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WorcesterThen: ca. 1918
Causes of Death in Worcester a Century Ago Don Chamberlayne January, 2018 |
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Now there’s a topic header sure to cause a rush to the exits. That might have been true of me as well, but when I came across the data in a search for information on the influenza pandemic of 1918 I found that the longer I looked, the more interested I became. Here are a few teaser questions to see if the subject can evoke any interest. In the city of about 175,000 residents in the late 1910s, the number of people who met their demise in a given year ran in the range of 2500 to 2600, about 1.5 percent. Given that base for estimating, how many would you guess died of cancer? of pneumonia? heart disease? malaria? diphtheria? accidents, homicide, or suicide? Unless you are a medical or public health professional, or otherwise unusually well versed in such matters, you may have found these questions fairly challenging. What follows is a compilation of numbers of deaths attributed to various causes a century or so ago, as published by the city’s Board of Health in its annual reports, which are available to the public in bound volumes known as City Documents. Volumes from the year Worcester became a city, 1848, through the mid-1930s are available at the Worcester Public Library in the Worcester Room on the third floor. The original source of the data consisted of death certificates filled out by the appropriate city authorities. Except in rare cases of unknown cause, a medical reason was always given, and no one was said to have died of “old age.” My task is that of a compiler, not an author, since I am far from knowledgeable on such topics and have no qualifications for explaining medical matters or writing any kind of analytical work on the subject. When necessary (which has been often) I look things up online, and I suggest that if necessary and as needed, the reader do the same. There are plenty of medical websites, such as those of the Centers for Disease Control, WebMD, Medicinenet, and the Mayo Clinic, as well as Wikipedia and many others. To represent data for “about a century ago,” I have taken the average of the numbers for each cause during four years surrounding, but not including, 1918: 1915, 1917, 1919, and 1921. The reason for this was to iron out the “bumps” in the data likely to occur during any one year, especially the huge bump in 1918 resulting from the influenza epidemic, in order for the data more nearly to represent a typical year in that period of time. Odd years were used instead of sequential years simply because the edition of City Documents for 1920 could not be located. The result is an average of two datasets before 1918 and two after 1918, giving us data for a typical year “about a century ago,” or “ca. 1918,” instead of an exact year. It has been necessary to combine most of the 188 different causes in the reports into categories, at risk of some not-quite-ideal combinations. It is hoped that these categories, which are defined by reference to the code numbers used in the Health Department reports, are accurate enough to serve the purpose without major objection. Please refer to the Board of Health report for 1917. Finally, a sensible next step in the learning process would be to compare the data for a century ago with modern-day causes of death. Maybe that will happen at some point in the future (hopefully by someone else), but for now it lies outside the scope of this effort. |
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The Top Ten Causes of Death in Worcester a Century Ago (average of 1915, 1917, 1919, 1921) Codes refer to the numbers of the causes shown in the Health Department reports. |
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1 Cardiovascular Diseases 372 14.5 % app. 56% organic diseases of the heart, and app. 35% diseases of the arteries, etc. (Codes 77-85) 2 Problems Unique to Infants/Toddlers 319 12.4 % app. 60% congenital debility, icterus, & sclerema, and app. 32% diarrhea and enteritis (under 2) (Codes 104, 150-152) 3 Respiratory System 316 12.3 % a lobar (pulmonary) pneumonia 166 (6.5 %) (Code 92) b bronchitis (acute and chronic), bronchial 150 (5.8 %) pneumonia, other respiratory (Codes 89-91, 93-96) 4 Kidney Diseases 270 10.5 % mostly Bright’s Disease, also nephritis, other (Codes 119-122) 5 Diseases of the Brain 231 9.0 % strokes, epilepsy & other forms of “mental alienation” (Codes 60, 64–69) 6 Tuberculosis (all kinds, see note below) 224 8.7 % app. 80% in the lungs (Codes 28-35) 7 Cancer (all forms) 186 7.2 % (Codes 39-46, 53) 8 Accidental or Violent Events 154 6.0% trauma by crushing (incl. MV or RR accidents), burning, drowning, homicide, suicide, & other (Codes 155-188) 9 Communicable Diseases * 128 5.0 % typhoid fever, measles, scarlet fever, influenza, malaria, whooping cough, diphtheria, syphilis, meningitis, erysipelas, tetanus (Codes 1-19, 21-26, 37, 61) 10 Digestive System 127 4.9% Mouth, esophagus, stomach, intestines, & anus (Codes 99-103, 105-118) Top Ten Causes Combined 2327 90.7 % * Tuberculosis, also a communicable disease, is treated separately here because it was at the time so prevalent, running considerably greater than the others combined (with the exception of the flu epidemic), and because it was so consistently a major killer for so many years. (For many years it was known as consumption). Also, because of the large number of deaths from influenza in early 1919, which comprised the third and final phase of the pandemic, data for that year were excluded and replaced by deaths from the flu in 1916. The purpose was to avoid an unusually high and non-representative figure. |
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Two more: 11 Diabetes (Code 50) 44 1.7 % 12 Pregnancy, childbirth and related (Codes 134-141) 35 1.4 % Total deaths accounted for: 2406 93.8 %
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Focus on Infant Mortality In addition to the special category shown here, averaging 319 infant deaths per year, there were other causes of infant deaths as well, bringing the total deaths under one year of age to 432, or 16.8 percent of all deaths. Thus, one of every six deaths in Worcester a century ago was to a child under one year of age. Besides the special category shown as the second-leading cause of death, other leading causes of infant death were bronchial-pneumonia (average of 41), lobar pneumonia (15), whooping cough (15), and bronchitis (9). Fortunately, most of these numbers have fallen greatly in the past century.
There is no way to determine the exact death rate for infants from the data available, but using the census of 1920, which showed 3705 children under one, adjusted to yield an estimate in 1918, with 432 deaths that year, the infant mortality rate comes to approximately 10.8% of live births. That amounts to one-in-nine babies not surving to age one.
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Focus on Accidental or Violent Events Leading causes of deaths in this category, ca. 1918: Trauma by crushing 50 mostly railroad and vehicle accidents Trauma by fall 31 Suicide (any method) 23 Conflagration and burns 17 Drowning 7 Homicide (any method) 5 Absorption of deleterious gases 5 Excessive heat or cold 5 Other causes of trauma 5 Poisoning 3 Electrocution 2 Other 4
Note the low homicide rate (which is only barely higher than that today), and the fact that suicides were four and a half times more prevalent than homicides. |
Focus on Communicable Diseases Leading Causes of Death by Communicable Disease, ca. 1918 Under Death-to- Death age 10 Case Rate Seasonality Diphtheria & Croup 25 82 % 8.0 % none observed Whooping Cough (Pertussis) 24 36 % 15.5 % none observed Influenza 19 12 % 13.7 % * Measles 14 71 % 2.5 % more in Spring Syphilis 12 0 Erysipelas 11 0 Meningitis 9 50 % 53.8 % none observed Typhoid Fever 7 11 % Scarlet Fever 6 71 % 2.0 % less in Summer Malaria 1 ** 0 Tetanus 1 *** * Influenza case data available only for 1919 & 1921 ** Four cases in four years, all in 1917 *** Of three cases during four years, one was under age 10
Adding to concerns about communicable diseases running at their “normal” rates was the fear of an epidemic, as was the case with a vengeance in 1918-19, when some 1100 persons lost their lives in the great influenza pandemic. Ref.: Worcester’s Experience of the Influenza Pandemic of 1918 (pdf) |
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From a Parent’s Viewpoint Infant mortality from birth to age one 432 (app. one in nine births) Deaths per year, children ages one to ten 202 (avg. of the 4 years)
Having survived the first year of life, to survive to age ten a child had to run the gauntlet of death probabilities for the next nine years. The overall rate was about 202 deaths per year for the entire cohort of children ages one through ten. In 1920, according to the census, this cohort consisted of 32,324 children, which reverse interpolates to an estimate for 1918 of 31,110. Nine years times 202 per year comes to 1818, which when divided by 31,110 yields a death rate of about 5.8%, or one of every seventeen youngsters. These data obviously are a bit crude, but the truth was likely somewhere in this “ballpark.”
The inference from all this is that for each child brought into the world at that time, parents had to survive a one-in-nine chance of losing the child between birth and one year, and then a one-in-seventeen chance of losing him or her over the next nine years. That meant about an 84% chance of making it to age ten. For example: Of 1,000 live births, following the probabilities, 110 would be lost in the first year, leaving 890, of which 52 would die during the next nine years, leaving 838 children surviving after ten years. And then came the “tween” and the teen years. Multiply this by several kids in a family and the result had to be a lot of worry and apprehension. And this was just the deaths; there were also the various forms of hardship and cruelty imposed by medical and other causes to add to that worry and apprehension. With all one’s concerns about long hours and low pay, staying fed and keeping warm, national and world politics, and so many other weighty matters, the health and safety of the children must have been among the most concerning of all. * * *
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