Tuesday, 8 October 2013

V is for Visitation of God

A term that is seen on a number of early death certificates is "Visitation of God", "Act of God" or Ex visitation e dei” which  is the Latin for "Visitation of God".

Generally this term is used when there appears to be a sudden, unexplained natural death. Actual cause might have been a stroke, heart attack or aneurysm so generally when there had been no previous illness.

Some examples: in Tasmania, Australia civil registration started in 1838. When you look through the early registers of death it is striking the number of occasions when the doctor, probably  a loss to explain the cause of death of adults and children alike, and he called it "Visitation of God." 

Within the first 10 years of the records, children from three months of age up to men and women aged in their 70's and 80's died from this cause. 

Visitation of God was also not an unusual verdict in an inquest up to the 1870s and found occasionally to 1900 or so.

The below examples from the Down Ireland Inquest Verdicts 1841 found here

BAXTER, James, on the 4th September 1841 at Aghadergh, Ireland visitation of God

BYRNE, Theophilus, on the 22nd Dec, at Tullyweir, visitation of God.

CARR, Mathew, on the 18th April, at Lurganbane, visitation of God.

CARSON, Andrew, on the 5th Oct. at Scarva, visitation of God.

CHAMBERS, William, on the 18th May, at Lurganbane, visitation of God.

CONNOR, John, on the 19th Oct, at Drumnabrace, visitation of God.

DOUGLASS, Elizabeth, on the 17th May, at Ballysallagh, visitation of God.

ENGLISH, David, on the 6th May, at Magherassul, visitation of God.

FARRELL, Mary, on the 1st Aug., at Ballykinlar, visitation of God.

FITZSIMONS, Hugh, on the 8th Jan, at Ardglass, visitation of God.

GRANT, John, on the 27th Dec. at Ballymagarrity, died by visitation of God.

HAMILTON, James, on the 13th March, at Ballyhasset, visitation of God.

IRWIN, Francis, on the 22nd Oct., at Dromaghadore, visitation of God.

JOHNSTON, Sarah, on the 12th Nov., at Lystallcarron, visitation of God.

KICLEY, John, on the 22nd April, at Bryansford, visitation of God.

KININGS, John, on the 14th Dec., at Conianstown, visitation of God.

LAVERY, John, on the 7th Nov. at Coolsallagh, visitation of God.

M'CONNELL, Daniel, on the 2nd Nov. Waringstown, visitation of God.

M'POLIN, William, 4th Jan, at Loughran, visitation of God.

NICHOLSEN, John, on the 24th April, at Ballymacknally, visitation of God.

O'HARE, John, on the 1st Jan., at Backaderry, by visitation of God.

ROONEY, Cecily, on the 16th Aug., at Saul, visitation of God.

WALKER, Isaac, on the 8th March, at Lisnashanker, visitation of God.

It is also interesting that there are a number of occasions where "Visitation of God" is given as well as what appears to be an accurate  medical cause is given such as in this example on a death certificate in 1842 in England after an inquest.  

In cause of death it says "Effusion of blood to the left ventricle of the brain" which is likely to be a burst aneurysm?  However  the Verdict was  "Died by the Visitation of God" and this was written on the certificate as was the medical cause. Was there some reason why the evidence from presumably a post-mortem not accepted?

The newspapers also reported the "Visitation of God" as is seen in
The Sydney Gazette and New South Wales Advertiser (NSW : 1803 - 1842) Saturday 4 October 1817, page 2
 "On Tuesday last, Thomas Lee, [sic] smith, of King-street, an industrious inhabitant of the Colony for several years past, expired suddenly in Pitt-street. An Inquest was convened on the occasion, whose verdict was Death by the Visitation of God"

I quite liked this one found on the death of Richard Cundy in 1847 who died at Richmond, Melbourne Victoria.,‘From a visitation of God following the consumption of spirituous liquors’  Perhaps a note of reprimand there?

"Visitation of God" has been seen on certificates from many countries including the colonies of Australia, Canada, the USA, England and other countries of the Commonwealth.

In the Second Annual Report of the Registrar General of Great Britain in 1840, William Farr presented the statistics of causes of death, defined as “diseases, which terminate in the extinction of existence” but he criticized the use of vague categories like "sudden death," "natural death," "visitation of God," and "old age” as not being helpful to determining actual cause of death.

The actual cause of death was important particularly in the new field of public health where with analysis as to deaths in urban and rural area, occupational deaths gave rise to many sanitation  and public health improvements.

William Farr developed a system of classification of the causes of death which, with development,  has become the International Classification of Death which is used throughout much of the world today and is in its tenth edition (ICD10).

William wrote many columns in the British Medical Journal explaining the classifications and the importance of having accurate causes of death reported. This and the increasing medical knowledge around the world meant that a death certificate with “Visitation of God” became a rarity as the century progressed.

I have heard of it on a certificate in 1910 and would be interested if you have a later certificate with this as a cause.

1856 New South Wales Certificate

Monday, 7 October 2013

Alcohol Overuse? Maybe

There was an interesting post on Facebook recently.

The question was if a death certificate said "cirrhosis of the liver" did that mean the person had died of overuse of alcohol? Over use of alcohol has been prevalent throughout all stratas of society leading to adverts like this.

Cirrhosis: irreversible change in the normal liver tissue that results in the degeneration of functioning liver cells. The liver cells are replaced with fibrous connective  tissue. The term is used when there is  scarring of the liver.

It was interesting reading the replies as a fair number of people answered yes. Now if you have personal or family knowledge in your family that the person had issues with alcohol or perhaps substance abuse then you are able to make that statment when you see cirrhosis on a death certificate.

Often if a doctor had personal knowledge of intemperate habits they were not shy of making that statement. These are a variety of terms found on death certificates when alcohol is known to have played a role:

Absinthism, Acne Rosacea.Alcoholia, Alcoholism, Alcoholophilia, Alcohol Poisoning, 
Barrel Fever, Chronic Alcoholism, Chronic Intemperance, Delirium Tremens, Dipsomania,
Ethanol Poisoning, Gindrinker’s Liver, The Horrors, Inebriation, Intemperance, Intoxication,
Moonshine, Oinomania, Wet Brain, Whiskey Liver, Wine Madness

I really like this one "Overindulgence of spiritis fermenti" (thanks to Susan Petersen)

While it is possible to die of acute alcohol poisoning the symptoms would have been very different to cirrhosis. Another cause of death relating to alcohol is death by methanol poisoning.

Methanol Poisoning (Wood alcohol poisoning)
Methanol is a form of alcohol made from wood instead of starches.  Methanol poisoning occurs when methanol is ingested and the methanol is converted to formic acid  during metabolisation in the liver.  This is poisonous to the central nervous system, and can cause blindness, coma, and death. 

So if the cirrhosis was not caused by alcohol what are other potential causes?

Would it surprise you to know that  the causative agent of cirrhosis in the past was unknown in around 50% cases? 

This was prior to the discovery of the Hepatitis B  virus (1965), Hepatitis D virus (1977) Hepatitis C virus (1989) and modern diagnostic tests.

There are a range of inherited diseases, some of which would have been obvious, so you would potentially have expected some mention of them on the death certificate:

Cystic fibrosis, alpha-1 antitrypsin deficiency, haemochromatosis, Wilson disease, galactosemia, and glycogen storage diseases.

The inherited diseases can interfere with how the liver produces, processes, and stores enzymes, proteins, metals, and other substances the body needs to function properly. Cirrhosis can therefore result from these conditions.

Other causes of cirrhosis include drug reactions, prolonged exposure to toxic chemicals, parasitic infections, and repeated bouts of heart failure with liver congestion.

Non-alcoholic fatty liver disease (NAFLD): In this cause fat builds up in the liver and eventually causes cirrhosis.Again there is a range of causes including obesity, diabetes mellitus type 2, protein malnutrition, coronary artery disease, and corticosteroid medications.

So is there a way to give more weight to a alcohol cause of cirrhosis in the past as after all we can't use modern diagnostic techniques? We can however do some trawling through the records.

FindmypastUK  have released some new criminal records such as the one below. This was for London, England habitual drunkards and he was sentenced to time (three years in this case) in a certified inebriate reformatory:

Ancestry has released records of Habitual Drunkards in Birmingham.

I reckon you would be pretty safe suspecting cirrhosis due to alcohol overuse in this instance. 

Other records to peruse are the newspapers local to the area they lived. Were they going up before the courts for "drunk and disorderly" "being intoxicated in a public place", "using abusive language" etc Again in these instances it would support alcohol as a cause.

However if you find none of these records perhaps you have been maligning your ancestor?