DR. CECIL E.A. COOK. C.B.E., M.D., D.P.H., D.T.M & H.
Formerly Commissioner of Public Health, Western Australia (1946-1949)
A talk to the Association of State Medical Officers, July 8, 1974:
First let me thank you for affording me the opportunity to join you this evening in your farewell to Bill Davidson with whom it has been my privilege and pleasure to work first in the Department here and later on the National Health and Medical Research Council. It happens that 1974 is the fiftieth anniversary of my first association with the West Australian Department of Public Health and perhaps in paying my own tribute to a valued colleague and esteemed friend, it would not be out of place to mention some of the major changes that have marked its progress in that time.
In 1923 having taken the Diploma in Tropical Medicine and Hygiene at the London School, I was awarded a Research Fellowship in Tropical Medicine and I cabled Dr. Cumpston, Commonwealth Director-General of Health, in Melbourne asking how I could use this in Australia. He replied that the West Australian Government was seeking a medical survey of the Aboriginal population of the North-West and Kimberleys with particular attention to Leprosy and it was arranged that I should undertake this.
I heard no more of the matter until in March of the following year, when being in Sydney with a newly acquired bride on our honeymoon, I was intercepted late one afternoon by a Custom Officer at the Neutral Bay Ferry turnstile at Circular Quay. He informed me I was expected to leave by train that night for Perth as all arrangements for the survey had been completed and the West Australian Department was impatiently awaiting my arrival.
As best I could, I arranged for the financial security of my wife and left that night for Melbourne with a little silver. In Melbourne I saw Cumpston who outlined for me the purpose of, and arrangements for the survey, explaining that the West Australian Government would be responsible for my actual expenses but would pay me no salary. I was to catch the mail train to Adelaide that night and join the Transcontinental train at Port Augusta changing to the Perth Mail at Kalgoorlie later. He explained that the Transcontinental railway track was not fully ballasted and the whole journey would take some five days to complete.
For my part I explained that I had no money and had expected to receive an advance in Melbourne. This not being officially practicable from the Commonwealth, he offered personally to lend me what I would need until I reached Perth. Feeling under an obligation to ask for as little as possible, I accepted one pound and eventually arrived in Perth with three pence.
In Perth I called on the Commissioner, Dr. Atkinson, who after a friendly chat, told me he had a golfing appointment and handed me over to the Under Secretary, Mr. Huelin.
Mr. Huelin was surprised to see me and expressed at length, and with some vehemence, his annoyance that I had arrived so soon. Arrangements for my transport through the North had not been completed and a start would not be possible for another three or four weeks. He was obviously dismayed at the prospect of maintaining me in idleness in Perth in the meantime. With alacrity I offered to return immediately to Sydney at the Department’s expense of course, but after a hurried calculation he decided to lodge me in the King Edward Hostel, a Temperance Hotel nearby, which he recommended as being convenient to the Department but with which I was not impressed. In passing perhaps, I might mention that in my first experience of a Perth Hotel, I was surprised by the dearth of local products on the table. Even the butter and the jam were of interstate origin, as was the dried milk powder which substituted for fresh milk. I gained the impression that for the West Australian of that day, farm production was of little moment, wealth was better sought on the gold fields of Kalgoorlie or the pearl beds of Broome.
After a few days I was dispatched to Moore River settlement to examine the aboriginal population there. This task took only a couple of days and I returned to Perth eager for more work. My return shocked the Under Secretary – apparently he had been congratulating himself on having transferred the obligation for my maintenance to the Native Affairs Department.
I suspect that about this time he began to regret the proximity of the King Edward Hostel to his office. This convenience originally commended as a merit, permitted, even encouraged, frequent visits from me seeking not only opportunities for employment but financial accommodation to supplement my resources which were still limited to the three pence with which I had arrived in Perth. The Under Secretary held the view that my financial situation was a Commonwealth responsibility and steadfastly refused to admit any obligation in this matter.
On one of these visits, I was told that the visiting Medical Officer at the Old Men’s home would like me to see there, an inmate who he suspected was suffering from leprosy. I readily agreed and asked for a cab – to be told I could use public transport. Thereupon I asked for the fare, once more re-opening discussion of my finances. The fare was not forthcoming and the visit was never made. Whether the old man was or was not suffering from leprosy, I do not know, but the incident convinced me that in the view of the lay administration of the Department or Public Health, the conservation of petty cash was more important than the condition of the patient.
You may feel I have unduly laboured these trivialities and perhaps I should assure you that I do not relate ·them as derogatory to the Under Secretary. I fully appreciate that he was resolutely refusing to abandon a principle made important to him in his training – the responsibility for the careful husbanding of public money. For this, as the lay financial controller of the Department his steadfast resolution under what must have been extreme provocation, can be admired. For me, however, the subordination of the minutiae of Health Administration to monetary consideration was a dismaying indictment of lay control in a professional Department and the experience has influenced my attitude to my lay colleagues throughout my working life.
Eventually, arrangements for the survey were completed and we sailed on the “SS Minderoo” for Derby. We were a party of four with an ornate, deluxe T-Model Ford tourer with a fold back cloth hood and brightly polished brass accessories. Besides a driver-mechanic, my companions were the Member for the Electorate of Roebourne, who represented the Department of Native Affairs and a Senior Officer of Police who was taking the opportunity afforded by my survey to conduct an enquiry into the death of an Aboriginal sought on a charge of murder.
Our Kimberley itinerary was planned to permit the medical inspection of natives on every station, settlement or camp accessible by car, on horse back or by boat between Derby and Wyndham and of course, involved leaving the main stock route to journey by side tracks and detours to visit those lying to either side. In fact, we managed this reasonably well, although we failed to reach a couple of centres in the Mount House area.
There were no roads as we use the term today. Vehicles drawn by bullocks, donkeys or horses required a route giving reasonable access to water and feed for the night camp and tended to follow the major rivers. This necessitated the crossing of innumerable tributaries – large and small. The wagons followed the tracks left by earlier transport of similar type through the lightly timbered country, to cross creeks and rivers at points where the banks permitted safe descent and ascent by the floundering wheels and the stream bed was sufficiently level, clear and stable to allow passage. Riders with packhorses, travellers in drays and buggies, drovers’ teams and travelling stock, followed roughly the same route, breaking up the surface where it was sand, cutting the black soil and clay pans into pock marked morasses in the wet and in the dry abrading the punctate surface once more into a trafficable surface.
Road making and road repair were effected by simple expedients. When a section of the track became difficult or impassable, a detour would be cut around it through the timber by felling trees “stump high” – low enough to clear the axles of wagon or buggy but high enough to permit easy avoidance by team and wheel. The damaged section would be closed by felling a tree or dropping a log across the track at each end of it. These improvisations handy enough for the teamster and rider, were a serious hazard for the early motorist. During the wet season traffic ceased for weeks at a time and grass and shrubs grew quickly, not only obliterating the new detour but concealing the obstacles blocking the old track.
Stumps grew foliage and simulated little bushes, necessitating constant vigilance in order to avoid collisions disrupting the chassis frame, breaking the axles, cracking the oil sump or differential housing. The sandy beds of creek and river crossings were badly broken by the hooves of teams and the wagon wheels cut tracks which a motor vehicle could not span. Models in those days often relied – as did our Ford – upon gravity feed to the carburettor from a fuel tank under the driver’s seat and it was a familiar experience having struggled laboriously across a sandy stream bed, to commence the ascent of the nether bank and there stall with no fuel feed for the motor. The alternative of crossing in reverse had its own hazard – the driver being unable to see where he was going – as the driving wheels threw up clouds of sand and dust.
At stations, the crossings could be effected with the assistance of horses or teams of laughing lubras, but for the most part the passengers had to do the pushing.
In limited areas of the North West, where the T-Model Ford had recently come into use as a Station Vehicle, we met a new inconvenience. There being no well defined road, it was natural to assume that where car tracks deviated from the track to one or other side, there was an obstacle to be avoided or a better surface to drive on. Too often, however, these were digressions by the Station truck to a distant yard or well to inspect a watering place or simply an aimless excursion in search of stock. On the sandy plain behind the 80 mile beach on the road from Broome to Wollai Downs where we expected a run of unprecedented speed and comfort, we spent many hours lost in this way.
Apart from damage by obstructions there were mechanical hazards in plenty. Burned out transmission bands – the T-Model Ford had no gear box – broken crown or pinion wheels, broken springs and axles all had to be repaired by the roadside or in the sand, whilst the load of necessary tools and spare parts added to the weight of the passengers, their swags and stores made a burden beyond the capacity of the springs of the vehicle to carry on an ungraded road.
I shall not dwell upon the experiences and vicissitudes of our journey from Derby to Moolabulla, at that time a Native Affairs Department Cattle Station and Reserve, beyond mentioning that in that comparatively short and easy section of our proposed itinerary, it became abundantly clear that our vehicle was quite unsuitable for the terrain to be traversed and prospects for an uneventful or even reasonably safe journey became, each day, more dismal.
The police officer, a veteran bush traveller, seems to have realised this early in our trip. At Moolabulla there were some hundreds of aborigines and I took some days to work through them. Affecting to be irked by the delay, he one day asked me how long I was likely to be, and when I suggested a couple more days, he elected to move on to Halls Creek where he could transact some police business whilst awaiting us. He left in a buckboard and it was arranged that he would rejoin the car at Halls Creek when we eventually got there. When we did arrive at Halls Creek – at that time on the original gold fields site, since abandoned – we were told he had left in his buckboard the day before and we were to pick him up at the Black Elvira or earlier if we overtook him. Arrived at the Black Elvira, we found he had already gone, nor did we ever overtake him. Indeed, in his buggy he covered the 600 odd miles to Wyndham by the Ord River Road three weeks ahead of us and had sailed for Perth long before we reached the port.
From Wyndham we returned to Halls Creek via Turkey Creek and travelled down to Broome and finally Port Hedland and Roebourne where the car , now virtually a total wreck, was abandoned. My guide and I continued the trip to Onslow in a hired Buick, which in its turn was wrecked on a stump some miles from Onslow. The survey in the Ashburton area was completed with Dr. Stenning of Onslow driving us in his private car.
Throughout the North, as distinct from the North-West, one could not but be impressed by the striking difference in the living standard of the people – with the single exception of wealthy Broome – compared to that of their compatriots nearer Perth.
There was of course, no radio communication short or long wave nor apart from the land line connecting Wyndham with Perth via Turkey Creek, Halls Creek, Fitzroy Crossing and Derby was there any means of telegraphic or telephonic communication. Mails were carried by pack horse or buggy at monthly, 6 weekly or longer intervals.
Housing was inadequate and often disintegrating without prospect of repair, water supplies were unreliable and hazardous, diet seasonally deficient, and hygiene poor. The people, in addition to the common maladies and indispositions afflicting humanity, were unusually exposed to accident and to endemic disease without benefit of advice or warning nor access to medical care or ambulance transport. There were small hospitals at each of the little ports and ·these were served by a general practitioner in private practice who received from the Government a subsidy by way of salary for undertaking the duties of Government Medical Officer, Local Magistrate, Protector of Aborigines, Quarantine Officer and sometimes Treasury Pay Master. At Fitzroy Crossing and Halls Creek the Australian Inland Mission had established hostels each staffed by two trained nurses, interested as much in providing for the social and religious welfare of the bush worker as in rendering medical first aid.
There was no laboratory service, large areas exposed to the endemicity and epidemicity of communicable bacterial protozoal and helminthic disease, lacked any diagnostic aid to assist in the prompt identification of pathogens, the early detection of hazard, or the recognition of unusual prevalence demanding remedial action.
There were no x-ray facilities even of the primitive type useful in detecting fractures of the long bones of the limbs – even electric power was available only in special situations, for instance at the meat works at Wyndham during the killing season. The only special piece of equipment I recall was a decompressor at Broome for the treatment of “the bends” in pearl divers. This I learnt was never used, as the crews “staged” their patients at sea instead of subjecting them untreated to the long journey from the pearling beds to the port. Beyond the little ports and settlements, there was a notable absence of white women – a refining influence without which the white male was permitted by his “absentee” employer to adapt to his environment – tending of necessity to live at a level determined by his aboriginal companions. In the more settled areas, except in Broome, the primitive accommodation discouraged all but a few loyal wives of mature age. Young men, usually soldier settlers, attempting to pioneer new pastoral properties in virgin land, in their isolation faced other hazards than those of poor communication and inaccessibility of medical aid. Three of those I visited in the course of my journey were fated to be murdered by natives within a year or two of our meeting.
The survey I found had originated from persistent allegations that there was a high incidence of leprosy and/or syphilis in the aboriginal population, more particularly in the Kimberleys. Most of these reports had been based upon the observation of the acute and chronic disfigurements of Yaws which vas widely prevalent among aborigines at that time. Leprosy was in fact strictly limited, cases were few and as yet there were no endemic areas. Prospects for easy control seemed promising, but without effective measures, wide dissemination in both races threatened. Venereal disease occurred sporadically, gonorrhoea in foci near the coast or along the stock route. Syphilis I did not see. Granuloma venereum was quite common in the aboriginal population and I saw it twice in white males in the East Kimberleys. At Wyndham I met a Medical Officer who held rigid views upon the incidence and management of venereal disease in white and native. He had let it be known that amputation of the external genitalia was the only treatment for granuloma venereum, a published opinion which spared him the necessity of attending or notifying any great number of cases in either race. I later discussed this embarrassment with Dr. Atkinson who agreed with me that its implications were serious, but doubted whether much could be done about it as he was a private practitioner “and a good magistrate”. He did in fact continue in Wyndham until he was relieved some four years later by a young Melbourne graduate who had recently attempted, unsuccessfully, to cross the continent in record time from East to West, by car.
This young man, no doubt deeply impressed by his recent experience of the hazards of outback road transport was struck by the possibility of the Wyndham marshes as air fields. He decided to teach himself to fly – after all, he argued, the pioneers of flight had had no flying instructors but had had to learn in aircraft which initially, had never been proved capable of flight. He at least had the advantage of access to aircraft of proved performance and the marshes offered him ample room to practise his take offs and landings. So in due course there arrived in Wyndham a shipment of aeroplane parts which he carefully and eagerly assembled in accordance with the instructions provided. Unfortunately, in his impatience to begin, instead of waiting until his aircraft could be towed or carried to the extensive marshes south of the port, he decided to attempt to fly it there, taking off from a small clay pan near the town. Once airborne, probably in an adverse wind current, he lost control and crashed, in rough ground, wrecking the machine beyond hope of local repair but himself unharmed. In the depth of despondency he decided to leave Wyndham telegraphing a months notice to the Commissioner in Perth and left for Darwin on the state ship “Koolinda” on which his successor arrived.
At that time I was in Darwin as Chief Medical Officer, Chief Protector of Aborigines and Quarantine Officer. The local general practitioner had left some months before, and I found it impossible to cope with the obligations of general and hospital practice as well as with my official duties. The arrival in Darwin of an unattached doctor presented opportunity for relief that could not be ignored. The pleas and blandishments however, of my friends and myself seemed to leave him unmoved, but under the influence of our hospitality, he lost track of time and I had his effects brought ashore from the ship which sailed without him. Clyde Fenton ultimately realised his ambition to fly and in doing so became in the strict sense, Australia’s first Flying Doctor, pioneering at no little expense and risk to himself, an Aerial Medical Service for outback Australia, which made him a legend in his own life time.
The purpose of this perhaps dreary recital of apparently irrelevant personal experiences in country with which you are familiar in very different guise has been to give you the background for attitudes adopted and decisions taken long ago, which perhaps in some small measure, have influenced your personal and official lives today. We learned, as Medical Administrators in those days, that there was a dire need to provide in the remote areas of Northern Australia, a medical service staffed with competent men with means of communication and transport permitting access to them at costs within the capacity of the poorest to pay; to provide a medical and health service for the Aboriginal population, tribal and detribalised to regulate the employment of aborigines and limit their exposure to industrial hazards; to control the conditions of their association with immigrant races so that the dissemination of communicable disease from one race to the other might be minimised; to develop a social environment encouraging white women to enter and remain in the area, with a sense of security and happy to make their homes and rear their families there – indeed to initiate and perform the function which you and your colleagues undertake as a routine today. But behind it all was the conviction that the ideational centre, the inspiration and the direction of this service must be free of restraint artificially imposed by Public Service conventions designed for metropolitan conditions and applied by lay administrators from a remote administrative centre. It must be flexible enough to meet suddenly emerging problems in an unstable area, the individual officer at the focal point being free to act on his own responsibility with resource and enterprise in strict compliance with the principles of an over-riding medical and native policy. It must be capable of maintaining an alert vigilant and informed supervision to detect epidemiological, social and ecological changes in the environment and in the behaviour or incidence of disease. To these objectives, I subsequently devoted my years in the Northern Territory in building up the N. T. Medical Service and its aerial activities, hoping it would serve as a model for comparable areas in adjacent Queensland and Western Australia.
Years later while serving with the Australian Army in the Netherlands East Indies as they were then known, my attention was drawn to a notice circulating amongst officers inviting applications for the position of Commissioner of Public Health, Western Australia. I submitted an application and was eventually informed that I had been appointed. About the same time I received from Dr. Kingsbury an assurance that neither Dr. Henzell, Director of Tuberculosis nor himself, who were together discharging the duties of Commissioner had applied for, nor wanted the appointment so that I need have no qualms in accepting or misgivings of acquiring a pair of disgruntled or superseded colleagues. Whilst these expressions of loyalty were gratifying, the news that the office of Commissioner held no attraction for either of the two logical successors to it was rather disconcerting.
The army resisted all requests for my release until after the Japanese Armistice and in the meantime a luminary from Army headquarters visiting the Area in which I was then serving confided in me what I had previously not known that my immediate predecessor had resigned because he could not brook interference by the Under Secretary in his administration. Recalling my own experience of this Under Secretary I promptly wrote personally to the Minister for Health in Perth assuring him of my eagerness to accept the challenges and opportunities of the Commissioner’s Office but stating emphatically that I would not consider appointment unless I had his personal assurance that I should be indisputably permanent head of the Department with direct access to him.
In his reply Mr. Panton told me he was no longer Minister for Health but he had discussed my letter with his successor and was able to give me the unqualified assurance I sought. This letter I still have – it closed the first of a serious of disputes about the status of Commissioner vis-a-vis the Under Secretary, the last of which led to my resigning and returning reluctantly to the Commonwealth.
On assuming office there appeared to me to be a number of activities and responsibilities of the Department which were .completely neglected and with the exception of the Tuberculosis division admirably directed by Linley Henzell practically no activity which was not run down to basement level in spite of talent and diligence, in subordinate staff. Rightly or wrongly I attributed this inactivity to the dead hand of the type of lay administration I had observed in the Department twenty odd years before. Amongst capable and conscientious officers there appeared to be a moody acceptance of inescapable stagnation and frustration attributed to a variety of factors peculiar to Western Australia as a “medicant” state within the Commonwealth. I found my staff loyal, capable and as we proceeded, zealous and enterprising and I cherish the notion that I may have made some contribution to stimulating an enthusiasm formerly lacking in their work.
We gave early attention to the North and North West which during the war had relied heavily upon the Armed Services for medical and health requirements but which after evacuation of troops seemed unable to attract or hold Medical or Nursing staff of a satisfactory quality. The terms of appointment clearly needed change.
Salaries superficially attractive enough were so highly taxed as to be rendered repellent and any attempt to raise them was itself defeated by the increased tax scale. Special new terms of appointment were devised to permit relatively long periods of study leave on full pay to be earned by a completed term of service. This device in effect raised the salary substantially without incurring extra tax. The expectation was that these tenures would prove attractive to younger graduates of merit and ambition anxious for opportunities for post-graduate study which they could not themselves afford and for which taxation would not permit them saving. Five well qualified young men were recruited in the United Kingdom and their quality may be judged by the fact that they included Eric Saint who later became Dean of your faculty of Medicine and Dudley Snow, your former Deputy Commissioner.
I found that members of Road Boards probably influenced by the title, found it hard to believe that as the Local Authority they had a responsibility for the administration of the Health Act. Several rejected this role completely insisting that they had insufficient funds to discharge their “proper” function – provision and maintenance of roads – without incurring any other obligation. A great deal of time and travel was devoted to correcting this misapprehension and to assuring the appointment of properly trained inspectorial staff to individual Road Boards or convenient groups of them.
We set up a special school for the training of Nurses for Country Hospitals. This promised well and permitted rapid improvement in Country Hospital staffing.
Improved staffing facilities for infant and child health were planned and attempts begun to assure adequate preventive and therapeutic medicine for Aborigines. As a first step for this proposal the office of Medical Inspector was taken over from the Department of Native Affairs.
There were difficulties – a housing shortage and a rapidly increasing population led to improvisations which threatened the creation of slum conditions. These we had to combat at the political rather than the administrative level. To crown all we were confronted by an epidemic of poliomyelitis for which we had no reserve of trained physiotherapists: this led to provision of a special hospital for which staff had to be recruited in the Eastern States.
As part of the general plan to improve preventive medicine at Community level the Minister agreed to set up a State Health Council upon which representatives of Specialist and General Medical Practice would sit with the Commissioner to exchange epidemiological and social information to discuss public health and medical service problems and debate projects for their resolution. This body was intended to secure a measure of professional co-operation affording the Department greater opportunity for effective action at the community level.
I had high hopes for the State Health Council but I suspect the medical profession of Western Australia has not taken full advantage of the opportunities for collaboration if offered. Some years ago, a Member of the Western Australia Faculty of the Royal Australian College of General Practitioners who was very active in attempts to improve liaison and co-operation between the College and the Department told me he had never heard of its existence and assured me it no longer functioned.
At intervals there were incidents of friction between lay and Medical staff in the Department. The Under Secretary never accepted the Minister’s assurances to me that the Commissioner was permanent head even though the Public Health Act left no doubt of this. Supported by the Public Service Commissioner it seems he was able to persuade successive Ministers – or so he claimed – that the undertaking given me by Mr. Panton was beyond the power of a Minister to give and was of no effect. No Minister ever confronted me with this disavowal of the earlier assurance. So from time to time incidents occurred trivial enough perhaps in themselves which led to acrimonious confrontation terminating in uneasy compromise. Ministers continued to assure me privately that there had been no qualification of my status and according to the Under Secretary to confirm him in his view that he was the permanent Head of the Department. To assist you to understand why I attach such importance to this matter of status you should recall that in my own experience I had seen or thought I had seen lay domination of the Department in earlier years bring it to a deplorable level of inefficiency and inaction as an instrument of Health administration, an agency without initiative and without prospect of change. With this background an excerpt from my representation to the Minister:
“I am not prepared as one charged with certain responsibilities by an Act of Parliament to risk decisions being made without my knowledge by a subordinate officer to whom I have not expressly given authority”.
In the midst of these uncertainties there was introduced into my office one day a naval type with a marked Scots accent who I was told intended to commence practice in Dalwallinu. He was of pre-possessing personality and in addition to his medical qualifications held a D.P.H. (Aberdeen). It was perhaps natural that I should make a mental note that Dr. W.S. Davidson might prove a valuable acquisition to the Department. Later when I saw that my retirement was inevitable and recalled that Linley Henzell had expressed reluctance to accept appointment as Commissioner I made the trip to Dalwallinu to suggest to Bill that he join me in the Department as my Deputy with a view to succeeding me as Commissioner in the not very distant future. In due course he joined me and I was grateful to find he shared my interest in the health and welfare of the North and North West. Incidentally in one of his earlier reports he gave a description of social conditions and attitudes in the North at that time which is a masterpiece and which I trust has been preserved in the Archives of the State; I commend it particularly to those of you who work in that area now.
When I finally prepared to leave and to return as I say, reluctantly to the Commonwealth, assuming without, I must confess reasonable ground and without confirming the assumption, that Linley Henzell still would not want the office, I recommended Bill Davidson as my successor. In the event, Linley was appointed and served with distinction. I have always since felt guilty of a gross breech of faith to both of these ·two men although I have never had from either of them any suggestion of reproach on the subject.
After my departure I watched with eager interest the work, first of Linley and his team and later of yours, Bill. As I look back at the Department of Public Health in Western Australia, as I have known it over the years and compare it with what you present to me today I am filled with admiration for what you have achieved from such an unpromising beginning. I do not presume to congratulate you Bill, on this outstanding performance but am impelled to express my admiration for it. I believe in Western Australia you have presided over a golden age in Public Health administration and attained here a standard of achievement unrivalled in Australia since Burnett Ham, Ashburton Thompson and Elkington lifted the eastern states from barbaric negligence to the civilised standards of their day. Not only have you achieved this in the conventional fields of health administration enshrined in the Health Act, but in the wider arena of modern endeavour in special measures for Child Health, in environmental control and in community health.
On this occasion marking your retirement may I express the hope that your years of rest will be as happy and enjoyable as your working years have been laborious and fruitful and the expectation that your career will serve as an inspiration and a challenge for your successors.