In reviewing such a universal theme as healing in relation to Tasmania, it is necessary to consider whether the island is microcosmic, or unique. We must conclude that, as in many other fields, it has been predominantly the former, but occasionally the latter. Three broad overlapping periods can be identified, the first of naive empiricism, the second of heroic experimentation, and the third dominated by scientific investigation, but paralleled by a divergent increase in the popularity of non-scientific practices. The first was dominated by the description and classification of disease, with limited understanding of causation, and as a consequence, treatments were based on experience and belief. The second was characterised by increasing theoretical knowledge and developing technology. It was a time when low expectation of cure in cases of serious disease enabled heroic experimentation. The third, which extends to our own time, is marked by the hegemony of scientific evidence and professional accountability, but also by an increasing public mistrust of science and technology.
The advance of medical knowledge and technology conduces to a Whig interpretation of its history, but that is too simple. Medicine is profoundly anti-evolutionary; it is about the survival of the unfittest. The prevalence of some inherited diseases, such as cystic fibrosis and early-onset diabetes mellitus, has increased as sufferers survive to reproduce. Remedies of little efficacy produce few harmful side-effects; powerful therapeutic agents produce more 'iatrogenic' illness. Conversely, as effective treatments become more acceptable, there is demand for treatment of much less serious conditions. The apotheosis of this trend is in the procedures I call 'consumer electives' cosmetic surgery for other than gross deformity, and much 'reproductive technology' to overcome infertility. Improved knowledge and technology enables heroic procedures, such as massive visceral transplants, which are enormously costly, so that the community is increasingly faced with a version of Bernard Shaw's 'doctor's dilemma' high cost medicine for the few, or lower cost medicine for the many. Such considerations are of great importance in Tasmania with its limited economic base.
Advancing science and technology encounters a flight from reason, a pervasive mistrust, a revival of everything from aromatherapy to zealotry, leading some sufferers to neglect necessary and effective treatment while comforting others with the apparent 'naturalness' and 'harmlessness' of unproven remedies.
The initial colonies in Van Diemen's Land inherited western European traditions of healing transmitted through folk knowledge and belief and through professional practitioners, initially mostly naval and military surgeons of varying quality and training. Surgery retained a tradition of apprenticeship to a trade, Medicine the aspiration of a learned profession, although training did not invariably occur in hospitals or in association with universities. The recognition of formal qualifications was incompletely codified, and distance and the difficulty of verifying alleged expertise meant that claimants to the courtesy title of 'Doctor' might range from the highly qualified, through those licensed as apothecaries but not as physicians, and others with uncompleted studies, to those with no prior experience at all. Clinical doctrine had yet to solidify around an orthodoxy. Training might have taken place in England, Scotland or Ireland, in France, or even in the German states.
The persistence of apprenticeship made training within the colony possible, an advantage that was largely lost once legislation required formal qualification. Under the scientifically-minded Lt-Governor Franklin, the first such legislation in any Australian colony was passed in 1836 and 1837.1 Although the major Tasmanian hospitals have had a long reputation for postgraduate experience and training in the specialties, the possibility of initially qualifying within Tasmania was not regained until the establishment of the University of Tasmania Medical School in 1966.2 Notable home-grown doctors # practised in the colony throughout the nineteenth century, for example William Crowther junior, the second of a medical dynasty extending from 1825 to the present day, who had been apprenticed to his father, but who later gained qualifications in London and Paris.3
Medical and surgical practice closely followed that of Europe and the United States, with major innovations arriving soon after their introduction overseas. During the heroic period, the most notable event was the first use of ether anaesthesia for surgery in the southern hemisphere, in 1847 at Launceston by Dr WR Pugh, who made the ether himself and derived his apparatus from a diagram published in London after Morton's first use of ether in Boston less than eight months earlier. X-ray apparatus was in medical use in Launceston in 1897, just eighteen months after Roentgen's discovery. A pharmacist with homeopathic sympathies and an enthusiasm for photography appears to have been involved in the earliest local experiments.4
British influence predominated in training and qualification, the Australian medical schools adopting the dual qualification in medicine and surgery in contrast to the United States, where single qualification in medicine or surgery long survived, and contributed to a 1919 cause célèbre in Tasmania associated with the name of Victor Ratten.5
A notable innovator was Dr John Ramsay of Launceston, the first surgeon in Australia to be knighted, a pioneer of intravenous fluid replacement (arguably a greater saver of life than any other medical procedure) and of medical radiology. In 1906, he successfully restarted a heart by cardiac massage through an incision, and in 1911, he attempted to transplant a pancreas in an attempt to save a diabetic patient, ten years before the discovery of insulin, and many years before successful transplant surgery became possible.6 The priority of Launceston doctors in the use of the innovations of the heroic era has often been noted. It would appear to be a reflection of the personalities involved, fostered by an ethos of self-reliance in a town where local enterprise had always been more important than government.
Whatever value they may have had in the long centuries after their quarantine by the rising waters of Bass Strait, the healing practices of the Aborigines proved no match for the infections introduced with the European visitors and settlers, and were unable to cope with serious but not immediately fatal wounds inflicted in the Black War. Understanding of Aboriginal healing practices is limited. They are reported to have managed pain by laceration of skin over the affected area, or by application of relics of the dead, either bones or packets of cremation ashes wrapped in animal skin, sometimes smeared with grease and red ochre.7 Wounds were treated with ash or powdered sepiostaire, fractures were splinted, headaches treated with bindings, abdominal complaints with Mesembryanthemum equilaterum as a purgative; decoctions of leaves were used for other purposes. There are uncorroborated records of massage, incantation, shamanism, and placing the sick in proximity to the recently deceased.8 Few vestiges of Aboriginal practice appear to remain in Tasmanian folk medicine or in Aboriginal oral tradition, but a poultice of Mesembryanthemum and ochre is known to have been used in the twentieth century, a survival of the use of both an historically reputed healing plant, and a pigment of great ritual significance.9
European folk medicine was limited by the availability of familiar herbs, although these were soon introduced, and lack of knowledge of potentially medicinal native plants. It was probably largely eclipsed by the widespread use of popular books of home medicine, such as William Buchan's Domestic Medicine, first published in 1769, and improved and reprinted many times in the early nineteenth century.10 Home doctoring has remained an important part of the trade of both booksellers and druggists, and is in full flower today.
Patent medicines and tonics were popular as elsewhere, but some local products such as 'Dr. Kidd's Influenza Elixir', a cough mixture from Evandale, achieved fame within Tasmania, and at least one achieved wider reputation. This was 'Vitadatio', a herbal tonic wine sold in champagne bottles, prepared by W Webber of Launceston from 1887, and still being advertised and exported throughout the British Empire at least until the 1930s.11 Few native substances achieved widespread medicinal use, but eucalyptus oil became an important export, and this and the less fragrant muttonbird oil were important elements of folk medicine; a mixture of equal parts of the two oils, swallowed for internal ailments and applied topically for skin conditions, was a well-known panacea.
Until the 1940s, when tuberculosis still stalked the land, and pneumonia was often fatal, there was widespread folk belief in the preventive value of scarlet flannel worn next the skin as undervests for those who could afford them and strips for those who could not. This produced a profitable sideline for the Launceston wool-weaving firm of Kelsall & Kemp, who used the brand name 'Doctor' for their flannels of all colours.
Hospitals were established first in Hobart Town in 1804, and in Launceston by 1808. The responsibility of the government for convicts fostered the development of substantial public institutions, not only infirmaries for the bond and the free, but also Invalid Depots and asylums for the insane, although limited studies of their functions suggest that there was no clear categorisation; an invalid depot might house indigent poor, demented or mentally insane inmates. One such depot was the genesis of what became the mental institution for the whole state, in its last years known as the Royal Derwent Hospital at New Norfolk. Locally organised general hospitals were to become a substantial burden to the state government, which demanded greater control in exchange for increased central funding, with a consequent loss of autonomy and innovation, and an inevitable move towards centralisation as costs increased and the minimum acceptable technology became more sophisticated. Modern transport reduced the need for a small hospital in every town, but the loss of these symbols of safety has never been politically popular.12
Nursing began in the hands of convict attendants, but was revolutionised under the influence of Florence Nightingale when some of her trainees were sought for the colony in the 1860s by the Boards of Management of the Hobart Town and Launceston Hospitals.13 Midwifery arrived as a separate profession of doubtful respectability, but from the later nineteenth century became more professional and increasingly a speciality of nurses, many of whom ran small lying-in establishments. In 1901, an Act of Parliament restricted the title and practice of a midwife to formally qualified women, except in places remote from medical aid.14 The Queen Victoria Hospital, opened in Launceston by a voluntary committee in 1898, was the first public maternity hospital.15 As in the other Australian states, home births became the exception from early in the twentieth century, with a high level of medical involvement in obstetrics that has only been challenged in recent years.
The funding of healing has a complex history. Because of the convict system, the State early assumed responsibility for some care of a substantial proportion of the colonial population. In 1853, depots for invalid transportees were transferred from the Convict Department to the Tasmanian government, but the management was devolved upon local boards the following year. Private individuals paid their own way, and formed voluntary bodies to operate charitable dispensaries, hospitals and invalid depots available to the poor. Friendly societies were set up as a form of self-help by lodges, temperance societies, and churches to accept regular subscriptions from which medical fees, pharmaceutical costs, and in the last resort, funeral benefits were paid on behalf of members. Tasmania had a proliferation of friendly societies, and when a Commonwealth Act replaced them with contributory medical benefits funds, Tasmania established more of these than any other Australian state, some deriving their entire membership from the employees of a major industry.
Most orthodox medical costs are now subsumed under the current arrangements between the commonwealth and the state, with private medical practice substantially subsidised by the commonwealth, and public hospital practice the responsibility of the state. Motor accident and workers' compensation insurance pays for a proportion of patients. The overriding difficulty for public health services in all the Australian states remains the fact that the Commonwealth has the majority of the financial resources, and the states have the majority of the responsibility.
Healing practices now termed alternative have followed overseas fashions throughout our history, and depend strongly on practitioners trained elsewhere, and on imported publications.16 The only major technique originating in Tasmania and influential elsewhere has been that associated with the name of FM Alexander from Wynyard, who, in quest of improved elocution, discovered that health could be improved by certain postural exercises, and set out to convince the rest of the world in 1908. Homeopathy was the most powerful potential rival to orthodox medicine during the late nineteenth and early twentieth centuries. Homeopathic pharmacies traded in the two cities, although never separately from allopathy, and Homeopathic Hospitals were opened in Hobart in 1899, 'the second of its kind founded in the Southern Hemisphere', and in Launceston in 1900.17 Chinese medicine came in rudimentary form with the mining communities in north-eastern Tasmania, was eclipsed with their decline, but has regained some popularity in recent years, as administered by Chinese practitioners and their students, and by orthodox medical practitioners trained in acupuncture.
Other therapies, notably chiropractic18 and naturopathy, have paralleled their popularity in the remainder of the Western world. Many alternative practitioners use more than one mode of healing, and in later twentieth century, a number of medical practitioners adopted alternative practices. Alternative practitioners are now subject to the jurisdiction of the Health Complaints Commissioner, and are being moved towards state registration of qualifications, paralleling the much earlier development for physicians and surgeons.
Despite the popularity of spas in Europe and North America from the eighteenth to the early twentieth century, none of the many mineral springs in Tasmania seem to have gained more than a local reputation, and no hydropathic establishments arose. Treatments involving various forms of massage retain great popularity and value. At the professional end of the spectrum, physiotherapy is an established part of orthodox treatment, and makes use of many fully researched techniques. Masseurs of varied training and none, some from the realm of sport, have achieved high and sometimes colourful reputations, notably Roy Cazaly in Hobart for later twentieth century, and somewhat earlier, the Canadian all-in wrestler, Francois Fouché, who appeared in Hobart during the 1940s. Therapeutic masseurs in Tasmania as elsewhere have been at some pains to distance themselves from the connotations arising from a popular mainland euphemism for brothels.
The years after the Second World War were marked by enthusiasm for preventive public health measures. Following a report by the Canberra expert Dr FW Clements,19 Tasmanian schoolchildren were given potassium iodide tablets weekly to prevent the development of endemic goitre, attributed simplistically to the deficiency of iodine in the glacial soils of Tasmania, but also affected by the passage of water through limestone aquifers, goitrogenic plants in dairy pasture, and bacterial pollution of waterways in settled areas. A later attempt to extend the measure to adults by way of iodised bread flour led to complications and was quietly abandoned.
Also during the 1950s, compulsory X-ray screening for pulmonary tuberculosis was introduced for the first time in Australia under the flamboyant state Minister for Health, Dr RJD Turnbull, not without opposition by civil libertarians. A sanatorium for consumptives had been established at New Town in 190620 to provide to all the open-air treatment developed in Switzerland, before the coming of anti-tuberculous drugs. Another was later opened between Perth and Evandale.
In the 1950s there was great concern about the poor dental health of Tasmanian children, and fluoridation of water supplies was adopted as a preventive for dental caries, despite strong opposition led by the Associate Professor (of Chemistry) John Polya. This, and the training in Hobart of dental therapists authorised to undertake some procedures, produced a remarkable improvement.
Influenced by eugenic ideas prevalent in the early twentieth century, there was some concern among doctors about the limited size, quality, and mobility of the Tasmanian gene pool, leading to informal arrangements for babies to be adopted on the Australian mainland, with reciprocal importation of children from across the strait. Folklore about inbreeding was reinforced by a misunderstanding of the mode of inheritance of Huntington's disease, a rare degenerative condition with a relatively high prevalence in Tasmania due to the accident of the immigration of affected families.21
A small, geographically defined, and relatively stable population, despite limited resources for laboratory-based research, has made Tasmania a near-ideal site for epidemiological studies, and the island supports both the Menzies Centre for Population Health Research based in Hobart and the Clifford Craig Research Foundation in Launceston. The broad scientific amateur interests of nineteenth century medical practitioners, the ethnological interests of colonial surgeons, the gaseous experiments of Dr Pugh, are now replaced by a high standard of less spectacular but much more professional research.
1. Philippa Martyr, Paradise of quacks: an alternative history of Medicine in Australia, Sydney: Macleay Press, 2002, p 57, cites a law of 1836 which permitted only legally qualified medical practitioners to assist at inquests, and two VDL acts of 1837 regulating medical practice and the sale of medicines and drugs, and setting up a doctors' court to examine fitness for registration as practitioners.
2. Richard Davis, Open to talent: the centenary history of the University of Tasmania 18901990, Hobart: the University, 1990.
3. ADB 3, Crowther.
4. Gwen Wilson, 'William Russ Pugh: man of mystery', in 150 years of Anaesthesia, Launceston Historical Society Occasional Papers, vol 4, 1997, summarises much of what is known of Pugh, including the question of his doubtful qualifications. His operations on 7 June 1847 are described in the Launceston Examiner, 9 June 1847, by its proprietor James Aikenhead who was a witness. The event is placed in historical and social context in Eric Ratcliff, The William Russ Pugh sesquicentenary oration, LHS Occasional Papers, vol 4; Launceston Hospital purchased equipment in 1896 (Clifford Craig, Launceston General Hospital: the first 100 years, Launceston: the Hospital, 1963); first recorded use by John Ramsay, Launceston Hospital, 7 May 1897 Paul Richards, 'History of the Launceston General Hospital with particular reference to Sir John Ramsay Surgeon-Superintendent 18981917', in LHS Occasional Papers, vol 4, 1997; The pharmacist-photographer was Frank Styant-Browne PAC Richards, B Valentine and P Richardson(eds) , Voyages in a caravan: the illustrated logs of Frank Styant Browne, Launceston: Launceston Library/Brobok, 2002.
5. Parliamentary debates reported in the Mercury, 1919; M Hodgson, unpublished work in progress; WG Rimmer, Portrait of a hospital: the Royal Hobart, Hobart: Royal Hobart Hospital, 1981.
6. Craig, pp 34-38; Richards passim.
7. NJB Plomley, A wordlList of the Tasmanian Aboriginal languages, Launceston: The Author, 1976, pp. 385-388; NJB Plomley, The Tasmanian Aborigines, Launceston: The Plomley Foundation, 1993, pp 56-58; Antonio Sagona(ed), Bruising the red earth: ochre mining and ritual in Aboriginal Tasmania, Melbourne: Melbourne University Press, 1994, pp 22-3. Sagona, p 51, speculates about a potentially medicinal plant by analogy with a related plant used by Australian Mainland Aborigines.
8. H Ling Roth, The Aborigines of Tasmania, Halifax: F. King & Sons, 1899, pp 63-66. Much of this derives from the journal of James Backhouse, 12 October, 1832 and therefore relates to the exile period; see NJB Plomley (ed), Weep in silence: a history of the Flinders Island Aboriginal settlement, Hobart: Blubber Head Press, 1987, p 229.
9. For successful treatment of a venomous spider bite (Jim Everett, personal communication, 20 September 2003).
10. William Buchan, M.D., F.R.C.P. Edin., Domestic medicine op; a treatise on the prevention and cure of diseases by regimen and simple medicines: with an appendix containing a dispensatory for the use of private practitioners, Edinburgh; Beel & Bradfute et al, 1812. Extant copy of Tasmanian provenance. (A provate practitioner here means an unqualified person treating at home.)
11. Vitadatio bottle label, author's collection; The cyclopedia of Tasmania, vol 2, Hobart, 1900, pp 123-4.
12. Joan C Brown, Poverty is not a crime: the development of Social Services in Tasmania 1803-1900, Hobart: THRA, 1972. See also Craig and Rimmer; Eric Ratcliff, 'Imperial Llnacy', in Australasian Forensic Psychiatry Bulletin 10, June 1990; GM Crabbe, History of Lachlan Park Hospital, Hobart: Government Printer 1966; RW Gowlland, Troubled asylum: the history of the Royal Derwent Hospital, New Norfolk: The Author 1981; E Ratcliff and K Kirby, 'Psychiatry in Tasmania: from old cobwebs to new brooms', in Australasian Psychiatry, 9/2, 2001, pp 12832; The trend is historic: 'The institution is one of the best in the Australian States, though how long it will remain so is doubful, as Parliament has more than once manifested a disposition to tinker with the management.' Henry Button, Flotsam & Jetsam, Launceston: A.W. Birchall & Sons, 1909, p 295.
13. LM Brown, History and memories of nursing at the Launceston General Hospital, Launceston: Launceston General Hospital Ex-trainees Association, 1980; Angus Downie, Our first 100 years: the history of nursing at the Royal Hobart Hospital, Hobart: T. J. Hughes, .
14. The Midwifery Nurses Act (1901).
15. Launceston General Hospital Historical Committee, Papers& Proceedings, vol 4, Celebrating the centenary: Queen Victoria Hospital 18971997, 1997.
16. A brief compendium of Tasmanian origin is HE Stanton, The healing factor: a guide to positive health, Melbourne: Fontana 1987.
17. The Cyclopedia of Tasmania, vol 2, Hobart, 1900, p 129; Jenny Gill, The Story of the Launceston Homeopathic Hospital, Launceston: the Author, 1989.
18. The first United States-qualified chiropractor to practise in Tasmania appears to have been Florence Motley of Law Street, Launceston, who was in practice at least from the early 1940s.
19. FW Clements, 'Goitre studies' I, II, III in Medical Journal of Australia, vol1, 35th year, nos 21-25, pp 637, 665, 753; Anita Osmond and FW Clements, 'Goitre studies III: The Iodine Prophylaxis of Endemic Goitre', in MJA vol 1, 35th Year, No 25, 1948, pp 753-757.
20. Walch's Tasmanian Almanac for 1923, p 271.
21. Inbreeding was given regrettable reiteration in Peter Conrad, Down home: revisiting Tasmania, London: Chatto & Windus, 1988 pp 114-15. Huntington's disease is inherited in a Mendelian dominant mode; it is therefore likely to appear in each generation, unlike diseases inherited as recessive characteristics which are therefore more likely to manifest when inbreeding has occurred. Other diseases with dominant inheritance that have appeared in Tasmania include acute intermittent porphyria and epibia.