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TERMINAL DISEASES IN THE PARISH OF DERRIAGHY, CO. ANTRIM, 1827-1927

William Kerr

 Until the burial of Samuel Duncan of Magheralave in Derriaghy parish churchyard on 29 November 1827, entries in the parish burial registers did not include the cause of death. On that occasion, however, and for some unknown reason, the curate at the time, Rev. E.J. Cordner, recorded that Duncan died of cancer. In doing so, Cordner started a practice which was to last for one hundred years, with the exception of an unexplained break of eight years between 1834 and 1842. From 1827 until 24 May 1834, the clergyman who conducted the burials entered the causes of death in the burial register. After the break referred to above, it was the sexton who recorded the causes of death, not in the official parish register, however, but in his day book. This custom began on 22 August 1842. The number of entries exceed six thousand, the last being made at the burial of Paul McHenry of Lagmore on 24 January 1927.

This record1 of the causes of death of some six thousand persons buried in Derriaghy parish churchyard over a period of a century, has never been published, still less analysed for any value it might have for medical or other research. Such an analysis is for the specialist. The object of this article is merely to draw attention to the existence of the record, to summarise it and to raise a number of questions about its value. It is proposed to group the diseases into blocks, usually covering ten years, for to lay them out year by year would occupy too much space in a journal of this size. The major causes of death in each of these ten year periods will be shown by percentages, indicating the proportion of persons who died from those diseases. Where the percentages of those dying of a particular disease falls below one per cent, such diseases will be entered without a percentage figure. For example, in the period 1843-9, influenza was among the diseases causing less than one per cent of deaths; it is therefore obvious that it was a very insignificant terminal disease among the four hundred and fifty one persons who died in that period. However, where in any given year within a ten year period a major change took place, a brief comment will be made.

There are ten groups of diseases, labelled A to J. Group A consists of diseases entered in the official pariah register covering the years 1827-34, while the succeeding groups are taken from the sextons' day books which seem to have been kept most meticulously and were actually more reliable in respect of the number of burials than the official registers: the incumbents tended not to record burials which were performed by ministers who were not members of the Church of Ireland. Group A is consequently a less reliable guide to the number of burials and the proportion of diseases causing death than the other groups. No sexton's day book survives for the period 1827-34, if indeed there ever was one.

GROUP A, 1827-34 
Number of burials, 317; average age at death, 37.

Diseases Percentage of deaths attributed Less than I%
Consumption 21.5 Water on chest
Old age 17.7 Child birth
Convulsions 9.1 Cholera
Asthma 5.0 Liver
No cause given 3.7 Epilepsy
Mortification 3.7 Drowned
Fever 3.1 Suffocated
Debility 3.1 Hydrocephalus
Paralysis 2.5 Atrophy
Dropsy 1.9 Accident
Smallpox 1.9 Water on bowel
Decline 1.9 Burned
Whooping cough 1.6 Cancer
Measles 1.6 Carbuncle
Scrofula 1.6 Croup
Decay
Inflamation 1.6 Hydrothorax
Contract l.3 Inanition
Lungs
Puerpural Fever
Ruptured blood vessel

The Census of 1841 included notification of the causes of all deaths in Ireland between 1831-41. In 1843, the eminent Dublin surgeon William Wilde2 submitted a lengthy report to parliament, featuring an analysis of the deaths contained in the Census3. He expressed serious doubts about the validity of many of the diagnoses and suggested that in many cases, the condition given as the cause of death may have been mistaken for another disease, or may have been the last symptom before death but arising from an existing, perhaps undiagnosed, underlying disease.

Of the diseases listed in Group A above, he cautioned against a too-ready acceptance of the terms 'inflammation, convulsions, mortification and dropsy,' to name but a few. For example, on 'inflammation', which occurs regularly in the lists given in this article, he wrote: 'No term is in more general use and none more vague and indefinite, which from its being either the proximate or remote cause of death, might be applied to at least one-half of the diseases specified in the Nosology'. (Nosology is the branch of medicine concerned with the classification of diseases). The term 'contract' which appears in Group A above (but not in the Census returns) occurs frequently in the lists featured here. So far, it has not been possible to identify its medical nature or its symptoms. 'Paralysis', which also appears regularly, is probably a stroke or cerebral haemorrhage.

GROUP B, 1843-9 Number of burials, 451; average age at death, 35.

Diseases Percentage of deaths attributed Less than 1 %
Decline 32.3 Childbirth
Old age 15.5 Insanity
Fever 9.0 Lightning
Contract 9.0 Bowel
Not known 7.7 Ulcer
Scarlatina 5.7 Influenza
Inflammation 2.4 Smallpox
Cholera 2.3 White surling
Dysentery 2.3 Sudden death
Whooping cough 2.3 Nerves
Asthma 1.9 Foundered
Paralysis 1.3 Drop on brain
Accident 1.1
Cancer 1.1
Dropsy 1.1
Measles 1.1

The most striking feature of this group is the large increase in the number of deaths from decline, which was often an alternative term for consumption. (It is noticeable that this latter term is missing from Group B). This period, 1843-9, includes the Famine years; the increase in decline may therefore be attributable to the effects of the potato blight. During the Famine, deaths from decline rose substantially in Derriaghy, as shown by the following figures: 1843-twenty-four; 1844-seventeen; 1845-twenty-six; 1847-twenty-one; 1848 - fifteen.

As consumption is normally a disease of slow growth, it is possible that decline covered other diseases which may have been caught through contact with immigrant Famine sufferers. The increase in deaths from fever may perhaps have been due to the well-attested movement of sick people from the stricken west of Ireland to the east. Deaths from fever (probably typhus) rose from two in 1845 to seven in 1846 and twenty-three in 1847, falling to four in 1848. The increase in scarlatina deaths rose from one in 1844 to twenty-two in 1845, with a sharp drop in 1846. This scarcely allows time for the sickness to have spread from the west. This outbreak may therefore have been a purely local one. The mysterious ailment, 'contract', rose sharply in this period in comparison with 1827-34, but it was most prevalent in 1844 and thus scarcely even an indirect result of the Famine. The condition known as 'white sailing' appears to have been the local pronunciation of 'white swelling,' which Wilde stated appeared at the joints.

GROUP C, 1850-9
Number of burials, 606; average age at death, 33.

Diseases Percentage of deaths attributed Less than 1 %
Decline 29.0 Brain; drop on; fever; Sudden death
Old age 15.0 inflammation Bowel Hive;
Contract 5.7 Burned Inflammation
Scarlatina 4.7 Apoplexy Coma
Inflammation 3.9 Bilious Gastric fever
Fever 3.7 Lungs inflammation Gravel
Whooping cough 3.6 Measles Inward complaint
Dropsy 3.5 Spine Knee inflammation
Dysentry 3.4 Erysipelas Nerves
Smallpox 2.3 Influenza Quinzy
Asthma 2.2 Liver cancer Suicide
Croup 1.9 Worm fever Ulcer
Chest inflammation; 1.6 Childbirth
water on Rheumatism
Heart failure 1.6 Hip disease
Head inflammation; 1.6 Drowned
water on Diabetes
Paralysis 1.6 Convulsions
Accident 1.3 Stomach cancer

The chief feature of this period seems to be either greater discrimination between causes of death or merely an increase in the diseases which occurred. The main killers are much as in the previous period, though fever decreased and there was an increase in deaths from whooping cough, croup, dysentery, smallpox and chest, head and heart ailments. Water on the chest may have been pleurisy; inflammation of the same may have been pneumonia. Drop on the brain and inflammation could perhaps have been meningitis; water on the brain was possibly a stroke. Bowel hive and bowel inflammation were probably some kind of enteritis.

GROUP D, 1860-9
Number of burials, 597; average age at death, 35.

Diseases Percentage of death attributed Less than 1%
Decline 28 Burned Died on road
Old age 13 Cancer Influenza
Scarlatina 6.5 Chest inflammation Gastric fever
Asthma 5.1 Apoplexy Insanity
Inflammation 3.6 Childbirth Sudent
Croup 3.1 Diptheria Leg inflammation
Head inflammation; 3.1 Liver; disease of; Mortification
water on inflammation of Sunstroke
Bronchitis 2.8 Kidney; water on
Consumption 2.8 Rheumatism
Fever 2.8 Spine
Heart failure 2.5 Stomach; abscess;
Contract 2.4 cancer
Dropsy 2.3 Teething
Paralysis 2.2 Throat; cancer;
Whooping cough 1.6 inflammation of;
No cause 1.6 lump on
Brain congestion 1.3 Bowel; inflammation of
nerve; water on Cholera
Measles 1.3 Smallpox
Accident 1.1 Ulcer
Lung disease; 1.1 Worm; worm fever
inflammation of Convulsions

No major change in the pattern of fatal disease is noticeable in this decade, except for the temporary disappearance of pneumonia, which may have been concealed under one or more of the other chest conditions listed. The alternation between names of diseases recognizable as accepted medical terms and apparently vernacular names continued. New examples of the latter include nerve on the brain, lump on throat (goitre?), hip disease (tuberculosis of the hip joint?), teething (which Wilde thought was used widely for gastro-intestinal complaints as well as infantile dental conditions), ulcer (any condition with ulcers as the obvious symptom) and leg inflammation (phlebitis?). These terms seem unlikely to have been used by a doctor. One is tempted to conclude that while the better educated and perhaps more intelligent members of the community used the appropriate medical name. the rest of the population adhered to the vernacular terminology. Unfortunately we have no knowledge of those who consulted a doctor, or those who made their own diagnosis or perhaps used a `wise woman'.

GROUP E, 1870-9 
Number of burials, 676; average age at death, 38.

Diseases Percentage of deaths attributed Less than 1%
Decline 27.3 Lungs; congestion on;
Old age 18.1 inflammation
Bronchitis 9.6 Cancer
Scarlatina 5.1 Fever
Inflammation 4.4 Contract
Paralysis 3.9 Gastric fever
Heart, blood on; 3.4 Pox; black
failure Diptheria
Head inflammation; 3 Rhuematism
nerves on; Worm fever
water on; Consumption
Not known 2.4 Apoplexy
Croup 2.2 Debility
Asthma 1.7 Drowned
Dropsy 1.6 Nerves
Accident 1.3 Throat inflammation;
Brain; congestion on; 1.3 lump on
effluence on; Ulcer
inflammation; Bilious
water on Bowel inflammation
Liver; disease of 1.1 Diabetes
Childbirth 1.1 Diarrhoea
Kidney 1.1 Dysentery
Measles 1.1 Gravel
Stomach cancer; 1.1 Hip disease
ulcer of Leg inflammation
Spine

Despite a threefold increase in the number of deaths attributed to bronchitis and a rise in deaths due to heart conditions, the average age at death rose from thirty-five in 1860-9, to thirty-eight within this period. More people were living to a good old age within this decade as opposed to the previous one: one hundred and twenty-three, as compared with seventy-eight in the decade 1860-9.

GROUP F, 1880-9 
Number of burials, 748; average age at death, 35.

Diseases Percentage of deaths  attributed Less than 1%
Decline 25.4 Brain; congestion; Hand cancer
Bronchitis 14.5 softness; water on Lockjaw
Old age 14 Consumption Ulcer
Not known 5.7 Rheumatic fever; pains Scrofula
Head congestion; 3.6 Apoplexy Hip
inflammation; Croup inflammation
water on Gastric fever Internal
Paralysis 2.9 Measles disease
Cancer 2.8 Asthma Neck
Heart failure 2.8 Childbirth inflammation
Dropsy 2.4 Drowned Neuralgia
Influenza 2.4 Mortification Ulcer
Whooping cough 2 Stomach cancer;
Lung congestion; 1.8 inflammation
inflammation of Throat cancer;
Accident 1.6 inflammation
Scarlatina 1.6 Worms; fever
Nerves 1.4 Abdominal abscesses
Complication of 1.3 Chest ulcer
diseases Contract
Kidney; inflammation 1.6  Diarrhoea
Spine  1.6 Cold fits

This decade is marked by a further increase in the number of fatalities caused by bronchitis, namely a rise from sixty-five in the decade 1870-9, to one hundred and nine. The increase was not sudden; from 1870 deaths from bronchitis had been rising steadily, from three in that year to fifteen in 1889. The curious `complication of diseases' occurs for the first time within this decade. Cold fits may have been convulsions without fever, worms and worm fever were perhaps (respectively) anaemia from tape worm and enteritis.

GROUP G, 1890-9 
Number of burials, 679; average age at death, 36.

Diseases  Percentage of deaths attributed  Less than 1%
Decline 21.3 Brain abscess; Syncope
Bronchitis 12.6 congestion; fever Abscess
Old age 10.3 Suffocation Coma
Lungs inflammation; 5.4 Typhoid fever Womb
congestion Childbirth cancer
Nerves 4.4 Convulsions Tumour
Paralysis 3.6 Liver cancer; Lockjaw
Dropsy 3.3 disease of; Scarlalina
Heart; tumour; 2.6 enlargement Sudend
inflammation Blood poison Suffocation
Complication of 2.5 Rheumatism; Suicide
diseases fever; pains; Throat
Cancer 2.3 Spine; abscess cancer
Diarrhoea 2 Not known Tongue
Influenza 1.9 Consumption cancer
Measles 1.9 Croup Delirium
Kidney; inflammation 1.7 Hip disease tremens
Burned 1.6 Stomach cancer Haemorrhage
Head abscess; 1.6 Bowel inflammation; Marasmus
inflammation; cancer; congestion
water on Diabetes
Diptheria 1.4 Drowned
Whooping cough 1.4 Ulcer
Asthma 1.3 Erysipelas
Gastric fever 1.3 Fever
Accident 1.1 Phthisis

These years saw a significant fall in the number of deaths due to decline and bronchitis, which more than outweighed an increase in deaths attributed to heart and lung disorders. It is interesting to note the first appearance of the modern medical terms phthisis and syncope and - oddly - the very old term marasmus, which one would have expected to have seen in earlier decades, since it was prominent among the diseases described by Wilde in 1843. (Marasmus seems to have been a generic name for any wasting condition). The number of cases of nerves trebled; this is thought to have been convulsions in infants. Sudent may have been sudden death.

GROUP H, 1900-9 
Number of burials, 612; average age at death, 37. 

Diseases Percentage of deaths attributed Less than 1%
Decline 19.1 Childbirth Hip disease Bilious
Old age 15 Fever Joint Coronas
Bronchitis 10.2 Influenza Accident Debility
Heart failure 6.8 Meningitis Apoplexy Eczema
Not known 5.7 Nerves Enteritis
Pneumonia 5 Consumption Bone cancer Epilepsy
Dropsy 3.4 Liver; cancer; Brights Erysipelas
Lungs congestion; 3.4 enlargement Cholera Fruttis
inflammation Spine; dislocation Diabetes Gravel
Paralysis 3.4 Stomach; ulcer Killed Head
Cancer 3.2 Bowel decline; Measles congestion
Complication of 1.9 inflammation Operation Indigestion
diseases Burned Teething Kidney
Asthma 1.3 Congestion Tuberculosis Lope on
Whooping cough 1.3 Croup Typhus putters
Diarrhoea 1.1 Gastric fever Appendicitis Rupture
Inflammation 1.1 Peritonitis Scarlatina Suicide
Syncope Tetanus

The number of fatal conditions was higher in this decade than in any earlier one and perhaps indicates a greater usage of doctors, combined with more accurate diagnostic skills on the part of the medical profession. Although most of the old names still persist, tuberculosis, meningitis, appendicitis, eczema, peritonitis and tetanus are recorded for the first time. It is unlikely that this decade saw their first occurrence but under which name they were previously recorded, it would be foolish to speculate. Lope on puden was almost certainly hernia, that is, a loop in the bowel or possibly appendicitis. Cocoma was in all likelihood coma. This period saw a further drop in cases of decline but a rise in heart failure. Notwithstanding, the new century saw the average life expectancy increase by one year.

GROUP I, 1910-19 
Number of burials, 524; average age at death, 46.

Diseases Percentage of deaths attributed Less than 1%
Old age 24.8 Whooping cough Diptheria
Heart failure 14.1 Accident Epilepsy
Bronchitis 7.8 Diabetes Fever
Not known 7.7 Brain; congestion; Haemorrhage
Brain-stroke 5.3 brain and kidney Nerves
Decline 6.1 water on Asthma
Consumption 3.6 Kidney Childbirth
Cancer 3 Lung congestion; Bowel inflammation
Tuberculosis 2.4 inflammation Bronchial pneumonia
Convulsions 2 Scarlatina Exhaustion
Dropsy 1.7 Appendicitis Hip disease
Meningitis 1.7 Brights Inflammation
Influenza 1.5 Liver Jaundice
Paralysis 1.3 No cause Measles
Debility 1.1 Pleurisy Nephritis
Premature
    birth Rheumatism
    Stomach; ulcer Sarcoma
    Blood poison Ulcer
    Croup  

This decade encompassed the great 'flu epidemic of 1919 but the yearly figures do not reflect its influence. The most dramatic feature of the period is the very large drop in deaths from decline, which fell by eighty-five. Curiously, the drop took place during the First World War, during which only one death from decline was recorded. The first half of the decade, on the other hand, had the usual large number of deaths from this particular cause. This phenomena might have been explained by the fact that so many men were away at the war-except for the fact that female deaths from decline were also non-existent. Conversely, the number of persons dying of old age increased considerably, suggesting that the health of the community improved during this period (although deaths from heart failure doubled). If the causes of death in the 7.7% whose condition was not recorded were known, undoubtedly a somewhat different picture would have ensued. As with the previous decade, more sophisticated medical terms were being used, such as jaundice, nephritis, sarcoma and bronchial pneumonia.

GROUP J, 1920-7 
Number of burials; 336, average age at death, 47.

Diseases Percentage of deaths attributed Less than 1%
No cause 24.1 Dropsy Whooping cough Ulcer
Old age 15.1 Contract Congestion Throat trouble
Heart failure 11.3 Diptheria Debility General paralysis
Tuberculosis 4.7 Epilepsy Decay Sleeping sickness
Pneumonia 4.6 Haemorrhage Erysipelas Teeth
Consumption 2.3 Influenza Gastritis Spina bifida
Bronchitis 2 Killed Cerebral haemhorrage
Stroke 1.7 Peritonitis Head
Accident 1.7 Rheumatism Inflammation
Paralysis 1.7 Scarlet fever Internal complaint
Senile decay 1.7 Tetanus Kidney
Cancer 1.4 Cerebral apoplexy Liver inflammation
Appendicitis 1.1 Arthritis Malignant
Convulsions 1.1 Anthrax Meningitis
Diabetes 1.1 Blood poison mental disease
Lung congestion; 1.1 Brights Nerves
inflammation Bronchial pneumonia Shock

Recording of causes of death ended abruptly in January 1927 and was never resumed, a great pity, as another twenty years would have taken the records into the era of antibiotics. Probably, then, one would have seen the disappearance of the longstanding unspecific terms which had been decreasing in use over the decades. In these final years, the transformation from the vernacular to the precise is noticeable-cerebral apoplexy, cerebral haemhorrage, sleeping sickness, spina bifida. The still unexplained contract lingered on (with two cases). Indeterminate terms also still occurred-malignant, internal complaint mid so on, but they were much fewer than before. The most dramatic change, however, was in the disappearance of decline, which had been the main cause of death between 1843 and 1909.

This concludes the introductory survey of terminal diseases among persons buried in Derriaghy parish churchyard over a period of one hundred years. Many questions about the findings remain unanswered. If all parishes had kept such records of causes of death, it would have been possible to determine whether the situation as regards diseases in Derriaghy was typical. In 1837 Thomas Fagan wrote in the sheets he compiled for the Ordnance Survey Memoir for Derriaghy, 'Climate in general believed to be very healthy. The latter corroborated by the extent of longevity at present in the parish. 4 The burial register shows that of the sixty-one persons buried in Derriaghy churchyard in 1837, 26.2% had reached or passed the age of seventy, a percentage much higher than indicated in later years, when the fuller records of the sextons' daybooks began. However, the county percentage for deaths from old age and debility in 1837, as shown in the 1841 Census, was 26.8% -very similar to the Derriaghy percentage for that year. If a high incidence of longevity is an indication of a healthy community, perhaps Fagan's comments on the healthiness of the Derriaghy climate was true of the years during which he was writing. By 1843 the percentage of deaths from old age had fallen to 15.5 and rose only twice by 1927. Had the climate changed or had people become more prone to diseases of a mortal nature? Had medical diagnosis become exact?

Another question which must be considered is one which was raised earlier. How many of the sick actually consulted a doctor? The nearest medical practitioner was located in the dispensary in Lisburn and (later) in Dunmurry. Without access to death certificates giving the professional medical causes of death, or to dispensary records giving diseases treated in persons from Derriaghy, it is difficult, if not impossible, to decide whether the causes of death were those supplied by a doctor to relatives of the dead, or whether some -or many - causes were home-produced diagnoses, expressed in vernacular rural language. The principle feature revealed in this article, from these tables of deathdealing diseases, is that for the majority of people in Derriaghy in the nineteenth century, life was short. The main killer was decline. Whether it meant consumption or a variety of conditions including or resembling it, it hung over a great many people like a sword of Damocles-merely threatening to fall but certain to do so.

References

1. The record is in the custody of the incumbent. I am indebted to the Very Reverend W.N.C. Barr for permission to make use of the parish records for the purpose of this article. I am also grateful to Dr. G.M. Colquhoun, for her assistance with the medical terms used here.
2. Wilde, who received n knighthood in 1864, was the father of Oscar. the playwright and author.
3. William Robert Wild, Esq., Census of Ireland for the year 1841: Report upon the Tables of Death.
4. On p.79.

William Kerr has devoted considerable study to the history of Derriaghy parish and together with the Very Reverend W.N.C. Burr, has published A Short History of Derriaghy; Christ Church. Derriaghy: Grave Inscriptions; The Oldest Register in the Parish of Derriaghy and Ordnance Survey Memoirs for the Parish of Derriaghy.