Childcare, Health and Mortality in the London Foundling Hospital, 1741-1800 : 'Left to the Mercy of the World' [1 ed.] 9781526130426, 9780719073557

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Jeremy P. Boulton, Senior Lecturer in Early Modern Social History, University of Newcastle This book is a thorough and engaging examination of an institution and its young charges, set in the wider social, cultural, demographic and medical context of the eighteenth century. By examining the often short lives of abandoned babies, the book illustrates the variety of pathways to health, ill-health and death taken by the young and how it intersected with local epidemiology, institutional life and experiences of abandonment, feeding and childcare. For the first time, the characteristics of the babies abandoned to the London Foundling Hospital have been examined, highlighting the reasons parents and guardians had for giving up their charges. Clearly presented statistical analysis shows how these characteristics interacted with poverty and welfare to influence heath and survivorship across infancy and early childhood. The book builds up sources from Foundling Hospital records, medical tracts and parish registers to illustrate how the hospital managed the care of its children, and how it reflected wider medical ideas on feeding and child health. Child fostering, paid nursing and family formation in different parts of England are also examined, showing how this metropolitan institution called on a network of contacts to try to raise its charges to good health.

CHILDCARE, HEALTH AND MORTALITY Levene AT THE LONDON FOUNDLING HOSPITAL, 1741–1800  

‘This is a well-written, scholarly and clear exposition of the demography of infants left with the London Foundling Hospital in the period, and will be required reading for anyone interested in eighteenth-century social history.’

•

CHILDCARE, HEALTH AND MORTALITY AT THE LONDON FOUNDLING HOSPITAL, 1741–1800

•

‘Left to the mercy of the world’

This book will be of considerable significance to scholars working in economic and social history, medical and institutional history, and histories of childhood and childcare in the early modern period. It will also be of interest to anthropologists interested in childrearing and feeding practices, and interfamily relationships.

Alysa Levene is a Senior Lecturer in the Department of History at Oxford Brookes University

Front cover— ‘A poor woman in a dingy attic, surrounded by her children’, Wellcome Library, London

www.manchesteruniversitypress.co.uk

Alysa Levene

Childcare, health and mortality at the London Foundling Hospital, 1741–1800

Childcare, health and mortality at the London Foundling Hospital 1741–1800 ‘Left to the mercy of the world’ alysa levene

Manchester University Press Manchester

Copyright © Alysa Levene 2007 The right of Alysa Levene to be identified as the author of this work has been asserted by her in accordance with the Copyright, Designs and Patents Act 1988. Published by Manchester University Press Altrincham Street, Manchester M1 7JA, UK www.manchesteruniversitypress.co.uk

British Library Cataloguing-in-Publication Data is available Library of Congress Cataloging-in-Publication Data is available ISBN 978 0 7190 7355 7 paperback First published by Manchester University Press in hardback 2007

The publisher has no responsibility for the persistence or accuracy of URLs for any external or third-party internet websites referred to in this book, and does not guarantee that any content on such websites is, or will remain, accurate or appropriate.

Dedicated in memory of Maurice and Walter, and for the beginning of Owen for H. W. M.

Contents

List of tables List of figures Acknowledgements Preface 1 Introduction

page viii x xii xiii 1

2 The characteristics of foundlings

16

3 Risks of death: the estimation of mortality

49

4 Survival prospects

68

5 The nursing network

90

6 Growing up as a foster child

118

7 Childcare and health in a local setting

145

8 Foundlings and the local demographic context

175

9 Conclusions

200

Select bibliography Index

211 221

List of tables

2.1 Sex ratio of foundlings abandoned to the London Foundling Hospital, 1741–99 2.2 Fates of foundlings admitted to the London Foundling Hospital, 1741–99 2.3 Age on entry to the London Foundling Hospital, 1741–60 2.4 Distribution of ages on entry to the Foundling Hospital under two months, 1741–60 2.5 Geographic origins of foundlings as a percentage of the total, by season of entry, 1756–57 2.6 Legitimacy status of foundlings, 1756–60, from ten-per-cent sample of entry billets 2.7 Legitimacy status of foundlings coming from London, 1756–60, from ten-per-cent sample of entry billets 2.8 Reasons for abandoning children to the London Foundling Hospital, 1756–60 3.1 Infant mortality per thousand entries at European foundling hospitals in the eighteenth century 3.2 Infant mortality at the London Foundling Hospital, in England and in London 3.3 Infant mortality at the London Foundling Hospital, 1741–60 3.4 Early childhood mortality at the London Foundling Hospital, in England and in London 4.1 Variables available for hazards analysis, London Foundling Hospital sample, 1741–60 4.2 Univariate hazards analysis: infants under the age of one, and infants not yet placed with a nurse, London Foundling Hospital, 1741–60 4.3 Univariate hazards analysis: nursing dataset, London Foundling Hospital, 1741–60

page 17 18 21 22 28 32 33 36 50 54 57 63 71

73 79

List of tables 4.4 Multivariate hazards analysis: infants under the age of one, London Foundling Hospital, 1741–60 4.5 Multivariate hazards analysis: children sent to nurse, London Foundling Hospital, 1741–60 5.1 Place of fostering with external nurses from the London Foundling Hospital, by county, 1741–64 5.2 Infant mortality rates among foundlings, by county of nursing, 1741–64 5.3 Socio-economic conditions, feeding type and foundling infant mortality rates in Middlesex, Kent, Surrey and Essex, 1741–1801 5.4 Type of nursing received at first foster placement, London Foundling Hospital, 1741–64 5.5 The nursing career of Jane Derby of Epsom for the London Foundling Hospital 6.1 Populations and acreages of sample parishes, 1801 6.2 Numbers of nurses and foundlings in four case-study parishes, 1741–64 6.3 Numbers of linked nurses and foundlings in four case-study parishes, 1741–64 6.4 Time elapsing between abandonment and placement with nurses in four case-study parishes, 1741–64 6.5 Birth intervals (in months) between nurses’ children with foundlings present, and without, case-study parishes 7.1 Children with infirmities at the Ackworth branch hospital, 1771 8.1 Illegitimacy ratios and rates of prenuptial pregnancy in four case-study parishes, 1715–1800 8.2 Infant mortality rates (IMRs) in four case-study parishes, 1715–1800 8.3 Corrected IMRs in four case-study parishes using unlinked infant burials, 1715–1800

ix

82 83 95 103

105 107 112 121 124 127 131

137 166 183 184 185

List of figures

1.1 Admissions to the London Foundling Hospital, 1741–1800 (log scale) 2.1 Seasonal patterns of baptisms and foundling admissions to the London Foundling Hospital, 1750–99 2.2 Economic background to the General Reception period at the London Foundling Hospital 2.3 Bread prices and numbers abandoned to the London Foundling Hospital, 1756–60 2.4 Types of note left with foundlings as a percentage of total left with notes, 1756–60 3.1 Infant mortality as a proportion of admissions at the London Foundling Hospital, 1741–99 3.2 Infant mortality at the London Foundling Hospital, 1741–99, corrected to represent a ‘rate’ 3.3 Infant mortality at the London Foundling Hospital and in London, indexed to 1743 (five-year moving average) 4.1 Number of foundlings under observation over time, ten-per-cent sample, 1741–60 5.1 Most popular counties for nursing infants from the London Foundling Hospital, 1756–60 5.2 Speed of placement from the Foundling Hospital with an external nurse, 1756–60 5.3 Mean wait for placement with an external Foundling Hospital nurse, 1756–60 5.4 Proportion of entrants needing medical attention and dying in Foundling Hospital infirmaries, 1756–60 5.5 Mean wait for placement with an external Foundling Hospital nurse by season, 1756–60 6.1 Location of case-study parishes in Yorkshire 6.2 Location of case-study parishes in Surrey

page 8 19 37 39 40 52 57 58 70 96 98 98 100 101 120 121

List of figures 6.3 Number of foundlings per nurse in four case-study parishes, 1741–64 7.1 Monthly pattern of foundling burials within a year of admission to the London Foundling Hospital, 1741–67 7.2 Seasonal patterns of foundling burials in the first month from admission and in the second half of the first year, London Foundling Hospital, 1741–64 7.3 Causes of death among children dying between one and five years from entry to the London Foundling Hospital, 1741–99 7.4 Numbers admitted to the Foundling Hospital infirmary, 1761–66 7.5 Morbidity in the Foundling Hospital infirmary, 1761–66 7.6 Causes of death at the Ackworth Foundling Hospital branch, 1757–73 8.1 Frequency of vital events, 1715–1800, five-point moving average: Ackworth 8.2 Frequency of vital events, 1715–1800, five-point moving average: Hemsworth 8.3 Frequency of vital events, 1715–1800, five-point moving average: Epsom 8.4 Frequency of vital events, 1715–1800, five-point moving average: Chertsey 8.5 Biometric analysis of cumulative infant mortality, four case-study parishes, 1715–1800 8.6 Seasonal patterns of burials in four case-study parishes, 1715–1800 8.7 Seasonal patterns of burials in Epsom and Chertsey (1715–1800), and infant foundling burials (1741–64) 8.8 Infant mortality rates by twenty-year period in four case-study parishes, 1730–90

xi

125 150

151

156 159 160 162 178 179 179 180 188 190 191 193

Acknowledgements

Thanks to the staff of the Foundling Museum in Brunswick Square, London, who kindly gave me permission on behalf of the Coram Foundation to quote from Foundling Hospital documents. I am grateful to the editors of the following journals for permission to reproduce previously published material: Continuity and Change for my article ‘The origins of the children of the London Foundling Hospital, 1741–1760: a reconsideration’, Continuity and Change, 18:2 (2003), pp. 201–35; Population Studies for my article ‘The estimation of mortality at the London Foundling Hospital, 1741–99’, Population Studies, 59:1 (2005), pp. 87–97 (http://tandf.co.uk). The maps that feature as Figures 6.1 and 6.2 are based on data provided through EDINA UKBORDERS with the support of the ESRC and JISC and use Kain and Oliver historic boundary material which is copyright of the AHDS History (University of Essex), Humphrey Southall, Nick Burton and the University of Portsmouth.

Preface

This book has passed through the hands of many supportive and knowledgeable people on its journey from PhD thesis to monograph, and I owe many people many thanks. I am particularly grateful to Richard Smith and Steve King for their great encouragement and support at different stages. Thanks also to many other people at the Cambridge Group for the History of Population and Social Structure, and the History Department at Oxford Brookes University: Jim Oeppen, Alice Reid, Tony Wrigley, John Henderson, John Stewart, Ros Davies, Richard Wall, Peter Kitson and Stuart Basten. Also to Jeremy Boulton, Wendy SigleRushton, Tim Hitchcock and Leonard Schwarz, and to audience members at various research seminars and conferences, especially at the Cambridge Group, the University of London’s Long Eighteenth Century seminar series, the Oxford University Economic and Social History seminar and the University of Sussex Work in Progress seminar. Thanks to the friends who have always been happy to hear more about foundlings, and who have provided unfailing encouragement, happy times, proofreading services and demographic events: Julie, Tracy, Rhiannon and Tom. The staffs of the archives I have worked in have been unwaveringly helpful, and have kindly given permission to use records they hold: the London Metropolitan Archive, the Guildhall Library, the West Yorkshire Archive Service at Wakefield, the Surrey History Centre and the Society of Genealogists in London. Staff at the East Sussex County Record Office in Lewes were kind enough to let me use their microfilm readers, and the headmaster, bursar and archivist at the Ackworth Quaker School were generous with their time when I went to visit. I would also like to acknowledge the generous financial support of the Wellcome Trust for the History of Medicine and the Leverhulme Trust. The University of Cambridge’s Ellen Macarthur Fund, Emmanuel College, Cambridge, and the Helen Brock Memorial Award from Selwyn College, Cambridge, all gave me smaller, but indispensable grants. Lastly, I would like to thank my family, who may not always have known exactly what I’ve been tinkering with for the last few years, but who, I know, will be proud anyway. And Rich: always.

1

Introduction

Whereas a male child was exposed and deserted by the parents of the sd child or persons unknown and left to the mercy of the world . . . Note left with child 12279, Lancelot Fry Admitted 3 April 1759 Died 17 May 1759

Lancelot Fry was abandoned at the London Foundling Hospital in 1759: one of tens of thousands of babies abandoned every year across Europe in the eighteenth century. He was among approximately 18 500 left at the London Foundling Hospital between its opening in 1741 and the close of the century, marking a break from the past in terms of scale and concentration in London. This book examines the way in which abandonment to the Foundling Hospital developed, how it was used as a strategy by parents and parish officials and how it was mediated into health and survival outcomes for the infants involved. The often-brief lives of foundlings such as Lancelot Fry also, however, raise questions of wider import. The reasons behind the abandonment of an infant, for example, tell us much about the family situations of the poor, and the way in which they managed poverty, the loss of a spouse or birth out of wedlock. Fry was sent to the hospital by parish officials in County Durham, which indicates that the institution also played an important part in the development of local poor relief provision. By investigating the mortality rates and survival risks of infants like Fry, it is possible to establish whether he died so young because of inherent weakness, or because of factors associated with his experiences as a baby. This clearly has repercussions for the study of mortality and survival among infants, and especially poor infants, more generally. The mechanics of how the hospital tried to keep infants like Fry alive tell us much about institutional practices, and how medical practitioners tried to meet the challenge of infant care. More broadly, the focus on infancy and early childhood is revealing of attitudes towards children

2

Childcare, health and mortality

and their experiences of family life. Fry was relatively unusual in not being placed even briefly with a wet nurse outside the hospital. Analysis of this phase of the foundlings’ life-course offers further insight into family and community relationships, survival and ill-health in different parts of the country both as a foundling and as a local child, and the role of wet nursing as a female occupation and poverty-avoidance strategy. In considering pathways to health, ill-health and death for foundlings, this book thus engages with contemporary developments in childcare, ideas on childhood and children, motherhood and medicine, and a multitude of wider debates on charity, welfare, entitlement and patronage. This introduction will set out the background to these debates, and to the founding of the hospital in 1739. Infant abandonment in early modern Europe Surplus and unwanted children have been exposed and abandoned throughout western history. John Boswell has revealed the improvised redistribution of these infants to homes where they were wanted from those where they were not since antiquity.1 By the fourteenth century this had been institutionalised in parts of southern Europe, with the foundation of urban foundling homes (often called hospitals, although care of the sick was not their main function).2 Sometimes infants were literally ‘found’ (hence the name ‘foundling’), often in public places where they were likely to be picked up. In many other cases, however, they were brought to the foundling home itself and abandoned anonymously on its steps, or in baskets or ‘wheels’ made for that purpose. All over Europe, it is still possible to visit old foundling hospital buildings and see the site of the tournée or ruota: a wooden circular box set in the wall of the building, which rotated to bring an abandoned infant inside without the person leaving it being seen. These early foundling homes were concentrated in southern Europe, where Catholic concerns over the spiritual fate of unbaptised babies and for the honour of unmarried mothers may have carried significant weight. Much of northern Europe (including both Protestant and Catholic countries) did not follow suit until the eighteenth century, when the ideals of the Enlightenment and concerns over population decline provided a second spur to the establishment of foundling hospitals. This drive coincided with (and perhaps contributed to) a great upsurge in the numbers of infants abandoned all over continental Europe. It is estimated that by the mid-nineteenth century, around 120 000 infants were abandoned annually in Europe, with nearly 35 000 of these in Italy, more than 30 000 in France, 15 000 in Spain and 15 000 in Portugal.3

Introduction

3

In Italy, virtually every community had access to a repository for the infants whom they could, or would, not keep at the end of the eighteenth century. By the nineteenth century, up to 40 per cent of all births in Italy were subsequently abandoned.4 Figures on infant abandonment in England, however, are harder to reconstruct, largely because it was not a mass phenomenon centred on one or more institutions. In fact, Volker Hunecke has suggested that the existence of a foundling hospital was a prerequisite for such a phenomenon.5 By counting the baptisms of foundling infants in several London City parishes, however, Valerie Fildes has found a rise in abandonment in the early modern period which outpaced population growth. She estimated that approximately 1000 foundlings a year were abandoned in London by the later seventeenth century.6 Anisha Dasgutpa has found a similar pattern in seven intramural London parishes, although she suggests that levels were related to the type, age structure and poverty of the parish.7 Certainly, foundlings might represent an onerous burden for the poor rates: parish payments to maintain them were higher per head, and often higher in total, than those spent on all the other parish poor and sick.8 Christ’s Hospital, a school for children of London freemen which initially also took in foundlings, admitted probably only six to nine per year by the end of the sixteenth century.9 There is less evidence of abandonment as a practice in rural England, although that is not to say that it did not occur. Richard Adair found only 32 foundlings recorded in total in the baptism registers of 25 rural parishes between 1550 and 1750, 27 of which were baptised after 1700.10 It is possible that others escaped registration but were cared for locally. The increased numbers found after 1750 do suggest that abandonment may have been becoming more common as the eighteenth century progressed and population growth took place. Adair found even less evidence of abandonment in towns outside London and suggests that it may not have been a significant practice in the non-metropolitan urban context.11 Relatively little is known, in fact, of the scale of abandonment in eighteenth-century London, or what sort of trend it followed. 173 children under four years of age were identified as foundlings or casualties under parish care in 62 intramural London parishes in 1767.12 Many more may have died in infancy. Evidence from the workhouse admission books of the St Martin in the Fields workhouse indicates a significant drop in foundling admissions from the 1770s. Baptism registers from St Martin’s and also from the neighbouring parish of St George, Hanover Square, display a similar decline in the incidence of baptised foundlings in the late 1770s and early 1780s. It is not clear if this was

4

Childcare, health and mortality

due to a decline in the actual incidence of the practice or changes in recording procedures, but the fact that the same trend is seen in both parishes lends weight to the possibility of a real decline in the practice of child abandonment, at least in the West End. Of course, it might be that children were being dropped elsewhere in the metropolis.13 In 1830, only 14 foundlings were registered by parish clerks for the area within the Bills of Mortality; the total had risen to 121 by 1838.14 Discussions of the causes of changing levels of infant abandonment in eighteenth-century Europe have been based on fluctuations in economic conditions, changes in sexual practices and the opportunities offered by the growing network of European foundling hospitals. While changes in economic fortunes on a national, local or personal level might leave parents unable to care for an infant, as Carlo Corsini has found for eighteenth- and nineteenth-century Prato, we cannot assume that growing population pressure or rising levels of illegitimacy necessarily led to growing numbers of foundlings. Fildes’s evidence for London, for example, came at a time of relatively low illegitimacy, while increased provision for mothers and babies in workhouses and lying-in hospitals by the mid-eighteenth century may have prevented infants being abandoned. The founding of the London Foundling Hospital may have skewed established practices for the poor, and created a surge in abandonment which was outside existing trends (perhaps influencing the trend in parishes like St Martin’s).15 It has also been argued, however, that the growth of service industries in many urbanising areas created more employment opportunities for young single women. This raised the number ‘at risk’ of bearing an illegitimate infant, who might be abandoned for the sake of the mother’s chances of employment and future marriage.16 Rising illegitimacy may also have led to greater levels of abandonment in countries where there was little tolerance for unmarried mothers.17 The London Foundling Hospital The option of abandonment to a dedicated institution was not available in England until the London Foundling Hospital began its operations in 1741. Similar plans had been mooted much earlier, however, and Christ’s Hospital had been founded for the destitute children of London in 1552. Demand was so great, however, that admissions were soon restricted to the children of freemen and citizens of the city.18 The hospital was still in existence in the eighteenth century (indeed, it still operates as a school today), but no longer admitted foundlings. In 1680, William Petty advanced plans for an institution to take in illegitimate

Introduction

5

children, in order to preserve their labour for the nation.19 In 1685, the Justices of Middlesex opened a ‘College of infants’ in Clerkenwell. It seems to have run on a small scale for several years, but soon disappeared.20 In 1687, Elizabeth Cellier petitioned James II for a royal hospital for foundlings, which would also facilitate the teaching of midwives, but nothing came of the idea.21 In the early eighteenth century several writers, including Joseph Addision, also made their support of a foundling hospital public.22 All of these proposals foundered on fears of immorality and costs. It was thought that a foundling hospital would discourage marriage, and promote extra- and pre-marital sex.23 Children were not yet widely thought of as potential earners and producers, so the costs of bringing them up seemed excessive and profitless. There was also little imperative for a foundling hospital, since England already had provision for abandoned children and poor families under the terms of its poor laws. This corpus of laws dated from the Elizabethan period, and made provision in cash, kind and (later) workhouse support for the deserving poor at a local level. It was funded by a tax on property, levied and collected by the parish.24 Maintenance was thus provided for abandoned infants, who were generally put out to nurse until they were old enough to enter a workhouse or to be apprenticed. Unmarried mothers and poor families were also eligible for relief, which might have prevented the abandonment of infants. That is not to say, however, that alternative provision for foundlings might not be popular once instituted. In order to access parochial relief, people had to make their stories public to parish officials, which might be seen as demeaning or even ruinous where pre-marital pregnancy was concerned. Relief might be dependent on entering a workhouse, and some parishes were not as generous as others, or censured what they saw as immoral behaviour. For all these reasons, people might prefer the anonymity of giving a child up to a foundling hospital. It might be attractive to parish officials also. Entitlement to relief was tied to a person’s parish of settlement, generally gained through birth, marriage, rate-paying or employment.25 Foundlings gained a settlement where they were born (an incentive to try to abandon an infant in a rich parish), but to parish officials they represented an immediate burden on the rates, and a foundling hospital removed them from their hands. The poor laws were thus a significant factor in shaping responses to infant abandonment in England. The eighteenth century, however, saw a coinciding of new concerns for the needy and a commercially minded ethos to save lives for the good of the nation, resulting in a whole range of new charitable forms. Of these, one of the grandest and

6

Childcare, health and mortality

most ambitious was the London Foundling Hospital.26 It embodied the most heart-rending appeals to the newly awakened compassion of the wealthy by saving poor children, and also offered a means of contributing to the nation’s future strength and productivity by keeping them alive.27 For a generation at war with France, well versed in the philosophies of a commercial society and fearing (wrongly) that the population was in decline, this was a timely appeal.28 Donna Andrew has noted how eighteenth-century charities needed to identify themselves with national concerns to gain support; in 1740s London, the Foundling Hospital hit its mark.29 The final impetus for the hospital’s successful foundation was the work of a man committed to saving the lives of abandoned infants: Thomas Coram. Coram was a retired sea-captain, and in the words of his contemporary philanthropist, Jonas Hanway, ‘a Person whose Merit and Virtues were . . . extraordinary, exerted with such vigour, and so great Consistency, for the Benefit of Society’.30 On his return to London from America in 1704, Coram was dismayed to see the bodies of exposed infants on his journeys into the City, and began to campaign for support for a foundling hospital. He spent seventeen years pursuing aristocratic backing for a Royal Charter, appealing for a cause which would prevent infanticide, shame and poverty. His efforts were rewarded in 1739 with a Charter for a hospital ‘for the maintenance and education of exposed and deserted young children’. The hospital took in its first infants two years later, on 25 March 1741.31 It was thus not until the combination of new charitable forms, the exigencies of war and its increased need for manpower and the determination of Coram came together that plans for a foundling hospital in England came to fruition. Until then, as Ruth McClure has written, ‘parochial parsimony had defeated the cause of the foundling’.32 Now, commercialism and sentiment united to support it. This combination of forces had weight on the Continent also: in Germany, for example, Enlightenment ideals also promoted new support for foundlings.33 In other respects, however, the situation in England differed markedly from that in other parts of Europe. Different attitudes to unmarried motherhood, locally specific concepts of family honour and shame and long-standing traditions of charity and family support affected both the form and the scale of responses to infant abandonment.34 Continental foundling hospitals were frequently centred on towns, for example, making abandonment largely an urban phenomenon, while the English poor laws carried statutory support into rural areas as well. They also countenanced the support of unmarried mothers, while elsewhere abandonment may have been the only option for such women. The extent

Introduction

7

of provision under the poor laws, and their greater emphasis on establishing financial responsibility for poor infants than on moral policing, may particularly have affected the characteristics of abandoned babies and their survival outcomes. These themes will be considered in the chapters which follow. Once established, the supporters of the London Foundling Hospital were quick to take action and organise themselves. Like many other mid-eighteenth-century charities, the hospital was based on middlingand high-society support, and upheld the tradition of patronage, dinners and gratification by association with a worthy cause so favoured by the philanthropically minded of those classes.35 Many of the titled and wealthy men on its subscription rolls were involved in a very nominal capacity, but they lent the charity weight and prominence, while a committed corpus of governors formed the mainstay of day-to-day business. It was largely they who appointed staff, and organised the acquiring of temporary premises in Hatton Garden until a permanent hospital could be built on land belonging to the Earl of Salisbury in Lamb’s Conduit Fields. These buildings were imposing, as were many foundling hospitals in Europe, and rapidly became popular with visitors, keen to see the children, visit the chapel, where Handel conducted annual performances of his Messiah, and view the growing art collection.36 The hospital’s main appeal, of course, was to the poor and needy. For financial and practical reasons, infants were admitted at first in batches of twenty, on pre-advertised days. They were chosen initially at random, although a ballot system was quickly instated, and examined for health. If healthy and under two months old, they were accepted. If they showed signs of infectious disease, or were over the age limit, they were turned away and others chosen. The variation in numbers over the period 1741 to 1800 is shown in Figure 1.1, ranging between 20 and 200 in these early years. The number of children who had to be rejected, however, prompted the governors to campaign for parliamentary support, which they secured in 1756. From this year a grant was made to support a ‘General Reception’ of all children offered. The maximum age limit was raised to six months in January 1757 and to a year in June 1757, and there was no longer any screening for health. Admissions soared to highs of 4000 per year (note the logarithmic scale in Figure 1.1, which allows this surge in numbers to be shown), but in 1760 parliament withdrew its grant, put off by the ever-increasing amount of money needed to finance the foundlings, and promising only to support the remaining children up to apprenticeship.37 Nonetheless, the vast majority of entrants to the hospital were admitted during this short period.

8

Childcare, health and mortality

Figure 1.1 Admissions to the London Foundling Hospital, 1741–1800 (log scale)

Admissions (log scale)

10 000

1000

100

10

1797

1792

1787

1782

1777

1772

1767

1762

1757

1752

1747

1741

1

Source: General Register, LMA, A/FH/A09/2/1–5.

The funding of the General Reception and its subsequent ending also reflect changing priorities in charity. The open admissions period coincided with the Seven Years’ War, when manpower was particularly a priority. By the later 1760s, the war had ended, and there was a more general sense of pessimism as to what charity could achieve and how the poor should be managed.38 The scale of admissions during the General Reception had prompted the hospital to build branches at Ackworth (Yorkshire), Westerham (Kent), Shrewsbury (Shropshire), Aylesbury (Buckinghamshire), Barnet (Hertfordshire) and Chester (Cheshire), to house children returned from country nurses prior to their apprenticeship. Now they had to be sold off, and the children apprenticed as soon as possible. Admissions fell abruptly, consisting for many years only of war orphans and children accompanied by a premium of £100. As the hospital’s income from land increased, however, admissions stabilised. Agreements were also entered into with several London parishes to care for their young charges in return for a fee, and 823 children came under the hospital’s care on these terms between 1767 and the end of the century. Constraints of space mean that they cannot be considered here, although there is scope for further work on their experiences, and on the relationship between the hospital and local parishes. In all admissions periods, the foundlings went through the same system. Once admitted, they were named and baptised, and sent to a wet

Introduction

9

nurse outside the hospital. If weak or sick, they were sent to the hospital infirmary until they were strong enough to withstand the journey. The workings of the nursing system and its impact on the children’s health and experiences are two of the main concerns of this book. The children remained with their nurses until the age of five or six, when they returned to the hospital to be educated and trained. At around eleven, they were apprenticed, mainly as domestic servants or to sea. At any age, children could be reclaimed by family or friends, on proof of identity, the posting of securities and the reimbursement of the expenses of raising the child. As will be seen, children who were handicapped in some way were either apprenticed with a premium or were kept in the hospital for the rest of their lives, working as their abilities allowed. Significance and wider implications The structure of this book broadly follows this life-course. The first half is concerned primarily with the characteristics of the infants at abandonment, and how this affected their survival prospects. Previous work on the hospital has rarely considered these topics, yet establishing who the foundlings were and what happened to them is of crucial importance. Not only were they a large population of infants and children, which makes them worthy of study in their own right, but these questions also give us significant insights into how abandonment worked as a povertyalleviation strategy in England, the condition of poor infants at birth and what their risk factors in terms of survivorship were. Chapter 2 examines the characteristics of groups of foundlings to discover where they came from, how old they were and what their family backgrounds had been. In Chapter 3, the mortality of the same sample of infants is investigated, providing an estimate of death rates which is properly comparable with those of infants outside the hospital. Chapter 4 presents the results of a statistical analysis of the factors which made the foundlings die in such numbers, and discusses how this related to their birth conditions, as opposed to their experience of hospital life. The second half of the book examines the critical nursing period for all foundlings placed with external nurses between 1741 and 1764. Since an infant’s risk of death declines over time, this early experience captured much of their most vulnerable time of life. The hospital’s records on nursing are enormously rich and detailed, and one of the benefits of this study is that it enables us to compare the foundlings’ experiences of nursing, childcare and health with those of non-foundlings. Most of what we know about childcare and feeding practices comes from medical treatises written by men, or from diaries and commonplace books

10

Childcare, health and mortality

kept by educated and wealthy families. The hospital’s records give us an insight into the reality of raising infants and children at a lower social level, the problems that arose when they were sick and the attachments formed with their nurses and their families. This section of the book thus feeds into many of the debates in the histories of early modern medicine and childhood. Records of ill-health in the hospital itself also shed light on institutional care, and again show the characteristic duality of purpose at the hospital, between caring for the poor and needy and showcasing the generosity and talents of more privileged men. Several high-profile society doctors served the hospital, and their writings and practices placed the foundlings’ care at the cutting edge of paediatric medicine. The second topic of import in the investigation of the nursing system is the light it sheds on women’s roles within the family and the family economy. Mercenary wet nursing has been investigated in considerable detail for several other European countries, but has been largely dismissed in the English context.39 In the absence of French-style bureaux de nourrices, and with no long-standing and nationwide network of foundling hospitals employing local women, the English wet nurse seems conspicuous by her absence. Yet Valerie Fildes suggests that, in fact, sending infants out for wet nursing was a significant practice throughout the eighteenth century, albeit probably not on the French scale, and several other historians have found evidence of private and parish nurse children in burial registers.40 Once again, however, discussions rely on upper-class sources, or on bare details from parish registers. The details of nursing as a form of employment and its impact on both the nursechild and the foster family are almost inaccessible. Here, the Foundling Hospital registers and letters from nurses’ inspectors offer a significant advance. The records point to a large-scale and geographically diverse group of nurses, some of whom took in a number of foundlings over a period of years. The details of this network are set out in Chapter 5, and the information it can give us as to health in Chapter 7. In Chapters 6 and 8, four groups of nurses are linked to their local parish registers, to provide a more detailed investigation of life as a foster mother, a nursechild or a resident of a parish hosting large numbers of foundlings. The stereotype of the uncaring and neglectful mercenary wet nurse will also be addressed and challenged. Although relatively little is known about nursing and child-fostering as a profession, we do know quite a lot about motherhood and the way in which ideals of women’s bodies were transformed in the eighteenth century. According to several authors, the condition of motherhood became sentimentalised, with women seen increasingly in terms their

Introduction

11

reproductive function.41 The rise of maternal breastfeeding was partly a cause and partly a product of this change. Ruth Perry and Felicity Nussbaum have linked this altered view of women to wider ideas on English colonialism, and to ambivalent and contradictory views of ‘savage’ colonial mothers versus sentimentalised English wifehood and motherhood. This book does not engage specifically with these debates, which seem, again, more appropriate to the higher classes of society. It remains significant, however, that this was a period in which women’s reproductive and nursing functions were being privileged, even if the context of nursing for the London Foundling Hospital was a scene far removed. The rich collection of documents surviving for many aspects of the Foundling Hospital’s organisation makes this study possible, and it is curious that they have been only very partially investigated by historians so far. The hospital is frequently cited as an example of an eighteenthcentury charity.42 It has also attracted several institutional histories, of which Ruth McClure’s Coram’s children is the most wide-ranging and sensitive.43 A growing body of literature also addresses how the hospital was used by poor mothers.44 These works have all added much of value to the history of institutions and to the economy of makeshifts, but considerations of the foundlings themselves are peculiarly absent. The exception is Adrian Wilson’s 1989 Continuity and Change article, which uses admissions data to examine the backgrounds of the children and the likelihood that they were illegitimate.45 His work illustrates the potential for empirical study of the hospital documents, and their implications for wider historical problems (in his case, changing marriage and courtship patterns in the metropolis and beyond). The current volume takes up this approach on a larger scale, examining the backgrounds, childcare practices, health and mortality of foundlings between 1741 and 1800. Inevitably, the main focus is on the infants who entered the hospital during the years of the General Reception, given the sheer weight of their numbers. However, even outside these years, the hospital continued to debate and develop its policies on child-rearing, and its aims of saving lives. Many of the central themes of the book, therefore, are valid for the whole period under study. Note on sources The two core sets of documents used for this study are the ‘General Registers’ or admissions books, and the ‘Inspections Books’ or nursing registers. Each child was given a unique identifying number on arrival, and this allows entries in different sources to be cross-matched, and life

12

Childcare, health and mortality

histories of individual children built up. Further information is gained from notes left by parents, documents filled in on admission, letters from nurses’ inspectors, and registers and records on ill-health. Official accounts of the hospital are also called upon to provide a ‘top-down’ impression of the governors’ aims. Some investigations are based on the full population of entrants between 1741 and 1800 (18 539 individuals); others are based on smaller samples. A note must be made on two of these samples in particular. In order to investigate the foundlings’ backgrounds, details were collected on 10 per cent of entrants in each month (referred to as the ‘ten-per-cent sample’). There was reason to think, however, that this sample was biased towards older infants, because of the type of information left in notes by their parents. A second tenper-cent sample was therefore collected, consisting only of infants for whom an age at entry was recorded. This sample was used only for the investigation into age distributions, and is referred to as Sample B. The date change to the new calendar took place in England on 2 September 1752, so 3 September became 14 September. Eleven days were therefore added to the ages of all the children who were in the hospital over this period. Notes 1 J. Boswell, The kindness of strangers: the abandonment of children in western Europe from late antiquity to the Renaissance (London, 1988). 2 J. Boswell, ‘Expositio and oblatio: the abandonment of children and the ancient and medieval family’, American Historical Review, 84:1 (1984), pp. 10–33. 3 V. Hunecke, ‘Intensità e fluttuazioni degli abbandoni dal XV al XIX secolo’, in École Française de Rome (ed.), Enfance abandonée et société en Europe XIVè–XXè siècle (Rome, 1991), pp. 36–8. 4 D. Kertzer, Sacrificed for honor: Italian infant abandonment and the politics of reproductive control (Boston, 1993), p. 3. This trend seems to have been nationwide, despite the country’s regional differences in economic growth and cultural practices (D. Kertzer, ‘Gender ideology and infant abandonment in nineteenth-century Italy’, Journal of Interdisciplinary History, 22:1 (1991), pp. 4–5). 5 V. Hunecke, ‘The abandonment of legitimate children in nineteenthcentury Milan and the European context’, in J. Henderson and R. Wall (eds), Poor women and children in the European past (London and New York, 1994), p. 118. See also V. Pérez Moreda, Las crisis de mortalidad en la Espanˇ a interior siglos XVI–XIX (Madrid, 1980), p. 171. 6 V. Fildes, ‘Maternal feelings re-assessed: child abandonment and neglect in London and Westminster, 1550–1800’, in V. Fildes (ed.), Women as mothers in pre-industrial England (London, 1990), pp. 140–68.

Introduction

13

7 A. S. Dasgupta, ‘Poverty, pauperism and parish relief in seventeenthcentury intramural London’ (unpublished PhD thesis, University of Cambridge, 2003), pp. 276–7. 8 V. Pearl, ‘Social policy in early modern London’, in H. Lloyd Jones, V. Pearl and B. Worden (eds), History and imagination (London, 1981), p. 126; Dasgupta, ‘Poverty’, pp. 279–80. 9 C. Kazmierczak Mazione, Christ’s Hospital of London, 1552–1598: ‘a passing deed of pity’ (Selinsgrove, Pennsylvania, and London, 1995), pp. 39–40. 10 R. Adair, Courtship, illegitimacy and marriage in early modern England (Manchester, 1996), pp. 34–5. 11 Adair, Courtship, pp. 190–1. 12 A. Levene, ‘The mortality penalty of illegitimate children: foundlings and poor children in eighteenth-century England’, in A. Levene, T. Nutt and S. Williams (eds), Illegitimacy in Britain, 1700–1920 (Basingstoke, 2005), p. 37. 13 Leonard Schwarz and Jeremy Boulton, personal communication, based on their ERSC-funded project, Westminster Pauper Biographies. 14 Cited in B. Weisbrod, ‘How to become a good foundling in early Victorian London’, Social History, 10 (1985), p. 206. 15 C. Corsini, ‘ “Era piovutu dal cielo e la terra l’aveva raccolto”: il destino dei trovatello’, in École Française de Rome (ed.), Enfance abandonée et société, p. 88. 16 R. Finlay, Population and metropolis: the demography of London 1580–1650 (Cambridge, 1981), pp. 140–1. 17 T. Hitchcock, ‘Redefining sex in eighteenth-century England’, History Workshop Journal, 41 (1996), pp. 73–90; Hitchcock, English sexualities, 1700–1800 (Basingstoke, 1997). For a discussion on changing levels of illegitimacy, and changing behaviour, see A. Levene, T. Nutt and S. Williams, ‘Introduction’, in Levene et al., Illegitimacy in Britain, pp. 1–17. 18 I. Pinchbeck and M. Hewitt, Children in English society (2 vols, London, 1969), pp. 131–2. 19 D. Andrew, Philanthropy and police: London charity in the eighteenth century (Princeton, New Jersey, 1989), p. 58. 20 Ibid., pp. 149–50. 21 E. Cellier, A scheme for the foundation of a royal hospital (London, 1687), Harleian Miscellany, IX [1745], pp. 136 –200. 22 T. Bray, A memorial concerning the erecting in the City of London or the suburbs thereof, an orphanotrophy or hospital for the reception of poor cast-off children or foundlings (London, 1727); on Addison, see The Guardian, no. 103, 11 July 1713. 23 R. McClure, Coram’s children: the London Foundling Hospital in the eighteenth century (New Haven, 1981), pp. 60–1. 24 P. A. Slack, Poverty and policy in Tudor and Stuart England (London, 1988), pp. 113–61; L. Hollen Lees, The solidarities of strangers: the English poor laws and the people (Cambridge, 1998), pp. 22–33; G. W. Oxley,

14

25 26

27

28

29

30

31 32 33

34

35

36 37

38 39

Childcare, health and mortality Poor relief in England and Wales, 1601–1834 (London and Vancouver, 1974), pp. 14–24. J. S. Taylor, Poverty, migration and settlement in the Industrial Revolution: sojourners’ narratives (Palo Alto, California, 1989), pp. 16–20. Other foundations included charities for penitent prostitutes, poor pregnant women and the sick. See Andrew, Philanthropy and police; D. Owen, English philanthropy 1660–1960 (Cambridge, Massachusetts, 1964); Oxley, Poor relief; B. Kirkman Gray, A history of English philanthropy (London, 1967 impression). P. Langford, A polite and commercial people: England 1727–1783 (paperback edition, Oxford, 1992), pp. 500–3; R. Porter, English society in the eighteenth century (revised edition, Harmondsworth, 1990), p. 266. Andrew, Philanthropy and police, pp. 54–7. Hanway voiced these concerns in his A candid historical account of the hospital for the reception of exposed and deserted young children (London, 1759), pp. 11–12. D. Andrew, ‘Two medical charities in eighteenth-century London: the Lock Hospital and the Lying-In Charity for married women’, in J. Barry and C. Jones (eds), Medicine and charity before the welfare state (London and New York, 1991), pp. 82–97. J. Hanway, Private virtue and publick spirit display’d. In a succinct essay on the character of Thomas Coram (London, 1751), p. 3. On Coram, see also McClure, Coram’s children, pp. 16–20, 23–5. For a more detailed history of the hospital’s foundation, see McClure, Coram’s children, pp. 16–36. Ibid., p. 9. O. Ulbricht, ‘The debate about foundling hospitals in Enlightenment Germany: infanticide, illegitimacy and infant mortality rates’, Central European History, 18:3–4 (1985), p. 211. A. Levene, ‘Health and survival chances at the London Foundling Hospital and the Spedale degli Innocenti of Florence, 1741–99’ (unpublished PhD thesis, University of Cambridge, 2002), pp. 1–55; Kertzer, Sacrificed for honor. McClure, Coram’s children, pp. 37–51 and 167–74; S. Lloyd, ‘ “Agents in their own concerns”? Charity and the economy of makeshifts in eighteenth-century Britain’, in S. King and A. Tomkins (eds), The poor in England 1700–1850 (Manchester, 2003), pp. 100–36; S. Cavallo, ‘The motivations of benefactors: an overview of approaches to the study of charity’, in Barry and Jones (eds), Medicine and charity, pp. 46–62. McClure, Coram’s children, pp. 66–72. R. H. Nichols and F. A. Wray (The history of the Foundling Hospital (Oxford, 1935), p. 58) set the total cost to parliament of the General Reception at around £500 000. McClure (Coram’s children, p. 120) gives the figure as £548 796 16s. Hollen Lees, Solidarities of strangers, pp. 83 –7. V. Fildes, Wet nursing: a history from antiquity to the present (Oxford, 1988); M. Lindemann, ‘Love for hire: the regulation of the wet-nursing

Introduction

40

41

42

43 44

45

15

business in eighteenth-century Hamburg’, Journal of Family History, 6 (1981), pp. 379–95; G. D. Sussman, Selling mothers’ milk: the wet-nursing business in France, 1715–1914 (Urbana, Illinois, 1982); C. KlapischZuber, Women, family and ritual in Renaissance Italy (English translation, Chicago, 1985). Fildes, Wet nursing; D. McLaren, ‘Marital fertility and lactation 1570– 1720’, in M. Prior (ed.), Women in English society (London and New York, 1985), pp. 22–53; McLaren, ‘Nature’s contraceptive: wet-nursing and prolonged lactation. The case of Chesham, Buckinghamshire, 1578–1601’, Medical History, 23 (1979), pp. 426–41; McLaren, ‘Fertility, infant mortality, and breast feeding in the seventeenth century’, Medical History, 22 (1978), pp. 378–96; Finlay, Population and metropolis, pp. 146–8; G. Clark, ‘Nurse children in Berkshire’, Berkshire Old and New, 2 (1985), pp. 25– 33; F. Newall, ‘Wet nursing and child care in Aldenham, Hertfordshire, 1595–1726: some evidence on the circumstances and effects of seventeenthcentury child rearing practices’, in Fildes (ed.), Women as mothers, pp. 122–38. R. Perry, ‘Colonizing the breast: sexuality and maternity in eighteenthcentury England’, Journal of the History of Sexuality, 2:2 (1991), pp. 204– 34; F. A. Nussbaum, ‘ “Savage” mothers: narratives of maternity in the mid-eighteenth century’, Cultural Critique, 20 (1991–92), pp. 123–51; E. Badinter, The myth of motherhood: an historical view of the maternal instinct (English translation, London, 1981). More generally, see P. Crawford, ‘The construction and experiences of maternity in seventeenthcentury England’, in Fildes (ed.), Women as mothers, pp. 3–38. For example, by Andrew, Philanthropy and police, pp. 57–65 and 98–102, and M. D. George, London life in the eighteenth century (Harmondsworth, 1927), pp. 56–60. McClure, Coram’s children. See also Nichols and Wray, History of the Foundling Hospital. R. B. Outhwaite, ‘ “Objects of charity”: petitions to the London Foundling Hospital, 1768–72’, Eighteenth Century Studies, 32:4 (1999), pp. 497–510; T. Evans, ‘Unfortunate Objects’: lone mothers in eighteenthcentury London (Basingstoke, 2005); J. Gillis, ‘Servants, sexual relations and the risks of illegitimacy in London, 1801–1900’, in J. L. Newton, M. P. Ryan and J. R. Walkowitz (eds), Sex and class in women’s history (London, 1983), pp. 114–45; F. Barret-Ducrocq, Love in the time of Victoria: sexuality and desire among working-class men and women in nineteenth-century London (English translation, New York, 1991); S. Williams, ‘ “A good character for virtue, sobriety, and honesty”: unmarried mothers’ petitions to the London Foundling Hospital and the rhetoric of need in the early nineteenth century’, in Levene et al., Illegitimacy in Britain, pp. 86–101. A. Wilson, ‘Illegitimacy and its implications in mid-eighteenth-century London: the evidence of the Foundling Hospital’, Continuity and Change, 4:1 (1989), pp. 103–64.

2

The characteristics of foundlings

my name is Charles Peters of honest but unfortunate parents Note left with child 722, Fitzwilliam Lilley Admitted 6 April 1751 Died 18 February 1758

The aims of this chapter are simple: to investigate and set out the characteristics of the thousands of infants who were abandoned at the London Foundling Hospital from its opening in 1741 to the end of the century. The analysis will highlight the variety of backgrounds the foundlings came from: a diversity which was known to contemporaries, but which has been largely overlooked by historians. Foundlings have been treated in modern studies as a homogenous population, on the basis of restricted pieces of evidence and perpetuating the assumption that they were mainly illegitimate infants born in London. By quantifying this diversity, this chapter highlights the range of circumstances which led to the abandonment of an infant (especially over the course of the General Reception), and suggests its implications for health. A largely quantitative approach sets the whole population of the hospital in context, and allows us to examine separate groups of children according to their characteristics. Table 2.1 sets out the gender composition of the foundling population, which is significant for several reasons. Firstly, it may tell us something about the reasons for abandonment; several historians have agreed that an even sex ratio among foundlings may indicate high levels of illegitimacy, where the sex of the child had little to do with the decision to abandon.1 A preference for abandoning one sex over the other suggests that the decision to give the child up was not made until after the birth, and was directed by gendered earning potential and future costs. Single mothers may not have been in a position to think so long-term. Secondly, the sex ratio is suggestive of survival prospects, since male infants have a lower chance of survival in the first weeks and months of life than females.2 A large proportion of males among the foundlings

The characteristics of foundlings

17

Table 2.1 Sex ratio of foundlings abandoned to the London Foundling Hospital, 1741–99 Total

18 539

Males

9 525

Females Sex ratio (males:females)

9 014 106:100

Source: General Register, LMA, A/FH/A09/2/1-5.

may inflate early mortality rates. A skewed sex ratio may also reflect the fact that infants of one sex were more likely than the other to have died before abandonment could occur. The sex ratio of the foundlings is very close to the normal biological standard at birth of 104:100.3 In February 1744/45 (New Style Calendar), the General Committee had decided that equal numbers of boys and girls should be admitted, but no such regulation was enforced during the General Reception period. The gender ratio observed for the hospital was, therefore, not directed by deliberate policy.4 The lack of gender preference suggests that parents using the hospital were faced with extreme poverty or hardship such that a baby had to be abandoned regardless of its longer-term earning potential. Alternatively, unmarried mothers may have realised the possibilities that the hospital offered to preserve their sexual honour or their employment prospects, again, regardless of the sex of the baby. The hospital may thus even have changed courtship practices as Adrian Wilson has suggested.5 There is certainly no evidence that parents used the hospital to shape the gender composition of their families in a consistent direction. Gendered questions such as these are discernible at other European foundling homes, where girls sometimes significantly outnumbered boys.6 In London, however, Fildes found the opposite: a greater incidence of male abandonment throughout the sixteenth century to the eighteenth.7 It is possible that the relatively small numbers of infants in her sample affected the sex ratio and also that abandonment to an institution such as the London Foundling Hospital involved stimuli other than abandonment to the parish. At the hospital, there is little evidence of gender-directed abandonment, which too suggests that mortality should not be affected by a preponderance or lack of higher-risk boys. The mortality of foundlings is, of course, one of the main themes of investigation in this study. Table 2.2 sets out the ways in which the foundlings left the hospital, and is the first indicator of levels of mortality.

18

Childcare, health and mortality

Table 2.2 Fates of foundlings admitted to the London Foundling Hospital, 1741–99

Died Apprenticed Reclaimed Married

N

%

12 033

64.9

5 920

31.9

221 1

1.2 0.01

Dismissed

50

0.3

Unknown

314

1.7

Total

18 539

Source: General Register.

Almost two thirds of entrants did not survive their time at the hospital, although more detailed analysis of mortality reported in Chapter 3 indicates that there were significant variations in death rates over time. The survivors were almost all formally apprenticed, 48.9 per cent of these being girls and 51.1 per cent boys. The mean ages at apprenticeship were ten years for boys and eleven for girls, which are comparable to the ages of parish apprentices, although younger than those of nonpaupers.8 A small proportion of foundlings were reclaimed by parents or friends, but this was not a very common occurrence, partly because high early mortality meant that many infants had already died, and partly because of the need to reimburse the hospital for their expenses in raising the child.9 Many of the successful reclamations were made very soon after abandonment: a quarter within one month, and almost half within the first six months. These children had often been taken from the mother by force by the father or parish officials, in which case they were returned without financial charge. In 1764, the necessity to reimburse expenses was waived, leading to the reclamation of many older children, and this suggests that the cost had prevented it earlier.10 Older children were also, of course, more likely to be able to contribute to the family’s income. A handful of foundlings left the hospital as adults, either dismissed at the age of twenty-one or, in one case, married. They had probably been working in the hospital until that point, or perhaps had a disability which had prevented them from being apprenticed.11 The foundlings of unknown fates are the few whose personal details were not complete, or whose details were entered on pages which have been damaged.

The characteristics of foundlings

19

Figure 2.1 Seasonal patterns of baptisms and foundling admissions to the London Foundling Hospital, 1750–99 130 120 110

Index

100 90 80 70 60 50 40 Jan

Feb

Mar

Apr

May

Jun

National baptisms, 1750–99 London baptisms 1757–59

Jul

Aug

Sep

Oct

Nov

Dec

Foundling admissions 1757–59

Sources: National population figures from E. A. Wrigley and R. S. Schofield, The population history of England 1541–1871: a reconstruction (London, 1981), p. 287. London baptismal data from the Weekly Bills of Mortality (Guildhall Library, London, St 1543); London Foundling Hospital data from the General Register.

The General Registers also allow an investigation into the seasonal pattern of abandonment for the years when admissions were open. We can thus test whether abandonment followed the seasonal pattern of births, or whether it peaked at particular times of year (which might suggest seasonal hardship). Figure 2.1 shows an index of baptismal seasonality for England and Wales for 1750 to 1799; one of foundling admissions for the years 1757–59 (the only ones which cover open admissions over the full calendar year); and one of London baptisms, 1757– 59, for the parishes covered by the Bills of Mortality.12 If the foundlings really were in the main illegitimate infants, we should more properly compare them with the seasonality of births out of wedlock, or of first births only (illegitimates being most likely to be first births). The pattern of illegitimate births has been shown to be very similar to that of

20

Childcare, health and mortality

legitimates, however, while information on first births only is difficult to access.13 The representativeness of seasonal foundling admissions in the years 1757–59 may be affected by the economic crisis escalating throughout 1757.14 This will be considered further below. The seasonal patterns for England and for the hospital shown in Figure 2.1 are similar, and correlate at 0.66 (1 representing a perfect correlation).15 The pattern of abandonment shows a greater range, however: the peaks are higher and the troughs are lower than the baptismal curves, and especially that for London.16 The smaller range in London’s baptismal seasonality suggests that characteristically rural seasonal rhythms were more muted in the metropolis. The index values for London baptisms and foundling admissions are correlated at only 0.18, suggesting either that not many of the children originated in London (which will be shown not to be the case), or that their metropolitan provenance did not have a great influence on the seasonal pattern of abandonment.17 When London baptisms are lagged by one month, however, the correlation with foundling admissions rises to 0.8.18 This suggests that the foundlings tended to be older when admitted to the hospital than London infants were at baptism.19 When this is corrected for by the use of the one-month lag, foundling admissions correlate very well with London baptisms. A month-lag of the national baptismal data makes no difference to the correlation with foundling admissions, perhaps because the national data have been corrected for the growing gap between birth and baptism. They also consist mainly of rural parishes, and contain only a small proportion of illegitimate births, which may further account for the lower correlation with abandonment. Table 2.3 presents the distribution of foundlings’ ages at entry to the hospital, and shows that most of them were abandoned soon after birth. Ages at entry were recorded in the General Registers for all children admitted from December 1758. Before that, age information comes from ten-per-cent sample B, as outlined in Chapter 1 (that collected for age data only).20 It is possible that there was some degree of ‘rounding’ in ages, especially when the estimate was made by hospital or parish officials rather than the parent(s). The impact of this feature should not affect the overall distribution of ages significantly, however, since the range is so small; up to January 1757 the maximum age limit was still two months. Rounding may affect the age categories into which the children fall, however. The data were collected up to 1760, as after this conditions for entry changed and many older children were admitted. Before the General Reception, only a small proportion of babies were abandoned at very early ages, presumably because of the need to wait for a taking-in session. From June 1756, at least 50 per cent of the intake

The characteristics of foundlings

21

Table 2.3 Age on entry to the London Foundling Hospital, 1741–60 (cumulative percentages) Cumulative % Pre-General Reception

1756

1757

1758

1759

1760

0

28.87

54.74

51.34

59.51

54.82

56.25

1

77.46

96.35

75.53

79.51

81.43

85.14

2

100

99.27

81.98

87.66

89.77

91.66

100

Age in months

3

87.09

90.13

92.33

96.97

4

90.58

95.32

94.99

98.49

5

93.27

97.05

96.24

99.02

6

94.88

97.3

98.11

99.32

7

95.69

97.3

98.72

99.47

8

97.84

98.29

98.72

99.47

9

99.18

98.78

99.62

99.77

10

100

99.27

99.67

99.92

11

100

100

100

100

372

405

3909

1319

Total N

142

137

Source: General Register and entry billets, LMA, A/FH/A09/1/1-173.

consistently arrived within a month of birth; the proportion rose to 59 per cent in 1758. At least 75 per cent of infants arrived before they were two months old, and others may have had their age rounded up to two months, which would place them in the next age category. It might be intuitively supposed that children who came in beyond this age were abandoned in response to the changing personal or economic circumstances of the parent(s). The validity of this assumption will be considered further below. Considering the children who came in under two months of age only, as in Table 2.4, we see again the marked rise in the admission of very young children after the General Reception began, a trend which was strengthened over the next few years. This may reflect more widespread knowledge of the hospital, or perhaps represents a response to changing economic conditions; hardship may have prompted more parents to abandon their baby very soon after it was born. When the age distribution was tested statistically, there was a significant difference in the age distributions of infants admitted before the

22

Childcare, health and mortality

Table 2.4 Distribution of ages on entry to the Foundling Hospital under two months, 1741–60 (cumulative percentage) Cumulative % Pre-General Reception

1756

1757

1758

1759

1760

1 day

1.42

4.51

8.83

10.15

8.6

6.6

2–7 days

2.84

15.79

28.97

32.61

30.09

30.16

1 week

6.38

27.07

41.69

45.84

40.91

40.52

2 weeks

17.02

35.34

50.53

56.92

51.87

50.13

3 weeks

44.68

60.90

71.73

77.23

79.95

78.28

1 month

44.68

69.92

75.97

82.77

79.95

78.28

5 weeks

53.19

75.94

84.80

88.00

82.88

82.37

6 weeks

71.63

84.96

92.22

95.07

90.88

93.48

7 weeks

100

100

100

100

100

100

Total N

141

133

283

325

3476

1197

Age

Source: General Register and entry billets.

General Reception and those entering between 1756 and 1760.21 The distribution for 1756 was also statistically different from those in the remaining years of the General Reception.22 The remaining distributions were essentially similar. Age structure on entry was evidently not constant over time, being partly determined by changing rules of admissions, but also by short-term economic and weather conditions and prevailing cultural constraints on giving up very young infants. The similarity of the age distributions of the sample and the full set is a reassuring indicator of the former’s representativeness. Although these infants were young when they entered the hospital, they were not newborns, as many were who entered continental foundling hospitals.23 In some Catholic countries such as Italy it seems that religious and cultural pressures left unmarried mothers with little choice but to give up their children to the local foundling hospital (although many legitimate infants were abandoned at young ages as well).24 In England, an unmarried woman might keep her child providing that she could support it, and the poor laws and a range of London charities might assist her in that. Brian Outhwaite and Randolph Trumbach have both found evidence of unmarried mothers later in the eighteenth century struggling for some time to keep their child before having to turn

The characteristics of foundlings

23

to the Foundling Hospital.25 Conversely, poor married couples may already have decided to abandon their child prior to its birth, which would lead to the giving up of very young legitimate children also. Illegitimacy may thus not necessarily have meant early abandonment in England. Only 130 children from the London Foundling Hospital carried information on both age and legitimacy status (discussed in greater detail below). Of these, 59 per cent of the legitimate children entered in the first month of life, compared with 43 per cent of the illegitimates. Approximately 80 per cent of infants in both categories had been abandoned by the age of two months, although there was a greater number of legitimate children entering in later months. The small sample size when broken down into legitimacy categories makes conclusions hard to draw, but there is no evidence to suggest that illegitimate infants were abandoned at younger ages than their legitimate peers.26 Similarly, there is little evidence that babies of one sex were abandoned earlier in life than those of the other: the distributions are almost equal at all ages. This reinforces the suggestion that abandonment was not directed by the sex of the baby. It does seem, however, that infants were abandoned at slightly younger ages in the winter months, when harsh weather and higher fuel bills combined with worsening employment prospects may have made supporting a child increasingly difficult for poorer families. Admissions in the full calendar years 1758 and 1759 (when the upper age limit was one year) show that 59.3 per cent of infants abandoned in autumn were under one month, and 58.4 per cent in winter, while in spring and summer the percentages were 51.3 and 55.2. This suggests that some parents abandoned their infants in response to immediate economic circumstances rather than making the decision before the children were born. The backgrounds of abandoned infants The analysis so far has raised some suggestions as to why infants were abandoned to the Foundling Hospital. More detailed information on a sample of foundlings will permit of further investigation into their family situations. In particular, it allows us to test the commonly held assumption that they were, in the main, London-born bastards. Extra information was not recorded for all children, however, and must be extracted where it is available from other sources. This analysis is, therefore, restricted to a sample of the first 10 per cent of entrants entering in each month between 1741 and 1760 (N = 1650). The cut-off date of 1760 was again chosen because of the subsequent changes in rules on admissions, which meant that many older children entered after that date.

24

Childcare, health and mortality

The aims of this part of the study are two-fold. The first is to establish the condition of the foundling on entry because of its implications for his or her base level of health and chances of survival. A mother who was trying to conceal a pregnancy, or was poor and malnourished, had a higher risk of producing an unhealthy or low-birth-weight baby. Thus, the child’s experience of life both before and after birth had a great impact on health status and chances of long-term survival.27 The second aim illustrates the value of investigations such as this to wider themes in economic and social history. In this case, the family backgrounds of foundling infants shed light on the workings of family formation and poor relief in England. Was the Foundling Hospital seen as a place where one could leave a child, possibly only temporarily, when times were hard? Did it encourage sexual immorality, as some contemporaries feared, by providing a convenient place to offload the products of illicit liaisons? Did it allow young single women to continue taking part in an economy of work and courtship from which a baby might have excluded them? The main source of evidence for this study is the entry billet. This document was a printed list of clothing, which was marked according to what the child was wearing at admission. Any marks on the child’s body were also noted, and occasional comments were made as to her or his general state of health (one sad example: ‘the most miserable object ever received’28). Parents and guardians were also encouraged to leave identifying notes and tokens with their child, to facilitate later reclamation, and these were sealed up with the billet and marked with the child’s number. The fact that these billets were filled in so painstakingly is indicative of the hospital’s high level of organisation. The reason why they were kept says much about the social concerns of those who ran it. The entry billet provided the vital identifying link between the child and the family should they wish to reclaim her or him or need to prove that he or she had been abandoned and not killed. By describing the child’s clothing or the token which had been left with her or him, parents could be matched to the correct billet, which bore the child’s identifying number. The billets are now all bound, opened, into books of 100, but all notes and scraps of fabric are pinned to the sheets, so that one can still read the parting words of parents to their children. Using a combination of data from the General Register and the billets and their attached notes from parents and guardians, it is possible to ascertain age on entry and parish of origin for most children in the sample. The same information is not uniformly available for each child, but all information on the child’s condition on entry (be it age, geographical provenance or marital status of the parents) has been recorded.

The characteristics of foundlings

25

There is, therefore, no part of the period where there is no information at all on a particular matter, and therefore change over time can be captured. A quantitative approach is again taken, in order to present an accurate picture of the characteristics of the foundlings. The two topics on which the billets are most informative are the geographical origins of the foundlings and their legitimacy status. The hospital aimed to preserve strictly the anonymity of persons abandoning infants, so no details of the foundlings’ backgrounds were kept in the General Register.29 Yet where the children came from and whether they were born in wedlock are of great importance to any study of health and survivorship, since illegitimacy carried a heavy mortality penalty, as did growing up in London, particularly in the first two-thirds of the eighteenth century. This information may also suggest who used the hospital, whether this changed in the General Reception period, and how people built it into their strategies of coping with poverty and hardship. The fact that the billets and their attached notes do contain information on these otherwise hidden topics is therefore of great interest. Adrian Wilson also saw the potential significance of the foundling data to wider fields of marriage and courtship, although he was not concerned with health or welfare. Using information from billets, he investigated the geographic origins of the children brought to the hospital, and then focused on the London-born infants to test various hypotheses relating to their legitimacy status. His sample study (of 1760 children between 1741 and 1760) indicated that a large proportion of children did originate in the metropolis – never fewer than 50 per cent and up to 80 per cent between June 1756 and June 1757.30 Having tested the likelihood that abandonment was prompted by illegitimacy, parental death or economic hardship, Wilson concluded that the majority of foundlings were indeed illegitimate because they were generally young on entry; abandonment was not correlated with adult burials (which might indicate orphaning); there was evidence of a positive lagged relationship with bread prices (explored further below), which suggested that hardship postponed planned marriages and left women responsible for prenuptially conceived children; and the seasonality of abandonment was consistent with that of illegitimate births.31 He therefore concluded that in London, price movements worked more quickly on marriages than in rural areas, rapidly encouraging or postponing them. London was thus a pace-setter for a trend towards pregnancy-led marriage which has been found for eighteenth-century non-metropolitan England.32 Since the foundlings were apparently in the main illegitimate, Wilson suggested that illegitimacy ratios in the city may have been very much higher than the 4 per cent given for non-metropolitan areas, possibly with even as

26

Childcare, health and mortality

many as 12 per cent of London births becoming foundlings, all of whom would have been born outside wedlock.33 Wilson’s study is both imaginative and outward-looking in its wider conclusions. Yet there are a number of reasons suggesting that it may need qualification for the period 1741–60 as a whole. His choice of samples is based on the fact that differing types of information were recorded for the children for different parts of the period. This, however, means that each of his tests of illegitimacy is based on a small and temporally restricted group of foundlings, who may not have been fully representative of all those entering the hospital. He attempts to compare directly the seasonal pattern of admissions of children entering before 1756 and those entering during the open admissions period of the General Reception. This is misleading, since when children entered in discrete groups, the seasonal pattern represents a supply of entrants which relates to admissions policy rather than demand.34 Aspects of Wilson’s assumptions in approaching the study are also problematic. The final assertion that illegitimacy was more widespread in the capital than elsewhere, for example, is never subjected to the consideration that London’s population contained many more young single women than was the case elsewhere. They might produce a higher ratio of illegitimate to legitimate children without behaving promiscuously as individuals. There are, therefore, reasons to think that aspects of his conclusions may not have been consistently robust for the whole twenty-year period covered by his study. Geographic origins It has already been noted that the London Foundling Hospital was the only such institution in the country, and as such it might have an extensive catchment area once admissions were assured. This was in sharp contrast with other European countries, where foundling homes were much more common. On the other hand, however, England’s systematic national poor relief system may have mitigated the need for a foundling hospital, again in contrast with other European countries. According to Hanway, the original intention was that the institution be for London children, where the need was perhaps greatest, although this was never stated explicitly.35 In reality, as Hanway realised, the demand stretched much further afield. Between June 1756 and August 1757, the billets record the parish of origin of every child, and there is some further sporadic information after this date in the notes. These sources show that infants came from almost every county in England. As might be expected there was a heavy concentration from locations in and around London, but single children came from as far away as the Isle of Wight and Caernarvonshire. Much

The characteristics of foundlings

27

critical attention was paid to the poor survival chances of infants carried such distances to foundling hospitals; in France, long-distance carriers of infants were known as faiseurs d’ange – ‘angel-makers’.36 The London Foundling Hospital was charged with encouraging similar practices also, although publicly it was denied.37 From 1758 however, receipts were issued to those who brought children to the hospital, in order to prove that they had been safely delivered. A lowering of the maximum age limit was also considered, in order to prevent children from being brought very long distances, but no satisfactory solution was found.38 The parishes whence the children came have been grouped into concentric zones around London (which is considered separately), in order to show the distance travelled to reach the hospital. Zone I comprises the counties of Kent, Surrey, Middlesex, Hertfordshire and Essex. Zone II is a swathe from Norfolk, through the Home Counties, to Sussex. Zone III is the south-west, from Wiltshire and Gloucestershire to Cornwall. Zone IV is the midlands, reaching west to the Welsh border. Zone V is Yorkshire and Lancashire; Zone VI is the northern counties; and Zone VII is Wales. An average of 57 per cent of the children entering the hospital each month came from London, with a further 17 per cent from Zone I. Table 2.5 presents the percentage of children arriving in each geographical category by month. Wilson suggests that there was a gradual inclusion of more far-flung areas into the hospital’s catchment area over time, and this does seem to be borne out in Table 2.5, although not to the extent that he claimed.39 This may be because Wilson’s focus on London meant that areas beyond the Home Counties were grouped together as a catch-all ‘Other’ category, which may have overstated the extent of growth in the hospital’s catchment area. Table 2.5 suggests that there was generally an upward trend in several of the non-London and south-east counties, but not approaching the almost continuous growth from approximately 12 per cent to nearly 60 per cent of the London share found by Wilson. The total figures involved in both this study and Wilson’s however, suggest that conclusions should be drawn with caution. Nonetheless, a large and growing proportion of foundlings were born outside London, and sometimes travelled long distances to reach the hospital. This is suggestive of a gradual outward movement of information about the hospital, which may increasingly have been used as an alternative to parish support. This may have been to escape the censure of parish officials, or it may have been a way to relieve local financial pressures on the poor rate, as will be explored further below. It is possible also to identify the parochial origins of those children who came from London parishes. Of the 332 metropolitan foundlings

28

Childcare, health and mortality

Table 2.5 Geographic origins of foundlings as a percentage of the total, by season of entry, 1756–57 Zone

Summer 1756

Autumn 1756

Winter 1756–57

Spring 1757

Summer 1757

Total

London (Ia)

61.8

73.1

62.5

52.3

42.4

Ib

23.7

13.4

16.7

15.0

26.1

19.1

II

9.2

7.5

12.5

20.0

12.0

12.8

57

III

2.6

0

4.2

4.5

0

2.4

IV

1.3

4.5

4.2

7.5

17.4

7.5

V

1.3

0

0

0

0

0.2

VI

0

1.5

0

0

0

0.2

VII

0

0

0

0.9

2.2

0.7

76

67

72

107

Total N

92

414

Note: The seasons each represent clusters of three calendar months (summer consisting of June, July and August, and so on). Source: General Register and Foundling Hospital billets.

in this sample, 39 (12 per cent) came from parishes within the City walls, and 293 (88 per cent) from those outside. This is not, however, notably disproportionate to the distribution of baptisms between the two areas.40 The hospital itself lay outside the walls, within the bounds of St Pancras parish, although it was deemed to be extra-parochial for the purposes of administration and the allocation of settlements. Within the walls, the parishes sending foundlings to the hospital were scattered, showing no particular pattern. Beyond the walls there was a concentration in those closest to the hospital: St George Hanover Square, St Andrew Holborn, St James Westminster, St Luke Old Street, St Giles in the Fields and St Giles Cripplegate (51.9 per cent of the total). The distribution shows that, perhaps unsurprisingly, the parishes sending higher numbers of foundlings were those nearest to the Foundling Hospital. Many of these parishes fall into the swathe moving east from St Giles, round the edge of the City, to Shoreditch, which were identified by John Landers as having particularly unstable patterns of mortality in several crisis years between 1740 and 1772. This was probably because of their large population of immigrants, who lacked immunity to some of the diseases they faced in their new environment.41 While the Westminster parishes surrounding the hospital were relatively wealthy, they

The characteristics of foundlings

29

also attracted large numbers of poorer people who provided services and commodities to the rich. Such employment tended to be seasonal, resulting in pockets of poverty and overcrowding among the less welloff.42 Many of the foundlings, therefore, came from areas with volatile and pernicious disease environments, which were prone to sharp peaks in mortality and also to pockets of poverty. These may have resulted in adult deaths which left infants unsupported, or they may have sent infants to the Foundling Hospital weakened by the cocktails of pathogens encountered in their home environments. Their home conditions may also have been poor in quality. We might expect that foundlings who were born in London, and therefore had a shorter distance to travel to reach the hospital, might be younger on average when they were abandoned than those whose journey took more planning and expense. The ten-percent sample shows that the London children were indeed slightly younger than their nonmetropolitan counterparts. Of the 404 London foundlings entering the hospital between 1741 and 1760 with age information, 62 per cent entered within a month of birth, compared with 55 per cent (78 children) and 51 per cent (190 children) of the total sample in 1756 and 1757 (when the maximum age on entry was in fact lower, although it rose in 1757). By the end of the third month of life, however, the proportions had evened out at around 90 per cent for both the London children and the full sample. Wilson has pointed out that the custom of lying in for a month after birth was still common, and as a consequence he takes entries up to a month after birth as being immediate.43 The fact that a higher proportion of London foundlings were left during this first month may suggest that in the metropolis the custom of lying in was waning, or that these mothers could not afford this luxury in terms of either money or family support. As far as gender is concerned, the London children reflect the same sex ratio as the full sample, and their younger age seems intuitively plausible, since those coming from a greater distance faced not only a longer journey, but also one which involved more planning, more expense and possibly a wait for irregular transport. Parish officials may also have delayed the journey of one child if they knew of another being given up from the same area, to avoid the trouble of arranging two separate journeys.44 It is also possible that greater population density and perhaps greater anonymity in London facilitated rapid abandonment. In other respects, those born in London seem not to have been unrepresentative of the full set of foundlings. However, their place of birth and younger age at abandonment may have represented a compounding of factors tending towards higher mortality.

30

Childcare, health and mortality

Illegitimacy The next issue to be addressed is the legitimacy status of the foundlings. Again, the billets offer an opportunity to reflect on issues which were never explicitly investigated by the hospital governors. In previous analyses, age on entry and details from mothers’ petitions to have their babies admitted have loomed large in the evidence used to judge the legitimacy status of the foundlings.45 Tim Hitchcock cites the Foundling Hospital as one of a number of charitable institutions where unmarried London mothers could leave their children and continue to participate in a working life with prospects of marriage.46 Nicholas Rogers similarly refers to ‘the hordes of illegitimate children’ left at the Foundling Hospital in the eighteenth century.47 There has been a tendency, therefore, to focus on illegitimate children when writing about abandoned infants. In contrast, in studies of marital breakdown, authors have cited economic motivations as precipitating the dissolution of the family, reasons which might equally well have prompted the abandonment of a child. Furthermore, the incidence of fathers abandoning their families rose greatly in periods of war, and many abandoned women turned to the parish after lengthy monogamous unions which had produced children. Sometimes the separation was seen as temporary, necessary only until the economic fortunes of the couple improved.48 Many of these severed relationships left parentless children as well as deserted women. However, the suggestion that some of the Foundling Hospital’s charges could be legitimate offspring abandoned when the marriage of their mother was disrupted or terminated makes only limited appearances in the literature.49 The evidence reported here shows that there are indications that these reasons were indeed responsible for significant numbers of legitimately born infants being brought to the hospital. Some studies of the Foundling Hospital itself have contended that the vast majority of foundlings were London-born bastards, at least at certain points in its history. Ruth McClure mentions the backgrounds of the children specifically only after 1760, when the withdrawal of parliamentary funding prompted new ideas on the sort of children who should be supported. At this stage, a stipulation was made that foundlings should be illegitimate London children with no recognised parish of settlement.50 As she states, ‘everyone took for granted the equation: foundling equals bastard’.51 More recent examinations of the petitions to have infants admitted after 1760 have noted that in fact family backgrounds were quite varied even after this date. Outhwaite found that 77 per cent of infants were stated to be illegitimate in a sample of 217 petitions submitted between 1768 and 1772, leaving up to a fifth possibly born in wedlock.52 Evans has highlighted the varied nature of the stories told by

The characteristics of foundlings

31

mothers in their petitions, and challenged the perception that their infants were invariably illegitimate.53 Assumptions of widespread illegitimacy have, however, been projected back into the General Reception period and earlier, when no policy as to family background was stated. The current study focuses on this period, and suggests that the legitimacy status of entrants appears, in fact, to have been more varied than has generally been supposed, despite the even sex ratio and young age at abandonment. Of the 1650 billets sampled, 299 (18 per cent) included notes which contain information as to the legitimacy of the child. Such evidence requires cautious interpretation, however, since many parents left no notes at all, and many others did not comment on the background of the child. It is perfectly possible, perhaps even probable, that married parents, or recently widowed partners, would be more likely to state their marital status than unmarried women. There could be several reasons for this, the most likely of which was to give the child’s case more moral strength (although this was actually unnecessary in a time of unrestricted admissions). It is possible also that parents wished to justify their actions, or wanted to encourage the hospital to provide good care for the child by implying that they would be in a position to reclaim it soon. Many letters stated that the parent was distraught at leaving the child; that they were of good moral character but had fallen on hard times; and that they would reward the hospital richly when their luck changed and the child was reclaimed (in fact, a rare occurrence, as was highlighted above). An example is found in the note left with child 6529 on 4 December 1757: ‘This little Innocent is the darling offspring of an unhappy but truly virtuous woman by the fondest husband who is born of a good family and may one time or other be able to show his gratitude to this noble charity.’54 It is also possible, though impossible to test, that unwed women who fell pregnant had lower standards of literacy, and in trying to hide the secret of the child’s birth would not have wanted to ask someone else to write a letter for them. This trend, however, may have been offset by the prevalence of notes written by parish officials, which tended to identify children as illegitimate. In terms of sex ratio there is no reason to suspect that the group is unrepresentative of the whole sample, although as will be noted below, it under-represents London-born children, and therefore perhaps also the youngest children. Given the lack of a decisive correlation between age at abandonment and legitimacy, it is hard to establish whether this may have affected the proportions of legitimates identified. Of the 299 notes containing information relevant to the legitimacy of the child, only 168 state explicitly whether the child was born in wedlock or not. From the other 131 the status can only be inferred with

32

Childcare, health and mortality

Table 2.6 Legitimacy status of foundlings, 1756–60, from ten-per-cent sample of entry billets N

%

Illegitimate

106

36.8

Legitimate

58

20.1

Mother only named

96

33.3

Father named or mentioned

28

9.7

288

99.9

Total Source: Entry billets.

varying degrees of plausibility. If there was a reference to the child’s ‘parents’, the foundling was reckoned to be legitimate, since it was being identified as part of a family unit, and was thus likely to display the same characteristics as a legitimate birth. If only the mother was named or mentioned, it was assumed that the child was more likely to be illegitimate, especially since these cases were identified principally from letters by parish officials, who usually stated if the child’s parents were married. Where the father was named or mentioned, the child was taken as being more likely to be legitimate, as a link was being made with a family unit rather than a single parent.55 Table 2.6 shows the results of this classification for the children who entered in the General Reception. Only eleven children abandoned before 1756 had information on legitimacy, and of these, all but two were legitimate by either statement or implication. The small incidence of notes left in the takings-in period means that too much weight should not be attached to this, except to indicate that even before 1756, entrants were not all illegitimate. Of the 164 General Reception children who could be categorised with some degree of certainty, 35 per cent were legitimate. Among the 124 with less information, however, three quarters were likely to have been illegitimate. Overall, we find 30 per cent legitimacy, which is a significantly higher proportion than that previously supposed. This higher estimate of legitimates has great implications for our understanding of poverty and family formation strategies, as well as for the study of mortality.56 Clearly, married parents availed themselves of the hospital’s services as well as single women, perhaps in response to hardship, or in the hope of limiting their families. The family backgrounds of children coming from London appear to have been slightly different, as shown in Table 2.7. No London-born children entering before 1756 carried information on their status. Of

The characteristics of foundlings

33

Table 2.7 Legitimacy status of foundlings coming from London, 1756–60, from ten-per-cent sample of entry billets N

%

Illegitimate

2

3.9

Legitimate

31

60.8

Mother only named

11

21.6

7

13.7

Father named or mentioned Total

51

100

Source: Entry billets.

the 51 General Reception London-born foundlings with legitimacy information, a large majority were legitimate by either statement or implication. Also noteworthy, however, is the small number arriving with legitimacy information; 85 per cent of London-born children in the sample did not. For reasons which can only be speculated upon, London children are harder to classify in this way; perhaps parents carrying their children a short distance to the hospital did not feel the necessity to leave a lengthy note. Perhaps there was a higher degree of undisclosed illegitimacy among London-born children. Although the small number of children whose legitimacy status can be identified makes any findings somewhat tentative, it is noteworthy that a significant proportion of the sampled children, and particularly those from London, were described as legitimate. Information on parents reclaiming children also offers an insight into family backgrounds. The General Registers often identify claimants, and some printed petitions to reclaim also survive from the 1760s. The latter sources often record the marital status of the petitioner. Again, we should be wary of bias in the type of people who made petitions to reclaim; perhaps married couples were better able to afford the costs of reimbursing the hospital’s expenses and of raising the child. As noted above, however, after April 1764 the obligation to reimburse costs was waived, and so from this date there should not have been any discrimination against the less well-off or the unmarried. In contrast to some other European foundling hospitals, the Foundling Hospital did not require a parent to provide proof of marriage to reclaim a child: simply proof of identity as the parent, and of sufficient resources to maintain the foundling.57 The General Registers show that 56.6 per cent of reclamations were made by the mother (125 children), but that 19 per cent of claimed

34

Childcare, health and mortality

children were taken out by the father (42 cases), and a further 2.7 per cent by the ‘parents’ (6 cases). The remaining 48 claimed children were stolen from their nurses (usually supposedly by their mothers), or were taken out by people whose identity was not recorded, or by other friends, relatives or patrons. A Register of Children Claimed, kept between 1764 and 1765, also showed that a number of petitions were made by nonparents (31 of a total of 159, or 19.5 per cent). It is possible that these children were adopted by patrons, or by relatives of the parents.58 Petitions to reclaim children made between 1759 and 1769 reinforce the conclusion that a higher proportion of foundlings were born in wedlock than has previously been thought. 188 such petitions survive, of which approximately 50 per cent were made by friends and relatives, or by parents whose marital status is not clear (‘mother’ or ‘father’). Of the remainder, just over 50 per cent were part of a couple at the time of the petition, although in many cases it cannot be assumed that both partners were the child’s biological parents. Approximately 34 per cent of all claimants were part of a couple at the time of the child’s conception: a proportion strikingly similar to the 30 per cent legitimacy suggested by the billets and notes. Just under 50 per cent of those with a marital status given were either unmarried or currently single. These proportions were found to hold true also for those claimants applying before the lifting of financial obligations in 1764. Many of the unmarried women petitioning at this stage were allowed to have their child back with no payment made, because the child had been taken by force or without their knowledge. It seems clear that there was always a significant proportion of single women among claimants, which suggests that the distribution of claimant types is reasonably representative of those who wished to have their child back even when stricter financial requirements were in place. The petitions to reclaim children, therefore, also point to a sizeable component of legitimate children among the foundlings. They also indicate again the instability of relationships among people of relatively low status in the eighteenth century. Many of the people applying to reclaim were currently single, had been deserted or had a marriage terminated by the death of the other partner, or they were in a different relationship from that which produced the foundling. The social status of the claimants is indicated by their occupations, which were generally skilled or semi-skilled trades, often in the clothing industry. The most common occupations were those of tailor, weaver, shoemaker, peruke-maker and mantua-maker, all of which may have been subject to the hardship of seasonal unemployment.59 The majority of claimants were living in London (73.9 per cent), probably reflecting the fact that the majority

The characteristics of foundlings

35

of foundlings came from the metropolis, and also that it was easier to make a claim when the hospital was nearby. There seems to have been little gender preference at work in the abandonment of legitimate or illegitimate children: 52.5 per cent of foundlings left with information on legitimacy were female, compared with 50.1 per cent in the full hospital population. There was a slight over-representation of girls among legitimate children (61.1 per cent, or 60 children), but only a slight under-representationn among illegitimates (47.3 per cent or 97 children). This supports the traditional assertion that boys were more valuable to the family economy in the longer term, but the imbalance is relatively small, especially when the comparatively small numbers are considered. Rather it seems that there was little sex preference at work in the abandonment of either legitimate or illegitimate children. On the basis of this sample, therefore, the arguments that illegitimate children were younger at abandonment than legitimates, and that legitimate females were more likely to be abandoned than legitimate males, can be rejected. When this matter is considered in conjunction with the evidence from the petitions which show unmarried mothers struggling to keep their children for as long as possible, it is evident that assumptions often advanced as to age at abandonment and the reasons for it need to be reformulated. Reasons for abandonment Information on why the child was abandoned was given in 231 notes, 226 of which were from the General Reception period. The reasons given are presented in Table 2.8. Most of the information came from notes written by parish, workhouse or hospital officials, and it may carry a certain amount of bias in the type of children represented. While parish or hospital officials may regularly have identified themselves as the sender of a child, parents may not have been so consistent in explaining their circumstances. This probably explains the fact that this group of foundlings under-represents London-born children (only 13.7 per cent were from the metropolis), since it was suggested above that those living in the capital had less need of the support of others than those elsewhere in abandoning their babies. In terms of gender, the ratio for this group of children is even, although they were slightly older on average than the full sample with age information (46.1 days rather than 25.7 for the whole sample). This may indicate that they had longer distances to travel to reach the hospital, and may have passed through the hands of other officials before they were sent on. This is supported by the fact that the large majority of children with additional information

36

Childcare, health and mortality

Table 2.8 Reasons for abandoning children to the London Foundling Hospital, 1756–60 Reason for abandonment

N

% of total

168

72.7

Economic reasons

16

6.9

Father abroad

11

4.8

9

3.9

Sent by parish

From lying-in hospital From workhouse

5

2.2

Death of father

2

0.9

Mother ill

2

0.9

Death of mother

2

0.9

Parents incapable

1

0.4

From Middlesex hospital

1

0.4

Cruelty of father

1

0.4

Parents unknown

1

0.4

Father absent, mother poor

1

0.4

Parents poor

5

2.2

Mother dead

2

0.9

Left by parents

1

0.4

Father soldier, mother dead

1

0.4

Mother poor

1

0.4

Father abroad, mother disabled

1

0.4

From parish, with additional reason:

Total

231

Source: Entry billets and notes.

on abandonment were sent by parish officials. The second most common set of motivations stated in the notes for abandoning a child concerns the poor economic circumstances of the parent(s). Broken promises of marriage do not feature as a reason for abandoning a child, although it is possible that forsaken women either did not choose to explain their situation or were not capable of writing so articulate a note. The small number of children entering before the General Reception who brought information on why they were abandoned also reflect this wider pattern of parental death and economic hardship. None of these children was sent with assistance from the parish.

The characteristics of foundlings

37

Figure 2.2 Economic background to the General Reception period at the London Foundling Hospital 8 7 200 6 5

150

4 100

3 2

50

Bread price (in pence)

Numbers in armed forces (thousands), Index of real wages

250

1 0

Real wage index

Armed forces

1780

1778

1776

1774

1772

1770

1768

1766

1764

1762

1760

1758

1756

1754

1752

1750

1748

1746

1744

1742

1740

0

Bread prices

Sources: Real wage index (for London) from E. W. Gilboy, in B. R. Mitchell, British historical statistics (Cambridge, 1988), pp. 154–5. Armed forces: data from T. S. Ashton, Economic fluctuations in England 1700–1800 (Oxford, 1959), Table 8, p. 187. Bread prices: data from Mitchell, British historical statistics, pp. 769–70.

Most of these notes come from the period 1756–58: years of high prices, coupled with economic pressures and high levels of male conscription for the Seven Years’ War.60 It is interesting to consider whether, as suggested above, the motivation for abandonment altered over time. Figure 2.2 contains several measures of changing economic circumstances covering the General Reception period. Given the focus in the notes on economic hardship and male conscription, data on prices, real wages and numbers serving in the army have been plotted. Downturns in economic conditions, and rises in numbers conscripted, may have led to more marriages being delayed or courtships broken off, possibly resulting in more illegitimate children; more married couples finding themselves unable to support their family; or more women being left in a financially unenviable position when their partners were conscripted. David Reher has found that in Spain there was a positive correlation between prices and child abandonment from urban households.61 Harsh

38

Childcare, health and mortality

winters and poor harvests may also have raised adult mortality, leaving a greater number of children at risk of being abandoned.62 It is worth noting, however, that Hanway believed that the main factor prompting many parents to abandon their children was not poverty but indifference to them.63 This is not the picture seen in the notes analysed here, although perhaps parents indifferent to their child would not have left a note with them. We are frequently warned that these sorts of data are not suitable for examining short-term trends, and especially not for individual years.64 In the case of abandonment, however, it is likely that it was precisely the short-term fluctuations in the family situation which acted as the trigger, especially if abandonment was not necessarily seen as permanent. This study is confined to the General Reception period, since this was the only time when abandonment was openly available for parents. Furthermore, there are more data available from notes for this period. The evidence shows that the General Reception coincided with a time of falling real wages from 1754; massive army conscription marking the beginning of the Seven Years’ War; and an initial rise in bread prices, although this was subsequently reversed. Figure 2.3 shows in more detail the short-term fluctuations, using the weekly bread prices set by the Assize of Bread and printed in the Weekly Bills of Mortality.65 Hay has found that price indices are positively correlated with the incidence of theft cases heard in the courts in the eighteenth century, suggesting that price series do accurately reflect hardship.66 The numbers abandoned to the Foundling Hospital are also included. The two series appear at first sight to follow a similar course, at least until the end of 1757 (ignoring the initial fall in abandonment, which represents the effect of the start of the General Reception). In fact, when both were detrended using a seven-point moving average, and the deviations about the mean plotted, there was found to be very little correlation between them, even when the series was divided into shorter time-periods.67 Clearly there was no immediate relationship between bread prices and abandonment to the London Foundling Hospital. Lagging does not serve to make the relationship more significant, even when the lag is of nine or twelve months, which Wilson suggests was the period before prices affected abandonment.68 The fact that the graph covers a short time-span, and also that bread prices were certainly not the only economic factor affecting abandonment, probably explains the low relationship found here. Further, the data from notes suggest that over the course of the General Reception there was a change in the way in which those abandoning infants used the hospital. From an initial focus on

The characteristics of foundlings

39

Figure 2.3 Bread prices and numbers abandoned to the London Foundling Hospital, 1756–60 250

10

200

8 150 6 100 4 50

2

Number f abandoned children

Price of quartern wheaten loaf (in shillings)

12

0

Bread prices

Jan 1760

Oct

Jun

Mar 1759

Nov

Aug

Apr

Jan 1758

Sep

Jun

Mar 1757

Nov

Aug

Apr

Jan 1756

0

Abandonment

Sources: Bread price data from the Weekly Bills of Mortality; foundling admissions data from the General Register.

parents leaving children according to necessity, there was a growth in the numbers sent with the help of parish officials. To investigate this change, the notes were coded according to the information they contained. This shows the amount of detail provided (suggesting the educational status of the parent, and the degree of emotional attachment to the child), and also the degree to which other institutions and parish poor law officials used the hospital. Figure 2.4 shows the proportion of notes in each category as they changed over the course of the General Reception. All were subject to short-term fluctuation probably caused by relatively small numbers in each category when broken down by month. However, it is clear that there was a growth in the number of notes written by parish ministers, overseers of the poor and churchwardens, particularly from the beginning of 1757. Apparently it took some months for parishes officers to realise the opportunity offered by the hospital to rid themselves of chargeable infants, or to begin to

40

Childcare, health and mortality

Figure 2.4 Types of note left with foundlings as a percentage of total left with notes, 1756–60

Percentage of total with notes

100 90 80 70 60 50 40 30 20 10

Name given only

From parent or guardian

From parish

Jan 1760

Sep 1759

May 1759

Jan 1759

Sep 1758

May 1758

Jan 1758

Sep 1757

May 1757

Jan 1757

Sep 1756

Jun 1756

0

From institutions

Source: Entry billets and notes.

convince mothers that abandonment represented the best option for them or their babies. Some of the notes in this category were written with the consent of the mother, and others were merely accounts of the child’s baptism, drawn by the vicar from the parish register. Not all of them therefore represent unwanted burdens sent on by the parish, but all show some collusion with local officers. Apparently, parents and officials alike became increasingly aware of how the hospital worked, and how they might go about using it. The result was an increase in the number of parents who applied to their vicar and parish officials for assistance in abandoning their child. Other institutions such as lying-in hospitals and workhouses do not show such a growth in their use of the Foundling Hospital. Since fewer London residents than people living elsewhere left notes with their abandoned children, it is likely that those sent with the assistance of the parish represent a growth in two types of abandoned children: children from outside London, who could less easily be carried to the Foundling Hospital without assistance from parish officials, and illegitimates, for whom the parish did not want the burden of care, or the trouble and expense of bastardy investigations.69 It has not hitherto been considered that the proportions of children abandoned at the London Foundling Hospital in these categories may have altered over time.70

The characteristics of foundlings

41

The data extracted from the notes left with foundlings demand some reconsideration of the traditional view of foundlings as children displaced by dysfunctional unions between non-married individuals. Despite the impression of widespread illegitimacy given by the age structure of foundlings and the seasonality of their abandonment, the billets and notes present a more complex picture and in fact refute the frequently stated link between young age at abandonment and illegitimacy. The foundling evidence indicates that a significant number of abandonments occurred as a result of breakdowns in established marital relationships through poverty or the death or absence of one partner. A typical story is found in the note accompanying child 6158, left at the hospital on 1 November 1757: Worthy Gents. I am very sorry to be so trobelsome to the Good Charety of this bot nesctey [necessity] foes [forces] me to it . . . my hosben is presed and I have keep my dear Child as Long as posebel . . . teel I have parted with all my things.71

This child was born of a legitimate union, and was given up when the mother was left alone and in dire economic straits. Stories such as this indicate the precarious economic position of many married couples, especially in wartime, both in the capital and further afield. Another important finding is the increased use of the hospital by parishes. The scale of operation at the Foundling Hospital during the General Reception suggests that it may have begun to play a significant part in parochial practices for poor mothers and children in the late 1750s. A further significant implication of the data is what it suggests for London’s illegitimacy ratio. Wilson calculated that over 12 per cent of all baptisms recorded in the London Bills of Mortality were abandoned to the Foundling Hospital during the General Reception, or half of all first births in the capital. These years therefore witnessed a ‘large-scale illegitimacy crisis’ in London, with the General Reception itself acting to make marriage less attractive.72 Following the suggestion that the foundlings were not in fact universally illegitimate, it is interesting to recalculate these figures. If 57 per cent of children came from London, and 30 per cent were born in wedlock, the proportion of Londonborn bastards among the foundlings is already lower than Wilson supposed. Further, only two thirds were baptised prior to entry (according to notes made on the entry billets) and therefore featured in the Bills of Mortality, a fact which Wilson did not directly consider. Thus, the new data suggest that possibly only 7 per cent of London baptisms became foundlings. This is still higher than the 4 per cent illegitimacy ratio suggested for the country, but does not support Wilson’s assertion that

42

Childcare, health and mortality

London was a sink of illegitimacy, or that the hospital discouraged marriage. In fact, sixteenth- and seventeenth-century data point to low levels of illegitimacy in the capital, and nineteenth-century evidence from the Registrar-General also suggests that London did not have excessively high illegitimacy rates.73 Thus, it seems that the existence of the hospital and in particular the General Reception did not encourage illegitimacy to any large degree, and in fact seems to have played a noteworthy role in survival strategies for married parents. Clearly, to present foundlings as invariably illegitimate and Londonborn is to understate the variety of their origins, for this period at least. Infants were sent to the hospital from all over the country, although the majority did originate in London. There were also many reasons for the abandonment of a child, including the death or absence of a partner, the failure of marriage plans, and poverty. The lack of any significant correlation between abandonment and bread prices suggests that the reasons were more complex than a short-term fluctuation in economic circumstances. The evidence also points to a pattern of relatively low urban illegitimacy, suggesting a continuum with seventeenth- and nineteenthcentury studies of bastardy. McClure’s equation that ‘foundling equals bastard’ has been tested, and rejected: no such uniform statement can be made as to the foundlings’ backgrounds. Clearly, people in many situations used the hospital to alleviate their own personal hardships. The short duration of the General Reception meant that parents and officials could not rely on abandonment to the hospital, but it remained as a possibility throughout the rest of the period and beyond. As such, it certainly formed part of the ‘economy of makeshifts’ for the married and unmarried poor alike. There are also significant implications for health and survivorship in this heterogeneity of foundling backgrounds. Infants entering after their first days and weeks had already survived the riskiest time of their lives. Illegitimate infants had a higher risk of death than those born in wedlock, particularly in the second half of the first year of life.74 Children born in London parishes which displayed unstable mortality patterns may well have been at higher risk than those born elsewhere. In Chapters 3 and 4, the relationship of these characteristics to ill-health and mortality will be investigated to see how large a part they played in determining the survival outcomes for the foundlings. Notes 1 Kertzer, Sacrificed for honor, pp. 110–12. 2 D. I. Kertzer and M. J. White, ‘Cheating the angel-makers: surviving infant abandonment in nineteenth-century Italy’, Continuity and Change, 9:3 (1994), p. 54.

The characteristics of foundlings

43

3 M. S. Teitelbaum, ‘Factors associated with the sex ratio in human populations’, in G. A. Harrison and A. J. Boyce (eds), The structure of human populations (Oxford, 1972), pp. 91–2. David Souden (‘East, west – home’s best? Regional patterns in migration in early modern England’, in P. Clark and D. Souden (eds), Migration and society in early modern England (London, 1987), p. 298, Table 40) also found a ratio of c. 104:100 for the 1750s and 1760s. 4 General Committee minutes, 27 February 1744/45, LMA, A/FH/K02/1-18. Throughout the General Reception, the sex ratio hovered around 106:100, ranging from 102:100 in 1756 and 1758 to 111:100 in 1760. The 1758 ratio indicates that this does not represent a consistently upward trend, but it is possible that it reflects a change in the reasons why children were abandoned, and hence perhaps the types of children who were left. This is considered in greater detail below. 5 Wilson, ‘Illegitimacy and its implications’. 6 P. P. Viazzo, M. Bortolotto and A. Zanotto (‘Five centuries of foundling history in Florence’, in C. Panter-Brick and M. T. Smith (eds), Abandoned children (Cambridge, 2000), p. 77) note the typically ‘Mediterranean’ pattern of larger numbers of girls abandoned than boys at the Spedale degli Innocenti of Florence from the fifteenth century, with ratios as uneven as 76.1:100 from 1445 to 1485, and 85.2 from 1777 to 1799. By the beginning of the nineteenth century the ratio was approaching parity, which has been taken to suggest that there was a growing proportion of illegitimate children among the foundlings. 7 Fildes, ‘Maternal feelings re-assessed’, pp. 150–1. 8 Snell gives an average age at leaving home for male pauper apprentices of 14.3 and one for females of 13.5 between 1700 and 1860. See K. D. M. Snell, Annals of the labouring poor (Cambridge, 1985), pp. 323–32. 9 In 1764–65, of 159 applications to reclaim a child, in only 55 cases (34.6 per cent) was the child found to be still alive. See Register of Children Claimed, 1764–65, LMA, A/FH/A11/1/1/1. 10 General Committee minutes, 4 April 1764. Girls were slightly more likely to be reclaimed than boys, and reclaimed children tended to have been slightly older when they were abandoned than those who were not (100.8 days compared with 67.3). See Levene, ‘Health and survival chances’, pp. 68–73. 11 See Chapter 7. 12 The national dataset is compiled from a sample of 404 parishes. It should be noted that it does not include London. 13 E. A. Wrigley, ‘Marriage, fertility and population growth in eighteenthcentury England’, in R. B. Outhwaite (ed.), Marriage and society: studies in the social history of marriage (New York, 1981), pp. 163–7. 14 See Wilson, ‘Illegitimacy and its implications’, p. 128, on rising bread prices in London in 1756–57, and T. S. Ashton, Economic fluctuations in England 1700–1800 (Oxford, 1959), pp. 20–1, on the defective harvest of 1756, which led to extensive food riots in the provinces and raised mortality in London.

44

Childcare, health and mortality

15 Significant at a 95 per cent level of confidence. 16 The standard deviation for the index of national baptisms is 8.45, for foundling admissions 14.06, and for London baptisms 2.8. 17 This is not statistically significant (p = 0.579). 18 Significant at a 99 per cent level of confidence. 19 The distinction between birth and baptism is a significant one, especially since the lag between the two events seems to have lengthened during the eighteenth century from a few days to a month or more. The national data have been corrected to account for infants who may have escaped registration in baptism registers by dying before they were christened. See E. A. Wrigley and R. S. Schofield, The population history of England 1541–1871: a reconstruction (London, 1981), pp. 89–102. The generally poorer quality of ecclesiastical registers for London parishes makes the lag between birth and baptism harder to gauge here. See R. S. Schofield and B. M. Berry, ‘Age at baptism in pre-industrial England’, Population Studies, 25:3 (1971), pp. 453–63. 20 This sample cannot claim to be entirely representative of the group as a whole, since certain types of infants were more likely to be left with a note stating their age. 21 At a 99 per cent level of confidence. The test used was the Kolmogorov– Smirnov, which assesses the likelihood that a pair of distributions came from the same population. This result indicates that we can be 99 per cent sure that they were not. 22 At between 99 and 95 per cent levels of confidence depending on which pair of years was being tested. 23 See, for example, Levene, ‘Health and survival chances’, pp. 118–20, showing that over half of all foundlings in two entry cohorts at the Innocenti hospital in Florence were abandoned on the day of birth, and at least 75 per cent within a week. 24 This view is strongly voiced in Kertzer, Sacrificed for honor. On legitimacy and age in Florence, see Levene, ‘Health and survival chances’, pp. 126–9. 25 Outhwaite, ‘ “Objects of charity” ’; R. Trumbach, Sex and the gender revolution: heterosexuality and the third gender in Enlightenment London (Chicago and London, 1998), pp. 280–2. 26 81.2 per cent of legitimates were admitted by two months, and 79.0 per cent of illegitimates. Illegitimate infants sent to the hospital by parish officials may have had their ages rounded up to two months, which would place them in the second age category rather than the first. 27 See S. King, ‘Dying with style: infant death and its context in a rural industrial township, 1650–1830’, Social History of Medicine, 10:1 (1997), pp. 3–23 and E. A. Wrigley, ‘Explaining the rise in marital fertility in England in the “long” eighteenth century’, Economic History Review, 51:3 (1998), pp. 435–64. 28 Billet for child 5393, 1 August 1757, LMA, A/FH/A09/1/64.

The characteristics of foundlings

45

29 This policy was inserted into the earliest public notices of admissions sessions. General Committee minutes, 4 March 1740/41. 30 Wilson, ‘Illegitimacy and its implications’, pp. 116–17. Wilson does not indicate the proportion of the total intake who originated in London, but describes the data over time; hence the vague measure of the London portion. The sample size for the London-born children is 108, which seems small given the weight which is placed on the significance of London birth. 31 Wilson cites Wrigley and Schofield, The population history of England, p. 292 note 4, which details several studies for Belgium, Sweden and France over the course of several hundred years. 32 Citing Wrigley, ‘Marriage, fertility and population growth’, pp. 158–61, and R. M. Smith, ‘Marriage processes in the English past: some continuities’, in L. Bonfield, R. M. Smith and K. Wrightson (eds), The world we have gained: histories of population and social structure (Oxford, 1986), pp. 85–8. 33 Wilson, ‘Illegitimacy and its implications’. For his sources, see endnote 62, p. 163. The figures on which Wilson calculated his illegitimacy ratios have been criticised by Adair (Courtship, footnote to p. 212), principally on the grounds that the formula used for calculating births outside marriage is not constant, especially in cases of high illegitimacy. Wilson added numbers of foundlings to illegitimacies in London, and then multiplied by four (a constant factor derived from the fact that one birth in four was a first birth). This produces the proportion of first births outside marriage. Since this multiplier is not constant, but moves inversely with the level of illegitimacy (since most illegitimate births are first births, they inflate the pool of first births), Wilson’s assumption may not be valid. 34 Wilson, ‘Illegitimacy and its implications’; for sampling methods, see pp. 112–15 and Appendix 1, pp. 141–6. For the use of time series analysis on seasonal admissions’ patterns, see pp. 125–8. 35 Hanway, A candid historical account, p. 35. 36 Kertzer and White, ‘Cheating the angel-makers’, p. 458. 37 An example of this practice in England is noted in The tendencies of the Foundling Hospital in its present extent considered . . . in several letters to a senator (London, 1760), p. 10. 38 General Court minutes, 11 July 1759, LMA, A/FH/K01/1-4. Long journeys to reach the hospital were also condemned in 1759 by parliament, who resolved ‘That the conveying of Children from the Country to the Hospital for Exposed and Deserted Young Children in London is attended with many evil consequences, and ought to be prevented’ (quoted in General Court minutes, 8 May 1759). 39 Wilson, ‘Illegitimacy and its implications’, pp. 116–19. 40 The Weekly Bills of Mortality (Guildhall Library, London, St 1543) show that 92.5 per cent of baptisms in 1757 were outside the City walls, and 92 per cent in 1758. Wilson hypothesised that the parishes beyond the City walls might have ‘behaved in an intermediate way’ in levels of

46

41 42

43 44

45 46

47 48

49

50

51 52

Childcare, health and mortality admissions to the hospital, between the intramural regions and the more distant counties (‘Illegitimacy and its implications’, pp. 119 and 148). This is again due to methodological differences from the current study; Wilson’s assertion is based on the concept of a ‘baptisms-deficit’ in the London population, composed of foundlings who were born in the metropolis but were abandoned before they were baptised. This reveals that, in relation to population, the deficit was larger for the parishes within the City walls than for the extramural parishes. This theory however involves assumptions as to proportions baptised, and proportions from London which are extrapolated from small samples. It seems likely that the evidence used for the current study is more rigorous, since it comes from the notes themselves. J. Landers, Death and the metropolis: studies in the demographic history of London, 1670–1830 (Cambridge, 1993), pp. 312–15. L. D. Schwarz, ‘Social class and social geography: the middle classes in London at the end of the eighteenth century’, Social History, 7 (1982), pp. 167–85; C. Spence, London in the 1690s: a social atlas (London, 2000). Wilson, ‘Illegitimacy and its implications’, p. 121. For example, two children arrived together from parishes in Worcester on 6 May 1757, with almost identical notes from parish officials. On 5 August 1757, two children were sent by the overseers from Gloucestershire parishes, and on 9 November 1757, two arrived from Southampton with notes from overseers. Wilson also notes that children often arrived together from certain areas (‘Illegitimacy and its implications’, p. 144). For example, Outhwaite, ‘ “Objects of charity” ’; Wilson, ‘Illegitimacy and its implications’. T. Hitchcock, ‘ “Unlawfully begotten on her body”: illegitimacy and the parish poor in St Luke’s Chelsea’, in T. Hitchcock, P. King and P. Sharpe (eds), Chronicling poverty: the voices and strategies of the English poor, 1640–1840 (Basingstoke, 1997), pp. 75–8. N. Rogers, ‘Carnal knowledge: illegitimacy in eighteenth-century Westminster’, Journal of Social History, 23:2 (1989), pp. 356–8. Hitchcock, ‘ “Unlawfully begotten” ’; D. A. Kent, ‘ “Gone for a soldier”: family breakdown and the demography of desertion in a London parish 1750–91’, Local Population Studies, 45 (1990), pp. 27–42; P. Sharpe, ‘Marital separation in the eighteenth and early nineteenth centuries’, Local Population Studies, 45 (1990), pp. 66–70. An exception is George, London life in the eighteenth century, p. 57, who notes the varied backgrounds of the children brought to the Foundling Hospital. McClure, Coram’s children, pp. 139–40. Illegitimate children gained a settlement by birth, but parishes might contest it if the mother was settled elsewhere, especially if they feared that the child would become a charge on the poor rates (Taylor, Poverty, migration and settlement, pp. 16–20). McClure, Coram’s children, p. 9. Outhwaite, ‘ “Objects of charity” ’.

The characteristics of foundlings

47

53 Evans, ‘Unfortunate objects’, pp. 98–126, passim. 54 Billet for child 6529, 4 December 1757, LMA, A/FH/A09/1/76. 55 This follows the practice established by P. Laslett and K. Oosterveen, ‘Longterm trends in bastardy in England: a study of the illegitimacy figures in the parish registers and in the reports of the Registrar-General, 1561– 1960’, Population Studies, 27 (1973), p. 286. 56 Illegitimate infants generally have a significantly raised risk of death early in life. See Levene, ‘The mortality penalty’, and references. 57 The foundling hospital at Bologna in Italy was one which insisted that only married parents might reclaim (Kertzer, Sacrificed for honor, p. 118). In 1756, however, the General Committee of the London hospital stated that a legitimate child might only be claimed by the father, if there was one (General Committee minutes, 8 September 1756). This suggests that many foundlings reclaimed by their fathers were legitimate. 58 Register of Children Claimed, 1764–65, LMA, A/FH/A11/1/1/1. 59 P. Earle (A city full of people: men and women of London, 1650–1750 (London, 1994), p. 13) notes that people employed in crafts which serviced the wealthy might be left idle after the end of the season. It is likely that many of the foundlings’ parents were not part of the more skilled elite who worked for the fashionable classes, but some may have been affected by this seasonal pattern. 60 Serving in the army is often cast as a welcome escape for men reneging on family responsibilities (Kent, ‘Gone for a soldier’; T. Evans, ‘ “Blooming virgins all beware”: love, courtship and illegitimacy in eighteenth-century British popular literature’, in Levene et al., Illegitimacy in Britain, pp. 18– 33; Earle, A city full of people, pp. 74–8. In peacetime, the army could be sustained by colonial recruits and large numbers of Scots and Irishmen, but in wartime, the army had to up their recruiting campaigns significantly, and many men were impressed in order to meet parliamentary targets for militia size (L. D. Schwarz, London in the age of industrialisation: entrepreneurs, labour force and living standards, 1700–1850 (Cambridge, 1992), pp. 95–6). By focusing on the lower classes, the recruiters probably did leave many women and children in poor financial circumstances. 61 D. S. Reher, Town and country in pre-industrial Spain: Cuenca 1550– 1870 (Cambridge, 1990), p. 147. 62 The end of the Seven Years’ War coincided with a large mortality peak in the capital, with raised levels of smallpox among adults in 1762 and 1763. The late 1750s were not characterised by crisis levels of mortality, but both smallpox and fever mortality were high in 1757 and 1758, and the high prices of 1756–58 affected the baptism levels of 1757 (Landers, Death and the metropolis, pp. 279–80, 284, 287). 63 Hanway, A candid historical account, p. 27. 64 Schwarz, London in the age of industrialisation, p. 168. There are also numerous problems with the various price and standard-of-living series,

48

65

66 67

68

69

70

71 72 73

74

Childcare, health and mortality which their compilers are usually quick to point out themselves. See, for example, S. Rappaport, Worlds within worlds: structures of life in sixteenth-century London (Cambridge, 1989), pp. 123–8; E. Gilboy, Wages in eighteenth-century London (Harvard, 1934), p. 19; Schwarz, London in the age of industrialisation, pp. 157–8, 168–75; D. Woodward, ‘Wage rates and living standards in pre-industrial England’, Past and Present, 91 (1981), pp. 42–3. Gilboy’s price index was selected for use here because it refers specifically to workers in London, which was the place of provenance for a significant proportion of the foundlings. The quartern wheaten loaf price is used; Appleby claimed that this reflected general nutritional levels (A. B. Appleby, ‘Nutrition and disease: the case of London, 1550–1750’, Journal of Interdisciplinary History, 4:1 (1975), p. 5). D. Hay, ‘War, dearth and theft in the eighteenth century: the record of the English courts’, Past and Present, 45 (1982), pp. 131–2. The correlation coefficient of the two series is −0.14. When the time-period was subdivided into four equal time-periods, only one showed a positive correlation (the third quarter, representing May 1758 to mid-April 1759), and the coefficient was only 0.03. Wilson, ‘Illegitimacy and its implications’, pp. 131–3. The correlation coefficient for the current data for a lag of nine months is 0.07, and that for twelve months is 0.11. Hanway suggested that some London parishes gave up all their poor infants to the hospital, confirming that London children were less likely than those from elsewhere to be abandoned with an identifying note (A candid historical account, p. 84). It would be enlightening to know more about how the parish officials learned of the hospital, and the role they considered it to play. Unfortunately the parishes sending children to the hospital sent only one or two children each, making information very hard to trace. None of the London parishes in question has good overseers’ accounts for the period, and a study of such accounts for non-London parishes is beyond the scope of the current study. Records for this period could not be traced for any of the London parish workhouses which sent infants. Billet for child 6158, 1 November 1757, LMA, A/FH/A09/1/71. Wilson, ‘Illegitimacy and its implications’, pp. 136–7. Adair, Courtship, pp. 202–3, P. Laslett, ‘Introduction’, in P. Laslett, K. Oosterveen and R. M. Smith (eds), Bastardy and its comparative history (London, 1980), p. 30. See Chapter 4 of this book, and Levene, ‘The mortality penalty’.

3

Risks of death: the estimation of mortality

Va mon enfant, prend ta fortune . . . Note left with child 4338, Margaret Hall Admitted 1 May 1757 Died 2 June 1763

The previous chapter has shown that a large proportion of foundlings died while under the care of the hospital, and that some of them probably entered in a compromised state of health. The quantification of mortality is one of the main aims of this study, for three reasons. The first is to further our understanding of the Foundling Hospital’s regime, and of how institutional care, not just at this hospital but also more widely, may have been mediated into death rates. The second is to compare the hospital with other contemporary institutions and other timeperiods: an aim which has not been achievable previously because of unsatisfactory methods of calculating mortality. There has been much discussion of foundling mortality in Europe, and so genuine methods of comparison are particularly desirable. The third aim is to compare the foundlings with the population outside the hospital, in order to examine whether this group of infants and children, who, after all, represent a very poor experience of childrearing despite the hospital’s best efforts, may give us an insight into rapidly falling infant mortality rates in England in the second half of the eighteenth century. The discussion of how the hospital tried to keep its charges alive, and how successful it was, should, therefore, give us important clues to the nature of wider demographic trends and the quality of institutional care. The foundation of the London Foundling Hospital coincided with the start of a fall in infant mortality in England. Studies suggest that infant mortality rates (IMRs) in London peaked at 450 deaths per thousand live births in the 1740s, but had fallen to 250 per thousand by the 1770s and were probably well under 200 by the end of the century.1 This fall was seen outside London as well, although initial levels of mortality

50

Childcare, health and mortality

Table 3.1 Infant mortality per thousand entries at European foundling hospitals in the eighteenth century Foundling hospital

Mortality per thousand entries

Period

Calahorra, Spain

551

1794–97

Cadiz, Spain

697

~1790

Zaragoza, Spain

865

1786–90

Florence, Italy

500–800

1750–1800

Rouen, France

791

Mid-century

946

End century

Paris, France

753

Mid-century

841

End century

890

1750–59

Dublin, Ireland

Sources: V. Pérez Moreda, Las crisas de mortalidad en la España interior siglos XVI–XIX (Madrid, 1980), p. 187; P. P. Viazzo, M. Bortolotto and A. Zanotto, ‘Five centuries of foundling history in Florence: changing patterns of abandonment, care and mortality’, in C. Panter-Brick and M. T. Smith (eds), Abandoned children (Cambridge, 2000), p. 86; J.-P. Bardet, M.-D. Crinne and J. Renard, ‘The death of foundlings: a tragedy in two acts’, in A. Bideau, D. Desjardins and H. P. Brignoli (eds), Infant and child mortality in the past (Oxford, 1997), p. 247; J. Robins, The lost children: a study of charity children in Ireland, 1700–1900 (Dublin, 1980), p. 22.

there were generally considerably lower than in the metropolis.2 The reasons behind this trend are unclear, although it seems that it was driven by a sharp fall in endogenous infant mortality (that arising from birth trauma and congenital defects). Suggested causes include an improvement in women’s ability to produce and raise healthy infants, changes in infant feeding practices to those that improved survival prospects, and progress in obstetrics and midwifery. Maternal mortality also fell in this period, which suggests that there was a common cause.3 Among foundling infants, however, mortality seems to have remained high. Table 3.1 shows estimates of mortality in the first year of life at several European hospitals (deaths within one year of life related to total entrants under one year of age), and shows that it was common for three quarters of infant foundlings to die within a year of admission. Foundling hospitals across Europe were keen to quantify this mortality, and to try to act to prevent it, but were seemingly unable to make any long-term improvements.4 The accounts drawn up by the hospitals

Risks of death: the estimation of mortality

51

themselves were not necessarily accurate, however, and their use by modern commentators has sometimes perpetuated misconceptions as to mortality levels. McClure, for example, quotes mortality figures drawn up by Hanway for the London Foundling Hospital, which sometimes underestimate and for other periods overestimate mortality.5 There has, however, been no attempt to compare foundling mortality directly with mortality in surrounding areas. In fact, such an exercise using figures calculated in the manner described above would be fruitless, since they do not represent a demographically correct measure of mortality. The method of relating deaths to entries involves no reference to the wider population at risk, and is therefore not comparable with rates outside, or even with mortality at the same hospital in another year. We have seen that ages at entry to foundling hospitals could be quite varied, resulting in varying periods of exposure to survival risks before entry. Factors such as these make the figures quoted in Table 3.1 useful for indicating the trend in mortality at foundling hospitals, but they cannot be used as an accurate measure of rates. In this chapter, I aim to apply a more robust method to the calculation of mortality rates at the London Foundling Hospital, which will allow comparison with other hospitals and with wider populations. This is valuable as it allows an assessment to be made of changes in mortality over time, and of the role of the institution and of medical care in setting survival prospects. By examining whether the hospital was able to improve mortality rates, we will be able to begin to judge the quality of medical care compared with that in other foundling homes, the impact of parliamentary funding and the nature of the disease environment in an eighteenth-century institution. The exercise will also allow us to compare the mortality of foundlings with that of infants living with their own families. We can assess whether the general decline in infant mortality also applied to the Foundling Hospital, and if not, whether it was because of poor care, overcrowding or poor health on entry. If it did, we may be able to speculate on the nature of the mortality decline in this period, and the reasons behind the general inability of foundling hospitals to lower their death tolls. The chapter will also consider briefly the levels of childhood mortality among the foundlings, to see whether any survival penalties continued beyond the age of one. The calculation of foundling mortality rates As an initial indicator of trends in mortality, and to illustrate the problems with previous calculations for European hospitals, deaths under one year have been related to numbers of entrants, in the same way as

52

Childcare, health and mortality

Figure 3.1 Infant mortality as a proportion of admissions at the London Foundling Hospital, 1741–99 800

Deaths per 1000 admissions

700 600 500 400 300 200 100

1797

1793

1789

1785

1781

1777

1773

1769

1765

1761

1757

1753

1749

1745

1741

0

Source: General Register, LMA, A/FH/A09/2/1-5.

was illustrated in Table 3.1. The resulting trend over time is shown in Figure 3.1. At first glance, it appears to show a reasonable set of mortality estimates over a fifty-year period. However, there are several reasons why it would be unwise to accept estimates calculated in this way. Firstly, the results may disguise changes in circumstances. Figure 3.1 suggests that mortality under one year generally fluctuated around 300 deaths per thousand entries, with highs during the General Reception period (1756–60) and in the first years of the hospital’s operation. From the 1780s, the trend, although lower, appears subject to greater fluctuations, from lows of under 100 to highs of 444. In fact, the numbers of admissions outside the period of unrestricted entry were very small, especially between 1782 and 1793, so that in some years there were only a handful of deaths. Some years yield no data, either because there were no entries or because there were no deaths – hence the gaps in the mortality series.6 Clearly, the number of children at risk varied from year to year, and so too did the mortality toll as measured in this way. It is arguable that only between 1756 and 1760, when entry was unrestricted, were the numbers large enough to provide any more rigorous testing (a problem which historians of other foundling hospitals with consistently higher entry levels may not have to face). We also know that the age of the foundlings at admission varied over time, as the upper limit

Risks of death: the estimation of mortality

53

was raised first to six months and then to a year in 1757. Further fluctuations in the age distribution may have been silently effected by changes in economic circumstances even when there was no policy change. Infants may have been abandoned at older ages when prices were high, or in times of war, as more families found that they were financially unable to cope with young children. There were also significant changes in the size of the pool of entrants, as was the case at other European foundling hospitals, where admissions were steadily rising over the century. Figure 3.1 does not, therefore, represent a true infant mortality rate because the total population is neither constant nor clearly defined. At best it indicates the trend of mortality among the infants abandoned at the hospital in any given year. It does not account for the fact that for every infant who entered the hospital later than her/his day of birth, there was a period of exposure before entry when the mortality risk was zero by definition, a situation referred to as ‘left-truncation’ in the survival literature. The usual method of treating every child as if it were in the at-risk set from birth has led to the underestimation of foundling mortality. Therefore, in this study, the individual data on dates of entry are used to build age-specific periods of risk and deaths. Assuming that at least some infants are observed from the day of birth and that all infants are subject to the same mortality regime, we can calculate true infant mortality measures. Mortality calculations were carried out using this method of defining the foundling population, on the ten-per-cent sample from 1741 to 1760 outlined in the previous chapter.7 The sample did pose several problems in this case. In particular, we have seen that not many of the foundlings were newborns, especially before the General Reception, although many were only a few days or weeks old. This means that mortality rates in the earliest age category (days 0–29) are impossible to calculate, because there is too little evidence on which to base them. The rate for the first week (days 1–6) is estimated by applying an inflation factor proportional to the change in rate between the age groups 1–6 and 7–29 in two other datasets.8 The IMR for the full first year (1q0) is the one returned by the calculation method, but it should be borne in mind that it may well be an underestimate because of the lack of full information for the youngest infants. It is worth noting that this problem is not so pronounced for hospitals such as the Innocenti in Florence, where a higher proportion of entrants were observed from birth or from very shortly afterwards. The rates that could be calculated or estimated for the London Foundling Hospital are presented in Table 3.2 below. Data for twenty-six English parishes, and for the London Quaker meetings of Peel and Southwark, are also given for comparison.

70.2

167.1a

28.3

421.1

254.2

29.8

7–29

96

78.5

0–29

156.0

16.0

30–59

114.7

11.6

60–89

159.5

25.7

90–179

78.9

22.6

180–273

89.7

19.1

274–365

654.4

630.5

327

162.8

1q0 (0–364)

Estimated by inflator method (see notes). Sources: England data from E. A. Wrigley, R. S. Davies, J. E. Oeppen and R. S. Schofield, English population history from family reconstitution 1580–1837 (Cambridge, 1997) p. 226. London data from Landers, Death and the metropolis, p. 136. Foundling data from London Foundling Hospital General Register and entry billets, LMA, A/FH/A09/1/1-173.

a

1759 and 1760 foundling newborns

London Foundling Hospital, 1741–60

London Quakers, 1750–74

England 1750–74

1–6

Days within the first year of life: mortality rates

Table 3.2 Infant mortality at the London Foundling Hospital, in England and in London

54 Childcare, health and mortality

Risks of death: the estimation of mortality

55

There are significant differences between the series shown in Table 3.2, in both the level and distribution of mortality over the course of the first year of life. The English national figures represent a quarter-century of falling levels of infant mortality, driven by a decline in very early deaths, predated by a steady rise up to that point.9 The London Quaker data also reflect this late eighteenth-century fall, but from a much higher level – approximately double that found for the rest of the country, as noted above. The rates reported for the London Foundling Hospital are double even those of London Quaker infants, despite the fact that almost half the foundlings did not originate in the metropolis. The notable difference in the distribution of foundling deaths compared with national and metropolitan figures is the larger proportion of neonatal deaths among the foundlings. The causes of this high mortality and its distribution will be considered below. For now, it is enough to note that the experience of mortality at the London Foundling Hospital was on a far higher scale than that of even the most poorly-off infants in the country. As noted above, the absence of data on early mortality means that considerable uncertainty must surround mortality estimates for the first week at the London Foundling Hospital. One way of checking them is to calculate death rates for those infants who did enter the hospital on the day of birth. There are too few newborns in the ten-per-cent sample to allow for meaningful testing, but in 1759 and 1760 age at entry was recorded for all infants entering the hospital. In these years, 378 infants were admitted on the day of birth, and mortality rates have been calculated and reported in Table 3.2 for this group.10 Death rates for these newborn foundlings were found to be lower for the first week of life than those in the sample (70.2 compared with approximately 167.1), probably as a result of the rough method of calculating mortality in the first week in the ten-per-cent sample, but considerably higher in the remainder of the first month (421.1 compared with 254.2). The degree of shortfall in early mortality may have varied from year to year, but the results of using this method of checking for accuracy show the need for caution in accepting mortality rates for the earliest age categories based on this method of estimation. For the categories after one month, however, a comparison with the group of 378 newborns entering between 1759 and 1760 is somewhat reassuring, and the overall infant mortality rates are strikingly similar: 654.4 per thousand for the newborns, and 630.5 for the larger sample. This suggests that the method using the extended at-risk population does not produce significantly different results from those obtained using the newborns abandoned at the hospital, at least after the first month. Within the first month, the left-truncation method may be adversely affected

56

Childcare, health and mortality

by having only a small group of infants on which calculations can be based. It seems, therefore, that we may be reasonably confident in using the figures produced by this method of calculating foundling mortality, though we should be cautious about the representativeness of figures imputed for the first month of life. Both sets of figures illustrate the same reduced risk of death in the second half of the first year of life that is seen in the data for the London Quakers and the English parishes, albeit at a much higher level. While the rate for days 7–29 in the ten-per-cent sample is over eight times higher than the national rate, that for days 274–365 is higher by a factor of only 4.7. Clearly mortality was at its highest very shortly after entry to the hospital, while chances improved for the survivors. The absence of data on very young foundlings and the small numbers entering outside the General Reception period mean that it is impossible to perform these calculations on a year-by-year basis. The results for the ten-per-cent sample as a whole, however, indicate that the traditional method of calculating infant mortality (that is, deaths related to entries) understates deaths within the first year by 25 per cent. As will be discussed further below, calculating a true infant mortality rate for the period after 1760 is impossible, because the higher mean average age on entry meant that there were no deaths under one month of age. It is possible that the underestimate may be less in the later period, but it would be very difficult to calculate precisely what it should be. Inflation by 25 per cent should be at least a rough indicator of corrected mortality levels. Figure 3.2 shows the course of infant mortality at the hospital as calculated in the ‘traditional’ manner (as shown in Figure 3.1), together with the same data subjected to the suggested inflator of 1.25. The graph shows that once total births are taken into account, the infant mortality rate at the London Foundling Hospital rises to levels approaching those estimated by the ‘traditional’ method for the Innocenti and other continental foundling hospitals, at least during the General Reception: levels around 500 to 800 per thousand. The graph also indicates a gradual reduction in mortality from 1770 to 1790, which suggests that, rather than producing uniformly high mortality rates over the period, the hospital was able to participate in the general lowering of mortality in the capital and the nation. The fluctuations after 1790, when admissions were small, are again evident. After 1760, the system of applying to have a child taken in slowed down the admissions process, and no children died in the entire first month of life. The underestimate of mortality rates is therefore likely to be greatest for this period. A comparison with rates for months 1–11 as set out in Table 3.3 below,

Risks of death: the estimation of mortality

57

Figure 3.2 Infant mortality at the London Foundling Hospital, 1741–99, corrected to represent a ‘rate’ 800 700 Rate per thousand

600 500 400 300 200 100

Corrected infant mortality

1797

1793

1789

1785

1781

1777

1773

1769

1765

1761

1757

1753

1749

1745

1741

0

Infant mortality (conventional method)

Source: General Register and entry billets.

Table 3.3 Infant mortality at the London Foundling Hospital, 1741–60 Days within the first year of life

Pre-General Reception

7–29

30–59

60–89

90–179

180–273

274–365 1q0 (0–364)

73.8

33.9

66.5

86.7

51.6

18.2 62.7

289.7

1756

257.6

288.1

135.6

248.4

90.8

1757

185.9

95.9

104.4

177.2

88.3

a

579.6

1758

159.0

79.3

103.6

167.0

74.2

102.1

519.7

1759

323.4

240.0

144.8

163.0

91.1

123.6

726.3

1760

535.6

317.3

161.1

157.1

60.0

83.2

833.5

74.3

84.9

124.4

82.4

49.6

357.3

Post-General Reception a

Rate omitted because of small numbers. Source: General Register and entry billets.

727.7

58

Childcare, health and mortality

however, also indicates that the post-1760 mortality was considerably lower than that for any of the years of the period of unrestricted entry, although slightly higher than for the period up to 1756. Although it should be borne in mind that we may not be comparing precisely like with like, since the environment into which the infants were born was not the same in the two periods, the data do suggest that the foundlings did indeed experience a significant lowering of infant mortality after 1760. Figure 3.3 sets this fall in infant mortality in the context of the wider metropolitan regime, using figures extracted from the Bills of Mortality. The data have been converted to an index, to show relative movements over time, and a five-point moving average has been applied to both series. The figure indicates that the foundling data follow a pattern which was seen in a more consistent fashion among London infants. Figure 3.3 Infant mortality at the London Foundling Hospital and in London, indexed to 1743 (five-year moving average) 700

Rate per thousand

600 500 400 300 200 100

London

1794

1790

1786

1782

1778

1774

1770

1766

1762

1758

1754

1750

1746

1742

0

London Foundling Hospital

Note: Landers’s method involves the application of several correction factors to the data, firstly to make them comparable to those from parish registers, and secondly to account for the under-registration of baptisms and burials. I am grateful to Dr Landers for advising me on the method; any mistakes are my own. Source: General Register and entry billets. The London data were extracted from the Bills of Mortality (J. Marshall, Mortality of the metropolis (London, 1832), pp. 63–86). The method used to convert the data into IMRs is Landers’s (Death and the metropolis, pp. 162–70).

Risks of death: the estimation of mortality

59

The effect of the General Reception is seen clearly, bringing greatly inflated mortality rates, as is the effect of the period later in the 1760s, when infants started to be admitted again. What is remarkable, however, is the decline in infant mortality both over the course of the preGeneral Reception period and again from around 1775. The scale of this fall in the 1770s and 1780s is comparable to that for the metropolis, although the small numbers of foundlings upon which these calculations are based should warn us against direct comparison. It is clear that infant mortality at the London hospital was not constant over time. The composition of that mortality remained relatively stable, however. The breakdown over time is shown in Table 3.3. Again, the IMR is an underestimate, although the degree of underestimation may vary from year to year. The absence of deaths occurring at the hospital under one month of age means that rates for the earliest age category cannot be calculated for the period after 1760. The overall figure of 630.5 for infant mortality given in Table 3.2 masks large variations from year to year. Before and after the General Reception, the rate was remarkably low: 289.7 and 357.3 per thousand, respectively. These rates are comparable to, or lower than, estimates found for London from the Bills of Mortality at this time.11 It is in these periods that the underestimates are likely to be most significant, however, because of the small numbers of newborns in the sample. It is clear that during the General Reception, the relatively favourable mortality rate of the earlier period altered dramatically, with infant mortality rising sharply to 727.7 per thousand in 1756. In the following years the rates fell, which suggests that the hospital was becoming more adept at managing the great numbers who were entering. By 1759, in contrast, mortality was rising again, reaching 726.3 for infants aged under one year and 345.5 for those aged under one month. In 1760 the situation worsened again, with the greatest losses being among the very youngest entrants. In the second half of the first year, however, mortality remained relatively stable over time. We may turn now to consider what caused both these fluctuations during the period of unrestricted admissions, and the general lowering of mortality towards the end of the century. Explaining levels of foundling mortality The foundlings had an array of characteristics on abandonment that raised their mortality risks: they did not experience prolonged maternal breastfeeding; they had an increased chance of having been born out of wedlock; many had travelled some distance to the hospital; and they

60

Childcare, health and mortality

were being exposed to a new disease environment, first at the hospital and then in the community where they were sent to be wet-nursed. These factors mean we should not be surprised that they died in greater proportions and at earlier ages than most rural and many urban infants. We will investigate the impact of factors such as these in the next chapter, but it is worth setting out here some of the influences of hospital life and medical care which may have contributed to the changing mortality rate over the period. In terms of the recruitment of wet nurses, the London Foundling Hospital may have had a two-fold advantage over continental contemporaries such as the Innocenti. First, for most of the period, the London hospital had a far smaller intake for which to find nurses. Secondly, England did not have a private wet nursing market on the scale of Florence’s, and so there was less competition for women who would take in nursling infants.12 By not having to compete with a large number of private families, the London hospital may have been able to attract better-off (and, therefore, perhaps better-nourished and better-housed) women, who were physically and economically better equipped to nurse and raise an infant. As will be set out in detail in Chapter 5, the London hospital also benefited from an extremely efficient administrative system, placing the majority of its charges quickly with nurses close to the hospital. There is, however, evidence to suggest that this efficiency slowed somewhat over the course of the General Reception, and that an increasing number of infants were sent to the hospital in a weakened or poor state of health. This changing situation offers a powerful explanation for the rising levels of infant mortality at the London Foundling Hospital during the period of open admissions. It also suggests that the hospital regime itself and its medical and nursing systems may not have been entirely to blame for the worsening mortality rates of the early General Reception years. The greater efficiency of the nursing system explains much of the difference in mortality rates between the Foundling Hospital in London operating under a system of open admissions and others in Europe. The selective nature of admissions outside the period 1756–60 in London was almost certainly responsible for much of the discrepancy between the earlier and later periods. While most European foundling hospitals accepted all infants subject to certain age restrictions, the London hospital actively screened its infants for ill-health outside the General Reception years. Elsewhere, the imperative to save babies’ souls made such restrictions more unpalatable. The fact that unhealthy infants were rejected from the London Foundling Hospital must go quite some way to explain the fact that the IMRs were lower there than in many other

Risks of death: the estimation of mortality

61

foundling hospitals in Europe. These factors may have been significant in shaping the mortality regime at the London Foundling Hospital, but the institution does seem to have been distinctive among its continental European counterparts in reflecting the characteristics of a regime that was lowering mortality outside its walls. In Florence, for example, Bortolotto and Viazzo have shown that a slowdown in admissions, such as that which occurred when the ‘wheel’ facilitating anonymous abandonment was removed in 1875, did not necessarily lead to improved levels of mortality.13 Instead, it took a thorough overhaul of sanitary and organisational schemes to effect an improvement. Corsini has also pointed out the significance of local factors in affecting the nature of abandonment in specific areas. For example, he has highlighted the high rates of reclamation of infants from the Innocenti, especially after the weaning period, which removed some of the infants who had survived to that point from the pool from which mortality is calculated.14 He also noted that the 1790s represented a period of general crisis in Tuscany, which may have affected the age and other characteristics of abandoned children.15 The possible effects of local factors like these – and wider ones such as the Seven Years’ War, which we have seen affected many families and individuals using the London Foundling Hospital – cannot be ruled out when mortality is being compared between institutions. We should not exclude the possibility that it was a change in the regime at the Foundling Hospital that resulted in a better chance of survival for the infants it cared for. There is no reason to believe that there was any change in the system of nursing either inside or beyond the hospital walls, however. Vigorous complaints from the medical staff in 1790 that they were having to work with bad conditions in the hospital infirmary that were of long standing suggest that the improvement cannot be attributed to better medical care either (although concern was at least being voiced). There is no indication that the hospital’s nursing regime changed to favour wet nurses from richer backgrounds, although if nutrition was indeed improving across the social strata, even poorer nurses may have been increasingly able to feed and raise a nursling successfully. Breastfeeding was always favoured by the hospital as the best means of raising infants, so there should not have been a change in feeding practices, which might otherwise have improved survival prospects.16 Nor did we find any evidence of a change in the type of infants admitted, there being always a mixture of legitimate and illegitimate infants given up, even after 1760. The exception is the increased number of infants noted to have been sent with parish assistance, but it seems doubtful that their relatively small numbers could have been responsible for

62

Childcare, health and mortality

changing levels of mortality. A change in the type of infants admitted cannot be ruled out, but it is unlikely to have been responsible for the improvement in survival prospects. Nor, it seems, was there a large-scale change in medical or sanitary care in the hospital itself. An explanation for falling mortality after 1760 may instead be found in the reasons for the general lowering of infant death rates in this period. The coincidence in trend among foundlings and non-foundlings alike suggests that even very disadvantaged infants were able to benefit from the factors underlying the general improvement in mortality. Any improvement in adult nutritional levels, such as that suggested by Wrigley, may have extended far enough down the social scale to improve the foundlings’ mothers’ prospects of carrying a healthy foetus to term, to an extent which the trauma of abandonment and the journeys and exposures to disease that it brought were not sufficient to offset entirely.17 The advantages conferred by this improvement in adult nutritional levels may have been reinforced for the foundlings entering the hospital after 1760 by the longer time they spent with their mothers before being given up, especially if they continued to be breastfed. The decline in gin-drinking after 1750 may also have improved the health of both adults and infants; certainly contemporaries such as Hanway laid considerable emphasis on gin consumption as a reason for the poor care of poor infants.18 Other authors have drawn attention to wider, panEuropean shifts in the nature and severity of risks to health, which may also have had a beneficial impact on the survival prospects of the foundlings as well as other infants.19 The mortality rates of foundling infants may, therefore, tell us much about the nature and social extent of improving levels of nutrition and health generally. At the same time, they suggest that institutions such as the Foundling Hospital were unable to tackle the problems presented by very large-scale admissions, although some improvements in mortality were effected during the middle years of the General Reception. Evidence that more infants entered the hospital in a poor state of health, however, may indicate that high death rates were not always a consequence of poor institutional care. It is interesting to speculate briefly on whether the high death rates of the foundling infants actually raised the overall mortality of the capital city. In fact, although the majority of the foundlings originated in London, it is notable that not many of them died there, but instead with their country nurses. The hospital, therefore, probably did not contribute a significant number of infant deaths to the metropolitan total: probably only 5 to 5.5 per cent of the total deaths even in the General Reception years.20 This was a feature noted by contemporaries also.

Risks of death: the estimation of mortality

63

In 1759, the preface to a printed collection of Bills of Mortality for London stated: The Foundling Hospital must have made a difference in the proportion of births to burials, and of the burials of infants to those of adults . . . for although many children are sent thither from the country, yet the greatest part received into the hospital are undoubtedly born in London, and are accounted for in the births; but the deaths of none of these children are ever inserted in the London Bills.21

Child mortality The main focus of this chapter is the investigation of infant mortality. If a significant part of this early mortality was due to the circumstances of the children’s birth, or the fact that they were weak on arrival, then we might expect mortality beyond the first year not to be so inflated. We will thus briefly consider levels of child mortality, in order to examine whether the survivors of the extreme cull of the young became hardy children, or whether they were still more vulnerable than non-foundlings. Table 3.4 sets out several measures of child mortality at the hospital and for England and London, calculated in the same manner as those for infants.

Table 3.4 Early childhood mortality at the London Foundling Hospital, in England and in London Days of life

England, 1750–74

Years of life

366–457

458–548

549–730

1q1 (1–2)

4q1 (1–5)

5q5 (5–10)

17.6

13.5

22.6

48.5

107.3

41.1

150

253*

57*

168.1

274.4

146.6

London Quakers, 1750–74 London Foundling Hospital, 1741–60

56.0

47.7

77.3

* The rates given by Landers for London are 3q1 and 4q5, and so cover a shorter age range than the other figures quoted. Sources: England data from Wrigley et al., English population history, p. 252. No rate was given for 1q1 for these periods, so the rates quoted here are averages of the three decades covered by each period, from Table 6.10, pp. 250–1. London data from Landers, Death and the metropolis, p. 136. London Foundling Hospital General Register and entry billets.

64

Childcare, health and mortality

Once again, the foundling mortality rates are significantly higher than the rates based on English parish reconstitutions, although not dissimilar to those of London Quakers. This suggests that beyond infancy, the foundlings were not greatly disadvantaged over children in the metropolis (although it should be noted that the foundlings spent little of their childhood before the age of five in London). The factors influencing survival in the two settings may have differed considerably, however. Some of the foundling infants who perished early might have survived had they had the benefit of maternal milk; others might have died without access to the medical care and constant level of nourishment in the hospital. The mortality rates found among the foundling children were probably reflecting quite different influences from those affecting children in London and England. The foundling data do, however, reflect the fact that risks to life decrease with age in childhood. The rates for the second year of life and afterwards are much reduced from those in the first. Like the rates for infants, child mortality varied somewhat over the course of the period 1741–60. The pre-General Reception period again exhibited lower mortality in all categories than the full group, while 1760 had almost consistently the highest rates of all the individual years of the General Reception, most notably in the age groups up to five years. The ranking of the remaining years fluctuates between age categories, suggesting that small numbers may have affected the rates to some degree. Once more, however, it seems indisputable that children entering during the General Reception period had a worse mortality record than those entering before and after, and that this disadvantage continued well into childhood. The greatest effect, however, seems to have been while the children were at nurse; between the ages of five and ten, the rates improved over the General Reception. The death rate between the first and second birthday for example, was 120.4 for the pre-General Reception children, and 227 for those entering in 1760, while those for children aged between five and ten were 226.7 and 33.5 respectively, although small numbers may again have affected these results. These trends may be another reflection of the fact that children were increasingly entering in a weak state, which predisposed them to early childhood illness. The main aim of this chapter was to provide more reliable mortality rates for infants abandoned to the London Foundling Hospital in the second half of the eighteenth century. By relating foundling deaths to the population at risk as timed from birth, and not merely from entry, we have shown that infant mortality at the hospital far exceeded equivalent rates for London. When examined over the course of the half-

Risks of death: the estimation of mortality

65

century, significant variation has been revealed, with rates rising considerably during the General Reception period between 1756 and 1760. During these years, mortality at all stages within the first year increased, with a high proportion of deaths occurring early in life. This finding suggests that it was the condition of the foundlings on entry that was responsible for much of their high mortality, rather than their experience of hospital life. At that time, the scale of admissions to the hospital appeared to prevent it from effectively combating high mortality, or enabling its infants to experience the falling rates of the metropolis. Once admissions fell from 1760, however, so too did mortality in the first year of life – a finding that is not affected when the absence of early deaths after this date are taken into account. The foundlings admitted in this period were able to benefit from the same improvement in mortality experienced by infants living in London, in a way in which infants abandoned in other European countries were not. When not struggling with large-scale influxes of infants, the hospital seems not to have significantly worsened the survival chances of its charges over those of infants in the capital. This is all the more remarkable when one considers that the foundling population included many illegitimate infants, who might be expected to have had an increased death rate. This improvement in survival prospects of foundling infants after 1760 shows the social reach of the national fall in endogenous mortality and its causes. It has been suggested that rising levels of nutrition among the population were translated into improved foetal viability and reduced levels of very early mortality. It is possible that the foundlings also benefited from these improved survival prospects from birth, which would indicate that even poor women or those facing temporary hardship were affected by improved nutrition. Infants admitted between 1756 and 1760 were not screened for health, however, which almost certainly raised their mortality over those admitted outside these years. We have also noted evidence that the medical staff were alert to the dangers of poor care within the hospital itself, although it is difficult to establish how far they were able to combat it. Nonetheless, the improvement in mortality rates may well indicate an improvement in nutrition among the foundlings, perhaps combined with social factors such as the cessation of excessive gin-drinking among their mothers, or wider epidemiological ones such as a pan-European shift in the disease regime. Certainly, by the time they reached childhood, the surviving foundlings seem not to have been particularly disadvantaged over London children in terms of risks to life. The chapters which follow take up some of these themes, investigating the impact of particular factors on mortality and examining more closely the nature of the nursing system.

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1 P. Laxton and N. Williams, ‘Urbanization and infant mortality in England: a long term perspective and review’, in M. C. Nelson and J. Rogers (eds), Urbanisation and the epidemiological transition (Uppsala, 1989), pp. 109–31; Landers, Death and the metropolis, pp. 137–8. 2 E. A. Wrigley, R. S. Davies, J. E. Oeppen and R. S. Schofield, English population history from family reconstitution 1580–1837 (Cambridge, 1997), pp. 249–61. 3 I. Loudon, ‘Deaths in childbed from the eighteenth century to 1935’, Medical History, 30 (1986), pp. 1–41; Loudon, Death in childbirth: an international study of maternal care and maternal mortality, 1800–1950 (Oxford, 1992), pp. 158–62; Wrigley et al., English population history, pp. 235–8; Wrigley, ‘Explaining the rise’, pp. 459–60. 4 J.-P. Bardet, C. Martin-Dufour and J. Renard, ‘The death of foundlings: a tragedy in two acts’, in A. Bideau, B. Desjardins and H. P. Brignoli (eds), Infant and child mortality in the past (Oxford, 1997), p. 245. On attempts in Florence see P. P. Viazzo, M. Bortolotto and A. Zanotto, ‘Child care, infant mortality and the impact of legislation: the case of Florence’s foundling hospital, 1840–1940’, Continuity and Change, 9 (1994), p. 22; Viazzo, Bortolotto and Zanotto, ‘Medicina, economia e etica: l’allattamento dei trovatelli a Firenze fra tradizione e innovazione (1740–1840)’, Bollettino di Demografia Storica, 30–31 (1999), pp. 147–59. 5 McClure, Coram’s children, p. 261, Appendix 3. 6 After the General Reception ended in 1760, admissions did fluctuate considerably up to the end of the century. Before 1756, the average annual intake was 96. After 1760 the average was 32 children per year up until 1773, when admissions rose to around 100 per year. There was then a dip from 1782 to 1793 (the period marked by the most extreme fluctuations in Figure 3.1), when admissions ranged from 4 to 62 per year. From 1793 numbers returned to approximately 50 children entering per year. 7 This is the ‘main’ sample, consisting of 1,650 individuals. The small numbers without age information were discarded. Rates were calculated using Cox regression analysis, and specifying left-truncation. 8 The inflator used is mid-way between the change observed in the English national data from family reconstitution and that observed in a cohort entering the Innocenti hospital in Florence that displayed very high early mortality (Levene, ‘Health and survival chances’, pp. 198–223). Thus, the estimated rate for days 1–6 represents 95.0 per cent of the mortality for days 7–29 in the English dataset, and 36.5 per cent of the mortality for these days in the Innocenti entry cohort of 1777. The mid-point between these figures is 65.7 per cent, and this is the proportion of mortality for days 7–29 taken as an indicator of first-week mortality (days 1–6) at the London Foundling Hospital. 9 Wrigley et al., English population history, p. 226.

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67

10 Left-truncation was not specified in this case, since the infants entered the hospital on the day of birth, although there would have been a period of some hours of exposure before admission. 11 Landers, Death and the metropolis, p. 136. The London Quakers appear to have experienced lower levels of infant mortality than the city as a whole. Landers calculated IMRs of 327 and 231 respectively for the quartercenturies 1750–74 and 1775–99, with the largest part of the fall being concentrated in the exogenous component. 12 Klapisch-Zuber, Women, family and ritual, p. 133. 13 M. Bortolotto and P. Viazzo, ‘Assistenza agli esposti e decline della mortalità infantile allo Spedale degli Innocenti di Firenze nello prima metà dell’Ottocento’, Bollettino de Demografia Storica, 24 125 (1996), pp. 25–6. 14 C. Corsini, ‘Materiali per lo studio della famiglia in Toscana nel secoli XVII–XIX: gli esposti’, Quaderni Storici, 33 (1976), pp. 1001–4. 15 Ibid., p. 1006. 16 See Chapters 5 and 7. 17 Wrigley, ‘Explaining the rise’, pp. 459–60. 18 Hanway, A candid historical account, p. 11; Bray, A memorial, p. 14; George, London life in the eighteenth century, pp. 41–55; Porter, English society, p. 13. 19 G. B. Risse, ‘Medicine in the age of Enlightenment’, in A. Wear (ed.), Medicine in society: historical essays (Cambridge, 1992), p. 94; E. A. Wrigley, Poverty, progress and population (Cambridge, 2004), pp. 404–6. 20 The calculation is based on the proportion of foundlings originating in London, and the proportion who were never sent to nurse, related to the number of deaths in the Bills of Mortality for 1757–59. 21 A. Millar, A collection of the yearly Bills of Mortality from 1657 to 1758 inclusive (London, 1759). I am grateful to Anisha Dasgupta for drawing my attention to this reference.

4

Survival prospects

[Her] name is Livelong . . . .

Note left with child 4370, Elizabeth Dixon Admitted 4 May 1757 Apprenticed 5 November 1767

The previous chapter illustrated that mortality at the London Foundling Hospital was high, but not constant over time. In this chapter, we investigate the causes of this mortality, and how it was mediated. Was there something distinctive about being an abandoned child which predisposed foundlings to high mortality, or was it a combination of more general factors which was responsible? Was it the characteristics which they brought with them which made them die in such numbers, or was it the experience of hospital life? Investigating these questions will give us a much greater understanding of mortality risks for babies and young children more widely. It will also allow us to uncover some of the pathways to survival in the disease medley that was London, in institutions like the hospital, and within the practice of wet nursing. These questions will be investigated using the statistical technique of proportional hazards modelling, on the basis of the ten-per-cent sample of 1650 foundlings.1 Again, we should note that this sample is heavily biased towards the General Reception period, but this does not detract from the investigation into infant and child survival. Statistical analysis allows us to attach a precise weight to the impact of different factors on survival, facilitating comparison with non-foundlings. I try here to present the findings in as clear and non-technical a way as possible; more technical details are presented in tables and in notes, but the text is designed to be understood by readers not versed in quantitative approaches. Proportional hazards models can tell us much about the impact of factors such as housing conditions, environmental surroundings and family structure on the survival of groups of individuals in the past.2 They have also been fruitfully constructed using data from foundling

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69

homes to investigate the impact of the hospital regime, or the demographic characteristics of abandoned children. Aurora Angeli has applied the method to the Italian hospital at Imola, near Bologna, and identified the speed of the move to a wet nurse as critical in determining survival.3 David Kertzer and Michael White have also used this approach for the Bologna hospital, using three nineteenth-century entry cohorts (1809– 10, 1829–30 and 1849–50, and 1869–70).4 Their tests again highlighted the importance of speedy placement with wet nurses, while sex and season of birth were also significant factors: boys had an almost 20 per cent greater risk of death than girls, while winter birth carried a significantly greater hazard than birth in the other seasons.5 A three-fold increase in the risk of dying was identified for infants being nursed inside the foundling hospital rather than outside.6 Survival chances also improved over time, the infants of the last cohort having a much improved chance of survival over the previous two. Analysis of the hospitals at Bologna and Imola thus suggests that a combination of birth characteristics and hospital experiences was responsible for the survival prospects of foundling infants, although Kertzer and White also stressed that much of the high mortality among foundlings may have been ‘simply a product of their first few days of life’.7 This mixture of risk factors raises the possibility that the foundlings’ raised hazards of death were partly based on the usual pathways to mortality, such as gender and seasonal temperatures. In addition to this, however, the institutional environment does seem to have played a crucial part. The analysis which follows investigates the interplay between these factors for the children cared for by the London Foundling Hospital. Figure 4.1 illustrates graphically the numbers of foundlings under observation in the ten-per-cent dataset for the London Foundling Hospital, and also separately by entry period. The horizontal axis shows the passing of time, and each foundling is plotted as he or she enters observation. As was noted in the context of mortality calculations, most of the foundlings had a period of risk before they entered the hospital because they were not abandoned immediately after birth. Left-truncation is similarly specified in these models, and is illustrated in the way in which observation points accumulate over the course of the first few months. The model is thus able to build in the fact that the period of risk started before the period of observation (that is, that the date of birth preceded the date of admission). The number of foundlings in the dataset then starts to fall off as they died. The fall-off is quite rapid in the first year, although foundlings are still being lost at the cut-off point of the models (at age five). The line representing the General Reception infants follows very closely that for the period from 1741 to 1760,

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Childcare, health and mortality

Figure 4.1 Number of foundlings under observation over time, tenper-cent sample, 1741–60

Number of foundlings under observation

1200 1000 800 600 400 200

1644

1461

1278

1096

913

730

548

365

213 274

30 91 152

0

Time (days) 1741–60

General Reception

Pre-General Reception

Source: General Register and entry billets, LMA, A/FH/A09/2/1–5 and A/FH/A09/1/1–173.

indicating how far the former group dominates the full dataset. The infants who entered before 1756 show a slower rate of both accumulation and of loss, which illustrates graphically their higher mean average age at entry and their lower mortality. They also represent a much smaller number of children. The variables available for the analysis of survival are shown in Table 4.1. They are extracted from the hospital’s General Registers and from the entry billets and notes. It will be noted that they fall into two groups: one including factors to do with the child’s birth and abandonment, such as gender, season of abandonment and place of birth; the other to do with their experiences after admission and, more specifically, of the nursing system. These consist of the length of time the child had to wait before being placed with an external nurse, and the distance travelled to get there. The impact of each variable on the foundlings’ survival was tested and quantified, and the most significant (either in statistical terms, or because they had historical significance) were then built up together into a multivariate model. Some variables may behave differently when modelled with another, which will be illustrated below. It should be remembered that the computer cannot interpret the data

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Table 4.1 Variables available for hazards analysis, London Foundling Hospital sample, 1741–60 Entry variables

Gender Season of abandonment Legitimacy Prior baptism Entry during General Reception Years of General Reception Sent by parish Birth in London Wet nursing on entry

Nursing variables

Distance to nurse’s home Time before placement with nurse

Source: General Register and entry billets.

it is given, and that it simply produces a statistical picture of the amount of impact each variable has on survival. Put simply, it calculates which variable or combination of variables causes the greatest amount of change in survival. The aim is to achieve a model which provides as much explanatory power as possible for the survival pattern of the foundlings. In historical cases, statistical models can often explain only a relatively small amount of the overall movement in the survival hazard, since the array of variables available for modelling is limited, and information which would be useful to include is unavailable. Nevertheless, it was seen above that the use of hazards modelling has proved enlightening in the case of other foundling homes. This will facilitate comparison between institutions. Several datasets were created, in order to test the impact of these variables on foundlings of different ages. In the first case, observation ceases at one year from entry; in the second, it ceases at five years from entry, beginning when the infant was placed with an external nurse. A third dataset was created which lasted only up until the point of placement with a nurse (or death before a nurse was found). This is to examine the impact of abandonment itself, rather than the experience of hospital life, although since placement was generally rapid, the period of observation is often only a handful of days. The infants who remained at the hospital for longer tended to be weak or sick, as will be discussed in greater detail in Chapter 7. The use of different datasets is designed to examine whether some variables had a cumulative impact over the course of the foundlings’ lives, or whether they had a greater effect on

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newly abandoned infants. For example, did birth in London increase mortality only in the months after abandonment, or did it have a lasting impact on London-born children, long after they had been put on the same footing as non-London foundlings? Questions such as this, of course, have a wider field of impact than the foundling datasets alone, since they provide suggestions as to how the London environment affected survival risks. When the variables detailed in Table 4.1 are examined, two terms will be used to assess their significance. For each variable, the foundlings are split into their constituent sub-groups (for example male/female, those abandoned in winter/spring/summer/autumn), and their risk to life is modelled against one another. For example, girls are modelled with reference to boys, or entrants in spring, summer and autumn against those entering in winter. The first term used is the odds ratio, which is the expression of risk in relation to the reference category whose odds ratio is 1. A ratio of 1.189 for the male variable therefore indicates that boys had an 18.9 per cent raised risk above females. Similarly, a ratio of 0.890 would indicate an 11 per cent reduced risk (1 minus 0.890). The second term is the significance level (expressed as a percentage), which indicates the likelihood that the result given could have happened by chance. The higher the significance level, the more confident we can be that it was not the result of random statistical variation. A 90 per cent level of confidence is generally a benchmark for significance. The impact of survival hazards on young infants Table 4.2 shows the results of investigating the variables for the two youngest datasets: infant under the age of one, and infants who had not yet been placed with a nurse. In each case, the results represent the impact of that variable alone. Multivariate analysis, where several variables are considered together, will be discussed below. The results indicate that variables in observation for one year are generally more significant than when they are considered for the children in the hospital prior to nursing. Several variables also show a different category at greater risk when the observation period is lengthened (for example, London birth, legitimate birth and parish involvement). The dataset consisting of infants not yet sent to nurse observes the weakest and sickest foundlings for longest. It is possible that these infants were sufficiently weak that characteristics such as the season in which they entered registered a different effect from that which they did when the children were observed for longer. The change in the behaviour of other variables from one dataset to the other may imply that some characteristics

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Table 4.2 Univariate hazards analysis: infants under the age of one, and infants not yet placed with a nurse, London Foundling Hospital, 1741–60 Model cut off at one year Variable

Odds ratio

Significance level (%)

Male gender

1.189

Season Winter Spring Summer Autumn

0.691 0.604 0.706

100 100 100

110.949

100

Entry in General Reception

98.6

Model cut off at nursing Odds ratio

Significance level (%)

1.141

94.6

0.875 0.716 0.764

82.2 99.9 98.9

9.305

10

Sent by the parish

1.407

99.9

0.994

Birth in London

0.768

99.9

1.380

100

Prior baptism

1.230

1.716

100

Legitimate birth

0.510

Wet nursed

0.853

Mean age at exit from dataset (days)

219.4

Number of deaths

821

99.9 100 86.1

5.2

1.242

86.2

0.947

40.4

50.2 226

Note: The season variable is presented differently in the two models because the highest odds ratio was attached to a different season in each case. The season used for the basis of comparison thus differs. Source: General Register and entry billets.

had a cumulative effect on mortality risks, so affecting the children in observation for up to a year in a different way from the youngest children. In terms of creating a model with maximum explanatory power, the one-year dataset may be superior to the other. The pre-nursing dataset, however, may be instructive in identifying the different effects of one variable on different groups of children. Both will be considered below. Gender Boys had a higher risk of death than girls in both datasets, with the risk raised slightly in the one-year set (from 14 to 19 per cent). The

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significance values are high, although somewhat reduced for the children under observation for a shorter time. It is known that boys do suffer a mortality disadvantage over girls in the earliest days of life, although this may result in an excess of deaths among infants who did not survive to enter the hospital. The fact that the variable proved to be more significant when the children remained in observation for up to a year suggests that this disadvantage continued beyond the first days of life. Season of entry As was found for the foundling hospital at Bologna, winter was the riskiest season for entry for the children observed up to one year. It carried a risk 30 to 40 per cent higher than any of the other seasons, and was highly significant.8 The disadvantage of winter entry was much more apparent for boys than for girls (not shown in the table). Boys had a 51 per cent higher risk of death if they were admitted in winter as opposed to summer. For girls, the risk was still 24 per cent higher, with autumn being the best season for entry: 30 per cent less hazardous than winter. The risks were less significant for girls than for boys, however, although still notable (97.8 per cent for autumn, 94.5 for spring and 94.2 for summer). The male disadvantage in survival terms was concentrated in winter, therefore, although the boys’ chances of survival were worse than those for girls in all seasons. The season of entry had a less nuanced effect on infants observed up to nursing. In this case autumn emerged as the most hazardous season, but overall the significance of the season variable was much reduced. Spring and summer were significantly better seasons for entry, but there was little difference between the two remaining seasons. A variable was created which simply separated entry in the warm (summer and spring) and cold (winter and autumn) parts of the year. Entry in the warm seasons brought a 20 per cent reduced risk of death at a significance level of 99 per cent. For the youngest, and probably the weakest infants therefore, entry during cold weather carried a great risk to survival, but this risk was extended into autumn as well as winter. Winter was generally a time of raised mortality risks in all age groups, and infants were particularly at risk from respiratory infections, which were more rife in winter. We will return to the impact of seasonal patterns on disease and death in Chapter 7. Entry during the General Reception A variable was constructed to measure entry during the General Reception versus entry before it. Entrants during the period of unrestricted

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admissions dominate the sample in terms of numbers (91 per cent), and, as was suggested in the previous chapter, experienced a much greater risk of death while under the hospital’s care: 111 times higher. While we would expect that the General Reception period was indeed a far more risky time than those before or after it, this odds value seems problematically high. For the infants who had not yet been found a nurse, the odds ratio was more plausible (9.305), but for neither group did the variable conform to the requirements for this type of analysis.9 Previous chapters have indicated that the children entering in the General Reception had quite different characteristics and experiences of hospital life from those entering earlier on. In an attempt to examine these differences further, the sample children entering on either side of 1756 were modelled separately. This showed that the General Reception children drive almost all the explanatory power of the variables. The variables considered for the pre-General Reception children had no statistical significance, and when the entire intake up to 1756 was considered in terms of gender and season (information which was available for all entrants, not just the sample), these variables were still not significant. When tested for the sample General Reception children alone, however, almost all the variables became more significant. The advantage attached to London birth grew to the order of 50 per cent compared with those born elsewhere, and prior baptism also became an advantage where it had previously carried a penalty. It thus seems that the General Reception children were affected by their characteristics to a greater degree than those entering earlier. It is, therefore, unsurprising that the variable does not conform to requirements for modelling, since the two groups of infants carried such different characteristics. It may still be possible to include it in the final model, however, by specifying it as a slightly different type of variable.10 Parish involvement It has been shown that a significant and growing proportion of children were sent to the hospital with assistance from officials in the parish of origin. These children were likely to have been illegitimate, and to have come from beyond London. The infants were therefore classified according to whether they entered with any involvement of the parish in order to establish whether such an entry pathway affected their chances of survival. In the model observing children aged up to a year, those who were assisted by the parish carried a 41 per cent higher risk of death, significant at a 99 per cent level of confidence. This could be because they were being cared for in a workhouse, by a parish nurse or in poor conditions by their parents. Their exposure to these conditions may have

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been greater than that of other infants, because, as we saw, they tended to be older by the time they were abandoned. It is also possible, however, that this variable captures some of the effect of legitimacy or distance from London, and it will be interesting to discover whether it remains significant when combined with these other variables. For the children waiting for a nursing placement, the variable was not at all significant, with hardly any difference between those sent by the parish and those not. It thus seems that the effect of parish involvement was continued for some time after the child’s abandonment, when it had a deleterious effect on survival, but that it did not necessarily take immediate effect. A slightly higher proportion of children sent without parish assistance were sent to a nurse, however (86.5 per cent as opposed to 80 per cent), and the proportion placed on the day of entry was higher (30 per cent of those placed rather than 24 per cent). Those sent with assistance from the parish may have secured a permanent supply of breastmilk less promptly that those who were not, perhaps because they were in a poor state of health on arrival. London birth Although infant mortality was much higher in London than in the rest of the country, foundlings born in London and observed up to one year fared better than those coming from elsewhere. Their improved chances were in the order of 24 per cent, and were statistically significant (99 per cent). For those foundlings waiting for a nurse, London birth brought a disadvantage of 28 per cent, which was also highly significant. This suggests that the distance travelled to get to the hospital was important in its effects on young babies, but that its influence varied according to the circumstances of the child. Since the Londonborn foundlings did not have far to travel to reach the hospital, it is possible that they were in a better state to withstand the journey to a nurse, and had better survival prospects in the longer term. Those who had to wait in the hospital perhaps suffered for longer from the effects of exposure to the crowded and unsanitary conditions in the metropolis while not receiving the benefits of a permanent country nurse. They may also represent the infants who had had the worst exposure to diseases and social conditions before being abandoned. This variable does not conform to the requirements for proportional hazards modelling, however, indicating that infants born in London and elsewhere had different survival patterns. This is perhaps not surprising, given their differing epidemiological, social and economic environments. The variable may too have to be treated differently if it is to be included in the final models.

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Prior baptism The fact that a child was baptised before entry probably had little effect on its chances of survival, but it might indicate the level of care before abandonment. Of the foundlings in the sample, 64 per cent had been baptised before entry. In fact, prior baptism carried a mortality disadvantage for both datasets (up to nurse and up to one year), in both cases at a very high level of significance. The disadvantage was worse for the foundlings waiting for a nurse (72 per cent higher risk compared with 23 per cent for the children observed up to a year). There is no obvious reason why baptism should carry a penalty, unless sickly infants were baptised quickly in order to prevent them from dying unbaptised.11 This may account for the raised penalty for the younger foundlings. It is also possible that this variable is actually acting as a proxy for some other factor, such as parish involvement. It is likely that parish officials would arrange for children who came under their care to be baptised, and it has been shown that they had a higher risk of early death in one dataset. Similarly, illegitimate children were slightly more likely than legitimates to have been baptised in these datasets, and it will be seen below that this characteristic also carried a mortality risk. Those children who had been baptised were also significantly older than others on entry (their mean average age was 53.6 days, compared with 12.6 days for those not baptised). While young infants have a greater risk of death, it is possible that a greater length of exposure corresponded to lengthier journeys to the hospital, or greater exposure to unhealthy surroundings. Legitimacy Legitimacy status is known or inferred for only a minority of children (24 per cent).12 This proved to be a highly significant variable for the children being observed for up to a year, with legitimates having half the mortality risk of illegitimates. This is as we would expect from patterns observed in the general population, although it is noteworthy that it extended also to the foundlings. For the infants under observation for a shorter time, the advantage is conferred instead on the illegitimates, although the variable is not statistically significant. It is possible that the legitimate children who were not found a nurse promptly were those who had been abandoned because their families were experiencing hardship, which may have affected the health of the child. When the range of the observation is extended to one year, the longer-term benefits of legitimate birth are seen among those who survived. It was noted in Chapter 2 that there was little information on legitimacy before the General Reception, and that most of the infants who could be classified

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Childcare, health and mortality

were legitimate. In order to test whether this affected the result, the General Reception children alone were modelled, and the variable was still found to be highly significant, although the advantage for legitimates was slightly reduced (to 44 per cent, at a confidence level of 99 per cent). For the pre-General Reception children, legitimacy carried an 88 per cent better chance of survival, although this was not significant, probably because of the very small numbers with information. Wet nursing A note was made in the General Register as to the type of nursing each child received on entry. This record was made even for children who did not survive to go to nurse, in which case it must have referred to the type of nursing they received in the hospital.13 It is likely that this would be significant in explaining mortality risks, since modern studies show that breastfeeding of any duration decreases the risk of early death.14 Infants who were wet nursed on entry (77 per cent of the sample) did have a 20 per cent lower risk of death. However, it did not prove to be statistically significant (confidence level 86.1 per cent). Among those waiting for a nurse, the risk was reduced by only 5.3 per cent, and was also not significant. Contrary to what one might expect, breastfeeding on arrival at the hospital does not seem to have conferred much of a survival benefit, perhaps because of the interruptions involved in the process of abandonment and placement with a nurse. The intensity of breastfeeding may also have been more significant than its duration; and this is a less easily measurable factor. For the children observed up to the age of one, there is a relatively large number of significant variables, indicating that there were many characteristics carried by the infant on entry which influenced her/his chances of survival. Gender, season of entry, period of entry, legitimacy and assistance from the parish will all be included in the model-building process. The dataset consisting of younger children had fewer significant variables, which suggests that these infants were indeed weakened to the point where their characteristics had little effect on their continued chance of survival. In some respects, such as illegitimacy and London birth, different factors appear to have been at work for these infants, which may have been related to their condition on entry. Survival up to the age of five years The dataset following those children who were placed with nurses examines the effects of hospital policy and the institutional environment. It

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Table 4.3 Univariate hazards analysis: nursing dataset, London Foundling Hospital, 1741–60 Variable

Odds ratio

Significance level (%)

Male gender

1.155

96.7

Season (ref to winter) Spring Summer Autumn

0.782 0.803 0.898

99.1 98.0 74.4

Entry in General Reception

2.768

Sent by the parish

1.132

100 78.3

Birth in London

1.092

77.2

Prior baptism

1.080

72.9

Legitimate birth

0.685

98.9

Wet nursed

1.093

53.9

Speed of placement (ref to day of entry) 1 day 2–6 days 7 days +

1.525 1.703 1.276

100 100 94.8

Distance travelled to nurse (ref to under 25 km) 25–50 km 50–100 km 100 km +

0.787 0.705 0.635

99.7 100.5 99.9

Mean age at exit from dataset (days)

1748

Number of deaths

885

Source: General Register and entry billets.

should be noted that this dataset excludes the least healthy children, who were most likely those who died in the hospital. Table 4.3 provides the results of the analysis of individual variables on this dataset. The entry characteristics The entry characteristics considered above were examined again to see whether they continued to exert such a strong influence on older infants and children. In most cases they became less significant, indicating, as expected, that their greatest impact was soon after entry. A similar disadvantage was attached to male sex (15 per cent rather than 18), but

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with slightly reduced significance, perhaps indicating that the disparity between the sexes lessens with time. It is noteworthy nonetheless that male sex continued to exert a penalty into childhood. The effects of season of entry were also lessened, although winter remained the most hazardous, and spring the least. The difference between most and least risky season was 20 per cent rather than 40 per cent in the first year after entry, however. The confidence levels attached to autumn entry were reduced, although the odds ratios of the other seasons remained significant. Boys were still more susceptible than girls to the vagaries of season, although only spring and summer were statistically significant. For boys these two seasons were each 32 per cent less risky than winter; for girls the equivalent figures were 22 and 5 per cent respectively. Mortality risks associated with entry in the General Reception were again worse than those associated with entry before that period, but these children had a more plausible factor of 2.7 times greater risk.15 The variables for prior baptism, London birth and parish involvement all exerted an influence in the same direction as in the previous model, but for the nursing children these were no longer statistically significant. Counter to a priori assumptions, there was almost no difference between wet or dry nursed children. Legitimacy continued to be statistically significant, albeit at a lower level than previously, with a slightly reduced advantage for legitimates. It is interesting that illegitimate birth continued to exert an influence on the foundlings’ survival prospects well into childhood. Speed of placement with an external nurse The time spent by the foundlings in the hospital before placement with an external nurse was divided into four categories, comprising those sent on the day of entry, those sent on the second day, those sent between two and six days, and those sent over six days from entry. Being sent to nurse as rapidly as possible created the least hazard, even though this may have meant two lengthy journeys in quick succession.16 Being kept in the hospital for even one day increased the risk of death by 53 per cent, and a stay of two to six days by 70 per cent. A longer stay brought a reduced penalty of 28 per cent, and was less significant than the other categories. This pattern can probably be explained by the fact that the healthiest infants were most likely to have been sent out immediately. Those sent after a short wait may have included some children who were kept in the hospital because they were weak. It is also possible that they were weakened by exposure to the pathogenic environment of the hospital. In either case, we are given an insight into the hospital environment and policy. A delay in placement with a nurse was

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not conducive to survival, whether that was because of poor conditions in the hospital or because of weakness and sickness on arrival. The sickest infants may also have been held back from an immediate journey to a nurse. Those surviving to go to nurse after six days may have been the hardier children, or those who had been strengthened by a stay in the infirmaries. This will be taken up again in Chapter 7. Distance travelled to nurse The distances the foundlings travelled to their nurses were also divided into four categories: less than 25 kilometres, 25 to 50 kilometres, 50 to 100 kilometres, and over 100 kilometres. The shortest journey proved to carry the greatest hazard: between 37 to 22 per cent higher than the other groups. This reinforces the contemporary belief that areas closest to London were less healthy, although it is also possible that the weakest infants were deliberately sent on the shortest journeys to try and preserve them. Those foundlings travelling the furthest distances had the best survival chances, and the odds ratios for all groups were statistically significant. It is possible that longer journeys prompted better preparation, and that these children were better cared for en route than those travelling shorter distances. Perhaps long journeys were undertaken only by the strongest infants, and they may also have been better supervised; the hospital paid for transport of nurses and children, but organised a caravan to go to Yorkshire. This may have meant less exposure to bad weather. These initial investigations of the entry characteristics and factors associated with nursing practices suggest that hospital governors were correct in their preoccupation with rapid placement with nurses at a distance from London. They also, however, indicate the care that needs to be taken in this analysis to avoid mistaking cause and effect. In many cases, a variable is in fact measuring something more subtle than at first appears, and this has to be borne in mind when constructing the models. We turn our attention now to the creation of multivariate models which measure the effect on survivorship of several variables working simultaneously. Building the models The univariate analysis and tests of suitability assessed above determined which variables were included in the model-building process. One variable was added at a time, and the model re-run after each addition, in order to see its effect. Variables were also tested for interactions between

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Table 4.4 Multivariate hazards analysis: infants under the age of one, London Foundling Hospital, 1741–60 Odds ratio

Significance level (%)

Male gender

1.186

98.4

Season (ref to winter) Spring Summer Autumn

0.718 0.540 0.719

99.9 100 99.9

Baptised

0.743

100

Legitimate birth

0.539

100

Chi-square

75.42

Mean age at exit (days)

219.4

Number of deaths

821

100

Note: The model is stratified by entry in the General Reception. Source: General Register and entry billets.

them. It was noted earlier that the variables denoting birth in London and entry during the General Reception did not conform to the requirements of proportional hazards models for the early age categories. In the model-building process they were included in turn as stratified variables, where the baseline hazard of each category is known to be different (for example, birth in London from birth elsewhere). The General Reception variable added far more explanatory power to the model than the London one, so the former was retained as a stratum. There is no measure of significance for the stratified variable itself, but its effect can be assessed by the behaviour of the other variables, and in the overall significance level (Chi-square) of the model. The two complete models are presented as Tables 4.4 and 4.5. Generally, the variables did not change radically when modelled multivariately. Prior baptism now affords a survival advantage of 26 per cent, whereas when considered alone it brought a penalty of 23 per cent. It is the interaction with the General Reception variable which causes the baptism characteristic to exert a different influence. We have seen that baptised infants were slightly older at abandonment than unbaptised ones. Perhaps during this phase of admissions, when survival chances were generally poorer than they were during the takings-in period, baptised infants benefited from the increased time and care they received from their mother. The inclusion of General Reception entry as a stratified variable

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Table 4.5 Multivariate hazards analysis: children sent to nurse, London Foundling Hospital, 1741–60 Odds ratio

Significance level (%)

Male gender

1.173

98.1

Season (ref to winter) Spring Summer Autumn

0.770 0.805 0.918

99.4 97.7 63.1

Distance to nurse (ref to under 25 km) 25–50 km 50–100 km 100 km +

0.770 0.738 0.652

99.9 99.9 99.8

Interval before nurse placement (ref to day of entry) 1 day 2–6 days 7 days +

1.162 1.297 1.087

86.4 99.6 48.5

Entry during General Reception Chi-square Mean age at exit (days) Number of deaths

2.406 115.38

100 100

1748 885

Source: General Register and entry billets.

had little effect on the other variables compared with an unstratified model. A model considering only infants before external nursing (not shown) had far less explanatory power, with only the prior baptism, legitimacy and spring entry variables showing statistical significance. Both the former variables continued to exert an influence in the opposite direction to that seen in the model cut off at one year, indicating that different pressures were indeed at work on the youngest, and probably the most vulnerable, infants in the sample. In many cases, the hazards models conform to what we know of riskincreasing factors in the wider infant population. Boys, for example, are generally found to have higher mortality very early in life, as is seen here for the foundlings. This is generally linked to genetic differences between the sexes at birth which make girls more able to fight disease, while boys are less robust and more prone to lung weakness.17 This imbalance is not always found in high-mortality populations, but does

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Childcare, health and mortality

appear in this case.18 Of 330 babies who had to be admitted to hospital infirmaries on entry in 1757 and 1758, however, 53.3 per cent were boys, which indicates that they were not notably more likely than girls to be sick on admission. Any other explanation relies on preferential treatment being given to girls, which is not the gender bias most generally suggested, and which is not borne out in the speed of placement with nurses. The sex differential remains somewhat obscure, but may be related to greater latent weakness in baby boys. The season variable also behaves as a priori assumptions suggested, especially in light of the Bologna evidence that winter was the riskiest season in which to be abandoned. It seems that the effects of travel in the cold months were severe for small infants, and were perhaps exacerbated by risks of respiratory infection.19 The adverse effect of one season seems to overshadow any specific relationships between month of birth and month of death.20 Illegitimate foundlings also conform to a pattern of greater risks for infants born out of wedlock, despite the fact that the legitimate foundlings were also disadvantaged in many respects. This is interesting, since the increased risk for illegitimate infants is generally thought to be based on exogenous causes to do with maternal employment, early weaning and poor housing. The findings reported here suggest that this had an impact even after only a month or two of exposure, or that there was a greater endogenous component than has generally been supposed, perhaps based on poor uterine health and nutrition.21 Hospital officials and nurses did not know which children were legitimate, so no preferential treatment should have been possible. The disadvantage was not apparent for the children waiting to be placed with a nurse; there, legitimate birth carried a penalty. Table 4.5 considers the multivariate analysis of survival up to the age of five. The gender and season variables changed little from the univariate analysis, and the odds ratios for both sex and spring and summer abandonment are statistically significant. Autumn was the most risky season for abandonment after winter, but is not significant. The variables measuring the effect of the nursing regime are more revealing. Considered singly, both the interval before placement and the distance travelled to reach the nurse were important. When the General Reception variable was introduced, however, the interval variable lost most of its explanatory power, with only one category remaining statistically significant (a wait of two to six days, which was the most hazardous category). Evidently the effect of the large-scale admissions during this period made the speed with which an infant was found a nurse ineffective in promoting survival. The distance variable remained important, with the shortest distances continuing to be the most

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hazardous. The final category considered was entry during the General Reception. This was still significant, with double the mortality risks for the children entering in these years, and this time conformed to the requirements of hazards modelling. An interaction between gender and General Reception entry indicated that it was significantly more risky for males; however, it was overall less fatal than it had been for the youngest children. The hazards models discussed here have highlighted a set of factors which set the stage for high mortality, in particular gender, the season of abandonment and the distance travelled to reach a nurse. As suggested at the outset, both the foundlings’ birth characteristics and their experience of hospital life had a significant impact on survival. Weight is added to the universality of some of these risk factors by the concurrence in results with the data from the foundling hospitals at Imola and Bologna. Further, risk factors such as gender, illegitimacy, a loss of sustained breastfeeding and exposure to cold weather and lengthy journeys were not peculiar to foundlings, although they did experience them in an unusual concentration. René Salinas Meza concurs with this conclusion in stating that ‘there was no one cause for explaining [the] appalling mortality [of foundlings], rather it was the result of a complex of extreme conditions to which abandoned children succumbed’.22 The analysis reported here thus has significant weight for studies of infant and child mortality more generally. At the London hospital, some factors seem to have had their most adverse impact early on in the children’s lives, and then receded. Illegitimate birth, for example, was no longer significant for foundlings at nurse, which indicates that its impact was not cumulative. In other cases, potentially significant factors such as the time elapsing before placement with a nurse were offset by the impact of the admissions regime. Hazards analysis also allows us to comment further on the wider impact of some of the risk factors discussed here. The environment of London, for example, was shown to be very different from that elsewhere, and being nursed close to the metropolis brought a raised risk of death. Birth in London, however, brought a survival advantage, although this may have partly reflected the shorter journeys endured by London-born foundlings rather than the disease environment. The nature of the institutional environment was also flagged as being of importance, with a lengthier stay there corresponding to higher mortality. At this stage it is difficult to say with certainty whether this was because of poor conditions in the hospital, or whether an increasing number of sick foundlings needed to be cared for in its infirmaries on entry. The hospital’s

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Childcare, health and mortality

organisational regime in placing foundlings with nurses also played an important part in promoting survival, highlighting the need for efficiency. The extent to which the hospital achieved this will be discussed in the chapters which follow. The protective qualities of breastfeeding for infants were called into question in this analysis, however, although this may have been because the duration and intensity of nursing were more important than a short experience. The amount of time spent with the mother in the home environment has been shown not to translate straightforwardly into health benefits or disadvantages generally. In some cases, spending a greater amount of time with a parent before abandonment seems to have raised the infant’s risk of death (for example, via parish involvement), despite the benefits generally associated with maternal nursing (some foundlings, of course, would not have been breastfed by their mother, or indeed breastfed at all). The nature of the home environment and the type and intensity of feeding received probably affected the impact that maternal feeding had on the child’s survival prospects, but clearly, more time at home may have meant more exposure to disease or artificial feeding. Models such as those constructed here are useful for testing the effects on survival of a combination of variables, which could not be examined in any non-empirical way. The results which emerge have shed light on the issues which contemporaries felt to be important, such as location of the nurse’s residence and the speed of placement of the foundling. Inevitably there were many potentially significant variables which cannot be measured, such as information on the child’s morbidity experience before abandonment, or its birth weight. The information available, however, has proved enlightening, and has highlighted some factors which played a large part in determining whether a child would survive or not. It has confirmed that there were indeed differences in survival chances at different periods of infancy and childhood, and between admissions periods. In the next chapter, we will examine some aspects of the nursing system in much greater detail, and begin to speculate on their impact on the foundlings’ experiences of family and hospital life. Notes 1 Hazards models are a form of multivariate regression: a technique which measures the impact of one or more factors on another. In this case, the risk of death is being quantified, and a series of variables representing the child’s sex, geographical provenance, family background and experience of the hospital regime are modelled to see their impact. Stata software was used to run maximum-likelihood Cox proportional hazards models. The technique does not require data to be parametric in shape, and thus

Survival prospects

2

3

4

5

6 7 8

9 10

87

provides a significant amount of flexibility in the questions that can be asked and the datasets which can be used. The models require the specification of an end point, which is represented either by death or by the attainment of a defined age (at which point the subject is censored; reclaimed children were also censored at the date of reclamation). Delayed entry (left-truncation) can also be specified. Variables are admissible only if they conform to tests of proportionality; that is, that the hazards of death for individuals in different groups are proportional to each other over time for any given variable. For example, the hazard associated with being male must be a scaled version (either up or down) of that associated with being female. If the survival curves are different, it is clear that some other factor is at work, and the variable is not suitable for inclusion in a proportional hazards model. All variables are tested to ensure that they conform to these requirements (using the log-log plot, and the Kaplan–Meier plot of observed and predicted survival curves). For more details, see Levene, ‘Health and survival chances’, pp. 226–30. For more on hazards analysis, see D. W. Hosmer and S. Lemenshow, Applied survival analysis: regression modeling of time to event data (New York and Chichester, 1999). For example, J. Trussell and C. Hammerslough, ‘A hazards-model analysis of the covariates of infant and child mortality in Sri Lanka’, Demography, 20:1 (1983), p. 1; A. Reid, ‘Infant feeding and post-neonatal mortality in Derbyshire, England, in the early twentieth century’, Population Studies, 56 (2002), pp. 151–66; Reid, ‘Neonatal mortality and stillbirths in early twentieth century Derbyshire, England’, Population Studies, 55 (2001), pp. 213–32; J. Kok, F. van Poppel and E. Kruse, ‘Mortality among illegitimate children in mid-nineteenth-century The Hague’, in C. A. Corsini and P. P. Viazzo (eds), The decline of infant and child mortality: the European experience, 1750–1990 (The Hague, 1997), pp. 193–211. A. Angeli, ‘Balie ed esposti: percorsi di vita. Imola nei secoli XVIII e XIX’, in G. Da Molin (ed.), Trovatelli e balie in Italia, secoli XVI–XIX (Bari, 1994), pp. 132–6. Kertzer and White, ‘Cheating the angel-makers’. The cohorts are from 1809–10 (N = 889), 1829–30 and 1849–50 (N = 518), and 1869–70 (N = 1208). It should be noted that ‘significant’ in this context indicates a measure of statistical confidence that the result is not the product of chance. The greater the level of significance, the better. Ibid., pp. 475–6. Ibid., pp. 304 and 465. In fact, 100 per cent certainty does not mean that there is no room for error, but that there is only an extremely small level of doubt about its significance. The proportionality assumption was violated, although it will be shown to conform to proportionality assumptions for those who were sent to nurse. As a stratified variable, where the baseline hazard of the two groups is different.

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11 This has frequently been suggested. See, for example, E. A. Wrigley, ‘Births and baptisms: the use of Anglican baptism registers as a source of information about the numbers of births in England before the beginning of civil registration’, Population Studies, 31:2 (1977), p. 283. 12 Legitimacy is treated as a dummy variable, and all those with missing information are given the mean value between 0 and 1 of those for whom such information is available. This allows the variable to be tested for the whole dataset without altering the distribution between the categories. 13 This can be surmised from the fact that several children who were initially admitted to one of the hospital’s infirmaries but were subsequently sent to nurse have their experience of nursing in both situations recorded. For example, they were noted as ‘dry nursed in the hospital, wet nursed outside’, or vice versa. 14 See Chapter 7. 15 The individual years of the General Reception were also tested in relation to entry before 1756. All were significantly riskier than the reference period, especially the years 1759 and 1760, which were 3.3 and 5.0 times worse, but none complied with the tests of proportionality. 16 As noted in Chapter 5, hospital officials were worried as to the effects on mortality of two journeys in quick succession. It seems that this was not the most lethal of the trials faced by the foundlings, however. The data presented above on the London-born children prior to nursing suggests that there may also have been a relationship between the distances travelled and the amount of time spent in the hospital. 17 D. J. P. Barker, Mothers, babies and health in later life (Edinburgh, 1998), p. 125; I. Waldron, ‘What do we know about causes of sex differences in mortality?’, Population Bulletin of the United Nations, 18 (1985), pp. 67–8; R. L. Naeye, L. S. Burt, D. L. Wright, W. A. Blanc and D. Tatter, ‘Neonatal mortality: the male disadvantage’, Pediatrics, 48 (1971), pp. 902–6; T. C. Washburn, D. N. Medearis, B. Childs, ‘Sex differences in susceptibility to infections’, Pediatrics, 35 (1965), pp. 57–64. R. Lalou (‘Endogenous mortality in New France: at the crossroads of natural and social selection’, in Bideau et al. (eds), Infant and child mortality in the past, p. 207) found for New France that the male mortality disadvantage was concentrated in the first few days of life. 18 H. Seibert, ‘The progress of ideas regarding the causation and control of infant mortality’, Bulletin of the History of Medicine, 8:4 (1940), p. 584: ‘when the infant death rate is high both sexes are carried off more or less indiscriminately by the ravages of an unfavourable environment, but when the rate is low, selection picks on the males’. 19 M. Breschi and M. Livi Bacci (‘Month of birth as a factor in children’s survival’, in Bideau et al. (eds), Infant and child mortality in the past, pp. 162–3) also find a strong impact of winter on newborns, while V. Fildes (‘The English wet nurse and her role in infant care, 1538–1800’, Medical History, 32 (1988), p. 153) notes the susceptibility of parish nurse-children to changes in temperature and environment.

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20 Using Belgian data for the nineteenth century, E. Vilquin (‘La mortalité enfantile selon le mois de naissance: le cas de la Belgique a XIXè siècle’, Population, 6 (1978), pp. 1137–53) found that there was a relationship between the month of a child’s birth and her/his experiences of season. Children born in January for example, showed higher winter mortality, but were also more susceptible to death the following summer. In the case of the foundlings, it is likely that the weaknesses described here mute any patterns such as these, substituting a pattern in which death rapidly followed birth, with a greater hazard for those born in winter and autumn. 21 Levene, ‘The mortality penalty’. 22 R. Salinas Meza, ‘Orphans and family disintegration in Chile: the mortality of abandoned children, 1750–1930’, Journal of Family History, 16:3 (1991), p. 324.

5

The nursing network

Wee part with Molly Collins with great grief but its in great hops of haveing her again Soon . . . Pray let her be suckeld. Note left with child 2288, Ann Mersham Admitted 7 September 1756 Died 25 February 1757

Both hazards analysis and the preoccupations of the hospital governors have flagged up the importance of the system of nursing for the longerterm survival prospects of foundlings. In this chapter, the system is subjected to careful scrutiny, to discover how it worked and what it may have meant for the foundling children’s early experiences. It soon became apparent to hospital officials that wet nursing by women outside the hospital walls offered the only realistic chance of foundling infants reaching adulthood, and they remained committed to it as a system despite the large-scale logistical problems it sometimes presented. In the course of the investigation it will become apparent that infants were sent to a wide variety of places, such that it is possible to identify a ‘nursing network’ which spread over much of the country. It is also clear that while many infants had relatively stable experiences of nursing with one woman throughout their early years, others were moved between different women and different places. Survival prospects were also not uniform across the network, as was suggested by hazards analysis. This opens up the possibility that some areas of the country were healthier for young nurse-children than others, or that some women were better nurses than others. For the women involved, nursing may have represented a significant part of the economy of makeshifts, while the widespread network of contacts established by the hospital tells us much about its social reach and levels of efficiency and communication. All these themes will be developed in this chapter and those that follow.

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91

Patterns of nursing The sources on nursing for the hospital are exceptionally rich, comprising several series of registers and many letters and accounts of nursing and the condition of individual children. Inspections Books record the dates of each child’s placements, the type of feeding he or she received, and the name and place of residence of the nurse. The date of death or removal to another nurse or branch hospital is also usually given, as is, occasionally, the cause of death.1 By cross-referencing to the General Register via the child’s identifying number, the time elapsing before the infant’s first nursing placement can be calculated. Similarly, all entries relating to the same child can be collated from the Inspections Books, making it possible to build up a picture of her or his mobility within the network, and to identify women who took in more than one foundling nursling. These data permit the workings of the nursing system to be analysed over time, and flesh out the results of the hazards analysis on its importance for survival. The data from the Inspections Books form the basis of the analysis reported in this chapter, covering 12 558 children who entered the hospital between 1741 and 1764. As ever, the great majority were General Reception children (93.4 per cent). In total, 78.3 per cent of General Reception children are represented in this record, and coverage of this period seems to be particularly complete. 80 per cent of foundlings with no entry in the Inspections Books were noted in the General Register to have died without being placed with a nurse. Only ten infants were definitely omitted incorrectly from the Inspections Books, all of them from early in the General Reception.2 The extent of coverage outside these years seems to be patchier, but the numbers involved are small. Despite the focus on a group of children entering over a short time-frame, the study of nursing shows how ideas on nurture were developed, and how an institution like the Foundling Hospital managed its charges and its contacts across a broad geographical sweep. The governors of the London Foundling Hospital frequently discussed the recruitment of nurses, the success of their arrangements and their resulting impact on survivorship in different parts of the country. As has been noted already, the absence either of other English foundling hospitals or of an extensive private wet nursing market in the eighteenth century provided the hospital with a wide geographical network of potential nurses to call upon. Poor law officials did place infants with nurses, but generally in a restricted local area, and they offered a low wage. The Foundling Hospital, in contrast, was able to call upon the

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Childcare, health and mortality

contacts of its governors and supporters in rural areas around the country to identify suitable women and people to oversee them. From its earliest admissions, the hospital had built up a system of inspectors to supervise the nurses, and ensure that they did not defraud the hospital by failing to declare a foundling’s death. The post was an unpaid one which required a significant time commitment, as well as a certain ability in financial matters. Inspectors, who could be either men or women, were required to visit the hospital’s children frequently to check on their well-being, and to pay the nurses their wages via a system of bills drawn on the hospital. They also liaised with the hospital on health concerns, employed local doctors to attend children, and supplied the nurses with hospital clothing for their charges. Because of the unpaid nature of the job, the inspectors tended to be gentlemen and clerics of relative wealth and standing, who were also likely to be acquainted with the numbers of women available to act as nurses. In April 1757, the General Committee stated its criteria when making an appeal for more country inspectors, who should be ‘Ladys or Gents of easy Fortunes & humane dispositions, conveniently situated in the country to Superintend such Nurseries, as they may establish’.3 The evidence from the Inspections Books suggests that the majority of inspectors were not from the highest ranks of local society, however. A total of 269 inspectors and named assistants are recorded, of whom 61.7 per cent were men. A quarter of these were denoted ‘Reverend’. Only a handful of male inspectors were titled: three ‘Sirs’, two ‘Reverend Sirs’, one ‘Major’ and one ‘Right Honourable’. The majority (67.5 per cent) were given no title, or were denoted ‘Mr’, although some were also given the somewhat non-specific suffix of ‘esquire’, which is suggestive of social standing. The general absence of high-ranking inspectors was true to an even greater degree for the 108 women, of whom 85 (82.5 per cent) were ‘Mrs’, and 11 (10.7 per cent) ‘Miss’. Six women were denoted ‘Lady’ (three of whom were recorded as supervising only one child each), and one was ‘the Honourable Mrs’. One notable, if untitled, name was that of the artist (and hospital governor) William Hogarth, who together with his wife presided over an inspection of ten children in his home area of Chiswick, Middlesex. Generally speaking, it is possible that men and women of local standing but relatively modest means were more likely to be permanently resident in the parish than titled inspectors, and may have known more about the circumstances of women offering themselves as nurses. Some inspectors were certainly successful in finding nurses for very large numbers of children: Roger Kynaston in Shrewsbury oversaw 802 foundlings in total; the Revd Mr Rogers was responsible for 664 in Chertsey and Egham

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93

(Surrey), and the Revds Thomas Trant and Timothy Lee had 623 and 518 charges respectively in Hemsworth and Ackworth, Yorkshire.4 The amount of time spent supervising foundlings probably varied considerably, according to both the number of children being overseen and the inclinations and other commitments of the inspectors. Gillian Clark found a variety of attitudes expressed by Berkshire inspectors towards their role. While John Collett wrote on 20 March 1759 that ‘I am really concerned that I am now to acquaint you of the death of no less than 3 of the foundling children’, Theophilus Hughes stated in 1761 that he was ‘unfeignedly glad’ to send a group of children back to the hospital, and ‘heartily wish [he] were quit of the rest.’ Hughes wanted to resign ‘this excessively troublesome office’ as soon as possible, having suffered financial problems arising from paying the nurses’ wages as well as supervising the children’s care.5 In addition, A. Linton found some variation in the frequency of inspectors’ visits to their nurses. Using fourteen case studies he found six inspectors who mentioned the frequency of their visits, which varied from ‘often’ and ‘once a week’ to ‘daily’.6 The role of patronage, and the non-tangible benefits that being an inspector could bring, should perhaps not be understated, however. Although the post was unpaid, it might attract the attention of highranking officials and supporters of the hospital, and cement loyalties with those who had local links. Several inspectors were clearly known personally to hospital officials, and the letters they sent were often as much about social capital as about health, wages and nurses. Timothy Lee frequently wrote from Ackworth about social matters, and sent the treasurer’s family presents such as a ‘Cock Pheasant . . . the Plumage very fine’.7 Others finished their letters by sending their regards to the wife and family of the hospital’s secretary or steward, suggesting that there were larger bonds of sociability and patronage at work. The inspector also had considerable potential to act as a patron herself or himself, as nurses had to be recommended to the hospital, and discretion rested with the inspector as to who should be sent up to London. Although the post might be a demanding one, therefore, it was not without its benefits. The hospital governors placed the highest importance on the system of supervised external wet nursing, finding that the continual presence of an inspector was something on which ‘it is beyond dispute that the Lives of thousands depend’.8 Fildes has noted that wet nurses have frequently been portrayed in a negative light, as being neglectful, drunk, incapable or thinly disguised baby farmers.9 Her own research suggests that this image needs some revision, and the Foundling Hospital records

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uphold her view. Fildes identifies the system of close supervision by inspectors at the hospital as being one reason for its relative successes in wet nursing compared with the system in some other European countries, and it is certainly true that when nurses knew they might be inspected at any time, greater care might be taken than when they were left to themselves.10 The hospital also had greater financial resources than parish poor law officials, and a greater network of alternative nurses than private families. This probably facilitated the transfer of children who were being ill-treated. The hospital also believed in positive rewards for successful nursing. Each nurse was paid a premium of 10s. if her nursling survived for a year; this was in contrast with other foundling hospitals on the Continent, where the nursing wage was sometimes reduced when the child was weaned. This prompted some women to return weaned infants so that they could continue getting the higher wage for a nursling.11 There were certainly cases of poor care among the women who nursed for the London hospital, and sometimes cases which slipped through the net of surveillance by inspectors. In October 1758, for example, the General Committee heard that the matron had discovered on a visit that foundlings in Brentford were being neglected.12 In general, however, the hospital governors tried to promote a system of good care, rewarded by premiums. The hospital officials were prepared to consider placements over a wide geographical area to achieve their aim of universal wet nursing. In fact, the distances travelled by foundlings to nurses were as diverse and lengthy as those travelled to get to the hospital in the first place. Such long journeys (possibly the second in rapid succession) may have further weakened some infants.13 Table 5.1 indicates the proportions of nurslings who were placed in particular counties on their first placement from the hospital. Subsequent moves are considered below. Most children were sent relatively short distances from London, though beyond the immediate environs of the metropolis itself. 62.9 per cent of infants were placed in Surrey, Middlesex, Essex or Hertfordshire, and a further 8.5 per cent were sent to Kent. The popularity of Surrey as a place of nursing despite the fact that the hospital had easier access in terms of distance and roads to Middlesex and Hertfordshire suggests that it was a county with which hospital governors had links.14 Roger Finlay’s work on London fertility also found that nurse-children were frequently placed in these counties in the seventeenth century.15 Fildes and Clark have both noted that wet nurses tended to live on access routes to large towns, and support this with evidence from Hertfordshire and Berkshire respectively.16 Foundling Hospital nurses may have lived in more remote areas, however, since they were recruited by people who

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Table 5.1 Place of fostering with external nurses from the London Foundling Hospital, by county, 1741–64 County

N

% of total

Surrey

2893

23.04

Middlesex

1858

14.80

Essex

1804

14.37

Hertfordshire

1213

9.66

Berkshire

1067

8.50

Kent

1063

8.46

Yorkshire

755

6.01

Hampshire

696

5.54

Staffordshire

397

3.16

Buckinghamshire

231

1.84

Bedfordshire

140

1.11

Sussex

112

0.89

Wiltshire

88

0.70

Derbyshire

87

0.69

Northamptonshire

83

0.66

Somerset

26

0.21

Worcestershire

20

0.16

Oxfordshire

8

0.06

Cambridgeshire

7

0.06

Nottinghamshire

6

0.05

Lincolnshire

3

0.02

Warwickshire

1

0.01

Total

12558

100

Source: Inspections Books, LMA, A/FH/A10/1/1/1–2.

knew the area. Patterns of nursing may also have been related to longstanding traditions of wet nursing, or a lack of other female employment, increasing the availability of nurses. Other children did travel greater distances, however, most notably to Yorkshire, Staffordshire and Somerset, although the numbers in some cases were small. Areas close to London were probably exploited for practical reasons: it was easier to transport children there, and it was more likely that potential nurses

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would have heard of the hospital, and be familiar with wet nursing as a form of employment. As time went on, however, the hospital began to appraise more critically the suitability of different areas for nursing, as will be discussed in greater detail below. Within the counties identified above, certain communities were popular receiving places for foundling infants. In Surrey, Chertsey, Dorking and Epsom all took large numbers of foundlings (703, 607 and 460 respectively). Hemsworth in Yorkshire took in 595 infants, and Farnham and Yateley (both in Hampshire) and Hornchurch (in Essex) each received more than 300 over the period covered by the Inspections Books. It should be noted, however, that these communities were the centres on which an inspection was based, and nurses might themselves live in more rural areas beyond, or even in another town or village. While 139 of the children sent to the Chertsey inspection, for example, were actually placed in Chertsey itself, 77 went to Walton-on-Thames, 63 went to Egham, and 53 went to Staines, all of which were nearby communities. The remainder went to other nearby parishes. Figure 5.1 shows the numbers of foundling nurslings received over time in the four most popular counties, and indicates considerable variation.

Figure 5.1 Most popular counties for nursing infants from the London Foundling Hospital, 1756–60

Number of foundlings placed

1400 1200 1000 800 600 400 200 0 1756

1757 Surrey

Note: N = 7529 foundlings. Source: Inspections Books.

1758 Middlesex

1759 Essex

Herts

1760

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Surrey, the most popular receiving area for foundlings, took a very large number in 1757 and considerably fewer thereafter, although it continued to be the most popular of the four counties represented here throughout the General Reception. Middlesex, in contrast, increased its numbers of foundlings up to 1758, after which it gradually fell in popularity. Essex and Hertfordshire both continued to increase their nurseries up to 1759. This may reflect saturation levels being reached at different points in different areas, or changing preferences by hospital officials. In fact, saturation seems to have been less of an issue than might be speculated: inspectors’ letters show that women in Surrey continued to put themselves forward as potential nurses in significant numbers after the hospital had decided to redirect its preferences to areas further from London.17 Hospital policy may thus have been the primary motivating force behind the patterns shown in Figure 5.1, but it is clear that the hospital was able to continue placing the majority of its infants with nurses throughout the General Reception. The speed with which infants were found nurses did slow over time once the General Reception had begun, however. The majority of infants who were not placed died very shortly after entry to the hospital, and they are almost always recorded as having been sent to one of the hospital’s infirmaries.18 This implies that the only children who were not sent to nurses were those who were sick, and that the hospital was able to find nurses for all the children who needed one. Figure 5.2 shows the rate at which infants who entered during the General Reception were placed with external nurses.19 It is clear that infants who were found nurses tended to be sent out rapidly; the majority of those who were had been sent within approximately a week of admission. After this point, further placements accrued only slowly, probably representing infants who were weak or sick on admission but who made sufficient recovery that they could subsequently be sent out. Almost 80 per cent of entrants to the hospital were placed with a nurse within sixty days, but three quarters had been sent out within ten days. This points to a considerable level of efficiency, given the logistics involved in having women continually sent up to receive infants. On average, the infants in the dataset as a whole were placed with an external nurse on their fourth day at the hospital. Over the course of the General Reception, however, this drifted upwards, as shown graphically in Figure 5.3. Over the whole period 1756–60, 23 per cent of those who were sent to external nurses were placed on the day of their arrival, and almost 90 per cent of those placed had been sent out within a week. In 1756, however, 36 per cent of placements had been made on the day of arrival; in 1757 this fell to 27 per cent, in 1758 to

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Childcare, health and mortality

Figure 5.2 Speed of placement from the Foundling Hospital with an external nurse, 1756–60 Cumulative percentage of entrants

100 90 80 70 60 50 40 30 20 10 0 0

5

10

15

20

25 30 35 40 Days since admission

45

50

55

Source: Inspections Books.

Figure 5.3 Mean wait for placement with an external Foundling Hospital nurse, 1756–60 5

Days since entry

4 3 2 1 0 1756

1757

1758 Year

Note: Day 1 is the day of arrival at the hospital. Source: Inspections Books.

1759

1760

60

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21 per cent, and in 1759 to 18 per cent. In 1760 there was a slight recovery, to 21 per cent of placements. During their time in the hospital, infants would be fed by internal nurses, but it is unlikely that they could be exclusively breastfed, given the increasing numbers of infants waiting in the house. Only twenty wet nurses were kept in the hospital, with a further six in the infirmary, and at times this number appears to have fallen, to the detriment of the babies’ health.20 Being cared for in the hospital was, therefore, less satisfactory for a healthy infant than prompt placement with an external wet nurse. The slowing down of prompt placement may indicate either an increased incidence of illness on entry or a system that was deteriorating in efficiency and reach. The General Committee minutes do note an increasing shortage of nurses, especially during the period of open admissions. In January 1760, the committee noted ‘the great number of children now in the Hospital, and that some Inspectors do not send up Nurses as heretofore’.21 It would not, after all, take a very large change in local earning opportunities or levels of poor relief for women to stop offering themselves as nurses. It is also possible, however, that there was a deliberate decision not to send children out to nurse immediately for fear of weakening them. In May 1757, Lady Vere, a distinguished supporter of the hospital, suggested that some of the infants were being sent into the country at too young an age, and in August 1758, the opinion was again voiced that the possibility of two long journeys in as many days might have had ill effects on the children.22 The overall commitment to wet nursing, however, may have overridden these concerns, although the committee did resolve in January 1758 that ‘no children be sent at too great a distance in the Country to Nurse, who may not be thought capable of bearing the fatigue’.23 The evidence for an increasing incidence of illness on entry is more compelling. The number of children who were sent to the infirmary on their arrival is recorded in the General Register, and it is clear that this was rising over the General Reception period. Only two children died in the infirmaries without ever being sent to a nurse before the General Reception, which might be expected from the fact that they were screened for health. From 1756 the proportion of entrants who needed medical attention either in the infirmary or in external wards established by the hospital rose significantly, from 15 per cent in that year to a high of 32 per cent by 1760. The proportion of these infants who died in the infirmaries also rose, from 70 per cent in 1756 to 83 per cent in 1759, although there was a slight improvement in 1760 (for both trends, see Figure 5.4). By 1760, therefore, close to a third of infants were too sick to be sent out immediately to a nurse, and three quarters of them

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Figure 5.4 Proportion of entrants needing medical attention and dying in Foundling Hospital infirmaries, 1756–60

Proportion of entrants sick (bars)

30 80 25 75

20 15

70

10 65 5 0

Proportion of sick who died (line)

85

35

60

1756

1757

1758

1759

1760

Note: N = 3076. Source: Inspections Books.

never recovered, although this represents a better rate of recovery than in previous years. In 1797, the General Committee minuted that during the General Reception, some infants were already dead when they were received, and that ‘[m]any did not live to be carried into the wards of the Hospital, or if alive survived their admission only a few Hours’.24 This is a strong suggestion that it was the condition of the children before arrival which resulted in the lower nursing rates, although committee minutes also suggest that there were shortages of nurses. The health status of entrants deteriorated over the course of the General Reception, which suggests that conditions for poor families were worsening, or that people were increasingly using the hospital as a dumping ground for dying infants (or perhaps as a place of last resort in the hope that they could be saved). Most infants, nonetheless, had to wait only a few days before they were provided with a regular supply of breast-milk. In contrast with the situation in some other European hospitals, there is little evidence of a strong seasonal pattern in the period of time a foundling had to wait to be placed with a nurse. The most common pattern is of nursing shortages in the summer months, when women could find alternative employment in agriculture. At the Innocenti

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Figure 5.5 Mean wait for placement with an external Foundling Hospital nurse by season, 1756–60 5

Days since entry

4

3

2

1

0 Winter

Spring

Summer

Autumn

Note: N = 12 166. These data are based on the General Reception only, since admissions outside this period were supply rather than demand-driven. Source: Inspections Books.

hospital in Florence, for example, infants had significantly increased stays in the hospital in June, July and August, especially in years where the hospital was finding it hard to attract sufficient numbers of nurses generally.25 This increased wait for a nurse took place during a season notoriously dangerous for risks of death from gastric disease, especially if infants were not being exclusively breastfed. At the hospital in London, however, any seasonal pattern seems to have been towards a greater difficulty of finding nurses in winter, as shown in Figure 5.5. This too may be related to the numbers and condition of infants on entry. The seasonal pattern of entry to the hospital infirmaries had a marked winter peak, with December, February and March having around 50 per cent more entries than that predicted by an even spread across the year. Demand for nurses was therefore high at a time when infants had a higher risk of being in a poor state at abandonment, and transport may have been more difficult because of the weather. The pattern of nursing may also reflect an absence of alternative employment opportunities or a lack of seasonal rises in poor relief payments in the communities the foundlings were sent to, or alternatively, that the wage paid by the hospital to its nurses was sufficient to offset other

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opportunities to earn in the summer months.26 Overall, the comparatively small differences between seasons suggests that nursing shortages were relatively rare in England. What seems to have been more significant than season in determining the speed of external placements was the place to which a child was sent to be nursed. When the most popular counties for nursing are examined separately, significant differentials emerge. Foundlings sent to Surrey and Yorkshire were more likely to be sent out at an early age than those sent to other counties, to an extent which was statistically significant at a 99 per cent level of confidence.27 Patterns of placement in these two counties were also significantly different from each other, with foundlings being sent to Yorkshire more promptly still (although the length of the journey might have slowed down their arrival). Hertfordshire and Essex showed differences from one another which were significant at a lower confidence level (placements to Essex were more rapid), but there was essentially no difference between the distribution of foundlings going to Middlesex and Hertfordshire, or Middlesex and Essex. This again indicates a high level of organisation with respect to the Yorkshire nurseries, despite their distance from London. Nurses in Surrey were also sent to London in sufficient numbers to assure a rapid placement of the foundlings they were allocated. The efficiency of individual inspectors may also have affected the turnover of nurses from different places at the hospital. The regional differentials in nursing which have been identified so far suggest that some areas may have offered better survival prospects to the foundlings than others. Hazards analysis has already indicated that the distance from the hospital was of significance, but the data from the Inspections Books allow us to be more specific in terms of geographical differences. It has also been noted that the hospital officials prioritised different areas for nursing at different times, and they made attempts themselves to quantify mortality to this end. Jonas Hanway cited hospital accounts revealing more than 80 per cent mortality for some areas in Middlesex.28 A contemporary account of 2859 children sent to nurse between June 1756 and June 1757 also shows differential mortality in different nurseries, although at a lower level: the mean average mortality was 38 per cent, and the only places diverging widely from this figure were those with very few children. Of the regions taking more than 100 foundlings, Yorkshire had the worst record with 50 per cent mortality, and Kent had the best, with 32 per cent.29 The General Committee also resolved in October 1758 that no more children should be sent to the areas closest to London, including Bow, Knightsbridge, Chertsey and Epsom, because they were judged to be unhealthy.30

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Table 5.2 Infant mortality rates among foundlings, by county of nursing, 1741–64 County

IMR

Surrey

607.5

Middlesex

745.6

Essex

641.5

Hertfordshire

602.7

Berkshire

573.2

Kent

551.7

Yorkshire

547.0

Hampshire

516.3

Others

471.9

Total

599.4

Note: N = 3962. Source: Inspections Books.

To an extent, the data show that the governors were correct in their judgement, but they also indicate a greater degree of nuance than they appreciated between areas close to London. The method outlined in Chapter 3 has been used to calculate mortality rates based on the nursing data; in this case, the observation ‘clock’ starts at the point at which the child was sent to her or his nurse. Numbers were restricted to those where an age at entry was known (3962 cases). Analysis of the age distribution of foundlings going to different counties indicated no significant differences, however, suggesting that younger (and perhaps therefore more vulnerable) infants were not preferentially sent on short journeys. Table 5.2 shows the resulting infant mortality rates for the largest of the receiving counties. It is immediately apparent that foundlings did not experience the same mortality risks over the network as a whole, although, as might be expected since these were the healthier children among the intake, their death rates were lower than those for the hospital as a whole. Mortality was considerably higher in Middlesex than in any of the other counties, but was raised generally in Surrey, Middlesex, Essex and Hertfordshire (the most popular counties for nursing), compared with Berkshire, Kent, Yorkshire and Hampshire. The counties taking smaller numbers of children (grouped as ‘Others’) had the lowest mortality of all. The elevated

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Childcare, health and mortality

infant mortality where many infants were placed suggests that large numbers adversely affected the quality of care or inspection. Alternatively, it may confirm the governors’ view that areas closest to London were inherently unhealthy. It is worth noting that even in the worst counties for mortality, the externally nursed infants fared better than those who were admitted initially to the hospital’s infirmaries. Among 325 babies noted in the Inspections Books to have been admitted to infirmaries on entry, mortality was 852.3 per thousand, which may if anything be an underestimate, since not enough age information was known to specify left-truncation. Those who were eventually placed with nurses were sent in particularly large numbers to Chertsey: 24 per cent of the 98 survivors (23 cases). Five infants (5 per cent) were sent to Hemsworth, but the majority of the others were not sent so far. This may indicate a preference for sending babies who had been ill on shorter journeys, but it may also reflect the small numbers involved. A range of reasons behind differential mortality rates in different nurseries may be investigated via indicators of care and local conditions. Table 5.3 presents the results of correlation analysis of infant mortality rates in the most popular nursing communities in Middlesex, Kent, Surrey and Essex, with information on population density, urbanisation and foundling breastfeeding rates. Mortality seems to have been little affected by the prevalence of breastfeeding among foundlings, which might be one care-based explanation for raised mortality. IMRs by county show a negative correlation with mean average breastfeeding rates for foundlings at −0.208 (indicating that mortality was indeed high where breastfeeding was low, but not to any great degree). Hazards analysis also showed that being breastfed produced a survival advantage, but that it was not statistically significant. Population density shows a much stronger relationship with mortality (0.876), indicating that poor socioeconomic and health conditions may have had an adverse impact on the foundlings.31 The percentage of the population working in trades, manufacture and handicrafts as opposed to agriculture (used as a crude measure of how urbanised the environment was) shows a strong negative correlation with mortality. Mortality was, therefore, higher where the proportion of workers in trades was lower, which suggests that more urbanised areas (using this measure at least) had lower death rates. This runs counter to the traditional finding that rural areas had lower mortality than urban ones. The measure of urban environment is a crude one, however, and it is possible that it captures a degree of economic development rather than the type of unhealthy urban environment associated with industrialisation.32 None of these correlation coefficients reaches statistical significance, although this may be related to the small number of cases involved.

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Table 5.3 Socio-economic conditions, feeding type and foundling infant mortality rates in Middlesex, Kent, Surrey and Essex, 1741–1801

Middlesex

Foundling IMR, 1741–64

Population density (persons per acre), 1801

745.6

0.88

% of workforce in trades, manufacture and crafts, 1801 13.2

% of foundlings breastfed, 1741–64 84.3

Kent

551.7

0.25

24.2

83.9

Surrey

607.5

0.46

14.9

94.6

Essex

641.5

0.27

8.7

87.0

0.876

−0.631

Correlation analysis Foundling IMR, 1741–64

0.208

Sources: Foundling IMRs and breastfeeding rates: Inspections Books and General Register, LMA, A/FH/A09/2/1-5. Population densities: Tables of Population 1801–1901 (compiled by George S. Minchin), in H. E. Malden (ed.), The Victoria history of the county of Surrey, Vol. 4 (London, 1912), pp. 447–53; William Page (ed.), The Victoria history of the county of Kent, Vol. 3 (London, 1932), pp. 356–70; William Page and J. Horance Round (eds), The Victoria history of the county of Essex, Vol. 2 (London, 1907), pp. 342–54; William Page (ed.), The Victoria history of the county of Middlesex, Vol. 2 (London, 1911), pp. 112–19; Comparative account of the population of Great Britain in the Years 1801, 1811, 1821 and 1831 with the annual value of real property in the year 1815 (ordered to be printed by the House of Commons, 19 October 1831). Occupational data: Abstract of the answers and returns made pursuant to an Act, passed in the forty first year of His Majesty King George III intituled ‘An Act for taking an account of the population of Great Britain, and the increase or diminution thereof ’. Enumeration Part 1 England and Wales (ordered to be printed by the House of Commons, 1801).

These figures cannot specify whether there was a causative relationship between local conditions, type of feeding and foundling mortality, but they are suggestive of raised risks associated with high population densities. The parishes incorporated in the analysis for Middlesex, which had particularly raised mortality, included the densely populated parishes of Twickenham and Bow, both of which housed more than one person per acre. Twickenham also had a particularly harsh poor

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Childcare, health and mortality

law system, which suggests that conditions may have been poor as well as densely populated.33 Only Camberwell in Surrey had a comparable population density among the communities included in the analysis. It is likely that Bow in particular (density 3.7 per acre) had a strong influence on the reported results. It is noteworthy that Bow was one of the areas ordered by the governors to be discontinued as a nursery because of the high mortality of foundlings sent there. Mortality statistics show that death rates were not on the scale that was quoted by Hanway, although he was correct to identify Middlesex as having particularly high mortality. Kent was also correctly picked out in figures collated by governors as being relatively healthy, although Yorkshire performs better in the current analysis than other counties. Contemporary figures are not directly comparable to those produced here, however, as they were probably not differentiated by age, and may have included older children who were sent out to nurses for their health, or as a second placement. Conclusions on the impact of local conditions on mortality must remain speculative, especially since certain areas were pre-selected precisely because they were thought to be healthy. The evidence does suggest, however, that densely populated places had higher rates of mortality, and that rates of breastfeeding were uniformly high enough to offer little extra protection. In addition, some areas were dropped from the nursing lists because of expense rather than their apparently adverse effect on survival: Lincolnshire was deemed in 1759 to be too expensive, although it was never a county which hosted many foster foundlings.34 Experiences of nursing The data presented thus far have shown the geographical distribution of the nursing network and the mortality rates it produced. The evidence also allows us to speculate more on the actual experiences of nursing, both for the foundlings and for the women who fostered them. Details of type of nursing, duration of stay and the number of other children present all offer insights into how the system actually worked, and give food for speculation on the type of experience that may have been produced. It has already been noted that the hospital followed a policy of nearuniversal wet nursing almost since its establishment. The data from the Inspections Books confirm that the great majority of foundlings were nursed in this way on their first placement from the hospital. Table 5.4 gives the proportions breastfed and nursed by hand (fed on paps, animal milks and other broths and panadas), for all children and for each year of the General Reception. In total, 87.5 per cent of infants sent out to

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Table 5.4 Type of nursing received at first foster placement, London Foundling Hospital, 1741–64 (percentage of total) Wet nursed

Dry nursed

No information

N

Total

87.5

8.9

3.6

12 558

1756

80.1

17.2

2.6

1 208

1757

87.8

11.8

0.4

3 444

1758

91.2

7.8

1.0

3 513

1759

94.8

4.7

0.5

2 943

1760

92.5

7.3

1.2

1 003

Source: Inspections Books.

nurses were breastfed. The 8.9 per cent who were artificially fed were probably those who were too weak to suck, had lost the sucking reflex, or were carrying a contagious condition which might infect the nurse.35 Others may have been given to a dry nurse when no wet nurse was available. Rates of wet nursing remained high over the General Reception, and in this case the hospital seems to have achieved greater rates of success over time. Since other evidence suggests that the condition of infants on entry was, if anything, deteriorating, it seems likely that this was due to an increased penetration of the potential wet nursing market. In 1759, in particular, wet nursing was a near-universal phenomenon. Broadly speaking, this pattern was true across the nursing network. Kent and Middlesex had slightly below-average rates of wet nursing (84 per cent in each case), while Hampshire and Staffordshire (95 and 97 per cent respectively) had high rates. The latter counties were not large receiving areas for foundlings, although both took over 100 during the period covered by the Inspections Books. It is possible that wet nursing was particularly prioritised there, but an alternative explanation is that the fewer children were placed in an area, the greater was the likelihood of finding enough wet nurses. The suggestion also stands that weaker children (who were perhaps more likely to have been dry nursed because of weakness or illness) were sent on short journeys to spare them, despite the risks of being close to London. Differences were most likely, however, due to small numbers in certain counties, and the difficulties of finding large numbers of wet nurses where very many infants were being found foster homes. There is also evidence, however, that dry nursing was favoured by some women, and numbers of infants fed in this way may have been

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partly a product of demand.36 There does not seem to have been a pay differential between wet and dry nursing, so there was no disincentive to the latter.37 As will be noted in Chapter 6, the dry nurses may have been women who were seeking employment but were not lactating. In other cases, women may have preferred not to run the risk of venereal infection, or may have regarded dry nursing as more convenient. It was easier to carry out other work if the child was not being breastfed, and it was theoretically possible to leave it in the care of another family member, although it seems unlikely that the hospital would have approved of this practice. Women may also have regarded dry nursing as a means of earning money without interrupting the breastfeeding of their own infant. In May 1757, an aristocratic patron of the hospital, Lady Vere suggested that in the present time of dearth, poor food might be affecting women’s ability to provide good-quality milk.38 On the other hand, however, breast-milk was at least free, while dry nursing involved purchasing bread and milk at market prices. Poor conditions may in fact have promoted wet nursing rather than dry. The vast majority of foundling infants did, however, experience the physical and emotional benefits of breastfeeding. For some, however, the relationship forged with the nurse was not long-lasting. Some foundlings were removed to another nurse in the same neighbourhood because of poor care, or the retirement or change of circumstances of the nurse. Others changed inspection, which may have represented a move in administrative terms only, if one inspector retired and another took over the care of the nursery, but in other cases it may have entailed a longer-distance move. The Inspections Books provide a new entry for each child when it came under a new inspector, and only careful crossmatching of identifying numbers reveals whether a change of nurse was actually made. It is thus not straightforward to represent the amount of geographical movement and changes of foster mother within the dataset. In total, 643 foundlings had more than one nurse within the same inspection (5 per cent of the total), and 31 had three nurses within the same inspection (0.25 per cent). Of the 643 experiencing a change of nurse, 199 also had a change of inspection subsequently. In 102 cases this did represent the child being nursed by three different women (in the remaining cases, the change of inspection was an administrative change only). Eight foundlings in total were each nursed by four different women. In terms of geographical mobility over longer distances, just over 16 per cent of foundlings had a change of inspection while at nurse (2043 cases), and 10 per cent of these (1.6 per cent of the total or 211 infants) had two. In 31 per cent of cases, matching entries relating to the same children revealed that the move was one on paper only;

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the nurse kept the child, and was put under a different inspector. The children placed under three inspectors were similarly less mobile than the registers make them appear at first glance. Of 211 foundlings in this category, 40 per cent did not move county, and 89 per cent of these stayed with the same nurse. 63 children were at different times under three different inspectors without leaving their original nurse, while 13 had three nurses under three inspectors. Clearly, a change of nurse was a fairly unusual occurrence, but among the more mobile children a geographical pattern is discernible, of movement from communities in the south-east of the country to Shropshire and Yorkshire. 797 children in total were sent to Shrewsbury (Shropshire), and 490 to Ackworth (Yorkshire), generally in the last years of the General Reception (1759 and 1760), when the foundlings were aged around two or three. Several reasons can be suggested for this longer-distance migration of young children. Firstly, as has already been noted, areas close to London had started to be identified as unhealthy, and Shrewsbury and Ackworth were two of the longest-established and most distant communities used by the hospital for nursing.39 Secondly, by 1759 and 1760, the governors were probably aware that the tide of opinion in parliament was turning against the continued funding of open admissions to the hospital. It may thus have been logistically beneficial to gather children together in anticipation of a rapid drop in admissions. Thirdly, as well there as being established nurseries with hard-working inspectors in each case (Roger Kynaston in Shrewsbury and the Revd Dr Timothy Lee in Ackworth), there were branches of the hospital in both places, set up towards the end of the General Reception. Foundlings could therefore be taken into the branch hospitals when they left their nurses, and be apprenticed from there, rather than being sent back to London. On both health and logistical grounds, therefore, the movement of small children to Shrewsbury and Ackworth made sense, although it may have been a traumatic experience for the children involved, many of whom were leaving the only mother they remembered. Even those who had a more stable experience of nursing had to undergo this separation, however, albeit at a slightly older age: the mean average age of return to the hospital or one of its branches was 5.2 years.40 An example of one of the most mobile children in the dataset illustrates the above trends. William Vaughan entered the hospital on 28 February 1757, and was sent to be wet nursed by Mary Berryman in Chertsey on 2 March. On 16 December 1757, he was removed to Ann May, also under the Chertsey inspection. At an unknown date, he was removed again, to Mary Smither, also of Chertsey. Finally, on 12 July 1759, at the age of approximately two and a half, he was sent to Ackworth,

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to be nursed by Hannah Grace. Cross-reference to the General Register indicates that he was, in fact, returned to the hospital in London before his journey to Ackworth; he was returned to his nurse on 18 May 1759 (presumably the date on which he moved to Mary Smither in Chertsey). William Vaughan survived early childhood, but died of fever in January 1765, when he was approximately eight years old. It is not clear whether this was in the Ackworth or London branch of the hospital. This child was an exception to the general rule, being nursed by four different women in the space of a little over two years. He was moved around both within the same geographical area, and also experienced a longer journey to Ackworth. His detour via London may indicate that he was sick, and was returned for treatment, or was judged to have been too young to be removed. If he was indeed returned to a new nurse, this may indicate dissatisfaction with his earlier treatment, although the previous nurse may by then have taken another nursling, preventing William’s return. His changes of nurse in Chertsey suggest either that he was a difficult or weakly infant or that he was exceptionally unlucky in being placed with several bad nurses. Both Mary Berryman and Mary Smither nursed several other infants from the hospital, however, which suggests that the quality of their care was not an issue. William’s health in infancy was clearly not compromised by his changes of nurse, but they must have been extremely disruptive for him, and may have seriously affected his chances of forming trusting bonds in each case.41 We may only speculate on what the effects may have been on his emotional and psychological development. A more typical example may have been Samuel Mostyn, who entered the hospital on the same day as William and was sent to be wet nursed by Elizabeth Bill in Romford, under the Hornchurch inspection in Essex, on 1 March. He remained with the same nurse until his return to the hospital in October 1762, when he was around five and a half. He was apprenticed in March 1767. This child may have had a more stable experience of nursing (although we cannot guarantee the quality of the bond made with the nurse), but the separation at the age of five may have been all the more traumatic for that. The nature of the nursing experience would also have been affected by the composition of the households the foundlings entered. The foundling would almost certainly have shared the home with at least one of the nurse’s own children, and perhaps with several other foundlings.42 It is very difficult to calculate the mean average number of foundlings taken by a nurse, because the data from the Inspections Books do not differentiate between women of the same name, and the same woman might also appear under several different inspections, as noted above.

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Data from the inspections at Ackworth, Hemsworth, Chertsey and Epsom, however, indicate that the mean average ratio of foundlings per nurse was approximately two.43 According to the hospital’s regulations, women were to have only one nursling at a time, ‘the cttee being of Opinion that she can’t well take Care of more’.44 She was also not allowed to take a third or subsequent child once she had had two die with her in twelve months, unless there were exceptional circumstances.45 In reality, there are many examples of women who cared for more than one foundling at the same time, although it is possible that they were not being simultaneously breastfed. The age at weaning appears to have been under one year, which is earlier than breastfeeding patterns suggest for the wider population.46 A General Committee resolution of November 1751 stated that children were not to be sent to Hemsworth until they were weaned and about one year old (implying that weaning preceded their first birthday).47 On 2 March 1757, the committee debated removing children from their nurses when weaned, but it was noted that they would thus miss out on the premium at a year. This again indicates that weaning came before a year.48 Probably the numbers of infants being abandoned during the General Reception made it hard to ensure that nurses had only one nursling at a time, however. Mary Coombs, in the Epsom inspection, for example, fostered the foundling William Parry in July 1757, and another, Samuel Fitch, in June 1758. William survived to be returned to the hospital in 1763, but Samuel died in July 1758. William may very well have been weaned by the time that Samuel arrived, however, so that although Mary had two infants simultaneously, she was not breastfeeding them both. Margaret Collier of the same inspection, on the other hand, does seem to have wet nursed two infants simultaneously. She took in the foundling Ann Stafford to be wet nursed in January 1757, and Maud Sanders in March 1757. Ann died in May 1758, and was presumably still being breastfed when Maud arrived. Breastfeeding two infants concurrently is physiologically possible, as mothers of twins demonstrate, although it may be exhausting. Nursing more than that number requires an increased food intake, and, of course, takes up an increasing amount of the nurse’s time. The more infants a woman was nursing, the greater the likelihood that they were not being exclusively breastfed, but were having their diet supplemented with artificial foods. This would raise the infants’ risks of gastro-intestinal infection from poorly prepared food and unclean feeding vessels. Just as some women do seem to have breastfed more than one foundling concurrently, it is also clear that women were allowed to take more foundlings after they had lost two. Since the mean total number of

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Table 5.5 The nursing career of Jane Derby of Epsom for the London Foundling Hospital Child’s name

Date of arrival

Fate

1 Benjamin Sparrow

1 Jun 1757

Left 2 Aug 1759

2

John Sunderland

23 Jan 1758

Died 10 Feb 1758

3

Penelope Child

16 Feb 1758

Died 8 Mar 1758

4

Albert Wood

8 May 1758

Died 22 Sep 1758

5

Jacob Sims

15 Feb 1759

Left 29 May 1764

6

William Lander

2 Apr 1759

Died 14 Jun 1759

7

John Blacoe

16 Jul 1759

Died 2 Oct 1759

8

Jasper Ford

19 Dec 1759

Died 7 Jan 1760

9

Catherine Lisle

15 Jan 1760

Died 14 May 1760

Source: Inspections Books.

foundlings per nurse was approximately two this was clearly unusual, but some women lost many children and were allowed to take more. Jane Derby, of the Epsom inspection, for example, took in a total of nine foundlings between June 1757 and January 1760, of whom seven died rapidly. Her nursing career for the hospital is illustrated in Table 5.5. The fact that most women did not nurse more than two children for the hospital meant that the ‘two deaths’ rule was not usually an issue. In fact, it suggests that two foundlings may have been considered an optimal number by the nurses, either in terms of the balance between income generated and time spent, or because the need (at least in theory) to have weaned one infant before taking another meant that they were unlikely to have had time to take in more than two before the end of the General Reception effectively removed the possibility of nursing for the hospital.49 Although Jane Derby was an extreme case in taking nine foundlings, it seems that she was trying to maintain a balance of two. The first infant, Benjamin Sparrow, survived to be placed with another nurse in Shrewsbury a little over two years after his arrival (and was ultimately apprenticed from the hospital), and the fifth, Jacob Sims, also survived to be returned to the hospital. In every other case, Jane received another infant only after the death of the previous one. Benjamin Sparrow and Jacob Sims were brought up together for six months, during which time two other infants were received and died relatively soon. Outside this six-month period, both Benjamin and Jacob only ever shared their nurse with one other foundling.

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The remainder of Jane’s foster infants generally died soon after arrival, suggesting that it was their pre-existing state of health which carried them off, rather than her standard of care. Certainly, she was unlucky enough to take four infants who had been abandoned in the winter, which hazards analysis highlighted as significantly the most risky season for survival prospects. The poor state of some children on arrival was pointed out by Nathaniel Edwards, one of the Surrey inspectors, in 1759. On 23 April of that year he wrote to Mr Collingwood, the hospital’s secretary, that: Ann Rosewell [a nurse] has had the misfortune of losing her last Child soon after she brought it home; it was so ill when given her that every body expected it wou’d have dy’d upon the Road. She really is a good nurse, & will do justice by the Children, the Hospital entrusts her wth, she was very much dispirited wth losing the Child so soon, but hopes the Governors wont have a bad Opinion of her as it was so ill when deliver’d to her, & if they’ll be good as to let her have another, she’ll take all the Care imaginable of it. If the Hospital thinks proper to let her have another Child I beg it may be a healthy one for I shou’d be loath to have them die that I have the Inspection of I am sr Your Humble Servt NEdwards50

This letter indicates that some infants were felt to be beyond the benefits of good care, and illustrates how good nurses were able to bypass the ‘two deaths’ rule. In Jane Derby’s case, all nine children were supervised by the same inspector, and it seems unlikely that he could have been unaware of her poor survival record. Instead, he chose to apply discretion, as Nathaniel Edwards did in the above case. In other cases, nurses tried to circumvent the rules by applying to another nearby inspector when they had been refused a child.51 Officials in London may not always have been able to check that the women who came up to the hospital had not had two foundlings die with them already; in November 1758, the sub-committee was ordered to consider how this information could be got without having to check the inspectors’ ledgers.52 Many foundlings clearly did not share their nurse with other infants from the hospital, but others were part of a multiple-nursing experience for both foster mother and infants. It seems that nurses often did not take a second infant until the first was weaned, but in some cases this was not adhered to, perhaps to the detriment of both nurslings. In exceptional cases, such as Jane Derby’s, successive deaths of young foundlings did not mark her out as a poor nurse, which suggests that

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the hospital realised that some deaths were unavoidable. This is an interesting departure from the common depiction of nurses as careless and blameworthy. The anthropologist Sarah Blaffer Hrdy articulates a commonly held contemporary view in writing that ‘it is widely believed that the use of wet nurses in premodern Europe was in fact a disguised, nonprosecutable form of infanticide’.53 The premium paid by the hospital after a year’s successful nursing shows that this was not the case here, and that deaths were not disregarded or even quietly encouraged, as has been said of women nursing parish poor infants. Hanway charged parish officials with removing children from ‘drunken mothers’ only to give them to a ‘decrepit woman or nurse’, under whose care they would soon perish.54 The Foundling Hospital seems to have sought much more rigorously supervised and sympathetic relationships with its nurses. It has also been shown that the hospital created a geographically extensive network of nurses, held together by the inspectors. These men and women were able to mobilise very large numbers of women to nurse for the hospital, and turnover of foundlings to nurses remained very rapid, even as the General Reception progressed. Mortality among the nurslings was high, but geographical differentials have been uncovered which mainly support the governors’ fears that areas close to London were unhealthy. So far, it has been possible only to speculate on the types of experience the foundlings had of nursing, on the basis of their mobility, their ages at leaving their nurses, and the possibility of having other foundlings present. In the chapters which follow, several groups of foundlings and nurses are analysed to examine these points more closely. Notes 1 Inspections Books, 1741–64, LMA, A/FH/A10/001/001/01-02. 2 The remainder of the infants had no information on nursing. Most of these died within a month of entry, but it is hard to be sure whether they did all die without going to a nurse. 3 General Committee minutes, 13 April 1757, LMA, A/FH/K02/1-18. Shopkeepers were specifically excluded, after problems arose from shopkeeper-inspectors paying their nurses with credit notes for their shops rather than cash (General Committee minutes, 17 January 1753 and 22 December 1756). 4 Inspections Books. As will be noted further below, some children were supervised by more than one inspector during their time at nurse, and some of these people inspected some of the same children at different times. 5 G. Clark (ed.), Correspondence of the Foundling Hospital inspectors in Berkshire, 1759–1768 (Reading, 1997), pp. 13, 15 and 131.

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6 A. Linton, ‘Child care in the second part of the 18th century as illustrated by the work of the Foundling Hospital and its inspectors’ (unpublished thesis, 1964, held at the London Metropolitan Archive, no affiliation given), p. 64. 7 Correspondence, 16 December 1769, LMA, A/FH/A06/1/22/9/45. 8 General Committee minutes, 13 April 1757. 9 Fildes, Wet nursing, pp. 92–8. 10 Ibid., pp. 159–60; Fildes, Breasts, bottles and babies: a history of infant feeding (Edinburgh, 1986), p. 160. 11 Kertzer, Sacrificed for honor, p. 145. 12 General Committee minutes, 25 October 1758. On 25 May 1743 another nurse was ordered by the committee to be discharged for abusing a child, and four days later bad reports were heard of nurses at Hampstead. The children were removed. Such reports to the General Committee were rare, however. See General Committee minutes, 25 May 1743, 29 May 1754, 12 June 1754. 13 The journey from London to Ackworth took between five and seven days, depending on the season (E. Vipont, Ackworth School (enlarged edition, Ackworth, 1991), p. 21). Gillian Clark states that the Berkshire parishes used by the hospital for nursing were at the limits of the distance that could be covered in a day (‘Nurse children’, p. 25). 14 Daunton shows that the turnpike system of road tolls may also have developed slightly later to the south of the capital than to the north, possibly making journeys to Surrey cheaper than those north of London (M. J. Daunton, Progress and poverty: an economic and social history of Britain, 1700–1850 (Oxford, 1995), pp. 297–307. Daniel Defoe noted the poor state of the roads in Surrey, however (D. Defoe, A tour through the whole island of Great Britain (2 vols, revised edition, London, 1962), Vol. 1, p. 162. 15 Finlay, Population and metropolis, pp. 146–8. 16 Fildes, ‘The English wet nurse’, p. 158; Clark, ‘Nurse children’, p. 27. 17 See, for example, correspondence, 28 August 1759, LMA, A/FH/A06/1/ 12/5/26. 18 In the ten-per-cent sample used for hazards analysis, 14.2 per cent of children never went to a nurse. It is difficult to be so precise in the case of the full dataset, because of uncertainties over the comprehensiveness of coverage of the Inspections Books. 19 Only children who were recorded as being sent out within sixty days of arrival were included in this figure and the calculations which follow. This was to overcome the problem of faulty dates; some children had clearly been recorded in error as being sent out a full year or month too early or late. Others had faulty dates which were not so easily resolvable, and other evidence indicates that very lengthy stays in the hospital before being placed with a nurse were unlikely. The figures for the full dataset show a lower proportion of total placements than the ten-per-cent sample used for

116

20 21 22 23 24 25 26 27

28 29

30 31 32

33 34 35

36

37

Childcare, health and mortality hazards analysis. In that sample, 85 per cent of entrants were placed with a nurse, compared with 78 per cent in the full dataset. This may be a facet of sampling, or of the small degree of incompleteness in the Inspections Book. There will also be a small degree of underestimation because the children with dubious information on the date when they were sent to a nurse are omitted. General Committee minutes, 7 July 1757, 16 August 1758, 9 January 1760, 16 January 1760. General Committee minutes, 16 January 1760. See also General Committee minutes, 20 February 1750/51. General Committee minutes, 4 May 1757 and 16 August 1758. General Committee minutes, 25 January 1758. General Committee minutes, 22 February 1797. See also General Committee minutes, 1 December 1756, for similar concerns. Levene, ‘Health and survival chances’, pp. 142–3. See Chapter 6 on the nursing wage. Using the Kolmogorov–Smirnov test for statistical difference in a cumulative distribution. Here, we may be 99 per cent sure that the two samples do not follow the same distribution as the remaining counties. J. Hanway, Letters on the importance of the rising generation of the labouring part of our fellow subjects (2 vols, London, 1767), Vol. 1, p. 211. ‘A list of the several places where the children taken into this hospital from the 2 June 1756 to the 2 June 1757 were nursed, as also the number that have died at each place within that period’, LMA, A/FH/A10/15/20. A further investigation was ordered in April 1758, and another was reported in October 1758. See General Committee minutes, 19 April 1758, 3 October 1758. General Committee minutes, 3 October 1758. Thanks to Dr Rhiannon Thompson for suggesting the possible significance of this variable. For example, see R. Woods and N. Shelton, An atlas of Victorian mortality (Liverpool, 1997), p. 51; C. Galley and N. Shelton, ‘Bridging the gap: determining long-term changes in infant mortality in pre-registration England and Wales’, Population Studies, 55:1 (2001), pp. 65–77. Steven King, personal communication, August 2005. General Committee minutes, 15 August 1759. Children who had been admitted to the hospital infirmaries before being sent to a nurse were more likely to be dry nursed with an external nurse than those who were healthy (comparatively speaking, at least) on arrival. While 87.5 per cent of all children were wet nursed, only 76.1 per cent of infants who had been sent to the hospital infirmaries were fed in this way. In October 1758, it was referred to a sub-committee to consider how to supply inspectors who wanted dry nursed infants. General Committee minutes, 18 October 1758. Eleven out of 305 ‘Nurses’ duplicates’ (receipts for pay) from 1759 were for dry nurses, and ten received the same wage as the wet nurses. The

The nursing network

38 39

40

41

42 43 44 45 46

47 48 49

50 51

52 53

54

117

exception was nursed in Shropshire, which seems to have attracted lower pay generally. See Nurses’ duplicates, 1759, LMA, A/FH/A10/1/5–8. General Committee minutes, 4 May 1757. In April 1760, the General Committee ordered the sub-committee to consider removing children not being properly cared for to Ackworth or Shrewsbury. This suggests that the quality of care was a significant issue. See General Committee minutes, 30 April 1760. A date of return is given for 3087 children. In other cases, the child was noted to have been returned to London, but was subsequently placed with another nurse. The average age of return for these children was 4.6 years. Some of these children may have been en route to one of the branch hospitals, from whence they would ultimately be apprenticed. This is certainly found to be the case in modern studies, although it seems unwise to extrapolate these findings to historical data. See, for example, M. Rutter, Maternal deprivation reassessed (2nd edition, Harmondsworth, 1981), and references. See Chapter 6 for exceptions to the expectation that the nurse would have children at home. See Chapter 6. General Committee minutes, 13 October 1756, 14 November 1759. General Committee minutes, 22 December 1756, 23 February 1757. Demographic data suggest that the average duration of breastfeeding in England was 19 months, and that it was a very common practice (Wrigley et al., English population history, pp. 207, 379–82 and 445–6). Landers has found evidence of high levels of gastric disease among London Quakers in the eighteenth century, however, suggesting that artificial feeding was relatively common among this community, though declining (Landers, Death and the metropolis, pp. 147–8 and 152). General Committee minutes, 13 November 1751. General Committee minutes, 2 March 1757. One of the Surrey inspectors wrote to the hospital in August 1759 that nurses could earn more by going out to work than by nursing one foundling, which suggests that two did bring in some sort of critical threshold income. See Correspondence, 28 August 1759, LMA, A/FH/A06/1/12/5/26. Correspondence, 23 April 1759, LMA, A/FH/A06/1/12/5/17. This practice was brought to the attention of the General Committee by the inspector at Kensington in February 1757. See General Committee minutes, 23 February 1757. General Committee minutes, 1 November 1758. S. Blaffer Hrdy, ‘Fitness tradeoffs in the history and evolution of delegated mothering with special reference to wet-nursing, abandonment and infanticide’, Ethnology and Sociobiology, 13 (1992), p. 415. Hanway, A candid historical account, p. 21. Other parishes were remiss in paying their nurses, possibly discouraging women from making their best efforts to keep the children alive. See Pinchbeck and Hewitt, Children in English society, Vol. 1, pp. 175–7, citing John Fielding in 1768.

6

Growing up as a foster child

She is born of honest Parents . . . they therefore humbly prays that the managers of the foundling Hospital may be pleased to order her to a Good motherly woman that will take Special Care of her . . . Note left with child 5072, Elizabeth Murray Abandoned 9 July 1757 Died 12 July 1757

Nursing in Ackworth, Hemsworth, Chertsey and Epsom This chapter and the two which follow focus on foundlings and nurses in four case-study communities: Ackworth and Hemsworth in Yorkshire, and Chertsey and Epsom in Surrey. The aim of carrying out these detailed local studies is to examine more closely the experiences of life as a foster child, and as a nurse paid by the Foundling Hospital. The data from hospital registers are linked to those from local parish registers, situating the study of abandoned children in their local context and reconstructing the family situations of their nurses.1 The benefits of record linkage using different sources have been shown to good advantage since the technique was first explored in England in the 1950s.2 The linkage exercise reported in this and subsequent chapters is not nearly so extensive as those carried out by scholars such as Keith Wrightson, David Levine, Pamela Sharpe and Barry Reay.3 Nor does it represent a full family reconstitution as illustrated in the work of the Cambridge Group for the History of Population and Social Structure and others. However, it is not the aim here to investigate a ‘total history’, or a full demographic analysis of the chosen parishes. The sources are interrogated very specifically for the light they shed on experiences of wet nursing, health, infant and child mortality, and the relationships between the London Foundling Hospital and specific localities. As such, the findings owe a debt to the techniques of microhistory and family reconstitution and the clarity with which such studies have been presented.

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119

It is worth pausing here briefly to consider two of the aims of this and subsequent chapters. Firstly, how far is it ever possible to uncover real experiences for past populations? Secondly, how far can foundlings in a mercenary wet nursing relationship be regarded as ‘foster’ children, with all the modern connotations of integrated family life that that evokes? To answer the first point, we must certainly bear in mind the fact that in the absence of personal testimonies, we can only speculate on the lived experience implied by demographic data. The addition of extra sources of information, however (in this case, the nursing records), does help to flesh out the skeleton facts of family reconstitution. And where human behaviour and decisions underpin the results of a record linkage exercise, it is possible at least to speculate on why certain women nursed for the hospital, and how the experience was mediated through their family structures to offer some indication of what that might have been like. This elusive ‘lived experience’ is also crucial in determining the appropriateness of a term like ‘fostering’. A child who was taken in to a family purely for the wage that he or she represented, and who was treated very differently from the nurse’s own children, was clearly less a part of a foster family than one who was eventually apprenticed to the father figure in order to provide for a permanent relationship. Nonetheless, the term challenges the oft-cited picture of meagre standards of care provided by women nursing poor children, and at its broadest evokes simply a child growing up in a family which was not her or his own. The four case-studies used in this analysis were chosen with several aims in mind. The principal motivation was to select communities which received large numbers of foundlings. Secondly, the method of record linkage necessitated the survival of unbroken parish registers for the eighteenth century. Thirdly, geographically distant parishes were chosen in order to probe similarities and differences between communities at differing distances from London, situated in different socio-economic and epidemiological climates, and prompting differing logistical challenges for the Foundling Hospital. The evidence presented in Chapter 5 indicated that both Surrey and Yorkshire were large receiving areas for foundlings, and that there was a relationship between them whereby young children were sometimes moved from initial placements in Surrey parishes to communities in Yorkshire. Within Yorkshire, Ackworth and Hemsworth were the only parishes receiving large enough numbers of foundling children to make the study feasible, and both have extant parish registers. Another reason for selecting West Riding of Yorkshire parishes is the detailed nature of many of their parish registers for the later eighteenth century.4 The register for Ackworth is particularly

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Figure 6.1 Location of case-study parishes in Yorkshire

Leeds

Halifax Hemsworth

DERBYSHIRE

Ackworth Sheffield

Source: Boundary data supplied by UKBORDERS. Scales differ.

detailed from earlier in the century also, recording ages and causes of death, occupational data and the mother’s name at the burial and baptism of infants and children. Since the hospital’s records do not give the name of the nurses’ husbands, the recording of the mother’s or wife’s name in baptism and marriage registers is vital for the reconstruction of the nurses’ families. The Surrey parishes were also chosen for their popularity as receiving places for foundlings, and for the unbroken state of the parish registers. In both Surrey cases, however, the quality of the registers is less good, and links with nurses’ families are made with less confidence. The problems arising from these deficiencies are noted in greater detail below and in Chapter 8, which reports the results of partial family reconstitutions of all four parishes. Figures 6.1 and 6.2 show the location of both pairs of parishes, and Table 6.1 gives their populations and population densities in 1801. Ackworth and Hemsworth lie in the south of the West Riding, to the south and east of the better-studied industrial cloth-making belt which centred on Halifax, Leeds and Bradford. In the eighteenth century, both were largely agricultural parishes, although stone was quarried in

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121

Figure 6.2 Location of case-study parishes in Surrey MIDDLESEX Epsom

Chertsey

Source: Boundary data supplied by UKBORDERS. Scales differ.

Table 6.1 Populations and acreages of sample parishes, 1801 Population

Acreage

Population density/acre

1432

2 645

0.54

803

4 163

0.19

Chertsey

2819

10 777

0.26

Epsom

2404

4 424

0.54

Ackworth Hemsworth

Sources: Comparative account of the population; W. Page (ed.), The Victoria history of the county of Yorkshire, Vol. 3 (London, [1903], 1974) pp. 485–548; Malden (ed.), The Victoria history of the county of Surrey, Vol. 4, pp. 447–53.

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Ackworth. The latter parish was described in 1871 as ‘a large village, and one of the best in [the] district. Probably we have no other which shews more signs of prosperity than this.’5 Hemsworth remained agricultural in character throughout the Industrial Revolution and enclosure period.6 Later on, a coal mine was sunk there to access part of the Barnsley main seam, greatly affecting the socio-economic character of the village.7 In the mid-eighteenth century, however, Ackworth in particular was noted for its healthy air and general affluence, and was apparently known as the ‘garden of the West Riding’.8 Its healthiness, the presence of large numbers of wealthy, interested individuals and its proximity to the apprenticeship opportunities of the West Riding woollen industries were all given as reasons for setting up a branch of the hospital there in the 1750s.9 Both places were small in terms of population, and Hemsworth had a particularly low population density. This may be suggestive of a healthy, uncrowded environment, although it also suggests that it was probably hard to inspect if its residents were far-flung. The home parishes of the nurses who formed the two Yorkshire inspections show a fairly widespread network of contacts, spreading down to Sheffield in the south of the county. The foundlings placed in the West Riding may, therefore, not all have been brought up in healthy, rural environments. Sheffield was a rapidly industrialising town in the eighteenth century, and Dr Lee commented disapprovingly after the death of the Hemsworth inspector, Thomas Trant, in 1759, that the quality of some of his nurses in that part of the county was unimpressive, and that Sheffield itself was apparently ‘ye worst Town Children cd be sent to for want of Milk’.10 Epsom and Chertsey, in contrast, were larger communities, with significant ties to their surrounding areas. Chertsey lies at the northern tip of west Surrey, bordering Middlesex to the north-east. Epsom is situated more centrally in the county, but neither parish was far from the outer environs of London in the 1700s, and both were tied to metropolitan markets and traffic. Chertsey was a relatively large market town, especially large in acreage, while Epsom was a centre for middling-sort society, attracted by the waters and the racing season.11 Daniel Defoe noted that the principal employments in Chertsey were malting and river transport in the 1720s, and that many people lived off the common land.12 Frederic Morton Eden, the eighteenth-century commentator on the poor, described Epsom as containing no considerable manufactories, but stated that ‘there are artisans of almost every description, as the town is a sort of mart, or place of general resort, for many of the circumjacent villages’.13 Eden went on to note that there is ‘a want of constant and suitable employment for women and children’, which may have had an impact on the numbers of women who were willing to

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nurse for the Foundling Hospital.14 Epsom had the highest population density of the four parishes, although numbers were probably greatly swelled by visitors at certain times of year. Both places would have been subject to significant traffic in visitors and traders, and this may have affected the exchange of pathogens in the environment. It may also, however, have ensured a higher level of medical support. Defoe commented that nearby Dorking (also a large foundling nursery) was said to have the best air in England, and Epsom’s situation on Banstead Downs, together with ‘the salubrity of the air’, gave it a reputation for good health also.15 Again, the nurses centred on the two inspections were spread over a large area of neighbouring parishes. The larger amount of transient traffic in Epsom and Chertsey may have lent them a significantly different character from Ackworth and Hemsworth. The nature and strength of links to surrounding parishes would also have affected how dense the nursing community was, and how easily the nurses were supervised. We can only assume that hospital officials recorded the place of residence given by the nurse in the Inspections Books, and different nurses may have identified their homes with differing degrees of precision. Nonetheless, it may be instructive that 33 per cent of nurses from the Epsom inspection identified their home as Epsom itself, compared with 18 per cent of Chertsey nurses who actually lived in Chertsey, 18 per cent of Hemsworth nurses living in Hemsworth, and only 11 per cent of Ackworth nurses giving their place of residence as Ackworth. Other women gave the parish as their place of residence at least once, but also gave other parish names on other occasions. It does appear, however, that the Epsom inspection was more closely concentrated on the parish itself than the other three casestudy inspections. Almost as many women said they came from Walton or Egham as from Chertsey. Both Pontefract and Knottingley supplied almost as many nurses as Ackworth in that inspection, while Sheffield provided around half as many as lived in Hemsworth. In the three latter case-study parishes, therefore, women came from a wider area than the Epsom nurses, although those who did not live in the parishes themselves tended to come from very close by. This does not seem to be straightforwardly associated with the size or density of the parish; Chertsey was a larger parish than Epsom in area, while Ackworth had the same population density. The concentration of nurses may instead have been related to the alternative opportunities for female employment, to longer-standing traditions of wet nursing or to local parish support for large and needy families. We should also consider to what extent the women who nursed for the Foundling Hospital would have been captured in parish registers of baptisms, marriages and burials. Early modern English population

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history is most commonly based on these ecclesiastical registers, and historical demographers are quick to point out that they cannot claim to cover the whole population. The registers are from the Anglican church, although nonconformists did sometimes register their vital events there, too. Studies are also biased towards those who remained in one place and celebrated their marriages, had their children baptised and died in the place where their own baptism was registered. Migrants, illegitimates and the never-married escape easy quantification.16 Further, children who died before they were baptised are frequently omitted from baptismal registers, appearing in burial registers alone or leaving no mark at all. This is a particular problem when calculating infant mortality rates, as will be commented on further in Chapter 8. Women putting themselves forward to nurse for the hospital, however, were likely to be relatively stable residents in their parishes, since they evidently envisaged themselves being tied to the hospital’s administrative arrangements for up to five years. They were also almost always married women with children of their own, which made them likely to have registered vital events in the parish. The hospital never specified that nurses had to be Anglicans, and some may have migrated to their parish of residence after the birth of their children. Still, it seems likely that there is a high chance that women who nursed for the hospital will appear in parish registers. Table 6.2 indicates how many women nursed for the hospital in each parish, the number of children they cared for, and the resulting ratio of foundlings to nurses. Women who accepted children from other nurses, whether in the same parish or elsewhere, are included, although this occasionally means that the same child is double-counted. The figures show that although Chertsey was by far the largest of the four nurseries Table 6.2 Numbers of nurses and foundlings in four case-study parishes, 1741–64

Ackworth

N foundlings

N nurses

Ratio foundlings:nurse

481

283

1.7:1

Hemsworth

527

376

1.4:1

Chertsey

756

329

2.3:1

Epsom

458

185

2.5:1

2222

1173

1.9:1

Total

Sources: Inspections Books, LMA, FH/A10/1/1/1-2, and parish reconstitutions (for sources see text).

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Figure 6.3 Number of foundlings per nurse in four case-study parishes, 1741–64 300 250

N nurses

200 150 100 50 0 1

2

3

4

5

6

7

8

9

10

N foundlings per nurse Hemsworth

Ackworth

Chertsey

Epsom

Source: Inspections Books and parish reconstitutions.

in terms of foundlings, it did not provide the largest number of nurses. Chertsey nurses thus had a higher number of foundlings each, on average, than those in the Yorkshire parishes. The ratio of foundlings to nurses also confirms that the mean number of children cared for was approximately two, as suggested in Chapter 5, although it was lower in Hemsworth. These figures are illustrated graphically in Figure 6.3, which shows that the great majority of women took in only one or two foundlings. It is also clear that a larger proportion of nurses in Chertsey than elsewhere accepted three, four or five. Very few women nursed more than four or five children from the hospital, although one or two took up to ten. Reconstructing nurses’ families The principal questions to be addressed in this chapter concern the experiences of nurses and nurslings, and to investigate this further the individual circumstances of the nurses must be reconstructed. A partial family reconstitution was carried out for all four case-study parishes, which identified the composition of family units. The method is outlined

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and referenced in greater detail in Chapter 8. Foundling Hospital nurses were then traced to these families by creating links between their forename and surname in the Inspections Books and the marriage registers.17 As noted above, the absence of information on nurses’ husbands’ names introduced a certain amount of uncertainty into this process, especially where a nurse had a name which was common for the area. Each link was then verified according to whether the nurse could have been lactating at the time when any wet nursed foundlings arrived. Dry nurses were allowed more leeway in the timing of the births of their own children, since they did not need to be lactating when they received a foundling. Additionally, in order to minimise spurious links, only nurses who specified that they lived in the parish itself were included. Where there was any doubt over the veracity of a link, it was not made, although judgements were made on individual cases.18 The registers for surrounding parishes were also searched manually for further links with women who named those places as their parish of residence. This significantly raised the number of nurses whose families could be identified, especially for the Ackworth inspection.19 As is the case in any record linkage exercise, the accuracy of ties made between datasets is open to some degree of error. In most cases, however, there were few multiple links generated, given that most nurses had to have been lactating and were therefore recent mothers. In total, 152 nurses were linked to parish registers, accounting for 380 nursing relationships. Information on the nurse’s age, the number of children she had, the occupation of her husband and the age of the foundling children she nursed all gives us an insight into the nature and experience of the fostering relationship. What kinds of family environments did the foundlings find themselves in? Were they nursed alongside children of their own age? Were the nurses representative of all mothers in their parishes? How much variety of experience was there for the foundling children? Table 6.3 offers preliminary answers to some of these questions, giving the numbers of linked nurses and the foundlings they cared for in each case-study parish. Comparison with Table 6.2 indicates that the nurses linked to the reconstitutions took in a larger number of foundlings each than the larger case-study populations, especially in Hemsworth (2.3 foundlings per nurse compared with 1.4) and Epsom (3.6 compared with 2.5). This suggests that nurses identified via reconstitution were not entirely representative of their inspections. It is possible that nurses of the same name have been mistaken for one woman, apparently raising the number of foundlings she took in. It is also possible, however, that women who lived closest to the centre of the inspection did take

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Table 6.3 Numbers of linked nurses and foundlings in four casestudy parishes, 1741–64

Ackworth Hemsworth Chertsey

N foundlings

N linked nurses

Ratio foundlings: nurse

N children of nurses baptised

Ratio children: nurse

120

64

1.9:1

267

4.2:1

60

26

2.3:1

116

4.5:1

84

30

2.8:1

138

4.6:1

Epsom

116

32

3.6:1

122

3.8:1

Total

380

152

2.5:1

704

4.6:1

Source: Inspections Books and parish reconstitutions.

in more children than those who lived in further-flung parishes. The linked women were by default those from the largest centres of nurses, and especially the focal parish itself. They were, perhaps, most likely to be known to the inspectors, and could logistically more easily enter into repeat relationships with the hospital if one foundling charge died. Women who took in several foundlings may also have been among those most likely to stay in one parish and record their vital events there. The higher ratios are also affected by a few individuals who nursed very large numbers of foundlings, as noted above. Such women were exceptional, however, and in each case the modal value was one or two. Table 6.3 also indicates the mean number of children the nurses had baptised throughout the period: on average 4.6 per nurse. This is significantly higher than the number of live births baptised on average in the parishes as a whole. Among the wider populations of married women, the mean average number of baptisms recorded was only 2.6.20 Women who nursed for the hospital, therefore, had significantly larger families than their local peers. This raises several interesting suggestions. Firstly, it was perhaps easier for a larger family to absorb the time and effort involved in raising further infants than for a smaller one (especially since more settled women might have more extensive kinship networks to call on for support with childcare). Perhaps mothers with many children had few other options than mercenary wet nursing to earn money outside the household. Secondly, women who had borne several children may have judged themselves to be sufficiently capable carers to turn to paid nursing (although the experience of Jane Derby illustrated in Chapter 5 indicates that even trusted nurses might have very bad

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mortality experiences as far as their foundling charges were concerned). They may also have been among the better-nourished of their peers, which increased their ability both to carry their own infants to term and to breastfeed two babies concurrently. Thirdly, nurses may have married younger than was the norm, gaining more fertile years of marriage. This is shown below to be indeed the case on the basis of the limited evidence available. Finally, their large family sizes highlight the possibility that Foundling Hospital nurses might have been from the ‘overburdened with children’ mould so troublesome to poor law officials, and that they had a particular need to nurse for a wage. Chapter 8 will consider in greater detail whether nursing foundling children was a stigmatised occupation, but it seems likely that it was preferable both in terms of social standing and financial remuneration to nurse for a private family if there was a choice. Perhaps the hospital’s nurses were from the poorer ranks of the community? The socio-economic standing of the nurses is quite hard to ascertain. Even Ackworth’s detailed parish registers yield occupational data for only fourteen of the nurses’ husbands, and there is information for only one Hemsworth husband. Neither of the Surrey registers gives systematic occupational data. The information that we have is quite revealing, however. Among the fifteen Yorkshire nurses’ husbands, there were ten who worked as labourers, husbandmen or farmers. None of the husbands gave their occupation consistently as husbandman or farmer, however, implying that they worked their own land at certain times of the year only. This is suggestive of relatively low socio-economic status, whereby they worked for at least part of the time as waged labour. The remaining five occupations, however, were respectively those of joiner, parish clerk, schoolmaster, shoemaker and tailor. This is indicative of higher social status, with employment based on skilled crafts and professions. These men may have been anomalous for the group; other studies of women who nursed for the hospital, for the parish or for private families, have revealed that they were generally the wives of agricultural labourers and artisans.21 Valerie Fildes and Dorothy McLaren also found evidence of a broader spectrum of occupations, however, suggesting that nurses’ families were not necessarily poor and living in poor conditions.22 This variation may also have been true for the nurses in Surrey and Yorkshire. Inspectors did occasionally mention poverty: Thomas Trant wrote of ‘the Sluttishness, or Poverty of the Nurses’ in response to complaints about the Hemsworth children’s clothing.23 Another inspector’s description of the ‘filthiness & indigence’ of the nurses under his care also paints a less than salubrious picture.24 The hospital stipulated that nurses (or more properly, their husbands) might not be

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in receipt of poor relief, however, so we may assume that they were not in a state of extreme indigence at the time when they were selling their milk. Whether the nursing wage was all that was keeping them off relief was another matter, to which we will return.25 Another indicator of socio-economic status is the women’s ability to sign their names. Although the marriage registers frequently recorded whether the parties signed or marked the marriage certificate, this information was available for only a tiny proportion of nurses. Of a total of eleven such women, only three signed, while the others made a mark. Among a sample of 304 nurses’ ‘duplicates’ (certificates made out when a nurse received a child) from 1759, 30 women signed rather than marked (10 per cent).26 Despite the problems of assuming literacy from the ability to sign, it seems clear that the women who nursed for the hospital were not particularly well educated.27 In Epsom, 53 per cent of brides signed the marriage register, and in Ackworth the percentage was 48. Dr Lee of Ackworth noted in January 1759 that he could ‘get no receipts or at least but very few from the Nurses, as not one in 20 can write’.28 The evidence suggests that the hospital’s nurses were not of particularly high social standing although there were exceptions. The discussion of poverty may be related to the age and life-cycle status of the nurse and her family. Information on the age of the nurse, or in the absence of that the time elapsing between her marriage and the fostering of her first (or only) foundling, reveals a wide variety in circumstances. The Ackworth marriage and burial registers give ages for seven nurses, who married at between 19 and 36 years of age. These seven women were between 31 and 63 when they took their first (or only) foundling, which shows that they nursed for the hospital at different stages in their life-cycles. For those without age information, the time elapsing since the marriage date gives an impression of age. Ackworth women started fostering foundlings a mean average of 13 years after their marriage, which implies that they had already borne several children of their own.29 The mean average age at marriage in both Ackworth and Hemsworth was just over 30, so this would have made them around 43 when they started nursing for the hospital. Hemsworth women had been married for a mean average of 11 years when they started fostering foundlings, which suggests that they were also in their early forties. Nurses in Epsom and Chertsey had been married for a shorter time when they began nursing for the hospital: in both cases, the mean average period was 5.5 years. The Surrey nurses were clearly taking in nursechildren at a much earlier stage in their life-cycle. In these parishes the mean age at marriage was lower, at 27 in Chertsey and 26 in Epsom,

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putting nurses there in their early thirties when they began fostering. Nurses’ recommendation certificates from the 1760s and 1770s show a mean age of 29.6 years for potential wet nurses, although the range spanned 20 to 41, and 34.2 years for dry nurses (range 22 to 50). This conforms to the picture seen for the Surrey parishes for the 1750s.30 As noted above, there is also some evidence to suggest that women who became nurses married at below average ages, which would have brought down the age at which they began nursing. Very few nurses could be linked to their own baptism, but in three out of four parishes those that could were an average of 5 or 6 years below the mean age at marriage. The total number of women who could be linked to a baptism was only 13, however, so we should be very cautious about placing too much weight on this feature of nurses’ demographic behaviour. The disparity in nurses’ ages is linked to the different use made of the four communities by the hospital. While the Surrey parishes and Hemsworth received large numbers of foundling infants on their first placement from the hospital, the Ackworth nursery developed along different lines. Only 111 infants were sent to Ackworth on their first placement from the hospital, but a further 405 were sent on later from other nurseries, mainly in the south-east. The foundlings nursed in Ackworth were, therefore, significantly older than those sent to the Surrey parishes, and were almost all beyond the age of weaning. They could thus be fostered by women who were above the age of child-bearing themselves. The Hemsworth children whose nurses were linked to the family reconstitution were all sent to Yorkshire within a month of entry to the hospital, but their nurses still tended to be older on average than those in Surrey. We can only speculate that this was due to personal preferences, and to the state of alternative female employments. Where there were few alternatives for young women with children to earn money, as there appear to have been in parts of Surrey, nursing may have been one of few options open to them. Table 6.4 gives a breakdown of the time elapsing between abandonment and a foundling’s placement with a nurse in the four communities. A very high proportion of Hemsworth foundlings (41 per cent) were sent to their nurses on the day when they entered the hospital, reflecting again the high level of organisation with regard to the Yorkshire parishes. The lengthy journey meant that the infants would not have arrived at the nurses’ homes for up to a further week, but they were cared for by their own nurses on the journey, which may have minimised the risks to survival. In Chertsey and Epsom, less than 20 per cent of foundlings were sent out to nurses on the day of abandonment, despite their greater proximity to the hospital. A further 50 per cent of

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Table 6.4 Time elapsing between abandonment and placement with nurses in four case-study parishes, 1741–64 (percentage of total)

Ackworth Hemsworth

Day 0

Day 1

Days 2–7

5.0

8.3

2.5

41.1

25.0

25.0

Chertsey

16.9

24.1

44.6

Epsom

19.8

20.7

48.3

0–1 year

1–2 years

2–3 years

3–4 years

4–5 years

5 years+

Total number of foundlings

17.5

10.8

17.5

3.3

10.8

40.0

120

100.0

0.0

0.0

0.0

0.0

0.0

56

97.6

1.2

1.2

0.0

0.0

0.0

83

100.0

0.0

0.0

0.0

0.0

0.0

116

Ackworth Hemsworth Chertsey Epsom

Note: The total is the number of children whose nurses could be linked to a reconstitution, and who had a plausible date of nursing (a handful of children had dates of placement which pre-dated their abandonment). Source: Inspections Books.

Hemsworth foundlings were placed with nurses within the next few days, such that 91 per cent of the total had been sent out within a week of abandonment. In Chertsey the percentage was 86, and in Epsom 89. In all three inspections, foundlings arrived within a short time of their abandonment, and only a tiny proportion of placements were of older infants (none in Epsom and Hemsworth). In Ackworth, in contrast, less than a fifth of placements with linked nurses occurred within a week of abandonment, and less than a quarter within a year of being left at the hospital. In that inspection, the majority of placements were of older children, of whom 40 per cent were over the age of five. These foundlings were probably placed in the short term with nurses before being taken in to the Ackworth branch of the hospital. The age distribution of the foundling children resulted in a different pattern of nursing, with Ackworth offering a rare opportunity for older, non-lactating women to earn money as nurses. If we examine individual child-bearing histories, we find a wide variety of circumstances among the nurses linked to family reconstitutions.

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In all four parishes, the majority of foundlings were placed in families with infants or children of similar ages to themselves (between 50 and 80 per cent of all placements in the four communities). In Hemsworth, Epsom and Chertsey this generally meant households containing babies and small children; in Ackworth it might mean older children since the foundlings themselves were often older. In all cases, however, the large size of some of the nurses’ families meant that there might be a wide range in the ages of the other children present. The foundling might be among the oldest or the youngest or anywhere in between, perhaps reflecting the need to supplement the household’s income at different stages in its development. In Ackworth, as might be expected from the age profile of the foundling children, a greater proportion of placements were in houses where the nurse’s own children were grown up, or perhaps where she had no children (or at least, none recorded in the registers). Ten Ackworth nurses (16 per cent) had grown-up children when they started nursing for the hospital, and a further eight (13 per cent) had none recorded. An example of an older nurse is ‘Widow Ellis’, probably Elizabeth Ellis, married in Ackworth in 1715 and widowed in 1760. She and her husband had baptised six children in the parish between 1715 and 1729. Two died within a year, but the rest seem to have survived childhood. She fostered four foundlings aged between five and six on the same day in May 1763, three years after the death of her husband and 34 years after the birth of her own youngest child. Elizabeth herself died in 1765, so the foundlings can only have been with her for a relatively short period before being taken into the Ackworth branch hospital. Anne Hattersley was also an Ackworth widow when she accepted one twoyear-old foundling in 1756, at the age of 56. She had married in 1732, and registered four baptisms in the parish between 1733 and 1742. Her husband, Robert, had died in 1745 of fever, at the age of 44, and caring for a foundling may have been a way of earning her living as a widow once her children were grown up. More usual was the experience of Margaret Collier of Chertsey, introduced in Chapter 5, who became a nurse for the hospital early in her child-bearing career. Margaret had her first child baptised in April 1756, and accepted her first infant foundling for wet nursing in January 1757. She may have weaned her own child already, and he was certainly past early infancy. A second foundling arrived in March 1757, and the two were presumably breastfed concurrently. Margaret’s second child was baptised in October 1758, and she went on to register four more in the parish. Wet nursing seems to have represented a way to earn money after the birth of her first child, after which she continued with her

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family. Of the foundling children, one died in May 1758, and the other left in July 1759. In fact, four of Margaret’s six children were born after her relationship with the hospital ended. Jane Derby, whom we also met earlier on, also took her foundling infants in alongside her own infant children, but did not space them out in the way that Margaret did. Jane in fact had only two children of her own, despite the large number of foundlings she fostered. John’s baptism preceded the arrival of her first foundling, but only by two months, indicating that she started selling her milk soon after his birth, and may still have been breastfeeding him. There was then a rapid turnover of three foundlings, the last dying only four months before the baptism of Jane’s second child, also called Jane. She was thus likely to have been lactating almost constantly throughout, making it fairly remarkable that she conceived a second child.31 It was, however, most common to take in a foundling later in the child-bearing process, when there were several young children in the household. This may have been the point at which supplementary income was most needed, in order to meet the expenses of the growing family. Faith Cheesbrough, of the Hemsworth inspection, for example, who registered her marriage and the baptisms of her children in the nearby parish of Kippax, baptised eight babies between 1745 and 1763. She received one infant foundling between the fifth and sixth children, having produced her offspring at fairly regular intervals throughout the period of child-bearing. Martha Dyson of Ackworth also fostered two foundlings at the end of her child-bearing career, but while her last child was still young. She did not celebrate her marriage in the Ackworth church, but had nine children baptised there between April 1739 and October 1757. She then took in two young children to nurse, in 1759 and 1761. Although neither was wet nursed, she still seems to have preferred to space the children out. Martha’s child-bearing and nursing career spanned a long period; by 1761 her oldest child was over twenty, but the youngest were four, six and nine, and she had two foundling charges who were three and a half and a one and a half respectively. Foundling infants clearly found themselves placed in a variety of household circumstances, alongside other infants, with older children, or alone. Once again, the nature of the bond formed with the nurse and her family would have had a large impact on the experiences of the foundling and the nurse’s own children, and this is something on which we can really only speculate. Evidence of poor care, reported in the next chapter, indicates that the nursing relationship was not always a happy one, but the fact that many nurses asked to keep their foundling

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children suggests that they were regarded as part of the family and as a sibling to their own offspring.32 Apart from its immunological and nutritional benefits, breastfeeding also creates an emotional bond between mother and child which may in itself increase survival chances for the infant.33 Many of the nurses evidently did form loving bonds with their foster children. Dr Lee wrote to the hospital in 1760 of two girls removed from their nurses because they had reached the age to return to the hospital, ‘but strange the Infatuation, the Nurses who had them are miserable without them altho they have Children of their own’.34 In 1761, he described a caravan journey to Yorkshire, during which the children ‘for 3 days & 2 nights never ceas’d crying for their mammys as they call their Nurses’.35 Nathaniel Edwards similarly wrote from Weybridge in June 1759 of a nurse who wished to have her foundling child back, for ‘it woud almost break her heart to part from it’.36 When, in February 1741/42, the hospital ordered the return of the first foundlings, their nurses were so reluctant to part with them that the order was postponed.37 The trauma of the eventual separations must have been great. John Brownlow, a nineteenth-century secretary of the hospital and a foundling himself, evokes something of this distress in his fictional account of a hospital foundling’s departure from his nurse: [he cried] heartily at the change of his situation from the affectionate charge of a woman who had learnt to love him as her own, to the cold discipline of a public establishment.38

The evidence presented above also suggests some possible motivations for becoming a nurse for the hospital. The example of older women and widows fostering children may indicate that the wage represented a vital way of achieving self-sufficiency without having to turn to the poor law. Poor law accounts show that the elderly, and especially elderly women, formed a very large proportion of relief recipients, and the possibility of nursing for the hospital may have been a significant alternative.39 The nursing wage of 2s 6d per week is comparable to poor law relief allowances late in the eighteenth century.40 It is not absolutely clear whether older children in Ackworth attracted the same wage; nurses of older foundlings in Shrewsbury were paid only 2s per week. Unfortunately, a sample of nurses’ duplicates for Yorkshire nurses did not have any information on the level of the wage.41 Nonetheless, the wage was significant and regular while the child lived. Nursing for the hospital may have allowed women who might otherwise have had to ask for assistance to remain financially independent. Steven King has characterised the north-west of England, including the West Riding, as having a ‘ramshackle and ultimately parsimonious’ attitude to relief

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payments, with a strong emphasis on self-reliance.42 This may also have affected the willingness of older women to act as nurses, making the opportunity all the more significant in this geographical area. It is known that pauper women often acted as carers for other paupers, including children.43 The possibility that older women used the opportunity of caring for children privately as a means of preventing recourse to the poor law has not previously been commented on. Of course, the hospital could not offer this opportunity as an ongoing option, since the end of the General Reception effectively curtailed the supply of children. Further, not all of the older nurses were poor. One inspector suggested that dry nurses were preferable to wet partly because they were often older ‘& often take children for amusement & not entirely for the pay’.44 Nonetheless, nursing may have played a not insignificant part in the economy of makeshifts of older women in this parish. The wage of 2s 6d (reduced after the General Reception to 2s) would have been a substantial addition to the household economy. Several eighteenth-century commentators give examples of wages in agriculture with which the nursing wage can be compared. All concur that a male labourer might earn between 9s and 12s per week without board (based on six days’ work per week), depending on the season.45 A woman nursing one infant for the hospital might therefore provide an additional 25 per cent of the household income in money terms, and much more if she nursed more than one concurrently. She would have earned more than the wage for one child if she worked in agriculture herself: between 3s and 5s per week, depending on the season.46 This work would have removed her from the house for long periods, however, and nursing may have been preferable for the sake of her own children, especially if she had a breastfeeding infant herself. While not as remunerative as other employments, therefore, nursing might be of significant value to growing families or single women, and had the further advantage of not being seasonally specific. It seems to have been better rewarded in England than in other countries: women who nursed for the Dublin Foundling Hospital received £2–3 per year, compared with £6 10s for the London hospital, while women in parts of France were moved to demonstrate about the falling real value or even cessation of the nursing wage towards the end of the century.47 Nurses do seem to have had a minimum threshold below which nursing was not seen as remunerative, however. In 1765, Dr Lee wrote to the hospital that many nurses gave up their foundling children when their wages were reduced to 1s 9d per week ‘wch as Times go on (considering ye Price of Corn &) is too little’.48 Alternative employments also depended on demand, however: in Epsom, we have seen that there were few alternatives, while

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work in agriculture may have been less accessible for women who lived in towns like either Epsom or Chertsey.49 Dr Lee’s statement on the nursing wage suggests a significant degree of conscious decision-making regarding female employment, which is not usually commented on. The general absence of attention to the wet nursing market in England has also led to neglect of the possibility that women used their ability to nurse and care for children as a means of accessing what might be a vital money wage within a regulated and formal employment framework. For younger women like Margaret Collier and Jane Derby, the birth of their first child represented an entry into this market of paid labour. Other women took in foundling infants later in their child-bearing career, which may have coincided with the period when the household was most in need of extra income. Women may also have hoped that wet nursing would act as a contraceptive, spacing out their own infants or preventing them from having more altogether. Dorothy McLaren has highlighted evidence of the contraceptive impact of wet nursing for late seventeenth-century Chesham, Buckinghamshire.50 She found that taking a nurse-child doubled the interval between the two children on either side, providing that the nurse-child itself survived. The death of the nursling effectively ended this protection, reducing the interval between children. A similar pattern is found in the current dataset, although the data suggest that the impact of wet nursing was not necessarily so straightforward in this case. The birth intervals between the nurse’s first and second children and second and third children were calculated in all cases where there was more than one child baptised and where no child died during the interval. Only the nurse’s first three children were included in the analysis, in an attempt to provide some cap on the age of the mothers; older mothers tend to have longer birth intervals, which might skew the results. Sometimes more than one foundling was taken in during a birth interval, but since the infants generally arrived in close succession and so did not result in a significantly lengthier period of nursing, these cases are not distinguished. The exercise is a crude one, but is necessarily so, given the complexity of fertility calculations and the fact that the data were not collected for this purpose. Table 6.5 sets out the results of this investigation, distinguishing between cases where a wet nursed foundling was taken in during the birth interval and where it was not. Ackworth nurses were not included in the analysis, given the small number of wet nursed foundlings there, and all three remaining parishes were aggregated in order to maximise the data available. As the table indicates, the arrival of a foundling did indeed coincide with a lengthier birth interval, by a factor of approximately

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Table 6.5 Birth intervals (in months) between nurses’ children with foundlings present, and without, case-study parishes Birth interval: no foundling present

Birth interval: foundling present

Between child 1 and 2

Between child 2 and 3

Between child 1 and 2

Between child 2 and 3

Months

30.3

29.0

49.7

55.7

N

46

33

13

20

Source: Parish reconstitutions.

two. The interval between the first and second births was 30.3 months (two and a half years) when there was no foundling taken in, and 49.7 months (over four years) when there was. Similarly, the intervals between the second and third children were 29 months with no foundling present, and 55.7 with a nursling. The intervals where no foundling was present are similar to those found in Wrigley et al.’s study of reconstituted English parishes.51 The concurrence is a reassuring indicator that the nursing data are not significantly unrepresentative of wider trends. This appears to be convincing support for the now commonly accepted thesis that breastfeeding has a significant contraceptive effect. What is slightly unsatisfactory about the current results is the fact that some nurses seem to have had lengthy birth intervals which pre-dated the arrival of a foundling, or which continued to be lengthy after the foundling had died or was beyond the age of weaning. For example, Margaret Cannon of Chertsey had four children baptised between November 1747 and February 1767. She had a space of ten years between the second and third children, during which time she took in three foundlings. All three arrived in 1757, however, and so it is unlikely that she was nursing them much beyond mid-1758. Unless she went on to nurse privately, we cannot assume that the lengthy intergenesic intervals in her family were entirely due to nursing foundling children. While the data do provide convincing evidence that nursing a foundling infant lengthened the amenorrhoearic period, we should be cautious in assuming that the entire effect seen in Table 6.5 was due to the impact of nursing. As will be shown in Chapter 8, there is very little evidence of private nursing in the four parishes, but we cannot rule out the possibility that some of the nurses were taking in other infants as well as foundlings.

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Another question which can be asked of the nursing data is whether taking in a foundling had an impact on the mortality of the nurses’ own children. Again, this is a difficult factor to quantify, and it is especially difficult to establish cause and effect. A simple count of the proportion of the nurses’ children who died within a year of their baptism suggests that nursing a foundling did not coincide with high mortality. In the Chertsey inspection, 12 out of 138 infants died; in Epsom, 9 out of 115; in Hemsworth, 7 out of 116; and in Ackworth, a larger proportion, 22 of 133.52 These figures roughly translate to 87.0, 78.3, 60.3 and 165.4 deaths per thousand live births, which are, generally speaking, low rates compared with wider figures on infant mortality.53 Deficiencies in the registers prevent us from drawing too many firm conclusions on the accuracy of these mortality rates, and the fact that the calculation includes children who were born before the foundlings appeared means that we should not take the exercise too far. It does, however, appear that the nurses did not suffer unduly high levels of mortality among their own children, which reinforces McLaren’s suggestion that the wives of tradesmen and labourers had comparatively low infant mortality.54 Few nurses had individually higher rates: in Epsom, no nurse lost more than two children, and in Chertsey, no more than three. It does not seem, therefore, that mortality figures were skewed by high mortality in particular families. As noted at the outset, the nature of the data used in this chapter allows only speculation regarding experiences, but demographic behaviour may shed light on certain socio-cultural and medical beliefs and practices. For example, the medical literature suggests that contemporaries believed that sexual relations while the wife was breastfeeding would spoil her milk. This was sometimes given as a reason for putting infants out to wet nurses among higher-class families.55 The nursing and parish registers show clearly that nurses did not conform to this behaviour, since they were evidently sometimes pregnant while nursing. This suggests that the belief did not apply as forcefully outside wealthy circles, and may not have been thought to have been so important with regard to a nurse-child. Clearly the hospital did not try to enforce any such stipulation, either. The Chertsey inspector Nathaniel Edwards wrote to the hospital in August 1759 with no indication of distaste that: There are several Nurses yt have had Children from ye Hospital yt are now ready soon to lay in & as they have done justice by those they have had, they’ll think it hard to be refus’d my Recommendation . . .56

The idea that a woman might nurse a child while pregnant and take on another after the birth of the child apparently caused the hospital governors little alarm.

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Nurses do not seem to have felt that nursing a foundling alongside their own child would harm their baby either, although economic necessity might have overcome any such fears. The hospital’s General Committee passed a resolution early on that no wet nurses were to be taken on whose children could not be provided for.57 It is debatable whether they were thinking of infants having to share their mother’s milk, or whether this related to older children who might be neglected. We have seen that some nurses did not start selling their milk until their child was several months old, and this may have been an attempt to protect it. Alternatively, they may have been unable to afford the increased calorific intake needed to breastfeed two infants concurrently. Others, however, took in nurslings very soon after the birth of their own child, suggesting that they did not see this as an issue. Finally, the data shed light on the question of the qualities of the nurses’ milk. The hospital did debate the suitability of women who nursed for the hospital, and as will be discussed further in Chapter 7, toyed at times with the idea of feeding the children by hand to avoid the ills of unsuitable nurses. They never articulated the idea that the foundlings might imbibe the bad qualities of their nurses, however, which was also a common belief, and was a reason commonly put forward against the use of animal milks. On a more practical level, medical tracts frequently expressed a preference for young milk rather than old as being better for the child.58 Again, this is a belief which the hospital seems not to have courted, although the General Committee did note in October 1741 that one of the Staines inspectors was to be asked whether any of the nurses returning children had young enough milk to take another.59 The record linkage exercise has thus been valuable on several levels. It has highlighted the types of family situations the foundlings were placed in, and shown that nursing represented a valuable cash addition to a family’s income. This seems to have been especially true for growing families, and, where older children were available to nurse, for widows, perhaps enabling them to remain self-sufficient for a longer period of time. Women who nursed for the hospital seem to have been among the most fertile of their communities, perhaps because they married at younger ages or were better nourished. Their economic situations may have varied, but their general inability to sign documents suggests that they were not particularly well educated. The investigation has also shown that the nursing communities in different counties did have distinguishing features. Although Yorkshire was less accessible from London than Surrey, the hospital’s caravans ensured a rapid turnover of infants from abandonment to placement with a nurse. The hospital also seems to have regarded the Yorkshire nurseries as healthier, and removed young children from nurses in the south-east in favour of Ackworth. This

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accounts for the different age profile of the foundling children in that nursery, and in turn it raised the possibility of employing older nurses. The willingness of women to work for the hospital may also have rested on alternative employment avenues, and on the attitudes of poor law officials. Parish registers have also given some insight into ideas and practices surrounding nursing. In the next chapter, we consider how these and other sources can be interrogated to examine the health of the foundling children in greater detail. Notes 1 Microfilmed copies of the Ackworth registers are held at the Society of Genealogists in London; those for Hemsworth are at the West Yorkshire Archive Service at Wakefield. The Epsom and Chertsey registers are held at the Surrey History Centre in Woking. 2 See, for an early example, W. G. Hoskins, The Midland peasant: the economic and social history of a Leicestershire village (London, 1957). On the development of microhistorical approaches in Italy, Germany and England, see R. M Thompson, ‘Economic and social change in a Somerset village, 1700–1851: a microhistory’ (unpublished PhD thesis, University of Cambridge, 2004), pp. 1–5. 3 D. Levine and K. Wrightson, The making of an industrial society, 1560– 1765 (Oxford, 1991); K. Wrightson and D. Levine, Poverty and piety in an English village: Terling, 1525–1700 (New York, San Francisco and London, 1979); A. Macfarlane, Reconstructing historical communities (Cambridge, 1977); D. Levine, Family formation in an age of nascent capitalism (New York, San Francisco and London, 1977); P. Sharpe, Population and society in an east Devon parish: reproducing Colyton, 1540–1840 (Exeter, 2002); B. Reay, Microhistories: demography, society and culture in rural England, 1800–1930 (Cambridge, 1996). 4 See R. A. Bellingham, ‘The Dade parish registers’, Family History: News and Digest, 10:2 (1995), pp. 76–9; Bellingham, ‘Dade parish registers’, Local Population Studies, 73 (2004), pp. 51–60. Also see Chapter 8. 5 W. S. Banks, Walks in Yorkshire: Wakefield and neighbourhood (London, 1871), p. 287. 6 J. A. Bulley, Hemsworth in history (1959 pamphlet, place of publication unknown), p. 5. 7 Ibid., p. 6. 8 J. L. Saywell, The parochial history of Ackworth, Yorkshire (London and Pontefract, 1894), p. 1. 9 H. Thompson, A history of Ackworth School during the first hundred years (Ackworth and London, 1879), p. 1. Saywell (The parochial history, p. 8) also speculated that the healthy air was an attraction for the Foundling Hospital governors. 10 Correspondence, 14 January 1759, LMA, A/FH/A06/1/12/11/94.

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11 Defoe, A tour through the whole island, Vol. 1, p. 157. The gentry took the waters at Tunbridge Wells. 12 Ibid., Vol. 1, pp. 144–5. 13 F. M. Eden, The state of the poor (3 vols, London, [1797], 1966), Vol. 1, p. 693. 14 Ibid., Vol. 1, p. 704. 15 Defoe, A tour through the whole island, Vol. 1, p. 152; S. Lewis, A topographical dictionary of England (4 vols, 4th edition, London, 1840), Vol. 2, p. 161. 16 This early problem has subsequently begun to be addressed, linking illegitimate children and the never-married to family reconstitutions. See, for example, P. M. Kitson, ‘Family formation, male occupation and the nature of parochial registration in England, c.1538–1837’ (unpublished PhD thesis, University of Cambridge, 2005); C. Jones, ‘Those whom God hath not joined: a study of never-married people in England and Wales in the nineteenth century’ (unpublished PhD thesis, University of Essex, 2004). 17 All names were standardised to overcome differences in spelling. The record linkage exercise was carried out using MS Access. Dummy marriages were created where children were baptised but no marriage was recorded in the parish, in accordance with reconstitution rules. See E. A. Wrigley, ‘Family reconstitution’, in D. E. C. Eversley, P. Laslett and E. A. Wrigley (eds), An introduction to English historical demography from the sixteenth to the nineteenth century (London, 1966), pp. 96–159. 18 For example, an exception was made for a nurse called Mary Berryman in Chertsey, who took in 13 children in this period. Two Mary Berrymans who were bearing children at the appropriate time were identified in the Chertsey family reconstitution. Given the very high number of foundlings involved, it was judged that both women acted as nurses, and the children were assigned randomly between them. Although the number assigned to each woman may not be correct, this method had the advantage of retaining them both in the dataset. 19 This trawling exercise raised the number of linked nurses from 34 to 64 for the Ackworth inspection. Other registers searched were those of Featherstone, Kippax, Silkstone, South Kirkby, Pontefract and Knottingley in the West Riding (all held at the West Yorkshire Archive Service in Wakefield), and Egham, Ewell, Walton on Thames and Woking in Surrey (held at the Surrey History Centre in Woking). 20 2.6 in Ackworth, 2.9 in Hemsworth, 2.9 in Chertsey and 2.1 in Epsom. These figures are not strictly comparable to completed family sizes (which are generally larger), as they do not take into account the number of possible child-bearing years per woman. Women having no children baptised are not included in these calculations. 21 Fildes, ‘The English wet nurse’, p. 151; Newall, ‘Wet nursing’; G. Clark, ‘A study of nurse children, 1550–1750’, Local Population Studies, 39 (1987), pp. 8–23.

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22 V. Fildes, ‘The wet nurses of the London Foundling Hospital, 1756–67’ (unpublished paper, 1988, library of the Cambridge Group for the History of Population and Social Structure); McLaren, ‘Nature’s contraceptive’, p. 433. 23 Correspondence, 15 January 1757, LMA, A/FH/A06/1/10/19. 24 Correspondence, 12 March 1765, LMA, A/FH/M01/002/137-8. 25 It would be interesting to link the nurses and their families to poor law records, to see whether they did subsequently appear on the relief rolls. Unfortunately, this exercise is beyond the scope of the current study, especially given the problems inherent in identifying older women named only as ‘Widow x’, and the large proportion of the elderly whom we would expect to end up supported by relief in any case. Poor law records also do not appear to have survived for Ackworth or Epsom. 26 Nurses’ duplicates, LMA, A/FH/A10/1/5–8, 1759. Fildes finds similarly low levels of literacy among a group of Hertfordshire nurses (Wet nursing, p. 176). 27 On literacy and signing, see Reay, Microhistories, pp. 213–35 and references. 28 Correspondence, 22 January 1759, LMA, A/FH/A06/1/12/11/96. 29 The calculation of time since marriage is affected slightly by the fact that some marriages are ‘dummy’ ones, set at the date of the first baptism in the absence of a recorded marriage in the parish. 30 Nurses’ certificates, LMA, A/FH/A6/9/1-12. 31 Jane may have been supplementing her milk with dry food, since the intensity of breastfeeding plays a part in post-partum amenorrhoea as well as its length (Wrigley et al., English population history, p. 434). 32 Initial work by the current author suggests that approximately 5.5 per cent of all foundling apprenticeships were to the nurse’s husband or someone else of the same name in the same place. 33 S. L. Huffman and B. B. Camphere, ‘Breastfeeding performance and child survival’, Child survival: strategies for research, supplement to Population and Development Review, 10 (1984), pp. 93–4; Fildes, Breasts, bottles and babies, p. 90. Perry states that this was not yet commented on in the eighteenth century, however (Perry, ‘Colonizing the breast’, p. 221). 34 Correspondence, 7 June 1760, LMA, A/FH/M01/3/68. 35 Correspondence, 30 May 1761, LMA, A/FH/A06/1/14/10/41. 36 Correspondence, 26 June 1759, LMA, A/FH/A06/1/12/5/22. 37 General Committee minutes, 16 February 1741/42. In March 1755, the committee resolved that children should not be returned until the age of five (General Committee minutes, 5 March 1755, LMA, A/FH/K02/1-18). 38 J. Brownlow, Hans Sloane: a tale illustrating the history of the Foundling Hospital in London (London, 1831), pp. 97–8. 39 M. Fissell, ‘ “The sick and drooping poor” in eighteenth-century Bristol and its region’, Social History of Medicine, 2:1 (1989) pp. 40–1; W. Newman Brown, ‘The receipt of poor relief and family situation: Aldenham, Hertfordshire, 1630–90’, in R. M. Smith (ed.), Land, kinship and life-cycle

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40

41

42 43

44 45

46

47 48 49

50

51

52 53

143

(paperback edition, Cambridge, 2002), p. 412; Hollen Lees, Solidarities of strangers, p. 52. Steven King cites poor relief payments of 2–3s per week in the south and east, and less in the north at the end of the eighteenth century (S. King, Poverty and welfare in England, 1700–1850: a regional perspective (Manchester, 2000), p. 57). Other benefits may have been in kind. Parish nurses were apparently paid 1s 6d per week (Fildes, Breasts, bottles and babies, p. 282). All the Shropshire nurses in the sample of 305 receipts (‘duplicates’) between May and August 1759 recorded pay of 2s per week, and all the children involved were over the age of one. A child of a similar age sent to a nurse in Middlesex, however, brought a wage of 2s 6d, which suggests that it was the location, not the age of the foundling, which dictated the level of pay. In this case, the Ackworth women may have been paid at the standard rate. King, Poverty and welfare, pp. 62–3. See, for example, Sharpe, Population and society, p. 231; S. Williams, ‘Poor relief, welfare and medical provision in Bedfordshire: the social, economic and demographic context c. 1770–1834’ (unpublished PhD thesis, University of Cambridge, 1998), pp. 43–6 and 216–27. Correspondence, 27 September 1758, LMA, A/FH/A06/1/11/8. A. Young, A six months tour through the north of England (4 vols, London, 1770), Vol 3, pp. 114, 121, 136; Eden, The state of the poor, Vol. 1, pp. 574, pp. 693–4; W. Marshall, The rural economy of Yorkshire (2 vols, London, 1788), Vol. 2, p. 300; Page (ed.), Victoria history of the county of Middlesex, Vol. 2, p. 106. Wages were higher in the south, but fell within the same bracket. Eden, The state of the poor, Vol. 1, p. 574; Marshall, The rural economy, Vol. 2, p. 300; Page (ed.), Victoria history of the county of Middlesex, Vol. 2, p. 106. Fildes, Wet nursing, pp. 151, 155. Correspondence, 23 May 1765, LMA, A/FH/A06/1/18/11/14. Peter Earle notes that where there were alternative opportunities for women, wet nursing is rarely found to have thrived as an industry (Earle, A city full of people, pp. 135–6). McLaren, ‘Nature’s contraceptive’, p. 432; McLaren, ‘Marital fertility and lactation’, pp. 33–43. Julie Marfany has also found this effect in a Catalan community in the eighteenth century (‘Industrialisation and demographic change in Catalonia, 1680–1829’ (unpublished PhD thesis, University of Cambridge, 2003), pp. 213–20). Wrigley et al., English population history, p. 447 (table 7.36), give intervals of 30.85 months for all intervals except parity 0 (first child) for the years 1750–79, where the first child of the pair survived. This figure includes only those children brought for baptism by women living in Ackworth itself. The figures roughly approximate to a ‘rate’ per thousand, since the nurses evidently remained in residence in the parish. Some uncertainty must

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54 55

56 57 58

59

Childcare, health and mortality surround whether they had all their children baptised there, and whether there were any unrecorded miscarriages, stillbirths or deaths before baptism. McLaren, ‘Fertility, infant mortality, and breast feeding’, p. 381. Fildes notes that this belief existed from antiquity onwards, and that writings on theory and practice changed little generally up to the midnineteenth century (Wet nursing, pp. 8, 25). See also R. Trumbach, The rise of the egalitarian family: aristocratic kinship and domestic relations in seventeenth-century England (New York and London, 1978), p. 199. Correspondence, 8 August 1759, LMA, A/FH/A06/1/12/5/25. Fildes also notes that nurses breastfed foundlings while pregnant (Wet nursing, p. 183). General Committee minutes, 7 March 1740/41. The governors may also have been thinking of internal wet nurses. For example, J. Nelson, An essay on the government of children (London, 1756), pp. 65–6; W. Cadogan, Essay upon nursing and the management of children from their birth to three years of age (London, 1748), p. 26; Fildes, Breasts, bottles and babies, p. 176. General Committee minutes, 7 October 1741.

7

Childcare and health in a local setting

he is hade the smolpx verry latle . . . Note left with child 5933, Peter Puff Admitted 10 October 1757 Reclaimed 6 June 1764

So far, the investigation of the London Foundling Hospital archive has focused predominately on the mortality rates and risks of the infants and children it cared for. This chapter considers questions of ill-health, which arguably gives a better impression of the everyday problems and experiences involved in caring for large numbers of small children. The health of nurslings was an immediate issue, both for the sake of the foundlings themselves and for its implications for passing contagion to nurses. Once the foundlings were weaned, and especially after they returned to the hospital or one of its branches, problems of crossinfection and contagion became even more acute. The first part of this chapter considers the health of nursling infants, set in the context of contemporary accounts of feeding methods and diseases of infants. The second part examines the procedures and policies adopted to combat ill-health among the weaned children, both while at nurse and after their return to the hospital. Where possible, the four case-study parishes will be called upon to illustrate larger-scale concerns and trends. The branch hospital at Ackworth also gives us further insights into the health conditions of young children in Yorkshire, and provides a foil to the infirmary records for the main hospital in London. The Ackworth hospital is particularly interesting for this study of ill-health, as it became a holding house for foundlings with congenital and acquired disabilities. Inevitably, among such a large body of children, some proved to be, or became, blind or crippled, or showed what would now be called learning difficulties. The records from this hospital, therefore, allow us a rare insight into the care of such children, and more generally into how the institutional care of sickness was managed.

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Childcare, health and mortality Nursing and feeding: infant health

It is today undisputed that maternal breast-milk is the ideal food for young infants, and the Foundling Hospital officials committed themselves early on to the next-best policy: breastfeeding by a nurse. A programme of universal wet nursing for all healthy infants was ordered as early as October 1740, although some trial was made of artificial diets (generally floury and milky paps) in the hospital’s early years. The governors may not have had modern knowledge on the biochemical makeup of breast milk and its beneficial impact on infant health, but experience proved that infants thrived better on such a diet.1 Cow’s milk, while the obvious alternative in the absence of modern artificial milks, is less easy for infants to digest, lacks antimicrobial agents, and carried the risk of tuberculosis from infected cows.2 Even worse risks were presented by dry foods, as they often had a poor nutritional value, and carried high risks of bacterial contamination.3 Breastfeeding gave foundling infants their biochemically most appropriate source of nutrition, and also a supply of antibodies against pathogens encountered by the nurse (although not against those encountered by the foundling before placement with her).4 Unless they had been maternally breastfed before they were abandoned, the foundlings did lose out on the protective and purgative qualities of the early breast-milk, the colostrum. Nonetheless, the substitution of a wet nurse’s milk was by far the best option for their ongoing health and survival.5 It is also possible, although impossible to verify, that the potential improvements in adult nutrition notwithstanding, foundlings’ mothers may have been more poorly nourished, more likely to have worked throughout their pregnancy because dependent on their own income, and more likely to have been living in the unhealthy environs of London than the foster nurses. This may have affected the quality of their breast-milk, and may also have predisposed their babies to low birth-weight and poor postpartum health.6 The preference for (generally maternal) breastfeeding reflects wider developments in the eighteenth-century medical community. Many doctors published works advocating feeding with breast-milk, and gave increasingly sophisticated and medically astute reasons for their preference.7 One of the most influential of these writers was William Cadogan, honorary physician to the London Foundling Hospital. He was one of the first doctors to stress the importance of a ‘natural’ method for raising infants and children, and his highly influential 1748 Essay upon nursing and the management of children from their birth to three years of age was published at the order of the hospital’s General Committee.8

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His work introduced many new ideas on feeding and practice into accepted medical thought, and it is particularly valuable that they may be taken as evidence of what was considered best practice at the hospital.9 Cadogan called for a more scientific approach to the management of infants and children, and was distinctive for his stress on a simple regimen, which led to ‘the more Health, Beauty, Strength and Spirits’ in mind as well as body.10 This holistic approach condemned the overloading of the infant’s system with rich food and heavy clothing, which endangered life and bred puny adults.11 Children should thus be clothed in loose garments, with no swaddling bands, and not confined in shoes and stockings. Food ought to be healthy, and given in moderate quantities, thus preventing illness and weakness.12 Many of these ideas were indeed put into practice at the Foundling Hospital. In May 1747, for example, the General Committee resolved that no shoes or stockings be sent with the young children to nurse until they could walk, and swaddling bands were not used for infants.13 Contemporary authors also considered artificial feeding for infants, for example for those weakened by illness. Some in fact preferred it, especially if good-quality nurses could not be found.14 This was cited as the main reason for trialling dry nursing at the hospital in the early 1740s, on the advice of the Royal College of Physicians.15 Within a month, however, the scheme had been dropped in favour of universal wet nursing.16 Cadogan was probably influential in shaping this policy, as was Sir Hans Sloane, Royal Physician, sometime President of the Royal College of Physicians and of the Royal Society and honorary attendant on the hospital.17 Other supporters did regret that more trial not been made of artificial feeding for the foundlings, but were unsuccessful in effecting any large-scale change.18 It is notable that the London Foundling Hospital did not experiment with artificial feeding in the more sustained way that some other contemporary foundling homes did; this was largely a testament to their success in recruiting wet nurses.19 Instead, their resolve is noted many times in the hospital records, and was not shaken by the prospect of unrestricted admissions. In June 1756, information sent out to prospective nursing inspectors stated that ‘The Hospital [chooses] to employ Wet Nurses as much, and dry Nurses as seldom as possible’, and in May 1758, the General Committee agreed that ‘This Committee are of opinion that the way in which the Hospital now proceeds is, all circumstances considered the properest’.20 When shortages of nurses dictated that more infants be dry nursed, the governors stipulated that the Matron should select ‘such children as can most easily be fed by hand’, and ‘take the greatest care in preparing the Nourishment proper for them’.21 These children seem to have been fed on floury paps, and

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there is evidence that goats were also provided for their milk.22 By 1759, however, the pap was no longer made with milk, which would have considerably reduced its nutritional value.23 Other notes made on the dry food were also not very positive: it was glutinous, the bread used in it was not well baked, and it was lumpy.24 Despite the cares of the governors it is perhaps not surprising that infants brought up on this regime did not thrive, deficient as it must have been in several vital minerals and vitamins. Fortunately for the majority of the foundlings, however, the advice of men like Cadogan and Sloane prevailed. While the foundlings missed the benefits of long-term nursing by their mothers, and some received no maternal nursing at all, the majority did receive the next-best alternative. While breastfeeding was good for foundlings, there was always a risk of contagion to the nurse if the infant had an infectious disease. While infants were screened against ill-health this should not have occurred, but syphilis, in particular, was notoriously difficult to identify at an early age, and some cases may have slipped through. In September 1756, the General Committee heard that two nurses had been sent to the hospital for treatment for venereal disease transmitted by foundlings. They were treated in the infirmary, and an allowance was paid to their families while they were away. The hospital maintained its commitment to wet nursing, but stated that where venereal disease was suspected, infants were to be fed by hand, ‘rather chusing to risque the Life of the child, than of the Nurse’.25 The hospital was aware that this was a matter which could cause bad feeling in the nursing communities, and that it was worthwhile to be as careful as possible. There is evidence that venereal disease did become more of a problem during the General Reception: in May 1759, the General Committee heard that there were more cases in the hospital than there were nurses, and that six foundlings were to be sent to the Lock Hospital for a cure.26 The hospital also found that there were nurses who claimed to have been infected by a foundling when in fact they had not. In October 1758, the General Committee noted ‘the constant trouble & the great Abuse to which this Charity may be liable by Nurses pretending to have Contracted Infectious Distempers by suckling the Children of this Hospital’. All children with infections were ordered to be dry nursed, but problems of contagion remained; in 1777, the hospital reiterated that ‘in all future Advertizemts for the Reception of Children there shall be inserted that no Child will be admitted to Ballot having any infectious or incurable disease’.27 Clearly, infectious diseases in general were a recurrent problem for the hospital, and not just venereal ones. In October 1760, Nathaniel Edwards, one of the Chertsey inspectors, wrote

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to the hospital’s secretary to inform him that one of the nurses had been infected with measles by her foundling infants, and was in danger of losing the sight in one eye as a result.28 Information on other diseases of nursling infants is somewhat scarce, being overshadowed by early deaths from ‘weakness’ and the ubiquitous and non-specific convulsions. Among a total of 966 causes of death for infants recorded in the General Registers, 48 per cent were given as either convulsions or fits. These labels, of course, tell us nothing about the underlying disease, or even cause of death. Infants are prone to febrile convulsions from a variety of causes, because they are not able to regulate their body temperature as older children can. Convulsions therefore frequently coincided with teething, which was an obvious cause of distress around the time of death and frequently appeared as a cause of death in its own right. Teething may also have prompted weaning, which was a period of raised risks from gastro-intestinal infection. Other infectious diseases may also have led to convulsions from raised temperatures. Infant deaths were also attributed directly to these other diseases: 61 infants died of smallpox, 79 of whooping cough, and 22 of measles. Others died from a variety of disorders, purgings and humours, most of which give us little insight into the specifics of ill-health. A handful were noted to have died from the fatigue of the journey: a poignant reminder of the trials the foundlings suffered in their early days. In many cases, however, no specific cause of death was given, although analysis of seasonal patterns of mortality may yield some clues. Figure 7.1 shows monthly indices of burials occurring within one year of entry to the hospital among foundlings sent to nurse in Epsom, Chertsey and Hemsworth, and of all foundlings entering the hospital during the General Reception (only 37 foundlings died within a year at Ackworth, making the numbers too small to break down by month).29 Among the infant deaths of Epsom and Chertsey foundlings, the mean average time elapsing from abandonment to burial was between six and a half and seven months; in Hemsworth it was just over three months, and among all General Reception children, just over two months. In the Surrey parishes this high mean age was due to a small number of foundlings dying almost a year after admission; in both places over 50 per cent of those dying within a year had died within 60 days of entry (51 per cent in Chertsey and 58 per cent in Epsom). In Hemsworth, the percentage was 38, and for the General Reception children 68. This younger age at death for the full data set is probably at least partly due to the increasing number of infants dying very soon after entry in the hospital without being sent to a nurse.

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Figure 7.1 Monthly pattern of foundling burials within a year of admission to the London Foundling Hospital, 1741–67 250

Index

200

150

100

50

0 Jan

Feb

Mar

Apr

May

All General Reception

Jun

Jul

Epsom

Aug

Sep

Oct

Hemsworth

Nov

Dec

Chertsey

Note: N = 388 for Chertsey, 240 for Epsom, 206 for Hemsworth, and 7886 for all General Reception foundlings. Source: Inspections Books and General Register LMA, A/FH/A10/1/1/1–2, A/FH/A09/2/1–5.

Figure 7.1 shows different monthly patterns of infant burials for the three communities, although all three largely mirror the trends of the wider General Reception dataset at greater extremes. In this latter group, the months November–March had raised mortality, while the late spring, summer and early autumn months were more benign (reflecting the findings from statistical analysis reported in Chapter 4). Burials within a year in Epsom show a marked peak in April, but generally, the first half of the year again had a higher concentration of deaths than the second. In Chertsey, a more muted April peak is also evident, but burials were more evenly distributed over the course of the year than in Epsom, and show a similar range of values to the full General Reception dataset. In both Surrey parishes there is clear evidence of an upturn in December, which in Chertsey persists into January. Hemsworth, in contrast, shows much heavier burial loading in the second half of the year, while the months March–July had fewer deaths than in the General Reception dataset as a whole. The concentration of deaths in the winter is a classic pattern for young infants, who are at particular risk from

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winter respiratory conditions. Deaths in Hemsworth began to rise from August, which suggests that bacterial infection in the heat of summer was also an issue. The Surrey communities also show the raised winter risk, but there spring seems also to have been a risky time, and summer gastro-intestinal infections were apparently less of a problem. It is possible that the April peak is related to local epidemiology, especially given that the data are heavily weighted towards the few years of the General Reception. Traditionally, seasonal patterns of burial are particularly marked for very young infants (peaking in winter), and for those of weaning age (peaking in summer). We may investigate this for the Foundling Hospital via the data shown in Figure 7.2. The numbers for individual communities are too small to allow meaningful analysis, so the data for Chertsey, Hemsworth and Epsom have been combined. The corresponding values for the General Reception infants are also shown. The seasonal index for infants dying in their first month after admission does show a very

Figure 7.2 Seasonal patterns of foundling burials in the first month from admission and in the second half of the first year, London Foundling Hospital, 1741–64 250

Index

200 150 100 50 0 Jan

Feb

Mar

Apr

May

Jun

General Reception first month General Reception months 6–12

Jul

Aug

Sep

Oct

Nov

Dec

Sample nurseries first month Sample nurseries months 6–12

Note: N = 306 for deaths within one month in the sample nurseries and 4468 for the General Reception, and 136 for deaths between 6 and 12 months in the sample nurseries, and 1000 for the General Reception. Source: Inspections Books and General Register.

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clear peak in December and January in both the sample and the full group, as was predicted. Smaller peaks are evident in April and August in the sample nurseries, which may be the result of local conditions or specific diseases. The pattern for the larger dataset is again more muted in amplitude than that for the samples. For burials occurring between six and twelve months from admission, there is a heavy loading in the first quarter of the year in both datasets, and little evidence of a summer rise which could be attributable to diseases related to the risky weaning period. The full General Reception dataset does show a small rise in index values in September. There are a number of possible reasons for this general lack of a summer rise: firstly, in the sample nurseries the sharp rise in April deaths in Epsom may be overshadowing other patterns; secondly, it is hard to specify when weaning would actually have occurred, especially given that infants might already have been up to six months old on entry (although we have seen that younger ages on entry were much more common); thirdly, it is possible that the hospital was able to protect infants being weaned in the summer from the increased dangers of bacterial contamination of that season, through the system of inspections and by specifying methods of weaning. The regularity of the nursing wage may also have meant that nurses did not need to go out to work at harvest time, but instead stayed at home with the foundlings. At any rate, the data do not show a raised incidence of summer-specific fatal disease among older infants, but they do confirm the elevated risk of disease in winter, especially for the youngest children but also for those dying later in the first year. The young foundlings’ health would also have been affected by the quality of their nurses’ care, particularly after the immediate risks of long journeys and preexisting weakness had passed. Despite the high priority it placed on wet nursing, the hospital was always alert to illtreatment and frauds by the nurses, who were the most obvious culprits for preventable disease and death. There are certainly examples of cases where nurses were negligent or even cruel, but the system of regular inspection seems to have mitigated the problems experienced by some other European foundling hospitals. According to Kertzer and White, Italian hospital officials were mistrustful of nurses, and relied on anti-fraud practices such as keeping external nurses in the hospital for four weeks in order to ensure that they could not have a suckling child at home themselves.30 Other problems reported at continental foundling hospitals included nurses substituting their own babies for foundlings who had died; nurses claiming children for other women who were not lactating; and mothers presenting themselves as nurses after

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giving up their own children, in the hope of being given them to nurse for a wage.31 Regular inspection of nurses was rare on the Continent, where foundling hospitals generally relied on the good-will of priests in the localities to recommend women and keep an eye on them. The London Foundling Hospital inspectors should have been in a much better position to know if a nurse’s milk supply had dried up, what her home circumstances were, and whether she was ill-treating a foundling. Certainly, the system of surveillance would have had to suffer a fairly major breakdown for women to be able to take home foundlings for other women who had not been approved, as appears to have taken place on a large scale in Russia. Knowing the local employment opportunities for women, inspectors should also have been alert to women weaning foundlings early in order that they could work in seasonal agriculture or manufacture. Perhaps this view credits the inspectors with more insight and more time for visiting nurses and foundlings than they could have managed in reality, especially when they were responsible for large areas. Frauds of the type seen on the Continent were rarely reported to the General Committee, however, probably partly because burial certificates were filled out by inspectors, and the identity tags of foundlings returned to the hospital on their deaths. The substitution of a foundling with the nurse’s own child (in order to continue drawing a wage) would be extremely difficult, and would ultimately cause problems when the child was supposed to return to the hospital. More of a problem for the London hospital was neglect, cruelty or ignorance from nurses, as alluded to in the previous chapter. Unfortunately, inspectors sometimes uncovered cases only after poor treatment had continued for some time. Thomas Langridge, the inspector in Epsom, had to be alerted by the hospital to the poor state of one foundling child, Ann Dawson. He wrote in response in May 1763: [I] am very sorry to think any nurse should suffer for a Child to go about in the manner you mention for I am very Innocent of any such doing had I know any thing of it I would have moved the Child from her Immediately, to have Prevented any such growing Evil.32

In this case, the network of inspection does seem to have failed, although the hospital may have been alerted to the case by another local inspector. Ann Dawson’s condition is not made clear, but her story ended happily; she survived to be apprenticed in January 1767, and was not recorded as having any disability. When Langridge detained the child, however, her nurse said that she had been promised that she might keep her, which suggests either that the relationship was based solely on the economic value of the child, or that her bad conditions concerned

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cleanliness and clothing rather than neglect, bad treatment or lack of affection. A more extreme case of the latter was highlighted in a letter from one of the Berkshire inspectors, William Earles, who wrote to the hospital in September 1759 of a particular nurse’s situation: The child I removed from her what was not kepp free from verment and in a verey nastey condishon. Had it remaind with her aney longer the child would never had aney use in its lims.33

In this case also, the inspector had to be notified by the hospital that a nurse was failing in her duty. Such a breakdown in inspection must have been more likely where nursing communities were very large. Chertsey, for example, was inspected by several people, each of whom was probably responsible for particular areas or groups of nurses. Epsom, however, was inspected by Thomas Langridge alone, and Thomas Trant was solely responsible for Hemsworth; both of these were extensive nurseries. Even with assistants, the supervision of large numbers of women over a geographically widespread area must have been extremely difficult. When Thomas Trant died in 1758, Dr Lee of Ackworth was unimpressed with the quality of some of his nurses: Many of the Nurses in that Country are very bad, & tho’ they every one had Certificates to Mr Trant, yet Numbers were otain’d from Parish Officers, who w’d sign for divers Reasons.34

Such examples as these show that the system of inspection was not perfect; nurses did occasionally neglect or mistreat foundling children and babies, and this was not always discovered until it was of long standing.35 Of course, many cases may not have been of deliberate neglect, but rather of poor standards of care or cleanliness. Others show the mercenary basis of the nursing relationship, with apparently little affection for the foundling child. The relative scarcity of such cases, however, suggests that in the main, abuse and neglect by nurses were uncommon. In June 1760, the General Committee resolved ‘That those good Nurses who have brought home fine children , have delivered to them the weakly children that may be returned from bad Nurses’. Thus they tried to forge strong relationships with good nurses, and ensure the proper care of children who had suffered under poor ones.36 Nurses taking over the care of such children were also sometimes paid a premium for their trouble.37 Foundling children might become particularly troublesome to their nurses if they became sick. In December 1772, for example, Thomas Langridge of Epsom wrote to the hospital treasurer about a nurse and her charge John Baldwin, who was very ill. The particulars of this case

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are slightly unusual, as John was a twelve-year-old who had already left the hospital as an apprentice, but had been returned because of poor health. His nurse, however, was making a common complaint, that the trouble of caring for a sick child was more than her wage was worth: The nurse that have John Bladwin [sic] says she have a Great hand with him and he is very Bad and shee dont like to keep him for that Money Inless you Please to allow her More money with him.38

On 5 January 1773, Langridge wrote on the matter again, stating that the child was ‘so very bad cant help himself is Obliged to keep his Bed and shee don’t think he will Live Long he does Every thing as he Lays’.39 Another letter of 8 January prompted the hospital to promise the nurse 5s per week.40 In a rather sad end to the story, it finally emerged, as the child was on the point of death, that the cause of his condition had been bad treatment by his master, which he had not dared tell of before. He was buried at Ewell on 7 May 1773.41 Although this was a particularly serious case, the trouble and expense of nursing ill children were common complaints. The General Committee had ordered as early as 10 October 1744 that nurses be paid premiums for this work, but it might also prevent them from earning money in other capacities, and always brought the risk of cross-infection to the nurse or her own children.42 Inspectors’ letters note cases of illhealth among their children, both contagious conditions and ongoing complaints. Thomas Langridge wrote in June 1772 that measles were rife in the area, while Nathaniel Edwards notified the hospital in August 1759 that some of those in his nursery were ‘very ricketty’.43 In 1767, Langridge asked the hospital’s advice on smallpox inoculation, and the General Committee had already ordered in June 1757 that nurses be paid up to 10s 10d if their charges had smallpox while with them.44 Nurses of blind children might also be paid a higher wage.45 It was diseases and conditions such as these which formed the major assaults on the health of the foundling children as they left infancy. Childhood ill-health and disease There is a significant amount of information available on the ill-health of foundling children as opposed to infants, in the form of both causes of death and records of non-fatal illness. This latter information gives a much greater impression than the former of the sorts of minor assaults on health which the foundlings suffered on a more regular basis. To take causes of death first, however, we find a pattern which is not strikingly different from that found on a more impressionistic basis for

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Figure 7.3 Causes of death among children dying between one and five years from entry to the London Foundling Hospital, 1741–99 Other 18%

Smallpox 19%

Teeth 4% Fits 5%

Fever 14%

Whooping cough 6% Convulsions 10% Consumption 11%

Measles 13%

Note: N = 445. Source: General Register.

infants. Figure 7.3 shows the breakdown of causes of death for the 445 children dying between one and five years from entry with a cause of death noted in the General Register.46 These children represent 21.6 per cent of all those dying in this age bracket, but they seem to have been older at death than those with no causes recorded: 961.6 days compared with 715.4 days. This suggests that causes of death were more definitely identifiable for slightly older children, or that those back at the hospital at older ages were more likely to have a cause of death recorded than those dying at nurse. They also show a flatter seasonal pattern of burials, which suggests again that certain seasonal diseases were not being captured in the causes of death given by the hospital. These caveats do not render cause of death information useless, but it should be borne in mind that it may not be entirely representative of the whole population of foundling children. Even for children after the age of one, convulsions and fits are still well represented among causes of death. However, infectious diseases, most notably smallpox and measles, are now more evident, with fever and consumption also each responsible for 10 per cent or more of all deaths with causes assigned. This is perhaps unsurprising, as the children came into contact with a greater variety of pathogens than the infants, and as they mixed more freely with other children and adults. Seasonal patterns are also still evident, with a peak in spring burials,

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and a more muted winter rise. Springtime was frequently identified with fevers, and many foundlings may have been carried off by this relatively non-specific cause.47 Contagious diseases and fevers were, therefore, the largest single identifiable causes of death for foundling children. While at nurse, the foundlings were subject to the local spread of pathogens and epidemics; when they returned to the hospital in London, or one of its branches, however, things may have become more complicated. The disease environment in the hospital was probably constantly changing, with returning children introducing new pathogens into a population with varying levels of immunity.48 Risks of infection might thus be high, and hospital officials tried to prevent the spread of contagious disease by isolating infectious cases and seeking advice from their medical advisors.49 As early as October 1740, the General Court ordered that a separate infirmary be set up for the sick, and it was updated and moved at several points.50 A resident apothecary served the hospital, and physicians and surgeons visited regularly. Changes in ideas over the eighteenth century placed more emphasis on the contagious nature of disease and the importance of environment in making a place healthy or unhealthy.51 These ideas were taken on board at the hospital, and continued attempts were made to make the infirmaries as conducive to health as possible. Generally, a policy of separation was followed whenever a child was found to be contagious, moving the child either to the infirmary or to buildings outside the hospital hired for the purpose. In July 1752 the General Committee resolved that any child diagnosed with an infectious condition was to be sent to a separate building in Leather Lane, opposite Gray’s Inn.52 In June 1780 all children with ‘diseased heads’ were ordered to sleep in separate beds in order to prevent infection.53 The hospital was thus often in the vanguard of new medical ideas and practice, probably transmitted through its elite medical attendants. It also had the space and resources to implement separation policies, which institutions such as workhouses may not have been able to do so effectively. As noted above, infirmary records and other reports permit a rare investigation of morbidity as well as fatal ill-health. These records show the reality of dealing with infectious disease and chronic conditions. One of the most prevalent of these diseases was measles, which was shown above also to be a significant cause of death among young foundlings. In the wider London context, measles was ‘not yet a steady or perennial cause of death’, with annual totals ranging from five to several hundreds, compared with several thousand smallpox deaths every year. Over the century, however, epidemics in London became more frequent and more

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severe, with four in the 1760s, and deaths reaching 610 in 1763.54 In the hospital, in contrast, measles was a more sustained threat to life than smallpox, which was muted in its virulence through the practice of inoculation. There was a large population of susceptibles among this frequently changing group of children, and both morbidity and mortality could be high when measles struck. In May 1768, for example, the sub-committee ordered that the caravan from Yorkshire be diverted to the branch at Westerham in Kent, because measles was rife at the London hospital, and in May 1770 the General Committee ordered that all apprenticeships be postponed as there were so many cases of measles in the house.55 In 1771, Sir William Watson, a physician to the Foundling Hospital, published an account of ‘putrid measles’, which swept through the hospital in 1763 and 1768.56 In 1766 another attack affected 74 of the 378 children in the hospital, but was of a more benign sort, and all those infected recovered. In 1763, in contrast, 180 of the 312 in the hospital were attacked, with 118 falling ill in the first fortnight of the epidemic. The disease was fatal for 19 children, and many others had to be sent into the country to recover their strength.57 This year was also marked by high measles mortality in London. In 1768, 139 of 438 children in the hospital fell ill, and 6 died. Both epidemics occurred at the same season of the year (May–June), although the second attack was less severe than the first. The severe form of the disease was nevertheless debilitating, being marked by high fever, persistent cough, sore eyes and troubled breathing, as well as the characteristic rash. Some of the deaths were accompanied by dysentery, others by laboured breathing, and others from what was described as mortification, particularly of the mouth.58 Watson also reported that an unusually severe episode of smallpox followed the measles outbreak of 1763, carrying off 11 children. A similar situation prevailed in 1790, when the infirmary was full of children suffering from measles ‘of a thoroughly anomalous character with the most alarming symptoms’, ten of whom died.59 Other diseases also appeared in epidemic form. The physician Dr Mayo stated in 1790 that he had known ten epidemics during his time at the hospital, including one of scarlet fever with a putrid sore throat, which affected between one and two hundred children at one time, and killed eight or nine.60 The severity of the epidemics at the hospital, and the sequence of diseases taking hold one after another, indicate the nature of the disease environment. Epidemics could flare up rapidly, while a child who had recovered from one attack was vulnerable to other illnesses. Outside the hospital, population density of non-immune children may have been sufficiently low that epidemics were less common;

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Figure 7.4 Numbers admitted to the Foundling Hospital infirmary, 1761–66 140

120

Number of children

100

80

60

40

20

0 1761

1762

1763

1764

1765

1766

Note: N = 6078. Source: Infirmary Weekly Reports, 1761–66, LMA, A/FH/A18/5/1.

in the Foundling Hospital, a more constant supply of vulnerable children led to a greater number of episodes of disease.61 The pattern of a sustained, low level of disease, punctuated by brief epidemics of measles or fever, is borne out in infirmary records, which survive from 1761. Figure 7.4 shows the numbers admitted to the infirmary between 1761 and 1766. Smallpox cases have been omitted from the data, as the children undergoing inoculation (who may have been virtually symptom-free) are indistinguishable from those who were actually suffering from the disease. The very large peak in May 1763 represents an epidemic of ‘eruptive fever’, perhaps related to the measles outbreak (which does not seem to have been treated in the hospital infirmary, perhaps to assist with the isolation of contagious cases), which peaked with seventy children sick at one time. In general, however, there were closer to twenty children in the infirmary together. Figure 7.5 shows the types of illness experienced, again excluding smallpox. Whooping cough also appeared rarely in the main infirmary, fever being the only infectious condition

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Figure 7.5 Morbidity in the Foundling Hospital infirmary, 1761–66 Whooping Cough Weak 2% Measles 2% 4% Itch 26%

Chilblains 18%

Sore mouth 4%

Sore eyes 2%

Eruptions 4% Fever 16%

Other 20% Dysentery 2%

Note: N = 9252. This is higher than the numbers quoted in Figure 7.4 because cases of chilblains and eruptions which were treated outside the infirmary wards but were recorded in the weekly reports are included. Source: Infirmary Weekly Reports.

to feature in large numbers. The proportion of fever admissions is significantly raised by the epidemic of 1763, but it appeared at other times as well, with a bias towards spring (supporting the suggestion made above that the spring peak in child burials was due to fever deaths). Mumps and chicken pox were not common, and are included in the ‘Other’ category, which also accounts for scrofula (a tubercular condition of the glands in the neck), and all burns, broken bones, ‘stoppages’ and inflammations. The other conditions seen on a large scale in the infirmary were chilblains and scabies (‘itch’), both of which posed very little risk of death but are indicative of the conditions in the hospital. The former occurred almost exclusively in winter, and affected so many children that most were in fact treated as out-patients in the main hospital building (but are included in these figures to give a more accurate picture of morbidity). In 1776 the apothecary reported to the General Committee that again there were too many children with chilblains on their hands and feet for the infirmary to contain, and some were cared for in the wards.62

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Scabies (highly contagious and itchy skin mites which are spread via skin-to-skin contact, and infected clothing and linen) was also a recurrent problem for the hospital. It was rare for there to be no cases in the infirmary, and occasionally it would account for up to forty patients in one week. It was most prevalent in winter and spring, and was at particularly high levels in 1763 and 1764. It may have been reintroduced into the hospital by children returning from nurses, since it was frequently noted that returning children had scabies. In December 1772, Dr Cope, the medical attendant at Ackworth, evidently received notice of this pathway of contagion, as he felt moved to write in his defence that: When I was called to attend the Hospital at Ackworth my predecessor had let the Itch & sore Heads overspread the Children. For, it was a maxim with Him that Cutaneous Complaints prevented other Diseases, but this was by no means the Case other Diseases they had, there, very bad ones of a very infectious Nature.63

He had the beds and walls cleaned, and did eradicate the conditions, except for small-scale seasonal occurrences in spring and autumn. The London hospital was not free from such problems itself; in March 1753, the General Committee employed one George Bridges to destroy the bugs from the beds, which together with the evidence of ‘eruptive’ skin conditions, sore eyes and scabies in the infirmary also suggests that contagion via lice and mites was an ongoing problem.64 A list of causes of death at the Ackworth hospital also points to the significance of environmental conditions and cleanliness in the diseases suffered by the foundling children. The Ackworth branch had its own infirmary and medical attendants, who were responsible both for children in the hospital and for those at nurse in the area.65 While Ackworth was a very different disease environment from London, the types of disease and the paths of transmission encountered seem to have been similar at the two branches, as illustrated in Figure 7.6. The numbers of children housed at Ackworth were generally large; in February 1765 it housed 568, more than at the main hospital in London, which then contained 407 children. Almost all of these children were over the age of six (99 per cent of the children at Ackworth, and 95 per cent of those in London). By June 1769 there were 342 children at Ackworth, who were outnumbered slightly by London (384), and the branch in Shrewsbury (568). In terms of disease spread, therefore, there was not much difference in the pool of subjects between London and Ackworth.66 Measles and convulsions were notably less common as causes of death at the Ackworth hospital in these years than they were among

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Figure 7.6 Causes of death at the Ackworth Foundling Hospital branch, 1757–73 Smallpox 18%

Other 9%

Whooping cough 2% Consumption 20%

Convulsions 3%

Mortification 2% Measles 4%

Dropsy 4%

Fever 13%

Dysentery 25%

Note: N = 169. Source: Register of deaths at Ackworth, 1757–63, LMA, A/FH/D/1/5/1.

the whole foundling child population. The lesser incidence of convulsions may be related to an older mean age at Ackworth, or perhaps simply to a difference in nosology. The occurrence of measles may be related to local epidemiology: a history of the disease specifically cites Ackworth as an area where it did not appear frequently, in contrast to London. There were no deaths from measles in the Ackworth population between 1747 and 1757, and only two in the following decade (although there were also eight burials from measles in foundling children).67 The foundlings apparently did not transmit the disease to the population outside the hospital. Smallpox, fever and consumption were very similar in their incidence as fatal diseases to the whole foundling child population. The most common single cause of death, however, was dysentery, which is suggestive of contaminated water or milk, and was a common cause of death for weanlings encountering pathogens associated with solid food for the first time.68 Almost all the children at the Ackworth hospital were over the age of weaning, but the risks of gastric disease were evidently still significant. The majority of these deaths took place during the winter (typical of the seasonality of the disease), and they often appeared concurrently with smallpox: between January and March 1765 14 children died of dysentery, while 11 died of smallpox.69 In June 1766, the Ackworth hospital steward wrote to the London branch that a child

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sent thence had spread measles to 200 foundlings in the Yorkshire branch, that the hospital had smallpox also present, and that ‘we have not yet got clear of the Dysentery’.70 Dysentery may thus frequently have been a sequel or symptom of another disease rather than the result of a separate bacterial infection. This focus on dysentery as a cause of death, and on scabies and contagious disease as forms of ill-health, suggests that the hospitals themselves sometimes created the conditions which led to disease, despite their best efforts. In 1753, Lady Vere visited with her sister, and was shocked to see a foundling girl whose hair contained ‘Quantities of that sort of nastyness that soon when in the Head becomes alive’. The staff promised more attention, but complained that they had too many children to care for.71 In April 1759 one of the external infirmary buildings, the Brill, near St Pancras, was described as being: a single House, old and Decayed, very Hot in Summer, and very cold in Winter, and lying so low that it has been found impracticable at some Seasons of the Year to prevent a Stagnant water in the Cellars.72

In February 1780, the buildings at Powis Wells, where children with scabies went for cure, were found to be partially tumbled down, and were ordered to be demolished.73 In 1790, the physician, Dr Mayo, made a formal complaint about the state of the infirmary and the role of the matron. The General Committee investigated, and found that several of the medical and domestic staff considered that deficient food and clothing had reduced many of the children to ‘puny wretches’, and the infirmary to a ‘nursery of contagion’.74 Ultimately, the matron was absolved of blame, but the infirmary was found to be deficient: it was too small, contained too few beds to allow the separation of different diseases, and was low-lying and damp.75 In consequence, another ward was converted into an additional infirmary, it was ordered that each child should have her/his own bed, and the table of diet was reviewed. The state of the hospital’s medical provision seems to have deteriorated badly at this stage in its history, but may always have been prone to overcrowding and uncleanliness when under pressure of numbers. One area of medicine in which the hospital was able to act more decisively was in its policy on smallpox. In the metropolis, the disease may have been responsible for nearly half the lives lost among those aged five to nine: the highest single cause of death in the city.76 We have seen that smallpox was responsible for almost a fifth of deaths occurring between one and five years from admission at the hospital, but a policy of inoculation at return from nurses almost certainly prevented a much higher death toll. Inoculation against smallpox was still viewed

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with some mistrust in England in the 1740s and 1750s, after several well-publicised high-society deaths in the 1720s. A revival of interest was encouraged by the support of several well-known London doctors, including Sir Hans Sloane and Dr Richard Meade, both of whom officiated at the Foundling Hospital, and it must have gained credence by its success at that institution.77 Smallpox is a typical crowd disease, thriving in dense populations, although since it confers lifelong immunity, a group of non-immunes is always necessary for it to remain endemic. Thus, it became predominately a children’s disease, transmitted through close contact in the form of respiratory discharges and matter from sores on the skin. It was characterised by a rash, fever and nausea, and could leave disfiguring marks and blindness in recovered patients. There was no effective cure once a patient was infected.78 The role of inoculation in the decline of smallpox as a killer disease has been debated, but the hospital lost only a tiny proportion of its inoculation patients, compared with a relatively high toll among the non-immune foundlings.79 In June 1743, Dr Conyers was asked to consider inoculating the children who had not had smallpox, and the policy was adopted from then on.80 It evidently met with criticism, however, as the governors felt bound to justify their actions publicly. In November 1749, the following advertisement was ordered to be printed in the Daily Advertiser: Whereas great numbers of Persons have lately dyed of the SmallPox, the General Committee of this Hospital think it may be Usefull to acquaint the Publick that some Years ago a Resolution was taken That all the Children belonging to this Hospital who had not the SmallPox in the Natural Way whilst they were at Nurse in the country, should on their Return from the country be Inoculated, and proper Rooms in a House at a great distance from the Hospital have been hired for that Purpose . . . The whole number [inoculated] hath been Eighty, Every one of which have done well without any Accident or Inconvenience under the care of Dr Conyers Phisician, and Mr Winchester Surgeon to this Hospital, for whose Charitable attendance the Committee do order their thanks to be given. NB No Nurses or Servants are hired into the Hospital, nor will any of the Children reside there, except such as have had the SmallPox.81

This indicates both the strong desire to avoid an outbreak of smallpox within the hospital itself and the residual mistrust of inoculation. The reality of the disease itself was frightening: in March 1765, the inspector Henry Herring of Toppesfield in Essex wrote to the secretary of the ‘unaccountable terror of the country’ when one of the foundlings became ill with smallpox, which raised the costs of nursing in that area.82 Contagion was no less a worry for the governors. In June 1763, the

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possibility of smallpox being carried to the hospital from the inoculation house at Cold Bath Fields was referred to a sub-committee, and in December 1781 there was anxiety that all the susceptible children in the house should be inoculated, since there was a case of smallpox there.83 At Ackworth also, admissions of children who had not had smallpox were occasionally stopped because of outbreaks in the house.84 The incidence of smallpox deaths there indicates that inoculation was not always carried out promptly, but there was a high rate of success among those who had the procedure. Between October 1759 and July 1769, 1296 children were inoculated at the London branch, of whom 101 did not seem to take the disease, but of whom only five died.85 A different approach was necessary for the children who proved to be disabled, or were left so by diseases and accidents. By the 1770s the General Reception children were of apprenticeship age, and from 1771 a policy was adopted of sending those who had physical or mental infirmities to the Ackworth hospital. Hospital officials seem to have been sounding out such a policy as early as 1765, however, eliciting an irate response from Dr Lee: In answer to the Inquiry of the Sub Committee by Mr Collingwood I am to desire to let them know that Idiots can’t be nursed at the usual price of other Children in this Neighbourhood. Those we have are in ye Hospital & a great trouble, You may be sure to us. Happy indeed hitherto we are that the Children don’t mimic them. If you sh’d send them we’ll send them to the Nurses that will take the most Care of them at the lowest price, but don’t approve of taking more into the House.86

By 1771, he seemed to be resigned to the situation, writing, ‘I wish you to see the Children in this Hospital, for considering that the Refuse of all the Hospitals have been sent hither, we are in very good condition.’87 While this sentiment suggests some unhappiness that the hospital was being sent all the disabled children, it is also indicative of their survivorship and sustainability. This is highlighted also in a resolution by the Ackworth committee in 1775, ‘That the Idiots and Idiotick Children be kept together in the Hospital as they are taught to do something and improve very much by the care that is taken of them’.88 The numbers of such children at Ackworth were a subject of much discussion, especially as the hospital started to empty in advance of shutting down. Financial imperatives by the late 1760s meant that the branches had to be scaled back: Aylesbury was emptied in 1767, Barnet in 1768 and Shrewsbury in 1772. The Ackworth branch was the last one to be shut down, perhaps because of its high success rate in apprenticing children, and because it contained the foundlings who were considered

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Table 7.1 Children with infirmities at the Ackworth branch hospital, 1771 Idiotic or of weak capacity Deformed Scrofulous Sore head Short-sighted or blind in one eye Small Dumb Other No information Total

25 25 16 13 13 12 3 5 15 127

Source: ‘List of children in the hospital at Ackworth 23 November 1771 mentioning the infirmities those labour under which render them unfit to be placed out apprentice’, LMA, A/FH/Q/12.

un-apprenticeable because of infirmity. It was finally emptied of all those children who could be apprenticed in 1773, and ultimately sold to the Society of Friends to become a Quaker school (as it remains today).89 Table 7.1 indicates the type of disabilities found among 127 children at Ackworth in 1771, as classified by hospital officials. Some of these children might have been able to work, either in the hospital or in certain trades outside. The ‘deformed’ children, for example, were mainly lame, ‘crooked’ or missing a limb (often because of accidental burns), which might not prevent them from working in sedentary trades, such as tailoring. Some of the ‘Idiotick’ children (the term was not so weighted with pejorative overtones as it is today) did work in the hospital wards, kitchens and gardens, sometimes for a wage. The scrofulous children and those with ‘scald head’ (ringworm of the scalp) might eventually be cured, although unsightly scarring and risk of relapse might make them undesirable apprentices nonetheless.90 When the emptying of the branch hospitals became an imperative, premiums were offered with disabled children, although there were concerns that this might attract unscrupulous masters.91 Others of the disabled children, however, had little prospect of employment, and the Ackworth and London committees had to find ways of providing for them. The governors were prepared to go to some trouble and expense to correct infirmities and disabilities. They bought trusses, crutches and leg irons, sent children into the country or to the seaside, and paid for expensive operations to correct infirmities. Blind

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children were often instructed in music, so that they would be able to earn a living outside the hospital.92 The more severely mentally handicapped children and those who were dumb and blind were unlikely to be able to earn a living, however, although almost all the children listed above were employed in some way at Ackworth. There were more than twice as many girls as boys listed (92 girls and 35 boys), which probably reflects the wider range of employment opportunities available to boys. There is no reason why infections, accidents and congenital conditions should so consistently affect girls more than boys. Several schemes for the long-term care of these children were suggested, in London and elsewhere.93 In 1772, the Ackworth Committee voted to keep them in the house under the care of an official, but the plan was vetoed by the London committee, presumably because it might hold up the sale of the buildings.94 Ultimately, however, if foundlings did prove incapable of work, the hospital took on responsibility for them for the rest of their lives. In March 1795 a child was returned from an apprenticeship for a second time because of her ‘defective understanding’, and the General Committee decided to keep her in the hospital. In a statement which embodied its ongoing commitment to its charges, it noted that ‘it may be Hurtful to the Girl to be from under the immediate protection of this Charity’.95 Some of the disabilities suffered by these children may have been the result of poor diet: for example cases of ‘crookedness’ (perhaps related to rickets and lack of Vitamin D), and poor sight (which may arise from a Vitamin A deficiency). The children’s diets compare favourably with those in institutions such as workhouses, and included milk and homegrown vegetables.96 Nevertheless, McClure estimates that they were probably malnourished, although possibly less so than they might have been had they grown up in their natal families. There are several references to short stature in the records; Dr Lee complained to the London committee in the 1760s that potential masters were disappointed at the size of some of the foundlings: ‘in Truth & Sincerity many people apply at our Hospital & go away empty because they say we are too small by a Size or two’.97 The governors’ willingness to experiment with different methods of feeding and treatment was a feature of foundling hospitals in this period, and can be seen as part of a new clinical investigation of paediatrics. Six foundling boys from the Innocenti hospital in Florence were the subject of a state-sponsored (successful) trial of smallpox inoculation in 1756, for example, while in France, a study was made in the 1780s of foundling infants fed on artificial foods.98 It is easy to see investigations like this as exploitative of orphan children, and their parentless status did undoubtedly ease access to medical and anatomical information.

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Such trials do, however, seem to have been rooted in a genuine desire to improve methods of feeding and care, and may have enabled real progress to be made in the field of child health. The hospital’s officials spent considerable time and effort trying to ensure that their charges received the best possible methods of feeding and care. The advice of influential medical men such as Cadogan, Mead and Sloane meant that the hospital was in the vanguard of trends towards ‘natural’ childrearing and feeding, although they were not able to prevent the risks posed to health by exposure to cold weather. The system of nursing inspectors seems to have prevented serious abuse and illtreatment of babies and young children, while the hospital infirmaries were used to isolate cases of infectious disease. Information on causes of death and ill-health, however, indicate that the foundlings experienced a rapid turnover of contagion related to poor environmental conditions. Epidemics of infectious disease were relatively common, and might affect a large proportion of the hospital’s population. This is not to say that ill-health was a constant spectre: Dr Lee wrote to the hospital from Ackworth in October 1758, describing his charges as: in good Exercise & Perfect Health. W’d you see the Picture of Health you sh’d make an Excursion & visit our Dining Room at 12 o’Clock any day you please.99

As time went on, however, the hospital at Ackworth took on responsibility for a large number of disabled children, to whom a permanent commitment was made if they were not able to work. It is extremely difficult to reach an assessment of the quality of care the children received, but this investigation of health and ill-health suggests that the foundlings at least did not lack for attention and commitment from the governors and medical staff. The institutional environment may have promoted diseases of uncleanliness and facilitated contagion, but it also had a larger array of treatments, medical opinions and space for separation and cure than many of its contemporaries, and certainly than poor parents had access to. In the next chapter, we will investigate how far the foundlings’ experiences of disease did differ from those of the children they were raised alongside in their nursing communities. Notes 1 Hazards analysis showed that while wet nursing improved survival prospects, its statistical significance was unimportant. In the longer term, however, sustained breastfeeding was undoubtedly better for health than any alternatives.

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2 G. J. Ebrahim, Breast feeding: the biological option (London, 1978), p. 55; Barker, Mothers, babies and health; D. B. Jelliffe and E. F. Patrice Jelliffe, Human milk in the modern world (Oxford, 1978). 3 For modern studies on the impact of artificial foods for infants, see, for example, Huffman and Camphere, ‘Breastfeeding performance’; H. S. Sauls, ‘Potential effect of demographic and other variables in studies comparing morbidity of breast-fed and bottle-fed infants’, Pediatrics, 64:4 (1979), pp. 523–7; A. S. Cunningham, ‘Morbidity in breast-fed and artificially fed infants, parts 1 and 2’, Journal of Pediatrics, 90:5 (1977), pp. 726–9, and 95:5 (1979), pp. 685–9. 4 Jelliffe and Jelliffe, Human milk, p. 90; Fildes, Breasts, bottles and babies, p. 81. 5 Jelliffe and Jelliffe, Human milk, p. 284; P. W. Howie, J. Stewart Forsyth, S. A. Ogston, A. Clark and C. du V. Florey, ‘Protective effects of breast feeding against infection’, British Medical Journal, 300:6716 (1990), pp. 11–16. 6 While a malnourished mother can still physically provide enough milk to satisfy an infant, undernutrition in utero affects the growth rate of the foetus. See, for example, Barker, Mothers, babies and health, pp. 10 and 16; H. I. Goldberg, W. Rodrigues, A. M. T. Thame, B. Janowitz and L. Morris, ‘Infant mortality and breast-feeding in north-eastern Brazil’, Population Studies, 38 (1984), pp. 105–15. 7 See, for example, M. Underwood, A treatise on the diseases of children, with general directions for the management of infants from the birth (2 vols, London, 1789), Vol. 2, p. 168.; W. Moss, An essay on the management, nursing and diseases of children from the birth (Egham, 1794); W. Buchan, Domestic medicine: or, a treatise on the prevention and cure of diseases by regimen and simple medicines (3rd edition, Dublin, 1774). 8 It is reproduced in A. Levene (ed.), Narratives of the poor in eighteenthcentury Britain, Vol. 3: Institutional responses: the London Foundling Hospital (London, 2006), pp. 95–112. 9 V. Fildes, ‘Neonatal feeding practices and infant mortality during the eighteenth century’, Journal of Biosocial Science, 12 (1980), p. 315. Underwood (A treatise, Vol. 2, p. 204) stated that swaddling was no longer recommended, because of the influence of Cadogan’s work. Other authors have also noted Cadogan’s influence, for example, G. F. McCleary, The early history of the infant welfare movement (London, 1933), p. 16; G. F. Still, The history of paediatrics (Oxford, 1931), p. 379; J. Rendle-Short, ‘Infant management in the eighteenth century with special reference to the work of William Cadogan’, Bulletin of the History of Medicine, 34:2 (1960), pp. 97–122. George (London life in the eighteenth century, p. 61) also speculates that the use of Cadogan’s ideas by Foundling Hospital nurses must have caused their wide diffusion. 10 Cadogan, Essay upon nursing, p. 5. 11 Ibid., p. 8.

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12 Ibid., pp. 9–20. 13 General Committee minutes, 6 May 1747, LMA, A/FH/K02/1-18. 14 For example, G. Armstrong, An account of the diseases most incident to children, from their birth to the age of puberty (London, 1777), pp. 148–9. 15 Correspondence, undated, LMA, A/FH/M01/2; 22 September 1757, LMA, A/FH/A06/1/8/5; General Committee minutes, 20 August 1740. An account of the hospital written in 1796 gives a more practical reason for the early experiments with dry nursing: ‘it being thought impracticable to procure a sufficient number of healthy wetnurses’ (Account of the hospital for the maintenance and education of exposed and deserted young children (1796), LMA, A/FH/A1/6/1, p. 15). 16 General Court minutes, 1 October 1740, LMA, A/FH/K01/1-4. 17 Cadogan, An essay upon nursing, pp. 25–6.; P. M. Dunn, ‘Sir Hans Sloane (1660–1753) and the value of breast milk’, Archives of Disease in Childhood, 85 (2001), p. F73; Correspondence, 28 Oct 1748, LMA, A/FH/M01/33/210–20. 18 Memo to the General Court (1758), LMA, A/FH/M01/8; ‘A method proposed for the nurture of foundlings’ (undated), LMA, A/FH/M01/ 8/201-4; Correspondence, 30 April 1757, LMA, A/FH/A06/1/10/7; 27 September 1758, LMA, A/FH/A06/1/11/8. 19 See, for example, M.-F. Marel, ‘À quoi servent les enfants trouvés? Les médecins et le problème de l’abandon dans la France du XVIIIè siècle’, in École Française de Rome (ed.), Enfance abandonnée, pp. 840–50; G. Cappelletto, ‘Gli affidamenti a balia dei bambini abbandonati in una comunità del territorio veronese nel settecento’, ibid., p. 327; J. Robins, The lost children, p. 16; Levene, ‘Health and survival chances’, pp. 167– 71; Fildes, Wet nursing, pp. 156–7. 20 General Committee minutes, 23 June 1756 and 3 May 1758. 21 General Committee minutes, 22 March 1758. 22 General Committee minutes, 11 January 1758. 23 McClure, Coram’s children, p. 195. Farinaceous foods should be given only as supplements to a milk-based diet; children fed on this alone tend to waste, and are prone to stones, since the diet has high levels of calcium and vegetable protein, and low levels of vitamin A and animal products. See W. B. Cheadle, Principles and conditions of artificial feeding (6th edition, London, 1906), p. 121; Fildes, Breasts, bottles and babies, pp. 214–16. 24 General Committee minutes, 6 April 1757; Correspondence, 17 November 1756, LMA, A/FH/M01/2/23. 25 General Committee minutes, 22 September 1756. 26 General Committee minutes, 8 May 1759. 27 General Committee minutes, 3 October 1758, 6 August 1777. 28 Correspondence, 25 Oct 1760, LMA, A/FH/A06/1/13/5/8. 29 Too few infants had an age at admission recorded for age at death rather than time elapsing since abandonment to be calculated.

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30 Kertzer and White, ‘Cheating the angel-makers’, p. 459. This practice was not forbidden by the London hospital. 31 Kertzer, Sacrificed for honor, p. 147; D. L. Ransel, ‘Abandoned children of imperial Russia: village fostering’, Bulletin of the History of Medicine, 50:4 (1976), p. 508. 32 Correspondence, 2 May 1763, LMA, A/FH/A06/1/16/11/11. 33 Clark (ed.), Correspondence, p. 30. 34 Correspondence, 14 January 1759, LMA, A/FH/A06/1/12/11/94. 35 For other examples, see Clark (ed.), Correspondence, p. 69; Correspondence, 26 February 1760, LMA, A/FH/A06/1/13/5/11. 36 General Committee minutes, 18 June 1760. 37 See, for example, General Committee minutes, 5 July 1758. 38 Correspondence, 29 December 1772, LMA, A/FH/A06/1/25/11/34. 39 Correspondence, 5 January 1773, LMA, A/FH/A06/1/26/10/31. 40 Correspondence, 8 January 1773, LMA, A/FH/A06/1/26/10/33. 41 Correspondence, 9 May 1773, LMA, A/FH/A06/1/26/10/3 and 4. 42 General Committee minutes, 10 October 1744. 43 Correspondence, 20 June 1772, LMA, A/FH/A06/1/25/11/33; 28 August 1759, LMA, A/FH/A06/1/12/5/26. 44 Correspondence, 26 January 1767, LMA, A/FH/A06/1/19/12/42; 1 February 1767, LMA, A/FH/A06/1/20/12/6; General Committee minutes, 15 June 1757. 45 General Committee minutes, 5 July 1757. 46 The children are not restricted to those entering in the General Reception, since there is less danger of the seasonality of death being related to the seasonality of birth or admission for those surviving for a year or more. 47 L. G. Wilson, ‘Fevers’, in W. F. Bynum and R. Porter (eds), Companion encyclopaedia of the history of medicine (2 vols, London and New York, 1993), pp. 382–411. 48 I. Taylor and J. Knowelden (Principles of epidemiology (2nd edition, London, 1964), pp. 207, 236–40, 248–59) cite modern examples of similar paths and risks of disease transmission in populations of children. 49 These resources represent those identified by McKeown and Brown as new to the eighteenth century: the expansion of hospital provision and medical staffs; advances in medical education (which the hospital sometimes helped to further, as in the case of smallpox inoculation); greater understanding of anatomy (again, assisted by the autopsies which were sometimes carried out on foundlings to determine cause of death), and the development of a protective therapy in the form of smallpox inoculation. T. McKeown and R. G. Brown, ‘Medical evidence related to English population changes in the eighteenth century’, in D. V. Glass and D. E. C. Eversley (eds), Population in history: essays in historical demography (London, 1965), p. 286. 50 General Court minutes, 1 October 1740. See also General Court minutes, 25 June 1755 and 12 May 1756.

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51 J. C. Riley, The eighteenth-century campaign to avoid disease (Basingstoke, 1987); M. Dobson, Contours of death and disease in early modern England (Cambridge, 1997), pp. 9–42. Many letters survive in the hospital archive on the topic of ventilation and wholesome air, particularly in the infirmaries. See, for example, Correspondence, 26 Nov 1756, LMA, A/FH/M01/2/45-8, and ‘Notes on medical conditions and treatment’ (undated), LMA, A/FH/M05/130-7. 52 General Committee, 22 July 1752. In May 1741, the General Committee had agreed that no child was to be accepted who had skin eruptions or any other infectious disease, evident or suspected (General Committee minutes, 20 May 1741). 53 General Committee, 7 June 1780. This condition may have been head lice, or the ubiquitous ‘scald head’ (ringworm of the scalp). 54 C. Creighton, A history of epidemics in Britain (2nd edition, 2 vols, London, 1965), pp. 632–43. 55 Sub-committee minutes, 28 May 1768, LMA, A/FH/A03/5/7; General Committee minutes, 2 May 1770. Creighton notes that it was only in public institutions that measles and scarlatina were more virulent than smallpox (History of epidemics, p. 646). For the importance of the ‘crowding factor’ in increasing opportunities for the spread of the disease, see A. Cliff, P. Haggett and M. Smallman-Raynor, Measles: an historical geography of a major human viral disease (Oxford, 1993), p. 35. 56 W. Watson, ‘An account of the putrid measles, as they were observed at London in the years 1763 and 1768’, Medical Observations and Inquiries by a Society of Physicians in London, 4 (1771), pp. 132–55. 57 The average age at death was five and a half years. 58 Cliff et al. (Measles, pp. 24–6) note all these symptoms as known immediate complications of measles and as ‘relatively common’. 59 ‘Minutes of the committee of enquiry upon Dr Mayo’s representation begun 7th January, 1790 and continued to 26th March 1790’, LMA, A/FH/A03/ 9/1, pp. 2 and 104. 60 Ibid., p. 2. 61 B. Bolker and B. Grenfell, ‘Are measles epidemics chaotic?’, Biologist, 39:3 (1992), pp. 108–10; R. M. Anderson (ed.), Population dynamics of infectious diseases: theory and applications (London, 1982), p. 40. 62 General Committee minutes, 7 February 1776. 63 Correspondence, 9 December 1772, LMA, A/FH/A06/1/25/11/3. 64 General Committee minutes, 13 March 1753. 65 Correspondence, 7 November 1763, LMA, A/FH/A06/1/16/11/47. 66 General Committee minutes, 18 August 1762, 20 February 1765, 28 June 1769. 67 Cliff et al., Measles, p. 58. Ackworth burial register, Society of Genealogists, London, YK/REG/4/942. See also Chapter 8. 68 Creighton (History of epidemics, Vol. 1, p. 48) notes that infantile diarrhoea was one of the greatest causes of death for London children from the Restoration onwards. Like its fellow cause of death ‘convulsions’,

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69 70 71 72

73

74

75

76

77

78

79

80 81 82

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however, the term does not actually indicate the underlying cause, but the final symptom before death. Taylor and Knowelden, Principles of epidemiology, p. 281. Correspondence from Ackworth, 11 June 1766 (copies held at Ackworth School). Correspondence, 13 January 1753, LMA, A/FH/A06/1/6/1. General Committee minutes, 6 April 1759. The Brill was used for ‘ye diseased and weak children of this hospital’ (General Committee minutes, 26 January 1757). General Committee minutes, 2 February 1780. Powis Wells had earlier been used by children with skin conditions, scrofula and eye complaints, who were found to benefit from drinking its waters. ‘Minutes of the committee of enquiry upon Dr Mayo’s representation’. Dr Mayo blamed the poor state of the foundlings in the hospital on exposure to cold and moisture, and food which was hard to digest and deficient in nourishment. The Account of the hospital of 1796 (LMA, A/FH/A1/6/1) confirmed these poor conditions, stating that the infirmary was ‘destitute of convenience’ and ‘bidding defiance to medical skill’. The account also praised the improvements in the infirmary after the investigations of 1790. J. Landers, ‘Age patterns of mortality in London during the long eighteenth century: a test of the ‘High Potential’ model of metropolitan mortality’, Social History of Medicine, 3:1 (1990), pp. 52–5, and Landers, Death and the metropolis, pp. 94–101, 113–20 and 152–6. Creighton, History of epidemics, Vol. 2, pp. 471–98. G. Miller (‘Smallpox inoculation in England and America: a reappraisal’, William and Mary Quarterly (1956), pp. 480–91) regards Sloane as ‘probably the most influential agent for the successful promotion of inoculation in England’ in the 1720s. Dobson, Contours of death and disease, p. 77. See also S. R. Duncan, S. Scott and C. J. Duncan, ‘The dynamics of smallpox epidemics in Britain, 1550–1800’, Demography, 30:3 (1993), pp. 409–14; D. R. Hopkins, Princes and peasants: smallpox in history (Chicago, 1983), pp. 3–5. See, for example, McKeown and Brown, ‘Medical evidence’, p. 292; P. Razzell, The conquest of smallpox: the impact of inoculation on smallpox mortality in eighteenth-century Britain (Firle, 1977), p. 143; P. E. Razzell and L. Bradley, ‘Smallpox: a difference of opinion’, Local Population Studies, 10 (1973), p. 68; P. E. Razzell, ‘The smallpox controversy’, Local Population Studies, 12 (1974), p. 42; T. McKeown, The modern rise of population (London, 1976), pp. 12–16; Creighton, History of epidemics, pp. 517–31; A. J. Mercer, ‘Smallpox and epidemiological-demographic change in Europe: the role of vaccination’, Population Studies, 39 (1985), pp. 287–307. General Committee minutes, 8 June 1743. General Committee minutes, 15 November 1749. Correspondence, 12 March 1765, LMA, A/FH/M01/2/132-5.

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83 General Committee minutes, 15 June 1763, 19 December 1781. 84 Correspondence, 5 October 1761, LMA, A/FH/A06/1/13/12/27. See also Correspondence, February 1762, LMA, A/FH/A06/1/15/10/6. 85 ‘An account of children inoculated since March 1759–69’, LMA, A/FH/ M01/006/62. Experiments into different methods of inoculation were tried occasionally, but the hospital continued to inoculate up to the end of the century, despite Jenner’s discovery of vaccination in 1789. See General Committee minutes, 7 April 1756, 10 October 1759. See also Creighton, History of epidemics, pp. 500–1; McClure, Coram’s children, p. 208. 86 Correspondence, June 1765, LMA, A/FH/A06/1/18/11/17. 87 General Committee minutes, 19 June 1771; Correspondence, 7 July 1771, LMA, A/FH/Q/12. 88 General Committee minutes, Ackworth, 12 July 1775, LMA, A/FH/Q/12. 89 Vipont, Ackworth School, p. 22. 90 Buchan particularly noted the prevalence of scabbed heads at the Ackworth hospital (Domestic medicine, p. 445). 91 McClure, Coram’s children, p. 216, and more generally, pp. 116–20. 92 For a fuller discussion of such treatments, see McClure, Coram’s children, pp. 216–18, 237–40. 93 For example, in 1774, a Mr Joseph Law offered to take them at £10 each per year for at least five years. See General Committee minutes, 22 June 1774 and 3 March 1779. 94 Minutes of the Ackworth Committee, 7 December 1772, LMA, A/FH/ A06/1/25/11/79. 95 General Committee minutes, 24 July 1771, 22 September 1773, 25 March 1795. Other foundlings had money set aside for them every year for when they turned twenty-one. See, for two examples of a foundling with a longterm scrofulous complaint and one with unintelligible speech, General Committee minutes, 8 March 1758. 96 McClure, Coram’s children, pp. 198–9 and 200–4. The dietary was reviewed frequently, and changed on medical advice. See General Committee minutes, 13 March 1740/41, 22 January 1755, 3 November 1762, 13 November 1782, 20 November 1782, 4 August 1790. For comparison with workhouse dietaries, see Pinchbeck and Hewitt, Children in English society, Vol. 1, pp. 153–4, and A. Digby, Pauper palaces (London, 1978), pp. 23 and 45–6. 97 Correpondence, 12 August 1766, LMA, A/FH/A06/1/19/12/17. See also Correspondence, 16 August 1769, LMA, A/FH/A06/1/22/9/55. 98 Levene, ‘Health and survival chances’, pp. 184, 162–4. 99 Correspondence, 28 October 1758, LMA, A/FH/A06/1/11/30.

8

Foundlings and the local demographic context

this to Remember my Garle for Ever . . . Note left with child 3734, Constance Dyer Abandoned 12 March 1757 Died 6 April 1765

This chapter takes up some of the issues discussed in the previous one, by tying the health and mortality experiences of the foundlings to the local context of their nursing parishes. The partial family reconstitutions for the four case-study parishes introduced in Chapter 6 will be outlined in greater detail, and exploited for what they can tell us about the risks to life for infants growing up in Chertsey, Epsom, Ackworth and Hemsworth and, by implication, also for the foundlings living alongside them. The differences between the four parishes will be explored, as will the impact the foundlings had both on the demographic picture left behind in their records and on wider social and cultural themes. The demographic analysis reported here is specifically confined to a consideration of infants. This is primarily because the focus of this study is infants and young children, but also because one can be relatively confident that infants remained present in the parish throughout their first year.1 Family reconstitution and the case-study parishes The technique of family reconstitution is well established, and is exemplified for English data in the work of the Cambridge Group for the History of Population and Social Structure, although many others have now applied it also.2 It relies on the linkage of baptisms, marriages and burials to create family groups whose demographic behaviour can be studied at various levels of aggregation. With the advent of rapid computerised linkage techniques, the process has become much quicker and more feasible for the individual to perform. For the current study,

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it was carried out with the specific intentions of identifying nurses and their family groups and calculating IMRs. The process is thus a partial one, since little attention is paid to the complexities of fertility calculations, or the need to make generational links over a long time-period.3 There are several requirements which parish registers must meet in order to be used for family reconstitutions.4 Firstly, they must survive for a long time-period, generally at least a century. In this case, the period being used is slightly less than this (1715 to 1800), because attention is focused specifically on the period of the Foundling Hospital’s main activity. The start date was selected in order to maximise the chance of capturing the nurses’ baptisms (although as Chapter 6 showed, this was in fact rarely successful). A long period was nonetheless desirable to prevent IMR calculations foundering on small numbers. The Epsom marriage register is kept patchily for the beginning of the period, but then recovers. The other registers do exist unbroken over the period. The second requirement concerns the quality of the registers. It is important that extra detail other than simply the person’s own name be recorded in baptism and burial records, so that they can more confidently be linked to other entries. In this case, it is especially important that at least one parent’s name be recorded, to make sure that the child is linked to the correct marriage. It should be noted at the outset that not all the registers fulfil this requirement for the whole period. While the registers for Ackworth and Hemsworth are particularly well kept, those for Chertsey and Epsom are less good, and Epsom in particular has periods where the father’s name is not recorded in burial entries and occasionally also baptism entries. The deficiency was overcome as far as possible by sorting all entries by their surnames and dates; where a burial was denoted as one of an infant or child, a link with a baptism was still possible. In other cases, however, they could not be verified by any other independent information, and it is highly likely that the resulting IMR calculations are an underestimate. The degree of underestimation will be discussed below. The extra detail in the Yorkshire registers is worthy of some comment, as it renders them especially suitable for reconstitution. Roger Bellingham has drawn attention to a corpus of registers centring on West Yorkshire, although appearing also around Durham and Lancashire, which contain a wealth of detail from the 1770s onwards.5 The baptism records frequently include the child’s date of birth (very significant for establishing accurate mortality rates and periods of risk), and the mother’s and sometimes even grandparents’ names as well as the father’s. The burial records include date of death, a precise age and the cause of death. Occupational information is also often given, and notes on

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where in the parish the subject was from. The detailed nature of the registers appears to have been the result of instruction from Archbishop Markham in 1777, given to ensure that registers stood up as legal evidence, and the fullest of the records are known as ‘Dade registers’, after the clergyman who initiated the reform. Despite their exceptional detail, however, extremely little work has been carried out on them.6 The Ackworth registers contain elements of the Dade characteristics, even before the time of Markham’s instruction. The baptism register contains dates of birth from 1744, and mothers’ names from 1753, and dates, ages and causes of death are present in the burial registers from 1755 (ages and causes alone from 1744). The Hemsworth baptismal registers record the mother’s name more patchily from around 1770, and never give dates of birth. The burial register is similarly a well-kept version of the standard, with causes and ages at death rarely given. Nonetheless, the level of detail given gives some cause for confidence that, for example, the identification of foundling burials will be straightforward. It is worth pausing to note that the exceptional state of the Ackworth registers from so early a date appears to have been the result of the efforts of the rector: none other than the Revd Timothy Lee, who also attended the Ackworth foundling inspection and branch hospital so assiduously.7 Several of the problems usually associated with the use of parish registers for family reconstitution may, therefore, be avoided for Ackworth, and perhaps Hemsworth as well. In particular, where family details are so uniformly given, there is considerably less danger than usual of matching children to the wrong family, or of having to leave them out altogether. If there is a problem of coverage, it is more likely to centre on whether certain individuals or groups of individuals failed to register demographic events at all, rather than on whether a full and accurate copy of the event was recorded in the register. We can be much less certain about the integrity of the Surrey registers. In all cases, other, more general problems of coverage remain. In terms of non-attendance at the Anglican church, none of the four parishes seems to have had large nonconformist populations, and certainly none has records surviving. In fact, the 1743 Visitation of Hemsworth recorded 118 families, and no dissenters.8 Migrating families may be more of a problem in the Surrey parishes, given the market- and pleasure-town nature of the communities. People may have been quite mobile in the short term, and burials of visitors and short-term migrants may have been entered in the parish registers. Finally, it is hard to quantify how frequently the deaths of unbaptised infants were recorded. Evidence suggests that burials of unbaptised infants were recorded in Epsom (in that there appears to

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Figure 8.1 Frequency of vital events, 1715–1800, five-point moving average: Ackworth 45 40 Number of events

35 30 25 20 15 10 5

Marriage

Baptisms

Burials inc foundlings

1799

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1787

1781

1775

1769

1763

1757

1751

1745

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1733

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Burials

Source: Parish reconstitutions (for sources see text).

be no corresponding baptism for some burials designated as those of infants), but with no age at death given, it is difficult to know whether to include them in mortality calculations. The Ackworth burial register records a handful of deaths occurring very early in life, but we cannot be sure that because the burial entries are detailed they necessarily covered all events that actually took place.9 No entries are noted specifically to be of unbaptised infants. It should be noted that these are provisos which apply to all studies based on parish registers. Although extra care should be taken in interpreting the Surrey results, there is not undue cause for alarm over the value of the reconstitution. With the background state of the registers established, we may turn to an examination of population, and especially mortality, trends in the four parishes. Figures 8.1 to 8.4 show the frequency of baptisms, marriages and burials recorded over the period.10 Population figures for the parishes in 1801 were given in Chapter 6. The numbers of foundling burials as denoted in the registers are also shown, in order to illustrate the impact that they made on the demographic record. The use of the five-point moving average smooths the sharp spike of foundling burials seen in some parishes; the numbers in certain years are even higher than these figures suggest.

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Figure 8.2 Frequency of vital events, 1715–1800, five-point moving average: Hemsworth 45 40 Number of events

35 30 25 20 15 10 5

Marriages

Baptisms

Burials inc foundlings

1793

1787

1781

1775

1769

1763

1757

1751

1745

1739

1733

1727

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Burials

Source: Parish reconstitutions.

Figure 8.3 Frequency of vital events, 1715–1800, five-point moving average: Epsom 120

Number of events

100 80 60 40 20

Marriages

Baptisms

Source: Parish reconstitutions.

Burials inc foundlings

Burials

1799

1793

1787

1781

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Figure 8.4 Frequency of vital events, 1715–1800, five-point moving average: Chertsey 120

Number of events

100 80 60 40 20

Marriages

Baptisms

Burials inc foundlings

1799

1793

1787

1781

1775

1769

1763

1757

1751

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Source: Parish reconstitutions.

The registers of all four parishes show evidence of growing populations. In Ackworth, baptisms rose sharply from just after mid-century, pulling away from the trend in burials. The numbers of marriages per year also rose, while burials remained relatively static. This all indicates an expanding population, especially from around 1750. In Hemsworth, the evidence is for even greater expansion, with the number of baptisms always being higher than the number of burials throughout the period. The rise in baptisms came earlier, but then levelled off from the 1750s. There was more fluctuation in the level of burials, and marriages also showed a gradual rise. In Epsom, baptisms did not out-run burials until the 1770s, which suggests either an initially declining population or one dependent on immigration for expansion. We should not rule out the possibility of under-registration of baptisms, especially given that there were apparently infants buried who had not been baptised. There was less movement in the frequency of burials and marriages over the period, once the registration of marriages became more complete. In Chertsey also, numbers of baptisms were initially close to those of burials, but pulled away significantly from the 1760s. Mortality levels were relatively static, with the notable exception of a spike in the late 1750s and early 1760s. There was also some growth in marriages towards the end of the century, another feature indicative of a growing population.

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In terms of the legacy left by the foundlings on the parish registers, the picture is variable. In Ackworth, the dotted line above the main burial trend-line shows that there was clear evidence of foundling burials in the 1760s and 1770s. This conforms to what we know of the ages and arrival dates of the foundling children who were sent to the Ackworth inspection. In Hemsworth, foundling burials appear from earlier on, and extend for a longer period of time. Again, this fits in with the fact that Hemsworth was one of the earliest nurseries to be established, and suggests that the burials of foundling infants and children were regularly noted in the register. Likewise, in Epsom, the large number of infant foundlings received during the General Reception is reflected in a peak of foundling burials in the late 1750s and early 1760s, although burials seem to climb independently later in the decade. In Chertsey, however, the foundling infants apparently had almost no impact in the burial register until after the end of the General Reception. At face value at least, the large spike in deaths in the late 1750s and early 1760s was internal to the parish. This large, isolated rise in burials in Chertsey at the time of the General Reception was possibly due to a local epidemic.11 The fact that we know that this was precisely the time when hundreds of vulnerable infants came to the area, however, makes this unlikely. It seems much more plausible that some of the extra burials were those of foundlings whose status was not recorded in the register. If so, this may be of considerable significance for studies of the large number of parishes where foundling infants were sent in the mid-eighteenth century. If they are not demarcated as such, they may be responsible for peaks in mortality which could be erroneously attributed to local conditions. In order to test this hypothesis, the burials of all individuals who were not linked to a family by a marker such as ‘son’, ‘daughter’ or ‘wife’ and who were not denoted to be an adult by age or occupation were searched for manually in the Foundling Hospital Inspections Books and General Registers. This linkage exercise had the most dramatic impact on the numbers of foundling burials identified for Chertsey, as might be expected. There, the number of such burials rose from 118 to 276, accounting entirely for the General Reception-era spike in mortality. Some of the burials which were noted to be of foundlings could not be linked to the hospital registers, as the name of the child was not given. Whether this is indicative of an uninterested attitude from the parish clerks, or of details being lost in an increased administrative load, is debatable. There was only one case of a ‘dropped child’ being baptised in Chertsey, while four ‘nurse children’ who could not be linked to foundling registers were buried. There is no evidence of foundlings or nurse-children who were unrelated to the hospital in the other parishes. The linkage exercise

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confirmed that more burials were those of foundlings than appears at first sight in the Yorkshire parishes also. The number of such burials in Ackworth rose from 165 to 181, and in Hemsworth from 52 to 77. In both cases, the relevant entries were generally demarcated in some way, as either ‘orphan’ or ‘from London hospital’. Without links to the hospital registers these were not felt to be consistently safe enough to take at face value, however, especially the non-specific ‘orphan’. The effect was to raise the number of foundling burials in 1764 in Ackworth. In Hemsworth, the extra foundling burials were mainly from the early years of the General Reception, making the rise in burials a more consistent one from 1756 to the mid-1760s. Epsom seems to have had the most consistent and thorough system of recording foundling burials, despite the other deficiencies in its registers. There, only five further foundlings were identified, raising the total number from 190 to 195. In this case, the nurslings seem to have arrived at a time of low local mortality, which then rose later in the 1760s, independently of foundling burials. It seems, then, that the demarcating of foundling burials was variable, and we should certainly be aware of the possibility that they may silently appear in many registers for Essex, Middlesex, Kent and Surrey for this period. The fact that foundling burials were not always denoted as such in Chertsey registers raises again the possibility that there might be problems with quality. The quality of parish registers depended very much on the conscientiousness of the individual making the record, and this might change several times over the course of several decades.12 The nature and extent of any deficiencies thus might not be consistent for the whole period under study. One way of assessing whether certain types of events were under-recorded generally is to measure them against comparable national figures. A count of illegitimate baptisms, for example, can easily be compared with the ratio calculated for other parishes. Illegitimacy ratios (the percentage of all baptisms which were out of wedlock) were quite variable from place to place, depending on local marriage and courtship customs, the degree of surveillance of the young and the attitude of parish clergy to unwed mothers.13 Significantly low levels of illegitimacy, however, might point to a lack of coverage in baptismal registers. Table 8.1 gives illegitimacy ratios and levels of prenuptial pregnancy for the four parishes. Prenuptially conceived baptisms are those which are recorded at 270 days or fewer from the marriage date, and have been found to comprise up to 30 per cent of all first births in national studies.14 Ackworth, Hemsworth and Chertsey all show a remarkable concurrence with this figure. In Epsom, however, only 17.2 per cent of

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Table 8.1 Illegitimacy ratios and rates of prenuptial pregnancy in four case-study parishes, 1715–1800 Illegitimacy ratio (% of all baptisms)

Pre-nuptial pregnancy (% of all first baptisms)a

Ackworth

4.3

30.0

Hemsworth

4.5

30.2

Chertsey

5.0

30.2

Epsom

1.5

17.2

National mean average 1750–74

4.1

31.0

a

Baptisms associated with dummy marriages were excluded. Sources: Parish reconstitutions. The national illegitimacy figure is from Peter Laslett, ‘Introduction’, in Laslett et al., Bastardy, pp. 14–15, Table 1.1a (mean of means), based on 98 parishes. Pre-nuptial pregnancy information is from Wrigley et al., English population history, p. 421.

children were conceived pre-maritally. Similarly, Ackworth, Hemsworth and Chertsey all yield illegitimacy ratios which are similar to those found by Peter Laslett for 98 English parishes. Epsom, however, has a significantly lower ratio, with only 1.5 per cent of baptisms being out of wedlock. It is possible that this parish genuinely did have high levels of sexual propriety, but the contrast with Chertsey makes this less likely. Instead, it seems that under-registration of illegitimate and pre-nuptially conceived births is responsible, perhaps in relation to the higher risks of illegitimate infants dying early in life and therefore before baptism. Because some baptism entries have no information at all on parentage, however, it is also difficult to distinguish between those which occurred outside marriage and those with missing data. Both cases point to deficiencies in registration. Further, a considerably larger proportion of baptisms could not be related to a marriage in Epsom, necessitating the creation of dummy marriages for the purposes of the reconstitution. In the Hemsworth reconstitution, 48 per cent of marriages were dummy ones, in Ackworth 53 per cent, and in Chertsey 61 per cent. In Epsom, the percentage was 70. A high proportion of dummy marriages might be indicative of high levels of in-migration, with couples moving in after marrying elsewhere. It was noted above that this might well be the case in both Surrey parishes, which were centres of trade and resort.15 Nonetheless, the high

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proportion of marriages of this type is also suggestive of deficient registration: either people were not marrying in the Anglican church, or records were not being made of all those events. In all cases, the proportion of dummy marriages fell after the change to a printed pro-forma for marriage registration in 1754.16 This suggests that a tightening-up of the requirements did improve the extent of registration. Chertsey and Epsom continued to have higher proportions of dummy marriages, however, and Epsom the highest of all.17 The degree of under-registration generally cannot be quantified, especially since it may have varied considerably over the period. These brief exercises have, however, pointed out the need for caution in assuming full coverage of events in Epsom in particular. In the discussion which follows, we will be mainly concerned with burials, but the loss of certain types of baptism entries affects the pool of infants used for calculating accurate mortality rates. The impact of this will be discussed in greater detail below. Infant mortality With the foundlings identified and removed from the burial count, we may now proceed to the calculation of infant mortality rates for the four parishes. The rate consists of the number of burials calculated through linkage to be of infants under the age of one, related to the total pool of baptisms of legitimate children (excluding any with missing information). Table 8.2 gives the IMRs calculated for the four parishes. It is immediately apparent that the IMRs calculated via family reconstitution for the four parishes are very low in comparison with those in other studies. Only in Chertsey does the rate even approach the 162.8 per thousand for the period 1750–75 calculated for twenty-six English parishes by Wrigley et al., although a rate of 116.9 is within the range

Table 8.2 Infant mortality rates (IMRs) in four case-study parishes, 1715–1800 IMR

N infant burials

Ackworth

58.0

100

Hemsworth

74.8

120

Chertsey Epsom Source: Parish reconstitutions.

116.9

707

75.2

259

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found for the twenty-six parishes taken individually.18 The rates for all four parishes were calculated in the same way, in order to preserve as much comparability as possible: they were all based on dates of baptism even where a date of birth was available, and infants denoted as being under the age of one were not included unless a corresponding baptism could be found. Some of this extra information can, however, be used to expand the possible number of infant burials in observation. It is likely that a number of infant burials were not included in the above calculations, especially in Epsom. This is because links were not made with burials with no corroborative information if there was anyone else of the same name in the registers who could have died at that time. For example, one James Brown was baptised in Epsom on 8 September 1799, son of James and Hannah. A James Brown was buried on 19 January 1800, but the burial was not indicated to be of an infant. The burial entry had no parents’ names given, and since there were other James Browns in the register (including the baptised child’s father, who did not register the baptisms of any more children), a link was not made. This is especially problematic when, as here, the surname was a common one. The most likely effect of this is that some infant burials are missed. While this cannot be precisely compensated for, a correction can be offered by including all burials labelled as infant ones, even where no link was made with a baptism, in order to maximise the information we do have.19 Where there was no corresponding baptism, the denominator pool should also be inflated by one. In other cases, however, as with James Brown, above, the baptism may already be counted. Table 8.3 gives corrected IMRs calculated by both methods, firstly adding all extra burials to the ‘at risk’ pool, and secondly adding none. Neither is likely to be accurate, but the two offer opposite ends of a

Table 8.3 Corrected IMRs in four case-study parishes using unlinked infant burials, 1715–1800 Corrected IMR: pool not inflated

Corrected IMR: pool inflated

N unlinked infant burials

Ackworth

77.1

75.7

33

Hemsworth

75.4

75.3

1

Chertsey

168.0

159.8

309

Epsom

169.5

154.9

326

Source: Parish reconstitutions.

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range of possible inflators. The exercise depends very much on the individual registers; in Hemsworth only one burial in the entire period was specified to be that of an infant, whereas in Epsom and Chertsey it was more common to label burials of babies. In the remaining parishes, however, a substantial difference is made by including the unlinked infant burials. Over 300 infant burials had remained unlinked to baptisms in Epsom and Chertsey, and even at the most conservative estimation, the resulting mortality rates are much more plausible compared with those in other English reconstitutions. The Epsom IMR is inflated by between 206 and 226 per cent, that for Chertsey by 137 and 144 per cent, and that for Ackworth by 131 to 133 per cent. Since the registers record infants in different ways, we cannot assume that any one of these inflators may be applied to the other parishes. As a check, however, the age at death information in the Ackworth burial register indicates that in only one case was an entry labelled ‘infant’ but actually referred to a child over the age of one. We can only hope that Chertsey and Epsom officials were similarly accurate, but the lack of corroborating age information makes this impossible to verify. Another correction which can be offered to the original reconstitution rates takes into account the lag which elapsed between birth and baptism, meaning that infants may appear up to two months younger than they really were.20 Wrigley offers a correction to IMRs which is based on the proportion of deaths in the first year that should theoretically take place within the first month.21 The application of this method results in rates in three cases which are closer to those of other English parishes: a range between 162.7 and 207.2 per thousand for Hemsworth, 70.5 and 88.6 for Ackworth, and 123.0 and 153.8 for Epsom. The resulting rate for Chertsey is notably high compared with the national average, however: 251.7 to 314.6, which at its upper range is closer to that of London than those of any of the non-metropolitan reconstituted parishes.22 The disparity between the neighbouring parishes of Ackworth and Hemsworth highlights how far the method depends on the coverage of infant deaths over the course of the first year (as will be commented on further below). Chertsey’s market-town status probably gave it a relatively high level of traffic in pathogens, but it seems very unlikely that it would outstrip other reconstituted market towns. The corrective method was based on the south-west rural-industrialising parish of Colyton, and perhaps cannot be applied in the same measure to other types of parishes. While this method is instructive in indicating a possible range of IMRs, it seems unwise to take these figures as accurate reflections of mortality.

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We now have a range of possible IMRs for the four parishes, although it is likely that the Hemsworth rates may still be an underestimate because of the lack of labelling of infant deaths. As Wrigley has warned, however, we should not necessarily assume that low rates are implausible. The Yorkshire parishes reconstituted by the Cambridge Group have among the lowest IMRs of the whole group.23 The agricultural parishes were also found to be the healthiest when grouped by economic type. Ackworth and Hemsworth were agricultural parishes, in what was perhaps a healthy part of the country. A nineteenth-century commentator on Ackworth certainly stated proudly that local death rates were very low.24 Steven King has also found comparatively low levels of infant mortality in the industrialising West Riding township of Calverley-cumFarsley.25 IMRs in the 70s per thousand may still be on the low side, but it may not be unrealistic to think that rates actually were below average. Chertsey and Epsom were also in a part of the country noted for its good health, but they were more akin to the Cambridge Group’s market-town group of parishes in terms of economic profile. This group had IMRs almost twice as high as those of the agricultural parishes (240 per thousand between 1675 and 1749).26 Using all unlinked infant deaths, the higher of the corrected IMRs for Chertsey and Epsom place them among the retail trade parishes in the Cambridge Group typology. This is probably a reasonable description of the two Surrey parishes.27 Ultimately, we can make no safe assurances of precise infant mortality rates for the four parishes, especially since the quality of the registers reminds us that we are not comparing like with like. We may push the analysis of the original rates a little further, however, to see the shape of mortality as it accumulated over the first year. This will give us a greater insight into where in the first year we may be missing infant deaths, and provide a check on their overall reliability. Figure 8.5 shows the biometric plot of the original mortality rates presented in Table 8.1. This follows a method first published in English by Jean Bourgeois-Pichat in 1951, and is designed to divide infant mortality into its component parts: the endogenous part, which arose from congenital defects and problems arising from birth trauma; and the exogenous part, which accrued from exposure to infection after birth.28 It consists of a plot of cumulative mortality against a logarithmic transformation of age at death. Bourgeois-Pichat found that a dataset with a full range of first-year mortality lay on a straight line when subjected to the log transform, cutting the vertical axis at the point representing the endogenous mortality rate. Here, we are not so much concerned with the niceties of exact endogenous and exogenous rates, which have

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Figure 8.5 Biometric analysis of cumulative infant mortality, four case-study parishes, 1715–1800

Cumulative infant mortality rate

125 Ackworth Hemsworth Chertsey Epsom

100

75

50

25

0 1 week

1 month

2 months

3 months Age at death

6 months

9 months 1 year

Source: Parish reconstitutions (I am grateful to Peter Kitson for creating this figure).

in any case been challenged in favour of neonatal and post-neonatal categories, but more with the overall shape of the graph.29 The shapes of the trend lines shown in Figure 8.5 are very instructive. The accumulation of deaths in both Chertsey and Hemsworth lie very close to a straight line, indicating that there was not significant under-registration at particular ages. The fact that they intersect the vertical axis at similar points is also a reassuring suggestion that they may not be very inaccurate at this point of the graph. The level of endogenous mortality in these parishes is low, but conforms to the trend of falling early mortality over the eighteenth century.30 The divergence of the two lines after this point may be indicative of the disease environment of the two places, with Hemsworth infants accruing deaths more slowly and to a lower end point than those in Chertsey. The Ackworth data conform to the picture of low endogenous mortality, but mortality then fails to accrue at a high enough rate to keep the line straight. It is possible that this indicates a very benign disease environment for young infants, but since the line is almost horizontal in the first month, this would imply that no deaths in this period occurred as a result of external (exogenous) causes. This seems very unlikely, and we must

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conclude that there is some under-registration of early deaths. This may represent deaths that occurred before baptism: in Ackworth, the lag between birth and baptism was approximately one month, which was about average for the eighteenth century.31 The graph for Epsom confirms the conclusions on under-registration put forward already. There are clearly large numbers of very early deaths missing, resulting in the line crossing the horizontal axis just before it reaches the vertical. There also seems to be a falling-off at the other end of the first year, as the trend line once again dips to form a convex upper surface. Between one and three months, deaths seem to accumulate at a similar rate to that seen for Chertsey, but in other respects, the graph is indicative of considerable under-registration. It would be very interesting to know more about the nature of the infant mortality regimes in the case-study parishes. Were deaths concentrated in certain families, for example, or in certain parts of the parish as Steven King and Pat Hudson have shown to be the case in Calverley and Sowerby?32 Such an ‘enriched’ reconstitution is beyond the scope of the current study, even if the sources existed. What we can do, however, is take further the comparison between infants growing up in Chertsey, Epsom, Ackworth and Hemsworth and the foundlings who spent some of their lives with them. The remainder of this chapter will examine two particular topics: firstly, the seasonal patterns and causes of death among infants in the case-study parishes compared with what we know of the foundlings’ patterns of mortality; and secondly, the impact which the foundlings had on the parishes, both in terms of mortality and more widely. Foundling infants and local infants The seasonal pattern of burials for all local infants (including those not linked to a baptism) is shown in Figure 8.6. The data for Hemsworth and Ackworth are conflated, because each only had a small number of infant burials per month. Chertsey shows the smoothest pattern of seasonal mortality, which is probably related to the larger number of infant burials in this parish. Both of the remaining trend-lines are subject to greater month-by-month fluctuation, although they conform to a general pattern of highs in the winter and early spring. The notable anomaly is the secondary peak in September and October in Epsom. The October high consists mainly of burials under the age of six months, which makes it unlikely that it represents weanling infants. It is also interesting to note that there is a slight peak in burials in April in Epsom, given the peak in that month among foundling infants being nursed there. This

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Figure 8.6 Seasonal patterns of burials in four case-study parishes, 1715–1800 200 180 160

Index

140 120 100 80 60 40 20 0 Jan

Feb

Mar

Apr

May

Jun

Hemsworth and Ackworth

Jul

Aug

Sep

Chertsey

Oct

Nov

Dec

Epsom

Note: N = 1015 for Chertsey, 545 for Epsom, and 268 for Hemsworth and Ackworth. Source: Parish reconstitutions.

raises the possibility that the foundlings were being affected by a period of infectious disease locally. The General Reception period was not one of raised mortality generally in Epsom, so it is possible that the April peak in burials was a regular feature of mortality there, perhaps related to seasonal traffic or the local environment. Generally, however, the four case-studies illustrate the raised period of risk in the first half of the year, which is common to all age groups, and which seems to have characterised the later eighteenth century.33 We may compare the figures on seasonality with those displayed by the foundlings being brought up in the case-study parishes. The comparison is useful for investigating whether the foundlings were affected by local patterns of mortality, or whether their survival prospects were already set by their condition on arrival. Hazards analysis certainly suggested that many of their survival risks already existed by the time they reached their nurses, but there was a significant amount of unexplained variation in the models. For the sake of clarity, the relevant figures are presented for the two larger of the four parishes, in Figure 8.7. Figure 8.7 suggests that the foundlings were not particularly affected by ongoing seasonal patterns in the disease regime of their host parishes.

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Figure 8.7 Seasonal patterns of burials in Epsom and Chertsey (1715–1800), and infant foundling burials (1741–64) 250

Index

200

150

100

50

0 Jan

Feb Chertsey

Mar

Apr

May

Jun

Chertsey foundlings

Jul

Aug Epsom

Sep

Oct

Nov

Dec

Epsom foundlings

Note: N = 388 for Chertsey foundlings, 240 for Epsom foundlings, 1015 for Chertsey infants, and 545 for Epsom infants. Sources: Parish reconstitutions; Inspections Books, LMA, A/FH/A10/1/1/1-2.

The April peak in Epsom has been noted above, but in the second half of the year there is a marked divergence in trends between foundlings and local infants. Whatever the nature of the rise in infant burials in September and October, it does not seem to have affected the foundlings. This is somewhat counter to a priori expectations that foundling infants would have been vulnerable to infectious diseases in their new communities. Only 10 per cent of Epsom’s male workforce worked in agriculture in 1801, which suggests that seasonal agricultural employments for women were unlikely to have had a big impact on childcare and weaning.34 This might otherwise explain a rise in deaths in the harvest months. In Chertsey, there is a much greater concurrence of seasonal trends between foundlings and local infants, especially in the middle part of the year. Here, the spring peak in burials is in March for infants, and April for foundlings, as in Epsom. The foundlings did have a proportionally lower experience of mortality in the autumn, but had higher levels in December and January. This fits with the finding reported in Chapter 4 that winter was a particularly risky time to be abandoned. In Hemsworth (not shown), the seasonal pattern of foundling burials showed much greater fluctuation than that of local infants, with much

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worse mortality from August to December (when mortality locally was low). Correlation statistics confirm the generally poor match between foundling and infant burials: 0.176 in Epsom, 0.411 in Chertsey, and a negative association in Hemsworth of −0.245. None was statistically significant. There were too few infant foundlings in Ackworth to test the association there. The Ackworth registers do, however, give information on cause of death, and this can also be compared with what we know of fatal illness among the foundlings. 48 of the 100 linked (non-foundling) infant burials in Ackworth had no other cause of death than ‘infant’. Of the remainder, 26 per cent died of convulsions, and a further 27 per cent from smallpox. Whooping cough and fever accounted for a further 27 per cent. Infectious diseases do, therefore, seem to have taken a greater toll on the infants born in Ackworth than they did on foundling infants. In both cases, however, non-specific causes of death preclude much detailed analysis. 183 foundling children had causes of death recorded in the Ackworth burial register, and this tallies very well with the causes recorded in Ackworth hospital records. 21 per cent of these children died of dysentery, and 18 per cent from smallpox. Dysentery did not feature as a cause of death for any children under the age of nine in Ackworth, which confirms that it was a feature of the hospital regime. The Ackworth foundlings who appear in the burial register were all children rather than infants, and their mean average age was almost eight and a half. At this age they were probably living in the Ackworth branch hospital, or possibly with nurses as they convalesced from illness. This explains the concurrence in causes of death with those at the branch hospital. Only twenty-two Ackworth-born children dying between the ages of five and nine had causes of death recorded in the burial register, and almost half of these died of smallpox (ten children). 18 per cent of deaths in the Ackworth hospital were from the disease. Again, this confirms that smallpox did not represent the same pernicious risk to life for the foundling children as for others, probably because of the hospital’s inoculation policy. A further 27 per cent of the Ackworth-born children died of fevers, compared with 13 per cent of Ackworth hospital deaths. The children who died in the Ackworth branch hospital had not necessarily grown up in the area, and so it is perhaps not surprising that they had a different experience of disease. Nonetheless, there is evidence to suggest that infectious diseases did carry off non-foundlings more frequently than foundlings, at least in infancy. This is undoubtedly partly a reflection of the way in which diseases were recorded by the parish and by the hospital respectively, but it also probably relates to the state of the foundlings when they arrived with

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Figure 8.8 Infant mortality rates by twenty-year period in four casestudy parishes, 1730–90 140

Infant mortality rate

120 100 80 60 40 20 0 1730–49 Hemsworth

1750–69 Ackworth

1770–89 Chertsey

Epsom

Source: Parish reconstitutions.

their nurses. It is quite possible that, weakened by lengthy journeys, fatigued by exposure to perhaps poor weather and suffering from the loss of maternal breast-milk, the foundlings appeared to die simply of convulsions, weakness or decline. Among the older children, dysentery does seem to have been peculiar to the foundlings in appearing as a cause of death, and points to poor food hygiene at the Ackworth hospital. The second topic for exploration is the impact which the foundlings had on the parishes where they were placed. Although they do not seem to have participated to much discernible extent in the local disease environment, they may have introduced disease to the community. Figure 8.8 shows IMRs in the case-studies by twenty-year period, in order to test whether there was any rise in the period of the General Reception. We should be aware that changes in IMRs over time might be the result of changes in registration as well as genuine alterations in mortality. In fact, only in Ackworth was mortality higher in the 1750s and 1760s than in previous or subsequent periods, and the extremely low IMR returned for the 1730s and 1740s is perhaps a cause for concern in terms of accuracy (relatively few links could be made with infant burials for this period). It may be significant that only Chertsey and Hemsworth conform to the general picture of falling mortality over the period

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(although Chertsey shows a slight rise in the final twenty-year period), and that they are also the parishes which appear to have the least underregistration. We must conclude, however, that there is no evidence to support the hypothesis that the foundlings had an adverse impact on infant mortality in their nursing parishes. Despite this empirical finding, contemporaries do seem to have worried about the impact the foundlings had on their communities. It seems unlikely that an influx of hundreds of infants in a few years could go unnoticed, and inevitably, people were anxious about the financial consequences of supporting them. Although they were sought after by women wishing to nurse for the hospital, some locals seem to have been averse to the idea of charity children. Thomas Trant of Hemsworth summed up the potential for bad feeling in a letter of 1757, hoping that the appointment of the local notable Sir Rowland Winn as a governor would calm the situation: Sir, the Numbers sent down this summer have alarmd the County – and the Farmers (several instigated by the Clergy themselves, not to say Gentlemen too) have in several places enter’d into Combinations to give their Milk to the Hogs, or throw it away, rather than let our Nurses have it. Nay, a Dignitary of this Neighbourhood has thought fit to refuse a Child, when dead, Christian Burial in his Church-yard. When this is the Case, no wonder there shd be here & there bad Doings enough.35

Trant was driven to asking all his nurses for new testimonials to try to overcome local aversion to the hospital. Winn himself wrote to the hospital the same year, stating that he was having trouble finding governors because ‘Country Gentlemen in these parts . . . do not like to give themselves much trouble’.36 One of the principal concerns of opponents to the hospital children was that they might become a charge to the poor rate. The hospital insisted that the parishes had no responsibility for the foundlings, but locals may not have known or have believed this. One of the Dagenham inspectors wrote to the hospital in 1757 that her nurses had been told that they would never get parish assistance themselves if they took in foundlings.37 Coercion of this type seems to have been rare, although Trant’s letter quoted above indicates that local people might make life hard for hospital inspectors and nurses alike. A historian of Ackworth cites ‘the frequent contests from the opposition of parishes’ as a reason for the giving up of the branch hospital there.38 In fact, this was not the case, but local opposition cannot have helped its smooth running. In 1763, the Ackworth branch asked for a stamp to be made for their cloth manufactory which stated that they were the ‘Orphan Hospital

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Ackworth’ rather than the ‘Foundling Hospital’.39 The Shrewsbury branch also called themselves an orphan hospital, and this may have been an attempt to reduce the stigma associated with abandoned children and charity.40 This said, many other people seem to have reacted with humanity and concern to the influxes of foundling infants to their parishes. We have seen that there was no shortage of women eager to act as nurses, and even if this was motivated by the wage, it still suggests a lack of stigma. It is possible that the hospital was a less strict employer of nurses than a child’s parents. A private arrangement may have made more stipulations on living in, or on the nurse’s diet or relations with her husband. There was also no shortage of people putting themselves forward to take foundling apprentices. Again, some potential masters probably had self-interested motives; financial premiums might be available, and the master got the benefit of the child’s work with relatively little outlay. Inspectors also complained to the hospital that nurses were not returning the foundlings’ clothes, or were using them for their own children. This suggests that even the distinctive charity uniforms were not necessarily stigmatised. Thomas Langridge of the Epsom inspection wrote to the hospital in 1767 that the poor were being inoculated locally, and that the foundlings could have the procedure for the same price. The inoculator had originally been averse to treating the children, but his eventual offer suggests that they were seen as part of the local community.41 This chapter has shown that the foundlings did have a large impact on the communities they were sent to for nursing, both on the demographic record and on the local consciousness. Despite the variable quality of the parish registers used, the family reconstitutions of Epsom, Chertsey, Ackworth and Hemsworth have shown the benefits of linking the topic of abandonment and nursing to local demography. It has been shown that in three of the parishes, the presence of the foundlings is clear in the burial records, inflating mortality significantly, especially in the years of the General Reception. The example of Chertsey, however, has highlighted the possibility that in other places, foundling burials were not demarcated as such, with potentially large repercussions for local studies. Infant mortality in the case-study parishes seems to have been low in Yorkshire and somewhat higher in Surrey, although exact quantification must remain beyond the current investigation. A variety of possible corrections to the calculated IMRs still suggest that Ackworth and Hemsworth had average mortality below that for the country as a whole, perhaps unsurprisingly given their agricultural character in a healthy part of the country. Chertsey and Epsom were closer to the

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national average, again unsurprisingly given their greater contacts with other areas. These findings support the fact that foundling nurseries close to London had worse mortality than those further away. If nothing else, the study of infant mortality has highlighted the great variability in parish register coverage, and the difficulty of comparing one community with another. Information on the seasonality of infant burials indicated some local vagaries from the national pattern, and also suggested that the mortality of foundlings was not necessarily affected by the local epidemiology. Causes of death in Ackworth confirmed this, with foundlings apparently being less prone to mortality from infectious disease. This may have been because of their low survival chances very soon after abandonment, while the survivors were perhaps the hardiest of the lot. If the foundlings did not share in the immediate disease environment, they did not seem to affect it either. Infant deaths in the case-study parishes do not seem to have risen in the decades when the foundlings were there. Contemporaries seem to have been more concerned about the financial implications of housing large numbers of foundlings, and were sometimes averse to providing them or their nurses with goods and services. The case-studies were selected because they took in particularly large numbers of foundlings, and the presence of the branch hospital at Ackworth would have raised their profile even more. In other communities, the impact of the foundlings’ arrival may have been much slighter. In places like Chertsey, Epsom, Ackworth and Hemsworth, however, we must conclude that the foundlings cannot but have had a large impact: on the state of female employment, the number of burials being carried out by the vicar, the supply of provisions and the sheer number of infants and children present. If we factor in also the effect of the increase in postal activity, the increased traffic on the public coaches and hospital caravans and the demand for medical services, the impact of the foundlings on the local demographic, social, economic and medical context must have been very large indeed. Notes 1 In order to calculate age-specific mortality rates, it is necessary to establish the numbers of people at risk of dying in the parish in each age group. While we can be relatively sure that infants were unlikely to migrate from a parish in their first year of life (especially if the family continued to register baptisms there), this assumption becomes increasingly shaky as age increases. See Wrigley et al., English population history, p. 210. 2 Ibid., esp. pp. 3–17 gives details on the technique and its aims. The method was originally refined by Louis Henry for French demographic data

Foundlings and the local demographic context

3

4 5 6

7

8 9

10 11 12

13 14

15

16

197

(E. Gautier and L. Henry, La population de Crulai: paroisse normande (Paris, 1958)). For an account of manual reconstitution, see Wrigley, ‘Family reconstitution’. For a full account of the mechanics of a partial reconstitution using MS Access, as was done here, see S. Basten, ‘The environmental and economic context of infant mortality: Yorkshire, 1777–1812’ (unpublished MPhil thesis, University of Cambridge, 2002). Thanks also to Rhiannon Thompson. Wrigley, ‘Family reconstitution’, pp. 102–4. Bellingham, ‘The Dade parish registers’; Bellingham, ‘Dade parish registers’. Examples are: Basten, ‘The environmental and economic context’; C. Galley, ‘An exercise in Dade parish register demography: St Olave, York, 1771–1785’, Local Population Studies, 74 (2005), pp. 75–83. The consistently high level of detail in many Yorkshire registers and the link with Dade were not commented on by Whiting in his 1949 article on the subject, beyond a note that causes of death were often recorded in the eighteenth century. See C. E. Whiting, ‘Parish registers with special reference to those of Yorkshire’, Yorkshire Archaeological Journal, 146 (1949), pp. 131–44. Banks notes that ‘During the rectorate of Dr. Timothy Lee (1744–77) more than ordinary care was shewn in keeping the books’ (Walks in Yorkshire, p. 289). Bulley, Hemsworth in history, p. 58. Razzell estimates that up to a third of all births were not baptised in the period 1760–1834 (‘The evaluation of baptism as a form of birth registration through cross-matching census and parish register data’, Population Studies, 26:1 (1972), p. 137). The marriage totals represent those recorded in the registers, not those inferred as dummies from a baptism. On the frequency of epidemics of infectious disease, see Creighton, History of epidemics. D. J. Steel, National index of parish registers, Vol. 1: Sources of births, marriages and deaths before 1837 (London and Chichester, 1976), Vol. 1, pp. 27–9, 34. Adair, Courtship, passim. P. E. Hair, ‘Bridal pregnancy in rural England in earlier centuries’, Population Studies, 20:2 (1966), pp. 233–43; Hair, ‘Bridal pregnancy in earlier rural England further examined’, Population Studies, 24:1 (1970), pp. 59–70. Rhiannon Thompson has found proportions of dummy marriages which approach these levels in a period of rapid in-migration in the Somerset coal-mining village of Camerton. For the period 1800–09, the proportion of dummy marriages was 62.7 per cent (Thompson, ‘Economic and social change’, p. 57). This was one of the consequences of Lord Hardwicke’s Marriage Act of 1753 (Steel, National index, Vol. 1, p. 13).

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17 For marriages taking place after 1 January 1754, the percentages of dummy marriages were 49.2 in Ackworth, 42.3 in Hemsworth, 56.0 in Chertsey and 62.3 in Epsom. 18 Wrigley et al., English population history, table 6.16, pp. 270–1 shows rates in the 90s per thousand for Bridford, Odiham and Hartland. 19 This effectively creates dummy baptisms based on the burial entry. 20 E. A. Wrigley, ‘Births and baptisms’; Schofield and Berry, ‘Age at baptism’. R. E. Jones (‘Infant mortality in rural north Shropshire, 1561–1810’, Population Studies, 30:1 (1976), pp. 305–17, and, ‘Further evidence on the decline of infant mortality in pre-industrial England: north Shropshire, 1561–1810’, Population Studies, 34:1 (1980), pp. 239–50) also comments on the implications for mortality calculations of infants dying unbaptised, and also on the increased shortfall in infant burials over the eighteenth century. He suggests that IMRs based on record linkage might understate mortality by up to 40 per cent. 21 E. A. Wrigley, ‘Mortality in pre-industrial England: the example of Colyton, Devon, over three centuries’, Daedalus, 47:2 (1968), pp. 546–80. 22 Laxton and Williams, ‘Urbanization’. The highest IMR found for one of the Cambridge Group reconstitutions was 311 per thousand for the fenland parish of March (Wrigley et al., English population history, pp. 720–1). 23 Methley had an IMR of 132 per thousand in 1675–1749, and Birstall of 128: ibid., table 6.17, p. 274. Basten also found extremely low rates of infant mortality in eight Yorkshire parishes with Dade registers (Basten, ‘The environmental and economic context’). 24 Saywell, The parochial history, p. 8. 25 King, ‘Dying with style’, p. 11. King suggests using an inflator of 10 per cent to account for unregistered infant deaths. This results in an IMR of 170–80 per thousand (p. 15). 26 Wrigley et al., English population history, table 6.17, p. 274. 27 They would be ranked between Bottesford and Banbury, the latter of which was more intensively involved in retail. Bottesford is placed in the ‘other’ occupational grouping. 28 J. Bourgeois-Pichat, ‘La mésure de la mortalité infantile’, Population, 6 (1951), pp. 233–48 and 459–80. See Wrigley, ‘Births and baptisms’ for a fuller explanation and demonstration of the method. 29 See Galley and Shelton, ‘Bridging the gap’, p. 76. 30 Wrigley et al., English population history, pp. 227–9; Wrigley, ‘Births and baptisms’. 31 Schofield and Berry, ‘Age at baptism’. 32 King, ‘Dying with style’; P. Hudson and S. King, ‘Two textile townships, c.1660–1820: a comparative demographic analysis’, Economic History Review, 53:4 (2000), pp. 706–41. 33 Wrigley et al., English population history, pp. 326–7; Landers, Death and the metropolis, pp. 212–15 (although see pp. 141–8 for evidence that London Quakers seem not to have participated in the trend to winter peaks in infant

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34

35 36 37 38 39

40

41

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mortality; this may indicate high levels of artificial feeding, which could keep summer mortality high). Abstract of the answers and returns made pursuant to an Act, passed in the forty first year of His Majesty King George III intituled ‘An Act for taking an account of the population of Great Britain, and the increase or diminution thereof.’ Enumeration Part 1 England and Wales (London, 1801). Correspondence, 15 January 1757, LMA, A/FH/A06/01/10/19. Quoted by Vipont, Ackworth School, p. 19. General Committee minutes, 22 June 1757, LMA, A/FH/K02/1-18. Saywell, The parochial history, p. 72. Correspondence, 8 May 1763, LMA, A/FH/A6/1/16/11/35. The letter was addressed to the ‘Orphan Hospital, London’. Jonas Hanway also suggested that the hospital change its name, in order to promote the happiness of the children (A candid historical account, p. 92). See L. Zunshine, Bastards and foundlings: illegitimacy in eighteenthcentury England (Ohio, 2005), pp. 104–10, for a comparable discussion over the use of the terms ‘bastard’ and ‘foundling’ in the hospital’s rhetoric. Correspondence, 26 January 1767, LMA, A/FH/A6/1/19/12/42, and 1 February 1767, LMA, A/FH/A6/1/20/12/6.

9

Conclusions

I’m sent to find if fortune’s kind and should it now prove true My parent fond will not despond of Sarah Montague . . . Note left with child 1366, Sarah Bishop Admitted 8 May 1756 Died 22 May 1756

The parent abandoning Sarah Montague hoped for a good future for their baby, but realised that ‘fortune’ would play a large part in whether these hopes would be realised. Sadly, fortune was not kind to Sarah, or to so many of her peers, and she died two weeks after she was abandoned. The discussions in this volume mean that we know very much more about the characteristics of foundlings like Sarah, what happened to them and what their experiences of feeding and health may have been than either their parents or even the hospital governors would have done. Their characteristics and mortality rates and risks have been quantified, and their patterns of feeding and health built up via links to the surrounding communities. The discussion of these issues has also highlighted how much interplay there is between the hospital governors’ concerns and aims and wider themes in the history of the family, medicine, childhood, poverty and institutions. In this conclusion, I will discuss briefly some of the more pertinent wider debates on which this study sheds light. Pathways to health, ill-health and death One of the most immediately significant outcomes of this study has been the variety of pathways to infant and child health it has uncovered. The investigation of foundling characteristics and backgrounds highlighted the fact that many infants were abandoned in response to poor economic conditions and family hardship. This suggests that their health

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and sustainability may have been poor even before they were left at the hospital. Mortality and survival analysis demonstrated that this translated into sometimes horrifyingly high death rates – up to four fifths of entrants at times – and that the condition of the foundlings on admission was responsible for much of their poor survival record. High mortality seems thus to have been a consequence of a combination of factors which enhanced the frailty of the foundlings, rather than a single characteristic unique to being an abandoned infant. The foundlings thus, in many respects, trod an extreme version of normal pathways to ill-health. Their experience of life before abandonment, and the process of abandonment itself, left many of them weakened beyond hope of recovery, as is testified by the fact that a very high proportion died soon after entry, on the road to wet nurses, or of convulsions, torpor and wasting. It is also suggested by the fact that foundlings in the case-study nurseries did not seem to share the seasonal burial patterns of local infants, or show an equivalent range of causes of death. In other ways, however, the foundlings showed different experiences of health and ill-health from non-foundlings, especially after their return to the hospital itself. Some of these were related to the nature of the disease environment, and others to the way in which disease was managed. An example is the policy of inoculation against smallpox, which represented an effective weapon against disease: one of the few known to eighteenth-century medical practitioners.1 Smallpox still caused a substantial number of deaths among the foundlings, but the loss among the hospital’s inoculation patients was extremely small. The practice was becoming more widespread in the second half of the eighteenth century, and many parishes paid for their poor to be inoculated. Nonetheless, it was unusual to have such an established and uniform practice, and the hospital may well have done much to popularise it in the 1740s. Again, this has wider resonance for disease prevention among children generally, although the foundlings may have been unique in having such general access to inoculation. The Foundling Hospital was thus able to participate in new developments in medical education and practice, quite possibly to the benefit of its charges. The nature of the disease environment at the hospital and its branches may in other respects have disadvantaged the foundlings. It is clear that the constant turnover of children with differing immune responses made for a volatile disease environment in which epidemics might take hold rapidly. This would have been especially accentuated for the General Reception children, on whom much of this study focuses. This pattern is a feature of young populations even today, where childhood illnesses

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spread rapidly around school classes and are passed to other siblings at home. It was a relatively rare experience in the eighteenth century, however, because of the numbers of children involved and the small range of ages; workhouses contained a much wider spread of ages, and schools tended to be smaller-scale. This concentration of young children into perhaps overcrowded conditions may have exacerbated the spread of diseases such as dysentery, which was prevalent at the Ackworth branch hospital. Scabies and ringworm seem also to have been recurring problems at the London branch, and several criticisms of infirmary provision suggest that it was not always as effective as it could have been in assisting the separation and treatment of the sick. While the hospital benefited from many of the advances in eighteenth-century understandings of sickness, especially since many of its medical advisors were in the vanguard of new practice, in other respects its charges suffered from a dangerous concentration of infection to which they might not have been exposed before, and to ongoing, low-level onslaughts on health. The study of the foundlings’ health and conditions, therefore, tells us much about pathways not only to ongoing viability as infants, but also to good (and poor) health as young children. It was also noted in the Introduction that the Foundling Hospital in many ways reflected the ideals and concerns of its age. This may be extended into its relationship with medical ideas and the emergence of an interest in child health. The hospital was founded on a wave of concern for the state of the population, and the promise that unwanted infants represented of future workers and producers. Their health and productivity were clearly of paramount importance to this ideal, as well as for humanitarian reasons. The increased interest in infant and child health was served by the presence of large numbers of foundlings in hospitals all over Europe, who could provide case-study experiments of new practices. The inoculation policy at the London Foundling Hospital may not have been an experiment in this sense, but it may well have served as one to wary observers outside the hospital. As was noted in Chapter 7, several foundling boys were used in a more formal experiment into the efficacy of inoculation in Florence. Trials into artificial feeding also took place in foundling homes, and although ultimately no successful methods were discovered, these, and autopsy examinations on those who died, may have contributed to the growth of an investigative branch of what would later be crystallised as paediatric medicine. The Foundling Hospital and eighteenth-century values The hospital also reflected several other important ideals which characterise the mid-eighteenth century. Coram appealed specifically to its

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utilitarian function when he stated in 1735 that the projected hospital would ‘not only save the Lives of many of Your Majesty’s Subjects, but be a means of rendring them useful to the Publick’.2 Its structure also made it particularly successful in soliciting support from polite society, because it ‘combine[d] that rare trinity, Art, Charity and Fashion’.3 It was very much an expression of the commercial optimism of the midcentury, based on a joint-stock subscription structure and naming many City men among its governors. It also tapped into contemporary culture in its use of print to publicise its successes, counter criticisms, circulate information and advertise its admissions policies.4 Its appeal enabled it to mobilise charitable individuals all over the country in its support, from Taylor White, the treasurer who served the hospital for twentyseven years, to Ackworth’s Dr Lee, ‘a gentleman who placed an intelligent and philanthropic mind almost entirely at the service of the young institution’.5 Just as the hospital benefited from the rise of philanthropy in the middle of the century, however, it had to ride its reformulation in the decades which followed. The General Reception was ended because parliament had ceased to be convinced that it was really saving infant lives, and there was also a shift towards doubting that such saving of life was strictly necessary or desirable. Growing concerns over the size of the indigent population, and the disincentive that the hospital was thought to give to marriage and self-sufficiency, were tied to a wider pessimism over the outcome of charitable giving and the productivity of the poor.6 The General Reception, with its enormously increased admissions levels and appalling mortality, was almost universally condemned after the event. Brownlow wrote in 1858 that it had been ‘conducted on a plan so wild and chimerical, and so widely differing from its original design [that it was] found to be diseased in its very vitals’.7 One twentieth-century historian of philanthropy has called the period of open admissions ‘disastrous’.’8 Another has characterised the widening of admissions as ‘a fatuous condition that went near to wreck the charity, worked incalculable harm to society, and incidentally saved it for a long term from any further applications’.9 This retrospective pessimism can be located in the shift identified by Joanna Innes away from institutional charity and towards more individualised giving.10 By the later part of the century, the hospital no longer tapped into currents of thought on charity and entitlement. For the few short years of the General Reception, the hospital played a significant part in the economy of makeshifts for poor parents, for poor law officials and for women who could find employment as nurses. After 1760, it continued to offer the hope of help, but it could no longer be counted on; it formed part of the trend to encourage the poor to be self-sufficient and resourceful.

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The Foundling Hospital also attracted increasing criticism over time for supposedly raising the foundling children above their proper social standing. This was a charge levelled against charity schools as well, as both types of institution had ties to educational and training opportunities which were beyond the reach of poor parents or parish officials.11 Labouring, service at sea and domestic service were the professions of choice for the foundlings, but some individuals were trained to be tailors, metal-smiths and other skilled craftsmen. Some of these trades would normally have been restricted to children of parents with significant landholdings.12 The governors became sensitive to these charges, noting that ‘Boys are brought up to fit them for Agriculture, at Sea Service, and other laborious employments; and the Girls to household and other menial Service, in such a manner as to give them early habits of Industry.’ They were not even to be taught to write (a resolution later revoked), lest it be deemed unsuitable education for charity children.13 Again, this may have been tied to the apparent fear of the poor which emerged towards the end of the eighteenth century, and also to anxiety over the preservation of social order after the French Revolution, and food riots and increasing rural unemployment in England. The hospital did, however, have a lasting legacy in the form of provision for the poor infants of London. One of its prominent governors, Jonas Hanway (who had also criticised the overly ambitious remit of the General Reception in drawing in foundlings from all over the country), incorporated the hospital’s system of external nursing into his plans for improved parish care for the infant poor, and many of the hospital’s policies were embodied in the legislation that he propelled through parliament.14 Fostering and family; motherhood and money In its policies on external wet nursing, the hospital achieved a significant measure of success. The analysis reported in the second half of this book highlighted the very large proportion of foundlings who were placed with a nurse within a few days of admission, and that the majority of those who were not were too sick to leave the hospital. There is relatively little evidence for nurses neglecting or mistreating foundlings, although isolated cases show that it did happen occasionally. In fact, the reaction of some nurses to the return of their foster children to the hospital suggests that very strong emotional bonds were sometimes forged with them. It is to be hoped that future work on the numbers who were subsequently apprenticed to the nurses’ husbands will shed further light on this. The tying of hospital records to parish registers uncovered a wide variety of family types joined by foundling infants, and the Inspections

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Books also pointed to a significant degree of nurse-sharing and movement between nurses. The difficulty of specifying emotional experiences from these data has already been noted, but one of the most novel and important outcomes of this part of the current study is its implications for bonding and family life. Caveats on the mobility of certain foundling nurslings aside, the majority were placed rapidly with a foster mother with whom they would stay throughout early childhood. Many foundlings had spent a period of days or weeks with their own mother before they were given up, but it seems likely that the trauma of separation from the foster mother would have been far greater than this earlier separation, since the child was older. Removal from one nurse to another may also have had an impact on the child’s emotional stability. It should be stressed, however, that we know almost nothing of the nature of the relationship between child and nurse except in cases of neglect or where the nurse asked to keep the child. It is highly likely that there was significant variation in experience, according to personality type, the motivation for taking a nurse-child and the pre-existing family structure. Some women may have fostered a foundling because they had lost an infant of their own, while others perhaps saw it simply as an opportunity to make money. With modern attitudes towards children and emotional bonding, we cannot conceive of a situation where an attachment would not be formed, but, as many historians remind us, we cannot make assumptions of past attitudes and feelings on the basis of modern expectations.15 Randolph Trumbach has attempted to apply modern findings on bonding and parental loss to the early modern history of nursing and childhood, but I would argue that this is inappropriate.16 Notions such as these were conceived within a twentieth-century framework of family life, and should not be appropriated to earlier periods. What I would prefer to take from the current study is what it adds to our existing understanding of the variety and flexibility of family forms in early modern England. Fildes argues that wet nursing was always more common in England than is often appreciated, and that it reached its zenith in the eighteenth century. Certainly, the current study has shown that the Foundling Hospital alone may have been responsible for saturating individual communities with nurse children. They entered families at different stages of development, and were sometimes moved from one nurse to another locally. Their impact on the local community must have been great in the largest of the foundling nurseries. It is interesting to speculate how far they were encompassed by what Sharpe has described as a ‘community willingness to pay for nurturance’.17 Scholars such as Richard Wall have also pointed out the frequent circulation

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Childcare, health and mortality

of young people in early modern England, via formal and informal apprenticeships.18 Was the nursing of foundling children part of this same community approach to childrearing? Certainly, the foundling study supports the well-known notion that families were willing to care for children who were not their own. The putting-out of parish nurse-children and apprentices and a more informal circulation of children between family members and connections were, after all, common. The foundlings, however, were part of a different and novel organisational framework, and were, furthermore, previously unconnected with the parishes in which they were placed. They were thus less connected with the building-up of social capital in terms of potentially reciprocal arrangement from which one might benefit oneself at a future time. The fact that the foundling children were eventually to be returned to the hospital and would not be longterm residents of the community may also have affected the degree to which they can be fitted into this model of a community-based responsibility for childcare. In fact, inspectors’ letters make it clear that elements within some communities were very averse to having foundlings present, implying that they were not always integrated into local social networks. A further point of significance to arise from the foundling study is the prominence it gives to nursing as an occupation for women. In many ways, nursing is the most obvious of all female employments, since it is predicated on women’s ability to bear children. The absence of wet nursing markets on the scale of those in Italy or France, however, has tended to lead to it being subsumed into a non-quantifiable (though crucially important) domestic, informal economy.19 We also know far too little of the mechanisms of nursing parish poor children, and this has perpetuated the neglect of this sector of female work, although Margaret Pelling has pointed out the difficulties of pinpointing what was meant by occupational labels such as ‘nurse’ in early modern sources.20 The position of Foundling Hospital nurses, however, was well regulated, and regularly remunerated in cash. This puts it much closer to the formal waged economy, although it did still take place in a domestic setting and was not incompatible with other household duties including childcare. Other historians have taken wet nursing outside the domestic sphere, by linking it to the national effort to save lives and fight wars. Ruth Perry writes that ‘Thousands of women were mobilized as surrogate mothers in this way, hired to play their unique part in the war effort’.21 The Foundling Hospital could certainly be encompassed in this statement. The conclusions made in this book, however, have tended to privilege women’s agency in the nursing relationship, rather

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than their subjugation to a rhetoric of colonialism and sentiment. Unusually, it was the nurse herself who took her foundling child to and from the hospital, and it was with her that the contract was made, rather than her husband. The Foundling Hospital archive thus allows us to see much more clearly the workings of a significant but often overlooked sector of plebeian female employment. Infant abandonment in England and Europe We have previously known extremely little about infant abandonment in eighteenth-century England. The Foundling Hospital clearly formed a focal point for the practice in this period, and almost certainly shaped the way in which it was used and built into survival strategies. There is much more to be discovered about how abandonment was used outside the General Reception period; for example, did parents give their child up to parish officials, or did they turn to parish or family support so that they could keep the child? For the period under review here, and especially for the General Reception, it seems clear that the hospital was part of what Innes has called a ‘mixed economy of welfare’, and that it intersected with parish relief on a number of levels. The existence of a national poor law system does, therefore, seem to have had a significant impact on the form and nature of infant abandonment in England. This, and attitudes to female honour and shame, seem to have most clearly marked out the practice from European abandonment. A brief comparison with the Innocenti hospital in Florence will illustrate these points. Florence did not have a system akin to the English poor law, although it did have a number of institutional charities to support the poor. The most pertinent of these to this study are the foundling hospital, which admitted all children offered throughout the eighteenth century (and earlier), and the Orbatello lying-in hospital (mainly for unmarried mothers). Both were part of what David Kertzer has identified as a widespread surveillance network of unmarried women by church officials and midwives. Illegitimate babies were taken straight to the Innocenti after birth; in 1744, a quarter of foundlings admitted came from Orbatello.22 Unmarried mothers could thus not keep their babies, and they had few alternative forms of support. This attitude was couched in terms of family and personal honour, concepts which do not seem to have been as current in England. There, in contrast, poor law officials were more concerned with establishing who had financial responsibility for abandoned or illegitimate infants than with moral standards, and generally preferred to keep children with their mothers. Greater

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attempts were also made to track down putative fathers, and affiliate them to their offspring to ensure a financial obligation to them.23 These differences resulted in foundlings being often much younger at abandonment in Florence than in England, where an unmarried mother might try to keep her child before resorting to abandonment. The practice also had a much longer-standing history in Tuscany as a means of both preserving honour and combating the poverty of married couples; a large proportion of foundlings at the Innocenti were born in wedlock. While the economic and demographic backgrounds of the two places may also have affected the likelihood that a child would be abandoned, it seems to have been prevailing religious and cultural mores, and the existence of alternative sources of welfare provision, which set differences in characteristics (most notably, age and legitimacy) between the children abandoned at the two hospitals. The form and levels of infant abandonment to the Innocenti were, therefore, quite different from those in England. This led to quite different experiences of nursing and mortality. The Innocenti used the same system of external wet nursing as the London Foundling Hospital, but its much larger numbers of infants (admissions were 800 per year by the 1770s), plus competition for nurses with private families and other foundling hospitals, made this more difficult to achieve as a universal policy. Foundlings were often placed much less promptly with wet nurses, and with a lower overall success rate than at the London hospital. Nursing wages frequently failed to keep up with the cost of living, making the situation all the more difficult, and in poor years more than 50 per cent of the annual intake might die without ever being placed with a nurse.24 There was also no equivalent to the English system of inspectors, and parish priests were instead asked to keep an eye on foundling children. This poor experience of nursing was reflected in consistently higher infant mortality rates for the Innocenti foundlings than for those abandoned in London: between 500 and 800 per thousand live births throughout the second half of the eighteenth century, with no decline over time comparable to that found for England. In this book, the subject of infant abandonment has been used both to shed light on a neglected aspect of eighteenth-century history, and to reflect on wider topics. Infant abandonment in England took quite a different form than that in the rest of Europe, and played a different part in the mixed economy of welfare. The Foundling Hospital was a product of specifically mid-century concerns, and was reliant on the vagaries of charity and attitudes to manpower and the poor for continued support. It plays an important part in the history of childhood, by highlighting attitudes towards children and the increased value placed

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on child life. Abandonment may be characterised as the result of indifference, and this was perhaps true of some parents, but others clearly thought that they were providing for a better future for their child. When studying its records, it is hard to dismiss contemporary claims that it encouraged abandonment, and we now know just how high its mortality toll was at times. This study, however, has uncovered details on how the hospital’s governors tried to preserve the lives of their charges, and how this was couched in terms of contemporary ideas. It has highlighted the extent of their administrative practice, and the efficiency of an eighteenth-century institution. It has also pointed out how far its network spread: all over the country, and into thousands of local communities and families. It has called into question Langer’s characterisation of the history of eighteenth-century foundling hospitals as ‘one of devoted effort but unrelieved tragedy’.25 This book has shown that this is a mistakenly simplistic interpretation when faced with childcare, health and mortality at the London Foundling Hospital. Notes 1 McKeown and Brown, ‘Medical evidence’, p. 286. 2 ‘Memorials and petition of Captain Coram and others for the Establishment of the Hospital and orders in Council thereon’, LMA, A/FH/A1/3/1. The memorial quoted was drawn up on 4 December 1735. 3 B. Rodgers, Cloak of charity: studies in eighteenth century philanthropy (London, 1949), p. 34. 4 Sarah Lloyd has noted this feature of eighteenth-century charities (‘ “Agents in their own concerns”?’, p. 121). 5 McClure, Coram’s children, p. 170; Thompson, A history of Ackworth School, p. 18. 6 Owen, English philanthropy, pp. 97–8. 7 J. Brownlow, The history and design of the Foundling Hospital, with a memoir of the founder (London, 1858), p. 16. 8 Owen, English philanthropy, p. 55. 9 Kirkman Gray, A history of English philanthropy, p. 161. 10 J. Innes, ‘The “mixed economy of welfare” in early modern England: assessments of the options from Hale to Malthus (c. 1683–1803)’, in M. Daunton, (ed.), Charity, self interest and welfare in the English past (London, 1996), pp. 139–80. 11 Langford, A polite and commercial people, pp. 132–3. See also Lloyd, ‘ “Agents in their own concerns”?’ 12 The qualification for such apprenticeships was the possession of a freeholding worth 40s (Pinchbeck and Hewitt, Children in English society, Vol. 1, p. 226). 13 General Court minutes, 8 May 1765, LMA, A/FH/K01/1-4.

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Childcare, health and mortality

14 For example, the 1762 ‘Act for the keeping the regular, uniform and annual registers of all parish poor infants under a certain age’, and the 1766 ‘Act for the better regulation of the parish poor children, of the several parishes therein mentioned within the Bills of Mortality’. See Pinchbeck and Hewitt, Children in English society, Vol. 1, pp. 181–89; George, London life in the eighteenth century, pp. 58–60. 15 For example, S. Wilson, ‘The myth of motherhood a myth: a historical view of European child rearing’, Social History, 9 (1984), pp. 181–98; A. James, C. Jenks and A. Prout, Theorizing childhood (Cambridge, 1998); L. A. Pollock, Forgotten children: parent–child relations from 1500–1900 (Cambridge, 1983). 16 Trumbach, The rise of the egalitarian family, pp. 230–1. 17 Sharpe, Population and society, p. 254. 18 R. Wall, ‘Leaving home and the process of household formation in preindustrial England’, Continuity and Change, 2:1 (1987), pp. 77–101. 19 See, for example, P. Hudson and W. R. Lee, ‘Introduction’, in Hudson and Lee (eds), Women’s work and the family economy in historical perspective (Manchester, 1990), pp. 2–48; contributors to P. Sharpe (ed.), Women’s work: the English experience 1650–1914 (London, 1998). 20 M. Pelling, ‘Nurses and nursekeepers: problems of identification in the early modern period’, in Pelling, The common lot: sickness, medical occupation and the urban poor in early modern England (London, 1998), pp. 179–202. 21 Perry, ‘Colonising the breast’, p. 208. 22 Levene, ‘Health and survival chances’, p. 123. 23 T. Nutt, ‘The paradox and problems of illegitimate paternity in Old Poor Law Essex’, in Levene et al., Illegitimacy in Britain, pp. 102–21. 24 Levene, ‘Health and survival chances’, pp. 139–41. 25 W. L. Langer, ‘Infanticide: a historical survey’, History of Childhood Quarterly, 1:3 (1974), p. 358.

Select bibliography

Primary sources London Metropolitan Archive, London (LMA) General Register, 1741–99, A/FH/A09/2/1-5. Minutes of the General Court, 1741–99, A/FH/K01/1-4. Minutes of the General Committee, 1741–99, A/FH/K02/1-18. Minutes of the sub-committee, A/FH/A3/5/7. Inspections Books, 1741–64, A/FH/A10/1/1/1-2. Foundling Hospital correspondence, A/FH/A06/1/6/1; A/FH/A06/1/8/5; A/FH/ A06/1/10/7, 9, 19, 41; A/FH/A06/1/11/8, 30; A/FH/A06/1/12/11/94; A/FH/ A06/1/12/5/17, 22, 25, 26; A/FH/A06/1/13/5/8, 11, 1/13/12/27; A/FH/A06/ 1/15/10/6; A/FH/A06/1/16/11/11, 35, 47; A/FH/A06/1/18/11/14, 17; A/FH/ A06/1/19/12/17, 42; A/FH/A06/1/20/12/6; A/FH/A06/1/22/9/45, 55; A/FH/ A06/1/25/11/3, 33; A/FH/A06/1/26/10/3, 4, 31, 33; A/FH/A06/1/26/11/34; A/FH/M01/2/23, 45-8, 132-5, 137-8; M01/3/68; A/FH/Q/12. Foundling Hospital billets (and associated notes), 1741–60, A/FH/A09/1/1-173. Petitions to reclaim children, 1759–69, A/FH/A11/2/2-20. Register of children claimed, 1764–65, A/FH/A11/1/1/1. Infirmary Weekly Reports, 1761–66, A/FH/A18/5/1. Regulations for managing the hospital, 1759, A/FH/A1/5/2. Nurses’ duplicates, 1759, A/FH/A10/1/5-8. Nurses’ certificates, A/FH/A6/9/1-12. Register of deaths at Ackworth, 1757–63, A/FH/D/1/5/1. ‘A list of the several places where the children taken into this hospital from the 2 June 1756 to the 2 June 1757 were nursed, as also the number that have died at each place within that period’, A/FH/A10/15/20. ‘Minutes of the committee of enquiry upon Dr Mayo’s representation begun 7th January, 1790 and continued to 26th March 1790’, A/FH/A03/9/1. ‘List of children in the hospital at Ackworth 23 November 1771 mentioning the infirmities those labour under which render them unfit to be placed out apprentice’, A/FH/Q/12. Memo to the General Court (1758), A/FH/M01/8. ‘A method proposed for the nurture of foundlings’ (undated), A/FH/M01/8/ 201-4.

212

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‘Notes on medical conditions and treatment’ (undated), A/FH/M05/130-7. ‘An account of children inoculated since March 1759–69’, A/FH/M01/6/62. Minutes of the Ackworth Committee, 7 December 1772, A/FH/A/6/l/25/11/ 79. ‘Memorials and petition of Captain Coram and others for the establishment of the hospital and orders in Council thereon’, A/FH/A1/3/1. Guildhall Library, London (GL) The Weekly Bills of Mortality (St 1543). Society of Genealogists, London (SOG) Ackworth parish registers, YK/REG/4/942. West Yorkshire Archive Service, Wakefield Parish registers of: Featherstone, WDP91. Kippax, RDP47. Silkstone, WDP137. South Kirkby, WDP168. Pontefract, WDP40. Knottingley, WDP134. Surrey History Centre, Woking Parish registers of: Epsom Egham Ewell Walton on Thames Woking

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—— ‘Marital fertility and lactation 1570–1720’, in M. Prior (ed.), Women in English society (London and New York, 1985), pp. 22–53. Malden, H. E. (ed.), The Victoria history of the county of Surrey (London, 1912). Marel, M.-F. ‘À quoi servent les enfants trouvés? Les médecins et le problème de l’abandon dans la France du XVIIIè siècle’, in École Française de Rome (ed.), Enfance abandonée et société en Europe XIVè–XXè siècle (Rome, 1991), pp. 840–50. Newall, F. ‘Wet nursing and child care in Aldenham, Hertfordshire, 1595– 1726: some evidence on the circumstances and effects of seventeenth-century child rearing practices’, in V. Fildes (ed.), Women as mothers in pre-industrial England (London and New York, 1990), pp. 122–38. Nichols, R. H., and F. A. Wray, The history of the Foundling Hospital (Oxford, 1935). Nussbaum, F. A. ‘ “Savage” mothers: narratives of maternity in the mideighteenth century’, Cultural Critique, 20 (1991–92), pp. 123–51. Outhwaite, R. B. ‘ “Objects of charity”: petitions to the London Foundling Hospital, 1768–72’, Eighteenth Century Studies, 32:4 (1999), pp. 497–510. Owen, D. English philanthropy 1660–1960 (Cambridge, Massachusetts, 1964). Page, W. (ed.), The Victoria history of the county of Middlesex (London, 1911). —— (ed.), The Victoria history of the county of Kent (London, 1932). —— (ed.), The Victoria history of the county of Yorkshire (London, [1903], 1974). —— and J. Horance Round (eds), The Victoria history of the county of Essex (London, 1907). Pearl, V. ‘Social policy in early modern London’, in H. Lloyd Jones, V. Pearl and B. Worden (eds), History and imagination (London, 1981). Pelling, M. ‘Nurses and nursekeepers: problems of identification in the early modern period’, in Pelling, The common lot: sickness, medical occupation and the urban poor in early modern England (London, 1998), pp. 179–202. Perry, R. ‘Colonizing the breast: sexuality and maternity in eighteenth-century England’, Journal of the History of Sexuality, 2:2 (1991), pp. 204–34. Pinchbeck, I., and M. Hewitt, Children in English society (2 vols, London, 1969). Porter, R. English society in the eighteenth century (revised edition, Harmondsworth, 1990). Ransel, D. L. ‘Abandoned children of imperial Russia: village fostering’, Bulletin of the History of Medicine, 50:4 (1976), pp. 501–10. Razzell, P. ‘The evaluation of baptism as a form of birth registration through cross-matching census and parish register data’, Population Studies, 26:1 (1972), pp. 121– 46. Reid, A. ‘Neonatal mortality and stillbirths in early twentieth century Derbyshire, England’, Population Studies, 55 (2001), pp. 213–32. —— ‘Infant feeding and post-neonatal mortality in Derbyshire, England, in the early twentieth century’, Population Studies, 56 (2002), pp. 151–66. Rendle-Short, J. ‘Infant management in the eighteenth century with special reference to the work of William Cadogan’, Bulletin of the History of Medicine, 34:2 (1960), pp. 97–122.

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Index

Note: ‘n.’ after a page reference indicates the number of a note on that page abandonment of babies on continent 2–3, 6 –7, 22, 26, 43n.6, 44n.23, 207–9 as poverty alleviation strategy 24, 36, 37–9, 42 scale of 1, 2–4 Ackworth causes of death in local population 192 foundling hospital branch 8, 109, 131, 132, 161, 165, 192, 194 –5 ill-health at 161–3, 165 –7, 192–3 see also case-study parishes; disability age of foundlings 20 –3, 29, 51, 52–3, 55 –6 apprenticeship 8, 9, 18, 109, 122, 158, 165– 6, 195, 204 artificial feeding see dry nursing baptism 44n.19, 46n.40 impact on survival 77, 80, 82 breastfeeding 59, 61, 62, 85, 86, 104, 138–9, 146 –7 Cadogan, William (1711–97) 148, 168 Essay upon nursing and the management of children from

their birth to three years of age (1748) 146–7 case-study parishes (Ackworth, Chertsey, Epsom, Hemsworth) 118 –44, 175 –99 characteristics 120–3, 177– 8, 187 child mortality in 192 demographic patterns 178–80 disease patterns in 192 family structures 110, 126–8, 131–3 illegitimacy ratios 182–3 infant mortality 149–52, 184–92 numbers of foundlings 96, 181–2 selection of 119 –20 charity 5–6, 202–3 Chertsey see case-study parishes Coram, Thomas (1688–1751) 6, 202–3 diet 163, 167 disability 18, 145, 165–7 disease 62 in case-study parishes 119, 122–3, 151–2, 162, 189–92 in London 28–9 see also ill-health of foundlings dry nursing by London Foundling Hospital 107– 8, 130, 131, 147–8

222

Index

emotional bonding 109, 110, 133–4, 204 Epsom see case-study parishes family reconstitution 125–6, 175–8 fostering 106–14, 119, 125–40, 204–7 changes of nurse 108–10, 130–1 foundling hospitals 4–5 mortality and 49–51 General Reception (1756–60) 7–8, 11, 16, 17, 19–20, 20–2, 26–7, 31–3, 35–40, 41–2, 43n.4, 52, 56–7, 59, 60, 62, 64, 65, 91, 181–2, 203 impact on survival 74–5, 80, 82, 85 geographic origins of foundlings 26–9 Hemsworth see case-study parishes honour 2, 6, 17, 207–8 illegitimacy in case-study parishes 182–3 of foundlings 4, 16–17, 19, 23, 25–6, 30–5 impact on survival 77–8, 80, 84, 85 in London 4, 25–6, 41–2 ill-health of foundlings 145, 148–9, 154–5, 156–65 on abandonment 24, 60, 65, 84, 97, 99–100, 113, 200–1 contagion 157, 161, 164–5, 201–2 epidemics 158–9 in hospital 61, 157–65, 201–2 infectious diseases 149, 156, 157–9 passed to nurses 108, 148–9 postponing fostering 97, 99–100

smallpox 157, 162, 163–5, 201 venereal disease 148 with nurses 154–5, 190–2 see also disability infanticide 6, 114 inoculation 155, 158–9, 163–5, 167, 192, 195, 201, 202 inspectors (of nurses) 92–4 legitimacy among foundlings see illegitimacy London abandonment in 3–4 mortality 28–9, 49 –50, 53 –5, 58 –9, 163, 172n.68 as place of birth for foundlings 20, 25 –6, 27–9, 32–3, 76, 80, 85 London Foundling Hospital admissions 7–9 see also General Reception buildings 7 foundation 5–7 infirmaries 157– 61, 163, 202 medical attendants 157–61 provincial branches 8, 109, 165, 194 –5 see also Ackworth sources 11–12, 24, 91 medical trials 167– 8, 202 mortality causes 62, 65, 104– 6, 149, 156 –7, 161–3, 192–3 in European foundling hospitals 50 –1, 61 London Foundling Hospital 52– 65, 85, 102–6, 111–14, 149 –52, 155–7 in London Foundling Hospital infirmaries 61, 85, 104 impact of, outside hospital 62–3, 138, 178, 181–2, 193 – 4

Index methods of calculating 51, 53, 55, 184–9 in wider population 17–18, 49–50, 53–6, 58–9, 63, 65 see also case-study parishes; London; seasonal patterns nurses (London Foundling Hospital) ages 129–30 family structure 110, 125–8, 131–4, 136–7 ill-treatment by 93–4, 114, 152–4 number of nurslings 109–14, 124–5, 126–7 residential patterns 94, 123 shortages of 99 social status 128–9 widows 132 nursing as contraceptive 136–7 disease and 101 as employment for women 10, 101, 133, 134–6, 152, 205–7 geographical patterns 81, 94–7, 102 impact on survival of foundlings 60–1, 69, 78, 80–1, 84, 85–6, 104–6 pregnancy and 138 qualities of milk 139 remuneration 94, 101, 108, 112, 134–6, 152, 155 speed of placements for foundlings 80–1, 84, 97–102, 130–1, 204 nutrition 50, 61, 62, 65, 108, 128, 146–8 parish registers 119–20, 123–4, 176–8, 182, 183–4 poor law 3, 134–5, 142n.25, 194, 204, 207

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poor law officials 91 infant abandonment and 5, 35–6, 39–41 relationship with survival 75, 80 proportional hazards modelling 68–72, 81–2 reclamation 18, 33–5, 43n.10, record linkage 118, 125–6, 181–2 seasonal patterns of abandonment 19–20 impact on survival 69, 74, 80, 84, 85 of mortality 149–52, 156–7, 189–92 of nursing 100–1 of sickness 100–1, 150–1, 160, 162 sex of foundlings 16–17, 29 illegitimacy and 16, 35 impact on survival 16, 69, 73–4, 79–80, 83, 84, 85 Sloane, (Sir) Hans (1660–1753) 147, 148, 164, 168 Spedale degli Innocenti di Firenze 43n.6, 44n.23, 50, 53, 56, 60, 61, 66n.8, 100–1, 167, 207–8 stigma attached to foundlings 128, 194–5, 206 war, impact of on abandonment 30, 37–9 weaning 111, 151–2 wet nursing 106–8, 136–87, 146–7, 205–7 impact on survival 78, 85–6 see also nurses; nursing women bodies 10–11 see also breastfeeding; nurses; nursing