Alfred Dudley ByrneThis address was delivered at the ninth Foundation Day Ceremony held at Royal Adelaide Hospital on 15 July, 1987.
I was conscious of the honour afforded me when asked to address this gathering on the nominated topic: ‘Progress in Gynaecology’.
It was suggested to me that it would be worthwhile recounting recollections of advances seen in my professional life time. My immediate reply was that in the short time which would be available to me such recollections would have to be very condensed if they were to be included. I fear that may still be so. But I thank the committee for the compliment.
To begin with let me define the terms already used.
‘Progress’ is advancement towards satisfactory higher standards. It can only be justified by comparison with some former status.
‘Gynaecology’ is the study of normal and abnormal states of female organs of reproduction – and their functioning – and relates to the so called ‘Diseases of Women’ a term largely used by authors of text books.
Two other terms you may hear used are relevant. These are midwifery and obstetrics. ‘Midwifery’ is a term which was more commonly used up to the last turn of the century. It donated the natural process of pregnancy culminating in the birth of a baby, viable or still-born, and more often than not that event was a matter of domiciliary care.
However, in more recent times, increasing importance has been paid to the business of keeping a pregnant woman healthy, in the interests of herself and her offspring. A need was seen for a name to cover this wider concept of care. The word chosen, and universally adopted, was ‘obstetrics’ – a word of Latin origin relating to the ancient name of midwife.
So, these days we have ‘obstetrics’ for the whole course of pregnancy, and ‘gynaecology’ covers normality and abnormality of female reproductive organs.
Last century, and perhaps up to the 1920s, midwifery was always considered to be a physician’s worry, rather than a surgeon’s responsibility. In fact, it was often said, within the precincts of surgical wards (and I quote): ‘Midwifery is no occupation for a gentleman.’ These days, of course, we -you and I- could never agree with that idea. I was taught just the opposite! Woe betide the student with slovenly approach.
Disinterest concerning the problems of parturition persisted in the Royal Colleges of Physicians and Surgeons, in England, up to the 1920s, and, although it was felt that a physician might always be available as a back-stop for a midwife in difficulty, no special training in relation to this art was devised, by either college, for their own candidates seeking higher diplomas.
Surgeons, admittedly, did have some slight interest in pelvic surgery. After all, it was to be found at the bottom of the abdominal cavity, which they often explored, and up to the late 1920s their leaders, especially in London, seemed to resent encroachment into the field – this despite the fact that the deeper layers of tissues forming the pelvic floor were generally not well understood by surgeons working higher up in the body.
However, all that was to change and more of that anon. Suffice it to say, for the present, that obstetrics is now seen as a very special part of gynaecology, and that both are interwoven to such an extent that a consultant must be considered an expert in both areas. In fact, these days, a specialist operating mainly in either branch is generally expected to be a Fellow of a College of Obstetricians and Gynaecologists.
In this regard there was a well-worn story, circulating in gynaecologists’ circles in London, some years ago of the well-known elderly specialist who was asked if his practices was still flourishing. He replied: ‘Most certainly, it is,’ and at this point I should remind you that the portion of the female parts most likely to be somewhat damaged during childbirth – even to the extent of requiring stitches – is called the perineum.
He had replied: ‘Certainly, it is’ – and then added: ‘For twenty odd years, in labour wards around this town, I supported the perineum. For the rest of my professional life I expect the perineum to support me!’
It becomes evident that consideration of Progress in Gynaecology Over the Last Sixty Years must cover a wider field than might have been necessary in the early decades of this century. Such progress, of course, has depended upon many factors.
Three which seem to me to have been important in the development of the art and science of the speciality are broadly speaking
- facilities which were, or which have become, available – eg buildings, equipment, and the means provided for use of them
- the right people in positions where they were able to make the most of the opportunities which fate offered, and
- new techniques acceptable in general medicine, and of use in this specialty.
But we need a background for comparison. So let me become historical, and recall some facts from the past – after all that is what heritage is all about.
Governor Hindmarsh landed at Holdfast Bay, after midday, on 28 December, 1836.
He proceeded to spot adjacent to a tent already occupied by one, Robert Gouger, the man chosen in London to be the official colonial secretary. Gouger and his young wife had arrived in the colony some seven weeks previously, having emigrated, along with seventy other passengers, in a privately chartered sailing vessel named Africaine.
Hindmarsh probably was not aware that behind him, in the tent, was young Mrs Gouger, already in the first stages of labour for her first baby.
The governor proceeded with the business of the Proclamation. Then, the Union Jack was hoisted; HMS Buffalo fired a Royal Salute. The assembled crowd cheered and then partook of cold collation and free beer.
Before returning to his quarters aboard the Buffalo, Hindmarsh announced the names of the eleven official advisers, appointed for the Crown, by the Colonial Office in London. The name of particular interest to us at this moment is that of Dr Thomas Cotter, appointed as colonial surgeon – a Dublin graduate.
Mrs Gouger laboured on, doubtless attended by a midwife, for there were already nearly five hundred immigrants scattered over the new colony. The colonial surgeon had not yet arrived, but did disembark a few days later.
Some time after midnight, in the early morning hours of the 29th, Mrs Gouger was delivered of a male infant. Sad to relate, neither she nor the baby did well. In fact after ten days of increasing debility, she died. Two days later, the baby also died.
Dr Cotter was justifiably angry at the lack of facilities, and made repeated representations to the authorities about that matter. Subsequently, two separate attempts at establishing a proficient dispensary were made, but patently such were unsuccessful.
During the next eighteen months Cotter fell out with the small board of management which, by then, had been appointed to oversee his activities. Finally, in 1839 he was dismissed. Dr James Nash, an English graduate who had immigrated in 1838, was appointed to succeed him. In fact, Dr Nash had been a member of the board appointed to over-see Cotter’s work. He held the post nearly twenty years.
Early in 1839, Governor Hindmarsh was recalled to England. A few months later, his successor, Governor Gawler, signed orders for the building of a small hospital. This was erected in the East Parklands and was opened in 1841. Amongst other facilities it provided (and I quote): ‘six beds for women’. These obviously were for gynaecological and midwifery use.
For those days, and by their standards, the hospital was a success. However, so fast was the population growing that within several years it was hopelessly inadequate. A bigger hospital just had to be built.
The second hospital on a more convenient site with plenty of room for future expansion, was built facing North Terrace – in fact, on the front end of this hospital site. It was not opened until 1857, by which time there had been built a second structure adjacent to the first hospital, to accommodate mental asylum cases. This, too, was becoming over crowded. In consequence the vacated wards of the first Adelaide Hospital were added to the available accommodation of the asylum, and were used for that purpose until a new mental asylum was built just outside the parklands at the south east corner of the city. The main building of the Parkside Asylum with its clock tower still standing is plainly visible to passers by.
The second Adelaide Hospital which opened in 1857, and took over the inpatients of the original hospital, and dealt with any fresh cases from then on, was a long narrow structure of two storeys, running east and west, parallel to North Terrace, standing roughly where the present Administration Building is. It was still there in my days, when I graduated and became a house-surgeon, and, even later on when I first came on to the honorary staff. The main structure contained administrative offices, residential accommodation for staff, a small theatre and a dispensary. The kitchen and store, and other service buildings were free standing behind the main structure.
At the western end of the main block was a bulky expansion, almost square in cross section, containing eight wards – four on the ground floor, and four on the upper floor. Originally this meant 120 patients’ beds for the hospital, but increasing demand for accommodation, in later years, led to those wards having verandah beds, protected by weather blinds, and so called ‘black beds’ in the centres of the wards, these soon to be considered as almost permanent fixtures.
Some ten years later, a corresponding wing, smaller in size, by virtue of the fact that it contained only four wards – two on each of two levels, was built at the eastern end of the main block. Of these wards, the upper two named Hope and Beatrice, are of interest. They eventually became the domain of two separate gynaecological clinics – each with its own honorary gynaecologist, along with his honorary assistant gynaecologist, in his own ward.
Adjacent to these wards, upstairs, was a small operating theatre which became known as Gynae Theatre, alongside which were a few service rooms, including a surgeons’ change room, with facilities en suite. Built-in cupboards, with wooden doors, in the change-room bore the names (painted on in block letters) of honorary gynaecologists appointed in succession as senior of each clinic, from the days of Edward Willis Way (in 1890) onwards. Similar doors bore listed names of honorary assistant gynaecologists, and their dates of appointment. Registrars, house-surgeons, students or visitors shared the rest, unallotted.
Somewhere, in the big new East Wing of the present rebuilt hospital, the two doors listing senior appointees; which were rescued at the time of the great demolition and re-located, fixed against a wall near the theatre allotted at that time to gynaecologists, should be on view for the benefit of posterity, and of special interest to this heritage committee.
In 1878, a small single storey unit was built behind the eastern end of the main block. It was free standing, and contained two wards. Originally meant to accommodate infectious diseases patients, it soon became available for other purposes, as such cases were quarantined elsewhere. Eventually, the unit came to be used for isolating septic, and potentially septic gynaecology cases. For this purpose a small theatre was established at the rear. Known as Da Costa Ward it served its allotted purpose for some sixty years being shared by the two gynaecology clinics until circa 1960.
In the final decades of last century, three other important institutions were added to the Adelaide scene, each of which had a marked influence on the activities of the Adelaide Hospital.
Firstly, the Adelaide Children’s Hospital, as a big charity organisation, was established on its present site in 1870. This not only provided much more suitable environment for sick children, but also eased considerably the demand for beds because until that time, on odd occasions, up to one third of Adelaide Hospital beds had been occupied by children.
Secondly, in 1874, the University of Adelaide was founded. But because of lack of funds, the Medical School was not started until 1885, and then only for the first two of a five year course. Six young men entered the course in its first year. By the time they had completed their first two years, arrangements had been made for them to follow on with the next three years of the course, whilst walking the wards of the Adelaide Hospital.
The man who interests us most, at this moment, was Dr Edward Willis Way. He was appointed under an awesome title relating to midwifery and diseases of women, which, however, was soon changed for a much shorter one – ‘Honorary Gynaecologist’.
Dr Way, as a child, had come with his parents from England. He spent his school days in Adelaide and then, in his late teens went to London to enter Guy’s Hospital as a medical student, where he took out the conjoint diploma. This permitted him to practise medicine in the United Kingdom. He went on to Edinburgh, and enrolled in the Royal Infirmary to further his education in gynaecology and obstetrics. There he graduated as MB and was appointed as a house-physician. During these years he had close association with Lord Lister, that great luminary who, as a scientist and surgeon, was largely responsible for the success, in English speaking countries, of the new doctrine of asepsis and anti-sepsis. The effect form him was to last a life time.
Way later became a demonstrator in anatomy at the infirmary and afterwards was appointed as a resident surgeon.
He returned to Adelaide in 1883, and soon became Honorary Physician, Adelaide Hospital. When the Department of Gynaecology was formed within the hospital, in 1890, he was appointed head of the department, as, by that time, he was also lecturer in obstetrics and diseases of women for the university. He soon gained a reputation, both locally and interstate, as a learned consultant, a lucid lecturer and an accomplished surgeon. In fact, he became accustomed to being watched in the operating theatre by visiting surgeons, introduced by his colleagues.
Way died suddenly and unexpectedly in 1901 whilst performing laparotomy in the theatre, His last words, uttered suddenly as he slumped to the floor were: ‘Watson come quickly!’ These were directed to his friend Archibald Watson, Professor of Anatomy, who was standing nearby. He expired almost immediately; the operation was completed satisfactorily by Dr James Hamilton, Honorary Assistant Gynaecologist, who was elsewhere in the hospital at the time.
James A G Hamilton, who, because of his initials, was known to his friends as JAG, succeeded Way as Lecturer in Gynaecology, University of Adelaide, and as Honorary Gynaecologist, Adelaide Hospital. The lectureship in obstetrics which Way had also held was passed to Dr Alfred Austin Lendon, MD (Lond) who held it until 1924. Hamilton who retired early because of increasing deafness, held his post until 1919. It was the age of men whose names became legendary, in the Medical School, University of Adelaide.
The third medically oriented institution to be established in Adelaide at the end of the last century was ‘The Queen’s Home’, so-named as a memorial to Queen Victoria who died while the original portion of the old building was under construction, in 1901.
The Queen’s Home was built in response to an idea put forward by Lady Tennyson, wife of the governor of the day. It was originally meant to be a charitable institution (to be called ‘The Lady Tennyson Home’) built specifically to provide comfort and accommodation (and I quote) ‘for respectable married women who were pregnant and awaiting confinement’ – at no cost to themselves, no matter how poor – or rich!
The name was changed in accordance with the belief of the governor’s lady, that its completion would make a fitting gesture of respect in honour of Her (Late) Majesty, in which case voluntary contributions from the public would play a large and meaningful part.
The governor’s lady and her friends, who had put forward the proposal, stipulated one restrictive provision: ‘No single pregnant women would be admitted’. The leaders of the medical profession in the city supported the general principle, but with two strong reservations
- that those persons who could afford to pay should be charged a fee, according to a sliding scale related to family income and
- pregnant single girls should not, repeat should NOT, be barred from admission
The governor’s lady was outraged over both demands. In writing to her relatives in England, she said some very nasty things about the doctors in Adelaide, reflecting gravely on their characters.
In the end, she lost out over fees, but her influence over a majority of the general committee, who, incidentally, were almost all lay persons, was such that it was not until the year of her death, in England, some fifteen years later, that pregnant single women were admitted to the Queen’s Home.
One wonders whether the two events were entirely unconnected, one way or another, as Dr James Hamilton had striven hard, and persistently, during intervening years, to have the ruling altered.
In due course, in 1902, a small midwifery hospital of two storeys was opened – though only providing accommodation for about half of the number of patients originally envisaged. This had been brought about by reducing the building in size. Instead of a central component containing an entrance hall, offices, and staff residential quarters, plus a northern wing containing labour ward facilities, and some post natal wards (and eventually an old fashioned, slow hydraulic lift), plus a southern wing containing post natal wards and nurseries, the whole complex was, at first, limited in size to the central block and the northern wing.
This meant that the entrance hall, as may be seen today, designed as a central feature in the front façade, was at the southern end of the original structure. It was some decades later that the southern wing was added. It being included in the more modern additions at the time. Thus, the entrance hall regained its originally intended central position in the balanced frontal façade of the old building.
When I first visited The Queens’ Home, as a student in 1925, there were two artefacts in the entrance hall which were destined to become memorabilia. One was a large brass panel fixed to the wall on which were engraved two long columns of names – one, a list of lay-persons who by philanthropy or other means had made considerable effort towards assisting the home. The other was a list of honorary medical officers who had served the home and provided supervision, care and treatment for patients, in an unpaid capacity. Where that panel is, at present, I do not know, but in view of existing predictions about the future of The Queen Victoria Hospital it should be preserved for posterity.
The second artefact was a pure white marble, clothed, female bust sculptured as a likeness of Queen Victoria in her young days. It stood on a carved wooden pedestal about four feet high, and was so-placed that everybody passing through the main entrance doors would see it.
It was considered to be quite valuable. It was also unique, being the only one anything like it in South Australia – although it was said some fifty years ago, that there was a very similar sculpture held in a gallery in the eastern states.
In the late 1930s, it was discovered that very few persons passing through the main entrance doors – be they students, staff or patients – knew whom the sculpture represented, nor what significance it bore in relation to the Queen’s Home. Because of that fact, it was proposed that the name of the institution be changed to ‘The Queen Victoria Maternity Hospital’. This suggestion was put forward by the retiring general committee at the annual meeting in 1939, and was agreed to.
Some years later, when building alterations adjacent to the entrance hall were being considered, the marble bust was sent elsewhere for safe keeping. It then became almost forgotten, over a period of a number of years. After an extended search, it was ultimately found carefully placed in storage, at the Art Gallery of South Australia on North Terrace from which resting place it was retrieved.
Where it stands, in these days, when the main entrance to the hospital is in the multi-storeyed structure near Grant Avenue, I do not know. It certainly should be preserved in some place of honour, being of historical as well as artistic value.
In more recent years, the name of the hospital has again suffered change. It has been shortened down to ‘The Queen Victoria Hospital’, because, so it is said, gynaecological procedures are becoming integrated so much with those previously defined as obstetric.
The names of those individuals who should be specially remembered for their guidance of the affairs of The Queen’s Home since its inception are: Dr J A G Hamilton, Dr A A Lendon, and Sir George Wilson. The latter being knighted for philanthropy and long years of service to the community. Each of these was also heavily involved in matters affecting the Department of Gynaecology, The Queen’s Home.
Of these colourful personalities, many stories were still being told in my student days. Along with names like those of Professor Archibald Watson, Professor Edward Rennie, Sir Edward Stirling, Sir Joseph Verco, Dr Arthur Lynch and the Honorary Surgeon Ben Poulton, their names were legendary.
Dr Alfred Austin Lendon, MD (Lond), whom I have already mentioned as the man who was appointed Lecturer in Obstetrics, University of Adelaide, after Dr Way’s death, arrived in the Colony in 1883 and soon afterwards was appointed, Honorary Physician, Adelaide Hospital.
At the end of his first five year term, he was not re-appointed, being replaced by a more recently arrived man (apparently one supported by a majority decision of a general committee). Understandably, Lendon was very upset over this. He resigned from the Adelaide Hospital and transferred his interest becoming Honorary Surgeon, Adelaide Children’s Hospital. He was soon elected to the Board of Governors, Adelaide Children’s Hospital, and eventually became vice-president. As Dean of the Faculty of Medicine, University of Adelaide, and Past President, The South Australian Branch of the British Medical Association, he proved to be a strong advocate on behalf of students. He obtained for them entry to the wards of the Adelaide Children’s Hospital, for clinical experience, and following that was able to ensure that students, already part trained in clinical medicine at the Adelaide Hospital, could, if necessary, satisfy the university’s pre-examination requirements via the Adelaide Children’s Hospital.
Lendon was a man of wide and varied interests. For thirty-odd years, he was President, the South Australian District Trained Nurses’ Society, and guided it growth to become a State-wide affair and a very successful organisation.
After his retirement, he became very actively interested in the work of the Anti-Cancer Campaign Committee of the University of Adelaide. Along with Dr F S Hone he helped ensure that the work was set on a firm basis.
Alfred Austin Lendon died in 1935, but is not likely to be forgotten: his reputation as a lucid lecturer, who urged his students to read ‘The Life and Opinions of Tristram Shandy’, and as a stalwart champion in the front ranks of the Anti-Cancer Campaign Committee of the University of Adelaide, will ensure that.
Equally famous in that era, in both obstetric and gynaecological branches of the specialty, was James Alexander Greer Hamilton. He became chairman of the honorary medical staff committee at the Queen’s Home, and the senior honorary gynaecologist of the Adelaide Hospital, as well as lecturer in gynaecology for the university for the years 1901 to 1919. He had been President, The South Australian Branch of the British Medical Association in 1890, whilst living in Kapunda. It was his frequent trips to the city, on that account, which triggered friendship with Dr Way, his move to the city, his ultimate assistancy with Dr Way and his appointment to the honorary staff of the Adelaide Hospital.
He became Honorary Surgeon, in charge of the Department of Gynaecology, Adelaide Hospital, on the death of Dr Way, in 1901, being already recognised as a very capable surgeon. James Hamilton was one of thirteen children of his father Rev Robert Hamilton of County Tyrone, in Northern Ireland – a man who had eight sons and fiver daughters. Four of the sons graduated in medicine in Dublin, and all four ultimately practised in Adelaide.
The eldest three were specialists – each of whom was on the honorary staff of the Adelaide Hospital, while the youngest, and much younger, brother was a general practitioner who practised in Unley, and later on North Terrace. But there was another man, with the surname of Hamilton, on the honorary staff of the Adelaide Hospital, as an honorary assistant physician at the same time. To identify these five Hamiltons, each from the others, it was the practice of the day to refer to them by their initials. So TK was the Honorary Ophthalmologist, Adelaide Hospital; JAG (referred to as Jag) was Honorary Gynaecologist, Adelaide Hospital; CW was Honorary Assistant Ophthalmologist, Adelaide Hospital; and AA (not related to the three brothers) was Honorary Assistant Physician, Adelaide Hospital. The general practitioner – that is the youngest of the four brothers – was RH (out in the suburbs).
Jag Hamilton had gained diplomas in both Dublin and Edinburgh where he concentrated on surgery. He came to South Australia in 1876 and spent fourteen years in country practice before coming to the city. He was a tall man, reportedly of magnificent physique and pleasing, cheerful personality who spoke with a rich Irish brogue. Like his brothers he had a great affection for horses, and regularly entered his animals in the annual shows.
In my young days there were many stories bandied around concerning Jag Hamilton and his brothers. Professionally, both Jag and TK had great beneficial effects on the standards of work set in the respective fields of medicine. Time and space prevent me from recounting some of the relevant stories, which are spliced with a liberal dash of Irish humour.
Jag Hamilton suffered increasing disability due to an inherited deafness, until finally, in 1919, he resigned from his postings as Lecturer in Gynaecology, University of Adelaide and Honorary Gynaecologist, Adelaide Hospital, as well as Senior Honorary Medical Officer, The Queen’s Home. He went to the country to live on his son’s farm, amongst horses valued for other traits than speed. But he returned after a few years suffering from terminal illness from which he died in 1925.
Arthur Francis Lynch was one of the first four men to graduate in medicine in the University of Adelaide, in 1889. In 1890, he and another of the four, named Frederick Goldsmith, became house-surgeon and house-physician at the Adelaide Hospital. They both left within a year, and went to areas in North Australia. Then Goldsmith went further on to the islands. Arthur Lynch settled in Port Darwin and served that town and a wide area of the hinterland for some six years. He then set off on a tour through countries of the Middle East, a trip which lasted two to three years. Returning to Adelaide by then well versed in tropical medicine (by which hangs an intriguing story) he set up practice in the city. He became a close friend of Professor Watson and gained appointment as Honorary Pathologist, Adelaide Hospital. After several years he turned to gynaecology, and became honorary assistant gynaecologist to Jag Hamilton. When the latter resigned on account of increasing deafness, Lynch was appointed Honorary Gynaecologist, Adelaide Hospital. However, he found himself to be so busy that he felt he could not do justice to that posting, so he resigned after only twelve months occupancy of that post.
Meanwhile, early in Jag Hamilton’s reign as senior Honorary Gynaecologist, Adelaide Hospital (with TG Wilson as his assistant) a second gynaecology clinic had been formed. The first appointee was Dr A E Shepherd of whom not much has been known beyond the fact that he was appointed by the government, roundabout the end of the so called hospital row, as Honorary Assistant Gynaecologist, Adelaide Hospital. In 1903, he was elevated to the post of honorary gynaecologist (with Dr W A Verco appointed as an honorary assistant), but he served for only three years. He was succeeded in his post by Dr T G Wilson who had been serving as Honorary Assistant Gynaecologist, Adelaide Hospital, since 1902.
Thus, the two gynaecology clinics came to be conducted for the next twelve years by Jag Hamilton and TG Wilson. Jag’s assistant was Arthur Lynch, TG’s for a time was W A Verco.
As already stated, Hamilton eventually resigned because of deafness. Lynch took his place, but stayed only twelve months, and then he, too, resigned. W A Verco became honorary gynaecologist of Hope Ward in 1920 (having been assistant gynaecologist since 1902, but junior to Wilson).
T G Wilson (later to become Sir George Wilson) was appointed as Lecturer in Gynaecology, University of Adelaide, in 1920. He held that post until 1940 during which time he also became Lecturer in Obstetrics, University of Adelaide, from 1924 onwards.
TG was a sound, conservatism and capable gynaecologist and obstetrician who was unwilling to approve new ideas until they had been well proven by others. A tall man, of solid build, he presented a stern countenance and serious demeanour in both the theatre and hospital wards. For him, gynaecology was a specialty, to be carried on by seriously-minded individuals concerned to act like gentlemen. Students and young graduates were expected to conform.
For his dedication to the care and treatment of hospital patients; for his organisation and management of facilities and staff to that end, and for his philanthropy in that direction, especially during times of need, he was honoured by conferral of a knighthood.
He resigned from the presidency of Queen Victoria Maternity Hospital in 1949, and was elected as vice patron, ranking next in official postings to His Excellency, the Governor of South Australia. He died in 1958.
T G Wilson’s honorary assistant in Beatrice Clinic was Dr Rupert Magarey – an honest and faithful practitioner, who had gone overseas to carry out postgraduate studies in obstetrics and gynaecology in early years, between the two world wars. Returning to South Australia, where he had been associated with Dr F S Hone at Semaphore, he later was appointed as honorary assistant in both obstetric and gynaecological clinics, in the teaching hospitals.
In 1928, he was appointed Honorary Gynaecologist, Adelaide Hospital, as senior of the Beatrice Clinic. He held that post until the age of sixty years when in the year 1939, in accordance with regulations, he had to retire. He was followed as honorary gynaecologist, by Dr Brian Swift. But Dr Swift, like a number of other honorary medical officers, enlisted in the Australian Imperial Forces and went off overseas. To help out in this situation, Dr Magarey came back to The Adelaide, and carried out the duties of a senior honorary gynaecologist for several years while Dr Swift was on military leave – a task he carried out with honour and distinction.
Meanwhile, Dr W A Verco, the senior gynaecologist in Hope Ward clinic, ran parallel to TG Wilson in the years 1920 to 1928. He was a quiet, unassuming man who had not troubled to seek higher level diplomas, and was content to let others have the limelight. He had built up a large private practice, and had a faithful following in the profession. This meant long hours spent in various theatres, around the town, which he managed unruffled, by starting early. Anaesthetist and assistant were expected to be ready also. It was not unknown for the latter to turn up to start the morning’s work at 6.45 am – a little late, perhaps – and find WA commencing the anaesthetic himself. So I am informed by an elderly colleague who was his house-surgeon.
WA’s favourite operation was ventro-suspension, utilizing a modified Gilliam technique, for incipient prolapse. His name is enshrined in Verco Buildings, a massive multi-storeyed structure on North Terrace, notorious for its thick concrete floors. His colleagues used to say the appearance of WA always reminded them of his building on North Terrace: ‘It was indestructible. It was built of concrete, and was supported by uterine ligaments.’
Verco’s honorary assistant gynaecologist, in the late 1920s was Dr Roland Beard MC – a lovable man who was a very careful operator, who tied ligatures on large arteries with four successive reef knots – three only for small ones. His motto when dealing with patients was primum non nocere (first do no harm). I heard it quoted oft-times, in the theatre in difficult situations. Roland Beard, who had been awarded a Military Cross for bravery under fire in France, had stayed overseas after the end of World War I and had spent four years with the professor at Birmingham. This yielded for him an FRCS. Later he became FRCOG as well.
In 1928, he was appointed Honorary Gynaecologist, Adelaide Hospital, in charge of Hope Clinic, replacing W A Verco. This post he held until retirement in 1947.
During those years, 1928 to 1947, several well-qualified men jockeyed for a position as honorary assistant gynaecologist on the seniority ladder. These included Drs J B Dawson, R F Matters, and H M Fisher, as well as B H Swift who was the senior of the four. Swift was appointed; Dawson went off to New Zealand where he became Professor of Obstetrics and Gynaecology, University of New Zealand, and later was knighted; Fisher went to Launceston and, as well as becoming the senior Consultant in Obstetrics and Gynaecology, Launceston General Hospital, was elected as the mayor of the city for a term of three years.
That left a situation where B H Swift was honorary assistant gynaecologist from 1928-39, and then was elevated to the post left vacant by the retirement of Rupert Magarey in 1939. R F Matters was appointed honorary assistant gynaecologist in Hope Clinic, as from 1940. He held that posting from 1940 to 1947.
Reginald Francis Matters, known to colleagues and students as ‘Rex’, was an Adelaide school-boy who, for family reasons, graduated in medicine, in Sydney, as MB ChB. Later he was to gain distinction as MD MS FRCS FRACS FRCOG and promoted Surgeon Commander, Royal Australian Navy (Reserve); he was afloat during World War II. He became Honorary Gynaecologist, Royal Adelaide Hospital, in 1948, being the senior specialist in Hope Clinic – a post which he held until retirement in 1954.
Rex was a cheerful, approachable and popular man with jaunty but gentlemanly, outlook, well liked by all students, and known to be a capable surgeon. He was honoured by conferral of a knighthood by Her Majesty Queen Elizabeth II.
Sir Francis Matters was to be seen on Anzac Day leading the Navy Officers’ Club, and of the Hospitaller’s Club of St John. He was actively interested in Legacy, and was an ex president of that organisation in South Australia. He died when aged eighty one years in 1975.
But the man who made the greatest impression on the gynaecological world in South Australia was Sir Brian Swift, Honorary Gynaecologist, Adelaide Hospital, in charge of Beatrice Ward, 1940-52.
Educated in Adelaide and then in Cambridge, he joined the Royal Army Medical Corps on graduation. He was awarded a Military Cross for bravery under fire in France in 1918. After some three years in general practice in Adelaide, during which he became Honorary Assistant Medical Officer, The Queen’s Home, he went overseas again, and gained the FRCS (Edin), and then proceeded to Vienna where he studied for a year with Schiller and Schauta. He returned to Adelaide in 1928, and was appointed Honorary Assistant Gynaecologist, Adelaide Hospital. He was also elevated to become Senior Honorary Medical Officer, The Queen’s Home. He subsequently became Lecturer in Gynaecology, University of Adelaide and Honorary Gynaecologist, Adelaide Hospital. He was elected a foundation Member, The Royal College of Obstetricians and Gynaecologists in 1930, and soon became a Fellow. He was Vice Chairman, later Chairman, The Australian Regional Council of the Royal College of Obstetricians and Gynaecologists when this was established.
He was knighted by Her Majesty Queen Elizabeth II for his services to women in obstetrics and gynaecology. He died in 1969, when aged seventy six years.
Brian Swift was a dynamic teacher of obstetrics and gynaecology. He was an accomplished surgeon with a bold approach and delicate touch, showing great respect for all healthy tissues. Acknowledged as an inspiration to those he taught, he was held in high respect by those he dealt with, and with affection also by those of us privileged to work closely with him. I was proud to be a junior member of his clinic.
Time and space prevent me from detailing the careers of younger men who followed on within the honorary system until that arrangement came to an end in 1970. Those who, in succession, became Honorary Gynaecologists, Adelaide Hospital, were: H E Pellew, A D Byrne, and G W Aitken in Beatrice Clinic and R L Verco and R M MacIntosh, in Hope Clinic.
In 1970, the honorary system relating to appointments of specialists and consultants to the responsible staff of teaching hospitals was replaced by employment of visiting specialists paid on a sessional basis.
So much for various personalities concerned with standards in the gynaecology department during the era of the honorary appointments system.
But what of the facilities which they had at their disposal for ensuring that standards advanced with the times?
In 1885, when the medical course was established, the Faculty of Medicine, University of Adelaide, was given limited space for seminar studies in the new additions built on to the north east corner of Mitchell Building. There they were adjacent to the old Prince of Wales Lecture Theatre which was a large highly tiered unit on the western side of the building. It was furnished with solid wooden benches and hard forms, and was approachable from various directions. Various disciplines had use of that facility. The medical faculty also had use of the laboratories, on an upper floor, for their practical work.
But Professor Watson, who occupied the chair of anatomy had another separate facility. It was an old building, situated some distance away, built into the lowest level of an escarpment on the boundary between the university campus and the Jubilee Oval complex, and near its eastern extremity. The old building had originally been a powder magazine – a portion of a police armoury of earlier days. More recently – that is, for the last fifteen years of the century – it had been used as a mortuary in which medical students had carried out anatomical dissections to the satisfaction of Professor Watson.
But in 1902, a newly built anatomy school came into use. It was a single-storey structure, with very large plain glass windows, located some distance behind Mitchell Building, near the top of the escarpment which ran roughly from east to west. It consisted mainly of two long parallel rooms – one used for dissection, the other as a museum – each measuring circa ninety feet by sixteen feet, with a small mortuary at one end and a few small service rooms at the other. There was no lecture theatre at first, but by 1923, when I started doing anatomy, there had been added, at the eastern end, a highly tiered lecture theatre capable of seating up to 200 persons. In it, on at least five mornings per week, for one hour’s duration and lasting over a full two years’ course, we had a series of lectures in human anatomy by Professor Frederic Wood Jones, a remarkable Englishman, a London graduate who was a lucid lecturer and a wonderful teacher, with great personality.
The years 1919 to 1921 saw considerable changes for the faculty of medicine. Professor Sir Edward Stirling had recently died, leaving the chair in physiology vacant. Professor Archibald Watson retired in 1919, leaving his chair also to be filled. To the former chair the university added the discipline of biochemistry, and invited to occupy it one, Professor Thorburn Brailsford Robertson, DSc, PhD, at the time of Toronto. He was a former graduate, as BSc, University of Adelaide, whom his mentor, Professor Stirling, had once described as worthy and, of all students he had known, the most deserving of a title of genius.
To occupy the chair of anatomy, Professor Wood Jones had received and accepted an invitation from the University of Adelaide, in 1920. That era was also remarkable for the erection of the Darling Building which had been built, with funds donated by the family of the late John Darling, junior, as a suitable venue in which to gather together the various sub-units of the medical school.
The massive red-brick building of three storeys, plus basement, was to be important from then on, for the foreseeable future, in the lives of students of all years in the new six year medical course. By reason of having passed essential subjects in higher public examinations, I, along with most of my immediate confreres, began the university medical course in second year. For two years we were interested in activities in the Darling Building on only the ground floor and the first floor. The former contained one large laboratory used for histology, a large highly tiered lecture theatre which, in depth, occupied the height of two floors, and a large area which was given over to a new medical reference library. The first floor was the principal domain of Professor Brailsford Robertson and contained, inter alia, various laboratories which he used for research and we used for practical studies in bio-chemistry.
The floor above, which was unexplored territory for us until fourth, fifth and sixth years, was shared by Professor J B Clealand, Professor of Pathology and Bacteriology, during the years 1920, to 1948 and Professor Harvey Johnson (who as far as we were concerned, was responsible for parasitology). He was of special interest, otherwise, because he had recently returned with Mawson’s expedition from the Antarctic, with two tons of specimens most of which, reputedly, were still to be uncrated.
We were aware that Brailsford Robertson was internationally famous for his successes in bio-chemical research, concerning the physiological importance of complex-proteins relating to growth and longevity in animals. He had already been acclaimed for being the second person in the world to isolate, identify, and produce in quantity, by his own efforts, in his own laboratory, the pancreatic hormone named insulin. This he did in 1922, with the assistance of an enthusiastic team of young graduates, in the Darling Building Laboratories. Within a couple of years, the demand for insulin, as replacement therapy for diabetes, became so great that it far exceeded the total limits of any available commercial supply. It is on record that, to meet the need, the University of Adelaide bio-chemical laboratories produced, for general use, some 40,000 doses of insulin.
It was to be recognised soon afterwards that insulin was of very special importance in gynaecology, in that its use in diabetic women improved greatly their chances of becoming fertile and successfully carrying a pregnancy to fruition. For gynaecologists it hammered home the truth of the dictum, already being propounded, round about that time, that fertility in women largely depended upon a correct balance of all hormones secreted in the female body.
Robertson’s research concerning complex proteins had been so successful, so it has been said, that the Federal Government was moved to establish the Council for Scientific and Industrial Research, popularly referred to as the CSIRO, and subsequently formed a special division relating to animal nutrition, with him as director. His work ultimately resulted in huge successes in relation to animal husbandry, and especially to advancements in wool production, for the sheep industry.
Brailsford Robertson died, unexpectedly, of acute respiratory infection, complicated by severe pneumonia, when aged forty six years in 1927. His death was a tragic loss, to the scientific world, of a great man who died in his prime.
The next obvious improvement in facilities for the department of gynaecology came with the return of Sir Brian Swift from overseas duty with the second Australian Imperial Forces. He had been appointed as Lecturer in Gynaecology, University of Adelaide, as Honorary Gynaecologist, Adelaide Hospital. It was he who initiated moves which successfully upgraded both the gynaecology and DaCosta theatres and as well achieved an improvement in the standard of furnishing of the gynaecology unit of a new outpatients department, sought and built about that time, but since replaced.
Roundabout 1950, a new medical school was built facing Frome Road alongside the Dental Hospital. This seven-storey structure was designed to accommodate most of the main units of the faculty under one roof, on a site adjacent to the wards of the Adelaide Hospital, and to deal with the greatly increased numbers of students (as compared with average enrolments in previous decades). It completely replaced the anatomy school which was later demolished, and relocated many interests occupying the Darling Building.
The latter remained the home of the chair of biochemistry with the potential to permit considerable expansion in accordance with demands of the times.
A recent personal recce, which culminated in a very friendly reception by Professor Elliott and a conducted tour by the Reader, Dr Barry Egan, revealed that the large lecture theatre has disappeared, yielding space for more laboratories and service rooms, as, too, has the medical reference library, for the same purpose. The laboratories themselves have been upgraded and extended. The main laboratory for students occupies a large space on the top floor and is a joy to behold. (For lectures, students go to a theatre next door on the campus.)
This extension and upgrading of facilities has great significance for gynaecologists, because of the very specialised intricate biochemical investigations which, these days, are being carried out in relation to such projects as extra corporeal, in vitro, fertilisation and implantation of products of conception, and for other comparable purposes. Without such, Adelaide’s successes in these fields, known world wide, could not have been achieved to such great extent.
In 1954, The Queen Elizabeth Hospital was built at Woodville, with the provision of 100 midwifery beds, and in 1958 Professor Cox was appointed to occupy the newly established chair of obstetrics and gynaecology. Under his guidance the university’s department of gynaecology developed special clinics, and relevant laboratories at The Queen Elizabeth were established.
Finally, in 1964, at Royal Adelaide Hospital, the time had come for the demolition of Hope and Beatrice Wards and the gynaecology theatre. Relocation of the two gynaecology clinics to the southern end of the fourth and fifth floors, in the new East Wing, and of theatre facilities to a pair of theatres on a lower level, beneath them was effected. The new multi-bay or multi-cubicle, wards with their added facilities were a great advance on the old dormitory style wards, soon to be demolished with the area to be over-built.
However, in accordance with the dictum that every new hospital is out of date by the time it is occupied, the gynaecology wards have moved on to some new location in more recently built additions, the exact site of which I am unaware.
So much then for the advancement in facilities which have been available to those who guided the course taken by the gynaecology department, during the era of the honorary specialist system.
As previously stated, progress depends upon many factors of which three categories seem to be important. In broad terms, as listed earlier they are facilities available, making possible the taking up of new ideas; the right individuals in responsible positions, for making the most of such opportunities as fate offers, and new developments in the art and science of medicine which may be of use in this specialty.
The first and second categories have been dealt with at some length. I turn to the third category.
Such developments may be technological and organisational, and may be mainly directed towards either branch of the specialty. Briefly then, those relating more to obstetrics.
The first great achievement of the century was the establishment of antenatal clinics, with emphasis on supervision during the whole of pregnancy. Dr T G Wilson, later to become Sir George Wilson, of both Adelaide Hospital and Queen’s Home fame, was rightly acclaimed as being the founder of the first antenatal clinic to run successfully in Australasia.
The introduction of lower segment caesarean section, replacing the old style approach for opening the uterine cavity. The newer approach, though somewhat more difficult to perform properly, is safer for the patient.
The discovery of the Rh factor in human blood, followed by realisation that fifteen percent of women of European stock are Rh negative, and that their babies will be at grave risk if pregnancy be due to spermatozoa from a completely Rh-positive male. The ultimate answer to the problem for a baby born alive, and so affected, lies in exchange transfusion. Very good results from this have been further enhanced by use of an immunising factor, and induced premature labour.
Establishment of a blood transfusion service, with temporary storage facilities of freshly drawn blood and maintenance of stocks of blood products for intra venous transfusion, against the risk of emergencies.
Recognition of the fact that control of metabolic bodily disorders, such as diabetes and hypertension, is imperative for the successful delivery of a healthy and viable baby, starting with achievement of pregnancy.
The establishment of The Queen Elizabeth Hospital, at Woodville, to serve the western suburbs, for the purposes of providing extra midwifery beds and easier access to antenatal clinics, as well as the facilities of a general hospital.
The appointment of Professor Cox to a chair of obstetrics and gynaecology, in 1958. His zeal and erudition have been productive of considerable progress.
The use of ultra sound in preference to X-rays, thus protecting the foetus, as well as the mother, from the dangers of irradiation.
And as concerns gynaecology from 1925 onwards:
The use of applied heat (1) as cauterisation of unhealthy tissue, (2) as through and through heat and diathermy, (3) as short wave and ultra sound. All these replacing foments and poultices, red flannel and radiators.
Better knowledge of surgical anatomy of the pelvis, with special reference to layers of the pelvic floor. F A Maguire, of Sydney, and B H Swift, of Adelaide, were very successful leaders in using efficient practicalities relevant to this field of repair.
Replacement of sub-total hysterectomy by total hysterectomy – a full-total hysterectomy, done with care to overcome pit-falls for the unwary, who often avoid them by doing less.
Special investigation for malignancy in the female reproductive organs including: (1) Papanicolaou smear, (2) fractional curettage, [(3)] selective biopsy including the advancing edge, (4) colposcopy, (5) laparoscopy leading on when necessary to laparotomy; with realisation of the importance of performing such procedures meticulously under vision in order to be credible.
Closer routine conferences with pathologists in the examination of biopsies.
New materials and new techniques: (1) the use of new biological products, such as penicillin, and its analogues, (2) the use of synthetic drugs, such as sulphonamides, or synthetic hormones or clomiphene citrate, (3) the use of micro surgery and cob web size sutures (as for example, in repair of fallopian tubes – although now largely superseded by extra corporeal in vitro fertilisation and implantation in utero).
The electron microscope; using ultra short electronic waves, it produces magnification of 200,000 times (for study of chromosomal DNA particles) and permits the practice of genetic implantation into other species.
The latest: the use of amnion membrane for covering raw surfaces: (1) to prevent adhesions intra peritoneally, (2) to promote healing on external surfaces.
But above all. The founding of the Royal College of Obstetricians and Gynaecologists, in London in 1929
- to provide an authoritative body of specialists in obstetrics and gynaecology, membership of which, once established, would be via a portal of entry supported by accredited training and examination, each to be valued at fifty per cent of a total obtainable
- to regulate the standards of training and the accreditation of teachers and examiners
- to provide regularly congresses and conferences open to all fellows and members
- to provide an elected body to act in political situations for all fellows and members
All new members were to be considered eligible for consideration, in due course, for elevation to fellowship, in accordance with standards achieved.
And further, all fellows and members would be expected to uphold the aim to maintain close adhesion between obstetrics and gynaecology in forming one speciality. This they would agree to by signing the register.
Extension to the dominions was foreseen, and to this end reference committees consisting of consultants, whose work was well-known in the four larger dominions, were formed in 1932. Others followed later – nowadays there are at least ten such scattered around the globe, in commonwealth countries. So successful was the whole venture that membership gained through training, and examination in the United Kingdom, grew rapidly – nowhere more so than in Australia. For this reason, and because of varying local circumstances, an Australian Regional Council of the Royal College of Obstetricians and Gynaecologists was formed in 1947, and given limited delegated authority. By 1966, there were 108 fellows and 180 members of the London based Royal College in Australia. For a number of different reasons it began to be realised that Australia should have its own separate college, and ground work for establishing such began to be considered. There was great kindly empathy, and goodwill, extended from England during the ensuing decade.
Eventually in 1978, the Royal Australian College of Obstetricians and Gynaecologists, the RACOG, was formed, with its own separate constitution. Professor L W Cox of Adelaide who had been president/chairman of the Australian Regional Council over the last two years was elected President, the Royal Australian College of Obstetricians and Gynaecologists, for 1978-9. Regional council was disbanded.
The constitution of the new college permits the introduction of two important innovations: (1) continuing medical education for all fellows and members would be available and strictly supervised, (2) renewal of fellowship, after completion of an original limited term, will be dependent, inter alia, on involvement in the continuing medical education scheme.
These matters are being supervised, in action towards fulfilment, at present.
In conclusion, I finally would make three points.
Firstly, I believe it to be evident that both art and science of gynaecology have advanced greatly for the benefit of women-kind at large, over the past several decades, and that such has been apparent in this hospital.
Secondly, (and in making this point I draw attention to the heraldic motto which accompanies the coat-of-arms granted to Royal Adelaide Hospital viz Servire ac Docere ‘To Succour and to Teach’. I believe that devotion to this motto has been vindicated.
Thirdly, in honour of our former teachers – the men who over past decades, taught us the art and science of obstetrics and gynaecology – I would raise my glass and quote the motto of the Royal College of Obstetricians and Gynaecologists Super Ardua Consurgamus ‘We Stand Together to Overcome Difficulties’.
Floreat Collegium ‘May the college Flourish’.