HYGIEA INTERNATIONALIS An Interdisciplinary Journal for the History of Public Health Volume 3, No. 1, 2002 The following Swedish research foundations have provided financial support for the journal: The Bank of Sweden Tercentenary Foundation Swedish Research Council Swedish Council for Working Life and Social Research ISSN, Print: 1403-8668; Electronic: 1404-4013 URL: http://www.ep.liu.se/ej/hygiea/ Editorial Board Giovanni Berlinguer, University of Rome “La Sapienza”, Italy Virginia Berridge, London School of Hygiene and Tropical Medicine, U.K. Patrice Bourdelais, École des Hautes Études en Sciences Sociales, France Linda Bryder, University of Auckland, New Zealand Marcos Cueto, Instituto de Estudios Peruanos, Peru Christopher Hamlin, University of Notre Dame, U.S.A. Robert Jütte, Robert Bosch Stiftung, Germany Øivind Larsen, University of Oslo, Norway Marie C. Nelson, Linköping University, Sweden Dorothy E. Porter, University of London, U.K. Günter B. Risse, University of California, U.S.A. Esteban Rodriguez-Ocaña, University of Granada, Spain John Rogers, Uppsala University, Sweden Jan Sundin, Linköping University, Sweden Lars-Göran Tedebrand, Umeå University, Sweden John H. Woodward, The University of Sheffield, U.K. Co-editors: Marie C. Nelson and Jan Sundin Technical Editor: Peter Berkesand Copyright This journal is published under the auspices of Linköping University Electronic Press, which, together with the Authors, retains the copyright of the journal. © Linköping University Electronic Press and the Authors Table of Contents Volume 3, No. 1, 2002 Editorial Marie C. Nelson Foreword 5 Anders Brändström, Introduction 7 Sören Edvinsson, and John Rogers Articles Anders Brändström, Illegitimacy, Infant Feeding Practices 13 Sören Edvinsson, and and Infant Survival in Sweden, 1750–1950: John Rogers A Regional Analysis Magdalena Bengtsson The Interpretation of Cause of Death 53 Among Infants Gunnar Thorvaldsen Rural Infant Mortality in Nineteenth 75 Century Norway Anne Løkke Infant Mortality in Nineteenth 115 Century Denmark Loftur Guttormsson and The Development of Infant Mortality 151 Ólöf Garðarsdóttir in Iceland 1800–1920 Eli Fure Social Differences in Infant Mortality 177 in the Norwegian Parish Asker and Bærum 1814–1878 Appendix 1 Map of Swedish Counties (län) 193 Appendix 2 Brändström, Edvinsson and Rogers 194 Appendix 3 Gunnar Thorvaldsen 198 Appendix 4 Eli Fure 200 Appendix 5 List of Publications 202 Foreword Marie C. Nelson e are very pleased to be able to present this thematic issue of Hygiea Internationalis which features studies of infant mortality in the Nordic Wcountries. Texts are included from Denmark, Iceland, Norway and Sweden, the results of a Nordic project. The introductory article by Anders Brändström, Sören Edvinsson and John Rogers draws together some of the main trends. At the same time the individual survey articles provides us with syntheses on the national levels: Brändström, Edvinsson and Rogers on Sweden, Ólöf Garðarsdóttir and Loftur Guttormsson on Iceland, and Gunnar Thorvaldsen on Norway. Magdalena Bengtsson presents a detailed study of the development of cause of death among infants in Sweden, while Eli Fure gives us insight into the use of computer analysis in studies of infant mortality in her methodological contribution. National studies of infant mortality have been with us for some years, but it is only more recently that attempts have begun to be made to present syntheses of research results that have been produced. If our research and local studies are to have further value, then it is important to reach beyond national borders, to see how regions cut across political boundaries and how various regions of Europe exhibited similarities and differences. This issue is an important step in reaching a more unified understanding of the developments in the Nordic countries. One of the features of this issue is the visual experience provided by the extensive maps. The opportunities now available in this respect allow the use of maps as an analytical tool in ways not previously available. We are only beginning to explore the possibilities here. During the next few weeks, we will be changing the composition of our editorial group. While I will be taking over the primary responsibility for the journal, Peter Berkesand will continue as our technical editor. His new position with Linköping University Electronic Press ensures both the production of the journal, as well as participation in the new developments associated within the field. We are also hoping soon to be able to add an administrative assistant to our ranks. Developments within the field of electronic publications, to say the least, are occurring at a pace that not many of us could have imagined just a few years ago. 5 Therefore, it is very important that we reconsider the ways in which this journal operates. Of course, we want to present quality work on the pages of the journal. At the same time, the mere presentation of articles alone does not fully utilize the potential of this medium. The question that we have is how could the journal be used in a more innovative way? This is where our readers come in. What ideas and suggestions do you have about how the journal could be developed? Let us know what thoughts and ideas you have. How would you like to see a medium of this kind used? Please contact either Peter Berkesand or me at the addresses listed on the main page of the International Network for the History of Public Health. Finally, the next issue of our journal will contain papers from the 2001 combined conference held in Norrköping, Sweden and will focus on occupational health. This thematic issue will include presentations from several parts of the globe. We hope to hear from our readers. Send us your ideas. 6 Introduction Anders Brändström, Sören Edvinsson, and John Rogers ne of the most successful achievements in improving the health of popu- lations has been the reduction of infant mortality. In many European Ocountries infant mortality rates have declined from levels often above 200 infant deaths per thousand live births to less than ten within the time span of a century. Furthermore, it is clear that the reduction of mortality among young chil- dren was to a very large extent due to human intervention. In this context the Nordic countries have been and continue to be in the forefront. In all of the Nordic countries the secular decline in mortality was to a large degree due to a reduction of infant deaths. This is not to say, however, that the decline of mortality followed the same pattern in each country. If we consider the timing of mortality in the demographic transitions of the Nordic countries, we find that mortality started to fall at very different points in time. In Denmark the crude death rate began to fall in the last decade of the eighteenth century. In Sweden and Norway the downward turning point started at the beginning of the nineteenth century. For Finland and Iceland mortality declined much later, during the latter half of the nineteenth century (Figure 1). Information on infant mortality varied among the Nordic countries. For Sweden and Finland time series exist from 1749 onward. Denmark began publishing national statistics on infant mortality in 1835, Norway in 1836 and Iceland in 1838 (Figure 2). Infant mortality trends and levels differed considerably in the Nordic countries. In Finland a pattern with constant high rates and large annual fluctuations is found from 1749 to the late 1860s. Sweden’s infant mortality was slightly lower than Finland’s in most years during the eighteenth century. In the first decade of the nineteenth century infant mortality fell in Sweden and the gap between the two countries increased. Compared to the other Nordic countries, Norway had significantly lower infant mortality and less pronounced annual fluctuations. Infant mortality was higher in Denmark than in Norway, and very similar to Sweden from 1830 onward. Iceland, on the other hand, had extremely high rates of infant mortality, among the highest in Europe, with certain years exceeding 400 deaths per thousand live births. Iceland did not reach levels similar to the other Nordic countries until the 1880s. In summary, Denmark Norway and 7 Figure 1. The demographic transition in the Nordic Countries. Source: Ståle Dyrvik, “Comment,” Scandinavian Population Studies, 5 (1979), 99. Sweden exhibited similar patterns during most the nineteenth century. In Iceland and Finland infant mortality declined first during the second half of the nineteenth century. At the turn of the nineteenth century, infant mortality in all of the Nordic countries converged, although Finland and Denmark continued to have slightly higher infant mortality rates. If twentieth century infant mortality in Europe is 8 Figure 2. Infant mortality in the Nordic Countries, 1749–1950. Sweden Denmark Finland Island Norway 700 600 500 400 300 200 100 0 1749 1756 1763 1770 1777 1784 1791 1798 1805 1812 1819 1826 1833 1840 1847 1854 1861 1868 1875 1882 1889 1896 1903 1910 1917 1924 1931 1938 1945 Source: Historisk Statistik för Sverige 1720–1967 (Stockholm 1969); B. R. Mitchell, European Historical Statistics 1750–1970 (London, 1978); Oiva Turpeinen, “Fertility and Mortality in Finland since 1750,” Population Studies, 33:1 (1979); Hagskinna. Icelandic Historical Statistics, eds. Gudmundur Jonsson and Magnus S. Magnusson (Reykjavik 1997). compared, all of the Nordic countries are in the group characterized by the lowest level of infant mortality throughout the entire period.1 However, national figures are only averages and often conceal very different mortality regimes. The results from several historical studies undertaken in the Nordic countries, some conducted already in the nineteenth century, clearly indi- cate that infant mortality varied considerably within each country. As was com- monplace elsewhere, urban infant mortality was higher than rural infant mortality until the twentieth century. In Norway, Sweden and Finland a coast-inland pattern appears to have existed with higher rates on the coast.