I’d already worked out what I was going to say in reviewing this book.
I am not keen on institutional histories. I dislike their celebratory nature and the way that their authors obviously feel compelled to doff their hats and gush over the institutional big-wigs and stalwarts. You can often sense the shadowy presence of the steering committee in the back-ground and that a publicist and risk-management expert are hovering in the wings.
However, I was drawn to read this history of the Royal Women’s Hospital after hearing a Radio National Hindsight program on it, available for download here. Janet McCalman, from the University of Melbourne ( I see that she, at least still works there, given the University’s decimation of its Arts faculty) wrote Struggletown: Public and Private Life in Richmond 1900-1965 – a history of the working-class suburb of Richmond, and Journeyings: The Biography of a Middle Class Generation 1920-1990, which followed the No 69 tram through the middle-class suburbs of Melbourne. She’s obviously drawn to writing larger social histories by focussing her lens on a small patch of inquiry.
And so Sex and Suffering: Women’s Health and a Women’s Hospital carries on an approach that she obviously feels comfortable with. As the title might suggest, this is not just a history of an institution: instead it deals with sex and the experience of being woman, health and institutions.
The experience of childbirth is intimately woven into the hidden parts of private lives and soon overlaid by the other experiences and achievements of a growing person. It is common to us all, and for a short period of time is overwhelming in its effect on the mother at her exposed, most basic core and on the people closest to her. So it was fascinating to consider the act childbirth- that most intimate and personal of events- as part of a social phenomenon that can be handled at the structural level in so many ways.
The book itself follows a chronological approach, with seven sections covering roughly 20-30 year periods. The emphasis varies in the sections, from the clinical (particularly in the sections discussing sepsis and antisepsis) to the social and structural (where the judgments of upper-middleclass doctors and the Board of Management were trained onto the predomiantly working-class and migrant clientele). Throughout most of the book, she draws on the case notes of individual women- helpfully supplemented with a glossary of medical terms in the margin- to make real her discussion of anaesthesia and surgery and its effect on horrendous labour situations, the horror of clostridium welchii which could kill a woman in hours, and the changes in attitudes towards labouring women and their partners. Ye Gods- some women had enormous babies- particularly in the post-Gold Rush period when women who had suffered malformations of the pelvis through malnutrition themselves as children, especially in Ireland, gave birth to large babies when their own diets had become carbohydrate-heavy in a new country. There’s something stark in reading the case notes reproduced at the end of the book that chart the death over a number of days of a woman, knowing that there are mothers and fathers, husbands and other children who have been left bereft.
I know that when I was in labour with my children, I was very conscious that I was part of a chain of labouring women in my family and thought -even then!- about how absolutely dreadful it would be to die in childbirth. Hormonally, physically and from an evolutionary sense, every sinew of your being in focussed on giving birth to that child then and there, even if it is your twelfth or illegitimate. I felt as if I was surrounded by generations of women who had given birth before, and that I was stripped down to my essential female-ness. In reading this book I was made conscious of the effects of bad births- those fistulas you now only know of in Third World countries, the lifelong invalidism that followed some births, and the amount of pain that lingered on year after year. It made the knowledge of my maternal grandmother’s seven births and several miscarriages, and my paternal grandfather’s first wife’s death in childbirth, more meaningful.
There are wonderful photographs and diagrams in this book. The photographs of Melbourne in the early chapters from both the La Trobe Picture collection and the Royal Women’s Hospital Archives are clear and showed perspectives of my city that I hadn’t seen before. The internal photographs of the hospital, again from the hospital archives, while deliberately posed, speak volumes about hospital discipline and nurses’ roles.
A second thread that runs through the book is a commentary on class and gender in Melbourne. The more feminist, women-centred Queen Victoria hospital stands as a counter-point to the more traditional, male-dominated Royal Women’s Hospital, and the class perspectives of the charity-oriented upper-middle class female board members run through the attitudes towards sexually-transmitted disease, abortion and adoption that the hospital had to deal with.
Well, this is what I was going to say until I got to the last part of the book. The last section, unfortunately, descended into that boosterism and oily fulsomeness of the standard institutional history. Probably for privacy reasons, the case histories dropped out of the narrative. Although they were replaced by oral history reminiscenes of experiences in the Women’s, they lacked the immediacy and contingency of those earlier case notes. Judgments about individuals who are alive and likely to read this book need to be tempered, and as a still-operating (though re-located) hospital , there is the equivalent, I guess, of the doctor’s “do no harm” in writing about the institutional culture. The management-speak of the final pages reflects the funding and political milieu in which institutions now exist, but I also suspect that it has been carefully vetted by the current hospital administration as well.
So, if you read this book- and I exhort you so to do- you might want to stop after Section VI in 1970. To that point, it’s fascinating.