Infant Mortality

Vol. 5 No. 1 - 1984

Infant mortality in Northern Irish provincial towns

by Francis X McCorry

Sleeping child by Rosamund S. Praeger
Sleeping child by Rosamund S. Praeger

Probably much more worrying to townspeople, in the inter-war period, than either overcrowding or tuberculosis (two major social scourges) was the high death rate among children.

It was difficult in Lurgan during this period to find individuals aged 60 years or over who could declare that no-one from their family had died in childhood. Childhood, of course, relates to children approximately ten years or younger, and the figures provided by the Registrar-General embrace only those who died within one year of birth. The level of such infant mortality rates generally impinge upon the social, economic and environmental conditions in each particular town, and may even carry unwanted inferences relating to the people of the area.

Urban and rural differences

There were considerable fluctuations in the infant mortality rate of Northern Ireland from the early years of the twentieth century until 1946, although the general trend was downwards. From 1946 to 1963, practically no interruption arose in the downward trend. In the pre-Second World War period, substantial differences were apparent between urban and rural rates, with the urban rate usually much higher; likewise, the infant mortality rate for males was always higher than the female equivalent. By 1963, with the vast array of social, environmental and medical services coming into play, the infant mortality rate had been drastically cut, and area and sex differentials had been greatly lessened.

The infant mortality rate is one demographic statistic which does not depend on population estimates, and for which no adjustments have to be made for the rate to be realistic. Thus, comparisons can readily be made for the rate to be realistic. Thus, comparisons can readily be made between the rates of regions, districts and individual towns. The integrity of the rates offered by the Registrar-General is assumed, although the accuracy of individual addresses supplied to him might sometimes be questioned; there is every likelihood that some addresses from the rural periphery of small provincial towns were attributed to the town itself, and so, in a small way, contribute to an enlargement of the urban rate.

However much the regional infant mortality rate can be shown to have been subject to constant change, such yearly or periodic changes seem insignificant when the magnitude of the fluctuations in the rates of provincial towns are examined. These fluctuations suggest a pattern in which inherent and constantly-existing deficiencies in the health-care of towns were often exploited by sharp, sudden and localised attacks of disease, whether of an endemic or epidemic nature; the demographic crises in Lurgan of 1708 and 1713 seem little removed from this twentieth-century situation. When a strong regional influence, detrimental to health, strikes with unequal severity at different towns, problems of interpretation arise; when one town escapes completely the strong regional influence, yet appears to succumb easily to severe localised attacks, the individuality of towns, as well as the precarious state of their health, is highlighted. The experience of Ballymena, and differing trends in Portadown, in the period, 1917-28, deserve consideration in this regard before outlining the infant mortality rates of Lurgan.

Ballymena may be regarded as a well-appointed town generally, of better than average economic well-being, and of fairly strict Presbyterian principle and associated thoroughness; it had its slums, its workhouse and a considerable attraction for rural shoppers. In 1917, the Ballymena infant mortality rate was 131 per 1,000 births, the highest urban rate in Northern Ireland, and higher even than the Belfast rate.

"The Great Flu" of 1918

In 1918, when most other Northern Irish towns suffered a high incidence of infant deaths, e.g. Portadown, with a rate of 188 per 1,000 births, and Belfast, 144, the Ballymena rate dropped to 68. It is generally assumed that soldiers returning from the Great War brought home with them the "great flu of 1918", causing so many deaths that the regional natural increase for that year was drastically reduced to a mere 1.199. It may also be assumed that Ballymena provided and took home again as many soldiers as any other district, relative to the size of the town's population.

The great 'flu undoubtedly had a major overall regional influence on the infant mortality rate, yet Ballymena apparently escaped not just relatively unscathed but totally untouched, all other influences being equal. In the subsequent four years, the Ballymena infant mortality rates were 81, 69, 77, and 53 respectively, all below the regional average and considerably below the average for all urban areas. In 1923, the infant mortality rate of Ballymena rose dramatically to 132, to become once again the highest urban rate in Northern Ireland, and almost double the regional average. The pattern then continued as before, with the town yielding a rate of 83, in the period, 1924-8, matching the regional average, yet below the figure for urban areas only.

Portadown, of like nature to Ballymena but without a workhouse, provides a similarity in trend but a contrast in timing; from a curiously low rate of 44 deaths per 1,000 births, in 1917, the town's infant mortality rate shot up to 188, in 1918, reducing somewhat to another very high figure, viz. 134, in 1919. It is probable that in some urban areas, the great 'flu persisted into 1919 - many troops did not return home until then - and this helps explain Portadown's very high rate, in 1919; little can be found, however, to account plausibly for the town's rate, in 1917, being three times less approximately than corresponding rates in Belfast, Lurgan and Ballymena. It is tempting to suggest that in spite of the Registrar-General's capacity to exact proper dates of births and deaths, some of the infant mortality figures for 1917 in Portadown were attributed to 1918, and that some of the infant deaths in Ballymena in 1918, were attributed to 1917, the year in which some of the infant-victims would have been born.

Taking the average rate of the two years for both towns produces figures which tally well with the trend in other urban areas. However, even infrequent usage of averages in this way would tend to minimise the fluctuations in rates which could hold the key to a full explanation of urban/rural, urban/urban, and male/female differences in the infant mortality experience of Northern Ireland.

Infant mortality rates in Lurgan were generally similar to the regional average and usually below the figure attributed to urban areas; this latter figure was based on the statistics relevant to seven urban districts during the period, 1917-23, and after the general revision of methods in 1924, the average urban figure was determined from the statistics of all urban areas including county boroughs. Apart from the years, 1917 and 1918, when the Lurgan rates were 126 and 141 respectively, the infant mortality rate in the town remained consistently below the 100 mark, an achievement which no other town matched. Nevertheless, over the entire inter-war period, there was little to choose between the rates in towns, except, of course, Belfast, which had a fairly dismal record in infant mortality.

Deeny, a local doctor, when setting out a brief demographic background of Lurgan, in 1937/38, gave some hint of current local medical thought, when he stated, `the crude death rate is slightly below that for Northern Ireland as a whole, and the infant mortality is low, particularly in conjunction with the high birth-rate; in the period, 1933-7, the regional infant mortality rate was 78, and that of Lurgan, 71.

There is a clear implication here that the higher the birth rate, the greater was either the inevitability or expectancy of higher infant mortality. This is a reasonable enough assumption to make provided that the number of births in a district was sufficient to stretch the capacity of those whose duty it was to attend births and provide medical aid to infants and their mothers, unless, perhaps, the slant of the inference was directed at the doubtful capacity of some who bore children to rear them. Both veins of thought may have been relevant; a few local women who `lost' infants, in the pre-war period of hardship, were adamant that lack of both interest and knowledge on the part of the medical services were chiefly responsible for the deaths of infants, at childbirth particularly. While this may be put down as a wholly subjective and natural reaction, the feelings expressed correspond with the findings of Hadfield who had little trouble finding similar and strongly supportive evidence for a like situation in the North-East of England.

Hadfield quoted Theobald who sought drastic reforms in the teaching and practice of midwifery, and concluded that there was `clear evidence that doctors in industrial areas often had not the facilities to give scientific modern attention and treatment to their patients. In this regard, the total or partial closing of many of the region's workhouses and the corresponding opening of new district hospitals was a definite advance, although Lurgan's turn to modernise and equip the workhouse premises did not come until the mid-1930's.

On the other hand, there was a segment of the population in Lurgan, who through either personal limitation, self-imposed or otherwise, or through the poorest living conditions and associated poverty, had little hope or chance of seeing infants through even a basic upbringing. There is every likelihood that such people increased the risk of an outbreak of disease spreading rapidly.

One of the courts in Lurgan, and most were sited near the town-centre, was said to be occupied by people who were ostensibly peddlers but really beggars, and this was in 1939. In this particular court, there were twenty-eight houses; other courts had a similar reputation, deservedly or not. In 1935-6, there was a considerable outbreak of infectious diseases regionally, mainly scarlet fever and diphtheria; though few districts escaped scarlet fever, Lurgan and Ballymena were two of the eight more seriously affected districts. Neither was adversely affected by the diptheria outbreak.

In the previous year, accompanying the continuing trade depression, deaths in the workhouses throughout the region rose considerably, particularly among all age-groups of children. Over the period, 1923-33, the death-rate due to epidemic diseases was 1.04 per 1000, in urban districts, and 1.03, in rural areas. In 1924, accompanying a severe epidemic of influenza, an increase occurred in the incidence of typhoid fever, more arising in rural areas, with serious outbreaks emanating from milk yielded in filthy conditions. Pneumonia was usually suffered equally by urban and rural areas, and as with other serious diseases, urban and rural cases in many instances met in the workhouses or fledging hospitals of towns.

Overall, in the inter-war period and later, the higher infant mortality rates of towns, and the sudden surges of death-bearing diseases, were the result of divers factors. Lurgan is advanced as a densely-packed town, situated beside the damp lands of Lough Neagh, relatively weak in economic well-being, with a fair share of slums. Dairy herds were milked within the town. Cow-rearing and pig-slaughtering were carried on in some backyards, and incidences of swine-fever were not uncommon. Yet, Lurgan had, marginally, a better record than most towns in respect of infant mortality.

The array of possible environment and social determinants, or hazards, which could increase infant mortality prevent any decisive comment on why this was so. It is just possible that a first-class fresh-water supply and an adequate sewerage system, Lough Neagh being the supplier of one and the recipient of the other, were the saving graces of an otherwise plain and vulnerable town. Both were products of nineteenth-century concern and action, stemming from an era when Lurgan officials took their public duties in health matters quite seriously, more seriously indeed than others in neighbouring towns.

However, the perpetual predicament of town government in matters of urban health care is well summarised in the following extract from a letter to a Lurgan newspaper, in 1873, which referred to the `putrid entrails of slain beasts at Sheil's Quarry,` and `town filth at Taylor's field,' both sites close to Lurgan on the Lurgan-Portadown road, and surviving as town dumps up until the pre-Second World War era:

'Townspeople should by all legal means endeavour to preserve their health, but is it right and reasonable that a full half-mile of a country road should be contaminated by the efforts exerted to promote the health of the town.'