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The origins of the modern mortality regime: infant mortality by social status in Georgian London

The origins of the modern mortality regime: infant mortality by social status in Georgian London

This project addresses two key questions in population history: how were cities transformed from demographic sinks into self-sustaining populations; and when and why did class differences in mortality emerge? The late eighteenth century constitutes a watershed in epidemiological and population history and marks the beginning of the demographic transition in England. Two developments in particular were profoundly important but remain very poorly understood. First, urban death rates improved faster than rural, and cities ceased to act as a brake on population growth, consuming the population excess of the countryside, and became population centres capable of natural increase. The fall in infant mortality was particularly dramatic; while infant mortality rates nationally declined by 50-60 deaths/1000 births, in London rates declined from extraordinary levels of 350-400/1000 in the mid-eighteenth century to the national average of c. 160/1000 by the 1840s. London comprised over half the urban population in the eighteenth century, and any change in its demographic rates exerted a profound influence on national trends. Second, class differences in life expectancy began to emerge, and social elites to pull ahead of the rest of the population. Our understanding of these transformations remains extremely limited.

This project addresses these questions using the exceptionally rich records of the large London parish of St. Martin in the Fields, 1752-1812. We have used the baptism and burial records to reconstitute infants into families and assigned a social status to each family based on the fees paid for baptism. Together with information on age at death and cause of death we can estimate infant and child mortality in reconstituted families by social status and cause. The richness of the records, which include street address at baptism and burial, age at baptism and death, cause of death and fees paid allow us to correct potential biases arising from delays between birth and baptism, migration, and import and export of corpses for burial. Initial results indicate that there was a social gradient in infant mortality with infants of wealthy families at substantially higher risk than even pauper infants. This pattern of risk was largely a function of an inverse social gradient in the prevalence of maternal breastfeeding. All status groups appear to have converged to a norm of relatively lengthy maternal breastfeeding by the end of the eighteenth century, and this resulted in a convergence of infant mortality rates with no extra advantage accruing to infants in higher status groups. At ages 1-4 years there was little status gradient in mortality and no improvement in mortality before c.1800 when smallpox mortality fell in all groups, implicating vaccination as the major cause of improvements in this age range.

Mapping and GIS analysis of the distributions of families by street address indicates that wealthier families lived mainly along the wider streets, higher above the Thames river and at lower densities. Notwithstanding these factors it appears that the intensity of the local disease environment was sufficient to overwhelm the advantages of wealth in urban populations in this period. This accords with the limited evidence derived for certain elite groups (peers, MPs and ministers) that adult life expectancies were no higher in these groups than for the population as a whole before the nineteenth century, and suggests that the strong relationship between income and life expectancy in contemporary populations is a relatively recent feature of modern demographic regimes.

This project forms part of a long-running project on the social and demographic history of London: see Pauper Lives in Georgian London.