As part of the development of their profession, colonial medical practitioners undertook a number of projects aimed at effecting change within the profession. These internal developments included the establishment of professional societies and medical journals, standardisation of medical education, and the development of mechanisms of internal pressure for the regulation of individual practitioners. Each of these endeavours contributed to the development of professional unity, a goal that was deliberately sought by the colonial medical profession and which was critical to state patronage and public support which were, in turn, critical to professionalisation. Vaccination presented challenges to, and opportunities for, bonding and therefore medical responses to the issues involved in the vaccination debate can be used to demonstrate how these strategies worked and why the medical profession perceived them to be so important. At the same time, setting medical responses to vaccination against this background will elucidate their motivation and foundations.
Almost all medical practitioners in the colonies received their qualifications in Britain until the late nineteenth century, when medical schools began to appear in the colonial universities.298 This had important ramifications for the identity of Australasian doctors, who were undeniably British in outlook, and had a clear impact on the attitude of the profession towards smallpox and vaccination. Having witnessed the ravages of smallpox while training or working in England, practitioners arriving in or returning to Australia were keen to impress the risk of epidemic and the responsibility of vaccination upon the colonial populations. Their British training meant that the overwhelming majority of medical practitioners in Australia were aware of British medical journals, especially The Lancet from 1823 and the British Medical Journal from 1857, and copies were to be found in the colonies. All members of the British Medical Association received the
BMJ as part of their membership benefits. However, by the mid-nineteenth century, Australian doctors were creating an identity of their own, separate from their British counterparts. While they undoubtedly remained heavily influenced by British medicine, there was an awareness that there was much about the Australian context that was unique and that Australian doctors had plenty to offer the profession as a whole.
298
An important aspect of this identity development was the establishment of colonial medical societies, which were instrumental in the process of professionalisation. Over the course of the nineteenth century, many medical societies were formed. While only a few thrived, the persistence with which Australian practitioners pursued the formation of colonial societies demonstrated the widespread desire for local forums for professional discussion, the development of collective professional identity in the colonial context, and the perceived need for a representative body to defend the interests of the profession.299 These aims were self-consciously sought, as the stated goals of the Victorian Branch of the BMA, established in 1879, demonstrated:
1. To promote the advancement of medical science among the members of the Medical Profession, and to establish a medium through which their opinions can be easily ascertained and expressed.
2. To advance the general and social interests of the Profession.
3. To promote fair and honourable practice, and to decide upon questions of professional usage and courtesy.
4. To correspond with bodies or individuals in other parts of the colonies on any matter touching medical interests, and, by moral influence, and the exercise of a judicious supervision, to prevent abuses in the Profession.
5. To consider any subject connected with the appointment of medical men to public institutions, situations, and services.
6. To consider any question of medical polity.
7. To further the federation of the Medical Profession in the various colonies of Australasia.300
Local medical societies were justified, then, on several grounds: continuing medical education, political representation, self-regulation, and the promotion of internal unity. Communication was facilitated between doctors through membership of these societies and the regular meetings that were held to discuss scientific and political issues relating to medicine. One of the most important roles that societies played was to provide a forum for debate to take place safely, a function that was particularly relevant within the vaccination debate. Disputes between groups of practitioners or individual doctors were very common, and when these conflicts took place in the public arena, they were damaging to professional credibility because they provided evidence of disunity, thus undermining medical expertise. By discussing differences of opinion within the privacy of the
299
For a fuller description of colonial medical societies, see note 10 above.
300
Letter from Louis Henry, MD, Hon. Sec. of the Victorian Branch of the British Medical Association, to all medical practitioners in Victoria, inviting them to join, cited in J. Breheny, ‘As it was in the beginning… the British Medical Association (Victorian Branch)’, MJA, (June 2, 1979): 504-506, p. 505.
society, embarrassing exposure could be avoided and the appearance of professional unity projected. Further, once a matter was satisfactorily settled, the society could then speak on behalf of its members, negotiating with both the state and the public more effectively than any group of individual doctors could achieve in the absence of that organisational structure. Examples of when this occurred include vigorous debate over re-vaccination in 1863, the appointment of lay vaccinators in 1874, and the best age to vaccinate in 1874 and 1889.301 Following ‘two numerously attended meetings of the Medical Society to discuss the proposed changes in the Vaccination Act’, the final report on the debate of 1874 concluded that:
The final result of this discussion, however, can hardly be doubted, and we trust it will be remembered in the future that the Medical Society is now sufficiently numerous and influential to be accepted as the voice of the profession upon any subject in which our common interests or the public health is concerned.302
Even more effective than meetings, however, were the journals often associated with the societies. Publications such as the Australian Medical Journal expressly stated that their aims were to facilitate communication within the profession, to provide continued medical education through scientific articles and discussion, to represent the medical, social and political views and interests of the profession and to act as a cohesive force for a geographically disparate medical community.303 Edited under the auspices of the Medical Society of Victoria, and published from January 1856, the AMJ purported to represent, and cater to, doctors throughout the Australian colonies.304 While it was recognised that some of its aims would be beneficial to members of the profession in terms of pecuniary and status gains, this was not necessarily their prime motivation. These aims were perceived as part of the ethical obligation of medicine and hence as much in the interests of the public as in the interests of individual practitioners.305
The application of this attitude was exhibited in the lobbying of the medical societies and journals for legislation regulating medical practice, privileging allopathy over alternative practices. Such acts had obvious benefits for doctors, and writers for these journals were usually quite open about arguing for the interests of the profession; it was, after all, their livelihood. Equally, however,
301
AMJ, 8 (1863), pp. 280-283; AMJ, 19 (1874), pp. 194-198; AMJ, 19 (1874), pp. 225-229; AMJ, 11 (1889), pp. 360- 364. 302 AMJ, 19 (1874), pp. 205-206. 303 AMJ, 1 (1856), p. 47. 304 Ibid., p. 48. 305 Ibid., p. 50.
arguments for such legislation were framed in terms of protecting an innocent and credulous public, and especially the poor:
It is not that the wealthy and intelligent classes are prone to be duped by the nostrums of medical quackery, – the evil is greater, because the uninformed, the credulous, the poorer classes, among whom affliction is far more serious and less easily alleviated, become the victims of a system of fraud, which perils life by its ignorance and recklessness, and against which the public is afforded neither protection nor redress.306
Vaccination legislation was viewed in a similarly mutually beneficial manner. Anti-vaccinationists frequently pointed to the ‘interested’ nature of medical involvement in vaccination laws.307 The profession, while not oblivious to the financial and professional benefits associated with compulsory vaccination, argued primarily in terms of protecting a public, usually poor and uneducated, from indifference or opposition induced by ignorance.308 The author of the above excerpt proceeded to identify a lack of unity among the profession as the factor preventing legislation on medical reform in both Britain and the colonies, and implied that communication through the journal could go some way towards addressing that issue, thereby providing the profession with greater leverage in dealings with the state over medical legislation, which was identified as a priority of the profession.309
Medical journals have been reasonably numerous in Australia, considering the relatively small population. The AMJ later merged with the Intercolonial Quarterly Journal of Medicine and
Surgery to form the Intercolonial Medical Journal of Australasia. It was joined by the
Australasian Medical Gazette in 1881, which was produced by the New South Wales Branch of the
British Medical Association. The IMJA folded in 1895, and although a new Australian Medical
Journal was established in Melbourne in 1910, it merged with the AMG in 1914 to form the
306
Ibid., p. 51.
307
An M.P., Compulsory Vaccination: weighed and found wanting. An array of Facts and Figures versus Fads and Follies, (Hobart: Propsting and Cockhead, 1888), p. 23; Can Disease Protect Health? : One of the “Unscientific Mob”,
The “Age” and Vaccination ; A Physician, The Case Against Compulsory Vaccination, (Melbourne: A.H. Massina & Co., 1890), pp. 9-10; ‘Public Health Bill’, NSWPD, 1896, 1st series, Vol. LXXXV, p. 3772; Mercury, 28 August, 1881, p. 3, c. c.
308
F. Tidswell, A Brief Sketch of the History of Small-Pox and Vaccination in New South Wales (read before the Australasian Association for the Advancement of Science, January 7, 1898), (Sydney: Govt. Printer, 1899), p. 7. See also, Vaccination Officer Reports.
309
For a discussion of the role of medical journals in British medical reform, see J. Loudon and I. Loudon, ‘Medicine, Politics and the Medical Periodical 1800-1850’, in W.F. Bynum, S. Lock and R. Porter (eds.), Medical Journals and Medical Knowledge (London: Routledge, 1992): 49-69.
Medical Journal of Australia. The MJA represented the interests of the Australian branches of the BMA, which later became the Australian Medical Association in 1962.
These were the most important Australian medical journals, in that they enjoyed the best reputations both within and outside the colonies. However, they were not the only ones produced. The others were: the first Australian Medical Journal, published in Sydney between 1846 and 1847; the Medical Record of Australia, published in Melbourne between 1861 and 1863; the Melbourne based (Australasian) Medical and Surgical Review, 1863-1865 and 1873-1875; the
Australian Medical Gazette, also in Melbourne, 1869-1871; the New South Wales Medical Gazette,
based in Sydney between 1870 and 1875; the Melbourne Medical Record from 1875 to 1977; and
the Australian Practitioner, out of Sydney, between 1877 and 1878.310 Clearly, the medical
publishing scene was dominated by practitioners in Melbourne and Sydney and the minor journals were often representative of cliques or factions within the profession, and offered viewpoints frequently at odds with those expressed in the major publications. Nevertheless, contributions were regularly received from members of the profession in the other Australasian colonies. There is a sense that the editors of the larger journals were trying to foster a collective sense of identity, despite the occasional swipes at intercolonial health policies, including differences in quarantine regulations and vaccination administration.
There were significant differences between the progress of medical societies and journals in each of the colonies, and this related to the marked variations in the speed with which medical and health legislation was introduced. Victoria was the first colony to establish a medical association and the first to produce a medical journal. The societies and journals of this colony tended to last longer, and have greater participation rates, than those of the neighbouring colonies. Despite frequent attempts, the profession in New South Wales could not match this performance until the late nineteenth century, and Tasmania was even slower to form a lasting society and its practitioners could only contribute to journals published elsewhere.
The differences are attributable to local conditions. The Gold Rush in Victoria resulted in a massive increase in pressure on health services, inspiring the Victorian government to pass
310
J.H.L. Cumpston, ‘The History of Medical Journalism in Australia’, MJA, 2 (1939):1-4, reprinted from MJA, 2 (1914): 14-16; B. Gandevia, ‘A Review of Victoria’s Early Medical Journals’, MJA, 2 (1952): 184-188; S. Due, ‘Early Medical Journals of Australia’, MJA, 161(1994): 340-342.
legislation aimed at dealing with this situation and providing more than sufficient work for the practitioners of the colony. These early favourable conditions meant that a fair degree of unity already existed amongst the Victorian medical profession, a situation only enhanced by the formation of medical societies and journals. Early organisation assisted in avoiding later conflict, when Victoria attained almost the highest ratio of allopathic medical practitioners to population in the late nineteenth century, and simultaneously contributed to Victoria having an extremely low proportion of unregistered practitioners, or ‘quacks’.311 New South Wales, however, possessed a great many quacks. Although Martyr argued that it was not so great a number when compared to the population of New South Wales, this line of reasoning cannot be sustained when in 1886 New South Wales had 183 unregistered practitioners, Victoria had 13 and Tasmania only 3. Even using per capita analysis, the number of unregistered practitioners in New South Wales in the late nineteenth century far outstripped those in Victoria and Tasmania.312
Seeking to emulate the success of its neighbour, the medical profession in New South Wales was hampered by a ‘dearth of organisational maturity and consensus’ during the mid-nineteenth century.313 Disunity among the profession was exacerbated by a ‘great variety of medical backgrounds, and intense competition for patients’, and these factors contributed to the failures of early New South Wales medical societies and journals.314 Additionally, the lack of medical societies and journals from an early stage contributed significantly to the continued lack of unity amongst the medical profession in that colony. Lacking an early catalyst similar to that experienced in Victoria, these problems were not overcome in the early stages of self-government, putting medicine in New South Wales at a disadvantage in its negotiations with the state and delaying the establishment of medical dominance.
311
P. Martyr, ‘When Doctors Fail: Ludwig Bruck’s List of Unregistered Practitioners (1886)’, Electronic Journal of Australian and New Zealand History 1/10/1997,
http://www.jcu.edu.au/aff/history/articles/bruck.htm; idem, A Paradise of Quacks: an alternative history of medicine in Australia (Paddington, NSW: Macleay Press, 2002).
312
In 1886, the population of New South Wales was 1,001,966 and so there was one unregistered practitioner per 5330 people. Victoria, with a population of 1,003,043, had one per 77,157 people. Tasmania had a population of just 137,211, and one unregistered practitioner per 45,737 people. These figures accept Bruck’s definitions and assume that his list provides a relatively accurate representation of unregistered medical activity. It uses the population estimates produced and accepted by contemporary official statisticians. See T.A. Coghlan, The Wealth and Progress of New South Wales, 1886-87 (Sydney: Government Printer, 1887), p. 130; Walch’s Tasmanian Almanac for 1888
(Tasmania: J. Walch & Sons, 1888), p. 241.
313
Lloyd, op. cit., p. 23.
314
Although Tasmania similarly lacked an early catalyst pushing the medical profession into early organisation, it was not disunity that caused it to lag behind the progress of medicine in Victoria. By far the smallest of the three colonies, in terms of population, Tasmania had correspondingly fewer doctors. The critical mass or, more importantly, geographical concentration of medical practitioners necessary for a formal association to be formed was not achieved in Tasmania until the late nineteenth century. Also, Bruck’s List indicates that quackery did not present a major threat to the livelihood of Tasmanian medical practitioners, thereby removing one of the major impetuses to unification. Nevertheless, Tasmanian practitioners were as interested in keeping abreast of medical developments, both international and intercolonial, as their brethren in Victoria and New South Wales, and keen to promote the interests of the profession, as their involvement in medical politics through other means demonstrates. Hence, they read and contributed to journals published in Melbourne and Sydney and, in some cases, joined the Victorian branch of the BMA. The differences between the colonial medical communities were reflected in the different extents to which medical expertise was influential in state policy formation. A more cohesive and organised profession in Victoria was particularly significant in the early enactment and implementation of compulsory vaccination, establishing precedents that were to have enduring consequences. The relative disorganisation of the medical professions in New South Wales and Tasmania, on the other hand, affected their ability to pressure the state successfully on the issue of compulsory vaccination legislation. This correlation between unity and influence was true on both general organisational and issue specific levels.
Articles concerning vaccination and smallpox were prominent within the medical press. It was an obvious means of communicating details of epidemics and the methods employed to curb them, to discuss contentious technical points, and to provide arguments for the medical readership to employ when challenged on the issue.315 This latter point is a tacit acknowledgement of the power and influence of the individual doctor, and the important role he played in the vaccination debate. Articles were repeatedly devoted to proving the efficacy and value of vaccination, to refuting the allegations made against it, and generally establishing vaccination as an unassailable tenet of medical orthodoxy. Why do all this if the medical community was already overwhelmingly pro- vaccinationist? One reason was that it served to shore up the foundations of faith so that they
315
would remain pro-vaccination, and not be gradually eroded by negative responses from the public, acting as peer-support networks for medical practitioners.
This was especially important for remote practitioners, with few alternative support systems. Thus, James Jamieson wrote an article in which he declared it to be ‘almost a kind of slaying of the slain to prove that vaccination acts in the way of preventing small-pox’, and then proceeded to do exactly that over three pages.316 As anti-vaccinationism gathered momentum in New South Wales, a helpful article was produced that described vaccination as ‘being so self-evident to all, except some few persons blinded by prejudices so erroneous, as to lead to the natural supposition that they are slightly insane.’317 In addition to carefully scripted vitriol, the author presented arguments for compulsion, against the transmission of secondary infections, and outlined the safe way to collect and transfer humanised lymph or calf lymph, should the patient be so stubborn as to insist. In this