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#1
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Questionable stats? (19th century stuff --Sorta OT)
Cataloging a book at work today I ran across a statistic that has me
VERY puzzled. It was a book about public health history and the quote read, "In 1857, 24 out of every 54 pregnancies in the U.S. resulted in post-partum puerperal fever ... as a result o fpuerperal fever, 19 out of every 54 pregnancies proved lethal to the mother. Given that most women at that time gave birth to more than 6 children, the risk of premature death over the course of their reproductive lives was enormous." The author gives no cite for this statistic ...but is he really claiming that almost 40% of births resulted in maternal death from puerpural fever? I can't figure out where he got the stat. Poking around a little I couldn't find anything for that particular year, but a few sources gave figures for the 19th-early 20th century in general as being around 6-7% ... and that's from ALL causes, not just puerpural fever. Ah well ... (It does make me question much of the other data in the book as well!) Naomi |
#2
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Questionable stats? (19th century stuff --Sorta OT)
Cataloging a book at work today I ran across a statistic that has me VERY puzzled. It was a book about public health history and the quote read, "In 1857, 24 out of every 54 pregnancies in the U.S. resulted in post-partum puerperal fever ... as a result o fpuerperal fever, 19 out of every 54 pregnancies proved lethal to the mother. Given that most women at that time gave birth to more than 6 children, the risk of premature death over the course of their reproductive lives was enormous." assuming those stats are correct, that's 44% got pueperal fever and of those, 35% died, which is 15% of pregnancies resulting in a death from puepural fever, which really cannot be right, though it could be read the way you appear to have read it, that of the 24 out of 54 who get puerperal fever, 19 of those 24 women die, either way, it makes no sense, if a book (or anything for that matter) doesn't quote sources, take any results with a large pinch of salt. Cheers Anne The author gives no cite for this statistic ...but is he really claiming that almost 40% of births resulted in maternal death from puerpural fever? I can't figure out where he got the stat. Poking around a little I couldn't find anything for that particular year, but a few sources gave figures for the 19th-early 20th century in general as being around 6-7% ... and that's from ALL causes, not just puerpural fever. Ah well ... (It does make me question much of the other data in the book as well!) Naomi |
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Questionable stats? (19th century stuff --Sorta OT)
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#5
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Questionable stats? (19th century stuff --Sorta OT)
ncrist wrote:
Given that the personnel wasn't entirely sanitary in those days (and I use "entirely" as an understatement), I can now say that it doesn't sound too unusual that 15% (if not more) died as a result of Puerpural fever. They state that that's one of the reasons why people in Irland wanted to leave their country so badly, leaving the potato famine aside. I don't think there's any way for that number to be accurate. If 15 percent of pregnancies or more ended in death (and with no birth control, most women had quite a few pregnancies), that would be a staggering number of women dying that just doesn't seem to be in evidence. Best wishes, Ericka |
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Questionable stats? (19th century stuff --Sorta OT)
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#7
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Questionable stats? (19th century stuff --Sorta OT)
Ericka Kammerer writes:
: ncrist wrote: : Given that the personnel wasn't entirely sanitary in those days (and I : use "entirely" as an understatement), I can now say that it doesn't : sound too unusual that 15% (if not more) died as a result of Puerpural : fever. They state that that's one of the reasons why people in Irland : wanted to leave their country so badly, leaving the potato famine : aside. : I don't think there's any way for that number to : be accurate. If 15 percent of pregnancies or more ended : in death (and with no birth control, most women had quite : a few pregnancies), that would be a staggering number of : women dying that just doesn't seem to be in evidence. : Best wishes, : Ericka Remember that om the nineteenth century there were far fewer hospital births than home births. I have also heard that the neonatal death reate in hospitals at that time were orders of magnitude higher than for homebirths, and that they did not really come down until the germ theory, and resulting hygine was commonly accepted by doctors. I don't find this number staggering for, say, around 1800. Larry |
#8
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Questionable stats? (19th century stuff --Sorta OT)
ChocolateChip_Wookie wrote: wrote: Cataloging a book at work today I ran across a statistic that has me VERY puzzled. It was a book about public health history and the quote read, "In 1857, 24 out of every 54 pregnancies in the U.S. resulted in post-partum puerperal fever ... as a result o fpuerperal fever, 19 out of every 54 pregnancies proved lethal to the mother. Given that most women at that time gave birth to more than 6 children, the risk of premature death over the course of their reproductive lives was enormous." The author gives no cite for this statistic ...but is he really claiming that almost 40% of births resulted in maternal death from puerpural fever? I can't figure out where he got the stat. Poking around a little I couldn't find anything for that particular year, but a few sources gave figures for the 19th-early 20th century in general as being around 6-7% ... and that's from ALL causes, not just puerpural fever. Ah well ... (It does make me question much of the other data in the book as well!) Naomi When judging the validity of the statistics, you have to take into account the nature of Puerpural Fever and where it came from, how it is transmitted and most especially the expectations of the time. [Snip most of VERY long historical context stuff.] have their children under the influence of a cocktail of narcotics, In 1844, Semmelweis was appointed assistant lecturer in the First Obstetric Division of the Vienna Lying-In Hospital, the division in which medical students received their training. He was appalled by the division's high mortality rate from puerperal fever - 16% of all women giving birth in the years 1841-1843. In contrast, in the Second Division, where midwives or midwifery students did the deliveries, the mortality rate from the fever was much lower, at about 2%. Semmelweis also noted that puerperal sepsis was rare in women who gave birth before arriving at the hospital. Right. So even in the WORST of the lying in hospitals, the rates topped out at about 16%. (And that was an especially bad range of years for Semmelwies's hospital. Most years the death rate in the 'medical' ward was around 11%). And for midwife attended births (home or hospital) most stats I've seen seem to run between 2 and 6%, presumably depending on location and specific era. (i.e., urban women in delivering in slums, even with a midwife, had higher rates than rural women.) And only a tiny minority of women delivered in hospitals (or even at home attended by doctors) during this era, so that 10-16% in lying in hospitals-rate would only be blip on the radar. Yet, according to this author some 35% of ALL births ended in the mother dying from purpural fever. (Not even 35% of all women eventually died from childbirth related causes, but about one out of every 3 births ended with the mother dying from infection.) Remember, she claimed that 19 out of every 54 women died of purperal fever in every delivery.) That rate would have quickly resulted in the rapid extermination of the human race! (I'm not great at math nor am I an epidemiologist ... but if I'm figuring correctly, if 35% of women died after their first delivery, that left 65% of the population to have another baby. If 35% of THOSE women died, that's another 23 deaths, so 65-23 = we're down to 42 women. Then, if those 42 had a 35% death rate, that's 16%, or 26 women left to have a fourth child. So only around a quarter of all women would survive to have more than 3 children. And when you then calculate in an infant/child mortality rate that DID approach 50% among most populations, you are well below replacement level, since fewer than half of all women could have had more than 2 children without dying, and only a tiny minority could have had more than 3 or 4. Yet that is clearly not the case. There were MANY women who gave birth to large number of children, and MANY women who survived their childbearing years. The first recorded epidemic of puerperal fever occurred at the Hôtel Dieu in Paris in 1646. Subsequently, maternity hospitals all over Europe and North America reported intermittent outbreaks, and even between epidemics the death rate from sepsis reached one woman in four or five of those giving birth [Loudon I. Deaths in childbed from the eighteenth century to 1935. Med History 1986; 30: 1-41.] Right. In maternity hospitals. Which only accounted for a minority of births. Just as a general side bar note - it was standard practice well into the 20th century for a pregnant woman to organise her will before labour commenced. One of Victoria's daughters is known to have done this in case she died during or shortly after labour and it was noted in a letter to her mother. I know this is true because I have a copy of the will my Great-Grandmother wrote which specifies the reason for completing this legal formality. She notes in her will that this is the 8th child she has carried to term and is concerned that she is 'pushing her luck' as it were and therefore was organising her will in the event that she died during or after the birth. Presumably that was Princess Vicky, since none of Victoria's other daughters had, so far as I recall, 8 children. (I think Alice had 6 or 7, Helena and Beatrice about 4, and Louise none at all.) But that's a valid point. Victoria had 9 children herself and survived to die of old age. Most of her 9 daughters and daughters-in-law had numerous children, and none of THEM died in childbirth. (Though a few had babies who died at birth or soon after.) Victoria's cousin Charlotte (George IV's only child) did indeed die from purpural fever -- if she hadn't Victoria probably wouldn't have been born at all! -- but I can't think of any other royal women (or mistresses) in her generation or the previous one who did. Now yes ... these were upper class women attended by private physicians for the most part. But still, if the death rates were anywhere NEAR 35% we should have seen more than one of these several dozen women succumbing. But yes, of course childbirth was dangerous. And I'm sure many women got their affairs in order just in case. But most women did NOT die. Most women survived their labors and went on to have many more children. Even the 3-5% rate that seems to be typical still adds up to quite a few deaths when you figure that most women gave birth to 4-8 children, sometimes more. So ... again .. if we assume an average of 6 children, with about a 4% maternal mortality rate per birth that would be about a one in four chance of dying in childbirth over a woman's life-time, which seems fairly reasonable. (Though, of course, first-time mothers would have been more likley to die, since many of the causes of death were chronic things that would have killed the mother the first time out. [i.e., prolonged, non-productive labor due to a contracted pelvis, leading to death from either exhaustion or infection. There is obviously SOMETHING very wrong with the initial statistic I quoted. It cannot possibly be right, and nothing I've ever read in any other source even approaches her figures. Naomi |
#9
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Questionable stats? (19th century stuff --Sorta OT)
Presumably that was Princess Vicky, since none of Victoria's other daughters had, so far as I recall, 8 children. (I think Alice had 6 or 7, Helena and Beatrice about 4, and Louise none at all.) Ooops, clumsy phraseology....the Great Grandmother with 8 children was my own and no relation to Queen Victoria or her daughters. I have a copy of my maternal ancestors will, not the will made by Victorias' daughter. I know the will existed for Victoria's daughter but cannot recall which one, it's one of those half remembered facts you pick up idly watching the History Channel. I would be happy to be corrected if anyone has the correct citation - I think it was the daughter she sent the chloroform to. Wookie |
#10
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Questionable stats? (19th century stuff --Sorta OT)
ChocolateChip_Wookie wrote:
In conclusion therefore, I would be inclined to believe the statistics - horrifying as they are to our modern eyes. Women did frequently die of puerpural fever, it was very common, so common in fact that women routinely organised their affairs before going into labour. Just finally, in the years 1994 - 1996 there were 16 recorded deaths from puerpural fever in the UK [Report Department of Health, 'Why women die']. Go ask your midwife if she knows what it is and what the signs are....I doubt she does. Arrogance breeds ignorance. Just because we have antibiotics, doesnt mean that puerpural fever has been irradicated...it hasnt. A 15 or 35 percent *per pregnancy* mortality rate (depending on how you parse things) might be an accurate statistic for a particular hospital during an epidemic or something, but I can't find *anything* *anywhere* that lists even a total maternal mortality rate that high for the mid-nineteenth century. Sweden was on the low end with something like a rate of 5 or 6 per thousand. The *highest* rate I can find anywhere is less than 10 percent, and that was in a particular clinic with all the high risk practices for puerperal fever. There's just no way that the national maternal mortality rate due to puerperal fever could be even 15 percent/pregnancy, much less 35 percent. Reports in the US show a much lower rate of maternal mortality. While the trend was moving toward the hospitalization of birth, by the mid-nineteenth century, most births were still at home in the US, with much lower maternal mortality rates. If there truly were a national 15 percent mortality rate, with an average of somewhere around 6 deliveries per woman at that time in the US, that would mean that an average woman would have had more than a 60 percent chance of dying of childbirth at some time in her life. That's just clearly ludicrous. Also, why on earth would you assume that a midwife wouldn't know the signs and symptoms of puerperal fever? That boggles the mind. Best wishes, Ericka |
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