Child health was more imperilled in Melbourne than in surrounding rural areas until the 1940s. But such crude statistics disguise a marked disparity in both morbidity and mortality between the inner and outer suburbs. Infant mortality, due primarily to summer diarrhoea, was twice as prevalent in the city, and, because inner-city children came into contact with common infectious diseases at an earlier age, childhood mortality rates were also high. A fatalism about childhood death pervaded the city, which was subject to regular epidemics of measles, scarlet fever, typhoid and diphtheria.
The foundation of the (Royal) Children's Hospital in 1876, offering to poor city children the cleanliness and skilled nursing which accounted for the higher survival chances of their suburban peers, marked the first challenge to this fatalism. The hospital provided a base for the emerging speciality of paediatrics with J.G. Beaney's (1828-91) Children: Their treatment in health and disease (1873) providing a prototype text. The role of the hospital in medical education was formally recognised in 1912, six years after the foundation of the Melbourne Paediatric Society, which predated the national association.
Outside the hospital, public health activists formed the Australian Health Society in 1875, educating poor mothers in elementary hygiene. By the early years of the 20th century, child health had become central to government policy as well. The introduction in 1909 of a school medical service to conduct regular inspections of schoolchildren reflected a view that state action could create a healthy social order. The introduction of infant welfare centres from 1917 extended this regime of assistance and surveillance to the earliest years. Kindergartens also functioned as sites at which both mothers and children could be instructed in hygienic practices. The Melbourne City Council set the lead for other municipalities, introducing vaccination schemes and free milk distribution for children in the 1920s and funding public cleansing stations for the elimination of lice and scabies in the following decade. The federally funded Lady Gowrie Centre, which opened in North Carlton in December 1939, provided a model, incorporating infant welfare, nursery school and kindergarten while also serving as a site for research and education, establishing norms for the population as a whole.
The progress anticipated by public health advocates was blunted by epidemics of cerebro-spinal meningitis (1914-16), influenza (1918-20) and polio (1908, 1911, 1917, 1930-31, 1937-39, 1945-46) and increasing levels of poverty during the depression years. Child victims required lengthy hospitalisation and often suffered high levels of residual disability. The spread of vaccination and the introduction of antibiotics, towards the end of World War II, provided a dramatic breakthrough, both reducing the seriousness of most childhood diseases and allowing for a vast increase in corrective surgery. While chronic illnesses such as asthma, cystic fibrosis, diabetes and leukemia are still common in childhood, new treatments have dramatically increased survival rates. Apart from perinatal and congenital conditions, which are the major causes of death in the first year of life, it is motor car accidents and drownings which now pose the main threat to child health in Melbourne.