Tessa Quinn
In the early 1900s, hospitals were not always safe places. Many patients died due to poor conditions in the wards, such as inadequate sanitation and a lack of trained nurses. The leading causes of death in the United States during this time included tuberculosis, gastrointestinal infections, diphtheria, and childbirth complications. The infant mortality rate was alarmingly high, with more than 150 out of every 1,000 children dying before their first birthday. However, the situation was not unique to hospitals, as cars, which were still rare, caused 36 deaths in 1900.
| Characteristics | Values |
|---|---|
| Leading causes of death | Tuberculosis, gastrointestinal infections, diphtheria, heart disease, cancer, pneumonia, influenza, blood hemorrhages, severe bacterial infections |
| Death rate from leading causes | 202 deaths per 100,000 population for pneumonia and influenza |
| Death rate for newborns and infants under 1 | 162.4 per 1,000 |
| Infant mortality rate in 1970 | 21.4 per 1,000 |
| Crude death rate in 1900 | 1,720 per 100,000 population |
| Crude death rate in 1995 | 880 per 100,000 population |
| Percentage of deaths in institutions in 1949 | 49.5% (39.5% in general hospitals) |
| Percentage of deaths in institutions in 1958 | 60.9% (47.6% in general hospitals) |
| Percentage of deaths in institutions in 1980 | 74% (60.5% in hospitals, 13.5% in other institutions) |
| Number of car crash deaths | 36 |
| Hospital conditions | Few toilets, poor sewerage systems, dirty wards, lack of food and medicine |
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What You'll Learn
Poor hospital conditions
The hospital conditions in the 1800s and early 1900s were not always safe, and many patients died due to poor ward conditions. Hospitals in the early 19th century were often unhygienic, with few toilets and poor sewerage systems. Infections were common, and patients would often contract illnesses such as typhus, typhoid, cholera, or dysentery while hospitalised. The lack of proper supplies of food and medicine, overworked medical staff, and poor cleanliness contributed to high death rates from infections and illnesses.
Florence Nightingale, a pioneer in nursing, was appalled by the conditions she witnessed. She and her nurses worked tirelessly to improve hospital conditions and establish better hygiene practices, which resulted in a significant drop in the death rate from 40% to 2%. She wrote two influential books, "Notes on Nursing" (1859) and "Notes on Hospitals" (1863), and opened the first Nightingale School for Nurses in 1860, leaving a lasting impact on healthcare standards.
During this period, the type, size, funding, and organisation of hospitals varied. There was a rise in small cottage hospitals and voluntary hospitals funded by wealthy patrons or charitable donations. Doctors often worked for free, and the hospitals catered to the working class, who paid into a fund for treatment. The poor were usually admitted to workhouses, which had infirmaries to treat the sick and elderly after 1867.
In the United States, only the socially marginalised, poor, or isolated received medical care in institutions for most of the 19th century. Middle- and upper-class individuals were typically cared for at home, even for surgical procedures. However, as society became more industrialised and mobile, and medical practices became more complex, it became challenging for families and communities to provide adequate care at home.
By the late 19th century, hospitals in the Western world evolved from charitable guesthouses to centres of scientific excellence, influenced by social and cultural developments, including the changing meanings of disease, economics, and scientific and technological advancements. Additionally, the Catholic Church played a significant role in establishing hospitals in the United States, with orders like the Dominicans, Franciscans, and Sisters of Charity setting up hospitals in major cities by 1900. These hospitals initially catered to specific ethnic groups but later served the general population.
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Tuberculosis
In the 1800s, consumptive patients sought "the cure" in sanatoriums, where it was believed that rest and a healthy climate could change the course of the disease. The first anti-tuberculosis sanatorium was established in 1854, 650 meters above sea level, at Görbersdorf. The sanatoria movement, which began around 1880, was an attempt to cure tuberculosis naturally and prevent its spread by moving patients into quiet environments, isolated from normal life, where the air was pure and freely circulating.
In 1882, Robert Koch identified the tuberculosis bacillus, revealing that TB was not genetic but highly contagious. This discovery helped convince members of the medical and public health communities that the disease was contagious, and public health campaigns were launched to educate people on how to avoid contagion. However, this also led to increased prejudice against those with TB, who were often rejected by society and became complete outcasts.
By the late 19th century, 70-90% of the urban populations of Europe and North America were infected with the tuberculosis bacillus, and about 80% of those who developed active TB died from it. In the United States, it was estimated that around 450 Americans died of tuberculosis every day at the turn of the century, most between the ages of 15 and 44. The disease was more prevalent in cities due to crowded and filthy living conditions, and the urban poor represented the vast majority of TB victims.
Mortality rates began to decline in the late 19th century throughout Europe and the United States, in part due to public health initiatives and improved socioeconomic conditions. However, it was not until the development of antibiotics in the 1940s that major clinical developments occurred, as the focus had primarily been on diagnosis rather than cure.
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Gastrointestinal infections
In the year 1900, gastrointestinal infections were one of the leading causes of death in the United States. While the understanding of gastrointestinal diseases and gastroenterology blossomed in the twentieth century, in the years leading up to 1900, hospitals were not always safe. Patients often died due to the unhygienic conditions in the wards, such as poor sewerage systems and a lack of toilets. Infections were common, and patients could easily catch diseases like typhus, typhoid, cholera or dysentery while in the hospital.
One example of a gastrointestinal infection is gastroenteritis, which involves both diarrhea and vomiting. It can be transmitted by drinking contaminated water or sharing personal objects. In 2015, there were two billion cases of gastroenteritis worldwide, resulting in 1.3 million deaths. Children in developing countries are the most affected, with children under two years of age frequently experiencing six or more infections per year.
Cholera is another example of a gastrointestinal infection caused by the bacterium Vibrio cholerae. It is transmitted by drinking water or eating food contaminated by the cholera bacterium. While cholera was not recorded until the 19th century, it continued to affect people in the early 20th century. The last two of seven cholera pandemics occurred in the 20th century.
The introduction of vaccinations has contributed to the decrease in death rates from gastrointestinal infections since the year 1900.
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Diphtheria
In the 19th century, hospitals varied in size, funding, and organisation. They were often unsafe, with poor sanitation and sewerage systems. Infections were common, and patients frequently died from illnesses like typhus, typhoid, cholera, and dysentery, which they contracted while in the hospital.
A diphtheria vaccination was first developed in the 1890s, but it was not widely used until the 1920s. The development of the vaccine led to a significant decline in deaths, and by the 1930s, the incidence of diphtheria had been reduced by 90% among those who received three doses. Today, diphtheria is rare in the developed world due to widespread vaccination, but it still occurs in sub-Saharan Africa, South Asia, and Indonesia.
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Childbirth
In the early 20th century, childbirth was a leading cause of death among women. While data on hospital outcomes during this period is limited, childbirth was a significant factor in the rise of hospitals. By 1900, only 5% of births took place in hospitals, but this number increased significantly over time, with nearly 75% of urban births occurring in hospitals by 1935.
Maternal mortality rates during childbirth remained stagnant until the late 1930s, even as hospital births became more common. Infant mortality rates due to birth injuries increased by 40-50% between 1915 and 1929 as hospital births became more prevalent. Historians have argued that the rise in infant deaths was due to increased operative intervention by practitioners in hospital settings.
In the early 1930s, two larger studies found that between half and two-thirds of maternal deaths occurred because poorly trained obstetricians relied too heavily on operative techniques. These deaths could have been prevented with better training and improved antepartum care and obstetric services.
Before the 20th century, childbirth was a dangerous and often deadly process. Puerperal fever, also known as childbed fever or postpartum sepsis, was a leading cause of maternal death, along with hemorrhage and eclampsia. Midwifery and medical practitioners were available, but their presence did not guarantee safety, as the understanding of hygiene and disease transmission was still developing.
While childbirth remains a challenging process, modern medical advancements have significantly reduced maternal and infant mortality rates. The development of sulfa drugs in the late 1930s, for example, contributed to reduced maternal mortality. Today, more women are surviving childbirth, contributing to an overall increase in lifespan.
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Frequently asked questions
Yes, people did die in hospitals in 1900. In fact, hospitals in the 1800s were dirty, unsafe places where patients often died from infections and illnesses like cholera, typhoid, and dysentery.
Hospitals in the 1900s varied in size, funding, and organisation. There were small cottage hospitals and voluntary hospitals funded by charity. Most surgeries were still performed in dirty conditions, without anaesthetic, and the link between germs and disease had not yet been discovered.
Yes, in the 1900s, most deaths occurred at home, with family members caring for their dying relatives. However, by 1949, nearly half of all deaths occurred in institutions like hospitals and nursing homes, and this number continued to rise in the following decades.
In the 1900s, medicine was not very advanced, and there were limited effective treatments for illnesses. Common causes of death included infections, epidemics of cholera and typhoid, and infectious diseases like tuberculosis.
