Melbourne, with its three universities, ten major teaching hospitals, and 17 medical research institutions, has long been a centre of Australian medical research. Medical research is a central part of modern societies, implying as it does a level of state centralisation and social responsibility that has been developing only since the mid-19th century. It expanded relatively slowly until the second half of the 20th century, but knowledge of international importance has resulted.
Prior to World War I little medical research was undertaken in Australia. A small population and an imperial culture ensured that those who were involved in research tended to migrate to institutions overseas. The research that was done occurred mainly at the University of Melbourne. The interwar period saw a growing opposition to the migration of researchers, and increasingly a belief that it was a government's responsibility to create a system of preventative public health. While federal government involvement in medical research was of fundamental importance, it occurred only slowly. The National Health and Medical Research Council, first recommended in 1925, was not established until 1936, and even then was under-funded. This funding helped support basic research in physiology and biochemistry, enabling Derek Denton and R. Douglas Wright to begin their research into cellular salt and water metabolism. The community of interest that developed was a major stimulus for the establishment of the Howard Florey Institute of Melbourne University. Private philanthropy also played a major funding role. Due in part to trustee Richard Casey, much of the State's share of the Walter and Eliza Hall Bequest was used to establish the Walter and Eliza Hall Institute. Initially it did valuable work on hydatid diseases and treatment for Australian snakebites, before becoming a centre for research on viral infections when (Sir) Frank Macfarlane Burnet became director in 1944. Already famous for work on the reproduction of communities of disease-causing bacteria, he went on to establish the necessary systems to develop an influenza vaccine with protein specialist Alfred Gottschalk. Burnet later won the Nobel Prize for his theory of immunological tolerance, but is most famous for his clonal selection theory of acquired immunity, the basis for much of the immunological work for which the Hall Institute is internationally known. During the interwar period individuals also sponsored clinical research, leading to the establishment in 1926 of the Alfred Hospital's Baker Institute.
Research became increasingly specialised after World War II, with many studies focusing on 'cosmopolitan' diseases like cardiac disease, stroke and cancer. Government funding was expanded, and in 1952 the Life Assurance Medical Research Fund was established. Basic scientific research continued to be a dynamic field, with research findings often culminating in clinically useful developments. Since 1966 Donald Metcalf, at the Hall Institute, has discovered four glycoproteins that stimulate blood cell growth. Further research has enabled these proteins to be cloned and their genetic material to be altered. These have a potential use in treatments for blood and bone cancers. Also at the Hall Institute the group of immunological researchers has enabled the recognition and further study of a group of antibodies known as lymphocytes. The two basic types, bone marrow derived and thymus derived, were first identified by Jacques Miller in 1961. Carried further, this insight has allowed great advances in knowledge and patient care. In the 1960s University of Melbourne's Professor Brown developed a technique to measure levels of oestrogen in the urine, a finding that enabled major advances for understanding and managing pregnancy and infertility. Foundations for work on one modern killer, diabetes, were laid in the early 1950s by Joseph Bornstein who identified the two types of diabetes.
Melbourne also has a long history in developments in cardiovascular medicine. From the postwar period surgical developments were conducted under the auspices of Sir James Officer Brown. Working at the Baker Institute, Paul Fantel discovered key factors that cause blood clotting. Later, also at the Baker Institute, Paul Korner built up systems for the study of the brain's role in circulation. Julie and Gordon Campbell have helped preventative care through their work identifying the arterial changes that contribute to arteriosclerosis. Also of note in this period was the work of Dr John Cade who, working at the Bundoora Repatriation Mental Hospital, identified lithium as a potent treatment for bi-polar disorder, a treatment that is still in use today.
There have also been important developments for patient care, both in the surgical and post-surgical context. In the 1940s Ian Wood and Richard Joske, working at the Royal Melbourne Hospital, did pioneering work on the use of the gastric biopsy tube. Also at the Royal Melbourne, Professor Maurice Ewing conducted the first kidney transplant in 1956. Rejection problems caused early work to fail, but in 1965 he had a long-term success through transplantation from a cadaver. This has been internationally important in encouraging cadaveric transplant programs. Development of the famed surgical implant, the 'bionic ear', resulted from detailed study of nerve deafness by Graeme Clark at the Royal Eye and Ear Hospital. Post-surgical patients have also benefited from the knowledge generated in Melbourne's strong research environment.
Melbourne's medical research environment has continued to be dynamic and successful. Funding now comes from both governmental and non-governmental organisations, including the National Heart Foundation sponsored in large part by public donations. Funding is often tied to the possibility of financially viable pharmaceutical products, but also in the hope of implementing public education and public screening programs. Given both the strength in basic science and in clinical research, Melbourne will continue to be one of Australia's centres of medical research.