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Medical Technology

Medical technology reflects the style of medical practice and the prevailing professional self-image. The first medical doctors in Melbourne brought with them simple but effective tools for diagnosis and therapy. The increasing popularity of the stethoscope, little more than a hollow tube applied to the chest, introduced by Laennec as recently as 1816, suggests a rising medical interest in physical examination during the period in which Melbourne was settled. By the 1890s the modern stethoscope had come to symbolise technological medicine. But the lancet, although one of the more common of the therapeutic technologies of early Melbourne doctors, was used only sparingly to bleed patients, and at the end of the century was utterly unfashionable. By then therapeutic goals had changed from restoring balance to a diseased body, to fighting specific diseases caused by elusive microbes.

Great changes took place in diagnostic technology during the 19th century. While many of the first doctors in Melbourne had brought stethoscopes with them, their successors were quick to import clinical thermometers in the 1860s and machines for recording blood pressure (sphygmomanometers) in the 1880s. A few Melbourne doctors also acquired improved microscopes and new ophthalmoscopes and laryngoscopes from Germany, as well as other products of the collaborations occurring there between research universities and industry. Thomas Shearman Ralph, the curator of the pathological collection at the (Royal) Melbourne Hospital, from 1859 was developing a reputation as a competent microscopist, and later became president of the active Microscopical Society. George Britton Halford, the first professor at the new medical school, acquired a microscope in 1864 and used it in his teaching. Bacteriological theories of disease causation were commonplace by the 1880s, but despite the exhortations of the leaders of the profession, local doctors did not resort to the paraphernalia of the laboratory to make their diagnoses until the late 1890s. With the establishment of the public health laboratory in 1897, bacteriological technologies, including culture media and incubators, finally found a home in Melbourne. In the same decade, news spread of the discovery of x-rays, and as early as 1896, the Melbourne Hospital appointed Australia's first radiologist.

Surgeons and obstetricians led the development and acquisition of therapeutic technologies in the 19th century. David John Thomas used ether as an anaesthetic in Melbourne in 1847, within a year of its discovery. Local doctors were also quick to take up the use of nitrous oxide and chloroform. In 1867, having just learnt of Joseph Lister's new practice of antisepsis, William Gillbee was spraying carbolic over his patients at the Melbourne Hospital, but it took until the 1880s to convince his colleagues. During this period some surgical and obstetric instruments were further refined in Melbourne; and doctors rapidly accepted new designs for prostheses, and improved needles and syringes.

In the 20th century doctors in Melbourne, as elsewhere, grew more reliant on technology to diagnose and treat their patients' ailments. As this technology increased in scale, complexity and cost, it was more likely to be found, initially at least, in the larger hospitals or private pathology service providers. The first electro-cardiogram (ECG) machines, which came to Melbourne in the 1920s, were large, expensive, and confined to teaching hospitals, but by the 1970s they were portable, cheap, and available in most general practices. Ultrasound now is also increasingly likely to be found in community settings. But more complex diagnostic technologies, such as computerised tomography (CT), introduced in the late 1970s, and magnetic resonance imaging (MRI), available in the 1990s, are still restricted to hospitals and major pathology services. For the past 50 or so years Melburnians have expected to find technology-intensive therapeutic sites, such as intensive care units, emergency departments and surgical theatres, in hospitals. Modern techniques of blood transfusion, organised from 1929 by the Victorian Red Cross Blood Transfusion Service, became standard practice after World War I. Since the 1920s motor ambulances have taken Melburnians to hospital.

Most of these diagnostic and therapeutic technologies have been developed elsewhere and taken up, often with a few modifications, in Melbourne. But more recently a few local medical researchers have begun designing new technologies, and linking with industry to market them internationally. For example, in the 1970s Graeme Clark and his colleagues at the Royal Victorian Eye and Ear Hospital produced an effective bionic ear now used throughout the world. That this solitary example has become so celebrated may, however, serve to demonstrate that success on this scale is still uncommon.

Warwick Anderson