Child Welfare, childhood, infancy, infant mortality, Kleinian theory, melanie klein in Australia, welfare, women in paediatrics
During the 1920s and 1930s it was the habit of newspaper reporters to meet the ships from England when they reached Australian shores. Briefed, perhaps, upon passengers of interest and status, reporters in each port – Fremantle in Western Australia, Adelaide in South Australia, Melbourne and, finally, Sydney, generally provided a short sketch of these distinguished passengers along with a photograph if space permitted. It was one way for the locals to learn about the goings on abroad. Each passenger, chosen for their achievement in their particular field, was returning with knowledge. Dr Kathleen Costello, a paediatrician specialising in infant development was one of them. In August 1930 she was returning to Australia, accompanied by her parents, after four and a half years pursuing medical studies in London and Europe.
I wonder whether some of these journalists were following a formula, impressing readers with the notion that their subjects had gone through the proper hoops abroad?. Kathleen Costello had gone to the right university and schools in pursuit of her career as a doctor and paediatrician. It seems to have suited the reporters that she followed the path of her male peers.
The West Australian broke the news. Costello was one of a cohort of medical students who studied at Charing Cross Hospital after completing studies at the University of London, it reported on August 19. She appears to have done the rounds of a typical medical student. After a term as house physician at the hospital after finishing her degree – she was the first Australian appointed thus, the reporter noted – she moved on to the Great Ormond Hospital for Sick Children and then accepted a position as house physician at the Infants Hospital at Westminster headed by Eric Pritchard, regarded as a foremost authority on Infant development and care.
It is interesting to read his 1914 book, ‘The Infant: Nutrition and Management,’ a summary of his work towards lowering infant mortality, for the ideas he encouraged in his students. During the first decades of the twentieth century medical practitioners turning their minds to reduce infant mortality included the Australian Helen Mayo. Part of the cause, they said, was lack of education. Other causes – illegitimacy, alcoholism ( babies smothered by mothers too drunk to notice the babe’s presence in the bed) and poverty. Pritchard had much to say on this. He laid out his principles nutrition and feeding, clothing and washing, airing and whether or not to allow a baby to cry.
Listen to Pritchard…
If infants are breastfed the feedings must be given at absolutley regular intervals and at not too short intervals; the infants must not sleep in the same beds as their mothers, and they must be fed not more than once at night, preferably not at all. They must not be wrapped up in too many clothes; they must not have stiff binders which impede movement, and when it is added that they must be regularly bathed, regularly aired and regularly exercised, it may almost be claimed that all the canons of good motherhood have been enumerated.
But then he continues, much to the horror of twentyfirst century people well versed in the psychoanalyst John Bowlby’s Attachment Theory…
Infants do not die because they do not receive enough food; they die because they are fed irregularly or too often, or because they are given too much. They do not die because they are exposed to the cold, they die because they are kept too much indoors with doors and windows closely sealed; they die because the have too many clothes, not because they shiver in rags…
and, most contentiously to us now, Pritchard continued;
they do not die because they are unloved and uncared for, they die because they are rocked and nursed and comforted too much; they die, in fact, for want of the exercise of good mothercraft, and not from poverty and starvation.
Was it such advice as this that prompted notions of the strictly four hourly feed and along with it the phenomenon of New Zealander, Truby King whose advocacy of the strict four hourly feed is a ghost we would like to lay to rest? Or are we seeing the worries of a generation of people who were beginning to realise that the babies who died could have been saved?
Eager to gain experience, at appears, Costello then moved to Europe – to Zurich and then Vienna to spend some time at the Pirquet Clinic – for infants and children.
Baron von Pirquet,born in 1867, is best known for his work in bacteriology, immunology and paediatrics and is remembered for his development of the concept of allergy. His research focussed on children: his clinic in Vienna was the centre of his research and teaching. Students from all over the world sought experience under his aegis including the future psychoanalyst and infant researcher, Margaret Mahler. It was a mixed blessing for this brilliant clinician whose work on psychological development in infancy would become seminal. Her biographer, Alma Halbert Bond, relates that Pirquet’s charm and charisma featured alongside his unwillingness to work with women on an equal basis. His research was scientifically thorough but, to Mahler’s consternation, he saw only the physical side of the infant’s condition. He was unwilling to admit the contribution and the importance of warm, human relationships for infants’ survival, if he noticed these at all.
Bond writes of Mahler’s relief when she began at the Moll Well Baby Clinic after departing from Pirquet’s Clinic in the mid 1920s. Mothers and babies were seen as a unit. They were kept together, even when the baby was sick. If there was no mother available, a ‘mothering person, a consistent caregiver, remained with the infant during her time at the clinic. For Moll, ‘love was the mental vitamin’ the key to survival and for the babies as for all humans the reason to live. A similar observation had been made by social reformer Florence Davenport Hill in England during the 1860s and, in Australia, by social reformer and writer, Catherine Helen Spence and her colleague Vida Goldstein during the course of a Congress of workers amongst state children held in Adelaide in 1909. Love, they said, was crucial, if a child was to do well. Children who were boarded out fared better in life than children who lived in institutions.
Back to Kathleen Costello. When she reached her destination the Sydney Morning Herald reporter asked a few more questions. He, or was it she? reached beyond the expected story and found out that her journey had not been an easy one. She was a woman, and maybe had landed in places, such as Pirquet’s Clinic where they were not welcome as colleagues. Perhaps as a result she was open to the ideas from the new psychology and psychoanalysis. In a piece published on 26 August 1930, Kathleen Costello spoke of the work being undertaken by Melanie Klein who had arrived in London in 1926. The reporter quoted her:
‘Wonderful child psychology works are being done in England. Everyone is particularly interested in the original methods of one doctor, Frau Klein, who works on a system of her own. She lets the children play in a huge play ground in her own house, and watches them at their games, sometimes giving them set games to play. She then treats them according to their behaviour. She has had remarkable results, especially with intractable children. She does not beat about the bush, with parents, either.’
Klein’s work recognised the early experiences of infancy as they negotiated the passage from birth to early childhood. The relationship between mother and infant was critical for the infant’s developing sense of selfhood. It lent support to theorists, such as Mahler, who recognised a link between so called ‘juvenile delinquency’ and problematic maternal-infant relationships.
In contrast with the easy brilliance of her European career implied by earlier newspaper reports, life was tough for women doctors in Europe. Costello said, ‘Women doctors must be prepared to cruise round a good deal, and find things out for themselves. Lecture courses in Vienna took much less time, but were not so thorough as the British… The difficulty in England was to get resident positions….
I do not know what happened to Kathleen Costello other than she set up a practice in Sydney shortly afterwards. Whether she married, changed her name, or remained in the profession I cannot ascertain… but as I pursue the unfolding story of psychoanalysis in Australia her remarks about Melanie Klein are prescient.
Eric Pritchard, ( 1914). The infant. Nutrition and management. Retrieved from: https://archive.org/details/infantnutritionm00pritrich 2 November 2013.
Wagner, Richard. (1964). Clemens von Pirquet, discoverer of the concept of allergy. Bulletin of the New York Academy of Medicine, 40(3), 229-235. Access from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1750523/, 3 November 2013.
The West Australian, 20 August 1930
Do we understand these things better now? I like to think we do. Your paediatrician here and her experience in those not so long ago days reminds me of one Truby King, and his exhortations about rigid feeds. Somehow I can’t help but think the notion of controlled crying for infants under one year of age is similar. There’s something awful about it, something about not wanting to listen to the baby. A terrific post here. Thanks, Christine.
Seems that Truby King was following the tenets of the day – albeit much more flamboyant than Pritchard. Had Kathleen Costello not been a woman, I wonder, Kleinian ideas may have taken hold earlier. Another one of the ‘What-Ifs?’ of history.