The Decline of Life: Old Age in Eighteenth-Century England
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In its tracing of "a perceptible, though attenuated, Virgilian strand" in the pastoral world of the German idyll, this book will surely establish itself as a significant work of scholarship. Hoyer Camden House. A Poet's Reich Camden House. A Study of the Major Novellas of E. Amazons and Apprentices Katherine R.
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Pizer Camden House. Inscription and Rebellion Sonja E. Klocke Camden House. Interwar Vienna Camden House. Heizer Camden House. Mitchell Camden House. The small size of the Quaker sample perhaps 1, individuals at its peak precluded a fine temporal analysis of the cause-specific data, and the smallpox deaths were analysed by year periods. Infant mortality of Quakers showed some unusual characteristics, being notable for unusually low levels of endogenous mortality even at the start of the period, 19 and it is possible that the London Quakers adopted smallpox inoculation with more enthusiasm than the rest of the metropolitan population.
The late eighteenth-century decline of smallpox that is apparent in the London Bills and in Landers's reconstitution sample of London Quakers coincided with a surge in national population growth, and dramatic improvements in particularly urban death rates. Several authors have argued for a pre-eminent role for inoculation and later vaccination in reducing mortality in the eighteenth and early nineteenth centuries.
In particular, McKeown attempted to explain the late eighteenth-century decline in mortality by extrapolation from his analysis of the Registrar-General's cause of death data from onwards, and was apparently unaware of the magnitude of the decline in smallpox mortality in the intervening period, and so dismissed both inoculation and vaccination as making an insignificant contribution to mortality decline. In this article we present new evidence regarding smallpox in London, using age- and cause-specific data from the large parish of St Martin-in-the-Fields.
This evidence is used to assess the extent of smallpox exposure in London's migration sphere, and to examine the causes of the apparent fall in smallpox mortality in the late eighteenth century, before vaccination. This study is pioneering in the sense that, unlike those who rely on the Bills of Mortality, we can look at the age-specific incidence of diseases in a large area of London from to Our evidence derives from the sextons' records of burials, giving the cause of death, age, name, address, and burial fee of almost everyone who was buried in the parish.
St Martin's was a large Westminster parish, with probably some 25—30, inhabitants throughout the course of the eighteenth century. The sextons' reports for the parish are remarkably complete. There is some omission of age and cause of death, but such omissions appear to be random. Exact age at death is given, and although there is considerable age heaping at older adult ages, this does not affect the ages at which most smallpox burials occurred.
Importantly, age at death was recorded in days, weeks, and months for infants, allowing fine-grained analysis of the age structure of mortality in infants and young children. Although most causes of death are problematic to identify in this period, smallpox was easy to recognize, and was probably reported fairly accurately. Where possible, totals of smallpox burials and burials by age have been corrected for missing ages and causes, but such corrections had little effect on the conclusions, given the lack of bias in these omissions.
Although the dataset covers the period to , data for years after have been omitted, because the workhouse burials were moved elsewhere from , and although these records have been retrieved, they lack information on cause of death. Section II describes the patterns of smallpox mortality in St Martin's, in particular the rapid decline in adult smallpox burials after c.
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Section III considers the composition of adult smallpox victims, especially with respect to their geographical origins. Section IV uses the changes in age patterns of smallpox in children to evaluate the contributions of inoculation and endemicization to the decline in adult smallpox in London, and the implications of these findings are summarized in section V.
Smallpox burial totals in St Martin's resembled very closely the pattern evident in the London Bills as a whole, with a maximum in the s and a very rapid decline after figure 1. Table 1 gives the ages of smallpox deaths in St Martin's, in the period before vaccination.
It must be stressed that this information is virtually unique for this period, being based on large sample sizes with little bias in omission by age and cause. Both age and cause of death were poorly recorded in the period — Years after were excluded, to exclude effects of vaccination. Smallpox burials were adjusted for burials of unknown age and cause. Where cause was given but not exact age, burials were distributed to exact ages using the cause-specific distribution of burials by age for age groups under 10 or 10 and over.
Burials with no cause of death given were first distributed to exact ages, and then distributed according to the age-specific ratio of smallpox burials to other causes. Almost all smallpox burials included exact age, and there was little age bias among burials with no given cause. Therefore the patterns produced by the redistribution of burials of unknown age and cause did not differ significantly from those of unadjusted smallpox burials.
This is in contrast to Landers's analysis of London Quakers, where the redistribution of deaths of unknown cause caused large changes in the age patterns of smallpox burials especially at younger ages; Landers , Death , pp.
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Both Landers's and the current analysis assumed that the risk of omission of cause of death was independent of the cause. This assumption is not critical in the case of St Martin's, because the adjusted series is not very different from the unadjusted using only burials explicitly described as smallpox victims. However, if smallpox were more likely to be recorded than other causes, this may invalidate some of Landers's conclusions. The contrast between the two periods, —66 and —99, is obvious.
The effect of the influx of young people to London is clear only in the earlier period. There is a large bulge of deaths at ages 20—49, which is inconsistent with the exponential decline in mortality predicted if smallpox were endemic. What is remarkable is that this is almost absent in the last quarter of the century. This represents a key finding of this study. The decline in smallpox was associated with a dramatic decline in smallpox deaths among adults, and a concentration among children aged under five.
The large size of the St Martin's population makes it possible to analyse the smallpox burials by single years, and thus to pinpoint the period when this dramatic age shift occurred. Figure 2a shows the proportion of smallpox burials attributed to adults corrected for missing causes and ages.