Ray Marshman was a conscientious, dedicated physician who devoted his life’s work to the treatment and prevention of tuberculosis, in his roles as doctor educator, and later administrator.

During his working life he saw a lot of change in the management of the disease.
He experienced the disciplinary management of patients at Cresswell Sanatorium in the 1940’s, when rest, good food and fresh air was paramount. Rest was often for prolonged periods of many months, followed by graduated exercise, as the patients’ health improved and xrays showed clearing of the lesions. Sometimes patients were kept in a sanatorium for years, or would be discharged only to be readmitted months later. The death rate of young people was considerable.

Apart from rest, procedures of induction and maintenance of artificial pneumothorax and pneumoperitoneum were carried out by Ray as Senior Resident Medical Officer. Surgical procedures such as thoracoplasty, division of pleural adhesions, and phrenic nerve crush were done at the Austin Hospital. In these years, patients diagnosed because of symptoms, often presented with gross disease, and other cases were discovered when work and family contacts were investigated.

In the early 1950’s when mass chest X-ray surveys picked up many cases, the disease was mostly not so advanced, sometimes minimal and often symptomless. Ray, as a senior medical officer at the Central Chest Clinic was one of those who had to decide which new cases would benefit from admission to a sanatorium or the Austin Hospital (which also had a children’s ward as well as adult wards for treating tuberculosis of bones, joints etc), or whether the patient could be treated as an outpatient.

This was a time when streptomycin, para aminosalicylic acid and isoniazid became available. Victorian hospitals were early in using these antibacterials in combination for prolonged periods. Ray, together with other senior medical officers, was a supporter of such a regime.

In the early 1950’s, the emphasis in treatment was on long-term use of these antibacterials, usually starting with the patient in a sanatorium, moderate regular rest, good food etc, then rehabilitation for return to appropriate work. There was optimistic expectation of good improvement. This regime often gave the optimum result and a return to normal life was often possible, carefully monitored by Ray and his colleagues at the Central Chest Clinic. Unfortunately, resistant strains of the bacteria were soon to emerge.

A proportion of patients after medical treatment were left with ‘unstable disease’, which, in the experience of the physician, was still active or likely to become so with the passage of time. Examples of such remaining disease were persistent cavity, caseous lesions, and bronchiectatic areas with positive sputum. For any patient with positive bacteriology when these residual areas were localised, there was a good case for recommending removal by local resection, segmental resection, lobectomy etc.

In treating long term chronic disease Ray had the necessary communication skills in getting patient understanding and cooperation. A member of a team of medical officers, visiting physicians and thoracic surgeons who met regularly to discuss all cases where surgical intervention could possibly be of benefit, Ray’s wide knowledge of the disease and of the background and lifestyle of many of these patients meant that his opinion was always valued and respected.

This was a time when there was a waiting list for sanatorium beds and surgical beds at the Austin Hospital. After 1954, a year also when probably the highest number of surgical procedures was done for pulmonary tuberculosis in Victoria, the waiting lists disappeared, and soon Cresswell, Greenvale and Fairfield beds were no longer needed for tuberculosis sufferers, and by 1959 Heatherton Sanatorium, which had taken patients from these other institutions was able to allot two wards to Prince Henry’s Hospital for non acute care.

During these changes, Ray was taking on more administrative responsibilities. While it is easy to aim for excellence and keep staff morale high when a service is growing, it is more difficult with a contracting service. Ray did this by setting a high personal standard, always pleasant to staff and colleagues who appreciated his worth as did his patients.

With all those he had to deal with, Ray was cheerful, at the same time serious and careful with his deliberations. He was a physician who truly wanted the best outcome for his patients and worked hard to achieve a first class service, with the aim of controlling as far as possible and minimising the occurrence of the disease. He was a humble man, humane in his dealings with patients and staff, never irritable, courteous in manner and speech, sometimes showing a wry sense of humour. He was straightforward, and his directions were clearly understood, which left no confusion in his administration. He was a man of integrity.