Category Archives: Medical Officer Reports

When looking at some Batley population statistics in relation to my family history, I was horrified to see the town’s infant mortality figures.

Infant mortality is the term applied to the deaths of children under one year of age. It is based on the proportion of the annual number of deaths at this age measured against births registered in the same area in that year. It is then extrapolated to represent a mortality figure per 1,000 births.

Batley’s figures were shocking, and acknowledged as such by the town’s various Medical Officers. For example in 1911 there were 852 births in Batley compared to 160 deaths of under 1s. This gives an infant mortality equivalent to a rate of 187.79 deaths per 1,000 births. And this was not the highest rate in this period, and it was at a time when things were improving.

I initially looked at Batley births and infant deaths from 1892 to 1971, plotting them in Table 1 below. The years from 1892 to 1914 make particularly sobering viewing. In four years the figures reached an infant mortality rate exceeding 200 per 1,000:

• in 1893 it reached 260.55 per 1,000 births;
• 1895 was 200.24;
• 1901 saw a rate of 209.30 and
• in 1904 it hit 235.94.

Table 1 (see Footnote 1)

In his 1914 Annual Report, Batley’s Medical Officer George Harper Pearce compared Batley’s infant mortality with the Great Town’s of England and Wales over a 25-year-period. Although in terms of population Batley was not one of the designated Great Towns, the Medical Officer felt by its urban nature and the fact it seamlessly flowed into its neighbouring population centres, it demonstrated all the characteristics of a Great Town. Therefore he felt its Public Health should be compared against this measure. It provided an unedifying comparison.

Although there was a commonality in the chief causes of infant mortality countrywide, namely premature birth, congenital deficiencies, hereditary illnesses, inexperience of mothers, unsatisfactory municipal sanitation, industrial conditions and improper food, Batley appeared to suffer the effects to a higher degree than its comparator towns. (Interestingly poverty was not mentioned as a factor). In 1914 Batley’s infant mortality figure of 149 compared to the corresponding Great Towns figure of 114. Looking at the earlier high rates I quoted for Batley in 1893, 1895, 1901, 1904 and 1911 and comparing with that of the Great Towns:

• In 1893 and 1895 the Great Towns rates were in the low 180s;
• In 1901 the Great Towns was 168;
• In 1904 the Great Towns stood at 160;
• 1911 the Great Towns figure was 140.

All therefore far below Batley’s rates, and sadly this was the general pattern.

I decided to focus on the years 1900 to 1914, the period marking the start of the 20th century leading up to the outbreak of the Great War. Both my paternal grandparents, and many of their siblings, were born in Batley in this period. My grandfather, born in 1906, was one of 10 children my great grandmother had between 1889 to 1910. My grandmother, born in 1908, had one other sibling, her senior by one year.

The total number of Batley infant deaths occurring in these years were:

• 1900: 148;
• 1901: 189;
• 1902: 148;
• 1903: 139;
• 1904: 193;
• 1905: 151;
• 1906: 155;
• 1907: 123;
• 1908: 139;
• 1909: 86;
• 1910: 107;
• 1911: 160;
• 1912: 100;
• 1913: 98;
• 1914: 122.

Looking at the mortality statistics for this period I’m amazed, and thankful, that only two of these twelve children died before adulthood; and of them only one death was classed as infant mortality. I have written about these two children here and here.

The upshot of these dire turn-of-the-century figures led to Batley Borough Council, aided by voluntary services, embarking on a concerted effort to reduce the town’s shameful infant death rates, many of which they deemed preventable.

As part of this drive, from 1908 onwards we get ever greater detail regarding infant mortality in the Batley Medical Officer reports including more in-depth analysis of the causes of Batley infant deaths.

The causes attributed to these infant deaths are plotted on the graph in Table 2 below:

Table 2

The figures behind the graph are at Table 3, below.

Table 3

Picking out some causes, we take for granted the impact of vaccinations today – perhaps some are even complacent about it. But looking at some of the death causes for infants – measles, whooping cough, tuberculosis – shows that for past generations these diseases were killers. And many more infants and children suffered life-changing disabilities arising from the complications of these illnesses. But beyond the direct deaths, bronchitis and pneumonia (illnesses in their own rights) could also be some of the secondary fatal complications of measles, whooping cough and even rickets.

Rickets does not feature in the prime Batley infant mortality causes in the years investigated. It is a condition affecting bone development in children which results in stunted growth and deformity. It affected a frighteningly large number of Batley children in this period. In 1909 64 cases of school-age Batley children suffering from rickets were investigated. The report discovered between them the 64 families involved had 340 children of which 119 were afflicted with the disease, 61 of these dying in infancy with their deaths attributed to bronchitis or convulsions. This is yet another demonstration that the causes of death in Tables 2 and 3 can mask much wider community health problems.

A particularly vague cause of death which features prominently throughout these years is described as atrophy, debility, marasmus. In 1908 Dr J. M. Clements, the then holder of the Batley Medical Officer post, said all the terms were more or less meaningless, failed to indicate a cause of death and should be avoided in death certification. Wasting was attributable to many things, including ante-natal issues and improper feeding. Until a more precise death cause was identified prevention would be difficult.

However by 1914 Dr Pearce, Batley’s Medical Officer since 1910, pinned it down to one particular cause above others – syphilis. In his 1914 Medical Officer Report he quoted from the Report for 1913-14 of the Medical Officer of the Local Government Board. In this the impact of syphilis was discussed, and the conclusion reached was direct deaths from it represented only a fraction of its effects.

It is a common cause of still births and premature birth; a considerable proportion of the deaths from marasmus and atrophy, as well as a large amount of disease in childhood and during school life, owe their origin to it.

Building on the Local Government Board report Dr Pearce stated in 1914 Batley 50 children had been born dead, 21 further deaths were a result of premature birth and an additional 13 had a cause of atrophy and marasmus:

It will be seen therefore that syphilis – a venereal disease – was more or less responsible (apart from dead born children) for thirty-four out of 122 deaths amongst infants or approximately more than 25 per cent.

Premature birth was a constant infant mortality theme. Besides the link to syphilis, the reports tried to make a connection with pregnant women working as rag sorters or weavers in the mills. In 1909 for example 18 instances of infant mortality occurred where mothers were in these occupations, and six of the deaths were attributed to premature birth with the mothers working in the mill until shortly before confinement. The tea, fried fish and chipped potato diet of pregnant mill-working mothers who had no time to cook were also blamed for childhood defects such as rickets. The solution put forward (but not adopted) was to prevent women working in the mill for a few months preceding childbirth.

One final cause identified in Tables 2 and 3 which may need explanation is overlaying. Basically suffocation of the infant from sharing a bed with an older person (usually the mother);

However in most of years the overwhelming proportion of deaths were attributed to diarrhoea, enteritis and gastritis. These diarrhoeal diseases were linked to seasonal weather, insanitary conditions and improper feeding. In his 1908 Medical Officer Report, Dr Clements looked at the 43 infant deaths attributed to this cause in this year. Only one infant was wholly breastfed. Of the others, 30 were wholly fed with cows milk, seven a mix of breast and cow’s milk, and five wholly on artificial foods. Dr Clements concluded:

…the only safe way of feeding the baby is by the mother’s breast. The mother’s milk is never once exposed to the air or to contamination, but passes direct from the site of manufacture in the gland to the baby’s stomach.

This also led to a link being made to this mortality cause and working mothers. It was said mothers quickly switched from breast feeding to partial of fully weaning infants in order to return to work as soon as possible. In his 1910 report Dr Pearce wrote:

Medical Officers of Health throughout the country would welcome a bill prohibiting women from working in the mills, or other places where female labour is employed, for several months previous to the birth of their infant, and for the whole period during which they are suckling the child. I would in fact go further and make it illegal for any mother to go out to work at all unless it could be shewn [sic] to be a case of dire necessity. A mother’s proper place is at home with her children.

Besides the danger of the infant ingesting contaminated food resulting in diarrhoea, the childcare itself left much to be desired. Mothers paid between 4s and 5s per week for their infants to be nursed whilst they worked. The surroundings were often deemed dirty and unsuitable, and it was not uncommon for this childcare to be provided by women with advanced TB.

The issue was illustrated in the March 1913 inquest into the death of a nine-week old baby girl, from the Batley Catholic community – the community associated with my family. It led the Coroner, Mr Maitland, to make some pointed comments about mothers leaving their children with neighbours and going out to work. In this case the mother returned to work when her baby was around six weeks old, leaving her and two older children with their grandmother, who told Nurse Musto she had brought up a family of the grandest lads in Batley, and knew quite well how to bring up children without her [Nurse Musto] interfering. 5s per week was paid for the baby’s care, out of which milk had to be provided, she being fed on a milk and water diet. The Coroner, on learning the father (a Collier) brought home 24s weekly asked why the mother felt the need to work. She responded “I would rather go to work than stop at home.” A verdict of “Death from pneumonia and also from want of proper attention and nursing” was reached with the Coroner observing:

…that there were many mothers who preferred to go out to work rather than bother with their children. It was simply selfishness

This, and other cases, led to the suggestion in the 1914 Medical Officer Report of the need for provision of crèche facilities staffed by skilled carers.

Other general findings noted by the series of Medical Officers included the fact first-born babies were more at risk, with the 1909 report identifying 32 of the 86 infant deaths that year being in this category. The same report also investigated the family histories of the 86 dead infants and, other than the first-born issue, noted a clear trend for the families affected to have a previous high rate of infant and child deaths. Ten family profiles were given including one mother of five children, all dead; Another mother of 13 had only three surviving children and of the 10 dead, eight had not survived their first year; similarly a mother of 10 had only three still living, with five of the seven deceased dying under one year of age. Based on this data the conclusion reached by Dr Clements was:

…it would appear that to a large extent the determining factor is the mother herself. Some women are “born mothers”; nature has endowed them with a knowledge of the care and attention needed by the baby; others are not gifted in this respect and they have not received any education to make up for the deficient.

1909 was a particularly interesting year. It can be seen from Table 1 that this year saw a dramatic decrease in Batley’s infant mortality rate. Its rate of 117 was actually lower than that of the Great Towns, which stood at 118. The drop was partly attributed to the cool, wet summer which reduced the severity of the seasonal diarrhoea outbreak – but this weather was not peculiar to Batley, and the number of deaths from diarrhoea in other similar weather years was far higher. The Medical Officer therefore believed 1909 was exceptional largely due to the preventative measures adopted in the preceding two years to combat the causes of infant mortality. There were two main factors behind these measures.

In 1906 a voluntary society was formed, the Batley Public Health and District Nursing Service. It took up the case of infant mortality, much of which was seen as preventable. Through voluntary subscriptions it appointed a Health Visitor, Miss Terry, to tackle the issue. So effective was the role, in July 1909 Batley Corporation agreed to fund this post and the Health Visitor became an official of the Council Health Department.

The other game-changer facilitating the work of the health visitor came in February 1908 when the Council formally implemented the Notification of Births Act. It meant that practically all births reached the notice of them within 36-48 hours, via either doctors, midwives or parents, enabling the Health Visitor to visit women quickly after birth.

By the time of the 1907 Report Dr J. A. Erskine Stuart, the town’s Medical Officer at this point, stated that although early it was days in the work of the Lady Health Visitor, he could vouch for one important fact: as a result of her labours the number of breastfeeding mothers had increased.

The duties of the fledgling Batley Health Visitor service included the schedule of first visits to mothers on receipt of a notification of birth. In these visits the Health Visitor gave advice about feeding, clothing and general baby care. By 1910 a printed pamphlet was left with mothers following this first visit. It contained a wealth of information about the nutrition and care of infants, including precise feeding and weaning instructions, washing guidance, advice on clothing and sleeping arrangements (every infant should sleep in a cot by itself) and information about eye care. It also advised against the use of dummies which it said caused mouth deformities. These comforters also increased the risk of sickness and diarrhoea as when dropped they were shoved back into the mouth, contaminated by dirt. One Batley Medical Officer believed dummies should be made illegal! If she deemed it necessary the Health Visitor would conduct follow-up visits.

Other duties included work around visiting mothers of stillborn children. Under the Notification of Births Act 1907 the Medical Officer was informed of the birth of any child “which has issued forth from its mother after the expiration of the twenty-eighth week of pregnancy, whether alive or dead.” To identify those born prior to this stage, from 1910 the Batley Health Department obtained a weekly return of stillborn children buried in from Batley Cemetery from the Registrar of the Cemetery. There was also work around unnotified births, as some were still ignorant of the requirement. She also worked on epidemic diarrhoea and made visits to those Batley residents suffering from TB. Another duty included health talks with mothers at meetings held by organisations such as Mothers’ Unions or Women’s Cooperative Guilds. Additionally one afternoon weekly was set aside for the Health Visitor to see mothers and infants in her Town Hall office. One particularly interesting initiative was around the establishment of funded cookery classes for poor mothers to teach them how to prepare nutritious, cheap family meals.

By 1910 such was the value of the Health Visitor’s role that she provided a summary of her work for inclusion in the overall Medical Officer annual report.

Obstacles noted by various Batley Health Visitors in this period included the tendency for mothers to take more note of family and neighbours rather than the health professional. Workload was also a huge issue, and was cited as one of the reasons for Miss Terry (Batley’s first Health Visitor) resigning her post in 1910. She also felt incapable of going through another Diarrhoea Season. She was replaced by Margaret Evelyn Harris, who in turn was succeeded by Alice Musto in January 1912. Miss Musto left in October 1914 to become a Staff Nurse with the Territorial Force Nursing Service and in December 1914 temporary replacement Florence Ray commenced work.

One further obstacle to the Health Visitor and the state of infant health and mortality was said to be the incompetence of midwives. This is a recurrent theme in the Medical Officer reports. For example those of  1910 and 1911 indicated none of the 13 registered midwives in Batley were qualified by virtue of Maternity Hospital Training and having passed examinations of the Central Board.

Despite the Health Visitor highlighting regularly cases of midwife ignorance, she had no power to intervene. The majority of midwives could not read, write or use a clinical thermometer or take temperatures. They treated premature babies no differently than full term ones, causing death. Barbaric practices were undertaken by some midwives including squeezing the child’s head into shape after birth. Another cruel procedure carried out by some midwives was squeezing the baby’s nipples, which frequently resulted in the formation of abscesses. The tradition of squeezing the mammary secretions of newborn infants was partly rooted in folklore and superstition around witch’s milk, with midwives and grandmothers believing that if this milk was not expressed from the mammary glands of newborns it would be stolen by witches.

In her contributions to the 1914 report, by which time two of Batley’s midwives did have qualifications, the newly appointed Florence Ray did not hold back in new views about Batley’s cadre of midwives, stating:

Several of the practising midwives are most unsuitable both on account of their ignorance and dirty habits.

One was castigated for:

…urging the mother to adopt the disgusting practice of frequently spitting into her infant’s eyes.

The Health Visitor was playing an increasingly important role in infant and child health in the community by highlighting deficiencies, suggesting solutions and providing help and assistance to mothers. The value of the activities of the Batley Health Visitor spread beyond the town. One example was in the Bradford Daily Telegraph of 31 January 1908:

Babies “At Home” at Batley
The crusade against infantile mortality is being vigorously pursued in Batley. A lady health visitor has been appointed, and yesterday she gave an “at home” to 220 babies and their mothers. The children were all under six months old, but appeared remarkably healthy. The guests were received by the Mayor and Mayoress…The health visitor proposes to hold “at homes” periodically in cottage houses.

This event was continued, with the 1910 report by the Batley Medical Officer including details of another successful tea attended by the Mayor and Mayoress along with 500 mothers of babies in June that year. The Yorkshire Post of 8 June 1910 reported the event, and the overall impact of the Health Visitor on infant mortality in the town:

Bright Babies at Batley
Nearly five hundred of Batley’s brightest babies beamed on the Mayor and Mayoress yesterday at an “at home,” held at the Town Hall. The function, which is an annual affair, is a striking tribute to the work done by Nurse Terry, the Health Visitor, and the Batley and District Public Health Service. It is a remarkable fact that in the first year of Nurse Terry’s service with the Committee, which is a voluntary institution, there was an infant mortality of 180 per thousand births, and in the following year this number had decreased to 162 per thousand. Last year, however, when the Health Visitor was engaged by the Corporation, and was thus a Public Officer as well as interested in the private institution, the death rate was still further reduced to 117 per thousand, which is the lowest ever reached in the sanitary history of the borough.

I wonder if my paternal grandparents or their siblings attended these events? And I also wonder if my maternal great grandmother was one of the midwives who received so much criticism.

The role of Health Visitor was just one of the initiatives focused on improving infant mortality rates in the town. And there were blips in these rates even after the appointment. But things were finally moving in the right direction.

In conclusion, I found it surprising so many of the themes discussed in early 20th century Batley are echoed in topics currently debated: from vaccinations to Breast is Best campaigning; from post and ante natal care to maternity and childcare provision; from providing cheap nutritious family meals to the pressures facing working mums. Above all the series of reports provided a new insight into the lives of my ancestors and the times and community in which they lived.

 

Footnote:

• Table 1 Note: In 1926 the number of deaths of under ones was reported as 44 in the main statistical notes of the annual Batley Medical Officer report. Elsewhere in that report it is given as 43 which equates to the mortality rate of 68.8 given in the report. I have revised the figure to equate to 44 deaths, giving a rate of 70.40

Sources:

• Various Batley Medical Officer Reports 1892-1971
• Bradford Daily Telegraph – 31 January 1908
• The Yorkshire Post – 8 June 1910
• The Leeds Mercury – 14 March 1913
• Yorkshire Evening Post – 14 March 1913

I’d also like to thank Janet Few whose recent Pharos Tutors course about Discovering you British Family and Local Community in the early 20th Century prompted me to start looking in more depth at various local history statistics and using graphs and charts to illustrate findings.