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Karitane's Contribution to Public Health in New INTRODUCTION: KARITANE’S CONTRIBUTION TO PUBLIC HEALTH IN NEW SOUTH WALES 1923-2000 Karitane is a society incorporated in NSW that commenced operation as the Australian Mothercraft Society (AMS) Plunket System in 1923, and become the Karitane Mothercraft Society (KMS) in 1970. Like the Plunket Society in New Zealand that it was modelled after, Karitane’s activities have always been connected with assisting mothers in the care and feeding of their babies. Karitane is an unusual name for an organisation in New South Wales (NSW); not immediately identifiable with either Australia’s British heritage or its Aboriginal culture. Some people in New South Wales will know that the name hails from a small peninsula on the coast of Otago in New Zealand’s South Island and may even identify it with Sir Truby King. The King family had a holiday cottage at Karitane and the name was adopted for the mothercraft homes set up by New Zealand’s Plunket Society in the main towns.1 Thesis and rationale This thesis is about Karitane’s part in the history of public health in NSW from the perspective of the development of mother and baby welfare services, an area of concern for the State’s public health authorities throughout the twentieth century. It examines how and why Karitane, a voluntary organisation, developed its services in NSW from 1923 to 2000; what did Karitane contribute to mother and baby welfare in that period? The main justification for the study was a paucity of information about Karitane in the literature on the development of mothercraft services in NSW. None of the existing sources give any way of gauging the scale of Karitane’s services and the reasons for its establishment remain obscure. Further reasons for this study are that Karitane’s experience is a good example of a voluntary organisation’s side of the ‘moving frontier’ between the private and public provision of health and welfare services, a neglected area of study. At the start of the twentieth century the Australian Labor Party (ALP) advocated that government provide health services for all, while the liberal/conservative interests considered that health and welfare were an individual’s responsibility and that communities should assist the poor. Karitane’s history shows the effects on a small specialist health service of the party political differences over the responsibility for health and welfare. As well, Karitane’s history demonstrates how the professional interests of health service providers can effect the provision of services. At the end of the twentieth century, when the State again looked to voluntary organisations to provide health and welfare services in ways reminiscent of the early twentieth century, it is timely to look at the history of Karitane, a voluntary organisation that spanned both eras. 1 M King, Truby King, the man: a biography, London: G. Allen & Unwin, 1948, 16-17. 2 Thesis structure This thesis uses historical methodology and it follows a chronological path through the twentieth century. The first two chapters are introductory, giving the reasons for the study and the background to concerns about mother and baby welfare. Except for chapters on the 1920s and 1990s, the decades of establishment and radical change, the chapters in the thesis span twenty-year periods and the conclusions are drawn together in the last chapter. All chapters incorporate contemporary developments in the health sector, particularly those in the NSW Department of Public Health (the Department); the public side of the ‘moving frontier’.2 Comparisons with other agencies have been made only in relation to how they have impinged on Karitane and in order to establish an approximation of the extent of Karitane’s contribution to mothercraft services. Although, as will be explained later, Karitane’s direct impact on public health cannot be measured, its development can clearly be related to the development of public health in Australia. Public health academic Fran Baum has identified definite periods in public health development and considers that appreciation of this history is important for understanding contemporary public health. Each chapter links events in public health and in Karitane’s development to the phases Baum identified.3 Outline In the first chapter the justification for the thesis is addressed in detail, starting with an analysis of the historiographic approaches in what has been written about Karitane by the main contributors. What emerges are gaps in knowledge about Karitane’s activity because of a lack of aggregated data; NSW Government records do not acknowledge any services provided by voluntary organisations for mothers and babies until the late 1950s. Also apparent in the literature is the overwhelming influence of one journal article on the image of Truby King and as a corollary on the image of AMS. Literature relating to the changes in voluntary organisations introduces the concept of the ‘moving frontier’ and the increasing importance attached to volunteers in maintaining community cohesion identified as ‘social capital’. Also introduced are the professional boundary issues for doctors and nurses and the role of the NSW Nurse’s Registration Board that were so influential in the development of Karitane. Teaching mothers was seen as a ‘relatively new branch of public health’ in the 1920s but mothercraft training was a personal health practice, and personal health was the domain of the private medical practitioner.4 The juxtaposition of public health and personal services posed a difficulty for public health doctors in maintaining professional solidarity. It highlighted the differences between preventive medicine, seen as ‘state medicine’ at that time, and curative medicine, the interest of the bulk of medical practitioners. 2 In this document the term ‘Department’ refers to the NSW Department of Health and its successors. 3 F Baum, The New Public Health, 2 ed, South Melbourne: Oxford University Press, 2002, 16-17. 4 JM Campbell, Report on maternal and child welfare in Australia, Canberra: Government Printer, 1930, 13. 3 Chapter two elaborates on the rise of infant mortality as a public health concern in Europe and Anglophone countries and the influence of wars. The international spread of scientific ideas in health and illness and how those ideas were adopted in Australia becomes evident in the mechanisms and programmes set up in NSW. The declining birth-rate was the subject of a NSW Royal Commission in 1903 and around the same time Sydney’s Medical Officer of Health, Dr W G Armstrong, initiated moves to involve the Department in reducing infant mortality.5 As was the case in Britain, public health officials were reluctant to venture into areas considered personal health and organizations like the Benevolent Society and the National Council of Women in Sydney were confined to supporting the poor. Australia though had a politically successful labour movement, the ALP, and its aspiration for state-provided medical services was a challenge to individual responsibility and the charitable approach to health and welfare. From the 1890s to the 1940s the State was actively involved in controlling the spread of illness and improving the health of the nation; Baum called this phase ‘Nation-building’. The politics of the ALP and the First World War emerge as an important factor in the establishment of successively, the Royal Society for the Welfare of Mothers and Babies (RSWMB), and the Australian Mothercraft Society. In 1916 a referendum on conscription changed the political balance when ALP representation in parliaments across Australia was decimated. In NSW this resulted in a move away from the efforts by Labor politicians for the State to provide mother and baby services, tipping the balance back towards the provision of services by a voluntary body, RSWMB. It was RSWMB that in 1919 invited Truby King to advise on setting up a system like New Zealand’s Plunket Society in NSW. A brief outline of Truby King’s route from psychiatrist to mother and baby welfare advocate is included in this chapter; he exemplified the international linkages in the spread of mothercraft services. The War was an important factor in the careers of Miss Elizabeth McMillan and the Department’s Dr Emmanuel Sydney Morris who were to have such a big influence in Karitane’s development. In London in 1918, McMillan did Plunket nurse training funded by the Commonwealth’s post-war repatriation education programme. That paved the way to her appointment as Matron at RSWMB’s Tresillian Mothercraft Home in 1921 and then to her spectacular sacking in 1923. Chapter three pieces together how the group of Plunket supporters turned the adversity of McMillan’s dismissal into an opportunity by founding the AMS in May 1923. Adopting the Plunket Society’s aims provided them with an ‘instant’ basis for operation. These aims extolled the value of health and the natural processes of motherhood and the Society operated with them unchanged until the 1990s. Motherhood equated with patriotism in this era of ‘Nation-building’ after the losses of the First World War. This chapter shows how the group went about achieving their goals and how elusive the aim of co-operating with ‘like organisations’ was to become. In the 1920s when the APL reasserted their interests in State provided health services the Department took over the provision of 5 Royal Commission on the decline of the birth-rate and on the mortality of infants in New South Wales, vol. 1, Sydney: Government Printer, 1904. 4 mother and baby welfare services, creating confusion over the boundaries between private and public services. Morris, appointed as the Director of the Department’s Division of Maternal and Baby Welfare, had far reaching influence on Karitane, ruling against the recognition of the Karitane Mothercraft Home as a training school for infant welfare nurses.
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