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

infants were not without support as most unmarried mothers in Hungary. However in the first decade of the 20

th century the lowest IMR districts in the two cities had similar IMRs, which changed during the next two decades. On the Stockholm curve we can see a stagnation of the IMR in the earlier period like in Budapest, probably as an early effect of the industrialization with its changes in the society, but also as a faster response to problems for example the introduction of the piped water and of the law which protected children born out of wedlock. We have information about physicians knowledge about the beneficiary effect of breast milk in both countries. Sweden had both breastfeeding campaigns and restriction of artificial nursing already in the first half of the 19

th century which might have influenced the earlier decline of IMR. In Sweden the institutionalized education of midwives started in 1707, more than 60 years earlier than in Hungary, where the first such organization started in the 1770s. The centralization of midwives training in Sweden in 1819 might suggest better organization and probably better quality, but we have no clear evidence for this. Although the data are not directly comparable, in my opinion the numbers strongly suggest that probably fewer deliveries were attended by a midwife in Hungary than in Sweden. Care of infants, including support for breastfeeding, was introduced as a duty of the midwife in Sweden already in the middle of the 19

th century, while in Hungary as sources suggest this happened only after 1908. This might also have made a difference in newborns' health and IMR. We cannot properly compare housing in the two capitals. Introduction of piped water had been started about 30 years earlier in Stockholm. Despite the lack of proper, comparable data, the fact that 88% of Stockholms inhabitants had water in their houses in 1900 and only 2% of the Budapests inhabitants had water closets in 1910 might suggest the lag of Hungarians. Bernhardt (1994) found correlation between IMR and overcrowding, but her study-base was too little to be able to conclude that only the crowding index was the risk factor. There could be other factors, like sanitation in the dwellings that were more important. Immigration grade in Budapest was much higher than in Stockholm at the turn of the century. In Budapest the expansion rate of water and sanitation systems could not keep up with the immigration wave. We have to take into consideration the following: 1. The study of Burström and Bernhardt (2001) shows a reduction in deaths caused by gastro-intestinal diseases after improvement in the water and sanitation system in Stockholm 2. Budays (1917) statement, who observed that the cause of the mortality stagnation among children under 7 could be the increase of mortality in gastro-intestinal diseases in the same period. These facts back the hypothesis which says that better sanitation alone could save many lives. Although primary school education became compulsory only 20 years earlier in Sweden (1842) than in Hungary (1868), differences in actual literacy were enormous. The literacy rate in the middle of the 19

th century in Hungary was ca. 50%, compared to almost 100% in Sweden. It is important to mention that we found that in some period in Hungary there were regions where higher illiteracy coincided with lower under-5 mortality rate. Although illit-