Thursday, October 24, 2013

Genealogy, Genealogists, Science & Healthcare . . . Oh My! (October 24, 2013)

Typhoid Death Rates 1890, 1906 and 1918.  [Cartoon by Zim, 1919]

Amid all the current controversy swirling around healthcare availability, coverage, and affordability in the U.S. -- and the political debate that can often can come down to views about whether or not basic, continuous healthcare is a right or a privilege -- what perspective, if any, can genealogists bring to the table?

Those of us who have delved into our family histories here in the U.S. very quickly come to the realization that our ancestors lived in very different worlds than we do; but it is not until we stumble across the very common instances of childhood deaths and disabilities in our family histories that we come face-to-face with the shocking realization that living beyond childhood was not something to be taken for granted by our ancestors -- and I'm not talking about ancestors in the time of the Great Migration or earlier.  

A few examples will serve to starkly illustrate what I mean . . .

This week Laura Mattingly of The Old Trunk in the Attic posted about the family of her great grandfather's brother, William B. Mann.  William was married twice, but he and his first wife, Nancy Clemie, had 11 children together before she died at age 55 in 1894.  Of the 11 children Nancy and William had together, five of them (born between roughly 1864 and 1870) died in infancy or childhood. The exact causes of death are not stated, but almost certainly included one or more infectious diseases.

Abby Greene Aldrich was born on October 26, 1874 in Providence, Rhode Island.  She was one of the 11 children of Abby Pearce Chapman and Nelson W. Aldrich, the future powerful U.S. Senator from Rhode Island.  Abby Greene Aldrich grew up in a privileged and affluent home.  She later married John D. Rockefeller, Jr. and together they had six children born between 1903 and 1915.  Of the 11 children born to Abby Greene's parents between 1867 and 1888, three of them died before age four.  In addition, two of the surviving children were seriously disabled by infectious diseases. One became completely deaf and the other was hearing impaired -- both for the rest of their lives. 

My maternal grandmother was born in 1897.  She was the fourth of the six children of Walter W. Cooke and his wife Leonette Flagg who were all born between 1892 and 1902.  My grandmother was one of only three children to survive beyond age six.

My paternal grandfather was born in 1896 and was one of the five children of John Andrew Tew and his wife Margaret Conner who were all born between 1885 and 1901.  Only my grandfather and his older sister survived beyond age two.  

Reliable childhood mortality statistics did not begin in the U.S. until roughly the turn of the last century.  Before 1900, death rate data was crude and so rates have been estimated from decennial census figures.  Using census estimates and then later mortality data, it has been estimated that the overall death rate in the 1850s in the U.S. was about 22 per 1,000 persons.  By 1900 the rate had fallen to about 18 per 1,000 and by 1940 the rate stood at 11 per 1,000 -- half what is was 90 years earlier.  

In 2003, the mortality rate in the U.S. for children under age five was 8 per 1,000 live births, but this still placed the U.S. higher in child mortality rates than the UK and Canada (6 per 1,000), Germany (5 per 1,000), Spain (4 per 1,000), Norway (4 per 1,000), Sweden (3 per 1,000) and France, Iceland, Portugal, Italy, Australia, Japan, Austria, and many other countries including Croatia!

Hard as it is for us to understand today, the predominant belief about the cause of infectious diseases prior to the 1870s was the "miasma theory."  This medical belief was that disease was caused by poisonous vapors or "miasmas" that were foul and smelled offensive.  It was generally believed  that a variety of illnesses were caused by the poisons in these noxious vapors being inhaled.  Before the 1870s and the development of theories about the biological bases for infections, resources were squandered on disease prevention approaches involving ventilation systems and ineffective quarantine programs.  And once bacteriologic science took off after the 1870s understanding of the exact routes of various infectious diseases was still slow to replace miasma theory and other non-scientific explanations for disease and non-accidental causes of death.

Part of the problem for attacking infectious diseases in the United States in the late 19th Century was captured by John M. Barry in his detailed book on the 1918 Flu pandemic, The Great Influenza: The Epic Story of the Deadliest Plague in History.  Barry summarized on p. 32 . . .

               [B]y the 1870s, European medical schools required and gave rigorous scientific
               training and were generally subsidized by the state. In contract, most American
               medical schools were owned by a faculty whose profits and salaries -- even when
               they did not own the school -- were paid by student fees, so the schools often had
               no admission standards other than the ability to pay tuition. No medical school in
               America allowed medical students to routinely either perform autopsies or see
               patients, and medical education often consisted of nothing more than two four-
               month terms of lectures. Few medical schools had any association with a
               university, and fewer still had ties to a hospital. In 1870 even a Harvard medical
               student could fail four of nine courses and sill get an M.D.  

The advent of a science-based approach to medicine had dramatic results as measured by dropping death rates and increasing life expectancy.  The cartoon depiction above of the effect on typhoid deaths is a good example.  Once science was able to demonstrate that typhoid was caused by the Salmonella bacterium and that the major pathway to infection was the ingestion of food or water contaminated by the feces of an infected person, then effective preventative measures were obvious and implementation of sanitation practices, water filtration, and chlorination led to dramatic decreases in the incidence and death rates associated with that awful disease.  In less than 30 years the typhoid death rate dropped from 80 to 100 per 100,000 to 7 per 100,000.  Many equally or more dramatic results with other diseases came with the development of the so-called "miracle drugs" (penicillin, streptomycin and others)  that scientific medicine discovered in the early decades of the 20th Century.  From 1900 to 1940, mortality rates in the U.S. fell by 40% with an average decline of about 1% per year during that period.  Life expectancy at birth during that same period rose from age 47 to age 63.  

As genealogical illustrations of the effects of this amazing leap in scientific medicine and disease prevention and treatment, we can look at subsequent generations in the family examples summarized above.  Two generations of even a very privileged and affluent family such as the Aldrich/Rockefellers can illustrate the point.  The generation of the children of Nelson and Abby Pearce Aldrich born in the late 1860s - 1880s suffered three disease-related deaths before age four and two who lived to adulthood, but with severe disease-caused hearing disabilities.  One generation later when Abby Greene Aldrich Rockefeller had six children of her own, all born between 1903 and 1915, all six lived to adulthood and into their 70s - 90s (except for one son who died at 61).

In my own family, my maternal grandmother's parents lost half of their six children born between 1892 and 1902 to disease.  My grandmother herself had three children born between 1927 and 1932.  All of them lived to adulthood and two are still alive and well in their 80s.  Her one son, my uncle, died just a few weeks before his 75th birthday.  My paternal grandfather's parents lost three of their five children to disease before age two, but my grandfather's three children all survived and today are ages 91, 87 and 80.         

So we, as genealogists, can help remind folks that we can achieve -- and have in the past achieved -- stunning advances in medicine, disease prevention and treatment, and in the provision of general healthcare in order to make the lives of all of our families more safe, secure and long lasting (no matter whether we are poor, middle class or rich).  We only need the determination to do it and the memory to heed the lessons of the past. 

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For more regarding the information referenced above see . . . 

Bernice Kert, Abby Aldrich Rockefeller: The Woman in the Family (New York, New York: Random House 1993).

David Cutler and Grant Miller, The Role of Public Health Improvements in Health Advances: The 20th Century United States ( , February 2004).

John M. Barry, The Great Influenza: The Epic Story of the Deadliest Plague in History (New York, New York: Viking Penguin 2004).

2011 Book of the Year, Encyclopaedia Britannica, Comparative National Statistics, pp. 742-743 "World and regional summaries," and pp. 810 - 815 "Health services."
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Copyright 2013, John D. Tew
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