Mortality and Death Causes in Revolutionary Veracruz, Mexico (Based on Analyses of the Civil Registry Death Records)

This article is devoted to a detailed analysis of death causes in Mexico during the Revolution and Civil War period. Our study is based on the death registration records in six government-controlled municipalities in Veracruz State which promoted registration accuracy. A total of 2 876 records from 1918 were analyzed, most of which contained information about the causes of death. The main objectives of the study were to determine the main causes of death, to identify territorial, age and gender differences, to establish the time and extent of the spread of the Spanish flu epidemic and the overall mortality rate in 1918. The 10th revision of the International Classification of Diseases (ICD-10), developed by the World Health Organization, was used as a basis for coding the causes of death. Thus, the causes of diseases that led to the death of the inhabitants of Veracruz were divided into eight main classes: infectious; respiratory; related to pregnancy or childbirth; those caused by difficulties in the perinatal period of fetal development; external violent reasons; unclassifiable, those associated with infancy and childhood; the unclassifiable; and finally, the missing. The analysis revealed registration problems, especially in the agrarian regions, caused by the poor development of medical infrastructure and aggravated by wartime conditions. Based on the analysis of individual level data on the causes of death, the authors identified the 161 diagnostic options found in the sources, identified the main ten death causes for each of the six cities of Veracruz, determined the level and accuracy of registration and the age characteristics of the spread of certain classes of fatal diseases. The most common cause of death was infectious diseases, particularly children from one to five years old suffered from these. The rate of respiratory diseases was also high, the proportion of deaths from these rose sharply in the last quarter of 1918, which was caused by the spread of the Spanish flu. The analysis of the nominative data made it possible to refute the official statement of the Mexican government about the cessation of influenza at the end of 1918. The high mortality rate from various respiratory diseases in December 1918 among young men suggests that the flu pandemic was hidden behind various other concepts.