2017-03-25 14.20.53

Recently I hiked Porters Creek Trail in the Greenbrier area of the Great Smoky Mountains National Park.  It was a beautiful spring day and I was rewarded with some early wildflower blossoms although most flowers had not yet come into bloom.  Along the trail are many signs of early 1900s mountain life.  Rock walls, leveled home sites, and a cantilevered barn remain as markers of the toil and sweat poured out by these early Americans.

The valley was home to a large pioneer population who moved to the area during westward expansion.  All that remains of the Cantrell’s farmstead are the stacked stone walls marking off long forgotten boundaries.  The Whaley’s cantilevered barn from 1875 still stands as an impressive structural site to this day.  One family cemetery from the early 1900s is easily accessible off the trail.

The Owenbys, like many other families, had to be a hearty people.  They built their lives from nothing but the labor in their hands.  In this valley, if it happened it was because they did it.  They had few resources to lean upon and surely suffered many hard setbacks along their journey.  Their cemetery is a stark reminder of the loss they felt all too often.

Of the nearly 20 graves in this cemetery, at least five of them were for infants.  Mary Whaley died the day she was born.  Lillian Ownby lived just two months.  The other infants had similar stories; none lived more than a year or so.

You can see similar stories from other cemeteries throughout the national park.  It was common for families to lose their young children in that day.  In our time this is thankfully uncommon.  Many of us today may only know one family who has suffered a similar loss.  There is certainly a large portion of our young parents who probably don’t know anyone who lost their child as an infant.  Grieving with families after a miscarriage is much more likely than grieving with families after an infant death.

So why did these babies die?  The CDC’s data shows that infant mortality rates have dropped from a staggering 100 babies per 1000 live births to less than 6 from 1915 to 2014.  This translates to a reduction of 89% and 93% in the rates of death of newborns and infants respectively from 1915 to 1997.

In the U.S. the causes of infant mortality are not know for 1900, but the top five causes of death for all people were:

  1. Pneumonia and influenza
  2. Tuberculosis
  3. Diarrhea, enteritis, and ulceration of the intestines
  4. Disease of the heart
  5. Intracranial lesions of vascular origin

Contrast that with recent statistics from 2014 where the top five causes of death of infants were:

  1. Congenital malformations, deformities, and chromosomal abnormalities
  2. Disorders related to prematurity and low birth weight
  3. Maternal complications affecting the newborn
  4. Sudden Infant Death Syndrome (SIDS)
  5. Unintentional accidents

It is amazing to me that infection doesn’t even break the top five causes babies die while holding the top three positions in 1900.  So we could perhaps change the title of this post to “Why Babies Live”.  I would answer, “Largely, because they don’t contract infections and if they do, we can treat them.”

I believe we can attribute this improve to the advancement of technology and medicine for clean water , clean food (pasteurized milk prevents non-pulmonary tuberculosis from spreading among other things), antibiotics to treat infections as they arise, and vaccines that prevent infections from developing.  We should remember this as the debate on vaccines rages continuously.  When articles on social media publish the ills of life saving antibiotics, we should remember that not too long ago we would have had no treatments available.  I’m not saying that we should over use medications or inconsiderately inject ourselves with therapeutics, however, I do believe we should keep our history in perspective.

Ever day I practice medicine is another day I try and bring the entire history of healthcare since Hippocrates into view for my patients.  Every pertinent fact and every available data point should be considered in presenting for them options as they address their illnesses.  There is no place for fear or apprehension, only a carefully discerned evaluation of our options and a well-laid plan of therapy formulated from the best medical evidence available.

I am thankful to be a Direct Primary Care physician as it affords me the time to spend with my patients sharing with them in their struggles and walking with them through the frontier valleys of their lives.

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