The midwife, the coincidence, and the hypothesis

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Abstract
Hertfordshire records At the beginning of the 20th century, there was widespread concern about the physical deterioration of the British people. One in 10 infants died before they were a year old, and many of those who survived reached adult life in poor health. During 1902, reports in the national press claimed that up to two thirds of the young men who volunteered to fight in the Boer War in South Africa (1899 to 1902) had been rejected because of unsatisfactory physique. An interdepartmental committee set up in 1903 drew a shocking picture of the nation's children—malnourished, poorly housed, and deprived. Moreover, the birth rate was falling. The medical officer of health for Hertfordshire at around this time stated: Hertfordshire does less than forty out of the fifty-five counties to perpetuate the national stock; for England and Wales the birth-rate has for thirty-three years been steadily declining, only two Continental countries (Belgium and France) having lower birth-rates, while that for Japan is increasing and is now ahead of every white race but Russia and three of the Balkan States. The new census figures show a lower rate of increase than in any decennium of the last century. This decay must betoken the doom of modern civilisation as it did that of Rome and Greece, unless some new moral or physical factors arise to defeat it. It is of national importance that the life of every infant be vigorously conserved. Ethel Margaret Burnside, the county's first “chief health visitor and lady inspector of midwives,” responded to this challenge. In 1911, she set up an army of trained nurses to attend women in childbirth and to advise mothers on how to keep their infants healthy after birth. The only known photograph of this remarkable and dedicated woman was taken when she was 17 years old (1). In later life she was described as “a big, bony woman, about 5 ft 10 inches tall, with a long thin face and dark hair, which she wore scraped back, a very imposing presence, a penetrating voice and a dominant personality.” The clerk to the county council is known to have lived in fear of her and would make himself immediately available if he knew she wished to see him. She persuaded him to provide 60 spring balances at 5 shillings each, so that each baby born in the county could be weighed at birth and at 1 year old. Fig 1 Ethel Margaret Burnside She was no desk bound manager, but a leader who travelled across the county supervising and encouraging her nurses. To begin with she travelled on her bicycle. “The cyclometer on my bicycle registered 2921 miles this year,” she wrote. Later she persuaded the county council to buy her a car, and she called it “little hero.” She ensured that the activities of her nurses were recorded. A health visitor went to each baby's home at intervals and recorded its illnesses and development on a card. A sample of mothers whom we have since interviewed remembered the midwives and health visitors as helpful people who skilfully delivered and cared for their babies. When the baby reached 1 year old the card was handed in to the county office, where the information was transcribed into ledgers in immaculate handwriting, a separate ledger for each village (2). So began the now famous Hertfordshire records, which were maintained across the county until the NHS was formed in 1948. View larger version: In this window In a new window Fig 2 Extract from one of the ledgers kept by Miss Burnside's nurses Footnotes Competing interests None declared.

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