'Mortality decline in eighteenth century London: new evidence from burials by cause, age and burial cost from the sexton

1. 'Mortality decline in eighteenth century London: new evidence from burials by cause, age and burial cost from the sextons' books of St. Martin-in-the-Fields' Romola Davenport (Cambridge Group for the History of Population and Social Structure) Leonard Schwarz (University of Birmingham) Jeremy Boulton (University of Newcastle)

2. The fall and recovery of life expectancy c.1650-1750 conceals large changes in the age pattern of mortality

3. Infant mortality rates Cambridge Group reconstitutions (including illegitimate) England & Wales

4. Infant mortality rates London Quakers Group reconstitutions (including illegitimate) England & Wales

5. Non-metropolitan infant mortality (Cambridge Group reconstitutions) • Steep decline in endogenous IMR from c. 1750 (heritable and congenital defects, conditions of birth, in utero conditions) • Little change in exogenous IMR (mainly infectious diseases) Metropolitan infant mortality (London Quakers) • Steep decline in endogenous IMR after 1750 • Significant decline in exogenous IMR after 1770s

6. One year olds Very modest improvement after 1760s (always remaining well above early C17th levels) England & Wales Cambridge Group reconstitutions (legitimate only)

7. One year olds London Quakers England & Wales Group reconstitutions (legitimate only)

8. Landers’ estimates of infant mortality from (corrected) London Bills suggest even higher infant mortality, and earlier, faster decline London Bills London Quakers England & Wales

9. Sources for London • London Bills: • burials by age (deaths under two grouped together) • burials by cause (no ages given) • baptisms • Anglicans only, but increasingly undercount parish register events after 1760s • Include stillborn and ‘abortive’ burials • London Quakers: • births and deaths • Some information on cause and occupation • Small sample size (max. 1000 individuals in mid-C18th) • Atypical and unstable social composition • Atypical behaviour? (e.g. very low endogenous infant mortality by early C19th)

10. St. Martin-in-the-Fields Population c.25,000 in 1801, c.1000 burials, 700-800 baptisms p.a. • Sextons’ burial books (1747-1825) record burials by • Cause • Exact age (days and weeks for infants) • Street address • Burial fee Include ‘stillborn’ and ‘exported’ burials (1767+) Don’t include details of parents, for child burials • Workhouse admission and discharge records (1725-1825) • admission dates by name, age, sex, and reason • discharge dates by name and reason • Baptism fee books record • graduated baptism fees and pauper exemptions • date of birth as well as baptism • Street address

11. (some of) The problems… • The population at risk (births) • Baptisms undercount births • Under-registration of baptisms increased over the C18th, due to non-observance and delayed baptism • Under-counting of deaths • Burials undercount deaths, esp. infants • Under-registration may have increased over the C18th, due to delayed baptism and non-observance • Traffic in corpses between urban parishes

12. Correction factors for baptismal under-recording may over-inflate births in St. Martin-in-the-Fields

13. Birth-baptism intervals, 1760 and 1795

14. Only 30-40% of infant burials could be linked to baptisms.Linkage patterns indicated effects of delayed baptism, migration and probably baptismal non-observance

15. The burial market in C18th London ‘exports’ identified by ‘fine’ from 1767 exports imports ‘native’ ‘Imports’ rise with opening of new burial ground in 1764 Workhouse burials in Camden Town

16. St. Martin’s burials reported to London Bills were an accurate report of parish burials (including stillborn), but excluded exported burials and extra-parochial workhouse burials

17. An overcount of burials?

18. Which burials relate to the population at risk? • Imported burials were biased by age and sex, and were excluded from analysis. However c. 5% of imported infant burials could be linked to a baptism (vs. c.40% for local burials) • Exports were biased by sex at adult ages, but resembled local burials in structure of age and cause even within the first year of life, except included fewer stillborn. Included in analysis. Approx. 20% of exported infant burials could be linked to a baptism (vs. c.40% of local burials). • It is likely that exports were higher before 1764, so their exclusion after 1767 (or correction for exclusion before 1767) would not ‘correct’ the burial series

19. Under-recording of infant deaths: does the pattern by age indicate deficits? Severe deficit of neonatal burials – almost none aged 0

20. The deficit is restored if stillborn and abortive burials are included Stillborns comprised c. 20% of burials aged under one.

23. Were most early neonatal deaths described as stillborn or abortive? • Extreme deficit of infant deaths at days 0-6, when mortality is highest • Sex ratio of stillborn infants similar to early neonatal deaths (160 and 140 males/100 females) • Very few Chrisom children (16/3418 neonatal burials). ‘Hurt in birth’ 11/3418 • If so, was the reason • Economic? Burial fees cheaper for stillborns and abortives (but also chrisoms). But stillborns in workhouse (where burials were ‘free’) comprise similar proportion of neonates to non-workhouse population. A few ‘stillborns’ identified as early neonatal deaths. • Fuzziness of stillborn definition?

24. Inclusion of stillborns inflates St. Martin’s infant mortality rate

25. Endogenous infant mortality

26. Exogenous infant mortality

27. Does smallpox explain everything? • Amongst London Quakers, smallpox declined as a cause of death at all ages in late C18th. The deduction of smallpox mortality eliminated the late C17th – early C18th rise in childhood mortality for ages 2-9, and reduced the rise at ages 0.5-1 • Woods has attributed the C18th decline of maternal and neonatal mortality and stillbirth rates to the rise and decline of smallpox mortality in London

28. Woods R (2009) Death before birth, p.226

29. Smallpox peaked as a proportion of burials in the Bills in the 1760s, and declined especially rapidly after 1800

30. Adults declined as a proportion of smallpox burials in the late C18th Percentage of smallpox burials by age

31. Precipitous decline in adult burials in 1770s

32. Similar pattern of decline in adult smallpox in St. Martin’s and Stepney (East End) Adult percentage of smallpox burials (ages 10+)

33. Adult decline accompanied by a rise in infant smallpox

34. Smallpox became concentrated at youngest ages Percentage of smallpox burials under ten, by year of age Significant difference by Kolmogorov-Smirnov test, for smallpox but not measles

35. Smallpox declined as a cause of death in older children, but rose in infants

36. These data are consistent with an increase in transmission of smallpox within London and nationally • A fall in adult smallpox risk may have contributed to the decline of endogenous infant (and maternal) mortality in London after 1770 • An increase in infantile smallpox would have raised exogenous infant mortality (as may have occurred in St. Martin’s in the late C18th), before vaccination. • Does the rapid fall in exogenous mortality of infants and children amongst the London Quakers (and the very low endogenous mortality) suggest early adoption of smallpox variolation? • If so, why does the London Bills infant mortality rate appear to fall so fast in the late C18th (since variolation was not widespread)? • A concentration of smallpox mortality at youngest ages nationally would have favoured mortality decline in later childhood and young adulthood, while disadvantaging younger children.

37. Further work • Baptisms by fee (population at risk by baptism fee category – infant mortality by social status) • New correction factors for London Bills • Seasonality of infant and child deaths