The year 1953 marks the 25th anniversary of the formation of the Northern Territory Medical Service, an occasion worthy of note for several reasons. It recalls the first essay of any Australian Government into a comprehensive and exclusively salaried medical service for an extensive area. It commemorates the first attempt by any administration to give practical expression to sociological ideas then unfamiliar, and to most repugnant, which have since become accepted as the guiding principles of social policy throughout the Commonwealth. It is a reminder that this enterprise for which there was no precedent, developed as an instrument of policy. Not under any considered plan of any Federal Government and not in response to any formed public demand, but rather as a result of the perseverance of a few idealists in the Commonwealth service who initiated and developed it in the face of discouraging Government caution, professional hostility and cynical local scepticism.
Up to 1927, the interest of the Federal Government in medical service in the Northern Territory was limited to the subsidising of two private practitioners – one as health officer and one as quarantine officer – and to maintaining a small ill-equipped hospital in Darwin. There was no organised system of preventive medicine for the Territory and only in Darwin a municipality marked its responsibility for local sanitation by its neglect rather than by its activity. The north-south railway terminated at Katherine. Road communication was chiefly by wagon and packhorse. There were no airways and no wireless communication, the overland telegraph and a monthly mailboat providing the only contact with the central Government and the outside world.
At that time, the Australian public, though openly committed to the White Australia policy, was unconvinced that a white population could successfully settle tropical Australia and withstand the rigours of the tropical climate.
In spite of Commonwealth expenditure on development the white NT population was falling. In a renewed endeavour to place the Territory upon a productive basis and to provide economic inducements for an accession of white population, the Commonwealth in 1927 appointed the North Australia Commission to undertake the development of the area.
In 1925 the Commonwealth Department of Health in collaboration with the London School of Tropical Medicine had conducted a medical survey of natives throughout Northern Australia. The report emphasised that uncontrolled tropical and other diseases in a native population must be expected to serve as a human reservoir of infection, prejudicing the success, even the survival of white settlement. It disclosed that in this region there was no medical or health organisation to assess the incident to control the spread of endemic disease.
Leprosy endemic in the native population was occurring with frequency amongst Europeans, both male and female, and it appeared probably that this disease must follow the course already taken in the other States of the Commonwealth and become domesticated with increasing incidence in European children. No effort was being made to control dissemination of hook worm, a disease which of itself would, if neglected, seriously prejudice the development of a healthy and productive white society. Venereal disease was very prevalent and widely disseminated. The circumstances largely attributable to the cohabitation of white males and native women in a community where the white female was so rare as to be an oddity. In the area constantly endemic and not infrequently epidemic, exacted a toll in morbidity and mortality threatening the survival of white settlement in several rural areas. Dengue seasonally prevalent in Darwin thus impaired the efficiency of the working population and contributed to a communal psychology of despair for future healthy white settlements.
It was recommended that the functions of chief protector of aboriginals then vested in the Commissioner of Police and the duties of chief medical officer then undertaken by a private practitioner should be combined in one medical officer, experienced in tropical hygiene, in order that native policy should be enlightened by the medical experience and the practice of preventive medicine facilitated by the powers over the native conferred on the chief protector by the Aboriginals Ordinance.
By a fortuitous circumstance, action inturned by this recommendation was delayed until 1927 when the officer appointed in pursuance of this recommendation arrived in Darwin with the staff of the Northern Australian Commission. The problem immediately to be faced was the promotion of settlement by white women. At that time, throughout the Territory, European males outnumbered females by more than 3-1. The actual disproportion was largely masked by the concentration in Darwin – outside the Urban area the disproportion was of the nature of 10-1. Although there were some 1200 European males in the rural area, the number of married women was under 130 and many of these were of Asiatic race or of mixed blood. The number of children of all races under 4 years of age was 72. This situation involved increasingly more intimate association between white males and the native race with inevitable economical and moral degradation of both. It appeared essential that a condition precedent to any effort to attract population to the area must be the provision of a health service which would safeguard the white population from any deleterious influence attributable to the environment and a medical service which could inspire sufficient confidence in European women to induce them to settle in the area and raise families.
The first step taken was to initiate routine medical examination of all natives in contact with white settlement followed where necessary, by isolation and appropriate treatment. Licences to employ natives were made conditional upon safeguards designed to prevent the transmission of endemic disease between the races.
A new native policy wholly distasteful to Territorians of the time was initiated. This involved elevation of the native from his existing subhuman or animal status to social parity with the white race, by education in hygiene communal response and the means to maintain himself as an economic unit in the prosperous and healthy community.
Although some measure of successful hygiene administration could be expected and was achieved by careful attention to the native race, complete objective remained unattainable while private practice continued in the Territory. The resources of the tiny population scattered over the vast area were inadequate to provide for private practice an income attractive to the quality practitioner competent to provide the necessary quality of service. Although a medical officer might be available for the care and treatment of natives in rural districts, the European population must rely upon obtaining the services of a practitioner from Darwin. The messenger calling for medical advice must be despatched on horse-back or on foot to the nearest telegraph station, taking several days to reach his destination. The medical practitioner must proceed to the patient’s bedside by similar means of transport. During his protracted absence the loss of practice rapidly raised the cost of the service to the patient to a figure well beyond his capacity to pay. On his arrival at the bedside the patient had often completely recovered or too often had died, but the bill remained to be paid. Basic measures for the control of communicable or tropical disease were impossible to take unless the health authority could have complete control and direction of the medical practitioner. In 1928 therefore, the administration was persuaded to purchase the practice of the only remaining private practitioner in Darwin and the medical service came to be.
Work was immediately commenced upon providing a medical service and amenities calculated to encourage settlement by white women. A new obstetric ward was directed to Darwin Hospital prenatal clinic, infant health clinic and district nursing service was established. The hospital subsequently established at Katherine, Tennant Creek and Alice Springs. A pharmacist was appointed to the staff for the dispensing of drugs required not only by medical officers but also for the provision of medicine chests at Police Stations, Missions, Mining Settlements and Pastoral Holdings. Information collected in prenatal and infant health clinics regarding the reaction of Europeans to the environment was supplemented by the routine medical inspection of school children.
Regular examinations of natives by medical officers throughout the Territory were soon supplemented by the appointment of laboratory technician who travelled through the rural districts undertaking haematological, helminthological and bacteriological examinations of the native population. New standards of hygiene – housing, water supplies, food control, mosquito control, wastes disposal and the like were held down by regulation and rigorously applied.
Two major difficulties confronted the infant medical service imperilling its survival and obstructing its expansion. Under the S.A. administration which ceased in 1911 residents of the Territory had not only experienced greater prosperity but had enjoyed more effectual representation in Parliament and the greater measure of self-government than they had since known under the Commonwealth. Much had been hoped for the years following transfer of the Territory to the Commonwealth and as they watched the progressive deterioration of the economy and the migration of old settlers, the bitterness of disillusion and fear of ultimate extinction engendered a universal distrust of the capacity and the integrity of the Commonwealth administration and of its officers individually. In a tiny settlement with no more communication with the outside world than was provided by one mail boat each month, the constant and unjust calumny deprived officers of any reasonable opportunity of enjoying that happiness and comfort of living, which every individual is entitled to expect. Officers of the medical services were appointed as temporary officers on short term appointments and the atmosphere in which they worked was such that they must be expected at any time to resign in order to avoid impairment of personal and professional reputation and to leave in search of a more comfortable environment. Incessant criticism too was likely to provoke at any time a sudden reversal of policy in the administration, for it must be remembered that the service had been evolved in response to recommendations from its officers and not on the basis of any firm conviction of its merit or value in the administration or the Federal Government.
The second difficulty was financial. The early years of the service were the depression years, and it was impossible to obtain from Government the funds necessary for expansion on the scale visualised.
To meet and encounter these threats, to survival and progress, a medical benefit fund was established under which a small weekly payment the contributor was entitled to free medical and hospital attention and free ambulance transport for himself and his dependants. This fund was calculated to serve the dual purpose of providing a source of certain and increasing revenue which could be used to finance expansion and at the same time identified the public interest with retention of the salaried service.
In 1934 Dr. C.C. Fenton joined the Medical Service and was stationed in Katherine. Dr. Fenton used as his means of transport over the extensive medical districted allotted him a De Havilland Moth Aircraft, in respect of which he was paid by the administration 2/- per mile. The chief medical officer was able by exercise of his powers under the Aboriginals Ordinance to require employers of aboriginals to put down landing grounds suitable for use by Dr. Fenton and very soon it was possible not only to provide prompt medical attention in cases of emergency but to conduct regular inspection flights to provide supervision under the Health and Aboriginal Ordinances. This work was considerably facilitated by the development about this time of the pedal wireless set which enabled stations to communicate promptly with Darwin.
As the years passed, the service expanded considerably undertook new tasks and developed to a condition under which it has been able not only to meet the demands of residents of the area but to achieve any great measure many of the objectives for which it was formed. Communicable disease has no greater incidence in the European population of the Northern Territory than in any other part of the Commonwealth. Not withstanding the high incidence of leprosy in the native population its dissemination to the white population has hitherto been controlled and no case has been for several years amongst white women or children. The population of the Territory has increased considerably and the disproportion between males and females has been largely corrected. The number of children born and reared in the Northern Territory has been considerably increased. By 1933 the number of married women outside Darwin had increased to 321 and the number of children under 5 to 278. In 1947 the number of married women in the Northern Territory had increased to 1,527 and the number of children under 4 to 1,009.
Today the Northern Territory Medical Service is a highly organised and valuable instrument for the execution of health and medical policies throughout the Territory Some of the conditions which prompted the formation of the Service are no longer conspicuous and there is a danger that they may be forgotten. The degree to which the medical service has contributed to the successful white settlement of this portion of Northern Australia could be judged by comparison with the condition of adjacent areas of the continent not less richly endowed by nature. The Service as it exists today is in no small measure a moral to the devoted service of the small team of medical officers, nurses, technicians and clerical staff who fought to develop it in very trying times and over several years under conditions which at any time might have justified them in discontinuing the effort.