Did London pass the “sanitary test”? Seasonal infant mortality in London, 1870-1914

By providing information on the number of live births and infant deaths for the Registration Districts of London, the published Quarterly Returns of the Registrar-General for England and Wales enable a reconstruction of seasonal infant mortality rates (IMRs) in the capital during the period 1870-1914. Analysis of these data shows a regular, excessive peak in infant mortality during the third quarter of each year. This evidence is used as a basis for the formulation of a “sanitary test” for the London districts. Through the work of the then Chief Medical Officer to the Local Government Board, Sir Arthur Newsholme, this concept was not an alien one to the nineteenth century medical profession and contemporary demographers. During his tenure between 1908-1919, Newsholme produced various Reports on Infant and Child Mortality, which provide much of the basis for this paper. At the turn of the century, high levels of summer infant mortality were used to inform and shape the rather complex arguments concerning the best methods by which to ensure effective infant care and safe domestic hygiene. With the aid of the assembled demographic evidence on seasonal infant mortality, the system of domestic visiting is evaluated in the light of the gradual orientation of Newsholme and others towards a more individualistic approach to the improvement of infant health.