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  1. Medicine in colonial Australia, | The Medical Journal of Australia
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Branches in the other colonies soon followed. The BMA saw itself as having imperial responsibilities, and the creation of colonial branches augmented its status and influence in Britain.

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By late in the 19th century, medicine's claims of being scientific and effective were accepted much more widely by citizens and politicians. This change in public opinion, like the creation of stronger associations, promoted the cause of the regulars. Whereas in the Sydney Morning Herald saw little difference between the healing powers of nurses and doctors, in it predicted medical science would banish infections, conquer cancer and overcome gout.

In —, mortality was very high, due mainly to dysentery, typhus and typhoid the latter two being first distinguished by the Registrar General for England and Wales in and abetted by malnutrition and scurvy.

Medicine in colonial Australia, | The Medical Journal of Australia

Annual aggregate mortality rates ranged from 47 to per population, while child deaths fluctuated between and per From the mid s, with the growing influx of young, free families and a high local birth rate, the pool of susceptibles, especially in urban centres, became sufficient to sustain the common infections of childhood, such as whooping cough and measles. Recurrent local influenza epidemics were connected to pandemics and regional epidemics. Marked urban growth without adequate sanitary measures gave rise to fearsome outbreaks of enteric infections, including diarrhoeal disease, the cause of many infant deaths.

With the irregular cycles of childhood infections, these outbreaks produced short-term fluctuations in mortality until about the s, when a sustained downward trend in mortality from communicable diseases is observable.

The decline in tuberculosis mortality, a major contributor to the death rate, was part of this secular trend. It was the decline in deaths from communicable diseases that dominated the sustained fall in aggregate mortality in the late 19th and earlier 20th centuries — the first phase of the modern health transition that raised life expectancy to unprecedented levels.

The second phase, beginning in the late 20th century, involved a fall in mortality from chronic non-communicable diseases. With puerperal infections an ever-present danger, maternal mortality remained high, showing no downward trend in the colonial era. In Victoria, there were 6. Leading causes of morbidity remained fairly constant, at least in hospital statistics, which do not offer a complete picture as many patients, especially the chronically ill, were nursed at home.

In the 18th century, Western doctors still relied on age-old sensory assessments like the taste of urine and on the patient's illness account. In the early 19th century, they began to employ simple instruments like the monaural stethoscope, along with sensory impressions from manual examination, while the patient account declined in importance.

The doctor's sensory impressions were then supplemented by numerical data and visual depictions, as evidence had to be standardised and reproducible. Later in the 19th century, hospitals, laboratories and universities finally came together to produce modern scientific medicine.

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In France in the first half of the 19th century, the great public hospitals provided the myriad patients needed to generate the volume of data on which a new style of clinical education developed. Basic to this was teaching the recognition of carefully delineated diseases that assumed the status of real entities and had been developed out of the careful observations of a generation of innovative clinicians. In Germany in the second half of the century, the laboratory and the experimental method further advanced scientific medicine.

From this union emerged organic chemistry and physiology as the basic disciplines; a role earlier played by morbid anatomy. Now technology was integral. Introduced by Carl Ludwig, the kymograph translated changes in bodily function into a line on a graph, while the much improved microscope became the means by which histology linked anatomy and physiology. Theodor Schwann's theory that tissues consisted of cells was developed by Rudolf Virchow, who showed cells arose from other cells and were the basic units in pathology.

The focus on morbid anatomy had encouraged surgical interventions, but wound infection and pain remained great problems. Joseph Lister's use of antiseptic carbolic acid spray during operations in the s, and the introduction of asepsis procedures a decade later, much reduced infection rates. William Gilbee, a Melbourne Hospital surgeon, successfully applied Listerism in wound dressing soon after reading about it in T he Lancet in , although he probably did not understand the role played by microorganisms.

By , Melbourne Hospital surgeons were strongly inculcating Listerian principles in students and, by , so safe had surgery become, the hospital reported a waiting list for operations for the first time. Ether was first used in Australia by a Sydney dentist and a Launceston surgeon at about the same time in Medicine's claim to be scientific was nowhere more strongly based than in the achievements of the new science of bacteriology, established in the s when Louis Pasteur showed fermentation resulted from the activity of microorganisms.

It was left to the great German bacteriologist Robert Koch to draw up a famous set of postulates by which to establish the pathogen responsible for an episode of infectious illness. In the decade from the late s, bacteriologists identified the pathogens involved in many significant communicable diseases: gonorrhoea, typhoid, leprosy, malaria, tuberculosis, erysipelas, cholera, diphtheria, tetanus, pneumonia, epidemic meningitis, Malta fever brucellosis and soft chancre. A notable achievement in this regard was the development of diphtheria antitoxin in the s.

However, with the antibiotic age a good way off, prevention was still the royal road to reducing the burden of disease and death. From an early date, colonial students often starting at 14 years of age were being trained under the traditional apprenticeship system. Between and , about 30 students completed apprenticeships with doctors in Sydney and Hobart. Having obtained a corporate licence by examination in Britain, they would return to practise in Australia.

On two occasions in the s, before the opening of the University of Sydney, it was proposed to establish a medical school at the Sydney Infirmary and Dispensary to prepare students for corporate examinations; neither plan was implemented. When Bedford was unable to guarantee the inpatients required by the colleges for teaching purposes, the proposal lapsed.

He had hoped to earn enough from the school to ensure the hospital was financially secure. Even in the early s, most colonial doctors were college licentiates. Schools finally opened in the new universities in Melbourne in , Sydney and Adelaide Melbourne and Adelaide encountered early problems.

The Melbourne profession was not welcoming; the MB was considered professionally insufficient, so from a BS was also awarded. The relationship between Melbourne Hospital clinicians and the school was an uneasy one, and clinical instruction remained unsatisfactory.

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In Adelaide, not only did the school have to cope with inadequate funding, but a medicopolitical struggle involving the school, Adelaide Hospital and the government came close to closing the school down permanently. However, in Britain in , she acquired diplomas from the Worshipful Society of Apothecaries and two Scottish Colleges. The first woman to study medicine in Adelaide, Laura Margaret Fowler, was admitted in and graduated in By the early 19th century, the four Scottish universities — Aberdeen, Edinburgh, Glasgow and St Andrews — were the leaders of medical education in Britain. The University of Edinburgh's faculty of medicine was pre-eminent and its aim was to produce a generalist physician and surgeon who later might become a specialist.

A great international centre, it also attracted students from England and other parts of Britain because Oxford and Cambridge were in decline. After peace was restored in Europe in , following the Napoleonic Wars, the Paris hospitals became the most advanced centres of training.

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However, Edinburgh's humanistic education, which stressed close observation of the human body as it reacted to illness and its treatments, remained a favoured source of education for British and colonial including Australian students. The University of Melbourne had begun teaching medical students in Box 1 , and the next year, George Britton Halford, a gifted experimental physiologist and foundation professor of anatomy and physiology, instituted anatomy classes. Halford was dean of the new faculty of medicine in — and — Harry Brookes Allen, his successor, was dean in — and — A Melbourne graduate himself, Allen was the outstanding Victorian pathologist, bacteriologist and public health expert of his era.

Until local medical schools were established in the 20th century, Western Australians, Queenslanders and Tasmanians were educated at the Melbourne school. The development of the professoriate reflected this, although financial constraint also mattered. A second chair pathology and anatomy was not created at Melbourne until Obstetrics, surgery, medicine, paediatrics and biochemistry chairs only appeared in the 20th century. At the University of Sydney, the faculty of medicine could award degrees from , but did not provide instruction.

There was a long delay in opening the Sydney medical school, partly due to lack of funds. Opposition from senior Sydney practitioners and John Smith MD Aberdeen , the foundation professor of chemistry and experimental physics and reluctant dean of the faculty of medicine, was also a factor, along with a policy decision to give primacy to non-professional education. First, it meant, from the outset, a very close relationship with its new teaching hospital, Prince Alfred opened in , that would not have been possible with the older Sydney Hospital and its established professional interests.

Importantly, it permitted efficient arrangement of conjoint control of hospital staff appointments. The appointment of an Edinburgh graduate, Thomas Anderson Stuart, as foundation professor of anatomy and physiology not only ensured the Scottish as opposed to English tradition of wedding teaching and examining was in place from the start, but ensured a Sydney education was at the progressive edge, at least in the English-speaking world.

Indeed, on arrival, Anderson Stuart reduced the antiquated emphasis on lectures and much increased practical instruction.

The University of Adelaide, founded in , enrolled its first six medical students in ; the delay being due to lack of funds, as in Sydney. It rapidly became a struggle over whether the hospital board supported by the honoraries or the government which, as the primary funder, believed it could intervene should determine policy. When the hospital board effectively denied the medical school access to clinical teaching, arrangements were made with Sydney from and Melbourne from for senior Adelaide students to complete their studies at one or the other. The fall of the Kingston government facilitated negotiations between the university and the profession, and clinical teaching began again in Other important battles included those with the chemists over their intrusion into medical care and with the friendly societies about doctors' remuneration and working conditions.

In Australia, as in Britain, doctors often dispensed drugs, and chemists provided medical advice as well as drugs. Of course, many people, especially in rural and remote areas, self-medicated with ingredients from the garden or livestock, as well as with drugs from the chemist. Patent medicines became hugely popular in the second half of the 19th century. Very much in demand were an English product, Bates' Salve, for treating bronchitis, asthma and lumbago; and two local products — eucalyptus as a panacea, and, copied from the Aboriginal people, goanna fat as a salve.

Cost differences were significant. A bottle of patent medicine might cost one shilling and sixpence, but a doctor's visit, ten shillings and sixpence. Not unreasonably, doctors saw chemists as unfair competitors who might also endanger the sick because they lacked diagnostic skills.