Of the Institution of the London Bills of Births, Mortality, and Diseases; their Defects, besides those already pointed out; important and easy Improvements recommended.

We shall now, with all possible brevity, enquire into the degrees of credibility and stability of the mathematical and medical data, furnished from the bills of mortality. The births, genealogies, procreation, multiplication, and deaths, of those few miracles of longevity, from Adam to Noah; from Noah’s descendants down to Abraham, Moses, and Christ, are recorded in scripture: some chapters of Genesis are plain registers of births and mortality. The male Israelites, above twenty years of age, were, at distant intervals, mustered and numbered by Moses and his successors; and in a few uncommon pestilences, the devastation is ascertained in the Jewish history. The descent and pedigree of kings, and other great men, have also been kept in most nations, who had made any progress in civilization: but general annual registers of births, diseases, and deaths, are modern establishments, and were unknown to the ancients.

On the continent of Europe, registers were instituted fifty or a hundred years before their introduction into England. In 1538, exact records of weddings, christenings, and burials, were first ordered by the King and council, to be kept in every parish church of England, by either the vicar or curate. But this order was very negligently obeyed in many parishes, until 1559, when, to prevent registers from rotting in damp churches, they were directed to be written on parchment. At first, they seem, both in Germany and England, to have been designed to prove the birth, death, and descent of individuals, and the right of inheritance in property or lands. In 1592, a year of pestilence, bills of mortality for London were instituted; but were discontinued until 1603, another year of pestilential desolation; which was the only distemper then taken notice of in the printed reports. In 1626, the different diseases and casualties of those who died in London, together with the distinction of the sexes, were added and published; and in 1728, the different ages of the dead were ordered to be specified in the London bills. Upon first establishing the distinction of diseases and casualties in the bills of the British metropolis, the primary intention seems to have been, to distinguish the numbers destroyed by the plague, and to detect concealed murders.

Public records of births and mortality are now partly become the rules of political arithmetic: but unfortunately for politicians, calculators of annuities, and medical men, they are yet every where far too incorrect and incomplete. Registers of diseases and deaths in London are entrusted to old women, two of whom are nominated in each parish, and called Parish Searchers, and who consider, the ultimatum of their commission is merely to prevent private funerals and concealed murder. The whole business in London is conducted in the following manner: Upon either being sent for to inspect a corpse, or on hearing the bell toll, and inspecting the books kept in the different churches, the searchers are apprised from whence notice has been sent of a death, in order that a grave may be opened. The two parochial matrons then, whose industry is stimulated by a small fee on each corpse, and whose report is necessary previous to interment, set out to examine that no violence is committed upon the dead, of which they have taken an official oath to make true declaration, and afterwards negligently enquire from the relations the name of the disease, adding the age and sex: or sometimes they are stopped in the hall, and dismissed without any scrutiny. These records, together with the christenings, in the latter of which the searchers have no concern, are deposited with the respective clerks of each parish church, and by the clerks the christenings of the established church, and the burials in their respective parochial church-yards alone, are carried once every week to a general hall in the city: on the following day the weekly bill, comprehending these partial returns, is printed and published; and at the end of the year a general bill, in which all the weekly returns are consolidated.

The law ordains, that every person who dies in the registered parishes of London, Westminster, and Southwark, is to be inspected by two parish searchers, and reported to the parish clerk, who then grants his certificate for the interment: or, if the corpse is carried away to a different parish of the metropolis for interment, the searchers report, and the clerk’s certificate, are equally necessary; otherwise that parish where the corpse is buried is liable to a fine. This process was originally intended to detect the plague, and concealed murders; in both which respects, during the present century, the parish clerks and the searchers have been almost useless. There is now no plague to detect; there are very few murders, and they are always proclaimed by some other means. Even in the preceding century, when the plague raged in London, the searchers report was rarely trusted without a physician or surgeon attending, to prevent mistakes.

Notwithstanding this ceremony of inspection by the searchers, and of making their reports to the parish clerk, it does not hence follow, that the clerk makes the return of the death to the general hall, unless the corpse is buried in his own ground, or parochial church-yard. If the corpse is carried to any dissenting ground, and to various other places of sepulture not within the bills, the death and disease is so much waste paper, and is never heard of amongst the burials. But if the corpse is carried to a different parish, together with a certificate, and such burying ground is registered within the bills, then the death and disease is returned to the hall by the clerk of that parish where the corpse is interred.

I made it my business to visit, and to converse with a variety of parish clerks in this metropolis, most of whom agreed with me, that, besides radical defects in the christenings and burials, there were many other gross omissions. One instance I shall mention, and many more might be collected. The parish clerk of Bethnal-green, in which are also three private madhouses, made no return to the general hall, during the year 1780, of either births or burials, and in the preceding year he returned only four burials: whereas in former years, this parish alone annually returned from three to five hundred burials. I was assured, that the company of parish clerks in their corporate capacity, even if willing, have no power of compulsion over any of their refractory and negligent members, to make regular and correct returns: it seems almost optional. It is obvious what flagrant discordance and error this must occasion in various calculations.

Exclusive of gross mismanagement and error from searchers and parish clerks, there are other inherent defects in the London registers, both of burials and births. They comprehend the births alone of those belonging to the established church, and the burials of such only who are interred in the registered parochial church-yards. Jews, Quakers, Papists, Protestant Dissenters of various sects, are not included in the annual christenings; and great numbers of their burials, and of the burying-places not only of the dissenting, but likewise of the established church, are omitted: of the former 32, and of the latter 35, according to Short’s list. Maitland, 1729, (see his History of London) discovered 181 religious congregations, whose christenings were not published, and 63 burying-places in and contiguous to the metropolis, wherein 3038 were annually buried, but excluded from the registers. The large modern and populous parishes of Pancras and Mary-le-bone, in one of which also stands the Foundling Hospital, are omitted in the annual bills. Six hundred abortive and stillborn, who have arrived at an age thought deserving of funeral, are added to the annual deaths, but omitted in the list of births; as are also many young infants who die before baptism.

I said, very few of the christenings of the dissenting sects in London were included in the public registers; but several of them are buried according to the formalities, or at least in the cemeteries of the established church; which must unnaturally magnify the comparative list of deaths. Another defect in the burials is, that numbers are carried into the country who are not accounted for: it is agreed, that several hundreds more are annually carried out of than are brought into London for interment. Most of the nobility and gentry are removed from London, after death, to their family seats. Dr. Price calculates the present annual deficiency in the London burials at 6000; and of the births somewhat greater; neither of which are brought to account in the registers.

The following is an average, which I have formed from the London bills of christenings and burials:

London bills at a medium annually.

Years.Christenings.Burials.

From 1671 to 168112,32519,144

1681 to 169114,43922,363

1691 to 170014,93820,770

1700 to 171015,62321,461

1711 to 172017,11123,990

1721 to 173018,20327,522

1731 to 174016,83126,492

1741 to 175014,45725,351

1751 to 175615,11921,080

1759 to 176815,71022,956

1770 to 178017,21821,000

The parishes, but not all the burial grounds in these parishes, now included within the London bills of mortality, amount to 147: of which there are 97 within the old city walls; 17 without the walls, but within the city liberties; 23 out parishes in Middlesex and Surry; and 10 out parishes in the city and liberties of Westminster. All the 97 parishes within the walls have not, for many years past, at a medium, buried 2000 annually: some of them do not make a return of a single burial in several years. We may name several parishes without the walls, any two of which united, return a number of annual deaths equal to the 97 parishes within the walls. In collecting and conducting the bills of these parishes, there is a rabble of 294 female searchers, and 147 parish clerks.

To render the returns of births, christenings, weddings, and burials in London complete, the clergyman of every religious sect should be compelled by law to make, every three months, a return of their christenings and weddings to the nearest parochial church. All the church-yards and burying grounds hitherto excluded from the bills, together with the parishes of Pancras, Mary-le-bone, and all the other modern additions and population to London, should likewise be comprehended in the registers; together with the numerous villages and excrescences of the metropolis, within seven miles of its circumference. The christenings should specify the name, sex, twins or tergemini, illegitimate if known, and the religious sect. The weddings should discriminate the place of abode, of the parties, the names and ages of each pair; whether first, second, or third marriages, and on which side; whether natives or foreigners, and the religious sect.

There appears at present no necessity to return weekly bills from the different parishes. This was originally intended to warn the London inhabitants of the numbers destroyed by the plague, and the infected parishes. Quarterly returns to the general hall would be sufficient; and one general annual bill, in which the quarterly mortality should be distinguished; in order to point out the seasons most noxious, and the reigning diseases; or to mark the hurricanes and monsoons of mortality. In infancy, and the early part of life, when the tide of devastation is strong and rapid, the mortality should be measured in shorter intervals. The first year from birth should be divided into interstices, from birth to six months, when teething commences; from six months to one year; from one to two; two to three; three to four; four to five; five to ten; ten to twenty; and so on to one hundred and upwards. Exclusive of abortions and stillborn, those who die in the first month before baptism, and of course cannot be included in the christenings, should be distinguished, in order to determine more accurately the amount of the births. Separate columns should be assigned for the name of the disease or casualty; for the cause, if known; and the duration of the affliction. Annexed to each disease should be the numbers dying at different ages of that malady. Males grown up to maturity who die, should be distinguished either as married, widowers, or bachelors; and females also of this description, either as married, widows, or virgins. Those carried out of London, or into it, for interment; the parochial children who die at nurse in the vicinity of the metropolis; the rank, profession, or trade; whether native or foreigner; should all appear in the general annual report in separate columns. The annual reports of all the hospitals, dispensaries, and prisons, and of the executed, should also be made to the hall, and included in the general annual register.

There are often objections and scruples to apply effectual remedies, or radical cures, to ancient institutions, however defective and inadequate. There certainly is no necessity for such a cumbrous complex machinery, or multitude of parish searchers and clerks, for conducting the London bills. Indeed they might probably be all dispensed with. The reports of the relations of the deceased, or of the parish officers, to the curate of the different churches, would perhaps answer every purpose; and the perquisites would be a considerable addition to the clerical pittance. I mean, however, only to offer a simple, easy, and unexceptionable palliative; which is, to appoint a physician to superintend the general hall, and the reports of births, burials, and diseases: and the whole to be subjected to the inspection of a committee of the Medical College, or of the Royal or Medical Societies. This would give authenticity, credibility, and respectability to the registers. From such a rich mine, and an authentic magazine, the most important and beneficial information would be derived; the increase or decrease of deaths, marriages, and births; the annual waste of the metropolis; the health, mortality, the diseases most fatal, their growth or declension; the effects of diet, drink, and medical practice. Calculators of annuities, reversions, survivorships, and insurances, would then be supplied with certain, instead of conjectural data: at present this alone is a prodigious article of traffick and commerce in this country: much litigation and expence respecting births and deaths, and the right to inheritance, would also be prevented. In a word, a vast variety of most interesting medical and political propositions, which are entangled in intricacy and obscurity, would, by this means, be evolved, and indisputably demonstrated.

It is also most devoutly to be wished, for the health, comfort, and decency of the metropolis, that all, or at least the majority of the burying grounds, were ordered to be formed in some dry spots of ground at the different extremities of the city; and that the dead were more detached from the living. No one whose curiosity for information has led him to these melancholy wrecks of human vanity, and to behold the yawning mouths of sepulchres, can reflect without pain and astonishment, on the manner in which between twenty and thirty thousand corpses are annually crammed into various holes, corners, public thoroughfares, and churches of this city: a feeling mind must shudder at, and shrink from the description. Nor can these cadaverous exhalations fail to pollute the air, and to engender diseases. Let the clerical revenue arising from graves be transferred to the new cemeteries.

We shall conclude, by pointing out the most celebrated treatises on human propagation, existence, mortality, and morbid devastation, by several philosophers. This is the epoch of a new science in politicks, philosophy, and medicine. Meritorious and successful efforts have been made to calculate the prospects of life and death, as the chances on dice, or the blanks and prizes in a lottery wheel. Graunt, somewhat later than the middle of the last century, first wrote a treatise on the London bills of births and mortality, and was followed soon after by Petty, King, and Davenant. The present century has produced several treatises on this subject; of which the most celebrated are Dr. Halley’s; De Moivre’s Treatises on Annuities and Chances; Susmilch’s Calculations; Simpson’s Select Exercises; some essays in the Philosophical Transactions; Dr. Jurin on the Small Pox only; Dr. Short’s Observations on various Bills of Mortality; M. Messance; Dr. Price’s Essays, the Archimedes in annuitant and reversionary calculation; Birch’s Collection of the London Bills of Mortality to 1759; Dr. Percival’s Essays; Dr. Millar’s Calculations respecting the Diseases of Great Britain, and Military Diseases; and Dr. Robinson’s, respecting Maritime Diseases.

Our curtain being now ready to fall, we shall address a few words to the Reader.—The present Publication had its origin in so short a time from the following circumstance. About six months ago, the President of the Medical Society of London called upon the author, at the desire of the Society, to request that he would deliver the annual oration, which was then fixed at four months distance only from that period: to which, with some reluctance, he consented. Indeed, he considered the solicitation both as a compliment, and a literary challenge: because, by the rules of the Society, one year’s previous notice to the orator had been the invariable practice. In the execution of this arduous and unprecedented attempt, the author is not ashamed to boast of industry and zeal. Were he to enumerate, in narrative and detail, the difficulties and fatigue which he had to encounter in collecting merely the materials of new information, he is persuaded that most gentlemen would have considered that alone sufficient exercise for their industry, patience, and perseverance during many months. Had he chosen to have followed the rhetorical path of the London College, his talk would have been far less onerous. But notwithstanding the eminent talents scattered throughout that learned body, from Linacre down to Hulse, Wintringham, Baker, Warren, Turton, &c. their united catalogue of public declarations, however classical, have not much contributed to medical edification, or public utility.

FINIS.