Researchers study death records for health trends

AMHERST, Mass. -- When Sylvester Graham died in 1851 the cause of death was listed as "Congress waters and tepid baths."

According to the records in Northampton City Hall, the eccentric health food pioneer remembered for inventing the graham cracker died at the age of 57 from drinking too much mineral water and ignoring his own advice to bathe in bracing cold water.

Now, researchers at the University of Massachusetts and the University of Michigan are taking a new look at about 60 years' worth of those old death records.

By using newspaper reports, journals and minutes of city health and other boards, they hope to flesh out the sometimes puzzling entries and track public health trends in an era when modern medicine and sanitation were emerging.

But the researchers hope their work will be of more than just historical interest.

"It could be a very important tool in looking at data from less developed countries," said Douglas Anderton, a sociology professor at the University of Massachusetts involved in the study.

He pointed out that modern medicine was slow to recognize the magnitude of the AIDS epidemic because many of the early deaths in Africa were attributed to a "wasting disease."

The massive, three-year study, launched this spring with a $901,000 grant from the National Institutes of Health, could also help developing countries decide how to spend sparse health-care dollars, Anderton said.

Understanding what happened in the past is important because rates of disease in developing nations today are comparable to those in industrialized Europe and America 150 years ago, said Graham Mooney, who teaches public health history at Johns Hopkins University.

The years covered by the Massachusetts study, 1850 to 1912, saw the evolution of public health and sanitation as germ theory was discovered and medical care was professionalized.

By the end of the period people were living longer and dying of different causes. For instance, there was a sharp decline in the deaths of women in childbirth and infectious diseases replaced dysentery as the leading killers of children.

Deaths from consumption, usually translated as tuberculosis, also appeared to drop sharply. But the researchers said by looking beyond death certificates they have found indications as many as 25 percent of the deaths attributed to consumption in the mid-1800s were not actually from the lung disease.

"It's hard to know what people died of when the people recording didn't understand disease the same way we do," said Susan Hautaniemi Leonard, an anthropologist at the University of Michigan, who is working on the study.

It wasn't until about 1900 that the names of diseases were standardized internationally. Stranger's fever became malaria and winter fever became pneumonia.

Although it's unclear just what killed Graham, it appears from newspaper reports that he had been suffering for a long time from some sort of rheumatic disease, Anderton said.

The study focuses on the two Massachusetts industrial cities because the state was the only one to require that a cause of death be recorded during the period, he said. Most other states didn't begin keeping that information until the early 20th century.

Holyoke was built as one of the nation's first planned industrial cities in the 1840s. In the late 19th-century it had the third-highest population density in the United States, with crowded immigrant tenements.

Northampton was also a tightly packed industrial city, with a long history of alternative therapies. Graham and his militant vegetarians campaigned against white bread made of refined flour and marketplace milk, which often was thickened and whitened with the addition of such things as chalk and plaster of Paris.

Northampton also was home to at least two competing water cure establishments. The city's modern acute care hospital is located on the site of one of those early establishments.

The 19th century practitioners believed in the curative powers of such things as wrapping the sick in cold, wet sheets, said Leonard.

And in an era when medicine was rudimentary, their ideas, like Graham's promotion of good nutrition, were not so way out.

"In cases of fever, it could have had a good effect," Leonard said. "And it was certainly better than administering mercury for fever, which was what many doctors did at the time."