Friday, 12 February 2016

"His majesty the baby"

In this week’s blog, Archivist Louise has been looking into how maternity care developed in Edinburgh:

At the end of last year, I promised to write more about another pioneering development in public health that was ‘born’ in our city. Time flies, but a visit from the newest member of the extended LHSA team last week (in the shape of Project Cataloguing Archivist Clair’s new-born) has reminded me to fulfil my promises!

A Maternity and Child Welfare Scheme health visitor gives one Edinburgh mother a helping hand (LHB16/38/19)

The beginning of the twentieth century in Edinburgh saw considerable progress in public health that carried forward the work of the first Medical Officer of Health, Henry Littlejohn. The introduction of pieces of legislation (in particular, of notification regulations) acted as catalysts to these changes. These laws included the 1907 and 1915 Notification of Births Acts, which required the local Medical Officer of Health to be notified as soon as possible after any birth. LHSA has records of these notifications from 1916 to 1962 in a series of registers in our public health collection (LHB16/47), which record basic details (including the mother’s name, sex of the child and place of birth). The 1915 (Extension) Act also gave local authorities the power to found schemes for monitoring mothers before and after birth and to take responsibility for the care of children under five years old.

In his report on the need for a Maternity and Child Welfare Scheme (MCWS) for Edinburgh, the then Medical Officer of Health, A Maxwell Williamson, recognised that, despite the considerable financial strain being put on the City during the First World War, such a scheme was necessary on account of high child mortality, particularly in poorer districts. In 1911 to 1915, the death rate of children under five throughout Edinburgh was 38.2 per thousand. However, by district the figures were much starker: in the same period, 112 under-fives in the southwest suburb of Morningside died, whilst 797 died in St Giles’ district (which was around the High Street area, extending north to Princes Street and south to Tollcross).

The Edinburgh MCWS was launched in 1917. It was described by Williamson as having essentially  ‘preventative’ and ‘curative’ aims – medical supervision would attempt to combat infectious diseases in children, whilst provision of care before, during and following birth would try to arrest deaths from poor maternity conditions. Maternity and child clinics were set up, with the centres of these being the existing Edinburgh Royal Maternity Hospital (ERMH) and the Royal Edinburgh Hospital for Sick Children. The centres were supported by a series of local dispensaries. The female-staffed maternity Hospice (run by Elsie Inglis for poor mothers) and Bruntsfield Hospital were also incorporated, along with kindergartens, open-air play centres and provision for ‘mothercraft’ classes. Ante-natal classes were also started in the ERMH to identify potential concerns prior to birth.

A 1917 Public Health Department circular, outlining the key provisions of the Scheme (LHB3/25/2).

In addition, a children’s convalescent home was set up in Gogarburn House, later to be turned into Gogarburn Hospital, an institution for those with learning difficulties:

Gogarburn Convalescent Home, 1919 (LHB16/2/1).

By the 1950s, MCWS was in full swing, with three ante-natal clinics, nine mothercraft clubs, playgrounds and child welfare clinics. The only annual report that we have for the scheme (LHB16/43/1) covers the range of its activities in 1954, including vaccinations, nurseries, mother and baby homes and food distribution.

Maternity and Child Welfare Scheme exhibition, Craigmillar School, 1947 (LHB16/38/19).

Medical Officer of Health Dr H E Seilar (centre) during the Welfare Foods campaign, 1953 (LHB16/38/19).

Although Edinburgh had offered free medical facilities for poorer women and children since the eighteenth century, MCWS provided status, stability and guaranteed funds for the care of mothers and babies. It is now recognised as a step on the way to the medicalisation of maternity care in the years that followed. 

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