Although smallpox epidemics predominated in the pattern of mortality fluctuations in the 18th century in England and other European countries, many deaths among children and adults were attributed to “fevers.” Hospital statistics and medical writings suggest that typhus was probably a more significant component of “fevers” mortality in England in the 18th century than typhoid. Typhus and typhoid were first distinguished under national registration in 1869, by which time typhus mortality had declined and typhoid accounted for a higher proportion of deaths. Of the 18,390 “fevers” deaths in that year, 47% were attributed to typhoid, 23% to typhus, and 30% to “simple fever.” “Convulsions” was often recorded as the “cause” of death in the first two years of life, although the symptoms are likely to have been due to bacterial infections linked with poor hygiene and fecal contamination of water and food, and with viral diseases such as smallpox that had not displayed the recognized symptoms. Many other deaths involving gastrointestinal disorders among children and adults were probably recorded in the London Bills of Mortality as “griping of the guts,” “bloody flux,” and “surfeit.”

The vagueness of some cause-of-death categories and increasing recognition of diseases clearly affect the assessment of their contribution to overall mortality decline. Even for the registration period, quantification based on cause-specific death rates is simplistic because of concurrent infections and interrelationships between diseases. Nevertheless, a summary of the simple components of mortality change provides some indication of the relative importance of different categories of disease and symptoms (see appendix C1). Estimates based on the London Bills of Mortality suggest that the death rate declined by 32% between 1751 and 1801. In simple arithmetic terms, the main contributions to each unit of change were “fevers” (-0.25), convulsions/teething (-0.40), consumption (-0.09), and smallpox (-0.08).3 National registration data indicate that the death rate in England and Wales declined by 22% between 1851 and 1901, with contributions to each unit of change from typhus/typhoid fevers (-0.17), cholera, diarrhea and dysentery (-0.12), convulsions/teething (-0.14), consumption (-0.33), and smallpox (-0.05).