Volume 8 1991

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.