Tuesday, 17 March 2020

Sex ratios and missing girls in 19th-century Greece

The “missing girls” phenomenon, arising from discriminatory practices that result in excess female mortality early in life, has been especially dramatic in China and India. Analyzing sex ratios, the number of boys per hundred girls, in 19th-century Europe, recent research suggests that these practices could have also been present in some European regions. One of the countries where the relative number of boys was more extreme is Greece, so our current work sheds more light on this particular case.

The previous images refer to The Murderess, a short story written by Alexandros Papadiamantis in 1903, that provides a bleak picture of the fate of Greek women at that time. Reflecting on her own life, the central female character realizes that there is nothing worse than being born a woman and this thought leads her to kill a series of young girls, including her new-born niece, almost as a mercy to save them from a gloomy future. This story is probably an exaggeration but the evidence we have gathered suggests that the mortality rates of Greek girls was much higher than what would have been normal in the absence of discriminatory practices.

Apart from abundant anecdotal evidence on son preference and the discrimination suffered by many girls, the Greek population censuses in the late-19th- and early-20th-century clearly point to the existence of “missing girls”.  During the period 1879-1920, the sex ratio under 5 years old ranged between 106.7 and 109.5 boys per hundred girls. These figures are abnormally high because, as explained here, the gender-neutral sex ratio should be lower than 101-102. The quality of Greek birth registers was lacking but this source also points in the same direction: the sex ratio at birth was around 111 and 119 boys per hundred girls in 1860 and 1884, respectively. Greek families also seem to have abandoned many more girls than boys, at least in the foundling hospitals studied in Athens, Hermoupolis and Kephallenia.

Although it is plausible that the under-reporting of girls might be behind these figures, there are different reasons that preclude this possibility. Firstly, as already mentioned, there is abundant qualitative evidence suggesting that discriminatory practices were not exceptions but the norm. Moreover, the 1880 census itself explains that the statistical authorities were expecting boys, not girls, to be under-reported due to the military purpose of the census. In addition, if under-registration was an issue, it was surely more important at birth or during the first year of life. The Greek sex ratios, however, increased as children grew older. The next figure shows how the sex ratio of children aged 5-9 was higher than that of younger children (aged 0-4), especially up to 1920. This evidence not only suggests that female under-reporting was not an issue, but also that gender discrimination continued unduly increasing female mortality rates as girls got older.

Sex ratios at age 0-4 and 5-9, 1879-2001

The sex ratios of different age-groups also correlate quite well at the province level. If under-registration was affecting some areas, girls would eventually show up in the census when older, thus reducing the correlation coefficient. This was not the case. Lastly, the contemporaneous US censuses (where most Greeks migrated during this period) also confirmed that the relative number of boys and girls born in the US from Greek parents was very similar to the figures found in the motherland censuses. 

What was happening? It is difficult to be precise but it is likely that both female infanticide and different degrees of neglect during infancy and childhood unduly increased female mortality early in life. Regarding the latter and in a context of generalized poverty where infant and child mortality was really high, an unequal allocation of resources within the household in the way that young girls were fed or treated when ill, as well as in the amount of work which they were entrusted with, was likely to have resulted in more girls dying from the combined effect of malnutrition and illness. It seems also that discriminatory practices were stronger (or had a clearer effect due to lack of resources) in large families.

Why were Greek girls discriminated? Although there is not just one factor behind this behaviour, the most important one is probably the dowry. Marrying their daughters was one of the main duties of Greek parents and this was connected to how generous the dowry was. In poor families, and especially in those with several daughters, girls were a heavy burden. The analysis of the regional variation in sex ratios also indicates that excess female mortality was higher in those areas where female labour opportunities were scarce. In any case, our work stresses that gender discrimination constituted an important problem in 19th-century Greece, an issue that has long been neglected despite all the hints that pointed in that direction.

Beltrán Tapia, F.J. and Raftakis, M., ‘All little girls, the bad luck!’ Sex ratios and gender discrimination in 19th-century Greece, EHES Working Paper 172 (November 2019).
A Spanish versión of this post was published in Nada es Gratis in December 4, 2019.

Thursday, 5 March 2020

“Cholera Forcing” and the Urban Water Infrastructure: Lessons from Historical Berlin

Kalle Kappner

    Over the last decade, the role of modern water supply and sewage disposal infrastructure in the West’s 19th and early 20th century urban mortality transition has attracted renewed attention among economic historians and development economists (Harris and Helgertz, 2019). A robust conclusion of this literature is that access to tap water and sanitary sewers was crucial in turning cities from hotspots of infectious diseases to evermore healthy places. However, the causal mechanisms linking patterns of declining mortality and expanding access to modern water infrastructure are still poorly understood. In particular, should the emergence of urban sanitation be seen as a rational, indeed inevitable reaction to the 19th century’s recurrent epidemic shocks and elevated urban mortality rates, an idea that Christopher Hamlin (2009) termed “cholera forcing”?

    In a recent EHES working paper, I retrace Berlin’s long and bumpy road to safe water conditions, challenging popular narratives that interpret modern water infrastructure as an efficient, scientifically motivated answer to Europe’s recurrent cholera epidemics since 1831. To the contrary, Berlin’s experience suggests a highly complicated relationship between urban epidemics, their statistical, proto-epidemiological examination, and water management reform. Far from serving as “our old ally”, an attribute later assigned by urban hygienist Robert Koch, cholera turned out not only a weak motivator, but in fact an ambiguous one.

    “The Great World Pestilence” in Berlin

    Quite representative in the Western European context, 19th century Berlin suffered from a characteristic “urban mortality penalty”, partly fuelled by periodic outbreaks of epidemic diseases. Cholera was not the most fatal, but arguably the scariest and most unpredictable member of Berlin’s disease panorama, amounting to almost 19,000 documented deaths in between 1831 and 1873.

    figure 1 a

    figure 1 b
    Figure 1a and 1b: Cholera incidence and Crude Death Rates in Berlin, 1830-1880

    In hindsight, it is not hard to understand why cholera raged in a repeated, yet seemingly erratic fashion. Berlin had experienced rapid population growth since the 1850s, bringing about the typical problems of increasing density, pollution, congestion and the consequent spread of infectious diseases. Commercial travelers repeatedly carried vibrio cholerae from the East and introduced the bacillus into the local cesspools, which in turn contaminated the water of nearby wells, spreading the diseases among the population. Berlin’s international connections, dense living conditions and inadequate sanitary conditions rendered the city an ideal transitional habitat.

    On Unwanted Tap Water and Miasmatic Plague Tubes

    Roughly 25 years after its first acquaintance with cholera, Berlin began a lengthy path to safe water conditions, substituting an essentially medieval infrastructure based on pump wells, cesspits, open gutters and the river Spree’s natural absorption capabilities by relatively clean tap water and sanitary sewers that disposed waste in the rural hinterlands.

    figure 2a

    figure 2b

    Figure 2a and 2b: Share of lots connected to the tap water supply and sewers in Berlin, 1850-1900

    Initially, recurrent epidemic shocks played hardly any motivating role. By the 1850s, it was aesthetic rather than sanitary concerns that brought the construction of a modern tap water network on the municipal agenda. However, a combination of misaligned economic incentives, low public demand, conflict over fiscal and administrative responsibilities, and, crucially, a lack of understanding of cholera’s fecal-oral transmission route ensured that the spatial expansion of the network was slow, reaching full coverage only by the 1890s. Moreover, there is evidence that failure to understand the adverse repercussions that an ample tap water supply would have on an urban water cycle still lacking safe sewage disposal contributed to the urban health crisis and cholera’s incidence in particular, as suggested by the disease’s forceful comeback in 1866.

    It took another 25 years until the issue of complementary sewers would be tackled. Analysis of contemporary discourse reveals that, while cholera’s continued appearance clearly motivated some sanitary reform, physicians, public health advocates, urban planners, and the general public for a long time disagreed on the shape that such reforms should take on. Were sewers preferable to manual disposal via containers and haulers? Was the strict separation of liquid waste from excrement and other organic waste preferable to mixed sewers that promised dilution of the contaminated material? Should waste be left to the river’s natural cleaning capabilities or were sediments and the soil’s microorganisms a more reliable disinfector? And what about dangerous, disease-ridden “sewer gases” that could spread via underground plague tubes? Far from suggesting a straight road to a unique sanitary solution, prevailing miasmatic theories were vague enough to levy arguments for competing solutions to the mounting urban health crises.

    The Data Did Not Speak

    In hindsight, it is tempting to interpret this lengthy transition phase as a result of technical, financial and political hurdles counteracting the inevitable triumph of rational approaches to the problems of cholera and infectious disease. However, a closer look at the epistemological struggles of contemporary Berlin’s health officers and medical statisticians suggests that the relationship between the extensive proto-epidemiological analysis of infectious diseases and efficient sanitary reform was highly ambiguous.

    Not only did the collection of ever larger amounts of data fail to yield any compelling reasons to rely on clean drinking water and sanitary sewers, as opposed to a myriad of competing policy recommendation focussing on ventilation, cleansing of the soil or quarantine. Moreover, the lack of adequate mathematical and statistical tools proved fatal for the proto-epidemiological approach to unraveling cholera’s complex properties. Well into the 1880s, Berlin’s health statisticians were forced to retreat to the role of mere documenters as prevailing miasma theories proved too blunt an instrument to cut through the jungle of cholera’s complex spatiotemporal patterns. The “myth of John Snow” (McLeod, 2000) notwithstanding, Berlin’s experience suggests that observational data and inductive logic did not suffice to set the urban health community on the right track and induce crucial investments into the urban water infrastructure. To the contrary, unable to free itself from the vagueness of miasma theory, proto-epidemiology turned out more an obstacle, rather than a driver of knowledge generation.

    “Cholera Forcing”: Tales, Realities, and Implications

    What lessons does a careful reinterpretation of the Western urban sanitation transition promise? Of course, there is no immediate danger of history repeating itself, as comprehension of both cholera’s etiology and the importance of safe water systems dramatically improved. Still, the absence of any automatisms in the Western cholera-sanitation-nexus at the least suggests a cautious interpretation of the disease’s potential to induce change.

    Powerful narratives of the West’s past struggle are highly consequential regarding the attitudes, recommendation, and modes of assistance that today’s developing world receives (Konteh, 2009). While it originates from a misleading backward extrapolation of modern technocratic approaches and scientific knowledge to the past, the real danger of the “cholera forcing” narrative arises when extrapolation of an imagined Western past serves as the basis for present policy recommendations.


    Hamlin, Christopher, 2009: “Cholera Forcing”. The Myth of the Good Epidemic and the Coming of Good Water, American Journal of Public Health 99(11), 1946-1954, doi: 10.2105/AJPH.2009.165688
    Harris, Bernard & Jonas Helgertz, 2019: Urban Sanitation and the Decline of Mortality, The History of the Family 24(2), 207-226, doi: 10.1080/1081602X.2019.1605923
    Kappner, Kalle, 2019: “Cholera Forcing” and the Urban Water Infrastructure: Lessons from Historical Berlin, EHES Working Paper 167
    Konteh, Frederick Hassan, 2009: Urban Sanitation and Health in the Developing World: Reminiscing the Nineteenth Century Industrial Nations, Health & Place 15(1), 69-78, doi: 10.1016/j.healthplace.2008.02.003
    McLeod, Kari S., 2000: Our Sense of Snow: The Myth of John Snow in Medical Geography, Social Science & Medicine 50(7-8), 923-935, doi: 10.1016/S0277-9536(99)00345-7

    Kalle Kapner is currently at Humboldt University of Berlin. Find more of his work here: https://hu-berlin.academia.edu/KalleKappner