The importance of philanthropy in the establishment of ‘proto-services’ which are later developed by the State should not be underestimated. As Rose (1990: 127–128) points out, philanthropic activity was instrumental in promoting a pro- phylactic mode of action against many of the moral problems of family life in the nineteenth century such as inebriety, illegality, promiscuity and so on. When allied with medicine, as it often was, philanthropy became a powerful force in lay- ing the groundwork for the later development of state-funded services for the normalisation of families. For example, the first child welfare movements in Australia began as philanthropic ventures (Reiger, 1986: 130). In 1904 William Armstrong, the first graduate of the new medical course at Sydney University, returned from a visit to France where he had seen the work of Pierre Budin and the Consultation de Nourrissons at Charité (Clements, 1986: 67). He established the first Sydney clinic for mothers and babies in 1914, mainly through philan- thropic support. Infant welfare centres were established earlier in Adelaide in 1909 when Helen Mayo returned to Australia after working at the Great Ormond Street Hospital for Sick Children in London. Again, this service was for many years funded by public donations. But by 1923 all Australian states had infant welfare movements which were, in fact, partially or fully state-funded. While
these services were essentially medical in nature, they were promoted as general health services and were mostly staffed by nurses who were supervised, and sometimes trained, by doctors.
The focus on family health, especially that of children, was of crucial impor- tance for the further development of nutrition. This was because, as Foucault points out,
The family is assigned a linking role between general objectives regarding the good health of the social body and individuals’ desire or need for care. This enables a ‘private’ ethic of good health as the reciprocal duty of parents and children to be articulated on to a collective system of hygiene and the sci- entific technique of cure made available to individual and family demand by a professional corps of doctors qualified and, as it were, recommended by the State.
(Foucault, 1980d: 174)
Community medicine, as it came to be known, was of particular importance for the emergence of the science of nutrition for a number of reasons. Through a focus on the health of children, community medicine had direct access to infor- mation about the family which, as we have already seen, was the site for earlier nutrition work by Atwater, Smith, Rowntree and Booth. Moreover, the family was not only a site for collecting information, it was, as we saw in the work of Atwater, a site for reform. The need for reform at the level of the family was made clear by a number of English surveys. A major one was the 1904 Report on the Physical Deterioration instigated in light of a report from the Director General of the Army Medical Services, in which it was stated that the Inspector of Recruiting was hav- ing trouble enlisting enough men with satisfactory physical stature for the Boer War (Drummond and Wilbraham, 1958: 405). A major part of the 1904 report was given over to the health problems of children, one-third of whom were considered to be malnourished. An earlier study in Leeds had shown that half of all children surveyed had marked rickets and 60 per cent had poor dentition (Burnett, 1979: 272). On the basis of the report free school meals were provided to the needy. Also, the routine examination of health, height and weight of school children began in 1907 (Floud et al., 1990: 178).
News of this work in England spread to Australia. For example, the report on ‘The physical condition of children attending public schools in New South Wales’ (1908) points to studies on children in Europe and England:
Though for six years past, [medical examinations of school children] have been taken in Great Britain and for a number of years in France, Germany and America, it has only been in the latter part of 1906 that such work was undertaken for the first time in Australia. ... In Great Britain and on the Continent, school administrators have to face problems arising out of crowded populations, sordid poverty, and the consequent neglect of physical
condition to which many children are subject at the hands of parents who are either helpless victims of their surroundings, or are wilfully evading their responsibilities. In Australia, fortunately these conditions do not prevail to such an extent as to create a problem of the same magnitude.
(New South Wales Department of Public Instruction, 1908: 1)
We should note here that in the early part of this century, Australian medicine was still strongly attached to and associated with Britain. There were a number of direct connections through, for example, education and research activities. As Fenner puts it,
When I graduated [from medicine] in 1938 it was still thought necessary to obtain the English fellowship or membership if one had ambitions in surgery or medicine, and it was the natural wish of every ambitious young medical graduate to work for a time in the United Kingdom.
(Fenner, 1988: 22)
It should not surprise us then that the health concerns of Britain were fully echoed in Australia. For example, Australian interest in child health was promoted by the English surveys mentioned earlier and, as we have seen, by Australians returning after working in Britain. By 1911 Australian paediatrics started to figure more prominently in medicine as judged by the number of papers presented at the Australian Medical Congress and articles in medical journals (Reiger, 1986: 166). As well as concerns about ill-health of children, Smith (1978) argues that an anx- iety about the falling birth rate in Australia, which bordered on alarm after the First World War, was instrumental in promoting child health. In Adelaide, the motto for the infant welfare movement was ‘Babies make the best immigrants’, highlighting the fact that one solution to the problem of the declining population was to reduce infant mortality.