Diseases as specified in the Bills are a disgrace to the medical science and civilisation in which as a nation we are acknowledged pre-eminent; nor can any effective reform take place while the sources of information are so ignorant and venal as at present. The information as to the disease of which any person dies is collected and verified in the following way.—The Churchwardens of each parish within the Bills of Mortality appoint two old women to the office of Searchers. These women as soon as they hear the knell for the dead, repair to the sexton of the parish to learn the residence of the deceased. They demand admittance into the house to examine the body in order that they may see that there is nothing suspicious about it, and judge of what disease the person died; and they report to the parish clerk. The regular charge for the performance of this office is 4d. to each Searcher; but if an extra gratuity be tendered, they seldom pass the threshold or hall of the house, and are content with whatever account is given; or should they actually view the corpse, it is easy to imagine what credit is due to the judgment they pronounce.[76]
In presence of defects so grave as to the number of the dead, and of diagnosis so grotesque as to the causes of death, it would be unwise to argue with any confidence from the data of these Bills; yet, such as they are, we have nothing else to appeal to. The variations of mortality from year to year were of wide irregularity; and whatever influence smallpox might have had, it does not appear to have had much in magnifying the annual totals. Let us take a dozen years when smallpox was heaviest from the last seventy years of the century, and observe its relation to the entire mortality, and to that from fevers—
| Year. | Burials from all Diseases. | From Smallpox. | From Fevers. |
| 1736 | 27,581 | 3014 | 3361 |
| 1740 | 30,811 | 2725 | 4003 |
| 1746 | 28,157 | 3236 | 4187 |
| 1749 | 25,516 | 2625 | 4458 |
| 1752 | 20,485 | 3538 | 2070 |
| 1757 | 21,313 | 3296 | 2564 |
| 1762 | 26,326 | 2743 | 3742 |
| 1763 | 26,143 | 3582 | 3414 |
| 1768 | 23,639 | 3028 | 3596 |
| 1772 | 26,053 | 3992 | 3207 |
| 1781 | 20,709 | 3500 | 2249 |
| 1796 | 19,288 | 3548 | 1547 |
| ——— | ——— | ——— | |
| 296,021 | 38,827 | 38,398 |
Again, let us take twelve years when the death-rate from smallpox was at its lowest. Here they are—
| Year. | Burials from all Diseases. | From Smallpox. | From Fevers. |
| 1745 | 21,296 | 1206 | 2690 |
| 1750 | 23,727 | 1229 | 4294 |
| 1751 | 21,028 | 998 | 3219 |
| 1753 | 19,276 | 774 | 2292 |
| 1773 | 21,656 | 1039 | 3608 |
| 1780 | 20,517 | 871 | 2316 |
| 1782 | 17,918 | 636 | 2552 |
| 1786 | 20,454 | 1210 | 2981 |
| 1788 | 19,697 | 1101 | 2769 |
| 1795 | 21,179 | 1040 | 1947 |
| 1797 | 17,014 | 522 | 1526 |
| 1799 | 18,134 | 1111 | 1784 |
| ——— | ——— | ——— | |
| 241,896 | 11,737 | 31,978 |
We thus see that in twelve years when the death-rate from smallpox was highest, as many died of fevers as of smallpox; and in twelve years when the death-rate from smallpox was lowest, there died thrice as many of fevers as of smallpox. Again, we have to remark, that, on an average of all the years, smallpox was accountable for something less than a tenth of the total mortality. Also we have to note, that the mortality from smallpox was in great part infant mortality, and that there is reason to believe measles was extensively confounded with smallpox. The infant mortality was prodigious. Rarely a year passed in which a fourth of the deaths was not set down to Convulsions—that is, to babes killed by improper feeding. In 1772 (the worst smallpox year of the century when 3,992 died) there were, 6,605 ascribed to Convulsions, the total mortality being 26,053.
Now I have no wish to minimise the London smallpox of last century, nor even to set 1797, when 522 died, against 1796, when 3548 died. I yield to none in detestation of smallpox as a preventible and therefore disgraceful affliction. Let so much pass for granted; but do not let us in any access of sanitary fury lose alike eyes and reason and rave like maniacs. If smallpox was bad, fevers were worse, and as both had a common origin, why should we make a wanton and unscientific distinction between them?
That smallpox should have been constantly present in London throughout last century was in nowise surprising. The citizens lived in a manner to invite and maintain fevers. I shall refer to their food and drink presently, and would now call attention to the fact that they were a stay-at-home generation almost beyond present-day belief. Cowper did not violate credibility when he sang—
John Gilpin’s spouse said to her dear,
“Though wedded we have been