By Susan Huff
As I studied my Icelandic family history, I noticed families where many of the children died in infancy. I made some assumptions that life was difficult for mothers and babies in the 1800s in Iceland, but I decided to try to learn more. I found a fascinating analysis of infant mortality in Iceland from 1800 to 1920. In this scholarly paper by a university professor and the head of statistics of Iceland, the authors outlined some root causes of infant mortality during this time period (Guttormsson & Garðarsdóttir, 2002).
Artificial Feeding & Unsanitary Conditions
Artificial feeding was a major cause of infant mortality. By 1800 artificial feeding was generally practiced in Iceland, as well as some other areas of Europe, particularly Bavaria in Germany, which also had extremely high infant mortality. Only the poorest mothers breastfed their babies—the mothers who didn't have access to cow's milk. The majority of Icelandic mothers gave their babies cow's milk and regular food (meat, fish, or butter) which adults chewed up and fed to their infant babies. Artificial feeding of infants caused intestinal obstruction, inflammation of the belly, and finally diarrhea resulting in dehydration and often death. Then compounded with artificial feeding was the problem of infant tetanus at Vestmannæyjar (an island in south Iceland) and Grímsey (an island in north Iceland). Both of these islands were dependent on fishing and birds. Unclean conditions from birds caused infant tetanus. Artificial feeding and unsanitary conditions resulted in an infant mortality rate of 50–70% at Vestmannæyjar and Grímsey (Guttormsson & Garðarsdóttir, 2002, p. 170).
Tetanus is caused by Clostridium tetani bacteria. "Spores of C. tetani (the dormant form of the organism) are found in soil contaminated with animal and human excreta" (Blain & Tiwari, 2020, para. 2). The spores enter the body through open wounds and then germinate under anaerobic conditions; the unhealed umbilical stump of newborns made them vulnerable to this infection. The progression of the disease is rapid, beginning with lockjaw and facial contractions which means the baby is not able to take nourishment. “Later the jaw loosens, the chin drops, and the child is no longer able to [suck or swallow]. Death occurs shortly afterward. Without treatment the disease is considered to be 100% fatal.” (Jacobsen et al., 2011, para.5).
This was clearly a horrible death, and it must have been very painful for parents to witness their newborns die from this disease. The symptoms, which also include convulsive spasms of skeletal muscles, were recognized and the condition had a name: lockjaw (English), ginklofi (Icelandic), and mundklemme (Danish). The disease is not transmitted from person to person but from direct contact with contaminated material. In most cases, the cause of neonatal tetanus was poor hygiene when cutting or dressing the umbilical stump immediately after delivery (Jacobsen, et al., 2011, para.2). The symptoms were well known, but the cause of the disease was not discovered until 1884.
Help from Denmark
At the beginning of the 1800s, neonatal tetanus caused 60–70% of newborn babies in Vestmannæyjar to die within the first two weeks of life (Jacobsen, et al., 2011, para. 2). As Iceland was under Danish rule, the Danish health authorities became aware of this alarming statistic. In 1847 the young Danish doctor, Peter Anton Schleisner, was sent to Vestmannæyjar to investigate conditions there. He was the sixth doctor in a succession of doctors sent from Denmark to Vestmannæyjar to try to solve the problem of infant death.
“He established a maternity hospital, gave advice on hygiene and encouraged
breast-feeding [without success] and a number of changes in diet. Since there
was no known treatment, Schleisner's only option was to resort to preventive measures. He dressed the umbilical stump with balsamum copiavae and tried
well-established methods such as opium tincture with saffron and mercurial ointment if there was any sign of infection. By the time he returned to Denmark
after nine months, mortality had been halved.” (Jacobsen, et al., 2011, para2).
Transmission of Tetanus
There were many theories about how tetanus was transmitted to newborns. Dr. Schleisner thought tetanus was linked to indoor climate and overcrowded living conditions at Vestmannæyjar, but this theory did not match with the manner in which tetanus is spread through contaminated material. (Jacobsen, et al., 2011, para.35).
In Iceland, people and animals lived together under the same roof. Animals lived on the lower level with people living above, typically in one room, with a single opening in the floor as the only entrance and source of air. It was thought that perhaps animal feces were the cause of tetanus, but this living arrangement was common across Iceland. While it is true that tetanus spores are found in soil contaminated with animal feces, there was some other explanation for why lockjaw was greater at Vestmannæyjar than in the rest of Iceland.
Vestmannæyjar had little access to fresh water. Cisterns collected water beside each house. Rainwater was collected for drinking, cooking, washing clothing, and personal hygiene. The water was often contaminated with seepage from domestic animals and from rotting animal carcasses on the ground. Another theory was that the cloths used to treat the umbilical stump were washed in contaminated water and then laid on the ground to dry, thus causing tetanus. But even after people started hanging the cloths in the wind to dry, the incidences of tetanus did not decrease.
The most likely explanation for the high rates of tetanus at Vestmannæyjar is dead seabirds. There were no trees at Vestmanæyjar, so dead seagulls and puffins were burned as fuel. Collecting these dead sea birds was the job of women. Infant deliveries by persons with unclean hands or on a contaminated surface were risk factors for tetanus. Handling dead seabirds and then caring for newborns without proper hand hygiene is the likely method tetanus was transmitted to newborns (Jacobsen, et al., 2011, para. 38).
Epidemics in Iceland
Medical doctors writing on infant health around 1800 agreed that "colic" (intestinal obstruction and inflammation of the belly, followed by diarrhea resulting in dehydration––a result of artificial feeding) was the most significant cause of infant death throughout Iceland (Guttormsson & Garðarsdóttir, p. 170). In addition, outbreaks that came from Europe raged in Iceland as epidemics, causing catastrophic mortality, and then would disappear for several decades. A smallpox epidemic raged in Iceland between 1785 and 1787 and then did not come again until 1839. Scarlet fever raged in 1797–1798 and did not come again until 1827. Whooping cough came in 1825, after having been absent from Iceland for more than 40 years. Measles epidemics in 1846, and again 35 years later in 1882, were huge killers of infants and children.
Between 1820 and 1850, Iceland experienced a rise in epidemics of scarlet fever, measles, and diphtheria introduced from Europe that took the lives of infants and children. Diphtheria was significantly more fatal to children than infants. Diphtheria first appeared as an epidemic in the 1820s, peaked around 1860, and continued to rage intermittently until the early 1880s (Guttormsson & Garðarsdóttir, p. 171). Example of Infant Mortality
The family of my great-great-grandfather, Jón Pétursson (I160242), is an example of a family with a large number of infant deaths. Jón Pétursson was born on the mainland of Iceland in Vestur-Skaftafellssýsla in 1829, and then his parents moved to Vestmannæyjar. His brother, Guðmundur, was born at Vestmannæyjar in 1836; Jón and Guðmundur were the only ones to live to adulthood of the nine children born to Pétur Jónsson (I252646) and Guðrún Eyjólfsdóttir (I208305). The next 6 children born at Vestmannæyjar all died from lockjaw between 7 and 11 days after birth: Eyjólfur, 1839; Eyjólfur, 1840; Guðrún, 1842; Björn, 1843; Stefán, 1844; and Helga, 1845. Such a tragedy! The ninth child, Ólafur, born in January 1847 (8 months before Dr. Schleisner came to Vestmannæyjar), avoided lockjaw only to die of barnasjúkdómur (child disease) when he was 4 years old. His death was during the diphtheria epidemic which was especially fatal for young children, so he could have died from diphtheria; his death record does not specify. Barnasjúkdómur, or child disease, was considered to be measles, scarlet fever, whooping cough, or diphtheria. The tragic death of so many children in this family is representative of many families living in the 1800s at Vestmannæyjar.
Conclusion
Iceland had extremely high levels of infant mortality due to the widespread practice of artificial feeding. Rather than breastmilk, infants were fed cow's milk and food that was chewed up by adults. In addition, neonatal tetanus at Vestmannæyjar caused lockjaw or ginklofi; the tetanus bacteria entered infants' bodies when the umbilical cord was cut with a contaminated instrument or through the unhealed umbilical stump. For infants born at Vestmannæyjar, lockjaw killed 60–70% of newborns within the first few weeks of life. Tetanus was found in dead sea birds and transmitted through unsanitary conditions. Between 1870 and 1915 there was a dramatic decrease in infant mortality—directly correlational to increased breastfeeding, to the point where Iceland matched continental Europe in infant mortality. District physicians and midwives collaborated on breastfeeding campaigns. The cause of lockjaw was finally discovered in 1884; subsequently, there was an increased awareness of hygiene and cleanliness which also reduced infant mortality. By 1920 Iceland became a relatively safe place for infants and children (Guttormsson & Garðarsdóttir, p. 176).
In today's world, neonatal tetanus has mostly been eliminated from developed countries thanks to tetanus vaccines for mothers and hygiene in delivering and caring for newborns. A baby born to a mother vaccinated against tetanus is also protected from the disease during the first two months of life. As of July 2019, neonatal tetanus remains a risk to newborns in 12 developing countries. The World Health Organization estimated that 30,848 newborns died from neonatal tetanus in 2017 in those 12 developing countries (Blain & Tiwari, 2020, para.7).
Your Research
If you are curious about causes of infant death in your family tree, as I was, especially if your family lived at Vestmannæyjar during the 1800s, you can look for death records in the ministerial books found on the website of The National Archives of Iceland.
Go directly to the website at The National Archives of Iceland with this URL: https://heimildir.is/folk.
Under Direct Route (Bein leið) on the right, click Prestsþjónustubækur for ministerial books with birth, death, and marriage records.
Find the correct book according to the sýsla, parish, and date. Look in the front of the book for the page numbers of death records (Dánir). Page through the book starting in the Dánir section to find the death date, listed chronologically by year, with the person's name.
This is the death record for Björn Pétursson born at Vestmannæyjar. I already knew his death date from Icelandic Roots. I went to the section of the book with death records (Dánir), found the year, and then looked for the month and day (all in chronological order). The first column shows he died on 21 June 1843. The next column shows he was buried on 29 June 1843. Next is his name, then where he died (Elínarhús—this is very helpful to confirm you have the right child if you know where the family lived), followed by his age (9 days), then the record number, and finally the cause of death—ginklofi, which is lockjaw in Icelandic.
Here is the death record of another child in the same family, Ejólfur Pétursson, who died on 17 August 1840 at Vestmannæyjar. In the cause of death column, it says af sama which means "of the same" or "from the same cause." Then if you look above, it says ginklofi or lockjaw. All of those babies on this page died of lockjaw 6 to 11 days after birth; this is so tragic.
References
Blain, A. & Tiwari, T.S.P. (2020). Chapter 16: Tetanus. In Manual for the Surveillance of Vaccine-Preventable Diseases, Centers for Disease Control and Prevention. Retrieved October 21, 2023 from https://www.cdc.gov/vaccines/pubs/surv- manual/chpt16-tetanus.html.
Guttormsson, L. & Garðarsdóttir, Ó. (2002). The development of infant mortality in Iceland 1800-1920. In Hygea Internationalis, Vol.3, No. 1, 2002, pp. 151-176. Retrieved September 18, 2023 from https://www.researchgate.net/publication/
Jacobsen, G. W., Hem, E., & Sigurdsson, J. Á. (2011). No doubt this childhood disease on Vestmannö can be prevented––neonatal tetanus on the Westman Islands. In Tidsskriftet Den Norske Legeforening. Retrieved October 8, 2023 from https://tidsskriftet.no/ en/2011/04/no-doubt-childhood-disease-vestmanno-can- be-prevented-neonatal-tetanus-westman-islands.
The National Archives of Iceland, Ministerial Books. Retrieved October 2, 2023 from http://heimildir.is/folk.