The birth of the welfare state

Graham Millington looks at child mortality rates 100 years ago

Brookscroft Clinic

Mothers and babies pose at Brookscroft Child Welfare Clinic, Walthamstow, in 1915. Credit: Vestry House Museum/Waltham Forest Council

In 1917 the Bishop of London gave a speech to publicise the horrific fact that each year 100,000 babies were dying within a year of their birth.

He said: “While nine soldiers died every hour in 1915, twelve babies died each hour [in 1917]. So it was more dangerous to be a baby than a soldier.”

Such figures were not lost on the Medical Officer for Health in Walthamstow Urban District, J.J.Clarke. Every year in his extensive reports, which are available for scrutiny at Vestry House Museum, he provided considerable information about the health and welfare of local people. This included figures for infant mortality.

Prior to the war, the infant mortality rate – which indicates the number of babies who had died per thousand births – had declined from 159 in 1900 to 78 in 1914. However, much of this was deemed to reflect the rapidly dropping birth rate rather than through remedial action. The Midwives Act 1902 had enhanced the professionalism of this service but it took the reforming Liberal-led government to pass the Notification of Births Act in 1907, requiring parents to notify the health inspector of any birth within 36 hours of delivery.

A health visitor would then be despatched to assess the baby’s environment and provide support for the mother if required. The Local Government Board, which held the responsibility to oversee the work of local authorities, would fund half the cost of the health workers. However, the scheme was voluntary and at the outbreak of war in 1914, Walthamstow had not taken it up.

A 1914 medical report cited reasons why. Three health workers would be required at a cost of £2,500 for antenatal and postnatal care, but: “Public opinion is not yet sufficiently educated to appreciate the possibilities of compensating results.”

Then came the First World War and the shocking truth that many of the eager and patriotic young men flocking to the recruitment centres nationally were being rejected because they could not meet the physical requirements. The recruitment process served as a survey of men’s health and the results were not good. This prompted the government to take a greater direct interest in the health and welfare of its people.

In 1915, the requirements of the Notification of Birth Act became compulsory. But in Walthamstow, Dr Elliot had already started the voluntary Walthamstow Child Welfare Society, formed: “To carry out similar work to that suggested by the Local Government Board.”

With the passing of the act, Walthamstow appointed Dr Rachael McKenzie to be in charge of antenatal classes and Walthamstow Child Welfare Society became formalised. It was staffed by two unpaid female doctors and two salaried nurses whose work was underpinned by numerous female volunteers accepted “from the educated and leisurely classes”.

This was not unusual during the war, because middle-class women nationwide saw volunteering as a way of supporting the country in time of need. They were very successful and, as the 1916 report reveals: “The ladies show great willingness and keenness for the work and have become qualified for the work they undertake.”

But why were so many babies dying? And what response was needed?

Nearly half of babies died within the first week of life, with causes that indicated the need for greater antenatal care. Bronchitis, pneumonia and enteritis prevailed in the homes of women unknowing of childcare while deaths by syphilis, accidental drowning, wilful neglect, and even murder, all featured on occasion. Premature births were a major problem as was summer diarrhoea, often caused by milk stored in unhygienic conditions.

This was sometimes compounded by mothers using a feeding tube device to feed their babies. Because the tube was difficult to clean it harboured lethal bacteria and the device became known as the ‘baby killer’. It was fortunate for many babies that breast feeding was practised by 85 percent of mothers and that powdered milk was available.

Consequently the health workers sought to provide advice and support across a broad range of issues. There was a need to teach expectant women how to look after themselves and be given healthcare when needed. New mums were taught about personal and home hygiene, food preparation, homecraft, and given insights into providing nursing care for their own children. This work was underpinned by government giving free milk to poor women, insisting on better training for midwives, and funding dental care.

The local infant and orphan asylum together with the children’s hospital in Hoe Street all received extra funding and indeed across the nation funding for child welfare continued to rise irrespective of the financial demands of the war.

In Walthamstow, the results were clear but perhaps disappointing. By 1920 the mortality rate was 60/1000 but then hovered around this figure for many years. Surprisingly in 1937, just before the Second World War, it was still in the high fifties despite the advances in social welfare.

By 1918, Walthamstow had extended its health services to include not only children but adults too, as everyone confronted the economic and social difficulties caused by the war. In this manner the welfare state evolved. Incidentally, only in the UK did infant mortality reduce during the war.

Had it not been for the war Walthamstow might have continued its leisurely pace at combating infant mortality despite the urgings of medical professionals who repeatedly indicated that many of the deaths could be avoided. Education and practical advice was vital, together with increasing facilities and better training for professionals.

It is interesting to note that in 2017 there were 12,320 people aged 100 or older, which is an increase of 74 percent in ten years. These were born during the First World War and have been the beneficiaries of a growing and more effective welfare state for their whole lives – a welfare state that was very much prompted by the demands of war.