THE EVOLUTION AND DEVELOPMENT OF HEALTH CARE ' OCCUPATIONS IN NEW SOUTH WALES.

BY

CHRISTOPHER RICHARDS

Project report submitted for the Degree of Master of Health Administration in the University of New South Wales.

1979 DEDICATION

For my Father, IToBl, who nurtured my interest in history and learning. and all those kind people who contributed information to use in this project. iij_

CONTENTS

sm,it-IARY ...... iv

I. INTRODUCTH,N ......

II. THE EMERGF:NC ~~ OF HEALTH C/\RE OCCUPf/flTC!!,'; 6

III. TRAINING SCHOOLS ......

IV. UNIVEF-?SITY ANIJ COLL1~Gf~ \1f<' AlJVA:Jc;~ll

EDUCATION TT~AilHNG ,SCHCUIS ...... 81

V. STATE OCCUPATIONAL A~;seic IATIC;;\:0 ...... 98

VI. NATIONAL OCCUPATIOHA L J\.'~ ..c;c,c IA'l'IC: >JS 1 1 1

VII. LICENSING OF HEALTH CARI:: OCCUF'ATION.S ...... 125

' VIII. CODES OF ETHICS ...... 140

IX. ANALYSIS OF THE EVOLUTION OF HEALTH

CARE OCCUPATIONS IN NEW SOUTH \/AU;:,s 149

x. l'~VOLUTION OF HEALTH CAf-

AN ECONOMIC AND SOCIAL INTERPRETATION 1 51

XI. CONCLUSION ...... 181

XII. REFERENCES ...... 184

XIII. APPENDIX ...... ?20 iv

SUMMARY

In this project the history of fourteen health care occupations in New South Wales were examined to determine if there was a common pattern in the emergence of certain distinguishing characteristics. The occupations studied were:-

1 • Dentistry 2. Dietetics 3. Hospital Administration 4. Medical Record Administration 5. Medicine 6. Nursing 7. Occupational Therapy 8. Orthoptics 9. Pharmacy 10. Physiotherapy 1 1 • Radiography 12. Rehabilitation Counselling 13. Social Work 14. Speech Therapy

The characteristics examined were:-

1. The emergence of health care practitioners 2. The emergence of training schools 3. The emergence of university and collece of

advanced education training programs 4. The development of state occupational associations 5. The development of national occupational associations 6. The introduction of licensinG acts and boards 7. The production of ethical codes

It was found'that these characteristics were either present in the occupations under study or were characteristics that they desired. However the emergence of these features did not follow any common pattern, in contrast to America, where a fairly standard sequence of evolution has been detected amongst a group of eighteen occupations.

An attempt was then made to explain why the characteristics of health service occupations should appear in the first place, and evolve the way they have. This was done using economic and social concepts, and the conclusion was reached that these occupations have attained their present features through the pursuit of status and economic gain. It was also concluded that the emergence of these features may not be directly related to the needs of patients or the rest of society. 1 •

1. INTRODUCTION

The aim of this project is to examine the historical evolution of fourteen health care occupations in New South Wales, to see if they follow any common pattern of development in the emergence of major characteristics. The characteristics chosen for examination are those that were used oy Wilensky (1) when he studied the "sequence of professionalization" of eighteen occupations in the United States. Wilensky found the following sequence of events to be fairly standard as these occupations evolved:-

1. Practitioners start doing full-time the thing that needs doing. 2. First Training Schools appear. 3. University Training Schools appear. 4. Local Professional Associations appear. 5. National Professional Associations appear. 6. State Licensing Laws appear. 7. Ethical Codes appear.

Each of these key events in the development of occupations is used as a chapter theme in this project. However several modifications have been made to make Wilensky's characteristics applicable to the Australian environment:- 2.

1.·The university training school chapter has been broadened to include colleges of advanced education (CAE'S) as these institutions are now major tertiary training centres in their own right in Australia, and have the power to issue degrees to successful undergraduates.

2. The chapter on local associations uses the word "state" instead of "local", as most of the early associations were state wide bodies, even though most of their members resided in Sydney. In America some associations began as regional or city groups. Later on these groups became local chapters of state-wide or national associations.

3. Wilensky follows the conventional wisdom of many sociologists in subscribing to the belief that professions are a distinct category of occupations with special features. He describes the emergence of these features as the "process of professionalization". But Roth (2) has superbly demonstrated that the sociological concept of a profession does not stand up to close scrutiny, and that a group of occupations cannot logically be considered different and special, and labelled as professions. For this reason the word occupation is used throughout this project in preference to the word profession. ') .

Consequently the aim of this project differs from

that of Wilensky. This v:, ;rk l.oo::s at the emergence of characteristics to detc:rrninc if a common pattern of evolution exists in He:w ;;outh Wales, whereas '.'/ilensky studied these characteristics in terms of occupationn dcvelopine into professions. If the emereence of the characteristits does not constitute a professionalization process then some other explanation must be provided. This ~mb;ject is taken up in Chapter Ten where an attempt is made to interpret the historical development of health care occupations in terms of social and economic theories.

Much of the historical material was collected from secondary sources, such as journal articles and the growing number of books on the history of health service institutions such as hospitals. The available bibliographies led tu many articles on the history of medicine and some on the history of nursing, but these works give few leads in uncovering material on.other health care occupations. A Medlars search led to a similar result. It uncovered material on the history of Lledicine, but little of account about other occupations. For this reason Medlars is not a useful vehicle for locating historical material for inter­ occupational comparisons. Journals of occupational associations were a valuable source of information 4.

but complete sets of journals are difficult to find. Hospital and training school libraries were invariably found to have many issues missing from their journal collections. Large collections of material on medical history are available at the Brownless Library at Melbourne University, and the library of the Victorian Branch of the Australian Medical Association. The College of Nursihg library in Melbourne has a good range of material on nursing history while the Lincoln College of Health Sciences library houses the journals of many health care occupations (which contain a few valuable historical review articles).

Members of each occupation were also contacted and a request made for assistance in uncovering historical information. Assistance was invariably provided. In most cases the people contacted were occupational association officials and/or "elder statesmen" who had witnessed the growth of their occupation over many years. Because many people were kind enough to assist, I have not attempted to list them all through fear of missing an important informant. But the help of all these people was greatly appreciated. I had originally planned to cover a wider range of occupations and states other than New South Wales, but when the size of the collected material began to grow alarmingly the scope of the project had to be restricted. This meant that I could not use a large amount of the data that people had obligingly provided. I plan to use this material in 5.

future projects.

A problem which presented itself from the outset, was the conflicting evidence concerning the dating of major events in the evolution of many occupations. Secondary sources often gave conflicting dates as did members of an occupation. In some cases the reflections of informants conflicted with the secondary sources. Many of these problems may have been solved by examination of the archives of occupational associations and contacting a larger number of people in each occupation, but this would have extended the time for data collection beyond the limits available. The dates used are those that I consider are most probably the correct ones, but subsequent research may show that some are in error. Further research may also demonstrate that other material in this project needs revision (eg. evidence of a long forgotten occupational association may be uncovered) but this is unavoidable in a project which places heavy reliance on secondary sources and some personal interviews (with a limited number of people within each occupation). I would be glad to hear from any reader of this project who detects any factual errors of this nature. 6.

II.THE Er·IERGEHCE OF HEALTH CA 1~1:;; OCCU~'ATTCU:;

I;'JTRODUCTIOH. In this chapter the emergence '.1 f h,2al th care occupations in Hew South \'!ales is cliscus,,;eu.. The objective is to demonstrate hov,r particular activities were taken up by one occupation, and how these activities grew and became increasingly complex, thus leadinr, to a new ·occupation appearinri; to to. 1-:e: charge of these activities. It should be noted that until the late 1920'S there was only a small number of health care occupations in Australia. The increasing number of occupations to appear since that time is a maior characteristic of medical history in the last half century, and it is a trend which shows little sign of abating.

I.DENTISTRY. The history of the dental profession is relatively short, as it was not until 1728 that Pierre Fauchard published in France the first complete treatise on dental practice. (3) Fauchard is now recognized as the "father of the dental profession".

In the years immediately following the arrival of the First Fleet at Sydney Cove there were no dentists practis­ ing in the colony. Any dental treatment such as extractions and the making of artificial teeth was carried out by the colonial surgeons or the colonists themselves. (4) All one needed was some type of extractinf, instrument or a piece of rope and a door! 7.

No record of a person practising as a dentist has been found prior to 1818. On the 30th. of May that year a Simon Lear of Castlereagh Street advertized in the Sydney Gazette, proclaiming himself as a Dentist and Corn Operator. As well as removing corns without pain he claimed he could make artificial teeth in a perfect manner, and bring discoloured teeth to a beautiful white colour. (5) It fs not known whether Lear had received any formal training in dentistry prior to his arrival "down under". If he had received any training prior to migration it would have been by apprenticeship, as at that time there was no dental college or school in England.

In the following month, on 20/6/1818, the Sydney Gazette carried another dental advertizement by a Mr. George White who advertized himself as a Dentist and Physician. For the next decade Simon Lear and George White appear to have been the only dentists in the infant colony. (6) In 1827 they were joined by Ambrose Foss, and in 1829 by Dr. Henry Jeanueret who is famous as the author of Australia's first dental publication. This was a pamphlet of 34 pages entitled "Hints for the Preservation of Teeth", and it appeared in 1830. (7)

By 1844 the four pioneer dentists already mentioned, had been joined by seven "new Chums". Gradually more and more dentists arrived from the "old country", but it was not until the 1880'S that resident dentists began 8.

appearing in the larger rural towns. Prior to this the populace in the country districts had obtained dental care by self-help, from doctors and pharmacists or from itinerent dentists who rode through the outback.. Back in the city a Dental Department was established at Sydney Hospital in 1887. (8)

The following points characterized dentistry as it emerged in the nineteenth century:- (9)

(A) No laws existed to regulate practice (B) No training schools existed to educate practitioners - the only training was by apprenticeship or self-education (C) Quackery abounded

II.DIETETICS. In the early days of the colony in New South Wales attention to the diet of the sick was lacking. When the new Convict Hospital was occupied in 1816 there was still no special diet for hospital patients. All patients, irrespective of their disease or incapacity, were given a daily ration of one pound of uncooked meat, and one pound of flour. In order to purchase luxuries such as tea and sugar many patients resorted to selling their rations to the townsfolk. As a result the hospital verandah would often become crowded on ration days as patients and townsfolk bartered their wares. (10) 9.

There was no routine supply of such things as milk and vegetables to hospital patients. However vegetables were sometimes given to the scorbutic patients, who continually arrived on the convict transports. Preventive measures against scurvy had been discovered prior to the settlement of Australia but these measures were ignored by many ships. Scurvy was a major problem in early colonial times, and it is significant that one of the earliest reports involving the medicinal properties of the local flora, concerned the anti­ scorbutic properties of native sarsparilla. (11)

Conditions at the Convict Hospital were even more gruesome than the picture painted above, as there was no cook to prepare the meals for patients. Although the hospital was built with two kitchens, one was allocated to the hospital overseer and the other was put into use as a mortuary and storeroom! Such were the priorities in bygone days. In consequence the patients were forced to cook their own meals on fires in the wards. Seeing the patients were locked in the wards at night by the overseer, and left to their own. care, one wonders how the hospital avoided a major fire.

William Redfern, the surgeon in charge of the new hospital, was the first person to make some dietary reforms for the convict patients. (12) He overhauled the system of bartering on the hospital verandah by organizing the sale of patient rations when this was 10

indicated (eg. he arranged for the sale of meat rations of dysentry patients so that they could purchase milk and other appropriate items). As well as this he often brought meals from his own home to help special patients.

V/hen Bowman's reign began as Principal Surgeon in 1819 he introduced many medical reforms in the Convict Hospital. Under Bowman's control the hospital entered what Watson has described as its "Golden Age". One of his reforms was the introduction of a new dietary scheme. In later years the head nurse (or matron) was required to visit all wards each day so that a diet book could be maintained. · In this the diet of every person was recorded. ( 13)

Following the introduction of the Nightingale system of nurse training into Australia in the second half of the nineteenth century the subject of invalid cooking was added to many nurse training programs. For example, Prince Alfred Hospital introduced instruction and practical demonstrations in invalid cooking in 1887. (14) However, as cooks prepared the.patient meals in the hospital kitchen this training was of most use to those nurses who left the hospital and took up private nursing

following graduation. In the 1880 1 S many other Australian hospitals added invalid cooking to their nurse training curricula.

Many of the roots of modern day dietetics can be 1 1 •

traced back to the interest in invalid cooking that arose last century. However the scientific basis of diet and nutrition is mostly an inheritance of this century where much of the development has come from America. (15) It was America that produced the first dietitians whose training was based on science subjects of university standard. This development in America was aided by the needs of the country that arose during the First World War. However, the development of dietetics along similar lines did not take place in Australia until the 1930 1 s. ( 16)

Trained dietitians were first employed in public hospitals in Australia at the Alfred Hospital and the Royal Melbourne Hospital in Victoria. (17) Miss Mabel Flanley became Australia's pioneer dietitian when she arrived in Melbourne from the United States in January 1930 to start a dietetic department at the Alfred Hospital. (18) In the same year Nesta Miller, a graduate nurse, returned from Canada where she had been sent for training in dietetics, to take charge of a new diet kitchen at the Royal Melbourne ~Ospital. (19) By 1934 there were four hospitals in Melbourne with dietary departments. (20) At this stage there were no qualified dietitians "north of the Murray and south of the Tweed".

In New South Wales the Hospital's Commission took the first initiatives towards establishing dietetic depart­ ments in 1934. In that year they decided that the 12.

Royal Prince Alfred Hospital and the Royal Alexandra Hospital for Children could employ dietitians. They were given the option of employing dietetic graduates from overseas countries, or arranging for me1.1bers of their own staff to train overseas in a recognized course. The second option was adopted by the Royal Alexandra Hospital for Children. They sent one of their graduate nurses, Miss Salome Eisenberg, to train in London. She success­ fully completed the Diploma Course in Dietetics at the Kings College of Household Science, and returned to her parent hospital in 1937 to initiate the dietetic department. Royal Prince Alfred adopted the first option and brought out an American dietitian, Edith Tilton, to

take charge of their food services. (21) She was a graduate of the University of Wisconsin, and she arrived in Sydney in 1936. Marriage cut short her pioneering work in 1937 and she was succeeded by another American dietitian, Ruth Gordan.

Miss Eneid Davies, a nursing graduate, went to England at the same time as Miss Eisenberg and completed the same training course. On her return to Australia in 1937 Miss Davies was appointed as dietitian at st. George District Hospital. She remained there until 1940 when she took up an appointment at the Royal Newcastle

Hospital. (22)

It is interesting to note that Miss Eisenberg and Miss Davies were the only nurses in New South Wales to undertake 13.

a post-graduate course in dietetics, and thus became dietitians. Once a training course was established at the Royal Prince Alfred only university graduates were accepted for dietetic training. This situation contrasted with that in other states such as Victoria where nursing graduates were able to continue entering the dietetics training programs that developed.

III.HOSPITAL ADMINISTRATION. The first hospitals in the penal colony of New South Wales came under the control of the Principal Colonial Surgeons. There were no Chief Executive Officers in the modern sense of the term to supervise the day to day operation of the convict hospitals. The Principal Surgeons were in turn, John White 1788-1794, William Balmain 1794-1805, Thomas Jamison 1805-1811, D'Arcy Wentworth 1811-1819, James Bowman 1819-1836, John Vaughan Thompson 1836-1844 and William Dawson 1844-1848. (23)

When the new Convict Hospital opened in 1816 D'Arcy Wentworth was the Principal Surgeon. However, he spent very little time in the hospital and left the daily management of the institution in the hands of Assistant Surgeon William Redfern. (24) The hospitals in the outlying districts such as Windsor, Parramatta and Bathurst were also supervised by Assistant Colonial Surgeons.

Following the cessation of transportation to New 14.

South Wales in 1841 the convict hospitals were gradually closed between 1842 and 1848. The convict hospital in Sydney was the last to close, thus bringing to an end the first era of hospital administration in the colony. (25)

Many of the convict hospitals were then taken over by local committees ·of management who used them to serve the health needs of the poor. The Sydney Dispensary which had been founded in 1826 to treat the sick poor, was able to gain possession of the southern wing of the Convict Hospital in Sydney in 1843. (26) When the last of the sick convicts were moved in 1848 the Sydney Dispensary took control of the central hospital building. This body was incorporated as the Sydney Infirmary and Dispensary in 1844. (27)

As the Sydney Infirmary and Dispensary the hospital was controlled and managed by a committee of management. (28) They elected a weekly committee of twelve members from their numbers, and it was this committee which actually controlled the day to day runnipg of the hospital. The name of the weekly committee was later changed to house committee.

The management of the hospital by a committee of honorary business men and dignitaries had many draw­ backs. As a result the committee appointed John Black­ stone as Lay Superintende.nt in 1867. ( 29) In 1869 this title was altered to manager. 15.

When Lucy Osburn arrived from England in 1868 to pioneer the Nightingale system of nursing in Australia at the Sydney Infirmary and Dispensary, managerial conflict errupted. (30) Problems of jurisdiction and responsibility arose, as the lay superintendant, the committee, and many of the doctors, would not accept the area of control that a lady superintendant claimed as her command under the Nightingale syst~m. With support from the Colonial Secretary Henry Parkes (later Premier), Lucy Osburn was able to survive the challenges she met, and pioneer the new system of nursing in Australia. In 1888 Sydney Hospital, as the Infirmary was now called, appointed their first medical superintendant thus giving the institution its third senior executive position.

The discussion above, using Sydney Hospital as the example, demonstrates how the day to day management of public hospitals gradually transferred from committees of management to a tripartite executive team consisting of a manager, a matron and a medical superintendent. However, Committees of Management remained as the bodies responsible for formulating overall hospital policy.

In the case of the colony's first Asylum for the Insane, which was established in 1811 at Castle Hill, the system of medical control which existed in the convict hospitals was not followed. A non-medical superintendent was appointed who was responsible directly to the governor. (31) Although this lay 16.

superintendent did not come under the control of the Principal Colonial Surgeon, medical staff from the colonial service occasionally rendered treatment to patients at Castle Hill. This system of non-medical administration in lunatic asylums was challenged over a period of years and eventually a system of medical administration was introduced.

Many of the early hospitals established in the colony were placed in the hands of a married couple who would reside on the site. The husband would act as warden, book-keeper and "jack of all trades" whilst the wife would act as cook, cleaner and nurse. Such an arrangement occurred when a hospital was established at Newcastle in 1815 (32), when the Benevolent Asylum opened in Pitt Street in 1820 (33), and when the Albert Memorial Hospital (the forerunner of the Wollongong District Hospital) opened in 1864. (34)

From the preceding discussion we can see that the modern hospital administrator can trace his roots to functions that were exercised in the past by:-

(A) The Colonial Surgeons (B) Committees of Management and their sub-committees (C) Hospital Wardens and Caretakers

(D) Lay Superintendents

Out of activities undertaken by these groups, and other 17.

·activities that have become necessary as medical know­ ledge has advanced, has evolved the mix of functions that is the domain of the modern Chief Executive Officer.

IV.MEDICAL RECORD ADMINISTRATION. Scanty medical records or no medical records at all, was the norm in early colonial times. When medical records did exist their only contents were generally the patients name, a date, and the patients illness or cause of death.

· Until late in the nineteenth century disease classi­ fication was rather crude and this highlighted the lack of scientific medical knowledge which existed at the time. (35) For example, the term "fever" was used liberally to include many diseases which were associated with a high temperature. "Phthisis", an old term for tuberculosis, was used for any wasting condition, whilst "dyspepsia" covered a multitude of problems involving the digestive system. As the real cause of most diseases was unknown the terminology referred to broad categories of symptoms and not to specific diseases.

As the twentieth century unfolded medical knowledge expanded exponentially. Doctors came not only to diagnose diseases accurately, but to have specific agents for their treatment. The medical record grew larger and more complex and the task of filing, analyzing and retrieving patient data became progressively more difficult. The task became too time consuming for medical practitioners to undertake themselves, and too difficult for clerks to 10.

undertake without technical supervision.

The year 1928 saw the emergence of the 1r1cdical record occupation in the United States, and four hospital based training programs were established in that country in 1935. (36) The equivalent development in Australia lagged behind by a considerable number of years.

During 1948 the Australian Hospitals Association discussed the problems associated with medical records in hospitals and decided to seek assistance from an overseas expert. With the financial help of the Carnegie Corporation they brought out Virs. E. K. Huffman in 1949 to suggest improvements to Australian practices. (37) Mrs. Huffman was Director of a Medical Record Program at the North Western University in Chicago. During her short visit of several months she visited both Sydney and Melbourne and conducted classes of instruction for personnel who worked with medical records in hospitals. The modern development of a distinct medical records occupation in Australia really dates from the visit of Mrs. Huffman in 1949. Followi~g this visit another American, Mrs. McKinney, was brought to Australia to further aid the development of medical record services. (38)

Qualified medical record practitioners are mostly found in New South Wales and Victoria where Australia's two training schools are sited. Even in these states 19.

the qualified practitioners are mostly located in the larger hospitals in Sydney and r~lbournc. In consequence there are numerous health care facilities in Australia which lack the services of a person educated in medical record science. To overcome this situation a correspondence course has been developed in the external studies section of Sydney Technical College to educate those without fo~mal training who are currently handling medical records. (39) In this vmy a second-level practitioner will be developed over the coming years.

V.MEDICINE. The first British medical practitioners to visit the east coast of Australia were the naval surgeon William Broughan Monkhouse and the surgeon's mate William Perry who were on the Endeavour with Captain Cook (40). However, it should not be thought that medical practice in Australia began with European settlement. For centuries prior to the arrival of the Whiteman the aborigines were practising their own brand of medicine.

Blainey (41) has pointed out that aboriginals had developed many useful medicines and had accumulated a detailed knowledge of the pharmacological value of many plants. Much of this knowledge was lost when contact with the Europeans was made. It would surprise many Australians that many of our native plants which are kept for ornamental purposes, also contain potent pharmacological properties. When one considers the nature of the drugs that were possessed by the surgeons 20.

in the First Fleet and the doses that were administered, one really wonders whether the ministrations of the "white witch doctors" were actually a retrograde step when compared with the medications used by the black medicine men.

In the field of diagnosis both black and white practitioners lacked the scientific knowledge that was needed to explain the real causes of disease. It was not until the end of the nineteenth century that white medicine began to accumulate enough scientific knowledge to base medical treatment on valid theories. Up until this point a case can be made that the black system was superior to the white, for it can be argued that European practices such as blood letting, violent purging, and admission to infection-ridden hospitals were more detrimental to health than they were curative.

Governor Phillip arrived in Sydney Cove with the First Fleet in January 1788. The fleet contained a group of naval surgeons to minister to the needs of the convicts and their keepers. Five of these surgeons remained in the colony as the colonial medical staff. This group consisted of a Principal Surgeon (John White), three Assistant Surgeons (William Balmain, Thomas Arndell, and Dennis Considen), and a junior surgeon (John Irving). (42)(43) The medical establishment was civil and they were directly responsible to the Governor in his civil capacity. These surgeons ceased to be naval surgeons, 21.

· and they were not responsible to the Governor in his role

as Chief Military Commander of the colony. (4Lt)

Soon after landing a crude hospital was built on the west side of Sydney Cove. In this structure the sick and injured were treated by the surgeons and about twenty convicts who acted as overseers, dressers, wardsmen, and nurses. The convicts were also expected to help themselves as much as possible. The hospital was very inadequate and tents had to be erected to cater for the excessive number of patients who needed help. (45)

When the Principal Surgeon returned to England on leave in 1794, William Balmain took over his duties as Acting Principal Surgeon. (46) White failed to return to Australia as his initial enthusiasm for the colony had been replaced with disillusion and pessimism. Consequently Balmain was gazetted as Principal Surgeon in 1796. During the Balmain administration the original hospital structure was dismantled and re-erected on a site near the present Argyle Cut. (47)

Superintendance of the convict hospitals was the responsibility of the Pricipal Surgeons and they 1:iade regular reports to the Governor on the operation of the institutions under their care. The Principal Surgeons also reported to the Commissary of the Colony on the use of medical stores. The Principal Surgeon and one Assistant Surgeon resided in Sydney Town whilst the 22.

other Assistant Surgeons were stationed at ParraLlatta and Norfolk Island. (48)

Following three years service as an Acting Assistant Surgeon, Martin t-lason shifted to the Hawkcsbury River region in 1804 and began practising medicine in a private capacity at Windsor. He is generally regarded as Australia's first private medical practitioner. However, it has been pointed out by Darvall (49) that the convict, John Francis Malloy, was charging private rJedical fees in the Hawkesbury region for many years before !Iason arrived there. It is doubtful whether ~alloy ever received any formal medical training prior to his transportation to Australia. He was given a land grant at the Hawkesbury in 1795 and it appears that he provided medical assistance to other settlers in the area from this time. On several occasions Balmain complained to the Governor about an unskilled convict practising medicine in the Hawkesbury region, and in all probability these references are made to Malloy. It appears then that there is some doubt about who really was our first private medical practitioner. From these early beginnings has grown the modern system of general practice based on a fee for service method of payment.

In 1805, Thomas Jamison succeeded Balmain as Principal Surgeon. later Jamison was recalled to England as a witness in the court-martial of Major Johnston who had taken part in the arrest of Governor Bligh. D1 Arcy '.'Jentworth was then appointed as Actin1~ l'rincipal Surgeon and he obtained the permanent appointnwnt in

1811 when Jamison died in l·~nr~lan:.l. ( ',O)

Governor Macquarie decided tu build a huge new convict hospital in 1810. The construction of the hospital took place between 1811 and 1816. (51) It was "christened" the·"Hum Hospital" because of the fact that a monopoly in the importation of rum was iiven to the builders. When the new hospital opened William Redfern carried out most of the patient treatment and really ran the hospital. D'Arcy Wentworth only visited the wards on odd occasions and occupied himself in other pursuits. Redfern was assisted in his hospital tasks by his apprentice, Henry Cowper. Following the completion of a three year apprenticeship in 1817, Cowper was appointed to the hospital as an assistant. By accepting this position Cowper became the first Australian Resident Medical Officer. (52) He received a salary of twenty five pounds per year plus rations. The other hospital workers were an overseer, a clerk, a matron, attendants and nurses. They w~re all convicts and they received no formal training for their tasks.

\\/hen Wentworth resigned Macquarie wanted Redfern to succeed him as Principal Surgeon. But there was opposition to this appointment because Redfern had previously been a convict and had been transported to Australia for the part he had played in the mutiny of the British North Sea Fleet at the Nore. (53) Because of this opposition the new appointment was given to James Bowman and ho took office in 1819. ~edfern then resigned in protest and discust. Despite thls, Bow,,1a.11 proved a capable administrator and introduced numerous reforms in the colonial medical service and at the Convict Hospital.

It is interesting to note that up until the nineteenth century there was a virtual caste system in the way medical services were provided in En~land. (54) Medical activities were divided between three separate occupational categories. These were:-

(A) PHYSICIANS they practised internal medicine (B) SURGEONS - they practised surgery (C) APOTHECARIES - they dispensed medicines. But many prescribed as well, and acted virtually as doctors.

Each of these occupations was controlled by a powerful occupational society (ie. The Royal College of Physicians The Royal College of Surgeons a.nd the Society of Apothecaries).

In 1815 the Society of Apothecaries gained a Royal Charter which made them medical practitioners as well as dispensers. (55)(56) After this the Apothecaries moved more and more into the field of medical practice and the Chemists and Druggists arose to take their place as 25.

dispensers of medicine. This is a classic case of one occupation gradually moving into the domain of another.

When Australia was colonized the system of guild control which existed in England was not transplanted onto Australian soil. Problems thrown up by isolation from the "Mother Country" such as the lack of medical facilities and m~dical practitioners, meant that the monopolistic English guild system was inappropriate to Australian conditions. Medical care was delivered by those who could provide it. This happened to be the naval surgeons who had entered the civil service and any other person who felt capable of helping the sick. Several of the medical practitioners who attained prominent positions in the new colony had received little in the way of formal medical training (eg. D1 Arcy Wentworth). There was no real attempt to divide medical practice into distinct categories and none of the medical guilds established branches in Australia.

VI.NURSING. Prior to the Nightingale era most nurses were uneducated women from the.lowest strata of society who were held in contempt because of the nature of the work they performed. It would have been considered "unladylike" for women from the aristocratic elite to have "lowered themselves" by coming into contact with the sick. (57) An exception to this rule existed in the case of some religious orders (both protestant and catholic) where religious sisters devoted themselves to 26

healing sick paupers. (58) Such nursing care can be dated back at least to the fifth century A.D. when an order of nuns led by St. Brigid gave help to the sick. ( 59) Generally the conditions that nurses worlrnu under were appalling.

With the arrival of the First Fleet in Australia convicts were called into service to provide the nursing care for fellow convicts who needed assistance. In all likelihood male convicts were used in this role as the female convicts were in short supply and were needed as prostitutes. (60) The care provided was rather crude as the sick convicts were expected to help themselves as much as their condition permitted and they were often left to their own resources, especially at night. The coming of continuous nursing care by educated and competent women was still many decades into the future when Sydney was first settled.

Nursing care was carried out by unqualified convicts in the first convict hospital built on the west side of Sydney Cove, the second convic~ hospital built near the site of the present Argyle Cut, and in the magnificent "Rum Hospital" that Macquarie had built in the street that he modestly named after himself. In fact, apart from the colonial surgeons, all hospital staff were convicts. Many came to their jobs as recently discharged or convalescing convict patients. (61) Eventually female convicts came to be used to nurse female convict 27.

patients whilst male convicts were used to nurse 1nale convict patients. The women who took on this role were untrained and were ~enerally old. Because the patients were convicts they were locked in their wards at night where they cared for themselves till the overseer unlocked the doors in the morning. (62) Any faeces or food debris, along with dead bodies, were then removed. There was some re,form during Bowman's reign as Principal Surgeon when he introduced a scheme for selecting the convict nurses on a more careful basis. However the • standard of care delivered remained fairly "rough and ready 11 •

The first trained nurses to arrive in Australia were catholic nuns from the Irish order called the Sisters of Charity. (63)(64) Mary Aikenhead founded this order in 1815 in Dublin and in 1834 the order opened a hospital called St. Vincents. To ensure that proper nursing care was provided Mary Aikenhead sent three of her nuns to the Hospital de la Pitie in Paris so that they could learn the techniques that the French nuns were practising. On returning to st. Vincents in Dublin they helped to teach other sisters of the order about the nursing procedures they had learnt. One of the nuns sent to Paris was a Sister M. de Sales O'Brien who later went to Australia. (65)

Bishop Folding the first catholic bishop of "New Holland and Van Diamand Land", saw that a need existed 28.

for educated nurses to lend assistance to the sic:;.. He wrote to Lary Aikenhead and asked if she could send a group of sisters to tho antinodes. In resDonsc to this appeal, five sisters were selected to sorve in the colony - M. John Cahill, r-:. Baptist de Lacy, M. Xavier Williams,

M. de Sales O'Brien and I·l. Lawrence cator. \'/hen they arrived at Sydney in 1838 they became the first nuns as well as the firs't trained nurses to set foot in Australia. ( 66)

As their first assignment the sisters went to the Female Factory in Parramatta where they gave care to the female convict inmates. Amongst other things they arranged for the women to be employed with sewing and laundry work, instead of breaking rocks and sawing wood which had been the previous practice. (67) The sisters also provided care for the neatly in the surrounding districts.

With the passing of transportation and the convict era the Sisters of Charity remained in Australia and continued their religious and welfare work. In 1857 they moved into "Tarmons", the home formerly occupied by Sir Charles Nicholson the Chancellor of Sydney University, and founded a hospital for free treatment of the sick poor. (68) This became St. Vincents Hospital and Sydney's second public hospital. (The first was the old Convict Hospital which had become Sydney Infirmary). As with all the Hospitals that the order established 29.

down the east coast of Australia, care was given to both catholic and protestant patients. For many years the nursing care in the hosµital was delivered by the Sisters of Charity themselves, and nurses without a religious training were not used. At this time these sisters still provided the only trained nursing service in the entire country.

Following her experience in the Crimean War, Florence Nightingale established a nurse training scheme at St. Thomas•s Hospital in London in 1860. This event proved to be epoch making in the history of nursing and medicine. The Nightingale system trained educated · women from middle and upper class backgrounds to care for the sick and injured and it led to the standard of nursing care being raised considerably. Because the nursing care being provided at the Sydney Infirmary was of an appalling standard the Colonial Secretary, Henry Parkes, wrote to Florence Nightingale seeking her assistance. The problem was made even more acute for Parkes and other politicians who met in a former wing of the hospital which served as Pa~liament House, as they could not stand the smells that wafted in from the Infirmary wards nearby. (69)

As a result of Parkes' plea for assistance, a group of sisters who had trained under the Nightingale system were dispatched to the colony under the leadership of Lucy Osburn. (70) The other trained sisters in the group were Mary Barker, Eliza Blundell, Annie Miller, 30.

Haldane Turriff arni Bessie Chant. (71) These wowen pioneered the Nightingale system on Australian soil. Many doctors and members of the hospital management committee resented the power and influence of the nurses in the new system and it took a period of years before these people adjusted to the idea, and came to accept the benefits to patient care that trained nurses could provide. New South Wales was the pioneer state in the introduction of Nightingale nurses and it was several years before Victoria and Tasmania followed suit. In both of these states their first trained nurses were Nightingale sisters from the Sydney Infirmary. Haldane Turriff went to the Alfred Hospital in Melbourne in 1871 to become that statds first Nightingale sister while several Nightingale sisters went to the General Hospital in Hobart in 1875.

From the 1880'S onwards an increasing number of sisters who had trained in Sydney went out to the country districts to pioneer trained nursing services in country hospitals. (72) Up until this time untrained women had provided the nursing care and ~ny country matrons were married women whose husbands acted as hospital caretakers and handymen. By the dawn of the twentieth century trained nurses were working in many hospitals throughout the state.

The last half of the nineteenth century saw untrained nurses (or sickroom attendants) from the lower ranks of 31.

society give way to trained nurses who were drawn from the higher socio-economic classes. As a result of

English pioneers such as Florence ;Jigh tinr;ale anct r-irs. Bedford Fenwick, and their Australian disciples, nursing changed from a despised occupation to a desirable female calling. Over this period the stigma attached to the occupation was lost. (73) Nightingale raised it to a calling with religious overtones to which young single ladies could devote their lives. The new system of nursine made its devotees give a totaJ cornrnitnwnt in terms of time and energy, to caring for the sick. It is only in recent years that relaxation to the rules in such areas as hours of work, salary, marriage, nursing home accommodation, uniform and ettiquette have removed nursing from the category of a quasireligious calling. One could criticize the Nightingale system for making women slaves to their employing hospital, but it did improve the standard of patient care immensely. Under the Nightingale system nurses became "economic orphans", while the male dominated health care occupations such as medicine, dentistry and pharmacy earned sufficient income from human misery to enable their members to live comfortably as members of the middle and upper classes that emerged in Australian society.

VII.OCCUPATIONAL THERAPY. Forms of occupational therapy were performed by various people in early colonial times. The work of the Sisters of Charity at the Female

Factory in Parramatta in the 1830 1 S could be described as .occupational therapy. They arranged for the female 32.

convict~ to be employed productively by sowing and wash­ ing. Prior to this they had been forced to undertake heavy manual duties as a form of punishment. It is reported that this change improved the prisoners both socially and morally. (74) It also helped theLl economic­ ally as some of the money obtained from their labour was returned to the prisoners as wages.

In Lunatic Asylums some occupational therapy and diversional therapy was carried out by doctors and other members of the asylum staff. Whether this was motivated by a desire to keep the patients from annoyinG their keepers or by a desire to improve the prognosis of patients, is a moot point. Whatever the motivation, occupational therapy was certainly practised in the nineteenth century, although no distinct occupational group arose to practice it on a full-time basis.

Even the words occupational therapy were used last century. The Roman Catholic Bishop of Hobart, Dr. R. W. Wilson, complained about certain inadequacies at the Tarban Creek Lunatic Asylum when he visited this institution in 1863. He included in his criticisms a reference to the facilities which were available for occupational therapy. In his opinion these were in­ adequate for the number of patients present in the asylum (75)

Distinct occupational therapy practitioners did not 33-

· appear in Australia until the years between the two world wars. During the 1920' S, Miss Syn:c, a nurse 1ivho had worked in England with psychiatric patients, practiaed occupational therapy at the ;·.:ant ParL. Mental llospital in Melbourne. She was officially appointed as Occupational Therapist in 1934, (76). In the same period another woman did some occupational therapy with orthopaedic patients at Sydney Hospital. However, her worl~ was not successful and she ceased practising at the hospital. Later on she did carry out further work in Sydney and Melbourne on a sporadic basis. (77) It should be noted that both these women had received no formal training in a recognized school of occupational tnerapy. In the , next few years several trained practitioners appeared in our "sunburnt country".

\'/hen the Second World War broke out in 1939, Australia possessed the grand total of three qualified occupational therapists. (78) The ladies concerned were:-

(A) Miss Sylvia Docker - An Australian physiotherapist who had trained as an occupational therapist in England. She was working in Melbourne. (B) Hiss Joyce Kearn - she had qualified as an occupational therapist in England and was working in Melbourne. (C) Miss Ethel Francis - An Australian who had qualified as an occupational therapist in Phila­ delphia, U.S.A. She was working in Sydney. Mis~ Francis became the first qualified occupational therapist to practise in New South Wales when she commenced work in Sydney in 1934. As well as practising privately she held a part-time appointment at tho Royal Alexandra Hospital for Children. She began worl: in the Psychiatric Department of the Royal Prince Alfred Hospital in 1939 and held this appointment until she enlisted in the army in 1941. (79) V/orking under Professor Dawson (Professor of Psychiatry at Sydney University) at the Royal Prince Alfred, Miss Francis established the first occupational therapy department in an Australian hospital. (80)

Large numbers of trained practitioners did not appear till the country's first school was established in Sydney in 1941. This was to meet the needs of the army for therapists to help with the rehabilitation of wounded soldiers. (81) It was the Second World War that provided the stimulus that led to the real growth of occupational therapy as a distinct occupational category in Australia. In the case of the United States it was the First World War that led to the evolution o~ occupational therapy. (82) It appears that war can be the "mother of an occupation" as well as the "mother of invention".

VIII.ORTHOPTICS. The development of orthoptics as a distinct health care occupation first occurred in En~land. Non-medically qualified women began assisting opthalmologists with their work and these women came to ~. r ) i.

be called orthoptists. Often these WO'.;ien were the wives or daup.;hters of the doctors. An ear1y r~nt:1j:3h nioncer was Miss Mary Maddox who ber;an work with Dr. ~:rnest Maddox (her father). By founding an orthoptLc clinic at the Royal Westminister Opthalmic Hospital in 1929, she became the first hospital orthoptist jn r:n1:land. (8))

In Australia the first orthoptists began work in Melbourne in the early 1930'E. (84) Sydney's pioneer orthoptist was Miss Emmie Russell who be~an private practice in 1933. Prior to this she had gone to Melbourne to receive training from the orthoptjsts practicing in that city. Later she helped found the state's first orthoptic clinic at the Royal Alexandra Hospital for Children. Clinics at other hospitals soon followed eg.Royal Prince Alfred, Sydney Hospital, etc. (85)

The development of orthoptics in Australia has closely followed the English model. (86) Some of the early practitioners were English migrants and the training programs that were established closely followed the syllabus used by the British Orthoptic Board. The British influence has continued up to the present time. However, the placement of student training in Colleges of Advanced Education may eventually lead to an indigenous form of practice emerging in the future. It should be noted that the "British" model of orthoptic practice involves orthoptists working in very close "36.

liaison with opthalmologists where they will only accept patients on medical referrnl.

IX.PHARMACY. The surgeons who came to Austral:ia with the First Fleet brought their own drugs with them ready prepared and packaged. However, many were rendered useless during the voyage because of harsh storage conditions that were encountered. For example, many of the ointments melted in the tropics and resolidified into stratified layers when the temperate zone was reached, because of the different melting points of the various ingredients. The heat and moisture of the tropics inactivated many of the drugs and caused the ointments 'and other topical preparations to turn rancid. (87)

During the voyage to Australia and the early years of the colony the dispensing of drugs was carried out by the Colonial Surgeons. Delays in obtaining further supplies from England meant that the colony was often without medicines and many other necessary goods. While the colonists anxiously waited for the ships to arrive from "home", they were living in the !flidst of a vast native flora which contained many plants with potent pharmacological properties. If they had investigated the medicinal value of the plants being used by the aboriginals they would have uncovered many medicines of value. As it was they continued to rely on the Northern Hemisphere for their drugs, and this has been a characteristic of the Australian health services till 37.

the present day. Without investigating the native flora for useful medicines, Australians have cleared the bushland for cultivation and grazing, and continued to import most of the drugs that doctors prescribe. Blainey (88) has described how aboriginal medicines contained many useful constituents, and has commented on

I the tragedy of this countrys failure to tap this important natural· resource.

The early surgeons did discover that native sarsaparilla could be used as an anti-scorbutic, and that an infusion of "wild myrtle" was a useful astringent in treating diarrhoea. (89) Also, the many uses to which · eucalyptus oil could be put, were quickly realized. However, these examples of indigenous medications stand out as beacons because of their exception to the general practice of importing drugs from England.

Establishment of chemist shopkeepers in the colony could not occur as long as the colony consisted of convicts and their keepers. Before retail chemist shops could come into existence there .needed to be a number of free settlers who could buy drugs and a number of private medical practitioners who could treat the non­ convict population and write prescriptions. As these conditions did not exist in the early years of settlement there were no chemist shopkeepers. The naval surgeons issued drugs to the soldiers while the colonial surgeons issued drugs to the convicts. Eventually 38.

private medical practice began, and soon afterwards the first chemists and drug.r;ists made their appearance.

The colony's first chemist was John Tawell who began business in Hunter Street in 1820. (90) In 1821 he transferred shop to Pitt Street where the business prospered. Tawell had been transported to New South Wales in 1815 for ,possessing forged bank notes ( which he probably forged himself). However he was pardoned after a short period and then set about his commercial pursuits. Tawell was not formally educated in pharmacy but he had been employed as a commercial traveller for a drug firm prior to his transportation. This enabled him to gain • sufficient knowledge to fulfil a useful function in the antipodes. Tawell's fortunes declined during the economic depression of the 1840'S and he came to an inglorious end in 1845 when he was executed for murdering his mistress.

X.PHYSI0THERAPY. The use of massage, electricity and bathing in special spas was all the rage in Europe and England at the end of the nineteenth century. This was probably helped by the fact that the Prince of Wales (later King Edward the VII) was fond of visiting the health centres bf Europe that provided such services. As with most fads and innovations that develop overseas, these activities eventually spread to Australia.

Use of massage for medical purposes began in .39.

Australia late in the ninetefn1tb century. At first there was no distinct cate~ory of health care practition- ers to provide the mar:;sar;e ::.,erviccs and U-w wurl~ was performed by nurses, doctors, and lay manipulators. In 1889 a doctor began deliverin~ lectures on medical massage to the trainee nurses at Royal Prince Alfred Hospital. (91) Nurses carried out much of the manipulative work that occurred in hospitals at this time, and some of the early masseuses began their careers as trained nurses.

In 1905 a balneological, hydrotherapeutic and massage department was established in the Royal Prince Alfred Hospital in the Albert Pavilion. The prime movers in the initiation of this department were Professor Anderson Stuart (at the time he was Chairman of the Board of Management at Royal Prince Alfred and Dean of the faculty of Medicine) and the masseuse Miss L. Armstrong. (92)(93) It was the first hospital massage department in New South Wales. However, the practice

of medical massage by a distinct new category of health care practitioners first occurred in Melbourne in the 1890'S. In this period a doctor's daughter, Miss E. McCanley, began practising as a masseuse. ( 94 )( 95)

A massage department was set up at Sydney Hospital under the control of a masseur. This department became the Department of Special Therapeutics in 1909 and Dr. Stevie Dixson was appointed as its director. (96) 40.

The needs for soldier rehabilitation that arose during the First World War gave an impetus to the development of massage services and departments. Many soldiers were disabled through loss of limbs and other permanent handicaps and this placed a great strain on the existing health service in providing adequate care. (97) Until that time massage had gained very little recognition as a distinct health care discipline. (98)(99)

The arrival of the 1920'S saw massage established as a recognized health care occupation. Most major city hospitals used the services of masseuses and masseurs and the status of the trained manipulator rose above that of the untrained worker. With the emergence of trained practitioners, the increase in status, and the changing nature of practice, the term massage was replaced by physiotherapy and trained practitioners became known as physiotherapists. (100)(101)

Physiotherapy was the first of the allied health therapies to emerge in Australia. (102) Its emergence at the turn of the century preceded the evolution of other special types of therapy such as speech therapy and occupational therapy by many years. Physiotherapy was the first of the new health occupations to appear in the twentieth century.

At first the occupation based its existence on functions such as massage, the use of heat and water, 4 1 •

and the use of electricity. However, like ~any other occupations the emphasis has chanced over the years, and

today I s practi tion(1rs illa!~e much use of posturi11r; and positioning. (103)

XI.RADIOGRAPHY. Radiography is an unusual occupation in the sense that its appearance occurred as a result of a single scientific discovery. It did not evolve over a lengthy period of time as moat occupations have done. The first practitioners appeared as soon as the discovery of X-rays was made known to the world.

Roentgen made his famous discovery in 139ry. ( 1OL1) But he kept the news secret for a time while he conducted further experiments to try and elucidate more about the nature of the new rays. He finally sent a preliminary communication on the subject to the President of the Physical Society of WurzberG in December 1895. This paper was called, "On a New Kind of Rays", and it was published in full in the Enr.;lish journal "Nature" on 23/1/1896. (105) The news of the discovery was rapidly communicated around the world causing a sensation with the scientific community and the lay public alike. In a world that was constantly amazed by the wondrous discoveries of scientists this news was especially sensational, as there was no previous information to suggest that such rays existed and the potential of the rays was immediately recognized. Roentgen published a second paper in harch 42.

1896 in which further info.rr.1a tion was disc 1osed. ( 106)

In Sydney the "Daily Tclec;raph" of 31/1/10')6 carried the first printed news in Australia of the discovery of X-rays. Mclbournians were first able to read about the new rays in the Age a little later. (107) Immediately many Australians began experiments to verify Roentgen's discovery, and to try and learn more about these "mysterious rays". This vms easily done as many researchers in Australia were already vrnrkinc with Crookes tubes and spark coils, and had in all likeli­ hood produced X-rays without being aware of the fact. But it was Roentgen who stumbled onto the correct combination of circumstances to make the rays detectable, and who followed up his observation to detect the cause. Serendipity could have smiled on any number of researchers in a multitude of countries, but that is one of the many "could haves" in the history of scientific discovery.

The first Australian to verify RoentgensI discovery is not known with certainty as.many workers were active in the field early in 1896 and the surviving records of their work are scanty in many cases. Professor Thomas Hankin Lyle of Melbourne University is generally credited as being Australia's first X-ray pioneer as the experiments he carried out in the physics laboratory at the university were the first to be published in the press. However, others may have pro- duced detectable X-rays prior to him, and not had their work published. An X-ray picture was taken by Lyle on or about 3/3/1896 and this was later reproduced in the "Australasian" of 14/3/1896. (108)

On 12/6/1896 Lyle took an X-ray picture to aid an operation at the Melbourne Hospi.tal. This was the first operation in Victoria to be carried out with radiological assistance. The "Argus" of 13/6/1896 reported the outcome of this history making operation. (109) His assistance with the operation made him Victoria's first radio­ grapher. It should be noted that Lyle was a physicist and not a medical practitioner.

In Bathurst, New South Wales, Father Joseph Slattery of St. Stanislaus College began experiments with X-rays in the School's laboratory as soon as he heard of Roentgen's discovery. (110) Surviving records do not say exactly when he first produced detectable X-rays, but the possibility exists that he may have preceded Lyle in doing this. In July 1896 he helped a local doctor (Edmunds) in treating a patient •. The result was so impressive that doctors in the area donated extra equipment for his work, so that they could make use of his radiographic services. (111) Father Slattery was probably the first person to produce detectable X-rays in New South Wales but may have been beaten for the title of the state's first radiographer by F. Smidlin. Smidlin was a shopkeeper who ran an electrical business in Sydney. In supplying Crookes tubes and sparl~ coils he built up an expertise in the use of this equip­ ment and gave instruction and advice to those who requested it. Over a period of years he gave much valuable tuition to medical practitioners who purchased the primitive equipment for X-ray production. Doctors were using his services as a radiographer from about June 1896 onwards. (112)

Richard Thr~lfall, the Professor of Physics at Sydney University is thought to have taken X-ray pictures at least by June 1896. But the exact date of his first picture cannot be determined. Another pioneer of 1896 was Dr. Cleaver Woods of Albury. He obtained equipment from Melbourne and began a range of experiments, including the use of X-rays in treating cancer. His experiments in cancer therapy had begun by cictober 1896, thus ma,king him one of the first people in the world to put X-rays to this use. His work in cancer therapy was mentioned in the "Daily Telegraph" of 24/10/1896. (113)

The first X-ray pictures in both Sydney Hospital and the Royal Prince Alfred Hospital were taken by laymen. These men were the forefathers of today's radiographers and they educated interested doctors in the operation of the new equipment. The fact that most of the early pioneers were not doctors is understandable when it is realized that the discovery of X-rays and the use of 45.

associated equipment came from the field of physics. Many science academics and int8restcd laymen had been working for some years with equipment that could produce X-rays, and their expertise was callP.d on by doctors when Roentgen's discovery became known. For some time after this discovery these non-medical pioneers were called in to assist doctors when they wanted X-ray pictures taken. · Most doctors did not purchase their own X-ray equipment and they were content to use the services of the pioneer radiographers. (114)

Some doctors began to specialize with the new diag­ nostic aid and they became the nation's first radiolo­ gists. In the case of New South Wales the first specialist was Dr. Herschel Harris. It is thought that his use of X-rays began in 1898. He became the first honorary medical radiologist at Sydney Hospital in 1900. when they established their X-ray department in that year. Later Harris obtained an appointment to Royal Prince Alfred as honorary radiologist. A resident radiologist was appointed to Sydney Hospital in 1907. This was Dr. Goodwin Hill and _the appointment was the first of its type in the world. (115)(116)

The Royal Alexandra Hospital for Children appointed an honorary radiologist in 1901, but did not purchase X-ray equipment until 1904. Until then Sydney Hospital and the Royal Prince Alfred supplied them with an X-ray service. At St. Vincents, X-ray euipment was first 46.

obtained in 1905 and Dr. H. Skipton Stacy became the honorary· radiologist. He was succeeded by Dr. Charles Ayres in 1909. (117)

Thus the system of radiology that evolved in Australia saw the establishment of X-ray departments in hospitals under the control of medical specialists called radiologists. Th'e laymen who took the first X-ray pictures evolved into trained technicians who are now known as radiographers and who work under the direction of the radiologists.

The first medical practitioners to specialize in the use of X-rays were known as skiagraphists. In the years following the First World War this term was gradually replaced by radiologist as the earlier name implied that the work was only concerned with X-ray photography. (118) The new term was broad enough to include both the diagnostic and the therapeutic aspects of the work.

XII.REHABILITATION COUNSELLING. Prior to the Second World War there was little government involvement with rehabilitation services. The services that were avail­ able were provided by private and voluntary agencies whose major concerns were the needs of special categories of handicapped people (eg. mentally handi­ capped and physically handicapped persons). (119)

The era of escalating government involvement with handicapped people and rehabilitation services began in the 1940 1 S when the Second Dorld ~ar produced a multitude of wounded servicemen in necti of help. (12fl) Assistance was provided to them through the agency of the Repatri­ ation Department. Aid to handicapped and disabled civilians began in 1948 when the Con~onwealth Rehabilitation Service was established within the Department of Social Services. (121)

Since the Second World War the federal and state governments and private and voluntary agencies have expanded their involvement in various types of rehabilitation services. With this expansion many categories of health care occupations have come to lend their skills to the various rehabilitation programs that have been established. The major role of some occu­ pations is centred around rehabilitative work, eg. physiotherapy, occupational therapy, speech therapy, rehabilitation counselling, orthoptics, orthotics etc. ( 122)

The roots of rehabilitation counselling lie in the establishment of the government rehabilitation programs

in the 1940 1 s. Education and training programs were placed under the direction of government officers, many of whori1 had a background in teaching. The modern day rehabilitation counsellors can trace their genealogy back to these officers. 48.

With the arrival of the 1950 1 S the government rehabilitation programs became progressively more vocational in nature, and government officers were expected to help prepare their clients for employment and supervise their placement in a suitable work place. These government officers came to be called Vocational Counsellors. Most appointments still came from teachine and this reflected the fact that the rehabilitation programs of this time were associated with retraining.

(123)

In more recent times counselling has come to need inputs in addition to those provided by teaching, such as those provided by psychology and sociology etc. As a consequence recent recruits have come from a rnor0. varied educational .background than in the past. In addition to teaching, recruits come now from psychology, social work, personnel administration, public administration etc. (124)

At the present time there is an emerging group of counsellors working in a variety of agencies whose job is centred around the rehabilitation of disabled people. A variety of titles are in use but their work is best placed in the category of rehabilitation counselline. However, it should be noted that the Department of Social Security still uses the title Vocational Counsellor for its officers who work in this area. (125) L+9 •

XIII.SOCIAL WORK. Up until the last quarter of the nineteenth century, much of the social work that was carried out in England and Australia was provided by the churches and local government. Religious practitioners and other workers consoled the poor and distributed a small quantity of food and money. They generally attempted to help the poor to ad,iust to their circumstances with the promise that the hereafter would be more palatable than the life they were currently leading. From the end of the nineteenth century a new non~sectarian occupation arose to help the poor. This was the occupation of social work which has grown to become a major group for the dispensing of assistance to those with social hardships. Eventually the institutionalized system of delivering charity and neighbourly assistance, passed to the control of the private agencies, hospitals and government departments, that employed the growing number of social workers.

The origin of modern day medical social work can be traced back to the establishment of the Charity Organization Society in London in 1869. In 1875, Charles Loch became General Secretary of this organization, and it was his untiring efforts that eventually led to the "birth" of medical social work. (126) Loch was concerned over what he considered was abuse of the free treatment provided by hospital outpatient departments. Many people made use of these services when they had the means to pay medical fees for · trea trnent by priva to medical practitioners. Tl1is practice placed a strain on the docturs who provided hospital care on an honorary basis. But it is a sad reflection on English society in the nineteenth century that the system of health care delivery available to the community depended on the social class to which people belonged. The community's social and economic barriers extended into the provision of health services. Cnly the poor were admitted to public hospitals where they were used in the training of medical students, and as guinea pigs for medical research. The rich were treated in their own home by doctors of their own choice, as they had the money to afford such services.

Public hospital treatment mirrored the prevailing attitudes towards charity. Doctors donated time towards helping the needy, while other members of the upper class donated money. In this way they could conspicuously display their benevolence and gain credit towards admission through the "pearly gate". Charitable acts could ease the conscience and show that something was being done, but it did nothing ~awards altering the structure of society which caused the poorer classes to exist in the first place.

Eventually Loch gained the sympathy of G. F. Sheppherd at the Royal Free Hospital, and they agreed to employ a trained social worker to monitor the use of their outpatient department for a three month trial period. · The appointee was to be chosen and trained by the Charity Organization Society. As a result of these negotiations Mary Stewart began work in the outpatients department at the Royal Free Hosni tal in lTanuary 1895 as England's first J_.ady Almoner. (127) Loch chose the term Lady Almoner to describe this new occupation of social workers working in a medical setting. The experiment was a success, and as a result, Stewart was allowed to extend her work to in-patients in 1897.

To do this she was given two assistants - r-Iiss Brimmell and Miss Davidson. (128) The system of employing Lady Almoners in public hospitals gradually spread through England. In the United States the first almoner was not appointed until 1905. In this case the title "medical social worker" was used. (129)

It took just over two decades before the first Australian hospitals began to employ almoners. Moves were made to establish almoner services in Melbourne

during the 1920 1 8 but it was not until 1929 that Agnes Macintyre came from St. Thomas•s Hospital in London to the Melbourne Hospital to initiate the first almoner service in this count~y. (130) Within a few years hospitals such as St. Vincents (1933), the Royal Children's Hospital (1931), the Alfred (1934), Prince Henry's (1934), and the Royal Womens Hospital (1934) had followed suit. Thus, most of t-Ielbourne's major hospitals had almoner departments by the mid 1930'S. 52.

Sydney hospitals took several years to follow the example of the Eelbourne Hospital. The first to do so was the Royal Alexandra Hospital for Children ·uho sent Miss Stella Davies to Encland to be trained as an almoner. On her return in 1933 she became Sydney's first almoner. Other hospitals soon followed with almoner appointments - Rachael Forster Hospital for Women and Children (1934), Sydney Hospital (1936), St. Vincents (1936), Lewisham (1937), Prince llenrys (1940) and Crown Street Wo~ens Hospital (1940). (131) Social Service Workers without almoner training were employed at the Royal Prince Alfred and Royal North Shore. Kowever they were partially recognized by the Almoners Institute at a later date. There had been no appointment to any country hospital in New South V/ales when the Second World Viar broke out.

In 1943 Newcastle Hospital established an almoner department while in the same year Callan Park Hospital appointed a social worker. This appointee became the first almoner to be employed in a mental hospital in New South Wales. Nine Sydney hospitals were employine; eighteen almoners by the end of the Second World War. (132) Eventually the title of almoner gave way to medical social worker.

XIV.SPEECH THERAPY. As with many other health care occupations, Speech Therapy was helped in its development as a distinct occupational category by the 53.

needs f6r treatment produced by two World Wars. (1~3) The roots of speech therapy can be traced bacl~ to developments that occurred in Europe in the nineteenth century - especially in Germany and Austria. (1~4) However the emergence of speech therapy both in Britain and Australia, has occurred in this century.

A speech clinic was first established in an English hospital in 1911 at st. Bartholomew's Hospital in London. The director of the clinic was Mr. Courtland McMahon. He came to the job as a teacher of voice production and public speaking and was given the title of "Instructor in Voice to the Ear, Nose, and Throat Department". At this time the term speech therapy had not come into general use. (135)

St. Thomas•s Hospital in London (where Nightingale had established her famous nursing school in 1860) formed England's second hospital speech clinic in 1913 under the direction of Miss Elsie Fogarty, a teacher of speech and drama. (136) Soon a third clinic opened at Guy's Hospital, and after this ihe number of clinics steadily increased. (137) Early hospital appointments such as those of McMahon and Fogarty were criticized by many medical practitioners who wished to see speech therapy services developed as a medical speciality. In contrast the non-medicos working in the field wanted to develop a distinct new health care occupation just as the almoners and masseurs had previously done. 54.

The practice of speech therapy that developed in inGland · concentrated mainly on speech defects, and it did not incorporate the associated field of audiology. However these two fields have developed as a sinclc occupation in many other countries (eg.United States).(138) As Australian speech therapy is largely English in its heritage, it has not incorporated audiology within its fold.

Australia's first speech therapist, r~iss Elinor Wray, returned to Sydney in 1929 after training in England. She wanted to set up a speech clinic in Sydney, but support was not forthcoming until Sir l~obert Wade asked her to treat some of his cleft palate patients. As this work was a success, the Royal Alexandra Hospital for Children established a Speech Clinic in 1931 with Miss Wray in charge. The clinic was the first in Australia. (139)(140)

DISCUSSION. When the First Fleet arrived at Sydney Cove and European settlement began on the Australian continent the only health care practitioners present were naval surgeons. Convicts provided the supportive services, and acted as dressers and nurses etc. During the nineteenth century distinct practitioners in the disciplines of hospital administration, dentistry, pharmacy and nursing made their appearance. At the turn of the century radiography and physiotherapy appeared. During the depression years the first practitioners of speech therapy; social work, orthoptics, occupational therapy and dietetics made their appearance in New South Wales. Since the Second World War rehabilitation counselling and medical record administration have developed into distinct health care occupations.

As medical care has become more sophisticated and new innovations have been introduced, the whole system of health care delivery has become far too complex for one occupation to fulfil every service function. As medical knowledge and innovations have developed new occupations have appeared to provide new services, or else specialization has occurred in an existing occupation to provide these new services. In some cases both develop­ ments have occurred eg.the discovery of X-rays led to the appearance of both radiology and radiography. The appearance of new occupations and occupational specialities has permitted a wider range of services to be provided to the community but it has led to problems as well. Difficulties in defining the boundaries of particular occupations and specialities have arisen with the segmentation of service provisi9n, as occupations have different perceptions of their responsibilities and prerogatives. Thus a large range of patient care services is achieved at the expense of some rivalry and territorial disputes between occupations.

The order of appearance of health care occupations in New South Wales is outlined in TABLE ONE. 56.

EMERGE1tCE OF HEALTH CAI~E OCCUPATIOITS IN NZV/ SOUTH 1.'!ALES TADU.: CNE

OCCUPA'£I01J YZAR

Medicine 1788 Arrival of the First Fleet which contained a complement of naval surgeons.

Hospital ,1788 The Colonial Surceons controlled Administration and the Convict Hospitals that were 1811 built from 1788 onwards. In 1811 a Lay Superintendent was appointed to the Castle Hill Asylum for the Insane.

Dentistry 1818 Simon Lear in practice in Sydney.

Pharmacy 1820 John Tawell began business as a chemist in Hunter Street, Sydney.

Nursing 1838 Sisters of Charity (trained sisters and nuns) arrived in Sydney.

Radiography 1896 F. Smidlin and Father Slattery used by medical practitioners to X-ray patients.

Physiotherapy 1905 Miss L. Armstrong appointed masseuse to the new massage department at Royal Prince Alfred Hospital. 57.

Speech 1929 ; :iss :8linor ·.iray ret urncd to Therapy and 3ydney in 1929 after qualifyinc 1931 in England. Sha becan a

hospital clinic in 1'}31.

Social 1933 I'.iss .Stell<1 Davios l)(;C&Ge r:ork ah10ner to the l;oya 1 Alexandra Hospital for Children.

Orthoptics 1933 :1iss Emmie :~us.sc11 bcr-;an private practice in Sydney.

Occupational 1934 :liss Ethel Francis began Therapy practising in Sydney.

Dietetics 1936 Edith Tilton began working at Royal Prince Alfred Hospital.

Rehabilitation 1940'S Public servants placed in charge Counselling of teaching and training programs in the Co1,rn1orn·rnal th Rehabilitation Service.

Medical 1949 Mrs. Huffman (from America) Record made a short visit to Sydney . Administration to train and advise. 58.

III.TRAINING SCHOOLS.

INTRODUCTION. This chapter discusses the r.ll.:vc 1.oprnen t of the training schools for health care occupations. It excludes University and College of Advanced Education training programs, which are the topic of the next chapter. The training schools that this chapter specifically examines, are those that were developed by occupational associations, hospitals or private individuals or organizations. In the case of most health care occupations initiatives in developing training programs arose in these areas well before Universities or Colleges of Advanced Education became involved. Occupational associations and hospitals have been innovators and pathfinders in the field of health edu­ cation whereas the tertiary institutions have provided the resources that have enabled the training programs to increase in standard and content. In the process the theoretical content of courses has increased while the practical component has generally been reduced. Practical apprenticeship type training has given way to theoretical training that empha9izes the scientific basis of the work involved. Whether this theoretical knowledge produces a superior practitioner or not, is a topic that is raised later in this project.

I.DENTISTRY. From the 1840 18 courses in dentistry began appearing in America and England. The Baltimore College of Dental Surgery began in 1840 and by 1853 there were 59. four American colleges operating dental courses. By 1900 this number had increased to at least [c,7. The Dental Hospital and London School of Dentistry began in England in 1858 whilst a charter was p.:iven to the Royal College of Surgeons in 1859 which allowed theu to award a Licentiate in Dental Surgery to candidates who passed the prescribed examination. (141) But it was not until the latter years of that century that the first initiatives were made to institute some type of formal college training in New South Wales. Until that time local practitioners received no trainine at all, entered some form of apprenticeship arrangement, or travelled to England, Europe or America to train in the dental colleges that had sprung up in these places. The apprenticeships generally occupied a term of at least three years. (142)

Sydney Technical College established the first formal course in dentistry in the state when they started a course in Manual Dentistry in 1885. (143) This course continued until 1891. Although the course was aimed at dental assistants, it appears that some dentists received their formal training from the course. Dr. Henry Peach (a dentist who had obtained his doctorate in the United States) began a private dental college in Sydney in the 1890'5. (144) This college was named the New South Wales College of Dental Surgery, but it only lasted for three years due to opposition from a group of dentists who did not wish to see dental training 60.

become a matter of private enterprise and control.

After the first Dental Act was passed in !Jew South

Wales in 1900 the Dental Association of New .South \'/ales turned their attention to helping apprentic8s :prepare for the registration examinations held by the Dental Board. They began classes to aid apprentices in 1905, but this only continued to 1907 when students were transferred to The Dental Hospital. Students fron1 the university dental course were already receivinc prattical training at this hospital. (145)

II.DIETETICS. The training of dietitians in New South Wales and Victoria was initiated very shortly after the first dietitians made their appearance. In Victoria three types of students were accepted into the dietetic training programs that developed:- (146) (A) Trained nurses (B) Diplomates of Domestic Science (C) Science graduates But in New South Wales, only university graduates were accepted from the beginning. Tnese differences in the modes of entry, led to many debates over training standards in the following years. By the exclusive acceptance of university graduates New South Wales followed the American training model. In contrast the Victorian courses followed the British training model (due to the acceptance of nurses and domestic economy

graduates). (147) 6 1 •

Joan Woodhill, a graduate in Agricultural Science became the state•s first student dietitian when she began her training at the Royal Prince Alfred Hospital in 1936.

(148) This training proeram was institutod by the dietitian Ruth Tilton who had been brought out from America. When she was married in 1937 her work was continued by another American dietitian, Ruth Gordon. At that stage the entrance requirements were either a science degree or an arts doeree that includod the study of physiology. Dietetic training remained at the Royal Prince Alfred until 1948 when the course was closed. The Royal Newcastle Hospital then started a training course, and in 1949 the Royal North Shore Hospital followed suit. (149)

III.HOSPITAL ADMINISTRATION. Until the 1940'S there was no scheme for formally training hospital administrators in Australia. Entrants to the specialized field of hospital management either learnt from experience or obtained qualifications in general management or accountancy etc.

Formal training in hospital administration first started in New South Wales in 1946/47. (150) Following the preparation of a report entitled "A Training School for Hospital Executives", for the Federal Council of the Australian Institute of Hospital Administrators, support was obtained from the Hospitals Commission of New South Wales and a trainint1: procra!n 62.

was instituted. TraininG was mainly by corrosponclence.

~ork continued within the Federal Council of the Institute towards the formation of a nationaJ training program to be run under the control of the Institute. In 1948 the enrolment of students began and in November 1950 the first subject examinations were held. The first graduates were awarded their Diploma of Hospital Administration in ~~rch 1953. (151) Of the first seven graduates four were from ~cw South Wales - R. Brown,

L.- J. Corke, A. E. Knowles and Dr. i-I. Puc~:ey. The other three graduates were made up of two West Australians and a Victorian. It should be noted that those early training schemes were run and controlled by the occupational association.

IV.MEDICAL RECORD ADMINISTRATION. (152) Following the visit of Mrs. Huffman to Australia in 1949 a short training program in the management of medical records began at the Royal Prince Alfred Hospital. A formal training school was established in this hospital in 1956 through the co-operation and assistance of the hospitais Board of directors, the Australian Hospitals Association and the New South Wales Association of Medical Record Librarians. The occupational association and the hospital board jointly ran the school through the agency of an Educational Advisory Council which contained representatives from both bodies. Royal Prince Alfred allowed their Chief Medical Record Librarian to become 63.

Director of training and provided the space and facilities necessary for the course to operate.

The training procram was based on thoso in operation overseas (especially the United States and 2ncland) and was run over three years. TraininG consisted of one year of academic study and two years of practical training. During the period the students received work experience they were paid by the hospital. Initially the entrance standard was Leaving Certificate but university graduates were able to enter a shorter one year traininc program which took account of their academic background.

Training continued along these lines until 1961 when several important changes were introduced. The course was shortened to two years to correspond with contemporary programs operating overseas and the new training program in i!elbourne, and the entrance standard was raised to r-;atriculation- level. The course was also restructured to consist of blocks of lectures and practical experience and the special training course for university graduates was retained.

With time the demands placed on the Chief l :ed.ical Record Librarian at Royal Prince Alfred in having a dual function of department head and training director became excessive. In consequence the functions were separated in 1969 and the position of Director of Training became a separate appointment. 64.

·v.MEDidINE. William Redfern was unable to produce evidence of his previous medical qualifications when the Governor pardoned him. In consequence a triuunal consisting of Thomas Janiison ( the current I•rincipal Surgeon), John Harris ( Surgeon to the New South \'/ales Corps) and William Bohan (Assistant Surgeon to the New South Wales Corps) was set up to examine his and other medical qualifications. Redfern and Luttrell were examined by this tribunal in September 1808. (153)(154) (155) After this all medical practitioners who wished to practise in the colony were expected to be examined in this way, and any person who failed had his name published in the Sydney Gazette and was ordered not to practise medicine. The successful candidates were issued with a certificate outlining their qualifications as a doctor. At a later date Redfern became a member of this examining board, that had originally been formed to examine him.

In 1813 Redfern took on James Sheers as an apprentice but this unfortunate lad died in 1814 before serving out his apprenticeship. However, his name lives on in history as Australia's first medical student. Redfern immediately obtained another apprentice Henry Cowper,

who helped him in his hospital work. (156) By helping in this way Cowper became Australia's first hospital clinical student. When his three year apprenticeship finished in 1817 he was appointed to the Convict Hospital as an assistant surgeon thus becoming the 65.

prototype resident medical officer in the colony.

During his apprenticeship Cowper li vod vd th Ped fern and accompanied him on his daily medical rounds. Cowper virtually became a mer.'.lber of Hedfern I s fadiiJ y. He paid no fees for his training and as his experience increased he was given greater responsibilities such as dressin~ wounds and dispensing medicines. ~ventually Cowper was left in charge bf the Convict Hospital for s110rt periods, while Redfern was away attending tu other matters.

When Bowman became Principal Surgeon he forbade the use of the hospital for the trainine of medical students (apprentices) and this ban continued until the end of the convict, era. In 1849 Frederick Milford became the first medical student to enter the hospital since it had become the Sydney Infirmary. Milford remained there as a student until 1852. J. c. Cox was a student there from 1850 to 1852. Also "walking the wards" of Sydney Infirmary about this period were Messrs Lumsden, Phelps, Grills and Sadlier. Students were officially recognized by the hospital in 1851, and rules governine their admission and work were approyed in January 1853. (157) (158) Surgeons using the hospital had to help in medical training. They were required to give notice of all operations and post-mortems so the students had an opportunity to attend.

VJhen Milford finished his period of training at Sydney Infirmary in 1852 he travelled to England to 66.

'furth~r his training and experience and to present himself for examination before one of the famous Joyal Colleges that controlled entry to medical practice in that country. The president and directors of tlle Infirmary gave him an official certificate to verify the hospital experience he haJ received. Until the establishment of a medical school at Sydney University the practice of ent~ring an apprenticeship in the colony and then proceeding overseas to present oneself before a Royal College characterized the small amount of medical training that did occur. (159) But it must be remembered that migration gave the colonies most of their medical practitioners. When the University Medical School began, the apprenticeship system of training quickly disappeared.

VI. NURSING. By writing to Florence Nightingale and arranging for trained nurses to come to the Sydney Infirmary, Henry Parkes had hoped that a training scheme could be established which would provide trained nurses for the other hospitals in the colony. This wish was to be quickly realized. Lucy OsQurn began a training

program after her arrival in Sydney in 1868. By the end of that year she had engaged six probationary nurses, and in 1869 she engaged four probationary sisters and seven probationary nurses. (160)(161)(162) At first Lucy Osburn gave lectures to her probationers on nursing topics twice a week, but later on these lectures became less regular. (163) The training program institutE:u o..t 67.

'Sydney Infirmary was the first Nightingale training school in the Southern Hemisphere and it was formed only eight years after Florence Nightingale had begun her famous system of training at st. Thomas•s Hospital in 1860. (164)

A specific training program for nurses at Sydney Hospital was drawn up in 1887 and its completion was made compulsory before a certificate was granted. This program involved a two year training period and included examinations. The training period was increased to three years in 1894, and increased again to four years in 1902. (165)

At st. Vincents all nursing was carried out by the Sisters of Charity until 1882 when they finally permitted women who were not religious sisters to train as nurses in the hospital. In that year two lay nurses began their training as probationers. No certificate was issued to these women. Formal training regulations were eventually drawn up in 1891, and the course was increased to three years. Successful students wer~ then issued with a certificate by the hospital. (166)(167)(168)

It was intended that Prince Alfred Hospital would be a nurse training school from its commencement in 1882 but it was several years before a properly organized program began. By 1886 certificates were being awarded and lecture programs were in operation. At first their 68.

- training period was two years (as was the case at Sydney · Hospital) but this was raised to three years in 1888 and up to four years in 1899. (169) Both these increases in the length of training preceded the equivalent increases at Sydney Hospital.

At the Royal Alexandra Hospital for Children no formal training scheme existed when the hospital began in 1880 and the women who undertook nursinG duties did not receive a certificate to recognize their practical experience. Nurses were eventually given a course of lectures in 1889 when the Prince Alfred Hospital permitted them to attend their nursing classes. Later the medical staff of the Royal Alexandra Hospital were able to conduct the nursing lectures so that the nursine staff did not have to travel to another hospital. Eventually certificates were given to nurses who had trained for two years, and in 1897 this training period was len~thencd to three years to correspond to the practice of the other major city hospitals. (170)

Nursing training based in hospitals rather than tertiary teaching institutions has continued to the present day. However, control over the curriculum and examinations passed from the hospitals to the Australasian Trained Nurses Association following its formation in 1889, and then to the Nurses Board following the passage of the Nurses Act in 1924. Over this period the training courses of many other heal t11 ·care occupations have passed from the control of occupational a.s.sociations and public llos!)ito..lc and entered a recocnized tertiary institution such us a university or a Collo[je of \dvanced ;:clucatioll. rrursing, if and when it makes this transition, wilJ be the last of the major health care occupations to do so.

VII.OCCUPATIONAL· THERAPY. 'Jhcn the Second 1.Jorld ·:Jar

bec;an an urgent neoci arose to supply the ar ..1eu forces with occupational therapists. Following a uectinc

between interested parties, which was called by the Hospitals Commission of New ~outh ~ales in 1939, a training program began in February 1940 under the control

of a committee headed by Professor Dawson. (1'?1 )(172) Dawson was Professor of J;sychiatry at .Sydney Un:Lvorsity.

The course began_ with two ntudents who attonJl~Li tlw East Sydney Technical College for craft traininc and joined with physiotherapy students for lectures in medical subjects at Sydney University. Practical experi­ ence was gained by attendance at sever.al of the large teaching hospitals. One of these students was a trained physiotherapist, Miss Jane Cru_st, and the other was i~ss Gwendoline Sims who became prominent in her field in later years.

This course proved unsatisfactory and the 1Jew South 'i/ales Branch of the Australian Physiotherapy Association was invited to take control of occunational therapy training in 1941. They agreed to do so, and 70.

-established a school vii th hiss Sylvia Docl~0r Cl.S tiie director. ( 173) She began her wor:: in Syc.iney in January 1942 and the school opened j_11 Februn:cy wi tlt tv:c:1ty-eic;ht

students. Australia I G first dj_plo1r,a in Occupational Therapy was awarded to ::iss Gwendoline Sims in October 1941 by the Australian Physiotherapy Association.

During the w~r years a number of courses of varying

lengths were run to rneet the needs of the ar1:1ed services and the civil services. Towards the end of the war the occupational therapists formed their own occuputional association and this body began negotiations with the physiotherapist's association to transfer control of the training school to the new body. This transf0r was finally arranged in January 1947. (174) Training continued under the control of the occupational therapist's association until the school entered the Cumberland College in 1973.

VIII. ORTHOPI'ICS. In 1938 the Opthalmological Society of New South Wales established a sub-committee to control and regulate the training of orthoptists in the state. The committee was set up following a request from the Hospitals Commission and it was called the Orthoptic Council of New South Wales. (175) Thus training was established and controlled by the medical speciality of opthalmology. At first the new Council held an examination for the five orthoptists who were wor'.:inr, in Sydney. After this they prescribed a twelve oonth 71 •

training program for all future entrants to the occupation. But English graduates who were registered by the British Orthoptic Board were allowed to enter practice without training again in Australia. (176)

The first two students began training in 1939. Under this program which was based on the English system devised by the B~itish Orthoptic Board students were attached to a trained orthoptist for practical experi­ ence and received lectures from opthalmologists. This system was modified in 1947 when Pat Lance became a part-time tutor and course co-ordinator. (177) She co-ordinated the training students were receiving from their prece~tors and helped the students interpret and understand the doctors' lectures. However the training was still fairly unstructured and was in need of being made much more formal.

With time the need for added education became apparent and the training period was increased from twelve to eighteen months. It was soon increased again to two years in 1956. From 1953 a new intake of

students was accepted each year. In the 1950 1 S headquarters for training were finally established at the Sydney Eye Hospital. ( 17.8) Prior to that time no single hospital served as a training centre and rooms for teaching purposes were hunted up in a variety of hospitals. ?2.

- IX.PHARW~.CY. One of the first acts of the :"har:::1aceutica1·

Society, that was formed in Hev1 South ':lales in 18?6, was the establishment of a program of lectures for apprentices. They arrani:;cd for a chcr:1ist caJ.1cd Dixon to deliver the lectures. ilowever, the classes were not well attended as they were not compulsory and r1any chemists would not let their appreritices spend tiine away from the shop. P.rior to 1876 the only traininG available to new entrants to the occupation was practical on-the-job experience which was generally gained through a period of apprenticeship. (179)

In 1878 Wright replaced Dixon as the Society's lecturer. Wright transferred to the School of Arts (Sydney Technical College) in 1880 when they instituted classes in pharmacy. The Pharmaceutical Society tried to keep their classes continuing but they were not well attended. As the society did not want to lose its command over pharmaceutical training a feeling of competition and rivalry grew up between the two training institutions.

The Pharmacy Act of 1897 clearly separated the

} 1harmacy Board from the Pharmaceutical Society ( the council of the society made up all but two of the Fharmacy Board that was constituted under the Poisons Act of 1876). The newly formed board then decided that it would only recognize pharmacy courses that vrnre conducted within Sydney University. The claoucc at 7).

·Sydney. Technical 8ollcce struggled on for several years but they finally folded after the ,-·haruc'.J.cy ::.oard repeatedly failed to recocnize thcu.

In Victoria formal education evolved i11 a c\j_fferent way, as the Pharmaceutical Society of Victori<'.l dGveloped and retained its own school. This school rouained under the contrQl of the occupational association until it joined the Victorian Institute of Co1J.cco~~ :i.n the 1960'S.

X.PHYSIOTHERAPY. A traininc course j_n rnascar;c vms commenced at the Royal Prince Alfred Hospital in 1907 by the New South V/ales Branch of the Australasian ila.ssage Association. ( 180) ( 181) ( 182) 11iss Arrnstroni:; was instrumental in launching this training pro~rarn. (183) The training course was under the control of the occupational association who awarded certificates to the successful candidates. (184) However, by arrangement with Sydney University, the students received part of their training by attending university lectures in such subjects as anatomy and physiology. (185)

The course continued to operate under the control of the occupational association until it entered the Cumberland College as a foundation school in 1973. In some of the other states the physiotherapy courses entered tertiary teaching institutions at an earlier date or passed to the control of a licensinc board. ?4.

XI.RADlOGRAPHY. (186)(187)(188)(189)(190)(191) Up until the 1930'S there was no course for the training of radiographers in New South Jales. In 1~3G the Australian and New Zealand ~\.ssociation of ,-:ac1iology (ANZAR) and the Extension Board of Sydney University arranged for the first f ori;1al study program in the state. After this ANZAR conducted the radioe;raphy courses by itself and awarded certificates to the successful candidates. ANZAR continued to control radiot;raphy education until 1949.

Following the formation of the incorporated Australasian Institute of "Radiography (AIR), this organization entered into discussions with ANZAR, and arranged for the. formation of a conjoint board to control the education and examination of radiographers in Australia. The conjoint board was formed in 1949 and its charter was approved in 1950. It was constituted with the following membership:- (A) seven members nominated by ANZAR. (B) two members nominated by AIR. Since that time the membership.make-up has altered, and the representation of radiographers has increased.

The conjoint board totally controlled radiocrauhy education in New South Wales until the course entered Sydney Technical College in 1962. However the conjoint board has continued to operate in the area of syllabus review and approval. 75.

·XII. K3HABILITATIO:J COUN,S~C.:LLDJG. Training in rehabili­ tation counselling becan in a recognized Colleee of Advanced Education and did not have any predecessors outside this sphere.

XIII.SOCIAL WORK. The New South Vales Board of Social Study and Training was formod in 1929 as a general training body for social workers. (192) It was the first such body formed in Australia and its oricin was the direct result of initiatives made by the National Council of Women (a federation of women's organizations). This council became interested in the field in 1927 due to the initiatives of Isobel Fiddler, and held a meeting in 1928 which led to the formation of the training board. Training consisted of a two year course which aimed to prepare social workers to function in a number of varying work settings. (193)

Social Workers employed in hospitals became disturbed by the quality and standard of the training provided by the Board of Social Study and Training. Vlhen their moves to improve t~is training failed they established their own Institute of Hospital Almoners in 1937. (194) This body then educated social workers who wished to seek employment in the medical field. It consisted of a third year of training taken at the completion of the two year general course. (195)

Almoner training continued to be controlled by this Institute even after the general course entered Sydney _University. 76.

·XIV. SPEBCH THERAPY. ( 196) ( 197) ( 198) In the la tc 1 '.)3u' S an Advisory Committee wor~:ed on the developri1cnt of a

training program for ..~peocl1 Tl1era11ists i11 :~cvJ :.:ol1th \"Jalos.

Assistance in this rnattor vms provided by the 'Sritish Society of Speech Therapists who had developed their own syllabus. The training school was eventually launched in 1939 at the Royal Alexandra Hospital for Children with Miss Elinor .~ray as the foundation Director of Training. It was the first training course for S})Cech therapists in Australia. The course was two years in length and a diploma was awarded by the Hospitals Commission of New South Vales. Training continued throughout the years of the Second World Jar and tov1ards the end of the war the course was lengthened. \'/hen the course began in 1939 there were only three trained speech therapists in all of Australia.

After its foundation in 1949, the Australian ColleGo of Speech Therapists functioned as an exa1aining and qualifying institution, as well as the occupational association. Although it did not make the training programs in the various states uniform, it did set minimum standards and helped to gain wider acceptance with medical practitioners.

DISCUSSION. Soon after the emergence of most of the health care occupations under study, traininc proerams were introduced. In most of the occupations training

was pioneered by occupational associations and/or 77.

· hospitals. Later on these training courses v1cre trans­ ferred to universities or Colleges of Advanced Education. The only exception to thiG has been nursing which still trains its students in hospital based programs. But there is much pressure within nursing to transfer under­ graduate nursing programs into tertiary teachinc institutions. The only occupation under review to have its initial training program in a College of Advanced Education has been rehabilitation counsolline.

Training programs for medicine, nursing, pharr.iacy and dentistry appeared during the nineteenth century, to be followed by one for physiotherapy soon after the turn of the century. During the depression years training programs for social work, dietetics, radiography, orthoptics and speech therapy emerged, while during the Second World War the initial training program in occupational therapy first appeared. Since the war programs for hospital administration and medical records have been introduced.

A summary of the development of training schools is provided in TABLE TWO. 78.

ESTABLISHMENT OF TRAINING SCHOOLS IN NEW SOUTH WALES TABLE TWO OCCUPATION YEAR EVENT

Medicine 1813 James Sheers became Australias and first medical student in 1813. 1851 Medical students "officially" recognized by Sydney Infirmary in 1851.

Nursing 1868- Lucy Osburn engaged her first 1869 probationary nurses in 1868 and her first probationary sisters in 1869, at Sydney Infirmary.

'Pharmacy 1876 The Pharmaceutical Society of New South Wales appointed a lecturer and began classes.

Dentistry 1885 and 1890'S Course in Manual Dentistry established at Sydney Technical College in 1885. Dr. Henry Peach started a private dental

college in the 1890 1 S.

Physiotherapy 1907 A training course in massage commenced at the Royal Prince Alfred Hospital, under the control of the Australasian Massage Association. 79.

Social Work 1929 The New South Wales Board of and Social Study and Training was 19?7 formed in 19?9 to educate general social workers. In 19?7 the Institute of Hospital Almoners was formed to educate medical social workers.

Dietetics 1936 Dietetic training initiated at the Royal Prince Alfred Hospital by Ruth Tilton. Joan Woodhill was the first student.

Radiography 1936 A training course began under the auspices of the Australian and New Zealand Association of Radiology and the Sydney University Extension Board.

Orthoptics 1938 The Opthalmological Society of New South Wales established a sub-committee to control and regulate orthoptic training.

Speech 1939 Traini~g school began at the Therapy Royal Alexandra Hospital for Children.

Occupational 1940 A training program began in 1940 Therapy and under the control of a committee 1941 headed by Professor Dawson. The Australian Physiotherapy 80.

Association took control in 1941.

Hospital 1946/7 A correspondence course began Administration and in New South Wales in 1946/7. 1948 The Institute of Hospital Administrators began a national training program in 1948.

.Medical 1949 Mrs. Huffman did some teaching Record and during her visit in 1949. ·Administration 1956 Following this, short training courses were run at the Royal Prince Alfred Hospital. Formal school established in 1956.

Rehabilitation No training course in existence Counselling prior to the program at the Cumberland College. 81 •

. IV. UNIVERSITY AND COLLEG:8 OF ADVANCBD EDUCATIC-H TRAIIaNG

SCHOOLS

INTRODUCTION. The development of·trainint; ccursos for health care disciplines within Universities and Colleges of Advanced Education is examined in this chapter. For a long period universities were reluctant to grant admittance to applied ~ciences such as medicine and its allied fields. Universities perceived their role to encompass the teaching of theoretical knowledge and the.

creation of 11 cultured11 minds, rather than the preparation of students for a specified field of employment. Consequently they restricted their teaching to arts, philosophy, theology and natural science. · Towards the end of the nineteenth century more subjects of an "applied" nature began to be taught within universities, and this trend has accelerated in the twentieth century. With the establishment of Colleges of Advanced Education

in Australia from the 1960 1 s onwards, a far greater range of occupations have been able to site their training programs within recognized degree conferring institutions. Colleges of Adv~nced Education have accepted many allied health courses which were previously operated by hospitals, occupational associ­ ations and licensing boards, and have increased the number of graduates who receive degrees or diplomas for academic success.

This century has seen universities change from 82.

'institutions devoted to the production of "cultivated gentlemen", to institutions involved with the production of graduates to suit the requirements of both private and public employers. This is easily seen by comparing the number of arts graduates with the number of science, engineering, medical and other technical graduates produced by the universities. The Colleges of Advanced Education are also primarily concerned with the production of graduates to fill particular production or service functions in the economy. Consequently. the tertiary teaching institutions of the present day fulfil a much broader function than that of the nineteenth century universities.

I.DENTISTRY. The Senate of Sydney University agreed to establish a Dental School within the Faculty of Medicine on 3/12/1900. This school commenced on 1/3/1901, and 17 students began the three year course which led to a License in Dental Surgery (L.D.s.). (199) Professor Anderson Stuart was a major force in getting dental training sited within the university and having it attached to the Medical Faculty. (200) Some dentists resented this control of dental training by another occupation and agitated for dentistry to become its own master within the university setting.

After this course began there was agitation for a "degree" to be awarded to the students instead of a "license". The senate then decided that students with a matriculation entrance standard could train for four years and receive a Bachelor of Dental Surgery. Those students who had already started the "license" course were allowed to convert. As a result the first dental degrees were awarded late in 1905. (201) The first licenses had been awarded late in 1903.

Dentistry finally became a separate faculty when the University Senate proclaimed six new faculties in October 1919. (202) These were engineerinc, dentistry, veterinary science, agricultural science, economics and architecture. They joined the four existin~ faculties of arts, law, medicine and science. Dr. R. Fairfax 'Reading was appointed the foundation Professor of Dentistry and Dean of the Faculty of Dentistry in August 1920. (203) Reading had trained in both medicine and dentistry.

II.DIETETICS. Right from the beginning of dietetic training in New South Wales in 1936, the only students accepted were university graduates. (204) Training was initially carried out at the ROY.al Prince Alfred Hospital. Later Royal Newcastle (1948) and Royal North Shore (1949) became the training hospitals. This one year program of training in dietetics was transferred to the control of Sydney University in 1967, where it became a Post-Graduate Diploma in Nutrition and Dietetics. (205) Prior to this date dietetic training had been controlled by the training hospitals and the 84.

New South Wales Institute of Dietitians. (20G)

III.HOSPITAL ADMINISTl~ATIOjJ. (207)(208) A ~;crrnol of Hospital Administration waG established within the University of New South ~ales in 1956, and in 1957 it launched a full-time one year certificate course. This course was run by the school until 1966. In 1959 the corresponden'ce course run by the Australian Institute of Hospital Administrators was transferred to the university following negotiations which had been finalized in the previous year.

Initially the students of the correspondence course did not receive a certificate from the university in recoenition of their studies. But in 1965 a Diploma of Hospital Administration was introduced following an increase in the content of the course. This course was further upgraded to degree standard a little later, and the first students began working towards a Bachelor of Health Administration Degree in 1968.

IV.J.1EDICAL RECORD ADMINISTRATION. (209) V/ith time it became apparent that the training course in J1eclical Record Administration needed to be carried out within a recognized tertiary training institution. The first move in this direction occured in 1974 when first year medical record students began attending the Behavioural Science course conducted by the newly formed Curnberland College. Lecturers from the Cumberland 8~.

College ~lso becawe involved in the anatomy anu physiology lectures given in the I:edical ~{ecorct .:ichool at Royal Prince Alfred llospital. Both these initiatives helped to lessen the academic isolation of the hledical record students. Finally, in 1977, the school transferred from the control of the traininr, hospital and the occupational association to the Cumberland College. Students now receive an Associate Diploma from this body.

V. i-1EDICINE. Plans for a medical school were discussed and debated for many years before New South '/!ales finally established their own school. While plans were 'made and shelved, the country's first medical school was opened in Melbourne in 1862. (210) In 1860 Sydney University and Sydney Infirmary had finalized plans for a medical school, but these plans were not acted upon. In 1869 plans were made for a medical training scheme which would consist of two years training in Sydney and two years training in London. Once again these plans

were aborted. (211) By the 1890 1 S it was decided to use the new Prince Alfred HospitJ9.l for clinical training. At this stage this new public hospital was under construction near the university.

Sydney University was established in 1851, (212) but it was not until 1882 that Professor Thomas Peter Anderson Stuart arrived in Sydney to take up the chair of Anatomy and Physiology and to initiate the medical 86.

school. (213) Four students began the university training program in March 1883. The students obtained their clinical training at the Prince Alfred Hospital. In 1909 Sydney Hospital established a clinical school and students could then visit this hospital as well for practical experience. (214) The first medical students were admitted to st. Vincents in 1891 but their clinical school was not officially founded until 1923. (215) It should be noted that all the Australian medical schools followed the Scottish and European system of being university based schools. In England hospital based medical schools had evolved.

There was opposition to the inclusion of medical schools within the universities. Those who thought that universities should be reserved for purely academic pursuits, resented the intrusion of applied sciences such as medicine into the university setting. For this reason medicine was thought of as an "intruder" for many years. Eventually the siting of medical schools within universities came to be accepted as a satisfactory form of medical training. Other problems encountered by the medical school in its formative years were the prejudice against local graduates (English graduates were considered "superior"), and the rivalry between the university and the hospital over areas of control and responsibility. The university was reluctant to surrender too many prerogatives to the hospitals. 8'1.

New· South 1i'/ales did not i:;ain their second ucdical

school until 1961 when o. school was founded at the University of New South \'/ales. (216) At about the same time, Victoria began their second medico.l school at Monash University.

VI.NURSING. (217)(218) The New South ','/ales nurses Registration Boara has approved two undergraduate basic nursing courses in Colleges of Advanced ~ducation. Both courses lead to a Diploma of Applied Science. One program is conducted at the Cumberland Coll.ece of Health Sciences (course approved in 1975), and the other is conducted at the Riverina Colleee of Advanced Education

~ in Wagga Wagga (course approved in 1976). These courses offer a training program centred on a recognized tertiary teaching institution and are an alternative to hospital based programs which have been the traditional portal of entry into nursing practice. Registered nurses are permitted to enter this training program to obtain the diploma (with exemptions based on their previous experience and training).

The registration board also approved two experi­ wental education programs which involved training at a university. Both courses were unsatisfactory for a variety of reasons, and they have both been discontinued. One program involved a years practical traininc at Arwidale District Hospital, three years study at the University of New England to obtain a degree, and a Ou.on

final year of nursing at noyal I'Torth .3horo Hosr)i tal. The othor program invol vcd a sini:i_ar c of:oino.tion of practical experience and study, with students vorkinc in the Prince Henry, Prince of 1.'!o.les and :2astern Suburbs group of hospitals and obtainine their deGree at the University of New South Wales. One of the problems. with these training programs was the fact that the students lost ititerest in nursine as a career once they had obtained their university decree.

University graduates are able to enter nursing practice by undertaking a shortened two year hospital course operated by the Royal Prince Alfred and Prince Henry group of hospitals. The Nurses Board approved this mode of entry in 1967.

The vast majority of nurses still train in hospital based programs using a syllabus approved by the licensing board. Hospital based education began with Lucy Osburn over a hundred years ago and still remains the norm despite the fact that other health care occupations have since arisen ~nd developed education systems which have passed to the control of universities and Colleges of Advanced Education. Nursing retains a type of training that other occupations have seen fit to abandon.

VII.OCCUPATIONAL THERAPY. In 1973 training in occupational therapy became a responsibility of the new 89.

Cumberland College of Health Sciences. (219) This brought to an end the control over education by the New South Wales Association of Cccupational Therapists.

Their reign as a 11 qua1ifyinr; association" hncl lastocl twenty-six years. In 1975 it was decided to crunt degrees to graduates in occupational therapy and the first degree students began their studies in 1976. (220)(221)

VIII.0RTH0PTICS. (222)(223)(224) In 1973 control of orthoptic training passed from the 0rthoptic Board of Australia (New South Wales Branch) to the new Cumberland College of Health Sciences. Pat Lance, who ' had headed the 0rthoptic Board's training program, v1as appointed head of the new orthoptic school. The decision to make this transfer was made by the Minister for Education in 1970. The syllabus used by the 0rthoptic Board was used as the basis of the new program which was set at an Associate Diploma level.

IX.PHARMACY. (225) Following the introduction of the Pharmacy Act of 1897 the recons~ituted Pharmacy Board decided that it would only recognize formal classes for apprentices that were carried out within Sydney University. However, the University did not begin instruction in pharmacy until 1899. The first lecturer at the University to specialize in the teaching of pharmacy was s. H. Stroud, and he was not appointed until 1918. Pharmaceutical training came under the 90.

· control of the medical faculty anJ Professur :uu.lerson Stuart. Training was still mostly on-the-job as apprentices spent a short tiriie each week at the university.

A pharmacy department evolved at the university between 1919 and 1921 (no specific year exists for this event as the department emerged gradually), a~d in 1920 the science faculty gave permission for pharmacy

graduates to return to the university to underta1rn further subjects which would lead to the award of a science degree in pharmacy. But few students took advantage of this opportunity. Later a diploma course was made available to pharmacy students.

The system of apprenticeship training supplemented by university lectures continued right up until 1959. In 1960 the first degree students began their studies thus ushering in a new era of pharmacy education. In the same year Sydney Wright was appointed as full Professor of Pharmaceutical Chemistry (after being appointed as Associate Professqr in 1957).

X.PHYSIOTHERAPY. In the late 1940 1 s moves were made in all states to gain entry into universities for physiotherapy courses. (226) No success was achieved in New South Wales, so training remained a responsibility of the New South Wales branch of the Physiotherapy Association. 91 •

Eventually a second mode of entry into the occupation was established in 1969, when an arrangement was made between the University of New South Wales and the local branch of the Australian Physiotherapy Association. (227) Under this arrangement students undertook a science degree and followed this with practical training in physiotherapy. However, the occupational associations diploma course remained as the main mode of entry into the field.

· Cumberland College took over the function of training physiotherapists from the occupational association in 1973. (228)(229) The Martin Report had recommended that training in physiotherapy should enter Colleges of Advanced Education and not be a university course. (230) Thus events in New South Wales followed the intentions of the Martin Report.

In 19?5 it was decided that physiotherapy graduates would receive a degree. instead of a diploma, and the first degree students began their studies in 1976. (231 )(232)

XI.RADIOGRAPHY. (233)(234) In 1962 radiography education entered Sydney Technical College. In 1965 the first graduates of this program began to practise as radio­ graphers. The syllabus was that of the Conjoint Board which continued to award successful students their Certificate of Competence. C)2.

No award was made to these students by Sydney Technical College. Students attended the Collece on a part-time basis for three years.

In 1974 a certificate course was initiated (three years part-time), and in 1978 an f1.s3ociate !)iploma of Medical Radiography was commenced. The diploma course is full-time in the first year and part-time in the two subsequent years. It is intended that this program will gradually replace the certificate course.

XII. REHABILITATION COUNSELLING. ( 235) In 19'74 the Department of Social Security sponsored a pilot course of one year~ duration in Rehabilitation Counselling at the Cumberland College. The students in this pioneer course were employees of the Department of Social Security who were working in the area of rehabilitation. This pilot course was successful, and this led to the introduction of a three year Associate Diploma course at the Cumberland College in 1975.

XIII.SOCIAL WORK. (236) In 1940 the New South Wales Board of Social Study and Training relinquished control of general social work training to Sydney University who began an undergraduate diploma course. But those who wished to work in a medical setting as almoners, still had to undergo the course of training prescribed and operated by the New South Wales Institute of Hospital Almoners. Finally in 1954, medical social worl-;. 93.

· training was passed to the control of Sydney University. Since that time there have been many changes in the curriculum and the standard of training has been progressively upgraded. For ex.ample, in 1955 a two year post-graduate diploma was introduced alongside the two year undergraduate diploma. As the post-graduate course proved unsuccessful it was halted in 1957 and the under­ graduate course was lengthened to three years. During this period many students combined an arts degree with their social work diploma while they attended the university. Sydney University awarded their first degrees in Social Work (Bachelor of Social Studies) in 1968. (237)

At the University of New South Wales students were first enrolled in the Bachelor of Social Work course in 1965. Some were enrolled in the second and third years of the course. It is thought that these students were converting from the Diploma in Sociology course to the social work degree course. Early in 1967 the first degree students graduated from the university. (238)

XIV.SPEECH THERAPY. (239)(240) Speech Therapy education transferred to the Cumberland College in 1973. In 1975 it was decided to award graduates a degree instead of a diploma, and degree students commenced their studies in 1976. 94.

DISCUSS.ION. It wasn't until 1882 that the Medical School was founded at Sydney University. This medical school allowed other disciplines to gain entry to a university setting as it began instruction classes for pharmacy apprentices in 1899, and it established a school of dentistry in 1901. Then there was a long period before general social work training entered the University in 1940.

Throughout the present century there have been many moves by health care disciplines to transfer their training course to a university setting. However most of these moves have proved to be abortive. The Martin Report recommended that most of the allied health disciplines should be sited within a new category of tertiary teaching institutions which came to be known as Colleges of Advanced Education. Many of these occupations rejected this suggestion as they saw their chances of university entry receding. University entry remained elusive and most of the allied health training courses remained under the supervision of hospitals and occupational associations untii the Cumberland College was opened in the early 1970 1 s. Since that time it has taken many of the allied health training programs under its "wings". Since 1973 physiotherapy, speech therapy, occupational therapy, orthoptics, rehabilitation counselling and medical record administration have become Cumberland training courses. It also conducts some nursing courses. The Cumberland College has permitted many training courses, which had previously been frustrated in attempts to gain university entrance, to enter a recognized tertiary institute with the capability of awarding degrees or diplomas to success­ ful graduates.

The development of tertiary level traininc schools is summarized in ,TABLE TimEE. r;G.

ESTABLISHMENT OF TRAINING PROGl~Al\S rr UiHVERSITE~S AND COLLEGES OF ADVAHCED BDUCA.'I1IC1l'J nr ::E,.'/ SOU'J.1H WA I.::SS •

TAB L~ 11 HRl!; E OCCUPATION YEAR

Medicine 1882/83 Medical School founded at Sydney University in 1882.

Pharmacy 1899 ~ydney University becan instruction classes for pharmacy apprentices within the Faculty of ;;edicine.

Dentistry 1901 School of Dentistry established within the Faculty of Medicine at Sydney University.

Social Work 1940 General Social Work training and transferred to Sydney 1954 University in 1940. Medical Social Work training followed in 1954.

Hospital 1956 School of Hospital Administration Administration established at the University of New South Wales.

Radiography 1962 Radiography training trans­ ferred to the Sydney Technical College.

Dietetics 1967 Dietetic training became a 97.

one-year post-graduate diploma course at Sydney University. Physiotherapy 1973 Training transferred to Cumberland Colle~e.

Occupational 1973 Training transferred to Therapy Cumberland College.

Orthoptics 1973 Training transferred to Cumberland College.

Speech 1973 Training transferred to Therapy Cumberland Colle~e.

Rehabilitation 1974/ Pilot training course run at Counsellors 75 Cumberland College in 1974. Regular course begun in 1975.

Medical Record 1977 Training transferred to Administration Cumberland College.

Nursing Most nurses are still trained in hospital based programs. 98.

V.STATE OCCUPATIONAL ASSOCIATIONS

INTRODUCTION. The evolution of state occupational associations is the subject matter of this chapter. National associations and their state branches are discussed in the next chapter. Once new occupations emerge a characteristic of their development is the joining together•of practitioners into organizations aimed at furthering the advancement of the occupation. Later on there is eenerally a movement towards amalgamation of the organizations in the various states to form a national body. This characteristic rivals the introduction of training programs as the first development to occur once an occupation emerges. Once formed occupational associations have generally become involved in initiating or upgrading education programs, lobbying for licensing acts, writinc ethical codes and generally seeking to upgrade the status and standing of the occupation.

I.DENTIS'I'HY. (241) A aumber of occupationaJ associations arose amongst the dentists of New South Wales to serve various interest groups. The first body to be establish­ ed was the Dental Association of New ~uuth 0alcs which began in 1892 and functioned until 1897. It then

collapsed because of squaubJtng in ten.a~ ly. Few records of the activities of this associatiun iw.vc :..:;urvived. But it does a_ripear that the main thrust (Jf thejr

activities was to se81: tiie cno.cL1ei1t of ur.:nta1 legislation. 99.

In 1903 the Association was revived and it continued to function until the national occupational association was formed.

The in-fighting in the original Dental Association of New South Wales led to the establishment of a reading and study organization in 1899 which was called the 0dontological Society of New South Wales. This body was somewhat elitist, as membership was only offered by invitation.

Following the introduction of the university training program for dentists the University of Sydney Dental Graduates Association was formed in 1904. Its size grew as the number of graduates increased over the years, and it evolved into a strong association which interested itself in scientific and political matters.

In 1906 The New South Wales Dental Graduates Society was founded as a splinter group which defected from the 0dontological Society. The year 1905 had seen the formation of the University of .Pennsylvania Alumni Association as a study and social group. Its formation reflected the fact that some Australains went to the United States to gain dental qualifications (especially doctorates).

The dentists who advertized their services (the so­ called unethical practitioners) formed their own 100.

association in 1906. This was called the Commonwealth Dental Association.

The first moves towards amalgamation occurrad in 1919 when the Odontological Society of New South Wales, the University of Sydney Dental Graduates Association, and the New South Wales Dental Graduates Society joined together as the Society of Dental Science. But the Dental Association of New South ·:Ja I uc whLch was the largest of the original associations, did not join this combine.

II.DIETETICS. Australia's first state dietetic association was formed in Victoria in 19~5. This body called itself "The Dietetic Asr:rnciation - Victoria". Its formation arose out of a meeting which was convened at the Alfred Hospital. Their first presiJent was a dietitian, Mrs. Isobel Bradshaw. New South Wolos followed the Victorian example in 1939 when they formed the Dietetic Association of New South \'/ales with Ruth

Gordon as the foundation president. (?.42) In tlle same year they registered themselves under the Companies Act.

( 243) Later branches were formed in Newca:--: tJe and Canberra.

III. HOSPITAL ADMINISTRATION. ( ?41+) The year 1 '.]7;~ saw the formation of the Institute of Hospital Secretaries of New South Wales. On 2/9/1941 the Institute was

incorporated under the Companies Act. Fcll,)wi_nr: the 101.

formation of a national institute the locaJ. asGociation declined and was finally djssolved in 1950. The national institute formed state bra1tchos wh~Lch replaced the separate state associations.

IV.i'-IEDICAL RECORD AD:IIHISTRATION. (24::i) ;.s a result of the visit by I·'.rs. Huf fwan to Australia in 191, 9 a state occupational association was for1ned in l;ew South ','!ales in the same year. It \'/as called the new ::.:;ou th ';'ial.c.s Association of l-fcdical Ticcord Librarians.

V.MEDICINE. A local medical association with the grandiose title of Australian iicdical Association was formed in Sydney in 1859. (2Li-6)(24?) However it was

really a state, and not a national orco.nization. At this tinw Victoria had its own viable ;,icJ.ical &ssociation. As the Australian :-:edica:i. Association had no journal of its own, sorae of its rnombers published articles in the lay press. This caused much friction, and was one of the reasons for the organization's decline and final demise in l~rch 1869. In 1872 another body called the :~ciical Practitioners Association was for1.:cd 1rnt it l1.:,'cc1. a very narrow interest (ie. improvins the standards of friendly societies). A section for thoso with medical intcrcats

was created within the Hoyal Society of Nev: ,South './ales in 1876, but this was not a long tcrLl aolution to the need for a separate and distinct Qctiical association. 102.

Eventually a viable body was created in 1880 when a New South Wales Branch of the British Medical Association was formed. (248)(249)(250) Branches of the B.M.A. were formed in every Australian state in the period from 1879 to 1911. Prior to these branches being established only Victoria had been successful in forming a long running medical association. (251) Lack of permanent occupational journals, in-fighting over ethical matters such as advertizing, and apathy, had led to a number of groups folding in the various states.

The branches of the B.M.A. in Australia were granted complete autonomy by the parent body in England in 1923. ' (252)

VI.NURSING. (253)(254)(255)(256)(257) A meeting of interested nurses and doctors was held in Sydney in 1898 to discuss the formation of an association for trained nurses. This led to the founding of the New South Wales Trained Nurses Association in July 1899. Because many interstate nurses applied for membership the name was altered to the Australasian Trained Nurses Association in December 1899. However the title "Australasian" was misleading as the association was largely based in New South Wales in the beginning. Victorian nurses formed their own association. With the exception of Victoria, branches were eventually formed in the other states in the early years of the present century - Queensland (1904), South Australia (1905), Tasmania (1906) 103.

and 0e~tern Australia (1~07).

The first president of the Hew .3outh '. .'ales ·l'r.::.ti!lcd Nurses Association was a medico, Dr. :iorton ::amiiuc. The first honourary secretaries were a medico,

Dr. Sinclair Gillies, and Eiss Sarah l :cGahcy VJho v1as then matron of Prince Alfred Hospital. The association came to regulate the itandard and content of the nurse training proe;rams in the state and 1,;aintaincd this function until the establishment of the Nursus Board. The board then took over this role.

VI I. OCCUPATIONAL THERAPY. ( 258) ( 259) FollovlinG the failure to gain entry for Occupational Therapists into the Australian Physiotherapy Association, a meeting was convened at the Girls Secondary Schools Club in Sydney on L1-/12/194Li. As a result of this meetini:; an Occupational Therapists Club was formed in January 191+5. This body held regular meetings and began a clinic where therapists could treat private patients. The club proved viable, and late in 1945 it became "The Australian Association of Occupational The.rapists". Durj_n13 the period that the Club was in existence the training school was still controlled by the Australian Physiotherapy Association.

VIII. ORTIIOPTICS. The first orthoptic occunational

association was a national body. But in actual fact it was

mainly made up of Victorian and He\': ;:;outh '!2,Jes practitioners. Few practitioners cxisteC outside these states as training prograills were only functioninc in Sydney ancl I-:elbourne. (260)

IX.PHARl·ffiCY. When the Apothecaries in Britain tried to bring the chemists and druggists under their control in the 1840 1 S, the chemists united in protest and formed the Pharmaceutical Society of Great Britain in 1841. (261)(262) This boc.ly became the model which colonial chemists tried to emulate. A group of Sydrwy che,11ists headed by Ambrose Foss forr:1ed a Phar1naceutical Society of New South Wales in 184Li-. (263) This orc.;an:i.zation struggled on through the 1840'5 but it did not emerge as a focal point for pharmacists in the state, and it eventually faded into oblivion.

The Poisons Bill that was first introduced into the state parliament in 186G threatened the independence of chemists as it contained a provision that choLlista would

be examined for competency by the ; "cdica1 Buuru. ,\s a result of this move a group of Sydney chemists who had been meeting regularly as a luncheon club decided to form themselves into a formal sac iety ancl o p11ose the Bill. The society was officially formed at a ~eeting at the Temperance Hall in Pitt Streat on 6/6/1368. (264) This society was called the Pharillacoutical Society of New South Wales (as its predecessor ho.d also boon called) and it has survived until the preGent clay. It is interesting to note that the ,)harrnaccuU_cal .Society 105.

of Victoria was also formoc'. as a re.::;ul t of ir:1pcndin5 leg is la tion that threatened the aut on,;;ny uf c iic:il:ist:::;.

The year of formation of the cxistine pharrnuceutical societies in each state is outlined in T1\BL~: FOU~1.

STATE YEAH CF FCRI-lATIOH C.F' ~-~>CJ.S'I'E!G .s'l1AT.2.: SOCI:STIE.S (265)

Victoria 185?

New South Wales 1868

Queensland 18ao

South Australia 1885

Tasmania 1890

Western Australia 1892

These societies are independent bodies to a large degree despite the for1uation of a national association

in 1976.

X. PHYSIOTHERAPY. ( 266) ( 267) ( 268) The l.Jr3w ;South 1.Jales I'lassage Association was initiated. in 1905 •.'rofassor Anderson Stuart who played such a prominent !.'ule in the formative years of many health care occupations was the first precident of this organization. B.Y tile end of 1905 small occupational associations were also

functioning in Victoria and South Australia. ~ithin D. 106.

short period of the State association being formed, a training program in massage had bec;un at the noyal Prince Alfred Hospital.

XI.RADIOGRAPHY. (269) (270) (271) (272) The Australian and New Zealand Association of Radiologists (A.N.Z..A.R.) was launched in 1934 with Dr. H. R. Sear as the first president. It w~s incorporated in New South Wales in February 1935. Soon after its formation it created a technical section in New South Wales, which allowed X-ray technicians to join as associa~e members. This technical section virtually functioned as the state occupational association for radiographers in New .South Wales. In Victoria a different path was followed as a branch of the English Society of Radio,a;rapl1crs was established.

The Technical Section of A.N.Z.A.R. survived the war years. But in the post-war period radiographers beca11 working for the formation of a separate or~anization which would be independent of the radiolociuts. Eventually their own federal institute was f or1.1ocl.

XII. REHABILI'rATION COUNS2LI,ING. ( 2'?3) Cn the 1 Oth. of

June 1974 a meeting was hold in the Police Citizens Boys Club, leichardt, in order to form an occupatic.,nal association. Thirteen interested pcop1o attew:ecl, and a motion was carried to form un association to be

knovm as the "Society of Rehabilitation Couilsc11:Jrs 11 • 107.

A steering committee was established to set up the formal organization of the· association and to investisate the procedures necessary for incorporation. The acsociation

was eventually incorporated in New South 1,'Jales in 1977. Most of the members come from New South \'Jales and attempts to form branches in other states have been unsuccessful.

XIII.SOCIAL WORK. (274) General Social V!orL..ers formed the Social Workers Association of New South Wales in 1933. Workers who lacked formal social work training were able to join. Two years later a similar body was formed in Victoria. Gradually associations were formed , in other states. Eventually there was a move to form a national body, and several interstate conferences were held in 1946 to achieve this end. A Federal body was formed later in that year.

In the case of the almoners, a state association was formed in Victoria in 1932. In 1934 they formed them­ selves into a national body called the "Australian Association of Hospital Almoners". Sydney's almoners joined this body as a state branch in 1936.

XIV.SPEECH THERAPY. (275) The first occupatj_onal association for speech therapy in Australia was a

national body. This was then superseded by another federal organization which established state branches to serve the needs of the various states. 108.

DISCUSSION. It appears that the first occupational association in the health care field in New South Wales was the short-lived Pharmaceutical Society of New South Wales which was launched in 1844. There may have been an occupational group formed amongst the government surgeons during the convict era but I could find no conclusive evidence for the existence of such a group in

my literature retiew • .Of the seven occupational characteristics examined in this project, it is only in the establishment of state and national associations that medicine was not the pathfinde~. Medicine trailed pharmacy in establishing the first state occupational association, and it trailed physiotherapy, dentistry and ' nursing in _forming a national occupational group.

By the end of the nineteenth century pharmacy, medicine, dentistry and nursing had established state associations, while physiotherapy formed one shortly after the turn of the century. During the great depress­ ion practitioners of social work, radiography, hospital administration and dietetics formed associations. The other occupations formed simil~r bodies in more recent times.

In most cases occupational associations were formed at the state level before national bodies were established. The only exceptions have been speech therapy and orthoptics. Once local groups were operating initiatives were begun to form national bodies. 109.

The order of appearance of state occupational associations is outlined in TABLE FIVE.

F.STABLISHMENT OF STATE OCCUPATIONAL ASSOCIATIONS IN NEW SOUTH WALES

TABLE FIVE

OCCUPATION YEAR EVENT

Pharmacy 1844 Pharmaceutical Society of New and South Wales established in 1868 1844. It later folded. Present society of same name formed in 1868.

\ Medicine 1859 Australian Medical Association and (a New South Wales body) 1880 formed in 1859. It later folded. New South Wales branch of the B.M.A. formed in 1880.

Dentistry 1892 Dental Association of New South and Wales established in 1892. It 1903 later folded and was revived again·in 1903.

Nursing 1899 New South Wales Trained Nurses Association established in July 1899. In December 1899 it became the Australasian •rrained Nurses Association. 1 IC,.

Physiotherapy ~ew South ~alee ;~ssace

AssocicJ tioll for,nc(~ •

Social Vlork 1933 .Social '.'/or1~e1·s A::;socia ti.on of New Souti1 ::ales formed.

Radiography circa The Australian and New 1935 Zealand Association of Radiology for~ed u technical section for radiocra.phers.

Hospital 19_38 1oundation of the Institute Administration of Hospital Secretaries of

I-few .South 1.'/alc.s.

Dietetics 1939 The Dietetics Association of

New South V/ales formed.

Occupational 1945 Occupational Therat1i.sts Therapy Club started in Sydney.

:-1edical Record Formation of the New South Administration '.'/ales AssociD.tion of :·;cdical Recortl Librarians.

Hehabilitation 1974 The Society of ~c~abilitation Counselling Counsellors formed.

Orthoptics The first assuciution

for~lied \Vas a na tj_onal body.

Speech Therapy The first as~;,Jc iJ tion

forn1ect was et 1ta ti,,1 tal bociy. 111.

VI. HAT IONAL OCC UPATIOI'JAI 1:t.SSOC IAT IC1:·:;::

INTRODUCTION. Occupational associations rE-r,ro.sc nting practitioners at the national level are discussed in this chapter. In most cases associations oricinated at the state level before moves were raade to form a federal body.

1.DENTISTRY. (276)(277) (2'?8) The first li1uve towards forming a nationwide association for Llcntistc ca1,1e in 1911. In that year the :Jational Dental .",.r.;3ociatiun was formed in Melbourne. This ineffective body survived until 1928. It was run by a nineteen man Feu.eral council which was elected by state dental councils. These state councils represented the various associ­ ations in each state. In effect it was a very loose federation of many local associations. It dicl not operate on the state-branch system and the federal council had virtually no control over the various local associations.

Over the years there were many moves to fort1 a rnorn effective national body, but these moves proved abortive until the Australian Dental Association was forrried in 1928. The :i~ew South Wales state branch 1·ms for:1:cd in the same year throu[;h the r.mtual acreement of the Society of Dental Science and the Dental Association of

New South 1.'!ales. These two bodien were LinaJly liquidated in 1930. Those dentists who alreed to abide 112.

by the state branch code of ethics were acceptable to apply for membership.

On 27/2/1928 the inaugural meeting of the New South Wales state branch of the Australian Dental Association took place. Their first regular monthly meeting occurred a short time later on 26/4/1928. In June 1929 they were incorporated undet- the Companies Act of New South Wales.

State branches of the Australian Dental Association formed in all six states in 1928.

II.DIETETICS. Following a lengthy period of negotiations

~ the state occupational associations in Victoria and New South Wales, agreed to form a national body in 1949. A constitution was compiled and the new body, which was called the Australian Dietetic Council, met for the first time in 1950. (279)(280)(281) It was a confederation of the two state associations and held little power or policy making credentials. Its major function was to promote liaison and exchange of information between dietitians all over the nation •. Real authority and control remained with the state associations. (282) Joan Woodhill was the first president.

Despite the shortcomings of the Australian Dietetic Council it lasted twenty six years until it was replaced by the Australian Associations of Dietitians in 1976. This new federal association accepts membership from 113.

individual dietitians in contrast to its predecessor which only accepted state associations as members. (283)

III.HOSPITAL ADMINISTRATION. An Institute of Health Service Administrators was formed in England in 1902. Hospital administrators in this country did not form a national association until 1945 when the Australian Institute of Hos~ital Administrators was incorporated in the A.C.T. (284) The first meetine; of the council of this new body met on 3/4/1946. While this development was taking place the two existing associations in Victoria and New South Wales continued operating for a short period until they finally ceased to function in 1950.

The federal institute initially established stato branches in New South Wales and Victoria, and later in the other states. The year of foundation of the various branches is outlined in TABLE SIX. 1 1 L~.

TAELE SIX

STATE YE:A2 .ST.ATC: BRAiTc::i;~S C•F T~,~ A.I.II.A. WERE FOR~~D (285)(286)(287)

New South Wales

Victoria 19~1

~estern Australia

South Australia

Tasmania 1s,G8

Queensland 1976

A.C.T. 197G

One of the first actions of the federal institute, was to begin a correspondence course in hospital administration. This program was run for several years until training activities were transferred to the University of New South Wales.

IV.MEDICAL RECORD ADMINISTRATION. (288) In 1956 the two state associations in New South Wales and Victoria formed the Australian Federation of Ledical Record Librarians. Late in 1977 they changed their name to the Medical Record Association of Australia. This name change was part of the move to remove the word "librarian" from any association with workers in the fj_eld of medical records. The change was needed because of a certain amount of confusion about the role and function of medical record personnel. 115.

V.MEDICINE. (289)(290) To give the various branches of the Bri tj_sh Medical Association a national focal point an Australian federal committee was set up in 1912. Autonomy was eventually granted to the state branches in 1923 by the BMA. A federal council for Australia was finally estab­ lished in 1933 and this body was incorporated under the companies act of New South Wales on 15/5/1933. The first meeting of this n~w federal council was held in Sydney on 28/8/1933.

Retention of the name "British" in the title of the national occupational association continued right up to the 1960 1S when it was reconstituted as the Australian Medical Asso.ciation. The Memorandum and Articles of Association of the new association were finally adopted on 10/6/1961. After this it was incorporated in Canberra on 25/10/1961, and it officially commenced to operate on 1/1/1962. Adelaide hosted the inaugural meeting on 19/5/1962.

VI.NURSING. (291)(292)(293)(294)(295) Following years of negotiation the Australasian Trained Nurses Association and the Royal Victorian Trained Nurses Association agreed to form a national body in 1923. This led to the launching of the Australian Nursing Federation in 1924. The first president was a doctor, Dr. R.J. Millard.

In 1937 the Federation affiliated with the International Council of Nurses and in 1955 they were 116.

·given the "Royal" prefix by the Queen.

VII.OCCUPATIONAL THERAPY. (296)(297) The Occupational Therapists Club which had been formed in Sydney early in 1945, changed its name to the Australian Association of Occupational Therapists in November 1945. Despite this name change it remained basically a state association until workers in the other st~tes began to form state branches several years later. The Victorian branch was established in 194? and the Queensland branch in 1948. In 1948 the national body was incorporated in New South Wales. Later on branches were established in Western Australia (1952), South Australia (1963) and Tasmania (1971)

VIII.ORTHOPTICS. (298)(299) Following a meeting in Sydney in 1942 a national association of orthoptists was launched in 1943. The name chosen was the Orthoptic Association of Australia. Its first president was a medico, Sir Norman Gregg. It should be noted that orthoptists in London had only formed the British Orthoptic Society in 1937.

IX.PHARMACY. (300)(301)(302)(303)(304) The first inter­ colonial pharmaceutical conference was held in Melbourne in 1886. (305) Similar conferences were held at fairly regular intervals from this time onwards. Although participants sometimes expressed a desire that the con­ ferences should lead to the formation of a national occupational association this wish remained unfulfilled. 117.

Hospital pharmacists formed a national society in 1960 and this body was incorporated in Victoria in 1962. (306) This society was originally called The Society of Hospital Pharmaceutical Chemists of Australia but the name has since been shortened to The Society of Hospital Pharmacists of Australia. The three states which originally formed this society in 1960 were Victoria, South Australia and Western Australia. New South Wales and Queensland joined in 1961 and Tasmania followed in 1962. As pharmacists in hospital practice only constitute a minority of pharmacy practitioners, this body is not representative of pharmacy generally at a national level.

At a conference in Melbourne in 1972 serious discussions began concerning the formation of a national occupational association which could represent all branches of pharmacy. Discussions continued over the next three years. Eventually at a meeting of state pharmaceutical society presidents in Sydney on 29/6/19?5, it was decided to establish the Pharmaceutical Society of Australia. It commenced opepation as an unincorporated body on 1/1/19?6, and was incorporated in the A.C.T. on 24/2/1977. All state societies except Western Australia have representatives on the society's council. It is hoped that the Pharmaceutical Society of Western Australia will join the movement in the future. 11 8.

·x. PHYSIOTHERAPY. (307) (308) (309) ( 310) (311) ( 312) The three state associations which had formed in New South Wales, Victoria and South Australia investigated the need for forming a national association. A meeting was held in Melbourne in December 1905 and it was decided that such a body should be established. A provisional committee was founded to launch the new association and a constitution was drawp up. The inaugural meeting of the Australasian Massage Association was held on 14/2/1906. As with many other associations in the health care field, the foundation president was a medical practitioner (Dr. Springthorpe). Masseurs and masseuses who had a year's experience with massage and had references from three medical practitioners who could vouch for the standard of their work, were eligible for membership.

Sydney hosted the first annual meeting of the association in 1907. At this meeting a FedeFal Council · was set up and state branches were established in New South Wales, Victoria and South Australia. Shortly afterwards branches were formed in Western Australia, Queensland and Wellington in N~w Zealand (by the end of 1908). After several years the association declined at the federal level and it was not revived until the

1930 1S. However the state branches continued function­ ing during this period.

In 1940 the name of the association was changed to the Australian Physiotherapy Association. This reflected 119. the cha~ging nature of practice, as practitioners were no longer devoting most of their energies to manipulative tasks.

XI.RADIOGRAPHY. (313)(314)(315)(316)(317)(318)(319) (320)(321) In the immediate post-war years radiographers began working towards the formation of an independent national association. During 1947 Nick Outterside from Sydney and Hayes-Piddlesden from Melbourne carried out negotiations which led to the formation of such an organization. From 1947 onwards groups of radiographers in each state began forming themselves into local branches of a national association. The branch in New South Wales was formed in 1948. After functioning for several years as an unincorporated association the national body was incorporated in New South Wales in 1950 as the Australasian Institute of Radiography. The first meeting of the new council was held in May 1950.

XII.REHABILITATION COUNSELLING. (322) The Society of Rehabilitation Counsellors is based in New South Wales and most of its members come from that state. Attempts to establish the association on a national basis, by forming branches in other states have not been fruitful.

XIII.SOCIAL WORK. (323) The almoners working in Melbourne formed a state association called the Victorian 120.

Association of Hospital Al~oners in 19~2. Its name was changed to the Australian Association of Hnspital Almoners in 1934, although it was still basically a state body until other states joined. Sydney's almoners decided to become the New South If/ales branch of this organization in 1936, rather than form a separate association. In May 1938 a federal structure was adopted, and a state branch was formed in South Australia in 1941. In 1949 they dropped the word "hospital" from their name as the word almoner really inferred hospital practice at that time.

A national association for general social vwrkers was founded in 1946. This was callP.d the Australian Association of Social Workers. They made provision for special interest groups to function within their structure in 1958, and by the end of that year a group for medical social workers had been formed. Following this initiative the Australian Assocj_ation of Almoners disbanded in March 1959, finally brinr,ine toe;ether the two streams of practice. The term almoner then dropped from use and the distinction between general social worker and medical social worker (or almoner) became progressively more blurred. Today the terms are synonymous and interchangeable.

XIV. SPEECH THERAPY. (324)(325) ( 326 )( 32? )( 328) An organization called the Australian Association of Speech

Therapists was formed in Sydney in 1')li4. In 191+9 it was 121 •

superseded by the Australian Colleee of Speech Therapists which was designed to educate and examine recruits to the occupation, as well as acting as the occupational association. The federal council of the British Medical Association in Australia gave formal recohnition to the college and its work in 1951. In 1953 the college was incorporated in Canberra.

DISCUSSION. The first national occupational association in the health field was the Australasian f-Iassage Association which was launched in 1906. National bodies in the fields of dentistry and nursing followed before medicine gained a national association in 1933. Since that time most of the studied occupations have formed bodies at the federal level. In the case of pharmacy which emerged as a distinct health care occupation in Australia early in the nineteenth century, a national association was not formed until 1976.

There is a large variation in the amount of control that the various national bodies can exert over the state branches and the number of pre~ogatives that have been invested in the national bodies. In the case of the Australian Medical Association a strong national association exists in Canberra where it can exert influence on various government policy makine; bodies. But in the case of pharmacy the new national association has been given limited powers and the state associations still act fairly autonomously. 122.

Just as there is a trend for statu associations to amalr;amate and form nat_ional bodies, there is a trend fer these national bodies to become stron3er and ucrc influential once they are formed. The advantar,es of presenting a unified front to goverm:1ent instrumental­ ities and other occupations aid in this s]ow transmission of power to the federal level.

ThB order of appearance of national occupational associations is summarized in TABLl~ S~VEN.

TABLE SEVEN

OCCUPATION YEAR

Physiotherapy 1906 Australasian !,)assagc Association formed.

Dentistry 1911 National Dental Association and formed in 1911. Replaced by 1928 the Australian Dental Association in 1928.

Nursing 1924 Formation of the Australian Nurstng Federation.

Medicine 1933 A Federal Council of the B.M.A in Australia was launched. Became the A.~.A. in 1962.

Social Work 1934 Australian Association of and Hospital Almoners formed in 1946 1934. Lustralian Association 123.

of Social Workers formed in 1946. The almoners association merged with the general association in 1959. Orthoptics 1943 Orthoptic Association of Australia launched in 1943. Speech Therapy 1944 Australian Association of 'and Speech Therapists formed. 1949 Superseded by the Australian College of Speech Therapists in 1949.

Hospital 1945 Australian Institute of Administration Hospital Administrators formed.

Occupational· 1945 Australian Association of Therapy Occupational Therapists formed.

Radiography 1947 Branches of the unincorporated and Australasian Institute of 1950 Radiography began to form from 1947. This Institute was incorporated in 1950.

Dietetics 1950 Australian Dietetic Council and formed in 1950. Replaced by 1976 the Australian Association of Dietitians in 1976.

Medical Record 1956 Australian Federation of Medical Administration Record Librarians formed. Pharmacy 1976 Pharmaceutical Society of Australia launched.

Rehabilitation The Society of Rehabilitation Counselling Counsellors is basically a New South Wales association. 125.

VII. LICENSING OF HEALTH CARE OCCUPATICfTS.

INTRODUCTION. In this chapter the evolution of -, :i.cE::nsing boards and licensinp; acts to ruc;ulut;_;; the practice:: ld. health care occupations is outlined. ,;Oi,18 of the occu­ pations under review are not licenGGd in :\.J•:1 Soutb 'c'Jalos, but are licensed in other states. In other cases a for~ of licensing cont.rolled by occupational organizations in contrast to statutory licensine is in existence. Where such variations exist, a discussion of the alternative forms of licensinc is incJuded in this chapter.

I.DENTISTRY. In the United States UH3 first dental legislation was enacted j_n 18l+ 1 in Alabama. Five more states followed this example between 18G8 and 1876. Eventually all of the American states came to enact dental legislation. (329)

England's first dental act came in 1878. In other countries dental legislation also appeared before the dawn of the twentieth century. eg. France in 1699, Italy in 1888 and New Zealand in 1880. (330)

In Australia three states introduced dental acts late in the nineteenth century. They were 'I'asmania

( 331), Victoria and Western Australia. New ,South ';'Jal cs eventually followed suit in 1900 where the Dental Act of 1900 came into effect on 1/1/1901. (332) The first 126.

Dental Association of New South Wales began the movement for such an act when it was formed in 1892. It drafted a dental bill but got no further in its endeavours. In 1896 another dental bill was presented to the state government but this initiative also proved to be abortive.

The Dental Act of 1900 did not prevent unregistered people from practising dentistry in the state. This provision was not made until the Dental Act of 1916. At this time there was still no restriction on dentists advertizing. Some of the dental associations had codes of ethics that prohibited members from advertizing their ' services, but one could circumvent this prohibition by resigning from the associations. Advertizing was eventually prohibited by the Dental Act of 1927. The next development in the evolution of dental standards in New South Wales was the abolition of the apprentice­ ship system in the Dental Act of 1934. Up until this time people could enter dentistry by completing the dental course at Sydney University or undergoing a prescribed period of apprentice~hip with a registered dentist. (333)

The Dental Act of 1900 had not made licensing compulsory, it had not banned advertizing, and it had not made a university training a prerequisite for registration. With the legislation that appeared between 1900 and 1934 these issues were gradually brought under the terms 127.

·or the· act, and dentistry gained tllc c.lvai1ccs that many of its practitioners sought. However it must be remembered that each advance wa3 fou;;ht by a stroni and vocal section of the occupation that had a vested interest in maintaining the status quo.

The appearance of dental legislation in all the Australian states is outlined in TABLE EIGHT.

TABLE EIGHT

STATE YEAR OF f IRST DE:\iTAL ACT (334)

Tasmania 1884 (335)

Victoria 1887

Western Australia 1894

New South Wales 1900

South Australia 1902 (Y5G)

Queensland 1902 (337)

II.DIETETICS. Dietitians are not registered by the state in New South Wales. In fact the only Australian state to register them is Victoria which has had a Dietitians Registration Act since 1943. (338) It is thought that this may be the first licensing act in the world involving dietitians. This act appeared fairly early in the development of dietetics as an occupation, as the country's first dietitian had only commenced worldng at the Alfred Hospital in Melbourne in 1930. 128.

Practitioners in New South Wales did not gain a system of state licensing. But they did establish the New South Wales Institute of Dietitians in 1944. (339) This body was set up to register dietitians and to inspect the training programs in the public hospitals to ensure that standards were adequate. The "Institute" was registered under the Companies Act and contained repre­ sentatives of the Hospitals Commission of New South Wales, the New South Wales Branch of the British Medical Associ­ ation, the University of Sydney, The Dietetic Association of New South Wales, and the Departme~t of Education of New South Wales. (340) In more recent times the make-up of "Institute" membership has altered slightly.

In effect the "Institute" behaves in the same way as a licensing board established by an act of parliament. It maintains a register of those practitioners who have passed approved courses of training and generally takes an interest in the standards and content of dietetic training programs. However, as it is not supported by legislation, it cannot make legally enforceable regulations regarding the practice of dietetics. For this reason its power and influence is less than that of a statutory licensing board. For example, registration with the "Institute" cannot be made compulsory for all dietitians practising in New South Wales. 129.

III.HOSPITAL ADMINISTRATION. There is no state licensing of hospital administrators in New South Wales. But in Victoria a rudimentary form of state licensing evolved as section 51 of the Hospitals and Charities Commission Act (1948) made it compulsory for hospital boards of management to seek the approval of the "Commission" before appointing new managers. (341)(342)

In 1949 regulations were made pursuant to this section of the act, which prescribed certain requirements which had to be met before people could be appointed as managers to hospitals of various sizes. (343) These requirements involved specific types of practical experi­ ence and/or attainment of a specific membership status within the Australian Institute of Hospital Administrators.

By virtue of these regulations the "Institute" took on some of the characteristics of a licensing board and "Institute" membership became a necessity for aspiring hospital managers in Victoria. The regulations were an attempt to ensure that certain standards were reached before managerial appointments ~ere made. In this respect the regulations functioned in a similar manner to licensing acts. NOTE - The new Health Commission Act made these regulat­ ions obsolete.

IV.MEDICAL RECORD ADMINISTRATION. Medical Record Administrators are not registered in any Australian state. 1 ·_)O.

V.LiDICDJE. The ori~ins of medical r(:c;ulc..tions in [~ew South Wales can be traced back to the r.todical boards which examined immie;rant doctors early in the nincteonth century. They examined doctors and pub1ishcd the names of those who failed in the Sydney Gazette. Doctors who failed were ordered to abstain from practisinc medicine in the colony. The first people to pass such an examination were 1,Villiam Redfern and SdVJard Lutrell in 1808. (344)(345)

In 1838 tw0 acts were passed which laid tho foundation for the future development of statutory licensing in New South 1//ales. The first of theEe was the Medical Witnesses Act of 1838 which gave power to coroners to summon qualified medical witnesses when people were unattended or under medical treatment at the time of death. (3L1.6)

The qualifications of these medical witness8s were defined by the second act which was entitled, "An Act to define the qualifications of Medical ~itnesses at Coroners Inquests and Inquiries.held before Justices of the Peace in the Colony of New South 'Jalcs". Th:is act establishea a three membered medical board wllich was reS})Onsible for maintaining a regist8r of quc:,1ificcl doctors who could act as r:1edical witnesses. This register was published annually. (347)()43) The act did not establish registration on modern lines a.s tlw roiister was for the use of the courts a~d nut t0 1 _: 1 •

prohibit the unregisterod from trcatinc patient~. (34?)

John Vaur;han Thompson was th0 first .L'rcsiclont c,_[ tl1is medica1 board.

Over the years that followed the terms of reference of the medical board were expanded and upgraded. The concept of protecting the public frou1 unqualified practitioners gridually,replaced thu concept of providing the courts with a list of acceptable witncsseG. However, the present statutory medical board can trace its roots to the board that was established in 1838.

This development of medical legislation and a medical board in New South Wales preceded British legislation by two decades. In 1858 a Medical Act was passed in Britain which established a General Medical Council to control medical education, and to register those who passed the prescribed training courses. (350)

When the medical board was first established in New South Wales the areas known as Victoria and Queensland were still part of the "mother" colony. The settlements at Port Phillip and I'-Ioreton Bay merely formed the centre of districts that were nart of New South Wales. Because of this regulations made in Sydney applied to the whole of the eastern coast of mainland Australia. In 1845 the Port Phillip District was given its own medical board even though the area was still part of New South Wales. The colony of Victoria 132.

was not·formed until 1851.

It should be noted that the first ctatc licc1,sinr: acts did not make registration compuJ ~Jory. Compulsory licensing and the prohibition of unquaJified people from practising medicine were later developments.

The origin of•medical licensing in each Australian state is outlined in TABLE NINE:-

TABL8 IHNE

STATE YEAR LICENSING VJAS ACHIEVED

Tasmania 1837 ( 351)

New South Wales 1838 (352)

South Australia 1841+ (353)(354)

Victoria (as 1845 (355) District of Port Phillip)

Queensland 1862 (356)

Western Australia 1869 (357)

VI. NURSING. In England the movement towards sta to registration of nurses began in tho 1870 1 5. Florence Nightingale opposed this ruovement and this was one of the reasons for the long delay in achiovinc; rcc:istratiun. (358) Fi.nally in 1919 an act was passed and a General

Nursing Council was established. (359)(360) r11 his body

regulates and controls the training of nurses as well as 133.

uaintaining a register of qualified practitj_oncrs.

England was rather late in the introduction of legislation affecting nurses. Even at the time of the outbreak of V/orld War One registration status had been achieved in the Cape Colony, Natal, the Transvao.l, the Orange River Colony, New Zealand, Ontario, ~~nitoba, Queensland, the Bombay Presidency of India, thirty nine of the United States of America, tlw Geriaan ::::rnpire and

in Belgium. (361) Thus, it can bo seen that our own Queensland led the "mother country" with regard to the licensing of nurses. Queensland introduced state licensing of nurses in 1912 while the other Australian

states followed in the 1920 1 s. In some states regulation of midwives preceded this legislation.

The origin of licensing acts for nurses in the

various Australian states is outlined in TABLE 'l1l~N: -

TABLE TEN

STATE YEAR LICEN.SING WAS ACIIIEVED

(362} (363) (36lt)

Queensland 1912

South Australia 1920

Western Australia 1921

Victoria 1<)23

New 3outh \'Jales 1 ') 21+

Tasmania 1927 134.

In New South Wales the first nurses act was passed by parliament in 1924, and it came into operation on 1/1/1925.

VII.OCCUPATIONAL THERAPY. Occupational therapists obtained a licensing act in Western Australia in 1957, (365) and in South Australia in 1974. (366) There are moves currently afoot to try and achieve licensing acts in the other states.

VIII.ORTHOPTICS. Orthoptists are not licensed by Act of Parliament in any Australian state. But the Orthoptics Board of Australia does fulfil a similar role to state licensing boards as it registers graduates of the training courses in Sydney and Melbourne. As there is full reciprocity with the British Orthoptics Board it also registers British graduates who come to Australia. Prior to the transference of the training courses to Colleges of Advanced Education the Orthoptics Board also controlled the training schools. Before graduates could register with the "Board" in New South Wales they once had to sign an agreement that they would abide by their occupations code of ethics. (367)

The Orthoptics Board of Australia was established in 1938, only four years after the formation of the British Orthoptic Board. Initially the controlling board was composed entirely of Opthalmologists. But, in 1964 orthoptists were given representation on their own board. 1 V5.

However, the majority of raembers are still Opthalwolo­ gists. (368) For this reason the occupation of orthoptics is still fairly strictly coutrolleJ by the medical speciality of opthalmology.

IX.PHARMACY. (369) Until the second half of the nineteenth century there were no laws re6ulatin~ the sale and distribu\ion of drugs in New South ~ales. Britain had introduced an Arsenic Act in 1851 which required the sellers of arsenic t~ record their sales, and a Pharmacy Act in 1852 which req-µi.red the Pharmaceutical Society to r.mintain a register of cheaists with acceptable qualifications. (370)(371)

The first pharmaceutical legislation in New South Wales was the Poisons Act of 1876 which restricted the sale of certain drugs to authorized vendors. A Pharmacy Board consisting of the President of the New South Wales Medical Board, the medical adviser to the State Government, and the Council of the Pharmaceutical Society of New South \!Vales, was also established under the act. This body was given the responsibility of maintaining a register of authorized poison vendors. To gain admittance to this register a person ncodcd to have been in business as a chemist before the act was passed, to have acceptable overseas qualifJcations, or to serve a three year apprenticeship with a chemist and then pass an examination. To prevent hardships in outback areas, unqualified people could be registered 136.

by gaining the approval of a doctor and a police magistrate.

The 18?6 Poisons Act was an emasculated form of the Bill that was originally submitted to parliament as the Act exempted prescriptions, patent medicines, photo-. graphic materials, veterinarian medicines, wholesalers, and vermin-destroying poisons from its control. However the act was the beginning of statutory regulation of drugs and their suppliers, and the present day Pharmacy Board can trace its roots back to the board that was establi.shed in 18?6. Further modifications and developments were introduced within the Pharmacy Act of 189?.which was the first major overhaul of pharmaceutical legislation in the state.

The year of the first pharmacy or poisons act in each Australian state is outlined in TABLE ELEVEN.

TABLE ELEVEN STATE YEAR OF FIRST PHARMACY OR POISONS ACT (372)(373)(374) New South Wales 1876 Victoria 1876 Queensland 1884 (375) South Australia 1891 Western Australia 1894 Tasmania 1908 and 1842 (376) 1 -37.

It ~hould be noted that even though the firGt Pharmacy Act in Tasmania was only pasi=rnd in 1908, the Court of Medical Examiners had been examinine; and licensing chemists since 1842, when they were eiven this power by the Medical Act that was introduced in that year. (The Medical Act of 1842 - 6.Victoria, No.2) In the other states you can find further examples of medical legislatidn affe~ting pharmacy prior to the introduction of the first pharmacy and poisons act.

X.PHYSIOTHERAPY. As the Australasian Massage Association had no authority or control over physio­ therapists who would not join, it campaigned for the introduction of state licensing acts. (377) In this way it hoped that uniform standards and controls could be maintained. This campaign eventually led to the intro­ duction of registration acts in all Australian states. The year in which registration was achieved in the various states is given in TABLE T'NELVE.

TABLE TWELVE

STATE YEAR OF-FIRST ACHIEVING REGISTRATION (378) Victoria 1922 Queensland 1928 New South Wales 1945 South Australia 1945 Western Australia 1951 Tasmania 1953 138.

In New South Wales the registration act was assented to on 21/3/1945. Its date of commenccnent was 1/11/1946. (379)

XI.RADIOGRAPHY. To date the only state to register radiographers has been Tasmania, which introduced a Radiographers Registration Act in 1971. (380)

XII.REHABILITATION COUNSELLIHG. Rehabilitation counsellors are not registered in,any Australian state.

XIII.SOCIAL WORK. Social workers arc not registered in any Australian state.

XIV.SPEECH THERAPY. Speech therapists are not registered in any Australian state.

DISCUSSION. Of the occupations under study only medicine, pharmacy, dentistry, nursing and physiotherapy are licensed by the state in New South VJales. However, dietetics, occupational therapy and radiography are licensed in one or more of the other states. In addition, there is a rudimentary form of state licensing for hospital managers in Victoria. :'1ost of the officials of the non-licensed occupations that I contacted expressed a desire for statutory licensinG to be achieved in the future. It appears then that development of state licensing as a distinguishing feature of health care occupations is in a period of 1_38t

"transition. The older occupations have 1icensin.r; acts and boards, while the newer occupations are currcr.tly working towards attaining them. The p,JssessioL of a licensing act by itself is not a universal distinGuishing feature of health care occupations but the possession of

..... an act or the desire to attain one l ""· If the current trend continues the occupations without licensinr, acts will eventually obtain them in the future.

The aims of licensing acts have changed sinco the ' first medical board was constituted in 1838. At that time the medical legislation aimed to establish a list of acceptable medical witnesses for coroners. Since that time licensing acts have changed their emphasis and they now claim to protect the public from incompetent practitioners.

The development of health occupation licensing is summarized in TABLE THIRTEEN.

THE DEVELOPMENT OF HEALTH OCCUPATION LICENSING

TABLE THIRTEEN

OCCUPATION YEAR OF FIRST LICENSED IN OTHER

LICENSING ACT IN STATES NEW SOUTH WALES

f·iedicine 1838 All states

Pharmacy 1876 hll states 139.

, Dentistry 1900 All sta.tc:;s

Nursing 1924 All atatcs

Physiotherapy 1945 All states

Occupational Western Australia Therapy and South Australia

Dietetics Victoria

Radiography Tasmania

Hospital Administration Victoria (rudi­ mentary form)

Medical Rec,ord Administration

Orthoptics

Rehabilitation Counselling

Social Work

Speech Therapy

NOTE: only five of the fourteen occupations are licensed in New South Wales. VIII.CODLS OF ETHICS.

INTRODUCTION. r!any health care occupati,)~ts ll:1vc developed codes of ethics defininr, tLu behaviour that they hope their members will observe. The originc of these codes is the subject of this charter. Information on codes of ethics proved to be the ~n0st difficult information' to obtaJn for this project. Published histories contain few rcfor,:rnceE> to ethical matters and for this reason much of the infor,ar~tiun for this chapter was obtained by contacting officials of the occupations. Even then the records of some or~anizations did not contain data on the origin of their ethical codes. Consequently the approximate year of origin was all that could be uncovered in sone cases.

I.DENTISTRY. The first indication of ethical rules in New South Wales can be found in tho :Iemorandum and Articles of Association of the Dental Association of New South Wales, which was first founded in 1892. (381) Amongst this associations• objects were the promotion of the character and status of ~entistry, and the need

for protective legislation. Members coul(l b(:J rc:i:oved for discreditable conduct which reflected on the status of the association. When the first Jcntists Act finally introduced in 1901, it contai11ecl sections stating that dentists could be derccistered for committing infamous conduct in a profcssiona1 respect. These provisions demonstrate how sanctions uvolvoJ 1 !. 1 •

to penalize practitioners vJtwso ucticns did not ,;.._;,:;t acceptable standards.

Between 1892 and 1906 six uajur ccntal ascqciatioriG came into existence in Now .South '../a] c,:..,. Five \Jere considered "ethical" as they had rc:stricti0llf, ,j11 the use of advcrtizing and large display sic;ns and show casos • . (382) The sixth association was the Cou,i,1om{0~ltl: Dental Association which re 1,rc::;e1ited. the L'.cntists wh,.> advertized. These practitioners wore consiJcred to \ be "unethical" by 1-:-~embers of the oUier associations.

The Australian Dental Associatici:-: v1as for111cd in 1928 and this orc;aniza tion had a coc:c of ethics fro,,1 the beginning. (383) Registered dentistc had to sub­ scribe to the code of ethics to bo acceptable for membership. The New South Wales Branch of tho Australian Dental Association was incorporated in 1929 and a code of ethics was produced under its by-law powers which are contained in the Articles of Association. (384)(385)

II.DIETETICS. The Dietetic Association of Now South Wales has never had a code of ethicE:. ( 386) In contrast the occupational association in Victoria (The Dietetic Associa~ion, Victoria) has had a code of ethics since its foundation in 1935. (387) 142.

"III.HOSPITAL ADMINISTRATION. The Australian Institute of Hospital Administrators first issued their code of ethics in May 1965. (388) This code was based on the one used by the American College of Hospital Administrators and the American Hospital Association.

IV.MEDICAL RECORD ADMINISTRATION. The New South Wales Medical Record Associatipn has had a code of ethics since its formation in 1949. (389)

V.MEDICINE. The Sydney based association called the "Australian Medical Association" produced a code of ethics in the year of its formation in 1859. (390) In 1894 The New South Wales Branch of the British Medical Association adopted a code of ethics. (391) The New South Wales Branch of the Australian Medical Association has had a code of ethics since its inception in 1962. (392)

Prior to the 1880'S Victoria was the only state to establish a medical association with any degree of perman­ ance. The organizations that sprang up in New South Wales, Queensland, South Australia and jasmania folded after functioning for short periods. (In Western Australia there was no medical association until the local branch of the British Medical Association was formed.) One of the reasons for the collapse of these organizations were the disputes that arose over ethical matters such as advertiz­ ing, and the publication of medical articles in the lay press. (393) 143.

VI.NURSING. An official code of ethics was adopted by the International Council of Nurses at their conference in Sao Paulo, Brazil in 1953. (394)(395)(396) This code applies to Australian nurses who belong to the Royal Australian Nursing Federation (R.A.N.F.) as this body has been a member of the International Council of Nurses since 1937. As this code had to apply to nurses in many countries it was made fairly genera~.

VII.OCCUPATIONAL THERAPY. The Australian Association of ~ Occupational Therapists has had a code of ethics since 1954. (397)

( VIII.ORTHOPTICS. The Orthoptics Board in New South Wales has a code of ethics. In the past graduates had to sign an agreement to abide by this code. The code includes prohibit­ ions against advertizing, prescribing drugs and glasses, and accepting patients without medical referral. This code is recognized and accepted by the Orthoptic Association. (398)

From my investigations it ~ppears that this code has been in existence since the establishment of the Orthoptics Board in 1938. However, I could not establish an exact date of origin with certainty.

IX.PHARMACY. (399) I was unable to discover when the Pharmaceutical Society of New South Wales first produced a code of ethics. Their executive secretary made enquiries ; 144. amongst present day officials but all that could be ascertained was that an ethical code has been in existence at least since the 1920 1s. But it is thought that the code probably dates back to an even earlier period.

X.PHYSIOTHERAPY. When the Australasian Massage Association was founded in 1906 it had two rules that members had to follow. Members ,were only permitted to accept patients by medical referral and could only advertize in an approved manner. (400) These rules formed the basis of the code of ethics that grew and evolved in the following years. Following a period of agitation for change, the requirement for medical referral was abolished in 1977. (401)(402)(403)

XI.RADIOGRAPHY. The Australasian Institute of Radiography does not have a code of ethics. (404)

XII.REHABILITATION COUNSELLING. The Society of Rehabili­ tation Counsellors does not have a code of ethics. (405)

XIII.SOCIAL WORK. The Australian Association of Social Workers adopted an experimental code of ethics in August 1957. (406) However, they did not establish procedures or mechanisms for interpreting or enforcing this code. The code was very generalized.

XIV.SPEECH THERAPY. (407)(408) Information on activities of the Australian Association of Speech Therapists in the 145.

area of ethics could not be uncovered in my search. In fact many present day practitioners seemed unaware of the existence of this pioneering occupational association. When the Australian College of Speech Therapists formed in 1949, one of its stated objectives was, "to improve and maintain a hir.;h standard of knowledge and honourable conduct amongst those persons practising the science of speech therapy''· I have been unable to find out exactly when the College drew up a code of ethics based on this objec~ive, but this had occurred by 1951, as the October 1951 issue of their journal contains an outline of some of their ethical rules. By this time the College had rules on such matters as advertizing, fees for private patients, transferring of patients from one therapist to another, seniority, and notice of conclusion of appointments. These rules must have been drawn up between 1949 and 1951.

DISCUSSION. All except three of the occupations under study, have codes of ethics that apply to New South Wales. Of these three it is foq.nd that dietitians in states such as Victoria do possess a code of ethics whilo rehabilitation counsellors hope to have one in the future. The earliest code in New South VJales that

I could find reference to, was the code produced by the short-lived Australian Medical Assocjation in 1859. However it must be remembered that most of our early medical practitioners came from Britain, where many · would have sworn to oticy the :Iippocr:J t:Lc (\o. t 11 n:itc •1 dates from antiquity, a:1cl/ or Dcrci vaJ I s Code r;:lich was published in 1803.

The importance accordctl to ethical cuJcu within individual occupations varies c;reatJ.y. ?:any of tllc occupations have no procedure for rcviewinc and cnforcinc their ethical codes. In contrast the Aust.co.lian 1'.cdical

Association does possess a recula tory 1:1cchaniG!YJ.

But there is little evide:1cc to sho\'! that co,rpl:Lance is rigidly enforced. The codes also vary in their size and detail. Some are long and detailed while others only contain a few general principles.

Possession of an ethical code is a characteristic of Llost of the health care occupations under review, but the possession of regulatory procedures is atypical. Even a long established occupation like radiography docs not possess a code of ethics. The positio~ of radiography could be commended, for it can be ar~ued that there is no point in having a code when little effort is expended in enforcing it.

A summary of the develol1ment of ethical codes is provided in TABLE FOURTEEH. TIU; DEV£LOPViEHT OF ~THIC:~L CC)D~S I:: ',.:,..1 .J

OCCUPATIOH YEAR

:He di cine 1859 The Australian i~edical Associ­ ation prouuced a cotie of

ethics.

Dentistry circa Five of th(.; si:: ::1ajor dentaJ 1900 associations that were ' established at the turn of the

century harl ethical rules regarding advertizing.

Physiother~py 1906 'l'he Austra1asiah ::assar;e Association had two ethical rules when it was founded in 1906.

Pharmacy 1920'S The Pharmaceutical Society of New South \'!ales has had a code

of ethics at least since the

1920 1 S • . Orthoptics circa The Orthoptics Doarrl of 1938 Australia has an ethical code. This has probably been in existence since 1938.

l·ledical Record 1949 The New South Wales i'Icdical Adrninistration Record Association hac had a code of ethics since it0 foundation in 1949. 148.

Speech Therapy circa The Australian College of 1951 Speech Therapists has had a code of ethics at least since 1951.

Nursing 1953 The International Council of Nurses produced an ethical code in 1953. This applies to R.A.N.F. members.

Occupational 1954 The Australian Association Therapy of Occupational Therapists introduced an ethical code in 1954.

Social Work 1957 The Australian Association of Social Workers adopted an experimental ethical code in 1957.

Hospital 1965 The Australian Institute of Administration Hospital Administrators issued an ethical code in 1965.

Dietetics

Radiography

Rehabilitation Counselling 149.

)X.ANALYSIS OF THE EVOLUTION OF HEALTH CARE OCCUPATIONS IN NEW SOUTH WALES.

A summary of the historical data described in the preceding chapters is provided in APPENDIX ONE. References for these dates can be found in the chapters where the events are discussed. An analysis of the sequence of evolution of the fourteen occupations under review shows that Wilensky's sequence is not followed exactly in any case. The occupatQon that follows this sequence most closely is nursing. Except for the absence of education in recognized tertiary institutes for all nurses this occupation follows the pattern of development that Wilensky described.

An alternative pattern of evolution that is typical of all the occupations, cannot be demonstrated when the data is reviewed. The characteristics under review have emerged with time, but not in exactly the same order for all occupations. The occupations have evolved in their own way but the end results are similar. That is, health care occupations develop tertiary standard training programs, associations at the national level with state branches, licensing boards to legally regulate practice, and codes of ethics to guide members in their behaviour. In some cases one or more of these characteristics may be absent (eg.licensing laws and ethical codes), but when they are it is generally found that the occupation wishes to obtain them. ... 150.

Having discovered that the characteristics under review have been acquired in varying sequences, it is still necessary to explain why these characteristics should appear in the first place. This task is attempted in the next chapter using social and economic concepts. Professionalization theory would probably stop at this point and claim that the emergence of these characteristics is evidence that occupations have evolved into professions. This concept may be appealing to members of these occupations but it disregards the economic and social forces that have shaped the modern world (and this includes health services and the occupations which operate them). 151.

X.EVOLUTION OF HEALTH CARE OCCUPATIONS

AH ECONO~:IC AND SOCIAL INTERPRETATIOIJ

INTRODUCTION. In this chapter the various characteristics of the new middle-class health care occupations are examined. Instead of attempting to describe the development of these occupations in terms of a professionalization process, I have tried to explain the appearance of their distinGuishing features in terns of the economic and social factors that have shaped ~estern society. In my opinion this approach gives the best explanation of how health service occupations have

co :c to ac~opt the values, be lie fs, c ust ous and institutions that characterize the~. Zcono2ic and social theory can tell you how and why certain events occurred, ·-_,'1cre&s :Jrofessionalizatio:1 theory only tells you what haD:~nci usins a set of definitions and assumptions that

a1°c i:.1_possiblc to prove. ( LirJS)

tocethcr in powerful craft suilds. These guilds

_;;er: or-:lizci the crafts in particular localities and were

eble: tJ exert a l)OWGrful hole: over their ;;1eubcrs. (410)

In tbc closed CO!"i':rnnities :)f the ::,idcllc aces the i:;uilds

~ere aG]c to deny outsiders the orrortunity of carryinc

out t::e \'10:r'·_ unde:ct.::i.'.:en ·;Jy tl1eir ::;<:ubers anJ. to ensure

co t 'na t i::c . o:.~es \'i OU~ c; not be eroded by a 152.

manpower surplus competing for a finite market

As the industrial revolution gained momentum society became more mobile and the craft guilds gradually lost their control over the workforce. (411) Manpower in various industries gradually became subject to the forces of demand and supply in open markets. In the pioneering communities that developed when European imperialism threatened to engulf the entire world, the guilds did not follow in the wake~of the white explorers. The contingencies of frontier life made it necessary for services to be provided by anyone who wished to deliver them, irrespective of their previous training and experience. The dual effect of an industrial revolution fueled by capitalism and free enterprise and the opening up of new continents for European settlement, destroyed the concept of occupations being controlled and monopolized by craft guilds. This was replaced by a COLlpetitive system where workers were at the mercy of mark.et forces and the whims of the "captains of industry".

Although some guilds continued to operate their po~er was broken with the arrival of the new economic order. In line with the :1ew economic philosophy which emphasized free trade, it became theoretically possible for all citizens to try their hand at any occupation that took their fancy. But certain social constraints limited the range of occupations available to most citizens. For example, the lac'~ of ability to 153.

'read and write immediately closed the doors to most high status occupations. Despite such constraints there was still freedom to enter a range of occupations within each social level in the community. (412) The main reason for the ease of entry into most occupations was the fact that governments were not prepared to sanction constraints to private enterprise. As the wealth and power of the British Empire was built up on industrial inventiveness and free trade, restrictions on entry into particular occupations would have conflicted with the economic wisdom of the period. Because the major constraint to entry into most occupations was social class and not academic attainment, there were huge variations in the standard of services provided. However this fitted in with the prevailing economic dogma that encouraged "survival of the fittest". As long as this Social Darwinism (413) was part of the conventional wisdom there was a place for the master craftsman and the charlatan. Somehow the free and open marketplace was supposed to ensure that inefficient workers and profiteers were weeded out of the economy. But history shows that free mar~ets did not lead to such an economic nirvana.

As the nineteenth century unfolded the abuses that arose from unbridled free enterprise, led to proposals for restrictions being made in the public interest. But the abuses had to be large before governnents would consider exceptions to the conventional wisdom. Some of 154.

"the first exceptions were made in the health sector of the economy. As health care is such a profoundly important and personal matter to all citizens (including politicians) this is not surprising. The problems caused by malpractice and ignorance can be fatal or lead to permanent disabilities. This probably explains why medicine was one of the first occupations to be regulated by government legislation during the industrial revolution, and given a monopoly in the public interest.

The pendulum began to move back in the direction from which it had come. The desires of various occupations to control their own destiny and to protect and expand their economic interests, combined with the need for governments to protect society from grossly sub-standard and fraudulent practitioners, and this led to the re-establishment of bodies to regulate and control particular occupations. In many respects these bodies were similar to the craft guilds that had existed in medieval times. (414)(415)(416) The guilds were reincarnated in the form of licensing boards and the twentieth century has seen a rapid proliferation in their numbers. In the process individual liberty has been eroded as the clients of protected occupations are denied the legal right to undertake particular tasks or to adopt certain titles. These rights are reserved for the practitioners of the protected occupations.

Following the establishment of a Medical Board in New South Wales in 1838 there has been a growth in the number of regulated health care occupations. Currently the following occupations are governed by licensing acts in New South Wales:- Medicine Pharmacy Dentistry Veterinary Surgery Nursing Optometry Physiotherapy Chiropody Optical Dispensing Dental Technology Chiropractic

In one or more of the other Australian states dietetics, radiography, occupational therapy, dental therapy, and clinical psychology have achieved licensing status. When the American situation is surveyed it is found that licensing has extended to an even greater variety of fields. (417)(418) Occupations such as inhalation therapy, social work, medical technology and sanitary inspection have been able to obtain licensing acts in some of the United States. In California at least twenty-five health related occupations are now licensed, and this number is far in excess of any Australian state. Our most highly licensed state is Victoria which currently has thirteen health related 156 •

. occupations covered by licensing legislation. The world wide trend is towards an increasing number of licensing acts as more and more occupations work towards obtaining these legislated monopolies that give an occupation an inalienable base on which they can build their economic security. In the process of making particular activities the reserve of one occupation further segmentation and specialization occurs in the provision of services, and barriers to workforce mobility are erected. This makes the redistribution of manpower difficult when changing service demands arise.

II.OCCUPATIONAL ASSOCIATIONS. Shortly after the emergence of health care occupations their practitioners have developed occupational associations to promote their interests and aspirations. In Britain and Australia these organizations played extremely important roles in launching most of the original training programs. (419) Since that time most of these programs have entered recognized tertiary institutes. But the associations have continued to influence educational policy through their representation on licensing boards and academic committees etc. Because many individuals are members of a variety of bodies associated with an occupation, a web of relationships and influence is established which can permit an occupation to maintain a degree of control over its training program, even after it has transferred to a university or a college of advanced education. (420) 157.

Occupational associations are also powerful pressure groups that lobby governments and other bodies for con­ cessions that increase their power, prestige and position within the hierarchy of the health services. Akers (421) closely examined the history of occupational associations in Kentucky and described how they lobbied for licensing acts with their associated monopolies. Once these acts had been passed the new licensing boards joined with the occupational associations to form powerful pressure groups that sought further advances for the occupation. There is an element of conflicting obligations in such relationships as licensing boards are intended to be the watchdogs of the public while occupational associations are intended to be the watchdogs of their membership. If occupational associations are able to subvert the licensing boards into instruments of occupational advancement and this advance­ ment does not serve the overall public interest by divert­ ing funds from more worthy causes etc., then the boards are not fulfilling their intended purposes.

Gilb (422) also examined the history of occupational associations in the United States and described how their function has changed with time. The first occupational groups in that country were often formed by groups of graduates from various training programs, as a means of continuing friendships and promoting fellowship when training was completed. In some cases membership was restricted by the number of men who could fit into the meeting room of a local tavern or 158.

the dining rooms of prominent members. Eventually their function as social clubs and gourmet groups changed and they evolved into powerful "private governments" that sought to control their environment by ensuring' that all relevant government legislation had the effect of advancing their status and power. Gilb suggests that occupations first gain control over their practitioners by ensuring that they are registered and regulated by licensing laws, and then they move even further into the political sphere in an endeavour to shape and control their own destiny. Gilb reaches the same conclusion as other sociologists in pointing out that these activities are not necessarily in the public interest.

The activities of occupational associations in the political sphere have been studied by many political scientists who have included them in their lists of the major pressure groups acting on the government in the United States. For example, Zeigler (423) includes occupational associations amongst the "big four" major pressure groups in that country. The other three are business, labour and agriculture. In this country the Australian Medical Association and the Pharmacy Guild have been cited as two of the major pressure groups operating in Canberra. (424) One of the reasons that groups such as these place offices in Canberra, is to increase their opportunity for lobbying federal parliamentarians and senior public servants. 159 •

. III. EDUCATION

IIIA.THE EVOLUTION OF EDUCATION FOR HEALTH SERVICE OCCUPATIONS. When occupational associations began to proliferate many of these bodies established training programs and awarded certificates to.successful candidates. Millerson (425) has described this practice in England while local examples are illustrated in Chapter Three of this project. In adopting this function occupational associations joined the universities as credential awarding bodies. However there was an essential difference between the type of training provided by these two sources of qualifications. The universities remained shackled to the teaching of the liberal arts while the occupational associations stressed the teaching of applied science. While the universities aimed to fill the minds of their students with philosophies that made them "proper" English gentlemen, the occupational associations trained their students in practical subjects so that they could carry out particular jobs. (426)

As the universities were high status institutions the new middle-class occupations attempted to transfer their training programs into these seats of traditional learning. Eventually the universities lowered the barricades they had erected against applied science and the Dons gave grudging acceptance to the teaching of such subjects as medicine, dentistry and engineering. 160.

However, many of the allied health sciences could not break down the old biases and myths, and it was not until the establishment of Colleges of Advanced Education that their training programs were able to enter degree conferring institutions in Australia. Occupational associations and licensing boards played an important part in lobbying for the transfer of training schools to high status tertiary institutes. Accompanying this process has been a trend to increase the length and content of training programs. Long and difficult courses function as advertizements to the community that an occupation is demanding and complex and thus deserving of high status and recognition and the appropriate financial rewards. If a training course -can be made longer than that of other occupations working in the same industry then this can be used to justify that occupation being given precedence in the industry's social hierarchy. The quest for higher status and economic advancement leads to continued competition amongst occupations to lengthen training programs and to surpass the achievements of their rivals.

IIIB.THE GREAT TRAI~ING ROBBERY. The standard of basic training given to most undergraduates has increased considerably in recent times. This has occurred to such an extent that many commentators are now questioning the length and content of training programs, and suggesting that many of the activities that present day practitioners carry out, could be performed by people 161.

with lesser skills. On-the-job training would probably suffice for many of the routine tasks that the highly trained health workforce currently performs.

The question of over-education (or under-employment) was taken up by Berg (427) who investigated the relation­ ship between the activities involved in a job, and the effect that the education of workers had on the way these activities were performed. He found that many workers had far more education than they needed to effectively carry out their daily work routines. In many cases increases in educational standards were associated with increases in job dissatisfaction, increases in staff turnover, and decreases in worker productivity.

Even though Berg's research was not involved with the health services it still has important implications, as there is no reason to suspect that the health industry is any different from other industries. The fact that many occupations in the health services are also to be found in other industries eg.engineers, administrators etc. would make it highly unlikely that the conclusions reached from Berg's research would not be applicable to the health industry as well.

Berg's observation that over-qualified people tend to become dissatisfied with their work, permits a frighten­ ing prediction to be made when it is combined with Leibenstein•s famous work on allocative efficiency 162.

and x-efficiency. (428) Leibenstein claims that the social welfare cost from the misallocation of resources due to monopoly and other trade restrictions is minimal when compared with the costs' caused by inefficient organizations, and industries that do not work as hard and as effectively as they could. He also claims that lack of motivation is a major contributor to the lack of productivity seen in some organizations and industries. Consequently it can be suggested that the over-education of the health care workforce may be producing a frustrated, unmotivated workforce which may in turn be causing a significant amount of "X-inefficiency 11 in the health services. Although there is insufficient empirical evidence to support the sequence of causation outlined above, research into this area is warranted because of the huge amount of money that the community allocates to the training of its health service personnel.

IIIC.HU:¼N CAPITAL. Some economists (429)(430)(431)(432) have sought to treat education li'.:e ca:::,i tal, and calculate the return on investment associated with the increasing educational attainments of various groups of people. ~~ny of these studies clai~ to have demonstrated returns on investnent with education, of the same dirn~nsion as that associated with traditional sources of capital. However, the archilles heel of these studies is their reliance on the higher salaries that are often associated with increased education, as 163. the economic indicator of the value of extra education. But these increases in salary may not be related to increases in productivity. Both Reder (433) and Rees (434) have suggested that the increased income that accrues to people with higher education is a reflection of the prejudices of employers who wish to have employees with the highest possible academic background wor~dng for them. It is also a reflection of the system of beliefs that has developed in our community which accords more status to academic achievements than it does to manual dexterity.

Any measure of the value of increasing education to the health services should be related to the outcome of patient treatment. To be justifiable in terms of social welfare, higher educational standards should be reflected by improvements in morbidity and mortality data. Any sugcestion that incrcasinG educational standards are to be welcoCTed because of salary increases they generate, is only justifiable if you are one of the people whose salary increases ! !! Despite the increasinc a~ount of money beinG spent on the education of health service personnel, t!1c increasin6 nuE;ber o·f trained health providers and the risinG standard and lencth of their traininc; pro.:;ra::;s, :r:orbidi ty and ~ortality rates have not respo~ded and demonstrated i;

most health occupations has transferred to tertiary institutions such as universities and colleges of advanced education, life expectancy improvements have gradually plateaued out. (436) Research workers such as Abel-Smith (437) and Fuchs (438) have noted the fact that there is little correlation between the quantity of resources that a country allocates to health services, and the health status of that country's citizens. Nossel (439) has also made this observation, and commented on the dilemoa that it provides for those people who \'fish to devote even more resources to the health services.

Illich (440) has examined the relationship between disease and a con:1:1uni tys health care worl:force. He concludes that, "the study of the evolution of disease patterns provides evidence that during the last century doctors have affected epidemics no Llore profoundly than did priests during earlier ti~es. =pidernics came and went, imprecated by both but touched by neither. They are not modified any more decisively by the rituals perforraed in uedical clinics than by those customary at relisious shrines''· Illich supports the notion that lifestyle, housing and nutrition are the major determinants of the overall health status of a comr:mnity. He discounts the common belief that a group of highly trained health care scientists operating from expensive hospitals are able to na~-:e significant changes to norbidity and mortality rates. 165.

Calculation of the value of education by the "human capital" approach may lead to a positive result (as any North Shore or South Yarra doctor could illustrate) but consideration of the influence of health provider education on the community•s overall health status gives a neutral or negative result. The success of health care occupations in lengthening and strengthening their training programs has not been productive in terms of making our coamunity more healthy. This might seem a paradox at first, but when these improvements in education are considered in terms of occupations struggling for upward social mobility and the associated econoDic rewards, the current situation can be readily explained. The development of a large hiGhly trained v10rl:force to contain the problems which can mainly be cured by lifestyle and diet can be explained in ter~s of economics and the pursuit of personal cain. It cannot be explained in purely ucdical ter:·:1s.

IIID.BARRIERS TC WORKFORCE MOBILITY. Increasing specialization of the labour force in the health industry, lengthy training programs and the introduction of licensing acts which preserve particular activities for individual occupations, have served to block the mobility of health care workers who wish to change their occupation within the health services. It is not possible to begin work in the health services as a nursing aide and to gradually wor:~ upwards through the 166.

job hierarchy to eventually become a senior physician. Advancement to higher status in the health provider "pecking-order" requires an individual to undertake the complete course of training in the occupation he aspires to join. The system of health education is not geared to cater for gradual, stepwise, upward mobility for those who wish to take on added responsibilities and the associated financial rewards. For example, nursing graduates are not exempted fron any part of medical training programs. Consequently the health field is limited in the career structure it can offer to prospective entrants to the industry. As training courses become longer and more complex, and the number of licensing boards increases, the barriers to workforce mobility are likely to become greater than they are at present. To overcome this problem Perry (441) has recoKmended that there should be both vertical and lateral mobility between health care occupations but to date there have been no moves to implement such a scheme.

III.E. Tl-iE HEALT5 SERVICE j,;E~ITOCRACY. As educational levels have increased and barriers to workforce mobility have developed, the provision of health services has been segmented into a number of areas which are controlled by different occupations. These occupations have varying prestige and incomes, and entry into each occupation requires passage through a specific progran of training. As a result we have seen the emergence 167.

of what Michael Young (442) has described as a "Meritocracy" ie. a system where promotion and rank are determined by educational achievement, and not by performance on the job.

A persons' position in the hierarchy of the health services depends on the program of formal education that is embarked upon, and the barriers to workforce mobility are only surmounted by undertaking a course of instruction in the field that a person wishes to enter. Academic success is necessary before a person can undertake certain tasks and adopt certain titles, and the number of tasks that a person is permitted to carry out can only be enlarged upon by achieving further academic success. In other words we have created a caste system that is based on the amount and content of schooling that a person receives.

The evolution of the meritocracy has not been without its critics. Illich (443) claims that neither learning or justice is promoted by a system of role assignment that depends on formal instruction and certification.

Illich states that, 11 the current search for new educational funnels must be reversed into the search for their institutional inverse: educational webs which heighten the opportunity for each one to transform each moment of his living into one of learning, sharing and caring". However, criticisms such as these have not changed the existing situation. In fact, there is 168.

increasing use of education as a means of assigning roles. This is illustrated in the health services by the trend towards delineation of privileges in hospitals (444)(445)(446) and the move towards compulsory education as a prerequisite for registration by licensing boards. (447) Both of these developments are being promoted as a means of improving the standard of care delivered by health service personnel. But they also infringe on human liberties and erect educational barriers that must be surmounted before particular activities can be undertaken. The rapid growth of new information is leading to the evolution of institutionalized techniques for keeping practitioners up to date that serve to prouote the "meritocracy" rather than inhibit it.

IV.ETEICS

IVA.THE HIP~OCRATIC TRADITIO~. Perhaps the earliest and ~ost fa~ous code of medical ethics in the world is the Hippocratic Oath. (448)(449) Although this set of medical rules is commomly attributed to Hippocrates the famous Gresl: physician, there is no evidence to show that he actually v:rote it. (4.50) The oath cann:Jt even be traced bac\: to the Hippocratic medical school that developed on the Island of Cos. In fact very little is kno\'ll' about ~Iinpocrates even thou[;h his nane is wj_dely l~no-.·;n.

~ven thou~h there arc difficulties in associatinc 169.

Hippocrates with the oath that now bears his name, the oath itself has had a huge influence on medical practice throughout Western civilization. The standards embodied in the oath came to be accepted as an ideal, which was placed before medical practitioners as the yard stick of excellence in treating patients. But those researchers who have examined the every day activities of physicians in ancient times have noted that the practices of many did not comply with the Hippocratic doctrines. (451) For example, it was common for ancient physicians to Give poisons to those patients who wanted to suicide, and. to practice infanticide, especially when illegitimate births wore involved. (452) In other Tiords, the oath did not reflect conte~porary practice. 3ut the ideals it contained were distilled i~to the for~ of a single physician ~ho contained all the attributes that many co~sidered to be essential to ma~e the perfect practitioner. In this way the present day irnage of the man we recognize as Hippocrates was moulded from a system of values and beliefs. In actual fact it is a totem name that symbolizes these standards. (453)

~hen medical practices throuGhout recorded history are studied divergences from the Hippocratic tradition can be found. The same thing can even be said about current medical practice. For exaople, the Hippocratic Oath prohibits the procurl?ment of abortions yet a significant proportion of present day ~edical 170.

practitioners find this procedure to be acceptable. It would appear that this ethical code has always been an expression of ideals, and that it has never been a code which all practitioners have followed. In medicine the code has the positive value of giving its practitioners a set of ideals which they can attempt to emulate, but this gives no solace to clients who may interpret the code as a guide to the standard of care that they can expect to receive on all occasions.

IVB. THE ETHICS OF THE EMERGENT t•1IDDLE CLASSES IN BRITAIN IN TH:2: Nilf.STE.2NTH CENTURY. As a result of the Industrial Revolution a large, powerful and vocal middle class e~erged in Britain. The same thing occurred in other nations as they gradually changed from agricultural to industrially based economies. New occupations proliferated and expanded, and their practitioners Grouped together and formed associations. A characteristic of the nineteenth century was the lar&e increase in the number of middle class occupations with their accornpanyin~ associations.

The middle classes evolved when the landed gentry were still at the apex of society's social hierarchy, and they tended to adopt many of the ~ores and customs of this hich status Group. (454) In a socially secmented society that was extremely conscious of status it was not surprising that the emerging middle classes ~odelled their behaviour on the highest 171.

echelons of society rather than occupational groups that were accorded low status by the community.

The quest for status by the emerging middle classes resulted in a tendency for the glamorous aspects of their work being emphasized and the aspects associated with low-bred artisans, commerce and industry being camouflaged from public inspection. Upward social mobility required association with the leisure classes and removal of all traces of a low-bred origin. It was ironic that the new middle class occupations rejected the rwres and customs of the "industrial cannon-fodder" that produced the ~anufactured goods that made Britain the worlds most powerful and influential nation in the nineteenth century, while they embraced the customs of the leisured aristocracy that had dominated the era they were leaving. This helps to explain why many of the new middle class occupations developed ethical codes that stressed gentlemanly behaviour reminiscent of the manners of the gentry. These codes prohibited the advertizing of services and other forms of direct competition between practitioners as such behaviour was associated with the trading classes. Capitalisu and free enterprise made Britain rich and powerful but the accompanying commercial customs were rejected by a segment of society that enjoyed part of this wealth and povrer. When Australia was colonized the same institutions, social classes and beliefs that existed in ~~n 6land were transplanted into the "Great 172.

South Land".

IVG.THE ETHICS OF THE NEW MIDDLE CLASS HEALTH CARE OCCUPATIONS. Expansion in the number of health care occu­ pations began late in the nineteenth century. But the real proliferation has occurred in the present century. This point is clearly shown in Chapter Two of this project. The new health care occupations have striven for middle class identity by imitating the mores and customs of the existing middle class occupations and adopting their values and beliefs. Consequently it comes as no surprise to find that the infant health care occupations have promoted a high status gentlemanly image. Once again this is illustrated by the production of codes of ettiquette where advertizing and other forms of direct competition are rejected. The ethical codes of these new occupations may prohibit the advertizing of services by individual members, but the codes themselves actually advertize the middle class aspirations of the whole group.

Although many of the occupational associations that have arisen in the health industry had compiled codes of ethics, they have not been able to enforce adherence. Occupational associations cannot make statute law as this function is reserved for governments, and they cannot make common law as this function is the domain of the law courts. If a practitioner wished to ignore an ethical rule the strongest sanction an association could adopt would be 173.

expulsion. However, the practitioner could still continue his work in the field without the benefits that accrue from group membership. The associations have not been overactive in seeking compliance with their ethical rules and the use of sanctions has seldom been resorted to. Many of the associations haven't even developed procedures for reviewing the activities of their members so that warnings could be issued when non­ compliance with their rules was detected. They have produced ethical codes but not the mechanism for making compliance obligatory.

When licensing laws came to be enacted, some ethical rules were translated into the licensing acts and the regulations made under them. In this way occupational ideals are converted from desirable standards to legally enforceable minimum standards of practice. In the process the prerogatives of individual practitioners gives way to prescribed norms. With the emergence of licensing acts, ethical rules have taken on a duality which did not exist in past centuries. The mores and standards of some occupations are now made up of a compulsory component that is embodied in licensing acts and regulations, and an optional component contained in the ethical codes of their associations.

Even though licensing acts have sought to make certain actions compulsory, a review of the cases where sanctions have been imposed illustrates the 1?4.

· rarity of such events occurring. Both Maley (455) and Cahill (456) have studied the way medicine administers its ethical standards and have noted the reluctance of this occupation to punish its renegades. Health care occupations are prepared to advertize their ideals and their claim to middle class status in licensing laws and ethical codes but they are not prepared to live up to this image and its accompanying obligations if their own members have to suffer in large numbers to make this image a reality. Ethical rules (both optional and compulsory) have served the middle classes well as vehicles for the conspicuous display of aspirations, but they have yet to evolve to the stage where they are a reliable guide to the minimum standards which all practitioners will automatically obey.

Many ethical rules could be described as 11 wordfacts 11 •

Galbraith (457) has stated that, 11 the wordfact makes words a precise substitution for reality. This is an enormous convenience. It means that to say something exists is a substitute for its existence and to say something will happen is as good as having it happen. The saving in energy is nearly total". As long as an occupation can convince its public that its practitioners act in a certain way it need not expend energy to actually achieve this standard of behaviour. But the adoption of rules for display purposes opens up the possibility that an occupation will eventually be challenged to live up to its self-made myths. 175.

Every occupation has a self image and a basic set of fictions about itself.(458) The adoption of a stereo­ type gives comfort and helps to camouflage the realities of every day activities. The lady with the lamp, the pilot gazing into the blue, and the sailor being bathed in spray and breathing fresh air are all symbols that have been adopted by occupations. They may be true images of certain situations that practitioners may encounter but they also diguise less glamorous activities that are undertaken by an occupation. The images mentioned above are really gross distortions for they conceal the fact that much of nursing is drudgery, and the fact that airmen and sailors spend more ti1:1e on terra firm.a than they do in the air or at sea. The development of ethical rules that promote the it1age of an occupation as one deserving of high status and reco~nition contributes to the set of fictions that occupations develop. These fictions have some positive value in aiding recruitment into an occupation and encouraging its public recognition with the accompanying financial rewards. But if the fiction strays too far from reality new recruits into an occu-:Jatic-n are lil:ely to become discontented and frustrated with their chosen career. The fictions in theL~selves are an expression of an occupatiorb aspirations and their quest for recognition as callings worthy of public veneration. Once recocnition is granted an occupation is in a better position to negotiate for higher salaries and to lobby for licensing 176.

acts and other privileges. In this context, the development of ethical rules that promote a gentlemanly image has definite economic ramifications. Once again we can see how a characteristic of the middle class occupations can be explained in economic terms just as easily as it can in terms of other theories.

THE FUTURE - A PERSONAL PREDICTION.

According to the distin6uished economist and social commentator John Kenneth Galbraith, (459)(460) the power in modern bureaucracies, whether public or private, no longer lies with those who have traditionally been thought to hold the reigns of power. He believes that the technical experts (technocrats) who man the command posts in a bureaucracy, and who intimately understand the complexities of the tas::s being undertaken, are the real holders of power in an organization who ultimately make the decisions for management. Thus in public and private institutions we can observe that those who occupy the highest positions in the organizations hierarchy arc increasingly dependent on the information and re c o;·:1'.'i10nc.a tions that they re ceivo fro::i technocrats, in rna':in.c; decisions and fort1ing oninions about narticular issues.

Galbraith has described this pheno2enon in the followins worlc usinG his usual perceptive and amusing style, ( !-1-G 1 ) "Joard c~10.ir:ncn or pre.side:r.ts are presented 177.

with the careful decisions of subordinate groups in an atmosphere of such deference that those so honoured often fail to see that their function is confined to ratification. All those who serve in a bureaucracy, public or private, are instinctively accomplished in such ritual. In public bureaucracies there is, perhaps, a special skill. Presidents, Secretaries of Defense, Prime l1inisters, and T

In the case of health service bureaucracies such as hospitals, this means that real power is passing into the hands of technical experts such as medical practitioners, para-r1edics, nurses and other occupations that carry out specialized tasl,s. Other authors such as Heilbroner (462)(463), Harrington (464), Illich (465) and Bell (466) have also pointed out that increasing power is being gained by the educated technical elite in our post-industrial society. For this reason I envisage that the occupational associations that represent these groups will become increasingly more powerful and influentiaJ and that they will bring increasinc pressure onto governments and institutional 178.

managers to succumb to their demands and desires. I also envisage that governments will be persuaded to pass an increasing number of licensing laws and to extend the provisions of those already in existence. Occupations will extend their monopolies in the name of paternalism and public protection. Health care scientists will form an important segment of the powerful technical class that will dominate post­ industrial society. Occupations will continue to promulgate and upgrade ethical codes so that the idealized image that they hold of themselves can be conspicuously displayed to the community to gain the recognition necessary for the negotiation of extra privileges.

As occupations accun;ulate status and wealth their new found importance will find expression in such actions as occupational name chanGes, the negotiation of impressive position titles within institutions, and the use of designating letters with the names of members. Caplow (467) has described how occupations change their names when their status increases to help dim the me~ory of their lowly oriGins in the mind of the conmunity. It has been claimed that the rich enjoy their wealth more by conspicuously displaying it to those who are less fortunate. (468) In a similar fashion eLlerginc middle class occupations display their newly won acceptance and recognition (or help to gain it in the first place) by adopting characteristics such as those mentioned above. As the technocrats become progressively 179.

more powerful and important, their success will be announced to the community by the adoption of impressive institutional characteristics. For this reason we are likely to see more occupations and occupational associations change their name in the future as they shake off their working class associations and improve their ranking amongst the groups that constitute the bourgeoisie.

The traditional microeconomic theory that evolved from a succession of economists beginning with Adam Smith (469) claimed that a community's resources were optimally distributed when there were a large number of small economic units operating in free marlrnts where the forces of supply and demand could be given full reign. But this econorr.ic freedom led to exploitation of the working classes as the owners of capital were the most powerful economic units in the system. This led to the evolution of trade unions to protect the interests of the worldng classes. Mic;_dle class occupations also saw the benefits of organization and hav~ developed their own unions and occupational associations. Consequently the modern world is no longer made up of a large number of small econoLlic groups. Today we find that large groupings of enployers and employees, together with the government, are able to negotiate a status quo that is isolated froI free market forces. As the technocrats grow in importance and power, we will find that they will be incrcasinGlY able to influence the distribution of the 180.

community's resources and to expropriate an even larger share for their own enjoyment. The more powerful a particular technical occupation becomes the easier it will be for them to increase their share of the nations wealth at the expense of others. Not only will their industrial associations be able to negotiate better salaries and working conditions, but their occupational associations and licensing boards will be able to negotiate monopolies in job functions, increase the length and content of their training programs and generally ensure that the trappings of practice are modern and sophisticated.

Commentators such as Horne (470) and King (471) have demonstrated how the development of Australia can be explained in terms of the pursuit of economic gain and the accumulation of material goods. A recent study (472) has also claimed that the so called "professions" in Australia are also motivated by personal gain in the activities that they undertake. It appears that materialism and self-interest pervades all our relationships and institutions, and I can see no change in this part of our national psyche in the immediate future. For this reason I predict that the increasing power of the technocrats will be used to give them even greater influence in framing the economic order of the twenty first century. The technical experts who operate our health services can look forward to a future where their influence is on the ascendancy. 181.

·xI. CONCLUSION.

In the earlier chapters of this project the historical development of health care occupations was examined and it was found that major characteristics had not developed in any standard sequence. In the previous chapter an attempt was made to explain the emergence of these characteristics in terms of economic and social theories. My limited excursion into this field led me to conclude that this approach had more credence than the "professionalization" theory. But more detailed investigations would need to be carried out before this hypothesis could be conclusively validated. The internal machinations of occupational associations, teaching institutions and licensing boards would need to be placed "under the microscope" to uncover the real motives underlying actions that raise the status and standing of particular occupations. As proposals for occupational advancement in the health services can be claimed to improve patient care they have a powerful emotional element working in their favour. But if a nations resources are to be used optimally, then occupations should be forced to demonstrate that such improvements in patient care, actually occur. The "output" of the health care system should be the maintenance of a healthy community where illness is promptly cured in the cheapest way. Palatial treatment facilities and a large highly trained workforce are "structure" and "process" components of the health care system and are not desirable 182.

·ends in their own right. (473) Such features only become desirable if they lead to demonstrable improvements in morbidity and mortality rates, that are cheaper than alternative actions. Although these improvements have not been demonstrated, the construction of treatment facilities and the upgrading of educational standards has continued. This observation was one of the reasons that led me to reject the "professionalization" theory of occupational evolution and to search for an alternative theory.

I have also predicted that health care occupations will become increasingly more powerful in the future, as further scientific discoveries and technical innovations make our society more complex. Some may lament the arrival of the post-industrial society, but there is no sense in becoming nostalgic for a bygone era that has been swept into the pages of a history book. The reality of our society is large bureaucracies ruled by technocrats, and we must appreciate the world as it is, before we can attempt to make changes.

Materialism and the pursuit of personal gain led to a multitude of social problems when there was aggressive free enterprise in open markets in the period of the industrial revolution. The same human motivations are causing further problems in our post-industrial society as large economic units manoeuvre for self advancement. The problems of both economic systems are derived from 183.

the people that operate them and not from the systems themselves. Perhaps the answer lies in a revolution of consciousness which would lead to a world where people really cared for the plight of others, and sought to distribute the world's resources on an equitable basis. Thoughts along this line have been expressed by social commentators such as Reich (474), Birch (475) and Fromm (476). But their appeals for change have not led to any revolution of the mind or reversed the current trends. Arthur Koestler (477) claims that there is little hope of altering the habits of men through rational argument as our species is inherently irrational, and I tend to agree with this sentiment. Until a major social upheaval occurs the ethic of hedonism is likely to rc~ain and the technical elite (including those in the health services) will continue to increase their power and ~restige. 184.

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167. Roberts, B. "Sydney has Nursing Tradition". International Nursing Review. Vol.8. No.1. Jan/Feb 1961. P.51.

168. Miller, D. op cit P.72.

169. Armstrong, D. op cit P.169.

170. Hipsley, P.L. "The Early History of the Royal Alexandra Hospital for Children, Sydney. 1880-1905. Angus and Robertson. 1952. P.78.

171. Docker, s. op cit P.2.

172. Sims, G.E. op cit P.30.

173. ibid P.30.

174. ibid P.34.

175. La.nee, P.M. "The Education of 0rthoptists in New South Wales". op cit P.17.

176. La.nee, P.M. "0rthoptics: Past, Present and Future". op cit P.3. 197 •

. 177. Lance, P.M. "The Education of Orthoptists in New South Wales". op cit P.17.

178. ibid P.17.

179. Haines, G. op cit P.63-5, 264-71.

180. Forster, A.L. "Physiotherapy - A Response to Challenge" op cit P.126 •

. 181. Evans, E.P. op cit P.77.

182. Cosh, P. "The Challenge of Physiotherapy Education in Australia". The Australian Journal of Physio­ therapy. Dec.1971.

183. Parker, D.W.L. "The Past and Future of Physiotherapy" The Australian Journal of Physiotherapy. Aug.1964. P.42.

184. Forster, A.L. "Physiotherapy - A Response to Challenge". op cit P.127.

185. Hill, D. "Physiotherapy as a University Subject in Queensland". The Australian Journal of Physiotherapy .. Sept.1974. P.119.

186. Carter, D.R. "The James N. Young Memorial Oration". The Radiographer. April 1955. P.7.

187. Young, c.c. "The Conjoint Board". The Radiographer. Feb.1961. P.16.

188. Callow, J. "The Conjoint Board". The Radiographer. Sept.1969. P.31. 198.

189. Bailey, M.M., Chambers, J.M.S., and Manny, M.L. "Down the Maze. Radiotherapy in New South Wales". The Radiographer. March 1975. P.10.

190. Smith, A.R.B. "New South Wales". The Radiographer. Dec.1974. P.149.

191. Carter, D.R. "As I have seen it. Fourty years in Radiography - a biographical memoir". The Radiographer. March 1976. P.23.

192. Lawrence, R.J. op cit P.34.

193. ibid P.55.

194. ibid P.61.

195. ibid P.56.

196. Eldridge, M. "A History of the Treatment of Speech Disorders". op cit P.115-6, 134.

197. Ellis, G.E. op cit P.24-5.

198. Eldridge, M. "A History of the Australian College of Speech Therapists". op cit P.2.

199. Halliday, R.W. and Watson, A.O. op cit P.71, 89, 132.

200. ibid P.84.

201. ibid P.90-1.

202. ibid P.178.

203. ibid P.179.

204. Rodgers, J.F. "The Role of the Dietitian/Nutritionist" MJ A• 197 5 • 1 : 27 2 • 199.

205. Handbook. University of Sydney.

206. Memorandum and Articles of Association of the New South Wales Institute of Dietitians.

207. Dewdney, J.C.H. "Australian Health Services". John Wiley and Sons Australasia·,, Pty. Ltd. 1972. P.301-2.

208. Powell, W.M. op cit P.34, 36.

209. Watson, P. op cit P.171.

210. Inglis, K.S. op cit P.107.

21 1 • Slater , P. op c it P. 15 7 , 16 1 , 16 9 , 171 •

212. Stokes, E.H. op cit P.13.

213. Sunderland, s. op cit P.81.

214. Stokes, E.H. op cit P.22-3.

215. Miller, D. op cit P.16, 31.

216. Sunderland, s. "Australian Medical Schools: Some Historical Considerations". Part Two. MJA. 1975. 2: 124.

217. Communication with P.A. Moses. (1978) New South Wales Nurses Registration Board.

218. Cumberland College of Health Sciences. Calender. 1978. P.119.

219. Communication with E. Duff. (1977) New South Wales Association of Occupational Therapists.

220. Communication with J.A. Rodgers. (1978) Cumberland College of Health Sciences. 200.

221. Cumberland College of Health Sciences. Calender 1978.

222. Craig, D. "Editorial" The Australian Orthoptic Journal. 1975. Vol.14.

223. Lance, P.M. "The Education of Orthoptists in New South Wales". op cit P.18.

224. Lance, P.M. 11 0rthoptics: Past, Present and Future". op cit P.2, 5-6.

225. Haines, G. op cit Chap.10.

226. Cash, P. op cit.

227. Dewdney, J.C.H. op cit P.292.

228. "Obituary - Miss Janette Benn". The Australian Journal of Physiotherapy. Sept.1975. P.110.

229. Forster, A.L. "Physiotherapy - A Response to Challenge". op cit P.127.

230. Forster, A.L. "Physiotherapy in Australia". op cit P.97.

231. Communication with J.A. Rodgers (1978) Cumberland College of Health Sciences.

232. Cumberland College of Health Sciences. Calender 1978.

233. Smith, A.R.B. "New South Wales". op cit P.149.

234. Communication with T.M. Turner. (1978) Acting Head Teacher. Radiography. Sydney Technical College. 201.

·235. Communication with Dr. J.L. Sheppard. (1977) Department Head. Department of Behavioural and General Studies. Cumberland College of Health Sciences.

236. Lawrence, R.J. op cit P.50, 109, 126, 140-1, 148.

237. Communication with M. Horsburgh. (1978) Lecturer. Department of Social Work. Sydney University.

238. Communication with the School of Social Work. University of New South Wales. (1978)

239. Communication with J.A. Rodgers (1978) Cumberland College of Health Sciences.

240. Cumberland College of Health Sciences. Calender. 1978.

241. Halliday, R.W. and Watson, A.O. op cit P.9, 59-61, 96, 137, 151, 162.

242. "History of Dietetics in Australia" (1) op cit P.5-6.

243. Memorandum and Articles of Association of the Dietetic Association of New South Wales.

244. Powell, W.M. op cit P.7-8.

245. Watson, P. op cit P.169.

246. Tovell, A. and Gandevia, B. "Early Australian Medical Associations". MJA. 19/5/1962. P.756-7.

247. Gandevia, B. and Tovell, A. "The First Australian 202.

Medical Libraries" MJA. 22/8/1964. P.317.

248. Tovell, A. and Gandevia, B. op cit P.757.

249. Gandevia, B. and Tovell, A. op cit P.318.

250. Communication with Dr. J.M. Martin (1977) Deputy Medical Secretary New South Wales Branch of the Australian Medical Association.

251. Ross-Smith, C.J. "The Evolution of a National Medical Association in Australia". MJA. 19/5/1962. P.746.

252. ibid P.749.

253. Slater, P. op cit P.293-5, 303.

254. Brodsky, I. op cit P.85.

255. Armstrong, D.M. op cit P. 11 , 81 •

256. Schulz, B. "Along the Way". The Australian Nurses Journal. 0ct.1974. P.10.

257. "Do You Know". Queensland Nurses Journal. Jan.1960. P.8.

258. Sims, G.E. op cit P.33-4.

259. Docker, s. op cit P.7.

260. Lance, P.M. "0rthoptics: Past, Present and Future". op cit P.4.

261. Trease, G.E. op cit P.183.

262. Matthews, L.G. op cit P.124.

263. Haines, G. op cit P.26-8. 203.

·264. ibid P.61.

265. Matthews, L.G. op cit P.142-5.

266. "New South Wales State News". The Australian Journal of Physiotherapy. July 1959. P.73.

267. Parker, D.W.L. op cit P.42.

268. Forster, A.L. "Physiotherapy - A Response to Challenge". op cit P.125.

269.nThe Australian Encyclopaedia." Angus and Robertson. Section on Radiology.

270. Smith, A.R.B. "New South Wales". op cit P.149.

271. Bailey, M.M., Chambers, J.M.s. and Manny, M.L. op cit P.10.

272. Outterside, N. "The Radiographer During the last Four Decades". The Radiographer. June 1969. P.10.

273. Society of Rehabilitation Counsellors. Minutes of inaugral meeting.

274. lawrence, R.J. op cit P.77-9, 173-7.

275. Eldridge, M. "A History of the Australian College of Speech Therapists". op cit P.4.

276. Halliday, R.W. and Watson, A.O. op cit P. 148, 159, 168.

277. Memorandum, Articles of Association and By-laws of the Australian Dental Association. 204.

278. "The Australian Encyclopaedia". Angus and Robertson. Section on Dentistry.

279. "The History of the Dietetic Profession in Victoria, and the Dietetic Association, Victoria". op cit P.6.

280. "History of Dietetics in Australia". (1) op cit P.6.

281. Bacon, J. op cit P.2.

282. "History of Dietetics in Australia" (2) op cit P.2.

283. Memorandum and Articles of Association of the Australian Association of Dietitians.

284. Powell, W.M. op cit P.3, 10-11.

285. ibid P.31-2.

286. Notice of Meeting. 31st. Annual General Meeting. 1977. Australian Institute of Hospital Administrators.

287. Communication with Mr. s. Williams (1977) Chief Executive Officer. Hornsby and District Hospital.

288. Communication with Miss P. Watson (1977) Lecturer. School of Medical Record Administration. Cumberland College of Health Sciences.

289. Ross-Smith, C.J. op cit P.746, 749-52.

290. Communication with Dr. J.M. Martin (1977) Deputy Medical Secretary. New South Wales Branch of the Australian Medical Association.

291. Armstrong, D.M. op cit P.81-2. 205.

292~ Kiddle, M. op cit P.6.

293. Schulz, B. op cit P.10.

294. Bowe, E.J. "The Story of Nursing in Australia since Foundation Day". The Australian Nurses Journal. April 1961. P.93.

295. Communication with the Royal Australian Nursing Federation - New South Wales Branch. (1978)

296. Sims, G.E. op cit P.34, 37.

297. Communication with E. Duff (1977) New South Wales Association of Occupational Therapists.

298. Lance, P.M. "The Education of Orthoptists in New South Wales". op cit P.18.

299. Lance, P.M. "Orthoptics: Past, Present and Future". op cit P.3-4.

300. Feehan, H.V. "Australian Society needed to fill gap at National Level". The Australian Journal of Pharmacy. Sept.1975. P.488.

301. "Ea.stern Societies Support National Society". The Australian Journal of Pharmacy. Nov.1975. P.590.

302. "Interim Council for National Society takes Office.

January lst. 11 The Australian Journal of Pharmacy. Dec.1975. P.640.

303. "Annual Report of the Council of the Pharmaceutical Society of Australia for the Year Ended December 31st. 1977!' The Australian Journal of Pharmacy. April 1978. P.247. 206.

304. Oscar, G.M. "Chronological Developments in the Formation of the Proposed National Pharmaceutical Society". Bulletin - Pharmaceutical Society of Victoria. Aug/Sept.1975. P.3.

305. Stevens, T.A. "Highlights in the March of Pharmacy". The Australian Journal of Pharmacy. 15/8/1951. P.730.

306. Communication with M. Wyer. (1977) Society of Hospital Pharmacists of Australia.

307. Forster, A.L. "Physiotherapy - A Response to Challenge". op cit P.125-8.

308. "A Foundation Member of the Australasian Massage Association". The Australian Journal of Physiotherapy. July 1959. P.60-1.

309. Parker, D.W.L. op cit P.42.

310. Communication with Mrs. Best. (1977) Secretary. New South Wales Branch. Australian Physiotherapy Association.

311. Communication with Mrs. C.K. Neale (1977) Secretary. South Australian Branch. Australian Physiotherapy Association.

312. Savage, E. op cit P.19.

313. Communication with New South Wales Branch Australasian Institute of Radiography (1977)

314. Memorandum and Articles of Association Australasian Institute of Radiography. 207.

315. "Harold William Anderson F.A.I.R.". (Obituary) The Radiographer. Dec.1964. P. 1.

316 .. "Tribute to Mr .. E.A. Ryan" (Obituary) The Radiographer. March 1966. P.22.

317. Outterside, N. op cit P.10.,

318. Callow, J .. op cit P.31 ..

319. Smith, A.R.B. "New South Wales". op cit P. 149.

320. Smith, A.R.B. "The End of an Era". The Radiographer. Jan.1972. P.4.

321. Carter, D.R. "As I have seen it. Fourty Years in Radiography - a Biographical Memoir". op cit P.25.

322. Communication with Mr. B. Earl. Society of Rehabilitation Counsellors.

323. Lawrence, R.J. op cit P.77-8, 95, 174, 177-9.

324. Cherry, o. "Margaret Eldridge 1906-1967 11 • (Obituary) Journal of the Australian College of Speech Therapists. Dec.1962. P.57-9.

325. Ellis, G.E. op cit P.24.

326. Eldridge, M. "A History of the Australian College of Speech Therapists". op cit P.4-11.

327. Eldridge, M. "A History of the Treatment of Speech Disorders". op cit P.134, 204-7.

328. "Editorial" Journal of the Australian College of Speech Therapists. Oct.1951. P.3.

329. Halliday, R.W. and Watson, A.O. op cit P.58. 208.

·330. ibid P.58.

331. Craig, c. "Launceston General Hospital. First Hundred Years. 1863-1963". Published by the Board of Management of Launceston General Hospital. 1963. P.53.

332. Halliday,R.W. and Watson, A.O. op cit P.58, 67, 87.

333. ibid P.151-8.

334. ibid P.54.

335. Communication with Dr. J.M. Sparrow (1977) Director of Hospital and Medical Services. Department of Health Services. Tasmania.

336. Chapman, A. (Ed) "History of Dentistry in South Australia. 1836-1936". Published by the Australian Dental Association - South Australian Branch. 1937. P.30.

337. Communication with Department of Health. Queensland. (1977)

338. "History of Dietetics in Australia". (1) op cit P.2.

339. ibid P.3.

340. Memorandum and Articles of Association of the New South Wales Institute of Dietitians. Published 1944.

341. Powell, W.M. op cit P.21.

342. Hospitals and Charities Act. 1948. (Victoria) Section 51.

343. Hospitals and Charities Act. 1948. Additional Regulations. June 1949. Regulation 4. 209.

344. Ford, E. "The Life and Work of William Redfern". op cit P.12-3.

345. Sunderland, S. "Australian Medical Schools: Some Historical Considerations". Part One. op cit P.80.

346. Cummins, C.J. op cit. P.62.

347. ibid P.63-4.

348. Watson, J.F. op cit P.84-6.

349. Ford, E. "Robert Porter Welch M.R.C.S. and his First Australian Medical Publication". MJA. 1973. 1:505.

350. Hector, W. op cit P.12, 19.

351. Communication with Dr. J.M. Sparrow (1977) Direct6r of Hospital and Medical Services. Department of Health Services. Tasmania.

352. Cummins, C.J. op cit P.62-4.

353. Stokes, A.F. "One Hundred Years of Medical History in South Australia. MJA. 31/7/1937. P.161.

354. Communication with the Medical Board of South Australia. (1978)

355. Mitchell, A.M. op cit P.231.

356. Communication with A. Tovell. Librarian. Australian Medical Association. Victorian Branch.

357. Cohen, B.C. "A History of Medicine in Western Australia". Paterson Brokensha Pty. Ltd. 1965. P.77.

358. Hector, W. op cit P.34. 210.

·359. Minchin, M.K. "Revolutions and Rosewater. The Evolution of Nurse Registration in Victoria.

1923-1973". Published by the Victorian Nursing Council. 1977. P.12. 360. "Nursing in South Australia. First Hundred Years. 1837-1937". op cit P.96.

361. Hector, w. op cit P.44.

362. Kiddle, M. op cit P.5.

363. Armstrong, D.M. op cit P.81.

364. Dewdney, J.C.H. op cit P.252.

365. Docker, s. op cit P.7-8.

366. Submission to the Department of Health from the Victorian Association of Occupational Therapists on the need for Registration. July. 1977. P.7.

367. Lance, P.M. "Orthoptics: Past, Present and Future". op cit P.3-4.

368. The Australian Orthoptic Journal. 1975. Vol.14. P.45.

369. Haines, G. op cit P.57-66.

370. Matthews, L.G. op cit P.132-3.

371. Trease, G.E. op cit P.179.

372. Matthews, L.G. op cit P.142-5.

373."The Australian Encyclopaedia." Angus and Robertson. Section on Pharmacy.

374. Stephens, T.A. op cit P.730. 211.

375. Communication with the Department of Health. Queensland, 1977.

376. Communication with Dr. J.M. Sparrow (1977) Director of Hospital and Medical Services. Department of Health Services. Tasmania.

377. Evans, E.P. op cit P.78.

378. Forster, A.L. "Physiotherapy - A Response to Challenge". op cit P.129.

379. Physiotherapists Registration Act. 1945. (N.S.W.)

380. Communication with Dr. J.M. Sparrow (1977) Director of Hospital and Medical Services. Department of Health Services. Tasmania.

381. Communication with Dr. R.W. Halliday (1978) Dental Historian. Author of "A History of Dentistry in New South Wales. 1788 to 1945".

382. Halliday, R.W. and Watson, A.O. op cit P.96-8.

383. ibid P.168.

384. Memorandum, Articles of Association, and By Laws of the Australian Dental Association (New South Wales Branch).

385. Communication with Mr. R.B. Newland (1977) Secretary. New South Wales Branch Australian Dental Association.

386. Communication with Miss J.F. Rodgers. (1977) Chief Dietitian. Royal Prince Alfred Hospital.

387. Communication with Mrs. C.N. Cats. Dietitian. (1978) 212 •

. 388. The Australian Institute of Hospital Administrators 31st. Annual Report for the Year Ended 31/3/1977. P.25-8.

389. Communication with P. Watson (1977) Lecturer. School of Medical Record Administration. Cumberland College of Health Sciences.

390. Tovell, A. and Gandevia, B. op cit P.756.

391. Communication with Dr. J.M. Martin (1977) Deputy Medical Secretary. New South Wales Branch of the Australian Medical Association.

392. ibid

393. Ross-Smith. C.J. op cit P.746.

394. Hector, W. op cit P.64-5.

395. Bowe, E.J. op cit P.95.

396. International Council of Nurses. Code for Nurses. Ethical Concepts Applied to Nursing. 1973. (Pamphlet)

397. Communication with E.Duff (1977) New South Wales Association of Occupational Therapists.

398. "Orthoptics". A booklet prepared by the Division of Vocational Guidance Services. Department of Labour and Industry, New South Wales. 1974. P.7.

399. Communication with Mr. D.B. Moorehouse (1978). Executive Secretary. The Pharmaceutical Society of New South Wales.

400. Forster, A.L. "Physiotherapy: A Response to Challenge". op cit P.125. 213.

401. Galley, P. "Ethical Principles and Patient Referral". The Australian Journal of Physiotherapy. Sept.1975. P.97-100.

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403. Communication with Miss B. Burke (1978). Chief Physiotherapist. Austin Hospital. Melbourne.

404. Communication with Mr. B. Lamb. (1978) Chief Radiographer. Austin Hospital. Melbourne.

405. Communication with Mr. Bronte Earl (1979) Society of Rehabilitation Counsellors.

406. Lawrence, R.J. op cit P.183.

407. Communication with the Australian Association of Speech and Hearing. ( 1978) 408. Memo to Members. Journal of the Australian College Speech Therapists. Oct.1951. P.5-6.

409. Roth, J.A. op cit P.6.

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425. Millerson, G. op cit.

426. Reader, W.J. "Professional Men - The Rise of the Professional Classes in Nineteenth Century England". Weidenfeld and Nicolson. 1966. P.9.

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438. Fuchs, V.R. "Who Shall Live?" Basic Books Inc. 1974.

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440. Illich, I. "Limits to Medicine". Marion Boyars. 1976. P.15.

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447. Cohen, s. and Miiki, L.H. op cit

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465. Illich, I. "Deschooling Society". op cit.

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474. Reich, c. A. "The Greening of America". Penguin. 1970.

475. Birch, c. "Confronting the Future". Penguin. 1975.

476. Fromm, E. "The Sane Society". Holt, Rinehart and Winston. 1955.

477. Koestler, A. "The Ghost in the Machine". Pan. 1970. ·SEQUENCEOF EVOLUTIONOF HEALTHCARE OCCUPATIONSIN NEWSOUTH WALES

APPENDIXONE CHARACTERISTIC PENTISTRY DIETETICS HOSPITAL MEDICALRECORD ADMINISTRATION ADMINISTRATION

1. Practitioners start doing full-time 1818 1936 1788 and 1949 the thing that needs doing. 1811 2. A training school is established. 1885 and 1936 1946/47 and 1949 and 1890'S 1948 1956 3. A university or college of advanced 1901 1967 1956 1977 education training school is established. 4. A state occupational association 1892 and 1939 1938 1949 is established. 1903 5. A national occupational associ­ 1911 and 1950 and 1945 1956 ation is established. 1928 1976 6. State licensing is achieved. 1900

?. A code of ethics is introduced. circa 1965 1949 1900 CHARACTERISTIC

3. 2.

4.

1.

5.

6.

?.

A

A

A

the ation education

A Practitioners State

established.

is

A

university

state training

national

code

established.

thing

is

licensing

of

occupational

established.

training

that

ethics

school

occupational

or

start

needs

college

is

is

is

school

achieved.

doing

introduced.

association

doing.

established.

associ­

of

is

full-time

advanced

MEDICINE

1788

1813 1851 1882/83

1859 1880

1933

1859

1838

and

and

NURSING

hospital

still

trained)

1838

1868/69 1924

1924 (most 1899

1953

THERAPY

OCCUPATIONAL

1973

1940

1941

1934

1945

1945

1954

and

ORTHOPTICS

circa

1943

193.3

1938 1938 1973 CHARACTERISTIC

3.

2.

4.

5. 1.

6.

7.

A

A

A

Practitioners

A

ation

the education established

is

State

A

state

university

training

national

code

established.

thing

is

licensing

of

occupational

established.

training

that

ethics

school

occupational

•

•

or

start

needs

college

is

is

is

achieved.

school

doing

introduced.

association doing.

established.

associ­

of

is

full-time

advanced

PHARMACY

at

1876

since

1820 1844 1868

1976 1899

1876

1920

least

1

and

s

the

PHYSIOTHERAPY

1973

1905 1905 1907 1906

1945

1906

RADIOGRAPHY

circa

1935 1936

1896

1947 1962 1950

and

REHABILITATION

COUNSELLING

1974

1974/75

1940

1

S 2. 3. CHARACTERISTIC

4.

1.

5.

?.

6.

A

A

A Practitioners

the

education A

ation established.

State is A

training

university

state

national

code

established.

thing

is

licensing

of

occupational

established.

that training

ethics

school

occupational

or

start

needs

college

is

is

is

school

achieved.

doing

introduced.

doing.

association

established.

associ­ of

is

full-time

advanced

SOCIAL

193? 1933

1929

1940 1933 (almoners) 1954

1934 1946

1957

(almoners) (general (almoners) (general

(almoners) (general (general

WORK

social

social

social

social

~

work) work)

work)

work)

SPEECH

1929 1973

circa 1939

1944

and and

THERAPY

1951

1931 1949