What did people die of in the past?

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.
Results for the year 1647, from Slate magazine's 'Interactive Game of Death'
Results for the year 1647, from Slate magazine’s ‘Interactive Game of Death’

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.

‘Harmless’ killers

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.

Tooth extraction in the early 19th century
Tooth extraction in the early 19th century
Advertisement for cocaine tooth drops. New York, 1885
Advertisement for cocaine tooth drops. New York, 1885











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.

Plague victims being carted away for burial. London, 1665
Plague victims being carted away for burial. London, 1665

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.
A Glaswegian slum in 1871. Cramped conditions and a conspicuous lack of adequate sewage and water supply systems ensured that such areas were rife with diseases such as cholera, typhus and typhoid fever
A Glaswegian slum in 1871. Cramped conditions and a conspicuous lack of adequate sewage and water supply systems ensured that such areas were rife with diseases such as cholera, typhus and typhoid fever


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


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