What was Killing Babies in 19th-Century Europe? Categorising Their Deaths Using ICD10h
DOI:
https://doi.org/10.51964/hlcs23751Keywords:
Infant mortality, Neonatal mortality, Post-neonatal mortality, Seasonality, 19th Century, Causes of deathAbstract
This paper draws together the results from a set of complementary analyses of the causes of infant mortality in eight European port cities in the late 19th century. The deaths were all coded according to ICD10h, with granular codes and a bespoke categorisation for infant deaths. The paper assesses and improves the categorisation of the causes of infant death by considering age and seasonal patterns. We find that while there were similarities in the levels and trends of infant mortality there were also important differences which are ripe for investigation by further research. Cause of death patterns were dominated by a transfer from vague to more specific terms over time, but the vague terms used tended to differ by location, and in the speed of their disappearance. Seasonality analysis suggested that most commonly used vague terms, including convulsions and weakness, probably reflected a variety of different underlying causes and should not be combined with more distinct and coherent categories such as airborne disease or food and water-borne diseases. Although teething is commonly treated as a proxy for diarrhoea, this does not appear to have been universally the case. We illustrate how comparative exercises such as this can further understanding of particular historic terms and their use in different settings, and can produce improved cause of death categorisations. Even the improved categorisation produced here, however, does not free the researcher from the need to consider changes in medical provision, knowledge and terminology within a sensitive and historically informed interpretation.
Downloads
References
Alter, G., & Carmichael, A. (1996). Studying causes of death in the past: Problems and models. Historical Methods: A Journal of Quantitative and Interdisciplinary History, 29(2), 44–48. https://doi.org/10.1080/01615440.1996.10112728
Alter, G., & Carmichael, A. (1997). Reflections on the classification of causes of death. Continuity and Change, 12(2), 169–173. https://doi.org/10.1017/S0268416097002889
Alter, G., & Carmichael, A. (1999). Classifying the dead: Toward a history of the registration of causes of death. Journal of the History of Medicine and Allied Sciences, 54(2), 114–132. https://doi.org/10.1093/jhmas/54.2.114
Anderson, R. N., & Rosenberg, H. M. (2003). Disease classification: Measuring the effect of the tenth revision of the international classification of diseases on cause-of-death data in the United States. Statistics in Medicine, 22(9), 1551–1570. https://doi.org/10.1002/sim.1511
Anderton, D. L., & Leonard, S. H. (2004). Grammars of death: An analysis of nineteenth-century literal causes of death from the age of miasmas to germ theory. Social Science History, 28(1), 111–143. https://doi.org/10.1017/S0145553200012761
Anon. (1902). Revised classification of causes of death in the national records. The Lancet, May 10, 1340–1341.
Bailey, M. J., Leonard, S. H., Price, J., Roberts, E., Spector, L., & Zhang, M. (2023). Breathing new life into death certificates: Extracting handwritten cause of death in the LIFE-M project. Explorations in Economic History, 87, 101474. https://doi.org/10.1016/j.eeh.2022.101474
Bengtsson, T., & Lindström, M. (2000). Childhood misery and disease in later life: The effects on mortality in old age of hazards experienced in early life, southern Sweden, 1760–1894. Population Studies, 54(3), 263–277. https://doi.org/10.1080/713779096
Bernabeu-Mestre, J., Ramiro Fariñas, D., Sanz Gimeno, A., & Robles González, E. (2003). El análisis histórico de la mortalidad por causas: Problemas y soluciones [The historical analysis of mortality by causes: Problems and solutions]. Revista de Demografía Histórica, 21(1), 167–193.
Brownlee, J., & Young, M. (1922). The epidemiology of summer diarrhœa. Proceedings of the Royal Society of Medicine, 15(Section of Epidemiology and State Medine), 55–74. https://doi.org/10.1177/003591572201501410
Corsini, C. A., & Viazzo, P. P. (1993). The decline of infant mortality in Europe 1800–1950: Four national case studies. UNICEF. https://www.unicef-irc.org/publications/pdf/hisper_decline_infantmortality.pdf
Crowther, A. (2006). By death divided. Scottish and English approaches to death certification in the nineteenth century [Paper presentation]. Society for the Social History of Medicine Conference 2006, Warwick, UK. https://www.gla.ac.uk/media/Media_82267_smxx.pdf
de Looper, M. W., Booth, H., & Baffour, B. (2019). Sanitary improvement and mortality decline in Sydney, New South Wales, 1857–1906: Drinking water and dunnies as determinants. The History of the Family, 24(2), 227–248. https://doi.org/10.1080/1081602X.2018.1550725
Dribe, M., Hacker, J. D., & Scalone, F. (2020). Immigration and child mortality: Lessons from the United States at the turn of the twentieth century. Social Science History, 44(1), 57–89. https://doi.org/10.1017/ssh.2019.42
Garrett, E., & Reid, A. (2022). What was killing babies in Ipswich between 1872 and 1909? Historical Life Course Studies, 12, 173–204. https://doi.org/10.51964/hlcs11592
Gibbons, H. L., & Hebdon, C. K. (1991). Teething as a cause of death. A historical review. Western Journal of Medicine, 155(6), 658–659.
Hardy, A. (1994). 'Death is the cure of all diseases': Using the general register office cause of death statistics for 1837–1920. Social History of Medicine, 7(3), 472–492. https://doi.org/10.1093/shm/7.3.472
Hirsch, J. A., Nicola, G., McGinty, G., Liu, R. W., Barr, R. M., Chittle, M. D., & Manchikanti, L. (2016). ICD-10: History and context. American Journal of Neuroradiology, 37(4), 596–599. https://doi.org/10.3174/ajnr.A4696
Jaadla, H., & Puur, A. (2016). The impact of water supply and sanitation on infant mortality: Individual-level evidence from Tartu, Estonia, 1897–1900. Population Studies, 70(2), 163–179. https://doi.org/10.1080/00324728.2016.1176237
Janssen, F., & Kunst, A. E. (2004). ICD coding changes and discontinuities in trends in cause-specific mortality in six European countries, 1950–99. Bulletin of the World Health Organization, 82(12), 904–913.
Janssens, A. (2021). Constructing SHiP and an international historical coding system for causes of death. Historical Life Course Studies, 10, 64–70. https://doi.org/10.51964/hlcs9569
Janssens, A., & Devos, I. (2022). The limits and possibilities of cause of death categorisation for understanding late nineteenth century mortality. Social History of Medicine, 35(4), 1053–1063. https://doi.org/10.1093/shm/hkac040
Janssens, A., & Pelzer, B. (2014). Lovely little angels in heaven? The influence of religiously determined cultural life scripts on infant survival in the Netherlands, 1880–1920. Historical Social Research, 39(1), 19–47. https://doi.org/10.12759/hsr.39.2014.1.19-47
Janssens, A., & Riswick, T. (2023). What was killing babies in Amsterdam? A study of infant mortality patterns using individual-level cause of death data, 1856–1904. Historical Life Course Studies, 13, 235–264. https://doi.org/10.51964/hlcs13438
Kintner, H. J. (1986). Classifying causes of death during the late nineteenth and early twentieth centuries: The case of German infant mortality. Historical Methods: A Journal of Quantitative and Interdisciplinary History, 19(2), 45–54. https://doi.org/10.1080/01615440.1986.10594168
Klüsener, S., Devos, I., Ekamper, P., Gregory, I., Gruber, S., Martí-Henneberg, J., van Poppel, F., Silveira, L., & Solli, A. (2014). Spatial inequalities in infant survival at an early stage of the longevity revolution: A pan-European view across 5000+ regions and localities in 1910. Demographic Research, 30, 68, 1849–1864. https://doi.org/10.4054/DemRes.2014.30.68
Kunitz, S. J. (1999). Premises, premises: Comments on the comparability of classifications. Journal of the History of Medicine and Allied Sciences, 54(2), 226–240. https://doi.org/10.1093/jhmas/54.2.226
Lewis, M. (1979). Sanitation, intestinal infections, and infant mortality in late Victorian Sydney. Medical History, 23(3), 325–338. https://doi.org/10.1017/S0025727300051796
Ludvigsen, L., Revuelta-Eugercios, B., & Løkke, A. (2023). Cause-specific infant mortality in Copenhagen 1861–1911 explored using individual-level data. Historical Life Course Studies, 13, 9–43. https://doi.org/10.51964/hlcs12032
Maltesdotter, M. H., & Edvinsson, S. (2025). What was killing babies in Sundsvall? A study of infant mortality patterns using individual level cause of death data, 1860–1892. Historical Life Course Studies, 15, 1–27. https://doi.org/10.51964/hlcs19299
Masuy-Stroobant, G. (1997). Infant health and infant mortality in Europe: Lessons from the past and challenges for the future. In C. A. Corsini & P. P. Viazzo (Eds.), The decline of infant and child mortality: The European experience, 1750–1990 (pp. 1–34). Martinus Nijhoff Publishers.
McGivern, L., Shulman, L., Carney, J. K., Shapiro, S., & Bundock, E. (2017). Death certification errors and the effect on mortality statistics. Public Health Reports, 132(6), 669–675. https://doi.org/10.1177/0033354917736514
Meslé, F., & Vallin, J. (1996). Reconstructing long-term series of causes of death: The case of France. Historical Methods: A Journal of Quantitative and Interdisciplinary History, 29(2), 72–87. https://doi.org/10.1080/01615440.1996.10112731
Molitoris, J. (2017). Disparities in death: Inequality in cause-specific infant and child mortality in Stockholm, 1878–1926. Demographic Research, 36, 15, 455–500. https://doi.org/10.4054/DemRes.2017.36.15
Morgan, N. (2002). Infant mortality, flies and horses in later-nineteenth-century towns: A case study of Preston. Continuity and Change, 17(1), 97–132. https://doi.org/10.1017/S0268416002004083
Mühlichen, M., & Cilek, L. (2024). What was killing babies in Rostock? An investigation of infant mortality using individual-level cause-of-death data, 1800–1904. Historical Life Course Studies, 14, 16–40. https://doi.org/10.51964/hlcs18472
Murkens, M., Pelzer, B., & Janssens, A. (2023). Transitory inequalities: How individual-level cause-specific death data can unravel socioeconomic inequalities in infant mortality in Maastricht, the Netherlands, 1864–1955. The History of the Family, 28(1), 95–131. https://doi.org/10.1080/1081602X.2022.2084442
O'Malley, K. J., Cook, K. F., Price, M. D., Wildes, K. R., Hurdle, J. F., & Ashton, C. M. (2005). Measuring diagnoses: ICD code accuracy. Health Services Research, 40(5p2), 1620–1639. https://doi.org/10.1111/j.1475-6773.2005.00444.x
Oris, M., Mazzoni, S., & Ramiro-Fariñas, D. (2023). Immigration, poverty, and infant and child mortality in the city of Madrid, 1916–1926. Social Science History, 47(3), 453–489. https://doi.org/10.1017/ssh.2023.9
Pozzi, L., & Barona, J. L. (2012). Vulnerable babies. Late foetal, neonatal and infant mortality in Europe (18th–20th centuries). Annales de Démographie Historique, 123(1), 11–24. https://doi.org/10.3917/adh.123.0011
Pozzi, L., & Fariñas, D. R. (2016). Infant and child mortality in the past. Annales de Démographie Historique, 129(1), 55–75. https://doi.org/10.3917/adh.129.0055
Preston, S. H., Keyfitz, N., & Schoen, R. (1972). Causes of death: Life tables for national populations. Seminar Press.
Pujadas-Mora, J. M. (2024). What was killing babies in Palma, Spain? Analysing infant mortality patterns using individual-level cause of death data, 1836–1930. Historical Life Course Studies, 14, 82–104. https://doi.org/10.51964/hlcs11677
Radtke, A. (2002). Rethinking the medical causes of infant death in early modern Europe: A closer look at church registers and medical terminology. The History of the Family, 7(4), 505–514. https://doi.org/10.1016/S1081-602X(02)00123-9
Raftakis, M. (2022). What was killing babies in Hermoupolis, Greece? An investigation of infant mortality using individual level causes of death, 1861–1930. Historical Life Course Studies, 12, 205–232. https://doi.org/10.51964/hlcs11601
Reid, A. (2001). Neonatal mortality and stillbirths in early twentieth century Derbyshire, England. Population Studies, 55(3), 213–232. https://doi.org/10.1080/00324720127696
Reid, A. (2002). Infant feeding and post-neonatal mortality in Derbyshire, England, in the early twentieth century. Population Studies, 56(2), 151–166. https://doi.org/10.1080/00324720215926
Reid, A. (2021). Why a long-term perspective is beneficial for demographers. Population Studies, 75(sup1), 157–177. https://doi.org/10.1080/00324728.2021.2002393
Reid, A., & Garrett, E. (2012). Doctors and the causes of neonatal death in Scotland in the second half of the nineteenth century. Annales de Démographie Historique, 123(1), 149–179. https://doi.org/10.3917/adh.123.0149
Reid, A., Garrett, E., Dibben, C., & Williamson, L. (2015). 'A confession of ignorance': Deaths from old age and deciphering cause-of-death statistics in Scotland, 1855–1949. The History of the Family, 20(3), 320–344. https://doi.org/10.1080/1081602X.2014.1001768
Reid, A., Garrett, E., Hiltunen Maltesdotter, M., & Janssens, A. (2024). Historic cause of death coding and classification scheme for individual-level causes of death – Infant Categorisations [Dataset]. Apollo - University of Cambridge Repository. https://doi.org/10.17863/CAM.109963
Reid, A., Garrett, E., Hiltunen Maltesdotter, M., & Murkens, M. (2024). Historic cause of death coding and classification scheme for individual-level causes of death – Manual [Method]. Apollo - University of Cambridge Repository. https://doi.org/10.17863/CAM.109960
Reid, A., Garrett, E., Jaadla, H., Dibben, C., Williamson, L., & Tobin, R. (forthcoming). From deathbed to database using ICD10h: A framework for coding and classifying individual English language cause of death data consistently over time, as applied to Scotland 1855–1973. Social History of Medicine. https://doi.org/10.1093/shm/hkaf077
Reid, A., Garrett, E., Jaadla, H., Schürer, K., & Rafferty, S. (2023). Fatal places? Contextual effects on infant and child mortality in early twentieth century England and Wales. Social Science History, 47(3), 397–424. https://doi.org/10.1017/ssh.2023.5
Reid, A., Garrett, E., Williamson, L., & Dibben, C. (2016). A century of deaths, Scotland 1855–1955: A view from the civil registers. In S. Buckham , P. C. Jupp & J. Rugg (Eds.), Death in modern Scotland, 1855–1955: Beliefs, attitudes and practices (pp. 131–160). Peter Lang.
Rendle-Short, J. (1955). The history of teething in infancy. Proceedings of the Royal Society of Medicine, 48(2), 132–138. https://doi.org/10.1177/003591575504800216
Revuelta-Eugercios, B., Castenbrandt, H., & Løkke, A. (2022). Older rationales and other challenges in handling causes of death in historical individual-level databases: The case of Copenhagen, 1880–1881. Social History of Medicine, 35(4), 1116–1139. https://doi.org/10.1093/shm/hkab037
Rey, G., Aouba, A., Pavillon, G., Hoffmann, R., Plug, I., Westerling, R., Jougla, E., & Mackenbach, J. (2011). Cause-specific mortality time series analysis: A general method to detect and correct for abrupt data production changes. Population Health Metrics, 9(1), 52. https://doi.org/10.1186/1478-7954-9-52
Risse, G. B. (1997). Cause of death as a historical problem. Continuity and Change, 12(2), 175–188. https://doi.org/10.1017/S0268416097002890
Rüttimann, D., & Loesch, S. (2012). Mortality and morbidity in the city of Bern, Switzerland, 1805–1815 with special emphasis on infant, child and maternal deaths. HOMO, 63(1), 50–66. https://doi.org/10.1016/j.jchb.2011.11.001
Sáinz-Otero, A.-M., Marín-Paz, A.-J., & Almenara-Barrios, J. (2020). The Classification of Causes of Historical Mortality (CCHM): A proposal of the study of death records. PLOS ONE, 15(4), e0231311. https://doi.org/10.1371/journal.pone.0231311
Sawchuk, L. A., Herring, D. A., & Waks, L. R. (1985). Evidence of a Jewish advantage: A study of infant mortality in Gibraltar, 1870-1959. American Anthropologist, 87(3), 616–625. https://doi.org/10.1525/aa.1985.87.3.02a00070
Sommerseth, H. L. (2023). What was killing babies in Trondheim? An investigation of infant mortality using individual level cause of death data, 1830–1907. Historical Life Course Studies, 13, 61–88. https://doi.org/10.51964/hlcs12290
van den Boomen, N. (2021). Born close to death. Region, Roman Catholicism and infant mortality in the Netherlands, 1875–1899 [Unpublished doctoral dissertation]. Radboud University Nijmegen. https://hdl.handle.net/2066/240453
van der Stegen, R. H. M., Koren, L. G. H., Harteloh, P. P. M., Kardaun, J. W. P. F., & Janssen, F. (2014). A novel time series approach to bridge coding changes with a consistent solution across causes of death. European Journal of Population, 30(3), 317–335. https://doi.org/10.1007/s10680-013-9307-4
van Poppel, F., Schellekens, J., & Liefbroer, A. C. (2002). Religious differentials in infant and child mortality in Holland, 1855–1912. Population Studies, 56(3), 277–289. https://doi.org/10.1080/00324720215932
Williams, N. (1996). The reporting and classification of causes of death in mid-nineteenth-century England: The example of Sheffield. Historical Methods: A Journal of Quantitative and Interdisciplinary History, 29(2), 58–71. https://doi.org/10.1080/01615440.1996.10112730
Wolleswinkel-van den Bosch, J. H., van Poppel, F. W. A., & Mackenbach, J. P. (1996). Reclassifying causes of death to study the epidemiological transition in The Netherlands, 1875–1992. European Journal of Population/Revue Européenne de Démographie, 12(4), 327–361. https://doi.org/10.1007/BF01796912
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Alice Reid, Angélique Janssens

This work is licensed under a Creative Commons Attribution 4.0 International License.