J.R. Johnson

I recently subscribed to We’re Here, a “nice little email for people from Earth” that originated from Hank and John Green’s Nerdfighteria. One issue last month included a thought piece I found interesting: The Tragedy of Prevention.

The thesis? “A tricky thing about modern society is that no one has any idea when they don’t die.”

That line stuck with me, and I’ve been toying with it for the past month. How, I wondered, could we be made more aware of those moments in particular, and our good luck in general?

The tragedy of prevention goes like this: The most effective way to save lives (prevention) is the least noticeable, which leads us to undervaluing it in our individual choices, in what we celebrate, and in public policy. That undervaluing of prevention leads to a great deal of needless death and suffering…

If every person who had their life saved by a vaccine, or an airbag, or a clean air regulation felt the same as a firefighter carrying an unconscious person out of a burning building, I think we’d feel a lot better about humanity, and maybe that would help us move forward more effectively.

Surely, I thought, there must be a website out there that will tell me all the times I coulda woulda shoulda died? When a search turned up nothing useful (and a whole lot that wasn’t, and wasn’t something I wanted to wade through), I decided to put AI to good use. This was my hypothetical:

Q: I am a 50-year old white man living in the US. You are a doctor specializing in historical causes of mortality, including vaccine-preventable diseases and other health-care preventable causes of mortality. Tell me all the moments in my life where I would have died if this were the year 1898. 

I picked 1898 because it had all the lessons of the 19th century but none of the World Wars of the 20th. It’s also just after the Gilded Age, a time currently being showcased as a time of All Good Things, at least for robber barons those in power.

What was the answer?

ChatGPT: This is a fascinating and sobering thought experiment. Assuming you’re a 50-year-old white man in the U.S. in 2025, you would have been born in 1975. Let’s now imagine that you lived your exact same life—same exposures, environment, risks, and medical events—but in 1898. Here are the major moments where you very likely would have died, or your survival would have been highly unlikely, given the state of medicine, vaccines, and public health at that time.

The answer started with fun diseases like diphtheria, measles and scarlet fever and moved on from there. It summarized a lot, but even this abbreviated trek through a hypothetical life over a century ago made me think: How lucky are we? 

If you’re curious, here’s the full answer,* complete with terrifying scenarios like no antibiotics, insulin or public sanitation, life expectancies under 50, and pretty much every disease ever from The Oregon Trail:

* Fair warning, I haven’t fact checked all of these specific numbers, but the overall point is both relevant and on target.

1. Infancy and Childhood (0–5 years)

🚼 Risk of Infant Death from Infectious Diseases

• Diphtheria, Pertussis (Whooping Cough), Measles, Scarlet Fever, and Smallpox were all common causes of childhood death.
• You would not have been vaccinated, as the only routinely available vaccine in 1898 was for smallpox.
• Infant mortality rate in 1898 was around 150 per 1,000 live births, meaning a 15% chance of dying before age 1.

📍Moment of Likely Death #1: Age 0–5 — Measles, Whooping Cough, or Diphtheria.
If you got any of these common childhood infections—as most kids did—you would face a high chance of dying from pneumonia, encephalitis, or airway obstruction.

2. Appendicitis, Accidents, or Infections (Any Age)

⚠️ Lack of Antibiotics and Surgery

• Appendicitis, if you ever had it, would have been a death sentence due to lack of surgical techniques and no antibiotics.
• Strep throat, infected cuts, dental abscesses, or pneumonia could have killed you due to the absence of penicillin (discovered 1928, not widely used until the 1940s).

📍Moment of Likely Death #2: Any bacterial infection that in your modern life was easily treated with antibiotics—especially in your teens or 20s.

3. Injuries and Trauma

🩸 Modern Trauma Care Didn’t Exist

• Car accidents didn’t exist yet, but horseback riding accidents, industrial injuries, and farm equipment injuries were common.
• No blood banks, IV fluids, or sterile technique meant internal injuries or bleeding often led to death.

📍Moment of Likely Death #3: Any serious physical injury. Even a broken leg with complications like infection or blood loss could have been fatal.

4. Adulthood Illnesses

❤️ Heart Attacks, Strokes, and Chronic Disease

• In 1898, there were no treatments for hypertension, high cholesterol, or heart disease. If you had any of these risk factors, your risk of death in your 40s or 50s was vastly higher.
• Diabetes was also nearly untreatable. Insulin wasn’t discovered until 1921. You would likely die within a year of diagnosis.

📍Moment of Likely Death #4: Undiagnosed or untreated chronic illness. If you’ve ever taken blood pressure meds, cholesterol meds, or insulin—you would have died without them.

5. Infectious Disease in Adulthood

🦠 Tuberculosis, Influenza, and Pneumonia

• TB was called “consumption” and was a leading cause of death.
• The “old man’s friend” (pneumonia) often claimed people in midlife or earlier.
• Influenza pandemics occurred repeatedly—including in 1918.

📍Moment of Likely Death #5: Any bout with flu or pneumonia. Without antivirals, antibiotics, or supportive hospital care, this could easily have been fatal.

6. Surgical Interventions

🛠️ No Modern Anesthesia or Sterile Technique

• If you’ve ever had a hernia repair, tonsillectomy, gallbladder surgery, or even dental work—your risk of dying from infection or surgical shock would have been significant.
• Hospitals were places people went to die; wealthy people often avoided them.

📍Moment of Likely Death #6: Any surgery. Even minor operations were high-risk.

7. Cancer

🔬 No Diagnostics, No Chemotherapy, No Radiation

• Cancer was often only diagnosed very late—usually through symptoms like bleeding or swelling.
• Surgical removal was often impossible or fatal due to poor technique and infection.

📍Moment of Likely Death #7: If you ever had or will have cancer, you’d likely die quickly and in pain.

Survival Odds in 1898

• Life expectancy for white men in 1898 was about 46 years.
• As a 50-year-old in 2025, you’re already past the average life expectancy of your 1898 counterpart.
• Public sanitation, antibiotics, vaccines, and modern surgery have already saved your life many times over—even if you’ve never had a dramatic medical crisis.

Bonus: Things You Would Not Die From in 1898

• Car crashes (few cars existed).
• Obesity-related diabetes (far less common).
• Opioid overdose (though morphine addiction was real, it was not yet a mass crisis).
• Mass shootings or modern warfare (depending on your background and profession).

And that’s the beauty of prevention!

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