Mortality differentials between rural and urban areas of states in the Northeastern United States 1890-1900.

Data from a number of countries show much higher mortality rates in urban than in rural areas in the nineteenth century. In this paper we examine the urban-rural mortality differential in the death registration states of the United States in 1890 and 1900. Before proceeding with the analysis, the data are evaluated and we determine that the data used for the 1900 analysis are more complete than data used in other analyses for the same date. An attempt is made to correct for the deficiencies in the 1890 data. When the urban and rural mortality levels are examined for individual states at both dates, urban mortality is generally higher than rural mortality. However, there is variability across states in urban mortality levels, rural mortality levels, and the urban-rural mortality differences. In general, the urban-rural mortality difference is larger in 1890 than in 1900. When the urban-rural mortality differences are examined in terms of the causes of death which account for the differential, we conclude that higher urban mortality rates are generally attributable to a few diseases—tuberculosis, diarrheal diseases and several other communicable diseases—the transmission of which depend heavily on close human contact or contamination of the environment.     

The elusive role of scientific medicine in mortality decline: diphtheria in nineteenth- and early twentieth-century Philadelphia

The designation of the Klebs-Loeffler bacillus as the cause of diphtheria in the early 1890s and the subsequent development of the antitoxin treatment in the years immediately following were at the time and continue to be viewed as triumphs of scientific medicine. I focus on these two developments to illustrate the problems that arise in attempting to answer the questions regarding the role that changes in medical practice--in this case, the use of antitoxin as a cure--played in lowering death rates at the time. Changes in diagnostic techniques, the selection of cases to be included, and ultimately the agendas of the persons constructing them affected the numerators and denominators of these rates. The data suggest that the antitoxin had some effect on already declining diphtheria death rates, but because of changes in understandings of the disease and contemporaries' presentation of the data, the size of that effect and its role in mortality decline more generally elude us. Our analysis of the past depends on numbers that reflect not only changing treatments but also changing understandings of disease at the end of the nineteenth century.