Building a New Biocultural Synthesis: Political-Economic Perspectives on Human Biology

8. Nature, Nurture, and the Determinants of Infant Mortality: A Case Study from Massachusetts, 1830–1920

Chapter 8 Nature, Nurture, and the Determinants of Infant Mortality: A Case Study from Massachusetts, 1830-1920 Alan C. Swedlund and Helen Ball In the latter half of the nineteenth century, rates of infant mortality in American cities were a matter of grave concern. As many as 15 to 20 percent of newborns died within their first year, and in the worst neighborhoods or most afflicted cities, rates could go much higher (Phelps 1912; Woodbury 1926; Swedlund 1990; Meckel 1991). Since the mid-nineteenth century, countless studies ofinfant mortality have been undertaken. Those ofthe time were aimed primarily at the illumination ofcauses and the prevention ofloss (e.g., Phelps 1912; Woodbury 1926). Recent twentieth-century studies have attempted to portray the historical events and factors involved and to reevaluate earlier data in terms of new methodologies and theoretical perspectives (e.g., Preston and Haines 1990; Meckel 1991). Several of these have addressed the political climate of the late Victorian (ca. 1870-1890) and Progressive (ca. 1890-1920) Eras and identified social, ideological, and economic dimensions of the problem (see especially Meckel 1991; Klaus 1993; Ladd-Taylor 1994). In earlier work (Swedlund 1990; Ball and Swedlund 1996) we took a regional approach to the issues and focused our attention mostly on Massachusetts . The Commonwealth of Massachusetts experienced some of the country's highest rates of infant and childhood loss in the second part of the nineteenth century and became a center for the national debates that ensued. The health community was early and actively involved in studying and trying to prevent infant mortality (e.g., Knowlton 1845; Shattuck et al. 1850; Boston Board of Health 1875; Massachusetts Board of Health 1879). Moreover, a variety of sources of data were readily available to us for both rural and urban communities. 191 192 Building a New Biocultural Synthesis National and international comparisons have contributed significantly to an appreciation of the factors associated with this historical period of epidemiological transition. Nevertheless, we contend that a finer-grained approach in a specific regional context might uncover relationships that are masked at larger scales of analysis.1 In this respect we agree with Kunitz (1994), who has argued the importance of location and historical contingency in explaining disease processes, but we are quick to acknowledge that the issues we address were also part of a Western experience occurring in the United Kingdom and continental Europe as well. Some aspects of urbanization, industrialization, and other effects of modernity were shared by all regions of the West, were interconnected, and cannot be understood without recourse to this larger system. In other respects, each nation and region had its own distinctive aspects that affected at least the course ofdebate, ifnot the nature ofthe transition (see Wolf 1982 and Roseberry 1989 for discussions on this connectivity). We argue that for New England and the northeastern United States, the critical factors for infant mortality had to do with the significant amount of foreign immigration and the history of women's labor participation consequent to early factory industrialization. These factors gave rise to some regional distinctiveness, and they form the centerpiece of our discussion. Debates on the excessively high infant mortality rates in the late-nineteenth-century and turn-of-the century West often focused on issues ofclass, gender, and ethnicity, but in the eastern United States race and ethnicity reached a level of interest and attention that was not matched in England or France (Meckel 1991; Klaus 1993). Understanding how these three factors were treated-and often conflated-is a central aim of this chapter. Through the Massachusetts example we investigate a number ofquestions pertinent to critical and political-economic approaches in biological anthropology. We also address the important issue of how to critique an episode in the history of science and at the same time do "good science." This involves fresh consideration of categories of analysis that are generally thought to be straightforward and unambiguous in their social science and epidemiological etymologies but that may be legitimately contested and problematized. It also involves deciding whether or not data that are collected and defined in a historically contingent context, and that may well carry certain subjectivities, may still be "recycled" and made useful for inferences about their historical significance and epidemiological precision . That is, can they satisfy the modern standards ofvalidity and relia- Nature, Nurture, and the Determinants ofInfant Mortality 193 bility requisite for meaningful hypothesis testing? To answer...