Urban mortality change and the workhouse:

St. Martin-in-the-Fields 1725-1824

Romola DavenportCambridge Group for the History of Population and Social Structure

Jeremy Boulton University of Newcastle

Funded by the ESRC and the Wellcome Trust

Infant mortality fell dramatically in London in the last quarter of the eighteenth century

London Quakers

London Bills

England & Wales

St. Martin’s workhouse in 1871

The workhouse accounted for 20% of all burials in the parish (10% of infant burials)*

*Based on burials of residents buried in parish

0 10 20 30 40 50 60 70 80 900

10

20

30

40

50

malefemale

age

% o

f re

side

nce

time

Workhouse records give date of and age at entry, and date of discharge. Burial books give address and cause.

Jan 1 1750

0 0.5

17

64 64.5 65

4.25 4.3 4.75 5

Bastard born in WH{smallpox}

Settlement right. Sent to Hospital

No admission reason given {Old Age}

Entered with mother and siblings. Discharged.

Young women dominated admissions, but not the workhouse population

female admissions female population at risk

The medical function of the workhouse produced strange age-patterns of mortality

Mortality rates by length of stay in the workhouse, ages 20-49 (patterns were similar at all ages). Note semi-log scale

The medical function of the workhouse is evident in the excessive mortality rates upon entry

But even for those who survived the extreme mortality upon entry, mortality in the workhouse was

much higher than in the national population

0 10 20 30 40 50 60 70 800

200

400

600

800

1000

St. Martin's workhouse(long-stayers)

English reconstitutionsample (married adult women)

comparison of female mortality rates in the second half of the C18th

age (years)

risk

of

dyin

gin

age

inte

rval

x 1

000

Large apparent improvements in survival at all ages over the century 1725-1824

males females

Death rates in first 6 months of residence improved at all ages

But death rates of long-stay inmates only improved at ages under 15,consistent with reductions in acute

infectious disease rates

1720 1740 1760 1780 1800 18200

200

400

600

800

1000

1-4

5-14

15-3940-59

60-79

year

prob

abili

ty o

f dy

ing

(x10

00)

survival after 6 months’ residence in workhouse (females)

Smallpox declined in adults but not children in the workhouse. No evidence for inoculation in the

workhouse.

Smallpox rates, after two months in the workhouse

(rate per 1000 person years, and % of burials)

age 1752-68 1775-1805

0 107 (2.6%) 126 (4.7%)

1-9 4 (15.2%) 10 (11.4 %)

Infant survival improved across the first year of life, but especially in the first month of life

1720 1740 1760 1780 1800 18200

200

400

600

800

1000

1-6 days

182-365 days

1-365 days

7-28 days

29-181 days

year

pro

babili

ty o

f dyi

ng

(x1000)

The workhouse accounted for 3-8 % of baptisms, and 5-15 % of infant burials

1720 1740 1760 1780 1800 18200

50

100

150

workhouse birthsworkhouse % of births

0

5

10

15

workhouse % ofinfant burials

year

# of

birt

hs

% of births,burials

in the workhouse

1772 rebuild 1783 new labour ward

Did the workhouse ‘murder’ infants?

Risk factors for neonatal mortality:

illegitimacy (70-85% of births)

high risk pregnancies? (excess multiple births, high maternal mortality)

poverty?

medicalisation of delivery

workhouse environment

Cox regression analysis of neonatal mortality

1-6 days 7-29 daysVariable % risk P % risk PIllegitimate 100 100Legitimate 90 .822 53 .073No info 80 .321 77 .073

1725-49 100 1001750-74 52 .006 44 .0001775-99 69 .137 54 .0001800-24 50 .055 20 .000

Winter 100 100Summer 47 .001 114 .377

Mixed ward 100 100Labour ward 88 .541 88 .351New labour ward 59 .081 44 .000

Neonatal tetanus may have been a major cause of neonatal mortality in the workhouse

0 5 10 15 20 25 300

10

20

30

40

1783-18241750-821725-49

age (days)

risk

of

dyin

g, p

er d

ay

No similar pattern in the parish

Seasonality of neonatal mortality in the parish (and amongst foundlings) suggests hand-feeding

Neonatal burials (days 1-29, adjusted for birth seasonality), St. Martin-in-the-Fields

No evidence of changes in seasonality that might indicate changes in breastfeeding practices

Seasonality of burials, St. Martin-in-the-Fields

Did the workhouse murder mothers?

1740 1750 1760 1770 1780 1790 1800 1810 18200

5

10

15

20 non-workhouseworkhouse

age (days)

risk

of

dyin

g, p

er d

ay

Period WH non-WH1747-71 52.5 (686) 8.2 (18810)1772-89 19.8 (910) 10.1 (13388)1790- 2.0 (500) 7.3 (26134)1805/24

Childbed burials

Mortality and urban workhouses

• Survivorship improved amongst infants and children in the workhouse 1725-1824

• Reductions in acute infectious disease mortality may have contributed. Improvements in workhouse management (eg. hygiene or segregation of infectious cases)? No evidence of smallpox inoculation

• The workhouse may have contributed to infant mortality through neonatal tetanus. Dramatic improvements in neonatal (and possibly maternal) mortality followed reorganisation of wards.

Supported by the Wellcome Trust and The ESRC

Foul disease

‘Foul disease’ burials exclusively a pauper, and mainly a workhouse, phenomenon

Paupers with foul disease were sent to hospitals and/or treated in the parish before the 1770s, but seem to have been treated in-house subsequently (3-6% of female burials aged 10-39, 1770-1805)

0 10 20 30 40 50 60 70 80 900

5

10

15

20

femalemale

age

buri

als