Dying Through the Centuries

The Reuben Fleet Science Museum in San Diego lists the top 10 causes of death in America in 1850, 1900, and 2000. And therein lies a tale...

Top 10 Causes of Death

	1850	1900
1	Tuberculosis (lung)	Pneumonia (lung)
2	Dysentery/Diarrhea (GI tract)	Tuberculosis (lung)
3	Cholera (GI tract)	Diarrhea (GI tract)
4	Malaria (blood)	Heart disease
5	Typhoid Fever (GI tract)	Stroke
6	Pneumonia (lung)	Liver disease (alcohol)
7	Diptheria (lung)	Accidents
8	Scarlet Fever (throat)	Cancer
9	Meningitis (spinal cord)	Normal aging
10	Whooping cough (lung)	Diptheria (lung)

	2000	2022
1	Heart disease (smoking, diabetes, high cholesterol, blood pressure)	Heart disease
2	Cancer (smoking, UV, obesity, alcohol)	Cancer
3	Stroke (same causes as heart disease)	WuFlu/Covid19 (lung)
4	Lung disease (smoking)	Accidents
5	Accidents	Stroke
6	Diabetes	Chronic lower respiratory diseases (smoking)
7	Pneumonia/Influenza (lung)	Alzheimer's disease
8	Alzheimer's disease	Diabetes
9	Kidney disease (high blood pressure, diabetes)	Chronic liver disease/Cirrhosis (alcohol)
10	Blood poisoning/septicemia	Nephritis/Nephrosis (kidney)

2022 Top 10 Causes of Death by number of dead:

1. Heart disease: 695,547 (high blood pressure, high cholesterol, smoking, diabetes)
2. Cancer: 605,213 (smoking, UV rays, obesity, alcohol)
3. COVID-19: 416,893   (lung)
4. Accidents:   224,935
5. Stroke: 162,890 (high blood pressure, high cholesterol, smoking, diabetes)
6. Chronic lower respiratory diseases: 142,342  (smoking)
7. Alzheimer’s disease: 119,399
8. Diabetes: 103,294
9. Chronic liver disease and cirrhosis : 56,585 (alcohol)
10. Nephritis, nephrotic syndrome, and nephrosis: 54,358 (kidney disease)

Why did the causes of death change so dramatically in just two centuries? In the 1800s, everyone used wood, charcoal or coal to cook and to heat their homes. Constantly breathing in wood, charcoal and coal smoke contributed to lung infections. Similarly, without knowledge of germ theory, clean water sources were difficult to locate and difficult to maintain. While even Hippocrates understood that water needed some kind of sand sieve to remove sediment and improve smell and taste, the idea that cleaning beyond this might be necessary would not arise until Leeuwenhoek's microscope (1670s) demonstrated the existence of bacilli and Pasteur's experiments (1861) linked bacilli to the existence of disease.

Cholera is a fine example of the difficulty this lack of knowledge caused. For centuries prior to 1870, people had known cholera outbreaks frequently followed large thunderstorms. They just didn't fully understand why: if latrines were sourced too close to drinking water, the flooding that often accompanied thunderstorms would cause the two to commingle. The London water pump incident in 1854 showed the link between water and cholera. Pasteur linked bacilli to disease. By 1883, the link between the cholera bacillus and  water-based cholera outbreaks had been definitively made. As a result, by the 1890s, American cities had begun chlorination and steam treatment of water. Gastro-intestinal diseases in the U.S. began to disappear. 

Today, it is hard to understand how quickly the lack of clean water and clean air used to kill people, but the lists demonstrate the fact. Consider alcohol. Every historical source acknowledges that colonial Americans drank enormous amounts of alcohol. However, historians rarely point out the smoke from cooking fires and the un-boiled water used to make meals generally killed people before alcohol-related liver disease could. Likewise, many modern commentators snigger over the fact that Robert Baden-Powell's first Boy Scout manual (1908) insisted "on the necessity of keeping one’s blood clean by having at least one bowel movement a day", but these same modern comedians fail to consider the Baden-Powell grew up at a time (mid-1800s) when most people died of infectious diarrheas.

By 1900, just as the Boy Scouts began to systematically teach a generation of children to be concerned about their daily bowel movements, urban water sources had been cleaned up enough to essentially eliminate deadly GI tract infections. The elimination of speedy GI tract killers allowed slower diseases, like alcoholic liver disease, to enter the top ten list. America's Temperance movement had begun in the early 1800s, but it didn't achieve much success until clean drinking water and alcohol-related liver disease caused a huge change in the most common causes of death. With GI tract disease greatly reduced, heart disease, stroke, cancer, accidents and - most important for the Prohibitionists - alcoholic liver disease were now able to climb the list and replace the various forms of diarrhea as major killers.

We had learned how to handle water; we still didn't have a solution for smoke-filled air. Because charcoal, coal and wood remained the most common ways to heat and to cook, the top ten list in 1900 was still dominated by lung ailments. The invention of gas and electric stoves changed that.

The British inventor James Sharp developed the gas stove in 1826. It debuted in the London Exhibition of 1851, but didn't become popular in the US until the beginning of the 20th century. By 1930, 14 million households cooked with gas, 7.7 million used coal and wood, 6.4 million used oil, and 0.875 million used electricity. Gas stoves meant not only a huge reduction in smoke and its particulate aerosols, but also the end of coal dust all over the kitchen. But, while natural gas was certainly better than charcoal, natural gas has never been as clean as electric stoves are. It is not surprising to see the natural gas stove slowly being replaced by the electric stove. As of 2015, 91% of homes had a stove/oven unit; 61% electric, 33% natural gas. 

This century-long change in indoor air quality essentially removed lung diseases from the top ten causes of death in America. As of 2022, we are left with high blood pressure, smoking, alcohol and viral diseases as the major slayers of men in wealthy societies. Notice the lists given above are the top ten causes of death in wealthy societies. Not every 21st century society is wealthy.

The WHO lists global causes of death by income group. The four income groups the WHO categorizes merely recapitulates most of this essay. The poorest countries, countries that cannot source clean drinking water, societies that still use animal dung and wood/charcoal to cook their food and to heat their homes, still die primarily from GI-tract infections and lung diseases. Their top 10 death list looks pretty much like our 1800's top ten death list. Worse, today's poor countries see their children die at a rate rich countries no longer pretend to have. But, as my eldest son reminded me, rich countries now hide the deaths of children behind abortion rates. 

While neonatal death was not listed in the American 1800 "top ten", that was an oversight on the part of the Reuben museum. Between 10 and 30% of children in post-colonial America died before their fifth birthday. If neonatal death were given its proper place in the 1850's list, it would top the chart. Today's poorest countries live the same life 1850's America lived: about 30% of their children die in the first year. If you are serious about comparing neonatal deaths, then we should remember roughly 30% of America's children die today via abortion.   That is, children in both poor and rich countries actually die at the same rate, but while children in poor countries die from disease, children in rich countries are murdered by their relatively wealthy parents. 

And this is but one indicator to demonstrate that, as income rises, access to clean water, non-smoke cooking methods and abortion changes the leading causes of death. As income rises, child death is hidden inside of abortion statistics. GI tract infection disappears and lung-infection deaths are reduced. As income rises, slower deaths of nutrition (heart disease/stroke/diabetes), brain disease (Alzheimer's) and various cancers replace the faster and more virulent bacterial and viral causes of death. 

The wealthy have discovered how to stop most viral, bacterial and inhaled-particulate deaths. We kill off the inconvenient children, allowing only convenient children to live. Now we concentrate on nutritional deficiencies and aging-related deaths. Progress is being made on both of the latter fronts. In another century, what kills rich folk today may only afflict the poorest of the poor, and by today's standards, tomorrow's poorest may not be considered poor. So, in a century, what will be left to kill the rich? When we finally conquer poverty, will we also conquer death?