When Doctors Fail: Ludwig Bruck's List of Unregistered Practitioners (1886)
Philippa Martyr, Tasmanian School of Nursing, University of Tasmania
The purpose of this paper is to turn one aspect of medical history completely upside down - the comic but slightly reprehensible figure of the quack as the necessary foil to orthodox, correct, successful medicine.
In orthodox medical histories, quackery is given a paragraph or three, mainly to indicate how far orthodoxy has travelled since quacks threatened the lives of the innocent and unsuspecting. Various forms of boundary-riding were used by the nascent ninete enth century medical profession to consolidate their claims against these dangerous frauds. One such means was Ludwig Bruck's List of Unregistered Practitioners (1886).
The stereotypical quack of medical history is a fly-by-night creature. He - for it is usually a he - uses a false medical title, and may be employed by an unsuspecting friendly society, thereby doing honest doctors out of work. He makes outrageous claims to cure any and all illnesses, he advertises openly, and travels often in his search for fresh dupes. He is fearful of legitimate authority, knowing that it will expose him for the fraud he is.
What is so surprising is that an actual examination of the types of people listed by Bruck reveals a quite different picture of the unregistered 'quack' in Australia in 1886. These men and women are not, by and large, users of false medical titles. Many of them are not mobile practitioners, and twenty-one of them had been in practice in the one area for more than ten years. Most do not make outrageous claims. Far from being shy of authority, twenty-one of them had worked at some stage in their career with registered practitioners. Thirty-nine of them were government-appointed public vaccinators or hospital staff, seven were clergymen, six were Justices of the Peace, and one was actually the Mayor of Wood's Point, Victoria. In fact, they are on the whole as presentable a cohort of Victorian health practitioners as anyone could ask for.
Why A List of Unregistered Practitioners?The obvious argument from the orthodox stance is to claim that Bruck simply meant to categorise the unregistered, not to make any point about 'quackery' in Australia. This is far from being the case. In the late nineteenth century, allopathic scientific medicine was not yet the controlling and dominating force it became in the early twentieth century. Professional boundaries were still being drawn, and the British Medical Association in Australia was still in its infancy. For these reasons, the creation and preservation of a medical professional identity was imperative in colonial Australia.
Lewis and MacLeod, Pensabene and others have argued that up to about 1880, it was difficult for allopathic, UK-trained medical practitioners to argue their superior skills and worth over the unqu alified practitioner. My own research suggests that this view is influenced strongly by British developments in the medical sciences, most of which date from this period, but does not allow for the time-lag between the development of an innovation and its widespread practice. Youngson has explored this idea, and there are ample Australian examples to confirm it. Not all these are necessarily representative of disbelief in scientific progress, but were also influenced by local and international medical politics - in Sydney medical circles in the 1880s, for example, young adherents of Listerism attempted "to dragoon their weaker brethren into ways of surgical rightness". In other colonies such as Tasmania, unorthodox therapies such as homeopathy enjoyed considerable public and legislative support well into the twentieth century.
The Australasian Medical Directory and Hand Book was a part of the process of professionalisation of medicine in Australia. It contained not only a full list of all registered practitioners, but those who were beyond the pale of medical orthodoxy a s well. The real value of Bruck's publication is that it allowed a practitioner to see, at a glance, if his fellow 'doctors' were legally qualified, and also for them to see that he was. In a climate which was rapidly being shaped into medical dominance, this was of tremendous importance. The List of Unregistered Medical Practitioners appears as an appendix to the larger publication, along with a further appendix listing the American medical colleges which were not recognised by the Illinois State medical authority, considered the most important in the country. I converted the original document to htm format in 1996, and currently maintain it on the WWW. References in this article will link to the WWW version of the List.
Ludwig Bruck was himself a medical practitioner, and was also a medical journalist. His articles include the analysis of medical statistics, such as "The present state of the medical profession in Australia, Tasmania, and New Zealand", which appeared in t he Australasian Medical Gazette. In this article, Bruck claims that New South Wales is known as "The Paradise of Quacks", but does not say by whom. This analysis of the Australasian medical profession, published sixty ears after the List of Unregistered Practitioners, offers a useful comparison, and also highlights the professional politics involved in declaring a practitioner persona non grata.
The List of Unregistered Practitioners
The List is divided into seven regions: New South Wales (city and country), New Zealand, Queensland, South Australia, Tasmania, Victoria, and Western Australia. Bruck is able to account for a total of 257 unregistered practitioners. It is a valuable historical resource, providing an insight into the broad range of therapies available to the public from unregistered practitioners, and also the wide range of practitioners themselves, from the legitimate but unregistered locum tenens, to the free-wheeling abortionist, to the purveyors of cures for fading 'manly vigour'. There are hydropathists, electrotherapists, homeopaths, oculists, phrenologists, chemists, herbalists, makers of patent medicine and vendors of books and pamphlets.
It is by no means a comprehensive list, but is based only upon those who replied to a circular sent out by Bruck:
To every person whose name appears in this list, a circular was sent, with the request to furnish the Editor with particulars as to his medical training, &co. Those who have no particulars attached to their names have not replied to it. [To the List]The List reveals an overwhelming concern with what constitutes a legitimate practitioner of medicine. There are, as well as these, other practitioners who worked as health care providers at the same time, but were not considered to be practising 'medicine ', such as masseurs and midwives. These do not appear on the List. Bruck's list of critera seem to have been:
The List also offers an insight into opposition existing to 'standard' (allopathic/heroic) medicine in Australia. The variety of therapies available and the often explicit criticism of doctors in the advertisements both suggest that the market for health care in the Australasian colonies in 1886 was not dominated by allopathic, UK-trained medical practitioners. At the time the List was compiled, very few Medical Acts in the colonies placed any kind of restriction on practice. What did become an offence fairly early was assuming the title of doctor or surgeon without any such qualification. But apart from this, medical practice was largely unfettered.
Bruck's List is an excellent example of the nineteenth century medical profession's willingness to take upon itself the status of protector of the public and dictator of medical orthodoxy. Very few of those on the list were guilty of any crime or of breaking any of the colonial laws concerning medical practice. Yet in order to save the 'public' from falling into the clutches of these types - and in the absence of any legislation which would allow this to be enforced beyond the assumption of false titles - these 'unregistered' practitioners, who were unregistered only by local medical boards consisting of allopathic, British-trained practitioners, had to be collected in a list. Bruck's List serves to marginalise and categorise these practitioners, and demonstrates medical willingness to exercise control over the provision of health care services in nineteenth century Australia.
Statistical Breakdown of the ListThe List bears the names of a total of 257 practitioners.[Table 1] The weight of numbers is clearly with New South Wales, which on the surface may appear to support Bruck's condemnation of the Paradise of Quacks. Yet compar isons with the numbers of registered practitioners reveal a rather different picture. Bruck's own 1893 study shows that Sydney city (with 84 unregistered practitioners on the List) has 139 registered practitioners, and New South Wales in total had 691 reg istered medical practitioners in 1893, only six years after the List was published.
Bruck claims in 1893 that there are over 200 unregistered practitioners in NSW, stating that this makes "one to three in proportion to registered medical men in active practice". What he does not state, naturally, is that thi s also equals three registered practitioners for every unregistered practitioner. The 'quacks' are clearly outnumbered. Bruck's comment in 1893 that the unregistered are found "nowhere in such astonishing numbers as in New South Wales" is also free from any comment that the population of New South Wales was, at the time, double that of any other colony in Australasia except Victoria.
The question of why Victoria had comparatively few unregistered practitioners, compared to its substantial population, is an interesting one. I believe that it can be attributed to a combination of elements: an overcrowded local registered medical populat ion, early medical organisation, legislation, and a ruthless medico-legal faction in their professional organisational structure.
The local medical profession was overcrowded - Victoria experienced the second highest rate of medical practitioners per capita in Australasia, at 1: 1441. (The highest was Western Australia, which compensated for this with an area in square miles almost twelve times that of Victoria).  Melbourne offered a medical practitioner for every 659 persons, the most dense medical population in Australasia. Victorian medical practitioners were also less mobile than those in other co lonies, and the local medical school had been producing graduates since the 1860s, by 1893 some 222 of them. This certainly increased pressure on the local medical market.
Lewis and MacLeod argue that the Victorian Medical Practitioners Act of 1862 was basically inadequate because it did not allow for the deregistration of practitioners guilty of infamous conduct.  What it did allow, however, was the penalisation of those who took false titles. New South Wales did not even have the advantage of this form of legislation until 1900. The Victorian act gave the two local medical organisations, the Medical Society of Victoria and the British Medic al Association, the power to force prosecution of those who took false titles, and it did so. Bruck takes cheer in this also, describing Victoria as
the smallest and most densely populated colony in Australia, wh ere all unregistered persons using the designation of doctor, surgeon, physician, or any other title that may be construed to mean that they are legally qualified, are rigorously prosecuted[. C]onsequently the number of quacks in that colony is considerab ly smaller, and the number of registered practitioners proportionately larger.It is by no means the same as having sweeping legislation to ban all unqualified practitioners, but it marked a difference between N SW and Victoria.
The gender distribution places men well in the majority.[Table 2] It is interesting, however, to note that many women may have been engaging in forms of unregistered practice which did not meet Bruck's criteria, such as mi dwifery. Those women who do appear, tend to fall into three main groups - herbalists, those practising occult therapies, and those with degrees or qualifications which are similar to those held by qualified medical men. Herbalists include Mrs Holden (Sydney) and Mrs Jones (Sydney). Occultists, usually medical clairvoyants, include Madame Chalk (Sydney), Mrs Mason (Sydney), Madame Rolland (Sydney). Those with 'qualifications' are Lizzie Costello, Maria Garske, Miss Longshore (all of Sydney), and Ellen Curling (rural NSW). Most of the latter specialise in the diseases of women and children, and in obstetrics. Miss Longshore claims to be related to a Mrs Dr Potts, and Ellen Curling claims to have studied with her father, a doctor, before she was qualified.
By and large, though, it is men who dominate the List. They offer a diversity of ethnic origins, types of therapy available, and length of experience. The next breakdowns of the List will reveal the types of therapies and the scope of many p ractitioners in offering more than one therapy or specialisation. This is significant in that it may have made the unregistered practitioner a form of 'general practitioner' in his or her own right.
The third breakdown, this time by therapy,[Table 3] shows again the predominance of Sydney city in Bruck's List. What it also indicates is the popularity of herbalism, botanic medicine and homeopathy in unregistered practice. The role of the dispensing chemist is far less significant, numerically, in this list than contemporary accounts allow, as most dispensing chemists practised within the law, and did not take false medical titles. The more marginal therapies and techniques such as phrenology are not numerically threatening, even though clairvoyance as a technique seems to have attracted some attention. Travelling practitioners can be mostly found, as one would expect, in largely rural colonies. The semi-qualified also feature strongly - those who would act as a locum tenens or as a registered practitioner's assistant.
The List's range of advertised claims [Table 4] offers some surprises. Many practitioners claimed to be able to cure more than one form of condition, which accounts for the high totals. Again, Sydney is dominant. The types of conditions which featured in advertising are interesting of themselves - the most popular is 'manly vigour', or impotence, combined with 'nervous debility' thought to be caused by masturbation. Rheumatics and sciatica, as chronic conditions, are also prominent. Eye conditions, in ophthalmia-ridden Australian colonies, also feature, as do skin diseases. The two most significant categories numerically are manly vigour and all diseases - the 'universal paregoric' advertising beloved of allopathic practitioners who wished to demonstrate the fraudulence of all unregistered practitioners by tarring them with the same brush of quackery. Only five offer to cure 'female irregularity' or 'give advice to ladies', and only four offer cures for venereal diseases.
The complaints of allopathic practitioners against their heterodox competitors were usually based on claims of defrauding. What is often not mentioned in allopathic complaints of the time is the amount of antipathy expressed for allopathy and 'doctors' in these advertisments. That these complaints may have been to an extent justified may account for the silence of contemporary medical accounts on the subject.
The claims listed [Table 5] are not numerous, and again predominate in Sydney. The failure-of-doctors theme is a notable one, as is the 'no mineral poisons' argument, which sustained a thriving homeopathy and herbalism cul ture in Australian medicine in the nineteenth century. The complaints against the excessive doses of heroic medicine were criticised as early as 1869:
If you are to be an allopathic you need but three things: opium, calomel and antimony. Anyth ing that cannot be reached by them ought not to be cured.The claim that no charge will be incurred without cure, in a time when professional strictures were making any form of advertising more and more difficul t for the allopaths, must have been galling. In a time when philanthropy and charitable work in hospitals, free of charge, was seen as a means of social advancement for upwardly mobile doctors, to make a contract of healing was vulgar in the extreme.
The image of the quack in nineteenth century writing is of the fly-by-night practitioner, who slips out of town in the dead of night, having defrauded dozens of their money, or one who, in a city, would leave an office suddenly deserted and boarded up. Ye t from Bruck's own List, it can be seen that in fact a great many of these practitioners had long careers, which presupposes satisfied customers, or a lack of registered competition.[Table 6] The large numbers of ru ral NSW practitioners who had long careers might argue for a lack of orthodox competition, which in turn would have fostered the unwillingness of registered practitioners to move outside the cities - to come to a district to find a trusted unregistered pr actitioner monopolising health care provision would be more than most professionally-trained doctors could stand. It is also interesting to note that only three of those mentioned claimed themselves to have had long careers - the rest are identified by Bruck as having had such careers.
This may help answer a key question about unregistered practice in Australia. It may actually be not so much an opposite or opponent to allopathic British-trained medical practice, but its direct antecedent. By way of example - albeit British - the follow ing advertisement appeared in the British newspaper the Bristol Gazette and Public Advertiser, March 21, 1799. It concerned a clinic set up in Dowry Square, Hotwells, for oxygen therapy.
At present it is only ready for out-patients, and the attendance of persons in Consumption, Asthma, Palsy, Dropsy, obstinate Venereal Complaints, Scrophula or King's Evil, and other diseases, which ordinary means have failed to remove is desired.This matches practically word for word any 'quack' advertisement listed by Bruck. When this is taken into consideration with the quite long careers of many unregistered practitioners, their role as an earlier incarnation of orthodoxy - as the status quo which was gradually being overturned by allopathic medicine and its union with science and germ theory - becomes a stronger contention. It also affords a fascinating 'live' sample which demonstrates just how historically mutable is the concept of medical orthodoxy. Its mutability also adds to its usefulness as a tool of social and political control.
Bruck also took care to list any use of false titles.[Table 7] This is the only legal advantage the medical profession had at the time: practitioners using false titles could be found guilty under the various medical ordin ances in force in the colonies. A total of 57 practitioners on the List had assumed medical titles or degrees of some sort. Some of those, too, could have had a day in court with the title 'Professor', which is not a medical title. Twelve such claims wer e made, which means that those using actual medical titles or degrees totalled only twenty-nine, or just over ten per cent of all those on the List.
Evidence of Legitimating CollaborationMedical history, when confronted with 'quackery', tends to be dichotomous. The quacks are on one side, or rather outside the medical pale. Inside are the orthodox legitimate practitioners, and the two avoid each other, one out of fear and the other out of scorn. I have already explored the issue of association and collaboration in late nineteenth century Australian medicine, using the example of massage and electrotherapy. . Other evidence can be collated from Bruck's Li st which argues that, despite internal professional argument over collaboration with unregistered practitioners, some did work with or even train the unregistered.[Tables 8-10]
Only seven practitioners appear in more than one category. In other words, fifty-seven of the practitioners on the List could claim some form of unquestionable legitimation. Only six of those who appear on any of these three tables made any claim t o a medical title.
Respectable Persons?If the position of the unregistered was recognised de facto by local health authorities in need of a public vaccinator or a replacement at a distant country hospital, others went in the other direction and combined unregistered medical practice with other walks of life. As doctors in colonial Australia could also be local magistrates or justices of the peace, their unregistered fellows did likewise.[Tables 11-12] The combination of a religious calling with medical care i s a long-standing one,  which has irritated more than one registered practitioner. When Dr John Rosselotty arrived in Busselton, Western Australia, in the 1860s, he found the locals preferred the medical care of their Angli can pastor, Mr Brown. A disgruntled Rosselotty wrote to the Colonial Secretary in 1870:
Of course I am aware that Mr Brown is at liberty to quack if he will, but I think he would only be doing his duty as a neighbour if he attended to the spir itual wants of the people and left me to attend to the bodily ones.
'All Nationalities'?Bruck describes the quack problem in Australia as consisting of an influx of 'irregular medical practitioners of all nationalities'. This implies a teeming medical multiculturalism, and Bruck himself mentions in the same ar ticle that there are fourteen Chinese doctors in the greater Melbourne area. Yet in his 1886 List, there is a certain homogeneity to the unregistered. Most appear to be of British or Australian origin, with only a small proportion - 24, or less than ten per cent - are of recognisably 'foreign' origin. Of this ten per cent, the overwhelming majority are German. There are some thirteen practitioners with US qualifications or experience.
ConclusionsSome conclusions, therefore, can be drawn from examining the List. The unregistered practitioners of the Australasian colonies in 1886 did not, as a rule, make wild claims to cure, nor did many of them advertise. Many were 'respectable' citizens and employed by local health authorities, and if not, had some other significant health care provider role that fostered many long careers. Few were travelling practitioners, and few were lodge doctors. Of the stereotypical 'quack', most suspects would appear to be based in Sydney, where most of the affronting advertisements, false titles and extravagent claims appear. Bruck's office was based in Sydney, and this may well have coloured his perception of the 'quack menace' in Australia. As a 'menace', it does not appear to have existed outside of Sydney. There is also an element of xenophobia common to British-trained medical practitioners at this time, which led many local medical boards to debar US-trained and other 'foreign' doctors from registering in the Australasian colonies. Queensland had already made this move by the time Bruck's List was published.
Most of those on the List were not guilty of breaking any law, save that imposed by the medical profession on its competitors. The nature of the complaints against allopathy in some of the advertisements, and the long careers of many of these unregistered practitioners, means that Bruck's List speaks more about the failure of doctors in colonial Australasia than about the scandal of unregistered practice. Far from exposing quackery, it exposes the frailties of a nascent profession, still scientifically uncertain, but determined to control the provision of health care services. That medicine was eventually successful, triumphing over the old-fashioned providers of universal paregorics, shows not only the flexibility of 'orthodoxy', but its power as a form of social control.
Dr Philippa Martyr is a lecturer in the Tasmanian School of Nursing and the Review Editor of the Electronic Journal of Australian and New Zealand History.