London's Dreadful Visitation: Mortality in 1665
MEMENTO MORI: REMEMBER THAT YOU WILL DIE
During epidemic plague outbreaks in London, timely and accurate information regarding incidence rates and geographical spread became crucial (Robertson, 1996, 337). To meet this need, the Bills of Mortality were initiated in 1592 under Queen Elizabeth I (Angus, 1854,117). Parishes in London and the surrounding counties of Middlesex, Surrey, and Westminster were mandated to report mortality rates, causes, and demographic details, utilizing a printing-press to assemble the Bills (Angus, 1854, 117-8). The Bills of Mortality tracked the plague for years, capturing The Great Plague of 1665-1666 (Robertson, 1996, 340). London’s Dreadful Visitation: or A Collection of All the Bills of Mortality for this Present Year compiles weekly mortality Bills from December, 20, 1664, to December 19, 1665.
This information was compiled weekly and disseminated to the public, informing political decisions, individual movements, and quarantine measures (Angus, 1854, 117-8). Upon the death of an individual, a bell was tolled (Angus, 1854, 118), prompting sworn women searchers of the parish to note the cause of death (Robertson, 1996, 329). If they were uncertain, they consulted a second opinion to preserve accuracy (Robertson, 1996, 329). The Bills “offered an immediate indicator” of epidemic spread of plague, guiding officials to confine the disease through quarantines or the creation of public health policies (Robertson, 1996, 337). For example, when weekly plague deaths surpassed 30, the theater houses of London were ordered to close as a preventative measure (Robertson, 1996, 337). The Bills captured the extremes of the disease, such as the week of September 5-13, 1665, which documented an impressive 6,958 casualties from the plague.
The Bills of Mortality offer an important representation of early public health interventions and epidemiological records; however, their utility may have been limited. Statistician John Graunt argued that the information had little use beyond providing general trends of burials, casualties, and sickness (Robertson, 1996, 335). He developed an empirical method of analyzing the data which would enable valid conclusions about demographic trends of diseases and mortality (Glass, 1964, 72-6). In Natural and Political Observations…Made upon the Bills of Mortality (1662), Graunt used morbidity statistics to identify “chronical (sic)” diseases as opposed to “acute” diseases (Glass, 1964, 72), confirmed the etiologic distinction between similar diseases such as livergrown and rickets (Glass, 1964, 73), and created a life table, which predicted survivorship and life expectancy by age group (Glass, 1964, 75). His analyses demonstrated how epidemiological statistics could predict future mortality trends and also contributed to early actuarial science, which predicts the financial impacts of uncertain future events (Robertson, 1996, 346).
While Gaunt’s work was transformative in early understanding of epidemiological trends, Gaunt doubted the accuracy of the statistics he utilized. He criticized the women who reported cause of death, claiming their reports were influenced by “a cup of ale” or a bribery of “a two-groat fee” (double their typical earnings) (Gaunt,1662, 36-37). This misogynistic distrust of the women searchers to provide cause of death information was reflected in the documents that outlined their duties; if they were discovered making false claims about the diseases they reported, they were to be corporally punished, physically isolated, and/or economically coerced (Munkhoff, 1999, 13). This job demanded accuracy, but unclear expectations and execution of the searchers’ roles by different parishes forced them to work without trust (Munkhoff, 1999, 3). Graunt also noticed inaccuracies in the reportings of abortives and stillbirths, due to the total number of burials exceeding the christenings every year after 1642 (Gaunt, 1662, 34-44). He explained this discrepancy due to differing religious beliefs, selectivity by Christian ministers, but most importantly the fee for registration (Angus, 1854, 118).
Some of these inaccuracies are observed in the week of January 10-17, 1664, pictured, where 394 people were reported buried. Examining the all-cause mortality sums, there are 381 deaths, with none attributed to the plague, meaning 13 deaths by burial were unaccounted for. Graunt was also very critical of the underreporting of syphilis, as patient’s deaths were often attributed to ulcers and sores (Glass, 1964, 71). Syphilis was difficult to diagnose because it had multiple names among physicians, like the Spanish Disease, the Polish Disease, or the French Pox (Qualtiere & Slights, 2003,5). Some medical authorities believed it could transform into other diseases such as leprosy, and its sexual nature brought social stigma, limiting research on the disease (Qualtiere & Slights, 2003, 1-6). The week of January 10-17 recognizes 2 deaths to French-pox, but the 2 deaths by ulcers and some of the deaths attributed to fever may have been misdiagnosed or secondary complications of syphilis.
Despite some inaccuracies, the Bills of Mortality served as a crucial tool for common-folk and officials of London to gain insights into the plague, enabling them to make better informed decisions to prevent the spread of the disease.
- Ainsley Lotito, Fall '23