EP. 77 — The Shocking Decline in Child Mortality with Dr. Perri Klass

ADAM CONOVER [00:00:22] Hello, welcome to “Factually”, I’m Adam Conover, and look, it is the day after the election here in America, but I am not recording this the day after the election because of the way we produced this podcast, I have to record it a couple of days in advance. So we are not able to do an episode that speaks to the exact mental state that you may be in on today that you were listening to this, November 3rd, 2020. And you know what? Let’s just not try. We’ve done our fair share of election episodes. You have probably been mainlining election media for the last couple months. Let’s be honest, two years straight. And I think we all need a break. So in the coming weeks, we will have more episodes about the American political system, democracy, political science, all those good topics. But for today, let’s take a break and talk about something different. Let’s talk about childhood. You know, childhood, that magical time we all experience where you, you play and you, you explore, you learn and you even have time to be bored. You just stare up at the sky and count clouds or whatever the hell. Hey, it’s been, it’s been decades since I’ve counted a cloud. Oh, I wish I were a child again. Right? We have this idea of childhood as being this fixed thing based around exploration, play, learning and boredom. But the truth is that the notion of childhood is actually quite recent. Because for most of human history, a kid’s life was mostly based around how much food their family could provide and how much food they could provide the family. Hunter gatherer societies way back when had relatively low birth rates, the amount of berries and nuts you can gather and the boars you can hunt, well, that doesn’t really change because you can crank out another couple of babies. In fact, as a hunter gatherer, more kids puts greater strain on your ability to produce. But this all changed with agriculture. Once humanity started growing wheat and corn and delicious savory turnips or whatever, the sky was the limit for how many kids you could have. Or rather the sky was really the limit for how big your work force could be. See, farming, as opposed to hunting and gathering, is extremely labor intensive. You need a lot of arms to feed all those mouths. And if you’re farming turnips in the year 1100 or whatever, you can’t really put out a call on LinkedIn every time you need some new people who can muck about in the filth growing shit. So instead people would literally grow their own workforce the old fashioned way, through steamy church ordained, peasant sex. Agricultural families often organize production and labor around the family. Literally using the kids as a workforce. So they would end up having six to eight of them just to work the fields. And this meant that childhood back then was radically different than it is today. Now, it’s not exactly like kids were forced to be little adults or something. You know, they still had opportunities to screw around and play. But you can imagine how the need to put children to work from an early age in a life or death struggle to produce enough food might make parents push maturity a little bit. You know? You can imagine a farm dad of yours saying, “Sorry little Atheel Birch, no SpongeBob for you, only the plow”. And this persisted for a long time. In America, at the end of the 18th century, women were still having about eight kids apiece. But by the early 20th century, they were just having 3.8 kids. This was a monumental change in the way that we raised our families. And there is no single explanation for this decline. With the Industrial Revolution, for instance, more people lived in cities, where it was more expensive to raise kids. Also, more kids had to go to school. Also, eventually, there were child labor laws which stopped many children from the important work of mangling their hands in cotton looms for their weekly saucer of gruel, which meant people were a little bit less incentivized to breed new kids as an income stream. But crucially, we now also know that women led the decline in birth rates over the 19th century. Why? Well, because they were part of an incredibly important movement to exert greater control over their own bodies and lives. Go figure. Now, fast forward to today, and we have this idea of childhood as a time of exploration, growth and education. Right? But it’s only in recent generations that our kids have had the luxury to construct a concept like boredom and to expect and even demand constant entertainment, because in the past they were just too busy working their little asses off. But look, this is far from the only huge transformation in our expectations for childhood and children. In fact, there’s another that’s even more important. See, today, we have this pretty reasonable expectation that when a baby is born, it will, you know, live. You know, people are surprised generally when babies die today. It’s a tragedy that we think of as being rather rare. But if we go back 120 or 150 years, and then thousands of years before that, we’re looking at a world where a huge proportion of all children died and the massive drop in childhood mortality that we’ve experienced is, in fact, one of the greatest triumphs of public health and medical history. And today on the show, we have someone incredibly awesome to tell us all about how this miracle occurred and let us in on this incredible history. Dr. Perri Klass is a pediatrician and writer. Her most recent book is called, “A Good Time to Be Born: How Science and Public Health Gave Children a Future”. Please welcome Perri Klass. Perri, thank you so much for being here. 

PERRI KLASS [00:06:01] It’s my pleasure. 

ADAM CONOVER [00:06:02] So you’ve written this wonderful book, “Good Time to Be Born”, about the, the differences in infant mortality, in childhood, in the way that babies were treated in American society just as recently as one hundred years ago. What are the most stark differences that stand out to you? 

PERRI KLASS [00:06:24] Well, what struck me, and I’m a pediatrician, so I trained in pediatrics in Boston in the late 1980s. And what struck me as I was working on this project was that in my grandmother’s era, in the early 20th century, in the 1920s, when my grandmothers were having their children in New York City, if you went around a table, everybody around the table would either have lost a child or would have lost a sibling or would have lost a good friend. Infant deaths, child death, was so common it touched every family, rich, poor, it touched every life. And then you go 60 years later into the 1980s when I’m training in pediatrics and it’s become a terrible, rare, deeply, profoundly dreaded tragedy, which sometimes strikes an unfortunate family but is by no means something that everybody assumes is just sadly part of the story of being a parent. And I was interested in that transition because when you stop to think about it, it’s not just in my grandmother’s era that so many families were touched by infant and child mortality. It’s actually stretching back before my grandmother’s era. It’s all of human history everywhere. And this change, this change that we’ve become a society in which infant death, childhood death is not a tragic but really pretty predictable part of so many family’s lives. When you come and think about it is actually probably one of our most extraordinary achievements as a species. We did this. We changed our biology. 

ADAM CONOVER [00:08:08] Yeah. You know, something I’m always really interested in my work is finding out, learning about what in our daily life that we think of as like the normal state of affairs is actually the anomaly. 

PERRI KLASS [00:08:23] Yeah. 

ADAM CONOVER [00:08:23] Like historically, because often things that we think are normal are anomalies and other things that we think are anomalies are actually normal. You know? And this is a really huge one where, yeah, we think a normal state of affairs, like a bedrock part of human society, at least here in America is having children and raising them to a certain age. And this is like a rhythm of life that we all go through. And our rhythm right now does not involve the routine deaths of children at a very young age. But that’s so recent that change is what you’re saying. 

PERRI KLASS [00:08:58] It’s so recent. It’s so recent. And admittedly, it’s recent only for a certain sector of the world. It’s true sooner in some countries, in some social classes in other countries, but it begins to spread. And if you look even in poorer countries around the world now, there’s a lot of progress and there’s a lot more security and safety. The kinds of, I mean, when I’m talking about at the turn of the century is maybe 3 out of every 10-, out of every 10 babies who die by the first birthday to 3 out of every 10, and so you remember people have more than one child. And then if your child makes it past the first birthday, and infant mortality is the number of live born children who die by the first birthday. So it’s how many out of every thousand children born alive don’t make it to the first birthday. And then child mortality we usually think of as how many make it to the fifth birthday. And so, again, even if you’re just thinking about my grandmother’s day, and I say my grandmother’s day, because when my grandmother was having children, of course they were my parents. They’re the people I grew up with. It’s not so long ago. 

ADAM CONOVER [00:10:16] Yeah. 

PERRI KLASS [00:10:16] And when my grandmother was having her children and when my parents were babies, there was nothing you could do about polio. When my parents were born, there was no an-, there were no antibiotics available if you got pneumonia. There was a whole range of things which if they happened to you, there just wasn’t anything anyone could do and what I’m interested, well, I’m interested in so many parts, that I’m interested in sort of how we did this as a species, how we made it possible for people to have two or three or four children and really assume that barring tragedy, barring terrible accidents, barring fairly rare and awful diseases, they could expect that the children would live to grow up and be adults. I’m interested in how we did that and the sort of the, the endeavor. And I’m also interested in the question of how that shapes us as parents or as pediatricians when we look at our children. And one of the questions that I found myself asking is, by so many standards, we are the luckiest parents in history, by so many standards. Right? 

ADAM CONOVER [00:11:27] Yeah. 

PERRI KLASS [00:11:27] We have this, this unbelievable level of safety, which my grandmother couldn’t have dreamed of, in which her grandmother certainly couldn’t have imagined. And yet, I mean, I would, I don’t need to speak for all of us, does it actually translate into less anxiety, more security? And if it doesn’t, what is it? I mean, no parent in the world, no parent in this country would trade for a higher infant and child mortality rate. 

ADAM CONOVER [00:11:59] No. 

PERRI KLASS [00:11:59] If I said to you, oh, you could live in a world where this will be nicer and that would be nicer, but you have to settle for three times the chance that one of your children might not make it. No parent would take you up on that. But why doesn’t that translate for us as parents into a sense of gratitude and a sense of security? And I, it made me think a lot, both as a parent and as a pediatrician, about the kind of anxiety that’s inherent in being a parent and what it’s connected to. And of course, it made me think about the thing which, going back to what you said, Adam, can we imagine what those parents felt like one hundred years ago when a child got a fever, when a child got a sore throat, when a child wasn’t doing well? How did you deal with that as a parent? And is there anything that we might think about when we think about our own anxieties today and our, our own uncertainties as parents? And I don’t pretend to have answers to all those questions, but they were some of the questions which I found most interesting when I was working on this book. 

ADAM CONOVER [00:13:08] Yeah, that’s really fascinating and one of my favorite things in history is I love work like yours that helps you embody the frame of mind of people in the past. That reminds you, OK, these are people who are going through daily lives and they have experiences and emotions and they’re just like me. And what were things like for them? And so, yeah, could you paint a picture of what it was like, what motherhood was like? I mean, look, I’m not a mother and nor will I ever be. But I have a little bit of a, I have friends who are mothers and I watch commercials and I read magazines. And I have a little bit of a sense of what some of that experience is like. What was it like 100, 120, 150 years ago?

PERRI KLASS [00:13:53] So I think that’s a really interesting question. And of course, on the one hand, I can’t answer it. On the other hand, I can answer it because there’s nobody who can stand up and tell me I’m wrong. Because the people who, you know-. 

ADAM CONOVER [00:14:04] No one knows better than you. 

PERRI KLASS [00:14:06] Right. So I don’t have a single answer to it. I want to start by saying that everything that I read certainly about parents 100 years ago, parents in the 19th century and even parents going back before that. They love their children as much as we do. You don’t ever get any sense, oh, a lot of babies don’t make it, so I better not let myself be too fond of this one. There are theories that if you go far enough back, parents had to, you know, if you go to times of really, really high infant mortality, of half of the babies aren’t making, making it, how do parents perhaps think about it, protect themselves? But if you go back to my grandmother’s year, if you look at the letters that are written by mothers in the early 20th century or the novels and poetry and letters written by parents in the 19th century, they love their children tremendously. But there is a certain amount of acceptance. That is to say, you find people saying, we know this happens to everyone, we’re terribly sad, but we know this happens. You find a certain kind of acceptance that this is part of parenthood. And one of my, perhaps, dubious theories about this. And again, I’m making this up and I have to admit I’m making it up. I’m trying to imagine myself into other eras. I found myself thinking sometimes about the ways that we in our time sometimes love a very elderly parent or grandparent. I found myself thinking about, say, the way that I felt about my own mother when she was in the last years of her life, in that I loved her deeply, but I knew she was fragile. I loved her deeply, but I knew that I might not have her with me for a very long time. And I wondered if perhaps there was a way of loving a baby which accepted the idea that I may not have this baby for a long, long time. So that’s one thing I’d suggest. I would also, of course, need to bring up religion. And the idea that for many parents, that acceptance, the idea that this beautiful, lovely child has been given to you, lent to you, but may be called back, may return to heaven, is both comforting, but also for parents, sometimes really challenging. That is to say, if you are a mother in a society where you are meant to accept this as possibly a religious duty and instead you feel deeply sad, instead you perhaps even feel angry, then you, you also live with the awareness that perhaps you are not behaving properly. And you can find people telling parents, especially perhaps telling mothers that this is something that you must accept, that your baby has gone home to heaven and therefore maybe you aren’t going to be grateful, but you have to be at least willing to accept it. And again, what’s interesting is that turns out to be very, very, very hard for a lot of people, even though their faith is strong. 

ADAM CONOVER [00:17:34] Yeah. Well, you said earlier that, the way you put it was that, you know, infant death or the death of young children, was in those days not as tragic as it is now. What strikes me is like it’s less perhaps I might rephrase that to say it was less unusual, but it certainly sounds like being a parent was just much more of a tragic experience that like they would have experienced it as tragically. But it was, it was not unusual to be so devastated, to, to have such loss. That was just a routine part of parenting. 

PERRI KLASS [00:18:09] You know, I don’t know if it was ever quite routine, but it was certainly more common and certainly more predictable and absolutely it was tragic. And if you go back and you read stories of people, people’s lives, what you find, as you would find in any era, is that people react differently. Nowadays, if somebody lost a child and was not able to recover easily from that grief and that, that loss was perhaps the central tragedy in an adult’s life, we would find that very understandable. But you’ll find people like that in the early 20th century and in the 19th century as well. People who know they should be able to recover and move on, women who are often pregnant again almost immediately, sometimes pregnant when the first child dies, but who are still clearly not able to move past that tragedy, even though they’re urged to. And I can, I can offer you some, even some famous examples of those people. And you find other people who, in one way or another are able to move forward with their lives, turn their attention to the next child. But it’s very different from person to person. It’s very individual. What I might say, though, is that there is probably some help and comfort in the fact that many other people around you have also suffered this loss. It’s not a terribly, it’s a, it doesn’t distinguish… mark out your family from all the other families. There’s a certain commonality. There’s a certain, you find, for example, when, when I was reading about Charles Darwin’s daughter who died and in his voluminous correspondence with the other great men of science, of his moment in England, with the geologists, the botanists, it’s one of the things they’re writing about. Now that I have, now that my poor little daughter has died, I understand what you went through. There’s a remarkable correspondence between Darwin and another scientist about how you handle the anniversary of a child’s death. And so I think that, that kind of commonality, the fact that you can talk to your colleagues or your friends or your circle about something like how do you handle, do you find that you feel terribly sad every year on the anniversary of your child’s death? That’s probably helpful for a lot of people. Whereas instead, families nowadays who have lost children, parents will often say that they almost don’t feel they can discuss it, that if you’re at a social gathering and someone says to you, do you have children? You can’t just say, we have three children, but one of them is no longer alive because it, it, it stops all conversation. It’s such an unusual event. It’s such a terrible tragedy. And what I wonder is whether, or some families, that makes it lonelier and that makes it a little, a little more harder to bear, sometimes.

ADAM CONOVER [00:21:25] I think that, I think the word we’re searching for maybe is “normalized”. That sort of loss was normalized 100 years ago. And now it’s not in a way that, I think you’re right, can make it more difficult to share with people or to find commonality with others, because it’s, it’s such a shocking thing to hear for so many people. The fact that you raised Charles Darwin is really interesting, because one of the things that really struck me about your book is that you, you wrote about how it affects, affected all classes, that it was not something that the rich people could buy their way out of. 

PERRI KLASS [00:22:03] I thought that was one of the most interesting things again and again that I came across, which was, this was not something which marked off rich from poor. Now, it’s always been worse to be poor and it’s always been worse to be a member of a marginalized group. It’s all, the mortality has been higher among the poor. The mortality has been higher among African American families and still is. Mortality was higher among immigrants who were crowded into the tenements, but the mortality was also high and sometimes when an epidemic came along just as high and sometimes perhaps even higher in families who thought of themselves as more protected and more privileged. And one of the reasons that that’s interesting is I think that it, it gives you a window. That is to say, if I want to make the case to you, that there was nothing that medical science could do, sometimes the easiest way to tell you is what happened to the president’s child or what happened to the prince. Or what happened? The richest man in history, John D. Rockefeller, the first billionaire, I believe in history, founded the Rockefeller Institute because his beloved grandson died of scarlet fever. And so if you were my grandmother, you would say, even if you were John D. Rockefeller, there was nothing you could do. And I thought that was, I thought it was interesting for a couple of reasons. I thought it was interesting because, of course, as you find ways to protect children, as you find ways to treat some of these diseases, as you find ways to immunize children, then it does become much more a question of access. Right? Access to medical care is a great thing, but access to medical care for scarlet fever before antibiotics exist is, you know, it’s a comfort, but it’s not a cure. 

ADAM CONOVER [00:24:10] Yeah. You wrote about how so many of our great institutions exist because some very wealthy people didn’t have children to pass their legacies onto and they ended up creating, I believe you said Wellesley College, was, was founded for this reason. 

PERRI KLASS [00:24:28] Yep. Wellesley College. Stanford University. Right? You have parents who, you know, with, with tremendous amounts of money and the hope of leaving something to a child and then the child is lost. So Wellesley College, the estate was bought by somebody who wanted to use it as a kind of a pleasure estate. His name, his name was, I think, Henry Durant. And they had a gifted young son they loved and they were going to build this wonderful estate for him. But he died at the age of eight of diphtheria, a disease that I’ve never seen because we immunize against it, but a terrible and frightening disease. And they had, they had this estate and it eventually became a college. And similarly the Stanfords who had an adolescent son, they took him to Europe on the grand tour. They had so much money and he got sick with an infection and they took him from doctor to doctor and from town to town, and he died. And so they left their estate and they left their money. I wrote part of the book at the Arts Colony of Yaddo, in upstate New York, in Saratoga Springs. Again, a fabulous, beautiful estate that a very, very wealthy couple built for their children and all four of their children died. And so I think that, you know, and then I mentioned John D. Rockefeller and his, his grandson. There, there are so many institutions that either the building or the grounds or the estate or just the fortune didn’t go to the children because the children didn’t live to grow up and all of the fortune and all of the grandeur wasn’t enough to protect children. 

ADAM CONOVER [00:26:27] Wow, and we’ve gone deep into this interview without me asking this, what were these children dying of? Like you mentioned, diphtheria, which to me that sounds like a very Dickensian disease. I feel like I’ve read that in 19th century novels. But, yeah, what, what were these conditions that the children had? And how did this start to change? 

PERRI KLASS [00:26:48] So I’m going to mention three different things. The babies, the sort of newborns, the one month olds, the little children, many of them are dying of causes that have to do with how they’re born. They’re dying of, that first month of life, always was tricky and it’s still tricky. They’re a little premature. They don’t feed well. They have multiple different conditions that they’re born with that aren’t quite-, you know, different organs that aren’t working right. They’re vulnerable to infection. So newborns and in fact, newborns are, in my book, this backwards because newborns are kind of the last group which are really addressed by this, this change. That is to say newborns are still dying in the middle of the 20th century who now absolutely would not die. And then right around the age of one, two, toddlers, a lot of them are dying of diarrhea. A lot of them are dying of infections that have to do with milk, when not being pure, before pasteurization comes along, or food that’s being mixed with water that’s not completely clean. And that should sound familiar because that still happens in many parts of the world. If you don’t have clean, reliable water, if you don’t have a reliable milk supply and children are, once children stop being breastfed, those children are at risk for diarrhea. And that’s a really dangerous disease for infants and young children. And then older than that, we’re talking about all of these other infectious diseases. Yes, diphtheria, whooping cough, scarlet fever, polio, all the diseases that we immunize against, and some of that we would just treat routinely now with antibiotics. And then beyond that, of course, there, we, I talk in the book about how once you clear some of those infectious causes out of the way, and I mean, we’re talking about an era in which every child gets measles. And so there’s a certain percentage of them have the bad complications of measles. We’re talking about an era in which when the diphtheria epidemics come through or the scarlet fever is bad, a lot of children get sick and then the ones who recover, most of them have, have some immunity and they’re, they do OK next time around. 

ADAM CONOVER [00:29:19] And, man, so really what you’re describing is these are, so many of all the ills that are affecting all of modern society that, you know, tainted water in cities is a plague around the, the late 19th, early 20th century. And, you know, infectious diseases, many of these are diseases adults get as well. But children are just more vulnerable to them. They’re smaller and they’re, would have less developed immune systems and, and it results in them dying. So what’s striking to me is that, this is a massive change, like you said, between then and now. But it’s not as though, hey, we discovered one thing, right? It’s not like there was one big change that happened, which is, so many of our big changes are like that, where, OK, we figured out that this was the germ theory of disease happened. We learned about antibiotics or something like that. You’re talking about dozens of different causes. So what explains the, like take us from how we got from then to now. What changed? What did we do as a society? 

PERRI KLASS [00:30:23] That’s such a good question, because that’s absolutely right. It’s not one change. That’s why, that’s why I feel in some sense, it’s an under-appreciated human achievement because it wasn’t a single campaign. If you look at polio, polio, as a campaign. We’re going to solve this. We’re going to find a vaccine. We found a vaccine. It’s great news. We’re going to vaccinate everybody. We vaccinated everybody. We’ve almost wiped out the disease. We see that, the way we see it with smallpox, where we actually do wipe out the disease. But this isn’t that. This is part public health and sanitation. Right? Let’s clean up the water supply. Let’s pasteurize the milk. Let’s open milk stations in the poor neighborhoods so that there’s clean milk available for families. It’s, so it’s public health and public, and visiting nurses and sanitation. It’s part bacteriology. Everything you said. Let’s figure out what’s causing these diseases. Some of them we can vaccinate against, some of them we can treat with antibiotics. It is antibiotics. And then moving on from there, if you look into the 20th century, it’s also what about those newborn babies? What’s happening in the delivery room? What do you do if a baby can’t breathe? What do you do if a baby needs a little extra help for the first week or two? Does prematurity have to be fatal? And what, you think about the science and technology that come in, starting at the beginning of the 20th century, but moving later. Right? Or still happening right through the 20th century. How can you save those newborns? And then, then I talk about this book, when you clear the, pediatricians used to spend their entire professional lives dealing with these infectious diseases, with measles or whooping cough or scarlet fever or with diphtheria, once you clear those out of the way because you’re immunizing, because you’ve got antibiotics, then you look around and you see accidents, you see Sudden Infant Death Syndrome, and you say to yourself, how do you make the world safer for children? How do you make cars safer for children? How do you make sleeping safer for children? And if you look at what happens in the 20th century as a society, we pay attention, we legislate, we think about car seats and booster seats. We start the Safe Sleep campaign, which is hugely important. But again, you see those deaths, you see those risks because you’ve cleared all of that tremendous burden of infectious disease out of the way because you’ve got the immunizations and you’ve, you’ve got the antibiotics. And the thing that I think is so interesting is that when you look at this over time, you see all of this happening. You see nutrition and clean milk and clean water and sanitation. You see parents demanding certain kinds of safety, parents demanding legislation, parents demanding protection, parents demanding that their children be safe from things which are risky. And all of that together, the reformers, the sanitation, the engineers, the scientists, the bacteriologists, the doctors, it adds up to this huge change in, I mean, if you ask me, it’s actually a huge change in what it is to be human, that you can look at your children and say, I expect them to live to grow up. I understand that there are no certainties. It’s not 100 percent. But my experience as a parent, I hope, and I’m entitled to hope, will be that my children will live to grow up. 

ADAM CONOVER [00:33:58] Well, that is, what an incredible change. And I want to talk more about what that means for us today and how we think of ourselves as parents, how we think about children. But we got to take a really quick break. We’ll be right back with more Peri Klass. OK, we’re back with Perri Klass. Before we really get into the modern day, I want to hear about one of the, more foun-, I want to hear some personal stories about some of the people who waged this fight. Tell me about Sarah Josephine Baker. Who is she? 

PERRI KLASS [00:34:35] Well, she is a doctor at the beginning of the 20th century in New York. She’s a really interesting character. She comes from a good family in upstate New York and they fall on hard times and she decides she’s got to support her mother and her sister. She goes to medical school and she finds herself practicing in the city right at the time that people are beginning to think about whether you could save babies on a large scale, and she becomes interested in public health. She’s a public health officer. She goes from house to house in the tenements. And this is a moment when people are very concerned. You’ve got a large immigrant population crowded together in these tenements. And one of the things that having them crowded together in the tenements means is that, say, when the summer comes and it gets hot and babies start dying of diarrhea, and I can tell you why they’re dying, you see them. There are a lot of them together. It doesn’t look right here. Here you are in a city that you think is a center of civilization, a central part of central culture. And there are all these babies dying. And people take on the question, visiting nurse services, settlement houses. People are interested in talking to the parents. People are interested in education. People are interested in milk stations. And she gets interested in the question of whether you could prevent these deaths. And she goes on to be a pioneer. And she’s credited by a newspaper at the time that 90-, if not for her, for Josephine Baker, if not for her 90,000 babies now alive would have died. So it’s a really massive campaign in terms of parent education, in terms of realistically figuring out how to help parents make the most of what they’ve got. But also in terms, and she writes about this very movingly, in terms of convincing mothers that actually, yes, they have it in their power to keep their babies alive. And the reason that that summer diarrhea is so deadly, it comes back to something you were saying before, which is of great interest to pediatricians everywhere. It’s why babies are very vulnerable to certain things. Babies are very, very vulnerable to anything that affects their airways because their airways are so tiny, so narrow, compared to adults. So if something inflames the airways or swells the airways or tends to obstruct the airway, long before it’s actually dangerous in adults, it’s much more dangerous in babies because the tubes are so narrow. So that’s always an issue in children. And the other thing that’s always an issue in children is dehydration and diarrhea. Children are very vulnerable to it. They’re, they don’t have as much blood volume in them. They lose fluid through their skin. They have more surface area, a whole bunch of anatomic and physiologic reasons. And so when the summer comes and the milk spoils and everything, there’s germs around and there’s flies around, children are at risk for a whole multitude of reasons to get stomach upsets. And a lot of them die. And there are heart wrenching descriptions of what it’s like for the parents to watch them. And remarkable delight that you read when you read Josephine Baker’s memoir about how amazing it is to realize that children do not need to die in the summertime, that that is not a natural, absolute fact of life. 

ADAM CONOVER [00:38:16] Wow, that’s an incredible mission. It must’ve been incredibly satisfying to save, to save that many lives. And you talk about parent education, at least based on what I’ve read of your book, it sounds like that’s something that parents were hungry for. That, you know, the government put out pamphlets on how to protect the life of your child and that they were incredible bestsellers because people were desperate for this information. 

PERRI KLASS [00:38:43] Parents love their children. They always do. They’ll, they do whatever it takes-. 

ADAM CONOVER [00:38:49] Ah, that explains it. 

PERRI KLASS [00:38:50] To keep their children safe. Right? And sometimes they, there were, there were people who, there’s somebody in my book who shows up with a fake tuberculosis cure to make his fortune. And parents are desperate for the fake tuberculosis cure because there’s nothing they can do. And I think that one of the things that’s true for many of the successful efforts and there were missteps and people go wrong and people sometimes don’t treat parents with sufficient respect. But for the successful efforts, it’s almost always about partnering with parents and realizing as, as pediatrics is nowadays, realizing that the people who really want most to keep these children safe and healthy are the people who love them so dearly, their parents, but also realizing that it’s very scary for parents sometimes to change something they’re doing to put their faith in something new. 

ADAM CONOVER [00:39:52] Well, so that brings me to my question about parents today, because we have this sort of stereotype of modern American parents that they are very anxious and very overly concerned about their child’s health, helicopter parenting and, you know, keeping everything very safe for the kids. But one thing that this you know, you telling me this story puts into perspective is that, well, maybe that makes sense, because for so much of history, like children did really easily die. And this really was life or death, and like any little thing could cause a child to pass away. So it makes that anxiety that, you know, we tend to laugh at in parents now seem more understandable to me. Does it seem that way for you? 

PERRI KLASS [00:40:35] So I’m going to offer you a theory. And I, again, you can-. 

ADAM CONOVER [00:40:39] Please. 

PERRI KLASS [00:40:40] Like it or you can not like it. But it’s the thing that I find myself thinking about when I, again, try to understand how parents and how pediatricians felt in an era when mortality was so much higher. I don’t think that my grandmother believed that it was in her power to keep her children absolutely safe. I think she had to live day to day with the knowledge that the world was dangerous, that bad things happen to children, that even if you were John D. Rockefeller, as she would have said, you could not necessarily keep a child safe. I think parents today living in what is objectively a world in which there is much less infant and child mortality. I think we’ve put parents today in a situation where they believe that if they make all the right decisions and all the right choices and take all the right precautions, that they can keep their children safe. And that is much truer than it would have been for my grandmother. But I think that the flipside of that is that parents feel then a sense of almost crushing responsibility, because one of the things which is designed in there when you have a baby and I’ve felt this for my own children and seen it with many other people, you look at this helpless baby, you feel this overwhelming sense of protectiveness, responsibility, this desire to do everything right. But I think that the idea that you actually can do everything right and that it is, in fact, a parent’s responsibility to make every decision correctly. Because if you do that, there’s some kind of guarantee that the flipside of that safety is a kind of parental anxiety, a kind of desperate desire to get everything right. And then, of course, we, as we all know, live in a world where you, you can’t actually get everything right. There’s not a secret code. There’s not a way to guarantee safety. But that, that responsibility to preserve perfect safety, I think sometimes weighs very heavily on parents now. 

ADAM CONOVER [00:42:58] Is that an anxiety that you think we should somehow relieve ourselves of? Or I mean, knowing what you do about the history of these emotions? Yeah. What do you, what do you think about that? Is that something that we should try to ameliorate or is that a necessary side effect? What? Yeah. 

PERRI KLASS [00:43:17] I think the right, the best thing we can do with that is turn it outward a little. Yes. If we can make the world safer for all the children, we can make the, if we can turn it into a way to make our streets safer, if we can turn it into a way to make sure that all of the different groups in our society enjoy all of the blessings of safety. I think if you turn it inward, as I have this one child and it is my absolute responsibility to make every decision properly and keep this child perfectly safe. First of all, it can’t be done. And second of all, you’ll probably tie yourself into the kind of knots that you were talking about earlier. I think if you say, now that I understand how a parent loves a child, now I understand why it’s important that we make our city, our community, our state, our country, our world as safe as possible for children. I mean, I’m a pediatrician. I think that there’s nothing better that we could all do, then decide to make our community, our city, our state, our country, our world as safe as possible for all the children. I think there’s a way, and I hear this in the voices of people like Josephine Baker, in which you take this emotion and you say, OK, how do we make the world more equally safe? How do we make sure that is remarkable, and this is a blessing. This is an amazing blessing. Everyone, you can look around at your own siblings, you can look around at your children. You could think about what would it mean to live in an era when no family went untouched and when many families were touched multiple times by child mortality. And you can take that gratitude for living in a world where it’s been so reduced. And think about how do we extend it, because it’s truly about trying to make everybody safe and trying to remove this tragedy from as many lives as possible. 

ADAM CONOVER [00:45:16] Yeah. I love that, and I think that’s, also a really, a really wonderful tonic to what I sometimes think of as the narrowing of perspective of people when they become parents is that, you know, well, they have a lot of responsibility, but only towards this one being, or one or two, when like we can expand that net of concern to the entire society, we can care for each other. And that leads me to my next question, because I want to talk about the ways in which this problem hasn’t been solved that, you know, in many parts of the world, but also here in the United States, like there are still places where the infant mortality rate is not what we would want. I mean, the infant mortality rate for for black mothers, for black children is twice what it is for, for white children. 

PERRI KLASS [00:46:00] Yep. 

ADAM CONOVER [00:46:00] My, is my understanding, you probably know better than I do, but that’s something that we’ve learned a lot about in recent years, has gotten a lot of coverage. And yeah, I wonder if you could speak to, speak to that at all. 

PERRI KLASS [00:46:12] Absolutely. And I think this, again, gets to what I’m, what I’m saying that what you want to do with this passion and to be fair, a lot of parents do not narrow. And one of the things that I saw in the 20th century, especially, was that parents who lost a child, frequently in memory, in honor of that child, they get a law passed. They, they modify the world in some way to make it safer for other children. And I think that when you turn that passion outwards, so, for example, the Safe Sleep campaign, which works with African American religious and civic organizations to make sure that that message about safe sleep comes through trusted community members. There’s a really good example. And when we come to the disparities which still exist in maternal mortality and also in infant mortality, which you absolutely still see higher in African American families, higher in indigenous families, you still see disparities by poverty. And the question of how you address that and what you need to do actually turns out to be a larger and more interesting question because it means addressing disparities in adult health, maternal health. It means addressing disparities in how medical care and preventive care are delivered. And so you can start with that infant mortality number, which shocks you and upsets you. But if you actually want to follow it, you’re going to end up trying to create a society where in which adults are healthier, families are healthier, medical care is more equally distributed. And I think that the victories over infant and child mortality have actually, even though, as you say, it wasn’t just a single campaign, they’ve helped us along to make a better society, a better world. But it’s by no means a story that we should think of as over. 

ADAM CONOVER [00:48:16] So we can move our attention from my children to all children to sort of all of society, that we can use our care for children as a way to care for each other more broadly? 

PERRI KLASS [00:48:29] I hope so. I think so. I mean, I think that, I think one of the reasons you become a pediatrician is that you like working with children. But another reason, honestly, is that even though sometimes you complain about them, you like working with parents. I actually think that becoming a parent helps you grow up, helped me grow up, helped me learn, you know, helps you learn about caring for someone more than you care for yourself, helps you understand some of the emotions you see around you in the world, some of the attachment you see. And I think that there’s a long history of parents who have used that, not necessarily while your baby’s little. We all know how busy you are, but have used that kind of personal growth as a way of connecting to the world and making the world better. And I think that, that’s a story which comes up again and again. In the book that I wrote, one of, you know, I start in the 19th century. I start with poets and writers who write about children’s death, write about some of these topics of what they themselves have suffered. But move on from that to the question of some of the reformers and medical people who take us forward in terms of keeping children safe. 

ADAM CONOVER [00:49:48] Well, that’s a wonderful, optimistic view. I want to push on you a little bit, though, because sometimes our concern for children can be used in regressive ways or ways that come from a place of fear, and it can be counterproductive. I’m thinking, for instance, school segregation battles are an example that, not, not as medically related, but people are very, you know, have reactionary views of their children’s environment. But I’m also very interested in, you mentioned vaccines for diphtheria and for all these diseases reducing the child mortality rate. And I think about today the, you know, the vaccine denialism movement, which is still based in oh, I’m concerned about the health of my child, but involves rejecting the vaccines that have actually resulted in the lives of so many children being saved. And there’s obviously a conflict there. And I want to know if you have any thoughts about that based on your work. 

PERRI KLASS [00:50:45] Well, one of the reasons I was interested in writing this book is that, honestly, the generational memory for disease is pretty short. That is to say, a disease disappears. You, you mentioned diphtheria. Well, diphtheria was a horror show, the disease. It’s a disease which chokes off your air way. It’s a disease, it’s a disease which, you know, was a, there are accounts of what it was like to watch children with diphtheria, which would just break your heart. And there are accounts by doctors of what it was like to take care of those children. It’s gone. There’s a vaccine. When the, when the original progress was made, it was, it was breaking news. It was one of the first great victories of bacteriology. The story that everybody still remembers is Bolto, the sled dog who carries the ant-, the race across Alaska to carry the antitoxin to the children. Right? Which we retrace every year when they run the sled dog race in Alaska. Right?

ADAM CONOVER [00:51:49] I didn’t know about this. That’s a really cool history. 

PERRI KLASS [00:51:51] Oh, yeah. Bolto. Well, it’s the most, he’s got a statue in Central Park of the heroic sled dog. And you can look him up. 

ADAM CONOVER [00:52:00] I can’t believe I don’t know about this famous dog. 

PERRI KLASS [00:52:03] OK. So let me tell you about this. It’s 1925. And in Nome, Alaska, there’s a developing epidemic of diphtheria. And the antitoxin which will work, which will save the children, is in Anchorage. So they sent it by train, as close as they can get. But there are still almost 700 miles to go. So there are 20 sled dog teams which take the antitoxin across Alaska and they stop at intervals to warm it because it’s going to get frozen as it, as it travels. And it’s a public event. The newspapers are carrying it. There are newsreels, the heroic dogs, and they make it. They get the antitoxin, antitoxin there and they save the children. 

ADAM CONOVER [00:52:51] Wow. 

PERRI KLASS [00:52:51] And that’s why there is a statue of a sled dog in Central Park in New York. But all I mean is this battle against diphtheria is headline news. News, news, news. Heroic sled dogs. They have a group of horses in New York that they’re injecting to produce the antitoxin. Their hero horses. That’s what they’re called in the headlines. They live like kings. 

ADAM CONOVER [00:53:12] Wow. 

PERRI KLASS [00:53:12] They’re taken care of in the world poshest-. But the point is that once it’s gone, once you have a vaccine and nobody gets diphtheria anymore, you forget it. And so I think that pediatricians, like me, sometimes are impatient with parents who are hesitant about vaccines. We don’t always do a good job of explaining. But I think one of the things that I realized is you forget the things that you were afraid of 50 years ago. They don’t seem scary. And so the diseases that people are protecting against with vaccines, even a disease like measles, it doesn’t frighten people and therefore something else comes along and scares them. And I think one of the things that I, I feel, looking back to these grieving and, and deeply sincere parents of the past, is that we shouldn’t forget these ways the children suffered because the children should not suffer from these diseases again. And there’s a logic to the efforts that we make to protect children with vaccines. I love vaccines and I believe in them. One of the reasons I believe in them is because, like other people in pediatrics, I’ve seen at least some of them. I’ve never seen diphtheria. Thank goodness. I’ve never seen polio. Those I’m learning about from a textbook, but I’ve seen bacterial meningitis from Ha-, Haemophilus influenza, and I’ve seen, you know, some of the diseases and some of the serious complications of diseases like measles and chickenpox, so I understand. And, you know, you hesitate to respond to parents by terrifying them with terrifying stories, but I understand the grief that these diseases have caused in the past. And I understand what an incredible thing it is that because of the vaccines, parents are not feeling that grief. 

ADAM CONOVER [00:55:10] Yeah, the thing you say about our short cultural memory is so much the human condition of human society. There are so many problems that are caused by that short cultural memory and none more than this. Like you almost wish that the ghosts of our grandparents and great, great grandparents could, could come and shake us by the shoulders and say, no, this could come back. Like, this is serious. Like, don’t you, don’t you understand the pain I went through? 

PERRI KLASS [00:55:39] Yeah. You do. 

ADAM CONOVER [00:55:39] You know what I mean? 

PERRI KLASS [00:55:40] You do. Absolutely. And I think that, that sort of, they would also say to you, looking around, they would say your baby was born a little early and your baby is fine. How amazing? 

ADAM CONOVER [00:55:58] Yeah. 

PERRI KLASS [00:55:58] Your child. I talk in the book about telling a grandmother, when I was practicing in Boston, telling her that her child had scarlet fever. She was from another country. She was Spanish speaking. And I remember the Spanish word for scarlet fever. And I said it and she began to cry and I thought, oh, this is good news. Your child has scarlet fever, we’ll give him a little penicillin. He’ll be fine. And she heard, my child has a terrible disease. So I think if my grandmother were here right now and she would say to you, you don’t have to worry about scarlet fever now? It’s, it’s nothing? You don’t have to, you know, you can treat bacterial pneumonia now? I mean, I think those, that joy, my grandmother, of course, like everybody her age, would remember exactly the moment when she stopped having to worry about the polio epidemics every summer. And she stopped having to make decisions about, you know, would she let her child go out and would she hang something around his neck that smelled bad because maybe it would protect him? You know, she would, I think that, the, the delight that they might take in some of these advances would also help us. 

ADAM CONOVER [00:57:12] Yeah. And how does, how does this work? You know, the, the research that you’ve done, this book is coming out at a time when we’re facing unprecedented, you know, an unprecedented medical crisis in the form of a pandemic, unprecedented wildfires that have blanketed the West Coast with poisonous air for a week now. I haven’t been outside in a week for two reasons now. How does that, do you, do you have any insight into the challenges of this moment vis a vis, you know, keeping children safe? 

PERRI KLASS [00:57:45] Sure. So one of the morals, and I think I say this in the book, is that the microbial world is with us, that bacteria and viruses take advantage of the ways that we live, as they always have, and that we have to pay attention and that we can’t, at any point say, OK, that’s done, we’ve solved it. But I would say that the overall message is that we’re actually very clever as a species and we can take on the individual challenges and address them and that we can also put these advances together. But it involves looking to science. It involves looking to public health. It involves making some decisions that are not just for our individual benefit, but that make our communities safer. I think, I mean, I think it’s a very optimistic book in the sense that this has happened. But I also think it’s an optimistic book in the sense that it makes me, there are individual people, scientists in this book who I think are mistaken or who I don’t like their attitude. And I have to be honest with you that, you know, there, there’s some of them are my heroes. Some of them are sort of my heroes. Some of them are not quite my heroes, but that their collective effort actually moves us forward to a place where there’s less tragedy and less grief. And I think that’s actually a pretty important message for us to hear at this complicated moment. 

ADAM CONOVER [00:59:17] Because you’re optimistic that we can continue on that path with all of the challenges that are facing us. 

PERRI KLASS [00:59:23] I’m optimistic about the different kinds of intelligence and creativity, and I’m optimistic about enterprises which draw on more than one discipline. Which take public health and epidemiology seriously, which take nursing seriously, which take parent activism ser-. And I’m optimistic about being able to put all of that together into moving forward. 

ADAM CONOVER [00:59:52] That is a wonderful message to end us on, thank you so much for being here, Perri, I can’t thank you enough. This is a fascinating conversation. 

PERRI KLASS [00:59:59] My great pleasure. Thank you for having me. 

ADAM CONOVER [01:00:06] Well, thank you once again to Perri Klass for coming on the show. I can’t thank her enough for sharing that with us. If you love that interview as much as I did. Please leave us a rating or a review wherever you subscribe. It really does help us out. I want to thank our producers, Sam Roudman and Kimmie Lucas, our engineer, Ryan Conner, Andrew W.K. for our theme song. I want to thank the folks at Falcon Northwest for building me this incredible gaming PC I record the show on. Check them out next time you’re looking for a gaming PC. They’re wonderful folks who will do you right. If you want to send me any suggestions, you may have for topics we can cover on the show, please send them to Factually@AdamConover.net. I will promise you we do read them and that is-, oh, you can find me an Internet! I almost forgot to do this part. You can find me on the Internet at AdamConover.net or at AdamConover wherever you get your social media, including Adam Ruins Tik Tok on Tik Tok. All right. Thank you so much for listening. We’ll see you next time. Stay curious.