Transcript

FIONA STARR: One of the most common treatments at the hospital was bloodletting, by cupping or by leeches sucking the blood. It followed the belief that illness was due to an imbalance of the humours or liquids of the body. Very quickly the Rum Hospital got a bad reputation for this practice, and convicts began to call it “the Sydney slaughterhouse.” Redfern’s assistant, Henry Cowper, reported in 1820 that he had bled one patient suffering brain fever “two pounds in the morning and three pounds in the evening,” but the patient had been allowed to get up immediately—after which he “dropped down dead.”

MIC CAVAZZINI: Welcome to Pomegranate, podcast of the Royal Australasian College of Physicians. I’m Mic Cavazzini, and today we take you back two centuries to the early days of the British colony in Australia. In the introduction was Dr Fiona Starr of Sydney Living Museums, who will retell early accounts of the colony’s first general hospital, better known as the Rum Hospital. You’ll also hear Peter Curson describe the worst disease epidemics that struck the colony over the 19th century. He is Emeritus Professor in Population and Health at Macquarie University. And Dr Lisa Murray, historian for the City of Sydney Council, talks about the perennial problem of where to bury the dead in an era of incredibly high mortality. The three speakers were hosted at a seminar series of the Australian and New Zealand Society for the History of Medicine.

Fiona Starr begins her story in 1810, when Lachlan Macquarie had just taken charge as Governor of New South Wales following a mutinous rebellion against his predecessor. Macquarie not only had the problem of restoring order and discipline, but immediately noticed the need for a bricks and mortar hospital to tend to the desperate outpost.

FIONA STARR: At that time there are about 10,500 settlers in Sydney, and while a makeshift hospital had been established down at the western side of Sydney Cove from 1788, it had become inadequate. So Macquarie, in his first dispatch home to Britain, he wrote of the absolute necessity for building a new hospital.

Macquarie didn’t get the financing he needed to build the hospital, and that’s where the “rum” came in. He struck up an enterprising deal with significant colonial figures: in exchange for building the three winged hospital, he would give them a three-year monopoly on the importation of rum and other spirits. So today we like to call it Australia’s first public-private partnership.

By 1816 the new buildings formed an imposing group on the highest part of the town, pretty much the most substantial buildings there at that time. Only two wings survive today, of course the Mint, which was originally the south wing of the hospital—and Parliament House, which is originally the north wing.

I think you probably already know the name of the first Assistant Surgeon because of the suburb that was named after him: William Redfern. So Redfern had actually been a convict himself. In 1797 he’d been convicted for taking part in a mutiny in the Royal Navy. And after proving his ability as a surgeon in the hospital on Norfolk Island, he was granted a free pardon, and then he was appointed as surgeon in Sydney.

He was known for his lack of bedside manner, and there were some doubts in the colony about his expertise or his training. But after many years of experiencing the colonial hospitals, he sat before a board of esteemed colonial doctors who gave him formal recognition for his years of experience.

PETER CURSON: Epidemics of infectious disease have in fact been a regular reminder of the insecurity of life, and the ubiquitous presence of death and disease, revealing us as we truly are—fearful about infection, wary of others, and overall highly sceptical about the government’s power to protect us. And finally, I suppose, they became the prime cause of public health reform.

I’ll begin with the great sickness of 1789. This is one of the most intriguing episodes in Australia’s early history. A handful of contemporary accounts suggest that the Aboriginal population were visited by a very virulent epidemic which caused great mortality and social disruption, and for some reason left the immigrant white population almost completely untouched. Thousands of Aboriginals were swept away by it.

Contemporaries strongly believe the disease to be smallpox, because of the appearance of eruptions, fever, and facial scarring. Or was it a more common infection, such as chicken pox, introduced to a totally non-immune population? The evidence remains inconclusive.

LISA MURRAY: The old Sydney burial ground, now the site of Sydney Town Hall, was established in late 1792. It was the first official cemetery kind of set apart in Sydney Town, and it served both the convict and the free population. The Reverend William Cowper estimated in 1845 that there were over 2,000 burials in this cemetery.

63 names can be connected to a headstone through documentary or material evidence. This figure of less than three per cent is no doubt conservative, but it supports the picture painted by contemporary descriptions of the cemetery, that the vast majority of the graves were actually unmarked.

By 1820 the old Sydney burial ground was overcrowded and deemed, and I quote, “Offensive to the inhabitants of the neighbourhood.” It was closed, and a new burial ground was set aside on Brickfield Hill, the Devonshire Street Cemeteries. Originally four acres of land was set aside for a Church of England burial ground. Subsequently other denominations were allotted adjacent land for burial grounds when they applied to the colonial government. Each denomination managed its own burial ground, which had an exclusive entrance, and of course its own scale of fees and charges. The layout of graves had to pay attention to the economical use of ground, and the orientation of graves east-west in a line also followed a British tradition. In addition, one corner of the cemetery was set apart by the assistant chaplain for “peculiar and special purposes at the discretion of the said chaplain.” This area was probably used for the unbaptised, executed criminals, and suicides.

The layout and location of Devonshire Street cemetery placed Sydney at the forefront of cemetery design. It was the colonials’ first response to the garden cemetery movement—the British trends in burial reform and funerary culture. The Australian newspaper in 1842 praised the cemetery’s commanding views of the city, and encouraged readers to take a stroll in the cemetery to admire the monuments.

PETER CURSON: I mention the 1867 measles epidemic. It probably represents the most severe childhood epidemic of the 19th century. In the area around Sydney and New South Wales 13,000 young children aged under five caught measles, and there were almost 1,000 deaths. While the infection rate was actually quite high across all social classes, possibly 60 to 80 per cent of all children in New South Wales, it was the poor who suffered the highest mortality. Many families in Sydney were living in marginal conditions, with children suffering some degree of protein deficiency and malnutrition.

The scarlet fever epidemic of 1875-76 probably caused between 50,000 and 80,000 cases of scarlet fever, as well as well over 8,000 deaths, and resulted in a series of official reports which for the first time in Australian history advanced some cautious measures for its management and control. The isolation of the sick, banning children from attending school, cleansing and disinfecting homes and public places—as well as concern for rubbish, polluted water and proper drainage.

FIONA STARR: So back on the ships, on the convict transport ships, we know that there were enormous losses of life in the first years. The mortality rate was one in 10. One of the most common diseases we know suffered by the convicts of course was scurvy, a vitamin C deficiency disease. By far the worst outbreak that we know about on any convict ship was the Lord Lyndoch in 1838. There had been 19 deaths during the voyage, and eight of which were due to scurvy. And on arrival in Sydney, 113 were taken directly to the Rum Hospital, where 20 of them died.

After an investigation in 1814 into shipboard hygiene by Redfern, the mortality rate declined. But despite those improvements on the ships, conditions in the wards at the Rum Hospital seemed to be appalling by all accounts. Redfern’s assistant, Henry Cowper, reported that, “The stench also upon going into the wards in a morning was so great as to cause vomiting, and Mr Redfern himself has been obliged to turn back sometimes.” The wards were poorly ventilated because the windows were fixed closed to keep the convicts from escaping. Patients also cooked their rations inside the wards at the fireplaces at the ends of the rooms, despite the stench from the dung heap in the yard behind the hospital, which wafted into the wards with the sea breeze.

LISA MURRAY: The burial grounds at Devonshire Street filled quickly, and the government couldn’t keep up with demand. In 1843 the Church of England applied to the government for a new piece of land for a cemetery. At that time the Bishop of Sydney stated, “The burial ground belonging to the Church of England is so completely occupied that not only are decency and propriety much outraged by its crowded state, but it is actually impossible to find room for more bodies.”

Five years later, the Church of England was still trying to shove more bodies in. The Reverend Walsh reported, “It is now scarcely possible to dig a grave without disturbing or disinterring the remains of dead bodies. I have seen the side or portions of coffins projecting at various depths into graves which have been dug. The practice of the gravedigger, when there have been many burials, is to place two or three coffins, one upon the other, the upper one sometimes lying within 18 inches of the surface”. The practice of multiple burials was referred to as “the packing system.”

Of course you can imagine that these burial practices were in total contrast to the cemetery ideal. Local residents and a sexton all testified that pauper burials were frequently conducted without a funeral service, particularly if there were no friends or relatives present, or if the weather was inclement. If prayers were said, they were often collective rather than individual, and sometimes performed a couple of days after the burial.

PETER CURSON: The smallpox outbreak of 1881 represents the first major psychosocial crisis associated with infectious disease in 19th century Australia. Although the actual number of cases and deaths were small, there were only about 163 cases, and about 41 deaths, the outbreak evoked large scale scenes of public fear, hysteria and panic, and was the first example in Australia of the widespread use of case identification, isolation and formal quarantine, as well as compulsory vaccination for all health workers and other workers of government.

Interestingly, the epidemic also gave rise to a whole bout of social conflicts, including a wave of anti-Chinese feeling, discrimination, boycotts and violence, arguing that the Chinese were somehow responsible for introducing the disease. And in some ways it’s probably the first example of the politicisation of disease in Australian history, when New South Wales politicians used the outbreak and the fear engendered to push through parliament a Chinese restriction bill.

FIONA STARR: Thousands of convicts who passed through Hyde Park Barracks, and we know many of their names, were assigned to work at the hospital as well, and they also were described as often drunk, careless , and neglectful of their duty. For example, one stole a watch from the bloodstained clothes of a deceased man, and another took the shirt off a body about to be put into a coffin, which so disgusted Surgeon Redfern that he immediately dismissed him. Many convicts even deliberately injured themselves, so with their work tools they induced blisters and burns and rubbed lime into their eyes, because of course being admitted into the hospital meant you didn’t have to work.

In a curious incident one Sunday in 1833, a group of 11 convicts from Hyde Park Barracks took themselves to the hospital next door, saying that they were unwell. But it wasn’t some mysterious infectious disease that they were suffering—they were actually avoiding the mandatory church service at St James Church across the road, which they had to attend every Sunday. Each man received 25 lashes.

LISA MURRAY: It was generally accepted that overcrowded burial grounds in the middle of the metropolis were a threat to public health. By the 1840s it was common practice for the Surveyor General to group denominational burial grounds together, separated from the churches and placing them on the outskirts of towns. In the end, the Church of England rejected the government’s proposal for a new general cemetery which wouldn’t have any denominational distinctions, and in 1847 set up the Sydney Church of England Cemetery Company to bury their dead at Camperdown cemetery.

The image of Camperdown cemetery was paradoxical. Certainly, this was the way local resident Joseph Kingsbury perceived the cemetery. He described it as “a very pretty place, and very pleasing to the eyes of the living.”

But at the same time he argued the cemetery was an inevitable nuisance, because of the effluvium from dead bodies. He believed that not even burying the bodies 12 feet deep would stop the exhalations. The effluvia rising from Camperdown cemetery on what was described as a close damp morning was said to be “a mist hanging over the ground like a veil.” The smells were described as “offensive,” “noxious,” and “unmistakeably suggestive of coffins.”

PETER CURSON: The outbreak of influenza which hit Australia in 1890-1891, it was really the first time Australia had been swept up in a major pandemic of influenza that affected a very large proportion of the population, regardless of social class, and the methods adopted to control diseases like smallpox could no longer practically be put into effect. Consequently effort was directed towards public education for the first time, which encouraged people to avoid public gatherings and crowds, to stay home if ill, to avoid coughing and sneezing in public, to avoid kissing anybody in public, and many schools, government services and businesses were closed and pushed to the edge.

Australia has also experienced seven major outbreaks of dengue. Between 70 and 80 per cent of the population living in small towns in southern Queensland and northern New South Wales caught dengue in 1897-1898. But the largest outbreak occurred between 1925 and 1926, when there were almost 600,000 cases of dengue on the eastern seaboard of Australia—imagine that. If dengue had killed more people, we’d have had a cure 100 years ago.

FIONA STARR: The surgeons of the hospital had only at their disposal the medicines outlined in the pharmacopeia of the time, which described about 200 medicines, as opposed to 5,000 or more listed today, and drugs and other hospital supplies were frequently stolen by patients at the hospital. And Redfern, in his notes, he has a remedy for what he calls “the evil,” which is for tuberculosis of the neck. It seems like something out of a medieval witchcraft manual, but it involved rubbing the sores with a leg cut from a live toad, which he noted would cause the parts to swell very much for about 12 hours, and give violent pain. And there were some other slightly more conventional remedies like onion juice for baldness, Turkish figs boiled in milk for treating cancer, and an eyewash made from lead.

In the pre-ambulance age, carts and wheelbarrows obviously were very useful to convey the sick to hospital, and the institution even had a cart to send out for this purpose. The problem was it often didn’t arrive on time, and in a sad case of 1836 this cart was called for to collect an ill woman named Jane Quigley, from what the newspaper called a “miserable hut” on the Botany Road. But she died two days before the cart arrived, which was eight days after it had been called for.

LISA MURRAY: Businesses around Camperdown cemetery complained of nasty greenish blue blowflies invading their workshops from the drainage sump in the cemetery, and from the pauper graves, which were left open for several days to receive numerous bodies, while maggots surfaced with floodwaters that gushed across Camperdown cemetery after severe thunderstorms, and subsequently contaminated neighbouring residential wells.

A former gravedigger at Camperdown confirmed that water accumulation in graves was a constant problem, “Sometimes we got to the bottom of a grave we used to get a bucket in, so as to empty it out and get it nice and dry before the funeral procession would come. Sometimes the stuff that was taken out used to be blood and all corruption, something like old Tooth’s stringy”—it’s a type of stout beer—“for when we get a bucket of it half full, it used to be over the top with froth.” And I suppose it was of course a stark reminder of our mortality, and of the corruption that followed death, an image that contrasted dramatically with the idealisation of God’s acre and religious beliefs in a physical resurrection.

PETER CURSON: And so to plague. The epidemic of plague which broke out in Sydney in 1900 was part of the last great pandemic of plague which swept out of China in the 1890s. I’ve always been fascinated by plague, and you may say, what’s the relevance today? Well, plague is more widely distributed around the world today than at any time in human history.

In 1900 there were 303 cases of plague in Sydney and about 100 odd deaths. But the epidemic caused widespread social and economic dislocation. In all of this the authorities were significantly helped by the fact that plague, like smallpox, fell mainly on Sydney’s working class areas, allowing the adoption of more draconian containment measures. All cases, and anybody who lived next door to a case, or had come up in contact in a shop with a case, were exported to the quarantine station, and in encapsulated there. And more than 1,800 Sydneysiders made that journey.

Whole neighbourhoods in inner Sydney were formally quarantined with brick barricades and police guards, and teams of cleaners and fumigators worked their way systematically through peoples’ homes, lime-washing interiors, disinfecting yards, and removing rubbish. There was a major rat extermination campaign in Sydney. The government offered a bounty on any rat. Interestingly, they discovered that many were importing bush rats from rural areas to get as much money out of it as they could.

There was also an attempt using Haffkine’s vaccine which had been developed a few years earlier to inoculate all health workers, police and contacts. And also offering it to the public, though that created the most incredible scenes of chaos in Sydney. On one day 1,000 people marched on the Board of Health offices demanding vaccination, breaking down the door, trying to get in. Approximately 10,000 people were vaccinated against plague in 1900, and like the earlier smallpox epidemic, plague gave rise to major social conflicts, neighbour against neighbour, the rich against poor, pro-vaccinators arguing against anti-vaccinators, the local government fighting with the state government, and everywhere against the Chinese.

The plague epidemic is important for the pioneering work of Ashburton Thompson and his team. Not only did they produce maps of the distribution and spread of plague, but Ashburton Thompson was perhaps the first person in the world to appreciate the link between fleas, rats and plague, and should be given acknowledgement for it.

FIONA STARR: There’s a convict death register that survives. About 1,500 convicts died at the Rum Hospital between 1828 and 1848. One account tells us that “in this hospital they don’t bother to enshroud anyone. They are placed stark naked in their coffins without any fuss. It often happens that in the morning they find a person dead in his bed without knowing when he died.”

Imagine the scene in the dissecting room at the rear of the south wing, where the assistant surgeons perform the necessary post mortems. The surgeons also anatomised and dissected executed convicts, which gave them an opportunity to practice surgical techniques, and that had been allowed in England since the mid-18th century, and was intended as a further deterrent to crime. And excavations near the dissecting room in the early 20th century revealed the remains of dissected specimens, and amputated limbs that had been buried there in the 1830s.

Some body parts were apparently never buried. Using his collection of skulls, one hospital surgeon named Moncrieff conducted phrenological studies of specimens at the hospital and he used his macabre collection to demonstrate how the study of convict heads could identify those most likely to commit crimes.

He lived in the south wing, and one day his convict cook named George Brown went absent without leave. The prisoner claimed that he had left the doctor’s service because there were “so many dead bodies in a state of putrefaction lying in the dissecting room, and Dr Moncrieff was always telling him to go and cut as much flesh as he could off the bones of the bodies and feed the dogs with it.”

LISA MURRAY: The insanitary conditions of colonial cemeteries were exposed in a series of New South Wales parliamentary debates and inquiries between 1855 and 1888. The Secretary of Lands conceded the interment of the dead in Sydney had become “exceedingly pressing,” and this issue was not finally resolved until 1867 when Rookwood Necropolis opened for burials.

In the meantime, Sydney’s cemeteries became a public scandal. While the objectives of the parliamentary inquiries were to either regulate or close the cemeteries, a discourse obviously developed around what constituted a decent burial. Many of the complainants expressed their disgust at the management of pauper and common burials, which were decried as being undignified and an affront to Christian sensibilities.

FIONA STARR: The Sydney Gazette claimed, “The inmates of the General Hospital meet with all that attention, skill and comfort which it is possible for men to receive. For cleanliness, attention, food and medical ability, no hospital in the world can be better off.” Who knows, maybe this was just government propaganda. These new stories that have come out suggest that the standard of medical care was not always best practice.

But the fact that an institution for healthcare was provided at all for the convicts put them one step ahead of the working classes in Britain, who had no such free care. And by providing the medical care for the convicts, the hospital supported the ability of the colonial government to establish Sydney, and it also shares in the significance of the broader convict story that’s been recognised in the World Heritage listing of Hyde Park Barracks.

PETER CURSON: Epidemics, like most disasters, remain an acid test of human behaviour during times of extreme stress. And one of the most interesting things about epidemics is that public reaction is rarely related to the severity of illness of the disease. The measles epidemic of 1866 was possibly Australia’s greatest childhood epidemic, but it hardly gave rise to any public comment at all. It was simply accepted as a rite to passage, a normal event of childhood. Compare that with the public reaction engendered by the smallpox outbreak, or indeed in more recent times, HIV/AIDS, and you see the very great difference.

One of the constant themes is the dissonance that exists between how experts and how ordinary people perceive risk. For you and I, risk is socially constructed, influenced by the people around us. Think back to the SARS epidemic. Would you not be influenced if suddenly everybody in your street was wearing a mask? If we do not learn from the past, if we simply dismiss what happened as part of a less scientific age, then we run the risk of making the mistakes made. As Ashburton Thompson said in 1899, “The brilliancy of modern discoveries blinds incautious eyes to old truths, often endangers sound practice.”

MIC CAVAZZINI:      That was Peter Curson ending this episode of Pomegranate. Thanks also to Fiona Starr and Lisa Murray for their colourful accounts of the early Sydney colony. The views expressed are their own, and may not represent those of the Royal Australasian College of Physicians.

These lectures were recorded at the “Our Healthy Heritage” series, hosted by the Australia and New Zealand Society of the History of Medicine every quarter. For more details, visit the Pomegranate website at racp.edu.au/pomcast. You’ll also find links to other resources curated by the College’s History of Medicine Working Group, and to Lisa Murray’s recently published Field Guide to Sydney’s Cemeteries. Or feel free to visit the College’s fabulous library collection in Macquarie Street, Sydney.

If you have any feedback or suggestions for the podcast, please e-mail pomcast@racp.edu.au, and share the story around using the Twitter hashtag #RACPpod.