Deprivation and Disease in Early Twentieth-Century America

This paper explores how early life exposure to poverty and want adversely affects later life health outcomes. In particular, it examines how exposure to crowded housing conditions and impure drinking water undermines long-term health prospects and increases the risk of age-related pathologies such as cancer, heart disease, kidney disease, and stroke. Exploiting city-level data from early-twentieth century America, evidence is presented that cities with unusually high rates of typhoid fever in 1900 had elevated rates of heart and kidney disease fifteen years later; also cities with unusually high rates of tuberculosis in 1900 had elevated rates of cancer and stroke fifteen years later. The estimated coefficients suggest that eradicating typhoid fever (through water purification) and tuberculosis (through improved housing and nutrition) would have reduced later death rates from heart disease, cancer, stroke, and kidney disease by 23 to 35 percent.

Death and the City: Chicago's Mortality Transition, 1850-1925

Between 1850 and 1925, the crude death rate in Chicago fell by 60 percent, driven by reductions in infectious disease rates and infant and child mortality. What lessons might be drawn from the mortality transition in Chicago, and American cities more generally? What were the policies that had the greatest effect on infectious diseases and childhood mortality? Were there local policies that slowed the mortality transition? If the transition to low mortality in American cities was driven by forces largely outside the control of local governments (higher per capita incomes or increases in the amount and quality of calories available to urban dwellers from rising agricultural productivity), then expensive public health projects, such as the construction of public water and sewer systems, probably should have taken a back seat to broader national policies to promote overall economic growth. The introduction of pure water explains between 30 and 50 percent of Chicago%u2019s mortality decline, and that other interventions, such as the introduction of the diphtheria antitoxin and milk inspection had much smaller effects. These findings have important implications for current policy debates and economic development strategies.

Lead Water Pipes and Infant Mortality in Turn-of-the-Century Massachusetts

This paper considers a largely unknown public-health practice in the United States: the use of lead pipes to distribute household tap water. Municipalities first installed lead pipes during the late nineteenth century. In 1897, about half of all American municipalities used lead water pipes. Using data from 1900 Massachusetts, this paper compares infant death rates and stillbirth rates in cities that used lead water pipes to rates in cities that used non-lead pipes. In the average town in 1900, the use of lead pipes increased infant mortality and stillbirth rates by 25 to 50 percent. However, the effects of lead water lines varied across cities, and depended on the age of the pipe and the corrosiveness of the associated water supplies. Age of pipe influenced lead content because, over time, oxidation formed a protective coating on the interior of pipes. As for corrosiveness, acidic water removed more lead from the interior of pipes than did non-acidic water. Consequently, infant death rates and stillbirth rates in Massachusetts towns employing old lead lines, and non-acidic water supplies, were no higher than in towns employing non-lead pipes. But in cities using new pipes and distributing acidic water, lead pipes increased infant mortality rates and stillbirth rates three- to fourfold.

The Elasticity of Demand With Respect to Product Failures; or Why the Market for Quack Medicines Flourished for More Than 150 Years

Between 1810 and 1939, real per capita spending on patent medicines grew by a factor of 114; real per capita GDP by a factor of 5. The long-term growth and survival this industry is puzzling when juxtaposed with standard historical accounts, which typically portray patent medicines as quack medicines. This paper argues that patent medicines were distinguished from other products by an unusually low elasticity of demand with respect to product failure. While consumers in other markets stopped searching for a viable product after a few failed attempts, consumers of patent medicines kept trying different products, irrespective of the number of failed medicines they observed. The market expanded as the stock of people buying potential cures accumulated over time. Because no one was ever cured and consumers possessed a highly inelastic demand with respect to product failures, demand was unrelenting. In short, patent medicines flourished not despite their dubious medicinal qualities, but because of them. There is also evidence that genuine medical advances, such as the rise of the germ theory of disease and new therapeutic interventions, helped expand the market for quack medicines.

Lead Pipes and Child Mortality

Beginning around 1880, public health issues and engineering advances spurred the installation of city water and sewer systems. As part of this growth, many cities chose to use lead service pipes to connect residences to city water systems. This choice had negative consequences for child mortality, although the consequences were often hard to observe amid the overall falling death rates. This paper uses national data from the public use sample of the 1900 Census of Population and data on city use of lead pipes in 1897 to estimate the effect of lead pipes on child mortality. In 1900, 29 percent of the married women in the United States who had given birth to at least one child and were age forty-five or younger lived in locations where lead service pipes were used to deliver water. Because the effect of lead pipes depended on the acidity and hardness of the water, much of the negative effect was concentrated on the densely populated eastern seaboard. In the full sample, women who lived on the eastern seaboard in cities with lead pipes experienced increased child mortality of 9.3 percent relative to the sample average. These estimates suggest that the number of child deaths attributable to the use of lead pipes numbered in the tens of thousands. Many surviving children may have experienced substantial IQ impairment as a result of lead exposure. The tragedy is that lead problems were avoidable, particularly once data became available on the toxicity of lead. These findings have implications for current policy and events.

When Bioterrorism Was No Big Deal

To better understand the potential economic repercussions of a bioterrorist attack, this paper explores the effects of several catastrophic epidemics that struck American cities between 1690 and 1880. The epidemics considered here killed between 10 and 25 percent of the urban population studied. A particular emphasis is placed on smallpox and yellow fever, both of which have been identified as potential bioterrorist agents. The central findings of the paper are threefold. First, severe localized epidemics did not disrupt, in any permanent way, the population level or long-term growth trajectory of those cities. Non-localized epidemics (i.e., those that struck more than one major city) do appear to have had some negative effect on population levels and long-term growth. There is also modest evidence that ill-advised responses to epidemics on the part of government officials might have had lasting and negative effects in a few cities. Second, severe localized epidemics did not disrupt trade flows; non-localized epidemics had adverse, though fleeting, effects on trade. Third, while severe epidemics probably imposed some modest costs on local and regional economies, these costs were very small relative to the national economy.

Cognitive Disparities, Lead Plumbing, and Water Chemistry: Intelligence Test Scores and Exposure to Water-Borne Lead Among World War Two U.S. Army Enlistees

Assessing the impact of lead exposure is difficult if individuals select on the basis of their characteristics into environments with different exposure levels. We address this issue with data from when the dangers of lead exposure were still largely unknown, using new evidence on intelligence test scores for male World War Two U.S. Army enlistees linked to the households where they resided in 1930. Higher exposure to water-borne lead (proxied by urban residence and low water pH levels) was associated with lower test scores: going from pH 6 to pH 5.5, scores fell 5 points (1/4 standard deviation). A longer time exposed led to a more severe effect. The ubiquity of lead in urban water systems at this time and uncertainty regarding its impact mean these effects are unlikely to have resulted from selection into locations with different levels of exposure.