Dead Babies: Constructing an image of urban normality in late Victorian Adelaide

In this paper, I’m going to dig up an odd episode from the history of 19thC Adelaide. It’s an episode that is interesting, I hope, for the light it sheds on one aspect of the image of urbanity in Australia. To be sure, it is an aspect of urban identity that is not often considered nor fully appreciated: one that might be called, admittedly a bit pompously, a medico-cultural urban ‘image’. What I want to do is use the episode to help define the emergence, in late colonial Adelaide, of this image.

The episode began with the metaphorical ringing of an alarm bell. The man who rang it was an outsider: Henry Hayter, who in the year 1878 was the government statistician of Victoria. In this year Hayter was poring over the returns for births and deaths supplied to him by registrars all over Australia; and as he did so, he noticed a rather curious fact about Adelaide. It was so curious, indeed, that he published a paper about it in that city – a paper whose urbane, but actually rather ironical, tone maddened the citizenry beyond endurance.¹

What Hayter had noticed was that very many babies were dying in South Australia in their first year. So what?, you may say. The late nineteenth century was a bad time to be a baby. Actually, what Hayter had noticed was more precise and much more intriguing than that. He had noticed that an astonishing proportion of those babies – well over half, in fact – had died, according the certifying doctor, of causes remarkably vague even by the standards of the time.

When I talk about rates of infant mortality, it’s important to have a point of comparison. In South Australia as a whole today, that rate is about 6 or 7 per thousand live births, one of the lowest rates in the world.

A century ago in the city of Adelaide, things were a bit different. The rate fluctuated, and the exact derivation of the figures may be questioned; but in the 1880s it probably peaked at a little over 200 per thousand. This was the highest rate ever recorded anywhere in Australia, in city or country. It was much higher than the overall rate for London; indeed, it was as high as the figure recorded in the most wretched slums of Whitechapel or Lambeth.³ The great British sanitary authority, Sir John Simon, referred to these suburbs dramatically as “the Herodian districts” and, since Adelaide was conducting its own massacre of the innocents on a similar scale, it also was labelled ‘King Herod’s very own city’ by the local press. These appalling figures generated a vigorous and often vitriolic three-way debate among doctors, politicians and the public. From the doctors came a good amount of breast beating. As one put it:

Annually about 1200 infants die in this colony. Shall we stand beside the thousand little graves mourning and make no effort to stay the hand of the Reaper? Can nothing be done to check this waste of precious life? Shall the anxious parent look to us in vain for hope, while we calmly prepare to sign the death certificate, “Died of debility”?⁴

Those rhetorical questions are perhaps a little sentimental for the modern taste. However, they do suggest the sense of baffled outrage which some of Adelaide’s doctors felt in contemplating the waste of little lives. There was even clumsy attempts to massage the statistics into a less ‘shameful’ form, to preserve the image of normality. The Central Board of Health apparently tried this in its fifth annual report, published in March 1879:

A characteristic of the death rate of South Australia, and which has been the subject of much comment, is the high rate of infant mortality. It is, however, questionable whether as regards a youthful community containing comparatively few persons past middle age than are resident in older communities, a fair comparison with them can be drawn.⁵

This is an obvious red herring. Of course it is true that in a “youthful community” infant deaths will form a higher proportion than usual of all deaths, but that is why infant deaths are always given with reference to a standard number of live births, by convention one thousand.⁶

Despite the fulminations of doctors and the press, nothing changed much for 20 years. The rate for the year 1898 was nearly the worst figure ever recorded, and that for 1899 was no better than it had been 10 years earlier. In the very hot December of 1896, 80 people died in the city and half of them were infants. What were they dying of?

Doctors then were fond of the distinction between ‘preventable’ and ‘non-preventable’ causes of death. Thus, the city’s medical officer, Dr Sprod, was able to report in 1889 that the number of “deaths due to preventable causes [is] exceedingly low.”⁸ This statement sounds preposterous when one baby in five was failing to reach its first birthday. Dr Sprod could justify making it because he counted as “preventable” only the deaths from the few infectious diseases that doctors might hope to do something about. All the rest, if not exactly shrugged off, were accepted as part of the nature of things. Ignorant or reckless mothers served as useful scapegoats. Ill-ventilated houses, overcrowded bedrooms, dirty feeding bottles: the doctor could sigh over such things, but they were not part of medicine. They were the “non-preventable” three fatal Ds - diarrhoea, dentition (teething) and debility. Uniquely in Adelaide, as Hayter had noted, on the death certificates the three Ds accounted for far more babies than all the other diseases put together. Yet as Hayter had also noted, these are not causes at all. They are symptoms. But symptoms of what, exactly?

This is a paper in urban history, not medical history, so that question need not detain us long. We can deal with it by taking in imagination an aerial view of the city of Adelaide in the year 1880. From a balloon, say, Adelaide then appeared as a trim, neat city of some 30,000 people, girdled by the famous parklands. Outside the parklands existed a straggle of suburbs and half-built townships, but for the most part this was still a neat city of rectangular forms still true to the plan conceived by its designer, Colonel Light, some forty years earlier.

The city was not crowded. The buildings were mostly one or two stories; there were no tenement blocks, and the sun penetrated every alley. The grid-iron street plan incorporated generously sized squares and reserves, and the little built-up city was totally surrounded by one vast green lung, its most famous feature – the parklands. At the end of Victoria’s reign, London had one hectare of park to every 3500 inhabitants, Melbourne had one for every 270, but Adelaide had a hectare of park for every 45 people.

However, this view of an Arcadia by the Torrens is seriously misleading. This was a city with a dirty little secret. If we allow our imaginary balloon to descend, our noses will tell us why Adelaide had the unenviable title of the “city of stenches”; a play on its more reputable cognomen of “the city of churches”. In front of the gaol, in a large olive plantation, the city's excrement was dumped each night from open carts, a technique already abandoned elsewhere in the country. Elsewhere the parklands were sullied by huge tips of rubbish. These tips were nothing like a modern sanitary land fill, for in the lack of any powerful earth-moving machinery it was impossible to compact them and keep them covered with earth. They were simply great loose, putrid piles of rotting refuse, tins, china, bottles, dead animals and so forth, all left open for up to a year at a time, emitting "noxious effluvia" and breeding myriads of flies.

Then there was road dust. Urban streets were unsealed, of course, and surfaced according to the macadam system with layers of graded stone. This system had been developed in Britain, and only worked in cool wet climates. In Adelaide, with its Mediterranean very hot, very dry summers, the quartzite rock dust lay thick on the streets each summer, and was stirred up into a vortex by the slightest breeze and every passing cart. It mantled the pavements and passers-by with a gritty and disgusting yellowish-grey deposit. For, of course, “dust” was a euphemism. It is hard, perhaps, for us to realise just how continuously filthy the streets were in the age of horse transport. In 1903 the daily amount of "dust" falling on Adelaide's streets was about 70 tonnes of dung and urine. Experiments conducted at the time showed that if soil was infected with the microorganism that causes enteric fever and then dried to dust, the germs were still viable up to a month later. The city’s medical officer in 1902 was a Dr Borthwick, and he put the matter succinctly for the city council:

dust becomes not only an intolerable nuisance, but a menace to health. It pollutes our houses and our food with objectionable putrefactive matter . . . and carries infection directly or indirectly into the body. There can be no doubt that pulmonary tuberculosis, typhoid fever and other diseases are carried in this manner. The offensive dust has been aptly termed "aerial sewage. . ."⁹

One place where the aerial sewage found a resting place was certainly on the surface of milk churns. In the last 20 Victorian years, milk in Adelaide was, quite literally, a killer product. It wasn’t pasteurised and there was no way of chilling milk in bulk, so there was no way of keeping it fresh for more than a few hours in the height of summer. City residents relied perforce on the products of the cow keepers, of which there were more than sixty in the city. Only too often this meant drinking the output of sickly or actually diseased cows, which were kept locked up for months on end in stinking sheds and milked by hand under revolting conditions.

It was almost a matter of course that the milk was adulterated; either just diluted with water, or with chalk or even coal tar added to improve its "creaminess” No wonder infants fed on this thin bluish fluid died of "debility" by the score. Worse still, much of the milk sold was horribly dirty. One city councillor memorably defined the product on sale as "an emulsion of cow dung”. All in all, milk left in metal churns to warm up on dusty city doorsteps was a perfect nutrient for incubating bacteria. Few mothers in the city bothered to boil the milk even for their infants, let alone for themselves.¹⁰ Milk production did not improve until the appointment of an inter-municipal board after the turn of the century. This board probably saved more infant life than the efforts of all the doctors of Adelaide put together.

So there is no mystery about what killed all those babies. They didn’t, of course, die of teething. They mostly died of dehydration following simple gastroenteritis. An additional factor was neglect. An unknown portion of the deaths, probably quite a high proportion, were in fact active or passive infanticides, especially in depressed times as contemporary cartoons hint. An analysis of the police reports by the historian Pat Sumerling has shown that in late Victorian Adelaide, one might run across dead babies anywhere: by the river, in the river, in the parklands, in backyard toilets.¹¹ Infanticide was just part of a birth control spectrum which ran from contraception (inefficient and poorly understood) through abortion (illegal, expensive and dangerous) to baby farming. The baby farm figured melodramatically in cartoons in a way that made it clear what the deal was: that for a flat fee a minder took the infant with the tacit guarantee that it would trouble the mother no further. Death would soon follow from neglect or straightforward murder.

Let’s look a little wider. Keeping infants alive is, we may agree, is the most elemental of public health duties. Yet some babies are always going to die soon after birth. What is an ‘acceptable’ number? If, out of every four births, one baby dies, is that a high rate or a low one? It depends, of course, on one’s expectations. Infant mortality is closely bound up with a society’s sense of its own worth, its own ideals. And it’s especially bound up with its notion of a model, a fit comparison, a benchmark: an ideal of urban normality.

For Victorian Adelaide, what that benchmark was is obvious enough. The founder of Adelaide, William Light, liked to call his city the Athens, or the Naples, of the south. Yet we may confidently assume that Light did not expect the comparison to extend to sending babies to the graveyard on the customary scale of those Mediterranean cities. What Victorian Adelaideans were really striving to create anew was a genteel English town: as it may be, a Cheltenham or a Bournemouth of the South Seas. As a local newspaper crowed as early as 1845:

It is the very want of distinctive colonial character about the . . . province that constitutes . . . its peculiar advantage. English society, manners, language and habits have been successfully transferred, and most heartily ashamed and sorry should we be if the children of our colonists were ever to degenerate.¹²

This perception of urban normality accounts all by itself for the medical breast-beating when the children of this English colony did worse than degenerate: they died in infancy, and in droves.

Although the Local Board of Health was keen on gathering statistics, it never occurred to doctors to draw comparisons with emerging cities of the western world: say, Memphis, Tennessee; Santa Barbara, California; or Capetown, South Africa. These are cities on the same latitude as Adelaide, 34.5 deg, from the equator, and share roughly the same climatic regime. But no such comparisons were ever drawn. They did not match the ideal of normality. Instead, invidious comparisons were drawn with northern European rates, and specifically the (lower) mortality rates in the factory towns of northern England. Such was the influence of what might be termed the medico-cultural 'health cringe' in colonial Adelaide.

Adelaide’s doctors were especially mortified that the infantile death rate continued to remain higher than that of most large British industrial cities where social conditions were terrible and where many married women worked in factories. Dr Sprod continued to be mystified, and he returned again and again, like a tongue to an aching tooth, to the British experience:

It is difficult to account for such a high rate of mortality, and is a matter deserving serious consideration. In England, where the surrounding circumstances are by no means so apparently favourable as here, the infantile death rate . . . in the thirty-three largest English cities is 143 per 1000 births. There, where the streets, especially in old cities, are narrow and circuitous, a deficiency of open spaces, ill-ventilated courts and alleys, over-crowded tenements, with deficiency of light and ventilation, plus the changeable and severe character of the weather, and with the poor children an insufficiency of nourishment and clothing, it would be expected that the mortality would be high. But with us where our streets are straight and wide, open spaces numerous, every house warmed by the sun, and bathed with a pure atmosphere, we should certainly expect better results.¹³

Notice the words that carry the emotional charge here: warmed, bathed, pure: this is the terminology of the resort town or the sanitarium. And that’s not an accidental comparison. In the second half of the century South Australia received a lot of ‘therapeutic emigrants’ from tubercular patients, fleeing to what was touted as the ‘land of perpetual spring’.¹⁴ The actuality was dreadfully offensive to the boosters. Had they crossed the world, built a antipodean Torquay, for this? To see their babies die in their thousands, as though they were living in a Manchester slum?

What happened in Adelaide must have been the common experience of the ‘white’ colonies of the nineteenth century. All were fragments of Europe transplanted across the world and set down in a place where all was new -- climatically, geographically, ecologically. Many of you will recall the paintings of the early emigre artist John Glover. At first Glover put Tasmania on to canvas as though its landscapes belonged to a warmer version of the Home Counties. In the same way, it took time for people to get the socio-medical realities of their new homeland into perspective. At first British manners and mores sufficed. But gradually, inevitably, the new reality did impose itself. The truth was that in the Victorian era you could not transplant a Bournemouth - and, in particular, you could not translate the medico-cultural assumptions of a Bournemouth – to the latitude of Cairo without alarming consequences.

Part of what it means to achieve an urban identity is learning what habits of life are sustainable and which are potentially fatal. That is what I meant at the beginning by a medico-cultural sense of selfhood. We can see the first stage in attempts to explain, and explain away, Hayter’s infuriating comments. Dr Way, the city’s health officer in 1880, thought that the primary cause was Adelaide’s hot, dry summers, which had a “direct prostrating effect upon the nerve centres”. His colleague Dr Sylvanus Magarey, the resident doctor at the Children’s Hospital, in a public lecture given in the wake of Hayter’s paper, starts from the premise that “there is undoubtedly something that is peculiar to this province that afflicts our infants.”

He thought that, in Adelaide, the hot dry summer heat acted directly and physically on the baby’s nervous system, causing “fluxionary hyperanaemia of the brain,” or, to put it less impressively, a rush of blood away from the head when the sun heated up the scalp. (This was, we recall, the era of the pith helmet for adults in tropical climes). This phenomenon, he thought, stood behind all the secondary symptoms of a disordered digestion, vomiting, loss of fluids and so on.¹⁵ Doctors got to the climate, but were unwilling to make the jump to the deadly interaction of climate and particular habits of life which are healthy only in higher and cooler latitudes.

It’s a truly extraordinary instance of cultural blindness that not a single one of the authorities I have quoted drew any connection between the production of milk, the ‘aerial sewage’ and the climate. Adelaideans lived in a climate similar to that of the countries of North Africa and the Middle East; countries which sensibly and traditionally used olive oil or ghee instead of butter for cooking, and less perishable alternatives for liquid milk and cream such as yogurt and whey. But Adelaideans, stout northern Europeans, had never heard of fermented milk products and used olive oil only to make cosmetics. They insisted on their liquid milk, their butter and their cream. You could get away with the production methods in the cold, humid high latitudes, but they proved downright lethal in the hot dusty climate of Adelaide.

My story, like all the best stories, has a happy ending. The colony eventually came to terms with its climatic regime, and got a grasp on its cultural identity. The South Australian Public Health Act of 1898 had the strictest provisions of any similar Act in Australia. Fewer babies began to die and after about 1910 the decline became a precipitous rush downward. By 1918 the rate was by far the lowest on record, at 41. (By comparison, in that same year, the rate for the city of Rome was 156.) By early 1937 it was 23 per thousand, which the city corporation was able to boast was then the lowest infant death rate in the western world. That was a remarkable achievement, but it did take fifty-seven years and the loss of tens of thousands of children, who died from infections fully preventable under prevailing knowledge and techniques. Behind all those dead babies lay not the three ‘D’s of diarrhoea, dentition or debility – but the fourth ‘D’, the D of Denial: the cultural denial of those who ignored the pains, as well as the pleasures, of trying to build a Cheltenham transplanted to the latitude of Tangiers or Tel Aviv.

Notes

1. Henry Heylyn Hayter, “Infant mortality in South Australia,” Transactions of the Philosophical Society of Adelaide, 2, 65-74.

2. The general question of mortality rates in Victorian Adelaide is discussed in Thomas L. Stevenson, “Light and living conditions: mortality in nineteenth century Adelaide,” Proceedings of the Tenth New Zealand Geography Conference and Forty-ninth ANZAAS Congress (Geographical Sciences) Auckland, January 1979 (New Zealand Geographical Society Conference Series No.10, 1979), 129-137.

3. All statistics of infant mortality rates in the Old World are drawn from the thorough discussion in Anthony S. Wohl, Endangered Lives: Public Health in Victorian Britain (Cambridge: Harvard UP, 1983), pp.10-42.

4. Sylvanus James Magarey, Infant mortality and the fatal diseases of infancy and childhood. A paper read at the Adelaide City Mission Hall, July 1880. Adelaide: Webb, Vardon & Pritchard, 1880, p.1.

5. Fifth report of the Central Board of Health for the year ending 31 March 1879. Bound in the Adelaide City Council’s Digest of proceedings (1878).

6. The rate was expressed in different forms at different times, but has always been readily convertible into a rate of death per thousand live births. In Victorian times, however, deaths were counted if they came within the first year of life, which makes close comparison with modern rates difficult. However, this is unimportant for the present argument.

7. Thomas Borthwick, A Contribution to the Demography of South Australia (London: Bailliere, Tindall & Cox, 1891) in his discussion of infant mortality rates up to 1889 asserts that the rate has “decreased considerably in recent years”; concluding that this “disposes of the assertion. . .that South Australia is exceptionally unfavourable to infant life” (pp.38-9). Surprisingly, however, Borthwick nowhere gives the rates for the city of Adelaide; only for the colony as a whole. Had he done so, they would have told a different story; we are left to speculate why he does not. Dr Magarey gave a city rate averaged for the period 1873-9 of 216 per thousand.

8. Adelaide City Council, Mayor’s Report (1889), pp.126-7.

9. Adelaide City Council, Annual Report (1902), p.48.

10. The role of milk in infant deaths in Victorian England is examined closely in M.W. Beaver, “Population, infant mortality and milk,” Population Studies, 27 (1) (1973), 243-254. For the Australian context, see Milton Lewis, “The problem of infant feeding: the Australian experience from the mid-nineteenth century to the 1920s,” Journal of the History of Medicine and Allied Sciences, 2 (April 1980), 174-187. Lewis claims elsewhere that infant mortality rates began to fall dramatically before milk production was made fully safe – at least, in Sydney. See his “Milk, mothers, and infant welfare” in Jill Roe, ed. Twentieth Century Sydney: Studies in Urban and Social History (Sydney: Hale & Iremonger, 1980).

11. Patricia Sumerling, “The darker side of motherhood: abortion and infanticide in South Australia 1870-1910,” Journal of the Historical Society of South Australia, 13 (1985), 111-127.

12. South Australian Gazette and Colonial Register, 9 August 1845. Quoted in G. Partington, The Australian Nation: Its British and Irish Roots (Melbourne: Australian Scholarly Publishing, 1994), p.21.

13. Adelaide City Council, Mayor’s Report (1893), p.94.

14. Robin Haines, “Therapeutic emigration: Australia – the last resort”. Unpublished BA (Hons) thesis, Flinders University, 1988.

15. Magarey, p.1, 21.