Lisa Featherstone

The Value of an Infant: The Rise of Paediatrics in Australia, 1880–1910

Between 1880 and 1910 paediatrics in Australia developed not merely as a response to Enlightenment philosophical understandings of the child as precious and special, but as part of a wider demand for reproduction and population. A brief sketch of the international context will situate the specific Australian conditions, which include education, professionalisation and the emerging concept of infant mortality. A level of general specialisation within medicine was necessary for the development of paediatrics, in addition to a general and new interest in child health, which was a response to the social, political and economic needs of the emerging nation.

Of all the groups treated by the medical profession, infants were among the most vulnerable. In the late–nineteenth century, babies had a rather tenuous hold on life. Prior to the 1880s and 1890s, the health and well-being of the child was inextricably linked with that of the mother, through the cycles of gestation, childbirth and lactation. The healthcare of the child was subordinate to the disciplines of obstetrics and gynaecology.¹ In this period, however, there was an increasing emphasis on children as individual bodies, and of interest in their own right. The predominant indication of such an interest was the rise of paediatrics, a new specialised discipline to cater for the child, and this article will chart this emerging specialty in Australia.

The rise of paediatrics as a specialty is complex without a sole causal agent. A number of social and scientific factors converged to create the need for a separate medical discipline for childhood diseases, beyond both obstetrics and general practice. This article will consider a profound shift in the medical profession's attitudes towards infants through a number of avenues. It will begin with a very brief overview of western attitudes towards child health, to contextualise debates in late–nineteenth century Australia and to help define the term paediatrics for historical use. The slow professionalisation of paediatrics in Australia will then be examined, including the rather fragmented developments towards federal bodies and uniform educational practices. The hospital will also be considered, both as a indicator of demand for children's services and as a new site for the development of the discipline of paediatrics. Lastly, there will be an analysis of the increasing importance of infant mortality in Australian medical discourse. The late–nineteenth and early–twentieth centuries will be shown as a turning point in attitudes towards children. This paper will suggest that while a more general 'enlightenment' had occurred over the seventeenth and eighteenth centuries, the perceived need for increasing the population, under the 'White Australia' policy, provided the immediate urgency to focus on children and their health.

Child health and the concept of childhood: an international perspective

A number of doctors and historians have traced the history of paediatrics.² In part, the history of paediatrics is the story of the wider specialisation that occurred within medicine during the second half of nineteenth century. George Rosen and George Weisz have shown medicine underwent fundamental institutional changes over this period. Prior to this, there were only a few specialities, such as the man-midwife, and most doctors treated general ill-health. Increasingly doctors began to focus the area of expertise of their practice. This was not merely a result of expanding medical knowledge, but was rather a response to the broader social and political specialisation of knowledge in science and technology. In particular, the emerging emphasis on rationality, classification and empiricism drove scientific research and development, and encouraged specialist subfields.³ The earliest developments were in surgery, specifically obstetrics, ocular surgery and dentistry. The concept of specialisation slowly but gradually moved outwards, progressively encompassing urology, oncology, dermatology and so forth.

Specialties emerged most rapidly in discrete arenas: ophthalmology is the classic example.⁴ Rosen suggests the development of clinical specialties was formed around the new and emerging concepts of organic disease and local pathology.⁵ In this context, paediatrics was not an obvious specialty, for there was no distinct pathology. Lacking the specificity of a single organ, it was different from most other specialties in that it focused on the whole body—a different kind of body.⁶ An early, influential American paediatrician, Dr. L. Emmett Holt, wrote, it was 'not so much that the diseases in early life are peculiar, as that the patients themselves are peculiar.'⁷ Thus the body of the child (like the body of the woman) was viewed at this time as a deviation from the 'normal' body of the white male.

A variety of clinical and professional changes are considered to have been necessary to the development of paediatrics, but social and cultural change were also important factors. While isolated texts on the health of children have appeared since antiquity, it was not until the eighteenth century that there was a substantial, consolidated increase in the number and quality of paediatric texts.⁸ It has been widely suggested that the increase in paediatric literature coincided with the rise of interest in the child in the Romantic period. The Enlightenment philosophies of Locke and Rousseau began to suggest childhood as a separate and special time, with corresponding rights and benefits.⁹ The Victorian period consolidated the concept of childhood as sacred, even 'priceless.' There was a shift away from thinking of children as economic resources, to sentimentally valuing them for their profound and almost inexplicable loveliness.¹⁰

Yet it is perhaps premature to link such doctrines about the increased 'value' of the child with the rise of paediatrics as a separate medical discipline. The junctions between Enlightenment philosophies, the growth of the concept of 'childhood' and the development of paediatrics are more complex and intricate than has so far been suggested. The eighteenth century certainly saw an increased interest in the mind and health of the child: childhood, as a timeframe and an experience, was now seen as separate and distinct. The treatment of children was slowly subjected to both scrutiny and practical reform. These included charity works, embryonic child protection legislation, compulsory education and changes to child labour regulations.¹¹ Children were increasingly objectified as bodies to be controlled, ordered and protected. The 'discovery' of poor, 'crippled' children as cases for reform by charity workers and the state is just one example. By the new century, disabled children—who had previously been viewed as 'tainted'—were potential candidates for philanthropic assistance and medical intervention.¹²

At the same time as the flowering of interest in children and their welfare, there was a rush of child-rearing manuals and guides. However, it is debatable whether this new attention was extended to medicinal care. There were examples of doctors treating children before the twentieth century, but there is little evidence that this was the norm. As one eighteenth century French doctor noted sadly, it was impossible to sustain a practice in paediatrics, as parents did not want to pay for medical care for their children.¹³ Instead it appears that children were marginalised within the practice of medicine, and doctors who treated children were the rare and strange exception.¹⁴ If medical assistance was required, this was provided by obstetricians, general practitioners and sometimes surgeons.

Thus while paediatrics and the treatment of children relied on the patients being seen as special and valuable, it is difficult to draw a direct or distinct line between Enlightenment theories and the development of the new specialty. To value the child was essential, but at the same time, an increasing value of the life of individual children could not itself fully sustain the development of a distinct branch of medicine. What was vital was the change from a Romantic conception of the co-joined mother and child, to a more scientific, medicalised concern with the infant alone. The final impetus to the scientific model, encompassing the professionalisation of paediatrics, occurred when children were valued, not only for their adorable and precious selves, but also because of their future utility: children would grow to be adults and be of value to the nation state. Concern for population was the key: paediatrics as a discipline was justified by the relationship of the child to the future adult.¹⁵

This combination of the Romantic interest in the child and the Victorian interest in population meant that paediatrics, or the concern for child health, was consolidated and deepened in the nineteenth century. By 1832, there were some seven thousand Western treatises on paediatrics. Of these, sixteen had been written prior to the seventeenth century and a further twenty-one in that century. Remarkably, some 6,800 works were produced between 1775 and 1832.¹⁶ In line with such change, by the late–nineteenth century medical texts recognised that children required special care, and that their illnesses and accidents were often peculiar to childhood.¹⁷ A turning point was the work of the American, Abraham Jacobi (1830–1919), known as the father of paediatrics. Appointed Professor of Diseases of Children at the New York Medical College in 1860, Jacobi was one of the first doctors to practice exclusively with children.¹⁸ Jacobi claimed contemporary child health care treated children simply as 'miniature men and women,' using the same classification of diseases and reduced doses for treatment. Radically, Jacobi suggested paediatrics should encompass an entirely different system of diagnosis and treatment.¹⁹ Jacobi thus set out the basis of a specialist study: the bodies themselves were special and thus the patients should be treated, with extra care, by a specialised group of doctors.

It is tempting to exaggerate the importance of early paediatric writers and texts and it is difficult to give a precise date for the emergence of paediatrics as a separate discipline. Historians support a variety of views, with a number suggesting modern paediatrics had its inception in the late–eighteenth century, with the production of numerous texts on children.²⁰ In contrast, Garrison suggests that paediatrics had 'no real existence' before the middle of the nineteenth century, while others claim paediatrics was not a separate discipline until well into the twentieth century.²¹ Such distinctions depend on the definition of paediatrics. A close analysis of the new child-centred literature does not necessarily persuade the historian that a profound change occurred. Early paediatric texts neither demanded nor constituted a systematic study of the health and diseases of children, and there was little acknowledgment of the need for a discipline to supervise the special or unique body of the child.²² A broader analysis of literature, clinical practice and professionalisation is even less persuasive. Paediatrics did not really develop until the early–twentieth century, as the rest of this article will argue.

The rise of paediatrics: Education and professionalisation

A professional body, which might be viewed as a sign of maturation and entrenchment, was slow to form. In Britain, in particular, there was some controversy over the establishment of child health as a specialty, with some doctors maintaining that more general health care, rather than specialties, was the key to maintaining the health of society.²³ In Australia, such conflicts were less marked, but even so professional bodies were late to develop. The Melbourne Paediatric Society was informally established in 1906 and a paediatric section for the New South Wales branch of the British Medical Association (BMA) was formed in 1922.²⁴ Paediatrics as a discipline was not officially consolidated until 1950 with the formation of the Australian Paediatric Association. Even then, the term 'paediatric specialist' was never defined and it was not until 1954 that the Australian Board of Paediatrics was established to determine the eligibility of doctors to be recognised as specialists.²⁵

Education in paediatrics was similarly slow to develop and the study of the health and diseases of children was marginalised within wider medicine well into the twentieth century. The absence of paediatrics from the medical curriculum at the Australian universities is notable, particularly as historians have viewed increasing interest in research and education as foundational to the development of new specialties in Europe.²⁶ In contrast, medical education on children in Australian universities was sparse, unsystematic and ill considered. The education of doctors was at odds with reality: in 1894, the editors of the AMJ noted that one third of all patients in general practice were children, and yet there was no formal study or instruction in the diseases of infants and children.²⁷ It was claimed that many doctors graduated into general practice with no knowledge of infant feeding or the common but deadly illness of infantile diarrhoea.²⁸ The diseases of children were subsumed into more general categories, replicating earlier models in which children were treated as diminutive adults, 'suffering exactly the same diseases, only in smaller bodies, and requiring the same treatment, in reduced doses.'²⁹

This was replicated within professional training at major conferences. The first Intercolonial Congress of Medicine in Adelaide, in 1887, had only one section concerned with child mortality. At the second Congress in Melbourne two years later, discussions on children covered syphilis, intestinal complaints, tonsillitis and zymotic diseases, but attracted only six doctors. The third Congress in Sydney, in 1892, contained no section on the diseases of children, probably because of the lack of interest.³⁰ Paediatrics, like gynaecology, was marginalised in wider medicine: in many ways, the bodies of the woman and the child remained largely outside the centre of medical understanding and concern.

The failure to provide an effective teaching of paediatrics may also have been due to the lack of specialist doctors. Many doctors, published in medical journals, professed to have an interest in children, but positions for paediatricians were not yet established, even within the children's hospitals. When the Royal Children's Hospital was established in Melbourne in 1870, it had no resident medical staff and three honorary medical staff covered the beds. In 1876, a resident was appointed, but Mr. Stewart had not yet passed his final exams. According to the honoraries, it was 'better to have a student than no one.'³¹ Similarly, the Sydney Hospital for Sick Children was without a resident medical officer, and a permanent position was not created until 1887. Even at the turn of the century, most of the honorary staff at the Melbourne Children's Hospital were not specialist paediatricians.³² According to Lorimer Dods, the onset of World War II saw only ten doctors working full time in the specialty.³³

In part, this may have been due to the gendered division of labour within medicine. As Rosemary Pringle has noted, there were strong links between femininity and childcare, and therefore 'gender appropriate' that women should care for sick children.³⁴ Even amongst doctors, paediatrics was seen as a discipline suited to women: in the early–twentieth century, many of the prominent female doctors worked in child health.³⁵ It is possible that the ideological links between women and child-health may have acted to downgrade the care of infants and children within medicine, to relegate it to the lesser sphere of women as nurturers.

More generally, if an awareness of the need to professionalise and specialise is important, then paediatrics began its slow emergence in the final decades of the nineteenth century. For paediatrics to develop, the medical profession had to be substantial enough for people to accept its necessity. In one sense, the rise of paediatrics was a part of a broader increasingly modern specialisation in both medicine and industry.³⁶ The professionalisation of doctors, however, was not enough to guarantee the emergence of a new specialty. As has been suggested, a cultural shift was necessary, spanning the separation of child and mother, and the vision of the infant as not only separate but also special. The site for this was the children's hospital.

The birth of the children's hospital

The separate children's hospital was a modern invention. The need for foundling homes and orphanages had been clear for some centuries, but the late–nineteenth and early–twentieth century saw a new interest in poor children more generally.³⁷ This was partly due to the pitiable conditions endured by children in poor homes and in various institutions. In general hospitals, for instance, the children of the poor were simply accommodated in general wards, mixing with the elderly, the mad and the diseased.³⁸ The rise of the hospital for children thus saw a fundamental change: the child was now treated independently from both the mother and the general population. The emergence of the children's hospitals from the 1870s and 1880s was therefore a powerful symbol of the new status of the child.³⁹

In Australia, the establishment of children's hospitals was keenly debated. In the 1870s, the Melbournian President of the Medical Society, Richard Fetherston claimed the social situation was not so dire in Australia as to demand the desperate measure of a children's hospital. He believed that post–goldrush Melbourne offered prosperity, nutrition and health care to all but the most degraded and intemperate. As he felt poverty was not common, or at least not undeserving, Fetherston believed a mother should not be separated from her child, emphasising the 'naturalness' of the mother-child bond, particularly when the child was sick. Many doctors believed that that the mother and infant should not be apart. On the other hand, some doctors had less faith in the skill and love of the mother, and professed instead the 'special knowledge' that the hospital could provide. This dichotomy—the scientific regimes of the clinic versus the ignorant care of the mother—meant that in many ways, the argument about children's hospitals centred on mothering.⁴⁰ As the editors of the AMJ suggested, the children's hospital was a necessity because poor mothers were slovenly, hopeless, ignorant and careless.⁴¹

Some distinguished doctors, most notably Charles Clubbe, were against the idea of a separate children's hospital. Clubbe, who had gained paediatric experience at the Royal Manchester Children's Hospital in England, was appointed as an honorary surgeon to the Hospital for Sick Children in Sydney in 1884.⁴² Prominent in medical politics in this period, Clubbe supported increased study of children by all medical staff, rather than the specific education of only some.⁴³ There were underlying anxieties, too, about economic and social control over bodies. Many expressed the very real fear that general practitioners would suffer financially if charity hospitals became more common.⁴⁴

The main opposition to the Children's Hospital, however, was clinical: the fear of contagion within institutions was profound. An epidemic could spread rapidly through children confined in close quarters and for this reason doctors were often reluctant to admit children to hospital. One general practitioner claimed in 1869 the children's hospital may as well be called, 'An institution for the Propagation of Contagious Diseases amongst Children.'⁴⁵

Despite such strong opposition, there were major developments in the late–nineteenth century. The initial movement to institutionalise paediatrics in Australia was the Melbourne Hospital for Sick Children, established in 1870 in a small house in Stephen Street by the pathologist William John Smith and the physician John Singleton.⁴⁶ The arguments used to justify the establishment of a separate children's hospital in Melbourne were outlined in the first annual report. Most importantly, it was seen as inappropriate to keep children and adults together in general wards, as there was a fear of unnamed 'moral evil.'⁴⁷ Further, children had special requirements and needed specific nursing, care and diet and as such could more readily be treated in a separate institution. Finally, the death rate of children in Victoria was seen as too high and it was felt that poor children in particular needed extra care.⁴⁸ Similarly, the Hospital for Sick Children in Brisbane was established in March 1878, as a response to the appalling child mortality in that city. Almost half of the children born in Brisbane died before their fifth birthday and the General Hospital would admit no children under that age.⁴⁹

There was certainly a demand for specialised care for children, despite the clinical concerns. It is striking that the growth of the paediatric hospital appears to have been largely driven by demand from the general population: including the society women who raised the money, the public who donated generously to the cause and the poor households that utilised the charity hospitals. The majority of doctors in the late–nineteenth century appear to have been reluctant to specialise in paediatrics, perhaps because it was less profitable than other areas. Nevertheless, the demand for hospital services expanded rapidly—and exponentially—and the development of paediatrics in the late–nineteenth century was therefore primarily driven by public insistence.

Children were admitted to the new hospitals for a variety of illnesses, the most common being contagious diseases, respiratory illness and digestive disorders.⁵⁰ Infants under the age of two were rarely admitted, for it was believed the best place for the baby was at home with the mother, especially if the child was being breastfed. There was a range of practical problems in the treatment of infants, including the lack of a suitable substitute for breastmilk.⁵¹ At the Sydney Hospital for Sick Children, only children aged over eighteen months were admitted until 1895.⁵² The Melbourne Children's Hospital opened its first ward for babies in 1903, when four infants were admitted.⁵³ Even then, it treated mainly surgical patients, especially children with congenital deformities such as cleft palate, hare lip and hernia.⁵⁴ The two main childhood killers, stomach disorders and pneumonia, were not treated to any great extent until the 1920s.⁵⁵

Although babies were excluded, the children's hospitals could not keep up with demand. The Melbourne Hospital for Sick Children suffered from overcrowding, despite frequent expansions. From the initial six beds in 1870, in 1885–86 inpatients numbered 593 and three years later the number had risen to 996.⁵⁶ Outpatients also increased rapidly; in 1888–89, some twenty thousand attended, while nine years later there were sixty thousand children visiting the department.⁵⁷ By 1900, the Melbourne Children's Hospital boasted eighty beds and saw fifty-eight thousand outpatient cases per annum.⁵⁸ The situation was similar in both Brisbane and Sydney.⁵⁹ From as earlier as 1886, six years after its conception, there were plans to move and expand the Sydney Hospital for Sick Children.⁶⁰ Originally, the Hospital had been established to cater for the poor neighbourhoods in its immediate vicinity. Instead, children came from across the suburbs of Sydney and even from country regions.⁶¹ By 1895, there were almost five hundred annual admissions, as well as five thousand outpatient consultations.⁶² In 1900, the hospital was turning patients away and there were calls for a new hospital of at least one hundred beds.⁶³ The new Royal Alexandra Hospital for Children was opened in December 1906 with ninety-eight beds.⁶⁴ By 1907, the outpatient department saw 120 patients per day, and three years later there were 47,964 consultations in the course of the year.⁶⁵

The increasing discussion of child health

At the same time as the hospital provided a site for the development of paediatrics, the end of the nineteenth century saw a substantial increase in medical publications on child health. New books were printed rapidly, and many were medical guides for the general public.⁶⁶ While such books do not necessarily indicate a rise in the specialty discipline of paediatrics, they do show a changing cultural and medical interest in the child, indicative of increasing social interest in child health and welfare—which was of course a precursor to the growth of paediatrics itself. Child health books were extremely popular in late colonial Australia. Muskett's The Health and Diet of Children in Australia was initially published privately in a small run and was then taken up by publishers in 1889.⁶⁷ This first volume sold out within months and Muskett then released a second expanded edition.⁶⁸ Similarly, his text The Feeding and Management of Australian Infants in Health and Disease ran to at least seven editions.⁶⁹ The care of infants and children was also increasingly discussed in more general medical self-help texts: Fullerton is an early example. In his 1884 Family Guide, he considered the treatment of children and their illnesses quite extensively. Aimed at mothers, Fullerton hoped to be helpful to women in rural areas, where medical help was often not available.⁷⁰

This period also saw a growth in debate within the medical community particularly in professional journals. Mid–nineteenth century considerations of infants and children in the medical journals were rare. There were a few early colonial works on children in the 1830s and 1840s, and there was some debate over infant feeding.⁷¹ Generally, however, when infants were discussed, writings tended to centre on congenital malformations, in particular the so-called monster child.⁷² Hideously deformed, the monster foetus/child was perhaps the most obvious and shocking of the possible outcomes and was hence an object of early curiosity.

By the late–nineteenth century, however, interest in child health in Australian medical journals increased rapidly. The Australasian Medical Journal, for example, included on average eight items a year on the diseases of children in the decade following its inception in 1856. In the following twenty years, the number of articles doubled and had doubled again by the close of the nineteenth century.⁷³ An interest in the more grotesque malformations continued throughout the late–nineteenth century, but was rapidly overshadowed by other debates.⁷⁴ Most common was concern over infant feeding, though new areas of interest also opened up. Congenital malformations were a peculiarity of paediatrics, as was prematurity, and these were considered at length.⁷⁵ Other childhood illnesses such as smallpox, whooping cough, scarlet fever and diphtheria were of particular concern. Notably, the first significant Australian contribution to international paediatric knowledge was in 1892, when two Brisbane doctors discovered paralysis in children could be caused by lead poisoning.⁷⁶

Many of these early writers were not necessarily specialist paediatricians, but had sincere and ongoing interests in child health. Many doctors took up a broad interest in childhood illnesses. For example, in the 1890s, the Queensland surgeon Sir David Hardie gave a number of lectures on diptheria in children.⁷⁷ Yet there were few Australians who specialised only in children's health. Probably the most notable was Sir William Snowball, an honorary doctor at the Melbourne Children's Hospital, who ran a private practice in paediatric medicine in Carlton.⁷⁸ Snowball contributed widely to the Australian Medical Journal, with articles describing conditions as varied as paralysis, renal failure, herpes, diphtheria, male circumcision, trauma and congenital deformities.⁷⁹ Snowball emphasised the differences between the adult and child patient, and from his published work, it would appear that he was profoundly concerned with educating other doctors about the care of children.⁸⁰ He was not afraid to report of unsuccessful treatments where the patient died, if there was something to be learned from the case itself. Even within the scientific scope of the published medical case study, Snowball's sympathy and concern for the sick child was apparent.⁸¹

Snowball, like his contemporary Frederic Still in Britain, was the exception rather than the rule, in his interest in a broad range of diseases pertaining to children.⁸² Even so, there was a marked increase in paediatric literature. Much of this new interest in children continued to focus on disorders of the stomach. Indeed, Philippa Mein Smith has described nascent paediatrics in Australia as 'an industry of preoccupation with the bowels.'⁸³ Such a preoccupation was reasonable: in Australia, the most common causes of death in infants were diarrhoea and stomach conditions, including malnutrition.⁸⁴ It is difficult to estimate the percentage of infant deaths caused by diarrhoea and other stomach related illnesses, not the least because of the disparities in naming and recording such illnesses. Recent estimates suggest that approximately one half of all infant deaths were caused by diarrhoea in all its forms and as such became a crucial category for medical analysis.⁸⁵

Infant mortality in Australia

Infant mortality progressively became central to the debates over child health. In Britain, the concept of an infant mortality rate developed only in 1875. Until then, infant deaths had been subsumed in general statistics. David Armstrong has suggested that the creation of the infant mortality rate was significant because it indicated both 'the emergence of a social awareness of these young deaths and more importantly, the social recognition of the infant as a discrete entity.'⁸⁶ With children becoming 'sacred,' their deaths too became 'intolerable,' both individually for parents, and publicly for the broader society.⁸⁷ At the same time, the bio-political importance of children was consolidated. Concern over infant mortality developed out of the dual fears over the declining birth rate and the 'depopulation of white Australia.' Infants were all the more precious because they were perceived to be rare. As such, it became important that all white babies survived the difficult years of infancy and childhood and the medical profession perceived itself to be instrumental in this fight between life and death.

Throughout the period 1880–1910, infant mortality was thought to be worryingly high. In New South Wales, in 1880, the mortality rate for infants under the age of twelve months was 114 per thousand. During the 1880s this mortality rate fluctuated, reaching a high of 131 per thousand in 1882. By 1890, the death rate had fallen to 105 per thousand.⁸⁸ A year later, it rose to 119 per thousand, but reached a high for the 1890s of 122 per thousand in 1898.⁸⁹ While the overall trend was for a decline in deaths, the most substantial drop was in the early years of the new century. By 1900, Australian infant mortality fell to below 100 per thousand and by 1905 this had fallen still further (see Table 1). Even so, there were significant annual variations, probably due to climactic variations and infectious diseases.

Year	NSW	VIC	QLD	SA	TAS	WA	Australia
1880	113.6	118.8	105.5	135.7	112.3	77.2	116.9
1885	131.2	125.8	148.5	113.4	112.6	92.5	127.9
1890	104.5	117.4	100.5	96.5	105.6	89.7	107.5
1895	105.9	102.4	91.2	94.6	81.6	143.3	101.3
1900	103.3	95.4	98.4	99.3	80.00	126.2	99.9
1905	80.6	83.3	75.5	72.8	80.7	104.2	81.8
1910	74.7	76.9	62.9	70.2	101.7	78.2	74.8

Table 1: Infant Mortality in Colonies and States, 1880–1910 (Deaths per thousand registered births). Source: Wray Vampleur, ed., Australian Historical Statistics (Sydney: Fairfax, Syme and Weldon, 1987), 58.

Illegitimacy and infant mortality were closely linked. In New South Wales in 1900, for example, 19.5 percent of deaths under twelve months were illegitimate children.⁹⁰ Given that illegitimate births made up only 7.01 percent of all births, illegitimate children were disproportionately represented in mortality figures.⁹¹ Thus while the death rate of legitimate infants was 89 per thousand, the mortality rate for illegitimates under twelve months was 103 per thousand.⁹² Coghlan calculated the death rate of illegitimate children under the age of five years was 241.4 percent higher than for those born inside marriage.⁹³

The causes of a high death rate amongst illegitimate infants were manifold. Single women who became pregnant were often left destitute. For her transgression of the moral and social order, her partner, family and employer often simply abandoned the woman to her fate.⁹⁴ She could be left both 'penniless and friendless.'⁹⁵ Under such circumstances, the woman lacked prenatal and natal care, and in Sydney there were cases of women giving birth in the street.⁹⁶ The incidence of serious complications including stillbirth was very high for these women. The Royal Hospital for Women at Paddington recorded a total of 547 births in 1906, of which forty-nine or nine percent were stillborn.⁹⁷ The only explanation for such a rate was the 'strenuous lives and struggle for existence,' of women forced to seek assistance at the Hospital.⁹⁸ Furthermore, fewer illegitimate children were breastfed, and were more likely to be abandoned, or left at the mercy of the baby-farmer.⁹⁹

Death rates also varied across geographical locations, with rural areas the safest place for babies.¹⁰⁰ Simply having a high population in towns and centres may have increased the death rate, in part due to the problems of a fresh milk supply.¹⁰¹ Across the colonies, rates could vary notably; in Tasmania the rate was the lowest in the Commonwealth of Australia, while Western Australia—especially during the gold years—had an infant mortality rate of 146.1 per thousand.¹⁰² Even within individual regions, there could be substantial differences, based on variables including income, family size, education and cleanliness within the home.¹⁰³ The climate played a major role: the impact was so vast that the seasons even defined the aetiology of infant disease and the term 'summer diarrhoea' was interchangeable with infantile diarrhoea.¹⁰⁴

While adult mortality had decreased markedly from the 1870s, infant mortality remained reasonably steady at least until the 1890s.¹⁰⁵ Even after the turn of the century, the situation was still acute, as the Royal Commission indicated in 1904: roughly one in ten children did not survive infancy and over fifty percent of these deaths occurred in the first three months of life.¹⁰⁶ On an international level, however, Australian infant mortality was not high, and was significantly lower than in England and most other European nations.¹⁰⁷ In many ways, Australian infants were relatively healthy. In Australia, the mean weight of infants born at full term was eight pounds.¹⁰⁸ Doctors reported proudly that on average children were born one pound heavier than their English counterparts and there were commonly extremes in weight not seen in Britain. In the colonies it was not altogether unusual to see an infant born weighing twelve pounds, while there were cases of children born weighing eighteen pounds.¹⁰⁹ Children were often taller and sturdier than their European counterparts, due to better diet, more sunlight and the absence of the worst of the European slums. There was certainly poverty and overcrowding in Australia, especially in urban areas, but generally the physical environment was preferable to the Old World.

Despite the comparatively low death rates, concern over infant mortality was pervasive and influential. Such a concern was political. The infants described were not simply children, but products for the state. Discussions of infant health were concerned not simply with medical aspects of disease but were steeped in social, political, cultural and economic beliefs. At a time when the birth rate was declining, it became increasingly important to society to ensure the survival of those white babies who were born. Individual babies were rarely the issue, even within medical discourse. The emphasis was instead on the baby as human capital. This is not to suggest, of course, that individual children were not mourned or loved or lost—quite the opposite.¹¹⁰

A striking example of the link between infants, the state and the empire appeared in the Intercolonial Medical Journal of Australasia in 1898. Dr. James W. Barrett, a surgeon at the Victorian Eye and Ear Hospital and an assistant lecturer at the University of Melbourne, attempted to estimate the 'value' of the Victorian infant. He calculated that had slavery existed in Victoria, and assuming that a slave worked at the same rate as a free man, there would be no loss in buying an infant at £112, and maintaining him until he could work, taking into account food, shelter and clothing. He concluded the Victorian infant would cost £94 to rear, but would increase the wealth of the state to the extent of £112.¹¹¹ Barrett's rather bizarre calculation indicates the manner in which infant life was indeed viewed as a resource for the nation. Further, given that Barrett himself did not have any special interest in paediatrics, his calculation shows just how widespread and interconnected medical knowledge and authority, the state, and conceptualisations of child health had become.

Doctors increasingly posited themselves, in their capacity 'as authorities on bodies,' as influential advisors on issues of both infant health and population, and they maintained a strong presence on government boards and inquiries.¹¹² The medical profession was thus a social and economic body as well as a scientific community. This colonial 'dominance,' as historian Evan Willis has called it, was achieved with the support of the state.¹¹³ In part this may have stemmed from the more fluid social structures in colonial Australia, where doctors were able to gain a more prominent position in local society.¹¹⁴ It was also part of the wider Victorian faith in science and progress, which increasingly emphasised the rational cure of both disease and social ills. Thus men in government turned to physicians when they dealt with broader issues of biopolitics; which in this case was the issue of population.

Fears over depopulation, though common across most Western nations at the turn of the century, were increasingly pronounced in the Australian context, given the vast space and small population of the colonies. Muskett, for example, believed that the life of a child in an 'underpopulated country' such as Australia was of far more value than the densely populated areas of England. Quantifying this, he suggested that the death of an infant in Australia was ten times more serious than if it occurred in the United Kingdom.¹¹⁵ Mirroring the discussion of the declining birth rate, there was an element of fear of racial, national and imperial decline. McLean claimed that high infant mortality was, 'endangering the stability of our race,' and leading inevitably to a fall from, 'equality amongst the great nations of this world.'¹¹⁶

Other doctors, too, actively promoted links between the infant and the white nation. As one doctor wrote in the Australasian Medical Gazette (AMG) in 1899, 'every infant represents a valuable asset to the State, the money spent in so saving them would be repaid tenfold.'¹¹⁷ Similarly the Victorian Government Statistician McLean suggested in the IMJ that, even aside from the humanitarian aspects, it was worthwhile saving the infant from an economic aspect, as each child would grow to be an asset to the state.¹¹⁸ In 1895, the President of the New South Wales branch of the BMA agreed, claiming the loss of infant life was a loss to the economy and a public loss to the country.¹¹⁹ In the next century, the editors of the AMG concurred: every child was a 'national responsibility as well as a national asset' and could be 'moulded into an element of national strength.'¹²⁰

It was then a short leap to try to improve the state, through saving infant lives. As the editors of the AMG noted, 'Every life has its value to the State. It follows, therefore, that it is the duty of the State and local authorities within the State to take every means possible to protect the life of every infant born.'¹²¹ This was the responsibility of the individual, the government and of course the medical profession. Such a juxtaposition of babies, doctors, and the nation, ultimately served to consolidate the medical profession and to encourage and stimulate the growth of paediatrics. The work of the medical profession was for the good of the race and the nation: medicine was not simply about health and disease in the individual but also influenced the wider social and political body.

Such concerns intensified in the new century.¹²² As in debates surrounding the declining birth rate, the perceived threat came not only from a degeneration of the national body but was also as an external force, most especially from Asia. High infant mortality became a symbol of these dual threats, and the public, the politicians, and the medical profession all demanded an explanation. Thus the New South Wales Royal Commission of 1903–04 was not simply concerned with the declining birth rate. A secondary point of consideration was infantile mortality. In many ways, the concern over infant deaths was the reverse side of debates surrounding falling births. As it became increasingly clear that it was difficult—if not impossible—to encourage or force women to reproduce, the lives of those children who were born became correspondingly important. With the birth rate so low, it was 'paramount' that white infant lives were saved.¹²³

Conclusions: From obstetrics to paediatrics

The emergence of an interest in child health was part of a wider awakening to childhood and the conceptualisation of children as both separate and special. The emergence of paediatrics was stimulated in Australia by a concern for high infant mortality and the prevalent attitude at the time that there was the need to populate the nation: every white baby became increasingly important for the state. Paediatrics, in combination with the institution of the hospital, had acted to split the mother and child: they were no longer joined together physically and ideologically through the practice of obstetrics. Instead, the child was separate and special, judged as an independent and valuable member of society.

Doctors were sufficiently professionalised to be positioned as authorities in infant health and were able to encourage the status of the child as valuable and needing specialist care. The hospital, in particular, became the site of medical authority and even though the development of the clinic was driven by consumer demand, the profession was able to gain markedly from the institutionalised treatment of children. At the same time that the medical profession gained authority over the family, education in the diseases of children was slow to develop. Professionalisation was still in the future and development was incomplete and somewhat fragmented: paediatrics was, in the early century, a nascent specialty.

Macquarie University

Notes

^1.� Fielding H. Garrison, "History of Pediatrics," in Abt-Garrison History of Pediatrics, edited by Isaac A. Abt (Philadelphia: Saunders , 1965), 2; Editorial, "An Hospital for Sick Children," Australasian Medical Gazette (hereafter AMG) 6 (1861): 36.

^2.� See Garrison, 1–172; George Frederic Still, The History of Paediatrics, 2nd ed. (London: Dawsons, 1965); Isaac A. Abt, "A Survey of Pediatrics During the Past 100 years," Illinois Medical Journal 77 (1940): 485–94; A.R. Colon with P.A. Colon, Nurturing Children: A History of Paediatrics (Westport: Greenwood Press, 1999).

^3.� George Weisz, Divide and Conquer: A Comparative History of Medical Specialization, (Oxford: Oxford University Press, 2006): xix.

^4.� George Rosen, The Specialization of Medicine with Particular Reference to Ophthalmology (New York: Proben Press, 1944).

^5.� Rosen, 22.

^6.� A. Jacobi, "The Relations of Paediatrics to General Medicine," Transactions of the American Paediatric Society 1 (1889): 8.

^7.� Cited in Kathleen W. Jones, "Sentiment and Science: The Late Nineteenth Century Pediatrician as Mother's Advisor", Journal of Social History 17 (1983): 80.

^8.� Still, 1–78; Garrison, 59–63. See also Colon, 108–112, 158; Josephine M. Lloyd, "The 'Languid Child' and the Eighteenth-Century Man-Midwife," Bulletin of the History of Medicine 75 (2001): 641–679; Samuel Kottek, "Citizens! Do you Want Children's Doctors? An Early Vindication of 'Paediatric' Specialists," Medical History 35 (1991): 105.

^9.� G.H.B. Storey, "The Emergence of Paediatrics as a Medical Specialty in Sydney, 1870s through 1930s: A Prolonged and Difficult Labour," (MPhil thesis, University of Sydney, 1997), 15, 23; Boyd M. Berry, "The First English Pediatricians and Tudor Attitudes Towards Childhood", Journal of the History of Ideas 35 (1974): 562–3; Ann F. La Berge, "Mothers and Infants, Nurses and Nursing: Alfred Donne and the Medicalisation of Child Care in Nineteenth Century France," The Journal of the History of Medicine and Allied Sciences 46 (1991): 20; Jones, 81; Dorothy Porter and Ray Porter, Patient's Progress. Doctors and Doctoring in Eighteenth Century England (Cambridge: Polity Press, 1989), 183; AN Williams, "Physician, Philosopher and Paediatrician: John Locke's Practice of Child Health Care", Archives of Disease in Childhood 91 (2006): 85–9.

^10.� See A. Zelizer, Pricing the Priceless Child: The Changing Social Value of Children (New York: Basic Books, 1985).

^11.� There is a vast literature on individual reforms. More generally, see Lawrence Stone, The Family, Sex and Marriage in England 1500–1800 (London: Weidenfeld and Nicolson, 1977), 405–448; Larry Wolff, "Then I Imagine a Child: The Idea of Childhood and the Philosophy of Memory in the Enlightenment", Eighteenth Century Studies 31 (1998): 380, 387; Zelizer; Carolyn Steedman, 'Bodies, Figures and Physiology: Margaret McMillan and the Late Nineteenth-century Remaking of Working-class Childhood', in In the Name of the Child: Health and Welfare, 1880–1940, edited by Roger Cooter (London: Routledge, 1992): 19–44.

^12.� See Roger Cooter, 'The Cause of the Crippled Child' in his Surgery and Society in Peace and War (Basington: Macmillan, 1993): 53–78.

^13.� Weisz, 5.

^14.� Porter and Porter, 183–4; Ruth McClure, "Pediatric Practice at the London Foundling Hospital," Studies in Eighteenth Century Culture 10 (1981): 361; Jacques Gelis, "The Child: From Anonymity to Individuality" in A History of Private Life, edited by Philippe Aries and Georges Duby (Cambridge: Cambridge University Press, 1993), 3:313–4; Kottek, 103–116.

^15.� Jonathon Gillis, "Bad Habits and Pernicious Results: Thumb Sucking and the Discipline of Late-Nineteenth-Century Paediatrics," Medical History 40 (1996): 71.

^16.� Colon, 189.

^17.� R.J. Touloukian, "Pediatric Surgery Between 1860 and 1900," Journal of Pediatric Surgery 30 (1995): 916.

^18.� Abt, 488. See also Russell Viner, "Abraham Jacobi and the Origins of Scientific Pediatrics in America," in Formative Years: Children's Health in the United States, 1880–2000, edited by Alexandra Minna Stern and Howard Markel (Ann Arbor: University of Michegan Press, 2002), 23–46.

^19.� A. Jacobi, "The Relations of Paediatrics to General Medicine," Transactions of the American Paediatric Society 1 (1889): 8.

^20.� Abt, 485; La Berge, 20; Kottek, 105; Roy Porter, "The Eighteenth Century", in The Western Medical Tradition: 800 BC to AD 1800, edited by Lawrence I. Conrad et al (Cambridge: Cambridge University Press, 1995), 405.

^21.� Garrison, 1; Harry Bloch, "History of Pediatrics, Part II", Southern Medical Journal 86 (1993): 85–130, 89; Lorimer Dods "As it was in the Beginning" Australian Paediatric Journal 4 (1968): 204.

^22.� Colon, xiv.

^23.� Storey, 154–5.

^24.� Dods, 204–208; Bryan Gandevia, Tears Often Shed: Child Health and Welfare in Australia from 1788 (Sydney: Pergamon Press, 1978), 140.

^25.� Dods, 208.

^26.� Weisz, 13.

^27.� Editorial, "The Teaching of Pediatrics," Australian Medical Journal (hereafter AMJ) 16 (1894): 599.

^28.�Ibid., 600.

^29.�Ibid., 599.

^30.� Storey, 74.

^31.� Lyndsay Gardiner, Royal Children's Hospital Melbourne 1870–1970 (Melbourne: The Royal Children's Hospital Melbourne, 1970), 46.

^32.� Peter Yule, The Royal Children's Hospital: A History of Faith Science and Love (Sydney: Halstead Press, 1999), 112.

^33.� Dods, 204. Even in the interwar and postwar periods, many paediatrians continued to supplement their income with adult patients. See David Stevens, "Pride, Prejudice and Paediatrics: Women Paediatricians in England before 1950," Archives of Disease in Childhood 91 (2006): 869; John Hemsley Pearn, Focus and Innovation: A History of Paediatric Education in Queensland (Brisbane: University of Queensland, 1986), 7.

^34.� Rosemary Pringle, Sex and Medicine: Gender, Power and Authority in the Medical Profession (Cambridge: Cambridge University Press, 1998), 106, 121. See also Alison Bashford, "Female Bodies at Work: Gender and the Re-Forming of Colonial Hospitals," Australian Cultural History 13 (1994): 70.

^35.� Pringle, 122; Stevens, 866–70.

^36.� Jones, 81.

^37.� Storey, I; On foundling homes, see Ruth K. McClure, Coram's Children (New Haven: Yale University Press, 1981); J. Ramsland, Children of the Backlanes (Sydney: University of New South Wales Press, 1986).

^38.� D.C. Fison, The History of Royal Children's Hospital Brisbane (Brisbane: Royal Children's Hospital Brisbane, 1970), 2.

^39.� See Angela Ballabriga, "One Century of Pediatrics in Europe", in History of Pediatrics, edited by B. Nicholas, A. Ballabriga and N. Kretchmer (New York: Raven Press, 1991), 6; Colon, 191; Elizabeth Lomax, "The Control of Contagious Disease in Nineteenth Century Paediatric Hospitals," Social History of Medicine 7 (1994), 383.

^40.� Editorial, "The Claims of Sick Children," AMJ 18 (1873): 50.

^41.�Ibid.

^42.� Storey, Appendix 2.

^43.� C.P.B. Clubbe, "An Inaugural Address," Medical Journal of Australia (hereafter MJA) (3 June 1922): 599.

^44.� Yule, 16–7.

^45.� Cited Storey, 155. As Lomax notes, the fear of cross infection was very real, 385.

^46.� K.F. Russell, The Melbourne Medical School 1862–1962 (Melbourne: Melbourne University Press, 1977): 47; Gardiner, 2.

^47.� Yule, 17.

^48.�Ibid.

^49.� Fison, 1.

^50.� Cited in Fison, 6.

^51.� Gardiner, 56–7.

^52.� D.G. Hamilton, Hand in Hand: The Story of the Royal Alexandra Hospital for Children Sydney (Sydney: John Ferguson, 1979), 62.

^53.� Gardiner, 56.

^54.� Yule, 165.

^55.�Ibid.

^56.� Gardiner, 24.

^57.�Ibid., 25.

^58.� Yule, 98.

^59.� Fison, 7.

^60.� P.L. Hipsley, Early History of the Royal Alexandra Hospital for Children Sydney 1880–1905 (Sydney: Angus and Robertson, 1952), 21.

^61.� Storey, 101.

^62.� Hamilton, 63.

^63.� Editorial, "The Children's Hospital, Sydney," AMG (1900): 208.

^64.� Hipsley, 104.

^65.� Hamilton, 77.

^66.� See for example Anon, Healthy Mothers and Sturdy Children: A Book for Every Family (Melbourne: Peter and Knapton Printers, 1893); Australian Health Society, "Rules for the General Management of Infants", in Sanitary Tracts Issued by the Australian Health Society (Melbourne: Australian Health Society, 1882); Board of Public Health, Infant Feeding: The Use and Abuse of Artificial Foods (Melbourne: Board of Public Health, 1896); A.W. Gardner, The First Few Months of Infancy: Being Hints to Mothers (Melbourne: Kemp and Boyce, 1888); Charles Hunter, What Kills Our Babies? (Melbourne: Mason, Firth and McCutcheon, 1878); James Jamieson, How to Feed Infants (Melbourne: Stillwell and Knight, 1871); James Jamieson, Diseases Which Should be Prevented, rev. ed. (Melbourne: Australian Health Society, 1892); Charles McCarthy, On the Excessive Mortality of Infants and its causes (Melbourne: George Robertson, 1865); J.P. McNeill, A Treatise upon the Proper Management, Nursing and Dietary of Infancy and Childhood, and Upon Diseases of Children (Sydney: Jas. Miller and Co., 1888); J.P. McNeill, Treatment of Children in Health and Sickness (Sydney: Jas. Miller and Co., 1888); Philip E. Muskett, The Health and Diet of Children in Australia, 2nd ed. (Sydney: Edwards, Dunlop, 1890); Philip Muskett, An Australian Appeal (Sydney: Edwards, Dunlop, 1892); Philip E. Muskett, The Feeding and Management of Australian Infants in Health and Disease, 7th ed. (Sydney: Brooks, 1906); John Service, On the Natural and Artificial Feeding of Infants (Sydney: Edwards, Dunlop, 1890); J. Usher, The Perils of a Baby (Melbourne: Samuel Mullen, 1888); T.R.H. Willis, "The Mortality and Management of Infancy," in Australian Helth Society, Health Lectures for the People, first series (Melbourne: George Robertson and Company, 1886)

^67.� Muskett, "Preface to the First Edition", in The Health and Diet of Children in Australia, unpaginated.

^68.�Ibid.

^69.� Muskett, The Feeding and Management of Australian Infants, xiii.

^70.� Fullerton, iii.

^71.� Gandevia, 95; M.J. Thearle, "Infant Feeding in Colonial Australia," Australian Paediatric Journal 21 (1985): 75–9.

^72.� See for example "Trisceles Monster," AMJ 1 (1846–47): 39; "Suggestions Respecting an Occasional Cause of Congenital Talipes Varus," AMJ 2 (1846–47): 19; S.J. Thomas, "Report of a Case of Double Monster," AMJ 1 (1856): 202.

^73.� Gandevia, 96.

^74.� See for example H.B. Allen, "Exhibited Vertical Section of Head of an Acephalous Foetus," AMJ 14 (1893): 179; W. Balls-Headley, "Exhibited Acephalous Foetus", AMJ 3 (1881): 310; A.A. Lendon, "An Infant with Two Mouths," AMG 7 (1887–88): 107; J.C. Verco, "Foetal Monster," AMG 6 (1886–87): 160; W.A. Wood, "Anencephalous Foetus", IMJ 1 (1898): 342.

^75.� H.B. Allen, "A Case of Congenital Malformations of the Heart," AMJ 1 (1879): 333; W.S. Byrne, "Two Cases of Imperforate Anus," AMG 11 (1891–92): 141; W.R. Clay, "Case of Congenital Umbilical Hernia," AMG 4 (1884–85): 108; A.T. Gunning, "A Case of Congenital Malformation," AMJ 2 (1880): 485; E. Stone, "Congenital Deficiency of Posterior Part of Diaphragm," AMJ 17 (1895): 554; C.E. Todd, "A Case of Inguinal Colotomy in an Infant" AMG 12 (1893): 185; J.F. Usher, "Diminutive Live Births," AMJ 2 (1880): 366.

^76.� L. Dods, 'Paediatrics in the Antipodes,' Australian Paediatric Journal 1 (1965): 3.

^77.� See Pearn, 1–2.

^78.� Lyndsay Gardiner, "Snowball, William (1854–1902)," Australian Dictionary of Biography, (Melbourne: Melbourne University Press, 1990), 12:8. It might be noted that Snowball did treat adults at least occasionally, see W. Snowball, "Two Cases of Strangulated Femoral Hernia," AMJ 5 (1885): 435–6. Both of these cases were adults.

^79.� W. Snowball, "Notes of a Case of Pott's Curvature of the Spine," AMJ (September 15 1880): 392–6; W. Snowball, "Hospital for Sick Children: A Case of Browning of the Skin," AMJ 2 (1880); 415–7; W. Snowball, "Children's Hospital: A Case of Abscess of the Brain," AMJ 2 (1880): 490–2; W. Snowball, "Notes on a Case of Double Psoas Abscess," AMJ 2 (1880): 493–500; W. Snowball, "Caries of Os Calcis," AMJ 4 (1882): 153–4; W. Snowball, "Anomalous Cases in Children's Practice," AMJ 5 (1883): 192–3; W. Snowball, "Anomalous Cases in Children's Practice," AMJ 5 (1883): 294; W. Snowball, "On Phimosis as a Cause of Reflex Nervous Affections," AMJ 5 (1883): 635–8; W. Snowball, "Congenital Caudal Growth – Removal – Death," AMJ 4 (1884): 537–8; W. Snowball, "A Case of Acute Ascending Paralysis," AMJ 8 (1886): 1–2; W. Snowball, "The Treatment of Diphtheria," AMJ 11 (1889): 491–500; W. Snowball, "Intus-Susception: Laparotomy," AMJ 9 (1887): 63.

^80.� See W. Snowball, "The Jury-Mast in Spinal Disease," AMJ 3 (1881), 493.

^81.� See for example, W. Snowball, 'Melbourne Hospital for Sick Children: Case of Addison's Disease', AMJ 2 (1880): 363–4.

^82.� P.M. Dunn, "Sir Frederic Still (1868–1941): The Father of British Paediatrics," Archives of Disease in Childhood 91 (2006): 308–10.

^83.� Philippa Mein Smith, "Truby King in Australia: A Revisionist View of Infant Mortality," The New Zealand Journal of History 22 (1988): 25. See also Lisa Featherstone, "Infant Ideologies: Doctors, Mothers, and the Feeding of Children in Australia, 1880–1910," in Children's Health Issues in Historical Perspective, edited by Cheryl Krasnick Warsh and Veronica Strong-Boag (Ontario: Wilfrid Laurier Press, 2005): 131–160.

^84.�Report of the Royal Commission on the Decline of the Birth-Rate and on the Mortality of Infants in New South Wales, (Sydney: 1904), 1:38

^85.� Philippa Mein Smith, "Infant Welfare Services and Infant Mortality: A Historians View," The Australian Economic Review 24 (1991): 27; Smith, "Truby King in Australia," 26.

^86.� David Armstrong, "The Invention of Infant Mortality," Sociology of Health and Illness 13 (1989): 212.

^87.� Zelizer, 23.

^88.� T.A. Coghlan, New South Wales Statistical Register for 1890 and Previous Years (Sydney: Government Printer, 1891), 426. All figures for death rates under 1 year.

^89.� T.A. Coghlan, New South Wales Statistical Register for 1900 and Previous Years (Sydney: Government Printer, 1902), 677.

^90.� From figures in T.A. Coghlan, The Wealth and Progress of New South Wales, 1900–01 (Sydney: Government Printer, 1902), 992.

^91.� From figures in Ibid., 987

^92.�Ibid., 992.

^93.�Ibid.

^94.� Infants Home Ashfield, Eighteenth Report of the Infants Home Ashfield (Sydney: Infants Home Ashfield, 1893), 6. See also J. Creed, "Report," in Report from the Select Committee on the Infants' and Children's Protection Bills: New South Wales Legislative Council (1891–92), 6.

^95.�Report of the Benevolent Society of New South Wales (Sydney: Benevolent Society, 1889), 12.

^96.�Ibid.

^97.�Annual Report for 1906: The Benevolent Society of New South Wales (Sydney: Benevolent Society, nd), 9.

^98.�Ibid.

^99.� Editorial, "Infant Life Protection," AMG (1908): 675; Judith Allen, "Octavius Beale Reconsidered: Infanticide, Babyfarming and Abortion in NSW 1880–1939," in What Rough Beast?The State and Social Order in Australia edited by the Sydney Labour History Group (Sydney: Allen and Unwin, 1982), 111–129.

^100.� Coghlan, Register for 1890 and Previous Years, 426; Coghlan, Register for 1900 and Previous Years, 677; James Jamieson, "On Infant Mortality," AMJ 3 (1881): 38–9.

^101.� William Mackenzie, "Caloric Values of Infant Feeding," IMJ (1903): 250; A. Jeffreys Wood, "Preservation of Infant Life", IMJ (1908): 129.

^102.�Report of the Royal Commission 1:37.

^103.� Philippa Mein Smith and Lionel Frost, "Suburbia and Infant Death in Late Nineteenth and Early Twentieth Century Adelaide," Urban History 21 (1994): 258–72.

^104.� A. Jefferis Turner, "Infantile Mortality," AMG (1910): 278.

^105.�Report of the Royal Commission, 1:37. In general, childhood mortality for those up to the age of five fell earlier, but significant changes to those under one year did not occur until the early years of the twentieth century.

^106.�Ibid., 37 .

^107.� W. McLean, "The Declining Birth Rate In Australia," IMJ (1904): 109; R.I. Woods, P.A. Watterson, and J.H. Woodward, "The Causes of Rapid Infant Mortality Decline in England and Wales 1861–1921, Part I," Population Studies 42 (1988): 349.

^108.� Muskett, The Health and Diet of Children, 96.

^109.� P.M., "A Review of 'A Manual for What Every Mother Should Know,'" AMJ 3 (1881): 318.

^110.� For example, in 1876 Rose Patterson wrote to her sister Nora on the loss of her child, "all the philosophy & reasoning in the world will do very little to soften a mother's grief, which I imagine to be almost a physical pain as certain to follow as the pain which follows the amputation of a limb." See Colin Roderick, Rose Patterson's Illalong Letters 1873–88 (Sydney: Kangaroo Press, 2000), p62.

^111.� James W. Barrett, "The Value of a Victorian Infant," IMJ 3 (1898): 95.

^112.� See for example, Report of the Royal Commission: Report from the Select Committee on the Infants' and Children's Protection Bills, New South Wales Legislative Council, 1891–92; "Royal Commission on Charitable Institutions: Synopsis, Minutes of Evidence and Appendix," Victorian Parliamentary Papers (1892–93) 4.

^113.� Evan Willis, Medical Dominance: The Division of Labour in Australian Health Care (Sydney: Allen and Unwin, 1983), 61–91. On a broader scale, see Michel Foucault, The History of Sexuality. Volume I: An Introduction (Harmondsworth: Penguin Books 1987).

^114.� Bryan Gandevia, "A History of General Practice in Australia," MJA 2 (1972): 381–5. See also Milton Lewis, "Populate or Perish: Aspects of Infant and Maternal Health in Sydney 1870–1939," (PhD Thesis, Australian National University, 1976), 295.

^115.� Muskett, The Feeding and Management of Australian Infants, xxiv.

^116.� McLean, 395.

^117.� Gerald E. Cussen, "Infantile Gastro-Enteritis," AMG (1899): 189.

^118.� W. McLean, "Alleged Artificial Restriction of Families," AMJ (1894): 396.

^119.� W.H. Crago, "Presidential Address to the NSW Branch of the BMA", AMG (1895): 149.

^120.� Editorial, "The Protection of Children", AMG (1909): 321.

^121.� Editorial, "Infant mortality in Tasmania," AMG (1907): 205.

^122.� For the broader imperial context, see Anna Davin, "Imperialism and Motherhood," History Workshop 5 (1978): 9–65.

^123.�Report of the Royal Commission, 38.

Content in the History Cooperative database is intended for personal, noncommercial use only. You may not reproduce, publish, distribute, transmit, participate in the transfer or sale of, modify, create derivative works from, display, or in any way exploit the History Cooperative database in whole or in part without the written permission of the copyright holder.