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John Roberton, Observations on the Mortality
and Physical Management of Children

Part I, Section IV

Remarks on the Foregoing Tables; and on the
Causes of Infantile Mortality in Large Towns

In glancing at the rate of infantile mortality in the Tables for different places, we cannot but observe how much greater it is where the operative class preponderates, than where the several orders of society are more nearly balanced. This is strikingly apparent, when we compare the Glasgow and Manchester tables with any of the others. The average mortality under 10 of these places is 56 per cent, whilst that of Liverpool is 48 and a fraction only, and that of London 44 1/2. It is true the per centage in the latter instance is probably too low; nevertheless, as neither in Liverpool, London, nor in any other large town the working population bears so high a proportion to the middle and upper classes as in Manchester (which may correctly be styled an immense workshop,) we can scarce doubt that the greater infantile mortality in the last mentioned town is mainly influenced by this circumstance. [1]

The Eccles table tends further to illustrate this observation. In the parish of Eccles more than nine-tenths of the inhabitants subsist by manufactures, trade, or handicraft. There the mortality under 10 is no less than 49.38, a higher rate even than that of Liverpool, or any of the other places, except Glasgow and Manchester; which can be ascribed to no other cause than the large proportion of its operative population. In Warrington and Carlisle, infantile mortality is great for the same reason. In both places operatives form the great bulk of the people. With these towns may be contrasted Northampton and Chester, where the working class is comparatively small. In each of these places the mortality under 10 is nearly 5 per cent lower than in either of the former.

In the country parishes of Winwick, Grappenhall, and Ackworth, where the chief employment is agriculture, [2] the total number of deaths, under 10, averages about 32 1/2 per cent. In Lymm, where there is a considerable village, it rises to above 40. In Spalding, again, it is extremely high, but this parish is in the Fens, and its total mortality is even greater than that of London, being 1 out every 31.34 of the inhabitants.

When we consider the peculiar circumstances of the labouring poor in Manufacturing Districts, their frequent privations, their improvidence, ignorance, and vicious habits, and the low, badly ventilated abodes of the majority of such of them as live in large towns, we cease to wonder that so few of their children comparatively should be reared.

In Manchester and Glasgow, many of the poorest class are Irish. It is difficult to estimate their number, but it cannot be less than 25 or 30 thousand in each place. Their habits are well known. In confined filthy yards, noisome cellars, old ruined buildings, we are sure to find this singular people the principle tenants, huddled together in their peculiar way, and in spite of every privation, marvelously content. So perfectly do most of them continue to maintain their native habits in this country, that no conveniences and comforts which they see others of their own condition enjoy, and which they might as easily attain, do in the least degree stimulate them: a proof how slow and difficult is the progress from barbarism to civilized life.

No circumstance in their mode of living is more singular that the numbers that frequently agree to inhabit the same apartment or dwelling, forming together an immense motley family, to the features of which no painter or dramatist has yet done justice. This gregarious propensity of theirs was remarked in the inspection of the state of the poor made during the late distress in this town. As many as 40 persons were occasionally found inhabitants of the same wretched dwelling. Such a practice must operate on infantile life more perniciously than even the pestiferous wards of a Foundling Hospital; and, no doubt, mainly contributes to the high rate of mortality under 10 in this place and Glasgow. As this is a subject of which the police of every great town should take cognizance, I transcribe the following sketch of the habitations of the poor in Dublin, from a work on the population of that city, by the Rev. J. Whitlaw. "As I was usually out at very early hours on the survey," says this writer, "I frequently surprised from 10 to 15 persons of all ages and sexes in a room not fifteen feet square, stretched on a wad of filthy straw, swarming with vermin, and without any covering, save the wretched rags that constituted their wearing apparel."

He further says, that he occasionally found from 30 to 40 individuals in one house: and some years before the period of his survey, No. 6, Braithwaite Street contained 108 human beings. From a careful inspection which he made of Plunket Street, it appeared that 32 contiguous houses contained 917 inhabitants, being on an average 28.7 to a house: and the entire Liberty averaged from 12 to 16 persons to each house. [3]

In this town (Manchester) we should not find many in circumstances such as these, but whoever will take the trouble to visit the cellars, garrets, and purlieus, generally, of Cock Gates, Fennel St., Long Millgate, and other of the older parts of Manchester, will discover a denseness of population, and some of its peculiar accompaniments which he may have imagined were not to be found out of the Liberty of Dublin.

In a community subsisting wholly by trade, a variety of unfavourable circumstances affect the children of the poor, some of which are in their nature unavoidable, and others (by far the worst) spring from vices that are always prevalent in a crowded state of society. Drunkenness, and disease the consequence of licentiousness, affecting the female part, will extend to their offspring; and the frequency of illegitimate births, where the parties are too depraved to submit to the duties of a parent, is, perhaps, beyond all others the most fertile source of infantile destruction. [4] Moreover, early marriages, though they cannot be called vicious, are always common where the means of subsistence fluctuate between extremes. Their effect is to produce feeble children, and afterwards to starve such of them as might, under other circumstances, be reared.

But without adverting to the vices of the poor how often do we see the mother of a large family obliged to follow some employment besides the care of her household; and that too at a distance from home! Meanwhile her children are unavoidably neglected. Besides, the abject poverty from which those who subsist by manufactures are never long exempt, occasionally makes it impossible for the poor to feed and clothe their families in a manner compatible even with ordinary health. To such causes of debility and disease, when we add filthiness, impure air, want of exercise, the great liability to infectious complaints, at an early age, in crowded neighbourhoods, mismanagement in health and sickness, especially the shocking practice of administering spiritous liquors even to infants at the breast, [5] and want of medical treatment, we readily perceive why infantile mortality is greatest where the poor are most numerous; and that it must increase in the manufacturing districts, coeteris paribus, in the ratio of the increase of the operative population. [6]

This latter fact, which is obvious, seems in a great measure to have escaped the late Dr. Watt of Glasgow. In commenting on the mortality bills for that city, he expresses himself "as utterly astonished to find the number of deaths under 10 as great in 1812 as it had been in 1783 in spite of vaccination and all the other improvements." He appears to forget that, within that period, Glasgow had doubled its population; and in all likelihood, trebled its operative class. [7]

In stating the causes of infantile mortality in large towns, our remarks need not be confined to the poor. Among the rich, some of the same causes operate also with fatal effect, and none more than impure air, and want of exercise. In Manchester where there are no public walks within the range of the town, these evils are severely felt, and that without the prospect of remedy. Here new streets are rapidly extending in every direction; and so great already is the expanse of the town, that those who live near the centre find it inconvenient or impossible to send their children, daily into the pure air. It is true, that nothing contributes more to the salubrity of a town than to allow the utmost freedom in extending its limits. In that case, the streets will be spacious, the buildings of moderate height, and a freer circulation of air maintained throughout; yet even the liberty to build, and to extend, with all its advantages, may be abused; which it certainly is, when no public walks are reserved for the accomodation of those who live in the central parts. In this respect, Manchester is notoriously defective; perhaps more so than any town of equal magnitude in Europe. Although its total annual mortality is not excessive, yet the proportion of children's deaths is so, and this may depend, in no small degree, on a circumstance, which, unlike some other causes of disease, is not occasionally, but continually operating; I allude to the local defect in the means of taking regular exercise in the open air.

To shew how rapidly large towns would become depopulated, were they not constantly recruited by migration; and how fatal they prove to human life, even in circumstances otherwise the most favorable to its preservation, Dr. Percival procured an account of the mortality occurring in the society of Friends in Manchester during 7 years. In this society he found their were 81 males and 84 females, of whom 54 were married, 9 were widowers, 7 widows, and 48 under 15 years of age. The births in 7 years were 34, the burials 47; one person, therefore in 24.6 died annually. The result is curious, and the reverse of what was to be expected.

Dr. P. ascribes so high a rate of mortality, proportionally higher than that of the whole town, to the Society, during the above period, having had little or no accession to its number of members from the country. Indeed, without a constant supply from this source, there is reason to believe large towns would be depopulated at even a speedier rate than in the instance just given. [8]

We have seen from the tables how much less is the percentage of deaths under the age of 10 in a country parish than in a town or city. To perceive the actual difference, however, between the two, with respect to the amount of infantile mortality, we must consider, that, as the mortality at all ages, in a country parish, is so much smaller in proportion to the population than it is in a town, were the deaths in the tables under 10 even the same in both, still the actual mortality under this age would not be so; it would be greater in the latter than in the former in the ratio of the mortality at all ages. [9] To illustrate this point let us take as an instance the Glasgow and Ackworth tables, and assume that the percentage of deaths under 10 is the same in each; it will not thence follow that as many children proportionally die in the one place as in the other: on the contrary as in Glasgow one in 40 of the inhabitants dies annually, and in Ackworth only one in 56; the deaths under 10 in the latter will be fewer in the proportion which 40 bears to 56 or 5 to 7. Dropping the assumption of an equal mortality under 10, in the registers of the two places, we find that in Glasgow it is 54.75, and in Ackworth only 27.33, which (omitting the fractions) gives a difference of one-half. Adding the two results together we find that out of the same number of inhabitants about three children die in Glasgow for one that dies in the country parish of Ackworth.

In some of the Welsh counties, Anglesea for instance, where the annual mortality is only 1 of 71.62, the deaths in infancy will probably be fewer even than in Ackworth. [10]


Footnotes

1. The number of married women delivered annually by "The Manchester Lying-in Charity" shews in a strong light how large the proportion of the inhabitants is of the poorest class. In the 12 months preceding May 1826, the number delivered was 3454. As the population of the town and suburbs is 155,758, and the annual number of births at the rate of 1 for every 28 inhabitants, (though 1 for every 30 would perhaps be more correct,) is 5563, nearly, we perceive that the accouchements of a portion of the population so great as 96,708 are annually attended at the public expense.

2. The immense parish of Winwick cannot, as a whole, be styled agricultural. Here, that part of it only is alluded to, where the inhabitants may be supposed to bury at Winwick Church.

3. The following sketch is too graphic to be omitted. "This crowded population where it obtains is almost universally accompanied by a very serious evil; a degree of filth and stench inconceivable except by such as have visited these scenes of wretchedness. Into the back yard of each house, frequently not ten feet dep, is flung, from the windows of each apartment the ordure and other filth of its numerous inhabitants, from whence it is so seldom removed that I have seen it nearly on a level with the windows of the first floor; and the moisture that after after heavy rains, oozes from this heap, having frequently no sewer to carry it off, runs into the street by an entry leading to the staircase. One instance out of a thousand that might be given, will be sufficient. When I attempted, in the summer of 1798, to take the population of a ruinous house in Joseph's Lane, near Castle Market, I was interrupted in my progress by an inundation of putrid flood, alive with maggots, which had, from an adjacent slaughter-yard, burst the back door and filled the hall to the depth of several inches. By the help of a plank and some stepping stones, which I procured for that purpose (for the inhabitants without any concern waded through it) I reached the staircase. It had rained violently, and from the shattered state of the roof, a torrent of water made its way through every floor, from the garret to the ground. The sallow looks, and filth of the wretches who crowded round me indicated their situation, though they seemed insensible to the stench, which I could scarce sustain for a few minutes. I counted in this sty thirty seven persons; and computed that its humane proprietor received out of an absolute ruin, which should be taken down the magistrates as a public nuisance, and profit rent of above £.30 per annum, which he extracted every saturday night with unfeeling severity. I will not disgust the reader with any further detail, and only observe, that I generally found room-keepers of this description, notwithstanding so many causes of wretchedness, apparently at ease, and perfectly assimilated to their habitations. Filth and stench seemed congenial to their nature; they never made the smallest effort to remove them; and if they could answer the calls of hunger, they felt, or seemed to feel, nothing else as an inconvenience."

4. In this country it is not easy to ascertain what proportion the illegitimate bear to the legitimate births. I have been politely furnished with a list of the filiations of illegitimate infants for the township of Manchester from July 1823 to December 1826. They amount to 1001 or about 300 per annum. The population of the township is 108000, and the births at the rate of 1 to 30, are 3600, of which number therefore about 1 in 12 is illegitimate. In all Sweden and Finland such births, to those in wedlock are as 1 to 20; but in the city of Stockholm, 1 in 3. In all France on the average of several years following the revolution they were as 1 in 11; and in Paris for the years 1820 1821 & 1822, they were something above 1 in 3, being full 36 per Cent.

As to the mortality of the illegitimate it is known to be immense. Taking the general average, it appears that in Cottingen 3 per cent. of the children born in wedlock are born dead; but out of wedlock so many as 15 per cent. In Berlin, the proportion is less; in 1819 and 1822, of the births in marriage, the still born were 1 in 25; out of marriage 1 in 12. The mortality among illegitimate infants, born alive, compared with the legitimate, is likewise proportionally great, "For 10 legitimate children who die in the first month, there are lost 24 natural children. In the 2nd & 3rd months the proportion is 2 to 1. In the second quarter, it is one and three quarters to 1. In the two remaining quarters of the first year, and one and half to one. In the 2nd year one and two fifths; in the third and fourth one and a third; in the 5th 6th & 7th one and a fourth; and of the total number of natural children only one tenth or one ninth pass the age of puberty." See Casper's Medical Statistics in the Edin. M. & S. Jour. No. 88.

5. The evil alluded to is extremely prevalent among the more ignorant and stupid of the poor. The instant a child becomes indisposed, gin or rum is their ordinary remedy. But the practice is not limited to cases of sickness; a friend of the writer, on whose report he can rely, was lately informed by the landlord of a noted DRAM-SHOP in this town that he was in the daily habit of seeing mothers pour undiluted spirits into their infants, "sometimes," as he expressed it, "till they become black in the face." If they shewed much aversion to the experiment, which was sure to be the case with the very young, the finger dipped in the liquor was first given, until the taste for it was acquired!

6. According to a Memoir by Villerme relative to the mortality of the different Arrondiseements of Paris; "it appears that, in the quarters occupied chiefly by the rich, the annual mortality is so low as one in 43 or even 45; that, in those inhabited chiefly by the poor, the average is so high as one in 25 or 24; and that the proportion, in the other parts of the City, observes nearly the ratio of the welath and consequence ease of the population. -- " Edin. med. and Surg. Journal, 1826.

7. I have thought it unnecessary to advert to the supposed effects of Cotton Mills, and similar establishments, on the health of children, who are now seldom admitted into any great public works but at an age, between which and puberty fewer deaths occur than during any other period of life. It is a curious fact that the number of deaths between the ages of 5 and 10 is little, if at all, greater in manufacturing towns than in the country. The reason is, that in the former most of the sickly and feeble die in the first few years of life; consequently only the vigorous, in general, attain their 5th year and above.

8. Being curious to compare the present rate of mortality in the society of Friends with Dr. Percival's estimate of it in 1774, a gentleman of that body, very kindly furnished me with the following statements, embracing a period of nine years, from 1817 to 1825 inclusive.

Members

Male

Female

In the beginning of 1817

391

185

206

At the end of 1825

489

226

263

Mean number of members

440

Total births during the 9 years 106. Burials in the same period 70. Under 2 there died 19; between 2 and 5, 5; between 5 and 10, 2; above 10, 44; -- in all 70. Annual average number of deaths, 8 nearly; or in the proportion of 1 person out of every 55.

Here we perceive the annual mortality is not near one-half of what it was 52 years ago; a prodigious difference truly, not to be accounted for merely on the ground of the rapid increase of the society during the nine years, although that was great; nor on the score of greater cleanliness and comfort among its members than obtained in Dr. Percival's time; for in these respects there is probably no change; neither can we imagine any considerable alteration in the town as regards its salubrity. I am inclined to think that this diminished rate of mortality depends, 1st on the rapid increase of members partly by migration from the country. 2nd on the habitations of the members being now, generally, either out of town, or in the most airy and salubrious parts of it. And lastly, on the decided advancement which has taken place since Dr. P.'s day, in the knowledge and treatment of diseases.

9. It is here assumed that the state of the population in country parishes and in towns, is the same in respect of the numbers living above, and under, ten years of age.

10. The following statement of the comparative mortality in England and Wales, is extracted from Milnes's work on Annuities &c. -- In the ten years preceding 1811, there died annually, in all England, 1 of 47.30. In all Wales, 1 of 58.57.


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