It is a common misconception that in the past people did not live very long. Life expectancy is an average measure of when people die. Because the death rate was so high for children this pulled the average down. But if you managed to get to your teenage years, then you could live a long time [though check here for maternal mortality].
Child Mortality in UK 1800-2022
The difficulty was getting past early childhood. Schoolchildren died in significant numbers from various epidemics but as a child develops so their susceptibility to illness declines. The most crucial time was the first 5 years.
1. Classifying Child Mortality
Today we talk about perinatal mortality – this is defined as the last period in the womb and the first week of life out of it. Infant mortality refers to deaths before the age of one and child mortality deaths between the ages of 1 and 5.
In the last 100 years the death rates for young children in all these groups has fallen by quite amazing amounts. The death rates for those aged 1-5 began to fall in the late nineteenth century and infant mortality in the twentieth. Today they are both tiny compared to the past. So how did children die in the past?
2. Death at birth
Historically many babies died in childbirth. They died because of various complications relating to the health of the mother or the baby itself. Today there are rules about what constitutes a live or a still birth but, in the past, these were recorded in confusing ways and many of those deaths – in or immediately following birth – would have been thought of as still births. In the past, unless they were richer, parents would likely not individually memorialise a baby born dead, or which died within the first few days.
3. Birth, birthweight and vulnerability
The healthier the mother, the healthier the baby. In the past many children will have been born with low birth weights reflecting the poor nutritional health of the mother. This helped make them susceptible to early death from disease and it contributed to stunting for those who survived. Stunting is slow growth in the first years that contributed to low adult height (adult height has grown over time) and possibly cognitive impairment for some. The death of the mother in child birth also put any surviving baby at greater risk too.
4. Childhood infectious disease
The biggest threat to young children were childhood infectious diseases. It was only with the registration of deaths after 1837 (and later attempts to classify and count causes of deaths) and an understanding of the diseases themselves that it became possible to measure their different contributions.
This allowed different patterns of death to be tracked more accurately. Some of these patterns were seasonal – diarrhoea was more evident in the summer, respiratory disease in the winter. Some of these were geographical. Infant and child mortality rates were higher in Scotland than England for example, they were higher in towns than rural areas and some towns compared to other towns. They also varied by social class as can be seen in the late nineteenth century data in the figure below.
4.1 Water borne infectious disease
In a world of poor sanitation many diseases were water borne – cholera, diarrhoea, dysentery, typhoid etc. Cholera – an epidemic disease has a notorious reputation but it was endemic diseases like diarrhoea that killed the young in huge numbers every year.
4.2 Air borne disease
Some diseases are airborne. This usually means that in addition to direct contact they are carried in tiny droplets in the air – from person to person. Measles is a major example which still kills many today – especially in poorer countries. Scarlet fever (now much reduced in virulence for the past) is another example. TB is also airborne but this has a long gestation period.
4.3. Insect borne infectious disease
Some diseases are carried by insects. Plague is the most famous example. Typhus is another. It is spread though infected body lice. It is obviously therefore linked to cleanliness but is especially a problem if social conditions deteriorate.
5. Why did Child and then Infant mortality rates fall?
Medical advance is not the primary explanation for the decline in either child or infant mortality. Until the years after World War 2 there was little doctors could do with science backed medical care on a mass scale.
The explanation of the falling rates has to be found in improvements in social conditions. The balance of factors is disputed but it was some combination of an increase in the standard of living with better food, better housing, better water supplies and sanitation. Family size was also beginning to fall so parents were able to give more attention to a smaller number of children.
6. Medical Care
Over recent decades medical care became more important. Three advances played a significant role at the population level.
One has been the development of vaccination against certain childhood illnesses. Before the mid twentieth century only smallpox had been reduced [and later eliminated] by first inoculation then vaccination.
A second has been the development of anti-biotics which have allowed doctors to treat a variety of forms of infection.
The third was a simple idea that babies should be scored for how healthy they were at birth. This is the Apgar scale named after Virginia Apgar who devised it. Apgar was an extraordinarily talented person who trained as a surgeon but was told she would never make in a man’s world. So she retrained as an anaesthetist [which is a very demanding role].
Apgar believed that too many babies were dying immediately after their birth or in the first hour or so. So she devised a simple 0-10 scale where 10 was perfect and 4 or less meant problems and published it in 1953. It immediately took off because it gave doctors and nurses something measurable and showed that even very poorly babies could survive in neo-natal units which soon followed. Wherever it was used the infant death rate fell dramatically.
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This is part of a series of blogs n the basics of historical demography. Others are
Getting Pregnant and the Fertility Transition: Historical Demography (1)
Giving Birth and Women Dying: Maternal mortality and Historical demography (2)
Mike Haynes - The Jobbing Leftie Historian and Researcher 