Urban mortality change and the workhouse: St. Martin-in-the-Fields Romola Davenport Cambridge 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

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

Large apparent improvements in survival at all ages over the century 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 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 (2.6%)126 (4.7%) 1-94 (15.2%)10 (11.4 %)

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

The workhouse accounted for 3-8 % of baptisms, and 5-15 % of infant burials 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 days7-29 days Variable% riskP% riskP Illegitimate Legitimate No info Winter Summer Mixed ward Labour ward New labour ward

Neonatal tetanus may have been a major cause of neonatal mortality in the workhouse 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? Period WHnon-WH (686) 8.2 (18810) (910)10.1 (13388) (500) 7.3 (26134) 1805/24 Childbed burials

Mortality and urban workhouses Survivorship improved amongst infants and children in the workhouse 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, )