London's Pulse: Medical Officer of Health reports 1848-1972

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London County Council 1957

[Report of the Medical Officer of Health for London County Council]

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Difficulties of interpretation
As over three and a half centuries have elapsed since the bills were first regularly produced,
it is naturally difficult to make valid comparisons either with the present day or intervening
years. Among the basic difficulties of interpretation are (1) the varying areas
covered by the bills ; (2) their incompleteness ; (3) changing nomenclature and (4)
changes in diagnostic fashions.
Area
During the 17th century outlying parishes were frequently added as London spread
but from 1726 onwards no actual addition was made to the area which the parishes
embraced. The increase in the number of parishes after 1726 was brought about by the
division of single parishes into two, e.g., in 1729, St. George's, Hanover Square, appeared
in the lists whereas formerly this district had been included as part of St. Martin-in-theFields.
This process is fully described in the General Report on the Census (1861), p. 13,
and by Angus and Ogle. A further change in the area covered by the bills was not made
until 1840 when the Registrar General established his weekly tables of mortality. The
Metropolis Local Management Act, 1855, defined the area of London for local government
administration and this area has remained substantially the same ever since though
there were minor changes when the metropolitan boroughs were formed under the
Local Government Act, 1899.
Incompleteness
The Bills included details only of those belonging to the Church of England and
christened or buried according to its rites. However (vide Anon, 1759) ' Some
papists and dissenters, who live at a distance from their respective burial grounds, and
cannot bear the expence of being carried thither are buried according to the rites of
the Church of England, and by that means have a place in the weekly Bills,' although
the remainder were excluded. It is difficult to estimate the number of dissenters during
the 18th century but this particular ' shortage ' was of considerable importance. Ogle
came to the conclusion that 20 per cent. should be added to the number of burials to
cover this omission.
Although a tax on christenings, marriages and burials (3d. per entry) was instituted
in 1783, it is doubtful if it had any substantial effect on the total number of death
registrations. It was repealed in 1794. There is no evidence in the Parish Registers
Abstract of the 1811 census of any trough in numbers after 1783 nor any peak after 1794.
(In addition it was necessary to pay a shilling to the searchers whose duties are discussed
later). It was also thought that the establishment of the Foundling Hospital in St. Pancras
in 1741 might have had an effect on the number of recorded deaths (Anon, 1759). During
a period of 46 months from 1756 when indiscriminate admissions were allowed it is
recorded that 10,389 died out of a total of 14,934 admitted—Nichols and Wray (1935),
p. 56. The bulk of the children thus admitted would probably have been born in London
but, as the hospital was outside the area covered by the Bills, their deaths would not
have been included.
By 1757, the fashion for country houses was increasing with the result that many
persons were carried out of London to be buried in their country parishes. It is known
that in ten years an average of 261 were carried out of one of the largest and most
populous parishes of Westminster every year to be buried, while only 184 were brought
in. Allowance can also be made for this sort of omission and Ogle puts it as high as an
additional 20 per cent.
Thus a total of 40 per cent. might well be added on to the total number of deaths
but there is yet a further omission, ' the neglect of parish clerks and their deputies in
not making exact returns to the common-hall,' (Anon, 1759). Apparently weekly
returns were not always made regularly and in some large parishes no returns were
made for several weeks. When the return was made the number of deaths may have
been stated as having occurred in one particular week. These omissions, although often
ascribed to negligence, were sometimes due to disputes between the clerk in orders and
the officiating clerk. During the early 19th century this type of omission became of
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