Soap, in some form or other, has been used by humans for millennia, with the oldest surviving products dating back to the ancient Babylonian period. Come the Industrial Revolution and the growth of mass consumption, distinct brands were formulated and aggressively marketed. Yet how could an advertisement for something as everyday as soap possibly be exciting, or indeed distinctive?
Prominent manufacturers such as Pears’ Soap (still in existence today) tried every advertising angle when promoting their products. Pears’ depicted the most famous actress of the day holding a bar of their soap; they paid a leading pre-Raphaelite artist for the right to use his material in an advertisement; and they tapped into dominant narratives of racist imperialism in order to sell as much soap as possible. Their most famous advertising image is probably Millais’ whimsical painting, Bubbles, and their most infamous is the 1884 advertisement showing a white child scrubbing away the ‘blackness’ from another child, which appears jolly delighted with the result.
More overtly political messages could also be found in Pears’ Soap advertisements. The concept of the White Man’s Burden – the duty of the superior white race to civilise the black savages – is illustrated in an advertisement from the 1890s in which spreading cleanliness is used as a justification for imperialism. The text reads: “The first step towards lightening the White Man’s Burden is through teaching the virtues of cleanliness. Pears’ Soap is a potent factor in brightening the dark corners of the earth as civilisation advances, while amongst the cultured of all nations it holds the highest place – it is the ideal toilet soap.”
A contemporary advertisement for an American brand, Ivory Soap, follows along in much the same vein, caricaturing Native Americans and featuring a cheery poem:
Said Uncle Sam: “I will be wise,
And thus the Indian civilize:
Instead of guns, that kill a mile,
Tobacco, lead, and liquor vile,
Instead of serving out a meal,
Or sending Agents out to steal,
I’ll give, domestic arts to teach,
A cake of IVORY SOAP to each.
“Before it flies the guilty stain,
The grease and dirt no more remain;
‘Twill change their nature day by day,
And wash their darkest blots away.
They’ll turn their bows to fishing-rods,
And bury hatchets under sods [earth],
In wisdom and in worth increase,
And ever smoke the pipe of peace;
For ignorance can never cope
With such a foe as IVORY SOAP.”
An even more preposterous Ivory Soap advertisement from 1888 reads as follows:
“We once were factious, fierce, and wild.
To peaceful arts unreconciled;
Our blankets smeared with grease and stains
From buffalo-meat and settlers’ veins.
Through summer’s dust and heat content,
From moon to moon unwashed we went;
But IVORY SOAP came like a ray
Of light across our darkened way.
“And now we’re civil, kind, and good,
And keep the laws as people should.
We wear our linen, lawn, and lace
As well as folks with paler face.
And now I take, where’er we go,
This cake of IVORY SOAP to show
What civilized my squaw and me,
And made us clean and fair to see”.
The great irony is, of course, that the Native Americans are depicted as anything but ‘fair to see’; they are grotesque, bestial parodies.
I recently came across a striking passage in Samuel Pepy’s diary in which he receives advice on how to get his wife Elizabeth pregnant. At the time of writing, July 1664, he and Elizabeth had been married for eight years, but they remained childless. While attending a dinner on 26th July, Samuel asked the women present if they could give him any advice on how to overcome his and his wife’s apparent infertility. The women “freely and merrily” gave the following precautions as a certain means of conceiving:
1. Do not hug my wife too hard nor too much. 2. Eat no late suppers. 3. Drink juice of sage. 4. Tent and toast. 5. Wear cool Holland-drawers. 6. Keep stomach warm and back cool. 7. Upon my query whether it was best to do it at night or morn, they answered me neither one nor another, but when we have most mind to it. 8. Wife not to go too straight-laced [with her corset]. 9. Myself to drink Mum [a kind of beer] and sugar. 10. Mrs Ward did give me to change my plate. The 3rd, 4th, 6th, 7th and 10th they all did seriously declare and lay much stress upon them, as rules fit to be observed indeed, and especially the last: to lie with our head where our heels do, or at least to make the bed high at feet and low at head.
Sadly for the Pepys, Elizabeth never did get pregnant. One diary entry from September 1664 reveals that when Samuel returned home after dinner with a friend, “I find my wife not well – and she tells me she thinks she is with child; but I neither believe nor desire it”. Whether this shows genuine resignation or a display of bravado, we will probably never know.
But how typical were the remedies suggested to Pepys in the wider context of 17th century England? The womens’ recommendation that the couple should have sex whenever they both feel like it is unsurprising, as contemporary opinion held that it was necessary for both partners to enjoy sex in order to conceive. Supposed aphrodisiacs were therefore touted as helpful in overcoming infertility. Not only did aphrodisiacs stir up lust; they were also thought to have physical effects on the body which made both men and women more fertile. Many more foods were considered aphrodisiacs than today. Aristotle’s master-piece (1684) listed:
…among such things as are inducing and stirring up thereto, are…Hen-eggs, Pheasants, Woodcocks, Gnatsappers, Thrushes, Black Birds, young Pigeons, Sparrows, Partridge, Capons, Almonds, Pine-Nuts, Raysons, Currants, all strong Wines moderately taken; especially those made of the Grapes of Italy; but Erection is chiefly caused and provoked by Satyrium Eringoes, Cresses, Erysimum, Parsnips, Artichoaks, Turnips, Rapes, Asparagus, Candid Geinger, Gallinga, Acorns buried to Powder, and drank in Muscadel, Scallions, Sea Shell-Fish, &c.
Aphrodisiacs aside, infertility treatment was strongly influenced by the reigning humoural theory. It was commonly held that all disorders proceeded from an imbalance of the four humours: black bile, yellow bile, phlegm, and blood. Consequently, much advice was focused on balancing the humours in the womb, by avoiding excessive cold, moisture, dryness or warmth.
Of course, medical practitioners of dubious quality peddled secret elixirs and the like, which were supposed to provide sure-fire remedies for infertility. These were frequently advertised on handbills (advertisements of one or two sides). Remedies were, however, not left to the quacks alone. Women shared knowledge amongst themselves; many recipes for concoctions to cure infertility can be found in accounts and recipe books of the period.
These remedies may seem laughable now, but apparent infertility was extremely distressing for women in 17th century England. Pepys’ experience would seem to bely the common view that infertility was always believed to be a woman’s problem; in the diary, he recognises that the problem could be his as well. Yet women often bore the brunt of the blame. If a woman failed to have children, she had failed her primary purpose in life. Seemingly infertile women risked being mocked and even shunned by their contemporaries, and some women must have at times empathised with Rebecca when she cried to her husband Jacob, “Give me children, or else I die” (Genesis 30:1).
The Bethlem Hospital, or Bedlam as it is more commonly known, is Europe’s oldest extant psychiatric hospital and has operated continuously for over 600 years. It was founded in London in 1247 during the reign of Henry III, as the priory of the New Order of St Mary of Bethlehem. Bethlem was not actually intended as a hospital, much less as a specialist institution for the insane, but rather as a house for the poor and a centre for the collection of alms to support the Crusader Church. However, the crown seized Bethlem in the 1370s and it became an increasingly secular institution staffed by crown appointees.
The first definitive record of the presence of the insane in Bethlem is from the details of a visitation of the Charity Commissioners in 1403. This recorded that among other patients there were six male inmates who were “mente capti”, a Latin term indicating insanity. The visitation also noted the presence of four pairs of manacles, eleven chains, six locks and two pairs of stocks, presumably used to restrain the most violent inmates. In c.1450 the Mayor of London described Bedlam as a “place [where may] be found many men that be fallen out of their wit. And full honestly they be kept in that place; and some be restored onto their wit and health again. And some be abiding therein for ever, for they be fallen so much out of themselves that it is incurable unto man”. Little is known of the treatment of the insane for much of the medieval period, though mechanical restraint, a meagre diet and solitary confinement are likely to have been common practices. The name “Bedlam” developed in the 14th century as a corruption of “Bethlem”, or “Bethlehem”.
By 1600, Bethlem was co-owned by the crown and the City of London, and run by a board of governors. The change in management doesn’t seem to have benefited the hospital’s inmates; conditions in 16th- and 17th-century Bedlam were appalling. Bethlem had been built over a sewer which served both the hospital and the surrounding area, and as it regularly blocked, waste of all kinds would seep into the building. The 1598 visitation by the Governors had observed that the hospital was “filthely kept”, and a later inspection found inmates actually starving. Under the leadership of the aptly-named Helkiah Crooke, who was dismissed in 1632 on grounds of absenteeism and embezzlement, charitable goods and foodstuffs were stolen by the steward and either personally consumed or sold on to patients. Those without the resources to trade with the steward often went hungry. It was at approximately this time that the word “Bedlam” seems to entered everyday speech to signify a state of madness and chaos.
The admittance of public visitors as a means of raising hospital income may have been allowed since the late 16th century; certainly there are 17th century accounts which describe the “Swarms of People” which descended on Bethlem during public holidays in order to amuse themselves by watching the mad inmates. The number of visitors seeking entertainment rose in the 18th century, becoming one of Bedlam’s most notorious characteristics. Visiting was defended by some commentators as a form of moral instruction, as it illustrated the dangers of immorality and vice which could, in popular belief, lead to madness. As one spectator commented, “[there is no] better lesson [to] be taught us in any part of the globe than in this school of misery…From so humbling a sight we may learn to moderate our pride, and to keep those passions within bounds, which if too much indulged, would drive reason from her seat, and level us with the wretches of this unhappy mansion”.
All well and good, but for the vast majority, Bedlam was simply a titillating source of cheap amusement which provided what historian Roy Porter describes as the “frisson of the freak show”. An 18th century observer recorded how on one occasion, “a hundred people at least [were] . . . suffered unattended to run rioting up and down the wards, making sport and diversion of the miserable inhabitants, [some of whom were] provoked by the insults of this holiday mob into furies of rage”. Unrestricted public access continued until 1770, after which time visitors required a ticket signed by a governor of the hospital. As distasteful as it was to have crowds flocking to make fun of the mentally ill, some historians have speculated that the lack of public oversight after 1770 allowed for more flagrant abuses.
Being such an infamous institution, Bedlam did not lack for attention in the public, literary and artistic spheres. Jonathan Swift memorably quipped, where better to recruit the nation’s politicians than Bedlam, since the inmates could not be any more insane than the ones in power! Bedlam provided a wonderfully melodramatic backdrop to literary texts, as in Eliza Haywood’s 1725 play The distress’d orphan or, Love in a mad-house. Haywood describes how “the rattling of Chains, the Shrieks of those severely treated by their barbarous Keepers, mingled with Curses, Oaths, and the most blasphemous Imprecations, did from one quarter of the House shock…tormented Ears while from another, Howlings like that of Dogs, Shoutings, Roarings, Prayers, Preaching, Curses, Singing, Crying, promiscuously join’d to make a Chaos of the most horrible Confusion”. Perhaps the most famous depiction of Bedlam is the final painting in Hogarth’s cycle The Rake’s Progress (1723-25). Driven mad by debauchery (probably an effect of syphilis), the cycle’s protagonist Tom Rakewell presents a sorry sight, sprawled on the floor of a dank cell in Bedlam. He is surrounded by other lunatics, one of whom thinks he is a king, another a bishop; wealthy visitors laugh at the wretched scene.
Bedlam’s medical regime – such as it was – was at best useless, at worst actively injurious to the mental health of the inmates. Mental illness was completely misunderstood at the time. Epileptics and people with learning difficulties and dementia were classed in the same group as people suffering from paranoia, schizophrenia and depression. Following Greek and Roman philosophy, it was believed that ailments were generally caused by an imbalance of the four humours; too much black bile, for instance, was thought to lead to depression. Consequently, a depletive medical system held sway in Europe until the 19th century.
The most common treatment in this system was blood-letting, but patients at Bedlam were also subject to forcibly induced vomiting, scarification and purgation. Such was the violence of the standard medical course that patients were regularly discharged or refused admission if they were deemed unfit to survive the physical onslaught. Alexander Cruden, a writer who was briefly incarcerated in Bedlam, said bitterly of the physicians there: “but is there so great Merit and Dexterity in being a mad Doctor? The common Prescriptions of a Bethlemitical Doctor are a Purge and a Vomit, and a Vomit and a Purge over again, and sometimes a Bleeding, which is no great mystery”.
The years 1814 and 1815 proved a turning point in Bedlam’s history. Edward Wakefield, a Quaker philanthropist and leading advocate of lunacy reform, visited several times during 1814 with the aim of inspecting conditions. Fearing bad publicity, Bedlam personnel tried to keep Wakefield out, but he eventually gained entry in the company of an MP and a governor of the hospital. He found that inmates were not classified in any logical manner, as both highly disturbed and quiescent patients were mixed together indiscriminately. Patients were chained to the wall, sometimes with thick iron rings around their necks; it was said that “chains are universally submitted for the strait-waistcoat”. In 1818 a former Bedlam inmate, Urbane Metcalf, described the case of a man named Popplestone, “whose leg rotted off as he was chained up for such a lengthy period that the metal cut into his flesh”. There was also the infamous case of the American marine, James Norris, whose intestines burst after being confined in chains for over a decade.
Wakefield and others revealed how keepers at Bedlam could be brutal and even sadistic towards their mentally ill charges. Wakefield recounted an incident in which “a man arose naked from his bed, and had deliberately and quietly walked a few paces from his cell door along the gallery; he was instantly seized by the keepers. thrown into his bed, and leg-locked, without enquiry or observation”. Metcalf reported an alleged case of murder: “Fowler [a patient], was one morning put in the bath by Blackburn [a keeper], who ordered a patient then bathing, to hold him down; he did so, and the consequence was the death of Fowler, and though this was known to the officers it was hushed up”. Metcalf also described a how a keeper named Davis, a “cruel, unjust and drunken man…for many years as keeper secretly practised the greatest cruelties to those under his care”.
Notwithstanding the prevailing idea that women were weak and fragile vessels who needed tender protection, female patients at Bedlam were not treated particularly gently. Wakefield describes his visit to the womens’ section as follows: “each [inmate was] chained by one arm or leg to the wall…The nakedness of each patient was covered by a blanket-gown only… One female thus chained, was an object remarkably striking; she mentioned her maiden and married names, and stated that she had been a teacher of languages…The Committee can hardly imagine a human being in a more degraded and brutalizing situation than that in which I found this female, who held a coherent conversation with us, and was of course fully sensible of the mental and bodily condition of those wretched beings [also incarcerated there]”. Sexual assault by male keepers was a problem faced by many women at Bedlam. John Haslam, author of the 1815 Report from the Committee on Madhouses, alleged that “some years ago, a female patient had been impregnated twice, during the time she was in the Hospital; at one time she miscarried; and the person who was proved to have had connexion with her, being a keeper, was accordingly discharged”.
Following Wakefield’s revelations, Thomas Monro, Bedlam’s principal physician, resigned after being accused of “wanting in humanity” towards his patients. Wakefield’s testimony, combined with reports about patient maltreatment at other asylums helped prompt a campaign for national lunacy reform, resulting in the establishment of a House of Commons Select Committee on Madhouses in 1815. This examined the conditions under which the insane were confined in county asylums, private madhouses, charitable asylums and in the lunatic wards of Poor Law workhouses.
Gradually, attitudes to madness changed across the medical profession and more widely in society. The emphasis increasingly shifted from the external control of the insane through physical restraint and coercion, to their moral management whereby a system of punishment and reward would encourage self-discipline. Bedlam itself became a more humane place under the influence of William Hood, who became chief medical superintendent in 1853. A further House of Commons Select Committee on the Operations of the Lunacy Laws, which met in 1877, heard the testimony of Sir James Coxe, who echoed society’s changing attitudes towards madhouses: “I think it is a very hard case for a man to be locked up in an asylum and kept there; you may call it anything you like, but it is a prison.” It was, however, not until 1890 that the status of lunatics was changed, by parliamentary legislation, from prisoners to patients.
The past was a dangerous time to be alive. If you were lucky enough to survive infancy and adolescence, you were very likely to die of any number of frightful diseases well before you reached what we regard as old age. Readers of old novels or historical death records are confronted with many unfamiliar names for these illnesses. I’m sure I am not the only person to read pre-1900 novels and think, what is brain fever? What’s the bloody flux? What on earth is pink disease? For the benefit of those readers, history students and any one else who is interested, I’ve compiled a brief glossary of medical terms which were once commonly used but are now rare or obsolete. Ague: Any intermittent fever characterised by periods of chills, fevers and sweats Apoplexy: Now refers to bleeding within internal organs, but historically meant a death which began with sudden loss of consciousness; covered what we now call heart attacks, strokes and aneurysms Bilious fever: A fever accompanied by nausea, vomiting and diarrhea Bloody flux: Dysentery Brain fever: Difficult to make a diagnosis in hindsight, but possibly meningitis or encephalitis. Very popular as a plot device with 19th century novelists, who portrayed it as a reaction to a severe emotional shock. Camp fever: Typhus; so-called because it was common in military camps with notoriously poor hygiene Consumption: Pulmonary tuberculosis. Another popular illness in Victorian novels. Corruption: General term for infection Distemper: A disease, especially an infectious one Dropsy: Edema – abnormal swelling of the body, often caused by kidney or heart disease Dropsy of the brain: Encephalitis Falling sickness: Epilepsy
Gaol (jail) fever: Typhus Great pox: Syphilis. Became something of a political football; the English, Poles, Italians and Germans called syphilis the ‘French disease’, the French called it the ‘Italian disease’, the Dutch called it the ‘Spanish disease’, the Russians called it the ‘Polish disease’, and the Turks called it the ‘Christian disease’. Green fever/green sickness: Anaemia King’s evil: See Scrofula Lung fever: Pneumonia Malignant sore throat: Diptheria Mania: Insanity Megrim: Severe headache, often limited to one side of the head Melancholia: Severe depression Mortification: Gangrene Pink disease: Disease of teething infants due to mercury poisoning from teething powders Plague: Any infectious disease with a high mortality rate, though will often refer to bubonic plague Pox: Syphilis, though also referred to any unknown disease which caused sores to appear on the body
Putrid fever: Diptheria Screws: Rheumatism Scrivener’s palsy: Writer’s cramp Scrofula: Primary tuberculosis of the lymphatic glands. Also known as the King’s Evil, due to the old belief that the monarch was able to cure scrofula victims. Sufferers would hang around the royal residence waiting for the king or queen to bless them. Ship fever: Typhus Spontaneous human combustion: The burning of a living human body without an apparent external source of ignition. Features in Charles Dickens’ Bleak House where the alcoholic Mr Krook dies of it. Spotted fever: Meningitis or typhus St Anthony’s Fire: One of several conditions characterised by intense inflammation of the skin, such as from erysipelas or ergotism. Rife in the Middle Ages due to the eating of ergot-contaminated rye bread.
St Vitus’ Dance: Phenomenon in which groups of people danced in a frenzy until they collapsed from exhaustion. Thought to have been a mass pschyogenic illness. Strangury: Condition marked by slow, painful urination, caused by muscular spasms of the urethra and bladder Surfet/surfeit: Vomiting from over-eating Swamp sickness: Malaria Sweating sickness: Infectious and often fatal disease affecting England in the 15th century Teeth: Death of an infant when teething; symptoms included fretfulnes, convulsions, diarrhoea, and painful and swollen gums. Children appear to have been more susceptible to infection during this time, although malnutrition from being fed watered milk has also been suggested as a cause. Tympany: A swelling or tumour Winter fever: Pneumonia Worm fit: Convulsions associated with teething, worms, elevated temperature or diarrhoea
Although we are regularly reminded of the potential health risks of drinking too much coffee, to my knowledge no-one has yet argued that men ought to cut back on coffee because it makes them impotent. However, that is exactly what one bawdy pamphlet from 1674 claims. Given the catchy title of The Women’s petition against coffee: representing to public consideration the grand Inconveniences accruing to their Sex from the Excessive Use of that Drying, Enfeebling Liquor, this scurrilous pamphlet claims to be a plea on behalf of the women of England which asks their men to stop drinking coffee, as it makes them unable to perform, thus leaving wives across the country languishing in a state of desperation.
To put this into context, coffee was an increasingly popular drink in 17th century Europe. It was mostly drunk in coffee-houses, where for just a penny, men enjoyed unlimited refills, access to the latest newspapers and a forum for intellectual discussion with other patrons; I wrote about the rise and fall of English coffee-houses in another post. Yet despite their enormous popularity, coffee and coffee-houses were not without their detractors. Serious-minded physicians published diatribes against the drink, and Charles II wanted to shut down coffee-houses as they were a potential hotbed of sedition. It’s no wonder, then, that a lot of satirical literature on the topic was printed. This pamphlet belongs in that category and shouldn’t be read as a serious social criticism, although some writers have mistakenly seen it as such. It probably wasn’t written by a woman at all; in fact, it scorns women by playing on the age-old stereotype of the gossiping woman unable to control her lustful appetites. However, what was calculated to entertain and make a quick profit back in 1674 still makes amusing reading today. Here is an abridged version with modernised spelling:
“The Humble Petition and Address of several Thousands of Buxom Good-Women, Languishing in Extremity of Want showeth, that ’tis Reckon’d amongst the Glories of our Native Country, To be AParadise for Women [due to] the brisk Activity of our men, who in former Ages were justly esteemed the Ablest Performers in Christendom; But to our unspeakable Grief, we find of late a very sensible Decay of that true Old English Vigour. Never did Men wear greater Breeches, or carry less in them of any Mettle whatsoever. There was a glorious Dispensation (’twas surely in the Golden Age) when Lusty Lads of seven or eight hundred years old, Got Sons and Daughters; and we have read, how a Prince of Spain was forced to make a Law, that Men should not Repeat the Grand Kindness to their Wives, above NINE times in a night: But Alas! Alas! Those forward Days are gone.”
“The Occasion of which Insufferable Disaster, after a serious Enquiry, and Discussion of the Point by the Learned of the Faculty, we can Attribute to nothing more than the Excessive use of that Newfangled, Abominable, Heathenish Liquor called COFFEE, which Drying up the Radical Moisture, has so Eunuched our Husbands, and Crippled our more kind Gallants, that they are become as Impotent and as unfruitful as those Deserts whence that unhappy Berry is said to be brought. For the continual sipping of this pitiful drink is enough to bewitch Men of two and twenty, and tie up the Codpiece-point without a Charm. They come from it with nothing moist but their snotty Noses, nothing stiff but their Joints, nor standing but their Ears. Nor can all the Art we use revive them from this Lethargy.
“Can any Woman of Sense or Spirit endure with Patience, that when privileged by Legal Ceremonies, she approaches the Nuptial Bed, expecting that a Man with Sprightly Embraces, should Answer the Vigour of her Flames, she on the contrary should only meet A Bedful of Bones, and hug a meagre useless Corpse rendered as sapless as a Kixe, and dryer than a Pumice-Stone, by the perpetual Fumes of Tobacco, and bewitching effects of this most pernicious COFFEE, whereby Nature is Enfeebled, the Off-spring of our Mighty Ancestors Dwindled into a Succession of Apes and Pygmies: and The Age of Man Now Cramp’t into an Inch, that was a Span.
“We have reason to apprehend and grow Jealous, That Men by frequenting these Stygian Tap-houses [coffee-houses] will usurp on our Prerogative of Tattling, and soon learn to excel us in Talkativeness: a Quality wherein our Sex has ever Claimed pre-eminence: For here like so many Frogs in a puddle, they sup muddy water, and murmur insignificant notes till half a dozen of them out-babble an equal number of us at a Gossiping. Though they frequently have hot Contests about most Important Subjects; as what colour the Red Sea is of; whether the Great Turk be a Lutheran or a Calvinist; who Cain‘s Father in Law was &c. yet they never fight about them with any other save our Weapon, the Tongue.
“Certainly our Countrymens’ palates are become as Fanatical as their Brains; how else is’t possible they should Apostatize from the good old primitive way of Ale-drinking, to run a whoring after such variety of destructive Foreign Liquors, to trifle away their time, scald their Chops, and spend their Money, all for a little base, black, thick, nasty, bitter, stinking, nauseous Puddle-water. Yet (as all Witches have their Charms) so this ugly Turkish Enchantress by certain Invisible Wiles attracts both Rich and Poor.
“Wherefore to the end that our Just Rights may be restored, and all the Ancient Privileges of our Sex preserved inviolable; That our Husbands may give us some other Testimonies of their being Men, besides their Beards: That they no more run the hazard of being Cuckolded by Dildo’s: But returning to the good old strengthening Liquors of our Forefathers; that Natures Exchequer may once again be replenished, and a Race of Lusty Hero’s begot to equal the Glories of our Ancestors. We Humbly Pray that henceforth the Drinking COFFEE may on severe penalties be forbidden to all Persons under the Age of Threescore. In hopes of which Glorious Reformation, your Petitioners shall readily Prostrate themselves, and ever Pray, &c.”
Slate magazine has created an ‘Interactive Game of Death’ in which you can find out what you might have died of had you been living at various points from 1647 to the present. It churns through historical English and American death records in order to come up with a list of the ailments and accidents which killed people in any one year. It’s a fun way to spend ten minutes, but more than that, it allows us an interesting glimpse into the shifting patterns of death and disease over the last three and a half centuries.
I’ve spent some time having a look at the results and have pieced together some interesting patterns. Sometimes these are difficult to explain, not least because of the bewildering variety of medical terms which confront the historian. There are some terms which are impossible to translate into modern medical terminology, and others, such as ‘fever’, are frustratingly vague. There are, however, some indications that socioeconomic developments could influence the spread of new diseases or contribute to the disappearance of old ones, as was the case with the rise of the industrialised city in 19th century Europe and North America. I have divided the patterns of mortality into four sections; seemingly ‘harmless’ killers, unusual or vague ailments, the rise of the industrialised city, and death in the 20th century.
Almost all of the diseases and ailments on the older historical death records can be treated today if caught in time. Despite this, some of their names still arouse a sense of dread. So terrible was their hold on the popular imagination at the time, that epidemics such as the Black Death and the Spanish Flu at once produce mental images of mass graves and deserted towns (the Black Death) and desperate parents all over the world unable to do anything for their previously healthy teenage children (Spanish Flu). We have not forgotten that these were deadly diseases.
It is not so with everything on the historical death records. Particularly in the older, pre-1800 records, there are many ailments which we would never associate with death. At first it seems odd to see toothache and worms listed as causes of death. Today, toothache is a painful nuisance, but no-one in the developed world should die from it if they have access to a doctor. We sometimes fail to appreciate that in an age before antibiotics and satisfactory hygiene (from a modern medical perspective), everyday complaints could turn fatal. Toothache was a routine ailment for almost everyone in pre-modern Europe. The best that could be done to combat it was getting some dodgy barber-surgeon to pull the offending tooth out with a pair of pliers. The worst consequence was death by septicaemia if the infection seeped into the blood.
Other illnesses and ailments listed in historical death records which are no longer linked with death in the popular imagination include indigestion, kidney stones, dysentery, worms, and teething. Teething is listed as a cause of death because the mercury used in many teething corals slowly poisoned the baby. Dysentery (then called the flux or the bloody flux, now better known as a form of gastroenteritis) was a a particular problem in places such as military camps. The overcrowding and particularly poor hygiene meant that contagion spread easily .
Unusual and vague ailments
‘Plague’, a catch-all term for bubonic or pneumonic plague, was one of the most feared killers in the medieval world. It was still endemic at the time of the earliest death record here (the London Bill of Mortality for 1647), yet in England, deaths from plague were almost unheard of after the Great Plague of London in 1665. It’s not entirely clear why it virtually disappeared from the records, but it did, putting an end to many centuries of terror of the ‘plague’ – only for new diseases to appear and terrify future generations with devastating epidemics.
Often in the pre-1800 records the causes of death are not unusual per se, but they are recorded in peculiar ways. For example, sometimes euphenisms were used to cover up deaths from sensual over-indulgence. Thus in 1801, someone in Porstmouth, New Haven, died of ‘debauchery’; probably what is meant is venereal disease. In 1647, a Londoner died of ‘surfet’ that is, vomiting from over-eating. Other causes of death are not just given unusual names, but would be deemed impossible now, as with the Londoner who is recorded as having died of grief in 1647. It’s easy enough to imagine how such a death record might have come into being. The authorities come round to the house to find out the cause of death; no one knows what it was, but the victim’s neighbour asserts that Tom or Mary has been prostrate with grief since their son died a year ago. The authorities promptly write ‘grief’ as the cause of death before moving on to the next person on the list. Thus, the record of ‘grief’ as a cause of death is not necessarily medical ignorance, though it raises a smile now.
One of the most vague terms to appear in historical death records, alongside ague (fever) and plague, is ‘brain fever’, which we find in English and North American death records in the 19th century. Retrospective diagnosis is always risky, but historians now speculate that brain fever may have been viral encephalitis. At any rate, its very vagueness made it a notoriously common plot device for 19th century novelists. Sometimes it feels as if it’s almost impossible to read a book by a Victorian author in which no character develops brain fever. Brain fever was a very useful literary device. It was relatively easy to introduce, as it tended only to be the reaction to a severe emotional shock, perhaps combined with having spent too long in the rain. It was an exciting disease, being always potentially fatal with a ‘crisis point’ to induce thrills in the reader, yet it was not contagious, so there was no danger of having to kill off any other characters. The high delirium into which it threw a character for several weeks meant that important secrets could be betrayed by the raving patient, which would introduce new intrigues and move the plot forward. To name only a few literary victims, Pip in Great Expectations, Cathy in Wuthering Heights and Marianne in Sense and Sensibility all suffer brain fever.
The rise of the industrialised city
Water supply was never particularly clean or reliable in cities, but in the 18th and 19th centuries, with the huge expansion of increasingly industrialised cities in Europe and North America, the problem of finding clean water became more acute than ever. The inadequate sewage system of the typical newly- industrialised city, together with the crowded and unsanitary living conditions, led to the rise of the water-borne diseases which would become terrifying killers until the 20th century, most notably cholera and typhoid fever. Aside from the poor water supply, the overcrowded, unhygienic conditions of the slums and tenements made contagious diseases such as diptheria, scarlet fever and typhus all too common. In the 19th century, American and British social reformers started drawing attention to slum areas, with the result that they were gradually cleared up by the authorities.
Death in the 20th century
The great shadow over the first decades of the 20th century was influenza, centering of course around the devastating Spanish Flu epidemic of 1918-19. Influenza was actually nothing new – its symptoms were clearly described by Hippocrates around 2,400 years ago – but it was from this period onwards that the illness was referred to by that name. Influenza is still listed as a cause of mortality in CDC Historical Data for the 1990s, though it is no longer the deadly, virtually untreatable threat of a hundred years ago. The mortality rate has greatly decreased, perhaps thanks to the availability of vaccinations and antivirals.
Other causes of death in the 20th century death records include tuberculosis (which faded away in the second half of the century), motor accidents, nephritis (inflammation of the kidneys), pneumonia and cerebrovascular diseases. Over the past few decades, the list of potentially fatal illnesses has narrowed considerably, and the majority of all illness-related deaths are now due to heart diseases, cancer, and to a lesser extent, diabetes mellitus. Sometimes these illnesses are treatable, but all too often they are still fatal.
The post was written from a western perspective as I was relying on English and North American death records. However, I must stress that many people in the developing world are still dying of diseases which Europeans and Americans imagine extinct, or ailments which are generally no longer fatal for us. In September 2011 there was a huge outcry over a 24-year old man from Cincinnati who died from toothache because he couldn’t afford the medical insurance which would have given him the antibiotics required to cure him. No such outcry is made every time someone in Africa dies of toothache, of cholera, or of childbed fever.
John Gaunt’s table of casualties in London (1629-1660)
Record of births and burials at Christ Church and St. Peter’s Church in Philadelphia (Dec. 25 1768-Dec. 25 1769)
Portsmouth, N. H., 1801 Bill of Mortality
Boston 1812 Bill of Mortality
Massachusetts mortality rates (1856-95) from “Mortality Changes in Amercia: 1620-1920”, Human Biology, September 1984. Vol. 56, No.3, pp.559-582
CDC Historical Data for 1910, 1920, 1930, 1940, 1950, 1960, 1970, 1980 and 1990
In my last post, on English and North American death records from 1647 to the present, I briefly mentioned how the development of the industrial city in 19th century Europe and North America changed patterns of disease and mortality. The dreadful overcrowding in the slums, together with a lack of adequate water supply, particularly encouraged contagious diseases such as cholera, typhus, scarlet fever, diptheria and typhoid fever. Slum districts were periodically ravaged by epidemics. The wealthy were of course also subject to epidemics, but they were probably in less danger as they lived in more sanitary conditions, had access to doctors and enjoyed a better diet.
As the 19th century wore on, more attention was drawn to the living conditions of the urban poor. The Victorian age saw an astonishing outpouring of philanthropic activity alongside the rise of political and social reform movements. In England, social reformers such as Henry Mayhew set about documenting poverty in an effort to bring the plight of the metropolitan poor to the public’s attention. In literature, Charles Dickens often portrayed the struggles of the urban underclass, most famously in Oliver Twist with its depictions of grim workhouses, child labour and London’s criminal underbelly.
One of the most infamous slums in London was Jacob’s Island in Bermondsey. The area was notoriously squalid and was described as “the very capital of cholera” by the Morning Chroniclein 1849. Both Mayhew and Dickens visited Jacob’s Island and were appalled by what they saw. Dickens was taken there by the Thames Police, with whom he would occasionally go on patrol. This gave him the inspiration for the ending of Oliver Twist; the principal villain, Bill Sykes, meets his death there in the stinking mud. Dickens describes Jacob’s Island in evocative terms:
“Crazy wooden galleries common to the backs of half a dozen houses, with holes from which to look upon the slime beneath; windows, broken and patched, with poles thrust out, on which to dry the linen that is never there; rooms so small, so filthy, so confined, that the air would seem to be so tainted even for the dirt and squalor which they shelter; wooden chambers thrusting themselves out above the mud and threatening to fall into it – as some have done; dirt-besmeared walls and decaying foundations, every repulsive lineament of poverty, every loathsome indication of filth, rot, and garbage: all these ornament the banks of Jacob’s Island”.
Henry Mayhew also described Jacob’s Island in a letter to the Morning Chronicle in 1848. Whilst perhaps less poetic than Dickens, Mayhew is more exact in his description, with a focus on the scientific aspects of the problem:
“On entering the precincts of the pest island the air had literally the smell of a graveyard, and a feeling of nausea and heaviness came over anyone unaccustomed to imbibe the moist atmosphere. Not only the nose, but the stomach told how heavily the air was loaded with sulphuretted hydrogen; and as soon as you crossed one of the crazy and rotten bridges over the ditch, you knew, as surely as if you had chemically tested it, by the black colour of what was once white lead paint upon the door posts and window sills, that the air was thickly charged with this deadly gas.
“The heavy bubbles which now and then rose up in the water showed you whence at least a portion of the metaphitic compound issued, while the open doorless privies that hung over the water-side, and the dark streaks of filth down the walls, where the drains from each houses discharged themselves into the ditch, were proofs indisputable as to how the pollution of the ditch occurred.
“The water was covered with scum almost like a cobweb, and prismatic with grease. In it floated large masses of rotting weed, and against the posts of the bridges were swollen carcasses of dead animals, ready to burst with the gases of putrefaction. Along its shores were heaps of indescribable filth, the phosphoretted smell from which told you of the rotting fish there, while the oyster-shells were like pieces of slate from their coating of filth and mud. In some parts the fluid was as red as blood from the colouring matter that poured into it from the reeking leather-dressers’ close by”.
Although the authorities were at first reluctant to do anything about Jacob’s Island – a policeman once tried to deny the very existence of the place when questioned by Dickens – by the early 1850s the ditches were filled and the area redeveloped as warehouses. Jacob’s Island was heavily bombed in World War Two and has undergone such considerable regeneration in recent decades that it is almost impossible, looking at it today, to imagine what a centre of pestilence and poverty it once was.