Heritage

14th May 2020

Impact of overcrowding on maternity care

‘Homes fit for heroes’ was one of the rallying cries of the working class across Britain after the First World War and housing was one of the major political issues in the General Elections of 1918 and 1920s and the local elections too. But lack of housing and high rents had an impact on maternity services too as highlighted in this emotive article from the Birmingham Gazette of 9th March 1920.

Birmingham Daily Gazette - Tuesday 09 March 1920 — Birmingham Daily Gazette – Tuesday 09 March 1920

‘Why should my baby be born in the workhouse? I don’t care how well I’m looked after there, or how kind the nurses see. I simply hate the thought of it.” This was the cry of a young married woman who, because she and her husband were among the thousands of young couples unable to get a house of their own. had arranged to go to the Maternity Hospital in Loveday-street, only to find when the time came for her to enter the hospital that there was no bed vacant, and that the authorities could do nothing but draft her on to the workhouse infirmary. She is only one of dozens similarly situated who have no choice in the matter.

Landlady Gives Notice.

“We are sending young married women to the workhouse as paying guests all the time,” an infant Welfare Superintendent told a Gazette woman. ” Many of them find the idea of going there almost unbearable, but there is nothing else to be done. Their landlady—if she is the usual kind of landlady and not an exceptionally considerate one—gives them notice, to leave their rooms as soon as she finds that a baby is expected. They find it impossible to obtain new lodgings; the high fees of the private nursing homes are beyond their means.; the maternity hospital is crowded out; so the only thing left for people who would gladly pay a doctor and a nurse, if only they could find a home of their own is the workhouse.”

Very Pathetic.

The Gazette representative then asked Mrs. Sidney Walker, chairman of the maternity hospital committee, whether anything was being done to relieve the pressure there. “We are doing what we can,” she said, ” but things are very bad indeed, and a great deal more must be done. Even the workhouse is getting crowded out. There is only room for 30 bode at Loveday-street, and it is appalling to think that that is all the provision made for a great city like Birmingham. ”

A house at Erdington has just been taken over, and one in another suburb will probably be taken shortly, where normal cases can be sent, to relieve the pressure at the maternity hospital. But there will only be room for twelve in each of these, so a great deal more accommodation will have to be found somehow.”

Some of the cases which have lately been turned away from the crowded maternity hospital have been very pathetic. Respectable people. who deeply resent having to live and bring up their children in one cramped room, plead hard to be taken in. One of these the other day was found to have only been able to get one room for herself. her husband and five children: the hospital would have admitted her if it possibly could, but there was no possibility of finding room. Another was sharing a room with a sister and a brother of 18; even she could not get into the hospital.

Piggott Street Lee Bank c.1910 — Typical back-to-back housing in Piggott Street, Ladywood c.1920

Seven in One Room.

Other astonishing cases of overcrowding which the Gazette representative came across in the course of her inquiries showed what Birmingham people are having to endure in these house less days. There was a family of seven living in one furnished room, for which they were paying 30s. a week; the family consisted of parents, three daughters of 19, 17 and 15, and two younger boys.

Birmingham Daily Gazette - Friday 01 December 1922 — Birmingham Daily Gazette 1 December 1922

A suburban house, in which there are only three upstairs rooms, is being shared by four married couples. “I do feel so for all these young people.” said Councillor Mrs. Mitchell who is also a member of the Maternity Hospital Committee. “Some of them have waited years to get married, only to find that it is still impossible to get a home. It is a shame that a city like Birmingham should have nothing better than the Workhouse Infirmary. to offer so many young mothers As a mother I can realise how terrible it must be for them for the treasured first baby to be born in a workhouse. I want to see a municipal maternity hospital established as soon as possible. To provide the housing we need is going to be a costly business but prevention is better than cure, and no matter what the houses cost it will be cheaper in the end to build them than to cope with all the disease and crime which must inevitably follow continued overcrowding.”

In our next blog we can see another article from the Gazette which follows on from this piece by looking in detail at the maternity provision at one of Birmingham’s Workhouse Infirmaries.

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

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

11th Nov 2019

John Robertson – Medical Officer of Health 1903-1927

As we have met together recently as a newly-formed team to consider our project

Born in Birmingham : Maternity, Midwives and Infant Welfare: 1914-1924

a frequent name on our lips has been ‘John Robertson’, the formidable Medical Officer of Health (MOH) for Birmingham for a great tranche of the early twentieth century.

John Robertson was born in Warminster in 1862 but educated in Edinburgh taking his MD with honours in 1887. His graduation thesis was ‘on the causation and distribution of consumption in England and Wales’ – a subject which he pursued throughout life. His early career in Public Health was as MOH for St Helens where he investigated the combating of diphtheria – a major killer of babies, children and adults at this time. From St Helens Robertson moved to an equivalent post in Sheffield and here he was active in promoting a local Act of Parliament to require the compulsory notification of tuberculosis.

In 1903 Robertson was appointed to the MOH post in Birmingham, succeeding Dr Alfred Hill. An obituary in the British Medical Journal describes him as a man who took ‘a broad view of his responsibilities … a town planner long before the term came into common use’. In Birmingham again he concentrated on schemes to minimise tuberculosis and infant mortality. He also held the Chair of Public Health at Birmingham University. In 1925 he was knighted for his services to the community, having previously received a CMG and OBE. Robertson retired from the Birmingham Corporation in 1927.

Whilst living in Birmingham Robertson, his wife, Jane and two daughters were resident at The Hollies on Court Oak Road in Harborne, where he died in December 1936, aged 74.

We look forward to finding out much more of the contribution this man made to public health in Birmingham.

The Annual reports of the Medical Officer of Health to the Chairman and Members of the Public Health and Housing Committee are a key resource for our project. They provide a detailed and comprehensive analysis of medical well-being of Birmingham and its inhabitants and provide many useful statistical tables which can be used to research the health of newborn infants and their mothers.

For example the Appendix to the 1917 Report includes a special report on ‘Maternity and Child Health during 1917’. This highlights that whilst the infant mortality rate overall continued to fall there had been no improvements over the last ten years in the mortality rate of babies under 1 month old. The MoH wished to see more gathering of statistics relating to stillbirths and newborn babies to try and pinpoint some of the causes. In another section he refuted the suggestion that many of the deaths due to ‘overlaying’ were as a result of women’s drunkenness.

Alison Smith (with additional notes by Liz Palmer)

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