Hospitals Department, and predecessors (GRG78)

The history of hospital care can be said to be continuous since 1837, when a very primitive Colonial Infirmary was established through the efforts of the Colonial Surgeon, Dr T.Y. Cotter. (1) There have been frequent and major changes in site, buildings and administrative arrangements but there has been a continuing link as the major hospital for the treatment of needy patients which has been maintained from the beginning almost entirely from public funds. (2) This was in spite of the fact that there had originally been hopes of support by private subscriptions (3) and does not detract from the generosity of many donors or the efforts of the Commissioners of Charitable Funds since 1875 (see GRG 94, p.1-5)

The Colonial Infirmary was set up in a small hut and later in a house, both in the vicinity of Holy Trinity Church, early in 1837. A Board was appointed for the "General Management and Control of the Infirmary" by Government Order No. 27 of 4 December 1838, with the Colonial Chaplain as Chairman. Regulations were drawn up and gazetted, including gratuitous service to inmates by the Colonial Surgeon. This service was meagre, not through the lack of goodwill but because of the financial state of the Colony and shortage of essential supplies. A final move to a larger hut in the West Parklands was made in 1839.

The inadequacy of the Infirmary was obvious and two unexpected contributions "for benevolent purposes" made it possible for Governor Gawler to propose the building of a new hospital for which plans, to a design by G.S. Kingston, were submitted to a Building Committee on 23 December 1839. (4) The site chosen was in the East Parklands a little to the North of the area set aside for a hospital in Colonel Light's plan. The foundation stone was laid by the Governor on 1 July 1840 and the Adelaide Hospital was in use by January 1841. (5) Three Honorary Medical Officers were appointed and it was decided to appoint a Board consisting of three Government officials and three private citizens but excluding the Inspector of Hospitals, who had played a prominent role in the building of the Hospital. A sub-committee appointed by this Board drew up the first set of rules and regulations which were adopted in February 1841. (6)

After some complaints a Board of Management for the Adelaide Hospital, made up of six Government Officials and six representatives of the subscribers, was appointed on 21 April 1841, and the office of Inspector of Hospitals was abolished. (7) There was conflict between the Board and the Medical Staff on a number of occasions and, when the Board informed the Government that the Hospital could not be supported by subscriptions and that the Government must assume control, the Government agreed but informed the Board, in a letter dated 30 March 1842 that they were relieved of their duties and the Colonial Surgeon would be directed to undertake management of the Hospital, (8) "until further arrangements could be made". In fact, this situation, and the management of the second Adelaide Hospital after 1856, continued until 1867.

By 1850 the need for a much larger hospital had been foreseen and a large site in the present location on North Terrace was chosen. Planning went ahead and construction commenced in 1855, the first building for the new Adelaide Hospital being completed in September 1856. Over the next century nearly fifty buildings in different styles and for different purposes were added tot he hospital on this site. The roles of these individual buildings also changed frequently over the years. With the opening of the new hospital the old building became part of the adjacent Lunatic Asylum but both blocks reverted to the control of the Adelaide Hospital, when the Parkside Asylum opened, in 1870 and remained in use for an additional period of over 60 years. The Adelaide Hospital became the Royal Adelaide Hospital on 2 November 1939. (9)

Major demolition on the North Terrace site to make way for larger modern facilities commenced in 1963 and the first new building was completed in January 1966. (10) The major rebuilding programme continued until 1973. Considerable alterations and refurbishing of older buildings were also completed.

Administrative changes after 1867 were frequent. In 1864, after complaints and allegations against the Hospital a Commission was appointed to inquire into the report on the management of the Hospital. In its report, dated 10 August 1864, (11) the Commission recommended that a Medical Board of Supervision to the Hospital should be appointed.

The suggestion that this duty could be carried out by the "present Medical Board" was not accepted by the Government. [The Medical Board had been appointed in 1844 (12) to control the registration of Medical Practitioners and, although many of its members have been associated with the Hospital, has never been responsible for control or management of the Hospital]. In 1867 the Hospitals Act (13) provided for the appointment of Boards of Management for all Public Hospitals. A proportion of the members was to be elected by contributors to hospitals the number being determined by the total of their donations,. A Board of Management for the Adelaide Hospital consisting of twelve members, eight of whom were from the medical profession, was appointed on 22 January 1868. (14)

There was strong medical representation on succeeding Boards of the Adelaide Hospital until the Hospitals Act Amendment Act was passed in 1884. (15) This Act referred to the Board of the Adelaide Hospital, in particular, not to all Public Hospitals (as the 1867 Act had done) and provided for a Board of sixteen members with not more than eight medical members. It also provided for one member to be a nominee of the University of Adelaide, in anticipation of the foundation of the Medical School. The first Board of Management under this Act was appointed on 31 March 1885. (16)

Whilst there were no further radical changes to the administrative arrangements of the hospital until 1921 management and administration went through an extremely turbulent period in the years 1894-1900. Disagreement between the Government and the Board over the promotion and discipline of nursing staff led to the complete replacement of the Board in February 1896. This action by the Government and other interference caused the resignations of the seventeen Honorary medical staff, the Medical Superintendent and the two senior members of the nursing staff. The resignation of the Honorary staff left the Medical School without clinical instructors. Subsequent developments following controversial replacement appointments of medical staff led to the dismissal of the Professor of Anatomy and one House Surgeon and the resignations of three other House Surgeons. An Adelaide Hospital Commission, appointed urgently in 1895 produced two reports which did not alleviate the situation, (17) making no major recommendations and finding that, generally, the hospital was "admirably conducted".

The Commission did recommend, however, that at least two ladies should be members of the Board and this was implemented in 1896 and continued until the administrative changes of 1921. The major concern of this period was to revive the Medical School. Finally, in March 1900, an agreement was reached between the Hospital Board and the University Council but it was not until 22 February 1901 that the Honorary Staff returned to the Hospital and clinical teaching of medical students was resumed. (18)

The resignation of the Medical Superintendent has been mentioned. This position, as senior salaried Medical Officer responsible to the Board, was created in 1890 and continued until 1959 when an Administrator was appointed as Chief Executive Officer, reflecting the changing needs in the problems of control of large administrative staffs in major hospitals. (19)

A short Hospitals Act Amendment Act, assented to on 2 October 1912, dealt with the powers of the Board regarding appointments and dismissals but did not change the constitution of the Board. (20) Major changes were brought about by the Hospitals Act Amendment Act, 1921. (21) Under this Act the Board was not to be re-appointed after the expiry of its term of office. It was to be replaced by a new Board of Management consisting of the Inspector-General of Hospitals (an officer re-created in 1914) as Chairman and two members appointed by the Governor. The first three-man Board took office on 22 February 1922. (22) This Act declared the Hospitals to be a Medical and Dental School in connection with the University and gave students from the University's courses the right to attend the Hospital for instruction. Previously teaching of students had been an act of grace on the part of the Board and could have been terminated at any time. A seven-man Advisory Committee, with members nominated by both the University and the Hospital, was set up to advise and assist the Council of the University with any matter concerning the medical and dental courses,. Provision for additional members of this Committee was made in 1931 (23) and again in 1958. (24) The Act also provided for the appointment of official visitors, to include at least two women, for the Adelaide Hospital.

The Hospitals Act was consolidated in 1934 (25) although commencement of this Act was not proclaimed until 1 May 1937. (26) In succeeding years there were numerous Amendment Acts but none of these involved major changes in the administration of the Adelaide Hospital.

Management by a three man Board, first established in 1922, continued until 21 January 1979. In 1976 it became probable that all public hospitals would become autonomous incorporated bodies following the passing of the South Australian Health Commission Act. (27) In anticipation of this a comprehensive review of the management structure of the Royal Adelaide Hospital and the production of a draft constitution for an incorporated hospital was undertaken. When the Hospital was incorporated under the Act on 22 January 1979 (28) the Constitution was signed and the old Board replaced by a nine member Board of Management. The Board was now free to manage the Hospital without any obligation to observe Public Service regulations for the first time since 1867.

Over the years there have been a number of major units, situated away from North Terrace, which have been under the control of the Board of Management. In 1932 the Infectious Diseases Hospital, Northfield was opened and the Infectious Diseases Block of the Adelaide Hospital closed. Similarly the Northfield Consumptive Home took over the role of the Consumptive Home of the Hospital. Both these Institutions were originally administered independently. During the reconstruction of the Hospital the Northfield Wards (as they became known) were considerably improved and became a Centre for Rehabilitation and Domiciliary are. The Morris Hospital provided accommodation for the first paraplegic Unit in 1962 and was later also considerably improved. It was declared to form part of the Royal Adelaide Hospital under the control of the Board on 29 March 1973. (29) In 1981 the Northfield Wards and the Morris Hospital combined under the name of the Hampstead Centre. (30) The Frome Ward, built in 1932 to house "open" tuberculosis patients, and the Chest clinic opened in July 1935 (31) were transferred to the control of the Inspector-General of Hospitals on 17 August 1939. (32)

They were returned to the control of the Board of the Royal Adelaide Hospital on 16 August 1962. (33) The Magill Wards, mainly for geriatric patients were used from 1929 but closed in 1970. The Adelaide Hospital Laboratory became part of the Institute of Medical and Veterinary Science when the latter was established under the Institute of Medical and Veterinary Science act of 1937 (34) which came into operation on 9 June 1938. (35) When the decision was made in 1967 to build the Modbury Hospital much of the responsibility for planning fell on the Board of the Royal Adelaide hospital and its staff. To facilitate this the Modbury Hospital was declared to form part of the Royal Adelaide Hospital on 21 December 1972. (36) It remained under the control of the Board until 30 June 1974 after which it became a Public Hospital on 1 July 1974. (37)

Two Government Gazette notifications of 1917 and 1922 may cause doubts in the mind of a student of Administrative History. When the first list of Departments under the Public Service Act of 1916 was declared the Adelaide Hospital was made a Department with the Chairman of the Board as Permanent Head. (38) On 23 February 1922 a new Inspector-General of Hospitals Department was formed by amalgamating the former Inspector-General's Department with the Adelaide Hospital Department, from 1 March 1922, with the Inspector-General as Permanent Head. (39) the Inspector-General had, however, become the first Chairman of the new three member Board on 22 February 1922. Thus, there was no change in the control of the Hospital management.

One further change in internal administration is worthy of mention. In 1923 the first Medical and Surgical Registrar commenced duty. Part of this duty was to supervise the case records which he commenced to do with great energy. (40) Up to this time the clinical records had been kept in large case books, details being recorded serially as each patient was admitted.

The only index was an alphabetical list in the front of each volume, which often became badly worn before it was filed. The new registrar introduced a system of individual folios for each patient containing separate sheets for each aspect of treatment. The folio system was a vast improvement on the old case books, but some difficulties still remained as records of out-patients were kept separately from in-patients' notes. In 1963 the system was changed to a unit record system (UR) in which a patient is given a unit number and all clinical records, in-patient or out-patient are kept in one folder. There is now a large Medical Records Office Staff but this system is still being continued (in 1986) with some modern innovations, such as colour coding. The Hospital's index to patient records has been placed on computer.

The name of the Inspector General of Hospitals Department was changed to Hospitals Department in 1940 and the Inspector General became Director General of Medical Services. In 1940 also the Adelaide Hospital became the Royal Adelaide Hospital.

For disposal of Royal Adelaide Hospital records, including patient case notes, see HD 1258/1946, 685/1949, 804/1949 and 55/1955 (GRG 78/1).

References:

(1) Hughes, J.E.: A History of the Royal Adelaide Hospital, Adelaide, 1967, p.2.
(2) Ibid.,,, p. 64
(3) Proceedings of Council, S.A. Government Gazette, 30 April 1840, p. 3
(4) Hughes, J.E.: Op Cit., p. 10.
(5) Ibid., p. 11.
(6) Ibid., p. 16
(7) S.A. Government Gazette, 29 April 1841, p. 5.
(8) Hughes, J.E.: Op Cit., p. 14.
(9) S.A. Government Gazette, 2 November 1939, p. 1213.
(10) Hughes, J.E.: A History of the Royal Adelaide Hospital, Adelaide 1982, Supplement to 2nd (Revised Edition) p. 211.
(11) S.A. Parliamentary Paper No. 31 of 1864.
(12) Ordinance of South Australia No. 17 of 1844.
(13) S.A. Act of Parliament No.. 7 of 1867.
(14) S.A. Government Gazette, 23 January 1868, p. 94.
(15) S.A. Act of Parliament, No. 306 of 1884.
(16) S.A. Government Gazette, 2 April 1885, p. 1176.
(17) S.A. Parliamentary Paper, No. 20 (Progress Report), No. 21 (Final Report) of 1895.
(18) Hughes, J.E.: Op.Cit., P. 204
(19) Ibid., p. 79
(20) S.A. Act of Parliament No. 1075 of 1912.
(21) S.A. Act of Parliament No. 1497 of 1921
(22) S.A. Government Gazette, 23 February 1922, p. 642.
(23) Hughes, J.E.: Op. Cit., p. 71
(24) S.A. Act of Parliament No. 47 of 1958.
(25) S.a. Act of Parliament No. 2158 of 1934.
(26) S.A. Government Gazette, 25 March 1937, p. 642.
(27) S.A. Act of Parliament No. 76 of 1976.
(28) S.A. Government Gazette, 2 December 1978, p. 2159
(29) S.A. Government Gazette, 29 March 1973, p. 1209.
(30) Hughes, J.E.: Op. Cit., Supplement to 2nd (Revised Edition) p. 214.
(31) Hughes, J.E.: Op. Cit., p. 48
(32) S.A. Government Gazette, 17 August, 1939, p. 421.
(33) S.A. Government Gazette, 16 August 1962, p. 317
(34) S.A. Act of Parliament No. 2372 of 1937.
(35) S.A. Government Gazette, 9 June 1938, p. 1270.
(36) S.A. Government Gazette, 21 December 1972, p. 2722.
(37) S.A. Government Gazette, 2 May 1974, p. 1614.
(38) S.A. Government Gazette, 14 June 1917, p. 992.
(39) S.A. Government Gazette, 23 February 1922, p. 641.
(40) Hughes, J.E.: Op. Cit., p. 99