The many faces of death

The many faces of death

Paul Matthews explores the numerous strange terms to be found on old death certificates and the grim fates they evoke

Paul Matthews, a freelance writer who has written widely on family history

Paul Matthews

a freelance writer who has written widely on family history

The causes of death given on death certificates in the 19th and early 20th centuries can be vague, puzzling and even disturbing. Sometimes the names of diseases were just different from those used today, but they can also give an indication of the state of medical knowledge at the time. Unfortunately for family historians, the terms were often used inconsistently and diagnoses were sometimes wrong.

The causes of death referred to below can be encountered on old death certificates, and earlier in the London bills of mortality, where we find some truly alarming entries such as eaten by lice, twisting of the guts, overjoy (which appears to mean some form of excess) and horseshoe head, the latter being a condition in infants in which the sutures of the skull were too open.


Causes of death could be alarmingly vague, and even act of god is found. More common are nebulous conditions associated with old age, such as decay, exhaustion, atrophy – indicating the deceased wasted away – general decline, old age, decrepitude, wasting, weakness, debility and most commonly senility. The latter quite often featured as a contributory cause, as in the case of Elizabeth Pollentine from my family tree who died aged 87 in 1930, the causes given as arteriosclerosis and senility.

Sometimes the doctor seemed unsure of his own diagnosis, as in supposed heart disease, and unknown is quite often given instead of a specific cause, especially for infants in remote areas. Sometimes all the certificate tells us is the part of the body afflicted, as in kidney disease, disease of the bladder, and chronic disease of the stomach. We also see gas of stomach .

tuberculosis poster
This poster from the USA Works Progress Administration 1936-41 urges people to avoid tuberculosis by sleeping and eating well and getting enough sunlight

Before vaccinations became widespread, infectious diseases were rife and until the arrival of antibiotics they were frequently fatal. Many now rare contagious diseases were once common and are often found on death certificates, such as smallpox, cholera, diphtheria, whooping cough, scarlet fever – also found as scarlet rash and scarlatina – and typhus, also called camp fever. Typhoid is a disease unrelated to typhus, although confusingly abdominal typhus was a term for typhoid. Typhoid was also called gastric fever, slow fever and enteric fever, and was thought to have caused the death of Prince Albert in 1861, although the diagnosis is now controversial. Pneumonia was a common cause of death, and still is, but was also known under different names, such as lung fever and winter fever. It could kill people at a relatively young age compared with today. My great-grandfather Frederick Garland died of bronchopneumonia in 1917 aged just 50.

death certificate
The death certificate of the author’s direct ancestor Frederick Garland aged just 50 – he died of pneumonia, a common cause of death

The word corruption is sometimes given instead of infection, and ague was used generally to refer to any intermittent infection, although malaria was most often meant. Spotted ague was another term for typhus. The exact meaning of putrid sore throat is uncertain. It often overlaps with scarlet fever but at other times might refer to any condition involving pharyngeal pus. Putrid sore throat is mentioned by Jane Austen (1775-1817) in Emma (first published in 1815).

Pneumonia poster
A poster 1936-7, from the USA Works Progress Administration

Quite a few apparently innocuous conditions seemed to be fatal, with different explanations in each case. Seeing bedsores on a certificate implies the patient was bedridden whatever the underlying cause, but the diagnosis is not just archaic: recent Scottish government statistics show that 78 people died from bed and pressure sores between 2005 and 2009, with death certificates citing these sores as a contributory factor in 566 cases over the same period. Bilious attacks, literally just an attack of vomiting, like bilious fever, could indicate any one of a number of diseases, including hepatitis or typhoid. Biliousness could be jaundice and liver disease. Diarrhoea is frequently found, and often implies dysentery. Somewhat alarmingly catarrh frequently resulted in death, but it this was not the catarrh we associate with a cold. It most likely meant catarrh pneumonia or other conditions causing lung inflammation with catarrh. Catarrh cropped up in many guises: there was bronchial catarrh, bronchitis, epidemic catarrh, influenza, and even vaginal catarrh, leukorrhoea.


Many of us suffer from colic, cramping abdominal pain, without fearing for our lives, but it used to be found on death certificates, no doubt when such pain accompanied a fatal disease. Congestion had nothing to do with colds or nasal congestion, the term instead suggesting the accumulation of fluid, often further defined as congestion of the lung, brain, liver or other organ. There was also venous and arterial congestion. Cramp and lethargy occur from time to time as does dyspepsia, which could be a symptom of a heart attack. Indigestion is similarly found, although it may just have been a lazy diagnosis. Most surprising of all is itch, but this probably referred to scabies. Rheumatism is not uncommon and could relate to any number of diseases affecting the joints. Brain fever and brain congestion could indicate meningitis or perhaps encephalitis. Brain fever is mentioned by Arthur Conan Doyle (1859-1930) in some of the Sherlock Holmes stories.

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Infant mortality used to be higher than today with many babies dying before their first birthday, and doctors were not always meticulous about the cause of death. Teething killed off a great many babies but this is not quite as surprising as it seems; teething babies are especially vulnerable to fevers and in days of poor hygiene and before antibiotics dangerous infections could easily take hold. You might also find debility from birth and deficient vitality, but there may be a hidden reason for this high infant mortality. Teething remedies were liable to contain cocaine or opium, and many different baby soothing syrups were opium based, like Godfrey’s Cordial (nicknamed ‘quietness’) and Kopp’s Baby Friend, while Mrs Winslow’s Soothing Syrup contained morphine. These opiates suppressed the appetite and consequently many babies died from malnutrition often known as marasmus or inanition but sometimes recorded as starvation or lack of breast milk .

Charles Dickens death certificate
Charles Dickens’ 1870 death certificate: the cause given is apoplexy (stroke)

Sometimes unfamiliar words are used to describe familiar conditions, such as apoplexy for stroke, as given in Charles Dickens’ 1870 certificate, morbus cordis for heart disease, hydrophobia and canine madness for rabies, and falling sickness for epilepsy. The somewhat unsettling bloody flux meant bloody stools and usually equated to dysentery. Flux is similarly found, but this could also mean a haemorrhage or any other excessive discharge. The eerily poetic rising of the lights referred to a lung condition, lights meaning lungs. Dropsy was an accumulation of fluid somewhere, sometimes specified as, for example, of the leg or of the brain. Hydrothorax was dropsy in the chest. Grip was influenza or similar, also found as grippe (la grippe is French for flu). Syphilis appeared as bad blood, great pox and French pox, and gangrene as mormal and mortification. Croup, sometimes croup pneumonia, came in two varieties, one due to diphtheria and the other to a virus. Both affected the larynx and trachea, causing a hoarse cough. You will sometimes find pigeon fancier’s lung, a type of hypersensitivity pneumonia caused by exposure to pigeon or other bird droppings.

Alphonse ‘Al’ Capone
The gangster Alphonse ‘Al’ Capone (1899-1947), who died of tertiary syphilis

Hardness of the liver was most likely cirrhosis, but could also have been other liver conditions. We also find gripping in the guts, planet struck, suggesting a sudden affliction, especially paralysis, purples, a rash due to bleeding in the skin that could be symptomatic of a number of diseases, and softening of the brain, suggesting a brain haemorrhage. Paralysis of the insane meant tertiary syphilis or neurosyphilis, the condition given as the cause of death for the gangster Al Capone (1899-1947) and the philosopher Friedrich Nietzsche (1844-1900). It is also found as general paresis and paralytic dementia.

The vile sounding trench mouth, more properly called acute necrotising ulcerative gingivitis, is still with us, although seldom life threatening. This painful disease of gum ulcers was associated with malnutrition and poor dental hygiene, and our ancestors’ dental health was poor. The end of a wooden stick could serve as a toothbrush (it sometimes left splinters), while false teeth might be made out of wood, animal’s teeth, or even the teeth of poor people who sold them to make ends meet.

Those whose family trees extend across the Atlantic may encounter some unfamiliar conditions, for example Rocky Mountain spotted fever (otherwise called tick typhus, an infectious disease spread by Rickettsia bacteria), and milk sickness, which was caused by drinking milk or eating meat from cows that had fed on the poisonous white snakeroot. Abraham Lincoln’s mother, Nancy, may have died from milk sickness in 1818. In the same year the American statesman and founding father Gouverneur Morris died in a most unusual way when he inserted a whale bone in his urinary tract in an attempt to relieve a blockage.

The UK has also seen its share of strange deaths as a trawl through old newspapers can reveal. According to an 1844 issue of the Dundee Courier, a 22-year-old woman died because her corset was too tight. An 1893 edition of the Yorkshire Evening Post reports a man dying from swallowing a billiard ball, and a 1904 edition has a death due to swallowing false teeth.

Life was hard for our ancestors and doctors often made things worse. Tobacco smoke enemas were fashionable in the early 1800s, toxic mercury long featured in many medicines, and surgical tools included haemorrhoid forceps and tonsil guillotines. Cocaine was found in many 19th century medicines, and cough drops could contain heroin. There were also hazardous recreational drugs. There were laughing gas parties in the 18th century and ‘ether frolics’ in the 1830s, but opium was the more usual drug of choice. Among its many users were Florence Nightingale (1820-1910), King George IV (1762-1830), William Wilberforce (1759–1833) and Samuel Taylor Coleridge (1772-1834).

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