First World War

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

19th May 2020

Giving birth at the Workhouse Infirmary

Last week’s blog looked at an article in the Birmingham Gazette of 9th March 1920 linking the problems of overcrowding and poor housing to the fear faced by many young women at the prospect of having to give birth at one of Birmingham’s Workhouses. In a follow up article a couple of days later the Gazette looked at the reality of the maternity ward within one of the workhouse infirmaries.

The Infirmary at the Kings Norton Union Workhouse was opened in 1897 and in addition to general wards there was separate provision for maternity cases. Although operated by the Guardians of the Poor the infirmary was separated from the Workhouse itself by a dividing wall and they were run as separate establishments. This Gazette article of Thursday 11 March 1920 provides a detailed description of the Maternity wards and is transcribed here in full:

CARE OF MOTHERS AT INFIRMARY.

Ideal Conditions for Maternity Cases.

They speak of the need for a municipal hospital, but what, after all, is this infirmary but a municipal hospital? Why people should think it less derogatory to go to a hospital supported by voluntary contributions, where they are really receiving charity, than to come to the Selly Oak Infirmary, which they themselves have been helping, to support by the rates they have paid for years. I cannot imagine,” said Dr. Martin, the infirmary’s chief medical officer, when I talked over with him yesterday the question of the housing shortage and the consequent need of more maternity hospital accommodation.

There can be no doubt that many of the expectant mothers, much as they resent the idea of being sent on to the Infirmary after having arranged to go to the Loveday-street hospital. settled down in a wonderful way when they find what the Infirmary is really like, and express their appreciation of the care and attention they receive from the trained staff there.

Restful beauty.

I have never seen a more beautiful part of any hospital than the large maternity ward at Selly Oak, which I was privileged to visit yesterday. The bright outlook, the windows arranged to catch every gleam of sunshine, the mothers’ beds and babies’ cots, with their dainty white drapery, the banks of flowers arranged on tables down the middle of the room, combined to give a sense of restful beauty. There were polished floors, the walls were painted in soothing tones of green and fawn. Nurses in their pretty uniforms moved up and down the ward., and happy looking young mothers lay in bed, with their babies in the cots by their sides. In a second ward I saw a group of expectant mothers, sitting round a table making swabs and dressings of cotton wool.

“Any work of that sort that they do is quite voluntary.” said the doctor. “but most of those who come in a few days before the birth of their baby prefer to occupy themselves in some quiet way during their waiting time.

Paying Patients.

There was a balcony outside each large ward overlooking the beautiful garden where masses of flowering currant were bursting into bloom. Even on a cold March day the air was pleasant in these sheltered nooks, with their south aspect, and I found one or two expectant mothers resting contentedly there. ” I very much prefer having my bed out here to being indoors,” said one of these, who chatted with me very cheerfully and told me she had been a tram conductress during the war. Of the forty cases in hospital this week almost all are paying patients.

“Their payments vary, of course,” the matron informed me, “but no distinction whatever is made. The nursing, the food, and the dress are the same for all.” Every patient, when she enters the hospital, has to change her own dress for the pink uniform of the infirmary. The dresses are a pretty shade of pale pink, and look fresh and clean, but it seemed to me rather a pity that they should be insisted on. To see one patient after another dressed exactly alike spelt “institution” more than anything I came across.

” Daddy Longlegs ” type.

The small separate room where each birth actually takes place is fitted up almost like an operating theatre—the white tiles, ample hot water supply, and special lighting and heating arrangements giving all the comfort and safety possible. I was introduced to the well-stocked library of clean, nicely bound novels. “These are kept entirely for the maternity wards.” the matron told me. “and we buy just what we think our patients would like to read. You see we have quite a number by Charles Garvice and Ethel M. Dell, and they like Rider Haggard and the ‘Freckles’ series ` and books of the ‘Daddy Longlegs’ type. I don’t accept presentation volumes for this library of ours. Spurgeon’s sermons? No, thank you!”

Each floor had its own bathrooms and linen storerooms, and it’s own small supplementary kitchen, where tea could be made or milk heated at a moment’s notice. All the maternity wards are shortly to be moved to the top floor of the hospital, where an entire reconstruction is taking place, and every room is being made as perfect and up to date as it can possibly be.

Met by Proud Husbands.

The food supplied to the patients is excellent. Never have I tasted more delicious bread than that which is made in the infirmary’s own bakery. Most of the mothers and babies, I found, were able to leave at the end of a fortnight when a proud husband and father probably arrives to escort them home. I left with the impression of having spent the afternoon in a hospital of an ideal description. And yet I felt that, as the old deep-rooted prejudice against going into a Poor Law institution can never be eradicated, it would solve the problem if we could change the name of the infirmary, and, instead of patients having to apply to the relieving officer for admission. have it run as a municipal hospital under the Ministry of Health.

C. H. C.

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

6th Apr 2020

Midwives in Birmingham 1914-24

A key topic in our project has of course been Midwives. Here project volunteer Maggie outlines the impact of the Midwives Acts on the increasing professionalisation of midwifery in Birmingham.

100 Years ago the majority of Births in Birmingham took place in the home with the assistance of a local Midwife. The Midwives who were working at that time had little training unless they had been formally working as nurses and many were untrained, known as a local handywomen “the woman you called for “ when your baby was coming. She would often be involved in helping the sick and the dying and sometimes would offer home help service washing and assisting with childcare

The period we are looking at,1914-1924, was a period of much change in Midwifery and maternity . There was much worry over paying for health care . Childbirth was not seen as a medical process and in working class areas doctors were rarely called except in severe emergencies as people could not afford to pay the fees.

“the work of a busy midwife is very hard, holidays and off duty times are difﬁcult to secure the responsibility is exceptionally grave, the remuneration comparatively small. Midwifery, more than any other branch of nursing, unquestionably taxes to the utmost professional skill and judgment, physical capacity and endurance, patience and sympathy.” From { Dr Janet Campbell Senior Medical ofﬁcer at The Ministry of Health through throughout the 1920’s in a report on the Physical welfare of mothers and Children in England and Wales 1923}

Midwives Bag - Image Science Museum — Midwifery bag complete with contents, bag by Arnold and Sons, London, 1925-1955. Science Museum

The ﬁrst Midwives act of 1902 was an Act to secure the better training of Midwives and to regulate their practice and introduced the Central Midwives board {CMB} The board formulated restrictive practice requirements , a supervisory requirement and a disciplinary system which were apparently designed to make it impossible for working class midwives to continue practising . Midwives who had a recognised qualiﬁcation in Midwifery either from The London Obstetrical Society or from certain lying in hospitals could apply to enrol on the register of qualiﬁed midwives . There were several training centres for midwives in Birmingham:

Birmingham Aston Union Workhouse Gravelly Hill
Birmingham Union Inﬁrmary at Selly Oak;
Birmingham Maternity Hospital Loveday Street
Birmingham Workhouse inﬁrmary Dudley Road

The 1902 Midwives Act which came into operation on 1st April 1903 required newly registered Midwives to undertake 3 months training which was increased to 6 months in 1916 and subsequently to 12 months by 1926.

Women who had been in practice for at least 12 months and who could show they were of good character { usually by a reference from a clergyman} could also apply . They were known as bona ﬁdes . Any other women who wished to take up the practice of Midwifery had to pass an examination in competence to obtain a certiﬁcate . In order to be admitted on the Midwife Roll candidates had to satisfy the Central Midwives Board the they had reached

A sufﬁcient standard of general Education
A birth certiﬁcate showing the candidate is not under 21
Certiﬁcate to the effect that the candidate had undergone training
A certiﬁcate of good moral character
Must pass an examination

From 1905 only women certiﬁed under the Act would be entitled to use the title of “Midwife” and to recover any fee for attendance as a midwife .

Certified Midwife Badge c.1918 — Early Badge for Certified Midwife

Training

The cost of the training which usually took place away from home. The use of medical latin in the examination would have been prohibitive to many working class women . A pupil midwife would attend and watch the progress of no less than 20 labours including making abdominal and vaginal examinations and delivering the baby. She would be required to nurse 20 lying in women during the 10 days following labour. (lying in is an old child birth term involving a woman resting in bed for a period after giving birth) She would have to attend a course of instruction which should be no less than 3 months with an oral practical and written examination .

The course included :

elementary anatomy of the female pelvis pregnancy and its complications including abortion

the symptoms mechanism course and management of natural labour

the signs of of abnormal labour

haemorrhage treatment

use of a clinical thermometer and catheter antiseptics- the way to prepare and use them

management of the puerperal patient ( the period of around 6 weeks after childbirth when the mother’s reproductive organs return to their non pregnant condition.
management (including feeding) of infants and the signs of important diseases which may develop with the ﬁrst 10 days after birth.
Obstetric emergencies and how to deal with them until a doctor arrives ( to include the knowledge of drugs needed in such cases
House sanitation & disinfection of the person their clothing and appliances

Midwives were subject to regulation concerning equipment and clothing and it was noted back in 1905 in the Journal of Midwives that the cost then of required equipment and a lined midwifery bag would be one guinea – prohibitive to many handywomen who were so often paid in kind .

Rules affecting Midwives

The rules laid down in the Midwives act were enforced by strict supervision undertaken by often local dignitaries many of whom were not trained in midwifery or nursing and the midwives had their homes investigated which was intrusive. After 1910 no person could “habitually and for gain “ attend a woman in childbirth except under the direction of a doctor. Any woman acting without being certiﬁed was liable on summary conviction to a ﬁne not exceeding £10. County boroughs were to be the local supervising authority over midwives within the area. they were to provide general supervision, investigate charges of malpractice negligence or misconduct and report to the CMB . They were also responsible for suspending any midwife from practice in accordance with the rules under the act During the month of January each year the supervising authority would supply the CMB with the names and addresses of all midwives who, during the preceding year, had notiﬁed their intention to practice in the area .The requirement was that every woman certiﬁed under the act would give notice in writing of her intention to practice . If any woman omits to give the said notice shall by summary conviction be ﬁned up to £5. The penalty for obtaining a certiﬁcate by false representation was a misdemeanour and the woman would be liable to imprisonment with or without hard labour for a term not exceeding 12 months.

Increasing professionalisation of midwives

The Medical Officer of Health Reports for Birmingham provide many statistics relating to the employment of midwives in Birmingham and can be used to show the impact of the Midwives Act over our period of study.

In 1914 253 midwives were registered to practise. 174 were admitted by reason of their having been bona ﬁde prior to the passing of the Midwives Act (1902) and the remaining 79 held recognised certiﬁcates of training in Midwifery. They attended 15,664 births during the year which was almost 70% of the total number of recorded births in Birmingham. .

16 attended over 200 births but most attended around 50 births each.

The reports also give details of suspensions and actions taken against midwives who did not comply with desired practice. In this year alone 62 midwives were suspended for poor practise. 53 for cases involving puerperal fever and 5 for cases of Pemphigus Neonatorum (see glossary)

Ten years later the proportion of certiﬁed to uncertiﬁed midwives had greatly increased. In 1924 here were 231 midwives of whom 170 were certiﬁed and 61 were bona ﬁde. Between them they attended 11459 births – 62 % of the total.

The reports also reveal the pay which depended on the status of the midwife:

Bona ﬁde midwives earned about £16 per year while trained midwives could command higher fees and earned £42 per year. In our next blog we will look at two different Birmngham midwives.

Maggie Brownlie

1st Jan 2020

New Year’s Greetings

25th Dec 2019

500 Birmingham Babies at Christmas

Christmas Greetings from the Born in Birmingham Project!

We’ve found a festive photograph to share with you this Christmas. It’s the remarkable scene of 500 babies and their mothers at a Christmas tea party at Birmingham Town Hall in 1917. It featured on the front page of The Picture World – a relatively short-lived newspaper published in Birmingham during the First World War.

The caption explains that the guests were invited from the poorest quarters of Birmingham where the problems of infant mortality were being grappled with by the Infant Welfare Society. So along with sandwiches and cake the mothers were probably served with advice on infant feeding and welfare!

Maybe your parent, grandparent or great grandparent was one of these babies entertained at this unique (?) gathering in Birmingham just over 100 years ago? If so the story may have been passed down the generations – and we would love to hear from you.

Liz Palmer