Study examines "Grammars of Death" to learn why we died
ANN ARBOR, Mich.—An anthropological demographer at the University of Michigan is digging through dusty 19th century archives to get a clearer view of exactly why mortality rates have been falling for the last century and a half.
"The ways people described deaths a hundred years ago were very different from the terms we use today," said Susan Hautaniemi Leonard, a researcher at the U-M Inter-University Consortium for Social and Political Research. "But to understand why mortality rates have dropped, and what factors are critical in the spread of contagious diseases, we really need to know with a high degree of precision what people died from in the past. In the United States, the average life expectancy at birth has doubled since 1880, when the average life span was 38.5. Global life expectancy is currently 66.7.
While pulmonary tuberculosis is the modern term for the leading cause of death during the period studied, the terms used to describe the condition ranged from "consumption" to "phthisis." Other leading literal causes of death included "dropsy," "fit" and "apoplexy."
Leonard, U-M historian Myron Gutmann and University of Massachusetts Amherst sociologist Douglas Anderton are parsing, or deconstructing, the literal descriptions of causes of death between 1850 and 1912. Their sources are newspaper accounts, medical journals and doctors' records as well as official death and medical records from two towns in Massachusetts---the only state that systematically recorded causes of death during this period when ideas about the causes of death and disease were changing radically.
Titled "Grammars of Death: 19th Century Literal Causes of Death from the Age of Miasmas to Germ Theory," their project is being funded by a three-year, $901,000 grant from the National Institutes of Health.
In the current (spring 2004) issue of the journal Social Science History, Anderton and Leonard identify the leading causes of death of the time, then translate them into modern diagnostic terms, drawn from the World Health Organization's International Classification of Diseases.
Leonard noted that the terms used to describe causes of death gradually change from a mixture of alchemy, astrology, and theories about poisonous miasmas to a growing understanding of modern germ theory and sanitation techniques.
"Despite a growing understanding of the contagious nature of many diseases, the remnants of a miasmic view along with social biases and moral prescriptions plagued 19th century disease classifications," she said. "Poisonous vapors coming from swamps or putrid matter were thought to be directly responsible even for infectious disease." Typhoid was thought to be the result of these atmospheric toxins, while gonorrhea was considered the wages of genital overstimulation.
"As dramatically as terms for many principal causes of death changed, the most radical shift in literal causes of death during the last half of the 19th century was the increasingly detailed qualifications and explanations in recorded cause-of-death descriptions," Anderton and Leonard explained in their article. Here, they found clear evidence of social biases, with detailed descriptions provided more often for men than for women who died of exactly the same causes.
For example, qualifying descriptions were provided for 75 percent of men, compared to 33 percent of women who died of unspecified injuries. In general, the researchers found that the deaths of females, children and older people were less often described and qualified than the deaths of middle-aged men. "Such biases suggest that the deaths of some individuals, or from some causes, were socially either more important or more problematic," the researchers noted.
Even when diseases were called by the same names as they are today, the impact of changing treatments are clearly evident in the historical records. In one area, for example, the researchers found that a smallpox epidemic among paper mill workers killed 47 people between November 1870 and February 1871. Ten years later, only 15 people in the same area died of a smallpox outbreak. "The building of a 'pest house,' along with the legal ability to quarantine those with small pox undoubtedly contributed to the better result in 1880," Leonard said.
"The new grant will let us capture that kind of data, and more carefully follow the clash of cultures and the conflict between individual rights and state control, particularly among immigrants who were rightfully suspicious of state intervention in their lives." According to Leonard, this information may be helpful in projecting the likely course of epidemics that could afflict densely populated contemporary societies, in the developed world as well as in developing nations.
Contact: Diane Swanbrow