The first mortality follow-up study: the 1841 Report of William Farr (physician) on the mortality of lunatics.

BACKGROUND In the 1830s in England, there was a great cultural interest in the collection and publishing of all kinds of statistics. The Council of the Statistical Society of London (founded in 1834) commissioned one of its Fellows, Dr William Farr, to investigate and prepare a report on the mortality of patients in the county asylums, with the mortality in a large number of proprietary houses that were licensed to care for patients with mental illness (then called lunatics) ordered for confinement because of their mental condition. Committees of Parliament had investigated the condition of the mentally ill confined to the asylums and taken measures in an attempt to improve their treatment and to correct abuses. RESULTS Farr collected data from Hanwell, the Middlesex County asylum opened in 1831, and other asylums on annual admissions, resident patients, deaths, discharges, derived years of residence (exposure to risk), and annual mortality rates by duration and as an aggregate. He used similar data from a recent report on a large number of licensed houses. For the best estimate of comparative mortality, an assumed age distribution by sex and rates from the English Life Table No. 1 (constructed by Farr for 1841). CONCLUSION Farr demonstrated that annual mortality rates were higher at durations 0-1.5 years than at durations 1.5-7.5 years, higher in men than in women, higher in paupers than in other patients, higher in licensed houses than in the Hanwell Asylum, and higher in the 4 large licensed houses than in a collection of smaller ones. COMMENT A brief sketch of Farr's life is given as a memorial tribute to his pioneer work in vital statistics, life table methodology, public health, and life insurance medicine.