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Old death files get a new life

AMHERST -- When Sylvester Graham died in 1851 the cause of death was listed as "Congress waters and tepid baths." According to the records in Northampton City Hall, the eccentric health food pioneer remembered for inventing the graham cracker died at the age of 57 from drinking too much mineral water and ignoring his own advice to take bracing cold baths.

Now, researchers at the University of Massachusetts and the University of Michigan are taking a new look at about 60 years' worth of those old death records.

By using newspaper reports, journals, and minutes of city health panels and other boards, they hope to flesh out the sometimes puzzling entries, and track public health trends in an era when modern medicine and sanitation were emerging.

But the researchers hope their work will be of more than just historical interest.

"It could be a very important tool in looking at data from less developed countries," said Douglas Anderton, a sociology professor at UMass-Amherst who is one of those conducting the study.

He pointed out that modern medicine was slow to recognize the magnitude of the AIDS epidemic because many of the early deaths in Africa were attributed to a "wasting disease."

The three-year study, launched this spring with a $901,000 grant from the National Institutes of Health, could also help developing countries decide whether to spend sparse dollars first on antibiotics or on providing clean water and sanitation, Anderton said.

Understanding what happened in the past is important because rates of disease in developing nations today are comparable to those in industrialized Europe and the United States 150 years ago, said Graham Mooney, who teaches public health history at Johns Hopkins University.

"And it is also important because, certain diseases such as tuberculosis are reemerging," said Mooney, who is not involved in the Massachusetts study but has done similar research in Britain. "Infectious diseases are still very much with us and understanding how they declined at a time when medical intervention was nonexistent or rudimentary could have impact on how we intervene."

The years covered by the Massachusetts study, 1850 to 1912, saw the evolution of public health and sanitation as germ theory was discovered and medical care was professionalized.

"It's a tremendous opportunity to study changing social conceptions of death during a period of radical change in the ways in which disease and death were understood," Anderton said.

By the end of the period, people were living longer and dying of different causes. For instance, there was a sharp decline in the deaths of women in childbirth and infectious diseases replaced dysentery as the leading killers of children. Deaths from consumption, usually translated as tuberculosis, also appeared to drop sharply. But the researchers said by looking beyond death certificates they have found indications as many as 25 percent of the deaths attributed to consumption in the mid-1800s were not actually from tuberculosis.

"It's hard to know what people died of when the people recording didn't understand disease the same way we do," said Susan Hautaniemi Leonard, an anthropologist at the University of Michigan, who is also working on the study.

It wasn't until about 1900 that the names of diseases were standardized internationally. Stranger's fever became malaria and winter fever became pneumonia.

Although it's unclear just what killed Graham, it appears from newspaper reports that he had been suffering for a long time from some sort of rheumatic disease, Anderton said. The study focuses on the two Massachusetts industrial cities of Northampton and Holyoke because the state was the only one to require that a cause of death be recorded during the period, he said. Most other states didn't begin keeping that information until the early 20th century, he said.

The two cities also had crowded urban conditions that make them interesting for public health research.

Holyoke was built as one of the nation's first planned industrial cities in the 1840s with the damming of the Connecticut River providing water power to run its paper and textile mills. In the late 19th-century it had the third-highest population density in the United States. Northampton, which is celebrating its 350th anniversary this year, was also a tightly packed industrial city in the mid-19th century. It has a long history of alternative therapies. Graham and his militant vegetarians campaigned against white bread made of refined flour and marketplace milk, which often was thickened and whitened with the addition of such things as chalk and plaster of Paris.

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