Patterns of Mortality by Age and Cause of Death Among Nineteenth-Century

Immigrants to Liberia
Author(s): Antonio McDaniel and Samuel H. Preston
Source: Population Studies , Mar., 1994, Vol. 48, No. 1 (Mar., 1994), pp. 99-115
Published by: Taylor & Francis, Ltd. on behalf of the Population Investigation
Committee

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Population Studies, 48 (1994), 99-115
Printed in Great Britain

Patterns of Mortality by Age and Cause of

Death Among Nineteenth-Century Immigrants
to Liberia*

ANTONIO McDANIEL AND SAMUEL H. PRESTONt

INTRODUCTION

Most of the information about mortality conditions in nineteenth-century Africa relates

to the small number of white settlers or visitors.' These studies show that international
migration to the tropics before 1850 typically increased mortality from infectious
diseases for the migrant population. The nineteenth-century West African disease
environment was one of the principal reasons why large numbers of Europeans did not
settle in West Africa.
This environment is revealed by high-quality data on the experience of Africans who
emigrated from the United States to Liberia during the first half of the nineteenth
century. They were collected by the American Colonization Society and cover the period
1820 to 1843. They appear to represent the highest mortality rates in accurately-recorded
human experience.2 Reports of agents of the Colonization Society often described in
considerable detail symptoms of the diseases that were afflicting the settlement, and
special medical inquiries were concluded in 1832 and 1849 designed to identify reasons
for what had come to be seen as excessively high mortality.3 Other reports of British
medical agents describe the epidemiological conditions of the West African coast.4
In this paper we use these data to examine the cause-of-death structure and age-
pattern of mortality in the Liberian settlements. We describe crude death rates and age-
standardized death rates by cause of death for each year, and periods of time from 1820
to 1843. We also examine the age-pattern of mortality and the extent to which it
conforms to existing models for all causes of death and from specific causes.

* This research was supported by a grant from the National Institute of Health (NICHD 1-RO1-HD-27485-
01). We would like to thank Carlos Grushka for his programming assistance. We also appreciate the
suggestions of the Population Studies editorial staff and reviewers.
t Population Studies Center and Department of Sociology, University of Pennsylvania, Philadelphia, PA
19104.
1 p. D. Curtin, Death by Migration: Europe's Encounter with the Tropical World in the Nineteenth Century
(New York: Cambridge University Press, 1989); H. M. Feinberg, 'New data on European mortality in West
Africa: the death on the Gold Coast, 1719-1760', Journal of African History, 15 (3) (1974), pp. 257-371;
K. G. Davies, 'The living and the dead: white mortality in West Africa, 1684-1732', in S. L. Engerman and
E. C. Genovese (eds), Race and Slavery in the Western Hemisphere: Quantitative Studies (Princeton, 1975).
2 A. McDaniel, 'Extreme mortality in nineteenth century Africa: the case of Liberian immigrants',
Demography, 29 (4) (1992).
3 Dr Henderson, 'Report on the medical statistics of the colony', in the Minutes of the Board of Managers,
American Colonization Society, May 14, pp. 273ff. (Library of Congress. Manuscript Division, Washington,
DC.); J. W. Lugenbeel, Sketches of Liberia: Comprising A Brief Account of the Geography, Climate
Productions, and Diseases of the Republic of Liberia (Washington, D.C., 1853).
4 W. F. Daniell, Sketches of the Topography and Native Diseases of the Gulf of Guinea West Africa (London,
1849).

99
4-2

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 100 ANTONIO MCDANIEL AND SAMUEL H. PRESTON

AFRICAN-AMERICAN SETTLEMENT IN LIBERIA

In the Census of 1820 1,771,656 African people were enumerated in the United States,
233,634 of whom were legally free citizens.5 The free African in America was a
contradiction and threat to the system of slavery.6 Although slavery was regarded as an
injustice by many, including Thomas Jefferson and James Madison, they believed it
impossible for whites and free Africans to live together in harmony and regarded
colonization of the African population abroad as a necessary companion to
emancipation. Others, especially in Virginia and Mississippi, supported colonization
because of their desire to remove freed Africans and the example that they presented to
slaves. Emigration from the United States was an alternative to racial integration.
Other supporters of colonization were motivated by the desire to create a colony in
Africa which would enrich American trade.7 Still others were motivated by the strong
desire to return home to mother Africa.8
The first efforts at colonization of African-Americans in Africa were led by Captain
Paul Cuffe, a wealthy African-American entrepreneur and pan-Africanist, who visited
Sierra Leone, a state established by Britain as a home for freed slaves and liberated
Africans captured from slave ships, in 1811.9 Following his visit he convinced some
British philanthropists to allow him to bring 38 African volunteer settlers from America
to Sierra Leone in 1815. Cuffe's example convinced many influential African-American
leaders of the time to form associations that supported colonization. Bishop Richard
Allen, James Forten, and Reverend Absalom Jones of Philadelphia, Reverend Peter
Williams, in New York, and Reverend Daniel Coker in Baltimore all viewed African
colonization as a viable solution to the problems that African-Americans confronted.'0
The American Society for Colonizing Free People of Color of the United States had
its origins in this flood of colonization sentiment that spread through the nation during
the early years of the nineteenth century." However, Cuffe's untimely death in 1817 left
the leadership of the colonization movement in the United States in the hands of the
American Society for Colonizing Free People of Color of the United States, and slave-
holder support for the Society proved too much for African-American leadership.'2
During the 1820s, even African leaders who continued to support emigration stopped
supporting the American Society for Colonizing Free People of Color of the United
States (ACS). "
In the beginning the ACS restricted its efforts to the removal of the 'free people of
color'. However, as a result of legislation in southern States which required manumitted

I U.S. Census Bureau, Negro Population in the United States 1790-1915 (Washington D.C., 1982).
6 W. L. Garrison (ed.), Thoughts on African Colonization: or An Impartial Exhibition of the Doctrines;
Principle and Purposes of the Americas Colonization Society. Together with the Resolutions Addresses and
Recommendations of the Free People of Color (New York, 1968 [1832]); P. J. Staudenraus, The African
Colonization Movement 1816-1865 (New York, 1961).
7 M. Kennedy, African Colonization-Slave Trade-Commerce (Senate Document No. 283, 27th Congress, 3rd
Session 1843).
8 L. D. Thomas, Paul Cuffe: Black Entrepreneur and Pan-Africanist (Chicago, 1988); M. Delany, Political
Destiny of the Colored Race on the American Continent (Senate Document No. 148. 37th Congress, 2nd Session
1862).
9 Thomas, op. cit. in fn. 8.
10 Staudenraus, op. cit. in fn. 6; W. L. Katz, 'Earliest responses of American negroes and whites to African
colonization', in W. L. Garrison, op cit. in fn. 6.
" E. L. Fox, The American Colonization Society, 1817-1840 (Baltimore, 1917); Staudenraus, op. cit. in fn.
6.
12 Garrison, op. cit. in fn. 6.
13 Staudenraus, op. cit. in fn. 6; R. J. M. Blackett, Building an Antislavery Wall: Black Americans in the
Atlantic Abolitionist Movement, 1830-1860 (Ithaca, N.Y., 1989).

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 LIBERIAN IMMIGRANT MORTALITY 101

slaves to be expatriated to Africa, the ACS's attempt was increasingly focused on

manumitted individuals. After 1828, the number of manumitted emigrants increased
dramatically, and by 1834 the emigrant population consisted almost exclusively of
manumitted slaves."4 This coincided with the transformation of the Society's aims,
symbolized by its change of name from the American Society for Colonizing Free People
of Color of the United States to the American Colonization Society (ACS). More than
16,000 Africans immigrated to Liberia from the United States during the nineteenth
century.'5 Some 11,000 of these emigrants migrated before the general emancipation in
1862.
The area to which they migrated was widely recognized as unhealthy, especially for
white settlers. Many considered African-Americans to be better adapted to the West
African conditions, to which most traced their origins in generations past.'6 Nevertheless,
an increased risk for all groups was generally acknowledged. Lugenbeel noted that 'the
physical system of every individual who removes from a temperate to a tropical climate
must undergo some change'."

DATA

Between 1820 and 1843, a total of 4472 immigrants from the United States entered
Liberia under the auspices of the American Colonization Society. Detailed records for
these migrants were kept by the Society and the United States Navy and published in
the Congressional Record.'8 The records were assembled from the records of the Board
of Managers of the American Colonization Society. Dates of arrival, emigration, and
death were recorded for each settler.
A complete census of the settlements was conducted in 1843. The discrepancy between
the number of settlers enumerated in the Census and the number expected was only nine
individuals, which suggests that record-keeping was extremely accurate.'9 Of the 4472
migrants, 2198 had died by the Census of August 1843. Fourteen of these deaths were
recorded as having occurred during the passage to Liberia. These data appear to
represent the highest accurately recorded mortality experience available for a human
population.20 When age-specific death rates for the entire period are converted into a life
table, life expectancy at birth is 1.68 years for males and 2.23 years for females.

CAUSES OF DEATH IN LIBERIA

'Cause of death' is a phrase used to simplify the factors that cont

death. It is now conventional to distinguish the main cause (the

14 Staudenraus, op. cit. in fn. 6.

15 United States Congress, Roll of Emigrants That Have Been Sent to The C
By the American Colonization Society and its Auxiliaries, To September, 1843 & c. (Senate Document No. 150,
28th Congress, 2nd Session, 1845); R. T. Brown, Immigrants to Liberia 1843 to 1865: An Alphabetic Listing,
Liberian Studies Research Working Paper No. 7 (Philadelphia, 1980); P. J. Murdza, Jr., Immigrants to Liberia
1865 to 1904: An Alphabetic Listing, Liberian Studies Research Working Paper No. 4 (Newark, Delaware,
1975).
16 Henderson, loc. cit. in fn. 3; Lugenbeel, op. cit. in fn. 3.
17 Lugenbeel, op. cit. in fn. 3, p. 27.
18 United States Congress, loc. cit. in fn. 15.
19 McDaniel, loc. cit. in fn. 2.
20 McDaniel, loc. cit. in fn. 2, especially Tables 1 and 2.

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 102 ANTONIO MCDANIEL AND SAMUEL H. PRESTON

the direct cause and the ancillary causes.2' These distinctions were not drawn during the
nineteenth century. Cassedy has noted that medical classifications and terminologies
during the early nineteenth century were 'arbitrary expedients which rarely completely
satisfied anyone'.22 Before the 1850s medical practitioners had no consistent or even
common way of speaking about the causes of death. During the nineteenth century,
arranging statistical lists of the causes of death was a creative endeavour by health
officials and medical investigators, not a science.23 Aetiological and anatomical criteria
were mixed haphazardly and reflected a lack of information about the cause of disease
and the need to rely upon a symptomatology that was itself often unsystematic.
However, the causes of death presented in this study, as in most studies of mortality
during the early nineteenth century, provide an idea of the type of factors which may
have influenced the pattern of mortality. Table 1 presents our description and suggested
interpretation of the main cause-of-death assignments found in the Liberian manu-
scripts.
During the nineteenth century the most important disease that West African settlers
faced was almost certainly malaria. So pervasive was the impact of malaria on
immigrant mortality that contemporary physicians saw it as a disease of acclimatization
which all immigrants must experience.24 In the case of Liberia, Henderson notes in his
report on the high mortality of the Liberian immigrant population that 'the mortality
considered is exclusively that of acclimation [sic], not the regular mortality of the
population'.25 The principal disease of acclimatization was malaria.
Humans are the major host for four species of malaria: Plasmodium falciparum, P.
vivax, P. malariae, and P. ovale.26 The majority of the deaths from malaria are caused
by cerebral complications, and most of these are due to falciparum malaria. All four
species cause the typical symptoms of chills and fever, and are responsible for
considerable morbidity. The most deadly species of malaria is P. falciparum, which had
a cosmopolitan distribution during the nineteenth century, with a concentration in more
densely populated areas of the tropics and sub-tropics. It spread into the temperate zone,
and was fairly common around the Mediterranean littoral, in the Balkans, and in the
Southern States of the U.S.A. In West Africa, an endemic region, two species of the
parasite, P. malariae and the dominant species, P. falciparum, predominate. While P.
malariae and P. vivax are rarely fatal, P. falciparum is a deadly cousin.27
The aetiology of P. falciparum is not well known for immigrant populations.
Eventually, individuals may acquire a resistance. Acquired immunity to falciparum
malaria results from bodily resistance to the parasite after infection that reduces the
parasite count.28 Typically, it results from surviving the disease many times, usually

21 For example, a child suffering from malnutrition (ancillary cause), who catches measles (main cause), dies
of a diarrhoeic dehydration (direct cause). The causes of death presented in this study give us an idea of the
type of factors which may have influenced the pattern of mortality.
22 J. H. Cassedy, American Medicine and Statistical Thinking, 1800-1860 (Cambridge, 1984).
23 Cassedy, ibid.
24 Henderson, loc. cit. in fn. 3; Lugenbeel, op. cit. in fn. 3; Daniell, op. cit. in fn. 4.
25 Henderson, loc. cit. in fn. 3, p. 274.
26 F. B. Livingstone, 'Malaria and human polymorphism', Annual Review of Genetics, 5 (1971), pp. 33-64.
27 Humans are the natural host of P. vivax. However there is a high degree of insusceptibility in the West
African population, both in West Africa and after centuries of residence in the United States (M. D. Young
et al; 'Experimental testing of the immunity of negroes to Plasmodium vivax', Journal of Parasitology, 41
(1955), pp. 315-318). An explanation of the phenomenon is lacking (P. C. Garnham, Malaria Parasites and
Other Haemospoeidia (Oxford, 1966)). It is possible that the West African population developed a genetic
peculiarity of the blood, which confers resistance to P. vivax, much greater than that provided by sickle cell
haemoglobin in ameliorating infections due to P. falciparum.
28 Garnham, op. cit. in fn. 24

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 LIBERIAN IMMIGRANT MORTALITY 103

Table 1. Causes of death in Liberia 1820-1843

Cause of
death titles Probable medical interpretation

Anasarca Oedema characterized by the accumulation of serum in the connective tissue of the
body; also known as dropsy
Casualty A result of accident or injury
Childbirth Complication from giving birth
Cholera An acute epidemic infectious disease caused by a specific germ. It is marked clinically
by a profuse water diarrhoea, muscular cramps, vomiting and collapse. The term was
also used more generally to refer to diarrhoea
Consumption Usually used to denote the fairly obvious symptoms associated with tuberculosis
Decline Vague term that could relate to diseases associated with ageing, or any chronic disease
process
Deranged brain Mental disturbance; insanity. Possibly resulting from stroke or convulsions
Despondency Probably due to mental illness and possibly to fever
Diseased brain Could include brain tumours (possibly due to high fevers or a tropical disease). May
also include convulsions resulting from dehydration
Diseased lung Probably influenza, pneumonia, and bronchitis
Drowning Self-evident
Exanthema Skin eruptions, such as those associated with scarlet fever or measles
Gynaecological Most probably complications of childbirth, miscarriage, abortions, or cancer of the
diseases reproductive organs
Fever A bodily temperature above the normal of 98.6 'C. (37 'C.); a symptom of an
infectious or parasitic disease in which body temperature rises above normal
Intemperance Alcoholic intoxication
Liver Most likely to be hepatitis B; possibly cirrhosis of the liver. Might also refer to a
variety of stomach ailments
Murder Self-evident
Old age Can include a number of diseases that typically do not show symptoms until advanced
age
Pleurisy Inflammation of the pleura, the serous membrane enveloping the lungs and lining the
walls of the thoracic cavity
Whooping cough Pertussis; an acute infectious disease marked by recurrent attacks of spasmodic
coughing until the breath is exhausted, then ending with a deep noisy inspiration
Worms Parasitic diseases
Unknown Illegible or missing from the record

Sources: Robert Hooper (ed.), 1824. Lexicon-medicum; or Medical Dictionary; Containing An Explanation
of the Terms (New York); Richard D. Hoblyn (ed.), 1846. Dictionary of Terms Used in Medicine and the
Collateral Sciences (Philadelphia: Lea and Blanchard); Richard Quain, (ed.), 1884. Dictionary of Medicine
(New York: Appleton and Co.). Stedmans' Medical Dictionary, 1966. 21st ed. Baltimore: The Williams and
Wilkins Company.

beginning in childhood. However, survivors do not acquire total immunity. The host is
refractory to a re-inoculation with the same parasite, yet all strains of the same species
are not immunologically similar. Given the relatively large number of strains, immunity
to a specific strain leaves an individual open to infection by other strains.29 Having
acquired an effective degree of resistance to a particular type or strain of malaria does
not result in a similar resistance or immunity to other types or strains.30 Thus, emigrants
born in the United States who had developed antibodies that are reasonably effective
against P. vivax or P. falciparum may not have had the same resistance to P. falciparum
in West Africa.
As noted, the causes of death presented in this study are not precise. During the
nineteenth century some deaths tended to be assigned to terminal conditions, and others

29 L. H. Miller and R. Carter, 'A review: innate resistance in malaria', Experimental Parasitology, 40
(1976), pp. 132-146.
30 Miller, loc. cit. in fn. 26; G. MacDonald, The Epidemiology and Control of Malaria (London, 1957

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 104 ANTONIO MCDANIEL AND SAMUEL H. PRESTON

to symptoms rather than to specific underlying causes. 'Fevers', for example, could
mean malaria, typhus, typhoid, yellow fever, epilepsy, and a range of nervous disorders.
However, yellow fever was apparently absent from the settlement, although its presence
was noted in neighbouring areas.3' Malaria was thought to be the main source of the
fevers.32
Tuberculosis was also a principal cause of death during the nineteenth century.
During the early part of the century, the acute epidemic diseases - cholera, smallpox,
yellow fever and the chronic epidemic of malaria - overshadowed the slow epidemic
caused by tuberculosis.33 During the nineteenth century, tuberculosis accounted for
almost one-fifth of all deaths in cities and densely populated areas. The progress of
tuberculosis was difficult to evaluate, and its infectious nature was questioned by many.
Yet, in the United States, tuberculosis was the leading cause of death in most large cities.
For example, in the early nineteenth century 20 per cent of all deaths in New York City
were attributed to tuberculosis.
Both tuberculosis and pneumonia were thought to be uncommon in Africa during the
early nineteenth century.34 However, our results suggest that this was not true of West
Africa, particularly for this immigrant population (see Table 2 below). The tubercle
bacillus multiplies less rapidly than ordinary bacteria, and thus, takes a relatively long
time to produce symptoms and to spread throughout a community.35 Infants, on the
other hand, sometimes died within months of their initial infection - in contrast to the
longer period of consumption which was fatal to adults.

DEATHS BY CAUSE IN LIBERIA

We have constructed eight cause-of-death groupings from the terms used in the
manuscripts: fevers and other infections and parasitic diseases; diseases of the brain;
disease of the lungs; tuberculosis (consumption); gynaecological diseases; accidents and
violence; circulatory and degenerative diseases; and other and unknown causes. In
Table 2 we present the distribution of causes of deaths for the Liberian immigrant
population by sex over the entire period 1820-43. By far the most important cause of
death was fevers, which accounted for about 42 per cent of the deaths. The distribution
of causes of death is similar for males and females, except that about six per cent of the
deaths of females are due to gynaecological diseases or childbirth, and males are much
more likely to have died from accidents and violence than females (11 per cent compared
with 4 per cent); homicide and drowning are the most important causes in this category.
Table 3 presents crude and age-adjusted death rates by cause for the entire period and
for three sub-periods: 1820-1828, 1829-1835 and 1836-1843. Mortality from all causes
declined sharply from 143.1 per 1,000 between 1820 and 1828 to 70.7 in 1836 to 1843.
This decline was entirely attributable to a reduction in death rates from fever (and other
infectious and parasitic diseases), which fell from 98.8 to 179 per 1,000 during this

3' Lugenbeel, op. cit. in fn 3.

32 Henderson, loc. cit. in fn. 3; Lugenbeel, op. cit. in fn. 3.
3 A. M. Lowell, 'Tuberculosis morbidity and mortality and its control', in Tuberculosis (Cambridge, 1969),
pp. 1-122. Lowell notes that the bacillus Mycobacterium tuberculosis was not isolated until 1882 by Robert
Koch.
3" K. F. Kiple and V. H. King, Another Dimension to the Black Diaspora: Diet, Disease, and Racism (New
York, 1981); P. 0. Curtin, 'African health at home and abroad', in K. F. Kiple (ed.), The African Exchange:
Toward a Biological History (Durham, 1988), pp. 110-139.
" I. T. Elo and S. H. Preston, 'Effects of early-life conditions on adult mortality: a review', Population
Index, 58 (2) (1992), pp. 186-212.

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 LIBERIAN IMMIGRANT MORTALITY 105

Table 2. Deaths by cause among Liberian immigrants, 1820-1843

Males (%) Females (%) Totala (%)

I Fever and other 456 (40.2) 420 (43.4) 921 (42.0)

infectious diseases
Fevers 429 395 869
Exanthema 18 16 34
Cholera 3 2 5
Whooping cough 4 6 10
Worms 2 1 3

II Diseased brain 60 (5.3) 34 (3.5) 96 (4.4)

III Disease of the lungs 97 (8.5) 81 (8.4) 188 (8.6)
Pleurisy 49 31 88
Diseased lungs 48 50 100

IV Consumption tuberculosis 99 (8.7) 91 (9.4) 193 (8.8)

V Gynaecological diseases (0.0) 56 (5.8) 57 (2.6)
Gynaecological diseases 43 44
Childbirth 0 13 13

VI Accidents and 119 (10.5) 34 (3.5) 156 (7.1)

violence
Accident 9 1 10
Homicideb 46 21 69
Drowning 57 5 63
At sea 7 7 14

VIII Circulatory and 170 (15.0) 138 (14.3) 317 (14.4)

degenerative disease
Decline 97 83 186
Old age 14 21 35
Anasarca 59 34 96

VIII Others and unknown 133 (11.7) 113 (11.7) 267 (12.2)
Othersc 7 5 12
Unknown 126 108 255

Total 1135 (100.0) 967 (100.0) 2195 (100.0)

a Includes deaths of persons of unknow

Includes casualty and murder.
Includes despondency, liver disease, grief, intemperance, kidney injury and sunstroke.

period. Death rates from all other causes fluctuated: 44.3 per 1,000 between 1820 and
1828, 37.1 between 1829 and 1835, and 52.8 between 1836 and 1843. Within this group,
death rates from accidents and violence fell sharply, while those from 'unknown' causes
rose. Age-standardization (using person-years lived in each age group between 1820 and
1843 as the standard) does not modify the basic features of these trends, although it
reduces the overall decline in mortality because it controls for the reduction in the
proportion of the population at highest risk during the first few years of life. The decline
in 'fever' deaths continues to account for the entire decline in death rates from all causes
combined.
The sharp decline in death rates from fevers during the period probably reflects the
fact that, as time advanced, a smaller fraction of the immigrant group consisted of
newcomers. The extraordinary mortality from fevers during the early period suggests
that many members of the immigrant population had not acquired immunity to diseases
included under this heading at the time of their arrival. The subsequent decline in
mortality is consistent with disease processes to which some immunity had been
acquired, of which malaria is probably the most important. Contemporary medicine

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106 ANTONIO MCDANIEL AND SAMUEL H. PRESTON

Table 3. Crude and age-standardized death rates by cause: total population

Death rates (per 1000)

Crude rate Age-standardized rate

Males Females Totala Males Females Totala

1820-1828
1 Fevers and other infectious 90.8 103.6 98.8 89.9 90.4 87.8
diseases
2 Diseased brain 1.0 0.0 0.5 1.0 0.0 0.5
3 Disease of the lungs 2.9 1.1 2.0 3.1 1.3 2.1
4 Consumption 7.6 12.3 9.8 7.3 12.3 9.8
5 Gynaecological diseases 0.0 2.2 1.0 0.0 2.3 1.1
6 Accidents and violence 21.0 2.2 12.8 21.7 2.3 13.3
7 Circulatory and degen. dis. 11.5 14.5 12.8 13.2 15.9 14.0
8 Others and unknown 5.7 3.3 5.4 5.8 3.2 4.9
All causes 140.5 139.2 143.1 142.0 127.7 133.5
1829-1835
1 Fevers and other infectious 46.9 48.6 49.1 40.1 42.7 42.2
diseases
2 Diseased brain 1.1 0.7 0.9 1.3 0.7 1.0
3 Disease of the lungs 4.1 3.6 4.2 4.1 3.8 4.2
4 Consumption 5.4 6.3 5.6 5.9 6.7 6.1
5 Gynaecological diseases 0.0 4.1 1.9 0.0 4.3 2.0
6 Accidents and violence 8.1 5.3 6.6 8.3 4.6 6.4
7 Circulatory and degen. dis. 10.8 11.1 10.7 11.8 11.8 11.6
8 Others and unknown 6.8 6.5 7.2 6.1 6.2 6.6
All causes 83.3 81.1 86.2 77.5 80.9 80.1
1836-1843
1 Fevers and other infectious 18.7 17.5 17.9 23.6 22.9 23.5
diseases
2 Diseased brain 4.5 2.4 3.4 4.5 2.4 3.3
3 Disease of the lungs 9.8 9.1 9.5 9.6 9.1 9.4
4 Consumption 10.1 8.8 9.3 9.8 8.5 8.9
5 Gynaecological diseases 0.0 4.7 2.2 0.0 4.5 2.1
6 Accidents and violence 6.8 0.2 3.5 6.7 0.1 3.3
7 Circulatory and degen. dis. 15.7 12.6 14.1 14.9 12.0 13.4
8 Others and unknown 11.1 10.4 10.9 12.2 11.6 12.3
All causes 76.8 65.8 70.7 81.2 71.2 76.4
1820-1843
1 Fevers and other infectious 35.5 35.9 36.4 35.5 35.9 36.4
diseases
2 Diseased brain 2.9 1.6 2.2 2.9 1.6 2.2
3 Disease of the lungs 7.1 6.4 6.9 7.1 6.4 6.9
4 Consumption 8.1 8.1 8.0 8.1 8.1 8.0
5 Gynaecological diseases 0.0 4.3 2.0 0.0 4.3 2.0
6 Accidents and violence 8.6 2.2 5.4 8.6 2.2 5.4
7 Circulatory and degen. dis. 13.5 12.2 12.7 13.5 12.2 12.7
8 Others and unknown 9.1 8.4 9.0 9.1 8.4 9.0
All causes 84.8 792. 82.6 84.8 79.2 82.6

a Includes persons of unknown sex.

maintained that newcomers to the tropics had to pass through a 'seasoning sickness'.
The medical lore of the time held that migration to the tropics exacted its price in
immediate mortality; however, those who survived became partially acclimatized. The
implication for migration policies was, therefore, to maintain the pace of immigration
and to dismiss the horrendous mortality as the price that needed to be paid.36

36 Henderson, loc. cit. in fn. 3; Lugenbeel, op. cit. in fn. 3.

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 LIBERIAN IMMIGRANT MORTALITY 107

Table 4. Crude and age-standardized death rates by cause: experience after the
calendar year of arrival

Death rates (per 1000)

Crude rate Age-standardized rate

Males Females Totala Males Females Totala

1820-1828
1 Fevers and other 2.0 5.7 3.5 2.1 5.3 3.5
infectious diseases
2 Diseased brain 1.0 0.0 0.5 1.0 0.0 0.5
3 Disease of the lungs 2.0 1.1 1.5 2.0 1.3 1.6
4 Consumption 7.9 10.3 9.1 7.5 10.7 9.2
5 Gynaecological diseases 0.0 1.1 0.5 0.0 1.2 0.6
6 Accidents and violence 13.8 1.1 8.1 14.5 1.1 8.6
7 Circulatory and degen. dis. 8.8 10.3 9.6 10.6 10.5 10.5
8 Others and unknown 4.9 0.0 2.5 5.0 0.0 2.6
All causes 40.3 29.8 35.4 42.7 30.1 37.0
1829-1835
1 Fevers and other 3.9 4.6 4.4 3.6 4.1 4.0
infectious diseases
2 Diseased brain 1.1 0.7 0.9 1.3 0.7 1.0
3 Disease of the lungs 3.9 3.4 3.9 4.0 3.6 4.0
4 Consumption 5.0 5.9 5.2 5.5 6.3 5.7
5 Gynaecological diseases 0.0 1.7 0.8 0.0 1.8 0.8
6 Accidents and violence 4.8 1.5 3.2 5.1 1.5 3.3
7 Circulatory and degen. dis. 10.1 9.3 9.5 11.0 9.8 10.2
8 Others and unknown 5.3 4.9 5.6 4.9 4.7 5.3
All causes 34.1 31.9 33.5 35.5 32.6 34.4
1836-1843
1 Fevers and other 3.1 3.4 3.2 3.4 3.4 3.3
infectious diseases
2 Diseased brain 4.5 2.3 3.3 4.5 2.3 3.3
3 Disease of the lungs 9.7 9.0 9.4 9.5 9.0 9.3
4 Consumption 9.8 8.7 9.1 9.5 8.4 8.7
5 Gynaecological diseases 0.0 4.8 2.2 0.0 4.5 2.2
6 Accidents and violence 6.9 0.2 3.5 6.7 0.1 3.4
7 Circulatory and degen. dis. 15.0 12.1 13.5 14.3 11.6 12.9
8 Others and unknown 10.5 10.0 10.3 11.3 10.5 11.2
All causes 59.5 50.5 54.5 59.2 49.9 54.3
1820-1843
1 Fevers and other 3.3 4.1 3.7 3.3 4.1 3.7
infectious diseases
2 Diseased brain 3.0 1.5 2.2 3.0 1.5 2.2
3 Disease of the lungs 6.9 6.3 6.7 6.9 6.3 6.7
4 Consumption 7.9 7.8 7.7 7.9 7.8 7.7
5 Gynaecological diseases 0.0 3.3 1.6 0.0 3.3 1.6
6 Accidents and violence 6.7 0.7 3.8 6.7 0.7 3.8
7 Circulatory and degen. dis. 12.6 10.9 11.7 12.6 10.9 11.7
8 Others and unknown 8.1 7.3 7.9 8.1 7.3 7.9
All causes 48.4 42.0 45.2 48.4 42.0 45.2

a Includes persons of unknow

To cast further light on this issue, we examined the mortality of Liberian immigrants
after their calendar year of arrival. The year of arrival was clearly the most devastating
for the immigrants, accounting for about 43 per cent of all deaths.37 Table 4 presents

37 McDaniel, loc. cit. in fn. 2.

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 108 ANTONIO MCDANIEL AND SAMUEL H. PRESTON

crude and age-adjusted death rates by cause, in three sub-periods for immigrants,
excluding experience during the year of passage. Over the entire period 1820 to 1843,
mortality from all causes amounted to 82.6 per 1,000 for the total population, compared
to only 45.2 for those who survived their year of arrival (comparing Table 3 and Table
4). Again, this reduction was almost entirely due to a lower death rate from fevers and
other infectious and parasitic diseases, which was reduced from 36.4 per 1,000 in the
total population to 3.7 in the immigrant population who survived the calendar year of
arrival.
Restricting analysis to exposure after the year of arrival eliminates the declining trend
in mortality from all causes combined. In fact, some increases occurred between 1836
and 1843, largely attributable to increased death rates from 'diseases of the lungs' and
from 'circulatory and degenerative diseases'. Death rates from all causes other than
fever were similar for the immigrants who survived their year of arrival and those of the
total population (compare Tables 3 and 4). Diseases of the lungs, consumption, and
circulatory and degenerative diseases replaced 'fever' as the major cause of death in the
three sub-periods for immigrants who survived the calendar year of arrival. Age-
standardization does not modify the basic features of these trends.

AGE STRUCTURE OF MORTALITY IN LIBERIA FROM MAJOR CAUSES

One test of the validity of the cause-of-death assignments in Liberia is to compare the
age-pattern of mortality from a specific cause with that recorded in populations in which
cause-of-death assignment is more precise. Preston has compiled data on causes of death
by age and sex for 16 national populations with high mortality ;38 in particular, life
expectancies between 25 and 45 years. These include three data sets from nineteenth-
century England, Italy in 1881, 1891 and 1901; and twentieth-century data from Chile
(4), Taiwan (3), South Africa coloured (1), U.S. non-whites (1), and Japan (1). In none
of these populations was mortality as high as in Liberia, but they are the sets with the
highest mortality that exist for comparison.
Figures 1-4 present comparisons of age-specific death rates, by cause, in Liberia over
the entire period 1820 to 1843 to the mean death rates from comparable causes in this
group of populations. The figures present the logarithm of the average of rates for
males and females. In Figure 1 death rates from 'fevers and other infectious and
parasitic diseases' are compared with 'infectious and parasitic diseases except
tuberculosis' in Preston's composite data set. In both the Liberian and the model curves
the highest death rates occur at ages 0-1 and 1-4, with a very slow increase after the
teens. In Figure 2, death rates from 'consumption' are compared with death rates from
'respiratory tuberculosis' in the composite data. Both show a characteristic sharp
increase between childhood and young adult ages, and a relatively level pattern
thereafter. In Figure 3 death rates from 'gynaecological diseases' in Liberia are
compared with 'maternal mortality' in the composite set. Both show a hill-shaped
pattern centred around the childbearing years. Most strikingly, the rapidly increasing
mortality from circulatory and degenerative diseases in Liberia recapitulates rather
precisely the 'cardiovascular' mortality profile in the composite set (Figure 4). Both
appear highly linear on a logarithmic scale, a pattern first noted by Gompertz (1825),
and the slopes are very similar.

38 S. H. Preston, Mortality Patterns in National Populations: With Special Reference to Recorded Causes of
Death (New York, 1976).

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 LIBERIAN IMMIGRANT MORTALITY 109

1 - - Liberia 1820 to 1843

o -- Composite
-1-

-2-

-3

-4i

-5 '

t -7 1 T I ' I I I I I
0 10 20 30 40 50 60 70
Age
Figure 1. Fevers and other infectious dise
from a composite of populations with lif

-3.0- Liberia 1820 to 1843

-3.5 - Composite

-4.0-

-4.5-

-5400--

-5.5 / #__--__ _ _

-6.0- \/

E -7.5

?~~~~ ~ ~~~ -80 ,-- i~-? X l- I --

0 10 20 30 40 50 60 70
Age

Figure 2. Consumption (tuberculosis) in Liberia compared with tuberculosis from a composite of populations
with life expectancies below 45 years.

This comparison suggests that the physicians who assigned causes of death in Liberia
were using criteria which were broadly similar to those used at a time when international
lists of causes of death incorporated more precise understandings of disease aetiologies.
The age patterns of cause-specific mortality in Liberia appear to be consistent with a
more modern composite pattern. In fact, there is a striking similarity in the age profiles,
although in general the Liberian curves lie above those in the composite.

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 110 ANTONIO MCDANIEL AND SAMUEL H. PRESTON

-4 - Liberia
1820 to 1843
5- Composite ----

-6-

-7- . \

-8~ ~~
-8- IX

-9 1
I \
-10-

E -l 11

- -12-
O 10 20 30 40 50 60 70
Age

Figure 3. Gynaecological diseases in Liberia compared with maternal mortality from a composite of
populations with life expectancies below 45 years.

-1- Liberia 1820 to 1843

-2- - - Composite

-3

-4- 40

o io 20 30 40 50 60 70
Age

Figure 4. Circulatory and degenerative diseases in Liberia compared with neoplasms, cardiovascular diseases,
and certain chronic diseases from a composite of populations with life expectancies below 45 years.

AGE STRUCTURE OF MORTALITY IN LIBERIA FROM ALL CAUSES COMBINED

We now turn to an explicit examination of the age-pattern of mortality in Liberia, which

is the population with the highest mortality for which statistics on deaths by age exist.
Its mortality is well outside the range of model life table systems, which themselves
represent, at the highest mortality levels, distant extrapolations from recorded
experience. Therefore, the Liberian data provide a useful test of the degree to which the
models can be used for populations with mortality radially different from that on which

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 LIBERIAN IMMIGRANT MORTALITY 111

the models are based. The principal model life-table systems do not include observed
mortality with a life expectancy below 33.4 years for Bavarian males, 1878,39 and 35.5
years for Italian females, 1876-1887; or 37.6 years, (males) and 40.1 years (females) for
Trinidad and Tobago, 1920-22.4o
It has often been asserted that Coale and Demeny's North model life table system
provides the best fit to child mortality in West African data, and that the West model
provides the best fit to adult mortality.4' This assertion is based on data from the second
half of the twentieth century. Preston has suggested that this correspondence may reflect
the fact that the age-pattern of deaths from malaria is intermediate between that from
respiratory tuberculosis and other infectious and parasitic diseases.42 Malaria is, of
course, very prevalent in West Africa, and the North pattern reflects a very high
incidence of death from respiratory tuberculosis.
In order to see how congruent the model life table systems are with the Liberian
experience, it is necessary to construct a system that extrapolates the model life tables
to a much higher level of mortality. Brass et al. have suggested that the age pattern of
mortality within a model life table system can be efficiently estimated as a two-parameter
transformation of a 'standard' age pattern of mortality appropriate for that model.43
The transformation is linear in the logits of the survivorship function.
Define
Ax = logit (I-1-x = 0- 5 In ((I1-lx/

where lx is the probability of surviving from birth to age x. Then Brass asserts that, to
a close approximation,
Ax==cxfl4X
aX + Bs,

where Ax is the survivorship function in a population that belongs to a particular

life table system and As is that in the 'standard' life table characteristic of that system.
cx represents the population's 'level' of mortality; when cx rises, death rates rise at all ages
relative to the standard. fi represents the 'slope' of mortality; when fi rises, death rates
rise at older ages (ages above that at which lx = 0.5) and fall at younger ages.
We have examined ten model life table systems to see which of them, after having
identified the best-fitting values of x and /3, comes closest to representing the age pattern
of mortality in Liberia. Four of these systems are the regional model life tables of Coale
and Demeny, which are based upon high-quality data for developed countries. The other
six are based upon the United Nations model life tables that were constructed from data
for less developed countries.44 The 'standards' used for each of these patterns
correspond to a life expectancy at birth for females of 35 years, which is the highest
mortality level tabulated in the U.N. models. We experimented with fitting each of Coale
and Demeny's models at their highest tabulated mortality level (women's life expectancy
of 20 years from Coale and Demeny, and of 15 years from John),45 but the fits were in
all cases much poorer than when tables with higher life expectancies were used. This
result suggests that Coale and Demeny's tables embody a relatively ineffective method

" A. J. Coale and P. Demeny, Regional Model Life Tables and Stable Populations. 2nd edition (New York,
1983).
40 United Nations, Model Life Tables for Developing Countries. Population Study No. 7 (New York, 1982).
41 W. Brass, A. J. Coale, P. Demeny, D. F. Heisel, F. Lorimer, A. Romaniuk and E. van de Walle, The
Demography of Tropical Africa (Princeton, 1968), pp. 130-135; A. Meredith John, The Plantation Slaves of
Trinidad, 1783-1816: A Mathematical and Demographic Enquiry (Cambridge, 1988), p. 90.
42 Preston, op. cit. in fn. 38, pp. 116-118.
43 Brass et al., op. cit. in fn. 41.
44 United Nations, op. cit. in fn. 40.
45 John, op. cit. in fn. 41.

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 112 ANTONIO MCDANIEL AND SAMUEL H. PRESTON

of extrapolation to the highest levels of mortality.46 In none of the empirical tables that
formed the base of the models was life expectancy below 30 years.
Table 5 presents the results of fitting the Liberian data to these different standards by
ordinary least squares regression. As expected, all the values of a are positive, and thus
represent a higher level of mortality in Liberia than in the standard chosen. Values of
,B are all well above unity. A fl-value of 1.00 would be observed if the same relationship
between adult and child mortality was found in Liberia as in the standard population.
Given the very high estimated values of a, mortality appears to have been unusually high
at older ages in Liberia relative to all of the standards.

Table 5. Simple linear regression of the logit transformations of the survivorship

probabilities of the Liberian data on model life table values

R2 a f

Males
Coale Demeny Models
West 0.994 2.362 2.683
North 0.996 2.329 2.785
East 0.991 2.264 3.317
South 0.991 2.466 3.143
UN Models
Latin America 0.995 2.553 2,891
Chile 0.983 2.562 2.539
South Asia 0.983 2.534 3.254
Far Eastern 0.990 2.534 1.987
General 0.996 2.579 2.585

Females
Coale Demeny Models
West 0.998 2.253 2.662
North 0.995 2.261 2.712
East 0.992 2.226 3.088
South 0.985 2.254 3.007
UN Models
Latin America 0.992 2.268 2.549
Chile 0.993 2.255 2.485
South Asia 0.984 2.243 2.966
Far Eastern 0.991 2.243 1.888
General 0.996 2.287 2.336

Table 5 shows that the best-fitting models for males are the 'North' and the UN's
'General' standard, which is a composite of the experience of all the less developed
countries included in the UN's data base. For females, the best-fitting pattern is the
'West', followed by the 'General' standard and the 'North'. The fit of these models is
extremely good, with R2 = 0.995 or higher. This degree of fit indicates that the age-
pattern of mortality in Liberia is an almost exact analogue of patterns observed in
populations with much lower mortality. The 'South' and 'South Asia' patterns, with
very high values of 4q,, indicative of high levels of diarrhoeal mortality,47 provide the
poorest fit. An even more extreme value of 4q, is provided by a high-quality life table
from Gambia, which according to U.N. suggestions could serve as a basis for a West
African model life table system. We have performed the same exercise with this empirical

46 Also see P. N. M. Bhat, Mortality in India: Levels, Trends and Pattems (Ph.D. Dissertation, Universit
of Pennsylvania).
47 Preston, op. cit. in fn. 38.

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 LIBERIAN IMMIGRANT MORTALITY 113

life table as the base, and the fit is quite poor: R' = 0.913 for males and 0.906 for
females. Ironically, a contemporary West African population provides by far the poorest
fit to a West African population in the early nineteenth century.

INFECTIOUS DISEASE AND EXTREME MORTALITY IN LIBERIA

The extraordinarily high burden of infectious disease in Liberia, reflected somewhat

crudely in its cause-of-death distribution, is undoubtedly a dominant influence on the
age-pattern of mortality. Model life tables are not very effective for making this
connection explicit, because they do not disaggregate causes of death. In order to
investigate this issue more directly, we introduce standard age-patterns of mortality
from different causes of death. As noted earlier, Preston has computed the average age-
specific death rates from various causes for 16 populations with life expectancies at birth
between 25 and 45 years.48 We collapse these categories into three: respiratory
tuberculosis, other infectious and parasitic diseases, and all other causes of death. We
then attempt to find the levels of mortality from these three causes that are most
consistent with the observed age pattern of mortality in Liberia. Malaria is scarcely
reflected in these standards, unfortunately, and we might expect its influence to be
reflected through some combination of modifications to standard death rates from
respiratory tuberculosis and other infectious and parasitic diseases.

Table 6. Coefficients relating standard age patterns of mortality by cause to age-

specific survival probabilities in Liberia, 1820-1843

Coefficient of standard age

pattern by cause (standard error
in parentheses)

Cause of death Females Males

Respiratory tuberculosis (k1) 6.38 2.03

(1.03) (1.37)
Other infectious and 27.85 33.74
parasitic diseases (k2) (1.01) (1.48)
Other causes of death (k3) 2.90 2.55
(0.26) (0.39)
R 2 0.9997 0.9996

We estimate the implied level of mortality from the three causes as follows: The
probability of surviving to age x, lx, is related to age-specific death rates through

=e- mada

where ma is the death rate at exact age a. It follows that,

lx e-foxlada = e-fPmalda x e-Sma2da x e-fo ma0ta

where mai is the death rate from cause i at age a. Thus

Inl -J ma da-J ma2 da - ma3 da.

o o 0

48 Preston, ibid

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 114 ANTONIO MCDANIEL AND SAMUEL H. PRESTON

0-

4 -

* -4-_

? -6
0

e -8
O-a

_0. -6 0 10 20 30 40 50 60 70 80
Age FMales

0
96

X-l 1 -7 1 1 |#
=~ ~~l _4L = - jm( _ a- jm(t a- jm(o a
0 10 20 30 40 50 60 70 80
Age Females
Figure 5. Probabilities of survival to various ages in Liberia and predicted probabilities based on cause-of-
death composite.

If age-specific death rates from a particular cause of death in Liberia are a scalar
multiple of death rates from that cause in the standard, then

In I,ZL =->1 Ma(Po) da-k2J mI(Pt) da -k3J ma(Pi)da,

where I,XL. is the probability of surviving from birth to agx in Liberia; Ma(Pt), Ma(Pi) and
ma(PO) are, respectively, death rates at age a in the standard from tuberculosis, other
infectious and parasitic diseases, and all other causes; and the Ki's are multipliers for a
particular cause of death that is appropriate for Liberia. The factors K, are then
estimated by linear regression which relates 'xL to 5m,(P0), 5m,(Pt), and 5mX(Pi). The
regression is forced through the origin to eliminate an intercept.
The results of this procedure are presented in Table 6. It is interesting to note that the

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 LIBERIAN IMMIGRANT MORTALITY 115

variance explained by this three-parameter procedure far exceeds that explained by the
two-parameter transformations of model mortality patterns from all causes of death
shown in Table 5. The fit of the Liberian data to the model is shown graphically in
Figure 5. The multipliers are all well above unity, a value that would indicate that the
level of cause-specific mortality in Liberia was the same as in the standard. All the
coefficients, except that for men for respiratory tuberculosis, are significant at extremely
high levels, (beyond 0.001). They indicate that, in order to reproduce the age-pattern of
survivorship in Liberia satisfactorily, death rates from respiratory tuberculosis in the
standard would have to be raised by a factor exceeding 2, those from all other causes by
factors of 2-3, and those from other infectious and parasitic diseases by extraordinary
factors of 27-34. These results help to confirm that the Liberian population was suffering
from a crushing burden of infectious disease, more than an order of magnitude greater
than even the highest mortality documented by Preston.49 Thus, this analysis, which
makes no use of the actual causes of death recorded in Liberia, but only of their age
pattern, confirms the central role of infectious diseases that appeared in the actual cause-
of-death assignments.

SUMMARY

This paper describes the pattern of mortality by age and cause of death among Liberian
immigrants, between 1820 and 1843. Their experience is believed to represent the highest
mortality regime in a sizable population for which accurate data exist. The extraordinary
mortality from fevers during the calendar year of arrival, and during the early period
(1820-1828), when much of the exposure was that of new arrivals, suggests that a large
number of immigrants had not acquired even partial immunity to 'fevers' at the time of
their arrival. The subsequent decline in mortality is consistent with disease processes to
which some immunity has been acquired (e.g. malaria).
The age-pattern of mortality of the Liberian immigrant population replicates rather
precisely existing models of age-patterns for all causes of death and from specific causes.
That is, the level of Liberian immigrant mortality is unprecedented, but the shape of the
pattern for all causes of death and from specific causes of death corresponds closely to
existing model mortality patterns. Both the age pattern of mortality and the cause-of-
death distribution suggest that death rates from infectious diseases were extraordinarily
high. This dual evidence indicates that cause-of-death assignments in Liberia were
relatively consistent with those made in other, more recent, high-mortality populations.

49 Preston, op. cit. in fn. 38.

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