by C.E. COOK (1963)
Abstract
Few of the diseases which in the past century have scourged the native population of the Northern Territory were indigenous.
Exotic infections introduced into areas where native society was intact disappeared under the inhibitory conditions created by the environment and native habit. Only when natives were concentrated into settlements without adequate hygiene instruction and without sanitary facilities, did these conditions proceed to destructive morbidity and mortality.
Lack of a readily obtainable and suitable supplement for mothers’ milk probably involved a relatively high mortality in the months of weaning. Apart from this, the dietary of the autochthonous Australian was probably adequate and well balanced even in periods of drought. An unbalanced diet on settlements has contributed to a high morbidity and mortality from deficiency anaemias and intercurrent infections.
It were perhaps well at the outset to qualify the somewhat pretentious title of this paper by stating its limitations. First we have no exact information about morbid conditions affecting the native Australian before the era of white settlement so that the disease pattern serving as the ultimate basis of comparison must be largely conjectural. Second, there having been in the early years of settlement little opportunity for medical contact with remote tribes, uninfluenced by European intrusion, none of the clinical refinements available today for the precise diagnosis of organic disease and no systematic and detailed recording of clinical conditions encountered, a complete comparison of the incidence of organic disease then and now is clearly impossible. There remains the opportunity to study the behaviour of those maladies mainly of infective or epidemic type which are readily identifiable in retrospect and which had an incidence so heavy or a course so acute that they achieved mention in the scanty medical records of the time.
Introductory
The behaviour of disease has been largely determined by the native social structure and mode of living and by the changes wrought in them by European influence. In his autochthonous condition the native Australia made no permanent camp, built no dwelling, accumulated no property, nor did he practice any animal husbandry or agriculture. In small groups, untrammelled by domestic impediments, he moved over considerable distances from water to water collecting his food as he passed from the natural bush around him. Contact with other groups of the same tribe was occasional and transient, contact with adjacent tribes minimal. He knew nothing of the relationship between infection and disease and consciously practiced no elementary prophylactic precaution in the disposal of human wastes. Nevertheless, all available evidence indicates that before white settlement, he was conspicuously free from most of those infections afflicting the static populations of the world living in permanent concentration in close proximity to herds of domestic animals amidst the accumulated by-products of human and animal existence. Indeed it might be reasonably expected that his lonely wandering life and an environment characterised by bright sunlight, extremes of temperature and a seasonal succession of flood, fire and drought, would together serve as a real if undesigned system of quarantine and disinfection sufficient to prevent the protracted endemicity of all but a few communicable diseases. By virtue of this protective mechanism, he was demonstrably able in complete security to disregard entirely the elementary obligations of personal and communal hygiene, neglect of which in more static societies would have been attended by recurrent disaster.
His diet at this time was rich in animal protein, varied, well balanced even in time of drought, and generally quite adequate to protect him from any deficiency disease. An important qualification of this generalisation refers to the weaning period. Having no domestic animal to serve as a source of milk the native mother can usually have had no readily obtainable and easily digestible supplement for or alternative to breast milk for her offspring at and after weaning. The conclusion is inescapable that malnutrition and anaemia must have contributed to a high mortality at this stage.
The universal practice of polygamy aggravated as it was by the marriage of girls and young women to older men, may be expected to have kept the birth rate relatively low. It seems probable, accordingly, that a low birth rate and a high infant mortality may, in conjunction, have effectively controlled natural increase and maintained the population at a steady level.
Historical
Early settlement of Northern Australia was by English military and convict colonisation of Melville Island (1824-28), Croker Island (1827-30), and Port Essington (1838-49). On these coastal outposts contact with natives was restricted to those in the immediate area of settlement.
After the abandonment of the English settlement at Port Essington, no further attempt was made until the South Australian Government sent Finnish to establish a post at Adam Bay on the Adelaide River (1864). The site which was badly selected and inhospitable was abandoned in favour of one on Port Darwin in 1868.
During the next few years a great pastoral migration commenced. Graziers from the areas of the older settlements to the east and south moved herds of cattle overland into the Territory and settled on extensive areas of land. For the most part, relations between the intruder and the native conformed to a pattern. Once the period of first contact and initial mutual suspicion was over, the young native male, naturally attracted to handling horses and stock, was induced to engage in station work. To minimise disturbance and dispersion of stock on the unfenced leaseholds, as many as possible of the older men, the women and the children, by issues of food and tobacco, were induced to abandon the habit of moving from water to water and to camp more or less permanently near the homestead.
The new mode of life affected three principal changes in the aborigine’s relationship to disease.
For the first time, without any knowledge of personal or communal sanitation and without any guidance from the better-informed, he settled into permanent camps which shortly became foul and unhygienic as litter, waste food, human and animal excreta accumulated. So were created conditions of insanitation which required only the introduction of bowel infection to initiate destructive epidemics.
He was now involved in new human contacts and thereby exposed to infections – exanthematous, respiratory, gastro-intestinal and venereal – new to his experience. For any particular group, of course, this risk for some years may have been more apparent than real. The early pastoral settlers had survived the rigours of a long droving trip, had been months remote from any contagion and must be supposed, generally, to have been free of disease. Only when the number of settlements multiplied and there developed roads which passed from station to station to be used with increasing frequency by travellers did the risk of infection increase materially.
The station ration provided ample beef which was, of course, ready to hand. The other basic components of the local dietary of the period – flour, tea and sugar, on the other hand, depended upon infrequent, slow, unreliable road transport by horse, bullock or camel team and were by comparison expensive and difficult to obtain. Essentially the new dietary did not differ fundamentally from that to which he was accustomed.
Later, with the development of Palmerston (Darwin) as a port, the construction of an overland telegraph line to Adelaide (1871), a discovery of gold (1872) and the laying of the first stages of a proposed trans-continental railway (1886), there was a considerable accession of new population in some involved. New migrants entered the country with increasing frequency, multiplying incalculably the opportunities for introducing and disseminating infection.
In 1874 to relieve an acute labour shortage, Chinese coolies were imported under indenture and new drafts continued to arrive annually until some thousands were engaged in mining, labouring and agriculture, along a narrow belt of country extending for some 150 miles south-east of Port Darwin.
Indentured labourers were submitted to no medical examination prior to embarkation and there proved to be amongst them many carriers and open cases of communicable disease. No women of their own race accompanied them and they soon repaired this social deficiency by taking consorts from amongst the native women of the tribes in their vicinity. Debauched with opium and alcohol, these tribes shortly learned to fraternise and cohabit with the Chinese under conditions of indescribable filth and squalor.
Social Change
As the years passed and the problem of the native degradation became more urgent, Government and Churches endeavoured, by establishing missions, to avert the involvement of surviving tribes. The object was to prepare the uncivilised Australian for his first contact with the new society and to equip him beforehand to enjoy its benefits whilst successfully resisting its degrading influences The sites chosen do not appear always to have been selected with a prescience assessing their suitability for the purpose which they ultimately assumed, or for the accommodation and sustenance of the numbers they eventually attracted. A particular site may have been adjudged attractive as a base for an evangelical team preaching the Gospel to a small and ever-changing group of natives. It does not seem to have been realised at the time that the little mission would ultimately develop into a static settlement accommodating and endeavouring to sustain throughout the year a greater part of the native people of the neighbourhood and that its purposes would come to include the conversion of a hunting to a farming people.
The first missions were establishing at Hermansburg in Central Australia (1877) and in the north of the Daly River (1886), Roper River (1908), and Bathurst Island (1911). European influence first commenced to move steadily eastward across Arnhem Land with the establishment of a Government station at Oenpelli and a mission at Goulburn Island (1916). Subsequently, missions were established at Milingimbi (1922), Yirrkala (1935), Elcho Island (1942), and Ross River (1952).
The native entering a mission brought with him the insanitary practices which he had safely indulged for generations. In the early years at least no system of sanitation was attempted and no measures were taken to train him in personal and communal hygiene. Whilst he was encouraged to abandon his migratory habit and settle in permanent communities, he was left completely uninformed of the risks to his health involved in the change.
Most of the missions did not run cattle so that beef was usually unobtainable. Even where a herd of cattle or goats was maintained animal husbandry was often so bad that few beasts could be found or spared for slaughter. The mission, therefore, in contrast to the pastoralist tended to rely upon a basic diet of white flour and sugar brought in from the nearest source of supply, supplemented perhaps by garden produce such as sweet potato, pumpkin and cassava grown on the mission. This unbalanced ration was regarded as only part of the diet and assumed to be further supplemented by game and plant foods from native sources.
The insidious results of the establishment of the early missions and Government native settlements were overlooked for some years. They derived from:
- the breakdown of the quarantine hitherto maintained by inter-tribal barriers, the herding of infected persons – white or black – in close or prolonged association with non-immunes under unhygienic conditions and the subsequent dispersion of infection by the periodic return of secondary cases and carriers to their own country;
- concentrating into a limited area a population beyond its capacity to sustain. Food supplies locally available being insufficient, the diet became unbalanced.
Medical Organisation
During the South Australian administration, medical practice in the Territory was conducted by one or two private practitioners in Darwin and for brief periods at times of railway construction or of exceptional mining activity by a third practitioner in the interior. These, whilst able to observe closely the disease pattern of the native population in the vicinity of the practice had few opportunities of studying that in tribes beyond settlement contact. Information concerning these is derived from a variety of sources such as explorers making initial contact with the native inhabitants, Medical Officers attached to early colonial settlements, mariners and Custom Officers whose duties took them along the coast, pastoralists, policemen and later missionaries who moved into new areas and reported their experiences with new tribes.
In 1911 the Territory was transferred to the Commonwealth and the first attempt was made to set up a complete welfare and medical aid organisation for natives. This took the form of an elaborate administrative establishment for native protection with its own Medical Officers. Careful medical surveys were conducted and reported in detail. This organisation began to disintegrate under local political influences and finally disappeared during World War 1 when the Government was pre-occupied with other problems and staff replacements were impossible.
The effort was resumed in 1927 when an organised Medical Service was established in the Territory. This service provided medical care for the general and for the native population and in addition, served as the health authority and the organisation for the protection of aborigines. The fundamental concept was that the health of both components of the mixed population depended upon preventing transmission of communicable disease from one to the other and eradicating sources of infection in either which might imperil the survival of the other.
To facilitate the control of disease in the native population the Chief Medical Officer as Chief Protector, was vested with powers to control employment and migration to arrange for the routine medical inspection of aborigines and to submit them to treatment. The Northern Territory Medical Service from 1928 commenced an ordered system of medical surveys for the detection of disease in both components of the population, undertook their treatment and attempted prevention. Its early years were years of economic depression but notwithstanding desperate financial stringency an aerial medical service was developed and staff was expanded to permit the extension of special medical coverage and routine services to every settlement. Considerable progress had been made in overtaking the leeway of three generations of neglect when during the Pacific War the north became an operational area (1942). The exigencies of war led to the discontinuance of medical surveys, interruption of medical service and evacuation of non-combatant population. The work was not resumed in its original scope until 1952.
Disease in Natives
For reasons already given the disease experience of the native before white intrusion must be largely a matter of conjecture.
Trachoma, yaws and granuloma venereum, strange to the invading white, were so often reported in tribes coming under observation for the first time that they may perhaps be confidently accepted as indigenous. The same is probably true of the dermatomycoses so common latterly in every tribe.
Early English colonists reported dysentery and outbreaks of “fever” generally understood to have been malaria. Some of the latter might well have been typhoid or febrile respiratory infections. These cases occurred some considerable time after establishment of the English military settlements and it would be remarkable if they were not introduced by the new colonists themselves or by their visitors. Communicable disease – dysentery, typhoid, malaria, tuberculosis, leprosy, hookworm and venereal disease, took a heavy tool in the area where Chinese were most numerous and led to a rapid decline and finally to virtual extinction of the local native population.
By contrast medical surveys conducted since 1912 have shown that members of adjacent tribes who respected the old tribal boundaries and retained their fear of travel in strange country, remained secure and free from the variety of diseases which decimated their neighbours. The north eastern section of Arnhem Land lying east of the Liverpool and north of the Rose River for years attracted no settlement or development, and natives here continued to live their normal lives unaffected by endemic disease until well into the twentieth century.
Demography
It is impossible today with any confidence to estimate the number of aborigines living in the Territory before the era of white settlement. Baldwin Spencer, Chief Protector in 1923, estimated the aboriginal population at the time at 50,000 but his successor, who had a wider local experience, doubted whether there were in fact 30,000. The official figure at the time was 20,000. These were sparsely spread over the whole Territory with a tendency to a higher density along the coastal fringe. During the late twenties and early thirties of this century when the Northern Territory Medical Service had achieved an unprecedented degree of contact and had attempted as careful a census as the conditions of the time permitted, the estimate was between 16,000 and 17,000.
Of recent years, systematic concentration of natives for purpose of education upon missions and Government settlements since 1950, has permitted the Department of Welfare to develop an elementary system of demography which, whatever its inadequacies and inaccuracies, does provide information permitting the assessment of the degree and rate of progress of social change.
It is not yet possible to apply to the native the system of birth and death registration applicable throughout the white community but employers, missionaries and welfare officers now co-operate in the collection and return of this detail as completely and accurately as possible. Limitations of the system as an exercise in statistics attach to the impossibility of collecting notification of birth or death from natives out of contact, uncertainty or identification which may result in a birth or death being counted more than once and the high proportion of deaths outside hospital or beyond medical aid in which the recorded cause of death must be the opinion of a lay observer or even of a native.
In 1958 the Native Welfare Department estimated the full blood native population at 16,318 (8,310 males, 8,008 females). Of these 54% were classified as domiciled on Government or Mission Settlements and another 8.5% as in contact with these institutions. 33.6 % were in employment, only 3.6% in towns. Only 6% were described as nomadic or not in contact.
The first point of interest in these figures is the distribution. Less than 4% of the total aboriginal population dwell in towns. The rest are remote from concentrations of white population being on missions or settlements, on pastoral properties or out of contact.
The crude birth rate in 1958 was estimated at 27.0 compared to the general Australian rate of 22.59 per thousand. The crude death rate was 16 compared to the general Australian rate of 8.50. The expectation that in the days before contact the neo-natal and infant mortality would be high, is borne out by current experience for, although the bulk of recorded births occurred where white medical or nursing supervision and complementary feeding are available, infant mortality in 1958 was 84 and the neo-natal mortality 57 per thousand live births compared to 20.49 and 14.5 respectively for the general Australia experience.
These figures, whatever their shortcomings, are sufficiently accurate to warrant the following general conclusions:
- Only a very small proportion (4%) of natives in the Northern Territory live now in the vicinity of the closest white settlement. These represent the remnants of the tribes who normally roamed this not inextensive area, supplemented by a greater number brought in for various reasons from areas beyond. The relative insignificance of the figure is a rough measure of the depopulation that has occurred in the area of densest and oldest white settlement.
- Only 6% of surviving natives can now be described as “nomadic” or out of contact leaving 94% currently exposed for good or ill to European influence.
- Some 30% are in rural employment, principally upon cattle stations. Conceding that the recruitment of labour from other areas will have, in some degree, swelled this figure, it suggests that opportunities for survival in contact with white civilisation have been much greater on pastoral properties than in areas of closer settlement.
- Two-thirds of the total native population are permanently or occasionally accommodated upon settlements or missions. Their healthy survival here will depend upon the correction of influences which in the past have operated to debilitate and destroy them.
- The birth rate compares favourably with the general Australia rate. The death rate, however, is high, particularly in infancy – so high indeed that it must be excessive amongst those tended on missions and settlements where infant care is organised and might be expected to effect a substantial reduction.
Food Deficiencies
During the period of adequate record avitamoses have not been a feature of native morbidity in the Territory because for natives on pastoral holdings, or employed by Europeans in towns, the diet, even if in some other respects unbalanced and inadequate, at least included adequate sources of the essential accessory food factors. Even on missions where the diet issued, besides being unbalanced and inadequate, was also deficient in vitamin and mineral, there appears usually to have been a sufficient component of native food to make good the vitamin deficiency.
A serious outbreak of scurvy with a high mortality occurred on a Central Australian mission during the drought of 1928-29 when natives relying wholly upon the mission for sustenance were restricted to a diet of white flour. Natives who fled the mission in fear and braved the rigours of the apparently barren desert beyond escaped.
On pastoral holdings the diet available to natives was high in animal protein and mineral and approached normal native standards in essential values. On settlements, however, where reliance has been placed upon white flour, farinaceous foods, locally grown cassava and the like, there has been a relatively high incidence of malnutrition and anaemia manifested in children by a condition resembling kwashiorkor.
After the establishment of the Northern Territory Medical Service in 1928, measures were taken to correct these deficiencies by prescribing a minimum and balanced dietary for natives. However, during the years of war and immediately thereafter, medical supervision was discontinued and there were changes in mission staff. The reappearance of these conditions was overlooked and the reason for their occurrence forgotten. More recently, with the resumption of medical supervision and with increases in subsidy permitting supply of an adequate diet, considerable progress has been made in cure and prevention.
Tuberculosis
Although tuberculosis is known to have been an important factor in the depopulation of native tribes in contact with railway and mining camps – frequently taking the military form and reaching a fatal termination in a few weeks, it has not attained a generally high incidence. King in 1951 conducted a Mantoux survey of Kimberly natives and noted little evidence of exposure to tuberculosis in remote groups. He noted that incidence began to rise early with the abandonment of “nomadic” life in favour of sustained contact with white settlement. A similar survey conducted by the Northern Territory Medical Service demonstrated these conclusions were equally true of the Territory.
Recent mass radiography of which assessment is not yet complete, discovered only 37 “active” cases in 8,187 natives examined (4.5 per 1,000), a figure which is expected to be substantially reduced when the cases identified are reviewed.
Mantoux survey and mass radiography show that incidence is highest –
- in the vicinity of older settlements (5 per 1,000), and
- on missions where infection has been introduced and sustained by a persistence of open cases amongst the staff (6.2 per 1,000).
By contrast, extensive areas of reserve showed a much lower incidence (1.4 per 1,000). It may be concluded that tuberculosis has attained its highest prevalence under conditions of settlement concentration. Incidence is significantly lower in tribes living their traditional life and from these, infection will not spread to adjoining tribes until intertribal barriers are broken down.
Hookworm
It is improbable that hookworm was endemic in the Northern Territory prior to white settlement.
- Had it been indigenous when it first attracted attention, it should have been uniformly prevalent in areas which subsequently proved endemic and a uniform species parasitism throughout all areas might reasonably have been expected.
- The dominant species (A. duodenale) is the prevalent Asian type. A survey in 1929 revealed a 70% hookworm infestation rate in pearling crews. No doubt the extension of pearl fishing along the Arnhem Land coast during the thirties played an important part in carrying this infestation eastward.
A survey of the Northern Territory in 1922 disclosed an incidence of 75% at Bathurst Island, half this at Goulburn Island 200 miles to the east and none at Elcho Island 150 miles further east. By 1929 the incidence in Bathurst Island had risen to 100%. Here promiscuous defaecation was the rule rather than the exception and mission authorities firmly declined to attempt the training of natives in hygiene. At Elcho Island in 1952 the incidence had risen to 47% and at Yirrkala 40%. Groote Island, even further to the east, was still free in 1953.
The disease was introduced to the potentially endemic areas by the immigration of parasitised persons following white settlement. The greatest single factor contributing to the present high incidence amongst natives has been their concentration on settlements under conditions of gross insanitation. These institutions have since served as a major source for the infection of new and the re-infection of old cases.
Heavy worm loads resulting from repeated re-infection in childhood, coupled with the diet lack in iron and animal protein, has in recent years – since World War 2 – led to a high incidence of severe macrocytic anaemia contributing to the mortality from intercurrent bowel and respiratory infections in children and women of childbearing age.
With improved sanitation and intensive treatment, the incidence of infestation has in the worst areas been reduced to 25%. Concurrently, the individual worm load has been reduced to a fraction of its former size. Indeed, prospects for complete eradication appear good.
Gonorrhoea
Gonorrhoea has not been a problem of missions and in spite of the unfortunate experience of these settlements with other diseases, the birth rate there has continued high. Travellers through pastoral holdings, drovers and station hands in search of work or in transit, only too frequently left a trail of infection amongst the native women on pastoral properties along the main stock routes. Repeatedly introduced and reintroduced, the disease spread locally among women of childbearing age and in the absence of an effective treatment, soon lead to a fall in the fertility rate which, as the years passed, was made obvious in many a station camp by the absence or rarity of children. This was particularly noticeable in the late twenties and the early depression years when the commencing switch from horse to motor transport and the movement of unemployed in search of work or rations, together, combined to increase the speed and frequency of movement along the main roads of the Territory.
Since the introduction of penicillin, the incidence of gonorrhoea has fallen remarkably and the birth rate has risen correspondingly.
Leprosy
Thousands of Chinese labourers brought into the Territory in 1874 and subsequently, included cases of leprosy. Infection soon spread to natives in the immediate vicinity of townships, railway construction and mining camps, where the Chinese were concentrated.
Native mortality from all causes in these areas was high and depopulation was rapid. The disease, therefore, had no opportunity of becoming domesticated and did not attain a high incidence. Cases were all in adults.
For many years the disease continued limited to the area of the railway and mining camps. Intact tribes living to the eastward remained unaffected until the establishment of a Government Aboriginal Station at Oenpelli and a Mission Station at Goulburn Island (1916). These institutions set themselves to gather the remnants of the tribes from the endemic area and to concentrate them under observation. Soon they began to encourage unaffected tribes to come in and fraternise. Following a leprosy survey in 1925, the forecast was made that leprosy would gradually move eastward from this point under this influence. This expectation has since been confirmed.
Delays in providing for the accommodation of cases detected permitted gradual extension but following the provision of a Leprosy Hospital in 1932, active search and prompt isolation had by 1940 so reduced the annual number of new cases that ultimate complete eradication seemed likely. Cases at this time were few in number, adult and came only from known localities of prevalence.
Following the Japanese bombing of Darwin in 1942 cases in isolation were discharged from hospital to return to missions, it being feared that war-like operations and official preoccupation with defence would prejudice their welfare. Simultaneously, the system of regular medical review broke down and the routine supervision of cases and contacts was discontinued. No special care was taken to segregate active cases from mission children and early secondary cases continued unsuspected to associate closely with their fellows in dormitory and schoolroom. Resumption of routine medical inspection nearly a decade later revealed an alarmingly high incidence of leprosy, more particularly in children on coastal missions. Conspicuous amongst the latter was one on which the disease had been unknown before the outbreak of war. When case finding was resumed the incidence here was found to be 56 per 1,000, practically all the cases being under 20.
A similar experience in the adjoining Kimberley region a decade earlier might have served as a warning. During the thirties of this century, lay inspectors concentrated at one point to await medical examination natives suspected by them to be suffering from leprosy. These included cases of florid lepromatous leprosy and a great number of susceptibles suffering from conditions other than leprosy. A large number of the latter developed active leprosy after their return home. As they had been certified free from leprosy, the progress of disease in them was watched with a curiosity that prompted no precautionary measure. In the event an alarmingly high level of incidence was attained on a number of Kimberly missions and these served as foci of dissemination to adjoining countryside.
Measures of active prophylaxis and improved methods of treatment have now brought leprosy under control and promise eventual eradication.
Autochthonous Diseases
Trachoma continues prevalent but treatment campaigns are reducing its incidence and preventing advance to the later stages which were formerly a prolific source of blindness. Yaws and Granuloma have virtually disappeared.
Conclusion
Few of the diseases which in the past century have scourged the native population of the Northern Territory were indigenous.
Exotic infections introduced into areas where native society was intact disappeared under the inhibitory conditions created by the environment and native habit. Only when natives were concentrated into settlements without adequate hygiene instruction and without sanitary facilities, did these conditions proceed to destructive morbidity and mortality.
Lack of readily obtainable and suitable supplement for mothers’ milk probably involved a relatively high mortality in the months of weaning. Apart from this, the dietary of the autochthonous Australian was probably adequate and well balanced even in periods of drought.
An unbalanced diet on settlements has contributed to a high morbidity and mortality from deficiency anaemias and intercurrent infections.