Phillip Roberts

Determining the Meaning behind Historical Disease Terminology through an Examination of Patterns of Terminology used in the Mortality Statistics of Victoria, 1853–1900

Presented are four methods which may be used to determine the meaning behind past terminology usage, demonstrated through the utilisation of Victorian Registrar-General Reports from 1853 to 1900. These methods are: (1) looking for direct changes in terminology usages; (2) use of a control disease; (3) comparing historical terms whose use mirrors each other; and (4) using risk factor statistics. Through these methods, it is concluded that in the second half of the nineteenth century the term 'hydrocephalus' referred to tubercular meningitis, 'intemperance' to alcohol poisoning, 'quinsy' and 'laryngitis' indicated a diphtheria infection, 'puerperal fever' referred to group A streptococci infection, 'typhoid/typhus' described typhoid more than typhus, 'teething' often indicated infantile diarrhoea and 'tumour' often a tapeworm infection.

A number of techniques can be used to determine the meaning of medical terminology in Victoria during the nineteenth century. These techniques have the potential to improve how historical epidemiological data is analysed, and to therefore gain a better understanding of historical human-disease relationships. This is done with the understanding that medical practitioners prior to the nineteenth century medical revolution were able to accurately report the symptoms which they observed within the restrictions of their collective knowledge. Therefore reports detailing mortality and morbidity data from eras where terminology used is no longer common today, represent a largely untapped resource in the study of disease ecology, presuming such terms can be given modern meaning.

Within this paper I present a number of methods that could be used to determine the modern meaning of past medical terminology in historical databases. These methods were developed through the examination of the Registrar-General's Reports of Victoria, covering the period from 1853 through to 1900. This paper will examine the following terminology as examples of the methods used in the exploration of historical disease descriptions: 'hydrocephalus,' 'intemperance,' 'quinsy,' 'laryngitis,' 'puerperal fever,' 'tumour,' and historical terminology describing joint disease, 'teething' and 'typhoid/typhus.'

Four methods where used to attempt to diagnose the meaning behind past disease terminologies through examining patterns of their use:

1. Direct changes in terminology usage

By looking for direct changes in terminology usage over time, it is possible to chart the epidemiology of a disease, or group of diseases, for that specific period. This was achieved through looking at terms whose use ceased dramatically and then attempting to identify the replacement terms. If the substitute term is more meaningful, it can then be used as a proxy for the superseded term. Two examples of direct changes in terminology usage shall be discussed. The first is demonstrated through the use of the term 'hydrocephalus,' which appears to be smoothly replaced by the term 'tubercular meningitis' in Victoria's Registrar-General's Reports. This translation could therefore indicate that these two terms describe the same group of conditions.¹ The second example is provided by the term 'intemperance,' which is replaced by 'chronic alcoholism.'

2. Use of a control disease

This method utilises the fact that many historic medical terminologies are still in use today, therefore simular term usage patterns of a well understood historic terminology and a less diagnostic term, can result in furthering understanding the less diagnostic term. This paper will demonstrate that the terms 'quinsy' and 'laryngitis' as a listed cause of death may often refer to diphtheria of the tonsils and larynx respectively.² In addition, the same method suggests that the term 'puerperal fever' refers to a group A streptococci infection following childbirth.³

3. Comparing terms whose use parallel each other

Often a number of disease terms will parallel each other, which can be used to infer further information about their meaning. For example, it will be shown that the phrase 'typhoid/typhus' refers to typhoid more often than typhus, as it parallels the use of the phrase 'atrophy and debility.' In addition, the use of the terms 'teething' and 'diarrhoea' parallel each other, suggesting that the use of the term teething often refers to the death of an infant from diarrhoeal disease.

4. Use of risk factor statistics

Because diseases may often be linked to social, environmental or economic risk factors, the use of statistics that relate to such factors may also be used to determine the meaning of historical disease terminologies. It will be shown that as the term 'tumour' parallels the economics of the colony, but not use of the term cancer, 'tumour' may often relate to hydatid disease or cysticercosis.

The colony of Victoria in the second half of the nineteenth century represents an extremely influential period in colonial Australian history, and one where the social and cultural environments of the colony and the country were shaped and reshaped.⁴ This is also unique from an anthropological perspective due to the greatly abnormal socio-economic, demographic and cultural developments that took place. These factors make this time and region a unique model period in which to observe the human cultural relationship within the Australian environment. The colony experienced massive migration and wealth due to the gold rush, political and social reforms after the 'Eureka' rebellion, economic depression when the easily won gold was mined out, industrial development to chase deeper mineralisation and the development of a more sustainable agricultural/industrial economy, all inside a fifty year period.⁵ This occurred in a temperate environment, with few exotic diseases, natural disasters, without war and before/during the introduction of modern medicine.

The colony of Victoria was also affected by the global events of this period. These included the development of germ theory, the emergence of surgery and nursing as respected professions, medical practice reforms, and a greatly increased understanding of disease behaviour and the human body.⁶

During the second half of the nineteenth century, Victoria had a doctor-to-patient ratio higher than Britain, with the Annual Reports to Parliament suggesting a great deal of enthusiasm for data collection in the colony.⁷ Henry Hayter, Victoria's Registrar-General from 1873 to 1893, and assistant Registrar-General from 1859, won international recognition for his work.⁸ The majority of Victorian doctors at this time were trained in the United Kingdom, and as such shared a common medical register with the British who were very much at the forefront of the medical revolution in the nineteenth century. Bowden reported that there existed a strong feeling of professionalism within Victoria.⁹ An autonomous Board of Health was established in 1855, which implemented, among other things, a small-pox vaccination program.¹⁰ The factors of a high quality of the statistical collection, the high quality of medical care and rapid cultural developments make this time and region an important model period for exploring the disease-culture relationship.

Methodological Considerations

This research is influenced by biological archaeology, which, using observances of disease in past cultures tries to reconstruct behaviours and practices in past social environments.¹¹ This is done through a modern knowledge of risk behaviours and the human-disease relationship. Traditionally this involves the study of skeletal material, however this paper is an example of the examination of historical mortality statistics.

Data Collection

A methodological consideration discussed by Borah is that historical data cannot be compared with modern bio-anthropological or epidemiological studies, because currently historical data, methods of data collection and language usage can not be compared with their modern equivalents.¹² Therefore, often historical data is ignored by these academics.

It is a goal of this paper to link historical data to contemporary studies and therefore show that historical mortality and morbidity data analysis has value to modern disease research.

Terminology Change

The process of representing historical public health records as mortality patterns presents inherent problems, predominantly due to potential false indications of disease frequency associated with the effects of different medical environments (be them historical, technological or cultural). Changes in rates of medical terminology could be due to technological and scientific development, changes in the logistics and administration of disease and death, or simply cultural changes. However, it should also be considered that patterns of past disease terminology usage will also follow the actual disease epidemiology, therefore, critical examination of the patterns of past medical terminology usage is highly important.

Correlation of Different Terminology Usage through Patterns of Usage

The task of interpreting rates of disease through linking patterns of medical terminology usage over time contains inherent problems for a number of reasons as diseases may have common risk factors, are interdependent, are biologically similar, or have symptoms of the same disease described differently. The disease-human relationship is also not necessarily constant. Such research is also confused by the variation in survival/recovery time experienced by different individuals. In this manner, the length of an individual's survival will manifest in a different array of symptoms, which will in turn potentially skew correlations of data based terminology, although they may have been caused by the same pathogen. However, if usage of two terms that describe different causes of mortality correlate over a number of years, it may be justified to question whether these two diseases in fact have a diagnostic relationship.

Assumption of correct diagnosis

This study works on the assumption that the cause of death attributed by the physicians of the time, and listed for the individual within the Registrar-General's Reports, is the major contributing factor in the described mortality. It is through using these diagnoses and descriptions that the study undertakes to determine the contemporarily relevant medical meaning of these terms.

However, the stated cause of death can often be complicated by many factors and is rairly simple. Roberts and Manchester discuss evidence from clinical research which indicates that assigning a single cause of death, even in modern society, is far from easy.¹³ A modern example that illustrates this point is a study by Ermene and Dolene which compares clinical and post mortem diagnoses in 444 autopsy reports.¹⁴ This study found complete agreement in only fourty-nine percent of cases, while thirteen percent were found to be in complete disagreement. It could be assumed, therefore, that nineteenth century death certificates contained inaccuracies to a similar extent.

In addition, the Registrar-General's were not medical professionals, but statisticians. This in itself has the potential to introduce errors, as highlighted by a 1975 case in Tasmania, which saw the statistician record 'severe pre-eclampsia' as 'eclampsia' which created a data anomaly.¹⁵ Such errors may, however, be reduced with large sample size, which, as discussed by Correy et al., will 'dilute errors of omission or commission.'¹⁶

Previous Work

A number of studies have aided in the formulation of the methodologies of this paper.¹⁷ This work touches on many fields of academia including medical history, epidemiology, through biological anthropology and archaeology.

These methodologies can be aligned with Grmek, whose concept of 'linguistic archaeology' aided in the reconstruction of the ancient Greek disease spectrum.¹⁸ It is understood that this has greatly enabled the study of the history of disease through the examination of disease descriptions of past peoples with a modern diagnostic understanding. The current study differs from Grmek in its examination of the frequency of terminology usage, rather than a linguistic study, building only on Grmek's short statistical analysis of wound frequency described in the Iliad.

Methodology

To demonstrate disease fluctuations in Victoria (1853–1900), the annual statistics on mortality of the colony where utilised (reported to parliament by the Registrar-General and collected from issued death certificates).¹⁹ This source appears to be the most comprehensive data available on the time period in question, theoretically including all deaths in Victoria regardless of race for each calendar year. This data often includes some now superseded terminology, but gradually becomes more descriptive as the century progresses, which is in line with advancements in medical knowledge.

To support this analysis, data on population, economics, fertility and occupation has been collected for the period from the annual statistics of the colony in the Parliamentary Papers between 1850 and 1900 and the census of Victoria for 1861, 1871, 1881, 1891 and 1901. The census of 1851 was not included due to the manner in which the data was reported, which resulted in it being incompatible with data from other years.

The most commonly accepted way of analysing mortality in epidemiological and ecological studies is through the comparison of rates of mortality to the living population of the same time period. These ratios can be reported as deaths per 1,000, 10,000 or 100,000 of the living population through the following calculation.²⁰

number of disease cases in a time period (one year)

total living population at the mid point of that time period (one year)	x	100,000 (1,000 or 10,000)

This calculation requires a comparable sample of the object population, which was available for this study. Lilienfeld and Stolley also state that calculation of disease ratios should use the living population from the mid-point of the time period calculated.²¹ Unfortunately, the Registrar-General's reports estimate the population at the end of a year. As a result, this study has used these figures, which has meant that the calculated ratios will be proportionately smaller than they would have been if the mid-period population was available. The patterns of terminology usage should, however, remain the same.

The first stage of the analysis entailed collecting all data reported by the Registrar-General in the period from July, 1853 (first published report), to 1900, and then entering this data into a matrix using the disease classifications of 1900. It should be noted that because the data collected in the year 1853 only represents the last six months of that year, each mortality result has been doubled to approximate a full year of data. Using the annual estimation of population the mortality ratio was calculated for each reference to a cause of mortality. The complete results of these calculations can be found in the Appendices of Roberts.²²

Data was collected from the Victorian Parliamentary Papers, which included colony income. These records were used to estimate periods of economic wealth and depression through charting the annual record of government surplus and deficiency. To estimate government saving, a cumulative 'Government Saving' chart was constructed by adding the government surplus and deficiency for each year cumulatively. Note that these charts have not been corrected for inflation or for population, as no information regarding inflation or taxation rates were available.

To examine non-specific terminology, terms were grouped by examining graphical patterns which mirrored each other, that is, charts with common peaks and troughs of mortality. The meaning of groups of term usage charts were then critically examined and explored based on the patterns that they demonstrated compared to other terms in their group, as well as population, economic data and known historical events.

Results and Discussion

The following section is a brief demonstration of the four different methodologies used within the study.

1. Direct changes in terminology usage

This section describes the historical terminology, 'hydrocephalus' and 'intemperance,' as used by Victoria's Registrar-General from 1853 to 1900. It is considered that these terms were often used to describe tubercular meningitis and alcoholism respectively. 'Hydrocephalus and 'intemperance' both retain this function in modern society, in certain situations. This correlation was highlighted when both terms abruptly ceased to be used within the period of study, and as it is unlikely that these conditions were eliminated from society within this timeframe, it is believed that the terminology was simply replaced. By comparing charts of terminology usage that are considered to describe a similar set of symptoms, it is possible to correlate a likely candidate for the replacement term. This term may replace all of the period in which the first term was used, or only part of it, as highlighted within the examples below. Through this correlation, the more detailed description of the replacement term can, in some instances, be broadly applied to the first.

1.a. Hydrocephalus versus Tubercular Meningitis

The most common modern interpretation of hydrocephalus involves the abnormal flow of cerebrospinal fluid, which results in increased pressure on the brain (sudden onset, or acute hydrocephalus, is often associated with tuberculosis). Normally hydrocephalus is caused by a congenital defect, cancer or other tumours, infection or injury.²³ Historically, the term appears to have been used for all conditions involving a build up of fluid within the cranial vault, including meningitis and trauma. This example highlights the changing meaning of terminology through time, and draws attention to the potential for regional variation of meaning.

Charted in Figure 1 are deaths per 100,000 described using the terms 'hydrocephalus' and 'tubercular meningitis.' It demonstrates that the use of the term 'hydrocephalus' ceases to be used by the Registrar-General after 1887, appearing to have been replaced directly by the term 'tubercular meningitis.' This would suggest that 'hydrocephalus' may have often been used to describe a tuberculosis infection of the meninges prior to 1887. However, from 1853 to 1868 the use of the term 'hydrocephalus' fluctuates greatly, describing between twenty to fifty deaths per 100,000. After 1868 it becomes less volatile, being consistently used to describe around the twenty deaths per 100,000. Therefore, from 1853 to 1868 the term may also describe another, unknown, condition. This is supported by the observation that the use of other terms describing tuberculosis does not show this pattern.

Figure 1: Deaths per 100,000 reported as 'Tubercular Meningitis' and 'Hydrocephalus,' in the Annual Registrar-General's report to the Victorian Parliament, 1853–1900.²⁴

1.b. Intemperance versus Chronic Alcoholism

'Intemperance' literally means a lack of self control and possibly relates to a self inflicted fatality through misadventure when used as a cause of death.²⁵ Historically, the term is commonly considered to have referred to chronic alcoholism, probably alcohol poisoning, or where death is directly linked to alcohol consumption. However, as Bate discusses, the goldfields are considered to have harboured the wide-spread modification of beverages by hotel owners, which included adding drugs and poisons (including strychnine) to drinks in order to cheaply increase the effects of intoxication.²⁶ This is likely to have resulted in an increase of the instances of manslaughter.

As shown in Figure 2 the use of the term 'intemperance' is replaced by the term 'chronic alcoholism' after 1886, which supports the historical understanding of the meaning of the term and the use of this method to determine the meaning of past disease terminology.

Figure 2: Deaths per 100,000 reported as 'Chronic Alcoholism' and 'Intemperance,' in the Annual Registrar-General's report to the Victorian Parliament, 1853–1900.²⁷

1.c. Circulatory Disease

As demonstrated in the abovementioned examples, it is possible to determine the meaning of past disease terminology through direct changes in their usage. Nevertheless, reconstructing implied disease epidemiology is rarely this simple. Figure 3 demonstrates that cardio-vascular disease increases consistently from 1854 to 1900, which corresponds with dietary changes, increased life expectancy, and changes in living environments over this time period. However, this chart is made up of twelve separate terms describing mortality, ranging from 'varicose veins' to 'aneurism' and 'angina pectoris,' which are different conditions, and as such have required some broad interpretation.

Figure 3: Deaths per 100,000 from various circulatory diseases. From the Annual Registrar-General's Report to the Victorian Parliament, 1853–1900. These have been charted cumulatively.²⁸

2. Use of a Control Disease

The use of a control disease to determine the meaning of historical disease terminology involves comparing such usage patterns to the pattern of a disease term that is still in use. This therefore implies that the historical term has either the same biological cause, or had the same environmental risk factors, which resulted in an increased frequency in the population. The following examples demonstrate that the use of the terms 'quinsy' and 'laryngitis' refer to diphtheria infections, while the term 'puerperal fever' refers to a group A streptococci infection.

2.a. Quinsy and Laryngitis versus Diphtheria Infection

It is suggested that the historical terms 'quinsy' and 'laryngitis' often referred to a diphtheria infection in Victoria's Registrar-General's Report of the nineteenth century. Peritonsillar abscess (Quinsy) is now rare, but prior to antibiotics and surgery it could be life threatening, particularly due to the threat of infection spreading into the palate and lungs, which could obstruct airways due to swollen tissue.²⁹ Laryngitis is a common infection of the larynx, but is not usually fatal except where there is involvement of syphilis, diphtheria, streptococci or tuberculosis.³⁰ From this, it can be determined that the terms of death 'laryngitis' and 'quinsy' in the nosology of the nineteenth century refer to a bacterial infection of the upper respiratory tract. The key area for investigation is determining what type of bacteria was involved.

Figure 4 charts the representative terminology of the major bacterial infections within the study period that are commonly associated with fatal infectious diseases of the upper respiratory tract. Within this data set 'scarlet fever' represents the behaviour of group A streptococci bacteria, 'syphilis' represents the behaviour of bacteria of the genus Treponema, 'tuberculosis' represents the behaviour of the bacterium Microbacterium tuberculosis, and 'diphtheria' represents the bacterium Corynebacterium diphtheriae. These charts display very distinctive patterns that can be used to show which bacteria were responsible for the majority of deaths where there was observed involvement of the tonsils/palate ('Quinsy') and larynx ('Laryngitis') through looking for parallels between the known and historical terminology usage.

Figure 4: Major bacterial infections as deaths per 100,000, reported by the Annual Registrar-General's Report to the Victorian Parliament, 1853–1900.³¹

Figure 5 plots the use of the terms 'Laryngitis' and 'Quinsy' in Victoria from 1853 to 1900. It is possible to eliminate tuberculosis and syphilis as being responsible in the majority of cases by simply comparing mortality patterns. 'Laryngitis' appears to adhere reasonably closely to the patterns of the diphtheria chart suggesting that they often have a similar cause in Corynebacterium diphtheriae. 'Quinsy' does not follow the diphtheria chart as closely, which suggests that streptococci infections were responsible for a substantial percentage of the cases of peritonsillar abscesses from 1853 to 1900. However, a common peak with diphtheria in 1860, correlations to rates of diphtheria from 1866 to 1869 and in 1878, and also the lack of association to the 1876 scarlet fever epidemic, suggests that diphtheria was responsible in the majority of cases.

Figure 5: Deaths per 100,000 reported as 'Laryngitis' and 'Quinsy', in the Annual Registrar-General's Report to the Victorian Parliament, 1853–1900.³²

2.b. Puerperal Fever versus Streptococci Infection

As discussed by Smith, in the nineteenth century puerperal fever was a term used to describe a wide variety of disorders where death of the mother followed childbirth.³³ The term appears to have been used if there were any symptoms of heart disease, dysentery, peritonitis, infection or haemorrhage in the fatality of the mother. Carter however, comments that in the majority of cases in Britain in the nineteenth century, this term refers to a group A streptococci infection.³⁴ This is also demonstrated to be the case in Victoria, by comparing rates of puerperal fever to other terms where it can be assumed that the streptococci bacteria was the infectious agent, as in the previous example. As reported by McCallum, the correlation between scarlet fever, erysipelas and puerperal fever had been observed by Victorian physicians as early as the 1860s, and many, at the time, believed the diseases to be linked.³⁶

Figures 4 and 6 show that puerperal fever usually referred to a group A streptococci infection after childbirth in Victoria from 1853 to 1900. The use of the term 'puerperal fever' to describe death appears to parallel patterns of scarlet fever epidemics to a greater extent than some of the more accepted terms for streptococci infections. In this regard, it is highly probable that during the study period, a group A streptococci bacteria caused a description of 'puerperal fever' when a mother died after childbirth. This may have been the result of the hygienic practices among midwives.³⁷ Cumpston and Lewis also point out that unmarried woman were more likely to die from this disease than married women, which potentially indicates that less skilled help was offered to women in such circumstances.³⁸

Figure 6: Deaths per 100,000 reported as 'Erysipelas', 'Rheumatic Fever' versus Puerperal Fever in the Annual Registrar-General's Report to the Victorian Parliament, 1853–1900.³⁵

3. Comparing historical terms whose use parallel each other

Often when examining historical epidemiological data it can be observed that patterns of term usage parallel each other, but neither term remains in usage today. This is likely to be the result either because they have the same biological cause (scarlet fever, rheumatic fever, puerperal fever, erysipelas) or they have common environmental risk factors (heart disease and diabetes or substance abuse and violence). Therefore, this can be used to gain more information about the meaning behind a number of terms, which will be demonstrated in the following two examples.

3.a. Typhoid or Typhus

Although it was recognised that typhoid and typhus were different diseases in the nineteenth century, physicians of the time found it difficult to separate them through their physical symptoms. Indeed, the records from the Registrar-General of Victoria from 1853 to 1900 reports the two diseases together as 'typhoid/typhus.' Typhus is caused by organisms of the genus Rickettsiae spread by arthropod parasites such as ticks, lice and fleas.³⁹ Typhoid however, is caused by the bacteria Salmonella typhi, and is spread via contaminated food and water.⁴⁰

Although different diseases, one would expect that rates of both would decrease with the improved living standards in Victoria throughout the second half of the nineteenth century. However, there is a close correlation with the description of death, 'atrophy and debility' (Figure 7), which describes a general loss of mobility, wasting away and a loss of muscular bulk which, superficially, indicates dietary diseases. This suggests that typhoid was the most probable contender for causing the majority of these deaths. This is supported by observances from Cumpston and Lewis that widespread pollution of water sources with sewage occurred within the study period.⁴¹ It also suggests that the term 'atrophy and debility' often describes diseases associated with poor sanitation or poor diet, which is supported through the actions of the Registrar-General to classify 'atrophy and debility' as a dietary disease.

Figure 7: Deaths per 100,000 reported as 'Typhus/Typhoid', 'Atrophy and Debility' in the Annual Registrar-General's Report to the Victorian Parliament, 1853–1900.⁴²

3.b. Teething and Diarrhoea

Another example is the comparison between the terms 'teething' and 'diarrhoea.' The term 'teething' is associated with an illness or fatality of an infant in the period of life where the milk teeth erupt.⁴³ Wilson and Mason also express concern regarding the misuse of this term by parents and health care workers even into modern times.⁴⁴ The eruption of the milk teeth, although often painful, has very little potential to be fatal by itself. Although past forms of treatment such as cutting, rubbing mercury powder into the gums or the extensive use of soothing syrups increased the potential of mortality, it is not believed these cases of malpractice would have caused the number of fatalities indicated in Figure 8 (which was comparable to whooping cough, pneumonia, heart disease, and bronchitis in the 1860s). Therefore the use of this term potentially hides other causes of death.

Figure 8: Deaths per 100,000 reported as 'Diarrhoea' and 'Teething' in the Annual Registrar-General's Report to the Victorian Parliament, 1853–1900.⁴⁵

As demonstrated in Figure 8, the terms 'teething' and 'diarrhoea' parallel each other, supporting the view that the term 'teething' often describes misdiagnosed infantile diarrhoea. This also suggests that many fatal cases of diarrhoea in the nineteenth century involved a younger demographic. It is also observed that the term 'teething' progressively drops out of fashion in the 1870s and 1880s and stops being used by the Registrar-General in the 1890s, paralleling 'diarrhoea' much closer in the 1850s and 1860s.

4. Use of risk factor statistics

As many different diseases have risk factors that increase or decrease the prevalence of a disease, industrial, economic or demographic statistics can also be used to determine the meaning behind past historical disease terminology.

4.a. Tumours and Economic Success

The 1870s and 1880s saw Victoria experience a period of economic success, followed by depression in the 1890s. These circumstances provide an example of the use of risk factor statistics, as this rise and fall in economic success correlates with the term 'tumour' and to a lesser extent 'epilepsy' and 'worms.' It is therefore hypothesised that this relationship, and the data indicating the success of the colony, potentially indicate hydatid disease or cysticercosis.

Figure 9 displays a crude estimation of government saving by calculating cumulatively government surplus or deficit for each year. It should be noted that this chart is not corrected for population or inflation, as taxation rates and inflation rates were not available. The pattern displayed is mirrored by the use of the term 'tumour' (Figure 10). 'Tumour' broadly refers to any abnormal growth of tissue, which may form an enlarged tissue mass.⁴⁶ In modern times, the term is most commonly associated with cancer, but the use of the term 'cancer' by the Registrar-General from 1853 to 1900 does not follow this pattern (see Figure 11), displaying no dramatic rise in the 1880s or drop in the 1890s. In addition, some invertebrate parasites can cause tumours to develop, as can congenital defects or iodine deficiency (goiter). It is believed, however, that the term 'tumour' most commonly refers to either hydatid disease (tapeworm infection) or cysticercosis (infection with Taenia solium, pork tapeworm) in this study. This is firstly the result of the ability of both these diseases to produce potentially fatal tumour like cysts, and secondly, because these diseases can be spread by domestic animals, which is relevant as it is believed that meat consumption and the number of domestic animals kept by people would increase during periods of economic success. Finally, the terms 'epilepsy' and 'worms' also, albeit loosely, follow this same pattern (Figure 12). True epilepsy is a genetic disorder which is rarely fatal; however epileptic-like fits can be linked to death because of pressure and/or lesions on the brain.⁴⁷ These may be caused by heavy metal poisoning, meningitis, tuberculosis, drug addiction, children with high fever, cancer, or as suggested above, parasite infections in the brain. 'Worms' is also a very broad term describing death. Invertebrate parasites that can cause fatalities in humans include blood flukes, Trichinosis, Ascaris and tapeworm.⁴⁸ The combination of this evidence appears to suggest that where 'tumour' was used as a cause of death often referred to a parasite infection, possibly tapeworm.

Figure 9: Annual surplus/deficiency as reported in the colony economic papers of Victoria from 1850 to 1900 reported to Parliament. Also included is a crude calculation of Government saving by charting a cumulative surplus/deficiency chart.⁴⁹

Figure 10: Use of the term Tumour, Deaths per 100,000 in Victoria from 1853 to 1900 as calculated from the Annual Registrar-General's Reports to the Victorian Parliament.⁵⁰

Figure 11: Use of the term Cancer, Deaths per 100,000 in Victoria from 1853 to 1900 as calculated from the Annual Registrar-General's Reports to the Victorian Parliament.⁵¹

Figure 12: Use of the terms Epilepsy and Combined Worms, Deaths per 100,000 in Victoria from 1853 to 1900 calculated from the Annual Registrar-General's Reports to the Victorian Parliament.⁵²

Conclusion

The modern meaning behind past medical terminology may be determined through observing patterns of usage and interpreting these patterns with reference to modern medical and epidemiological understanding. This type of study is potentially important for improving the amount of data epidemiologists, biological anthropologists and biological archaeologists have to draw upon for examining the patterns of past diseases.

This research indicates that it is possible to link the terms, 'hydrocephalus' and 'tubercular meningitis,' suggesting that often the use of the term hydrocephalus referred to a tuberculosis infection of the meninges. The same method was able to identify similarities in the use of the terms 'intemperance' and 'chronic alcoholism.'

The use of a control disease shows promise as a technique for determining the more likely cause behind historical mortality terminology. It has been shown that the terms 'quinsy' and 'laryngitis' often referred to diphtheria and that the term 'puerperal fever' often referred to streptococci infection. These conclusions were derived through comparing the patterns of historical terminology usage to a disease that could be assumed nineteenth century physicians were diagnosing accurately.

As historical terminology usage patterns can parallel each other this can be useful in improving our understanding of the meaning behind past disease terminology. Examples included: as the term 'typhoid/typhus' parallels the phrase 'atrophy and debility' describing mortality, it can be determined that typhoid is the most common cause of death where these terms were used; also, because the terms 'teething' and 'diarrhoea' parallel each other, this likely indicates that the use of the term 'teething' describes infantile diarrhoeal disease in the nineteenth century.

As different demographics, economic and industrial environments can be associated with different disease ecologies, the use of industry, population or economic data as a tool can be helpful in determining the meaning behind some historical terminology usages. It has been shown in this paper that as rates of the use of the term 'tumour' parallels the economic success of the colony, this term may be referring to hydatid disease (tapeworm infection) or cycsterosis.

The reconstruction of past mortality patterns through historical data analysis is reliant on an understanding of the meaning behind past medical terminology. This paper highlights a number of methods, that may be developed and modified for use by historical biological archaeologists or historical epidemiologists to reconstruct the meaning of past disease terminology.

Australian National University

Notes

^1.� Phil Roberts, "Gold Fever: Disease and its Cultural Relationship, a Case Study on the Development of the Colony of Victoria, 1950 to 1900," (MA Thesis, Australian National University, 2006).

^2.�Ibid.

^3.�Ibid.

^4.� Weston Bate, Lucky City: The First Generation at Ballarat: 1851–1901 (Melbourne: Melbourne University Press, 1978); Weston Bate, Victorian Gold Rushes (Melbourne: Penguin Books Australia, 1988); Keith Macrae Bowden, Goldrush Doctors and Ballarat, (Melbourne: K.M. Bowden, 1977); Tony Dingle, The Victorians: Settling (Sydney: Fairfax, Syme, & Weldon Associates, 1984); Joseph Jenkins, Diary of a Welsh Swagman, 1869–1894 (Melbourne: Sun Books, 1977); Jean Gittins, The Diggers from China: The Story of Chinese on the Goldfields (Melbourne: Quartet, 1981); David Goodman, Gold Seeking : Victoria and California in the 1850s (Sydney: Allen & Unwin, 1994); A.G.L. Shaw, A History of Port Phillip District: Victoria Before Separation (Melbourne: Melbourne University Press, 2003); W.B Withers, History of Ballarat: and Ballarat Reminiscences (Ballarat: Ballarat Heritage Services, 1999).

^5.� Bate, "Victorian Gold Rushes"; Dingle.

^6.� Bruce Lenman and Trevor Anderson, eds., Chambers Dictionary of World History (New York: Chambers, 2003); Roy Porter, The Greatest Benefit to Mankind: A Medical History of Humanity from Antiquity to the Present (London: Fontana Press, 1999).

^7.� Diana Dyason, "The Medical Profession in Colonial Victoria, 1834–1901," in Disease, Medicine and Empire; Perspectives on Western Medicine and the Experience of European Expansion, edited by Roy MacLeod and Milton Lewis (London: Routledge, 1988).

^8.� A.J. Proust, "Tuberculosis in Australia: Part 1." in History of Tuberculosis in Australia, New Zealand and Papua New Guinea, edited by A.J. Proust (Canberra: Brolga Press, 1991).

^9.� Bowden.

^10.� Dyason, "The Medical Profession in Colonial Victoria, 1834–1901"

^11.� Jesper L. Boldsen, "Leprosy and Mortality in the Medieval Danish Village of Tirup," American Journal of Physical Anthropology 126, (2005): 159–168; John Caldwell and Bruce Caldwell, "Was There a Neolithic Mortality Crisis?" Journal of Population Research 20, no, 2 (2003): 153–168; Vered Eshed et al., "Has the Transition to Agriculture Reshaped the Demographic Structure of Prehistoric Populations? New Evidence From the Levant" American Journal of Physical Anthropology 124 (2004): 315–329; Mary Jackes, David Lubell and Christopher Meiklejohn, "Health but Mortal: Human Biology and the First Farmers of Western Europe," Antiquity 71 (1997): 639–58; Anne Keenleyside, "Changing Patterns of Health and Disease Among the Aleuts," Arctic Anthropology 40, no. 1 (2003): 48–69; Clark Spencer Larsen, "Biological Changes in Human Populations with Agriculture." Annual Review of Anthropology 24 (1995): 185–213; M.F. Oxenham, Nguyen Kim Thuy, Nguyen Lan Cuong, "Skeletal Evidence for the Emergence of Infectious Disease in Bronze and Iron Age Northern Vietnam," American Journal of Physical Anthropology 126 (2005): 359–376; Michael Pietrusewsky and Michelle Toomay Douglas, "Intensification of Agriculture at Ban Chiang: Is there Evidence in the Skeletons?" Asian Perspectives 40, no. 2 (2001): 157–177; Erik Trinkaus, "Neanderthal Mortality Patterns." Journal of Archaeological Science 22, (1995): 121–142; James W Wood et al., "The Osteological Paradox: Problems of Inferring Prehistoric Health from Skeletal Samples," Current Anthropology 4, no. 4 (1992): 343–370.

^12.� Woodrow Borah, "Introduction," in Secret Judgement of God; Old World Disease in Colonial Spanish America, edited by Noble David Cook and W. George Lovell. (Norman: University of Oklahoma Press, 1992).

^13.� Charlotte Roberts and Keith Manchester, The Archaeology of Disease (New York: Cornell University Press, 2007).

^14.� Branko Ermenc and Anton Dolenc, "Possibilities of Comparing Clinical and Post Mortem Diagnoses," Forensic Science International 103 (1999): S7-S12.

^15.� J.F. Correy, N.M. Newman and J.T. Curran, "The Tasmanian Obstetric and Preinatal Audit," in Epidemiology in Tasmania, edited by Hilary King (Canberra: Brolga Press, 1987)

^16.�Ibid.

^17.� Andrew B Appleby, "Nutrition and Disease: The Case of London, 1550–1750," in Health and Disease in Human History: A Journal of Interdisiplinary History Reader, editied by Robert I. Rothberg (Cambridge: MIT Press, 2000); Peter Gardiner and Mayling Oey, "Morbidity and Mortality in Java 1880–1940: The Evidence of the Colonial Reports." in Death and Disease in Southeast Asia: Explorations in Social, Medical and Demographic history, edited by Norman G. Owen (Singapore: Oxford University Press, 1987); Terence H. Hull, "Plague in Java," in Death and Disease in Southeast Asia: Explorations in Social, Medical and Demographic history, edited by Norman G. Owen (Singapore: Oxford University Press, 1987); Bobbie Shuster and Sam Shuster, "Lost at Sea: Missing Diseases in the Mid Nineteenth Century Merchant Navy," in History, Heritage and Health, edited by Jeanette Covacevich (Brisbane: The Australian Society of the History of Medicine, 1996). As examples.

^18.� Mirko D. Grmek, Diseases in the Ancient Greek World (Baltimore: Johns Hopkins University Press, 1989)

^19.� Bowden.

^20.� David E. Lilienfeld and Paul D. Stolley, Foundations of Epidemiology (Oxford: Oxford University Press, 1994).

^21.�Ibid.

^22.� Roberts, 250–256.

^23.� Douglas M. Anderson, ed., Dorlands Illustrated Medical Dictionary (Philadelphia: Saunders, 2003).

^24.� William Henry Archer, Office of the Government Statist, "Registrar-General's Report of the Births, Deaths and Marriages in the Colony of Victoria for 1858," in Papers Presented to Parliament: Session 1858–59 2 (1859); As above from 1859–1872; Norman Campbell, Office of the Government Statist, "Registrar General's Report of the Births, Deaths and Marriages in the Colony of Victoria for 1854," in Papers Presented to Parliament: Session 1854–55 2 (1855); As above from 1855–1857; James J. Fenton, Office of the Government Statist, "Statistical Register of the Colony of Victoria for the Year 1894: Part VI, Vital Statistics, etc.," in Papers Presented to Parliament: Session 1895–96 3 (1896); As above from 1895–1900; Henry Heylyn Hayter, Office of the Government Statist, "Statistical Register of the Colony of Victoria for the Year 1873: Part VIII, Vital Statistics, etc.," in Papers Presented to Parliament: Session 1874 3 (1874); As above from 1874–1893 excluding 1878; Henry A. Hendren, Office of the Government statist, "Statistical Register of the Colony of Victoria for the Year 1878: Part IV, Vital Statistics, etc.," in Papers Presented to Parliament: Session 1879–80 2 (1879).

^25.� J.B. Sykes, ed., The Concise Oxford Dictionary of Current English (Oxford: Clarendon Press, 1987).

^26.� Bate, Victorian Gold Rushes.

^27.� Archer et al.

^28.�Ibid.

^29.�Medlineplus, National Library of Medicine,. www.nlm.gov/medlinplus.com (accessed 12 March 2008, last updated 11 March 2008).

^30.� Anderson.

^31.� Archer et al.

^32.� Archer et al.

^33.� F.B. Smith, The People's Health, 1830–1910 (London: Weidenfeld and Nicolson, 1990).

^34.� K. Codell Carter, "Puerperal Fever," in The Cambridge Historical Dictionary of Disease, edited by Kennth Kiple (Cambridge: Cambridge University Press, 2003).

^35.� Archer et al.

^36.� Janet McCalman, Sex and Suffering: Women's Health and a Women's Hospital: The Royal Women's Hospital, Melbourne 1856–1996 (Melbourne: Melbourne University Press, 1998).

^37.� Carter; and Christine Hallett, "The Attempt to Understand Puerperal Fever in the Eighteenth and Early Nineteenth Centuries: The Influence of Inflammation Theory," Medical History 49, no. 1 (2005): 1–28.

^38.� J.H.L. Cumpston, Health and Disease in Australia: A History. (Canberra: Australian Government Publishing Service, 1989).

^39.� Anderson.

^40.�Ibid.

^41.� Cumpston.

^42.� Archer et al.

^43.� Richard Quain, ed., A Dictionary of Medicine Including General Pathology, General Therapeutics, Hygiene, and the Diseases Particular to Women and Children, (London: Longmans, 1882); P.H.R. Wilson and C. Mason, "The Trouble with Teething: Misdiagnosis and Misuse of a Topical Medicament," International Journal of Paediatric Dentistry 12, (2002): 215–218.

^44.� Wilson and Mason.

^45.� Archer et al.

^46.�Medlineplus.

^47.� Jerrold E. Levy, "Epilepsy," in The Cambridge Historical Dictionary of Disease, edited by Kennth Kiple (Cambridge: Cambridge University Press, 2003).

^48.� David Werner, Where There is No Doctor: a Village Health Care Handbook, (San Francisco: The Hesperian Foundation,2003).

^49.� Office of the Government Statist, "Statistical Register of the Colony of Victoria for the year 1900: Part III, Finance," in Papers Presented to Parliament: Session 1902 2 (1901).

^50.� Archer et al.

^51.� Archer et al.

^52.� Archer et al.

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