England Epidemics and Major Causes of Death S to W (National Institute)

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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