UNIVERSITY OF COLORADO AT BOULDER
ABSTRACT
INFANT HEALTH IN WIGAN, ENGLAND
DURING THE FIRST WORLD WAR
ADVISORY COMMITTEE MEMBERS: PROFESSOR FRED ANDERSON, PROFESSOR PAUL STROM AND THESIS ADVISOR, PROFESSOR MARTHA HANNA
BY
ERIN MILLER
MAY 2006
If this subject matter interests you, you may contact me at:
erinashleymiller(at)gmail<d0t>com
“We were in the midst of a war which was carrying away a lot of our manhood and it would be even more necessary in the future to take care of the little infants…in order to make up the losses through war.” [1]
– Wigan Observer, 8 May 1915
War is believed to have a devastating effect on public health, particularly the health of infants and children, because the cost of war diverts resources away from such basic aspects of society as sanitation and health care. The rhetoric of the 1960s was “War is not healthy for children and other living things.”[2] War causes a number of different “social disruptions” including the lack of food and other material necessities, overcrowding, the breakdown of normal sanitary systems, and a shortage of medical care.[3] The lack of food, medical care, and medical supplies often caused by war leads to poor obstetrical health, and therefore a higher rate of maternal and infant mortality.[4] However, World War I in Great Britain was an exception to this general principle. The infant mortality rate declined by twenty percent in Great Britain during the war period, as compared to the seven percent decline from 1905 to 1913.[5] Further, Great Britain was unique in this experience; it was the only combatant nation that experienced a decline in infant mortality rates during the Great War.[6]
Historians disagree as to which factors prevented a dramatic increase in infant mortality in England during the First World War, and in fact caused the infant mortality rate to decline substantially. The question is debated regarding the nation in general and industrial, working-class communities in particular. British historian Jay M. Winter claims that the improvements in the standard of living among the working-class led to a decrease in the infant mortality rate. Deborah Dwork argues, by contrast, that government maternal education programs were the determining factor in improving infant health.
Winter states that Wigan experienced declines much greater than average in infant morality rates due to the increase in the industrial presence in the town during the war.[7] He asserts that the increased industrial production of war materials provided employment for unskilled and semi-skilled men and women. Poverty stricken families began to have two full time wage earners as fathers joined the military and mothers went to work in factories. Winter states, “Unemployment and casual employment were virtually eliminated . . . Wages were more regular, and wage-earners more numerous in working-class households.”[8] A large demand for overtime work and a regulated minimum wage for agricultural work also increased family wages.[9] Winter also insists that “social policy changes were not behind wartime changes in mortality rates.”
Deborah Dwork asserts, by contrast, that precisely these types of social policies acted as catalysts to improve infant mortality rates in Great Britain. She argues that education programs for mothers that were started by both the government and independent volunteer agencies were the determining factor in the continued decline of infant mortality rates in Great Britain during World War I. She argues that “improved mothercraft”[10] was not an easy solution, but in fact an expensive, comprehensive, and successful one. The government initially attempted to curb infant mortality through more simple measures such as milk regulations, which attempted to decrease infantile diarrhea by improving the availability of hygienic milk because contaminated milk was known to be associated with the development of the disease. The government went to a program of maternal education only after those measures had failed. There were such a vast number of possible sources of infection for infants that maternal education was the only means of substantially decreasing the risks to infants.[11]
Local studies are able to inform the question of which factors were most important in improving infant health during a calamitous war. In fact, Lynda Bryder argues, “It is only by detailed studies at the local level that one can hope to form any impression of the real effects of the First World War on the health of the people.”[12] She also suggests that Wigan might prove a valuable local study because Winter cites the town as being extremely favorably affected by the war. Winter also argues the importance of local studies as national studies tend to “conflate contradictory trends.”[13]
Wigan makes an interesting case study, not only because Winter uses the town as an example to prove his argument, but also because before World War I, Wigan, in the very heart of industrial England, had one of the highest rates of infant mortality, and its infant mortality rate declined very little in the decade leading up to the war.[14] The primary industries in Wigan were coal mining (in which one third of the total worker population of the town was employed) and textile work; and communities where both of these industries were prevalent were widely associated with high infant mortality rates before the war.[15] Further, from 1902 to 1913, “little improvement” in infant health had been made in the town, and its infant mortality rate was considered “excessive [over 120 deaths per 1,000 births] in each of the 12 years.”[16] Yet, from 1914 through 1919, the town experienced declines in infant morality rates much greater than average. In fact, during the war years, infant mortality declined in Wigan at twice the rate registered during the period immediately prior to the war.[17] The infant mortality rate in Wigan dropped by 62 deaths per 1,000 births between 1913 and 1919, from 179 deaths per 1,000 births to 117. Figure 1 depicts the course of infant mortality in Wigan.
Fig. 1.
Source: County Borough of Wigan Medical Officer of Health Reports for the Years 1900-1928.
Note: Infant mortality is defined as deaths occurring during the first 12 months of an infant’s life. The war years have been designated between the vertical lines.
Historians have not completed a detailed local study of infant health during the war in any of the northern industrial towns; thus, the effect of the war on the infants of the working poor, and the social governmental programs created during the war that were focused on improving the health of working-class infants, has not been closely examined. Prior to the war, Wigan was considered “an almost exclusively industrial town. The ‘middle-class’ element…is small; at the other end of the scale the proportion of casually employed labor is also small.”[18] Analyzing the effect of World War I on infant health within the town of Wigan allows for a greater understanding of which factors proved the most important in determining infant health in a famously bleak industrial community. It enlightens the debate considering other industrial working-class communities, and the nation as a whole.
My local study of Wigan proposes some possible explanations for the uniquely British experience as the only major combatant nation in the First World War in which infant mortality declined. Sanitation and housing did not improve in Wigan during the war, and, contrary to Winter’s explanation for the decrease in infant mortality, real wages did not increase in the town. Nor does it appear that more women entered the workforce in Wigan, or that child neglect decreased substantially. Social governmental programs aimed at improving infant health in working-class, industrial, urban areas helped to decrease infant mortality in Wigan, and likely other such communities around the country. The study suggests that these social government programs were able to improve the health and lives of infants in England. Wigan provides a case study that favors Dwork’s argument that the growth in government-sponsored educational programs, established in the aftermath of the Boer War and then expanded after 1914, led to a decrease in infant mortality in industrial towns during World War I.
It is clear that most of the programs that worked to improve infant health in Wigan during the war had their roots in the years prior to the war. In England in general, but particularly in working-class industrial societies such as Wigan, the tremendous impact of these programs during the war years was due to their significant expansion during the war.
The most significant element of the government’s increased efforts to improve the health of infants in Wigan was a doubling of the number of health visitors in the town in July of 1915. Health visitors not only visited infants (and children up school age after 1915) on a routine and regular basis, but also inspected, educated, and examined midwives, and opened infant welfare centers. The national government funded all but £50 of the new system to provide for the health of all of Wigan’s infants. This program included the hiring of the two additional health visitors and the opening of a second infant welfare clinic. The increased staff allowed the visitors to regularly visit all children up to school age. The increased visiting to older children worked to substantially increase pre-natal care in the borough as health visitors could refer pregnant women with older children to the infant health centers to receive advice on their pregnancy. Government efforts to improve the supply of pure milk and the availability of treatment for venereal diseases also helped increase the health of the infants in Wigan. It is likely that the expansion of health visitor programs, which enabled greater supervision of midwives and more infant health welfare centers, as well as government programs for the provision of hygienic milk and the treatment of venereal diseases accounted for the decrease in infant mortality seen in other industrial towns in Britain such as Birmingham, Bolton, St. Helens, and Newport.[19]
When J. M. Winter completed a detailed local study of London in 1993, he, to some extent, backed off his earlier convictions that an increase in real wages and not governmental social policies was behind the improvement in infant health. He states that in the working-class boroughs of London during the war, “…infant welfare was enhanced by near full employment, which meant heavy overtime and high wages, yielding better nutrition, public health initiatives such as infant welfare clinics, and rent restriction.”[20] The social programs to improve infant health were focused in working class communities with high infant mortality rates. Therefore, local studies of areas that include working-class populations more accurately depict the full effect of these programs than national studies. Winter continues, “Clearly we should avoid making simply correlations between economic performance and mortality rates. Rather, we must look at social and economic changes on a much wider front, including changes in social policy, public health policy…as well as changes in real incomes.”[21] In the case of Wigan, it has been demonstrated that real wages did not increase during the war, and that therefore, most of the improvement in infant health was due to these government initiatives. This case study of Wigan, as well as Winter’s study of London, (even though his population was not as predominantly working-class as that of Wigan), illustrate that the improvement in infant health during the war was not due to a trickle-down effect of economic expansion. Rather the improvement in infant health was due to focused governmental programs established and expanded in an effort to improve the health and lives of infants. This study shows that a government, prompted by war, was able to create a comprehensive infant health care plan that significantly improved the health of infants. As Winter explains, “Total war had transformed the relationship between state and working class, creating a quasi-welfare state by default if not by design.”[22]
The fact that other combatant nations recognized the importance of preserving infant life in the atmosphere of the most destructive and widespread war in modern history illuminates the fact that basic government programs to promote infant welfare were not alone enough to decrease infant mortality. In considering the experience of other nations, it becomes clear that an expansion of pre-war infant health programs and a necessary minimal standard of living were both required in order to offset the destructive forces of war on public health.
In Germany during the war, “civilian health and the birth rate became issues of national survival.”[23] However, despite the greater concern among government officials relating to infant health in Germany and that programs to provide services to mothers and infants were initially expanded during the war, these programs were cut by its end. While pregnant women, infants, and children were initially given priority in receiving milk rations, their benefits were gradually diminished through 1916, and by late 1917 pregnant and nursing women, infants, and children had lost their extra milk rations in a government effort to provide more protein-rich rations to munitions workers.[24]
Further, it appears that a minimal standard of living is also required to improve infant and maternal health. Infant welfare centers, called “consultation offices,” expanded dramatically in Belgium during the war. There were 97 such centers in 1914, and 768 by the war’s end.[25] However, it is likely that the standard of living dropped below a minimally required level. Maternal education is not of much use if national food supplies are so meager that a mother cannot feed herself, nurture her unborn child, or provide sustenance for her young children.
Health visitors and infant welfare centers remain valuable resources for improving infant and maternal health in many economically disadvantaged areas in developed countries, and throughout lesser-developed nations. Recently, researchers once again proved the value of health visitors in increasing child health among a high-risk population in Memphis, Tennessee. The children of women with two or more socioeconomic risk factors (unmarried, less than twelve years of education, or unemployed) that received visits from health visitors showed higher intellectual functioning and receptive vocabulary scores, and fewer behavioral problems at age six, as compared to a control group that received only transportation to scheduled pre and post-natal exams.[26] Health visiting and infant welfare centers are cost-effective methods of improving the lives of women and children in urban, working-class, industrial communities around the world.
Beyond health visitors and infant welfare centers, the other programs that helped to improve the health of infants in Wigan during the First World War – improved natal care, the provision of pure milk, and the treatment of venereal diseases – also prove beneficial in improving the lives of infants in less developed countries around the world today. Many public health officials compare current conditions in developing communities do those in developing communities around 1900. The provisions of milk and high quality milk substitutes, as well as the treatment of venereal diseases have also become more efficient and cost-effective, as technologies in those fields have advanced.
This study holds important lessons for decreasing infant mortality rates in working-class, industrial communities with sub-standard housing and sanitation conditions. This study shows that improvements in sanitation and housing conditions, an increase in earnings, or a drop in the birth rate are not necessary pre-cursors to improved infant health. Government initiatives and programs are capable of improving the lives of mothers and their infants as long as a minimal standard of living is maintained.
FOOTNOTES
[1] Wigan Observer, 8 May 1915, 7 (C).
[2] Barry S. Levy and Victor W Sidel ed., War and Public Health (Washington D.C.: American Public Health Association, 2000) 27.
[5] J. M. Winter,“The Impact of the First World War on Civilian Health in Britain” The Economic History Review, New Series 30, no. 3 (August 1977): 494 [journal online] available from: http://www.jstor.org/.
[6] Ibid., 493.
[7] J. M. Winter, “Aspects of the Impact of the First World War on Infant Mortality in Britain,” The Journal of European Economic History 11 (Spring 1982): 718.
[8] Ibid., 728.
[9] Ibid., 728.
[10] Deborah Dwork, War is Good for Babies and Other Young Children, A History of the Infant and Child Welfare Movement in England 1898-1918, (New York, NY: Tavistock Publications, 1987), 208.
[11] Ibid., 148.
[12] Linda Bryder, “The First World War, Healthy or Hungry?” History Workshop Journal 24 (Autumn 1987): 155.
[13] Jay Winter, Jon Lawrence, and Jackie Ariouat, “The Impact of the Great War on Infant Mortality in London,” Annales de Démographie Historique (1993): 329.
[14] House of Commons, “Local Government Board, Supplement in Continuation of the Report of the Medical Officer of the Board for 1913-1914 Containing a Third Report on Infant Mortality, Dealing with Infant Mortality in Lancashire.” Sessional Papers, 1914, vol. XXXIX, 11. (hereafter cited as Infant Mortality in Lancashire)
[15] Ibid., 16.
[16] Infant Mortality in Lancashire, 3.
[17] J. M. Winter, The Great War and the British People (New York: Palgrave Macmillan, 2003), 148.
[18] Infant Mortality in Lancashire, 75.
[19] Winter lists these towns as examples of county boroughs with greater than average declines in infant mortality, see: Winter, “Aspects,” 718.
[20] Winter, Lawrence, and Ariouat, “Infant Mortality in London,” 347.
[21] Winter, Lawrence, and Ariouat, “Infant Mortality in London,” 349.
[22] Winter, Lawrence, and Ariouat, “Infant Mortality in London,” 349.
[23] Paul Weindling, “The medical profession, social hygiene and the birth rate in
Germany, 1914-1918,” The Upheaval of War, Family Work, and Welfare in Europe, 1914-1918, ed. Richard Wall and Jay Winter (New York: Cambridge University Press, 1988), 417.
[24] Berlinda J. Davis, Home Fires Burning, Food, Politics, and Everyday Life in World War I Berlin (Chapel Hill: The University of North Carolina Press, 2000), 175.
[25] Peter Scholliers and Frank Daelemans, “Standards of Living and health in Wartime Belgium,” in The Upheaval of War, Family Work, and Welfare in Europe, 1914-1918, ed. Richard Wall and Jay Winter (New York: Cambridge University Press, 1988), 152.
[26] Olds et al., “Effects of Nurse Home-Visiting on Maternal Life Course and Child Development: Age 6 Follow-up Results of a Randomized Trial,” Pediatrics 114 (December 2004): 1550-1559 [journal online] available from: http://www.pediatrics.org/cgi/content/full/114/6/1550.
BIBLIOGRAPHY
PRIMARY SOURCES
ARCHIVAL SOURCES
Monro, H. C. to Whitehall, S. W. 1. 22 February 1918. Public Health and Housing Committee Minute Books. 1916-1920. P.70. Lancashire Archives, Lancashire.
United Kingdom. County Borough of Wigan. Medical Officer of Health Report for the Year 1900 through 1928.
United Kingdom. County Palatine of Lancaster. Report of the Medical Officer of Health for the Year 1913 through 1919.
Wigan Observer (Wigan), 8 May 1915.
PUBLISHED SOURCES
Campbell, Janet M. Report on the Physical Welfare of Mothers and Children, Volume Two. Liverpool: C. Tinling and Co., Ltd., 1917
Hope, E. W. Report on the Physical Welfare of Mothers and Children, Volume One. Liverpool: C. Tinling and Co., Ltd., 1917.
Dumas, Samual, and Vedel-Petersen, K.O., Losses of Life Caused by War. Ed. Harald Westergaard. Oxford: The Clarendon Press, 1923.
United Kingdom. House of Commons. “Midwives Bill, Memorandum.” Sessional Papers, 1899, Vol. VI.
________.“Midwives Bill.” Sessional Papers, 1902, Vol. III
________. “Bill to provide for the early Notification of Births [as amended by Standing Committee A.]” Sessional Papers, 1907, Vol. III.
________. “Local Government Board, 1909-1910, A Report on Infant and Child Mortality.” British Sessional Papers, Vol. XXXIX.
________. “A Bill to Enable Local Authorities under the Notification of Birth Act, 1907, to appoint Health Visitors” Sessional Papers, 1911, Vol. II.
________. “Forty-second Annual Report of The Local Government Board, 1912-1913, Second Report on Infant and Child Mortality.” British Sessional Papers, 1913, Vol. XXXII.
_______. “A Bill to Ensure the Supply of Pure Milk to Certain Persons.” British Sessional Papers, 1914, Vol. III.
________. “Local Government Board, Supplement in Continuation of the Report of the Medical Officer of the Board for 1913-1914 Containing a Third Report on Infant Mortality, Dealing with Infant Mortality in Lancashire.” Sessional Papers, 1914, Vol. XXXIX.
________. “Local Government Board, Supplement in Continuation of the Report of the Medical Officer of the Board for 1914-1915 Containing a Report on Maternal Mortality in Connection with Childbearing and its relation to Infant Mortality.” Sessional Papers, 1914-1916, Vol. XXV.
________. “Local Government Board, Supplement in Continuation of the Report of the Medical Officer of the Board for 1915-1916 Containing a Report on Child Mortality at ages 0-5 in England and Wales.” Sessional Papers, 1914-1916, Vol. XXV.
________. “Report on the Work of the Central Midwives Board for the Year ended 31st March, 1916.” Sessional Papers, 1916, Vol. XIII.
________. “Annual Report of the Chief Medical Officer, 1919-1920.” British Sessional Papers, 1921, Vol. XVLL.
SECONDARY SOURCES
ARTICLES
Byder, Linda. “The First World War, Healthy or Hungry?” History Workshop Journal 24 (Autumn 1987): 141-157.
Fildes, Valerie. “Infant feeding practices and infant mortality in England, 1900-1919.” Continuity and Change 13. no. 2 (1998): 251-280.
Harris, Bernard. “The Demographic Impact of the First World War: An Anthropometric Perspective.” Social History of Medicine 6, no. 3 (December 1993): 342-366.
McDermott, J., R. Steketee, S. Larsen, and J. Wirima. “Syphilis-associated perinatal and infant mortality in rural Malawi,” Bulletin of the World Health Organization 71, no. 6 (1993): 773-780.
Olds, David L., Harriet Kitzman, Robert Cole, JoAnn Robinson, Kimberly Sidora, Dennis W. Luckey, Charles R. Henderson, Jr, Carole Hanks, Jessica Bondy, and John Holmberg. “Effects of Nurse Home-Visiting on Maternal Life Course and Child Development: Age 6 Follow-up Results of a Randomized Trial,” Pediatrics 114 (2004): 1550-1559. Journal online. Available: http://www.pediatrics.org/cgi/content/full/114/6/1550. Internet. Accessed 19 March 2006.
Shuman, Andrew J. “A concise history of antimicrobial therapy (serendipity and all)” Contemporary Pediatrics. (October 1, 2003) Journal online. Internet. Accessed 20 March 2006.
Winter, Jay M. “Aspects of the Impact of the First World War on Infant Mortality in Britain.” Journal of European Economic History 11 no. 7 (Spring 1982): 713-738.
________. “The Impact of the First World War on Civilian Health in Britain.” The Economic History Review New Series 30, no. 3 (August 1977): 487-507. Journal online. Available: http://www.jstor.org/. Internet. Accessed 17 Oct. 2004.
Winter, Jay M, Jon Lawrence, and Jackie Ariouat. “The Impact of the Great War on Infant Mortality in London.” Annales de Dèmographie Historique (1993): 329-353.
Woods, R. I. P. A. Watterson and J. H. Woodward. “The Causes of Rapid Infant Mortality Decline in England and Wales, 1861-1921, Part II.” Population Studies 43 (1989): 113-132.
BOOKS
Davis, Berlinda J. Home Fires Burning, Food, Politics, and Everyday Life in World War I Berlin. Chapel Hill: The University of North Carolina Press, 2000.
Dewey, Peter. War and Progress, Britain 1914-1945. New York: Addison Wesley Longman Limited, 1997.
Dwork, Deborah. War is Good for Babies and Other Young Children, A History of the Infant and Child Welfare Movement in England 1898-1918. New York, NY: Tavistock Publications, 1987.
Hannavy, John. History and Guide, Wigan. Gloucestershire, Great Britain: Tembus Publishing Ltd., 2003.
Jewkes, John and E. M Gray. Wages and Labour in the Lancashire Cotton Spinning Industry. Manchester: Manchester University Press, 1935.
Arnot, R. Page. The Miners: Years of Struggle, A History of the Miner’s Federation of Great Britain (from 1910 onwards). London: George Allen and Unwin Ltd., 1953.
Levy, S. Barry and Victor W Sidel, ed., War and Public Health. Washington D.C.: American Public Health Association, 2000.
Loudon, Irvine. Death in Childbirth, An International Study of Maternal Care and Maternal Mortality 1800-1950. Oxford: Clarendon Press, 1992.
Peel, C. S. How We Lived Then 1914-1918, A Sketch of Social and Domestic Life in England During the War. London: John Lane The Bodley Head LTD., 1929.
Quètal, Claude. History of Syphilis. Translated by Judith Braddock and Brian Pike. Baltimore: The Johns Hopkins University Press, 1990.
Szreter, Simon. Fertility, Class and Gender in Britain, 1860-1940. Cambridge: University Press, 1996.
Waites, Bernard. A Class Society at War, England 1914-1918. New York: Berg Publishers Limited, 1987.
Wall, Richard and Jay Winter ed. The Upheaval of War, Family Work, and Welfare in Europe, 1914-1918. New York: Cambridge University Press, 1988.
Wilkinson, James and H. Stuart Hughes. Contemporary Europe, A History. New Jersey: Prentice Hall, 1998.
Winter, Jay M. The Great War and the British People. New York: Palgrave Macmillan, 2003
SPECIAL THANKS:
For their kind guidance:
Martha Hanna, Associate Professor, Department of History, University of Colorado, Boulder
Victoria Turrell, Archivist, Lancashire Record Office, Lancashire County Council
Alan Davies, Archivist, Wigan Archives Service, Leigh Town Hall
Staff at the Wigan History Shop
Staff at the Wigan Tourist Information Centre
For their generous financial support:
The Undergraduate Research Opportunities Program (UROP) at the University of Colorado at Boulder
You can get to 
Erin Miller 
Leave a Reply