The most important feature of the administration of the health of indigenous groups in Western Australia in the decade 1910 to 1920, was the setting in train of two administrative changes. The first was when the Aborigines Department amalgamated with the Department of Fisheries, and the second began in 1915 when Immigration was added to form the Department of Aborigines, Fisheries and Immigration. C.F. Gale remained in charge of the Aborigines Department until April 1915, when A.O. Neville became Chief Protector. In this period venereal disease, the onset of leprosy, hookworm and access by Aborigines to country hospitals for medical treatment preoccupied the departments dealing with Aboriginal protection and primary health.

In 1910 Daisy Bates joined an international party to study Aborigines in the central and northern areas of Western Australia. The Western Australian Governor made her a travelling protector and paid her as a Special Commissioner. Part of her duties was to ‘conduct inquiries into all native conditions and problems’. Another of her tasks was to look at how Aborigines and half-castes were employed on stations, and to act in guardianship and care of Indigents, and this included keeping an eye on the distribution of rations. The half-caste question loomed large in her mind along with the ‘morality of native and half-caste women in towns and mining camps’, and other matters affecting their welfare from an administrative point of view. Bates witnessed police rounding up Aborigines suspected of having chronic infections while she was on the expedition in 1910.

From Laverton, in the central eastern part of the State, she travelled to Dorré and Bernier Islands. Decades later the shock of her experiences there remained vivid in her memory. She wrote that the two lock-up hospitals on Dorré and Bernier Islands were no places of refuge for the sick. She described them as places of deplorable suffering, ‘misery and horror unalleviated...tombs of the dead’. Her concern was that the Government had abandoned its previous generally humane protection policy when faced by the potential scourge of venereal disease. In doing so, ‘regardless of tribe and custom and country and relationship, they were herded together – the women on Dorré and the men on Bernier. Many had not seen the sea before, and died in terror of it.’

Bates remarked that very little companionship existed and most of the inmates were either unknown to each other or feared contact with other Aborigines who were regarded as strangers. Similarly, most of the women roamed aimlessly in all weather and at most times of the day. Some women cried of loneliness and others stood for hours in one position peering across the water because they missed their relations, or grieved for their country. Many simply died of grief and many graves littered the islands in evidence. This painted a true picture because, when patients died on the islands the hospital buried them on the island and the hospital had no responsibility to send the bodies back to the families, or felt no compunction to do so. When the police disease patrols brought the patients in they had no legal responsibility to record where they came from. Similarly, Bates observed the carelessness of police contracted to bring diseased patients in from bush living places. She described one policeman who arrived

with new consignments of unfortunates collected throughout the vast State, and [she] went over to Carnarvon to meet them. [The police]...camped four miles away on the outskirts, with about 133 natives, all stricken with disease....[She wrote] shall I ever forget the surge of emotion that overcame me as they saw me, and they lifted their manacled hands in a faint shout of welcome, for some of them recognised me? There was a half-caste assistant with [the policeman]..., and the natives were chained to prevent them from escaping....In one donkey-wagon were forty-five men, women, and children, unable to walk.

To Bates the attempts by Government to arrest the spread of venereal diseases and treat the effects, appeared inhumane. Any government system for dealing with the epidemic required that the project continue for a very long time before effective means for controlling the disease among Aborigines began producing results. Bates’s views on these means clearly diverged from the Government’s but she never stated what alternative approach she favoured.

From the opening of the lock-up hospitals in 1908 to its closure in 1918, Aboriginal males and females were collected by police on behalf of the Medical and Public Health Department. On Dorré and Bernier Islands they were isolated from one another (including from their own relatives) by sex, and from white settlers. Because of the shortages of white woman in mining, fishing and pastoral service towns white men had sexual relations with Aboriginal women. Such activities were the cause of most of Aboriginal female venereal infections. As a result, indigenous women made up the largest number of people admitted for treatment at the lock-up hospitals. For example, in 1910, 72 females and 57 males were transported to the Islands suffering from sexually transmitted diseases. At the same time 10 male and 27 female Aborigines were discharged to their homes as cured. The inmates were drawn from widely dispersed areas somewhere between Wyndham and Carnarvon, and their departure left a total of 119 patients on the two islands. Many of the patients, according to the Chief Protector, were in the older age groups and had been suffering from some form of venereal disease from well before the advent of the lock-up hospital.

Once on the islands the patients were ‘allowed to live their own lives in their natural way.’ What this meant was that when bush and camp people came they were allowed to live in the sand hills and erect their own shelters. By 1910, however, the hospital staff were finding it ‘impossible to give the very bad cases the necessary attention.’ The Government, ‘on the report of the Superintendent Medical Officer,...authorised...the erection of an incurable ward...of 20 beds for females...and...10...for males.’ In addition, an expert pathologist, Dr Steel, took up duties to try and ‘discover the aetiology, treatment, and cure of the venereal diseases from which the natives suffered.’ That year the Aboriginal male patients gathered the timber to build the new ward, and they collected 500 loads of coral, sand and limestone. With the coral they helped to mix the concrete to build constructions. When that was finished they built the fences and looked after animals that provided the meat for the medical staff. Building and farm-worker jobs were allocated to the able bodied males. For females bread-making, collection of firewood and transport of drinking water by bucket made up their contribution to daily operations. To collect the fresh water the women dug holes in the sand to access the underground water system and then carry the fresh water back to the hospital kitchen. This water supplemented rain water from the hospital roof which drained to concrete storage tanks. Apart from the task of carrying water, bush people were neither familiar with such tasks and were not used to hard labour. As a result, conflict between the nursing staff and inmates arose because of the way Aborigines were expected to perform these duties. This saved the Department money on building but caused problems in other direction. ‘The standard of medical care...was undermined by the persistent punishment applied to Aborigines’, which meant that patients would be physically whipped by hospital staff if inmates failed to do the tasks allocated.

In the following year, a number of fights occurred between Aborigines. A white female employee later reported that the Medical staff ‘locked up the ringleaders’ involved in the troubles. Part of the problem arose from an attempt to keep some Aboriginal men on Dorré island rather than to transfer them back to Bernier Island where they were normally hospitalised. Travel between the mainland and the two islands was always fraught with danger because of the westerly winds and swift flowing tides. When the men were allowed to stay, some of the women objected and fights broke out. Mary Anne Jebb argued that the cause of conflict was the austere management practices adopted by the medical staff on the islands. But in Daisy Bates’s opinion pre-existing hostilities among the patients appeared to be an underlying cause. Conditions did improve in 1912 when the extension to the Bernier Island hospital permitted some sufferers to receive surgical treatment they would otherwise not have been able to get. Surgical operations involved repair of male and female genital wasting or damage from the long-term neglect of the infected region of the body.

During the period from 1911 to 1916, although the numbers of patients with diseases – presumed at the time to be sexually transmitted infections – began to decline, the method of collecting patients became more organised. For example, patients were collected by boat from a number of mid-west-coast ports and taken to the island lock-up hospitals. In 1911, 1912 and 1916 special disease patrols were sent into the Gascoyne, Ashburton and De Grey districts to bring Aborigines into coastal towns for venereal disease screening prior to their dispatch to the island lock-up hospitals. In 1911 the disease patrol brought 96 men, women and children to Carnarvon. According to the Chief Protector’s Annual Reports of 1912 to 1916, which gave no medical treatment details, the disease patrols were headed by travelling inspectors. These inspectors collected smaller numbers of Aborigines in this period because minor cases of infection were treated on the spot while other cases were transported to Marble Bar for dispatch to the island hospitals.

Though controversial, a research project on venereal disease which commenced in 1911 began to reveal a new perspective on the disease from which indigenous people were suffering. According to Biskup, early research proved inconclusive, but ‘the break-through came on the eve of the war when the ailment was finally diagnosed as Granuloma of the pudenda, an infection which at the time was thought to be venereal disease. In addition, this disease was assumed to be peculiar to the Aboriginal race.’ Mary Anne Jebb has argued, however, that Biskup’s assumption that this complaint was an infectious disease peculiar to Aborigines was unsound. She based her views on the fact that a medical researcher, J.R. Hickenbotham, had noticed ‘interesting discrepancies in the manifestations of syphilitic lesions present in white stockmen.’ The disease, Hickenbotham showed, ‘was also present in Aboriginal women with whom they cohabited. Furthermore he had treated the patients with syphilitic treatment measures and only the white stockmen had responded.’ Hickenbotham speculated that the white male pastoral workers might have had a milder form of the disease than the Aboriginal women, but their malady had little to do with race. In any event, Aborigines had less chance of getting the treatment they needed in the general hospital and under the medical circumstances of the time.

Throughout the period a total of 635 indigenous people were admitted to the lock-up hospitals created on Dorré and Bernier Islands (white people infected with sexually transmitted diseases were sent to Perth). The total number sent to these hospitals consisted of 426 males and 209 females. There is no evidence available to explain why twice as many females as males were admitted for treatment, but might certainly have been the problems women experienced as a result of the effects to their reproductive cycle and genital wasting. One explanation however, is that the males (mostly white) could always go south to Perth or other Australian capitals for the treatment. Another reason might have been that in the Gascoyne, Pilbara and Kimberley regions females were attracted to white settlement in greater numbers. As with the Asian mariners in the north, older Aboriginal males could indulge in the trading of sexual favours for cash from white settlers. Camps were established throughout the large river systems frequented by white and Asian settlers. Both pastoralists and Aboriginal settlers were attracted to the more productive lands around the mouths of the Fortescue River just south of Roebourne, the De Grey River north of Port Hedland and the Fitzroy and Drysdale Rivers. Here Aborigines could establish their camps in situations offering many advantages including permanent fresh water, bush food sources in the rivers and the sea, permanent dwelling places and easy access to the nearby towns, where store-food could be obtained for cash earned from white settlers.

In 1917 only 18 women and 4 men were admitted to the lock-up hospital near Carnarvon. In the same year 25 females and 7 males were allowed to return home. The numbers of people who died at the institution totalled 116 females and 46 males. According to Mary Anne Jebb’s calculations, only 13 people stayed longer than three years, most of whom were females. Many patients stayed for only six months to a year and were then sent home as cured. Meanwhile, some local government bodies in the north began constituting themselves as local authorities under the new State health legislation. They began exercising their legal capacity to frustrate projects that would benefit Aborigines suffering from sexually transmitted diseases. They did so by constructing Aboriginal hospitals near the towns within their jurisdiction. The new hospital at Port Hedland, for instance, might have been built further north at either Wyndham, Derby or Broome but for the protests of local Broome townsfolk who calculated – successfully as it turned out – to prevent the Government from doing so. Similarly, calls came to bring the Commonwealth into the debates about venereal disease and hospitals for Aborigines in which to treat the epidemic. The closure of the lock-up hospitals on both Bernier and Dorré Islands took place in 1918 and a new ‘native hospital’ was opened at Port Hedland to deal with a range of illnesses and diseases suffered by Aborigines. As the incidence of venereal diseases subsided, leprosy acquired greater prominence for health and protection agencies and white settlers in country towns. Although only 22 cases of leprosy were reported in Western Australia in the 22 years between 1898 and 1920, the disease had been steadily spreading from the Gascoyne area into the Fitzroy River region of the Kimberley from about 1908.

Leprosy was first recorded among Aborigines who came from the mouth of the Fortescue River near Roebourne and around the Fitzroy estuary at King Sound. These two regions provided the largest number of lepers and the first group to be segregated on make-shift lazarets on Barret and Berzout Islands. It was from these locations that leprosy spread, and by 1920 it had spread throughout the Kimberley. Some confusion existed over which authority was to deal with questions of primary and public health posed by the epidemics of venereal diseases and leprosy. The numbers of diseased Aborigines, Asians and white settlers was becoming an urgent issue. Who should accept the responsibility, however, was not clear, and the overlapping legislation on infectious diseases, quarantine, local government clouded responsibility further. Aboriginal protection and public health led to disputes between the interested agencies.

One missionary’s interpretation enables us to appreciate the difficulties which arose from trying to care for Aboriginal and Chinese lepers on isolated tidal sand islands. On 18 February 1908 a Dr Cortis wrote to the Principal Medical Officer in Perth to say that an outbreak of leprosy had occurred on islands located in King Sound. Dr Cortis reported that he had visited Sunday and Cygnet Islands, where he found that the Catholic missionary, Father Nicholas Maria, had collected most of the sick, blind and infirm Aborigines onto on island. There were about 45 men and about 50 women, and also a baby ‘with an infected arm hanging from the body as if to drop off.’ Adult Aborigines that Cortis examined appeared to have cancer covering the whole of their faces. Cortis asked for larger subsidies and more medical assistance. He and other medical practitioners and hospital staff throughout the State, together with protectors, pastoralists, townsfolk in the north and diseased sick and dying Aborigines, had some time to wait before a reasonable level of order would be brought to the chaotic health situation. The Royal Commission of 1904-5 brought some respite but changes had to be made to the laws relating to public health, disease control and the creation of regional health authorities.

Reform did come on 1 June 1911 when the Western Australian Executive Council passed the Health Act 1911-12. This new legislation changed the infectious disease clauses to take account of rural Aborigines needing attention. The significant changes, however, related mostly to the organisation of public health at the local government level. The legislation, nevertheless, made it possible for government to designate twenty new Road Board districts as health districts. At the same time it enabled existing Road Boards to receive government funding as health districts. A further 47 health districts became subject to direct control from the Board of Health, and a further 29 municipal districts came under the direction of the Health Department, which, with enhanced powers, was able to begin reorganising the public health system. Sufficient legislation existed to tackle the related problems of public health, Aboriginal protection and the treatment of Aborigines with infectious diseases.

The new Health Act 1911-12., approved on 1 July 1911, contained important changes. The most significant change was that the Medical and Public Health Department absorbed two earlier portfolios of the Medical and Health Departments. The new department assumed control of the venereal disease hospitals at Bernier and Dorré Islands established under the Aborigines Protection Act 1906. Although attention to Aboriginal lepers remained the responsibility of the Chief Protector (and his staff in rural and isolated regions), the Medical Department received additional powers under the Infectious Diseases Act 1896 to administer treatment to anybody with infectious disease. Unfortunately, the Department did not exercise its new powers. It lacked both the health infrastructure and the resources to influence what it could do in either the southern or the far northern areas of the State.

In one sense this was a natural development arising from increases in the State’s population and advances in its economic development. In another sense it raised the awareness of local settler society about health in the region. That in turn promoted moves among the settlers to reject local measures to aid sufferers of leprosy and venereal disease: no one, it seemed, wished to have leprosaria or venereal disease clinics in their neighbourhoods. Such attitudes both complicated and restricted the task of government agencies responsible for treating patients who suffered from these ailment.

In the period from 1910 to 1915, medical identification of leprosy improved, but diagnosis by health workers and government agents remained difficult. The main complication was that other mutilating diseases such as tuberculosis and venereal diseases – syphilis and gonorrhoea – made diagnosis by hospital staff, doctors, police and protectors sometimes impossible. Although there was some debate about what ought to be done about lepers, the spread of leprosy in the north continued because almost no health authority existed there. Lepers were simply deposited on islands in Cygnet Bay, 300 kilometres north west of Derby. This served to isolate leprosy cases from the general public, and visits by medical personnel rarely took place. About once in every eight months the police delivered water, bulk food such as flour and tea and firewood.

Medical services for special diseases such as leprosy developed slowly. In general those infected were isolated from villages, towns and cities. In Western Australia the same practice was adopted and early victims, both Chinese and Aborigines, were taken from remote bush camps by police. If either suspected or diagnosed as a carrier of the infection these patients faced the terror of both isolation and harsh painful treatment regimes. In Australia, early medication meant that leprosy patients received orally, or intravenously, chaulmoogra and hydnocarpus oils, made from vegetable derivatives of the East Indian chaulmoogra tree. These oils greatly improved the option of injection directly into the muscles, but were nauseating and a traumatic substitute for taking the dose by mouth. This form of treatment was adopted by Dr Durack of Marble Bar in the Pilbara of northern Western Australia, who treated Manilamen with chaulmoogra oil by mouth. Locally derived treatments were rather more severe: in Roebourne Dr Maunsell added arsenic to the medication while in Derby antimony was considered a suitable addition by Dr Hodge.

Administering chaulmoogra oil orally with a small amount of strychnine was a practice adopted overseas. This caused nausea in some patients. As an alternative treatment Dr Victor Heiser in the Philippines began a course of treatment by ‘hypodermic injection with a formula composed of chaulmoogra oil, resorcin, and camphorated olive oil,...in 1 cc doses.’ Dr Heiser began the treatment on 15 February 1911 and, by April of 1911, increased the dosage to 12 cc per day over two months and then reduced back to 1 cc and then back to the maximum dose by October 1911. Before the treatment began the patient tested positive to a bacteriologically test. On completion of the trials the researcher found that ‘the patient was microscopically [tested] negative for leprosy.’ Although the leprous macules (a spot of discolouration of the skin or thickening and swelling to the skin that forms a distinct area from the normal tissue) developed as ulcers these healed by 1913 and microscopic tests failed to show any presence of the leprosy bacilli. This was a short term result because no cure had been recognised at the time. Research on leprosy treatment was going on throughout the world and researchers had, by 1914, just begun to locate the similarities of both the leprosy and tuberculosis bacillus. At the same time in Australia only ‘standard’ treatments persisted.

In 1911 Chief Protector Gale visited the lazarets on Cygnet Bay islands. He kept in close contact with Dr Maloney of Roebourne and Dr I. Maunsell of Broome, both of whom cooperated in keeping the Chief Protector informed about the progress of the disease. Dr Maunsell went to Bezout Island on 15 September 1911 and examined 5 female Aborigines. He reported that two Aborigines, a man named Jimmy and his wife Nangetty, cared for about five adult females. Four of the women, after bacteriological examination, returned positive swabs for leprosy. Maunsell added that there was ‘no doubt that Wagar and Cooranung...suffered from leprosy and the disease had become more marked in the last six months.’ In addition, he saw an Aboriginal female called Parley, alias Jemima, whom he diagnosed as ‘syphilitic and not suffering from leprosy.…The...eruption she had before she went to Bezout [Island in King Sound] has practically cleared away.’ Many sufferers were understandably modest about close examination by doctors. Many doctors too, like Dr Maunsell, would not have wanted to impose a diagnosis on such isolated groups. Similarly, doctors could only guess at the stage of progress of the disease in such isolated groups because they had no legal capacity to move people to the mainland.

Gale’s trip to the region, and particularly Berzout Island was to experience the difficulties his staff were faced with at first hand. On Berzout, Gale saw that ‘the natives were at the time of...his visit living principally on turtle meat and eggs, which they much prefer to the food supplied to them’ by government. The size of the island on which patients lived was ‘roughly about [two kilometres] in length and 100 to 200 yards wide and well above the sea level, so is in every way...suitable for the purposes of segregation.’ While there he saw the sheds in which stores were kept and those where patients could move to take shelter from the elements. Large water tanks were located for people to get water for drinking and cooking as needed. Before leaving the island Gale ‘made arrangements for all the tanks to be filled in case anything unforeseen happened preventing a regular supply [of timber, and firewood and stores] being delivered.’ The supply was sufficient to last for about eight months.

Gale wrote that when he arrived on the island he ‘found 7 bags of flour, 2 bags of sugar,...4 bags of tea, 4 dozen 2 pound tins of meat, and 3 dozen tins of jam in the stores, which the patients have access to any time.’ Dr Maloney, the District Medical Officer at Roebourne complained about the conditions but was criticised by the Health Department as the holder of ‘alarmist’ views, but it was enough to bring Gale to the area. Once there he satisfied himself that the depot staff under his control were carrying out their tasks as satisfactorily as possible. He felt also, that, from a medical point of view, ‘there was much left wanting in the proper treatment of these leper patients.’

There were about eight adult ‘natives’ on the island whom Gale thought were suffering from leprosy, 2 males and 6 females. Some of the lepers had other relatives with them, and Gale advised the Under-Secretary of the Premier’s Department that he thought this was unsatisfactory. Gale pointed out that the health Department authorised the police to place the lepers on the island. He agreed with the District Medical Officer that this was unacceptable:

I admit the difficulty of holding any native suspect until his or her disease is determined, but the opinion of Dr Maloney has been frequently voiced by himself when at Roebourne that an illegal action is taking place with natives which the authorities would dare not do if the subjects were Europeans, and I feel sure this phase of the question will be ventilated by the public sooner or later.

One of the difficulties was that the island was twenty kilometres from the mainland, which made travel dangerous for the medical staff. In heavy weather the time taken to travel to and from the island was about thirteen hours. The police cutter that ferried the stores, firewood and water, and took the medical officers to and from the island was a poor craft. In view of such difficulties Gale thought that a place on the mainland had to be found, despite public objections.

In the two years from 1912 to 1914 debate ensued over whether leper patients ought to be taken south to one of the islands off the coast of Carnarvon. No decision was possible, however, due to the conflicting interests involved. That was until a white female presented at a Perth hospital with signs of leprosy. The head of the Health Department, Everrett Atkinson, then pressed the Minister for Health to take action. A tidal island close to Roebourne was located, and the quarantine station at Cossack was designated as an alternative location. A district medical officer, Dr Davidson, put the problem of indecision, over the building and the locating of a lazaret, down to a lack of communication between the interested parties. At the same time the numbers of leprosy victims were growing and bush medication, that is traditional remedies, proved as inappropriate as those of western medicine.

Traditional medications and cures for some illnesses did exist among bush people. In some cases, especially with fevers and the associated pain, treatment had mixed benefits. Sorcerers treated the sick person by ordering that they eat a particular plant or by rubbing the juice and oils of the plants on the body with animal fat. This activity was accompanied by the patient being treated by a traditional magician, or ‘clever’ healers, who could be male or female. These practitioners sat near the patient, or placed them wholly in water to lower the patient’s temperature. Thus the symptoms rather than the disease were treated. As far as the patients were concerned, medical science was as impotent as cultural ideologies in explaining what leprosy was, how people contracted the disease and how it should be treated.

The Western Australian Government began collecting aggregate data on leprosy as early as 1905. The first researcher to use that data was Dr Cecil Cook in his 1922-23 epidemiological study of leprosy. The health administration for leprosy and its treatment processes have remained relatively unknown until recently, however. This was possibly due to restrictions on both the personal medical and government records on the disease and the nature of the legislation covering the government records.

At the end of Gale’s term as Chief Protector communicable diseases infecting Aborigines had spread to such an extent that some venereal diseases and leprosy had become endemic. Gale had two major concerns about the issue of bringing health care to Aborigines. The first involved the international hookworm campaign, which in Western Australia largely focused on Aboriginal missions and government settlements. The second was medical care for Aborigines in rural hospitals.

Interest in Ancylostomiasis, or hookworm, was well described in the reports of the Australian Hookworm Campaign, which defined it as ‘an insidious infectious malady, caused by two species of parasitic intestinal worms (Necator americanus and Ancylstoma duodenale) which attach themselves to the delicate inner lining (or mucous membrane) of the small intestine, and there give rise to multiple small haemorrhages.’ Both species are ‘nematodes’, which are parasites of animals as well as plants. The worm passes through the larval stage in the ground. The final report of the Australian Hookworm Campaign noted ‘a preponderance of the Necator’, and commented that

more recent work in the northern coastal districts gives an opposite result. The recent immigration of numbers of Southern Europeans may have changed the ratio of the species....Where the Ancylostoma is predominant it is believed to [come] from Chinese and Southern European sources, while the origin of the Necator [is] the Melanesian archipelagos.

The hookworm larvae prefer warm, moist, oxygenated habitats. Such conditions stimulate the hatching of the egg and the larvae cut through the human (or other animal) host’s skin to enter the blood stream. Once in the blood stream the worm travel through the lymphatic and blood vessels to the heart and lungs. They break the thin walls of the alveoli of the lungs, travelling up the trachea, down the oesophagus, and finally attach themselves to the wall of the small intestine. Groups of people burdened with poor group hygiene are most likely to be affected. This was especially the case where Aboriginal fringe-camp hygiene practices resulted in the creation of reservoirs of hookworm infection.

Hookworm, in the decade 1910 to 1920, became more widely reported among Aborigines, but it also infected white Australians. The first surveyed in 1918 among Western Australian Aborigines, reported rates of infestation ranged between 50 and 90 per cent. The Chairman of the Road Board at Broome wrote to the District Medical Officer, Dr Atkinson, to notify him that a case of hookworm had been found in Broome. This prompted the State Government to contribute 33 percent of the total cost of conducting a hookworm survey in the north. Other contributors were the Commonwealth Government and the International Health Board of the J.D. Rockefeller Foundation. A sample survey was conducted in 1918 in Western Australia and showed the presence of hookworm. The continuity of inspections for communicable diseases by District Medical Officers, who visited some missions, was broken only by the commencement of the First World War.

The Medical and Public Health Departments had already been monitoring hookworm infection in the northern parts of the State. Dr Hayes indicated that the mission provided favourable conditions for the spread of hookworm because of the presence of pools of stagnant water at the locations where bare footed children played. At some locations crude sanitation aided its spread rather than helped in its prevention. The incidence of the disease was not surprising considering ‘the number of Malays...Manilamen etc., in north west, spread the disease to Aborigines.’ A later letter from John Dale (Deputy Commissioner of Public Health) advised the Minister about the ‘Hookworm Campaigns’ that were proceeding in the eastern states. Dale told the Minister that the idea for such a health campaign came from the International Health Bureau, an establishment of the J.D. Rockefeller Foundation of the United States of America. The motivation behind Rockefeller’s action in developing a world wide campaign targeting hookworm arose from, among other things, Joseph Bancroft’s promotion of the health sciences in Australia.

After hostilities ceased in Europe in 1918 the Australian Institute of Tropical Medicine re-commenced their efforts in the hookworm campaign in cooperation with the Health Board of the Rockefeller Foundation. The campaign was based on criteria established by Anton Breinl in 1911. Breinl had written that notification of the presence of hookworm was insufficient and that the geographical incidence had to be known, as well as its demographic distribution. Compulsory treatment then had to be imposed on sufferers. The thrust of the first survey focused on Queensland, where a high prevalence had already been identified. In Western Australia, interest was focused on the north, and appropriate data collected. The initial sample survey commenced in 1918-19 and it was conducted with school children selected as a representative sample of the Aboriginal institutionalised population. This method changed when some mission populations needed a different sampling approach. In those cases adults were taken as a representative group of the population. In areas where hookworm was known or suspected to be endemic a mass screening occurred to obtain samples from everyone at the mission. The results of the Western Australian sample survey were made available to Parliament, but not until 1921.

Concentrating on the operations of the sample survey, the hookworm campaign centred on the Aboriginal community at Beagle Bay near Derby. An agreement was approved by Dr Sawyer of the Western Australian Health Department, with the Director General of the Commonwealth Health Department, Dr Cumpston, on 6 May 1921. While the concerns about hookworm infestations in Aboriginal groups preoccupied Western Australian health circles, the struggle to pay for primary health care for Aborigines continued, as did the struggle to give them access to ordinary country hospitals, medical establishments and private medical practitioners’ clinics. From 1900 to the 1920s the Medical Department in Perth administered country hospitals. This meant that stockworkers and Aboriginal mission populations were denied direct access to health care from doctors. Stockworkers in most regions of the State had to rely heavily on property owners and pastoralists possessing medical chests to deliver their primary health care services because no professional help was available. Aborigines on missions largely had to fend for themselves or rely on priests and missionaries to meet their primary health care needs. This often meant involvement by missionaries in the political and legal battles over the care and costs of treating their mission inmates.

Father Lyon Weiss wrote to the president of the Medical Board of Western Australia in Perth, as early as 1905 asking for pressure to be brought to bear on the Government to use its influence on hospital administrations and asking them to admit Aborigines, particularly those from the Kimberley region. Weiss told the Board that local hospital establishments at Broome, Derby and Wyndham would not cooperate to admit Aborigines. In the interest of justice and humanity Weiss asked whether hospitals in Western Australia had ‘a rule which debarred people from hospitals on the basis of their race.’ The Board’s reply indicated that Aboriginals were admitted and did receive the same treatment and care as other patients. Hospitals had special wards for Aborigines in many parts of the State, and where provisions were not provided the natives were placed in the general wards and made to lie side by side with other patients. Weiss knew that the Board was protecting the medical profession and the status quo, and he was unable to argue about health practices elsewhere. This was a continuing battle between missionaries, protectors and some property owners whose responsibility it was to pay for their sick labour.

As country hospitals increased in number centralised management became unworkable. After 1 July 1911, when the Heath Act of 1911-12 came into force, municipalities everywhere became health districts and Road Boards whose boundaries joined became a local health authority. A dichotomy existed in that, on the one hand, hospital staff and private doctors demanded payment from Aborigines before rendering a service. On the other hand, these same people accepted responsibility for their health. Chief Protector Gale knew this and he indicated that every care and consideration should be given to sick Aborigines because as patients hospital staff were duty bound to ‘make them as comfortable as possible.’ The reality was, as Weiss knew also, that the prejudice of health personnel dominated their actions.

As early as 13 November 1911 the Medical Department began involving itself in the way Aborigines were treated at country hospitals. On 25 November 1911 the Principal Medical Officer wrote to the Narrogin hospital that tents were on their way for use by Aboriginal patients. In addition the Chief Protector wanted to know why a separate ward was needed for Aborigines. By 1914 the Aborigines Department built the wards and they needed maintenance two years later. In 1916 Neville had been the Chief Protector for a year when the problem of maintaining ‘native’ hospitals emerged. He wrote to Narrogin hospital objecting to paying for repairs on the ‘native’ ward. The District Medical Officer, James. B. Lewis wrote during November 1919, that a large number of natives had been admitted to the hospital and placed in a portable frame tent at the rear of the hospital. According to Lewis, these natives were housed outside the main hospital because they were not clean. He added that their habits made the white patients uncomfortable. ‘If materials were approved, the orderly could manage the construction. Otherwise the Police Department have a frame tent that could be used.’ The Medical Department wanted the old ward (which was erected at the Protector’s expense) to be maintained by the Chief Protector together with an additional ward because of the increased numbers of Aborigines the hospital was taking. Neville noted on file that two small wards at the back of the hospital were intended for Aboriginal cases. Continuing his reaction, the Chief Protector wanted to know from the Medical Department whether his Department was to understand that because of the increasing number of Aboriginal patients, there was no separate accommodation for them. The problem of accommodating Aborigines abated when the Carrolup reserve offered a refuge where sick Aborigines could be cared for if disaster struck (as it did in the 1918-1919 Spanish influenza pandemic).

In 1916 two reserves were created because Chief Protector Neville wanted to remove people who had begun congregating in fringe camps on the outskirts of Perth. One was at Moore River and the other at Carrolup. These camps were populated mainly by unemployed Aborigines moving south from the Roman Catholic mission at New Norcia, which had recently closed. Aborigines had been gathering around the fringes of small towns since the Aborigines Department had been implementing its policy of closing the missions and bringing their inmates more deliberately into the workforce. As people experienced the freedom and ease of movement in the new style of fringe-camp life they tended to live close to where work became available rather than return to the rigours of Government and strictness of mission reserves if at all possible. In addition, the Department aided this change by encouraging private pastoral land ownership to employ Aboriginal labour on local farms in the southern districts of the State.

As World War I intensified it took white labour from the economy and allowed Aborigines to gain work in both the city and rural areas of the south. Near Perth Aboriginal domestics lived in fringe-camps located in bushland on the outskirts of the suburbs. These camps attracted most attention, and from 1916 a number of complaints were received from nearby white residents about conditions there. The Department also showed concern when reports came in about an epidemic of measles, bronchitis and pneumonia which affected many Aboriginal residents. In 1918 Neville instructed the local police to order Aborigines to shift their camps to Moore River, a reserve near the country town of Carrolup. Once there these camp populations suffered recurring respiratory infections. In part this was due to peoples’ inability to adapt to mass social living and poor economic circumstances. In part also these camp dwelling places meant that Aboriginal residents were forced to live partly indoors and partly outside and as a result they were subject to all the elements. In addition, both adults and children were in poor physical condition. Then, Soldiers began returning from the European War and with them came the Spanish influenza.

In late October 1918 the federal authorities quarantined two ships returning from the European theatre of war via South Africa. The first was the Charon Bay, a passenger steamer and mail carrier. The ship entered quarantine on Wednesday 21 October 1918. This vessel arrived at Broome in Western Australia, with many passengers on board seriously ill from Spanish influenza, which was also known as ‘pneumonic’ and ‘swine’ influenza. At the same time, the Director of Commonwealth Quarantine Services assured the nation that this, like diseases such as cholera and other infectious disease threats from Asia, should hold no fear for Australians on the mainland because they were in no immediate danger. The Charon Bay contained a large number of Fremantle residents. The second passenger steamer was the Mataram from London via South Africa, arriving in Darwin on 22 October 1918 on its way to Sydney. The quarantine officials in Darwin directed the vessel to sail immediately to Brisbane due to the larger quarantine facilities developed there.

Undoubtedly the pandemic spread throughout Western Australia. However, there is very little direct evidence of its impact on the Aboriginal population. At this time, Aborigines were not reported as being affected with the disease in Western Australia. But influenza did occupy the mind of the Chief Protector of Aborigines when he wrote his reports for 1918 to 1920 to Parliament. No additional information was given by the Medical and Health Departments which published aggregate data on the Spanish Influenza pandemic. Similarly, these departments made no distinction on the basis of race in handling the pandemic. In any case, a number of characteristics were different in 1918-1919 from earlier epidemics. One difference was its rapid movement across the world, from America, France, England and Spain to places such as South Africa, India and New Zealand to Australia. Reports soon reached Australia that the pandemic was a serious event affecting vast numbers of people in many different countries, especially those people who had little or no immunity. Strangely, those stricken were generally the younger rather than the older members of society. Mortality figures revealed that, unusually, it was the strong, healthy and young adults who were most severely affected. By contrast, among Aborigines most deaths were in the older age groups, particularly among those already weakened by other wasting diseases such as tuberculosis, venereal disease and pneumonia.

The influenza death toll in Western Australia soon rose to 538 people of both sexes, out of a total population of 332,732. There are conflicting estimates of the numbers of Aborigines who perished. Chief Protector Neville maintained that the health of Aborigines in the southern region remained good, and in his 1918-1920 reports to Parliament he indicated that a total of only five Aboriginal deaths from influenza occurred in 1918. No adequate health reporting system existed in Western Australia and information on either epidemics among indigenous groups or pandemics such as in 1918-1919, were reported long after the event, or not at all. In 1919, Neville reported that 17 Aborigines had succumbed to influenza. A more recent claim puts the Western Australian mortality figure at 150 Aborigines from both sexes. The general population suffered most after May 1919, with a peak in July, and a slow fall thereafter. Commenting on his Department’s work for the year ending 1918, Neville wrote that the pandemic affected Aborigines only to the extent that ‘a little’ influenza appeared ‘here and there’. Unlike the reporting system in Queensland, which had the status of a legal death and disease register, the Western Australian reporting system came from protectors’ reports, and only as estimates.

Neville repeated the words of the previous year in his report to Parliament saying, ‘the health of the natives throughout the State had been good.’ His firm conclusion was that no epidemic of a serious nature had occurred amongst them. It is entirely possible that deaths from influenza may have been misdiagnosed as pneumonia, given that medical personnel in America, Europe and Queensland had difficulty distinguishing between pneumonia and influenza. The rise in deaths from influenza was swift, when considered in terms of either the size of the State and the numbers of Aborigines in the whole of the State, but it was not catastrophic. In contrast to Queensland, the number of Aborigines dying from influenza in Western Australia appeared, from reports, to be low. If this was the case it reflected the quarantine efforts of protectors, police, pastoral property owners and missionaries.

The influenza pandemic came and went but the big issue in 1919 was the threat to white settlers of the perceived increase of leprosy among Aborigines. However, much of the fear was unfounded because only 22 cases of leprosy emerged between 1898 and 1920. But the disease had been spreading from the Gascoyne area into the Fitzroy River region since the earlier decade. As reports of increasing numbers of Aboriginal lepers circulated white townsfolk in the Gascoyne, Pilbara and Kimberley regions feared for their own health. To counteract the prospect of white settlers becoming infected the police confined suspected victims on isolated and remote tidal islands, a practice repeated from earlier outbreaks. Government agents, and police, then had the hazardous task of both keeping the patients in food, water and shelter for the rest of the decade. The first group of lepers from the Kimberley were segregated on Barretta and Berzout Islands at the beginning of the decade. From then to 1920 time leprosy began spreading throughout that region.

At the beginning of the decade Chief Protector Gale had to cope with an epidemic of venereal disease and although he brought in a style of protection not envisaged by Walter Roth, he did bring protectors, missionaries and pastoralist closer than at any previous times. Gale visited ‘native’ hospitals, ushered in the lock-up hospitals on Bernier and Dorré Islands and the National Hookworm Campaign, and involved the Department in caring, albeit on a rudimentary basis, for lepers stranded on tidal island in King Sound. Neville presided over the advent of segregated ‘native’ wards at country hospitals and the opening of the new ‘native’ hospital at Port Hedland. When the Spanish flu pandemic occurred in Western Australia it was impossible to know what the overall effect on Aborigines was because proper disease and death records were never kept, as they were in Queensland. Health services in the northern regions of the State began to develop as the flu pandemic subsided, at the same time as leprosy began to dominate the minds of the Western Australian politicians and the settlers of the Kimberley and Pilbara regions. Austerity marked the way the State reorganised its protection policies and the way it influences its approach to reserves, the hookworm campaign leprosy and venereal infection, while at the same time, a greater interest in ethnographic advice emerged, all of which are theme I develop in Chapter five.

Synopsis || Contents || Intro || 1 || 2 || 3 || 4 || 5 || 6 || 7 || 8 || 9 || 10 || Conclusion || Bibliography