Discussion Papers In Economics
And Business

Urban laboring poor against Infant Mortality at Osaka city of the early 20th century:
Who saved babies?

Emiko Higami, Kenichi Tomobe and Makoto Hanashima

Discussion Paper 13-30

Graduate School of Economics andOsaka School of International Public Policy (OSIPP)
Osaka University, Toyonaka, Osaka 560-0043, JAPANUrban laboring poor against Infant Mortality at Osaka city of the early 20th century:
Who saved babies?

Emiko Higami, Kenichi Tomobe and Makoto Hanashima

Discussion Paper 13-30

November 2013

Graduate School of Economics andOsaka School of International Public Policy (OSIPP)
Osaka University, Toyonaka, Osaka 560-0043, JAPANUrban laboring poor against Infant Mortality at Osaka city of the early 20 th century: Who saved babies? *Emiko Higami a† , Kenichi Tomobe b† and Makoto Hanashima c†

Abstract
The average infant mortality rate (IMR) was 155.4 in rural areas in Japan, and IMR in Osaka city was
231.6 during 1906 to 1910.

The outstanding level of IMR in Osaka city might have been influenced

by somewhat negative urban factors, which we can call the “urban penalty.” Dr. Hiroshi Maruyama
discovered the α-index in 1938. The α-index represents infant mortality number divided by neonatal
mortality number. After all, Maruyama set one month after birth as a boundary to divide endogenou s
and exogenous. The α-index shows a qualitative measure of infant mortality. Post neonatal mortality
was increased due to acquired diseases such as diarrhea, pneumonia and beriberi. This shows that theeffect of the urban penalty was raising the α-index. The α-index of the industrial zones shows thatbad maternal conditions affected endogenous factors. Most mothers suffered from a deficiency ofbreast-feeding capability. The first reason was anemia. The second reason was mothers’ ignorance
about breast-feeding. The third reason was mother’s illnesses. They had to rely on bottle-feeding
without any knowledge to handle artificial milk. Those babies often died from diarrhea or
pneumonia.

Keywords: Infant Mortality Rate (IMR), Breast-feeding, α-index, diarrhea, visiting nurses
JEL classification Number: J13, N35, R23†aEmiko Higami Graduate School of Economics, Osaka University 1-7 Machikaneyama-machi

Toyonaka, Osaka 560-0043,JAPAN e-mail : mge805he@gmail.com†b

Kenichi Tomobe Graduate School of Economics, Osaka University 1-7 Machikaneyama-machi

Toyonaka, Osaka 560-0043,JAPAN e-mail : tomobe@econ.osaka-u.ac.jp†cMakoto Hanashima Institute of areal Studies, Foundation Sekiguchi Bunkyo-ku, Tokyo

112-0014, JAPAN e-mail : mhana@ias.or.jp* This paper is presented for the 38 th Annual Meeting of the Social Science History Association at
Chicago, Illinois, USA, 21-24 November, 2013. This research is financially supported by the
Grant-in-Aid for the Scientific Research of JSPS (No.20530306, 2012-2015, Osaka University,
Kenichi Tomobe).

Introduction

Statistics officer, Yasunori Nikaido, first highlighted the issue of infant mortality in Japan in his
1914 article entitled “The Characteristics of Infant Mortality in our Country.” 1 Between 1906 and1910, the average infant mortality rate (IMR; infant deaths per 1,000 live births) was 188.7 in urban
areas (cities with more than 50,000 people) and 155.4 in rural areas. Nikaido assumed it was
urbanization itself that contributed to the higher IMR of urb an areas, especially since the average
crude birth rate was a full 10 points lower in urban areas than in rural ones. The existence of negative
urban factors is also suggested by the fact that when the crude birth rate was similar between two
urban areas, for example 20.7 in Tokyo and 20.2 in Osaka, the IMR was considerably lower in Tokyo(176.4) than in Osaka (231.6), indicating that some form of additional “urban penalty”, such as
population density and air pollution, was at play in Osaka. Besides these s tructural factors, it appears
that the higher rate of breastfeeding, a behavioral factor, in rural areas contributed to the higher urban
IMR. S. Scott and C.J. Duncan note that humans produce milk with a very low nutrient density andhave low stress of lactation. They state, “It is usually assumed that this lactation strategy has been
determined by the very slow growth rate of the human infant, which in turn has been naturally
selected as providing the optimal time for the growth, development and training o f a large brain.”2
Walhout detected, in a Dutch province, a change in breastfeeding patterns between 1875/79 and1895/99 that was associated with an increase in the IMR caused by diarrhea and other acute diseasesof the digestive system, indicating a decrease in breastfeeding practices.3 Also, according to J.
Vogele, T. Halling and L. Rittrtshaus, feeding practices were the key determinant of infant mortality
in early twentieth-century Germany, when the transition to so-called artificial nutrition took placeand more than 70% of all infant deaths resulted from gastro-intestinal disorders. 4
In 1938 Dr. Hiroshi Maruyama introduced the α-index, which divides the number of
infant deaths by the number of neonatal deaths 5 . At that time, the majority of neonatal deaths werecaused by endogenous factors and congenital feebleness, such as preterm birth, congenital weakness,
malformation and peculiar disease, and death occurred immediately after birth. Post -neonatal deaths,
on the other hand, were caused by exogenous factors such as diarrhea and infectious and respiratory
diseases. Accordingly, Maruyama set one month after birth as the dividing line between endogenous
1

See Nikaido(1915)
Scott S. & Duncan C.J., 2002. Infancy, Chap. 8. Demography and Nutrition: Evidence fromHistorical and Contemporary Population. Oxford Blackwell Publishing, p.144.
3
See E.C.Walhout(2010)
4
See J.Vogele, Halling and Rittrtshaus (2010)5
See H. Maruyama (1976). Japan’s vital statistics present neonatal mortality as the number of deaths
in one month, and we therefore use NMR in this way.
2

1

and exogenous factors. Thus, the α index is a qualitative measure of infant mortality.

Figure 1. Changes in infant mortality rate (IMR) , neonatal mortality rate (NMR) and
α-index（IMR/NMR） in Osaka city,1906－1934 and Japan, 1899-1934
Source: Jinko dotai tokei [Vital Statistics of Japan].

4

450
（‰）
400
350

3

300
250

(α-index）2

200
150
100
50
0

Osaka City IMRJapan IMR

Osaka City NMR

Japan NMR

Osaka City α-index

Japan α-index

S. Ito also reported post-neonatal mortality was increased by diarrhea, pneumonia and theacquired disease beriberi.6 Thus, an urban penalty would likely increase the α-index score. Between
1907 and 1932, he conducted infant nutrition surveys and found a low breastfeeding rate associatedwith the highest IMR in cities. For example, infants fed artificial milk had an IMR 1.8 times higher
than that for infants fed breast milk. Figure 1 shows the IMR, neonatal mortality rate (NMR, pe r
1,000 live births) and the α-index scores for Japan and Osaka city. The IMR of Osaka city as a whole
was above the national average for one period during the early Showa era (1926 -1945), while thecity’s α index score for was considerably higher than the national average. When comparing the αindex of Osaka city and the national average, the α index for Osaka city peaked at 4.3 in 1922, which
was in the Taisho era (1912-1926) when the α-index scores were the highest in Japan generally andindicate urban penalty.
The purpose of this paper is, firstly, to examine in detail the cause of the comparatively
higher IMR of Osaka city. Figure 2 shows the IMR from diarrhea (per 1,000 live births) of Tokyo,
6

See S.Ito(1998)
2

Osaka, Nagoya and the national average. Between 1908 and 1926 the IMR from diarrhea in Osaka
fluctuated from 40 to 70, and diarrhea accounted for most deaths, namely, one-fourth to one-fifth of
all infant deaths. The α-index was larger than national average because of these infant deaths fromdiarrhea. The average IMR of Osaka city was 219.3 during that period, with the IMR from diarrhea
playing a major role in the overall IMR.As many mothers in Osaka were unable to breastfeed theirbabies, they were fed bottled milk, and some suffered malnutrition and consequently died of diarrhea.
Women’s labor issues might have contributed to the decreased rate of breastfeeding. The re weremany spinning factories in the Osaka area around 1900. A female employee generally started work at
the factory at 12 or 13 years of age and continued working there for around 1o years or so before
getting married and becoming a mother. In this research, we look first at how working practices in
the factories may have negatively affected breastfeeding practices, and second, we examine how
Osaka city managed to reduce its IMR in the 1920s so that it fell to 143.1 by 1928, which wascomparable with the national average.

Figure 2. Infant mortality rates from diarrhea of Osaka City, Tokyo City
and Nagoya City, 1906-1936.

Osaka Prefecture and Japan,

1899-1936

Source: Jinko dotai tokei [Vital Statistics of Japan].
80
70
60
50
(
)

‰ 40
30

20
10
0

Tokyo City

Osaka City

Nagoya City

Osaka PrefectureJapan

Variations in infant mortality between different areas of Osaka city

Osaka city was formed in 1889 with four wards (ku)—Kita, Higashi, Nishi, and Minami—whichwere all affluent commercial wards. Outside of the city by Osaka Bay, Nishinari district had some3

areas with high IMRs. These areas overlapped with the industrial part of the city, and in 1897, 28
outlying towns and villages, including Konohana Minato and Taisho were incorporated by the city 7.

Map Infant Mortality Rates of Districts in Osaka city, Nishinari-gun and Higahinari-gun, 1920

Source: Osaka-fu eisei siryo 2 [The Osaka-Prefecture hygienic report, vol.2 (Osaka Prefecture
police)] 1923

At this time, Nishinari district was divided into two areas, Nishinari and Yodogawa, andthe Bay area was included in Nishi ward in order to develop its trade. Later, in 1925, Osaka city
incorporated Higashinari district and Nishinari district.

7

We use the average IMR of 1914-1918 and the diarrhea IMR of 1916. Osaka city was composed of
15 districts in the period 1932-1943.
4

Table 1. Comparison of α-Index, IMR and IMR from diarrhea of each districtin Osaka city in 1920-1935
1920(1)
Ward/District

IMR(‰)

Kita

204

Konohana

Diarrhea

1935(2)
Diarrhea(2)-(1)

IMR(‰)

45.6

3.102

104

14.9

2.837

30.7

0.265

271

61.8

3.210

122

15.2

2.869

46.6

0.342

Higashi

185

44.8

3.036

99

8.7

2.489

36.1

0.547

Minami

176

48.6

3.378

103

10.4

2.614

38.2

0.765

Naniwa

275

65.9

3.803

129

19.1

2.731

46.8

1.072

Tennoji

226

63.3

3.474

102

13.0

2.543

50.3

0.931

Nishi

133

34.4

2.980

82

8.6

2.278

25.8

0.702

Minato

217

58.1

3.284

126

21.0

2.605

37.1

0.679

Taisho

223

57.2

3.151

130

18.8

2.926

38.4

0.224

140

22.1

2.740

39.6

138

24.7

2.741

37.0

Higashiyodogawa

127

22.4

2.810

39.3

Asahi

120

16.5

2.617

34.6

144

23.8

2.963

27.3

96

13.0

2.554

38.1

122

18.1

2.726

33.9

IMR(‰)

Nishinari
Nishiyodogawa

Higashinari

254＊

213※

61.7

51.1

n/a

n/a

Sumiyoshi
Osaka City

209

52

3.272

IMR(‰)

α-Index

Diarrhea

α-Index

IMR(‰)

α-Index0.546

Source: (1) Osaka-fu eisei siryo 2 [The Osaka-Prefecture hygienic report, vol.2 (Osaka Prefecture
police)] 1923, 20-29. (2) Osaka-shi eiseikumiai-betu syusan shibo nyujishibo tyosa [Survey of births,
deaths and infant deaths by hygiene districts of Osaka city (Osaka city health bureau and Osaka
infantile protecting association)] 1937, 19-49.
Note:＊Nishinari-gun, ※Higashinari-gun. We use average IMR of 1914-1918 and Diarrhea IMR of 1916
of two districts.

Osaka city was composed by 15 wardts during 1932-1943.

The biggest slums were in Naniwa, in the northern part of Nishinari and the western partof Tennoji. From 1920 to 1935, the eastern part of Tennoji changed to a residential area for salaried
workers and Higashinari formed a new small-scale industrial zone. Sumiyoshi and Asahi still had
relatively large areas of farmland. Overall, the IMR, IMR from diarrhea and the α-index of slum andindustrial areas were higher than commercial, agrarian and salaried workers’ residential areas.
5

Next, comparing Naniwa which had the highest IMR and Konohana which had thesecond highest IMR, Naniwa had a high IMR and a high α index score, whereas Konohana had a highIMR but a low α index score. This tendency in infant mortality was also seen in the industrial Bay
area, such as Taisho. The low α index score indicates that neonatal mortality was high, where infants
died from congenital feebleness. The industrial zones had the worst two indices scores, indicating
maternal conditions were the poorest. Naniwa had considerably more infant deaths from beriberi andmeningitis caused by breastfeeding and thus its α-index was high.
The IMR of Naniwa was more than twice that of Nishi which had the lowest IMR.
However, 15 years after, the differences between two distracts had shrunk to a 1.57 -times difference.
Moreover, the α-index score for all districts had reduced to less than 3. The IMR and α index values
had been equalized. This occurred because an Osaka prefecture survey had clarified the cause of highinfant mortality, and the prefecture and Osaka city actively introduced measures to reduce infantmortality.

Parents’ occupation and IMR

The first national census in 1920 showed that 63% of the population of Osaka city was composed ofpeople who originated from another prefecture. Working women accounted for 23% of the city’s
female population aged 14 to 59.

Table 2.

Number of working population of unmarried/married women andtheir main occupations,

1920

Working population%

The Main Occupation(person)Factory workers (Spinning, Textile, Cigarette), Nurse,
Single49,24355
Operator, Attendant in restaurant, Licensed prostitute

Married

21,62324

Retailer, Used-goods, Teacher, Midwife

18,73221

Sewer of Japanese clothes, Day laborer

89,598100

Divorced
Widow

Source: Dai 1kai kokusei-tyosa Fuken no bu Osaka-fu dai 3[The First National Census Part ofPrefecture No.3 Osaka (Statistic bureau of Home affairs Ministry)], 1926.

6

Table 2 shows the main occupations among the female workforce: 13% were employers,
7% were employees and 80% were workers 8. Most employers were selling goods and were around 40
to 44 years of age. While retailing goods at stores in their houses, they were able to keep house at th esame time. Women engaged in commerce could add to their workload and advance to more
responsible positions as their children grew. This meant that when a woman working in commerce
had to care for her baby, she generally did not have to work hard. When she was under 35 years ofage, she was likely an unemployed subordinate, but tended to be a working woman between 35 to 40
years of age.

In terms of women who were employees, most were public employees like teachers.

The majority of female teachers were aged 25 to 29.

Table 3. The working population rates of Industrial /Business activities and IMR, 1930
Industrial employment

Business employment

rate(1)（％）

rate(2)（％）

Kita

37.46

41.81

139

Konohana

48.27

31.23

122

Higashi

28.27

50.22

95

Nishi

21.78

59.05

113

Minami

25.07

58.15

109

Naniwa

43.28

42.17

131

Tennoji

34.81

39.91

144

Minato

40.29

32.24

122

Taisho

40.29

32.24

134

Nishinari

44.98

35.66

132

Nishiyodogawa

53.98

24.90

134

Higashiyodogawa

51.38

26.50

138

Asahi

54.62

27.15

124

Higashinari

54.62

27.15

143

Sumiyoshi

28.97

39.97

115

Osaka City

40.36

37.88

128

Ward

IMR(3)(‰）

Source: (1)(2)- 6 Dai Tosh Tyukan jinkou [Daytime population in Japanese six main
Cities(Statistic b ureau of Home affairs Ministry)]1936, (3)Osaka-shi eisei sikennsho jigyo seisekigaiyo[Achievement Report (Osaka City Hygiene Laboratory 1931)], 1933
8

Employees and workers were the differences by type of wages and status.
7

The distribution of occupations in Osaka city in 1930 can be broken down as follows.
The industrial sector employed 40.36% of workers, the commercial sector 37.88%, the public sector
and self-employed 8.26%, the transportation sector 6.36% and primary industry 1.63%. Table 3
shows a comparison between the working population rates in industry and business (commercial) in
each administrative ward and compared IMR. Regression analysis, with the IMR of each ward as thedependent variable and the industrial and business employment rates as the independent variables,
reveals that the business employment rates correlate negatively with the IMRs. Retailing goods in a
shop accounted for 60% of commercial employment. As the national census mentioned, women
engaged in retail from a shop in their house could continue working while also caring for their baby
and keeping house. The other group for whom this trend was clear were salaried business men
employed in offices whose wives were homemakers and could therefore breastfeed their babies. It
was for these reasons that the IMR among commercial families became low.
Not surprisingly then, industrial employment rates correlated positively with
IMRs. If factory laborers became mothers and preferred to continue working, it was hard for them todo so, as there were no day nurseries in the factories. Because they had to work 10 to 12 hours a day,the babies had to have artificial milk while the mothers were working. Moreover, because manylaborers’ wives working in the spinning factories came from other prefectures, they did n ot carry on
the traditional child care practices of their own mothers.

Table 4. The co-relationship between working population rates and IMR :Industry and BusinessIndustrial employment

Business employment

rate

rate

Occupation rates

0.782＊-0.783＊t-value

2.8596-2.8614R2

0.38610.3864

Y=IMR

Note: ＊

5％significant（OLS）

Female spinning factory workers and nutritional factors

In 1870, The Ministry of Defense built Hohei Kosho, the army arsenal, to the east of Osaka Castle,
and the plant started producing ammunition and ironware. The following year, the Osaka Mint
8

Bureau was established in Tenma to produce coins and manufacture sulfuric acid and caustic soda. In
1881, the Osaka Steel Company was founded on the northern bank of Aji River. In 1883 , Osaka
Spinning Limited went into business at Sangenya in Nishinari district and started spinning
manufacturing with 10,000 bobbins. The company had high dividend -yielding stocks. The company
introduced nightshifts to fully utilize the machines and maintain good profits, and it was soon joinedby many other spinning factories built in the same district or in the Bay area.
A recruiter for the spinning company recruited poor farmers’ daughters in the ruralprefectures of western Japan. Some spinning companies had a textile weaving factory where over1000 employees worked, 78% of who were girls or young women. Female workers under the age of
14 accounted for 10% of all spinning factory workers, 15-20 years olds accounted for 36%, 20-25
years olds 20%, and over 25 years old 12%. Single women lived in dormitories at the factory, andthey worked 11-hour days, from 6 in the morning to 6 at night or did a nightshift, with only a 1 -hour
break. Nightshifts were particularly hard for the women workers and many lasted o nly 1 year in thefactories. Those who stayed in Osaka often changed jobs to other spinning factories or other types offactories. It was not long before there were shortages in the spinning factories and the recruiters
would need to start looking again. This rapid turnover ultimately forced the companies to improvethe meals and laundry services for workers so that they could retain them. However, until then, themeals did not contain enough protein and fat, and the workers were not taught how to cook, lau nderor keep house by the dormitory staff. They therefore lacked knowledge not only on child -rearing andwomen’s hygiene, but also on breastfeeding. 9 In 1926, the Factory Law was amended to prohibit
women working nightshifts and went into effect in 1929.
When Osaka prefecture released a report in 1923 on infant nutrition over the past 6 years
in Kujo, Nishi ward, 58.6% of infants who died from diarrhea had been fed artificial milk or mixed
artificial and breast milk, despite infants fed by artificial milk or mixed artificial and breast milk
amounting to only 34.9% of all infants. 10 Even though artificial or mixed nutrition clearly carried
more risks to infants than breastfeeding, 674 mothers were recorded as changing from breast milk to
artificial or mixed milk during that period. Of these 674 cases, 296 of the infants survived and 378
died. As reasons for this change in nutritional behavior, 49.8% of the mothers who switched toartificial or mixed milk did so because they had insufficient breast milk or the infants did not suckle
properly. Women in the spinning factories worked so hard that they gradually became weak andanemic, causing a lack of breast milk, so the infant would become malnourished. 11 12

See Uno(1915)
See Kunisawa(1926)
11 See Konishi(1928)
9

10

9

In addition, mothers were not knowledgeable about breastfeeding. When they had theirfirst or second baby, their breast milk was often limited because they did not know about thephysiology of breastfeeding. Sixty-three percent of mothers whose infant died had given their childdiluted condensed milk merely based on their intuition and did not know that the mammary glandneeded suckling stimulation from the infant to give sufficient milk. As an example, although mothers
needed to persevere letting the baby suckle the breast for 7 to 10 days, they often gav e upbreastfeeding within 2 to 3 days and started using condensed milk, which was sweet and easy to feed.
Babies preferred the condensed milk and stopped suckling the mother’s breast. If the mother did notbreastfeed for 2 to 3 weeks, she would no longer lactate. Almost all mothers were found to havechanged their feeding method within 1 month after giving birth.

Table 5. The survey of diseases coming from nutritional change in Kujo 1923
Died infant's mother

Grown infant's mother（％）

Beriberi

80

61

54.7

Mastitis

9

9

7.0

Digestive disease

7

7

5.4

Nephritis

7

3

3.9

Heart disease

5

4

3.5

Tuberculosis

1

5

1.9

Other

36

61

23.6

Total

138

120

100.0

Source: Kunisawa,T.Nyuyouji hogo ni kansuru hokoku[Report on the protection of infants andchildren]1926, 129-132.

The survey also found that 258 mothers (38.3%) changed the way they fed their infant due
to illness. Table 5 shows a breakdown of the mothers’ illnesses: 18 mothers were suffering frompossible mastitis and 141 from beriberi, the most prevalent illness, which accounted for 54.7% of allmaternal illnesses. Beriberi is caused by a shortage of thiamin and could not be treated. Once it
became widely known that beriberi could be transmitted to the suckling infant, a woman who ha dswollen legs because of light kidney trouble after childbirth often hastily judged herself that she had
beriberi and stopped breastfeeding. So, many mothers did not have accurate knowledge aboutchild-rearing. Infants continued to die because the mothers were not being educated in child care,
12

Osaka-shi Shakai-bu.1922.[Osaka city social research bureau] “Rodo chosa hokoku 13 Shoko
hoken” [Labor Research Series Report, No.13 :Labor’s health] 1923.
10housekeeping or hygiene by anyone in their families or dormitory staff.

Education for poor mothers

Hikoichi Motoyama, then President of Osaka Mainichi Newspaper, formed the Osaka Mainichi
Newspaper Charity Organization to promote medical care in 1911. He learned that many pregnant
women among the poor did not receive care from a midwife during childbirth. In 1914 theOrganization started to offer free midwifery services to poor pregnant women who did not otherwise
have access to a midwife. The women who applied needed to ask the police department for a ticket touse the midwifery services. The midwife conducted prenatal check-ups and provided care during thedelivery. Osaka prefecture also appointed Shigejiro Ogawa as an adviser in 1918 and he established aregional nongovernmental relief service system13. In 1920 he began assistance for pregnant women
who would not be able to provide care for their infants. These women were malnourished and did nothave access to a midwife or treatment. In 1923 the charity, in cooperation with the relief service
system, employed 40 midwives, arranging for one part-time midwife to work in each district. The
midwife helped bathe the newborns for 7 days after birth, took care of the newborn’s umbilical cord
and when a mother found it difficult to obtain enough breast milk, taught the mother to easily dilute abottle of milk and sold the mother milk at low cost.
The charity’s midwives handled 373 cases, and in 1929 for example, of th e 333 babies
born, 171 celebrated their first birthday. Notably though, 100 other infants moved with their mothers,
often with the family slipping out of town quietly, although some were adopted and some went to themother’s home town. Of the 373 infants delivered, 62 died: 21 died from a congenital defect, 19 fromdiarrhea (2 were breastfed and the remaining 17 babies were fed artificial or mixed milk), 6 frompneumonia, and 7 from unknown causes. If we assume that all the 100 babies that moved away with
their family survived, then the IMR of babies whose mothers used the charity were 186, which was
actually higher than the IMR of 161 for Osaka city in 1929. Table 6 shows the extremely poor
housing conditions in which these babies were born and raised; they were overcrowded, dark anddraughty, with poor sanitation.

13

The regional relief service supported elderly people and children who either had no caregi vers or
were not able to support themselves. Also, poor families earning less than 25 yen per month could
receive the service even if all family members worked.
11

Table 6. Types of housing of pregnant women who used midwifery services provided by Osaka
Mainichi Newspaper Charity Organization in 1926
One household in a
Three

Two
house

Cheap

Boat

lodgingonUnkn

households

households

1

2

3

per house

per house

room

rooms

rooms

8

83

14

66

16

Total
own

house

sand

25

3

Pregnant

12

227

women
Source: Osaka Mainichi Shinbun Jizendan 20 Nenshi [Atwenty-year history of Osaka Mainichi

Newspaper Charity Organization], 1931, p.185

Parturient women visited the charity’s midwife to deliver the baby without having any
prenatal checkups. Women who were 9 months’ pregnant accounted for approximately half of all
who used the free midwifery service. They were employed as maids or factory workers. Women who
were factory workers had usually worked hard, having a side job not only before childbirth but also
soon afterwards. The charity’s midwives helped with 2,132 cases (2,107 pregnancies) during theperiod 1914-1930: normal deliveries 1,751, preterm deliveries 87, 41 miscarriages and 141 stillbirths.
Osaka city established the Osaka City Child Guidance Clinic in 1918 . The head of theClinic, Hiraku Sandaya, regarded infants as being included in the term ‘child’ and clinic instructors
therefore visited homes where mothers did not know how to care for their babies and provided them
instruction14 . The Clinic was reorganized into Osaka City Nursery in 1924. The visiting nurses chosehouses that appeared poor and unable to access medical care. They visited 5 times within the first 100
days of birth, instructing mothers how to breastfeed or how to safely feed milk to infants who could
not breastfeed. They taught nutritional improvement and prevention of beriberi and meningitis. Ifthey found the babies were sick, they suggested the mothers use a free ticket they provided (available
to families earning less than 800 yen a year) to go to the clinic in Osaka City Nursery. These early
treatments saved the lives of many infants.

14

The instructors had to break down the superstitions surrounding child care. For example,
superstition meant that a newborn’s first drink was not his mother’s milk but an infusion of
medicinal herbs, saffron, rice gruel, salt water, sugar water, raw milk and so forth. Only one -fourth of
all mothers gave her newborn her own breast milk.
12

Figure 3. The distribution of causes of infant deaths in Osaka city. 1906 -1930 unit：‰
Source:Jinko doutai tokei[Vital statistics of Japan],Shiin tokei[Cause -Specific Death Statistics ofJapan]

Thus, as can be seen in Figure 3, the IMR from diarrhea of Osaka city was reduced
from 68.8 in 1918 to 28.1 in 1930, a drop of 40.7. The part -time midwives provided by thenewspaper’s charity and the visiting nurses of Osaka City Nursery were proactive in the preventionof infantile diarrhea. Mothers needed to have knowledge about nutrition and child -rearing, especially
how to breastfeed and dilute artificial milk safely and hygienically.

Conclusion

The industrialization of Osaka occurred mainly though growth of the textile industry. Young womenfrom rural areas joined the spinning factory workforces. Once there, they worked long hours and hadpoor diets, which caused illnesses like anemia. After childbirth, their poor general health condition
often meant they found breastfeeding difficult. In addition, long hours of standing while pregnant atwork tended to cause premature delivery. The young women’s mothers tended to live far away,
unable to teach them how to raise children, maintain hygiene and keep house. For these reasons they
did not understand the physiology of breastfeeding—a desperate problem since their baby’s lives
13

depended on them having such knowledge. The IMR in the industrial areas was higher than in otherareas and the α-index was lower than in the slum, indicating poor maternal health conditions
associated with endogenous factors and congenital feebleness. In addition, most mothers could not
produce enough breast milk and had to depend on bottle-feeding without any knowledge of handling
artificial milk. Their babies died from diarrhea or pneumonia because they were malnourished.
However, once charitable and later municipal efforts began in Osaka, the IMR rate gradually
improved as care and instruction for the mothers improved infant survival rates. The midwives andvisiting nurses offered prenatal checkups, childbirth assistance, bathing the newborns, feeding
instruction, milk at low cost and free clinic access. Sometimes just with them vi siting, mothers could
rest for a while. These early treatments and efforts saved the lives of many infants. Later as thestandard of living gradually rose, households could manage on the husbands’ wages and wife’s
wages for piecework done at home, and the women rarely returned to factory work. The lives of theinfants depended on their mothers having adequate knowledge of nutrition and child-rearing. Ogawa
and Sandaya's administrative talents and Motoyama's organizational skills were crucial in the fight toreduce infant mortality. As a result of all these efforts, the IMR from diarrhea of Osaka city was
reduced in a relatively short space of time from 68.8 in 1918 to 38.6 in 1926.

Bibliography
Hanashima Makoto.＆ Tomobe Kenichi 2012.“Urbanization, Industrialization and Mortality inModern Japan: A Spatio-temporal Perspective”, Annals of GIS 18.1,57-70.
Higami Emiko & Tomobe Kenichi.2013. Chap.14“Infant mortality and beriberi in Osaka city between
the world wars: Impact of the mother’s diet on health”, Liu Tsui-jung Environmental History in East
Asia:Interdisciplinary Perspectives, Routledge London.forthcoming.
Ito Shigeru.1998. “Senzen Nippon ni okeru nyujishibo mondai to sono taisaku” [Thedecline infant mortality in the pre-war Japan], Shakai Keizai shi gaku[Socio-Economic
History Review] 63.6: 725-752.
Kunisawa Takeo.1926. “Nyuyoji hogo ni kansuru hokoku” [Reports on the protection of infants andchildren] Tokyo: Naimusho Eisei-kyoku [Hygiene Bureau of of Home affairs Ministry].

14

Konishi Yoichi. 1928.”Fujin Rodosha no Hinketsu sono Genin ni tuite” [The cause of anemia of
Textile female workers] Rodo Kagaku Kenkyu [Labor science research] 5.4:65-91.
Mino Yutaka. 1926. “Nyuji-in jigyo no jissai-mondai” [The practical problem of nursery project],
Shakai Jigyo Kenkyu [Resaerch of Social Projects]14.5: 5-27
Maruyama Hiroshi.1976. Nyuji shibo : Shakai Igaku Kenkyu I [Infant mortality: Socio Medical
Research, vol.1], Tokyo: Iryo Tosho Shuppan-sha.
Nikaido Yasuhiro.1915. “honpo no nyuji sibo no tokutyo” [The characteristic of Infant mortality in
our Country] Tokei syusi [Statistical Journal] 404,411,412: reprinted 2000. Tokyo: kuress
syuppan:775-804.
Naikaku Tokeikyoku. [The Cabinet Statistic Bureau] “Jinko dotai tokei” [The vital statistics ofJapan]. “Shiin tokei” [Cause-Specific Death Statistics of Japan]

Naimusho Tokeikyoku.1926. [Statistic Bureau of Home affairs Ministry]. “Dai 1-kai kokusei tyosa
fuken no bu Osaka-fu dai 3” [The First National Census Part of Prefecture No.3 Osaka].
Naimusho Toukeikyoku.1936.[ Statistic Bureau of Home affairs Ministry]. “Rokudai Tosh tyukan
jinkou” [Daytime population in Japanese six main Cities]
Okubo Naoaki,& Misugi Yoshitosi.1928. “Nyuyoji hogo shishin: Osaka ni okeru nyuyoji hogo no
kihonteki tyosa”[The index: Basic investigation of children protection in Osaka] Osaka.Osakanyuyoji hogo kyokai [Osaka infantile protecting association].
Osaka-fu Naimu-bu.1921.[Osaka Prefecture home affairs bureau] "Osaka-fu Homen iin Jigyo nenpo
Taisho 9 nen” [An annual report of regional relief service commissioner in Osaka Prefecture 1920]
Osaka-fu Keisatu-bu.1923. [Osaka Prefecture police].“Osaka-fu eisei siryo 2”[Osaka Prefecture
Hygiene Report, Vol. 2], “Osaka-fu eisei siryo 3” [Osaka-Prefecture hygienic report, vol.3]:
reprinted 2007.Tokyo.Kingendai siryo kankou-kai.
Osaka-shi hoken-bu/Osaka nyuyoji hogo kyokai. 1937.[Osaka city health bureau and Osaka infantile
protecting association] “Osaka-shi eiseikumiai-betu syusan shibo nyuji-shibo tyosa” [Survey ofbirths, deaths and infant deaths by hygiene districts of Osaka city].

15

Osaka-shi eisei sikensho.1933.[Osaka City Hygiene Laboratory] “Osaka-shi eisei sikennsho jigyo
seiseki gaiyo”[Achievement Report of Hygiene Laboratory 1931]
Osaka-shi Shakai-bu.1922.[Osaka city social research bureau] “Rodo chosa hokoku 13 Shoko hoken”[Labor Research Series Report, No.13 :Labor’s health] 1923. “Rodo chosa hokoku 22 Koyo kankei”[Labor Research Series Report, No.22 :An employment relationship]
Osaka Mainichi Shinbun Jizen-dan.1931.[Osaka Mainichi Newspaper Charity Organization]“Osaka Mainichi Shinbun Jizen-dan 20nen-shi”[The history between twenty years of Osaka
Mainichi Newspaper Charity Organization]
Scott.S & Duncan. C.J.2002. Demography and Nutrition: Evidence from historical and contemporary
population Chap. 8.Infancy: Oxford, Blackwell publishing.
TomobeKenici.& Suzuki

Akihito.2006“Shiin-betsu

shibousya-subetu

Tokei databesu”

[Cause-Specific Death Statistics Database in Japan (URL wttp://www.rekishow.org)]
Uno.Riuemon.1915. “Syoko Yugu-ron Soron dai-1” [Problem of treatment to factory worker:
General remarks, the first].Osaka, Kogyo Kyouikukai Syupan.
Vogele.J, Halling.T. & Rittrtshaus.L.2010. Entwicklung und popularisierung arztlicher
Stillempfehlungen in Deutschland im 20.Jahrhundert, Medizinhinhistorisches Journal 45:222-250.
Walhout.E.C. 2010.Is breast best？Evaluating breastfeeding patterns and causes of infant death in a
Dutch province in the period 1875-1900.History of the Family 15:76-90.

16