INTERVENCIONES DIRIGIDAS A LAS HIPÓTESIS ESPECÍFICAS
1. Modificación de los antecedentes y los sucesos contextuales
Colonial Australia presented an opportunity for the British government to establish a completely
new structure for the provision of health care.189 While the configuration of existing British
systems of health and social support systems exerted a strong influence over the moulding of this framework, settlers and authorities alike were keen to avoid the dehumanising disadvantages
of workhouses and voluntary hospitals.190 Until the late 1830s, when medical boards were
established to investigate the validity of practitioners‟ qualifications and formally define the boundaries between orthodox and irregular health providers, these groups of practitioners operated alongside one another in an uneasy and unregulated market of government hospitals,
charitable dispensaries, voluntary agencies, and private practitioners.191
The provision of government healthcare in the Australian colonies was overseen by a principal
surgeon, supported by assistant and district surgeons.192 Together, these practitioners were
responsible for the medical care of convicts, officials, emancipists, free settlers, and in some
circumstances military personnel.193 However, the extent of their duty of care towards all but
188 It is necessary to examine the history of the provision of healthcare in New South Wales as the Medical Service in
Van Diemen‟s Land was part of New South Wale‟s for the early period of its history.
189 N. Barrett, „The Contribution of Australians to Medical Knowledge‟, Medical History, 11 (1967), p. 321; M. Morris,
„A Matron‟s Honour: The Trials of Alice Gertrude Kenny‟, Island Magazine, 76 (1998), p. 46.
190 B. Gandevia, „Occupation and Disease in Australia since 1788‟, The Medical Journal of Australia, 22 (1971), p. 1105;
C. Cummins, A History of Medical Administration in NSW, 1788-1973 (2nd ed., New South Wales Department of
Health, North Sydney, 2003), p. 3.
191 Medical qualifications were regulated in Australia through the 1837 establishment of the Board of Medical
Examiners and the formalisation of the 1838 Bill to Regulate the Practice of Medicine; this process did not occur in Britain until the General Medical Council was formed in 1858 (Lloyd, „A History of Medical Professionalisation‟, p. 15, p. 21; Martyr, „No Paradise for Quacks?‟, p. 141; K. Russell, „Medicine in Melbourne: The First Fifty Years‟, The
Medical Journal of Australia, 2 (1977), p. 17).
192 While the principal surgeon was responsible for the day-to-day management of medical services, major decisions
such as the distribution of appointments, promotions, and dismissals were overseen by the Governor (Cummins, A
History of Medical Administration in NSW, p. 14).
193 See Glossary for definition of terms (C. Craig, Launceston General Hospital: First Hundred Years, 1863-1963 (Board of
prisoners under sentence was the subject of ongoing debate.194 Outside their medical obligations, colonial surgeons were also expected to supervise penal discipline and involve themselves in community affairs, such as the mediation of judicial matters, the establishment of
community institutions and participation on inquiry, medical, and lunatic boards.195
A hospital was among the first buildings erected upon the arrival of the First Fleet.196 These
facilities, however, were barely functional, consisting of a small village of tents under the
authority of Surgeon-General (Principal Surgeon) John White.197 Demonstrating the urgency of
providing improved accommodation for the sick, who lay sweltering under the February heat, and the importance of tending to the health of the convict workforce, just a few weeks later
these tents were replaced by a wooden building with a shingled roof and dirt floors.198 By 1790 a
prefabricated hospital had arrived from England; although it was designed to be erected in a
matter of hours, the six hundred and two pieces took two weeks to assemble.199 Vulnerable to
the harsh Australian conditions, this hospital soon succumbed to white ants and fell into a state of disrepair, but the ramshackle structure remained Sydney‟s primary medical institution until the
completion of the infamous „Rum Hospital‟ in 1816.200 While this hospital had been pieced
together after six years of negotiation (both within the government and between the government
194 Upon the amalgamation of civil and military medical services in 1836, military personnel posted at outstations
were attended by colonial surgeons, while in urban centres the larger numbers of military personnel could support the dedicated assignment of a naval surgeons (Cummins, A History of Medical Administration in NSW, p. 17, p. 20).
195 W. Anderson, The Cultivation of Whiteness: Science, Health and Racial Destiny in Australia (Melbourne University Press,
Melbourne, 2005), pp. 68-69.
196 S. Nicholas, „The Care and Feeding of Convicts‟ in S. Nicholas (ed.), Convict Workers: Reinterpreting Australia’s Past
(Cambridge University Press, Cambridge, 1988), p. 192.
197 E. Ford, „Medical Practice in Early Sydney: With Special Reference to the Work and Influence of John White,
William Redfern and William Bland‟, The Medical Journal of Australia, 2 (1955), p. 42; E. Ford, „Some Early Australian Medical Publications‟, Medical History, 16 (1972), p. 206; Cummins, A History of Medical Administration in NSW, p. 13.
198 J. Kerr, Design for Convicts: An Account of Design for Convict Establishments in the Australian Colonies During the
Transportation Era (Library of Australian History, Sydney, 1984), p. 4; Ford, „Medical Practice in Early Sydney‟, p. 45.
199 Kerr, Design for Convicts, p. 4; Cummins, A History of Medical Administration in NSW, p. 24.
200 Kerr, Design for Convicts, pp. 35-36; Ford, „Medical Practice in Early Sydney‟, p. 48; Cummins, A History of Medical
Administration in NSW, p. 25; R. Hicks, Rum, Regulations and Riches: The Evolution of the Australian Health Care System
and its workforce), and various delays surrounding labour and construction, Parramatta could
boast a solid brick hospital as early as 1796.201
Sydney‟s new hospital was comprised of a two-storey building, located in an airy situation free
from any damp and well-fenced with high walls.202 Each of its eight wards could accommodate
twenty-two patients. Commissioner John Thomas Bigge, conducting interviews and inspections as part of his inquiry on behalf of the British government, noted with disapproval that a number of these rooms had been appropriated for other purposes, such as use as a court of law and an
artist‟s studio.203 Kitchens, privies, washing, and bathing rooms were placed behind the main
building, at either end of which were located the staff quarters.
As penal and immigrant settlements expanded through New South Wales, more convict hospitals were established in districts such as Windsor, Liverpool, Newcastle, Bathurst,
Goulburn, Port Macquarie, and Norfolk Island.204 In 1823, Bigge noted that a principle surgeon,
six assistant surgeons, a hospital assistant, and a superintendent of lunatics oversaw the provision of healthcare in these institutions, while Van Diemen‟s Land‟s hospitals had been equipped with four surgeons.205
As in New South Wales, convict hospitals in Van Diemen‟s Land followed the extension of settlement. Hobart Town‟s sick were distributed between rented houses and gaols from 1804 until the mid-1820s; this accommodation was evidently “ill situated, low, and possessed no
201 Nicholas, „The Care and Feeding‟ in Nicholas (ed.), Convict Workers, p. 192; J. Bigge, Report of the Commissioner of
Inquiry, on the State of Agriculture and Trade in the Colony of New South Wales (1966 facsimile of original, published by The
House of Commons, London, 1823), p. 105.
202 Bigge, Report of the Commissioner of Inquiry, p. 106. 203 Bigge, Report of the Commissioner of Inquiry, p. 106.
204 Cummins, A History of Medical Administration in NSW, p. 25; Bigge, Report of the Commissioner of Inquiry, pp. 107-108. 205 Bigge, Report of the Commissioner of Inquiry, p. 104, p. 110.
domestic accommodation.”206 By 1825 Hobart could finally boast a permanent medical
institution; housed in a long brick building and “standing upon an eminence in a very healthy airy
situation.”207 Six years later, when the total nonindigenous population of Van Diemen‟s Land
was close to twenty-one thousand people (of which approximately seven thousand one hundred were prisoners), Launceston, Port Arthur, and New Norfolk each operated a district hospital, while temporary wards were established in George Town, Campbell Town, Bothwell, Jericho,
Richmond, Norfolk Plains, Waterloo Point, Macquarie Harbour, and Maria Island.208 These
hospitals were staffed by ten surgeons, a clerk, and a dispenser.209 Some institutions were also
able to offer outpatients‟ clinics, and all served as bases from which district surgeons travelled to
tend convicts assigned in outlying areas.210
Until 1831, public works‟ convicts were treated in government hospitals at no charge. Masters were required to provide rations for their assigned servants while they underwent hospital treatment, but only for their first fourteen days, and only if they wished to have their servants
returned to them upon their recovery.211 Upon receiving Bigge‟s recommendation, the new
Secretary of State, Sir George Murray, was aghast at the level to which the state subsidised the
costs of penal medical care, and instructed Governor Darling to implement reform.212 From
June 1831, masters were required to pay a fee of one shilling per day towards their servants‟ hospital expenses for a period of thirty days if they wished to be reunited with their charges after
206 B. Kelly, A Background to the History of Nursing in Tasmania (Mercury-Walch, Hobart, 1977), pp. 14-15; J. Brown,
Poverty is Not a Crime: The Development of Social Services in Tasmania, 1803-1900 (Tasmanian Historical Research
Association, Hobart, 1972), p. 4.
207 W. Crowther, „Some Aspects of Medical Practice in Van Diemen‟s Land, 1825-1839‟, The Medical Journal of
Australia, 1 (1935), p. 512; H. Widowson, Present State of Van Diemen’s Land , comprising an Account of its Agricultural
Capabilities with Observations on the Present State of Farming (S. Robinson, London, 1829), p. 24.
208 By 1847, the colony‟s population had expanded to over seventy thousand (twenty-four thousand five hundred of
whom were convicts (Brown, Poverty is Not a Crime, p. 17; J. Bischoff, Sketch of the History of Van Diemen’s Land (John Richardson, London, 1832), pp. 48-49).
209 Crowther, „Some Aspects of Medical Practice‟, p. 512.
210 In New South Wales, the Sydney General Hospital established an outpatient‟s clinic (Ford, „Medical Practice in
Early Sydney‟, p. 48).
211 W. Nichols, „„Malingering‟ and Convict Protest‟, Labour History, 47 (1984), p. 18. 212 Nicholas, „The Care and Feeding‟, p. 192
their treatment had concluded.213 To prevent hospitals from becoming “improperly burdened with men who do not require [active medical] treatment,” masters were also expected to collect their assigned servants promptly; any master who delayed was at risk of having his servant
reassigned.214 However, these regulations not only discouraged masters from leaving their
convicts in hospital for extended periods of time, they also served to dissuade them from seeking
professional care for their workers at all.215
The free population felt the impact of fees associated with hospital treatment more than those associated with the care of penal patients. Settlers were admitted for 3/- per day, while paupers who “could not bear the expense of their own cure” were funded 2/- per day by the Colonial
Government to receive inpatient care.216 This extension of care by authorities was, however, not
entirely benevolent – it was hoped that by demonstrating an ability to support the health of citizens through times of crisis, more immigrants would be encouraged to increase the
population of the infant Australian colonies.217
These colonies could be lonely and isolating places for the ill. The vast majority of inhabitants were far removed from their families and, like rural British labourers venturing to London seeking employment, they could not rely on traditional community networks for support in times of ill health. As in Britain, those who could afford it were able to select from the wide variety of unorthodox practitioners offering treatments ranging from homeopathy and Turkish baths to
patent medicines and powders.218 The pauperised, however, had fewer options. While those in
Britain could turn, however reluctantly, to the workhouse infirmary in times of desperation, the
213 In 1843 these regulations were made more severe; masters were liable for one shilling for every day of treatment,
regardless of length, if they wanted their convict returned (Nichols, „„Malingering‟, p. 26).
214 Nichols, „„Malingering‟, p. 21.
215 Nicholas, „The Care and Feeding‟ in Nicholas (ed.), Convict Workers, p. 192.
216 Brown, Poverty is Not a Crime, p. 4, p. 18; Cummins, A History of Medical Administration in NSW, p. 30. 217 Brown, Poverty is Not a Crime, p. 2.
218 Martyr, „No Paradise for Quacks?‟, pp. 146-147; J. Burnham, „Psychotic Delusions as a Key to Historical
determination of early settlers to avoid replicating the degrading „old Poor Law‟ system in
Australia meant that the destitute sick had no such system to rely upon.219 As the Launceston
Advertiser lamented, many sick were “without friends or relatives to succour them in affliction,
the casualties of disease and want.”220
Indoor relief in hospitals and invalid depots was essentially the only form of welfare provided to the poor in Van Diemen‟s Land. Occasionally rations were issued from the store to the destitute as a form of outdoor relief, but this was considered a short term measure until hospital
accommodation could be secured. In 1839, Governor JohnFranklin declared that to prevent abuses of this free provision of rations, no single person would be eligible to receive support direct from the stores – all were to be admitted to an invalid depot such as New Norfolk. A very small number of destitute families were maintained on government stores until 1844, when
Lieutenant-Governor John Eardley-Wilmot announced that all charity rations were to cease.221
These families were almost certainly forced to separate when their source of provisions was discontinued – young children would have been sent to orphanages, while older children and adults were compelled to find work or, in cases of illness or infirmity, to seek shelter and care at
invalid depots or hospitals.222 For many – such as those forced into poverty through disease or
disability – hospital may have been an appropriate solution. For others, outdoor relief would have permitted them the means and the dignity to maintain themselves and their families outside government institutions. Some voluntary agencies endeavoured to continue in the government‟s stead by providing outdoor relief to families, and while the impact upon the families they were
able to assist was positive, their limited resources meant that only very few could be helped.223
219 Cummins, A History of Medical Administration in NSW, p. 8, p. 53.
220Launceston Advertiser, 4 June 1846.
221 Cummins, A History of Medical Administration in NSW, p. 8, p. 53. 222 Brown, Poverty is Not a Crime, p. 20, p. 51, pp. 54-55.
In New South Wales, acknowledging the obvious need for alternative medical support systems, wealthier settlers indulged their philanthropic urges to promote the establishment of charitable
institutions. In early April, 1826, the Sydney Gazette carried an appeal for funds to establish a
public dispensary, eloquently reminding its readers that:
many of the Free Class of Poor Inhabitants of the City of Sydney, when suffering from Disease, are unable to pay for Medical Advice, and not having any claims on the Government Medical Establishments, are frequently doomed to hunger on the bed of sickness, and perhaps fall victim to its painful effects; it becomes necessary to appeal to the Benevolence of the richer Inhabitants, to endeavour, by
their assistance, to avert the Evils to which their poorer neighbours are subject.224
With a similarly charitable sentiment, the Benevolent and Friendly Society established its first Australian branch in New South Wales in 1818. The Society was supported by the Colonial Government, who recognised it as an economical means of extending indoor and outdoor
support “for the relief of the poor, aged, [and] infirm.” 225
The urban poor of Sydney also had recourse to a sixty-bed asylum, opened in 1821, and its attached infirmary which was equipped to provide medical care for forty patients. Severe overcrowding, demonstrating the dearth of poor relief in the colony, caused admission to
frequently be restricted to the totally infirm, while the able-bodied and those suspected of having
“blatantly immoral habits” were rejected or summarily discharged.226 In 1845 the Sydney
Dispensary – the first voluntary hospital in Australia – was established with the aim of providing free or cheap medical care to the poor through the charity of private practitioners. However, with their restrictive admission criteria reminiscent of British voluntary hospitals, only emergency and accident cases and those deemed to be afflicted with acute conditions which would respond
224Sydney Gazette (12 April 1826) cited in Cummins, A History of Medical Administration in NSW, p. 56.
225 Cummins, A History of Medical Administration in NSW, p. 51. 226 Cummins, A History of Medical Administration in NSW, p. 52.
favourably to treatment were eligible for care, meaning that chronic and incurable cases were
turned away.227
In Van Diemen‟s Land, Lieutenant-Governor William Sorell envisaged a similar union between
the government and charitable movements supporting the health of the poor.228 Just after
Christmas in 1832, Dr William Crowther and Mr Pearson Rowe, with the backing of one hundred and fifty subscribers and two hundred members, founded the Public Dispensary in
Hobart Town.229 Each member was required to contribute 3s per month, one month in advance,
to “receive Advice, Attention and Medicine…for himself and his family.”230 Under its
subscription scheme, for an annual payment of one guinea, each member was able to
recommend three poor „objects of charity‟.231 Despite promising levels of initial support – in the
first six months, “upwards of 200 fit objects of charity have been successfully relieved of
disease” – the Dispensary began to suffer from a deficit of willing sponsors with sufficient spare
money, and closed its doors after only five years.232 The lack of success of voluntary agencies
was influenced by the sense of “passive indifference” pervading the colony – donors seemed to
prefer supplying the needy with reactive, emergency handouts rather than supporting
programmes which proactively assisted the sufferers to improve their lives.233 In New South
Wales, however, a spirit of self-help led voluntary groups to assist the poor to support
themselves, rather than rely on passive charity.234
227 Cummins, A History of Medical Administration in NSW, p. 52, p. 55. 228 Brown, Poverty is Not a Crime, p. 2.
229 Crowther, „Some Aspects of Medical Practice‟, 516. 230 Crowther, „Some Aspects of Medical Practice‟, p. 516. 231 Crowther, „Some Aspects of Medical Practice‟, p. 516.
232 W. Crowther, „To the Public‟, Hobart Town Courier (7 June 1833), cited in Crowther, „Some Aspects of Medical
Practice‟, p. 516; Brown, Poverty is Not a Crime, pp. 14-15.
233 Brown, Poverty is Not a Crime, p. 11.
234 B. Earnshaw, „„The Lame, the Blind, the Mad, the Malingerers‟: Sick and Disabled Convicts within the Colonial
In 1845, the same year in which the Sydney Dispensary was opened, Eardley-Wilmot suggested establishing a workhouse in Van Diemen‟s Land to compensate for his discontinuance of the
limited outdoor relief, but nothing became of the proposal.235 Workhouses – and, indeed,
voluntary hospitals and asylums – were tainted with unpleasant reputations. The care provided in these institutions was characterised by a lack of privacy and stringent moral and behavioural regulations, with foul and raucous language pervading every overcrowded ward. Those who were admitted faced treatment in dangerously unhygienic conditions, with filthy bedding and