C.E. COOK, C.B.E., M.D.
At the outset may I express my deep appreciation of the honour, implicit in your invitation to deliver the Herbert Michael Moran Memorial Lecture in Medical history? Conscious of this honour and its obligations, it is with some diffidence that I undertake the task. Leaving aside my personal shortcomings in preparation and address, which I must assume were already discounted when the invitation was extended, I still remain in doubt whether, for Moran’s purpose, my subject can qualify as medical or the entire period to be traversed as history. I derive some reassurance from the reflection that Herbert Michael Moran, athlete, surgeon, solider and man of letters, himself signally accomplished in this diverse array of human activities, was possessed of a deep interest in mankind. In him a critical perception of human follies and motives was tempered by a generous admiration of purpose and achievement and a sympathetic understanding of failure and defeat. To him, I am persuaded, the story of the part played by his own profession in a conflict between two civilizations in his own country would not have been unimportant.
The native Australia in his own pristine habit wore no clothing, built no dwelling and practised no agriculture or animal husbandry. He moved in small groups over wide but precisely delimited tracts of country, living as a hunter on nature as he found it, his itinerary and his duration of his stay in one place being determined by the seasonal availability of water and food or by ceremonial obligation. His diet was predominantly one of animal protein supplemented by fruit, roots and honey from the bush around him.
Contact between groups of the same tribe was of inconstant frequency and duration; contact with adjacent tribes only occasional and brief. Social organization was designed to assure exogamous marriage, and polygamy was the rule. In most tribes motherhood came early, not unusually at 14 years.
The size of the population before white settlement in the area now called the Northern Territory is unknown estimates range from 30,000 to 50,000.
Infant mortality was probably high. There was no convenient substitute for milk during the weaning period, and infanticide was practised to meet the difficulty of a mother feeding or carrying more than one infant. Commonly there were two children to a family, the survivors of perhaps five births.
Apart from deaths by violence, the adult death rate was probably not unduly high. Early reports suggest that a fair proportion survived to reach the age of 70 years.
In his mobile isolation, the Australian seems to have been singularly free from the infections which have for centuries plagued other people of the world living in static communities amidst the accumulated by-products of human and animal existence. In this security he learned nothing of the importance of sanitation and safely practised negligent habits of waste disposal utterly incompatible with life in a settled community.
The only communicable diseases certainly known to have been endemic amongst the tribes were trachoma, framboesia and venereal granuloma. Smallpox is said to have occasioned heavy mortality along the north cost about 1860, but the authority for this report is uncertain. Malaria and amoebic and bacillary dysentery were introduced to the north coast by Malay traders and by the early British military settlements, but there is no evidence that these became permanently or even temporarily established in the tribes. Indeed, the quarantine barrier imposed by respect for tribal boundaries would normally have been made extension unlikely, whilst the native’s lonely wandering existence in an area subject to successive seasons of drought, fire and flood would have favoured eradication of most infections introduced from these sources.
There was no knowledge of the aetiology of disease or of specific therapy. Decoctions of leaves or gum, hot sand or ashes might be used as local applications for the relief of pain; a tight band around the head was specific for headache. For more intractable conditions, recourse was taken to magic – incantations supplemented by bleeding or incision and feigned removal of foreign bodies from the area of pain.
Injuries were better understood and more rationally treated. Burns, by far the commonest accident owing to the practice of sleeping close to fire, were treated with decoctions of bark containing tannin, and with ashes. Fractures were immobilized in splints of bark and clay.
A striking feature was the uncomplicated healing of extensive lacerations. All the early observers were impressed by the rarity of secondary infection. This attribute permitted gross surgical assaults upon the person for ceremonial or ornamental purposes. These included perforation of the nasal septum, knocking out of an upper incisor, amputation of the terminal phalanx of a finger and keloid scars on the face, the torso and upper parts of the arms. The last-mentioned were produced by rubbing earth in deep cutaneous incisions, and after healing were commonly as thick as, or thicker than, the finger and perhaps twice as long.
In most tribes, initiation of the male involved circumcision and to many subincision also. The latter was sometimes completed in stages, but ultimately entailed an artificial hypospadias from meatus to scrotum. The cutting instrument was traditionally a sharp stone or shell. These operations were, of course, performed without anaesthetic, the boy being held by close male relatives. Contrary to reasonable assumption, subincision was not practised as a measure of birth control; most tribes appear to have had no idea that conception was associated with sexual intercourse. Pregnancy was believed to result from entry of a spirit into a woman passing a spirit centre. The lighter colour of a mixed-blood child was easily explained – “too much me bin eatem white feller flour”.
Ornamentation for ceremonial occasions commonly involved withdrawal of blood to be used as a fixative for decorative features or fibres. As much as a pint would be withdrawn from the ligated veins at the elbow, or a few drops by tearing apart the mucous membrane of the sub-incised urethra.
A belief that the weak and ailing could acquire the strength of the young and physically strong by drinking their blood led to voluntary gifts of blood to the old. Not offered, but much prized for the same purpose in certain tribes, was human perirenal fat. This was forcibly taken from the healthy youth through a lumbar incision. If the operator were inexperienced, anatomically misinformed or overcome by sympathy for his victim, only subcutaneous fat might be taken. The survival rate of this operation subsequent to the introduction of European pathogens was low.
The earliest attempts to colonize the north coast of Australia were made by the British Government, military and convict settlements being established successively at Fort Dundas on Apsley Straight (1824-1825), at Raffles Bay (1827 – 1829) and at Port Essington (1838-1849). At Fort Dundas the hostility of the natives confined enterprise to the immediate neighbourhood of the stockade, and this experience seems to have influenced policy at later settlements. Even though more friendly relations and sustained contact were established at Port Essington, no development of the hinterland was attempted, and the tribal life continued undisturbed.
Malaria, typhoid and dysentery introduced by store ships from Asian ports were at time epidemic in all these settlements, but there is no record of serious involvement of the native population nearby.
Soon the exuberant growth of Singapore diverted from the outposts the lucrative eastern trade they had been expected to attract, and changes in the global political situation robbed them of their strategic value. Port Essington was evacuated in 1849, and efforts to colonize the north of Australia from England came to an end.
In 1863, South Australia was extended to include the Northern Territory, and in 1864 an expedition under Boyle Travers Finniss was dispatched to select and survey a port and capital on the northern coast.
During its early years, the young colony had learned that degradation, spoliation and extinction of the native tribes were usually the price of successful white settlement. The South Australian Register in 1840 commented that natives had acquired nothing of European civilization but its vices and diseases, and concluded that unless something were promptly done, the speedy extinction of the whole race was inevitable. Some years later, Curr remarked that 15% to 20% of natives fell to the rifle and disease took the rest.
In this atmosphere, the South Australian Government set itself to design a native policy for its Northern Territory. It would attempt to effect the easy adaptation of the native into the new society, hoping to establish him as a contributing and participating partner in the colony’s greater prosperity. As a first step, a Protector was included on the establishment of Finniss’ expedition, and the officer chosen was the Colonial Surgeon, Dr. F. E. Goldsmith, whose duties as Protector were set out in special orders. As Colonial Surgeon he was to prevent the affliction of the native people with imported communicable disease. As Protector he was to learn the language, study the social organization of the tribes and recommend the siting of reservations for their exclusive occupancy. He was to foster friendly relations and offer inducements to them to work, to encourage trade, and to police scrupulous discharge of obligations to them. He was to make them comprehend their privileges and responsibilities as British subjects, to prevent interference with their women or their debauchery with liquor, and to control the issue of relief rations. These were staff orders and had no background of special law.
It is tempting to believe that the choice of the surgeon to act as Protector was dictated by an enlightened prescience. The transfer of white settlers from a temperate zone to a tropical area, there to live under conditions of primitive sanitation in proximity to a native population, was well recognized in later years to be attended by hazards to the health and survival of both peoples. More probably, the choice was determined by recognition that of all Finniss’ officers the surgeon would have most time for the extra duties involved.
Whatever the Government’s intentions and hopes, Goldsmith’s term as Protector was a complete failure. He early incurred the hostility of Finniss by holding an inquest on the death of a native shot dead by one of the party during a skirmish. Finniss told his Minister that the appointment of a Protector was premature, and that the instructions issued to Goldsmith could not be reconciled with the role of the expedition, which was, he held, to take the country by force.
Unable to rid himself of Goldsmith, Finniss set about making his life burdensome and the discharge of his office impossible, openly scoffing at his medical competence, undermining confidence in his ability and ridiculing his advice for improving the sanitation of the camp and the diet of the party. The labour necessary for his natural history and acclimatization studies was refused.
Goldsmith resigned and returned to Adelaide early in 1865; Finniss, officially placing on record his personal gratification, added that he himself, otherwise must have dismissed him.
The duties of surgeon for the population of 170 were undertaken by Dr. Ninnis of H.M.S. Beatrice, and the function of Protector appears to have lapsed.
Later in 1865, Finniss was recalled, and Surveyor Goyder was sent north to find another site for settlement; he was accompanied by Dr. J. Stokes Millner. Goyder chose a site on Port Darwin which he called Palmerston, and in 1870 Lieutenant Bloomfield Douglas was appointed Government Resident, with Millner as his Colonial Surgeon and Protector of Aboriginals.
The earlier white settlements – the British garrisons and Finniss’ expedition to Adam Bay – affected native life but little. The first radical change attended the pastoral development that followed the new settlement at Palmerston.
To recruit young able-bodied natives of both sexes to his service, the white settler offered food which the native found palatable, and in some respects more easily obtained, more certainly assured, more convenient to prepare and more liberal in supply than that to which he was accustomed. As a further inducement, tobacco was regularly supplied and sometimes alcohol, or even opium.
The depasturing of stock in unfenced country involved risk of loss by dispersion. In the dry season natural waters were far apart, and to prevent straying the grazier relied heavily upon the habit of stock grazing within easy distance of a particular waterhole. Native camps on waterholes and native migration and hunting pursuits harassed cattle, impaired their condition and drove them from pastures and waters accessible to the stockmen. To reduce this loss, the grazier encouraged the natives to camp more or less permanently in the vicinity of his homestead by issues of food, consisting chiefly of beef, flour, sugar, salt and tea. The beef was locally available and in abundant supply. The other items had to be bought and carried long distances by infrequent and slow wagon or pack-horse train. The new diet, therefore, like the old, was mainly one high in animal protein.
So, for the first time, the wandering hunting life was interrupted, and the native began to settle in camps, bringing to the new life the unhygienic habits he had safely practised for centuries. No one thought to warn him of the dangers, to plan the camps or to instruct him in community life. In the result, there were created conditions of filth and insanitation imperilling the health of both races.
New dangers attended railway construction and mining, which followed the pastoral development. Alluvial mining involved widespread destruction of vegetation along river flats, and the extensive inversion of soil types by the burial of rich surface loam under the unproductive clays, shales and rock excavated from the underlying strata. Agriculture also meant destruction or dispersion of native game and eradication of much of the native food flora.
The effect of these influences was to render the normal native life more arduous and less attractive. Game was dispersed, and many of the sources of vegetable food were destroyed or denied. Simultaneously, the active adolescent engaged in pursuits about the station or attending mission school, had little opportunity to develop his hunting arts and skills, whilst he acquired new wants which the old life could not satisfy. At a time when the hunter and forager must go further afield, the younger and more agile were preoccupied with new types of labour, and those dependent on them became more and more reliant upon white bounty.
In 1874, Chinese coolies were introduced to work on the newly discovered goldfields. More were later imported for railway construction. Having no women of their own, they procured native women for prostitution, attracting the natives to their camps by liberal gifts of food and liquor and the inculcation of the opium habit. Opium smoking at this time was not an offence at law, and excise was an important source of revenue.
From this time forward, the Colonial Surgeons’ reports referred to increasing morbidity and mortality amongst the tribes in contact; phthisis and respiratory infections, dysentery, malaria, venereal disease and later leprosy each took its toll.
The Surgeon Protectors were given no special statutory power, and for legal support depended solely upon the provisions of the common and criminal law. This circumstance perhaps explains their inaction, as year after year they watched the progressive degradation of the native and the advance of disease. Annual reports were meagre and uninformative, except as records of inactivity. The spirit of the time seems to have been acceptance of the inevitable. Just as the zeal of Goldsmith had infuriated Finniss, so the complacency of later Colonial Surgeons may have been agreeable to their Government Resident.
A glimmer of an active spirit of sympathy glowing behind the façade of official complacency and political expediency was revealed in 1884 by Dr. R. J. Morice (Colonial Surgeon 1877 to 1884), and like Goldsmith, he paid for his intervention with his office. Dr. Morice, in defiance of Government Resident Parsons’ direction, briefed counsel for the defence of natives charged with the murder of four white men on the Daly River, Parsons, who was of recent appointment, believed, perhaps with reason, that the Colonial Surgeon had lent himself to a legal conspiracy to embarrass the Government Resident, and he terminated Morice’s services.
During his dispute with Morice, Parsons learned for the first time that the Colonial Surgeon, as Protector, had obligations to Adelaide and to the Government Resident, of which he had previously been unaware, and which no one since Goldsmith had attempted to discharge. In appointing Percy Moore Wood (1885 to 1889) to replace Morice, Parsons directed him actively to discharge the duties originally allotted to Goldsmith, including the planning of native reserves.
Wood reported in natives a high incidence of tuberculosis, venereal disease and malaria, and a heavy mortality from tuberculosis and malaria. He undertook mass vaccination of the native population of Palmerston, assuring their protection from smallpox introduced to the port from time to time by Chinese immigrants. He identified beriberi in native prisoners in Palmerston gaol and eradicated it by improving the prison diet. He found 10 cases of leprosy in Chinese, and initiated the South Australian legislation for notification and isolation which subsequently served as a model for the other States. He complained of the degradation of natives by voluntary and procured prostitution, organized by Chinese and Malays. He recommended a member of aboriginal reserves, but these were subsequently described by Baldwin Spencer as neither suitable nor adequate for their purpose.
To Wood belongs the credit of stirring in Government and public a consciousness of obligation, a realization that current methods of native administration were inadequate, and recognition of the need for legislation to permit the control of vice and to prevent abuses in employment.
He was succeeded in 1890 by O’Flaherty, who tenure of office until 1896 is notable only for his identifying in 1890 the first case of leprosy in a native, and for returning to his tribe a second leprosy subject found four years later.
F. Goldsmith, who followed O’Flaherty in 1896, renewed Wood’s agitation, and pressed for legislation to make the nominal protection an effectual reality. He forecast the early extinction of the Larrakia – the Port Darwin tribe – owning to paucity of children. He reported that he was rarely consulted by natives, but was concerned mostly with the very ill or moribund admitted to hospital. He described respiratory disease, including tuberculosis, as levying a heavy toll on natives. Referring to the prevalence of leprosy in the Alligator River tribes, he advocated measures of control “before natives frequenting white settlement become affected”. Goldsmith played an active part in agitation for an Australian Institute of Tropical Medicine.
In 1904, Goldsmith’s successor, Kennington Fuller, impressed by the inability of the police to prevent the increase in opium addiction in Aborigines, succeeded in having a law passed totally prohibiting the importation and sale of opium – a law described as effecting a decided decrease in the traffic and removing one of the worst dangers threatening the native.
Cecil Strangman, appointed Surgeon Protector in 1905, held that his duties as Protector interfered with his practice, and after two years he had he office transferred to the police. So, for the first time in the Territory’s history, responsibility for native welfare passed from medical into lay hands.
In 1911 the Northern Territory was transferred from South Australia to the Commonwealth. The change in administration was heralded as the dawn of a bright new era of development by a healthy, prosperous and increasing white population; indeed, in the years immediately following there was considerable activity.
Anton Breinl, Director of the newly-established Institute of Tropical Medicine at Townsville, made surveys of the incidence of tropical disease, and warned that the detection and cure of epidemic disease, including malaria, were conditions precedent to successful white settlement.
Baldwin Spencer, Professor of Biology at the University of Melbourne, who had attained distinction as a student of Australian anthropology, was appointed a Commissioner with the powers of Chief Protector, to study the needs of native administration and to frame a native policy. He recommended a system of protection based upon inviolable reserves in which surviving tribes could continue their traditional tribal life without interference, and regulation of the conditions of association between black and white in the areas of contact. The reserves he recommended were not gazetted until 1920.
The newly passed Aboriginals Act (1910) of South Australia was adopted as Territory law, and a special corps of three Medical Protectors was appointed. Now, medical officers and sanitarians were to have a free rein to penetrate into tribal country to seek out and cure disease and to remedy contributory conditions.
Basedow (as Chief Protector), Burston and Holmes took their duties in the middle of 1911. These appointments suggest that, initially at least, the Commonwealth Government, like the South Australian Government 50 years earlier, looked upon the native problem as principally medical, and from its greater resources provided a trained staff that the State could not afford. If this were so, it proved no firm conviction; within a year the plan had been abandoned. Basedow resigned within three months, and Burston on completion of a year’s service.
Baldwin Spencer succeeded Basedow as Chief Protector, and left the Territory finally after a year. The responsibility of administering the Aboriginals Ordinance was nominally assumed by the Government Secretary, and the duties of the office were discharged with diminishing zeal and efficiency by a succession of administrative officers of progressively lower rank, until in 1920 the function of protection reverted once more to the police.
Holmes’s enlistment at the outbreak of the Great War in 1914 had left Darwin with only one medical officer, Leighton Jones, who continued as Chief Medical Officer and Chief Health Officer until 1927, assisted for some years after the war by a succession of quarantine officers. Jones improvised and conducted with skill and ingenuity a special hospital to provide medical attention for natives living in the vicinity of Darwin; but as before, this service was limited to the relatively few who sought attention or who were presented by police or employer.
In 1925, it fell to my lot to conduct, on behalf of the London School of Tropical Medicine, a medical survey of the Aboriginal population of the Northern Territory. At that time there was no exact knowledge of the morbid conditions affecting the native population before white settlement, or subsequently. The Colonial Surgeons had had no contact with tribes outside the Port Darwin Area, and even here only with prisoners, the gravely ill, or the seriously injured brought to hospital by employer or police. The native sick preferred to return to their own country, and were lost to view whether they recovered or died. There were available none of the modern aids to precise diagnosis, and out of respect for native prejudice and fear, autopsy was performed only when it was obligatory under the law. There remained the opportunity to note those maladies, mostly infective and readily identifiable in retrospect, which had an incidence so heavy or a course so acute that they were noted in the scanty medical records of the time.
Granuloma, yaws and trachoma were indigenous. After white intrusion, respiratory infections took a heavy tool everywhere and at all ages. Smart outbreaks of typhoid and dysentery, usually associated with Chinese mining camps, occurred from time to time and had a relatively high mortality.
All Colonial Surgeons had referred to the importance of tuberculosis as an agent of depopulation; its distribution, however, was strictly focal. Clinically at this time it showed a tendency to miliary infection with a rapid course to fatal termination. Whilst it contributed to the decimation of tribes in the mining belt or achieved heavy incidence amongst natives exposed to patients with open lesions on mission staffs, it did not reach their neighbours.
Leprosy, introduced by Chinese labour, spread sporadically amongst the remnants of tribes in contact with railway and mining camps; but the depopulation of these areas and intertribal quarantine limited its extension and favoured its ultimate disappearance.
Hookworm, chiefly of Asian origin, had attained a high incidence on certain missions, and from these centres was being disseminated by population movement to new areas.
Malaria, brought in by immigrants from South-East Asia and New Guinea, continued focally endemic, with sudden epidemic exacerbations under the influence of natural or artificial environmental change. The number of deaths from epidemic and endemic subtertian malaria can only be conjectured, but over the years it must have been considerable.
Gonorrhoea widely prevalent in natives living in association with Europeans in town or country, seriously reduced fertility and contributed to reduction in the birth rate.
At that time, the greater part of the native population still held aloof from white settlement, and intruders into native country risked death from the spear. More than 70% of the estimated Aboriginal population were nomadic, and of the remainder in contact with missions, employed seasonally on stations or casually in townships, the great majority returned to the tribal life for much of the year.
Outside Darwin and the small railway townships linked to it, there were very few white women and virtually no white children. Isolation from European contact and constant association with Aborigines of both sexes led white men in the pastoral industry, prospecting or on official duty at outposts of Government, to adopt, with varying degrees of abandon, a standard of living more nearly approximating that of the Aboriginal than that of the white. Under these conditions, the endemicity of malaria, hookworm and leprosy and the prevalence of venereal disease in natives posed a threat to successful settlement.
In certain areas, particularly where there had been Chinese camps, the high mortality and low fertility rates resulting from uncontrolled prevalence of disease had accomplished or were threatening extinction of the local tribes.
Respect for intertribal boundaries had served as an effectual quarantine barrier, protecting adjoining tribes from infection by their neighbours. Removal of natives from endemic areas to or through new country by employers or missions, and enticement of natives from unaffected areas to missions or into townships for employment, were tending to remove these safeguards.
Concentration and retention of natives on mission stations, without either instruction in the hygiene demands of community life or facility to meet them, had produced foci of heavy and increasing prevalence of endemic disease. Missions, too, relied upon the native continuing to feed himself and his family at least in part from natural sources, and provided only a supplement of flour, sugar and tea. Mission sites were usually badly chosen, and lacked the resources to support for long the population attracted to them. Natives came to rely too heavily upon the ill-balanced, inadequate mission rations, and malnutrition and vitamin deficiency diseases followed.
Essential ingredients for a native policy clearly included: (i) provision of an efficient medical service equipped with aid posts, hospitals and adequate means of communication and transport available promptly on call for both races, at a cost within the reach of all; (ii) active and unremitting search for, and curative treatment of carriers of communicable disease in both races; (iii) measures of environmental sanitation and prophylaxis to prevent the dissemination of communicable disease in township, camp, or mission; (iv) control of native employment to safeguard the health of both races; (v) instruction in nutrition, particularly in infancy, to assure the safe transition from native to European diet; (vi) control of the conditions under which natives were accommodated and fed, whether in employment or on missions.
No medical service could succeed in these tasks without the powers over the individual, black or white, conferred by the Aboriginals Ordinance. No lay authority could make the attempt. The Colonial Surgeons had had no support in law and no organization. The police had had legal heads of power and organization, but no medical or hygiene training. A medical service could quite successfully perform any function of which a lay service was capable, and to avoid the expense and confusion of dual control, it was recommended that the role of protection should be vested in the Chief Medical Officer.
In 1927, after the appointment of the North Australia Commission, this recommendation was implemented. The Chief Protector now had the medical training, the legal powers and the organization necessary for the performance of this task.
Hitherto, Medical Protectors had reported that they knew nothing of the natives outside the settled areas. They had no opportunity to assess the incidence of preventable disease or to apply measures of control. By combining the functions of health administration and native welfare, the Health Officer now gained direct access with full authority to every native (whether employed or not), to every employer of native labour, to every camp and to every mission. Active search for disease was undertaken by routine medical inspection of every native in contact at least once every year. The occasion of engaging labour was as a routine made the opportunity to submit the native and his family to medical examination, to dictate the hygienic conditions under which the employee was to be housed, fed and employed, and to refuse a licence to employ where medical records disclosed that the proposed employer or any of his family suffered from any disease likely to be communicated to the employee.
The Chief Protector was in a position too, to dictate the conditions of accommodation and diet on missions. He could secure the amendment of legislation in the fields of both heath and native administration, to accommodate the problems of each. Above all, the confidence inspired in the individual native by the role of Protector in great measure offset the fears and doubts attaching to the role of medical practitioner.
The develop the policy, a medical service was created for the Northern Territory in 1928. From 1928, its first complete year, the financial embarrassments of the great economic depression had to be confronted. Development and extension of activity had largely to rely upon funds the service itself could generate locally. This was attempted from licensing fees, medical benefit funds and collection of hospital and medical fees, so successfully that within a decade five hospitals and a leprosarium had been established outside Darwin and a staff of six medical officers attained.
By the mid-1930’s, the enterprise and dedication of one of these, Clyde Fenton, had developed a Flying Doctor Service, and the Chief Protector was able to impose upon the applicant, as a condition of a licence to employ Aborigines in country districts, the obligation to provide an airstrip to specifications set out by the Department of Civil Aviation. Medical officers or specially trained patrol officers travelled throughout the Territory in an active search for the carriers of communicable disease. Patients detected were treated or isolated, and appropriate measures of environmental sanitation ordered. Nurses trained in infant care advised mothers on the rearing of children in an environmental where milk was an uncommon luxury. By this and other means, a standard of medical service was provided which encouraged the immigration of white women and the rearing of white families in country districts, so that, simultaneously with the improvement of native medical care, some of the problems deriving from miscegenation were minimized.
It shortly became clear that, as the eradication of disease arrested depopulation and assured survival of the native race, plans for its future must comprehend and facilitate adoption of white standards of living qualifying for comfortable accommodation in white society. This transition, it appeared, could best be commenced by the housing of detribalized natives in planned communities, where they could become accustomed to a well-balanced European diet and to residence in hygienic dwellings serviced with an adequate water supply and safe sanitary service, whilst their families were educated and reared like white children.
In 1935 this policy was approved by the Minister. A special area, to be equipped with its own cottages, school, hospital and gardens, was acquired in 1936 to accommodate natives living the Darwin areas, the intention being that this community should serve as a model for existing missions and for other stations later to be developed.
Irresolution about a proposal to establish an Air Force base nearby and indecision as to its boundaries postponed development of the project, which, barely under way in 1938, was further delayed by building difficulties and finally frustrated in 1939 by the outbreak of war and changes in administration.
As the financial depression eased and money became more freely available, the Commonwealth Government had considered creation of a Native Affairs Branch, apart from the medical service.
The medical officers of the Northern Territory Medical Service passed a resolution expressing the official and professional preference of each for the retention of the joint service in the interests of efficiency.
The Administrator affected to regard this as a threat to “strike” in an effort to dictate Government policy. He arranged to transfer the health and medical services of the Territory to the Commonwealth Department of Health, and the Chief Medical Officer was removed to duty elsewhere. A new native Affairs Branch was created within the Northern Territory Administration. The Northern Territory Medical Service has remained outside the responsibility of the Administrator ever since. Whatever virtue this odd dichotomy of Territorial administration may be considered to possess, it has the following objectionable features.
- The native welfare and medical components, though sharing common interests, are administratively divorced. On the one hand the welfare officer, who has the opportunity of sustained contact with the individual, the tribe, the settlement and the mission, lacks the training in medicine and hygiene permitting prompt discernment and remedy of health hazards in the existing or planned environment. On the other hand, the medical service has no executive authority and only episodic contact. Unfamiliar with the practicalities, limitations and niceties of native administration, medical officers cannot easily anticipate these hazards or perceive opportunities for their timely correction.
- Neither component has direct contact with the other, the official channel of communication being through Canberra.
- Policy in native welfare is formulated within the Administration and the Department of Territories, and can be strongly influenced by local considerations. Policy on health is determined in Canberra, in the context of completely different values.
- Advancement in the Department of Health is outside the Territory, and the local expertise of a Chief Medical Officer is lost with his promotion.
The administrative changes of 1939 removed from the Native Affairs Department all officers trained in hygiene and cognizant of the medical hazards of the new policy. At its very inception, an operation designed as a medical exercise to correct medical and social problems was taken out of the hands of its planners, and vested in a staff unequipped for the task and denied easy access to experienced advice.
In its early years, lack of coordination between the Native Affairs Branch and the medical service resulted in a number of regrettable developments. To cite but two, the herding of mission children in contact with infectious leprosy led in certain areas of endemicity to an incident approximating 50 cases per 100 of population. On some missions, prolonged consumption of an unbalanced diet low in animal protein resulted in a high level of macrocytic anaemia, particularly among the women.
During the Pacific war, tribes previously living bush lives aloof from white settlement were brought into close and sustained contact with service outposts and operational bases. Detribalization commenced in new areas, and it appeared desirable to accelerate the establishment of new transition settlements until all tribes could be serviced.
On resumption of civil administration in the Territory, funds being available, the Commonwealth adopted an active policy of multiplying native settlements, and today the distribution of the native population is in strong contrast to that of 30 years ago.
In 1963, of a total native population of 19,334, only 1-3% were described as “nomadic”, compared to more than 70% of 19,244 in 1933. Notwithstanding this mass withdrawal from the “bush”, only 10% were described as in regular employment outside missions and settlements, compared to 15.5% 30 years earlier.
With the effectual control of gonorrhoea by penicillin, the birth rate has improved materially. In the 1930s it was a common experience to find localities where there were young adults, but no children. Overall, children – including mixed bloods – represented from 20% to 25% of the native population. Today children represent 37%, the proportion on some missions running as high as 55%, a figure to be compared with the general Australian level of 30%.
Aboriginal infant mortality continues unduly high, an experience reported by every State of the Commonwealth. L.F. Jones reports that, of registered native births, 13.5% of the infants die in the first year and 20% in the first four years of life. Gastro-intestinal and respiratory conditions, unyielding to modern forms of treatment, are mainly responsible.
The closer observation permitted by the establishment of settlements, and the improved diagnostic opportunities of modern times, reveal an increased prevalence of diseases not formerly reported. In the 20 years from 1919 to 1939, no native deaths from cancer were recorded. By contrast, from 1959, 24 of 800 native deaths were reported due to cancer; whether this increased incidence reflects better diagnosis or racial response to the changed environment, or in some degree to both, is not established.
Notable today as a probably consequence of ample feeding and relative idleness are obesity and hyperglycaemia.
The medical problem of depopulation has been solved, but the Aboriginal evolving is vastly different from his ancestors. Perhaps too much has been attempted too abruptly.
The rigours of primitive existence in the bush, and the barbaric standards of survival imposed by tribal law, exerted a strict selection of physical and mental type. Attainment of proficiency as a hunter and the prospect of enduring agonizing initiation mutilation as a precedent to participation in solemn ceremonial ritual, gave life a reality of meaning and purpose not easily now discernible.
Today, concentrated in idleness on missions and settlements, fed as he is without hunting or hazard from communal kitchens, sharing common ablution and latrine blocks, the native’s individuality is in danger of submergence. In this environment of complete dependence, he does not acquire attributes and habits conducive to comfortable existence in the community outside when the accustomed help and facilities are not available.
The obligations to be undertaken, the difficulties to be overcome, and the means of coping with them are not brought to notice. It cannot be expected that he will learn the habitual selection and proper preparation of a varied and adequate diet comfortably within his means. He does not become habituated to recognizing and accepting his responsibilities to the community in the control of such diseases as malaria, venereal disease and leprosy – the obligation to notify occurrence and relapse, and the faithful compliance with social demands of prophylaxis and curative and maintenance therapy.
In danger, too, is the native’s concept of his special identify with nature. No more are deprivations, discomforts or hazards contrived by magical influences to be confronted by the bold and resourceful or propitiated by ceremonies effecting the spiritual cohesion of the tribe. Too easily now they can be attributed to incompetence, neglect or ill-will in the white management.
Sympathetic care and the devoted effort to converse intended by the Australian people as a belated but nonetheless real benevolence, may come to be looked upon as a birthright by the recipient knowing no other life. Desire, feeding upon satiety, may well develop into a waxing greed inspiring new demands which, if unsatisfied, will evoke the bitterness and resentment of deprivation.
The self- reliance, resourcefulness, proud independence and fortitude which gave dignity to the native’s ancestors are in danger of yielding place to the apathy of the indolent, the servility of the patronized and the petulance of the unsatisfied parasite.
The rising generation is in danger of becoming cynical ere yet it has known enchantment.
Withdrawal of the family from the bush for retention on a settlement while the child attends school has disrupted one social system without substituting another. It has, too, tended to invert the order of precedence within the family, destroying the respect for age and experience which is the basis of parental authority. In an environment created to simulate European living standards, the school child in and of the community soon learns to move with ease and confidence. In sorry contrast, his father, accustomed to a completely alien background, slow to adapt, idle except perhaps for some communal chore, too often appears a figure of ridicule dependent for help and assurance upon the child.
There is a pressing need for the training of the native in avocations for which his special inclinations and aptitudes best suit him, and for the development of industries in which, so trained, he can be employed. Unless inspiration and purpose can be restored to these lives, saved from extinction largely by medical care and now groping in obscurity for identify and destiny, they must be doomed to industrial and social calamity. Perhaps for these, too Moran would have prayed:
Grant them, O Lord, the vision of a star!
The Herbert Moran Memorial Lecture in Medical History of the Royal Australasian College of Surgeons, delivered on November 28, 1964, at Canberra.