Chapter Six
New Directions for Children’s Health
The First World War and Its Aftermath
By the time that he was appointed Chief Medical Officer of the Board of Education in 1907, George Newman recognized at least three causes of infant mortality in Britain, which he described as an “index of social evil.”
1Newman, The Health of the State, 110. These included the physical capability of the mother to care for her child, the foodstuffs provided to the child, and infant “mismanagement” including exposure to the elements or an unsanitary environment.
2Newman, The Health of the State, 122. Faced with a demographic crisis, Newman urged both local public health authorities and the Local Government Board to undertake greater state investment in the health of children. He proposed that “the centre of gravity” should move “steadily in the direction of positive and personal hygiene,” which should include “the prevention of maternal and infant mortality.”
3Newman, The Building of a Nation’s Health, 139. Newman pressed for greater investment in domestic hygiene and the protection of food from contamination – two aspects of public health that had not received sufficient administrative support and funding before the last decade of the nineteenth century. This required both an ongoing reappraisal of the primary causes of infantile diseases as well as a much more complicated task of disseminating this knowledge widely and publicly through maternal education.
4Walker-Smith, “Sir George Newman,” 353. Additionally, gaining access to the home and providing direct aid to mothers also required addressing a complex political question about what the proper role of the state in a classically liberal society should be. Many statesmen believed that providing for his family was the greatest incentive for a male
breadwinner to work, and to provide excessive economic aid would create a dependency that even New Liberal British statesmen could not abide.
5Lewis, The Politics of Motherhood, 13–14, 16. But from a public health perspective, more direct aid for families proved essential.
In the aftermath of the Great War, in 1919, Newman remained one of England’s leading experts on children’s health and argued that “a strong and virile race of people” required “healthier children as its foundation.” His concerns about children’s health extended past infancy. As Newman continued, while “healthy maternity and healthy infancy are essential preliminary conditions . . . to protect the child from diseases which arise from neglect of its body, to build up its physique, and to provide it as part of its education with an understanding and practice of the laws of health” were equally important.
6Newman, An Outline of the Practice of Preventive Medicine, 56.Newman wrote these words at a pivotal moment in the immediate aftermath of the First World War. Over the preceding three decades, at least at the local level, public health officials increasingly took their responsibility to not only “protect the child from diseases” but also provide valuable lessons about the “laws of health” to heart. As I argued in Chapters 2 and 3, education began with mothers. The Medical Officers of Health in Birmingham, Liverpool, Manchester, and other large cities began to employ health visitors professionally to provide this education in the last decade of the nineteenth century. Shortly thereafter, educational authorities launched targeted programs to promote children’s health in schools, where children were taught the importance of a balanced diet and to how engage in healthy physical education. Both health visits and school medical services played a vital role in protecting children from the effects of the urban penalty. But, both the promotion of health visits and the establishment of school clinics were also subject to the whims and budgets of local authorities. The First World War would change this. In its wake, the mandate to protect children’s health would fully shift onto the national stage.
It is well established that the First World War had a profound transformative impact on politics, diplomacy, and imperial aspirations across Great Britain and its Empire. To this I would add that the war also had dramatic effects on domestic and social issues, including the history of medicine and public health. During and immediately after the First World War public health in England experienced yet another historically important inflection point. After the Great War, Parliament began to play a more direct role in shaping the contours of public health programs, by codifying many of the local programs we have considered thus far into national law and supporting them with more centralized funding. In part, this was a reaction to the rising costs of health care. But more so, I argue, due to the experiences during the Great War that reinforced the lessons learned from the Second Anglo-Boer War about children’s vital role in the future of the British Empire.
This shift toward nationalized health care is most apparent in the renewed attention paid to English infant mortality rates. Thus, this chapter seeks to bring our story full circle, returning to the problem of infant mortality during the First World War. At the start of the war, the national average infant mortality had finally dropped below 100 per 1,000 live births to an average of 95 per 1,000 in 1914. By the war’s end, the average infant mortality rate in England and Wales had dropped further, to 87 per 1,000 live births in 1918.
7Winter, The Great War and the British People, 141. Health visitors played a particularly important role. The number of health visitors employed nationally more than quadrupled from six hundred in 1914 to 2,577 in 1918, and the number of municipal maternity and child welfare centers more than doubled from three hundred to seven hundred between 1914 and 1918.
8Dwork, War Is Good for Babies, 211. Our goal in this chapter is to consider how Parliament played an increasing role in promoting children’s health and how the epicenter of public health efforts shifted from cities to the state during and immediately after the First World War.