In a Strange Garden: The Life and Times of Truby King
Chapter Fourteen: The later years of Plunket
Chapter Fourteen: The later years of Plunket
In 1921 Truby King was appointed Director-General of Child Welfare, and had moved to Wellington. Plunket continued to survive as a voluntary organisation independent of government control, offering mothers free advice. By 1931 the infant death rate, at thirty-two per 1000, was the lowest in the world; there were 129 Plunket nurses, making nearly 200,000 calls to mothers and babies in the home, at the mother's request. Over 623,000 mothers and babies visited the Plunket rooms in that year. New Zealand was an acknowledged leader in infant care. The name of Truby King was still on everyone's lips, despite the fact that he had relinquished the position of Medical Director of Plunket and was approaching the twilight of his life.
In the New Year's Honours of 1925 King was knighted 'for services to the Empire'. The Post Office complained that there had never been page 166 such a rush of letters, telegrams and cables from all round the world. Sir Truby wrote to all Plunket nurses:
Dear Co-Workers, My wife and I wish to convey to you our great appreciation of your kind congratulations. Though the honour comes in name to us, it is the Society as a whole that has won the distinction; and as long as our nurses continue to play their part as devotedly as they have done in the past, the Society will deserve well of the State and the Throne. Our own is not the first title graciously granted to the Society. Recognition of good work faithfully carried out came years ago when the title 'Royal' was conferred by their Majesties on the New Zealand Society for the Health of Women and Children. This ought to act as a perpetual inspiration and incentive to each of us to give our best and to do our best at all times, for the sake of women and children, for the advancement of the Dominion and for the honour of the Empire.'1
Not every aspect of Plunket met with total acceptance. The delightfully forthright Dr G. M. Smith wrote:
The Plunket Society for many years underfed babies. Sir Truby King's work was magnificent, much of the baby technique was splendid, and many infants survived that but for him would have died. For the first time a simple technique of cleanliness in infants' food and general care was energetically taught to the mothers and nurses of New Zealand. That is the reason for the great success. It was not due to their ideas of feeding; that part of it was all wrong, and known to be wrong 30 years ago. (But note a healthy baby is tough. He can usually survive in spite of a healthy diet.)2
Dr Smith railed against Truby King's Plunket dogma and Plunket's independence of the state and the medical profession. Dr Helen Deem had succeeded Dr Tweed just before the war as medical advisor to the Society and acted in a way Truby King would have strongly approved, despite her gender. She was a human dynamo, every bit as committed as the Great Founder. After four years of marriage and one child her husband died. Deem flung herself page 167 wholeheartedly into Plunket and its activities, working seven days a week. Perhaps her most ambitious work was a massive statistical study of nearly 9000 infants from all over New Zealand. They were measured, weighed and had their nutrition recorded. From this emerged growth curves for the first year of a baby's life that were hailed as being the most significant work since Truby King. Helen Deem paid tribute to him thus:
Sir Truby King visualised the ways and means of reducing this young country's infant loss, but his efforts were also directed towards fostering the all-round health of the babies who survived. He was a pioneer in the field of Health Education, believing 'that as far as motherhood and babyhood were concerned there was as much need for practical reform and "going to school" on the part of the cultured and well-to-do as there was on the part of the "so-called poor and ignorant".' To this end he envisaged an Infant Welfare service, and, accordingly, established a Training School for qualified nurses (Plunket Nurses), who would eventually teach 'Health' to mothers in their own homes and at Plunket Rooms. The society was started inter alia as a league for mutual helpfulness; the fact that the great majority of our mothers today seek Plunket advice proves conclusively that the service which was designed to 'Help the Mothers' is fulfilling its objectives.3
After the Second World War the Society had to come to terms with the maternity hospital crisis, with the state system and the six Karitane hospitals unable to cope with the 'baby boom'. Plunket rose to the occasion, helped advise the government, and kept their sanity and independence. By 1947 85 per cent of all babies were seen by one of the 190 Plunket nurses, who made over 220,000 home visits, with more than half a million mother-and-children visits to Plunket rooms. By now there were over 100 Plunket branches, still ruled from Dunedin by the fur-coat brigade.
The post-war challenges of the polio epidemic were met by Plunket, when the Society ensured that the children of New Zealand were immunised. Plunket Mothers' clubs were formed, introducing another layer of women volunteer helpers. Plunket work was seen page 168 as a respectable and respected activity within the community; it provided an opportunity for women to meet away from the traditional environs of church and family, and increased their confidence and self-esteem. Plunket still received 'state assistance without state interference' despite governments of varying persuasions. The Society's iconic status could not be undermined. In the future, the issue of accidents in the home would become a cause that Plunket would take up and work hard to resolve.
Helen Deem retired and in 1956 she was succeeded by Dr Neil Begg, a pediatrician by training and a Truby King admirer. Begg continued the good work in the King mould, albeit with greater conciliation and restraint, but less fire and brimstone. In 1957 the vermilion Truby King stamp was issued. It was the first New Zealand stamp to depict a private citizen. Begg carried on the King tradition in the fight to eradicate hydatids, a child-killer that had its origins on the farm and had been a notifiable disease since 1873. Just as King had conscripted the mothers to take ownership of their children's health, Begg conscripted the farming community to attack hydatids. The Plunket Society and Federated Farmers accepted the challenge of self-help in disease eradication, culminating in dog owners agreeing to an annual levy of £1 per dog towards hydatids eradication. Truby King would have thoroughly approved of this successful campaign.
By the 1960s there were 109 Plunket branches, with 230 Plunket nurses. Breast-feeding was again in decline, from 80 per cent in 1938 down to a more modest 43 per cent, perhaps reflecting the increase in solo mothers, working mothers and differing pressures from a changing society. This was the era of Dr Spock, whose permissiveness contrasted with the Victorian rigidity advocated by Truby King. Modern mothercraft was pushed into the background. Neil Begg in 1970 published The Child and his Family to reflect changing beliefs in child care, and signal a more permissive approach to bringing up infants. Plunket became more liberal, more democratic. With 75 per cent of the branches now in the North Island, the Society could no longer resist the move north. The ladies of the fur-coat brigade in page 169 Dunedin accepted the end of their dominance of Plunket affairs, and the head office moved to Wellington.
The issues concerning Plunket were coming thick and fast. Maori had never been represented in the Plunket movement. The statistics didn't recognise them, nor did the Dunedin ladies. Early King writings had been translated into several languages, but never into Maori until Maui Pomare took action in 1916. The increase in Polynesian mothers in the greater Auckland area became an issue. Also there was the difficult question of battered babies, which led to a focus on child safety in general. The Society's relationship with Maori and Polynesian mothers has never been strong. Plunket would argue that volunteer work was not easily encouraged across racial barriers. The health system provided further impediments, with different treatment of Maori babies. In the last two decades, some improvement has been noted, with Kaiwhina Plunket nurses working on the marae. A recent historical document from Otaki records poignantly the uneasy relationship between Plunket and iwi:
Our mother was one of the first Maori Plunket nurses, having completed her three year general nursing training at Palmerston North hospital, followed by a year of maternity training (in Gisborne during the war) and finally a year in Dunedin completing her Plunket training. When she became a 'patient' at Otaki Maternity, the Plunket nurse arrived to 'do her rounds' but when she and Matron got to Mum's ward they talked to the woman next to Mum, glanced at Mum and commented as they walked past that 'of course you'll have the District nurse'. At that time Plunket was for Pakeha and the District nurse visited Maori families. When we asked our mother why we didn't have the Plunket nurse for our little sisters, she always said we didn't need one as she was our Plunket nurse. When I was admitted to Otaki maternity 30 years later, I opted for the Plunket nurse!'4
By the 1970s the six Karitane hospitals had run their course. Successive annual meetings grappled with the spiralling costs, declining usage, bed occupancy and changing times. Plunket had to recognise that the cost of running such hospitals was too high and page 170 that the service was no longer appropriate. Karitane had become a 'dumping ground' for Social Welfare children. Each hospital was 'owned' by Plunket, with strong local emotions associated with any suggestion of closure. Invercargill threatened court action, capitulating only after a bitter public fight. The five other hospitals (Dunedin, Christchurch, Wanganui, Wellington and Auckland) gave way, amidst protracted and bitter recrimination. In the Melrose mausoleum, Truby would have experienced difficulty in remaining at rest.
Later, Plunket would have to contend with government meddling with the health system. With the advent of Health Boards and with a nervous eye on its funding requirements, Plunket found it necessary to realign its boundaries to suit the sixteen new entities. Then when the Health Boards were scrapped and four regional health areas instituted, Plunket restructured again. Every time a new health reform was announced, Plunket needed to be sure that they were not disadvantaged or marginalised. Lobbying became a necessity, and Plunket were forced to become more politically astute. Unsurprisingly, they found little support from other agencies who were also at the mercy of government health policy like IHC, CCS and Family Planning. A continued strong support for Plunket was demonstrated in 1992 when rallies and marches were held in all main centres, culminating in a petition of over 100,000 signatures to parliament demanding support and adequate funding for Plunket services.
Lynne Giddings in her 1993 assessment of the Plunket Society noted:
The Truby King system, as espoused by the society, emphasised a regular routine of feeding, sleeping and excreting for babies. Weight gain became the measure of success. To many women then and since, this authoritative advice was possibly a relief. Over time, however, the focus on routine became formalised into a rigid set of rules thoroughly taught to Plunket and Karitane nurses in their training, and the nurses became authority figures in their own right.
For the most part, Plunket nurses had to reflect the dominant ideology of the society to gain acceptance with the women on page 171 their branch committee. If a nurse disagreed with the ideology or teaching of the medical director, the women on the committee did at times support the Plunket authorities rather than their local nurse. This rigidity of approach to infant care has received much critical attention in recent years; historians have linked it with paternalistic attitudes prevalent in New Zealand towards women and children.
Since the 1980s, the society has worked to dispel the view that all the Plunket nurses do is 'weigh babies', encouraging nurses to work with mothers in ensuring the care and safety of their babies. Home visits have remained a high priority, and have been a life-saver for many women. The early mothers' groups have been revamped and formalised as the invaluable New Mothers' Support Groups, which began in the 1970s. Since then, too, an increasing number of Plunket nurses have been mothers.
Plunket in the twenty-first century has a thoroughly modern look. Its website proudly boasts its direction: 'To ensure that New Zealand children are among the healthiest in the world' (though statistics would suggest they have been that way since time began). The 'Purpose Statement' says 'Plunket believes in supporting the development of healthy families'. Both statements are accompanied by their Maori translation.6
The document confirms Plunket's accord with the principles of the Treaty of Waitangi and notes proudly that over 90 per cent of all babies born in New Zealand are enrolled with Plunket services. The identified health goals include:
— Reduction in Sudden Infant Death Syndrome (cot death) rates
— Reduction in unintentional injuries to children
— Increase in breast-feeding rates
— Reduction in the incidence of child abuse and neglect
— Increase in immunisation coverage
— Improvement in parenting skills and social support for families
— Reduction in rates of hearing loss in childrenpage 172
— Reduction in the incidence of asthma in children
— Promotion of child and family nutrition.
Plunket views itself as 'a community-based organisation which employs qualified staff working in partnership with a team of volunteers. Plunket services are partially funded by the government. The remaining costs are covered by volunteer fundraising, enabling Plunket to offer a range of programmes and facilities in local communities.'
An informed source who wished to remain anonymous observed that it was fascinating how little Plunket had changed since its inception. The volunteers were still white, middle-class women who retained authority over the professional nursing staff, via their fundraising. 'We own the clinics, the cars, pens & pencils' remains the attitude of the ruling class of Plunket.
How Truby King would view the Plunket of today is uncertain. He might find the jargon as perplexing as we find his Victorian terminology. He might disapprove of the more modern, relaxed and consultative Plunket nurses, who had lost the 'battleaxe' authoritarian demeanour of his day. Or he might feel that Plunket has been extremely successful in implementing his 'community care' strategies, having adapted to changing times without giving away its precious independence. He would see how little has changed from his initial prescription and might well be proud of the Plunket of the new millennium.page 173
1 Truby King, Plunket archives, Hocken Library.
2 G. M. Smith, More Notes from a Backblocks Hospital (Caxton, 1941).
3 Helen Deem, Plunket records, Hocken Library.
4 Rachael Selby, Reflections: Otaki Women Looking Back in 2000, Otaki Women's Health Group, 2001, p. 1.
6 King, Truby King — The Man, p. 300.