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29
Kuehni CE, Strippoli M-PF, Silverman M. Food intolerance and
wheezing in south Asian and white children: prevalence and clinical
significance. J Allergy Clin Immunol 2006;118:52830.
30
Chauliac ES, Silverman M, Zwahlen M, Strippoli M-PF, Brooke AM,
Kuehni CE. The therapy of pre-school wheeze: appropriate and fair?
Pediatr Pulmonol 2006;41:82938.
31
Spycher BD, Silverman M, Minder C, Kuehni CE. Phenotype
definition in childhood wheezing illness: a data-driven approach.
Eur Respir J 2006;28 (Suppl 50):267s.
32
Spycher BD, Silverman M, Brooke AM, Minder C, Kuehni CE. A
multidimensional data-driven approach to phenotype definition in
childhood wheeze and cough, Submitted for publication.
33
Staley KG, Stover C, Strippoli M-PF, Spycher BD, Silverman M,
Kuehni CE. Mannan-binding lectin in young children with
asthma differs by level of severity. J Allergy Clin Immunol
2007;119:5035.
Published by Oxford University Press on behalf of the International Epidemiological Association
! The Author 2007; all rights reserved.
Celebration: William Farr (18071883)
an appreciation on the 200th anniversary
of his birth
DE Lilienfeld
Accepted 22 March 2007
If one were to ask a student in an introductory epidemiology
course which Victorian epidemiologist most influenced the fields
development, theres a good chance the student would say John
Snow. As that student begins collecting surveillance data as part
of a doctoral thesis, the odds are good the student will not know
who first developed the concept of surveillance. When the student
begins analysing those data, theres a likelihood the data will be
coded using the International Classification of Diseases (ICD),
especially if the data concern more than one disease entity.
Should the results indicate the need for public health action, the
student might contact a local, state or federal public health
agency to report the results and advocate for appropriate
intervention. Yet, in each of these instances, the influential
Victorian epidemiologist who pioneered in the area of the
students actions was William Farr (Figure 1).
Farr is relatively unappreciated by modern epidemiologists
compared with his more feted peer, John Snow.13 Yet, it was
Farr who developed the first national vital statistics system and
assured its use as a surveillance instrument. His efforts also
Stanford University School of Medicine, Palo Alto, California, USA.
E-mail: lilienfeld@comcast.net
34
Kuehni CE, Brooke AM, Silverman M. Prevalence of wheeze during
childhood: Retrospective and prospective assessment. Eur Respir J
2000;16:8185.
35
Michel G, Silverman M, Strippoli M-PF et al. Parental understanding
of wheeze and its impact on asthma estimates. Eur Respir J
2006;28:112430.
36
Kuehni CE, Strippoli M-PF, Zwahlen M, Silverman M.
Association between reported exposure to road traffic and respiratory
symptoms in children: evidence of bias. Int J Epidemiol
2006;35:77986.
37
Keil T, Kulig M, Simpson A et al. European birth cohort studies on
asthma and atopic diseases: I. Comparison of study designsa
GALEN initiative. Allergy 2006;61:22128.
38
Keil T, Kulig M, Simpson A et al. European birth cohort studies
on asthma and atopic diseases: II. Comparison of outcomes and
exposuresa GA2LEN initiative. Allergy 2006;61:110411.
International Journal of Epidemiology 2007;36:985987
Downloaded from http://ije.oxfordjournals.org/ by guest on February 2, 2016
doi:10.1093/ije/dym132
facilitated the use of that system for the conduct of
epidemiologic studies. Farrs endeavours to craft a disease
nosology usable by vital statisticians and epidemiologists led to
the creation of the ICD.4 The structure of the ICD derives from
Farrs 1860 proposal.4 These concepts and ideas have become
interwoven into the fabric of epidemiology, so much so that
Farrs name is not necessarily mentioned as the innovator. Yet,
without his many contributions, the face of epidemiology today
would be markedly different.
A definitive biography of Farr and compilations of his
writings provide ample opportunity for modern epidemiologists
to learn about Farr.48 In view of his considerable contributions
to the discipline, it seems fitting to celebrate his 200th birthday
with brief considerations of both his biography and his impact
on our field.
Biography
William Farr (November 30, 1807 to April 14, 1883) was born
in Kenley, Shropshire, England to poor parents.9 When Farr
was 2 years old, he moved to Dorrington. In Dorrington, he
came under the influence of Joseph Pryce, the towns squire
(http://en.wikipedia.org/wiki/William_Farr, accessed November
25, 2006).
986 INTERNATIONAL JOURNAL OF EPIDEMIOLOGY
Figure 1 Dr William Farr. Courtesy of Victorian Times Project based
at CDLR at the University of Strathclyde, and the Big Lottery Fund
(formerly New Opportunities Fund). Reprinted with permission
Educated at the local school, Farr decided in 1826 to study
medicine. He undertook studies in Shrewsbury; and he
supported himself as a dresser (surgeons assistant) in a
nearby infirmary, walking 14 miles daily. Three years later,
Farr inherited 500 from Pryces estate; he used these funds to
travel to France for continued medical studies, where he was
introduced to hygiene and medical statistics. The Paris School
was in its heyday; Pierre Louis was establishing a numerical
approach to clinical research. Farr is known to have attended
Pierre Louis classes, but Eyler suggests Farrs interest in
medical statistics did not derive from Louis alone.4 Farr also
acquired some training in Switzerland.
In 1831. Farr returned to Shrewsbury for 6 months work as a
house surgeon, and then went to University College in London.4
A year later, the London Society of Apothecaries qualified him
as a physician, though some suggest he practised as a
pharmacist.9 In 1833, he married a farmers daughter and the
couple settled in London near Fitzroy Square. Farr wrote
articles on hygiene, public health and statistics (http://
www.lshtm.ac.uk/library/archives/farr.html, accessed November
25, 2006) to supplement his income. The quality of this work
commanded the attention of the editor of the Lancet,
Dr Thomas Wakley. In 1837, Farr completed two works of note:
a chapter called Vital Statistics for the pre-eminent Victorian
economist John McCullochs reference text Statistical Account
of the British Empire, and an article on consumption (of which
his wife would die that same year) with Sir James Clarke.9,10
Clarke was so impressed by Farr that in 1837, when the Office
of the Registrar General began operations, he and Wakley
recommended Farr for the post of Compiler of Abstracts.
The Registrar Generals Office had been created by Parliament
in 1836 to track births and deaths in England and Wales as
the means of assuring the proper transfer of property rights
between generations of the landed gentry (http://www.histpop.
org.uk/demo-b/servlet/View?pathBrowse/Essays&activeyes&
mno2002, accessed November 25, 2006). Any activity beyond
such tracking exceeded Parliaments intent. Hence, Farrs
appointment as Compiler of Abstracts did not carry with it
responsibility for any of the vital statistics/epidemiology projects
Farr would take on during the next four decades (http://
www.arts.gla.ac.uk/History/Medicine/bdhiggs.doc, accessed
November 25, 2006).
As Compiler of Abstracts, Farr created the first national vital
statistics system.4,11 He began the compilation of vital statistics
data on an annual basis, including analyses of causes of death
and assessments of mortality by occupation. To support this
work, he developed a nosology from which the ICD developed.
Farr was an enthusiast on the use of vital statistics, and his
efforts in this regard were recognized by the London Statistical
Society (predecessor of the Royal Statistical Society), which
elected him Treasurer, Vice President, and in 1871, President.
Farrs advocacy of vital statistics found its way into several
Downloaded from http://ije.oxfordjournals.org/ by guest on February 2, 2016
activities outside the bounds of the Registrar Generals Office,
including data (and analyses) for Sir John Simons Local Board
of Health, the Royal Army and Navy and Dr John Snows
landmark epidemiologic studies on cholera. With regard to the
latter, Farr was not an early adopter of William Budds and
Snows hypothesis that contaminated water was the means by
which the epidemic propagated.12,13 Until he reviewed the data
for the 1853 epidemic of cholera in Newcastle, Farr contended
the spread of the disease was attributable to miasmas (14-14).
However, data from the Newcastle outbreak were sufficiently
compelling to Farr for him to change that view.1,4,1416
Following the death of his wife in 1837, Farr moved to Stoke
Newington in 1841. He remarried a year later (http://
www.lshtm.ac.uk/library/archives/farr.html, accessed November
25, 2006). His second wife bore him eight children, and the
family moved to larger quarters as its needs expanded. His
second wife passed away in 1876. Farr was self-taught as a
mathematician and a linguist (fluent in French, German and
Italian). He maintained a strong friendship with Florence
Nightingale.4,10,17 When she indicated an interest in vital
statistics, he obliged her with data she subsequently published.
Although there is some suggestion she might have discretely
been Farrs Victorian mistress, it is not clear that she and Farr
were indeed lovers.4,10
When Major Graham, the second Registrar General and the
principal one under whom Farr served, retired in 1879, Farr
made it known he wished to be Registrar General himself.
However, he did not receive the appointment, and in
consequence, he retired in 1880.4,9,10 Three years later, he died.
Contributions to epidemiology
Farrs contributions to epidemiology are myriad. They range
from systems construction to the Farrs law of epidemics
(the latter refers to Farrs observation that the risk of cholera is
inversely related to altitude).4 In consideration of Farrs efforts,
we must distinguish between what Farr knew in the 1800s and
what we know today. For example, Farr occupies a prominent
role in the epidemiologic investigations into the means by
which cholera spread. Yet his conviction that miasmas were the

causal agent of the disease is known today to be wrong.1,1416,18
Nonetheless, Farr based his view on epidemiologic data
available at that time (in the 1850s), and he was quick to
acknowledge his error when better data so indicated. The
incongruence of his law of epidemics with the development of
the 1866 cholera outbreak in England led him to conclude that
miasmas could not be the etiological agent. He then advocated
strongly on behalf of better water supplies to prevent recurrence
of the epidemic.1416
The creation of a national vital statistics system amenable to
epidemiologic exploitation is arguably Farrs single greatest
achievement.11 It not only established a means of providing
data to epidemiologists, it also was an exemplar for other
countries seeking to create similar systems. Further, the system
provided data not only for the cholera investigations which
unfolded during the 1850s and 1860s but also for the first
systematic studies in occupational epidemiology by Greenhow
and for Seatons analyses of the efficacy of smallpox vaccina-
tion.4,12 The latter became the scientific basis for English public
health policy for more than a half century. As Higgs has noted,
Farrs success did not stem from his efforts alone; the Registrar-
General, Major Graham, played a strong supporting role,
without which it is not clear Farr would have been as effective
as he was.19 Nonetheless, Farr implemented a system which
has functioned, albeit with revisions to accommodate advances
in medicine and changes in society, for one and a half
centuries.
Not all of Farrs accomplishments derive from his work in the
Registrar Generals office. For example, Farr was engaged by
the London Statistical Society to undertake an analysis of the
mortality associated with the treatment of lunatics. Although
by modern standards, his analysis was not refined, it suggested
several changes in the care given to such patients (http://
www.mdx.ac.uk/www/study/3_11.htm, accessed November 25,
2006).20 Surely this analysis is one of the earlier ones in health
service research.
Farrs focus on accurate analyses resulted in his contributions
to the formation of the ICD. Though there are considerable
limitations to any nosology, this one facilitated the analysis of
data (fostering rational health policy) and thereby propelled the
publics health forward. Farrs work distinguishing risks and
rates is also noteworthy.21
Conclusion
William Farrs contributions to epidemiology were both broad
and deep. His creation of a vital statistics system, role in the
formation of the International Classification of Diseases, and
prominence in resolving the mode of communication of cholera
in Victorian England were each seminal to modern epidemiol-
ogy. The same can be said for his development of the concept of
surveillance.22,23 Sir Isaac Newton famously observed, If I have
seen further it is by standing on ye shoulders of Giants.
(http://en/wikiquote.org/wiki/Isaac_Newton, accessed November
26, 2006). In epidemiology, it is upon William Farrs shoulders,
among others, that we stand today. For this reason, on
November 30, 2007, epidemiologists around the world should
toast William Farr on the occasion of his 200th birthday.
THE LEICESTER RESPIRATORY COHORTS 987
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