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Authors: Laurence Lerner
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that child is present in the dying writer, not through sympathy but in a more literal sense, through memory. This is the nearest thing we have yet had to a child's account of her own death. 19
A Postscript: Diagnosis and Non-diagnosis
What did these children die of? Almost all of them died of infectious diseases, and we know in statistical terms what these diseases were. Smallpox was the biggest killer until the introduction of vaccination early in the nineteenth century. Even then, smallpox remained the most common cause among poor children until well into the century, because the practice
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of vaccination only spread slowly down the social scale. After that came pulmonary tuberculosis ("consumption"), which was also endemic. Then came diseases that swept England in epidemics (especially cholera), and those that came in waves of greater and less severity (measles, scarlet fever). Typhus, diphtheria, and whooping cough were also important. Frequency of all these diseases dropped dramatically with improvements in public health after the mid-century: it is of course prevention not cure that has lowered the child death rate so dramatically in our time. Even antibiotics do not cure all of them.
All that is well-known, but what did particular children die of? Often we know, but often we do not. I have looked at some dozens of child deaths in memoirs and letters and am struck by how often we are told that a patient died of "spotted fever of the most malignant character," of "fever and brain disorder," of "inflammation of the bowels," of ''convulsions," or simply of a serious illness. 20 It is common practice today, especially in America, when mentioning a death (even in the case of the very old, and certainly in other cases) to state the cause of death; clearly this was not the case in Victorian times.
There are three, perhaps four, reasons for this. The first is medical ignorance: the further back in time we go, the less capable medical science is of classifying and diagnosingindeed, the more alarming medical science is in every respect! Some of the doctors we meet in the pages of these memoirs do not inspire much confidence: Elizabeth Prentiss told Dr. Watson that she thought her little son had "water on the brain": her description is fairly detailed, and suggests either a brain tumor or tubercular meningitis. To expect the doctor to diagnose this would be asking too much, but it is alarming to read that, even in 1852, "he said it was not so, and ordered nothing but a warm bath"; twelve days later the child was dead. We have already seen how little Sir Richard Croft could do for Princess Charlotte and how dearly he paid for his presumed incompetence. The official bulletin, presumably provided by Croft himself, attributed her death to "exhaustion of vital energy, occasioned by excessive and insupportable pain." 21 This appears to suggest a blockage in the course of delivery, but the fact that the child was born normally and was "one of the finest infants ever brought into this world" makes that very unlikely. The Princess must surely have died of sepsis or a hemorrhage: it looks as if Croft did not realize thisor was he being vague in order to preserve what he saw as the proprieties? Of course, the occasional bland or incompetent physician is not of
Page 37
great historical significance: more interesting is to observe how far medical science itself was or was not able to diagnose.
The second reason for vague and general description could be, simply, the Victorian belief that diagnosis is not important. If death is the release of the soul from the body, if it is to be welcomed as being received into the presence of God, then the body has ceased to matter, and one need waste no attention on what caused it to cease functioning. Here for instance is Mrs. Tait's description of the dead Chatty:
There she lay in the room in which I had given her birth; but that day I felt indeed the spirit was gone, and the little form
A Postscript: Diagnosis and Non-diagnosis
What did these children die of? Almost all of them died of infectious diseases, and we know in statistical terms what these diseases were. Smallpox was the biggest killer until the introduction of vaccination early in the nineteenth century. Even then, smallpox remained the most common cause among poor children until well into the century, because the practice
Page 36
of vaccination only spread slowly down the social scale. After that came pulmonary tuberculosis ("consumption"), which was also endemic. Then came diseases that swept England in epidemics (especially cholera), and those that came in waves of greater and less severity (measles, scarlet fever). Typhus, diphtheria, and whooping cough were also important. Frequency of all these diseases dropped dramatically with improvements in public health after the mid-century: it is of course prevention not cure that has lowered the child death rate so dramatically in our time. Even antibiotics do not cure all of them.
All that is well-known, but what did particular children die of? Often we know, but often we do not. I have looked at some dozens of child deaths in memoirs and letters and am struck by how often we are told that a patient died of "spotted fever of the most malignant character," of "fever and brain disorder," of "inflammation of the bowels," of ''convulsions," or simply of a serious illness. 20 It is common practice today, especially in America, when mentioning a death (even in the case of the very old, and certainly in other cases) to state the cause of death; clearly this was not the case in Victorian times.
There are three, perhaps four, reasons for this. The first is medical ignorance: the further back in time we go, the less capable medical science is of classifying and diagnosingindeed, the more alarming medical science is in every respect! Some of the doctors we meet in the pages of these memoirs do not inspire much confidence: Elizabeth Prentiss told Dr. Watson that she thought her little son had "water on the brain": her description is fairly detailed, and suggests either a brain tumor or tubercular meningitis. To expect the doctor to diagnose this would be asking too much, but it is alarming to read that, even in 1852, "he said it was not so, and ordered nothing but a warm bath"; twelve days later the child was dead. We have already seen how little Sir Richard Croft could do for Princess Charlotte and how dearly he paid for his presumed incompetence. The official bulletin, presumably provided by Croft himself, attributed her death to "exhaustion of vital energy, occasioned by excessive and insupportable pain." 21 This appears to suggest a blockage in the course of delivery, but the fact that the child was born normally and was "one of the finest infants ever brought into this world" makes that very unlikely. The Princess must surely have died of sepsis or a hemorrhage: it looks as if Croft did not realize thisor was he being vague in order to preserve what he saw as the proprieties? Of course, the occasional bland or incompetent physician is not of
Page 37
great historical significance: more interesting is to observe how far medical science itself was or was not able to diagnose.
The second reason for vague and general description could be, simply, the Victorian belief that diagnosis is not important. If death is the release of the soul from the body, if it is to be welcomed as being received into the presence of God, then the body has ceased to matter, and one need waste no attention on what caused it to cease functioning. Here for instance is Mrs. Tait's description of the dead Chatty:
There she lay in the room in which I had given her birth; but that day I felt indeed the spirit was gone, and the little form
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