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Life in 1918
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The Nation's Health

If you had lived in the early twentieth century, your life expectancy would have been much shorter than it is today. Today, life expectancy for men is 75 years; for women, it is 80 years. In 1918, life expectancy for men was only 53 years. Women’s life expectancy at 54 was only marginally better.


Why was life expectancy so much shorter?

During the early twentieth century, communicable diseases—that is diseases which can spread from person to person—were widespread. Influenza and pneumonia along with tuberculosis and gastrointestinal infections such as diarrhea killed Americans at an alarming rate but non-communicable diseases such as cancer and heart disease also exacted a heavy toll. Accidents, especially in the nation’s unregulated factories and workshops, were also responsible for maiming and killing many workers.

High infant mortality further shortened life expectancy. In 1918, one in five American children did not live beyond their fifth birthday. In some cities, the situation was even worse, with thirty percent of all infants dying before their first birthday. Childhood diseases such as diphtheria, measles, scarlet fever and whopping cough contributed significantly to these high death rates.


Sewers and Sanitation:

In the nineteenth century, most physicians and public health experts believed that disease was caused not by microorganisms but rather by dirt itself.

Sanitarians, as these people were called, argued that cleaning dirt-infested cities and building better sewage systems would both prevent and end many epidemics. At their urging, cities and towns across the United States built better sewage systems and provided citizens with access to clean water. By 1918, these improved water and sewage systems had greatly contributed to a decline in gastrointestinal infections and a significant reduction in mortality rates among infants, children and young adults.

But because diseases are caused by microorganisms, not dirt, these tactics were not completely effective in ending all epidemics.


Public Health and Education:

Educational campaigns which emphasized personal hygiene and community hygiene were crucial tools in the battle to prevent disease. Because many Americans were illiterate or not fluent in English, these campaigns relied heavily on the use of images to convey their message.

As Americans’ understanding of disease evolved and as physicians and laypeople came to understand that microorganisms (“germs”) caused diseases, public health campaigns became more sophisticated. These newer campaigns continued to advocate cleanliness as a means of preventing disease but they also urged people to avoid germs, the causative agents of disease.

During the early twentieth century, health campaigns were mounted by state, local and federal authorities; private organizations also initiated their own campaigns.

By 1918, when the influenza pandemic began, Americans routinely looked to government and private health organizations for information about how to battle disease.

Taking the Fight Against Disease into the Community:

While posters were effective tools for educating Americans about epidemics and good sanitary practices, public health officials realized that these tactics were insufficient in and on their own.

In many communities, public health nurses and reformers actively taught people techniques to improve their health. Many women, for example, were taught not only the importance of sanitizing drinking and eating utensils but also how to sterilize these items. Public health nurses also provided new mothers with assistance in nursing newborns and in many school districts, they assisted doctors in vaccinating children against smallpox, typhoid, typhus and a range of other diseases.

By 1918, public health nurses were valued and important members of both rural and urban communities. During the influenza pandemic, these nurses served on the front lines, providing care to patients in their communities.

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