In the mid-19th century, about 60% of deaths among children aged 1–4 years were attributed to airborne infectious diseases and respiratory diseases that were mostly caused by microorganisms. Many of the airborne infectious diseases still common among unvaccinated children in Western countries were frequently fatal in the 19th century. As in developing countries today, children in large families with poor living conditions and inadequate nutrition, would have been at high risk of dying from a series of interrelated or concurrent airborne, respiratory, and other acute infectious diseases. The adverse effect of malnutrition on mortality risk from infectious diseases is well known, and malnutrition can itself be caused by infectious disease as a result of reduced food intake or impaired digestive mechanisms. The association of malnutrition with over half the cases of measles and diarrheal disease in developing countries reflects this two-way relationship. Both measles and whooping cough have independent epidemic cycles, reflecting sociodemographic factors, the immunity gained by survivors, and the time required for replenishment of the “pool of new susceptibles.” In the 19th century, the streptococcal disease scarlet fever usually occurred later in childhood, causing particularly high mortality at ages 1–4 years.

Child Mortality Decline

Although infant mortality contributed little to the decline in the overall death rate in the second half of the 19th century in England and Wales, a decline in the child (1–4 years) death rate contributed significantly. Among the childhood diseases, scarlet fever was the biggest arithmetic component of mortality decline, contributing -0.12 to each unit of change in the total death rate (all ages) between 1848–54 and 1901, and -0.04 between 1901 and 1951, while whooping cough contributed -0.02 and -0.03, and measles -0.01 and -0.03, respectively. There was a clear turning point in the child death rate in the mid-1860s, after which it declined consistently apart from fluctuations predominantly caused by scarlet fever epidemics (fig. 8.1).

The main diseases that contributed to the decline in child mortality from the mid-1860s were scarlet fever, typhoid and other fevers, cholera and diarrheal diseases, tuberculosis, whooping cough, and smallpox.