The protagonist, Moll Hackabout, has arrived in London's Cheapside. Moll carries scissors and a pincushion hanging on her arm, suggesting that she sought employment as a seamstress. Instead, she is being inspected by the pox-ridden Elizabeth Needham, a notorious procuress and brothel-keeper, who wants to secure Moll for prostitution. The notorious rake Colonel Francis Charteris and his pimp, John Gourlay, look on, also interested in Moll. The two stand in front of a decaying building, symbolic of their moral bankruptcy. Charteris fondles himself in expectation.

Londoners ignore the scene, and even a mounted clergyman ignores her predicament, just as he ignores the fact of his horse knocking over a pile of pans.

Moll appears to have been deceived by the possibility of legitimate employment. A goose in Moll's luggage is addressed to "My lofing cosen in Tems Stret in London": suggesting that she has been misled; this "cousin" might have been a recruiter or a paid-off dupe of the bawdy keepers. Moll is dressed in white, in contrast to those around her, illustrating her innocence and naiveté. The dead goose in or near Moll's luggage, similarly white, foreshadows Moll's death as a result of her gullibility.

The inn sign, with a picture of a bell, may refer to the belle (French for beautiful woman) who has newly arrived from the country. The teetering pile of pans alludes to Moll's imminent "fall". The goose and the teetering pans also mimic the inevitable impotence that ensues from syphilis, foreshadowing Moll's specific fate.

The composition resembles that of a Visitation, i.e. the visit of Mary with Elizabeth as recorded in the Gospel of Luke 1:39–56.^[10]

The wig box of highwayman James Dalton (hanged on 11 May 1730) is stored over her bed, suggesting a romantic dalliance. The magistrate, Sir John Gonson, with three armed bailiffs, is coming through the door on the right side of the frame to arrest Moll for her activities. Moll is showing off a new watch (perhaps a present from Dalton, perhaps stolen from another lover) and exposing her left breast. Gonson, however, is fixed upon the witch's hat and 'broom' or the periwig hanging from the wall above Moll's bed.

The composition satirically resembles that of an Annunciation, i.e. the announcement by the angel Gabriel to the Virgin Mary that she would conceive and become the mother of Jesus, the Son of God, as recorded in the Gospel of Luke 1:26–39.^[13]

Moll is in Bridewell Prison. She beats hemp for hangman's nooses, while the jailer threatens her and points to the task. Fielding would write that Thwackum, one of Tom Jones's sadistic tutors, looked precisely like the jailer (Tom Jones 3:6). The jailer's wife steals clothes from Moll, winking at theft. The prisoners go from left to right in order of decreasing wealth.

Moll is standing next to a gentleman, a card-sharp whose extra playing card has fallen out, and who has brought his dog with him. The inmates are in no way being reformed, despite the ironic engraving on the left above the occupied stocks, reading "Better to Work/ than Stand thus." The person suffering in the stocks apparently refused to work.

Next is a woman, a child who may have Down syndrome (belonging to the sharper, probably), and finally a pregnant African woman who presumably "pleaded her belly" when brought to trial, as pregnant women could not be executed or transported. A prison graffito shows John Gonson hanging from the gallows. Moll's servant smiles as Moll's clothes are stolen, and the servant appears to be wearing Moll's shoes.

Moll is now dying of syphilis. Dr. Richard Rock on the left (black hair) and Dr. Jean Misaubin on the right (white hair) argue over their medical methods, which appear to be a choice of bleeding (Rock) and cupping (Misaubin). A woman, possibly Moll's bawd and possibly the landlady, rifles Moll's possessions for what she wishes to take away.

Meanwhile, Moll's maid tries to stop the looting and arguing. Moll's son sits by the fire, possibly sick with syphilis as well. He is picking lice or fleas out of his hair. The only hint as to the apartment's owner is a Passover cake used as a fly-trap, implying that her former keeper is paying for her in her last days and ironically indicating that Moll will, unlike the Israelites, not be spared. Several opiates ("anodynes") and "cures" litter the floor. Moll's clothes seem to reach down for her as if they were ghosts drawing her to the afterlife.

In the final plate, Moll is dead, and all of the scavengers are present at her wake. A note on the coffin lid shows that she died aged 23 on 2 September 1731. The parson spills his brandy as he has his hand up the skirt of the girl next to him, and she appears pleased. A woman who has placed drinks on Moll's coffin looks on in disapproval. Moll's son plays ignorantly. Moll's son is innocent, but he sits playing with his top underneath his mother's body, unable to understand (and figuratively fated to death himself).

Moll's madam drunkenly mourns on the right with a ghastly grinning jug of "Nants" (brandy). She is the only one who is upset at the treatment of the dead girl, whose coffin is being used as a tavern bar. A "mourning" girl (another prostitute) steals the undertaker's handkerchief.

Another prostitute shows her injured finger to her fellow whore, while a woman adjusts her appearance in a mirror in the background, even though she shows a syphilitic sore on her forehead. The house holding the coffin has an ironic coat of arms on the wall displaying a chevron with three spigots, reminiscent of the "spill" of the parson, the flowing alcohol, and the expiration of Moll. The white hat hanging on the wall by the coat of arms is the one Moll wore in the first plate, referring back to the beginning of her end.