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Insights into Health, Life and Death inVictorian London’s East EndRachel Ives

IntroductionIn 2011, AOC Archaeology conductedan excavation under the playground ofSt. John’s Church of England PrimarySchool in Bethnal Green in advance ofthe construction of a new nurseryschool (Fig. 1). Documentary researchshowed that the playground was

formerly the site of a privately-ownedburial ground managed by apawnbroker, a Mr John Kilday.1 MrKilday opened the burial ground in1840 and ran it for 15 years prior to itsclosure by Act of Parliament inSeptember 1855. Some 20,000 burialswere interred at the site during those 15

years. Mr Kilday reportedly officiated aschaplain over the first burials himselfprior to appointing a Reverend Templefor the remainder.2 The Bishop ofLondon was approached to consecratethe ground but he refused on thegrounds that burials had already beenmade. The Bishop had lamented thelack of consecrated burial spaceavailable to the poor in the east ofLondon due to the opening of manyprivately-owned grounds and theclosure of overcrowded parishchurchyards. He also criticised theslovenly and indecent funerarypractices he believed were beingperformed in some of theunconsecrated East London burialgrounds.3

By the 19th century, Bethnal Greenhad become one of the mostimpoverished parishes in London. Theexpansion of the urban population gaveway to rapid speculative building oftenwith insufficient or ineffective waterand sewerage provision.4 Theconversion of existing properties intosubdivided multiple-occupancy homesalso exacerbated pressure on existingservices. The high density of thepopulation encouraged the easytransmission of infectious diseases oftenwith underlying or co-occurringchallenges to the immune systemstemming from poor quality diets.

“The parish of Bethnal Green haslong possessed an unenviable notorietyon account of its neglected state anddefective sanitary condition. It formsone of the eastern districts of theMetropolis – districts which are themost unhealthy of all comprised in theMetropolitan Registration Returns. Theyinvariably suffer much more than theother metropolitan districts fromepidemics and unusual causes ofmortality”.5

A total of 1033 burials wereexcavated from the site under the sitecode PGV10 (Fig. 2). Among these, 396complete or partial coffin plates

Fig. 1: site location, showing Bethnal Green in Tower Hamlets, the location of the site in BethnalGreen and the areas of archaeological fieldwork.

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identifying the individual’s name, dateof death and age of death wererecovered. A further 23 individualswere named on surviving gravestonesand wooden gravemarkers.6 The burialsdate to just after the introduction of civilregistration for births, deaths andmarriages (1836–1837), which requiredthe issue of a death certificate thatstated the cause of death. While thissystem was imperfect and faced manychallenges,7,8 there was potential tomatch the deaths of the identifiedburials with the registered certificates.This provided an exciting opportunity toexamine the correlation between theevidence of an individual’s health asassessed directly from their physicalremains and contemporaryinterpretations of their cause of death.Collectively, this named sample allowsa fascinating investigation into theidentity and lives of some of thoseburied at this private burial ground.

Materials and methodsA research grant funded by the City ofLondon Archaeological Trust allowed306 death certificates to be accuratelytraced for the identified sample. Thestudy sample showed that the majorityof individuals had died either in BethnalGreen or in the immediate parishes,including Whitechapel, Shoreditch,Hackney, Stepney and Spitalfields. Afurther 41 certificates were found;discrepancies in the full name of theindividual or date of death beyond thatthought likely to be a simple error

meant that these were discounted fromthe final dataset.

It is known that despite efforts made

to make death registration compulsory,there was some degree of non-compliance9 and it is possible that

Fig. 2: area of excavation underlying the footprint of the proposed development showing thedistribution of grave-shafts and number of burials found per grave-shaft.

Fig. 3: composite image of examples of the documented cause of death recorded across a sample of death certificates from the identified burials.Examples of deaths shown include: Hooping cough [sic] and pneumonia, consumption after 5 years illness, scarlatina, small pox without previousvaccination after 10 days illness, measles 1 month pneumonia 2 weeks, and accidental death from a fall.

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some of the deaths of the identifiedburials from the Bethnal Green samplemay not have been formally registered.An advertisement for the burial groundreproduced by a medical officer,George Paddock Bate, in 1883 statedthat papers (i.e. copies of deathregistration) were to be shown at theoffice of the burial ground whencommissioning the funeral.10 While thisoutwardly implies compliance withdeath registration, the extent to whichfunerals may have been undertakenwithout registration remains unknown.

Results and discussionThere was a very high success rate infinding death certificates that matchedthe identified individuals (306certificates found from 419 identifiedindividuals, 73%). In the juvenilesample there was an 82% success ratein retrieving death certificates (161) fora total of 196 coffin plates that showedboth juvenile age and sex. There was an86% success rate in matching deathcertificates (145) retrieved for a total of169 complete adult coffin plates.

Examples of the causes of deathshown on the death certificates areshown in Fig. 3 and a summary of thecategories of cause of death across thesample is shown in Fig. 4. The mostfrequently reported causes of deathwere tuberculosis (16%) and otherrespiratory infections (13%), childhood

illnesses (see below) (11%), wastingconditions (see below) (7%), scarletfever (6%), whooping cough (5%) andaccidents (4%). This compilation isnecessarily broad and variouscategories have been grouped in someinstances; respiratory conditions hereinclude conditions such as bronchitis,asthma and pneumonia, but excludethe specific condition tuberculosis (TB)in order to better illustrate the highnumber of deaths associated with thelatter infection, despite forms of TBbeing a pulmonary infection. Thesecategories are also illustrative and so donot offer the scope to discuss possiblecontemporary mis-recordings ofdiseases (e.g. whether tuberculosis wasaccurately differentiated frompneumonia). Further broad groupingsused include childhood conditionsrepresented by convulsions, croup,hydrocephalus, rubeola and teething, aswell as wasting conditions that includeatrophy, marasmus, mesenteric diseaseand starvation, although it is highlylikely that there was some degree ofoverlap among these conditions duringlife. The death certificates in someinstances recorded multiple illnesses aspresent at the time of death and, for thepurposes of this broad summary, noattempt has been made to separatemultiple conditions and the firstcondition recorded has been compiledto create Fig. 4. Further considerations

of these aspects of the project will bediscussed in more detailed futurepublications.

The results of the study haveprovided immense insight into theoverall health and lifestyle ofindividuals in the East End of Londonduring the Victorian period. The studyaimed to investigate factors influencingperinatal mortality and childhoodgrowth, infections, accidents and thecauses of post-mortem investigations inthe identified burials. Several insightsfrom the project are outlined below andthe project results will be published ingreater detail in the near future.

Maternal and perinatal mortalityDuring the excavation seven adultfemales and one adult male were foundwith juvenile skeletal remains alsoburied inside the adult coffin. All of thejuveniles were aged by measuredlengths of the long bones as between 34and 39 foetal weeks. Without anyfurther means of information, suchfemale burials are often likely to beinterpreted as reflecting instances whereconditions occurred during pregnancyand childbirth that may have affectedthe child and mother’s health. Thedeath certificates illuminated a complexrange of causes of death in several ofthese cases. Rather than a specificpregnancy-related complication, AnnCowper (PGV2804) had died fromtuberculosis. An accidental fall causedan uncontrollable haemorrhage leadingto the death of Maria Gray (PGV2373).As Maria’s death was a suddenaccident, the death certificate showedthat the coroner had been informed,although there was no skeletal evidenceof post-mortem cut marks. Mary Slater(PGV2712) died from uterinehaemorrhage. As the estimated age ofthe foetal remains found in her coffinwere near full term (38–39 weeks) it islikely that both the maternal and childdeaths occurred during or shortly afterchildbirth. Sarah Wetherilt (PGV2743)died from peritonitis. This may havedeveloped due to an infection orperforation of soft tissues possiblylinked to premature birth of the 35week old foetal child. If complicationshad developed during labour, manualhelp or the use of tools during aninternal examination may have led totrauma. This term was also often used

Fig. 4: summary of the broad categories of cause of death across the identified assemblage (1840–1855).

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to record the development of puerperalfever or septicaemia resulting from thepassing of an infection to the soft tissuesoften by doctors or midwives.11 Thecensus records confirmed that this wasnot Sarah’s first pregnancy. As such, it ispossible that a complication haddeveloped resulting in a premature birthand possible intervention andsubsequent localised trauma and/orinfection. The unidentified male adultfound with neonate remains may havebeen a family member potentiallyaffected by a contagious illness, such asan infection or fever. Alternatively,midwives reportedly removed stillbirthsfor burial and it is possible thatjuveniles may have been buried as amatter of convenience with an adultburial.12

Childhood healthA total of 658 well-preserved juvenileskeletons (over 25% complete) wereosteologically analysed. Anoverwhelming majority of the juveniles(79%) died before the age of threeyears. There were peaks in younginfants dying between the ages of oneto six months and children dyingbetween one and five years. Deathcertificates were found for a largeproportion of the juveniles (24%, 160).The records show that young infantswere dying from convulsions,pneumonia, diarrhoea and atrophy.These deaths may have been related tounderlying nutritional deficiencies asvitamin C and D deficiencies werenoted on skeletons within this agegroup. Child deaths occurring in thoseaged between one and five years werefrom measles, scarlet fever, whoopingcough, diarrhoea and fever. Vitamindeficiencies, specific infections such astuberculosis, and accidental traumawere identified on the skeletal remainsof individuals in this age group.

In some instances, specificconditions rapidly cause death forwhich there is no skeletal response. Forexample, there was no clear evidenceof smallpox infection in the osteologicalassemblage, yet the death certificatesidentified two cases that had developedafter the 1840 Vaccination Act in whichinfants were freely infected withcowpox in an attempt to protect againstsmallpox. The death certificates statedthat neither individual had been

vaccinated, supporting some historicalinterpretations of the ineffectiveimplementation of this Act, resulting inthe compulsory Vaccination Act of1850.13

The skeletal record often representsthe cumulative sequence ofpathological changes that had affectedan individual. The contemporary aim ofcertification was to provide a means ofcategorising the immediate cause ofdeath to allow a better insight into themanagement of public health. Thecombined evidence is exceptionallyenlightening in terms of reconstructingpersonal health. An example of severeand long-standing tuberculosis leadingto gross vertebral destruction andnotable postural deformity hadoccurred in Elizabeth Ann Lawson(PGV2004) who died aged three yearsand six months old. The acute cause ofdeath was measles. This provides aninteresting reflection on the gaps thatclearly exist where only one source ofinformation is studied and emphasiseshow a holistic approach across allavailable data can maximise ourinterpretations of past life and health.

Initial results showed there weresignificant delays in skeletal growth insome infants, often due to poornutrition, illness and contemporarysocio-cultural practices. In one notableinstance the coffin plate of EmmaFreebain (PGV2520) identified that shedied aged one year and five monthsold. Her death certificate showedunder-reporting of her age, which wasgiven as one year and gave her causeof death as atrophy. Her dentaldevelopment suggested she was 1 yearand four months old. Yet the size of herlong bones, excluding those clearlypathologically-affected, suggested sherepresented a child aged between 1.5and 3 months old, indicating her longbones were growth-stunted for her age.Emma had experienced a severeepisode of vitamin D deficiency shortlybefore she died. Her skeleton showedchanges of active or recently activerickets, which had led to pathologicalfractures throughout the long bonesand ribs. A lack of sunlight exposureand a diet without oily fish or eggs willpredispose to a vitamin D deficiency14

and it is likely that Emma was keptindoors or her skin was covered whenshe was outside and her diet was

limited in quality. Emma’s deathcertificate showed that her mother wasa domestic servant, who were oftenexpected to live with the family beingserved and were discouraged frommarrying and having their own family.15

The 1851 census identified Emma as anurse child registered with the Watkinsfamily who also had the care of asecond nurse child, Alfred Gosling.Baby-minders often had a poorreputation for the care of infants andfrequently provided low-quality foodtogether with opiate-based remediesthat would keep the infant quiet.16

An accidental historyA large number of individualsexcavated from Bethnal Green hadbeen affected by trauma. One hundredand eighteen adults had one or morefractures as did 16 juveniles. Manyinjuries would have been caused byaccidental falls due to slippery anduneven pavements and roads,exacerbated in places by poor streetlighting and poor weather conditions.17

Falls could also occur at home and

Fig. 5. Example of multiple fractures occurringthrough a vertebra and an amputation throughthe forearm of Mary Felpts likely caused byaccidental crushing by a railway carriage.

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injuries could further result fromaccidents suffered at work. Trauma mayalso have resulted from collisions withvehicles. Several death certificatesprovided wider insights into the causesof skeletal injuries. In one example,Mary Felpts (PGV2387) died followingaccidental crushing by a railwaycarriage. Mary’s skeleton had severefractures throughout the spine (Fig. 5) aswell as new bone formation over herlegs and feet, possibly in reaction to softtissue trauma. Mary had receivedmedical intervention as an amputationhad been performed on her rightforearm (Fig. 5) perhaps as a result of acrushing injury. The upper-middleportion of her radius and ulna had beencut through removing the remainder ofthe forearm and right hand. As therewas no evidence of any bone reactionat the cut surfaces it is likely Mary diedsoon after the procedure. The deathcertificate showed that Mary had diedin the London Hospital in 1852 and it ismost likely that the amputation hadbeen performed there. A survey of 400operations carried out at the LondonHospital between 1852 and 1857identified 142 were amputations withnotably more males affected (121) thanfemales (15) with sex not recorded insix cases.18 This may reflect a higheraccidental injury rate in malescompared to females. A post-morteminvestigation had been performed(craniotomy and thoracotomy)following Mary’s death, probably toexamine any internal injuries and togauge if any other factors hadinfluenced her death.

Despite the wealth of skeletalevidence for trauma, in some instancesan injury may occur that only affectssoft tissue, or causes death rapidlybefore the skeleton can respond. Thecomplementary documentary analysishas helped to provide a more complete

insight into accidental deaths amongthe Bethnal Green burials. WilliamFlatman (PGV1707), for example, diedaged 10 years old from an accidentaldeath having been run over by anomnibus. There were no fractures onWilliam’s skeleton and it is likely thathe died from a crushing internal injurysoon after the accident. John EdwardBrooke (PGV1731) died aged 7 yearsold from having drowned accidentallyin Sir George Duckitt’s Canal in BethnalGreen in 1852. Sir George Duckitt waspermitted by an Act of Parliament tomake a navigable canal joining theRiver Lee Navigation in the parish of St.Mary Stratford Bow to the Regent’sCanal near Old Ford Lock in BethnalGreen. There were no pathologicalchanges on John’s skeleton that couldbe related to this cause of death. In onefurther instance, Joseph William JacobMiller (PGV2003), a painter and glazier,died from wounds to his intestineshaving fallen from a window onto theiron spikes surrounding the area below.Joseph’s death certificate indicated thata post-mortem had been performed, butthis was limited to his soft tissues asthere were no cut marks on hisskeleton.

ConclusionsThe integrated study of deathcertificates together with anosteological analysis has provided awealth of new insights into life, healthand causes of death across burials madein the privately-owned burial ground atPeel Grove in Bethnal Green by themid-19th century. The documentaryresults make a significant contributionto allowing us to better understand thebioarchaeological record and allow usto reconstruct a much more vividaccount of past life in the Victorian city.The results highlight the scope of aholistic approach using documentary

and physical sources to offerperspectives of both chronic and acuteillnesses by which a wider view of theimpact on an individual’s health can begauged.

AcknowledgementsThe author and AOC are grateful to theCity of London Archaeological Trustand the for theresearch grant that funded the purchaseand study of death certificatesassociated with the identified burialsexcavated from Bethnal Green. Theauthor would like to thank the staff ofthe General Register Office for helpwith the supply of such a large numberof certificates. Also St. John’s Church ofEngland Primary School, and inparticular former head Fiona Singleton,together with Steve White, TowerHamlets Diocese Development Officer,and Neville Brown, CB Swift, for theircommission of the archaeologicalworks and their interest throughout theproject. Stuart Forbes kindly offeredadvice on the transcription of severalcertificates. The author gratefullyacknowledges all AOC field and post-excavation staff who worked on theproject, especially Ian Hogg and HelenMacQuarrie, together with externalspecialists and Kim Stabler, formerly ofthe Greater London ArchaeologyAdvisory Service. Lesley Davidson,AOC, produced the illustrations for thispublication.

1. R. Ives, H. MacQuarrie and I. Hogg An East EndOpportunity – Insights into Post Medieval Life, Death andBurial from Excavations at Kilday’s Ground, Bethnal Green(forthcoming).

2. G.P. Bate Report on the Sanitary Condition of St.Matthew, Bethnal Green during the year 1882 (1883) 35.

3. Op cit note 1.

4. For a detailed survey of the parish see T. Baker(ed.) A History of the County of Middlesex: Volume 11:Stepney, Bethnal Green (1998) www.british-history.ac.uk/report.aspx?compid=22751.

5. H. Gavin Sanitary Ramblings being Sketches andIllustrations of Bethnal Green a Type of the Condition of

the Metropolis and Other Large Towns (1848) 5.

6. Op cit note 1.

7. A. Hardy ‘Diagnosis, Death and Diet in London,1750-1909’ in R.I. Rotberg (ed.) Health and Disease inHuman History (2000) 45–59.

8. I.A. Burney Bodies of Evidence. Medicine and thePolitics of the English Inquest 1830-1926 (2000).

9. Ibid.

10. Op cit note 2.

11. Op cit note 7.

12. R. Woods Death before Birth: Fetal Health andMortality in Historical Perspective, (2009); F.B. Smith ThePeople’s Health (1990).

13. M.W. Carpenter Health, Medicine and Society inVictorian England (2009).

14. M. Brickley and R. Ives The Bioarchaeology ofMetabolic Bone Disease (2008).

15. S. Steinbach Women in England 1760-1914. A SocialHistory (2005).

16. For example F.B. Smith op cit note 12; A.S. WohlEndangered Lives. Public Health in Victorian Britain (1983).

17. See for example E. Cockayne Hubbub: Filth, Noise,and Stench in England 1600-1770 (2007).

18. E.J. Chaloner, H.S. Flora and R.J. Ham‘Amputations at the London Hospital 1852-1857’J Royal Soc Medicine 94 (2001) 409–412.