Infant Mortality, Because Its Symptoms in Children Were Less Apparent Than They Were Among Adults
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This PDF is a selection from an out-of-print volume from the National Bureau of Economic Research Volume Title: Fatal Years: Child Mortality in Late Nineteenth-Century America Volume Author/Editor: Samuel H. Preston and Michael R. Haines Volume Publisher: Princeton University Press Volume ISBN: 0-691-04268-3 Volume URL: http://www.nber.org/books/pres91-1 Conference Date: n/a Publication Date: January 1991 Chapter Title: The Social and Medical Context of Child Mortality in the Late Nineteenth Century Chapter Author: Samuel H. Preston, Michael R. Haines Chapter URL: http://www.nber.org/chapters/c11541 Chapter pages in book: (p. 3 - 48) ONE THE SOCIAL AND MEDICAL CONTEXT OF CHILD MORTALITY IN THE LATE NINETEENTH CENTURY Y THE LATE nineteenth century, epidemics of cholera, ty- phus, yellow fever, and plague were claiming many fewer Blives in the modernizing states of Europe and North America. Governments had successfully asserted their rights to quarantine in- fected populations when these episodic horrors appeared, and im- proved standards of military hygiene had also blunted the diseases' spread (Kunitz 1983, 1986). Increasingly, the diseases of consequence were of an endemic infectious nature, the products of pathogens that were ever-present in communities and that took their greatest toll among infants and young children. These diseases were sufficiently dangerous to produce mortality levels that were, by present stan- dards, appallingly high. Nearly two out of every ten children died before reaching their fifth birthday. American child mortality was substantially higher in 1900 than it is today in either Asia or Latin America. Although the Death Registration Area (DRA) that was formed in 1900 covered only an unrepresentative 26 percent of the population, it is the only source of information about the medical causes of chil- dren's deaths. The published 1900 United States Census furnished information assembled by registrars and enumerators on deaths by age, sex, and cause for the DRA during the year preceding the census of June 1, 1900 (U.S. Bureau of the Census 1902b). Despite imperfect diagnoses and incomplete recording of deaths, the data are instruc- tive regarding the orders of magnitude of various diseases. Table 1.1 shows that, within the DRA, deaths below age 15 were highly concentrated at the youngest ages. Approximately 88 percent of these deaths occurred at ages 0-4, and 59 percent were infant deaths. Among the leading causes of death were gastrointestinal dis- eases, which caused 20 percent of all deaths for children aged 0-14 and 25 percent of deaths for infants. These diseases included such conditions as cholera infantum, enteritis, and diarrhea. Another leading group of causes was respiratory diseases, which included pneumonia and bronchitis. 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Respiratory diseases also accounted for 19 percent of deaths among infants and 16 percent of deaths among children aged 5-14. Other identifiable infectious diseases, including measles, scar- let fever, diphtheria, whooping cough, and smallpox, were also im- portant, constituting 11.5 percent of all deaths among children below age 15. Despite the availability of diphtheria antitoxin since the mid- 18908, this disease accounted for 11 percent of the deaths in the age group 1-4 and 14 percent in the group aged 5-14. Scarlet fever, mea- sles, and whooping cough remained life-threatening to children in this era. Smallpox, on the other hand, had been largely eliminated as an important cause of death, almost certainly because of vaccination. Other important causes of death were meningitis (5 percent of child deaths) and accidents/injuries (3 percent of child deaths). Tu- berculosis, although significant as a cause of adult deaths (represent- ing 15 percent of all deaths to persons aged 15 and over), contributed only 2 percent of all deaths below age 15. There is evidence, how- ever, that tuberculosis was severely underestimated as a cause of, or contributor to, child and even infant mortality, because its symptoms in children were less apparent than they were among adults. Autop- sies 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 tu- berculous mothers in Baltimore in 1915 had 2.65 times the infant mor- tality rate of offspring of nontuberculous mothers. Among the deaths attributed to malformations and other congeni- tal conditions, some were undoubtedly truly congenital defects, largely affecting infants in the first days and weeks of life. Other terms within this category such as inanition (or inability to absorb nutrition, mostly affecting infants) and debility/atrophy were quite imprecise.