The Death of Innocents

Or infant mortality in the Victorian era.

A while back, a meme went round twitter asking “What would have killed you before modern medicine?” The answers were many and various. Measles was an obvious one. Scarlet fever. Influenza. Childbirth. Cancer was common, as were accidents: wound infections and compound fractures. But what most people responding to this meme didn’t realise is that the real challenge of mortality before the development of vaccines and antibiotics was surviving early childhood. If you could survive to your fifth birthday, then you had a fairly good chance of surviving to adulthood. If you could avoid the many infectious diseases and tuberculosis, then you might die at work in an accident, or in childbirth. Or you might live long enough to develop cancer and die of that instead. Or you might live to be 85 and die of bronchitis in the workhouse.

So, why was it so difficult to survive the first five years? Let’s break it down.

First, you have to survive forty-ish weeks of pregnancy. In a world where overcrowding was common, DIY abortions were also common, and could kill the woman as well as the foetus. Stillbirths and miscarriages were also common, since there was absolutely no antenatal care in the modern sense of the word.

Then you have to survive being born. Unless you are extremely poor, you will be born at home, delivered by a local midwife. There was no formal training for midwives, and no registration scheme until the 1900s. So, your local midwife would be a woman with plenty of experience. If she was struggling to deliver a baby, she would call for the local doctor. Local doctors did not necessarily know anything about childbirth. I came across an inquest in Peterborough where three doctors were unable to identify a uterus. Newborns often died of seizures in the hours after birth, due to being starved of oxygen during the delivery. If your parents were extremely poor, or your mother unmarried, you might be born in the workhouse, where (ironically) your delivery might be supervised by better qualified staff than at home.

Now, your mother also has to survive pregnancy and birth. There was no real contraception available, so working class women could expect to be pregnant every two to three years, if they breastfed, and annually if they didn’t or were very fertile. The average woman had eleven children in her lifetime in 1841, dropping to six by 1911. There were limited options if a baby was difficult to be born: forceps had been developed in the late eighteenth century but required skill to use them safely, and most provincial doctors were terrified of using them. Caesareans were a last resort, done to save the baby of a dying woman, as they had a maternal mortality rate of 85%. They did not become a routine part of childbirth culture until the 1940s. Your birth is not aseptic: it occurs in the family bed without clean hands or clean sheets. There are no antibiotics to treat postnatal infection, in the uterus itself or in birth injuries. The standard treatment for postnatal haemorrhaging is brandy. Should your mother die in childbirth, and you survive, your future is limited unless your father can find someone to look after you quickly.

Congratulations, you have survived birth. Now you have to survive early infancy, where if you are lucky, you are breastfed. If you are unlucky, you are fed on a mix of milk and cornmeal (best case scenario) or water and bread. There is no sterilisation, so diarrhoea is a common cause of death. There are no antibiotics, so minor chest infections can kill a baby in days. There is, however, a staggering array of opiate-based drugs made by chemists to give tiny babies. Teething? Cocaine, opium and alcohol. Colic? Opium and alcohol. Constipated? Fruit syrup and alcohol. Diarrhoea? More opium. Opiates given to babies makes them quiet, constipated, anorexic and sleepy. And it quite often made them die. Opium and cocaine were not restricted in over-the-counter medicine until the 1920s, which is something to bear in mind when older people complain about the drug habits of today’s youth. In at least one Fenland village, beer was laced with opium in an effort to avoid malaria. Should you find a baby’s death certificate where the cause of death is marasmus, it is fairly likely that the baby died of wasting due to opiate use.

Once you begin to move under your own steam, a whole new world of things that can kill you emerges. Open fires, openly boiling water, lamps and candles. Clothing isn’t flame retardant, and both boys and girls wore dresses in infancy. If you caught your clothing, you went up like a firework. Baby harnesses, such as seats and cribs, were often made of wicker. And burns and scalds didn’t have to be severe to cause death: infection was common.

The sheer amount of open water is also difficult to get the modern mind round. Every home had a cistern, a water butt, and many babies drowned in them while playing. In Peterborough, where I live, there were dozens of unfenced streams, fen drains, flooded gravel pits and rivers for children to fall into. Although there are no cars, there are horses and carts, and just getting caught across the head by a iron wheel edge is enough to kill a small child. Most small children were sensible enough not to play near the railways, but another issue in the Victorian era is that working-class children were not adequately supervised compared to now. I’ve read dozens of inquests where children died because they were under the ostensible supervision of a bedridden elderly family member. Most, however, were just left with older siblings. Five-year-olds watching two-year-olds.

Then there is the ever-present spectre of disease. Diseases we know now as fatal: meningitis, polio, measles, tetanus, diphtheria. Diseases we know now but don’t consider so deadly in small children: scarlet fever, bronchitis, pneumonia, tonsillitis, appendicitis, diarrhoea+vomiting, flu. And diseases we don’t know now, at least not generally in England. Typhus, a virus spread by body lice and fleas. Tuberculosis, which spreads most viciously in overcrowded living spaces. Malaria, endemic on the fens. Cholera and typhoid, waterborne bugs which cause rapid death by extreme dysentery. All these diseases were helped along by the generally poor health of children at the time, particularly in urban areas. Rickets, malnutrition, short-stature, all weakening a child’s immune system.

Frankly, it’s a wonder any of our ancestors survived at all.