Perceived causes of death within the Bills of Mortality

Although the London Bills of Mortality are perhaps the best known and most complete set of records relating to death and disease we have from the 18^th century, they were also compiled in many other towns, for example, Chester, Warrington, Dublin. They were initially begun in 1592 in order to document outbreaks of plague and other diseases in each parish, were compiled by the parish clerks and published on a weekly basis. Eventually, these were collected together and published as annual volumes.

The information in these Bills was obtained by searchers, elderly female pensioners with no medical training, who would look at the bodies and then decide the cause of death, either by their appearance, or the information they had been given by doctors or relatives of the deceased. A correspondent, writing to the Gentlemen’s Magazine in 1799 deplored the fact that:

In two parishes, which I could point out, the searchers cannot write; the mistakes they make are numberless, in the spelling Christian and surnames, for, they trust to memory till they get home; then, child or neighbour writes what they suppose it to be.

John Graunt, one of the first British demographers, made scathing criticisms concerning the veracity of the searchers in his magnum opus, “Natural and Political Observations Made upon the Bills of Mortality” published in 1662. He suspected that the reason so few deaths appeared to be caused by venereal disease was because the searchers had been bribed, or of course, they may have just been particularly reticent about mentioning the subject. From the table below, we can see that there were only 81 recorded deaths from the French Pox, or syphilis.

Forasmuch as by the ordinary discourse of the world it seems a great part of men have, at one time, or other, had some species of this disease, I wondering why so few died of it […]

[…] that the Old-women Searchers after the mist of a Cup of Ale, and the bribe of a two-groat fee, instead of one, given them, cannot tell whether this emaciation, or leanness were from a Phthisis, or from a Hectick Fever, Atrophy, &c. or from an Infection of the Spermatick parts […]

Despite Graunt’s misgivings, the Bills of Mortality remain an important contribution to our knowledge concerning the death and disease of this period.

Although many of these forms of death such as, horshoehead, headmouldshot and purples look strange to us, they obviously had meaning for contemporaries, whilst others, for example, convulsions, consumption, teeth and worms could cover a multitude of different ailments. Graunt, of course, was under no misapprehension that many of the diagnoses made by the searchers were wrong, but it is highly likely that the medical profession would have been no more accurate. Even today it is thought that some 25% of death certificates are inaccurate. However, outside London, the cause of death was recorded in only a small number of parish registers, for example, Leeds and Selby in the West Riding of Yorkshire.

London Bills of Mortality – Diseases and Casualties for the years 1783 and 1784

We must remember that for people living in the18th century death was never far away. A simple cut or broken bone could lead to blood poisoning, sepsis, and ultimately, without the benefit of modern antibiotics, death.

Infantile deaths – natural or infanticide?

The number of infant deaths as recorded in the London Bills of Mortality during this period was absolutely staggering. The total number of all deaths in 1783, was 19,029 and of this, 6,632 were infants under the age of two, i.e. 34.85%, whilst the figures for 1784 were hardly any better, 5,729 infant deaths out of a total of 17,828, i.e. 32.13%. What was the reason for these deaths? Apart from the diseases mentioned above, a far more sinister cause could have been infanticide.

The discovery of the dead body of a new-born child aroused suspicions that a single woman in the neighbourhood had committed murder. Bodies were usually discovered in privies or in fields or rivers, or hidden indoors under mattresses, in cupboards, or in locked boxes.

As well as straightforward murder or abandonment, there is good reason to believe that the wet nursing profession was responsible for many infant deaths in both this and the following century.

The wet nurses and foster mothers, the “angel makers”, who were responsible for looking after babies in their charge, deliberately neglected them, especially if illegitimate, and if they were not, often at the behest of their natural mother, thereby causing an early death. According to Malcolmson there were very few indictments for infanticide during the second half of the eighteenth century in Britain. However, that is not to say that there was a failure to investigate cases of sudden death. As Jackson says:

[…] medical opinion as to the cause of death was by no means disregarded, during the eighteenth century. This is well illustrated by the large number of investigations held into the deaths of new-born children thought to have been murdered by their mothers.

Perhaps we should not be surprised at these low figures, and with so many children dying at birth it would be difficult to prove that death was intentional. Even today, it can be notoriously difficult to distinguish between infanticide and genuine cot deaths. It was well known that the smothering of babies by their mothers was a common occurrence, and contemporary commentators were damning in their criticism, as can be seen from a pamphlet published in 1757 by George Burrington:

[…] (people) sent their Bastards to the Foundling Hospital; if they are not admitted, there are Men and Women, that for a certain Sum of Money will take them, and the Fathers never hear what becomes of the Children afterwards…in and about London a prodigious Number of Infants are cruelly murdered unchristened, by those Infernals, called Nurses; these detestable Monsters throw a Spoonful of Gin, Spirits of Wine, or Hungary-Water down a Child’s Throat, which instantly strangles the Babe; when the Searchers come to inspect the Body, and enquire what Distemper caused the Death, it is answered, Convulsions, this occasions the Article of Convulsions in the Bills of Mortality so much to exceed all others. The price of destroying and interring a Child is but Two Guineas; and these are the Causes that near a Third die under the Age of Two Years, and not unlikely under two Months.

It is interesting to note that nearly all those accused of infanticide were unmarried women. The stigma attached to having an illegitimate child must have been more than some women could bear, especially as this could mean instant dismissal from their jobs, and if the infant lived, not only would they lose their employment, and endure public shame, but would most probably be unable to support themselves and the child.

Hoffer in “Murdering Mothers: Infanticide in England and New England 1558-1803”concludes that: “married women were not accused of murdering their newborn babies.” Documented cases of married women being accused are exceptional. Perhaps the reason for this was that “child-murder or murderous neglect by married people was surprisingly widely condoned, virtually impossible to police, and rarely punished.” It would appear from the evidence throughout Europe that infanticide was viewed by a good proportion of the population as one of the means that parents used to save their other children from starvation.

It was to try and stop this situation that various individuals and philanthropic organisations set up foundling hospitals where unwanted children could be looked after and cared for. The 18^th century saw an explosion of such hospitals, but tragically, the death rate was staggering. Nearly 80% of children into the Rouen hospital during the mid-eighteenth century died, and by the end of the century this had risen to the astounding figure of 95%. Between the years 1700-1800, the Madrid foundling hospital had a mortality rate of 75%, the Dublin hospital, one of 89%, and by the end of the century very few hospitals had a rate of under 60%.

It would seem that the main reason for this was the gross overcrowding these institutions had to contend with. In the 18^th century, overcrowding on a huge scale was invariably accompanied by high rates of infectious disease. Many of the babies had come from the countryside and therefore had little or no resistance to urban diseases. Sanitation was, at the best, basic in the extreme, and this encouraged diseases such as infantile diarrhoea, and smallpox was always waiting in the wings, ready to strike. Finding enough wet-nurses to cope with all the infants must have posed an insoluble problem, and the children were farmed out to rural wet-nurses. When none could be found, babies were fed on pap or cow’s milk, and in the days before sterilization, this was a virtual death sentence.

Causes of death listed in the Bills of Mortality which are particularly relevant to infants

In the next article: The Medical Profession.

In this series:

• The Laki Dry Fog in Europe (1783): 18th C Living Conditions, Part 6
• The Mad Hatters:18thC Living Conditions, Part 5
• Scurvy, Smallpox, Syphilis: 18thC Living Conditions, Part 4
• A Lousy Life: 18thC Living Conditions, Part 3
• ‘A Modern Dietician’s Nightmare’: 18thC Living Conditions Part 2
• Grotty, Smelly, Smoky: 18thC Living Conditions Part 1