Historical Evidence

Although precise statistical data are lacking, the little that scientists have been able to compile from various anthropological and archaeological sources clearly indicates that throughout most of its existence humankind has had to contend with an extremely high death rate. At least 20 percent and probably more of all newborn babies died before their first birthdays, and for most there was no more than a 50 percent chance of surviving to adulthood. More specific estimates of mortality in antiquity are limited to occasional estimates of average life expectancy, the number of years lived, on the average, by the members of a given population. This average life expectancy, or average age at death as it is sometimes crudely defined, is influenced most strongly by the mortality rate in infancy (Shryock et al. 1976); hence, where conventional birth and death statistics are not available, this measure can be used as something of a proxy for the infant mortality rate. Available historical estimates indicate that, while some of our primitive ancestors surely attained extremely old ages, the average life expectancy in ancient times among most groups was probably not much more than 25 or 30 years, and in some populations it was even lower (Russell 1958).

Although overall survival improved somewhat over the years, average life expectancy had not greatly improved as recently as the start of the present century. Estimates for England and Wales, for example, indicate that average life expectancy for the period 1891-1900 was only about 45 years (44 for men and 48 for women) (Dublin, Lotka, and Spie-gelman 1949), and in the United States in 1900 it was only about 50 years (48 for men and 51 for women) (U.S. Bureau of the Census 1960). Moreover, it was still common at that time for as many as 15 percent or more of all newborn babies to die before their first birthdays. Data for the United States, for example, indicate an infant mortality rate for 1900-2 of 162 per 1,000 live births (U.S. Bureau of the Census 1960); and rates of comparable magnitude (between 150 and 170) have been estimated for this period in a number of other western European countries (Woods, Watterson, and Woodward 1988).

Contemporary scholars, concerned with the high levels of infant and childhood mortality, were clearly aware of their causes. Some were environmental factors, such as foul air, contaminated water, and poorly ventilated, overcrowded housing, which contributed to the high incidence of a variety of infectious, respiratory, and parasitic diseases. Other causes were related to poor child care, including inadequate and unsanitary delivery conditions and improper feeding practices, notably a lack of breast feeding and the associated consumption of contaminated milk, all of which led to high rates of mortality from diarrheal diseases (Woods, Watterson, and Woodward 1989). Moreover, it had generally been known since at least the mid-nineteenth century that these detrimental health conditions were differentially distributed among the population and that the lower social classes experienced much higher infant death rates than the middle and upper classes (Woods et al. 1989). As previously mentioned, research over the years has clearly established that family income is the most significant determinant of the physical well-being of all family members, and particularly that of infants and young children. Arthur Newsholme, for example, one of the best-known investigators of this topic in the late nineteenth and early twentieth centuries, identified poverty as a major corollary of poor sanitation and high infant mortality. In England nearly 80 years ago he wrote, "No fact is better established than that the death rate, and especially the death rate among children, is high in inverse proportion to the social status of the population" (Newsholme 1910).

Similarly, in summing up his classic study of infant mortality in the United States during the first quarter of this century, Robert Woodbury (1925) noted that infant death rates were "highest when the father's earnings were low and lowest when the father's earnings were relatively high." Although Woodbury's findings suggested that several other variables bore a causal relation to infant mortality (e.g., race, physical condition of the mother, age of mother, type of feeding, length of interval between pregnancies), all of these were highly correlated with the earnings of the father. Thus, in summing up the interrelationship between infant mortality, father's income, and the other causative factors, he concluded:

The analysis indicated that low earnings of the father exerted a potent influence over the prevalence of these factors and therefore must be regarded as primarily responsible for the greater mortality associated with them. The presence of intermediate factors in the chain of causation does not lessen the responsibility of low earnings as a primary cause. (Woodbury 1925)

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