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Breaking the Medical Code: Understanding Outdated Medical Terminology

by Donna Przecha

Have you ever eagerly perused the death certificate of an ancestor looking for the cause of death only to find words that appear to be English but had no meaning to you in this context? On modern certificates we expect to see unfamiliar medical terms such as "myocardial infarction," "carcinoma" or "arteriosclerosis." A quick look at a dictionary or medical dictionary reveals that these are heart attack, cancer and hardening of the arteries. But what do you make of "dropsy," "consumption," "apoplexy," or "softening of the brain?" Were these exotic diseases that have vanished from the face of the earth or do they have modern equivalents?

Archaic Names

Fortunately many have faced this problem and there are several places to look for modern translations including the Genealogy Glossary and Dr. Paul Smith's exhaustive 26 page list. Modern medical names tend to be descriptive of how the affliction is operating in the body — such as auto immune deficiency syndrome (AIDS). Prior to the 19th century, doctors didn't have lab tests, x-rays and autopsies to tell them what was really going on so the terms tended to describe symptoms they could observe or of which the patient complained. These are not precise diagnoses in the modern sense. It can be helpful to read the description on more than one list to get a better idea of what the doctors were observing.

Dropsy, also called edema, meant water retention and swelling. This isn't too helpful as a cause of death, but such a symptom is often caused by heart or kidney problems. Consumption usually indicated tuberculosis, but it actually described a wasting away of the body, so it could refer to other illnesses. Apoplexy and softening of the brain both indicated symptoms of a stroke. Many diseases are accompanied by fever and so dozens of illnesses had "fever" in the name. This is not a family of diseases and the only thing any two might have in common would be a high temperature.

With some of the more common diseases, one almost has a complete description of the disease just from a list of names by which it was called.

Descriptive Fevers

Malaria is caused by a parasite that is transmitted to humans by a mosquito bite. It causes bouts of fever and sweating and is not always fatal, but it is reoccurring. It has been called "periodic," "remitting" or "paroxysmal" (sharp recurrence) fever. It is also known as "jungle," "swamp" or "marsh" fever (mosquitoes breed in warm, swampy areas). Malaria means "bad air" referring to the bad smell of stagnant swamp water. It was not until 1897 that it was discovered that the mosquitoes that lived around the malodorous swamps were the actual culprits. A more apt name might have been "Mosquito Fever" but the name "malaria" was entrenched by the time the true cause was known.

Typhus is caused by a microorganism transmitted between humans by fleas, ticks and human head and body lice. It is characterized by high fever and a rash. Body lice proliferate among groups of people living close together who are not too particular about their personal hygiene. The various names explain where such people could be found and where the disease often was epidemic: "ship," "war," "trench" (where armies were found), "camp," "hospital" and "jail" fever. It was also called "spotted," "petechal" (referring to a bloody spot on the skin) and "putrid" fever. It was not until 1910 that the cause of what should have been "Louse Fever" was discovered.

Black Plague

Causes of death in the past were quite different from what you will find today. One of the most destructive was the Black Plague or Black Death. While being probably one of the most deadly diseases known to man, it is also one of the best documented. The disease is still in existence today and occurs throughout much of the world, including the Western United States. The most common form is Bubonic Plague which is spread by fleas on infected rats and is characterized by swelling of the lymph glands (buboes). It can spread to the lungs and become pneumonic plague, which is spread by coughing and is highly contagious.

There were several epidemics during Roman times when it is estimated to have killed 100 million people. Epidemics of the plague did not seem to occur between 767 and 1330. At that time it returned to Western Europe with a vengeance and struck every generation between then and 1722. It is estimated to have killed 50% of the population. The cause was not identified until 1894.

If you have European ancestors, they probably had experience with the plague. It was a terrifying disease since they didn't know the cause or the cure and it struck swiftly. In modern terms it might be likened to a combination of AIDS in its spread and Ebola in its swiftness and deadliness. The only measure that seemed at all effective was isolation. If the plague was about, port cities closed their ports and isolated themselves. It was a wise move since the rats that lived on ships were some of the most efficient carriers. People of wealth who lived in cities would flee to their country homes. This was effective as long as one of the household hadn't been infected before leaving the city. They also tried to isolate those who were sick, but the plague often spread so fast that this simply wasn't practical.

English Sweating Sickness

In 1485 a mysterious new disease called the sweating sickness appeared (also called "sudor anglicus", "bloody sweat" and "day fever"). Five epidemics swept through England between 1485 and 1551. It affected English people almost exclusively, passing over visiting foreigners, and stopped at the borders of Scotland and Wales. It may have appeared in Europe once but even there the English seemed more susceptible. It was not seen again after 1551 and no really satisfactory explanation has been found.

Doctors and Medical Practices

Some maintain that until the later 19th century, doctors actually did more harm than good. Some believed the body harbored evil humors and had to be purged. Others seemed to feel the blood was bad and they would bleed patients by cutting or using leeches to suck the blood. Such procedures instead made the sick person weak and uncomfortable — and probably hastened their deaths. Making a patient sweat also was favored by some doctors, but if a person was dehydrated, as often happens with a fever, this was the exact opposite of what was needed. "Bad air" (often meaning night air) was often thought to be harmful so they house was kept tightly closed thus allowing any air-born carriers an ideal environment to multiply and infect the entire house.

Since they had no way to discover actual causes or cures of medical problems, they just had to experiment and they probably did discover some natural or herbal medicines that were helpful for minor problems such as upset stomach, headache and fever. Some of our modern practices seem so improbable, you cannot fault these early doctors for trying some of the things they did. For example, delivering a baby by cutting open the mother was a radical thing to do the first time. Had it not been successful, it might have been called murder. It also seems bizarre that a mold (penicillin) can heal some infections or that a poisonous plant (digitalis) can produce a medicine to ease heart problems. However, doctors from earlier centuries didn't stumble upon these cures.

Causes of Diseases

In many cases they were close to discovering a cause. Bad air was thought to be bad because of the smell rather than examining and cleaning up what caused the smell — swamps, garbage or sewage — which were the real culprits. It was also believed that you could contract a disease from just seeing it. For example, some believed you could catch epilepsy if you watched someone having a seizure. In some places, rats died before and during the outbreak of the plague. Just observing this was thought to cause a person to get the plague.

Drinking water is a frequent source of infection but this seemed to seldom be suspected. Perhaps this lack of suspicion was because the water looked clear, tasted good and was absolutely necessary for life. Typhoid fever (which is different from typhus) is spread by fecal material. While is it often spread by unwashed hands, fecal material, perhaps from an outdoor privy, frequently could leak into a nearby well and contaminate the water supply for a large number of people. What makes typhoid fever doubly difficult to track is the existence of "carriers" — people who do not have any symptoms of the disease, but carry it in their system and pass it on to others. Mary Mallon, known as "Typhoid Mary", a cook in Chicago, was a carrier who spread the disease to at least 47 people.

In addition to communicable diseases, there were congenital problems or those that were not contagious. Epilepsy is one example, although in earlier centuries it was not certain whether it was contagious. Diet caused at least one major problem: scurvy, which comes from a lack of vitamin C. This became a serious problem between 1600 and 1800 when navigation permitted long voyages at sea. Since keeping fresh fruits and vegetables edible for the months they were at sea was impossible, sailors became ill with wounds that would not heal, swollen gums, loose teeth and eventually cardiac and pulmonary difficulties. Eventually, it was discovered that certain herbs and grasses brought relief. In 1747, by trial and error, it was discovered that citrus fruits provided protection against scurvy.

Causes of Death

Mortality tables showing causes of death immediately reveal a great deal about life at any point in history. Tables after 1990 show something like the following breakdown, depending on how categories are grouped:

  1. Heart disease
  2. Cancer
  3. Stroke
  4. Chronic obstructive pulmonary diseases
  5. Accidents
  6. Pneumonia & Influenza
  7. Diabetes
  8. AIDS
  9. Suicide
  10. Chronic liver disease & cirrhosis

These figures were taken from the World Almanac 1998 and Information Please 1998. Historical statistics are more difficult to find. One example during the plague era records 68,595 plague deaths vs. 5,257 for ague and fever (malaria?) and 4,808 for consumption (tuberculosis). 397 died due to "rising of the lights" which has been identified as croup.

The 1968 Information Please Almanac gives causes of death back to 1900 and reveals big changes just within 90-95 years. In 1900-1904, tuberculosis accounted for the largest number of deaths, followed by pneumonia and diseases of the heart. Communicable diseases of childhood, including measles, scarlet fever, whooping cough and diphtheria also took a large toll. By 1966, heart diseases were way out in front with cancer a distant second and communicable diseases of childhood hardly significant enough to even register. (Comparisons are difficult since different charts group diseases differently.)

Influenza

A fairly modern epidemic which gets rather little notice is the great influenza pandemic of 1918-19. We think of flu as a rather annoying but fairly harmless inconvenience which lasts a week and then we are back to work. The flu that swept the world just after World War I was quite different. It spread like wildfire and it was deadly. Some estimate that more people were killed by the flu than were killed by the war. No one knows exactly how this virus was different but the answer may be forthcoming. In Alaska scientists have recently excavated graves of people who died from this flu. The bodies have been frozen in the tundra all these years and investigators believe that the virus is still alive. They hope to study it and preserve it so that a vaccine could quickly be available if it should ever reappear.

Studying historical illnesses gives a fascinating insight into our ancestors' lives and brings meaning to many exotic names that you have heard of. For an interesting discussion of the above illnesses as well as ergotism, scrofula, leprosy, smallpox, measles, yellow fever, breakbone fever, syphilis, pellagra, beriberi, rickets, the English sweating sickness and more, read Plague, Pox and Pestilence, edited by Kenneth F. Kipple (New York City: Barnes & Noble, 1997).


About the Author
I began genealogy in 1970 when we were living in Ogden, Utah for a short time. I was immediately hooked when, on my first visit to the local Family History Center, I found my great-grandparents in the 1850 Ohio census. I have been researching ever since on my own family and for others. I soon recognized the value of computer programs for keeping track of the data. I was a founding member of the Computer Genealogy Society of San Diego and editor of the newsletter. I have written a third party manual on ROOTS III and, with Joan Lowrey, authored two guides to genealogy software. Using ROOTS III and WordPerfect, I have written several family history books for others, but have yet to stop researching long enough to complete my own family history!

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