What really caused their death

your family

a First in art three-p series!

What really caused their death?

A death certificate is one of the most valued tools among family historians. But is there more information on them than meets the eye? In the first of our three-part series on medical history, public health microbiologist Helen Smith shows us how to read between the lines

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he cause of death of an ancestor is of immense interest to genealogists in general, and for the increasing numbers of people who are specifically researching their medical family history. And while death certificates are fantastic documents in their own right, they were never designed for family historians reading them a century or two later!

The first thing we look at when we have the certificate in our hands, is the cause of death. The words “Burns and suffocation following explosion of fire damp at Universal Colliery due to accident” is very informative and leads to further research, but when you see terms such as “marasmus”, “inanition” or “visitation of God”, just what do these terms mean?

The introduction of certification Today when someone is ill, they visit the doctor, who orders a range of tests resulting (usually) in a diagnosis. Without today’s X-rays, CT scans and pathology tests, most diagnoses in past times were based on the visible symptoms. This can result in terms such as Blue Disease (cyanosis, or lack of

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oxygen), Bronze John (yellow fever), Falling Sickness (epilepsy) and at times when there is no visible reason for the death, an “Act of God”.

With our modern day familiarity of the causes of infectious diseases, it is easy to forget that knowledge of micro-organisms and what actually caused infection was not well accepted or even understood by the medical professions until the late 19th century. Their knowledge of internal anatomy, medicine and incidentally, their spelling ability, also varied between medical practitioners. The levels of medical care available to our forebears would also differ depending on their ability to pay the doctor’s fees. The majority of people could not afford a visit from a doctor and could not afford medication.

Hospitals were feared by many as a lot of people died from infectious diseases acquired in hospital.

In the heyday of the British Empire, sailors, soldiers and traders were constantly travelling to foreign lands and bringing what we would now consider exotic diseases back with them. Symptoms were often first in the dock areas where travellers 

Opposite Leather doctor’s bag with contents, English, 1890-1930. Courtesy Science Museum London/Wellcome Library London Below An example of a death certificate.

This one, for Thomas Quested, was certified in Kent, England in 1858

When a doctor’s first contact with a patient was at or after death, the diagnosis needed for a death certificate was based on the deceased’s appearance and details provided by the family.

A death did not have to be medically certified by law until 1874 in England. In Australia deaths were not required to be medically certified until around 1889 at the earliest.

Here, Thomas Quested’s death certificate shows that he died from bronchitis. Other causes of death may not be so obvious. The summary of terms on the following page show what some of the more obscure terms mean.

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Some terms you may find on death certificates Act of God When death has occurred, often suddenly without a known reason American plague Yellow fever Bad Blood Syphilis Black Consumption Occupational disease of coal miners — prolonged exposure to the coal dust results in fibrosis of lungs Black Death Bubonic plague Bladder in throat Diphtheria which causes a pseudo-membrane in the throat Camp, famine, gaol or ship fever Typhus Child Bed Fever Puerperal fever: Infection following birth of a child (usually caused by a bacteria such as Streptococcus pyogenes) Congenital Lues Syphilis transmitted by mother to child during gestation Devonshire Colic Lead poisoning particularly in artists working in potteries Foundry Fever Zinc or metal poisoning French Distemper/French pox Syphilis (named thus by the English) Intermittent Fever Malaria King’s Evil Tuberculosis of neck and lymph glands Lues disease Syphilis Mad Hatter Syndrome Occupational disease of hatmakers — mercury poisoning affects central nervous system.

Marasmus Severe malnutrition. Failure to thrive, usually used for children.

Marasmus Senilis Wasting or decay of body in aged persons Mariner Disease Scurvy Marsh Fever Malaria Melancholy/Melancholia Form of insanity often listed for death by suicide Mortification Necrosis (death) of tissue caused by inflammation/infection, gangrene.

Overlaid To lie over or upon a child so as to suffocate it Pestilence Plague Phthisis Tuberculosis Rice Water Stools Cholera: Acute and severe contagious diarrhoea Rosalia Scarlet Fever Rubeola Measles Scrofulosis Tuberculous Thresher’s Fever Occupational disease — acute inflammation of the lungs caused by a hypersensitivity reaction of the lung after contact with mould spores from hay, straw and other crops.

Trismus Tetanus (lockjaw)

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“There were social implications in medical diagnoses… diseases such as syphilis were more likely to be listed as a cause of death in a poorer patient than a middle-class patient.”

disembarked, and where rats and other vermin also left the ships.

The requirement for a death to be certified by a doctor became law at different times in different places. In England, for example, it became law in 1874. Due to the costs, many people would not have had medical intervention prior to death, so the doctor only became involved after death. This meant a doctor had to perform a retrospective diagnosis based on visible symptoms and information from family and friends. This can mean that less obvious diseases or genetic conditions would not be appropriately diagnosed.

There were also societal implications in medical diagnoses. As there was no cure, sexually transmitted diseases, such as syphilis, were common in all levels of society. They were, however, more likely to be listed as a cause of death in a poorer patient than a middle-class patient. Insanity leading to suicide was also another cause of death likely to be glossed over in the middle-class patient.

Champions for the cause So if including cause of death on a certificate was not meant for the benefit of family historians, why the push to show it? In a bid to improve public health, is the short answer, thanks to statistician, William Farr. The London Bills of Mortality were published weekly from 1603 to the mid-1830s, from information given by parish clerks so that people could see the increases or decreases in death caused by the plague. Soon all causes were given. This information proved very useful to the authorities and, in 1836 when the advent of national registration was discussed, Farr and others fought to have cause

Left Stethometer, 1800-1950. A stethometer is used to measure how far the chest expands during breathing. The dial-like device is placed on the front of the chest and the blue string stretched out to the centre of the back. When the patient breathes in, the movement of the string produces a reading on the dial. These readings are useful in diagnosing a disease such as tuberculosis. Image courtesy Science Museum London/Wellcome Library London

of death included on the certificates. He was an innovator in analysing this medical information, and published many reports, a number of which are available on Internet Archive (www.archive.org).

In 1839 Farr developed and implemented a standardised approach to the classification of disease. He then spent the next 40 years educating doctors in the importance of determining the real cause of death and standardising the classifications of disease at a time where 10 miles from where you lived was almost considered a foreign country. One way he was able to provide information to the country’s doctors was via the British Medical Journal. Some historical issues are available online (www.bmj.com).

Farr’s analysis of the death certificate information had a large impact on decreasing disease incidence, particularly in infectious and occupational diseases, because outbreaks and trends in diseases were able to be seen. This information was used by town planners and by John Snow in the famous cholera outbreak of 1854 in London, where Dr Snow used the death information to localise an epicentre of infection, the Broad Street pump. He removed the pump handle, which stopped access to the contaminated water and ended the epidemic. This was at a time when it was still believed by the majority of the population that bad odours caused the disease.

The Farr classification system was changed over time, and in 1881 was completely modified by Dr William Ogle, becoming known as the Farr-Ogle system. This modified system was adopted at varying times during the 1880s by each of the Australian colonies. In 1903, Australia and most of the world’s developed countries replaced this system with the International Classification of Disease (ICD), where

all doctors are obliged to report a disease within this coding system. Currently Australia is using the 10th version of this classification system (ICD10).

So what do you do when you find an unusual term on a death certificate? First look to see who certified the death: do they have medical qualifications, do they give a time of last illness? This will give an indication on the reliability of the given cause. There are a number of online sources that can be very useful (see box below). Rudy’s List is particularly useful as it lists historical medical terms in 23 languages. And of course Google is always a great place to start.

Death certificates can be wonderful sources of information but it is important to be aware of their limitations or omissions. Putting the information you do have into context could open up the possibility of discovering even more about your ancestor’s life.  ✳ Helen Smith’s book, Death Certificates and Archaic Medical Terms (Unlock the Past, $10) is available now through Gould Genealogy (www.gould.com.au). Follow Helen at http://twitter.com/HVSresearch

Where to next?

Rudy’s List of Archaic Medical Terms www.antiquusmorbus.com An excellent site for historic medical terms in 23 languages including German, Polish and Swedish Medline’s Medical Encyclopedia www.nlm.nih.gov/medlineplus Click on “Encyclopedia” for more than 4000 articles about diseases, tests and symptoms

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