Archives

8th Feb 2021

Birmingham Children of War

Long before the idea for the Born in Birmingham project the Friends of Birmingham Archives and Heritage (FoBAH) ran another project researching the experiences of children living in Birmingham during the first world war. If you haven’t already come across it the blog is still available to read here https://birminghamchildrenofwarblog.wordpress.com/ and the resultant summary in the form of a learning guide is now available to read online here: https://issuu.com/fobah/docs/birmingham_children_of_war_learning_guide_2017

We are currently just waiting for a couple of copyright clearances on images for the Born in Birmingham learning guide and associated exhibition. But hopefully will be able to share with you soon.

Liz Palmer

20th Apr 2020

Infant Mortality Rates Birmingham 1913-24

We’ve become accustomed to hearing from the Chief and Deputy Officers of Health for England on a regular basis over the last few weeks. But did you know that each local authority also has a Medical Officer of Health (MoH) and that the first one for Birmingham was appointed back in 1872? The Annual Reports of the MoH make fascinating reading. Printed copies of the Birmingham MoH reports (& those of the School’s MoH) can be viewed on request at the Library of Birmingham when it is open, but they can also be found online at the Wellcome Collection http://search.wellcomelibrary.org/ – Simply search for “medical officer of health birmingham” and the year of interest between 1873 and 1973 and lose yourself for a few hours.

David Low, one of our volunteer researchers and an retired paediatrician made extensive use of the MoH reports in his research on the Infant Mortality Rate during our period of study. This is a summary of some of his findings:

Why so much emphasis on Infant Mortality Rate [IMR], deaths under 1 year of age per 1000 live births?

Dr John Robertson Medical officer for Health submitted his report of “Child Welfare in 1913” to the Public Health and Housing Committee in May 1914.

“the extent of Infant mortality in Birmingham…and the amount of permanent damage to young children done by the ignorance and carelessness on the part of parents is still so great …to consider whether something further cannot be done to prevent this unnecessary waste of human life”. In 1913 4257 [33%] of all deaths were in children under 3 and 3070 [23.7%] under 1. He considered that half were preventable, noted that areas of “careful artisans” had an IMR half that of areas of poverty and the resulting inefficiency & carelessness. His ward maps demonstrated the relationship of infant mortality to the gradient of socio-economic deprivation [my words not his], between the Central, Middle and Outer Wards.

He considers that much of the inefficiency of adults has its origin in their own preventable childhood illnesses. This equates with the concerns of the Infant Welfare Movement and its emphasis on physical development and the quality rather than the quantity of the population in an era of declining birth-rate.

He states that the real object of the report is “to suggest further methods of imparting information to adults as to the rearing of young children and to suggest methods of dealing with the health of parents so that a healthy stock may be produced”.

Was he successful?

The yearly MOH reports contain a plethora of statistics. As a retired Consultant Paediatrician, I have recalculated and reinterpreted them to try and answer the question

In 1913 86% of deaths under 1 could be classified as due to either Perinatal causes [38%] or Infection [48%].

Perinatal causes were classified as “largely due to some defect on the part of the mother” and were mainly responsible for deaths in the first week or first month of life; premature birth, congenital malformations and a complex heading of debility, atrophy and marasmus. Marasmus is derived from the Greek, meaning to waste away and is generally applied to the undernourishment of the child.

Despite the expansion of the Maternity and Infant Welfare Centres and their staff, and the increasing emphasis on improving antenatal care, there was no improvement in the IMRs for premature birth and congenital malformations by 1924. However, I think we can attribute the 50% fall in IMR for debility, atrophy and marasmus to the education on feeding in those centres and the referral from them to defined beds in Barnt Green in 1916 and later to Witton Babies Hospital in 1921, where 102 marasmic babies were admitted with “good results”.

These charts show the growth rate of selected babies at Carnegie Institute when specific support measures were put in place to support feeding.

Infant Mortality Rates are composed of the following: Neonatal mortality rate (deaths in the first 4 weeks of life per 1000 live births) which only fell by 13.2% [41 to 34.6], whereas the Post Neonatal Mortality rate (deaths between 4 week and 1 year per 1000 live births) fell by 45.32% [87.9 to 48.06]. This strongly suggests that the majority of the reduction occurred in infectious diseases. The death rate in the 0-5 year child population also fell by 34.8% over this period.

Infectious diseases

Diarrhoea and enteritis

This was the great success story, with deaths under 1 year reduced from 746 [25%] in 1913 to 160[11%] in 1924, and the IMR falling from 31.3 to 8.7. Dr Robertson described this as the “most easily preventable” and that “dirt in various forms is the exciting cause of the disease”. Hot weather, precipitating summer epidemics, was dreaded. Education by Health Visitors and the Maternity and Infant Welfare Centres about hygiene and feeding, especially breast feeding, was the key to this improvement. Handbills such as “Protecting Babies during Hot Weather” in 1914

and “Prevention of Flies” in 1915 were distributed to all houses in the poorest areas.

Public health issued byelaws requiring owners to provide portable galvanised dustbins, and a booklet for stable owners to remove horse dung and weekly emptying of ashbins and ashpits. Robertson also highlighted the lack of storage facilities for food and the dust from street horse dung blowing directly into many living rooms.

Nearby manure was still a problem in 1921 when Witton Babies Hospital had to cover babies with mosquito nets and empty fly traps containing 100-500 flies every 2 hours.

Measles, Whooping Cough, Scarlet Fever and Diphtheria

The burden of these diseases for all children, especially the under 5s, was immense. Between 1914-24 there were 14,383 cases of diphtheria and 89,143 cases of measles reported [underestimate], and 12961 cases of whooping cough between 1916-18. There was no change in incidence. Being highly infectious they were no respecter of class or ward and carried important sequelae for adult life. Mortality remained high, particularly for young children, and 4 or 5 times higher in the inner poorer wards. Between 1916-24 deaths under 5 years from measles were 1441 and from whooping cough 1912. From 1914 Nursing Societies were contracted to supply a visiting nurse for severe cases of measles, and then whooping cough, as expert nursing was felt to be key. Whereas all diphtheria cases were admitted to hospital, there was debate about whether severe cases of measles and whooping cough especially from dirty and poor houses should be admitted to hospital, Capacity and expense were issues and in the case of whooping cough the “high mortality” “would alarm the community” and bring “any hospital into disrepute”.

Scarlet Fever was primarily a mild disease of older children but with important sequelae. There were 23,766 cases between 1916 and 1924, with a case mortality for under 5s reduced from 6% in 1913 to 2.7 % in 1924.

Diphtheria

Dr Robertson’s 1924 report describes advances in the management of this disease. The use of high doses of antitoxin to treat cases early was introduced in Birmingham in the 1890s and this, combined with hospital admission for all cases and skilled nursing, had resulted in case mortality dropping from 29.2% [1890-93] to 14.5% [1913-16] to 8.5% [1920-23], although case mortality for the under 5s was still 17% in 1923. Immunisation of nursing staff working on diphtheria wards introduced in 1921, using a mixture of toxin and antitoxin, meant that meant no nurse had contacted the disease compared to 13 in 1918

In 1924, it was approved that all children between 2 and 5 should be immunised by 3 weekly injections.

Pneumonia and Bronchitis

The IMR remained consistently high fluctuating between 15 and 21 for this collection of respiratory illnesses. In 1924, it was the cause of 661 under 5 deaths, of which 55% were under 1.

Summary

Between 1913 and 1924 there was a very significant reduction in “the waste of human life” to quote Dr Robertson. A 35.6% fall in the infant mortality rate from 129 to 83, a similar decline in children under 5, and these declines were not interrupted by World War 1 or the post war depression. These were reflected in the three ward area categories and compared favourably with the rates of England and Wales and other large towns. In 1924 2128 [19%] of all deaths were in children under 3, 1518 [13.56 %] under 1, and there had been significant reductions in deaths from marasmus and diarrhoeal disease. However, the burden of other childhood infectious diseases remained high.

David C Low

13th Apr 202013th Apr 2020

Two contrasting midwives

Following on from last week’s blog by Maggie about the changing role of midwives during the 1914-24 period here she looks at the lives of two midwives of the period.

Kelly’s directories found in the Library of Birmingham covering the period we are examining gives listings of all the Midwives who were permitted to practice in Birmingham year by year and can be used with the information on the Central Midwives Register and other genealogical records to trace the lives and career of some of these women who often remained in practice in Birmingham for many years.

Firstly a quick look at one of the old school – Hannah ARMISHAW.

The Central Midwives Register provides name and address of the women but also details when the midwife was enrolled on the register – and also the qualification they held. And other genealogical sources such as the 1911 Census can give us information about age and family circumstances.

The CMB Register for 1915 shows Hannah living at 77 Victoria Road Harborne and gives us the additional information that she was first registered in 24 November 1904 and her qualification was that she had been in practice prior to July 1901. The symbol before her name means that she had indicated to the Board that she intended to practice during 1915. Further searches in the annual Registers show that she was listed from 1905 until 1926.

From the 1911 census we can find Hannah Armishaw living with her husband William Illsley Armishaw, an Army Pensioner. Hannah was 61 years old – and according to the CMB Registers was to practise for a further 15 years until the age of 76! The census enumerator has added in red ink the word ‘Certificated’ next to her self-recorded occupation of midwife. The census also reveals that she was no stranger to childbirth herself having given birth to fourteen children of whom 12 were still living. Three of her daughters were still living at home – all working in the chocolate business (no doubt at nearby Cadbury factory at Bournville).

We have been lucky to discover that a descendant of Hannah ARMISHAW has posted this wonderful family image of the ARMISHAW family online – and very pleased to have been granted permission to use it. It is one of the only images we have found locally of a midwife in uniform.

In contrast, Lizzie Keeping was one of the new breed of qualified midwives.

Unlike Hannah Lizzie was not a local girl and appears to have moved in pursuit of her career. She was born in Reading in 1866 and the 1901 census shows her working as a staff nurse at Brentford Union Workhouse Infirmary Isleworth Middlesex. She was on the UK and Ireland Nursing Register from 1902 registration number 295.

Lizzie obtained her midwife qualification from the London Obstetrical Society in July 1903 and enrolled on the Midwives Roll on 24/11/1904 registration number 9472 whilst working at Lambeth Workhouse Infirmary.

Sometime prior to 1910 she moved to Birmingham – to Mary Street, Balsall Heath and practised from that address for a quarter of a century.

The 1911 census shows her living at 262 Mary Street Balsall Heath Birmingham with her occupation listed as trained nurse and midwife. Also in the house were her sister in law and children and also listed as Joint head of the household a Clare Bement, described as Trained Nurse & Midwife acting as Inspector of Midwives at City Health Department. Both of these women lived together on Mary Street until Clare’s death in 1938 and appear to have been working as midwives till this date. Both would have been in their late 60s.

Following Clare’s death Lizzie Keeping left Balsall Heath and retired to Devon – to Whitpot Mill, Kingskerswell, where she died aged 76 on 27/01/1942 leaving effects worth £1825.

Maggie Brownlie

8th Mar 2020

Abortion in Birmingham: the hidden realities

We have been investigating many aspects of maternity services as part of our project but, of course, then as now, not all pregnancies were wanted. At our launch event back in September one of the visitors to the pop-up exhibition was Cambridge student Milly Coleman who has been researching the history of abortion in Birmingham. Here, appropriately on International Women’s Day, is a summary of her research.

Last summer, I spent a few weeks in the Wolfson Archives researching backstreet abortions and the women who had them in Birmingham in the late nineteenth and early twentieth century.

At that time, working class women wanted to limit the size of their family for a multitude of reasons, such as preventing overcrowding and maintaining the living conditions of their families.Moreover, industrialisation allowed women to work, giving them an extra incentive not to have more children.

To limit the size of their families, working class women had two legal options:

Abstinence
Contraception (which was unreliable and expensive).

Alternatively, but illegally, they could have an abortion if they did fall pregnant. All abortions were technically illegal before 1967, so finding records of them presented a challenge because abortionists necessarily needed to be secretive.

By criminalising the act of abortion, lawmakers created a stigma and forced women to risk their own health to avoid having a child. Additionally, they could not report malpractice or blackmail, and even if something went wrong many were reluctant to seek medical assistance.

The average woman would not have talked about procuring an abortion, but ‘bringing on a period’ using colloquially named chemicals – ‘bitter apples’ was colocynth and ‘hikey pikey’ was hiera picra – or using household chemicals such as washing soda or turpentine. [1]

Colocynth Bottle. Copyright Science Museum

Hiera Picra Pills. Flickr.com Attribution-NonCommercial-NoDerivs 2.0 Generic (CC BY-NC-ND 2.0)

Consequently, it was challenging to recover the stories of women who had abortions, as abortionists did not keep incriminating written records.

Inevitably then, many surviving documents originate from cases where the process went wrong and can be found in the medical records of Birmingham Women’s Hospital and Birmingham Maternity Hospital.

Birmingham Women’s Hospital served ‘a large number of poor women in Birmingham suffering from ailments peculiar to their sex, for whom no adequate means of treatment existed’, and was the largest women’s hospital in England around 1900.[2]

The annual reports of both the maternity and women’s hospitals demonstrate the patronising tones that the upper middle class governing board took towards their working class patients. The charities undoubtedly had good intentions and did very important work, but that middle class judgement is clear in the annual reports.

Through my research I wanted to understand who the women having abortions were, since so much of the contemporary debate focused on either cases of rape, or sex workers.

The voices of poor married women who couldn’t afford another child were largely overlooked in arguments about the legalisation of abortion, so I tried to focus on average women from Birmingham to counter this. Their stories have been accessed via medical records and the records of social workers and abortion reformers.

In the Report of the National Birth Rate Commission, written in 1916, Mrs [Florence Carol] Ring, a Birmingham-based social worker, estimated that one in four poor women attempted an abortion at some point, although this is likely to be an underestimate since a conspiracy of silence existed around naming abortionists and methods.

Mrs Ring provides a unique perspective as she had the trust of the working class community she served, and she describes that ‘the poor begin by having children and then resort to abortion later on when the family increases in size’. [3] I wanted to understand a little more about the lives of these women and their motivations.

I used the In Patient Register at Birmingham Women’s Hospital to create a profile of the women admitted to the hospital due to a failed or complicated abortion. The staff recorded the name, age, marital status and address of patients, as well as the occupation of their husband or father if they were unmarried.

The cases of abortion recorded in the Register represent a tiny minority of all abortions, as women risked arrest by going to hospital, but they offer useful data on the age and marital status of patients.

From 1912-1916, 87.4% of the women admitted for complications from abortions were married. Although the average age fell slightly when World War One began, the lowest it reached was 29.6 in 1916. [4]

This illustrates that in Birmingham, married women who already had children were the principal demographic having abortions.

These women had abortions out of desperation, since any reaction to an unwanted pregnancy had its own dangers and potential stigma.

Working class women in Birmingham faced overcrowding and a lack of sanitation in the slum-like ‘back-to-backs’.

Miss Martin, a midwife from the Selly Oak area of Birmingham with nine years of experience, testified in 1916 that some landlords refused to house larger families so the birth of another baby could lead to homelessness for the whole family.

In addition, exposure to chemicals in industrial workplaces and previous births in quick succession meant that women’s health was put at risk by further pregnancies.

Brookes argues that contraception and abortion were essential to maintaining living standards, yet legally and in popular rhetoric, the health and sanity of women was portrayed as secondary to the unborn baby.

Women therefore faced a choice between abstinence, contraception, keeping the baby, adoption or abortion. Upper class voices criminalised and degraded the mother’s body regardless of her choice, leaving no easy solution. And in many cases, the cost and ease of access to abortion made it the best option for many working class women and their families.

Milly Coleman

[1] P. Knight, ‘Women and Abortion in Victorian and Edwardian England’, History Workshop 4:57 (1977), 57-68 at p58
[2] Article about Bingley Hall Charity Exhibition, Volume of press cuttings relating to Birmingham Hospitals (Birmingham: Wolfson Centre, HC WH/5/1/1, Library of Birmingham, c.1900). The headline and author of this article was cut off when the volume was compiled.
[3] ‘Testimony of Mrs Ring’, The Declining Birth Rate: Its Causes and Effects – Report of the National Birth-Rate Commission (London: Chapman and Hall Ltd, 1916), 277-281 at p280
[4] In Patient Register of Birmingham Women’s Hospital, vol.3 (Birmingham: Wolfson Centre, HC WH/3/1/3, Library of Birmingham, 1912-1916)
[5] ’Testimony of Miss Martin‘, The Declining Birth Rate: Its Causes and Effects – Report of the National Birth-Rate Commission (London: Chapman and Hall Ltd, 1916), 273-277 at p274
[6] B. Brookes, Abortion in England 1900-67 (London: Croom Helm, 1988), p12

1st Mar 2020

Infant Welfare Centres in Birmingham

Birmingham was a pioneering City when it came to the establishment of municipal Infant Welfare Centres (IWCs). Laurie has been looking at the role of IWCs and the changes during 1914-1924.

The purpose of Infant Welfare Centres (IWCs) was to reduce the high infant mortality rate (IMR), to improve the health of babies who survived their first year, and to look after the health of mothers before and after giving birth. They were enthusiastically promoted by Dr John Robertson, Birmingham’s Medical Officer of Health (MOH).

The first IWC in Birmingham was established in 1907 by voluntary subscriptions to Birmingham Infants’ Health Society using a room in the Medical Mission, Floodgate St, followed in 1908 by the first municipal IWC in New John St West, in two of the poorest districts in the city with the highest IMRs.

Selly Oak Infant Welfare Centre in the former Village Bells Inn

In May 1914, presenting his annual report to the Public Health and Housing Committee for the previous year, the MOH included a separate report on Child Welfare, in which he deplored the city’s 3,070 deaths of infants under 12 months of age as a great waste of life. Dr Robertson claimed that over half the deaths were preventable, such as those from diarrhoeal diseases and ante-natal causes. He believed that education of mothers was the best way forward, and he outlined the work already underway in the existing 4 voluntary and 4 municipal IWCs, the latter staffed by lady doctors appointed by the Committee. His aim was to expand such work across the city by creating 6 further ‘welfare stations for mothers and children’. The plans of the MOH were hampered by the outbreak of war, as rented accommodation suitable for use as IWCs became difficult to obtain, and many staff in the Public Health Department left for war work.

In 1915 a Maternity and Infant Welfare Sub-committee was established which included two women, one of whom, Mrs Dora Walker, was appointed Chair at the end of its first year. Training was organised for IWC workers at the Municipal Technical School. Government grants of 50% towards the running costs of municipal IWCs (and voluntary centres meeting certain requirements) became available and by the end of the war, Birmingham had 13 municipal and 8 voluntary centres; some had been relocated to more suitable premises from their original buildings.

The main functions of the IWC were to monitor the progress of infants by weighing them, followed by consultation with the doctor if necessary. Minor ailments were dealt with in the centre, and more serious cases referred as appropriate. This enabled earlier diagnosis and treatment of problems which otherwise might have worsened, as mothers living in poverty may well delay seeking medical advice they had to pay for. The Superintendent (a qualified nurse, midwife or health visitor) oversaw the maintenance of records and was available at each consultation to provide advice for mothers. Older infants (aged 1-5) had their own sessions in some centres, or were supervised in a separate room.

Mothers would be encouraged to attend health talks on a wide variety of topics related to correct methods of feeding and rearing infants. Particular importance was attached to the benefits of breastfeeding, the constant need for cleanliness, and the value of fresh air for babies. The topics sometimes included mental and moral training of children. Visits to mothers, and antenatal and postnatal consultations were also introduced.

Alongside the activities within the centres, the visiting of infants in their homes was crucial in the education of mothers. Infant Visitors attached to the IWCs aimed to see every new baby in their area within 10-14 days of birth to give advice on its feeding and care, the mother’s health and general household matters. An initial record card was completed and the mother encouraged to bring the baby to the local IWC, with repeat home visits if necessary.

IWCs had different frequencies of consultations and varying facilities, depending on the location and population of the district they served: there were 108 notified births in rural Northfield in 1921 compared to 1,636 in inner-city Hope St. Nearly all centres held sewing classes, where used garments were altered to make clothes for children, and some held cookery classes, Mother-craft competitions, and savings clubs. Dried milk was available at a reasonable price, with assured stocks throughout the war. Social activities such as summer outings and Christmas parties were often arranged by voluntary helpers, who were considered invaluable, giving a welcome extra dimension to the centre’s work.

MS4101 New Year’s Social Gathering at Green Infant Welfare Centre

At some centres in poorer districts, maternity feeding stations were set up for mal-nourished pregnant and nursing mothers. They were given a hot dinner for which they were asked to pay 1d if they were able. This provision was gratefully accepted by the mothers and improvements were noted in their own and their babies’ physical health and mental wellbeing. Weekly dental clinics were introduced in 1917 for mothers and children attending IWCs. It became increasingly difficult for the voluntary IWCs to attract sufficient funding by subscriptions, even with government and city grants of 80%, and eventually most opted to be taken over by the municipality.

The archives contain many references to the appreciation of mothers for the benefits they and their children gained from attending IWCs. The numbers of home visits and attendances of children at the centres in Birmingham show a healthy increase between 1918 and 1924:

	Births notified	Total visits to children	Total child attendances
1918	12333	111070	67080
1924	15981	232708	126998

Growth in work of Infant Welfare Centres from 1918-1924

Laurie Spencer

1st Jan 2020

New Year’s Greetings

18th Sep 201918th Sep 2019

Tracing Brummie Midwives

100 years ago the majority of births took place at home – with the assistance of a local midwife. Concern over the competency of many untrained midwives the 1902 Midwives Act aimed to regulate the profession by requiring certification of midwives and fines for anyone practising without certification. In addition the Act established the Central Midwives Board to regulate the training courses and to maintain the register of certified midwives.

Useful sources for tracing midwives and their careers are the Central Midwives Register (available to view on Ancestry) combined with local trade directories. The 1913 Kelly’s Directory of Birmingham lists nearly 200 registered midwives and gives their home addresses. It should be remembered that most midwives were effectively self-employed at this time and only relatively few worked in the local Maternity Hospitals. Hence the need to be listed in such directories. The Central Midwives Register provides name and address of the women but also details when the midwife was enrolled on the register – and also the qualification they held. And other genealogical sources such as the 1911 Census can give us information about age and family circumstances.

Thus from the 1913 Directory we can see that a Mrs Hannah Armishaw was a registered midwife living at 77 Victoria Road, Harborne.

m0525-01062 reduced — Extract from 1913 Kelly’s Directory of Birmingham showing list of Registered Midwives

The Central Midwives Board Register for 1915 confirms this address and gives us the additional information that she was first registered in 24 November 1904 and her qualification was that she had been in practice prior to July 1901. The blurb at the start of the Register suggests that at this date about half of registered midwives had undergone training and passed the Examination of the Central Midwives Board and the other half, as with Hannah Armishaw, were registered on the basis of their prior experience. The symbol before her name means that she had indicated to the Board that she intended to practice during 1915. Further searches in the annual Registers show that she was listed from 1905 until 1926.

Armishaw CMB Register 1915 — 1915 Central Midwives Board Register

Turning to the 1911 census we can find Hannah Armishaw at the same address living with her husband William Illsley Armishaw, an Army Pensioner. Hannah was 61 years old – and according to the CMB Registers was to practise for a further 15 years until the age of 76! The census enumerator has added in red ink the word ‘Certificated’ next to her self-recorded occupation of midwife. The census also reveals that she was no stranger to childbirth herself having given birth to fourteen children of whom 12 were still living. Three of her daughters were still living at home – all working in the chocolate business (no doubt at nearby Cadbury factory at Bournville)

Extract from 1911 Census showing Hannah Armishaw, midwife

We are hopeful that during the project at least one volunteer will be interested in examining the records such as these in more detail to give us a better understanding of who these early registered midwives were, how long they stayed in the profession and the proportions of them that had passed the relatively new qualifications. Newspaper searches may discover stories related to some of the midwives especially if any were struck off for practising whilst unregistered or were involved in cases of malpractice.

Come along to our project launch on Saturday 21st September at the Library of Birmingham to find out more about the archival records we will be using during the project – and how you can get involved.

Liz Palmer, Project Co-ordinator