England, Health Records - International Institute

Short History
Prior to the dissolution of the monasteries by Henry VIII in the 1530s monks and nuns had provided some care for the sick and those with then-incurable diseases such as leprosy. Most people’s health care came from folk remedies administered at home or by ‘wise women’, and most households had a herb garden wherein many of the ingredients were grown; and others were collected in the fields and woods. Ashley provides a useful history of old remedies. Along with the genuine healers there were large numbers of quack doctors, often touting their own concoctions as magic cure-alls. Advertisements for these are common in newspapers until the late 19th century.

The elite London College of Physicians was founded in 1518, whilst the ‘inferior’ Surgeons’ and Barbers’ Companies, formed in the late 15th century, merged about 1540. There were also apothecaries who dispensed medicines.

Until well into the 18th century there was frequent use of blood-letting, purges and emetics but a few scientific advances were being made particularly inoculation, and in 1798 vaccination, for smallpox. It was not until the mid-19th century that anaesthetics and antiseptic procedures allowed major internal operations to be performed. Pasteur’s work on the microbial etiology of disease came in the late 1860s and Koch’s in 1881-2, but antibiotics were not discovered until 1928. A succinct history of medical practice was given by Dr. Porter of the Wellcome Institute for the History of Medicine.

Anatomists and Resurrectionists
A necessary part of medical education was anatomical dissection, although it was repugnant to many. Henry VII allowed the Barber-Surgeons’ Company to have the bodies of four executed felons annually for dissection. To satisfy greater demand there was a good trade in ‘fresh bodies’ supplied by body snatchers or resurrectionists. Occasional references to missing bodies or apprehension of the perpetrators can be found in parish registers, parish chest materials and newspapers.

The demand for corpses for dissection was greatest in Edinburgh’s renowned university medical school, and it was here in 1827-28 that the infamous Burke and Hare developed the resurrectionist’s trade into murder. Their story is told at Scottish History Online.

In 1831 a similar case occurred in London and forced parliament to change the law. In 1832 it became legal for anyone in legal possession of a body to hand it over for dissection, provided the person had not expressly stated before he died that he did not wish to be anatomised. Workhouses were also allowed to assign unclaimed bodies to medical schools. The supply now kept up with the demand and grave-robbing became unnecessary.

Tom Wood (2002) in Family Tree Magazine notes that 750 bodies were needed annually for the London hospitals, and refers to Richardson’s book on the subject. Details on modern regulations regarding the supply of bodies and some conjectures on past usage by a chief anatomy technician were related by Wood (2003, Family Tree Magazine). The anatomy database provides details of bodies donated to medical science since 1992. The older companionanatomy registers at TNA commenced in 1832, those up to 1971 are in class MH/74 (Sandford).

Post-Mortems and Inquests
There was less popular aversion to autopsies or post-mortems to decide the cause of death. Coroners, formerly crowners as they were on crown business, have had the duty to investigate the circumstances of sudden, unnatural or suspicious deaths since 1194, and deaths in prison and during hospital operations were added to this list later. Before 1926 all inquests were held before a jury and one sees reference to twelve men sat on the body of the deceased. Thomas Hood’s Faithless Nelly Gray includes the lines:

A dozen men sat on his corpse, To find out why he died -

Some examples of coroner’s orders can be found below.

Chart: Examples of Coroner’s Orders

The result of the post mortem and/or the verdict from the inquest, was included in the cause of death column on the death certificate. This would be followed by the phrase Inquest/Post mortem (or PM) held and sometimes its date(s) as well. If the wording isInquest adjourned then it means that someone has been charged with the death, and it may or may not give the name of the accused, or may say by person or persons unknown. Examples of such certificates are shown in the course English: Civil Registration Records including Wales.

Any mention of a post-mortem, inquest or coroner’s certificate should be followed up in:


 * Newspapers. Depending on the nature of the demise there could be considerable coverage in the local and/or national newspapers.
 * Coroners’ records. Surviving records of coroners’ hearings usually include the individual inquest or inquisition which gives the verdict, name, date, time, cause of death and the signatures of the jurors. Unfortunately in most cases the fascinating supporting evidence has been discarded over the years.

The National Archives contains much material before the mid-18th century, but after that only if the inquest resulted in a murder or manslaughter trial. Details of what TNA holds can be found in their leaflet L30. Most surviving material after 1750 is held in county archives, the finding aid being Gibson and Rogers. There is a 75-year closure period but exceptions can be made if you contact the local coroner’s office.

Nurse Children
A nurse child was one sent out to a woman paid to care for it, either by wet-nursing a baby, or dry-nursing an older infant, the latter term formerly meaning a child up to age 7. It was very popular amongst the middle and upper classes, although it was also used for foundlings, for example those from the Foundling Hospital and Christ’s Hospital in London. Those living in crowded cities would typically send their children to the far healthier countryside for their first three years or so. London parishes often had special ties with a certain village(s) in the home counties or even slightly further afield and children from that parish were nursed there over many years. Alternatively, the city family may have had a familial or trade tie with a country parish, perhaps the place of origin of the husband or wife and found a suitable wet- or dry-nurse through their own contacts.

Burial registers of the nurse-parish can provide much information about the child’s family. Infant mortality being much higher than it is today, many of the thousands of nurse-children died in their early years and were usually buried in the nurse-parish. Their burial entries often have more information than is usual at the time since:


 * Outsiders were normally given a greater write-up than parishioners.
 * Both the parent (or foundling hospital) and the nurse needed a record of the date on which payment for services should end.
 * If they were from upper class families this would be reason for more detail to be given.
 * Children of members of the City of London Livery Companies would often have the name of their father’s company recorded.

In addition to the child’s name and date of burial other details may be recorded such as:


 * A nurse-child from [London].
 * The specific address or parish they were from.
 * Name of the father (and sometimes mother).
 * The father’s occupation.
 * The father’s livery company.
 * Name of the nurse.

This information may not have been given at the time of the child’s christening, usually in its home parish, or indeed anywhere else!

Clark’s two articles on nurse-children and their nurses make interesting reading; her period of study was 1540-1750, but the practice continued much later, nurse children being commonly found throughout the 19th century census returns as well. An index to nurse child burials is being compiled through the Society of Genealogists. This will be of obvious value in providing clues to the origins of city inhabitants.

The brutal methods of baby rearing in the 17th-18th centuries are described by Wood (2000c)—it’s a wonder that any of our ancestors survived!

Family Nutrition
In the mid-19th century the staple diet was bread and potatoes; fresh fruit and vegetables would only be available in season, and the protein portion was meagre. A typical list of weekly expenditures was given by Grindrod.

Chart: Typical Weekly Budget for Mid-18th Century Family with Several Children

Since there was no Old Age Pension until 1912, the elderly continued working as long as they could, and when incapable of working they went into the workhouse unless they had family or other support.

During the Second World War the population was probably better nourished than at any previous time because of public diet education and rationing of foods to the essentials. The latter continued for eight years after the end of the war, with more and more items coming off ration as the food supply got back to normal. My last ration book is shown below and indicates that the proteins (meats, eggs, cheese and bacon), fats and sugar were the last items to be rationed as they are on the only page used.

1953-54 British Ration Book

(From the personal collection of Dr. Penelope Christensen)

Public Health
In pre-Restoration times our ancestors were not too bothered by sanitation (Razzell) and the earthen floors were used in the absence of toilets until the 18th century. Brick flooring was introduced in the late 17th century and became very popular, since which time the English had a reputation for domestic cleanliness. The relationship of this to mortality rates is discussed by Razzell.

Taking the waters by drinking or bathing at curative spas having sulphur or chalybeate springs came from the continent as early as 1560 but was at its height of popularity in the 18th and 19th centuries. The most fashionable centres were Bath and Wells in the west country and Epsom and Tunbridge Wells south of London. There were many others, and your ancestors could have visited them from time to time, perhaps accounting for some of those inexplicable census absences. The Prince Regent, later George IV, popularised the restorative effects of sea air and bathing at Brighton in the early 19th century.

State Intervention for Good Health
There was large-scale state intervention to promote good health during the 19th and 20th centuries. The first national public health board was convened in 1805-1806 regarding a fever then present in Spain and Gibraltar. In 1831-1832 there was another concerning the cholera outbreak in Britain. Chadwick’s 1842 Report on the Sanitary Conditions of the Labouring Poor resulted in a Royal Commission on the Health of Towns which reported in 1844-1845. As a result of their deliberations the Public Health Act was passed in 1848 which encouraged Local Boards of Health (MOH) to be established to survey and address their local needs. Smith quotes an example from these surveys:

Chart: Sanitary Conditions of the Labouring Poor Example from Longbridge Deverill, Wiltshire—1852

Several other acts of parliament followed and by 1870 there were 700 authorities working under public health and government legislation, and these were not co-ordinated with the poor law and registration authorities. Outside the major towns parish vestries, boards of guardians, highway boards and others were all involved in public health matters. To simplify all this two Public Health Acts of 1872 and 1874 established rural and urban sanitary authorities with the compulsory advice of a Medical Officer of Health. This explains the puzzling acronyms USD (Urban Sanitary District) andRSD (Rural Sanitary District) on registration certificates. In 1888 the new county councils appointed the MOH’s and in 1894 urban and rural district councils became the administrators.

Health Surveys
Several public health surveys were made between 1885 and 1895, the returns and correspondence being at The National Archives. TNA has records of the resulting acts and regulations and some local records survive in county archives, but they are unlikely to contain information about individuals. Further information on public health in 19th century Britain can be found in TNA document D73. Of more direct use to the family historian are the Charles Booth surveys of poverty in London carried out from 1886 until around 1902. This massive 17-volume work contains street-by-street accounts of living and working conditions, and major occupations of those in each street. A series of colour-coded maps accompanies the text to indicate the poverty levels as follows: black indicates extreme poverty, various shades of blue are slightly better-off, then rising through purple to the comfortable pink, the relatively affluent red, and top-of-the-scale affluent yellow.

Booth’s most detailed accounts are of the east end and central London, and Battersea south of the river, which are in volume 1. It is important to know that Booth used pseudonyms for both streets and people in this volume, however in volume 2 he gives a key to the real street names. The exact date of each walk he did with the police officers is noted, and you can get information about individuals if you have an exact address and use the Booth notebooks in conjunction with the census returns. The rest of metropolitan London is covered in further volumes but in a less detailed manner, and with more emphasis on poor rather than affluent neighbourhoods. Several volumes are devoted to the conditions of work in different trades, which give descriptive material relevant to any ancestor in that trade.

The original published edition is hard to find, but Steele has collected the information on south east London districts in book format, and this is reviewed in Family History News and Digest volume 13 #2, page 91. Scott has a pair of excellent articles in Family Tree Magazine, published before the LSE (London School of Economics) digitised and indexed the notebooks and they can be found at Charles Booth online archive. Not everything is online but some examples are found below.

Chart: Charles Booth’s Notebooks

Ministry Of Health
The Ministry of Health was created in 1919 and various public assistance bodies succeeded the poor law authorities in 1930. The National Archives leaflet D109 describes the relevant records for the period 1919-1939 kept there.

National Identity and Health Service Numbers

 * Those born prior to WWII. In 1939, as a preparation for wartime rationing and security the British government issued everyone with a National Identity Registration Number. This consisted of a four-letter code for your area and a number under 1000 indicating your household, followed by a slash or colon and then a single digit representing your place in the household. Example: AEGP125/2
 * For those born from 29 Sep 1939 a four letter area code for your birthplace was followed (without a slash or colon) by the entry number in column 1 on your birth certificate. Example: DWXC 367.
 * After WWII the same system continued but with the introduction of the National Health System in 1948 the number became your National Health Service (NHS) Number.

Some changes in area codes have been made over the years and a five-letter code was adopted for those born from 1965. The whole number is on the short-form birth certificate for those born since September 1939, but only the number and not the area code on the long- form certificate.

The examples that follow show the registrar’s number on a birth certificate during WWII, the area code and same number on the National Registration Identity Card, and the same on the later National Health Service Medical Card. During and after the war the ID card had to be produced and stamped in order to obtain a new ration book when the old one ran out.

Column 1 of Birth Certificate
(From the personal collection of Dr. Penelope Christensen)

National Registration Identity Card
Note five official stamps NR MF (probably National Registration, Ministry of Food) added when new ration books were issued.

(From the personal collection of Dr. Penelope Christensen)

Chart: National Health Service Medical Card
(From the personal collection of Dr. Penelope Christensen)

Blood Groups
Family and local historians are greatly interested in the work of geneticists on mapping blood groups. They confirm the evidence provided by surname distribution and community studies that most families remained close to their roots for many hundreds of years, at least until the Industrial Revolution. The origins of the main types have been described as:


 * Type O probably Celtic stock i.e. Irish, Cornish, Scottish, North Wales. Also Hampshire and Surrey.
 * Type A is continental i.e. Angles, Saxons, Normans. Common around the Wash (Lincolnshire, Norfolk).
 * Type B is fairly rare.
 * Type AB is the rarest group but common amongst gypsies (wrongly called Egyptians in old parish registers) and in NW India from whence they derive.

Lawrence contributed a good article on her family’s blood groups.

DNA


The relatively new science of molecular genealogy has established that each individual who has ever lived has a unique genetic makeup. There are three kinds of tests that can be done to investigate genetic markers in DNA using:

-Autosomal genes on the 22 pairs of non-sex chromosomes. These are shuffled every generation and are the ones largely responsible for the uniqueness of each individual.

-Y sex chromosome of the males in the family. The Y chromosome is passed almost without changes from father to son, and there is a good correlation with surnames, but this is not perfect—and we all know why!

-Mitochondrial DNA which is inherited by all children from their mother, but only passed on by daughters.

Michael Joyce explains about the Human Genome Project and the uses of DNA samples in family history in his article, Genes and Genealogy, such as:


 * Corroborating a family connection with a deceased person.
 * Where descent from a well-known individual is possible.
 * When illegitimacy is suspected.
 * Checking relatedness where a family connection is uncertain.
 * Tracing natural parents of adopted children or those conceived in the laboratory.

He discusses future usage of the technique, and Michael Wood makes further hypotheses on this theme.

W. J. Wall discusses how a study of the genomic and mitochondrial DNA of Anna Anderson and the Romanovs proved that they were not related, and who she really was. Chandler has the story of Queen Victoria and haemophilia (and the intriguing possibility that she may have been illegitimate), as well as the Cheddar man and his modern descendant.

Further comments on the potential of DNA testing for delving further back than written records. Rawlings relates a wonderful story about how DNA analysis sorted out the parentage of siblings in her family.

A worldwide population study, the Molecular Genealogy Research Project collects samples for DNA analysis and correlates with the donors pedigree charts—see to contribute as an individual or to arrange for them to come to a conference to give a lecture and take samples (minimum 50 people). We organized such a spit party, as one wag called it, at Abbotsford Family History Center and it was a huge success.

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Information in this Wiki page is excerpted from the online course English: Education,Health and Contemporary Documents offered by The National Institute for Genealogical Studies. To learn more about this course or other courses available from the Institute, see our website. We can be contacted at [mailto:wiki@genealogicalstudies.com wiki@genealogicalstudies.com] We welcome updates and additions to this Wiki page.