Kapronczay Károly szerk.: Orvostörténeti Közlemények 202-205. (Budapest, 2008)

TANULMÁNYOK — ARTICLES - VARGA, Gabriella: A comparative study of the social-political determinants of infant and child mortality in Sweden and Hungary 1850-1945. - Összehasonlító tanulmány a svéd és a magyar csecsemőhalandóság szociálpolitikai tényezőiről 1850 és 1945 között

In Sweden the IMR had been fluctuating from the earliest properly recorded period, the middle of the 18

th century until 1810, then it constantly declined. In ninety years the rate fell 50% and reached 100 per 1000 in 1894 (SCB). One of the important preventive measures was the compulsory smallpox vaccination in Sweden introduced in 1816 (Sundin et al., 2005). Success of smallpox vaccination can be attributed to the good cooperation between physicians and local governments. Good cooperation can be attributed to the high status of the local governments due to their high grade of self-government. (Sundin et al. 2005) Smallpox vaccination in Hungary became compulsory in 1887. (Kapronczay, 2001) Difference between the two countries remained almost constant, IMR has been 100% higher in Hungary than in Sweden for a long period; IMR in Hungary was 225 in 1900, where the decline was slower compared to the Swedish IMR of 98 in 1900. Buday (1917) found that the slowdown in the mortality rate among children under 7 in Hungary in the period between 1896 and 1912 could be explained by the increase of the mortality rate in gaslro-intestinal diseases. He noticed in his study the worst trends among small farmers and servants in towns. Although farmers were in a better economical situation than agricultural workers, their "doctor seeking" behaviour was underdeveloped. Children did not lack food, but in many cases improper handling and storage of food caused infections leading to death. The contrast between different areas was also very harsh both in U5MR and IMR with the worst numbers on the Hungarian Great Plain. According to Weszelovszky (1882) in the period between 1871 and 1877 the under-5 mortality between different counties varied from 355 to 547 and between different cities from 300 to 589. There were exceptions but the mortality among children under five was almost always lower in the cities than in the countryside in this period. Half a century later this social gap ameliorated and IMR was 196 in the countryside where 68% of the population lived, while at the beginning of the 1920s 192 was the average countrywide. At that time IMR in the countryside was 13% higher than in county seats, where 19,3% of the country's population lived (Pfeiffer, 1926). If we look at the 7 big geographical areas which are mainly defined by the largest rivers in Hungary (Danube, Tisza and Maros) U5MR could differ from 347 (Transylvania) to 437 (in the region between the Danube and Tisza) in 1891. (M. St. Évk, 1893) In earlier periods differences between Swedish counties were also very great. A study of Östergötland county shows that in the second half of the 18 century mortality rate was the highest in the largest city of the county, Linköping, twice as high as Swedens average within the same period. IMR was highly correlated with population density and inversely correlated with the distance from urban areas. Author concludes that in the period between 17501850 summer peaks were due to symptoms caused by poor hygienic conditions and winter peaks were related to respiratory originated deaths (Sundin, 1995). We could see the same pattern in Hungary as well. Contrast between different regions was generally less dramatic in Sweden in the late 19

,h century. Burström (2003) shows that the urban to rural ratio was about 1,5 in 1881-1890. These rates equalised first in the period between 1921-30 and started to demonstrate an opposite trend. Although the contrast between the rural and urban mortality rates declined, the differences inside a city still remained huge. Differences can be analysed based on the mothers' marital status, the parents' socio-economical situation, housing conditions and districts.