Causes of Death in Ramsgate 1774-1812: The Exceptional Detail provided by the Rev. Richard Harvey

CAUSES OF DEATH IN RAMSGATE 1774-1812: THE EXCEPTIONAL DETAIL PROVIDED BY THE REV. RICHARD HARVEY IN THE PARISH REGISTERS OF ST LAURENCE

margaret bolton

Parish registers provide a wealth of material not just for genealogists but for demographic historians. Statistical analyses can be made to demonstrate changing patterns of fertility and mortality and to provide crude estimates of population for the pre-census era. They are not, however, ordinarily of much use for epidemiologists or medical historians because many entries simply record the name of the deceased and the date of burial. Fewer than one per cent of parish registers include causes of death and those which do normally only provide them for a very limited period. It is for this reason that the registers of St Laurence in Thanet are so important. Not only do they include causes of death for a thirty-eight year period from 1774 to 1812 but they incorporate annual numbers of inhabitants and houses for each part of the parish, information about family relationships, ages and often places of origin.

The decision to expand the register in this manner was made by the vicar, the Reverend Richard Harvey, who had arrived in the parish eight years before. It is uncertain why he chose to do this and at that particular time given he did not do so in the other parishes of which he was vicar.1 The change in recording substantially increased his workload as instead of simply entering brief details of each death, he now had to make enquiries of the physician or apothecary or family members who had attended the deceased at the end. He also had to keep records of every house in the parish with notes of all those who lived within and to update these records every year, no small task with over six hundred properties and a rapidly expanding population. The fact that he did this conscientiously for nineteen years, after which time his successor took on the work, indicates that it was considered to be an important activity.

The most likely reason behind Harvey’s decision was that he had read a paper published by the physician Thomas Percival in 1773 which advocated doing exactly what he did. Percival suggested that there were many reasons why the data would be useful including:

demonstrating the increase or decrease of certain diseases

giving physicians a guide to the likely fatality of different distempers according to age and season

enabling the healthiness of different places to be compared

showing the influence of particular trades on longevity

helping politicians to assess the growth of population which contributed to national wealth

assisting insurers in calculating life assurance costs

helping parish officials in estimating money likely to be required for old age payments and care of widows and orphans

providing a guide to morals by showing the numbers perishing from illnesses relating to intemperance²

At the same time, doctors were being encouraged to maintain their own records so they could assess the impact of various treatments and make decisions based on empirical observation and quantifiable data. The introduction of inoculation and later vaccination for smallpox provided a keen encouragement to this but it remained uncommon.

Harvey’s efforts show him to have been a man of the enlightenment. Percival had suggested that the increased cost to the clergy of carrying out the extra work could be recouped by the sale of quarterly statistical abstracts of the data at a shilling a time but there is no evidence that Harvey did this or that anyone incorporated his data into their research, though this may have happened. Whilst we cannot know, therefore, if the work had a purpose or was simply a reflection of his own interests, what is certain is that it has left us a valuable insight into the mortality patterns of the late eighteenth and early nineteenth century in Ramsgate and the impact of the wars with France upon a coastal town.

The Source Material

Between 1774 and 1812 inclusive, a total of 4,164 people were buried at St Laurence.3 Causes of death appear for all but fifty-four of these, the blanks inc-luding thirteen servicemen, seven visitors and fifteen infants. That means that the register is 98.5 per cent complete with regard to causes. Ages appear for 3,898; however the entries with no age include 182 soldiers and 43 strangers, most of whom were unidentified bodies washed up on the beach. Allowing for the army practice of not providing the vicar with personal data and for those whose ages could clearly not be known, it can be seen that age information is supplied for 98.9 per cent of burials.

With any study based on parish registers, questions must be asked about the veracity of the data. To this end the following checks have been made. Details of the 582 people who died during the same period who have memorials either within the church or in the churchyard have been checked against the burial registers to ensure that names, ages and dates corresponded. Next, efforts were made to trace all males buried who were aged twenty or over, excluding visitors and soldiers, and it proved possible to verify the ages of 645 of the 846 men involved. Some were impossible to trace because they had names which were so common that an exact identification was impossible, others must have come from outside the area, and some may never have been baptised. However, the fact that just over three quarters could be confirmed generates confidence in the general accuracy of the records and the likelihood that the ages of the other men were also at least reasonably correct. Finally, a check was made on all families who had more than one child of the same name. Working on the presumption that if a second child was baptised with the same name, the previous one must have died, the register was searched to ensure that a burial entry existed in accordance with this. In all but two cases, such a burial was located. Based on those results, the conclusion is that the register is as accurate as any document is likely to be allowing for human frailty.

Population Growth

Bordered by Minster in the west, Margate to the north and to the east Broadstairs, by the eighteenth century the parish was already effectively divided into two areas, the rural village of St Lawrence and the fishing town of Ramsgate and both were growing in this period (Table 1 and Fig. 1).

Between 1774 and 1800, Ramsgate grew by sixty-two per cent and St Lawrence by a third. Although the number of houses available increased by forty-two per cent in Ramsgate and twenty per cent in St Lawrence, the average number of occupants of each house rose from four to five. The growth also reflected the changing balance of power in the community. In 1774, over a third of parishioners had lived in the St Lawrence sector which was an almost exclusively farming community. By 1800, that figure had dropped below thirty per cent and census returns show that it continued to decline. By the 1821 census, only a fifth of the inhabitants lived in St Lawrence and the total number was only thirty per cent higher than it had been in 1800. By contrast, Ramsgate had more than doubled in the same period (Fig. 2).

To some degree, the growth experienced at Ramsgate was a reflection of the national picture. Between 1774 and 1812, the population of England is said to have increased by 51.6 per cent from 6.6 million to 10 million.4 Although there were demographic factors affecting the growth patterns locally, the principal causes were economic. Plans to extend and improve Ramsgate Harbour had begun in the mid eighteenth century but the major part of the work was carried out between 1778 and 1792.5 This increased trade substantially as more and bigger vessels could be accommodated and they could travel further afield. In parallel with this and continuing afterwards, was the rise of sea bathing. Tourism created an entirely new industry in the area with many attendant jobs. Finally, there was the war with France. Ramsgate was on the front line and had thousands of troops quartered on its cliffs, a number of whom subsequently married and settled in the town. These three factors increased the demand for labour and broadened the opportunities for work. In the past, most men had been limited to either fishing or agricultural labouring with a few taking up skilled trades or shopkeeping. Now there was a wider variety of jobs and the chance to make a fortune.

In 1793, Zechariah Cozens recorded his thoughts on the growing town:

Ramsgate, since the rage for sea bathing hath taken place, has had its share of visitants and consequently is every year much improving in its buildings and other accommodations. Here are many good lodging houses, several hotels, inns &c, a handsome assembly room, a very good library, coffee rooms, warm salt-water baths…The town being well paved is very clean and its commodious basin and magnificent pier, two striking objects to an eye unused to such expensive scenes, cause it to be particularly pleasant. …Upon the hill about half a mile from the extremity of the town is St Lawrence a pretty little village which commands one of the most extensive prospects in the island having a fine view of the Downs, the French coast, the towns of Sandwich and Deal at a few miles distance and Ramsgate close under the brow of the hill as well as a scene of luxuriant cornfields and fertile meadows.⁶

Migration

Amongst demographic historians, a long dispute has raged about whether the population growth of the late eighteenth and early nineteenth century was due more to a reduced mortality as an increased number of people survived infancy and lived longer or whether it was because people married younger and so had the time to produce more children.7 In Ramsgate, the death rate throughout the period remained relatively stable at around one person in every forty-four each year8 but the birth rate increased from around one per thirty five in the pre-war period to one per twenty-five from 1793 onwards but whilst this fertility increase led to some growth, another reason for the population expansion was migration. The parish registers enable us to assess how this changed over the period in two ways. When the places of birth of all men who died in the parish aged twenty or more, excluding temporary visitors and soldiers, are analysed it can be see that prior to the war with France, a clear majority of the adult male population came from the Isle of Thanet with almost three quarters of those being both born and buried in the parish of St Laurence (Table 2). With the coming of war, this situation changed to the extent that by 1812 only just over a quarter of the men had been born in the parish. The largest number of migrants came from the Sandwich and Deal area including their neighbouring villages such as Woodnesborough and Eastry. As the war with France progressed, the number of those men born outside the county increased as soldiers who had been stationed here chose to stay. In parallel, the popularity of the town from the 1780s onwards saw fashionable people decide to settle following their enjoyment of a holiday in the area. They included James Townley, the London lawyer and his architect wife Mary, the Attorney-General Sir William Garrow, Admiral Lord Keith and Lady Augusta Murray who had married the Duke of Sussex.

Another way to look at migration is to consider the population figure given for each year in the parish register and to add to this the number of baptisms taking place at St Laurence as well as in the nonconformist chapel in town and then deduct the number of burials with the result then being compared to the population total shown for the following year. Such an exercise could never be totally accurate because it is unknown at what time of year Richard Harvey conducted his population count and people would have been born and died during the process but nonetheless the exercise shows that throughout the 1770s, there was relatively little difference. For example, in 1777 the population was said to be 2,786. A total of 78 were baptised and 69 buried, excluding visitors, so the population should have been 2,795. In fact, in 1778 the population was counted at 2,793.

In 1783-4 there was an influx of almost a hundred and fifty people which corresponds with work on the dry dock at Ramsgate Harbour. Due to a smallpox epidemic in 1784, burials unusually exceeded baptisms but for the next few years things returned to their previous stability with around eighty baptisms and sixty burials each year, a rate which led to slow but steady population growth.

The start of the 1790s saw the situation change. Baptisms rose to around one hundred and thirty a year with burials at around a hundred yet the annual population totals often show a sharp increase. For example, in 1791 there were 3,392 inhabitants amongst which 132 were born and 100 died so there should have been 3,424 at the next count but in 1792, Harvey found 3,601 residents. In the first decade of the nineteenth century, some sixty people were moving to the town every year necessitating the erection of at least a dozen homes. This crude method of calculation is evidence of an accelerating rate of migration. The increased fertility rate in the same period is suggestive that the migrants were primarily young people.

Visitors and Soldiers

The temporary residents of the town can be divided into four groups, those who came as part of their work, those who came for their health or pleasure, children sent to the boarding schools established in the town and those who came as part of the war effort. Unsurprisingly, sudden death features more commonly as a cause of death for visitors than it does for regular inhabitants. Sixty-nine were recorded as having drowned with three dying after falls, one man perishing after the chaise in which he was travelling overturned and another being run over by a wagon. In December 1806, a thirty year old sailor from London named William Rowland stepped off his recently docked brig the Fortitude only to be set upon by ruffians who stabbed him three times and left him bleeding to death.9 The parish register records only two other murders in this period, both involving soldiers. In the first in November 1811, an elderly local man, Edward Swinnock, was shot by two deserters from the 23rd Light Dragoons who were stationed in the town.10 In the second, Michael Latimore of the Leitrim Militia which had taken up residence in Ramsgate a month earlier, was killed by a hatchet blow from two visiting sailors in April 1812.

Between 1774 and 1812, the deaths of almost three hundred service personnel are recorded plus four of their dependants. Only one of the men was shown to be in the Royal Navy, the remainder were in the army. The worst year by far for casualties was 1809 with 79 men dying on their return from Corunna and a further 84 back from Walcheren. On 31 January 1809, the Kentish Gazette published the account of one officer who landed with his men at Ramsgate:

After a most tremendous passage and a most disastrous and ill fated expedition, I am once more safe arrived in my native land but in a very exhausted state of body from excessive fatigue and hardship such as I did not imagine my constitution capable of enduring. I have not been out of my clothes for a month nor sheltered more than four nights in that time. The scenes of horror that have taken place beggar all description; ten thousand men will not make good our losses in killed, wounded and prisoners. Men, women and children with horses, mules, asses, strewed the road during the last fortnight which died through the severity of the weather, hunger and fatigue … Our marches were generally in the night over mountains covered with snow after ascending from valleys drenched through with rain, without food and numbers barefoot, and no other shelter than the canopy of heaven. My eyes were like salamanders for want of sleep and my legs reduced to the size of drumsticks, my joints benumbed and swelled that we could not march more than a mile per hour through roads knee deep in mud. All the treasure and baggage was destroyed for want of means of conveyance … In this state we reached Corunna … I am sorry to say that numbers of our wounded were unavoidably abandoned as we finally retreated in the middle of the night to the shipping in a most distressed and sorry state.

Over the next two weeks, thousands of men were landed, thirty troop ships being discharged on 14 February alone. Some of the soldiers were moved on to Margate or Chatham but the bulk remained in the town where doctors struggled to cope with the typhus epidemic which the men had brought with them. Usually soldiers were quartered in local hostelries but on this occasion the decision was made to segregate the sick in a temporary hospital at Ramsgate barracks in order to try to contain the disease. The plan worked with only one local inhabitant appearing to die of typhus and just one in twenty of the affected soldiers.11 The casualties included one of the army surgeons to whom a memorial tablet was erected in the nave of St Laurence church:

Sacred to the memory

of Charles Smith esq.

of Richmond in Surrey

late Surgeon of the Royal Surrey Militia

who died at Ramsgate on the 23rd of February 1809

of a fever brought on by his kind and

unremitting attention to

the sick soldiers landed there from Spain

aged 30 years

This stone is erected by his brother officers as

a testimony of their great regard.

The Walcheren expedition of 1809 proved to be one of the most disastrous of the war, so much so that a parliamentary enquiry was ordered and the Army Medical Board re-organised. On 17 September, a correspondent from Ramsgate told the Kentish Gazette: ‘We have upwards of 300 in our barracks sick, some desperately so, but the fever is not contagious as first feared. On Thursday, thirteen had died at our barracks since their arrival and nine bodies are now lying in the dead room.” Richard Harvey arranged collections for the sick at the church. The illness was said to be a form of malaria.12

Amongst the other causes of death recorded for soldiers were jaundice, lockjaw (tetanus), consumption and two who died in the severe cold weather of the winter of 1808-9 when the local temperature was reported to have dropped as low as -21F.13 In November 1799, the fourteen year old drummer boy of the 63rd Foot regiment tumbled to his death over the cliff.

The late eighteenth century was famous for the rise of sea bathing as an antidote to ill health. Richard Russell’s A Dissertation on the Use of Sea Water, first published in 1753 and John Speed’s Commentary on Sea Water which was often sold bound together with this, were particularly influential running through six editions in just fifteen years. At Ramsgate, there is evidence of sea bathing from at least 1754 and by the 1790s, the area was being patronised by royalty.

With the exception of the Duke and Duchess of York, no medical records exist to show what ailments these illustrious visitors hoped to alleviate by their stay.14 Russell had claimed that bathing in sea water as well as drinking it was good for scurvy, jaundice, leprosy, gonorrhoea and scrophula. His work was based on the humeral theory of medicine and he thought the bitterness of sea water would drive off the cold humours that caused epilepsy and palsy and would disperse tumours. He argued that since salt was a known preservative for food, it stood to reason that consuming it in sea water would prevent putrefaction and decay in the human body. Speed agreed but warned that drinking sea water was unwise for those whose constitutions were hot. He added to the list of conditions sea water could cure rheumatism, rickets, menstrual problems, headaches and nervous fits.

Local people were quick to accept these medical reports and they highlighted both the advantages to be gained by sea bathing alongside the benefits of the local weather in their advertisements:

There are but few distempers incident to human nature which either the cold, the warm or vapour sea bath and the air of a salubrious spot on the margin of the main such as Thanet are not equal to meet and prove more or less beneficial….Every year’s experience gives manifold proofs of their very great utility to health: they restore and preserve.¹⁵

Jane Austen, who visited the town in 1803, satirised the claims of advertisers in her unfinished novel Sanditon in the character of Mr Parker who

held it indeed as certain that no person could be really well … without spending at least six weeks by the sea every year. The sea air and sea bathing together were nearly infallible, one or the other of them being a match for every disorder of the stomach, the lungs or the blood; they were anti-spasmodic, anti-pulmonary, anti-sceptic, anti-bilious and anti-rheumatic. Nobody could catch cold by the sea, nobody wanted spirits, nobody wanted strength. They were healing, softening, relating, fortifying and bracing … If the sea breeze failed the sea bath was the certain corrective and where bathing disagreed the sea breeze alone was evidently designed by nature for the cure.

A more bemused local, John Lyon, thought it amazing that bathing in the sea which had only previously been seen as an amusement should have such healing powers.¹⁶

It is not surprising therefore to see that there are a number of people recorded in the burial register as visitors. In some cases they clearly died of the illness which had brought them to the area, usually consumption, in other cases they perished as a result of heart attacks or strokes or from infections which it may be assumed that they contracted during their visit since it is unlikely that any parent would have brought a child with measles or whooping cough. In August 1810, a ten year old boy named Peter Rowland who had been sent to the town for his health, died after his invalid carriage was caught by the wind and hurtled over the cliff into the sea leaving him with severe head injuries and broken limbs.17

Whilst there is no way of knowing how many people visited the area and departed rejuvenated and with restored health, some of those who did not recover left evidence of their feelings about this. A tomb in St Laurence churchyard remembers Thomas Lindsey of Mayo who died in 1810 aged fifty-one. The inscription reads:

Born in that county which he made his constant

residence, he hoped to have ended his days there

but being fixed with a lingering illness he sought

relief by a change of climate at the solicitation of

his friends. Alas in vain

This monument is erected to his memory by

his afflicted father

Henry Blaine wrote a book about his visit saying:

In hopes of recovering that invaluable blessing, health, on Friday August 10, 1787, I embarked on board the ship Friends, bound for Ramsgate in Kent. I had heard there was such a place; and many had raised my expectations by their reports of the efficacy of sea-bathing; and others encouraged my hopes, by repeating their own experience of benefit received. …but the health I went in pursuit of I entirely missed; and I was brought home to endure one of the sharpest dispensations I ever experienced, to be reduced by a violent stroke of the palsy, from a healthful, vigorous rate of body, in a few months, to be one of the most feeble and helpless of human beings; surrounded by a wife just expressing the time of nature’s distress, and a large family of small children in a very sickly state. My wife has been happily brought through her distress; our infant the Lord has taken to Himself; our children are restored to tolerable health; but as for myself, I seem to be apace hastening to the eternal state.¹⁸

At least 215 of the burials are of people from outside the area. Forty-three were simply listed as unknown strangers whose bodies were recovered from the sea. The remainder includes twenty-five people from overseas of which nine were American, six Swedish, four Irish, two German and one each from the Low Countries, Norway, Denmark and Spain. Of the remainder, fifty-seven were from London and forty-two from other places in Kent. It is not always clear from the register whether the person was a tourist or in the area for work. At least thirty-five of the men were sailors who died whilst their vessel was in port. A further thirty-two were children under ten travelling with their parents. Excluding the working seamen, forty-four per cent of adult visitors who died are remembered by a gravestone or internal tablet, a fact indicative of the wealth of the visitors.19

Causes of Death

The parish register lists 118 separate causes of death ranging from the comprehensible such as asthma and smallpox to the vague like ‘decay’ or ‘suddenly’. In many cases, what is shown as the cause of death is just a symptom of another condition. This is particularly true of things like convulsions or cough. This is not simply because Harvey was recording information from people who were not always trained doctors. For centuries, conventional medical wisdom had regarded sickness as due to an imbalance of the humours with the result being that illnesses were seen as individual rather than generic. For example, diabetes was seen as the product of excess blood not a condition in its own right.20 In cases where it was evident that a group of people were suffering from the same health problems, such as plague, it was unreasonable to suppose that there was a mass simultaneous unbalancing of humours so the theory of miasma emerged, the idea that foul air caused illness. It was not until 1731, just four decades before Harvey started his record keeping, that François Sauvages published his Treatise on the classes of diseases arguing that diseases should be classified according to symptom. The idea that doctors should investigate further and look at pathological anatomy was not to emerge for another seventy years and even then advances would have taken time to reach the provinces. It is unlikely that any doctor in Ramsgate or anywhere else would have even thought of physically examining a patient before 1820. Harvey’s entries regarding causes of death must therefore be seen as being totally in line with the latest medical thought of the times. Moreover, there is evidence that local doctors were interested in medical developments because the first entry for ‘water on the brain’ as a cause of death appears in 1797 just seven years after it was first accepted as a separate disease in the London Bills of Mortality and vaccination was being practiced in the town within three years of Jenner’s discovery as is shown by the death due to cowpox in January 1801.

In order that the causes of death may be analysed in context, it is necessary to consider them in light of the nosological definitions of the period.21 Excluding visitors and soldiers, the inhabitants of Ramsgate and St Lawrence were believed to have perished of the following (see Table 3).

Infancy: both demographic historians today and doctors in the eighteenth century regard the measure of infant mortality as vital in assessing the health of a population. At the time, a third of London deaths were attributed to infantile diseases with it being reported that half of all babies born in the metropolis failed to reach their third birthday.22 Modern research has shown that in England between 1750 and 1799, 135 boys and 122 girls per thousand died before their first birthday.23 Of this, a quarter of the deaths occurred during the first month of life.

It is not easy to calculate the infant death rate at Ramsgate. Although the burial registers have been well kept, a check made on those listed as having died during infancy reveals that forty-three per cent of them had not been baptised into either the Anglican church or as non-conformists. Having no birth record makes it impossible to know the age of those shown as infants. An analysis of the baptism register shows that both girls and boys were baptised on the nearest Sunday to their fortieth day of life on average so it is reasonable to assume that a large proportion of the unbaptised deaths occurred amongst children aged six weeks or less. This view is supported by an exercise to find the date of the previous birth in the case of families who lost a child which showed that over seventy per cent had had a child within the past thirty months, and ninety-five per cent of couples who lost a child had had a child within the previous four years. The infant who died would therefore fit into the usual birth interval.

The baptism pattern is of interest in itself. In the period prior to the 1783 Stamp Act which established a fee of 3d. for a baptism to be registered, just under a third of infants who died had not been baptised but this rose to almost half after the Act indicating that a considerable number of people in the town were living on such a low income that they did not wish to spend the money until it seemed likely that the child would live. It also shows a change in attitudes from previous generations. In the Elizabethan and Stuart period, baptism took place on the Sunday after birth (or sooner in emergencies) so less than one per cent of Thanet children buried had not been baptised. Georgian parents no longer feared that an unbaptised child would go to hell24 and it seems possible that up to a sixth of adults, particularly those from poor backgrounds, may never have been baptised.

Of the 5,900 live births known to have occurred in Ramsgate and St Lawrence, 16.4 per cent of boys and 13.2 per cent of girls died in their first year of life, a rate above the national average and more than it had been in the Elizabethan and Jacobean period.25 In so far as ages can be known or reasonably estimated, it would appear that a third of that mortality was in the first month of life.

The parish register gives a variety of causes for the deaths. Just over one in seven died of infectious diseases such as smallpox, measles and whooping cough each of which were readily identifiable illnesses. The majority, 77.8 per cent, relate to general decay, convulsions, bowel disorders and teething. Hugh Smith in a 1785 volume advising mothers to breastfeed warned:

It is well known, that the thrush and watery gripes generally terminate existence in the early months; and, if they survive these maladies, the time of teething too frequently brings on a fatal catastrophe….The danger in cutting their teeth is justly to be feared. This difficulty proceeds altogether from a weakness of constitution, arising from the same first mismanagement in point of diet : and here a train of dreadful symptoms present themselves ; the head, the stomach, the bowels, are all at times terribly affected; a general wasting of the body frequently ensues, and unconquerable fevers prevail, which generally terminate in convulsions and death.

Contemporary doctors were quick to argue that parents were often responsible for the death of their children but they did not necessarily blame them. They recognised that dire poverty meant that many parents lacked any ability to provide warmth and clothes for their infants and that even when they did, they were generally ignorant about what to feed their children and unable to afford suitable nutrition. A 1795 study of labourers across England showed that the average man earned seven to eight shil-lings a week which would be spent keeping a family of five as shown in Table 4.26

Wages in Thanet were a bit higher than the national average which is one of the reasons why people moved to the area but they were still poor as prices were also higher. For example, on 23 November 1795 farmers in Thanet agreed to increase wages from 1s. 6d. to 2s. a day which was above the 1s. 2d. elsewhere but wheat in Thanet was £5 4s. 2d. per quarter compared to £3 15s. 2d. nationally.27 Butter was 1s. 6d. per pound compared to 10d. nationally.28

Poverty was a major contributor to the high rates of infant mortality and the Meader family of Harbour Street was not untypical. The couple married at twenty and had thirteen children in twenty-two years, eleven of whom died before they were three months old.29 The mother being almost continually pregnant would have had no opportunity to work and the father was a labourer whose wages could not stretch to medical attention or good food even if he had gone without himself.

Respiratory Problems: the biggest factor in this group was consumption (although there were fifteen deaths attributed to asthma). Dr Black described its manifestations as follows:

The progressive encroachment of the disease is evident, by increased debility, emaciation, and partial sweats; oedematous ankles; diarrhoea; depilation; consumption and melting away of the fat and muscular flesh: until at last sapless, and macerated into ghosts, the twinkling vital snuff is extinguished.³⁰

As the stethoscope had yet to be invented, the only definite way that a physician had to diagnose pulmonary consumption was through an autopsy so the category of consumption was used to cover anyone who coughed up blood on a regular basis and who became progressively weaker. Inevitably this means that some cases of bronchitis were included in the definition but that was not recognised as a separate disease until 1814.31

Given that consumption was estimated to be the killer of a fifth of all adults, it inevitably attracted considerable medical attention but there was frustration at the lack of any cure, even though it was believed that sea bathing and spending time in the fresh air of Thanet would alleviate symptoms temporarily. Before 1882 there was no understanding of consumption being infectious or caused by bacteria, and contemporary views of what could cause it varied. Heberden saw it as primarily hereditary but also liable to result from spending time outdoors in cold winds.32 Black believed that time spent in cold, damp environments was the chief factor but also thought it could be caused by depression, intoxication and the perusal of libidinous books and prints.33 Tallomel thought it was caused by consuming mercury and opium in patent medicines.34 Russell attributed it to parents swaddling babies.35

Also in this category came whooping cough or chincough as it was more often known at the time. Seventy-one cases were listed in the parish register all amongst children under four. Deaths were spread across the years but there were minor outbreaks in 1777, 1800 and 1803 killing six, nine and twelve infants respectively.

General decay: hundreds of deaths were attributed to decay which is meaningless in medical terms. Undoubtedly some of these would have been cases of consumption which had simply not reached the blood spitting stage and others would have been cancers, heart disease and liver failure. The most important fact about deaths due to decay is that they show the person had been suffering for a long time and that the end was expected. Given that a sick person was unable to work, this meant that whole families were left in dire financial straits. The church was able to offer some assistance but the sheer number of cases meant that help was inevitably inadequate and the poorhouse crowded.36

Old Age: today, the Isle of Thanet has an above average rate of elderly people and this was also true in the late eighteenth century.37 Definitions of age vary but the Dictionary of Practical Medicine issued in 1833 stated that women reached advanced age at 55, old age at 68 and decrepitude at 75 whilst men entered advanced age at 60, old age at 70 and decrepitude also at 75.38

The parish registers indicate that 23.4 per cent of burials were of people over the age of sixty with eight per cent being in their sixties, ten per cent in their seventies and the remainder in their eighties or older. The oldest was John Maxted who was baptized on 10 October 1686 and buried on 13 August 1786 but there were twenty-six other people over ninety when they died. This rate represents a small increase over a century before when a fifth of parish burials were of people aged sixty or more.39

It is impossible to know what proportion of the population at any given time was over sixty: back projection estimates suggest that it would have been between seven and eight per cent nationally.40 The fact that the number of deaths due to old age in St Laurence parish was almost double the rate in London suggests that the proportion was higher locally, perhaps nearer ten per cent.41 Guidebooks of the period frequently highlighted the fact that the local weather contributed to the longevity of the inhabitants, one claiming: ‘The temperate islander may be frequently seen at the age of ninety performing his domestic functions with all the activity and bustle of youth’.⁴²

Certainly, of males born in the parish between 1701 and 1740, one in eleven was still alive and living in the same place at the age of sixty and with probably as many again living in other places, it would appear that the chances of reaching sixty for anyone who survived infancy were between one in four and one in five. As today, women were more likely to reach old age with women outnumbering men from the age of seventy onwards 3:2.

Diseases due to inflammation: contemporaries included a range of illnesses in this category such as smallpox, measles, quinsy, sore throat, rheumatism, gout and pleurisy. Of these, the most serious by far was smallpox with Ramsgate seeing 295 cases over the period with particular epidemics in 1784, 1790, 1799, 1807-8 and 1810. Of the victims, 85 per cent were aged four or less with deaths being spread pretty evenly throughout the year. It is impossible to know whether the victims caught the disease naturally or from inoculation. There is no direct evidence that inoculation was being performed in the town but the low rate of adult casualties suggests that it was. Deaths from inoculated smallpox were reckoned to occur once in every six hundred cases whilst one in every six cases of natural smallpox was ordinarily fatal.43 It is certain that the town adopted vaccination early for there is an unusual death of an infant from cowpox in January 1801, barely a year after the first clinical trial had been completed in London.44 Sadly the source of the matter used for the procedure is unknown so it is impossible to know if the child simply reacted badly or contamination was involved.

Measles was another illness which proved particularly fatal to children. The parish register records ninety-nine cases with particular outbreaks in the spring of 1795 and 1808. Just one adult victim was recorded with ninety-seven per cent of cases being amongst the under-fours.

Miscellaneous: this group included a variety of diseases and disorders including strokes, cancer, gangrene, heart attacks and ulcers as well as conditions such as lunacy, epilepsy, headache and vapours. Just fifteen cases of cancer were recorded with all but two of these amongst women. The disease would have been difficult to diagnose and William Heberden only mentions it in relation to breasts and wombs, recommending surgery in the former case due to ‘the insignificant pain of cutting it out while it is small and the prospect of it healing readily on account of the smallness of the wound’ though he notes that many women were reluctant to accept this procedure and took hemlock and opium instead.45 Strokes killed thirty-nine people almost all of whom were elderly whilst unexplained sudden deaths were responsible for the demise of one hundred and forty-six. Of these, twenty-three were infants whilst the bulk of the remainder were aged fifty and above. A further thirty-nine died of an ‘inflammation’.

Fevers: the fever category covered a range of conditions which today would be recognised as typhus, typhoid, influenza and malaria as well as scarlatina. It is significant that whilst fever was the second greatest killer in London, it played a much smaller role in Ramsgate where it accounted for barely one in twenty deaths.46 This difference probably reflects the fact that the population density was much lower than in London which prohibited its spread. Ramsgate was also the first town on the Isle of Thanet to obtain an act for paving, lighting and cleansing its streets and payments show that this cleaning took place monthly from 1783 onwards with drains also subject to regular inspection and cleansing.47

Evacuation problems: a whole range of bowel disorders and urinary infections were included in this category including stoppage, looseness, colic, gripes, jaundice, bloody flux, gravel and diabetes. Just over a third of the deaths occurred amongst infants and the distinction between ‘bowel inflammation’ which saw the death categorised under evacuations, and ‘convulsions’ which put it into the infant group, almost certainly owed more to fashions in medical terminology than to pathology. Cases of bowel inflammation first appear in the register in 1797, a year which sees an unusually low number of deaths attributed to convulsions. Almost all the infant deaths took place between August and November which was the peak season for infantile diarrhoea.48

Amongst adults, stoppage and kidney stones were most frequently recorded against the older members of the community (average age 55) whilst jaundice affected younger adults (average age 27).

Swellings: the major contributor to this category was dropsy with one hundred and twenty-four cases which were evenly spread between the sexes and age groups beyond the age of forty. There were six abscesses and eight cases of hydrocephalus amongst children aged from two to fourteen. No cases of goitre were recorded which indicates that unlike many areas, there was a lack of iodine deficiency, most likely due to inhabitants consuming freshly caught fish.49

Accidents and external factors: almost half the cases in this category were people who drowned either in the harbour or by falling off the pier. In addition to those fifty, seven fell over the cliffs which were unfenced at this period. Other accidents took place in the home such as the elderly widow who fell down the stairs in 1806, a middle aged man who fell into his well when trying to draw water in 1785, the toddler who accidentally hanged himself with a string in 1802 and fourteen people who died following incidents which left them severely burnt. Three people died after falling from their horse whilst another died after a kick.

Aside from a teenager who died of frostbite and a vagrant woman who was found starved to death under a hedge in 1805, there is no direct evidence of inhabitants dying as a result of external factors but it is evident that there were times of severe distress. The winter of 1794-95 was the coldest on record and bread and coal had to be distributed to the poor at Ramsgate.50 It was followed by a measles epidemic. The summer of 1799 was extremely wet with there being only eight dry days between June and November. As a result the harvest failed and food prices more than doubled though wages did not. A second harvest failure in 1800 meant prices remained at this rate until the end of 1801. The number of burials recorded at St Laurence from 1799 to the end of 1800 was the highest on record with not just infants and the elderly seeing death rates more than double their previous average, but also significant rises amongst adults and children. Most of these deaths were attributed to long term decline but it is evident that dearth was a major contributor.

Childbearing: forty-three women were reported as having died in childbed between 1774 and 1812. Of these, only seventeen are known to have died giving birth to a living child, though in two cases the baby died almost immediately and was buried alongside the mother. One of the saddest cases was Thomasine Curling who died in 1778 aged thirty-five when giving birth to her tenth child in fourteen years. Her gravestone noted that three of those children were already in the tomb and the fourth, whose birth had been the occasion of her death, was laid with her.

It is impossible to give an absolutely exact rate for deaths related to childbirth as stillbirths are not recorded and it is uncertain how many children were never baptised either at St Laurence or in the nonconformist chapels. However, almost six thousand children are known to have been born during this period so the rate of maternal mortality is at worst seven per thousand. This is only slightly less than the Early Modern period. Of 7,949 live births on the Isle of Thanet between 1560-1620, the mother died in childbed in sixty-eight cases which is just under nine per thousand.

Skin diseases: the smallest category, skin problems accounted for only six deaths. The group included three small children with rashes which doctors were unable to identify plus two older children and a twenty-three year old woman whose deaths were attributed to the king’s evil. Later generations would understand that scrofula or the king’s evil was really a form of tuberculosis but in Harvey’s day it was defined as a skin disease.51 Given that the town was a port and also contained hundreds of soldiers who undoubtedly brought followers with them, it is perhaps surprising that the figure is not higher for venereal diseases would ordinarily have been included here. The fact that nobody in the town ever died from such a thing either indicated that the inhabitants were of exceptional moral character or that people lied.

Options for treatment

During this period, Ramsgate was home to several medical men including Dr Samuel Holland and surgeons Tyro Grigson and Edward Daniel. Whilst the wealthy inhabitants and visitors could afford to utilise the services of a physician who would typically charge a pound per visit,52 this was well beyond the limits of the ordinary inhabitants of the parish. Some of the developing middle classes might have used an apothecary and it is possible that Richard Harvey, like other clergy of his day, would have had a scheme which would allow certain deserving poor to access the services of such at the parish’s expense. For the bulk of the population, however, the only option was to visit Peter Burgess’s shop in the town and to purchase one of the patent medicines on sale there. Even if the patent medicines were actually effective – and the best selling Dalby’s Carminative was opium and castor oil dissolved in wine – their price was often prohibitive. Acknowledging this, Theophilus Lobb advised the poor to grind salt petre and mix it with sage or burdock tea for fevers and to rub the chests of convulsive infants with olive oil. The most effective remedy he believed was Peruvian bark or quinine but at 6d. an ounce in its raw state or 2s. 9d. a prepared bottle that would represent a significant proportion of income for many.53

The Kentish Gazette reveals Burgess stocked a wide range of products promising to cure an impressive range of conditions including:

Cumberland Bituminous Fluid: ‘prepared from the fossil bitumen lately discovered in the mines of Cumberland … the most effectual remedy made known to the world for … rheumatism, rheumatic gout, lumbago, pains of the back and kidneys, numbness, palsy’. 7s. 6d. per bottle.54

Dr Sibly’s Reanimating Solar Tincture: ‘In all circumstances of sudden death, whether by blows, fits, falling, suffocation, strangulation, drowning, apoplexy, thunder and lightning, duelling &c, immediate recourse should be had to this medicine which will not fail to restore life’. 13s. per bottle.55

Cornwall’s Oriental Cordial: ‘It restores tone to the stomach, removes the effects of unripe fruit – spasm, cholic, wind, gout and indigestion…and resists the effects of attacks of disease which terminate in sudden dissolution’. 5s. 6d.56

Dr Taylor’s Anti-Spasmodic Pills: ‘a certain cure of the epilepsy or falling sickness, convulsion fits, hysteric and paralytic affections and an infallible antidote to that mortal malady the apoplexy’. 4s. 6d. for 22.57

Dalby’s Carminative: ‘for the wind, cholic, fluxes, and other disorders in the bowels of infants as well as of adults’. 1s. 9d. a bottle.58

Balm of Gilead: ‘instantly relieves spasms in the side, breast and intestines, disposes a genial warmth, and prevents cramps or numbness in or after bathing in spring or sea water…removes every symptom of… dimness of sight, confused thoughts, wanderings of the mind… The valetudinarian by birth who has received from his parents the inheritance of a diseased or unprolific frame; the delicate female whom an immured and inactive life, together with the immoderate use of tea, has brought on all the calamitous symptoms of a consumptive habit and are without timely assistance sinking into an untimely grave; to such as these the cordial Balm of Gilead affords the most perfect relief’. 10s. 6d. a bottle or 33s. for four.59

Wessels Jesuit drops: ‘cures scurvy, gravel, dropsy, stranguary, weakness and obstruction in the urinary passage and venereal diseases’. 2s. 9d. a box.60

Conclusion

The burial registers of St Laurence in Thanet are an important indicator of the state of provincial medical understanding at the turn of the nineteenth century and provide a valuable contribution to demographic understanding. Ramsgate would continue to grow as a port and as a resort and is today some thirty times larger than it was in Harvey’s day, yet his vignette at the very time it started to grow remains fascinating and an insight into the lives of both visitors and inhabitants.

endnotes

1 He was also vicar of Eastry and Worth from 1772 until his death in 1821.

2 Thomas Percival, 1773, Essays Medical and Experimental, vol. II (London), 239-250.

3 CCA-U3-19/1/6, CCA-U3-19/1/7.

4 E.A. Wrigley and R.S. Schofield, 1981, The Population History of England 1541-1871 (Cambridge), 534.

5 Charles Busson, 1985, The Book of Ramsgate (Buckingham), 22.

6 Zechariah Cozens, 1793, A Tour through the Isle of Thanet (London), 60-61.

7 For a fuller discussion of this subject see Massimo Livi-Bacci, 2001, A Concise History of World Population (3rd edition) (Oxford), 58-75 and Andrew Hinde, 2003, England’s Population: History since the Domesday Survey (London), 177-80.

8 By comparison, it was 1 in 37 in Maidstone, 1 in 33 in Faversham, 1 in 21 in Gravesend, John Howlett, 1782, Observations on the increased population, healthiness, &c. of the town of Maidstone, 8-9.

9 Salisbury and Winchester Journal, 5 January 1807.

10 Hampshire Chronicle, 18 November 1811.

11 Kentish Gazette, 17 March 1809.

12 Albert Gore, 1879, The Story of our Services (London), 152-3.

13 Kentish Gazette, 20 January 1809. This equates to -31C.

14 Margaret Bolton, 2013, Seven Centuries of Service (Mayo), 317.

15 John Anderson, 1795, A Preliminary Introduction to the Art of Sea Bathing (Margate), 15-16.

16 John Lyon, 1763, A Description of the Isle of Thanet, 14.

17 Hampshire Chronicle 27 August 1810.

18 Henry Blaine, 1788, A Voyage to Ramsgate for Health (London), 7, 53.

19 This was double the rate of locals.

20 William Heberden, 1816, Commentaries on the History and Cure of Diseases (London), 120.

21 The categories here are those used by William Black in his An Arithmetical and Medical Analysis of the Diseases and Mortality of the Human Species (London 1789) which itself built upon Sauvages’ work.

22 Black, Arithmetical, 19.

23 Wrigley and Schofield, Population History of England, 249.

24 For a discussion on early modern beliefs about the fate of infants who died unbaptised, see David Cressy, 1999, Birth, Marriage and Death (Oxford), 114-7.

25 Between 1560 and 1620, the rate of infants dying before their first birthday was 131 per 1,000. This was one of the lowest rates on the island for the period. The maritime parishes were significantly more healthy than the rural ones where death rates averaged 194 per 1,000.

26 David Davies, 1795, The Case of Labourers in Husbandry (London). This amount would have bought ½ oz. bacon per head per day, 1/5 oz. cheese and 2fl.oz. milk.

27 John Mockett, 1836, Mockett’s Journal (Canterbury), 36; J.M. Stratton, 1969, Agricultural Records (London), 253.

28 Anon, 1780, The New Margate and Ramsgate Guide in Letters to a Friend (London), 29.

29 Margaret Bolton, 2007, The Isle of Thanet: its History, People and Buildings, (Hastings), 127-8.

30 Black, Arithmetical, 97.

31 Bronchitis was first clinically defined in 1808 by Charles Badham but it did not appear in the London Bills of Mortality until 1814, see The Medical and Physical Journal, 31:522.

32 Heberden Commentaries, 311, 317.

33 Black, Arithmetical, 100.

34 H.H. Tullidge, 1817, An inquiry into the nature of pulmonary consumption, and of the causes which have contributed to its increase (London), 36.

35 Russell, 1753, A Dissertation on the Use of Sea Water (London), 4.

36 Between 1795 and 1803, rates increased by almost fifty per cent to cover the increased costs of caring for higher numbers of poor. See Rosemary Quested, 2001, The Isle of Thanet Farming Community (Wimbledon), 96.

37 The ONS analysis of the 2011 census found 16 per cent nationally were aged 65 or more, 21.1 per cent in Thanet.

38 James Copland, 1833, Dictionary of Practical Medicine, vol. 1 (London), 39-48.

39 Data taken from 1670-1700 and based on 1,068 burials for whom an age is known.

40 Wrigley and Schofield, Population History of England, 529.

41 Black, Arithmetical, 42.

42 W.C. Oulton, 1820, Picture of Margate (Margate), 8.

43 William Woodville, 1799, Reports of a Series of Inoculations for the Variolae Vaccine or Cowpox, (London), 151.

44 William Woodville, 1799, Reports of a Series of Inoculations for the Variolae Vaccine or Cowpox (London).

45 Heberden, Commentaries, 248.

46 Black, Arithmetical, 42-4.

47 Christopher Richardson, 1885, Fragments of History pertaining to the Vill or Wille or Liberty of Ramsgate (Ramsgate), 13.

48 R.E. Jones, 1980, ‘Further Evidence on the Decline in Infant Mortality in Pre-industrial England’, Population Studies, 34:2:246.

49 Michael B. Zimmermann, 2008, ‘Research on Iodine Deficiency and Goiter in the 19th and Early 20th Centuries’, Journal of Nutrition, 138,11: 2060-2063. Endemic goitre existed across much of western and southern Britain, see Susan Scott and Christopher Duncan, 2002, Demography and Nutrition (London), 246-248.

50 Kentish Gazette, 23 January 1795.

51 Black, Arithmetical, 42-4. The full range of conditions which Black defined as skin diseases were scurvy, evil, rashes, leprosy and the French pox.

52 Kentish Gazette, 6 April 1804.

53 Theophilus Lobb, 1761, The Good Samaritan (London) 8, 15, 17; Ipswich Journal, 8 April 1786.

54 Kentish Gazette, 9 December 1808.

55 Kentish Gazette, 1 February 1793.

56 Kentish Gazette, 9 October 1807.

57 Kentish Gazette, 17 November 1809.

58 Kentish Gazette, 9 December 1808.

59 Kentish Gazette, 6 April 1804, 6 May 1808.

60 Kentish Gazette, 5 January 1813.

Fig. 1 Extract from Andrews, Dury and Herbert map (1769) showing the extent of the parish of St Laurence. St Lawrence (sic) village lies next to the harbour town of Ramsgate. In 1827, Ramsgate became a parish in its own right.

TABLE 1. POPULATION GROWTH IN RAMSGATE AND ST LAWRENCE 1774-1800

	Ramsgate		St Lawrence
	Population	No. of houses	Population	No. of houses
1774	1,749	435	906	200
1784	2,008	458	923	206
1794	2,473	560	1,142	240
1800	2,831	616	1,208	241

Fig. 2 The Population Growth of Ramsgate and St Lawrence, 1774-1821, compared.

Table 2. Places of birth of adult men buried at St Laurence

1774-1812 (Per CENT)

Place of Birth	1770s	1780s	1790s	1800s	1810s	Total
Ramsgate/ St Lawrence	41.6	41.8	36.1	35.1	27. 5	309
Other Isle of Thanet	15.7	16.9	13.0	12.2	12.8	117
Total Thanet	57.3	58.7	49.1	47.3	40.2	426
Canterbury city	1.1	3.4	3.2	2.3	2.0	22
Canterbury area villages – Wingham, Chislet, Sturry, etc.	5.6	2.8	4.2	3.1	3.9	31
North-east coast – Whitstable, Herne, Faversham, etc.	1.1	0.6	0.5	2.7	1.0	11
Sandwich, Deal and environs	2.3	7.9	11.6	8.0	6.9	69
Dover, Folkestone and environs	1.1	1.1	1.9	4.2	3.9	22
Romney Marsh	1.1	0.6	0.5	0.8	2.0	7
Sittingbourne and environs	0.0	0.6	0.0	0.8	0.0	3
Medway towns and villages	1.1	0.0	0.9	2.7	2.0	11
Maidstone and environs	1.1	1.1	1.4	3.1	1.0	15
Mid Kent	1.1	1.7	2.8	0.4	2.0	13
Weald	2.3	0.0	0.5	0.8	2.9	8
North-west Kent	1.1	0.0	0.0	0.8	0.0	3
Unknown or outside Kent	23.6	21.5	23.6	23.3	32.4	204

Table 3. Reported causes of death in St Laurence, 1774-1812

Cause of Death	Number	Per Cent
Problems relating to infancy	636	17.4
Respiratory problems	632	17.3
General decay	556	15.2
Old age	476	13.0
Diseases due to inflammation	422	11.5
Miscellaneous	285	7.8
Fevers	210	5.7
Evacuation problems	143	3.9
Swellings	142	3.9
Accidents and external factors	105	2.9
Childbearing	43	1.2
Skin diseases	6	0.2

Table 4. Average weekly expenditure of a labouring family

	s.	d.
Bread and flour	3	6
Meat and fish		10
Rent		9
Clothing and work tools		5
Tea and sugar		4
Milk		4
Candles		3
Soap		3
Fuel		3
Cheese		2
Salt and yeast		2
Beer and gin		2
Thread		2