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Inequalities of gender and health 1857-1985: a
long-run perspective from the Melbourne Lying-In Hospital birth
cohort.
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| Abstract: |
This paper reviews the Australian historical record in health and
gender inequalities since the mid nineteenth century through to the end
of the twentieth century, using survival data from an historical cohort
of impoverished people born in the Melbourne Lying-In Hospital between
1857 and 1900. This data reveals the long shadow cast by disadvantage in
early life and the critical importance of secure households in
supporting infancy and childhood. Above all, the income security and
support of mothers, was critical to survival of infants and children,
and those households trapped in the casual economy, remained the most
vulnerable to premature death. Only the improvements in labour force
regulation, government employment and trade education after World War
II, broke the cycle of poverty that had persisted in Australia since the
earliest clays of European settlement. Keywords: socio-economic determinants of health, historical cohorts, gender |
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| Subject: |
Hospitals, Gynecologic and obstetric
(Case studies) Gender equality (Social aspects) Women (Civil rights) Women (Health aspects) Medical care (Australia) Medical care (Social aspects) |
| Authors: |
McCalman, Janet Morley, Ruth |
| Pub Date: | 09/22/2008 |
| Publication: | Name: Australian Journal of Social Issues Publisher: Australian Council of Social Service Audience: Academic Format: Magazine/Journal Subject: Sociology and social work Copyright: COPYRIGHT 2008 Australian Council of Social Service ISSN: 0157-6321 |
| Issue: | Date: Autumn, 2008 Source Volume: 43 Source Issue: 1 |
| Topic: | Event Code: 290 Public affairs Canadian Subject Form: Medical care (Private); Medical care (Private) |
| Product: | Product Code: 8000001 Medical & Health Services; 9105210 Health Care Services NAICS Code: 62 Health Care and Social Assistance; 92312 Administration of Public Health Programs SIC Code: 8000 HEALTH SERVICES |
| Geographic: | Geographic Scope: Australia Geographic Code: 8AUST Australia |
| Accession Number: | 178347941 |
| Full Text: |
Introduction 'Gender' and 'inequality' are both experienced as relationships. They are historical, shaped by time and place, and persisting in memory and institutions across generations. They are embodied relationships that can be measured in morbidity and mortality. Finally, they are tested in the most fundamental task of all creatures: the reproduction of a viable new generation that, in its turn, is able to reproduce itself. Family formation is a critical measure of a society's health and prosperity at a population level. It involves far more than biological fertility. It requires the establishment of a sustainable household economy that can provide the shelter, food and training that children need to develop so that they in their turn, can reproduce a viable new generation (Krieger et al. 2004). It does not matter how those households are composed: there are many different forms of family structure that have worked in the past and which work well now (Laslett 1965, 1971 and 1983; Gillis 1997). The critical question is whether they can nurture a new generation; and that in turn depends very much on the economy and social ecology in which they are embedded. The western family has been distinctive for more than a thousand years for its strategies of late marriage and deliberate celibacy to control fertility in times of economic hardship (Hartman 2004). European societies have always had large numbers of men and women who never married, and the church did much to provide alternative support for those without families, and it built its wealth on the legacies of those without heirs (Goody 1983). In the twentieth century, the welfare state in its various forms has essentially provided a structure so that people can survive without a family. Historians of public health, like Dorothy Porter, argue that public health and medicine have been the most significant drivers of the growing power and reach of the state in public and private life (Porter 1999). And it is in the context of the history of social interventions and entitlements that we need a tong-run perspective on gender and inequalities in health in contemporary Australia. By the early twentieth century Australia and New Zealand had come to be seen as social laboratories where a new form of democratic, protectionist, welfare society was under trial. The four main areas of experimentation were the manhood suffrage and 'Australian' or secret ballot; the regulation of work time in the eight-hour day; a strong trade union movement with government arbitration of wage and workplace disputes; and finally the role of the state as a provider of employment and welfare (Denoon 2000). In the same year as the eight-hour day victory, 1856, the Melbourne Lying-In Hospital was opened as a charity institution for women and their children. The babies born in the hospital over the next four decades entered the world as the most disadvantaged of all white colonists: their mothers were all poor at the time of their impending confinement; around half of them were unmarried; many were destitute, abandoned by family and friends, some were even prostitutes and thieves (McCalman 1999). It was for children such as these that the social laboratory was most needed, and the outcome of those lives which covered a period from 1857 to 1985--from the real beginning of Melbourne as a great city to the present day--can be seen as a natural experiment to test the institutions, policies and performance of the Australasian social laboratory. Settler colonies were not only sites of dispossession and destruction, they were also severe testing grounds for those who took possession and transplanted their culture and institutions. The public success of that transplantation in turn depended upon the private success of many thousands of individuals in making a life in a new place. This amounted to far more than securing a stake in the land through the acquisition of property or an entitlement through work. It depended for everyone, at all levels of society, on building new networks of social credit and capital--and that depended on their social as well as their work skills, their charm, plausibility and strength of character. The most fortunate arrived with financial capital to invest, certificated qualifications and letters of introduction. Their social capital was portable. But those who arrived quite unknown to anyone, or with their reputation in tatters, had to set about building the daily connections with strangers that made survival possible. This is one reason for the high casualty rate of immigrant Irish: they were most inclined to emigrate as young single adults whereas Scots and English assisted immigrants were more likely to set out as married couples or with siblings: 'I never seen a man I'd ever seen before' one successful Irish immigrant who had come at seventeen would later tell his children (McCalman 1993; McClaughlin 1998). The historical narrative for the next generation is dominated by those who succeeded in founding enduring households, who began to establish a stake in the country: farm land, a plot, a house, a connection to a community, an entitlement of some sort. And that achievement, for most, was measured in their leaving descendants who in turn were able to establish viable households and reproduce a next generation. These are the biological winners whose history we most often record. Therefore the most successful of all new settlers, as historians of the family like Pat Grimshaw, Charles Fahey and Jane Beer, have shown, were those who not only found a way to make a living, but also produced large families that survived infancy and in turn married into neighbouring large families (Beer 1989; Harper 2003). Even so, in the second and third generations, despite more equal numbers of the sexes, a significant proportion of men and women finished their lives disconnected from a household. There remained a 'marriage problem' for both the respectable and the poor, and one of the key themes of Graeme Davison's Rise and Fall of Marvellous Melbourne was the anxiety of the pioneer generation over the future prospects--and character--of the second generation: 'what is to become of our sons (and by implication, daughters)?' (Davison 1978). The peculiar demographics of an instant society, dominated by the immigration of young men and women, meant that various 'marriage kinks' limited the pool of eligible males for the first-born daughters: notably for the early-marrying poor in the 1870s and the later-marrying respectable in the 1880s (Larson 1994). We know that fully a third of the women who reached marriage age in the 1890s depression remained childless, as though Antipodean Europeans returned to traditional methods of managing fertility in times of economic hardship by high rates of celibacy and delayed marriage. Just as significant were the numbers of men--both manual workers and black-coated employees--who failed to find a wife and establish a household, largely because they failed to secure a place in the economy at the right time. Graeme Davison, and later Ann Larson, discovered that the second colonial generation were poorly served not just by the schools, but more importantly, by the immaturity of the apprenticeship system (Davison 1978; Larson 1994). The children of the gold rush generation often found themselves being taken from diggings to diggings, before the family gave up and settled in Melbourne by the late 1860s and 1870s. New connections had to be forged with each change of community, and the networks of association that underwrote trade apprenticeships took time to rebuild in a new society. Opportunities for learning complex skills were few and many emerged into adulthood with trades that were half-learnt. As poor families struggled to survive, often with a sick, absent or drunken male head, children had to enter the workforce as soon as possible, foregoing formal training. The young working class that faced the 1890s depression was distinctive for its high proportion of unskilled males (Lee 1986; Fahey 1993). Unskilled girls could get work in the growing factories--diluted task-work in footwear and clothing, and seasonal work in food processing; but unskilled males had to rely on building and construction, seasonal rural work and the docks. Unskilled factory work for males was typically seasonal also, as it was for girls--even in the 1920s many shoe factories operated only part of the year. The aim of the ambitious was to become a trusted permanent 'job-for-life' worker--which meant 'changing sides' in loyalties in the local community and holding yourself and your family apart. The unskilled male workers, once their physical strength waned and if they were unfortunate and the 'grog got to them', risked becoming progressively unemployable--too slow, too weak, too befuddled to learn new things and stick to the rules. When the economy began to recover in 1938, there was suddenly a labour shortage--not of workers, but of skilled workers. The war economy, which had to be less selective, found work for most, even offered accelerated on-the-job training. And after the war, those too young for the pension found secure work in government and local government services. Thus did the 'underclass' suddenly disappear--or rather the unskilled finally become incorporated into the 'Australian settlement' by the 1950s (McCalman 1984; Fahey 2002). It is within these historical parameters--opportunities and constraints--that each new generation had to find its way. How did those on the bottom rung fare? Our natural experiment Our research inquiry is around 'gender and inequalities' and the embodiment of historical experience. Our base data is the survivorship of infants, children, young adults and mature adults who were born in the Melbourne Lying-In Hospital (now the Royal Women's Hospital) between 1857 and 1900 and who died before 1986. The full details of this research project have been described and reported elsewhere (Morley et al. 2006), but for the purposes of this discussion, a brief account is needed of the methods and limitations. Personal data were recorded from birth registers still kept at the hospital. We searched contemporary birth and death certificates using the CD-ROM indices published by the Victorian Department of Justice. (Births cannot be searched in the public arena beyond 1900, nor deaths beyond 1985.) No death was accepted as 'found' unless it could be corroborated by additional historical information: parents' names, marriage certificates etc. Genealogies were constructed to reconstitute family structures, determine family patterns of life span and especially of infant mortality. Further historical records fleshed out the biographies of mothers and babies in the dataset: social welfare records, criminal records, armed services records. Those we failed to find may have migrated out of Victoria, had plain common names like William Smith or Ellen Ryan, had their name changed after adoption or fostering and lost knowledge of their birth mother, adopted an alias, or had their deaths concealed. In the first decades of vital registration, many were able to evade the authorities and while births were registered by the hospital administrative staff, an infant's death could well not be registered by its parents or carers. The problem was made especially difficult by the fact that almost half the mothers admitted to the labour wards were unmarried and not a few gave false names to the hospital. However, those we had failed to find most closely resembled, in social and biological characteristics, those who died in infancy. This Melbourne dataset is, to date, the oldest in the world with detailed data on birth weight and obstetric complications that have been linked to death data for the study of any associations between characteristics at birth and life span, in particular in relation to coronary heart disease (Barker 2006). An overview of their life courses 1857-1985 Our findings were surprising. From 16,272 registered births in the hospital between 1857 and 1900, we have traced 8584 (53%) death certificates. These comprised 4296 (50%) infant deaths under 12 months of age, 941 (11%) who died between the ages of one and sixteen years, 3347 (39%) men and women who lived until at least 16 years of age, of whom 2938 (31%) survived beyond age 40 years. Babies and mothers Infant mortality was exceptionally high both by international standards and compared with infant mortality in Melbourne and suburbs, and only began to fall after 1887. [FIGURE 1 OMITTED] The infant mortality for babies born in the Lying-In Hospital 1886-90 was 59% (figure 1) whereas in the City of Melbourne, the most densely populated community in the colony, the infant mortality for those not born in institutions in 1886 was 18.5%, while the metropolitan rate including all births and deaths was 17.8%. In salubrious suburban Kew, it was 7.19%: that is the babies born in the hospital in 1886 were three times more likely to die than those born in neighbouring streets in Carlton and 8 times more likely to die than those born in middle-class Kew (Jamieson 1887). Why did they die in such horrific numbers? First, they were born in a dirty hospital and after antiseptic midwifery was introduced with the opening of a new maternity wing in 1887, the mortality of mothers and neonates started to fall. But the most important reason why so many babies died is because they were born to what we are calling 'unsupported women'--those who did not have reliable husbands earning the regular wages to provide a dry, warm home, an adequate income and good food so that these mothers could rest, eat well, keep clean and above all, patiently breast feed their babies for at least nine months. It was, in institutional terms, a failure of households--human reproductive units without adequate shelter, food and security to support infant life. Socio-economic status at birth was initially coded into 7 groups, on the basis of three items: mother's marital status, whether the father was named on the birth certificate and recorded paternal occupation. (These were all measures of household viability and security.) The seven groups were: a) unmarried mother (including a handful who were divorced or widowed), father unnamed (n=3179); b) unmarried mother, father named (n=771); c) married mother, father's occupation not stated (n=470); d) married mother, father's occupation unskilled (n=1768); e) married mother, father's occupation semi-skilled (n=577); f) married mother, father's occupation skilled manual (n=1568); g) married mother, father's occupation non-manual, or professional/managerial (n=253). Because some groups were small we subsequently collapsed these into three groups: 1. Unsupported mother (combining groups a and b) 2. Married mother, father's occupation not stated, unskilled or semi-skilled (combining groups c, d and e) 3. Married mother, father's occupation skilled manual or non-manual, or professional/ managerial (combining groups f and g) Those who survived infancy to reach age 40 were heavier at birth than those who did not (mean birth weight 3.5 kg versus 3.2 kg, figure 2) and more likely to have married mothers (figure 3) who had already borne a child (figure 4). Merely 13% of the babies weighing under 1.5kg lived until the age of 40 years, whereas 40% of those weighing 3kg or more lived to this age. Birth weight was an indicator of a person's likelihood of leaving descendants and birth weight was in turn an indicator of the age, martial status and maturity of their mother. There was a fatal reciprocity between failure of a household at birth and prospects of reproducing a next generation. The second half of the nineteenth century was an unstable, tumultuous period in Australian history. We were interested to see if there were differences in life expectancy and socio-economic outcomes for cohorts born in different economic, social and demographic conditions: some experienced more hardship in childhood, others in adolescence, as the colonial economy went from gold rush, to depression, to boom and bust in just five decades. Therefore we divided the babies into four historical cohorts: 1. 1857-1870, or Pioneers' Children, born to largely overseas-born mothers during the final phase of the alluvial gold rush; 2. 1871-1880, or Builders' Children, born to a mixed group of mothers, increasingly colonial-born, during the dislocations after the end of alluvial mining and the building of Melbourne and its urban infrastructure; 3. 1881-1890, or Boomers' Children, born predominantly locally-born mothers during the building boom years of 'Marvellous Melbourne'; and 4. 1891-1900, or Bust Generation, second-generation colonials born during the severe depression and drought of the 1890s, with some surviving into the late twentieth century. [FIGURE 2 OMITTED] Despite this range of historical experience, the only significant change was in the improved survivorship of infants from 1887: there were no discernible gains in adult life span, despite the radical changes in standards of living and biomedicine in the twentieth century. The nineteenth past continued to cast a long shadow on the life expectancy of these Australians born into poverty. [FIGURE 3 OMITTED] As we have discussed elsewhere, this sudden fall in infant mortality was largely confined to a discrete number of babies whose unsupported mothers had to place them in the care of others to be artificially fed. A combination of medical and police intervention, using coercive powers under the Infant Life Protection Act, had a dramatic effect on the survival of babies in the care of nurses or relatives (Anon. 1895). This fall in mortality in the 1890s was not matched in the wider community until after 1900 (Mein Smith 1997). Young people and capacity building Ages 16 to 40 were critical as capacity building years in which the survivor of infancy and childhood needed to establish work and emotional capacities that would sustain life and support a new generation. These were also the years of greatest risk for the most disadvantaged who had managed to survive beyond childhood. The most common personal disaster in childhood and early adolescence was the desertion or death of a father--an economic and emotional catastrophe that could plunge a family into poverty for two generations. It usually meant an early entry into the workforce, which precluded the acquisition of skills through extended schooling and apprenticeship. Girls faced the risk of teenage pregnancy, sickness (especially tuberculosis), truncated schooling, delinquency, unemployment, extra-marital pregnancy--all could quickly set a life-long pattern of extreme poverty and marginalisation. Therefore survivorship--or risk of death--after the age of 16 years, irrespective of the cause of death--is the starting point for the measurement of an individual's 'risk profile'. Gender differences in lifespan were only apparent after the age of 16 years: young women did worse than young men before the age of 40 years, but better thereafter. In fact women who survived to 40 years did not start to have a longer life span than men until the cohort born in the 1880s--a cohort who had significantly smaller families than those born 1857-1870 and 1871-80. The 1880s and 1890s cohorts were also those who became long-time cigarette smokers, as well as being adolescents or children during the terrible 1890s. (Everyone in the cohort who died before the age of 45, missed the antibiotic revolution, in particular of streptomycin for tuberculosis.) None the less, these gender differences in survivorship were subtle, and may also have been artefactual in that it was slightly more difficult to trace women's death certificates because of name changes (figure 6). [FIGURE 6 OMITTED] Gender differences become more complex when we drill down into the data with the assistance of historical context. If we extrapolate from the occupation of fathers as recorded at birth on the birth certificate and in the hospital's ledgers, their probable security of income over the next ten to fifteen years, we can get some insight into the effects of regular and irregular household income and all the material, social and emotional effects that were likely to flow from that. These are not strong data, being based on historical guesswork, but they are suggestive. If we take premature death between the ages of 16 and 40 years as a marker of more severe socio-economic and health disadvantage, then childhood security had different effects on young girls and young boys. In rough, insecure households where alcohol abuse and domestic violence were more prevalent as responses to stress and repeated insults, girls did very poorly. They were less able to escape from the home and closer to the sufferings of their mothers. Girls gained even more than boys from having fathers in white-collar or skilled jobs; boys growing up on farms, orchards and market gardens did wonderfully well; their sisters less so, perhaps burdened with more housework, early morning milking and farm work (figure 7). [FIGURE 7 OMITTED] Life after 40 If we look at the data at the other end of the life-cycle, death after the age of 40, there was the expected sharp social gradient in adult survivorship, as measured by 'social location at death'. Assessments of relative social status were made on a street-by-street basis according to the socio-economic standing of that street, property values and average rents at the time of the individual's death. This required the application of detailed knowledge of local histories over time. The streets were broken into similar differentials to those used by Charles Booth in the poverty map of London in 1896 and readapted for London in 1991 (Dorling 2000), because Booth and his researchers were keenly aware of the differences between the 'rough' or 'casual poor' and the 'respectable' or 'regular earners'. The eight categories of social location at death for adults were casual (destitute or very poor); regular and semi-skilled (moderately poor); skilled manual: mixed area; comfortable (well-off): rural/regional and asylum or charitable care. The most interesting gap in survival was between the casual/very poor in a suburb like North Melbourne, and the regularly employed poor in Northcote. Irregular earnings gleaned from casual employment--on the wharves, in building and construction, seasonal process work, seasonal rural work in harvesting, ploughing, fruit-picking, droving, timber-cutting--all disrupted income and family life. Men were often away for long periods; income was erratic so that debts to landlords and local shops mounted; 'midnight flits' were necessary and frequent and only the cheapest, nastiest housing was available to such 'bad payers' and 'high risk tenants'. Children had to change schools and a third or more of the children in a school like Errol Street Primary School in North Melbourne were such transients in the 1890s, when compulsory primary education had been in operation for two decades (and when our 1880s-1890s cohorts were in school) truancy was still catastrophic in working-class suburbs. Much of that truancy was driven by working-class children's need to supplement erratic family incomes in time of crisis. But the unskilled labourer who managed to become a permanent worker on the Victorian Railways transformed his family life. He was paid all year round, he was paid even when wet weather closed down outside jobs, he had a union that could protect him more effectively, he could afford a better house because he could guarantee regular rental payments, he could actually imagine the future. People who died still living in the cheapest, nastiest housing were people who had amassed no personal equity that had endured to the end of life (McCalman 1984). The only entitlements they could call on were the Old Age pension and charity hospital care-that is until the 1950s, when there might be public housing. The proportion of our cohort who benefited from the Victorian Housing Commission is astounding. Those who missed the entitlement bus paid with their lives (figure 8). [FIGURE 8 OMITTED] Also significant was the relatively poor survival of rural dwellers, most of them people without farm land, whose life spans were about the same as inmates of asylums for the mentally ill and the disabled--confined individuals who were at severe risk of tuberculosis in addition to their existing problems. 'Social parenthood', households and living longer Victorian death certificates are remarkable for the demographic detail that has been required since Vital Registration began in 1855. The witness to the death has always had to supply details of the deceased's parents, mothers' maiden name and the parents' occupations and places of birth; then the deceased's own record of family formation: marriages, divorces, deaths of spouses, children with ages, still living or deceased. This severely tests the memories and attentiveness to detail of family members and friends, so that the quality of that information on the death certificate is an indicator of the quality of the deceased's relationships with kith and kin. Mistakes and silences are as important as the details provided, so we could call the record of family formation on the death certificate 'social parenthood'. Accordingly another indicator of adult life span was whether people had descendants recorded on their death certificates or not: differentiating between those who died 'without friends' and those who managed to reproduce themselves and stay in touch with their family. Those with recorded families lived longer than those apparently without families, and for men, those recorded as having four or more children, had the longest lives (figure 9). [FIGURE 9 OMITTED] Some of the men in our cohort who died apparently without friends and descendants had fathered children but where estranged from their families, and many who died young were chronic invalids--consumptives, psychiatrically ill, disabled. Others died violent or accidental deaths, or took their own lives. There is a complex relationship between fertility and life-span suggested by these historical data: the ability to support a household so that it remains connected to you might depend on both pre-existing physical strength and psychological resilience as well as on the slings and arrows of outrageous fortune. In a world of work that required physical strength and stamina--a strong back for instance--taller, physically stronger men may well have started with a biological advantage that is manifest also in their record of parenthood. It might also suggest that psychological resilience that would protect against depression and/or alcoholism might also be manifest in successful household formation. Women's survival curves were a little different. First, those who never married or left acknowledged children had the shortest lifespan, and with female wages generally being at best 60% of the male wages before the 1970s, the plight of self-supporting working-class women was truly awful. For a number we traced illegitimate children in their adolescence or later, and those babies had generally died or been adopted. Single motherhood, possibly a time in prostitution, sometimes made later marriage difficult or doomed women to a poor choice of potential spouses. A small number were from criminal families or were children of prostitutes and had been rescued by welfare authorities. Few were recorded as having had a family; a number died themselves as alcoholics. Other single women survived because they inherited some family property and that was the best guarantee of a longer life; single women who came to the notice of the Charity Organization Society were destitute in mid-life and old age. Tuberculosis, as expected, was the most common killer of young women and their prolonged invalidism generally precluded marriage and childbearing. And there is some evidence in the biographies in the dataset, that women who developed tuberculosis in the twentieth century, after its infectiousness was understood, were less inclined to marry than their fellow sufferers in the nineteenth century (figure 10). [FIGURE 10 OMITTED] At least until their late fifties, women who had more than four children were the least likely to die, but very large families combined with poverty took a toll after the menopause. A recent systematic review of international literature reveals that in the past high fertility was positively associated with lifespan, but less so today. Nulliparity remains associated with shorter lifespan (Hurt 2006). When we look in detail at what these two measures--social location and recorded household formation at death--actually meant over historical time, what we see is a reciprocity between gender and inequalities: the extent to which the health of women and children depended on the capacity of their husbands and fathers. Women could only escape this reciprocity if they produced a new generation of reliable earning men to support them--good sons. Since the 1970s, that reciprocity has been interrupted by the single mother's supporting benefit, more equal pay and the vast increase in female participation in the workforce. Microhistories The dataset we have constructed from the birth ledgers and vital registration records has been expanded with the addition of historical material from other sources: industrial school records for children taken into care; military records for men who enlisted in both world wars; criminal records; inquests and social work case records from the Charity Organization Society (COS) and its successors. This means that we can amplify and illustrate with microhistories groups of people from our database. These records, however, are themselves just momentary sightings, made often at the worst moments in an individual's life. Some of the COS records, however, report visits by social workers over a number of years, even decades, and with reconstruction of genealogies, it is possible to put real human flesh on these statistical bones. Flora Scott was born in the Women's Hospital in 1893, at the worst time of the 1890s depression. Her mother before her had been born in the hospital, and now at 25 Flora was having her third child to Tom Scott, an impoverished dealer and hawker. By the time Flora was ten years old, her father had disappeared and her mother was listed as a costermonger in South Melbourne. At just sixteen, Flora fell pregnant to Leslie Hamilton, aged eighteen, whose mother had died when he was four. In 1927, the COS visited her and found the family living in squalor in Rodney Place, a narrow lane off Pelham Street in Carlton. Local traders were remarkably generous towards very poor people under investigation by the COS, but in this case there was no sympathy for the Hamiltons: the man, he said, did light carting and thieving; the children were also thieves; and Flora he described as a 'dirty, filthy woman'. But she was a battler. Now aged 32, she claimed to have worked in vaudeville, and sang at race meetings until the police moved her on. She told the social investigator that she went by another name and 'always wore goggles and kept her head well down so that people could not see her at the races'--but she had made a pound the previous week. The 'woman's neck was dirty' but the little girl was clean. A year later, three days before Christmas, she sought help again: she was again pregnant and no longer allowed to sing at the races: 'She is very dirty in appearance, but looks very miserable and would be grateful for assistance over the holidays'. Exactly two months later, she died suddenly from a cerebral haemorrhage. Her baby died with her. Ruth Morley, believes that a cerebral accident like that in a young woman raises suspicions of domestic violence. And how did her family fare? The little girl was adopted, one son was put in a reformatory in the country, the oldest had a criminal record. Her husband and another son, aged 16, were both knocked down and killed by motor cars in separate accidents. None of the other four sons lived past 62 and one died of cirrhosis of the liver. They married but left small families and at least one died estranged from his family. Emotional deprivation and extreme poverty, even when people tried to form families, compromised the survival of the next generation. Married women who died prematurely in this cohort were quite often victimised, bullied and beaten; women who were more autonomous were also stronger physical survivors. Again current research is revealing that domestic violence affects women's health in all ways, not just psychologically. The COS investigators had a keen nose for bullying men: one they suspected was Charles Nugent who they noted was of 'fine physique--almost plausible, very practised at seeking help. He looks well-nourished and healthy; Mrs Nugent looks very worried and ill'. Their oldest daughter was to die from a septic abortion; a son was to drown at 22 in an irrigation channel near Shepparton; two children were put into care in an orphanage and Mrs Nugent died too early at 48 from a haemorrhaging duodenal ulcer. Her robust husband lived until 83, but his death certificate mentioned only five of his nine children--including only 4 of those still living. Another loyal Women's Hospital family gave birth in the hospital over two generations. Gladys Williams' story began with her mother coming to Melbourne as a young, single woman from NSW. She was probably illiterate as she spelt her name many ways. She had a premature illegitimate son when she was just 19 who died at 17 days; another son two years later who cannot be traced. At 27 and pregnant again, she married an unskilled man who worked sometimes as a furniture removalist for his brother, a carrier. This baby, Gladys, was a strong 8 lbs. The next two boys died, one as a baby, the other at 3 years of age. Their last son survived, never married, and served in World War II in the home defences. He died at just 51 years. When Gladys was 14 and her brother just 5, their father died. By the time she was seventeen, Gladys was pregnant and married in haste to a man who liked to work up bush 'on the timber'. In 1925 the COS was called in. She was now 26 years old. Fred had been out of work for five months, their rent in David St, Carlton was 16/- a week: 'Seemed a decent woman', noted the social worker, 'and has had a lot of trouble. Has had seven children and lost three of them, the last a baby of 3 months quite recently'. They were behind in their rent and Melbourne Ladies' Benevolent Society had given her 8/- for groceries and 2/- for meat the week before'. The COS agreed to help with the rent. Between 1925 and 1938, the COS intervened 6 times. The family were at a different address each time. New babies kept appearing, despite Fred running off with another woman for a time. He had a steady job at Angliss meatworks for seven years but once he ran off, the maintenance became erratic. There were 13 babies in the end, with 5 dying in infancy or early childhood. By the age of 37 Gladys had lost her hearing and the social worker expressed the unprofessional opinion that 'she is not a prepossessing type and was rather sulky'. One of the daughters took on most of the housework, especially since her mother had another baby at 40, and the social workers were concerned that this child was 'underdeveloped mentally and physically--very stooped'. The second youngest had just had infantile paralysis. However the two oldest children were now working, albeit seasonally, in the hosiery factory, and contributing along with their father who lived away. The son married, served in the AMF for 4 years, and when she finally died--from congestive cardiac failure and bronchopneumonia--she was resident in the Greenvale Aged Care Village. Concluding observations: the results of the social laboratory This story had a happy ending because World War II was the circuit breaker. It enabled men to reinvent themselves, to create a new work history and reputation (or 'character'). It rewarded them with entitlements to retraining and cheap home loans after the war. The post-war economy offered the growth to create new long-term jobs, especially in manufacturing industry and government services. The unions, in a time of labour shortage, had the bargaining power to bring a measure of regularity and security to casualised work on the docks and in building and construction. The Housing Commission began building whole new communities in Melbourne and in regional centres; the state government suddenly had to build over 80 new secondary high schools just in metropolitan Melbourne. Clever kids could attend university as salaried student teachers or on a means tested Commonwealth Scholarship (Bolton 1996). The 'underclass' suddenly began to disappear. John Welshman has just published a new book on the discourse around the 'underclass' in Britain from the mid-nineteenth century to the present day. Gladys and her family would have been written off in the Victorian era as 'the residuum' in the mid century; moralised as 'urban degenerates' by the late 1880s; then 'biologised' into congenital degenerates by the eugenicists of the 1920s and 1930s; medicalised as 'problem families' in the 1950s and mechanised as 'dysfunctional families' in the 1980s. But as Welshman reminds us, they have been prone to disappear in times of full employment and strong government investment in human capital building (Welshman 2006). The essential point to be made is that gender and inequalities in the past were meshed with the male obligation to be a good provider for a reproductive household, which is why the stories of failed men are part of the story. And when it was difficult or impossible to be a good provider, the flow-on effects for women and children were severe and long-term. Their burden and their failure was a matter of life and death, and our escape from that cycle of insecurity, cumulative insults and intergenerational damage, came only with the provision of security of income, decency in the workplace and the social entitlements to support life. The current workplace deregulation is a profoundly regressive step. The social laboratory that so interested observers in the late nineteenth century took another half century, and two world wars separated by a global economic collapse, to extend the entitlements to the very poor that could enable them to sustain their families in health and wellbeing. But the nation's peculiar sense of duty to returned servicemen arguably played a more significant role in providing the poor with a second start and a secondary welfare state long before those supports were extended to all. This perhaps was the truly significant legacy of Anzac (Garton 1996), and even this was denied at the time to Indigenous returned servicmen. Acknowledgements We wish to thank Dr Gita Mishra, University College London; Dr Cecile Trioli, Dr Joanne Townsend, Jane Beer and Professor John Carlin. References Anon. (1895) 'Infant Life Protection Act', Australian Medical Journal, 20 (Nov), 512-514. Barker, D.J.P. 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