School of Historical and Philosophical Studies - Theses
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ItemCommunicable Knowledge: Medical Communication, Professionalisation, and Medical Reform in Colonial Victoria, 1855-66Orrell, Christopher Edward Gerard ( 2020)This thesis examines the process of medical professionalisation in colonial Victoria from 1855-66. During this eleven-year period the medical profession of colonial Victoria were able to create Australia’s first long lasting medical societies and medical journal, found the first medical school, and receive legislative support of their claims to exclusive knowledge of medicine. The next time an Australian colony would have these institutions created would not be for another 20 years. This thesis examines these developments through a framework of communication, primarily from the medical community itself. Communication was central to the process that resulted in the creation of the above listed institutions. Here communication is examined as the driving force behind the two processes of professionalisation: the internal, community creating and boundary forming aspect; and the external process through which the community gains external recognition of their claims. For Victorian practitioners during the period of this study the internal process drives the creation of the societies, the journal, and the medical school, whereas the external process is typified by the campaign for ‘Medical Reform’ that sees the community engage in agitation for legislative backing of their conception of medicine as science over other alternate medicines. Communication was not isolated within the colony. As such the place of the Victorian medical community as a node within transnational networks of knowledge exchange is examined. As Victoria was better integrated into these networks than its colonial neighbours, an examination of the involvement of said flow of information in the creation of professional communities is considered an important part of this analysis. Behind these processes of community creation, I trace a thread of disunity sparked by professional differences. Highly publicised arguments over differences in medical opinion play out in the colonial press. This comes to a head at the end of the period of study. Despite their focus on communication the medical community ignores the role their public conduct plays in this process. The end result is that, while they were able to create these lasting institutions, their public conduct saw the public’s opinion of them stay low through to the end of the century.
ItemThe placebo mystique : biomedical implicationsClifford, Vanessa ( 2005)The 'placebo effect' is a medical enigma. It lies at the heart of modem medical research but remains an amorphous concept; used either as a weapon to dismiss the subjective successes of alternative therapies or to bolster medical claims to scientific 'truth'. In a paradoxical fashion, mainstream medicine overtly rejects the significance of the placebo effect, whilst simultaneously using its existence as justification for the use of placebos in clinical trials. This study aims to explore the complex relationship between biomedicine and the 'placebo effect'. Specifically, I aim to understand how dispute about the meaning of the 'placebo effect' developed and how it currently impacts upon clinical and research work. The study is structured in two parts; the first part contains a discussion of the historical background to confusion about placebos; the second part contains a report on a survey conducted to assess current understanding(s) of the placebo effect amongst Australian medical practitioners. The survey demonstrates that confusion persists amongst clinicians and researchers as to the nature of placebos and the placebo effect. There is disagreement about when placebos should be used, when placebo effects are involved and what conclusions should be drawn from the studies that are performed. The survey made it clear that many doctors are uncertain about the indication for placebo use in clinical trials; many doctors were under the mistaken impression that placebos are essential to control for the placebo effect. I argue that this misconception may well have its origins in Henry Beecher's incorrect assertion that the placebo effect makes placebos an essential component of randomised controlled trials. I discuss the implications of this, mostly particularly in influencing researchers to use placebo controls in situations where they are not methodologically essential.
ItemHealing without hospitals : homeopathy and medical pluralism in nineteenth century New South Wales (1840-1880)Bak, Tao ( 2000)As in the neighbouring colony of Victoria, homeopathy in colonial New South Wales attracted the support and attention of a wide cross section of society. In this thesis I concentrate on the varying ways in which homeopathy made its presence felt within New South Wales - with particular focus on the period 1840-1880. Linking itself with colonial ideals of progressive social reform, homeopathy in New South Wales, much like its counterpart in the United States, managed to establish itself in opposition to the `conservative' element within nineteenth century society. In a colony which has been described as `excessive' in its preoccupation with liberalism, the New System of homeopathy in New South Wales fitted neatly with both the anti-orthodox sentiment prevalent within New South Wales society, as well as the vision of a better, more egalitarian world which many colonists brought with them to the new country. During the 1850s the homeopaths and their supporters concentrated their efforts on the Sydney Homeopathic Dispensary both as a symbol of progress of the New System within the colony and as a means by which to extend the social benefits of this cheaper, milder and (for many) more effective medicine to the broader community. During the 1860s, with the Dispensary struggling to remain viable, the homeopaths attempted to secure legal support for the New System, petitioning the government to provide homeopathic treatments in government funded hospitals. During the 1870s, the homeopaths made their presence felt primarily through their role in blocking the repeated attempts of the regular medical profession to secure regulatory (restrictive) medical legislation within the colony. Focussing in particular on the public and political debates surrounding Sir Alfred Stephen's 1875 Medical Bill, I focus in the last section of my thesis on the nature of the opposition to restrictive legislation in the colony. I argue that this opposition needs to be understood not only in terms of the lack of unity within the regular medical profession itself, as has often been emphasised, but on the existence of a coherent and self-conscious defence of medical pluralism within the colony - a campaign within which the homeopathic movement in New South Wales played a central role. Working primarily outside of the bounds of the symbolic markers of professionalism (institutions, journals, societies,) often associated with a mature and influential medical tradition, homeopathy in New South Wales was less visible than in many comparable places during the nineteenth century, but no less influential.