Poor nutrition causes a weekend immune system leading to many illnesses that by the middle of the century accounted for a quarter of the total infant deaths in England and Wales. High infant and child mortality was a serious concern to the Medical Officers of Health in London, and discussions of the dimensions and causes of the problem frequently enter their annual reports. For example, a Report on the sanitary condition of the Limehouse District for the year 1898, includes a report on “infantile mortality.” The Medical Officer of Health for this district reported that:
In 1898, the number of deaths of infants under 1 year of age was 388. This corresponds to 208 deaths for every 1,000 births. This means that for every 10 children born during the year only 8 lived 12 months. From enquiries made, I find that there are only two districts in London that have a higher infantile mortality, viz., Holborn, with 221 deaths for 1,000 births, and St. Saviour, Southwark, with 211. Of the Eastern Districts, 3 have almost as high a rate of infantile mortality as the Limehouse District. These districts are Shoreditch, with 196 per 1,000 births, St. George’s-in-the East with 195, and Poplar with 191. The infantile mortality for the whole of London is high, and last year was 166 per 1,000 births.(p. 19)
In discussing the causes of infant mortality, he noted that “Of those under 1 year of age [that died], 104 were breast-fed and 130 were reared on artificial food” (p. 24). Clearly infant nutrition was a factor in infant mortality.
In the Report on the public health and sanitary condition of the Parish of Clerkenwell for the year 1900 the Medical Officer noted that,
Out of the total of 296 infant deaths, 73 occurred in the first quarter; 61 in the second; 100 in the third (40 in August alone) and 62 in the fourth quarter. As a general rule it may be said that . . . infant mortality is highest in the summer half [because diarrhea is more frequent in summer months]. Prematurity and malnutrition as causes of infant mortality are nearly twice as high in towns as in rural districts.
This Medical Officer also identified diarrhea (often caused by spoiled or contaminated food) and malnutrition as significant causes of infant death.
One of the other common reasons for childhood malnutrition in the Victorian era was due to withholding of food as punishment for children. This was a very common form of discipline of the time to send the child to bed without dinner for breaking a rule or failing a lesson.
The diet of older children varied greatly depending on the class and income level. Most families lived on a diet of bread and weak tea, cheese potatoes, milk, and beer if they could afford it. Since meat was a luxury item and cheese and milk where more expensive than bread and potatoes, many meals of low income families did not meet nutritional needs. Also, since in this time the father was the main bread winner and needed his strength to provide for the family he would receive the majority of the good food. When he was full then the eldest child down to the infants were fed the left overs.
Most middle-class mothers breastfed their infants, into their second year of life. The use of wet nurses was more common in the upper-class families, as they were not affordable for middle-class families. Even then most upper-class women only used a wet nurse in case of illness or deficiency where they could not nurse their babies. Wet-nurses became fashionable in the Victorian era. Wet nurses not only gave the mother more free time but it kept a distance between the parents and the fragile child that was likely to survive. Unfortunately, the “farming out” or the use of wet nurses may have contributed to this high infant mortality rate. It is believed that many wet nurses of this time abused these children by way of starvation. Some wet nurses were known to work for more than one family thus trying to stretch out their milk.
Sometimes mothers would not breastfeed their infants because of their beliefs. It was believed that sexual intercourse would make a mother’s milk curdle up. This caused husbands to insist that their wives not breastfeed at all, causing poor nutrition in the child. Another belief was that a woman’s milk would dry up if she became pregnant while nursing.
Another source of malnutrition was mothers who could not afford a wet nurse would feed their children a milk substitute by hand made of a past of bread and water that was thinned with milk and sweetened with sugar. This caused a poor diet lacking the nutrients and vitamins that these young children required to survive. It was at the end of the Victorian era that doctors realized a need to educate parents on the importance of breastfeeding, when to wean your child, and proper nutrition for the breastfeeding mother to decrease the chances of infant mortality.
For example, in the Annual report for 1894 of the Medical Officer of Health for Southwark, the Medical Officer noted:
it is seen that “debility, atrophy, and inanition,” is the chief cause of infantile death in St. George’s. This ill-defined group refers mainly to chronic wasting disease, produced by malnutrition, which is again a consequence of improper feeding. Infants fed on mother’s milk for the most part escape these fatal consequences, which chiefly affect children brought up by hand. In this connection I must again emphasise the fact that infants during the first six months of life are as little fitted to digest bread, arrowroot, cornflour, biscuits, tops and bottoms, or any of the so-called infant foods as they would be to live on sawdust, shavings, or other foreign matter.(p. 13)
He offered “Certain practical rules dealing with the problem of how to bring up children,” and opined that, “Their free distribution among parishioners would, I believe, be a step in the right direction towards improving the condition of infant life in Southwark.”
Medical officers were convinced that one of the major causes of infant mortality was due to the practice of giving children narcotics, primarily opium. Popular medications of the time containing opium (laudanum) were cheap enough for even poor people to afford. One ounce of such medicine was the cost of a pint of beer. The sale of these narcotics was unregulated at the time. Widespread from town to country, five out of six working class families used them habitually. They not only used them for tooth aches for children but as a quieting aide for fussy babies. Many working class families used it to quiet their children so they could work throughout the day.
Use of these opiates to calm children was common in low income houses. Parents were known give opium to their children so they would not feel the hunger pains when they where not able to afford food. Due to opium’s side effect of decreased appetite, opium killed far more infants through starvation than directly through overdose.
Written by Tracy Turner
Anthony S. Wohl, Opium and infant mortality
Davies, Sue. 2014. “St Pancras school for mothers .”