James Estcourt Hughes, Emeritus Surgeon, Royal Adelaide Hospital
This address was delivered at the second Foundation Day Ceremony held at Royal Adelaide Hospital on 9 July, 1980.
At the beginning of this address I must nail my colours to the mast by saying that I firmly believe that we should never lose sight of our past, whether it be as the people of a nation, the staff of a hospital or as individuals. Because of this belief, today’s commemoration service impresses me as a most significant occasion. To take part in it is a privilege and to those responsible for my being here I offer my sincere thanks.
When I was asked to speak to you today the invitation was accompanied by the suggestion that I should choose a subject with some bearing on the foundation of the hospital. I was happy to agree to this, because it seems that, as a result of the speed at which we live at the present day, few people have either the time or, it would appear, the inclination to give much thought to the history of either their country or of those institutions with which they are associated. I have decided therefore to speak about some early landmarks in the history of our hospital, a subject which will involve discussing the hospital services provided in Adelaide between the years 1836 and 1856, that is to say during the first twenty years of what was then the Province of South Australia.
I have been unable to determine the exact date on which the first Adelaide Hospital was opened and, later, I shall say something about this question, but we cannot overlook the fact that the hospital was the lineal descendant of the Colonial Infirmary, the story of which must be told because, little as it merited the description, it was the first public hospital in Adelaide and ceased to exist, unlamented and unhonoured, when its successor was ready for occupation. We can no more ignore the existence of this shabby ancestor, than we can ignore the fact that, at the time, Adelaide was a small settlement, the inhabitants of which lived in tents and huts, which provided uncertain shelter and few, if any, comforts.
The men responsible for the foundation of South Australia gave little thought to the medical needs of the people they had induced to travel half-way round the world to start a new life in a colonial outpost where everything had to be done from scratch. They had however appointed a colonial surgeon, Dr T Y Cotter, who did not arrive to take up his duties until January, 1837. Meanwhile by the end of 1836 there were six doctors in South Australia. Dr John Woodforde the first to arrive, came with Colonel Light in the Rapid, two were the medical officers of HMS Buffalo and there were three others.
Immediately Dr Cotter arrived he was thrown into the midst of a controversy concerning the provision of care for the indigent sick, and if ever a man was asked to make bricks without straw, that man was Dr Cotter.
Unfortunately the story of the Colonial Infirmary is, almost from beginning to end, one of wretchedness and squalor. It is difficult to forgive the authorities for this, although it might be urged in their defence that their actions were dictated not so much by a lack of sympathy with the plight of the needy patients as by a severe shortage of money.
Dr Cotter’s first plea for help was based on the needs of three sick men, who were camped under an old sail, which provided their only shelter. One of the men was described as ‘lying on the ground with a rug under him, surrounded by filth, going days without food and being entirely dependent for relief on the charity of passers-by’. In response to the doctor’s appeal a finance committee was appointed and it was decided to rent for infirmary purposes a hut, twelve feet by eighteen feet, which was situated somewhere near where Holy Trinity Church now stands. This was only a temporary measure and in May, 1837, a small thatched cottage in the same locality was purchased for £71.3.9 but the former owner did not vacate it until 13 July and only then were the first patients moved in. Unfortunately, the colonial surgeon was not satisfied and reported that the hut was uninhabitable, one serious defect being that the roof leaked to such an extent that when it rained the floors were ankle deep in water. He also complained that, when asked for supplies, the colonial storekeeper sent along a few saucepans, some blankets and coats, but no beds, bed linen or earthenware. Not only were these simple necessities lacking, but also there were no sanitary provisions, not even a commode, so that when the need arose, the patients were obliged ‘to go out into the bush’. It is not surprising that, under these more than Spartan conditions, three of the first four patients promptly died.
Doggedly, Cotter persisted with his requests and complaints. For instance, he asked that the grounds should be fenced, a space for cooking provided and a privy erected. On 20 January, 1838, he wrote saying that the infirmary was without fuel, light and soap, the blankets and the patients’ clothing needed washing and there were no vegetables for patients suffering from scurvy. The patients were forced to club together out of their meagre resources to buy a candle. On 9 April he reported that the resident commissioner, who shared power in the Colony with the governor, with whom he was constantly at loggerheads, had refused an application for rations and medical comforts, so that the only help for the inmates came from charity. Later still, on 25 August, he stated that the bed coverings consisted of only a few dirty blankets and great-coats and the mattresses were made of sacks sewn together and filled with shavings. There were three iron double bedsteads, which had been borrowed, and at the time of his writing there was no nurse, no fuel, no water and no candles. Admissions were being refused because it was impossible to provide care, cleanliness and comfort; in fact, the building was ‘in every respect totally unfit for the reception of sick people’. Cotter added that he was compelled to use his own money to preserve the existence of the three patients then in the infirmary.
This last outburst stirred up a public controversy in which the newspapers took an active part and from which poor Cotter did not escape unscathed. The outcome was that, in December, 1838, a board was appointed to manage the affairs of the infirmary and at some time within the next few months the old infirmary hut was abandoned and the infirmary was moved to one of a group of buildings that had been erected as an immigration barracks at Immigration Square, which was in the west parklands, north of where the Bureau of Meteorology is located today.
In spite of all its shortcomings the infirmary had attendants from time to time. The first of these gallant people was a Mrs Wickham who undertook the duties of nurse and cook at the modest remuneration of ten shillings a week. She was a kindly soul and a resilient one, who, on one occasion, paid the fuel bill out of her own pocket and had great trouble in recovering the amount owing to her. The next to be mentioned was a Mr Chadwick and then Mr John Widgeon, who became ill as a result of the conditions at the infirmary and was dismissed because he was alleged to have received £9.16.0 on behalf of the infirmary but had failed to account for the money. In 1840, Sergeant Jolly of the 39th Regiment undertook general duties at the infirmary for a weekly salary of £1.10.0 and rations. At this time the average number of patients was seven.
By May, 1839, the inadequacy of the Colonial Infirmary was apparent to all and Governor Gawler, who had succeeded Governor Hindmarsh in October, 1838, proposed to use two financial windfalls which had come his way as the nucleus of the funds necessary for the erection of a new hospital. This means that the unedifying story of the first South Australian public hospital may now be closed with as little regret as was no doubt shown when its doors were closed and the first Adelaide Hospital was ready to take over its role.
Throughout his term of office, Governor Gawler was rather reckless with the colony’s limited funds, but he was enthusiastic about the proposed hospital and the project moved ahead quite quickly. A building committee was appointed, amongst the members of which was C S Kingston, a quarrelsome Irishman of republican sympathies, who was said to have been ‘slightly acquainted with the profession of architect and civil engineer’. It was he who drew up the plans for the new hospital and was possibly responsible for selecting the site on which it was to be built, which was just north of Botanic Road and west of Hackney Road. Colonel Light in his plan for Adelaide had set aside an area for a hospital, which was south of Botanic Road and close to where the Waterworks Depot now stands but in this instance his plan for the city was not followed.
Tenders for building the hospital were called late in December, 1839, and Mr Benjamin Fuller submitted the lowest tender, which was for £2,260. Because of the well recognised financial instability of the administration, Fuller asked for a guarantee that he would be paid. He must have received some assurance on this matter because when the time came he undertook the work. That Fuller has some grounds for his misgivings is shown by the fact that the last part of his money was not paid until a considerable time after the completion of the building and then only after he had taken legal action to secure payment.
Meanwhile, the governor had issued a manifesto inviting subscriptions to the building fund from members of the public, but, later he reported to the Colonisation Commissioners in London that ‘he could scarce find any to assist’ and, in fact, only £300 was given in donations, which was certainly not a generous response.
By 10 July, 1840, work on the building was sufficiently advanced for the governor to lay the foundation stone at a ceremony in which members of the public showed as little interest as they had shown in subscribing to the cost of the building. In spite of the fact that it failed to evoke any enthusiasm at the time, it is this occasion which we are commemorating today as the 140th anniversary of the foundation of this hospital. When the building was eventually pulled down in 1938, this foundation stone laid nearly a century before was preserved and may now be seen in the entrance hall of the present Administration Block.
The hospital was designed to accommodate thirty patients in two twelve-bed wards and one of six beds, but it was pointed out that another ten patients could be received if necessary. One interesting feature of the building was that the wards and other rooms all opened at a central room sixteen feet square, which served as front hall, dining room, board room and operating theatre, while an almost incredible omission was that no kitchen was provided. During its long life many alterations and additions were made to the original structure which ended its days as the Consumptive Home and Cancer Block of the second Adelaide Hospital.
We must now consider just when the first Adelaide Hospital was opened. Probably discouraged by the poor attendance at the laying of the foundation stone, the authorities did not arrange any official ceremony to mark the inauguration of the hospital. The Inspector of Hospitals, Dr J P Litchfield, announced late in November, 1840, that he expected the hospital to be ready for use in a fortnight and it does seem likely that the building was at least partly occupied by the end of the year. On 14 January, 1841, Dr Litchfield finally announced that the hospital was ready and, on 25 January, James Jolly, formerly of the Colonial Infirmary and now surgeon’s assistant at the Adelaide Hospital, lodged requisitions for tables, seats and beds, and I lean to the view that the institution became a going concern either late in January or early in February, 1841.
Although the hospital was now quite well-housed, its opening did not usher in an era of peaceful progress. Financial problems continued to beset it and official parsimony, sometimes by choice and sometimes of necessity, plagued the institution. Originally the government had hoped that the hospital would be run on voluntary or semi-voluntary lines but it soon became apparent that this hope would not be realised and that the government would have to bear the whole financial burden, an obligation which it did not accept gracefully.
A board was appointed to run the hospital, but this arrangement lasted for only fifteen months before the board was relieved of its duties and the conduct of the hospital was handed over to the Colonial Surgeon, Dr J G Nash, who had succeeded Dr Cotter.
In January, 1841, three honorary medical officers were appointed to look after the patients and this number was soon increased to four and then to five. The honorary staff asked for but was refused, representation on the board, whereupon its members, with one exception, resigned in protest and the board had to make other arrangements until the honorary staff returned and co-operated with Dr Nash in the work of the hospital. This is the beginning of the history of the honorary staff, which, with one or two interruptions, served the hospital until 1970, when it was replaced by a paid visiting staff.
I hope that you will bear with me while I referbriefly to my own association with the hospital. This began in February, 1924, when I was a fourth year medical student and apart from one short break, I have been connected with it ever since. Indeed, I do not hesitate to say that the highlight of my professional life was my being appointed an honorary surgeon to the hospital. My pride in the honorary staff was such that I join those who regret that, in 1970, changed circumstances led to its supersession as mentioned earlier.
Of the attendants at the new hospital little is known. James Jolly carried on until 1844. He was succeeded by Robert Travers Lewis who had at one time been suspected of engaging in the illicit distillation of whisky, and then, in 1847, Henry Briggs came to the hospital and continued to serve it and the second Adelaide Hospital until 1873. His wife joined him and became the first matron of the second Adelaide Hospital.
When the original hospital was built it was confidently expected that it would meet the needs of Adelaide for a long time, but by 1850 it was clear that it would not do so. After the customary lengthy discussions, it was decided to build a new hospital on the site now occupied by Royal Adelaide Hospital and this second Adelaide Hospital, opened in 1856, survived until 1963, when, with its buildings tired, worn out and below the standard required for a modern teaching hospital, it fell to the demolitionists and was replaced by the hospital we know today. In order to prevent any confusion about the name of the hospital, I must remind you that the privilege of using the Royal prefix was granted by His Majesty King George VI in 1939, since when it has been Royal Adelaide Hospital.
In this address I have been more concerned with the bricks and mortar aspect of our history, but, of course, although the physical structure of a hospital is important, it is the people who work in it who give it character and are responsible for establishing its traditions and I would like to say that, in its long history, our hospital has never lacked men and women of quality who have unfailingly pointed the way ahead to those who were to follow them. In the years to come may our hospital go from strength to strength and continue to live up to its motto: Servire ac Docere.