Baby Graves: Infant Mortality in 1865-1908.

Linda Beresford BA (Hons) Murd.

Thesis submitted for the degree of Doctor of Philosophy in accordance with

the requirements of Murdoch University (School of Social Sciences and

Humanities), Perth, Western Australia, June, 2006

i I declare that this thesis is my own account of my research and contains as its main content work which has not previously been submitted for a degree at any tertiary institution.

...... (Your name)

ii Abstract

The thesis examines the problem of infant mortality in Merthyr Tydfil 1865- 1908. In particular it investigates why Merthyr Tydfil, an iron, steel and coal producing town in south , experienced high infant mortality rates throughout the nineteenth century which rose by the end of the century despite sixty years of public health reforms. The historiography of infant mortality in nineteenth-century Britain includes few Welsh studies although the Coalfield played an important part in industrial and demographic change in Britain during the second half of the nineteenth century. The thesis argues that conditions of industrial development shaped the social, economic and public health experience in Merthyr, ensnaring its citizens in social disadvantage, reflected in the largely unacknowledged human toll among mothers and babies in that process. The thesis analyses the causes of over 17, 000 infant deaths in Merthyr Tydfil from the primary evidence of an unusually complete series of Medical Officer of Health Reports to identify the principal attributed causes of infant death and explain their social origins and context. The thesis examines the work of Dr. Thomas Jones Dyke, MOH from 1865-1900, who was the author of most of these reports, and assesses his in public health, but suggests that there were limits to his capacity to address the problem of infant mortality. The analysis showed convulsions, tuberculosis, measles and whooping cough, lung diseases, diarrhoea, nutritional causes of death and infant deaths from antenatal causes of maternal origin to be those which drove up infant mortality rates in Merthyr from the 1880s. From 1902 antenatal causes of infant death, independent of the sanitary environment, and directly linked to the health of mothers, were the only ones still rising. Public health reforms were unable to address the social factors which engendered poverty and ill-health. Large families dependent mainly on male breadwinners had little margin of economic safety. Industrial conflicts in Merthyr revealed the inability of the Poor Law to address the problems of mass destitution in an urban setting. Women experienced few opportunities, married early and undertook heavy domestic labour reflected in early death rates for women and high perinatal infant death rates due to the poor health and socio-economic status of mothers. The of midwives from 1902, with the potential to save many infant lives and to advocate for working-class mothers, failed to do so in Merthyr by 1908.

iii Although specifically addressing the issues of infant mortality in nineteenth- century Britain, the issues raised are of contemporary relevance since infant deaths reflect many social dynamics of inequality through which infant lives are inevitably sacrificed.

iv Table of Contents

Abstract iii Table of Contents v List of Figures viii List of Tables ix Maps and Illustrations xiv Abbreviations xv Acknowledgements xvi

Introduction 2

Aims of thesis 3 Justification 4 The Historical Problem of Infant Mortality 4 Infant Mortality as a Complex Social Problem 8 Public Health in Victorian Wales 11 Industrial and Social Background in Merthyr Tydfil 13 Women and Welsh Historiography 16 Research Process and Source Material 18 Methodology 20 Causes of Death by Weeks and Months in Merthyr Tydfil 1905-8 25 Research Analysis and Conclusions 26 Thesis Structure 29 Conclusion 30

Chapter 1 Public Health and Infant Mortality in Merthyr Tydfil 1849-1908. 33

Industrialisation and Population Change in Merthyr: the first phase 34 Social Administration and Politics of Merthyr 38 Cholera and Social Change 45 Water and Sanitation 1850-1908 52 Industrialisation and Population Change in Merthyr: the second phase 57 The Housing Problem and Health 58 Addressing the Housing Problems in and Merthyr 63 Housing and Capitalism 69 Conclusion 71

v Chapter 2 The Social Impact of Industrialisation in Merthyr Tydfil 1834-1908 73

Social and Economic Effects of Industrialisation 1834-1908 74 , Food and Health 80 The Application of the Poor Law in Merthyr Tydfil Union from 1834 83 Social and Economic Impact of Industrial Unrest 89 The Great Strike of 1898 94 Poverty and Social Distress 96 ILP and the Poor Law 98 Conclusion 100

Chapter 3 The Work of a Medical Officer of Health: Infant Mortality in Merthyr Tydfil 1849-1908 102

Dyke’s Personal and Professional Life 105 Dyke’s Priorities 111 Dyke and Infant Mortality 124 Conclusion 139

Chapter 4 Causes of Infant Death in Merthyr Tydfil 1865-1908: Convulsions, Tuberculosis and Infectious Diseases 151

The Causes of Infant Deaths in Merthyr Tydfil 1865-1908 152 Categories of Attributed Causes of Infant Death 157 Causes of Death by Weeks and Months in Merthyr Tydfil 1905-1908 160 Ill-Defined Causes of Death: Debility, Dentition, Teething and Convulsions 164 Infant Mortality and Infectious Diseases in Merthyr Tydfil 1865-1908 171 Tuberculosis 177 Smallpox, Whooping Cough, Measles and Scarlet Fever 183 Diphtheria, Croup and Upper Respiratory Tract Infections 198 Cephalitis, Meningitis, Inflammation of the Brain 200 Secondary Infections and Other Diseases 201 Conclusion 202

Chapter 5 Lung Diseases, Diarrhoea, and Infant Deaths in Merthyr Tydfil 1865-1908 205

Lung Diseases 206 Diarrhoea 221 Conclusion 241

vi Chapter 6 The Mother and Child: Infant Mortality in Merthyr Tydfil 1865-1908 244

Deaths of Maternal Origin and Nutritional Causes 246 Illegitimacy, Marriage, Birth-Rates and Infant Mortality 262 Midwives and Infant Mortality 267 Appointment of Health Visitor 1907 275 The Hidden Cost of Women’s Labour 278 Conclusion 283

Conclusion 285

Afterword 295

Appendix 297

Bibliography 378

vii

List of Figures

Figure 1. Population Growth In Merthyr Tydfil 1851-1921 38

Figure 2. Excess Births Over Total deaths in Merthyr Tydfil 1841-1921 38

Figure 3. Comparative Population Growth and Housing, Merthyr Tydfil 1851-1921 39

Figure 4. Comparative Infant Mortality Rates Merthyr Tydfil, Wales, England and Wales 1844-1916 48

Figure 5. Comparative Birth Rates Merthyr Tydfil, Wales, England and Wales 1838-1916 49

Figure 6. All Causes of Infant Death in Merthyr Tydfil 1865-1908 as Disease Specific Infant Mortality Rates per 1000 Registered Births 153

Figure 7. Seven Year Moving Average of Major Causes of Infant Death in Merthyr Tydfil 1865-1908 154

Figure 8. Infectious Diseases in Merthyr Tydfil 1865-1908 156

viii List of Tables

Chapter 1.

Table 1. 1. Percentages of Infant Deaths in Weeks and Months During the First Year of Life in Merthyr Tydfil 1905-8 and 1919 35

Table 1. 2. Population Growth in Merthyr Tydfil 1801-1911 37

Table 1. 3. Place of Birth and Composition of Population Aged Over 20 Living in the Parish o f Merthyr Tydfil in 1851 37

Table 1. 4. Area and Population of Parishes in Merthyr Tydfil Poor Law Union 1831-1891 39

Table 1. 5. Changing Administrative Structure of Merthyr Tydfil and Adoptive Public Health Acts 42

Table 1. 6. Births, Deaths and Infant Mortality Rates in Merthyr Tydfil 1841-1847 50

Chapter 2

Table 2. 1. Number of Males and Females Aged Below and Above the Age of 20 in Various Occupations in Merthyr Tydfil 1861 75

Table 2. 2. Statement of Coal Raised in the Parish of Merthyr-Tydfil 1866- 1875 76

Table 2. 3.Occupations and Weekly Wages of Males Above 20 years of Age in Merthyr Tydfil Based on Census of 1861 80

Table 2. 4. Weekly Wages of Skilled Workmen 1871 80

Table 2. 5. Prices of Coal, Iron Bars, Colliers Wages and Staple Foods in Merthyr Tydfil 1865-1879 81

Table 2. 6. Aberdare Parish Relief 1857-8 90

Chapter 3.

Table 3. 1. Proportional Death Rate of Children under 5 years to 1,000 deaths at all Ages (Percentage) in Merthyr Tydfil 1866 135

Table 3. 2 .Birth and Death Rates per 1000 population, and Deaths of Children Under 1 Years per 1000 Registered Births 136

ix Table 3. 3 . Dyke’s Table of Deaths at All Ages in 1898. TABLE IV. Shewing[sic] the number of Deaths at all ages in 1898, from certain Groups of Diseases, and proportions to 1,000 of Population, and to 1,000 deaths from all causes; also the number of Deaths of Infants under one year of age from other groups of Diseases and proportions to 1,000 Births and to 1,000 Deaths from all causes under one year 138

Chapter 4

Table 4. 1 .Number of Infants Deaths Under One Year of Age from Other Causes in Merthyr Tydfil 1905-1908 160

Table 4 .2. Number of Infant Deaths in Each Category in Merthyr Tydfil 1865-1908 and Changing Contribution to Infant Mortality 160

Table 4. 3. Summary of Ages and Causes of Death as Percentages of Total Infant Deaths in Merthyr Tydfil 1905-8 161

Table 4. 4. Summary of Numbers, Ages and Causes of Death Infant Deaths in Merthyr Tydfil 1905-8 161

Table 4. 5. Hierarchy of Causes of Death and Number of Deaths as Percentages of Deaths at Various Stages of First year of Life in Merthyr Tydfil 1905-1908 162

Table 4. 6. Ages at Which Causes of Death Peak in Merthyr Tydfil 1905- 1908 163

Table 4.7. Deaths of Infants Under One Year of Age from Suffocation / Overlying in Merthyr Tydfil 1905-8 164

Table 4. 8. Deaths of Infants Under One Year of Age by Weeks and Months in Merthyr Tydfil 1905-1908 from Convulsions 170

Table 4. 9. Summary of Peak Years and Sequence of Decline of All Forms of Infectious Diseases in Infants Under One year in Merthyr Tydfil 1865-1908 172

Table 4. 10. Modes of Spread of Infectious Diseases and Number of Deaths in Merthyr Tydfil 1865-1908 173

Table 4. 11. Numerical Hierarchy of Infant Deaths from Infectious Diseases as Percentages of Infectious Diseases and Total Infant deaths in Merthyr Tydfil 1865-1908 174

Table 4. 12. Deaths from Infectious Diseases in Merthyr Tydfil 1905 –1908 176

Table 4. 13. Deaths of Infants Under One Year of Age by Weeks and Months from Infectious Diseases in Merthyr Tydfil 1905-1908 176

x Table 4. 14. Deaths of Infants Under One Year of Age by Weeks and Months In Merthyr Tydfil 1905 –1908 from Tubercular Diseases 181

Table 4. 15. Number of Smallpox Cases In Different Age Groups in Merthyr Tydfil 1872 183

Table 4. 16. Deaths of Infants Under One year from Whooping Cough in Merthyr Tydfil 1905-1908 185

Table 4. 17. Measles Epidemics in Merthyr Tydfil 1865-1908 187

Table 4. 18. Number and Ages of Infant Deaths Under One Year of Age From Measles by Weeks and Months in Merthyr Tydfil 1905-1908 187

Table 4. 19. Percentage of Deaths at Various Intervals From Measles in Merthyr Tydfil and Brighton 1904 192

Table 4. 20. Death Rate from Measles per 100,000 Population in Merthyr Tydfil 1866-1905 192

Table 4. 21. Number and Ages of Infant Deaths Under One Year of Age from Scarlet Fever by Weeks and Months in Merthyr Tydfil 1905-1908 194

Table 4. 22. Number and Ages of Infant Deaths Under One Year of Age from Meningitis by Weeks and Months in Merthyr Tydfil 1905-1908 201

Chapter 5

Table 5. 1. Principal Causes of Deaths and Numbers Due to Each in 1865 207

Table 5. 2. Years of Peaks in Lung Diseases as Diseases Specific Infant Mortality Rates and Percentage of Infant Mortality Rates in Merthyr Tydfil 1866-1908 208

Table 5. 3. Deaths of Infants Under One Year of Age by Week and Months In Merthyr Tydfil 1905-1908 from Lung Diseases 209

Table 5. 4. Comparative Death Rate per 1000 Population Each Quarter Merthyr Tydfil and England and Wales, 1865 216

Table 5. 5. Summary of Three Diarrhoea Periods in Merthyr Tydfil 1866- 1908 225

Table 5. 5a. First Period 1866-1882: DSIMR and Percentages of Total Deaths Each Year of Deaths from all Forms of Diarrhoea 226

Table 5. 5b. Second Period 1883-1893: DSIMR for Deaths from Diarrhoea In Merthyr Tydfil 226

xi Table 5. 5 c. Third Period 1893-1908: DSIMR Deaths from Diarrhoea in Merthyr Tydfil 227

Table 5. 6. Comparative Infant Mortality Rates in England and Wales During the Third quarter of 1899 232

Table 5. 7. Number of Deaths from Diarrhoea with the Number of Rainy Days and the Rainfall July-October for the Years 1894-1903 235

Table 5.8. Contrast Between Effects of Wet and Dry Summers on Diarrhoeal Deaths 1903-4 235

Table 5. 9. Number of Infant Deaths Under One year of Age by Weeks and Months from Various Diarrhoeal Diseases in Merthyr Tydfil 1905-1908 238

Table 5. 10. Mode of Feeding in Infants Where Death Occurred 239

Chapter 6.

Table 6. 1. Number of Infant Deaths by Weeks and Months in Merthyr Tydfil 1905-1908 from Causes of Maternal Origin 249

Table 6. 2. Percentage of Infant Deaths from Causes of Maternal Origin as in Merthyr Tydfil 1905- 1908 249

Table 6. 3. Deaths of Infants Under one Year of Age From Atrophy, Debility and Marasmus in Merthyr Tydfil 1905-1908 253

Table 6. 4. Deaths of infants Under One Year of Age By Weeks and Months In Merthyr Tydfil 1905-1908 from Nutritional Disorders 254

Table 6. 5. Deaths of Infants Under One Year of Age in Merthyr Tydfil 1905– 1908 from Nutritional Disorders 255

Table 6. 6 .Number of Deaths From Main Causes of Infant Death in Merthyr Tydfil 1905-8 261

Table 6.7. Disease Specific Infant Mortality Rates From Main Causes of Infant Death in Merthyr Tydfil 1905-8 262

Table 6. 8. Births and Deaths of Illegitimate Infants in Merthyr Tydfil 1898- 1906 263

Table 6. 9. Number of Births, Total Infant Deaths and Infant Deaths of Maternal Origin in Merthyr Tydfil 1902-8 271

Table 6. 10. Males and Females Employed in Various Occupations in Merthyr Tydfil 1891 and 1901 280

xii Table 6. 11. Proportion of Men to Women and of Married Women in the Population 281

Table 6. 12. Comparative Mortality Rates per 1000 population for Males And Females 15-55 Years 1878-1910 in Pontypridd Registration District and England Wales 282

Table 6. 13. Maternal Mortality Rates in Merthyr Tydfil, Pontypridd Registration District and England and Wales 1881-1910 283

xiii Maps and Illustrations

Frontispiece. Dr. Thomas Jones Dyke, Medical Officer of Health for Merthyr Tydfil 1865-1900 1

Plate 1. Baby Graves Cartoons by Staniforth, c.1900-1910 32

Plate 2. The South Wales Coalfield 141

Plate 3. Merthyr Tydfil’s Coalmines 142

Plate 4. View of Merthyr Tydfil n.d. c. 1913 143

Plate 5. Merthyr General View 1913 144

Plate 6. Sand Street Dowlais 1934/5 145

Plate 7. Merthyr Dowlais Town and Iron Works 1929 146

Plate 8. Peaceful Persuasion: or, Strengthening the numbers of the Federation at Maesteg 1906. 147

Plate 9. Dowlais Housing 1936 148

Plate 10. Feeding Bottle Patent 1860 149

Plate 11. Long-Tubed Feeding Bottle 1891 150

xiv List of Abbreviations

AAM Amalgamated Association of Miners BMA British Medical Association BMJ British Medical Journal CMB Central Midwives Board DIC Dowlais Iron Company DSIMR Disease Specific Infant Mortality Rate GBH General Board of Health GCC County Council GRO Glamorgan Record Office, LGB Local Government Board IMR Infant Mortality Rate per 1000 live/registered births. MOH Medical Officer of Health NAPSS National Association for the Promotion of Social Science NOS Not Otherwise Specified MTBG Merthyr Tydfil Board of Guardians MTLBH Merthyr Tydfil Local Board of Health MTU Merthyr Tydfil Union MTUDC Merthyr Tydfil Urban District Council PRO Public Record Office, Kew, London

xv

Acknowledgements

This research has been funded by two scholarships from Murdoch University which have made this project possible. I wish to acknowledge the following repositories for access to main primary source material. In London, The Public Record Office (Kew), the NSPCC Archive, and the Wellcome Institute History of Medicine Library. In Wales, Cardiff Central Library, the Glamorgan Record Office Cardiff. I especially wish to acknowledge the support of the staff at Merthyr Tydfil Public Library, in particular, Carolyn Jacob for making a wealth of material available to me from the Local History Collection and her ongoing assistance once I had returned to Western Australia. The work of Tydfil Thomas was a constant source of inspiration for me. My thanks also to Eira Smith for introducing me to Merthyr’s geography. In Western Australia I wish to acknowledge the use of scholarly resources at the University of Western Australia and at Murdoch University Library. Among the staff at Murdoch University Library I particularly wish to acknowledge Pam Matthews, Rosita Chan, En Koh and Grant Stone not only for their expertise, but also their friendship and support over the course of the project. I also wish to thank Susan Watts for information regarding infant feeding bottles from the History of Infant Feeding Association archives. I am greatly indebted to Dr. Julia Hobson for her wise insights and incisive practical guidance through the weekly practicalities of piecing together a thesis, to Associate Professor Michael Calver for some inspiring discussions and to Karen Olkowski and Georgina Wright for the tireless support they offer to all postgraduate students. These are some of Murdoch University’s many quiet achievers who contribute so greatly to the academic excellence of the University and its educational philosophies. I am grateful to Professor Pat Jalland for her mentoring in the historian’s craft during my undergraduate studies and encouraging me to pursue my research interests, and to Professor John Hooper, for his academic wisdom. Special thanks go to Emeritus Professor Geoffrey Bolton as my for his wisdom, wit, expertise, kindness, sense of humour and extraordinary patience in seeing the project through to completion. I am also greatly indebted to Iain Brash of the University of Western Australia for his patient hard work and incisive editorial advice that enabled me to finally reduce a rather large and unwieldy draft to a manageable thesis. I wish to thank him for his

xvi encouragement and for giving so generously of his time and sharing his love of history with me. Constructing and creating a thesis is a labour of love which requires hard work, commitment, perseverance, patience and passion nearing obsession. It is often a painstaking and lonely business which can be exceptionally tedious for those who watch the process. A number of stalwarts patiently encouraged me along the way, assisting me in many ways to give birth to this thesis. Without their support, encouragement and practical assistance the journey to completion would have been undeniably much harder. My family has been a great source of inspiration, especially my mother who has lived through some hard times. I appreciate the support of Glyn and June for patiently accommodating me through my research, for transport, love, laughs and sharing valley life with me and without whom this project would have been almost impossible. Viana, and Tristan never doubted that I could or should do this; I am grateful to Rhianwen for teaching me what is important, how precious life is and both my daughters showed me the strength of a mother’s love. Thanks to Bill, who travelled some of the way with me, but sadly chose not to complete the journey. Thanks also go to Jane Grimes, Jenny Davies and Johanna Videmanis as fellow travellers through life and along the academic road. A sense of humour is among the many qualities which I cherish among my friends. Thanks, Helen, for listening patiently to the mysteries of nineteenth-century Merthyr Tydfil, an unknown world away and for always being there; Elna for her wisdom; Chris and Elizabeth for good company; Sylvia and John for always having a fresh slant on things; Melanie for keeping me focused on the path ahead in mutual mentoring process and reminding me how far I’ve come; Joyce for showing me new ways of looking at life; Lois and Janice Achimovich for their support and inspiration through madness and mayhem. Finally I am greatly indebted to Michael Perrella not only for his technical expertise in desktop publishing, graph production and data interpretation, but also for his generosity, professionalism, humour and friendship during the final stages. I want to thank all of these people for their patience and believing that I would succeed.

xvii

Dr. Thomas Jones Dyke Medical Officer of Health for Merthyr Tydfil 1865-1900

1 Introduction

This thesis addresses the historical problem of infant mortality in Merthyr Tydfil, 1865-1908. Sixty years of public health improvements followed the severe cholera epidemic of 1849, but infant mortality remained an intractable problem. The thesis asks why Merthyr Tydfil had such exceptionally high rates of infant mortality and why they increased despite several decades of public health reforms. Infant mortality gradually became preventable as public health understanding of the problem moved from environmental health concerns to an awareness of the broader socio-economic aspects of the problem, many of which affected the health of mothers and babies. Most of these problems were related to the conditions of industrial dependency in the town and beyond the scope of sanitary measures. The social and environmental conditions emanating from Merthyr Tydfil’s industrial background contributed significantly to notorious infant mortality rates during the nineteenth century as the town developed from the late-eighteenth century as a principal iron, steel and coal town. In 1848, a general life expectancy of 17 years was accompanied by high infant mortality rates. In 1849, before any sanitary improvements to the town, an infant mortality rate of 238 /1000 live births was estimated. This declined somewhat from 1865 to the mid 1870s, but showed a rising trend by the end of the century. In 1899, the worst year across Britain for infant mortality due to a hot dry summer and many deaths from summer diarrhoea, infant mortality peaked in Merthyr Tydfil at 272 /1000 live births, and in 1901 was still 262 / 1000. ( Appendix. Table1.) The town lacked an independent middle class and effective social administration, explaining a dismal lack of civic amenities.1 Merthyr Tydfil Local Board of Health was elected in 1850 to meet an urgent need to control infectious diseases and improve a noxious urban environment by providing a clean water supply, drainage and sewerage, but the problem of substandard and overcrowded housing plagued the town into the twentieth century. Dr. Thomas Jones Dyke, eminent in the emerging field of public health, was appointed Medical Officer of Health in 1865, a role in which he continued until his death in 1900. From 1865, under Dyke’s guidance, attempts were made to raise the town’s sanitary standards and improve overcrowded and insalubrious housing conditions. Infant mortality was considered to be an inherent part of these problems

1 Ieuan Gwynedd Jones, ‘Clark and Politics’, in Brian Ll. James (ed), G.T. Clark, Scholar Ironmaster in the Victorian Age, University of Wales Press, Cardiff, 1998, pp.70-71. 2 which was expected to improve as general sanitary conditions ameliorated. The public health reforms in Merthyr reduced deaths in other age groups but had little impact on infants before 1902. When sanitary measures failed to reduce infant mortality rates, the problem was considered to be one of ignorance on the part of working-class mothers. By the end of the nineteenth century the main influences on infant mortality were diarrhoea, lung diseases and causes of maternal origin, due to antenatal conditions independent of the sanitary environment. From 1902 infant deaths from antenatal causes of maternal origin were the only causes of infant death still rising. The public health and industrial background to the town is introduced in Chapter 1.

Aims of Thesis

The thesis aims to examine the causes of infant deaths in Merthyr Tydfil 1865- 1908 and place the statistical and historical problem of infant mortality within the social framework of this Welsh industrial town during that period. A further aim of this local study of infant mortality in Wales is to locate the specific problem of increasing infant mortality in Merthyr Tydfil within the broader historical perspective of infant mortality in nineteenth-century Britain. The thesis incorporates important issues raised in the historiography of infant mortality, which contains very few Welsh studies, an important oversight in view of the significant growth of the South Wales Coalfield from the mid-nineteenth century and its importance in British industrial, economic, political and demographic change. The primary research within the study analyses the causes of death of over 17,000 infants from data extracted from a complete series of Medical Officer of Health reports for the town from 1865-1908 to ascertain the assigned causes of death and to explain rising infant mortality rates in the town. The thesis identifies the main causes to which infant deaths were attributed between 1865 and 1908 and how they varied over the period. The medically assigned causes of infant death are placed in the social and economic context of the public health and industrial development of the town to explain their social origins. The research findings are explained in Chapters 4, 5 and 6. The thesis explores some of the social and economic aspects which imprisoned Merthyr as a working-class town in social deprivation into the twentieth century and identifies a core of intractable social problems which undermined the social and physical health of families and prevented public health measures from being effective in reducing infant mortality rates.

3 The thesis examines to what extent infant deaths reflected environmental conditions outside the home and therefore had the potential to be prevented through sanitary measures, and how far they originated within the social environment of the home where the infant spent the most vulnerable time of its life. Whilst local authorities could control the standard of environmental health in the , their powers were limited in controlling conditions within the home where many of the problems associated with high mortality and morbidity originated. It was particularly important to determine to what extent infant deaths were directly related to the health and well being of the mother independent of sanitary measures. The study provides no simple answers, in concluding that adverse social and environmental conditions which continually lay beyond the scope of public health measures until the twentieth century supported the majority of causes of infant death.

Justification

The Historical Problem of Infant Mortality

Infant mortality now stands as a significant component of public health, bridging medical diagnosis of the causes of infant death and the social dimensions underlying those causes of death. Social contextualization is necessary to adequately explain the complex factors involved in the statistical construction of infant mortality rates which in Merthyr were well above national rates and above the level regarded by the World Health Organisation as the level at which diarrhoeal deaths reflect an insanitary environment, adversely affecting infant survival. Kathleen Newland summarised the issues which make infant mortality an important social indicator. “No cold statistic expresses more eloquently the difference between a society of sufficiency and a society of deprivation than the infant mortality rate.” Furthermore, “[h]igh infant mortality is associated with certain social problems that may persist even in the face of rising per capita income: environmental contamination, lack of education, discrimination against women, poor health services and so forth.” 2 However, Newland points out that “[h]igh infant mortality is often associated with poverty and low infant mortality with wealth,

2 Kathleen Newland, Infant Mortality and the Health of Societies, Worldwatch Paper 47, Worldwatch Institute, 1981, United Nations Fund for Population Activities, p.5. As a comparison, in 2005 Angola ranked first in global infant mortality rates at 191.19/1000 births. The ranked 195, with a rate of 5.16/ 1000, Australia ranked 203, with a rate of 4.69/1000 and Singapore last, with a rate of 2.29/1000. URL: http://www.indexmundi.com/g/r.aspx?c=xx&v=29 4 but the correlation, as indicated, is far from perfect. Poverty itself doesn’t cause babies to die, nor does wealth rescue them.” 3 For this reason, “In searching out the explanation of infant deaths, two levels of analysis are needed: one to identify the immediate causes of death and another to examine the social, economic and environmental conditions that make infants vulnerable to those immediate causes.” 4 My initial interest in the topic of infant mortality stems from my experience as a midwife in south Wales, which allowed me the privilege of becoming intimately involved with one of the most significant points in women’s lives. Beyond the statistics, infant death reflects one of the most fundamental and profound human experiences, that of giving birth and witnessing the end of that brief life. The difficulty for historians is that women’s responses to that experience remain largely unrecorded. Infant mortality rates are frequently quoted to indicate poor social conditions but they also serve as an analytical tool to explore the social life of a community and enrich our understanding of the way in which they acted as a barometer of social malaise. The national problem of infant mortality in nineteenth-century Britain was made up of many varied local experiences, providing researchers across many disciplines the opportunity to investigate disparate local and regional experiences as well as common aspects. The topic provides a rich arena for local research within which each study has its own validity. Industrial south Wales was an area of social disadvantage for much of the nineteenth and twentieth centuries and Merthyr Tydfil, with notoriously high infant mortality rates, provided the opportunity for further local research. 5 Welsh language and geographical location separated the identity of Welsh industrial towns like Merthyr culturally from other great manufacturing towns in Britain, but did not isolate them from common concerns. 6 My Honours dissertation explored the multiple and complex causes of infant mortality, which shifted from a statistical to a social problem in Victorian and Edwardian Britain. 7 My research drew on reports of the inspectors of the General Board of Health and the Local Government Board on the urban and rural social conditions in England and Wales. Three reports on Merthyr Tydfil by Thomas Webster

3 Newland, Infant Mortality and the Health of Societies, pp. 8-9. 4 Ibid., p. 6. 5 Nick Danziger, Danziger’s Britain: A Journey to the Edge, Harper Collins, London, 1996, pp. 309-331. Danziger visited South Wales and compassionately observed the social difficulties which still existed there. 6 Ieuan Gwynedd Jones, Mid-Victorian Wales: The Observers and The Observed, University of Wales Press, Cardiff, 1992., p.5. 7 Linda Beresford, ‘Suffer the Little Children: Infant Mortality in Nineteenth Century Britain, 1850- 1911’, Honours Dissertation submitted for the degree of Bachelor of Arts, Murdoch University, Western Australia, 1995. 5 Rammell in 1848, by William Kay, M.D. in 1854 and Inspector J. Spencer Low in 1906 encapsulated a broad range of issues relevant to infant mortality in the town. 8 Angela John, in ‘Sitting on the Severn Bridge’ describes the need to accord Welsh history a sense of rightful ownership, but also the need to make Welsh history visible in the national sense as part of British history; “Integration of Welsh history into ‘British’ history can ignore significant and peculiarly Welsh perspectives as well as risk seeing Wales only in terms of how it contributed to the forging of a British State.” 9 This study of infant mortality in Merthyr Tydfil adds to the small but growing number of local studies from this important socio-geographical area within British industrial, economic and social history. Though outside the period of this study, of particular relevance to Merthyr between the war is the study by Liz Peretz which compares regional variations in maternal and child welfare between the wars in Merthyr Tydfil, Oxfordshire and Tottenham. Far from being a unified state service, local authorities made autonomous fiscal and political decisions regarding the level and type of services provided and depressed areas could not afford to provide the level of health and welfare required. 10 C.H. Lee also addresses regional inequalities in a paper in which he uses infant mortality rates as a measure of health inequality. Lee cites the Black Report “that any factors which increase the parental capacity to provide adequate care for an infant will, when present, increase the chance of survival, while their absence will increase the risk of premature death…..” 11 Lee concludes that “Variations between infant mortality rates in different regions and in the long term provide, therefore, a significant indicator of

8 T.W.Rammell, Report to the General Board of Health on a Preliminary Inquiry into the Sewerage, Drainage, and Supply of Water, and the Sanitary Condition of the Inhabitants of the Town of Merthyr Tydfil, 1850, The Local Reports to the General Board of Health 1848-1857., Dr. J. Spencer Low’s Report to the Local Government Board on the Sanitary Circumstances and Administration of the Merthyr Tydfil Urban District, 1906. Urban and Rural Social Conditions in Industrial Britain., The Reports to the Local Government Board 1869-1908: Urban and Rural Social Conditions in Industrial Britain, The Harvester Press Microform Collection Series 1 and 2. William Kay, M.D., Report of the Sanitary Condition of Merthyr Tydfil; Drawn up at the Request of the Local Board of Health, and Read at the Meeting on the 15th Day of May, 1854, Merthyr Tydfil, 1854. 9 Angela V. John, “Sitting on the Severn Bridge: Wales and British History’, History Workshop Journal, Issue 30, Autumn, 1990, p. 91. 10 Liz Peretz, ‘Regional Variation in Maternal & Child Welfare Between the Wars: Merthyr Tydfil, Oxfordshire & Tottenham’, in Philip Swan and David Foster, Essays in Regional and Local History, Hutton Press, 1992, North Humberside, pp.133-4. 11 C. H. Lee, ‘Regional Inequalities in Infant Mortality in Britain, 1861-1971: Patterns and Hypotheses’, Population Studies, 45 (1991), pp.55-56. The Black Report, published in 1980, showed that there had continued to be an improvement in health across all the classes (during the first 35 years of the National Health Service) but there was still a co-relation between , (as measured by the old Registrar General’s scale) and infant mortality rates, life expectancy and inequalities in the use of medical services. URL: http://www.ucel.ac.uk/shield/black_report/Default.html 6 variations in basic economic and social well-being.”12 He found that regional divergence in infant mortality 1870-1920 reflected the cost of industrialisation based on housing density and structural changes in employment, particularly in mining communities such as those in Glamorgan and Monmouth.13 The historiography of infant mortality in Victorian and Edwardian Britain tends to concentrate on major manufacturing and textile towns and contains few Welsh studies. Naomi Williams’ thesis illustrates the inherent difficulties which she overcame in using local records and some ways in which local studies can provide information available only through local sources, as she identifies several patterns of infant mortality in twenty-two towns across England, but none in Wales.14

A major problem in interpreting these trends is that only a limited amount of age-specific cause of death information was published for each town. Ideally one would wish to build up an annual series of cause-specific infant mortality rates in order to examine whether the causes associated with the upturn in mortality during the late 1860s and early 1870s, and also that in the late 1890s, were the same for each town. Unfortunately, no figures were systematically published on an annual basis by the G.R.O. One could turn to the Medical Officer of Health Reports for various towns, however, because the reports vary in terms of the period for which they are available and, more importantly, because they are not readily accessible, the only alternative is to rely upon the Decennial Supplements of the G.R.O. 15

For much of the nineteenth century William Farr used the returns of local district registrars to compile the vital statistics which informed the annual reports of the Registrar General. In essence, local studies return to those sources in an attempt to unravel the complexities of local variations within and between regions. The Registration districts from which these facts were gathered concealed many local idiosyncrasies. Districts were variously designated urban or rural but most districts did not fall neatly into these categories. Merthyr Tydfil Union in Glamorganshire was formed under the Poor Law reforms of 1834, consisting of a large number of rural parishes, with that of the rapidly industrialising town of Merthyr Tydfil at its centre. Changing administrative structures during the nineteenth century further complicated the collation of information and administration. From 1875 the Public Health Act and

12 Lee, ‘Regional Inequalities Infant Mortality in Britain, 1861-1971, p.56. 13 Ibid., pp. 63-65. 14 Naomi Williams, ‘Infant and Child Mortality in Urban Areas of Nineteenth-century England and Wales: A record-linkage Study’, Ph. D. Thesis, University of Liverpool, 1989pp. 4, 29, 57-93. 15 Ibid., pp. 48-49. 7 professionalisation of medical officers of health raised the question of distribution of public health duties between local boards of health and boards of guardians. 16 The observations on the health, economic and social conditions in Merthyr Tydfil contained in the annual reports of Dr. Thomas Jones Dyke, a highly respected sanitarian, as Medical Officer of Health to the Merthyr Tydfil Local Board of Health from 1865 to 1900 form the backbone of this thesis. Their value lies in his intimate lifelong knowledge of the district, the continuity of his reports through his long professional tenure, their consistent internal methodology, and the continuity of these protocols by his successors. The availability of an unusually complete series of reports from 1865-1908, and the town’s history of high infant mortality rates are major reasons for choosing to examine public health and infant mortality in Merthyr Tydfil. His significant professional contribution to Merthyr and the broader public health field is discussed in Chapter 3.

Infant Mortality as a Complex Social Problem

F. B. Smith’s The People’s Health 1830-1910 provides a very useful overview of infant mortality.17 He argues that no single explanation adequately embraces the complex issues which sustained high infant mortality rates in Britain in the nineteenth century. Appalling sanitary conditions in urban and rural Britain were identified in the early-nineteenth century as a cause of high death rates, but the statistics which formed infant mortality rates did not adequately explain the many social factors involved. 18 As Victorian Britain became an increasingly urban society through industrial growth, sanitary reforms made frustratingly little impact on infant mortality. Lower rural rates contrasted with increasing urban infant mortality suggested a connection between women’s in manufacturing and textile towns and possible occupational links. 19 From the mid-nineteenth century women’s employment was believed to lead to

16 Ieuan Gwynedd Jones, Health Wealth and Politics in Victorian Wales, The Ernest Hughes Memorial Lectures delivered at the College on -27, 1978, University College of , Swansea, 1979; Jones, Mid-Victorian Wales., pp.30-34. 17 F. B. Smith, The People’s Health 1830-1910, first published 1979, reprinted Weidenfeld and Nicolson, London, 1990, Chapter 2, pp. 65-113. 18 Jones, Mid-Victorian Wales., pp. 6-7. Professor Ieuan Gwynedd Jones pursued the subject of working class and political consciousness and democratic process in his lecture, Health Wealth and Politics in Victorian Wales, pp. 22-39. 19 In the potteries, for example, women worked with high levels of lead and experienced high abortion rates. Adelaide Mary Anderson, Women in the Factory: An Administrative Adventure, 1893 to 1921, John Murray, London, 1922, pp.114-125, 149-165., George Newman, Infant Mortality a Social Problem, Methuen, London, 1906, pp. 69-72, 90-138. 8 neglect of infants, and the ignorance of mothers to improper care and feeding of infants. However, their employment also contributed to household incomes and offered a buffer against poverty. 20 Infant death rates, always higher among illegitimate infants, led to the investigation of abandonment and infanticide, made possible by forensic pathology to determine whether babies were stillborn or had breathed prior to death. 21 Midwives’ reputations were questioned when babies were reportedly stillborn and buried without registration. 22 The professional regulation of midwives was initiated through the Midwives Act of 1902. Their training included the care of newborn babies during the vulnerable first weeks of life, an initiative with the potential to save many infant lives, discussed in Chapter 6. From the 1890s the role of substandard working-class housing in high infant death rates was investigated increasingly. Smith cites Mrs. Drake’s study of infant life in Westminster in 1907 based on her first hand experience, which in every case links low income and poor housing with high morbidity and mortality amongst both infants and mothers.23 The Fabian Socialist survey conducted by Maud Pember Reeves in 1912 in Battersea, London, revealed destitution among some families, poverty among others, and decent impecuniousness among the rest. 24 This was almost certainly the case in Merthyr and most working-class areas. Letters to the Women’s in 1915 revealed in their own words the extent of women’s suffering. 25 Infant deaths from epidemic summer diarrhoea rose as part of the process of industrialisation and urbanisation in what Woods et al described as “the urban sanitary diarrhoea effect.” 26 Their work identifies the disparate class experiences of infant mortality between London suburbs at the turn of the century, just as Rowntree identified

20 M. A. Baines, Excessive Infant- Mortality: How Can It Be Stayed? A Paper Contributed to the National Social Science Association, (London Meeting;) To Which is Added a Short Paper, Reprinted from the Lancet on Infant-Alimentation, or Artificial Feeding, As a Substitute for Breast-Milk, Considered in its Physical and Social Aspects., John Churchill and Sons, London, 1862.The socio-medical researches of Dr. Jessie Duncan in Birmingham 1909-1911, National Conference on Infantile Mortality 1914., cit. Lionel Rose, Massacre of the Innocents: Infanticide in Great Britain 1800-1939, Routledge & Kegan Paul, London, 1986, pp.10-11., Jane Long, ‘Conversations in Cold Rooms: Women, Work and Poverty in Nineteenth-century Northumberland c.1834-1905’, Ph. D. Thesis, University of Western Australia, 1995. 21 Katherine O’Donovan, ‘The Medicalisation of Infanticide’, The Criminal Law Review, Sweet and Maxwell, London, 1984, pp. 259-264. 22 Rose, Massacre of the Innocents, pp. 57-93. 23 Smith, The People’s Health, pp.124-126. 24 Mrs. Pember Reeves, Family Life on a Pound a Week, Fabian Women’s Group, Fabian Tract No.162, 1912. 25 Margaret Llewellyn Davies (ed), Maternity Letters from Working Women, Collected by the Women’s Co-operative Guild, First published 1915, reprinted Virago, London, 1978. 26 R. I. Woods, P.A. Watterson, & J.H. Woodward, ‘The Causes of Rapid Infant Mortality Decline in England and Wales, 1861-1921’, Part 1, Population Studies, Vol. 42, (1988), pp.343-366, Part II., Population Studies, Vol. 43, (1989), pp.113-132. 9 different mortality rates in different areas of York in the 1890s. 27 The poorest and least educated mothers were more likely to give their infants inferior quality tinned, skimmed, condensed milk from filthy bottles, whilst dried milk was used by professional and artisan classes. M. W. Beaver attributes infant mortality decline from 1900 to improved milk supplies which were the cornerstone of the infant welfare movement. 28 Breastfeeding greatly improved the chance of infant survival and was strongly advocated. Ian Buchanan’s article concerning infant deaths from diarrhoea in six colliery communities including Aberdare and Rhondda identified flies as an important infective agent. 29 Moreover, among colliery women the reason for cessation of breastfeeding was likely to have been insufficient milk; “cannot” rather than “will not.” 30 The national fall in infant mortality rates in the first decade of the twentieth century coincided with the work of the infant welfare movement which aimed to improve the health of babies and reduce “the waste of infant life.” Deborah Dwork writes authoritatively and comprehensively on the work of the infant welfare movement in War is Good for Mothers and Babies (1994). High infant mortality rates co-existed with high birth rates and the move to fewer, healthier babies was led by the upper and middle classes in the Edwardian period, but large families persisted among the working classes well into the twentieth century. F. B. Smith refers to the problem of high birth rates and high infant mortality rates in industrial towns including Merthyr Tydfil. Eugenicists described an urgent need to improve the stock of the nation after the Report of the Interdepartmental Committee on Physical Deterioration, 1904 had revealed the extent of the poor health of working-class recruits for the Boer War. The health of mothers at this stage was only just beginning to be considered as one of the most significant factors in infant mortality. The 1904 report also revealed that working-class women worked hard, had little rest and poor diets. It was little wonder that they gave birth to weakly babies. 31

27 Seebohm B. Rowntree, Poverty: A Study of Town Life, 2nd Edition, Thomas Nelson & Sons, London., c.1900. 28 M.W. Beaver, ‘Population, Infant Mortality and Milk’, Population Studies, Vol.XXVII, No.2., July 1973, pp.. 244, 253. 29 I. H. Buchanan, ‘Infant feeding, Sanitation and Diarrhoea in Colliery Communities, 1880-1911’, in Derek J. Oddy and Derek S. Miller, (eds), Diet and Health in Modern Britain, Croom Helm, 1985, pp.148.158-162. 30 Ibid., pp.156-157. 31 Smith, The People’s Health, pp.68-69., 118-120. Report of the Inter-departmental Committee on Physical Deterioration, Vol.XXXII, 1904., Vol 1.1. Report and Appendix. Report of the Inter- Departmental Committee on Physical Deterioration Vol 1. 1904. [Cd.2175]; Linda Beresford, ‘Suffer the Little Children: Infant Mortality in England and Wales 1858-1911’, pp. 103- 108. 10 Edwardian social reforms included the employment of health visitors by local authorities which allowed the adoption of the Notification of Births Act, 1907 and reporting of births to local authorities within a few hours. From the 1890s the National Society for the Prevention of Cruelty to Children added to the number of professionals allowed legitimate access to people’s homes and the closer supervision of infant and . The medical inspection of schoolchildren and provision of milk and meals from 1908, and a review of Poor Law policies in 1909 were beneficial social initiatives, but many lay beyond public health policy. Infant mortality was a social class experience in which the poorer and most disadvantaged mothers and babies participated most. Smith, quoting Newsholme, compares the infant death rates in 1911 among the upper and middle classes at 77 per 1,000 and among miners at 160 per 1000. He observes: “Yet the deprivation that imprisoned working-class life remains crucial to any understanding of high infant morbidity and mortality rates.” 32

Moreover, as the rate for the comparatively well paid miners shows, infant mortality was not a simple outcome of poverty, nor of whether mothers worked outside the home,….. The normally static stock of poor housing and the rental or leasehold tenure of that stock must also have contributed to the poor sanitation and amenity normal in mining villages and the bad health that distinguished such communities. These complex factors were apparently still at work despite the social welfare revolution of the Second World War. 33

Smith’s observations on the effects of social deprivation hold true for this study of Merthyr.

Public Health in Victorian Wales

Professor Ieuan Gwynedd Jones places the history of public health in Wales in a national context. 34 He examines the patterns of diet, health, housing and labour conditions, and how these interrelated with living conditions to contribute to ill-health and disease in nineteenth-century Wales. Public health problems in Wales included poverty, inadequate diet and housing, overcrowding, and migration between districts and communities described in 1865 by Dr Julian Hunter, increasing people’s

32 Smith, The People’s Health, pp. 123-4. 33 Ibid., p.122. 34Jones, Mid-Victorian Wales, pp.24-53., Jones, Health, Wealth and Politics, Ieuan Gwynedd Jones, Communities: Essays in The Social History of Victorian Wales, Gomer Press, Llandysul, 1987. 11 vulnerability to ill-health. 35 Dr. Simon described the descent through poverty, malnutrition and sickness as part of a wider picture social deprivation, commenting that “...[t]here must be much direct causation of ill-health, and the associated causes of disease must be greatly strengthened by privation.” 36 The cold, damp atmosphere in mountainous regions contributed to rising infant mortality rates. The average general death rate for Wales 1841-1860 of 22 / 1000 population concealed significant local and annual variations. Professor Jones particularly identifies the high infant mortality rates in Merthyr. 37 He described the poverty underlying mortality statistics in rural Wales as much as the trauma and filth of industrial cities such as Merthyr where the problem of overcrowding was of great concern. 38 With its bountiful natural resources Wales was vulnerable to industrial and economic exploitation, inducing a migration from rural areas into industrial towns such as Merthyr. Transport networks connected towns with the coastal ports, increasing the importation of diseases such as cholera and smallpox. Trampers seeking work, and vagrants, helped spread diseases between communities. Labourers seeking work in industrialising towns lodged in overcrowded conditions and were exposed to occupational lung diseases such as tuberculosis. Work in iron and coal towns was often dangerous; an insidious toll of accidents, deaths and chronic ill health often left a dependent family without means of financial support. 39

Within this context of health and earnings, of housing and food, of the certainty and regularity of income being more important than the earnings, it is not the differences between agricultural labourers and industrial labourers and their families that are socially significant and important but the convergence between these different ways of life and the existence in town and country alike of a community of want. 40

In Wales, an emergent industrial class suffered severe social and economic deprivation creating a marked social division and the growth of political consciousness. “What many middle-class politicians took to be the apathy of the working classes was in reality

35 Julian Hunter, The Housing of the Poor Parts of the Population in Towns, cit. Jones, Mid-Victorian Wales, pp. 37, 43-44. 36 ‘Conditions of Nourishment’, Sixth Annual Report of the Medical Officer of the Privy Council (1863), 15. cit. Jones, Mid-Victorian Wales., p.44. 37 Jones, Mid-Victorian Wales, pp. 25- 26, 30-31, 43-44. 38 Jones, Health Wealth and Politics in Victorian Wales, Jones, Mid-Victorian Wales, pp. 36-40. 39 T. Boyns, ‘Work and Death in the Coalfield, 1874-1914’, Welsh History Review, Vol.12., December 1985., pp. 514-537. 40 Jones, Mid-Victorian Wales , p. 46. 12 the workers’ own realistic assessment and understanding of their own situation.” 41 Professor Jones considered the political survival of Merthyr Tydfil during the process of industrialisation to be very tenuous at times.42 The reports of the Inspectors of the General Board of Health in London, as sanitary engineers, and those from the Local Government Board with medical backgrounds, addressed the local environment, technology, diet, housing, working conditions and occupational health. George Thomas Clark, an excellent example of a brilliant Victorian mind at work, inspected over forty towns and cities throughout England and Wales for the General Board of Health from December 1848 to March 1850 as one of the Board’s superintending inspectors. 43 His varied and talented career advanced to managing the Dowlais Iron Works in Merthyr Tydfil from 1852-1898, chairing the Board of Guardians 1859-1881 and the Local Board of Health from 1862. I.G. Jones describes these reports as “statistically sophisticated reports, the first we can rely upon confidently for a depiction of the main factors in the quality of life for the inhabitants of the valleys.” 44 Andy Croll mounts a more critical textual analysis of the reports indicating their bias towards a Chadwickian view of the problems and their solutions. 45 Many aspects of Clark’s life are explored in a memorial volume edited by Brian Ll. James. Under Clark’s leadership Merthyr might have been transformed into one of Victorian Britain’s leading cities, but opposition from some ironmasters and property owners contributed to what Iuean Gwynedd Jones describes as “criminally slow” sanitary improvements in the town. 46

Industrial and Social Background in Merthyr Tydfil

Merthyr depended on the iron and coal industries for its existence, but Merthyr’s economic output was not without human cost in high mortality rates, ill health, poverty and poor living conditions associated with trade cycles and an increasing gap between

41 Ibid., p. 50. 42 Ieuan Gwynedd Jones: ‘ Merthyr Tydfil the Politics of Survival’, Llafur, Vol.2, No.1. Spring 1976, pp. 18-31. 43 Andy Croll, ‘Writing the Insanitary Town: G.T. Clark, Slums and Sanitary Reform’, in Brian Ll. James, (ed), Scholar, Ironmaster in the Victorian Age, pp. 26-27. 44 Jones, Mid-Victorian Wales, pp. 7-10. 45 Croll, ‘Writing the Insanitary Town’, pp. 27-32. 46 I.G. Jones, ‘Clark and Politics’, James, pp. 68- 69. Clark’s magnificent house at Talygarn reflected opulence in stark contrast to working class housing in Merthyr and at Dowlais. The Miners’ Welfare Committee bought Talygarn in 1923 and it later became a miners’ convalescent home. Derrick C. Kingham, ‘Clark of Talygarn’, James, Scholar, Ironmaster in the Victorian Age, p. 177. 13 wages and profits. Wages were governed by commodity prices and employment determined by industrial demand. Changing labour markets and variations between districts and industries, caused men to move between towns and industries seeking work as part of the industrial transitions from iron to steel production and the growth of the coal industry. Although wages were high at times for skilled labourers, unskilled labourers did not fare so well. Industrial action could bring the entire coalfield to a halt, as in 1898, and families co-existed with economic uncertainty and severe hardship at times. Conflicts of interest between the needs of industry and those of the townspeople became evident firstly in the lengthy delay in providing water for the town, and secondly during the industrial disputes of 1875 and 1898 in which the Poor Law was used to the advantage of industrialists. Merthyr was administered by two main bodies, the Merthyr Tydfil Board of Guardians from 1836 and the Merthyr Tydfil Local Board of Health from 1850. The domination of these boards by powerful industrialists is one of Merthyr’s distinguishing historical features, creating a rich source of political, economic and social analysis in the historiography of the town. The building of a workhouse under pressure from the Poor Law Board was delayed until 1853 when costly indoor rather than outdoor relief was to be provided. Disputes increased the divide between capital and labour, alienating and disempowering the workforce. In 1875 a strike and lock-out affected the majority of townspeople, especially dependent families. The alleviation of poverty was the responsibility of Merthyr Tydfil Board of Guardians, governed also by industrialists and property owners, concerned with the interests of ratepayers, the needs of the poor and their industrial strategies. The principles of the Poor Law were never intended to address mass urban poverty, and proved totally inadequate when the whole town suffered greatly during the major industrial crises in 1875 and 1898. Community soup kitchens provided meals for starving children, with local, national and international support. 47 Dyke alluded frequently to the effects of poverty on workers and their families. Social and economic hardship at times for the townspeople over several decades created endemic poverty in the community. The levels of general impoverishment were revealed by the reports of the School Medical Officer from 1908. These circumstances merged into the economic realities of life in Merthyr as a major centre of industry during the nineteenth century, and are reflected in high infant mortality rates as these conditions took their toll on the health of mothers. The social

47 Tydfil Davies Jones, ‘Poor Law and Public Health Administration in the Area of Merthyr Tydfil Union 1834-1894’ MA Thesis, University of Wales, 1961 held at Merthyr Tydfil Public Library. 14 and economic impact of industrial conditions on the health of families is examined in Chapter 2. The considerable research Tydfil Davies Jones undertook into the working of the Poor Law in Merthyr is first revealed in her MA thesis, which studies the application of the 1834 Poor Law Amendment Act and Public Health Legislation from 1848 in Merthyr Tydfil Union, identifying the inevitable link between poor health and poverty. As Tydfil Thomas, she reveals the powerful economic, social and political changes in Poor Law administration which took place in this area during the nineteenth century in Poor Relief in Merthyr Tydfil Union in Victorian Times (1992). 48 Her analysis of the 1875 industrial dispute provides an interesting political aspect of the Poor Law. Her book was welcomed by Sîan Rhiannon Williams because ‘if there is a single area in which the operation of the New Poor Law of 1834 was put to the test , that area was the newly industrialised south Wales, and, in particular Merthyr Tydfil Poor Law Union. Williams describes this as “a story in which the interests of are heavily weighted against humanitarian concerns.” 49 This exceedingly well-researched work is an important of social relations in Merthyr Tydfil and Aberdare. Her work has proved a great source of inspiration and has provided a useful measure of Merthyr’s progress in reducing infant mortality rates by the end of the century. The chronic housing problems in Merthyr created a major structural, political, and demographic social problem, discussed in Chapter 1. The mid-nineteenth century housing problems were investigated by Carter and Wheatley, and Kate Sullivan investigated the housing problems in later Victorian and Edwardian times. 50 Much unregulated industrial housing was built from the end of the eighteenth century by iron companies and private landlords around Merthyr’s ironworks. The paternalistic interest in the town shown by ironmasters earlier in the century declined with the transfer of ownership to companies. A housing survey in 1866 revealed many deficiencies with persistent overcrowding. Landlords were later reluctant to improve properties due to their age and state of disrepair, whilst tenants were anxious to keep rents low.

48 Tydfil Thomas, Poor Relief in Merthyr Tydfil Union in Victorian Times, Glamorgan Archive Service,1992, p.1. 49 Sîan Rhiannon Williams, ‘ Review of Poor Relief in Merthyr Tydfil Union in Victorian Times by Tydfil Thomas’ in Welsh History Review, Vol.17, 1994, p.141. 50 Harold Carter, and Sandra Wheatley, ‘Some Aspects of the Spatial Structure of Two Glamorgan Towns in the Nineteenth Century’, Welsh History Review, Vol.9., No.1., 1978, pp.32-5., Harold Carter, and Sandra Wheatley, Merthyr Tydfil in 1851 A Study of the Spatial Structure of A Welsh Industrial Town, University of Wales Press, Cardiff, 1982., Kate Sullivan, ‘The Biggest Room in Merthyr: Working-Class Housing in Dowlais, 1850-1914’, Welsh History Review, Vol. 17, No.2, December 1994, pp.155-185.

15 Improvements, closures, and higher rents forced families to share houses, and often beds. In these circumstances infants were extremely vulnerable. Housing shortages increased as the population grew rapidly with the opening of new colliery districts. The transfer of administration from the Local Board of Health to the Merthyr Tydfil Urban District Council in 1895, and a strong socialist presence in the town, initiated substantial housing improvements but insufficient for the extensive problem. Many derelict and overcrowded houses continued to share outside taps and sanitary arrangements into the twentieth century. George Sims, a social journalist, wrote a series of controversial articles on towns in 1906-7 for The Western Mail, in which he drew attention to the poor housing and high levels of infant mortality which existed in Merthyr and Dowlais, and which he denounced as “Merthyr’s shame.” 51 In 1912 the Independent Labour Party reappraised the traditional view of the economic contribution that the iron, steel and coal industries, especially Dowlais Iron Company, had made in making Merthyr Tydfil a national and global forerunner in terms of industrial production during the nineteenth century.52

After all the industrial history of a people is the most important aspect of any record of their social relationships…. Indeed, the industrial conditions of the common people mark the possibilities and the limitations of communal life, and historians are just beginning to realize that the institutions of a country and the conditions of life in a town cannot be rightly understood unless an attempt is made to get at the lives of the workers.53

It is at this historical and social interface of human relationships that the thesis lies.

Women and Welsh Historiography

The political and economic aspects of industrial histories have tended to render women invisible within the domestic sphere. The collection of essays edited by Angela John in Our Mother’s Land goes a long way to reclaiming the lives of women from the gender imbalance of Welsh historiography. 54 John’s appraisal of the roles of Lady

51 George Sims, ‘Human Wales’, Western Mail, 1907. Cartoons By Stannisforth, Western Mail, Cardiff, c.1900-1910. 52 The Democrat’s Handbook to Merthyr, Educational Publishing Co., Cardiff, c.1912. [These articles also appeared in the 1912 ILP Souvenir handbook of the Merthyr Branch of the ILP Annual Conference, 1912.] 53 Preface to The Democrat’s Handbook to Merthyr. 54 Angela V. John, (ed), Our Mother’ Land: Chapters in Welsh Women’s History 1830-1939., University of Wales Press, Cardiff, 1991. 16 Charlotte Guest and Rose Crawshay as wives of ironmasters indicates their strong presence and involvement in Merthyr’s affairs.55 Dot Jones examines the domestic contribution of wives and mother to the coal economy and the toll on their life expectancy, discussed further in Chapter 6. 56 Kay Cook and Neil Evans, and Rosemary N. Jones examine the vociferous political involvement of women in their communities. 57 Deirdre Beddoe’s work further addresses the gender imbalance by examining women’s domestic work and employment opportunities. 58 There were far fewer employment opportunities in Wales than in areas with more occupational diversity, and the remaining employment was largely for single women, often employed in domestic service. 59 Married women, prohibited from many industrial occupations, were forced to depend on male breadwinners, increasing the potential for endemic poverty among families. 60 Yet the women in Wales undertook hard physical labour in the home. This alternative work sphere went largely unrecognised, at great cost to female health and life expectancy. 61 Women in Merthyr married young, and, like many working-class women, lived and bore children in unhealthy surroundings with few amenities. Their ill-health was reflected in rising infant death rates from premature birth and deaths from antenatal causes as a further consequence of socio-economic difficulties, discussed in Chapter 6. 62 The conditions under which the working classes lived are accessible to historians, but attitudes to childbirth, childrearing and the death of infants are less so. Their experiences belonged in the private realm, the recording of which was a luxury denied most families as they shared overcrowded houses, relying on neighbours and family to help when times were hard. In Merthyr, high birth rates were welcomed as compensation for high infant mortality rates until a shift in thinking towards eugenicist models from 1905 encouraged

55 Angela V. John, ‘Beyond Paternalism: The Ironmaster’s Wife in the Industrial Community’, John, (ed), Our Mother’ Land: Chapters in Welsh Women’s History 1830-1939., pp.43-68. 56 Dot Jones, ‘Counting the Cost of Coal: Women’s Lives in the Rhondda, 1881-1911.’ In John, (ed), Our Mother’ Land:, pp.109-134. 57 Kay Cook and Neil Evans, ‘The Petty Antics of the Bell-Ringing Boisterous Band’? The Women’s Suffrage Movement in Wales, 1890-1918., John, (ed), Our Mother’ Land, pp.159-188., Rosemary A. N .Jones, ‘Women, Community and Collective Action: The ‘Ceffyl Pren’ Tradition’, John, (ed), Our Mother’ Land, pp.17-41. 58 Deirdre Beddoe, ‘Munitionettes, Maids and Mams: Women in Wales, 1914-1939’, John, (ed), Our Mother’ Land: pp.189-209., Deirdre Beddoe, Back to Home and Duty Women Between the Wars 1918 - 1939., Pandora, London, 1989, Deirdre Beddoe, Out of the Shadows A History of Women in Twentieth- Century Wales., University of Wales Press, Cardiff, 2000. 59 L.J. Williams and Dot Jones, ‘ Women at Work in Nineteenth Century Wales’, Llafur, Vol.3., No.3.,1982., pp.20-29. 60 Ibid., pp. 21-22. 61 Dot Jones, ‘Counting the Cost of Coal: Women’s Lives in the Rhondda, 1881-1911.’ John, (ed), Our Mother’ Land, pp.109-134. 62 Ibid., p.109. 17 a lower birth rate. Early marriage age and high birth rates also contributed to high infant mortality rates. Of direct relevance to infant mortality in Merthyr is Newland’s observation that “The poorest families experience the most dramatic leaps in infant mortality as family size increases.” 63

Research Process and Source Material

The wealth of material relating to public health and social and industrial development of the town available at the Glamorgan Record Office, and Merthyr Tydfil Local Studies Centre in Merthyr Tydfil Public Library provided much of the necessary background resources for this thesis. The microform collection of nineteenth-century newspapers held at Merthyr Library provided valuable insights into the daily life of the community. The thesis draws upon a number of primary and secondary sources concerning Merthyr Tydfil, south Wales and infant mortality. Merthyr’s notorious infant mortality rates have been absorbed into the cultural understanding of Merthyr as a place where life is uncertain and pleasure snatched amidst the harsh realities of life. The history of Merthyr Tydfil is already a rich narrative and it is not possible here to do justice to the many sources available but none specifically address the historical and social problem of infant mortality in the town. The early public health and social history of Merthyr has been defined by a series of significant primary reports by Sir Henry De la Bêche, T.W Rammell, William Kay, W. Farr and J. Spencer Low which have been used to construct Merthyr’s historical identity and the analysis of social relations in the town. 64 The secondary sources of professional historians provide well-researched analyses of various aspects of life in Merthyr at different periods especially the social, demographic and economic aspects of life in the south Wales coalfield. 65 I hope that my contribution may be

63 Newland, Infant Mortality and the Health of Societies, pp. 39-41. 64 T. W. Rammell, Report to the General Board of Health on a Preliminary Inquiry into the Sewerage, Drainage, and Supply of Water, and the Sanitary Condition of the Inhabitants of the Town of Merthyr Tydfil in the County of Glamorgan, 1850., William Kay, Report on the Sanitary Condition of Merthyr Tydfil; Drawn up at the Request of the Local Board of Health, 1854. ‘The South Wales Cholera Field’ ‘Report on the Cholera Epidemic of 1866 in England,’ Supplement to the Twenty-Ninth Annual Report of the Registrar General, London, 1868, 9., pp. xlix-xlixii., Sir Henry T. De La Bêche, Report on the Sanatory Condition of Merthyr Tydfil, Glamorganshire, Reports from Commissioners: State of Large towns and Populous Districts with Minutes of Evidence and Appendix [Part I and Part II], Vol. XVIII, 4th February -9th August, 1845., pp.142-151. Dr. J. Spencer Low’s Report to the Local Government Board on the Sanitary Circumstances and Administration of the Merthyr Tydfil Urban District., 1906. 65 Colin Baber and L.J. Williams, Modern South Wales: Essays in Economic History, University of Wales Press, Cardiff, 1986., David Egan, Coal Society: A History of the South Wales Mining Valleys 1840-1980, Gomer Press, Llandysul, Dyfed, 1987., Jones, Communities, Essays in the Social History of Victorian Wales, Phillip N. Jones, Colliery Settlement in the South Wales Coalfield 1850-1926, H.R. 18 juxtaposed with existing work to further illuminate Merthyr’s past. The crucial history of Merthyr’s water supply has been assessed by Raymond Grant. 66 The Merthyr Historian contains many interesting papers on various aspects of local history from the research of the Local History Group. Elwyn Bowen has published : A Study of the Welsh Countryside. 67 Several research theses appraise Merthyr’s rich local history. Keith Strange gives a lively and comprehensive account of a decade in Merthyr Tydfil in ‘The Condition of the Working Classes in Merthyr Tydfil 1840-50’ (1982). He examines the realities of life for the people of Merthyr in the mid-nineteenth century and their responses to work, wages, poverty, health, crime and religion. 68 The translation of social issues into reformist strategies is evaluated by Andy Croll through evolving popular culture of the town in ‘From Bar Stool to Choir Stall: Music and Morality in Late Victorian Merthyr.’ 69 The study of music informs many aspects of social relations, particularly in creating the notion of respectability. Undoubtedly an underclass in Merthyr descended into the abyss of poverty, intemperance, prostitution, and violence at this time. Historically, a constant tide of human disintegration probably represents a small steady proportion of the population at any time. The fine distinction between impoverishment and neglect was often morally judged by Victorian and Edwardian social reformers to be intemperance. Nevertheless, from 1908 the testimonies of the school medical officer bear witness to many malnourished, ill clothed, unhealthy children bearing the social and physical scars of an impoverished childhood in Merthyr. The Medical Officer of Health Reports for Merthyr Tydfil 1845-1908 are a rich, undervalued and underutilised historical resource. They are important social documents and provide an invaluable primary source for the thesis. Dr. Dyke formulated a standardised reporting system enhanced by his successors, Dr. Simon, Dr Jones and Dr Alexander Duncan. Most of these are held at Merthyr Tydfil Public Library and the Glamorgan Record Office. Further research at the Public Record Office, Kew, and at the Wellcome Institute brought together a complete series of the Medical Officer of Health

Wilkinson (ed) Occasional Papers in Geography, No.14, University of Hull Publications, (1969), Brinley Thomas, ‘The Migration of Labour into the Glamorganshire Coalfield 1861-1911’, Economica, 1.10, November 1930, pp.275-294., W.E. Minchinton, (ed) Industrial South Wales 1750-1914, London, 1969. 66 Raymond Grant, Water and Sanitation: The Struggle for Public health in Merthyr Tydfil , D. Brown & Sons, Bridgend, , 1991. 67 Dr. Elwyn Bowen, Vaynor A Study of the Welsh Countryside, Stephens & George Ltd., Merthyr Tydfil, 1992. 68 Keith Strange, ‘’The Condition of the Working Classes in Merthyr Tydfil, 1840-50’, Ph.D., Swansea University, 1982. Introduction p. iii. 69 Andy Croll, ‘From Bar Stool to Choir stall: Music and Morality in Late Victorian Merthyr’, Llafur, Vol. 6. No.1., 1992. p. 17. 19 Reports for Merthyr Tydfil 1865-1908, which encompasses the late Victorian period and the pivotal and transitional era of change towards infant welfare in Edwardian times.

Methodology

The general death rate fell during the nineteenth century, whilst the deaths of children under five gradually declined. However, a large percentage of these deaths were of infants under one year of age. 70 Historically, references to infant mortality rates did not always distinguish between deaths under five years of age and under one year of age. Edmund Greenhow’s report on gender specific, disease specific, occupational and regional mortality in 1858, followed by William Farr’s work on medical statistics, emphasised the contribution of infant mortality rates and deaths of children under five years to general death rates. Farr considered all data collected by specific age groups prior to 1862 to be “except as a matter of curiosity, utterly useless” since people did not know their exact age and five year intervals were generally used for statistical purposes. 71 According to F. B. Smith such figures, used by historians, “mask as much as they reveal.” 72 Infant deaths under one year of age did not decline nationally until 1902-5 and remained high especially in mining communities across Britain.73 The MOH reports complain frequently about the general demographic inaccuracies between decennial census figures. The use of infant mortality rates as an index, calculated on the number of deaths of infants under one year old per 1000 registered births, avoids many of the historical distortions caused by changing demographic features of the population. In mid-nineteenth-century Wales, average infant mortality rates were 120 / 1000 births, lower than in England at 150 / 1000. These figures are underestimated by about 10% through inefficient early-nineteenth-century registration systems, 6% by 1850 and reasonably reliable by 1874 when registration of births became compulsory. 74 Naomi William’s record cross-linkage in 1871 revealed that under-registration of deaths was predominantly due to poor registration, neonatal deaths (missing burials), and residential mobility which contributed to many missing

70 E. H. Greenhow, M.D.,Papers Relating to the Sanitary State of the People of England, General Board of Health, London, 1858, Gregg International, 1973., William Farr, Vital Statistics; A Memorial Volume of Selections from the Reports and Writings of William Farr, 1885, reprinted by Scarecrow Press Inc., Metuchen, New Jersey, 1975, pp.184, 121, 183-5. 71 Farr, Vital Statistics; p.184. 72 Smith, The People’s Health., p. 65. 73 Ibid., pp.119,123-4. 74 Jones, Mid-Victorian Wales., pp. 30-31, and Smith, The People’s Health, pp. 65-69. 20 post neo-natal deaths. 75 Compulsory notification of births was adopted by many local authorities from 1907, shortening the forty-five day gap between birth and the requirement for it to be registered, but notification was not universal until 1915. 76 The registration of stillbirths was not legally required until 1926. 77 By the end of the nineteenth century infant mortality rates for Wales exceeded that of England and Wales and Merthyr Tydfil’s rates were greatly in excess of both. (Appendix, Table 1 and Fig 4., Chapter 1.) There are inherent and unavoidable inaccuracies in the statistical sources for which allowance needs to be made. Difficulties include inaccurate data, inappropriate classification and certification of causes of death, non-standardised statistical methodology and the need to interpret such data in social, political and economic terms. Anne Hardy’s paper summarises the distortions in nineteenth-century vital statistics, which over the last thirty years or so have increasingly come to be regarded as inherently flawed. 78 Hardy found disjunctions between the General Register Office’s data and that used by the local medical officers of health and concludes “The more one considers how the GRO’s mortality series were constructed, the more they become nothing more nor less than artefacts, the productions of a rich and varied medical culture which itself could usefully do with extensive investigation.” 79 She quotes Bill Luckin in her assessment:

The evaluation and assessment of the GRO’s cause of death statistics thus becomes a long and winding road. …..Although there are problems also in using the GRO’s series for both births and marriages, it seems fair to say that they pale beside those of death, and more especially, of cause of death. Death is a hard fact, but cause of death is a matter of medical judgment, in which some decisions are relatively uniform across a , and others extremely fluid. Certification of cause of death ultimately takes the historian into the very personal world of individual clinical judgment, and of all the various influences that shape that judgment across the course of a

75 Naomi Williams, ‘Infant and Child Mortality in Urban Areas of Nineteenth-century England and Wales,’ p. 80. 76 Sir Arthur Newsholme, The Elements of Vital Statistics, originally published in 1889, reprinted, George Allen and Unwin, London, 1923, p. 71. 77 Rosalind Mitchison, British Population Change Since 1860., Macmillan, London, 1977, p. 49. 78 ‘Birth pains and death throes: the creation of vital statistics in Scotland and England: .A symposium supported by the Wellcome Trust arising from the ‘Scottish Way of Birth and Death’ Project, Centre for the History of Medicine, University of Glasgow. Friday 17 September 2004 http://www.google.com.au/search?hl=en&q=Anne+hardy+Death+Medicine+and+the+GRO&btnG=Goog le+Search&meta= Anne Hardy, Death, Medicine and the GRO, Wellcome Trust Centre for the History of Medicine at UCL. “This is an informal paper written in response to Anne Crowther’s request for reminiscences of my experiences with the GRO cause of death statistics for England and Wales, and given as an introduction to the Glasgow Centre for the History of Medicine’s workshop on historical statistics. The argument of the later section of the paper is articulated more formally in a ‘commentary’ published in A. Hardy, ‘Commentary: Macro-epidemiology and the lessons of history’, Revue d’epidemiologie et sante publique, 52 (2004): 353-356.” 79 A. Hardy, ‘Commentary: Macro-epidemiology and the lessons of history’, pp. 353-356. 21 practitioner’s lifetime. Bill Luckin’s warning of nearly 25 years ago – that these statistics should only be used with great caution and scepticism only acquires edge with the years. 80

With these difficulties taken into account, this study uses the annual reports of the local Medical Officers of Health for Merthyr Tydfil 1865-1908 to investigate the relationship between infant mortality and social conditions in Merthyr Tydfil. Appended to each of the reports is a summary table of ages and attributed causes of death at all ages, including infants under one year of age which provide the basic data from which the analysis of a total of over 17,000 infant deaths has been derived. The study investigates the social origins of the stated causes of death and the impact of public health endeavours on general and disease-specific infant mortality. It co-investigates the evolution of public health interpretations of infant mortality from a focus on the urban sanitary environment to one on maternal health, and explains the contrast between these new effective understandings with the inability of local authorities to curtail infant mortality in Merthyr Tydfil. The task of analysing the causes of infant deaths in order to combine both sound quantitative numerical and qualitative social analysis was challenging. The medically assigned causes of infant death needed to be re-assigned to categories and classifications which reflect the social origins of infant death. Deaths were initially classified into twelve main groups intended to illuminate the social causes underlying those deaths, which involved the generation of many tables, annotated where necessary. There were relatively few unclassifiable causes of infant death and these were accorded their own category. A complete list of conditions assigned to each category is found in Appendix. Table 7. The full analysis of all causes is located in Appendix. Tables 7-19, and discussed in Chapters 4, 5 and 6. Calculation of infant mortality rates has been based on the number of registered births and infant deaths reported to district registrars and contained in Dyke’s reports, a process which appears to have been carried out with a relatively high degree of efficiency and accuracy in Merthyr. In analysing the causes of infant mortality in Merthyr, the disease specific infant mortality rate (DSIMR) provides consistency in assessing change for various causes of death. The number of deaths given by the MOH gives an interesting perspective each year on causes of infant death, in that “fewer” or a “great number” indicates the immediate perception of the problem and the actual numbers give a useful and accessible comparison of the various causes of death

80 Anne Hardy, Death, Medicine and the GRO, p. 10.

22 in real terms. Every effort has been made to ensure the accuracy of figures, and I accept responsibility for any mathematical errors that may have occurred. However, some discrepancies have proved unavoidable due to numerical or statistical inconsistencies within the MOH reports and source tables, particularly from 1901-8, where data has been compiled from tables to account for as many infant deaths as possible. The number of deaths given in tables of deaths at week and months in the first year 1905-8 do not exactly tally with the principal tables of deaths at all ages. Many examples are provided in the notes to Appendix. Tables 1 (a), 2 and Table 7. The analysis has been taken to two decimal places in most instances, particularly where the number of deaths analysed is small. However, the reader is urged to bear the above difficulties in mind and encouraged to consider the analysis as a reasonably accurate representation of infant deaths in Merthyr Tydfil 1865-1908, in terms of general trends, patterns and inferences rather than as absolute figures. Medical nosology and classifications of disease is also generally accepted as an inherent problem to be negotiated in historical research. Assigned medical causes of infant death are widely acknowledged as providing a somewhat nebulous and possibly inaccurate explanation of infant death. There were huge disjunctions in the construction of medical knowledge which created problems in terminology. Convulsions, dentition and teething are among the most frustrating causes of death cited, since they are symptoms rather than causes of death. For example, the changing rate of deaths from convulsion in the late 1870s suggests their possible re-classification as diarrhoeal deaths. 81 Not all deaths were reported or certified by medical practitioners, and even when they were, the cause of death was often inaccurate. The term “causes”, must be understood as a convenient phrase, but not all were direct causes of infant death; many were indirect, secondary or contributory factors. M.G. Marmot and J. N. Morris, who present a sociological model of public health, conclude that for the most prevalent diseases at any time, “[t]he notion of ‘necessary’ cause is not generally very helpful in studying human health and disease.” 82 More useful is the notion of ‘sufficient’ causes, currently known as risk factors, which are social and environmental conditions that are causally distal and that increase the prevalence and severity of multiple diseases. 83 This

81 A. M. Gassage, and J. a. Cooutts, “A Discussion on Convulsions in Infancy”, the British Medical Journal, 19 August, 1899, pp.460-463. Magdalene Bengtsson, ‘The Interpretation of Cause of Death Among Infants’, Hygiea internationalis, Vol., 3, December 2002, pp. 53-73. The paper raises some interesting points regarding causes of death and changing mortality patterns in Sweden. 82 M.G. Marmot and J.N. Morris, ‘The Social Environment’, in Walter W. Holland, Roger Detels, and George Knox, The Oxford Textbook of Public Health Volume 1: History, determinants, scope and strategies., p.97. 83 Ibid., p.116. 23 is essential to a social analysis of infant mortality; the dependency of infants upon their environment combined with their vulnerability to disease suggests the need to consider the interplay of manifest disease and milieu. Not only was the body itself intellectually dissected for the purpose of medical reporting, but it was also dissociated from its social environment. The causes of death determined by the Royal College of Physicians according to a medical physiological and anatomical nosology changed over time and were not necessarily accurate. 84 The causes of death were medically classified according to functional bodily systems through which the disease or cause of death was expressed, for example zymotic or infectious diseases, respiratory, nervous, digestive or skeletal systems. Some causes of death e.g. bronchitis were easily assessed; others, e.g. caries of spine, had to be extracted from the skeletal system in order to draw all deaths from tuberculosis together for the purpose of analysis. Deaths in childbirth were classified as diseases of women although deaths from puerperal fever were for some time included as zymotic diseases, alongside chickenpox and measles. Dyke obtained his information from local registrars with whom he developed a collaborative working relationship to obtain information as accurate as possible within the provisions of birth and death registration. To his credit, there are relatively few unexplained deaths and the analysis revealed a reasonably comprehensive picture of all the many recorded causes of infant death which make up the annual infant mortality rates, and not simply the principal causes. A total of 610 infant deaths in Merthyr were unclassifiable 1865-1908. The first main category of my re-classification included causes of death related to the community environment external to the home, including causes of death relating to sanitation and water supply, in particular cholera, enteric fever and typhoid, with a further category for infectious diseases which originated outside the home as community epidemics. The second much larger category included causes of death which reflected the internal home environment or social circumstances within the home. These included individual secondary and home-acquired infections, lung diseases, tuberculosis, convulsions, nutritional deficiencies, and causes of maternal origin, diarrhoea, sudden and violent deaths. This category also includes the classification of deaths of maternal origin. Syphilis, for example, was medically assigned as an infectious disease, but needed to be placed in a category which reflected the fact that syphilis as a cause of infant death had been congenitally acquired from the mother.

84 N. Williams, ‘Infant and Child Mortality in Urban Areas of Nineteenth-century England and Wales, pp. 52-53, Table 2.8, pp.79-80. 24 Likewise congenital abnormalities occur through various mechanisms which affect the foetus in utero, whether through environmental toxins or through nutritional deficiencies in the mother. A classification for diarrhoeal deaths was necessary since the historical problem of escalating infant deaths from summer diarrhea has been the subject of a number of studies. Dyke did not understand infant mortality in the way it is now in additional terms of maternal health and perinatal risks, assuming instead that infant mortality rates would fall through improving environmental health standard for the general population. Dyke applied sound basic public health principles during his administration, many of which reflected the orthodoxies of his youth. Despite his endeavours, infant mortality rates rose by the end of the century Dyke was aware of the inherent difficulties and resulting inaccuracies of statistical methods and wrote in 1865 “If any slight errors should be discovered, I will trust that the novelty, as well as any difficulty, of the calculations may be admitted as an excuse.” 85 His methods failed to reveal rising infant death rates that become evident when using standard calculations of infant deaths per 1000 registered births. 86

Causes of Death by Weeks and Months in Merthyr Tydfil, 1905-1908

Woods, Watterson and Woodward found that the fall in infant mortality at the beginning of the twentieth century was due to a reduction in post-neonatal rather than neonatal mortality. Naomi Williams observes that pre-1905 age classifications of infant deaths generally preclude investigation of endogenous causes that are chiefly due to maternal health factors associated with early infant death, and their separation from exogenous (environmental and social) causes in later infancy. 87 In Merthyr Tydfil,

85 T.J .Dyke, MOH Report for Merthyr Tydfil, 1865, p.6 86 In his report for 1890, p.14, Dr. Dyke made a retrospective summary of the years 1866-1890. The average age of death at 17 ½ years, 1845-1855, was prolonged to 27 ½ years, 1886-1890. In the years 1845-55 deaths from typhoid fever were 21 ½ per 10,000 population but fell to an average 3 ⅔, 1866- 1890. Deaths from consumption fell from 38/10,000, 1845-55, to 19/10,000 from 1866 to 1890. However, these figures must be treated with caution since the first set is based on 10,000 population averaged over a decade and the second set averaged over 25 years. For these same periods Dyke estimates deaths from lung diseases affecting all sexes and all ages at 28 per 10,000, 1845-55, rising to 43/10,000, 1866-1875, and again rising to 47 /10,000, 1876-1885, whilst from 1886-1890 it fell to 30 /10,000. The rise in lung diseases was most apparent in children under five years of age, which was 133/4 /10, 000, 1845-55, averaged 21/10,000, 1886-1890. The death rate from diarrhoea before any sanitary works was 11 ¼ /10,000 and averaged 3 ¾ /10,000 from 1866 to 1890, p.14. 87 Woods et al, “The causes of rapid infant mortality decline in England and Wales, 1861-1921, Parts I and II, Population Studies, 42, 1988, pp. 343-366, pp.352-353, and 43, 1989, pp.113-132 cit. Naomi Williams, ‘Infant and Child Mortality in Urban Areas of Nineteenth-century England and Wales: , pp. 50, 52.

25 endogenous infant deaths rose significantly from the 1880s, a finding which does not appear to be accounted for by changing specifications of causes of death. In 1866 Dr. Dyke recorded the age at death in weeks and months of 441 infants in his report, but this method was not pursued. In 1905 the Local Government Board required a separate appendix giving the age at death of infants in weeks and months to be included in the MOH reports. Therefore it is only possible to assess the causes of death in weeks and months during the first year of life for the four years 1905-8, and the causes of death given in those tables do not reconcile exactly with the number of infant deaths given in the tables of deaths at all ages. Nevertheless, this provides helpful information on the different causes and patterns of death at different stages during the first year and allows some useful inferences to be drawn for the period 1865-1908. (Table 4.6.) For example, disease clustering by age can better explain likely causes of death for deaths registered as convulsions. Approximately 30% of infant deaths occurred within the first month of life and up to 50% within the first three months.(Table 4.3.) 88 The varying causes of death at different ages within the first year of life represent the socio-economic and physical environment experienced by the mother and infant from birth and the transition from endogenous to exogenous causes.

Research Analysis and Conclusions

Analysis of these groups of infant deaths identified the major causes of infant death influencing the upward trend in infant mortality rates until the end of the nineteenth century. These were convulsions, diarrhoea, lung diseases, and antenatal causes. Annual variations in disease-specific death rates due to epidemic cycles and seasonal extremes were observed. The findings of the analysis of all causes of death analysed in twelve initial groups are charted in Figure 6., Chapter 4, overlaid with 7 year moving trend lines for the major categories of infant death which drove up infant mortality rates 1865-1908. Figure 7., Chapter 4 shows clearly the seven year moving averages of all major causes of infant death. The major trends over time were that infant deaths from epidemic diseases declined slightly from 1876, but measles and whooping cough persisted as significant causes of infant death. Deaths from convulsions declined as deaths from lung diseases, diarrhoea and causes of maternal origin rose. Deaths from

88 D.J .Thomas and A. Duncan, Annual Report of the Medical Officer of Health for the Year 1905, Borough of Merthyr Tydfil, p.29, Alex. Duncan, Annual Report of the Medical Officer of Health for the Year 1908, Borough of Merthyr Tydfil, p.19. 26 nutritional causes provided a continuing steady influence on infant mortality rates. By 1908 deaths of maternal origin were the only ones still driving up infant mortality rates in Merthyr Tydfil. Many of the causes of infant death interacted and therefore should be considered as part of an overall picture of the causes of infant mortality and this is emphasised throughout the thesis. An important observation that Dyke made on several occasions was his estimate that each death in Merthyr represented ten cases in the community, many of whom survived with compromised health. In Merthyr, infant deaths from infectious diseases were not the decisive factor of infant death rates, discussed in Chapter 4. Their prevention was the objective of many applications of public health legislation. Whooping cough, measles and other viral and bacterial infections proved especially deadly for infants and were promoted by overcrowding and compromised immunity in the under fives. Overcrowding also contributed to deaths from tuberculosis, lung diseases and diarrhoea. These could arguably have been obviated by public health measures to improve hygiene and sanitation of dwellings and address overcrowding, such as application of building regulations and ensuring affordable and available housing. In Merthyr these methods were poorly implemented despite their strong advocacy by Dyke to the Board of Health and his insistence on the connection between high death rates and poor housing. During the 1890s, Dyke observed great pressure on housing due to the influx of young families into the district as new coal mines opened up in Merthyr’s lower and newer districts. The small decline in deaths from infectious diseases concurs with McKeown and Record’s hypothesis that deaths from infectious diseases declined without medical intervention through improved living standards and changing host response. 89 However, little evidence of a sustained rise in living standards in Merthyr has been discovered in this study. Dyke’s evidence indicates that deaths from lung diseases increased following epidemics of whooping cough and measles, but increased at a greater exponential rate than may be explained by their association with measles and whooping cough. The rises in infant deaths from lung diseases in the 1890s and a rise in tuberculosis deaths over a similar time-frame, suggest that overcrowding allowed the rapid dissemination of infantile epidemic pneumonia and the respiratory syncytial virus. This is frequently the case in infants and can go on to cause severe weight loss and malnutrition during which tuberculosis, an opportunistic disease, could take hold. Chronic diarrhoeal infections

89 T. McKeown and R. G. Record, ‘Reasons for the decline of Mortality‘, M. W. Flinn and T.C. Smout, Essays in Social History, Clarendon Press, Oxford, 1974, pp.218-250.

27 further undermined the health of infants, causing weight loss and malnutrition in a vicious cycle. Woods et al identify the rising diarrhoea deaths as indicator of urban social disparity and significant cause of infant death by the Edwardian period. 90 I. H. Buchanan’s specific study of diarrhoea deaths in colliery communities including the Rhondda is particularly relevant. 91 Deborak Dwork, in War is Good for Babies and other Young Children (1987), explores the role of the infant welfare movement and local authorities in reducing infant deaths from diarrhoea. 92 Infant deaths from lung diseases and diarrhoea are discussed in Chapter 5. In the industrial and social conditions described in Chapters 1 and 2 girls married young and bore large families. 93 Heavy work in the home was also governed by the nature of men’s industrial work. The resultant poor life expectancy and high maternal morbidity affected infant health, as evidenced in the rising infant mortality rates from causes of antenatal origin. ( Appendix. Table 17.a., Table 6.12. ) There were several causes of infant death of maternal origin emanating from antenatal conditions of the mother, independent of the sanitary environment. Debility, atrophy and failure to thrive were causes of infant death concerned with normal growth and development of the infant, many of which appeared to originate from poor nutrition during foetal development and chronic maternal illness. These are discussed in Chapter 6. The mandatory training and regulation of midwives with the introduction of the Midwives Act of 1902, had enormous potential to save many infant lives. Yet by 1908, infant deaths from antenatal causes were still rising. The number of trained midwives was insufficient to replace bona fide midwives forced to retire from practice. Inspection of bona fide midwives from 1903 found low levels of hygiene and literacy. Many spoke only Welsh and were thus unable to take advantage of training and undertake examinations conducted in English, the alternative to retiring from practice. The Health Visitor appointed in Merthyr Tydfil in 1907 was able to visit many mothers and babies and gauge the extent of their problems. However, the social malaise of poverty

90 Woods, et al, “The causes of rapid infant mortality decline in England and Wales, 1861-1921, Parts I pp.352-353, and Part II, pp.113-132. 91 Ian H. Buchanan, ‘Infant Mortality in Mining Communities’, Ph.D. Thesis, London School of Economics, 1983., Buchanan, “Infant feeding, sanitation and diarrhoea in colliery communities 1880- 1911, in Oddy and Miller, Diet and Health in Modern Britain, pp.148-177. 92 Deborah Dwork, War is Good for Babies and Other Young Children, Tavistock Publications, London, 1987. 93 Enquiries regarding family histories often reveal age disparities and evidence of girls marrying under the age of 16. Proof of age was not required until 1927. Observations shared in conversation with Carolyn Jacob, Local Studies Librarian, Merthyr Tydfil Local Studies Unit, Merthyr Tydfil Public Library. 28 engendering chronic ill-health required comprehensive socio-economic measures which were beyond the scope of public health reforms.

Thesis Structure

The first three chapters explain the development of public health in Merthyr Tydfil 1845-1908. Chapter 1 introduces the industrial conurbation of Merthyr Tydfil which grew from the end of the eighteenth century to gain global supremacy in iron production by the mid-1840s, until the industry declined by the 1870s through the technological transition to steel production. Throughout the nineteenth and early twentieth centuries the coal industries expanded into the lower parts of Merthyr and neighbouring districts. The chapter introduces the town’s social, public health and industrial and housing development 1845-1908. Chapter 2 evaluates the social impact of industrialisation 1842-1898 and explains why the conditions of industry engendered chronic impoverishment for families despite high wages at times, especially among miners. 94 Chapter 3 assesses the contribution of Dr. Thomas Jones Dyke as Medical Officer of Health to the town 1865-1900 and his professional role in the broader national arena of public health reform. His intimate local knowledge was of great benefit during his administration, but deteriorating health during his final years was beginning to undermine his work at a crucial time of rising infant mortality rates. He died still holding office in 1900. The last three chapters examine the social and environmental causes of infant death with an annotated analysis of causes of infant death according to the Medical Officer of Health Reports for Merthyr Tydfil 1865-1908. Chapters 3, 4 and 5 contain the analysis of the attributed causes of death of over 17,000 infant during this period. Chapter 4 analyses convulsions, tuberculosis and infectious diseases as causes of infant death. Although deaths from infectious diseases among infants did not, by themselves, influence the upward trend of infant mortality rates, the control of infectious disease was a basic tenet of public health. It was therefore important to understand how it related to infant mortality. Every cause-specific infant mortality rate corresponds to a far greater morbidity rate, increasing susceptibility to and severity of further diseases; in this sense causes of infant death are dynamic and compounding. Chapter 5 analyses diarrhoea and lung diseases, the major causes of infant mortality rates, insanitary conditions and seasonal extremes. In spite of the harsh conditions in which they brought

94 Smith, The People’s Health, pp. 119-120, 123. 29 up their families, mothers were blamed for their carelessness in rearing their offspring. Education of mothers in infant feeding and some improvement in housing saw these causes of infant death begin to decline from 1902. Chapter 6 concludes the analysis by examining the maternal and nutritional causes of infant death and exploring the complex social and environmental conditions in which the women of Merthyr found themselves. These circumstances made it nigh impossible to improve public health for them, even with such public health measures as those championed by Dr. Dyke. This chapter also foregrounds the lives of women in industrial Wales who have for a long time been “invisible” to the history of the Coalfield. Theirs is a historical invisibility that parallels the eclipsing of human need in economic pursuits.

Conclusion

When the life of the Merthyr community is explored in order to explain infant mortality, the research process transforms into a mutual illumination of infant mortality by community history and vice versa. It becomes apparent that no single factor conveniently explains the town’s high infant mortality rates, nor the patterns of infant deaths from their chief causes; convulsions, infectious diseases, lung diseases, diarrhoea, malnourishment and premature birth. Living and working conditions in Merthyr Tydfil must form part of the account, for the documented provision of basic public health infrastructure can mask the underlying inadequacies of town life for the bulk of the population. High infant mortality rates in Merthyr Tydfil are best explicated by a combination of factors: poor urban environment; overcrowding; poverty; poor maternal health and high birth rates. These represented features of life in Merthyr as an industrial community throughout the period examined. The thesis argues that the majority of causes of infant death were supported by adverse social and environmental conditions which continually lay beyond the scope of public health measures until the twentieth century. An increasing portion of deaths can be linked back to antenatal causes and the health of the mother, which reflected her social circumstances and her inability to adequately care for the infant within that social environment. The need for broad social reform lay at the root of infant mortality as much as the need to control disease and meet the basic sanitary requirements of the community. I do not consider the limitations of working on a project such as this from Western Australia to have detracted from the study unduly. The prescribed limitations

30 of this study make it in no way exhaustive, creating many avenues for further research. The thesis as a Welsh study aims to contribute both to the local and to the national understanding of the multiple historical experiences of infant mortality across Britain in the nineteenth and early twentieth centuries. It also opens up further areas of research to students of public health and history and places one of Wales’ most significant towns firmly on the national and global map. Merthyr Tydfil has a vibrant history, much of which lives on through generational and community memories. I hope that this research will inform some aspects of the past for the people of Merthyr, and encourage researchers to recognise and use available Medical Officer of Health reports as rich historiographic sources despite their inherent difficulties concerning nineteenth-century statistics.

31 Cartoons by Staniforth, Western Mail, Cardiff, c.1900-1910

Plate 1.

32 Chapter 1

Public Health and Infant Mortality in Merthyr Tydfil 1849-1908

Introduction

In spite of several decades of sanitary improvements during the nineteenth century infant mortality in Merthyr did not fall. Public health problems that began with the early industrial development of the town in the eighteenth century, and persisted into the twentieth, contributed to chronically high levels of infant mortality. In the cholera year of 1849 Merthyr’s infant mortality rate was 238/1000 births. In 1899, Merthyr’s infant mortality rate peaked at 271/1000 births when a hot dry summer across the nation caused many deaths from epidemic summer diarrhoea. This chapter examines a number of these problems, their origins and how the only local authorities Merthyr possessed for most of the nineteenth century responded to them. The Merthyr Tydfil Board of Guardians, first elected in 1836 under the New Poor Law, struggled to address the problems of poverty, disease and high mortality rates in a notoriously filthy town. Cholera in 1849 provided the incentive for initiating public health reforms with the implementation of the Public Health Act of 1848 and the formation of Merthyr Tydfil Board of Health in 1850. The provision of water and sanitation was of general benefit in lowering death-rates, but was not universal even by the twentieth century. Merthyr’s longstanding housing problems, particularly ageing, substandard accommodation, slum areas and overcrowding, contributed to high infant mortality rates as a significant feature of Merthyr’s public health problems into the Edwardian period. In 1898 and 1906 the social journalist George Sims critically linked living conditions in Dowlais to high rates of infant mortality, and to capitalist exploitation of the working classes. The analysis of the causes of over 17,000 infant deaths 1865-1908 from the MOH Reports for Merthyr Tydfil indicates that although environmental conditions in Merthyr are vital in accounting for high infant mortality rates in the town, the social and economic effects of industrialisation were equally significant and are explored in Chapter Two. The MOH reports for 1905-8 enable one to determine the ages at which infant deaths occurred. These reports summarise the percentages of deaths at various ages during the first year of life. Approximately 30% of deaths occurred in the first

33 month of life and approximately 50% within the first three months, many related to antenatal conditions or premature birth. This is discussed further in Chapter Six. Deaths thereafter are more likely to be associated with adverse environmental circumstances. The antenatal health of the mother and hence the infant’s prospects for survival cannot be separated from the social and economic conditions of life in Merthyr. Dr. Alex. Duncan, MOH for Merthyr Tydfil, concluded in 1908, that:

It is not to be expected that the improvement in the sanitary surroundings will greatly lessen the number of deaths occurring in the first month of life, as antenatal conditions must be held to be largely responsible for them.1

In 1908 the Merthyr Express affirmed these conclusions:

It is to be noted, therefore, that the first week is the most fatal to infants, and the number occurring during this period will probably be not greatly reduced by improvement in the sanitary surroundings of the patients. Antenatal conditions must be held to be the cause of death in most of these cases; and this will apply to the majority of deaths occurring during the first month of life.2

By 1919, although the infant mortality rate had fallen to 90/1000, 25% of deaths occurred in the first week, 88% of those deaths directly linked to premature birth, and 42% in the first month. 3 Environmental health problems only partly elucidate why public health reforms failed to lower infant mortality rates in the nineteenth century, since the health of mothers was overlooked as a relevant concern until the Edwardian period. These aspects of the historical problem of infant mortality in Merthyr Tydfil are examined in subsequent chapters as part of the analysis of the causes of infant deaths. ( Table 1.1.)

Industrialisation and Population Change in Merthyr: The first phase

Merthyr Tydfil is located at the head of the deep valleys leading to the bleak mountain ranges of the Beacons which link Monmouthshire, Glamorganshire, Breconshire, West and Mid-Wales, on the perimeter of the south Wales coalfield where the essential resources of water, charcoal, iron ore, limestone and coal for iron

1 Dr. Alex Duncan, MOH Report for Merthyr Tydfil for 1908, p.18. 2 The Merthyr Express, 2 May, 1908, p.8. 3 MOH Report for Merthyr Tydfil for 1919, Appendix,Table IV. 34 Table1.1. Percentages of Infant Deaths in Weeks and Months During the First Year of Life in Merthyr Tydfil 1905-8and 1919 (MOH Reports for Merthyr Tydfil 1905-8 and 1919.) Age at 1905 1906 1907 1908 1919 death % Number % Number % Number % Number % Number Under 14% 81 16.2% 79 19.3 % 81 14.3% 69 25% 42 1week 1-2 weeks 3% 18 4.3% 21 3% 13 3.5% 17 7% 12 2-3 weeks 3% 18 5% 24 5% 21 5% 24 5% 9 3-4 weeks 10% 59 3.3% 16 3.3% 14 3.9% 19 4% 7 Total 1st 30% 176 28.7% 140 30.7% 129 26.7% 129 42% 70 month including first week 1-2 months 8% 44 12.5% 61 10.5% 44 11% 53 2-3 months 8% 48 9.8% 48 9% 38 9% 44 All infant 46.5% 268 51% 249 50.2% 211 46.8% 226 58% 97 deaths under 3months 3-4months 6% 37 10% 49 7% 29 10% 49 4-5months 7% 40 8% 37 7.4% 31 7.5% 36 5-6months 7% 41 5.3% 26 5% 21 5.8% 28 3-6 months 20.5% 118 23% 112 19% 81 24% 113 17% 28 6-7 6.6% 38 6.6% 32 7.4% 31 6.8% 33 7-8 6% 34 4% 19 3.8% 16 5.8% 28 8-9 6% 35 2.9% 14 5.7% 24 4% 20 9-10 5% 28 4.7% 23 4.5% 19 5% 24 months 10-11 4.3% 25 3.9% 19 4.5% 19 3.7% 18 months 11-12 5.2% 30 4% 20 4.5% 19 4% 20 months 6-9 months 18.6% 107 13.3% 65 16.9% 71 16.8% 81 14.9% 25 9-12 14.4% 83 12.7% 62 13.6 % 57 12.9% 62 10.2% 17 months 3-12 53% 308 49% 239 49.7% 209 53% 256 41.9% 97 months Uncertified 26 2 6 3 0 Deaths Certified 550 485 414 479 167 Total 576 487 420 482 167 number of deaths

production were found. 4 The hamlets of Merthyr, Dowlais and grew as a conurbation around the iron works from the end of the eighteenth century joined by and Troedyrhiw as the town expanded. Merthyr passed through its first major phase of industrialisation during the late eighteenth and early nineteenth centuries as it spearheaded the industrial development

4 Egan, Coal Society, pp. 5-32. 35 of South Wales to supply iron for military use, from the Napoleonic War to the Great War. The Dowlais and Works supplied iron rails globally from 1825, producing 40% of Britain’s iron by 1831. 5 Production reached 46,756 tons in 1820 and had increased four-fold to 204,339 tons by 1846. Iron and coal were transported to the growing ports of Swansea and Cardiff to meet the growing demand for iron rails for railway building and the demand for steam coal to fuel industrial engines. Profits increased as traffic on the doubled every seven years. 6 By the 1840s Merthyr had attained global supremacy in iron production, attracting a migrant population from surrounding rural counties to a chaotically expanding industrial iron town. “Whatever these places were, they were not towns in the accepted sense, and the people who lived in them were not ‘town-dwellers’ but the ‘inhabitants of the iron- districts’. They might be urban; they were certainly not civic.” 7 From 1801-1851 the population of Merthyr grew substantially, particularly 1831-1851 due to massive immigration and an excess of births over deaths. It more than doubled between 1841 and 1851 to make Merthyr the largest town in Wales. 8 From 1851-1881 the population was almost stationary, as the economic conditions in the iron, steel and coal industries fluctuated. From 1881-1901 the population increased by 20,271 as the general population of the south Wales coalfield grew and the newer districts grew around opening coal mines, especially around Merthyr Vale. (Table 1.2., Appendix. Tables 2- 2e.) 9

Table 1. 3. shows that 40% of the population in 1851 had been born in the neighbouring rural Welsh counties of Carmarthen, Brecon, Pembroke and Cardigan and 26% in Merthyr Tydfil. 10 The predominantly working-class population of Merthyr was made up of varying nationalities and levels of labour skills. Demand for industrial labour attracted workers from many parts of Britain including Irish immigrants from the

5 Thomas, Poor Relief in Merthyr Tydfil Union in Victorian Times, pp. 1-5, John Davies, History of Wales, Penguin Books, London 1990, p.403. 6 Combined iron output from the Dowlais, Cyfarthfa, Penydarren and Plymouth works increased from 170,248 tons 1816-20, to 524,511 tons 1836-1840. Hugh Jones, ‘Industrial History of Merthyr’, The Democrat’s Handbook to Merthyr, pp. 40-42. A List of profits and dividends is given, pp. 40-41., a list of rateable values p.42. [These articles also appeared in the 1912 ILP Souvenir handbook of the Merthyr Branch of the ILP Annual Conference, 1912.] 7 Jones, Health, Wealth and Politics in Victorian Wales, p.15. 8 Census, 1851, Table 1,xi, District No.582., cit. Kay, M.D., Report on the Sanitary State of Merthyr Tydfil, Drawn Up At The Request of the Local Board of Health, and Read at the Meeting of the Board, on the 15th Day of May, 1854, pp.16-17. 9 D. J. Thomas, Annual Report of Medical Officer of Health for Merthyr Tydfil for 1904., p.8. 10 Grant, ‘Merthyr Tydfil in the Mid-Nineteenth Century: the Struggle for Public Health’, p. 575., Thomas, ‘The Migration of Labour into the Glamorganshire Coalfield (1861-1911)’, pp.276-7. 36 11 1820s. These workers were largely recruited to the lower paid occupations in the iron works.

Table 1.2. Population Growth in Merthyr Tydfil 1801-1911: Jones, Hugh, “Industrial History of Merthyr”, The Democrat’s Handbook, (c.1912), p.37.* Year Population 1801 7,707 1811 11,104 1821 17,404 1831 22,083 1841 34,978 1851 46,389 *[46692 Appendix Table 2] 1861 49,810 * [50461 Appendix Table 2 ] 1871 51,891 * [52,000 Appendix Table 2 ] 1881 48,857 * [49,000 Appendix Table 2] 1891 58,080 Agrees with table 2. 1901 69,277 [69,493 MOH Report for 1905] 1911 81,293 * The population numbers are as cited in the source. The numbers used in Appendix Table 2 are compiled from the MOH reports and differ slightly from the above and within different reports. They should therefore be considered as estimates only. According to Gareth Hopkins, ‘Population’ in Merthyr Tydfil Teachers Centre Group, Merthyr Tydfil: A Valley Community, D. Brown and Sons Ltd., Bridgend, 1981, p.377. the population of Merthyr peaked in 1901 at 80,000 and fell to 55,000 by 1975.

Table 1. 3. Place of Birth and Composition of Population Aged Over 20 Living in the Parish o f Merthyr Tydfil in 1851 (Raymond K. Grant, ‘ Merthyr Tydfil in the Mid- Nineteenth Century: The Struggle for Public Health,’ Welsh History Review, Vol. 14, 1989, p.575, Brinley, Thomas, ‘The Migration of labour into the Glamorganshire Coalfield (1861-1911)’, Economica, Vol. 10., November, 1930, pp.275-294., pp.276-7.) Number of persons over 20 yrs Percentage of Total Place of Birth in Parish of Merthyr Tydfil 14,189 40.4 Neighbouring Welsh Counties (Carmarthen, Brecon, Pembroke and Cardigan) 9,120 25.9 Merthyr Tydfil 4,146 11.8 Glamorgan 2,330 6.55 Ireland 5,308 15.1 Elsewhere (Midlands)

Total 35,093

11 Pat Molloy, And They Blessed Rebecca: An Account of the Welsh Toll-gate Riots, 1839-1844, Gomer Press, Llandysul, 1983, p.16. 37 Merthyr Tydfil 1851-1921

90000 80000 70000 60000 50000 40000

Popultaion 30000 20000 10000 0

6 1 6 1 89 90 91 92 1851 1856 1861 1866 1871 1876 1881 1886 1891 1 1 1906 1911 1 1 Year

Figure 1. Population Growth In Merthyr Tydfil 1851-1921

Merthyr Tydfil 1841-1921

3500

3000

2500

2000 Births 1500 Total Deaths Number 1000

500

0

4 1 8 5 0 7 4 1 84 85 85 90 90 91 92 1801 1 1 1 186 1872 1879 1886 1893 1 1 1 1 Year

Figure 2. Excess Births Over Total deaths in Merthyr Tydfil 1841-1921

Social Administration and Politics of Merthyr

As the town’s workforce rapidly expanded the population was forced into inadequate housing in a town with no civic infrastructure and lacking the most basic amenities, contributing to the town’s appalling reputation for squalor and filth. The town initially lacked a water supply, sewerage and drainage and by the end of the nineteenth century was plagued by the intractable problems of rapidly deteriorating housing and slum dwellings with chronic overcrowding. These problems were managed by the Board of Guardians until 1850, then in conjunction with the Local Board of

38 Health, by Merthyr Tydfil Urban District Council from 1895 and Merthyr Tydfil Borough Council from 1903.

Merthyr Tydfil 1851-1921

90000 3000

80000 2500 70000

60000 2000

Population 50000 Occupied Houses 1500 Marriages 40000

Population Births

30000 1000

20000 Marriages/Births/Occupied Houses 500 10000

0 0 1851 1861 1871 1881 1891 1901 1911 1921 Number

Figure 3. Comparative Population Growth and Housing Merthyr Tydfil 1851-1921.

Table 1. 4. Area and Population of Parishes in Merthyr Tydfil Poor Law Union 1831-1891. (Merthyr Tydfil Union Abstract of Accounts, October, 1894., cit. Tydfil Thomas, Poor Relief in Merthyr Tydfil Union in Victorian Times, 1992., Appendix 1., p.155.) Parish Area Population in Acres Year 1831 1841 1851 1861 1871 1881 1891 Aberdare 16,858 3,961 6,471 14,998 33,247 37,704 35,514 40,906 Gelligaer 16,388 825 3,215 3,807 5,777 9,192 11,592 12,754 Merthyr 17,714 22,083 34,978 46,389 49,810 51,891 48,857 58,080 Penderyn 12,765 1,385 1,488 1,775 1,331 1,668 1,598 1,433 Rhigos 5,420 505 615 1,047 822 863 1,008 964 Vaynor 6,597 1,933 2,286 2,667 2,984 2,792 2,851 3,057 Total 75,742 31,692 49,053 70,683 92,971 104,110 101,420 117,194

The formation of Merthyr Tydfil Union under the Poor Law Amendment Act of 1834 bringing nine urban and rural parishes under the administration of the Board of Guardians also shaped the history of the town. The Workhouse was built in 1853 amidst

39 great controversy.12 Merthyr Tydfil, as the only Union in south Wales without a workhouse until 1853, attracted vagrants since they could not be compelled to accept indoor relief. In 1849 an estimated 10,000-11,000 itinerant people passed through Merthyr, accommodated in filthy overcrowded lodging houses.13 Merthyr Tydfil and Aberdare were the principal centres of population. The population of the Union more than doubled from 49,053 in 1841 to 117,194 by 1891. (Table 1. 4.) The Rural Sanitary Authority reported separately to the Poor Law Board and from 1871 to the Local Government Board. Merthyr Tydfil Board of Guardians carried out many public health and administrative duties on behalf of the Poor Law Board for the whole registration district and was responsible for controlling infectious diseases in the community and running the hospital and the workhouse. 14 These responsibilities continued when the Local Board of Health assumed responsibility for the parish, town and urban district of Merthyr Tydfil. Aberdare and Merthyr Tydfil Local Boards of Health obtained legal powers under the provisions of the Public Health Acts of 1848, 1866 and 1875, particularly in respect of infectious diseases and housing. This study concerns the central urban districts of Merthyr Tydfil, 15 initially divided into six wards, Dowlais, Penydarren, Cyfarthfa, Tydfil’s Well (Merthyr Town), Gellideg and Troedyrhiw. Merthyr Vale and Quaker’s Yard were later included within Merthyr’s boundaries as coal mining expanded into the lower districts. 16

A distinctive feature of the social administration and politics of industrial Merthyr for much of the nineteenth century was the role of the ironmasters. They controlled the parliamentary representation of the town, dominated the boards set up to deal with the poor law and public health and blocked attempts to have Merthyr incorporated under the Municipal Corporations Act of 1835. 17 According to The Democrat’s Handbook in 1912:

The history of local government in the of Merthyr Tydfil is unique in character….in the sense that all changes in the status of the town

12 Three relieving officers were appointed for each of three districts, the first Merthyr Tydfil and Vaynor, the second Gelligaer, Llanfabon and Llanwonno, the third Ystradfodwg, Rhigos, Aberdare and Penderyn. The parish of Ystradfodwg was transferred to Pontypridd Union, created in 1863 as the population of the Rhondda Valleys grew. Thomas, Poor Relief in Merthyr Tydfil Union in Victorian Times, pp. 22-27. 13. Thomas, Poor relief in Merthyr Tydfil Union, pp. 39-41. 14 The Rural Sanitary Authority was administered by the Board of Guardians, and Poor Law Medical Officers. Communication and cooperation between the two Boards was essential, for example during the smallpox epidemic 1872. The system led to inefficiencies identified by Dyke, discussed in Chapter 3. 15 Patchy records for rural districts of Merthyr Tydfil and other areas of Glamorgan are available at the Glamorgan Record Office and The Public Record Office in London as reports forwarded to the General Board of Health, Local Government Board, and from 1895 to Glamorgan County Council. 16 Thomas, Poor Relief in Merthyr Tydfil Union in Victorian Times, p.42. 17 A. Citizen, “History of Local Government in Merthyr Tydfil’, The Democrat’s Handbook, pp.79-83. 40 have been obtained, not by a natural transition from one stage to another following the advance in legislation, but by a continual struggle on the part of the common people of the town against the iron and coal masters of the district.18

Rammell observed the absence of a middle class with the vision and power to advocate for change.19 Professor Ieuan Gwynedd Jones concisely summarises the social structure of the town as

the absence of men of independent means, not connected with the works, and residing in the town, people that is to say, who could be independent of the ironmasters, set standards of behaviour, and stand between the common people, including tradespeople, artisans and craftsmen, and the industrialists. But even if such a class of people had existed, there was no forum for debate, no machinery of government which they could hope to control. Indeed, because the ironmasters ruled like princes within their own territories, which were ‘like states in miniature’, and suffered no interference in their affairs from any other competitors or by any other body (even statutory bodies like the Poor Law Commissioners) the public good inevitably suffered. Politics in such a situation was the art of doing as little as possible, and of resisting rather than initiating change.20

The two main administrative bodies, the Board of Guardians and the Local Board of Health, were dominated by the town’s powerful industrialists and their vested interests. The Board of Health was dominated by ‘the four iron masters who contributed above half the district rates.’ 21 Tydfil Thomas calculated that in 1849 the ironmasters contributed £7,937.14.s.0d in poor rates and expenditure on poor relief was £10,034.25s.5d, demonstrating that the ironmasters contributed approximately 70% of the rates. 22 Sir John Guest of Dowlais Iron Company (DIC), the first chairman, died in 1852 and his place was taken by Robert Crawshay of Cyfarthfa Iron Works. Anthony Hill of Plymouth Iron Works, and Benjamin Martin, agent of the Penydarren Works were also members of the Board.23 Lady Charlotte, whose tenth and last child was born in 1847, capably ran DIC until she left Dowlais for Canford in Dorset following her marriage to Charles Schreiber in 1855. George Thomas Clark and Henry Austin Bruce were appointed Trustees of DIC and the works profitably expanded. 24 G.T. Clark, had

18 Ibid., p. 77 19 Rammell, Report to the General Board of Health on a Preliminary Inquiry into the Sewerage, Drainage, and Supply of Water, and the Sanitary Condition of the Inhabitants of the Town of Merthyr Tydfil in the County of Glamorgan, London, 1850, pp. 11-12. 20 Jones, ‘Clark and Politics’, pp. 70-71. 21Minutes. MTLBH, IV, 12, Grant, ‘Merthyr Tydfil in The Mid-Nineteenth Century: The Struggle for Public Health’, p.586. 22 Thomas, Poor Relief in Merthyr Tydfil Union in Victorian Times, Appendix 5, p.159. 23 Jones, Communities: Essays in the Social History of Victorian Wales, pp.261-2 and MTLBH MIN. I, 158 cit. Grant, ‘Merthyr Tydfil in the Mid-Nineteenth Century: the Struggle for Public Health’, p.586. 24 John, ‘Beyond Paternalism: The Ironmaster’s Wife in the Industrial Community’, John, (ed)., Our Mothers’ Land: Chapters in Welsh Women’s History 1830-1939, pp. 43,47-8, 50-53., Joseph Gross, 41 worked as an engineer under I.K. Brunel on the and had pursued many inquiries under the Public Health Act of 1848, as an Inspector of the General Board of Health. 25 He was therefore very familiar with the requirements of both the Act and sanitary engineering. Clark’s expertise as a talented and influential citizen of Merthyr linked the town significantly with sanitary reform and the implementation of public health at a national level. Table 1. 5. Changing Administrative Structure of Merthyr Tydfil and Adoptive Public Health Acts (MOH Reports for Merthyr Tydfil1854-1908.) Year Administrative Body Acts 1836 Merthyr Tydfil Board of Guardians Public Health Act 1848 1850-1895 Merthyr Tydfil Local Board Health Adulteration of Food Act 1860 Notification Infectious Diseases Act 1866 Public Health Act 1875 Artizans Dwelling Bill 1875 Dairies, Cowsheds and Milkshops Order (1885) ( Infectious Disease Notification Act, Bubonic Plague added) 7th January 1891) (Infectious Disease Prevention)(March 18th 1891) Public Health (Amendments) Act 1890 March 18th 1891. Regulations Under the Dairies Cowshed and Milkshops Order June 1st 1901. 1895 Merthyr Tydfil Urban District Council Housing Working Classes Acts Health Committee (1890) (March 18th 1891) Houses of Working Classes Committee 1905 Merthyr Tydfil Municipal Borough Liverpool Corporation Act 1907 (Tuberculosis) Appointment of Health Visitor and Inspector of Midwives (1907) Notification of Births Act 1907 1908 Merthyr Tydfil County Borough Council School Medical Officer of Health Appointment of (1908) Public Health (Measles and German Measles) Order 1916 (Cancelled January 1st 1920)

The conflict between the needs of industry and those of the labouring population prevented these boards from acting fully in the best interests of the townspeople, even at the expense of the health of the population. Eligibility to vote for the boards was limited to men over twenty-one years of age holding property rated above £10 per annum. Only 520 out of 40,000, or one in 77 inhabitants, were eligible, mainly the industrial masters,

‘Water Supply and Sewerage in Merthyr Tydfil 1850-1974’, Merthyr Historian, V.2, 1978, pp. 69-70 and Grant, “Merthyr Tydfil in the Mid-Nineteenth Century: the Struggle for Public Health”, p.588, Revel Guest and Angela V. John, Lady Charlotte: A Biography of the Nineteenth Century, Weidenfeld and Nicolson, London, 1989, p.xii. 25 Croll ‘Writing the Insanitary Town: G.T. Clark, Slums and Sanitary Reform’, pp.24-47. 42 landowners, and traders. Property owners held plural votes according to the value of their property qualification, giving the ironmasters the balance of power. Election to public office, including local boards of health and boards of guardians, was based on property qualifications until abolished in 1882. The property qualification for guardians of the New Poor Law was £500 or an income of at least £15 a year. By 1867 one man in 57 had the vote in the constituency of Merthyr Tydfil. 26 Most workers were excluded from political power, and the few who had votes often voted according to the dictates of their employer’s agents in the absence of a secret ballot. 27

The Reform Act of 1832 created the new parliamentary borough of Merthyr Tydfil, which included Aberdare, Merthyr Tydfil in Glamorganshire and Vaynor and Cefn-Coed in Breconshire. Sir John Guest, owner of DIC was elected as Merthyr’s parliamentary representative amidst Merthyr’s early radical Chartism. Henry Austin Bruce succeeded Guest, holding the seat 1852-68. 28 The Reform Act of 1867 extended the vote to male householders, increasing the voting population in Merthyr from 1,387 to 14,577 in 1868 and gained Merthyr a second MP. 29 The Act also allowed disgruntled employees to express their deteriorating relationship with H.A. Bruce. 30 The Trade Unions Act of 1871 and the growing Trade Union movement increasingly expressed a sense of social injustice and heightened tensions between owners and workers. The Ballot Act of 1872 encouraged nonconformist radicalism and a further Reform Act in 1884 carried Merthyr further towards democracy. 31 In 1868 Bruce lost his seat to Henry Richard, a Welsh, Liberal, Non-Conformist with no industrial or fiscal interests, and to the industrialist Richard Fothergill. In 1888, D.A. Thomas of the South Wales Coalowners Association was returned unopposed, the miners “erroneously” believing that this was in their interests. 32 Keir Hardie, the first Independent Labour MP to enter parliament, was elected member for Merthyr Tydfil in 1900. These elections gradually

26 Thomas, Poor Relief in Merthyr Tydfil Union, p. 8. 27 Ibid., p. 7. 28 Bruce was Home Secretary 1869-73, but by that time he was MP for Renfrewshire, ousted by Henry Richards. 29 Thomas, Poor Relief in Merthyr Tydfil Union, p. 8. 30 Brian LL. James, ‘‘The Making of a Scholar Ironmaster: An Introduction to the Life of G. T. Clark’, James,(ed), G.T. Clark: Scholar Ironmaster in the Victorian Age, p.19., Jones, ‘Clark and Politics’, pp.74- 79. G. P. Smith’s ‘Social Control and Industrial Relations at the Dowlais Iron Company c.1850-1890’, M. Sc. Thesis, , 1981., examines the degree of socialisation and social control exerted on the employees by the domination of the ironworks in their lives at Merthyr during the Clark’s tenure of office. 31 Thomas, Poor Relief in Merthyr Tydfil Union pp. 5-8. 32 William Lawrence, ‘Political History of Merthyr Tydfil’, The Democrats Handbook to Merthyr, pp. 54-5. 43 transformed the political landscape from the earlier domination by industrialists over a disenfranchised population.

The incorporation of the town was first sought under the Municipal Corporations Act of 1835 in 1837, and again in 1857, 1876, 1880 and 1897. The ironmasters, anxious to maintain their representative power on the Local Board of Health, opposed any advance in the status of the town’s governing body. 33 In 1902 extensive powers were granted to Glamorgan County Council, renewing the struggle for a Charter. The move was again determinedly opposed by the iron and coal companies in April 1903. It required a special Act of Parliament to create the town a Municipal Borough on 6 June 1905. 34 Following opposition from large companies and Glamorgan County Council, Merthyr became a County Borough on 8 April 1908.35

A network of ILP branches grew all over the constituency and an alliance was forged between trade unionists and Socialists through the Labour Representation Association. Keir Hardie wrote of his involvement in Merthyr “As our movement grows in power the health and amenities of the old town and its environs are improving. Already the worker walks more erect, and the bondage of Capitalism becomes daily more irksome.” 36 The inadequacy of Merthyr’s Local Board of Health to deal with the needs of a large town became evident as the population increased. In 1895, it was replaced by the Merthyr Tydfil District Council and Health Committee, ushering in a new era of social reform. Members of both the Council and the Board of Guardians became more sympathetic to working-class needs. Many problems were inherited from the Local Board of Health and the major concern of large companies was still the cost in rates rather than the benefit to Merthyr’s inhabitants. The solution, according to the Independent Labour Party lay “in the representation of the people upon that body.”37 Independent Labour Party members of the Urban District Council and the Board of Guardians increasingly used their democratic and political power to place social reforms firmly on the political agenda. 38 From 1895 Merthyr’s more democratic local government set about the onerous task of building affordable working-class housing

33 ‘The History of The Incorporation Movement in Merthyr Tydfil’, Merthyr Express Almanac and Year Book for 1898, Merthyr Tydfil, 1898, pp. 89ff. Lawrence, ‘Political History of Merthyr Tydfil’, The Democrat’s Handbook To Merthyr, p. 81. Ironmasters played a crucial role in Merthyr’s early political history from the early nineteenth century. David J. V. Jones, ‘A Unique Society’, The Last Rising: The Newport Insurrection of 1839, Oxford University Press, Oxford, 1985., Chapter 1, pp.7-45. 34 Lawrence, ‘Political History of Merthyr Tydfil’, pp. 81-83. 35 Ibid., p.79. 36 J. Keir Hardie, M.P., ‘My Relations with the Merthyr Boroughs’, The Democrat’s Handbook To Merthyr, p.13. 37 Lawrence, ‘Political History of Merthyr Tydfil’, p. 83. 38 Egan, Coal Society, pp. 40-44. 44 funded largely from the public purse, which acted as an exemplary model for other districts in south Wales. 39 When Merthyr received its Charter of Incorporation in 1903 the Borough was reorganised into 8 wards with the Trades Council returning all its candidates in all wards. This gave 14 Labour members out of 32 members of the Corporation and increased the opportunity for reforms favourable to the working classes, particularly in regard to housing.

Cholera and Social Change

The rapid expansion of the population 1821-1851 as workers flooded to the booming iron town meant that workers were crowded into hastily constructed houses and densely packed alleys and courts with no urban design or infrastructure. Cholera epidemics in 1832, 1849, 1854 and 1866 raised ongoing concerns about the prevailing sanitary state of the town. 40 The Royal Commission on the Sanitary State of Large Towns and Populous Districts (1844), investigated the insalubrious condition of Merthyr and the Public Health Act of 1848 empowered local authorities to establish local boards of health to improve the sanitary environment. 41 Merthyr Tydfil ratepayers petitioned the General Board of Health to implement the 1848 Act, strongly favoured by Sir John Guest, owner of the DIC. 42 Lewis Lewis, Vice-Chairman of the Board of Guardians, representing ratepayers, opposed it, fearing that it would increase the rates.

The high rate of mortality which had been alluded to was caused by the mode of life of the people, working underground, and by want of sufficiency of food, and not by want of sanitary laws. What they wanted was more meat.43

Workers feared that landlords would increase rents if they were compelled to improve properties. John Williams, a miner who owned three cottages, also opposed the proposal, believing that it would compound the existing miseries of poverty:

39 Kate Sullivan, ‘The Biggest Room in Merthyr’. Working-Class Housing in Dowlais, 1850-1914., The Welsh History Review, Vol.17, Dec, 1994., No.2. pp.184-185 . 40 Ieuan Gwynedd Jones, ‘The People’s Health in Mid- Victorian Wales’, Mid-Victorian Wales: The Observers and The Observed, Ch.2, 41 M.W. Flinn, (ed), Report on the Sanitary Condition of the Labouring Population of Great Britain by Edwin Chadwick 1842, Edinburgh University Press,1965. 42 Rammell, Report to the General Board of Health on a Preliminary Inquiry into the Sewerage, Drainage, and Supply of Water, and the Sanitary Condition of the Inhabitants of the Town of Merthyr Tydfil, in the County of Glamorgan, pp.3-4. Merthyr Express, 27/1/1900. 43 Mr. F. James, Clerk to the Board of Guardians, Rammell, Report to the General Board of Health on a Preliminary Inquiry into the Sewerage, Drainage, and Supply of Water, and the Sanitary Condition of the Inhabitants of the Town of Merthyr Tydfil, in the County of Glamorgan, p. 4, 45

I am opposed to the introduction of the [Public Health] Act [because] it compels everyone to take water, and that they will be obliged to pay 1 d. a week for it. My reason is, that people have not enough to buy food, and have nothing to spare for water; and that it costs them nothing to fetch water. The wives of many being barefooted, there is no expense of shoe-leather. I don’t know if I would rather pay 1 ½ d. a week for the doctor than for water; half a pint of beer costs 1 ¼ d. I should not be inclined to give half a pint of beer for a supply of water for the week.44

Thomas Webster Rammell inspected the town in 1850. His report was followed by the formation of Merthyr Tydfil Local Board of Health. Rammell found the filthy town distinctly lacking in civic amenities and devoid of civic government.45 Dr. William Kay as temporary MOH in 1854 warned that little had improved since Rammell’s visit.46 The basic public health provisions of water, drainage and sewerage followed further cholera outbreaks in 1854 and 1866. The Sanitary Act of 1866 conferred further powers on local boards of health particularly in relation to control of infectious diseases. 47 The spread of cholera by polluted water supplies was not understood in 1849, but the filth and inadequacy of existing sources were abundantly clear. During the very hot summer and drought that year people drank from the dwindling, polluted water supply. 48 From May to September 3,248 cholera cases were reported, with 1,416 deaths in Merthyr, Penydarren and Dowlais. 49 By 1866, the spread of cholera from polluted water was understood together with the necessity of a clean water supply as a prerequisite for a healthy urban environment. 50 In 1850 Inspector Rammell found the town desperately in need of a piped water supply and adequate drainage and sewerage. Many hastily erected houses were small

44 John Williams, miner, and owner of 3 cottages, Rammell, Report to the General Board of Health on a Preliminary Inquiry into the Sewerage, Drainage, and Supply of water, and the Sanitary Condition of the Inhabitants of the Town of Merthyr Tydfil, p. 47. 45Rammell, Report to the General Board of Health on a Preliminary Inquiry into the Sewerage, Drainage, and Supply of water, and the Sanitary Condition of the Inhabitants of the Town of Merthyr Tydfil, p. 12. 46 Kay, Report on the Sanitary Condition of Merthyr Tydfil; 1854, p. 75. 47 Jones, Mid-Victorian Wales, pp. 33-34. The annual reports of the Medical Officers of the Privy Council are available only in manuscript from Royal College of Surgeons. See also A. H. Williams, ‘Public Health and Local History’, The Local Historian, 14, No. 4, 1980, pp. 202 -210. Williams describes the wealth of material relating to public health in Wales held at the Public Record Office and the difficulty of legislation and correspondence in English for a predominantly Welsh speaking population. pp. 206-9. 48 Rammell, Report to the General Board of Health on a Preliminary Inquiry into the Sewerage, Drainage, and Supply of Water, and the Sanitary Condition of the Inhabitants of the Town of Merthyr Tydfil, in the County of Glamorgan, pp.34-7. 49 Ibid., p.62. 50 William Farr, ‘Report on the Cholera Epidemic of 1866 in England:’ Supplement to the Twenty Ninth Annual Report of the Registrar General, 1868, pp. ix -x. Grant, “Merthyr Tydfil in the Mid-Nineteenth Century: the Struggle for Public Health”, pp.584-5 cit. Asa Briggs, Victorian Cities, Folio Society, Bury St. Edmunds, 1996., p.21. 46 and overcrowded, without privies and water. The water supply was derived from springs, from wells frequently contaminated by cesspits, and from the , polluted by human ordure. 51 Seepage from twenty-one overcrowded burial grounds overflowed into water sources. A number of “severe and fatal cases of cholera occurred in a nest of hovels, all in a disgusting state of filth,” called Bethesda Square, situated below the graveyard of Bethesda Welsh Independent Chapel:

There is a well in the square, or rather a hole, containing filthy water, which must necessarily have percolated in part from the churchyard: this water the poor people who came under my notice were only too glad to use when they could obtain it…..My conviction is that the state of the churchyard contributes largely to the extraordinary unhealthiness of this spot.52

Consequently, mortality rates there were high and life expectancy among the majority of the working-class population was seventeen years. 53

In 1850 Merthyr had ‘a higher mortality rate than any other commercial or manufacturing town in the kingdom.’ Cholera, smallpox, typhoid, and typhus caused 21% of the deaths between 1841-7. Later MOH reports reveal that the damp, cold winter climate caused infant deaths from bronchitis and pneumonia to increase in winter months. During the hotter months, deaths from epidemic summer diarrhoea escalated, especially as the century wore on. The reports also reveal measles, whooping cough and premature birth as major causes of infant death. The majority of deaths 1841-7 were under 20 years old (5,036 out of 7,779 in seven years.) Children under five years old accounted for 55% of deaths.54 The deaths of 2,090 infants under one year old formed over a third of these 5,036, over a quarter of the total deaths 1841-7. 55 Tydfil Thomas describes the effects of these epidemics on infant mortality as “sensational.” 56 Table 1. 6. illustrates this point with the addition of infant mortality rates calculated on the given figures for those years. Despite high infant mortality and death-rates 1841-7, the number of babies surviving outnumbered the total deaths by 3,636, a pattern which continued

51 Rammell ‘Report to the General Board of Health on a Preliminary Inquiry into the Sewerage, Drainage, and Supply of Water, and the Sanitary Condition of the Inhabitants of the Town of Merthyr Tydfil, in the County of Glamorgan, ‘p.37.,cit. T. J. Dyke, Medical Officer of Health Report for Merthyr Tydfil for the Year 1865., p.14. 52Rammell, Report to the General Board of Health on a Preliminary Inquiry into the Sewerage, Drainage, and Supply of Water, and the Sanitary Condition of the Inhabitants of the Town of Merthyr Tydfil, in the County of Glamorgan, p. 45. 53 Ibid. pp.16-17. 54 Grant, ‘Merthyr Tydfil in the Mid-Nineteenth Century: the Struggle for Public Health’, p. 594. 55 Rammell, Report to the General Board of Health on a Preliminary Inquiry into the Sewerage, Drainage and Supply of Water and the sanitary Conditions of the Inhabitants of Merthyr Tydfil, 1850, p.24.cit. Thomas, Poor Relief, p. 54. 56 Thomas, Poor Relief in Merthyr Tydfil Union, 1992, p.50. 47 during the nineteenth century as a significant factor in population growth. From 1881- 1891 population growth in the registration District of Merthyr Tydfil was 16,764. During this period there were 37,302 births and 24,328 deaths. Births exceeded deaths by 12,924, leaving a net increase by immigration of 3,840. (Figs. 1. and 2., Appendix Tables 2-2(e).)

Fig 4. Comparative Infant Mortality Rates 1844-1916

300

250

200 E&W 150 Wales

Persons Merthyr 100

50

0

8 4 0 6 2 8 4 62 68 8 8 87 88 88 89 183 1844 1850 1856 1 1 1 1 1 1 189 190 1910 1916 Year

Figure 4. Comparative Infant Mortality Rates Merthyr Tydfil, Wales, England and Wales 1844-1916.

Rammell proposed damming the Taf Fechan River [River Taff] to provide Merthyr with piped water. He also proposed a sewerage system allowing the principal main sewer to discharge into the river below the Plymouth Works. The cost of these schemes was to be met by loans to the Local Board of Health from the Commissioners of Public Works and from the Atlas Assurance Society. 57 In 1854 a further cholera outbreak was managed by the Local Board of Health in conjunction with the Board of Guardians. Dr. William Kay, appointed temporary MOH in 1854, still regarded Merthyr as “one of the dirtiest towns in Her Majesty’s dominions”, an unenviable reputation considering the insalubrities of most British towns at the time. 58 Kay warned that

57 Grant, “Merthyr Tydfil in the Mid-Nineteenth Century: the Struggle for Public Health”, pp.587-591. 58 Jones, Communities: Essays in The Social History of Victorian Wales, pp. 244-5, Thomas Jones Dyke, British Medical Journal, 1855, pp.192-196., The Reports of the Medical Officer of the Privy Council in which Dr. Greenhow ‘s evidence records particularly diseases relating to occupations, Dr. Julian Hunter’s evidence in the Second Report “On Cholera and Diarrhoeal Mortality” Parliamentary Paper 1860 XXIX, 201, pp.111.121 and the Fourth on Merthyr Tydfil and Abergavenny Parliamentary Paper 1862, XXII, 179 pp.160ff.., and Dr. Dyke’s later evidence to the Sanitary Commission First Report, 1870, Qs. 6275-6425) and the medical reports to the Poor Law Commission., all cit. Jones, ‘Merthyr Tydfil, The Politics of Survival’, p.30. 48 immediate measures were necessary to improve matters. Many unhealthy localities were improved, particularly the notorious Cellars, at Pontstorehouse. From 251 deaths/10,000 inhabitants in 1849 and 59 in 1854, the number had fallen to 22/10,000 inhabitants in 1866, a considerable improvement, from Merthyr’s deplorable state described by Sir Henry T. de la Bêche in 1849. Nevertheless there remained many matters to address in 1866. 59 William Farr’s Report on the Cholera Epidemic of 1866 in England included an account of the South Wales Cholera Field when in 1849 Merthyr, at the centre of the Welsh outbreak, experienced the highest mortality in England and Wales. 60 Dr. Dyke stated that, “everywhere human excrements were to be seen or smelt.” 61

Comparative Birth Rates

45 40 35 30 E&W 25 Wales 20

Persons Merthyr 15 10 5 0

0 6 2 8 9 838 8 8 898 904 1 1844 1850 1856 1862 1868 1874 188 1 1 1 1 1910 1916 Year

Figure 5. Comparative Birth Rates Merthyr Tydfil, Wales, England and Wales 1838-1916.

Farr raised the crucial issue of the social and class experience of cholera, of which Merthyr as a predominantly working-class industrial town was a sad example, the majority of deaths occurring in the urban heart of Merthyr. His observations apply to the social experience of most diseases. 62

59 Dyke, MOH Report for Merthyr Tydfil for 1866, pp.24, 26, 30 ff. 60 Farr, Report on the Cholera Epidemic of 1866 in England:, Supplement to the Twenty Ninth Annual Report of the Registrar General, 1868, Table 7, p. 18., The death-rate differs from that published in the Cholera report of 1849 since they were made prior to the Census of 1851. 60 61 Dyke, Appendix p.243, p.xlix- .xlx., to Farr, Report on the Cholera Epidemic of 1866 in England , Supplement to the Twenty Ninth Annual Report of the Registrar General, 1868. 62 ‘An Account of Deaths in Merthyr Tyfil in 1866’, Dr. Dyke, Medical Officer of Health for Merthyr Tydfil, Report to the Local Board’ in William Farr, ‘Notes on Cholera in Districts’,Appendix to 29th Report of the Registrar-General, 1868, pp.242-3. 49 Wealth gives command of the necessaries of life in food, clothing, dwelling –it implies personal purity, and also secures prompt and skilful medical treatment. Poverty presents the sad reverse. Hence the poor as a general rule suffer more than the rich in cholera. 63

Table 1. 6. Births, Deaths and Infant Mortality Rates in Merthyr Tydfil 1841-1847. (Compiled from W.T.Rammell, Report to the General Board of Health on a Preliminary Inquiry into the Sewerage, Drainage and Supply of Water and the Sanitary Conditions of the Inhabitants of Merthyr Tydfil, 1850., p.12, cit. Tydfil Thomas, Poor Relief in Merthyr Tydfil Union in Victorian Times, 1992, p.50. Years Births Deaths Deaths Deaths Deaths Total Total Total Infant Under Under 3 Under Under 20 Deaths Deaths Deaths Mortality 1 Yr Yrs. 5Yrs. Years Under 20 Above Rate Yrs 20 Yrs. 1841 1,483 247 253 54 86 640 334 974 166.55 1842 1,531 228 160 36 68 492 289 781 148.92 1843 1,574 226 140 37 91 494 316 810 143.85 1844 1,600 360 382 135 143 1,020 497 1,517 225 1845 1,694 309 216 65 130 720 362 1,082 182.41 1846 1,813 335 243 62 103 743 438 1,181 184.78 1847 1,759 385 310 93 139 927 507 1,434 218.87 Total 11,454 2,090 1,704 482 760 5,036 2,743 7,779 Average 1,636 299 243 69 109 719 392 1,111 182.76 Per Year

Not all deaths in any epidemic of cholera were recorded, making it impossible “to determine directly what relative numbers are attacked at each age”, and the diagnosis of choleraic diarrhoea imposed further difficulties, but Farr’s analysis of the age distribution of cholera in 1866 showed infants and the elderly to be the most vulnerable groups. 64 It would seem a logical assumption that cholera would account for a high number of infant deaths due to the appalling sanitary environment, but Farr’s report mentioned only two infant deaths; the son of an engine cleaner of Chapel Street died on 27 November, and the daughter of a metal weigher, at Dowlais, on 11 November. However, according to Dyke’s report for 1866, nine of 136 cholera deaths were under one year, 6-7%, or 1: 236 (an infant mortality rate of 67/1000.) 65 Of 413 infant deaths that year, a total of 15 deaths were from diarrhoea, choleraic diarrhoea and cholera combined. Given the conditions described, the infant death-rate is not as high as

63 Farr, Report on the Cholera Epidemic of 1866 in England, p.l vii. 64 Farr, Report on the Cholera 1868, p. lxi. The difficulty of assessing the impact of disease and the comparative value of statistical data is also demonstrated by Dyke’s notes on cholera contained in the Appendix to Farr’s Report for 1866. p. 242. 65 Dyke, MOH Report for Merthyr Tydfil for 1866, Table XX11, p.70. 50 might have been expected and an improvement in infant mortality would be anticipated following several decades of sanitary improvements and increasing medical and scientific knowledge in the field of public health. Prolonged breastfeeding may have protected babies from water-borne disease. The town’s public health record was criticised in a letter from the Medical Officer of the Privy Council dated 2 June 1867. In reply, Clark defended Merthyr’s position, indicating that the lowered death-rates during cholera epidemics 1849-1866 justified the effectiveness of measures taken. 66 Between 1857 and 1871 Merthyr raised loans of £172,600 for public capital works, representing at least 15% of the entire amount raised in Wales. 67 By 1875, Dyke gave the total costs including administration wages and as “a quarter of a million money.” Dyke affirmed these works as “a labour of love” in the interests of preventing suffering. 68 Although infant mortality rates occasionally fell below 150/1000 between 1842 and 1881, the trend was one of rising infant mortality rates towards the end of the nineteenth century. Whilst public health in Merthyr may have improved for a period following the provision of water to the town, other factors were at work in raising infant mortality rates from the 1880s. The rise in deaths from epidemic summer diarrhoea later in the nineteenth century was a feature of urbanisation, the result of a complex set of social parameters associated with social inequalities, and an increase in bottle feeding as part of the social and economic problems associated with high levels of infant mortality (Chapter 5.) A major flaw in any form of public health regulation was that it could not totally anticipate or control people’s daily activities. The randomness of human behaviour creates a public health problem in itself, seen in nearly every aspect of infant mortality discussed in this thesis. Cholera was also spread by ignorance and chance, as well as filth. In 1866 the inhabitants of Merthyr were “in constant communication” with the towns of Llanelli, Swansea, Briton Ferry, Aberdare and Swansea where cholera was found. One of the nurses at the cholera hospital visited her son in “the idiot ward” several times; the son and two other inmates died. 69 The husband of another woman who died of cholera claimed her bedclothes on the day of her burial. He slept under the unwashed clothes

66 In 1849 cholera claimed 1,452 victims out of a population of 46,378; in 1854 only 424 had died, and in 1866 there were only 136 deaths in a population of 55,000. Grant, “Merthyr Tydfil in the Mid- Nineteenth Century: the Struggle for Public Health”, pp. 593-4. Dyke’s report for 1867 attested to the advances made in the health of the town since 1852. Dyke, Medical Officer of Health Report for 1867, pp.21-22. 67 Jones, Mid-Victorian Wales, pp.35-36. 68 Dyke, Medical Officer of Health Report for 1875., p.18. 69 Whilst such a term is unacceptable today, the reference is consistent with nineteenth-century pauper classifications in the Workhouse Infirmary and emphasises the consequences of poverty, lack of education and inadequate care of the sick and needy. 51 that night and died three days later. 70 An aged Irishwoman employed in picking and cleaning rags may have come into contact with infected clothing. 71 Such patterns of human interaction and behaviour were later replicated in the spread of the apparently innocent diseases of measles and whooping cough which this thesis reveals as two of the most deadly causes of infant death (Chapter 4.)

Water and Sanitation 1850-1908

Merthyr’s lack of a clean water supply, the lack of sewerage, the age and condition of housing and overcrowding were Merthyr’s principal environmental health problems. The provision of sanitation for the town was a major accomplishment of the Local Board of Health to which Dyke frequently alluded with pride. Whilst clearly beneficial to the town, its provision masked the underlying inadequacies of town life for the bulk of the population. The provision of a water supply provided a prime example of the conflicts between the vested interests of industrialists on the Local Board of Health and the public health requirements of the town. The water supply was compromised for at least ten years in the interests of the iron masters and shareholders. 72 G.T. Clark, Trustee and Manager of DIC, was also Chairman of both the Board of Guardians and the Board of Health. Water was crucial to the operation of the major industries from which the economic lifeblood of the town flowed, and the needs of industry frequently prevailed over those of Merthyr’s population. Water was diverted from the River Taff for use in the iron works; the dirty oily remains were returned to the polluted river, frequently used as a latrine. It was then used for all domestic purposes, including drinking. 73 Both the needs of the town and the individual iron works were met after protracted negotiations, a capital loan of £82,000, and the sanction of the scheme by Parliament through the Merthyr Tydfil Waterworks Act of 1858 and the building of reservoirs at intervals until 1926 to meet the needs of a growing population. 74 By 1861,

70 Dyke, Medical Officer of Health Report for 1866, p.74. 71 T. J. Dyke, ‘Abstract of First Cases of Cholera Epidemic of 1866, in Merthyr Tydfil’, Table XVII, MOH Report for Merthyr Tydfil for 1866, Appendix, p.82. 72 Jones, Mid-Victorian Wales, p.52. 73 Dyke, MOH Report for Merthyr Tydfil for 1865. pp.11, 14-18., MOH Report for Merthyr Tydfil for 1866., pp. 24, 70-71., Sir Henry T. De La Bêche, ‘Report on the Sanatory Condition of Merthyr Tydfil, Glamorganshire’, Second Report of the Commissioners on the State of Large Towns and Populous Districts with Minutes of Evidence and Appendix, Part 1 and Part 11, 1845.,Vo. XVIII., 4th February-9th August, 1845., pp.145-146. Rammell, Report to the General Board of Health, 1850., pp. 33-48., William Kay, Report on the Sanitary Condition of Merthyr Tydfil, 1854., pp.59-62. 74 Dyke, Medical Officer of Health Report for Merthyr Tydfil for 1865, pp. 17-18. Grant, Water and Sanitation : The Struggle for Public Health in Merthyr Tydfil’, pp.23-24. 52 the 50,000 inhabitants of Merthyr and Dowlais received an unlimited supply of water, free from organic impurity “equal to the best in quantity and quality, supplied to any place in the United Kingdom.” 75 The proposal to dam the River Taff was obstructed by ironmasters on the Board of Health who wished to ensure the supply of water to the works. However, they saw that they could profit from supplying water to the town by forming a Joint Stock Company in which they would be the major shareholders, which would require a private parliamentary bill to give them the power to carry out the scheme.76 The General Board of Health condemned the proposal in a letter to the Local Board dated 15th November 1851, since “The abandonment of the water supply to private companies involves the disregard of the public interest” and advised that the Local Board should “persevere in their Application to parliament for compulsory powers of taking what is necessary for the Water Supply of their district and that no Joint Stock Company will be formed within it.” 77 The General Board of Health referred to the Report by the Royal Commission for Inquiring into the State of Large Towns (1845) in which the water to fifty English towns was supplied by Joint Stock Companies:

These companies, having been formed by Individuals anxious for a profitable investment, dispose of it [water] only to those persons who are willing to buy it at such rates, and on such conditions, as they are pleased to impose…Being a trading body, they naturally carry their pipes into those parts of the town where they can get the largest and best customers, and if the supply for the whole town is limited, the inhabitants of poorer districts where water is most required for the purposes of cleanliness and health, are quite neglected, and are without any redress whatever.78

Industrialists also disputed the use of water between the iron companies, further undermining the efficiency of the Board. In September 1864, William Crawshay of Cyfarthfa Ironworks, Richard Fothergill, proprietor of the Plymouth Ironworks and the

75 Dyke, Medical Officer of Health Report for Merthyr Tydfil for 1866, p.17. In 1884 further parliamentary legislation enabled the Cardiff Waterworks Co. to impound water in the Taf Fawr Valley and the rising population of Merthyr required the Lower Neuadd Reservoir to be built. The was completed in 1892, the Beacons Reservoir opened in 1897, Upper Neuadd (Zulu) Reservoir was built in 1902 and Llwyn On Reservoir was completed in 1926, all with the consequent depletion of farmland and a decline in the rural population and lifestyle of Vaynor. Bowen, Vaynor: A Study of The Welsh Countryside, pp.58, 65-66. 76 Sir John Guest and William Crawshay were each to subscribe £2000, Robert Crawshay £1,000 and William Meyrick £500 with a further £20,000 pounds to be raised by shares. Mins, Merthyr Tydfil Local Board of Health Minutes, I, 35,44 cit Grant, ‘Merthyr Tydfil in the Mid-Nineteenth Century: the Struggle for Public Health’, p. 587. 77 Merthyr Tydfil Local Board of Health , Minutes Vol. 1.pp.42,44, cit. Grant, “Merthyr Tydfil in the Mid-Nineteenth Century: the Struggle for Public Health”, p. 574. 78 De La Bêche, ‘Report on the Sanatory Condition of Merthyr Tydfil, Glamorganshire’, Second Report of the Commissioners on the State of Large Towns and Populous Districts with Minutes of Evidence and Appendix, Part 1, 1845., pp.86-7. 53 Glamorganshire Canal Co., obtained an interim injunction in the Court of Chancery restraining the Board from supplying water to DIC for industrial purposes. Clark had to champion both the public health cause and the interests of Dowlais Iron Company. The Board compromised by ensuring that ‘an ample supply of water for domestic purposes shall take precedence of any Supply for Machinery or Motive Power.’ The Crawshays insisted on their rights under the Merthyr Tydfil Waterworks Act of 1858 and by a majority vote which saw Clark outvoted the Crawshays’ terms were accepted. The domestic supply of water from the reservoir was to have precedence ‘except in so far as…the Cyfarthfa and Plymouth Ironworks and the Glamorganshire Canal Company… are at present under the said Act entitled to such precedent Supply’. Clark resigned both the Chair and his seat on the Board, but returned to both at the next annual meeting in March 1865.79

By the turn of the century Merthyr had sufficient water to sell to Cardiff, a major public health transformation. However, even when the town was reported to be fully supplied by mains water from 1865 and later sewered, some locations remained without these basic facilities. By 1862, many houses had been connected to the mains water supply, but many householders were reluctant to pay the new water charges. In 1864 a number of people still drew water from wells situated near old, deep cesspools.80 In 1867, 4,193 houses were supplied with water from 490 standpipes, which were left running in the streets and were prone to bursting in icy weather. 81 By 1903 these circumstances had changed little; a great deal of water was still wasted where a court and sometimes a whole street was supplied from an outside tap. “These taps are constantly out of repair, and the householders are not always careful to turn the water off after use.” 82 In 1896, a drought made it necessary to turn off the water supply for several hours each day. Without water the iron mills ceased working, resulting in much poverty, especially in Dowlais, only relieved by the help of friends and neighbours. 83 By 1866, a fall in the general death-rate and a rise in the average age of death were evident but sewerage and drainage were distinctly lacking. 84 In a letter to the Board dated 2 June, 1864, G.T. Clark referred to the continuing high mortality in the

79 MTLBH Minutes, VI, 60,85-86, 108-12, 176 cit. Raymond Grant, “Merthyr Tydfil in the Mid- Nineteenth Century: the Struggle for Public Health”, p.589. 80Dyke, Appendix p. 243, p.xlix- .xlx., to William Farr, Report on the Cholera Epidemic of 1866 in England., p. xlx. 81 Grant, “Merthyr Tydfil in the Mid-Nineteenth Century: the Struggle for Public Health”, p.590, Grant, Raymond, Water and Sanitation The Struggle for Public Health in Merthyr Tydfil, pp. 25,30. 82 D. J. Thomas, Merthyr Tydfil Urban District Council. Annual Report of the Medical Officer of Health for the Year 1903 by D. J. Thomas, 1904. p. 46. 83 Dyke, Medical Officer of Health Report for Merthyr Tydfil for 1896, p.14. 84 Dyke, Medical Officer of Health Report for Merthyr Tydfil for 1866, pp.29-30. 54 town especially among infants. It was the highest in Wales and higher than many of the great English towns such as Sheffield, Leeds, and Birmingham. Clark attributed this excessive mortality to the lack of proper drains and sewers since water was available to most inhabitants, observing cynically:

The sewerage admits of being done by degrees, out of income, taking the lowest and worst districts first. In obtaining water the town had to buy off the opposition of wealthy and powerful opponents; to sewerage no one can be opposed. [It would] place the health of its working classes more upon a par with that which is undoubtedly now the portion of those in the upper or well to do ranks.85

The slow and patchy provision of sewerage severely limited the benefits of a water supply. The better class of houses was generally provided with cesspools or privies, but most workers’ cottages were built with no sanitary provision whatsoever. 86 Some privies were emptied onto the banks of the Taff along with household refuse. 87 Older buildings generally had no closets, or perhaps one closet for several houses. One row of twenty pitmen’s cottages had one very small cesspool, whilst in Ystalyfera a row of cottages had a sentry box, “ a moveable box in the garden, in a plot of ground in front, which is moved about from time to time as the pit becomes over full; and immediately below that was the water supply of the locality.” 88 Henry Austin Bruce, the stipendiary magistrate, regularly forded the river close to Merthyr, witnessing people relieving themselves publicly “whilst only a few yards off women and girls are filling their pitchers with water.” 89 Grant describes the reasons given by landlords for not providing basic conveniences in cottages as “transparent excuses derived from ignorance, indifference and greed.” 90 One landlord did not see why he should provide

85 Merthyr Tydfil Local Board of Health Minutes. VI, 18-19, cit. Raymond Grant, Water and Sanitation: The Struggle for Public Health in Merthyr Tydfil, p. 27. 86 Rammell, Report to the General Board of Health on a Preliminary Inquiry into the Sewerage, Drainage and Supply of Water and the sanitary Conditions of the Inhabitants of Merthyr Tydfil, 1850, pp. 25, 28,30-31. In 1869 a Chancery suit instituted by a Company of Colliery proprietors against the Board of Health alleging that their boilers were fouled by water discharged into the Taff prevented any extension of sanitary works which would have benefited the masses. Dyke, Medical Officer of Health Report for 1869, pp. 22-23. 87 Rammell, Report to the General Board of Health on a Preliminary Inquiry into the Sewerage, Drainage and Supply of Water and the sanitary Conditions of the Inhabitants of Merthyr Tydfil, 1850 p.28, Grant, “Merthyr Tydfil in the Mid-Nineteenth Century: the Struggle for Public Health”, p.580. 88 T. J. Dyke, MOH for Merthyr Tydfil, Royal Commission on the Housing, of the Working Classes, June 24th 1884, Minutes of Evidence to the Third Report, 1884-85,[c.4547-1], Vol.XXXI, pp.482-483., 13,018., p.483. 89 Rammell, Report to the General Board of Health on a Preliminary Inquiry into the Sewerage, Drainage and Supply of Water and the sanitary Conditions of the Inhabitants of Merthyr Tydfil, 1850, p.33, cit. Grant, “Merthyr Tydfil in the Mid-Nineteenth Century: the Struggle for Public Health”, p.581. 90 Grant, “Merthyr Tydfil in the Mid-Nineteenth Century: the Struggle for Public Health”, p. 581. 55 privies for his tenants which would be used by neighbours who had none. 91 John Williams considered more privies to be genteel, but unnecessary, since the river served perfectly well. 92 The Local Board of Health was obliged to purchase night soil carts to empty cesspits at the landlord’s expense. Their contents were also tipped into the river until Anthony Hill protested vigorously in July 1856. 93 By 1903, cesspools were still being built in some locations. 94 In 1864 Samuel Harpur, the Board’s surveyor, prepared plans for the sewerage of Merthyr beginning a protracted process beset by the difficulty of sewage disposal. Injunctions had been taken out against English boards restraining them by common law from using rivers as open sewers. 95 From August 1866 to October 1868, brick sewers were laid but in November 1869, Nixon, Taylor and Cory, the owners of Merthyr Vale Colliery, obtained a perpetual injunction in the Court of Chancery restraining the Local Board of Health from discharging sewage into the River Taff. 96 In February 1869, as an alternative solution to sewage disposal, a sewage farm was proposed about half a mile south of Troedyrhiw. The sewage was later filtered and chemically treated in covered tanks and used as fertiliser to grow vegetables for the town. Although Merthyr’s sewerage had greatly improved by the mid 1870s, it continued to meet with difficulties. In 1896, for example, subsidence due to colliery workings at made it necessary to replace 1,1000 yards of sewer pipe, and the town was still not fully sewered by 1903.97 In 1903 over 5,000 house to house inspections were made revealing over 4,000 nuisances. Much squalor and overcrowded housing remained which continued to contribute to Merthyr’s public health and infant mortality problems.98

91 Rammell, Report to the General Board of Health on a Preliminary Inquiry into the Sewerage, Drainage and Supply of Water and the Sanitary Conditions of the Inhabitants of Merthyr Tydfil, 1850, pp. 31-32, cit. Grant, “Merthyr Tydfil in the Mid-Nineteenth Century: the Struggle for Public Health”, p.581. 92 Rammell, Report to the General Board of Health on a Preliminary Inquiry into the Sewerage, Drainage and Supply of Water and the Sanitary Conditions of the Inhabitants of Merthyr Tydfil, 1850, p.41, cit. Grant, “Merthyr Tydfil in the Mid-Nineteenth Century: the Struggle for Public Health”, p 581. 93 Grant, “Merthyr Tydfil in the Mid-Nineteenth Century: the Struggle for Public Health”, p. 593. 94 D. J. Thomas, Medical Officer of Health Report for Merthyr Tydfil for 1903., p.55. 95 Dyke, Medical Officer of Health Report for 1869, p.26, Dyke, Medical Officer of Health Report for 1870, p.26, Appendix, p.37.The sanction of parliament was obtained in 1870. Dyke, Medical Officer of Health Report for 1871,p.14 , p.26,Grant, Water and Sanitation: The Struggle for Public Health in Merthyr Tydfil, p. 28. 96 Dyke, Medical Officer of Health Report for 1869, pp.22-23., Medical Officer of Health Report for 1870, p. 26., Grant, “Merthyr Tydfil in the Mid-Nineteenth Century: the Struggle for Public Health”, pp. 591-3. 97 Dyke, Medical Officer of Health Report for 1896, p.15. 98 Thomas, Medical Officer of Health Report for 1903, pp. 57, 47-57. 56 Industrialisation and Population Change in Merthyr; the second phase

During the second phase of industrial development later in the nineteenth century Merthyr’s iron industries declined despite the technological transition to steel production from the 1870s as coal production increased throughout the rapidly expanding south Wales coalfield. Merthyr’s fortunes and population fluctuated with the fortunes of the iron and coal industries and people migrated between districts and occupations. By the end of the century, Spanish immigrants were recruited following the European expansion of the Dowlais ironworks. In 1850 over half of Merthyr’s 30,420 inhabitants were employed in four iron and steel works. Penydarren works closed in 1858, Plymouth works in 1880, and coal replaced iron and steel as the major industry as the Rhondda Valleys came to lead steam coal production for the world. By 1860 only 25% of Britain’s pig iron was produced in south Wales compared with 40% in 1831. By 1860 only 25% of Britain’s iron was produced in south Wales. 99 The Merthyr Telegraph in 1860 considered the town’s prosperity to be declining; in 1870, an estimated 3000 people left the parish and overall the population of Merthyr decreased by 6% 1871-81. 100 By 1911 only 14% of the population of 80,999 was employed in the iron and steel industries. Nevertheless, Dowlais survived as an iron making town and from 1871-1911 the population there remained fairly constant at 12 - 13,000.101 By 1914 the population of Merthyr had risen to 85,082, but from 1915-1919 fell from 76,493 to 71,638, as the beginning and the end of the Great War influenced the 102 demand for iron. On the other hand by 1919 over 19,000 men were employed in Merthyr’s collieries raising over 3 million tons of coal.

The population of Merthyr fluctuated with trade cycles, and changing demands for labour. (Appendix. Table 2.) The masculine nature of the heavy industries attracted a young male population. With low and diminishing participation rates of women in the labour market, early marriage, large families and high birth-rates remained characteristic of Merthyr into the early twentieth century despite a decline nationally and in Wales. Large families, often dependent on a male breadwinner with erratic

99 John Davies, History of Wales, Penguin Books, London, 1990, p.403. 100 Davies, History of Wales, pp. 403-4. Higher wages were paid for mining coal for sale than for furnaces. The estimation of immigration and emigration was difficult as Dyke explains. The population of Merthyr had declined by 5370 in the six months ending March, 1871, but that of Gellygaer had increased by 4, 415 due to the expansion of Dowlais collieries. Dyke, Medical Officer of Health Report for 1870, pp.1-3. 101 Jones, ‘Industrial History of Merthyr Tydfil’, The Democrat’s Handbook, pp.36-42. 102 C. Thomas, ‘Industrial development to 1918’, Merthyr Teacher’s Group, Merthyr Tydfil-A Valley Community , D. Brown and Sons Ltd., Bridgend, 198, p. 293. 57 wages, were a prominent feature of life in Merthyr, but one for which local housing conditions were particularly unsuitable. The migration of labour into and within the south Wales coalfield as coal production increased from the 1860s, created massive population growth of 253% and persistently overcrowded housing 1870-1911. Over 100,000 immigrants moved into the south Wales coalfield 1900-1911. The average occupancy was six people per house.103 Areas such as the Rhondda experienced rapid industrialisation and urbanisation as the deep steam-coal seams were mined. Housing was rapidly erected as new collieries opened. The Rhondda had higher death rates than Merthyr by 1910.104 In areas like the Rhondda Valley, more recently constructed houses were of better quality. Building Clubs assisted workers in the construction of houses allowing owner-occupancy rates of up to 60%, whereas in Merthyr just 5% owned property, leaving a larger population at the mercy of unscrupulous landlords. 105 One- third of Britain’s working-class population lived in overcrowded conditions in industrial areas. Overcrowding of 20-30% existed in Northumberland and Durham compared with 12% in Merthyr. Regional studies are useful in shedding light on the different experience between these areas.106

The Housing Problem and Health

Despite the link between poor housing, ill-health and mortality having long been recognized, it took many years to bring about the changes necessary to improve working-class housing. Evidence to the Royal Commission into the Housing of the Working Classes 1884-5, stated that unhealthy living conditions caused diseases and suffering as well as high death rates:

…infantile mortality among the poor is enormous. Carelessness on the part of mothers is an accompaniment of overcrowding, and to these causes was ascribed the high death rate [sic] among infants under five years of age in certain areas which were the subject of special investigation. But there is a great deal of suffering among little children in overcrowded districts that does not appear in the death-rate[sic] at all. In St. Luke’s opthalmia, locally known as the blight, among the young is very prevalent, and can be traced to the dark, ill-ventilated, crowded rooms in which they live; here are also

103 Thomas, ‘The Migration of Labour into the Glamorganshire Coalfield (1861-1911)’, pp. 277, 280. 104 Sullivan, ‘The Biggest Room in Merthyr: Working-Class Housing in Dowlais, 1850-1914’, pp.155- 185. 105 Ibid., p. 182. 106 Buchanan, ‘Infant Mortality in Mining Communities’, Ph.D. Thesis, London School of Economics, 1983. Buchanan’s thesis compares infant mortality in mining communities. 58 found scrofula and congenital diseases, very detrimental to the health of the children as they grow up.107

In 1901 Dr. John Sykes, MOH for St. Pancras summarised the complex social housing problem as one involving public health, economics, engineering, law, changing urban demographics and the social needs of the occupants. This complexity was, of itself, sufficient to account for the unyielding nature of the problem.108 Dr. Simons’ report for 1901 also argued that the complex question of housing was difficult to approach exclusively from a public health perspective. Merthyr’s medical officers of health constantly drew the relationship between poor living conditions, disease and death- rates to the attention of the local authorities with whom responsibility rested. They were outspoken on the subject of housing, Dr. Simons particularly so, linking housing directly with high death-rates, and berating the Merthyr council for their inertia on the matter:

The housing question has lately been referred to in almost every annual report presented to you…. It is undoubtedly the most acute and serious health problem that the Council has to confront. It is one of the most important factors of your high death rate. You cannot afford to shelve the problem. Any future prosperity of the district will simply accentuate the evil. Prosperity will act as a stimulus to the influx of population.109

Poverty among the labouring classes also contributed to abnormally high death rates and became a source of infectious disease.110 The link between substandard dwellings and high death-rates was stressed repeatedly. According to Dr. Simons in 1901, Merthyr still had the highest death-rate in Glamorgan at 31/1000. The MOH report for 1901 indicated significantly higher death rates in older houses from tuberculosis, infant mortality and diarrhoea:

The deaths from all causes are 66 per cent, from Zymotic Diseases 141 per cent, from Diarrhoea, 280 per cent, from Respiratory Diseases 39 per cent; from Tubercular Diseases 81 per cent, and the Infantile Mortality 81% higher in these houses than in the whole of the district. Tried by all the tests derivable from vital statistics these houses proved to be extremely unhealthy.111

The infant mortality rate for 1905 was 204 / 1000 births in Merthyr compared with 140 for 76 large towns and 124 for the whole of England and Wales. The infant mortality

107 First Report of the Commissioners on the Housing of the Working Classes [England and Wales] 1885, [C. - 4402.] p. 14. 108 John F. Sykes, ‘The Milroy Lectures on The Influence of the Dwelling Upon Health’, Lecture I., The British Medical Journal, 2 March , 1902, pp.505-509., ‘The Housing of the Working Classes II’, The British Medical Journal, 20 April, 1902., pp.972-3. 109 Thomas, MOH Report for Merthyr Tydfil for 1901, p.32. 110 Ibid., p.33. 111 Ibid., p.35. 59 rate for 1906 showed “an improvement in the appalling sacrifice of child life”, but still remained “abnormally high”. 112 During 1903 over 5,000 houses were inspected and 1,000 other premises visited to investigate infectious diseases with over 4,000 nuisances detected. 113 Dowlais had the highest death-rate in the district. 114 Dowlais, in 1901 accommodated 1,240 inhabitants.115 In 1903 there were 206 back-to-back houses of faulty construction there and the death-rate was nearly 9% higher than that of the whole parish.116 In 1904 “The older districts still exhibit year after year, an excessive mortality.”117 Dr. Simons pointed out “This question affects primarily the poor, but if the poor are housed in such a manner that their health is undermined, all other classes must suffer directly or indirectly.” 118 He strongly urged the Council to take action on these matters, reminding them of their civic responsibilities: “It is up to municipal authorities, as guardians of the public health, to improve these conditions. Don’t expect help from landlords who secure compensation for slums demolished- a change of law is needed to penalize them.” “To anyone acquainted with the district there is no necessity to justify the action of the Council under the Housing of the Working Classes Act…” 119 In 1905, the MOH report again indicated that the Council could not afford to neglect the housing problem, either from a public health point of view or fiscally. The deficit in rents collected by the council was easily compensated for, by reducing overcrowding and thus the risk of infectious diseases, thereby avoiding vast expense to the community. He quoted the apt remarks of Dr. Kay in 1854:

The neglect, then of sanitary measures viewed under this as every other aspect, is clearly and indisputably the neglect of sound economy, and at variance with the dictates of justice and humanity, but with the principles of pecuniary policy.120

112 Sims, ‘Difficult Dowlais,’ Human Wales, p. 22. 113Merthyr Tydfil Urban District Council, Annual Report of the Medical Officer of Health for the Year 1903 by D. J. Thomas, 1904. Wellcome Institute Library, London, Ref: F0001619B00 pp. 56-57. 114 Sullivan., ‘The Biggest Room in Merthyr: Working-Class Housing in Dowlais, 1850-1914’, p.165. Sullivan gives tables from MOH reported in The Merthyr Express. 115 Thomas, MOH Report for Merthyr Tydfil for 1901, p.34. 116 Thomas, MOH Report for Merthyr Tydfil for 1903., p.52. 117 D. J. Thomas, Merthyr Tydfil Urban District Council : Annual Report of the Medical Officer of Health For the Year 1904, B. R. S. Frost &c., Merthyr and Dowlais , 1905, p. 6. 118 Thomas, MOH Report for Merthyr Tydfil for 1901., p. 32. 119 Ibid., p.34. Dr Richard Jones of Blaenau Festiniog addressed the inaugural meeting of the Cymmrodorian Section of the National Eisteddfod at Bangor appealing largely to laymen for higher health standards. He also stated “The supineness of sanitary authorities in respect of sanitary matters is sometimes beyond belief…..It is not too much to say that many sanitary authorities do very little during the year except obstruct the action of their medical officers of health causing unnecessary delay and expense.” ‘Sanitation in Wales’, The British Medical Journal, 9 July, 1904, p. 86. 120 D. J. Thomas and A. Duncan, Borough of Merthyr Tydfil. Annual Report of the MOH Report for Merthyr Tydfil for the Year 1905. H.W.Southey & Sons., Merthyr Tydfil, 1906. p.41. 60 In 1903 Dr. Thomas rejected the view of Dr. Dyke that the climate was responsible for many deaths, blaming poor housing and impure water supply. Neither view is exclusively valid. These causes interacted in various ways, as did most causes of death.

This death-rate is often fallaciously assumed to be on account of its [Merthyr’s] exposed position and cold damp climate, but the more recently built parts are the most exposed, yet one of the healthiest localities. It is the older and more insanitary areas that, year after year, contribute to the higher death- rate121

In 1903, 5000 houses were examined by sanitary inspectors. The MOH described slums in Erin Row with a death rate of 53/1000, one death in each of 23 houses. Over 1000 dwellings were fit only to be condemned.122 In 1906-7, George Sims, as a journalist and seasoned observer of human conditions, drew public attention to the longstanding housing problems in the town. His criticisms of living conditions in Merthyr and Dowlais drew considerable indignation from many quarters in view of the extreme difficulties the authorities faced in the district: 123 He championed the struggle against poverty, social inequality and poor living conditions and the undeniable connection between such conditions and high rates of mortality. In Merthyr, as elsewhere, infant mortality rates reflected the social, political, economic and moral health of the community.

A low rate of infantile mortality indicates a healthy community, a high rate points in exactly the opposite direction. The high rate, as Sir John Simon has shown, is an indication of the existence of evil conditions in the homes of the people. It will be interesting to see if this contention is borne out by the housing conditions in a borough which has the unenviable position in the Infantile Mortality return, for the various sanitary districts of the County of Glamorgan. Only a year ago Merthyr headed the list.124

The national and imperial focus on infant mortality during the Edwardian period provided the broader view necessary to understand the social aspects of the problem.

121 In Penydarren Ward, 3 houses were closed in Gas Row. The whole of Gellifaelog had an excessive death-rate: but in Gas Row; 9 deaths, Sand Street:9; and Lower High Street ;7; have the worst record; also the courts between High Street Penydarren and the Morlais Brook. All these house have to be frequently inspected to prevent overcrowding. Gellifaelog and the area around the High Street contain less than one third of the total number of inhabited houses in the ward, but of 298 deaths in Penydarren, 151 occurred in these two localities. Thomas, MOH Report for Merthyr Tydfil for 1903, pp..52- 3. 122 Sullivan, ‘The Biggest Room in Merthyr: Working-Class Housing in Dowlais, 1850-1914’, pp.167-8. 123 Sims, ‘Difficult Dowlais,’ p. 23. 124 Ibid., p.22. 61 The infants of Merthyr had already been perishing for too long, but until their deaths became “a vast drain upon our national resources of life” there was no concerted effort to identify and prevent the causes of this national waste of resources.125 Sims argued for a direct connection between poor housing and infant mortality, which he saw in terms characteristic of many “progressives’ in the period, with more than a touch of eugenics and national and imperial racial ideology. Sims’ observations and the ideological position from which he mounted his indictment were characteristic of the period and seem to represent the views of those who believed the social conditions and health of the poor could be improved. These ameliorist opinions shaped the Report of the Inter- departmental Committee on Physical Deterioration of 1904, as part of the inquiry into the reasons for the failure of volunteers for the South African War to meet the required health standards. The Report rejected ideas of permanent degeneration, the great fear of many conservatives, but high infant mortality rates and the health and working conditions of mothers had featured in the Report as part of the general examination of the poor health and living conditions of the working-class population. The effect was:

….to rouse the public conscience to the Imperial peril of this vast drain upon our national resources of life. One quarter of the total deaths every year in England and Wales is of children under twelve months of age. 126

In 1906 Sims published a series of articles in The Western Mail, subsequently issued as a pamphlet Human Wales in 1907. It was accompanied by a Staniforth cartoon which depicted Merthyr Tydfil personified in Welsh national costume weeping over multitudes of baby graves. 127 Sims drew on the evidence of the MOH Report to conclude that Merthyr’s bad housing was a primary cause of the poor health of the people and by implication of the town’s high infant mortality rate, since “it is here that the young children perish as from a plague”.128

The conditions in the homes of the masses in Merthyr are responsible for an appalling rate of infant mortality and for an “excessive general mortality” which is duly chronicled and deplored by the Medical Officer of Health in his latest Report.129

125 Ibid. 126 Ibid. 127 George Sims, ‘ Dowlais’, The Western Mail, 27June, 1907., ‘Merthyr’ and two letters., The Western Mail 28 June 1907., Sims, George, ‘Baby Graves’, The Western Mail, 29 June, 1907, p.7, ‘Road to Reform’ The Western Mail, 11 July, 1907. Cartoons by Staniforth, Western Mail, Cardiff, c.1900-1910. 128 Sims, ‘Difficult Dowlais, p. 22. 129 Sims, “Mending of Merthyr”, pp. 30-31. 62

Sims cited Dr. Alexander Duncan’s MOH Report for Merthyr Tydfil for 1906, stating: “Our death rate is still abnormally high, and this, as in former years, is mainly due to the excessive infantile mortality that prevails.” 130 In 1907 the deaths of 420 infants less than one year of age accounted for 25% of deaths at all ages. Deaths of children 1-5 years numbered 223, making a total of 643 deaths of infants and children under 5 years of age, with the deaths of infants accounting for approximately two-thirds of that number, 44% of total deaths at all ages.131

Merthyr does not destroy its refuse but it destroys its children and to stay the massacre of the innocent children Merthyr must wait until the Government brings in a bill which will enable the Municipality to “acquire land more easily.” In the meantime, in the Annual Report of the Medical Officer of Health, 1,055 houses are tabulated as more or less “unfit for human habitation.” 132

Families particularly suffered the double imposition of paying high rents for “vile and insanitary accommodation” and were consequently unable to afford proper food and clothing. The effects of such living conditions were clearly visible to Sims: 133

In many of these areas the women are pale, emaciated and spiritless. The children are ill-clad and dirty. The people are as desolate, as colourless and as gloomy as the towering grassless summits of the coal tips that look down upon them night and day.134

Addressing the Housing Problems in Dowlais and Merthyr

While local authorities could control the standard of environmental health in the community, their powers were limited in controlling conditions within the home where many of the problems associated with high mortality and morbidity originated. Water borne diseases could be prevented by improved water supplies and sewerage, but diseases such as typhus and tuberculosis reflected squalor, poverty and malnourishment, increasing deaths from lung diseases in the cold winters. Many of these diseases were sustained by overcrowded, damp, badly ventilated dwellings, contributing to high

130 Sims, ‘Difficult Dowlais,’ pp. 22,32. 131 The Merthyr Express. 2 May, 1908., p.8. 132 Sims, ‘The Mending of Merthyr’, Human Wales, p.32. 133 Sims, ‘Difficult Dowlais’, p. 25. 134 Ibid. 63 mortality rates. The longstanding housing problems in Merthyr were the subject of several official inquiries during the nineteenth century and the topic of recent academic studies. 135 The structural, political and economic nature of Merthyr’s housing problem made it a social problem which concerned everyone. The legacy of deteriorating accommodation, high rents, low wages and overcrowding was the detrimental effects on the health of the population. The link between poor housing and high death rates was evident throughout the nineteenth century and the chronic public health problems associated with substandard housing and overcrowding were a constant feature of working-class life in Merthyr Tydfil into the twentieth century. 136 The MOH reports reveal the persistent and frustrating nature of the problems, the link between poor living conditions and high death-rates, and the difficulties which lay in the path of housing reform. From the late eighteenth century, to accommodate the influx of ironworkers, ramshackle buildings on ninety-nine year leases had been hastily erected without any regulation or urban planning. Better quality houses built by iron companies were usually occupied by higher paid workers while lower paid workers inhabited inferior accommodation. As leases expired, the deteriorating houses formed slum areas which were easier to close than to repair. 137 Over and under houses, suited to the steep hillside terrain, back to back houses, and damp cellars led to the spread of illness and disease “and inevitably to a high death rate, especially among infants.” Infant death rates in Dowlais in 1902 were 38.8 /1000 compared with 19.67 in Penydarren.138 The houses lacked light and ventilation and cellars and rooms were frequently let to other families. Communal water pumps and privies served courts and alleys. Despite the provision of water and sewerage to the town, and the application of more stringent building regulations from 1866, many houses remained without such amenities into the twentieth century. A housing survey implemented following the cholera of 1866 revealed many

135 A pictorial survey of housing development in Wales was undertaken by Jeremy Lowe, Welsh Industrial Workers Housing, 1775-1875., Welsh School of Architecture, UWIST, Cardiff, 1994. A spatial study of housing In Merthyr in 1850 was undertaken by Carter and Wheatley, Merthyr Tydfil in 1851., Carter and Wheatley, ‘Some Aspects of The Spatial Structure of Two Glamorgan Towns in The Nineteenth Century’.The history of housing in Dowlais was surveyed by Sullivan, ‘The Biggest Room in Merthyr: Working-Class Housing in Dowlais, 1850-1914’, the title sardonically based on the observation that the biggest room in Merthyr was the room for improvements, p.167. 136 Sullivan, ‘The Biggest Room in Merthyr:’ p.158. Pictures of Dowlais slums featured in Henry Allgood’s ‘Notes on Dowlais,’ East Dorset Liberal Association, 1910. Houses in Gas Row, Dowlais were demolished, still without running water available in 1937. County Borough of Merthyr Tydfil: Housing Act 1936 Slum Clearance Scheme: Gas Row Dowlais, 1937. 137 Sullivan, ‘The Biggest Room in Merthyr:’ p.160. 138 Ibid., pp.157-8.,165-166. 64 deficiencies.139 If property owners were compelled to improve old and unsound dwellings, many would close houses rather than improve them. Housing improvements also increased rents which created overcrowding as people tried to economise. In 1884- 5 Dr. Dyke, as MOH for Merthyr Tydfil, gave evidence to the Royal Commission on Housing of the Working Classes concerning the many deficiencies which existed in regard to housing and building regulations, especially in older houses approaching expiry of a lease. By the late nineteenth century, these had deteriorated into slum areas, particularly in Dowlais, with high death rates. These were the chronic environmental and living conditions experienced in Victorian and Edwardian Merthyr Tydfil. The working-class housing problem was increasingly a matter of national concern. The Sanitary Act of 1866 and its Amendment Act in 1874, the Torrens Act of 1868, the Public Health Act of 1875 and the amended Acts of 1879 and 1882 reinforced the powers of local authorities to regulate housing, but the problems in Merthyr were chronic and extensive, yet the Housing of the Working Classes Act (1890) was not adopted in Merthyr until April 1900. 140 In 1874, the British Medical Journal reported a series of articles in the local press and by a special commissioner in the Western Mail concerning the housing in certain areas of Aberdare and Merthyr, in which “members of parliament, justices of the peace, and other local magnates, who have not the plea of poverty to put forward as an excuse for their glaring shortcomings”, were held responsible for most instances of sanitary neglect. According to the British Medical Journal, these accusations were corroborated by the chairman of one of the authorities. A communication on the matter was sent from the Local Government Board to the Aberdare authority. 141 In 1906 the journalist George Sims argued that property ownership by council members compromised the abilities of the salaried officers to impose work orders and invoke local government acts. He proposed that one of the first steps to reform should be ensuring the independence of these officers, particularly medical officers of health. 142 Merthyr Tydfil, was one of fifty provincial towns investigated by the Commissioners on the Housing of the Working Classes 1884-5, to which Dr. Dyke gave evidence. 143 He indicated that in the majority of instances the local sanitary authorities would take the

139 Dyke, Medical Officer of Health Report for Merthyr Tydfil for 1866, pp. 86-90; Appendix pp. i—xii. 140 Sullivan, ‘The Biggest Room in Merthyr:’ p. 157. 141 ‘Sanitary Neglect in High Places’, The British Medical Journal, 10 October, 1874, p.480. 142 Sims, ’The Road to Reform’, Human Wales, pp.89-90. Dr Richard Jones” ‘Sanitation in Wales’, The British Medical Journal, 9 July, 1904, p. 86. 143 Evidence of T. J . Dyke, Royal Commission on the Housing of the Working Classes, 1884-5, Vol. II. Minutes of evidence and Appendix As To England and Wales.[C.-4402.-1.], London, 1885, pp. 482-3. 65 necessary steps when advised by the MOH, “but it is very difficult to get the whole of the work thoroughly done.” 144 Dyke indicated that nearly all older cottages were in a very bad state of repair, but that new dwellings were satisfactory.145 In view of the age of the buildings and short duration of the lease left to run, the sanitary authorities could hardly insist on major structural repairs. Buildings were often built of porous sandstone and very damp.146 In such houses the death rate, which was 23/1000 for the urban district, would increase to 37/1000. 147 Dyke also identified several loopholes in building regulations which might be closed. In 1885 it became a statutory requirement to re-house people if properties were closed. 148 The Housing of the Working Classes Act (1890), enabled local authorities to borrow money from the Local Government Board to purchase building land to clear slums, renovate and build. The Local Board made some progress in re-housing slum dwellers but was otherwise reluctant to commit itself fully to the Act.149 Kate Sullivan in ‘The Biggest Room in Merthyr’(1994), argues that the formation of the Merthyr Tydfil Urban District Council in 1895 was “a turning point in the history of working- class housing….” with the power to address housing problems reinforced by the Housing of the Working Classes Act of 1890. 150 In 1904 the British Medical Journal reported that the Merthyr Board of Guardians had called the attention of the Merthyr District Council to “the frightful state of the poor of the parish”, stating that it featured the worst slum housing in Wales. The article praised the efforts of the Council to rectify the situation and the work of the MOH in persistently drawing their attention to the issue.151 This political transition failed to have any immediate impact on infant mortality rates since progress was slow and piecemeal, due to the extent and duration of the problem. Moreover, other social factors contributed to high infant mortality: High birth rates, endemic poverty within a working-class community, and poor levels of maternal education contributed to an impoverished social environment within the poor urban environment.

144 Ibid., 12,989., p. 482. 145Ibid., 12,974 to 13,119, pp.482-3. 146 Ibid., 12,991, p.482. 147 Ibid., 12,994, p.482. 148 Sullivan, ‘The Biggest Room in Merthyr:‘ p.169. 149 Dyke, MOH Report for Merthyr Tydfil for 1898., p.25. The Act was adopted in 1900 according to Sullivan, ‘The Biggest Room in Merthyr’: pp.165, 168. In 1905, when Merthyr became a County Borough, the Council incorporated a Health Committee and a Houses of the Working Classes Committee, p.169. 150 Sullivan, ‘The Biggest Room in Merthyr’ p.164. 151 ‘South Wales; The Housing Question in Merthyr.-Infectious Diseases.’ The British Medical Journal, 11 June, 1904., p. 1405. Dr. Thomas described the difficulties and accomplishments in Public Health, May, 1905, pp.526-533. A lengthy and unflattering description of housing in Merthyr is found in the Lancet , 21 January, 1911, pp.193-194 and 28 January, 1911, pp. 265-267. 66 The problem of providing good accommodation with affordable rents at a reasonable cost to ratepayers was increasingly left to the local authorities as private investment in housing declined. 152 As the involvement of industrial leaders in the affairs of the community declined through transfer of ownership to companies, working- class housing deteriorated further. Dowlais, having led world iron production in the 1840s, was in its industrial death throes by the first decade of the twentieth century. By 1912 declining iron and steel production, the closure of Cyfarthfa Works and Crawshay’s Cwm Colliery had put 2000 men out of work, coal supplies were depleted and output reduced. Merthyr’s collieries, among the oldest, were due to close within a few years and it was not considered wise to invest in housing in an area in decline. Crawshay, Hill, Nixon-Navigation Coal Company and Merthyr Tydfil Ratepayers Association opposed the Council’s proposal to borrow money to build 2-3 bedroom houses. The Guest, Keen and Nettlefold Company had taken over ownership of DIC and their representative at that time was unaware that the company still owned housing in Dowlais.153

The withdrawal of private investment in housing made the political involvement of the working classes all the more relevant in improving working-class living conditions. By 1900 Merthyr District Council had begun slum clearance but had not started to build alternative affordable housing. Merthyr and Districts Trades and Labour Council criticised the Council for failing to take action. A petition from 29 branches of the Trades and Labour Council to Merthyr District Council in May 1900 proposed cheap housing at affordable rents to beat unscrupulous landlords and as an obligation by the Council to act in the interests of the poorer members of the community. The Trades Council distributed 20,000 leaflets among households in July and in November Keir Hardie’s address in Merthyr made housing a significant political issue. 154 In 1905, when Merthyr became a Borough, housing reform was a leading issue for local candidates, supported by Labour members of the Borough Council and of Merthyr Tydfil Board of Guardians who had secured their positions under the auspices of the Trades and Labour Council. 155 Merthyr’s Charter of Incorporation as an independent County Borough in 1908 was a final step in the process of autonomous local government with the power to influence the health and living conditions of the people.

152 Sullivan, ‘The Biggest Room in Merthyr:’ pp.176, 183-4. 153 Ibid., pp. 183-4. 154 Ibid., pp.164-5, The Democrat’s Handbook, p. 61. 155 Sullivan, ‘The Biggest Room in Merthyr:’, p.169, The Democrat’s Handbook., pp.49-50. 67 The census of 1901 showed worse overcrowding than in the previous decade. Rents more than doubled in Dowlais from 6-8/- a month to 14/-£1 a month.156 It seemed impossible to build satisfactory houses at affordable rents to conform to building regulations, and to also consider the cost to ratepayers. The Trades and Labour Council argued that this was possible, and blamed the Council for pushing up rents since landlords increased their rents to meet those charged by the Council. One-third of houses in Dowlais were still company-owned. In 1906, following a communication from the Trades and Labour Council to the Local Government Board, the town was inspected by Dr. J. Spencer Low, who agreed that Dowlais and Penydarren contained some of the worst slums he had ever seen. Beds in damp unventilated rooms were occupied round the clock by shift workers, and overcrowding assisted the spread of infectious diseases.157 The persistent problems of affordability, suitability and overcrowding in housing created the challenge to meet legal building requirements whilst maintaining affordable rents, and Merthyr emerged as a leading example in this respect. A loan of £15,000 at 3% for 30 years from the LGB on 5 December 1900, secured land at Gellifaelog on a 99 year lease and the scheme relieved some pressure on housing. 158 Merthyr’s seven housing schemes placed Merthyr as a leader in housing reform in south Wales, and set new standards for working-class housing, proving that municipal housing was possible and financially viable. 159 By 1902-12 only 1,400 municipal houses had been built or were in the process of being built by authorities in the three counties of Glamorgan, Monmouthshire and Carmarthenshire. Only eight authorities in three counties had undertaken to provide workers with council housing and only fourteen had taken any action at all in regard to working-class housing. In 1907 A deputation from Neath and Swansea inspected new houses under construction at Penywern and were inspired to follow Merthyr’s example in constructing homes affordable to those on modest incomes.160

156 Sullivan, ‘The Biggest Room in Merthyr:’ p.167. 157 J. Spencer Low, Report to the Local Government Board on the Sanitary Circumstances and Administration of the Merthyr Tydfil Urban District. 1906.,p. 16. 158 Sullivan., The Biggest Room in Merthyr:’, pp.31-2. 159 Ibid., p.184. 160 The Merthyr Express, 20 July, 1907, p.7. 68 Housing and Capitalism

Sims viewed the poor housing and high infant mortality rates as an expression of the social injustice brought about by the exploitation of the working classes by capitalists.

I have seen the conditions in the worst wards of Merthyr, and with a Full sense of the gravity of the words, I have no hesitation in saying they are a disgrace to Capital and a degradation to Labour. It is intolerable that this curse to the community should be allowed to continue on the plea that nothing can be done until the State comes to the rescue.161

Sims regarded the living conditions in Dowlais as representative of the gross divide of class and wealth which Merthyr and Dowlais represented. The inhabitants of Dowlais benefited from “the stream of gold that flows from Dowlais” only by “desolation and squalid poverty”.162 “There are whole areas in Dowlais, inhabited by human beings, which are a black stain upon the humanity of those for whom these human beings toil.” From Dowlais the only place left to go to was “the Workhouse. And that is generally full.” Not afraid to mince his words Sims declared: “Some of the great employers of labour, whose vast wealth comes from Dowlais, would not kennel their dogs as they allow their unfortunate workpeople to be kennelled.” 163 Sims described Dowlais 1906-7 as “a long grey-black hill, with huge steel works and collieries on one side of it, and row after row of miserable hovels on the other.” 164 He considered many Dowlais dwellings to be “little better than pig styes.”165 “To these terrible homes men come home from their terrible work to live terrible lives, and often, alas, to die terrible deaths.” 166 In these conditions the rents of some houses were higher than in other districts where recently erected council tenements had better accommodation and facilities. In Dowlais, Cyfarthfa and Penydarren, the oldest areas of Merthyr, Sims considered the exploitative system of “house farming” to be one of “grinding the faces of the poor.”167 He considered a house farmer to be “the persecutor of the widow and the robber of the orphan”, “a public enemy” and “in every case of neglect that the authorities can bring home to him he should be dealt with as a public

161 Sims, ‘Mending of Merthyr’, Human Wales, p .31. 162 Sims, ‘Difficult Dowlais’, Human Wales, pp.26-27. 163 Ibid., p.27. 164 Sims, ‘Difficult Dowlais’, p.22. 165 Ibid, p.24. 166 Ibid. 167 Sims ‘The Road to Reform’, Human Wales, p.87. 69 enemy and punished to the utmost limit of the law.” 168 Riots in May 1898 during the April-September Coal Strike demonstrated public anger towards landlords over rent increases and evictions. Crowds attacked pawnshops and houses of unpopular landlords and succeeded in forcing one landlord to return the key to the tenant. Such disturbances highlighted the levels of community tensions in Dowlais.169 Nevertheless many industrial employers continued to house their workers in substandard accommodation at the time of Sims visit in 1906. Sims condemned the intransigence displayed by the local authorities in failing to remedy the evil of Dowlais. He was outspoken on the subject of housing and exploitation of the labouring classes by industrial capitalists and landlords, arguing that they should meet their social responsibilities and not leave the housing problem for the State and local government to resolve. He believed that those who benefited from and exploited the labouring masses should act more responsibly for the benefit of the community. Private owners of capital and industry such as the Guests had earlier in the century largely assumed this responsibility but increasingly corporations and trustees considered their first obligations were to the company and shareholders.170

I say frankly that I think it is a bad thing for the owners of property and the great employers of labour, that it should be necessary for an Act of Parliament to be passed before land in the neighbourhood of such huge industrial enterprises as those of Merthyr can be acquired at a reasonable price for the decent housing of the toiling masses.171

The housing problems in Merthyr and Dowlais reflected the working-class struggle to improve their conditions of living and working. A shift in social consciousness and social equity resulted in greater control over the administration of the town in the interests of the working classes through the socialist principles which influenced members of the Urban District Council to pursue social reform from 1895, particularly in regard to Merthyr’s housing problems. However, the struggle to advance the health and living conditions in Merthyr was only just beginning.

168 Sims, ‘The Road to Reform’, pp.87-88. 169 Sullivan, ‘The Biggest Room in Merthyr:’ pp. 162-3. 170 Sims, ‘Mending of Merthyr’, p. 31. 171 Ibid., p.30. 70 Conclusion:

Despite several decades of sanitary improvements during the nineteenth century infant mortality in Merthyr continued to rise. Cholera in 1849 provided the incentive for initiating public health reforms. The Merthyr Tydfil Board of Guardians from 1836 and the Local Board of Health from 1850 struggled to address the problems of poverty, disease and high mortality rates in a filthy town. The provision of water and sanitation lowered death-rates, but was not universally provided by the twentieth century. Public health problems relating to housing, persisted from the eighteenth to the twentieth centuries; slum areas and overcrowding contributed to chronically high infant mortality rates into the Edwardian period but not wholly accountable for them. Initiatives to improve the standard of health in the town were impeded as powerful industrialists dominated the Local Boards and attempted to meet their obligations to both the citizens and ratepayers of Merthyr and to the management and shareholders of Merthyr’s industries. The process of establishing a water supply, sewerage and drainage is an excellent example of the way in which the people of Merthyr were disadvantaged by the social power of industrialists, reinforced through their positions of social responsibility.

In 1906 George Sims linked living conditions in Dowlais with high rates of infant mortality, and to capitalist exploitation of the working classes. The social and economic effects of Merthyr’s industrial history and the detrimental effect of the chronic housing problems in Merthyr on the health of the community were measured by increasing infant mortality rates which failed to respond to the forty years of public health improvements. 172

Environmental conditions only partly explain why public health reforms failed to lower infant mortality rates in the nineteenth century. The importance of the health of mothers was overlooked until the Edwardian period. The MOH reports for 1905-8 attributed to antenatal causes approximately 30% of the deaths that occurred in the first month of life and approximately 50% of those within the first three months. Deaths thereafter were more likely to be associated with an adverse urban environment though the antenatal health of mothers continued to play an important part. Sims also expressed the eugenicist point of view that to lower the infant mortality rate required a shift in

172 Sullivan, ‘The Biggest Room in Merthyr:’ p.185. 71 thinking from quantity to quality of infants born. 173 High birthrates were a significant feature of Merthyr’s infant mortality problem discussed further in Chapter 6.

It is impossible to separate the antenatal health of the mother and its influence on the infant’s prospects for survival from the social and economic conditions of life in Merthyr. Despite the improvements to sanitation as a basic tenet of nineteenth-century public health reforms, and improvements in housing standards by the end of the nineteenth century, the intransigent nature of the housing problems meant that the women of Merthyr reared their babies in adverse environmental conditions which contributed directly or indirectly to a large number of infant deaths. Although those conditions are significant in explaining high infant mortality rates in Merthyr, the social and economic effects of industrialisation were also critical in creating conditions of poverty which affected the lives of many mothers and their families.

173 Sims, ‘Difficult Dowlais’, p.22.

72 Chapter 2

The Social Impact of Industrialisation in Merthyr Tydfil 1834-1908

Introduction

Chapter 1 described the impoverished urban environment of Merthyr Tydfil, the consequences of industrialisation and rapid population growth. It also introduced the social conditions which adversely affected the health of mothers and contributed to high infant mortality rates. This chapter argues that as a result of economic uncertainty Merthyr’s population was always vulnerable to sudden poverty. The iron and coal industries dominated life in Merthyr Tydfil. Uncertain and irregular wages, linked to commodity prices and mining methods, , the risk of injury or death at work and industrial unrest together created a climate of social and economic uncertainty in which financial hardship was often commonplace among many families, and at times impacted severely on the population. The technological transition from iron to steel manufacturing dramatically altered labour patterns, heralding the decline of the iron industry in Merthyr. Empowered by the Trade Union Act of 1871, workers expressed their dissatisfaction with labour conditions through industrial disputes, which escalated in character and intensity across the south Wales coalfield by the end of the century. A strike and lock-out in 1875 in Merthyr and the Great Coal Strike of 1898, which affected the whole of the south Wales coalfield, involved thousands of people and caused great hardship. The principles of the Poor Law proved unworkable in the interests of the poor, but a powerful tool in the hands of the ironmasters, who held powerful positions on the Board of Guardians and were able to manipulate Poor Law regulations for political gain and to influence the outcome of industrial disputes in 1875 and 1898.1 The political dimensions of the Poor Law were emphasised when Merthyr Tydfil Union was confronted with the effects of mass or the consequences of an industrial dispute when large numbers of workers were laid off. Merthyr’s experience reflected the inadequacy of the Poor Law to deal with poverty on a mass or protracted scale. Concerned to keep down the poor rates, and required to work within the directives of first the Poor Law Board and from 1871 the Local Government Board, the Guardians

1 Derek Fraser, The New Poor Law in the Nineteenth Century, Macmillan, London, 1976, p.111. Fraser observes that the political dimensions of the Poor Law tend to have been neglected. 73 struggled to meet the needs of the community at times of major crisis, on occasion facing insolvency. The chapter provides evidence of poverty related to the conditions of industry and the ineffectiveness of Merthyr Tydfil Union to relieve social distress on a large scale, particularly during two major industrial crises in 1875 and 1898. The impact on families was profound, requiring the provision of soup kitchens to alleviate hunger. Families fell victim to the processes of industrialisation, poverty affecting the health of mothers and future generations. This chapter links the environmental aspects of life in Merthyr Tydfil with the social and economic conditions of industrialisation. It describes the disadvantages of the social environment in which children grew to adulthood, affecting their health as mothers during childbearing years. Assuming a fertile age group of 15 to 40 years, the mothers of 1908 would have been born between 1868 and 1893. Further evidence linking rising infant deaths with the inferior health of mothers is examined in Chapter 6.

Social and Economic Effects of Industrialisation 1834-1908

The fluid nature of the workforce, the social power of the ironmasters and industrial conflict left the workers and their families at the mercy of industry. The wages linked to trade cycles and commodity prices in the iron and coal industries created a fragile, labile and uncertain economic environment. From 1865 to 1879 Dr. Thomas Jones Dyke, MOH for Merthyr Tydfil, considered it important to include the price of bar iron, the amount of coal raised, the price of staple foods and wages in his annual reports because of their social and economic influence on the health of the population.( Appendix. Table 4.) Family dependency on employed workers meant that unemployment affected a large proportion of the population, a persistent social and economic pattern throughout the coalfield. The working conditions in these heavy industries also exposed workers to great physical dangers. Disasters in which sometimes hundreds of miners were killed were newsworthy, but an insidious daily toll of accidents also made life precarious. Mine safety improved during the second half of the nineteenth century, but the number of deaths was substantial due to the growth of the industry. Between 1868 and 1919 a miner was killed in Britain every six hours, seriously injured every two hours and sufficiently injured to require a week off work every 2-3 minutes. “The psychological impact of working in such a dangerous industry was incalculable: ‘no man knows when he leaves his happy fireside in the morning but

74 ere night he may be carried home a mangled corpse.’” 2 This was independent of major disasters of which Senghenydd was the worst with the loss of 439 lives in 1913.3 There is some evidence for the extent of dependency. In February 1848 a dispute between the Bute Estate and DIC over the renewal of the lease and threatened closure of the ironworks created the prospect of mass unemployment. Inspector Owen, from the Poor Law Board, estimated that 23,600 men were employed at the furnaces in the locality. DIC employed 6,600 workers and 2,000 worked at Penydarren, also experiencing the trade slump, making approximately 8,600 people unemployed and 21,500 people dependent on them.4 Based on the Census returns of 1861, and a population of 54,000, Dyke gave the numbers employed and wages in various occupations in the iron and coal industries. Table 2. 1. shows 14,477 males and 790 females, a total of 15,267 on whom many of the remaining population were dependent. Dyke estimated that for each person employed two more were dependent, making a total of 45,000 people dependent on the iron trade.

Table 2.1. Number of Males and Females Aged Below and Above the Age of 20 in Various Occupations in Merthyr Tydfil 1861. (MOH Report for Merthyr Tydfil for 1865., p.8.) Occupation Males Under Males Above Females Under Females Totals 20 20 20 Above 20 Coal Miners 2,098 4,547 108 114 6,867 Iron Miners 381 1,524 1,905 Iron Makers 921 3,217 212 178 4,528 Masons, 246 1,543 95 83 1,967 Carpenters, Quarrymen, Labourers Totals 3,646 10,831 415 375 15,267

Life in Merthyr was uncertain at the best of times. By 1850, 165 furnaces in Wales were producing almost a million tons of pig-iron out of 3.6 million for the whole of Britain. A severe depression in the iron trade from November 1858 reduced orders with a further drop in price, though demand for steam coal increased. The financial management of the ironworks and collieries during the nineteenth century was not without its difficulties. G. T. Clark as manager of DIC was faced with costly and decreasing Dowlais coal supplies, increased production costs and reduced output of iron. Greater use of exhaust gases as fuel was made to reduce the consumption of coal. More powerful engines using compressed air were introduced for haulage and pumping.

2 John Benson, British Coalminers in the Nineteenth Century: A Social History, Gill and Macmillan, Dublin, 1980, p.43. 3 Ibid., p.42. 4 Thomas, Poor Relief in Merthyr Tydfil Union, pp. 30-33. 75 A further strategy was to buy in cheaper and better quality coal from Penydarren collieries when the Penydarren Iron works closed in 1858. In 1859 Hirwaun works closed and Dowlais made 200-300 men redundant, adding to existing pauperism.5 A shortage of coal and the capital costs of moving to steel production added to the economic difficulties for DIC and by the mid-1860s railway charges were costing approximately £50,000 a year. 6 The first rolling of Bessemer produced steel in Dowlais was in June 1865.7 The Cyfarthfa Works closed with the onset of industrial action in 1874 and did not open again until 1879 after £150,000 was spent in converting the plant for steel production. The Dowlais Works moved to East Moors in 1891 and Guest, Keen and Nettlefold took over the Dowlais works in 1902 and the Cyfarthfa works which closed in 1910. It re-opened in 1914 to supply shell cases during the Great War and finally closed in 1919.8

Table 2. 2. Statement of Coal Raised in the Parish of Merthyr-Tydfil 1866-1875 (Compiled from MOH Reports for Merthyr Tyfdil 1866-1875.) Firm 1866 1867 1868 1869 1870 1871 1872 1873 1874 1875 Craw-shay 200,789 199,163 272,979 229,341 215,539 213,351 189,155 166,229 182,712 141,587 Plymouth 332,677 327,310 305,957 282,387 257,258 256,517 218,832 263,634 230,507 172,122 Dowlais 266,527 304,979 299,589 306,003 241,179 284,594 286,389 237,142 302,161 302,818 Will-iams 156 Pant-glas Benj. Davies 5,787 5,249 4,646 4,664 4,864 4,325 5,335 Sam Thomas 13,237 12,264 12,231 12,500 Graig Coal 11,904 9,755 8,644 7,427 8,367 8,008 7,478 9,378 5,607 5,315 Penydarren I.C. 158 772 3,250 5,378 3,803 3,073 Fothergill 12,381 8,650 Aberdare I.C. 16,538 21,145 27,140 Rowland 6,425 5,995 5,234 Griffiths Benjamin Wood 4,680 Gellifaelog 354 2,018 1,423 Galon Ucha 1,250 3,379 1,250 Total 831,077 858,720 904,046 842,480 740,360 778,695 729,105 714,040 772,592 629,749 + + - - + - - + -

The overall amount of coal raised in Merthyr Tydfil Parish declined 1866-1875, from 831,077 tons in 1866 to 629,749 tons in 1875. (Table 2.2.) Crawshay’s Cyfarthfa Works and Plymouth Works were the main producers of coal, with several other collieries producing smaller and less consistent amounts, but DIC was the only firm to continually increase output, even though the “Strike and Lock-out” in 1875 reduced the output of coal in Merthyr by 142,000 tons.9 The amount of coal raised in 1876 rose by

5 L.J.Williams, ‘Clark the Ironmaster’, James, G.T. Clark: Scholar Ironmaster in the Victorian Age, pp.48-64. 5 Thomas, Poor Relief in Merthyr Tyfdil Union., p.116. 6 Williams, ‘Clark the Ironmaster’, pp .54-6. 7 Thomas, ‘Industrial Development to 1918’, Merthyr Tydfil A Valley Community, p .285. 8 Ibid., p. 293. 9 Dyke, MOH Report for Merthyr Tydfil for 1875, p.8. 76 128,000 tons due to the opening of new pits, but the price of steam coal fell steadily from an average of 16/11d. per ton in 1874 to 9/ 3d. in 1878. Similarly, the price of bar iron sold in Wales fell from an average of £12.8s.4d.in 1873, to £5.15s.0d. in 1878, matching the price received in 1868. In 1876 the great reduction in the price of iron and general absence of demand made its production “not only profitless, but precarious.”10 John Benson argues that miners and their families experienced a gradual improvement in living standards during the second half of the nineteenth century with a rise in real wages and smaller family sizes. Whilst it is difficult to generalize, there is evidence of individual and collective self-help with miners being thriftier and more responsible than is generally allowed. 11 Nevertheless Benson agrees that uncertainty was the most important characteristic of miners’ wages before the Great War. These were related to the level of skill, with surface labourers earning least and hewers, wheelwrights and mechanics enjoying good incomes. Wages were also influenced by the difficulty of extracting coal from each particular seam in which they worked.12 In 1871 Rhondda coal owners were offering wages 10% above those paid in Aberdare and 25% above those paid in Merthyr. 13 What also defined prosperity was the family’s collective capacity to derive income. In Merthyr, wages were determined by the price of iron and coal and falling prices were reflected in wage reductions. Colliers’ wages were reduced from 29/2d in 1865 to 16/6d in 1868 while the price of bar iron fell from £7.10s to £5.15s, with monthly variations. Wages of 30/- in 1873-4 were reduced to 16/ 6d in 1879. (Appendix. Table 4.) 14 At times workers needed to forgo their usual occupations and find work wherever it was available, even at reduced wages. Strikes in 1871 and 1875 offset any wage rises. 1876-1879 offered low wages and short time. The owners of the iron works in many instances had their own collieries to supply furnaces, and were able to offer work there. Because of the individual character of coal seams, it was sometimes possible to find work in other areas as the number of collieries throughout South Wales increased. 15

10 Dyke, MOH Report for Merthyr Tydfil for 1876, p.9. 11 Benson, British Coalminers in the Nineteenth Century, p. 215. 12 Ibid., pp.65-68. 13 Ibid., p.77. 14 Dyke uses the mean of the monthly average of prices at which Bar Iron was sold per ton at the shipping port of Cardiff as quoted in The Engineer newspaper, the prices of “Best Smokeless Steam Coal, Colliery screened as reported in the trade circular of Messrs. Tellefsen, Holst & Wills”. The amounts of coal raised are reported from the Assistant Overseer, Mr. W. J. Jones. Dyke was unable to ascertain the amount of Iron made and exported from the parish. Dyke, MOH Report for 1872, p. 27., Baber and Williams, (eds), Modern South Wales, Essays in Economic History, and Thomas, ‘The Migration of Labour into the Glamorganshire Coalfield (1861-1911)’ , provide good starting points for further analysis of economic and trade cycles. 15 Egan, Coal Society , p. 81. 77 In 1877 Dyke described the effects of the major industrial transition from the manufacture of iron to steel from 1866 by DIC by expansion of the works and capital investment in the new and expensive Bessemer and Siemens-Martin manufacturing processes.16 This replaced the demand for iron rails by steel and many ironworks, unable to afford the change, closed down. The Cyfarthfa, Penydarren and Plymouth works closed, unable to compete with the lower production costs of steel at Dowlais Iron Company. Iron rails produced for £14 a ton, were replaced by steel rails that sold at £5.17s.6d and were far more durable, further reducing demand. By 1878, practically all the iron smelted was used in the manufacture of steel, and while the collieries in the parish raised 1.5 million tons of coal during the year, the price averaged 9/3d a ton and the price of bar iron was as low as £5 per ton. The Bessemer process converted molten iron into ingots which could be cooled, reheated and drawn out through steel rollers as rails, bars or rods, making the of moulders and puddlers redundant. Iron production required sixteen classes of labour, but the new process needed only nine. Welsh iron ore contained large amounts of phosphorus and silica unsuitable for the manufacture of steel, making local ironstone miners redundant. Instead, DIC continued to produce 2000 tons of iron and steel a week, using imported Spanish ore from Bilbao. The dramatic reduction in demand for labour skills also affected wage levels. Within these classes of workers wages also varied with the demand for labour and varying degrees of occupational skill. 17 Wages varied with the trade skills from 15/- a week for labourers, craftsmen, hauliers and quarrymen to 60/- for rail rollers.18 Iron stone miners sought work in collieries adding 2000 to the 4000 men already working, and daily earnings fell with the increase in numbers employed. While the rate of wages was not reduced, in 1867 the demand for iron was slow and the men were employed on “short time.” 19 In 1868 demand for railway iron grew, but by 1878 the trade “was even more depressed than in the years immediately preceding,” the weekly wages similar to those received a decade previously.20 In 1868 the export of iron rails to the United States for building railways was expanding with 600,000 tons exported in 1871. A large number of skilled colliers, puddlers, and mill men, able to earn high wages, emigrated to the United Sates. Britain immediately suffered a skilled labour shortage, followed by

16 Williams, ‘Clark the Ironmaster’, pp.4-60. 17 Alex Dalziel, The Colliers’ Strike in South Wales,1871, Its Cause, progress and Settlement, Cardiff, 1872. 18 Dyke, MOH Report for Merthyr Tydfil for 1865, p.8., Dyke, MOH Report for Merthyr Tydfil for 1868, p.11. 19 Dyke, MOH Report for Merthyr Tydfil for 1867, p. 21. 20 Dyke, MOH Report for Merthyr Tydfil for 1878, pp. 28-30. 78 demand for increased wages and a subsequent rise in the price of iron and coal. Through the skilled labour available America was producing 700,000 tons of iron, reducing their need for iron imported from Britain to only 1,000 tons by 1877. During the prosperity of 1872-74, colliers’ wages increased from 16/6d. in 1868 to 30/- in 1873-4. The cost of coal rose from 9/-to 23/- and bar iron from 115/- to 210/-. Pits were sunk, furnaces built, and orders taken on credit in anticipation of limitless wealth, but then the price of producing steel was reduced to a quarter of its former level. Iron mills closed and the coal raised to fuel the mills produced a glut, which was thrown on the open market, driving the price down. Hundreds of men, their jobs gone, competed in the labour market for a pittance, whilst output increased further, driving down prices 21 The average weekly earnings of colliers fell from 29/.2d. in 1867 to 15-18/- a week in 1877. The average earnings of skilled adult colliers employed for most of the week did not exceed 16/6d, “while many hundreds of men had to submit to being employed for only a third or half of their working hours.” 22 Not only did the economic and wage structures vary from year to year, they also varied from month to month, making it difficult to depend on wages. Until September 1879, DIC furnaces were the only ones smelting iron-ore at the rate of 2000 tons a week. In August iron rails had been sold for less than the cost of production, but by November their price increased from £4 to £7, and by December they were fetching £8.5s. per ton. Puddlers, ballers and mill men returned to their trade, considered obsolete, and hopes of prosperity rose again as the Cyfarthfa furnaces were re-ignited. The increased demand for iron and steel in September 1879 also created an increased demand for coal in the manufacturing process and a rise in living standards. The increase in coal production that year, however, was not accompanied by an advance in wage rates for colliers, though more work became available as the hundreds of labourers returned to their former employment in the iron and steel works. 23 Throughout 1880, Merthyr enlivened as DIC added tin plate to their production and Cyfarthfa added Bessemer pig iron smelting to their processes. Colliers were fully employed, raising 1,342,000 tons of coal. “This increase in the amount of coal raised gave to the working man more of those home comforts, which he had been forced to do without for some years.” As evidence of “This improvement in the social well-being of our labouring bees”, the number of marriages in the parish increased from 470 in 1879 to 568 in 1880.

21 Ibid., pp. 32-33. 22 .Dyke, MOH Report for Merthyr Tydfil for 1877, pp.7-9. 23 Dyke, MOH Report for Merthyr Tydfil for 1879, pp.17-18. 79 With the prosperity and the erection of new steel production plant at the Cyfarthfa works, people flooded into the town. 24

Table 2. 3.Occupations and Weekly Wages of Males Above 20 years of Age in Merthyr Tydfil Based on Census of 1861 (Dyke, MOH Report for Merthyr Tydfil for 1868., p.11.) Occupation Number of Workers Average Weekly Earnings Coal Miners 4,664 16/.6d. Ironstone Miners 1,562 15/. Fillers, Founders, Puddlers, 3,300 25/. Ballers, Rollers, Railmen Craftsmen, Quarrymen, Hauliers, 1,574 15/. Labourers

Table 2. 4. Weekly Wages of Skilled Workmen 1871(Dyke, MOH Report for Merthyr Tydfil for 1871., p.10.) Occupation Weekly wage Colliers 25/-. Ironstone Miners 22/.6d. Furnace Men 24/-. Puddlers 29/- Ballers 31/-. Rail Rollers 60/-

Wages, Food and Health

The health of miners, colliers and their families also suffered as a result of industrial conditions. Chronic lung diseases were acquired through the combined effects of industrial dust and extreme temperatures, and superimposed with tuberculosis, exacerbated by damp and poorly ventilated, overcrowded dwellings. Tuberculosis also affected miners’ families as Enid Williams’ illuminating study in the 1930s showed. 25 In 1869 poverty increased with the depression of the iron trade. The poor had little enough food before, and their bodies weakened by hunger, cold and damp, succumbed to scrofula, represented by an increase in deaths from “constitutional maladies.” Men and women aged 20 – 40 were particularly affected since they had to subsist on even less food in order to support their families. 26 Dyke reported an increase of 50% in consumptive and scrofulous (tuberculous) diseases. 27 Deaths from convulsions increased by 17% and lung diseases by 14% on the already high averages of the previous three years. The rate of deaths from lung diseases for children under 5 years of

24 Dyke, MOH Report for Merthyr Tydfil for 1880, p.14. 25 Enid Williams, M.D., The Health of Old and Retired Coalminers in South Wales, University of Wales Press Board, Cardiff, 1933. 26 Dyke, MOH Report for Merthyr Tydfil for 1869, pp. 11-12. 27 Dyke, MOH Report for Merthyr Tydfil for 1869, pp. 9-12. 80 age for the whole of England was 12 per 10,000 but in Merthyr 19.7, creating “an urgent need to repair these openings in our sanitary armour.”28

Table 2. 5. Prices of Coal, Iron Bars, Colliers Wages and Staple Foods in Merthyr Tydfil 1865-1879 (T. J. Dyke, compiled from MOH Reports for Merthyr Tydfil, 1865- 1879 based on Abstracts of Board of Guardians.) Years Bar Iron Steam Colliers Beef or Flour per Potatoes Butter per Ton Coal per Wages Mutton Sack per Cwt. Ton per lb. £. s. d. £.s. d. £.s. d. £.s. d. £.s. d. £.s. d. £.s. d. 1862 6.2.6 0.0.51/2 2.03.0 0.5.5. 1865 7.10.0 0.0. 61/2 1.12.6. 0.4.7. 1866 6.4.6. 0.0.7 ½ 2.0.4. 0.3.9. 1867 5.17.6. 0.0.6 ½ 2.8.10 ½ 0.4.7.

1868 5.15.0. 0.9.0. 0.16.6. 0.0.5 ¾ 2.83. 0.4.10 1869 6.4.0. 0.10.0. 0.18.6. 0.0.5 ½ 1.19 1 ½ 0.3.8 ½ 1870 7.4.0. 0.12.0. 1.2.6. 0.0.6 ½ 1.18.1½ 0.3.9. 1871 7.11.0. 0.15.6. 1.5.0. 0.0.6 ½ 2.3.3. 0.4.2. 0.1.2. 1872 10.10.10 0.19.8. 1.10.0. 0.0.7 ¾ 2.5.0. 0.4.9. 0.1.1. 1873 12.8.4. 1.3.3. 1.10.0. 0.0.8 ½ 2.11.9. 0.6.6. 1874 10.0.0. 0.16.11. 1.10.0. 0.0.8 ½ 2.4.6. 0.4.4. 0.1.2 1875 8.17.6. 0.14.3. 1.6.6. 0.0.8 ¼ 1.13.10. 0.3.7. 1876 6.7.6. 0.10.3. 1.5.0. 1877 5.0.0. 0.10.3. 0.18.0. 0.0.7 ½ 2.1.0 0.4.7. 1878 5.0.0. 0.9.3. 0.16.6. 2.1.9. 1879 5.5.0. 0.9.30. 0.16.6. 1.13.0.

The economic variations described above also affected daily existence through fluctuations in the cost of food and rent. In 1867, “a gradual impoverishment of the people was taking place, and concurrently the price of bread increased; so much so that the average cost of a sack of flour was enhanced by one fifth.” 29 1873 –74, were the optimal years for prices of iron and coal and decent wages, accompanied by a rise in the cost of food. Using the Abstracts of the Merthyr Board of Guardians, Dyke compiled a list of prices paid for contracts for food for the years 1865 to 1879. “The chief article of human food [bread] was very materially increased in 1867, as compared with the prices in previous years.” 30 (Table 2. 5.) In 1873, a year of prosperity, “[t]hese prices were much higher than those usually paid.” 31 An increase in wages and decrease in the price of food “the inexorable logic of figures” suggests an improvement in the health of the population at such time, but Dyke did not find that to be the case. During poor economic times, such as 1862 when wages were low, the mortality was 24.59, characterised by deaths from diseases of poverty, but

28 Ibid., pp. 10-13. 29 Dyke, MOH Report for Merthyr Tydfil for 1867, p. 21. 30 Ibid., p.16. 31 Dyke, MOH Report for Merthyr Tydfil for 1873, p.14. 81 in 1865 when wages were high, the death rate was 30.26 per 1000, due to diseases of a different character, which in Dyke’s opinion, were attributable to dissolute and thriftless self-indulgence.32 But other factors were always at work. Dry weather in May and June 1867 interrupted the growth of animal foods with a subsequent rise in the price of meat in 1868. There were lengthy periods of rain in the autumn of 1867, causing an increase in the price of corn, making it difficult for the average working man to obtain enough bread for his family. The first quarter of 1868 was exceptionally wet and cold, whilst June and July were very dry and heavy rain fell in August and September. The drought caused light hay and root crops to fail and the heavy rain reduced the yield of wheat, oats and barley, further increasing the costs of bread and meat. Men with large families and low wages were forced into small houses, allowing measles to take hold. 33

Patiently poverty was borne, but side by side with destitution, Diseases crept into the workman’s home. During the cold and wet spring of 1868, Measles, silently, but widely infected the children, especially in Dowlais and Penydarren. They disappeared over summer only to return that winter. 34

Dyke’s comments in 1871 on the effect of these fluctuating periods of prosperity and distress on the health of the population over the decade are interesting and accord with observations on the effects of the Lancashire Cotton Famine. 35 In 1875 Dyke observed that the death-rate of children was less in 1875 than in any previous year. 36 This counterintuitive response to conditions of crisis is an historical paradox as yet inadequately explained.

To the many thousands in Merthyr whose daily bread is earned by hard toil in piercing the Ironstone rock, in cutting the “black diamond,” or in fusing the precious metal obtained from the former by the fervent aid of the latter, a rate of wages, which would be adequate to the purchase of a sufficient quantity of nutritious food, is a matter of the very first necessity. That such an adequate rate of wages was weekly earned will be apparent upon carefully considering the figures in section 15 on page10. A certain stability of health, due to the daily use of a sufficiency of nourishing food, enabled our working men and their families to endure the frequent and long continued periods of wet and cold weather, which prevailed throughout the year, without any marked increase in the numbers of the sick. That this was so is demonstrated by the absence of any

32 Dyke, MOH Report for Merthyr Tydfil, for 1865, p. 9. 33 Dyke, MOH Report for Merthyr Tydfil for 1868, pp.21-22. 34 Ibid., p. 21. 35 Barbara Thompson, ‘Infant mortality in nineteenth-century Bradford’, in Robert Woods, and John Woodward, Urban Disease and Mortality in Nineteenth-Century England , Batsford Academic and Educational, London, 1984., p.127. 36 Dyke, MOH Report for Merthyr Tydfil for 1875, p. 14. 82 excess in the deaths from maladies affecting the respiratory organs, and notably by the very few deaths from diarrhoea, a disease which, when provisions are dear, labour ill paid, and the weather wet and cold, counts its victims by scores. 37

The key word is perhaps adequate wages. In 1876 Dyke lamented that in times of too much prosperity Welshmen commonly seemed to lose their commonsense and became somewhat frivolous in terms of diet and dress, to the detriment of their health.38 Despite the adversity caused by the strike of 1875, Dyke observed a lower death rate among adults from diseases of the heart, liver and kidney, which he substantiated with the statement that “fewer persons were presented before the tribunal of the magistracy” as “the drinking habits of the people had also diminished.” 39 Certainly there would have been little, if any money, to spare for the alehouse. The fact that men were not working in the polluted and oppressive atmospheres of the coal and iron works is likely to have been beneficial for their health. Fortunately, for infants and children, an inclement autumn meant fewer infant deaths from summer diarrhoea and whooping cough, and measles epidemics were not severe that year. However, in 1878, according to Dyke, diseases of the heart and liver increased when wages allowed indulgence in the ale-houses, and decreased during the bad times; “there have also been fewer deaths of young children from convulsions, and no kind of disease has shown any disposition to increase.” 40 Dr Dyke only provided information on the price of commodities, food and wages for the years 1865-1879, a period of 14 years, but his reports provide a valuable insight into the economic vagaries of life in Merthyr Tydfil and their effects in everyday terms on the population. Further evidence is provided in Dyke’s observations on the effects of the industrial strife of 1875 on families.

The Application of the Poor Law in Merthyr Tydfil Union from 1834

The bitter industrial dispute of 1875 left the recently formed Amalgamated Association of Miners bankrupt. The mechanisms of the Poor Law were enacted when

37 Dyke, MOH Report for Merthyr Tydfil for 1871, p.15. 38Dyke, MOH Report for Merthyr Tydfil for 1876, Public Record Office, Kew, MH 12 /6338, p.14. Dyke complained that great prosperity caused the people to cast off sensible homespun woollen garments suitable for the climate and instead wear unsuitable silk. He witnessed their health suffered from luxurious living. 39 Dyke, MOH Report for Merthyr Tydfil for 1875., pp. 14-15.. 40 Dyke, MOH Report for Merthyr Tydfil for 1878, p.32. 83 mass unemployment led to destitution on a large scale for a protracted period in 1875 and 1898, demonstrating the inadequacy of the Law to assist at such times. In fact the mechanisms of the Poor Law were used by the Guardians to starve the miners into submission. 41 The New Poor Law of 1834 was designed to remedy the problem of pauperism, especially in the countryside, while continuing to protect the helpless, not to deal with a mass industrial or urban crisis. The principles of political economy required people to be responsible for their own welfare. The Poor Law Report of 1834 did not attempt to investigate the causes of poverty, which was described as the condition of someone who had to work ‘to obtain a mere subsistence,’ which was the normal lot of most of the working classes. It was therefore not considered ‘expedient’ to relieve such poverty. However, the Commissioners honoured the principles of the Elizabethan Poor Law in assisting the ‘indigent poor’, the feeble, elderly, infirm, and children. They were concerned with the cost of providing relief, especially in rural conditions, and were anxious to discourage able-bodied labourers from receiving relief by instituting the labour test. Applicants had to complete task work before being relieved. 42 For example, in 1852, H.A. Bruce argued the need for providence among workers, particularly the habit of saving for sickness and old age, saying that

….the palmy days of their prosperity were gone, that they must not look to the return of the high wages of former years. Increased competition at home and abroad appears to have permanently lowered the profits of the trade, and with them the prospect of high wages…..they must look to the improvement in their condition in the cultivation of provident habits, and that their wages, if more carefully husbanded and judiciously spent, were still amply sufficient to provide for the comforts and decencies of life. 43

Although friendly societies and frugality provided social and economic support for the prudent, a poverty stricken underclass always required poor relief. From 1836 to 1853 the cost of outdoor relief, reflecting the chronic needs of the community, rose steadily. (Appendix. Table 5.) The Guardians insisted on providing financial relief rather than in kind as the Commissioners required, saying that ‘Merthyr Tydfil was different from agricultural districts and neighbouring manufacturing districts.’ 44 Whilst

41 Thomas, Poor Relief in Merthyr Tydfil Union, p.129-131. 42 ‘Remedial Measures’. S.G.&E.O.A. Checkland, (ed), The Poor Law Report of 1834, Penguin, Harmondsworth, 1973, pp. 334 ff. on ‘Remedial Measures’. 43 Bruce, H.A., ‘Merthyr Tydfil in 1852’, A Lecture Delivered to the Young men’s Mutual Provident Society at Merthyr Tydfil, February 3rd, 1852, William Wilkins, Post Office, Merthyr Tydfil, 1852..p.16. 44 Minutes, MTBG, 12 November 1836, 25 March 1837, cit. Thomas, Poor Relief in Merthyr Tydfil Union, p. 25. 84 pressure from the Poor Law Board to build a workhouse was based on economy, the Guardians were aware that when trade was slack workers were underemployed, and to obtain relief meant forcing them into the workhouse. 45 The amount paid out by Relieving Officers increased from £5,202 in the period April 1837 to March 1838 to £14,035 between April 1852 and March 1853.46 Merthyr Tydfil Union was the only one of 18 unions in south Wales to increase expenditure from 1836. 47 Expenditure fluctuated, falling in 1844, 1845 and 1846 during the prosperity of the railway boom and in 1853 with the revival of trade and the opening of the workhouse, but rising again in response to industrial and a series of epidemics 1847-49. 48 The financial burden of interdependent sickness and poverty drained the resources of the Board of Guardians and undermined community relations. The Board tried to maintain a flexible system of poor relief whilst keeping the poor rates down until the Union workhouse was opened in 1853.49 During trade or industrial disputes the poor law authorities faced the difficulty of widespread destitution. To give relief required the work test, otherwise posing the threat of pauperizing a large body of workers. Chronic hunger and ill-health were frequently evident among families, either through the effects of low wages and substandard accommodation or industrial disputes. When mass unemployment threatened workers at DIC in 1848 Inspector Owen proposed that land should be made available for the men to dig if they were unable to find work at the other ironworks or on the railways. The Guardians feared that men used to the heat of the furnaces would not be able to stand working outside in the cold winter months and that if men left to find work in other districts, their wives and children would be left for the Union to support. The Board wished to offer only stone breaking as task work and proposed work-sharing on reduced hours and supplementing the wage in order to keep families. The Poor Law Board was reluctant to agree. The crisis was averted when DIC and the Bute Trustees reached an agreement over the lease. 50 During the Aberdare colliers’ strikes of 1850 and 1857, many miners lived on credit, ensuring that their deprivation continued into better times. Colliers and ironworkers lived a precarious economic existence but despite the hardships faced by many, few accepted indoor relief. Workers lived on charity, Friendly Society Funds and credit, and

45 Thomas, Poor Relief in Merthyr Tydfil Union, p. 79. 46 Minutes MTBG, cit. Thomas, Poor Relief in Merthyr Tydfil Union, p.26. 47 Ibid., p. 33. 48 Ibid.,pp. 26-27. 49 Ibid.,pp. 17-26. 50 Ibid., pp. 30-33. 85 in 1857-58 people somehow got by rather than enter the workhouse.51 Parish relief was a last, desperate resort and the extent and effects of poverty cannot be assessed from the returns of paupers relieved. The Guardians were reluctant to build a workhouse for fear of working-class agitation against the unpopular concept and because the cost of indoor relief to ratepayers was greater than the cost of outdoor relief.52 The workhouse was built of necessity in 1853, following years of pressure from the Poor Law Board, and after a series of epidemics caused much hardship, and because of publicity given to the plight of pauper children. 53 Having no public accommodation for them the Guardians boarded young children, for 2/6d a week in filthy overcrowded lodging houses. 54 In 1847 a reporter from The Morning Chronicle revealed the scandalous conditions in which these pauper children were farmed out: “I thought of the high mortality of infant life in Merthyr, and it seemed to me a mercy rather than otherwise, that children should be taken away from such hardships, neglect and sufferings.” 55 In one house they saw

The corpse of a child in a winding sheet, laid upon a table; a white handkerchief, folded small, covered its eyes, but did not conceal the features, which waxy and pallid, death had composed into a smile. Though the child had been dead two days, it was unprovided with a coffin. The odour of the house was almost insupportable. Before the fire were three or four children; amongst them a boy named Martin B-----,11 years of age, who had been placed there by the parish, the allowance being 2 shs. per week. This boy had no shirt; he was bare-footed, in rags, his hair bristled up, and he was literally black with filth. 56

H. A. Bruce, stipendiary magistrate, landowner and ex-officio Guardian, used the condition of pauper children as a further imperative to build a workhouse. Bruce was passionate about the provision of proper care for these children under the Poor Law. In 1852 he stated that the number of children under 16 relieved in the parish of Merthyr Tydfil during the six months April to September 1851 was 2,901; and that in the entire Union the figure was 3,747. Of these, 1,536 lived with their father and 1,290 with widowed mothers; 165 were illegitimate children living with their mother and 226 were

51 Thomas, Poor Relief in Merthyr Tydfil Union, pp.116-7. 52 Thomas Poor Relief in Merthyr Tydfil Union, pp. 30-33. 53 Ibid., p. 8. 54 Ibid., pp.39-41. Strange, ‘The Condition of the Working Classes in Merthyr Tydfil 1840-50.’ 55 Ginswick, J., Labour and The Poor in England and Wales, 1849-1851: The Letters to the Morning Chronicle from The Correspondents in The Manufacturing and Mining Districts, The Towns of Liverpool and Birmingham and The Rural Districts Vol III: The Mining and Manufacturing Districts of South Wales and North Wales, Frank Cass, London, 1983, pp. 86,87, cit. Thomas, Poor Relief in Merthyr Tydfil Union, pp. 63-4 56 Ginswick, Labour and The Poor in England and Wales, 1849-1851, pp. 86-7, cit. Thomas, Poor Relief in Merthyr Tydfil Union, p. 64. 86 orphans. The fathers of 318 children were 'non resident' and the parents of 120 children were "not able-bodied." 57 Five years earlier Bruce and his brother-in-law, J. C. Campbell, the Rector of Merthyr, had campaigned for an industrial trade school to enable pauper children to avoid a lifetime of pauperism, an important approach to the relief of poverty. The proposal divided the Board since ratepayers would be required to finance both a workhouse and an industrial school. The Board decided to first build a workhouse to accommodate the children, and the proposal for an industrial school was not considered again until 1876. 58 Meanwhile the Poor Law Commissioners were urging the provision of a workhouse with hospital accommodation for sick paupers.59 Inspector Farnell argued that, whereas the other nine neighbouring Unions had reduced their expenditure since 1836, Merthyr’s had increased from an average of £6,817in the three years 1838-1840 to an anticipated £12,110 in 1848. This ignored the cost of epidemics and the recession in the iron industry. As late as 1847 public outrage was expressed towards the idea of a workhouse, but by 1848 wages rose, unemployment fell and workers drifted away from Chartism. 60 The Merthyr Board of Guardians decided at a meeting on 17 June 1848 to build a workhouse to accommodate 500 people at a cost of £10,000. 61 The proposal was supported by the Aberdare and Merthyr Guardians but not by the rural parishes. The local press summarised the position thus:

As however, the parishes of Merthyr Tydfil and Aberdare contain a full three-quarters of the population of the whole Union, and as their Guardians may without offence be supposed to be better selected from a more intelligent and better-informed class than those of parishes which form the minority, and, as moreover, the majority was supported by the declared adhesion of the four largest ratepayers, the Dowlais, Cyfarthfa, Penydarren and Aberdare companies, this expression may be considered decisive.62

A site was allocated in September 1849, but negotiations were delayed by the cholera epidemic of 1848 and by controversy over the provision of an industrial school. During 1850 capital finance was negotiated with the Atlas Insurance Company when the

57 Bruce, ‘Merthyr Tydfil in 1852’, pp. 11-12. 58 Bruce, ‘Merthyr Tydfil in 1852’, pp. 11-12. I am indebted to Iain Brash for the following information in regard to H. A. Bruce’s statement: “ In 1852 H. A. Bruce indicated that [2,047] children under 16 were relieved in the Union in one day on July 1st 1851. 3747 is the total number of individual children relieved in the MT Union in the six months April - Sept. 1851. See Thomas Mackay, History of the English Poor Law, Vol. III, London, 1904, p.603.” 59 Cardiff and Merthyr Guardian, 12 June 1847, cit. Thomas, Poor Relief in Merthyr Tydfil Union, p. 49. 60 Thomas, Poor Relief in Merthyr Tydfil Union, p. 76. 61 Ibid., pp. 78-79. 62 Ibid., p.76. 87 ironmasters declined to lend the money. Plans were considered in October 1850. Construction once it began was spasmodic until the Board threatened to impose penalties in July 1852. The exact date of completion is not recorded in the Minutes but the Workhouse opened in 1853 once staff were appointed and in September, two dozen hammers ordered for stonebreaking. 63 From 1853-1894, outdoor relief in Merthyr always far exceeded that provided in the workhouse. The workhouse test was totally inadequate to deal with mass destitution from industrial causes and it was cheaper to maintain families in their own homes on temporary outdoor relief. 64 From 1861-1871 approximately one-twelfth of the population was in receipt of parish relief. 65 In 1871 the Local Government Board renewed the attack on outdoor relief. The Guardians endeavoured to keep rates down since these burdened the propertied classes and it was believed that thrift should carry people over hard times. Outdoor relief could not be abolished, but the workhouse was increasingly offered to those seeking poor relief. There were only twenty-one able-bodied paupers in the workhouse during the bitter strike of 1875, and eleven the previous year. In 1883, when there was a shortage of able-bodied paupers on indoor relief, women and girls were sometimes ordered to work in the workhouse in return for wages, food and outdoor relief. When discharged from the workhouse to seek work paupers were merely given a small allowance or some bread and cheese for a day or two. 66 The cost of relieving the able-bodied in Merthyr alone was £8,149.8s.9d. in 1875. 67 Merthyr Tydfil Union embodied the difficulties associated with the implementation of the Poor Law, especially the difficulty of implementing the labour test for able-bodied workers and providing indoor rather than outdoor relief. There were inherent difficulties associated with the unpopularity of the concept and the practicalities of imposing such measures related to the particular conditions related to Merthyr as an iron town. These difficulties were emphasised during two bitter industrial disputes in 1875 and 1898.

63 Ibid., 78-82. 64 Ibid., pp.115-132. Appendix 8, p.164. 65 Jones, ‘Industrial History of Merthyr Tydfil’, The Democrat’s Handbook, p. 44. 66 Thomas, Poor Relief in Merthyr Tydfil Union , p. 113. 67 Ibid., pp. 131-2.

88 Social and Economic Impact of Industrial Unrest

The architects of the New Poor Law did not understand the diverse causes of poverty and therefore failed to provide measures of relief adequate to the needs of an urban and industrial community rather than individual classifications of pauper. They did not intend to address protracted mass destitution, and certainly had no wish to condone industrial action, quite the opposite. The legislation’s moral philosophy in fact reinforced class differences and disempowered the poor. During times of large-scale industrial strife, thousands of workers and their dependents were forced to survive by whatever means available to them when Merthyr Tydfil Union, operating to the requirements of the Poor Law Board found it difficult to meet enforced poverty on a large and at times protracted scale. Families, especially women and children suffered particularly during such times, continuing to suffer the social and economic effects for some time during the recovery phase following such hardship. Industrial disputes, together with the effects of underemployment and erratic wages created conditions of economic uncertainty, which inevitably adversely affected the standard of living at basic levels, creating a climate of poverty for many as the underlying condition which affected the health of the population, particularly maternal and infant health. Unionism was slow to develop in Merthyr following the early chartist insurrection. Some militancy among Aberdare colliers in 1850 and 1857 was followed by the formation of the Glamorgan Union of Colliers. The Trade Union Acts of 1871 and 1875, major industrial action in Merthyr in 1875, and the formation of the Amalgamated Association of Miners advanced the trade union movement. 68 Union funds were intended to support striking workers. However, funds were quickly depleted, members were slow to join unions, leading to hostility and many minor skirmishes against black-leg workers. The Great Coal Strike of 1898 was a major turning point for unionism with the formation of the South Wales Miners Federation. 69 From 1831 the attempts of coalminers and ironworkers to form unions were crushed by the ironmasters, but attempts at industrial action continued.70 In 1857, a 15% wage cut for Aberdare colliers was introduced without any consultation and in December 4,000-5000 men went on strike over industrial relations and increasing social inequalities. The strike lasted seven weeks and troops were called to maintain order.

68Ibid., pp. 5, 34-39. 69Egan, Coal Society, p. 62. 70Ibid., p. 61. 89 Strikebreakers or ‘blackleg’ labour brought in from other districts were met with open hostility in which women participated.71 From necessity and semi-starvation the men were forced back to work in February 1858 with a further 5% reduction in wages as a result of losses occasioned by lost production. A trade crisis in 1865, with a decline in the iron industry and a cutback in coal production in Aberdare, caused a rise in pauperism. The Merthyr Board of Guardians repatriated Irish paupers, made stone- breaking task work harder, and imposed the workhouse test on all able-bodied women with one child.72 (Table 2. 6.)

Table 2.6. Aberdare Parish Relief 1857-8 (Tydfil Thomas, Poor Relief in Merthyr Tydfil Union, p.117.) Half Year Ending Indoor Outdoor March 1857 38 886 March 1858 60 1,064

The 1870s began in boom conditions, but 1872-73 nationally were the last years in a boom period, and a period predominantly of recession began from late 1873. Appendix. Table 4. confirms that Merthyr shared in the boom, high prices for coal and bar iron and a strong demand for labour, which made possible a substantial increase in wages. When prices began to fall, naturally there was increasing conflict between capital and labour. The dangerous nature of work in the iron and coal industries and the increasing prosperity of coal and iron owners fostered a rising perception of social injustice and workers increasingly expressed their concerns in terms of capitalism and exploitation as industrialists demonstrated their greater ability to survive the economic downturn, whilst the mass labour force absorbed the economic impact, brutally at times. In 1874-77 there was lack of growth or only slow rises in production. In 1877-79 all branches of trade were severely depressed and unemployment was at its highest level in the fifty years preceding the Great War.73 The latter half of the nineteenth century was marked by disputes over wage structures and conditions of employment, aimed to secure a minimum standard of living for workers, and improve mine safety as coal mines opened at deeper and more dangerous levels. Tensions throughout the whole community increased as the miseries of 1871 and 1875 were again experienced during the Great Coal Strike in 1898. Many were small and localised disputes as numerous small unions represented their particular

71 Rosemary A. N. Jones, “Women, Community and Collective Action: The ‘Ceffyl Pren’ Tradition”, John,(ed), Our Mothers ‘Land., pp.36-37. Egan, Coal Society, pp. 63, 67. 72 Thomas, Poor Relief in Merthyr Tydfil Union, p.118. 73 Ibid., pp.115-116. 90 district or field of labour. Tensions were also created around the issue of voluntary unionism and those refusing to join. From the 1870s trade unionism became more widely established across the south Wales coalfield as the Lancashire-based Amalgamated Association of Miners built up a membership of 42,000 in south Wales. The AAM was defeated in two disputes in 1871 and 1875, partly due to the continuing hostility of coalowners to trade unions generally and partly due to the weakness of the Union. According to the Western Mail in 1871 miners expected strike pay of 10/- a week and received only 2/2d after three weeks, equivalent to 9d per head per week. Two important results of the 1874-5 strike were the establishment of a Sliding Scale Committee to negotiate wage levels with the employers and the recognition of union leaders by the coal owners and the Cambrian Miners’ Association. Thomas Halliday, President of the AAM, stood as a Labour candidate in the General Election of 1874 when, though not elected, he obtained 4,912 votes, indicating a change in political consciousness. 74 District Unions replaced the AAM representing miners on the Sliding Scale Committee. Many organizations were controlled by coalowners and up to the 1890s Britain’s coalminers were slow to join trade unions. In 1892 the Sliding Scale Agreement achieved industrial peace, but it appeared to benefit the masters more than the men. There was little attempt to maintain either wage rates or the price of coal, but the dissatisfaction led to no organised action. Unionism spread more rapidly with the formation of the Miners’ Federation in 1898, but in 1893 only 45,000 out of 120,000 miners in south Wales belonged to unions due to the hostility of coalowners and because of the mass immigration of labour into the coalfield in the 1890s. Colliers tended to dominate the unions, which caused other trades to set up their own unions and take their own industrial action as in the Hauliers Strike of 1893. The withdrawal of labour by one portion of the work force inevitably affected many other areas of industry, which could make industrial action more effective, but insidiously undermined the community. By 1896 a workmen’s committee was set up to control the underselling of coal, whilst at the same time D A. Thomas, M.P., the senior member for Merthyr Borough, was attempting the same. An alliance of masters and workmen agreed through the Sliding Scale Committee to coal prices which would guarantee both profits for the masters and fair wages for the men. The question of underselling continued to dominate discussions and certain collieries refused to cooperate. 1898 was a turning point for trade unionism among south Wales miners when a six-month lock-out took place as

74 Egan, Coal Society, pp. 61-62. 91 William Abraham (Mabon) led unions seeking a 10% wage increase, negotiating against Sir W. T. Lewis (Lord Merthyr) leader of the Coalowners Association in south Wales.75 The Sliding Scale Committee was transformed into the Conciliation Board, and the South Wales Miners’ Federation, established in 1898 as a direct consequence of the strike, became affiliated to the Miners’ Federation of Great Britain.76 These arrangements formed the background of industrial politics in which economics, labour and political ideologies shaped the social responses and identity of industrial towns such as Merthyr Tydfil throughout the nineteenth and into the twentieth century. Two particular examples in Merthyr were the major industrial crises of 1875 and 1898. The strike and lockout of 1875 demonstrated the subversion of social power in the interests of industrialists and to the detriment of the workers and their families, an example of the political dimensions of the Poor Law. Powerful vested interests could not only dominate the administration of the law but turn it to their advantage, further alienating the socially disadvantaged. The Guardians acted legally, but made apparent the inadequacies of the system and the necessity of further reforms. For Merthyr Tydfil Union, it demonstrated the ineffectiveness of the Poor Law, unable to meet the scale of demands of mass unemployment and poverty, particularly during the strikes of 1875 and 1898. In his annual report for 1875 Dyke described the social and economic impact of the disputes, the response of the Board of Guardians and the effects on the community. His poignant report translates industrial politics and medical statistics into human dimensions. The levels of social distress clearly affected Dyke deeply as he described the sudden and disastrous effects of inability to labour in an industrial town dependent on two major male-dominated primary industries.

In the first month, the trouble which had been foreshadowed by the frequent differences between the masters and men, as to the mode of regulating wages, came down upon the district in all its suddenness and extremity. Notices were issued on New Year’s Day, that at the end of the month all contracts would cease: On the 1st February the Ironworks and most of the collieries were closed, ten thousand working persons ceased to labour, and twenty thousand persons, dependent upon the daily toil of these for daily bread, were deprived of their support…..

For a time the savings of years enabled the thrifty to bear the Deprivation, but those whose disposition it was to use the day’s

75 Ibid., p.62. 76 Jones, ‘Industrial History of Merthyr’ The Democrat’s Handbook to Merthyr, p. 48., Davies, A History of Wales, pp.441-444,469-480,487-494.

92 wage in the day, were at once thrown on the parish. Labour was offered them -that of stone-breaking- many hundreds availed themselves of this means of supplying a scanty meal to their wives and little ones, and though the season was unusually rigorous, it was noted that affections of the organs of breathing were less frequent than usual.…….77

The disputes affected thousands of workers and their families simultaneously, creating one of many disastrous economic crises for the town. Saving was prudent, but life was also short and precarious and, faced with such realities, poor relief barely afforded subsistence levels at the best of times, let alone on a vast and protracted scale. Emigration in search of work became a normal feature of life in Merthyr, one more difficulty to face as men sought work elsewhere, leaving their wives and families to survive as best they could. Such disputes created more than economic crises, they created social crises, placing workers in an invidious position. The choice between worker solidarity and starving families was unbearable, but many felt unable to accept the work offered, creating anger towards scab labour. The dispute tested the Poor Law on the subject of whether strikers, having “voluntarily” entered into a state of poverty and unemployment, should be granted poor relief. The Guardians found it difficult to administer task work on such a huge scale and on 30 January 1875 granted poor relief only to men with dependent families. The owners decided on a ‘lockout’ to prevent strikers being supported by men at work, but there was already such social distress in Upper and Lower Merthyr Tydfil that both Relieving Officers broke down through sheer exhaustion. By 19 February the Guardians met almost daily due to the severity of the situation and it was decided that single men would be relieved only in the workhouse. 78 The winter months January to March were often so bitterly cold with severe weather on the exposed mountain sites that surrounded Merthyr Tydfil that outdoor work became impossible and sheds were considered necessary for stone breaking work. The Guardians feared mass action by the workers with an organised run on the poor rates and breaches of the peace. Clark, Chairman of the Board of Guardians and Trustee of the Dowlais works, attended a meeting of employers in London on 25 February, 1875 where it was decided to continue in ‘the same uncompromising, silent resistance’. The owners in effect were able to starve the workers into submission through their position as Guardians of the poor. 79

77 Dyke, MOH Report for Merthyr Tydfil for 1875, p. 13. 78 Thomas, Poor Relief in Merthyr Tydfil Union, pp. 121-2. 79 Ibid., p. 131. 93 On 17 March 1875 Inspector Doyle of the Local Government Board proposed that the masters offer the able-bodied task work at sufficient wages to keep the men off the poor rate.80 He urged a neutral position by the Board; their task was to provide sufficient work and to refuse relief to those who refused to labour, thereby meeting the needs of the masters, the men and the small ratepayers. G. T Clark supported this position and promised that the Masters Association would consider the request. A faction within the Board challenged the ironmasters’ autocracy in local and parliamentary politics and Dr. J. W. James, supported by W. Gould, a former Chartist, asked whether the work to be offered was underground. If so the Guardians could be accused of supporting the masters against the men, who would have to work at a 20% reduction of wages. More stringent measures were taken towards the able-bodied. Men were to work every day of the week, although some of the Board opposed this. Seventy-one men threw down their hammers at 11a.m on Good Friday, and left to go to church but were consequently dismissed and left destitute. 81 At last on 29 May 1875, after extreme suffering, the men agreed to a 12% reduction in wages and the operation of a sliding wage scale. In 1876, wages in the iron and steel works were reduced 12% from 1 January, and a further 7 % in November. 82

The Great Strike of 1898

The Great Coal Strike of 1898 lasted just over five months and affected the whole of the south Wales coalfield. In March 1898 a workmen’s Conference rejected the employers’ proposal for a new Sliding Scale. Negotiations stalled on the issue of plenary powers. By September the delegates recommended the termination of the Sliding Scale, a fortnight’s holiday, and a fixed at 30% above the standard, and the owners retaliated by giving six months notice of termination of employment contracts. By the autumn of 1897 a strike by engineers resulted in many pits working less than half time with much poverty experienced. The employers agreed to recognise a minimum wage rate, but the strikers with little faith in their leaders, prolonged the dispute when a settlement seemed possible. Matters drifted from January to March, as 100,000 miners stood idle throughout south Wales and Monmouthshire. On Monday 18 April, an appeal was made to the workers and general public of the United Kingdom to resist a reduction in wages. The owners, proposed a new Sliding

80 The Merthyr Express, 20 March, 1875. 81 The Merthyr Express, 3 April 1875 cit. Thomas, Poor Relief in Merthyr Tydfil Union, p. 127. 82 Dyke, MOH Report for Merthyr Tydfil for 1876., p. 10. 94 Scale Agreement, which would have worsened the workers’ position, and negotiations broke down. A Strike Fund was set up on behalf of South Wales and Monmouthshire colliery workers, in particular “to assist in the feeding of the women and children of this struggle”. Agreement was finally reached on 1 September 1898 to terminate the strike. 83 The social impact of the strike was equally as important as the political and economic impact and in the development of labour history. The Merthyr Express reported the immediate effects of the commencement of the strike.

Once the colliers came out on Saturday, the whole of the pits from one end of the valley to the other were brought to a standstill and a mass meeting of men employed at the Dowlais, Cyfarthfa and Plymouth Collieries was held at Thomastown near the centre of Merthyr. At Dowlais Works several departments were closed for want of fuel and it was feared That the furnaces would soon have to be damped down if work did not soon resume at the pits. A similar situation led to a stoppage at Ebbw Vale……..

and a consignment of Lancashire coal was received by the Merthyr Gas Company. 84

Dowlais Iron Company shut down by 23 April with the exception of a couple of blast furnaces. Tower Colliery, owned by the Marquis of Bute, was threatened with permanent closure by flooding with subsequent loss of employment for the people of Hirwaun. 85 Further dismissals left only a few labourers working two or three days a week. Scores of colliers left to seek work elsewhere and more than fifty families returned to Ireland. Men employed in the iron and steel works, where wages were comparatively low, were put out of work through no fault of their own, for want of coal. Poverty and distress were also felt by the workers of the Cardiff Railway Company, with no commodities to transport. In that week alone 800 men in Merthyr applied for poor relief for themselves and their families, but over 100,000 men were out of work in the South Wales Districts. Sir W. T. Lewis distributed money to men with families, which was accepted as a loan to be repaid once work resumed, ensuring the poverty experienced during the strike continued well beyond it. 86

83 Merthyr Express Almanac for the Year 1899, p. 82. The course of the strike and its social impact was illustrated by a series of compelling cartoons. J. M. Staniforth, Cartoons of the Welsh Coal Strike, April1st to September 1st, 1898, Western Mail, Cardiff, 1898. See especially pp.10,21,27, 28, 32 and 37. 84 Merthyr Express, 9 April, 1898, p. 3. 85 Ibid.. 86 Merthyr Express, 30 April, 1898, p.3 . 95 The Guardians once again faced the difficulties encountered in 1875. With DIC at a standstill, the distress “was very acute.” 2,000 people sought relief at Dowlais Workhouse. Mr. Bircham, Inspector for the Local Government Board, reiterated that the Guardians legally “could only relieve able-bodied men by opening a labour-yard or by offering them indoor relief.” 87 The Board proposed to restrict relief to destitute women and children, and a committee was appointed to assess every case on its merits. Several men agreed to work for the sake of their wives and children. One man had lived in the town for forty years, but had ten children, had never before applied for relief. 88 Those who agreed to stone breaking, and accepted relief, were removed from the register of voters, reducing the number of voters in the election at which Keir Hardie was elected for Merthyr. The Board of Guardians, besieged by applicants for poor relief, was soon in financial difficulties. Expenditure in MTU amounted to £36,000 at a time when local businesses were also suffering from the effects of the strike. The financial cost of the industrial struggle was estimated at £3 million in lost wages for colliery workmen and £1/2 million for the men at the iron works, an estimated total of £10 million. 89 The total cost of the strike in relief to families by the Board of Guardians was £20,000. 90 The cost to the health and well-being of the population was incalculable.

Poverty and Social Distress

During these periods of industrial unrest families experienced a very uncomfortable hand-to-mouth existence. The suffering in Merthyr in 1875 raised donations locally, nationally and internationally to provide one good meal a day of soup and bread “to the suffering children of the poor”. 91 Soup kitchens fed 4000 children daily for fifteen weeks. In addition, door-to-door collections by mothers must have caused considerable distress for those who swallowed their pride in order to beg for food, from those who could themselves ill-afford to give. The women and children of Merthyr became the innocent victims of the politics of capitalism and labour. If one good meal of soup and bread were sufficient to reduce deaths among children, Dyke asked rhetorically – what if relief had not been received? It is difficult to imagine that such measures were possibly an improvement on the normal experience for families. A

87 Ibid. 88 Ibid. 89 Merthyr Tydfil Almanac for the Year 1899, p. 89. 90 Jones, ‘Industrial History of Merthyr’ ILP, The Democrat’s Handbook to Merthyr, p. 48. 91 Dyke, MOH Report for Merthyr Tydfil for 1875, p. 13. 96 community does not recover quickly from such a calamity, its consequences being felt for some considerable length of time. Within a fortnight of the beginning of the 1898 strike, soup kitchens were started in every district. 18,000 children were fed every day in Merthyr and family men once again worked in the stone yards.92 The Merthyr Express reported that “The pinch of poverty is being keenly felt in the town, and many families are in great want.” 93 A public meeting called by F. T. James, the High Constable, to decide what measures should be taken to alleviate the distress, was attended mainly by men with families in need. Clearly an effort must be made to “at least fill the mouths of women and children.” A central relief fund for Dowlais, Penydarren, Fochrhiw and was instituted. 94 The entire town was canvassed for donations to the fund. Gifts of money, groceries and merchandise showed sympathy for the workers. Larger donations were made by the likes of D. A. Thomas, M.P. who donated £30 towards the sustenance of a community in want. 95 The Board of Guardians used the elementary schools as soup kitchens in the town and in outlying districts. “A liberal supply of good wholesome, nutritious soup, together with bread,” was provided to nearly 3000 children and a number of adults daily. In , soup kitchens fed 212 boys, girls, infants and babies with an expected increase in numbers to follow. Many reports of schoolchildren indicated total destitution. At Penrhiwceiber many children went to school without breakfast and little prospect of dinner. Several teachers supplied food to children at their own expense.96 Mr. J. H. Williams, Relieving Officer for the upper district of Merthyr, reported that “there was wholesale destitution, nearly all being in a very poor state.” When he visited one house, twenty people were there to bring him to their homes. He worked until 1 a.m. each day and could not get people away from his house. He visited 150 cases and gave tickets to 60. Mr. Morgan, the Assistant Relieving Officer, visited 100 cases in Penydarren, all strikers, and gave thirty tickets. He reported that there was “great destitution” in Quarry Row; he had searched for food and found none, but discovered that the men had “tramped” a good deal in search of work. Mr. Jones, Relieving Officer at Pontlottyn, also reported great distress in his district. Dr. Davies

92 Merthyr Express Almanac, 1899. R. Page Arnot, South Wales Miners, p.63., cit. C. Thomas, ‘Industrial Development to 1918’, Merthyr Tydfil Teachers group, Merthyr Tydfil: A Valley Community, p.329. 93 Merthyr Express, 23 April, 1898, p. 3. 94 Ibid. 95 Merthyr Express, 30 April, 1898, p. 3. 96 Ibid. 97 reported twenty “very destitute” families. Mr. Richards, Relieving Officer for Aberdare had, however, only received one application from an able-bodied man. Mr. J. Davies, Relieving Officer for Lower District, was “overwhelmed” with applications for relief, but was only able to grant relief to keep them from starving or to those receiving medical treatment. He had visited 150 cases and "in most cases there was not a morsel of food”; only a small percentage were ironworkers. “He found women with babies to the breast with no covering save an old frock, and they told him they had not a bit of food in their stomachs.” He had searched for food in these houses and found none; one woman had pawned all her children’s’ clothes for food. 97 By June, the coal dispute was still unresolved and many strikers participated in The Great March from Dowlais to Merthyr Vale. Keir Hardie addressed a workers’ meeting and finally a new agreement ended the strike, leaving Merthyr’s citizens to piece their lives together once more. Such was life in Merthyr.

ILP and the Poor Law

The increasing sense of social injustice was explored through the politics of Socialism. The Democrat’s Handbook (1912) emphasised that there were two sides to Merthyr’s industrial history, the economic gains made by Merthyr’s major industries, and the workers’ experience of industrial progress, which presented a decidedly alternative view of the process.

The degrading conditions under which people live, which had grown side by side with this enormous production of material wealth are passed over, or are mentioned as if they were but remotely, if at all, related to the capitalistic system of organizing industry. 98

Local branches of smaller trades unions were stimulated by the growth of the South Wales Miners’ Federation and the propaganda of the Independent Labour Party, and the local Trades and Labour Council increased solidarity among workers. The membership of growth of Co-operative movements also increased.99 The Merthyr branch of the Independent Labour Party was formed in July 1896.100 Keir Hardie’s first involvement with Merthyr was at the Aberdare miners’ conference in 1887. Hardie again visited Merthyr in 1896, and in 1898 spent a fortnight speaking in support of the

97 Ibid., J.M.Staniforth, Cartoons of the Welsh Coal Strike, p.21, 28, 32. 98 Preface to The Democrat’s Handbook to Merthyr. 99 Jones, ‘Industrial History of Merthyr’ , The Democrat’s Handbook to Merthyr, pp.48-49. 100 Lawrence, ‘Political History of Merthyr Tydfil’, The Democrat’s Handbook to Merthyr, pp.58-9. 98 miners’ “strenuous fight for a .” 101 Workers receiving poor relief during the 1898 strike were temporarily disenfranchised. The strike of 1898 provided a good opportunity for propaganda and an address by Hardie raised £500 for the Strike Relief Committee giving the movement substantial impetus.102 Hardie stood both for Merthyr and Preston in 1900. 103 D. A. Thomas was returned with 8,595 votes and Hardie 5,745, giving Merthyr representation by its first genuine Labour and Socialist MP. D. A. Thomas retired in Jan 1910 after 22 years service and Hardie was once more returned with 10,251 votes. 104

The ILP secured nearly one-third of the seats when Merthyr was created a Borough, one of its members, Mr. Enoch Morrell became Mayor; a number of members were also elected to the Merthyr Tydfil Board of Guardians. 105 Mr. John Prowle, miner, described the influence of Socialism on the Board of Guardians.

Ours is a record we all feel proud of. It is a work we love. It is a work not up to the ideals of socialism; we are not creating a society where paupers will be unknown, we are not removing the causes, but we are caring for the wrecks. Had our Board the power of removing the causes, with our group’s energy, slumdom and suffering would be matters of history only on the municipal records and not a reality. 106

Once Socialists were admitted to the Board 1901-7, they “started attacking right and left.” 107 Prowle described the grievous state of affairs which was so often met.

I am sorry to have to admit that we have the lowest types of children under our care; and if the Children’s Act was carried out in our district as it should be, we should have double the number we have today. It grieves one to see what so often happens. A mother and children, degraded and filthy, coming into the workhouse from the most hideous slums, and after a few days quarantine in the workhouse the children are sent to cottage homes. A few days after the mother takes her discharge, and the children, who now like our homes, cry bitterly to stay; but go they must. It is a common occurrence to find the same children in and out three or four times a year. We are awakening to a sense of our responsibility to the next generation by adopting the frequent visitors, securing control over them until they are of the age 18 years.108

101 Hardie, ‘My Relation With the Merthyr Boroughs’, The Democrat’s Handbook to Merthyr, p. 10. 102 Lawrence, ‘Political History of Merthyr Tydfil’, The Democrat’s Handbook to Merthyr , p. 59. 103 Hardie, ‘My Relation With the Merthyr Boroughs’, The Democrat’s Handbook to Merthyr , p. 12. 104 Lawrence, ‘Political History of Merthyr Tydfil’, The Democrat’s Handbook to Merthyr , p. 60. 105 Hardie, ‘My Relation With the Merthyr Boroughs’, The Democrat’s Handbook to Merthyr , p. 13. 106 John Prowle., ‘Poor Law Administration of Merthyr Parish’, The Democrat’s Handbook to Merthyr, p. 90. 107 Ibid., p. 84. 108 Ibid., p.85. 99 Before 1901 there were three Lib-Lab members of the Board of Guardians, and another seven were admitted in 1901. The number continued to increase until by 1912 there were 18 out of 55 members.109 They were able to force up outdoor relief from 1/6d per child to 3 or 5/-. They moved for all new applications for relief to come before the whole Board and granted 25/- a week to widows with 5 children provided they stayed home and did not go out charring. They also granted clothing, provisions and access to convalescent homes. “We have steadily forced up relief from 2/6d. to anything we choose. Everything the doctor advises, whatever its cost, is got. A consumptive father and son received 40/- a week, in addition to extra medical relief. Although Merthyr paid the highest relief in the district, the rate of pauperism in Merthyr was the lowest of any industrial union at 2.9 per 1,000. “Therefore we say that higher relief reduces, not increases pauperism. We are pushing the mark up, but are not yet satisfied that we have reached the goal called adequate relief…our motto always is, ‘Get what they require.’” The Assessment Committee had hitherto been run by ironmasters, coalmasters and businessmen who were able thus to keep their rates down. Company officials on the Board’s Assessment Committees were therefore able to “be of service to their class.” An independent valuation review of the Dowlais Steel Works increased the assessment by £7000, which the company paid. The rateable value of the Union was £650,000 and an expenditure of £90,000 p.a. as the larger concerns showed a tendency to shift the burden onto smaller ratepayers. 110

Conclusion

The economic and social features of Merthyr Tydfil as an industrial town led to chronic states of impoverishment. The social and economic patterns of industry impacted on everyday life but major industrial conflicts in 1875 and 1898 created acute hardship on top of already chronic difficulties for families, particularly for women and children. Mothers who gave birth in 1908 in the fertile age group 15-40 years would themselves have been born between 1868 and 1893. Those in the older age group would also have borne several children and experienced years of failing health as a result of childbearing apart from any other stressful influences. The effects of poverty on their health as children would also affect women’s health as mothers over the following decades. These women would thus have carried forward though their generation into a second generation the social effects of poverty and industrialisation, reflected in infant

109 Ibid., p. 84. 110 Ibid., pp. 88-9. 100 mortality rates which are considered to be an excellent independent form of social barometer of any community’s well-being. The alleviation of poverty fell to the Merthyr Tydfil Board of Guardians who, as industrialists and ratepayers, were compromised in their ability to serve the needs of an impoverished populace, adhere to the requirements of the Poor Law and serve the interests of industry, particularly during times of industrial conflict. Industrial disputes demonstrated the inadequacies of both the philosophy and administration of the Poor Law during the nineteenth century and the way it shaped the culture and identity of the town. The administration of Merthyr Tydfil Union formed an important part of the identity of the town and helped shaped the life of an industrial community. The prosperity of the town rested on the larger economic imperatives of trade cycles and the way in which the whole town was dependent on and vulnerable to the fortunes of the iron and coal trades. This created a fluid and transitory work force, vulnerable to economic changes, with a large proportion of the town dependent on workers in two main industries. This left little margin of security during times of hardship. The masters of primary industry were able to control the political and social agenda of the town, through their positions of social responsibility as Guardians of the Poor Law usurped during the industrial conflicts in 1875 and 1898. Their course of action was determined by the Poor Law of 1834, which not only hampered their efforts to deal with local needs, but also empowered their social manipulation of industrial disputes, with workers beaten into submission by poverty and hunger. The social and economic cost to the community was immeasurable. From 1871 the trade union movement created a power base to argue for working-class interests against those of ironmasters and coal owners, but small gains were achieved at enormous social cost. The Unions increasingly expressed their feelings of exploitation and alienation in the labour process as Keir Hardie was elected as the first Labour member for Merthyr in 1900. The town lacked a democratic municipal government until 1895 when the administration of the town passed to Merthyr Tydfil Urban District Council. Socialist members were able to influence more socially compassionate policies towards the alleviation of poverty and suffering by understanding its ecology and genesis at a grass roots level, manipulating the Poor Law in a different way to the advantage of the working classes.

101

Chapter 3

The Work of a Medical Officer of Health: Infant Mortality in Merthyr Tydfil 1849-1908

Introduction

Dr. Thomas Jones Dyke served the Merthyr Tydfil Local Board of Health from 1865 until his death in 1900. Dyke’s dedicated contribution to the health of the town is assessed by Tydfil Davies Jones, in Poor Law and Public Health Administration in the Area of Merthyr Tydfil Union 1834-1894 (1961), 1 and Barbara A. Frampton in The Role of Dr. Dyke in the Public Health Administration of Merthyr Tydfil, 1865-1900, (1968). 2 Both conclude that the blight on Dyke’s term of office was the failure to reduce infant mortality rates. This chapter builds on the work of these authors by examining the professional and administrative aspects of Dyke’s role, the problems he faced, his priorities and primary concerns, to help explain why his administration failed to reduce infant mortality rates. The problems of infant mortality were more rapidly defined and addressed once Glamorganshire came under the direction of a County Medical Officer in 1895 and by Dyke’s successors from 1900. The chapter indicates many of the key issues identified in the thesis concerning infant mortality in Merthyr Tydfil. It links Chapters 1 and 2, describing the social background against which infant mortality is examined, with the analysis of the attributed causes of death in Chapters 4, 5 and 6. The experience of Merthyr Tydfil provides an excellent example of nineteenth century transitions in the processes of public health. The focus shifted from sanitary engineering to the prevention of contagious diseases and then to the social causes of ill- health in the community, each phase involving a revaluation of earlier paradigms. By 1875 there was little change in the general death rate, to which infant mortality contributed heavily, and infant mortality rates generally did not begin to fall before the

1 Tydfil Davies Jones, ‘Poor Law and Public Health Administration in The Area of Merthyr Tydfil Union 1834-1894’, MA Thesis, University of Wales, Cardiff, 1961. 2 Barbara A. Frampton, ‘The Role of Dr. Dyke in The Public Health Administration of Merthyr Tydfil 1865-1900’, M.A. thesis, University College of Swansea 1968 .

102 end of the nineteenth century. 3 The major areas of progress affecting infant mortality emerged rapidly during the late nineteenth and early twentieth centuries, implemented through the infant welfare movement. Dyke was an excellent example of a nineteenth-century public health physician whose professional reputation extended well beyond Merthyr Tydfil. He was primarily concerned with all aspects of the emerging professional field of public health which might prevent death and sickness as an economic drain on resources and an expression of human suffering. He was convinced that the efficient working of public health administration would help control disease and reduce death rates and believed that the deaths of infants and children would fall in response to these measures. His basic approach to public health, forged during the dark early years of Merthyr’s sanitary history, changed little during his term of office. His primary concerns and understanding of the function of public health related to infectious disease, sanitation and sewage. He also published several pamphlets on public health administration. His understanding of the origins of disease evolved slowly from the miasmic theories of his early medical career, to which he subscribed throughout his days, whilst sublating emerging germ theories. His principle was that prevention, wherever possible, was always the best approach. In 1883 Dyke explained:

One section of these maladies is termed miasmatic , that is something which “pollutes the air, the water, or the food, which we breathe , drink or eat….. Hygienists believe these maladies to be “preventible” in the sense that human beings need not of necessity have them.” 4

In many instances plain commonsense won out over scientific theory: “You will ask what was the discovered removable cause of these 89 cases of Fever: I answer filth – human filth – putrefying human filth.” 5 What mattered was that the problem was solved and towards this end Dyke instructed the Board to the best of his ability throughout his career. Dyke achieved much within the constraints of existing knowledge and the mechanisms of public health to improve the environment of the town. Dyke stated his views clearly to the Royal Sanitary Commission in 1869 and contributed valuable insights into the complex structure of nineteenth-century public

3 M. W. Flinn, ‘Introduction’, Alexander P. Stewart, and Edward Jenkins, ‘The Medical and Legal Aspects of Sanitary Reform’ Robert Hardwicke, London, 1867, reprinted by Leicester University Press, 1969, p.7. 4 Dyke, MOH Report for Merthyr Tydfil for 1883, pp. 3-4. 5 Dyke, MOH Report for Merthyr Tydfil for 1874, pp. 8-9. 103 health administration which at times made it cumbersome and slow to administer. The Commission paved the way for the public health reforms of the 1870s, particularly the Public Health Act of 1875. It addressed the question of compulsory rather than permissive health acts, testing the level of intervention and autonomy between central and local authorities to determine where responsibility and accountability should rest. 6 For example, Dyke wrote in his 1868 report; “Strenuous exertions were made by your officers to remove the causes; but their earnest efforts were baffled at every step by the imperfections of the sanitary laws.” 7 The inefficiencies of the nineteenth-century public health system and local administration themselves played a part in the slow progress to reduce infant mortality through improving the urban sanitary environment. Because of these views he took a deep personal and professional interest in public health administration and the role of medical officers of health. M. W. Flinn defines public health “as the elimination of the causes of preventable mortality” which applied in the mid-nineteenth century to infectious diseases. 8 Dyke’s report for 1868 quotes William Farr, “What are the aims of Public Medicine? Primarily to prevent diseases; and although it does not heal the sick, it surrounds them with all the conditions most favourable to recovery…..To accomplish them is to bestow on mankind riches more precious than gold.” 9 These definitions fit very closely with Dyke’s philosophy of preventing the preventable. The chapter draws on Dyke’s reports and writings to illustrate the problems he faced during his term of office, his understanding of disease processes, his methods and pressing concerns. He argued consistently and passionately for taking the steps to prevent the causes of illness and death, which had to be understood to be preventable before appropriate measures could be taken. This often required time as part of a critical process of professional evaluation. The priorities of the Local Board of Health from 1850-1865 were to control infectious diseases, establish water and sewerage for Merthyr, and address the continuing problems of structurally unsound and overcrowded housing. As Medical Officer of Health Dyke shared these priorities and acted consistently according to his duties as set out by the Board; throughout his career Dyke linked inferior housing with high death rates; in his view weaknesses in administration, especially inadequate building regulations, perpetuated the connection.

6 Flinn, ‘Introduction’, Stewart and Jenkins, The Medical and Legal Aspects of Sanitary Reform, pp. 10- 12. 7 Dyke , MOH Report for Merthyr Tydfil for 1868, pp. 4-5. 8 Flinn, ‘Introduction’, Stewart and Jenkins, The Medical and Legal Aspects of Sanitary Reform, p.7. 9William, Farr, ‘Address on “State Medicine,’ ‘cit. Dyke, ‘Frontispiece’, .MOH Report for Merthyr Tydfil for 1868, 104 Dyke and his peers, constrained by contemporary levels of knowledge, cannot be entirely blamed for the failure of measures taken to save many young lives. The problems and causes of infant mortality in its many aspects were discussed in the medical journals from the 1860s. The process of discovery gathered momentum by the end of the century as many of the social dimensions of the problem were understood. Attempts were made to address the problems of housing, poverty, infant feeding and summer diarrhoea, throughout the Edwardian period, particularly through the infant welfare movement. Sir Arthur Newsholme’s reports on infant mortality as MOH for Brighton 1888-1908 and Medical Officer to the Local Government Board from 1909 to 1919 greatly influenced both the government and the medical profession. Seebohm Rowntree’s study of poverty in York published in 1901 and the Interdepartmental Committee of Inquiry into Physical Deterioration of 1904 further explored aspects of infant mortality and social impoverishment. 10 During the early part of Dyke’s lengthy career he was beleaguered by many competing and urgent or protracted local problems, of which infant mortality was a part. During his final years Dyke’s failing health almost certainly prevented him from keeping abreast of changing perceptions of the problem as one of national importance. For most of his term, Dyke worked with two local administrative boards governed by powerful vested interests. His successors benefited from modern knowledge, a new vigour, and the increasing support and power of a local Council committed to the improvement of working- class conditions, and the bolstering strength of a national impetus to address the problem.

Dyke’s Personal and Professional Life

Thomas Jones Dyke was born in Merthyr Tydfil in 1816 and was closely involved with the community until his death in 1900. His career began in 1831, apprenticed to the surgeons of the Cyfarthfa Iron and Coal Works. He graduated as an Apothecary and a Member of the Royal College of Surgeons in 1838, from Granger’s School of Anatomy and Guy’s and St. Thomas’s Hospitals in London, and commenced practice in Merthyr Tydfil in 1839. He was the Parish Surgeon for Merthyr, and District Surgeon to Dowlais Iron Company for fourteen years. 11 He first raised concerns about

10 Newsholme, The Elements of Vital Statistics, pp. 109-11., Reports from Commissioners, Inspectors and Others, Report of the Inter-Departmental Committee on Physical Deterioration, (Vol.XXXIII), 1904, Vol.1.1., Report and Appendix [Cd. 2175]., Seebohm B. Rowntree, Poverty: A Study of Town Life, 2nd edition, Thomas Nelson & Sons, London, c. 1900 , Seebohm B. Rowntree, ‘Discussion on the Relation of Poverty and Disease’, British Medical Journal, Vol.II., 16 August 1902, pp.49-451. 11 Merthyr Express, 27 January, 1900. 105 the unhealthy state of Merthyr in his paper, ‘The causes of unhealthiness of towns,’ read in December 1848, with a second paper on the subject in December 1849. 12 During the cholera of 1849, Dyke was appointed Medical Officer to the Board of Guardians but was himself disabled by a severe attack of the disease. His increasingly busy practice was again interrupted by cholera in 1854. As Surgeon to the Dowlais Works, Dyke wrote to G. T. Clark in 1860, seeking reimbursement for the huge amounts of time and medicines dispensed for workers and their families, and the cost of employing an assistant. Clark refused this request, placing an economic value on the health of his workers: “Whatever may be the case in your district the doctoring of our workpeople is costing us more than it has hitherto done, and, besides, more in proportion to the quantity of iron made and the number of men employed.”13 In 1865 Dyke became the first permanent MOH for Merthyr “….with pleasure though the was but 20 guineas a year.” Dyke’s life thereafter was committed to public health.14 In May 1877 the Children’s Hospital was established in Bridge Street with surplus funds raised by the Rector of Merthyr’s appeal during the industrial unrest of 1875 and financial assistance from the Marquis of Bute. Dyke’s wife assisted in running the hospital and Dyke regarded these as happy times: “It was my privilege to be entrusted with the care of the sick. I did my best with the ever present aid of my darling wife and many of her lady friends.” The hospital was gradually transformed into the General Hospital by Dyke and his colleagues. 15 Dyke’s wife died twelve years before her husband after a childless marriage. In addition to his medical role, Dyke was appointed High Constable 1876-7, and was senior Commissioner of Taxes in the town. He became a magistrate fourteen years before his death but sat infrequently on the Bench. He was a founder and manager of the St. David’s National Schools, “His interest in education was secondary only to the sanitary condition of the town.” 16 Dyke was Secretary for the Loyal Cambrian Lodge of Freemasons for twenty years, from June 1839, and Secretary for the Provincial Grand Lodge for South Wales and Monmouthshire. He became Grand Senior Warden and in 1894 was presented with his portrait in recognition of his fifty-five years of membership. When he died Dyke was considered to be the last founding survivor of the

12 Ibid. 13 Letter Dyke to Clark, 18 January, 1860, D.DG C8/7/1, and 31 October 1860,D/DG C8/7C/4, Letter Clark to Dyke, D/DG C8/7/2, Dowlais Iron Company Correspondence, Glamorgan Record Office, Cardiff. 14 Merthyr Express, 27 January, 1900. 15 Ibid. 16 Ibid. 106 St. David’s Lodge of Freemasons, No.679, at Aberdare, and one of the oldest freemasons in Wales. As a practical and caring man, Dyke’s frustration increased as his health failed. His close friend, Charles Wilkins drew on his own observations and on Dyke’s earlier autobiographical account to compile Dyke’s obituary , describing him as 17

a close observer of men and conditions, and at the van of many a scientific discovery. Of bacteria he wrote many years ago in the National Magazine, and in all he brought to bear strength of observation, keen analytical powers, with the ready illustration supplied by a well stored mind. His annual reports, which were regarded as textbooks over a wide range, shewed him in the position of a watchful guardian over the hygienic interests of the people, and by these he will be remembered. 18

Dyke apologised that his final report in 1898 lacked his usual attention to detail: “My health has been somewhat indifferent during the past year….Your kind forbearance towards me I am deeply grateful for.”19 He suffered an “illness caused by his advanced age” but “he bore his troubles without murmur, and almost up to the last took an interest in all that concerned him as medical officer of health.” Dyke passed away peacefully at home on 20 January, 1900 aged 83 years, having outlived most of his social circle. His private funeral was attended by brother freemasons, colleagues and local dignitaries. His remains were laid to rest in his wife’s crypt at Cefn Cemetery on 24 January, 1900. 20 Alderman Thomas Williams, who had known Dyke for fifty years, expressed his regret at the passing of a fellow magistrate, stating that his death was a loss not only to the town; during his thirty-five years as MOH his reports had always been regarded as of great value. “As a medical officer he was looked up to by the whole county.” 21 Dyke was a highly respected and influential member of the local community. His intimate knowledge of the town began in its early days as a largely rural environment dominated by the expanding iron and coal industries as the prime iron producing town in Wales. He watched Merthyr grow through its infamous sanitary history with the formation of the Union and Local Board of Health. He was well acquainted with the social aspects of the parish, his compassion evident in his early reports as he watched the growing population struggle with its labour conditions. He

17 Ibid. 18 Dyke, MOH Report for Merthyr Tydfil for 1898, pp.5-6. 19 Ibid. Dyke’ s Report for 1898 was written in April 1899, and his report for 1899, had he lived, would have been written in April 1900. The report for 1899, a crucial year, was written by his assistant ,W W. Jones as temporary MOH. 20 Merthyr Express, 27 January, 1900. 21 Dyke, MOH Report for Merthyr Tydfil for 1898., pp.5-6. 107 was particularly moved by the plight of children during the industrial strife of 1875, and experienced first hand the health and habits of the people, moving among the poor and the sick. He also associated with owners, trustees and managers of the iron and coal works, and necessarily trod a diplomatic path between the two classes of Merthyr as he educated the Local Board towards the perceived causes of sickness and meeting their sanitary obligations. “But it must be stated that as long as people occupy damp dwellings, that they live in places where such vegetable parasites find fit breeding places- dry well-ventilated houses afford no such nests.” 22 The difficulties Dyke faced were frequently increased by the daily activities of residents:

Despite the best efforts of the Board to provide residents with amenities…. The pans of closets… are made of earthenware; these get choked; the poker is at hand, the ware is quickly broken….. in every instance without exception…. Negligence being due to the ignorance or folly of the occupants of the house. 23

Dyke’s professional involvement extended well beyond the boundaries of Merthyr Tydfil to national concerns and organisations, mirroring the implicit relationship between the local and the broader administrative structures of public health. He published several papers which reflected his passionate interest in the of the field, reporting regularly to the British Medical Journal on the progress of public health in Merthyr. In 1871 the BMJ reported the difficulties Dyke encountered in Merthyr:

We have not been able to find time and space for an analysis of the causes of preventable disease at Merthyr Tydfil, for which we possess some very instructive materials. We observe, however, that the death rate for 1870 was 26.45; and that some blundering obstructiveness of the local authorities has allowed relapsing fever, small-pox, typhus, and scarlet fever to prevail, notwithstanding that they have made from time to time a considerable sanitary expenditure. Principiis obsta is a principle very difficult to instil in these gentlemen’s minds; but they may be assured that, if they would steadily act upon it, and follow implicitly the course which their able sanitary officer, Mr. T.J. Dyke, is peculiarly capable of prescribing to them, they would effect a great saving in life, health, and money.24

Dyke’s writings reflect a dialogue between the local practicalities of his work as MOH and professional interests at a national level. Rubbing shoulders with many nineteenth- century notables Dyke for many years kept abreast of and actively contributed to

22 Dyke, MOH Report for Merthyr Tydfil for 1883, pp. 6-7. 23 Dyke, MOH Report for Merthyr Tydfil for 1877, p..5. 24 The British Medical Journal, 28 January, 1871, p.97. 108 professional developments in public health. He was a staunch member of the British Medical Association and as president of the South Wales and Monmouthshire branch on 5 July 1871, he was described as “a gentleman holding a very high professional position in the county, whose scientific attainments were well known, and who …would fulfill the duties of his office most ably.” 25 The National Association for the Promotion of Social Science, was concerned with a broad range of social issues. In 1873, at the NAPSS National Conference, Dyke’s model report for the use of medical officers of health, was recommended to standardise reporting in all sanitary districts.26 In 1885, his address to the Annual Meeting of the BMA at Cardiff on the History of Public Health in Merthyr Tydfil, reprinted in the British Medical Journal and Merthyr Express made clear that he considered the sanitary environment the foundation of public health and his later papers confirm these interests and priorities. His paper, On the Downward Intermittent Filtration of Sewage, As It is Now In Practical Operation at Troedyrhiw was read at the Annual Meeting of the South Wales and Monmouthshire Branch of the BMA at Merthyr Tydfil in 1872, and published in the BMJ on 16 November 1872. 27 In November 1872, Dyke addressed the local branch: The Work of a Medical Officer of Health and How to Do It.28 “You will understand that the medical officer’s services are not remunerated at their commercial value.” 29 The BMJ promoted the paper: “It is the work of one of the most experienced workers and careful thinkers within the domain of State Medicine.” 30

Whilst Dyke’s work was closely involved with the practicalities of public health in his district, he was keenly aware of the importance of public health policies in the national arena. Although these issues appear to have little to do with the problem of infant mortality, they are important as part of Dyke’s larger strategy, from which he believed everyone, including infants, would benefit. These matters took up a great deal of his attention since he considered prevention as the corner stone of public health policies and administration and legislation were the tools through which these aims were accomplished. The practical operation of these important policies at the local level

25 The British Medical Journal, 29 July, 1871, p.135. 26 Transactions of the National Association for the Promotion of Social Science, 1873., pp. 494-495. 27 Thomas Jones Dyke, On the Downward Intermittent Filtration of Sewage, As It is Now In Practical Operation at Troedyrhiw , paper read at the Annual Meeting of the South Wales and Monmouthshire Branch of the British Medical Association on the 17th July, 1872. 28 Thomas Jones Dyke, F.R.C.S.The Work of a Medical Officer of Health and How to Do It., Address Delivered Before the South Wales & Monmouthshire Branch of the British Medical Association, November, 1872., Simpkin, Marshall and Co,, London, Farrant and Frost, Merthyr Tydfil, 1872., Reprinted from the British Medical Journal, November 16th, 1872. 29 Ibid, p.9. 30 Ibid. 109 ultimately governed their national effectiveness in reducing death rates, of which infant deaths formed a significant proportion.

Dyke’s reports address public health issues which cannot be separated from the social development of the town, reflecting the impact of industrialisation, and the way in which community relations influenced disease processes. As he wrote near the end of his career: In making a general survey of the work of the year, it is abundantly evident that the steady sanitary progress which has been the policy of your Council continues, and you have laboured under the disadvantage of dealing with a great industrial centre which sprang so readily into existence…31

His writings reveal the increasingly specialised role of MOH which required an intimate and composite knowledge of the many forces at work in a community. The duties described under the Public Health Act of 1866 included identifying public health risks, controlling outbreaks of infectious diseases, inspecting public nuisances and food for public consumption, performing any duties required by Acts of Parliament, attending Board meetings and presenting quarterly and annual returns of sickness, death and vaccinations.32 The MOH needed to analyse the death returns to identify, predict and prevent the causes of death which emerged. In doing this, Dyke faced the difficulty of ensuring statistical consistency within his reports. Geographical and social links defied the administrative boundaries which included parish and county boundaries, parliamentary divisions and poor law districts. Epidemics might occur on two sides of the street lying within different administrative districts. In 1866 Dyke explained a distortion in the dispassionate statistical accounting of death:

One cause of this apparent unhealthiness is, that the 34 deaths which occurred at Cethin Colliery in December 1865, and which were registered in January 1866, (rightfully these should have been charged to 1865,) are debited to the district of Troedyrhiw, in which Cethin is situated; these however should have been charged to the whole parish, inasmuch as the residences of the colliers who died there, were dispersed over most of the other divisions.33

31 Dyke, MOH Report for Merthyr Tydfil for 1898, p.6. 32 Thomas Jones Dyke, M.R.C.S.,ENG;& L.S.A.,LOND., Medical Officer of Health; Honorary Member of the Metropolitan Association of Officers of Health, &c., &c., Report on the Sanitary Condition of Merthyr Tydfil, For The Year 1865. Presented to the Local Board of Health on the 5th April, 1866, by Rees Lewis, Merthyr Tydfil, 1866. 33 Dyke, MOH Report for Merthyr Tydfil for 1866, p.32. 110 Cooperation between local boards of health, boards of guardians and district registrars provided the information from which Dyke compiled the tables of causes of death at all ages and the statistical analysis of disease as a gauge of sanitary progress. 34 This was in itself an important achievement since levels of cooperation between sanitary inspectors, registrars, medical officers and local authorities varied considerably across the nation.35 The detailed reports were sent to the General Board of Health until 1855, the Medical Department of the Privy Council, and, from 1871, to the Local Government Board. His reports also reveal the changing public health agenda from 1865 and the processes of understanding and curtailing disease in the community. Dyke was keenly aware of the social dynamics of pauperism and until 1879 he included in his reports useful material relating to the social and economic climate of the town. In later reports stipulations of the Local Government Board tended to stifle such useful creativity. The reports emphasise the achievements of the Board but stress the continuing need for improvements. In 1896 Dyke praised the work of the Council and its predecessors. Low fever death rates stood as testimony to their efforts, despite the difficult circumstances which existed in Merthyr : “To those who know Merthyr, and its people, the hard battle for food very many have to strive, the unhealthy surroundings of their homes….” 36 Dyke managed the epidemics which continued to make regular appearances, but they were clearly a waste of life and an economic drain on the health and purse of the town when prevention was the best strategy possible.

Dyke’s Priorities

As MOH Dyke’s priorities combined both medical and administrative objectives, the prevention and control of infectious diseases and the improvement of the means by which public health issues were managed and regulated. In pursuit of these objectives he obtained considerable experience and a notable reputation. It is an indication of the regard in which he was held as a public health administrator that he was called as a witness before the Royal Sanitary Commission in 1869. The Commission was anxious to assess the usefulness of the Sanitary Act of 1866 for preventing the spread of contagious diseases and addressing housing questions. Despite earlier public health inquiries, legislation and the expenditure of large sums of money

34 Dyke, MOH Report for Merthyr Tydfil for 1865, p.6. 35 Beresford, ‘Suffer the Little Children’, pp.61-62. 36 Dyke, MOH Report for Merthyr Tydfil for 1896, p. 9. 111 on capital works, local authorities were still beset by deadly epidemics. 37 Sickness and mortality represented a huge social and economic cost: 38

The mere money-cost of public ill-health, whether it be reckoned by the necessarily increased expenditure, or by the loss of the work of both the sick and of those who wait upon them, must be estimated at many millions a year.39

In his evidence to the Royal Commission Dyke was very critical of the bureaucracy and legislation surrounding public health administration, which caused delays in dealing with public health matters. A considerable bureaucracy had developed, marked by inefficiencies, omissions and duplications between local and central authorities. Every district had a poor law medical officer and legal adviser, and might at any time be visited by a government inspector from the Local Government Act office, a medical inspector from the Privy Council, certifying surgeons under the Factories Act, inspectors of workshops, in addition to the ordinary inspectors of nuisances, and health officers, as was the case in Merthyr.40 During Dyke’s four years as union medical officer, inspectors of the Poor Law Board had visited the workhouse, but their inquiries were confined to indoor paupers. They saw very little of outdoor paupers, nor of the state of the houses in which they lived. 41 Dyke believed that the crucial work of sanitary inspectors should encompass many of these duties including the inspection of factories and workshops. 42 He also believed that the regulation of housing should be strengthened and standardised across the country, ‘for there is a crying necessity for that all through our district now.’ 43 He particularly criticised numerous unnecessary and detrimental delays brought about by having to give notice of a nuisance to the local authorities, who then gave notice to the owner or occupier to remedy the fault. Dyke would have agreed with the view put to the Commission by Dr John Simon, Medical Officer to the Privy Council:

The state of the law, in relation especially to local authorities, is chaotic… I suppose we may say that in all country districts there is one authority for every privy, and another authority for every pigsty…The Vestry for the privy and the guardians for

37 Evidence of John Simon, ‘Minutes of Evidence’, First Report of the Royal Commission on Sanitary Laws [1860-69] C.-4218 Vol.XXXII,, Q.1859., p.103., 38 Ibid. Part 11. ‘Observations’, Second Report of the Royal Sanitary Commission, Vol.1.,[C.281], 1871, . p. 15. 39 Ibid pp. 15-16. 40 Evidence of T. J. Dyke, 12 July 1869., First report of the Royal Sanitary Commission with Minutes of Evidence up to 5th August, 1869, [1868-69], Q. 6392., p.349. 41 Ibid., Q.6393-6402, p. 351. 42 Ibid., Q.6391., p. 349. 43 Ibid., Q. 6329., p. 347. 112 the pigsty; but I also apprehend that, with regard to the privy, one authority is expected to prevent it being a nuisance, and the other to require it to be put to rights if it is a nuisance. 44

Dyke and the Local Board acted within the permitted limits of existing public health administration and the mechanisms for executing their duties. When he was asked whether he thought the local authority would be strong enough to carry out laws against the owners of large works and people of great influence in the district, he replied “I do not find any difficulty, as certifying surgeon of factories, in moving the greatest of our iron princes. In fact there is no difficulty with the great proprietors; it is with the small ones that difficulties lie.” 45 Legislation, Dyke argued, needed to be simplified and strengthened to place local administration under a central authority. 46 In an idea far ahead of its time, he proposed an efficient central ministry of public health including a legal, medical and engineering department, with sufficient skilled personnel to visit each poor law union, resulting in prompt, uniform action to control contagious diseases. 47 The Commission sought Dyke’s opinion on proposals to divide England and Wales into Sanitary Districts with sub-districts under the supervision of a Medical Officer of Health.48 Dyke replied that skilled medical officers of health should be debarred from medical practice, 49 “they should simply be medical minds, and not medical men.” 50 Their work should also include the registration of births and deaths. 51 This would require extensive re- organisation of the work of all officers concerned with public health duties and was unlikely to occur unless as an obligatory reform. 52 The President of the Association of Medical Officers of Health summarised the findings of the Royal Sanitary Commission; “that existing laws were condemned as incomplete, confined, and contradictory. The local authorities were found to be too numerous and too apathetic, and the existing central authorities undermanned and underarmed.” 53 The effect of the Public Health

44 Evidence of John Simon, ‘Minutes of Evidence’, First Report of the Royal Commission on Sanitary Laws [1860-69] Q.1809-1812., pp. 98-99. 45 Evidence of T. J. Dyke, 12 July 1869., First report of the Royal Sanitary Commission with Minutes of Evidence up to 5th August, 1869, [1868-69], Q.6376, p.349. 46 Part 11.’ Observations’, Second Report of the Royal Sanitary Commission, Vol.1.,[C.281], 1871, pp. 15-16. 47 Evidence of T. J. Dyke, 12 July 1869., First report of the Royal Sanitary Commission with Minutes of Evidence up to 5th August, 1869, [1868-69] Q.6331-5, p.347. 48 Ibid., Q.6417, p.351. 49 Ibid., Q. 6418., p.351. 50 Ibid., Q.6422., p.351. 51 Ibid.,Q. 6423., p.351. 52 Ibid.,Q. 6424-5., p.351. 53 The British Medical Journal, 25 March, 1871., p. 311. 113 Bill, 1872 was extensively debated through the pages of the BMJ. Dyke addressed the South Wales and Monmouthshire Branch of the BMA on the subject at Brecon and Carmarthen in 1873. 54 In 1875, as President of the Society of Officers of Health, South Wales and Monmouthshire, Dyke read his paper The Medical Officers of Health Authorized to be Appointed Under the Provisions of the Public Health Act 1875, Their Grades, Duties and Spheres of Labour. 55 This defended the specialised local expertise required to fulfil the role. Dyke was voicing his opinion within an important national debate on the future structure and management of public health following the amalgamation of health and poor law administration under the Local Government Board in 1871. Criticism of the Board’s administration, dominated by Poor Law matters, was made through the medical press and public discussion. Dyke’s address, Missing Links in the Sanitary Administrative Service, read at the Sanitary Congress, Leamington in 1877, asserted: “I would say that it is in accordance with English custom that we should know with whom we have to deal.” 56 Dyke criticised the reports of the highly skilled, medically trained inspectors of the Local Government Board as

… a comparatively useless statement of well-known facts. A series of iterations of the same causes, producing the same series of consequences. Consequences which are now well-recognized sequences of those causes. Surely it is not now necessary to demonstrate in microscopic detail the outbreak of enteric fever in Little Pedlington, from the pollution of a spring –…..and yet it is in this unconnected, disjointed labour, that some of the brightest minds in the medical profession are condemned to toil. 57

He argued that these inspectors, rather than looking piecemeal at districts, one week in Kent, one week in Wales, the next in Cumberland, should instead examine all aspects of a particular disease in a specific area and report on the whole of that area, since there were eleven inspectors and eleven Registration Districts. 58 Dyke also criticised the ineffectiveness of sanitary engineers’ reports: “A report, most able, elaborate, and

54 T.J. Dyke, ‘On Those Sections of the Public Health Bills, Now Before Parliament, Which Affect the Medical Profession,” The British Medical Journal, 13 April, 1872, pp.390-392. ‘The Public Health Act in Wales’, The British Medical Journal., 28 June 1873, p.746. The British Medical Journal, 22 Feb, 1873, p.210., 3 May, 1873, pp.488-9. 19 July, 1873, p.71., 16 August, 1873, pp.191-193. 55 Thomas Jones Dyke, F.R.C.S. Eng. The Medical Officers of Health Authorized to be Appointed Under the Provisions of the Public Health Act 1875, Their Grades, Duties and Spheres of Labour, paper read to the Society of Officers of Health for South Wales and Monmouthshire, held on the 28th March,1876 at Swansea. 56 T. J. Dyke, Missing Links in the Sanitary Administrative Service. Read at the Sanitary Congress, Leamington, 1877, p.4. 57 Ibid. 58 Ibid., p.5. 114 exhaustive is sent in; a copy is sent to the Local Authority, who smile at the wise counsels given, and still go on wasting money, and sacrificing human health and human life.” 59 In his Address on Public Medicine to the Annual Meeting of the BMA at Cardiff in July 1885, Dyke criticised the lack of administrative direction for medical officers:

No line of work set out, each has to work alone, unsupported by advice, by instruction, without anyone to back him up…..What wonder is it that we often “gang awry,” that in adjoining districts advice diametrically opposite is given to perplexed Boards of Health.60

Dyke described the idea of a Medical Adjutant, in effect describing the later role of the County Medical Officers.61 This role may also have been a catalyst for a more cohesive approach to the problem of infant mortality across the nation from the mid-1890s. When the findings of the Commission were reported by a Joint Committee of the British Medical and Social Science Associations at a conference in Plymouth, in August 1871, Dyke was present.62 His paper, [On] the Modes of Dealing with Outbreaks of Pestilent Fevers (1871), was tabled at the Social Science Congress, Leeds in 1871.63 It stressed the importance of water supply and sewerage, the benefits of the Sanitary Act of 1866, the inspection and ventilation of dwellings, the provisions of hospitals for the sick, a disinfector, and a carriage for conveying the sick as practical means of controlling infectious diseases. Under the Act, Dyke found it difficult to obtain certificates from medical attendants, and no officer of the Local Board was legally sanctioned to enforce the removal of infectious persons to a hospital; any person attempting this “would do so at his personal peril.” 64 In Merthyr infectious diseases associated with poverty and filth accounted for many deaths. Dyke constantly reminded the Board of the widely accepted medical viewpoint that poverty contributed to much mortality, something beyond its jurisdiction. 65 Each annual report began with an examination of the location, topography, and

59 Ibid., p.7. 60 T. J. Dyke, Address on Public Medicine to Fifty Third annual Meeting of British Medical Association at Cardiff, July,1885, Farrant and Frost, Merthyr Tydfil, 1885., p.16. 61 Ibid., p. 16. 62 ‘Report of the Joint Committee of the British Medical and Social Science Associations’, The British Medical Journal, 19 Aug, 1871., pp.203-208. 63 Thomas Jones Dyke, On the Modes of Dealing with Outbreaks of Pestilent Fevers, London, 1871., read at the Social Science Congress, Leeds., published in the British Medical Journal, October 21st 1871., p.476. 64 Evidence of T. J. Dyke, 12 July 1869., First report of the Royal Sanitary Commission with Minutes of Evidence up to 5th August, 1869, [1868-69],Qs. 6294, 6303, p.346. 65 Dyke, MOH Report for Merthyr Tydfil for 1865, p. 19. 115 climate of the town and the “vital statistics” or demographic details of the population. Dyke regularly received copies of deaths registered in his district, giving early warning of infectious diseases, but frequently complained about the imperfectly assigned causes of death. Only 15% of deaths were certified by a medical practitioner, making returns of death and sickness unreliable. In South Wales “consumption” covered any slow death, and eventually appeared in the Registrar General’s returns as phthisis. 66 Dyke believed that the duty of registering births and deaths could be better managed by the MOH, particularly “In the death of young children from convulsions not certified, the visitation of God, natural causes, debility, and such like.” 67

Throughout his career Dyke emphasised the priorities of sanitation, drainage and improving living conditions in the practical prevention of many deaths and regularly ascribed falling death rates to the water supply. Overcrowded and substandard dwellings compounded any public health threat, particularly from infectious diseases. In 1866 a detailed housing survey was undertaken by the Board whose surveyor thereafter provided quarterly reports on improvements in the water supply, drainage, state of repair of houses and details of legal proceedings. 68 Improving the general sanitary environment and addressing housing problems was essential since isolation of infectious cases was impossible in overcrowded dwellings. The Workhouse Infirmary was inadequate for the population and the sick needed to be isolated from the pauper inmates. 69 A separate isolation hospital took many years to eventuate.

The poverty of the patients, and their low nervous power , will largely account for the fact that the proportion of recoveries from fevers treated in hospitals is not so great as when patients are treated in their own homes, but on the other hand, the danger of diffusing disease is obviated.

It has been shown that the excretions of fever patients can and do produce in others the like diseases; it would therefore be wise to isolate the fever wards from all ordinary communication with the wards and closets frequented by other sick people. 70

Cholera was again approaching from many parts of Asia and Europe and the effectiveness of the water supply was limited by manure heaps and cesspools which

66 Evidence of John Simon, ‘Minutes of Evidence’, First Report of the Royal Commission on Sanitary Laws [1860-69] C.-4218 Vol.XXXII, Q. 1832, p.100. 67 Evidence of T..J. Dyke, 12th July 1869., First report of the Royal Sanitary Commission with Minutes of Evidence up to 5th August, 1869, [1868-69], Q. 6308-9, 6317, 6324., pp.346-7. 68 The survey, appended to Dyke’s Annual report for 1866, is an important social document which deserves much closer consideration than can be given here. 69 Thomas, Poor Relief in Merthyr Tydfil Union, pp. 107-111. 70 Dyke, MOH Report for Merthyr Tydfil for 1865,,p.23. 116 spilled out their contents to spread disease. Sewers were also needed and Dyke criticised the Board for failing to make improvements as the town expanded to Abercanaid and Troedyrhiw;

Partial provision has been made by the landholders to carry off the surface drainage; but unfortunately, this Board did not exercise their power of compelling the builders of the houses to form proper sewers, and to connect the closets attached to each house with the same. Long continued epidemics of contagious fevers, attended by very many deaths, have resulted in both villages. 71

The replacement of privies and cesspools as self-contained sewage units with water closets without adequate sewage disposal often resulted in pollution of rivers still used as drinking water, as was the case in Merthyr. 72 A virulent form of typhus affected possibly 800 people in 1865. For every typhus death, an average of nine other cases recovered. 73 Mr. Cresswell, Surgeon to the Dowlais works, “…had attended cases of Typhus fever in every street in Dowlais.” 74 Dyke blamed a general neglect and “a want of energy on the part of your officers appointed to see that the scavengers had performed their duty.” 75 The distinction between typhus or famine fever, associated with destitution and spread by fleas and lice, and typhoid fever, a water-borne disease, is not always evident in Dyke’s early reports. The distinctions are academic in the sense that people were poor, sick, and living in unhealthy, overcrowded living conditions. Typhus, “the tell-tale of a bad sanitary state,” was present in Merthyr most years from 1851 to 1865, and in many subsequent years. 76 In 1854 Dr. Kay had observed the need for more burial grounds with the rapid burial of cholera victims, but by 1865 overcrowded burial grounds throughout Merthyr were still used for interments. 77 Dyke believed that typhus [typhoid] had spread from the Dowlais burial grounds:

an offensive effluvium was frequently perceived in the neighbourhood of the Thomas Town Church Burial Ground; and when you learn that in this ground ( which was pronounced to be well nigh full in the spring of 1864,) 184 bodies were interred in 1864, and 244 in 1865, making 428; you will be convinced that the complaint was well- founded. 78

71 Ibid., p.8. 72 Flinn, ‘Introduction’, Stewart and Jenkins, The Medical and Legal Aspects of Sanitary Reform, p.8. 73 Dyke, MOH Report for Merthyr Tydfil for 1865, pp. 22-23. 74 Ibid., p.23. 75 Ibid., p.19. 76 Ibid., p.24. 77 Ibid., p.11. 78 Ibid., p.11. 117 Thirteen cases occurring in two neighbouring houses indicated poverty, overcrowding and filth. The poor settled in the older parts of the town where houses rarely had “’thorough ventilation’, and usually have no conveniences…..” 79 This lowered rents but increased the likelihood of food and water-borne diseases; “the disposition to disease consequent upon poverty is greatly increased by bad air and bad smells.” The Board took Dyke’s advice to close the burial grounds and provide cemeteries outside the town. 80 Scarlet fever, measles, small-pox and typhus caused nearly a quarter of total deaths in 1865, although it was rare for four infectious diseases to be epidemic simultaneously. 81 Together they reflected the lack of sewerage, substandard housing, overcrowding and poverty;…“the difference… is the death-toll, through three of the diseases, which your people have paid during one year, for dirt, foul air, and foul smells.” 82 Dyke considered these fevers to be preventable, but needed the general public to realise that “the causes are known, and that they are removable.” 83 It also required that the Board recognise its responsibilities. In 1872, Dyke wrote “A mortality so great, due to diseases assumed to be to a certain extent preventible, may well claim your attention.” 84 Dyke advised the Board of many practical measures to prevent the spread of infectious diseases: “These deficiencies lie within the province of your officers to discover, and they can be legally remedied by means which you can direct.” 85

…….a man may justly say, the causes of typhus fever being known, the particular places where these causes exist and grow being also known, it simply requires the power to remove the known causes, to use that power and the disease could `not be. Such you have proved to be the fact, for some years ago you drained and sewered the “Cellars” -until then the most unhealthy part of Merthyr- and yet though the same class of people live there, and though the fever raged around the place all through the year, not only not a single death occurred there, but not a single case occurred. If this be true, then it should follow that wherever typhus has been, there was in that place a known cause of the disease, which your appointed officers might have removed. It has been said that there must always be causes of typhus. Yes- but only where the powers given by law have not been used, or where duties have been neglected. I would ask everyone who may read this to let the truth sink deeply into their minds- that typhus may be prevented. 1st. By

79 Ibid., p. 10. 80 Ibid., pp.11-12. 81 Ibid., Table V., p.13, p.19. 82 Ibid., p. 20. 83 Ibid., p. 21. 84 Dyke, MOH Report for Merthyr Tydfil for 1872, p.6. 85 Dyke, MOH Report for Merthyr Tydfil for 1865, p.10. 118 not permitting over-crowding in dwellings. 2nd. By insisting upon the thorough ventilation of houses. 3rd. By the removal of human filth from the neighbourhood of dwellings. 86

Dyke overlaid miasmic theories with emerging germ theories as, through his professionalism, he kept abreast of medical debates. He urged his colleagues to do so for very practical reasons.

While on the one hand you cannot but regret that so much pain to the sufferers and sorrow to the survivors may have been occasioned, on the other hand you cannot be held responsible for the result, inasmuch as no means are at present known to sanitary science, by which the destruction of the causes, which give rise to these diseases can be effected. Much may be done to limit their diffusion by the use of disinfectants, by isolation of cases, and fumigation of dwellings.87

The exception was enteric fever, of which the causes were known and Dyke therefore considered to be preventable. 88 In 1879, Dyke urged medical practitioners to inform the sanitary authority swiftly of houses where enteric fever was present to allow “the sparing of many valuable lives, and oft-times the preservation of the Doctor’s own life, as he also too frequently inhales the diseases, and dies, the victim of his own neglect of the precepts of sanitary knowledge.” 89 Dyke argued that diseases were to a great extent preventable by the exercise of vigilance by sanitary inspectors and through the power vested in the Board of Health under the 1866 Sanitary Act, and particularly in the construction of well-ventilated sewers.

In the construction of the ventilators to the sewers you are forming, the greatest care should be taken to disinfect the upward current of sewage air; for the Registrar General of Births &c. says “that the Zymotic matter of Scarlet Fever floats in the air of unventilated rooms, is attached to the clothes and furniture, and its corpuscles are collected in the middens, the cesspools, and the drains.” 90

Illustrating the difficulties of cooperation by the Board and the habits of the people, in 1880, Dyke referred to a house in Tydfil’s Well where up to fifty fowl were kept in the

86 Ibid., p. 22. 87 Dyke, MOH Report for Merthyr Tydfil for1874, p.8. 88 Ibid. 89 Dyke, MOH Report for Merthyr Tydfil for 1879, p.5. 90 Dyke, MOH Report for Merthyr Tydfil for 1865, p.20. 119 house, guano embedded in the floor. The wife died of typhoid fever and two children contracted the disease. 91 The exact mechanisms of infection were not understood in 1865, yet Dyke explained to the Board, with a practical example, how fevers were spread from the breath into the air, and from skin particles. Infection could be inhaled by persons attending the sick, spread by touching infected linen, or through excreta or failure to wash the hands after attending such patients:

It is believed by those who have attended to these matters, that the germs of all contagious diseases are living things given out from the bodies of the sufferers. Each particular disease having its cause or origin in some one particular living thing. These germs or seeds of disease pass off from the sick by the breath, from the skin, but notably from the excretions from the bowels. A child carried into a room where another child is ill of measles or infantile fever, breathes the air, and if susceptible, that is, not in good health, is likely in so breathing to take in the seeds of the disease into its own body. A housemaid who makes the bed of a person who has had scarlet fever may inhale the fine particles thrown from the skin which are floating in the air of the room, and have there from scarlet fever. The nurse attending or the doctor visiting persons ill of typhus, take into their bodies by the air they breathe in the sick room the peculiar germs of that disease. With regard to fevers of the typhus kind, it is well established that the excretions from the bowels of the patients have in them the causes of the disease, and that when these are thrown upon ash-heaps, or into cesspools or water-closets, and thence find their way into sewers, there these exceedingly minute living seeds of disease are propagated in innumerable myriads. 92

Dyke’s advice was sound, despite imperfect knowledge, allowing appropriate measures to be taken. Both scarlet fever and measles were spread by air-borne organisms, and by reducing overcrowding, ventilating rooms and limiting exposure to the disease the incidence could be reduced. A steam fumigation unit for disinfecting clothing and bedding proved useful in limiting the spread of infectious diseases when constructed during the smallpox epidemic of 1872. 93 Smallpox was also a disease of poverty. 94 Vaccination against smallpox was an established preventive health measure where a particular focus on infants and the implementation of public health policies coincided to good effect. Public vaccination was a practice which the Merthyr and Aberdare Local Boards of Health and the Board

91 Dyke, MOH Report for Merthyr Tydfil for 1880, p.10. 92 Dyke, MOH Report for Merthyr Tydfil for 1865, pp.21-22. 93 Dyke, MOH Report for Merthyr Tydfil for 1872, p.22. 120 of Guardians carried out with reasonable efficiency, despite the huge district extending over county boundaries which meant nothing to people as they travelled between districts. Many adult cases were imported by vagrants and trampers seeking work.

A careful study of the facts….. cannot fail to convince any impartial man that the trust reposed by the public in the preservative power of Vaccination, in warding off the fatal issue of that most loathsome and lethic of contagious maladies- Small-pox-is founded upon true and just grounds. 95

The Vaccination Act of 1840 provided for public vaccination by the Board of Guardians, but the vaccination rate was less than half the births registered.96 This situation was regarded by John Simon as ‘a curious illustration of the slow rate of social progress… that sixty years after Jenner’s discovery, deaths by small-pox were amounting to a fourth part of the entire district mortality.’ 97 Union Medical Officers considered compulsory vaccination to be the only way to overcome the indifference of parents to the necessity of vaccination. 98 Compulsory vaccination was introduced with the Vaccination Act of 1871, but William Fawssett, a Union Medical Officer asked: “…are we one jot nearer the grand object of general vaccination than we were before? I trow not. The present system is clogged with certificates and papers that are worse than useless.” 99 The vaccination rate and vaccination techniques were neither uniform nor proficient and F.B. Smith questions the extent of their role in reducing the incidence of smallpox, but includes the roles of notification and isolation in contributing to that result. Nevertheless smallpox was one of the few diseases which substantially diminished by the end of the nineteenth century. 100 Naomi Williams also argues that vaccination was a significant factor in lowering infant mortality rates.101 There is little doubt that the vaccination of infants helped in reducing the incidence of smallpox, but its effect was also to transfer the incidence of the disease to the adolescent and young adult age group which accounted for 253 deaths in 1872, whilst 40 infants died.

94 Smith, The People’s Health, p. 156. 95 Dyke, MOH Report for Merthyr Tydfil for 1872, p .21 96 Births were under-registered in 1845, making the rate even lower. 97 John Simon, Papers relating to the Sanitary State of the people of England: Being the results of an Inquiry into the different Proportions of death produced by certain Diseases in different Districts in England; communicated to the general Board of health by Edward Headlam Greenhow, M.D., with An Introductory reports, by the Medical Officer of the Board, on the Preventability of Certain Kinds of Premature Death, Eyre and Spottiswoode, London, 1858., p. xxx. 98 PRO., MH12/16327,13 Aug 1845, cit. Tydfil Thomas, Poor Relief , 1992, pp.43, 133-134, 141-144. 99 Wm. Fawssett, Esq., Letter to the British Medical Journal, 17 October, 1863, p.433. 100 Smith, The People’s Health, pp. 160-170. 101 Williams. ‘Infant and Child Mortality in Urban Areas of Nineteenth-Century England and Wales’, pp. 171-2. 121 Smallpox rarely occurred in vaccinated persons, but the vaccination needed to be repeated in adolescence to ensure immunity. 102 By 1898 the Local Government Board estimated that 61% of infants were vaccinated within three months of birth.103 During the course of Dyke’s career, 93-97% of infants were vaccinated in Merthyr, the shortfall being largely accounted for by deaths within the first three months. (Appendix. Table 6.) In Merthyr, sixty-eight smallpox deaths occurred in 1865 with a fatality rate of one in five and Dyke commented that “340 cases of this preventible disease occurred last year” 104 In 1865 he described how the Board of Guardians had divided the parish into districts with easily accessible places appointed for free vaccinations; “the parents are duly informed by the Registrars of Births of times and places of vaccination.”105 In 1865, public vaccinations numbered 1,478; of those 1,356 were infants under one year of age. Births numbered 2,206, of which 441 (about 20%) died in early infancy leaving 409 infants unvaccinated, many of whom were too sickly to be vaccinated. Dyke dispassionately states that “68 were under one year of age, and I remarked, in going through the lists, that they were chiefly very young infants, who were under the age appointed for vaccination.” 106 Neglect on the part of parents in the face of freely available smallpox vaccination was regarded as indefensible by Dyke, who chose to quote the words of the Registrar-General likening neglect of vaccination to manslaughter:

It is to be hoped that the means so generally afforded the public for procuring this great protective against Small-pox will be universally used, as it has been indisputably shown that of children who have four or more good circular marks of vaccination, not more than one in a thousand takes Small-pox; and that one would have the disease in its mildest form. Again I must quote the remarks of the Registrar-General: in his 21st report he writes:- “Small-pox exists now almost on sufferance, and only owing to the neglect or to the inefficient practice of vaccination. It is not possible to determine who is to blame for not procuring for the helpless children the protection which the legislature has provided against the small-pox. The Coroners, by holding a certain number of inquests, might ascertain how the matter really stands, and thus prevent acts of negligence, which, in their consequences, are as fatal as the ordinary offences of manslaughter.” 107

102 Details of the smallpox epidemic in Merthyr, Dyke, MOH Report for Merthyr Tydfil for 1872, Smith, The People’s Health, pp. 158-165, Charles Creighton, A History of Epidemics in Britain: Vol. Two, From The Extinction of The Plague to The Present Day, (Cambridge University Press, 1894). Reprinted by Frank Cass & Co., Ltd., London, 1965, pp. 610-613. 103 Smith, The People’s Health, pp.158-165. 104 Dyke, MOH Report for Merthyr Tydfil for 1865, p. 20. 105 Dyke, MOH Report for Merthyr Tydfil for 1865, p. 20. 106 Dyke, MOH Report for Merthyr Tydfil for 1872, p. 18. 107 Dyke, MOH Report for Merthyr Tydfil for 1865, pp.20-21. 122 Dyke was concerned with lowering the general death rate and advocated a compulsory system of registration of sickness for smallpox, cholera and typhoid. 108 Each smallpox death was obliged to be reported in 1872 but there was no legal requirement to return the number of cases which occurred. This information was given voluntarily by medical attendants, and it was unlikely that every case was reported. 109 The deaths of children under five years old from smallpox were replaced epidemiologically by deaths from measles and whooping cough, often lethal infections for babies. 110 These deadly diseases were not notifiable and were sustained by the pool of non-immune young children. Dyke became increasingly frustrated with the way in which epidemics were spread through school attendance and wrote two pamphlets on this subject, addressing the duties of school managers during times of contagious epidemics, a constant complaint in his reports. Dyke warned that “There is no known preventative of Measles, of Scarlet fever, or of Whooping Cough.” 111 Dyke summarised the situation;

Hygiene may not be able to prevent the incidence of the disease, but attention to its precepts (the provision of pure air, pure water, and a dry well ventilated house), will afford means for averting a vast number of fatal terminations. But this is not all, maladies of this character leave the survivor weak and feeble; and thus left, he is liable to become sickly and deficient in vital strength. Here again the surroundings of a child’s sick bed, a house whose foundations and whose walls are dry, an unpolluted atmosphere, and an unlimited supply of pure water, are the means by whose aid he will be enabled most successfully to combat the debilitating influences of sickness. 112

By late autumn 1890, “the long-desired notification of cases of contagious disorders by the medical attendants, came into operation.” 113 However, measles and whooping cough were not among those to be notified and closure of schools during epidemics remained the most effective in Dyke’s sanitary arsenal. Dyke did not specifically identify infants as particularly vulnerable to measles and whooping cough, but the analysis of infant deaths indicates that these were by far the most dangerous illnesses for infants. The need to prevent the spread of such diseases through school closure seemed entirely sensible when the diseases spread rapidly through schools and were then

108 Dyke, On the Modes of Dealing with Outbreaks of Pestilent Fevers, London, 1871, pp. 5-8. 109 Dyke, MOH report for Merthyr Tydfil for 1872, p. 14. 110 Creighton, Dyke, ‘Causes of Death in Merthyr Tydfil, At Different Ages, in the Year 1872’, Appendix, MOH Report for Merthyr Tydfil for 1872, Smith, The People’s Health, pp.156-7. 111 Dyke, MOH Report for Merthyr Tydfil for 1872, p. 25. 112 Dyke, MOH Report or Merthyr Tydfil for 1873, p. 7. 113 Dyke, MOH Report for Merthyr Tydfil for 1890, p .6. 123 brought into the home, spreading disease to infants and young children. This was the larger context within which Dyke saw the problems of infant death. It strengthened his determination to minimise the effects of infectious diseases to limit morbidity and deaths among the younger population, who suffered greatly during epidemics. Such deaths were considered preventable, as were diseases of filth, whilst convulsions and prematurity were largely considered to be inevitable. Therefore Dyke did not see the deaths of infants as a distinct issue which needed special attention and different approaches.

Dyke and Infant Mortality

The data Dyke collected and his observations provide an invaluable primary source of evidence from which to interpret the historical problem of infant mortality in Merthyr Tydfil, where the problem of infant deaths was absorbed within the urgency of epidemic disease outbreaks and subordinated to the chronic general urban sanitary needs. He was certainly not indifferent to the problem of infant deaths but the subject was implicit rather than explicit within his reports. In 1866 he inveighed against ‘this wicked waste of human life’, particularly among illegitimate infants, whose death rate was nearly double that of legitimate infants, an issue which drove much interest in the topic of infant death from the mid-1860s. Aware of this aspect of infant mortality, Dyke included details of illegitimate births and deaths in his reports.

The enquiry into the causes of this wicked waste of human life belongs rather to the makers of the laws, than to members of the medical profession; of course the reason why they die is because they are neglected: - but why so neglected? The able secretary of the Harveian Society, Mr. Curgenven, has lately directed public attention to this subject – the waste of Infant Illegitimate Life, and has pointedly called upon the magistrates who administer the Bastardy laws to enquire, whether those laws do not press unjustly upon the mothers of those unfortunate children? 114

The social, moral and legal aspects of illegitimacy were explored by the Harveian Society and a report was presented to the Home Secretary. Dyke alluded to this debate in his report for 1866. High levels of infant mortality accompanied illegitimacy, the social stigma of which increased the risk of infanticide, abandonment or gross neglect of infants linked to baby farming and burial insurance, as the new

114 Dyke, MOH Report Merthyr Tydfil for 1866, pp. 50-51. 124 science of forensic pathology called into question the integrity of midwives when babies were “stillborn.” The question was raised of how a single mother could be expected to support a child, but recommendations that the Affiliation Laws be revised to recoup costs from the putative father were unsuccessful because it was difficult to prove paternity. It also generated criticisms of working mothers who were thought to neglect their children, particularly in textile towns. In Merthyr women’s participation in paid employment declined during the nineteenth century and this was not a significant issue. However, low participation rates in the paid workforce meant that women were less able to contribute to family income and assist financially during lean times, making them more likely to suffer poverty or financial hardship.

As MOH and through his membership of bodies such as the NAPSS and the BMA, Dyke would have been familiar with the work of Dr William Farr, for many years from 1839 statistician to the General Register Office, where his founding epidemiological and statistical work shaped the reports of the Registrar General. 115 Farr’s observations led him to express the eugenicist view that:

It will appear that a vast number of weakly children are every year introduced into the English population, and that, unless proper means be taken to fortify the constitution in manhood, the relative vigour will not increase in the same ratio as the population.116

Farr’s views concerning infant mortality are of considerable interest for this thesis, but there is no direct evidence to indicate what Dyke thought of them even though he was always aware of and concerned about the problem. Farr identified many of the issues relevant to the problem of infant mortality, all of which were familiar to Dyke. Farr observed the differing mortality rates for each month of life during the first year in various localities, the rates varying in each instance, but in healthy districts it was 111/1000 live births, approximately half that of unhealthy districts. 117 Farr attributed the principal causes of infant mortality, diarrhoea, convulsions and atrophy, to maternal

115 Farr corrected the statistical errors of Edwin Chadwick and John Simon and worked closely with Florence Nightingale and John Snow. Farr, ‘ Introduction,’ Vital Statistics, p.xii. For an account of the professional people associated with these organisations, their social circle and sphere of influence see John Eyler, Victorian Social Medicine: The Ideas and Methods of William Farr , John Hopkins University Press, Baltimore, 1979., Michael J. Cullen, The Statistical Movement in Early Victorian Britain: The Foundations of Empirical Social Research, Harvester Press, Sussex, 1975. 116 Farr, Vital Statistics, p .196. Eyler, Victorian Social Medicine: The Ideas and Methods of William Farr, pp. 154-158. 116 Farr, Vital Statistics, pp. 200-201. 117 Ibid. 125 neglect. He also believed that many causes of infant death were a ‘deplorable waste of life’, avoidable and related to individual living conditions, and considered many causes of infant death to be preventable. 118

This procreation of children to perish so soon – the sufferings of the little victims- the sorrows and expenses of their parents- are as deplorable as they are wasteful….. The mother when she looks at her baby is asked to think of its death, and to provide by insurance not for its clothes but for its shroud and other cerements…… all that is certain is that the children are bred in such unfavourable and unnatural conditions that they perish in excessive numbers.. the extent to which the several causes contribute to their destruction requires further investigation; but enough is known to justify the belief that such causes may be to a considerable extent removed.119

Farr was greatly concerned by infant mortality since it formed a large part of the general death rate, and by 1875 had considerably refined his methods of assessing the rates and causes of infant mortality. It was difficult to assess the number of infant deaths accurately and decennial census figures did not reflect the varying numbers dying each year during epidemics.120 The Reports of the Registrar General made frequent comparisons of deaths at various stages during the first year of life based on the proportion of deaths per 1000 births which enabled standardised comparisons of districts and annual variations. 121 As many as 38% of infants perished in the first month of life, the rate declining thereafter in healthy districts, but in unhealthy districts of Liverpool infant mortality again increased after six months, possibly pre-empting later significant studies into the effects of urbanisation on infant mortality. 122 Farr stressed the importance of distinguishing between infants who died from debility and those who died prematurely. 123 He identified the many complex factors involved in the differing levels of infant mortality in various towns including the poor sanitary environment and women’s employment leading to neglect of infants:

Some of the principal causes are improper and insufficient food, bad management, use of opiates, neglect, early marriages, and debility of mothers; but whatever may be the special agencies at work which are so prejudicial to infant life, it must be borne in mind that a high death-rate is in great measure also due to bad sanitary arrangements. 124

118 Beresford, ‘Suffer the Little Children,’ pp.31-33. Footnotes 74-88, Farr, Vital Statistics, p. 200. 119 Farr, Vital Statistics, p. 184. 120 Ibid., pp.188,191, 206-208. 121 Ibid, pp.191,199, pp.200-201, 206. Beresford, ‘Suffer the Little Children’, pp. 31-32. 122 Farr, Vital Statistics, pp.188 -9, 199-200. Woods et al. ‘The Causes of Rapid Infant Mortality Decline in England and Wales, 1861-1921, Part 1., Part II’. Woods and Woodward Urban Disease and Mortality in Nineteenth-Century England. 123 Farr, Vital Statistics, p.188. 124 Ibid, p.192. 126 …much depends, at the starting point of life, whether infants breathe the poisoned air of large towns, or the fresh pure atmosphere of healthy districts. 125

Farr believed that weakly and imperfectly formed infants were unlikely to survive. He expressed the view that weakly babies were too frail to survive, and it was little wonder that they died:

Thus 1,000,000 children are just born alive, but some of them have been born prematurely; they are feeble; they are unfinished; the molecules and fibres of brain, muscle, bone are loosely strung together; the heart and the blood, on which life depends, have undergone a complete revolution; the lungs are only just called into play. The baby is helpless; for his food and all his wants he depends on others. It is not surprising then that a certain number of infants should die;…..little is positively known; and this implies little more than that the brain and spinal marrow, nerves, muscles, lungs and bowels fail to execute their functions with the exact rhythm of life. 126

It is evident from Dyke’s reports that he was aware of all these aspects of the problem of infant deaths in Merthyr, especially those within the first days of life. Farr’s opinions would have been well known in professional circles, and if such views illustrated or influenced medical thinking at the time, then it is not surprising that what we would now regard as unacceptably high levels of infant mortality were accepted as ‘normal’ and such deaths were regarded as inevitable, a view to which Dyke possibly subscribed. Dyke would certainly have been aware of Farr’s influential opinions and considered them in their practical application in Merthyr. Whilst Farr identified many of the factors which contributed to infant mortality, he did not propose any potential solutions other than those which were implicit in his findings, such as improving the urban environment and improving the care of infants. Whereas Farr’s genius lay in gathering national statistics and making them socially coherent on a large canvas; the problem of infant mortality Dyke faced in Merthyr was only one of many urgent and important concerns which he had to manage on a day to day basis. In 1875 for example, the distress throughout the area during the industrial dispute required urgent and practical attention. For the first decade or so of Dyke’s career, infant mortality rates, apart from epidemic years, appeared to be responding to basic sanitary improvements in the town. Referring to deaths from convulsions in 1877, Dyke expressed views similar to those of Farr, and an acceptance of the inevitability of a certain number of infant deaths:

125 Ibid, p.200. 126 Ibid, p.203. 127

I must ask you to note the excessive mortality of young children which is set down as having been caused by “Convulsions,”-121 under one year of age. Deaths from bronchitis and Pneumonia among the very young reached a total of 153; thus these causes conjointly occasioned 305 deaths. Are they preventable? I must, with regret, say no. In the first place you cannot by any act of yours modify to any degree the conditions which render a child of tender age prone to convulsive seizures. 127

Furthermore, considering the difficulties facing the newborn Dyke thought it a wonder that so many survived:

This sacrifice of infant life is one, which I fear, we cannot yet hope to see reduced. The tender life of the very young is subjected to so many changes and chances, that it is to be wondered rather that so many live, than that so many die. 128

Although Dyke considered deaths of many young infants to be inevitable, he believed that hope lay in the education of mothers in rearing their offspring. That vision also laid the blame for many infant deaths on their mothering.

Possibly when those who are to become mothers shall have been better educated, and taught some of the leading principles by which a healthy life is to be maintained, when the happy millennium of elementary and middle class education shall have realized its beatific vision then we may hope that mothers may rear every one of their offspring. 129

Dyke expressed concern at times about a perceived indifference among the general population born of ignorance or complacency regarding the problem of infant deaths, especially those which could be prevented. Dyke attributed a large number of deaths from convulsions to their ignorance in matters of infant feeding and criticised “The unwisdom of mothers… visiting in houses where children are sick” 130 In 1869 Dyke wrote:

Probably much of this unnecessary mortality of the innocents may be owing to the improper food with which they are fed, and the great exposure to cold and wet to which their partially exposed bodies are exposed. 131

In 1882 he repeated

As a rule, the disorder of the system which results in Convulsions, is induced by improper and unhealthy food. It is scarcely within the bounds

127 Dyke, MOH Report for Merthyr Tydfil for 1874, pp.10-11. 128 Dyke, MOH Report for Merthyr Tydfil for 1877, p.5. 129 Ibid. 130 Dyke, MOH Report for Merthyr Tydfil for 1877, p.4. 131 Dyke, MOH Report for Merthyr Tydfil for 1869, p.13. 128 even of hope to expect that mothers may soon be so educated as to be capable of carefully preparing and administering healthy food to children; and this more especially when on the one hand, the milk supplied by stall-fed cattle in the winter is in itself deficient in nutrient value, and on the other hand the various preparations sold as substitutes are known to be still more inferior as articles of infant food.132

When, by 1882, the deaths of babies under three months old accounted for 21% of all deaths and 15.6% of births, Dyke despairingly wrote: “If such a rate of mortality prevailed among calves, lambs, or porkers, great would be the outcry and lamentation!”133 Dyke believed that the solution lay in the orthodoxies of sanitary reform, in providing clean water, unpolluted air to breathe and dry well-ventilated dwellings. 134 Ideally, general environmental improvements would prevent or control infectious diseases and reduce the deaths of children and infants by allowing them to grow sufficiently strong and healthy to resist and overcome any indispositions they might encounter. From the outset Dyke campaigned for housing improvements but Merthyr’s problems were enormous and protracted and these efforts only addressed the environmental, not the social aspects of the problem. Dyke was keenly aware of these social aspects of public health, particularly the effects of adverse social, economic and environmental circumstances on the health of families, particularly mothers and children, but many of them lay beyond the immediate purview of public health and had to await the cementing of policies and the implementation of new strategies which Dyke had envisaged for many years. In referring to the improvement to housing brought about by guttering and draining Dyke wrote in 1866 “the ground floor of houses become to some extent dried- hence an improvement in the health of those who pass their whole time at home, mothers and children.” 135 Dyke also advocated the importance of educating girls in domestic and childrearing skills.136 In 1895 he envisaged the training of midwives to avoid unnecessary deaths from puerperal fever:

It is always a matter of regret that mothers should thus suffer, yet knowing the want of care in many ways, the wonder in my mind is that the malady is not more frequent…. The establishment of a nursing institute in connection with the general hospital, will in a few years supply an adequate supply of skilled nurses.” 137

132 Dyke, MOH Report for Merthyr Tydfil for 1882, p.27. 133 Ibid., p. 3. 134 Dyke, MOH Report for Merthyr Tydfil for 1874, p.11. 135 Dyke, MOH Report for Merthyr Tydfil for 1866, p.37. 136 Dyke, MOH Report for Merthyr Tydfil for 1877, p.5. 137 Dyke, MOH Report for Merthyr Tydfil for 1895, p.5. 129 Among the social factors which contributed to Merthyr’s mortality rates were alcoholism and the inhospitable climate. Dyke believed that alcoholism was a social factor outside the control of public health which contributed to preventable mortality rates, and that among mothers it contributed to the deaths of infants. Alcoholism was considered to undermine morality and contribute to poverty and Dyke and many of his BMA colleagues in south Wales were advocates of temperance. For Dyke this was a topic of local, cultural, and possibly personal significance as well as a public health issue, which resonated with a national move towards temperance. It also became a class issue when social observers blamed the working classes for many of their own problems when alcoholism was seen as an unnecessary and irresponsible morally and socially corrupting influence.

…but I must here say, that one of our chief ironmasters has expressed the whole truth in the remark, “that a larger number of working men die in the prime of life, in good times than in bad.” The cause being the excessive use of intoxicating drinks.138

Heavy physical labour in the iron and coal industry entrenched the social habit of beer drinking along with popular entertainment, especially in the early days when beer might be considered to be less dangerous to consume than the Merthyr water. Local hostelries supplied the cultural, social and political needs of the people of Merthyr where people could socialise away from their overcrowded homes. 139 Prohibition played an important part in Welsh politics from the middle of the nineteenth century and was also tied to a growing sense of morality and respectability. 140 Prosecutions for drunkenness in Merthyr fell from 74% of cases tried in Glamorgan 1842-3, to 30% of cases 1887-8.141 Nevertheless, inebriation among mothers, and increasing cases of syphilis were among the accusations and shortcomings levelled against mothers in the Edwardian era. Weather details, especially rainfall, were included in official reports such as MOH Reports and in the Annual Reports of the Registrar General. The significance of rainfall in reducing deaths from summer diarrhoea and the propensity for hot summers to increase them, was not appreciated until the Edwardian period when the breeding cycles of flies and their role in spreading infantile diarrhoea was understood. This knowledge was incorporated into the campaign against the use of artificial feeding of

138 Dyke, MOH Report for Merthyr Tydfil for 1865, p.9. 139 Croll ‘From Bar Stool to Choir stall: Music and Morality in Late Victorian Merthyr’, pp. 18-19, 20-21. p.25. 140 W. R. Lambert, Drink and Sobriety in Victorian Wales c.1820-1895. University of Wales Press, Cardiff, 1983., pp. 203-247. 141 Ibid., p.34. 130 infants, especially with tinned and condensed milk. The need for home hygiene was then also identified as a powerful preventive factor in reducing infant deaths.142 Dyke took a particular interest in the role of the inhospitable climate as an influence on infant mortality rates, which he argued increased deaths from lung diseases, but was outside the control of the Board. Situated at the foot of the Brecon Beacons, Merthyr had a cold wet climate that adversely influenced death rates during the winter months. “The influence of Temperature, of the Rainfall, of winds, and of atmospheric pressure, in the production of disease, are well-known.” 143 In 1866 Dyke comments on the fog which frequently enveloped Troedyrhiw: “– the proximate originator of much sickness. In each of these districts excessive moisture, charged with the refuse of human beings, prevails.” 144 Under such circumstances Dyke thought it inevitable that deaths from lung diseases of “those who are in the first dawn of life” would occur.145

Many may be disposed to pass over this fact with the trite remark, that young infants have so little vitality in them, that it is not to be expected that they can resist the low temperature and moist atmosphere of these elevated regions.146

However, Dyke condemned any complacency, drawing an analogy, in 1866, between infants and calves, saying that if 1 in 40 died from lung diseases, the farmer would dry his cattle shed and drain his meadows, but “In the matter of human life, the public take no such care…” 147 Nevertheless, he optimistically believed that some measures to be taken by the local authority, “will tell most favourably.” 148 Until the Edwardian period, the medical fraternity collectively considered many infant deaths to be inevitable, but many were also considered to be preventable since many problems lay in the way infants were cared for in unhealthy homes.149 Dyke never relinquished his beliefs that healthy housing, the future education of mothers, the prevention of infectious diseases and the efficient administration of public health without unnecessary delays which cost lives, would all ultimately benefit the population as a whole including infants. However, in 1900, the year that Dyke died, as many as 16

142 Deborah Dwork, War Is Good for Mothers and Babies and other Young Children: A History of the Infant and Child welfare Movement in England, 1898-1918, Tavistock Publications, London, 1987. 143 Dyke, MOH Report for Merthyr Tydfil for 1865, p.12. 144 Dyke, MOH Report for Merthyr Tydfil for 1866, p.42. 145 Ibid, p. 43. 146 Ibid, p. 44. 147 Ibid., p .44. 148 Ibid.. 149 Dyke, MOH Report for Merthyr Tydfil for 1874, p.10. 131 houses in several instances still shared one water tap. Dr Jones described the wretched hovels that were only removed when

…their existence became a scandal and reproach to your town. Many still exist, noisome holes in the ground, foul, sickly smelling cellars under the street level, whose very existence is undreamt of and unknown to the scores who pass within a few yards daily…. So crowded is the population that it has actually been necessary to commence to demolish premises before the occupiers could be persuaded to leave, and even then they could only secure shelter by overcrowding their equally miserable and hardly better housed neighbours. The result was the tolerance and repair of some buildings which would not otherwise be tolerated by the health department.150

The section in the MOH reports specifically addressing infant mortality does not appear during Dyke’s tenure, but begins from 1900 when his successor, Dr. C. G. Simons, specifically addresses this important issue. A forward shift in medical knowledge is perceptible in the BMJ during the late nineteenth and early twentieth centuries evolving with professional advances in the fields of obstetrics and gynaecology. 151 The importance of the mother’s health and understanding of antenatal physiology, foetal development and infant survival advanced the understanding of infant mortality as a complex social problem. Medical professionals lacked the requisite collegiate knowledge to address the problems of infant mortality, until they ventured more confidently into the social ecology of public health problems, until there was a willingness to engage with the many social factors, particularly social class, poverty, housing, overcrowding, nutrition and maternal health, which contributed to the problem of infant mortality. Dyke did not perceive infant mortality in the way it is now understood as an historical problem, neither was the infant mortality rate used by Dyke in the way it is now, as a central and sensitive health indicator. Infant mortality is now considered to be an important social index since infants are the last to benefit from sanitary improvements or rising living standards. Dyke, Farr and their colleagues recognised that infant deaths reflected the living conditions and social experiences of the population. They worked within a culture of nineteenth-century positivism which justified policies

150 W. W. Jones, M.D., D.P.H., Temporary MOH for Merthyr Tydfil, Annual Report on the Sanitary Condition of Merthyr Tydfil During the Year 1899, pp.10-11., GRO GC/PH/33/99. 151 Refer to BMJ articles. Of particular interest in this emerging medical discourse is the following article: G. F. McCleary, ‘The Influence of Antenatal Conditions on Infantile Mortality’, the British Medical Journal, 14 August, 1904, pp.321-323.

132 and measured progress by statistical returns. The processes of the nineteenth-century sanitary movement aimed initially to reduce general death rates. Adult death rates were the first to fall, followed by the decline of deaths under five years, and infant death rates fell after the turn of the century. 152 Dyke’s reports included tables of causes of death at all ages including infants under one year of age from 1865. The retrospective analysis of these 17,000 deaths in this thesis reveals rising rather than falling infant mortality rates by the end of the nineteenth century. Despite analysing infant deaths per 1000 births to express the infant mortality rate from 1881, (Table 3.2.), Dyke continued to assess the success of his public health policies using the general death rate, and mean age of death in reporting sanitary progress.

It is not however in the lessening of human suffering only that your efforts have been crowned with success, the facts as extracted from the records of death show that life has been lengthened. Not only were fewer persons sick, and a lesser number of illnesses fatal, but those who did die, lived a longer time.153

By 1894 Dyke calculated the average age of death as “The sum of the years lived by those whose deaths were recorded, divided by the number of deaths, gave 25 as the average, as compared with 17 ½ years in the dark days of Merthyr.”154 The death rates declined slowly and did not fall consistently below 23 until 1895. When Dyke refers specifically to deaths under one year of age, he uses inconsistent values, frequently measured against the total population. His methods varied, but generally he confined himself to total deaths in early life as a percentage of total deaths or births, an approach which failed to reveal rising infant mortality rates or the underlying causes of infant mortality. When Dyke was giving evidence to the Royal Sanitary Commission he was asked whether the sanitary improvements in Merthyr had been “particularly efficacious with respect to infant mortality?” He replied “They have very much so.” 155 To support this statement, Dyke gave statistics relating to infants under one year old. In 1852, he said, there were 78 infant deaths per 10,000 living population and in 1867 the number was 58. In 1852 the deaths of children under five to all deaths was 527 per 1,000 and in 1867 it was “but 409”. 156 Such figures are meaningless when measured against a population of 10,000 and deaths under one year

152 Mitchison, British Population Change Since 1860, pp.39-40. 153 Dyke, MOH Report for Merthyr Tydfil for 1872, p.32. 154 Dyke, MOH Report for Merthyr Tydfil for 1894, p.5. 155 Evidence of T.J.Dyke, 12 July, 1869., First report of the Royal Sanitary Commission with Minutes of Evidence up to 5th August, 1869, [1868-69 Q. 6341, p.348. 156 Evidence of T.J.Dyke, 12 July, 1869., First report of the Royal Sanitary Commission with Minutes of Evidence up to 5th August, 1869, [1868-69]Q.6342.p.348. 133 are included in the deaths of children under five. Table 3.1. shows the variation in deaths of young children as a proportion of all deaths in various districts of Merthyr in 1866. Congruent with modern understanding, the deaths of under fives decreased as deaths from infectious diseases decreased in Merthyr, but infants under one year then formed an increasing proportion of deaths under five. 157 Deaths under five years in Merthyr accounted for approximately 55% of total deaths 1841-1853; from 1866-1891 approximately 45%, and 1892-1908 approximately 50% of total deaths. From 1841 to 1853 deaths of infants under one accounted for approximately 50% of deaths under five years. From 1866-1908 this increased to 60-70%. From 1841 to 1888 infant deaths formed approximately 25% of total deaths and 35% from 1889 to1908. This period of increase coincided with a rise in infant deaths as a percentage of births from 1889. Approximately 15-20% of babies born 1841-1888 died within the first year, from 1889- 1901 this rose to 20-25% before returning to former levels. The dates tend to fall in line with Woods’ hypothesis that the increase in deaths from diarrhoea coincided with urban population growth and the rising popularity of bottle feeding by the 1890s.158 However, this is also the period when infant deaths from antenatal causes increased in Merthyr from 7.7 deaths /1000 births in 1866 to 34/1000 births in 1907, increasing particularly from 1891. Dyke often refers impassively to the number of infant deaths, percentages of total deaths, or percentage of births, but his statistical methods failed to reveal the extent of the problem until later years. ( Appendix: Table 9.) For more than a decade from 1866 Dyke gave the number of infant deaths under one year for each classification of cause of death but summarised them collectively as deaths below and above five years of age. In 1866 Dyke recorded the proportional death rates of children under five years of age in each division of Merthyr, referring loosely to the infant population and “the deaths of little folk.”159 Table 3. 1. shows the wide variation between districts as percentages of deaths of children under five years varied from 35% in Tydfil’s Well to 61.2% in Penydarren. This variation between districts was important to Dyke and explained largely by environmental problems. In 1874 Dyke reported that nearly one- fifth of children born in 1874 died within the first year of life, whilst the percentage of children under five dying was 52%, “this is in excess of the average.” He then refers to

157 Mitchison examines the historiographical debates concerning the causes of mortality decline in relation to infants and children in Mitchison, British Population Change Since 1860, pp. 41-54. 158 Woods et al., ‘The Causes of Rapid Infant Mortality Decline in England and Wales, 1861-1921’, Part 1, pp.344-5. 159 Dyke MOH Report for Merthyr Tydfil for 1866, pp.79-81. 134 the appended table of causes of death for an explanation of the diseases “which have caused this great mortality.” 160 By 1879 Dyke observed “how marked an improvement has taken place in the sanitary condition of the district, as evidenced by the comparatively low percentages of the deaths of young children.”161

Table 3.1. Proportional Death Rate of Children under 5 years to 1,000 deaths at all Ages (Percentage) in Merthyr Tydfil 1866 ( Table XXIV, MOH report for Merthyr Tydfil for 1866, p.81) Division Proportional rate of death under 5 years to 1,000 deaths at all ages. (percentage) Gellydeg 385 (38.5%) Tydfil’s Well 366 (36.6%) Troedyrhiw 360 (36%) Merthyr 410 (41%) Dowlais 511 (51%) Penydarren 612 (61.2 %)

Dyke’s reports were structured around a nosology which identified medical causes of death. Infant deaths were reported within this context, and the deaths of infants are evaluated within the sections addressing the main causes of death. Dyke’s methods of statistical evaluation revealed the number of infant deaths associated with certain diseases, but did not address the collective number of deaths under one year old as the specific conceptual problem of infant mortality. Dyke frequently refers to infant deaths, but only under headings based on medical taxonomies and medically assigned causes of death applied to all age groups. Dyke obtained returns from the district registrars to improve the accuracy of numbers and causes of death, but the overall problem of infant mortality was obscured within the reporting of epidemics and absorbed within the many other problems of public health administration. His methods of statistical evaluation identified the number of infant deaths and, from 1881, Dyke recorded the infant mortality rate per 1000 registered births (Table 3. 2.), yet he failed to identify the larger problem of infant mortality, despite an undeniable increase from 1884, the year in which infant diarrhoea increased. However, Dyke still does not refer to this fact in his reports.

160 Dyke, MOH Report for Merthyr Tydfil for 1874, p. 4. 161 Dyke, MOH Report for Merthyr Tydfil for 1879, p.3. 135 Table 3. 2 . Birth and Death Rates per 1000 population, and Deaths of Children Under 1 Years per 1000 Registered Births (MOH Reports for Merthyr Tydfil 1881- 1908.) Years Birth Rate per 1000 Corrected Death Rate Deaths of Children Population per 1000 Population Under 1 year per 1000 Registered Births. 1866-70 38.7 24.5 169 1871-75 39.3 26.8 165 1876-80 33.3 21.9 124 Mean of 15 years 37.1 24.4 153 1881 35.5 27.6 137 1882 34.7 23.8 156 1883 35.2 22.8 158 1884 35.5 24 171 1885 34.4 25.6 171 1886 33.3 25.3 182 1887 32.8 21.7 177 1888 35.3 21.8 143 1889 34.0 23.1 209 1890 34.7 26.0 205 1891 39.3 30.6 193 1892 37.0 28.3 242 1893 37.5 22.3 219 1894 36.7 19.8 186 1895 38.1 24.6 240 1896 34.1 20.0 217 1897 34.8 22.0 214 1898 34.7 19.5 199 1899 32.0 23.6 271 1900 34.0 21.2 217 1901 38.68 25.85 261 1902 39.6 22.9 183 1903 38.4 18.98 153 1904 38.5 19.7 186 1905 38.0 22.0 206 1906 36.2 19.0 181 1907 35.8 19.2 154 1908 35.4 18.5 176

Dyke’s reports from 1891-1897 deal almost exclusively with fevers as causes of death, so for the last years of his career Dyke failed to recognise summer diarrhoea as a principal preventable cause of infant death, perhaps because to do so invalidated his utopian vision of a pure water supply preventing such deaths. Epidemic summer diarrhoea was discussed increasingly in the medical journals by the end of the nineteenth century, and infant deaths from diarrhoea formed the principal cause of infant deaths in Merthyr in 1898, but Dyke does not address this fact. The last year in which he specifically addressed diarrhoea as a cause of death was in 1890, when he reported the deaths of 46 children under five years of age, with a death rate of 0.8 per 1,000 population. 162 According to the analysis in this thesis, the IMR from diarrhoeal deaths rose from 3.3 / 1000 births in 1866 to 17.8/ 1000 births by 1890. By 1898 this

162 Dyke, MOH Report for Merthyr Tydfil for 1890, p.7. 136 rate had increased to 22.9 /1000 births. Dyke’s methodology does not reveal this fact in the way the infant mortality rate does. Under the heading of the Digestive System Dyke writes:

Of the total mortality, 53 due to the maladies of this system, 24 deaths were caused by dentition. Usually teething occasions death by the irritation set up of the nervous system, resulting in convulsions. It would be well in all cases of death attributed to dentition, to state whether “convulsions; were not the final cause of death. So also with entries often made of “ gastric catarrh,” “gastritis,” “enteritis,” “intestinal irritation,” occurring to children under five years, it would be desirable to state whether diarrhoea was or was not a prominent symptom. And, again, “enteritis” has been very frequently assigned as the cause of death, in certain localities, and in certain families, when at the same time Enteric fever was prevailing among those families in those localities.163

The above paragraph encapsulates the problems Dyke faced in making sense of the causes of death determined by nosological taxonomies and indeed the difficulties faced by historians. Dyke was at this stage entering his final decade, his health failing. His methods of reporting infant deaths failed to identify the composite problems of infant mortality. His use of inconsistent parameters failed to relate infant deaths to 1000 registered births (the infant mortality rate). For example, Table 3. 3. demonstrates the way in which Dyke shows the deaths at all ages from certain groups of diseases and the proportions to 1,000 population and to 1,000 deaths from all causes. Division I gives the deaths per 1000 population at all ages and deaths per 1000 of total deaths at all ages for principal zymotic diseases, pulmonary diseases and principal tubercular diseases. Division II shows deaths of infants under one year per 1000 births and deaths per 1000 of total deaths under one year for wasting diseases (including marasmus, atrophy, debility, want of breast milk and premature birth) and from convulsive diseases (including hydrocephalus, infantile meningitis, convulsions and teething). A total of 113 deaths from wasting diseases occurred, equivalent to 45 deaths per 1000 births and 225 per 1000 of total deaths under one year. The table shows a total of 54 deaths from convulsive diseases equivalent to 22 deaths per 1000 births and 107 deaths per 1000 deaths under one year of age. This table addressed in total the causes of 167 deaths, with a combined infant mortality rate of 67 per 1000 births. The total number of infant deaths in 1898 was 505, with an infant mortality rate of 199 leaving the specific causes of death of 338 infants unreported in this table.

163 Dyke, MOH Report for Merthyr Tydfil for 1890, p. 8. 137 Table 3. 3 . Dyke’s Table of Deaths at All Ages in 1898. TABLE IV. Shewing[sic] the number of Deaths at all ages in 1898, from certain Groups of Diseases, and proportions to 1,000 of Population, and to 1,000 deaths from all causes; also the number of Deaths of Infants under one year of age from other groups of Diseases and proportions to 1,000 Births and to 1,000 Deaths from all causes under one year. (Dyke, Medical Officer of Health Report for Merthyr Tydfil for 1898, p.21.) DIVISION 1. Total Deaths per 1000 of Deaths per 1000 of total Deaths deaths Population at all ages at all ages. 1.Principal Zymotic 138 1.9 98 Diseases… 2.Pulmonary Disease 279 3.9 197 …. 3.Principal Tubercular Diseases 136 1.9 97

DIVISION II. Total Deaths per 1000 of Births Deaths per 1000 of total Deaths (Infants under one year). deaths under One Year.

4. Wasting diseases… 113 45 225 … 5. Convulsive Diseases 54 22 107 Notes. 1. Includes Smallpox, Measles, Scarlet Fever, Diphtheria, Whooping Cough, Typhus, Enteric (or Typhoid), and Simple Continued fevers, and Diarrhoea. 2. [No details provided] 3. Includes Phthisis, Scrofula, Tuberculosis, Rickets and Tabes. 4. Includes Marasmus Atrophy, Debility, Want of Breast Milk, and Premature Birth. 5. Includes Hydrocephalus, Infantile Meningitis, Convulsions and Teething.

It was time for a fresh approach. A rapid rise in the levels of interest, knowledge and actions concerning infant deaths is seen in the MOH reports from 1900, when Dr. C. G. Simons took over Dr. Dyke’s duties. The reports begin to address specifically the subject of infant mortality as a public health problem, and to use the standard infant mortality rate per 1000 registered births as a consistent sanitary index. In less than a decade following Dyke’s death a dramatic reappraisal took place regarding the social ecology of infant mortality, its causes and prevention. Infant deaths were statistically evaluated in a way which allowed the recognition of influence of antenatal conditions on infant death rates, and linked high birth rates with high infant mortality rates. Dr.

138 Jones’ report for 1899 stated that the cause of the high death rate was the excessive deaths of infants from diarrhoea, giving Merthyr a higher infantile mortality rate than the 33 Great Towns. The effect he regarded as unfortunate since deaths outnumbered births, “ a state of things which is fortunately very rare. ”164 The eugenicist emphasis on the quality rather than the quantity of births required a reappraisal of the belief that a high birth rate was to be applauded in sustaining the population, when in fact a lower birth rate was more likely to ensure the survival of infants.165 The new medical orthodoxy accepted that antenatal conditions were the underlying cause of the majority of deaths within the first month of life.166 This explicitly linked the survival and vigour of babies with the health of the mother for the first time, which in turn was implicitly linked with the social and economic circumstances of the mother, a central tenet of this thesis.

Conclusion

Dr. Thomas Jones Dyke as Merthyr’s Medical Officer of Health was highly respected well beyond Merthyr’s boundaries, but infant mortality rates rose rather than fell during his exemplary career. Dyke’s reports are instructive sources of social and medical history and provide valuable insights into the causes of infant deaths in Merthyr 1865-1900. The early formative years of his career during and after the cholera crises were concerned with improving the sanitary environment of the town and controlling the spread of infectious diseases. Substandard housing was an area of particular concern to Dyke and linked to high death rates. These were the priorities of his administration from 1865. Dyke was constrained by the paradigms of public health which were current during his early professional life, yet many preventive measures were effective based on sound commonsense and the removal of filth and ordure. Dyke was deeply committed to the evolving professional field of public health and the processes which would prevent deaths from infectious diseases, and assumed that infant and child deaths would fall in response to those measures. Dyke adhered to the fundamental philosophies of improving the sanitary environment throughout his career, incorporating new medical orthodoxies to the best of his ability. He identified many bureaucratic inefficiencies and deficiencies in public health laws which delayed the effective prevention of life- threatening epidemics. His reports reflected these priorities and concerns.

164 Jones, MOH Report for Merthyr Tydfil for 1899, p.13. 165 Alex. Duncan, MOH Report for Merthyr Tydfil for 1907, p. 9. 166 Ibid., p. 19. 139 General civic improvements prior to 1865 transformed the sanitary environment of Merthyr Tydfil, but infants failed to benefit from these measures. From 1865 the life expectancy of adults increased and the general death rate gradually decreased by the time of Dyke’s death in 1900. Waves of epidemics, the protracted need to focus on the urban sanitary environment and infrastructure, housing problems, the view that infant mortality especially in early life was non-preventable, an inefficient bureaucracy of medical administration, a statistical approach which failed to reveal the extent of the problem and an ageing Medical Officer of Health were all factors which detracted from, rather than intensified, concerns over infant mortality. Dyke’s assiduous collation of statistical data failed to evaluate the problem of infant mortality as it is now understood. Dyke was aware of infant mortality as part of the general problems he faced in Merthyr, but doubted how far it was preventable given the social and environmental conditions in the town. His theories of preventing public health problems were based on sound and enduring principles which were frustrated by administrative inefficiencies and people’s daily activities. Major advances in understanding the causes of infant mortality occurred in the late nineteenth and early twentieth centuries, represented by the infant welfare movement, after Dyke’s lengthy term of office was over. Dyke worked alone, without guidance or support in his role as MOH, until the appointment of a County Medical Officer in 1895. A fresh energy in understanding and addressing the problem of infant mortality emerged with his successors from 1900.

140

Plate 2.The South Wales Coalfield ( David Egan Coal Society, 1987., p.vi. )

141

Plate 3. Merthyr Tydfil’s Coalmines. (Merthyr Tydfil Public Library, Valley Views, 1997.)

142

Plate 4. View of Merthyr Tydfil n.d. c.1913. ( Merthyr Tydfil Library Photographic Collection 0085107)

143

Plate 5. Merthyr General View ( J. P. Lewis bookseller, 1913, Merthyr Tydfil Public Library Photographic Collection) 144

Plate 6. Sand Street Dowlais 1934/5 (Merthyr Tydfil Public Library Photographic Collection)

145

Plate 7 Merthyr Dowlais Town and Iron Works (Aerofilm 29879 B 26.9.1929 Merthyr Tydfil Public Library Photographic Collection )

146

Plate 8.

147

Plate 9. Dowlais Housing (W.F. Lestrange Wasted Lives , 1936, p.14. Merthyr Tydfil Library Collection )

148

Plate 10. Long- Tubed Feeding Bottle ( Chemist and Druggists Diary 1891. Courtesy of Susan Watts )

149

Plate 11. Feeding Bottle Patent 1860 Courtesy of Susan Watts.

150 Chapter 4

Causes of Infant Death in Merthyr Tydfil 1865-1908: Convulsions, Tuberculosis and Infectious Diseases

Introduction

Chapters 4, 5 and 6, analyse the attributed causes of death of over 17,000 infants enumerated in the Tables of Ages and Causes of Death at All Ages appended to the Annual Medical Officer of Health Reports for Merthyr Tydfil 1865 -1908. The chapters address the major factors influencing infant mortality. Dyke’s lengthy term of office until 1900 gives an inherent consistency to the data, but the period 1865-1908 also embraces the changing Edwardian perspectives on infant mortality revealed by Dyke’s successors. The chapters identify the social origins of infant mortality in this Welsh industrial community. Although divided for convenience, they cohere as an explanation of the causes of Merthyr’s high infant mortality rates. They demonstrate the interaction between public health measures and infant mortality over forty years and explain the analysis within a medical and social context. This chapter addresses the ill-defined causes of infant death wherein convulsions were the symptomatic cause of many deaths. Tuberculosis and infectious diseases are discussed as important public health concerns linked to overcrowded living conditions. Chapter 5 discusses lung diseases and diarrhoea as major influences on infant mortality rates and Chapter 6 discusses nutritional and maternal aspects of infant death. In 1905 the Local Government Board issued a standard table to be included in MOH reports showing causes and ages of death in weeks and months for all deaths under one year of age.1 The years 1905-1908 are the only ones in the series for which this information is provided. These deaths illustrate the effect of different causes of death on various age groups under one year. Endogenous infant mortality within a month of birth accounted for the intractable core of infant mortality regarded as non- preventable for most of the nineteenth century. It accounted for approximately one third of infant mortality in Merthyr by the Edwardian period, linked predominantly to

1 Thomas and Duncan, MOH Report for Merthyr Tydfil for the Year 1905, p.29. 151 antenatal causes.2 Exogenous mortality after the first month was more likely to be linked to social and environmental causes, and influenced by identifiable social, environmental, behavioural and policy changes which were likely to have the most impact on infant mortality. 3

The Causes of Infant Death in Merthyr Tydfil 1865-1908

Infant mortality rates showed marked annual and seasonal variations which in some years could be explained by sporadic, seasonal or cyclical, epidemic patterns. These did not conveniently arrange themselves to suit the statistician’s calendar. They often continued into the next statistical year, frequently overlaid or complicated by other infectious diseases, each impacting more, but not exclusively, on certain age groups than others. The autumn scarlet fever epidemic of 1863, for example, when measles and smallpox were also widespread, continued through the spring until Christmas 1864.4 It was followed by a very virulent form of typhus fever, absent since 1859, and during 1865 typhus, smallpox, measles and scarlet fever were epidemic in some part of the parish throughout the year. 5 Typhus and smallpox affected primarily the adult population. Most of the 239 deaths from scarlet fever and measles were children under five years of age; measles and whooping cough particularly affected babies. Dyke recognised a rise in lung disease deaths when whooping cough epidemics occurred. However, epidemics alone do not explain fluctuating infant mortality rates. No single factor adequately explains infant mortality in Merthyr. Multiple factors exerted their influence at any one time, adding to the dimensions of the historical problem and not all causes of death influenced infant mortality rates equally each year. Appendix. Tables 7, 7. (a) and 8 and Figures 6. and 7. show the differing mix and primacy of convulsions, lung diseases, diarrhoea, nutritional deaths, tuberculosis, and infectious diseases as the principal causes of death. Convulsions ceased to dominate by 1892, replaced by first lung diseases and diarrhoea, then by nutritional and antenatal causes. However, none of these causes individually explain infant mortality since all causes of death together contribute significantly to the infant mortality rate each year.

2 Ibid., p. 29., Williams, ‘Infant and Child Mortality in Urban Areas of Nineteenth-century England and Wales’, pp.19, 23-25. 3 Williams, ‘Infant and Child Mortality in Urban Areas of Nineteenth-century England and Wales’, pp. 23-24. 4 Dyke, MOH Report for Merthyr Tydfil for 1865, p.20. 5 Ibid., p.19. 152 300

250

Convulsions Tuberculosis Lung 200 Nutritional Maternal Diarrhoea 150 Sudden deaths Unclassified Infant mortality Community Diseases 100 Infectious Diseases Secondary Infections Dentition/ Teething

50

0

8 4 5 6 6 72 74 77 79 8 88 90 93 9 99 04 0 ear 8 8 Y 1866186718 1869187018711 187318 1875187618 187818 188018811882188318 18851886188718 188918 1891189218 189418 1896189718981 190019011902190319 190519 1907

Figure 6. All Causes of Infant Death in Merthyr Tydfil 1865-1908 as Disease Specific Infant Mortality Rates per 1000 Registered Births .

153

Seven Year Moving Average

100 100

90 90

80 80

70 70

60 60

50 Convulsions 50

40 40

Infant Mortality Rates Mortality Infant Nutritional 30 30 Lung 20 20 Infectious

10 Maternal 10 Tuberculosis Diarrhoea 0 0

8 0 3 8 3 8 3 6 8 1 3 6 866 871 876 881 884 886 889 891 894 899 904 Year 1 1867186 1869187 1 1872187 187418751 1877187 187918801 1882188 1 18851 1887188 1 18901 1892189 1 1895189 18971891 1900190 19021901 1905190 1907

Figure. 7. Seven Year Moving Average of Major Causes of Infant Death in Merthyr Tydfil 1865-1908.

154 and provide sufficient explanation for high infant mortality rates.6 From 1892 the sum of all other causes of death exceeds the rate of the principal primary cause of death. These broad trends are identified from the analysis of tables of ages and causes of death for Merthyr Tydfil 1865-1908. The inherent difficulties of working with nineteenth-century statistics discussed in the Introduction and in Chapter 3 are widely acknowledged. The classification and accuracy of causes of death need to be negotiated in any study of infant mortality. The apparent cause of death reported, although self-evident in many instances, cannot be assumed to accurately represent the cause of death. Nonetheless, some useful conclusions can be drawn from the analysis of this local source material. For the purpose of this study it has been necessary to acknowledge these difficulties whilst collating the data, and to re-assign where necessary the causes of death stated in the MOH reports to categories which reflected the social origins of infant death. In Merthyr, deaths from convulsions, which were a major influence on infant mortality rates, declined rapidly from 1895. Deaths reported to be from convulsions were essentially symptomatic so the exact cause of death cannot be accurately established. The evidence reviewed in this chapter suggests that convulsions were intrinsically linked with diarrhoea deaths, deaths of maternal origin and infectious diseases. As deaths from convulsions declined, so did their influence on infant mortality rates. 7 The most significant influence on the rising infant mortality rate in Merthyr from the 1880s was deaths reported to be from lung diseases, diarrhoea, and causes of maternal origin. Deaths attributed to lung diseases and diarrhoea increased dramatically, driving up infant mortality rates. Deaths of maternal origin also increased significantly whilst deaths from nutritional causes rose slightly before beginning to decline from 1901. Infant deaths attributed to tuberculosis tended to decline from 1870, but increased dramatically 1890-94 before resuming their decline in 1898. They exerted some influence on infant mortality rates until the late 1870s and particularly during the 1890s. Deaths from infectious diseases had some influence on infant mortality rates before 1875, but generally remained steady or declined slightly over the entire period. They were of little influence on the increasing infant mortality rates, which began to rise in the 1880s. The relationship of ill-defined causes of death to other causes of death is

6 Marmot and Morris, ‘The Social Environment’, in Holland et al., eds, The Oxford Textbook of Public Health Vol.1, p.116. 7 In a study of the cause of death in nineteenth-century Sweden, slag, a vague term of death similar in usage to convulsions, was replaced by gastrointestinal diseases in the causes of death by 1870-1875. Magdalena Bengtsson, ‘The Interpretation of Cause of Death Among Infants’, pp.64-66. http://www.ep.liu.se/ej/hygiea/ra/012/paperb.pdf 155 discussed in this chapter, which also examines infant deaths from tuberculosis and infectious diseases regarded as a major public health concern.

100 90 80

70 Tb 60 Measles Whooping Cough 50 Convulsions 40 Diarrhoea 30 Lung Diseases 20 10 0

r 9 3 1 5 6 7 97 0 0 ea 8 8 9 9 Y 1 18 1877 1881 1885 1889 1893 1 1 1

Figure 8. Infectious Diseases in Merthyr Tydfil 1865-1908.

. The IMR for England and Wales fell to and remains below 150 from 1902. That for Wales remained below 150 until 1886. It peaked at 174 in 1899, influenced by high rates in the growing industrial areas of south Wales and many infant deaths nationally that year. In Merthyr Tydfil between 1841 and 1853, prior to the effects of sanitary improvements, the highest rate of 238/1000 births occurred in the infamous cholera year of 1849. During the cholera epidemic of 1866 the IMR fell to 192 per 1000 births. The following year, it fell further to 147 /1000 births and to 138 /1000 in 1881. Thereafter, infant mortality rates rose dramatically between 1882 and 1901. (Appendix. Table 1., Fig. 4. Chapter I.) The highest IMR of 272 /1000 births in 1899 coincided with a national peak of 163 /1000 when infant deaths across the nation increased during a very long hot summer with many epidemic summer diarrhoea deaths. In 1901, Merthyr’s IMR of 262 /1000 was again well above that of the early cholera years and significantly higher than England and Wales, with 151 /1000. By 1908 it was still unacceptably high, at 175 /1000, despite over forty years of relentless pursuit of public health policies, compared with the national IMR which had fallen to 120 /1000.

156

Categories of Attributed Causes of Infant Death

For reference purposes the detailed analysis and annotated tables of numbers of deaths and disease specific infant mortality rates of over 17, 000 infant deaths in Merthyr Tydfil 1865-1908 are given in Appendix. Tables 7-19. The chapter summarises the salient points. For the purpose of uniformity all causes of death have been calculated as disease specific infant mortality rates, that is to say deaths per 1000 registered births for each cause of death in order to identify trends, patterns and changes, and to assess the impact of various factors contributing to infant deaths 1865- 1908. For the sake of accuracy, interest and perspective the number of infant deaths, or percentages, is given where useful. To analyse the causes of all deaths recorded 1865-1908 the following categories were selected: first, representing the causes of death that may be attributed to environmental factors external to the home: (1.1) water-borne diarrhoeal diseases, and (1.2) communicable (infectious) diseases; second, a group of categories relating to the internal home environment: (2.1) secondary and home-acquired infections, (2.2) lung diseases, (2.3) tubercular diseases, (2.4) nutritional disorders, (2.5) disorders of maternal origin (antenatal causes), (2.6) diarrhoea, (2.7) sudden and violent deaths; and finally (3) unclassifiable deaths. For details of the medical conditions in each category see Appendix. Table 7.

These categories served well enough for quantifying the number of deaths, but when it came to interpreting the causes in terms of the social origins of disease, the divisions were not so clear-cut. It became apparent that none of the causes of death within these classifications operated independently from each other and the causes of infant death were inextricably linked with their social environment. There was fluidity between the external community and the internal home environment, which public health measures could not control, and which was not reflected by the statistics. It was clearly important to understand the community to which these statistics related.8 Each infant life lost represented an individual set of social circumstances and people did not arrange their lives neatly in order to suit the requirements of statistics or social inquiry. The moveable and permeable boundaries between internal and external home

8 Newland, Infant Mortality and the Health of Societies, p. 6. 157 environments are explored as the chapters move between these boundaries as necessary to understand the causes of infant death in the community. Sanitation and water supply were expected to reduce diseases of filth, in particular cholera, enteric fever, typhoid and choleraic diarrhoea as water-borne diseases. Such deaths accounted for less than 1% of infant deaths. Apart from the year 1866, which included 11 cholera deaths, the incidence of death from continued, enteric or typhoid fever was very low among infants. (Appendix. Table 16.) A total of 25 infant deaths were attributed to these causes 1865-1908, statistically very small. Either infants were protected by breastfeeding or deaths were attributed to other causes. Deaths from convulsions were the most numerous, but their presence exerted a declining influence on infant mortality rates by the 1890s. Originally classified as a disease of the nervous system, this symptomatic cause of death is extremely problematic for historians to interpret. Convulsions are frequently a sign of impending death and an expression of some other cause of death and are therefore difficult to evaluate. Some evidence is put forward in this chapter that convulsions and diarrhoea deaths were linked. Deaths from convulsions (3,509) accounted for 34% of infant deaths 1866-9, falling to 14% of infant deaths 1905-8, 20% of those occurring within the first month. This suggests the improved reporting of cause of death and possible transference from one category to another.9 Diarrhoea deaths (2,052), including gastric catarrh, gastroenteritis, diarrhoea, and choleraic diarrhoea, rose substantially from under 5% 1865-9 to 19.33% 1905-8, deaths possibly formerly reported as due to convulsions. (Appendix. Table 15.) Dentition and teething (430 deaths) were ill-defined and poorly understood causes of infant death, originally classified as diseases of the digestive organs under which classification were also included diarrhoeal deaths. Dentition and teething, which accounted for only 2.0% of deaths overall, varied from a low imr of 1.21 /1000 births in 1878 to a high in 1898 of 11.62 deaths / 1000. All forms of tuberculosis(1258 deaths) and other constitutional diseases declined dramatically from 14% of infant deaths 1866-9, to 2% by 1905-8 despite a rise 1890-98. (Appendix. Table 11(b).) Infectious diseases (1474 deaths) declined slightly, accounting for 9% of deaths 1868-9 and just under 8% 1905-8. Statistically these deaths, contrary to expectations, do not drive infant mortality in Merthyr. They are nonetheless important historically and form a substantial part of this chapter. Infants were unavoidably

9 Bengtsson, ‘The Interpretation of Cause of Death Among infants’, pp. 64.-66.

158 exposed to infectious diseases, in the community, frequently brought into the home by other family members or visitors, particularly school age children. Of these whooping cough and measles were the most deadly for infants. (Appendix. Tables 11-11(g).) Syphilitic deaths, listed with infectious diseases in the tables of causes of death, were analysed with causes of death reflecting maternal origin. (Appendix. Tables 17-17(a).). Secondary infections (111 deaths), mainly localised skin conditions, including the highly infectious erysipelas, were surprisingly few despite poor living conditions. One death occurred from infection following vaccination in 1890. (Appendix. Table 12.) The increase in lung disease deaths (3057) from 13.7% of deaths 1865-9 to 20.2% 1905-8, discussed in Chapter 5, may also be accounted for to some extent by transference due to more accurate reporting of death previously reported simply as convulsions. (Appendix. Table 14-14 (c ).). Nutritional causes of death (2706) increased slightly, from just under14% to just over 15% of deaths by 1905-8. (Appendix. Tables 18-18(a).) Deaths of maternal origin and antenatal causes increased dramatically from 4.3% overall to 17% by 1905-8, also possibly due to deaths formerly assigned to convulsions and more accurately assigned to this classification. Sudden and Violent Deaths (180) formed a consistently small part of overall mortality rates with little change in the number of deaths, typically less than 3 / 1000 births. The years 1876 and 1897 show a rise above 4 deaths /1000, and the highest rate of 6.32 /1000 was recorded in 1895. Of the total sudden or violent infant deaths 1865- 1908, 60 were certified as overlying and 18 as suffocation.10 The remaining causes were burns, scalds, drowning, or natural causes. (Appendix. Table 10.)

The portion of unclassifiable deaths was approximately 2% for most years, but 6.3 % of deaths were unclassifiable in 1866. In total 574 deaths were impossible to classify 1901-1908. Two exceptional years were 1901, when 340 deaths (48%) and 1902, when 201 deaths (39%) were unclassifiable, recorded as “All Other Causes.” (Appendix. Table 7 (d).) Table 4.1. gives the example of the years 1905-8 when 42 % of unclassified deaths occurred within the first month.11

10 Dyke, MOH Report for Merthyr Tydfil for 1867, p.14. 11 Inquests were held into some deaths but the records are unavailable. Naomi Williams found that most under registration in her study (missing burial records) occurred amongst neonates. Williams, ‘Infant and Child Mortality in Urban Areas of Nineteenth-century England and Wales’, p.80. 159 Table 4.1. Number of Infant Deaths Under One Year of Age from Other Causes in Merthyr Tydfil 1905-1908. (MOH Reports for Merthyr Tydfil 1905-1908.) Other Causes Age 1905 1906 1907 1908 Total Under 1 wk 8 2 1 11 1-2 wks 4 3 1 8 2-3 wks 1 1 1 4 7 3-4 wks 3 3 6 Total under 1 13 7 4 8 32 month 1-2 months 1 5 4 1 11 2-3 months 1 1 3-4 months 1 1 1 2 5 4-5 months 1 1 2 4 5-6 months 1 1 2 4 6-7 months 2 1 3 6 7-8 months 1 1 8-9 months 1 1 9-10 months 1 1 10-11 months 1 1 1 3 11-12 months 4 1 2 7 Total under 1 yr 27 15 18 16 76

Table 4.2. Number of Infant Deaths in Each Category in Merthyr Tydfil 1865-1908 and Changing Contribution to Infant Mortality (MOH Reports for Merthyr Tydfil 1865-1908.) Category of infant death Number of deaths %Total % of infant deaths Deaths 1866-9 1905-8 Convulsions 3 341 19.4 33.85 14

Lung diseases 3 055 17.7 13.70 20.20

Nutritional 2 659 15.4 13.78 15.23 Diarrhoeal 1 954 11.3 4.59 19.33 Maternal 1 594 9.2 4.30 17.02 Infectious diseases 1 476 8.6 9.03 7.74 Tuberculosis 1 231 7.1 13.85 1.95 Unclassified deaths 636 3.7 2.22 3.74 Dentition and teething 408 2.4 2.0 Sudden and violent deaths 178 1.03 1.19 0.66 Secondary infections 87 0.5 0.66 External diarrhoeal 20 0.1 0.81

Table 4.2. summarises the number of deaths from each category and compares the percentage of deaths in each category for the early years 1866-9 and 1905-8 at the end of the period.

Causes of Death by Weeks and Months in Merthyr Tydfil, 1905-1908

Endogenous infant mortality within the first month formed a consistent and well-recognised proportion of infant mortality during the nineteenth century. Weakly 160 babies dying within a week of birth were likely to be born prematurely, or have congenital disorders. Deaths within the first month, approximately one-third of all infant deaths, generally continued this process. Such deaths are a good indication of the physical and social health of mothers. Table 4. 3. shows these patterns as percentages of infant mortality with deaths in the first month accounting for 19% of death, half of those due to causes of maternal origin. Most causes of death are represented in most age groups to a greater or lesser degree.

Table 4. 3. Summary of Ages and Causes of Death as Percentages of Total Infant Deaths in Merthyr Tydfil 1905-8. (MOH Reports for Merthyr Tydfil 1905-8.) Age at death % Total infant Deaths 1905-8 Infectiours Diseases Convuls-ions Tuberculosis Lung Diseases Nutritional Maternal Diarrhoeal Suffocation/ Overlying Other Causes Under 1 wk 1.84 0.15 1.69 11.43 0.20 0.56 15.87 Total Under 1 month 0.20 5.43 0.05 1.02 4.87 14.61 1.43 0.25 1.48 29.34 % of infant mortality

1-3 months 0.30 4.10 0.35 3.64 4.0 1.38 3.89 0.20 0.61 18.47 3-6 months 1.38 2.56 0.51 4.97 3.89 0.5 7.48 0.10 0.66 22.05 6-9 months 3.07 1.02 0.56 5.64 1.74 0.20 3.74 0.41 16.38 9-12 months 2.76 0.97 0.46 4.92 0.71 0.30 2.76 0.05 0.56 13.49

Total Deaths 1-12 7.51 8.65 1.88 19.17 10.34 2.38 17.87 0.35 2.24 70.39 months % infant mortality

Total under 1 yr % 7.71 14.08 1.93 20.19 15.21 16.99 19.30 0.60 3.72 99.73 of infant mortality

Table 4. 4. Summary of Numbers, Ages and Causes of Death Infant Deaths in Merthyr Tydfil 1905-8. (MOH Reports for Merthyr Tydfil 1905-8.) Age Total Infectiours Diseases Convuls-ions Tuberculosis Lung Diseases Nutritional Maternal Diarrhoeal Suffocation/ Overlying Other Causes Under 1 wk 36 3 33 223 4 11 310 Total Under 1 month 4 106 1 20 95 285 28 5 29 573

1-3 months 6 80 7 71 78 27 76 4 12 361 3-6 months 27 50 10 97 76 10 146 2 13 431 6-9 months 60 20 11 110 34 4 73 8 320 9-12 months 54 19 9 96 14 6 54 1 11 264

Total Deaths 1-12 months 147 169 37 374 202 47 349 7 44 1380

Total under 1 yr 151 275 38 394 297 332 377 12 73 1950

161 Table 4. 5. Hierarchy of Causes of Death and Number of Deaths as Percentages of Deaths at Various Stages of First year of Life in Merthyr Tydfil 1905-1908. (MOH Reports for Merthyr Tydfil, 1905-8.) Cause of death Number of deaths % of Total Infant Deaths in 1st Week Deaths in 1st Month deaths as % Total Deaths as % Total Deaths Lung disease 394 20.19% 0.15 1.02 Diarrhoea 377 19.30% 1.43 Maternal 332 16.99% 11.43 14.61 Nutritional 297 15.21% 1.69 4.87 Convulsions 275 14.08% 1.84 5.43 Infectious disease 151 7.71% 0.20 Other causes 73 3.72% 0.56 1.48

Tuberculosis 38 1.93% 0.05 Suffocation/Overlying 12 0.60% 0.20 0.25 Total 1949 99.73 15.87 29.34

Exogenous deaths after the first month begin to reflect conditions acquired within the home and social environment as immunity conferred by breastfeeding declined.12 (Table 4. 4., Appendix. Table 7 (c).) Historiographically, women’s work, maternal health, infant welfare, infant feeding practices, the training of midwives, are particularly relevant to infant deaths in the first month. 13 Woods et al argue that exogenous causes of infant mortality were those considered preventable and could potentially be reduced, especially diarrhoea which commonly occurred in later infancy, and could therefore be evaluated against discernible influences such as policy changes and practical measures such as milk schemes and street cleansing. 14 The distinctions between endogenous and exogenous causes of death are important, but somewhat artificial, in that infant deaths did not fall neatly into these classifications. This study shows particularly that deaths from convulsions and nutritional causes bridged the two periods. Dr. Dyke was very familiar with the fact that many infants died within a short time of birth and within the first month, many of convulsions, atrophy or debility. There was little change in the 15-16% of infants dying in the first week between 1866 and 1908.15 Table 4. 5. and Appendix Table 7.( c ).show the varying contribution of age at death and cause of death which made up infant mortality each year 1905-8. Table 4. 5. shows the numerical hierarchy and percentage of infant deaths from each attributed cause 1905-8. The main causes of death affecting different age groups are summarised in Table 4. 6.

12 Williams, ‘Infant and Child Mortality in Urban Areas of Nineteenth-century England and Wales’, pp. 20-21. 13 Ibid., pp.23-29, 14 Ibid., pp.20-21. 15 Dyke, MOH Report for Merthyr Tydfil 1866, Table XXV1, p. 83. 162

Table 4. 6 . Ages at Which Causes of Death Peak in Merthyr Tydfil 1905-1908 (MOH Reports for Merthyr Tydfil 1905-8.) Age Cause of Death Under 1 Week Maternal Under I Month Maternal/ Nutritional/Convulsions 1-2 Months Convulsions/Nutritional 3- 4 Months Diarrhoea 6-8 Months Lung Diseases 10-11 Months Tuberculosis

Endogenous deaths accounted for 15.85 % of total deaths within a week of birth and 29.81 % within the first month 1905-8, plus deaths attributed to nutritional causes and convulsions. The causes of death which affected very young infants were prematurity, debility and marasmus, convulsions, suffocation and overlying, most associated with antenatal causes and forming a fairly consistent pattern 1905-1908 (Table 4. 6.) A third of deaths from suffocation and overlying occurred within the first week of life, and another third within the first month, all under 4 months old. Over one- third of deaths from other causes also occurred under one month of age, a third of those in the first week. Approximately a third of deaths from nutritional and developmental problems occurred within the first month of life, a third of these in the first week. The nutritional problems of weak premature infants in the form of atrophy, debility and marasmus continued until the seventh or eighth month, linking the endogenous and exogenous periods and reflecting both poor maternal health and a poor social environment. The remainder of nutritional and developmental deaths occurred up to seven months of age, decreasing in number as the infants approached one year of age. Deaths from convulsions also continued into the seventh month, being a symptom of impending death due to other underlying causes. Lung diseases, diarrhoea, nutritional deaths, convulsions and infectious diseases, and tuberculosis were the principal causes of death for older infants. Bronchitis and pneumonia were common symptoms of most infant ailments and were also a response to environmental conditions, particularly overcrowding. The threat of diarrhoea increased with weaning, again reflecting the home environment. Deaths from infectious diseases increased from about 6 months as maternally acquired immunity receded and infants were exposed to infectious diseases. Tuberculosis deaths had dramatically decreased by 1905-1908 and peaked at 10- 11months, acquired in the social environment.

163

Ill-Defined Causes of Death; Debility, Dentition, Teething and Convulsions,

Table 4. 7. Deaths of Infants Under One Year of Age from Suffocation/Overlying in Merthyr Tydfil 1905-8 (MOH Reports for Merthyr Tydfil 1905-8.) Suffocation/ Overlying Age 1905 1906 1907 1908 Total Under 1 wk 1 1 2 4 1-2 wks 2-3 wks 1 1 3-4 wks Total under 1 2 1 2 5 month 1-2 months 1 2 1 4 2-3 months 1 1 3-4 months 1 1 2 10-11 months 1 1 11-12 months Total under 1 4 3 4 2 13 yr

Four of the total of 13 deaths due to suffocation or overlying 1905-8 occurred in the first week of life and five in the first month. (Table 4. 7.) It is simply not possible to say what caused these deaths. Such deaths were scrutinised more closely from 1874 with the compulsory notification of deaths and the increasing use of forensic science to determine the cause of death. This category of death has given rise to much speculation about the level of infanticide in the community, but there is little conclusive evidence in this regard. With crowded living conditions, large families and irregular working hours, beds were occupied day and night. Homes were fraught with dangers and it was difficult to supervise babies frequently left in the care of older children. Recent research in to environmental causes of sudden infant death includes the effects of pollutants leading to upper airway obstruction and suffocation. The lack of adequate ventilation was a major and well-documented problem of overcrowded dwellings, where babies commonly slept with their mothers. 16 In 1890, 3 infants suffocated from overlying as they slept with their mothers.17 Environmental pollution was very evident where homes huddled chaotically together beneath the pall of smoke and industrial fumes from the ironworks and collieries. It is clear from photographs that industrial smog enveloped the houses in close proximity to the ironworks. (Plate 7.).18 In 1869 Dyke, as Certifying Surgeon of

16 John Andrew Corbyn, and Pamela Matthews., Environmental Causes of Sudden Infant Death, Western Technical Press, Fremantle, Western Australia, 1992., pp.54-55. 17 Dyke, MOH Report for Merthyr Tyfdil for 1890., p.8. 18 Dyke, MOH Report for Merthyr Tyfdil for 1879., p.20. 164 Factories, described poisonous gas fumes sometimes escaping from the blast furnaces.19 In 1868, 15 deaths due to “causes not assigned” included such vague terms as “Abscess,” “Tumour,” and “Natural Causes”.20 Dyke called upon the Coroner to remedy this. :

Lastly I must say that to such vague terms as “Natural Causes,” “Visitation of God,” but five deaths have been set down. The number is now so few that I am induced to think that a very slight degree of will on the part of the Coroner and his Deputy may enable those who have to chronicle the results of Disease to omit this unfit heading from this catalogue.21

Such terms were still in use in 1874.22 “Natural causes” were returned as the cause of death of 8 infants under one year old in 1875 after enquiry by Coroner’s Juries,23 and in 1872 the deaths of 6 children were from “Causes Not Specified.”24 In 1886, debility was recorded as the cause of death of 69 infants under one year, “in a very large number of cases, these little ones perished within the first day after birth.” 25 In 1877, 65 babies died from debility within I day to 3 months, and 79 from convulsions, making a total of 144 deaths registered under categories which give no clear indication of the causes of death. They do however, indicate the condition in which the infant died. Dyke believed that medical attendants should assign the cause of death more accurately. 26 A further 67 infants died from “Debility” in 1890, and Dyke commented “It would be well if some more accurate descriptions were given:” 27 Little changed and in 1891, 79 deaths from ill-defined causes included a large number of babies only a day old assigned again to debility, and a further 70 deaths in 1895. All deaths due to “atrophy and debility” were classified as “developmental disorders”, rather than as prematurity. They have therefore been categorised for analysis as nutritional causes of death since they suggest poor growth and development, and are discussed further in Chapter 6. Teething and dentition were inadequately explained causes of death which reflected symptoms rather than underlying causes. Teething was frequently associated with fever, fretfulness, convulsions and diarrhoea in babies who had survived early infancy and were not suffering from any other identifiable cause of death. Most cases

19 Dyke, MOH Report for Merthyr Tyfdil for 1869., p.14. 20 Dyke, MOH Report for Merthyr Tyfdil for 1868., p.9. 21 Dyke, MOH Report for Merthyr Tyfdil for 1869, p.14. 22 Dyke, MOH Report for Merthyr Tyfdil for 1874., p.12. 23 Dyke, MOH Report for Merthyr Tyfdil for 1875., p. 7. 24 Dyke, MOH Report for Merthyr Tyfdil for 1872., p. 4. 25 Dyke, MOH Report for Merthyr Tyfdil for 1886., p. 8. 26 Dyke, MOH Report for Merthyr Tyfdil for 1887., p. 8. 27 Dyke, MOH Report for Merthyr Tyfdil for 1890., p.8. 165 occurred around seven months of age when weaning and dietary change occurred as well as teething. 28 In 1867 Dyke linked teething with convulsions :

I cannot fail to connect the occurrence of the disease [ convulsions]with its usual cause:- teething and must say, from my own experience of more than five and thirty years, that I believe many scores of lives of children might annually be saved by a timely division, with a sharp lancet, of the tense and inflamed gum over the growing tooth. 29

Again in 1879 Dyke stated that

in very many instances, the first exciting cause is the irritation set up by cutting teeth; many a mother would be spared the terrible suffering of parting with her child, if she would in due time apply to the medical man to have the gum over the growing tooth divided. 30

Lancing was a popular practice which carried a grave risk of haemorrhage or infection; it declined with new generations of medical practitioners.31 In 1876 Dyke also suggested “more judicious nursing, earlier attention to the growth of the teeth, and a still greater facility than is even now possessed of obtaining professional aid.”32 However, parents could not be compelled to cooperate with such measures, and needed to be educated in the care of teething and sick babies.33 In 1888 Dyke stated that 86 deaths were assigned to convulsions but “to this number should be added 16 fatalities due to “Dentition,” accompanied by convulsions, so that the total deaths due to convulsions would be 102, one-twelfth of all deaths.”34 Belief continued in teething as a cause of infant death, but without adequate explanation, despite continual commentary on the inadequacy of such a term in accounting for the death of a distressed infant. 35 From 1906 “dentition and teething” does not appear as a cause of death in the annual reports, presumably assigned to “Other Causes”. Dyke recognised the need for more precise causes of death in 1869: “it is, I think gratifying that a more reasonable cause is now found to designate these deaths of very young children.” 36 In 1873 Dyke again expressed his frustration at the use of this term

28 Smith, The People’s Health, p.103. 29 Dyke, MOH Report for Merthyr Tyfdil for 1867., p.13. 30 Dyke, MOH Report for Merthyr Tyfdil for 1879., p.6. 31 Smith, The People’s Health, pp.103-4., J. Smith, M.D.,(Dentist),‘On the Peculiarities of Dentition in Man, and its Influence on Infantile Mortality, Monthly Journal of Medicine , June 1855, pp.4-10. 32 Dyk., MOH Report for Merthyr Tydfil for 1876., pp. 6-7. 33 Ibid. 34 Dyke. MOH Report for Merthyr Tydfil for 1888, p.5. 35 Smith, ‘On the Peculiarities of Dentition in Man’. 36 Dyke, MOH Report for Merthyr Tydfil for 1869, p.13. 166 and urged the origin of the diseases to be stated. 37 In 1867, Dyke described the increase in deaths from convulsions as “an increase proportional to the increase in the population” implying that he anticipated a consistent proportion of such deaths.38 In 1868, 46 or almost half of 108 such deaths were under one month old, but 33 of the deaths were “not certified.” In Dyke’s opinion these deaths should have been ascribed to “Debility” in such young infants.39 “The convulsive movements rarely come on until a short time before death: - a want of vital power being generally the condition of the infant from its birth.” 40 Infants were weak at birth and general debility or feebleness preceded convulsions. Dyke linked deaths from infectious diseases with febrile convulsions, observing that deaths from convulsions fell during epidemics when zymotic disease was recorded as the cause of death, but also when disease was absent. In 1870 fewer convulsions deaths than usual occurred when scarlet fever claimed the lives of many who “might otherwise have fallen victim to Convulsions, the result of dentition etc.” 41 In 1871 the number of deaths from convulsions was reduced by one-third, probably due to “the absence of widespread contagious maladies.”42 According to Dyke infants also experienced convulsions before the characteristic symptoms of scarlet fever, measles or whooping cough appeared. 43 As the major attributed cause of death throughout the nineteenth century, the extent to which convulsions was linked to other causes of death is poorly understood. The term simply described a symptom of many possible underlying causes of death, but contemporary views linked convulsions variously with feeble infants, teething, infectious diseases, poor feeding habits and diarrhoea deaths. The causes of convulsions were difficult to determine. In August 1899 “A Discussion on Convulsions in Infancy,” published in the British Medical Journal, considered many factors associated with convulsions; their underlying causes, the imperfect state of medical knowledge and treatment, the inaccuracy of statistics, and the extremely important social dimension. 44 Hypoxia, due to respiratory problems, prematurity, congenital defects, infections,

37 Dyke, MOH Report for Merthyr Tydfil for 1873, pp.9-10. 38 Dyke, MOH Report for Merthyr Tydfil for 1867., p.13. 39 Dyke, MOH Report for Merthyr Tydfil for 1868, p.8. 40 Dyke, MOH Report for Merthyr Tydfil for 1869, p.9. 41 Dyke., MOH Report for Merthyr Tydfil for 1870, p.20. 42 Dyke., MOH Report for Merthyr Tydfil for 1871., p.8. 43 Ibid., p.9. 44 A.M. Gassage, M.B.Oxon, M.R.C.P. Assistant Physician, Westminster Hospital, and East London Hospital for Children and J.A.Coutts, M.B.Cantab., F.R.C.P., Physician, East London Hospital for Children, “A Discussion on Convulsions in Infancy “, the British Medical Journal, 19 August, 1899, pp.460-463. 167 malnutrition, incorrect feeding and hereditary factors could all be linked to convulsions which occurred under a great variety of conditions in infancy, their prevalence believed to be “exaggerated” by lay people.45 “Many dying infants, too, if not most, suffer from convulsive movements of the limbs just before or at the point of death.” They were “merely a mode of dying.” 46 It was generally agreed that convulsions originated from irritability of the incompletely developed infantile nervous system, a predisposition which increased in premature and frail infants and diminished with age and maturity. 47 Disturbance of respiratory function was considered the most common factor. Pulmonary collapse was invariably found at post mortem in infants no matter the cause of death, “a consideration not yet appreciated by the profession.” Convulsions due to hypoxia rather than fever were common during the course of pneumonia. Post mortem the brain tissue was always found to be “enfeebled,” either the result or the cause of the convulsions. 48 The cause of convulsions due to teething was generally believed to be peripheral nerve irritation but this was unusual. 49 In newborn infants, especially those born prematurely or with an immature nervous system, convulsions are easily induced by hypoxia. Congenital cerebral defects were a possible cause of convulsions and congenital syphilis in infants. 50 Acute febrile convulsions due to bacterial infection were more common in later infancy. 51 Convulsions might also occur with dehydration and electrolyte imbalance, especially accompanying diarrhoea. Many infants dying from the effects of diarrhoea convulsed at the point of death. 52 Epidemiologically, deaths from convulsions fell steadily from 24,700 in 1878 to 18,384 in 1897 in England and Wales despite an increasing population. Statistically, the number of deaths from convulsions bore remarkable similarity to the number of deaths from digestive disorders, notably diarrhoea, atrophy and debility. 53 In London, mortality rates from diarrhoea, enteritis, atrophy, want of breast milk, jaundice, tabes,

45 Waldo E. Nelson, Victor.C.Vaughan, R.James McKay., Textbook of Paediatrics, Ninth Edition, W.B. Saunders Company, Philadelphia, 1969., p. 1250. 46 Dr. Hughling Jackson in Gassage and Coutts, “A Discussion on Convulsions in Infancy “, p.460. 47 Gassage, and Coutts, “A Discussion on Convulsions in Infancy”, p.461. 48 Ibid. 49 Ibid. 50 Ibid., p.462. 51 Nelson et al., Textbook of Paediatrics, pp. 1247, 1258. Tetany was reputed to be the cause of high infant mortality on the Scottish island of St Kilda where traditional practices persisted of anointing the umbilical cord with cow dung. The infants faded away in an enfeebled state over a week. Umbilical cord infections leading to tetany cannot be ruled out in some instances in nineteenth-century Merthyr. Tom Steel, The Life and Death of St Kilda , The National Trust for Scotland, 1965, pp. 108-111. 52 Gassage, and Coutts, “A Discussion on Convulsions in Infancy”, p.464. 53 Hugh R. Jones, M.A., M.D., D.P.H., B.Sc., Demonstrator of Bacteriology, University College, Liverpool, in Gassage, and Coutts, “A Discussion on Convulsions in Infancy”, p.462. 168 thrush, and dysentery, suggested that deaths from convulsions ought to be ascribed to disorders of the digestive system. The transference of deaths from one cause of death to another was believed to account for a fall in deaths from convulsions and an increase in deaths from prematurity 1897-9 possibly because of more accurate diagnosis of diseases of the central nervous system. 54 A similar process appears to have occurred in Merthyr as the trend for deaths from convulsions fell and the trend for deaths from diarrhoea and causes of maternal origin increased. Convulsions were also believed to be due to unsuitable food and malnutrition. The association of convulsions, digestive disturbances, and improper feeding is most important. A possible transference between some recorded causes of death cannot be ruled out with implications for our understanding of the factors driving infant mortality in nineteenth-century Britain. Diarrhoea deaths rose as bottle feeding increased. The preparation of artificial milk feeds under unhygienic conditions was dangerous, but hypernatraemia caused by the wrong composition of infant food was equally so. 55 Cow’s milk contains high levels of sodium and phosphorus and, made up in the wrong concentrations, especially in powdered form, causes dehydration, distorting sodium and potassium concentrations in the infant’s blood. The baby, crying with thirst, is fed more milk by the mother who thinks the baby is hungry. High phosphate levels in cow’s milk may also lower calcium levels, causing convulsions. Low magnesium levels can occur in underfed babies or those with vomiting and diarrhoea, also causing convulsions. Rickets, caused by Vitamin D deficiency, and neurological defects in the baby caused by deficiencies in the maternal diet are also part of this picture. 56 A large proportion of infants with convulsions were found to be rachitic, rickets perhaps indicating malnourishment of the brain.57 The confusion around convulsions as a cause of infant death was increased by the complexity of medical statistics and social factors: Dr. Farr found that deaths from convulsions gave insight into the social condition of the people when he linked convulsions variously with the ignorance of mothers, the proportion of women employed in industry, the number of under-age marriages and the condition of the town

54 Ibid., p.463. 55Ibid., p.463. 56 Nelson et al, Textbook of Paediatrics, pp.1260-1., D.G.Vulliamy, The Newborn Child , Fourth Edition, Churchill Livingstone, Edinburgh, 1977., pp.131-2., Margaret F. Myles, Textbook for Midwives with Modern Concepts of Obstetric and Neonatal care, Ninth Edition, Churchill Livingstone, Edinburgh, 1981, pp.540-541., Pamela A. Davies, R.J. Robinson. J. W. Scopes, J.P.M.Tizard and J.S.Wigglesworth, Medical Care of Newborn Babies, Spastics international Medical Publications, London, 1972., p.189. 57 Gassage, and Coutts, “A Discussion on Convulsions in Infancy”, p.461. 169 in respect to overcrowding, sanitation etc. 58 Farr succinctly summarised the problem we still face:

convulsions must be regarded as causally related to digestive disorders or other organic disease, and, indirectly also to social conditions tending to produce disease. It is important to reduce the complexity of medical statistics, which are more than usually intricate, because they involve very frequently more than one factor. It is desirable to reduce to a minimum the obstacles which tend to prevent the recognition of the ultimate origin of disease, for progress in the improvement of public health is retarded through want of accurate knowledge.59

Table 4.8. Deaths of Infants Under One Year of Age by Weeks and Months in Merthyr Tydfil 1905-1908 from Convulsions (MOH Reports for Merthyr Tydfil 1905- 8) Convulsions Age 1905 1906 1907 1908 Total Under 1 wk 12 11 6 7 36 1-2 wks 4 4 2 4 14 2-3 wks 3 8 8 4 23 3-4 wks 18 3 5 7 33 Total under 1 37 26 21 22 106 month 1-2 months 11 9 14 9 43 2-3 months 9 8 7 13 37 3-4 months 3 7 6 8 24 4-5 months 1 6 4 2 13 5-6 months 6 2 1 4 13 6-7 months 3 4 1 3 11 7-8 months 4 4 8-9 months 2 2 1 5 9-10 months 1 4 5 10-11 months 1 1 1 3 11-12 months 2 1 3 5 11 Total under 1 76 65 58 76 275 yr

Death rates from convulsions in Merthyr were lowest in 1903 during a very cool summer with a low rate, at 19.6 / 1000 births. The highest rate of 64 /1000 was recorded in 1880, when deaths from “Inflammation of the Brain” and from “Convulsions” exceeded the average. 60 From 1905 to 1908, approximately one-third of deaths from convulsions occurred in the first month of life, a third of these within the first week, almost certainly associated with prematurity, hypoglycaemia, hypoxia or congenital abnormalities. (Table 4. 8.)

58 Ibid., p.464. 59 Ibid., p.463. 60 Dyke, MOH Report for Merthyr Tydfil for 1880., p.6. 170 It seems reasonable, from the example of 1905-1908, and from Dyke’s frequent references to the loss of life due to convulsions during the early days and weeks of life, to assume that at least a third of all deaths from convulsions 1865-1908 can be linked to deaths within the first month. 61 The remaining two-thirds of infant deaths from convulsions may reasonably be associated with diarrhoea, lung diseases or febrile conditions. The decreasing trend of deaths from convulsions from 1892 meant that they no longer drove the infant mortality rates upwards and an increase in deaths from nutritional causes, deaths of maternal origin and lung diseases suggest more accurate reporting of causes of death. Lung diseases, diarrhoea, nutritional causes of death and infectious diseases formed the greater part of infant mortality associated with adverse social circumstances, poor diet and overcrowded and insanitary living conditions. Appendix. Table 8., shows the principal causes of death each year and the way they varied from year to year.

Infant Mortality and Infectious Diseases in Merthyr Tydfil 1865-1908.

As MOH for Merthyr Dyke believed that many deaths from infectious diseases could be prevented or averted through the application of public health provisions and principles to which he was wholeheartedly committed. As major public health concerns, and a risk factor for young infants, this section of the chapter focuses primarily on tuberculosis, whooping cough and measles. The contemporary evidence of the medical officers of health, familiar with these diseases, indicates that epidemics could rampage virtually unchecked through a community. Their responsibility was to minimise the impact of any epidemic, but in this they were hampered by the everyday activities of people regardless of epidemics. Dyke’s primary concern was the prevention of infectious diseases, believing them to be spread by damp dwellings, overcrowding and through school attendance. According to Dyke, deaths from lung diseases increased during infectious disease epidemics as a secondary cause of death.62 By themselves, deaths attributed to tuberculosis and infectious diseases accounted for a relatively small proportion of deaths in Merthyr 1865-1908, intrinsically insufficient to be a driving force in high infant mortality rates. Historically, despite the best efforts at prevention, epidemics run their course, perhaps moderating their form and disappearing, if only temporarily.

61 Vulliamy, The Newborn Child, pp. 131-2. 62 Dyke, MOH Report for Merthyr Tydfil for 1878, p. 5. 171

Table 4. 9. Summary of Peak Years and Sequence of Decline of All Forms of Infectious Diseases in Infants Under One year in Merthyr Tydfil 1865-1908 (see Appendix Table 22. ) Year Whooping Meningitis, Scarlet Measles Tuberculosis Diphtheria & Cough Cephalitis etc. Fever Croup etc. 1870 28.15 1873 5.70 1874 5.46 1885 19.37 1892 38.5 1896 7.28 1905 15.30 1907 0.37 1908 11.37 1.10 2.20 5.85 0.73

The infants of Merthyr Tydfil, like any other community, were exposed to a wide range of infectious diseases. The infant death rate from infectious diseases varied each year depending on epidemics present in the community. There was also a belief that infectious diseases were inevitable in childhood, and it was best to expose children to the disease “and get it over with”. 63 Infants were exposed to diseases brought into the home by family, siblings and visitors. Infection was spread either by air-borne droplet infection or by contact, viral or bacterial in origin, the likelihood increased by unhealthy overcrowded living conditions. Those most deadly to babies were mesenteric tuberculosis, measles and whooping cough, none of which were notifiable diseases. Breastfeeding, which has recently been shown to stimulate an active protective response, transferred some immunity to the baby. 64 Infectious diseases occurred mainly in older babies and young children as they were weaned and immunity declined. The presence of any conditions which undermined the infant’s health substantially increased the risk to infants from infectious diseases or secondary infections. There was little protection against most infectious diseases except isolating infected cases, minimising exposure of non-infected persons, disinfecting dwellings and belongings, and maintaining a clean environment. Vaccination against smallpox was an effective measure and the prompt administration of the diphtheria antitoxin from the end of the nineteenth century helped minimise diphtheria deaths.

63 Thomas and Duncan, MOH Report for Merthyr Tydfil for 1905., pp.14-15 64 Dr. Ginni Mansberg, ‘Breast milk has secret antibiotic ingredient’, Medical Observer, 15 September, 2002, p.2. 172 Table 4. 10. Modes of Spread of Infectious Diseases and Number of Deaths in Merthyr Tydfil 1865-1908 (MOH Reports for Merthyr Tydfil 1865-1908.) Airborne (Droplet Infection) Contact (Touch, Clothing, Bedding Housedust, Skinflakes) Whooping Cough 595 Scarlet fever 115 Measles 425 Erysipelas 46 Scarlet Fever 115 Smallpox 41 Meningitis (all forms) 145 Chickenpox 3 Pulmonary Tuberculosis 18 (205) Diphtheria and Croup , Laryngitis , Tonsillitis 144 Influenza 3 (1445)

Milk Tabes Mesenterica 1027 Scarlet fever 115 Diphtheria 68 (1210)

Thomas McKeown argues that the decline in deaths from infectious diseases, which began during the nineteenth century before widespread immunisation became common well into the twentieth century, was due to an improvement in the standard of living and nutrition, and a natural process of increasing host resistance to organisms and declining virulence of the disease. The decline identified was among the 3-34 year old age group with no improvement in infant mortality. The diseases which declined were smallpox, measles, scarlet fever, diphtheria, whooping cough, diarrhoea, cholera, typhus, enteric fever, and tuberculosis. 65 This study identifies tabes mesenterica, measles and whooping cough as those diseases which particularly affected infants under one year old. This process appears to have taken place in Merthyr Tydfil. Deaths from infectious diseases among infants show a declining trend which is difficult to account for, given the social and environmental features of the town. It is for example hard to see how it could be accounted for by a rise in living and nutritional standards in Merthyr, where any rise in living standards was undermined by the effects of constant overcrowding and the economic realities of a community dependent on iron and coal. Table 4. 9. compares the year of highest disease specific infant mortality for each infectious disease with the decline by 1908. Whooping cough, meningitis, scarlet fever and diphtheria declined, but measles continued to make its deadly presence felt with a severe epidemic in 1905. The decline of tuberculosis was delayed by a resurgence from 1892-1902. Table 4. 10. shows the mode of spread of various infectious diseases. The

65 Thomas McKeown, The Origins of Human Disease, Basil Blackwell, Oxford, 1988., p.122., McKeown and Record., ‘Reasons for the Decline of Mortality in England and Wales During the Nineteenth Century’, pp. 224-227. 173 conglomerate of diseases spread by droplet infection, touch, bedding and skin flakes, explains the ways in which overcrowding aided the spread of diseases. Table 4. 11. Numerical Hierarchy of Infant Deaths from Infectious Diseases as Percentages of Infectious Diseases and Total Infant deaths in Merthyr Tydfil 1865- 1908 (MOH Reports for Merthyr Tydfil 1865-1908.) Cause of Death Number of % of deaths from infectious % total deaths 1865-1908 deaths diseases 1865-1908 (2843) (17,140) Tuberculosis Tabes mesenterica 1027 36.12 5.99 Tb brain 159 5.59 0.93 Tuberculosis 42 1.48 0.24 Tb lung (Pthisis) 18 0.63 0.11 Scrofula 11 0.39 0.06 Tb caries spine 1 0.04 0.006 Total Tuberculosis 1258 44.25 7.34

Infectious Diseases Group 1: Whooping cough 595 20.93 3.47 Measles 425 14.95 2.48 Scarlet fever 115 4.05 0.67 Smallpox 41 1.44 0.24 Influenza 6 0.21 0.04 Chicken pox 3 0.11 0.02 Total Group 1 1185 41.69 6.92

Group 2: (Upper Respiratory Tract) Diphtheria 68 2.39 0.40 Croup 33 1.16 0.19 Laryngitis 29 1.02 0.17 Diphtheria and membranous 7 0.25 0.04 croup Tonsillitis 4 0.14 0.02 Pharyngitis 3 0.11 0.02 Total Group 2 144 5.07 0.84

Group 3: (Meningitis / Cephalitis) Cephalitis 7 0.25 0.04 Inflammation of the brain 67 2.36 0.39 Meningitis 65 2.29 0.38 Infantile Meningitis 4 0.14 0.02 Meningococcal septicaemia 2 0.07 0.01 Total Group 3: 145 5.11 0.84

Secondary infections Erysipelas 46 1.62 0.27 Other 33 1.16 0.19 Skin disease 17 0.60 0.10 Sepsis 15 0.53 0.09 Total secondary infections 111 3.91 0.65

Total Non Tuberculous 1585 55.78 9.25% Infectious Diseases Total Infectious diseases 2843 100.03 16.59% including Tuberculosis

174 Table 4.11. illustrates the numerical hierarchy and relative importance of each infectious disease to infant mortality. Appendix Tables 11-11 (g). account fully for these deaths. In order to analyse the reported causes of death, all forms of tuberculosis have been classified together under that heading. All other infectious diseases have been organized into three groups. Group 1: Deaths attributed to smallpox, whooping cough, measles, scarlet fever, chicken pox, influenza. Group 2: Reported deaths from throat and upper respiratory tract infections, croup, diphtheria, membranous croup, laryngitis, tonsillitis and pharyngitis. Group 3: Deaths certified as cephalitis, inflammation of the brain, meningitis, purpura, meningococcal septicaemia and infantile meningitis. Secondary Infections: Local or specific infections particularly erysipelas and skin infections. Various forms of tuberculosis, measles and whooping cough accounted for a total of 80.1% of deaths from infectious diseases. Tuberculosis, predominantly tabes mesenterica, accounted for 44.25% of infectious disease deaths, whooping cough 20.93% and measles 14.94%. The remaining 19.9% is accounted for by all other forms of infectious disease. However, to place deaths attributed to infectious diseases in perspective in relation to all infant deaths 1865-1908, all forms of tuberculosis accounted for only 7.34 % of total infant deaths, measles 3.47% and whooping cough 2.48%. All other forms of infectious disease account for a further 3.3 % of total infant deaths 1865-1908. Various forms of meningitis or inflammation of the brain accounted for 145 deaths 1865-1908 and 144 deaths were due to diphtheria, croup and upper respiratory tract infections, a relatively small proportion. Deaths from infectious diseases and diarrhoeal deaths were the two causes of death which varied considerably from year to year. The effect of deducting them from the infant mortality rate as annual variables clearly demonstrates the importance of the cumulative effect of all other causes of death on the infant mortality rate. Combined, they accounted for a maximum of 31.20% of infant deaths in 1908, leaving 70% of infant deaths to be explained by other causes. (Appendix Tables 13 -13 (a ).) From 1865-1908 infectious diseases account for a maximum of 20.63 % of the IMR in 1870, the worst year collectively for deaths from infectious diseases, a DSIMR of 38.58 deaths / 1000 births. To gain a measure of their importance and to balance the perspective, in 1870 almost 80% of infant mortality is explained by other factors and more in other years. In 1899 diarrhoea deaths accounted for 34% of infant deaths

175 leaving the explanation for the remaining 66% of infant deaths to be otherwise accounted for, as was the case in most years. The death rate from all infectious diseases in Merthyr tended to decline slightly from 1868-1908, but whooping cough and measles still posed a serious threat to infants. (Appendix. Table. 11. ) Table 4. 12. shows the relative number of deaths from each of the infectious diseases in Merthyr 1905-8 and the cyclical patterns of the measles epidemic in 1905 and whooping cough in 1908. Together measles and whooping cough accounted for 120 of 151 deaths 1905-8. Table 4. 12. Deaths from Infectious Diseases in Merthyr Tydfil 1905 –1908. (MOH Reports for Merthyr Tydfil, 1905-8.) 1905 1906 1907 1908 Total Measles 43 12 6 61 Whooping 4 15 9 31 59 Cough Meningitis 8 1 2 3 14 Tuberculosis 4 1 4 9 Diphtheria & 3 4 7 Croup Scarlet Fever 3 1 4 Laryngitis 1 1 1 1 4 Chicken Pox 1 1 Erysipelas 1 1 Total 62 22 26 41 151

Table 4. 13. Deaths of Infants Under One Year of Age by Weeks and Months from Infectious Diseases in Merthyr Tydfil 1905-1908. (MOH Reports for Merthyr Tydfil 1905-8. ) Total

Age

Tb Measles Whooping Cough Fever Scarlet Diphtheria & Coup Laryngitis Chicken Pox Meningitis Erysipela 1-2wks 1 1 2 2-3wks 1 1 3-4 wks 1 1 Total under 1 1 1 1 1 4 month 1-2 months 1 3 4 2-3 months 2 1 3 3-4 months 2 1 4 1 3 11 4-5 months 1 6 1 8 5-6 months 3 6 1 10 6-7 months 7 10 2 19 7-8 months 7 7 3 17 8-9 months 1 10 10 2 1 1 25 9-10 months 1 11 5 1 2 1 21 10-11 months 8 4 3 15 11-12 months 4 12 2 1 1 3 23 Total over 1 9 60 59 4 6 3 1 14 156 month Total under 1 9 61 59 4 7 4 1 14 1 160 yr

Table 4. 13. summarises the causes of death from infectious diseases recorded for each stage of the first year of life for the years 1905-8. Deaths from infectious

176 diseases, especially measles and whooping cough, increased from 3 months of age, as acquired immunity decreased and infants were exposed to diseases primarily through contact with other children. Isolated deaths from meningitis, croup and erysipelas occurred within the first month. 66 Meningitis posed a greater threat to infants above 3 months of age than diphtheria, croup, laryngitis, scarlet fever or chicken pox.

Tuberculosis

Tuberculosis, a disease of social deprivation, was constantly and commonly present in Merthyr, worsened by overcrowding, poverty and malnutrition. Tuberculosis was commonly known as ‘scrofula’ or ‘consumption’, and caused wasting and emaciation, whilst the tubercle bacillus ate into the various structures and organs of the body. In 1876 Dyke described scrofulous diseases as those “characterized by the deposit of tubercular matter in the glands, brain, lung, intestines or bowels, and which in the majority of cases takes the form of sickness known as “consumption.” Those “sunk into death by this constitutional malady” accounted for 20% of the whole deaths in the year. 67 The term “atrophy”, was frequently used, but Dyke reported in 1868, that “ it was now stated that the patient died of tubercular diseases either of the brain, lung or bowels.”68 Tuberculosis of different parts of the body was not always caused by the same organism. Tuberculosis of the lungs (phthisis) was more common in adults than in children, whilst tabes mesenterica, (tuberculosis of the intestines), was common in infants and young children. Tabes mesenterica produced an unmistakable irregularly swollen doughy feeling abdomen with classical symptoms. 69 Wales was notorious for tuberculosis, possibly due to the damp climate and poorly constructed dwellings, especially among coalmining communities. 70 Dyke frequently described dwellings in which the walls were placed against earth banks, the floors saturated with moisture during damp weather. With poor ventilation, diseases such as consumption and inflammation of the lungs flourished. 71 Drainage reduced dampness in houses, demonstrated by a fall in deaths from “constitutional maladies” in

66 Nelson, Textbook of Paediatrics, pp.561-2. 67 Dyke, MOH Report for Mertyr Tydfil for 1876, p.6. 68 Dyke, MOH Report for Merthyr Tydfil for 1868, p.7. 69 Thomas Dormandy, The White Death: A History of Tuberculosis, The Hambledon Press, London, 1999, pp.329-330. 70 Ibid., p.23. 71 Dyke, MOH Report for Merthyr Tydfil for 1880, p.6. 177 1868. 72 The Board had no legislative powers to constrain the building of houses on low-lying damp foundations such as those at Troedyrhiw, and at Ynysowen, where water in the subsoil was within two feet of the surface. In 1873 Dyke warned of the dangers to health of allowing such buildings, although built to the letter of the law.73 In 1874 he again warned the Board that scrofulous diseases were highest in dwellings where damp cold foundations existed. The incidence fell in areas where subsoil had been drained.74 The contribution of damp housing to tuberculosis was also demonstrated by Dr. George Buchanan, Assistant Medical Officer to the Local Government Board in 1876. 75 Tuberculosis was associated with poor environment, poverty, poor diet and overcrowding. It increased in 1869, and Dyke blamed poverty resulting from the depressed iron trade. This meant even less food for bodies already weakened by hunger, leaving them “prone to those determining causes, cold and wet, which acting upon their debilitated frames, induced Diseases whose end was Death.” 76 Deaths from scrofulous diseases in Merthyr in 1869 were 49.2 per 10,000 population compared with 34.9 in England according to the Registrar General. Those affected were mainly in mid-life 20- 40 years, existing on low wages and supporting families. 77 Again in 1878 Dyke referred to the “long continued depression in the staple trades of the district” which

must have tended to diminish the quantity of nutritious food which our working men and their families could procure and yet so much needed: the same cause has also limited the amount of clothing they could buy: hence has followed a general lowering of the standard of health, and as a necessary sequence a proneness to diseases of the scrofulous or tubercular character has been induced, these being especially the maladies which occur when people are ill-fed or ill-clothed.78

Tuberculosis was an opportunistic disease which flared up in the wake of other illnesses. 79 In 1886 tubercular death accounted for 11.2 % of all deaths, a fall possibly due to a large number of deaths from scarlet fever and whooping cough that year.80 By 1885, despite the adverse conditions in Merthyr, phthisis deaths had already fallen to 19 per 10,000 population and by 1887 deaths from consumption had more than halved to

72 Dyke, MOH Report for Merthyr Tydfil for 1868, p.8., Dyke, MOH Report for Merthyr Tydfil for 1870, p.19. 73 Dyke, MOH Report for Merthyr Tydfil for 1873, p.9. 74 Dyke, MOH Report for Merthyr Tydfil for 1874, p.10. 75 Dyke, MOH Report for Merthyr Tydfil for 1876, pp.12-13. 76 Dyke, MOH Report for Merthyr Tydfil for 1869, pp.10-11. 77 Ibid., pp.11-12. 78 Dyke, MOH Report for Merthyr Tydfil for 1878, p.14. 79 Dormandy, The White Death , p.235. 80 Dyke, MOH Report for Merthyr Tydfil for 1886, p.7. 178 14 per 10,000 population as a result of sanitary and housing improvements, although much further action was required. 81 In 1894 Dyke advised the Board that tuberculosis, previously considered hereditary, should be considered contagious, spread by the air breathed out by infected persons and inhaled as dust from dried sputum spat upon the floor, a very common habit in mining communities. Dyke also indicated that the disease might be contracted from animals, and warned that the milk of tuberculous cows was dangerous to infants, unless boiled for 10 minutes. It was therefore essential to inspect cattle and vaccinate them against tuberculosis once this became possible. 82 Under the Dairies, Cowsheds and Milkshops Order of 1885 and 1886, adopted in Merthyr in 1889, bye-laws ensured the regulation and inspection of relevant buildings and the registration of cow keepers. 83 In 1893 a single inspector found it difficult to supervise some 450-500 cowsheds in the 27 square miles of the parish. Dairies were largely found on farms, from where the milk was taken into the house of the milk-seller, strained and immediately taken into town for sale. In several instances this was found to be the source of infectious disease and the Sanitary Inspector had acted to prevent the sale of the milk through which scarlet fever, diphtheria and enteric fever as well as tuberculosis could be spread. 84 Tuberculosis became preventable through screening of cattle and legislation governing milk supplies from the late 1890s, coinciding with a fall in the number of infants recorded as dying from the disease in Merthyr. Dyke’s advice preceded the Royal Commission on Tuberculosis 1896 to 1898 which endorsed tuberculin testing of cattle. 85 The Committee recommended that local sanitary authorities control and inspect meat, milk supplies, cattle, cowsheds and dairies to ensure tubercle free produce, and embark on

81 Dyke, MOH Report for Merthyr Tydfil for 1887, p.6. Enid Williams studied the health of old and retired miners in 1933. Her insights explain the combined social impact of mining and tuberculosis on families. Her study, which included 30 Aberdare miners, suggested that the miners brought the tubercle bacillus into their homes…..”Particularly at risk were hewers exposed to shale dust which contained dangerous silica particles. The roof of a mine from which coal was ripped near Aberdare contained over 80% free silica. Williams, The Health of Old and Retired Coalminers in South Wales, pp.97. Williams compares the occupational exposure to coal dust and silica and effects on health., pp.19-20,44, 67,70, 96, 98,103-107. 82 Dyke, MOH Report for Merthyr Tydfil for 1894, p. 8. 83 Ibid., pp. 8, 17. William Williams, A Sanitary Survey of Glamorganshire and Cardiff, Daniel Owen and Company Ltd., Cardiff, 1895. p. 109. 84 Dyke, MOH Report for Merthyr Tydfil for 1893, p.19. 85Royal Commission to Inquire into Administrative Procedures fro Controlling Danger to Man Through use as Food of Meat and Milk of Tuberculous Animals, Report, Minutes of Evidence and Appendices. 1898 [C.8824] XLIX.333,365., Royal Commission to Inquire into Effect of Food from Tuberculous Animals on Human Health, Report: 1895 [C.7703] XXXV.615., Minutes of Evidence., Special Inquiries, Index 1896 [C.7992]XLV.II. The following link is for an article concerning the issues which delayed bovine testing for so long, URL: http://www.pubmedcentral.nih.gov/articlerender.fcgi?articl=546294

179 public education campaigns to prevent the spread of the disease, and proposed new national building regulations allowed for fresh air and sunlight. Compulsory notification of the disease was considered unacceptable in professional and public opinion at the time. 86 The cause of tuberculosis in infants and children engendered considerable debate. The Report of the Subcommittee on Tuberculosis appointed 12 October 1898 indicated that many infants and children dying of respiratory and wasting diseases were affected by tuberculosis, although no symptoms were shown whilst alive. The failure of early childhood tuberculosis mortality to decrease in line with other age groups was attributed to infected milk. Milk as a source of infection was disputed; the two distinct organisms causing tuberculosis of the lung and intestines, one bovine, one human, had not been finally identified. Tabes mesenterica was caused by the bovine strain of tuberculosis, which may also have been responsible for many cases of tuberculous meningitis, tuberculosis of the bones, joints and skin, and lupus vulgaris, rather than the human strain. 87 It was argued at the International Tuberculosis Congress, held in Berlin in 1899, that most infantile tuberculosis was acquired by inhalation whilst in contact with infected persons. Overcrowding and poverty contributed to this, but intestinal infection was considered less common in infancy than in later childhood. 88 The prevention of tuberculosis in dwellings and public places could be achieved by housing legislation, the exclusion of tuberculous people from workplaces and the prohibition of spitting in public places, a common habit in mining communities. A Royal Commission set up in 1904 disproved Koch’s findings in 1901 that it was not possible for bovine forms of the disease to be transmitted to humans and called for urgent legislation on the matter. By 1906 several clauses were adopted following the Commission’s interim Report. 89 By 1907 the spread of bovine tuberculosis to humans via meat and milk was established beyond question, accounting for the majority of cases of tuberculosis in infants and children.90 The Local Government Board attempted to introduce comprehensive Milk and Dairies legislation in 1901, 1912 and 1913 following the findings of the Royal Commission on Tuberculosis 1907-1914. 91

86 The British Medical Journal, 28 January, 1899., pp. 242-244. 87 Dormandy, The White Death, pp.329-330. 88 Dr. Still, Assistant Physician for Diseases of Children, King’s College Hospital and Hospital for Sick Children, Great Ormond street, “Observations on the Morbid Anatomy of Tuberculosis in Childhood’, the British Medical Journal, 19 August 1899, p.458. 89 Dormandy, The White Death, p.331. 90Duncan, MOH Report for Merthyr Tydfil for 1907., p.27. 91 Jim Phillips and Michael French ‘State Regulation and the Hazards of Milk, 1900-1939’, Social History of Medicine, Vol.12., No. 3., Dec. 1999, p.375. 180 Table 4. 14. Deaths of Infants Under One Year of Age by Weeks and Months In Merthyr Tydfil 1905 –1908 from Tubercular Diseases (MOH Reports for Merthyr Tydfil 1905-8.) Age Tubercular Tabes Other Tubercular Total Meningitis Mesenterica Disease 3-4 wks 1 1 Total under 1 1 1 month 1-2 months 2 1 3 2-3 months 1 3 4 3-4 months 1 2 3 4-5 months 4 4 5-6 months 2 1 3 6-7 months 2 2 4 7-8 months 1 3 4 8-9 months 2 1 3 9-10 months 1 1 10-11 months 3 4 7 11-12 months 1 1 Total 1-12 9 19 9 37 months Total under 1yr 9 20 9 38

By 1900 many deficiencies among dairies still existed in Merthyr and new regulations were considered. 92 In 1903 Dr Thomas considered the fact that milk was locally produced and delivered whilst fresh was favorable and he believed summer grazing to be beneficial to the health of the cattle. Most milk vendors obtained their supplies locally from rural Gelligaer or Vaynor, but two received their supplies from Somerset and Herefordshire. Despite the fact that inspection under the Food and Drugs Act was controlled by the police, the County Analyst found less than 5% of milk samples to be contaminated, although teats and udders were rarely washed before milking. 93 The tuberculosis clauses of the Liverpool Corporation Act were incorporated into the Merthyr Tydfil Corporation Act of 1907, allowing for the stricter reporting and supervision of cows, dairies and milk supplies.94 The number of registered cowsheds, dairies and milk shops in Merthyr was reduced to 100. 95 By 1908 it was noted that more milk sellers were in the habit of washing their hands before milking! 96 The Health Visitor’s work, following her appointment in 1907, included visiting the homes of consumptives and advising on preventing the spread of the disease. 97 Insanitary housing slowly improved and in 1906 voluntary, rather than compulsory, notification of the disease was considered. Phthisis still accounted annually for more deaths than all

92 Simons, MOH Report for Merthyr Tydfil for 1900, p.14. 93 Thomas, MOH Report for Merthyr Tydfil for 1903, pp. 44-45. 94 Duncan, MOH Report for Merthyr Tydfil for 1908, p.30. 95 Duncan, MOH Report for Merthyr Tydfil for 1907, p. 24. 96 Duncan, MOH Report for Merthyr Tydfil for 1908, p.30. 97 Duncan, MOH Report for Merthyr Tydfil for 1907, pp.18-19. 181 other common infectious diseases combined. 98 By 1908 no system of notification had been adopted, the only measures were the disinfection of dwellings and bedding after death. Provisions for consumptives were made at the workhouse infirmary and preparations made to build a sanatorium. 99 GT Clark’s magnificent house at Talygarn served as a sanatorium for miners in the twentieth century.100 The total number of infant deaths attributed to all forms of tuberculosis in Merthyr was 1258, of which 1027 were assigned to tabes mesenterica. ( Table 4.11., Appendix Table 11 (b).) However, all forms of infant deaths from tuberculosis accounted for only 7.4% of all infant deaths 1865-1908. The trend was for tuberculosis to decline, but with a dramatic rise to 38.45 infant deaths/ 1000 births in 1892, possibly due to the large influx of young families into the rapidly expanding lower district of Merthyr Vale and Treharris with severe overcrowding and several epidemics.101 That year, with an IMR of 239/1000, infectious diseases, particularly measles, convulsions, lung diseases and tuberculosis, together indicated the opportunistic nature of diseases on a vulnerable population and the interrelatedness of all causes of infant death. Dyke was not unduly concerned since the rate of 13 per 10,000 population compared very favourably with 38 per 10,000 prior to any sanitary improvements. An equally dramatic and consistent fall in the tuberculosis deaths occurred from 1897/8 through Dyke’s encouragement of Merthyr’s regulation and supervision of dairies and milk supplies well ahead of national initiatives. Infant deaths reported to be from tuberculosis fell from 22.26 deaths / 1000 births in 1897 to 4.01 per 1000 in 1898. A rate as low as 1.43 deaths / 1000 births is recorded for 1904 and 4.75 /1000 by 1908.102 The impact of specific forms of tuberculosis and the age at which infants were affected is seen from the examples of 1905-8, when a considerable reduction in the disease had occurred. Of 20 deaths from tabes mesenterica, 16 were between one and seven months of age and 3 aged 10-11 months, suggesting infected milk to be the source (Table 4.14.)

98 Thomas and Duncan, MOH Report for Merthyr Tydfil for 190., p.14. 99 Duncan, MOH Report for Merthyr Tydfil for 1908., pp.17-18. 100 Kingham, ‘Clark of Talygarn’, in James, ed. , G. T. Clark, Scholar Ironmaster, pp.169-170, 177-179. 101 Dyke, MOH Report for Merthyr Tydfil for 1892, p.10. 102 Williams, A Sanitary Survey of Glamorgan, p.109. 182 Smallpox, Whooping Cough, Measles and Scarlet Fever

Smallpox

During the period of this study infant deaths in Merthyr from smallpox were rare, only 41 between 1865 and 1908, 40 of which died during the national epidemic of 1872, which affected the town severely. The epidemic attacked a vulnerable, poverty- stricken population following the industrial unrest of 1871. Despite the severity of the epidemic, the infant mortality rate was relatively low at 141 /1000 births since there was an absence of epidemics and associated deaths from lung diseases. (Appendix Table 11 (c).) Deaths from all forms of tuberculosis were also lower in 1872. Of 100 smallpox deaths under 5 years old in 1872, 40 were unvaccinated infants under I year old.103 In 1852 80% of smallpox deaths were children under five, many unvaccinated. Table 4.15 shows the age distribution of smallpox deaths in Merthyr in 1872 and its impact on infants. Table 4. 15. Number of Smallpox Cases In Different Age Groups in Merthyr Tydfil 1872. (MOH Report for Merthyr Tydfil, 1872, pp.12-14.) Age group Number of Smallpox Cases per 1000 Number of deaths Total Population 0-1 yr 40 0-5 yrs 5.73 100 5-15 yrs 18.7 93 15-25 yrs 17.1 75 25-45 yrs. 7.3 81 All Ages 368

A consistently high vaccination rate of infants followed this smallpox outbreak reducing the fatality amongst infants to one death in 1900 in Dowlais.104 Smallpox, whilst dramatic and newsworthy, posed less danger to the infants of Merthyr than the far more common whooping cough and measles. Smallpox was preventable with vaccination, isolation and vigilance, measures which Dyke implemented assiduously in Merthyr. Up to 97% of infants born were publicly or privately vaccinated. (Appendix. Table 6.) Those unvaccinated were generally infants who died or were too sickly to vaccinate during the first three months of life. Of 6,109 infants born 1870-1872, 5,887 were vaccinated by public vaccinators, not including private vaccinations.105 The

103 Dyke, MOH Report for Merthyr Tydfil for 1872, p. 11., Table 5, p.12., Table 7. p. 17. 104 Simons, MOH Report for Merthyr Tydfil for 1900, Table V, p.41. 105 Dyke, MOH Report for Merthyr Tydfil for 1872, p.3. 183 vaccination programme appears to have worked well and, despite sporadic outbreaks of smallpox, infant deaths from smallpox became a rarity. (Appendix. Table 11 (c).) To maintain levels of protection in the community from vaccination it was necessary to revaccinate after 10-12 years during adolescence. 106 According to Creighton in 1898, the age distribution of smallpox changed during the nineteenth century, from a disease of infants to one affecting young adults, almost certainly through the effect of compulsory infant vaccination. Infants instead became prone to measles and whooping cough. 107

Whooping Cough and Measles

Together, measles and whooping cough accounted for 1020 infant deaths in 42 years, posing a threat which was often not taken sufficiently seriously in a community where both diseases were endemic. The frequent cyclical patterns of infectious diseases, caused fluctuations in infant mortality depending on the severity and frequency of the epidemics, but these do not explain the dramatic variations in the general infant mortality rates. (Appendix Tables 11 ( c ) and (d ).) Whooping cough caused 595 infant deaths 1866-1908, at the time essentially unpreventable, and accounted for the greatest number of deaths from all forms of infectious diseases in 1866 with 59 deaths. It accounted for the highest infant death rate among all forms of infectious diseases in 1870 with 28.15 deaths /1000 births, causing that year to present the highest infant mortality of 37.01/1000 from infectious diseases, excluding tuberculosis. Epidemics occurred in 3-5 year cycles, with epidemic peaks roughly every four years, yet it was present to some degree in Merthyr every year, especially in 1866, 1870 and 1886. In 1874, whooping cough, measles and scarlet fever combined to make up an infant mortality rate from infectious diseases of 26.87/1000. 1874 saw the highest death rate of infants from scarlet fever whilst the measles death rate was highest in 1885 with 19.37 deaths /1000 births. The following year whooping cough was again severe. Whooping cough, measles, scarlet fever and diphtheria flourished in school communities and were brought into the home by siblings. Table 4. 16. shows the cyclical patterns of whooping cough and the age at death of babies affected by the diseases 1905-8.

106 Dyke, MOH Report for Merthyr Tydfil for 1872, p.18., Thomas, MOH Report for Merthyr Tydfil for 1902, pp.12-19. 107 Creighton, A History of Epidemics in Britain, Vol.2 pp. 610-613., Smith, The People’s Health, pp.156- 7. 184 Table 4. 16. Deaths of Infants Under One year from Whooping Cough in Merthyr Tydfil 1905-1908 (MOH Reports for Merthyr Tydfil 1905-1908.) Age 1905 1906 1907 1908 Total WHOOPING COUGH Under 1 wk 1-2 wks 2-3 wks 3-4 wks Total under 1 month 1-2 months 1 2 3 2-3 months 2 2 3-4 months 1 1 2 4 4-5 months 1 1 2 2 6 5-6 months 2 2 2 6 6-7 months 1 4 5 10 7-8 months 1 6 7 8-9 months 2 2 1 5 10 9-10 months 1 1 3 5 10-11 months 2 1 1 4 11- 12 months 1 1 2 Total under 1 yr 4 15 9 31 59

In 1882 whooping cough caused the deaths of 39 children but parents refused to treat it as a serious infectious disease. Dyke wrote:

The unbelief of parents in the contagiousness of Whooping Cough, will, I fear, still be the means by which this disease will be diffused; if the mother could be led to know that the malady can be avoided by not coming in contact with those sick of it, then the health and life of the child would be preserved.108

Fifty-six children died from whooping cough in 1886. Dyke lamented that the sickness was regarded as an inevitable part of childhood and hence no precautions were taken to prevent the spread of the disease. 109 In 1892 Dyke feared an extensive outbreak, warning that the disease was spread by phlegm expectorated upon the floors of houses or schoolrooms. Mixed with dust, particles floated in the air to be inhaled by others. It was therefore vital that sufferers of this disease did not go into public places. 110 His fears proved unjustified, the epidemic prevented by very fine weather for most of the summer and autumn of 1893, with people outdoors a great deal. 111 However, due to the hot summer, diarrhoea deaths rose to 30 / 1000 that year. In 1905, the MOH described

108 Dyke, MOH Report for Merthyr Tydfil for 1882, p.7. 109 Dyke, MOH Report for Merthyr Tydfil for 1886, p.6. 110 Dyke, MOH Report for Merthyr Tydfil for 1892, p.9. 111 Dyke, MOH Report for Merthyr Tydfil for 1893, p.11. 185 the highly contagious, protracted and distressing nature of the illness, the ensuing lung diseases, and the reasons it was impractical to make it notifiable: 112

This disease is one of the most distressing and painful causes of death among children, and the figures given do not represent the whole mortality due to this cause. It is undoubtedly the primary cause of a number of the deaths certified as due to disease of the lungs, the lung trouble following on the whooping cough. This disease is not notifiable, as the isolation of the infected infant presents many difficulties. In a large proportion of cases the patient would have to be accompanied by the mother, and the period of detention in hospital would, in the majority of cases be protracted, owing to the long period during which it is infectious. It is within my own knowledge that the introduction of a case of whooping cough into a court, such as we have in Dowlais and Penydarren, results in the infection of the whole infant population of that court. 113.

Although whooping cough was not a notifiable disease, in 1907 Dr. Duncan stressed that it undoubtedly caused a number of deaths certified as due to respiratory illnesses, “and, like measles, does not come within the purview of the Sanitary Authority, except when it makes its appearance in a school.” 114 Only the patient was excluded from school in such cases, brothers and sisters not affected were allowed to attend. 115 The following year a severe outbreak affected most wards of the district. With 20 children absent and suffering from the disease, Pant School was closed and disinfected. Contacts were excluded for two weeks, but those who had previously had the disease were not. The illness took a steady toll on infants and children. 116 From 1866-1908, 425 infants died from measles. Epidemics occurred in regular cycles but the disease was frequently present in the years in between. Fortunately, Merthyr was free of measles deaths in several years. (Table 4. 17.) Thirty-five babies died of measles during the severe epidemic in 1885, a further 35 in 1897, 43 in 1892, 28 in 1901 and 43 in 1905. From the highest DSIMR of 19.37 /1000 births in 1885, the infant death rate from measles declined gradually to 15.30 in 1905, its rate of decline lagging behind that of whooping cough. (Table 4.17., Appendix Tables 11 (c) and (d.)) There were 61 infant deaths from measles 1905-1908. Of these only one death occurred under 1 month of age. Most deaths occurred between the ages of 3 and 12 months, the incidence increasing with the age of the infant (Table 4. 18.) The effect of

112 Thomas and Duncan, MOH Report for Merthyr Tydfil for 190., p.23. 113 Duncan, MOH Report for Merthyr Tydfil for 1906, p.11. 114 Duncan, MOH Report for Merthyr Tydfil for 1907, p.14. 115 Ibid. 116 Duncan, MOH Report for Merthyr Tydfil for 1908, p.13. 186 the 1905 epidemic can be seen in the number of deaths that year and the absence of deaths in 1906. Table 4. 17. Measles Epidemics in Merthyr Tydfil 1865-1908 (MOH Reports for Merthyr Tydfil 1865-1908.) Year No of Infant Deaths Disease Specific Infant Mortality Recorded from Measles Rate from Measles. 1866 0 1868 16 7.75 1872 0 1874 24 10.93 1876 0 1878 0 1879 0 1880 20 12.29 1885 35 19.37 1891 0 1892 43 18.37 1895 20 7.90 1897 35 14.6 1899 0 1901 28 10.41 1905 43 15.30 1906 0

Table 4. 18. Number and Ages of Infant Deaths Under One Year of Age from Measles by Weeks and Months in Merthyr Tydfil 1905-1908. (MOH Reports Merthyr Tydfil 1905-1908.) Age 1905 1906 1907 1908 Total 3-4 wks 1 1 Total under 1 month 1 1 1-2 months 2-3 months 3-4 months 1 1 4-5 months 1 1 5-6 months 2 1 3 6-7 months 4 2 1 7 7-8 months 7 7 8-9 months 6 3 1 10 9-10 months 9 2 11 10-11 months 4 2 2 8 11-12 months 9 3 12 Total under 1 yr 43 NIL 12 6 61

Several examples exist in the MOH reports of the way measles epidemics infiltrated the community, particularly through schools, to Dyke’s great concern. 117 Dyke considered the closure of schools to be an important preventative measure. Measles occurred in several locations in the autumn of 1879 and by February 1880 many hundreds of children were affected over many weeks, but only two deaths were registered. The disease continued throughout the district until September, mild at first, but as the cold winter set in deaths increased to 122 with severe inflammations of the

117 Dyke, MOH Report for Merthyr Tydfil for 1881, p.5. 187 lungs. 118 In September 1885 a pupil at St. David’s National School developed measles and by the end of October 34 siblings of children attending the school had the illness. The disease spread quickly throughout the district also assisted by visits between relatives. 119 The closure of schools on 21 December finally ended the outbreak. 120 The Sanitary Authorities asked medical practitioners in the district for the particulars of cases in their care and MTLBH recommended that school managers close schools under the 98th section of the Minutes of the of the Education Department 6 March 1882. 121 Education Department Minutes required that the siblings of any sick child should also be excluded from school. Dyke believed that where many cases of illness were reported all children under 5 years should be excluded from school for 30 days, and Sunday Schools closed also. 122 In 1888, 48 cases of measles appeared at Twynyrodyn School in before school closure on 7 December ended the outbreak .123 The measure helped reduce the number of cases, although Sunday Schools were not closed. Closing schools could not prevent people from visiting houses where measles or other infectious diseases were present, and thus spreading them throughout the districts. Dyke described an incident in 1881 when a sudden and severe outbreak of scarlet fever at one school caused the death of three children, who then lay in a house opposite the school gate. Young and old, including mothers with babies in their arms, crowded into the room to view “the painful sight.” The sickness spread severely within 10 days of this incident. 124 Here, the ideology and agenda of public health in curtailing the spread of disease, and the social and cultural imperatives, values and habits of the population were seemingly at odds. Mothers and children, compelled by a mixture of fear, pity, compassion, horror and curiosity visited to pay their respects to the bereaved family, in awe of the precarious and perilous balance between life and death. In Merthyr it was doubtless a case of “there but for the grace of God go I…,.” People would rather place themselves at risk than desert relatives, neighbours or friends in time of need. That was how the community survived. Dyke’s rationale of school closure was presented in a 125 paper, Duties of School Managers in Relation to Epidemics, and Health of Inmates, read at a Conference held at

118 Dyke, MOH Report for Merthyr Tydfil for 1880, p.4. 119 Dyke, MOH Report for Merthyr Tydfil for 1882, pp. 14-19. 120 Ibid., p. 21. 121 Ibid., p.22. 122 bid., p.26. 123 Dyke, MOH Report for Merthyr Tydfil for 1888, pp.3,9. 124 Dyke, “Duties of School Managers in Relation to Epidemics, and Health of Inmates”, Appendix to MOH Report, 1888, p.16. 125 Dyke, MOH Report for Merthyr Tydfil for 1888, p. 9. 188 the International Health Exhibition in London, 30 July 1884. 126 Dyke summarised the imperfect, but advancing, state of scientific knowledge in regard to infectious diseases, and emphasised the importance of good ventilation in classrooms. The children most affected by infectious diseases were those who had not been exposed to the infections, aged 3-7, who voluntarily attended school.127 Dyke likened this measure to that of forbidding livestock markets and fairs during outbreaks of foot and mouth disease.128 In 1888 Dyke advocated that the School Board and the Inspector should be empowered to require the assistance of sanitary authorities at such times to save many children’s lives and “the lessening of human sorrow”.129 The sanitary authorities refused to sanction this with the result that the epidemic lasted many months and caused a large number of deaths.130 Another problem concerned notification of measles and whooping cough. The Infectious Diseases (Notification) Act, 1889, came into operation in October1890 in Merthyr, permitting sanitary authorities to arrange for the notification of diseases and to exclude children suffering from infectious diseases such as measles, whooping cough, diphtheria and scarlet fever from schools. 131 School managers were also required to notify the sanitary authorities of children absent from school suffering from any of these diseases. 132 Under the Act measles, whooping cough and diarrhoea were not required to be notified.133 In 1892, 43 infants under one year died of measles with a further 122 deaths of children 1-5 years. With a death-rate of 1 in 10 this meant that 1,760 cases would have been reported had the disease been notifiable. Dyke posed the rhetorical question why the notification of a disease which accounted for a tenth of the total deaths for the year would not be required to be notified.134 One reason put forward was the length of time between infection and the appearance of a rash during which time no symptoms were apparent. During this incubation period it was possible to pass on the

126 Dyke, “Duties of School Managers in Relation to Epidemics, and Health of Inmates”, p. 11. 127 Ibid., pp. 11-15. 128 Ibid., p.18. 129 Ibid., p.19. 130 Ibid., pp.16-17. 131 Graham Mooney,’ Public Health versus Private Practice: the Contested Development of Compulsory Infectious Disease Notification in Late-Nineteenth-Century Britain.’ Bulletin of the History of Medicine, 73:2, pp. 238-6. Mooney explores the issues and tensions regarding notification, which he regards as a largely neglected topic. Resistance centred around state intervention and control in the life of the individual, professional rivalry, the sanctity of the Hippocratic oath and confidentiality, financial considerations including the effects of social class, shame and loss of income induced by notification and isolation, and public and class attitudes to notification including confiscation or loss of personal items during fumigation. 132 Dyke, MOH Report for Merthyr Tydfil for 1892, p.6., Table F., pp. 14-15. 133 Ibid., pp.8-9,13. 134 Ibid., pp.9, 14-15, p.23, 189 infection to others by exhaled droplets, infection passed directly from person to person. Among schoolchildren within 14 days the number of cases could increase tenfold, a strong argument for early school closure for at least 21 and preferably 28 days if such measures were to be effective.135 Again in 1896 and 1897 Dyke complained that neither measles nor whooping cough was required to be included in the weekly return of infectious diseases to the Local Government Board.136 Dyke’s concern was almost certainly increased by the fact that they appeared to be increasing as a proportion of total deaths. 137 In 1897 both illnesses occurred frequently during the year and spread rapidly, again accompanied by the request for school closures. 138 However, it became apparent that general school closure was ineffective. Measles epidemics were likely to occur when 30-40% of class members were not immune to the disease, and continue until this percentage fell to 15-20%. In many instances, by the time the school was aware that the child was ill, it was too late to prevent the spread of the illness.139 There was little point in excluding older children from school when measles threatened, since the majority, (95%), was immune, having already experienced the disease, but it was important to exclude young children. Experiments at Woolwich in London, over a four year period proved that school closure disrupted school work without minimising the spread of infection. In December 1908, when the disease affected most districts until July 1909, schools were closed in Merthyr, but that did not benefit the children less than three years who were at the greatest risk. 140 Although measles was frequently introduced into the house by children attending school, roughly half the cases had no connection with school attendance. Nonetheless, notification by schools to the authority was considered helpful, and it was proposed that children under five should be deterred from attending school. Education of the parents by distributing leaflets, through the work of the school nurse and medical inspection of schoolchildren, together with home visits from the Health Visitor, was considered to be more useful.141 The appointment of a health visitor was considered useful to assess households where measles was present, and to ensure precautions were taken by parents to prevent its spread. “The visits paid, and the instructions issued,

135 Ibid., p.9. 136 Dyke, MOH Report for Merthyr Tydfil for 1897, p.7. 137 Ibid., Table V., p.23. 138 Dyke, MOH Report for Merthyr Tydfil for 1892, p.8. 139 Duncan, MOH Report for Merthyr Tydfil for 1907, p. 13. 140 Duncan, MOH Report for Merthyr Tydfil for 1908, p.11. 141 Duncan, MOH Report for Merthyr Tydfil for 1907, p.11. 190 would tend to engender a saner view amongst the public as to the seriousness of the disease.” 142 In Cardiff, it was anticipated that the appointment of a health visitor to be involved with infected cases would reduce the death rate from these “so-called minor ailments.”143 Measles and whooping cough occurred frequently in association with each other. Opinions differed as to the sequence, but whooping cough in the second half of 1903 appeared to follow measles which lasted five months until August, the scattered outbreaks causing many deaths among under five year olds. Bronchopneumonia in conjunction with measles or whooping cough could prove fatal; “the aggregate loss of life from measles and whooping cough is far greater than that from all the notifiable diseases combined.” 144 The difficulty for the sanitary authorities lay in lack of information regarding cases.145 In Burton-on–Trent the practice of compulsory notification had been ineffective and was abandoned in 1901. In Aberdeen it had been tried from 1881 and abandoned in 1903 since the benefits did not outweigh the costs. 146 Notification failed because of the mildness of some cases, and because parents failed to comply. Under the Public Health (Measles and German Measles) Order of 1916, the first case of measles occurring in a house became notifiable, empowering local authorities to provide nursing assistance for the poorer inhabitants of the district, but was not available in the Borough in 1919, although Health Visitors advised on nursing care. The Ministry of Health cancelled the Order 1 January 1920, but local authorities could apply to continue the order. Merthyr Tydfil made no such application since no hospital beds were available for cases where the home surroundings were inadequate. In 1900 Dr Simon was highly critical of existing provisions for isolation of infected cases. At Pant Hospital cases of smallpox, diphtheria, whooping cough, erysipelas and puerperal fever were all under the same roof and enteric fever cases were in close proximity to smallpox cases. Of 138 cases of typhoid admitted, 20 died, and one case of puerperal fever died. The nurses slept under the same roof as their patients and several suffered ill-health. There was “absolutely no equipment in way of instruments, and few nursing appliances, at either of your Hospitals.” A modern steam disinfector was urgently needed to replace that installed by Dyke in 1872. 147

142 Thomas and Duncan, MOH Report for Merthyr Tydfil for 1905, p.23. 143 Thomas, MOH Report for Merthyr Tydfil for 1903, p.15. 144 Ibid., pp.14-15. 145 Thomas and Duncan, MOH Report for Merthyr Tydfil for 1905, p.21. 146 Ibid., p.22. 147 Simon, MOH Report for Merthyr Tydfil for 1900, Table A, pp. 12-13. 191 The majority of cases were spread through personal contact, therefore the risk increased in overcrowded and sub-standard housing. In 1904 Dr. Newsholme’s Annual Report compared measles deaths in Brighton and Merthyr. Deaths occurred at a later stage in Merthyr, suggesting that secondary lung diseases were involved, attributed to Merthyr housing, which was very different from “a fashionable watering place.”148 (Table 4. 19.) A significant number of deaths in Merthyr occurred in back-to-back houses with no through ventilation, a problem with which the Council was well aware.149

Table 4.19. Percentage of Deaths at Various Intervals From Measles in Merthyr Tydfil and Brighton 1904 (MOH Report for Merthyr Tydfil, 1904 p.19.) 1-5 days 7-12 days 13-18 days 19-24 days 25-31 days Later period

Merthyr 10.4% 27% 35.5% 25% 2.1% 0% Brighton 21% 45% 18% 5% 1% 10%

Table 4.20. Death Rate from Measles per 100,000 Population in Merthyr Tydfil 1866-1905. (MOH Report for Merthyr Tydfil for 1905 p.13.) Years 1866-70 1871- 1876- 1881- 1886- 1891- 1896- 1901- 1875 1880 1885 1890 1895 1900 1905 Deaths 48.8 92.8 72.2 97.6 45 94.2 55.4 90.7

In 1905, with 43 infant deaths the MOH in his annual report reviewed the history of measles epidemics in Merthyr over the previous 40 years in an effort to impress upon the Council members “the enormous sacrifice of life which is directly attributable to the disease and the failure of measures hitherto adopted to diminish this appalling mortality.” 150 (Table 4. 20.) A marked decrease in the incidence of all other infectious diseases had been observed since the appointment of the MTLBH. Cholera was but a memory, typhus virtually unknown, smallpox, typhoid and scarlet fever deaths reduced, the Council “having worked strenuously and efficiently to bring about a reduction in the death rate of the district.” Where measles was concerned, all efforts had failed. 151 In 40 years measles had claimed 1,712 lives, 426 of these babies, with little discussion since “the sufferers from Measles form the silent, the innocent, and the unprotected portion of the community.” 152 The report emphasised both the unnecessary cost in infant lives and the preventable nature of the disease. It was impossible to compare the death rate for measles with other areas of the UK because the birth rate had

148 Thomas and Duncan, MOH Report for Merthyr Tydfil for 1905, p.19. 149 Ibid., p.20. 150 Ibid., p.11. 151 Ibid., p.14. 152 Ibid., p.14. 192 been falling nationally with a subsequent fall in the number of under fives in the population. In Merthyr, however, the birth rate had been maintained at a more or less uniformly high level and an assessment of the number of measles deaths per 100,000 population was considered reasonable. 153 The study found that 85% of the population was formerly within 2 miles of the town centre and nearly the whole of the district was visited at one time by an epidemic. By 1905 this was less than 60%, and the distribution of the population had significantly altered. Troedyrhiw was formerly the only densely populated part of the southern or lower part of the district, but Merthyr Vale, Treharris and Aberfan expanded rapidly as young families moved in. 154 The risk of measles greatly increased among a large non-immune population pool of under five year olds susceptible to infection, particularly if their health was already compromised. Where people lived in close contact in overcrowded accommodation these risk factors increased substantially. Measles was one of the most highly contagious of the infectious diseases and highly infective before symptoms appeared, particularly in an overcrowded urban environment. Measles was discounted as harmless, whereas, with the exception of diarrhoea, it accounted for more deaths than any of the other three principal zymotic diseases. “Oh, it’s only Measles” was commonly heard and parents allowed their children to visit infected households in order to contract the diseases and “get it over as soon as possible.” It was “a common superstition that a child must get Measles, and the sooner he gets it the better. Probably, no superstition is attended with more disastrous results.” It was therefore important to educate the public about the serious threat to life from measles.155 It was more easily said than done to ensure that mothers did not expose their infants to infection. Visiting relatives during sickness or after a death in the house, were community practices which undermined public health efforts. It was impossible to change community attitudes overnight and little changed. Despite the pessimism of the study and concern over its prevalence, and despite the absence of effective measures against measles, the death rate continued to fall and in 1919 was 0 08 per 1,000 compared with 0.10 for the whole of England and Wales and 0.13 in the 96 great towns.156

153 Ibid., p.12. 154 Ibid., p.13. 155 Ibid., p.15. 156 Annual Report of the Medical Officer of Health for the Year 1919, County Borough of Merthyr Tydfil, p. 7. 193 Scarlet Fever

Scarlet fever occurs mostly among 2-8 year olds, but posed some risk to infants, causing 112 deaths 1865-1908. In many years no infant deaths from scarlet fever were recorded, but in most years a few occurred. The highest mortality rate of infants from scarlet fever occurred in 1881 with 7.53 infant deaths per 1000 births with the death of 13 infants. (Appendix Table 11 (d).) The mortality from the disease fell in 1907 was 0.73 per 1000 births A total of 4 deaths from scarlet fever occurred, 1905-1908, out of 1192 cases notified. One death was at 2-3 months of age and three above 8 months of age. (Table 4.21)

Table 4.21. Number and Ages of Infant Deaths Under One Year of Age from Scarlet Fever by Weeks and Months in Merthyr Tydfil 1905-1908. (MOH Reports Merthyr Tydfil 1905-1908.) Age 1905 1906 1907 1908 Total SCARLET FEVER

2-3 months 1 1 3-4months 4-5 months 5-6 months 6-7 months 7-8 months 8-9 months 1 1 2 11-12 months 1 1 Total under 1 3 NIL 1 NIL 4 yr Total Deaths 21 11 11 6 49 Total Cases 334 245 307 306 1192 Notified

Scarlet fever is a serious bacterial infection caused by Group A beta haemolytic streptococcus, which produces the distinctive rash and other toxic effects. Acute tonsillitis and pharyngitis with high fever, severe headache, vomiting and prostration, are followed in 24 to 72 hours by the rash with a typical “strawberry tongue “ and skin peeling in 3-7 days. Diagnosis is extremely difficult in infants. Septic complications, more common in infants, include ear infections, meningitis, heart disease, and renal disease. Bright’s disease, a post-scarlatinal streptococcal infection of the kidneys, caused 10 infant deaths from 1890-7. 157 The period of sickening for scarlet fever was usually 5-7 days and for measles 10-15 days.158 The incubation period between infection and the appearance of a rash is 12-15 days.159 Streptococcal infections vary

157 Nelson et al., Textbook of Paediatrics, pp. 556-560. 158 Dyke, “Duties of School Managers in Relation to Epidemics, and Health of Inmates”, p.15. 159 Dyke, MOH Report for Merthyr Tydfil for 1882, pp.23-25. 194 with geographical location and season, highest in late winter and spring. Many asymptomatic carriers of the organisms in the community made isolation measures against scarlet fever unsuccessful. In 1880 Dyke observed that scarlet fever had followed closely on the trail of measles in many Glamorgan towns and had been the cause of many deaths in Aberdare. He expected the disease soon to “run its pernicious course.”160 Scarlet fever appeared in early spring 1881, with 3 isolated and apparently unconnected deaths and became widespread and severe by the end of the year. The deaths represented 1255 cases, which Dyke considered a low figure since many cases were too mild to report and others suffered from general dropsy, (heart failure) which often followed scarlet fever. A more accurate figure was probably 2000 cases. 161 In July 1881, the illness changed in character with many sudden deaths “from suppressed Scarlet fever.” 162 From July 1881 to June 1882, 350 deaths occurred from scarlet fever. 163 Dyke again advised the Chairman of MTLBH and the School Board regarding school closure. His advice was “little heeded,” but if it had been, Dyke believed that “the melancholy death-toll would have been lighter and less.” 164 The matter required Dyke to defend his opinions on school closure and his position as MOH, when it was stated at the meeting of the MTLBH that five-sixths of the doctors in Merthyr did not agree with this measure. Dyke named nine doctors who agreed with his opinion and three who did not. 165 Dyke sought the support of the Medical Staff through the President of the Local Government Board for his position. The Board censured MTLBH, ruling that it was dilatory in the matter of school closure. The fact that the Urban Sanitary Authority had made no such recommendation was regrettable, since this could have curtailed the spread of the disease. 166 Although the sanitary authority had no mandate to enforce school closure, school managers would doubtless have followed such a recommendation. The disease spread via clothing and bedding and by direct contact with an infected person, skin flakes or less commonly by contaminated food, drink or objects. The spread of scarlet fever by contaminated milk encouraged the inspection and supervision of milk supplies, possibly to a greater extent than tuberculosis, but is given

160 Dyke, MOH Report for Merthyr Tydfil for 1880, p.5. 161 Dyke, MOH Report for Merthyr Tydfil for 1881, pp.5-8. 162 Ibid., p.10. 163 Dyke, MOH Report for Merthyr Tydfil for 1882, p.8. 164 Dyke, MOH Report for Merthyr Tydfil for 1881, p.14. 165 Ibid., p.12., Mooney,’ Public Health versus Private Practice:, pp. 238-67., discusses the issue of professional rivalry in regard to notification of diseases. 166 Walter S. Sendall, Assistant Secretary to Local Government Board, 27 January, 1882, to Clerk to the Merthyr Tydfil Urban Sanitary Authority , Dyke, MOH Report for Merthyr Tydfil for 1881, PRO MH12/1641, 1881., pp.15-16. 195 little attention in the MOH reports before 1895 when it is mentioned in conjunction with the implementation of the Cowsheds, Dairies and Milkshops Order. Overcrowding in poor housing facilitated the spread of the disease. The population of the newer southern districts, especially Merthyr Vale and Treharris since 1889, often forced two or three families to share one house. Under these conditions one infectious case could easily conflagrate to affect many children.167 Sufferers were advised through notices not to mingle publicly, and people were urged to minimise attendance at funerals and to keep siblings of children affected home from school. Houses where cases occurred were well-ventilated and disinfected with chloride of lime, whilst bedding was fumigated and old clothing and rags were burned. 168 These measures made little impact, which did not surprise Dyke, since he believed every school in the district to be a focus of infection.169 The movement of people around the district during the course of their work also helped spread diseases to rural and mining villages, and outbreaks were unpredictable. A severe epidemic in Dowlais lasted from August 1886 into the following year, although nearby Penydarren only experienced 4 deaths.170 In 1891 it was reported that a case of scarlet fever had occurred in the house of a laundress the previous year. Laundry was aired in the room where the child was sick. The underclothing belonged to twenty different establishments and soon after scarlet fever appeared in some of those places.171 Since the Infectious Diseases (Notification )Act had not at the time been adopted in Merthyr, the woman could only be advised not to continue her business in the presence of scarlet fever but to do so would have incurred loss of income. 172 The Infectious Diseases (Notification) Act, 1889, adopted by MTLBH in October 1890, made scarlet fever a notifiable disease and required isolation of the patient. The Act required the head of the family, under penalty, to notify any infectious disease in the household, but few did so. The timing of notification was also important, as early as possible. In 1908, 306 cases were notified, after the rash had disappeared when the skin was peeling. This made it difficult for isolation to be fully effective in stamping out the disease. 173 Most cases were notified by the medical attendants. In

167 Dyke, MOH Report for Merthyr Tydfil for 1892, p.10. 168 Dyke, MOH Report for Merthyr Tydfil for 1881, p.9. 169 Dyke, MOH Report for Merthyr Tydfil for 1882, p.10. 170 Dyke, MOH Report for Merthyr Tydfil for 1886., p.5. 171 Dyke, MOH Report for Merthyr Tydfil for 1891, p.6. Dyke, MOH Report for Merthyr Tydfil for 1892, p.7. 172 Dyke, MOH Report for Merthyr Tydfil for 1892, p.6., Table F, pp.14-15. Mooney,’ Public Health versus Private Practice, pp238-67. Mooney identifies the loss of income induced by notification and isolation, and public and class attitudes to notification including confiscation or loss of personal items during fumigation. 173 Alex.Duncan, MOH Report for Merthyr Tydfil for 1908, pp.13-14. 196 1903, 9 notifications of scarlet fever in infants under one year of age were received, with two deaths occurring. The infant deaths equalled 22% of cases notified compared with the deaths of 8% of children 1-5 years. The cases were widely distributed throughout the district, with 40% of the cases occurring during the last quarter and the cold winter months. Treharris and Dowlais were comparatively free, having been severely affected in 1901. Isolation was not as effective a measure as hoped, and parents did not discourage infection, since it was as easy to nurse two patients as one. The risk of infection reduced greatly after the age of ten and it was not inevitable that anyone should catch the infection.174 No cases of scarlet fever were admitted to hospital between October 1902 and February 1903 due to the presence of smallpox and typhoid fever cases. According to the census of 1901 there were 46 one-roomed tenements and 1356 two-roomed tenements making it impossible to isolate patients at home.175 By 1904 scarlet fever seemed to be much less severe, “of an entirely different kind to that which had caused such a high mortality 20 years ago.”176 As the symptoms got milder, there was a tendency to regard the disease more lightly. In 1904 the majority of cases occurred in the lower district. 177 In 1905 the upper district was most affected. In 1906 the MOH reported that the numbers isolated in hospital were smaller than desirable, and some cases went unrecognised due to their mildness.

The percentage of cases moved to hospital “ is still very small, though larger than the previous year. This is due to want of public appreciation of the value of isolation, and it is to be hoped that greater advantage will be taken of the New Hospital for infectious diseases. Though possibly, owing to the occurrence of mild unrecognised cases, hospital isolation will never be the means of stamping out this disease, yet in a working class district such as this, hospital isolation is of the utmost value in checking its spread. The plan of keeping the patients in hospital for one month only, unless suffering from an aural or nasal discharge, was continued, and apparently with successful results, as no returns cases were notified.178

In 1907, 307 cases were notified, many from the lower district with 101 cases hospitalised and 11 deaths. It was difficult to persuade parents to allow their children to be taken to hospital eight miles away. A few cases again became sick after returning home, and it was decided to revert to keeping cases in hospital for six weeks. When returning home, they were advised to avoid contact with other children for two weeks,

174 Thomas, MOH Report for Merthyr Tydfil for 1904, p.15. 175 Ibid., p.15. 175 Ibid., Thomas, .MOH Report for Merthyr Tydfil for 1903, pp.30-31. 176 Thomas, MOH Report for Merthyr Tydfil for 1904, p.15. 177 Ibid. 178 Duncan., MOH Report for Merthyr Tydfil for 1906, p.11. 197 to avoid catching cold, and to remain outdoors as much as possible.179 This advice was wholly impractical given the circumstances of working-class life for most people in Merthyr. Isolation at home, with limited amenities and facilities, was difficult. The public did not generally appreciate the need for isolation, or perhaps they were fatalistic, unconsciously recognising the complex network of social relations which made up the community which took on a life of its own in defiant mockery of regulatory efforts. The deaths of infants suggest a downward trend in scarlatinal deaths, and a decline in the virulence of the disease. With no treatment available, the decline of the disease was almost certainly assisted by notification, by isolation of patients, by the prevention of contamination of milk supplies, and the diligence of school managers and by the less virulent nature of the disease in later years, although the practice of these principles was more easily said than done.

Diphtheria, Croup and Upper Respiratory Tract Infections

Diphtheria accounted for 144 infant deaths in Merthyr Tydfil 1866-1908 and mainly affected older age groups. Diphtheria, like scarlet fever, was a disease of school- age children, but infant deaths from these infections stress the vulnerability of infants to their home and community environment. In 1896 the mortality rate from diphtheria was 58% of cases, 46 of which were under 5 years of age.180 By 1901, 188 cases were reported, 98 of these in Dowlais, with 41 deaths (21.8 %) and in 1902, 120 cases, 44 of these in Penydarren., with 32 deaths (26.6 %). 181 In 1903, 108 cases were notified, with 25 deaths (23.14 %). Of these, 3 notifications were of babies under one year of age, with 2 deaths in this age group, (66 %.)182 Diphtheria deaths in infants, although not a high proportion of infant deaths, increased from 0.94/1000 in 1867 to 4.71 / 1000 births (11 infant deaths) in 1896 before declining. (Appendix Table 11 (f).) Whilst the danger to infants clearly existed, it made a minimal contribution to infant mortality in Merthyr. Diphtheria, an acute bacterial infection identified by Klebs in 1883, and Loeffler in 1884, was characterised by a sloughing sore throat. It was spread by clothing, even months after use, by persons in contact with the disease, by domestic animals and by raw milk. 183 People could carry the disease asymptomatically for years afterwards.184

179 Duncan, MOH Report for Merthyr Tydfil for 1907, p.15. 180 Dyke, MOH Report for Merthyr Tydfil for 1896, p. 9. 181 Thomas, MOH Report for Merthyr Tydfil for 1902, p.19. 182 Thomas, MOH Report for Merthyr Tydfil for 1903, p. 29. 183 Harry Wain, A History of Preventive Medicine, Charles C.Thomas, Illinois, 1970., pp.354-5. 198 In 1890 Von Behring recognized the deadly toxic effects of the body’s response to the infection, which included airway obstruction, damage to various organs, and chronic disabling illness such as rheumatic heart disease. 185 The life saving anti-toxin became publicly available in 1892, but needed to be administered within 24 hours of the onset of the disease. The state of housing in Merthyr, the levels of overcrowding, a generally poor urban environment, and the presence of a poorly understood disease made cases inevitable. Dyke’s experience during the past twenty-five years was that defective and blocked drains caused disease. 186 In 1880 he described five fatal cases of diphtheria “due to sanitary imperfections in or about the habitations of the sick.”187 Where cases of diphtheria occurred “it is always found that a stopped closet, or a broken pan or pipe, are to be met with.188 Dyke concluded that from December 1882 to April 1883, 17 diphtheria deaths in Dowlais occurred mainly in residences connected with one main sewer, where a grating had been covered with earth. A new ventilating shaft was constructed, the sewer flushed, and no further cases were reported.189 In 1893, 114 cases occurred in Dowlais in early, dry, cold January, following a severe frost. The water flow was inadequate to flush the sewers and when the thaw set in and allowed sewer gas to escape, and heavy rain flushed the sewers, no more cases occurred. Defective sewers were again found and repaired in 1907 where diphtheria cases were reported.190 In 1891 there were 25 notifications and 11 deaths from diphtheria but “in many instances children ill of Scarlet Fever were reported in the same house, and at the same time; the throat malady appeared to be “a local development of Malignant Scarlet Fever.” 191 In 1892, many scarlet fever cases were reported in the households where diphtheria also was reported, and in most instances, faulty drain traps or broken closet pans were also found. 192 By 1897, however, Dyke was forced to admit that diphtheria occurred as frequently in newly erected houses as in older ones. The officers of the local Health Department connected the disease with where chickens, ducks and other birds

184Hubert O Swartout, Modern Medical Counsellor, Warburton, Australia, 1959, pp.748-9. S. Paget, Pasteur & After Pasteur , Medical History Manuals, Adam and Charles Black, London, 1914., pp.10-15. 185 Wain, A History of Preventive Medicine, pp.356-7. 186 Dyke, MOH Report for Merthyr Tydfil for 1893, pp. 6-7. 187 Dyke, MOH Report for Merthyr Tydfil for 1880, p.6. 188 Dyke, MOH Report for Merthyr Tydfil for 1886, p.6. 189 Dyke, MOH Report for Merthyr Tydfil for 1883,pp.4-5. 190 Duncan., MOH Report for Merthyr Tydfil for 1907,p.16. 191 Dyke, MOH Report for Merthyr Tydfil for 1891,p.3. 192 Dyke, MOH Report for Merthyr Tydfil for 1892, p.8., Dyke, MOH Report for Merthyr Tydfil for 1894, p.6. 199 were kept in backyards.193 In 1904 an attempt to trace the source of several diphtheria cases involved the investigation of two milk suppliers who delivered milk to several patients, but the MOH concluded that direct contact was likely to be the source of the infection. 194 Teachers were encouraged to report children suffering from sore throats. 195 In 1904, 14 cases were notified among school students at Abermorlais, with 4 deaths.196 In 1908, 18 children were found crowded into one room in a private house following a number of cases in a small private school. 197 Diphtheria antitoxin injection dramatically reduced the number of deaths, but diphtheria remained a very serious and highly contagious disease, requiring urgent medical attention, with a much higher mortality among cases not removed to hospital. 198 Many parents neglected to call in a doctor early enough and some children were practically moribund by the time notification was received. Such cases would not have been moved to hospital.199 In many cases parents preferred to send other children out of the house rather than send patients to hospital. In 1908 only 18 cases were removed to hospital due to limited accommodation. 200 The Merthyr death rate of 0.41 / 1000 population did not compare favourably with that of 76 large towns of the previous year of 0.16 per 1000. As a result the MOH advised the Council to distribute free serum to the medical men of the district, but the Council “did not see their way to fall in with this suggestion.” 201

Cephalitis, Meningitis, Inflammation of the Brain

Together, all forms of inflammation of the brain accounted for 145 infant deaths, more than those attributed to diphtheria, croup, laryngitis and tonsillitis. Deaths due to various forms of meningitis peaked in 1873 at 5.7 / 1000 births (12 deaths) and then appear to diminish. (Appendix. Table 11 (g).) Meningitis is highly contagious, can be caused by any number of viral or bacterial pathogens, and can also occur secondary to

193 Dyke, MOH Report for Merthyr Tydfil for 1897, p. 8. Max Josef von Pettenkofer, 1818-1901, a German chemist and sanitarian, studied the aetiology and spread of cholera. His landmark system of sewage disposal eliminated typhoid from the city. Blakiston’s New Gould Medical Dictionary, Second Edition, McGraw-Hill Book Company Inc., New York, 1956., p. 895. 194 Thomas, MOH Report for Merthyr Tydfil for 1904, p.16. 195 Duncan, MOH Report for Merthyr Tydfil for 1906, p.12. 196 Thomas, MOH Report for Merthyr Tydfil for 1904,p.16. 197 Duncan , MOH Report for Merthyr Tydfil for 1908, pp.14-15. 198 Thomas and Duncan, , MOH Report for Merthyr Tydfil for 1905, p.24. 199 Duncan, MOH Report for Merthyr Tydfil for 1907, p.16. 200 Duncan, MOH Report for Merthyr Tydfil for 1908, p.14. 201 Duncan, MOH Report for Merthyr Tydfil for 1906, p.12. 200 other infections such as sepsis, influenza, pneumonia, salmonella, tuberculosis or typhoid fever or even post vaccinal.202 Dyke was unclear as to the cause of this illness, but in 1884 pondered: “How far the increased strain upon the cerebral nervous system of very young and rapidly growing children, may have to do in promoting this form of disease, must be the subject of extended enquiries.” 203 From 1904, all deaths in this category are tabled as due to meningitis. A total of 14 deaths are recorded from 1905- 1908, 8 of these in 1905. All were above 3-4 months of age with the majority above 6-7 months old. (Table 4.22.) Table 4.22. Number and Ages of Infant Deaths Under One Year of Age from Meningitis by Weeks and Months in Merthyr Tydfil 1905-1908 (MOH Reports Merthyr Tydfil 1905-1908.) MENINGITIS 1905 1906 1907 1908 Total 3-4 months 2 1 3 4-5 months 1 1 6-7 months 1 1 2 7-8 months 1 2 3 8-9 months 1 1 9-10 months 1 1 11-12 months 2 1 3 Total under 1 8 1 2 3 14 yr

Secondary Infections and Other Diseases

A total of 111 infant deaths from secondary infections were recorded 1865-1908, 46 of these from erysipelas and 17 from skin disease (Appendix. Table 12.), forming a low steady rate of infant mortality from secondary infections up to 3.92 infant deaths /1000 in 1905. One death in 1890 was “After Vaccination,” another death occurred in 1906 in an infant 2-3 weeks old. While statistically not significant they need to be acknowledged as part of the other causes which are overlooked in favour of examining the major causes of infant mortality. Erysipelas (St. Anthony ’s Fire) is an acute streptococcal infection, usually of the skin, which confers no immunity to further infection. The patient needs to be isolated and relapses are common, although less severe. Localised infection may occur at the site of a skin wound, from eczema, impetigo, varicella or vaccinia (vaccination sites). In newborn infants the site is usually around the umbilicus, genitalia, face and extremities. The site may be red, hot, tender, or vesiculating. The infection may spread via the lymphatic system in infants to cause lesions in the liver, kidneys, brain, heart or other organs, and may cause suffocation if it

202 Nelson., Textbook of Paediatrics, p. 688. 203 Dyke, MOH Report for Merthyr Tydfil for 1884, p.7. 201 spread to the larynx. Not surprisingly, the infection may be accompanied by fever, by a subnormal temperature, malaise, irritability, vomiting and loss of appetite, all symptoms of a sick baby. Complications of erysipelas in infants can include septicaemia, bronchopneumonia, peritonitis, abscess and ulceration of the infected area or brain abscess.204 Prior to antibiotic therapy being available a mortality of up to 80% could be expected in susceptible infants. Overcrowding and substandard living conditions increased the dangers of infection to babies and young children.

Conclusion

As an important public health issue, the control of infectious diseases was a primary agenda, and infectious diseases in Merthyr have therefore been considered as part of the problem of high infant mortality. The analysis reveals that deaths from all forms of tuberculosis and infectious diseases do not explain Merthyr’s high infant mortality rates.A total of 2843 infant deaths were attributed to infectious diseases in Merthyr Tydfil 1866-1908, most from mesenteric tuberculosis, whooping cough and measles. All forms of infectious disease, excluding tuberculosis, accounted for at most 38.58 infant deaths per 1000 births in 1870 leaving a number of other factors to be considered. Merthyr’s appalling reputation before the appointment of the Merthyr Tydfil Local Board of Health in 1850 was difficult to overcome despite the supply of water to the town, the provision of sewerage and drainage, and general sanitary improvements. The eminent sanitarian, Dr Thomas Jones Dyke, as Medical Officer of Health was wholeheartedly committed to the assiduous application of public health principles, including the prevention of the spread of infectious diseases. Once the basic sanitary requirements were established, Dyke identified the chronic state of poor housing and overcrowding as contributors to infectious disease, lung diseases and high infant mortality. Dyke attributed tuberculosis among families to poverty, chronic ill-health, damp dwellings and hereditary factors, and the decline of the disease to drainage of damp dwellings. Tuberculosis declined overall, particularly following the adoption of the Cowsheds, Dairies and Milkshops Order of 1889. A rise in the 1890s coincided with the rapid growth of population in the lower district and overcrowding as young families shared accommodation and a pool of non-immune under five year old children sustained endemic measles and whooping cough, accompanied by chronic lung diseases.

204 Nelson, Textbook of Paediatrics , pp.561-2. 202 Tuberculosis, as an opportunistic disease, appears to have flourished in these overcrowded conditions featuring chronic ill-health. Measles and whooping cough, however, were endemic in Merthyr, sustained by the large non-immune population of under five year olds in a town where early marriage, large families and overcrowding were common. Apart from smallpox vaccination there was no specific prevention or treatment for infectious diseases other than the general principles of isolation of patients, general disinfecting and cleansing, the exclusion of infected children from schools, the inspection of milk supplies and the notification of infectious diseases. Isolation was also impractical, due to overstretched public facilities, and was almost impossible in overcrowded homes. Community attitudes that infectious diseases in childhood were inevitable, and such practices as visiting, accompanied by children, those sick or dead from infectious diseases, obstructed the public health vision of control over the private sphere, over people’s movements and customs. This lack of public cooperation, created an unconscious community sabotage of public health protocols which stemmed from adherence to the knot of community affiliation which ensured one’s survival in Merthyr. Dyke was adamant that infectious diseases were spread through school attendance and insisted that school closure was essential to control epidemics. Until 1891 school managers were under no legal obligation to comply with his request, but appear to have cooperated voluntarily. The permissive Infectious Diseases (Notification) Act of 1889, adopted by Merthyr Tydfil Local Board of Health in October 1890, lacked compulsory notification of measles, whooping cough and tuberculosis. Notification was more useful in principle than practice due to the long incubation period whilst diseases were infectious, and the mildness of some cases. Most older children were immune to measles and whooping cough, and their exclusion from school assisted little. Scarlet fever and diphtheria were diseases of older children, also spread by school attendance, which still posed some risk, however small, to infants. All deaths from infectious diseases were only the tip of the iceberg. For every death there were, according to Dyke, an estimated ten cases of infection in the community, many capable of generating chronic ill-health. Dyke’s persistent efforts to minimise the destructive effects of epidemics should not be undervalued. Despite the adverse conditions which characterised Merthyr during the nineteenth century, deaths from tuberculosis, whooping cough, measles, scarlet fever and diphtheria in Merthyr tended to decline by 1908. Measles continued to be of concern in 1905, causing many infant deaths.

203 The fact remains however that infectious diseases alone do not appear to have been the primary causes of high infant mortality rates. We need also to look elsewhere. Chapter 5 will address lung diseases and diarrhoea as causes of death which increased from the 1880s. Chapter 6 will explore nutritional causes of death in conjunction with deaths of maternal origin and antenatal causes which linked the high death rate of infants with the health of mothers.

204 Chapter 5

Lung Diseases, Diarrhoea, and Infant Deaths in Merthyr Tydfil 1865-1908

Introduction

Chapter 4 discussed the analysis of all causes of infant deaths in Merthyr Tydfil 1865-1908 and focused on infectious diseases as a significant public health concern. Although whooping cough and measles were endemic in Merthyr and posed a significant threat to babies, infectious diseases by themselves could not possibly account for the high levels of infant mortality in the town. Dyke observed that deaths from lung diseases often increased following whooping cough and measles epidemics. Chapter 4 also identified the marked increases in deaths from both lung diseases and diarrhoea from 1884 -1901 which contributed substantially to the high mortality rates. It also suggested that the fall in reported deaths from convulsions as a symptomatic cause of death may be connected with gastric disorders and more accurate reporting of diarrhoea deaths.1 This chapter therefore examines lung diseases and diarrhoea as major causes of infant death in the social context of nineteenth-century Merthyr. When lung diseases and diarrhoea are recorded as the primary cause of death, they must be accepted as such, but they provide another example of the way in which various causes of infant death interact. They share certain similarities. Both can by themselves bring about the death of an infant; both are also frequently the main accompanying symptom(s) of other illness in babies. Both are subject to seasonal influences; lung diseases increased during the cold winter months and diarrhoea deaths increased during the warm summer months. Both were spread by close contact in the overcrowded conditions which were frequently experienced in Merthyr. Since most overcrowding occurred in working-class areas, deaths from diarrhoea and lung diseases were notoriously high in those areas, especially in mining communities, as was the case with most other causes of infant death. 2 Certainly deaths from both lung diseases and diarrhoeal diseases rose in Merthyr during the 1890s as deaths from convulsions declined. (Figs.6, 7, Appendix, Table 15.) The increases raise the question of whether there may be a connection between the two

1 Gassage and Coutts, “A Discussion on Convulsions in Infancy “, The British Medical Journal, 19 August 1899, pp. 460-463. 2 Ann Hardy, The Epidemic Streets: Infectious Diseases and the Rise of Preventive Medicine 1856-1900, Clarendon Press, Oxford, 1993, reprinted 2003., pp. 28, 38.

205 diseases, although the differing seasonal factors influencing them may account for the lack of any clear pattern in their movement. Deaths from both diseases rose in 1895, whereas in 1899 diarrhoea deaths rose markedly, not just in Merthyr but across the nation, when deaths from lung diseases did not.

Lung Diseases

Lung diseases themselves accounted for a significant number of infant deaths, but a considerable number of factors associated with them helped sustain infant death rates. Bronchitis and pneumonia were frequently secondary to, or associated with, other illnesses, particularly infectious diseases, and might also be accompanied by diarrhoea. The increasing trend in deaths from lung diseases may indicate more accurate diagnosis or classification of causes of death, but, like convulsions, it does not necessarily indicate an accurate diagnosis of the primary cause of death. The increase in deaths from lung diseases and from diarrhoea may partially be accounted for by the declining number of deaths assigned to convulsions, which fell from 51.7 /1000 births in 1866 to 27.8 / 1000 in 1908. The exchange between convulsions, diarrhoea, and lung diseases and the relationship between infant mortality from lung diseases, tuberculosis, whooping cough, measles, convulsions and diarrhoea are shown in Appendix. Table 15 and Figures 6 and 7. There are no consistent correlations between deaths from lung diseases, infectious diseases, diarrhoea or convulsions, although they appear to be connected in some way in certain years. Many of the years in which lung diseases peaked coincide with epidemics of measles or whooping cough, sometimes both, although whooping cough was present every year except 1869. (Appendix Table 15.) Lung diseases accounted for a minimum of 12.21 infant deaths per 1000 births in 1872 and as many as 49.82 in 1905, a particularly bad year, when there was also a high number of deaths from measles. Many deaths from lung diseases are likely to have been from secondary pneumonia following measles, suggesting that deaths originating from infectious diseases were much higher than officially recorded, but the incidence of lung diseases (49.82 /1000) being greater than that of all infectious diseases (27.49/1000 including all forms of tuberculosis) suggests also that a chronic pool of viral or bacterial pneumonia was endemic and able to take its toll on infants, especially during the cold winter months. Lung diseases and infectious diseases were linked both medically and socially. There were understandably marked variations in deaths from lung diseases each year

206 depending on the weather and the presence of epidemics. Lung diseases tended to increase with epidemics of whooping cough and measles, worsened by the harsh winter climate. One reason for this is the immature temperature regulation mechanisms of young babies.3 The cold weather in 1865, for example, almost certainly compounded the effects of infectious diseases. That deaths at all ages from lung diseases increased in the cold weather in conjunction with deaths from “contagious fevers” is evident from Dyke’s tables (Table 5.1.) Over half of the 1,634 deaths in 1865 occurred in the first half of the year from lung diseases and “Contagious Epidemics.” 4

Table 5. 1. Principal Causes of Deaths and Numbers Due to Each in 1865 (Dyke Report for 1865, Table V11, p.21) Quarter All Scarlet Measles Smallpox Typhus Bronchitis Consumption Causes fever Etc. 1st 508 54 42 42 40 28 89 2nd 453 52 12 17 27 14 80 3rd 297 34 9 12 7 57 4th 376 45 7 9 55 Total 1634 185 54 68 86 58 281

The likelihood of respiratory complications from whooping cough was great. Ninety per cent of deaths from whooping cough in children under three are caused by secondary bacterial pneumonia, and the younger the infant the more serious the outcome is likely to be. Whooping cough can last several weeks or even months, and malnourishment makes a child less able to withstand the severity of coughing and the weight loss which accompanies an attack of whooping cough due to persistent vomiting, leaving them severely debilitated.5 Further complications as a result of whooping cough include convulsions and tubercular meningitis. 6 In 1903 the MOH for Merthyr noted that epidemics of measles and whooping cough seemed frequently to occur in association with each other, with a pernicious effect.7 Measles often seriously depletes a child’s nutritional status, leading to chronic ill-health, the child commonly manifesting with diarrhoea and bronchitis a month later, and allowing tuberculosis the opportunity to take hold. The respiratory complications which followed measles were a frequent cause of death, especially if the disease were viewed lightly and the child poorly cared for whilst recovering.8 Pneumonia was estimated to cause up to 90% of deaths from measles, made worse by poverty,

3 George Newman, Infant Mortality: A Social Problem, Methuen and Co., London, 1906., p. 49. 4 Dyke, MOH Report for Merthyr Tydfil for 1865, Table V11, p. 21. 5 Thomas, MOH Report for Merthyr Tydfil for 1903, pp. 14-15. 6 Hardy, The Epidemic Streets, Infectious Disease and the Rise of Preventive Medicine, 1856-1900, Oxford 1993, pp.13, 15, 16. 7 Ibid., p. 21 8 Ibid., pp. 41-45.

207 overcrowding and compromised health. 9 The seasonal occurrence of measles and the ensuing lung diseases was aided by the fact that most people remained indoors during winter, often closeted with highly infectious diseases. Overcrowding increased the risk of spreading the disease to other children and reduced the possibility of good nursing care. Parents and adults were not immune to these diseases, affecting their ability to care and provide for children.10

Table 5. 2. Years of Peaks in Lung Diseases as Diseases Specific Infant Mortality Rates and Percentage of Infant Mortality Rates in Merthyr Tydfil 1866-1908 (MOH Reports for Merthyr Tydfil 1865-1908.) Year Troughs Peaks Factors DSIMR % of IMR DSIMR % of IMR

1868 14.54 11.18 1870 30.24 16.17 Whooping cough, measles, scarlet fever 1872 12.21 8.31 1873 40.36 Whooping cough, measles, scarlet fever 1876 18.41 13.24 1881 13.90 1886 40.80 21.07 Whooping cough, measles, scarlet fever 1888 22.85 15.87 1891 47.33 24.52 Influenza 1895 47.00 20.17 Measles, whooping cough 1896 27.42 12.87 1903 26.89 17.58 1905 49.82 24.30 Measles

Deaths from pneumonia and bronchitis among infants increased nationally 1873- 1902, coinciding with an increase in such deaths among the general population.11 Following the cold winters of 1879 and 1880, 66-79% of all lung disease deaths in Merthyr were above five years of age, and deaths under one year accounted for 11-14% of deaths. During the influenza of 1891, almost 72% of deaths from lung diseases were above five years of age and 20% were under 1 year. The balance of deaths from lung disease among 1-5 year old children and babies under one year shifted from year to year until 1889, but thereafter the analysis shows reported deaths from lung disease among the under one age group are consistently greater as diarrhoea deaths also rose noticeably. (Appendix Table 14 (a) and (d).) In 1866 infant deaths attributed to lung diseases represented 11.31% of all infant deaths in Merthyr, but by 1905 that figure had risen to 24.3%; and the DSIMR for lung diseases rose to steadily higher peaks, reaching 49.82 deaths per 1000 births in 1905. (Table 5.2.,Appendix, Table 14 (c).) Even the troughs between peak years increased, suggesting an increasing and chronic pool of

9 Ibid., pp.41-42. 10 Ibid., pp.17-18. 11 Newman, Infant Mortality, p.53.

208 lung diseases. In 1891, the peak DSIMR of 47.33 deaths /1000 births coincided with an epidemic of influenza, while the peaks in 1870, 1886, 1895 and 1905 coincided with epidemics of whooping cough and measles, and with severe winters. 12 Table 5. 3. Deaths of Infants Under One Year of Age by Week and Months in Merthyr Tydfil 1905-1908 from Lung Diseases ( MOH Reports for Merthyr Tydfil 1905-8) Age Bronchitis Pneumonia Total Under 1 wk 3 3 1-2wks 2-3 wks 6 2 8 3-4 wks 5 4 9 Total under 1 month 14 6 20 1-2 months 28 9 37 2-3 months 17 17 34 3-4 months 14 19 33 4-5 months 20 17 37 5-6 months 9 18 27 6-7 months 16 22 38 7-8 months 11 27 38 8-9 months 10 24 34 9-10 months 9 25 34 10-11 months 7 23 30 11-12 months 12 20 32 Total 1–12 months 153 221 374

Total under 1 yr 167 227 394* * 396 including two deaths from other lung diseases

The toll of 3,057 infant deaths from lung diseases in Merthyr 1865-1908 comprised 1,668 from bronchitis and 1,228 from pneumonia, and 161 from other forms of respiratory ailments. The age at which these infant deaths occurred 1905-8 is shown in Table 5.3. The total of 396 deaths from lung diseases 1905-8 represents 20% of all infant deaths in those years, only 5% of which occurred within the first month of life and less than 1% within the first week and almost certainly associated with premature birth and underdeveloped lungs, discussed in Chapter 6. The majority of cases occurred from the second to the seventh month. Bronchitis deaths increased rapidly from the first month through to the fifth month, then declined, but pneumonia deaths increased from the second to the seventh month and were then sustained through to 12 months. Higher fatality rates were to be expected from pneumonia than from bronchitis. The substantial number of deaths from bronchitis almost certainly represented only a portion of the number of cases, leaving those that recovered with weakened constitutions.

12 I am indebted to Professor Geoffrey Bolton for the information that his grandparents were married during the memorably severe winter of 1895. A painting by Dr Joseph Murie, St Paul's from the river. Winter (1895), held at the National Maritime Museum , London, Repro ID: H6656 shows St Paul's Cathedral towering over the frozen Thames during the winter of 1895. This was the time of the 'Great Freeze', when the river was paralysed by a long and severe winter. Although the Thames did not freeze over completely as it did in the days of the 'frost fairs', the disruption to normal river traffic was considerable. URL: http://www.portcities.org.uk/london/server/show/conMediaFile.8663/St-Pauls-from- the-river-Winter-(1895).html

209 Respiratory illnesses and epidemics interwove through other aspects of life in Merthyr in creating the death rates. In 1869, for example, wages were lower, poverty abounded, and there were many deaths during a severe typhus epidemic. Although whooping cough was absent and measles was mild, peaks in lung diseases and convulsions coincided, and there was a slight rise in diarrhoea deaths.13 Deaths from convulsions increased by 17% that year, and acute lung diseases by 14%. According to Dyke, these diseases “are of that urgent character that need, imperatively need, early and prompt treatment by experienced medical men, and careful watching by parents and nurses.”14 Deaths from infantile convulsions in Merthyr in 1869 at 25.5 /10,000 population were nearly double those in England and Wales at 13.1 /10,000. Deaths from acute lung diseases in Merthyr were 19.7 per 10,000 compared with 12 per 10,000 in England and Wales.15 Dyke warned that

From the above it will be apparent that there is urgent need to repair these openings in our sanitary armour. Probably much of this unnecessary mortality of the innocents may be owing to the improper food with which they are fed, and the great exposure to cold and wet to which their partially clothed bodies are exposed. 16

During the smallpox epidemic year of 1872, there were fewer than 2 deaths/ 1000 births from whooping cough, no deaths from measles, and few deaths of infants from lung diseases. During the whooping cough and measles epidemic of 1873, however, 31% of all deaths from lung diseases were under one year of age. It is evident from Dyke’s 1878 report that in his view whooping cough contributed to a rise in deaths from lung diseases and bronchitis. In 1878 he explained many of the factors affecting whooping cough and lung diseases in Merthyr:

It is believed that the Contagion of Whooping Cough is mainly contained in the phlegm expectorated by the sick child, and that the malady is propagated by the diffusion of the exhalations from that phlegm, through the air surrounding the patient. It is notorious that children labouring under Whooping Cough are not confined to the house, but are allowed to go about the streets, to attend Schools, Chapels, &c., and hence the promoting cause of the malady is widely spread, numbers of little ones are affected, and in a certain proportion of cases the issue is death. These fatalities are however mainly due to inflammation of the air passages and of the lungs. Doubtless many instances of the occurrence of diseases of the organs of breathing, concurrently with Whooping Cough, may be due to the straining

13 Dyke, MOH Report for Merthyr Tydfil for 1869, p. 3. 14 Ibid., p.12. 15 Ibid., p.13. This is another example of Dyke’s reporting which obscured infant mortality by not using a standardised reference range. 16 Ibid.

210 inseparable from the violent paroxysmal cough; doubtless also some cases are due to unwise exposure to cold; but I am of opinion that the main cause is the neglect, on the part of the parents, to avail themselves of the advice of a skilled medical practitioner, under the mistaken belief that it is a malady that must be allowed to run its course; for unquestionably, when Whooping Cough is carefully treated, the duration of the attack may be shortened, and the contagion of the malady destroyed. 17

In 1886, 29 infants died from whooping cough, accounting for 14.79 deaths /1000 births, and 103 babies died from convulsions. Measles accounted for a further 6 deaths, whilst another 80 infants died from lung diseases at a peak rate of 40.80 /1000 births. Whooping cough almost certainly influenced the high rate of deaths from lung diseases in 1866, 1870,1873-4,1878,1882-3,1886,1889-91,1894, and 1898, at roughly four year intervals. ( Appendix, Tables11 ( d)., 15..) Measles was present in many years, and measles epidemics in 1874, 1880, 1885, 1892, 1897, 1901 and 1905 are likely to have been a great influence. As emphasised in Chapter 4, whooping cough, like measles, was not a notifiable disease, a point which Dyke and his successors made repeatedly. 18 There is clearly a relationship between lung diseases, measles and whooping cough, which is borne out by the evidence of the MOH reports, which is not wholly reflected by the analysis of recorded deaths from lung diseases and infectious diseases. The association between lung diseases and infectious diseases is not entirely substantiated by the analysis of causes of death except in certain years. Moreover, as deaths from infectious diseases forms a plateau or tended to decline, deaths from lung diseases continued to rise, accounting for 49.82 /1000 births in 1905. The peaks in deaths from lung diseases in 1877, 1887, 1891 and 1895 are not adequately explained by infectious disease patterns. The whooping cough epidemics of 1866 and those from 1889 onwards do not correspond with peaks in lung diseases, and neither do the measles epidemics of 1874, 1880, 1885, 1892 or 1897. However, whereas in several years neither measles nor whooping cough caused an exceptionally high death rate, together their impact was more significant, amplified by subsequent deaths from lung diseases. An example of the compounding effect occurred in 1885, when 35 babies died, 9 others died from whooping cough and 68 from lung diseases (25%). Although measles and whooping cough accounted for only 15% of infant deaths that year, the deadly combination of these diseases with bronchitis or pneumonia accounted for 37% of infant

17 Dyke, MOH Report for Merthyr Tydfil for 1878, pp.5-6. 18 Dyke, MOH Report for Merthyr Tydfil for 1897, p. 8., Dyke, MOH Report for Merthyr Tydfil for 1876, p.8., Duncan, MOH Report for Merthyr Tydfil for 1908, p.13. Duncan, MOH Report for Merthyr Tydfil for 1907, p.14.

211 deaths, and 42% including opportunistic deaths from tuberculosis. 19 However, the primary evidence of Dyke and his successors that deaths from bronchitis and pneumonia increased during epidemics of measles and whooping cough cannot be ignored and the MOH reports give further insights into other factors at work. In 1869 Dyke succinctly drew together the Merthyr climate, poorly constructed and badly ventilated houses and urban filth to explain the way in which poverty and malnutrition, combined to raise the death rates.

This long continuance of wet weather acted most perniciously; for remembering that the houses in the parish are mostly built of a porous sandstone, on foundations of unmortared stone, with floors of paving- stone laid on the soil after the removal only of the sod the result was to saturate the foundations of the abodes of our poorer brethren with water, that water moreover charged with the excrementitious deposits freely scattered in backyards and gardens: the cold winds required that the doors and windows should be kept closed, and thus that throrough ventilation which houses so damp imperatively needed was prevented, lastly food was dear, and labour ill remunerated; these various causes combined to raise the average mortality to 28 in the thousand.20

In practical terms, lung diseases posed a very real threat to infants whether in their own right, or secondary to other conditions. The opportunity was greater in overcrowded dwellings and where the infant was weakly or its health was undermined by a series of chronic infections resulting in malnutrition. Dyke blamed the weather in the mountainous district of Merthyr, but also occupational conditions. By 1889, 339 deaths from respiratory diseases accounted for 25% of all deaths, 21 but in 1890 this reached 30% when influenza exerted “its pernicious influence upon those who were suffering from chronic bronchial affections and chronic lung diseases.” 22 The following year “the all-pervading and pestilent action of the malady known as Influenza, brought sickness into many thousands of houses, and death to a great number, who were hurried, at the very briefest notice, to the end of this world’s life.” 23 A total of 600 deaths from laryngitis, bronchitis, and pneumonia accounted for 33% of total deaths including 171 less than five years of age. Of the latter, 109 were infants who apparently were not immune to the pernicious effects of their social environment, surrounded as they were by sufferers of chronic lung conditions, in a harsh climate, in substandard housing. The adult population moved freely about their business, frequently either infecting others or

19 Dyke, MOH Report for Merthyr Tydfil for 1885, p. 6. 20 Dyke, MOH Report for Merthyr Tydfil for 1869, pp. 19-20. 21 Dyke, MOH Report for Merthyr Tydfil for 1889, p. 3. 22 Dyke, MOH Report for Merthyr Tydfil for 1890, p. 8. 23 Dyke, MOH Report for Merthyr Tydfil for 1891, pp. 8-9.

212 being infected themselves by colds, influenza, tuberculosis, and other infectious diseases. Annual variations in lung disease deaths suggested seasonal influences as well as prevailing epidemics Dyke was clearly frustrated knowing that there were steps which could be taken to prevent some such deaths. In 1873, with a very cold winter, there were many deaths due to acute lung diseases, but diarrhoea deaths also rose. Whooping cough contributed to the deaths from lung diseases that year, and Dyke witnessed children needlessly exposed to a very cold climate from which they should have been protected. (Appendix, Table 15, Table 5.4.) Uncertain exactly how these diseases related to each other and their effect on the respiratory tract, Dyke explained their mode of spread by living germs or seeds, by emanations from the soils, by minute floating particles, yet also by sudden changes in temperature:

Affectations of the organs of breathing must necessarily include many forms of disease. The air we breathe may be too cold, and chills may result; it may be changed too rapidly from heat to cold, or the reverse,and the delicate construction of the lung tissue may be affected; emanations from the soil, minute floating particles, capable of each producing its own specific malady, these inhaled, injuriously affect the health, and induce specific forms of disease. Thus it has been in 1889,1890 and 1891 that Influenza on the one hand, Scarlet Fever on the other, each in its wide spreading course has claimed its victims. These are the causes that human intelligence can scarcely more than hope to grapple with.24

He also connected respiratory complaints with impoverishment and unhealthy living conditions, arguing that lung diseases were also an expression of insufficient food, poor nursing, the cold wet climate and damp unhealthy housing, as he had explained in 1869. The seasons each brought their own difficulties for infants in the struggle for survival. The warm summer months brought relief from the cold wet winters, but could also increase the risk of epidemic summer diarrhoea in hot dry summers. Wet summers proved kinder to babies with fewer flies about to spread infection. Social occasions could increase the spread of infectious diseases, particularly during the summer holidays as people visited relatives in other districts. Once children were back at school, infections could spread rapidly in the closed stuffy atmosphere of the school room. However, come the cold winter months the cold, wet, climate of Merthyr high in the mountains could prove deadly for the very young and the old. Some districts were more exposed than others to cutting winds. Dowlais, at the head of the valley, was very

24 Ibid., p.17.

213 exposed, extremely cold, and damp. Gellideg was a small fairly isolated community which otherwise enjoyed a fairly healthy population.

Acute Inflammation of the organs of breathing have been the main causes of sickness and mortality. The frequent changes of temperature in these vales, and on the hill sides, which is due to the formation of the district in narrow ravines between lofty ridges; the lowness of the night temperatures caused by the descent of cold air from the hilly ranges, the great number of wet days (176 in the year), the large amount of water falling as rain (57 inches annually) and the clayey soil overlying the coal and ironstone formations; these, each and all, have conduced to render this upland valley cold and damp, while the occupations of the workmen, have necessarily exposed them to the chilling influences of the north-east winds blown over ridges 12 to 16 hundred feet above sea-level. It is thus, that in the town of Dowlais, which is especially exposed to the cold blasts coming over the lofty Beacons, the winds descending from the narrow water-bearing valley of the Lesser Taff, burst upon the habitations there, unsheltered by hillock or ridge. The consequence is a large excess of deaths from acute lung diseases. Again, the houses on the Western side of the valley in the hamlet of Gellideg are especially exposed to the blighting blasts of the east wind, and here also the sparse population is each year much affected by acute lung diseases. The other parts of the district are comparatively sheltered and do not suffer to the same extent. 25

There were also significant variations in the death rate within the year. The summers of 1864-5 had been very dry, contributing to much sickness. 26 From January to the end of March 1865, the weather in the first quarter was predictably, but particularly, cold and frosty:

The temperature in March was so cold that we have to go back 20 years to find a period of so low a temperature. Snow storms were so frequent, that snow fell on 81 days during the Quarter, at one or other part of the country; on some days over the whole of England and Scotland at the same time. 27

The death rate during the first quarter was 41 /1000 in Merthyr and 27/1000 in England and Wales. Table 5. 4. shows the dramatic rise in the death rate during the first, cold winter quarter of the year compared with the remaining quarters and compared with the national death rate. January 1867 was very cold with frost, snow and night time temperatures averaging 27F [ 1 C], falling as low as 20F [-7C.] March 17th was again cold with a day temperature of 23F [-4C]. “On the 1st December a very violent gale of wind blew from the North, accompanied by rain and snow.” At 3pm the gale was at its height, and by 10pm, “when the wind had lulled’, the temperature had fallen to 29F [-

25 Dyke, MOH Report for Merthyr Tydfil for 1878, pp. 14-15. 26 Dyke, MOH Report for Merthyr Tydfil for 1865, p. 19. 27 Ibid., p.13.

214 2C.] Thereafter the temperatures for several nights were 25F [-1C]. 28 Daytime temperatures might not rise appreciably from very cold night temperatures, and the cutting winds could cause a rapid drop in temperature also. In 1868 the mean temperature during the first week in January fell to 5 degrees below freezing.29 “These influences [the weather], acting upon a population whose industry was ill-rewarded owing to the depression of the Iron Trade, were in 1869 very painfully manifested.” 30 Dyke also reported summer temperatures of 84F in the shade and 120F in the sun during that summer.31 Severe winters such as December 1872 virtually stopped the movement of coal out of Merthyr, and mild winters in 1881 and 1884 were bad for collieries producing for domestic consumption.32 1883 was very cold in March, 1891 was very cold from December to April and 1895 was one of the coldest years recorded.33 Dyke ceased to regularly report weather conditions after 1872, although reports on rainfall continued. The available reports confirm that winter temperatures in Merthyr were sufficient to compromise the fragile health of young, sick or premature babies, especially when combined with overcrowding, poorly ventilated damp houses, and the presence of infectious diseases, the changeable mixture of circumstances which explained different mortality rates in different districts.

A rise in lung diseases as a percentage of total deaths in 1873 and 1874 coincided with a combination of factors prejudicial to good health. The period 1871-75 was punctuated with bitter industrial strife which, along with widely fluctuating prices of iron bars, affected the income of workers and their families. Dyke succinctly describes the sudden and disastrous effects, in 1875, of inability to labour in an industrial town dependent on a single major industry. 34 Once labour ceased there was little income for families. Saving was prudent, but not always possible. Poor relief afforded little more than subsistence. Many men migrated in search of work leaving their wives and families in Merthyr. The community at large suffered greatly, though generous public donations allowed 4000 children to be fed from soup kitchens daily for fifteen weeks. In addition, mothers swallowed their pride in order to beg for food and solicit assistance door-to-door. The provision of a daily meal from soup kitchens appeared to improve the children’s health, saying little of comfort concerning their diet

28 Dyke, MOH Report for Merthyr Tydfil for 1867, p. 19. 29 On 30 October at 10.40p.m. “a shock of earthquake was felt which lasted about three seconds.”Dyke, MOH Report for Merthyr Tydfil for 1868, p. 13. 30 Dyke, MOH Report for Merthyr Tydfil for 1869, p. 19. 31 Ibid., p.20. 32 Benson, British Coalminers in the Nineteenth Century: p.8. 1900 was also a severe winter. 33 This is confirmed by Met Office records. URL: www.metoffice.com/climate/uk/stationdata/index.html 34 Dyke, MOH Report for Merthyr Tydfil for 1875, pp. 13-15.

215 at other times. Dyke ascribed the reduction in the death rates during this period to nourishing food given to the children, and adult abstention from intoxicating liquor, 35 but labour remained irregular, wages were low and food was dear throughout the remainder of the year, an excellent example of the economic interdependence of social health and industrial relations. However, the relatively low infant mortality rate of 159/1000 that year also indicated that a whooping cough epidemic, which began in 1873, had reached its height in 1874 and had virtually ceased in 1875. There were also few diarrhoea deaths. The DSIMR from lung diseases, which had been 40.36 in 1874, fell away to 27.24 in 1875.

Table 5.4. Comparative Death Rate per 1000 Population Each Quarter Merthyr Tydfil and England and Wales, 1865 ( MOH Report for Merthyr Tydfil for 1865, p.13) Quarter of the Rainfall Merthyr Rainfall Death rate Death rate Year England and Merthyr Tydfil England and Wales Wales 1st Quarter 9.88 inches 6.10 41 27 ¾ 2nd Quarter 7.90 7.25 32 22 ¼

3rd Quarter 8.95 6.50 22 21 ½

4th Quarter 23.64 9.25 26 25 1/2

Lung diseases affected people of all ages, infants, the elderly and industrial workers. In 1879, during a prolonged cold period, there were 223 deaths from “acute inflammation of the organs of breathing.” Of these 36 were under one year of age, 16% of infant deaths. According to Dyke:

These maladies were exceptionally infrequent during the long prevalence of wet weather in the spring and summer months: when, however, on the 3rd of October the dry cold East wind began to blow, and continued until the 26th December, during this unusually lengthened period of 12 weeks of dry cold weather, severe colds were taken, and deaths from acute diseases of the air passages and lungs became very frequent. Reference to the tables will show that it was the very young, and those far advanced in years, who more especially sank under the diseases; but yet it will also be seen that very many in the prime of life died there from. 36

The climate took its toll on workers, exposed to high temperatures at work, and then exposed to the cold wet climate as they returned home. Occupational mortality associated with the iron and coal industries was high among adult males. Death,

35 Dyke, MOH Report for Merthyr Tydfil for 1875, p. 14. 36 Dyke, MOH Report for Merthyr Tydfil for 1879, p. 6.

216 disability or incapacity to work left families economically vulnerable where the bulk of the population depended on the wage earners. In 1881 Dyke explained that lung diseases particularly affected males in the 40-60 age group, 37 and in 1887 23% of total deaths from respiratory problems occurred among the working men:

………. doubtless, the occupation of our working men in the dusty coal pits, on the equally dusty coke yards and cinder tips, or at the smelting furnaces, and in the covered, but open, rolling and rail mills, these tend very much to induce a state of the air passages which readily becomes affected by disease. 38

However, deaths among infants from lung diseases represented 27.55 % of total deaths that year and 31% by 1904. The deaths above and below five years of age as a percentage of total deaths from lung diseases are compared in Appendix. Table14. The number of adult deaths increased from the late 1870s and early 1880s, about 15-20 years after the opening of the deep coal pits, long enough to have permitted the development of pneumoconiosis and miner’s lung diseases among colliers and mine workers. 39 As Surgeon to the Dowlais works for several years, Dyke understood only too well the conditions of employment, the relentless toil for wages, and the circumstances of living in Merthyr, and sympathised with the daily grind of workers. During the Great Strike of 1898 deaths from lung diseases above 5 years of age increased to 63% of deaths from 50% the previous year, whilst those under one year increased from 27 to 32%. The number of children under one year of age dying from lung diseases in 1898 was almost double that of the 1-5 age group. There was also a whooping cough epidemic that year, yet infant mortality was less in 1898 than in both the previous and following years, another example of the annual unpredictability in consistently explaining the causes of infant death. From the bare statistics of lung diseases, Dyke described a community, living in a harsh, cold, wet environment, eking out a daily tortuous round of employment in occupational conditions which bred chronic lung diseases. Besides the unavoidable facts of the inhospitable climate and occupational hazards of life in Merthyr, Dyke emphasised that whilst these predisposing factors contributed to the high incidence of lung diseases in Merthyr, the main cause of death was the damp substandard housing in which many of the people lived. Many were constructed before the introduction of local

37 Dyke, MOH Report for Merthyr Tydfil for 1881, p.18. 38 Dyke, MOH Report for Merthyr Tydfil for 1887, p. 7. 39 Williams, The Health of Old and Retired Coalminers, Chapter 4.

217 regulations regarding drainage and ventilation. Such housing certainly did not enhance the chances of recovery from respiratory tract infections:

It is to the continued presence of maladies of this class [lung diseases] that the major proportion of the deaths in this parish are due. Year by year, I have had to report to you the same large numbers of deaths due to the same causes. Wind and weather are beyond your control; the sickly nature of the avocation of the Collier and of the Iron-Worker, are equally out of range of improvement, but I cannot but repeat that although the main exciting cause of these inflammatory affections is exposure to cold, yet I believe the main cause of the deaths will be found in the dampness of the dwellings of the working men. This dampness is due to original bad construction, the absence of sub-soil drainage, and the deficiency of through ventilation. 40

He added to his argument the fact that such living conditions in tandem with chronic lung diseases also contributed markedly to deaths from consumption:

I must now repeat for the twentieth time……. that the fatal issues of these maladies are greatly due to the damp and unhealthy dwellings in which so many of our working men and their families reside. The medical men in this Parish are heavily handicapped in having to treat diseases, more especially of the Lungs, in such unwholesome habitations; and it is not only the direct results of maladies that are to be regarded, but that when by treatment the patient has been tided over the acute stage, continued residence in these under-dwellings tends to promote the growth in the Lungs of that most mortal of diseases Consumption. 41

In the deadly, damp, poorly ventilated living conditions bronchitis, epidemic pneumonia and tuberculosis lay dormant, waiting for a constitution weakened by acute infection or chronic disease on which to superimpose the potentially deadly bacteria. Brought down by acute infections the possibility of subsequent pneumonia increased, in turn allowing tuberculosis to gain a hold on a weakened constitution. Whilst Dyke expressed his concerns over the level of lung diseases as a community problem, it became increasingly one related to that of infantile mortality, as Dr. Thomas explained in 1903 when identifying the factors contributing to infant mortality;

Diseases of the lungs form another heavy item in the infantile mortality. 29 deaths were due to Bronchitis, and 43 to pneumonia. More than half the total deaths from these diseases occurred in children

40 Dyke, MOH Report for Merthyr Tydfil for 1884, p. 8. 41 Ibid, p. 6.

218 under five years of age. Bronchitis and Pneumonia proved fatal to 25 persons between the ages of five and forty-five years, whilst in children under five, they were responsible for 126 deaths [72 of these were under one year]. 42

Infants within the home were exposed to many of these conditions, reflecting in their microcosm the conditions of the adult world surrounding them. He emphasised that substandard housing compounded the effects of whooping cough, measles, bronchitis and pneumonia.

In this last year as previously, when Measles was prevalent, the constantly recurring second cause of death was Bronchitis; reference to the House-to House-Inspection Book, shewed the very great number of deaths from “Measles, bronchitis” which occurred in these damp cellar dwellings. 43

Dyke had little patience with those dressed in a frivolous and unsuitable manner for the climate, courting colds and flirting with influenza, and little confidence in the ability of wives and mothers to care adequately for their families when sick. It is little wonder that in overcrowded and substandard facilities overburdened women were unable to nurse the sick properly. In fear of sudden changes of temperature causing chills, he warned against the perils of children moving from the overheated, stuffy classrooms into the cold damp Merthyr air as they ran home from school. In 1883 he vividly described the working and living conditions in Merthyr:

…you will not fail to observe that the larger number of deaths occurred to those in the prime of life and usefulness, and may be disposed to ask. Can nothing be done to prevent this waste? Let me first answer: the maladies first originate in a “slight cold;” next let it be remembered that the necessity to labour daily is the imperative lot of our working men. Exposure in early morn or late at night to the chill wintry blast, to the cold soaking rain, and whether glowing with heat, the result of exhausting labour at the furnace, or the rolls, or ascending weary with toil from the high temperature of the coalmine to be exposed to the chilling wind at the coal-pits mouth- these must be endured. Women clothed in thin easily wetted garments wending their way to the works or to the shop- children scantily clothed, hastening through rain to heated schoolrooms- these all “catch cold,” a little chill, a little cough, some fever, a few days of most painful illness, and the race has been run. In a hilly district such as this, where rain falls on 170 days in the year, these perils are unfortunately unavoidable; possibly something might be done to lesson the evil by teaching the wives and mothers some of the more simple lessons of sick nursing. 44

42 Thomas, Merthyr Tydfil Urban District Council, MOH Report for 1903, p. 37. 43 Dyke, MOH Report for Merthyr Tydfil for 1885, p.7. 44 Dyke, MOH Report for Merthyr Tydfil for 1883, pp. 7-8.

219 Predictably, mothers were blamed by one after another of Dyke’s successors for their irresponsible care of infants. In 1900, Dr. C E. G. Simons, MOH for Merthyr Tydfil, cited the high incidence of deaths from lung diseases in children under five, complaining that children wore inadequate clothing and blamed fashion and the ignorance of mothers:

Bare legs and abdomen only partly covered is the condition of nearly all the children between these ages[under 5]. Children require warmer and more careful clothing about these parts than adults do, but the fashion of the times and the ignorance of the mothers lead to the opposite condition being adopted. 45

Dr. D. J. Thomas probably referred to the Welsh fashion of carrying babies wrapped in a shawl entwined around the mother, when he expressed his opinion that:

The absurd form of clothing which leaves so much of the body exposed is accountable for many deaths, but the wilful [sic] manner in which the children are taken out late at night is responsible for more. It is no uncommon occurrence for children to be out in the arms of their mothers at ten or eleven o’clock at night. They come out into the cold air from a warm stifling atmosphere, and it is no wonder that the children suffer from respiratory diseases. 46

In 1905 Dr. Alex Duncan repeated that:

The large number of cases of Pneumonia may partly be attributed to climatic conditions, and the common practice of taking young children out at night to places of amusement, and when marketing; but the essential cause is infection which no doubt may be aided by a chill, and cleanliness of the environment of the baby is of prime importance in preventing the disease. 47

Overcrowding in badly ventilated accommodation undoubtedly assisted the spread of infectious diseases and lung diseases, especially as the population increased during the 1890s. The respiratory syncytial virus, identified in the 1960s, is the most common cause of bronchitis, pneumonia, croup and upper respiratory tract infections, accounting for about a third of cases in infancy. It is easily spread from person to person, particularly where large groups of children are in close relationship to each

45 Simons, MOH Report for Merthyr Tydfil for 1900, p. 17. 46 Thomas, MOH Report for Merthyr Tydfil for 1903, p. 37. 47 Thomas and Duncan, MOH Report for Merthyr Tydfil for 1905, p. 30.

220 other. Annual epidemics occur in autumn, winter and spring. 48 There is every possibility that the virus was one of the organisms at work in nineteenth-century Merthyr and would account for deaths occurring in the autumn at the same time as diarrhoea deaths occur, for deaths during the cold winter months and for deaths associated with whooping cough and measles, which frequently occurred during spring. Deaths are always the tip of the iceberg, and each death in the community conservatively represents the presence of approximately another ten cases which did not result in death.

Diarrhoea

The similarities between lung diseases and diarrhoeal diseases have already been pointed out at the beginning of this chapter. Both causes of death increased during the final decades of the nineteenth century and contributed significantly to rising infant mortality rates. Like deaths from lung diseases, deaths from diarrhoea as a primary cause of death in Merthyr Tydfil 1865 to 1908 under-represented the full extent of the problem and, like lung diseases, diarrhoea deaths were made worse by overcrowded living conditions and could result in chronic ill-health. Children who recovered from the immediate effects of diarrhoea were often so debilitated that they later easily became susceptible to “marasmus”, a condition in which chronic malnutrition led to malabsorption, failure to thrive and bronchitis.49 Diarrhoea is often one of the many symptoms of illness in babies. Infants rapidly succumb to the effects of dehydration from copious diarrhoea, losing a good percentage of their body weight. If the immediate effects of diarrhoea are not fatal, chronic or superimposed infections may result in chronic malaise of the infant or death from malnutrition, the one compounding the other. Diarrhoeal diseases were generally a reflection of poor living conditions, poor hygiene both inside and outside the home and poor infant feeding practices, explaining their higher prevalence in working-class communities, as part of a cycle of social deprivation. However, any artificially fed infant was at risk in the Edwardian period since the mode of spread of epidemic summer diarrhoea was poorly understood. Whilst diarrhoea deaths rose steadily from 1884, the years 1899 and 1901 particularly accounted for significant rises in diarrhoea mortality.

48 Nelson et al., Textbook of Paediatrics, pp. 885-6. 49 Thomas, MOH Report for Merthyr Tydfil for 1903, p. 32.

221 Diarrhoeal infections link the public health concentration on the provision of clean water supplies and improving the urban sanitary environment to its failure to reduce the numbers of infant deaths because of the mitigating social conditions which held back such efforts. Following the last cholera epidemic of 1866 in Merthyr, the community benefits of town cleansing, a clean water supply and sewerage gradually reduced the general incidence of cholera, typhoid and enteric fever, and hence the general death rate. Very few infant deaths from these filth diseases were reported, but this raises the question of whether such deaths were reported as convulsions during the early period. The DSIMR and cases of water-borne community diarrhoeal infections are charted in Appendix. Table 16. Very few such deaths are recorded and the impact on the infant mortality rate was insignificant. Apart from the cholera year of 1866 when such deaths contributed 5.12 to the overall infant mortality rate of 192/1000 births, a total of 11 deaths out of 413, the rate does not in any year exceed 1 death / 1000 births.50 The few deaths that did occur were for the most part due to enteric or typhoid fever. Two typhus deaths are listed in 1869 and 1870, when the distinction between the two diseases seems unclear. These diseases are of course of quite different origins and social features, but their inclusion in this category does not significantly alter the outcome of the analysis. However, the early water supply was piecemeal and, even after the turn of the century, it was not always adequate, pure or dependable. Cholera, typhoid fever and enteric fever had been established as preventable water-borne communicable diseases, but epidemic summer diarrhoea could not be prevented until its causes and mode of spread were understood. In 1887 Dr. Ballard proposed that a specific organism was responsible for causing diarrhoea and soon afterwards the bacillus of shiga (Shigella) was identified. 51 Rotaviruses generally cause “winter” viral diarrhoea and enterotoxogenic bacteria proliferate in water supplies and food to cause “summer” bacterial diarrhoea. 52 Fewer deaths occurred with high summer rainfall but increased during hot dry summers, with over 90% of the deaths occurring between July and October, 80% of those in infants under one year of age. 53 Dr. Dyke quite rightly believed that such deaths were preventable if a clean water supply was provided and domestic surroundings improved. Since we do not have detailed causes of infant death before and after the provision of a water scheme in

50 See footnote to Appendix. Table 7. 51 Thomas, MOH Report for Merthyr Tydfil for 1903, p.33., Andrew McDonald, ‘Gastroenteritis in Children, Current Therapeutics, Vol., 36., No.2., February 1995, pp.27-29. 52 Leonardo Mata, ‘Epidemiology of Acute Diarrhoea in Childhood’, Joseph A. Bellanti (ed), Acute Diarrhoea: Its Nutritional Consequences in Children, Nestle Nutrition Workshop Series Vol.2., Raven Press, New York, 1983. pp. 12-13. 53 Thomas, MOH Report for Merthyr Tydfil for 1903, p.33.

222 Merthyr, it is difficult to say whether infants directly derived any benefit from this measure. The adult population would certainly have derived such benefit, but even in the cholera year of 1866 the number of infant deaths was low. Breastfeeding would have afforded some protection to infants until the increasing use of artificial feeding and contaminated water supplies marked a rise in diarrhoea deaths from 1883 and particularly from 1893. Common sense indicates that the population undoubtedly benefited from these measures, but the later rise in infant diarrhoea deaths is a different story. Merthyr’s water supply was not as pure or complete as Dyke believed it to be. It becomes clear from his reports and those of his successors that whilst the majority of inhabitants benefited from the water supply, there remained many who did not and infants remained as vulnerable as ever to their environment. By 1900 very few houses were without mains water, but water was frequently scarce in the lower parts of the district, a problem which it was hoped would improve when the new aqueduct was constructed. The peaty acids of the soil had a corrosive action on the iron pipes causing leakages. Service pipes were also “carelessly laid in ashes,” causing the lead to be eaten away by electrolytic action. The water had a slight solvent action on lead, but no cases of lead poisoning were traced. 54 No matter how comprehensive the community water supply, it needed to be available within the home and used properly in conjunction with other basic hygiene measures such as hand washing and the protection of food and milk from contamination. As diarrhoea deaths in infants rose markedly, such deaths were linked to conditions of infant feeding within the home. The protection afforded babies by prolonged breastfeeding was lost as bottle- feeding increased. Conditions in Merthyr homes were such that it is little wonder that so many deaths occurred from diarrhoea. Despite Dyke’s intense scrutiny of the water supply, drains and sewers of Merthyr, deaths from common diarrhoeal diseases increased as the nineteenth century closed, apparently making a mockery of all the sanitary improvements. Diarrhoea deaths rose from 1.9% of infant deaths in 1866, (3.58% including 11 cholera deaths), to 34.06% in the diarrhoea year of 1899 and still accounted for 21.78% of infant deaths in 1908. This phenomenon was not confined to Merthyr, but was a feature of national infant mortality identified by Woods et al as “the urban-sanitary diarrhoea effect.” 55 They argued that diarrhoea death rates among infants increased as a consequence of urbanisation, as part of the inequitable social class experience of infant mortality, and a reflection of epidemic summer diarrhoea during the hot summer and autumn months. A

54 Simons, MOH Report for Merthyr Tydfil for 1900, p.7. 55 Woods et al, ’The Causes of rapid Infant Mortality decline in England and Wales, 1861-1921, Part 1 and Part 11.

223 decline in breastfeeding and an increase in artificial feeding contributed further to these unhappy circumstances. This appears to have been the case in Merthyr Tydfil, but diarrhoea deaths by themselves do not adequately explain high rates of infant mortality in the town which must be seen as part of a more complex social picture. Considerable discussion took place in the BMJ regarding the exact nomenclature of these diseases of the digestive system, which changed over time. In 1890 Dyke questioned the validity of the various terms used in association with diarrhoeal deaths, stating that

with the entries often made of “gastric catarrh,” “gastritis,” “enteritis,” “intestinal irritation,” occurring in children under five years, it would be desirable to state whether diarrhoea was or was not a prominent symptom. And, again, “Enteritis” has been very frequently assigned as the cause of death, in certain localities, and in certain families, when at the same time Enteric fever was prevailing among those families in those localities.56

In 1900, the Royal College of Physicians recommended the term “Epidemic Enteritis” as a synonym for epidemic summer diarrhoea. As the use of such terms as gastro-enteritis, mucoenteritis and gastric catarrh diminished, so the number of deaths registered from diarrhoea rose.57 By 1903 diarrhoea was still classified as a principal zymotic (infectious) disease.58 In 1905 all diarrhoea deaths are listed together and not otherwise specified. (Appendix. Table 16 (a).) In practice these distinctions are academic since all instances in which gastric disturbances and diarrhoea in young infants cause dehydration can result in rapid death irrespective of the exact cause. For the purposes of this analysis all forms of diarrhoea, have been grouped together as diarrhoea deaths. For the years 1905-1908 all forms of diarrhoea are reported by age in weeks and months under one year. As diarrhoeal deaths rose across the country, contemporary medical journals debated a range of causes of epidemic summer diarrhoea, whether infant feeding methods, contaminated milk supplies, the ignorance of mothers, the dusty atmosphere in dry weather, inadequate ventilation of houses or the general insanitary environment common to working-class housing. 59 Most of these causes were at work in Merthyr, exemplified by the MOH reports. Chapter 4 addressed the causes of convulsions in infants, a cause of death which declined as reported deaths from diarrhoea and lung diseases increased (Figs. 6, 7,

56Dyke, MOH Report for Merthyr Tydfil for 1890, p. 8. 57 Ibid., p.32. 58 Ibid., p.33. 59 The British Medical Journal contains numerous articles on the subject from the 1890s and particularly from 1899.

224 Table 15.) The chapter also reported the discussion in the BMJ on the causes of deaths from convulsions, indicating that they were frequently a precursory symptom in diarrhoea deaths.60 This link was made in Farr’s Report on the Cholera in 1866, but the discussion in 1899 also suggested that the fall in deaths from convulsions might be accounted for by the increase in reported deaths from diarrhoea. This raises the possibility that diarrhoea deaths were in fact more numerous than reported, and that the observed rise at the end of the nineteenth century may be due to under–reporting of diarrhoea deaths in the earlier periods. In that case, diarrhoea deaths were possibly a more constant feature of infant death in the nineteenth century than has hitherto been recognised.

The characteristic symptoms…. are not so well marked in early infancy…; and the reason of [sic] this is that the muscular and nervous systems being then less active, and giving rise to less convulsive and violent symptoms, the medical attendants return the cases as diarrhoea.….under the age of five years according to this estimate, four cases of diarrhoea must be added to every six deaths registered from cholera to get the actual deaths by this epidemic. 61

The connection between diarrhoea deaths and infant mortality is not so evident in the early period, but diarrhoea deaths increased significantly by the end of the nineteenth century, forming an increasing proportion of infant mortality rates in Merthyr Tydfil 1866-1908. (Appendix. Table16 (a).) The increase fell into three distinct periods, summarised in Tables 5.5, 5.5a-c.

Table 5. 5. Summary of Three Diarrhoea Periods in Merthyr Tydfil 1866-1908 (MOH Reports for Merthyr Tydfil 1865-1908) Years Total Number of % Total Number of % Total Total % Total Infant Deaths From Infant Deaths Infant Deaths Infant Deaths Community Deaths from deaths All Forms Deaths Diarrhoeal Diarrhoea of Diseases Diarrhoea 1. 1866- 5101 19 0.37 177 3.45 196 3.82 1882 (17yrs) 2. 1883- 3714 1 0.02 271 6.70 272 7.32 1892 (10 yrs) 3. 1893- 8325 5 0.06 1605 19.28 1610 19.34 1908 (16 yrs) Total 17140 25 0.15 2053 11.84 2078 12.11

60 Gassage and .Coutts, “A Discussion on Convulsions in Infancy “, pp. 460-463., Newman, Infant Mortality, pp. 139-140 concerns convulsions as one of the most frequent features of epidemic diarrhoea. 61 Farr, Report on the Cholera,1868, p. lix.

225 During the first period, 1866 to 1882, diarrhoea deaths formed a low percentage of between 2 and 7 % of infant deaths. The most deaths in this period occurred in 1869 with 10.25 deaths/ 1000 births. ( Table 5. 5a.)

Table 5. 5a. First Period 1866-1882: DSIMR and Percentages of Total Deaths Each Year of Deaths from all Forms of Diarrhoea (MOH Reports for Merthyr Tydfil 1866- 1883.) Year Total Community Diarrhoea Total All Infant Diarrhoeal Forms Deaths Diarrhoea

Number Number Deaths of % Infant Deaths DSIMR Number Deaths of % Infant Deaths DSIMR Number % Infant Deaths DSIMR 1866 413 11 2.49 5.12 7 1.59 3.26 18 4.08 8.38 1867 310 18 5.81 8.52 18 5.81 8.52 1868 269 1 0.37 0.48 16 5.95 7.75 17 6.32 8.23 1869 322 1 0.31 0.51 20 6.21 10.25 21 6.52 10.76 1870 359 1 0.28 0.52 11 3.06 5.74 12 3.34 6.26 1871 291 1 0.34 0.47 8 2.75 3.73 9 3.09 4.20 1872 301 2 0.66 0.98 8 2.65 4.40 10 3.31 5.38 1873 393 12 3.05 5.70 12 3.05 5.70 1874 420 1 0.24 0.46 10 2.38 4.55 11 2.62 5.01 1875 322 11 3.42 5.45 11 3.42 5.45 1876 241 1 0.41 0.57 12 4.98 6.80 13 5.39 7.37 1877 232 7 3.02 3.97 7 3.02 3.97 1878 251 6 2.39 3.32 6 2.39 3.32 1879 221 8 3.62 5.00 8 3.62 5.00 1880 264 9 3.41 5.53 9 3.41 5.53 1881 238 10 4.20 5.79 10 4.20 5.79 1882 254 4 1.57 2.30 4 1.57 2.30 Total 5101 19 0.37 177 3.45 196 3.82

Table 5. 5b. Second Period 1883-1893: DSIMR for Deaths from Diarrhoea in Merthyr Tydfil (MOH Reports for Merthyr Tydfil 1882-1893.) Year Total Community Diarrhoea Total Infant Diarrhoeal Deaths Deaths Deaths

Number % Infant Deaths DSIMR Number % Infant Deaths DSIMR Number % Infant Deaths DSIMR 1883 280 22 4.94 12.41 22 4.94 12.41 1884 315 24 7.62 13.1 24 7.62 13.08 1885 306 25 8.17 13.9 25 8.17 13.84 1886 368 26 8.05 13.3 26 8.05 13.26 1887 327 20 6.19 10.6 20 6.19 10.64 1888 289 17 5.88 8.5 17 5.88 8.45 1889 410 1 0.25 0.5 29 7.13 14.9 30 7.38 14.90 1890 415 36 8.67 17.8 36 8.67 17.82 1891 445 29 6.52 12.6 29 6.52 12.69 1892 559 43 7.56 18.4 43 7.56 18.37

Total 3714 1 0.02 271 6.70 272 7.32

226 During the second bridging period, 1883-1892 diarrhoea deaths still formed a relatively small 6-8% of infant deaths, but exert more influence on the infant mortality rate with a maximum of 18.37 deaths /1000 births in1892, the peaks coinciding visibly with peaks in the infant mortality rate. ( Fig. 6. and Table 5.5 b.)

Table 5. 5 c. Third Period 1893-1908: DSIMR Deaths from Diarrhoea in Merthyr Tydfil (MOH Reports Merthyr Tydfil 1893-1908. ) Year Total Community Diarrhoea Total Infant Diarrhoeal Deaths Deaths Deaths

Number % Infant Deaths DSIMR Number % Infant Deaths DSIMR Number % Infant Deaths DSIMR 1893 529 72 13.6 18.37 72 13.61 29.90 1894 429 2 0.47 0.87 59 13.75 29.90 61 14.22 30.77 1895 610 116 19.01 25.62 116 19.01 25.62 1896 507 1 0.20 0.43 104 20.51 45.81 105 20.71 46.28 1897 530 87 16.42 44.56 87 16.42 44.56 1898 505 114 22.57 35.21 114 22.57 35.21 1899 640 218 34.06 45.69 218 34.06 45.69 1900 483 72 14.91 92.49 72 14.91 92.49 1901 704 134 19.03 27.09 134 19.03 27.09 1902 518 85 16.41 49.83 85 16.41 49.83 1903 422 55 13.03 19.98 55 13.03 19.98 1904 523 1 0.19 0.36 105 20.07 37.50 106 20.43 37.86 1905 576 1 0.17 0.36 115 19.97 40.93 116 20.33 41.29 1906 487 107 21.97 39.43 107 21.97 39.43 1907 420 57 13.57 20.90 57 13.57 20.90 1908 482 105 21.78 38.88 105 21.78 38.88 Total 8325 5 0.06 1,605 19.28 1,610 19.33

The third period, from 1894-1908 introduces the urban sanitary diarrhoea effect described by Woods et al. A significant rise in the contribution of diarrhoea death rates to infant mortality from 1894 of 30.77 deaths /1000 births saw a dramatic rise in diarrhoeal death rates peaking at 92.49/1000 births in 1899, an exceptional year, in keeping with the rise across the country due to a hot dry summer. Diarrhoea deaths in 1899 accounted for 34% of infant deaths. The peak diarrhoea death rate of 49.83 /1000 births in 1902 fell to 20.90 /1000 in 1907, but again rose to 38.88 /1000 in 1908. (Table 5.5 c.) From 1902-1908 a health campaign against summer diarrhoea attempted to make diarrhoea deaths yet another preventable cause of infant death. Peaks in DSIMR from diarrhoea did not always coincide with peaks in infant mortality rates, but the significant increase in diarrhoea deaths from 1894 undoubtedly influenced rising infant mortality rates. In 1902 a diarrhoeal death rate of 49.83/1000 coincided with an infant mortality rate of 262/1000 and in 1899 the diarrhoea death rate

227 of 92.49 /1000 births corresponded with an infant mortality rate of 272/1000, the highest recorded 1866-1908. During Dyke’s early term of office many factors influenced infant mortality rates and diarrhoea deaths were a community problem which was to be addressed by providing a water supply to the town as a primary objective. Based on the evidence before him, Dyke was justifiably proud of his achievements in improving the health of the town through a pure water supply. Diarrhoea deaths increased in 1869, but Dyke in his report for that year does not mention this fact, being more concerned with the effects of a typhus epidemic and diseases associated with poverty due to a recession in the iron trade. He did, however, note that the water supply was distinctly discoloured with peat after rain. Whilst a small amount was not harmful, this was “unsightly and displeasing.”

As long as the water is drawn during floods from the River, so long this reddish-brown colour be observed. At some not distant time, I will hope that a small supply-reservoir may be made, higher up the valley, between Llwynon and Pantardaf, in which water can be retained in sufficient quantity, for say seven days’ supply, to do away with the need of constantly taking supply from the river.62

Despite these inherent problems, until 1883 the town appears to have enjoyed the benefits of sanitary improvements with low rates of diarrhoea reported. In 1873 diarrhoea accounted for the death of 10 breastfed infants under 1 year old, “one per cent of the whole mortality”. No deaths were due to acute diarrhoea. 63 Dr. Dyke was evidently not disturbed by this fact since presumably it was not an unusual occurrence for diarrhoea deaths to occur in breastfed infants, but not apparently in epidemic proportions. 64 A series of letters to The Times in 1873 suggested that the sewage disposal scheme at Troedyrhiw might spread typhoid fever via the milk of cows fed on sewage grass. Dyke was forced to defend the sale of thousands of cabbages, onions, peas, beans, parsnips and carrots grown on sewage farms, saying that there was not “the slightest tittle of evidence” to show that diarrhoea followed the consumption of milk obtained from cows fed on Italian rye grass, turnips and mangolds obtained from sewage land. 65 The statement serves more as a defence of the sewerage scheme than a

62 Dyke, MOH Report for Merthyr Tydfil for 1869, p. 22. 63 Ibid. 64 Ibid. 65 Dyke, MOH Report for Merthyr Tydfil for 1873, p. 11., Samuel Harpur, ‘Can Typhoid fever be caused by the use of the Milk of Animals fed upon produce grown on sewage farms? Letters on this Subject Published in “The Times”, in August 1873. Merthyr Tydfil Public Library.

228 contribution to our understanding of diarrhoea rates. However, it does tell us that large quantities of fresh, nutritious vegetables were available for consumption. In 1874 a further 10 infant deaths occurred. Dyke stated that although many children were bottle fed on cows’ milk diarrhoea rates were low:

There are many hundreds of children brought up in this district on boiled milk, imbibed through a vulcanite tube from a feeding bottle; the milk is obtained from stall-fed cows, who in the winter, spring, and summer are partially fed on grass grown in the meadows irrigated with sewage. That the milk so yielded and used is not inimical to the health of the young is, I think, conclusively shown by the exceptionally low mortality due to Diarrhoea. It will further be noticed that of those who were of an age to use vegetable food, only four succumbed to Diarrhoea. Those members of the medical profession who have been some years engaged in practice in Merthyr, will readily concur with me in saying that Diarrhoea is much less frequently observed now than formerly. This is doubtless due mainly to the good water supply, efficient scavenging, and the construction of sewers and drains; 66

In 1875 and 1878 low rates of diarrhoea were recorded with infrequent deaths, a total of seven under two years.67 In 1879, Dyke considered that the deaths of 8 young children from diarrhoea, classified under Zymotic diseases, “were due rather to teething, and probably to errors in diet, than to any contagious germ.” 68 In 1880 the low incidence of diarrhoea attested to the purity of the town’s water supply and Dyke felt obliged to remark that the deaths of eight children in the first year of life “could not reasonably be assigned to water drinking.” He reassured the Board that the water was tested regularly and found to be “perfectly free from any organic impurity.”69 In 1881, when 9 infant deaths from diarrhoea were recorded, Dyke reported the diarrhoea rate was 0.22 per 10,000 compared with 11.2 “in the dark days of your sanitary history.” 70 In 1882, the infrequent occurrence of these deaths again apparently testified to the purity of the water supply in which “the quantity of nitrogenous matter [was] infinitesimally minute…” 71 From 1883, however, diarrhoea rates began to increase as shown in Tables 5.5.a, b., and c., and Appendix. Table 16 (a.) 72 In 1883 there were fewer deaths in Treharris and Dowlais (6) where water was supplied from a new main, but an increase in Merthyr, Penydarren, and other districts (30) where water was supplied from a lower source of

66 Dyke, MOH Report for Merthyr Tydfil for 1874, p. 11. 67 Dyke, MOH Report for Merthyr Tydfil for 1878, p. 16. 68 Dyke, MOH Report for Merthyr Tydfil for 1879, p. 5. 69 Dyke, MOH Report for Merthyr Tydfil for 1880, p. 7. 70 Dyke, MOH Report for Merthyr Tydfil for 1881, p. 18. 71 Dyke, MOH Report for Merthyr Tydfil for 1882, p. 28. 72 Dyke, MOH Report for Merthyr Tydfil for 1883, p.10.

229 the Taf Fechan than that supplied to Dowlais, which had a lower diarrhoea rate proportionally than other districts. The increase occurred among water-drinking children. Samples of water taken at Dowlais and Merthyr on the same day revealed that the Merthyr supply contained considerably more vegetable matter than that at Dowlais. In the summer of 1883 water samples from the straining and filtering basins at Penybryn were found to be full of growing water plants and vegetable matter in solution. The basins were cleaned and by the end of the year the water had regained its purity.73 Dyke was justifiably proud of the fact that for some years Merthyr had the lowest infantile diarrhoea death rate in the United Kingdom, which it again achieved in 1884, with 0.6 deaths per 1000 population. However, 31 infantile deaths from diarrhoea were considered a considerable increase compared with previous years and again large quantities of organic vegetable matter were found on microscopic and chemical analysis of the water supply. The receiving, settling and filtering tanks were again cleaned with an improvement in water quality.74 Further microscopic analysis that year found that the Dowlais water showed considerable numbers of minute water plants in suspension, giving the water a distinctly green colour. An improvement was seen when the supply was obtained directly from the New Noyadd Reservoir. Cleaning the filter beds improved the Merthyr supply.75 In 1885, infant diarrhoea deaths continued to rise, increasing in Dowlais and Penydarren, whilst rates remained unchanged in other districts of the town. Dyke explained that partially in 1883, and throughout 1884 and 1885 the Dowlais water supply was derived from the new reservoir constructed in the upper part of the Taf Fechan Valley. When the water was examined it contained large quantities of vegetable organic matter and living growing plants –confervae- (algae) in warm weather, the spore ands seeds of which survived winter to spring to life again the following summer. Dyke thought that they originated from the impure supply taken from the new source before the work was finished, whilst many scores of men and horses etc were at work in the vicinity. There was little doubt in Dyke’s mind that the water plants accounted for the increase in deaths from diarrhoea. The presence of potentially toxic algae may well explain that particular increase in diarrhoea deaths. “Time alone will show whether the water in the covered storage reservoir will ever be freed from the seeds of these confervoid plants.” 76

73 Dyke, MOH Report for Merthyr Tydfil for 1883, p.5. 74 Dyke, MOH Report for Merthyr Tydfil for 1884, pp. 5-6. Dyke gives 31 infantile diarrhoea deaths in his report, referring to 23 deaths under one year old and 8 deaths 1-5 years old. His assessment per 1000 population does not identify age groups. 75 Ibid., pp. 12-13. 76 Dyke, MOH Report for Merthyr Tydfil for 1885, p. 5.

230 During 1886, although diarrhoea rates were low in Dowlais and Penydarren in the upper district, some diarrhoea deaths were reported in Troedyrhiw and Merthyr Vale in the lower district. These occurred when the water supply was irregular, one or more days with no water at all or insufficient pressure to raise the water to the higher rows of houses. Many of the pipes along the road between those locations and Merthyr had fractured or had poor joins and when the water was turned off, as it frequently was in summer, the subsoil drainage was drawn into the empty pipes, polluting the water when it was again turned on. Once the pipes were repaired and full pressure restored, no more deaths occurred and the purity of the water supply was restored.77 In 1887 the rates were again among the lowest of large town populations.78 In 1888 “the rarity of infantile diarrhoea as a summer epidemic testified again to the purity of the water supply,79 whilst in 1889 such deaths were “a very low average”, 80 even though 1889 was an abnormally dry year. 81 Dyke’s reports do not engage with the rising diarrhoea deaths 1884-1892. Perhaps, based on the total population, the rise was not immediately apparent. He also observed that “Deaths are reported in each month in the year in nearly equal numbers”, suggesting a steady rather than a seasonal influence at work as opposed to the increase during hot summer months which occurred with summer diarrhoea. In 1892 Dyke reported that “The frequency of this malady is not now so marked as it was in my earlier days, when the water supply was so polluted.” 82 However, the marked increase in diarrhoea deaths among infants is evident in this analysis from 1893-4. An increase in diarrhoea deaths in 1893 amounted to “a mortality about half as much again as usual.”83 (Appendix. Table 16 (a.)) Dyke explained that, “The heat during the summer of 1893 was excessive, and would tend to cause milk –the food of young children- to ferment, become sour, and tend to induce diarrhoea.” 84 With the increasing popularity of artificial feeding, Dyke in 1892 blamed the use of contaminated milk and the increase in bottle-feeding rather than the water supply for diarrhoea deaths:

How far the use of so called “condensed milks,” or of ordinary cow’s milk, soured by exposure to bad air passing from the back yards through the small pantry used also as a passage, or by the too general use of the feeding-

77 Dyke, MOH Report for Merthyr Tydfil for 1886, pp.6-7. 78 Dyke, MOH Report for Merthyr Tydfil for 1887, p.5. 79 Dyke, MOH Report for Merthyr Tydfil for 1888, p.4. 80 Dyke, MOH Report for Merthyr Tydfil for 1889, p.3. 81 Thomas, MOH Report for Merthyr Tydfil for 1903, p.42. 82 Dyke, MOH Report for Merthyr Tydfil for 1892, p. 9. 83 Dyke, MOH Report for Merthyr Tydfil for 1893, p.11. 84 Dyke, MOH Report for Merthyr Tydfil for 1893, p.11.

231 bottle instead of the source provided by nature to mothers; how far these causes may have led to this form of disease would be difficult to determine.85

Dyke’s attention turned to milk as a public health concern in 1894 as he addressed the issue of tuberculosis.86 An increase in artificial feeding under unhygienic home conditions, the incorrect use of condensed milk and sour milk improperly stored were three very good explanations of “The use of milk food, soured by heat,” was also blamed for the deaths of 108 very young children in 1897.87 In 1904 Dr. Thomas, summarised diarrhoea deaths, the infective organism unknown, as symptomatic of various causes of infant death, a contagious urban disease. Milk provided an ideal medium for causing the problem, particularly during the warm summer months, but he blamed the ignorance of mothers in feeding their offspring:

The disease is essentially a symptom dependent on various causes, and the most severe forms occur during the summer heat. The disease is rarely seen out of large towns, and most observers regard it as a contagious zymotic disease, though the specific germ has not with certainty been discovered. Milk is probably the chief medium by which the germs are carried into the body, and, as it has been pointed out in previous reports, the ignorance of mothers in the proper management of children and their feeding is the most important factor in the causation of the disease. Very frequently, the parents believe that a bottle of medicine is sufficient to cure the symptoms, and are quite oblivious of the fact that one of the factors in the illness is improper feeding, and until that is remedied the disease will persist. Even with care, the difficulty of keeping milk sweet in a warm dry summer is considerable. Dust and various other things laden with germs, are liable to be deposited in the milk. 88

Table 5. 6. Comparative Infant Mortality Rates in England and Wales during the Third quarter of 1899 (The British Medical Journal, Nov 11th, 1899, p.1377.) Location Infant Mortality per 1000 births in 33 great Towns Burnley 507 Preston 392

In 67 Other large towns Stockport 443 Rhondda 448 Aberdare 449 Merthyr Tydfil 429 Rest of England and Wales 208

85 Dyke, MOH Report for Merthyr Tydfil for 1892, p. 10. 86 Dyke, MOH Report for Merthyr Tydfil for 1894, pp. 8, 17. 87 Ibid., p.8. 88 Thomas, MOH Report for Merthyr Tydfil for 1904, pp.18-19.

232 The infamous year of 1899 was the worst across the nation for deaths from epidemic summer diarrhoea due to a very hot summer. After a wet April, cold May and a fine June, there were three very hot periods in the third quarter of the year, from 6-22 July, 29 July to 27 August and 3-8 September. and temperatures reached 65.7F in the south of England. (Table 5.6.) There had been only two instances of such high temperatures since 1771, in 1779 and 1857. Diarrhoea deaths across the country in the second quarter numbered 1418, but in the third quarter there were 25,952 diarrhoea deaths, nearly 76% above the average for the quarter in the previous ten years89. Unfortunately Dr. Dyke passed away in January 1900, leaving the annual report for Merthyr to be compiled by the temporary MOH, Dr. W. W. Jones.90 The combination of heat and drought in 1899 was exceptional. Owing to severe drought the supply of water was rationed to four hours a day. As a consequence the drains and sewers were inadequately flushed. Water for the lower portion of the district was drawn from unfiltered and polluted sources at Treharris and Troedyrhiw. The drought fortunately broke “before an absolute water famine prevailed.”91 The proposed Upper Neuadd Reservoir, which would provide a surplus of one million gallons a day, even should the population reach 100,000, was considered a good economic proposal since the water could be sold to towns further down the valley. 92 The general death rate of 22.9 per 1000 was the highest since 1895, mainly due to the large number of diarrhoea deaths among infants. Dr Jones identified some of the issues concerning diarrhoea in the town:

Indeed so heavy was the mortality during the months of August and September that the number of births was exceeded by deaths, a state of things which is fortunately very rare!. Merthyr has a higher Infant Mortality Rate than the whole of the 33 great towns of England and Wales. I believe it is very largely due to the bad housing of the working classes in the district, a very large proportion being compelled to live in wretched insanitary dwellings, with no proper provision for storing food, which quickly becomes unfit for human consumption during such a hot summer and autumn as prevailed in 1899; this especially affects young children in whom are so quickly induced those gastro intestinal disorders which so rapidly become fatal.93

The most elementary sanitary principles were not observed in cowsheds and they could not be allowed to continue to operate in their present state:

89 ‘The Summer of 1899: The Heat and Drought, and Deaths from Diarrhoea’, The British Medical Journal, 11 November 1899., p. 1377. 90 Jones, MOH Report for Merthyr Tydfil for 1899. 91 Ibid., pp.8-9. 92 Ibid., p.9. 93 Ibid., p.13.

233 It is too much to hope that they can be put into a state (after many years of neglect) to satisfy modern sanitary requirements, but I look with some confidence to the removal of the filthy (to use no stronger term) surroundings under which milk is produced for the food of the infant population of your town.94

In 1902 diarrhoea deaths decreased compared with 1901. “The cold damp weather experienced during the third quarter of the year undoubtedly resulted in a diminution of deaths from diseases of the digestive organs.” 95 1903 was memorable for heavy and continuous rainfall, the wettest year recorded, with only one day without rain from March to October, and a subsequently low rate of diarrhoea deaths.96 In 1903 the wet summer saw what were thought to have been the lowest diarrhoea rates for decades (19.98/1000), whereas in fact, diarrhoeal death rates had always been lower than this until 1893. The statement indicates the level of accommodation of increasing levels of diarrhoea deaths which had been reached in public health. The infant mortality rate in 1903 was lower than it had been for the past 15 years at 153 per 1000 births, the lowest on record for the district,97 which was considered “A fair test of the sanitary condition of a district.”98 In 1903 and 1904 the MOH compared the number of deaths from diarrhoea with the number of rainy days and the rainfall July-October for the years 1894-1903: ( Tables 5.7., 5.8.)

It will be seen that the prevalence varies almost inversely with the number of rainy days. Though this ratio does not work out with mathematical accuracy, it is sufficiently close to justify the assumption that the relation is one of cause and effect. 99

August 1906 was a very wet month and only 10 deaths occurred, but during September, when very little rain fell 73 deaths occurred and 15 in October. 100 Good rainfall in 1907 lowered the number of deaths from diarrhoea but did not indicate any improvement in the standards of municipal and domestic cleanliness. Of 69 deaths from diarrhoea, 57 were of children were under one year of age; of this total 14 died in September, 19 in October and 12 in November.101

94 Ibid., p.10. 95 Thomas, MOH Report for Merthyr Tydfil for 1902, p. 28. 96 Ibid., pp.33-35, 42. 97 Thomas, MOH Report for Merthyr Tydfil for 1903, p. 6. 98 Ibid., p.35. 99 Ibid., p.34. 100 Duncan, MOH Report for Merthyr Tydfil for1906, p.13. 101 Duncan, MOH Report for Merthyr Tydfil for 1907, p.17.

234 Table 5.7. Number of Deaths from Diarrhoea with the Number of Rainy Days and the Rainfall July-October for the Years 1894-1903. (MOH Report for Merthyr Tydfil, 1903, p.34.) Year Deaths per No. of rainy Amount in Ins. DSIMR IMR 1000 births days 1894 25.62 70 21.7 25.62 186 1895 45.81 66 23.8 45.81 233 1896 44.56 75 24.5 44.56 213 1897 35.21 64 22.7 32.51 214 1898 45.69 59 18.1 45.69 202 1899 92.49 48 16.7 92.49 272 1900 27.09 63 20.5 27.09 178 1901 49.83 59 13.1 49.83 262 1902 30.39 76 14.9 30.39 185 1903 19.98 92 35.5 19.98 153

Table 5.8. Contrast Between Effects of Wet and Dry Summers on Diarrhoeal Deaths 1903-4.(MOH Report for Merthyr Tydfil for 1904, p.19.) 1903 1904 Births 2752 2803 Deaths from Diarrhoeal Diseases 86 134 Under One Year 52 104 Under 5 years 69 118 Total rainfall 86.1 inches 61 inches July –October Rainfall 35.5 inches 18.5 inches July-October Number of rainy Days 92 71 Deaths of infants under one year from diarrhoeal diseases per 1000 18 37 births

In 1903 the editorial in the BMJ concerned “The Wet Summer and the Public Health.” It referred to the torrential rain as “Natures’ scavenger” which washed away debris and cleansed drains. Although the previous summer was also wet, the rain fell in slight showers which did not have the same cleansing effect. The summer of 1903 marked the end of a series of dry summers over the preceding dozen years, which may explain the window of rising urban diarrhoeal deaths at the end of the nineteenth century. Having recognised the seasonal variations in diarrhoea deaths, it was possible to take some basic steps towards resolving the problem. At the very least streets should be cleansed with copious amounts of water to emulate the natural cleansing effects of rain. This measure was easily within the scope of most sanitary authorities. 102 However, there remained many other problems associated with epidemic diarrhoea, some of which were easily managed, others not so easily. Environmental hygiene measures such as paving and cleansing yards and ensuring cleanliness in cowsheds and milk shops, went some way towards reducing the dust and flies believed to be responsible for summer diarrhoea, and in 1900 Dr Simons particularly criticised the continuing practice of

102 ‘The Wet Summer and Public Health’, The British Medical Journal, 29 August ,1903., p. 475.

235 throwing slops on the road. This was not especially referred to in the bye-laws, the Public Health Acts or the Towns Police Clauses, “the probability being that the framers did not consider that such a disgusting habit was possible in the latter part of the century.” 103 Simons’ report also explained the role of insects, particularly flies, in spreading infectious diseases, particularly typhoid, and described the importance of wire gauze cages to keep flies away from food, the importance of locating food stores away from latrines and the importance of cleanliness in storing and preparing food.104 There were other serious matters that required attention. Dr Simons demanded that houses be provided with proper food storage cupboards and higher levels of cleanliness were maintained in the Borough. Refuse tips in Merthyr in some instances came within close proximity of the houses, attracting flies as the contents of ashbins were deposited. 105 There were ten refuse tips in the district “all are unsightly and objectionable, but some of them are positively dangerous.” At the Plymouth Tip, 80 loads of refuse a day from Merthyr Town, Georgetown, Brecon Road and Abercanaid were deposited. Houses at Quaker’s Yard were some 200 yards from the Graigberthlwyd Tip, the contents of which were considered “the most objectionable in the whole parish.” 106 New houses were being constructed within 100 yards of the Caeracca Tip on the eastern side of the Morlais Brook. In High Street, houses were within 30 yards of the Gellifaelog Tip, which received about 70 loads daily, the surface level of the tip being higher than the roadway. A culvert had been created for the Morlais Brook in order to allow tipping to continue with disastrous results for women and children.

The tip is not fenced in, and women and children are allowed to roam over it and sort the refuse. Apart from the risk they run, they raise dust and scatter it about the neighbouring houses. During warm weather the premises within a radius of about 250 yards are pestered with flies. 107

It was again envisaged that the appointment of a health visitor and district nurses, the sanitary equivalent of a maid of all work, would resolve many of the sanitary authorities long standing problems. It was thought that these women would ensure that house refuse was regularly removed along with stable and byre manure, and that hens

103 Simons, MOH Report for Merthyr Tydfil for 1900, p.12. 104 Ibid., p.11. 105 Ibid., p.14. 106 Thomas, MOH Report for Merthyr Tydfil for 1903, p. 49. 107 Ibid., p. 50.

236 were not kept in back yards.108 In 1908 deaths once again decreased with the rain and increased as the weather turned dry. Penydarren suffered the greatest number of deaths, due mainly to large amounts of house refuse which encouraged flies, and the proximity of the nearby rubbish tip where they were “ a veritable pest”, especially where houses had no pantries to protect food. By 1908 little improvement in municipal hygiene had been observed although a rubbish destructor was in use, but the work of the health visitor had assisted in improving standards of domestic cleanliness and in encouraging breastfeeding.109 Breastfeeding provided the optimal nutrition and immunity which babies needed to survive in Merthyr and throughout nineteenth-century Britain. Artificial feeding and weaning increased their susceptibility to diarrhoeal diseases, particularly in circumstances of poor domestic hygiene. Despite the advocacy of breastfeeding in order to prevent deaths from diarrhoea, the evidence for Merthyr Tydfil from 1905-1908 demonstrates that diarrhoea deaths occurred mainly in infants from 1-7 months. (Table 5. 9.) The MOH report for 1903 criticised mothers for not breast feeding their babies, the practice “being out of fashion, and that not because of any necessity for mothers to earn their own livelihood.” 110 The sound advice was based on very practical considerations. The use of long rubber tubed feeding bottles was both popular and dangerous. Mothers assumed that if a bottle was washed it was clean, regardless of the fact that milk lodged in the angles of the bottle. The use of hot water to clean the tube also partially dissolved the rubber, allowing the surface to collect milk which turned sour and allowed germs to breed. The bottles were often refilled without washing, the baby frequently sucking on the propped bottle until empty without any need to be held or nursed. 111 The use of highly concentrated condensed tinned milk was particularly dangerous because, once opened, the lid could not be replaced and flies were attracted to the contents which also tempted toddlers to dip their fingers in. 112 Adults also used it to sweeten their tea, dipping dirty spoons in. Moreover, the sweetly saturated contents through their wrong composition could create diarrhoea in infants. Bottles could also spread infection to the baby through handling by siblings and adults with unclean hands and little knowledge of rudimentary infant hygiene. Dummies were frequently retrieved from the dirty floor and immediately replaced in the baby’s mouth. In circumstances

108 Duncan, MOH Report for Merthyr Tydfil for 1907, p.17. 109 Duncan, MOH Report for Merthyr Tydfil for 1908, pp. 16-17. 110 Thomas, MOH Report for Merthyr Tydfil for 1903, p.36. 111 Ibid., pp.36-7. 112 Dwork, War is Good for Babies and Other Young Children: pp. 46-49., Buchanan, ‘Infant feeding, Sanitation and Diarrhoea in Colliery Communities, 1880-1911’, pp.157-158.

237 where several households shared one privy, and a single tap when the water supply was working, and where rubbish tips came within yards of houses, it is difficult to imagine how satisfactory levels of hygiene in infant care could be maintained.

Table 5. 9. Number of Infant Deaths Under One year of Age by Weeks and Months from Various Diarrhoeal Diseases in Merthyr Tydfil 1905-1908 (MOH Reports for Merthyr Tydfil 1905-8.) Age Diarrhoea Enteritis, Gastric Catarrh Total Gastroenteritis, Mucoenteritis Under 1 wk 1-2 wks 2 1 3 2-3 wks 6 1 7 3-4 wks 13 3 2 18 Total under 1 19 6 3 28 month 1-2 months 21 7 2 30 2-3 months 23 19 4 46 3-4 months 33 16 9 58 4-5 months 28 17 5 50 5-6 months 25 12 1 38 6-7 months 25 6 3 34 7-8 months 17 5 1 23 8-9 months 10 4 2 16 9-10 months 14 5 2 21 10-11 months 17 1 18 11-12 months 10 4 1 15 Total 1-12 months 223 96 30 349 Total under 1 yr 242 102 33 377

The MOH report for 1905 indicated that “the gloves were off” as far as diarrhoea deaths were concerned. The inspection of cowsheds and dairies for cleanliness, the regulation of fowl-keeping and the cleansing of paving and courtyards could all help reduce the problem, by removing the debris which attracted flies. 113 Advice was distributed to mothers on the care of infants, especially during hot summer months. Babies needed to be kept cool in hot weather by placing them in the open air in the shade, by removing soiled napkins at once, keeping flies away and scrupulously cleaning bottles and teats. That year the Health Department re-issued and distributed a pamphlet through medical practitioners and midwives, advocating breastfeeding to the age of nine months, but even partial feeding was better than none at all. It included instructions on making up cow’s milk for various age groups, with the advice not to re- use any milk which remained, and instructions for weaning foods based on milk up to the age of 18 months. Two bottles were to be alternated, thoroughly cleaned with hot water and a little soda and kept in clean water until required again. Skimmed milk was not to be used, nor was condensed milk, which could cause rickets if used exclusively.

113Thomas and Duncan, MOH Report for Merthyr Tydfil for 1905, pp. 25-26.

238 If condensed milk were necessary it was essential to use whole milk varieties.114 The incorrect dilution of milk powders and condensed milk may cause diarrhoea and dehydration. An analysis of 107 deaths found that the majority of deaths occurred in artificially fed babies, but suckling evidently did not guarantee the safety of the infants either, since 12 babies who were only suckled died. (Table 5. 10.). 115 Undoubtedly faulty infant feeding was one factor, but certainly not the only one which contributed to the deaths of these babies. Many diarrhoeal infections were viral in origin and, like lung diseases, spread rapidly in overcrowded conditions, especially in young or malnourished children.

Table 5. 10. Mode of Feeding in Infants Where Death Occurred. ( MOH Report for Merthyr Tydfil 1906, p.13) 1. Suckled only 12 Suckled and Farinaceous Food 3 Suckled and Cow’s milk 2 Suckled and Condensed Milk 1 2. Cow’s Milk only 16 Cow’s Milk and farinaceous Food 27 3. Condensed Milk only 18 Condensed milk and Farinaceous food 24 4. Farinaceous food only 4

The total number of deaths from all forms of diarrhoea 1905-8 was 377. (Table 5. 9.) There were 115 deaths in 1905, and 100 in 1906, but only 57 in 1907, reflecting a cool wet summer, and 105 in 1908. The peak in diarrhoeal deaths between the first and seventh month of life, most around 3-4 months, shows how diarrhoea was a problem of older infants, presumably coinciding with weaning. (Table 5.10.) Thereafter diarrhoeal diseases are more likely to become chronic conditions associated with infection and malnutrition, especially in combination with visitations of infectious diseases and ensuing lung diseases. This is also a modern and recognisable pattern of infantile diarrhoeal disease, particularly in instances of chronic social or environmental deprivation and paucity. The deaths form part of exogenous infant mortality linked to social and environmental conditions, many of which were increasingly preventable as part of the health visitor’s work from 1908. The examination of attributed causes of infant death in Merthyr Tydfil confirms the conclusions of Woods et al. that diarrhoea deaths rose across Britain at the end of the nineteenth century as a feature of urbanisation despite the sanitary reforms which

114 Ibid., pp.26-27. 115 Duncan, MOH Report for Merthyr Tydfil for 1906, p.13

239 most large towns and cities had undertaken. 116 Diarrhoea deaths provide an excellent example of the way in which both national, regional and local features contribute to this rise. The patterns of diarrhoea deaths in Merthyr Tydfil appear to be close to those identified by Naomi Williams in such towns as Birmingham, Wolverhampton and Stoke in the west Midlands, and Southampton117 The increase in diarrhoeal deaths, mainly in infants 1-8 months, coincided with declining breastfeeding and increasing artificial feeding, either from necessity or choice despite breastfeeding offering a simpler, less expensive and more hygienic solution. Nineteenth-century critics of artificial feeding methods frequently blamed the occupational employment of women for their increasing use, but in Merthyr relatively few women were employed outside the home, which did not of course mean that the women of Merthyr did not work very hard indeed to care for their families. The nature of employment for the breadwinners, much of it in and filthy conditions, created a heavy burden for the women. These conditions however did not change substantially between 1866 and 1908. What did change was the availability of artificial milk. Peer pressure can exert a powerful influence, and as artificial feeding gained popularity its use would increase. The belief that something is more modern can also suggest that it is better. The ability to purchase artificial foods suggests also the freedom to make economic choices. The reason that most mothers gave for not suckling their babies was their inability to do so,118 but that provides little insight to the reasons for their inability, such as insufficient milk, lack of time, ill health, or that a baby was too weak to suck. Breastfeeding requires good maternal health and diet and can undermine a mother’s health as well as being very demanding of her time. Illness of the mother would undermine her ability to breastfeed and the death of the mother would leave a surviving infant needing to be artificially fed. Artificial feeding also allowed a mother to delegate infant feeding to another person, possibly an older sibling. Overcrowding and the presence and needs of other family members, lodgers etc. within the home may also have interfered with the ability to breastfeed. One thing is certain, that infant feeding was “women’s business” in the home, taking public health from the public into the private realm. In Merthyr, living conditions were more a matter of necessity than choice. The pressure of population on housing remained throughout this period and conditions within the home were in most cases far from perfect. By 1908 there remained houses with no water supply, inadequate privies,

116 Woods et al. ‘The Causes of Rapid Infant Mortality Decline in England and Wales, 1861-1921’, Part 1 and Part II. 117 Naomi Williams,’ Infant and Child Mortality in Urban areas of Nineteenth- century England and Wales’, pp.44-46. 118 Duncan, MOH Report for Merthyr Tydfil for 1906, p.14.

240 deficient sewerage and drainage. Even where these amenities existed, old habits of throwing slop into the streets continued. Flies helped the spread of epidemic summer diarrhoea. During hot summers, with drought threatening, with a closely packed urban population in houses without means of preserving milk in a fit condition for consumption, in many instances in close proximity to ashbins and rubbish dumps, it is hardly surprising that epidemic summer diarrhoea was a problem. From 1902 the training of midwives also entailed aspects of home hygiene and, under the supervision of the health visitor, trained midwives would certainly have assisted in disseminating the knowledge required for safe infant feeding practices to mothers and into the homes. However, many older midwives remained uncertified and ignorant of many basic rules of hygiene and many mothers, either inexperienced or ignorant of such requirements. Looking after babies properly in Merthyr must have proved challenging to most. For many infants, the combination of artificial feeding, inexperienced or uneducated mothers, insanitary accommodation, erratic water supplies, and a dirty and overcrowded urban environment proved increasingly by the turn of the century to be a deadly combination.

Conclusion

Deaths from lung diseases and diarrhoea rose to account for a significant proportion of Merthyr’s rising infant mortality from the mid -1880s and particularly by the end of the century. Both increased as reported deaths from convulsions declined, suggesting the possible transference of deaths with more accurate reporting of cause of death by the end of the nineteenth century. Both were subject to seasonal influences. An increase in lung diseases was observed following whooping cough and measles epidemics, made worse by the cold winter climate, extending the impact of infectious diseases on the infant community. Overcrowded living conditions, a constant feature of life in Merthyr, encouraged the spread of respiratory illnesses among children and adults, which proved deadly to babies whose constitutions were weakened for any reason. Overcrowding is thus an important aspect of any discussion of high levels of infant mortality in working-class communities. Lung diseases were, and remain, a somewhat enigmatic, but very real and important part of the social problem of infantile mortality. The analysis of lung diseases in Merthyr suggests an association between deaths from lung diseases, infectious diseases, convulsions and diarrhoea. The effects of measles and whooping cough, the

241 cold damp climate and substandard housing contributed substantially to the rising toll from lung diseases, made worse through close community contact and intensified in the cramped, suffocating atmosphere of the working-class housing. The climate, the housing, the conditions of employment in an industrial town dependent on iron and coal were unavoidable facts of life in Merthyr and hard to change. Young babies were also less able to withstand the biting cold of some Merthyr winters and it was easy to blame mothers for their ignorance and poor nursing and for exposing their children to the cold climate at all hours of the day and night. Diarrhoea deaths rose dramatically in Merthyr Tydfil from 1895-1908, increasing infant mortality rates, particularly in 1899 and 1901. The rise in infant mortality attributed to diarrhoea deaths may possibly also be accounted for by the transference of deaths previously reported as convulsions since a fall in deaths from convulsions coincided with the rise in diarrhoea deaths.119 The very deaths which the nineteenth-century visions of a sanitary utopia intended to prevent were frustratingly increasing. The water supply of Merthyr proved at first to be effective in reducing the water-borne filth diseases for which Merthyr had been notorious, but by the mid-1880s was showing some evidence of possible contamination by algae and faults in supply pipes, and inadequacy during periods of drought. Not only was 1899 a very hot, dry summer, the increase in deaths across the country during the last decade of the nineteenth century may be explained by a series of very hot summer weather for approximately 12 years prior to 1902, and the lack of cleansing rainfall, which allowed filth to accumulate. The conditions were ideal for flies to breed and transmit infections.120 In Merthyr several ash tips were within a short distance of houses. Much infant diarrhoea was preventable by more assiduous attention to cleanliness in the urban environment, which was distinctly lacking in Merthyr, and improving the water supply to all houses. Milk was added to major public health concerns from 1893, as it was proved to be a vehicle for the transmission of infectious diseases, e.g. enteric fever, scarlet fever, diphtheria, tuberculosis and diarrhoea. In an attempt to reduce preventable diarrhoea deaths, the local authorities showed initiative in educating mothers, firstly in the importance of breastfeeding, and secondly in hygienic practices regarding infant feeding, assisted by the appointment of a health visitor in 1908.

119Gassage and Coutts, “A Discussion on Convulsions in Infancy”, the British Medical Journal, 1 9 August, 1899, pp.460-463. 120 ‘The Summer of 1899: The Heat and Drought, and Deaths from Diarrhoea’, the British Medical Journal, 11 November 1899, p. 1377. Buchanan, ‘Infant feeding, Sanitation and Diarrhoea in Colliery Communities, 1880-1911’, pp. 157-158, Thomas, MOH Report for Merthyr Tydfil for 1903., pp.49-52, 57-58.

242 This chapter has demonstrated that not only was the increase in diarrhoea deaths a feature of urbanisation, it was also a feature of overcrowding, as were the increasing deaths from lung diseases. Overcrowded living conditions encouraged the spread of both viral and bacterial infections and are a very important aspect of any discussion of high levels of infant mortality in working-class areas. The thesis stresses that the cumulative effects of all causes of infant death, of which lung diseases and diarrhoea were an important part, created the infant mortality rate and reflected the social circumstances of the population. Chapter 6 will examine the increasing levels of endogenous death from antenatal causes of maternal origin in conjunction with deaths from nutritional causes which link deaths within the first month of life with deaths in the later period of the first year.

243 Chapter Six

The Mother and Child: Infant Mortality in Merthyr Tydfil 1865-1908

Introduction

The first part of this chapter concludes the analysis of deaths in Merthyr Tydfil 1865-1908 by examining infant deaths of maternal origin within a month of birth and from nutritional causes, and public health perspectives and interventions in regard to the perceived problems regarding mothers and babies. The chapter concludes by looking more closely at the issues and difficulties faced by mothers in caring for their infants in this industrial town to explain why high levels of infant mortality continued despite the efforts of the public health movement. From the mid-nineteenth century the medical profession continued to criticise and unfairly blame mothers for their ignorance, neglect and improper feeding which were considered to be the cause of many infant deaths from convulsions, diarrhoea, debility, marasmus and deaths from antenatal causes. A decline in breastfeeding and the rising popularity of bottle-feeding increased the danger of diarrhoea deaths. The causes of infant mortality emanating from the social environment of the home required extending public health protocols from the external sanitary environment and into the private domain. Antenatal causes of infant death increased towards the end of the nineteenth century to account for a greater proportion of infant deaths within the first year. By 1907 (Fig. 7. Table 6.2.) deaths due to antenatal causes were the only causes of death still rising, sustained by nutritional causes of death. The MOH conceded in his reports for 1904-5 that these causes of infant death could not be attributed to the sanitary environment. Many infants died from convulsions, prematurity, debility or congenital abnormalities within a short time of birth, before the impact of adverse environmental factors exerted any great influence on their chance of survival. The causes of infant mortality fell into two periods. Endogenous infant mortality occurred within the first month independent of sanitary conditions, and exogenous mortality related largely to environmental causes. In order to address endogenous infant mortality, the health and survival of babies had to be directly linked with the health of the mother. This link was to some extent achieved through the infant welfare movement, but even so, there remained a disjunction between the perceived needs of mothers and babies. Through the nascent movement women were professionally trained as midwives and health visitors, to raise standards of care for mothers and infants and to

244 ensure that mothers properly cared for their babies. The role of midwives in the care of mothers and babies before, during and after delivery ceased soon afterwards, usually within two or three weeks, but that of health visitors carried over into childhood years as a broader and more influential community health role. Their work also increased awareness of the extent of the social and economic conditions among working-class mothers among whom infant mortality rates were highest. The new direction of public health policies needed to embrace many issues of social as well as medical importance. The role of midwives and health visitors may be considered an important new dimension in public health with considerable potential to prevent perinatal infant deaths. Midwives spearheaded the new public health policies and strategies which took them directly into the home, where many babies died within a short time of birth, and where a number of factors influenced infant deaths, especially the care received from the mother. The lack of formal training among midwives was of concern in regard to preventing maternal deaths in childbirth, a separate issue from that of infant mortality. From 1902, the Central Midwives Board (CMB) increasingly regulated the training and practice of midwives. Midwives in Merthyr were supervised from 1904 by an Inspector of Midwives appointed by Glamorgan County Council. The number of trained midwives in the county remained extremely low, insufficient to replace those retiring from practice. Midwifery training not only involved the care of mothers during delivery, but also included antenatal health advice and the care of infants during the vitally important early days and weeks after delivery, allowing them to give valuable practical instructions to mothers in the care of babies. Teaching mothers to feed their babies safely from birth was essential to lower diarrhoea deaths in later infancy, but the Midwives Act of 1902 was not an initiative intended specifically to reduce infant mortality, although this objective was nonetheless implicit in midwives’ training. Once Merthyr became a County Borough, the Health Visitor and Inspector of Midwives was appointed in 1907. This allowed the town to regulate its own midwives and to adopt the Notification of Births Act, which required all births to be reported to the MOH, and the babies visited within a short time of birth to ensure the health of the mother and infant. The Health Visitor in Merthyr not only supervised midwives; as School Nurse she also witnessed the poor health of children who survived infancy and widespread family poverty recorded from 1908 in the reports of the School Medical Officer. She also referred cases of neglect to the local branch of the National Society for the Prevention of Cruelty to Children (NSPCC), established in Merthyr in 1895. Her role being broader than that of midwives, and her lengthier involvement with families

245 brought her more directly into contact with the social and environmental conditions within the domestic sphere relating to infant mortality after the perinatal period, so that her work related to all causes of infant death during the first year of life. However, as this chapter demonstrates, these sound preventive public health principles fell far short of their objectives when put into practice, and clearly within the period under consideration in this thesis could have had little impact on infant deaths, especially those from antenatal causes. The health of mothers was undermined by the high birth rates proudly reported in Merthyr when the national birth rate was falling. By 1906, however, the MOH reversed this position by explaining that high infant mortality rates were implicit in high birth rates. The number of pregnancies and large families played a significant part in the health of the mother, which determined the infant’s ability to withstand a poor social environment. Her health, like that of the family, was easily undermined by impoverished circumstances. A mother’s ability to breastfeed and provide a safe home environment for her infant enhanced its chances of survival, but life in Merthyr frequently did not allow these opportunities. Early marriage and a lengthy period of childbearing, high birth rates, economic disadvantage, heavy work in the home, and adverse environmental conditions could affect the health of the mother, the outcome of pregnancies and the chance of infant survival.

Deaths of Maternal Origin and Nutritional Causes

The nascent medical specialities of obstetrics and paediatrics in Victorian and Edwardian times allowed nosologies which differentiated only between babies dying within a short time of birth from congenital malformations, premature birth and those dying from debility, atrophy or marasmus. The latter group were referred to as developmental disorders but in this thesis are considered as nutritional disorders. These terms almost certainly distinguish between babies born before full term, but normally developed for their gestational age, and those born at full term, but underweight for their gestational age and suffering from intrauterine growth retardation due to poor maternal health, diet or placental insufficiency, but the distinctions are not always clear. In practical terms, in the late Victorian and early Edwardian period, both sets of infants began life enfeebled, with physical deficits which made it harder for them to survive. Dr Thomas surmised in 1903 that “some of the 30 [deaths] returned as Debility from birth may have been due to some congenital disease. In all these, the factors are certainly

246 independent of sanitary conditions.” 1 In 1904 he provided the more precise information that:

40 deaths were due to premature birth, in eight the cause of death was certified as malformation, and in another eight it was atelectasis. There were only three deaths due to diseases inherited from the parents, but possibly some of the 30 returned as Debility from birth may have been due to some congenital diseases. In all these, the factors are certainly independent of sanitary conditions. In 1904 43 deaths were due to Prematurity and 47 from congenital debility. 2

Dyke was exceedingly familiar with the problems of prematurely born and weakly infants, regarding these early deaths ranging from one day to within three months of birth as non-preventable, a sad fact of life which Dyke reported each year in its various forms. In 1867, “sickness incident to those prematurely born, and to those in the first three months of life, occasioned 50 deaths.” 3 Deaths from ‘maladies incidental to Childhood’ or ‘Developmental problems’ numbered 51 in 1870, 67 in 1871 and 75 in 1872. 4 In 1874, 94 deaths were attributed to “Premature Birth” and to “Debility”, and Dyke states that “In nearly all these instances the age at death was under three months.”5 In 1875, a further 73 infants died of diseases “due to development” within the first three months of life. 6 In 1877 Dyke explained that debility referred to problems which affected an infant during the first three months of life. 7 In 1884, he stated that from “that form of weakness incident to very young infants, 58 deaths resulted.”8 In 1885 he reported more specifically that “under the heading of “debility,” the deaths of 52 infants are entered; in the majority of instances they were not above a day old.” 9 In 1887, he reported that 13 infants died from “Premature Birth”, and three from “Congenital malformations.”10 In 1888, “Premature Births and Malformations were the assigned causes of death of 20 very young infants.” 11 In 1889, the number was 24, and in 1890 premature births accounted for 15 deaths and congenital malformations for nine infant deaths. 12 In 1892, 44 infants died of malformations and premature birth, but Dyke adds,

1 Thomas, MOH Report for Merthyr Tydfil for 1903, p. 36. 2 Thomas, MOH Report for Merthyr Tydfil for 1904, p. 20. 3 Dyke, MOH Report for Merthyr Tydfil for 1867, p.7. 4 Dyke, MOH Report for Merthyr Tydfil for 1872, p. 24. 5 Dyke, MOH Report for Merthyr Tydfil for 1874, p.12. 6 Ibid., p.7. 7 Dyke, MOH Report for Merthyr Tydfil for 1877, p.6. 8 Dyke, MOH Report for Merthyr Tydfil for 1884, p.8. 9 Dyke, MOH Report for Merthyr Tydfil for 1885, p.7. 10 Dyke, MOH Report for Merthyr Tydfil for 1887, p.6. 11 Dyke, MOH Report for Merthyr Tydfil for 1888, p.4. 12 Dyke, MOH Report for Merthyr Tydfil for 1889, p.3., Dyke, MOH Report for Merthyr Tydfil for 1890, p.7. 247 “In the majority of cases these were babes of a few minutes or hours old.” 13 In 1895 there were 40 such deaths, and according to Dyke in 1896 “Those of the first days of life, the prematurely born and the malformed internally, were returned at the number of 55.”14 Infant deaths in Merthyr from antenatal causes of maternal origin increased over time from approximately 10% of all deaths to approximately 17% by 1908, whilst a steady number of deaths from nutritional causes led to failure of normal growth and development of the infant. Together they contributed substantially to infant deaths. Deaths of maternal origin show a steady rise from 7.71 / 1000 births in 1866 to 9.8 /1000 in 1871 and 13.8 /1000 in 1873, possibly due to the adverse effects of poverty on mothers following the economic upheavals of 1871-5. They rose more steeply from 19.54/1000 in 1891 to 31.80 /1000 in 1908, contributing substantially to the rising infant mortality rate in Merthyr in the late Victorian period. There were 1,727 deaths of maternal origin and 2,706 from nutritional or developmental disorders, a total of 4,433 preventable infant deaths mostly of social origin, nearly a quarter of total deaths. There were 1,071 deaths due to prematurity and atelectasis, where the inadequately developed lung cannot function properly; and 309 congenital abnormalities which can be immediately identified with folate deficiencies. Deaths from congenital abnormalities rose from 0.49 / 1000 in 1866 to a peak of 11.73 in 1907. The reports for 1866 and 1905-1908 containing details of infant deaths by weeks and months under one year, show most deaths of maternal origin, particularly premature births and congenital abnormalities, consistently occurring within a month of birth, the majority in the first week. (Table 6.1.) Of 100 deaths from congenital defects 1905-1908, 67 died in the first week and 87 in the first month, but a few lingered until their tenth month. Current understanding of congenital neural tube defects in infants stemming from maternal folate deficiency suggests that such deaths in the nineteenth century indicated dietary deficiencies in the mothers. Congenital defects are also more likely to occur in older mothers.15 The importance of maternal nutrition in producing healthy babies is now regarded as a preventive health strategy of primary importance.16

13 Dyke, MOH Report for Merthyr Tydfil for 1892, p.11. 14 Dyke, MOH Report for Merthyr Tydfil for 1895, p. 5., Dyke, MOH Report for Merthyr Tydfil for 1896, p.10. 15http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/(Pages)/Birth_defects_heart_abnormalities?op en 16http://www.marchofdimes.com/printableArticles/14480_1926.asp 248 Table 6.1. Number of Infant Deaths by Weeks and Months in Merthyr Tydfil 1905- 1908 from Causes of Maternal Origin (MOH Reports for Merthyr Tydfil 1866-1908.) Premature Congenital Syphilis Birth Total Age Birth Abnormalities Injuries Under 1 wk 151 67 5 223 1-2 wks 12 9 2 23 2-3 wks 13 8 1 22 3-4 wks 12 3 2 17 Total under one 188 87 5 5 285 month 1-2 months 9 6 7 22 2-3 months 3 1 1 5 3-4 months 1 2 3 4-5 months 2 3 5 5-6 months 1 1 2 6-7 months 1 1 7-8 months 1 1 2 8-9 months 1 1 9-10 months 3 1 4 10-11 months 2 2 11- 12 months Total under 1 - 15 13 19 47 12 months Total under 1 203 100 24 5 332 yr

Table 6.2. shows deaths from causes of maternal origin as percentages of infant deaths 1905-8, most peaking in 1907. Most deaths of premature infants and those from congenital abnormalities, a third of total deaths from convulsions, and a third of deaths from debility occurred within the first month of life, many within the first week and were acknowledged by Dyke’s successors, but not by Dyke, to be due to antenatal rather than environmental causes. Of 203 deaths from prematurity 1905-1908, 151 occurred within the first week, 188 in the first month of life, and only six survived into the second month. The poorly developed physiology, lungs and temperature regulation functions of infants made them prone to many complications, many expressed as convulsions.

Table 6. 2. Percentage of Infant Deaths from Causes of Maternal Origin as in Merthyr Tydfil 1905- 1908 (MOH Reports for Merthyr Tydfil 1866-1908.)

Deaths of Maternal Origin 1905 1906 1907 1908

Premature Birth 8.85% 9.45% 13.33% 10.44% Congenital 2.78% 6.37% 6.66% 5.22% Syphilis 0.69% 1.44% 0.95% 1.88% Birth injuries N/A N/A 0.95% 1.21% Total 12.33% 17.25% 21.9% 17.75%

The most common cause of death reported was prematurity. From 1937, premature babies were defined by birth weights under 2,500g (5.5 lbs) irrespective of gestational age. In 1961 the World Health Organisation replaced the term “premature” 249 with “low birth weight”. 17 Babies born before 37 weeks gestation usually account for two-thirds of low weight babies. 18 Many deaths associated with prematurity were linked to maternal conditions during pregnancy. Although there is still no apparent cause for up to 60% of premature births, and the physiology of labour is still poorly understood, factors include genetic defects, twins, heart, kidney or lung problems in the mother, pre-eclampsia, antepartum haemorrhage, and low socio-economic background. 19 The greater the number of pregnancies the more likelihood of subsequent premature birth, particularly due to cervical incompetence, a likely scenario in Merthyr where large families were common. Furthermore, congenital abnormalities were more likely to occur in older mothers nearing the end of their fertility. Small immature infants, and underweight for gestational age (UGA) babies who have suffered intrauterine growth retardation and soft tissue wasting due to under nutrition, experience many problems in the neonatal period, including hypoxia or asphyxia, hypoglycaemia, hypothermia, jaundice, respiratory distress and convulsions. 20 Premature babies need scrupulous hygiene to prevent infection and small frequent feeds preferably of their mother’s breast milk, artificially fed by pipette if necessary. 21 Careful nursing is crucial to the survival of these babies, and at the turn of the century specialised knowledge and care was in its earliest days.22 Such babies may also develop rickets and are prone to blindness. 23 These conditions at birth would reduce the chances of surviving later illnesses. Syphilis accounted for less than 2% of infant deaths of maternal origin 1905-8, but are important to consider from a social perspective since surviving infants could suffer from later disabilities. From 1865-1908, 238 babies died from syphilis, approximately 8 each year. The highest rate of 7.29 /1000 occurred in 1870 but decreased to 3.65 in 1908, higher than usual. There were 24 deaths of syphilitic infants, 1905-1908, 5 of which occurred in the first week of life and the rest sporadically through to the eleventh month. Syphilis was a silent deadly killer and women may not have been aware of the infection, or too ashamed to seek treatment which was long, unpleasant and toxic prior to the availability of antibiotics. Syphilis in the tertiary stages

17 Vera Da Cruz, Mayes Handbook of Midwifery, Seventh Edition, Bailliere, Tindall & Cassell, 1967, p.335. 18 Margaret Myles, Textbook for Midwives, p. 515. 19 Prematurity: Born too soon, too small, Perinatal Epidemiology Research Initiative, March of Dimes, http://www.marchofdimes.com/printableArticles/14332 1157.asp 20 Ireland et al. Paediatric Primary Health Care, pp. 101, 105-112. 21 Da Cruz, Mayes Handbook of Midwifery, pp. 335-341. 22 Myles, Textbook of Midwifery, pp. 515-.516. 23 Da Cruz, Mayes Handbook of Midwifery, p. 341. 250 attacked the brain and many adult sufferers were confined in lunatic asylums. 24 Babies with congenital syphilis might be stillborn, apparently healthy at birth or have easily recognised signs of the disease. Venereal diseases among mothers, although infrequent, required vigilant care of the newborn. Opthalmia neonatorum, a highly infective gonorrhoeal infection, could lead to total loss of sight. 25 The child was highly infectious and needed to be carefully nursed .26 Neonatal pemphigus was also highly contagious.27 The assigned causes of infant death included in the category antenatal causes include congenital abnormalities, spina bifida, malformation of the spine, bladder, cleft palate, hydrocephalus, imperforate anus, intussusception and intestinal obstruction, dropsy, liver/spleen diseases, syphilis, heart disease, atelectasis or inadequate development of the lung associated with prematurity, cancer, and prematurity. The numbers of infant deaths and the DSIMR from these causes are shown in Appendix. Tables 17, 17 (a) Also included in this group are four birth injuries in 1907 and one in 1908. One death from bladder disease in 1904 is assumed to have been congenital. Heart disease accounted for a total of 35 deaths, due possibly to congenital malformations, syphilis, or streptococcal infection. Cancer accounted for three deaths which are considered congenital for the purpose of this analysis. Liver and spleen diseases and jaundice were due to a number of causes, including blood rhesus factors and congenital syphilis. 28 Many of these conditions were common among low birth weight and pre-term babies and those born with a range of congenital abnormalities. 29 Increasing care in stating the cause of death may explain some of the rise, but most of these conditions are unlikely to have been misdiagnosed, leading to the conclusion that such deaths reflect poor maternal health and nutrition and extended childbearing as underlying factors. These deaths suggest a general unhealthiness of mothers due to economic and social circumstances beyond their control and explain why more general public health measures failed to reduce the notoriously high levels of infant mortality in Merthyr. The economic and social adversity in which mothers reared

24 The Merthyr Express, January 31, 1885., p.5. In 1885 there were 206 inmates in the workhouse with 6 or 7 syphilitic cases in the infirmary and a syphilitic ward was to be built. Two girls had requested admission to the infirmary suffering with venereal disease, but two days later one of the girls was seen walking the street apparently plying her trade. Although the Contagious Diseases Act did not apply in the district it was possible to compel such cases to remain under treatment, and it was proposed that the Board of Guardians apply for that power. However, the Board was of the opinion that this could not be obtained and no further action was taken 25 Andrews, Midwifery for Nurses, p.272. 26 Ibid., pp. 274-5. 27 Da Cruz, Mayes Handbook of Midwifery p. 360. 28 Vulliamy, The Newborn Child, pp. 163-168. 29 Ibid., pp. 86-7, 90-94, 100-110, 113, 119-20, 124-6, 131-2, 134, 135-7. Some causes of death found in nineteenth-century Merthyr are still commonly found today in countries where poverty and malnutrition are common. 251 their infants has been clearly demonstrated in previous chapters. Deaths due to antenatal causes, addressed within this chapter, cannot be isolated from the overall picture of infant mortality in the town and indeed are central to it.

Nutritional Disorders

In addition to deaths of maternal origin, deaths from debility and nutritional causes have been analysed separately from, but need to be considered together with, deaths from antenatal causes. Although delivered at full term, these babies were almost certainly gestationally underweight and exhibited a different survival pattern, often lingering for weeks or months whilst clinging to life, but failing to thrive. In 1877, 65 deaths from debility, in babies from one day to three months old, and 79 deaths from convulsions made a total of 144 deaths registered under causes of death which did not indicate the condition from which the infant died. Debility was an imprecise cause of death and Dyke believed that medical attendants should assign the cause of death more accurately.30 A further 67 infant deaths from “Debility” occurred in 1890 and Dyke commented that “It would be well if some more accurate descriptions were given:” 31 In 1886, debility was recorded as the cause of 69 infant “Deaths from Ill-defined Causes.” Many died within the first day of life. 32 In 1891, 79 deaths from ill-defined causes included a large number of babies only a day old assigned again to “debility”. 33 In 1895, the deaths of 72 infants were due to “ill-defined causes”. Many deaths due to “debility” occurred within a day of birth, and all deaths due to “atrophy and debility” in the MOH tables, were classified as “developmental disorders”, in many instances categorised together with marasmus as “wasting diseases”, suggesting poor growth and development, rather than prematurity. Failure to thrive, a modern term, describes chronically undernourished and under developed infants suffering from a range of conditions from starvation to chronic disease with evidence of chronic and recurrent infections preceding marasmus, where the child chronically ill is undernourished and has a wizened, wasted appearance.34 It covers conditions where normal growth and development fail to occur, and seems to describe the physical conditions reported in this group of infants. Any illness in malnourished babies compounds the problem. Any infectious disease in children may

30 Dyke, MOH Report for Merthyr Tydfil for 1887, p. 8. 31 Dyke, MOH Report for Merthyr Tydfil for 1890, p. 8. 32 Dyke, MOH Report for Merthyr Tydfil for 1886, p. 8. 33 Dyke, MOH Report for Merthyr Tydfil for 1891,p. 9. 34 Ireland et al., Paediatric Primary Health Care, pp.59, 64-67. 252 easily result in malnutrition which then exacerbates chronic ill-health. 35 Measles, whooping cough, pneumonia and chronic diarrhoea or gastroenteritis may all precipitate malnutrition. Too little food may be given or too little taken or absorbed due to vomiting, diarrhoea, or chronic illness. 36

Table 6.3. Deaths of Infants Under one Year of Age From Atrophy, Debility and Marasmus in Merthyr Tydfil 1905-1908. (MOH Reports for Merthyr Tydfil, 1905- 1908.) Age 1905 1906 1907 1908 Total Under 1 wk 12 8 7 6 33 1-2 wks 5 7 3 4 19 2-3 wks 2 8 3 3 16 3-4 wks 14 4 1 5 24 Total under 1 month 33 27 14 18 92 1-2 months 6 13 6 13 38 2-3 months 8 17 10 6 31 3-4 months 3 11 5 6 35 4-5 months 5 5 4 5 19 5-6 months 5 9 2 3 19 6-7 months 3 5 4 7 19 7-8 months 4 3 1 8 8-9 months 1 2 2 5 9-10 months 1 4 2 7 10-11 months 1 1 1 3 11- 12 months 1 1 2 Total under 1 yr 67 94 53 64 278

The nutritional causes of infant death analysed include debility, marasmus, rickets, starvation and want of breast milk. In addition to 2,508 deaths from atrophy, debility and marasmus, 1865-1908, and 95 from wasting diseases, other causes of death included in this category were 29 deaths from rickets, 39 from want of breast milk, 12 from starvation, 21 from thrush, and 11 from stomatitis associated with pellagra, all suggesting severe general malnutrition among infants. (Tables 18, 18 (a).) 37 The example of 1905-8 indicates the ages at which infant died from these afflictions. (Tables 6.3, 6.4 and 6.9.) It is also important to again remind the reader that these deaths represented perhaps 10% of surviving cases of nutritional deficiency among infants, with many more among young children. A total of 2,706 nutritional deaths 1866-1908 contributed fairly steadily to the infant mortality rates until the Edwardian period when their decline began, coinciding with the rise in deaths of maternal origin The DSIMR of 32.56/1000 births in 1866 declined steadily to 25.95 in 1908 with the exception of 1899. The highest rate of 47.52 /1000 live births was reached that year, when deaths from maternal causes also reached their highest level of 34 deaths /1000

35 Ibid., p.65., Nick Spencer, ‘Historical evidence linking poverty and child health in developed countries,’ Poverty and Child Health, Radcliffe Medical Press, Oxford, 1996, Ch.4., p.67. 36 Ireland et al., Paediatric Primary Health Care, pp.59-60. 37 Ibid., pp.65-7, pp. 68-9, p.70. 253 births. These deaths were connected through the generalised poverty experienced during the Great Strike of 1898 in which the health of mothers and children suffered.

Table 6.4. Deaths of Infants Under One Year of Age by Weeks and Months in Merthyr Tydfil 1905-1908 from Nutritional Disorders (MOH Reports for Merthyr Tydfil, 1905-1908.) Age Atrophy, Debility Want of Breast Rickets Total and Marasmus Milk, Starvation Under 1 wk 33 33 1-2 wks 19 19 2-3 wks 16 1 17 3-4 wks 24 2 26 Total under 1 month 92 3 95 1-2 months 38 3 1 42 2-3 months 31 4 1 36 3-4 months 35 35 4-5 months 19 1 1 21 5-6 months 19 1 20 6-7 months 19 1 1 21 7-8 months 8 8 8-9 months 5 5 9-10 months 7 1 8 10-11 months 3 3 11- 12 months 2 1 3 Total over 1 month 186 10 6 202 Total under 1 yr 278 13 6 297

Thirteen deaths 1905-1908, none under two weeks old, were attributed to ‘Want of Breast Milk / Starvation.’ Deaths peaked at 2-3 months and ceased after 6-7 months, suggesting a slow process of failing health, weight loss, malnutrition and starvation, possibly associated with weaning. The mother may have been unable to produce sufficient milk for the infant or the baby unable to suck or absorb the milk for many reasons. (Table 6. 4., 6. 5.) Any generalised conditions which undermined a mother’s health might prevent her from producing sufficient milk, but inadequate diet and overwork would also reduce her ability to feed the baby. Breast milk was naturally formulated to the individual needs of the baby, and protected it against many illnesses, but Ellen Ross describes malnutrition commonly occurring among dowager or “ex- babies” as they are weaned rapidly in order to feed a new baby. 38 This was also likely in Merthyr where large families were common. 39 Wilful or social neglect could also occur in some families, as revealed by reports of the Merthyr and Dowlais Branch of the NSPCC. Six deaths from rickets 1905-1908, between 1 and 12 months of age, may have been the result of nutritional deficiencies either in the mother or infant. The fact that some babies died of rickets suggests that other cases existed in the community. Added to the deaths from want of breast milk and deaths from marasmus and prematurity, these

38 Ellen Ross, Love and Toil: Motherhood in Outcast London, 1870-1918, Oxford University Press, New York, 1993., pp. 144-6. 39 Andrews, Midwifery for Nurses, p.276. 254 deaths suggest chronic levels of ill-health and malnutrition amongst mothers and children. In a community where male breadwinners supported the family, it was customary to see that the head of the family was well-fed whilst other family members “made do.” 40 Inspection of school children from 1908 revealed generalised levels of malnutrition, poor eyesight, hunger and apathy among schoolchildren as a continuation of poor health in infancy and early childhood, and general levels of hunger and apathy suggested chronic levels of poverty among families. 41

Table 6.5. Deaths of Infants Under One Year of Age in Merthyr Tydfil 1905 –1908 from Nutritional Disorders (MOH Reports for Merthyr Tydfil, 1905-1908.) Nutritional 1905 1906 1907 1908 Total Disorders Atrophy, 67 94 53 64 278 Debility and Marasmus Want of Breast/ 1 6 6 13 Starvation Rickets 1 4 1 6 Other Nutritional Total 67 96 63 71 297

Infant deaths from want of breast milk, rickets and starvation suggest a core of sickness and malnourishment associated with poor maternal health whilst deaths from marasmus and debility suggest deprivation within the family that resisted economic upturns, in a classic cycle of poverty and chronic infections. Normal growth and development also depends on genetic, environmental, socio-economic, emotional and nutritional factors. Neglect in any of these areas can adversely affect normal growth and development. 42 Socio-economic factors are of prime importance in determining the quality of life of infants and children in any community and efforts to cycles of ignorance, poverty, under nutrition and social deprivation require social and political change on a large and determined scale. 43 Unemployment, irregular wages, poor housekeeping and infant rearing skills, lack of breastfeeding, large families

40 Ross, Love and Toil., pp. 32-36. 41 Duncan, MOH Report for Merthyr Tydfil for 1908, pp. 45-50., ‘The Doctor In School’, Merthyr Express, 11 January 1908., p.12., A. Duncan, Annual Report of the School Medical Officer for the Year 1920 to Merthyr Tydfil Education Committee, pp. 9-31. ‘The Feeding of Schoolchildren’. The Child’s Guardian, May 1906., p.57. A letter to the Merthyr Express argues that “ Every right-minded person must feel indignant at the encroachments made to subvert the liberty of the people. ” The writer railed against ‘the allopathic priests….forging the chain to enslave the people by a Registration of Births Bill, a Death Certification Bill, Inspection of Schools,…&c. ‘The Doctor in School’, Merthyr Express, 25 January 1908, p.6. 42 Ireland et al., p. 62. 43 Ibid., p.63., Spencer, ‘Historical evidence linking poverty and child health in developed countries’, pp.56-57. 255 accompanied by substandard housing all contributed to this problem, but industrial mining towns and high density living were particular risk factors which explain part of the regional inequities in the experience of infant mortality researched by C. H. Lee (1991). 44 When, in 1903, the IMR in Merthyr fell surprisingly and exceptionally to 153/1000 births, a 40% reduction from 1901, Dr Thomas warned against complacency. 45 As the infant mortality rate returned to more typical levels of 186/1000 in 1904, due mainly to an increase in deaths over the summer months, deaths from marasmus also increased. According to the MOH “This might be expected, as this disease is primarily due to digestive disturbances.” 46 This concurs with the picture of diarrhoea, chronic malabsorption and malnutrition already described. In 1904, Thomas emphasised the pernicious effects of the problem of infantile mortality, not only in the numbers dying, but in the debility of those surviving:

It is unnecessary to emphasize the importance of this subject. The bare fact that one-third of the total deaths in the district is contributed by infants under one year of age is sufficiently startling, but the causes which operate in the production of this high mortality leave their effects on a large number of those who survive. 47

In all these, the factors are certainly independent of sanitary conditions. 70 deaths due to diseases of the digestive organs and 50 deaths from marasmus which, in its primary stages, is essentially dependent on digestive disturbances. It is probably no exaggeration to state the large majority of these were preventable deaths, and can be ascribed to errors of feeding. 48

Together, maternal and nutritional causes of infant death accounted for 40.48 deaths / 1000 births in 1866 and 57.37 deaths / 1000 in 1908, peaking at 80.6 in 1899. (Appendix Table 19.) This peak followed the economic hardships of the 1898 strike, but also coincided with the very hot drought year in which summer diarrhoea deaths peaked, an excellent example of the difficulties of isolating the causes of infant death. Frustrated at the apparent failure of public health measures to reduce infant mortality, and recognising the social and antenatal origins of many causes of infant death, the MOH shifted the emphasis in their reports to criticisms of mothers and their part in

44 Ireland et al., p.65., C. H. Lee, ‘Regional inequalities in infant mortality in Britain, 1861-1971’, Population Studies, Vol.45.,1991., pp.343-366., cit. Spencer, ‘Historical evidence linking poverty and child health in developed countries’, p.56. 45 Thomas, MOH Report for Merthyr Tydfil for 1903, pp. .35-6. 46 Thomas, MOH Report for Merthyr Tydfil for 1904 , p. 20. 47 Thomas, MOH Report for Merthyr Tydfil for 1904, p. 21. 48 Ibid. 256 sustaining infant mortality, making it essential that midwives and health visitors were trained to help mothers overcome their “ignorance” in matters of infant care.49 The infants of Merthyr needed all the protection they could get. In 1905, 14% of infant deaths occurred in the first week of life and 30% died within the first month, the remaining 70% throughout the first year, with an infant mortality rate of 205/1000, the same as 1854 in the cholera years. The MOH reports continued Dyke’s earlier criticisms of mothers for their ignorance in feeding improper foods to infants and neglect in not breastfeeding, a familiar and persistent theme. Not only did children die from underfeeding, but also, according to the MOH for Merthyr in 1901, from overfeeding on the wrong foods.

Many of the deaths due to Marasmus (48), Disorders of Digestion (97), and Convulsions (72 ) are due to the ignorance displayed by mothers in these parts in feeding their children. Bottle feeding is now bidding fair to become universal. Young mothers will not take the trouble to nurse their children, and year by year as the bottle feeding gains, so will the infantile death rate increase. There is a field where the Council might do good work if they provided the parents of newly born children with instructions how to feed their children…it is most extraordinary that in this age of progress the most important knowledge of how to feed the young seems to be universally neglected with disastrous results. If the Council were to place in every young mother’s hands the information that no child should be given solid food until nine months old without the permission of a medical man, and if they could be pointed out the risks of overfeeding, which is as fatal as starvation, if they could be persuaded that the ‘bottle” is a bad makeshift for breast nursing…., then I am sure that deaths among infants would decrease most markedly. At the present time it is only the strongest children survive, and the more a child wastes from overfeeding, or from being fed on indigestible tinned food and biscuits in the place of milk, the more ignorant neighbours ply the poor little mortal with all kinds of nostrums and rubbish in the shape of “Patent Foods” which the infantile stomach was never constructed to digest. 50

Mothers were also criticised for taking advice from a neighbour who,

has had ten children or more, and who has buried eight of them. If your Council intend to move with the times, and enquire what can be done to prevent the slaughter of the innocents that goes on year by year, it is this “experienced neighbour” who will be the stumbling block. 51

49 Dr Richard Jones of Blaenau Festiniog addressed the inaugural meeting of the Cymmrodorian Section of the National Eisteddfod at Bangor appealing for higher health standards. He criticised the use of deadly long-tubed feeding bottles, urged the importance of educating girls in home hygiene matters. ‘Sanitation in Wales’, The British Medical Journal, 9 July 1904, p.86. 50 Simons, MOH Report for Merthyr Tydfil for 1900, p.17. 51 Ibid. 257 A major concern, was the fact that breastfeeding appeared to be declining and artificial feeding increasing. Midwives and health visitors needed to encourage and assist mothers to breastfeed, vital to infant survival in adverse social, economic and environmental circumstances. It was particularly important to care properly for babies to prevent deaths from epidemic summer diarrhoea. A recent study established that breast milk contains a powerful natural antibiotic enzyme, enzymexanthine oxidase, absent from artificial infant formulae. It is potent, even in low concentrations, against salmonella and E. Coli. and is therefore actively beneficial in addition to the passive benefits of transferred maternal immunity to certain diseases.52 Deaths were less likely to occur in breast fed babies and more so in babies fed artificially, particularly “putrefying food as the medium of introducing the specific poison.” 53 In order to breastfeed mothers needed nourishment and rest, the provision of which lay beyond the defined role of public health. In 1900 the MOH proposed that the Council provide the parents of newborn infants with instructions on infant feeding. 54 Early in 1902, 10,000 copies of instruction leaflets were printed by the Health Committee to be distributed by the Registrars of Births and Deaths and medical practitioners when births were notified. The effectiveness of this measure was difficult to gauge immediately since a fall in infant mortality in 1902 was more likely due to the wet summer with lower incidence of diarrhoea. 55 A damp summer in 1907 was said to be one of the healthiest on record. 56 In Cardiff, Swansea and the Rhondda, diarrhoea deaths accounted for 14%, 10% and 20% of infant deaths respectively in 1905 compared with Merthyr where they accounted for 19.96% of infant deaths. Since 1901, cards written in English and Welsh had been distributed to about four-fifths of the mothers in the Rhondda, in only a portion of the district, through one Registrar of Births and Deaths, with guidelines for the feeding and general management of babies. A noticeable fall in diarrhoea deaths had occurred in areas where cards had been distributed over the four years. The inhabitants were all of the same social class, earning the same wages and the scheme was used to argue in favour of the appointment of women inspectors to visit people’s homes. 57 In Merthyr, the issuing of instructions on infant feeding may have contributed to the gradual decline

52 Medical Observer, 15 September, 2000., p.2. 53 Duncan., MOH Report for Merthyr Tydfil for 1906., p.13. 54 Ibid. 55 Thomas, MOH Report for Merthyr Tydfil for 1902., pp.10-11. 56 The Merthyr Express, 7 September 1907., p.7. 57 The Child’s Guardian, 9 September 1906., p.104. 258 in diarrhoea deaths, which had already begun before their distribution, but the summer weather patterns continued to have a marked effect. In 1903 Dr. Thomas lamented that infants were denied their nourishment of birthright without good reason since few women were employed outside the home in Merthyr. The child may have been receiving an abundance of nourishing food, but derived no benefit from it, as it was not a suitable food. The best food is denied the infant, as breast feeding is out of fashion, and that not because of any necessity for the mothers to earn their own livelihood. 58

He criticised mothers for neglecting their duty in failing to breastfeed, thereby

The supply of babies is diminishing, but the infantile mortality remains almost as high as it did 50 years ago. Sanitary progress has been instrumental in reducing the death-rate, and it is only natural to expect that the infantile mortality should also follow suit, but we have to admit the failure of such efforts in the case of the latter, and such failure is due primarily to the introduction of various social factors which have counterbalanced the good effect of sanitary improvements. The two most important factors are the tendency of mothers to neglect their primary duty of nourishing their infants, and the ignorance displayed in the artificial feeding of babies.59

The campaign intensified to promote the benefits of breastfeeding and to ensure that artificial feeding was safely carried out. Dr. Thomas expressed his opinion in 1904:

Every doctor of long experience will admit that artificial feeding is much more common now than in former years, and it is certain that such an unnatural method is practised in the ignorance of the injury it inflicts upon the baby. The breast-fed infant has a far better chance of survival than his bottle fed brother. Not only he escapes the perils of digestive disturbances, but it is also probable that he is less liable to contract certain infectious diseases. Professor Welch in his Huxley lectures says:- “The infant comes into the world with its immunising bodies, the antibodies, smaller in amount and less energetic than those possessed by the healthy adult. It is an important function of the mother to transfer to the suckling through her milk the immunising bodies, and the infants stomach, has the capacity, which is afterwards lost, of absorbing these substances, in an active state. The relative richness of the suckling’s blood in protective anti-bodies explains his greater freedom from infectious diseases.” 60

Of particular concern to health professionals was the use of “the bottle with a long rubber tube.” Plates 10 and 11. show why this type of bottle was so difficult to clean. 61

58 Thomas, MOH Report for Merthyr Tydfil for 1903, p.36. 59 Ibid., p.21. 60 Thomas, MOH Report for Merthyr Tydfil for 1904, p.21

61 I am indebted to Susan Watts for a wealth of information on infant feeding bottles Sue Watts, ‘Allenburys foods and feeders’ -Pharmacy History Australia, Vol.3, No 26, July 2005. http://www.psa.org.au/ecms.cfm?id=513#allen.

259 Sometimes it is used because it saves trouble; there is no necessity to hold the baby or bottle whilst the former is being fed; he is allowed to suck until the bottle is empty; the latter is refilled after a most perfunctory cleansing, and often without even an attempt being made to wash it. This process saves trouble, but it plays havoc with the child’s digestive powers. 62

In 1905 the MOH report acknowledged for the first time that hitherto the antenatal condition of the mother had not been sufficiently considered as a cause of the increasing infant deaths, but also blamed alcoholism, syphilis and neglect on the part of mothers.

Premature births and congenital defects account for 46 of the81 deaths, and syphilis and alcoholism in the mother are potent causes in their production…… ….. Many of the deaths from Marasmus, Atrophy and Debility are also due to bad feeding, but these names probably conceal deaths really due to inherited syphilis. 63

The attack on mothers continued more forcibly in 1906.

It is unfortunately the case that deaths from premature births and congenital defects are increasing in England and Wales of late years, and this can only be due to antenatal conditions, to which little attention has been paid [my emphasis]. Authorities who have investigated this point are unanimous that the most powerful predisposing agent to death from these causes is parental, and more especially, maternal alcoholism.” Many of the deaths from Debility, Atrophy and Marasmus are really due to improper feeding, and would be eliminated if mothers were able to suckle their offspring; 64

The reports exemplify the perceived problems, and the familiar themes of social reformers who effectively lay the blame for ill-health and insalubrious living conditions on the working classes themselves. The MOH warned schoolchildren and the community at large that “alcoholic indulgence is a cause of the poverty which is at the back of our sanitary difficulties….and undoubtedly alcoholic indulgence must be held responsible for the low standards that prevail in parts of the district.” 65 He argued that premature birth and congenital defects in infants could only be prevented by “measures applied to their parents.” 66 An editorial in the Child’s Guardian also stated that most of children’s miseries were on account of ignorance of the mother, but acknowledged that “many mothers whose children appear weak and ill are anxious on their behalf, and are

62 Thomas, MOH Report for Merthyr Tydfil for 1903, pp. 36-7. 63 Thomas and Duncan, MOH Report for Merthyr Tydfil for 1905, p.30. 64 Duncan, MOH Report for Merthyr Tydfil for 1906, p.16. 65 Thomas and Duncan, MOH Report for Merthyr Tydfil for 1905, p.31. 66 Ibid. 260 quite ready to do all in their power to provide remedies for the ailments, but no one has taught them how.” The society’s leaflet “How to Bring Up a Baby” could be given to all parents registering a birth. ….” 67 It also pointed out that Dr Sykes, the MOH for St Pancras, had started a school for mothers to teach them the care of babies and children. Lessons included preparing cheap, nutritious food and economical ways of cooking. An estimated 50% of a working wage was spent on food and the poorer the family the greater the percentage. The introduction of similar, simple, practical lessons in elementary schools would pay dividends when these girls came to be wives and mothers with a resulting fall in infant mortality rates. 68 In Merthyr, the teaching of domestic hygiene in day and night schools was considered to be a helpful addition to visits to mothers at home by a health visitor. The MOH fortunately also emphasised that the health of the mother was vital in preventing deaths due to antenatal causes, especially during the first week of life, a point which tended to become overlooked in the emphasis on mother’s ignorance and infant feeding. 69

Table 6.6. Number of Deaths From Main Causes of Infant Death in Merthyr Tydfil 1905-8, (MOH Reports for Merthyr Tydfil 1905-1908.) Causes of 1905 1906 1907 1908 Total death Lung Diseases 139 87 93 75 394 Diarrhoea 115 107 57 105 384 Maternal 71 84 92 85 332 Nutritional 67 96 63 71 297 Infectious 62 22 26 41 151 Diseases Convulsions 15 8 9 16 48 469 404 340 393 1606

The MOH report for 1906 identified and compared the principal causes of infant deaths, stressing the importance of the problem. Premature births, congenital defects, atrophy, debility and marasmus accounted for 35% of all infant deaths .70 From 1905-8 lung diseases, diarrhoea and deaths of maternal origin were the principal causes of

67 The Child’s Guardian, August 1908, pp. 91-2. 68 The Child’s Guardian, August 1907, p.87. 69 Thomas and Duncan, MOH Report for Merthyr Tydfil for 1905, pp.30-31, Duncan, MOH Report for Merthyr Tydfil for 1906, p.16. ‘Infantile Mortality’, Merthyr Express, 2 May 1908., p.8. 70 Duncan, Medical Officer of Health Report for Merthyr Tydfil for 1906, p.16. This important public health transition was summarised by G. F. McCleary in 1904; “There appears to be a tendency to regard infantile mortality for all practicable purposes as a matter of improper feeding and lack of maternal care, and to disregard altogether the importance of the conditions affecting the infant before birth.” He argued; ’We must get rid of the expression” non-preventable” in relation to infantile mortality, and set ourselves to investigate the antenatal factors, and to bring them within the scope of our administrative measures.” G.F. McCleary, ‘The Influence of Antenatal Conditions on Infantile Mortality’, The British Medical Journal, 13 August 1904, p 321. Table, p.321 confirms the pattern of causes of infant deaths found in Merthyr. 261 infant death which needed to be addressed, but deaths due to antenatal causes were those which were continuing to rise, making initiatives aimed to prevent these deaths an essential preventative public health strategy, but one which was unlikely to be effective by 1908. The number of trained midwives was very small, the contribution of antenatal causes to infant mortality was not publicly stated until 1905, and the Health Visitor in Merthyr was not appointed until 1907, when the Notification of Births Act was also adopted. (Tables 6.6. and 6.7..)

Table 6.7. Disease Specific Infant Mortality Rates From Main Causes of Infant Death in Merthyr Tydfil 1905-8. (MOH Reports for Merthyr Tydfil 1905-1908.). Category 1905 1906 1907 1908 DSIMR 1905-8 Lung Diseases 49.8 32.1 34.5 27.4 35.86 Diarrhoea 40.9 39.4 20.9 38.4 34.95 Maternal 31 31 34.9 31.8 30.22 Nutritional 20.1 35.4 23.1 25.6 27.03 Infectious 22.06 8.48 9.90 15.72 13.74 Diseases Convulsions 27.1 24 21.3 27.8 24.37

Illegitimacy, Marriage, Birth Rates and Infant Mortality

Poor maternal health in Merthyr was an important social dimension of infant mortality previously overlooked, as were the early marriages and high birth rates characteristic of mining communities. Illegitimate babies also stood a poorer chance of surviving. 71 A series of horrifying cases of neglect among baby farmers had been investigated nationally in the 1870s where single mothers were compelled to have their babies minded in order to support themselves financially. Infanticides investigated also involved midwives as accomplices.72 When babies died for no apparent reason, or were suffocated or overlain, there was always the suspicion of foul play or infanticide. It was necessary to establish whether the baby had breathed at all, thereby having established a separate existence from the mother, or had never breathed and was stillborn. The circumstances were sometimes hard to establish and midwives were apt not to inquire too closely. It was customary to take such babies to the sexton to be buried without legal formality. In 1877 the Inspector of the Merthyr Burial Board recommended that those in charge of various burial grounds be instructed that still born babies were not to be

71 Thomas, MOH Report for Merthyr Tydfil for 1904, pp. 20-21. 72 Lionel Rose, Massacre of the Innocents, pp.79-92. 262 buried unless consent was obtained from him. In 1876 a Bill was passed deeming that stillbirths were not to be buried without a burial certificate from the attending doctor or midwife. 73 In 1906, when 23 of 487 deaths were of illegitimate babies, equivalent to an IMR of 450 /1000 births, Dr. Duncan intimated that “The dangers of illegitimacy are connected with the nursing out of such babies.” 74 Russell Davies gives an insight into the world of illegitimacy and the stresses that such a situation created, driving some to infanticide. 75 A few sad instances of abandoned babies and possible infanticide, the bewilderment and distress of mothers, and the involvement of friends, neighbours and midwives found in the Merthyr Express add a very human dimension to the problem of infant mortality in Merthyr. 76

Table 6.8. Births and Deaths of Illegitimate Infants in Merthyr Tydfil 1898-1906 (MOH reports for Merthyr Tydfil 1898-1906.) Year Illegitimate Illegitimate Total Deaths Infant Infant Births Births in Number of Among Mortality Mortality Upper lower Illegitimate Illegitimate Rate rate Among registration registration Births Infants. Illegitimate district District Infants. 1898 26 47 1902 29 41 16 183/1000 228/1000 1903 81 15 153 185 1904 86 26 302 1905 20 197 224 1906 23 450

Merthyr’s illegitimacy rates were lower than for south Wales generally or England and Wales and from 1868-1908 no more than 4-5% were illegitimate. (Appendix. Table 20., Table 6.8.) Illegitimate birth rates in the lower district were almost double those in the upper district although no explanation is given for this, and higher in rural areas. 77 The detail given by Dyke’s successors was patchy and suggests different methods of calculating rates of illegitimacy. In 1871 Dyke explained that the lower illegitimacy rates experienced in Merthyr “are probably due to the more frequent marriages which take place when wages are

73 ‘Meeting of Merthyr Burial Board’, The Merthyr Express, 15 September 1877., p. 8. ‘ Baby Burials at Dowlais’, The Merthyr Express, 12 October 1895, 74 Alex Duncan, MOH Report for Merthyr Tydfil for 1906., p.16. 75 Russell Davies, ‘In a Broken Dream’: Some aspects of Sexual Behaviour and the Dilemma of the Unmarried Mother in South West Wales, 1887-1914.’, Llafur, Vol.3., No.4., 1983, pp.24-33. 76 The Merthyr Express, 11 April 1885., p. 4., 18 April 1885, p.8., The Merthyr Express, 12 September 1895, p.6. ‘ Baby Burials at Dowlais’, The Merthyr Express, 12 October 1895, ’ Infant’s death at Dowlais’ The Merthyr Express, 18 January 1908, p.9.[the article refers to, a three – year old infant, presumably an editorial error.] 77 Thomas, MOH Report for Merthyr Tydfil for 1904, p.11 263 high.” 78 Dyke recorded the number of marriages (Appendix. Table 21. ) and observed variations in the marriage rate, which he attributed to the economic climate each year, suggesting that young people exercised responsible choices in the timing of their marriage. The majority took place before registrars and relatively few in churches, in keeping with the predominantly non-conformist culture of the town. In 1873 Dyke commented that “Doubtless the high wages received by your working men contributed mainly to this great increase in marriages.” 79 In 1874; “The successive diminutions in the rate of wages doubtless contributed to this result [fewer marriages].” 80 In 1884, the higher number of marriages indicated “the larger number of residents in the parish, and to a certain extent shows the better pecuniary condition of the working men.”81 In 1893 however, fewer marriages took place due to “The Poverty which existed during the continuance of the strike among hauliers and their fellow-workers…” 82 In 1898, marriages were fewer; “This represents a considerable decrease, due no doubt to the coal strike.” 83 In 1902, however, the MOH explained that the marriage rate continued to be high for the whole Union, but particularly so in Merthyr Parish, since there was a tendency for people in rural districts to get married in a large town. Marriage rates might not therefore be a true reflection of Merthyr’s inhabitants. 84 The marriage rate also influenced the birth rate, which in Merthyr remained high long after the national rate declined. High birth rates sustained high infant mortality in a self-perpetuating and well–recognised biological cycle. Dyke indicated that “reference to the column of marriages since 1873 will explain how the increase of the infant population has arisen.” 85 He continued: “but there is no reason to fear that the marriage-rate is falling, as it continues high throughout the Union. This also receives confirmation in the high birth-rate which has characterised the district.” 86 In 1891, Dyke stated that the increase in the birth rate to 39.3 / 1000 population “is mainly due , I believe, to the influx of numbers of young married people, attracted by the call for working men at high wages.” 87

78 Dyke, MOH Report for Merthyr Tydfil for 1871, p. 4., Dyke, MOH Report for Merthyr Tydfil for 1872., p.4., Dyke, MOH Report for Merthyr Tydfil for 1874, p.3., Dyke, MOH Report for Merthyr Tydfil for 1878, p.3., Dyke, MOH Report for Merthyr Tydfil for 1880, p.20. 79 Dyke, MOH Report for Merthyr Tydfil for 1873, p.3. 80 Dyke, MOH Report for Merthyr Tydfil for 1874, p.2. 81 Dyke, MOH Report for Merthyr Tydfil for 1884, p.3. 82 Dyke, MOH Report for Merthyr Tydfil for 1893, p.2. 83 Dyke, MOH Report for Merthyr Tydfil for 1898, p.8. 84 Thomas, MOH Report for Merthyr Tydfil for 1902, p.8. 85 Dyke, MOH Report for Merthyr Tydfil for 1874, p.3. 86 Thomas, MOH Report for Merthyr Tydfil for 1902, p.8. 87 Dyke, MOH Report for Merthyr Tydfil for 1891, p.16. 264 Early marriage was also a working-class phenomenon as Dr. Duncan explained in 1906: “No doubt the high birth rate of towns where there is a large working-class population is partly accounted for by the fact that marriage takes place earlier than among the middle and upper classes.” 88 Where few employment opportunities for women existed outside the home, women tended to marry at an early age, thus maximising their child bearing years with subsequent high levels of fertility. The report for 1907 quoted the 69th report of the Registrar General regarding the high fertility rates experienced in coalmining districts as being due to the high proportion of young married women. 89 The birth rates for England and Wales declined from 1876 but the decline for Merthyr Tydfil did not begin until 1895. (Appendix. Table 21.)90 Even so, in 1902 the Merthyr birth rate was still 39.6. 91 In 1904 it was 38.5 and of the 70 large towns, only the Rhondda had a higher rate with 39.7 / 1000 inhabitants.92 The report for 1907 indicated that the birth rate in Merthyr in 1906, (36.3) was the same as the highest birth rate recorded for England and Wales in 1876. 93 The calculation of the birth rate was not an exact science. In 1883 it was calculated on the estimated population of 50,000; 94 in 1884 on the enumerated population and numbers living on 30 June. 95 The birth rate also varied within the parish, which in 1893 was 37.4 but in was 31.5.96 The MOH report for 1903 discussed at length the various means of calculating demographic change, and reviewed the birth rates for the previous decade, giving higher rates than those indicated in each of the earlier annual reports. The MOH concluded that “Whichever method is adopted, Merthyr Tydfil had the highest birth-rate in the kingdom, both in 1901 and 1902.” 97 In 1904, Dr. Thomas thought it unnecessary to emphasise the importance of infant mortality; the facts spoke for themselves. Not only were infants dying, the national birth rate, unlike in Merthyr Tydfil, was falling. The declining birth rate throughout the kingdom is more probably due to a decreased fertility and this appears more discouraging as the infantile mortality shows no signs of a reduction.98

88 Duncan, MOH Report for Merthyr Tydfil for 1906, p. 8. 89 Duncan, MOH Report for Merthyr Tydfil for 1907, p. 8. 90 Thomas, MOH Report for Merthyr Tydfil for 1903, p. 9. 91 Thomas, MOH Report for Merthyr Tydfil for 1902, p.7. 92 Dyke, MOH Report for Merthyr Tydfil for 1904. p.10. 93 Duncan, MOH Report for Merthyr Tydfil for 1907, p.8. 94Dyke, MOH Report for Merthyr Tydfil for 1883, p.11. 95 Dyke, MOH Report for Merthyr Tydfil for 1884, p. 3. 96 Dyke, MOH Report for Merthyr Tydfil for 1893, p.2. 97 Dyke, MOH Report for Merthyr Tydfil for 1903, p.9. 98 Thomas, MOH Report for Merthyr Tydfil for 1904, p. 10. 265

Dr. Thomas believed that a high birth rate was desirable to compensate for high infant mortality rates, and to counteract a steady national decline in the birth rate: “… in view of the disquieting fact that the birth rate throughout the kingdom has been showing a steady decline since 1887, it is satisfactory to note that here it has continued uniformly high. ….” 99 A similar point of view was expressed in 1905, when birth rates averaged 37.99 /1000 over the previous decade “ in view of the fact that the birth-rate throughout the kingdom has been showing a steady decline for the last 20 years, it is satisfactory to note that here it continues uniformly high.” 100 The sanitary reforms of the nineteenth century had failed to reduce the high infant death rate and the falling national birth rate was producing insufficient babies to replace those lost; moreover many that survived were weak and sickly. 101 The Eugenicist view was that healthy infants grew to populate the nation with healthy adult stock, and infant mortality rates reflected residual debilities in the surviving population. Large family size undermined the health of mothers and increased poverty in the community, perpetuating a cycle of social deprivation, as the experience of Merthyr Tydfil demonstrates. There was evidence in Dr Duncan’s report for 1906 that a shift had occurred in opinion about the birth rate when he quoted the Registrar General’s annual report for 1905, indicating the reasons why a moderate birth rate with low infant mortality was a better way to sustain population numbers:

A high birth-rate does not necessarily involve a larger effective addition to the population than does an average, or even a low birth-rate. In too many cases high birth- rates are associated with excessive sickness and mortality during the first few years of life, the result being that not only do fewer than a normal proportion of the children survive at the age of 5 years, but those who do survive at that age have fallen below the normal standard of physical fitness. There is therefore some ground for the opinion that moderate birth-rates associated with low mortality among children may be more effective towards the upkeep of the population than high birth-rates associated with high mortality among children. 102

99 Thomas, MOH Report for Merthyr Tydfil for 1904, pp.9,10. On p.9 of the 1904 report Dr. Thomas gives the national decline beginning from 1895: He also disagrees with the estimate of population growth calculated by the Registrar General: ”In face of the fact, that throughout the kingdom, it [the birth- rate]has shown a continuous decline since 1895, this phenomenon argues against an overestimate of the population. The natural increase, that is, the excess of births over deaths registered during the year, was 1,366, as compared with an increase of 1,103 obtained by the Registrar General’s method of estimation.” Appendix Table 1 shows the birth rate for England and Wales declining steadily from 1877, based on B. R. Mitchell and Phyllis Deane, Abstract of British Historical Statistics, Cambridge University press, 1971. 100 Thomas, MOH Report for Merthyr Tydfil for 1905, p. 9. 101 Thomas, MOH Report for Merthyr Tydfil for 1904, p. 21. 102 Duncan, MOH Report for Merthyr Tydfil for 1906, p. 9. 266 The following year Duncan strengthened his views in accordance with those of the Registrar General, suggesting that high birth rates should not be considered as an offset to high infant mortality and that lower birth rates would enable more children to survive.103 And in 1908, when the birth rate for Merthyr was at 35.4 and that for England and Wales the lowest on record at 26.3 per 1000 in 1907, Dr. Duncan noted that a decline in the birth rate was beginning in Merthyr, but unfortunately to a much lesser degree than for England and Wales, and doubted, “Whether, in view of our large infantile mortality, this is a matter for congratulation…” 104 Dr Duncan’s 1908 report was somewhat inaccurately summarised in The Merthyr Express. Many throughout the country believed that a falling birth rate was “a sure sign of decadence”, and since Merthyr’s birth rate was tending to decline, efforts should be made to reduce infant mortality.105 Dr Duncan was arguing that fewer babies would ensure healthier babies, but the paper seemed to assume that the fewer babies would be equally unhealthy; therefore more efforts should be made to reduce the death rates. This somewhat circular and poorly understood argument implies an element of choice in having large families and that people were hitherto able to reduce infant mortality but had not chosen to. Limitation of family size was not an option for most women for cultural and economic reasons and the social conditions which sustained infant mortality were beyond the mandate of health policies. For most there was little they could do to improve their circumstances and many of the factors contributing to infant mortality were beyond their control.

Midwives and Infant Mortality

It was not until the late Victorian and early Edwardian period that recognisably modern advances were perceivable in understanding the physiology of pregnancy, the development of the foetus and the importance of the mother’s health to infant survival. Midwifery care linked these two concepts. The mother’s health was crucial to that of the developing foetus, but an infant bereft of its mother was unable to receive either her care or her breast milk. Though the Midwives Act of 1902 did not refer specifically to the reduction of infant mortality, its intention was to provide for the regulation and

103 Duncan, MOH Report for Merthyr Tydfil for 1907, p. 9. 104 Duncan, MOH Report for Merthyr Tydfil for 1908, p.9. 105 Duncan, MOH Report for Merthyr Tydfil for 1908, p. 9. The Merthyr Express, 2 May 1908, p.8. 267 professional training of midwives in the care of mothers and babies in the antenatal period and during the crucial days after birth. The national death rates for mothers in childbirth ranged between 4-5 /1000 births 1861-1903. (Appendix. Table 22.) 106 Dyke reported a steady number of 5-8 maternal deaths / 1000 births each year, which rose to 11-15 /1000 in 1874, 1875, 1893, 1894 and 1901 without explanation. In 1874, “The great peril of Childbirth” claimed the lives of 33 women, including 16 deaths from puerperal fever, “somewhat higher than average,” 107 and the following year 21 mothers died of childbirth or “its immediate consequences.” 108 Although in 1876, “…mortality attendant upon childbirth was … exceptionally low; one in 220 births,109 in 1879 one in 123 births “ended fatally” for the mother. 110 Most women were attended by midwives, but in 1880 Dyke did not consider the deaths to be due to their attendance: “It is well- known that in this district mothers, in their hours of peril, are attended principally by midwives, and it is satisfactory to find that the peril is not increased by the custom of the locality.” 111 Despite this earlier support, in 1892 Dyke questioned the competency of midwives involved with maternal deaths from puerperal fever, suggesting that they might be transferring infection between cases. Refusing to acknowledge them as bona fide professionals he “cautioned” them to be more careful.112 In 1893, he specifically stated that in most cases of puerperal fever the midwife had also laid out the dead, some of whom had died of infectious disease. 113 ..in my opinion the facts disclosed by enquiry showed that the midwives attending certain cases were distinctly to blame, as being clothed in garments used upon occasions such as funerals, charged with the bad odours of the death chamber. 114

Almost a decade later, the Midwives Act of 1902 instigated statutory obligations for the training and practice of midwives, one of which was to refrain from attending cases of infectious disease and laying out bodies. Other practices the 1902 Act was presumably intended to control included the advice given to women by untrained midwives. An example of the sort of advice which

106 Smith, The People’s Health, p.13. 107 Dyke, MOH Report for Merthyr Tydfil for 1874, p.12. 108 Dyke, MOH Report for Merthyr Tydfil for 1875, p. 7. 109 Dyke, MOH Report for Merthyr Tydfil for 1876, pp. 6-7. 110 Dyke, MOH Report for Merthyr Tydfil for 1879, p. 7. 111 Dyke, MOH Report for Merthyr Tydfil for 1880, p. 7. 112 Dyke, MOH Report for Merthyr Tydfil for 1892, p. .8. 113 Dyke, MOH Report for Merthyr Tydfil for 1893, p.11. 114 Dyke, MOH Report for Merthyr Tydfil for 1894, p. 6. 268 the 1902 Midwives Act wished to prevent is found at an inquest held at Lincoln into the death of a twin baby 20 days old, born prematurely and weakly. The infant suffered convulsions for a week, but the midwife advised against seeking medical advice because “she knew from the first there was no chance of the child living.” She had frequently given such advice to parents. She had a reputation as an experienced and capable woman “and had the impression she was as good as any doctor.” She had overstepped the limits of her duties and was severely censured. A verdict of “death from natural causes was returned.” 115 Not only were midwives held responsible for maternal deaths from puerperal fever, but also increasingly for perinatal deaths. Midwives were trained post-1902 not only to care for mothers during delivery, but also to ensure as far as possible the mother’s health in the antenatal and postnatal periods and to care for both mothers and babies in the crucial perinatal period. Inquests were held at Merthyr in 1907 when four infants died of birth injuries and another in 1908. 116 The investigations mark a determination to explain every infant death and make practising midwives accountable for infant and maternal deaths. Assessment of the social circumstances of their patients affected the way in which midwives carried out their work, but their training was a medical and professional matter, not a social one. Health visitors played a more significant role in engaging with social issues in the community. These changes in professional training and accountability might be expected to improve the death rate of infants from antenatal causes and in due course they would. However, the number of trained midwives in Glamorgan immediately following the Act of 1902 was insufficient to meet the needs of mothers and babies. Merthyr had no direct control over local midwives until a health visitor was appointed in 1907, and infant deaths related to antenatal causes continued to rise until then. The requirements of the Central Midwives Board to supervise the work of midwives were carried out by the Midwives Act Sub-Committee of Glamorgan County Council under the supervision of the County Medical Officer, Dr. W. Williams, with no local powers vested in Merthyr. Dr. Williams regarded this as “important work of ministering to the wants of our poor women in childbed and to the newly born babies.” 117 In 1903 there were 700 women

115 ‘Censure on a Midwife’, The British Medical Journal, 4 February 1899., p.294. 116 Duncan, MOH Report for Merthyr Tydfil for 1907, Table V, p.59., Duncan, MOH Report for Merthyr Tydfil for 1908, p.18. Unfortunately the records of these investigations are unavailable. 117 W. Williams, Report of County Medical Officer to the Sanitary Committee, Glamorgan County Council, 12th October, 1904, p. 2. GRO., GC/PH/16. Midwives were required to send for medical aid. In defined cases of flooding, convulsions or rupture of the uterus a fee was paid to attending medical Officers by the Board of Guardians, or, if he was unable to obtain this, in Cardiff, a fee of one guinea was paid by Cardiff Corporation. Public Health, August 1905, p.734. 269 calling themselves midwives in Glamorgan. 118 After 1 April 1905 no woman was allowed to practise habitually and for gain and call herself a midwife, unless she held a certificate in midwifery from the London Obstetrical Society, the Royal College of Physicians of Ireland or any other CMB-approved certificate. A midwife had otherwise to satisfy the CMB that she had been in bona fide practice as a midwife for at least a year prior to 31 July 1902 and was of good character. Bona fide midwives could continue to practise thus until 1 April, 1910. Any woman not included in these categories was required to pass the CMB examination before obtaining a certificate in accordance with the CMB regulations and on payment of the fee. Each midwife was required to be registered on the Midwive’s Roll with the supervising local authority on the 1 January each year. Offences under the Act were examined in the Court of Quarter Sessions. They were required to keep records of their cases and their work was supervised. Midwives were suspended from duty whilst breaches of protocol were investigated. In 1904 three-quarters of the midwives practising did not apply to be placed on the roll, “owing, probably to a distaste to come under the regulations of the Central Midwives Board.” 119 Absence from the register only precluded a woman from calling herself a midwife and permitted her to attend confinements until 1 April 1910, a regulation which did little to assist either mothers or babies. After that date she was not permitted to be habitually employed in attending births. 120 The transition period appeared to be reasonable, but the number of midwives qualifying in Glamorgan was insufficient to replace midwives ceasing to practise. The number of bona fide midwives gradually decreased, but the majority of the trained midwives came from London, Glasgow or Dublin with no local knowledge. 121 By November 1907, there were 39 professionally trained midwives in Glamorgan and 595 in bona fide practice. 122 By May 1908, progress had been made with 60 professionally trained midwives, a 50% increase in six months, but still insufficient to replace the 568 bona fide midwives still practising. 123 In Merthyr, by 1910, only 22 out of 65 practising

118 Three or four women conversant with the needs of the poor were to be co-opted to the Committee. Report of Midwives Act 1902 Sub-Committee, Minutes and Reports., 1 April 1903, p.3. GRO., GC/PH/16. 119 Dr. W. Williams, Report of the Sub-Committee on the Midwives Act 1902, 23 November 1903., Glamorgan County Council Sanitary Committee, GRO., GC/PH/16.,Thomas, Annual Report of the Medical Officer of Health for 1904 to Merthyr Tydfil Urban District Council, pp.17-18. 120 Thomas, Annual Report of the Medical Officer of Health for 1904 to Merthyr Tydfil Urban District Counci., pp.17-18. 121 W. Williams, Report of Executive Officer, to Chairman and Members of the Midwives Executive Sub- Committee, n.d.1904., p.2., GRO., GC/PH/16. Report to Midwives Act 1902 Executive Sub-Committee, 20 February 1906., p.1., GRO., GC/PH/16. 122 Report to Midwives Act Executive Sub-Committee, 25 November 1907., GRO.,GC/PH/16. 123 Report to Midwives Act Executive Sub-Committee, 26 May 1908., GRO, GC/PH/16. 270 midwives were professionally trained.124 There was an urgent need for trained midwives throughout the county, but the number of cases in any district where there was a shortage of midwives was insufficient to create a livelihood. In these areas uncertified women would not be permitted to practise after April 1910, and many were forced to discontinue on account of old age or ill health. 125 Ystalefera, in West Glamorgan, with a population of 6,000 and a birth rate of 34.8, had three registered midwives, two getting on in years and unable to be relied upon to face the weather at all times of night and in cold weather. On two occasions a midwife was needed for two cases at the same time with only one unqualified nurse between the two.126 The situation described in Ystalefera gives an inkling of how the shortage of qualified midwives would have affected Merthyr where there was a population of 77,219 and 2,736 births in 1908 (approximately 52 a week) when there were only 60 qualified midwives for the whole of Glamorgan. (Table 6. 9.) Table 6.9. Number of Births, Total Infant Deaths and Infant Deaths of Maternal Origin in Merthyr Tydfil 1902-8 (MOH Reports for Merthyr Tydfil 1902-8) Births Infant Deaths Deaths From Antenatal Causes Year 1902 2797 518 91 1903 2752 422 63 1904 2803 523 112 1905 2810 576 87 1906 2714 487 84 1907 2727 420 95 1908 2736 482 87

The reports of the Midwives Act Sub-Committee shed light on the level of education and standards of practice of midwives, the health of midwives and mothers, and the less than perfect world in which the women of south Wales lived. Once again the principle was a far cry from the practice. In December 1904 Miss A. Richards of Epsom was appointed Inspector of Midwives by Glamorgan County Council at a salary of £ 80.0.0. p.a. plus travelling expenses, and made 1,208 visits to midwives throughout the county by August 1906. 127 She found it difficult to find the midwives at home when

124 Register of Practising Midwives for Merthyr Tydfil, 1910. Merthyr Tydfil Public Library. 125 Report to Midwives Act Executive Sub-Committee, 17 August, 1908., p.1, GRO., 1GC/PH/16. 126 Letter from W. J. Lewis, MOH for Pantardawe Rural District Council, 24 November, 1908 , Report of W. Williams, Executive Officer, to Midwives Act Executive Sub-Committee, 25 November, 1908., p.6., GRO., GC/PH/16. 127 Meeting of Midwives Act 1902 Executive Sub Committee, Minutes and Reports, 10, 17 November and 9 December 1904 [1 Document] GC/PH/16, p.2. Glamorgan County Council, Report to Midwives Act 271 she called during her extensive itinerary. 128 There was plenty of other evidence of shortcomings in personal, procedural and domestic hygiene. The levels of hygiene among some midwives were low, failing to wash their hands or clothes. In 1904 only 49 of the midwives inspected wore washable dresses, 57 used disinfectants, 78 possessed case books, and 14 had “a bag of appliances”. 129 Disinfection techniques were punishing in an effort to combat puerperal fever, but the reports indicate that in many cases midwifery practice was not to blame. 130 The poor health of some mothers prior to confinement is also evident. 131 Relatives suffering from scarlet fever, diphtheria and sore throats in overcrowded rooms also exposed mothers to streptococcal infections and the risk of puerperal fever. 132 Illiteracy levels of approx 25-27% were found among the midwives inspected in 1904-5, and 94 midwives, 24.2%, were unable to sign their names.133 Only 16 of 214 midwives visited in 1907 could take the temperature and count the pulse and only 27 others could read a thermometer. Instructions were given wherever possible by Nurse Evans who commenced duty inspecting midwives in July 1906.134 Each midwife was required to purchase a copy of the CMB rule book at a cost of 6d. and required to read

1902 Sub-Committee, 24 August, 1906.,GRO., GC/PH/16., Report of W. Williams, Executive Officer, to Chairman and Members of the Midwives Executive Sub-Committee, n.d.1904., p.1., 128 Meeting of Midwives Act 1902 Executive Sub Committee, Minutes and Reports, 10 November 1904 , 17 November and 9 December 1904 , [1 document], GRO., GC/PH/16., p.2. , Report of W. Williams, Executive Officer, to Chairman and Members of the Midwives Executive Sub-Committee, p.1.,n. d. 1904. 129 A complaint was received regarding a midwife suffering from oezoena, a foul smelling nasal discharge, although nasal swabs found no bacteria likely to cause puerperal fever. Report to Midwives Act 1902 Executive Sub-Committee, 20 February, 1906., p.3. 130 Numerous examples are found in the reports of the Midwives Act Sub-Committee 1902-10. A discussion in the British Medical Journal in 1899 concerned the number of cases of unexplained fever at the Dublin Rotunda hospital. It was found that the diapers [sanitary towels] used by parturient women were washed in the ordinary way with others in the laundry. When these were boiled in carbolic solution for 10 minutes, the fevers ceased. ‘Pyrexia After Delivery’, The British Medical Journal, 3 June,1899., p.1332. 131 A patient at who died at was found to be in an advanced state of tuberculosis. Report to Midwives Act Executive Sub-Committee., 28 November,1905., GC/PH/16. A patient died at Merthyr having had a severe haemorrhage before anyone was called to asssist. Report to Midwives Act Executive Sub-Committee, 24 November, 1906., A patient who died at Merthyr Vale had been very ill and in a weak state for some months. Report to Midwives Act Executive Sub-Committee 3 May, 1907., GC/PH/16. 132 Da Cruz., Mayes Handbook of Midwifery, 1967., p.301. Report to Midwives Act Executive Sub- Committee, 24 August., 1906., GC/PH/16. Report to Midwives Act Executive Sub-Committee, 24 November, 1906., GC/PH/16. Report to Midwives Act Executive Sub-Committee , 19 February 1910., GC/PH/16. 133 Report of W. Williams, Executive Officer, to Chairman and Members of the Midwives Executive Sub- Committee, n.d., 1904., p.1. Report of Executive Officer to Midwives Act 1902 Sub-Committee, 31 May 1905., p.2., Report of Executive Officer to Midwives Act 1902 Sub-Committee, 28August, 1905., GRO., GC/PH/16., p.4. 134 Report to Midwives Act 1902 Sub- Committee, 24th August, 1906, Report to Midwives Act 1902 Sub- Committee, 18 February, 1907., p.1., GRO., GC/PH/16. Puerperal fever was defined by a specific rise in temperature over a specified number of days. 272 the codes of practice.135 Although 117 midwives possessed a rule book, “very few appear to have read them, or had them read to them, in other words it was found that the rules were generally ignored.” Many spoke Welsh as their first or only language. Moreover, midwives trained outside Wales may perhaps have experienced difficulty communicating with local Welsh-speaking women.136 Cultural factors such as this need to be considered. In 1908, the MOH for Pontardawe RDC expressed his concern that the limited knowledge of English would require candidates to undertake examinations in Welsh, which might prevent them from qualifying.137 The Sub-committee resolved that the Rules of the Board be presented in Welsh for the use of the midwives who read and understand Welsh better than English. Requests for a Welsh language version of the rule book appear to have gone unheeded.138 Many local midwives lay out the dead despite Rule 15 of the Central Midwives Board that: “No midwife shall undertake the duty of laying out the dead, or follow ANY OCCUPATION that is in its nature liable to be a source of infection.” Midwives reported their colleagues for breaches of the rule, and several were suspended from duty. Nevertheless midwives continued to do so and to dress infected wounds. 139 Quarterly reports of the Sub-Committee included the number of premature births notified and the number of stillbirths, which were not officially registered until 1927, and therefore not included in the number of infant deaths. 140 Factors which contributed to prematurity, early marriage, poor maternal health, large family size, low socio- economic status and poor living conditions were all apparent in Merthyr Tydfil. Childbirth under such circumstances was an event which midwifery training could only partially address.

135 Midwives Act Sub-Committee 1902 Minutes and Reports, 1 April, 1903., p.3., Meeting of Midwives Act Sub-Committee, 12 July 1904, GC/PH/16, p.1. 136 Report to Midwives Act 1902 Sub-Committee., 28 November, 1905. 137 Letter from W. J. Lewis, MOH for Pantardawe Rural District Council, 24 November, 1908, Report of W. Williams, Executive Officer, to Midwives Act Executive Sub-Committee, 25 November, 1908., p.6. In 1905 a training centre was approved by the CMB at Merthyr Vale under C. R. White Esq. LRCP, LRCS Edinburgh for five trainees; one attended and passed the examination.137 By 1909, The prohibitive cost of training at CMB approved schools was £13- £20, that of the training at the Cardiff and District Branch of the Queen Victoria Jubilee Nurses’ Institute, 13 guineas. 138 Report to Midwives Act 1902 Sub-Committee., 28November, 1905. A copy of the resolution was forwarded to the CMB, who replied that no such arrangements had as yet been made. A subsequent letter referred the matter back to the Welsh County Councils for their opinions, the matter to be again considered once this was done. The CMB did not intend to consider the matter until revision of the existing code of practice was completed. 139 Report of W. Williams, Executive Officer, to Midwives Act 1902 Sub-Committee, 31 May 1905., Report of Executive Officer to Midwives Act 1902 Sub-Committee, 28 August, 1905., Report to Midwives Act Executive Sub-Committee, 28 November,1905. 140 Report of W. Williams, Executive Officer, to Midwives Act 1902 Sub-Committee, 31May 1905., Report of Executive Officer to Midwives Act 1902 Sub-Committee, 28 August 1905., Report to Midwives Act Executive Sub-Committee, 28 November 1905. 273 Babies born prematurely struggled to stay alive and professional training of midwives included the care of the newborn infant which would improve its chances of survival. A training manual advised that

On district work nurses will find that they are much handicapped by the poverty of their patients, and by the fact that they cannot devote their whole time to the care of one baby. However, the nurse can teach the mother a good deal in the course of her 10 days attendance and can introduce her to the principles of infant feeding. 141

In order to prevent unnecessary deaths from suffocation or overlying, midwives were advised that infants should never sleep in the mother’s bed where it could be rolled on or covered with bedclothes and smothered, “practically however, it is almost impossible to persuade the poor to provide a separate cot.” 142 Midwives did their best to improvise separate sleeping arrangements for babies with the use of drawers and grocery boxes, but old habits died hard, especially in overcrowded living conditions such as those described by Inspector Low of the Local Government Board in 1906; some Glebeland dwellings had leaking roofs, damp walls and no slop drainage. Lodgers were taken into these houses by subdividing the kitchen into a room just big enough for a bed for the husband, a night worker, by day and the family by night. The houses comprised three storeys, one room on each, the lower one a sublet cellar. In one such dwelling, a lodger’s wife was ill in bed with enteric fever. In some cases beds were shared by day and night workers. 143 In such overcrowded and insanitary conditions it is little wonder that the health of mothers failed and infant deaths from antenatal causes continued to rise. Clearly, the attempts to ensure the safety of mothers in childbirth from 1902, with the additional benefits of ensuring the safety of babies during the crucial first days and weeks of life, through the professional training of midwives was a public health initiative which was frustratingly slow to bring to fruition, yet one which had the potential to save the lives of many mothers and babies. However, throughout Glamorgan, and in Merthyr, these advantages were not sufficient to influence the rising

141 Andrews, Midwifery For Nurses, p.283. 142 Ibid., pp. 268-9. 143 Spencer Low’s Report to the Lo cal Government Board on the Sanitary Circumstances and Administration of the Merthyr Tydfil Urban District, 1906., pp. 3-4. 144 Maud Pember Reeves did much to raise awareness of the virtual impossibility of raising a healthy family on a working-class wage, and the ability to do so depended on the domestic and economic choices made in the home by mothers in her study of working class life in London, Mrs. Pember Reeves, Family Life on a Pound A Week, London, 1912.Fabian Society Tract No.162. , Ellen Ross, Love & Toil, emphasises many of the same issues. 274 deaths from causes of antenatal origin by 1908. Moreover, the role of midwives was limited to the few weeks following the birth and had the unfulfilled potential to reduce approximately 30% of infant deaths in the perinatal period, but midwives made very few social interventions on behalf of their patients, a role which later fell to the health visitor and other social, political agencies such as the NSPCC and Fabian Socialists. 144

Appointment of Health Visitor 1907

In 1905 the MOH recommended that:

To diminish the terrible infantile mortality, I would recommend that when we become a County Borough a lady inspector should be appointed; she could also act as inspector of midwives. Her work as an inspector would consist largely in visiting recent mothers, and advising them as to the proper hygiene and feeding of the children. As indicated in previous reports, improper feeding, due to the ignorance of mothers, is at the root of a large part of the infantile mortality that prevails in this district, and as a further aid to combat this ignorance it would be well if the teaching of the subject of domestic hygiene and economy was considerably extended in day and night schools….The standard of the comfort and cleanliness of the home determines in a large manner the infantile mortality, and also the future health of the children if they escape,….145

The following year Dr. J. Spencer Low of the Local Government Board also advised that the appointment of a health visitor was required to make an impact on Merthyr’s high rates of infant mortality within the home. 146 He observed:

The filthy houses of the poor, the lack of pantry accommodation for the safe storage of milk and other food, the proximity of the Council’s refuse tips, poverty, indifference, deliberate neglect after proper instruction, want of care owing to the inexperience of the mother, hereditary diseases, lack of nourishment of the mother, overcrowding and insanitary surroundings generally, prevalence of zymotic disease, as well as affections of the respiratory system, must needs have in Merthyr, as elsewhere, an adverse influence upon the infantile mortality. 147

In April 1907 Merthyr Tydfil, having achieved County Borough status, appointed 38 year old Nurse Rebecca A Thompson, of the Nurses Home, Penydarren as Health Visitor and Superintendent of Midwives at a salary of £75 a year rising by

145 Thomas and Duncan, MOH Report for Merthyr Tydfil for 1905, p.30. 146 Spencer Low’s Report to the Local Government Board on the Sanitary Circumstances and Administration of the Merthyr Tydfil Urban District., 1906., pp16-17. 147 Ibid., p.16. 275 annual increments of £5 to £100 p.a. She had practised and taught midwifery extensively at Merthyr General Hospital and within the district for several years. Although she did not hold the required Sanitary Institute certificate, her age, familiarity with the district and knowledge of infant feeding outweighed this requirement. 148 Following her appointment Merthyr was permitted by the Local Government Board to adopt the Notification of Births Act 1907 which declared it the duty of the father or person in attendance at the birth to give notice in writing within several hours of the birth to the MOH instead of the six weeks allowed for registration. 149 This provided a positive and immediate step to protect newborn babies and ensure the future effectiveness of the Midwives Act. The intention was that Nurse Thompson should visit each mother not attended by a medical practitioner, advising the mother on feeding, clothing and breastfeeding, and leaving a pamphlet with feeding instructions. Dr. Duncan reported in 1908 that she had made 1,383 visits with 64 re-visits, but, “owing to the extent of the district, and the amount of her work in other directions, it has not been possible to develop this part of her work to its full extent.” This was equal to approximately only half of the mothers that gave birth that year. In 1908 ladies collected from door to door for subscriptions and donations towards the Dowlais and Penydarren District Association of the Queen Victoria Jubilee Nurse Association to maintain two Jubilee Nurses at £80-100 p.a., including board, lodging and uniform. Dr. Duncan considered the appointment of a Jubilee Nurse at Merthyr, Penydarren and Dowlais a valuable aid to reducing infantile mortality.150 The benefits to be derived by the poor of the district were considered to be:

….incalculable…. It will bring within the reach of every working home a skilled and highly trained nurse. The lives saved, the suffering alleviated, and the knowledge diffused will constitute a return for the sacrifice made in maintaining the Association. No charge is made for the attendance of the nurse. 151

The necessity to teach hygiene and domestic skills to safeguard the lives of infants had been stated many times in the MOH reports for Merthyr. In 1903, for example, a mother assisted a neighbour suffering from typhoid fever to use a bedpan.

148 The Merthyr Express, 2 May ,1908., p.12., Duncan, MOH Report for Merthyr Tydfil for 1908, p.5. The BMA informed the Sanitary Institute and the CMB that they disapproved of lay persons being appointed as Inspectors of Midwives. A qualification as an Inspector of Nuisances from the Royal Sanitary Institute in addition to midwifery qualifications was useful. (Public Health, August, 1905, p. 735. 149The Merthyr Express, 2 May 1908., p.8. Glamorgan County Council Report to Midwives Executive Committee by W. Williams, 25November, 1908, pp.3-4. 150 Duncan, MOH Report for Merthyr Tydfil for 1908, p.19. 151 The Merthyr Express, 7 March, 1908, p.10. 276 She did not wash her hands afterwards and went home to cut some bread and butter for her child who subsequently contracted the disease. 152 Hand washing, however, depended on access to plentiful water in the home, and an appreciation of the necessity to do so. Good hygiene was almost impracticable with shared taps and privies. As Dr. Low pointed out: “The rubber dummy teat, so frequently dropped on the filthy ground and, uncleansed, again sucked by the baby, is probably a means of administering to it the poison which causes diarrhoea in infants.” 153 However, the role envisaged for the Health Visitor in Merthyr was extensive and left insufficient time to meet the needs of mothers and babies effectively. The task was huge and matters of consequence for mothers and new born babies would change only little and slowly, despite the lofty and commendable idealism. 154 At the end of the period examined in this thesis the 1908 National Conference on Infantile Mortality discussed a broad range of important issues especially the need to extend the powers of Boards of Guardians in relation to infants, the means of helping mothers below the poverty line, the means of dealing with parents who neglect children through intemperance and the regulation of baby food manufacture.155 These were important and necessary social changes if the health of mothers and babies were to improve, but there were also many other important issues. Miss M. Carey, of Westminster’s Sanitary Inspector’s Association, defended mothers from blame saying that “there was a medical question besides a question of ignorance, and a great responsibility rested upon doctors, to whom mothers properly looked for the best advice.” 156 According to Miss Carey, the medical profession had for too long blamed mothers whilst failing to provide community leadership in support of the difficulties faced by so many mothers and infants. By 1908 Merthyr had taken several wise and important steps towards reducing the deaths of infants, but these measures were still dictated by public health principles which did not adequately address the health of the mother or the social environment which dictated it. Midwives and health visitors were professionally trained to enter the most intimate sphere of the home, legitimately extending the public health realm into the private domain. Midwives were involved in the care of newborn babies at a crucial

152 Thomas, MOH Report for Merthyr Tydfil for 1903, p.26. 153 Spencer Low’s Report to the Local Government Board on the Sanitary Circumstances and Administration of the Merthyr Tydfil Urban District., 31st March, 1906., p. 16. 154Duncan, MOH Report for Merthyr Tydfil for 1906, p.18. 155 Report of the Proceedings of The National Conference on Infantile Mortality, Westminster, 1906., Report of the Proceedings of The National Conference on Infantile Mortality, Westminster, 1908., Duncan, MOH Report for Merthyr Tydfil for 1906, p.18. 156 Report of the Proceedings of the National Conference on Infantile Mortality, 1908, p.79. 277 period for survival, but the broader social and environmental issues which influenced the deaths of older infants were largely beyond their influence. Midwives were regulated by Glamorgan County Council until 1907 and Merthyr had no direct control over their work.. Moreover, the number of trained midwives was totally inadequate for the number of births in Merthyr and the number of untrained midwives far outstripped those professionally trained. By 1908 the work expected of the Health Visitor and the number of births in Merthyr meant that she could not possibly visit each baby born and perinatal deaths remained the leading cause of infant death. 157 A positive step for infants from 1902 was the distribution by registrars of leaflets that provided instructions on infant feeding, which may have contributed to the decline in diarrhoea deaths. We have no idea how these interventions were viewed by the working classes, resented or welcomed. Used to taking their babies into bed, did mothers adjust to putting their babies to sleep in an orange box or drawer? On this the records are silent, but many useful insights were gained into the conditions in many working-class homes, the genesis of much infant death, through the work of midwives and health visitors.

The Hidden Cost of Women’s Labour

The chapter has so far linked infant deaths to the poor health of the mother largely from the public health and professional perspective. This section examines more closely the world of Merthyr’s mothers who were so frequently blamed for many of the apparent causes of infant death. Among the charges already cited in this thesis were improper feeding and failing to breastfeed, poor nursing when children were sick, not dressing their children properly, taking babies out in bitterly cold weather, ignorance, and the consumption of alcohol, charges which smack of moral judgement on women of the working classes, and failure to acknowledge the difficulties under which they laboured and the social conditions in which they were ensnared. The focus on temperance ignored the difficulties of uncertain income, substandard accommodation, overcrowding, large families, poor education and the reasons behind the existing social inequalities. The poor paid the price of industrial progress in the form of persistent social problems and high infant mortality rates. Elsewhere in Britain, particularly in textile towns, women’s employment outside the home was blamed for high infant mortality due to neglect of babies. The fact that

278 high infant mortality occurred in mining towns where few married women worked outside the home required a different explanation. In Merthyr, Dr. Thomas considered that there was little necessity for the increase in artificial feeding, since the women were not compelled to earn their own living there. Dr. Spencer Low also accused the mothers of neglecting their duty to their offspring: “Here the female members of the families do not commonly go out to work; hence there is no reason why mothers should not in general nourish and otherwise look after their infants.”158 In fact, the industries of Merthyr and other mining towns generated little employment for married women which might help buffer the family against poverty. The coal, iron and steel trades were dominated by males, and although skilled wages were higher than in many occupations, the family often depended on a single breadwinner and so was more economically vulnerable. In 1902 the MOH summarised the number of occupied persons in various industries in Merthyr in 1891 and 1901. The majority of females, were employed as domestic servants or dressmakers, who predominantly would have been single, and their numbers declined over the decade. (Table 6.10., 6.11.) The male dominated nature of employment in the coal and steel trades, relatively high wages during economic upturns, early age of marriage and high birth rates, all conspired to keep women in the home, and the arduous nature of domestic toil in mining communities placed a huge burden on them. The women of working-class families contributed to the local economy with their unpaid labour at home, their daily labours, unregulated by any form of legislation.

In “Counting the Cost of Coal: Women’s Lives in the Rhondda,1881-1911”, Dot Jones using Census returns and mortality figures for the Rhondda Valleys found that “The mortality rates of women who worked in the home were higher than those of their menfolk who worked in the pit, in direct contrast to national mortality trends.”159 Because of its geophysical features the coalfield was notoriously dangerous, with 11 out of 23 colliery accidents in Britain between 1850 and 1914 occurring in the Rhondda. 160 Dot Jones emphasises the largely unrecognised economic contribution of women in mining communities who paid for their contribution in high, early mortality. As she writes:

The unremitting toil of childbirth and domestic labour killed and debilitated Rhondda women as much as accident and conditions in the mining industry

158 Spencer Low’s Report to the Local Government Board on the Sanitary Circumstances and Administration of the Merthyr Tydfil Urban District., 1906., p.16. 159 Jones, ‘Counting the Cost of Coal’, pp.109,126-7. 160 Ibid., p.112-3. 279 killed and maimed Rhondda men. What is startling is the extent of women’s sacrifice and the way it was accepted without being noticed or questioned.161

Mining communities grew rapidly as 366,000 people migrated into the south Wales coalfield 1851-1911. 162 The Rhondda Valleys in Glamorgan had a population of 113,735 by 1901, equivalent to that of Preston or Halifax, but were unable to offer similar employment for women. 163

Table 6. 10. Males and Females Employed in Various Occupations in Merthyr Tydfil 1891 and 1901(MOH Report for Merthyr Tydfil 1902, p.36) Class of Occupation 1891 1901

Male Female Males Female

1. Professional 427 470 470 490 2.Commercial 416 11 748 38 3.Domestic Service 40 2638 111 1925 4.Conveyancing 1116 18 1463 9 5. Mines/ Quarries 9699 118 12,187 36 6.Metals 3386 43 3609 19 7.Building 1110 8 1682 3 8.Dress 457 1103 429 959 9.Food/Drink/Tobacco 913 940 1160 446 10.Other Occupation 3,922 492 3,440 431 Total Number 21,486 5,841 25,299 4,356 Occupied 11.Unoccupied / 2,249 14,361 3,286 20,272 Retired Total Surveyed by 23,735 20,202 28,585 24,628 Gender Total 43,937 53,213

161 Ibid., pp. 124-6. Jones refers to the work of Elizabeth Andrews, a Rhondda miner’s wife who helped form the Co-Operative Women’s Guild in 1910 and campaigned for pit-head baths and maternity and child welfare., pp.127-128. 162 Ibid., p.110. 163 Ibid., p.109. 280 Table 6.11. Proportion of Men to Women and of Married Women in the Population (Dot Jones, Counting the Cost of Coal: Women’s Lives in the Rhondda, 1881-1911, in Angela V.John (ed), Our Mothers’ Land: Chapters in Welsh Women’s history 1830-1939, p.113.) 1891 Males/100 females age 15-34 % married or widowed women aged 20-24 England and Wales 93 29.9 Durham 105 43.3 Monmouth 116 40.2 Glamorgan 120 42.4 Rhondda 167 59.1 Source: Census 1891

The needs and routines of the workingmen dominated household life. Labour in the home was arduous until the advent of pithead baths, and miners’ wives set high standards of housekeeping, the familiar one being that of scrubbing the entrance stone to the house. 164 Shift workers returned home at irregular hours, filthy from their work and in need of baths, food, sleep and recreation. With no bathrooms, women prepared tin baths in the living room with water often from an outside tap. 165 One Rhondda woman prepared baths three times a day after each shift from 7a.m. Men came first, children second and the women last. Children made up 40% of the population with 30% of households containing four or more children. Large family size made it difficult to make ends meet, and families bore the brunt of any of economic downturn, the conditions taking a toll on health. The mixture of overcrowding, poverty and poor living conditions was a deadly one reflected in the rising infant mortality rate and the early deaths of mothers. 166 Domestic work was unrelenting and the health of mothers suffered from constant childbearing. Lodgers contributed to the family income, but also increased overcrowding and made further demands on women’s resources. The penalties were paid in high and early death rates of women in such communities. (Table 6.12.) 167 According to Deirdre Beddoe: “It is hard to imagine how heavy the burden of housework was on Welsh women at the beginning of the century, lacking as they did all the basic amenities that we now take for granted….” Coal dust was all pervasive, as they washed filthy coal blackened clothes. Open fires and scalding water were hazardous to women and children, clothing easily catching alight whilst reaching to the

164 Ibid., p.124. 165 Ibid., p116. 166 Ibid., p.121. 167 Ibid., pp.118-9. 281 mantelpiece. 168 Beddoe summarises women’s unrecognised contribution to coalfield society:

Unlike coal or slate, we do not have the tonnage figures for sheets washed, dried and ironed, for potatoes peeled and boiled, for loaves of bread kneaded and baked in fire-side ovens. Women’s work has passed unrecorded and, because it was unpaid, has not been technically recognised as work at all. But it was women’s work which formed the bedrock of industrial production, serving the needs of working men and reproducing the next generation of miners, quarrymen and dockers.169

Table 6.12. Comparative Mortality Rates per 1000 population for Males and Females 15-55 Years 1878-1910 in Pontyptridd Registration District and England Wales,(Dot Jones ‘Counting the Cost of Coal’, in Angela V.John,(ed), Our Mothers’ Land , 1991.,Tables 9a, b, and c., p.125). Period Pontypridd England and Age Registration and Group District Wales a).1878-80 Female Male Female Male 15- 7.9 6.8 5.8 5.4 25- 9.0 8.1 7.7 8.2 35- 11.5 10.1 10.9 12.8 45- 16.2 15.8 15.1 19.6 b).1891- 1900 15- 7.0 5.3 4.5 5.1 25- 8.6 6.5 6.1 6.8 35- 10.6 9.9 9.6 11.5 c). 1901- 1910 20- 5.0 3.8 25- 6.2 4.7 35- 9.5 8.0 a).1878-80 Annual Reports of the Registrar General b).1891-1900 Supplement to the 65th Annual Report of the Registrar General c). 1901-1910 Supplement part III to 75th Annual Report of the Registrar-general

The conditions described were very similar in most mining communities, poor health reflected in the maternal and antenatal causes of infant mortality. The death rates of women 20-44 years in Pontypridd registration district 1878-1910 were constantly higher than for men, in marked contrast to rates for England and Wales where death rates of women were lower than men’s. Later studies of death related to occupational groups found the young wives of hewers and getters particularly at risk.170 (Tables 6.12., 6.13.) Jones argues that the high Rhondda death rates for women were associated with high maternal mortality rates. Merthyr’s maternal mortality rates, though lower

168Deirdre Beddoe, ‘Good Wives and Respectable Rebels, 1900-1914’, Out of the Shadows A History of Women in Twentieth Century Wales, University of Wales Press, Cardiff, 2000., pp.16-19. 169 Ibid., pp.17-18.

282 than those for Pontypridd 1881-1908, were still nearly double those of England and Wales and did not fall 1900-1910 to the same extent that they did in Pontypridd The underlying causes of the high death rates for women: poor housing, the insanitary home environment, economic uncertainty and the nature of women’s domestic work were social issues outside the medical sphere, for many women of Merthyr the legacy of a chronic cycle of deprivation.

Table 6.13. Maternal Mortality Rates in Merthyr Tydfil, Pontypridd Registration District and England and Wales 1881-1910 (Dot Jones ‘Counting the Cost of Coal’ , in Angela V. John,(ed), Our Mothers’ Land, 1991.,p.127; Source Decennial Supplements of Registrar- General., MOH Reports for Merthyr Tydfil, 1881-1908). Years Merthyr Tydfil Pontypridd England and Wales. Registration District

1881-1890 7.02 8.0 4.7

1891-1900 7.66 8.1 5.1

1901-1910 6.1 4.0

1901-1908 7.51

Conclusion

The main causes of infant death within a few weeks of birth were convulsions, prematurity, and debility reflecting social causes of death particularly the health of the mother. Deaths of maternal origin increased over time and nutritional causes of death led to failure of normal growth and development of the infants and contributed substantially to infant deaths. High levels of infant mortality, particularly from causes of maternal origin and nutritional factors, reflected poor antenatal conditions. Poor maternal health, high birth rates and poor socio-economic circumstances contributed substantially to high levels of infant mortality in Merthyr Tydfil 1865-1908. The death rates of both mothers and infants reflected their poor social environment. Mothers were criticised, particularly by the medical profession, from the mid-nineteenth century for their ignorance and neglect which led to improper feeding resulting in deaths of infants from debility and marasmus, convulsions and diarrhoea, the large number of deaths reflecting an increase in bottle feeding and the disadvantaged social and physical environment. Domestic education was considered an important step in educating mothers and reducing such deaths. 283 By the Edwardian period there was increasing awareness that many causes of infant death were due to preventable antenatal causes linked to the health and well- being of the mother. There was also a major shift in the understanding of the relationship between high birth rates and high infant mortality rates 1906-7. The training of midwives and the appointment of a health visitor were intended to help save the lives of many mothers and babies, but had made little impact on deaths from antenatal causes by 1908. Not only was the number of adequately trained midwives insufficient to meet the perinatal requirements of mothers and babies, but much of the mortality was the result of an impoverished social environment, particularly within the home, and the under-nourishment of mothers and babies, social factors which were not addressed. Undeniably, poor socio-economic circumstances could no longer be ignored by blaming midwives for maternal deaths and mothers for baby deaths. Many of the issues involved huge social change, which the local authorities in Merthyr were not afraid to embrace in so far as they were able, particularly once County status was granted. Although the changes in the Edwardian period were a major step in the right direction, years of difficulty still lay ahead as a result of continuing social and economic disadvantage related to the industrial nature of the town and inherent regional inequalities which persisted well into the twentieth century. * * * * * * ** * * * * * * * * * * * *

284 Conclusion

Merthyr Tydfil had one of the highest infant death rates in the United Kingdom during the first half of the nineteenth century and experienced rising levels of infant mortality during the later nineteenth and early twentieth centuries, despite many years of public health reforms. Dr Thomas Jones Dyke was Medical Officer of Health to Merthyr Tydfil Local Board of Health from 1865 until his death in January 1900. His assiduous reporting on the health of his district, and that of his successors until 1908, forms the primary evidence for this thesis. General civic improvements prior to 1865 greatly transformed the sanitary environment, and later sanitary infrastructure continued these improvements, but infants failed to benefit from these measures.

Infant mortality rates rose from the 1880s until the end of the nineteenth century and did not begin to fall again until the Edwardian era. In 1849, 238 infant deaths /1000 births were recorded, a third of total deaths at all ages. In 1899 infant mortality reached 272 /1000, and in 1901 262/1000 accounting for 39% of all deaths before starting to slowly decline. The thesis has examined why sixty years of public health reforms in Merthyr failed to reduce infant mortality and why infant death rates rose by the end of the century. The core of the study is an analysis of the attributed causes of over 17,000 infant deaths in the context of the industrialising society of Merthyr from 1845, detailed in the Medical Officer of Health reports 1865-1908.

Many public health problems in Merthyr emanated from the town’s industrial history. The survival of the town’s population and that of its major industries were mutually dependent. Both suffered through adverse trade conditions, industrial transitions and labour disputes. Poor diets were common, especially when work or wages were at low levels. Major industrial conflicts in 1875 and 1898 created acute hardship on top of already chronic difficulties for families. The paucity of employment opportunities for women left families without alternative income sources in the event of worker strikes and dismissals. Public health reforms failed to address the underlying social issues of poverty among the working classes in Merthyr. Public health reformers failed to lower infant mortality rates in the nineteenth century because poor urban environmental conditions only partially explained infant mortality. Until the Edwardian period they failed in particular to connect the survival of infants with the health of mothers and the social and environmental reasons for their apparent inability to care adequately for their babies. Women’s work within the home,

285 by the nature of their husband’s work, was dirty and laborious. The bearing and raising of large families on low household wages in slum-like conditions compromised maternal health. This was reflected in high infant mortality rates, particularly those arising from antenatal causes, as these were directly associated with the health of the mother. Indirect associations also existed in, for example, the inability to breastfeed and diseases contracted from insanitary and nutritionally inferior milk products. Dr. Dyke, the MOH, was a highly respected sanitarian who came to intimately understand the town’s problems over the course of his extensive tenure. Yet when he died in 1900 infant mortality rates were much higher than when he first took office. He understood his work in public health through the early-nineteenth-century orthodoxies of his youth that subsumed infant mortality within the broader public health issues in the town. This is reflected in his infant mortality measurements, which were rated by the size of the general population rather than as a proportion of live births. He argued that poor housing and overcrowding, an unhealthy sanitary environment and poverty contributed greatly to high morbidity and death rates. He therefore vigorously pursued the efficient application of public health legislation and principles towards resolving housing problems alongside infectious disease control as equally important and preventable causes of death and disease. Dyke’s necessary focus on waves of epidemics, urban sanitary infrastructure, degenerate housing and overcrowding detracted from direct targeting of infant mortality. Because he considered the problem as part of the overall causes of mortality in the town rather than also crucially connected to maternal health, he regarded the deaths of many young infants as inevitable; indices that would persist until population health improved. Despite his acute awareness of the tragedy of infant death, this interpretation of infant mortality obscured in concept its distinctive causes, and in method, the increasing extent of the problem.

The MOH reports for 1905-8 revealed that approximately 30% of infant deaths occurred within the first month and 50% in the first three months of life. (Chapter 1, Table 1.1.) Deaths thereafter were likely to be associated with an adverse urban environment, and particularly the home. Dyke was acutely aware of the preventability of infant deaths related to inadequate sanitation. Many of those which occurred within a few days and weeks of birth Dyke considered unpreventable, as their association with maternal health was not widely acknowledged until the Edwardian period. Dyke’s successors pursued a more comprehensive approach to infant mortality that increasingly incorporated social factors into medical understandings of disease. This was reflected,

286 particularly from 1905, in changing attitudes to high birth rates and the importance of antenatal health of mothers.

300

250

Convulsions Tuberculosis Lung 200 Nutritional Maternal Diarrhoea 150 Sudden deaths Unclassified Infant mortality Community Diseases 100 Infectious Diseases Secondary Infections Dentition/ Teething

50

0

4 2 3 0 1 2 8 9 0 1 7 66 67 7 75 76 8 8 84 85 9 9 9 93 9 9 0 0 0 ear 8 8 8 8 8 8 8 8 8 8 8 8 9 9 Y 1 1 1868186918701871187218731 1 1 187718781879188018811 1 1 1 188618871888188918 1 1 1 189418951896189718 18 1 1 1902190319041905190619

Figure 6. All Causes of Infant Death in Merthyr Tydfil 1865-1908 as Disease Specific Infant Mortality Rates per 1000 Registered Births

The analysis of the attributed causes of over 17,000 infant deaths between 1865 and 1908 identifies several phases during which infant mortality rates were affected by different causes of infant death. The medical causes of death do not necessarily reflect their social etiology, which it has been the aim of this thesis to explain. The findings are illustrated by two main graphs. The first, Chapter 4, Figure 6., shows all groups of causes analysed. The second graph, Chapter 4, Figure 7., illustrates the seven-year moving average trend lines for the major influences on infant mortality rates. It identifies several phases during which infant mortality rates rose or fell, affected by different causes of infant death. Infant mortality showed a brief downward trend from 1873-77 before a noticeable rise from 1882-1893 driven by rising deaths from lung diseases, tuberculosis, convulsions, diarrhoea and deaths from antenatal causes. From 1894 deaths from lung diseases declined slowly, and convulsions as a cause of death declined rapidly, but were offset by a steep rise in deaths from diarrhoea. Diarrhoea rates continued to rise steeply until 1900 before gradually declining. Tuberculosis deaths declined rapidly from 1896 such that diarrhoeal deaths and antenatal deaths became decisive in driving up infant mortality rates. From 1900 deaths of maternal

287 origin remained as the only cause of infant deaths which was still rising.

Seven Year Moving Average

100 100

90 90

80 80

70 70

60 60

50 Convulsions 50

40 40

Infant Mortality Rates Mortality Infant Nutritional 30 30 Lung 20 20 Infectious

10 Maternal 10 Tuberculosis Diarrhoea 0 0

1 9 7 3 5 1 7 73 76 7 84 8 9 9 98 0 06 ear 8 8 8 8 9 Y 1866186718681869187018 18721 187418751 1877187818 18801881188218831 1885188618 1888188918901891189218 189418 189618971 1899190019 19021903190419051 1907

Fig. 7. Seven Year Moving Average of Major Causes of Infant Death in Merthyr Tydfil 1865-1908.

Chapter 4 argued that deaths from all forms of tuberculosis and from infectious diseases do not, in themselves, explain Merthyr’s high infant mortality rates, but were nonetheless an important part of the problem. Deaths from infectious diseases declined only slightly by 1908. A pool of non-immune children under five years old sustained endemic measles and whooping cough, frequently accompanied by chronic lung diseases which led to weight loss and malnourishment and allowed opportunistic diseases such as tuberculosis to take hold, flourishing in the overcrowded living conditions which engendered chronic ill-health. Tabes mesenterica caused the greatest number of tuberculosis deaths in infants, and all infant deaths from tuberculosis equaled the combined total deaths from measles and whooping cough. Tuberculosis rose in the 1890s, coinciding with the rapid growth of population in the lower district and overcrowding among young families. Tuberculosis declined with the later adoption of the Cowsheds, Dairies and Milk Shops Order of 1889. Dyke estimated that every death from infectious diseases represented ten other cases in the community, many capable of generating chronic ill-health. His persistent efforts to minimise the destructive effects of epidemics should not therefore be undervalued. Chapter 5 examined the rise in infant deaths attributed to lung diseases and diarrhoea and the decline in deaths attributed to convulsions, possibly due to changes in

288 reporting. Young babies were less likely to withstand the biting cold of some Merthyr winters. Deaths from lung diseases and diarrhoea accounted for an increasing proportion of Merthyr’s rising infant mortality from the mid 1880s and particularly by the end of the century. Both accounted for deaths among older, rather than newborn infants, and were subject to seasonal influences. Dyke observed an increase in lung diseases following whooping cough and measles epidemics, especially in winter, extending the impact of infectious diseases on the infant community, although this connection could not be extrapolated from the data. Lung diseases spread quickly through close contact in the cramped, suffocating atmosphere of working-class housing. Both illnesses worsened in overcrowded living conditions, and lung diseases created their own epidemics such as epidemic pneumonia and the spread of the respiratory syncytial virus which proved deadly to babies with weakened constitutions. Overcrowded living conditions encouraged the spread of these and other viral and bacterial infections and are a very important aspect of any discussion of high levels of infant mortality among working- class communities.

Diarrhoeal deaths rose dramatically in Merthyr from 1884 and increased dramatically by the turn of the century, particularly in 1899 and 1901, possibly accounted for in part by a fall in deaths from convulsions that coincided remarkably with the rise in diarrhoeal deaths. The rise in summer diarrhoea deaths also coincided with the increasing popularity of bottle feeding. Milk as a vehicle for the transmission of infectious diseases, was added to public health concerns from 1893, with tighter control over hygiene during its production and sale. Epidemic summer diarrhoea was a feature of urbanisation, overcrowding and substandard living conditions. The increase in diarrhoeal deaths across the country during the last decade of the nineteenth century, particularly in 1899, may possibly be explained by a series of very hot summers and the lack of cleansing rainfall which allowing filth to accumulate, creating ideal conditions for flies and other vectors to breed and transmit infections. Mothers, unaware of rudimentary hygiene and often lacking the most basic amenities at home, were blamed for their ignorance, neglect and improper feeding which resulted in deaths of infants from debility and marasmus, convulsions and diarrhoea. Education of mothers was considered an important step in reducing such deaths, and in 1902 the local authorities began issuing instructions to mothers regarding infant feeding when births were registered, coinciding with a downturn in diarrhoea deaths. Observers frequently criticised them despite the abysmal living conditions in which they struggled to bring up their children. Dyke observed a reduction in

289 waterborne diseases from 1865 for which Merthyr had been notorious prior to the introduction of the water supply, but by the mid-1880s it was showing evidence of contamination by algae, corrosion and fractures in supply pipes, and was turned off for hours during periods of drought. Many houses continued to share outside taps and privies into the twentieth century. Several municipal ash tips were located within a short distance of houses. Although a decline in infant mortality rates is discernible in Merthyr from 1902, they were still above those when Dyke became MOH in 1865 and above those during the cholera years, 1845-1866. The study stresses the interconnectedness of all causes of infant death and views as important for consideration the sufficient causes of diseases, as outlined by M.G. Marmot and J. N. Morris1. For example, deaths from infectious diseases take on a more serious role when linked to deaths from lung diseases, while nutritional causes of death from failure to thrive were associated with deaths from diarrhoea, infectious diseases and generally compromised infant health. The long-term effects of both disease and its underlying social problems on the health of surviving babies were gauged within a few years when the poor health of malnourished schoolchildren was first assessed by the health visitor as school nurse in 1908. The children were found to have multiple health defects including poor vision and deafness.

Chapter 6 examined the contribution to infant mortality of deaths within the perinatal period from convulsions, prematurity, and conditions that can be traced to adverse family and social circumstances, particularly the mother’s health, and nutritional causes of death. Fairly consistent levels of deaths from nutritional causes from 1865-1908 were common to both the perinatal period and the later stages of the first year of life. Increasing medical specialisation in the care of mothers and babies by the Edwardian period resulted in more frequent attribution of death to antenatal causes. Deaths from antenatal causes of maternal origin increased markedly by the 1890s and were the only causes of death still rising by 1908. These antenatal causes of infant death reflect the poor physical and social health of mothers. Early marriage contributed to high fertility rates that were directly linked to high infant mortality. High birth rates were promoted in Merthyr as a national and moral duty until the value of a lower birth rate and fewer, but healthier, babies was publicly endorsed by the Registrar General in

1 M.G. Marmot and J.N. Morris, ‘The Social Environment’, in Walter W. Holland, Roger Detels, and George Knox, The Oxford Textbook of Public Health Volume 1: History, determinants, scope and strategies., p.97 290 1905-6. The birth rate slowly declined from 38 /1000 population in 1905 to 35.4/1000 in 1908, still well above the national birth rate for 1908 of 25.8/1000.

Although recognition of the importance of antenatal conditions in determining infant survival was a significant change in understanding the causes of infant mortality, midwifery training did not significantly improve the health of mothers and babies in Merthyr. By 1908, antenatal causes of infant deaths were the only causes still rising. These increases are beyond those explicable by the increasing attribution of deaths to antenatal causes. Changes in the understanding of the physiological development of infants emphasised the importance of the mother’s health in preventing infant deaths. The provision of trained midwives and health visitors under the Midwives Act of 1902, was a positive step towards reducing the mortality of mothers and infants, but was of limited effectiveness in Glamorgan and Merthyr. The trained midwives were too few to replace those forced to retire from practice, many of whom had only a rudimentary knowledge of hygiene and were deemed illiterate, being unable to read the rules and codes of practice. Welsh as their primary language prevented them from taking midwifery examinations conducted in English. However, the appointment of a health visitor and superintendent of midwives in 1907 alongside attempts to improve slum housing, showed an awareness of the broad public health needs of the community. The adoption of the Notification of Births Act in 1907 was an important adjunct to her appointment, allowing access to mothers and babies within a short time of birth, instead of the six weeks allowed for registration. The reduction of infant mortality required the lowering of birth rates, which required profound social and cultural changes. The Edwardian shifts towards the maternal health determinants of infant mortality, however laudable, were limited in their benefits to maternal and infant health since the social origins of disease lay largely beyond the purview of public health policies. The death rates of both mothers and infants reflected their poor social environment. Poor maternal health, high birth rates and poor socio-economic circumstances contributed substantially to high infant mortality rates despite nineteenth-century sanitary reforms. Dyke was correct to emphasise the connection between poverty and poor health. Poor law policies, formulated in the early nineteenth century, were inadequate to address the social needs of an urban working-class population by the end of the century. The protracted nature of social and environmental problems in Merthyr originated from the town’s dependence on its primary industries. During the period of this study Merthyr experienced the changing labour markets associated with the decline of iron

291 making, the transition to steel production and the growth of the coal industry. The population increased rapidly during the 1890s with expansion of coal mining in the district. The governance of the town by powerful industrialists ensured the primacy of industrial needs in the town until 1895, when administration passed to a democratically elected Urban District Council. Deteriorating slum housing, overcrowded living conditions and entrenched poverty undermined maternal and infant health. Early marriage, high birth rates, and large families, lack of employment opportunities for married women in male-dominated heavy industries and the uncertain wages of the industrial economy maintained the predominantly working-class character of the town. The struggles of women to raise families within a chronic milieu of social deprivation, often lacking basic amenities, were reflected in the attributed causes of infant mortality. Heavy domestic labour further contributed to high early death rates among coalfield women. The thesis has evaluated the attributed medical causes of infant mortality recorded in the unusually complete series of MOH reports for Merthyr Tydfil 1865- 1908. These were examined in the context of the public health and industrial development of the town to determine why public health measures failed spectacularly to reduce infant mortality rates by the end of the nineteenth century. The thesis finds that the underlying socio-economic problems associated with industrialisation were beyond the scope of public health reforms, despite constant efforts to address the environmental health problems of Merthyr Tydfil. Deteriorating and overcrowded housing, widespread and severe poverty, rapid fin de siècle population growth as the coal industry expanded and pro-natalist attitudes were key determinants of Merythr’s high infant mortality from 1865-1908. Better housing initiatives from 1895, lower rents, and initiatives to reduce diarrhoeal deaths produced a downturn in deaths from lung diseases and diarrhoea by 1902. Nutritional causes of death, endemic through poverty, underpinned the continued rise in deaths from antenatal causes and the general rate of infant death. It is precisely this intimate social connection between poverty and disease that explains why new public health initiatives in the Edwardian period aimed at maternal health, that would be of future importance to improving maternal and infant health, failed to effectively lower infant deaths from antenatal causes by 1908. The potential benefits of medical innovation are mitigated when they precede rather than accompany social interventions, for as the field of social medicine was later to discover,

292 “social and economic conditions were intimately related to the greater or lesser prevalence of disease”. 2 The analysis of the stated causes of over 17,000 infant deaths in Merthyr Tydfil has allowed the study to range over several phases of public health development including the crucial Edwardian transition, during which knowledge and awareness regarding infant and maternal welfare needs advanced considerably. A new formula for public health reporting of infant mortality from 1905 permitted a breakdown of the age of infants in weeks and months during the first year of life. This permitted identification in the analysis of lung diseases, diarrhoea, nutritional and perinatal deaths due to antenatal causes as the major stated causes of infant death which drove up infant mortality rates from the 1880s. By 1902 most were declining except perinatal deaths, which continued to rise by 1908. The poor sanitary environment and overcrowded living conditions contributed substantially to high infant mortality rates. The social etiology of many deaths becomes evident through the rising deaths from antenatal causes, which can be traced to a maternal health compromised by chronic poverty, poor nutrition, fecundity and gruelling domestic labour. Rises in infant deaths due to premature birth are indicative of the low social economic status due to the correlation between incidence of premature births and deaths, a condition traceable to the health of the mother. There are few studies of infant mortality that take Welsh rather than English industrial towns as historical sites of enquiry. A major objective of the thesis therefore was to investigate the historical problem of infant mortality in Merthyr Tydfil as an essential addition to studies of infant mortality in both British and Welsh history, and correspondingly pursue a historiography that attended to both the supra-national pattern of British industrialisation and to the town’s national and local specificity. The thesis contributes to the growing constellation of local studies of infant mortality in Victorian and Edwardian Britain that can illuminate this complex historical problem. This research project has permitted an exciting cross-disciplinary engagement on the part of the researcher in attention to both medical and social aspects of disease. It has also necessitated local research that, in accentuating the unique and detailed cultural history of the locality under study, has been as much a source of inspiration as of content.3 Much of the most detailed information which informs the regional and national

2 George Rosen, ‘Approaches to a Concept of Social Medicine. A Historical Survey’, The Millbank Memorial Fund Quarterl, Vol.26, No.1., January, 1948, p.12. 3 J. D. Marshall, ‘Proving Ground or the Creation of Regional Identity? The Origins and Problems of Regional History in Britain’, Philip Swan and David Foster, Essays in Regional and Local History, Hutton Press Ltd., North Humberside, 1992, pp.11-26, 293 understanding of the problem is available only at the local level, as this study demonstrates.4 The thesis has attempted to give voice to the abject conditions of industrialisation endured by working-class families, of which high rates of untimely death amongst mothers and infants were an important consequence.

4 Williams, Infant and Child Mortality in Urban Areas of Nineteenth Century England and Wales, p.4. 294 Afterword

Years of difficulty lay ahead for Merthyr based on inherent regional inequalities in south Wales which persisted well into the twentieth century.5 These regional inequalities and continuing problems are seen in the lack of antenatal and child welfare provisions in Merthyr in 1917 reported by the Carnegie United Kingdoms Trust Report on the Physical Welfare of Mothers and Children. 6 Houses remained scarce in parts of Merthyr with many still not up to modern standards. Much poverty was found among steel workers, but little among colliers. There was very little employment for women outside teaching, domestic service, dressmaking, and approximately 6% of married women were employed mainly in brickworks, and in three steam laundries. Merthyr Corporation had provided some infant and maternity welfare services, but mothers remained generally uninformed as to the proper care of infants, and the medical practitioners had little time for antenatal and postnatal work. An antenatal clinic, hospital beds run by an obstetric doctor and treatment facilities for venereal diseases were badly needed. The infant mortality rate which had fallen to 136/1000 from 1911- 13 had risen to 157 in 1915. The deaths of mothers in childbirth which in 1901-3 had been 10.4 per 1000 births had halved to 5/1000 in 1915. Three female health visitors averaged 2000 infant and maternal welfare visits per year with 1000 revisits. Although infant welfare consultations were provided at clinics, no antenatal consultations or classes for mothers were provided. There was still a shortage of midwives. Ninety six per cent of births were attended by 58 registered midwives, 26 of whom were untrained. Several trained midwives had given up practice, unable to make a living in competition with bona fide midwives. Premature birth was still the greatest cause of infant death and accounted for up to 30% of total infant deaths. The Carnegie report anticipated no great improvement without some form of State intervention. Merthyr and the South Wales Coalfield continued to suffer through the depression of the 1930s and through further industrial disputes and recessions. King Edward VIII visited south Wales in 1936 and uttered the phrase which has now become part of valley folk lore; “Something must be done”. 7

5 Danziger,Danziger’s Britain, pp. 309-31., Lee, ‘Regional Inequalities in Infant Mortality in Britain, 1861-1971: Patterns and Hypotheses’,57,-59,63-65. 6The Carnegie United Kingdoms Trust, Report on the Physical Welfare of Mothers and Children. pp.326-7. 7 Ted Rowlands, ,‘Something Must Be Done’ South Wales V Whitehall 1921-1951, ttc Books, 2000, cover note. 295 Liz Peretz, reviewing the regional provision of maternal and infant welfare services during the inter-war period to 1937, found that far from being a cohesive national service, the level of service provision was largely at the discretion of local authorities. This depended on the level of commitment and available financial resources, which further adds to explanations of regional differences and disparities.8 A woman might travel several miles to a makeshift ante-natal clinic in a local chapel or club, only to find it closed for the next ten days. 9 Mothers understood the primary function of the clinic to be the distribution of cod liver oil and milk rather than antenatal care. The health visitors covered a large area, frequently only visiting an infant once before it entered school.10 This thesis has been specifically about infant mortality in Merthyr Tydfil and has identified the particular combination of circumstances which contributed to the problem. Some of the matters raised were particular to Merthyr or industrial Glamorgan, others more generally to mining towns or socio-economically disadvantaged communities. Many elements of this study may be extrapolated towards an understanding of contemporary instances of infant mortality within disadvantaged communities. Of particular relevance, for example, is the health of indigenous Australians, for whom medical interventions unmatched by social ones ensure poor health outcomes across generations. A NSW report surmised that the large gap between infant mortality rates among indigenous and non-indigenous Australians is associated with adverse social circumstances and inadequate antenatal care11. These deaths were largely due to prematurity and stillbirth. Infant mortality in this case, as in Merthyr Tydfil, is both a particular problem in its connection with maternal health and distinctive medical conditions of pregnancy, yet forms part of a larger pattern of poor health outcomes arising from socioeconomic marginalisation.

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8 Liz Peretz.’Regional Variation in Maternal and Child Welfare Between the Wars: Merthyr Tydfil, Oxfordshire &[sic] Tottenham’ in Swan and Foster, Essays in Regional and Local History, pp133-149. Facilities in Merthyr Tydfil were inferior to those in Tottenham, but superior to those in rural Oxfordshire., pp.137-8. 9 Ibid. My grandmother undertook a similar journey carrying her prematurely born twin infant. The infant died in her arms as she returned home. 10 Ibid. pp. 137-8. All mothers on with infants under one year of age were eligible for these rations. 11 Government of South Australia, Department of Human Services , Maternal, Perinatal and Infant Mortality in South Australia, 2002, Adelaide, 2003. URL: http://www.dhs.sa.gov.au/pehs/pregnancyoutcome.htm 296 Appendix

Table of Contents

Table of Contents 297

Appendix. Table 1. Infant Mortality Rates and Birth Rates for England and Wales, Wales and Merthyr Tydfil 1838-1922 302

Appendix. Table 1(a). Deaths of Children Under Five Years and of Infants Under One Year as a Percentage of Total Deaths, Percentage of Deaths Under Five Years and Percentage of Births in Merthyr Tydfil 1841-1853 and 1866-1908 304

Appendix. Table 2. Basic Demographic Data for Merthyr Tydfil1841-1921: Population, Occupied Houses, Marriages, Births, Birthrates, Deaths, Death Rates and Infant Mortality Rates 306

Appendix. Table 2(a). Retrospective Estimates of Population, Birth Rates and General Death-Rates 1891-1901 Based on 1901 Census 311

Appendix. Table 2(b). Percentage Change in Decennial Population in Merthyr Tydfil 1801-1908 311

Appendix. Table 2(c). Contribution of Excess Births Over Total Deaths at All Ages, Immigration and Emigration to Population Change in Merthyr Tydfil 1841-1908 312

Appendix. Table 2(d).Contribution of Excess Births Over Total Deaths at All Ages, Immigration and Emigration to Population Change in Merthyr Tydfil for each Decade 1851-1908 313

Appendix. Table 2(e). Summary of Total Contribution of Excess Births Over Total Deaths at All Ages, Immigration and Emigration to Population Change in Merthyr Tydfil 1851-1908 ( MOH Reports for Merthyr Tydfil 1854-1908 ) 314

Appendix. Table 3. Years When General Death Rate Fell Below or Exceeded 23 deaths per 1000 Population and Years when the Infant Mortality Rate Exceeded or Fell below 150 deaths per 1000 Registered Births 315

297

Appendix. Table 4. Price of Steam Coal, Iron and Steel Rails, Bar Iron and Colliers Wages 1865-1879 317

Appendix. Table 5. Expenditure on Pauperism and Number of Paupers in Merthyr Tydfil Union 1851-1893 319

Appendix. Table 6. Infant Vaccinations In Merthyr Tydfil 1866-1898 320

Tables 7-20 Analysis of Causes of Infant Death Under One Year of Age from Medical Officer of Health Reports for Merthyr Tydfil 1865-1908

Categories of Causes of Infant Death 321

Appendix. Table 7. Number of Infant Deaths According to Tables of Causes of Infant Death In Medical Officer of Health Reports for Merthyr Tydfil 1865-1908 323

Appendix. Table 7(a). Analysis of Infant Deaths According to Tables of Causes of Infant Death In Medical Officer of Health Reports for Merthyr Tydfil 1865-1908 as Disease Specific Infant Mortality Rates per 1000 Births 326

Appendix. Table 7(b). Years when Infant deaths Under 150 per 1000 or Above 175/ 200 per 1000 Births In Merthyr Tydfil 1866-1908 327

Appendix. Table 7(c). Summary Table of Causes of Death by Weeks and Months of Infants Under One Year of Age in Merthyr Tydfil 1905-1908 328

Appendix.Table 7(d). Unclassified Deaths of Infants Under One Year of Age in Merthyr Tydfil 1866-1908 329

Appendix. Table 8. Principal Causes of Death Each Year and Total DSIMR of All Remaining Causes of Death Forming the Infant Mortality Rate Each Year 1865-1908 in Merthyr Tydfil 330

Appendix. Table 9. Estimates of Percentages of Infant Deaths and Causes of Death Discussed by T.J.Dyke as MOH for Merthyr Tydfil 1865-1908 332

298 Appendix. Table 10. Sudden and Violent Deaths in infants Under One Year of Age in Merthyr Tydfil 1866-1908 336

Appendix. Table 11. Disease Specific Infant Mortality Rates of All Groups of Infectious Diseases in Merthyr Tydfil 1866 -1908 337

Appendix. Table 11(a). Number of Infant Deaths From All Groups of I nfectious Diseases in Merthyr Tydfil 1866-1908 338

Appendix. Table 11(b). Number of Infant Deaths and Disease Specific Infant Mortality Rate from Tuberculosis in Merthyr Tydfil 1866-1908 339

Appendix. Table 11(c). Number of Infant Deaths from Smallpox, Whooping Cough, Measles, Scarlet Fever, Group 2 and Group 3 in Merthyr Tydfil 1866- 1908 340

Appendix. Table 11(d). Disease Specific Infant Mortality Rates and Years of Severity (Bold Type) for Smallpox, Whooping Cough, Measles, Scarlet Fever, Group 2 and Group 3 in Merthyr Tydfil 1866-1908 342

Appendix. Table 11(e). Number of Infant Deaths From Infectious Diseases in Merthyr Tydfil 1866-1908: Group 2: Diphtheria, Croup, Laryngitis, Tonsillitis 343

Appendix. Table 11(f). Disease Specific Infant Mortality Rate of Infant Deaths From Infectious Diseases in Merthyr Tydfil 1866-1908: Group 2: Diphtheria, Croup, Laryngitis, Tonsillitis 344

Appendix. Table 11(g).Number of Infant Deaths From Infectious Diseases in Merthyr Tydfil 1866-1908:Group 3:Cephalitis, Meningitis, Inflammation of the Brain 345

Appendix. Table 12. Numbers DSIMR of Secondary and Other Infections in Infants in Merthyr Tydfil 1866-1908 and Percentage of Infant Mortality Rate 346

Appendix. Table 13. The Impact of Infectious Diseases and Diarrhoeal Diseases as Annual Variables on the Infant Mortality Rates for Merthyr Tydfil 1866-1908: Disease Specific Infant Mortality Rates and Combined Disease Specific Infant Mortality Rates for Infectious Diseases and Diarrhoea 349

299 Appendix. Table 13(a). The Impact of Infectious Diseases and Diarrhoeal Diseases on Infant Mortality Rates for Merthyr Tydfil 1866-1908: Disease Specific Infant Mortality Rates for Diarrhoeal and Infectious Diseases as a Percentage of the Infant Mortality Rate 351

Appendix. Table 14. Total Number of Deaths at All Ages from All Causes, Total Number of Deaths at All Ages, Deaths Above Five Years of Age and Under Five Years of Age from Lung Diseases in Merthyr Tydfil 1866-1908 353

Appendix. Table 14(a). Numbers of Deaths, DSIMR and Percentages of Deaths Under Five Years of Age from Lung Diseases in Merthyr Tydfil 1866-1908 354

Appendix. Table 14(b). Number of Deaths of Infants Under One Year of Age from Lung Diseases in Merthyr Tydfil 1866-1908, Disease Specific Infant Mortality Rate and Percentage of Infant Mortality Rate 355

Appendix. Table 14(c). Numbers of Deaths of Infants One to Five Years of Age from Lung Diseases in Merthyr Tydfil 1866-1908 356

Appendix. Table 14(d). Deaths Under Five Years of Age as Percentage of Total Deaths from Lung Diseases in Merthyr Tydfil 1865-1908 357

Appendix. Table 15. Comparative DSIMR for Measles, Whooping Cough, Convulsions, Diarrhoea, and Lung Diseases in Merthyr Tydfil 1866-1908 358

Appendix. Table 16. Number of Infant Deaths from Waterborne Community Diarrhoeal Diseases and Disease Specific Infant Mortality Rates Merthyr Tydfil 360

Appendix. Table 16(a). Numbers of Deaths from Diarrhoeal Diseases and Diseases Specific Infant Mortality Rates with Infant Mortality Rates in Merthyr Tydfil 1866-1908. 362

Appendix. Table 16 (b). Comparison of Number of Rainy Days and Rainfall July-October 1894-1903, Diarrhoea Death Rate (Descending Order), and Infant Mortality Rates, 1867-1903 364

Appendix Table 17. Number of Deaths under One Year of Age From Causes of Maternal Origin in Merthyr Tydfil 1866-1908 366

300

Appendix. Table 17(a). Disease Specific Infant Mortality Rates of Deaths Under One Year of Age From Maternal Causes in Merthyr Tydfil 1866-1908 368

Appendix.Table 18. Number of Deaths of Infants Under One Year of Age From Nutritional Disorders in Merthyr Tydfil 1866-1908 370

Appendix. Table 18 (a). DSIMR of Deaths of Infants Under One Year of Age From Nutritional Disorders in Merthyr Tydfil 1866-1908 371

Appendix. Table 19. Disease Specific Infant Mortality Rates for Infant deaths Under One year of Age from Maternal and Nutritional Causes of Death in Merthyr Tydfil 1866-1908 373

Appendix. Table 20. Legitimate and Illegitimate Births as Percentages of Total Births in Merthyr Tydfil, South Wales and England and Wales, 1865-1908 375

Appendix. Table 21. Marriages and Birth Rates in Merthyr Tydfil 1868-1908 376

Appendix. Table 22. Numbers, Causes of and DSIMR of Maternal Death in Merthyr Tydfil 1866-1908 377

301 Appendix. Table 1. Infant Mortality Rates and Birth Rates for England and Wales, Wales and Merthyr Tydfil 1838-1922 ( B.R. Mitchell and Phyllis Deane, Abstract of British Historical Statistics (1971); John Williams, Digest of Welsh Historical Statistics, Vol.1 (1985) from Medical Officer of Health Reports for Merthyr Tydfil 1845-1920.) Year IMR IMR IMR Birth Rate Birth Rate Birth Rate E&W Wales Merthyr * E&W Wales Merthyr 1838 30.8 1839 151 125.5 31.8 1840 154 127 32.0 1841 145 121 166.6 32.2 30.9 1842 152 117 148.9 32.1 30.7 1843 150 112.6 143.6 32.3 30.9 1844 148 119.9 225. 32.7 31.3 1845 142 117 182.4 32.5 30.2 1846 164 122.2 184.8 33.8 32.0 1847 164 147.4 218.9 31.5 30.4 1848 153 129.6 161.4 32.5 31.3 1849 160 136.4 238.2 32.9 31.8 1850 162 120.3 173.9 33.4 32.2 1851 153 126.9 181.9 34.3 32.3 1852 158 134.8 205.4 34.3 32.4 1853 159 139. 199.4 33.3 32.0 1854 157 133.5 34.1 33.3 1855 153 133.2 33.8 33.3 1856 143 125.1 34.5 34.7 1857 156 124.6 34.4 34.8 1858 151 145.4 33.7 34.1 1859 153 131.9 35 36.1 1860 148 133.1 34.3 34.9 1861 153 128.3 34.6 33.7 1862 142 126.5 35 34.6 1863 149 124.5 35.3 34.9 1864 153 129.5 35.4 35.8 1865 160 139.6 35.4 35.7 1866 160 125.7 192.1 35.2 26.2 40.2 1867 153 128.5 146.7 35.4 35.6 38.9 1868 155 121.7 130.3 35.8 36 37.4 1869 156 125.5 165 34.8 35.2 31.5 1870 160 130.2 187.2 35.2 35.0 37 1871 158 126.2 135.8 35 35 41.2 1872 150 125.1 147 35.6 35 39 1873 149 130.9 186.6 35.4 35.2 39 1874 151 138.7 191.3 36 37.1 40.3 1875 158 138.6 159.5 35.4 36.7 37 1876 146 126.2 121.3 36.3 37.1 33.2 1877 136 127.3 131.4 36 36.2 35.3 1878 152 136.7 151.6 35.6 35 32.8 1879 135 122 138.1 34.7 34.2 31.7 1880 153 133.9 162.3 34.3 32.8 33.5 1881 130 119.9 137.9 33.9 33.1 35.2

302 Appendix. Table 1. Infant Mortality Rates and Birth Rates for England and Wales, Wales and Merthyr Tydfil 1838-1922 (Mitchell and Deane, Abstract of British Historical Statistics (1971), Williams, Digest of Welsh Historical Statistics, Vol.1 (1985) and Medical Officer of Health Reports for Merthyr Tydfil 1845-1920.) Year IMR IMR IMR Birth Rate Birth Rate Birth Rate E&W Wales Merthyr E&W Wales Merthyr 1882 141 122.7 146.1 33.8 34.3 34.7 1883 137 136.8 158 33.5 32.4 35.4 1884 147 129.9 171.7 33.6 33.1 35.2 1885 138 131.7 169.3 32.9 33.2 34.4 1886 149 150.1 187.7 32.8 33 33.3 1887 145 136.2 171.9 31.9 31.8 32.8 1888 136 124.3 143.6 31.2 31.8 35.3 1889 144 144 210.7 31.1 31.3 34.3 1890 151 150.1 205.5 30.2 31.3 35.1 1891 149 151.2 193.2 31.4 33.3 39.3 1892 148 149.5 242 30.4 32.7 37 1893 159 158.4 219.7 30.7 33.7 37.5 1894 137 141.8 186 29.6 31.8 36.7 1895 161 165.5 240 30.3 33.3 38.1 1896 148 151 217 29.6 32.8 34.1 1897 156 155.6 214 29.6 33.9 34.8 1898 160 154.2 199 29.3 32.2 34.7 1899 163 174 271 29.1 30.9 32 1900 154 150.2 183 28.7 31 34.5 1901 151 161.5 261 28.5 31.3 36.7 1902 133 140 183 28.5 32 39.6 1903 132 134 153 28.5 31.6 38.4 1904 145 148 186 28 31.6 38.5 1905 128 141 206 27.3 31.2 38 1906 132 137.5 181 27.2 30.6 36.2 1907 118 125.2 154 26.5 32.1 35.8 1908 120 137.1 176 26.7 31.1 35.4 1909 108 113 25.8 30.1 1910 105 117.3 25.1 28.6 1911 130 135 24.3 27.8 1912 95 106 23.9 27 1913 108 117 24.1 26.9 1914 105 110 119 23.8 27 27.7 1915 110 112 157 21.9 25.3 25.3 1916 91 92 109 20.9 23.2 24.0 1917 96 92 103.9 17.8 20.5 20.3 1918 97 95 113 17.7 21.6 23.6 1919 89 92 91 18.5 20.7 24.5 1920 80 86 84 25.5 26.7 29.7 * Infant mortality rates calculated where necessary from Medical Officer of Health Reports for Merthyr Tydfil 1845-1920

303 Appendix. Table 1(a). Deaths of Children Under Five Years and of Infants Under One Year as a Percentage of Total Deaths, Percentage of Deaths Under Five Years and Percentage of Births in Merthyr Tydfil 1841-1853 and 1866-1908(Source: MOH Reports for Merthyr Tydfil 1854-1908.) Year Births Total deaths Deaths Under 5 Deaths Under 1 Deaths Under 5 % Total deaths Deaths Under 1 %Total deaths Deaths Under 1 % Deaths Under 5 Deaths Under 1% of Bbirths 1841 1483 974 554 247 57 25 44 16 1842 1531 781 424 228 54 29 54 15 1843 1574 810 403 226 50 28 56 14 1844 1600 1517 877 360 58 24 41 23 1845 1694 1082 590 309 55 29 52 18 1846 1813 1181 640 335 54 28 52 18 1847 1759 1434 788 385 55 27 49 22 1848 1785 1086 561 288 52 27 51 16 1849 1791 2925 998 428 34 15 43 24 1850 1857 1238 653 323 53 26 49 17 1851 1954 1481 761 374 51 25 49 19 1852 1812 1451 810 391 56 27 48 22 1853 1904 1489 772 400 52 27 52 21

1865 1866 2150 1373 625 413 46 32 71 21 1867 2112 1145 468 310 41 27 66 15 1868 2064 1119 495 269 44 24 54 13 1869 1952 1269 529 322 42 25 63 17 1870 1918 1530 760 359 50 23 47 19 1871 2143 1258 552 291 44 23 53 14 1872 2048 1555 552 301 35 19 55 15 1873 2106 1407 685 393 49 28 57 19 1874 2196 1797 938 420 52 23 45 19 1875 2019 1194 507 322 42 27 64 16 1876 1764 1019 363 241 36 24 66 14 1877 1765 1113 462 232 42 21 50 13 1878 1656 1132 433 251 38 22 58 15 1879 1600 1035 339 221 33 21 65 14 1880 1627 1243 510 264 41 21 52 16 1881 1726 1355 489 238 36 18 49 14 1882 1738 1190 532 254 45 21 48 15 1883 1772 1140 445 280 39 25 63 16 1884 1835 1247 489 315 39 25 64 17 1885 1807 1344 561 306 42 23 55 17 1886 1961 1420 634 368 45 26 58 19 1887 1879 1239 536 327 43 26 60 17 1888 2013 1243 438 289 35 23 66 14 1889 1946 1330 606 410 46 31 67 21 1890 2020 1500 699 415 47 28 59 21 1891 2303 1793 615 445 34 25 72 19 1892 2341 1706 902 559 53 33 63 24 1893 2408 1433 720 529 50 37 73 22 1894 2303 1300 636 429 49 33 67 19

304 Appendix. Table 1(a). Deaths of Children Under Five Years as a Percentage of Total Deaths and Deaths of Infants Under One Year as Percentage of Total Deaths, Percentage of Deaths Under Five Years and Percentage of Births in Merthyr Tydfil 1841-1853 and 1866-1908 (Source: MOH reports for Merthyr Tydfil 1854-1908) Year Year Births Total deaths Deaths Under 5 Deaths Under 1 Deaths Under 5 % Total deaths Deaths Under 1 %Total deaths Deaths Under 1 % Deaths Under 5 Deaths Under 1% of Bbirths 1895 2532 1647 820 590 50 37 74 24 1896 2334 1375 696 497 51 37 73 22 1897 2471 1598 938 530 33 33 63 21 1898 2495 1409 684 505 49 36 74 20 1899 2357 1690 863 640 51 38 74 27 1900 2658 1628 731 473 45 30 66 18 1901 2689 1795 978 704 54 39 72 26 1902 2797 1622 759 518 47 32 68 19 1903 2752 1360 615 422 45 31 69 15 1904 2803 1437 686 525 48 36 76 19 1905 2810 1627 860 576 53 35 67 20 1906 2714 1425 701 487 49 34 69 18 1907 2727 1462 643 421 44 28 65 15 1908 2736 1435 689 479 48 34 70 18

1. Deaths under five years accounted for approximately 55% of total deaths 1841-1853; from 1866- 1891 approximately 45%, and 1892-1908 approximately 50% of total deaths.

2. From 1841-1853 deaths of infants under one accounted for approximately 50% of deaths under five years. From 1866-1908 this increased to 60-70% congruent with existing knowledge that deaths of under fives decreased as deaths from infectious diseases decreased and deaths of infants formed an increasing and important proportion of deaths under five. It confirms that infants were the last to benefit from nineteenth century sanitary improvements or any rise in living standards, and that the infant mortality rate is an important social index.

3. 1841-1888 infant deaths under one formed approx 25% of total deaths. 1889-1908 they formed approx 35% of total deaths, the period of increase consistent with rise in infant deaths as % births (see para 4.).

4. From 1889 infant deaths as a % of births begin to increase in line with theories relating to urban sanitary diarrhoea hypothesis. Approximately 15-20% of babies born 1841-1888 died within the first year, from 1889-1901 this rose to 20-25% before returning to former levels.

305 Appendix. Table 2. Basic Demographic Data for Merthyr Tydfil 1841-1921: Population, Occupied Houses, Marriages, Births, Birthrates, Deaths, Death Rates and Infant Mortality Rates ( Compiled from MOH Reports for Merthyr Tydfil 1845- 1921.)

Year Popula Occupied Marriages Births Birth Deaths tion Houses Rate Merthyr

Under Under Total General Infant One 5 Deaths Death Mortality Year Years Rate Rate per 1,000 live births 1801 7705 1811 11104 1821 17404 1831 22083 1841 34978 1463 247 554 974 27.8 166.6 1842 1531 228 424 781 148.9 1843 1574 226 403 810 143.6 1844 1600 360 877 1517 225. 1845 1694 309 590 1082 182.4 1846 1813 335 640 1181 184.8 1847 1759 385 788 1434 218.9 1848 1785 288 561 1086 161.4 1849 1791 428 998 2925 238.2 1850 1857 323 653 1238 27.4 173.9 1851 46692 8354 568 2056 374 761 1481 31.7 181.9 1852 47006 624 1904 391 810 1451 30.9 205.4 1853 47320 753 2006 400 772 1489 31.5 199.4 1854 47634 658 2053 1880 39.5 1855 47948 621 2074 1424 29.7 1856 48262 683 2204 1283 28.6 1857 48576 659 2289 1325 27.3 1858 48890 541 2049 1776 36.3 1859 49204 597 2254 1495 30.4 1860 49520 571 2092 1322 26.7 1861 50461 9395 485 1963 1270 25.2 1862 51404 502 1959 1264 24.6 1863 52320 552 1975 1307 25.0 1864 53180 756 1940 1328 25.0 1865 53106 693 2206 1634 30.3 1866 53480 10589 723 2150 40.2 413 625 1373 25.3 192.1 1867 54338 10500 567 2112 38.9 310 468 1131 20.8 146.7 1868 55451 10158 574 2064 37.4 269 495 1090 20.3 130.3 1869 55905 10180 707 1952 31.5 322 529 1229 22.0 165 1870 51770 10212 681 1918 37 359 760 1530 32.3 187.2 1871 52000 10220 538 2143 41.2 291 552 1242 23.8 135.8 1872 52500 10397 809 2048 39 301 552 2048 29.6 147

306 Appendix. Table 2. Basic Demographic Data for Merthyr Tydfil 1841-1921: Population, Occupied Houses, Marriages, Births, Birthrates, Deaths, Death Rates and Infant Mortality Rates ( Compiled from MOH Reports for Merthyr Tydfil 1845- 1921.)

Year Population Occupied Marriages Births Birth Deaths Houses Rate Merthyr

Under Under Total General Infant One 5 Deaths Death Mortality Year Years Rate Rate per 1,000 live births 1873 54000 10647 851 2106 39 393 685 1407 26.0 186.6 1874 54450 10800 743 2196 40.3 420 938 1797 33.0 191.3 1875 54500 10810 480 2019 37 322 507 1194 21.9 159.5 1876 53000 10800 528 1764 33.2 241 363 1079 21.9 136.6 1877 50000 9500 528 1765 35.3 232 462 1118 22.2 131.4 1878 51891 10220 470 1656 32.8 251 433 1132 22.4 151.6 1879 50354 9787 568 1600 31.7 221 339 1036 20.5 138.1 1880 48500 9700 658 1627 33.5 264 510 1243 25.6 162.3 1881 49000 9900 693 1726 35.2 238 187 1355 27.6 137.9 1882 50000 10100 678 1738 34.7 254 532 1190 23.8 146.1 1883 50000 10200 653 1772 35.4 280 445 1140 22.8 158 1884 52000 10438 820 1835 35.2 315 489 1247 24.0 171.7 1885 52500 10485 579 1807 34.4 306 255 1344 25.6 169.3 1886 55909 10757 585 1961 33.3 368 634 1420 25.3 187.7 1887 57000 11000 608 1879 32.8 327 536 1239 21.7 174 1888 57000 11000 553 2013 35.3 289 438 1243 21.8 143.6 1889 57000 11000 716 1946 34.3 410 609 1330 23.3 210.7 1890 57969 11057 703 2020 35.1 415 699 1500 26.0 205.5 1891 58080 11092 660 2302 39.3 445 615 1793 30.7 193.3 1892 63155 11440 640 2341 37.0 559 902 1706 28.3 239 1893 64090 11600 569 2408 37.5 529 718 1433 22.3 219.7 1894 65569 12041 669 2303 36.7 429 636 1300 19.8 186 1895 66324 12181 659 2532 38.1 590 820 1647 24.6 233 1896 68437 12454 616 2334 34.1 497 696 1375 20.0 213 1897 70811 12767 927 2471 34.8 530 838 1598 22.0 214 1898 71903 12912 705 2495 34.7 505 680 1409 19.5 202.4 1899 73577 13741 651 2357 32.0 640 863 1690 23.6 271.5 1900 77024 14156 907 2658 34.5 473 731 1624 21.1 178 1901 69512 13011 2689 36.68 704 978 1795 25.85 261 1902 70624 653 2797 39.6 518 759 1622 22.9 185.2 1903 71651 2752 38.4 422 615 1360 18.98 153.3 1904 72745 2803 38.5 525 686 1437 19.7 187.3 1905 73848 2810 38.0 576 860 1627 22.0 205

307 Appendix. Table 2. Basic Demographic Data for Merthyr Tydfil 1841-1921: Population, Occupied Houses, Marriages, Births, Birthrates, Deaths, Death Rates and Infant Mortality Rates ( Compiled from MOH Reports for Merthyr Tydfil 1845- 1921)

Year Population Occupied Marriages Births Birth Deaths Houses Rate Merthyr

Under Under Total General Infant One 5 Deaths Death Mortality Year Year Rate Rate per 1,000 live births 1906 74961 2714 36.2 487 701 1425 19.0 179.4 1907 76085 2727 35.8 421 643 1462 19.2 154.4 1908 77219 2736 35.4 479 689 1435 18.5 175.1 1909 1910 1911 1912 1913 1914 85082 2362 27.7 282 1396 15.7 119 1915 76493 2161 25.3 340 1452 18.9 157 1916 74387 1955 24.0 215 1145 15.3 109 1917 74508 1693 20.3 176 1093 14.6 103.9 1918 72264 1911 23.6 216 1396 19.3 113.0 1919 71638 1835 24.5 167 1109 15.4 91.0 1920 74493 2216 29.7 188 1110 14.6 84.0 1921 81800 2253 27.5 205 1069 13 90.0

Notes on anomalies in demographic data used to compile the above tables

1.Where possible, the figures used are those calculated by the MOH for each year. Population numbers vary between tables, particularly where retrospective figures are given in reports. They may vary within reports as they are based on population estimates. They may also be inconsistent with cenus data even within census years since the population was assessed during different months of the year. In 1893 the population of the district of Graig Berthllwyd in Llanfabon was added to the district.1

As the rate of increase has varied, the mode adopted by the Registrar General, based on the assumption that the population increases in a geometrical ratio, would also give an incorrect result. It is evident that if vital statistics are to be of any permanent value a census must be taken oftener.2

This in turn causes some variations in the birthrate and the general death rate per 1000 estimated population. Therefore the above information should be viewed in terms of general trends. Some reports vary when nett deaths belonging to the district are used in calculations, whilst others use the total deaths. Deaths of infants are sometimes, not always adjusted in this way. 2. Early data used in constructing Table 2. (above) to 1853 are based on William Kay’s Report for 1854, Dyke’s calculations as given in Table 1 in his report for 1865 are used for the years 1854-1865, although Dyke’s figures vary slightly from those of Dr. Kay. Thereafter the figures given are as reported in the MOH reports. Dyke explains in his Report for 1865 :

These figures [1851-1865] are based upon information given me by the registrar general of marriages, births, and deaths, a return of the number of houses assessed to the Poor Rate made by 1st November ,1865, given by Mr. Edward Lewis, assistant overseer, the published extracts of the Board of

1 Jones, MOH Report for Merthyr Tydfil for 1901, p.7. 2 Ibid.

308 Guardians of this Union, and the census tables for 1861. It is very probable that, notwithstanding all my care, the figures may not be accurate, the difficulties of of the work having been enhanced by these circumstances;- In one set of figures, that I have had to deal with, the population of the Union, 107.105 was the basis; in another, the population of the Borough, 83.875; in a third, the population of the sub-districts of Upper and Lower Merthyr. All these had to be reduced to, and compared with, the estimated population of the parish in 1865. If any slight errors should be discovered, I will trust that the novelty, as well as any difficulty, of the calculations may be admitted as an excuse. 3

3.The statistics from 1847 to 1865 were supplied by Dr. George Buchanan from returns of births and deaths at the General Register Office and copied to Dyke. These included the population of the Registration District of Merthyr, including Merthyr and Vaynor parishes. Based on this information Dyke corrected his estimates of the population of Merthyr of 54,000 to 53,106 by deducting the population of Vaynor Parish Statistics provided by Dr. Buchanan is included in Dyke’s report for 1866, which vary from Dyke’s calculations in 1865. 4 4.There is no appended table of ages and causes of death at all ages for the year 1865. The analysis commences from 1866. The number of deaths under one are not totalled by Dyke. The number of infant deaths in the appended Table of Ages and Causes of Death at All Ages is 413. 6. From 1866 to 1871 The Table of Ages and Causes of Death at All Age includes deaths in the Union Workhouse. 6.In 1868 Dyke gives the population as 55,451 but bases his calculations on his estimate of population at 1 July, 1868- 55,136. 7.In 1871 the census figures give the population as 51,891 but Dyke bases his report on his population estimates of 52,000.5 8.In 1872 Dyke gives the population in autumn 1872 as 52,800, but bases his calculations on population at 30 June as 52,500.6 9.In 1867 Dyke adjusts the total number of deaths to discount non-parishioners dying in the Workhouse. 10.The number of houses is total number not adjusted to un/occupied 11.In 1872 Dyke gives a retrospective table of vital statistics which gives the number of births for 1866 as 2124, not 2150.7 12. In 1876 the number of deaths under one year is given as 214 in the body of the report and 232 in the appended table of causes of death. 13. In 1879: “From the enquiries I have made, I have been led to believe that the number of occupied houses has not increased during the year; I therefore shall assume the number of the houses, and the residents therein at the same figures as in the year 1878….the occupied houses 9,787 and the inhabitants 50,354. These numbers differ from those reported in the previous year (51,891 and 10,220).” 8 14.The 1881 Census was taken on 3 April before Dyke had presented his report for 1880 and Dyke used this to assess the population at 48,500. In his report for 1881 Dyke amends this number 9to 48,857 and on that number estimates the population in 1881 to be 49,000 on 30June. 15. The retrospective Table 1.shows the population for 1881 as 49,000 and 50,000 for 1882 and 1883 with 10,200 inhabited houses each year.10 16.The report for 1884 states the number of occupied houses in 1881 to be 9,768.11 17.In Dyke’s report for 1886 the number of infants under one year who died is given as 386. This is presumed to be an error of transposition since the number of infant deaths analysed by Dyke is 368. 18. Dyke gives the number of deaths under one year as 407 on page 2 of his report, but analyses the deaths of 410 infants. pp. 9-11.12 19. The report for 1891 gives the population figures for each decade 1801-1891.13 20. Dyke comments that the death rate of 30.68 is the highest recorded in 20 years.

3 Dyke, MOH Report for Merthyr Tydfil for 1865, p.6. 4 Dyke, MOH report for Merthyr Tydfil for 1866, pp.2-3. 5 Dyke, MOH Report for Merthyr Tydfil for 1871, p.1. 6 Dyke, MOH Report for Merthyr Tydfil for 1872, p.2. 7 Dyke, MOH Report for Merthyr Tydfil for 1872, p.2. 8 Dyke, MOH Report for Merthyr Tydfil for 1879, p.1. 9 Dyke, MOH Report for Merthyr Tydfil for 1886, p.4. 10 Dyke, MOH Report for Merthyr Tydfil for 1883, p.13. 11Dyke, MOH Report for Merthyr Tydfil for 1884, p.1. 12 Dyke, MOH Report for Merthyr Tydfil for 1889, pp.2, 9-11- 13 Dyke, MOH Report for Merthyr Tydfil for 1891, p.2.

309 21.The data for 1900 is given by Dr. C.E.G.Simons. This estimate is made after careful consideration of the basis on which that for 1899 was made, which he considered to be on the whole a very carefully devised basis. Dr. Jones stated that although the estimate was at best a guess, nonetheless he believed it would not be found to be very far below the actual population. The birth rate Jones considered to be proportional to the past records of the district. 22. 1901 Dr Thomas adjusted the estimates of population according to the census of 1901. Until January 1901 Britain was divided into the 33 Great Towns and 67 Large Towns, of which Merthyr was one. This was changed to 3 Groups. Group1 included 75 Borough and Urban Districts with a population exceeding 50,000 of which Merthyr was one. Group 2 included 75 districts with a population less than 50,000, and group 3 included rural districts. In 1891 the district of Llanfabon (Graig-Berthllwyd with 924 persons) was added to Merthyr district. “No method of estimating the population during the intercensal periods has been devised that will always give correct results.”14 The enumerated population was much less than the estimated figures upon which the statistics for the last four years had been based. The death-rate, based on estimated figures was therefore misleading. The real death-rate in 1899 was 2.21per 1000 and in 1900 2.64 per 1000 higher than that based on the estimated population for those years. Estimates were based on geometrical calculations which did not reflect the rapid population changes in an industrial district.15

14 Thomas, MOH Report for Merthyr Tydfil for 1901, p.7. 15 Ibid.

310 Appendix. Table 2(a). Retrospective Estimates of Population, Birth Rates and General Death-Rates 1891-1901 Based on 1901 Census (D. J. Thomas, MOH Report for Merthyr Tydfil for 1901, Table 1, p.20.) Year Population Birth Rate General Death Rate 1891 59226 38.88 30.27 1892 60145 38.91 28.36 1893 61094 39.41 23.45 1894 62063 37.1 20.94 1895 63055 40.14 26.03 1896 64072 36.42 21.45 1897 65111 37.95 24.54 1898 66173 37.7 21.3 1900 68370 38.85 23.75 1901 69512 38.68 25.85

Appendix. Table 2(b).Percentage Change in Decennial Population in Merthyr Tydfil 1801-1908. ( D. J.Thomas, MOH Report for Merthyr Tydfil for 1901, Table 1, p.7.) Population Increase % increase Decrease % decrease 1801 7705 1811 11,104 3309 42.94 1821 17,404 6300 56.73 1831 22,083 4676 27.46 1841 37,264 15,181 68.74 1851 46,692 9,9428 25.4 1861 50,461 3769 8.07 1871 51,891 1430 2.83 1881 48,857 3,034 5.84 1891 58,080 9,223 16.83 1901 69,228 10,224* 17.32 1908 77,219 7,991 10.35 *Thomas states that the natural increase in population due to the excess of births over deaths was 8,645 (p.6)

311 Appendix. Table 2(c).Contribution of Excess Births Over Total Deaths at All Ages, Immigration and Emigration to Population Change in Merthyr Tydfil 1841-1908 (MOH Reports for Merthyr Tydfil 1854-1908.) Year Year Population Population Increase Population decrease Total Deaths All Ages Births Excess of Births Over Deaths Immigration Emigration ( 1851 46692 1481 2056 473 -159 1852 47006 +314 1451 1904 361 -47 1853 47320 +314 1489 2006 415 -101 1854 47634 +314 1880 2053 173 +141 1855 47948 +314 1424 2074 650 -336 1856 48262 +314 1283 2204 921 -607 1857 48576 +314 1325 2289 964 -650 1858 48890 +314 1776 2049 273 +41 1859 49204 +314 1495 2254 759 -443 1860 49520 +316 1322 2092 1370 -429 1861 50461 +941 1270 1963 693 +250 1862 51404 +943 1264 1959 695 +221 1863 52320 +916 1307 1975 668 +192 1864 53180 +860 1328 1940 612 +208 1865 53106 +820 1634 2206 572 -198 1866 53480 +374 1373 2150 777 +81 1867 54338 +858 1131 2112 967 -513 1868 55451 +454 1090 2064 945 -491 1869 55905 +454 1229 1952 683 -4818 1870 51770 -4135 1530 1918 388 -518 1871 52000 +230 1242 2143 885 -385 1872 52500 +500 2048 2048 493 +1007 1873 54000 +1500 1407 2106 699 -245 1874 54450 +450 1797 2196 399 -349 1875 54500 +50 1194 2019 825 -2325 1876 53000 -1500 1019 1764 745 -3745 1877 50000 -3000 1113 1765 652 -298 1878 51891 +354 1132 1656 524 -524 1879 50354 -1537 1035 1600 565 -2061 1880 48500 -1854 1243 1627 384 +6 1881 49000 +500 1355 1726 371 +692 1882 50000 +1000 1190 1738 548 -548 1883 50000 1140 1772 632 +1368 1884 52000 +2266 1247 1835 588 -388 1885 52500 +500 1344 1807 463 +2937 1886 55909 +3409 1420 1961 541 +550 1887 57000 +1091 1239 1879 640 -640 1888 57000 1243 2013 770 -770 1889 57000 1330 1946 616 +353 1890 57969 +969 1500 2020 520 -409 1891 58080 +111 1793 2303 510 +4565 1892 63155 +5075 1706 2341 635 +300 1893 64090 +935 1433 2408 975 +504 1894 65569 +154 1300 2303 1003 -248 1895 66324 +755 1647 2532 885 +1228

312 Appendix. Table 2(c).Contribution of Excess Births Over Total Deaths at All Ages, Immigration and Emigration to Population Change in Merthyr Tydfil 1841-1908 (MOH Reports for Merthyr Tydfil 1854-1908.) Year Year Population Population Increase Population Decrease Total Deaths All Ages Births Excees Births Over Deaths All Ages Immigration Emigration 1896 68437 +2113 1375 2334 859 +1515 1897 70811 +2374 1598 2471 873 +219 1898 71903 +1092 1409 2495 1086 +568 1899 73557 +1654 1690 2357 667 +2800 1900 77024 +3467 1628 2658 1030 -8542 1901 69512 -7512 1795 2689 894 +218 1902 70624 +1112 1622 2797 1175 -148 1903 71651 +1027 1360 2752 1392 -298 1904 72745 +1094 1437 2803 1366 -263 1905 73848 +1103 1627 2810 1183 -70 1906 74961 +1113 1425 2714 1289 +555 1907 76805 +1844 1462 2727 1265 -851 1908 77219 +414 1435 2736 1301

Appendix. Table 2(d).Contribution of Excess Births Over Total Deaths at All Ages, Immigration and Emigration to Population Change in Merthyr Tydfil for each Decade 1851-1908 ( MOH Reports for Merthyr Tydfil 1854-1908 ) Years Years Population Population Increase Population Decrease Total Deaths All Ages Births Excess of Births Over Total deaths Immigration Emigratio 1851-60 46692 14926 20981 6055 -2286 1861-70 50461 +3769 13156 20239 7083 -5554 1871-80 52000 +1539 13230 18924 5694 -3694 1881-90 49000 -3000 13008 18697 5689 +3391 1891- 58080 +9080 15579 24202 8623 +2809 1900 1901-7 69512 +11432 10728 19292 8564 -857 1908 77219 +7707 Total 30527 80627 122335 41708 6200 12391

313 Appendix. Table 2(e). Summary of Total Contribution of Excess Births Over Total Deaths at All Ages, Immigration and Emigration to Population Change in Merthyr Tydfil 1851-1908 ( MOH Reports for Merthyr Tydfil 1854-1908 ) Population 1851 46,692 Births 122,335 Immigration 6,200 Deaths 80,627 Emigration 12,391 Total 93,018 128,535 Population growth 30,527 1851-1908 Population 1908 77,219

314 Appendix. Table 3. Years When General Death Rate Fell Below or Exceeded 23 deaths per 1000 Population and Years when the Infant Mortality Rate Exceeded or Fell below 150 deaths per 1000 Registered Births. (Compiled from the MOH Reports for Merthyr Tydfil 1905-8 ) Year Years when the Years when the Years when the Years when the General Death rate General Death Infant Mortality Infant Mortality Fell Below 23/1000 Rate Exceeded Rate Fell below Rate Exceeded population 23/1000 150/1000 150/1000 Population registered Births registered Births 1851 31.7 181.9 1852 30.9 205.4 1853 31.5 199.4 1854 39.5 1855 29.7 1856 28.6 1857 27.3 1858 36.3 1859 30.4 1860 26.7 1861 25.2 1862 24.6 1863 25 1864 25 1865 30.3 1866 25.3 192 1867 20.8 147.7 1868 20.3 130.3 1869 22 165 1870 32.3 187.2 1871 23.8 135.8 1872 29.6 147 1873 26 186.6 1874 33 191.3 1875 21.9 159.5 1876 19.2 136.6 1877 22.2 131.4 1878 22.4 151.6 1879 20.5 138.1 1880 25.6 162.3

315 Appendix. Table 3. Years when the General Death Rate Fell Below or Exceeded 23 deaths per 1000 Population and Years when the Infant Mortality Rate Exceeded or Fell Below 150 deaths per 1000 Registered Births. (Compiled from the MOH Reports for Merthyr Tydfil 1905-8 ) Year Years when the Years when the Years when the Years when the General Death rate General Death Infant Mortality Infant Mortality Fell Below 23/1000 Rate Exceeded Rate Fell below Rate Exceeded population 23/1000 150/1000 150/1000 Population registered Births registered Births 1881 27.6 137.9 1882 23.8 146.1 1883 22.8 158 1884 24 171.7 1885 25.6 169.3 1886 25.3 187.7 1887 21.7 174 1888 21.8 143.6 1889 23.3 210.7 1890 26 205.5 1891 30.7 193.2 1892 27 239 1893 22.3 219.7 1894 19.8 186 1895 24.6 233 1896 20 213 1897 22 214 1898 19.5 202 1899 22.9 271 1900 21.1 178 1901 25.9 262 1902 22.9 185.3 1903 19.8 153.3 1904 19.7 187.3 1905 22 205 1906 19 179.4 1907 19.2 154.4 1908 18.5 175

316 Appendix. Table 4. Price of Steam Coal, Iron and Steel Rails, Bar Iron and Colliers Wages 1865-1879 (Compiled from incomplete data MOH Reports for Merthyr Tydfil 1865-1879. ) Year/Month Price of Steam Price of Bar Price of Iron Price of steel Colliers Coal Iron Rails Rails Wages 1865 £7.10s. 29.2d. 1866 £6. 4s.6d. 29s.2d. 1867 £5.17s.6d. 29s.2d. 1868 £5.15s.0d. 16s.6d. 1869 £6.4s.0d. 20s.5d. 1870 £7.4s.0d. 25s. 1871 £7.11s. £6.2s.6d./ £7.10s. 1872 £0.19s.8d. £10.10s.10d. 25s. Average

January £0.12s.9d. £8.2s.6d. 1873 February £0.14s.3d. £9.7s.6d. March £0.15s.6d. £9.9s.10d. April £0.16s.9d. £9.18s.6d. May £0.17s.3d. £10.0s.0d. June £0.17s.9d. £10.5s.0d July £0.18s.9d. £11.0s.0d. August £1.5s.0d £12.7s.6d. September £1.11s.0d. £12.12s.6d. October £1.6s.0d £12.10s.0d. November £1.1s.0d. £11.4s.0d. December £1.0s.0d. £10.5s.0d. 1873 £1.3s.3d. £12.8s.4d. Average

January £1.3s.0d. £10.15s.0d. 1874 February £1.3s.6d. £10.17s.0d. March £1.3s.6d. £12.12s.6d. April £1.3s.6d. £13.5s.0d. May £1.3s.6d. £13.5s.0d. June £1.6s.6d. £12.17s.6d. July £1.3s.6d. £12.10s.0d.

317 Appendix. Table 4. Price of Steam Coal, Iron and Steel Rails, Bar Iron and Colliers Wages 1865-1879 ( Compiled from incomplete data MOH Reports for Merthyr Tydfil 1865-1879. ) Year/Month Price of Steam Price of Bar Price of Iron Price of steel Colliers Coal Iron Rails Rails Wages August £1.3s.6d. £12.2s.6d. September £1.4s.0d. £12.5s.0d. October £1.4s.0d. £13.0s.0d. November £1.1s.0d £13.10s.0d December £1.2s.6d. £12.0s.0d. 1874 £0.16s.11d £10.0s.0d. 1873-1874 Average 30/- January £1.2s.6d. £11.10s.0d. 1875 February £1.1s.0d. £11.10s.0d. March £1.0s.0d £11.10s.0d. April £0.18s.0d. £11.10s.0d May £0.17s.0d. £10.0s.0d. June £0.16s.0d. £9.10s.0d. July £0.15s.0d. £9.10s.0d August £0.15s.0d £9.10s.0d. September £0.15s.0d £9.10s.0d October £0.15s.0d £9.0s.0d. November £0.14s.6d. £8.10s.0d December £0.14s.0d £8.10s.0d. 1875 £0.14s.3d. £ 10.15s. 0d. 1876 £0 10s.3d. £6.7s.6d. 1877 £5.17s.6d. 15-18/- 1878 £0.9s.3d. £5.15s.0d. 16s.6d. 1879 £4.0s.0d. £4.2s.6d. 16s.6d. August 1879 £7.0s.0d. £8.5s.0d December

318 Appendix. Table 5. Expenditure on Pauperism and Number of Paupers in Merthyr Tydfil Union 1851-1893 (Merthyr Tydfil Union Abstract of Accounts September 1850- October 1894 cit. Tydfil Thomas, Poor Relief in Merthyr Tydfil Union in Victorian Times , Appendix 8, p.164. Year Population Expenditure in Indoor Outdoor Total £ paupers paupers relieved relieved. 1851 70,683 £21,598.19.3 15,320 15.320 22% 1852 £21,373.6.0 14,600 14,600 1853 £21,028 419 8,797 9216 1854 £20,265.16.0 774 7,770 8544 1855 £18,507.18.5 823 7,948 8771 1856 £22,663.19.4 815 9,823 10,638 1857 £24,128.12.8 872 10,895 11,767 1858 £24,876 932 11,678 12,610 1859 £25,610.3.8 991 10,837 11,828 1860 £25,260.19.5 1,179 11,470 12,649 1861 92,971 £29,640.13.0 1,557 13,752 15309 16% 1862 £27,984.2.0 1,494 14,796 16290 1863 £29,585.13.9 1,394 13,640 15034 1864 £29,329.13.6. 1,253 13,149 14402 1865 £28,919.7.0 1,338 13,125 14463 1866 £33,311.10.4 1,048 14,455 15503 1867 £33,441.8.6 1,293 17,158 18451 1868 £36,166.12.7 1,767 18,451 20218 1869 Figures are missing 1870 £36,114.13.3 1,189 11,750 12939 1871 104,110 £24,241.14.3. 1,277 10,305 11,582 11% 1872 £33,896.12.9 1,048 4,530* 5,578* 1873 Figures are missing 1874 £16,752.10.2* 680* 5,410* 6090* 1875 £26,408.3.8* 683* 5,050* 5733* 1876 £33,075.13.0 1,160 6,838 7998 1877 £30,817.18.2 1,265 8,307 9572 1878 £32,429.5.9 1,145 9,054 10,199 1879 £29,759.5.10 1,127 9,177 10,304 1880 £29,038.15.10 1,027 8,519 9,546 1881 101,420 £33,274.1.8 971 9,010 9981 10% 1882 £26,016.18.11 967 7,879 8846 1883 £26,325.11.5 898 7,089 7987 1884 £26,844.0.5 1,039 6,383 7422 1885 £27,595.19.6 696 6,478 7174 1886 £25,567.14.3 1,153 7,160 8313 1887 £29,886.5.5 961 7,267 8228 1888 £25,126.13.2 1,017 7,297 8314 1889 £24,747.9.1 1,041 7,296 8337 1890 £19,649.2.7 1,163 7,980 9143 1891 117,194 £28,756.9.4 1,474 6,920 8394 7% 1982 £28,602.16.9 1,590 7,122 8712 1893 £31,284.12.3 1,875 9,048 10923 1898 £36,000 *These figures are for half year only. The others are missing.

319 Appendix. Table 6. Infant Vaccinations In Merthyr Tydfil 1866-1898 (compiled from MOH Reports for Merthyr Tydfil 1866-1898.) Year Births Vaccinations % of births Deaths Deaths as percentage of births 1866 2150 1600 441 20.5 1867 2112 1734 310 14.7 1868 2064 1618 269 13 1869 1952 1815 322 16.5 1870 1918 1308 359 18.7 1871 2143 2619 291 13.6 1872 2048 1960 301 14.7 1873 2106 1781 393 18.7 1874 2196 1935 420 19.1 1875 2019 1837 322 15.9 1876 1764 1640 241 13.7 1877 1765 1715 97 232 13.14 1878 1656 1518 91 251 15.2 1879 1600 1443 90 221 13.8 1880 1627 1505 93 264 16.2 1881 1726 1577 92 238 13.8 1882 1738 1499 95 254 14.6 1883 1772 1584 90 280 15.8 1884 1835 1632 315 17.2 1885 1807 1620 97 306 16.9 1886 1961 1559 Lower than 368 18.8 ususal 1887 1879 1753 93 327 17.4 1888 2013 1802 95 289 14.4 1889 1946 1805 410 21.06 1890 2020 1698 92 415 20.5 1891 2303 2038 97 445 19.3 1892 2341 1982 559 23.9 1893 2408 2187 Large number 529 22 1894 2303 2013 429 18.6 1895 2532 2086 90 590 23.3 1896 2334 2191 93 497 21.3 1897 2471 2075 84 530 21.4 1898 2495 1870 75 505 20.2

320 Tables 7-20 Analysis of Causes of Infant Death Under One Year of Age from Medical Officer of Health Reports for Merthyr Tydfil 1865-1908

Categories of Causes of Infant Death

To analyse the causes of all deaths as recorded in the Medical Officer of Health Reports for Merthyr Tydfil 1865-1908 the following categories were selected.

Category 1 External to Home

This category represents the causes of death that may be attributed to environmental factors external to the home environment.

Water-borne Diarrhoeal Diseases This includes typhoid, enteric fever, cholera, choleraic diarrhoea and simple cholera as water-borne diseases. It also includes two deaths from typhus in 1869 and 1870, which to the twentieth century mind should not be included in this category, but at the time the distinction between typhus and typhoid remained obscure. Other diarrhoeal deaths have been assigned to a separate category. This separation enables the evaluation of the effects of urban sanitary improvements on infant health.

Communicable Diseases These include the community based infectious diseases smallpox, whooping cough, measles, scarlet fever, diphtheria, membranous croup, laryngitis, sloughing sore throat, pharyngitis, tonsillitis, meningitis, cephalitis, purpura and inflammation of the brain.

Category 2 Internal Home Environment This included causes of death influenced by social conditions and the home environment.

Secondary and Home-Acquired Infections This includes diseases acquired through infection or secondary infections, particularly of skin; erysipelas, skin diseases, mortification (gangrene), eczema. erythema, pemphigus (Lyle’s disease), abscess (tumour), scalp, ulcers, after vaccination, pyaemia, peritonitis and other septic conditions.

Lung Diseases This group includes bronchitis, pneumonia, acute bronchitis, pleurisy, asthma, broncho- pneumonia, congestion of the lung and other respiratory diseases.

321 Tuberculous Diseases This group includes scrofula, caries of the spine, tuberculosis of the lung (phthisis), tuberculosis of the brain, tabes mesenterica, tuberculosis not otherwise specified (NOS), other constitutional diseases.

Nutritional Disorders This group includes deaths from want of milk, starvation, anaemia/chlorosis, thrush, stomatitis, apthae, inanition, wasting diseases, marasmus, atrophy and debility, rickets, debility not otherwise specified (NOS)

Disorders of Maternal Origin ( Antenatal Causes)

This includes congenital malformations NOS, spina bifida, malformation of the spine, cerebro-spinal, hydrocephalus, imperforate anus, intussusception, intestinal obstruction, dropsy, liver disease, syphilis, heart disease, atelectasis, prematurity, cancer. These conditions reflect the mother’s social and physical health during pregnancy and are in no way pejorative towards mothers.

Diarrhoea This group includes gastric catarrh, gastroenteritis, diarrhoea, choleraic diarrhoea.

Sudden and Violent Death This category includes burns and scalds, suffocation, overlying, drowning, sudden death, sudden or violent death NOS, natural causes, multiple injuries, manslaughter/murder, phosphorous poisoning, accident, found dead.

Category 3 – Unclassifiable A total of 610 deaths (3.55%) were unclassifiable. Of these, 340 in 1901 and 201 in 1902 were listed as “All Other Causes.” Uncertified deaths, disease of joints, were impossible to classify.

322 Appendix. Table 7. Number of Infant Deaths According to Tables of Causes of Infant Death In Medical Officer of Health Reports for Merthyr Tydfil 1865-1908

g Convulsions Convulsions Tubercuolosis Diseases Lung Nutritional Maternal Diarrhoea Sudden Deaths Ineternal Subtotal Unclassified Total Infant Deaths Year Community Diarhoeal diseases Infectious Diseases External Subtotal InfectionsSecondary Dentition & Teethin 1866 11 75 86 2 14 109 48 51 70 17 7 7 325 2 413 1867 14 14 2 10 110 33 47 53 18 18 4 295 1 310 1868 1 23 24 3 108 58 30 18 8 16 3 244 1 269 1869 1 9 10 2 3 120 48 57 45 15 20 2 312 322 1870 1 74 75 4 14 89 39 58 51 15 11 3 284 359 1871 1 29 30 8 80 29 43 66 21 8 3 258 3 291 1872 2 58 60 1 7 92 16 25 67 19 8 235 6 301 1873 50 50 2 8 111 42 85 51 29 12 2 342 1 393 1874 1 64 65 0 9 121 37 62 81 25 10 7 352 3 420 1875 21 21 1 19 83 41 55 53 28 11 2 293 8 322 1876 1 10 11 1 12 78 29 32 44 13 12 9 230 241 1877 16 16 2 5 73 14 47 44 19 7 5 216 232 1878 15 15 2 2 79 15 47 64 18 6 3 236 251 1879 9 9 1 9 66 15 36 59 16 8 210 2 221 1880 29 29 1 13 104 12 34 42 16 9 3 234 1 264 1881 18 18 2 6 83 24 24 52 18 10 1 220 238 1882 31 31 2 3 79 21 38 57 17 4 2 223 254 1883 27 27 1 9 75 30 45 47 23 22 1 253 280 1884 19 19 2 7 85 27 62 58 29 24 1 295 1 315 1885 46 46 3 7 65 15 68 51 21 25 5 260 306 1886 45 45 1 7 86 28 80 71 21 26 3 323 368 1887 22 22 3 13 79 28 73 66 19 20 4 305 327 1888 8 8 6 14 79 20 46 65 29 17 5 281 289 1889 1 39 40 7 14 112 30 80 67 27 29 4 370 410 1890 45 45 4 8 109 27 89 64 27 36 6 370 415 1891 13 13 2 15 121 40 109 69 45 29 2 432 445 1892 65 65 0 14 120 90 98 79 48 43 2 494 559 1893 49 49 6 20 87 81 86 60 64 72 3 479 1 529 1894 2 39 41 3 5 72 46 101 46 53 59 2 387 1 429 1895 35 35 7 22 106 54 119 70 45 116 16 555 590 1896 1 37 38 5 6 79 53 64 75 68 104 5 459 497 1897 61 61 19 69 55 90 81 55 87 10 466 3 530 1898 34 34 4 29 54 10 90 107 57 114 6 471 1 505 1899 26 26 4 27 73 13 92 98 81 218 8 614 640 1900 30 30 1 19 70 14 93 100 67 72 5 441 2 473 1901 38 38 2 7 116 63 134 4 326 340 704 1902 19 19 1 5 113 91 85 3 298 201 518 1903 46 46 2 13 52 12 74 96 63 55 7 374 2 422 1904 1 31 32 4 18 56 4 102 130 65 105 3 487 6 525 1905 1 62 63 11 2 76 15 140 59 87 115 8 513 576 1906 23 23 2 65 8 87 96 84 107 3 452 12 487 1907 27 27 2 58 9 94 63 96 57 5 384 10 421 1908 43 43 76 16 75 71 87 105 3 433 3 479 Total 25 1474 1499 111 430 3509 1258 3057 2706 1727 2053 180 15,030 610 17,140

Notes to Table 6. The reader is referred to the discussion on methodology in the Introduction, pp.20-26. Every effort has been made to ensure the accuracy of figures, and I accept responsibility for any mathematical errors that may have occurred. However, some discrepancies have proved unavoidable due to some statistical inconsistencies within the source tables and MOH reports, particularly from 1901-8 where data has been compiled from tables to account for as many infant deaths as possible. Examples are provided in the notes below. The number of deaths given in tables of deaths at week and months in the first year 1905-8 do not exactly tally with the principal tables of deaths at all ages. The reader is encouraged to bear this in mind, and view the analysis in terms of overall trends and as a reasonably accurate representation of infant deaths in Merthyr Tydfil 1865-1908.

323 1866:The total infant deaths tabled and analysed under Causes of Death at All Ages is 413, Appendix 2, p. xiii. However, in Table xxvi, p. 83 of Annual Report the number of infant deaths under one year by days, weeks and months is stated as 441. The first number leaves 2 infant deaths unclassified. The second leaves 28 deaths unclassified. This also alters the infant mortality rate slightly to either 192 or 205/1000 1867:Number of deaths from dentition and teething are recorded. 1 unclassifiable death is from Disease of Joints. 1868: 1 unclassifiable death from No Cause is Assigned 1869, 1870: 1 external death from Typhus each year has been included with Epidemic Infectious Diseases since Typhus was under the heading “ Contagious, Epidemic and General”. Although some confusion still existed which blurred the distinction between Typhus and Typhoid, and in his earlier reports Dyke tends to refer to typhus in the context of contaminated water and drainage. 1871, 1872, 1873, 1874, 1875, 1879, 1880 3 deaths in 1871, 6 deaths in 1872, 1 death in 1873, 3 deaths in 1874, 8 deaths in 1875, 2 in 1879, 1 in 1880 were from “Causes not specified” and are therefore “Unclassified” 1880:1 Sudden Death from Manslaughter/Murder 1884: 1 Unclassifiable death tabled as Tabes Dorsalis. Since this is a manifestation of adult tertiary stage syphilitic infection, it would not apply to an infant. It may be surmised that this was a transcribing error that should have read “Tabes Mesenterica”. 1887:Error in MOH Report for 1887. Table 3, p. 16 gives 2 deaths instead of 4 from Violent causes, and a total of 323 deaths instead of 325. 1888Deaths from Atelectasis, a condition that occurs in the poorly developed lung premature infants, have been recorded in the “Maternal” category. 1889:1 death from “Continued Fever”, under the heading of “Continued, Enteric or Typhoid Fever” has been placed in the “External Diarrhoeal” category. 1890:“Secondary Infection” includes 1 death from Lupus, a skin infection, and 1 death following vaccination with Vaccina. 1890, 1891:1893: 2 deaths in 1890, 1 death in 1891, 3 in 1893 and 2 in 1897 from Bright’s Disease, a post-scarlatinal kidney condition, and originally classified under Kidney Disease, have been included with Scarlet Fever deaths. 1892:Error in MOH Report for 1892. Table 3, p.26 gives a total of 250 instead of 240 deaths from Local causes, and total infant deaths as 569 instead of 559. 1893, 1894, 1897:1 death each year 1893 and 1894 from Disease of Bones and Joints 3 deaths from Diseases of Bones and Joints in 1897. Unclassifiable 1895:Error in MOH Report for 1895. Table III, p.18, The total number of deaths from all causes is given as 610 but accounts for only 590 deaths. A total of 51 instead of 40 deaths from Developmental causes is given, and 256 instead of 257 deaths from Local causes. The Table also erroneously gives the number 71 as causes Not known, Inquest. Report includes 1 Sudden Death from Phosphorous poisoning. 1896:Error in MOH Report for 1896. Table III p.20 gives 175 instead of 165 deaths from Local causes and total deaths as 507 instead of 497. 189769 deaths listed under Convulsions include 1 from epilepsy. 1 death from “Gastric Ulcer” classified with Diarrhoeal deaths. Ulceration and blood stained vomitus might appear with severe gastro-intestinal infection, or with tuberculous lesions. 1898:7 deaths attributed to rickets, originally classified under Developmental causes All such deaths reclassifies under Nutritional causes of death. 1899:Convulsions includes 2 “Other Nervous Diseases”. 1900:Error assumed in MOH Report for 1900. Table III, p.31 gives 11 infant deaths from Smallpox and a total of 483 infant deaths. Dr Simons reported 2 Smallpox admissions to the Fever Hospital and 1 death (p.13.)

324 1901: The numbers are extremely difficult to reconcile. The numbers are given according to the Table IV, Causes of, and Ages at Death, during [sic]Year, 1901. The 342 Unclassified deaths include 335 deaths “All Other Causes”, and 7 uncertified deaths “All Under One Month.” These causes, although uncertified, were entered by the registrars as Convulsions, -3; prematurity, - 2; Debility,-1; Natural Causes,-1.(MOH Report for 1901, p.12.) A total of 121 inquests were held, of which at least 18 appear to have concerned infant deaths, including Convulsions, 8, Suffocation in bed, 5, Prematurity, 2, Congenital debility, 1, Marasmus, 1, Neglect and want of nourishment, 1. (MOH Report for Merthyr Tydfil for 1901, p. 14). 1902:Table IV, The Table of Causes of, And Ages at Death, for 1902 is erroneously labelled 1901, although the numbers agree with those given in the body of the MOH Report for Merthyr Tydfil for 1902.There are 201 deaths from “All other causes” and therefore unclassifiable. There were 7 uncertified deaths of infants all under on month old, (p.10) Despite the Notification of 93 smallpox-cases, including 2 infants, there were no infant deaths from smallpox recorded. 1903:Although Table IV, Table of Causes of, And Ages at, Death During Year 1903, (MOH Report for Merthyr Tydfil for 1903, .p62,) gives 195 deaths from “All Other Causes”, in several instances the number of deaths are given in the body of the report, especially p.57. 1904:Table IV, Table of Causes of, And Ages at, Death During Year 1904 lists 223 deaths form “All other causes”, (MOH Report for Merthyr Tydfil for 1904, .p52.), However, an untitled table on page 46 accounts for all deaths except 2 from causes “Not specified.”, but 1 death from Ositis, Mastoid Disease, 1 death from Catarrh and 2 deaths from haemorrhage were Unclassifiable. 1906: 2 uncertified deaths and 10 Unclassifiable (All Other Causes) 1907: 6 Uncertified deaths and 4 All Other Causes. “Maternal” deaths include 4 birth injuries.

325 Appendix. Table 7(a). Analysis of Infant Deaths According to Tables of Causes of Infant Death In Medical Officer of Health Reports for Merthyr Tydfil 1865-1908 as Disease Specific Infant Mortality Rates per 1000 Births Year Community Diseases Infectious Diseases Secondary Infections Dentition/ Teething Convulsions Tuberculosis Lung Diseases Nutritional Maternal Diarrhoea Sudden deaths Unclassified Infant mortality 1866 5.12 34.88 0.91 6.5 50.69 21.86 23.19 32.56 7.71 3.26 3.26 0.93 192.09 1867 6.62 0.95 4.7 52.08 15.62 22.25 25.01 8.52 8.52 0.95 0.47 146.78 1868 0.48 11.14 1.45 52.32 28.10 14.54 8.72 3.88 7.75 1.45 0.48 130.32 1869 0.51 4.61 1.03 1.5 61.47 24.59 29.20 23.01 7.68 10.25 1.03 164.95 1870 0.52 38.58 2.09 7.3 46.40 20.33 30.24 26.59 7.82 5.74 1.56 187.17 1871 0.47 13.53 3.7 37.33 13.53 20.07 30.80 9.82 3.73 1.40 1.39 135.79 1872 0..98 28.32 0.49 3.4 44.92 7.81 12.21 32.71 9.28 4.40 2.92 146.97 1873 23.74 0.95 3.8 52.71 19.94 40.36 24.22 13.77 5.70 0.95 0.47 186.60 1874 0.46 28.55 4.1 55.10 16.85 28.23 36.88 11.38 4.55 3.19 1.36 191.25 1875 29.14 0.50 9.4 41.11 20.31 27.24 26.25 13.87 5.45 0.99 3.96 159.48 1876 0.57 10.40 0.57 6.8 44.22 16.44 18.14 25.51 7.37 6.80 5.10 136.62 1877 9.07 1.13 2.8 41.36 7.93 26.63 24.93 10.76 3.97 2.83 l 131.44 1878 9.06 1.21 1.2 47.70 9.06 28.38 38.65 10.87 3.32 1.81 151.57 1879 5.63 0.62 5.6 41.25 9.37 22.50 36.88 10.00 5.00 1.29 138.12 1880 17.82 0..62 8 63.92 7.38 20.90 25.81 9.83 5.53 1.84 0.61 162.26 1881 10.43 0.16 3.5 48.08 13.90 13.90 30.12 10.43 5.79 0.58 137.89 1882 17.84 0.15 1.7 45.45 12.08 21.86 32.80 9.78 2.30 1.15 146.14 1883 15.24 0..56 5.1 42.32 16.93 25.40 26.96 12.98 12.41 0.56 158.01 1884 10.37 1.09 3.8 46.32 14.76 33.79 31.61 15.80 13.08 0.55 0.59 171.66 1885 25.46 1.66 3.9 35.97 8.30 37.63 28.22 11.62 13.84 2.77 169.34 1886 22.95 0.51 3.6 43.85 14.28 40.80 36.21 10.71 13.26 1.53 187.65 1887 11.71 1.60 6.9 42.04 14.90 38.85 34.60 10.11 10.64 2.13 174.02 1888 3.97 2.98 7 39.24 9.94 22.85 32.29 14.41 8.45 2.48 143.56 1889 0.51 20.04 3.60 7.2 57.55 15.24 44.11 34.43 13.88 14.90 2.06 210.68 1890 22.28 1.98 4 53.96 13.37 44.06 31.68 13.37 17.82 2.97 205.44 1891 5.64 0.87 6.5 52.56 17.37 47.33 28.22 19.54 12.59 0.87 193.31 1892 27.77 6 51.26 38.45 41.86 33.76 20.50 18.37 0.85 238.78 1893 20.35 2.49 8.3 36.13 33.64 35.71 24.09 26.58 29.90 1.25 0.41 219.68 1894 0.87 16.93 1.30 2.2 31.26 19.97 43.86 19.97 23.01 25.62 0.87 0.43 186.27 1895 13.82 2.77 8.7 41.86 21.33 47.00 27.65 17.77 45.81 6.32 233.01 1896 0.43 15.85 2.14 2.6 33.85 22.71 27.42 32.13 29.14 44.56 2.14 212.93 1897 24.69 7.7 27.92 22.26 36.42 32.78 22.26 35.21 4.05 1.21 214.48 1898 13.63 1.60 11.6 21.64 4.01 36.07 42.88 22.85 45.29 2.40 202.40 1899 11.03 1.70 11.5 30.97 5.52 39.03 41.58 34.37 92.49 3.39 271.53 1900 11.30 0..38 7.2 26.34 5.27 35.00 37.62 25.21 27.09 1.88 0.75 177.95 1901 14.13 0.74 2.60 43.14 23.4 49.83 1.49 126.44 261.80 1902 6.79 0..36 1.79 40.40 32.54 30.39 1.07 71.86 185.19 1903 16.72 0.73 4.7 18.89 4.36 26.89 34.51 23.62 19.98 2.54 0.72 153.34 1904 0.36 11.06 1.43 6.3 19.98 1.43 36.38 46.34 23.18 37.50 1.07 2.14 187.29 1905 0.36 22.06 3.92 0.7 27.05 5.43 49.82 21.00 30.96 40.93 2.84 204.98 1906 8.48 0.74 23.95 2.95 32.06 35.37 30.95 39.43 1.11 4.27 179.43 1907 9.90 0.73 21.26 3.30 34.47 23.10 35.20 20.90 1.83 3.66 154.38 1908 15.72 27.77 5.85 27.41 25.95 31.80 38.88 1.10 1.09 175.07

326 Appendix. Table 7(b). Years when Infant deaths Under 150 per 1000 or Above 175/ 200 per 1000 Births In Merthyr Tydfil 1866-1908 (MOH Reports for Merthyr Tydfil 1966-1908) Year Community Diseases Infectious Diseases Secondary Infections Dentition/ Teething Convulsions Tuberculosis Lung Diseases Nutritional Maternal Diarrhoea Sudden deaths Unclassified Infant mortality 10 Years when IMR fell below 150/1000 births

1867 6.62 0.95 4.7 52.08 15.62 22.25 25.0 8.52 8.52 0.95. 0.47 147 1868 0.48 11.14 1.4 52.32 28.10 14.54 8.72 3.88 7.75 1.4 0.48 130 1871 0.47 13.53 3.7 37.33 13.53 20.07 30.80 9.82 3.73 1.40 1.39 136 1872 0.98 28.32 0.49 3.4 44.92 7.81 12.21 32.71 9.28 4.40 2.2 147 1876 0.57 10.40 0.57 6.8 44.22 16.44 18.14 25.51 7.37 6.80 5.10 137 1877 9.07 1.13 2.8 41.36 7.93 26.63 24.93 10.76 3.97 2.83 1 131 1879 5.63 0.62 5.6 41.25 9.37 22.50 3688 10.00 5.00 1.29 138 1881 10.43 0.16 3.5 48.08 13.90 13.90 30.12 10.43 5.79 0.58 138 1882 17.84 0.15 1.7 45.45 12.08 21.86 32.80 9.78 2.30 1.1 146 1888 3.97 2.98 7 39.24 9.94 22.85 32.9 14.41 8.45 2.48 144 Years when IMR 150-200 /1000 births

1866 5.12 34.88 0.91 6.5 50.69 21.86 23.19 32.56 7.71 3.2 3.26 0.93 192 1869 0.51 4.61 1.03 1.5 61.47 24.59 29.20 23.01 7.68 10.25 1.03 165 1870 0.52 38.58 2.09 7.3 46.40 20.33 30.24 26.59 7.82 5.74 1.56 187 1873 23.74 0.95 3.8 52.71 19.94 40.36 24.22 13.77 5.70 0.95 0.47 187 1874 0.46 28.55 4.1 55.10 16.85 28.23 36.88 11.38 4.55 3.19 1.36 191 1875 29.14 0.50 9.4 41.11 20.31 27.24 26.25 13.87 5.45 0.99 3.96 159 1878 9.06 1.21 1.2 47.70 9.06 2838 38.65 10.87 3.32 1.81 152 1880 17.82 0.62 8 63.92 7.38 20.90 25.81 9.83 5.53 1.84 0.61 162 1883 15.24 0.56 5.1 42.32 16.93 25.40 26.96 12.98 12.41 0.5 158 1884 10.37 1.09 3.8 46.32 14.76 33.79 31.61 15.80 13.08 0.55 0.59 172 1885 25.46 1.66 3.9 35.97 8.3 37.63 28.22 11.62 13.84 2.77 169 1886 22.95 0.51 3.6 43.85 14.28 40.80 36.21 10.71 13.26 1.53 188 1887 11.71 1.60 6.9 42.04 14.90 38.85 34.60 10.11 10.64 2.13 174 1891 5.64 0.87 6.5 52.56 17.37 47.33 28.22 19.54 12.59 0.87 193 1894 0.87 16.93 1.30 2.2 31.26 19.97 43.86 19.97 23.01 25.62 0.87 0.43 186 1900 11.30 0.38 7.2 26.34 5.27 35.00 37.62 25.21 27.09 1.88 0.75 178 1902 6.79 0.36 1.79 40.40 32.54 30.39 1.07 71.86 185 1903 16.72 0.73 4.7 18.89 4.36 26.89 34.51 23.62 19.98 2.54 0.72 153 1904 0.36 11.06 1.43 6.3 19.98 1.43 36.38 46.34 23.18 37.50 1.07 2.14 187 1906 8.48 0.74 23.95 2.95 32.06 35.37 30.95 39.43 1.11 4.27 179 1907 9.90 0.73 21.26 3.30 34.47 23.10 35.20 20.9 1.83 3.66 154 1908 15.72 27.77 5.85 27.41 25.95 31.80 38.88 1.10 1.09 175 11 Years when IMR above 200/1000 births

1889 0.51 20.04 3.60 7.2 57.55 15.24 44.11 34.43 13.88 14.90 2.06 211 1890 22.28 1.98 4 53.96 13.37 44.06 31.68 13.37 17.82 2.97 205 1892 27.77 6 51.26 38.45 41.86 33.76 20.50 18.37 0.85 239 1893 20.35 2.49 8.3 36.13 33.64 35.71 24.09 26.58 29.90 1.25 220 1895 13.82 2.77 8.7 41.86 21.33 47.00 27.65 17.77 45.81 6.32 233 1896 0.43 15.85 2.14 2.6 33.85 22.71 27.42 32.13 29.14 44.56 2.14 213 1897 24.69 7.7 27.92 22.26 36.42 32.78 22.26 35.21 4.05 1.21 215 1898 13.63 1.60 11.6 21.64 4.01 36.07 42.88 22.85 45.29 2.40 202 1899 11.03 1.70 11.5 33.97 5.52 39.03 41.58 34.37 92.49 3.39 272 1901 14.13 0.74 2.60 43.14 23.4 49.83 1.49 126 4 262 1905 0.36 22.06 3.92 0.7 27.05 5.43 49.82 21.00 30.96 40.93 2.84 205

327 Appendix. Table 7(c). Summary Table of Causes of Death by Wee ks and Months of Infants Under One Year of Age in Merthyr Tydfil 1905-1908 (MOH Reports for Merthyr Tydfil 1865-1908.) Age Infectious Infectious Diseases Convuls- ions Tuberculo sis Lung Diseases Nutritiona l Maternal Diarrhoea l Suffocatio n/ Other Causes Total Under 1 wk 36 3 33 223 4 11 310 1-2 wks 2 14 19 23 3 8 69 2-3 wks 1 23 8 17 22 7 1 7 86 3-4 wks 1 33 1 9 26 17 18 3 108 Total under 1 month 4 106 1 20 95 285 28 5 29 573 1-2 months 3 43 3 37 42 22 30 4 11 195 2-3 months 3 37 4 34 36 5 46 1 167 3-4 months 9 24 3 33 35 3 58 2 5 172 4-5 months 9 13 4 37 21 5 50 4 143 5-6 months 9 13 3 27 20 2 38 4 116 6-7 months 19 11 4 38 21 1 34 6 134 7-8 months 17 4 4 38 8 2 23 1 97 8-9 months 24 5 3 34 5 1 16 1 89 9-10 months 20 5 1 34 8 4 21 1 94 10-11 months 15 3 7 30 3 2 18 1 3 82 11-12 months 19 11 1 32 3 15 7 88 Total 1-12 months 147 169 37 374 202 47 349 7 44 1380 Total Under 1 yr 151 275 38 394 297 332 377 12 73 1950

328 Appendix.Table 7(d). Unclassified Deaths of Infants Under One Year of Age in Merthyr Tydfil 1866-1908 (MOH Reports 1866-1908.) Year Non- Parochial Not Specified of Disease Joints Found Dead Uncertified All Other Causes Total 1866 1 1 2 1867 1 1 1868 1 1 1869 1870 1871 3 3 1872 6 6 1873 1 1 1874 3 3 1875 8 8 1876 1877 1878 1879 2 2 1880 1 1 1881 1882 1883 1884 1tabes dorsalis 1 1885 1886 1887 1888 1889 1890 1891 1892 1893 1 1 1894 1 1 1895 1896 1897 3 3 1898 1899 1900 1 1 2 1901 5a 335 340 1902 7 194 201 1903 2 2 1904 2 1 Haemorrhage 2, 6 Catarrh 1 1905 1906 3 9 12 1907 10 10 1908 3 3 Total 1 31 7 1 15 555 610 a. all under one month old

329 Appendix. Table 8. Principal Causes of Death Each Year and Total DSIMR of All Remaining Causes of Death Forming the Infant Mortality Rate Each Year 1865- 1908 in Merthyr Tydfil (MOH Reports for Merthyr Tydfil 1865-1908.) * Year Principal Second Third Fourth All cause of principle principle Principle other death cause of cause of Cause of Causes death death Death DSIMR DSIMR DSIMR DSIMR DSIMR 1866 convulsions 50.69 infectious 34.88 nutritional 32.56 lung 23.19 50.77 disease disease 1867 convulsions 52.08 nutritional 25.01 lung 22.25 tuberculosis 15.62 31.82 disease 1868 convulsions 52.32 tuberculosis 28.10 lung 14.54 infectious 11.14 24.22 disease disease 1869 convulsions 61.47 lung 29.20 tuberculosis 24.59 nutritional 23.01 26.68 disease 1870 convulsions 46.40 infectious 38.58 lung 30.24 nutritional 26.59 45.36 disease disease 1871 convulsions 37.33 nutritional 30.80 lung 20.07 infectious 13.53 34.06 disease disease 1872 convulsions 44.92 nutritional 32.71 infectious 28.32 lung 12.21 28.81 disease disease 1873 convulsions 52.71 lung 40.36 nutritional 24.22 infectious 23.74 45.57 disease disease 1874 convulsions 55.10 nutritional 36.88 infectious 28.55 lung 28.23 42.49 disease disease 1875 convulsions 41.11 lung 27.24 nutritional 26.25 tuberculosis 20.31 44.57 disease 1876 convulsions 44.22 nutritional 25.51 lung 18.14 tuberculosis 16.44 32.31 disease 1877 convulsions 41.36 lung 26.63 nutritional 24.93 maternal 10.76 22.12 disease 1878 convulsions 47.70 nutritional 38.65 lung 28.38 maternal 10.87 25.97 disease 1879 convulsions 41.25 nutritional 36.88 lung 22.50 maternal 10.00 27.49 disease 1880 convulsions 63.92 nutritional 25.81 lung 20.90 infectious 17.82 33.81 disease disease 1881 48.08 nutritional 30.12 lung 13.90 tuberculosis 13.90 31.89 convulsions disease 1882 convulsions 45.45 nutritional 32.80 lung 21.86 infectious 17.84 28.19 disease disease 1883 convulsions 42.32 nutritional 26.96 lung 25.40 tuberculosis 16.93 70.46 disease 1884 convulsions 46.32 lung 33.79 nutritional 31.61 maternal 15.80 44.14 disease 1885 lung 37.63 convulsions 35.97 nutritional 28.22 infectious 25.46 42.06 disease disease 1886 convulsions 43.85 lung 40.80 nutritional 36.21 tuberculosis 14.28 52.51 disease 1887 convulsions 42.04 lung 38.85 nutritional 34.60 tuberculosis 14.90 43.63 disease 1888 convulsions 39.24 nutritional 32.29 lung 22.85 maternal 14.41 34.77 disease 1889 convulsions 57.55 lung 44.11 nutritional 34.43 infectious 20.04 54.25 disease disease

330 Appendix. Table 8. Principal Causes of Death Each Year and Total DSIMR of All Remaining Causes of Death Forming the Infant Mortality Rate Each Year 1865- 1908 in Merthyr Tydfil (MOH Reports for Merthyr Tydfil 1865-1908.) Year Principal Second Third Fourth All cause of principal principal principal other death cause of cause of cause of Causes

DSIMR DSIMR death DSIMR death DSIMR death DSIMR 1890 convulsions 53.96 lung 44.06 nutritional 31.68 infectious 22.28 53.46 disease disease 1891 convulsions 52.56 lung 47.33 nutritional 28.22 maternal 19.54 45.66 disease 1892 convulsions 51.26 lung 41.86 nutritional 33.76 maternal 20.50 91.40 disease 1893 lung 36.13 tuberculosis 33.64 maternal 26.58 nutritional 24.09 98.44 disease 1894 lung 43.86 convulsions 31.26 diarrhoea 25.62 tuberculosis 19.97 65.56 disease 1895 lung 47.00 diarrhoea 45.81 convulsions 41.86 nutritional 27.65 70.69 disease 1896 diarrhoea 44.56 convulsions 33.85 nutritional 32.13 maternal 29.14 73.25 1897 lung 36.42 diarrhoea 35.21 nutritional 32.78 convulsions 27.92 82.15 disease 1898 diarrhoea 45.29 nutritional 42.88 lung 36.07 maternal 22.85 55.31 disease 1899 diarrhoea 92.49 nutritional 41.58 lung 39.03 maternal 34.37 64.06 disease 1900 nutritional 37.62 lung 35.00 diarrhoea 27.09 convulsions 26.34 51.90 disease 1901 diarrhoea 49.83 lung 43.14 maternal 23.40 infectious 14.13 131.30 disease. diseases 1902 lung 40.40 maternal 32.54 diarrhoea 30.39 infectious 6.79 75.07 disease diseases 1903 nutritional 34.51 lung 26.89 maternal 23.62 diarrhoea 19.98 48.34 1904 maternal 23.16 diarrhoea 37.50 lung 36.38 nutritional 46.34 43.91 disease 1905 lung 49.82 diarrhoea 40.93 maternal 30.96 infectious 22.06 61.21 disease disease 1906 diarrhoea 39.43 nutritional 35.37 lung 32.06 maternal 39.43 33.14 disease 1907 maternal 35.20 lung 34.47 nutritional 35.21 convulsions 21.26 28.25 disease 1908 diarrhoea 38.88 maternal 31.80 convulsions 27.77 lung 27.41 49.21 disease * Individually, none of these causes adequately explain infant mortality. The mix and primacy of convulsions , lung diseases, diarrhoea, nutritional deaths, tuberculosis, infectious diseases as the principal causes of death varied each year to create the varying infant mortality rates. All other causes of death together also contribute significantly to the infant mortality rate each year.

331 Appendix. Table 9. Estimates of Percentages of Infant Deaths and Causes of Death Discussed by T.J.Dyke as MOH for Merthyr Tydfil 1865-1908 (MOH Reports for Merthyr Tydfil 1866-1908.) Year Infant Infant Children 0-5 Causes of Death Discussed by Dyke deaths deaths % Total Under 1 Under 1 Deaths Year % Year % Births Total Deaths 1852 527/1000 Lack of sanitation 1866 443/1000 Cholera, scarlet fever, smallpox, measles, convulsions, teething, debility, sudden deaths, lung diseases, diseases of the brain and convulsions, atrophy, debility, 1867 409/1000 Scarlet fever, smallpox, measles, tabes, convulsions, teething, sudden deaths 1868 441/1000 Atrophy, debility, scrofula, convulsions, 1869 - - - Scarlet fever, whooping cough, typhus, scrofula, convulsions, lung diseases, debility, natural causes 1870 - - - Scarlet fever, measles and whooping cough, typhus, relapsing fever, enteric fever, scrofula, inflammation of the lungs 1871 - - - Infantile convulsions “ claim by far the largest number of deaths”-fewer than previous year due to “absence of contagious maladies” (p.8). 1872 - - - Smallpox , measles, scarlet fever, diphtheria, whooping cough, 1873 - - - Diphtheria, enteric fever, scrofula, infantile convulsions “a symptom of disease” (p.10) acute lung diseases, chronic diarrhoea 1874 19.1 23.3 52% Measles, scarlet fever, diphtheria, whooping cough, enteric fever, scrofula, convulsions, lung diseases, diarrhoea, debility, prematurity 1875 26 42% ‘absence of any contagious fever spreading among the youthful portion of the community’ (p.5), scrofula, infantile convulsions, (100 deaths -less than usual (p.5), developmental diseases, 8 infant deaths from “natural causes” 1876 12.1 21 35.8% Infectious diseases almost entirely absent, infantile convulsions, lung diseases, teething, (poor nursing, lack of medical aid), prematurity 1877 13 20.8 41.5% Measles, enteric fever,, scrofula, infantile convulsions, lung diseases, debility,

332 Appendix. Table 9. Estimates of Percentages of Infant Deaths and Causes of Death Discussed by T.J.Dyke as MOH for Merthyr Tydfil 1865-1908 (MOH Reports for Merthyr Tydfil 1866-1908.) Year Infant Infant Children 0-5 Causes of Death Discussed by Dyke deaths deaths % Total Under 1 Under 1 Deaths Year % Year % Births Total Deaths 1879 13.8 21.5 - “ Happily there has been almost complete immunity from any widespread diffusion of these usually most fatal diseases.” (p.4.) Diarrhoea…”due rather to teething, and probably to errors in diet, than to any contagious germ.” (p.5) convulsions, inflammation of the lungs, 1880 16 21.2 41% Deaths under one “greatly in excess of the usual number.” (p.3.)Measles, scarlet fever, enteric fever, typhus, diphtheria, inflammation of the brain, convulsions, diarrhoea, accidents 1881 13.7 17.2 36.6% Scarlet fever, scrofula, acute inflammation of the brain, infantile convulsions 1882 15.6 21.3 44.6% Scarlet fever, measles, whooping cough, syphilis, lung diseases, convulsions,, lung diseases 1883 15.8 24.5 39% Measles, diphtheria, whooping cough, scarlet fever, enteric fever, diarrhoea, tuberculosis, inflammation of the brain, lung diseases 1884 11½ 25 ¼ 39% Enteric or typhoid fever, diphtheria, infantile diarrhoea, syphilis, lung diseases, acute

inflammation of the brain, debility 1885 22.9 41.75% Measles, bronchitis, diarrhoea, convulsions, debility 1886 25.8 High rate of infant mortality due to “pernicious presence of measles,” “Scarlet fever and Whooping Cough have been the destroying maladies”(p.4)convulsions “the pest of infant life”(p.80), debility (many within the first day of life) (p.8) 1887 26.0 43% Smallpox, teething, (convulsions and debility “one- eighth of all deaths” ) 1888 23.2 35% Measles, scarlet fever, whooping cough, diphtheria, enteric fever, chicken pox, diarrhoea, convulsions, debility, Brights’ diseases.

333 Appendix. Table 9. Estimates of Percentages of Infant Deaths and Causes of Death Discussed by T.J.Dyke as MOH for Merthyr Tydfil 1865-1908 (MOH Reports for Merthyr Tydfil 1866-1908.) Year Infant Infant Children 0-5 Causes of Death Discussed by Dyke deaths deaths % Total Under 1 Under 1 Deaths Year % Year % Births Total Deaths 1890 27.7 46.6 Influenza, Typhus, typhoid, premature birth, malformations, acute inflammation of the brain, convulsions 1891 28.4 34% Scarlet fever, typhoid, erysipelas, diphtheria, convulsions, Inflammation of the brain, influenza, lung diseases, debility 1892 33.3 52% “Much in excess” Scarlet fever, diphtheria, Enteric or typhoid, erysipelas, measles, whooping cough, diarrhoea, premature birth and malformations, convulsions, respiratory diseases 1893 36.8 50% Diphtheria, diarrhoea, scarlet fever, the last two mainly in 4-8 year old attending infant school, whooping cough and measles, erysipelas, enteric or typhoid, debility, convulsions, teething. 1894 32.3 49% Scarlet fever, typhoid, erysipelas 1895 36.4 41.3% Scarlet fever, typhoid, smallpox, convulsions 1896 32.5 51.3% Smallpox, measles, whooping cough, scarlet fever, diphtheria, typhoid, 1897 30.0 51.7% Scarlet fever, diphtheria, measles, whooping cough, typhoid. 1898 35.3 48.1% No comment 1899 37.8 51% Diarrhoea Dyke’s comments on the ages at death : In 1881: 238 infants died, 17.5% of total deaths. 13.7% of infants born died within the first year. The deaths of under fives amounted to 36.6% of total deaths. ( MOH Report for 1881, p.3.) In 1882 deaths of infants under one year accounted for 21.3% of total deaths and 15.6% of the infants born (nearly one out of six). “If such a rate of mortality prevailed among calves , or lambs or porkers, great would be the out-cry and lamentation.” ( MOH Report for 1882, p.3.) In 1883 the deaths of under one year old infants were equal to 24.5 % of all deaths and 15.8% of births. The deaths of children under five represented 39 % in 1883 and 1884 of all deaths compared with 44.6 % in1882. (MOH Report for 1883, p..30) In 1884 the deaths of infants were equivalent to 25 1/4 % of total deaths and 11 ½% of births. Dyke published his paper ‘On the Duties of School Managers in relation to Epidemics and Health of Inmates’ that year 16 In 1885 Dyke reported that the deaths of infants ‘Represents an infant mortality of 41.75 per cent. of all deaths: this is a rate much higher than usual, and was due especially to the pernicious prevalence of Measles.” (1885p.30 )

16 T. J .Dyke, F.R.C.S., Eng., Medical Officer of Health, Merthyr Tydfil, ‘Duties of School Managers in Relation to Epidemics, and Health of Inmates,’ Read at a Conference held at the International Health Exhibition in London on Wednesday, July 30th, 1884.

334 In 1886 the number of deaths under five represents “an infant mortality of 43 per cent. of all the deaths….In 1886 Scarlet fever and Whooping Cough have been the destroying maladies.” ( MOH Report for 1886, p.40) In 1887 infant deaths represented 26% of all deaths according to Dyke, and deaths of those under five amounted to 43% of all deaths. ( MOH report for 1887, p.2) In 1888 the deaths of children under five years amounted to 35% of all deaths compared with an average of 42%, largely due to the absence of epidemics such as measles. ( MOH Report for 1888, p.20) In 1889 Deaths under five accounted for 45.7% of all deaths. In 1891 the deaths of children under five years equaled 34% of all deaths. ( MOH Report for 1891, p.5). In 1892 the deaths of 902 children, under 5 years of age were recorded, this number would represent 52% per cent. of all deaths. The number is much in excess of the average prevailing in this parish… but it is greatly less than in the former averages (namely 80) as was the rule before the introduction of pure water, and the other Sanitary measures, due to the initiative of your predecessors, and zealously continued by yourselves. ( MOH Report for 1892, p.3.) In 1893 the deaths of 718 children under five years were registered, equal to 50 per cent. of all deaths – a very high number, but somewhat less than in 1892, diphtheria, diarrhoea, scarlet fever, and measles being the maladies which in the main caused death. By far the greater number of cases of measles and scarlet fever occurred to children of from four to eight- the age at which they attend the infant department.(MOH Report for 1893, p3) In 1895 Dyke did not specifically report on deaths under five or deaths of infants when reporting under the heading of Ages at Death, despite the rise in deaths under one year as a percentage of deaths and the infant mortality rate having risen to 240 per 1000 births, the highest rate since Dyke took office. (MOH Report for 1895.p.4)

335 Appendix. Table 10. Sudden and Violent Deaths in infants Under One Year of Age in Merthyr Tydfil 1866-1908 (MOH Reports for Merthyr Tydfil 1866-1908) Year Burns/ Scalds Drowning Multiple Injuries Phosphorous Poisoning Violent Deatsh Manslaughte r/Murder Accident Overlying Suffocation Sudden Death Natural Causes Total DSIMR 1866 1 3 3 7 3.26 1867 2 2 4 0.95 1868 2 1 3 1.45 1869 1 1 2 1.03 1870 2 1 3 1.56 1871 1 2 3 1.40 1872 1873 1 1 2 0.95 1874 6 1 7 3.19 1875 1 1 2 0.99 1876 1 8 9 5.10 1877 4 1 5 2.83 1878 2 1 3 1.81 1879 1880 2 1 3 1.84 1881 1 1 0.58 1882 1 1 2 1.15 1883 1 1 0.56 1884 1 1 0.55 1885 1 4 5 2.77 1886 1 2 3 1.53 1887 2 2 4 2.13 1888 1 3 1 5 2.48 1889 3 1 4 2.06 1890 2 1 3 6 2.97 1891 2 2 0.87 1892 1 1 2 0.85 1893 3 3 1.25 1894 2 2 0.87 1895 4 3 1 8 16 6.32 1896 2 3 5 2.14 1897 1 2 7 10 4.05 1898 1 2 3 6 2.40 1899 8 8 3.39 1900 2 2 1 5 1.88 1901 4 4 1.49 1902 3 3 1.07 1903 1 6 7 2.54 1904 3 3 1.07 1905 2 2a 4 8 2.14 1906 3 3 1.11 1907 1 4 5 1.83 1908 1 2 3 1.10 Total 30 6 8 1 8 1 26 68 18 5 19 180

336 Appendix. Table 11. Disease Specific Infant Mortality Rates of All Groups of Infectious Diseases in Merthyr Tydfil 1866-1908 ( Medical Officer of Health Reports for Merthyr Tydfil 1866-1908.) Year Smallpox, Croup, Diphtheria, Cephalitis, Total Tuberculosis Whooping Cough Membranous Inflammation of the All forms Measles, Scarlet Croup, Laryngitis, Brain, Meningits, Fever, Chicken Pox, Tonsillitis, Purpura, Infantile Influenza Pharyngitis Meningitis 1866 28.56 2.72 2.72 34 21.86 1867 4.26 1.89 0.47 6.62 15.62 1868 10.66 0.48 11.14 28.10 1869 1.53 2.05 1.02 4.61 24.59 1870 37.01 1.04 0.52 38.58 20.33 1871 10.73 1.4 1.39 13.53 13.53 1872 22.47 1.95 3.91 28.32 7.81 1873 15.20 2.85 5.70 23.74 19.94 1874 26.87 2.28 28.55 16.85 1875 6.94 1.98 1.49 29.14 20.31 1876 1.13 2.83 1.70 10.40 16.44 1877 5.67 1.13 2.27 9.07 7.93 1878 7.85 0.60 0.60 9.06 9.06 1879 2.50 0.63 2.50 5.63 9.37 1880 15.98 1.84 17.82 7.38 1881 9.27 1.16 10.43 13.90 1882 14.96 1.15 1.73 17.84 12.08 1883 14.14 0.56 0.56 15.24 16.93 1884 7.64 0.55 2.18 10.37 14.76 1885 24.35 0.55 0.55 25.46 8.30 1886 21.93 1.02 22.95 14.28 1887 10.12 1.60 11.71 14.90 1888 2.98 0.99 3.97 9.94 1889 15.93 4.11 20.04 15.24 1890 20.31 1.49 0.50 22.28 13.37 1891 2.60 0.87 2.17 5.64 17.37 1892 23.50 3.42 0.85 27.77 38.45 1893 14.95 1.66 3.74 20.35 33.64 1894 12.60 1.74 2.61 16.93 19.97 1895 12.64 0.39 0.79 13.82 21.33 1896 6.43 7.28 2.14 15.85 22.71 1897 20.23 3.24 1.21 24.69 22.26 1898 10.42 2.41 0.80 13.63 4.01 1899 6.40 1.27 3.39 11.03 5.52 1900 6.78 1.51 3.01 11.30 5.27 1901 12.64 1.49 14.13 2.60 1902 5.71 1.07 6.79 1.79 1903 13.45 0.73 2.54 16.72 4.36 1904 9.28 1.42 0.36 11.06 1.43 1905 17.79 1.42 2.85 22.06 5.43 1906 5.90 2.21 0.37 8.48 2.95 1907 8.81 0.37 0.73 9.90 3.30 1908 13.94 0.73 1.10 15.72 5.85

337 Appendix. Table 11(a). Number of Infant Deaths From All Groups of Infectious Diseases in Merthyr Tydfil 1866-1908: (Medical Officer of Health Reports for Merthyr Tydfil 1866-1908.) Year Group:Smallpox, Group2:Croup,Diphtheria, Group3:Cephalitis, Other Total WhoopingCough, Membranous Croup, Brain Measles, Scarlet Laryngitis,Tonsillitis, Inflammation Fever, Chicken Pharyngitis Meningits, Pox Purpura, Infantile Meningitis 1866 63 6 6 1 Ague 75 1867 9 4 1 14 1868 22 1 23 1869 3 4 2 9 1870 71 2 1 74 1871 23 3 3 29 1872 46 4 8 58 1873 32 6 12 50 1874 59 5 1 64 Chickenpox 1875 14 4 3 21 1876 2 5 3 10 1877 10 2 4 16 1878 13 1 1 15 1879 4 1 4 9 1880 26 3 29 1881 16 2 18 1882 26 2 3 31 1883 25 1 1 27 1884 14 1 4 19 1885 44 1 1 46 1886 43 2 45 1887 19 3 22 1888 6 2 1 8 Chickenpox 1889 31 8 39 1890 41 3 1 45 1891 6 2 5 13 1892 55 8 2 65 1893 36 4 9 49 1894 29 4 6 1 Influenza 39 1895 32 1 2 35 1896 15 17 5 37 1897 50 8 3 61 1898 26 6 2 34 1899 15 3 8 26 1900 18 4 8 1 Influenza 30 1901 34 4 38 1902 16 3 19 1903 37 2 7 46 1904 26 4 1 31 1905 50 4 8 62 1906 16 6 1 1 Influenza 23 1907 24 1 2 1 27 Chickenpox 1 Influenza 1908 38 2 3 1 influenza 43 Total 1176 144 145 9 1474

338 Appendix. Table 11(b). Number of Infant Deaths and Disease Specific Infant Mortality Rate from Tuberculosis in Merthyr Tydfil 1866-1908 (MOH Reports for Merthyr Tydfil 1866-1908) Year Scrofula Caries TB Lung TB Tabes Tuberculosis Total DSIMR of Phthisis Brain Mesenterica Spine

1866 1 40 7 48 21.86 1867 2 28 3 33 15.62 1868 8 50 58 28.10 1869 10 38 48 24.59 1870 3 36 39 20.33 1871 1 1 27 29 13.53 1872 2 14 16 7.81 1873 5 37 42 19.94 1874 2 2 33 37 16.85 1875 1 7 33 41 20.31 1876 2 1 26 29 16.44 1877 4 10 14 7.93 1878 2 13 15 9.06 1879 4 11 15 9.37 1880 12* 12 7.38 1881 1 23 24 13.90 1882 3 18 21 12.08 1883 8 22 30 16.93 1884 3 24 27 14.76 1885 3 12 15 8.30 1886 6 22 28 14.28 1887 3 25 28 14.90 1888 2 18 20 9.94 1889 3 27 30 15.24 1890 2 25 27 13.37 1891 5 35 40 17.37 1892 15 75 90 38.45 1893 16 65 81 33.64 1894 3 43 46 19.97 1895 7 47 54 21.33 1896 4 49 53 22.71 1897 8 4 43 55 22.26 1898 4 6 10 4.01 1899 2 11 13 5.52 1900 1 5 5 3 14 5.27 1901 1 6 7 2.60 1902 2 3 5 1.79 1903 1 2 4 5 12 4.36 Year 1904 4 4 1.43 1905 3 5 3 4 15 5.43 1906 4 4 8 2.95 1907 1 3 5 9 3.30 1908 3 1 1 8 3 16 5.85 Total 11 1 18 159 1027 42 1258

339 Appendix. Table 11(c). Number of Infant Deaths from Smallpox, Whooping Cough, Measles, Scarlet Fever, Group 2 and Group 3 in Merthyr Tydfil 1866-1908 (MOH Reports for Merthyr Tydfil 1866-1908.) Year Group 1 Group 2 Group 3 Total Diphtheria Cephalitis and croup Meningitis Smallpox Whooping Scarlet Cough Measles Fever / /Pertussis Brights Disease 1866 59 3 6 6 *75 1867 5 3 1 4 1 14 1868 6 16 1 23 1869 1 1 1 4 2 9 1870 54 7 10 2 1 74 1871 9 8 6 3 3 29 1872 40 3 3 4 8 58 1873 19 10 3 6 12 50 1874 22 24 12 5 *64 1875 9 4 1 4 3 21 1876 2 5 3 10 1877 5 5 2 4 16 1878 13 1 1 15 1879 4 1 4 9 1880 4 20 2 3 29 1881 2 1 13 2 18 1882 13 8 5 2 3 31 1883 13 12 1 1 27 1884 11 1 2 1 4 19 1885 9 35 1 1 46 1886 29 6 8 2 45 1887 8 4 7 3 22 1888 3 2 2 *8 1889 20 10 1 8 39 1890 27 7 5+2 3 1 45 Brights Disease 1891 1 4+1 2 5 13 Brights Disease 1892 8 43 4 8 2 65 1893 19 13 1+3 4 9 49 Brights Disease 1894 25 2 1 4 6 *39 1895 12 20 1 2 35 1896 8 6 1 17 5 37 1897 10 35 3+2 8 3 61 Brights Diseases 1898 25 1 6 2 34 1899 15 3 8 26 1900 1 11 5 4 8 *30 1901 6 28 4 38

340 Appendix. Table 11(c.) Number of Infant Deaths from Smallpox, Whooping Cough, Measles, Scarlet Fever, Group 2 and Group 3 in Merthyr Tydfil 1866-1908 (MOH Reports for Merthyr Tydfil 1866-1908.) Year Group 3 Group 1 Group 2 Cephalitis Total Meningitis Diphtheria and croup Smallpox Whooping Scarlet Cough Measles Fever Group 2. Group 3 Diphtheria Cephalitis and croup Meningitits 1902 7 9 3 19 1903 18 17 2 2 7 46 1904 21 1 4 4 1 31 1905 4 43 3 4 8 62 1906 15 6 1 *23 1907 9 12 1 1 2 *27 1908 31 6 2 3 43 Total 41 595 425 115 144 145 *1474 *1866 74 + 1 Ague *1874 63 + 1 Chickenpox *1888 7 + 1 Chickenpox *1894 38 + 1 Epidemic Influenza *1900 29 + 1Epidemic Influenza. Error in Report shows 11 deaths from Smallpox instead of 1 *1906 22 + 1 Epidemic Influenza *1907 25 + 1 Chicken Pox + 1Epidemic Influenza *1908 42 + 1 Epidemic Influenza Total of 1474 includes these nine deaths.

341 Appendix. Table 11(d). Disease Specific Infant Mortality Rates and Years of Severity (Bold Type) for Smallpox, Whooping Cough, Measles, Scarlet Fever, Group 2 and Group 3 in Merthyr Tydfil 1866-1908 (MOH Reports for Merthyr Tydfil 1866-1908) Year Smallpox Whooping Measles Scarlet Total Cough Fever Group 2. Group 3 Diphtheria Cephalitis and croup Meningitits 1866 26.75 1.36 2.72 2.72 1867 2.37 1.42 0.47 1.89 0.47 1868 2.91 7.75 0.48 1869 0.51 0.51 0.51 2.05 1.02 1870 28.15 3.65 5.21 1.04 0.52 1871 4.20 3.73 2.80 1.4 1.39 1872 19.53 1.47 1.47 1.95 3.91 1873 9.02 4.75 1.43 2.85 5.70 1874 10.02 10.93 5.46 2.28 1875 4.46 1.98 0.50 1.98 1.49 1876 1.13 2.83 1.70 1877 2.83 2.83 1.13 2.27 1878 7.85 0.60 0.60 1879 2.50 0.63 2.50 1880 2.46 12.29 1.23 1.84 1881 1.16 0.58 7.53 1.16 1882 7.48 4.60 2.88 1.15 1.73 1883 7.34 6.72 0.56 0.56 1884 6.00 0.55 1.09 0.55 2.18 1885 4.98 19.37 0.55 0.55 1886 14.79 3.06 4.08 1.02 1887 4.26 2.13 3.73 1.60 1888 1.49 0.99 0.99 1889 10.28 5.14 0.51 4.11 1890 13.37 3.47 3.47 1.49 0.50 1891 0.43 2.17 0.87 2.17 1892 3.42 18.37 1.71 3.42 0.85 1893 7.89 5.40 1.66 1.66 3.74 1894 10.86 0.87 0.44 1.74 2.61 1895 4.74* 7.90 0.39 0.79 1896 3.43 2.57 0.43 7.28 2.14 1897 4.05 14.16 2.02 3.24 1.21 1898 10.02 0.40 2.41 0.80 1899 6.40 1.27 3.39 1900 0.38 4.14* 1.88 1.51 3.01 1901 2.23 10.41 1.49 1902 2.50 3.21 1.07 1903 6.54 6.18 0.73 0.73 2.54 1904 7.49 0.36 1.43 0.71 0.36 1905 1.42 15.30 1.07 1.42 2.85 1906 5.53 2.21 0.37 1907 3.30 4.40 0.37 0.37 0.37 1908 11.37 2.20 0.73 0.37 *Recorded as Pertussis (whooping cough)

342 Appendix. Table 11(e). Number of Infant Deaths From Infectious Diseases in Merthyr Tydfil 1866-1908: Group 2: Diphtheria, Croup, Laryngitis, Tonsillitis (Medical Officer of Health Reports for Merthyr Tydfil 1866-1908.) Year Croup Diphtheria Diphtheria & Laryngitis Pharyngitis Total Membranous Tonsillitis Croup 1866 6 6 1867 2 2 4 1868 1 1 1869 3 1 4 1870 2 2 1871 3 3 1872 2 2 4 1873 1 5 6 1874 3 1+1 5 Laryngismus 1875 2 1 1 4 1876 2 3 5 1877 1 1 2 1878 1 1 1879 1 1 1880 1881 1882 1 1 2 1883 1 1 1884 1 1 1885 1 1 1886 1887 3 3 1888 2 2 1889 1890 3 3 1891 1 1 2 1892 4 3 1 8 1893 2 2 4 1894 3 1 4 1895 1 1 1896 11 3 3 17 1897 5 3 8 1898 6 6 1899 3 3 1900 4 4 1901 4 4 1902 3 3 1903 2 2 1904 2 2 4 1905 1 3 4 1906 1 4 1 6 1907 1 1 1908 1 1 2 Total 33 68 7 29 4 3 144

343 Appendix. Table 11(f). Disease Specific Infant Mortality Rate of Infant Deaths From Infectious Diseases in Merthyr Tydfil 1866-1908: Group 2: Diphtheria, Croup, Laryngitis, Tonsillitis (Medical Officer of Health Reports for Merthyr Tydfil 1866-1908.)

Year Croup Diphtheria Diphtheria & Membranous Laryngitis Tonsillitis Pharyngitis Total Croup 1866 2.72 2.72 1867 0.94 0.94 1.89 1868 0.48 0.48 1869 1.54 0.51 2.05 1870 1.04 1.04 1871 1.4 1.4 1872 0.98 0.98 1.95 1873 0.48 2.37 2.85 1874 1.37 0.91 2.28 1875 0.99 0.50 0.50 1.98 1876 1.13 1.7 2.83 1877 0.57 0.57 1.13 1878 0.60 0.60 1879 0.63 0.63 1880 1881 1882 0.58 0.58 1.15 1883 0.56 0.56 1884 0.56 0.55 1885 0.55 0.55 1886 1887 1.60 1.60 1888 0.99 0.99 1889 1890 1.49 1.49 1891 0.43 0.43 0.87 1892 1.71 1.28 0.43 3.42 1893 0.83 0.83 1.66 1894 1.30 0.43 1.74 1895 0.39 0.39 1896 4.71 1.29 3 7.28 1897 2.02 1.21 1.29 3.24 1898 2.41 2.41 1899 1.27 1.27 1900 1.51 1.51 1901 1.49 1.49 1902 1.07 1.07 1903 0.73 0.73 1904 0.71 0.71 0.71 1905 0.36 1.07 1.42 1906 0.37 1.47 0.37 2.21 Membranous croup 1907 0.37 0.37 1908 0.37 0.37 0.73

344 Appendix. Table 11 (g). Number of Infant Deaths From Infectious Diseases in Merthyr Tydfil 1866-1908:Group 3:Cephalitis, Meningitis, Inflammation of the Brain (Medical Officer of Health Reports for Merthyr Tydfil 1866-1908.) Year Cephalitis Inflammation Meningitis Meningococcal Total Disease of the Brain Septicaemia Infantile Specific Purpura Meningitis Infant Mortality Rate 1866 6 6 2.72 1867 1 1 0.47 1868 1869 2 2 1.02 1870 1 1 0.52 1871 3 3 1.39 1872 8 8 3.91 1873 12 12 5.70 1874 1875 3 3 1.49 1876 2 1 3 1.70 1877 4 4 2.27 1878 1 1 0.60 1879 4 4 2.50 1880 3 3 1.84 1881 2 2 1.16 1882 3 3 1.73 1883 1 1 0.56 1884 4 4 2.18 1885 1 1 0.55 1886 2 2 1.02 1887 1888 1889 8 8 4.11 1890 1 1 0.50 1891 5 5 2.17 1892 2 2 0.85 1893 9 9 3.74 1894 6 6 2.61 1895 2 2 0.79 1896 5 5 2.14 1897 3 3 1.21 1898 2 2 0.80 1899 4 4 8 3.39 1900 8 8 3.01 1901 1902 1903 7 7 2.54 1904 1 1 0.36 1905 8 8 2.85 1906 1 1 0.37 1907 2 2 0.73 1908 3 3 1.10 Total 7 67 65 2 4 145

345 Appendix. Table 12. Numbers DSIMR of Secondary and Other Infections in Infants in Merthyr Tydfil 1866-1908 and Percentage of Infant Mortality Rate (MOH Reports for Merthyr Tydfil 1905-1908) Year Erysipelas Skin Disease Mortification (Gangree) Eczema Erythema Pemphigus Abcess Abcess/Tbmour Scalp Abcess Abcess Ulcers After Vaccination Pyaemia Other Septic Lupus Peritonitis Total Cases DSIMR % of IMR

1866 1 1 2 0.91 0.44

1867 1 1 2 0.95 0.65

1868 3 3 1.45 1.12

1869 1 1 2 1.03 0.62

1870 3 1 4 2.09 1.12

1871

1872 1 1 0.49 0.33

1873 2 2 0.95 0.51

1874

1875 1 1 0.50 0.31

1876 1 1 0.57 0.42

1877 2 2 1.13 0.86

1878 1 1 2 1.21 0.80

1879 1 1 0.62 0.45

1880 1 1 0.62 0.38

1881 2 2 1.16 0.84

1882 2 2 1.15 0.79

1883 1 1 0.56 0.25

1884 2 2 1.09 0.63

1885 2 1 3 1.66 0.98

1886 1 1 0.51 0.27

346 Appendix. Table 12. Numbers DSIMR of Secondary and Other Infections in Infants in Merthyr Tydfil 1866-1908 and Percentage of Infant Mortality Rate (MOH Reports for Merthyr Tydfil 1905-1908)

Year Year Erysipelas Skin Disease Mortification (Gangree) Eczema Erythema Pemphigus Abcess Abcess/Tbmour Scalp Abcess Ulcers Abcess After Vaccination Pyaemia Other Septic Lupus Peritonitis Cases Total DSIMR % of IMR

1887 1 2 3 1.60 0.92

1888 1 1 3 1 6 2.98 2.13

1889 2 3 1 1a 7 3.60 1.70

1890 1 1 1 1 4 1.98 0.97

1891 1 1 2 0.87 0.45

1892

1893 5 1 6 2.49 1.13

1894 1 2b 3 1.30 0.70

1895 2 4 1 7 2.77 1.19

1896 3 1 1 5 2.14 1.00

1897

1898 1 1 2 4 1.60 0.79

1899 2 2 4 1.70 0.63

1900 1 1 0.38 0.21

1901 1 1 2 0.74 0.28

1902 1 1 0.36 0.19

1903 1c 1 2 0.73 0.48

1904 1 1d 2 1 4 1.43 0.82

1905 2+1f 1 1 1 1a, 1 11 3.92 1.91 1e, 2c,

1906 1 1 2 074 0.48

347 Appendix. Table 12. Numbers DSIMR of Secondary and Other Infections in Infants in Merthyr Tydfil 1866-1908 and Percentage of Infant Mortality Rate (MOH Reports for Merthyr Tydfil 1905-1908) Year Year Erysipelas Skin Disease Mortification (Gangree) Eczema Erythema Pemphigus Abcess Abcess/Tbmour Scalp Abcess Ulcers Abcess After Vaccination Pyaemia Other Septic Lupus Peritonitis Cases Total DSIMR % of IMR

1907 2 2 0.73 0.47

1908

Total 46 17 3 2 1 2 3 5 1 2 1 3 15 1 9 111 a. Rheumatic Fever: (Heart Disease secondary to streptococcal infection.) b. Boils. c. Nephritis. d. Septicaemia. e. Otitis. f. Cellulitis.

348 Appendix. Table 13. The Impact of Infectious Diseases and Diarrhoeal Diseases as Annual Variables on the Infant Mortality Rates for Merthyr Tydfil 1866-1908: Disease Specific Infant Mortality Rates and Combined Disease Specific Infant Mortality Rates for Infectious Diseases and Diarrhoea (MOH Reports for Merthyr Tydfil 1865-1908) Year DSIMR for DSIMR for Combined IMR Minus Infant Infectious Diarrhoeal DSIMR for Combined Mortality Diseases Diseases Infectious DSIMR for Rate Diseases and Infectious and Diarrhoeal Diarrhoeal Diseases Diseases 1866 34.00 3.26 37.26 167.74 192 1867 6.62 8.52 15.14 131.86 147 1868 11.14 7.75 18.85 111.15 130 1869 4.60 10.25 14.85 150.15 165 1870 38.58 5.74 44.32 142.68 187 1871 13.53 3.73 17.26 118.74 136 1872 28.32 4.40 32.72 114.28 147 1873 23.74 5.70 29.44 157.56 187 1874 29.14 4.55 33.69 157.31 191 1875 10.40 5.45 15.85 143.15 159 1876 5.67 6.80 12.47 124.53 137 1877 9.07 3.97 13.04 117.96 131 1878 9.06 3.32 12.38 139.62 152 1879 5.63 5.00 10.63 127.37 138 1880 17.82 5.53 23.35 138.65 162 1881 10.43 5.79 16.22 121.78 138 1882 17.84 2.30 20.14 125.86 146 1883 15.24 12.41 27.65 130.35 158 1884 10.35 13.08 23.43 148.57 172 1885 25.46 13.84 39.30 129.70 169 1886 22.95 13.26 36.21 151.79 187 1887 11.72 10.64 22.36 151.64 174 1888 3.97 8.45 12.42 127.58 143 1889 20.04 14.90 34.94 176.06 210 1890 22.28 17.82 40.10 164.90 205 1891 5.64 12.59 18.23 174.77 193 1892 27.77 18.37 46.14 192.86 239

349 Appendix. Table 13. The Impact of Infectious Diseases and Diarrhoeal Diseases as Annual Variables on the Infant Mortality Rates for Merthyr Tydfil 1866-1908: Disease Specific Infant Mortality Rates and Combined Disease Specific Infant Mortality Rates for Infectious Diseases and Diarrhoea (MOH Reports for Merthyr Tydfil 1865-1908) Year DSIMR for DSIMR for Combined IMR Minus Infant Infectious Diarrhoeal DSIMR for Combined Mortality Diseases Diseases Infectious DSIMR for Rate Diseases and Infectious and Diarrhoeal Diarrhoeal Diseases Diseases 1893 20.35 29.90 50.25 169.75 220 1894 16.93 25.62 42.55 143.45 186 1895 13.82 45.81 59.63 173.77 233 1896 15.85 44.56 60.41 152.59 213 1897 24.69 35.21 59.90 154.10 214 1898 13.63 45.69 59.32 142.68 202 1899 11.03 92.49 103.52 139.61 272 1900 11.30 27.09 38.39 168.48 178 1901 14.13 49.88 64.01 183.99 262 1902 6.79 30.39 37.18 147.82 185 1903 16.72 19.98 36.70 116.30 153 1904 11.06 37.50 48.56 126.44 187 1905 22.06 40.93 62.99 142.01 205 1906 8.48 39.43 47.91 131.05 179 1907 9.90 20.90 30.80 123.20 154 1908 15.72 38.88 54.60 120.40 175

350 Appendix. Table 13(a). The Impact of Infectious Diseases and Diarrhoeal Diseases on Infant Mortality Rates for Merthyr Tydfil 1866-1908: Disease Specific Infant Mortality Rates for Diarrhoeal and Infectious Diseases as a Percentage of the Infant Mortality Rate (MOH Reports for Merthyr Tydfil 1865-1908.) Year DSIMR for DSIMR for Combined Infant Mortality Infectious Diarrhoeal DSIMR for Rate Diseases as % of Diseases as % of Diarrhoeal and IMR IMR Infectious Diseases as % of IMR 1866 16.58 % 1.59 % 18.17% 192 1867 4.50 5.80 10.30 147 1868 8.56 5.96 14.52 130 1869 2.79 6.21 9.00 165 1870 20.63 3.07 23.70 187 1871 9.95 2.74 12.69 136 1872 19.26 2.99 22.25 147 1873 12.69 3.05 15.74 187 1874 15.26 2.38 17.64 191 1875 6.54 3.43 9.97 159 1876 4.14 4.96 9.10 137 1877 6.92 3.03 9.95 131 1878 5.96 2.18 8.14 152 1879 4.08 3.62 7.70 138 1880 11.00 3.41 14.41 162 1881 7.56 4.20 11.76 138 1882 12.22 1.58 13.80 146 1883 9.65 7.85 17.50 158 1884 6.02 7.60 13.62 172 1885 15.07 8.19 23.26 169 1886 12.21 7.05 19.26 188 1887 6.74 6.11 12.85 174 1888 2.84 6.04 8.88 143 1889 9.50 7.06 16.56 211 1890 10.87 8.69 19.56 205 1891 2.92 6.52 9.44 193 1892 11.62 7.69 19.31 239 1893 9.25 13.59 22.84 220

351 Appendix. Table 13(a). The Impact of Infectious Diseases and Diarrhoeal Diseases on Infant Mortality Rates for Merthyr Tydfil 1866-1908: Disease Specific Infant Mortality Rates for Diarrhoeal and Infectious Diseases as a Percentage of the Infant Mortality Rate (MOH Reports for Merthyr Tydfil 1865-1908.) Year DSIMR for DSIMR for Combined Infant Mortality Infectious Diarrhoeal DSIMR for Rate Diseases as % of Diseases as % of Diarrhoeal and IMR IMR Infectious Diseases as % of IMR 1894 9.10 13.77 22.87 186 1895 5.93 19.66 25.59 233 1896 7.44 20.92 28.36 213 1897 11.54 16.45 27.99 214 1898 6.75 22.62 29.37 202 1899 4.10 34.00 38.10 272 1900 6.35 15.22 21.57 178 1901 5.39 19.04 24.43 262 1902 3.67 16.42 20.10 185 1903 10.93 13.06 23.99 153 1904 6.32 21.43 27.75 187 1905 10.76 19.97 30.73 205 1906 4.74 22.03 26.77 179 1907 6.43 13.57 20.00 154 1908 8.98 22.22 31.20 175

352 Appendix. Table 14. Total Number of Deaths at All Ages from All Causes, Total Number of Deaths at All Ages, Deaths Above Five Years of Age and Under Five Years of Age from Lung Diseases in Merthyr Tydfil 1866-1908 (MOH Reports for Merthyr Tydfil 1865-1908.) Year Total Total Deaths Deaths Deaths Disease % of Deaths Deaths All Over 5 Under 5 Under 1 Specific Overall Infant All Ages From Years Years Year Mortality IMR Ages Lung From From From Rate from Diseases Lung Lung Lung Lung Diseases Diseases Diseases Diseases 1866 1376 156 74 82 51 23.19 11.31 1867 1145 185 97 88 47 22.25 15.14 1868 1119 90 26 64 30 14.54 11.18 1869 1269 136 43 93 57 29.20 17.70 1870 1530 186 69 117 58 30.24 16.17 1871 1258 127 41 86 43 20.07 13.65 1872 1555 135 84 51 25 12.21 8.31 1873 1407 278 123 155 85 40.36 21.58 1874 1797 321 166 155 62 28.23 14.78 1875 1194 187 94 93 55 27.24 17.13 1876 1019 128 72 56 32 18.14 13.24 1877 1113 272 61 111 47 26.63 20.33 1878 1132 210 131 79 47 28.38 18.67 1879 1035 213 141 72 36 22.50 16.30 1880 1243 237 188 77 34 20.90 12.90 1881 1355 220 158 62 24 13.90 10.07 1882 1190 201 112 89 38 21.86 14.97 1883 1140 215 119 96 45 25.40 16.08 1884 1247 255 149 106 62 33.79 19.65 1885 1344 308 162 146 68 37.63 22.27 1886 1420 307 169 138 80 40.80 21.07 1887 1239 265 130 135 73 38.85 22.33 1888 1243 366 259 107 46 22.85 15.87 1889 1330 322 177 145 80 41.11 19.48 1890 1500 363 199 164 89 44.06 21.49 1891 1793 556 399 157 109 47.33 24.52 1892 1706 356 183 173 98 41.86 17.51 1893 133 318 163 155 86 35.71 16.23 1894 1300 282 126 156 101 43.86 23.58 1895 1647 367 181 186 119 47.00 20.17 1896 1375 246 118 128 64 27.42 12.87 1897 1598 337 167 170 90 36.42 16.94 1898 1409 278 174 139 90 36.07 17.86 1899 1690 332 181 151 92 39.03 14.35 1900 1628 346 191 165 93 35.00 19.66 1901 1795 415 223 192 116 43.14 16.47 1902 1622 382 194 188 113 40.40 21.84 1903 1360 263 134 129 74 26.89 17.58 1904 1437 326 158 178 102 35.68 19.08 1905 1627 421 201 220 90 49.82 24.30 1906 1425 291 129 162 87 32.06 20.82 1907 1462 359 198 61 94 34.47 22.38 1908 1435 291 156 135 75 27.41 15.66

353 Appendix. Table 14(a). Numbers of Deaths, DSIMR and Percentages of Deaths Under Five Years of Age from Lung Diseases in Merthyr Tydfil 1866-1908 (MOH Reports for Merthyr Tydfil 1865-1908.) Year Deaths 0- 5 Deaths 1-5 Deaths 1-5 Deaths Deaths DSIMR Deaths Years From Years From as % Deaths Under 1 Under 1 from Under 1 Lung Lung Under 5 Year From as % Lung Year as % Diseases Diseases from Lung Lung Deaths Diseases of Total Diseases Diseases Under 5 Deaths All from Ages From Lung Lung Diseases Diseases 1866 82 31 37.8% 51 62.2% 23.19 32.69 1867 88 31 35.2% 47 53.4% 22.25 25.41 1868 64 34 53.1% 30 46.9% 14.54 33.33 1869 93 36 38.7% 57 61.3% 29.20 41.91 1870 117 59 50.4%* 58 49.6% 30.24 31.18 1871 86 43 50% 43 50% 20.07 33.86 1872 51 26 51% 25 49% 12.21 8.52 1873 155 70 45.2% 85 54.8% 40.36 30.56 1874 155 93 60%. 62 40% 28.23 18.73 1875 93 38 40.9% 55 59.1% 27.24 29.41 1876 56 24 42.9% 32 57.1% 18.14 25.00 1877 111 64 57.7% 47 42.3% 26.63 24.63 1878 79 32 40.5% 47 59.5% 28.38 22.38 1879 72 36 50% 36 50% 22.50 16.90 1880 77 43 55.8% 34 44.2% 20.90 14.35 1881 62 38 61.3% 24 38.7% 13.90 10.91 1882 89 51 57.3% 38 42.7% 21.86 18.91 1883 96 51 53.1% 45 46.7% 25.40 20.93 1884 106 44 41.5% 62 58.5% 33.79 24.31 1885 146 78 53.4% 68 46.6% 37.63 22.08 1886 138 58 42% 80 58% 40.80 26.06 1887 135 62 45.9% 73 54.1% 38.85 27.55 1888 107 61 57% 46 43% 22.85 12.57 1889 145 65 44.8% 80 55.2% 41.11 24.84 1890 164 75 45.7% 89 54.3% 44.06 24.52 1891 157 48 30.6% 109 69.4% 47.33 19.60 1892 173 75 43.4% 98 56.6% 41.86 27.53 1893 155 69 44.5% 86 55.5% 35.71 27.04 1894 156 55 35.3% 101 64.7% 43.86 35.82 1895 186 67 36% 119 64% 47.00 32.43 1896 128 64 50% 64 50% 27.42 26.02 1897 170 80 47% 90 53% 36.42 26.71 1898 139 49 35.3% 90 64.7% 36.07 32.37 1899 151 59 39.1% 92 60.9% 39.03 27.71 1900 165 72 43.6% 93 56.4% 35.00 26.88 1901 192 76 39.6% 116 60.4 43.14 27.95 1902 188 75 39.9% 113 60.1 40.40 29.58 1903 129 55 42.6% 74 57.4% 26.89 28.14 1904 178 66 37.1% 102 57.3% 35.68 31.29 1905 220 80 44% 90 56% 49.82 21.38 1906 162 75 47.8% 87 53.7% 32.06 29.90 1907 161 67 41.6% 94 58.4% 34.47 26.18 1908 135 60 44.4% 75 55.6% 27.41 25.77 *Years in bold indicate years when deaths 1-5 years exceeded those of infants under one year old. In all other years deaths under one year of age accounted for the majority of deaths under five years from lung diseases.

354 Appendix. Table 14(b). Number of Deaths of Infants Under One Year of Age from Lung Diseases in Merthyr Tydfil 1866-1908, Disease Specific Infant Mortality Rate and Percentage of Infant Mortality Rate (MOH Reports for Merthyr Tydfil 1865- 1908.) Year Acute Bronchitis Bronchitis Pneumonia Bronchopne umonia Congestion of Lung Pleurisy Asthma Other Lung Disease Total Deaths DSIMR % of IMR 1866 11 40 51 23.19 11.31 1867 13 34 47 22.25 15.14 1868 8 22 30 14.54 11.18 1869 28 29 57 29.20 17.70 1870 23 35 58 30.24 16.17 1871 22 21 43 20.07 13.65 1872 13 12 25 12.21 8.31 1873 59 26 85 40.36 21.58 1874 47 13 2 62 28.23 14.78 1875 42 13 55 27.24 17.13 1876 21 11 32 18.14 13.24 1877 32 15 47 26.63 20.33 1878 36 11 47 28.38 18.67 1879 21 15 36 22.50 16.30 1880 29 5 34 20.90 12.90 1881 16 8 24 13.90 10.07 1882 22 16 38 21.86 14.97 1883 42 3 45 25.40 16.08 1884 30 32 62 33.79 19.65 1885 55 13 68 37.63 22.27 1886 56 24 80 40.80 21.07 1887 44 29 73 38.85 22.33 1888 31 15 46 22.85 15.87 1889 59 21 80 41.11 19.48 1890 56 33 89 44.06 21.49 1891 76 33 109 47.33 24.52 1892 60 38 98 41.86 17.51 1893 48 38 86 35.71 16.23 1894 63 38 101 43.86 23.58 1895 78 41 119 47.00 20.17 1896 32 32 64 27.42 12.87 1897 29 61 90 36.42 16.94 1898 40 50 90 36.07 17.86 1899 32 60 92 39.03 14.35 1900 39 12 38 1 1 2 93 35.00 19.66 1901 49 8 59 116 43.14 16.47 1902 57 4 52 113 40.40 21.84 1903 29 43 2 74 26.89 17.58 1904 53 47 2 102 36.38 19.08 1905 50 89 1 140 49.82 24.30 1906 38 49 87 32.06 20.82 1907 46 47 1 94 34.47 22.38 1908 33 42 75 27.41 15.66 Total 81 1587 1228 149 1 3 2 6 3057

355 Appendix. Table 14(c). Numbers of Deaths of Infants One to Five Years of Age from Lung Diseases in Merthyr Tydfil 1866-1908.(MOH Reports for Merthyr Tydfil 1865-1908.) Year Acute bronchitis Bronchitis Pneumonia Broncho- pneumonia of Congestion Lungs Pleurisy Asthma Other Respiratory Total Deaths 1866 3 28 31 1867 10 31 31 1868 5 23 28 1869 15 21 36 1870 16 43 59 1871 24 19 43 1872 12 14 26 1873 41 29 70 1874 72 21 93 1875 26 12 38 1876 12 12 24 1877 39 25 64 1878 18 14 32 1879 23 13 36 1880 20 23 43 1881 26 12 38 1882 35 16 51 1883 34 16 51 1884 25 19 44 1885 53 25 78 1886 24 34 58 1887 28 34 62 1888 21 40 61 1889 38 27 65 1890 41 34 75 1891 38 10 48 1892 25 50 75 1893 23 46 69 1894 18 37 55 1895 26 40 66 1896 30 34 64 1897 20 60 80 1898 8 41 49 1899 12 47 59 1900 14 11 47 72 1901 22 13 76 1902 9 12 52 1 75 1903 11 43 1 55 1904 21 37 8 66 1905 16 61 1 2 80 1906 20 52 75 1907 14 51 2 67 1908 7 53 60

356 Appendix. Table 14(d). Deaths Under Five Years of Age as Percentage of Total Deaths from Lung Diseases in Merthyr Tydfil 1865-1908 (MOH Reports for Merthyr Tydfil 1865-1908.) Year Deaths 0- 5 Years as Deaths 1-5 Years as % Deaths Under 1 Year % of Total Deaths of Total Deaths From as % of Total Deaths From Lung Diseases Lung Diseases From Lung Diseases 1866 52.56 19.87 32.69 1867 47.57 16.76 25.41 1868 45.71 30.51 20.12 1869 68.38 26.47 41.91 1870 62.90 31.72 31.18 1871 67.72 33.86 33.86 1872 37.77 19.26 8.52 1873 55.76 25.18 30.56 1874 46.83 28.10 18.73 1875 49.73 20.32 29.41 1876 43.75 18.75 25.00 1877 40.81 23.53 24.63 1878 37.62 15.24 22.38 1879 33.80 16.90 16.90 1880 32.49 18.14 14.35 1881 28.18 19.27 10.91 1882 44.28 25.37 18.91 1883 44.65 23.72 20.93 1884 41.57 17.25 24.31 1885 47.40 25.32 22.08 1886 44.95 18.89 26.06 1887 50.94 23.40 27.55 1888 29.23 16.67 12.57 1889 45.03 20.19 24.84 1890 28.24 20.66 24.52 1891 48.60 8.63 19.60 1892 48.74 21.07 27.53 1893 55.32 21.70 27.04 1894 50.68 19.50 35.82 1895 52.03 18.26 32.43 1896 50.45 26.01 26.02 1897 50.00 23.74 26.71 1898 45.48 17.63 32.37 1899 47.69 17.77 27.71 1900 46.27 20.81 26.88 1901 49.21 18.31 27.95 1902 49.05 19.63 29.58 1903 54.60 20.91 28.14 1904 52.26 20.25 31.29 1905 55.67 19.00 21.38 1906 44.85 25.77 29.90 1907 46.39 18.66 26.18 1908 60 20.62 25.77

357 Appendix. Table 15. Comparative DSIMR for Measles, Whooping Cough, Convulsions, Diarrhoea, and Lung Diseases in Merthyr Tydfil 1866-1908. (MOH Reports for Merthyr Tydfil 1865-1908.) Year DSIMR DSIMR DSIMR Lung DSIMR DSIMR Measles Whooping Diseases Convulsions Diarrhoea Cough 1866 26.75 23.19 50.69 3.26 1867 1.42 2.37 22.25 52.08 8.52 1868 7.75 2.91 14.54 52.32 7.75 1869 0.51 29.20 61.47 10.25 1870 3.65 28.15 30.24 46.40 5.74 1871 3.73 4.20 20.07 37.33 3.73 1872 1.47 12.21 44.92 4.40 1873 4.75 9.02 40.36 52.71 5.70 1874 10.93 10.02 28.23 55.10 4.55 1875 1.98 4.46 27.24 41.11 5.45 1876 1.03 18.14 44.22 6.80 1877 2.83 2.83 26.63 41.36 3.97 1878 7.85 28.38 47.70 3.32 1879 2.50 22.50 41.25 5.00 1880 12.29 2.46 20.90 63.92 5.53 1881 0.58 1.16 13.90 48.08 5.79 1882 4.60 7.48 21.86 45.45 2.30 1883 6.72 7.34 25.40 42.32 12.41 1884 0.55 6.00 33.79 46.32 13.08 1885 19.37 4.98 37.63 35.97 13.84 1886 3.06 14.79 40.80 43.85 13.26 1887 2.13 4.26 38.85 42.04 10.64 1888 0.99 1.49 22.85 39.24 8.45 1889 5.14 10.28 41.11 57.55 14.90 1890 3.47 13.37 44.06 53.96 17.82 1891 0.43 47.33 52.56 12.59 1892 18.37 3.42 41.86 51.26 18.37 1893 5.40 7.89 35.71 36.13 29.90 1894 0.87 10.86 43.86 31.26 25.62 1895 7.90 4.74 47.00 41.86 45.81 1896 2.57 3.43 27.42 33.85 44.56

358 Appendix. Table 15. Comparative DSIMR for Measles, Whooping Cough, Convulsions, Diarrhoea, and Lung Diseases in Merthyr Tydfil 1866-1908. (MOH Reports for Merthyr Tydfil 1865-1908). Year DSIMR DSIMR DSIMR DSIMR DSIMR Measles Whooping Lung Convulsions Diarrhoea Cough Diseases

1897 14.16 4.05 36.42 27.92 35.21 1898 0.40 10.02 36.07 21.64 45.29 1899 6.40 39.03 30.97 92.49 1900 1.88 4.14 35.00 26.34 27.09 1901 10.41 2.23 43.14 49.83 1902 3.21 2.50 40.40 30.39 1903 6.18 6.54 26.89 18.89 19.98 1904 0.36 7.49 36.38 19.98 37.50 1905 15.30 1.42 49.82 27.05 40.93 1906 5.53 32.06 23.95 39.43 1907 4.40 3.30 34.47 21.26 20.90 1908 2.20 11.37 27.41 27.77 38.88

359 Appendix. Table 16. Number of Infant Deaths from Waterborne Community Diarrhoeal Diseases and Disease Specific Infant Mortality Rates Merthyr Tydfil 1866-1908 (MOH Reports for Merthyr Tydfil 1866-1908.) Year Choleraic Cholera Typhus Enteric/Typhoid Simple Simple Totals DSIMR Infant Diarrhoea * Fever Continued Cholera Mortality Fever Rate

1866 7 2 2 11 5.12 192 1867 147 1868 1 1 0.48 130 1869 1 1 0.51 165 1870 1 1 0.52 187 1871 1 1 0.47 136 1872 1 1 2 0.98 147 1873 187 1874 1 1 0.46 191 1875 159 1876 1 1 0.57 137 1877 131 1878 152 1879 138 1880 162 1881 138 1882 146 1883 158 1884 172 1885 169 1886 188 1887 174 1888 140 1889 1 1 0.51 211 1890 205 1891 193 1892 239 1893 220 1894 2 2 0.87 186 1895 233

360 Appendix. Table 16. Number of Infant Deaths from Waterborne Community Diarrhoeal Diseases and Disease Specific Infant Mortality Rates Merthyr Tydfil 1866-1908 (MOH Reports for Merthyr Tydfil 1865-1908.) Year Choleraic Cholera Typhus Enteric/Typhoid Simple Simple Totals DSIMR Infant Diarrhoea * Fever Continued Cholera Mortality Fever Rate

1896 1 1 0.43 213 1897 214 1898 202 1899 272 1900 178 1901 262 1902 185 1903 153 1904 1 1 0.36 175 1905 1 1 0.36 205 1906 179 1907 154 1908 175 Total 7 2 2 11 1 2 25 *The distinction between typhoid and typhus, a disease of poverty spread by fleas, was unclear in Dyke’s early reports.

361 Appendix. Table 16(a). Numbers of Deaths from Diarrhoeal Diseases and Diseases Specific Infant Mortality Rates with Infant Mortality Rates in Merthyr Tydfil 1866-1908. (MOH Reports for Merthyr Tydfil 1866-1908.) Year Diarrhoea Gastritis Gastric Catarrh Enteritis Vomiting Gastric enteritis Haemorrhage from Bowels Total DSIMR Infant Mortality Rates 1866 6 1 7 3.26 192 1867 16 1 1 18 8.52 147 1868 16 16 7.75 130 1869 19 1 20 10.25 165 1870 9 2 11 5.74 187 1871 6 2 8 3.73 136 1872 8 8 4.40 147 1873 10 2 12 5.70 187 1874 10 10 4.55 191 1875 10 1 11 5.45 160 1876 8 4 12 6.80 137 1877 5 2 7 3.97 132 1878 6 6 3.32 152 1879 6 2 8 5.00 138 1880 4 1 4 9 5.53 162 1881 7 3 10 5.79 138 1882 2 2 4 2.30 146 1883 22 22 12.41 158 1884 23 1 24 13.08 172 1885 23 1 1 25 13.84 169 1886 26 26 13.26 188 1887 19 1 20 10.64 174 1888 17 17 8.45 140 1889 28 1 29 14.90 211 1890 36 36 17.82 205 1891 28 1 29 12.59 193 1892 41 2 43 18.37 239 1893 71 1 72 29.90 220 1894 59 59 25.62 186 1895 116 116 45.81 233 1896 104 104 44.56 213 1897 83 3 87 35.21 214 1 Gastric Ulcer 1898 35 70 8 1 114 45.29 202 1899 51 5 16 146 218 92.49 272 Diseases of Stomach 1900 16 19 15 22 72 27.09 178 1901 60 74 134 49.83 262 1902 43 42 85 30.39 185

362 Appendix. Table 16(a). Numbers of Deaths from Diarrhoeal Diseases and Diseases Specific Infant Mortality Rates with Infant Mortality Rates in Merthyr Tydfil 1866-1908. (MOH Reports for Merthyr Tydfil 1866-1908.) Year Diarrhoea Gastritis Gastric Catarrh Enteritis Vomiting Gastric enteritis Haemorrhage from Bowels Total DSIMR Infant Mortality Rates 1903 30 8 13 4 55 19.98 153 Stomach Other Disease Digestive Disturbance 1904 75 8 21 1 105 37.50 187 Other Digestive Disturbance

1905 115 115 40.93 205 1906 52 13 42 107 39.43 179 1907 25 10 22 57 20.90 154 1908 57 10 38 105 38.88 175 Total 1403 57 98 320 5 168 1 2053

363 Appendix. Table 16 (b). Comparison of Number of Rainy Days and Rainfall July- October 1894-1903, Diarrhoea Death Rate (Descending Order), and Infant Mortality Rates, 1867-1903 (MOH Report for Merthyr Tydfil, 1903, p.34)

Year IMR DSIMR Rainy Days Rain in Inches Total Rainfall Diarrhoea July-October July-October In Inches deaths 1899 272 92.49 48 16.7 61.3 1901 262 49.83 59 13.1 54.4 1898 202 45.69 59 18.1 60.8 1895 233 45.81 66 23.8 60.8 1896 213 44.56 75 24.5 55.0 1897 214 32.51 64 22.7 75.8 1902 185 30.39 76 14.9 49.5 1893 220 29.90 1900 178 27.09 63 20.5 70.0 1894 186 25.62 70 21.7 72.2 1903 153 19.98 92 35.5 86.1

1892 239 18.37

1890 205 17.82

1889 211 14.90

1885 169 13.84

1886 188 13.26

1884 172 13.08

1891 193 12.59

1883 158 12.41

1887 174 10.64

1869 165 10.25

1867 147 8.52 1888 140 8.45 1868 130 7.75 1876 137 6.80 1881 138 5.79 1870 187 5.74 1873 187 5.70 1880 162 5.53 1875 160 5.45

364 Appendix. Table 16 (b). Comparison of Number of Rainy Days and Rainfall July- October 1894-1903, Diarrhoea Death Rate (Descending Order), and Infant Mortality Rates, 1867-1903 (MOH Report for Merthyr Tydfil, 1903, p.34) Year IMR DSIMR Rainy Days Rain in Inches Total Rainfall July-October July-October In Inches 1879 138 5.00 1874 191 4.55 1872 147 4.40 1877 132 3.97 1871 136 3.73 1878 152 3.32 1866 192 3.26 1882 146 2.30

365 Appendix Table 17. Number of Deaths Under One Year of Age From Causes of Maternal Origin in Merthyr Tydfil 1866-1908 (MOH Reports for Merthyr Tydfil 1905-1908) Year Congenital Abnormaliti es Spina Bifida Malformatio n of Spine Bladder Hydrocephal us Imperforate Anus Intussuscepti on Intestinal Obstruction Dropsy Liver/Spleen Disease Syphilis Heart Disease Atelectasis Prematurity Cancer Total DSIMR 1866 2 5 1 9 17 7.71 1867 1 3 8 6 18 8.52 1868 2 6 8 3.88 1869 1 1 11 2 15 7.68 1870 1 14 15 7.82 1871 2 11 1 7 21 9.82 1872 1 2 8 8 19 9.28 1873 3 1 1 2 10 12 29 13.77 1874 1 1 6 17 25 11.38 1875 6 22 28 13.87 1876 5 1 7 13 7.37 1877 4 2 7 1 5 19 10.76 1878 1 2 8 1 6 18 10.87 1879 1 5 10 16 10.00 1880 5 2 1 1 7 16 9.83 1881 1 1 2 4 10 18 10.43 1882 3 1 6 7 17 9.78 1883 1 5 1 16 23 12.98 1884 3 1 1 7 4 13 29 15.80 1885 4 5 12 21 11.62 1886 2 9 1 9 21 10.71 1887 3 1 1 1 13 19 10.11 1888 3 1 1 2 1 4 17 29 14.41 1889 11 2 1 13 27 13.88 1890 8 4 15 27 13.37 1891 18 1 2 2 21 1 45 19.54 1892 12 4 32 48 20.50 1893 15 1 3 5 1 39 64 26.58

366 Appendix. Table 17. Number of Deaths Under One Year of Age From Causes of Maternal Origin in Merthyr Tydfil 1866-1908 (MOH Reports for Merthyr Tydfil 1905-1908)

Year Congenital Abnormaliti es Spina Bifida Malformati on of Spine Bladder Hydrocepha lus Imperforate Anus Intussuscep tion Intestinal Obstruction Dropsy Liver/Splee n Disease Syphilis Heart Disease Atelectasis Prematurity Cancer Total DSIMR 1894 5 1 2 11 34 53 23.01 1895 14a 1 1 2 27 45 17.77 1896 17 1 1 10 1 38 68 29.14 1897 16 1 5 1 31 1 55 22.26 1898 17 1 1 4 2f 32 57 22.85 1899 15 1 5 3 57 81 34.37 1900 1b 3 1 2 5 5 50 67 25.21 1901 2 60 1 63 23.43 1902 3 88 91 32.54 1903 8 2 1e 3 1 8 40 63 23.62 1904 5 1 1 1 2 1g 11 43 65 16.05 1905 11B 4 1 5 5 4 6 51 87 30.96 1906 31 7 46 84 30.95 1907 32c 4 3 57 96 34.88 1908 26d 10 1 50 87 31.80 Total 279 23 7 1 1 3 6 20 5e 35 238 35 34 1037 3 1727 a. 1 lymph angiosum. b.Naevus. B.includes 3 cleft palate. c. includes 4 birth injuries d. includes 1 birth injury e. Jaundice f. 2 veins and arteriesg. vascular

367 Appendix. Table 17(a). Disease Specific Infant Mortality Rates of Deaths Under One Year of Age From Maternal Causes in Merthyr Tydfil 1866-1908 (MOH Reports for Merthyr Tydfil 1865-1908.) Year Congenital Abnormaliti es Spina Bifida Malformatio n of Spine Bladder Hydrocephal us Imperforate Anus Intussuscepti on Intestinal Obstruction Dropsy Liver/Spleen Disease Syphilis Heart Disease Atelectasis Prematurity Cancer Total 1866 0.93 2.33 0.47 4.19 7.9 1867 0.95 1.42 3.79 2.84 9 1868 0.97 2.91 3.88 1869 0.51 0.51 5.64 1.03 7.65 1870 0.52 7.29 7.81 1871 0.93 5.13 0.47 3.27 9.80 1872 0.49 0.98 3.91 3.91 9.29 1873 1.42 0 0.48 0.95 4.75 5.7 13.78 .48 1874 0.46 0.46 2.73 7.74 11.39 1875 2.97 10.90 13.87 1876 2.83 0.57 3.97 7.37 1877 2.27 1.13 3.97 0.57 2.83 10.77 1878 0.60 1.21 4.83 0.60 3.62 10.86 1879 0.63 3.13 6.25 10.01 1880 3.07 1.23 0.61 0.61 4.30 9.82 1881 0.58 0.58 1.16 2.32 5.79 10.43 1882 1.73 0.56 3.45 4.03 9.77 1883 0.56 2.82 0.56 9.03 12.97 1884 1.64 0.55 0.55 3.82 2.18 7.08 15.82 1885 2.21 2.77 6.64 11.62 1886 1.02 4.59 0.51 4.59 10.71 1887 1.60 0.53 0.53 0.53 6.92 10.11 1888 1.49 0.50 0.50 0.99 0.50 1.99 8.45 14.41 1889 5.65 1.03 0.51 6.68 13.87 1890 3.96 1.98 7.43 13.37 1891 7.82 0.43 0.87 0.87 9.12 0.43 19.54 1892 5.13 1.71 13.67 20.51

368 Appendix. Table 17(a). Disease Specific Infant Mortality Rates of Deaths Under One Year of Age From Maternal Causes in Merthyr Tydfil 1866-1908 (MOH Reports for Merthyr Tydfil 1865-1908.) Year Congenital Abnormalities Spina Bifida Malformation of Spine Bladder Hydrocephalu s Imperforate Anus Intussusceptio n Intestinal Obstruction Dropsy Liver/Spleen Disease Syphilis Disease Heart Atelectasis Prematurity Cancer Total 1893 6.23 0.42 1.25 2.08 0.42 16.12 26.52 1894 2.17 0.43 0.87 4.78 14.76 23.01 1895 5.53 0.40 0.40 0.79 10.66 17.78 1896 7.28 0.43 0.43 4.28 0.43 16.28 29.13 1897 6.48 0.40 2.02 0.40 12.54 0.40 22.24 1898 6.81 0.40 0.40 1.6 0.80 12.83 22.84 1899 6.36 0.42 2.12 1.27 24.18 34.35 1900 0.38 1.13 0.38 0.75 1.88 1.88 18.81 25.21 1901 N/S 0.74 22.31 0.37 23.42 1902 N/S 1.07 31.46 32.53 1903 2.91 0.73 0.36 1.09 0.36 2.91 14.54 22.9 1904 1.78 0.36 0.36 0.36 0.71 0.36 3.92 15.34 23.19 1905 3.92 1.42 0.36 1.78 1.78 1.42 2.14 18.15 30.97 1906 11.42 2.58 16.95 30.95 1907 11.73 1.47 1.10 20.90 35.22 1908 9.50 3.65 0.37 18.27 31.79

369 Appendix.Table 18. Number of Deaths of Infants Under One Year of Age From Nutritional Disorders in Merthyr Tydfil 1866-1908 (MOH Reports for Merthyr Tydfil 1866-1908.) l Year Want of Breast Milk Starvation Anaemia Chlorosis Thrush Stomatitis Apthae Inanition Wasting Diseases Marasmus Atrophy debility Rickets Debility &Undefined Other Constitution Total 1866 1 69 70 1867 1 1 51 53 1868 1 17 18 1869 45 45 1870 51 51 1871 6 60 66 1872 67 67 1873 3 48 51 1874 4 77 81 1875 2 51 53 1876 1 43 44 1877 44 44 1878 64 64 1879 59 59 1880 42 42 1881 52 52 1882 57 57 1883 1 46 47 1884 58 58 1885 51 51 1886 2 69 71 1887 1 65 66 1888 2 63 65 1889 67 67 1890 64 64 1891 69 69 1892 79 79 1893 2 58 60 1894 46 46 1895 70 70 1896 75 75 1897 1 2 78 81 1898 7 100 107 1899 94a 4 98 1900 2 1 1 1 45 45 5 100 1901 1902 1903 1 50 30 3 12 96 1904 10 1 2 66 47 4 130 1905 25 1 33c 59 1906 1 94b 1 96 1907 6 53b 4 63 1908 6 64b 1 71 Total 39 12 3 21 11 1 1 95 161 2247 29 100 12 2706 a. wasting diseases include marasmus, atrophy, debility, want of breast milk and prematurity. b. atrophy debility and marasmus c.Above table compiled from table of deaths at all ages, all causes, total 59 deaths,1905, P56. Table V, p63 (1905) lists 67 deaths from atrophy debility and marasmus.

370 Appendix. Table 18 (a). DSIMR of Deaths of Infants Under One Year of Age From Nutritional Disorders in Merthyr Tydfil 1866- 1908(MOH Reports for Merthyr Tydfil 1866-1908.) Year of Want Breast Milk Starvation Anaemia Chlorosis Thrush Stomatitis Apthae Inanition Wasting Diseases Marasmu s Atrophy debility Rickets Debility &Undefin ed Other Constituti onal Total 1866 0.47 32.01 32.56 1867 0.47 0.47 24.15 25.01 1868 0.48 8.24 8.72 1869 23.01 23.01 1870 26.59 26.59 1871 2.80 28.00 30.80 1872 32.71 32.71 1873 1.42 22.79 24.22 1874 1.82 35.06 36.88 1875 0.99 25.26 26.25 1876 0.57 24.94 25.51 1877 24.93 24.93 1878 38.65 38.65 1879 36.88 36.88 1880 25.81 25.81 1881 30.12 30.12 1882 32.80 32.80 1883 0.56 25.96 25.96 1884 31.61 31.61 1885 28.22 28.22 1886 1.02 35.19 36.21 1887 0.53 34.60 34.60 1888 0.99 31.30 32.29 1889 34.43 34.43 1890 31.68 31.68 1891 28.22 28.22 1892 33.76 33.76 1893 0.83 24.09 24.09

371 Appendix. Table 18 (a). DSIMR of Deaths of Infants Under One Year of Age From Nutritional Disorders in Merthyr Tydfil 1866- 1908(MOH Reports for Merthyr Tydfil 1866-1908.) Year of Want Breast Milk Starvation Anaemia Chlorosis Thrush Stomatitis Apthae Inanition Wasting Diseases Marasmus Atrophy debility Rickets Debility &Undefine d Other Constitutio nal Total 1894 19.97 19.97 1895 27.65 27.65 1896 32.13 32.13 1897 0.40 0.81 31.57 32.78 1898 2.81 40.08 42.88 1899 39.88a 1.70 41.58 1900 0.75 0.38 0.38 0.38 16.93 16.93 1.88 37.62 1901 1902 1903 0.36 18.16 10.90 1.09 4.36 34.51 1904 3.56 0.35 0.71 23.54 16.76 1.42 46.34 1905 8.90 0.36 11.74c (21.00 1906 0.37 34.64b 0.37 35.37 1907 2.20 19.44b 1.47 23.10 1908 2.19 23.39b 0.37 25.95

372 Appendix. Table 19. Disease Specific Infant Mortality Rates for Infant deaths Under One year of Age from Maternal and Nutritional Causes of Death in Merthyr Tydfil 1866-1908 (MOH Reports for Merthyr Tydfil 1866-1908.) Year Congenital (a) a Prematurity (b) Syphilis Other (c) Nutritional Total IMR 1866 4.19 2.33 1.4 32.56 40.48 192 1867 0.95 2.84 3.79 1.42 25.01 32.59 147 1868 0.97 2.91 8.72 12.60 130 1869 1.02 5.64 1.03 23.01 30.70 165 1870 0.52 7.29 26.59 34.40 187 1871 0.93 3.27 5.13 0.47 30.80 40.60 136 1872 0.49 3.91 3.91 0.98 32.71 42 147 1873 1.9 5.7 4.75 2.38 24.22 38.95 187 1874 0.46 7.74 2.73 0.46 36.88 48.27 191 1875 10.90 2.97 26.25 40.12 159 1876 3.97 2.83 0.57 25.51 32.60 137 1877 2.27 2.83 3.97 2.27 24.93 36.27 131 1878 0.60 3.62 4.83 1.27 38.65 48.97 152 1879 0.63 6.25 3.13 36.88 46.89 138 1880 3.07 4.30 0.61 2.45 25.81 36.24 162 1881 1.16 5.79 2.32 1.16 30.12 40.55 138 1882 2.29 4.03 3.45 32.80 42.57 146 1883 0.56 9.03 2.82 0.56 25.96 38.62 158 1884 2.19 7.08 3.82 4.91 31.61 49.61 172 1885 2.21 6.64 2.77 28.22 39.84 169 1886 1.02 4.59 4.59 0.51 36.21 46.92 188 1887 1.60 6.92 0.53 0.53 34.60 44.18 172 1888 1.99 10.44 0.99 1.50 32.29 47.21 144 1889 6.68 6.68 0.51 34.43 48.30 209 1890 3.96 7.43 1.98 31.68 45.05 205 1891 8.25 9.12 0.87 1.3 28.22 47.76 193 1892 5.13 13.67 1.71 33.76 54.27 215 1893 6.65 16.12 2.08 0.42 24.09 49.36 220 1894 2.60 14.76 4.78 2.87 19.97 44.98 186 1895 5.93 10.66 0.79 0.40 27.65 45.43 241 1896 7.71 16.28 4.28 0.83 32.13 61.23 217

373 Appendix.Table. 19. Disease Specific Infant Mortality Rates for Infant deaths Under One year of Age from Maternal and Nutritional Causes of Death in Merthyr Tydfil 1866-1908 (MOH Reports for Merthyr Tydfil 1866-1908.) Year Congenital (a) a Prematurity (b) Syphilis Other (c) Nutritional Total IMR 1897 6.48 12.54 2.02 1.2 32.78 55.02 215 1898 7.21 12.83 1.6 1.2 42.88 65.72 202 1899 6.78 24.18 2.12 41.58 74.66 272 1900 2.64 20.69 1.88 37.62 62.83 182 1901 22.31 0.37 22.68 262 1902 31.46 1.07 32.53 185 1903 3.64 17.45 1.09 1.08 34.51 57.77 153 1904 2.5 19.26 0.71 1.08 46.34 69.89 187 1905 7.48 20.29 1.42 1.78 21.00 54.97 205 1906 11.42 16.95 2.58 35.37 66.32 179 1907 11.73 20.90 1.47 23.10 57.2 154 1908 9.50 18.27 3.65 25.95 57.37 176 a. includes Congenital abnormalities, spina bifida, malformation of the spine, hydrocephalus, imperforate anus, intussception, intestinal obstruction. b. Includes prematurity and atelectasis c. Includes dropsy, heart disease, liver/spleen, cancer Nutritional disorders include want of breast milk, starvation, anemia, chlorosis. thrush , stomatitis, apthae, inanition, wasting diseases, marasmus, atrophy and debility, rickets and “other constitutional” diseases.

374 Appendix. Table 20. Legitimate and Illegitimate Births as Percentages of Total Births in Merthyr Tydfil, South Wales and England and Wales, 1865-1908 (MOH Reports for Merthyr Tydfil 1865-1908.) Total Legitimate Illegitimate % Total S Wales Illeg. Births births births births Births % registered Merthyr total E&W Year Year 1865 2206 1866 2150 1867 2112 42/1000 61/1000 5.9/1000 1868 2064 1976 88 53 63 59 1869 1952 104 8.1 5.8 1870 1918 94 1871 2143 100 4.6% 1872 2048 1953 95 4.6% 5.8 5.6 1873 2106 111 5.27% 1874 2196 87 3.96% 1875 2019 77 1876 1764 64 3.6% 1877 1765 69 Under 4% 1878 1656 73 4.4% 5.6 1879 1600 50 3% 1880 1627 65 4% 1881 1726 85 5% 1882 1735 1883 1772 71 1:25 1884 1835 71 3.8% 1885 1807 65 3.5% 1886 1961 91 4.6% 1887 1879 77 4% 1888 2013 4% 1889 1946 4.2% 1890 2020 3.5% 1891 2303 88 1:26 1892 2341 80 1:29 1893 2408 110 4.5% 1894 2303 81 3.5% 1895 2532 80 1896 2334 76 3% 1897 2471 73 3% 1898 2495 73 1899 2357 1900 2658 1901 2689 25.6/1000 1902 2797 70 25.1/1000 1903 2752 81 29.4/1000 40/1000 1904 2803 86 30/1000 1905 2810 89 3.1% 1906 2714 40/1000 1907 2727 90 33/1000 1908 2736 65 23.7/1000

- 375 - Appendix. Table 21. Marriages and Birth Rates in Merthyr Tydfil 1868-1908 (MOH Reports for Merthyr Tydfil for 1865-1908.) Population Church Registrar Total Marriage Marriage Birth Birth IMR marriages Marriages rate rate rate rate before E&W merthyr E&W Merthyr registrar Year 1868 36.31 37.43 1869 35.34 31.45 1870 83 598 681 16.2 13.1 35.3 37 1871 82 456 538 16.7 20.7 35 41.2 1872 76 733 809 16.7 15.4 35 39 1873 94 756 850 17.6 15.7 35.8 39 1874 80 663 743 36.1 40.3 1875 51 429 480 35.9 37 1876 45 454 499 36.5 32.2 1877 56 472 528 34.5 35.3 1878 42 428 470 35.9 32.8 1879 34 534 568 35.1 31.7 1880 56 602 658 34.6 33.5 1881 693 643 693 33.9 35.2 1882 33 645 678 33.7 34.7 1883 35 618 653 33.3 35.4 1884 46 774 820 33.5 35.2 1885 66 513 579 32.5 34.4 1886 47 538 585 32.4 33.3 1887 62 608 670 32.8 1888 60 493 553 30.6 35.3 1889 65 641 716 34.3 1890 85 618 703 35.1 1891 73 660 733 39.3 1892 90 550 640 37.06 1893 75 494 569 37.4 1894 72 597 669 35.1 1895 71 588 659 38.1 1896 83 533 616 34.1 1897 74 863 937 34.8 1898 184 521 705 37.7 1899 651 34.9 1900 713 194 907 38.8 1901 653 28.6 38.6 1902 15.7 18.5 28.5 39.6 1903 28.4 38.4 1904 27.9 38.5 1905 28.2 38 1906 27.1 36.2 1907 26.3 35.8 1908 35.4

- 376 - Appendix. Table 22. Numbers, Causes of and DSIMR of Maternal Death in Merthyr Tydfil 1866-1908 (MOH Reports for Merthyr Tydfil 1866-1908.) Year Childbirth Haemorrhag e Puerperal Peritonitis Embolism Puerperal fever Metro Peritonitis Puerperal Convulsions Sudden death Metritis Uterine disease Ovarian Disease Abortion Placenta praevia Other Childbirth Uterine Haemorrhag Total DSIMR 1866 13 13 6.05 1867 11 11 5.21 1868 3 3 3 1 1 11 5.33 1869 4 1 2 7 3.59 1870 2 3 5 1 5 16 8.34 1871 7 8 3 18 8.40 1872 2 8 10 4.88 1873 5 4 9 4.27 1874 14 16 3 33 15.03 1875 12 9 1 2 24 11.89 1876 4 4 8 4.54 1877 6 1 3 10 5.67 1878 6 3 1 10 6.04 1879 8 2 3 13 8.13 1880 4 2 3 9 5.53 1881 11 11 6.37 1882 12 12 6.90 1883 3 1 1 1 8 14 7.90 1884 10 4 14 7.63 1885 15 15 8.30 1886 18 18 9.18 1887 8 8 4.26 1888 11 11 5.46 1889 18 18 9.25 1890 10 10 4.95 1891 14 6 20 8.68 1892 17 17 7.26 1893 13 23 36 14.95 1894 19 8 27 11.72 1895 10 1 11 4.34 1896 6 3 9 3.86 1897 6 6 12 4.86 1898 15 4 19 7.62 1899 1900 5 1 6 1 1 1 15 5.64 1901 13 25 38 14.13 1902 2 21 23 8.22 1903 5 20 25 9.08 1904 7 11 18 6.42 1905 6 9 15 5.34 1906 3 9 12 4.42 1907 6 8 14 5.13 1908 7 13 20 7.31 Total 319 8 11 1 123 28 11 5 25 1 3 3 1 124 1 664

- 377 - Bibliography

Arrangement of Bibliography

1. Parliamentary Papers and Official Reports:

2. Local Administration: Papers and Reports: (a) Merthyr Tydfil Local Board of Health: (b) Medical Officer of Health Reports: (c) Dr T. J. Dyke Papers and Publications: (d) Merthyr Tydfil Board of Guardians: (e) Midwives and Health Visitors:

2 Contemporary Publications: a. Books and Pamphlets: b. Journals: c. Newspapers

3 Secondary Sources: a. Books and Book chapters: b. Articles: c. Theses: d. Working Papers: e. Videos: f. Web References:

1. Parliamentary Papers and Official Reports:

De La Bêche, Sir Henry T., ‘Report on the Sanatory[sic] Condition of Merthyr Tydfil, Glamorganshire’, Second Report of the Commissioners on the State of Large Towns and Populous districts with Minutes of Evidence and Appendix, Part 1 and Part 11, 1845 [602] XVIII, pp.142-151.

Reports of the Commissioners of Inquiry into the State of Education in Wales, Appointed by the Committee of council on Education, Part 1, Carmarthen, Glamorgan and Pembroke. HMSO, London, 1848.

Rammell, Thomas Webster, Report to the General Board of Health on a Preliminary Inquiry into the Sewerage, Drainage, and Supply of Water, and the Sanitary Condition of the Inhabitants of the Town of Merthyr Tydfil in the County of Glamorgan, London, 1850, Urban and Rural Social Conditions in Industrial Britain: The Local Reports to the General Board of Health 1848-1857, Series One, No. 219, The Harvester Press, Brighton, 1978.

Papers Relating to the Sanitary State of the People of England by E.H. Greenhow for the General Board of Health with Introduction by John Simon, London, 1858, reprinted, Gregg , Farnborough,1973.

Annual Reports of the Registrar-General 1861-1875.

378

Farr, William, ‘Report on The Cholera Epidemic in England (1866):’ Supplement to The Twenty-Ninth Annual Report of The Registrar-General of Births, Deaths and Marriages in England, 1868; 1867-68 [4072] XXXVII.

Second Report of the Royal Sanitary Commission Vol. .II; 1871[C.281-1.] XXXV.

Second Report of the Royal Sanitary Commission, Volume III, Part II, Reports on the Working of the Public Health Act, 1872.,Appendix No.1,Reports of Local Government Board Inspectors on the Working of the Act of 1875, (134). Vol. XL Report of A. Doyle, Esq., No. 8 District, pp.78-80, 82-85.

Report of a Committee Appointed by the President of the Local Government Board to Inquire into the Several Modes of Treating Town Sewage 1876. [C.1410]. XXXVIII, Appendix No.1, ‘Sewage Farms’ :Merthyr Tydfil, pp.23-25.

First Report of the Royal Commission on the Housing of the Working Classes [England and Wales] 1885, with Minutes of evidence and Appendix; 1884-85 [C.4402.] [C.4402- 1] XXX.

Third Report of the Royal Commission on the Housing of the Working Classes, Minutes of Evidence; 1884-85 [C.4547-1].XXXI, pp.482-483., Evidence of T. J. Dyke, MOH for Merthyr Tydfil .

Final Report of Her Majesty’s Commissioners Appointed to Inquire Into Accidents in Mines And the Possible Means of Preventing their Occurrence or Limiting Their Disastrous Consequences; Together with Evidence and Appendices, 1886 [C.4699] XVI.

Royal Commission to Inquire into Administrative Procedures fro Controlling Danger to Man Through use as Food of Meat and Milk of Tuberculous Animals, Report, Minutes of Evidence and Appendices. 1898 [C.8824] XLIX

Royal Commission to Inquire into Effect of Food from Tuberculous Animals on Human Health, Report: 1895 [C.7703]XXXV.615., Minutes of Evidence., Special Inquiries, Index 1896 [C.7992]XLV.II

Report of the Inter-Departmental Committee on Physical Deterioration 1904 [Cd.2175] XXXII.

J. Spencer Low’s Report to the Local Government Board on the Sanitary Circumstances and Administration of the Merthyr Tydfil Urban District., 31st March, 1906., HMSO, London, 1906.The Reports to the Local Government Board, 1869-1908: Urban and Rural Social Conditions in Industrial Britain, Series Two., No. 231, The Harvester Press, Brighton, 1978.

Reports to the Local Government Board on Public Health and Medical Subjects No.56, Ministry of Health, Great Britain, HMSO, London, 1911 and 1914.

Medical Research Council, Chronic Pulmonary Disease in South Wales Coalminers, Special Report Series, No.250, HMSO, London, 1945.

379 2 Local Administration: Papers and Reports:

(a) Merthyr Tydfil Local Board of Health:

Merthyr Tydfil Board of Health Minutes 1850-1860, 1863, 1894.

Merthyr Tydfil Urban District Council Minutes 1895-1905.

Merthyr Tydfil Borough Council Health Committee Minutes 1905-8.

Sewage Irrigation Lands, Report by William Hope, Esq., V.C., To The Merthyr Tydfil Local Board of Health, March 18th, 1875, P. Williams, “Telegraph” Office, Merthyr Tydfil., Merthyr Tydfil Public Library.

(b) Medical Officer of Health Reports:

William Kay, M.D., Report of the Sanitary Condition of Merthyr Tydfil; Drawn up at the Request of the Local Board of health, and Read at the Meeting on the 15th Day of May, 1854. Merthyr Tydfil, 1854. Merthyr Tydfil Public Library.

Report on the Sanitary Condition of Merthyr Tydfil for the Year 1865. Presented to the Local Board of Health on the 5th April, 1866, by Thomas Jones Dyke, M.R.C.S., Eng; & L.S.A. London., Medical Officer of health; Honorary Member of the Metropolitan Association of Officers of Health, &c., &c. Rees Lewis, Merthyr Tydfil, 1866. Merthyr Tydfil Public Library.

Second Annual Report on the Sanitary Condition of Merthyr-Tydfil, Being for the Year 1866, with Appendix, Prepared for the Local Board of Health by their Medical officer, Thomas Jones Dyke, Fellow of the Royal College of Surgeons of England; Member of the British Medical Association; Etc., Etc., M.W. White and Sons, Merthyr Tydfil, 1867. Merthyr Tydfil Public Library.

Third Report on the Sanitary Condition of Merthyr-Tydfil for the Year 1867 by T. J. Dyke, M.W. White and Sons, Merthyr., 1868. Merthyr Tydfil Public Library.

Fourth Annual Report on the Sanitary Condition of Merthyr-Tydfil, Being for the Year 1868, With Appendix, Prepared for the Local Board of Health by the Medical Officer, Thomas Jones Dyke, etc., M.W. White and Sons, Merthyr., 1869. Merthyr Tydfil Public Library.

Fifth Annual Report on the Sanitary Condition of Merthyr-Tydfil, Being for the Year 1869, Prepared for the Local Board of Health by the Medical Officer, Thomas Jones Dyke, etc., M.W. White and Sons, Merthyr., 1870. Merthyr Tydfil Public Library.

Sixth Annual Report on the Sanitary Condition of Merthyr Tydfil, Being That for the Year 1870,With Appendix, &c., Prepared for the Local Board of Health by the Medical Officer, Thomas Jones Dyke, etc., Farrant and Frost, Merthyr-Tydfil,.1871. Merthyr Tydfil Public Library.

Seventh Annual Report on the Sanitary Condition of Merthyr-Tydfil, Being That for the Year 1871 With Appendix Etc., Prepared for the Local Board of Health by the Medical

380 Officer, Thomas Jones Dyke, etc., Farrant and Frost, Merthyr-Tydfil,. 1872. Merthyr Tydfil Public Library.

Eighth Annual Report on the Sanitary Condition of Merthyr-Tydfil, Being That for the Year 1872. With Statistical Analysis of 2619 Cases of Small-Pox, Prepared for the Local Board of Health by the Medical Officer, Thomas Jones Dyke, etc., Fellow of the Royal College of Surgeons of England; Member of the British Medical And Social Science Associations, The Association of Officers of Health, The Epidemiological Society, Etc., Etc., Farrant and Frost, Merthyr-Tydfil,. 1874. Merthyr Tydfil Public Library.

Ninth Annual Report on the Sanitary Condition of Merthyr-Tydfil, Being That for the Year 1873,. Prepared for the Local Board of Health by the Medical Officer, Thomas Jones Dyke, etc., Fellow of the Royal College of Surgeons of England; Member of the British Medical And Social Science Associations, The Association of Officers of Health, The Epidemiological Society, Etc., Etc., Farrant and Frost, Merthyr-Tydfil,. Simpkin, Marshall, and Co. London, 1874. Merthyr Tydfil Public Library.

Tenth Annual Report on the Sanitary Condition of Merthyr-Tydfil, Being That For The Year 1874, Prepared For The Local Board of Health, By Their Medical Officer, Thomas Jones Dyke, Farrant and Frost, Merthyr Tydfil. Public Record Office , Kew, MH 12 / 6337

Eleventh Annual Report on the Sanitary Condition of Merthyr-Tydfil, Being That For the Year 1875. Prepared for the Local Board of Health by Their Medical Officer, Thomas Jones Dyke, etc., Farrant & Frost, Merthyr-Tydfil, 1876.

T. J. Dyke, Twelfth Annual Report on the Sanitary Condition of Merthyr Tydfil for 1876, Public Record office, Kew, MH 12 /6338

Local Board of Health Merthyr-Tydfil Supplemental Report of the Medical Officer of Health for The Year 1876, Merthyr-Tydfil, 1st June, 1877. Public Record office, Kew, MH 12 /6338

Thirteenth Annual Report On The Sanitary Condition of Merthyr-Tydfil, Being That For The Year 1877, Prepared For The Local Board of health, By Their Medical officer, Thomas Jones Dyke, Farrant And Frost, Merthyr-Tydfil, 1878. Merthyr Tydfil Public Library.

Fourteenth Annual Report On The Sanitary Condition of Merthyr-Tydfil, Being That For The Year 1878, Prepared for The Local Board of Health By Their Medical Officer, Thomas Jones Dyke, Farrant And Frost, Merthyr Tydfil. Merthyr Tydfil Public Library.

Fifteenth Annual Report On The Sanitary Condition of Merthyr-Tydfil, Being That For The Year 1879, Prepared for The Local Board of Health By Their Medical Officer, Thomas Jones Dyke, Farrant And Frost, Merthyr Tydfil. Merthyr Tydfil Public Library. Sixteenth Annual Report On The Sanitary Condition of Merthyr-Tydfil, Being That For The Year 1880, Prepared for The Local Board of Health By Their Medical Officer, Thomas Jones Dyke, Farrant And Frost, Merthyr Tydfil. Merthyr Tydfil Public Library.

Seventeenth Annual Report On The Sanitary Condition of Merthyr-Tydfil, Being That For The Year 1881, Prepared for The Local Board of Health By Their Medical Officer,

381 Thomas Jones Dyke, Farrant And Frost, Merthyr Tydfil, 1882. Report includes a Letter to T. Williams, Esq., Clerk to the Merthyr-Tydfil Urban Sanitary Authority, from Walter S. Sendall, Assistant Secretary to the Local Government Board, 27th January, 1882 regarding Dyke’s Special Report to the Urban Sanitary Authority with reference to the present epidemic of Scarlet Fever In the District. Public Record Office, Kew, MH 12 /16341

Eighteenth Annual Report On The Sanitary Condition of Merthyr-Tydfil, Being That For The Year 1882, Prepared for The Local Board of Health By Their Medical Officer, Thomas Jones Dyke, Farrant And Frost, Merthyr Tydfil. 1883. Merthyr Tydfil Public Library.

Nineteenth Annual Report On The Sanitary Condition of Merthyr-Tydfil, Being That For The Year 1883, Prepared for The Local Board of Health By Their Medical Officer, Thomas Jones Dyke, Farrant And Frost, Merthyr Tydfil, 1884. Merthyr Tydfil Public Library.

Twentieth Annual Report On The Sanitary Condition of Merthyr-Tydfil, Being That For The Year1884, Prepared for The Local Board of Health By Their Medical Officer, Thomas Jones Dyke, Farrant And Frost, Merthyr Tydfil, 1885. Merthyr Tydfil Public Library.

Twenty-First Annual Report On The Sanitary Condition of Merthyr-Tydfil, Being That For The Year1885, Prepared for The Local Board of Health By Their Medical Officer, Thomas Jones Dyke, Farrant And Frost, Merthyr Tydfil, 1886. Merthyr Tydfil Public Library.

Twenty-Second Annual Report On The Sanitary Condition of Merthyr-Tydfil, Being That For The Year1886, Prepared for The Local Board of Health By Their Medical Officer, Thomas Jones Dyke, Farrant And Frost, Merthyr Tydfil, 1887. Merthyr Tydfil Public Library.

Twenty-Third Annual Report On The Sanitary Condition of Merthyr-Tydfil, Being That For The Year1887, Prepared for The Local Board of Health By Their Medical Officer, Thomas Jones Dyke, Farrant And Frost, Merthyr Tydfil, 1888. Merthyr Tydfil Public Library.

Twenty-Fourth Annual Report On The Sanitary Condition of Merthyr-Tydfil, Being That For The Year1888, Prepared for The Local Board of Health By Their Medical Officer, Thomas Jones Dyke, Appendix: Duties of School Managers in Relation to Epidemics, &c., Farrant And Frost, Merthyr Tydfil, 1889. Merthyr Tydfil Public Library.

Twenty-Fifth Annual Report On The Sanitary Condition of Merthyr-Tydfil, Being That For The Year1889, Prepared for The Local Board of Health By Their Medical Officer, Thomas Jones Dyke, Farrant And Frost, Merthyr Tydfil, 1890. Merthyr Tydfil Public Library.

Twenty-Sixth Annual Report On The Sanitary Condition of Merthyr-Tydfil, Being That For The Year1890, Prepared for The Local Board of Health By Their Medical Officer, Thomas Jones Dyke, Farrant And Frost, Merthyr Tydfil, 1891. Merthyr Tydfil Public Library.

382 Twenty-Seventh Annual Report On The Sanitary Condition of Merthyr-Tydfil, Being That For The Year1891, Prepared for The Local Board of Health By Their Medical Officer, Thomas Jones Dyke, Farrant And Frost, Merthyr Tydfil, 1892. Merthyr Tydfil Public Library.

Twenty-Eighth Annual Report On The Sanitary Condition of Merthyr-Tydfil, Being That For The Year1892, Prepared for The Local Board of Health By Their Medical Officer, Thomas Jones Dyke, Frost and Smith, Merthyr Tydfil, 1893. Merthyr Tydfil Public Library.

Twenty-Ninth Annual Report On The Sanitary Condition of Merthyr-Tydfil, Being That For The Year1893, Prepared for The Local Board of Health By Their Medical Officer, Thomas Jones Dyke, H. W. Southey, Merthyr Tydfil, 1894. Merthyr Tydfil Public Library.

Thirtieth Annual Report On The Sanitary Condition of Merthyr-Tydfil, Being That For The Year1894, Prepared for The Local Board of Health By Their Medical Officer, Thomas Jones Dyke, H. W. Southey, Merthyr Tydfil, 1895.

Thirty-First Annual Report On The Sanitary Condition of Merthyr-Tydfil, Being That For The Year1895, Prepared for The Urban District Council By Their Medical Officer, Thomas Jones Dyke, H. W. Southey, Merthyr Tydfil, 1896

Thirty-Second Annual Report On The Sanitary Condition of Merthyr-Tydfil, Being That For The Year1896, Prepared for The Urban District Council By Their Medical Officer, Thomas Jones Dyke, H. W. Southey, Merthyr Tydfil, 1897.

Thirty-Third Annual Report On The Sanitary Condition of Merthyr-Tydfil, Being That For The Year1897, Prepared for The Urban District Council By Their Medical Officer, Thomas Jones Dyke, H. W. Southey, Merthyr Tydfil, 1898.

Thirty-Fourth Annual Report On The Sanitary Condition of Merthyr-Tydfil, Being That For The Year1898, Prepared for The Urban District Council By Their Medical Officer, Thomas Jones Dyke, H. W. Southey, Merthyr Tydfil, 1899.

Annual Report on the Sanitary Condition of Merthyr Tydfil During the Year 1899, by W. W. Jones, M.D., D.P.H., Temporary MOH for Merthyr Tydfil, GRO GC/PH/33/99

Annual Report on the Sanitary Condition of Merthyr Tydfil During the Year 1900, by C.E.G. Simons, M.B., D.P.H., Presented to the Merthyr Tydfil urban District Council., H.W. Southey and Sons, Merthyr Tydfil, 1901.

Annual Report of the Medical Officer of Health for the Year 1901., by D. J. Thomas, Merthyr Tydfil Urban District Council, Glamorgan Record Office, GC/PH/33/9.

Merthyr Tydfil Urban District Council: Annual Report of the Medical Officer of Health for the Year 1902, by D .J. Thomas, , Glamorgan Record Office, GC/PH/33/10.

Merthyr Tydfil Urban District Council: Annual Report of the Medical Officer of Health for the Year 1903, By .D. J. Thomas, Joseph Williams and Sons, Merthyr Tydfil, 1904., Provincial MOH Reports, Wellcome Institute Library, London, Ref: F0001619B00

383 Merthyr Tydfil Urban District Council :Annual Report of the Medical Officer of Health For the Year 1904, By D. J. Thomas, B.R.S.Frost &c., Merthyr and Dowlais , 1905. Merthyr Tydfil Public Library.

Borough of Merthyr Tydfil. Annual Report of the MOH for Merthyr Tydfil for the Year 1905, by D. J Thomas, and A.. Duncan, H. W. Southey & Sons., Merthyr Tydfil, 1906, Merthyr Tydfil Public Library

Borough of Merthyr Tydfil, Annual Report of the Medical Officer of Health, For the Year 1906, by Alex. Duncan., The Merthyr Telegraph Printing office, Merthyr Tydfil, 1907. Merthyr Tydfil Public Library.

Annual Report of the Medical Officer of Health for the Year 1907, by Alex Duncan, Borough of Merthyr Tydfil, Glamorgan Record Office, GC/PH/33/14.

Annual Report of the Medical Officer of Health for the Year 1908, by Alex.Duncan Borough of Merthyr Tydfil, Glamorgan Record Office, GC/PH/33/15.

Annual Report of the Medical Officer of Health for the Year 1919, by Alex.Duncan, County Borough of Merthyr Tydfil. Merthyr Tydfil Public Library

Duncan, A., Annual Report of the School Medical Officer for the Year 1920 to Merthyr Tydfil Education Committee. Merthyr Tydfil Public Library

County Borough of Merthyr Tydfil: Housing Act 1936 Slum Clearance Scheme: Gas Row Dowlais, 1937, Merthyr Tydfil Public Library.

(c) Dr T. J. Dyke Papers and Publications:

T. J. Dyke, Letter to George T. Clark Esquire, 31st October, 1860. Glamorgan Record Office RO D/DG C8/7/4

Draft Letter. Mr. Clark to Mr. Dyke. Glamorgan Record Office D/DG C8/7/2

Thomas Jones Dyke, On the Modes of Dealing with Outbreaks of Pestilent Fevers, London, 1871., read at the Social Science Congress, Leeds., published in British Medical Journal, October 21st 1871.

Dyke T.J., ‘On Those Sections of the Public Health Bills, Now Before Parliament, Which Affect the Medical Profession,” The British Medical Journal, April 13th, 1872, pp.390-392.

Dyke, Thomas Jones, On the Downward Intermittent Filtration of Sewage, As It Is Now In Practical Operation at Troedyrhiw, near Merthyr Tydfil, Being The Address Read At the Annual Meeting of the South Wales and Monmouthshire Branch of the British medical Association, held at Merthyr Tydfil, on the 17th July, 1872, by the President Thomas Jones, Dyke, F.R.C.S., Second Edition, Farrant & Frost, Merthyr Tydfil, Simpkin, Marshall & Co., London, n.d. c.1872. Merthyr Tydfil Public Library.

Dyke, T. J. The Work of a Medical Officer of Health and How to Do It, Address delivered before the South Wales & Monmouthshire Branch of the British Medical Association, Reprinted from the British Medical Journal, November 16th 1872., Farrant

384 and Frost, Merthyr Tydfil, Simpkin Marshall and Co., London, 1872. Merthyr Tydfil Public Library.

Forms For the Use of Officers of Health By Thomas Jones Dyke, Esq., F.R.C.S.. Eng., Medical Officer of Health, Merthyr Tydfil, Year Book of Births, Vaccinations, Marriages & Deaths In The District of Merthyr Tydfil by T.J. Dyke, Medical Officer of Health, Farrant & Frost, Merthyr Tydfil, Simpkin, Marshall & Co., London, 1873. Merthyr Tydfil Public Library.

Dyke, T.J., Paper, ‘On the Systematization of Reports of Medical Officers of Health, with the view of making them comparable with one another,’ Transactions of the National Association for the Promotion of Social Science, 1873., pp.494-495.

‘Can Typhoid fever be caused by the use of the Milk of Animals fed upon produce grown on Sewage Farms?’ Letters On This Subject, Published in “The Times’, In August, 1873, With An Extract from a Report of The Medical Officer of Health Of The Sanitary Authorities of Merthyr-Tydfil, And A preface By Samuel Harpur, Assoc. Inst. C. E., Member Of The Association Of Municipal And Sanitary Engineers And Surveyors, Engineer And Surveyor To The Merthyr-Tydfil Local Board of Health. Farrant And Frost, Merthyr-Tydfil, 1873. Merthyr Tydfil Public Library.

Dyke, Thomas Jones, Remarks on the Proposal to Appoint Consultative Medical Inspectors in Wales and West Monmouthshire, Read at the Annual Meeting of the South Wales & Monmouthshire Branch of the British Medical Association Held at Carmarthen on the 27th June, 1873, Reprinted from the Welshman, Morgan and Davies, “Welshman” Steam printing Office, Carmarthen, 1873. Merthyr Tydfil Public Library.

Dyke, Thomas Jones, F.R.C.S. Eng. Medical Officer of Health, Urban & Rural, Merthyr-Tydfil; President of Society of Officers of Health, South Wales and Monmouthshire., The Medical Officers of Health Authorized to be Appointed Under the Provisions of the Public Health Act 1875, Their Grades, Duties and Spheres of Labour, Paper read to the Society of Officers of Health for South Wales and Monmouthshire, held on the 28th March, 1876 at Swansea. Merthyr Tydfil Public Library.

Dyke, T. J., ‘Improving Health in Merthyr Tydfil’, The Sanitary Record, January 22, 1876, clipping attached to MOH Report for 1874, p.19Merthyr Tydfil Public Library.

T.J. Dyke, Thomas Jones, FRCS, Missing Links in The Sanitary Administrative Service, Paper Read at the Sanitary Congress, Leamington, 1877. Merthyr Tydfil Public Library.

T.J. Dyke, Duties of School Managers in relation to Epidemics, And Health of Inmates, Appendix to MOH Report for Merthyr Tydfil for 1888, Read at a Conference Held at the International Health Exhibition in London on Wednesday, July 30th, 1884. Farrant & Frost, Merthyr Tydfil, 1884. Merthyr Tydfil Public Library.

British Medical Association, Address in Public Medicine, ‘The Sanitary History of Merthyr-Tydfil’, By Thomas Jones Dyke, F.R.C.., Medical Officer of Health for Merthyr-Tydfil, Fifty-Third Annual Meeting At Cardiff, July, 1885 [Reprinted for the Author from The British Medical Journal, August 1st, 1885.] Farrant & Frost, Merthyr Tydfil, 1885, Merthyr Tydfil Public Library

385

(d) Merthyr Tydfil Board of Guardians:

Merthyr Tydfil Poor Law Union and the Workhouse / Public Assistance Institutions and Cottage Homes Records GB 0214 UM 1853 -1897.

Merthyr Tydfil Union Board of Guardians- Abstracts- Description of Wards and Particular of Recipients of Relief, 1897, Merthyr Tydfil Public Library.

(e) Midwives and Health Visitors:

Midwives Act 1902 Sub-Committee Minutes and Reports, 1903-17, 1936, 1945. GC.PH.16 Glamorgan Record Office.

Register of Practising Midwives for Merthyr Tydfil, 1910. Merthyr Tydfil Public Library.

Women Sanitary Inspectors Association SA/HVA, Contemporary Medical Archives Centre, Wellcome Institute for the History of Medicine.

Queen’s Nursing Institute SA/QNI, Contemporary Medical Archives Centre, Wellcome Institute for the History of Medicine.

3. Contemporary Publications:

(a) Books and Pamphlets:

Acton, William, Prostitution Considered in its Moral, Social and Sanitary Aspects, first published London, 1857, reprinted Frank Cass, London, 1972.

Allgood Henry, ‘Notes on Dowlais’, [Leaflets issued during the contest re Dowlais], East Dorset Liberal Association, Poole, Dorset, March 12th 1912., Merthyr Tydfil Public Library

Anderson, Adelaide Mary, Women in the Factory: An Administration Adventure 1893 to 1921, John Murray, London, 1922

Andrews, Elizabeth, A Woman’s Work is Never Done, Ystrad Rhondda Cymric Democrat Publishing Society, 1956.

Andrews, Henry Russell., M.D., B.S., London, MRCP. Midwifery For Nurses, London, Edward Arnold, 1909.

Annual Statement of the Accounts of the Rechabite Friendly Society, Held at the Temperance Hall, Merthyr Tydfil, for the Year Ending July 14th, 1873. Merthyr Tydfil Public Library

Astle, John G.E., The Progress of Merthyr: A “Diamond Jubilee” Review with Synopsis of Local Information, Edwin Davies, Merthyr Times, Merthyr, 1897 Merthyr Tydfil Public Library

386 Astle, John, G. E., Illustrated Report of the Merthyr Tydfil Incorporation Inquiry, 1897, J.G.E.Astle, Merthyr Tydfil, 1897.

Baines, M. A., Excessive Infant- Mortality: How Can It Be Stayed? A Paper Contributed to the National Social Science Association, (London Meeting;) To Which is Added a Short Paper, Reprinted from the Lancet on Infant-Alimentation, or Artificial Feeding, As a Substitute for Breast-Milk, Considered in its Physical and Social Aspects., John Churchill and Sons, London, 1862.

Dowlais Parish Register, Burials in the Parish of Dowlais 1844, 1848-1854., Merthyr Tydfil Public Library

Bell, Lady Florence, At The Works, first published 1907, Reprinted Virago Press, London, 1985.

Black, George, The Young Wife’s Advice Book; A Guide for Mothers in Health and Self- Management, Ward Loch Co., London, 1888.

Borrow, George, Wild Wales, first published 1854, Collins, London, 1955.

Bruce, H. A., The present condition and future prospects of the working classes in South Wales, London, 1851, Merthyr Tydfil Public Library.

Bruce, H.A., Merthyr Tydfil in 1852, A Lecture Delivered to the Young men’s Mutual Provident Society at Merthyr Tydfil, February 3rd, 1852, William Wilkins, Post Office, Merthyr Tydfil, 1852. Merthyr Tydfil Public Library.

Bunting, Evelyn M., Bunting, Dora E.L., Barnes, Annie E. and Gardiner, Blanche, A School for Mothers, London, Horace Maubihall and Son, 1907.

Campbell, George L., Miners’ Insurance Funds: Their Origin and Extent, Waterlow & Sons Limited., London, 1880

The Carnegie United Kingdom Trust, Report on The Physical Welfare of Mothers and Children: England and Wales, Volume One, 1917.

Chadwick, Edwin, Report on the Sanitary Condition of the Labouring Population of Great Britain, 1842, edited M.W. Flinn, Edinburgh University Press, 1965.

Checkland, S.G. & E.O.A. (ed), The Poor Law Report of 1834, First published in 1834, Reprinted Penguin, Harmondsworth, 1973.

Citizen, A., ‘History of Local Government in Merthyr Tydfil’,The Democrat’s Handbook, 1912. The Educational Publishing Co., Cardiff, c. 1912., pp. 77-83.

Clarke, T. E., A Guide to Merthyr Tydfil and the Traveller’s Companion (1848) reprinted Cardiff Academic Press, 1996.

Coombes, Bert, These Poor Hands, London, Victor Gollancz, 1939.

387 Creighton, Charles, A History of Epidemics in Britain: Vol. Two, From The Extinction of The Plague to The Present Day, first published Cambridge, 1894, Reprinted Frank Cass & Co., Ltd., London, 1965.

Cummings, D.C. A Historical Survey of the Boilermakers and Iron and Steel Ship Builders Society Aug 1834 to Aug 1904, Newcastle Upon Tyne, 1903.

Dalziel, Alex, The Colliers’ Strike in South Wales, 1871, Its Cause, progress and Settlement, Cardiff 1872.

The Democrat’s Handbook to Merthyr, Educational Publishing Co., Cardiff, c.1912.

Ellis, Havelock, (ed), Public Health Problems, The Contemporary Science Series, n.d.c.1900.

Engels, Frederick, The Condition of The Working Class in England, First published 1882, reprinted by Grafton Books, London, 1986.

Enock, Arthur Guy, This Milk Business: A Study from 1895 to 1943, H. K. Lewis & Co. Ltd., London, 1943.

Fabian Society Tracts: No.1. Why Are the Many Poor? London 1884-1897. No.5. Facts For Socialists from the Political Economists and Statisticians, London,1895. No.13. What Socialism Is, London, n.d. No.38. Paham Mae Lluaws Yn Dlawd? Welsh Translation of Tract No.1. The Fabian Election Manifesto 1892. No.42, Rev. Stewart D. Headlam, Christian Socialism, London, January1896. Webb, Sydney, Socialism: True and False, London 1894. No.52. J. W. Martin, State Education at Home and Abroad, London, June 1894.No.68 The Tenant’s Sanitary catechism, (May 1896). No.162. Mrs.Pember Reeves, Family Life on a Pound A Week, London, 1912.

Farr, William, Vital Statistics: A Memorial Volume of Selections from The Reports and Writings of William Farr, Scarecrow Press Inc., Metuchen, New Jersey, 1975.

Fennings, Alfred, Every Mother’s Book or The Child’s Best Friend, Isle of Wight, c. 1860 Fraser, James, Illustrated History of The Loyal Cambrian Lodge, No. 110 of Freemasons, Merthyr Tydfil. 1810-1914, Merthyr Tydfil, 1914.

Ginswick, J., Labour and The Poor in England and Wales, 1849-1851: The Letters to the Morning Chronicle from The Correspondents in The Manufacturing and Mining Districts, The Towns of Liverpool and Birmingham and The Rural Districts Vol III: The Mining and Manufacturing Districts of South Wales and North Wales, Reprinted Frank Cass, London, 1983.

Glasier, J. Bruce, Keir Hardie, The Man and His Message, The Independent Labour Party, London, 1919.

388 Greenwood, Florence, J., ‘Is the High Infantile Death-Rate Due to the Occupation of Married Women?’ London, 1901.

Greenwood, James, Seven Curses of London, London, 1869.

Greenwood James, The Wilds of London, 1874, Garland, New York, 1985.

Hardie, J. Keir, M.P., ‘My Relations with the Merthyr Boroughs’ The Democrat’s Handbook To Merthyr, The Educational Publishing Co., Cardiff, c.1912,. pp. 9-13.

Higgs, Mary and Hayward, Edward E., Where Shall She Live? The Homelessness of the Woman Worker, P. S. King. & Son, Westminster, 1910

Hughes, Emrys, Keir Hardie Some Memories, Francis Johnson, London, c.1920.

Jenkins, Rev. J.E., Vaynor: Its History and Guide, Merthyr Tydfil, 1897. Merthyr Tydfil Public Library.

Johnson, Francis, Keir Hardie’s Socialism, The Independent Labour Party, London, 1922.

Jones, Hugh, ‘Industrial History of Merthyr’, The Democrat’s Handbook to Merthyr, Educational Publishing Co., Cardiff, c.1912., pp.36-50.

Keating, Peter, (ed), Into Unknown England 1866-1913: Selections From the Social Explorers, Manchester University Press, Manchester, 1976

Lawrence, William, ‘Political History of Merthyr Tydfil’,The Democrats Handbook to Merthyr, Educational Publishing Co., Cardiff, c.1912., pp.51-62.

Leyland, John, (ed), Contemporary Medical Men and Their Professional Work: Biographies of Leading Physicians and Surgeons with Portraits from the Provincial Medical Journal, Office of the Provincial Medical Journal, Leicester, 1888.Vols.I and II.

Llewellyn Davies, Margaret, (ed), Maternity Letters from Working Women, Collected by the Women’s Co-operative Guild, First published 1915, reprinted Virago, London, 1978.

Local Quarterly Report of the Independent Order of Oddfellows, Manchester Friendly Unity Society, October 1906, Merthyr Tydfil Public Library

London County Council, Schemes of Instruction in First Aid, Home Nursing, Health and Infant Care, Evening Schools Session 1907-8. London County Council, 1907.

Macmillan, J, (Shawnet), Cameron, Infant Health A Manual for District Visitors, Nurses and Mothers, Hodder and Stoughton, London, 1915.

McMillan, Margaret, Infant Mortality, The Independent Labour Party, London, 1907.

Merck’s 1899 Manual of the Materia Medica A Ready Reference Book for the Practising Physician, Merck & Co., New York, 1899.

389

Menelaus, On The Employment of Women and Children in The Iron works of South Wales 16th May, 1866, Glamorgan Record Office D/DG Sect. C.

‘The Express’ Almanac and Year Book for 1895, Merthyr Express, Merthyr Tydfil, 1895.

The Express’, Almanac and Year Book for 1896, Merthyr Express, Merthyr Tydfil, 1896.

‘The Express’, Almanac and Year Book for 1897, Merthyr Express, Merthyr Tydfil, 1897.

‘The Express’, Almanac and Year Book for 1898, Merthyr Express, Merthyr Tydfil, 1898

National Conference on Infantile Mortality. Report of the Proceedings of The National Conference on Infantile Mortality, Held in the Caxton Hall, Westminster, on the 13th and 14th June 1906. P.S. King & Son, Westminster,1906.

National Conference on Infantile Mortality. Report of the Proceedings of The National Conference on Infantile Mortality, Held in the Caxton Hall, Westminster, on the 23rd, 24th and 25th March, 1908. P.S. King & Son, Westminster, 1908.

Newman, George, Infant Mortality: A Social Problem, Methuen and Co., London, 1906.

Newsholme, Sir Arthur, The Elements of Vital Statistics, originally published in 1889, reprinted, George Allen and Unwin, London, 1923

Paget, Stephen, F.R.C.S., Pasteur and After Pasteur, Charles Black, London, 1914.

Pankhurst, Sylvia, Save the Mothers: A Plea for Measures to Prevent the Annual Loss of About 3,000 Child Bearing Mothers and 20,000 Infant Lives in England and Wales and Similar Grievous Wastage of Other Countries, Alfred A. Knopf, London, 1930.

Mearns, Andrew, The Bitter Cry of Outcast London, James Clark, London, 1883. reprinted Cedric Chivers, Bath, 1969.

Reid, Marian, A Plea for Woman, Edinburgh, 1843. Reprinted Polygon, Edinburgh, 1988.

Report of the Forty Fifth Annual Session of the Merthyr Tydfil Grand Division Sons of Temperance Assembled at the Gosen Vestry, Treorchy, January 25th 1904. Merthyr Tydfil Public Library

Rogers, Joseph, Reminiscences of a Workhouse Medical Officer, London, 1889.

Rowntree, B. Seebohm, Poverty: A Study of Town Life, Thomas Nelson and Sons, London, c. 1900.

390 Rules of the Gwenynen Glan Canaid Lodge, No.136, A Branch of the Merthyr Tydfil District of the Merthyr Unity Philanthropic Institution, Merthyr Tydfil, 1879. Merthyr Tydfil Public Library

Sanger, William, The History of Prostitution, The Medical Publishing Co., New York, 1910.

Shaw, Bernard, The Intelligent Woman’s Guide to Socialism, Capitalism, Sovietism and Fascism, First published 1928, reprinted Penguin, London 1982.

Sims, George, Human Wales, Western Mail, 1907.

Slater’s Royal National and Commercial Directory 1858 and 1880.

Smith, J., M.D., ‘On the Peculiarities of Dentition in Man, and Its Influence on Infantile Mortality’, Monthly Journal of Medicine, June, 1855.

Smith, Thomas, The Admission Register: Caedraw Board School, Infants Department. 1875-85. William Collins, Sons & Comp., London. Merthyr Tydfil Public Library

Spargo, John, The Bitter Cry of The Children, New York, Macmillan, 1909

Spring Rice, Margery, Working-Class Wives; Their Health and Conditions, Penguin, Harmondsworth, 1939.

Squire, William, ‘Infantile Temperatures in Health and Disease’, London, 1869.

Staniforth, J.M. Cartoons of the Great Welsh Coal Strike, April 1st to September 1st, 1898, Western Mail, Cardiff, 1898.

Staniforth, J.M., Cartoons by Staniforth, Western Mail, Cardiff, n. d., c. 1900-1910.

Stewart, Alexander P., and Jenkins, Edward, ‘The Medical and Legal Aspects of Sanitary Reform’ Robert Hardwicke, London, 1867, reprinted Leicester University Press, 1969.

Stopes, Marie, Contraception, Theory, History and Practice, G. P. Putnam’s Sons, Lndon, 1932.

Sykes, Dr. J. F. J., Public Health Problems, 1892, London, 1892

Thomson, Alexis and Miles, Alexander, Manual of Surgery, Seventh Edition. Oxford University Press, London, 1926.

The Verisan Home Medical Guide and Year Book 1939, Timothy Whites and Taylors, Ramsgate, 1939

Rhondda, Viscountess, This Was My World, Macmillan, London, 1933.

Wilkins, Charles, The South Wales Coal Trade, Cardiff, D. Owen and Co., 1888.

391 Williams, Enid, M., M.D., The Health of Old and Retired Coalminers in South Wales, University of Wales Press Board, Cardiff, 1933.

William Williams, A Sanitary Survey of Glamorganshire and Cardiff, Daniel Owen and Company Ltd., Cardiff, 1895.

Wilkins, Charles, The History of Merthyr Tydfil, Harry Wood Southey, Merthyr Tydfil, 1867.

Wilson, J.G., Inflating the Lungs of Infants Born in an Asphyxiated State with Remarks, Gebbie & Co., Glasgow, 1859.

Wolstenholme, Miss, Infant Mortality: Its Causes and Remedies. A. Ireland & Co., Manchester, 1871.

(b) Contemporary Journals ( selected items arranged by date):

Transactions of the National Association for the Promotion of Social Science, 1851- 1873. . Routh, C.H.F., ‘On the Mortality of Infants in Foundling Institutions and generally, as influenced by the Absence of Breast Milk’, Part 1, BMJ, 16 January-24April., 1858.

‘Reports to National Association for the Promotion of Social Science Department of Public Health’, BMJ, 6 October. 1860, pp.784-785.

‘Opiates to Children.’ BMJ, 4 October, 1862, p374.

‘Prof. Sigmund of Vienna on Syphilis in Infants’, BMJ, 18 June, 1864, p.670.

Hastings, Sir, C., ‘President’s Address to the Public Health Department Social Science Department at York’, BMJ, 1 Oct, 1864, pp.379-384.

‘Report of the Joint Committee of the British Medical and Social Science Associations’, BMJ, 19 Aug, 1871., pp.203-208.

‘The Public Health Act in Wales’, BMJ, 28 June,1873,p.746, to16 August, 1873, pp.191-193.

‘Sanitary Neglect in High Places’, BMJ,, 10 October 1874, p. 480.

Tynewydd Colliery Disaster ‘Resistance to Starvation’, BMJ, 21 April, 1877, pp. 490- 1., ‘The Entombed Miners’, BMJ, 28 April 1877,pp.522-3., ‘The Recent Catastrophe at Tynewydd Colliery, Near Pont-y-pridd’, BMJ, 12 May, 1877, pp.580-2.

Druce, S. B. L,”The Alteration in the Distribution of the Agricultural Population in England and Wales between the Returns of the Census of 1871 and 1881”, The Journal of the Royal Agricultural Society, 1885, pp.96-126.

‘Censure on a Midwife’, BMJ, 4 February, 1899, p.294.

392 ‘Pyrexia After Delivery’, BMJ, 3 June, 1899, p.1332.

Still, Dr.,“Observations on the Morbid Anatomy of Tuberculosis in Childhood’, BMJ, 19 August, 1899, p.458.

Gassage, A.M. and Coutts, J.A., ‘A Discussion on Convulsions in Infancy’, BMJ, 19 Aug, 1899, pp.460-463.

‘The Summer of 1899: The Heat and Drought, and Deaths from Diarrhoea’, BM, 11 November, 1899,p. 1377.

Cautley, Edmund, ‘Infantile Scurvy’, The Lancet, 20 July, 1901, pp.143-144.

Sykes, John F. ‘The Milroy Lectures on The Influence of the Dwelling Upon Health’, BMJ, 2 March, 1902, pp.505-509.

‘The Housing of the Working Classes’, BMJ, 20 April, 1902., pp.972-3.

Armstrong, Hubert, ‘A Note on the Infantile Mortality from Tuberculous Meningitis and Tabes Mesenterica’, BMJ, 26 April., 1902. p.1024.

Ballantyne, J.W., ‘The Problem of the Premature Infant’, BMJ, 17 May, 1902., pp1196- 1200.

‘Discussion on the Relationship of Poverty to Disease’, BMJ, 16 August, 1902, pp.441- 452.

Paton, Noel D., ‘The Influence of diet in pregnancy on the Weight of the Offspring’, Lancet, 4 July, 1903., pp.21-2.

Tidswell, Herbert H., ‘Physical Degeneration in Children of the Working Classes’, BMJ, 15 August, 1903, pp.356-7.

‘South Wales; The Housing Question in Merthyr.-Infectious Diseases.’ BMJ, 11 June, 1904, p. 1405.

‘Sanitation in Wales’, BMJ, 9 July, 1904, p.86.

McCleary, G. F. ‘The Influence of Antenatal Conditions on Infantile Mortality’, BMJ, 14 August, 1904, pp.321-323.

Bosanquet, Helen, ‘Pauperization and Interests’, BMJ, 27August, 1904, pp.434-6.

Editorial, ‘Infantile Diarrhoea’, BMJ, 17 December, 1904., pp.1653-4.

Berry, William, ‘Death Certification’, Lancet, 24September, 1904, pp.893-4.

Fulton, George C.H., ‘Infantile Mortality: Its Causes and Prevention’, BMJ, 3 December, 1904, pp.1513-1515.

Thomas, D.J., ‘The Action of the Merthyr District Council Under the housing of the Working Classes Acts’, Public Health, May 1905, pp.526-533.

393

‘Midwives Act’, Public Health, August, 1905, pp.734-5.

‘The Feeding of Schoolchildren’, The Child’s Guardian, May 1906, p.57.

‘Teaching Mothers’, The Child’s Guardian, August 1907, p. 87.

‘The prevention of infantile Mortality’ BMJ, 14 December, 1907, pp.1727-8. McCaw, John, ‘Tuberculosis in Childhood and Its relation to Milk’, BMJ, 21 December, 1907, pp.1757-1759.

Drake, Mrs., Barbara, ‘A Study of Infant Life in Westminster’, Journal of The Royal Statistical Society, Vol. 71, 1908, pp.678-686.

Graham,Edwin E. M.D., ‘Infant Mortality: Chairman's Address before the Section on Diseases of Children, at the Fifty-Ninth Annual Session, American Medical Association, 1908’., Journal of the American Medical Association, Vol. 51, No.13, 26 September, 1908, pp.1045-50.

Williams, Lady, ‘Malnutrition as a Cause of Maternal Mortality’, Public Health, Oct. 1936, pp.11-19.

Davies, Daniel, ‘The Rhonddas in the Eighties’, Quarterly Review, 558, April 1951, 217-30.

(c )Newspapers (Selected items in date order):

Veritas, ‘The District Visitors Diary Sketch 11”, Cardiff and Merthyr Guardian, 23 November. 1861.

‘Meeting of Merthyr Burial Board’, The Merthyr Express, 15 September, 1877, p. 8.

‘The Health History of Merthyr Tydfil’, The Merthyr Express, 8 August 1885, p.3.

‘Baby Burials at Dowlais’, The Merthyr Express, 12 October, 1895

‘In Memoriam’ ‘Dr. T. J. Dyke – Interesting Reminiscences of Old Merthyr’, The Merthyr Express, 27 January 1900.

Sims, George ‘ Dowlais’, Western Mail, 27 June, 1907.

Sims, George, ‘Baby Graves’, Western Mail, 29 June, 1907, p7

‘The Doctor In School’, Merthyr Express, 11 January, 1908, p.12.

‘The Children’s Society; Work of the Merthyr, Dowlais, and District Branch’, Merthyr Express, 18 January, 1908, p.12.

‘Intemperance and Cruelty to Children. Stirring Meeting at Mountain Ash’, Merthyr Express, 25 January, 1908, p.5.

‘The Doctor In School’, Merthyr Express, 25 January 1908, p.6.

394

‘To Save the Children’, ‘Wages, Rent, and Cost of Living’, Merthyr Express, 15 February, 1908, p.7.

‘Deplorable State of Things at Dowlais. Five Families in One House, Terrible Condition of Children’, The Merthyr Express, 22nd February, 1908, p.8.

‘The Doctor in School’, The Merthyr Express, 25 January, 1908, p.6.

‘To Save the Children’, ‘Wages, Rent, and Cost of Living’, The Merthyr Express, 15 February, 1908, p.7.

‘Deplorable State of Things at Dowlais. Five Families in One House, Terrible Condition of Children’, Merthyr Express, 22 February, 1908, p.8.

‘Queen Victoria Jubilee Nurses. Dowlais and Penydarren District Association’, The Merthyr Express, 7 March, 1908, p.10.

‘Infantile Mortality’, The Merthyr Express, 2 May, 1908., p.8.

White, Jim, ‘The Miners That Time Forgot’, ‘Night and Day’, Daily Mail, 18 May, 1997, pp.20-8.

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Williams, Huw, ‘Public Health and Local History’, The Local Historian, Vol.14, No.4, Nov.1980, pp.202-210.

Williams, L.J., and Jones, Dot, ‘Women at Work in Nineteenth Century Wales’, Llafur, The Journal of the Society for the Study of Welsh Labour History, Vol.3, No.3, 1982, pp.20-29.

Williams, Naomi, ‘The Implementation of Compulsory Health Legislation: infant smallpox vaccination in England and Wales, 1840-1890’, Journal of Historical Geography, Vol.20, No.4, 1994, pp.396-412.

Williams, Naomi and Galley, Chris, ‘Urban-rural Differentials in Infant Mortality in Victorian England’ Population Studies, Vol.49, Nov 1995, pp.401-420.

Williams N.J., and Mooney, G., ‘Infant Mortality in an “Age of Great Cities”, London and the English provincial cities compared c.1840-1910’, Continuity and Change, Vol. 9, 1990, pp.185-212.

Williams, Ronald, J., ‘The Influence of Foreign Nationalities on the Life of the People of Merthyr Tydfil’, The Sociological Review, April 1926, pp.148-152.

424 Williams, Sîan Rhiannon, “ ‘Poor Relief in Merthyr Tydfil Union in Victorian Times’. By Tydfil Thomas”, (Review), Welsh History Review, Vol. 17, 1994-5, pp.141-2

Williams, Sydna Ann, ‘Care in The Community: Women in Early Nineteenth-Century Anglesey’, Llafur, The Journal of the Society for the Study of Welsh Labour History, Vol.6, No.4, 1995, pp. 30-43.

Winter, J. M., ‘Infant mortality, maternal mortality, and public health in Britain in the 1930s’, Journal of European Economic History, Vol.8, 1979, pp.439-462.

Woods, Robert, ‘The Structure of Mortality in Mid-Nineteenth Century England and Wales, Journal of Historical Geography, Vol.8, No.4, 1982, pp.373-394.

Wolleswinkel-van den Bosch, Frans WA van Poppel, Caspar WN Looman, ‘Determinants of infant and early childhood mortality levels and their decline in The Netherlands in the late nineteenth century’, International Journal of Epidemiology, Vol.29, 2000, pp.1031-1040.

Woods, R.I., Watterson, P.A. and Woodward, J.H., ‘The Causes of Rapid Infant Mortality Decline in England and Wales, 1861-1921, Part 1., Population Studies, 42, 1988, pp.343-366.

Woods, R.I., Watterson, P.A. and Woodward, J.H., ‘The Causes of Rapid Infant Mortality Decline in England and Wales, 1861-1921, Part II’, Population Studies, Vol. 43, 1989, pp.113-132.

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Wrigley, E.A., ‘Births and Baptisms: The Use of Anglican Baptism Registers as a Source of information About the Number of Births in England before the Beginning of Civil Registration’, Population Studies, Vol. XXXI, No.2, July 1977, pp.281-312.

Zuck, D., ‘Mr Troutbeck as The Surgeon’s Friend: The Coroner and The Doctors-An Edwardian Comedy’, Medical History, Vol.39, No.3, July 1995, pp.259-287.

(c) Theses:

Beresford, Linda, ‘Suffer the Little Children: Infant Mortality in Nineteenth Century Britain, 1850-1911’, Honours Dissertation, Murdoch University, Western Australia, 1995.

Buchanan, Ian Hamilton, ‘Infant Mortality in Coal Mining communities 1880-1911’, Ph.D. Thesis, London School of Economics, 1983.

Frampton, Barbara A., ‘The Role of Dr. Dyke in The Public Health Administration of Merthyr Tydfil 1865-1900’, M.A. thesis, University College of Swansea 1968

425 Jones, Tydfil Davies, ‘Poor Law and Public Health Administration in The Area of Merthyr Tydfil Union 1834-1894’, MA Thesis, University of Wales, Cardiff, 1961

Long, Jane, ‘Conversations in Cold Rooms; Women, Work and Poverty in Nineteenth- Century Northumberland c.1834-1905’, Ph.D. Thesis, University of Western Australia, 1995

Strange, Keith, ‘The Condition of The Working Classes in Merthyr Tydfil 1849-59’, Ph.D. Swansea, 1982

Williams, Naomi, ‘Infant and Child Mortality in Urban Areas of Nineteenth-Century England and Wales: A Record-Linkage Study’, Ph.D. Thesis, University of Liverpool, 1989.

426 (d)Working Papers:

Anne Hardy, ‘Death, Medicine and the GRO’, an informal paper given as an introduction to the Glasgow Centre for the History of Medicine’s workshop, ‘Birth pains and death throes: the creation of vital statistics in Scotland and England’, A symposium supported by the Wellcome Trust, arising from the ‘Scottish Way of Birth and Death’ Project, Centre for the History of Medicine, University of Glasgow, Friday 17 September 2004. http://www.google.com.au/search?hl=en&q=Anne+hardy+Death+Medicine+and+the+ GRO&btnG=Google+Search&meta=

(e)Videos:

A Century in Stone: The Eston and California Story, Craig Hornby, A Pancrack Production, Teesside, Cleveland., 2005.

A Hundred Years of Rhondda: A People Remember A Commemorative Video, Rhondda Borough Council., 1994.

Echoes of the Iron Kingdom, A Merthyr Video Workshop Production, Merthyr Tydfil c. 1998.

(f) Website References:

Index Mundi Infant Mortality Rate Rank Chart URL: http://www.indexmundi.com/world/infant_mortality_rate.html

Meteorological Office Records. URL: www.metoffice.com/climate/uk/stationdata/index.html

Government of South Australia, Department of Human Services , Maternal, Perinatal and Infant Mortality in South Australia, 2002, Adelaide, 2003. URL: http://www.dhs.sa.gov.au/pehs/pregnancyoutcome.htm

Article concerning the issues which delayed bovine testing for so long, URL: http://www.pubmedcentral.nih.gov/articlerender.fcgi?articl=546294

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