Tuesday, 17 April 2012

Causes of Death: Ancestors with Whooping Cough

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The Cough that Carried Them Off



[This article first  appeared in the now obsolete Practical Family History in 2010]

One of the most sinister sounds of the past must have been that of a small child with whooping cough. The disease began like the common cold with a runny nose, sneezing, decreased appetite, increased phlegm, broken sleep and fever. From this, a repeated hacking cough developed. Parents must have dreaded the onset of the inspiratory whooping (a high-pitched intake of breath) which could end in a fit of vomiting. Such are the wonders of the internet that you can now listen to the sound of a child with whooping cough at http://www.whoopingcough.net/sound%20of%20whooping%20cough%20with%20some%20whoop.htm

Pertussis should be considered as a really important contributor to the histories of those many families who contracted it. In the first place, along with measles, scarlet fever, and diphtheria, it  was one of the four great killers of children of the nineteenth century. Death certificates of ancestors who died from whooping cough may refer to the disease by its scientific names - ‘pertussis’ or ‘tussis convulsiva’ (‘tussis’ meaning ‘cough’). In letters, diaries and other records, it may have been mentioned more colloquially as ‘chin cough’ or ‘the cough of a hundred days.’   Since the cough weakens the body’s immune system and makes it susceptible to other diseases, there may be other causes of death recorded alongside whooping cough on death certificates: pneumonia or bronchitis, for example. Because of the intense coughing it induced, whooping cough could also bring on burst blood vessels, nosebleeds, skin bruises, hernias and even brain damage.

Secondly, it’s worth remembering that many of our ancestors suffered but did not die from whooping cough. In their cases, having this particular disease (with its unsociable symptoms and cures that were more guesswork than science) often shaped both their childhood and their subsequent life experiences. Many children suffering from the distinctive cough, for instance, were sent away to spend time in the fresh air at seaside resorts and spa towns away from other children. Others visited one of the many specific sites around the country renowned for their supposed ability to get rid of the disease. These included the National Trust’s first property Dinas Oleu (acquired in 1895) in the cliffs above Barmouth, and Dupath Well near Callington in Cornwall - an ancient bathing spot in which the waters were purported to cure whooping cough and skin diseases. For some children, then, having whooping cough was their first (and perhaps their only) period away from home.

For some adults, a persistent cough throughout life was a lasting testimony to the fact that they had survived whooping cough as children. Charles Lutwidge Dodgson (aka Lewis Carroll) (1832-1898) caught whooping cough in the spring of 1848. He recovered but was so debilitated that he contracted mumps later the same year. The cough returned at various times during his life and the mumps left him partially deaf. The prolific children’s writer Enid Blyton contracted whooping cough in the first months of her life (in 1897) but was nursed through it by her father – something to which her biographers have attributed her very close relationship with him in later life.

There were some more surprising results of the disease that may shed light on the future careers of your ancestors. Those who suffered as children later recalled the weeks and months spent isolated from others and the painful psychological legacy of these. For some, their time spent with whooping cough was a crucial period in their development  - a period in which, forced upon their own resources, they read or painted, developing artistic habits and powers of concentration that were to determine how they went on to lead their adult lives. 


Death of Lillie Symes


Lillie Symes (my great aunt) died from whooping cough at the age of thirteen months in January 1894. In many ways, Lillie was a typical victim of the disease in that she was under eighteen months old, female and from a poor industrial community. At the time of her death, she was living in crowded conditions with her parents, four sisters (all under eight years old) and a lodger, in Ancoats, one of the poorest areas of Manchester. And Lillie’s death – as in the case of many victims – was the result of complications rather than from whooping cough alone; her death certificate also records bronchopeneumonia as a cause of death.

Medical websites such as www.whoopingcough.net have given me enough information to enable me to be able to imagine the growing sounds of panic in that little house in Ancoats as Lillie’s illness developed over weeks and perhaps months. The ordinary cough would have developed into intense bouts of coughing – paroxysms of one or two minutes duration in which the little child would have gone red, her body tense, her eyes bulging. She may have had up to a hundred bouts of coughing a day each one ending in a desperate attempt to take in a breath and with it (probably, though not necessarily) the infamous, dreadful ‘backdraw’ or whoop. Vomiting of mucus and food may well have followed.

Whooping cough is extremely contagious, particularly among children. It’s now known that the infection is spread through contaminated droplets in the air produced during coughing. Luckily, none of Lillie’s sisters, including her twin, Annie, fell prey to the disease. More fortunately still, perhaps, Lillie’s mother (my great-grandmother) who was three months pregnant with my grandfather at the time, also managed to escape infection.

Lillie was one of many victims of whooping cough. Before immunisation, epidemics of the disease came every three or four years in Britain. Some sources suggest that eight in ten children in the period had whooping cough before they were five. In Scotland alone in the year before Lillie’s death, 131 children died from whooping cough in the month of April and 145 in May. These accounted for between 5 % and 6 % of all mortality rates at the time. School log books from the nineteenth century often record school closures because of the disease or the exclusion of large numbers of children with the infection.

No Specific Cure

Despite the fact that it was widely acknowledged that there was ‘no specific cure for whooping cough and that no drug could check the onset nor stop the progress of the disease’ Quain’s Dictionary of Medicine, 1902, there were a large number of embrocations, liniments and inhalants available on the market at the time of Lillie’s death. These included Bevington’s drops (ingredients unknown) and Dr Bow’s Liniment thought to contain ammoniated camphor liniment, belladonna liniment, soap liniment, strong ammonia and tincture of opium.  

As well as the range of costly – and mostly useless - pharmaceuticals on offer, a whole host of alternative ‘cures’ for whooping cough were also suggested. In Cornwall, infusions made from holly were recommended. In Staffordshire an ancient legend suggested that you should take the sick child outside and let it look at the new moon, lift up its clothes and rub your right had up and down its stomach whilst reciting a prayer. Passing a child three times under and over a donkey was the most bizarre in a long list of non-scientific cures recommended to the desperate.

Since they were poor and Methodists, it’s unlikely that the Symes family either procured expensive medicines for Lillie or tried any of the more fanciful of these suggested cures. Rather they probably followed popular medical guidance of the time: advice passed down from one generation to another by word of mouth or in common household advice books. Lillie would have been nursed in a sitting position, efforts would have been made to clear the mucus from her nose and throat, and her intake or food and drink would have been fussed over. Homemade medication might have involved a ‘liniment made of one teaspoonful of oil of cloves, two teaspoonfuls of oil of amber, and two tablespoonfuls of camphorated oil well shaken up together in a bottle, [and] rubbed into the pit of the stomach and into the spine every night.’ Teas, garlic and honey were also recommended as methods of cutting the phlegm.
Immunocompromised patients and infants younger than 1 year are more at risk of developing severe disease.

Key risk factors include age <18 months; baby born to mother who became infected at 34 weeks or more gestation; no or incomplete immunisation; compromised immune system (e.g., HIV-seropositivity); lung disease; school teachers; healthcare workers (e.g., nurses); close contact with an infected person; and household contact with an infected person.

Infants may have apnoea with only a mild cough. [1] [2] [28]
The Sunlight Year Book of 1898 suggested that patients with whooping cough should stay indoors and take every precaution against catching bronchitis or pneumonia. It   also included advice about the right sorts of food to eat -  ‘the best being broth, milk, eggs, curds and whey and barley water.’  Bedrooms should be ‘well ventilated,’ and ‘free from draught. A muslin curtain should be thrown over the bed at night’ and ‘a piece of flannel [might] be swathed around the abdomen.’ The book went so far as to suggest that ‘in severe cases, some carbolic acid may be spread on a red hot shovel; [since] the fumes in the air are believed to have the same effect as taking the patient to the gas works.’

For those with access and means, whooping cough was serious enough to warrant hospital admission. It was also contagious enough to warrant some institutions such as King’s College Hospital having a separate entrance for whooping cough cases from 1913. The new online Historic Hospitals Admission Project (http://www.hharp.org)  makes it possible for family historians to search for individual children who may have been admitted to one of a number of London Children’s Hospitals (and other institutions) with various diseases between 1852 and 1914.  Many of those admitted to Great Ormond Street Hospital with whooping cough were also suffering from complications (‘sequela’), including croup and bronchitis.  Two year old Emma Day, for example, was admitted with whooping cough on April 24th 1852, she was treated for 12 days and left the hospital cured. Joseph Hamlet was not so lucky. Aged 2 years and 2 months, he was admitted to hospital on May 3rd 1853 and died the following day. The database includes his handwritten case notes.

A Vaccine At Last


Unfortunately for her, my great aunt Lillie’s death preceded the discovery of the whooping cough bacterium (‘Bordatella pertussis’) by twelve years. But it was a good while before an effective vaccine was developed.  Indeed, well into the twentieth century even those in the highest classes of society could succumb to the cough. In May 1923, Elizabeth Bowes Lyon (Duchess of York, wife of the future King George VI and later the Queen Mother) caught whooping cough on her honeymoon at Glamis Castle and described it as ‘not a very romantic disease.’

A vaccine finally became available and was tested by scientists from the Whooping Cough Immunisation Committee of the Medical Research Council between 1948 and 1954. Prior to its introduction by the NHS in 1957, whooping cough was affecting approximately 100,000 people a year in England and Wales. Afterwards, the rate of reported cases dropped to 2,000 a year. Fears about the safety of the whooping cough vaccine in the 1970s caused a drop in its uptake and a corresponding rise in the number of cases. From the mid 1980s, however, the general efficacy of the vaccine has been recognised. Antibiotics are now also prescribed if the disease does occur.

Thankfully, cases of whooping cough are now very few and far between and deaths are rare indeed. The atrocious whooping noise that so often signalled disaster in the households of our ancestors is now very much a sound of the past.


Useful Books


Day, Paul, Whooping Cough: A Journey Towards Truth, Lulu.com, 2008

Jerger, Jeanette J. A Medical Miscellany for Genealogists, Heritage, 2009

Porter, Roy. The Cambridge Illustrated History of Medicine, CUP, 2001



Useful Websites


www.whoopingcough.net General site of information and advice on whooping cough

http://www.olib.rpsgb.org.uk/pdfs/mussheetwhoopcough.pdf  Museum of the Royal Pharmaceutical Society showing the different cures that have been suggested for whooping cough through the ages.

www.rmhh.co.uk/medical.html   Website of archaic medical terms including a timeline of major epidemics in the UK throughout history.

http://www.antiquusmorbus.com/Index.htm Archaic medical terms (including German and French terms).

http://www.cyndislist.com/medical.htm#Diseases  Collection of websites and medical terms useful to genealogists.

http://www.online-medical-dictionary.org/ A free online medical dictionary.

http://hharp.org/ Historic Hospital Admission Records Project. On-line database of admissions to various hospitals mainly in London between 1852 and 1914.


Keywords: European ancestors, family history, genealogy, England, health, whooping cough, death certificates

Causes of Death: The Flu Epidemic of 1918 (Scotland)

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Did Your Scottish Ancestor Die of Swine Flu?


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 [This article first appeared in the now obsolete Discover My Past Scotland 2010]


Confined to Bed. Flu Sufferers were advised to stay at home and in bed. Sunlight Year Book, Lever Brothers, 1897 

The current swine flu pandemic is by no means the first time in recent history that a disease has threatened thousands of lives – and family histories -  at once. In 1918 -1919, a devastating flu virus swept across Europe, Asia and Africa. In Scotland, initial estimates put the death toll at 17, 575. When deaths from flu-related illnesses are taken into account, the figure might have been as high as 33,000 – devastating in a population of just 4.8 million. In Britain, as a whole, the numbers were a startling 228,000 according to some estimates and worldwide it is estimated that as many as 50 million people may have died.

‘Not only does this epidemic of influenza tower over all previously recorded epidemics of similar nature: it proved the most fatal epidemic disease of any form that has occurred in Scotland since death registration began.’

T.F. Dewar, ‘Influenza in Scotland,’ Edinburgh Medical Journal, 1919, 23:303-8


It is unclear whether the flu virus started in China, in America or elsewhere. But the  first bouts in Britain were  - perhaps surprisingly - in Scotland on Clydeside, brought probably by troops returning from the front line in France to the port of Glasgow in April 1918. There were also some cases in April among the Royal Navy Grand Fleet at Scapa Flow (Orkney) and Rosyth (Fife). Then in May 1918, the flu hit the civilian population of Glasgow. At first, there were few fatalities but as the year progressed, the disease became more virulent. By mid-October 1918, approximately 310 people were dying every week from flu in Glasgow. Undertakers were overwhelmed and coffins were in short supply.







Wilfred Wilkinson. British soldiers stationed in France were hard hit by the flu virus  - contracted possibly from American reinforcements and possibly from Chinese trench diggers. My own collection

An extra problem for the sufferers in Scottish cities was that many doctors were enlisted in military service. In part of Fife, for example, there were 5,731 people to one doctor and in one area of Glasgow that normally had 17 GPs, ten were on military duty and three were ill themselves resulting in only four doctors being available for 55,000 people. Many elderly doctors were brought out of retirement to respond to the challenge, but some of these also fell victim to the virus.

‘The Mother of All Pandemics’


The 1918-1919 flu outbreak was an unusually severe and deadly strain of avian flu. It is thought to have entered the swine population as well as the human population in 1918. Experts believe that today’s bird and swine flu viruses are closely related to this earlier strain. Indeed, it’s possible that today’s much discussed H1N1 strain may have originated on the Western Front itself.



Symptoms and Treatment


There is plenty of evidence on the internet at sites such as http://www.health24.com/medical/Condition_centres/777-792-811-1705,16646.asp and  http://www.archiveshub.ac.uk/jan06a.shtml  that can help you imagine how your ancestors might have experienced the flu. Sufferers reported headaches, earaches, nightmares, fever, coughing spells, intense pain in the eyes and limbs, and loss of weight. In many cases, the skin turned bluish purple as a result of cyanosis caused by de-oxygenated haemoglobin in the blood vessels. This caused the flu to be known colloquially as ‘the blue death.’ In the worst cases a liquid formed on the lining of the lungs and victims effectively drowned in their own blood. Sometimes people died within a day of contracting the disease.

With no such antiviral drugs as Tamiflu on the market, doctors could volunteer only what now seems pretty inadequate advice. Patients were requested to gargle night and morning with a solution of permanganate of potassium and common salt. A variety of other largely ineffective treatments were put forward including Oxo, quinine, Vick’s Vaporub, and a concoction of pine oil, lavender oil and eucalyptus oil. It was understood that the disease could be spread by contact between infected people. Scottish Medical officers recommended that sufferers stayed at home and got plenty of fresh air. Many schools were closed and it was recommended that people keep away from cinemas, theatres and other places at which many people congregated.


Death Certificates and what to look for


If you suspect that your ancestors’ deaths in 1918 or 1919 were caused by the flu virus, take a closer look at their death certificates. Consider exactly where they were living when they died. Starting in the ports, the flu followed rail and road networks inland. Overall, the highest proportion of deaths in Scotland were in Edinburgh, Coatbridge, Falkirk, Leith, Kirkcaldy and Glasgow followed by Dundee, Perth, Clydebank, Paisley, Aberdeen, Kilmarnock, Motherwell, Greenock, Hamilton and Ayr. The worst hit areas in the Autumn of 1918 were the urban areas of Hamilton, Motherwell, Kilmarnock, Aberdeen, Clydebank, Perth, Dundee, Kirkcaldy and Coatbridge. In the spring of 1919, the disease struck most lethally in Ayr, Greenock, Paisley, Glasgow, Leith, Falkirk and Edinburgh. Part of the reason that the flu spread so successfully was that British soldiers and civilians were physically vulnerable after four years of fighting. In general, people were anxious, physically exhausted and undernourished – all characteristics which encouraged and exacerbated the disease. There were also thousands of people in transit and more places in which overcrowding was an issue such as in munitions factories, and on public transport. If your ancestors lived in more remote towns and rural areas, they are less likely to have contracted the disease.

Your ancestor’s exact date of death may also be of particular interest. In Scotland, the flu virus came in three waves between April 1918 and March 1919. The first phase (from April to July 1918) was generally considered mild. Its chief victims were those under two years old, the elderly and the sick. The second phase of the disease in October and November of 1918, however, claimed a different sort of victim. This time many deaths occurred in the ranks of healthy young adults aged between 20 and 40. Indeed, nearly half of all the deaths from the flu affected those in this age group. This meant that many young children lost one or both parents. The third phase of the disease which struck in February-March 1919 was also vicious and produced a high death toll.

You should also take a closer look at the cause of death on your ancestor’s death certificate. Be careful: flu was often confused with other conditions, and in the initial pandemic phase, when it was still little understood, deaths were often attributed to 'PUO' (a pyrexia of unknown origin). Once identified, the disease became known as the ‘Spanish flu’ (partly because reporting of it was not subject to censorship in Spain, a fact which made it appear more virulent there than anywhere else). It was also known as La Gripe Española, or La Pesadilla and as 'three-day fever'. Remember also that many sufferers died from complications after the flu. Their deaths may have been attributed to ‘pneumonia,’ ‘pleurisy’ or ‘bronchitis.’

Look carefully too at the records relating to your soldier ancestors. They may not have died straightforwardly from gunshot wounds, but from the flu that prevented them from recovering from injury. One useful website detailing the deaths from flu of Scottish servicemen from Orkney is http://www.rbls-kirkwall.org.uk/memorials/ww1BCasualties/SpanishFlu.doc. Finally, it’s worth bearing in mind that many survivors of the flu virus were left severely depressed. A number of suicides and murders in Britain were put down to the after effects of the flu.                        

Other evidence


If you are looking for other information on your ancestors’ experience of flu in 1918-1919, you may be disappointed. Newspapers – both local and national were oddly quiet on the subject. Even The Scotsman barely mentions the disease. This silence may have been the result of a tacit agreement between government and press to ensure that public morale was not further depressed after all the bad news emanating from the Front Line.


The Scot who said ‘Spit Kills’

 

One of the most famous doctors to tackle the 1918-1919 virus was a Scot. Dr James Niven was born in Peterhead in 1851 and trained firstly at Aberdeen University. Niven was Chief Medical Officer of Manchester from 1894-1922 and was responsible for introducing a large number of public health measures designed to hold back the progress of the flu. It was Niven, for example, who coined the phrase ‘ Spit kills.’ He was also one of the first to suggest closing businesses and schools as a response to the disease. Niven, like many older people, had himself lived through the so-called Russian flu pandemic of 1889-1890, and had probably developed an immunity to later strains of the disease.

 


Dr James Niven Obituary. Dr James Niven – a Scot – who fought the virus on the streets of Manchester.  The Obituary of Dr James Niven 1851-1922, British Medical Journal, October 10th 1925.  2 (3380):673-674. Reproduced with permission from the BMJ Publishing Group.

 

 

  


The virulence of the flu pandemic had enormous consequences for the history of many ordinary Scottish families. Indeed, if one or more of your ancestors did die of the flu, you may find that your family tree changed shape and direction entirely in the space of less than two years between 1918 and 1920. Many people were widowed and may later have married again; family breadwinners disappeared; large numbers of young children died; thousands of youngsters lost one or both parents and were adopted by other family members; household groups split up and moved to other parts of the country, and in some cases, out of the country altogether. It’s worth bearing in mind that once the 1921 census becomes available, many of us will find momentous changes have taken place in our ancestors’ households since the previous census of 1911. And these may well have been due as much to the deadly flu virus of 1918-1919 as to the Great War itself.

Useful Websites


http://virus.stanford.edu/uda/ - general history of the 1918 flu pandemic

http://www.archiveshub.ac.uk/jan06a.shtml  Archives Hub collection of material on coughs and sneezes in history, especially the 1918 flu outbreak.

http://www.rbls-kirkwall.org.uk/memorials/ww1BCasualties/SpanishFlu.doc List of casualties of the Spanish flu among servicemen from Orkney 1918-1920

www.rcpe.ac.uk/journal/issue/journal_37_4/Butler.pdf Article by A.R. Butler and J.L. Hogg, ‘Exploring Scotland’s Influenza Pandemic of 1918-1919: Lest We Forget’


Useful Books


Barry JM. The Great Influenza: The Epic Story of the Deadliest Plague in History. Viking; 2004.

Brown R. The Great War and the Great Flu Pandemic of 1918. Wellcome, History 2003.

Honigsbaum, Mark, Living with Enza: The Forgotten Story of Britain and the Great Flu Pandemic of 1918, Palgrave, 2008.

Kolata, Gina Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the virus That Caused It. San Val 2001.

Quinn, Tom, Flu: A Social History of Influenza, New Holland Publishers, 2008

Oxford, John S., Ranger, Terry, Killingray, David and Phillips, Howard eds, The Spanish Flu Pandemic of 1918: New Perspectives. Routledge: Studies in the Social History of Medicine, 2003.

Van Hartesveldt FR. The 1918-1919 Pandemic of Influenza: The Urban Impact in the Western World. Edwin Mellen Press: 1992.


Keywords: European ancestors, genealogy, family history, Scotland, Scottish, health, flu, ancestry