The Nation Celebrating the centenary of FederationAustralian medicine in the last 50 years: from solid foundations to staggering diversity | 
MJA 2001; 174: 3
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On 1 January 1901, six separate British colonies united peacefully to
become a nation of fewer than four million people which it was hoped
"would dominate the Southern Seas . . . and be a permanent glory to the
British Empire".1 The nation was the
Commonwealth of Australia. Its citizens were both defiantly
Australian and proudly British.
For these Australians life was severe and short, plagued by pestilence and poor public health. The new nation's infant mortality rate was 103 per 1000 live births, and the average life expectancy was 55.2 years for men and 58.8 years for women. Infectious diseases, particularly tuberculosis, were the main causes of death.2,3 It was the age of the family doctor. He was a graduate of one of the three newly founded colonial medical schools or, more likely, of a medical school in Great Britain. The scientific breakthroughs of Lister's antisepsis and advances in anaesthesia were raising surgery to new heights, but most medicine was largely empirical, and devoid of an extensive experimental basis. It was the age of Osler's medicine, with its emphasis on the trust inherent in the patient-doctor relationship; on diagnosis underpinned by observation, the use of hands and the stethoscope; and on wisdom born of experience. Pursuing postgraduate education, or gaining membership of the Royal College of Physicians or Surgeons, meant a lonely exile in the "old country". This issue of The Medical Journal of Australia coincides with our nation's 100th birthday. As we reflect on what defines this young nation, two features stand out -- our diversity and our tolerance. Close to one in four of our nearly 20 million people are not of Anglo-Celtic or Aboriginal descent4 and about one in five are born overseas, increasingly in Asia.5 We are still defiantly Australian but less proudly British. Our lives are longer and less severe; the infant mortality rate is now five per 1000 live births, and the average life expectancy has increased by 20 years for men and 23 years for women.3,6 Except for our Indigenous communities, infectious disease is no longer society's scourge and the major causes of death are now intertwined with longevity and our affluent lifestyle.2 This is the age of the specialist, a graduate of an Australian medical school with diplomas from Australian clinical colleges. Australian medicine, as elsewhere, is now dominated by science and technology. Exactly 50 years ago the Journal celebrated the Commonwealth's Jubilee with a special issue "to show how the practice of medicine has developed in this country in the first fifty years". Then, the Journal concluded that "the record will give cause for satisfaction".7 And what a record it was! Research was fostered through the growth of institutes such as the Walter and Eliza Hall and the Baker in Melbourne, the Kolling and the Kanematsu in Sydney, the Institute of Medical and Veterinary Science in Adelaide, and the State Institute of Medical Research in Brisbane. To promote cooperation between the Federal and State governments, public health was given new status with the establishment of the Federal Department of Health and the Federal Health Council. The opening of the Commonwealth Serum Laboratories in Melbourne fostered a sense of national self-reliance through its production of biological products for human and veterinary use. In fact, our growing national certainty fuelled the founding of the College of Surgeons of Australia (later to become the Royal Australasian College of Surgeons) and the Association of Physicians of Australasia, including New Zealand (later to become the Royal Australasian College of Physicians). The National Health and Medical Research Council was established, as were teaching hospitals in our major cities, which flourished despite a "town and gown" divide. Two world wars moulded our national identity, and from their carnage and chaos emerged unforeseen medical advances. Finally, at the end of our first 50 years, the Commonwealth Government approved plans for a National Institute of Medical Research, which became the John Curtin School of Medical Research. These achievements laid solid foundations for the next half of the century. To celebrate the centenary of Federation, this issue of the Journal explores how medicine has developed in these past 50 years. We asked doctors to identify defining moments in Australian medicine; to chronicle changes in disease, ethics in medicine, medical education, research, public health, and pharmacotherapeutics; and to explore the problematic issue of medicine's march towards increasing specialisation. What emerges is a record of staggering diversity that "will give cause for satisfaction". However, this record also contains forebodings of division and disunity, strangely reminiscent of the colonies before Federation. The last 50 years have seen the demise of extensive empires, but the annals of Australian medicine in these years contain echoes of Winston Churchill's prophetic pronouncement in the 1940s that "the empires of the future are the empires of the mind". Martin B Van Der Weyden
©MJA 2001
Readers may print a single copy for personal use. No further reproduction or distribution of the articles should proceed without the permission of the publisher. For permission, contact the Australasian Medical Publishing Company. Journalists are welcome to write news stories based on what they read here, but should acknowledge their source as "an article published on the Internet by The Medical Journal of Australia <http://www.mja.com.au>". <URL: http://www.mja.com.au/> © 2001 Medical Journal of Australia. We appreciate your comments. |
