Todd Savitt - Race and Medicine in Nineteenth-and Early-Twentieth-Century America

Infant mortality in antebellum Virginia was extremely high. During the 1850s, between 16 and 20 percent of all deaths in the state occurred among children under the age of one year. The major causes of death included croup (much of which was probably diphtheria), diarrhea and dysentery, whooping cough, pneumonia, scarlet and other types of fever, and suffocation (also referred to as smothering and overlaying).

Typical historical cases of presumed overlaying share several of the unmistakable hallmarks of SIDS. Compare a twentieth-century physicians description of the latter with an overseers and a planters remarks on the former:

I [Nathaniel Ryan, overseer] am sorry to inform you [Edmund Hubard, slave owner] that Matilda has lost her youngest child she over laid it, it was well and hearty when she went to bed and found it dead sometime in the night.

Last week [wrote Robert Hubard to his brother, Edmund] Tilla overlaid/ when asleep/and killed her youngest childa boy 6 or 7 months old. This was no doubt caused by her own want of care and attention.

Most people, both today and 120 years ago, automatically assume that the fault lies with the parent and that the death is preventable. These are false assumptions. Physicians now know that children cannot be smothered as long as there is any circulating air available, even when the infant is beneath the covers or wedged against the sleeping mother.

(Studies published since the mid-1970s have revised this thinking. Commenting on that earlier view, a SIDS expert wrote in 2001, It is now recognized that occasionally infants can be overlaid, especially by a drug-affected or exhausted parent, or by a young sibling, that infants can suffocate under pillows or bedclothes, and that although rare, intentional suffocation of infants also occurs.)

In addition to this descriptive similarity between SIDS and overlaying, there is a remarkable epidemiological correspondence, in both age and seasonal variation. Crib death does not occur among children of all age groups. Those younger than two weeks and older than one year are almost entirely spared; those between two weeks and four months are prime victims. (The recent back to sleep campaign educating parents to put their infant children to sleep on their backs has resulted in a significant reduction in SIDS deaths, particularly in the highly susceptible two-to-four-month-old age group.

The relative incidence of purported overlaying was much lower in antebellum Virginia (about 4 percent of infant deaths) than that of SIDS in present-day America (26.5 percent of infant deaths between two weeks and eleven months of age) for several reasons. Because people did not understand the cause of sudden infant death, they usually classified it as unknown in most mortality lists. Even today we cannot explain this phenomenon of unexpected death in young babies, but rather than lump it with other unknown causes of death, medical scientists have provided us with the descriptive term Sudden Infant Death Syndrome.