Saturday, February 24, 2007

Fatal Years


Here are some notes from reading this highly rewarding book:

Fatal Years - Child Mortality in Late Nineteenth Century America
by Samuel H. Preston and Michael Haines
Princeton University Press (January 1, 1991)

Book Description
Fatal Years is the first systematic study of child mortality in the United States in the late nineteenth century. Exploiting newly discovered data from the 1900 Census of Population, Samuel Preston and Michael Haines present their findings in a volume that is not only a pioneering work of demography but also an accessible and moving historical narrative. Despite having a rich, well-fed, and highly literate population, the United States had exceptionally high child-mortality levels during this period: nearly one out of every five children died before the age of five. Preston and Haines challenge accepted opinion to show that losses in privileged social groups were as appalling as those among lower classes. Improvements came only with better knowledge about infectious diseases and greater public efforts to limit their spread. The authors look at a wide range of topics, including differences in mortality in urban versus rural areas and the differences in child mortality among various immigration groups. "Fatal Years is an extremely important contribution to our understanding of child mortality in the United States at the turn of the century. The new data and its analysis force everyone to reconsider previous work and statements about U.S. mortality in that period. The book will quickly become a standard in the field."--Maris A. Vinovskis, University of Michigan


Autopsies in several cities around the turn of the century showed that 10 percent or more of infants who died were infected with tuberculosis (von Pirquet 1909). Woodbury (1925:35) reports that offspring of tuberculous mothers in Baltimore in 1915 had 2.65 times the infant mortality of offspring of nontuberculous mothers.

According to the prominent economist Irving Fisher, "Every observer of human misery among the poor reports that disease plays the leading role" (Fisher 1909:124). A 1908 survey of schoolchildren in New York found that 66 percent needed medical or surgical attention or better nourishment (cited in Fisher 1909:74).

"... in coming centuries, we may hope to greatly lessen or destroy the disease?" Thirty-nine physicians replied "no", 6 "yes", and 3 did not reply (Bowditch 1877:117).

John Duffy (1971:401) suggests that the germ theory awakened the upper classes to the realization that bacteria did not respect social or economic conditions and that a person's health was dependent on that of others.

Milk could and did spread typhoid, scarlet fever, diphtheria, strep throat, and tuberculosis (North 1921) ... Pasteurization was also widely believed to harm the taste of milk (North 1921:274). In 1911 only 15 percent of the milk supply in New York was pasteurized. Before 1908, when pasteurization was made compulsory in Chicago, only fifth of milk sold had been pasteurized (North 1921:246).

Samples of milk supplies intended for consumption from around the country in 1905-10 showed that 8.3 percent contained tubercle bacillli (North 1921).

...rural residents were already substantially protected from one another by distance

The extreme dependence of the child on the mother is best illustrated by what happened when she died in childbirth or shortly thereafter. While we have no evidence about this from the nineteenth century, a study of registered births (about 13,000) in Baltimore during 1915 found that the infant mortality rate among babies whose mothers died within two months of childbirth (N = 32) was 625 per 1000 (Rochester 1923:151). Of the 366 children admitted without their mothers to New York City's Infant Hospital in 1896, 97 percent had died by April 15, 1897 (Henderson 1901: 105). The death of a mother was only the extreme instance of parental incapacity, of course, and contemporary accounts described widespread health problems of American women that affected their maternal performance (see Leavitt 1986; ch. 3 for a review).

The Children's Bureau study of infant mortality in eight cities between 1911 and 1915, in which the Baltimore study represented about half of the observations, found that death rates among those not breastfed were 3-4 times higher than among the breastfed (Woodbury 1925)

Undoubtedly, an important advantage of breastfeeding was the protection it gave against diarrheal diseases, which struck with particular vengeance in summer (Lentzener 1987). Valuable evidence from Berlin in 1901 showed that the seasonality of infant mortality was essentially absent among breastfed children: the ratio of July/August deaths to February/March deaths was 2.90 for infants fed on cow's milk and 1.06 for infants who were breastfed (Schwartz 1909:168).

... very high mortality of children born out of wedlock. Rochester's study of Baltimore found that the infant mortality rate for illegitimate children was 300.7 per 1000, compared with 103.5 per 1000 for legitimate births (Rochester 1923:170)

Illness and death were apparently accepted in a passive attitude of Christian resignation (Dye and Smith 1986:343)

Writing about her experiences with Irish mothers in New York's Hell's Kitchen in 1902, Josephine Baker comments that they "seemed too lackadaisical to carry their babies to nearby clinics and too lazy or too indifferent to carry out the instructions that you might give them. I do not mean that they were callous when their babies died. Then they cried like mothers, for a change. They were just horribly fatalistic about it when it was going on. Babies always died in summer and there was no point in trying to do anything about it" (Baker 1939:17).

In the extreme, male wards of the state who posed serious threats to the public order could be castrated (e.g., Barr 1905; Fisher 1909) -- not an uncommon operation.

Ginsberg (1983), for example, suggests that boys were treated better than girls in nineteenth century Massachusetts (as revealed in their lower mortality) because they had higher earning capacities.

In Irving Fisher's words, "The crowning achievement of science in the present century should be, and probably will be, the discovery of practical methods of making life healthier, longer, and happier than before" (Fisher 1909:64).

The superior mortality of rural residents is most plausibly attributed to their simply being more widely separated from one another's germs. Of course, rural areas differed profoundly from one another, as later inquiries by the Children's Bureau made abundantly clear. ... A study of a mountain region in North Carolina in the period 1911-16 found ... 64 percent of residents infected with hookworm; and an infant mortality rate of 80 per 1000 (Bradley and Williamson 1918).

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Anonymous Anonymous said...

Thanks for posting this!

Everyone should read this post. The horrific toll of infant mortality 100 years ago, and the passive resignation with which it was accepted, may well mirror the way present attitudes toward aging will be viewed 100 years from now.

12:18 PM  
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2:32 AM  

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