Bureaucracy, Benevolence and Medical Innovation

Abstract

In 1956, Graeme Larkins, the first doctor appointed to the position of 'geriatrician' in Victoria, gave his first public address on the topic of geriatric services.1 He began by saying that there was nothing new about the methods to be used in the purpose-built unit then under construction at Mount Royal Home and Hospital for the Aged (hereafter Mount Royal) at Parkville. The restorative treatment to be provided in this novel hospital setting was new only in the sense that it was to be used for old people whose disabling conditions had previously been treated by putting the afflicted person to bed.2 What Larkins did not mention was that the introduction of geriatric services also entailed establishing a new type of medical role and definition of sickness. Unlike the other medical roles Victorians had come to expect in their hospitals, the role of 'geriatrician' (a title not then in common use in either Australia or Britain which provided the model for the geriatric service) focused not on the cure of specific disease conditions, but on minimising and preventing disability in patients who could not be cured and who, in their dependence, relied upon publicly funded institutions. John Lindell, first medical chairman of the Hospitals and Charities Commission (HCC), outlined the purpose of the geriatric units, that were to be situated in the benevolent institutions, at a meeting in 1954 of representatives both from Mount Royal and from the Queen Elizabeth Home in the provincial city of Ballarat.3 The units were to be centres for geriatric services, each serving a specific region, from which a medical practitioner appointed as 'geriatrician' would classify patients referred from the public hospitals and from the surrounding community, assessing the potential of each individual for rehabilitation.4 This medical practitioner would then oversee the provision of appropriate restorative treatment by nurses and therapists, followed by discharge to an environment judged, with the assistance of a social worker, to be the most appropriate to that person's needs. Ideally, he or she would then be supported in this environment by com-