One afternoon
in June 1898, Florence Dicks, aged four and her six-year old sister Ellen sat
down to afternoon tea. The meal was overseen by their mother Eliza. As the
girls munched their sandwiches, their mother casually mentioned, in the course
of conversation, that their eighteen-year-old sister Edith had died. She then
changed the subject and as if nothing untoward had happened, encouraged them to
eat up their meal.
This was the
scene as related many years later by Florence Dicks (my grandmother) to her own
daughter (my mother). After all that time, the death of her older sister was
still a mystery to her. What had happened to Edith and why had her mother been
so reticent in talking about it? Was there a scandal hiding in her parents’
comfortable middle class family?
Now, with the
wealth of information available to family historians, we can attempt to answer
the questions that Florence was never able to resolve. In this article I will
explore the death of Edith Dicks and its impact on her family. I do not uncover
evidence of a scandal, but I do find an intriguing medical mystery that is
still being debated today.
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| Florence and Ellen Dicks |
The Family Dicks: Victorian Middle Class
Suburbanites
Edith Lizzie
Dicks was born in Dalston, North London, in 1880. Her father, Samuel Bernard
Dicks, worked for a firm of seed growers and merchants. He variously described
himself as a seedsman, a manager and a commercial traveller. He married Eliza
Barratt in 1872 and Edith was their fifth child. They went on to have ten
children in all, my grandmother Florence being the youngest.
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| Edith Dicks, 1880 - 1898 |
The firm that
Samuel Dicks worked for, Cooper, Taber Ltd, was based in Witham, Essex and had
a London office in Southwark. It was not at the glamorous end of the Victorian
seed market, but specialised in vegetables, advertising the merits of its
swedes, turnips, cabbages and carrots. A highlight of the company’s year was
its annual vegetable show, when growers competitively displayed their mangel
wurzels for a £5 silver tankard. The firm had interests in Europe and Samuel often
travelled abroad as part of his duties.
 |
| Samuel Dicks's Business Card |
Samuel Dicks
was not a horny-handed son of the soil and his family lived in relative middle
class gentility. They moved house frequently as the family grew and his career
prospered. In the early 1890s they moved to a newly-build semi-detached house in
Howard Road, Penge, now in the south London Borough of Bromley, where Florence
was born in 1894. Despite its relative spaciousness, the house would have been
crowded, for all Samuel and Eliza’s ten children lived at home during the
1890s. At the time of Edith’s death in 1898, Herbert was 24 and worked as a
warehouseman and salesman for a woollen clothing firm. William, 23, was a
nurseryman, on the point of setting up his own business. George, 21, was
working for the same firm as his father and Percy, 16, was a clerk. Then there
was Ernest, 13; Arthur, 11 and Frank, 9 and finally the little girls Ellen and
Florence. In previous years the Dicks had employed a live-in servant but there
was now no room (or no money) for paid help and Edith, who at 18 had no paid occupation,
was likely to have spent her time helping her mother run the household. The
family were members of the New Jerusalem Church, a small non-conformist
denomination that followed the precepts of an 18th century Swedish
thinker, Emmanuel Swedenborg www.generalconference.org.uk.
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| Samuel and Eliza Dicks, photogaphed the year before Edith died |
The Death of Edith Dicks
The detailed circumstances of Edith Dicks’s death are still opaque, however I do have her death certificate. Completed by H.
Shackleton, M.D, it states that Edith died on 20th June 1898; the
cause of death, haemorrhage from a gastric ulcer. Poor Edith died of natural
causes.
So on the face of it, there is no
mystery surrounding Edith Dicks’s death. But questions still remain. Today, we
tend to think of ulcer as an illness of middle-aged or older men and a symptom
of stress, or an unhealthy lifestyle. We do not associate it with 18-year old girls living in comfortable
circumstances. What led to Edith developing a fatal stomach ulcer? And why, if
Edith died a natural death, was her mother so guarded about its circumstances with
her younger daughters?
A Brief History of Gastric Ulcer
Gastric, or stomach ulcer occurs
when the layer of mucus that lines the walls of the stomach breaks down,
allowing the acid that fills the stomach to attack its walls. Ulcers can also
occur in the duodenum (between the stomach and small intestine). The generic
term ‘peptic ulcer’ is often used for ulcers in either site. The main symptom
of gastric ulcer is abdominal pain, especially following eating, though some
people with ulcers have no symptoms and only discover that they are affected if
complications arise.
Uncomplicated ulcers, while
uncomfortable, are not dangerous and may heal themselves after a few weeks or
months, though they may recur. The most drastic complication is perforation, where
the ulcer breaks completely through the wall of the stomach or duodenum and
their contents pour into the abdominal cavity. More common is haemorrhage, as
happened to Edith Dicks. This occurs when the ulcer breaches a blood vessel in
the wall of the stomach. Haemorrhage may take place gradually over a period of
time, if the blood vessel is relatively small, or may be sudden and extensive
if the ulcer breaches an artery. The main symptom of a bleeding ulcer is
‘hematemesis’, or vomiting blood. Blood may also be seen in the person’s
stools.
Historically, peptic ulcers were
regarded as being caused by lifestyle factors, such as poor hygeine, diet, smoking or
drinking, or indeed by stress. These were thought to lead to excess production
of stomach acid. Treatment focused on modifying these factors, or administering
drugs that aimed to reduce levels of gastric secretions. Then in 1982,
Australian scientists Barry Marshall and Robin Warren discovered a bacterium, helicobacter pylori (H. pylori), that could live in the harsh environment of the stomach and duodenum
and that is now regarded as the cause of peptic ulcer (in 2005 Marshall and
Warren were awarded the Nobel Prize for medicine for their discovery). The
focus of treatment shifted to administering antibiotics to kill off H. pylori, along with newer and more effective acid-inhibiting drugs. Today,
peptic ulcer is a relatively uncommon condition, mainly affecting older people
(some of whom develop ulcer from extensive use of non-steroid anti-inflammatory
drugs – NSAIDS – such as Ipobrufen). The development of the endoscope (a camera
attached to a tube that is passed into the stomach to view the ulcer and
sometimes to apply treatment) and modern surgical techniques have reduced the
dangerousness of complications, though emergencies can still occur and
untreated, complicated ulcers can still prove fatal.
So this is the situation
regarding peptic ulcer today, but what of the past? It is now thought that H. pylori has been common in humans since prehistoric times, though 80% of
people infected with H.
pylori do not suffer from ulcers and
the exact mechanism by which H.
pylori causes ulcers is still not
known. Evidence of peptic ulcer disease also goes back to prehistory: a 2000
year-old mummy has been discovered in China who apparently died of a perforated
ulcer. Diagnosis of peptic ulcer in the UK was however uncommon before the 19th
century, though the disease was known to the medical profession. Then, in the
first half of the 19th century, gastric ulcer began to be diagnosed
more frequently, at first most commonly among young servant girls. Then, in the
latter years of the century, diagnosis became common in the UK and elsewhere in
the Western world, leading some to talk of a ‘pandemic’ of peptic ulcer disease
by the end of the century. Stomach ulcer was more commonly diagnosed in women,
particularly younger women like Edith Dicks, while duodenal ulcer (which
reached its peak a few years later than stomach ulcer), was more common in men.
In the 19th century,
before modern drugs and surgical and investigative techniques, complications of
peptic ulcer were serious. Perforation of a peptic ulcer was invariably fatal,
the person quickly succumbing to infection. Haemorrhaging ulcers often healed
themselves, but fatalities, as in Edith Dicks’s case, were not uncommon.
Sometimes the ulcer would bleed over a period of time, leading to anaemia,
weakness and organ failure. In other cases, where the ulcer ruptured an artery,
death was rapid and messy.
Rates of peptic ulcer diagnosis
remained high in the early years of the 20th century, then from
around the middle of the century they began to decline. This preceded the
discovery of H.pylori
and the advent of modern treatment. At the
same time, the age profile of those most likely to contract peptic ulcer
gradually changed: from being a disease of predominantly younger people at the
beginning of the century, it became more common in the middle-aged and elderly.
This shift in the prevalence and
age profile of peptic ulcer has been attributed by medical historians to a
“cohort effect”. This theory holds that, for some reason, people born in the
latter years of the 19th century (such as Edith Dicks) were
particularly prone to peptic ulcer disease. The disease did not affect everyone
in the “cohort” – despite its increased incidence it only affected a small
minority. It also affected different individuals at different ages – some, like
Edith, suffered from it when they were young, while others were not affected
until later in life. As time went on, the prevalence of peptic ulcer declined,
as the affected “cohort” gradually died off.
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| An example of the evidence used to support the "cohort effect" theory of peptic ulcer. The graph plots the rates of diagnosis of gastric and peptic ulcer at 12 London hospitals over a 120 year period. We can see the rise and fall of cases, with rates of duodenal ulcer peaking later than gastric ulcer. Duodenal ulcer was more common in men and gastric ulcer more common in women. From Baron & Sonnenberg (2002). |
As to why that particular cohort
was particularly at risk of peptic ulcer disease, medical historians are
baffled. It is assumed that their peptic ulcers were caused by H.pylori infection, contracted in early childhood, but there is no reason to
believe that more of them were infected with H.pylori than at other times in history – it has always been common in human
stomachs. Some have suggested that people at that time were infected with a
particularly virulent strain of H.pylori, but there is no substantial evidence
that this was the case. Others have focused on the changes in diet and public
health that went along with industrialisation and urbanisation in the later 19th
century and possible environmental triggers that made H.pylori more dangerous to some individuals. We cannot however go back into the
past and use modern epidemiological methods in retrospect, so the mystery is
likely to endure.
Edith Dicks therefore appears to
have been an unfortunate victim of an epidemic of gastric ulcers, of unknown
cause, that affected individuals – especially young women – in the latter years
of the 19th century. She was doubly unlucky in that she experienced
complications; her ulcer bleeding catastrophically and fatally. Her death, far
from being scandalous, was due to tragic natural causes.
So the mystery of Edith Dicks’s
death is solved? Well, probably. Alexander Pollock, a retired G.P., has
recently completed an M.D. thesis on the history of peptic ulcer and calls into
question some of the evidence on which our explanation is based. He queries
whether there actually was a “cohort effect” underlying the rise of peptic
ulcer in the 19th century, holding that its apparent increase during
the century was due to changes in diagnostic fashion. He points out that the
“cause of death” entered on 19th century death certificates was
often wrong, as doctors at that time had to rely on their clinical judgement
rather than modern investigative techniques. In Edith’s case, Dr Shackleton is
likely to have based the cause of death on evidence of hematemesis, but gastric
ulcer was not the only cause of vomiting blood. Finally, the possibility of
scandal cannot be ruled out completely: it was not unknown for doctors to
change the cause of death in some circumstances to protect the reputations of
respectable families. We were not there at the time, so we will never know what
actually happened to poor Edith. However, the available evidence supports the
“cohort effect” explanation of her death and after nearly 120 years, we should
perhaps leave it at that.
Eliza Dicks and the Victorian Way of Mourning
One further
mystery remains: Eliza Dicks’s apparently offhand reaction to Edith’s death, as
recalled by her remaining daughters. It is of course possible that Florence,
who was only four at the time, was mistaken in her recollection of events.
However, such shocking news could constitute what psychologists call a
“flashbulb memory”, when highly significant events are recalled later in vivid
detail (for example many people can remember exactly what they were doing when
they heard the news of the New York “9/11” attacks) and there is some evidence
that such memories are essentially accurate. Assuming that the scene was as
Florence remembered it, how may we account for her mother’s behaviour?
On the face of
it, Eliza’s response to her daughter’s death was very un-Victorian. Death and
mourning in Victorian times, especially for the wealthier classes, was an
intense experience, surrounded by ritual. Most people died at home and the
whole family was often involved in the death and spent time with the person
before death and with the body afterwards. Funerals could be as lavish (and
expensive) as weddings are today and the right mourning clothes had to be worn.
The facts of the person’s death were not hidden; obituaries would describe in
great detail the person’s last days and hours. Sometimes, post-mortem
photographs were taken, with the dead person dressed in their best and posed as
if sleeping – or even up and about – and made into postcards to send to
relatives. Why was Edith’s death treated so differently?
Again, we were
not there so we can only speculate, but here are some possibilities. Firstly,
Edith died in 1898, near the end of the Victorian era and by then attitudes
towards death and mourning were changing, with families responding more as they
do today, when death and grieving are regarded as more private issues.
Secondly, it seems that her father, Samuel Dicks, was absent when Edith died – it
was mentioned above that he travelled abroad in the course of his work – as
Edith’s death certificate was signed by her eldest brother Herbert, then aged
24. Eliza therefore had to face the initial consequences of the tragedy on her
own, while continuing to look after the rest of her extensive family and might
be excused for protecting herself by taking on a business-like manner.
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| Herbert Dicks, who at the age of 24 signed Edith's death certificate |
Finally, we do
not know whether Edith’s illness was prolonged and she faded away from chronic
bleeding, or if she suffered a sudden catastrophic bleed from a ruptured artery,
but we may speculate that it was the latter. The fact that her father was away
suggests that he was not expecting any tragic occurrence and Florence and Ellen
were apparently unaware that their sister was ill. It is even possible that
Edith and her mother had no inkling of what was about to happen before the
event. If this was the case, it would have been the opposite of the Victorian
fantasy of a “beautiful death” as depicted in twee mid-19th century
paintings – it would have been shocking, agonising and messy. Again, we cannot
blame Eliza for defending herself from the emotions that the event would have raised.
The Dicks Family Moves On into the 20th
Century
So Samuel,
Eliza and their remaining children picked themselves up and got on with their
lives. Doubtless, their strong Christian faith would have helped them come to
terms with their loss. By the time that World War 1 began, all the sons had
left home. The five eldest (Herbert, William, George, Percy and Ernest) were
all married and most had children of their own. All, like their father, were
working in “white collar” jobs for small businesses around South London. The
two younger sons had both moved away; Arthur was aboard and Frank was living
and working in Edinburgh. All seven sons survived the war and I have told the
tale of Frank’s experiences as a conscientious objector in another article.
Florence and Ellen both married and set up homes in Anerley, near to where they
had been brought up. After Eliza’s death in 1921, Samuel Dicks went to live
with Florence and her husband Frederick Nicholls, remaining with them until his
own death in 1925. Thus, memories of Edith and her short and ultimately tragic
life faded – until now.
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| Samuel Dicks in later life with his daughter Florence and her husband Frederick Nicholls |
Sources Used
Articles from
The Essex Herald 1895, available at The British Newspaper Archive: http://www.britishnewspaperarchive.co.uk/
Information on peptic ulcer
available from NHS Choices: http://www.nhs.uk/Conditions/Peptic-ulcer/Pages/Introduction.aspx
Baron H &
Sonnenberg A (2002) Hospital admissions for peptic ulcer and indigestion in
London and New York in the 19th and early 20th centuries.
Gut 50: 568-560
Duggan J &
Duggan A (2006) The possible causes of the pandemic of peptic ulcer in the late
19th and early 20th century. MJA 185(11/12): 667-669
Pollock A
(2014) From dyspepsia to Helicobacter: a history of peptic ulcer disease. MD
thesis, University of Glasgow
Sonnenberg A
& Baron J (2010) Rising trends of gastric cancer and peptic ulcer in the 19th
century. Alimentary Pharmacology and
Therapeutics 32: 901-907
Susser M &
Stein Z (2001) Peptic ulcer and civilisation. International Journal of Epidemiology 30: 13-17
