In-migration and diphtheria mortality among children in the Sundsvall region during the epidemics of the 1880s

While many works have examined urban mortality rates in nineteenth-century Europe, much less attention has been placed on disease patterns in the peripheral areas surrounding these population centers. This study demonstrates that during the Swedish diphtheria epidemic of the early 1880s, mortality rates among children living in the industrial parishes on the outskirts of the town of Sundsvall exceeded those found in the town itself. The epidemic was fueled by the mass in-migration of laborers and their families from distant provinces who sought work in the region's sawmills. Thus, in contrast to the common pattern of disease entering through a port city and spreading into the interior, in this case diphtheria followed the paths of migrants through the rural parishes of the Sundsvall region to the sawmills and then finally into the town itself. This spatial pattern was reversed in the late fall when migrants returned home. Conflicts within the medical profession regarding how best to prevent or contain diphtheria, popular suspicion and distrust of local physicians, and the introduction of the disease into a population with no prior contact with it, all helped increase the number of young corpses.