Whilst death rates overall
continued to fall in England and Wales in the late-Victorian
period, deaths of infants under the age of one began to show
an increase after 1896, peaking at 163 per 1,000 births in
1899. Some contemporary commentators blamed working-class
mothers for neglect, lack of hygiene and inappropriate feeding.
Poverty, however, and the number of premature babies provide
a more likely explanation of the high infant mortality rate.
Maud Pember Reeves's Round About A Pound A Week rebutted
such accusations of neglect:
that the diet of the poorer London children is insufficient,
unscientific, and utterly unsatisfactory is horribly true.
But that the real cause of this state of things is the ignorance
and indifference of their mothers is untrue. What person or
body of people, however educated and expert, could maintain
a working man in physical efficiency and rear healthy children
on the amount of money which is all these same mothers have
to deal with?
After 1901, infant death rates fell, to 138 per 1,000 births
for the period 1901 to 1905, starting a trend that would continue
through the century. In 1981, the number of infant deaths
per 1,000 births was 16.
Concerns about the poor quality of army recruits for
African War led to a public outcry: working-class
men were perceived (by middle-class commentators) to be in
a state of moral and physical 'deterioration', possibly due
to poor living conditions in urban slums. Earl Grey wrote
to The Times in November 1901, arguing that a
population reared in the sunless slums of our smoke-enveloped
cities, unless reinforced by marriage with men and women born
and reared in God's fresh air, deteriorate quickly to such
an extent that the third generation is either sterile, or
at best capable of giving birth to an infirm and rickety posterity.
An inter-departmental committee on physical
deterioration, set up by the government partly in response
to such concerns, reported in 1904 and its findings on urban
poverty helped to pave the way for the introduction of free
school meals and other benefits for poor children and their
Many 19th century public health reforms were fuelled
by the fear of infectious disease spreading rapidly within
overcrowded towns and cities. The Infectious Diseases (Notification)
Act of 1889 had made it compulsory to notify local medical
officers of health of any cases of specified infectious diseases
(such as typhus, smallpox and scarlet fever) and to compel
sufferers to be sent to an isolation hospital. The state saw
itself as being responsible - as a public good - for containing
the spread of infectious disease, but individual health care
was still seen largely as a matter for the individual concerned.
The Local Government Board sought to promote better sanitation,
water supplies and vaccination as part of the government's
policy - clean local water supplies had been essential for
the eradication of typhoid and cholera. The annual report
of its Medical Officer for 1901 describes a smallpox epidemic
in London in the autumn of 1901 (spreading to over 6,000 cases
by the end of March 1902) as well as outbreaks of bubonic
plague in Cardiff and Liverpool, both linked to the plague
pandemic at this time. No cases of cholera, however, had been
confirmed since 1896.