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In the 19th century, becoming a child was extremely dangerous.
As of 1900, about 18%, or nearly one in five, American children died before their fifth birthday. The most common cause was infections – pneumonia, diphtheria, dysentery, measles, and other diseases ramped households, and children were particularly at risk.
In particular, cities were “cauldrons of infection.” Fatal Year: Child Mortality Rate in America in the Late 19th Centurytold me. But around the country, epidemics are “rituals of childhood passage, some of which are far worse than others, but all of them cause serious morbidity, and many of them cause death,” said Howard Markel, a medical historian who studied epidemiology.
In contrast, less than 1% of children today die before age 5, and until recently, former childhood illnesses like measles were essentially unprecedented in the United States. What has changed?
While better hygiene and understanding of germ theory is part of the story, one key factor that has changed America's childhood over the past century is the widespread adoption of vaccines. Today, children in the US are routinely vaccinated against measles, mumps, devera, diphtheria, polio, certain types of pneumonia and meningitis. Other vaccines, including typhoid, are used worldwide.
This public health victory saved hundreds of millions of lives and prevented billions of cases of illness. On the list of “10 biggest hits in medicine,” Markel said at least nine people would be vaccinated.
That message has been exemplified recently by being one of the nation's most prominent vaccine skeptics as secretary to the Department of Health and Human Services, thanks to an increase in anti-vaxious sentiment in the US and around the world, and recently confirmed by Robert F. Kennedy Jr. Just a few weeks after Kennedy's tenure, the measles outbreak has become sicker than 100 people, killing unvaccinated children in Texas.
At this time of declining vaccination rates and increasing risk of preventable diseases, we wanted to flashback into human history over the long term before vaccines became available. Childhood in the previous century before vaccinations were sick, yes, but sadness and loss tend to forget that the outbreak of illness is more unusual. It allows us to understand that we can teach us about the choices we make today, the outcomes, for our families and society.
When illness and death were the norm
In the years before the vaccine, the prevalence of the disease meant that premature death touched almost every family. “In the second half of 1900, we could hope to lose at least one child to illness,” Stephen Mintz, a history professor at UT Austin who studied childhood, told me via email. That means most children could expect to lose at least one sibling.
James Marten, a historian who studied childhood, recalls three names in the family's local cemetery. “They were all sisters and brothers of my grandfather.
There is a misconception that the size of the family has increased and the invisibility of nearby childhood illnesses has made the child loss no longer catastrophic for survivors. In fact, when the child died, “parents suffered from extraordinary grief,” Mintz said.
For example, after the death of her son Willie from typhoid fever in 1862, Mary Todd Lincoln wrote in a letter, “My question to myself is, “Can life bear?”
The children also did not escape this grief. They may take part in mourning – a late 19th century photo of Helen Frick, the heir as a young girl, shows her wearing a rocket containing a photo of her dead sister. They may also encounter constant reminders of loss in the form of new brothers or sisters with the names of their deceased brothers.
Illness has hit people from all walks of life, but poor children and children of colour face additional risks. New sanitary infrastructure, like sewers, which limit the spread of disease, was first set up in wealthy white neighborhoods, making poor families vulnerable, said Nancy Tomes, a history professor at Stony Brook University who studied the history of the disease. Meanwhile, hundreds of thousands of Native American children were often forced to board schools due to frequent hygiene conditions that led to an astounding number of deaths.
Death and serious illnesses are staples of literature for children in the 19th century, and are often inspired by the loss of reality. Beth's illness and death due to complications of scarlet fever contracted from Louisa May Alcott's baby Little woman The death of Alcott's sister herself in 1858 wrote Peri Class, a pediatrician. Laura Ingalls Wilder's sister Mary became blind in 1879 (when Laura was 12 and Mary was 14), possibly from meningoencephalitis, an episode featured in Wilder's book. Along the coast of Silver Lake: “The fever subsided in Mary's eyes, and Mary was blind.”
Many infections affected children disproportionately, but adults also died. In the 19th century, it can be expected that by the age of 21, half of all children will lose their parents, Mintz said. “The psychological sacrifices were enormous.”
There were also economic and practical sacrifices. Widowed mothers and their children often had to enter outdoors and poor homes in the 19th century, because they were unable to support themselves. If the mother dies, the father may send the children to live with their relatives or to an orphanage “packed at this point,” Tomes said.
On the other hand, for those who have become ill, the experience of the illness itself can be painful and frightening. For example, diphtheria forms a thick membrane behind the throat, making breathing extremely difficult.
The illness was called a “strawler angel,” Mintz said. If children pass the first stage, they could die of heart failure six weeks later, Markel said.
Even survivors of infectious diseases can face lifelong effects. For example, polio can lead to paralysis, and some children spent weeks, months or even years on iron lungs to help breathe. (Paul Alexander, one of the last users of Iron Lung, passed away last year on the device after more than 70 years.)
Although devastating, endemic diseases like measles have become anticipated a few years before widespread vaccination.
Polio, which arrived in the United States in the late 19th century and led to more isolated and unpredictable outbreaks, caused more fear, said Markel. Parents kept their children out of school and filmed the pool and cinema. “It really shapes your everyday life and what you do when people learn about these things,” Merule Eisenberg, a history professor at Oklahoma State University who studies the pandemic, told me.
The polio vaccine introduced in 1955 ended those horrors. Today, it is one of a series of vaccinations, allowing most children in wealthy countries to grow freely from the infectious diseases that have caused many ancestors to illness and kill them. “We take that for granted the opportunities and possibilities that kids have now,” Eisenberg said.
However, these diseases will not go away. In poor countries where vaccine distribution is more challenging, preventable diseases still advocate for children's lives, Rashida Ferand, an epidemiologist at the London School of Hygiene, told me. Diphtheria cases are rising in Pakistan, and polio remains endemic in Afghanistan there.
As the outbreak of measles in Texas shows, illnesses that have devastated families for centuries could also return here. And it's especially important now to remember childhood history before vaccines – experts say – vaccinations are widely questioned, and the ramp-prolonged illness and sadness of human history over the past few thousand years have disappeared from public memory (nevertheless).
“It's the past that we've mostly forgotten and make our prospects miserable, so if you go down this path, you should keep that in mind,” Preston said.
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In response to my story about Trad Kids last week, readers wrote about growing up as the second oldest of five religious children.
“I was sure I was expected to be a mother who would stay at home, and no one was worried about my lack of career path,” the reader wrote. “I was depressed, very introverted and anti-social. And while I was transitioning to nonbinary with all men, I am strange and independent. I am always pursuing education and planning to study abroad in the country I want to live in.”
Thank you to this reader for sharing your experiences. As always, you can contact us with any future story questions or suggestions.
