The Children Left Behind
By 1891 Liverpool had solidified its position as the most densely populated English town, with an average population density of 99.3 persons per acre. Birmingham, by comparison, had a population density of 51.2 per acre, and in Manchester the population density was 39.6 per acre. (London’s population density in 1891 was only 56.5 per acre, for perspective.)
1Taylor, Report on the Health of Liverpool during the Year 1891, 1. While the three cities remained crowded by the end of the 1880s, all three also employed a firmly entrenched Medical Officer of Health. All three cities had begun the important work of expanding sewers and flush toilets to replace privies and ash pits, eliminating courts and back-to-back housing, and improving household ventilation. The Medical Officers of Health, unsurprisingly, would highlight these successes in their annual reports. In 1887, John Leigh, who was approaching the end of a nearly half-century career in public health, attributed the gradual decline in municipal mortality rates in Manchester to the culmination of the many sanitary improvements he had overseen over his career, including paving the streets, ventilating the sewers, improving water quality, provisioning foodstuffs for the poorest residents of the city, and reducing the prevalence of fevers.
2Leigh, Report of the Medical Officer of Health, Manchester City 1887, 13–15. In Liverpool, J. Stopford Taylor similarly reported optimism, beginning in the year 1887. The death
rate that year (23.6 per 1,000 living) was the lowest to date in the most densely populated city in Great Britain, a record the city further cemented over the following years.
3Taylor, Report of the Health of Liverpool during the Year 1887, 5–6. In opening his fifteenth report on
The Health of the Borough of Birmingham in 1887, Hill similarly reported that “the sanitary condition of the town must be regarded with much satisfaction.”
4Hill, Report on the Health of the Borough of Birmingham for the Year 1887, 3. The following year, Hill reported, the annual mortality rate in Birmingham reached a record low (17.5 per 1,000 living) – before averaging around 2.03 percent over the last decade of the nineteenth century.
5Hill, Report on the Health of the Borough of Birmingham for the Year 1887, 4.~
Figure 1.1. Annual death rate in Birmingham, Liverpool, and Manchester compared, 1869–1929. Source: Medical Officer of Health Reports.
Demographic trends in Manchester followed a similar pattern. Medical Officer of Health John Leigh reported in 1887 an annual mortality rate of 23.1 per 1,000, though mortality rates were higher in the poorer central districts like Ancoats (29.8) and St. Georges (26.5) and considerably lower in rural districts like Rusholme (13.7).
6Leigh, Report on the Health of Greater Manchester, 1887, 1–2. When Niven took over the position of Medical Officer of Health for Manchester in 1894, he noted that “the year 1894 was one of extremely low death-rates generally.” Niven attributed this reduction in the annual mortality rate to 19.8 per 1,000 living (the lowest on record in Manchester since 1871) to a combination of factors, including a generalized reduction in cases of infectious diseases and a decline in deaths due to premature births, old age, and diseases of the organs. Niven also argued that human action and sanitary engineering played an important role.
7Niven, Report on the Health of Greater Manchester, 1894, 2–3, 6. Favorable weather also helped.
While annual death rates in all three cities were improving (Figure 1.1), infant mortality remained a serious problem, exceeding the national average (see Figure 0.3). This fact greatly concerned the Medical Officers of Health. For example, Hill lamented that “Birmingham has never occupied a favourable position.” In 1886 the infant mortality rate of 189.9 per 1,000 live births was “worse than any [year] since 1875” in Birmingham’s recent medical history. Infant mortality improved slightly the following year (1887), to 182.6 per 1,000 live births, but was still higher than almost any other major English city.
8Hill, Report on the Health of the Borough of Birmingham for the Year 1887, 18–20. Hill described Birmingham’s infant mortality as a “great blot” during an otherwise “satisfactory” year in terms of public health.
9Hill, Report on the Health of the Borough of Birmingham for the Year 1887, 20, 14. According to Hill, high rates of infectious diseases, especially summer
diarrhea, were a major contributing factor to this “great blot,” and required the serious and careful attention of public health services.
Infant mortality would continue to trouble Hill throughout his tenure as Birmingham’s Medical Officer of Health until his retirement in 1903. He lamented in 1890, for example, that the high rate of infant mortality was “the most unsatisfactory feature which I have from year to year to report. Almost invariably our city compares badly with other large towns, and the great loss of infant life which I have usually to record is very deplorable.”
10Hill, Report on the Health of the City of Birmingham for the Year 1890, 15. Much to Hill’s frustration, over the last decade of the nineteenth century infant mortality rates averaged 18.58 percent (185.78 per 1,000 live births) before beginning to seriously decline at the turn of the twentieth century.
The infant mortality rate in Liverpool also became a serious cause for concern in the last decades of the nineteenth century. Deaths of children under five accounted for 44.4 percent of all deaths reported in 1887, a year in which the city experienced an infant mortality rate of 186 per 1,000
live births.
11Taylor, Report of the Health of Liverpool during the Year 1887, 15–16. In 1890, Taylor reported the deaths of 3,438 infants below one year of age (19.5 percent of all births). Children below the age of five accounted for 44.2 percent of all deaths in the city in the year, down slightly from a previous ten-year average of 45.2 percent.
12Taylor, Report on the Health of Liverpool during the Year 1890, 22. The ten-year average for infant mortality in the last decade of the nineteenth century, however, remained at 19.1 percent, and exceeded that average in 1893 (21 percent), 1895 (20.2 percent), and 1897 (20.1 percent).
In 1895, Liverpool expanded from 5,210 acres to 13,236 acres and the wards were redrawn. With an abrupt increase in population, it was not surprising that the infant mortality rate increased along with the growth in total population.
13Hope, Report on the Health of Liverpool during 1895, 9. Nevertheless, the premature deaths of children under one year of age greatly concerned newly appointed Medical Officer of Health E.W. Hope.
14Hope, Report on the Health of Liverpool during 1895, 11. Hope primarily attributed surges in infant deaths to climatic conditions, which he believed gave rise to an abnormally high number of cases of respiratory infections in the winter, followed by a hot and dry summer, which caused an abnormally high number of cases of diarrheal disease (a subject we will return to in the next chapter).
15Hope, Report on the Health of Liverpool during 1895, 14. However, Hope also believed that in the wards where infant mortality was at its highest, “indolence and disorder” and parental neglect exacerbated environmental factors in driving up infant mortality rates.
16Hope, Report on the Health of Liverpool during 1895, 20.In Manchester, three different Medical Officers of Health lamented the seriousness of the infant mortality rate between 1885 and 1895, and they offered a range of perspectives on the roots of the problem. John Leigh predominantly blamed neglectful mothers. In one of his last reports as Manchester’s Medical Officer of Health, he described how, over the course of his career, he had observed a “striking” number of cases of “intemperance on the part of mothers,” resulting in the “neglect of [their] children and a high infant mortality.”
17Leigh, Report of the Medical Officer of Health, Manchester City, 1887, 20. His immediate successor, John Tatham, reported in 1893 that “the mortality of children during the earlier years of life is commonly regarded as the most reliable test of the healthiness of a population.”
18Tatham, Report on the Health of Greater Manchester, 1891–1893, 17. Without condemning working mothers as Leigh had done, Tatham warned that mortality rates in Manchester for children under five
exceeded the national average by more than 47 percent.
19Tatham, Report on the Health of Greater Manchester, 1891–1893, 19. James Niven associated fluctuations in infant mortality with diseases of childhood, arguing that English children were “assailed by many fatal diseases one after the other.” Niven believed that from birth to three months children were most susceptible to premature birth, convulsions, lung diseases, overlaying, diarrhea, whooping cough, and hereditary syphilis; from three to six months lung diseases, diarrhea, and brain diseases were the most common killers of infants; from six to twelve months of age lung disease and diarrhea remained the most dangerous afflictions. If the child survived infancy, they also had to survive the risk of exposure to whooping cough and measles, lung diseases (including tuberculosis), diphtheria, and scarlet fever until roughly the age of five. To combat these diseases and related dangers to children’s health, Niven stressed the importance of educating parents about how to guard against them, rather than simply casting blame on parents.
20Niven, Report on the Health of Greater Manchester, 1894, 6–7. When the infant mortality rate peaked, as it did in 1895, for example, Niven noted a correlation with excess disease mortality as well.
21Niven, Report on the Health of the City of Manchester, 1895, 3–4.