The early decades of the twentieth century witnessed a profound change in the relationship between the living and the dead in America, according to Gary Laderman in Rest in Peace: A Cultural History of Death and the Funeral Home in Twentieth Century America. Though this change occurred more slowly in the South and in rural areas, it gradually affected the entire country. The transition was from intimacy with dying and death to estrangement, and there were three main reasons for it: a reduction in mortality, the growth of hospitals as places where people died, and the appearance of the modern funeral home.
Between 1900 and 1940, mortality rates in the United States and other industrialized nations decreased dramatically (the only noticeable increase being during the influenza epidemic of 1917-18). Correspondingly, life expectancy began to radically improve. Though there was obvious variation according to community and region, it is safe to say that families were forced to deal with the death of a loved one far less frequently that at any other time in human history. It came to be the case that the corpse had all but disappeared from the lives of ordinary Americans.
Some of the reasons for this decrease in mortality were the growth of medical science and technologies, improvements in sanitation and personal hygiene, reforms in public health, and better nutrition. Demographer Peter Uhlenberg argues in one study that declining mortality rates led to changes in family structure as well. For example, the decline in infant mortality led to intensified affection between parents and their children, and in turn to few people dying between ages 20 and 50. This decreased the number of orphans, limited the number of deaths individuals within the nuclear family would encounter, and the longer life expectancy would give children more time with grandparents.
According the statistics gathered by Judith Walzer Leavitt and Ronald L. Numbers in Sickness and Health in America: An Overview, infant mortality decreased from a rate of over 125 death per 1000 live births at the end of the nineteenth century to less than 50 by 1940. The death rate for 25-34 year-olds, both male and female, was also less than half of its 1900 level by 1940. Life expectancy increased from 47 to 60. Another change was that people were not dying so much of infectious diseases as of “man-made” heart disease, cancer, and strokes.
At the same time, hospitals became the main setting for caring for the sick and the passage from life to death. Toward the end of the nineteenth century, there were less than 200 hospitals in the United States, and a high percentage of those were mental hospitals. By the mid-1920’s, there were well over 6000, an increase of 3800 percent, according to Thomas J. Schlereth. The accompanying phenomenon was the medicalization of death, the establishment of the doctor as the main professional figure associated with the dying process, and dying often took place in a secluded hospital room rather than at home in the bosom of the family.
There were profound cultural implications of the shift from dying in the home to dying in the hospital as well.
Dying became something for which ever more scientific and technological intervention was required, and the spiritual needs of the dying person were emphasized far less. The family deathbed drama of the nineteenth century was replaced by the virtuoso high tech attempt of the physician to save the patient. Death was by now not accepted so much as seen as a failure, or unfortunate accident, rather than a natural part of life, which would have a dramatic effect on the funeral industry.
Image: Death haunts even the beautiful: an early 20th-century artist says, “All is Vanity.” This is the more intimate leaning toward death that citizens held before reduction in mortality, the growth of hospitals as places where people died, and the appearance of the modern funeral home.