I can understand the meaning of the phrase off to hell..., but I was wondering why, of all the possible vehicles that may have been chosen, it came to be in a handcart?
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This is mainly due to the alliteration of the phrase:
You can see that all of the objects above begin with the letter h. To say "going to hell in a VW" or "going to hell in an ice cream truck" would have less impact.
Pithy sayings of this sort often involve either alliteration or rhyme ("In like Flynn," "wake and bake"), which give them a tag-like quality that's easy to remember and rhetorically more emphatic.
To hell in a handcart refers to the Great Plague in London. The dead were left in the street in the 1600's and were collected by a bailiff who did not risk horses so used a handcart like a wheelboro to transport them to a common grave.