was likely to have had a significant impact on the prevalence of sickness in the Society generally
[10].
However, even if a large part of the underlying increase in recorded morbidity before 1921 was age-related, there is some evidence to suggest that there may have been a more significant increase in age-specific morbidity rates after that date. During the period between 1871 and 1937 (the year in which the last remaining member of those who joined in 1871 either left the Society or died), the individuals in our sample received sickness pay on a total of 57,089 days, but the number of days on which benefits were paid to those under the age of eighty was only 49,739. If these men had claimed benefits at the same rate as the men who joined between 1895 and 1899 (to whom no benefits were paid from the age of eighty onwards), they would have received sickness pay on 57,479 days, a difference of 7,740 days. In view of the fact that the majority of members only began to receive substantial amounts of sickness pay once they were over the age of fifty, it seems clear that these claims would only have begun to exercise a significant influence on the annual figures towards, or even after, the end of our period. This suggests that even though there may have been little evidence of any increase in age-specific morbidity before 1914, age-specific morbidity (as reflected in the incidence and duration of sickness claims) did begin to increase after that date.
Causes of sickness claims
As we have already acknowledged, our present knowledge of the data does not permit us to examine all the variables which might have contributed to the patterns we have identified in the Hampshire Friendly Society records, but we can use the Society’s published records to examine one particular variable, namely the nature of the complaint or the type of sickness which caused different claims to be lodged. In 1875, 1876, 1877, 1878, 1879, 1881, 1887, 1891 and 1910, the Society published details of the different types of claim, the number of claims made under each heading, and the number of days claimed, and we have used these data to carry out a more detailed analysis of the Hampshire Friendly Society returns in these years.
Table 7 shows the number of claims lodged and the total number of days claimed in each of the years currently under review. With one exception, the summary figures accord quite well with our own estimates for the number of days claimed per member per year in column 6 of Table 6. The exception is 1875, which was the first year in which information about the causes of claims was published. The report only listed twenty different categories of sickness, and it is possible that the overall figure is low as a result of underrecording. The returns for the years from 1876 onwards contain a much fuller listing of sickness categories, and accord much more closely with the figures which we have calculated in the previous table
[11].
Tabl. 7
Number of sickness claims and number of days claimed by members of the Hampshire Friendly Society, 1875-1910
In Sick, not dead, Riley argued that the incidence of sick claims declined between 1870 and 1911, whilst their duration increased, but, as we have already indicated, there are problems with the methods which he used to measure the two “gauges” of sickness. In his work, Riley measured the incidence of sick claims by counting the number of members to whom benefits were paid, and he measured duration by counting the number of days on which they received sickness pay in each calendar year. It is arguable that this method of measuring sickness would in itself tend to underestimate the incidence of sick claims, because it fails to distinguish between separate claims submitted by the same individual, and overestimate their duration, for the same reason. However, this is not the only criticism which can be levelled against attempts to measure the incidence of sickness with the aid of friendly society data. One of the biggest methodological problems is the fact that the original data were only collected on an annual basis. This means that we cannot yet distinguish between two claims, which may have been submitted in consecutive years, and a single claim, which may have spanned both years
[12].
In view of these difficulties, it is useful to be able to compare Riley’s findings with the figures which the Society itself recorded in its published reports between 1875 and 1910, since these data are based on the number of claims, rather than the number of members on whose behalf they were submitted. However, it is also important to recognise that the data reported in Table 6 are also susceptible to particular period effects and, especially, to the distorting effect of the influenza epidemic of 1889-91. We have therefore attempted to compensate for this by showing two separate sets of results. In Table 7, columns 3-7 show the incidence and duration of sick claims with the exception of claims submitted under the headings of colds, catarrh and influenza, and the next five columns show the incidence and duration of sick claims for all causes. If we take the two sets of results together, then they do appear to provide some support for Riley’s underlying contention. It seems that when claims associated with colds, catarrh and influenza are excluded, the overall incidence of claims shows no clear trend over the course of the period, but the average duration of sick claims rose from 42 days in 1876 to 58.4 days in 1910. However, it is also important to remember that these figures are based on the total number of members covered by the assurance scheme, and not on the number of members who were actually eligible for sickness pay. In view of the fact that the proportion of members who were eligible for sickness pay declined over time, it is likely that both the incidence and the duration of sickness claims were actually increasing
[13].
In addition to examining the effects of the influenza epidemic on the incidence and duration of sick claims, we can also use the information in the Society’s Annual Reports to shed light on some of the other factors which lay behind claims submitted by its members. In order to maintain the distinction between the incidence of sick claims and their duration, Table 8 shows the leading causes of sickness in terms of the number of claims being made, and Table 9 shows the leading causes in terms of the number of days to which each claim referred. There is a substantial, though by no means total, overlap between the two tables. Table 8 shows that the leading causes of sickness claims, taking the period as a whole, were injuries and accidents, colds, rheumatism, influenza and abscesses. The leading causes, measured in terms of the number of days claimed, were injuries and accidents, rheumatism, debility, colds, consumption and bronchitis.
Tab. 8
Leading causes of sickness claims among members of the Hampshire Friendly Society, 1875-1910
Tab. 9
Leading causes of sickness claims, by number of days claimed, among members of the Hampshire Friendly Society, 1875-1910
These findings reinforce the picture which emerged from Riley’s own analysis of the data for the Bristol, Abthorpe and Clun societies which we reproduced in Table 1, but they also go further than this, because they enable us to plot the significance of different causes of sickness over time. One of the most striking findings in Table 1 was the fact that a high proportion of all cases (15.78%) were attributed to “accidents”, and this figure is very similar to the figure for the proportion of cases in the Hampshire Friendly Society records which were attributable to “accidents and injuries”. Table 10 shows that there was no obvious pattern in terms of the incidence of claims arising from accidents and injuries, but the duration of such claims shows a striking degree of consistency, with no years showing an average duration of less than 26 days, and only one year (1878) showing an average duration of more than 28.3 days. It was because the average duration of claims for sickness pay as a result of accidents and injuries remained remarkably constant that the proportion of sick time lost under this heading showed a small decline– from thirteen per cent in 1875 and 1876 to less than ten per cent in 1910 (see Table 10).
Tab. 10
Incidence, duration and prevalence of sick claims associated with injuries and accidents
It seems clear, therefore, that we cannot attribute the overall increase in sickness time to an increase in either the incidence or duration of claims relating to accidents or injuries, but the data in the Hampshire Friendly Society reports do enable us to examine the relationship between incidence and duration for other causes. The sheer number of different types of claim makes it difficult to identify trends in all but a small number of key conditions, but we can attempt to overcome this difficulty by grouping the individual causes of sickness into different categories based on the latest revision of the World Health Organisation’s International Classification of Diseases (see Appendix A). This procedure is open to a number of possible objections, based primarily on the fact that it involves grouping the diagnoses made by medical practitioners at the end of the nineteenth century and the beginning of the twentieth century into categories constructed by epidemiologists in the second half of the twentieth century. However, this method does enable us to form a clearer picture of the overall pattern of changes in the causes of sickness, and it also allows us to examine Riley’s propositions in further detail.
In Sick, not dead, Riley drew attention to the differences between changes in the cause-structure of morbidity and cause-structure of mortality. He argued that infectious diseases had already ceased to play a major role in the causation of adult male mortality by the end of the nineteenth century, and that respiratory diseases were increasingly being overtaken in importance by organ disease. However, respiratory diseases continued to play a major role in the causation of sickness and, as a result, “the new profile dominated by organ disease emerged more slowly in relation to sickness than to death” (Riley, 1997, 188-97). At the same time, he also argued that the transition from infectious disease to chronic respiratory and organ disease did have an effect on sickness duration. In 1999, he argued that “as the profile of disease shifted from acute infectious maladies to more protracted respiratory and degenerative ailments, the average duration of sickness episodes rose”. This formed an essential part of “the most plausible account that can be given of changes in sickness rates across the period” (Riley, 1999a, 121).
In the light of these different statements, it is worth looking more closely at the detailed account of the different causes of morbidity among members of the Hampshire Friendly Society in Tables 11-13. These tables suggest that there was no great change in the relative importance of chronic respiratory conditions or organ diseases over the course the period. In 1876 (the first year for which we possess adequate data), tuberculosis, bronchitis and other respiratory diseases (excluding colds, catarrh and influenza) accounted for 11.67 per cent of all claims, and in 1910 they accounted for 11.08 per cent of all claims. Over the same period, the percentage of claims associated with diseases of the circulatory, digestive and genito-urinary systems rose from 7.56 per cent to 9.11 per cent. However, these conditions did account for a growing proportion of sick days. In 1876, they were responsible for 8.25 per cent of all sick days, and in 1910 they were responsible for 12.72 per cent of sick days.
Tab. 11
Incidence of sick claims, by disease category, 1875-1910
Tab. 12
Days claimed under each heading, as percentage of all days claimed, by disease category, 1875-1910
Tab. 13
Average duration of sick claims, by disease category, 1875-1910
Although these tables support the view that there was no great change in the relative importance of either chronic respiratory or organ disease, they also suggest that there was a general increase in the proportion of claims associated with more long-lasting diseases. Over the period as a whole, there were twelve separate categories or sub-categories of disease—phthisis, consumption and tuberculosis; neo-plasms; endocrine, nutritional and metabolic disorders; mental and behavioural disorders; diseases of the nervous system; diseases of the eyes and ears; diseases of the circulatory system; bronchitis; diseases of the musculoskeletal system; diseases of the genito-urinary system; congenital malformations; and “symptoms, signs and abnormal findings”—which had an average duration of more than forty days, and there was a significant increase in the proportion of sick days associated with these conditions. During the period between 1876 and 1910, the proportion of claims associated with these different conditions and types of condition rose from 32.01 per cent to 38 per cent, and the proportion of sick days rose from 53.49 per cent to 62.08 per cent.
In view of these findings, it is likely that at least some of the overall increase in the average duration of sickness episodes can be attributed to the increase in the relative importance of longer-lasting conditions, but it is unlikely that the whole of the increase can be explained in these terms. If we look at Tables 13 and, especially, Table 14, then it is clear that at least part of the increase was also caused by an increase in the average duration of the episodes which took place within each disease category. Even though some of this increase may itself have been caused by a change in the relative importance of the conditions making up each category, this is unlikely to provide a complete explanation. It therefore seems clear that one of the main reasons for the increase in sickness duration as a whole was that people who were suffering from the same types of condition were tending to remain off work for longer periods.
Tab. 14
Average duration of sick claims, by disease category, 1875/81-1910 (1875/81=100)
Conclusions
It is difficult to reach any firm conclusions about the reasons for the different kinds of trends identified in this paper at the present time, but we can offer a number of tentative, and provisional, suggestions. In Sick, not dead, and other publications, Riley has argued that there was an increase in the age-specific morbidity of men belonging to the Ancient Order of Foresters between 1872 and 1911. Our findings only provide a limited amount of support for this view. Although we also found an increase in recorded morbidity levels, it seems clear that much, if not all, of this increase can be explained by changes in the Society’s age structure. However, our findings do suggest that there may have been an increase in age-specific morbidity after the period covered by Riley’s study, which may reflect the impact of the national health insurance scheme on the propensity, or ability, of friendly society members to claim sickness benefits.
In addition to looking at the relationship between age and morbidity, we have also examined the different headings under which members of the Hampshire Friendly Society lodged their claims. In Sick, not dead, Riley argued that even though the incidence of sickness claims may have declined between 1872 and 1911, their duration increased, and this was why the total number of “sick days” also increased. However, as we have already seen, the direct evidence for Riley’s claims is rather limited, and not all the evidence points in the same direction, whilst the method used to calculate incidence is also open to question. Our own findings suggest that, once we have taken account of the decline in the proportion of assured members who were eligible for sickness pay, both the incidence and the duration of sickness episodes are likely to have increased. Although this conclusion may seem controversial, it is actually much more consistent with the evidence on age and morbidity, which suggests that both the incidence and the duration of sickness episodes tend to increase with age.
One of the most important questions which has been raised by historians of morbidity concerns the precise nature of the conditions which caused people to become ill. Riley showed that there were clear differences between the cause-structure of mortality and the cause structure of morbidity at the start of the twentieth century (Riley, 1997, 188-97), and our data reinforce this view. However, we have also been able to move beyond Riley’s study by showing how the cause-structure of morbidity changed over time, and this has enabled us to offer some provisional suggestions regarding the extent to which the overall increase in sickness duration should be attributed to changes in the profile of diseases, as opposed to increases in the average duration of individual diseases. It now appears that the increase in the proportion of longer-lasting conditions can only explain part of the overall increase in sickness duration, and that part of this increase should be attributed to an increase in the average duration of the claims submitted within different disease categories
[14].
During the last decade, a number of writers have suggested that one of the main reasons for the apparent increase in recorded morbidity was a change in people’s attitudes to sickness, rather than in the experience of sickness itself (Johansson, 1991; Szreter, 1994, 279-80), but our data provide only a limited amount of support for this view in the period before 1914. Although we have drawn attention to some of the ways in which changes in the administration of the Society’s rules may have influenced the pattern of sickness claims over short periods, our findings do not suggest that there was any great increase in the willingness of individuals to declare themselves ill during the period as a whole. However, they do raise some important questions about the relationship between age and morbidity. Although the Hampshire Friendly Society kept detailed records of the number of days on which benefits were paid to each member from the late-1860s onwards, it only began to retain information about the conditions experienced by individual members from 1892 onwards. Consequently, it will not be possible to investigate the relationship between age and cause-specific morbidity for the first half of the period covered by this paper. However, if we can go on to conduct a more detailed analysis of the relationship between age and different types of sickness for the later period, we shall then be in a much better position to examine the range of factors which may have been associated with the apparent increase in age-specific morbidity after 1892.
Appendix A
Classification of conditions and diseases mentioned in the Annual Reports of the Hampshire Friendly Society
BIBLIOGRAPHIE
·
Alter, G. and Riley, J.C. (1989), “Frailty, Sickness and Death: Models of Morbidity and Mortality in Historical Populations”, Population Studies, 43, 25-45.
·
Baernreither, J. (1889), English Associations of Working Men, London, Swann Sonnenschein.
·
Emery, H. (1998), “Review of James C. Riley, Sick, not Dead: the Health of British Workingmen during the Mortality Decline”, EH. Net, H-Net Reviews, July 1998.
·
Gosden, P. (1961), The Friendly Societies in England 1815-75, Manchester, Manchester University Press.
·
Gosden, P. (1973), Self-help: Voluntary Associations in Nineteenth-century Britain, London, Batsford.
·
Hampshire and General Friendly Society (1901a), Annual Report of the Hampshire and General Friendly Society for 1900.
·
Hampshire and General Friendly Society (1901b), Valuation, 1899. Report of the Actuary.
·
Hampshire and General Friendly Society (1905), Annual Report of the Hampshire and General Friendly Society for 1904.
·
Hampshire and General Friendly Society (1907), Annual Report of the Hampshire and General Friendly Society for 1906.
·
Hampshire and General Friendly Society (1910), Annual Report of the Hampshire and General Friendly Society for 1909.
·
Hampshire and General Friendly Society (1911), Annual Report of the Hampshire and General Friendly Society for 1910.
·
Hampshire and General Friendly Society (1912), Annual Report of the Hampshire and General Friendly Society for 1911.
·
Hampshire and General Friendly Society (1913), Annual Report of the Hampshire and General Friendly Society for 1912.
·
Hampshire and General Friendly Society (1914), Annual Report of the Hampshire and General Friendly Society for 1913.
·
Hampshire and General Friendly Society (1922), Annual Report of the Hampshire and General Friendly Society for 1921.
·
Hampshire and General Friendly Society (1923), Annual Report of the Hampshire and General Friendly Society for 1922.
·
Hampshire Friendly Society (1827), Annual Report of the Hampshire Friendly Society for 1826.
·
Hampshire Friendly Society (1876), Annual Report of the Hampshire Friendly Society for 1875.
·
Hampshire Friendly Society (1877), Annual Report of the Hampshire Friendly Society for 1876.
·
Hampshire Friendly Society (1878), Annual Report of the Hampshire Friendly Society for 1877.
·
Hampshire Friendly Society (1879), Annual Report of the Hampshire Friendly Society for 1878.
·
Hampshire Friendly Society (1880), Annual Report of the Hampshire Friendly Society for 1879.
·
Hampshire Friendly Society (1882), Annual Report of the Hampshire Friendly Society for 1881.
·
Hampshire Friendly Society (1888), Annual Report of the Hampshire Friendly Society for 1887.
·
Hampshire Friendly Society (1889), Annual Report of the Hampshire Friendly Society for 1888.
·
Hampshire Friendly Society (1891), Annual Report of the Hampshire Friendly Society for 1890.
·
Hampshire Friendly Society (1892a), Valuation, 1889. Report of the Actuary.
·
Hampshire Friendly Society (1892b), Annual Report of the Hampshire Friendly Society for 1891.
·
Hampshire Friendly Society (1893), Annual Report of the Hampshire Friendly Society for 1892.
·
Hampshire Friendly Society (1894), Annual Report of the Hampshire Friendly Society for 1893.
·
Hampshire Friendly Society (1895), Annual Report of the Hampshire Friendly Society for 1894.
·
Harris, B. (1999), “Morbidity and Mortality during the Health Transition: a Comment on James C. Riley, ‘Why sickness and death rates do not move parallel to one another over time’”, Social History of Medicine, 12, 125-31.
·
Harvey, B. and Oeppen, J. (2001),
“Patterns of Morbidity in Late-medieval England: a Sample from Westminster Abbey”, Economic History Review, 54, 215-39.
·
Johansson, S.R. (1991), “The Health Transition: the Cultural Inflation of Morbidity during the Decline of Mortality”, Health Transition Review, 1, 39-65.
·
Johnson, P. (1985), Saving and Spending: the Working-class Economy in Britain 1870-1939, Oxford, Clarendon Press.
·
Lee, C.H. (1979), British Regional Employment Statistics 1841-1971, Cambridge, Cambridge University Press.
·
Macnicol, J. (1998), The Politics of Retirement in Britain, 1878-1948, Cambridge, Cambridge University Press.
·
Neave, D. (1991), Mutual Aid in the Victorian Countryside: Friendly Societies in the Rural East Riding 1830-1914, Hull, Hull University Press.
·
Parliamentary Papers (1894), PP 1893-94 C. 7238 xxi, 1, Fifty-fifth Annual Report of the Registrar-General of Births, Deaths and Marriages in England (1892).
·
Parliamentary Papers (1902), PP 1902 (109) xcvi, 1, Report of the Chief Registrar of Friendly Societies for the year 1901. Part A.
·
Riley, J.C. (1987a), “Disease without Death: New Sources for a History of Sickness”, Journal of Interdisciplinary History, 17, 537-63.
·
Riley, J.C. (1987b), “Ill-health during the English Mortality Decline: the Friendly Societies’ Experience”, Bulletin of the History of Medicine, 61, 563-88.
·
Riley, J.C. (1989), Sickness, Recovery and Death: a History and Forecast of Ill-health, Basingstoke, Macmillan
·
Riley, J.C. (1997), Sick, not dead: the health of British workingmen during the mortality decline, Baltimore, Johns Hopkins University Press.
·
Riley, J.C.(1998), “Response to Emery’s review of Sick, not dead”.
·
Riley, J.C. (1999a), “Why sickness and death rates do not move parallel to one another over time”, Social History of Medicine, 12, 101-24.
·
Riley, J.C. (1999b), “Reply to Bernard Harris, ‘Morbidity and mortality during the health transition: a comment on James C. Riley”’, Social History of Medicine, 12, 133-7.
·
Riley, J.C. and Alter, G. (1989),
“Frailty, Sickness and Death: Models of Morbidity and Mortality in Historical populations”, Population Studies, 43, 25-46.
·
Riley, J.C. and Alter, G. (1996), “The Sick and the Well: Adult Health in Britain during the Health Transition”, Health Transition Review Supplement, 6, 19-44.
·
Southall, H. and Garrett, E. (1991),
“Morbidity and Mortality among Early-nineteenth Century Engineering Workers”, Social History of Medicine, 4, 231-52.
·
Szreter, S. (1994), “Mortality in England in the Eighteenth and Nineteenth Centuries: a Reply to Sumit Guha”, Social History of Medicine, 7, 269-82.
·
Thick, A. (1990), “The Hampshire Archives Trust and the Archives of the Hampshire and General Friendly Society”, Business Archives, 60, 56-60.
·
Whiteside, N. (1987), “Counting the Cost: Sickness and Disability among Working People in an Era of Industrial Recession”, Economic History Review, 40, 228-46.
·
Woods, R. (1996), “Physician Heal Thyself: the Health and Mortality of Victorian Doctors”, Social History of Medicine, 9, 1-30.
·
World Health Organisation (1992-4), International Statistical Classification of Diseases and Related Health Problems (10th revision), 3 volumes, Geneva, World Health Organisation.
NOTES
[*]
Earlier versions of this paper have been presented to conferences at the Open University (Mutuality, survival strategies and the friendly society, 24 November, 2000); the University of Linköping (Norrköping Campus) (Occupational health and public health - lessons from the past, challenges for the future, 6-9 September, 2001); The Hague (European Social Science History Association, 27 February – 2 March 2002), and the University of Tübingen (First International Conference on Economics and Human Biology, 11-13 July 2002). We are grateful to the organisers of these conferences for the opportunity to present our findings, and we should like to thank the audiences for their helpful comments. We are particularly grateful to George Alter, Patrice Bourdelais, Bruce Fetter, Robert Fogel, John Murray and Jim Oeppen for their comments on earlier drafts.We should also like to thank Sofie Akhurst for research assistance, and Anne Thick and Audrey Fisk for advice concerning the records of the Hampshire Friendly Society and the Ancient Order of Foresters respectively. Our research into the morbidity of Hampshire Friendly Society members has been supported by the University of Southampton Faculty of Social Science Research Fund.
Earlier versions of this paper have been presented to conferences at the Open University (Mutuality, survival strategies and the friendly society, 24 November, 2000); the University of Linköping (Norrköping Campus) (Occupational health and public health - lessons from the past, challenges for the future, 6-9 September, 2001); The Hague (European Social Science History Association, 27 February – 2 March 2002), and the University of Tübingen (First International Conference on Economics and Human Biology, 11-13 July 2002). We are grateful to the organisers of these conferences for the opportunity to present our findings, and we should like to thank the audiences for their helpful comments. We are particularly grateful to George Alter, Patrice Bourdelais, Bruce Fetter, Robert Fogel, John Murray and Jim Oeppen for their comments on earlier drafts.We should also like to thank Sofie Akhurst for research assistance, and Anne Thick and Audrey Fisk for advice concerning the records of the Hampshire Friendly Society and the Ancient Order of Foresters respectively. Our research into the morbidity of Hampshire Friendly Society members has been supported by the University of Southampton Faculty of Social Science Research Fund.
[1]Johnson’s definition also excludes the members of benevolent societies, workingmen’s clubs, specially authorised societies, specially authorised loan societies, medical societies and cattle insurance societies, which were all registered as friendly societies under the Friendly Societies Acts. The total membership of these organisations in 1899 was 610,254. The combined membership of the Ancient Order of Foresters and the Manchester Unity of Oddfellows was approximately 1,377,000. For further information, see Parliamentary Papers, 1902, 29.
Johnson’s definition also excludes the members of benevolent societies, workingmen’s clubs, specially authorised societies, specially authorised loan societies, medical societies and cattle insurance societies, which were all registered as friendly societies under the Friendly Societies Acts. The total membership of these organisations in 1899 was 610,254. The combined membership of the Ancient Order of Foresters and the Manchester Unity of Oddfellows was approximately 1,377,000. For further information, see Parliamentary Papers, 1902, 29.
[2]Although Riley suggested that the secession rate among members of the AOF was relatively low, other sources suggest that the secession rate among members of other societies was somewhat higher. In 1903, Alfred Watson, the Actuary to the Manchester Unity of Oddfellows, calculated that approximately one-eighth of new members left the society within five years of joining between 1893 and 1897, and Reuben Watson told the Royal Commission on the Aged Poor that approximately half of all friendly society members eventually dropped out (Macnicol, 1998, 115-6). Our own calculations suggest that between two-thirds and four-fifths of all those who joined the Hampshire Friendly Society in 1851, 1861, 1871, 1881 and 1891 left the Society before death (Table 2).
Although Riley suggested that the secession rate among members of the AOF was relatively low, other sources suggest that the secession rate among members of other societies was somewhat higher. In 1903, Alfred Watson, the Actuary to the Manchester Unity of Oddfellows, calculated that approximately one-eighth of new members left the society within five years of joining between 1893 and 1897, and Reuben Watson told the Royal Commission on the Aged Poor that approximately half of all friendly society members eventually dropped out (Macnicol, 1998, 115-6). Our own calculations suggest that between two-thirds and four-fifths of all those who joined the Hampshire Friendly Society in 1851, 1861, 1871, 1881 and 1891 left the Society before death (Table 2).
[3]For example, it is worth noting that many friendly societies, including the Ancient Order of Foresters, pursued aggressive recruiting policies during the period considered by Riley, in order to bring new groups of workers “within the fold” (Baernreither, 1889, 181; Gosden, 1961, 80-1). Riley does not examine the extent to which changes in the social composition of the Foresters’ membership may have contributed to changes in the pattern of sickness claims.
For example, it is worth noting that many friendly societies, including the Ancient Order of Foresters, pursued aggressive recruiting policies during the period considered by Riley, in order to bring new groups of workers “within the fold” (Baernreither, 1889, 181; Gosden, 1961, 80-1). Riley does not examine the extent to which changes in the social composition of the Foresters’ membership may have contributed to changes in the pattern of sickness claims.
[4]For a full list of branches, see Hampshire and General Friendly Society, 1901a.
For a full list of branches, see Hampshire and General Friendly Society, 1901a.
[5]In order to become an Honorary Member, it was necessary to make a benefaction of at least £10, or an annual subscription of at least £1; Honorary Members were not permitted to draw any emoluments from the Society. Any subscriber who was a member of the clergy or a magistrate was entitled to sit on the Board of Directors, together with any other Honorary Member who subscribed more than £20. At least four members of the Board of Directors sat on the Board of Trustees, which also included a Patron, Vice-Patron, President, and Vice-Presidents, together with a Secretary and Treasurer who were nominated by the Honorary Members. The Society’s rules also stipulated that the majority of the Trustees should at all times be substantial householders, assessed to the relief of the poor upon a sum not less than £50 (Hampshire Friendly Society, 1827, 3-4).
In order to become an Honorary Member, it was necessary to make a benefaction of at least £10, or an annual subscription of at least £1; Honorary Members were not permitted to draw any emoluments from the Society. Any subscriber who was a member of the clergy or a magistrate was entitled to sit on the Board of Directors, together with any other Honorary Member who subscribed more than £20. At least four members of the Board of Directors sat on the Board of Trustees, which also included a Patron, Vice-Patron, President, and Vice-Presidents, together with a Secretary and Treasurer who were nominated by the Honorary Members. The Society’s rules also stipulated that the majority of the Trustees should at all times be substantial householders, assessed to the relief of the poor upon a sum not less than £50 (Hampshire Friendly Society, 1827, 3-4).
[6]Although the main aim of the Society was to provide assurance benefits, it also operated a deposit scheme from 1867 onwards. This became an increasingly important branch of the Society’s activities. In 1900, when the Society had 8,998 assured members, its total membership (including deposit members) was 14,876 (Hampshire and General Friendly Society, 1922; Thick, 1990, 57).
Although the main aim of the Society was to provide assurance benefits, it also operated a deposit scheme from 1867 onwards. This became an increasingly important branch of the Society’s activities. In 1900, when the Society had 8,998 assured members, its total membership (including deposit members) was 14,876 (Hampshire and General Friendly Society, 1922; Thick, 1990, 57).
[7]The following occupations have been included in this category: billiard table proprietor; butler; cook; footman; gamekeeper; garden boy; garden labourer; gardener; groom; hairdresser; hall keeper; indoor servant; lamp boy; musician; ostler; page; page boy; paper boy; servant; under-gardener.
The following occupations have been included in this category: billiard table proprietor; butler; cook; footman; gamekeeper; garden boy; garden labourer; gardener; groom; hairdresser; hall keeper; indoor servant; lamp boy; musician; ostler; page; page boy; paper boy; servant; under-gardener.
[8]It is possible to provide a further check on this by comparing the published figures for average sickness in 1921 and 1922. In its Annual Report for 1922, the Society published separate figures showing the numbers for eligible for sick pay and the total volume of “sick days” in weeks and days for each six-day week. It also published its own estimate of the average level of sickness amongst eligible members. The total number of eligible members was 7,024, and the total number of sick days (assuming that each week contained
It is possible to provide a further check on this by comparing the published figures for average sickness in 1921 and 1922. In its Annual Report for 1922, the Society published separate figures showing the numbers for eligible for sick pay and the total volume of “sick days” in weeks and days for each six-day week. It also published its own estimate of the average level of sickness amongst eligible members. The total number of eligible members was 7,024, and the total number of sick days (assuming that each week contained