Has All That Has Been Done Lately For Infants Failed?

ANNALES DE DÉMOGRAPHIE HISTORIQUE 2010 n° 2 p. 131 à 146

“HAS ALL THAT HAS BEEN DONE LATELY FOR INFANTS FAILED?” 1911, INFANT MORTALITY AND INFANT WELFARE IN EARLY TWENTIETH-CENTURY GERMANY by Jörg VÖGELE

Declining birth rates and continuing high infant mortality rates, particularly when assessed from an international perspective, led to the emergence of an increasing infant welfare movement in Imperial Germany1. Fears about the nation’s future in economic and military respects made the reduction of infant mortality a central theme in the debates on social policy. This was reinforced by an appeal by the Empress Auguste Victoria herself addressed at the board of the Patriotic Women’s League to combine forces in the battle against high infant mortality (Schlossmann, 1908). In the first decade of the twentieth century the infant welfare campaign soon developed from a voluntary association of philanthropists to a national and imperialist movement (Weindling, 1989, 206-209; Schabel, 1995; Stöckel, 1996). The causes of infant mortality were investigated and detailed concepts of infant care elaborated upon. For example, the legal status of infants, fertility, housing conditions, parental education, wealth and occupation and, particularly, feeding practices were and still are considered as key variables2. As low breastfeeding rates in Germany, together with the often inadequate condition of artificial food, were identified as key factors behind the high infant mortality rates, the main

objective of the infant care movement was to increase the rate of breastfeeding. Consequently, breastfeeding campaigns were launched throughout Germany, striking a balance in their means between propaganda and instruction, education and control (Fehlemann, 2004). The key target group was unmarried mothers. Infant welfare centres were created by the municipalities or by private associations and by 1907 there were already over a hundred specialist establishments, mainly based in the large towns or big cities of Germany (Trumpp, 1908). Against this backdrop the extremely high infant mortality rates of the hot summer of 1911 were met with tremendous shock, calling into question all the recent efforts to combat high infant mortality: “Has all that has been done lately for infants failed? Has all our work been in vain and will all future work be in vain?” asked Arthur Schlossmann, the director of the Düsseldorf children’s hospital and one of the leading paediatricians in early twentieth-century Germany (Schlossmann, 1911). Indeed infant mortality rates peaked in 1911 in the whole German Empire, both in urban and rural areas of Prussia as well as in towns with a population exceeding 15,000 inhabitants with rates around 19 percent (Figure 1).

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Fig. 1 Infant Mortality in Germany 1911

Sources: Preussische Statistik 188 (1904), 60; Veröffentlichungen des Kaiserlichen Gesundheitsamtes (Beilagen) 2 (1878)-38 (1914).

This article focuses on: (1) the demographic impact of 1911, including data concerning local, regional and urbanrural differences in infant mortality rates as well as on: (2) the political and practical consequences concerning the infant welfare campaigns on national, federal, and local levels. Special emphasis will be put on the specific developments in Düsseldorf, as it was amongst the first cities (alongside Berlin) to launch a new and comprehensive concept of infant care which functioned as a paradigm for the infant movement in Germany. This programme attempted to unite government, communities and private welfare work in the “Society for Infant Welfare in the Administrative District of Düsseldorf ” (Vögele, 2001).

1911 AND INFANT MORTALITY In the early twentieth century infant death rates continued to be highly affected by climate and temperature. The cold summer of 1902, for example, was accompanied by low infant mortality,

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and the hot summer of 1911 registered high infant mortality rates (Kruse, 1912). Seasonal fluctuations were traditionally characterized by a pronounced summer peak, but temperatures during the heat wave of 1911 reached extraordinary heights. Germany, like many other European countries, registered an extremely hot summer (the highest temperatures recorded during the period 1874-1946). The number of summer days (> 25 degrees Celsius) surpassed those of other years by far: Berlin registered 53 days, Düsseldorf 80, Frankfurt 65, Leipzig 58, Munich 55, Nuremberg 63, Cologne 63, Dresden 53, Breslau 49 and even Hamburg 32. The maximum was reached in Duisburg with 104 days and 42.5 centigrade3. As local data (in terms of age-specific deaths in 1911 from the Düsseldorf area) reveals, the heat wave caused health problems exclusively for the young, whereas the elderly were not affected at all (Figure 2)4. Moreover, the number of infant deaths during the summer months of July,

1911, INFANT MORTALITY AND INFANT WELFARE IN EARLY TWENTIETH-CENTURY GERMANY Fig. 2 Selected Age-specific Deaths in the Düsseldorf Area, 1911

Source: Statistische Monatsberichte für die Stadt Düsseldorf, 1911.

Tab. 1 Infant Deaths in Bavaria, 1910 and 1911

July August September

1910 3749 4222 3646

1911 4602 6368 6146

Increase N 853 2146 2500

Increase % 22.8 50.8 68.8

Source: “Säuglingssterblichkeit in Bayern im Jahre 1911”, Münchener Medizinische Wochenschrift 59 (1912), 1470-1471.

August and September of 1911 surpassed the traditional summer peak of infant mortality by far. In Düsseldorf, a city with relatively low infant mortality rates compared to other German cities, the number of infant deaths during the period from July to September 1911 was twice as high when compared to the respective period in 1910, and led to a maximum IMR of 58.2 percent in August 19115. In southern Germany, in Bavaria, for example, where infant mortality rates were traditionally far above the average, the increase amounted to over 60 percent when compared to the preceding year 1910 (Table 1). Seasonal fluctuations in temperature with the concomitant enormous risk of infant deaths during the hot summer months was an established theme

among contemporary paediatricians and epidemiologists (Silbergleit, 1896; Vögele, 1994; Vögele, 2001, 313-319). Towns and cities were considered to be dangerous. Where the Prussian average was concerned, the summer peak contributed to the higher urban infant mortality rates (Figure 3) (Kruse, 1912; also Baum, 1912; Vögele, 1996). In an international context, German figures were extremely unfavourable (Table 2), although data was taken from the end of the nineteenth century and cannot be directly linked to the heat wave. In the ten largest German towns more than 30 percent of all infant deaths occurred in the third quarter of the year. However, the rate of infant deaths in the majority of the large European cities remained below this mark6.

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Fig. 3 Seasonal Distribution of Infant Mortality in Urban and Rural Prussia, 1911

Source: W. Kruse, “Was lehren uns die letzten Jahrzehnte und der heisse Sommer 1911 über die Säuglingssterblichkeit und ihre Bekämpfung”, Centralblatt für allgemeine Gesundheitspflege 31 (1912), 175-201, p. 178.

Fig. 4 Seasonal Distribution of Infant Mortality in Berlin according to Nourishment, 1908 (percent)

Source: Statistisches Jahrbuch der Stadt Berlin 32 (1913), 183.

Data for Berlin, where information about infant feeding was collected in the course of the census, reveals that excess summer mortality affected artificially-fed infants most profoundly, whereas breastfeeding provided some protection in the hot periods of the year (Figure 4). This pinpoints the disproportionate role of digestive diseases and disorders amongst infants, which were attributed to inadequate feeding practices. Around 1900 more than 70 percent of all infant

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deaths resulted from gastro-intestinal disorders (Picture 1) (Vögele, 2001, 120). Consequently, feeding practices have been regarded as the key determinant of infant mortality in Germany. Artificial feeding was associated with high infant mortality, and extensive breastfeeding with low infant death rates (Knodel and Kintner, 1977). The potential impact of breastfeeding on the survival chances of infants becomes obvious when a homogenous social group is analysed, in this case 628 women, who gave birth in the

1911, INFANT MORTALITY AND INFANT WELFARE IN EARLY TWENTIETH-CENTURY GERMANY Tab. 2 Seasonal Distribution of Infant Mortality in European Towns and Cities, 1889/1893 (percent)

City London Liverpool Paris Bordeaux* Rome** Florence* Geneva*** Zurich* Stockholm Copenhagen Amsterdam* Petersburg**** Moscow* Berlin Breslau Cologne Dresden Düsseldorf Frankfurt/M. Hamburg Leipzig Munich Nuremberg

1st Quarter 25.3 22.5 25.0 25.3 30.2 31.4 20.1 25.9 26.2 23.1 25.4 27.2 18.9 21.0 19.0 19.6 19.3 18.9 21.3 21.9 16.7 20.0 22.8

* 1891/1893

** 1890/1893

2nd Quarter 21.5 23.1 25.3 21.7 22.1 20.7 23.4 23.6 23.5 24.9 25.5 28.5 32.7 25.2 25.8 23.2 25.8 22.3 25.0 20.4 19.8 24.2 22.9 *** 1889/1892

3rd Quarter 29.6 30.5 28.2 32.9 24.0 25.4 33.7 24.9 29.5 30.6 26.7 24.1 30.9 34.7 36.4 36.7 36.4 39.8 34.3 37.3 46.2 34.3 33.8

4rth Quarter 23.6 23.9 21.5 20.1 23.7 22.5 22.8 25.6 20.8 21.4 22.4 20.2 17.5 19.1 18.8 20.5 18.8 19.0 19.4 20.4 17.8 21.5 20.5

**** 1886/1888

Source: H. Silbergleit, “Kindersterblichkeit in europäischen Grossstädten”, Huitième Congrès international d’Hygiène et de Démographie, tome VII, Budapest 1896, 443-456, p. 454.

Cologne maternity asylum. Only poor married women were admitted, and the municipal welfare committee had to confirm their indigence. Amongst this group in 1900-1901 infant mortality fluctuated between 8 deaths per 100 live births—when breastfeeding was practised for over three months—and 37 deaths per 100 births for infants who were either not breastfed at all or only for a period shorter than three months (Dietrich, 1902). Breastfeeding minimised the chances both of malnutrition and of the acquisition of infectious diseases. Breast milk

was not only considered to be nutritionally ideal, but it was also seen as clean and passed on immunization from the mother to the child. In contrast, artificial food promoted bacterial infection, especially when prepared with milk, water, or, as was customary in some areas, with food pre-chewed by an adult. Infants were nourished with meal-pap and sugar water, often prepared in the morning and warmed up three to four times a day. Chicory-coffee was also given to the newborn. The bottle was filled with pre-chewed bread and sugar

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Pic. 1 Infant Suffering from Gastro-intestinal Disorders, 1904

Source: University of Düsseldorf, Institute for the History of Medicine.

and the nipple dipped in beer (Müller, 2000). It was even reported that it was not uncommon to use opiate additives in artificial food to pacify the infants in southern Germany. Contemporaries often criticised the widespread use of beer, gin, and spirits to “nourish” the infant or child. Even at the beginning of the twentieth century, parental guidelines for infant care felt obliged to point out that alcohol might damage the infant’s health7.

Contemporary local investigations in Germany implied that the frequency of breastfeeding tended to decrease with higher income and was hardly existent in the upper classes. Even more striking were regional differences regarding the rate of breastfeeding. In the eastern and southeastern regions of the German Empire, high infant mortality rates corresponded to the absence of breastfeeding in this region (Map 1) (Kintner, 1985; Kintner, 1987). Source: Das Deutsche Reich in gesundheitlicher und demographischer Beziehung. Festschrift den Theilnehmern am XIV. Internationalen Kongresse für Hygiene und Demographie Berlin 1907 gewidmet vom Kaiserlichen Gesundheitsamte und vom Kaiserlichen Statistischen Amte, Berlin 1907.

Map. 1 Infant Mortality in Germany, 1900-1904

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1911, INFANT MORTALITY AND INFANT WELFARE IN EARLY TWENTIETH-CENTURY GERMANY

At the beginning of the twentieth century, it was estimated for the whole German Reich that the mortality rate among the artificially nourished infants was up to seven times higher than that of the breastfed infants. Investigations from the beginning of the twentieth century reveal that breastfeeding could compensate for unfortunate economic and social conditions in the sense that breastfed children from lower classes had substantially higher survival chances than non-breastfed children from wealthier families (see Figure 5). In selected sections of the administrative

district of Düsseldorf, the mortality rate of bottle-fed children from wealthier families (paternal yearly income of more than 1,500 Marks) was, with around 30 percent for one-year-olds and 18 percent for two-year-olds, much higher than the mortality rate of breastfed children from poorer families (paternal yearly income of less than 1,500 Marks) with 14 and 7 percent respectively. Among infants from poor families who were artificially fed, the mortality rate was 56 percent in the first quarter of a year and 32 percent in the second quarter (Baum, 1917, 172-173).

Fig. 5 IMR in the Administrative District of Düsseldorf with Respect to Nourishment and Father’s Income, approx. 1905

Source: M. Baum, “Lebensbedingungen und Sterblichkeit der Säuglinge im Kreise Grevenbroich” in: Zeitschrift für Säuglingsfürsorge 6 (1912), 197-208 and 309-316.

1911 AND THE INFANT WELFARE MOVEMENT

In view of the dramatic increase in infant deaths during the heat wave of 1911, it might be interesting to investigate the public impact of this catastrophe. In order to pursue this question we focussed on two newspapers, the regional Düsseldorfer General-Anzeiger and the national Neue Preußische Zeitung during June and

September 1911 and analysed whether and in which ways infant morta-lity, the summer peak, and the infant welfare campaigns were covered in the news reports. Already in the summer of 1911 the remarkable increase in temperature became a public subject. This is reflected by the coverage of the selected newspapers. Both the Düsseldorfer General-Anzeiger and the Neue Preußische Zeitung informed their readers about the heat wave and its

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consequences. The reports, however, focused on the exposure of many regions to bad harvests, water shortages and increases in the prices of basic foodstuffs (potatoes; sugar beets)8. Excess infant mortality rates, however, seem to have been only of subordinate interest in this context. Numbers of deaths were reported mainly in short announcements, and the causes attri-buted to the heat wave. It was mentioned that mothers should look after the quality and condition of the cow’s milk, and that they should not wean their baby in the hot summer months. The theme, however, did not make it into the headlines of the newspapers. Furthermore, the strong increase of the infant mortality did not lead to any public criticism of the infant welfare movements. Rather it was

suggested that the existing campaigns should be intensified. In this context references were made to the 3. Internationale Kongress für Säuglingsschutz, which was supposed to be held in Berlin in September of the same year. On the whole, the heat wave and the increase in infant mortality remained a rather marginal public discourse, and rather a scholarly discussion in academic medical journals (Händel, 1911). Maybe this is not surprising, as—seen from a broader perspective—infant mortality in 1911 was still considerably low when compared to nineteenth-century rates, and it was only the first decade of the twentieth century which brought the onset of improvements with rates below 20 percent (Figure 6) (See also Prinzing, 1899; Rott, 1926/27).

Fig. 6 Infant Mortality in Germany, 1875/7-1913

Sources: Preussische Statistik 188 (1904), 60; Veröffentlichungen des Kaiserlichen Gesundheitsamtes (Beilagen) 2 (1878)-38 (1914).

This was the point the campaigners took up. As the infant welfare movement was still in its early stages, it could not be blamed for the epidemiological effects of 1911. Arthur Schlossmann was quick to answer his own question mentioned earlier, whether all efforts had been in vain, with a definite: of course not. On the contrary, the means and rights of the Society should be

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expanded and intensified (Schlossmann, 1911, 2). Furthermore, the events of 1911 made it perfectly clear that high infant mortality was primarily a social problem, and helped to shift the approach even more definitely from a eugenic to a social-hygienic approach. A closer look at the developments of the Düsseldorf Society of Infant Welfare shall illustrate this issue.


Arthur Schlossmann, born in 1867, had received training as a paediatrician in Berlin. When he moved to Dresden in the early 1890s, he founded a “Policlinic for Infants and Children” and engaged himself in a range of initiatives in the field. In 1906 he moved to the recently founded Academy of Practical Medicine at Düsseldorf and became the director of the paediatric clinic. He acted as the driving force and key figure in establishing the Society of Infant Welfare in the region. After negotiations with state and municipal officials concerning mainly financial aspects, the Society was founded on 7th November 1907. Arthur Schlossmann acted as chairman. All rural districts and towns of the administrative area became founding members. Together they had to pay an annual fee of 20,000 Marks (Schlossmann, 1908, 239-249). At the end of the first business year the Society had already grown to 350 members; amongst them were various corporate members such as business companies, other associations and private persons of high rank in policy making, in economy and society (Bericht…, 1907). Therefore the Society was a combination of the relevant institutions, associations and private persons who directed or influenced welfare policy in the region. Thus, the Society obtained a solid financial basis and political consolidation. Already in the second year Dr Marie Baum, a trained chemist and former factory inspector, was employed as chief executive, and the management became professional. The approach was based on social hygiene, although the view was also on future “healthier” generations and thus included an element of eugenics

(Woelk, 2000). Schlossmann concluded that the risks faced by infants could kill both the weak as well as the strong, yet bad care or even disease in the early days of life might also lead to the misfortune that infants did not develop into strong adults, but into vulnerable and fragile grown-ups who might become easy prey for tuberculosis or other consuming diseases and thus a burden on public welfare and society in general (Schlossmann, 1908, 242; Woelk, 1998). Increasingly, social darwinistic interpretations of infant mortality as a natural selection process receded in favour of a more social hygienic motivation for infant welfare. The declared aim was to bring knowledge of infant care, infant feeding practices and infant welfare particularly to the working classes and to create the public awareness that appropriate care could be of more importance for the infant’s health than social and economic status of the parents. For this purpose, the Society launched a wide range of activities that took into account the different economic and social structures as well as religious and cultural backgrounds. Leaflets and brochures were distributed, and the Society offered free medical advice and held regular courses in the towns of the area. Additionally, two women teachers were employed to cover the rural areas by moving from village to village with mobile equipment. With illustrations, photographs and even films they tried to demonstrate the scientific findings, the physical development of infants and propagated adequate infant care in a popular way (Picture 2). Schlossmann himself featured in an animated poster, urging that mother’s milk was irreplaceable (Picture 3).

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Pic. 2 Breastfeeding Propaganda “Can you replace my mother?”

Source: GE-SO-LEI. Grosse Ausstellung in Düsseldorf 1926 für Gesundheitspflege, Soziale Fürsorge und Leibesübungen. Zusammengestellt und bearbeitet von Dr. med. Marta Fraenkel, Bd. 2, Düsseldorf 1927, 684.

Pic. 3 Breastfeeding Propaganda “Mother’s milk is irreplaceable!!”

Source: GE-SO-LEI. Grosse Ausstellung in Düsseldorf 1926 für Gesundheitspflege, Soziale Fürsorge und Leibesübungen. Zusammengestellt und bearbeitet von Dr. med. Marta Fraenkel, Bd. 2, Düsseldorf 1927, 683.

During the heat wave of 1911 it was particularly the mortality of legitimate infants which—in relative terms—rose disproportionately (which is evident to a certain degree as the rates of illegitimate infants were already extremely high). Schlossmann attributed this to the fact that illegitimate infants could be “monitored and controlled, whereas legitimate

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infants did not receive the pleasure of similar care” (Schlossmann, 1911). As a consequence, legitimate infants became included in the programme, and reports regularly pinpointed that married mothers accepted the advice of the welfare centres more readily than unmarried mothers (Bericht, 1911/12, 29). The distrust of unmarried mothers


was the result of their legal situation. Illegitimate children had to be kept under the care of an official guardian and state authorities possessed the right to put unmarried mothers under police supervision. With the increasing welfare work this state control passed over into the hands of trained female welfare workers, yet the deep mistrust of unmarried mothers persisted. A visit to the welfare centre could expose them to state supervision, and therefore they tried to avoid any contact with the welfare workers. Yet, if a mother was suspected of neglecting her child, she could be compelled to visit the welfare centre or to endure compulsory home visits. The Society offered breastfeeding allowances from 1913 onwards. With one to five Marks per week Düsseldorf paid considerably more in comparison to other towns and cities (Vögele, 2001, 384). The amount was even liable to be increased during the dangerous summer months (Rott, 1914, 26). Furthermore, the mothers could possibly avoid an expensive doctor’s visit if they went to the preventive medical check-ups for infants. In some welfare centres they could receive high-quality cow’s milk or infant clothes. In infant health care courses the mothers were taught about raising infants and living a hygienic lifestyle. In the following years a home-visiting service was developed. The welfare workers visited the mothers at home and advised them on matters of hygiene and housekeeping. Their paternalism, based on bourgeois ideals of values and hygiene, was one reason why the infant welfare programme was considered by the mothers to be twosided. On the one hand the welfare workers could give valuable help and

instructions, especially to lower-class mothers who often lacked basic knowledge and skills. On the other hand, they often proved to be an invasive and critical force within the private sphere of the families (Frevert, 1984). In addition, the Society offered infant care courses for young women and mothers. Although there is only unsystematic information available, the few examples indicate that the acceptance remained limited. In Düsseldorf, the audience amounted, on average, to 12 persons per course (Bericht, 1910/1911, 9). Teachers complained about the irregular attendance and a general lack of interest. When asked for the reasons, young mothers stated that they considered the care for an infant as an instinctive natural behaviour. Some felt offended in their sense of shame, stating that young girls should not know about these matters (Bericht, 1912/1913, 12). Furthermore, there were indications that the welfare workers did not reach the intended target group. One of the teachers reported that most participants of her courses came from the “better working classes”. Particularly domestic servants— in contrast to the factory workers—were the most regular participants (Bericht, 1912/1913, 13). As domestic servants were better acquainted with bourgeois life-styles it might have been easier for them to extend bourgeois norms and values to the areas of hygiene and infant care. Other participants mentioned in the reports were the wives of civil servants, physicians, teachers and priests (Bericht, 1910/1911, 9). The acceptance of the courses, however, improved over the years with the consequence that courses were extended and an increasing participation could be registered after World War I.

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Furthermore, Marie Baum attempted to establish factory nursing institutions in some of the smaller towns which were based on textile industry and therefore registered high female labour force participation. This initiative failed, however, due to the resistance of the regional authorities. Although many manufacturers were members of the Society, they were not willing to support their female workers. On the eve of World War I such facilities existed in no more than 21 German cities (Rott, 1914, 37-39). In contrast to other countries care for the breastfeeding mother

herself, like providing her with additional food, remained almost completely unknown in Germany. It was, however, only in the deprived war years, when breastfeeding increased. In 1916 Marie Baum concluded with disappointment that the shortcomings during the war years caused such a substantial rise in breastfeeding rates which all their campaigning had not been able to achieve (Bericht, 1915/16, 65). Even after the war breastfeeding ratios remained at a high level. Consequently, the summer peak vanished in the following decades (Figure 7).

Fig. 7 Seasonal IMR in Düsseldorf, 1905, 1915 and 1925

Sources: Jahresbericht des Statistischen Amts der Stadt Düsseldorf für 1905, 419-5; Jahresbericht der Stadt Düsseldorf für 1915-1918, 33 and 37; Jahresbericht der Stadt Düsseldorf für 1925, 22 and 25.

After World War I the “Society of Infant Welfare” postulated that it was able to fight high infant mortality by continuously broadening the network of welfare institutions and measures (Butke and Kleine, 2004; Stöckel, 1996, 293377; Woelk, 1998, 156-157). Consequently, the Society extended its range of activities to welfare work, and changed its name in 1919 to “Verein für Säuglingsfürsorge und Wohlfahrtspflege im Regierungsbezirk Düsseldorf ” (Society

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for Infant Welfare and Welfare Work for the administrative district of Düsseldorf ). In the following years, however, an increasing number of activities were taken over and carried out by municipal welfare offices and less by the Society itself. As this had been the eventual aim of the Society, the decrease in its duties was not considered to discredit its work. Instead, the successful implementation of the welfare concepts, especially for infants, into the “Weimar style” welfare


policy can be attributed to the Society. It was only in the 1920s when social hygienic concepts were upstaged in favour of racial hygienic thoughts of selection and qualitative differences of human beings. It was, however, the National Socialists who propagated an opposing public health model based on biological principles which focused on exclusion instead of inclusion.

CONCLUSION The Society for Infant Welfare in the Administrative District of Düsseldorf is an important example of the history of infant, children and youth health care in many respects. At first, as a regional association, it took a mediating role between state and local social politics. Moreover, its representatives formed a modern caring system in a region characterized by rapid industrialization on the one hand, but also with large rural areas on the other hand. In this context the hot summer of 1911 seems to have functioned as a catalyst for an extension of the welfare work based on a modern social hygienic approach. In the hot summer months infant mortality rates

increased about 60-100 percent when compared to those in the corresponding months of the previous year. Despite that, the campaign against high infant mortality rates seemed to have remained an academic discussion, as excess infant mortality rates played only a subordinate role in public discourse as it was reflected in newspapers. However, the campaigners successfully exploited the heat wave to fade eugenic tendencies into the background. Increasingly, the Society concentrated not only on infant care, but also expanded its activities towards child and youth welfare. With its innovative concept it shaped the form of public child and youth welfare in the entire region after World War I. The members constantly worked towards integrating infant welfare into the municipal public health system. They succeeded during the Weimar Republic. Jörg VÖGELE Institut für Geschichte der Medizin, Heinrich-Heine-Universität Düsseldorf, Postfach 10 10 07, 40001 Düsseldorf. email: [email protected]

NOTES 1. The following article is based on a paper delivered at the European Social Science History Congress in Lisbon, 27 February - 1 March, 2008, Family/Demography Network. 2. For basic historical demographic research on infant mortality in Germany see Imhof, 1981; Imhof, 1985; Kintner, 1982; Lee, 1980; Spree, 1988; Spree, 1995; Vögele, 1998. 3. Source: Statistisches Jahrbuch Deutscher Städte 20 (1914), 33. 4. Quarterly infant mortality rates to eradicate the effect of any seasonal variations in births account for: 1st quarter: 9.1; 2nd quarter: 11.9; 3rd quarter:

37.2; 4th quarter 10.9 (per 100 live births). For methodological details see (Mooney, 1994). 5. Beilage zu den Statistischen Monatsberichten der Stadt Düsseldorf, Juli-September 1911. 6. It has to be taken into account that the seasonal distribution of infant mortality could be significantly affected by the seasonal distribution of births, as well as potentially also reflecting the different relevance of neonatal mortality and postneonatal mortality in the different nations, etc. 7. For more details and further examples see Vögele, 2001, 153-161. 8. See also http://www.wetterzentrale.de/cgi-bin/wetterchronik

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JÖRG VÖGELE

SUMMARY

Declining birth rates and continuing high infant mortality rates, particularly when assessed from an international perspective, led to the emergence of an increasing infant welfare movement in Imperial Germany. In the first decade of the twentieth century the infant welfare campaign soon developed from a voluntary association of philantropists to a national movement. Infant welfare centres were created by the municipalities or by private associations. They elaborated detailed concepts of infant care. As low breastfeeding rates in Germany, together with the often inadequate condition of artificial food, were identified as a key factor behind the high infant mortality rates, the main objective of the infant care movement was to increase breastfeeding. Consequently, breastfeeding campaigns were launched throughout Germany, balancing in their means between propaganda and instruction, education and control.

Against this background the extremely high infant mortality rates during the heat wave of 1911 were experienced as a tremendous shock, putting all the recent efforts to combat high infant mortaliy into question: “Has all that has been done lately for infants failed”? This paper focusses on (1) the demographic impact of 1911, particularly on the basis of regional and urban-rural differences in infant mortality rates as well as on (2) the political consequences both on national, federal, and local levels. All in all the campaign against high infant mortality rates seemed to have largely remained an academic discussion, as excess infant mortality rates played only a subordinate role in public discourse. However, the campaigners successfully exploited the heat wave to fade eugenic tendencies into the background.

RÉSUMÉ

La dénatalité et des taux élevés de mortalité infantile, surtout lorsqu’ils étaient comparés internationalement, conduisirent à l’émergence dans l’Allemagne impériale d’un mouvement de protection infantile. Dans la première décennie du XXe siècle, la campagne en faveur du bien-être des nourrissons connut un développement qui fit passer ce qui n’était qu’une association volontaire de philanthropes à un mouvement national. Des centres de protection infantile furent créés par les municipalités ou par des associations privées. Ils élaboraient des programmes détaillés de soin aux nourrissons. Les taux d’allaitement maternel faibles en Allemagne, combinés avec les mauvaises conditions de l’allaitement artificiel, furent pointés comme le facteur clé expliquant la forte mortalité infantile. Pour cette raison, le principal objectif du mouvement de puériculture a été d’augmenter l’allaitement maternel. D’où des campagnes lancées dans toute l’Allemagne, qui mettaient aussi bien l’accent sur la propagande que sur l’enseignement, sur l’éducation que sur le contrôle des mères.

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Dans ce contexte, les taux extrêmement élevés de mortalité infantile au cours de la canicule de 1911 constituèrent un choc terrible, mettant en question tous les efforts déployés les années précédentes pour lutter contre la mortalité infantile élevée : « Est-ce que tout ce qui a été fait récemment pour les nourrissons a échoué ? » Cet article met l’accent sur l’impact démographique de la crise de 1911, notamment sur la base des différences régionales et urbaines-rurales dans les taux de mortalité infantile, avant d’aborder ses conséquences politiques tant au niveau national, fédéral que local. Dans l’ensemble, la campagne contre les taux élevés de mortalité infantile semble être largement restée une discussion académique. La poussée des taux de mortalité infantile n’a joué qu'un rôle secondaire dans le discours public. Toutefois, les protagonistes ont réussi avec succès à exploiter la vague de chaleur pour estomper les tendances eugéniques et les faire passer à l’arrière-plan des programmes de lutte contre la mortalité infantile.