Church Record-Keeping and Public Health in Early New England*

    THE medical practice in which many an early New England preacher engaged is a well-known phenomenon. It was an activity that filled an essential need in society during a time when trained physicians were few and far between. To the historian, this added role is an attractive one, and one that helps soften the harsh image of the Calvinist clergyman that has been built up over the years.

    Far less conspicuous in the seventeenth and eighteenth centuries, and far less well known to posterity, is a second health-related activity, one which large numbers of preachers continued to perform in New England well after the need for clergymen to practice medicine had largely disappeared. This was their function as record-keepers, not only of the religious ceremonies of their congregations, but of certain of their medical events as well.1 In that role, the clergy emerge as unofficial but nonetheless de facto health monitors of their communities. During the long generations before civil provisions were made to gather information about the causes of death, these men were providing such services to their communities.

    Tudor England furnished ample precedent for the vital record-keeping that was adopted in the colonies. In fact, two different kinds of official vital statistics were provided for in the mother country during the seventeenth and eighteenth centuries, though only one was the direct responsibility of the clergy. Under the parish register system of the Church of England, local clergymen were required to maintain records of christenings, marriages, and burials. In addition, London and eventually certain other cities provided for weekly and annual bills of mortality, documents which were designed to keep the populace informed of the incidence of plague and other diseases.2

    The early leaders of Massachusetts were thoroughly familiar with these report systems, and they firmly endorsed the principle of having good public records of vital events. In their new environment, however, they did not adopt either system in just the same form it took in England. The individual churches of New England did continue, as in England, to keep their own vital registers, but these were no longer accepted as the official repositories of vital events. Instead, in both the Massachusetts Bay Colony and in Plymouth, governmental registration was introduced and made the responsibility of local town clerks. In Massachusetts, as in the old country, such registers were imperfect from the start and were almost totally lacking in such health-related information as the causes of death. For some two hundred years, until the public health movement of the 1840’s, they did little more than fulfill the legalistic role of providing documentation for probate proceedings.3

    Meanwhile, the kinds of printed bills of mortality that were hawked on London’s streets every Thursday never did make their appearance in New England until late in the colonial period. True, abbreviated notices of mortality became familiar departments of Boston newspapers starting early in the eighteenth century, notices based on information furnished by the sextons of local graveyards. Lacking as they usually were, however, in such details as the sex, age, and causes of death of decedents, these summaries served little more than to provide readers with topics for gossip. Certainly they furnished little information that would help the community leadership cope with public health problems.4

    The needs of local governments for information as to causes of mortality thus had to be met by other means. On some occasions, such as the smallpox epidemic of 1721, officials conducted ad hoc enumerations to determine how extensive the mortality had been. At other, less urgent, times, they found it sufficient, in the small Massachusetts towns, to rely on less formal, unofficial arrangements. Not infrequently, of course, the general tenor of such information was more or less common knowledge. At the same time, however, every community had a few individuals who could furnish more exact figures. These included magistrates, educated women, and others who, from the beginnings of settlement, kept their own private tallies of local mortality and sometimes of its causes.5 Still, of these it was the clergyman, with his continuing access to and familiarity with his congregation’s vital events, who was tacitly recognized as the normal authority in these matters. Strictly speaking, the minister was responsible only for the religious records of his church—for keeping the journals of baptisms, marriages, and burials, along with those of membership, disciplinary actions, and other events. In the absence of published official bills of mortality, however, the typical preacher expanded his record-keeping to include some of the circumstances of death, notably the causes.

    The earliest pastoral mortality registers were not originally published, and no other clear evidence has been uncovered to prove that they were ever consulted by anyone outside the church. Nevertheless, it may well have been the case, in the normal course of seventeenth- and eighteenth-century events, that their information was made routinely, if informally, available to the various community leaders as the need to know occurred. At the very least, in a general way, this aspect of pastoral record-keeping represented a continuing tradition of concern for the collective disease and death in the community. As the data in the journals expanded in the latter half of the eighteenth century, moreover, to reflect more of the details of disease and death, these pastoral mortality records did assume demonstrable usefulness in community health considerations.6

    The remainder of this paper is chiefly an examination of this pastoral tradition and how it evolved. It is also, to some extent, a modest review of the ways New Englanders died during the two centuries prior to the beginning of the industrial era.

    One does not have to go very deeply into early Massachusetts history to become aware of the special significance of death in personal experience, as well as in theological perception and in literary and artistic themes.7 At the very least, perhaps, the reader can quickly formulate an image of old Judge Sewall faithfully scribbling verses in his diary to note the demise of a neighbor:

    Tom Child has often painted Death,

    But never to the Life before:

    Doing it now, he’s out of Breath;

    He paints it once; and paints no more.8

    Sewall and his contemporaries were fully as concerned with the collective aspects of mortality as with the individual phases. Historians, in turn, have become progressively interested in the nature and significance of this collective experience. Historians of medicine over the years have devoted much attention to the exceptional numbers of deaths that resulted in New England from time to time from outbreaks of epidemic disease, notably smallpox and the throat distemper. More recently, historical demographers have been searching exhaustively in the records of individual communities for clues as to the impact of mortality trends on familial, economic, and social development.9 Neither group, however, has paid much attention to the overall phenomenon of collective mortality, to the day-by-day deaths caused by endemic conditions or accidents in addition to those from epidemics.

    The better pastoral journals reveal much about this broader spectrum of mortality. In this paper, a small sample of these journals will be examined, documents that reflect not only the diverse modes of mortality in the various communities but also changes of attitude toward death on the part of the minister-recorders. Clearly, the entire body of such documents and related materials ought one day to be systematically examined for its medical content.

    The earliest clerics entered their notations of deaths in their journals along with the “remarkable providences” or other noteworthy events which occurred in New England. Thus, in journals kept between 1649 and 1673, the Reverend Samuel Danforth of Roxbury recorded the deaths of his day in a vivid setting of natural catastrophes—earthquakes, comets, fires, storms, and other phenomena—events which he may or may not have thought to have been contributory to the deaths. He also gave much attention to events which affected the colony’s food supply: droughts, the flooding of meadows, mildewing or blasting of wheat crops, damage to fruit trees and corn by caterpillars, frost, or wind. Apart from the deaths of his own parishioners and family, Danforth made individual entries by name only of the demise of New England preachers or other leaders. Up to 1668 there was rarely more than one death a year among the clergy, but in that year the number jumped to five and remained high for several years. The deaths of ordinary people, outside his own church, by contrast, were not recorded except in a collective sense: “many dyed” of smallpox in September 1649; “several” succumbed to coughs or undefined epidemics in each of three different years; many died of agues, fevers, and fluxes in 1658; for some unexplained reason, “many women died of childbirth” in 1667; and almost every year he noted the deaths of all hands at sea in disastrous shipwrecks.

    In 1668 Danforth made his first note of an execution; and over the next six years, he recorded nine others, for such crimes as murder, infanticide, buggery, and mutiny. Only one suicide came to his attention from around Massachusetts in twenty-four years, but deaths from accidents were numerous and varied. Anonymous boys drowned, and men fell off ladders while building houses. Women and girls died from scalding water or from falling down the stairs of their homes. In 1667 a rope-maker’s helper in Boston had his head split open when a cable broke, and the next year a Dorchester miller was torn apart when he fell into the cogs of his water wheel. Two Woburn well-diggers were buried alive in 1670, while even before that time whalemen were occasionally caught in their harpoon lines and perished in the sea. In contrast to such gruesome events, the death of a man by falling from a horse during a race in 1673 comes as something of a relief, reflecting as it does the lighter side of seventeenth-century Massachusetts life.10

    The journal started a century later by the Baptist preacher Isaac Backus provides an equally illuminating view of eighteenth-century mortality. Backus’s journal, which he called a “bill of mortality,” records ordinary deaths over the fifty-six-year period from 1749 to 1805 in the rural southeast region of Massachusetts centering on Raynham, Middleborough, and Bridgewater, though it also included some from Taunton and Norwich, Connecticut. Unlike Danforth, Backus gives individuals’ names and dates for virtually all deaths listed, and sometimes the ages of the long-lived. He does not single out clergymen or officials for special attention. However, much as his predecessor had done, Backus also kept close tabs on “remarkable providences,” unusual natural phenomena, and “untimely” deaths around New England which might give clues to the will of God. He made careful note of great storms, earthquakes, and “awful lights” in the North, events which struck terror among his rural parishioners as indicators of the approach of the Judgment Day. Like Danforth, he was keenly alert to instances of men, buildings, or haystacks being struck by lightning, possibly as acts of God’s retribution. However, almost any accident or visitation of disease could be looked at in the same light, as for example, the 1753 outbreak of the “camp distemper,” which claimed some 150 lives in Norwich. In a response that was typical of the day, Backus saw that epidemic as clear evidence of “God’s dispensations to this Town! May the inhabitants awake and learn righteousness.”

    Apart from their religious significance, the “remarkable” causes of death which Backus registered reflected fully as much about the diversity of life and death in rural Massachusetts of the mid-eighteenth century as Danforth’s did for the seventeenth-century community around Massachusetts Bay. From time to time there were suicides, executions, and murders—poisoning and shooting were popular among the latter. Drownings and household calamities continued to be common; infants were occasionally frozen or “overlaid.” Accidental occupational deaths were fully as grisly as during the earlier period: farmers disemboweled by their pitchforks; a Providence distiller steamed to death in his still; numerous men and boys crushed by falling trees or by overturned ox-carts. Likewise, as in the previous century, the pleasures of life continued to take their toll: a Hartford girl choked on a nut shell on her way to an evening “frolick”; a Taunton man broke his neck in a friendly “wrastling” match; and various convivial men suffered fatal attacks or accidents while drunk, including one who made a final belated repentance: “I am going to Hell. Alas! I can’t bear it, but yet I must bear it forever.”

    During the French and Indian wars of the 1750’s and again during the Revolution, Backus noted without comment the instances of local men who died in distant military service. He made much more of those who dropped dead peacefully and without warning at home—some in their sleep, others while talking with neighbors by the road, one “at his plough.” Yet, apart from such events and accidents, he recorded only a few of the specific diseases which caused death: an odd case of “canker” here, one of “appoplexy” there; one person from worms, several of the “long fever.” Apart from typhus, the only malady which seems to have attained epidemic proportions in southern New England during the quarter-century before the Revolution was what Backus’s generation called the “bloody flux,” or dysentery. Smallpox apparently never raged out of control during the entire half century before 1805, for though Backus religiously recorded all of the scattered deaths from this disease, only fifty came to his attention over a thirty-two-year period in the two towns of Middleborough and Bridgewater.11

    For all its length, Backus’s document, like Danforth’s, does not really provide much more than a fuzzy profile of either the variety or extent of mortality in his community. There is no indication as to whether he recorded only the deaths of his Baptist parishioners or whether he included those of other denominations as well. There are no clues as to the nature or reliability of his sources of information. Such vagueness and imprecision were entirely characteristic of most pastoral journals up to the mid-eighteenth century. Yet, in some places about this time, journals were beginning to demonstrate a new higher level in the quality, completeness, and sophistication of their material.

    57. The Reverend Isaac Backus (1723/4–1806), by an unknown artist. Courtesy Andover-Newton Theological School, Newton Center, Massachusetts.

    58. The Reverend Ezra Stiles (1727–1795). Stippled engraving by Samuel Harris, in Abiel Holmes, Life of Ezra Stiles (Boston, 1798). Courtesy American Antiquarian Society.

    59. Bill of mortality for Dover, New Hampshire, 1767–1786, from Jeremy Belknap, History of New-Hampshire, 2nd ed. (Boston, 1813). Courtesy J. Worth Estes.

    One such document was the record kept for Newport, Rhode Island, between 1760 and 1764, by Ezra Stiles, who was then pastor of the Second Congregational Church of that city. Newport, a compact and cosmopolitan seaport city of 6,000–7,000 during the 1760’s, furnished both different kinds and different magnitudes of mortality from the dispersed agrarian towns of Bridgewater and Middleborough. Moreover, the well-educated Stiles brought a far broader range of intellectual resources to bear on these events than did Backus. Stiles was one of a new generation of New England clergymen whose Enlightenment interests in science were affecting their theology. Specifically, the concept of a capricious and willful God intervening at random to influence events or punish mankind was for some giving way to that of a rational God governing the universe according to well-established laws. As part of this, mortality was increasingly coming to be seen not so much as a matter of special providences as something which occurred in more or less regular patterns according to God’s deliberate plan. Thomas Prince of Boston, as early as 1736, was drawing material for funeral sermons not only from Scripture and the classics but from John Graunt, William Petty, Edmund Halley, and other Englishmen whose investigations had demonstrated such patterns.12

    For Stiles the maintenance of his mortality journal was only part of a broad curiosity about and continuing investigation of these regularities of vital events and populations, concerns which we cannot go into fully here.13 Unlike Danforth and Backus, he did not fill his journal with remarkable providences. Nor did he tap New England’s ministerial communication network for the deaths of the prominent and for untimely deaths of others. On the other hand, he did make a deliberate attempt to make his register comprehensive and complete for the entire city of Newport, not just reflective of the events of his own church.

    Stiles usually recorded deaths by their precise dates; by the sex, race, and age of the deceased; by their religious affiliations, if any, and often their occupations; and by the causes of death when known. Deceased were listed by full name except in the cases of visitors in the city and of minors, Indians, or blacks; these were identified as the “infant” of the Rowland Phillipses or the “Negro Man” of Captain Wilkinson, and so on. Stiles did his best to include any of Newport’s seafarers who died in far-off Jamaica, Africa, Asia, or simply “at sea.” For the local scene he took pains to find out who had died in the almshouse or in inns and boardinghouses. Throughout, in order to supplement his personal observations, he used the town’s sextons, midwives, keepers of the poor, and physicians as sources of information. At the end of each year, he summarized much of the information in tabular form, though he failed to attach current figures of Newport’s population or of the respective church memberships.

    By far the largest numbers of deaths that Stiles recorded each year had occurred at the beginning of life. About one death in every five was of an infant under a year old, while eight or ten additional were still-births. The second largest incidence of mortality understandably came at the other end of the life span, from causes connected with old age, with some one out of seven deaths occurring among individuals over sixty. Fatal accidents as such rarely found their way into the journal, but maritime Newport could count on one out of every twelve deaths to be from drowning or otherwise connected with the sea.

    Stiles also recorded, almost every year, the deaths of two or three mothers in child-bed, including one in 1762 at the reported age of sixty-four. In 1764, his informants pinpointed five deaths from consumption and one from cancer. However, for all his varied sources, he distinguished very few particular disease entities. Year in and year out, the one specific disease which consistently appeared on his lists, as on Backus’s, was smallpox. While that ailment never reached epidemic proportions in Newport during this period, it could be regularly counted on to take six or eight lives annually among the 6,000–7,000 inhabitants, a far larger toll than among the roughly comparable rural population of Middleborough and Bridgewater.14

    A substantial but thus far undetermined number of middle and late eighteenth-century preachers seem to have improved their mortality journals in much the same ways that Stiles did. Some of these divines, in fact, went beyond Stiles, notably by specifying significantly larger numbers of particular disease entities among the causes of deaths. With this improvement, the pastoral journals became virtually equivalent in content to the London bills of mortality. As such, some of them even began to find their way into print. In New Haven, parts of Chauncy Whittelsey’s thirty-year record of the First Church were published in 1787; they revealed that a third of the congregation’s deaths during that time had been caused by four diseases: consumption, “canker,” dysentery, and fits or convulsions. More elaborately, Jeremy Belknap, in his History of New-Hampshire (1784–1791), pulled together the mortality records of almost a dozen local clergymen; Belknap’s own twenty-year journal for Dover distinguished over thirty-five specific diseases as causes.15

    By the end of the century medical men, along with learned men generally, were showing considerable interest in the registers kept by the ministers. Editors of America’s earliest published medical journals, in fact, welcomed any such compilations that were sent in by Federal period clergymen. At the same time, it was well known that physicians themselves could rarely be looked to for such contributions, even though the profession might have been expected to keep such information routinely.16 This anomaly is worth looking into briefly. It was exceptionally well highlighted by the outcome of a New England scholarly venture immediately after the Revolution.

    In the mid-1780’s, some sixty-two private records of mortality were gathered together from towns in Massachusetts and New Hampshire in response to an appeal of the American Academy of Arts and Sciences. During the next few years, Edward Wigglesworth, the Hollis Professor of Religion at Harvard, used this unprecedented American collection to prepare his celebrated table of life duration and expectancy, the first American life table for a general population.17 Apparently, however, no attempt whatsoever was made to study the materials for what they could have revealed of the diseases of the region, even though this had been one of the Academy’s specific objectives in collecting these documents, and even though the body’s membership included many physicians.

    The Academy’s 1785 questionnaire had, in fact, been directed toward New England’s physicians as well as toward clergymen. However, of the sixty-two reports or registers of mortality which were actually turned in to the Academy, apparently few if any came from doctors.18 It is a good possibility that Edward Augustus Holyoke, who in the mid-1780’s made a series of analyses of Salem health conditions and bills of mortality, may have responded to the questionnaire.19 Dr. Hall Jackson of Portsmouth, New Hampshire, who kept a private journal of the births, diseases, and deaths in his practice between 1774 and 1795, also could have done so. No other physicians seem likely to have been contributors. Certainly none demonstrated any interest in exploring or analyzing arithmetically the medical significance of collective vital events.20

    The reasons for this lack of interest are not entirely clear, but a few points can be suggested. Everywhere, doctors were fully as intimately associated with the mortality of their communities as were clergymen. For most of the former, however, death was predominantly an individual phenomenon which occurred to specific patients. Normally, the physician’s responsibility to his patients was on a one-to-one basis, not at all comparable to the minister’s continuing relationship to a congregation as a group. He thus had no built-in interest in the collective mortality of a cohesive group. Unlike the clergyman, unless the doctor was a port physician or physician to the poor, he was under no accountability to church or state in connection with his patients’ vital events, their births, diseases, or deaths. Moreover, again unlike the clergyman, he had no motivation from long-standing professional traditions to record quantifiable vital events.21

    Up to the century’s end, then, the various local bills of mortality of Massachusetts, published and unpublished, continued to emanate mainly from the clergy, while they generally continued to reflect much the same rural and maritime patterns of life and mortality which Backus and Stiles had recorded for their communities. However, new factors were beginning to affect both of these patterns. As medical knowledge and institutions expanded, late in the century, the physician became increasingly concerned with collective mortality, and public officials gradually began to look to him for information on the subject. At the same time, collective mortality was beginning to show the early effects of urban growth and industrialization. Boston, which had been outgrowing its small-town status before the Revolution, by 1800 had some 25,000 souls and already showed signs of the special health problems associated with urban growth. Meanwhile, in Pawtucket, Waltham, and other tiny river towns, the early seeds of the factory system were being planted, seeds which blossomed out in full industrial splendor scarcely more than a generation later, in Lowell during the 1820’s. As these pressures of urbanism and industrialism accelerated, demands built up for ongoing public medical attention to disease and mortality, for effective public health mechanisms at the state as well as the local level. As part of this, the informal tradition of the clergyman’s private mortality journal thus gradually gave way, by the 1840’s, to the concept of a uniform public registration of deaths and their causes for the entire state.