The origin of quantitative studies of population is most often traced to a single book: John Graunt's Natural and Political Observations Made upon the Bills of Mortality published in 1662. In this modest volume, Graunt, a London tradesman, argued that “Trade and Government may be made more certain and Regular” through the application of arithmetic, and that knowledge of “how many People there be of each Sex, State, Age, Religion, Trade, Rank, or Degree, &c.” provided a fair method “to balance Parties and Factions both in Church and State.” Writing in the immediate aftermath of the English Civil War, Graunt was keenly aware of the suffering caused by religious intolerance and economic turmoil. He also felt the widespread desire for order and stability after Charles II's ascension to the throne. Through quantification, Graunt sought to construct a new form of knowledge that could provide a trustworthy resource for reducing conflict, maintaining political equilibrium, and cultivating commercial prosperity.

Graunt's friend and patron William Petty fervently embraced the new project and coined a name for Graunt's method: political arithmetic. Petty shared Graunt's confidence in the certainty and regularity of mathematics.

During the 1750s and 1760s in the county of Suffolk, the English surgeon Robert Sutton developed a new inoculation technique that produced a milder case of smallpox and greatly reduced the risks of dying. Instead of making a deep incision, Sutton made a very slight puncture. His son, Daniel Sutton, followed his father's practice and popularized the new procedure. “The lancet being charged with the smallest perceivable quantity (and the smaller the better) of unripe, crude or watery matter,” Daniel Sutton explained, “immediately introduce it by puncture, obliquely, between the scarf [epidermis] and true skin [dermis], barely sufficient to draw blood.” Daniel Sutton became a prolific inoculator and cultivated the practice of general inoculations, where all the inhabitants of a small town or village would be treated at once. He and his partners claimed to have inoculated 55,000 persons between 1760 and 1767, “of which number six only died.”

When inoculation was first introduced in England, physicians and surgeons had interpreted the practice in humoral terms and deemed it necessary to prepare an individual for the procedure. For up to a month prior to the actual incision, the patient would be bled, purged, and put on a low diet.

In 1798, Thomas Malthus published his Essay on the Principle of Population in which he sought to convince the public of the threat of overpopulation after decades of debate over depopulation. Malthus's fear of overpopulation differed significantly from the long-standing anxiety over depopulation. The latter, as we have seen, was treated as a fundamental impediment to the wealth and strength of a nation, and accordingly, attention focused almost entirely on the external threats to a nation with a small or diminishing population: insufficient number of men to bear arms, too few laborers to till the fields, a decline in commerce and learning. Juxtapose this scenario with the internal threats provoked by overpopulation: hunger, death, and possible rebellion. Malthus's question was not one of good or despotic government, but of the ability to govern at all. Only an event as disruptive as the French Revolution could have produced such a radical change of perspective. The internal threats posed by the people of Paris, rather than the external threats of foreign armies, were held responsible for the excesses of the events in France. Looking around his own country, Malthus could only assume that the dislocations in population brought on by manufacturing would lead inevitably to a similar bloody outcome.

Malthus was not alone in expounding this emerging internal danger. Politicians in both Britain and France perceived the same unruly possibility, and for this reason, both governments imposed a national census in the early years of the nineteenth century.

Just as the fear of plague led to the collection and publication of the London bills of mortality, which Graunt had so creatively used in his Natural and Political Observations, smallpox stimulated the development of medical arithmetic during the eighteenth century. Although smallpox had a significantly lower fatality rate than plague, its impact on public life was almost as great. Numerous members of the royalty succumbed to smallpox, including Queen Mary of England in 1694 and Louis XV of France in 1774. Smallpox caused disfigurement, blindness, and widespread suffering, which haunted the popular imagination. But it was not just the experience or fear of smallpox that led individuals to analyze its mortality rates. As with plague, the hope of preventive measures to offset the incidence of smallpox played an important role. Quarantine and fleeing potentially risky environments for safer climes were standard public health measures used to prevent or at least to limit plague epidemics. However, there existed a more potent preventive measure for smallpox: inoculation.

Inoculation provided an individual with a measure of safety – of immunity – against future smallpox epidemics.

In his brilliantly satirical Lettres persanes (1721), the French philosophe Charles Louis de Secondat, Baron de Montesquieu (1689–1755) asked somewhat seriously whether the modern world was less populated than the ancient world and answered a resounding yes. “After a calculation as exact as may be in the circumstances,” he asserted without providing any evidence of such calculations, “I have found that there are upon the earth hardly one-tenth part of the people which there were in ancient times. And the astonishing thing is, that the depopulation goes on daily: if it continues, in ten centuries the earth will be a desert.” Montesquieu not only saw the world's population as declining, but even more fundamentally, regarded it as changing. Population had a history as well as a future.

In mercantilist writings, population had generally been treated as a static or finite entity, and questions focused on geographical comparison: Was London larger than Paris? Was Holland more densely populated than England? By contrast, Montesquieu focused attention on temporal comparison and the dynamics of population – what the French called the movement of population. His dire prediction for a dramatic decline in population was regarded by contemporaries with alarm and propelled the subject of depopulation into the realm of public controversy throughout Europe.

This book is about the activity of counting – specifically the counting of births and deaths – during the long eighteenth century. From the 1660s on, the numbers of born or dead, it was argued, would shed light on numerous political and medical issues. Yet despite this emerging desire for numbers, there were almost no government institutions, either at the national or local level, to collect and record these numbers. Rather, it was individuals from rural clergy to metropolitan physicians who did the counting. These political and medical arithmeticians, as they were called, invented ingenious methods of quantifying. They counted not just the number of christenings or burials in a specific geographic area but also, and often more importantly, different groups of individuals identified and classified by particular taxonomic schemes. These activities were as much about what to count as about how to count: The two were inextricable. Arithmeticians, in this way, brought quantitative analyses to bear on discussions of medical practice and therapy, salubrity and fecundity, and the growth or decline of population. Vital accounts – the numbers of dead and born – became, in short, the quantitative measure of public health and welfare.

Counting, Samuel Johnson told James Boswell in 1783, “brings everything to a certainty, which before floated in the mind indefinitely.” Johnson was not the only one to admire the bracing effects of counting.

Physicians have long believed that disturbing experiences arouse intense emotions that can cause illness and disease. Similarly, human behaviors that can be interpreted in the diagnostic language of our own time as post-traumatic pathology date back to classical times. The first medical instances of describing, labeling, and treating such behaviors appeared during the seventeenth century, when army doctors typically regarded the cases as an organic disease of an unknown nature, cowardice, or malingering. Traumatic neurosis as a distinct psychiatric category, however, with an independent diagnostic identity and psychological – or mixed somatic and psychological – origins emerged in Western Europe and North America only during the last third of the nineteenth century.

The period 1870–1910 witnessed an unprecedented burst of creative psychological theorizing in Europe and the United States. This was the founding generation of modern psychology, psychiatry, and psychotherapy during which the sciences of the mind largely assumed the theoretical and professional forms in which we know them today. The observation and theorization of psychological trauma played no small part in this intellectual development. One of the first physicians of this period to explore systematically the idea of posttraumatic pathology and to write extensively about it – and who was a direct and demonstrable inspiration to medical traumatologists in the next generation – was the Parisian neuropsychiatrist Jean-Martin Charcot.

THE BACKGROUND TO CHARCOT'S WORK ON TRAUMATIC NEUROSIS

Charcot (1825–1893) studied trauma during the second half of his career, from the later 1870s through to his death in the early 1890s.

On July 6, 1884, the law of accident insurance, an act with far-reaching consequences, became effective in the German Reich, marking the beginning of a social and legal policy that gave the modern state a new shape as a “société assurancielle.” Following the establishment of private accident insurance in the wake of the expansion of the railways, the introduction of a liability law in 1871, and the implementation of health insurance in 1883, the 1884 legislation created a new conception of what constituted an accident. Thereby the role of the physician was transformed; doctors became “surveyors” [Gutachter] who must establish whether an accident was an “adequate cause” of an injury and then assess its impact on the victim and the insurance company. Trauma as a consequence of accidents occupies a peculiar place in the realm of accident medicine: From “railway spine” and “railway brain” to “traumatic neurosis,” physical injuries increasingly lose importance and attention gradually shifts to the psychic sphere. Henceforth, the accident takes the form of psychic trauma and shock and enters the realm of psychiatry. The clinical picture of traumatic neurosis described in 1884 by the German neurologist Hermann Oppenheim establishes a direct link between accident and injury. It is not a matter of external and corporeal injury, but rather of a “pathologically altered psyche with abnormal reactions” that, according to Oppenheim, derives from a psychic shock.

The last two decades have witnessed the emergence of what some have called a new, decidedly critical “welfare consensus” in Europe and North America. Many politicians, academic observers, public policy analysts, and public and private administrators of social services have come to agree on a relatively coherent set of axioms: that the state is overburdened; that the expansion of the welfare state has hindered economic growth; that the social safety net has created an inflation of needs; that welfare bureaucracy is too big, too inefficient, and more adept at creating problems than solving them; that the sovereignty of the individual and of civil society has been eroded by the proliferation of state welfare activities; that welfare has created institutional and electoral interests that irrationally prop it up; that the entire system is over-professionalized; and that welfare promotes anti-social values.

Criticism and the ensuing retrenchment have not been directed indiscriminately at the welfare state, however. Cuts to date have targeted mostly poor relief and housing programs, but have left pensions relatively untouched. Meanwhile, welfare has been the principal object of the backlash, as social insurance has continued to grow. In fact, throughout the supposedly “anti-welfare state” 1980s, surveys showed that citizens of welfare states overwhelmingly supported the entire range of social insurances that constitute and are commonly referred to as “social security.”