Eighteenth century medics (subscriptions, licences, apprenticeships)

but the authors seem unfortunately to have been given no opportunity to amend or reconsider them. Regrettable also in such a diverse collection is the absence ofan index. The papers are very variable in quality, too often over-long, and with frequently excellent data employed in largely descriptive presentations confined to single localities, lacking context or even an attempt to assess wider implications. Much ofthe work reported is clearly in the early stages and some ofthe papers, like Nystr6m's interesting discussion of long-term changes in the classification of causes of death, are more research agenda than peices of substantive research. However, permeating the contributions as a whole is a welcome and multi-faceted concern with the role ofcultural factors as influences on the impact ofdisease and therefore on mortality. In the 1970s, historical demographers were forced to recognize that the prime determinants of fertility were socio-cultural. In the 1980s, they are now also to a great extent seeing mortality a social variable. Thus, local variations in practices of breast-feeding become a key influence on infant deaths, patterns of alcohol consumption a major factor affecting national differences in death rates for middle-aged men, the domestic division of labour produces gendering of mortality at certain ages, national differences in attitudes to syphilis lead to an apparent greater sympathy in Scandinavia towards hospitals seeing its treatment as a high priority. Other important cultural elements which are stressed include choice of food and, even more importantly, methods of preservation and storage (what was the impact of all that salt used for preservation?), and folk remedies and palliatives (those opiates used to calm children were not only the outcome of a particular socially-and economically-induced drug technology but also reflect beliefs about appropriate behaviour among adults and children). At another level, even a willingness to invest resources in attempts to reduce mortality not only reflects historically-specific ideologies about priorities and attitudes to life and death but also a belief, at least among opinion leaders, that those who claim to be experts actually do know how to reduce disease and its impact. And, finally, several papers nicely remind us of how, especially in a historical context, the differing objectives of compilers, current medical theory, lay beliefs, and access to information are all at work in socially shaping the statistics on causes of death that so many demographers have spent so much time in analysing as if they were Durkheimian …