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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

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 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 (  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,, 2008

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

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

Useful Websites General site of information and advice on whooping cough  Museum of the Royal Pharmaceutical Society showing the different cures that have been suggested for whooping cough through the ages.   Website of archaic medical terms including a timeline of major epidemics in the UK throughout history. Archaic medical terms (including German and French terms).  Collection of websites and medical terms useful to genealogists. A free online medical dictionary. 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