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Birthplace of Australian nursing celebrates bicentenary

Sydney Hospital has helped to advance patient care enormously since its humble and wretched beginnings 200 years ago, writes Flynn Murphy.

It began life as a collection of tents pitched on the western shore of Sydney Cove, when life as a nurse was so bad that the job was used as a punishment.

When Captain Arthur Phillip sailed into Sydney in 1788 with a waterborne disease-factory known as the First Fleet, scores of sick convicts, marines and their families were unloaded from ships and moved to a rudimentary tent infirmary in modern day Circular Quay. There, they were tended to by the more unfortunate of Australia’s first convicts.

From these wretched beginnings would eventually grow Sydney Hospital, the birthplace of professional nursing in Australia. But back when the First Fleet arrived, unhygienic conditions and the prevalence of infectious disease meant nobody wanted to tend to the sick.

The tent infirmary persisted for more than two decades until 1810, when Governor Macquarie took office. Knowing that Australia needed a hospital, and unwilling to be derailed by a lack of funding from London, Macquarie came up with the idea of contracting three wealthy businessmen to use convict labour to build on a street named after himself, and to pay them by giving them a monopoly on rum imports. That was how Australia’s first hospital, now home to a best-practice drug and alcohol facility, came to be known as the Rum Hospital.

Today, dominating its present site on Macquarie Street in the CBD, the grand Victorian-style hospital comprises 113 inpatient beds and employs more than 240 nurses. It has three academic departments affiliated with the universities of Sydney and NSW which specialise in hand, eye and sexual health, as well as outpatient services in general medicine, and what remains the referral unit for all major hand surgery in NSW (established by Bruce Conolly in 1971).

It’s a long and complex history, skilfully captured in Caps and Veils: The Nursing History of the Sydney Hospital Matrons and its Nurses by Valerie Griffiths and released this year to coincide with celebrations for the bicentenary of the hospital’s move to Macquarie Street (while Macquarie laid the foundation stone in 1811, the hospital was in fact completed on April 2, 1816).

The publisher of the book, Elinor Wrobel, is curator of the Lucy Osburn-Nightingale Museum – a treasury of medical artefacts nestled on the first floor of the four-story gothic revival Nightingale Wing, which was built in 1868 and became the country’s first nursing school.

“Our history is a pivotal history of the development of Sydney,” Wrobel told Nursing Review during a kindly offered after-hours tour. “Macquarie Street was laid out especially for this hospital.”

Wrobel trained as a nurse at the Sydney Hospital nursing school during the 1950s. She has seen a string of medical firsts and breakthroughs in her time, and remembers when the first male nurses were employed in the 1970s.

She also remembers colleagues succumbing to all sorts of infectious diseases.

“Bear in mind tuberculosis was quite well represented here when I trained in the ’50s, and it was only after the Second World War that they had [tuberculosis antibiotic remedy] streptomycin. We used to nurse them on the verandas – we had all these big open verandas, so [patients] were nursed with isolation techniques there. We had all sorts of terrible diseases: cholera, you name it. When diseases would run rampant, [isolation] tents would be erected in the Domain [a large adjacent park].”

As both a historian and a former practising nurse, Wrobel is well-placed to evaluate the impact of the Sydney Hospital nursing school on nursing in Australia. While it may be Florence Nightingale’s name on the building, she explains that the patron saint of professional nursing in Australia is one Lucy Osburn.

In the mid-19th century, at the end of the Crimean War, word had spread to the antipodes of a young English nurse making waves with her steadfast approach to sanitation and hygiene. The nurse, Florence Nightingale, was called upon by then-colonial treasurer Henry Parkes to help establish best-practice nursing in Australia, and at his request, Nightingale sent Lucy Osburn and five other nurses to Sydney to inaugurate the Sydney Hospital Training School for Nurses.

The nurses arrived in March 1868 to take control of the infirmary. Wrobel reminded NR that in those days, the idea of gentlewomen working as hospital nurses was shocking to many. Free people and convicts alike could be ordered by a judge to work at Sydney Hospital as a form of punishment for crime or transgression.

“Nightingale sent the Lady Superintendent Lucy Osburn only on the condition that a nurses’ home would be built – that the nurses wouldn’t be locked up with the patients at night. Because, as a form of punishment for reformed convicts here in the colony, if they were naughty the judge would sentence them to serve some time as a nurse at Sydney Hospital. So that shows you how bad conditions were. People forget that.”

Under the tutelage of Osburn the nursing school grew in prestige. Over the years it housed and trained thousands of nurses. After Osburn returned to England in 1884, many of the original five took up positions at other hospitals around Sydney, spreading the high standard of care.

“The Sydney Hospital was where professional nursing in Australia began,” explained Dr John Graham, an emeritus honorary consultant physician at the Hospital. “When I went there as a student in the ‘60s the nursing school was still flourishing, and it was regarded as a mecca for nurse training. A lot of them went on to become leading nurses, matrons and directors of nursing at other places.”

Graham retired from medical practice last year after working at the hospital for most of his adult life. He says it is not uncommon for Sydney Hospital staff to spend their entire working lives at the facility, something he attributes to the collegiate atmosphere.

Graham first attended informally as a medical student in 1965. He was looking for techniques in ear, nose and throat surgery that he could apply to a research degree he was doing half way through his medical course in the physiology department at the University of Sydney.

“I was being asked to develop an operation on pussy cats where we were testing various parts of the neurological pathways for hearing, and they hadn’t ever done any research like it. They asked me to work out how they could implant electrodes that could record really what the cochlear devices do today for people with hearing impairment.”

Graham went on to study formally, and then work, at the hospital, which he said was a real privilege. He has held various positions over the years, including as chairman of the Medical Staff Council, and chairman of the Department of Medicine.

“It was a hospital where virtually every first and every best occurred in Australia. When I went there they already had the first coronary care unit in the southern hemisphere – that had just been developed about eight years earlier. The renal unit did more renal transplants than any other unit in the world. The leukaemia unit was regarded as the top one in the southern hemisphere, and was only matched by the one in Massachusetts General Hospital. The colorectal unit was the very first of its kind in Australia. The melanoma unit was the first in Australia. The Kanematsu institute of pathology researched blood disorders, bone disorders, with wonderful pathologists who everybody in the country relied on.

“They covered everything; they were all the quintessential experts in their fields. To be a student there, you were indeed lucky, and the people who taught us were the top people in Australia, and so the teaching we got was fantastic.

“At Sydney Hospital we made a point of never budging from the generalist concept ... patients were looked after holistically. So the fact that you arrive and your real problem might be pneumonia but you have a varicose ulcer at the right side of your ankle and your diabetes might be slightly out of control, and you’re a touch anaemic and nobody’s ever sorted it out for you – if you came to Sydney Hospital, whoever looked after you would nut down on everything. That’s of huge benefit to the patient.

“And of course the students and the young residents who come and work here love it too, because it’s one of the few times in their training that they get to see someone who’s interested in a person as an entire human being.”

Graham hopes this generalist mentality will be the legacy of the Sydney Hospital.

“I’m a brave man saying this, but most of the nurses know my view: it’s sad that nurse training doesn’t occur on site at hospitals anymore. In my view undergraduate nursing should be done at hospitals. I know in practice, that won’t happen, because the commitment by politicians is not there.

But that’s my honest opinion – the best nurses were trained on site at hospitals learning in a master and apprentice fashion.

“Sydney Hospital nurses, the ones trained in the Nightingale School – they’re the best.”

The exhibition, Sydney Hospital: celebrating 200 years of care, and an historical tour within the hospital will run until December 2.

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