Born in Birmingham: Maternity, Midwives & Infant Welfare 1914-24

Born in Birmingham Maternity, Midwives & Infant Welfare 1914-1924

FRIENDS OF BIRMINGHAM ARCHIVES

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H E R I TA G E

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Credits & Acknowledgements

FRIENDS OF BIRMINGHAM ARCHIVES

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H E R I TA G E

FoBAH acknowledges support from: National Lottery Heritage Fund First World War: then and now grant Staff of Archives and Collections at the Library of Birmingham With thanks to volunteers and FoBAH committee members: Maggie Brownlie, Sandra Flynn, Robert Gould, Alison Laitner, David Low, Cathie Paton, Laurie Spencer, Fiona Tait, John Purser, Jan Wright Project Co-ordinator: Liz Palmer Project Administrator: Anne Hornsby Project Supervisor: Alison Smith Digitisation: Richard Albutt Design: Kerry Leslie Images reproduced with the permission of: Library of Birmingham University of Birmingham Science Museum Wellcome Collection Front cover: Birmingham Infants Health Society & School of Mothercraft 6th Annual Report. MS4101.

Back cover: Mother & Baby. Hope Lodge Annual Reports. MH106.

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The Friends of Birmingham Archives and Heritage (FoBAH) is a volunteer group formed in 2009 to promote and support the work of Birmingham Archives and Collections within the Library of Birmingham in making their collections as available to as wide an audience as possible.

In 2016-17, FoBAH ran a successful project funded by the Heritage Lottery Fund entitled Birmingham Children of War which focused on the experience of children in Birmingham during the First World War. This current project, Born in Birmingham: Maternity, Midwives and Infant Welfare 1914-24, arose out of the earlier work as we wanted to look more closely at the factors affecting births in Birmingham from conception through to early infancy.

The project enlisted the help of volunteers to research archival and library resources to uncover all they could about topics that were of interest to them including the role of professionals such as midwives and health visitors, the growth of infant welfare centres, infant mortality and issues such as illegitimacy and abortion. Meeting on a weekly basis the volunteers learned how to use library and archives’ catalogues to locate material on their chosen themes. This was augmented by workshops on the use of archives, the use of online newspaper archives and basic family history research using Ancestry. There was also a visit to the archives of the Wellcome Collection in London.

Volunteers have regularly shared their findings via the project’s blog: www.borninbirmingham.home.blog and www.facebook.com/BornInBrum1914 And small snippets via: www.twitter.com/borninbrum1914 To find out more about FoBAH: www.fobah.org

Born in Birmingham Maternity, Midwives & Infant Welfare 1914-1924 A learning guide for researching maternity services and infant welfare issues in Birmingham 1914-1924 A project by the Friends of Birmingham Archives and Heritage 2019-2020 funded by the National Lottery Heritage Fund.

This learning guide features edited articles by FoBAH members and volunteers. Additional content and a digital download of this guide can be found on the project blog.

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Introduction

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Role of Midwives

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Infant Mortality

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Infant Welfare Centres

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Carnegie Infant Welfare Institute

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Health Visitors

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Hospitals

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Baby Week

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Family Planning

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Abortion

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Illegitimacy

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Infant Feeding

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Pen Portraits

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Glossary

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Selected Resources

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Born in Birmingham Maternity, Midwives & Infant Welfare 1914-1924

Born in Birmingham examines the role of midwives and health visitors in the city during World War One and its aftermath.

The project also looks at how Birmingham tackled the problems of mother and child welfare in the years 1914-1924.

In 2018, when we were planning the Born in Birmingham project amidst the celebrations of the 70th anniversary of the NHS, it seemed as if 2020 would be the ideal year to deliver the project, timed as it was to coincide with the International Year of the Nurse and Midwife. We had no idea that the Covid-19 pandemic would throw everything into disarray and difficulty.

Whilst most of the research was complete, we were disappointed not to be able to undertake the planned launch event in April 2020. It is sobering to reflect that the Spanish Flu pandemic of 19181920 fell in the period of study, which takes on an entirely new significance in the present time as we reflect back on that period.

The project came out of the success of an earlier venture undertaken in 2016-17 by the Friends of Birmingham Archives and Heritage. A successful Heritage Lottery bid launched the ‘Birmingham Children of War’ project which examined the experiences of children’s lives on the Home Front.

Several of the project’s volunteers were keen to continue with their explorations of Birmingham archives and chose to concentrate on the earliest stages of life that had only been touched on previously. Key legislation in the form of the Midwives Act 1902, and the subsequent formation of the Central Midwives Board was starting to have an impact by 1914 so it seemed relevant to focus on the vital role of midwives and health visitors in what was a time of rapid change and increasing professionalisation.

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Birmingham was a national pioneer in the establishment of Infant Welfare Centres across the city, which provided some sort of safety net to many on low incomes. Emphasis was placed on infant welfare due to the high levels of infant mortality and it was also recognised that future prosperity might be reliant on the health of the population. Great strides were made in reducing infant mortality through practical measures and health education including the annual Baby Week.

Studying this period highlights not only what was progressive and beneficial to women and infant welfare, it also serves to remind us that then, as now, women’s experiences could be traumatic. Birmingham’s first family planning clinic was not established until 1927 and prior to then health visitors were forbidden from promoting contraception. Abortion was illegal but still practised and, most commonly, used by married women to limit unaffordable additions to their families. Illegitimacy was still a stigma and the health outcomes of illegitimate babies were considerably poorer than those born in wedlock.

The project is the culmination of the hard work of a team of volunteers and has uncovered a great deal about the history of the city of Birmingham and women’s health in this period. The planned launch and exhibition could not take place, however we are excited to be able to share the research with you.

Rachel MacGregor Chair of FoBAH FRIENDS OF BIRMINGHAM ARCHIVES H E R I TA G E

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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.

— Dr Janet Campbell, Senior Medical Officer at The Ministry of Health in a report on the Physical welfare of mothers and Children in England and Wales 1923.

Image from The Graphic, 25 December 1915 5

Role of Midwives Maggie Brownlie

One hundred years ago, the majority of births in Birmingham took place in the home with the assistance of a local Midwife.

The 1914-1924 period saw much change in midwifery and maternity services both locally and nationally.

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). Prior to this most midwives had had little training unless they had been formally working as nurses and many were completely untrained, known as a local handywoman - “the woman you called for when your baby was coming”.

Midwives would often be involved in helping the sick and the dying and sometimes would offer home help service washing and assisting with childcare as well as assisting with the birth.

There was much worry about paying for healthcare. 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.

Following the 1902 Act, the CMB formulated restrictive practice requirements, a supervisory requirement and a disciplinary system. The newly introduced Register of Midwives allowed those who had a recognised qualification in Midwifery either from The London Obstetrical Society, or from certain lying-in hospitals, to enrol.

Some untrained midwives were allowed to register if they could demonstrate experience prior to the introduction of the Act (known as ‘bona fide’ midwives). The cost of the training, which usually took place away from home, and the use of medical Latin in the examination, deterred many working class women.

Research Tip Kelly’s directories covering the period 1914-1924 give annual listings of Midwives practising in the city. They can be used with information on the Central Midwives Register, and other genealogical records to trace midwives lives and careers.

Locally there were 4 approved centres of training: Birmingham Aston Union Workhouse, Gravelly Hill Birmingham Union Infirmary at Selly Oak Birmingham Maternity Hospital, Loveday Street Birmingham Workhouse Infirmary, Dudley Road A midwife-in-training would attend and watch the progress of no less than twenty labours, including making abdominal and vaginal examinations and delivering the baby. She would be required to nurse twenty lying-in women during the ten days following labour. And, she would have to attend a course of instruction for a minimum of three months with an oral, practical and written examination.

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.

The rules laid down in the Midwives Act were enforced by strict supervision, undertaken often by local dignitaries most of whom were not trained in midwifery or nursing, and the midwives had their homes investigated which many considered 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 to a fine of up to £10. The local authority could also suspend midwives guilty of any malpractice.

The Medical Officer of Health Reports provide many statistics relating to the employment of midwives in Birmingham.

Extract from Central Midwives Board Register, available on Ancestry.co.uk

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Case Studies Hannah Armishaw, bona fide midwife, 1851-1940 Hannah was born in Northfield.

Census records show her in various occupations including servant and laundress, it is not clear when she first began acting as a midwife. There’s no evidence that she was ever trained. The CMB Registers from 1905 to 1926 show Hannah was first registered in 24 Nov 1904. Her qualification was her practice prior to July 1901 - a bona fide midwife.

The 1911 census shows Hannah living at Victoria Road, Harborne, with her husband William Illsley Armishaw, an Army Pensioner. According to the CMB Registers Hannah practised until the age of 76! The census reveals that she was no stranger to childbirth herself, having given birth to fourteen children, twelve still living. Hannah died in 1940 at the age of 91. One of Hannah’s ancestors has a photograph of Hannah in her uniform taken c.1910 (above) It is the only image we have found locally of a midwife in uniform.

Lizzie Keeping, certified midwife, 1866-1942 Midwifery bag c.1925 © Science Museum

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.

Sixteen attended over two hundred births, most attended around fifty.

The reports give details of suspensions and actions taken against midwives who did not comply with desired practise. In 1914 alone 62 midwives were suspended for poor practice.

53 for cases involving puerperal fever and five for cases of Pemphigus Neonatorum.

Ten years later the proportion of certified midwives had greatly increased. In 1924, there were 231 midwives of whom 170 were certified and 61 were bona fide. Between them they attended 11,459 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 contrast to Hannah, Lizzie Keeping was one of the new breed of qualified midwives.

She wasn’t local, and appears to have moved in pursuit of her career. Born in Reading, 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, reg no. 295.

Lizzie obtained her midwife qualification from the London Obstetrical Society in July 1903 and enrolled on the Midwives Roll on 24/11/1904 reg no.

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 twenty five years.

The 1911 census shows her living at 262 Mary Street, with her occupation listed as trained nurse and midwife. Also in the house were her sister-in-law and children, and listed as joint head of the household Clare Bement, described as a trained nurse and midwife, acting as Inspector of Midwives at City Health Department. Both lived together on Mary Street until Clare’s death in 1938 and appear to have been working as midwives until this date.

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.

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Certified midwife badge, made in Birmingham, Fattorini, 1918

Infant Mortality

Deaths under 1 year, 1913 & 1924 Other

David Low

Convulsions

Deaths 1913

Overlaying

Deaths 1924

Syphilis Scarlet Fever Non TB Meningitis

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”.

TB Meningitis Abdominal, etc Diphtheria & Croup Measles Whooping Cough Diarrhoea, Enteritis, Gastritis Pneumonia & Bronchitis Congenital Malformation Atelectasis & Birth Injury Atrophy, Debility & Marasmus

Dr John Robertson, Medical Officer for Health, 1914

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

In 1913, 4,257 [33%] of all deaths were in children under 3 and 3,070 [23.7%] under 1. Dr John Robertson considered that half were preventable, noted that areas of “careful artisans” had an Infant Mortality Rate (IMR) half that of areas of poverty and the resulting “inefficiency and carelessness”.

His ward maps demonstrate the relationship of infant mortality to the gradient of socioeconomic deprivation, between the Central, Middle and Outer Wards.

Robertson 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 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”.

Premature Births

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100

200

300

400

500

600

700

800

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.

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”.

Infant Mortality Rates are composed of the following: Neonatal mortality rate (deaths in the first 4 weeks of life per 1,000 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 1,000 live births) fell by 45.32% Was he successful?

[87.9 to 48.06]. This strongly suggests that the The yearly MOH reports contain a plethora of majority of the reduction occurred in infectious statistics. As a retired Consultant Paediatrician, diseases. The death rate in the 0-5 year child I have recalculated and reinterpreted them to try population also fell by 34.8% over this period. and answer the question.

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Birmingham Mortality Rates

Infant Mortality Rate deaths, per 1000 live births

Perinatal Mortality Rate

Premature Births

Neonatal Mortality Rate

120

Postnatal Mortality Rate Infant Mortality Rate

100

Debility, Atrophy & Marasmus

Congenital Malformations

25

E&W Infant Mortality Rate 20

80 15

60 10

40

5

20

0

0 1913

1924

2016

2017

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 breastfeeding, 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.

Measles, Whooping Cough & Scarlet Fever 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 12,961 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 1,441 and from whooping cough 1,912. 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.

1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924

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 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.

If you would like to view the infographics at a larger scale, please visit our blog:

www.borninbirmingham.home.blog 9

Infant Welfare Centres Laurie Spencer

Senior Babies’ Department Weighing Day MS 4101

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.

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 Street, followed in 1908 by the first municipal IWC in New John Street West, in two of the poorest districts in the city with the highest IMRs. As referenced previously (page 8), in May 1914, presenting his annual report to the Public Health and Housing Committee for the previous year, the Medical Officer for Health (MOH) Dr John Robertson, 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. 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.

Dr Robertson’s 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.

Research Tip

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Infant Welfare Centres may also be referred to as Infant Consultations, Guilds of Mothers, Schools for Mothers, Schools of Mother-Craft or Maternity and Infant Welfare Centres.

In 1915, a Maternity and Infant Welfare SubCommittee 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, the city 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.

Home Visits 1918-1924

The numbers of home visits and attendances of children at the centres in Birmingham show a healthy increase 1918-1924:

Selly Oak Infant Welfare Centre WPS WK/S/478

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 Street.

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.

At some centres in poorer districts, maternity feeding stations were set up for malnourished 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.

Year

Births Notified

Total visits to children

Total child attendances

1918

12,333

111,070

67,080

1924

15,981

232,708

126,998

Welfare Centres 1914-1924

The increase in numbers of Welfare Centres: 1914

1924 Municipal

Short Heath Rd Erdington

Aston St

Smith St

Darwin St

Berkeley Rd Hay Mills

Stratford Rd

Broad St

Bloomsbury St

Trinity Rd

Voluntary

Bristol Rd S Northfield

Warwick Rd Greet

Carnegie Institute

Washwood Heath Rd

Harborne Lane Selly Oak

Wright St

Hope St

Voluntary

Irving St

Floodgate St

Lansdowne St Winson Green

Stirchley & Cotteridge

Lichfield Rd

Handsworth

St Vincent St

Harborne

Municipal New John St W Windsor St

Floodgate St Staniforth St Selly Oak Stirchley & Cotteridge Total= 8

Total = 22

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Carnegie Infant Welfare Institute Sandra Flynn Following a 1918 report by the Carnegie Trust on the Physical Welfare of Mothers in the UK, the Trust decided to embark on the building of a number of Infant Welfare Centres (IWC) across the country and Birmingham was chosen as a potential site.

Thus, Birmingham Corporation was offered the funds to build an IWC providing certain conditions were met. A site was found in Hunters Road, Hockley, at a cost of £1,604 and plans were drawn up. The War caused some delays and an increase in costs, it was delivered at a cost of £25,000.

In many ways the Carnegie was ahead of its time. It was built with many facilities that other centres did not have. A unique feature was the observation ward which contained 8 cots, these were on wheels to enable the babies to get plenty of fresh air via a purpose-built balcony.

Although this was not used to treat premature babies it was used for a variety of conditions including general infections, diarrhoea, diabetic management, rickets and pneumonia. The ward had a small laboratory attached to it which enabled a laboratory assistant to undertake analysis of samples including blood, urine and faeces tests, and analysis of stomach contents.

The results of this together with recorded data from the ward, was used for research.

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The centre took part in the training of the city’s newly appointed infant visitors. Trainees spent three months at the centre including one month on the ward together with training on record keeping, antenatal care and the art of delivering health talks.

The building had an impressive entrance hall with a portrait of a mother and child donated by W A Cadbury. There was a room for toddlers with an attendant on duty to keep them safe whilst allowing their mothers to attend the clinic. There was a large airy weighing room with a fireplace for warmth. In the consultation room, mothers could discuss any problems with a medic.

No drugs were given or sold from the centre, so they were often advised to visit a doctor or infirmary/hospital.

Other services included a breastfeeding clinic; baby massage lessons (!) and an X-ray department. A centre for light treatment for Birmingham was opened in 1925 on the site.

In addition, there was a canteen which provided a hot meal for nursing and expectant mothers in need, at a minimal cost of 2d.

Education was carried out via sessions on mothercraft, sewing, cookery and monthly lectures on a variety of topics which fathers were also invited to attend.

Infant Welfare Institute, Hunter's Road, Handsworth, Interior WK H5 0529.

Elizabeth Exell, Matron of Carnegie Centre. Photo used with kind permission of Thornburyroots.co.uk

Elizabeth Exell The first Matron to be appointed at the Carnegie was Elizabeth Exell. Born in Thornbury, Gloucestershire in 1885, Elizabeth first trained as a nurse at The Bath Royal United Hospital. At the start of WW1 she joined the British Expeditionary Force as a nursing sister and was posted to the Hotel Claridge in Paris and then later to a hospital in Wimereux near Boulogne.

These hospitals were unique as they were run entirely by women, at a time when women were deemed acceptable as nurses, not as doctors or surgeons. Elizabeth returned to England in 1917 and worked at the Endell Street Military Hospital, London also run by the Women’s Hospital Corps.

She received the British Victory Medal and the 1914 Star for her service in the WW1 campaign.

‘Childhood’, sculpture by William Bloye, Memorial to Elizabeth Exell, Matron of Carnegie Centre.

After leaving the army, Elizabeth moved to Birmingham as Matron at the Pype Hayes convalescent home. In 1923, she was employed as Matron at The Carnegie Institute. During her time at the centre Elizabeth became a member of the Royal College of Nurses.

Elizabeth died in 1933 at the age of 48 – she was found in the bathroom at the Carnegie and had suffered an aneurysm in an artery. Her obituary stated that she had ‘worked tirelessly and was respected, loved and admired by colleagues and patients alike’. She was commemorated by a statuette by William Bloye, entitled Childhood (middle right) which stood in the entrance hall of the Carnegie for several decades. The current location of the statuette is unknown and any information as to its whereabouts would be welcome.

‘Maternity’, sculpture by William Bloye, Carnegie Infant Welfare Institute entrance.

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Health Visiting Jan Wright Research Tip Names of Birmingham Health Visitors can be found in Public Health Department wages book for 1918-19. Sadly many are listed using their husband’s initial so can be difficult to trace in other records.

See Resources p.31

The 1914-1924 period saw a large increase in the number of Health and Infant Visitors as a result of concern about infant mortality rates, and also in response to the Notification of Births Act in 1915, which required that the Medical Officer of Health be notified of all births within 36 hours.

The increasing number of Infant Welfare Centres (IWC) became the focus for Infant Health Visitors, working entirely with mothers and their infant children. By the end of the war there was a wellestablished staff of 61 Infant Visitors attached to IWCs, and 33 Health Visitors who worked with mothers and infants outside of the Welfare Centre boundaries as well as with older children.

The development of health visiting in Birmingham can be discovered in the Minutes of the Birmingham Health Committee. The first four women Health Visitors were appointed in 1899 to work almost entirely in the four poorest districts of Birmingham. These first Health Visitors developed from the existing role of sanitary inspectors or visitors. They worked primarily to promote health and provide health education working at the level of the infant, their family and community. Their priority was to improve sanitation and reduce infectious disease - a clear distinction from nursing.

By 1902 with an increase of staff, 12 districts within Birmingham were formed and Health Visitors were required to visit all houses of three rooms or less where a birth had taken place, making repeat visits where necessary, enquiring into the circumstances of all infant deaths and reporting any cases of cruelty.

They distributed hand bills explaining management of the house and yard and precautions to be taken against measles, diarrhoea, typhoid and consumption and stressed the importance of breastfeeding.

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Health Visitors carried disinfectant powder and emphasised the need for cleanliness as well as thrift and temperance. The Health Visitors should be ‘well educated’ and physically strong women.

The key was to go into the home as ‘a friend and not to find causes for reproach’.

In 1912 Superintendent Health Visitor, Blanche Gardiner was pleased to announce that the number of health visitors had risen to 19, one visitor for each of the 19 districts and 4 Infant Visitors. The 4 Infant Visitors focused their work entirely on infant welfare. The 19 Health Visitors also worked with mothers and infants, and had other responsibilities at this time receiving all the names of babies born in their district, visiting jointly with the Infant Visitor if required.

The Health Visitor went to every household where an infant had died of diarrhoea or contracted ophthalmic neonatorum. She assessed housing conditions and if dirty or insanitary housing was detected, she would make suggestions for improvement. She also worked with older children and families, with a duty to report any negligence or malpractice shown by midwives. In 1913 there were 16,219 visits made by Infant Visitors and Health Visitors.

An early 19th Century Sanitary Visitor. © Attribution 4.0 International (CC BY 4.0)

By 1915, work concerned with the prevention of infant mortality was entrusted to the Maternity and Infant Welfare Sub Committee. One of its functions was to take control of the Health Visitors. The minutes contain detailed accounts of the recruitment and appointment of Health Visitors, their wages and holidays as well as the establishment and accommodation of Infant Welfare Centres. Individual cases where there was cause for concern were also raised and acted upon.

The Sub Committee minutes show that in 1915 Miss Lucy Jane Loach was appointed as an Infant Visitor attached to the Municipal Infant Welfare Centre at St Vincent Street. She obtained a nursing certificate from Birmingham Union Selly Oak Infirmary in 1913 and qualified as a midwife in 1923. Her role of Infant Visitor was to visit the homes of newborn babies at the end of the first week of life and thereafter on a monthly basis during the first year.

Encouragement would be given to the mother to come to St Vincent Street Centre for infant consultation if required. She could refer to charitable services if there was need and ask the doctor to visit on the same day if necessary. She would assess the health of the mother and take note of employment and wages of the father.

She earned 35s-37s per week. In 1916, she may have been involved with a Motherhood Exhibition where health visitors staffed an Infant Welfare stall, talking and explaining exhibits to assist with healthy living.

As part of the war effort in 1917, the Health Visitors arranged and staffed a window exhibition at the request of the Citizens Committee at the War Economy Centre in Windsor Arcade. The keynote was ‘Saving of Infant Life is Economy’ and ‘Contamination of Food is Waste’. This occurred during the summer months before rationing began.

The Royal Sanitary Institution oversaw the first formal training courses for Health Visitors in 1916.

Many existing Sanitary Officers became Health Visitors at this stage. Training included elementary physiology, cookery and household management, hygiene, infections, maternity and child welfare, elementary economics and social problems. A Health Visiting qualification was established in 1919, and in 1925, the MOH took over the training and a midwifery qualification became a requirement. Locally, in-house training was provided for new Health Visitors at the Carnegie Institute in 1924.

By 1924 there was a significant decline in the IMR in the city. In the 1924 MOH report, the Health Visiting Superintendent praised her staff and considered that much of the prevention of disease and the diminution of the IMR was due to their high quality work. Whilst there are many reasons for this decline, it would be reasonable to conclude the impact of health visiting and the strong working relationship with the Infant Welfare Centres. Originally health visiting was targeted at the poorer parts of Birmingham, and from 1921 onwards the majority of babies born in the city received the service.

Health Visitor and new mother in scene from “Motherhood” a film commissioned by the National Baby Week Council (1917)

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Maternity & Women’s Hospitals Loveday Street Maternity Hospital Birmingham’s first maternity hospital was The Birmingham Lying-In Hospital and Dispensary for the diseases of Women and Children for Birmingham and the Midland Counties, founded in 1842. The aim of the charity was to ‘supply proper medical and obstetric attendance to poor married women’ and ‘relief in the diseases incident to women and children’. Originally sited on Whittall Street but later on Broad Street in 1867, the in-patient department closed and the midwifery cases were seen at home. The passing of the Midwives Act in 1902 focused attention on the need for better provision and a site on Loveday Street was purchased and the Maternity Hospital opened on November 20 1907. Managerial and financial responsibility for the charity passed to the administrators of the Birmingham and Midlands Hospital for Women in 1911 but the House Committee and Medical Committee retained their autonomy.

The annual reports of both the maternity (HC MH/1/6) and women’s hospitals (HC WH/1/10) provide much detail of the work carried out both within the hospital and via the midwifery service.

They also reveal the patronising attitudes of the governing board to their working-class clientele and, the moral judgements that were made with regard to services for unmarried mothers. The Maternity Hospital refused to see them as inpatients or out-patients. “The husband and wife have always lived apart’ was given as a reason to refuse care and these cases were ‘considered more suitable for the Workhouse Infirmary’.

Liz Palmer

In fact, shortages of beds meant that there often were no beds available even for ‘respectable married women’ and so many who needed additional care or due to overcrowded houses had nowhere suitable to give birth were also reliant on the Infirmaries. This was highlighted in articles in the Birmingham Gazette in March 1920. Although they did try to paint a rosy picture of the maternity ward in Selly Oak Infirmary, they also pointed out that even though many women had to pay to be there, they still had to swap their own clothes for the pink uniform of the infirmary.

Women’s Hospital The Birmingham & Midland Hospital for Women was founded in 1871 following the closure of the in-patient department of the Maternity Hospital. Its aim was ‘exclusively the reception and treatment of women afflicted with disease peculiar to their sex’. It had various locations until 1905 when The Women’s Hospital opened at Showell Green Lane, Sparkhill and included the adjacent Park Road Convalescent Home, known as ‘Woodfield’ which had opened in 1899 with accommodation for 6 patients. The Taylor Memorial Home of Rest for the terminally ill was opened at Showell Green Lane on June 11, 1910 Surviving records include patient records, case notes and operation registers (HC WH/3) from the period covered by this project, they are closed for access for 100 years. A nurses’ register (HC WH/4/1/1) details nurses working at the hospital.

The Annual Reports give overviews of activities, conditions treated and surgeries carried out.

Edith Agnes Meikle (1880-1963) One of the longest serving Matrons of the Maternity Hospital, born on 6 June 1880 in Tarbolton in Ayrshire, one of 12 children of farmer Robert Meikle and his wife Janet Hunter. The Nursing Registers show she was certified whilst training at the Royal Alexandra Infirmary in Paisley 19061909 and registered in 1917, Registration number 6707.

Delivery Theatre Loveday Street Maternity Hospital, source unknown.

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Edith undertook further training in midwifery and passed the Central Midwives Board examination in 1911 whilst working at Glasgow Maternity Hospital. By 1917, she had moved to England to take up a position at the Nightingale Nursing Home in Derby. In May 1920 she was appointed Matron at Loveday Street Maternity Hospital - a post she would hold for the next 25 years. She was chair of the Birmingham branch of the College of Midwives and chair of the Birmingham and Midland Teachers Group of the College of Midwives from 1930. When she retired in 1945 on the grounds of ill-health it was estimated that 31,000 babies had been born at the hospital during her matronship. Edith returned to Ayrshire and died there in 1963, age 83.

Children’s Hospitals

Alison Smith Image from The Hospital Gazette special number: historical and constructional accounts of the Birmingham hospitals, June 1914. LF 46 660151

In 1862 The Birmingham and Midland Free Hospital for Sick Children had been built in the heart of the city in Steelhouse Lane and later in the century the in-patient provision for children moved to a larger building in Broad Street. By the early years of the 20th century, this provision too was restricted in size and increasingly out of date.

1910 saw plans for a new children’s hospital revived with funds generated by the Birmingham Daily Mail’s support for the King Edward VII Memorial Fund. Land was purchased in Ladywood and a foundation stone was laid in 1913. A ‘Brick League’ scheme was also introduced and any child contributing one guinea would have his or her initials cut on a brick and on the appointed day in 1913, 476 children laid their own initialised bricks.

The new hospital opened without ceremony in December 1916 and a Royal visit in May 1919 saw King George V and Queen Mary showing a particular interest in the open-air treatment of patients. Wards in the new hospital had been built on a NW to SE axis to provide optimum sunshine with balconies offering easy access to fresh air.

Whereas all diphtheria cases were admitted to the Children’s Hospital, there was debate about whether severe cases of measles and whooping cough especially from dirty and poor houses should be admitted. Capacity and expense were issues. In the case of whooping cough it was feared the “high mortality” “would alarm the community” and bring “any hospital into disrepute” Medical treatment for babies and children was changing and the annual report for 1919 records the opening of a new department of Bacteriology and Pathology, removing the reliance of the hospital on nearby university laboratories.

An X-ray department opened in 1920 followed by the establishment of a Massage and Therapeutic

department. Surgical cases were also increasing, with specific day beds made available for the many ear, nose and throat operations.

The after-care arrangements for young patients were also improving with an almoner, a medical social worker, appointed towards the end of WW1. Negotiations with the city’s Public Health Committee were also in hand from 1919 onwards with a view to the resources of the hospital being made available to those administering the Infant Welfare Scheme within Birmingham.

HC/BCH contains comprehensive original and printed records and photographs of the various children’s hospitals.

Sir Leonard Gregory Parsons was a guiding light of the children’s hospital following his return in 1918 from war duties until his retirement in 1946.

The first Professor of Child Health at the University of Birmingham, elected a Fellow of the Royal College of Physicians in 1923, Parsons insisted upon the scientific investigation of children’s diseases and the importance of antenatal factors. He promoted the construction of a separate building on the Ladywood site to house the under twos - the ‘Babies Block’, for infants most susceptible to infectious illness and disease. Parsons was the first to use synthetic Vitamin C to treat scurvy in children. Acknowledged widely within his profession, Parsons was knighted in 1946 and elected a Fellow of the Royal Society in 1950.

Sir Leonard Gregory Parsons by Walter Stoneman, bromide print, 1946 © National Portrait Gallery, London

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Baby Week Laurie Spencer The National Baby Week Council (President: the Prime Minister, Lloyd George) planned the first Baby Week to take place during 1-7 July 1917, in order to raise public awareness of the need to save babies from preventable early deaths, and to build up the nation’s strength in the light of the low birth rate and lives lost in the war. All Infant Welfare Centres were encouraged to participate.

On Sunday 1 July, sermons would be preached on motherhood and child welfare. Baby shows, pram parades and mother-craft competitions would be held, and Lloyd George ordered a propaganda film Motherhood to be made. The Queen opened the National Baby Week Exhibition in Westminster Central Hall; she held an 8-week-old baby boy whose father was fighting in France, chatted to mothers and patted babies.

In Birmingham, a mass meeting was held in the Town Hall on Sunday, with a men-only afternoon session addressed by a doctor. Many activities were arranged by local IWCs for National Baby Week, which became an annual event. There were talks, lectures, displays and demonstrations for visitors, competitions and outings for mothers.

prizes were awarded in two regional heats and at the finals in London, Birmingham excelled; taking first prize in the finals in two classes: Bertram Roberts, 6-9 months (St Vincent Street IWC) and Iris Proud, 9-18 months (Winson Green IWC).

In 1921, open-air ‘court talks’ were given by Health Visitors to groups of mothers in the more congested areas of the city. Sparkhill and Greet IWC leafleted the whole district and mothers came ‘in crowds’ for tea with regular attenders.

Groups of 300 mothers and babies were taken from Aston by charabanc to spend the day in Pype Hayes Park. Greet’s medical officer, Dr Lena Walker, held an unusual competition in 1922 for the most efficient cleansing of milk receptacles.

The next year the Lady Superintendent, Miss Shewell, produced and acted in a propagandist play and in 1924 organised demonstrations of a nurse bathing a baby.

On 1 July 1924, the Daily Gazette claimed that Birmingham probably had the most interesting and varied activities in Baby Week outside London, and that year needed a fortnight for the education and social engagements of the thousands of ‘welfare mothers’!

Stirchley and Cotteridge School for Mothers won three successive National Health competitions for useful and original ideas: ‘parlour meetings’ where mothers invited neighbours to hear about their centre; two essays for use with women’s meetings and older school girls; and the production of Baby Week Magazine in 1919 aimed at fathers and sold to men’s groups. This comprised 26 pages of articles and letters by mothers (and a few fathers) on the many benefits to mothers who attended the school, and how fathers could help within the family.

In 1919, under the auspices of the National Baby Week Council, The Daily Sketch launched a Baby Competition in three age classes with free entry through an IWC. After a local preliminary round, Research Tip

The Wellcome Collection in London holds original material relating to National Baby Week and many other topics covered in our research. www.wellcomecollection.org

Above: Flies & Disease MoH London c.1920. Opposite top L: National Baby Week Challenge Shield awarded to Stirchley & Cotteridge School for Mothers. © Wellcome Collection. R: Baby Week Magazine 1919 MS 2032. Bottom L: Poster by Miss E Walker Finlay. R: Poster for National Baby Week © Wellcome Collection.

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Family Planning Liz Palmer

The first birth control clinic was not opened in Birmingham until 1927 and there are no records within the archives of what family planning services, if any, were provided locally prior to this.

The first Family Planning Clinic in the UK was opened in London in 1921 by the pioneer in the field of family planning, Marie Stopes. It was named the Clinic for Constructive Birth Control and Racial Progress and was followed shortly by other clinics in Aberdeen, Belfast, Cardiff and Leeds. They supplied free help and advice on sexual matters. Stopes campaigned for effective birth control for women.

However, this was inspired mainly by her eugenicist views as she thought the ‘quality’ of society could be improved by breeding out negative inherited traits.

It is likely that contraception was discussed at the growing numbers of welfare centres but it would not have been permitted to provide condoms or cervical caps even to married couples. Advice would also have been hard to come by. And, for working class families contraception could be cost-prohibitive; a pack of 3 condoms would cost about 1 shilling, a good proportion of the weekly pay-packet. French letters, or condoms, cost 3/- per dozen in the 1920s. The average skilled worker earned 30/per week but a third of households survived on less than 21/-. With mouths to feed and rent to pay, contraception was less of a priority.

‘Methods of prevention are disagreeable and difficult as well as being expensive’ according to Mrs [Florence Carol] Ring, a Birmingham based social worker who gave evidence to the 1916 National Birth Rate Commission into Declining Birth Rates.

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Condoms had connotations of prostitution and were unreliable. Many contraceptive methods were sold discreetly meaning that quality varied greatly. To be absolutely effective, contraception clinics recommended using two methods of contraception such as sponges and soluble pessaries, costing at least 5/-, which was almost a quarter of the weekly income of one third of families. A midwife working in Selly Oak, a Miss Martin also gave testimony to the Commission and explained that ’The large families [...] occur mostly in the labouring classes, below the poverty line’. Contraception offered a way for some women to control family size, but only women with money.

It was a topic that was often debated amid concerns about population decline and improving the quality of life for working class families. At the 1921 Church Congress held in Birmingham in 1921, Lord Dawson of Penn, physician to King George V, spoke in favour of the availability of Birth Control, an opinion endorsed by the Medical Officer of Health for Birmingham, Dr John Robertson.

The first Birth Control Clinic in Birmingham did not open until 1927, partially funded by local philanthropist Sir John Sumner (founder of Typhoo Tea) although it had been under discussion for some time. An article in the Birmingham Gazette in October 1924 described a meeting at the Temperance Hall at which several prominent national campaigners for birth control spoke. They included Robert Kerr, Editor of New Generation – published by the Malthusian Society, and Dr C V Drysdale and his wife: Bessie Ingman Drysdale.

Above: ProRace Cervical Cap designed by Marie Stopes © Science Museum, London.

Attribution 4.0 International (CC BY 4.0) Opposite: Headline 1924 Article about proposed family planning clinic in Birmingham. Birmingham Gazette.

How dare the upper and middle classes think of keeping the information that they have themselves from their poor bowed down brothers and sisters of the working class?

I was talking about the need to give birth control knowledge to working men’s wives, through the Welfare Centres, to a lady the other day, and she objected: But if that is done, where are our servants to come from?!

Research Tip The annual reports of the Birmingham Family Planning Association from 1927 to 1960 are to be found in the archives (MS 1571/14).

— Bessie Ingram Drysdale.

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Abortion Milly Coleman Research Tip The National Birth-Rate Commission established by the National Council on Public Morals published 2 reports in 1916 & 1920 containing discussions about abortion and contraception, and many references to Birmingham. Several sessions were chaired by the Bishop of Birmingham, Henry Russell Wakefield. www.babel.hathitrust.org

Prior to 1939 all abortions were technically illegal. There was no provision in law for abortion no matter the circumstances.

It is estimated that between 110,000 and 150,000 women in Britain used a variety of methods to induce an abortion every year in the interwar period, yet despite the mundanity of abortions, they risked long prison sentences every time.

In Birmingham, overcrowding was a serious concern as the population expanded rapidly.

Moreover, industrialisation allowed women to work, giving them an extra incentive not to have more children.

Recovering the stories of women who attempted to control the size of their family by means of abortion, poses a challenge as they were forced to employ secrecy. Many surviving documents on abortions come from when they went wrong, specifically medical records from Birmingham Women’s Hospital and Birmingham Maternity Hospital.

The pervading myth was that only unmarried women, specifically prostitutes, had abortions.

In reality abortion was pervasive. In 1916 the National Birth Rate Commission published its report into Declining Birth Rates. One of those giving evidence was Mrs Florence Carol Ring, who estimated that one in four poor women attempted an abortion at some point. This is however 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’. This illustrates that abortion was not a rejection of motherhood, but essential to caring for other children. Abortionists were protected by 22

their community, since they were an essential part of the struggle to pay bills. Women in every neighbourhood knew someone who had benefited from the services of ‘a woman who goes under some such name as “Granny”, or some colloquial name, and who uses crochet hooks generally, or a knitting needle’, but these abortionists did not keep records.

The in-patient Register at Birmingham Women’s Hospital creates 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 were married. Although the average age fell slightly when World War One began, the lowest it reached was 29.6 in 1916. This illustrates that in Birmingham, married women who already had children were the principal demographic having abortions. 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. She further testified that ’the labouring women [...] do it by bringing on miscarriages’ and that their motivation was that ’they want to do better for their children’. Miss Martin recognised the issue of poverty when she testified that ’preventive methods seem to be known by the better class of working people’ whereas poorer women used abortions’.

Reynold's Lightening Pills packet © Wellcome Collection. CC BY.

Female Residents at Noel Road Home. Birmingham City Mission. Noel Road Training Home and Refuge for Girls. 1908 23

Illegitimacy Cathie Paton

The unmarried mother during our period of study received little help from the government and faced a life of poverty.

Her illegitimate child carried social stigma and had fewer legal rights than those born to married women.

They carried the title of being illegitimate for their entire lives, even if their parents subsequently married. The situation did not change until post-hoc legitimisation was introduced under the Legitimacy Act of 1926.

The number of illegitimate births in Birmingham was recorded annually. The feared increase during the War did not materialise. The spike in numbers during the war years was thought to be as much to do with an increase in the numbers

Research Tip The Birmingham Medical Officer of Health Reports give statistics of illegitimate births and commentary on health outcomes. Available to view at Library of Birmingham or online at Wellcome Library

of young women who arrived in the city to fill the vacancies left by the men and to take up jobs in well paid war work. From 702 illegitimate births recorded in 1915, the highest level was in 1918 at 5.1% per 1,000 at 858 births. It had returned to its pre-war level by 1923 at 3.2% per 1,000.

It was not the rise in numbers which was of grave concern to the city’s Medical Officer for Health, it was the mortality rate. This was 2 to 3 times higher than legitimate births even though when born, the babies were as healthy. In his reports he shows a keenness for something to be done to improve their lot, but came up against strong public opinion, which thought that by helping unmarried mothers, it would increase illegitimacy.

The MOH wanted illegitimate children, up to the age of 15, to become wards of the Court of Summary Jurisdiction with guardians in place of or supporting the mother. These efforts were blocked. Neville Chamberlain presenting his Bastardy Bill to Parliament on 7 May 1920, said ‘I think it will be agreed by all who have done social work among the people of this class, that in large measure this very high illegitimate infant mortality rate is due to the want of nourishment of the mother, the inability to get proper nourishment and proper medical care both for the mother and for the child.’

Mother & Baby. 72nd Annual Report of the Birmingham Lying-In Charity L46.24 24

What were the choices for the unmarried mother? Abortion was one, but remained illegal until 1967. Adoptions by the end of the war were increasing but they were not a legal entity until 1926. Foster care was usually the most common option. Women paid a fee to the foster parent and were permitted visitation rights. If there was a lack of financial support or employment, mother and child stayed in the workhouse or the child was put into an orphanage. If they left the workhouse and were unable to meet the costs of childcare, it was reported in 1918 in a letter from Hope Lodge in Handsworth that ‘the baby often dies or becomes stunted in body and mind and the girl falls to lower depths of degradation’.

Unmarried mothers needed to work to support their babies but the quality of foster care was poor. The 1908 Children’s Act had been put in place to protect foster children following some well publicised ‘baby farming’ scandals.

Now, all paid carers of children under 7 had to be registered and their homes were open to inspection. Unfortunately, there were not enough inspectors to carry out the necessary visits and neglect and malnourishment were common.

There was also a decline in respectable foster parents as many moved over to wartime work which paid better.

With a shortage of care, the cost escalated.

Foster mothers started to charge between 12/6 (12 shillings and sixpence) to 15/- a week where previously it had been 5/- to 6/-.

Society at large expected unmarried mothers to be responsible for the maintenance of their child and not rely on the Poor Law. Great attempts were made to obtain an affiliation order from the father but it stayed at a maximum of a paltry 10/- a week. In 1920, Neville Chamberlain was campaigning for this to be increased to 40/-. Many women failed to obtain one and even then, fathers disappeared without fulfilling their obligation. In 1924, only 50% of fathers in Birmingham were paying affiliation orders.

The Association for the Rescue and Training of Young Women employed two workers to chase such absconders or help to obtain affiliation orders from the courts. Women also received some assistance from a Maternity and Child Welfare Grant introduced in August 1918.

This paid grants to help towards housing and other provisions for widows, deserted and unmarried mothers with children under 5 years.

In Birmingham, religious organisations and those with a social conscience, such as the Ladies Association for the Care and Protection of Young Girls started to recognise the desperate situation of the unmarried mother and the high death rate of their babies.

The Cornish’s Birmingham Year Book of 1920 lists Mother and Baby homes throughout Birmingham.

Suitable young women, pregnant for the first time, were selected to be helped and stayed in the homes for a minimum of 4 months. The average age of the young women was 15 years.

The 1913 Mental Deficiency Act was still in being, making it possible to incarcerate young women for moral imbecility for being unmarried and pregnant with a second or subsequent child.

As well as learning how to care for their infants, the young women were taught skills to make them employable upon leaving. Most went into domestic service or laundry work. It was noted that they often could not afford the high childcare costs, so grants were provided to augment the girls’ wages and nurseries began to emerge to provide affordable childcare. Homes such as Hope Lodge continued to support the girls once they had left and gave encouragement to former occupants to stay in their jobs by awarding prizes.

By the end of the war, mass adoption was taking place, and adoption societies put pressure on the government to legitimise the whole process and to protect the children. This resulted in the 1926 Adoption Act. Prior to this, working classes had tended to avoid adoption fearing their children would be used as household drudges.

The illegitimate baby would stay within the family being brought up by the grandmother or aunt as their own. In overcrowded housing, this became the known secret of the neighbourhood. Higher up the ranks of society, the pregnant girl would be moved away from her own neighbourhood to give birth secretly to the child and the baby spirited away to be adopted elsewhere. Great lengths were taken to ensure no one found out as illegitimacy was a taint that could destroy a woman’s life, wreck both her and her siblings’ prospects in marriage and even harm the family business. Eugenics were opposed to adoption, however adopters themselves were quite happy to take on an illegitimate child believing in nurture over nature.

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Infant Feeding Anne Hornsby Breastfeeding was encouraged to give little ones the best start in life. Babies were suckled for at least a year. Not only was this cheap and natural, but it was commonly believed that a woman could not conceive while still breastfeeding.

However, it was too often the case that, for a variety of reasons, mothers were unable to suckle their babies. Undernourishment and bad feeding inevitably took their toll, causing many babies to become restless and bad tempered. Many toddlers and babies were fed pap – a bread and water paste flavoured with sugar and treacle.

If the breast milk was poor or insufficient, mothers were encouraged to increase their fluid diet; the best fluid recommended was cow’s milk. A satisfactory supply of clean, wholesome milk was of concern for all.

In the Birmingham Mail, March 1914 - a County Vet remarked upon the poor hygiene in germlaiden dairy farms: “I have seen men loading the manure from the fold yards to carts and getting their hands very dirty, who have gone straight to the pen and sat down to milk, only rubbing their hands over their hips to remove the superfluous dirt”.

An article in the monthly periodical, ‘Edgbastonia’ 1914, entitled “Pure Milk and Pasteurisation” showed the constant peril of disease ridden germs in milk was recognised. “Great and wellrecognised investigators are convinced that more cases of typhoid come from unclean milk than from any other source; indeed, it is often stated that on very good authority that 50% of children fed on cow’s milk who die from tuberculosis got the disease from the milk. Everyone is agreed that it is not possible to overstate the far-reaching importance of the question of the reduction of infant mortality. Every man and every woman of every civilised country should feel a deep and personal interest in it. It affects not only the happiness of the home, but the welfare of the nation and the future of the race”.

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The National Clean Milk Society was formed in 1915 with the object of improving the hygienic quality of milk consumed by the nation and in a leaflet entitled, Campaign for Clean Milk 1916, special consideration focused on the mortality amongst young children, “Amongst the infants who are artificially fed, the mortality is approximately ten times as great as that amongst those who are fed from the breast... impure milk may carry off as many lives as the deadly weapons of war”.

Contamination of milk occurred in four places; on the farms where it was produced; in the transit from the farms to towns; in the dairies of the towns to which it was transported and distributed; and in the houses of the consumers.

Recommendations such as clean milk exhibitions and competitions, the introduction of refrigerated railway cars for the transportation of milk, and the compulsory licensing of all dairy farms, and places where milk products were sold, were proposals to raise the standard of milk and milk products.

Glaxo dried milk was promoted as a complete food, not only for baby, but for expectant and nursing mothers, growing children and the disabled, claiming to be intensely nourishing, free from risk of milk-borne disease, and did not cause indigestion, or ‘that heavy, full feeling’ which comes from cow’s milk. In 1917-18, the Ministry of Food purchased over 4,000 tons of Glaxo for the feeding of babies during the War; showing it to be a valuable alternative to breast milk.

Left: Mellin’s Food for Infants © Wellcome Collection. Top: The correct position for bottle feeding from The Mothercraft Manual, Mabel Liddiard 1924. Opposite: Taken from Greet & Sparkhill IWC Annual Report MS 4101.

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Pen Portraits Dame Hilda Lloyd (1891-1982)

Portrait Bust of Dame Hilda Lloyd by Jacob Epstein (1951). © University of Birmingham: Research and Cultural Collections, BIRRC-A0249

Dr John Robertson (1862-1936)

John Robertson MD was Birmingham’s Medical Officer of Health from 1903-1927. © BMJ.

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Hilda Lloyd, born Hilda Nora Shufflebotham in 1891, was the daughter of high-class Moseley grocer John Shufflebotham and his second wife, Emma. Hilda attended King Edward VI High School for Girls in Edgbaston and from there opted to remain in Birmingham to begin medical training at the University of Birmingham from 1910 graduating with a BSc and then MB, CHB by 1916. She became resident Surgical Officer at the Maternity and Women’s Hospital immediately after graduation and obtained her Fellowship of the Royal College of Surgeons in 1920. Subsequently she was appointed to the consultant staff at the Women’s Hospital.

Hilda’s pioneering work included establishing Birmingham’s first emergency obstetrical service: the flying squad. She was the first female to achieve a professorship at UoB (in 1944) and became chair of Obstetrics and Gynaecology in 1946. She received national recognition when, in 1949, she was elected as the first female President of a Royal Medical College, at the

Born in Warminster in 1862, Robertson was 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 he pursued throughout life. His early career in Public Health was as MOH for St Helens where he investigated 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. Robertson was appointed to MOH in Birmingham in 1903, succeeding Dr Alfred Hill.

Royal College of Obstetricians and Gynaecologists (RCOG) serving a three-year term. In 1951, she was knighted Dame of the British Empire ‘for her services to her Speciality, College and her University’.

Hilda was also heavily involved from the 1920s with the promotion of birth control and family planning in Birmingham. She was a member of the committee formed to set up the Birmingham Women’s Welfare Centre along with Elizabeth Cadbury and Sir John Sumner. This first centre opened in Castle Street with the slogan: ‘CHILDREN BY CHOICE, NOT CHANCE’.

In 1930, Hilda had married Bernard Lloyd, a fellow surgeon, and they lived in Edgbaston at 40 Harborne Road. Following Bernard’s sudden death in 1948, she married another surgeon and neighbour, Baron Theodore Rose. Following their retirements in the early 1950s they indulged their passions for walking and travel. Baron died in 1978 and Hilda spent the last couple of years of her life in Stourbridge where she died 18 July 1982 aged 90.

In Birmingham he continued to concentrate 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 was resident at The Hollies, Court Oak Road in Harborne, where he died in December 1936, aged 74. An obituary in the British Medical Journal says he took ‘a broad view of his responsibilities... a town planner long before the term came into use’.

Blanche Gardiner (1868-1953)

Emmeline Hannah Cadbury (1883-1966)

Emmeline Cadbury, © Bournville Works Magazine 1920

Margaret Wilks (1866-1954)

Born in Leicester in 1868, Blanche Gardiner was one of the younger daughters of a large, well established family. Employed in London as a Sanitary Inspector specialising in infant welfare, by 1912 she was working in Birmingham as a Superintendent of Health Visitors and in this role described her responsibilities for a team of Health Visitors. Such visitors worked in each of the city’s 19 districts, visiting all infants in their first year of life. By 1924 Miss Gardiner was responsible

for 94 Health Visitors involved in a wide range of matters relating to maternity and child welfare. In her report of that year to the Medical Officer of Health she registers her ‘pleasure to record and testify to the high quality of the Health Visitor’s work... in the prevention of disease and diminution of the infant mortality rate’.

Daughter of William and Hannah Wilson, members of the (Society of) Friends Foreign Mission Association (FFMA), Emmeline was born in Madagascar in 1883. In 1902, at the age of 18, she married William Adlington Cadbury, son of Richard Cadbury and nephew of George Cadbury, and came to live in Edgbaston, Birmingham. The couple had 6 children: Hannah (Joy) b.1903, John b.1905, Alan b.1907, Constance b.1910, Richard Tapper b.1911 and Brandon b.1915.

her husband, Emmeline Cadbury supported charitable projects in the city and after the First World War they became supporters of projects in war-torn Europe, eg. a children’s home in Kitzbuhel in the Tyrol, Austria (the European Famine Fund Committee).

In addition to his employment in the Cadbury Bros company, William Adlington Cadbury was very active in civic life in Birmingham, as a councillor (1911-1939) and in 1919, as Lord Mayor with Emmeline as Lady Mayoress. Together with Wilks was born into the family of an Independent Minister living in North London. Known as ’Maggie’ as a child and young woman, she was described as a ‘monthly nurse’ at the end of the 19th century – that is, she was employed to look after women in the months before and after they gave birth. Such roles were largely without any medical qualifications until the Midwives Acts of 1902 and 1910 required midwives to undertake formal training. Wilks enrols on the first Midwives Roll in 1903 and the 1911 census finds her living independently in Islington and describing herself as a ‘Maternity Nurse’. With the development of Infant Welfare Centres in the mid-1910s, Margaret moved to

Image: Early responsibilities, a drawing from Punch, 1900. Credit Wellcome Collection

The Trident Trust, later the W A Cadbury Trust, supported the Stirchley and Cotteridge School for Mothers in the early 1920s and financed the building of the Child’s Welfare Centre in Charlotte Road, Stirchley in 1927. In 1934, Emmeline Cadbury became a magistrate in Birmingham. She was also Vice president of the Royal College of Nursing and President of the Birmingham Branch of the National Council of Women.

Birmingham to lead the newly formed Stirchley and Cotteridge School for Mothers, living in Willow Road, Bournville. This venture encouraged child welfare, craft and cookery lessons, many organised by mothers themselves. A magazine of the period tells us that Miss Wilks, then Superintendent, was available to see members each morning and on a Tuesday evening.

A purpose-built infant welfare centre was erected in 1927 on Charlotte Road, Stirchley with the support of the Trident Trust and Mrs W A Cadbury, it is described in a newspaper report as ‘a model institution. Its work, from a national point of view, absolutely essential’.

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Glossary Aneurysm refers to a weakening of an artery wall that creates a bulge, or distention, of the artery which if it ruptures can be fatal.

Antenatal before birth; during or relating to pregnancy.

Atrophy the progressive degeneration or shrinkage of muscle or nerve tissue.

Congenital malformations conditions or defects that affect the baby from birth.

Consumption an old term for tuberculosis (TB) so called because the disease seemed to consume the individual, with their weight drastically dropping as it progressed.

Diphtheria a potentially fatal contagious bacterial infection that mainly affects the nose and throat, and sometimes the skin. Now rare in UK due to immunisation.

Enteritis inflammation of the small intestine caused by bacterial or viral infections.

Illegitimacy legal and social status of a child whose parents were not married to each other at the time of their birth.

Immunisation the process whereby a person is made immune or resistant to an infectious disease, typically by the administration of a vaccine. Vaccines stimulate the body’s own immune system to protect the person against subsequent infection or disease.

Infant Mortality Rate [IMR] deaths under 1 year of age in a given year per 1000 live births.

Marasmus derived from the Greek, meaning to waste away and is generally applied to the undernourishment of the child.

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Moral imbecility the 1913 Mental Deficiency Act, enabled unmarried mothers to be categorised as “moral imbeciles” and sent to mental health facilities.

Neonatal mortality rate the number of children that die under 28 days of age in a given year, per 1,000 live births.

Opthalmic Neonatum a conjunctivitis eye infection that occurs within the first 30 days of life. It is caught mainly during birth by contact with the mother’s birth canal that is infected with a sexually-transmitted disease – typically gonorrhea or chlamydia.

Perinatal the period immediately before and after birth.

Phemphigus Neonatum A dermatological condition now known as Staphylococcus Scalded Skin Syndrome which causes blistering of the skin.

Rickets a condition that affects bone development in children usually caused by a lack of Vitamin D and/or Calcium. It causes bone pain, poor growth and soft, weak bones that can lead to bone deformities.

Scarlet Fever or scarlatina an illness involving a distinctive pink-red rash mainly affecting children, which if left untreated can sometimes lead to severe complications.

Sequela a chronic condition that is a complication which follows after a more acute condition.

Selected Resources The following are a selection of the main resources within Birmingham Archives and Collections at Library of Birmingham, used during the research phase of the project.

Baby Week

Infant Welfare & Infant Welfare Centres

Stirchley and Cotteridge Baby Week magazine MS 2032

Medical Officer of Health Report into Infant Welfare 1913. Birmingham Corporation Documents I2

Birmingham Children’s Hospital Records of Birmingham Children’s Hospital, previously The Birmingham and Midland Free Hospital for Children; King Edward VII Memorial Children’s Hospital; The Children’s Hospital HC/BCH A little book illustrating the Children’s Hospital Birmingham 1920. LP46.23 CHI Children in hospital: a hundred years of child care in Birmingham. Waterhouse, Rachel. 1962. 46.23 WAT The Diana Princess of Wales Children’s Hospital, Birmingham, 1999 A362. 11094246DIA

Birmingham Maternity & Women’s Hospitals Records of Birmingham Women’s Hospital, formerly The Birmingham and Midland Hospital For Women HC MH/1/6 Annual reports of the Birmingham Lying-in Hospital and Dispensary for diseases of Women and children, for Birmingham & Midland Counties (Birmingham Lying-in Charity) 1908-1917 HC/MH/1/6/3 Public Appeal Committee Minutes 1903-1918 HC WH/1/8/1 Printed Memorandum and Articles of Association 1918 HC WH/1/11/1

Family Planning Annual reports of the Birmingham Family Planning Association 1927-1960 MS 1571/14 Lord Dawson of Penn LS 11/5/28/190494

Health Visitors Public Health Department wages book giving weekly wages for Child Welfare staff 1918-1919 BCC/1/BM/D/1/5/2/6

Illegitimacy Sub-committee re Maternity Cases (Ladies Rota) Brief details of the admission of individuals to various Maternity wards (many associated with Poor Law Unions):- Erdington House: Western Road House: Selly Oak House: Hope Lodge GP/B/1/2/7/21/1-2 Annual Reports from Association for the Rescue and Training of Young Women 1912-18 MS 603/3/1/1

Medical Officer of Health Reports 1914-1924 L45.11 Notification of Births Committee, subsequently Maternity and Child Welfare Committee minute book 1915-1920 BCC/1/BV/1/1/1 Deaths of infants under 13 months. Covering Kings Norton and Smethwick. GP/B/29/9/1 Material from Sparkhill and Greet Infant Welfare Centre and the Floodgate Street Maternity and Infant Welfare Centre MS 4101: Carnegie Infant Welfare Institute report 314039 Birmingham Settlement Annual Reports 1914-24 LB41.2 Public Health Committee minute books 1914-1919 BCC/1/BM/1/1/4-7 Maternity and Infant Welfare Sub-Committee minute book November 1915 - December 1919, minutes 1-664. BCC/1/BM/4/1/1 Boarding Out and Infant Welfare Committee Minutes 1912-14 GP B/1/2/5/5/1

Midwives Central Board of Midwives Registers: Available on Ancestry.co.uk (subscription) Birmingham Trade Directories: Hard copies available to view in Heritage Research Area on Level 4 of LoB; Can also view on Ancestry (Search for Midlands Directories); In addition to the resources above the project made use of resources held in both the Library and Archives at the Wellcome Institute in London and a variety of online resources.

Biographical details of key individuals were researched primarily using digitised records available via Ancestry.com and contemporary newspapers on BritishNewspaperArchive.co.uk

www.borninbirmingham.home.blog BornInBrum1914

Annual Meeting of the Ladies Association for the Care and Protection of Young Girls 1914 L41.2

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