Medical Research into Ann Walker’s Death

By Leitner Daleen (Twitter: @DaleenLeitner https://twitter.com/DaleenLeitner)

Statement of Purpose: The purpose of this research was to seek a clearer definition and precise medical explanation based on the evidence we could find of the circumstances of Ann Walker’s death in 1854.

Trigger Warning: illness, death

Our search began with the death certificate, which listed “Congestion of the brain, Effusion” as the cause of death.

Many of the terms used in 1854 describing the illness that befell Ann Walker are no longer used in medical practice today, presenting the researcher with a unique set of challenges. As a result of our research, it was determined:

1. “Congestion of the brain” was a term used widely from 1761 to describe a number of conditions of the brain, including but not limited to the blockage of blood vessels.
2. “Effusion” was the term used to describe the discharge of blood, prurient or serous [of, or relating to serum] fluid into a cavity.  Hemorrhage is the term we use today.
3. “Stroke”, on the other hand, was not used on the death certificate, and as I sought medical reference material to further clarify what seemed to be a stroke—or, as it is called today, an ischemic event– it just wasn’t there.

Perplexed, I sifted through hundreds of pages of medical books, several of which were listed in Anne Lister’s library, guaranteeing me the benefit of terminology and understanding that was available in the 19^th century. The breakthrough came when I noticed a term in the index of Robert Hooper’s Physician’s Vade Mecum: “apoplexia” or “apoplexy”. I had seen that term before in other sources, for example in Sir Benjamin Collins Brodie’s lectures on inflammation of the veins, and in Dr. Buchan’s Domestic Medicine in his description of Palsy.

Carefully reading the material on apoplexy in the Vade Mecum, I quickly ascertained that the term “apoplexy” was used as we use the word “stroke” today, with Hooper offering the clearest description of the various degrees of stroke, including those with “effusion” or hemorrhage, and those with seizures and paralysis.

Apoplexy is defined by the “sudden loss of muscular control with the lessening or loss of sensation and consciousness, caused by the rupture or blocking of a cerebral blood vessel, with hemorrhage into an organ, cavity or tissue.” Apoplexy is from the Greek word for stroke. It had been in usage for centuries. “Cerebral congestion” as a cause of apoplexy was first proposed by Morgagni in 1761. [Gustav Roman, Abstract, “Cerebral Congestion, a Vanished Disease”, 1987.

By 1860, medical knowledge had begun to expand to a better understanding of the arterial system and the role of hypertension, so that over the next century, “congestion of the brain” faded from the lexicon of medical practice. However, as a historian interested in the history of medicine, I have to say that the old terms were quite a bit more intriguing than our modern equivalences.

My research concluded with the finding of yet another publication, which confirmed that we had defined with precision “congestion of the brain, effusion”. In the archives of the Library of the Royal College of Surgeons, there is a publication by Wm. Boyd Mushet, M.D. (London, 1866) entitled:

“A Practical TREATISE on APOPLEXY”

Its Pathology Diagnosis, Therapeutics and Prophylaxis

With an essay on so-called nervous apoplexy or congestion of the brain
And serous effusion
[CEREBRAL HAEMORRHAGE]

The title page summarizes our findings, and offers the modern term, “cerebral hemorrhage”. The entire publication may be read at archive.org/details/b22302694

The contemporaneous letters found in the West Yorkshire Archives confirm that

1. Ann had a major ischemic event or stroke, in which the term “fit” was used in keeping with the usage of the time.
2. The word “fit” was used to describe the complete loss of consciousness that occurred at the onset of a cerebral hemorrhage. Hooper’s Physician’s Vade Mecum describes the various forms this fit can take.
3. Ann’s was a severe and terminal illness. She may have had prior warning by having an acute headache or feeling ill just before, but she probably did not suffer pain.
4. She was able to regain a modicum of consciousness (albeit “feeble”) but there were more strokes in rapid succession and she remained “as sick as possible”, unable to recover. She died within a matter of days.

Based on these findings and confirmed by this evidence, I therefore offer the working hypothesis of “Cerebral Hemorrhage” as the cause of death.

References:
Buchan, Wm., Dr. Buchan’s Domestic Medicine , Newcastle, 1812.
Brodie, Sir Benjamin Collins, The Works of Benjamin Collins Brodie with an Autobiography, Vols.I-III, London 1865.
Hooper, Robert, Physicians Vade Mecum, American Edition, New York, 1846.
Mushet, Wm. Boyd, Treatise on Apoplexy, London, Royal College of Surgeons, 1866.
Roman, Gustavo C. M.D., “Cerebral Congestion A Vanished Disease”, Arch Neurol, 1987; 44(4)444-448.

Edited by Louise Godley

See also The Last Days of Ann Walker https://insearchofannwalker.com/the-last-days-of-ann-walker/