Hugh Robert Gilmore, Emeritus Physician, Royal Adelaide Hospital
This address was delivered at the fifteenth Foundation Day Address Ceremony held at Royal Adelaide Hospital on 14 July, 1993.
It is customary on this yearly commemorative occasion to give a brief address on some aspect of life in the Royal Adelaide Hospital, usually an historical review.
In attempting to look at the chaplaincy service over the years, some gaps in recorded detail make it appropriate that the groups of devoted men and women who have given this service be acknowledged as a whole rather than named.
However, the pioneering work in establishing a full-time chaplaincy in this hospital by the Reverend John Baker starting in 1963 through the next nineteen years, overlapping by a year or two his successor the Reverend George Wright, who served a further nineteen years from 1973 until his retirement in December, 1991, needs special mention.
His place has been taken by the Reverend Baldwin Van Der Linden of the Uniting Church. These gentlemen were joined by Roman Catholic and Anglican priests who are respectively Father Oliver O’Brien and Father Brian Newman at this time. To all these, both past and present, I express my thanks for their help in the compilation of this record.
The present establishment along with the part-time helpers is listed in the recently released annual report of the hospital. Described there are also some of their activities, week by week in the various sections of the hospital. I shall not spend time in repeating any of this.
The spiritual needs of the sick patient are well met by his, or her, usual minister or priest in the setting of the community. Medical practitioners of experience know how invaluable this support can be in helping restore full health to the sick, bring comfort to the dying and solace to the bereaved.
In a small community, the parish led by its minister can extend into the local regional hospitals but in large acute hospitals such as Royal Adelaide Hospital this continuing ministry becomes a practical impossibility; time to gain access, car parking, for example, defeats even the most determined.
For those who minister in the large hospital, special problems arise as they will be meeting people not known to them and many of whom may have given little thought to religious matters in general, or more than likely, as it applies to the individual in his, or her, hour of need.
Also, increasingly, the patients will not be representative of the wider community as social circumstances will bring larger numbers from the many ethnic groups who now make Australia their home. Some of these will come from Christian backgrounds but many will not; Jewish, Moslem, Buddhist, Hindu and other religions will present, and we should not overlook the traditional tribal beliefs of our own Aboriginals, or those from the many regions of Africa.
A further, and rather new trend, will bring its special challenge too; the short time stay for the average inpatient. I do not expect that an outpatient service will be a high priority in the further development of the chaplaincy service although, occasionally, some continuity may be seen as helpful after discharge from inpatient care.
These aspects all pose special demands and the need for flexibility, sensitivity and a preparedness to help and minister to each situation as seems most appropriate – such attributes can only flow from mature, and experience clergy, whom we are most fortunate to have as our chaplains.
Brief mention is made of the quite recent origin of the full time chaplain on the staff of our teaching hospitals which, in South Australia, are all government institutions. This new addition to the long established staff structure of these major hospitals, had its beginnings in the United States of America in the 1920s. On his return from study in the United States of America, Doctor Basil Hetzel with local interested clergy, notably Reverend Stan Haynes, gathered an informal medico-clerical group in Adelaide.
I was a member of this group for a while although I resigned when I found precious time for clinical practice, was competing with the more leisurely and somewhat repetitive discussion group.
The advent of the new Queen Elizabeth Hospital made it possible for the concept of a full time chaplain to be part of its basic structure and the leading denominations were approached. The only positive response came from the Methodist Conference who empowered its home mission department and superintendent, the Reverend Arthur Bottrel, to act and a full time chaplain was funded from this source in 1959.
Thus, it came to pass that the Reverend Frank Hansen was appointed as the first full time chaplain to The Queen Elizabeth Hospital in 1960, a post he held until his retirement in 1979. His experience in the position as well as other related aspects, he summarised in the Gordon Rowe Memorial Lecture given in 1991, copies of which are available at an address I can give any person interested in having this excellent summary, of both the local experience, as well as a broader review of the topic.
I further acknowledge the pioneering work of the late Archdeacon Sambell of Melbourne, later Archbishop of Perth, in being the first in Australia to inspire this work of the church in its teaching hospitals. Quoting him on this development, he said
Hospitals to my mind present areas of greatest need, and are therefore areas where Christ would first be found ministering. The hospital chaplain is an evangelist in his ministry to the patients, most of whom are outside the life of the church.
A few words about spiritual healing follow. Religion and medicine have had a close relationship down through the ages, and in most cultures of mankind. Time only allows passing reference to this aspect in this review today.
As an act of faith the Roman Catholic Church and the Orthodox have retained a firm line on the occurrence of Miracle. One only needs note the ongoing and apparently quite enduring impact of persons and places such as Bernadette Soubirous of Lourdes, Fatima of Santorem and Francis of Assisi; to name but three (although I feel bound to remark in passing, that Penola and its environs in our South East seems to be having a frustrating search for similar blessings).
Recognition by the other main stream churches of this lost aspect of the healing ministry has spawned a number of Guilds of Healing in the United Kingdom. One of the first of these was the Anglican Guild of St Raphael in 1915 and in 1947, the ethical committee of the British Medical Association agreed that, I quote; ‘members of the medical profession might cooperate with priests in their ministry to their patients without offending medical etiquette’ printed as a supplement to the British Medical Journal vol II 1947. In 1956, they became even more daring and produced a memorandum of evidence submitted by a special committee of the council of the British Medical Association addressed to the ‘Archbishop’s Commission on Divine Healing’ and published as pamphlet by the British Medical Association.
In the United Kingdom other groups at this time were the church psychological clinic run by Reverend Doctor Leslie Weatherhead and a Guild of Pastoral Psychology.
In Scotland, The Iona Community of the Church of Scotland with Reverend Doctor Sir George Macleod as it main mentor, came to be a powerful force. This reverend gentleman puts out in very lucid terms the evolving experience of some ten or more years, and I shall quote verbatim some of his pithy writing which appeals to my somewhat blinkered vision of this subject. He says
Healing is a central obligation of the Church. Christ came neither to save souls nor save bodies, he came to save men. In Christ there is neither Jew nor Greek, Bond nor Free, Male nor Female. He is the atonement… Christ makes crooked men straight… here the crooked mind, and there the crooked body, and most often, a combination of crooked mind and body.
The healing of bodies was the common experience of the early church; and one reason why from the third century to the present, we left our hands in Benediction, is to fulfil the necessity of the early injunction, ‘to keep them up’, at the end of the communion service, or mass, so great was the surge forward of the sick, in the congregation, to obtain the healing touch from the hands charged with charismatic power. In the Gospels there is frequent mention of the dual commission – to preach the gospel and to heal the sick.
In a more orderly or ecclesiastical way, this dual witness continued through the medieval period but dropped out from the Reformation witness, increasingly, as the acids of modernity corroded the fullness of the Faith…thus, it is not an ecstatic church that adopts it, rather to neglect it is subnormal.
In the present situation, one may say The Roman branch of the Catholic Church, in this, as in other regards, retains what might be called a pre-scientific power.
In so far as the Protestant witness has retained the practice, it has until recently become almost the prerogative of a few sects of the Christian Church…the Christian Scientists, Spiritualists, and the Pentecostalists etc; where it is in danger of becoming a heresy, as over emphasis upsets the balance of the full gospel. Now, the whole reformed church is awakening to its obligation once more. Herein lies a great hope, and a danger.
Dr Macleod continues
For at least ten years, we have been developing a practice which initially evoked scorn from certain clergy, but encouragement from doctors and psychologists; now there is sufficient experience to give a brief account of present practices as they are held in the Iona Community
- intercession for the sick by name
- the laying on of hands…with ministrant’s hands being the focus of the prayerful concern of the congregation of the faithful who are present.
Dr Macleod then elaborates the dangers he foresees, and which I shall mention but not elaborate in detail
- reversion to the primitive…we must keep our peculiar contribution to divine healing within the area of the scientific. Admit the miraculous by all means…what doctor does not in the ordinary course of his work? But do not confine its working to the ecclesiastical department of God’s mercies. The Church is not the miraculous element in the natural world, it is the interpreter of what is in any event a miraculous world
- impersonality…the danger of just going through the motions
- the danger of separateness i.e. healing sealed off from social concern…as our world grows more difficult, and complex by reason of our scientific breakaway from God, there is real danger of this panic reversion.
Reverting to the local scene, the chaplains in their daily movement about the hospital will have close contact with two major professional groups, the nurses and doctors.
I will not comment on the nurses, both those in training, and fully trained nursing staff without whom the hospital could not function. I do, however, have some views about the medical staff ranging from the students in training, to the most senior staff whether they be at the visiting level, full time such as director and their immediate supporting staffs.
A very brief look at the history of the development of medical knowledge gives some insight into the formative influences that bear on the student of today, and also the mature medical practitioners with whom they will be associating.
The Greek school of the Aesculapiads, whose wisdom and teachings have been passed down as the work of Hippocrates, held its place alongside the mythology of ancient Greece about 500 to 600 BC.
In the minds of these ancient men, along with the habits and attitudes of the many centuries to follow, the world of awe inspiring events, the unremitting struggle for survival, the need to find food and shelter and the capricious behaviour of nature, seemed to need propitiation which took various forms, perhaps a sacrifice of some sort, held in the hands of a special few, priests and medicine men.
With the decline of Rome, we have the advent of the Middle Ages roughly 400 AD to 1300 AD, the years of feudalism, with a powerful Church which had a monopoly of knowledge and learning. It was the age of religious scholasticism and dogma, where even the Hippocratic corpus was forgotten so that medicine stood still or declined.
However, it should be noted that it was the application of the Christian ideal of caring for the sick and disadvantaged that saw the founding of infirmaries with their strong intention of care, associated usually with abbeys, monasteries and convents. Two examples spring to mind in London; St Bartholomew’s founded in 1123 and St Thomas’s in 1215; although strange to say, these ancient institutions are at this very time facing the threat of change, even extinction.
In the 15th century, with stirring of the Renaissance, the old Greek medicine was rediscovered thanks to the nurture of it by the Arabs who added their own considerable contribution.
Thomas Linacre (1460-1524) in 1518 founded the Royal College of Physicians of London through Henry VIII granting letters patent on the advice of Cardinal Wolsey, his chancellor.
In the 17th century following the anatomists led by Versalius, Newton, Harvey and others, light began to be shed on the physical and medical world.
The 18th century, often called the century of enlightenment, had many illustrious men such as Withering, Jenner and John Hunter.
The 19th century, rightly called Darwin’s, also had Pasteur, Laennec, Simpson and Florence Nightingale. In 1858, the General Medical Council was founded to control the corpus of knowledge that should be required to register and therefore qualify as a practising medical practitioner.
Darwin brought a new way of thinking about biological material, human, animal, and plant. He established a continuity from physical, geological, chemical materials through to those of biology including man. It was not easy to see the place of God in the new scheme of things, let alone worship and practice found in all the Christian churches. Indeed, in the life of Darwin, one has a paradigm for the way the majority of students of biology including medicine, find their minds being conditioned by their studies and scientific discipline, to this very day.
A very brief look at the life of this remarkable man therefore follows.
Darwin was born in Shrewsbury, Shropshire, February 12, 1809, the fifth child of a wealthy sophisticated family. His maternal grandfather was Josiah Wedgwood and his paternal grandfather was a well-known 18th-century physician and savant, Erasmus Darwin. From an elite school in Shrewsbury in 1825 he went to Edinburgh medical school, but in 1827 he dropped out and entered Cambridge to prepare for acceptance as a priest in the Church of England.
He graduated in 1831, and almost immediately set out on his monumental trip on HMS survey ship, the Beagle, as an unpaid naturalist.
Thus, at the age of twenty-two years and graduating Bachelor of Art (List No 10/178) and having signed the mandatory thirty-nine articles to enter the church at his degree conferring ceremony, he had advanced in his Christian commitment as far as he would go.
Indeed, by 1850, he took his stand as an ‘unbeliever’, rejecting Unitarianism of some of his Wedgwood forebears as being the ‘featherbed to catch a falling Christian’ to use the biting description used by Erasmus Darwin when speaking of the Unitarian faith of the other grandfather, pottery patriarch, Josiah Wedgwood.
The evolutionary process which has moved from simple cellular organisms to the complexity of mammalian life, including man, is a mystery.
We perceive the driving force with difficulty. There is no clear-cut answer in science to the question as to why it all happens. The ‘why’ is left to religion. The triumphs of science do have their effects on religion. Both science and religion try to give a total world view with religion claiming a greater power to interpret the meaning of the universe; the result is that science appears always to be encroaching on what once were religious preserves. The philosophical problem of the late 20th century is the assumption that science and its technologies provide answers to illness and the preservation of health. The success of the scientific approach in the last century is so great, it would be surprising if this assumption was not made.
However, in historical perspective, such a belief seems unrealistic and opposition to this naïve idea is already building up as I shall mention shortly.
The earlier Hippocratic tradition of concern for the whole person, in his/or/her environment, has been replaced by the post-enlightenment view that illness is a mechanical failure.
The Cartesian view of the body as a machine has held centre stage, and still tends to hold it: humans have been reduced through the application of science skills to an ambulatory assemblage of parts. It is socially and intellectually gratifying for doctors to think of themselves as scientists. It connotes working in the realm of fact and truth. It is this way of thinking that promotes specialisation, and multiplication of specialists.
To enter medical education requires skills in scientific subjects, and involves six years of breathing the heady air of one field after another of scientific experience. This tends to produce a graduate who sees himself as a scientist.
I have been associated with the training of medical practitioners for forty years, and in this time, there have been four revisions of the curriculum; one consistent aim has been to have more training out of the teaching hospital and in the community. I believe some success has been achieved.
From this brief summary, of the way the body of knowledge and discipline that science has brought to medicine, I think it is perfectly understandable how a student starting his or her medical course with a firmly held faith in the Christian tradition, will have undergone a severe challenge. Many, as did Darwin, will have moved towards agnosticism. Those who manage to hang on as active practising church members will be careful to keep their faith well away from their professional practice. The most that can remain is an effect that their religious insights may have on their personal behaviour with their patients in daily practice. Thus it is that practitioners will welcome the assistance that chaplains can bring to their patients in matters relating to the spirit and soul.
I know that these aspects of human behaviour are tremendously important and that, psychiatry, will of necessity tread in these less scientific areas of man’s life. However the stature of a physician or general practitioner, ‘the complete physician’ if you will, is measured by the extent to which he perceives that sickness of a patient is often in this ill-defined territory of man’s spirit and nonphysical being, perhaps, with overtones expressed in disturbance of bodily function. This much said, the area of psychosomatic medicine will be encompassed by sound medical training without the need to create another specialty, let alone the need to speak of holistic medicine.
As a final comment, it is topical to think, again all too briefly, of some of the common problems we share.
There are inevitably many where the professional work of the medical staff and the chaplains overlap in varying degree. I mention but a few. Accreditation and audit are well established practices. The Board of Management, Royal Adelaide Hospital, has created an ethics committee with a broad base, including a chaplain.
A good starting point here would be the old Hippocratic injunction: ‘First do no harm’. At times, it seems medical technology and therapy have advanced more rapidly than our capacity to use them judiciously. Guided by the sixth commandment of the Judaic Christian tradition, we doctors have been conditioned in our training to view death as the ultimate enemy.
An example, often seen, is in our intensive care units where staff can behave as if death were an illegitimate happening or an abomination. In these units, life, or some aspects of it, can be sustained more or less indefinitely. It requires maturity of judgement and experience to see the fine line which separates such an ability from benefit on the one hand, and undesirable interference on the other.
In the short period of fifty years, roughly my own practising lifetime, a decision about death has been taken away from ‘natural causes’ which hitherto virtually played all the cards.
Dying is inevitable. Euthanasia derived from two Greek words means an easy, or good death, and is an evergreen topic for controversy, particularly if the adjective ‘active’ is added. Many physicians, in one survey as many as eighty percent, favoured, or practised, ‘negative’ euthanasia. Fortunately, the clergy and most of the legal profession alike realise that the decision to support life, or not, requires skilful medical judgement and commitment; and, in the final analysis, should be a contract between the caring physician, and his, or her, patient.
Abortion linked with genetic counselling or neonatal cytology and biochemistry, is another hoary problem.
The role of transplant surgery is rapidly advancing, throwing up many difficult socio-ethical questions.
Peering around the corner, I can see the imminent challenge of DNA, genetic manipulation, or even transplantation with many thorny associated decisions and problems.
And so one could go on, if time permitted. However, I hope I have shown in several ways how we are enriched and helped to have as fellow members on our staff, sharing fully in our professional life, the gentlemen who are our chaplains.
To close, I quote St Augustine of Hippo, that wise man of old, who said
Faith is to believe what we do not see; and the reward of this Faith is to see what we believe.