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Posts tagged ‘infant welfare movement’

The Story of the Teeth

I was born with comically bad teeth. I have only one wisdom tooth – welded firmly to my jaw – and had multiple permanent teeth for some of my milk teeth, and none for others. (I still have two milk teeth.) That I don’t look like a caricature of a Blackadder-ish wisewoman is down entirely to my parents’ swift removal of me to a brilliant orthodontist who – with the aid of braces, plates, and two operations – gave me a decent set of teeth.

I spent rather a lot of my childhood and adolescence in pain, as my teeth and jaw were cajoled and wired into place. (I must add, though, that my parents provided me with an endless supply of sympathy, and soft, delicious things to eat, as well as plenty to read.) It was partly for this reason that I never understood the outrage that greeted the news of Martin Amis’s decision to spend around £20,000 in fixing his teeth, ending decades of persistent toothache.

Of course, much of the anger about this amount was linked to his lucrative move, in 1995, from the late Pat Kavanagh, the literary agent who helped him to build his career, to Andrew Wylie, causing an acrimonious rift with Julian Barnes, Kavanagh’s husband. Indeed, AS Byatt later apologised to him for having criticised both his dental work and his acceptance of an extraordinarily high advance negotiated by Wylie, explaining that she had had toothache at the time.

In his memoir, Experience (2000), Amis writes evocatively of the hell of toothache: that it seems to be the only manifestation of dull pain which can’t be blocked out or ignored. It demands attention. (Apparently James Joyce and Vladimir Nabokov were fellow martyrs to tooth pain. There is, clearly, a link between toothache and stylistic experimentation.)

It’s no wonder that modern dentistry is usually cited as one of the best reasons against time travel. The dentist Horace Wells (1815-1848) originated the use of nitrous oxide (laughing gas) as an anaesthetic during dental surgery. Wells died – partly as a result of an addiction of chloroform, ironically – before nitrous oxide became the anaesthetic of choice, rather than ether for example, among dentists. In South Africa, I’ve found evidence to suggest that it was possible to have teeth extracted under anaesthetic from around the 1880s – although it’s likely that this was available to wealthier patients before then.

In fact, the state of one’s teeth has been a potent indicator of class difference since at least the nineteenth century. Access to dentists and technology – powders, pastes – to prevent tooth decay meant that the middle and upper classes had better teeth than those who were poor, whose diets tended to feature substantial amounts of tooth-eroding sugar, and whose visits to dentists – who had usually had little or no training – were done only in case of dire emergency.

In the pub conversation described in TS Eliot’s The Waste Land (1922), the speaker refers to a friend, Lil, who worries that her recently demobbed husband will leave her, partly because she had aged so much during the recent Great War:

Now Albert’s coming back, make yourself a bit smart.
He’ll want to know what you done with that money he gave you
To get yourself some teeth. He did, I was there.
You have them all out, Lil, and get a nice set

As false teeth became cheaper and more widely available, it seemed to make better sense to have all one’s teeth out at once, rather than suffer a lifetime’s worth of dental pain.

We attach a wide range of meanings to teeth: from the elongated incisors of vampires, to the whiter-than-white rictus grins of celebrities. My friend Shahpar in Dhaka points out that in south Asia, some Muslims associate oral hygiene using the bark of the miswak tree with holiness, as they believe that the Prophet used the bark to clean his teeth. More generally, people in the region place an exceptionally high value on having a healthy, full mouth of teeth – reflected in some truly appalling jokes.

I’ve been reading about anxieties about oral hygiene and dentistry recently, hence this interest in shifting cultural and social constructions of teeth. During the early decades of the twentieth century, global anxieties about infant mortality and childhood health, resulted in a heightened concern about the care of children’s teeth. This was part of an infant welfare movement which had emerged all over the world at the end of the nineteenth century, in response to unease about high rates of infant mortality (usually as a result of diarrhoea), the apparently failing health of urban working-class men, and eugenicist anxieties about maintaining white control over political, social, and economic power.

Denture Shop, India, 1946*

Although child welfare campaigners during the nineteenth century drew parents’ attention to the need to instil in their children good habits of dental hygiene, the discourse around the state of children’s teeth during the early twentieth century differed. To be fair, rotting teeth and gum disease are the cause of a range of health problems, and it makes sense to direct public health policy towards making dental services freely available.

But particularly during the 1920s and 1930s, preventing poor oral hygiene and tooth decay began to take on moral overtones. Doctors and child welfare activists increasingly understood bad oral health as a signifier of chaotic, ‘unscientific’ upbringings – which, they believed, tended to occur in working-class families. Writing about Major General Sir Frederick Barton Maurice’s influential 1903 study of the large numbers of volunteers who were deemed to be physically unfit to fight in the South African War (1899-1902), Anna Davin explains:

If, as it seemed, these puny young men were typical of their class (‘the class which necessarily supplies the ranks of our army’), the problem was to discover why [they suffered from so many physical ailments], and to change things. Proceeding to speculate on possible explanations, [Maurice] accounted for the prevalence of bad teeth among recruits by unsuitable food in childhood (‘the universal testimony that I have heard is that the parents give the children even in infancy the food from off their own plates’), and decided at once that ‘the great original cause’ (of bad teeth at this point, but subsequently, and with as little evidence, of all the ill-health) was ‘ignorance on the part of the mothers of the necessary conditions for the bringing up of healthy children’.

This was one of several essays and articles which argued that poor nutrition in childhood – most notably feeding babies food meant for adults – caused ‘bad teeth’ and, thus, compromised health in adulthood. The best means of remedying this situation was to encourage mothers (and in the minds of doctors, welfare campaigners, and policy makers, these mothers were inevitably working-class) to adhere to ‘scientific principles’ in raising their children, chief of which was providing babies and young children with a diet calibrated precisely to their needs. These principles and diets were formulated by health professionals – medical men – and they, as well as nurses, health visitors, and others, encouraged mothers to abandon ‘superstitious’ and ‘ignorant’ childrearing practice in favour of properly ‘scientific’ guidelines.

Those doctors and campaigners influenced by eugenics argued, though, that children’s moral character depended on good dental hygiene. (Susanne Klausen explains what we mean by ‘eugenics’: ‘in its broadest definition…eugenics was concerned with improving the qualities of the human race either through controlling reproduction or by changing the environment or both.’) In The Story of the Teeth, and How to Save Them (1935), Dr Truby King, the extraordinarily influential founder of the global mothercraft movement, argued that the health and strength of babies’ and children’s teeth depended, firstly, on the health of the pregnant and lactating mother, and, secondly, on proper nutrition.

Breastfeeding – not on demand, but at regular intervals depending on the age of the baby – was, he believed, the foundation for the development of strong teeth and jaws. The introduction of nutritious food once the baby was six months old should, he wrote, encourage the child to chew, thus stimulating the nerves and blood vessels in the face, causing the milk and permanent teeth to emerge quickly and cleanly.

King had dire warnings to those parents – particularly mothers – who, he suggested, ‘gave in’ to the demands of their babies and children:

Decay of the teeth is not a mere chance unfortunate disability of the day – it is the most urgent and gravest of all diseases of our time – a more serious national scourge than Cancer or Consumption….

Why? Because oral hygiene and healthy teeth ensured that the citizens of the future would be morally good, productive, conscientious individuals:

‘Building the Teeth’ and ‘Forming a Character’ are parts of construction of the same edifice – standing in the relationship of the underground foundations of a building to the superstructure.

Our dentists tell us that nowadays when they insist on the eating of crusts and other hard food [necessary for encouraging the child to chew and, thus, in King’s view, develop its jaw], the mother often says ‘Our children simply won’t!’ Such children merely exemplify the ineptitude of their parents – parents too sentimental, weakly emotional, careless, or indifferent to train their children properly. The ‘can’t-be-so-cruel’ mother who cries half the night and frets all day on account of the mother’s failure to fulfil one of the first of maternal duties, should not blame Providence or Heredity because her progeny has turned out a ‘simply-won’t’ in infancy, and will become a selfish ‘simply-can’t’ in later childhood and adolescence. Power to obey the ‘Ten Commandments,’ or to conform to the temporal laws and usages of Society is not to be expected of ‘SPOILED’ babies when they reach adult life. …

Unselfishness and altruism are not the natural outcome of habitual self-indulgence. Damaged health and the absence of discipline and control in early life are the natural foundations of failure later on – failure through the lack of control which underlies all weakness of character, vice, and criminality.

Good teeth meant good citizens. Bizarre as this thinking may have been, it did – often – have positive outcomes. For instance, similar views held among South African doctors and child welfare campaigners were behind the establishment of a network of dental clinics for poor children – albeit mainly white children – during the 1920s and 1930s. Children whose parents could not afford private dental care, could attend these clinics gratis.

One of the most striking characteristics of eugenicist thinking was its tendency to blame mothers’ ignorance, stupidity, or credulousness for the poor health of their babies and children, ignoring the environmental factors – the contexts – in which they raised their offspring. King’s implication was that mothers were ultimately responsible for the ‘vice and criminality’ of society: if they, he wrote, had simply disciplined their children, feeding them properly and ignoring their demands, then all adults would be productive, self-controlled citizens.

Although King’s reasoning is demonstrably bonkers, this tendency to blame (single) mothers for children’s anti-social behaviour persists, particularly within right-wing political and media circles. This is a strategy which absolves the state and other institutions of any responsibility for ensuring that children are adequately care for.

The study of attitudes towards teeth and dentistry reveals a range of beliefs about parenting, childhood, and, nutrition. It seems, then, that we are not only what we eat, but we are also how we eat.

Sources cited here:

Anna Davin, ‘Imperialism and Motherhood,’ History Workshop, no. 5 (Spring 1978), pp. 9-65.

Susanne Klausen, ‘“For the Sake of the Race”: Eugenic Discourses of Feeblemindedness and Motherhood in the South African Medical Record, 1903-1926,’ Journal of Southern African Studies, vol. 23, no. 1 (March 1997), pp. 27-50.

Antora Mahmud Khan and Syed Masud Ahmed, ‘“Why do I have to Clean Teeth Regularly?” Perceptions and State of
Oral and Dental Health in a Low-income Rural Community in Bangladesh’ (Dhaka: BRAC, 2011).

Truby King, The Story of the Teeth and How to Save Them (Auckland: Whitcombe & Tombes, 1935).

Further Reading:

Naomi Murakawa, ‘Toothless: The Methamphetamine “Epidemic,” “Meth Mouth,” and the Racial Construction of Drug Scares,’ Du Bois Review, vol. 8, no. 1 (2011), pp. 219-228.

Alyssa Picard, Making the American Mouth: Dentists and Public Health in the Twentieth Century. (New Brunswick: Rutgers University Press. 2009).

David Sonstrom, ‘Teeth in Victorian Art,’ Victorian Literature and Culture, vol. 29, no. 2 (2001), pp. 351-382.

* This photograph is from Retronaut.

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Tangerine and Cinnamon by Sarah Duff is licensed under a Creative Commons Attribution-ShareAlike 3.0 Unported License.

Milking It

This week the committee organising the 2012 Olympics in London caused widespread anger when it announced that breastfeeding mothers would have to buy an extra ticket to bring their babies into sports venues. Some venues have a few discounted tickets for children, but others don’t. One commentator posted on Mumsnet

that while she and her husband were lucky enough to get tickets to an equestrian event in August, organisers had told her there are no children’s tickets so she will have to pay £95 for a three-month old in a sling.

Those who can’t afford an extra ticket, or who lose out in the next round of ticket allocation, are advised to stay away. Unsurprisingly, Britain’s Equality and Human Rights Commission has suggested that this is potentially a case of ‘indirect sex discrimination’ because it will affect considerably more women than men.

This situation is ridiculous in so many ways. What angers me the most is that the Olympic committee took this decision in a country where the National Health Service advises that babies be breastfed exclusively for the first six months of life. The members of the committee seem either to think that women shouldn’t breastfeed in public – an irritating view about which I am going to be extraordinarily rude at some stage – or that mothers with babies have no desire to attend public events.

In the midst of the uproar, The Ecologist tweeted an article which it had published six years ago about the debate over whether women should breast- or bottle-feed their babies. It’s an argument that parents, doctors, and policy makers have been holding since at least the beginning of the twentieth century, and it’s to the credit of Pat Thomas that her piece provides a good overview of shifting attitudes towards infant feeding over the course of the past hundred years or so.

But it’s also a problematic piece of writing, and one which demonstrates particularly well why so many mothers feel bullied about how they decide to feed their babies. Thomas makes no attempt to hide her view that all mothers should breastfeed their children. She begins with a terrifying list of statistics:

The health consequences – twice the risk of dying in the first six weeks of life, five times the risk of gastroenteritis, twice the risk of developing eczema and diabetes and up to eight times the risk of developing lymphatic cancer – are staggering. With UK formula manufacturers spending around £20 per baby promoting this ‘baby junk food’, compared to the paltry 14 pence per baby the government spends promoting breastfeeding, can we ever hope to reverse the trend?

I’d love to know where she found these figures – particularly given her opening statement that women have breastfed for ‘nearly half a million years’. (How does she know this? Why the coy, qualifying ‘nearly’?) Thomas is, though, correct to point to the compelling evidence that breastfed babies tend to be healthier than those who are fed on formula, and that breastfed children may do better at school and have stronger immune systems. Also, there is a direct and proven link between the use of baby formula and high child mortality rates in the developing world.

She blames the slow decline of breastfeeding over the course of the twentieth century on the medicalization of childcare, and on the advertising strategies employed by formula companies – most notoriously Nestle. I have little to add to her second point, other that, broadly, I agree with her. The International Code of Marketing of Breastmilk Substitutes, a response to the Nestle Boycott of the late seventies, needs to be properly implemented. But her argument about the medicalization of women’s experiences of childbirth and childrearing is not entirely correct. She quotes Mary Renfrew from the Mother and Infant Research Unit at the University of York:

‘If you look at medical textbooks from the early part of the 20th century, you’ll find many quotes about making breastfeeding scientific and exact, and it’s out of these that you can see things beginning to fall apart.’ This falling apart, says Renfrew, is largely due to the fear and mistrust that science had of the natural process of breastfeeding.

In particular, the fact that a mother can put a baby on the breast and do something else while breastfeeding, and have the baby naturally come off the breast when it’s had enough, was seen as disorderly and inexact. The medical/scientific model replaced this natural situation with precise measurements – for instance, how many millilitres of milk a baby should ideally have at each sitting – which skewed the natural balance between mother and baby, and established bottlefeeding as a biological norm.

During the early years of twentieth century, global concern about high rates of child mortality animated a child welfare movement which aimed to improve the conditions in which children were raised. In Europe, North America, Australia, New Zealand, and parts of Africa and Latin America, medical professionals held up rational and scientific methods of feeding and caring for babies as the best means of eradicating the ‘ignorant’ practises which, many believed, caused babies to die. This new emphasis on hygiene, speedy medical intervention, and regular monitoring of babies’ development and health at clinics and hospitals did lower rates of morbidity – as did declining fertility rates, the control of infectious disease, economic prosperity, and increased attendance of school.

Doctors and specialists in the relatively new field of paediatrics were particularly interested in how babies were fed. Contrary to what Thomas suggests, the nineteenth-century orthodoxy that breastfeeding was the healthiest and best option for both mothers and babies lasted well into the 1940s. Innovations in artificial formulas provided mothers who couldn’t breastfeed – for whatever reason – with good alternatives, and doctors did recommend them. There were anxieties that malnourished mothers’ milk would not feed babies sufficiently, and doctors recommended ‘top ups’ with formula or other liquid.

The real difference between nineteenth- and twentieth-century attitudes towards breastfeeding was that it was increasingly controlled and patrolled by trained professionals. As Renfrew notes, mothers were told how much milk their babies needed at each feed, and there was a lot of debate in medical journals and in other professional forums about how and when babies should be fed.

The set of guidelines formulated by the incredibly influential, New Zealand-based Dr Truby King emphasised the importance of routine in feeding. King’s mothercraft movement – which established clinics and training centres around the British Empire during the first half of the twentieth century – taught mothers to feed ‘by the clock’. At five months, a baby was to be fed only five times per day – and at the same time every day – while one month-old babies had an extra, sixth feed.

Like many childcare professionals of the period, King believed that feeding on demand was not only unhealthy – it placed babies at risk of under- or overfeeding – but it was morally and intellectually damaging too. Babies who understood that crying would cause them to be fed would become spoilt, lazy children and adults. Indeed, this points to the infant welfare movement’s more general preoccupation with mothers and motherhood. As the interests of the state were seen, increasingly, as being linked to the proper rearing and education of children, the role of the mother grew in importance. King called his centres ‘shrines to motherhood’, for instance.

But the naturally fussy, over-cautious, and credulous mother was not to be trusted to follow her own instincts: authorities and professionals, who tended to be male, were to provide her with rational, scientific advice on raising her baby. It’s difficult to gauge mothers’ response to the information aimed at them. In her study of mothers in the United States in the 1920s and 1930s, Julia Grant concludes that mothers did heed childcare professionals, but modified their advice according to the views and experiences of their peers. Similarly, mothers in New Zealand took what they wanted from King’s pamphlets on childrearing.

Equally, mothercraft clinics and breastfeeding advice days were well attended by mothers and babies. Several mothercraft centres all over the world also included a dietetic wing, where nursing mothers could stay for up to a fortnight, learning how to breastfeed their babies. There, they would be taught how to breastfeed by the clock, and how to cope with mastitis and painful breasts and nipples. Wonderfully, hospital fees were means tested, so poor mothers could attend for free.

Throughout its existence, the Cape Town dietetic hospital never had an empty waiting list, and similar units in Britain, Australia, and New Zealand were as enthusiastically supported by women. Mothercraft seems to have been at its most successful when mothers could choose how and when they wanted to its advice and services.

While it’s true that the medicalization of breastfeeding transformed this act into a ‘science’ which needed to be re-taught to mothers – that it became possible to inform a mother that she was breastfeeding incorrectly – and that this was underpinned by misogynistic and eugenicist ideas around childhood, motherhood, and the nation, it is as true that mothers did respond positively to the advice provided by mothercraft and other organisations. Clearly, mothers wanted more advice about how to feed their babies – and that they altered it to suit their conditions and needs.

It’s for this reason that I think that Thomas is doing mothers a disservice. Encouraging more women to breastfeed needs to respect the fact that women’s choices about how to feed their babies are influenced by a variety of factors and considerations. Thomas – and other breastfeeding evangelicals – seems to buy into the same discourse of maternal irresponsibility as childcare professionals did in the early twentieth century: the belief that women somehow don’t really understand what’s best for their babies, and must be properly educated. Even if her – and others’ – motives are progressive and well-meaning, they still fail to take mothers seriously.

Further Reading

Sources cited here:

Rima D. Apple, Mothers and Medicine: A Social History of Infant Feeding, 1890-1950 (Madison: University of Wisconsin Press, 1987).

Linda Bryder, A Voice for Mothers: The Plunket Society and Infant Welfare 1907-2000 (Auckland: Auckland University Press, 2003).

Julia Grant, Raising Baby by the Book: The Education of American Mothers (New Haven and London: Yale University Press, 1998).

Philippa Mein Smith, Mothers and King Baby: Infant Survival and Welfare in an Imperial World: Australia 1880-1950 (Basingstoke: Macmillan, 1997).

Other sources:

Linda M. Blum, At the Breast: Ideologies of Breastfeeding and Motherhood in the Contemporary United States (Boston: Beacon Press, 1999).

Molly Ladd-Taylor, Mother-Work: Women, Child Welfare, and the State, 1890-1930 (Urbana and Chicago: University of Illinois Press, 1994).

Marilyn Yalom, A History of the Breast (New York: Ballantine Books, 1997).

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Tangerine and Cinnamon by Sarah Duff is licensed under a Creative Commons Attribution-ShareAlike 3.0 Unported License.