In The Beginning
Medical organisation in Australia began very shortly after that in England and it was meant to deal with much the sameset of circumstances as those in the old country. In England, the Provincial Medical and Surgical Association had been founded in 1832 in the rural area of Worcestershire, primarily through the efforts of Dr Charles Hastings of the Worcester Infirmary and a group of supporters, with four basic and seriously difficult objectives. As its name implies, one reason for beginning this “Great Experiment” was to resist what was considered to be the overweening influence on the profession of its practitioners in the great medical centres such as London, Edinburgh and Glasgow. Another was the need to unite and represent the physicians, surgeons and other medical practitioners and defend their interests from those of the apothecaries, barbers, blood-letters and all the other disparate groups who had attached themselves to medicine in those days. Associated with that was the need to establish and impose on its members a rule of ethics that would end the quackery, in-fighting, poaching, urging, jobbing, secret commissions and other practices that had disfigured the profession to that point. Finally, through activities such as meetings, discussion and publication of papers, the new association set out to raise the standards of medical science and practice and to encourage scientific study. Most significantly for the profession in Australia as well as in Britain, the association adopted Dr Hastings’ strongly-held (though not at first universally-supported) view that, if the new association were to achieve all these objectives, especially that concerning health standards, it needed to act politically.
Considering the task it had set itself, it is not hard to understand why it took almost 25 years for the association to establish its national credentials, taking up the title British Medical Association(BMA) from another group that had expired along the way. The new organisation and its members had achieved much in that time. They had persuaded Parliaments to establish the General Medical Council and the Medical Register and impose professional and ethical standards on medical practitioners in a legislative environment familiar to us today. They had driven the great sanitary and other public health reforms that had been achieved in Victorian Britain, ensured the paramountcy of health and safety in the new factory legislation and helped reform the medical education system (including training for nurses and midwives). These achievements had been hard won. As Dr Hastings had discovered, doctors proved notoriously hard to organise. But, in the process, members of the new association also gained great advantages for their profession. Through organisation, cooperation and collegiality, the new body had developed into a national force for great public good. By tackling the quacks and chancers who had so discredited medicine, it had also resurrected and cemented the reputation of a profession that had gone through hard times.
Medical professionals in the new colony, some of them themselves members of the BMA, watched all this with great interest, and an ambition to repeat it in Australia. It was recognised that the physical and social conditions in early Australia were harder than any known in England and that what health systems existed here were different in each settlement. Moreover, the BMA experience showed that any effort to extend the BMA’s achievements to Australia would almost certainly run into the English difficulty of organisation among doctors. Though the Australian environment and society were so vastly different, doctors in the new colony did share one condition with their English counterparts, one that had so complicated efforts to organise in England: an extremely competitive professional culture. So, for years after European settlement in Australia, doctors had formed groups that came and fought and went – flaming and dying out. Even as late as 1847, the first medical journal published in Australia, The Australian Medical Journal, had cause to complain in a tetchy editorial that:
“there is not any portion of the community so completely disunited, so thoroughly disorganised. So notorious is it that the squabbles of the doctors have become a standing jest to the non-medical public, much of our liberality to whom proceeds from our illiberality towards each other, and who, while it reaps a rich harvest of benefits in innumerable ways consequent on our constant endeavour to outbid each other for its favours, laughs in our face and sets us down for a set of nincompoops”.
Nearly a generation later, things had still not got much better. In 1870, The New South Wales Medical Gazette (itself, as it turned out, only a temporary phenomenon, a casualty of the disharmony) described what it called “the mischievous state of medical ethics by the establishment of medical societies”. Many attempts had been made to remedy this, it said, but they had failed:
“through the restrictions enforced by their rules and by-laws . . . The want is felt in every town or district of town or country of a society founded on the broadest possible base both as to admission of members and subjects for discussion."
The history of early medical organisation in Victoria and New South Wales provides spectacular examples of this.