England, Diseases and Causes of Death - International Institute

Medical Terminology
Family History journals are replete with notes on odd and amusing causes of death such as:


 * Stoppage in the stomick.
 * Extreme filthiness.
 * Eating his own hair.
 * Killed by standing too near a cow and a bull!

Some general points to note:


 * People were buried alive in the Middle Ages and later for various reasons, for example unconsciousness due to hypothermia, drug or alcohol overdose, or diabetic coma.
 * How many infant deaths were misdiagnosed? Was pneumonia really cystic fibrosis? And could a succession of infant deaths have been due to the rhesus factor or congenital syphilis?
 * Allergies were not understood.
 * Schools were dependent on Attendance numbers for their funding in the late 19th century so often did not close when there was an outbreak of infectious disease.
 * Before doctors possessed sophisticated diagnostic techniques they tended to write symptoms rather than causes on death certificates.

The commonest medical terminology encountered by the family historian researching death and burial registers is given in the chart below. For more on the conditions associated with our ancestors’ diseases as well as conditions of childbirth see Nigel Underwood’s 1991 article, Survival of the Fittest? Jeanette Jerger’s book, A Medical Miscellany for Genealogists on medical terminology for (mainly North American) genealogists is worthwhile, and Mearns’ Words Used to Describe Medical Conditions in the 18th and 19th C. (Aberdeen and North-East Scotland Family History Society Journal #73, page 33-35) gives a list of Scottish terms.

There are several websites devoted to this subject, for example:

Cyndislist Olive Tree Genealogy Archaic Medical Terms Hall Genealogy

Chart: Obsolete Medical Terminology

Occupational Diseases
Many of our ancestors’ occupations contributed to their demise mainly because of generally dirty conditions, poor nutrition, causes of disease being unknown and the effect of working conditions not considered. Some of the major problems were:


 * Alcohol-related problems, which could easily occur when beer was safer to drink than the water, and spirits would be a temptation amongst people associated with the trade who got free perks with the job. The hopelessness of the lower classes was often drowned nightly in gin or beer.


 * Anthrax, or woolsorter’s disease, first entered England in 1847 and is primarily an animal disease. Tradesmen dealing with carcasses, hair or wool of infected animals get it, but person-to-person transmission is very rare. Before the mid-20th century it frequently lead to septicaemia and death; today vaccination and antibiotic treatment are available. Bergman wrote a good article on anthrax for family historians, and Dart provided important additional information.


 * Lead poisoning caused early death amongst smelters, plumbers, painters, paper stainers and pottery glazers. They suffered through disabling colic, anaemia, failing vision and paralysis.


 * Mercury poisoning took its toll of looking-glass (mirror) silverers, water gilders who coated metal with a mixture of gold and mercury, and hatters because the effects of working with mercury were unknown. They lost weight, trembled and had impaired speech so appearing as mad as a hatter.


 * Puerperal (or Childbed) Fever and other complications of childbirth can be placed in this category and took many women’s lives before antisepsis and nutritional deficiencies were understood. The role of midwives is explained by Joan E Grundy in her 2003 Family Tree Magazine article, Midwifery and Childbirth in 17th and 18th Century England, and puerperal fever and other complications of childbirth by Wood (2000b).


 * Silicosis, also called stone-cutter’s phthisis, and pulmonic disease, is caused by dust, particularly that from silica or quartz and was common amongst potters, miners, dry grinders, flint knappers, sand blasters and stonemasons. A similar affliction, siderosis, caused by inhaling metallic particles was common amongst saw makers and Sheffield cutlers, being also known as grinder’s rot. The symptoms of coughing up thick mucus and bronchitis were similar to TB and were undoubtedly frequently misdiagnosed. When a man’s workplace was part of his home then the whole family suffered. Other occupations such as French polishers, flax workers and millers were also constantly surrounded by dust and could contract similar diseases. Shoddy workers (rag tearers) developed shoddy cough (Goodger).

J. L. Goodger offers further insight into occupational diseases and further reference material in his article ''Life in the 19th Century. Who Said That Hard Work Never Hurt Anyone?'' Family Tree Magazine Vol 8 #8.

Cancer
Cancer was regarded as purely a female disorder in the 18th century as the common ones, breast and cervical cancer, were often obvious. At the same time most cancers were misdiagnosed as consumption or old age, and until 1883 fatal blood loss due to cervical cancer in post-menopausal women was called menstruation of old age—a marvel but also a portent of death.

Cholera
There are two types of cholera that the genealogist will meet:


 * Before the 1830s the term referred to cholera nostra, also known English cholera or summer diarrhoea, and could include any acute intestinal disorder.
 * After 1830 the virulent cholera morbus or Asiatic cholera reached England as part of the first pandemic (world-wide epidemic). Between 1831 and 1834 it had cause 60,000 deaths in the population of 14 million. Cholera was greatly feared because of its horrible symptoms, and there were further imported outbreaks in 1848-1849 (125,000 deaths), 1853-1854 (30,000 deaths), and 1866 (18,000 deaths). In addition cholera exacted a regular toll every year particularly in ports and coastal cities liable to infection from abroad. My second great grandmother Sophia Thom, wife of a mast maker in Rotherhithe, Surrey on the River Thames died of it on her 37th birthday on 17th Aug 1849 at the height of the 2nd English cholera epidemic.

Cholera was often improperly treated with purgatives, consequently most sufferers died. One of the major symptoms, diarrhoea, may have been given as the cause of death, perhaps for fear of causing public alarm. If your ancestor died of this during one of these major epidemic years it may really have been cholera.

Cholera was mainly a disease that afflicted the poorer, malnourished sections of society through dirty water and food. During 1832 the local boards of health were required to send in reports with full details of each person contracting the disease; these may still be found in The National Archives (Goddard).

The 1848 Public Health Act started to address the problem of adequate sanitation and clean water supplies but it was not until London’s Great Stink of 1858 that a suitable sewage collection and treatment system was formulated. Halliday’s book on the subject is titled The Great Stink of London: Sir Joseph Bazalgette and the Cleansing of the Victorian Metropolis, and Don Felgate’s (1993, 1999) articles gives a shorter account of the polluted water problem, including the toshers who scavenged in the sewers whilst fighting off rats, and Bazalgette’s plan for the Embankment and the lost rivers of London.

Diarrhoea
This is a symptom of many diseases, but was quoted as the foremost cause of infant death, and was prevalent in dirty home conditions where poor or incorrect food was supplied. Calomel was used ‘to get rid of the poison’ but as this is a purgative it was precisely the wrong treatment. Naturally the children of the poor suffered most, and up to 50% of illegitimate children died in their first year. Often, these babies were weaned far too early so mother could go back to work, or given opium or laudanum to quiet them so mother could sleep.

Diphtheria
Although rare at the beginning of the 1800s and not clearly differentiated from other ulcerative throat diseases until 1819, it spread from the continent from 1855. It was one of the commonest childhood infectious diseases and a major cause of death in children well into the 20th century. There is a very touching account by Biggs using the Medical Officer’s Report and detailed maps of an outbreak in Lewisham, Kent in 1896 and its effects on one family. Most families have some experience with the disease; my mother nearly died of diphtheria around her 4th birthday in July 1918. Her cousin, Edith Grace Batey, died on 14 Mar 1920 at 48 Vanbrugh Hill, Greenwich, Kent (the address of the workhouse infirmary) age 3 years ofDiphtheria certified by L. Buchanan M.D.

Influenza
Virulent forms of influenza have been amongst the greatest killers of the past. The epidemic termed sweating sickness and thenew ague noted in parish registers in the 1550s, and particularly 1557-59 was probably influenza.

The worst international outbreak (pandemic) ever recorded was after the First World War, when half the world’s population was infected and estimates of deaths range from 15 to 40 million, more than the total number killed in the Great War (WWI) itself. It was known at the time as the Spanish Flu, because it was first reported by newspapers in Spain, they being neutral in the war. It was unusual also because it was most deadly for those between the ages of 20 and 40, whereas most influenza strains wreak havoc amongst young children and the elderly. The World Influenza Centre was established in London in 1946 to prevent a recurrence of the 1918-19 pandemic, and by identifying the causal strain and quickly developing a vaccine they were able to reduce the fatality rate during the 1957-58Asian flu pandemic, and the Hong Kong one in 1968.

Measles
This was a killer as it lay dormant between major outbreaks thus no immunity was built up by those born after the last outbreak. Measles often lead to pneumonia and death before it was controlled by vaccination in the 20th century.

Plague (Bubonic Plague or Black Death)
Bubonic plague was first seen in England in Kent in 664, and again in 829, with several more isolated outbreaks before the huge outbreak of 1348-1352. This epidemic was given the name Black Death some 200 years later. They were probably all caused by similar organisms although there may have been confusion with anthrax and pneumonic plague. Climatic changes in the early 14th century gave rise to a series of poor harvests causing starvation and malnutrition for the peasants across Europe. This resulted in significant depopulation of the land, and by reducing the health of the majority contributed to the severity of the epidemic. A third or more of the population died as a result of these conditions and the black death, the clergy suffering a death rate of 40-45% judging by the number of vacant benefices (Hey). Jenny Mukerji comments on the various causes of European depopulation in the 14th century in her 1996 article, European Population Levels in the 14th Century - It’s a Wonder We Are Here at All! (Root and Branch, West Surrey FHS, Vol 23 #2, page 60-61).

There were subsequent epidemics in 1360-1362 and 1369 and the total social and economic consequences were staggering. For the first time labourers were in short supply and were able to force an increase in wages and benefits, as well as liberating themselves to move to a better job elsewhere rather than being tied to their home manor.

Many settlements became moribund and some villages were abandoned as the population moved to create viable units. There are few records of names of those dying because this was before the advent of parish registers (1538). However, manorial records indicate a loss of between one-third and two-thirds of tenants in this 21-year period. Occasionally there are records of specific instances, such as in Canterbury, Kent in 1593 (Collins) when levies were imposed for preventative action and the city records show payments as: … to Goodman Ledes, watching Anthony Howes dore … when his house was infected with plague …

The disease, transmitted to humans by fleas carried by the black rat, remained endemic in Britain until the 1660s with major epidemics in 1563 and 1603 in London and others elsewhere but particularly in the south-east of England. Occasional references are therefore found in the burial registers, as in the following two examples:

Chart: Plague in Parish Registers

The Great Plague of 1665 is well-known, notably from the mortality schedules of London and the heroism of the villagers of Eyam, Derbyshire. Eyam’s tailor had received a box of cloth and old clothes from London and he was the first to contract the plague which brought about his death four days later. It spread rapidly in the village and the two ministers lead the parishioners in isolating themselves so that no other villages would be affected. Eyam lost 267 of its 350 inhabitants (Mee).

Havell describes the effect on another rural town, Needham Market, Suffolk which lost possibly 80% of its population in 1665. The cause of plague was then unknown but it was known to be highly contagious. The parishioners voluntarily isolated themselves by erecting a chain across the two roads into their town, and left money in bowls of vinegar there to exchange for food from nearby villages. They had no permanent minister and no records survive of burials in the mass graves, unlike the village of Eyam, Derbyshire who had a burial register and whose ministers survived to write the records.

The symptoms started with red, circular rings on the skin, followed by fever and sneezing, and death came usually within hours. It was much feared and various folk remedies were believed to ward off the disease, such as carrying a posy of flowers in front of one’s face, or a pomander or chewing certain herbs. The nursery rhyme comes from this time: Ring a ring of rosies A pocketful of posies A-tishoo, a-tishoo We all fall down

Chart: Prevention of the Plague

Perry discusses the general 1665 bill of mortality for 125 parishes in and around the City of London, and an example for one parish is given below. In total over 70% of the 97,306 deaths were caused by the plague.

Chart: Mortality Schedule for a London Parish

Goddard (1997) has contributed a thoughtful piece on the effect of the plague on families. After the 1665 epidemic subsided the plague never returned to the British Isles, although no satisfactory explanation has yet been found. In London the Great Fire of 1666 certainly destroyed some 13,000 rat-infested houses which indubitably helped.

Scarlet Fever
The scarlet fever streptococci caused a similar number of deaths amongst rich and poor young children. The cleanliness of the rich being offset by their drinking more milk, from infected dairies.

Scrofula (King’s Evil)
Until the 19th century many believed that scrofula or struma, which is a tuberculosis of the lymphatic glands, could be cured by the king’s touch, hence it was termed the king’s evil. The Monarch was in steady demand for performing the ceremony, often for hundreds each prescribed day, although the value of the pendant coin given the sufferer may have been the main attraction! Lodey describes the history of the disease and the ceremony. As a certificate had to be obtained from the parish first, records are frequently seen in the parish register of the dates and names of those to whom certificates were issued.

Smallpox
Smallpox made only a minor impact in Europe and Britain before the 16th century but was fairly common by the early 17th century. It became a major killer in the late 17th and 18th centuries, especially in crowded cities amongst the under-fives, and the rural areas where contact was more sporadic, amongst young adults. The epidemic of 1694-1695 killed Queen Mary II, and it has been estimated that during the 18th century 13% of each generation perished from smallpox. Those who survived an attack were often severely pockmarked, which reduced their chances of marriage or favour in society. Fashionable ladies wore attractive patches (beauty spots) over their scars. The more educated parts of society accepted inoculation with a mild strain of the disease, the practice introduced from Constantinople by Lady Mary Wortley Montague who persuaded the Princess of Wales to have two of her daughters (successfully) inoculated in 1722. After Jesty’s work in 1774 and Jenner’s in 1798 on the efficacy of cowpox vaccination, this safer procedure became popular.

Parish registers often note smallpox, accidents and suicides as causes of death, even when causes were not regularly given. Smallpox deaths were exempted from the Burial in Woollen Act, so one sees entries such as this:

Vicki Smith tells the fascinating story of a mid-18th century private smallpox inoculation house in Sussex. Accounts of the Poor Law Overseers or Guardians frequently show the doctors’ expenses for vaccinating the poor, for example:

Unfortunately the records of vaccination were not kept as they were in Scandinavia, in the parish registers which also acted as civil registration.

Vaccination was made compulsory by Act of Parliament in 1853, and the programme was supervised by the Boards of Guardians of the Poor Law Unions. However, this regulation caused some parents to deliberately avoid registering births of their children so they could evade vaccination, for which Wood (2000) gives examples.

Some lists of vaccination patients have survived heavy weeding of these voluminous materials, but are closed for 75 years from the date of the last entry. The registers of successful vaccination record the child’s name, date and place of birth, date of registration, father’s name (or mother’s if illegitimate), and date of the certificate of successful vaccination. Some records are not filled in properly or fully, and although later ones may contain more medical detail they do not record the child’s date and place of birth, nor the parents’ names, from 1875, as birth registration was then compulsory. The vaccination registers, kept in the county archives and often filmed, can provide an alternate source for those whose birth registration cannot be found.

There were smallpox epidemics in 1871-2 and 1880-1. In 1980 the World Health Organization declared that smallpox had been eradicated, however the later excavation of the crypt of Spitalfields church in London raised the possibility of re-introduction. The 3,000 bodies, many of them well-preserved in lead-lined coffins, were from the 18th and early-19th centuries, and about 10% were known to have died of smallpox. The Victoria &amp; Albert Museum staff used medical precautions as it is not known how long the organism can survive.

Syphilis
Syphilis, or the French pox, (as well as other venereal diseases) were rampant and caused large numbers of the population to be deaf, blind, idiotic or suffer from jaundice. General paralysis (of the insane) (GPI) was a late stage of syphilis (tertiary syphilis) and a frequent cause of incarceration in lunatic asylums (Allen).

Tuberculosis (TB)
The commonest manifestation of the different kinds of tuberculosis is pulmonary TB, commonly referred to as consumption, phthisis or decline. It was extremely prevalent amongst teenagers and young adults who were undernourished, and overworked or overtired. About 200 years ago it killed up to a quarter of the population, and even a hundred years ago it was still responsible for one eighth of deaths. With 19th century urbanisation it was the largest single killer of adults.

The persistent cough, pallor and weight loss was followed by the spitting of blood and then death. Formerly thought to be an hereditary disease, it was only in 1882 found to be an infection caused by a bacillus, and the bovine form can be passed on through drinking infected milk. Pulmonary tuberculosis was the major reason why public transportation vehicles sported signs saying Do not spit, as it was known to be spread from sputum. Sufferers had long recuperation periods in sanatoria until the 1950s when a really effective therapy was introduced. See John Guy, ''What Did They Die Of? No. 1 Tuberculosis''. (1991) for further history of TB.

Typhoid Fever
Typhoid was also known as enteric fever, and often improperly treated with purgatives, consequently most sufferers died. It was not differentiated from typhus fever until the 1860s. Typhoid is spread by contaminated water or food in dirty conditions, and can be passed on by asymptomatic carriers; John Guy, ''What Did They Die Of? No. 3 Fever. (1992) relates the story of the most famous of these, Typhoid Mary.'' Perhaps the most tragic death from typhoid was Prince Albert who died in 1861.

Typhus Fever
An endemic disease spread by the body louse or rat fleas amongst the malnourished poor living in unsanitary conditions, and confused with typhoid fever until the 1860s. Typhus is characterized by rose-coloured spots, prostration and delirium. There were periodic outbreaks of typhus, especially amongst the urban poor and armies involved in siege warfare.

Whooping Cough (Pertussis)
In old documents whooping cough was often referred to as chincough. It was virulent in young children and lead to often fatal pneumonia and bronchitis until controlled by vaccination in the 20th century.

Last Words
The development of medicine came about through a synergism of philanthropy, state intervention, municipal enterprise and advances in medical science. During the Victorian era there were improvements in medical training and significant developments in medicine, such as antiseptic surgery and understanding of the etiology of infectious diseases. However, Lavinia Mitton in her 2001 work The Victorian Hospital concludes that the vast improvement in health and life span in the 19th century came mainly from improvements made possible by engineering, such as clean water, adequate sewage disposal, rapid transportation of vegetables and fruit, and less crowded housing.

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