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Child care, infant mortality and the impact of legislation: the case of Florence's foundling hospital, 1840–1940

Published online by Cambridge University Press:  29 January 2009

Pier Paolo Viazzo ,
Maria Bortolotto  and
Andrea Zanotto
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Continuity and Change , Volume 9 , Issue 2 , August 1994 , pp. 243 - 269
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Copyright © Cambridge University Press 1994

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References

ENDNOTES

1 A succinct and authoritative review of the results of this early wave of studies is provided by Knodel, J., ‘Breast-feeding and population growth’, Science 198 (1977), 1111–15.CrossRefGoogle ScholarPubMed

2 See Lee, R., ‘Infant, child and maternal mortality in western Europe: a critique’, in Brändström, A. and Tedebrand, L.-G. eds., Society, health and population during the demographic transition (Stockholm, 1988), 9–21.Google Scholar

3 Just how widespread this practice was in the European past remains exceedingly difficult to ascertain. Even for France, which is by far the best documented country, any survey of wet nursing before the last quarter of the nineteenth century is bound to be impressionistic. Some evidence for Paris indicates, however, that in the 1780s over 90 per cent of all newborns were placed with wet nurses. The proportion dropped to about 50 per cent in 1801–1802 and to a conservative estimate of 41 per cent in 1869. Around 1900, when the wet nursing business was markedly on the decline, the total number of infants placed with wet nurses every year was still as high as 80,000 (slightly over 10 per cent of all newborns). See Sussman, G. D., Selling mother's milk. The wet-nursing business in France, 1715–1914 (Urbana, III., 1982), 101–88Google Scholar; Sussman also shows that the practice of sending infant children away to be cared for by mercenary wet nurses was essentially an exchange between cities and at first, their rural hinterlands and later with their larger regional markets. It is worth noting that in the late nineteenth century the rates of infant mortality recorded in many rural French departments were significantly affected by the ratio between the number of nurslings ‘imported’ from distant urban areas and the number of locally born infants.

4 For a broad historical overview of wet nursing, including the nursing of abandoned infants, see Fildes, V., Wet nursing. A history from antiquity to the present (Oxford, 1988).Google Scholar A useful survey of the literature is also provided by Grieco, S. F. Matthews, ‘Breastfeeding, wet nursing and infant mortality in Europe (1400–1800)’, in Grieco, S. F. Matthews and Corsini, C. A., Historical perspectives on breastfeeding (Florence, 1991), 15–62.Google Scholar

5 Pullan, B., Orphans and foundlings in early modern Europe (The Stenton Lecture 1988; Reading, 1989), 10–11, 24.Google Scholar Although most writers would probably still trace these differences to the religious divide between Catholic and Protestant Europe, their argument is partly undermined by the fact that foundling hospitals were much more firmly established in the southern countries than in the rest of Europe well before the Reformation.

6 See Hunecke, V., ‘Intensità e fluttuazioni degli abbandoni dal XV al XIX secolo’, in Bardet, J.-P. et al. , Enfance abandonnée et société en Europe, XIVe-XXe siècle (Rome, 1991), 32–6.Google Scholar

7 For a survey of the literature and a general statement of these findings, see Hunecke, V.. I trovatelli di Milano. Bambini esposti e famiglie espositrici dal XVII al XIX secolo (Bologna, 1989), 13–47Google Scholar, and Sà, I. dos Guimarães, ‘The circulation of children in eighteenth-century southern Europe: the case of the foundling hospital of Porto’ (unpublished Ph.D. dissertation, European University Institute (Florence), 1992), 1–69.Google Scholar

8 See Sá, dos Guimarães, ‘The circulation of children’, 40.Google Scholar

9 Morel, M.-F., ‘The care of children: the influence of medical innovation and medical institutions on infant mortality 1750–1914’, in Schofield, R., Reher, D. and Bideau, A. eds., The decline of mortality in Europe (Oxford, 1991), 199.Google Scholar Similar views have been recently expressed by Hunecke, (I trovatelli di Milano, 15–22)Google Scholar, Sá, Guimarães, ‘The circulation of children’, 58–60Google Scholar, and very incisively by Bardet, J.-P., Dufour, C. and Renard, J. (‘La mort des enfants trouvés, un drame en deux actes’, IUSSP Conference on ‘Child and infant mortality in the past’ (Montreal, 1992)).Google Scholar

10 See Morel, , ‘The care of children’, 199–204.Google Scholar

11 Morel, M.-F., ‘A quoi servent les enfants trouvés? Les médecins et le problème de l'abandon dans la France du XVIIIe siècle’, in Bardet, et al. , Enfance abandonnée, 837–58.Google Scholar On smallpox inoculation, see Andreucci, O., Del vaiuolo e della sua profilassi. Cenni storici (Florence, 1863), 232–3.Google Scholar

12 On the history of Russian foundling homes, see Ransel, D. L., Mothers of misery. Child abandonment in Russia (Princeton, 1988)Google Scholar, and Berelowitch, W., ‘Les hospices des enfants trouvés en Russie (1763–1914)’, in Bardet, et al. , Enfance abandonnée, 167–217.Google Scholar

13 Ransel, , Mothers of misery, 31.Google Scholar

14 On the London Foundling Hospital and the system of the ‘General Reception’, see McClure, R. K., Corom's children: the London Foundling Hospital in the eighteenth century (New Haven, 1981), 76–136CrossRefGoogle Scholar, and Wilson, A., ‘Illegitimacy and its implications in mid-eighteenth-century London: the evidence of the Foundling Hospital’, Continuity and Change 4 (1989), 103–64.CrossRefGoogle Scholar

15 Some students of infant abandonment would argue that changing economic circumstances, such as general impoverishment or a greater involvement of women in the labour market, led married couples to resort increasingly to the wheel as a way of leaving their children at the foundling homes. Other scholars, however, believe that the rise in infant abandonment in southern Europe was primarily accounted for by a parallel increase in illegitimacy. Recent overviews of the debate are provided by Sá, dos Guimarães, ‘The circulation of children’, 15–18Google Scholar, and Kertzer, D. I., Sacrificed for honor. Italian infant abandonment and the politics of reproductive control (Boston, 1993), who strongly supports the illegitimacy hypothesis.Google Scholar

16 The first foundling was admitted to Florence's Spedale degli Innocenti in 1445; the Ospedale Maggiore in Milan was founded in 1456; and the Grand Hôtel-Dieu in Lyons was taking in children as early as the beginning of the sixteenth century. The foundling homes of Moscow, St Petersburg and Vienna were opened in 1763, 1770 and 1784 respectively.

17 Sá, Dos Guimarães, ‘The circulation of children’, 54–5.Google Scholar

18 Ransel, , Mothers of misery, 3.Google Scholar

19 See Pellegrini, L., ‘L'esposizione dei fanciulli a Milano dal 1860 al 1901’, in Gorni, M. and Pellegrini, L., Un problems di storia sociale. L'infanzia abbandonata in Italia nel secolo XIX (Florence, 1974), 152Google Scholar, and Bruscoli, G., Lo Spedale di S. Maria degli Innocenti di Firenze dalla sua fondazione ai giorni nostri (Florence, 1900), 294–5.Google Scholar

20 Raseri, E., ‘I fanciulli illegittimi e gli esposti in Italia’, Annali di Statistica, 2nd series, 19 (1881), 1–26.Google Scholar See also Di Bello, G., Senza name né famiglia (Florence, 1989), 6.Google Scholar

21 The exact figures in 1890 were 16,587 for Moscow and 9,593 for St Petersburg. In 1892, admissions had dropped by about 30 per cent to 10,915 and 6,874 respectively. See Ransel, , Mothers of misery, 307.Google Scholar

22 Ransel, , Mothers of misery, 111.Google Scholar

23 For a recent and lively discussion of this debate in Italy, see Kertzer, , Sacrificed for honor, ch. 7.Google Scholar

24 Archivio Ospedale degli Innocenti di Firenze [henceforth AOIF], Affari Generali, CCCLXi, 76, Relazione a corredo del Rendimento di conti del Region Spedale degli Innocenti di Firenze per I'anno 1882. For a more detailed analysis of this document, see M. Bortolotto and A. Zanotto, ‘Livelli e tendenze della mortalità infantile allo Spedale degli Innocenti di Firenze nella seconda metà dell'Ottocento’ (Innocenti Institute Research Paper AS/3; Florence, 1993).

25 AOIF, Affari Generali, CCCLXI, 76Google Scholar, Relazione a corredo, 3.Google Scholar

26 Ibid., 9.

27 Ibid., 11.

28 The phrase ‘methodological anarchy’ was used as late as 1923 by the chief medical officer of the Innocenti to denounce the persistence in twentieth-century foundling homes of a bewildering variety of methods to reckon infant mortality. See Dotti, G. A., Regio Spedale degli Innocenti ‘Brefotrofio’ di Firenze. Relazione sanitaria del biennio 1921–1922 (Florence, 1923), 42–3.Google Scholar A certain proneness by administrators of foundling hospitals to provide ‘cosmetic figures’, arrived at by deceptive methods of reckoning mortality, has been hinted at by Ransel, (Mothers of poverty, 47).Google Scholar

29 It should be noticed that the 1883 report provides only proportional figures. However, we have been able to recover the corresponding absolute figures from the archival series cited below in endnote 39. An examination of these data reveals some ambiguity in the definition of ‘sucklings’. Although this term formally designated until 1874 all children under two years of age, it would seem that the administrators, when calculating suckling mortality, took into account only the deaths of infants under twelve months of age.

30 See the pioneering study by Trexler, R., ‘The foundlings of Florence, 1395–1455’, History of Childhood Quarterly 1 (1973), 259–84Google Scholar, and more recently Klapisch-Zuber, C., Women, family, and ritual in Renaissance Italy (Chicago, 1985), 132–64Google Scholar, Boswell, J., The kindness of strangers. The abandonment of children in Western Europe from Late Antiquity to the Renaissance (New York, 1988), 417–27Google Scholar, and especially Gavitt, P., Charily and children in Renaissance Florence. The Ospedale degli Innocenti, 1410–1536 (Ann Arbor, Mich., 1990).Google Scholar Gavitt's book and the case of the Innocenti are discussed in a broad comparative perspective in Hunecke, V., ‘Findelkinder und Findelhäuser in der Renaissance’, Quellen und Forschungen aus Italienischen Archiven und Bibliotheken 72 (1992), 123–53.Google Scholar

31 See Bortolotto, , ‘Lo Spedale di Santa Maria degli Innocenti: una rassegna storico-bibliografica’ (Innocenti Institute Research Paper AS/1; Florence, 1991), 45–6.Google Scholar

32 The two classic works are Bruni, F., Storia dell'Imperials e Regio Spedale di S. Maria degli Innocenti di Firenze (Florence, 1819)Google Scholar, and Bruscoli, Lo Spedale di S. Maria degli Innocenti. Another useful book published before the Second World War is Cherici, U., L'Assistenza all'Infanzia ed il R. Spedale degli Innocenti di Firenze (Florence, 1932).Google Scholar Recent studies include Di Bello, Senza name né famiglia, and above all a series of pioneering papers by Corsini, C.: see in particular his influential article ‘Materiali per 10 studio della famiglia in Toscana nei secoli XVII–XIX: gli esposti’, Quaderni Storici 11 (1976), 998–1052Google Scholar, and ‘Structural changes in infant mortality in Tuscany from the 18th to the 19th century’, in Bengtsson, T. et al. eds., Pre-industrialpopulation change (Stockholm, 1984).Google Scholar

33 See Zuccagni-Orlandini, A., Ricerche statistiche del Granducato di Toscana, vol. 1 (Florence, 1848), 472–97Google Scholar, and Castelli, L., Città di Firenze. La popolazione e la mortalità del centennio 1791–1890 (Florence, 1893), x–xi.Google Scholar

34 Kertzer (Sacrificed for honor, ch. 4) has recently argued that in the nineteenth century there was a marked contrast between the largely rural origin of infants abandoned in Florence and the predominantly urban origin of Milan foundlings revealed by Hunecke, V. in ‘Problemi della demografia milanese dopo l'Unità: la chiusura della ruota ed il “crollo” delle nascite’, Storia Urbana 5 (1978), 81–90.Google Scholar Although this kind of information is always difficult to interpret, there are reasons to believe that the contrast was not as marked as suggested by Kertzer. A detailed analysis of the provenance of the 1,632 foundlings admitted to the Innocenti in the year 1875 for whom the place of origin is known (out of a total of 1,845) has shown that just over 70 per cent came from the city. See Bortolotto, and Zanotto, , ‘Livelli e tendenze’, 21–3.Google Scholar

35 These estimates are provided by Corsini (‘Materiali’, 1006), who stresses a number of basic similarities between abandonment patterns in Florence and Milan.

36 See Gavitt, , Charity and children, 162–70.Google Scholar

37 The number of Innocenti wet nurses in the early nineteenth century has been roughly estimated from the figures provided in Bruni, , Storia dell'Imperiale e Regio Spedale, vol. 2, Tables IV and V.Google Scholar

38 See Bruscoli, , Lo Spedale di S. Maria degli Innocenti, 292–7.Google Scholar

39 AOIF, XLIV, 11–65Google Scholar: Dimostrazioni mensuali, quadrimestrali e annuali del movimento di famiglia (1838–1874)Google Scholar; Dimostrazione giornaliera del movimento di famiglia (1875–1892).Google Scholar The second series has gaps in 1876 and 1878. Fortunately, it has been possible to recover sufficient, if not complete, information for these two years from the Relazione a corredo of 1883 and from another document of 1878 (Richiesta a queslo Spedale di Notizie…fatta dal Direttore dell'Uffizio Comunale di Statistica di Budapest, AOIF, Affari Generali, CCCXL, 20).Google Scholar

40 It would of course be foolish to deny the existence of any link between increased mortality and epidemic diseases. In a note appended to the Dimostrazione of 1849 we read, for instance, that ‘The greater mortality in the class of sucklings, and also amongst weaned children, was caused by the influence of the disease known as flux, or dysentery.’ Nevertheless, it is remarkable that the only two major outbreaks recorded in the period between 1838 and 1892 - the epidemic of cholera that ravaged Florence in 1855 and the great epidemic of diphtheria of 1871–1872-hardly affected the mortality of the younger foundlings. See Bortolotto, and Zanotto, , ‘Livelli e tendenze’, 47–8.Google Scholar

It is worth adding, in a different vein, that a comparison between the two curves in Figure 2 and the data assembled by Bandettini, P. (I prezzi sul mercato di Firenze dal 1800 al 1890 (Rome, 1957))Google Scholar reveals that only between 1853 and 1858, when grain prices rose suddenly, to decline a few years later, did admissions to the Innocenti experience a similar pattern of rise and fall. No relation has been found between variations in grain prices and trends in infant mortality among Innocenti foundlings.

41 AOIF, Affari Generali, CCLXXVII, 102Google Scholar, Schiarimenti richiesti al Donor Luigi Calosi Ispettore Sanitaria del nostro Spedale sulla Mortalità delle Creature… specialmente negli ultimi 3 anni.

42 AOIF, Affari Generali, CCLXXVII, 102Google Scholar, Ispezione sanitaria del Regio Spedale degli Innocenti di Firenze li 16 Ottobre 1861.

43 AOIF, Affari Generali, CCLXXXIII, 89Google Scholar, Lettera al Cav. Senatore Prefetto della provincia di Firenze del 28 Luglio 1863.

44 Ibid.

45 AOIF, Affari Generali, CCLXXXIII, 89Google Scholar, Aumento del salario per le balie esterne del nostri gettatelli da It. L. 7.56 a L. 10.00 al mese per ottenere una maggiore concorrenza delle medesime.

46 AOIF, Affari Generali, CCCLXI, 76Google Scholar, Relazione a corredo, 96.Google Scholar

47 Ibid.

48 AOIF, Affari Generali, CCLXXXIII, 89Google Scholar, Lettera al Cav. Senatore Prefetto della provincia di Firenze.

49 See, for example, Bosi, V., Regio Spedale degl'Innocenti di Firenze. Resoconto sanitario-statistico dell'anno 1893 (Florence, 1895), 19Google Scholar; and AOIF, Affari Generali, CCCCIX, 19Google Scholar, Indagini circa la mortalità infantile verificatasi nel Brefotrofio nèll'anno 1916.

50 See Bortolotto, and Zanotto, , ‘Livelli e tendenze’, Table XI.Google Scholar

51 See Corsini, , ‘Structural changes’, 142.Google Scholar

52 See Guidi, Guido, Dell'assistenza all'infanzia illegittima (Florence, 1923), 20–1.Google Scholar

53 This remark was made in 1917 by Cherici, U., Relazione circa una più razionale assistenza degli Esposti, 2Google Scholar, in AOIF, Affari Generali, CCCCIX, 50.Google Scholar The most detailed account of the measures taken by Florence's foundling home to prevent the spread of syphilis is provided by Bosi, V., ‘Relazione del medico-capo’, in Regio Spedale degli Innocenti di Firenze. Resoconto amministrativo, statistico e sanitaria dell'anno 1894 (Florence, 1896), 52–72.Google Scholar

54 The best series of mortality rates for the period 1905–1915 is to be found in AOIF, Affari Generali, CCCCIX, 19.Google Scholar Unfortunately, infant mortality is calculated by relating a denominator represented by the total number of foundlings admitted in a given calendar year to the number of infants belonging to that cohort who died in the same calendar year. This produces an underestimation of real infant mortality of about 25 per cent.

55 AOIF, Affari Generali, CCCXCIII, 29Google Scholar, Aumento da L. 25 a L. 30 mensili del salario per le nutrici interne ad incominciare dal 1. luglio 1909 e da L. 12 a L. 15 mensili il salario per le nutrici esterne ad incominciare dal 1. gennaio 1910.

56 Guidi, Germane, Di alcune sindromi speciali, assai gravi, nell'attuale epidemia influenzale, nei bambini, in AOIF, Affari Generali, CCCCXI, 30.Google Scholar Data on the very high levels of infant mortality in other Italian foundling homes during the war period are provided by Guidi, Guido, Dell'assistenza all'infanzia illegittima, 4–5.Google Scholar

57 Innocenti, R. Spedale degli, Relazione del Presidente del Consiglio d'Ammnistrazione sul funzionaments del Brefotrofio nell'anno 1918 (Florence, 1919), Table 1.Google Scholar

58 See especially Cherici, Relazione circa una più razionale assistenza degli Esposti. See also Guidi, , Dell'assistenza all'infanzia illegittima, 23Google Scholar, and Cherici's later account in his 1932 book L' assistenza all'infanzia, 262.Google Scholar An indirect confirmation of the crucial role played by the dearth of wet nurses is provided by the very steep rise of mortality in the first month of life (neonatal mortality), from values ranging between 80 and 100 per thousand in 1913–1915 to 195.6 per thousand in 1916, 232.6 per thousand in 1917 and 286.6 per thousand in 1918.

59 See Guidi, , Dell'assistenza all'infanzia illegittima, 7–10.Google Scholar

60 Although the number of women assisted by this institution was small, the infant mortality record was very good, with only 8 infant deaths out of 154 live births (just over 5 per cent). See Relazione finale dell'Asilo Materno (Florence, 1919), 15–16Google Scholar, and also Brunetti, G., L'obbligo dell'allattamento materno e l'Asilo di maternità (Florence, 1919).Google Scholar

61 Cherici, , Relazione, 3.Google Scholar

62 See Dotti, , Relazione sanitaria, 5–6.Google Scholar

63 See Guidi, Guido, Regio Spedale degli Innocenti. Rendiconto statistico clinico per il quinquennia 1923–1927 (Florence, 1929), 24Google Scholar, and Dotti, , Relazione sanitaria, Graph 2.Google Scholar

64 See Guidi, , Rendiconto statistico clinico 1923–1927, 6–9, 24–5.Google Scholar A recent overview of the evolution of infant mortality in the early twentieth century is provided by L. Del Panta, ‘Infant and child mortality in Italy from the 18th to the 20th century’, IUSSP Conference on ‘Child and infant mortality in the past’ (Montreal, 1992).Google Scholar

65 See Panta, Del, ‘Infant and child mortality’, 18–20.Google Scholar

66 An incisive account of the ideological and legal changes promoted by the social welfare movement in Italy, with special reference to the condition of foundlings, is provided in Kertzer, Sacrificed for honor, ch. 7.