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Studies in Economic History

Patrick Gray
Joshua Hall
Ruth Wallis Herndon
Javier Silvestre Editors

Standard
of Living
Essays on Economics, History, and
Religion in Honor of John E. Murray
Studies in Economic History

Series Editor
Tetsuji Okazaki
Faculty of Economics
The University of Tokyo
Tokyo, Japan
Aims and Scope
This series from Springer provides a platform for works in economic history that
truly integrate economics and history. Books on a wide range of related topics are
welcomed and encouraged, including those in macro-economic history, financial
history, labor history, industrial history, agricultural history, the history of institutions
and organizations, spatial economic history, law and economic history, political
economic history, historical demography, and environmental history.
Economic history studies have greatly developed over the past several decades
through application of economics and econometrics. Particularly in recent years, a
variety of new economic theories and sophisticated econometric techniques—
including game theory, spatial economics, and generalized method of moment
(GMM)—have been introduced for the great benefit of economic historians and the
research community.
At the same time, a good economic history study should contribute more than
just an application of economics and econometrics to past data. It raises novel
research questions, proposes a new view of history, and/or provides rich
documentation. This series is intended to integrate data analysis, close examination
of archival works, and application of theoretical frameworks to offer new insights
and even provide opportunities to rethink theories.
The purview of this new Springer series is truly global, encompassing all nations
and areas of the world as well as all eras from ancient times to the present. The
editorial board, who are internationally renowned leaders among economic
historians, carefully evaluate and judge each manuscript, referring to reports from
expert reviewers. The series publishes contributions by university professors and
others well established in the academic community, as well as work deemed to be
of equivalent merit.
All books and chapters in the Studies in Economic History book series are
indexed in Scopus.
Editorial Board Members:
Loren Brandt (University of Toronto, Canada)
Myung Soo Cha (Yeungnam University, Korea)
Nicholas Crafts (University of Warwick, UK)
Claude Diebolt (University of Strasbourg, France)
Barry Eichengreen (University of California at Berkeley, USA)
Stanley Engerman (University of Rochester, USA)
Price V. Fishback (University of Arizona, USA)
Avner Greif (Stanford University, USA)
Tirthanker Roy (London School of Economics and Political Science, UK)
Osamu Saito (Hitotsubashi University, Japan)
Jochen Streb (University of Mannheim, Germany)
Nikolaus Wolf (Humboldt University, Germany)
(in alphabetical order)
Patrick Gray • Joshua Hall
Ruth Wallis Herndon • Javier Silvestre
Editors

Standard of Living
Essays on Economics, History, and Religion
in Honor of John E. Murray
Editors
Patrick Gray Joshua Hall
Religious Studies College of Business and Economics
Rhodes College West Virginia University
Memphis, TN, USA Morgantown, WV, USA

Ruth Wallis Herndon Javier Silvestre


Department of History Applied Economics
Bowling Green State University Facultad de Economia y Empresa
Bowling Green, OH, USA Zaragoza, Spain

ISSN 2364-1797     ISSN 2364-1800 (electronic)


Studies in Economic History
ISBN 978-3-031-06476-0    ISBN 978-3-031-06477-7 (eBook)
https://doi.org/10.1007/978-3-031-06477-7

© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature
Switzerland AG 2022
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Preface

John Edward Murray was the Joseph R. Hyde III Professor of Political Economy
and Professor of Economics at Rhodes College in Memphis, Tennessee, when he
passed away suddenly on March 27, 2018, at the age of 58.
He was born on April 9, 1959, in Cincinnati, and became the first member of his
family to attend college. He worked at a variety of jobs to pay his tuition, including
phlebotomist, house painter, roofer, and ice cream vendor, graduating in 1981 from
Oberlin College with a degree in economics. He later added an MS in mathematics
from the University of Cincinnati, and the MA and PhD in economics from The
Ohio State University, where he wrote his dissertation under Rick Steckel.
John taught high school math before pursuing his graduate work in econom-
ics. After finishing at Ohio State, he accepted a position at the University of Toledo,
where he remained for 18 years before accepting the Hyde Professorship at Rhodes
College in 2011.
He had a lifelong penchant for learning, spending a summer studying the German
language in Schwabish Hall in 1984, and summers as an NEH scholar in Munich in
1995 and at Duke in 2013.
Murray authored two books and co-edited a third. His first book, Origins of
American Health Insurance: A History of Industrial Sickness Funds (Yale University
Press, 2007) was named one of ten “Noteworthy Books in Industrial Relations and
Labor Economics” in 2008 by the Industrial Relations Section, Princeton University.
His second book was co-edited with Ruth Wallis Herndon and titled Children Bound
to Labor: The Pauper Apprentice System in Early America (Cornell University
Press, 2009). Economic History Review said it was “a model for both comparative
and national studies” of childhood and labor in historical context. His third book,
The Charleston Orphan House: Children’s Lives in the First Public Orphanage in
America (University of Chicago Press, 2013), received the George C. Rogers, Jr.
Prize, awarded by the South Carolina Historical Society for the best book on South
Carolina history.
He published book chapters, monographs, encyclopedia and handbook contribu-
tions, and numerous articles in refereed journals including the Journal of Economic
History, Explorations in Economic History, Economic History Review, Agricultural

v
vi Preface

History, and many others. His clear, crisp writing style and ability to explain com-
plicated economic concepts made him a frequent choice to write for the popular
press as well.
John’s scholarly interests were varied, which is reflected in the essays in this
volume. His most recent work centered on coal mine safety, post bellum African-­
American labor supply, and families in nineteenth-century Charleston. He published
extensively in the areas of the history of healthcare and health insurance, religion,
and family-related issues from education to orphanages, fertility, and marriage, not
to mention his work in anthropometrics, labor markets, and literacy. His intellectual
work was often informed by his religious convictions, and he spent time studying
Catholic theology at Sacred Heart Major Seminary in Detroit.
John had a deep commitment to his family. His first book was dedicated to his
wife Lynn, and his second and third books to his children Rose and Sarah. He would
share with delight information about his family with colleagues, and his office was
filled with artwork by his children and family photos.
This anthology honors John E. Murray, whose scholarly interests and collegial
network ranged well beyond the economics departments in which he worked
throughout his professional life. His sudden death in March 2018 ended many ongo-
ing conversations in economics, history, and religion. John considered himself a
historian as well as an economist, and he held himself to the scholarly standards of
both disciplines. He interpreted economic data and put it to work in the service of
history. He read history and put it to work in the service of economics. His work was
also informed by his lifelong study of religion, and he maintained lively and colle-
gial friendships with scholars of religion. The essays in this volume reflect John’s
scholarly interests and were written with his interests in mind.
John Murray was a person who conversed with others. The following chapters
continue conversations that John started, encouraged, or inspired. He read second-
ary literature voraciously and would quickly contact the author of an article or book
that caught his interest. His gift for starting conversations brought many people into
his network and led to wonderful collaborations. The four editors of this volume
met him at different moments of his professional life and in very different
circumstances.
1996: John started the conversation that brought Ruth Herndon into his scholarly
community. In 1996, when Herndon was at the Philadelphia Center for Early
American Studies at the University of Pennsylvania (now the McNeil Center), she
published a brief “Research Note” in the Journal of Social History about the signa-
ture literacy of poor people warned out of New England towns in the latter eigh-
teenth century. Literacy and poor people being two of John’s interests, he naturally
read the essay and promptly wrote Herndon at the Philadelphia Center, unaware that
since the article’s publication she had taken up a faculty position in the Department
of History at the University of Toledo, where John was himself teaching in the
Department of Economics. When Herndon received John’s letter, forwarded from
the Philadelphia Center, she picked up her office phone, and called her new UT col-
league. After John got over the shock of this serendipity, he initiated a series of
brown bag lunch conversations that gradually grew into co-authored conference
Preface vii

papers, then a co-authored journal article, then a major research grant proposal sup-
porting their co-edited anthology Children Bound to Labor. Although Herndon sub-
sequently moved to Bowling Green State University and Murray moved to Rhodes
College, they continued their conversation on childhood, parenting, education, and
labor in historical context. Shortly before he died, they had proposed a conference
session together.
2003: Josh Hall first met John when he was teaching at Capital University in
Columbus Ohio. Economic history was what first got Josh interested in economics
and he had heard that there was an Ohio economic history meeting that he might
attend. Having been born in Toledo, he figured that was enough of a connection to
reach out to John Murray by email. And so a correspondence began that touched on
baseball, the Wright Brothers, graduate school in economics, and economic history.
In 2004, John provided advice when Josh applied to doctoral programs in econom-
ics. In 2007, Josh was a finalist for a job at Rhodes College he didn’t get. However,
a year later they were searching for an endowed chair and he encouraged John to
apply. The rest, as they say, is history. Josh greatly misses John’s occasional email
exchanges and is not surprised that so many were touched so deeply by John and
his work.
2004: Javier Silvestre met John at the 2004 Cliometrics World Congress, in
Venice, where the latter chaired the session in which the former presented a paper.
Both shared a broad interest in workplace safety in different countries. Some time
after the Congress, John proposed that Silvestre coauthor a paper on safety in
European coal mining, using an almost unexploited source. However, it was not
until several years later that the real work began. The resulting paper ended up with
a strong focus on technology, to that point an almost entirely unexplored field for
both authors. Once the paper was accepted for publication, in 2014, such an amount
of information on technological change in nineteenth-century European coal min-
ing had been gathered that John proposed that he and Silvestre embark on a project
together. The premise was that, as far as technological change is concerned, perhaps
different strands of the literature, economic history in particular, had been more
focused on the eighteenth and twentieth centuries. Technology in nineteenth-­century
coalmining needed to be reassessed. John’s enthusiasm was contagious. Over the
years, regular emails were exchanged on the subject of improvements in mechanical
fans, safety lamps, or explosives. He travelled to Spain a few times. In Zaragoza,
intense work sessions on the “coal project,” as John called it, were combined with
long evening walks and talks. It was difficult not to share some of his many inter-
ests: from freedom of speech to sports, via blues music, as well as dogs, of course,
to mention but a few. He was also a visiting scholar at the University of Barcelona.
His Origins of American Health Insurance book came at a time when the study of
the genesis of the Spanish welfare state was gathering strength among young eco-
nomic historians.
2011: Patrick Gray met John through mutual acquaintances in the Department of
Economics when he moved from Toledo to Memphis in 2011 to become the Joseph
R. Hyde III Professor of Political Economy at Rhodes College. Lunch conversations
regularly turned to such topics as baseball—especially John’s beloved Cincinnati
viii Preface

Reds—and raising children. John was very well read, and he wore his learning
lightly. This made him an outstanding scholar. John was not a member of the
Austrian School, but he agreed with the remark attributed to Friedrich Hayek that
“if you only understand economics, then you don’t understand economics,” and he
exemplified the spirit it expressed. His wide-ranging publications attest to a bound-
less intellectual curiosity and a punctilious attention to detail. John’s endowed chair
came with a generous book budget, and he was not afraid to use it. Theology was a
special interest. His home and office bookshelves groaned under the additional
weight of volumes related to biblical studies, church history, and philosophy.
Copious notes in the margins and underlined passages show that, far from being just
for show, he had actually read them. How to read and teach Augustine and Luther in
the interdisciplinary humanities sequence offered at Rhodes were frequent topics of
conversation. His approach to these texts bespoke an admirable humility that comes
with knowing the limits of one’s knowledge and expertise. Along with his gentle
spirit and hearty laugh, this is what his colleagues will miss.

Religious Studies  Patrick Gray


Rhodes College
Memphis, TN, USA 
College of Business and Economics  Joshua Hall
West Virginia University
Morgantown, WV, USA  
Department of History  Ruth Wallis Herndon
Bowling Green State University
Bowling Green, OH, USA  
Applied Economics  Javier Silvestre
Facultad de Economia y Empresa
Zaragoza, Spain
Contents

1 Urbanization, Sanitation, and Mortality in the Progressive


Era, 1899–1929 ����������������������������������������������������������������������������������������    1
Louis P. Cain and Elyce J. Rotella
2 The Continuing Puzzle of Hypertension Among African
Americans: Developmental Origins and the Mid-century
Socioeconomic Transformation��������������������������������������������������������������   19
Garrett T. Senney and Richard H. Steckel
3 Health and Safety vs. Freedom of Contract: The Tortured
Path of Wage and Hours Limits Through the State Legislatures
and the Courts������������������������������������������������������������������������������������������   43
Price Fishback
4 
Sickness Experience in England, 1870–1949 ����������������������������������������   69
Andrew Hinde, Martin Gorsky, Aravinda Guntupalli, and
Bernard Harris
5 Friendly Societies and Sickness Coverage in the Absence
of State Provision in Spain (1870–1935)������������������������������������������������   97
Margarita Vilar-Rodríguez and Jerònia Pons-Pons
6 A Difficult Consensus: The Making of the Spanish
Welfare State�������������������������������������������������������������������������������������������� 119
Sergio Espuelas
7 The Effect of the 1918 Influenza Pandemic on US Life
Insurance Holdings���������������������������������������������������������������������������������� 141
Joanna Short
8 “Theft of Oneself”: Runaway Servants in Early Maryland:
Deterrence, Punishment, and Apprehension ���������������������������������������� 167
Farley Grubb

ix
x Contents

9 Adult Guardianship and Local Politics in Rhode


Island, 1750–1800������������������������������������������������������������������������������������ 185
Ruth Wallis Herndon and Amílcar E. Challú
10 Later-Life Realizations of Maryland’s Mid-Nineteenth-Century
Pauper Apprentices���������������������������������������������������������������������������������� 211
Howard Bodenhorn
11 
Family Allocation Strategy in the Late Nineteenth Century��������������� 245
Trevon Logan
12 
Child Labor and Industrialization in Early Republican Turkey�������� 279
Semih Gokatalay
13 
Orphans, Widows, and the Economics of the Early Church �������������� 297
Patrick Gray
14  Economic Approach to Religious Communes: The Shakers���������� 309
An
Metin Coşgel
15 
Religion, Human Capital, and Economic Diversity
in Nineteenth-­Century Hesse-Cassel������������������������������������������������������ 323
Kristin Mammen and Simone A. Wegge
16 Productivity, Mortality, and Technology in European
and US Coal Mining, 1800–1913������������������������������������������������������������ 345
Javier Silvestre
17 
Breathing Apparatus for Mine Rescue in the UK, 1890s–1920s���������� 373
John Singleton
18 
Grain Market Integration in Late Colonial Mexico ���������������������������� 395
Amílcar E. Challú
19 
William McKinley, Optimal Reneging, and
the Spanish-­American War �������������������������������������������������������������������� 423
Joshua R. Hendrickson
20 Capitalism and the Good Society: The Original Case
for and Against Commerce���������������������������������������������������������������������� 451
Daniel Cullen
21 Situating Southern Influences in James M. Buchanan
and Modern Public Choice Economics�������������������������������������������������� 465
Art Carden, Vincent Geloso, and Phillip W. Magness
22 
John Murray: A Teacher, a Mentor, and a Friend�������������������������������� 477
Joshua R. Hendrickson
Contributors

Howard Bodenhorn Clemson University, Clemson, SC, USA


Louis P. Cain Northwestern University, Evanston, IL, USA
Art Carden Samford University, Birmingham, AL, USA
Amílcar E. Challú Bowling Green State University, Bowling Green, OH, USA
Metin Coşgel University of Connecticut, Storrs, CT, USA
Daniel Cullen Rhodes College, Memphis, TN, USA
Sergio Espuelas Universitat de Barcelona, Barcelona, Spain
Price Fishback University of Arizona, Tucson, AZ, USA
Vincent Geloso George Mason University, Fairfax, VA, USA
Semih Gokatalay UC San Diego, La Jolla, CA, USA
Martin Gorsky London School of Hygiene and Tropical Medicine, London, UK
Patrick Gray Rhodes College, Memphis, TN, USA
Farley Grubb University of Delaware, Newark, DE, USA
Aravinda Guntupalli University of Aberdeen, King’s College, Aberdeen, Scotland
Joshua Hall West Virginia University, Morgantown, WV, USA
Bernard Harris University of Strathclyde, Glasgow, UK
Joshua R. Hendrickson University of Mississippi, Oxford, MS, USA
Ruth Wallis Herndon Bowling Green State University, Bowling Green, OH, USA
Andrew Hinde University of Southampton, Alton, Hampshire, UK
Trevon Logan Ohio State University, Columbus, OH, USA

xi
xii Contributors

Phillip W. Magness American Institute for Economic Research, Great


Barrington, MA, USA
Kristin Mammen College of Staten Island –CUNY, Staten Island, NY, USA
Jerònia Pons-Pons Universidad de Sevilla, Sevilla, Spain
Elyce J. Rotella University of Michigan, Ann Arbor, MI, USA
Garrett T. Senney Office of the Comptroller of the Currency, Washington, DC, USA
Joanna Short Augustana College, Rock Island, IL, USA
Javier Silvestre Universidad de Zaragoza, Zaragoza, Spain
John Singleton Sheffield Hallam University, Sheffield, UK
Richard H. Steckel Ohio State University, Columbus, OH, USA
Margarita Vilar-Rodríguez University of A Coruña, Coruña, Spain
Simone A. Wegge College of Staten Island and the Graduate Center, City
University of New York, New York, NY, USA
Chapter 1
Urbanization, Sanitation, and Mortality
in the Progressive Era, 1899–1929

Louis P. Cain and Elyce J. Rotella

Abstract Between 1899 and 1929, deaths from waterborne diseases declined dra-
matically in American cities. The major cause of such declines was spending on
sanitation systems (water, sewers, and refuse collection). Cities spent enormous
amounts to build and maintain water and sewer systems, and to collect and dispose
of refuse. We first estimate the size of the payoff to cities of such expenditures,
where the payoff is measured in averted deaths. Using a panel of annual mortality
and municipal expenditure data from 152 cities, we estimate that a 1% increase in
sanitation expenditures was associated with a 3% decline in the mortality rate. In the
second section of the paper, we ask whether the mortality reducing effects of sanita-
tion expenditures differed by the type of water resources available to the city (ocean,
lake, river). The answer is unambiguously yes, with cities located on lakes facing
the most difficult sanitary situation.

Keywords Urbanization · Mortality · Sanitation · Water · Sewers · Refuse

1.1 Introduction

As the nineteenth century drew to a close, the demand for public sanitation works in
American cities began to accelerate. No city can exist without a supply of freshwa-
ter, but the widespread acceptance of the germ theory made it clear that the water
should be clean – and not just clean to the senses of taste, smell, and sight, but clean

L. P. Cain
Northwestern University, Evanston, IL, USA
Loyola University Chicago, Chicago, IL, USA
e-mail: [email protected]
E. J. Rotella (*)
University of Michigan, Ann Arbor, MI, USA
e-mail: [email protected]

© The Author(s), under exclusive license to Springer Nature 1


Switzerland AG 2022
P. Gray et al. (eds.), Standard of Living, Studies in Economic History,
https://doi.org/10.1007/978-3-031-06477-7_1
2 L. P. Cain and E. J. Rotella

according to accepted biological standards. Especially after the adoption of the


flush toilet, it became necessary to help the water that made its way into homes and
businesses find its way back out. And, it became imperative that both wastewater
and solid waste be removed as potential breeding grounds for diseases that plagued
cities. In the early years of the nineteenth century, water for firefighting was a prin-
cipal driving force behind the demand for improved urban water supplies. In the
later years of that century, citizens’ demand for urban water supplies became more
complex. In the middle of the century, sanitarians such as Edwin Chadwick (1842)
in London and Lemuel Shattuck (1850, 1948) in Massachusetts demonstrated the
correlation between bad water and disease. Once the germ theory was promulgated,
there was an explanation for the relationship. Cities with existing sanitary facilities
were now pressed to improve them; cities which lacked facilities were now pressed
to build them. Disease prevention required that the water be treated, and both filtra-
tion and chlorination were adopted in a wide variety of cities. Similarly, wastewater
required treatment, and a variety of sewage treatment technologies were invented
and adopted in the first decades of the twentieth century. The question that motivates
this study is: what kind of return did cities realize from the investments they made
in sanitary infrastructure?
In Constructing Urban Culture, Stanley Schultz (1989) explores the relationship
between American cities and city planning. Public health problems as they emerged
in rapidly growing metropolises at the end of the nineteenth century led to technologi-
cal solutions. As part of his examination of the effect of sewering the cities, Schultz
presents data on death rates and miles of sewer constructed and concludes: “Filtration
of water and sewage brought a dramatic drop in typhoid mortality rates, a drop that
averaged 65 percent in selected major cities” (174). In Schultz’s analysis, the cause of
the drop in typhoid deaths is simply asserted. Earlier studies by economic historians
of public health determinants of mortality include Edward Meeker (1972, 1974) and
Gretchen A. Condran and Eileen M. Crimmins-Gardner (1978, 1983).
The goal of our study is to estimate the direction and magnitude of the relation-
ship between the public works improvements of the Progressive era and the decline
in mortality from waterborne diseases. Did cities’ expenditures on water, sewers,
and refuse “pay off” by reducing the death rate from typhoid, diarrhea, and dysen-
tery? If yes, how big was the payoff?
Among economic historians who have scrutinized other dimensions of the
Progressive movement is John Murray. In his Origins of American Health Insurance
(2007), he examined sickness funds which would have mitigated the expenses of
getting sick. We do not have as good data on morbidity as there are for mortality, but
it seems reasonable to believe that a reduction in mortality attributable to waterborne
diseases is consistent with a reduction in morbidity as well. Consequently, we argue
that sanitation works which reduced morbidity and mortality thereby ameliorated a
portion of the risks that sickness insurance would have covered. Murray’s project is
complementary to this paper. Our results help explain Murray’s finding of little pop-
ular support for compulsory health insurance. People preferred to push municipali-
ties to spend money on avoiding illness by reducing waterborne diseases as opposed
to mitigating through insurance the expenses incurred as a result of getting sick.
1 Urbanization, Sanitation, and Mortality in the Progressive Era, 1899–1929 3

David Cutler and Grant Miller (2005) studied the effectiveness of urban water
supplies in the early twentieth century by using what they argue is exogenous varia-
tion in both the timing and location of the new technologies to identify the effects of
water improvements. They conclude that the causal influence of water purification
(specifically filtration and chlorination) on mortality was large. They find that clean
water was responsible for nearly half the total mortality reduction in those cities, as
well as for three-quarters of the reduction in infant mortality and nearly two-thirds
of the reduction in child mortality. In a later paper (2006), they argue that this
improvement was not limited to the largest cities. Similarly, Joseph Ferrie and
Werner Troesken (2008) estimate that 35–56% of the decrease in Chicago’s crude
death rate up to 1925 can be attributed to water purification and the eradication of
waterborne diseases. Marcella Alsan and Claudia Goldin (2019) examine the devel-
opment of clean water and effective sewerage systems in Boston between 1880 and
1920 and estimate that those works were responsible for much of the first sustained
decrease in child (under 5) mortality.
In this study, we expand the list of expenditures to include sewage works and
refuse collection as well as waterworks. If such expenditures were effective in
reducing the death rate from waterborne diseases, did they pay off by reducing the
total death rate as well? A decline in the total death rate could have resulted because
deaths from waterborne causes were a large share of total deaths, and the factors
that were responsible for the decline in waterborne deaths determined the decline in
total deaths. Secondly, improvements in water, sewers, and refuse could have led to
reductions in deaths from causes other than waterborne diseases because such dis-
eases were spread by the same vectors, or because declines in morbidity from the
causes responsible for waterborne diseases reduce the likelihood of deaths from
other causes. To paraphrase demographers, people accumulated fewer insults when
these waterborne diseases were averted, and, therefore, they were less likely to suc-
cumb to other diseases. For example, Preston and Van de Walle (1978) argue that, in
the case of intestinal diseases, public health changes led to this effect (see also
Szreter 1988; Wohl 1984; Woods 2000).
This paper examines relationships between US municipal expenditures and death
rates from 1899 to 1929. Urban historians (Glaab and Brown 1967; Mohl 1985)
consider this to be an era of reform, the first awakening of the environmental move-
ment leading to a dramatic expansion in budgetary expenditures on such works. By
1907, virtually every American city had installed sewers, and most big cities were
using filtration and chlorination to assure the safety of their water supplies (Galishoff
1980; Tarr et al. 1980).
From the very late 1890s to the very early 1930s (with a few missing years), the
federal government published compilations of both financial and mortality statistics
for cities.1 This paper stops in 1929 before the onset of the Great Depression and the

1
Data on both finances and mortality are contained in Bureau of Labor Statistics Bulletin, #24, 30,
36, and 42, for the years 1899–1902, and Census Bulletin #20 for 1902–1903. The Bureau of the
Census published Mortality Statistics of Cities annually between 1900 and 1936 and Financial
Statistics of Cities more or less annually between 1905 and 1931.
4 L. P. Cain and E. J. Rotella

availability of federal funds for municipal improvements. Its main focus is to link
statistically both the total death rate and the death rate from diarrhea, dysentery, and
typhoid (diseases spread by impure water and filth) to the expenditures on sanitation
(water supply, wastewater, and refuse works).
A second question addressed in this paper derives from Cain’s (1977) argument
that there are four distinct urban sanitary histories. The differentiating feature is the
type of water resource on which a city is located. Cities located on salt water cannot
draw their water supply from the abundant water close at hand and often have to rely
on sources hundreds of miles removed from the city. On the other hand, these cities
can dispose of their wastes in the adjacent salt water. Cities located on freshwater
lakes have historically used the lake for both water supplies and waste disposal.
Such cities are forced to geographically separate the water intake and sewer outfall
as far as possible to avoid befouling their drinking water with their wastes. This
interdependency creates what are arguably the most difficult sanitation problems
faced by any type of city. Cities located on major rivers simply have drawn their
water upstream from the city and disposed of their wastes downstream, taking care
that the potential sewage backwash cannot reach the water intake. Cities located on
smaller, minor rivers often have had to look elsewhere for an adequate water sup-
ply; they utilize distant lakes and rivers or rely on well water. Such small river cities
still dispose their wastes in the river, but they may have to build sewers to a down-
stream point where the river can receive a large volume of wastewater.
Each of the cities in our sample has been identified as belonging to one of these
groups. We will examine whether the effects of the water, sewer, and refuse vari-
ables differed by city type. Since the different city types faced different costs and
constraints in attempting to reduce mortality by investing in water, sewage, and
refuse works, we expect that the payoff to such investments varied between cities.
Therefore, cities facing different costs and constraints had incentives to invest in
sanitation strategies involving different mixes of these variables.

1.2 Data

Annual data on mortality and municipal expenditures were collected for 152 cities
for the period 1899–1929. The sample was defined to include all cities with popula-
tions over 25,000 in the 1910 Census. A few smaller freshwater lake cities were
added in order to increase the number of observations in that group. While some
cities had to be dropped from the sample because of insufficient data, the pooled
sample used in the reported regressions includes data from 87 cities in 1902 and 125
cities in 1929.
1 Urbanization, Sanitation, and Mortality in the Progressive Era, 1899–1929 5

1.2.1 Mortality Data and Variables

The mortality data used in this study were collected from the Mortality Statistics of
Cities which annually published death-by-cause statistics. Data were collected on
deaths from typhoid fever, dysentery, and diarrhea as well as all causes taken
together. While historical evidence on death-by-cause is notoriously problematic
because of changing definitions of diseases and changes in diagnoses, the diseases
studied in this paper were well identified in this period.
Typhoid, dysentery, and diarrheal diseases were spread by impure water and
food, and by contact with feces and other filth. In this paper, we follow the conven-
tion of referring to this group of diseases as “waterborne,” even though water is not
the exclusive means of transmission. We expect, as did contemporaries, that these
diseases were controlled by programs to deliver clean water, remove and treat sew-
age, and collect and dispose of refuse.
Deaths from all causes and deaths from waterborne diseases were used together
with population data to calculate the total death rates (TDR) and waterborne disease
death rates (WDR) used as dependent variables in the regressions reported in
Sect. 1.4.

1.2.2 Financial Data and Variables

This study makes use of data on annual operating costs and capital acquisition costs
of waterworks, sewage works, and refuse collection and disposal systems. These
data were published in various bulletins up to 1903 and in Financial Statistics of
Cities beginning in 1905. There are few direct figures available for 1904. Not every
series was reported every year, and no Financial Statistics were published in 1913,
1914, or 1920. For 1921 and 1922, information on sewers and refuse were reported
together under the heading “Sanitation.” Interpolation based on expenditures in the
same city in adjacent years was used to apportion the 1921 and 1922 reported fig-
ures between refuse and sewers.
Financial data were used to construct two kinds of variables employed in the
regression analysis: capital variables and current operating cost variables.
Expenditures on capital were aggregated over all years up to the year of observation
and then divided by the population in the year of observation thereby producing an
estimate of the per capita value of the works. The per capita value of sewage facili-
ties (SEWKALL) and refuse collection and disposal facilities (REFKALL) were
constructed in this manner. The accumulated value of capital in waterworks
(WATKALL) includes the value of the waterworks at the beginning of the period.
This value was reported in the Census bulletins, and, for most cities, this is the value
in 1899. Galishoff (1980, 52) includes a graph based on US Public Health Service
data indicating that most cities had selected the source they used and constructed
municipal works before the turn of the twentieth century. Treatment, principally
6 L. P. Cain and E. J. Rotella

filtration, and disinfection, principally chlorination, were adopted after the turn of
the century. A small minority of cities in the sample did not have municipal water-
works and were not included in the main regressions reported in Sect. 1.4.
Information on annual operating expenditures for water, sewers, and refuse were
used to create the variables WATERAV3, SEWERAV3, and REFUSEAV3 which
are the average operating expenditures per capita for the year under observation and
the previous 2 years.

1.2.3 Control Variables

Six variables were collected for control purposes. These include each city’s land
area (LANDAREA) and assessed valuation (ASSDPC) for each year. Land area
provides a measure of geographical size and change within the study period, while
the assessed valuation measures the city’s ability to pay. Since the Progressive era
was a period of annexation and consolidation, the inclusion of these variables con-
trols for this type of city size growth.2
Two series were collected from the historical weather records to control for cli-
matological differences in time and space. The total rainfall in inches measures the
wetness of a particular year, while the length of the growing season in days mea-
sures for how much of the year climactic conditions (temperature, altitude, and
rainfall) permitted normal plant growth.3
Finally, two dummy variables were employed. The first, WAR, includes the
period of the First World War and its aftermath, which included a vigorous inflation
and a virulent outbreak of influenza. The other, LATE20, controls for 3 years in the
late 1920s when many cities overestimated their populations, the figure used to
make per capita calculations.

1.3 The Regression Model

Annual statistics from 1899 through 1929 were pooled to create a panel data set.
The data used in the regressions cover the period 1902–1929 with data on 1899–1901
used to create variables based on averages and aggregates of past expenditures. The
effects of capital and operating costs on death rates were estimated using a one-way
fixed effects regression model. This technique runs an ordinary least squares
regression on the entire panel, estimating a separate intercept term for each city.

2
Data on Allegheny, Pennsylvania, were collected and added to those of Pittsburgh to incorporate
that annexation explicitly in the sample.
3
Unfortunately, the weather bureau did not collect information for all the cities in the sample, so in
some cases what has been included comes from a city which is a climatological clone of a sam-
ple city.
1 Urbanization, Sanitation, and Mortality in the Progressive Era, 1899–1929 7

Chi-­squared tests confirm the superiority of this specification over the simple OLS
model without fixed effects.
The simple OLS model was estimated with the full set of control variables dis-
cussed above plus variables for population density (population/land area), popula-
tion growth (the population this year/the average population in the three previous
years), and the year. The weather variables proved to be very powerful with mortal-
ity substantially higher in the wetter and warmer cities. All the control variables had
the expected signs. While they were important for explaining the urban mortality
experience, all but YEAR, LANDAREA, ASSDPC, and the two dummy variables
(WAR and LATE20) were dropped from the regressions reported in the next section
because their impacts are included in the fixed effects.4

1.4 Results

The first three decades of the twentieth century were years of considerable improve-
ment in medical practice, food delivery and preparation, and urban sanitation. Also,
living standards were rising as personal income was rising throughout the period.
The widespread acceptance of the germ theory of disease led to the adoption of
procedures designed to reduce the spread of many common nineteenth-century dis-
eases. As Mokyr (1983) emphasizes, the evolutionary diffusion of public health
techniques over the twentieth century explains much of the decline in mortality
rates and the emergence of a new demographic regime. As life expectancy increased,
other diseases came to be more common causes of death. The “Second Industrial
Revolution” based on electricity and automobiles introduced potentially more
deadly technologies, while accelerated urbanization increased the potential for vio-
lence.5 The overall pattern of change in urban mortality can be seen in Table 1.1.
In 1902, the 15.124 per 10,000 population deaths attributable to waterborne dis-
eases were 8.9% of all deaths. By 1929, the 1.857 per 10,000 deaths from water-
borne diseases were only 1.4% of the total. The total death rate dropped by 20%
over the period (16.713/1000 to 13.409/1000), but death rates from waterborne dis-
ease dropped by almost 90%. We can get some idea of the importance of this rapid
decline in waterborne diseases by engaging in a simple counterfactual exercise. If,
beginning in 1902, there had been no decline in the death rate from waterborne
diseases, and if the death rate from all other causes had declined at its actual rate,
then the total death rate in 1929 would have been 14.836 instead of 13.323. That is,
instead of falling nearly 20% from 1902 to 1929, the death rate would have fallen
by only 12.2%. From this, we can conclude that 43.2% of the actual decline in the

4
A one-way random effects model was also estimated allowing for city-specific heteroscedasticity
correction using a generalized least squares technique. The results were almost identical to the
OLS specification, and, therefore, only the OLS fixed effects results are reported.
5
The proportion of total deaths from accidents, suicides, and other acts of violence does not appear
to have increased over the study period.
8 L. P. Cain and E. J. Rotella

Table 1.1 Average urban death rates


Total Deaths from Waterborne Deaths from Waterborne diseases as a
Year deaths diseases Percentage of all deaths
1902 16.713 15.124 8.9%
1903 16.868 15.064 8.8
1904 16.686 15.377 9.1
1905 16.826 15.673 9.2
1906 17.136 16.455 9.5
1907 17.682 16.749 9.3
1908 16.370 15.171 9.1
1909 15.545 14.105 9.0
1910 16.657 14.232 8.5
1911 15.776 11.824 7.4
1912 15.234 10.072 6.6
1913 n.a. n.a.
1914 n.a. n.a.
1915 15.197 8.691 5.6
1916 15.503 9.131 5.7
1917 15.861 8.780 5.4
1918 20.691 8.279 3.9
1919 14.489 5.838 4.0
1920 14.721 5.751 3.9
1921 12.958 5.054 3.9
1922 13.272 4.080 3.0
1923 13.661 4.028 2.9
1924 13.128 3.502 2.6
1925 13.367 3.668 2.7
1926 13.774 3.240 2.3
1927 12.660 2.410 1.9
1928 13.715 2.213 1.6
1929 13.409 1.857 1.4
1929/1902 67.828 12.278
Percentage
change
1902–1929 19.769 87.722
Total death rates are per 1000 inhabitants; waterborne disease death rates are per 10,000 inhabitants
These rates are averages for the cities included in the pooled sample. Waterborne diseases include
diarrhea, dysentery, and typhoid

total death rate between 1902 and 1929 can be attributed to the decline in deaths
from waterborne diseases.
The variables included in the regressions are described in Table 1.2; the results
with the total death rate as the dependent variable are reported in Table 1.3. The
variable WATKALL captures improvements in water quality that resulted from fil-
tration, the construction of filter beds and plants. In each case reported in Table 1.3,
1 Urbanization, Sanitation, and Mortality in the Progressive Era, 1899–1929 9

Table 1.2 Definitions of independent variables included in regressions


WATKALL Sum of all capital expenditures on waterworks prior to the year under
observation plus the value of municipal waterworks in 1899 (or in the year
acquired) in per capita terms
WATERAV3 Average operating expenditures on waterworks and water treatment over the two
preceding years and the year under observation in per capita terms
SEWKALL Sum of all capital expenditures on sewage facilities up to the year under
observation in per capita terms
SEWERAV3 Average operating expenditures on the sewer system over the two previous years
and the year under observation in per capita terms
REFKALL Sum of all capital expenditures on refuse collection and disposal up to the year
under observation in per capita terms
REFUSEAV3 Average operating expenditures on refuse collection and disposal over the two
preceding years and the year under observation in per capita terms
YEAR A trend variable, the year under observation
WAR A dummy variable equal to 1, if year = 1917–1920
LATE20 A dummy variable equal to 1, if year = 1925–1927
ASSDPC Assessed valuation in hundreds of dollars per person
LANDAREA Square miles in hundreds of square miles

this coefficient is positive, quite the opposite of what would be expected if there
were a spillover to deaths from other causes from the factors one anticipates would
reduce waterborne diseases. For all the cities in the sample, and in three of the four
city types, the positive coefficient is statistically significant suggesting that an addi-
tional dollar spent on waterworks was associated with higher overall death rates,
after controlling for sewer and refuse expenditures. The variable WATERAV3 cap-
tures improvements in water quality resulting from disinfection, expenditures for
chlorination. In only one case, freshwater lake cities, is this variable negative.
Similar difficulties are present in the sewer and refuse variables.
We conclude from Table 1.3 that a consideration of expenditures on urban sanita-
tion in the years 1899–1929 produces little understanding of what determined the
total death rate. Even though the decline in waterborne diseases was a very large
part of the decline in total urban mortality in this period, the results do not show that
the total death rate responded as one might expect from the expenditures on water,
sewers, and refuse. Hereafter, consideration of the effects of urban sanitation expen-
ditures will focus on their impact on the waterborne disease death rate. These
results are reported in Table 1.4.
For all cities taken together, the existence of a waterworks and the addition of
filtration works during this period (WATKALL) had an important effect on reducing
waterborne deaths. On the other hand when we examine the impact of operating
expenditures (WATERAV3), we see that cities with higher waterborne disease death
rates either spent more on disinfection or the addition of disinfection marginally
increased deaths. Examining these results by the various city types puts the findings
into sharper relief. The negative coefficient on the water capital variable is signifi-
cant only for saltwater cities that must travel the greatest distance to find a source of
10 L. P. Cain and E. J. Rotella

Table 1.3 Total death rate regression results


Fresh water
Variable All Salt water Lake Major river Minor river
WATKALL 0.00205a 0.00047 0.00515a 0.00297a 0.00260a
WATERAV3 0.01193a 0.01190 −0.04553a 0.00888 0.01692
SEWKALL 0.00115b 0.00144 0.00174 0.00219b 0.00126
SEWERAV3 0.01842b 0.03447a −0.00999 0.00009 −0.00884
REFKALL 0.00495 −0.01396 −0.06731a −0.00965 0.06949a
REFUSEAV3 −0.03913a −0.04246a −0.01679 −0.06290a −0.02534
YEAR −0.01301a −0.01583a −0.00268 −0.00902a −0.01488a
WAR 0.15811a 0.11243a 0.13657a 0.16132a 0.18510a
LATE20 −0.02067a −0.01242 −0.03640b −0.02714 −0.03270b
ASSDPC 0.00177a −0.00231b 0.00123 0.00188a 0.00310b
LANDAREA 0.00008a 0.00003 −0.00107a −0.00036a −0.00095a
R2 0.657 0.760 0.737 0.568 0.680
n 2609 716 291 883 723
Dependent variable is the log of the total death rate
a
Statistically significant at the 95% confidence level
b
Statistically significant at the 90% confidence level

Table 1.4 Waterborne disease death rate regression results


Fresh water
Variable All Salt water Lake Major river Minor river
WATKALL −0.00349a −0.00818a 0.00653 −0.00075 −0.00028
WATERAV3 0.00945 −0.01690 −0.09220b −0.01414 0.02982
SEWKALL −0.01332a −0.00951a −0.00119 −0.01201a −0.02099a
SEWERAV3 −0.04766b 0.00126 −0.10747 0.09388 −0.37971a
REFKALL −0.07875a −0.13693a −0.64572a −0.08444a 0.01024
REFUSEAV3 −0.05264a −0.05707b 0.17879a −0.07358a −0.11522a
YEAR −0.07369a −0.08113a −0.05024a −0.06788a −0.06652a
WAR 0.21762a 0.16005a 0.11556 0.20325a 0.25446a
LATE20 0.00264 −0.08883a 0.01338 0.10020a −0.04403
ASSDPC 0.00408a 0.00338 −0.02260a 0.00393b −0.00235
LANDAREA 0.00029a 0.00042a −0.00326a 0.00002 0.00018
R2 0.840 0.897 0.825 0.824 0.829
n 2609 716 291 883 723
Dependent variable is log of the waterborne disease death rate.
a
Statistically significant at the 95% confidence level
b
Statistically significant at the 90% confidence level

fresh water. The expected negative effect is present in both types of river cities, but
the coefficient is in fact positive for freshwater lake cities. While this coefficient is
not statistically different from zero, the positive sign may be interpreted as a conse-
quence of these cities customarily drawing water from the same water source into
which they deposit their wastes. The differences in the size of the coefficients are
1 Urbanization, Sanitation, and Mortality in the Progressive Era, 1899–1929 11

also worthy of note. An additional dollar spent on water capital in saltwater cities
has ten times the impact as in major river cities, and expenditures in major river cit-
ies have three times the impact as in minor river cities.
The only city type in which annual expenditures for the water department show
a positive coefficient is minor river cities, those which rely most heavily on ground-
water supplies.6 Since this city type is the only one for which refuse capital expen-
ditures do not have a significant negative effect, where the effect is in fact positive,
one might conclude that refuse could be leeching into groundwater supplies. It is
only in freshwater lake cities where disinfection has a significant negative effect,
and it seems likely chlorination was important in combatting impurities in the
wastewater that was discharged into these cities’ water supply sources.
The two sewage variables both have a statistically significant negative effect on
the waterborne disease death rate in the regression for all cities taken together. In
each type of city, the expenditure on sewer construction and sewage treatment works
has a negative effect. It is significant for all but the freshwater lake cities, who, given
the interdependency between water supply and wastewater disposal, have to spend
a great deal more to get the same effect on death rates as the other city types. The
variable means reported in Table 1.5 do not indicate, however, that these freshwater
lake cities spent a great deal more for sewage capital than did the other city types.7
Annual expenditures on sewers have a more complex pattern across city types.
While the all city regression has a significant negative coefficient, the same is true
only for the minor river cities. Lake cities also have the expected negative coeffi-
cient, but those for saltwater cities and major river cities are in fact positive. None
of these latter three coefficients is statistically significant. In almost every case,
minor river cities use the river as their disposal source, but they may have to convey
their wastewater several miles downstream to a point where the river is sufficiently
large to handle the city’s volume. It is a simple matter of disposal strategy, which is
less of a problem for the other three types. Both saltwater cities and major river cit-
ies locate their water supply sources in such a way as to minimize the cost of waste-
water disposal. They have located their sewage works such that sewage services
have an effect on the death rate, but the annual expenditures on sewer maintenance
get short shrift relative to the need to maintain the purity of their water supplies.
The solid waste variables, which involve many fewer dollars than the other two
as the table of variable means (Table 1.5) documents, prove to have a statistically
significant negative effect in almost every city type and for all cities taken together.
Given the close connection between waterborne and foodborne diseases, the regular
removal and disposal of food wastes in such a way as to remove them from water
supply sources has important consequences. The only exception to the significant

6
Some, such as Denver, constructed systems reminiscent of saltwater cities to tap distant sources.
7
In the case of the Sanitary District of Chicago, more than 10 years of capital expense led to a large
decrease in cholera deaths in the first year after the Main Channel was opened. Unfortunately, the
District is a supra-governmental body and, therefore, not included in the Financial Statistics of
Cities. When the North Side Treatment Works opened in the mid-1920s, Chicago had spent more
on sewage treatment than the expenditures in the next ten largest cities combined.
12 L. P. Cain and E. J. Rotella

Table 1.5 Means of variables included in regressions


Fresh water
Variable All Salt water Lake Major river Minor river
WATKALL 29.057 34.323 26.706 27.367 26.726
WATERAV3 1.5753 1.7403 1.4698 1.6647 1.3472
SEWKALL 10.900 11.223 11.987 10.369 10.830
SEWERAV3 0.30401 0.44751 0.23902 0.22481 0.28773
REFKALL 0.29401 0.23173 0.29952 0.29795 0.36411
REFUSEAV3 0.79976 0.95536 0.88345 0.72686 0.71077
YEAR 1916.4 1916.2 1916.5 1916.3 1916.7
WAR 0.13147 0.12989 0.12371 0.13137 0.13555
LATE20 0.13952 0.13128 0.15120 0.13930 0.14523
ASSDPC 10.873 11.851 8.7395 12.275 9.1335
LANDAREA 195.11 233.61 256.80 191.35 137.42
TDR 15.208 15.083 13.579 16.008 15.001
WDR 8.6698 8.4624 8.1803 8.8118 8.8762

negative effect for outlays of refuse disposal capital is minor river cities, where the
potential that decomposing refuse may pollute groundwater supplies is a possible
explanation for the (statistically insignificant) positive effect observed for those cit-
ies. The only exception for annual expenditures on refuse disposal is freshwater lake
cities, which had a significant positive effect. This coefficient is a puzzle.
Inasmuch as the fixed effects model controls for variation between cities, and
since the regressions are estimated on a pooled cross-section, time-series basis,
three variables are used to control for variation across time in all the regressions.
The first such variable is YEAR, which has the expected negative coefficient and is
statistically significant in all cases. These years saw tremendous increases in medi-
cal knowledge and education, as well as important changes in food preparation with
canning, dehydration, and refrigeration producing large changes in the way the typi-
cal household confronted meal planning and preparation.
WAR is a dummy variable for the years 1917–1920 during which three major
events may have had a positive effect on waterborne death rates. The first is the
effect that wartime controls and postwar inflation might have on expenditure levels,
conceivably postponing some sanitation expenditures to postwar years when infla-
tion caused deferred expenditures to be more expensive. The second is rapid popu-
lation growth in some urban areas, much of it due to the migration of agricultural
workers from the south to urban industrial jobs in the north, and to the growth of
cities with large military installations. The crowding this created, both during and
after the war, put pressure on existing sanitation systems and may have led to
increases in waterborne death rates. In fact, there is a marked slowing in the rate of
decrease in these diseases revealed in Table 1.1, followed by an acceleration in the
early 1920s. The third effect, the influenza pandemic of 1918–1919, may have
increased the disease environment so that low levels of waterborne contamination
affected more people. The coefficients on WAR are all positive and statistically
significant for all cities other than lake cities.
1 Urbanization, Sanitation, and Mortality in the Progressive Era, 1899–1929 13

The third of the variables controlling for variation across time is LATE20, a
dummy for the period 1925–1927 during which many cities consistently overesti-
mated their population given the levels reported in the 1930 Census. Thus, the death
rates would tend to be underestimated.
Finally, ASSDPC and LANDAREA are included to control for the fact that, dur-
ing these years, many cities grew by annexation and consolidation, although the
great age of annexation was ending just as the study period begins (Cain 1983).
Since annexed areas could be either healthy or unhealthy, either well-endowed with
sanitation capital or not, the diverse pattern of coefficients should not be surprising.
Their inclusion in these regressions is attributable to the fact annexation is not con-
sidered to be a fixed effect ex ante.8
These regression results only pertain to cities with municipal water supplies. In
an attempt to assess whether the results of Tables 1.3 and 1.4 might also apply to
cities with private water supplies, two additional regressions were run. The results
are reported in Table 1.6. Because the number of cities without municipal supplies
is relatively small, it is not possible to run regressions by city type. The first regres-
sion simply reruns the sample for all cities reported in the earlier tables without the
water variables. The second regression repeats this specification for the cities with
private supplies.9 The final column of Table 1.6 reports the results of a simple

Table 1.6 Municipal vs. private water supplies


Variable Municipal Private Test result
SEWKALL −0.01376a −0.00951a Same
SEWERAV3 −0.05106b 0.00246 Same
REFKALL −0.08150a −0.22241a Differ
REFUSEAV3 −0.04310a 0.00941 Same
YEAR −0.07514a −0.07448a Same
WAR 0.21399a 0.19256a Same
LATE20 0.00457 0.09407a Differ
ASSDPC 0.00402a −0.00014 Differ
LANDAREA 0.00028a 0.00019 Same
R2 0.840 0.831
n 2609 933
Dependent variable is the log of the waterborne disease death rate
a
Statistically significant at the 95% confidence level
b
Statistically significant at the 90% confidence level

8
Regressions excluding these two variables indicate that the loss of what in the all cities case are
two statistically significant coefficients does not affect the overall results reported here.
9
It should be noted that the distribution of cities by type for these two cases is approximately equal.
It should also be noted that the cities included in the private regression are those that had no
municipal works at the start of the study period. Inasmuch as several of these cities shifted to
municipally owned works during the period, they are also included in the other regression for
those years.
14 L. P. Cain and E. J. Rotella

statistical test as to whether the coefficients of the first equation are in the confi-
dence intervals of the second equation. By this test, three of the four coefficients for
the sewage and refuse variables in the cities with municipal waterworks are in the
confidence intervals for the cities with private works. Six of the nine variables
included in the equation meet this test. This provides support for a conclusion that
the effects of sanitation expenditures on the waterborne disease death rate are simi-
lar in cities with municipal and private waterworks.

1.5 Summary and Conclusion

This paper seeks to answer two questions. First, was there a payoff to cities’ expen-
diture on sanitation works, and how big was that payoff? As Table 1.7 documents,
cities received a big payoff to expenditures on waterworks, sewer systems, and
refuse collection and disposal in the form of reduced deaths from waterborne dis-
eases.10 The second question is whether there were observable differences in the
four city types. As Table 1.7 illustrates, the answer to that question is yes. This study
further demonstrates that the mechanisms which do a good job of explaining the
decline in waterborne disease death rates (Table 1.4) do not perform anywhere near
as well in explaining the decline in the total death rate (Table 1.3). Indeed, the cor-
relation between the two grows smaller over time, suggesting that additional study
is needed to explain the decline in overall urban mortality in the early twentieth
century.
The total per capita expenditures that appear in the first row of Table 1.7 are the
sum of the variable mean expenditures listed in Table 1.5. The greater expenditures
for saltwater cities are attributable to the high expenditure on water capital in those
cities. The rest of Table 1.7 lists the annual decrease in the number of deaths attrib-
utable to waterborne diseases that would result from a one-percent increase in per
capita expenditures on each of the six categories. Over all the cities in the pooled
sample, a one-percent increase in each of the six categories would have saved 27
lives annually in a city of average size.
In Table 1.7, we see substantial differences between the types of cities. A one-­
percent increase in expenditures on water capital in saltwater cities would have
averted almost 24 deaths, a much greater effect than elsewhere. A one-percent
increase in annual expenditures on water, interpreted as expenditures on disinfec-
tion, would have had its greatest effect in freshwater lake cities, averting over 11
deaths. Increased expenditures on sewer capital had their greatest potential impact

10
In 1902, typhoid deaths were, on average, 26% of all deaths from waterborne diseases; by 1929,
this had fallen to 16%. Thus, deaths from typhoid had fallen faster than those from intestinal/diar-
rheal diseases.
1 Urbanization, Sanitation, and Mortality in the Progressive Era, 1899–1929 15

Table 1.7 Reduced waterborne disease deaths from increased expenditures


Fresh water
All Salt water Lake Major river Minor river
Total expenditure per capita $42.93 $48.92 $41.58 $40.65 $40.27
Averted deaths associated with a 1% increase in expenditures per capita
Variable
WATKALL −8.79 −23.73 14.28 −1.81 −0.66
WATERAV 31.29 −2.49 −11.08 −2.07 3.57
SEWKALL −12.58 −9.03 −1.17 −10.97 −20.15
SEWERAV3 −1.26 0.05 −2.10 1.86 −9.69
REFKALL −2.01 −2.68 −15.81 −2.22 0.33
REFUSEAV −3.65 −4.61 12.93 −4.71 −7.27
TOTAL −26.99 −42.49 −2.94 −19.92 −33.88

in river cities, particularly minor river cities, where the number of deaths attribut-
able to waterborne diseases would have been reduced by an annual average of more
than 20. An additional one-percent increase on annual operating expenditures for
sewers in minor river cities would have saved an additional ten lives. The 16 reduced
deaths in freshwater lake cities that would have resulted from a one-percent increase
in expenditures on refuse capital could have been countered by 13 more deaths from
increased annual expenditures on refuse collection and disposal, which worked to
reduce mortality in the other three city types.
The differences we see in Table 1.7 are consistent with the sketch of each city
type appearing in the first section of this essay. To reiterate with the broadest brush-
strokes, the capital expenditures of saltwater cities on water supply and wastewater
works helped reduce waterborne disease deaths. While most cities adopted disinfec-
tion of their water supplies during this period, disinfection proved to have a signifi-
cant effect only in the freshwater lake cities. The intelligent location of sewage
works was important to both major and minor river cities, and the annual operating
expenditures of the sewer system were of additional importance to minor river cit-
ies. This study incorporates refuse collection and disposal as part of sanitation, and
the effects are as we expected with the exception of the positive effect of annual
operating expenditures in freshwater lake cities. Finally, and tentatively, the com-
parison of cities with municipal versus private waterworks presented in Table 1.6
suggests the analysis of cities with municipal waterworks derived from Tables 1.3,
1.4, and 1.7 applies generally.

Acknowledgments We are grateful for the research assistance of Ashish Aggarwal, Supriya
Mathew, and Stacey Tevlin and for the financial assistance of the Center for Economic History, the
Balzan Foundation, and Loyola University Chicago. We thank George Alter; John Brown; Stanley
Engerman; Joel Mokyr; Tom Weiss; participants in the International Economic History Congress
in Leuven, Belgium; and participants in seminars at the University of Illinois, Indiana University,
and Northwestern University.
16 L. P. Cain and E. J. Rotella

Appendix: Murray Reminiscences

Louis Cain: I first met John at an academic conference, perhaps he was still in grad
school. In any event, it was about a quarter century ago when our friendship began.
We got to spend an extended time talking about our work when John came to give
a seminar at Northwestern in 2000. In the Fall of 2005, I joined Bob Fogel’s
Center for Population Economics at the University of Chicago and began lobbying
to have John come and give a seminar there. Six years later, he came. By then,
Bob’s health was failing, and we often didn’t know until an hour or so before the
seminar began whether he would appear. I knew Bob would enjoy John’s topic, but
Bob’s assistant called just before lunch to say that he was not going to make it. I
apologized for Bob’s absence, but John was just happy to have been invited. He
had booked a flight that left several hours after the seminar so we had a lot of time
to talk about the books each of us was finishing. As luck would have it, those
books were both the subject of an “author-meets-critics” session at the 2012 Social
Science History Association meetings in Vancouver. I was grateful and apprecia-
tive that one of our critics was John Murray. His comments were always to the
point but delivered with the kindness that was the hallmark of this gentle and
generous scholar.
Elyce Rotella: I got to know John at meetings of the Economic History
Association and the Social Science History Association but did not come to know
him well until after I relocated to the University of Michigan in 2007. Because John
was at the University of Toledo – less than an hour away from Ann Arbor – he came
regularly to our weekly Economic History Seminar. He was an active seminar par-
ticipant with valuable comments to offer for every paper. It was a pleasure to see
him regularly which gave me the opportunity to develop a personal relationship that
typically involved sharing stories of our musical daughters. We had many research
interests in common. One of my treasured possessions is an autographed copy of his
book on health insurance that he gave to me.
In addition to being a highly productive scholar, John was the very definition of
a good citizen. He was a stalwart of the Economic History Association, the Social
Science History Association, and the Cliometric Society – serving in leadership and
service positions for these groups and their journals. When a colleague was elected
President of the Social Science History Association, he immediately approached
John for the big job of chairing the Program Committee. John had to turn down the
offer because he had already done that job a few years earlier.

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Cambridge
Chapter 2
The Continuing Puzzle of Hypertension
Among African Americans: Developmental
Origins and the Mid-century
Socioeconomic Transformation

Garrett T. Senney and Richard H. Steckel

Abstract African Americans have an excessive prevalence of hypertension relative


to whites, particularly in the South. We seek to understand this puzzle by applying
the developmental origins hypothesis to the rapid socioeconomic improvement that
occurred after World War II. The long experience of pre-World War II poverty pre-
pared African Americans born around the 1950s for survival in a lean world of poor
nutrition and hard work, but created vulnerabilities for chronic diseases when con-
ditions improved later in life. We analyze individual-level evidence from the CDC’s
Behavioral Risk Factor Surveillance System with household income data, finding
results consistent with the developmental origins hypothesis, that accelerated
income growth from poverty strongly indicates an increased prevalence of hyper-
tension. This strongly suggests that the collection of individual-level, intergenera-
tional data is necessary to further evaluate this puzzle.

Keywords Developmental origins · Hypertension · Health · Behavioral Risk


Factor Surveillance System · Cardiovascular disease

G. T. Senney (*)
Office of the Comptroller of the Currency, Washington, DC, USA
e-mail: [email protected]
R. H. Steckel
Ohio State University, Columbus, OH, USA
e-mail: [email protected]

© The Author(s), under exclusive license to Springer Nature 19


Switzerland AG 2022
P. Gray et al. (eds.), Standard of Living, Studies in Economic History,
https://doi.org/10.1007/978-3-031-06477-7_2
20 G. T. Senney and R. H. Steckel

2.1 Introduction

African Americans have a high prevalence of hypertension, an important precursor


of cardiovascular disease and stroke, which is a major contributor to the racial dis-
parities in health observed in America (Lackland and Keil 1996; Sowers et al. 2002;
Wong et al. 2002; Hertz et al. 2005). In 2007–2014, the age-adjusted hypertension
prevalence rates were 41.6% for African Americans and 29.0% for whites
(Mozaffarian et al. 2016, chart 9.2). An extensive literature documents that the dis-
parity in hypertension prevalence persists even after adjustment for a wide range of
socioeconomic and behavioral factors (Redmond et al. 2011). Figure 2.1 shows that
the prevalence of hypertension for African Americans in 2011 varied widely across
the country. It is important to note that hypertension is particularly pronounced in
the South. The highest rates exist in the swath of states from Texas to West Virginia.
Notably, this region roughly coincides with the stroke and the diabetes belts identi-
fied by the CDC, conditions that are recognized as correlates or precursors of car-
diovascular disease (Lackland et al. 2016).1
The prevalence of hypertension is also elevated in other states adjacent to this
block. However, that elevated prevalence for African Americans living in the South
contrasts with the lower rates among blacks living in Africa or in the Caribbean
(Cooper et al. 1997). Given this evidence, unique aspects of the American environ-
ment likely contribute to the pattern of hypertension prevalence. The previous litera-
ture discusses numerous possible explanations for the high prevalence of
hypertension among African Americans, but there is no scientific consensus on its

Fig. 2.1 Hypertension prevalence in 2011 of African Americans 18 years and older. (Source:
BRFSS, CDC. Note: Prevalence denotes the share of individuals who are being treated for hyper-
tension or who have been told by a physician, nurse, or healthcare professional that they have
hypertension. Because some individuals have not been examined for hypertension, this measure
underestimates the true rate)

1
www.cdc.gov/dhdsp/maps/national_maps/stroke_all.htm and www.cdc.gov/diabetes/pdfs/data/
diabetesbelt.pdf.
2 The Continuing Puzzle of Hypertension Among African Americans: Developmental… 21

underlying cause. Therefore, the situation of higher prevalence of hypertension


among African Americans in the South is a unique and interesting public
health puzzle.
One approach worth further study, the developmental origins hypothesis, relates
changes in the intergenerational socioeconomic conditions to increases in the preva-
lence of chronic adult diseases. Medical studies have shown that young children
respond to poor nutrition and stress by compromising organ integrity and degrading
biological processes that regulate physiological systems in later life (Gluckman
et al. 2008; Barker and Thornburg 2013). If people rendered vulnerable then face an
energy-rich diet or elevated stress in later life, pathophysiological processes are set
into motion that might significantly increase their likelihood to have hypertension.
The developmental origins hypothesis views rapid socioeconomic improvement
near the middle of the twentieth century as a possible latent factor that has elevated
hypertension among African Americans who had an intergenerational history of
poverty. Beginning in the 1950s, the South underwent an economic, social, techno-
logical, and political revolution that had profound effects for African Americans,
creating a sudden improvement in living conditions broadly defined. Being guided
by the literature on hypertension and the developmental origins hypothesis, we
empirically examine the claim that this major socioeconomic change created unbal-
anced physical growth for cohorts born on the cusp of change, which made them
particularly vulnerable to hypertension as adults.
We investigate the connection between socioeconomic change and hypertension
using individual-level data gathered by the Behavioral Risk Factor Surveillance
System (BRFSS) and by state-level, household income data for African Americans.
As discussed below, two factors allow us to identify and measure the impact of the
changing socioeconomic environment on hypertension among African Americans.
First, conditions in utero are crucial for the development of major organs such as the
cardiovascular system. At this age, the growth process adapts the design of these
organs to the type of nutritional conditions the child is expected to inhabit in later
life. Once fully formed, these organs have limited capacity to adapt to changing
environmental conditions. Second, a sudden improvement in conditions between
birth and adulthood places these cohorts at greater risk of hypertension. Successive
generations of poverty and hard work, for example, led to low birth weight and
limited the functional capacity of these organ systems. By dividing the BRFSS data
into birth cohorts that experienced contrasting rates of socioeconomic change, we
can measure the effects of rapid socioeconomic improvement on adult hypertension.
We consider how rapid socioeconomic change operated on biological processes
known to affect hypertension. In this regard, income acts as a portmanteau variable
that captures several effects associated with improving socioeconomic status. The
others include diet, work effort or physical activity, leisure, and obesity, all of which
accompanied the mid-century industrialization and modernization of the South.
Specifically, we consider how the diffusion of new technology, especially the tractor
and the cotton picker after 1950, eased work effort and calories expended in agricul-
ture. Higher incomes enabled the purchases of automobiles that reduced the need
for walking as a primary source of transportation. Other activities that would expend
22 G. T. Senney and R. H. Steckel

calories, such as recreational exercise, made limited headway in the South. With
industrialization women increasingly worked outside the home, and while benefi-
cial for income, led to unsupervised eating habits of children who consumed more
snack foods, perhaps while watching television after school, and to greater purchase
of less-nutritious prepared foods for family meals. In the context of the southern
diet, which featured starch, fat, and salt, these behavior patterns contributed to obe-
sity, which is a major risk factor for hypertension (Hall et al. 2015; Jiang et al. 2016;
Leggio et al. 2017).
Because our data and methods lead to conclusions that are only suggestive, an
important goal is to motivate the collection of intergenerational household-level
data for African Americans that could provide a rigorous evaluation of this method-
ology. Most useful would be intergenerational evidence on household income and
socioeconomic status combined with measures of lifestyle behaviors and
hypertension.

2.2 Background

The literature discusses numerous possible explanations for the disparity in hyper-
tension prevalence, including obesity, diet, quality of medical care, stress related to
socioeconomic change, poor access to health insurance, socioeconomic status, salt
retention, and substance abuse (Centers for Disease Control and Prevention 2010).
Several studies report, however, that the disparity in hypertension prevalence per-
sists even after adjustment for a wide range of socioeconomic, behavioral, and bio-
medical risk factors (Redmond et al. 2011). Despite large interventions to eliminate
hypertension disparities, evidence such as that shown in Table 2.2 indicates that
these differences have actually grown over the past few decades (Geronimus et al.
2007), suggesting that unrecognized factors are important in driving inequalities in
hypertension (Fuchs 2011).
The developmental origins hypothesis provides a mechanism for understanding
the origins of hypertension and other noncommunicable diseases found in later
adult life. Some 30 years ago, David Barker and colleagues proposed the develop-
mental origins approach (Barker and Osmond 1986; Barker 1990), after Barker
noticed that older adult deaths from heart disease in England were correlated with
infant mortality rates and birth sizes in their cohorts and geographic locations of
birth. Although there were many skeptics, discovery of the relationship stimulated a
search for possible mechanisms built around the idea that early life conditions influ-
ence adult susceptibility to cardiovascular disease (Lackland 2004). Subsequently,
medical researchers proposed and refined ideas (see, e.g., discussions in Kuzawa
and Pike (2005) and Kuzawa and Sweet (2009)), and a strong following developed
among economists, demographers, and numerous medical researchers (Lackland
et al. 1999, 2003; Hanson and Gluckman 2008; Skogen and Overland 2012; Barker
and Thornburg 2013; Steckel 2013; Lackland 2014). This type of work also engages
economic history (Fogel and Costa 1997; Bleakley 2007), environmental econom-
ics (Deschenes et al. 2009), and family decision-making (Del Bono and Ermisch
2 The Continuing Puzzle of Hypertension Among African Americans: Developmental… 23

2009; Del Bono et al. 2012). The approach also has the advantage of providing a
mechanism for understanding the interconnection with stroke and diabetes.
Mounting evidence suggests that fetuses and infants respond to poor nutrition
and stress by compromising organ integrity and degrading biological processes that
regulate physiological systems in later life (Gluckman et al. 2008; Barker and
Thornburg 2013). Evidence shows that individuals are predisposed to hypertension
if the heart, vascular tree, kidneys, and pancreas are modified in the womb in
response to maternal social stress and poor nutrition. If people rendered vulnerable
face an energy-rich diet or elevated stress in later life, pathophysiological processes
are set into motion that might significantly increase their likelihood of hypertension.
During their developmental stages, humans are able to accommodate stresses
and environmental changes by pleiotropic gene expression patterns that promote
survival. The adaptations made to the stressful environment change the structure
and function of organs before birth and might be passed on to future generations
through epigenetic mechanisms (Aiken and Ozanne 2014). When the fetus is opti-
mized for a lean world, but instead must process a lush load of net nutrition as an
adult, there is a mismatch between expectations and reality. This unexpectedly rich
nutrition actually proves harmful in certain ways to the individual in the longer term
(De Boo and Harding 2006; Swanson et al. 2009). Given this mounting evidence,
there is a need for determining the mechanisms that underlie the observation and the
generality of the finding for other noncommunicable diseases (Jasienska 2009;
Kuzawa and Sweet 2009).
Study of the Helsinki birth cohort, a longitudinal study of 13,517 men and women
who were born in Helsinki University Hospital from 1924 to 1944, shows that low
birth weight, especially when followed by obesity in early adolescence, is associated
with later life hypertension (Barker et al. 2002). Figure 2.2 shows the excess burden
of hypertension as a function of these factors. All births of low weight (<3000 g) had
elevated odds ratios of adult hypertension, but the risks were greatest (odds = 2.5) for
individuals born with weights under 3000 g and a BMI at 11 that exceeded 17.6.
Our goal is not to test or evaluate all of the suggested explanations for elevated
hypertension among African Americans, which would be a considerable task, but
rather to integrate social science research with medical knowledge to advance the
understanding of this puzzle. Our efforts are warranted by the persistence of the
puzzle and the lack of generally accepted explanations. With our data and methods,
we cannot “prove” that the mechanism of the hypothesis operated through rapidly
changing socioeconomic conditions, but we can achieve the important goal of mak-
ing a plausible case for additional study.

2.3 Creating a Vulnerable Population

The Socioeconomic Transformation Figure 2.3 shows that the American South
was relatively poor for several decades following the Civil War. Regional income
per capita in New England was roughly three times that of the South (Kim and
Margo 2003). Conditions drastically improved in the middle of the twentieth cen-
24 G. T. Senney and R. H. Steckel

Fig. 2.2 Odds ratios of hypertension in adults as a function of birth weight and BMI at age 11.
(Source: Barker et al. 2002)

Fig. 2.3 Relative regional income per capita, 1840–1990 (USA = 100). Legend: ne New England,
ma Middle Atlantic, enc East North Central, wnc West North Central, sa South Atlantic, esc East
South Central, wsc West South Central, mt Mountain, pc Pacific. (Source: Kim and Margo 2003)
2 The Continuing Puzzle of Hypertension Among African Americans: Developmental… 25

tury, as regional industrial structures as well as income per capita converged dra-
matically. Southern per capita incomes grew significantly faster than the national
average (Kim and Margo 2003). This was a remarkable achievement because the
quarter century following 1950 was the strongest period for economic growth in the
twentieth century. Not only did the South gain relative to the rest of the country in
mid-century, but African Americans gained relative to whites. Between 1940 and
1980, the real incomes of white men grew 2.5 times, while that for African Americans
grew fourfold (Smith and Welch 1989). As a percentage of white male wages, those
for African Americans averaged 43.3 in 1940 and 72.6 in 1980. Opinions differ on
the sources of this progress, but schooling, civil rights legislation, and south-north
migration were all part of the mix (Heckman 1990; Donohue and Heckman 1991;
Margo 1993).
Pointing toward the importance of civil rights legislation in creating new labor
market opportunities, the median income of African American men in the South
relative to the 25th percentile of southern white men grew by 34% points between
1960 and 1990 (Card and Krueger 1993). Therefore, we argue that southern African
American adolescents of the 1960s and 1970s were particularly vulnerable to hyper-
tension as adults because their parents and older ancestors were poor, and this gen-
eration realized dramatic improvements in net nutrition beyond an age when
biological adaptation to rapidly improving circumstances was limited or impossible.
Income growth per se created vulnerabilities, but as discussed below, this variable is
also a proxy for many changes affecting the diet, work effort, and lifestyles of the
African American population, especially those living in the South. Among these
factors was desegregation of hospitals and fair housing laws, which may have had
independent, beneficial effects on hypertension.
In our analysis, the developmental origins hypothesis predicts that the children of
generationally poor parents who were born under rapidly improving conditions
would have higher rates of hypertension as adults. This paper considers how these
changes translated into greater prevalence of hypertension for African Americans
by relying on the timing of socioeconomic change and its differential impact across
states to identify forces that influence this disease. The empirical strategy has
acknowledged limitations, but if the hypothesis is powerful, one would expect to
find elevated prevalence rates in states and among ethnic groups with this dynamic
environmental history.
Earlier work using state-level data has found that long-term poverty followed by
rapid economic improvement increased the risk for type 2 diabetes at the state level
(Steckel 2013). Given the aforementioned related study and following the develop-
mental origins hypothesis, we suspect that African American families, especially in
the South, who were persistently and severely poor until undergoing significant
income growth after the middle of the twentieth century will have suffered high
rates of hypertension.
Circumstantial evidence suggests an association between income growth and
prevalence. Figures 2.4 and 2.5 provide data on the socioeconomic transformation
in the South and its relationship to the geographic prevalence of hypertension.
26 G. T. Senney and R. H. Steckel

3.0
Growth of Median Houseold Income (Relative to 1940)

2.5

2.0

Nation
[29, 37)
1.5
[37, 39)
[39, 42)
[42, 46)
1.0 [46, 54]

0.5

0.0
1940 1950 1960 1970 1980 1990 2000 2010
Census Year

Fig. 2.4 Growth of black median household income by hypertension region (population weighted).
(Sources: Census 1940, Census 1950 V2 Detailed Characteristics Table 87 and 56 for AL and HI,
Census 1960 V1 Chapter D: Detailed Characteristics Table 133, Census 1970 V1 Chapter D:
Detailed Characteristics Table 192, Census 1980 V1 Chapter D: Detailed Characteristics Table 243
and 244 for AL, Census 1990 V1 CP-2 Table 53, Census 2000 Summary File 4, Census 2010 ACS)

Figure 2.4 shows the growth of median African American household income from
1940 to 2010 ranked by the prevalence of hypertension in 2011 and organized by
clusters of states having similar levels of prevalence. The group of states having the
highest prevalence of hypertension in 2011 were also the states in which income
growth was most rapid. For example, in the cluster of states where prevalence was
in the range of 46%–54%, median household income grew the fastest, by a factor of
2.45 from 1940 to 2010. Figure 2.5 shows that the states with the highest prevalence
rates in 2011 were also the poorest in 1940. These results indicate that rapid growth
out of poverty may have triggered the rise in the prevalence of hypertension.

2.4 Controls

We recognize that many variables other than those associated with fetal origins are
linked to hypertension, and they must be recognized in the empirical analysis.
Among these are smoking, educational attainment, current income, and exercise.
2 The Continuing Puzzle of Hypertension Among African Americans: Developmental… 27

45,000

40,000
Median Household Income (2010 Dollars)

35,000

30,000 Nation
[29, 37)
[37, 39)
25,000 [39, 42)
[42, 46)
[46, 54]
20,000

15,000

10,000
1940 1950 1960 1970 1980 1990 2000 2010
Census Year

Fig. 2.5 Black median household income by hypertension region (population weighted). (Sources:
Census 1940, Census 1950 V2 Detailed Characteristics Table 87 and 56 for AL and HI, Census
1960 V1 Chapter D: Detailed Characteristics Table 133, Census 1970 V1 Chapter D: Detailed
Characteristics Table 192, Census 1980 V1 Chapter D: Detailed Characteristics Table 243 and 244
for AL, Census 1990 V1 CP-2 Table 53, Census 2000 Summary File 4, Census 2010 ACS)

Numerous studies identify smoking as a risk factor in cardiovascular disease,


although there is some disagreement on the biological pathways (Rhee et al. 2007;
Virdis et al. 2010; Gao et al. 2017). Likely suspects are impaired endothelial func-
tion, arterial stiffness, inflammation, and lipid modification.
Education and current income may operate through several pathways to lower
hypertension (Leng et al. 2015). First, high-income, well-educated people were bet-
ter informed about the risks and causes of hypertension, and therefore more likely
to pursue a healthy lifestyle. Second, the poor and less educated have less knowl-
edge of healthcare facilities, and a greater feeling of helplessness or lack of control
over their health situation (Xu et al. 2013).
Exercise obviously affects obesity, but studies show that it has an independent
beneficial effect on hypertension (Dimeo et al. 2012; Pescatello et al. 2015; Naci
et al. 2018). A meta-analysis of major exercise and drug trials showed that exercise
and drug interventions were similarly effective in reducing mortality outcomes for
coronary heart disease, and physical activity interventions were actually more effec-
tive for the secondary prevention of stroke mortality (Naci and Ioannidis 2013).
28 G. T. Senney and R. H. Steckel

2.5 Testing the Hypothesis: Data and Methods

We investigate the strength of the developmental origins hypothesis by analyzing


data on individuals collected by the 2011 BRFSS, a cross-sectional telephone sur-
vey conducted by state health departments with technical assistance from the
CDC. In addition to age and race, this source provides data on education, poverty,
smoking, obesity, and patterns of exercise. These variables are defined by answers
to the following questions:
• Hypertension: Have you ever been told by a doctor, nurse, or other health profes-
sional that you have high blood pressure?
• Smoking: Do you now smoke cigarettes every day, some days, or not at all?
• Education: What is the highest grade or year of school you completed?
• Exercise: During the past month, other than your regular job, did you participate
in any physical activities or exercises such as running, calisthenics, golf, garden-
ing, or walking for exercise?
• Obesity: About how much do you weigh without shoes? About how tall are you
without shoes? Data used to calculate BMI.
According to the developmental origins hypothesis, one would expect rapid
socioeconomic change to have had its greatest impact on adult disease for African
Americans when the individuals were children or young adults. Development in
utero and early childhood created a thrifty phenotype for them, and rich net nutri-
tion would have challenged their cardiovascular system as adults. To match periods
of vulnerability to chronological patterns of economic growth, we divide the BRFSS
sample into five cohorts defined by these age groups: 18–34, 35–44, 45–54, 55–64,
and 65+. The group aged 65+ in 2011 would have been children or young adults
between roughly 1940 and 1970, so for this cohort, we measure economic growth
between these 2 years.2 Similarly, for the group aged 55–64 in 2011, the corre-
sponding years are 1950–1980, and so forth. There is nothing compelling about a
30-year interval, and so we also conduct sensitivity tests for other windows. For a
20-year interval, the oldest age group would have spent birth to early adulthood
from roughly 1940 to 1960.
The BRFSS questionnaire provides information on income and poverty, but
unfortunately, the data cannot be linked longitudinally because the survey partici-
pants differ over time. As an alternative, we use the median income of African
American households at the state level, which has limitations because there is het-
erogeneity within states. Competitive labor markets within states ameliorate the
problem but migration complicates it. We adjust nominal income using the Federal
Reserve Bank of Minneapolis’ Chained-weighted CPI with 1982–1984 as the base
year. The variable we use is the ratio of median household income in period 2 to that
in period 1.

2
We would consider measuring growth from an earlier period, say 1930, but unfortunately the
median household income data are unavailable prior to 1940.
2 The Continuing Puzzle of Hypertension Among African Americans: Developmental… 29

Our interpretation of the developmental origins hypothesis accepts that rapidly


improving socioeconomic conditions that follow persistent poverty create non-­
harmonious growth and elevate the risk of adult hypertension. Individuals whose
families lived in poverty for generations would have been prone to have children
whose cardiovascular system would be stressed by rich net nutrition later in life.
Under this theory, sudden prosperity would have created nutritional abundance and
weight gain, exposing these cohorts of children to greater risk of hypertension.
Maternal income has been shown to have a significant impact on birth weight for
those infants who are already at high risk hereditarily. However, it is not clear
whether income acts as a developmental buffer for low-birth-weight infants as their
lives progress. These findings suggest the existence of biosocial interactions
between hereditary predisposition and socioeconomic environment matter (Conley
and Bennett 2001). The developmental origins concept connects non-harmonious
growth trajectories in early life with chronic illnesses of adulthood. As noted in
Barker (2002), per capita income can be a proxy for nutritional conditions as dis-
cussed below.
We employ a probit regression to model the presence or absence of hypertension
of individuals in 2011. In this statistical formulation, the dependent variable takes
on the value of 0 or 1 depending upon the hypertensive condition of the individual,
with 1 (present) and 0 (absent). The model estimates the probability that an observa-
tion with particular characteristics will fall into either the present or the absent
category.
Among the explanatory variables, economic change is measured by the ratio of
median household income at the state level in period 2 compared to period 1. Period
1 is defined by the approximate year of birth and period 2 by the approximate year
in which the individual reached early adulthood. The times can be only approximate
because income is measured every decade.
Under the proposed hypothesis, the coefficient on the ratio of income should be
positive, large, and statistically significant, but the size of the coefficient would
depend upon the timing of the birth cohorts relative to the rate of economic growth.
Specifically, the impact would have been greater on individuals who were older
when rapid growth occurred because they had less opportunity to adjust.

2.6 Results

The coefficients in the table of results denote the marginal effect of each indepen-
dent variable on the dependent variable, holding other variables constant. As indi-
cated earlier, the value of the variable rMedian income used in the regression
depends upon the age group in which the individual is located. To capture the effect
of changing socioeconomic circumstances on hypertension, we measure income
growth from the time period of birth to young adulthood.
It is well-known that hypertension increases with age, and for this reason, we
include age dummies as regressors that identify birth cohorts. As the age of the
30 G. T. Senney and R. H. Steckel

groups declined relative to the period of rapid growth, individuals had greater
opportunity to adapt to change, and consistent with this observation, the coefficients
on the dummy variables for age declined. Notably the coefficient for the age group
65+ (1.536) was 4.1 times greater than that for the age group 35–44. This result is
consistent with our expectation, derived from the developmental origins hypothesis,
that individuals who were younger during a time of great change had more opportu-
nity to adapt.
The results for the other coefficients are as expected. Higher median household
income in 2010 lowers the prevalence of hypertension because richer households
are better able to afford medical care. A related income measure, living in poverty,
raises it. Many studies have noted that health improves with the level of education
and in our specification people with lower education (high school or less) have a
greater prevalence. Several studies also report that the prevalence of hypertension
increases with smoking, obesity, and lack of exercise, all of which are confirmed in
Table 2.2.
It is reasonable to ask whether this number is large or small. In making this deter-
mination, we note that reported hypertension underestimates actual hypertension
prevalence, especially among minority groups. A recent study found that fewer than
50% of adults with hypertension controlled their blood pressure in 2007–2008,
which approximately doubles the impact on health of the income coefficient in
Table 2.2. The coefficient on median income in 2010 is negative and significant in
two specifications and is marginally significant in a third one. The direction of the
effect (negative) is intuitive because larger current income enables households to
better provide healthcare for their children.
The regression results suggest that intergenerational poverty followed by rapid
socioeconomic improvement elevates the risk of hypertension, which describes the
experience of African American adults born after World War II. This analysis is
consistent with developmental origins hypothesis as states with the larger income
growth, controlling for other factors, tended to have larger prevalence of hyperten-
sion. Below we offer interpretations of the variables that control for current
conditions.
Lower education suggests that the individual is less informed about the impor-
tance of regular health maintenance or less able to locate resources to assist in
obtaining healthcare. In line with established research, we find that the coefficient is
positive and statistically significant. Stress associated with poverty can cause hyper-
tension. It is well documented that potential stresses include job, financial, and fam-
ily distress (Kulkarni et al. 1998). The coefficient is positive and significant; our
result is well in line with the documented fact that low-income families tend to have
generally poorer health than wealthier families (Marmot 2002).
Medical research has shown that excess body fat is associated with higher levels
of hypertension and mortality (Faeh et al. 2011; Zheng et al. 2013). Consistent with
this pattern, obese individuals were significantly more likely to be hypertensive in
all cohorts. Similarly, exercise reduced the chances of hypertension, although the
variable is marginally significant in only one specification.
2 The Continuing Puzzle of Hypertension Among African Americans: Developmental… 31

2.7 Discussion

In recent decades, social scientists and medical researchers have studied the upward
trend in obesity rates, and collectively they have put forward several explanations.
All begin, however, with some type of energy accounting, i.e., that the growth of
calorie consumption outpaces the growth of physical activity. Among the ideas put
forward are a rise in the cost of time-intensive, home-prepared meals associated
with women working outside the home (Cutler et al. 2003; Hamrick and Okrent
2015), technological change that made work less demanding (Philipson and Posner
2003; Lakdawalla and Philipson 2009), changes in diet featuring processed foods
that replaced home-prepared meals (Devine et al. 2006), stress-induced eating cre-
ated by managing the challenges of socioeconomic change (Torres and Nowson
2007), and the proliferation of fast-food restaurants that conveniently provided calo-
ries at low cost (Chou et al. 2004; Schlosser 2012). Many of these arguments apply
to African Americans, especially those who lived in the South.
Table 2.1 shows the trend in obesity by race from 1959–1962 to 2015–2016. In
all years, obesity rates of blacks exceeded those of whites, and on average were 39%
higher. Here we discuss pathways by which the transformation of African American
socioeconomic conditions, particularly in the South, ultimately promoted obesity,
which in turn contributed to hypertension in a vulnerable population by reducing the
physical activity of daily life in an environment of a rich diet and little recreational
exercise. The major components of our analysis are the mechanization of agricul-
ture, lack of recreational exercise, the spread of automobiles, women’s employment
outside the home, and the continuation of a rich diet.
The Mechanization of Agriculture Based on the 1950 Census, agriculture was
the dominant industry in the South (U.S. Bureau of the Census 1952). In the swath
of states that extend from Texas and Oklahoma to North Carolina, the average share
of African Americans employed in agriculture was 31.8%. It exceeded 35% in North
Carolina, South Carolina, Arkansas, and Georgia. By 1980, however, the average
share in the 11 states had declined to 3.4% and slightly exceeded 5% in only three
states—Florida, Arkansas, and Mississippi (U.S. Bureau of the Census 1983).
Relief from field labor came late to the South relative to other regions (Hurt
1989). Mechanization of the harvest was difficult to accomplish in the region’s most
important crops of cotton and tobacco. Even today, the latter requires extensive
hand labor and thus mechanization contributed little to productivity in this crop.
Therefore, we focus on the predominant crop, cotton.
A 1939 study of man-hours per acre in cotton production in the Mississippi Delta
showed that that vast majority of time (62.9%) was devoted to the harvest, while
cultivating, thinning, and weeding the crop absorbed an additional 30.9% (Holley
2000, p.134). Picking cotton by traditional methods required long hours of stoop
labor, and unlike grain for which mechanical harvesters had existed for over a cen-
tury, cotton harvesting faced two challenges: irregularly spaced bolls and bolls that
ripened at different times on the same plant (Holley 2000). Development of new
32 G. T. Senney and R. H. Steckel

Table 2.1 Trend in obesity rates, white and African Americans


Year Freq. % obese AA % obese white
1959–1962 6672 20.82 13.21
1971–1974 16,730 22.28 13.73
1976–1980 12,520 30.91 20.62
1988–1994 17,752 28.57 21.41
1999–2000 5448 37.77 27.60
2005–2006 5563 43.60 32.04
2009–2010 6527 48.63 33.87
2015–2016 5992 44.77 37.21
Source: CDC. National Health and Nutrition Examination Survey

Table 2.2 Explaining the prevalence of hypertension across individuals within age cohorts with
30-year income gap after birth

80/50 30 Year Gap


rMedian Income 0.015*** 0.022***
(0.007) (0.007)
Income 2010 -0.004*** -0.004***
(0.001) (0.001)
HS or Less 0.085*** 0.086***
(0.019) (0.019)
Poverty 0.163*** 0.163***
(0.023) (0.023)
Smoking 0.072*** 0.072***
(0.019) (0.019)
Obesity 0.483*** 0.483***
(0.001) (0.002)
Exercise -0.004*** -0.004***
(0.001) (0.002)
Age 35-44 0.396*** 0.374***
(0.037) (0.039)
Age 45-54 0.893*** 0.862***
(0.032) (0.036)
Age 55-64 1.340*** 1.302***
(0.032) (0.038)
Age 65+ 1.589*** 1.536***
(0.034) (0.043)
N 21,718 21,718
Pseudo R2 0.2472 0.2473
Notes: Age group 18–34 is the omitted group. rMedian income for the 30-year gap column: 65+
(70/40), 55–64 (80/50), 45–54 (90/60), 35–44 (00/70), and 18–34 (10/80)
2 The Continuing Puzzle of Hypertension Among African Americans: Developmental… 33

Fig. 2.6 Diffusion of the cotton picker: percent of the crop picked by machine within regions.
(Source: US Department of Agriculture (1974), Table 185)

varieties that ripened bolls at about the same time solved the latter, but it took some
engineering to build a machine that was effective at removing bolls with little
destruction of fibers while also eliminating plant debris.
The diffusion of the cotton-picking machine during the 1950s and 1960s nearly
eliminated hand labor in picking by the early 1970s. Figure 2.6 demonstrates the
extent of change. In 1950, approximately 5% of the crop was picked by machine
and by 1970 the figure had risen to virtually 100%. Although mechanical cotton
pickers largely replaced hand labor between the late 1940s and the 1960s, hand
methods persisted on small farms for a decade or more (Heinicke and Grove 2008;
Logan 2015).
The diffusion of the tractor was a second important change that eased the burden
of physical labor in the South (Fig. 2.7). Relative to other regions, farmers were
slow to adopt this machine, and mules lingered on small farms operated by older
farmers until the 1960s (Ellenberg 2007). Southern customs were fashioned by a
long history of physical labor in the fields that welcomed rest at the end of the work-
day and discouraged work on Sunday. These habits persisted after diffusion of the
tractor and the mechanical cotton harvester, thereby adding to weight gain in an
environment where people maintained a rich diet and eschewed recreational exer-
cise (Church et al. 2011)
The South was not a region where habits of recreational exercise and health club
memberships readily replaced a decline in caloric expenditure associated with a
Another random document with
no related content on Scribd:
“Harrow Wanderers v. Gentlemen of Cheshire.—T.
S. M. Trentham, not out, 205.”
“We have it from a reliable source,” says the Athletic
News, “that the authorities at Old Trafford are making
strenuous efforts to induce Mr. T. S. M. Trentham, this
year’s captain at Harrow, and the youngest member of the
famous brotherhood whose name he bears, to qualify for
Lancashire. As doubtless our readers are aware, the
authorities at Old Trafford have always been justly
celebrated for their generous appreciation and
encouragement of the cricketing talent of other counties,
and in the case of young Mr. Trentham there is something
peculiarly appropriate in the benevolence of their present
attitude, as it is rumoured that Mr. Trentham once had an
aunt who lived near Bootle.”

I could read no more. The Sportsman dropped from my unheeding


hands, and I had just begun to whistle the opening bars of the “Dead
March,” when two brown boots and the lower parts of a pair of grey
flannel trousers wriggled from the lawn through the open window.
They were surmounted two seconds later by a straw hat, a straw-
coloured moustache, and an aquiline nose, which I identified as
belonging to the General Nuisance. He had an exquisitely neat
brown paper parcel under his arm, and a smile of fifty candle-power
illuminating his classic features. I was horrified to see it.
“You’re early this morning,” I said resignedly. “It wants a quarter to
eight yet. Have some breakfast?”
“Tha-anks,” he drawled, “but I’ve had my milk. I’ve called round to
bring you yours.”
As he spoke he removed the string from the parcel in the most
leisurely manner and disclosed a pile of carefully folded newspapers
with names pencilled on the corners. Having discovered mine, he
handed it to me with that air of benevolent condescension that head
masters wear on speech day.
“How nice of you!” I said. However, I’m afraid this irony was so
delicate that he didn’t feel it.
“My dear fellow, not at all,” he said. “There’s one for everybody. I’m
delivering ’em to the whole team, don’t you know.”
Needless to say, he had presented me with an immaculate copy of
the Sportsman. I picked up my own discarded sheet from under the
table.
“Awf’ly obliged, old chap, but I’ve got one, thank you,” I said,
pleasantly.
“That’s lucky,” said he, “you can give one to your friends. Rather
pretty reading, isn’t it? Awf’ly decent set, Trenthams, Elphinstone,
etcetera.”
“Git!” I said, gazing round for a boot-jack or a poker, or something
equally likely to debase his physical beauty.
“Ta-ta then, see you later!”
To my infinite joy he appeared to be taking the hint. But he had only
just conducted his infernal smile to the right side of the window,
when he jerked it back again, and said:—
“Oh, I forgot! I say, Dimsdale, I ought to tell you this. I rather think
Billy was drunk last night. His eyes are as red as a ferret’s this
morning, and his housekeeper told me in confidence that when she
got up this morning and went to call him she found master’s umbrella
in bed and master sleeping in the umbrella-stand.”
“No, don’t say that,” I gasped, with a sinking at the heart. Alas! we’d
only got two bowlers, and Billy was the one on whom we depended
most.
“Fact!” said the General Nuisance cheerfully; “wouldn’t trouble you
with it if I thought it wasn’t true. Lawson drove up with the Doctor as I
came away. I implored our gentle secretary not to mourn, since a few
Seidlitzs and a stomach-pump can do a lot in a very little time. I don’t
know if you’ve noticed it, but it is generally slow bowlers who resort
to intemperance, because as they’ve only got to lose their perfect
length to embitter the lives of others, their possibilities become quite
unbearable on a big occasion. At the M.C.C. match Lawson sat
beside him at lunch both days counting his liqueurs. Poor old
Lawson! I felt it my duty to assure him just now that it really took very
little to make Billy lose his length. I also took the liberty of reminding
him of what happened when he lost it once before, against Emeriti,—
5 overs. 0 maidens. 51 runs. 0 wickets.
and Emeriti had got quite an ordinary side.”
Just as the muffineer arrived at the head of the General Nuisance,
the General Nuisance was mean enough to duck. This act enabled
the muffineer to crash through the plate-glass window.
“Timed that to a ‘T,’” said he. “Can see absolutely anything this
morning. Certain to book fifty if I once get in, which I take to be a
strong enough reason why an inscrutable Providence will cause us
to lose the toss and keep me in the field all day.”
“Hope you will be there,” said I savagely, “and I’d like to see you
taking long-field on both ends. And I hope you’ll drop a catch in front
of the ladies’ tent. And I hope when you come racing round the
corner to make that magnificent one-hand dive to save the four, the
bally thing’ll jump and hit you in the teeth. And if you do go in to bat I
hope you’ll be bowled neck and heels first ball.”
Ignoring this peroration he again appeared to be at the point of
withdrawing his hateful presence. But too well did I know the General
Nuisance to anticipate such a consummation. He merely seated
himself on the sill in an attitude that would enable him to cope with
sudden emergencies, and then said:—
“Oh, by the way, the youngest Gunter girl; you know, the little one
with the green eyes and the freckles—just got engaged they say.”
“Who to?” I said fiercely. The General Nuisance certainly plumbed
the depths of human fiendishness, but in conversation he had a
command of topics that were irresistible.
“Who to?” I said.
“One of the Trenthams,” he smiled. “Ta-ta! See you ten-thirty.”
He was gone at last, and I had barely time to praise Heaven’s
clemency that this was even so, when William entered with the face
of an undertaker out of work.
“Clean gone, sir,” he said. “Abso-blooming-lutely! Looked high and
low, and Mrs. Jennings ain’t no notion.”
“Looked in the lining of the bag?”
“Everywhere,” said the miserable William.
“Well,” said I, “unless it’s found I don’t get a run to-day.”
“I can tell you, sir,” said William, “that I’d rather lose my perquisites
than that this should have ’appened at Little Clumpton v. Hickory. But
there’s the Winchester, and the Magdalen, and the M.C.C. Couldn’t
you get some in one of them, sir?”
“Daren’t risk it,” I said, “not at Little Clumpton v. Hickory. Yet, let me
see, hasn’t Mr. Thornhill one of the Authentics?”
“Why, Lor’ bless me, that he ’ave, sir!”
“Well, get your bike at once, give my compliments and kind regards
to Mr. Thornhill and tell him I’ve lost my Authentics and will he lend
me his. Explain that it’s Little Clumpton v. Hickory, and that I can only
get runs in the Authentics. It’s now eight-twenty, and it’s eighteen
miles to Mr. Thornhill’s place. Can you bring it to me by eleven?”
“Well, sir, if I don’t, you’ll know I’ve burst a tyre.”
Within five minutes William was riding to Thornhill’s as if his life
depended on it, with the stable-boy to pace him.
CHAPTER III
LITTLE CLUMPTON v. HICKORY
I CAME down to the ground at a little after ten. The match was to
begin at eleven, sharp. The only sights of interest on my arrival were
the ground-man marking out the crease, and the Worry at the nets in
a brand-new outfit. The “pro” and three small boys were striving to
knock a shilling off his middle.
“You’re touching ’em pretty this morning, Daunton,” said I, out of pure
excellence of heart. I wished him to keep up his pecker.
“Think so?” he said nervously. “I’ve had an awful bad night, and I
believe there’s something the matter with my wrist. I wish I wasn’t
playing.”
The Worry’s life was a burden to him on match days. When he went
in to bat he issued from the pavilion with a wild eye and a haggard
mien, and a rooted idea that he was bound to be bowled first ball.
This he invariably played forward to, as the strain on his nervous
system was so severe that it was a physical impossibility for him to
wait and receive it in his crease. He counted every run he got, and, if
there was the faintest doubt about a snick, he would say, “I hope you
noticed that I touched that, umpire.”
The crowd was already beginning to assemble. Vehicles and
pedestrians were flocking in from twenty miles around. Hickory was
a neighbouring village, only seven miles distant, but the rivalry was
so keen that the local public-houses did no trade while the great
match was in progress. It always had been so, and always would be.
Even in the early forties Little Clumpton v. Hickory had become
historical. Alfred Mynn and Fuller Pilch had actually graced the
annual encounter in the Park. There was only one match a season;
two would have been more than human endurance could have
borne; and the Park, which generations of its noble owners had been
very proud to lend for this nation-shaking function, was the only
cricket-ground in the vicinity that could hope to accommodate the
rival partisans. It might have been that once on a time the ’Varsity
match had been played on other turf than Lord’s; but the Park was
the only spot in England that had ever had the privilege of witnessing
Little Clumpton v. Hickory on its velvet sward. Let kings depart and
empires perish, but this always had been so and always would be!
To appear at Little Clumpton v. Hickory was not the lot of common
men. Only the elect could hope to do so. To take wickets or make a
score at this encounter was to become a classic in one’s lifetime.
There were hoary veterans round about, whom the uninitiated might
take to be mouldering mediocrities, but no—“see t’ owd gaffer theer?
well, ’e wor a ’56 man; and t’ littlin theer across the rowad ’e wor
’59”—which being interpreted means that 1856 and 1859 were the
dates of their distinction. Therefore do not let the young think, as
unhappily they do just now, that they must write a book to become
immortal. Why will not a few thousands of these seekers after fame,
these budding novelists and early poets, take to cricket? For is it not
more honourable, and certainly more glorious, to make a century at
Little Clumpton v. Hickory, and make half a shire shout your praise,
than to translate Omar Kháyyám and become a nuisance to
posterity?
Presently I beheld a sight that nearly brought the tears into my eyes.
The Optimist and the Pessimist were coming arm-in-arm across the
grass. The lion lay down with the lamb at Little Clumpton v. Hickory.
The Secretary walked alone with looks and words for none. He was
so positively dangerous that the General Nuisance forbore to ask
him what bowling we had got.
Having changed, I was sallying forth from the pavilion in the
possession of bat and ball for the purpose of “having a knock” when
a sudden palpitation made the crowd vibrate.
“’Ere’s Hickory! Good owd Hickory!”
A solid English-throated cheer announced that the enemy were in
sight. A thrill ran through me as I gazed in the direction of their
coming, for certainly the appearance of such a celebrated side was
something to be seen. It was. A four-in-hand came bumping along
the stretch of uneven meadow at a clipping pace. And to my
indignant horror and bewilderment I saw that the reins were
commanded by a person that wore nice white cuffs and a brown
holland blouse. Conceive the cream of English cricket with their legs
tucked up on the top of that rocking, creaking, jumping, jolting coach
at the mercy of a person in a brown holland blouse! It was a thing
that required to be very clearly seen before it could be accepted. In
agony of mind I rubbed my eyes and looked more intently at the
furiously on-coming vehicle. Never a doubt its pace was reckless,
criminally reckless, considering the priceless freight it bore.
“What do you think of that?” I cried, turning in my distress to the man
beside me. He happened to be the Ancient, so-called, because of his
thoughtful air and his supernatural wisdom. “Just look at the
confounded thing, I’m certain that girl’ll have it over. Gad! did you
see her dodge that ditch by about three inches? Those men must be
perfect fools! Why doesn’t that idiot beside her lend a hand? But
some of these women are steep enough for anything. That girl ought
to be talked to.”
“Well, suppose you do the talking,” said the Ancient, with his most
reflective air. Then, as the drag lurched into our midst, wheels and
harness grunting, the glossy animals in a lather; and they were
drawn up with a sure hand in front of the pavilion while a cheering
and gaping throng pressed about the wheels to impede the great
men in their descent, the Ancient pensively continued, “Tell you
what, my boy, I should rather like the chance of talking to that young
person.”
To do her justice, she was certainly a source of comfort to the eye.
When she yielded the reins and stood up on the footboard she had
that air of simple resolution that is the source of England’s pride.
She was so tall and trim and strong, there was such a decision in her
curves that her brown holland with white cuffs and collar, her Zingari
tie, and hat-band of the same red and yellow brilliance round a straw,
with heavy coils of hair of a proper country fawn-colour beneath, lent
her that look of candid capability that nature generally reserves for
cricketers of the highest order. I never gave the cracks from Hickory
a second thought. Everything about her was so clean, so cool, so
absolute, that before she had left the box I had quite convinced
myself that whoever she might be she was a young person whose
habit was to do things.
“Catch!” she cried, and threw down the Hickory score-book.
She then superintended the unlading of the coach roof of its pile of
brown and battered cricket bags, whilst the crowd pressed nearer to
the wheels and evinced the liveliest concern as to “which is A. H.?
And who’s the tall chap? And who’s the Parson? And don’t he look a
funny little cuss? And who’s the very tall chap? ’Im wi’ the big ’ead?
H. C. o’ course. And who’s the lamp-post? And that theer fleshy
bloke who’d got three boys to carry his bag, a fourth to carry his hat,
and a fifth his newspaper, must be Carteret, because it said in the
Daily Chronicle that he was the fattest short-slip in England and took
life easily.” Of such are fame’s penalties!
The young person in brown holland having made it her business to
see that the bags were bundled down with the necessary degree of
violence, said: “I think you men had better go and change
immediately. I’ll have a look at the wicket.”
She swung down from the step before any of the men below could
lend a hand, and, while the whole eleven moved towards the pavilion
with their luggage, the young person in brown holland made her way
through the throng with the confidence of a duchess at a charity
bazaar, and strode across the grass without the least suspicion of
the Meredithian “swim.” And it was quite a coincidence that the
Ancient and myself should choose a spot as near the wicket as the
unwritten laws allowed, for the purpose of having a little practice.
The ground-man was lingering over the last touches to his
masterpiece when the young person in brown holland actually set
foot on the sacred earth that the general public is not even permitted
to approach. The face of the ground-man was well worth looking at.
When the feelings of a great artist are outraged it is a very painful
sight. Alas, poor Wiggles! the agony of his countenance no pen
could depict. He lifted up his head and emitted a slow-drawn growl.
This had no effect whatever. Indeed, an instant later, this most
audacious individual had the incredible effrontery to bring down a
pretty solid brown boot, by no means of the “little mice” type either,
twice upon the pitch itself. It was more than a merely human ground-
man could endure.
“Begging pardon, miss,” said he, “but are you aware, miss, that this
here is a—a wicket?”
“Well, my dear man,” said the person thus addressed, “do you
suppose I thought it was a bunker?”
The Ancient and I agreed that this was an achievement. For a
member of the general public to retort effectually on a real live
ground-man was as great a feat as to look at the Chinese Emperor.
The face of Wiggles was a study. Meanwhile, the lady having
sufficiently tried the adamantine surface with her boot, bent down
and pressed on it with her thumb. A feather would have slain the
miserable Wiggles at that moment. Was it possible that any human
creature, let alone the sex, could presume to test, and criticise, and
doubt his masterpiece in this way! But worse was coming.
Apparently the young person in brown holland was determined to
satisfy herself in regard to every detail.
“Ground-man,” she said, “has this turf any tendency to crumble?”
“No, it ain’t,” said the ground-man savagely.
Having laid her doubts in this direction, she proceeded to view the
wicket lengthwise. Setting her alert tanned face in a precise line with
the stumps, she said:—
“Ground-man, are you sure that these sticks are quite plumb!”
“If they ain’t it’s the fust time i’ thirty yeer.”
“But surely the leg peg your end wants pulling out a bit. That’ll do. It’s
all right now.”
When the utterly demoralised Wiggles discovered that he had
unconsciously obeyed the behests of the young person in brown
holland, I never saw a man who more regretted his own inability to
kick himself.
“Well, ground-man,” she said slowly and reflectively, “I think this
wicket is good enough for a Test Match. Here’s a shilling for you.”
The hesitation of Wiggles was really painful. A shilling is a shilling
always, but how could a self-respecting ground-man accept one in
these humiliating circumstances? His views on political economy,
however, reconciled his outraged feelings to this added insult. He
took the shilling with a defiant air.
“And, ground-man,” she said, “mind that I tip you for every individual
century that is got for Hickory to-day.”
“Thank you kindly, miss,” said Wiggles, with a groan. He was Little
Clumpton to the marrow. The poor wretch cast a despairing glance
at the Ancient and myself, while we practised in the most assiduous
manner.
Suddenly a peal of laughter came from the young person in brown
holland. It seemed that the sight-board in front of a dark fringe of
trees behind the bowler’s arm had attracted her polite attention.
“Charlie’s arm’ll be over that,” she cried delightedly. “We’ll put him on
that end.”
“Ancient,” said I, “do you hear what that—that girl’s saying? Why
doesn’t that idiot Wiggles order her off the field? If she stops there
much longer we’re a beaten team.”
Just then she turned her attention to us engaged in practice. Now
the sight of this—this person who was so busily occupied in laying
traps and pitfalls for Little Clumpton’s overthrow enraged me to that
degree that I determined to get rid of her by uncompromising
methods. She stood in the exact line of my crack to cover.
“Ancient,” I said, “just chuck up a nice half-volley on the off, and I’ll
make this place a bit too hot for that young person in brown holland.”
The Ancient lost no time in becoming accessory before the fact, and,
throwing my leg across, I put in every ounce I’d got.
“Oh, goo—od stroke! goo—od stroke!” cried our intended victim in a
very joyful voice. And we had the privilege of witnessing the young
person we were conspiring to remove calmly place her feet and
hands together, as per Steel and Lyttelton, and field and return that
red-hot drive in the neatest, cleanest, county style.
“Well, I’ll be damned,” said I.
“If she’s fielding cover for them,” said the Ancient grimly,
“somebody’ll be run out. We’d better advise Lennox and Jack
Comfort not to try to steal ’em. I shan’t go for short ’uns, I can tell
you.”
The Ancient owed his eminence to the fact that no detail was too
mean for his capacious mind. Besides, he was as strenuous,
serious, and self-centred as a novelist with a circulation of a hundred
thousand copies.
Much to the relief of Wiggles and ourselves, the sight of a perfect
broad-shouldered giant of a fellow issuing from the pavilion at this
moment, clad in flannels, bat in hand, lured the young person in
brown holland from her very inconvenient and highly dangerous
station at the wicket.
“Hi, Archie, got a ball?” she cried at the pitch of a splendid pair of
lungs.
“Hullo, Grace!” replied the giant in a voice by no means the inferior of
her own. “You’re just the very chap. I want half a dozen down. Let’s
cut across there to the nets. Here you are. Look out!”
Thereon the giant hurled a ball a terrific height into the eye of the
sun. It seemed so perilously like descending on our heads that poor
Wiggles put up his hands and began to run for his life. Not so the
young person in brown holland. She stepped two or three yards
backward, moved a little to one side, shaded her eyes a moment
from the glare to sight the catch, and next instant had the leather
tucked beautifully under her chin in a manner worthy of a G. J.
Mordaunt.
“Wiggles,” said I, “do you happen to know who that lady is?”
“Wish I did, sir,” said Wiggles feebly. “She’s a terror, ain’t she? But I
hope she don’t come here too often. I reckon she’s a Trentham, she
is. That wor A. H. what just come out. Lord, and just look at that
theer gal a bowlin’ at ’un. She sets ’un back on his sticks an’ all.”
We turned our attention to the nets, and beheld her bowling slow
hanging length balls to A. H. Trentham, almost a facsimile of Alfred
Shaw.
“I tell you, Dimsdale,” said the Ancient, “if this is what lovely woman’s
coming to, it’s high time some of us crocks took to golf. I wonder if
Miss Grace plays for M.C.C. I notice she’s got their colours on. I’ve
always contended that they never look so well as when worn by W.
G., but I’m hanged if this new Grace don’t give the Old Man points.”
CHAPTER IV
An Impossible Incident
THE great men were now coming out in twos and threes to have a
knock.
“Hullo!” said I, “that’s Elphinstone. Remember him at ‘the House.’
There’s not much of him, but what there is is all-sufficing. And just
look at those great big bounding Trenthams. Anyone of ’em could
put the little parson in his pocket. And I say, Ancient, do you notice
that the young one, about the build of Townsend—I mean the one
clapping his hands for the ball—do you notice that he’s an enlarged
copy of the young person in brown holland? Same hair, and eyes,
and nose, and everything; same cheerful enterprising look. It’s a
million to a hay-seed she’s a Trentham, too.”
But the Optimist approached, an encyclopædia of the scientific and
the useful.
“Brightside,” said the Ancient, “we want to know who that girl is
who’s sticking up A. H. like Alfred Shaw.”
“Better go and ask Lawson,” said the Optimist. “I’ve just suggested
that he puts a placard up in the refreshment tent to the effect that the
singularly interesting being in brown holland is Miss Laura Mary
Trentham, yet another member of the world-famous cricket family of
that name. Lawson’s being simply besieged with questions.”
“But A. H. called her Grace just now?”
“Her baptismal name is Laura Mary, but they call her Grace because
she keeps five portraits of that hero on her bedroom mantelpiece.
Rumour also says that she keeps strands of his beard stowed away
in secret drawers. This she indignantly denies, however, as she
swears that if she’d got them she’d wear them in a brooch.”
“H’m! And what an extraordinary resemblance there is between her
and T. S. M.”
“They’re twins. She’s about an hour the older of the two, and I
believe she bullies him outrageously. And I rather think she gives her
honourable and reverend papa, and the remainder of the family, a
pretty lively time. Why, here’s the old gentleman himself.”
The Captain and the Humourist were accompanying a fine old
clergyman in an inspection of the wicket. He was gigantically built.
His perfectly white hair lent him a venerable expression that was
hardly borne out by his massive shoulders and athletic figure, for
they had not the faintest suspicion of age.
“By Jove!” said the Optimist in enthusiastic tones, “that old boy’s
been a player in his day. In the fifties he practically beat the Players
single-handed more than once. In fact, the old buffers say at Lord’s
that for three years he was the best amateur bowler that there’s ever
been. Of course wickets have altered since his time, but up at Lord’s
they swear that Spofforth at his best was never in it with ‘the
Reverent.’”
“’Don’t wonder then,” said I, “that this Clerk in Holy Orders has got
such a devil of a family. Look out, mind your heads!”
Captain George, of the Artillery, had chosen that moment to open his
shoulders to the youthful T. S. M. with the result that a lovely
skimming drive dropped twenty yards in front of the pavilion and
bounced with a rattle on to the corrugated iron roof. We had barely
time to observe this when a buzz of amazement went round the
crowded ring. It seemed that at last A. H., of Middlesex, had “had a
go” at one of the insidious deliveries of Miss Grace, his sister, with
the result that he lifted her from the far net clean over the ladies’ tent.
“Yes,” said the Ancient, “they appear to be a thoroughly amiable,
courteous, carefully brought-up, gentle-mannered family. There they
go. It’s H. C.’s turn now. He’s very nearly killed a little boy. They
seem to bowl like hell, and hit like kicking horses!”
This brought misfortune to us in hard reality. The General Nuisance
strolled up with his permanent simper.
“Oldknow,” said he, “unwillingly I heard the profane utterance of your
pagan mind. It is grievous for a man of your parts and understanding
to give way to language of that character. But you will be glad to hear
that our esteemed Secretary, Lawson, is suffering at this moment
from an attack of incipient paralysis. It appears that that blackguard
of a Billy is confined to bed.”
“The brute!”
“The beast!”
“The pig!”
“What I we are actually left to face a team like this with one bowler?”
said I, the first to recover from the shock.
“Don’t be in such a hurry,” said the General Nuisance, with his
geniality rising almost to the point of hysteria. “We aren’t even left
with one. As a matter of fact we haven’t a bowler of any sort. It’s true
that we’ve any amount of the usual small change. I can bowl three
long hops and two full tosses in an over, so can you; so can all of us;
and that, dear friends, is what we’ve got to do.”
“But you are forgetting Charlie,” said the Optimist of the lion heart.
“Oh dear, no,” said the General Nuisance, “’wouldn’t forget him for
the world. If you would only wait and let me break the news with my
usual delicacy. Charlie’s just wired to say that his mother-in-law has
been taken seriously ill, and that he and Mrs. Charlie have been
obliged to go to town.”
Straightway the Ancient wheeled about, and fled—fled with a curse
into the recesses of the pavilion, far from the madding crowd, the
pitiless sun, the perfect wicket, and those dreadful men from Hickory
loosening their arms.
“Tha-ank you! Tha-ank you!” called the bowler, as a pretty little leg
hit from J. P. Carteret struck the inoffensive Optimist between the
shoulder-blades.
“Comfort,” said I, addressing myself to the General Nuisance, “if
there had been the least sense of propriety in that rotten played-out
thing called Providence, that ball had hit you on the head.”
“Dear friends,” said the General Nuisance, “don’t you think that
Charlie’s mother-in-law well maintains the traditions of her tribe?”
“The abandoned old woman!” cried I.
“Never mind, I think it’s our turn to win the toss,” said the Optimist,
unconquered still.
They ought to grant the Victoria Cross to men of this heroic mould,
who remain wholly invincible to circumstance. Some credit was due
to me as well, for I had the presence of mind to behave as custom,
nay, etiquette, demands, when things are going wrong. I broke out
into loud and prolonged abuse of the harmless necessary Secretary.
“Lawson is an utter and consummate ass!” said I. “A man with the
intelligence of an owl would surely know that his bowlers were bound
to let him down at the eleventh hour. They always do. They always
consult their own book before they think about their side. I shall
suggest at the next meeting of committee that Lawson be asked to
resign. Nature never designed a fool to be a secretary; besides, one
looks for foresight in a secretary. Here he’s actually not made the
least provision for a case of this sort, which a man with the
penetration of the common hedgehog would have anticipated at the
beginning of the season. And, Comfort, what’s he doing now? Surely
he knows that Middlesex aren’t playing, and of course he’s had the
sense to wire for Hearne and Albert Trott.”
“No, I believe not,” drawled the General Nuisance; “but we must give
credit, my dear Dimsdale, where credit’s due, for even that
submerged Secretary of ours has, impossible as it may appear, gone
one better than even your intelligence suggests. He’s just cabled to
Australia for Jones and Trumble. They’re not so well known to the
Hickory cracks as Jack Hearne and Trott; besides, they’ve been
resting all the winter, don’t you know.”
Here the pavilion bell pealed lustily as a signal for the ground to clear
immediately, it being now within a few minutes of eleven o’clock. It
was a real relief that our conversation with the General Nuisance
had at length been interrupted, since I for one could feel a quantity of
awful consequences fairly itching in my finger-tips. If nature had not
a habit of going out of its way to encourage original sin in all its
phases, the General Nuisance must have died with a jerk at a
comparatively early period of his development.
The summons was promptly obeyed. The players came trooping in
from the remote corners of the playing-piece; and it was observed
that while Hickory walked confident, lusty, and obtrusively cheerful,
Little Clumpton were in that state of nerves when strong men pluck
at their moustaches and their ties. When we entered the dressing-
room we found the Captain and the Secretary conferring together in
tragic whispers. This in itself was sufficient to strike a chill into the
boldest heart; and we stood apart out of pure respect and
appreciation for the solemn sight. Presently the Captain rose, and a
shudder went through us all, for we saw by his intense expression
that he was going out to toss. And we remembered that the Captain
was the unluckiest man in England with the spin; that he had won
the toss against Hickory last year; that our so-called bowling was
absolutely unworthy of the name; that the wicket was perfection; and
that the finest batting side that had ever appeared for Hickory was
drinking stone-ginger beer and cracking rude jokes in their dressing-
room across the way.
Alas, no jokes and ginger beer for Little Clumpton! Even the
Humourist forbore to make a pun; the Optimist was silent as the
tomb; and two large-hearted persons sat on the face of the General
Nuisance, partly in the public interest, and partly that manslaughter
might be averted for a time. When the Captain, pale but stern, went
forth to toss, the Worry tottered from his seat and softly closed the
door. We had no desire for publicity. As for the preliminaries and
suspense of the sacred rite itself, in that direction madness lay. The
Pessimist alone dared to interrupt the holy peace that pervaded this
dull and miserable dressing-room; but he was a man without any of
life’s little delicacies, and utterly devoid of the higher instincts and the
finer feelings.
“I say, you men,” said he, “we might be a set of Hooligans riding to
the assizes in Black Maria to make the acquaintance of Mr. Justice
Day. Why doesn’t somebody smile? Suppose you try, Brightside, as
you’re always such a jolly cheerful sort o’ Johnny.”
“Shut up,” said the Secretary, “if you desire to avoid what’s
happened to that blasted Comfort!”
This pointed reference appeared to touch the General Nuisance in
his amour propre, for after a violent struggle he was able to
sufficiently disengage his mouth from the vertebral columns of his
guardians to painfully suggest:—
“S’pose I give—compliments—club—to—Grace Trentham and ask
her to come and—bowl a bit—for Lil Clumpton. She can—give such
—a long start—to—the refuse we’ve——”
Here, however, his custodians, by half garrotting him, and the
judicious application of Merryweather’s “barn door,” were able to get
their refractory charge in hand again.
And now the door opened softly, and the Captain stalked in, saying
nothing. The fell deed was accomplished. Yet who was going in, not
one of us knew, and not one of us had the courage to inquire. Those
inscrutable eyes and that high expansive brow were as impassive as
the Sphinx. Not a muscle twitched, not a line relented in the
Captain’s face, and not a man of us dared frame the ingenuously
simple question:—
“Halliday, have you won the toss?”
We noted the Captain’s smallest movements now with wild-eyed
anxiety. We saw him wash his hands, we saw him part his hair, and
when he said: “Chuck me that towel, Lennox,” in sepulchral tones,
his voice startled us like an eighty-one ton gun. Then he proceeded
to divest himself of his blazer. “We are fielding!” flashed through our
inner consciousness; but—but he might be going in first. He rolled
his sleeves up with horrible deliberation. Oh, why had not that
wretched Lawson, miserable Secretary as he was, the pluck to say:
“Halliday, have you won the toss?” Surely it was the Secretary’s
place to do this, else what was the good of having a Secretary if he
couldn’t ask the Captain who was going in, and simple things of that
sort?
The Captain hung his blazer up reflectively on one of the pegs of his
locker; he foraged in his cricket bag; he drew forth a pair of pads.
“He’s taking wicket!” was the thought that made our flesh creep,
since he had been known to undertake these thankless duties on
very great occasions. But—but he might be going in first. And at
least he might have had the common humanity to put us out of our
misery. He had buckled on one pad, and was carefully folding his
trousers round his ankle prior to adjusting the second, when he
looked up sadly and addressed me familiarly by name.
“Dimsdale,” he said slowly and meekly, “have you any very rooted
disinclination to going in first with me?”
The Secretary jumped up and literally fell upon the Captain’s neck.
The General Nuisance was immediately released. The Optimist and
the Pessimist were as brothers, identified in joy. The Worry amused
himself in a quiet way by turning cart-wheels across the floor.
Indeed, it was a moment when life was very good.
Now the honour was so stupendous that had been conferred upon
me, that it was more than a young and ambitious man with his name
to make could realize at first. It was beyond my most highly-tinted
dreams that I should be singled out to go in first with the Captain in
my first Little Clumpton v. Hickory. Why should I, of all the talented
men our team possessed, be chosen for this distinction? Was there
not the Humourist, with his dauntless “never-saw-such-bowling-in-
my-life air”; the Pessimist, who had played for the county twice this
season; the Ancient, with all the weight of his accumulated wisdom,
his guile, and his experience; the Worry, who if allowed to stay ten
minutes, neither men nor angels could remove; the General
Nuisance, too, who must have been an almost superhuman bat to be
allowed to play at all? It was a moment of my life when I said with all
becoming modesty: “Thanks, old chap,” and proceeded to put on my
pads with hands that trembled.
“First wicket, Ancient,” said the Captain, writing down the order. It
was wonderful how merry the room had suddenly become: the buzz
of tongues, the whistling of the music of the music hall, the
Humourist working at his pun, the General Nuisance veiling his
satisfaction in gin and ginger beer, all testified that cricket was a
noble sport, and that life was really excellent.
“I say, you men,” said the Captain, “remember that our game’s to
keep in. No risks, mind; no hurry for runs, you know. We haven’t got
a bit of bowling, and somebody’s told ’em so.”
I was in the act of testing the handle of my bat, when I recollected
with a pang that I was minus my Authentics. What should I do?
William had not appeared with its substitute, yet in a couple of
minutes I should be going in to bat on perhaps the biggest occasion
of my career. Heaven knew I was horribly nervous as it was, so
nervous, that when I thought of marching out to that wicket, before
that crowd, to face that bowling, I began to desire a gentle death and
a quiet funeral. It was now five minutes past eleven, and still that
confounded William had not come! What should I do? The more I
thought of the Magdalen, the Winchester, and the M.C.C., the more
impossible they became.
“Ready?” said the Captain.
“Ye—es,” said I; “q—quite ready.”
“Hickory aren’t out yet,” said the kind-hearted Optimist, looking
through the window.
“’Wonder why they don’t hurry,” said the General Nuisance; “I can
see that Dimsdale’s positively trembling to get at ’em. Besides, the
umpires have been out quite five minutes.”
“They’re funking us,” said the Humourist.
Ah, these humourists, what lion hearts they’ve got!
“Perhaps they are being photographed,” some enlightened mind
suggested.
The Worry opened the door, although I vainly assured him that there
really was no hurry, to have a look at what Hickory were up to.
“Why,” said he breathlessly, “they’re playing two wicket-keepers.”
Sure enough, two men with pads on stood conversing in the
doorway of their dressing-room, and looking across at us.
“’Never heard of such a thing before,” said the Secretary, with a
puzzled air, “as a side having two wicket-keepers. H.C. must be a

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