Infant mortality in Victorian Britain: the mother as medium.
r he decline in infant mortality in some regions of Europe may have been prolonged. Levels of infant deaths of 200 to 300 per 1,000 births were recorded in France, Sweden, and England in the eighteenth century and by the 1840s they were nearer to 150. This trend was then halted and reversed in those areas experiencing the worst blights of rapid urbanization so that the undisputed long-term decline is, for Britain, commonly put at the beginning of the twentieth century-some 40 years or so after the downturn in overall mortality. Similar turning points have been observed in the southern German states, Austria, and Russia.2 From British evidence, however, it seems that deaths from diarrhoea related diseases may have masked a pre-existing downward trend in other sources of infant mortality. There is evidence of a rise in infant diarrhoea at the very end of the nineteenth century which has been linked to a succession of hot and dry summers and, by at least one writer, to the surge in horse transport, and hence street manure and flies.3 Estimates by Williams and Galley suggest that in rural areas in this period diarrhoea accounted for fewer than five infant deaths per 1,000 births, and work by Lee and by Williams and Mooney has demonstrated that these areas experienced little interruption in the long-term decline in infant mortality.4 Indeed, explanations for the decline in rural infant mortality are difficult to find. Infant deaths from diarrhoea in urban areas have been linked to poor sanitary and other environmental conditions. It seems that there were, on average, about 20 to 30 infant deaths from diarrhoea per 1,000 births in urban areas in the late nineteenth century. Hence, even allowing that this may not have been a precisely defined disease category, there still remained a large number of infant deaths in urban areas which were attributable to other causes. If diarrhoea related deaths are excluded, a clearer long-term downward trend emerges for urban as well as rural areas so that the long-term trend cannot be explained simply as a matter of cleaning up the urban environment. Again, no explanation has been offered in the literature.