It can be a little uncomfortable to consider our own mortality but, as we shall see, in the modern era we are a lot more fortunate than our forebears. The commonest causes of death in the UK in the 21st century are largely medical conditions related to older age or which are more likely to kill older people. They include dementia, heart disease, stroke, various cancers, and chest complaints such as bronchitis, influenza and pneumonia. You can see detailed analysis of current trends on the Office for National Statistics  website.

If we travel backwards in time to, say, 1930 then some differences begin to emerge. Heart disease, stroke and chest complaints still feature prominently. However, the third biggest cause of mortality in 1930 was tuberculosis, often known as consumption or phthisis pulmonalis, a condition which commonly affected young people. Sadly, infections in babies were also common then because there were no antibiotics and few vaccines in 1930. Another interesting difference is that accidents appear in the top 10. This was to some extent driven by the absence of meaningful health and safety legislation. Health and safety is sometimes derided in the 21st century when it is taken to ridiculous extremes, but before such legislation existed many people were killed in accidents at work or when going about their daily business. There was a lack of sensible safety standards, and little accountability when people were adversely affected. Apart from workplace accidents, drownings, accidental poisonings and fires were other common accidents.

Continuing our time travel back to the early Victorian era, I have chosen the year 1838 for comparison. Data for this year is available for England and Wales from GRO death certificates which were collated by the Registrar General to produce an annual report. In this year the top cause of death was tuberculosis. In fact, a number of other infections feature in the top 10, including typhus (a disease also known as ship’s fever or gaol fever), pneumonia, smallpox and whooping cough. The last of these is principally an infection affecting young children. The top 10 also includes convulsions as the third leading cause of death. These fits or seizures were often a sign of infection in babies and infants. So you can already see that at the beginning of the Victorian era deaths in children were a lot more common than they are today.

Another trend that becomes more common as we go back in time is for very vague diagnoses. Often symptoms such as the aforementioned convulsions are treated as diseases in themselves. For example both ‘old age’ and ‘debility’ feature in the top 10 for 1838. Debility means generalised weakness and so could include anything from starvation to wasting diseases such as cancer. Interestingly, heart disease does not feature at all in the top 10. This is perhaps partly because fewer people lived to an old enough age to experience a heart attack, but also because in former times the heart was thought not to be affected by disease. Accidents still feature in the top 10.

If we want to go back in time before the civil registration of births, marriages and deaths then it is not possible to obtain a nationwide set of data. However, in some cities bills of mortality were regularly published in the 17th and 18th centuries. These were created when causes of death were reported after bodies were bought for burial by the Church. Usually the people determining the cause were not medically qualified and so some caution needs to be exercised when interpreting the data. Some causes of death were very obvious – even to the layman – such as smallpox, whereas others were capable of misinterpretation. This also partly explains why very vague symptomatic diagnoses become increasingly common. If you look at the bills of mortality for London in the 1750s, the prevalence of infection as a cause of death is overwhelming. The four most common reasons identified for dying were convulsions, tuberculosis, fever and smallpox. As already noted, convulsions were often a symptom of infection in babies, whereas fever is a very common symptom in all sorts of infections such as scarlet fever, influenza and typhoid. Sadly, deaths of babies due to miscarriage or stillbirth was so common that this too now features in the top 10.

Fascinatingly, teeth were commonly identified as a cause of death. There are all sorts of reasons for this. Rotten teeth can cause septicaemia and death, and this may account for some cases. However, when a body was bought for burial, visual evidence of rotting teeth or relatives explaining that the deceased had toothache in the run-up to dying were often noted down as a potential cause of death. In mediaeval times it was believed that small worms lived in people’s teeth and that they could be harmful. So there was a general suspicion about the dangers of one’s own teeth.

Bills of mortality for London go back to the 17th century too. If we study causes of death in London for the 1660s we see a similar trend to the 1750s in that infections and vague diagnoses predominate. Added to this, of course, is the great plague of 1665. In that year, 97,306 people died in London but 68,596 died of plague, so it accounted for nearly 70 per cent of all deaths. By comparison deaths from tuberculosis, otherwise a leading cause of death in any year, accounted for only 4,808 deaths. Another common cause of death which makes it into the top five causes in the 1660s is ‘griping in the guts’. Again it is a very generalised symptom-oriented diagnosis. It must have embraced a wide range of diseases from dysentery and appendicitis, to ulcers and bowel cancer.

The obvious importance of infection as a cause of death in the past means that, by and large, children and young people were much less likely to make it into adulthood. We can get an idea of this effect by measuring life expectancy. This is defined as the average number of years a newly born baby can expect to live. It can be calculated by adding up the age of everyone who died in a particular year, and dividing it by the total number of deaths. In 2018 the life expectancy in England and Wales was about 80 years of age. To be more precise it was 79.2 years for a newborn baby boy and 82.9 years for a girl. If we look at these figures for earlier times the life expectancy is dramatically worse. As recently as 1950 the life expectancy was only about 68, and in 1900 it was 47. In 1500 it has been estimated at only about 35 years of age. The main reason for these low figures is the deaths of huge numbers of babies and children. Note that a life expectancy of, say, 35 does not mean that no one lived beyond that age, because it is an average figure.

There are many reasons for the lower life expectancy that our ancestors had to endure. Since infection was such a common cause of death, it is easy to prove that the absence of vaccines and antibiotics is the biggest factor that ensured our ancestors had shorter lives on average. But there are many other reasons including poor sanitation and lack of knowledge of good hygiene, malnutrition and poor living conditions. Many people lived in damp, cold and crowded places which made the spread of infectious disease easy and inevitable. Healthcare in past eras was often weak, ignorant and expensive, and welfare support for most people was exceedingly limited. It was only in the late 19th century that it was accepted that bacteria could cause human disease, and the first decent commercially available antibiotic, penicillin, was not widely available until after the Second World War.

The importance of vaccination in preventing children dying cannot be overemphasised. In 1861, for example, when the population of the UK was about 30 million people, 12,309 children died of whooping cough, a disease which is nowadays completely preventable by childhood vaccination. In addition 9,055 children died of measles and 4,517 died of diphtheria in 1861. Again these infections are prevented by modern vaccines. Out of interest 9,077 children also died of scarlet fever in 1861, an infection that is now easily treated by penicillin. These four causes alone accounted for nearly 35,000 deaths of young children, and mercifully in the 21st century these deaths are all preventable.

In summary, the medical reasons for people dying these days are often diseases of older age such as dementia and heart disease. The further you travel backwards in time the more likely it is that your ancestor died of a simple infection which these days would be prevented by vaccines and good hygiene or treated by antibiotics. This all goes to show how very fortunate we are to live in this century since so many of us would never have survived into adulthood in former times. {