Eilidh Garrett, Chris Galley, Nicola Shelton and Robert Woods (eds), Infant mortality: a continuing social problem. A volume to mark the centenary of the 1906 publication of Infant mortality: a social problem by George Newman, Aldershot, Ashgate, 2006, pp. xvii, 293, £55.00 (hardback 978-0-7546-4593-1)
| Autor: | Alysa Levene |
|---|---|
| Rok vydání: | 2008 |
| Předmět: | |
| Zdroj: | Medical History. 52:545-547 |
| ISSN: | 2048-8343 0025-7273 |
| DOI: | 10.1017/s0025727300003069 |
| Popis: | As its sub-title states, this collection of essays is a cumulative reflection on the themes of George Newman, the first Chief Medical Officer to the Ministry of Health's 1906 seminal investigation into infant mortality. As the first part of the title suggests, however, it also aims to draw attention to how far his concerns as to the geographic and socio-economic differentials in infant mortality continue to be upheld with more detailed analysis. The contributions are uniformly high in quality, and form an admirably cohesive whole. Taken together, they provide a commentary on different aspects of Newman's work, contextualized by two chapters on Newman himself. Significant nuances are provided to his general conclusions, especially on the rural/urban division in infant mortality rates (IMRs). The book ends with several chapters with a modern and forward-looking stance, which highlight the need for ongoing concerns as to inequalities in infant health in modern Britain. Newman's 1906 Infant mortality: a social problem was not a path-breaking analysis. Rather, as the first chapter by the editors and the second and third by Chris Galley and Robert Woods respectively point out, its strength came from its drawing together of writings and current thought on IMR. It was published at a time when infant mortality was becoming a high profile area of investigation, and it was immediately influential. Its main thrust was to identify ways in which infant mortality might be lowered; a pertinent concern given the persistently high death rate of the young compared with other age groups (although Newman's work actually appeared as it was beginning to enter its period of dramatic decline). He identified several significant themes for infant survival which are taken up in the current book: the impact of local factors; the significance of infectious disease, in particular diarrhoea; the relevance of socio-economic status; and the importance of the mother's role. The current book is strongest on the regional nature of infant mortality, and the way that it interacted with local environmental, employment and socio-economic conditions. In particular, Sam Sneddon (studying rural Lincolnshire), Tricia James (Northamptonshire), and Eilidh Garrett (Kilmarnock and Skye), uncover sub-regional nuances unappreciated by Newman. These studies show that the traditional high urban/low rural IMR regime has been over-emphasized, and that local female employment markets, access to healthcare officials and socio-economic status were all important. Richard Smith and Jim Oeppen, in an impressive synthesis of previous and new work, also demonstrate that the relationship between the IMR and living standards “remains far from clear” (p. 65), that high IMRs have been found for affluent areas, and that certain trends in mortality have held true across social classes. Graham Mooney and Andrea Tanner highlight this discrepancy via the deprived and high mortality area of Notting Dale in Kensington. Here, projections of moral worth (especially of mothers) shaped the provision of welfare support for infants, although charity-supported creches seem ultimately to have provided the means for mothers to continue working without compromising the health of their babies too much. The least investigated aspect of Newman's thesis, although the most contentious for historians, is his emphasis on the role (and therefore blameability) of mothers in raising infants successfully. Although several authors note the impact of female employment (for example, Sneddon, James, and Mooney and Tanner), Alice Reid is the only one to overtly engage with the notion of maternal responsibility. She also most explicitly considers paths of causation; a topic left somewhat glossed over in some of the other chapters. In her statistical study of health visitor records for early-twentieth-century Derbyshire, she stresses the significance of early visiting for the survival prospects of the most vulnerable infants, and also the role of health visitors in educating women in methods of artificial feeding (notoriously pernicious for infants) and in promoting delayed weaning. Newman's emphasis on the importance of female education is at least partially upheld, although the overtones of blame are clearly distasteful to all the authors who mention it. The final section of the book engages with modern data, which considerably raises its impact. Chapters by Danny Dorling and Yvonne Kelly draw attention to ongoing differentials in access to resources, with a continued urban penalty still evident, and a north-south divide. Once again, the debate is moved on from Newman's standpoint, for example, introducing the impact of policy planning and ethnic differences on infant mortality. Nicola Shelton's concluding chapter sensitively reviews the need for further consideration of differentials in IMRs in modern Britain, and the ongoing significance of many of Newman's conclusions. All three chapters in this final section stress the potential for further reduction in IMRs. While the book's clearest strength is its concentration on local regimes and the need to soften the weight given to the urban/rural divide in IMRs, it does achieve what it sets out to do on a more general level. All the chapters are contextualized by Newman's ideas, and offer a range of perspectives on how to move them forward. The role of developments in medical care and treatment is still relatively absent, as both Woods and Shelton note for Newman's own work, although Eric Hall and Michael Drake specifically take up his focus on diarrhoea as a killer of infants, and both they and Garrett do highlight the role of local medical officers on the picture we receive of mortality patterns. There is, however, a sensitive awareness of the significance of other factors Newman did not have the expertise or data to consider (including female work patterns, problems of access to doctors and registration facilities, and local housing, education facilities and even weather). There is also a clear emphasis on modern policy applications and the need for ongoing reflection on how to improve IMRs. The combination of sophisticated local historical studies with reflections on modern applications raise this book's appeal, and give it significant interest value for historians, sociologists and social policy experts. |
| Databáze: | OpenAIRE |
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