In a Strange Garden: The Life and Times of Truby King
Chapter Ten: A prototype for Plunket
Chapter Ten: A prototype for Plunket
Mary at thirteen months old was described by Bella as 'a very delicate baby . . . almost a skeleton'. As the breast-feeding option was unavailable, Mary was fed from a bottle with a mixture of cow's milk and cane sugar. Bella was not happy with her progress and, frustrated with her husband's apparent lack of interest, chided: 'Fred, you're more interested in your animals than your own child.' Bella suggested that he should devise a more suitable food, as he had done for his animals. She knew that Truby the scientist would accept the challenge.
He devoured everything he could about the feeding of infants to supplement his previous medical knowledge. He would have been impressed with the pioneering work of Budin in France, von Reubner in Germany and Strauss and Rotch in America, who were all working on aspects of infant feeding and medical care. Better still, Truby had page 120 just been joined at Seacliff by Dr Falconer, fresh from studying Public Health at University College, London. Falconer told him of the work at the Battersea Milk Depot, where Dr McCleary had a cure for infant diarrhoea. For Truby King, fresh from his triumphs of creating artificial dairy feed substitutes for calves, this struck a chord. In characteristic fashion he delved into Falconer's reports from Battersea, then into the literature from France and the United States. The topic that most arrested King was the American approach of 'humanising' cow's milk, which required the modification of fat, protein and sugar levels to more closely mimic human milk. Given the new information and the need to devise a practical feeding regime for little Mary, he set to.
Later in 1905 Truby took the opportunity to educate his audiences at the annual conference of the Farmer's Union in Wellington. He had been invited to give two speeches. The first was called 'Agricultural Education in Japan', in which he stressed his appreciation of the simple rural Japanese life and the strength of the family. His comments include such gems as 'the strength of the Japanese nation was in the sacrifice of the women to their families' since children were breast-fed until they were twelve to eighteen months of age. He slipped in a strong condemnation of Anglo-Saxon women for their failure to breast-feed, and their adoption of artificial foods. (The fashion for New Zealand women of the time was against breastfeeding babies, certainly not to the degree or duration King had seen in Japan.) His Seacliff work had convinced him that early nutritional problems were at the root of mental disorders and he knew that infant mortality had declined in France by 40 per cent during the Franco-Prussian war of 1871, when women were unable to farm out babies and had to resort to breast-feeding. What the Farmer's Union made of this is not reported, but Truby continued on day two of the conference with a description of Rotch's method of 'humanising' cow's milk for the feeding of infants. He began his talk with a homily on infant feeding:
If it is necessary to be guided by the laws of nature, and to be page 121 systematic and accurate in the feeding of plants and lower animals, such care is surely incumbent on us in the rearing of human beings. Yet what do we find in practice? In spite of the fact that suckling is the only perfect method of feeding any young mammal, it has become the exception and not the rule . . . Nutrition given by the mother in the natural way is always the best. . . for the most part she the mother who rears her child by means of a bottle is densely ignorant of the duties of maternity, and does not realise the injustice she is doing to herself and her offspring. She has no knowledge of or respect for the laws of Nature, and imagine, the advertising charlatans have superceded Providence in the feeding of babies.
The vision of an assembly of farmers at a national conference willingly listening to diatribes on breast-feeding is hardly credible, but given Truby's undoubted powers of oratory, we must assume that they did listen. He probably won over the farmers with analogies they more readily accepted relating to Nature's laws of the nurture of plants and animals. Little did the farmers realise that they were experiencing the first public outpourings of King's 'To help the mothers and save the babies'. This was not the last time they would hear it.
Shortly after the conference, King was approached by Chief Justice Sir Robert Stout, who had been impressed with the presentation. He gave Stout a summary which incorporated a precis of the 'humanising' of cow's milk. Stout's response was to request the editor of Wellington's Evening Post to publish the address. The Post acceded to Stout's request: 'The information ought to be widely disseminated . . . if medical experts like Dr Truby King say that one of the causes [of infant mortality] is improper food, it is surely necessary that the mothers of children should know how to preserve the lives of their infants.'Truby King's address followed. Soon after this, King published The Feeding of Children, and then an expanded version, The Feeding of Plants and Animals.
Stout had been prompted by his patriotic desire to prevent 'infant loss'. This was a familiar theme to King. From his reading he knew that the British feared that unless the Colonies were occupied by page 122 people of British stock, they would be invaded by foreigners, especially 'Asiatics'. Britain in the twentieth century was experiencing a more humanitarian trend, echoing growing concern for people at risk, especially children, resulting in the Factory Acts of 1879 and 1887 and the Prevention of Cruelty to Children Act of 1889. The prevalent belief was that 'hand fed' infants thrived better than breastfed. Baby foods like Benges, Allen & Hanburys and Nestles were becoming convenient and widely accepted.
America, too, was grappling with infant feeding. The 'humanisation' of cow's milk, to make it more approximate to the constituents of breast milk, was being investigated. By 1893 New York had its first milk pasteurisation depot.
In France the great fear was depopulation; it was noted that the natural population increase (births minus deaths) had declined nearly sixfold during the nineteenth century. Of real concern to the French was Germany, whose natural population increase in the same period was positive. Despite exhortations to 'increase and multiply', the decline continued. Fears that the young French republic would be dwarfed and overwhelmed by Germany stimulated improvements in neo-natal care and education. Healthy, educated children were seen as the future of France.
Infant mortality had therefore come under scrutiny. In Paris, more than a quarter of infants died in their first year. In the last decade of the nineteenth century, over a million infant French lives had been lost. This prompted investigation into infant diseases and care, especially feeding. As early as 1876 investigators had concluded that the major killers gastroenteritis and diarrhoea could be prevented by proper infant care, suitable food and feeding. Pierre Budin, Professor of Obstetrics in Paris, became aware that his women patients were returning 'because the previous infant had died'.2 He embarked on a study of infant health and established France's first infant clinic in 1892. A visiting foreign doctor remarked, 'Your clinic is not very interesting, all the infants are doing very well.'3 Under Budin's care, the infant mortality rate was cut significantly. Records showed that the rate of death per thousand births in Paris averaged 178, while for page 123 infants attending his clinic the rate was reduced to forty-six. This was achieved by many of the principles that Truby King would adopt: home visits, dispensaries for the supply of milk, supervision of infants in foster homes and emphasis on breast-feeding. The work of Budin and others was greatly admired in Britain and Europe, where infant mortality rates were just as worrying as in France. Budin's influential book, The Nursling, published in 1900, became a standard tome on infant care. He died in 1907, just after the English translation of his book was published. In the foreword, Professor Simpson of Edinburgh University noted, 'With a dwindling birth rate, it becomes a matter of urgent necessity to discover and develop means of reducing infant mortality.'4 King had been one of Simpson's better students and, with a good reading knowledge of French, would have been aware of Budin's work.
By contrast, early New Zealand was 'healthier' than Britain, with its favourable climate, lack of real poverty and primary production focus. The birthrate was increasing, and the infant mortality rates were already the lowest in the Western world, half that of England and Wales. Socially, New Zealand was not lagging behind. The Women's Christian Temperance Union was founded in 1885, being instrumental in the Infant Life Protection Act in 1893, the year Truby's father died. The same year another group, the Society for the Protection of Women and Children, was formed and by 1900 had branches in the main cities. In 1904, to popular acclaim, Richard Seddon initiated the Child Life Preservation Memorandum. This resulted in the registration of midwives and the establishment of a training school, a world first. By 1907 the four cities had St Helen's maternity hospitals, with services freely available to all.
The New Zealand of the early twentieth century already had established voluntary women's groups and state maternity hospitals. All it lacked was a source of authoritative advice for mothers. Truby seized the opportunity. Capitalising on the concerns espoused by Stout, he neatly dovetailed the infant mortality issue with his pro-breast-feeding ideas. He was building up a considerable head of steam, and by 1906 was confidently asserting it was every child's page 124 birthright to be breast-fed. He was vociferous in his attacks on the prevalent practice of artificial feeding. Never afraid to pander to nationalistic fears, he would use jingoistic phrases in support of 'the English race'5. Some of his more extreme utterings were taken to be Eugenist in their stance. His supporters Stout and MacGregor were vocal advocates of the Eugenic movement, and King certainly paid more than lip service to it. He cleverly incorporated Eugenic ideas into his crusades, but remained focused on his main theme of a sound mind in a sound body.
By this time, Mary King was 'the most beautiful baby, fat, rosy and strong',6 all apparently due to the power of correct feeding with humanised milk. Truby resolved to take the Mary King experiment out to the people. He had discussed the lofty ideas of reducing New Zealand's infant loss and improving the general health of babies with the medical fraternity. Their lukewarm response did not deter him. His practical response was to carry on the experiment in the village of Seacliff. He reasoned that if a nurse could show families in their own homes how to care for infants, she could communicate to the mothers the principles of proper feeding and care.
After discussion with Miss Beswick, matron of Seacliff Asylum, King chose as his prototype community nurse a 'noble little highlander',7 staff member Miss Joanna MacKinnon. Joanna was not a registered nurse, nor did she have any training in infant care, but doubtless her Scottish origins, her fondness for children and her personality shone through. Paid by and equipped with careful instruction from Truby King she began work in Seacliff village, teaching mothers how to modify cow's milk in their homes. The first baby to receive humanised milk was a boy of three months. He had been fed on a patent food and was 'thin and feeble and suffering from indigestion'.8 Miss MacKinnon showed his mother how to prepare the milk and with this changed diet he was soon strong and healthy. The mothers of the Seacliff village were hardly going to argue with the dictates of their Dr King.
Miss MacKinnon's success in the village encouraged Truby King to extend the experiment. She was boarded in Dunedin with the page 125 Murray family, working under his close supervision. He made sure her work was widely known, and that 'Nurse' MacKinnon would, on request, visit the home to give demonstrations of the method of home modification of milk and advice on infant care.
Before Christmas 1905 Truby King was publishing instructions in the Evening Star on 'The guidance of mothers in the feeding of infants'.9 With the co-operation and support of the press, the message was getting out.
King and Miss MacKinnon were astute enough to enlist pillars of the church in their educational crusade. Sister Alice of the Wesleyan Church and Sister Evelyn of the Presbyterian Church were both trained by Miss MacKinnon in Truby King's methods. Eighteen months later Sister Evelyn established the first Presbyterian orphanage in New Zealand. By April of 1906 Miss MacKinnon had become known as Nurse MacKinnon and had fifty babies under her direct care. King was working on the provision of fresh milk. At the time, milk was poured into 'billies' of dubious hygiene from cans on delivery lorries. Infected milk resulted in gastroenteritis, one of the major causes of infant mortality at the time. Aided by Dr Falconer, he approached the Taieri and Peninsula Dairy Company to see whether they would modify cow's milk for infant use. The company agreed to supply the facilities for refrigeration and bottling and to deliver chilled milk to the mothers if Truby King supplied a nurse and an assistant specially trained in its preparation. The ubiquitous Nurse MacKinnon supervised the scheme, and an assistant was recruited, trained at King's expense and put to work at the dairy company. The venture was a total success.
Next, King addressed the question of sugar content in humanised milk. He contended that lactose (sugar of milk) was superior to cane sugar, being natural and more easily digested, resisting fermentation in infants' stomachs. He was partially correct, in that breast milk has a much higher lactose content than cow's milk, but his accusations against cane sugar were hardly proven. He went further to identify cane sugar as 'the leading cause of indigestion and diarrhoea in infants'.10 Members of the medical profession who did not support page 126 King's extravagant statements were charged with 'overlooking the fundamental principle of biological chemistry'.11 The scorn that King could pour on dissenters was considerable, but his adherents increased, with assistance from the ever supportive press.
King then sought to lower the price of imported lactose. The only source of lactose was chemists who were unwilling to reduce their margins. With the grocers onside, he took the simple, if bold approach of importing a ton of lactose of 'the highest quality procurable'.12 The cost to him was two months' salary, but he shrugged off the risk. The exercise was a success, and in a year lactose consumption in Otago had soared 2000 per cent and through his lobbying the import duty had been removed.
His crusade to lower infant mortality by feeding hygienic humanised milk where mothers could not or chose not to breast-feed was paying off. His profile was increasing, as was that of Nurse MacKinnon and her team. King, who never lost an opportunity to push his latest theory, thundered in his annual report to the Inspector-General of Mental Hospitals in 1906, 'I have devoted much practical attention during the year to questions bearing on prophylaxis in regard to the rising generation.'13 One assumes he was making a connection between the improvement in infant care and the potential decline in numbers of future mental patients? MacGregor continued in his unhesitating support.page 127
2 Pierre Budin, The Nursling, the Feeding and Hygiene of Premature and Full Term Infants (London, 1907), translated by Malone.
5 Lynne Milne, The Plunket Society — an Experiment in Infant Welfare, University of Otago, MA thesis, 1976, p. 34.
6 Ibid., p. 41.
7 Ibid., p. 77.
8 Milne, Tlie Plunket Society — an Experiment in Infant Welfare, p. 41.
9 Ibid., p. 42.
10 Ibid., p. 44.
11 Ibid., p. 45.
12 Truby King, 'Karitane Products', p. 4.
13 Milne, The Plunket Society — an Experiment in Infant Welfare, p. 46.