Nursing Services in the Rockhampton District, 1911 – 1957

Nursing services in the Rockhampton district, 1911 – 1957

Wendy Lee Madsen, BA, RN, MHSc

School of Nursing Queensland University of Technology

Doctor of Philosophy 2005

ii Abstract

Abstract

Throughout the twentieth century, nursing services gradually moved from being located within the community to being concentrated in institutions, such as hospitals. The aim of this thesis is to identify those nursing services that existed within the Rockhampton region from 1911 to 1957; to document the evolution of the services; and to explore those factors that influenced this evolution. In particular, an emphasis is placed on social and political factors. The nursing services explored in this thesis include private duty nursing, private hospitals, church and charity facilities, public hospitals and public community services. These services represent most nursing opportunities during the first half of the twentieth century. However, this thesis takes a unique position by exploring all services in detail within a limited location. In order to accomplish this, an empirical historical method is utilised, based on a wide range of documentary primary sources drawn from archival collections relating to Rockhampton and the nursing profession.

By examining a limited geographical area, this thesis highlights the complexity of nursing in regards to who nursed, how nursing was practiced and what factors influenced nursing. A particular feature that emerges within this thesis is the important role untrained nurses played within nursing services throughout the period under review. This group dominated private duty nursing and lying- hospitals in the Rockhampton region, although were gradually restricted to facilities for the aged and chronically ill. Trained nurses also became more institutionalised throughout the period, gradually losing former levels of autonomy as they gained more controlled working conditions, wages and career structures. Finally, this thesis highlights variations in nursing services between metropolitan and regional areas of Queensland.

Key words: nursing, nursing services, regional Australia, history

iv Contents

List of illustrations and tables vi

Abbreviations viii

Acknowledgements ix

Introduction 1

Chapter 1 8 Researching nursing’s history: some methodological issues

Chapter 2 45 The evolution of nursing services: responding to government action

Chapter 3 80 Private duty nursing: the loss of independence

Chapter 4 119 Nurses and private hospitals: owners, managers, workers

Chapter 5 168 For the love of God: churches and charities

Chapter 6 216 Opening Pandora’s box: the rise of public institutions in the Rockhampton district

Chapter 7 271 Public health nursing: promoting the growth of the (white) nation

Conclusion 316

Appendix A Private duty nurses, 1901 - 1949 321

Appendix B Nurses and their lying-in hospitals in Rockhampton 327

Appendix C Map of Rockhampton city 330

Appendix D Infant mortality rates, Australia, 1901 - 1945 331

Bibliography 332

v List of illustrations and tables

Figures

1.1 Rockhampton area 10 1.2 Contextual considerations of nursing services in Rockhampton 32 4.1 Leinster Hospital staff, c. 1930 126 4.2 Tannachy Hospital staff 127 4.3 Albert Hospital 132 4.4 Nurse Costello’s lying-in hospital, 2002 136 5.1 Inpatients of Children’s Hospital 179 5.2 Floor plan of Women’s Hospital 187 5.3 Salvation Army Rescue Home, Glenties, c. 1913 192 5.4 Floor plan of original Salvation Army Maternity Hospital, c. 1937 196 5.5 Floor plan of Bethesda, c. 1937 197 5.6 Mater Misericordiae Hospital, c. 1919 200 6.1 Responsibilities of Matron, Yeppoon Hospital, 1922 233 6.2 Floor plan of Yeppoon Hospital, 1930 234 6.3 Plan of Westwood premises, 1919 236 6.4 Westwood Sanatorium, 1919 237 7.1 Maternal and Child Welfare Centre, Rockhampton, 2002 289 7.2 Standard floor plan of Maternal and Child Welfare Centres, c. 1922 289

Tables

2.1 State Enterprises in Queensland 52 2.2 Wages and conditions of private duty and hospital nurses 76 3.1 Numbers of ATNA members employed by hospital or other organisation in 1923 85 3.2 QATNA recommended fees for private duty nurses

vi 1905 – 1955 109 3.3 Basic male wage for Brisbane 1921 – 1958 111 4.1 Nurse graduates of Hillcrest Private Hospital 1914 - 1949 125 4.2 Private deliveries in Rockhampton 1939 138 4.3 Lying-in hospitals in Rockhampton 1916 – 1930 140 4.4 Puerperal fever rates for Queensland 1901 – 1940 155 5.1 Graduates from Children’s Hospital Rockhampton 1904 – 1931 177 5.2 Infant deaths, Women’s Hospital 1925 – 1928 182 5.3 Women’s Hospital graduates and length of training 1918 – 1931 184 5.4 Patients admitted to Women’s Hospital 1918 – 1922 185 5.5 Graduates from Mater Hospital 1920 – 1934 202 5.6 Graduates and retention rates of trainees, Mater Hospital 1942 – 1958 203 6.1 Average daily occupancy for Rockhampton Hospital 1915 – 1926 221 6.2 Hospital districts in Queensland, c. 1928 222 6.3 Allocation of beds at the Rockhampton Hospital 1949 223 6.4 Movement of nursing staff at Rockhampton Hospital 1916 – 1927 229 6.5 Prescribed rest periods at Westwood Sanatorium 238 6.6 Inpatients of Westwood Sanatorium 1923 – 1941 239 6.7 Staffing at Westwood Sanatorium 1932 – 1949 242 6.8 Occupancy of Mount Morgan Hospital 1926 – 1954 247 6.9 Nursing staff of Mount Morgan Hospital 1926 – 1930 248 7.1 Attendance at Maternal and Child Welfare Centre, Rockhampton 1923 – 1924 290 7.2 Subsequent movement of maternal and child welfare trainees 1925 – 1938 310 7.3 Proposed schedule for branch visits 311

vii

Abbreviations

ACHHAM Australian Country Hospital Heritage Association Museum

ATNA Australasian Trained Nurses’ Association

POD Post Office Directory

QATNA Queensland Branch of the Australasian Trained Nurses’ Association

QNRB Queensland Nurses’ Registration Board

QSA Queensland State Archives

RCC Rockhampton City Council

RCCML Rockhampton City Council Municipal Library

RDHS Rockhampton District Historical Society

viii

Acknowledgements

When I embarked on this research project, I had little concept of the difficulties I would encounter, mostly of a personal nature. I sincerely thank my supervisors, Dr Alan Barnard, Dr Denis Cryle (CQU) and Dr Gary Ianziti for their understanding and support during those times, and for their trust in my ability to complete this project. I would also like to thank Dr Angela Cushing, who was unfortunately unable to continue as my supervisor, but who offered early encouragement and guidance that was greatly appreciated.

I would like to thank the members of the Australian Country Hospital Heritage Association, especially Yvonne Kelley, for allowing me access to their extensive collection, even while in the midst of moving locations. The members of the Rockhampton District Historical Society have also been very helpful, as have the staff at the Rockhampton City Council Municipal Library, Special Collections; Queensland Nurses’ Union; the Queensland State Archives and the Queensland State Library. I have also appreciated the efforts of staff at the Salvation Army Heritage Centre; the Mount Morgan Museum; the Benevolent Society, Rockhampton; and the Sisters of Mercy Archives, Rockhampton. Without the assistance of so many people, the data necessary for this study could not have been gathered. I would particularly like to thank the many nameless people who over the past century had the foresight to retain documents and photographs relating to nursing to allow such a study to occur.

Finally, I would like to thank my family for their unwavering support, especially my two sons, Joshua and Jack, who have demonstrated outstanding patience with their mother over the past few years.

I dedicate this thesis to the memory of my father, Trevor Rattenbury.

The work contained in this thesis has not been previously submitted for a degree or diploma at any other higher education institution. To the best of my knowledge and belief, the thesis contains no material previously published or written by another person except where due reference is made.

Signed: ______

Date: ______

xi Introduction

Rockhampton, Central Queensland, huddles around the wide, brown Fitzroy

River, named because of the rocky outcrops resting in the middle of the slow moving, tidal waters. Towards the east, the massive Berserker Range towers over the city, blocking the cool, sea breezes. The streets are wide and for the most part, flat, prone to flooding when the frequent droughts are finally broken by torrents of storm water. The streets now have many trees providing relief from the searing heat of a Rockhampton summer. However, these are a fairly recent addition to the city. Prior to the 1960s, few trees graced the dusty streets, although mango trees were found in most backyards.1 Rows of wooden houses, wrapped in verandahs, standing tall on stilts in a vain effort to catch a breeze, swelter under iron roofs.2 It is a busy city as it forms the hub of

Central Queensland. Surrounded by a number of small townships, it is also the start of the railway line heading west, forming the lifeline for small communities along the way. However, it is a wheel that sits in relative isolation, many miles from the seats of power in Brisbane, yet connected through influential politicians and business interests.

In amongst the daily goings-on of Rockhampton and its satellite towns, often unseen, move the nurses: bringing babies into the world, holding the hand of those exiting. Sometimes working alone, sometimes surrounded by other

1 McDonald, R., The Tree in Changing Light, Milsom Point, Knopf, 2001, p. 18. 2 McDonald, L., Rockhampton. A History of City and District, St Lucia, University of Queensland Press, 1981, p. 338.

1 nurses. This thesis takes you on a journey to the Rockhampton region, during a time when communities struggled with the loss of their young men through wars, when epidemics such as polio and diphtheria regularly claimed the lives of the young, when Spanish influenza devastated whole towns and when children went to bed hungry. It was also a time when nursing moved from a community-based occupation to one governed by institutions and authority; from when nurses were someone’s grandmothers, to white, starched professionals. By exploring this regional area over the period of time from

1911 to 1957, these transitions in nursing come into sharper focus. This thesis then, examines the shifting boundaries of nursing services within the region over a period of time. It outlines the evolution of the various services and investigates those factors affecting nursing services overall: those within the private sector and those associated with welfare provision.

Rockhampton was a significant city and region in Queensland during the first half of the twentieth century. The reasons for choosing this area as the location for this thesis are explored in Chapter 1. The importance of this region is discerned when considering the range of health services in the region and the timing of these services. For example, Rockhampton was often the first to receive new government services outside Brisbane, but also contained a range of more traditional nursing services such as untrained private duty nurses and lying-in hospitals. The large numbers of these nurses, as found in

Rockhampton, allows for a more concise analysis of the factors affecting nursing services during this time. Chapter 1 also discusses the context of such an analysis and points out the necessity of an empirical historical approach, one

2 that considers broad contextual factors when drawing conclusions. In particular, it is necessary to consider social, economic and political contexts, while keeping in mind nursing services have also been influenced by medical developments, labour issues and those affecting women.

The second chapter of this thesis provides the background of the political changes affecting health services. In particular, it explores the influence of ideologies adhered to by the labour movement such as nationalism and democratic socialism. These ideologies provided the foundations for government intervention into the lives of citizens, and consequently affected the delivery of a number of nursing services. How these legislative changes affected nursing services within the Rockhampton district will be considered throughout this thesis. What becomes evident is that much of the legislation dealing specifically with nurses did not have an immediate effect, although changes became apparent over time. Untrained nurses were eventually restricted in their practice, while trained nurses became increasingly associated with hospitals, especially State-funded hospitals. The second aspect noted in this chapter is the lack of involvement of the nurses’ professional body, the

Queensland branch of the Australasian Trained Nurses’ Association (QATNA), in any of the legislation enacted. In most instances, the QATNA either did not discuss the various Acts, or reacted in a minor way to the proposed changes.

This is despite the profound effects some legislation had on some of its members as will be apparent throughout this thesis.

3 The main part of the thesis has been segmented according to the similarities of the services involved. Chapters 3 to 7 each cover a separate group of services, roughly presented in chronological sequence according to inception and development, but which also demonstrates the increasing role of the government within nursing services. As such, Chapter 3 looks at the more traditional nursing service of private duty nursing. These nurses were initially untrained practitioners, who gained knowledge and skills through experience.

However, this avenue increasingly became the domain of trained nurses: those who had completed a period of formal hospital training. These two groups vied for the private duty nursing market, each with their own reasons for entering into this area of work. As such, various factors affected each of these groups differently. This chapter, in particular demonstrates a high prevalence of untrained nurses in the private duty nursing market in the Rockhampton region, and as a result challenges the image of private duty nursing often found in literature based on metropolitan studies.

The distinction between trained and untrained nurses is further explored in

Chapter 4. This chapter focuses on private hospitals, including those run by nurses. Again, untrained nurses predominated in this market in the

Rockhampton region further suggesting the image of the untrained nurse found in the literature needs to be reconsidered. Far from the threat to society they were painted as being during the early part of the century, these women were long-term residents who had built solid reputations with doctors and the community. However, several factors coincided which eventually eliminated lying-in hospitals, the main type of nurse-owned private hospital. The other

4 aspect explored in this chapter relates to doctor-owned private hospitals. In particular, it is suggested a fundamental difference existed between nurse- owned and doctor-owned private hospitals, as the latter tended to expand to meet the requirements of a nurse-training facility. As a result, doctor-owned hospitals had a more viable future.

Chapter 5 moves the focus away from the private market and considers those nursing services associated with welfare provision. It considers those services offered by churches and charities, although there were a number of overlaps with those offered privately. Many church and charity nursing services arose from nineteenth century ideals of philanthropy. As such, this ethos is explored in relation to the services located in the Rockhampton region. However, throughout the early twentieth century, church and charity nursing services underwent a number of changes, particularly in the way they were managed whereby they often competed in the private hospital market. Indeed, a number of these services used fee-paying patients to support their work. Nineteenth century philanthropy, however, infiltrated and influenced these services in other ways. For example, the notion of who ‘deserved’ to receive charity services continued to be evident well into the twentieth century. This chapter also highlights the involvement of women both as providers of services and as users of these services. As such, the services offered by these groups tended to focus on ‘feminine’ concerns: the welfare of mothers, children and the elderly.

The issues of welfare introduced in Chapter 5 are explored further in Chapter

6, only here the role of the State is highlighted. This chapter focuses on

5 institutional nursing as offered by ‘public’ hospitals. The range of State institutions covered in this chapter allows the various roles and responsibilities of hospital nurses to be explored, from those in positions of authority to the untrained. The chapter also demonstrates how government interventions promoted the increasing association between nurses and public hospitals.

The State government also became increasingly involved in a number of community welfare nursing services. Primarily in response to concerns about the high level of infant mortality and the lack of suitable army recruits, services such as maternal and child welfare and school nursing expanded throughout the

State. These services form the focus of Chapter 7. Mothers were encouraged to heed the advice of the trained nurses within these services as childrearing became more ‘scientific’ and children were subjected to being measured and surveyed throughout their infancy and childhood.

Throughout this thesis several issues become apparent. Firstly, the level of involvement of formally untrained nurses within nursing services seems to have remained high throughout the first half of the twentieth century. While the type of involvement changed as a result of legislative restrictions, the prevalence did not. This aspect deserves much closer scrutiny within the nursing literature and challenges a number of fundamental tenets of professional nursing regarding the role of training and what distinguishes a professional nurse. Secondly, the level of independence within nursing practice declined significantly as nurses became increasingly controlled by authorities.

This was evident in hospitals as well as community services such as maternal

6 and child welfare, where although nurses worked in relative isolation, they had uniformity of practice as a result of training and other controls. The final aspect is that trained and untrained nurses formed the backbone of health services in the Rockhampton district: those offered privately, via charities or through government intervention. They worked under appalling conditions at times, were paid meager wages, if any at all, worked long hours and took on significant responsibilities. Nursing was not a job, it was a full time commitment: from the untrained private duty nurse who could be called upon at any time, to the trained nurse living on the hospital premises, overseeing the nursing and administration of the facility. Many nurses in the Rockhampton district demonstrated the high level of self-sacrifice that is often associated with nursing. However, this thesis reveals that not all saw nursing as a vocation, and that profit and status were also influential.

By focusing on a limited, but significant geographical area, this thesis paints a picture of nursing not readily seen in the literature. It shows the many facets of nursing and a richness in texture and complexity that is not demonstrated when only one service is explored. While the images drawn here may not be readily transferred to other geographical contexts, this thesis at least challenges many of the images that have been portrayed thus far, derived as they are, mostly from metropolitan studies. As such, this thesis contributes to the growing history of nursing literature and contributes to our understanding of nursing in

Australia and its regions.

7 Chapter 1

Researching nursing’s history in Rockhampton: laying

the foundations

This thesis investigates the evolution of nursing services in the Rockhampton region, and examines these within the political and social contexts of

Queensland during the period 1911 to 1957. The significance of this study is the focus it places on regional Queensland and its recognition that the experiences of nurses in a regional area of Queensland may not have been the same as those from the metropolitan areas, or indeed, from regional and rural areas of other States or countries. Furthermore, this thesis takes a unique position of examining the evolution of a range of services in an in-depth manner within a limited geographical region to reveal the possible interplay of local and wider factors affecting change. This chapter will outline the significance of this study in regard to the nursing profession and relevant literature, and will consider some of the methodological issues confronted when undertaking such a study.

The primary objective of this study is to identify what nursing services existed in the Rockhampton region during the first half of the twentieth century, and to trace the developments and changes that occurred within those services. The geographical area of this region includes Rockhampton city, and the towns

8 within a 50 kilometre radius, such as Mount Morgan, Yeppoon, Emu Park and

Westwood (see Figure 1.1). The Rockhampton region was selected as

Rockhampton was an important strategic centre within Queensland.

Rockhampton was the centre of a thriving beef industry, with a large meat works. In addition, the significant quantities of gold from Mount Morgan passed via Rockhampton’s port facilities. Rockhampton was declared a city in

1902 and as such represents many of the benefits associated with a municipality. However, the smaller towns in the district provide a good contrast to the city and represent many of the features and problems associated with country towns. In regard to health services during the first half of the twentieth century, Rockhampton was often the first to receive services outside

Brisbane, some 700 kilometres to the south. For example, the first child and maternal welfare centre to be established outside Brisbane was built in

Rockhampton in 1923. Westwood Sanatorium was established within 50km of

Rockhampton for the treatment of tuberculosis in 1919. In addition, the only purpose-built Sister Kenny Clinic to be established in Queensland was built in

Rockhampton in 1939, although it was never used for this purpose.

9 Figure 1.1 Rockhampton region1

As such, a range of nursing services were available to the residents within

Rockhampton and the surrounding district, including private hospitals, government sponsored hospitals, a convalescent home, and community based nursing services. Through examining this region in closer detail, a greater understanding is gained of the evolution of regional nursing services and the relationships between the various services. In addition, focussing on a limited geographical area provides an opportunity to examine in depth the influence of

1 PCD Directories,2003.

10 various factors upon the working lives of nurses. As such, this thesis provides a specific regional perspective on nursing services as they existed in the first half of the twentieth century, and in so doing, highlights a number of differences between nursing services as documented within metropolitan centres, and those that existed within a regional area.

The expansion and demise of the various nursing services within this specific geographic region need to be explored in relation to factors influencing those changes. Of particular interest to this study are social and political factors. As such, the time period 1911 to 1957 is identified as a significant era for a number of reasons. Firstly, this period encompasses a time of considerable social upheaval and change relating to two world wars and a period of economic depression. Secondly, national and international nursing services underwent considerable change as the main avenue of employment shifted from being community based to hospital based. Finally, this period represents a time of political stability within Queensland, with the Labor party in government for most of the period 1915 to 1957. The relevance of successive

Labor governments will become evident throughout this study as the Labor party supported a number of interventionist policies. That is, legislation was introduced that directly affected the lives of the State’s citizens. The year 1911 was chosen as the commencement of this study as this was the year nurse registration was introduced into Queensland. Although a Labor government did not come into power until 1915, this particular piece of legislation had a significant effect on who could nurse and where, and was the first instance of

State government intervention resulting in broad changes to nursing services.

Nursing services: national and international developments

The nursing services presented in this thesis reflect the four main avenues of nursing available throughout most Western countries during the late nineteenth and early twentieth centuries. These are private duty nursing, private hospital work, public or charity hospital nursing,2 and publicly funded community based nursing services. While the services within each country developed differently in regards to timing and emphasis, all experienced a gradual rise of professional nursing, that is trained nurses becoming the predominant group.

Also, all countries witnessed an increasing level of medical influence within society as medicine encompassed techniques affecting anaesthetics and diagnostics leading to more advanced surgery and safer pharmaceuticals. This activity was primarily undertaken within the public hospital domain and led to gradual improvements in the reputation of public hospitals: from places where the poor and dying went, to places seen as the epitome of health and healing.

Alongside this shift in hospital image was the movement of trained and training nurses into these hospitals. Therefore, the transition from community based nursing activities to those within the hospital, as described throughout this thesis, was not confined to Rockhampton or to the State of Queensland, but rather was a worldwide phenomenon. This section will briefly outline this overall movement and highlight some of the international and national variances.

2 Throughout this thesis the term ‘public’ has been taken from its broadest meanings and includes all hospitals and institutions that were supported by the public at large. This includes charities run by volunteer groups who raised funds through a variety of means as well as government run and sponsored organizations.

In order to examine the types of nursing services existing in Queensland and

Australia in the nineteenth century, it is worthwhile referring to the health systems that existed in Britain. Dingwall, Rafferty and Webster3 identify four main categories of nurses in the early nineteenth century aside from inmates attending inmates as was the practice in poor houses. These groups included members of the sick person’s household (including family and servants); handywomen; private duty nurses; and medical attendants who worked in the private and voluntary hospitals. As the British settled in Australia, so similar health services were established. However, some differences are apparent. For example, it is likely the new immigrants had less family support to assist them during sickness or injury, requiring them to seek out the services of the government-run hospitals.4 Handywomen were nurses who served the needs of the working class, while private nurses attended the middle and upper class patients in their own homes in Britain.5 Such a distinction among those women who practiced nursing independently was not evident in Australia until later in the nineteenth century, when trained nurses wished to distinguish themselves from the untrained. Finally, medical attendants, or wardsmen, were

3 Dingwall, R., Rafferty, A.M., Webster, C., An Introduction to the Social History of Nursing, London, Routledge, 1988, p. 7. 4 The early hospitals within Australia are reported to have had constant problems of overcrowding and under-financing related to demands outstripping the supply and ability of the government and voluntary hospital system. Gregory, H., A Tradition of Care. The History of Nursing at the Royal Brisbane Hospital, Brisbane, Boolarong Publications, 1988; Trembath, R., Hellier, D., All Care and Responsibility. A History of Nursing in Victoria, 1850 – 193, Victoria, The Florence Nightingale Committee, Australia, Victoria Branch, 1987; Bell, J., ‘Queensland’s public hospital system: Some aspects of finance and control’, Public Administration, vol. 27, no. 1, 1968, pp. 39-49. 5 Dingwall, et al., op. cit., p. 7.

13 very prevalent within government and voluntary hospitals in Australia until the introduction of a nurse-training system from 1868.6

Prior to 1930, most trained nurses in Western societies could expect to spend at least a part of their career undertaking private duty nursing, that is, attending cases in the patient’s home.7 While these nurses could be seen as having a reasonable level of autonomy, there was a considerable amount of competition for work. The competition for cases came not only from those women who had no training, but also from the staff of hospitals. It was common practice for hospitals to send trainees into the private duty nursing market during quiet times on the ward.8 In addition, Gregory9 shows that trained nurses from the

Brisbane Hospital were also permitted to attend private cases during the 1890s when staffing permitted. This competition occasionally forced professional organisations to become more pro-active.10 In fact, some have argued the main reason behind the drive by nursing bodies to seek registration legislation can be related to the attempt to exclude untrained nurses from the private duty market.11 Interestingly, the legislation covering nurse registration in

6 Cushing, A., ‘Perspectives on male and female care giving in Victoria, 1850-1890’, in Bryder, L., Dow, D.A. (eds), New Countries and Old Medicine. Proceedings of an International Conference on the History of Medicine and Health, Auckland, The Auckland Medical Historical Society, 1995a, pp. 263-270; Trembath and Hellier, op. cit., p. 12; Gregory, op. cit., p. 6; Russell, R.L., From Nightingale to Now. Nurse Education in Australia, Sydney, W.B. Saunders/Bailliere Tindall, 1990, p. 9; Durdin, J., They Became Nurses: A History of Nursing in South Australia, 1836 – 1980, Sydney, Allen & Unwin, 1991, p. 20. 7 Strachan, G., Labour of Love. The History of the Nurses’ Association in Queensland 1860 – 1950, St Leonards, Allen & Unwin, 1996, p. 136. 8 Durdin, op. cit., p. 27. 9 Gregory, op. cit., p. 32. 10 For example, an over-supply of private duty nurses in Arkansas prompted the decision to restrict nurse trainee numbers. Lane-Miller, E. ‘From home to hospital: changing work settings of Arkansas nurses, 1910 – 1954’, Journal of Nursing History, vol. 3, no. 2, 1988, p. 38. 11 Strachan, op. cit., p.70; Rafferty, A.M., The Politics of Nursing Knowledge, London, Routledge, 1996, p. 77.

14 Queensland from 1912 did not prevent a woman from practicing as an unregistered nurse. Ironically, she could work only as a private duty nurse.12

Private duty nurses could be expected to deal with a wide range of cases, however, maternity cases were preferred because this type of work was more reliable. Furthermore, as maternity cases required the nurse to be resident just before the birth until one month afterwards, this type of work provided a continuous income for at least a month.13 As most births pre 1920s took place within the home or a cottage hospital, this type of work was quite common.14

Indeed, home births remained a popular option in England longer than in

Australia or the USA.15

Although most private duty nurses lived at the residence of the patient while they were attending a case, sometimes a nurse would live elsewhere and visit a patient on a daily basis. Selby16 describes the midwifery services of a Mrs Fry in Mackay, whereby the birth was attended and the mother and baby visited daily for the next week. This was also the model used by district nursing associations when they became established. For example, the Church of

12 Strachan, op. cit., p. 79. 13 Mortimer, B., ‘Independent women: domiciliary nurses in mid-nineteenth century Edinburgh’, in Rafferty, A.M., Robinson, J., Elkan, R. (eds), Nursing History and the Politics of Welfare, London, Routledge, 1997, p. 138. 14 Selby, W. Motherhood in Labor’s Queensland, 1915 – 1957. Doctoral thesis, Griffith University, 1992, p. 98. 15 Dawley, K., ‘Ideology and self-interest. Nursing, medicine, and the elimination of the midwife’, Nursing History Review, vol. 9, 2001, p. 101. 16 Selby op. cit., p. 94.

15 England employed a trained nurse in 1901 to attend the sick in Redfern and

Waterloo.17

Aside from district nursing, one of the difficulties faced by trained nurses seeking work away from hospitals was communication. Referring doctors and patients needed to be able to contact a nurse, often at short notice. In addition, many nurses needed to have a place to stay when not attending a case. These problems were partly overcome through the use of nurses’ homes. Nurses’ homes were run by Lady Superintendents, who allocated particular cases to the nurses of the home. A nurse would pay the home a retainer fee for accommodation, food and for keeping her name on the list for available work.18 The work of a private duty nurse was sporadic and the hours and conditions under which she worked were often extremely arduous. As a result, the working life of a private nurse was frequently no longer than ten years. 19

Trembath and Hellier20 and Strachan21 suggest private nursing in Australia did not recover from the effects of the 1930s depression and changes in medical practice requiring patients to be treated in hospital. In contrast, Lane-Miller22 indicates private nursing remained a viable option for a small number of nurses in the USA until the 1960s.

17 Wilson, J., ‘Bush nightingales. A view of the nurses’ role in Australian cottage hospital industry’, in Pearn, J. (ed), Health, History and Horizons, Brisbane, Amphion Press, 1992, p. 34. 18 Trembath and Hellier, op. cit., pp. 89-90. 19 Strachan, op. cit., p. 137. 20 Trembath and Hellier, op. cit., p. 155. 21 Strachan, op. cit., p. 148. 22 Lane-Miller, op. cit., p. 47.

16 The second option available to nurses was that of private hospital nursing – either as an employee or as the proprietor. Private hospitals owned by doctors or nurses served the needs of those within the community who could afford to pay for this service. The only other type of hospital services available were voluntary or charitable institutions for the destitute. As will be discussed in

Chapters 5 and 6, most of these latter hospitals in Australia relied heavily on government grants to remain operational. Most private hospitals started from houses, either rented or bought. While some of these ventures grew to become quite substantial hospitals such as the Wakefield Hospital in Adelaide,23 many remained as small cottage hospitals run by one or two nurses. Typically, the cottage hospital was the private residence of a nurse, often untrained, who undertook a variety of cases, although maternity provided a significant proportion of her work.24 Private hospitals were targeted with licensing and rigid regulations from the early twentieth century.25

Although private hospitals were numerous, they rarely reached the size of public institutions. The first hospitals established in each of the colonies of

Australia were initially entirely government funded.26 Colonial governments tried to encourage a system of health care similar to Britain. The early hospitals were run by voluntary committees of socially high standing men, as in Britain, and patients paid for the hospital service either through a fee-for-service basis

23 Durdin, op. cit., p. 27. 24 Selby, op. cit., pp. 93-94. 25 For example, the Private Hospital Act, 1908 in New South Wales specified managers of private hospitals needed to be trained nurses or qualified doctors, as a means of decreasing the infant morality rate. Strachan, op. cit., p. 71. 26 Schultz, B., A Tapestry of Service. The Evolution of Nursing in Australia, Volume 1. Foundations to Federation 1788 – 1900, Melbourne, Churchill Livingstone, 1991.

17 or by regular contributions.27 However, hospitals in Australia have always relied heavily on government funding. For example, Bell28 records the government tried to reduce its financial contribution to the Brisbane Hospital from 1849. As Trembath and Hellier29 note, the voluntary system in Australia was somewhat paradoxical. Although the State contributed the majority of funds, hospital committees were suspicious of any signs of State interference in the management of hospitals, fearing this would stop altogether the small flow of funds from private contributors. Hence, although most of the major hospitals within Australia were considered to be ‘voluntary’ institutions until the mid twentieth century, the reality was they existed primarily on government funding. For this reason, most voluntary hospitals have been classified as public hospitals for the purposes of this thesis.

Public hospital nursing was carried out by male attendants and female nurses until the introduction of trained nursing in the late nineteenth century.

Although trained nurses had been in Australia since 1838, in association with the Sisters of Charity,30 Lucy Osburn and her five companions from St Thomas

Hospital in England are generally recognised as introducing the system of nurse training in Australia from 1868.31 However, the spread of training hospitals was often sporadic. Osburn established nurse training at the Sydney

Hospital soon after her arrival.32 The Alfred Hospital in Melbourne began

27 Baly, M.E., Nursing and Social Change, 3rd Edition, London, Routledge, 1995; Bell, op. cit.; Gregory, op. cit. 28 Bell, op. cit., p. 39. 29 Trembath and Hellier, op. cit., p. 11. 30 McCoppin, B., Gardner, H., Tradition and Reality: Nursing and Politics in Australia, Melbourne, Churchill Livingstone, 1994, p. 2. 31 Gregory, op. cit., p. 15; Strachan, op. cit., p. 5; Trembath and Hellier, op. cit., p. 4. 32 Schultz, op. cit., p. 78.

18 training in 1880.33 Instruction to nurses was not implemented at the Brisbane

Hospital until 1886,34 a similar time to the commencement of nurse training at the Rockhampton Hospital.35 By the turn of the twentieth century, most public and private hospitals with more than ten daily occupied beds had instigated nurse training and were associated with the Australasian Trained Nurses

Association (ATNA), or a similar organisation.36

Hospital administrations were attracted to nurse training schemes because they offered a source of cheap labour: nurse trainees. Hence, nursing staff could consist of a small number of trained nurses who supervised the large number of trainees. In Australia, the duration of training depended on the number of beds occupied within the hospital: five years training for hospitals with a daily occupancy rate of ten to twenty beds; four years for hospitals with twenty to forty beds; and a minimum of three years for those hospitals with more than forty beds. However, for much of the twentieth century, many larger hospitals in Queensland stipulated four years of training.37

The final category of nursing service includes a diverse collection of community-based services funded by the government and community groups.

While most of the community based activity, both in Australia and internationally, focused on child and maternal services, other government-

33 Trembath and Hellier, op. cit., p. 18. 34 Gregory, op. cit., p. 22. 35 Kelley, Y., ‘Rockhampton nurses’, Recreating Queensland Nurses, Queensland Nursing History, One Day Conference, 1994. 36 Strachan, op. cit., p. 48. 37 Gregory, op. cit., p. 51.

19 funded activities existed. For example, Durdin38 notes the employment of a public health nurse in South Australia in 1899 and Buhler-Wilkinson39 outlines the USA government funded nurses in health promotion activities, particularly those dealing with infectious diseases. Health visiting was encouraged within the United Kingdom, although it was initially a voluntary activity. Welsh40 notes this activity came to be totally funded by local authorities from the 1920s when the role was primarily concerned with maternal and child welfare.

Health visiting was also an important nursing service in Canada from the early twentieth century.41 Some Australian State governments also sponsored school nursing and bush nursing.42

The issue of the maternal and infant mortality rate is closely tied to much of the eagerness governments showed towards promoting the perinatal aspect of nursing.43 According to Peretz,44 legislation passed from 1902 in Britain was

‘enabling’ or permissive legislation allowing local authorities to set up services to address this issue. Durdin45 proposes concern over the high infant mortality rate prompted the Adelaide City Council to add ‘visiting mothers with young infants’ to the responsibilities of the Municipal nurse in 1909. Selby46 argues

38 Durdin, op. cit., p. 71. 39 Buhler-Wilkinson, K., ‘Home care the American way: An historical analysis’, Home Health Care Services Quarterly, vol. 12, no. 3, 1991, pp. 9-12. 40 Welsh, J., ‘Family visitors or social workers? Health visiting and public health in England and Wales, 1890 – 1974’, International History of Nursing Journal, vol. 2, no. 4, 1997, p. 15. 41 Duncan, S.M., Leipert, B.D., Mill, J.E., ‘Nurses as health evangelists’, Nursing Science, vol. 22, no. 1, 1999, pp. 40-51. 42 Dickey, B., ‘The Labor government and medical services in New South Wales, 1910 – 14’, in Roe, J. (ed), Social Policy in Australia. Some Perspectives 1901 – 1975, Sydney, Cassell Australia, 1976, p. 70. 43 Brennan, S., ‘Nursing and motherhood constructions: Implications for practice’, Nursing Inquiry, vol. 15, 1998, p. 12. 44 Peretz, E., ‘Infant welfare in inter-war Oxford’, International History of Nursing Journal, vol. 1, no. 1, 1995, p. 7. 45 Durdin, op. cit., p. 71. 46 Selby, op. cit.

20 much of the legislation affecting nurses in Queensland was primarily motivated by the high infant and maternal mortality rate. This issue is explored further in the next chapter and recurs throughout this thesis.

Literature review

As this thesis focuses on the history of nursing services, it necessarily draws on three main domains of literature: history of nursing; political history and women’s history. It is not practical or appropriate to undertake a complete literature review of all these areas here. Therefore, this section will provide a brief overview of works drawn upon for this research. A more extensive review of the literature pertinent to specific nursing services is included in each chapter.

Critical analysis of nursing’s past is a recent development within the nursing profession.47 Although numerous nursing ‘histories’ have been written over the past century, the trend to take a more analytical approach to the historical developments within nursing only began around twenty years ago. The origin of this more analytical approach is generally acknowledged to have been the publication of Celia Davies’ Rewriting Nursing History in 1980,48 closely followed by contributions by Maggs49 and Melosh.50 These publications,

47 Sarnecky, M.T., ‘Historiography: a legitimate research methodology for nursing’, Advances in Nursing Science, July, 1990, pp. 1 – 10. 48 For example: Strachan, op. cit., p. xix; Rafferty, op. cit., pp. 3-4; Davies, C. (ed), Rewriting Nursing History, London, Croom Helm, 1980. 49 Maggs, C.J., The Origins of General Nursing, London, Croom Helm, 1983. 50 Melosh, B., The Physician’s Hand. Work Culture and Conflict in American Nursing, Philadelphia, Temple University Press, 1982.

21 along with a number of others since that time,51 have attempted to place the development of nursing practice and services within a political, economic or social context, an aspect of nursing history that had previously been missing.52

Maggs53 suggests the lack of debate and scholarship within nursing history is related to nurses taking on the task of writing about nursing’s past rather than historians. In addition, Cushing54 laments how more often than not, nurses in the past have shown only an interest in the heritage events of the past. This has resulted in a limited exploration of nursing’s development being evident in the nursing literature.

One consequence of the recent character of nursing historiography is a decided lack of appropriate secondary sources from which to base further study. While there has been a significant increase in the number of analytical works focussing on nursing’s past, most have tended to concentrate on the development of nursing in North America and Britain, in particular, England.

However, this does not necessarily constitute a negative outcome, as it encourages the Australian researcher to examine the development of nursing from an international perspective and promotes a greater understanding of influential factors relevant to a particular study. For example, McPherson55 suggests mid twentieth century health care policy reforms in the USA were

51 For example: Baly, op. cit.; McPherson, K., Bedside Matters. The Transformation of Canadian Nursing 1900 – 1990, Toronto, Oxford University Press, 1996; Rafferty, op. cit. 52 Godden, J., Curry, G., Delacour, S., ‘The decline of myths and myopia? The use and abuse of nursing history’, Australian Journal of Advanced Nursing, vol. 10, no. 2, 1992/1993, pp. 27- 33. 53 Maggs, C., ‘A response to Angela Cushing’, International History of Nursing Journal, vol. 2, no. 2, 1996, pp. 88-91. 54 Cushing, A., ‘Nursing history in Australia’, International History of Nursing Journal, vol. 1, no. 1, 1995b, pp. 69-70. 55 McPherson, K.I., ‘Health care policy, values and nursing’, in Chinn, P.L. (ed), Developing the Discipline. Critical Studies in Nursing History and Professional Issues, Maryland, Aspen Publishers, 1994, p. 124.

22 driven by economic policy rather than by a coherent, internally consistent approach valuing equal distribution of health care services. Rafferty56 notes the British government was more likely to initiate reform within nursing services rather than respond to influences by the nursing profession during the early twentieth century. Meanwhile Baly57 has examined the development of government interventionist policies and the promotion of the welfare state in

Britain from the sixteenth century. These publications all raise broader issues to be confronted in this thesis. Hence, the international literature on nursing history provides a necessary background against which the changes in nursing services in regional Queensland may be compared and contrasted.

The status of nursing historiography in Australia is not dissimilar to that found internationally. Although a range of nursing histories have been published, most have focused on recording significant events or persons of a particular hospital, organisation or State.58 These have been written by nurses for nurses, and hence do not place the events within a wider political or social context. An increasing number of Australian publications have moved beyond simply recording the past and have attempted to contextualise and explain the developments within nursing.59 While this thesis draws upon these works, few

56 Rafferty, op. cit., p. 3. 57 Baly, op. cit. 58 For example: Nurses’ Memorial Foundation of South Australia Inc., Nursing – 150 Years of Caring in South Australia, Adelaide, Nurses’ Memorial Foundations of South Australia Inc., 1989; Gregory, H., Brazil, C., Bearers of the Tradition. Nurses of the Royal Brisbane Hospital 1888-1993, Brisbane, Boolarong Publications, 1993; Brown, L.M., History and Memories of Nursing at the Launceston General Hospital, Launceston, The Launceston General Hospital Ex-trainees Association, 1980; Burchill, E., Australian Nurses since Nightingale 1860 – 1990, Melbourne, Spectrum Publications, 1992; Durdin, op. cit. 59 For example: Russell, op. cit.; Trembath, and Hellier, op. cit.; Dickenson, M., An Unsentimental Union. The New South Wales Association,1931-1992, Sydney, Hale & Iremanger, 1993. More recent examples include: Nelson, S. Say Little, Do Much. Nurses, Nuns, and Hospitals in the Nineteenth Century, Philadelphia, University of Pennsylvania Press,

23 of them have direct relevance to the issues explored here. However, collectively they provide an overview of a range of nursing services in various

States and Territories in Australia.

As this study focuses on the development of nursing services in the

Rockhampton region, four specific pieces of relevant literature have been identified. Bartz Schultz has attempted to document all nursing services in each State of Australia.60 The monumental character of this book precludes it from containing any critical analysis, and indeed, the author notes that this was not her intention. However, this work provides a useful platform from which to start examining those nursing services available in Queensland prior to

Federation. The second volume of this work, when available, will be very pertinent to the current study as it presents an account of nursing’s development in Australia and Queensland from 1900.

Helen Gregory’s book on the expansion of nursing at the Royal Brisbane

Hospital provides a closer look at nursing in Queensland’s largest hospital.61

Gregory is an example of a historian from a non-nursing background writing on the changes in nursing history, and has examined the development of nursing to some extent within a broader social and political context. For example, she outlines the issues and problems faced by the hospital’s administration. This administration was particularly significant during the

1930s and 1940s as Charles Chuter held dual positions of the Hospital Board’s

2001; Mein Smith, P., Mothers and King Baby. Infant Survival and Welfare in an Imperial World: Australia 1880 – 1950, Hampshire, MacMillan Press, 1997. 60 Schultz, op, cit. 61 Gregory, op. cit.

24 chairman and as a public servant intimately involved in the development of much of Queensland’s health policies at the time.62

Glenda Strachan’s book, Labour of Love, is based on work undertaken as part of her doctoral studies.63 It focuses on the activities of the Australasian

Trained Nurses’ Association (ATNA) in Queensland, the main professional nursing body within this State, from its instigation in 1904 until 1950.

Strachan suggests the ATNA showed very little initiative, tending to react only when events and circumstances impacted directly on specific groups of nurses, for example, public hospital nurses. Although the main focus of the study falls on industrial aspects, reference is made to other legislation and their effect on nurses. Strachan discusses at length the working conditions of the private duty nurse and provides one of the few detailed accounts of this type of nursing in

Australian nursing literature.

Private duty nursing is also an important feature in Wendy Selby’s doctorate on motherhood in Queensland from 1915 to 1957.64 Selby examines the effect of the policies and legislation of the Labor government in Queensland upon the childbirth and child raising experiences of mothers. As such, midwifery services are explored in considerable detail. Selby’s work is of particular significance to the current research as it deals specifically with the effect of government legislation upon nursing services, although it focuses mainly on maternity services. However, Selby argues legislation dealing with nurses’

62 Patrick, R., A History of Health and Medicine in Queensland 1824 – 1960, St Lucia, University of Queensland Press, 1987, p. 87. 63 Strachan, op. cit. 64 Selby, op. cit.

25 registration and private lying-in hospitals had a significant negative impact on the viability of many nurses practising within the community.

Each of these studies has contributed to an understanding of nursing services in

Queensland, and each has identified specific instances or events relating to nursing in Rockhampton, although usually only in passing. McDonald65 has undertaken an extensive study of the Rockhampton district from the beginning of white settlement, part of which includes outlining the establishment of several health care institutions, including the Rockhampton Hospital,

Westwood Sanatorium and Yeppoon Convalescent Home. McDonald also mentions the transition of midwifery services from private ‘lying-in’ cottage hospitals to larger institutions. While this work is of value in identifying dates and names of relevant health care institutions within the Rockhampton area, it offers limited insight into the development of these institutions and their effects on nursing services.

Another significant area of literature examined for this research is political history within Queensland. Unlike nursing history, political history is a well- established discipline with numerous analyses of developments within the various political parties and governments. However, as with most political historical accounts, little attention is paid to the social effects of the legislative changes, including those relating to nursing.

65 McDonald, L. Rockhampton. A History of City and District, St Lucia, University of Queensland Press, 1981.

26 Stuart Macintyre66 provides an overview of the emergence of the Labor Party in Australia and analyses those factors that drove much of Labor’s political and social agenda. Issues such as safeguarding employment and living standards, class conflict and welfare provisions are evident in many of the pieces of legislature developed under the early Labor governments. This was particularly evident in Queensland where Labor was in office for an extended period of time. Historians such as Denis Murphy67 and Ross Fitzgerald68 have written numerous publications regarding the reign of the Labor Party in

Queensland. However, as general political histories, these publications tend to focus on those factors influencing the development of legislation rather than the consequences of the legislation upon the lives of ordinary citizens.

Of the literature dealing specifically with health legislation, Ross Patrick and

Jacqueline Bell are significant contributors. Patrick69 has examined a wide range of health services and the associated enabling legislation within

Queensland. However, as with the general political histories, the influential factors and key figures involved in the development of the legislation tend to be the primary focus. As indicated earlier, the nursing profession was not inclined towards political lobbying and hence the role played by nurses in the development of policy and legislation was minimal. This aspect is further explored in the following chapter.

66 Macintyre, S., The Labour Experiment, Melbourne, McPhee Bribble Publishers, 1989. 67 Murphy, D.J. (ed), Labor in Politics. The State Labor Parties in Australia, 1880-1920, St Lucia, University of Queensland Press, 1975; Murphy, D., Joyce, R., Cribb, M. (eds), The Premiers of Queensland, St Lucia, University of Queensland Press, 1990. 68 Fitzgerald, R., Thornton, H., Labor in Queensland. From the 1880s to 1988, St Lucia, University of Queensland Press, 1989. 69 Patrick, op. cit.

27 Bell70 has detailed the key to much of Queensland’s Labor governments’ ability to provide desired services: controlling the Golden Casket lottery. Bell also outlines the financial position of Queensland’s major hospitals during the first part of the twentieth century and the relationship the government had with the controlling bodies of these hospitals.

The final area of literature examined relates to social history and in particular the role of women in Australian society. As with the literature relating to political history, there is a considerable amount of literature in this field, with most generated since the mid 1970s. The range of topics covered in this field is quite extensive and broad and considers women in paid71 and unpaid work,72 wartime activities,73 racial74 and class issues.75 As a result of this breadth, this chapter will only briefly review a few pertinent studies of particular interest to this study.

70 Bell, op. cit. 71 For example, Aveling, M., Damousi, J., Stepping Out in History. Documents of Women at Work in Australia, Sydney, Allen & Unwin, 1991; Kirby, D., ‘Writing the history of women working: photographic evidence and the ‘disreputable occupation of barmaid’, in Frances, R., Scales, B. (eds), Women, Work and the Labour Movement in Australia and Aoteorea/New Zealand, Sydney, Australian Society for the Study of Labour History, 1991; Johnson, P., ‘Gender, class and work: the Council of Action for Equal Pay and the equal pay campaign in Australia during World War 2’, Labour History, no. 50, 1986; Kingston, B., My Wife, My Daughter and Poor Mary Ann. Women and Work in Australia, Melbourne, Thomas Nelson (Australia), 1975. 72 For example, Willis, S., ‘Homes are divine workshops’, in Windschuttle, E. (ed), Women, Class and History. Feminist Perspectives on Australia 1788 – 1978, Melbourne, Fontana Books, 1980. 73 For example, Goldsmith, B., Sandford, B., The Girls They Left Behind, Ringwood, Penguin Books Australia, 1990; Gowland, P., ‘The women’s peace army’, in Windschuttle, E. (ed), Women, Class and History. Feminist Perspectives on Australia 1788 – 1978, Melbourne, Fontana Books, 1980; Hardisty, S. (ed), Thanks Girls and Goodbye. Land Army 1942 – 1945, Melbourne, Viking O’Neill, 1990. 74 Huggins, J., ‘White aprons, black hands: Aboriginal women domestic servants in Queensland,’ Labour History, no. 69, 1995, pp. 188-195. 75 Bashford, A., ‘Female bodies at work: Gender and the re-forming of colonial hospitals’, in Walker, D., Garton, S., Horne, J. (eds), ‘Bodies’, Australian Cultural History, no. 13, 1994, pp. 65-81.

28 The collection of essays edited by Curthoys, Eade and Spearritt76 covers issues relating to women’s unions, wages and housework among others. Similarly, issues relating to women and class are contained in the collection edited by

Windschuttle.77 Of particular interest to this study is the essay by Willis78 which examines the rise of mothers’ unions in Australia. This union began activities in Queensland at the beginning of the century and was strongly supported throughout the study period by Lady Cilento, 79 who was married to

Sir Ralph Cilento, the Director-General of Health and Medical services in

Queensland from 1935. One of the early works of significance in the area of women and work is by Ryan and Conlon80 who looked at the lack of involvement by women in the union movement and the establishment of the

Women’s Employment Board among other issues across a broad time frame.

The collection of essays edited by Reeke81 is also significant for this study as these focus on women’s experiences in Queensland.

Finally, many of the issues facing women in the early decades of the twentieth century have been explored in Kerreen Reiger’s work.82 Reiger’s study considers the changing domestic domain of women and hence incorporates a number of nursing services relevant to women. In particular, Reiger

76 Curthoys, A., Eade, S., Spearritt, P. (eds), Women at Work, Canberra, Australian Society for the Study of Labour History, 1975. 77 Windschuttle, E. (ed), Women, Class and History. Feminist Perspectives on Australia 1788 – 1978, Melbourne, Fontana Books, 1980. 78 Willis, op.cit. 79 Cilento, P., ‘Mothercraft in Queensland. A story of progress and achievement’, Royal Historical Society of Queensland Journal, vol. 8, no. 2, 1966/67, pp. 317-341. 80 Ryan, E., Conlon, A., Gentle Invaders. Australian Women at Work, Ringwood, Penguin Books Australia, 1975. 81 Reeke, G. (ed), On the Edge. Women’s Experiences in Queensland, St Lucia, University of Queensland Press, 1994. 82 Reiger, K., The Disenchantment of the Home. Modernising the Australian family 1880 – 1940, Melbourne, Oxford University Press, 1985.

29 documents the increasing medicalisation of childbirth and the interference of

‘experts’ in child rearing. Reiger’s work is significant in that it details some of the effects of nursing services upon the family from the family’s perspective.

However, the study is mostly focused in a Victorian, metropolitan context.

Although nursing is often mentioned within much of the literature relating to women’s history, it is often in passing or as an example of traditional

‘women’s’ work. However, this area of literature will inform this study by contributing to an understanding of the social context and through identifying possible social factors that may have influenced, or been influenced by, changes within nursing services. In particular, the role of women in establishing and managing nursing services is explored in Chapter 5.

This brief review of the literature suggests a significant gap exists in the body of knowledge that deals with the effect of government policy upon the nursing services of Queensland, and in particular, those relating to regional areas. This thesis will contribute to the understanding of nursing in a key regional area of

Queensland during the first half of the twentieth century, during a period when nursing services evolved and reacted to a range of factors, including social and legislative changes.

Research questions

As the above review of the literature suggests, the history of nursing as a field of study relates to a number of historical disciplines. This thesis, whilst

30 focussing on a particular geographic region, recognises the developments in nursing being examined must be located within a broader social and political context. Therefore, the avenues of inquiry for this thesis incorporate social history, political history, and the local history of the Rockhampton region.

These contexts are visually represented in Figure 1.2. At the same time, it is recognised that cutting across these contexts are a number of specific developments relevant to this study. Specifically these include national and international changes within the nursing profession; national and international economic circumstances; and changes within medical science and the medical profession. That is, while there is a focus on examining regional nursing services in relation to political and social developments in Queensland, nursing, medical and economic influences also need to be investigated. As such, each service examined in this thesis considers factors of both a local and broader nature in order to determine the effects on the evolution of that service.

Overall, three fundamental questions have been pursued: What nursing services existed in the Rockhampton region in the years 1911 to 1957? How did these services evolve during those years? What role did governmental policies have on the evolution of those services? A number of associated and more specific questions have been derived from these overarching questions.

These specific questions include:

• What was the prevalence of private nursing within the Rockhampton region?

• What was the relationship between private nursing and the hospitals in and around the Rockhampton region?

Figure 1.2 Contextual considerations of nursing services in Rockhampton.

International International and national Social developments in Queensland and national medical economic development development Political developments in Queensland

Nursing services in Rockhampton region

International and national nursing development

• Did the location of Rockhampton as a regional centre have any effect on the type of nursing services provided?

• What local and social factors affected the evolution of nursing services in the Rockhampton region?

• How did the Labor government and the political decisions made about health care delivery in Queensland affect private duty nursing and the other avenues of nursing employment?

• Was the government in Queensland responding to local needs within the community when making decisions affecting nursing services, or was it following national or international trends?

32 In response to these questions, this thesis demonstrates a complex interplay between a range of factors. Social, political and economic factors are identified at a local level as well being influential from national and international levels. These all worked towards changing the face of nursing in the Rockhampton area.

It is possible to identify to some extent the prevalence of private duty nursing in the Rockhampton region, including the involvement of untrained nurses.

Indeed, the prevalence of untrained nurses within community and hospital based services is an aspect that emerges as holding more significance than originally anticipated. Private duty nursing was a significant avenue of nursing service prior to the 1920s. Other options for nurses included operating a cottage hospital or employment at a small number of doctor-run hospitals:

Leinster, Hillcrest and Tannachy hospitals. Nurses could seek employment from church or charity institutions such as the Mater Misericordiae Hospital, the Salvation Army Maternity Hospital, the Children’s Hospital, the Women’s

Hospital or the Rockhampton Hospital, although the latter three were mostly supported by government funding prior to 1925 when they were amalgamated under the Rockhampton Hospital Board. Another government funded option included tuberculosis nursing at Westwood after 1919. School nursing and maternal and child welfare nursing also became available by the early 1920s.

Smaller communities such as Yeppoon and Mount Morgan also had some private duty nursing and hospital options for nurses. As such, the

Rockhampton region clearly contained a representation of the range of nursing

33 services available in Australia at the time, further justifying the selection of this region as an appropriate location for this research.

The relationship between private duty nursing and hospital nursing is an interesting one. This thesis demonstrates an overall shift of nurses working for themselves towards working for institutions, and especially hospitals. This occurred for both trained nurses and untrained nurses, although trained nurses seem to have moved fairly fluidly between the private duty realm and that of the hospital during these early years. This tendency diminished as private duty nursing became less prevalent by the late 1920s.

The evolution of nursing services in the Rockhampton region was influenced by local and social factors. These include broader issues such as the changing role of philanthropy in the community, whereby charities were increasingly run as businesses. The increasing level of government control of hospitals also saw the level of community involvement decrease. For example the Women’s

Hospital, Children’s Hospital, Yeppoon Hospital, Mount Morgan Hospital and the Rockhampton Hospital were run by committees made up of volunteers, many of whom were women. These committees ceased to exist when the hospitals came under government control.

Local factors also had profound effects on nursing services. For example, the closure of the Mount Morgan gold mine in 1927 significantly affected the population of this township. As a result, the level of private duty nursing decreased in the town, and there was an increased level of responsibility placed

34 on the trainees at the Mount Morgan Hospital, as few trained nurses were employed. In regards to Rockhampton, I propose the rise in water rates charged by the City Council contributed to the closure of a number of lying-in hospitals in the mid 1920s. However, these factors need to be considered in the broader social and economic conditions of the time. In particular, the effect of the economic depression from the late 1920s is likely to have been influential.

Finally, this thesis demonstrates that governments had a significant role in the evolution of nursing services either directly or indirectly. Some of the actions of the government were in response to broader social issues, such as the concern regarding the high maternal and infant mortality rates prompting the instigation of the maternal and child welfare services. However, the establishment of Westwood Sanatorium provides an example of governmental response to more local needs, in this case the high level of miners’ phthisis evident in Mount Morgan residents. The most profound affects of governmental action, however, probably relate to the registration of nurses, the implementation of nurses’ awards and the gradual takeover of public hospital finances and administration. These latter aspects resulted in public hospitals becoming more attractive to nurses as employment options. However, it needs to be acknowledged that the rise of hospitals as the main avenue of health services within the community occurred throughout the Western world and that it is difficult to clearly delineate between the cause and the response in this situation. That is, it is difficult to say whether the government’s increased funding and control facilitated the rise in importance of public hospitals in

35 Queensland, or whether such interventionist policy came about in response to the increase in public demand for hospital services. This thesis explores this issue in relation to nursing services, and while not ignoring the general forces towards increased hospitalisation, proposes that the increased willingness of nurses to work in hospitals certainly enabled this shift.

Overall, this thesis demonstrates that while some nursing services were directly affected by government intervention, such as the implementation of maternal and welfare services, others evolved as the result of indirect government action, social factors, economic factors, medical changes, and the interaction of these factors at a local and broader level.

Methodology

A traditional historical method has been used to answer the research questions.

There are a number of stages involved in historical research. First, data is sought from primary sources. Primary source material includes diaries, manuscripts, public records, hospital records and some printed sources such as journals and books, which were produced at the time under review.83 These documents are located in libraries, archives, museums and personal collections.

As each piece of evidence is gathered, the researcher assesses it for authenticity and reliability. Once the data has been collected it is analysed to enable the researcher to reconstruct the events and associated players, and then to

83 McGann, S., ‘Archival sources for research into the history of nursing’, Nurse Researcher, vol. 5, no. 2, 1997/98, pp. 19-29.

36 interpret the reconstruction. 84 It is the issue of interpretation that has been the most contentious within historical debate over the past few decades.

There are a variety of approaches the researcher may take regarding interpretation. These include the positivist/empirical approach, the relativist approach, the hermeneutic approach, discourse analysis, and finally postmodernism.85 The differences between the approaches are considerable, with the positivist/empirical approach advocating that it is possible to identify impartial ‘facts’ and ‘actual reality’, while the postmodernist approach disputes these and sees all interpretation as relative.86 The approach, however, does not just affect how the data is interpreted, but can also influence the filtering process in collecting the data. That is, whether a piece of data is considered relevant or not and hence whether it is considered in the final analysis.

As such, researchers advocating more relativist positions have included an extra step to the above methodological process. This extra step involves selecting an ‘appropriate theoretical framework’ at the commencement of the project, in order to assist with the analysis and interpretation of the data.87 One might, for example, choose a feminist perspective. However, traditional historians reject this step, arguing the researcher is actively acknowledging his/her bias and indeed pursues that bias when interpreting the sources and

84 Lusk, B., ‘Historical methodology for nursing research’, Image Journal of Nursing Scholarship, vol. 29, no. 4, 1997, pp. 355-359. 85 Hallett, C., Nursing History workshop, February 2003, Bundaberg. 86 Ibid. 87 Sarnecky, op. cit., p. 3.

37 constructing an argument.88 This strikes at the very heart of the inductive process as described by Cushing89 which is associated with the empirical approach.

While many researchers may not overtly impose a theoretical framework, who they are may be of significance. The extent to which the researcher’s own identity and ideological views influence the relationship the researcher has with the data is frequently the subject of discussion. Traditional historians such as Marwick90 argue it is possible to remain impartial when dealing with data. However, other historians suggest that deeply held beliefs inevitably influence the way we view data: what data is included in the analysis and how that analysis is shaped.91 To help counter my own subjectivity, I have utilised data from a variety of sources;92 considered carefully the context, biases and purpose of each piece of evidence examined; and attempted not to bring preconceived ideas into the process.93

While many benefits have become evident as a result of more recent approaches to the history method, Patmore94 suggests placing the study within an extensive context is of greater value. Patmore provides the example of

Australian labour historiography to illustrate this point. He notes that prior to

88 Marwick, A., The New Nature of History. Knowledge, Evidence, Language, Hampshire, Palgrave, 2001, p. 8. 89 Cushing, A., ‘Method and theory in the practice of nursing history’, International History of Nursing Journal, vol. 2, no. 2, 1996, pp. 5-32. 90 Marwick, op. cit., p. 3. 91 Thorpe, B., Colonial Queensland. Perspectives on a Frontier Society, St Lucia, University of Queensland Press, 1996, p. 10. 92 Rafferty, A.M., ‘Writing, researching and reflexivity in nursing history’, Nurse Researcher, vol. 5, no. 2, 1997/ 98, pp. 5-16. 93 Cushing, 1996, op. cit., p. 21. 94 Patmore, G., ‘Australian labour history: a review of the literature 1981 – 1990’, Labour and Industry, vol. 5, no. 1 & 2, 1993, pp. 33-48.

38 the 1980s, labour historical research was located within a very narrow paradigm, focussed on the traditional white, male workforce. Feminist authors challenged labour historians to include women in labour and economic historical accounts and utilised other primary sources not previously considered to provide a more holistic account of labour in Australia.95 Patmore believes this more holistic account was obtained with most labour historians remaining true to the empirical approach,96 the difference between earlier and later histories being the inclusion of a broader context. That is, labour historians have sought explanations by considering more influencing factors rather than imposing a theoretical framework.

The need to recognise a broader context is also becoming evident in more recent women’s histories. Simonton97 cites Davis’ 1976 view regarding the tendency to record women’s activities ‘wrenched’ from their historical context.

Lake98 also suggests the application of some theoretical frameworks, particularly those that see success in ‘masculine’ terms, can obscure much of the political activity of women. As such, recent researchers focussing on the history of women have placed their studies within broader social, political and economic contexts.99 Indeed, nurse historians have recently made similar assertions for the history of nursing.100

95 Ibid, p. 36. 96 Ibid, p. 40. 97 Simonton, D., ‘Nursing history as women’s history’, International History of Nursing Journal, vol. 6, no. 1, 2001, p. 35. 98 Lake, M., ‘Feminist history as national history: writing the political history of women’, Australian Historical Studies, no. 106, 1996, p. 160. 99 Simonton, op. cit., p. 35. 100 Nelson, S., ‘The fork in the road: nursing history versus the history of nursing, Nursing History Review, vol. 10, 2002, pp. 175-188.

39 As the aim of this research is to identify those nursing services available in the

Rockhampton region and to consider the evolution of these services, it is appropriate to take an empirical or more ‘traditional’ inductive approach. The rationale for this decision is based on the nature of the study, which aims to document the existence and changes within local services, and identify local and broader factors influencing these changes. Furthermore, the lack of relevant academic analysis available in the literature also promotes the necessity of an inductive approach. The inductive approach involves asking specific questions, seeking available evidence and describing and explaining events and relationships.101 Tosh102 suggests that the role of the historian is to preserve the record of the human past, to expose power struggles that have taken place, and to make the present aware of the different forms of past thought. This approach very clearly addresses the aim of this research.

The primary source material used for this research was derived from collections held within the Rockhampton Municipal Library, the Australian

Country Hospital Heritage Association (incorporating the former Rockhampton

Hospital Museum), the Rockhampton District Historical Society, the Sister of

Mercy archives, the Capricornia Collection at Central Queensland University, and the Centre for Rural and Remote Nursing at Central Queensland

University. In addition, documentary evidence held in the Queensland State

Library, John Oxley Library, and the Queensland State Archives and the

Queensland Nurses’ Union was accessed. Finally, a small number of records

101 Rafferty, 1997/98, op. cit. 102 Tosh, J., The Pursuit of History, Essex, Longman Group, 1991.

40 were located in the Benevolent Society’s office in Rockhampton, and the

Salvation Army’s Heritage Centre in Sydney.

The documents accessed from these collections include correspondence between government bodies and letters between governments and private individuals; government reports; newspapers and journals of the time, including The Australasian Nurses’ Journal which printed the details of new members of the Australasian Trained Nurses’ Association (ATNA); registers of general and midwifery nurses; minutes of meetings; lecture notes; instruction manuals; directories; and photographs.

Although there is a more ready acceptance of a wider variety of primary source material in recent times, including film, photography, artefacts and oral testimony,103 it has been decided to base this study on written documentary evidence. However, the study has accessed a small number of secondary sources which have utilised oral histories, and these have been valuable. The rationale for not including oral testimonies relates to the breadth of the study which would require a large oral history study to be undertaken in order to supplement the documentary sources. This would constitute a much larger project than would be appropriate for the purposes of this thesis, as oral testimonies are very time and resource consuming.104 Other difficulties associated with oral histories are limitations associated with memory and unintentional inaccuracy.105 As such, oral history projects need to consider

103 Rafferty, 1997/98, op. cit. 104 Seldon, A., ‘Interviews’, in Seldon, A.(ed), Contemporary History. Practice and Method, Oxford, Basid Blackwell, 1988, p. 4. 105 Ibid., p. 6.

41 issues of sampling to counter some of these problems.106 However, this thesis has identified a number of key aspects that would be appropriate for further research, including those using oral histories. These include the demise of the

Salvation Army Maternity Hospital, the establishment of aged care nursing and school nursing.

There were a number of difficulties encountered associated with the data collection of primary source material for this research. Firstly, those services which were not institutionally based, particularly private duty nursing and lying-in hospitals, have left very few traces on the historical record. The records that may have been kept by individuals are not in the public domain, although some may exist as part of private memorabilia. The Post Office

Directories have proved to be invaluable in this regard, by indicating individuals who nursed within the community. Secondly, the enforcement of private hospital registration from 1916 in Rockhampton also provided a fragile paper trail of lying-in hospitals. Unfortunately, many private hospitals in

Rockhampton have destroyed their records over time, or as in the case of the

Mater Misericordiae Hospital, did not keep many records in the first place during the early years of operation.

For those services that gained political attention, such as the maternal and child welfare movement, a large amount of data was generated at the time, and hence survived. However, other government services, such as school nursing, do not seem to have attracted the same level of attention, or at least, there are fewer

106 Ibid., p. 7; Kirby, S., ‘The resurgence of oral history and the new issues it raises’, Nurse Researcher, vol. 1, no. 2, 1997/98, pp. 45-58.

42 traces remaining of these. Eventide Nursing Home also had very little data available in the collections accessed for this research. As such, the evidence gathered for this research is at times scattered and fragmentary.

When using the empirical method, the availability of primary source material is of upmost importance. Indeed, Black and MacRaild107 suggest the availability of primary sources can determine the content and subject area of historical endeavour. The huge collections of politically related archives means historians interested in this discipline do not need to go far to find relevant material. However, not all aspects of historical interest are so blessed, as is outlined above. Despite the opening up of acceptable primary sources associated with ‘newer’ sub-disciplines within historical interest, there can still remain a problem of scant resources in specific areas.

One of the difficulties associated with limited primary sources is that the interpretation and reconstruction of events, dependent as they are on primary sources, can be distorted as a result. To counter this, historians often rely on secondary sources from elsewhere (other states, countries or disciplines) to fill- in the gaps. Oral histories have also been used for this purpose.108 Where ever possible, I have tried to counter the problems posed by limited primary sources by referring to a wide range of secondary sources, to access as broad a range of primary sources as possible, and finally, I have tried not to overstate my conclusions.

107 Black, J., MacRaild, D., Sudying History, 2nd Edition, Hampshire, MacMillan Press, 2000, p. 87. 108 Seldon, op. cit., p. 4.

43 Conclusion

This chapter has provided an overview of the background tapestry into which this study has been woven. The threads of the various nursing services have been identified, as has the outline of the picture as provided by the research questions and framework. The tools chosen to work the picture are the primary sources. The following chapters each deal with a particular aspect of the picture, providing individual detail and texture. However, this background provides the overall context of that picture and keeps the image created in perspective.

44 Chapter 2

The evolution of nursing services: responding to

government action

Berridge states, ‘All history is political, in particular that relating to health’.1

Although there are many elements of health services that can be historically analysed from a variety of perspectives, this thesis demonstrates the significance of political input into nursing services. Indeed, one of the key factors affecting nursing services of the early twentieth century was the involvement of government, either through legislation or through the specific provision of services. This chapter will focus on the role of government and provide an overview of the changes in nursing services as they occurred in the

Rockhampton region. Although government legislation was not the sole factor in bringing about the changes documented here, the Acts of parliament enacted over the forty-six years of review did have some profound effects on those who nursed, and where and how nursing was conducted. Furthermore, Philippa

Mein Smith advocates that in order to understand the evolution of the welfare

State, as Queensland became, it is important to consider the political context.2

As such, this chapter provides an outline of the transitions described in detail in later chapters. Before a full appreciation can be gained of this transition,

1 Berridge, V., Health and Society in Britain since 1939, Cambridge, Cambridge University Press, 1999, p. 5. 2 Mein Smith, P., Mothers and King Baby. Infant Survival and Welfare in an Imperial World: Australia 1880 – 1950, Hampshire, MacMillan Press, 1997, p. 143.

45 however, it is pertinent to review some of the ideals associated with the labour movement in general, and more specifically in Queensland, thus providing the political context from which the analysis of nursing services will then be undertaken.3

Political ideologies

There are three significant concepts relevant to this thesis that influenced the political climate of the early twentieth century, all of which originated in the middle of the nineteenth century. These concepts are nationalism, socialism and the labour movement. While all political parties were more or less influenced by these movements, they were particularly relevant to the Labor

Party, both at Federal and State levels. As such, it is worthwhile exploring each concept briefly in relation to this thesis.

Many Australian historians have considered the development of nationalism, or a national identity, within Australia since Russell Ward’s analysis in 1958.4

Over the past 30 years, however, the role of racism as the adhesive factor in

Australian nationalism has gained increasing attention. McMinn5 suggests

Australians formed an ‘unusual’ form of nationalism from the late nineteenth

3 For a more extensive review of the labour movement and the Labor governments in Australia, see: Macintyre, S., The Labour Experiment, Melbourne, McPhee Gribble Publishers, 1989; Murphy, D.J., Labour in Politics. The State Labor Parties in Australia 1880 – 1920, St Lucia, University of Queensland Press, 1975; Fitzgerald, R., Thornton, H., Labor in Queensland. From the 1880s to 1988, St Lucia, University of Queensland Press, 1989; Patmore, G., Australian Labour History, Melbourne, Longman Cheshire, 1991. NB: There is a tradition in labour history to use the spelling, ‘labour’ in relation to the labour movement, but to use ‘Labor’ in association with political parties. This has been followed in this thesis. 4 Ward, R. The Australian Legend, Melbourne, Oxford University Press, 1958. 5 McMinn, W.G., Nationalism and Federalism in Australia, Melbourne, Oxford University Press, 1994, p. 120.

46 century whereby the only common doctrine held by most Australians as they moved towards Federation, was that of a White Australia. Indeed, McMinn6 and Alomes and Jones7 note the Immigration Restriction Act 1901 was the first piece of substantial legislation passed by the newly formed Commonwealth government. This legislation provided for the restriction of certain races immigrating to Australia, and allowed the government to remove prohibited immigrants.8 While the legislation aimed particularly at restricting Chinese and South Sea Islander workers, it represents a deep fear within Australia regarding the perceived vulnerability of Europeans in an isolated part of the globe. This fear was manifested in a variety of ways and was influential in social reforms aimed at improving the health (and number) of white

Australians.9 For example, the introduction of the ‘Baby Bonus’ or maternity allowance by the Federal government in 1912 was aimed specifically towards increasing the number of white, healthy babies to populate the country.10

It should be noted at this point that the White Australia Policy was primarily aimed at non-white races that were external to Australia and did not consider the Indigenous people within Australia. This is likely to be related to the perceived lack of threat associated with Aboriginal people by the end of the nineteenth century who were expected to ‘die out’.11 Although unlawful killings of Aboriginal people continued in ‘frontier’ areas of Australia, these were frequently overlooked at all levels of government both in Australia and

6 Ibid. 7 Alomes, S., Jones, C., Australian Nationalism, Sydney, Angus & Robertson, 1991, p. 136. 8 Ibid. 9 McQueen, H., A New Britannia, Melbourne, Penguin Books, 1986, p. 269. 10 Beddie, F., Putting Life in Years. The Commonwealth’s Role in Australia’s Health since 1901, Canberra, Commonwealth Department of Health and Aging, 2001, p. 10. 11 Ibid., p. 8.

47 Britain.12 McQueen13 suggests the extermination of Aboriginal people was given a ‘gloss of scientific rectitude’ through theories such as Darwin’s

‘survival of the fittest’. Ultimately, those who did survive were kept away from white society and provided with minimal health services.14 Woorabinda, an Aboriginal community in Central Queensland, is an example of such segregation. As noted in Chapter 6, this community was provided with very low levels of funding for health services, reflecting the low priority afforded to this community by the State government.

The restriction of non-white immigration was overtly supported by the labour movement because it wanted to preserve jobs and wages and hence a particular standard of living for white men and their families.15 Indeed, it was the protection of white jobs and wages that motivated the labour movement’s adoption of a range of policies including that of socialism. While the labour movement has often been labelled ‘red’, the reality is the labour movement in

Australia, and in particular the Labor parties at Federal and State levels, conformed more to a social democratic model, whereby the State intervened in the economy more as a control rather than in terms of outright ownership of all industries.16 Grundy17 notes the Federal Labor party advocated socialism but carefully qualified this ideal through the slow development of collective

12 Trainor, L., British Imperialism and Australian Nationalism, Cambridge, Cambridge University Press, 1994, p. 83. 13 McQueen, op. cit., p. 52. 14 Beddie, op. cit., p. 8. 15 McMinn, op. cit., p. 122. 16 Mendes, P., ‘The social policy of the ALP: past, present and future’, Social Alternatives, vol. 17, no. 3, 1998, p. 34. 17 Grundy, D., ‘Labour’, in Griffith, J. (ed), Essays in Economic History of Australia, Milton, The Jacaranda Press, 1970, p. 237.

48 ownership of monopolies. In 1950, Ross,18 himself a socialist, accused the

Labor party of having very vague notions of socialism which had never been clearly defined in the party’s platforms. As such, Australian ‘socialism’ was a

‘carefully worked out compromise’, whereby private operators could seek profits but standards were regulated and governments provided competition.19

Indeed, McQueen20 suggests the Labor Party interpreted socialism to mean little more than State intervention to aid capitalism.

The Queensland Labor Party had greater socialist values than a number of other States due to the strong relationship this party had with the trade union movement.21 However, it needs to be recognised that the equality sought by the labour movement and hence the Labor party was very limited in scope and did not encompass all peoples. As McQueen22 points out, the development of racial purity and a self-reliant community took precedence over collective monopolies and the extended industrial and economic function of the State.

That is, the Labor Party was racist before it was socialist. Those excluded from equality included women and non-British subjects, especially unmarried mothers and Indigenous and Chinese people.23 These groups were seen as a threat to white male jobs as they were paid lower wages. Indeed, the union movement did not embrace women workers until the late 1940s. Only then did it begin to advocate equal wages for women, if undertaking male work, as it

18 Ross, L., ‘Socialism and Australian labour. Facts, fiction and future’, The Australian Quarterly, vol. 22, no. 1, 1950, p. 26. 19 Bolton, G., ‘Australia since 1939’, in Griffin, J. (ed), Essays in Economic History of Australia, Milton, The Jacaranda Press, 1970, p. 292. 20 McQueen, op. cit., p. 203. 21 Grundy, op. cit., p. 227. 22 McQueen, op. cit., p. 39. 23 Selby, W. Motherhood in Labor’s Queensland, 1915 – 1957. Unpublished PhD thesis, Griffith University, 1992a, p. 281.

49 was assumed employers would prefer men to women for the same price.24 The trade movement was not interested in women working in traditional female occupations, such as nurses.25 As such, nurses tend to feature only indirectly in most of the reforms of the Labor party. However, as we shall see, nurses did benefit by using some of the industrial legislation that was introduced by the

Labor government.

It should also be acknowledged that while the Labor governments actively intervened in the economic and social life of its citizens, non-Labor governments and groups, both in Australia and in other Western societies, were also gradually moving toward more interventionist policies. For example, free, compulsory education was introduced in Queensland in 1875, even before the formation of the Labor party.26 Furthermore, Federal schemes such as the introduction of aged (1908), invalid (1908) and widows’ (1926) pensions were introduced by non-Labor governments making Australia a leader in social welfare at that time.27 Indeed, Tsokhas28 points out the State consistently played a significant role in the Australian economy – more so than any other

Western nation. From 1860 to 1914, Australian colonies subsidised roads, bridges, railway, sewage, water works, docks and harbours, often reducing the

24 Johnson, P., ‘Gender, class and work: the Council for Action for Equal Pay and the Equal Pay Campaign in Australia during World War 2’, Labour History, vol. 50, 1986, pp. 132-146. 25 Wright-St Clair, R.E., ‘Hospital reform: hot topic in the 1920s’, in Bryder, L., Dow, D.A. (eds), New Countries and Old Medicine, Proceedings of an International Conference on the History of Medicine and Health, Auckland, Auckland Medical Society, 1995, p. 67. 26 Fitzgerald and Thornton, op. cit., p. 117. 27 Cotter, R., ‘War, boom and depression’, in Griffin, J. (ed), Essays in Economic History of Australia, Milton, The Jacaranda Press, 1970, p. 279; Cox, E., ‘Pateratria: child rearing and the State’, in Baldock, C.V., Bass, B. (eds), Women, Social Welfare and the State in Australia, Sydney, Allen & Unwin, 1983, p. 191. 28 Tsokhas, K., Making a Nation State. Cultural identity, Economic Nationalism and Sexuality in Australian History, Melbourne, Melbourne University Press, 2001, p. 7.

50 overhead expenditures of private companies to allow for private investment.29

It is likely that this process was accelerated under Labor governments, although in order for the ideals to be implemented, an extended period in office was required. For example, Dickey30 notes the Labor government in New

South Wales from 1910 to 1914 was not in office long enough, nor had the political clout in the Legislative Assembly, to gain support for the implementation of its social welfare schemes. In contrast, the Queensland

Labor Party held government almost continuously from 1915 to 1957, apart from the years 1929 to 1932. In addition, the Labor members of parliament held considerable power within the Legislative Assembly in the preceding decade to 1915. This longevity allowed the Labor government to implement many of its ideals, especially after the Legislative Council was dismantled in

1921.31

Labor in Queensland

The Labor Party was established in Queensland in 1890 and from the beginning saw itself as a reforming party based on urban and rural unions, although non-unionists such as farmers were also perceived to come under the

Labor umbrella.32 The party grew in popularity from the turn of the twentieth century such that in 1905 it formed a quasi-coalition government and tried to

29 Ibid. 30 Dickey, B., ‘The Labor government and medical services in New South Wales 1910 – 1914’, in Roe, J. (ed), Social Policy in Australia. Some Perspectives 1901 – 1975, Sydney, Cassell Australia, 1976, p. 64. 31 Murphy, D.J., ‘Edward Grenville Theodore. Ideal and reality’, in Murphy, D.J., Joyce, R., Cribb, M. (eds), The Premiers of Queensland, St Lucia, University of Queensland Press, 1990a, p. 321. 32 Murphy, D.J., ‘Thomas Joseph Ryan. Big and broadminded’, in Murphy, D.J., Joyce, R., Cribb, M. (eds), The Premiers of Queensland, St Lucia, University of Queensland Press, 1990b, p. 263.

51 press for some of its reforms such as a free hospital system.33 However, it was not until Labor had won a clear majority in the Legislative Assembly in 1915 that it had the opportunity to implement its reforms. One of the outstanding features of the early Labor government was the introduction of a range of State enterprises. Table 2.1 outlines these enterprises and when they were established.

Table 2.1 State Enterprises in Queensland34

State Enterprise Year of State Enterprise Year of introduction introduction State Butcher’s Shops 1915 State Hotel (Babinda) 1917 State Pastoral Stations 1916 State Cannery 1918 State Railway 1917 State Produce Agency 1918 Refreshment Rooms Government Insurance 1917 State Smelters 1920 Office State Fishery 1917 Hamilton Cold Stores 1928

Although these State enterprises were wide ranging, it will be noted most were established by 1920. Fitzgerald and Thornton35 suggest the enterprises were introduced to reduce profiteering and to help steady the supply of commodities to Queenslanders, thereby inhibiting exploitation of shortages outside

Queensland. Furthermore, the State enterprises were part of a broader social scheme. For example, Hawkins36 proposes the State Cannery was meant to provide an outlet for pineapples grown at Beerburrum as part of the Soldier

Settler scheme. Unfortunately, most of the State enterprises were not financially successful, for a variety of international as well as local reasons.

33 Bell, J., ‘Queensland’s public hospital system: some aspects of finance and control’, Public Administration, vol. 27, no. 1, 1968, p. 39. 34 Fitzgerald and Thornton, op. cit., p. 70. 35 Ibid., p. 87. 36 Hawkins, R.A., ‘Socialism at work? Corporatism, soldier settlers and the canned pineapple industry in South-Eastern Queensland, 1917 – 39’, Australian Studies, no. 4, 1990, pp. 35-39.

In regards to health services, the Labor government in Queensland took a more direct approach. For example, in 1919 the government established Westwood

Sanatorium. The funding of this new facility clearly illustrates the social welfare ideals of this government. The government was responding to the crisis of accommodation for patients with miner’s phthisis and took on the responsibility of building, staffing and managing the facility. The on-going success of this management is questioned in Chapter 5 which suggests this became more effective after the Rockhampton Hospital Board took over in

1946. Nevertheless, Westwood Sanatorium represents one of the early forays of the Labor government into the direct provision of health services.

Another significant feature of the Labor government in Queensland was the establishment of the Industrial Conciliation and Arbitration Court in 1916, a key reform and avenue for workers to resolve their disputes with employees without having to resort to strike action. It was through this avenue that gains in wages and conditions for nurses were sought after the formation of the

Queensland Nurses’ Association in 1921.37 According to Murphy38 this legislation provided Queensland with some of the most democratic laws of any

Australian State, particularly in regards to industrial issues.

The 1920s saw dramatic changes to nursing services as a result of more direct government action. Of particular interest here was the introduction of the

Maternity Act 1922 and the Hospital Act 1923. As a result of these pieces of

37 Strachan, G., Labour of Love. The History of the Nurses’ Association in Queensland 1860 – 1950, St Leonards, Allen & Unwin, 1996, p. 100. 38 Murphy, 1990b, op. cit., p. 319.

53 legislation, the government oversaw a vast expansion and control of health services in Queensland.39 While financial constraints inhibited complete implementation of Labor’s nationalisation of health service ideals initially, the resolution to use the Golden Casket lottery funds in 1923 allowed some gains to be made.40 Selby41 suggests channelling this money into maternity and health services was a shrewd move whereby the lottery money was ‘sanctified’ and made acceptable to a public suspicious of gambling and ‘tainted’ money.

By the late 1920s, the State enterprises were declared as unprofitable and began closing down,42 thus dismantling one of the main thrusts of early reformist intervention. In 1929, the Labor government was overwhelmingly defeated, victims of the increasing drought, rising unemployment and a perception of sacrificing labour principles.43 From 1929 to 1932, Queensland was governed by the Country Progressive National Party under the leadership of Arthur Moore. This government introduced a range of deflationary policies.44 It also implemented a Royal Commission in 1930 that significantly eroded wages and conditions for public hospital nurses.45 Intra-party disharmony and sheer bad timing led to the defeat of Moore’s government in

39 Patrick, R., A History of Health and Medicine in Queensland 1824 – 1960, St Lucia, University of Queensland, 1987, p. 98. 40 Ibid., p. 98. 41 Selby, W., ‘Motherhood and the Golden Casket: an odd couple’, Journal of the Royal Historical Society of Queensland, vol. 14, 1992b, pp. 407-408. 42 Kennedy, K., ‘William McCormack. Forgotten Labor leader’, in Murphy, D., Joyce, R., Cribb, M (eds), The Premiers of Queensland, St Lucia, University of Queensland University, 1990, p. 368. 43 Ibid. 44 Costar, B., ‘Arthur Edward Moore. Odd man in’, in Murphy, D., Joyce, R., Cribb, M. (eds), The Premiers of Queensland, St Lucia, University of Queensland Press, 1990, p. 385. 45 Gregory, H., A Tradition of Care. The History of Nursing at the Royal Brisbane Hospital, Brisbane, Boolarong Publications, 1988, p. 73.

54 1932.46 The opposition non-Labor parties in Queensland remained in disarray until the 1950s.47

Upon regaining office in 1932, the Labor government worked at creating jobs and reducing deficits. This was managed through increases in railway freights and fares, income taxes on those in the upper brackets and on companies.48

This government also introduced public works programs to decrease unemployment.49 The stability which characterised the Labor government during the 1930s led one commentator in 1936 to state that, ‘Queensland has fewer archaic laws, more fruitful social services and a more efficient government than any other State’.50 The policies introduced in the 1930s and

1940s emphasised rural endeavours and decentralisation at the expense of industrialisation.51 This may explain the difficulty the Queensland branch of the Australasian Trained Nurses’ Association (QATNA) had in promoting industrial nursing in Queensland, as few manufacturing industries were evident.

Overseeing much of the government’s expansion into health services was

Edward Hanlon. Hanlon was one of the most prominent politicians regarding health services during the first half of the twentieth century. Although some changes had occurred in the 1920s whereby ‘base’ hospitals had been created

46 Costar, op. cit., p. 394. 47 Carroll, B., ‘William Forgan Smith. Dictator or democrat’, in Murphy, D., Joyce, R., Cribb, M. (eds), The Premiers of Queensland, St Lucia, University of Queensland, 1990, p. 426. 48 Ibid. 49 Ibid, p. 411. 50 McCallum, J.A., ‘The Australian labour party’, The Australian Quarterly, vol. 8, no. 29, 1936, p. 73. 51 Knight, K.W., ‘Edward Michael Hanlon. A city bushman’, in Murphy, D., Joyce, R., Cribb, M. (eds), The Premiers of Queensland, St Lucia, University of Queensland, 1990, p. 444.

55 under the control of hospital boards,52 it was the influence of Hanlon as

Minister for Home Affairs, and after 1936 as Minister for Health and Home

Affairs, that dramatically altered health service delivery in Queensland.

Hanlon took up the portfolio of Home Affairs from 1932 and distinguished himself as an administrator.53 He oversaw the reorganisation of the department, including the introduction of the role of Director General of Health in 1936; introduction of ‘free’ hospital services; creation of the Queensland

Radium Institute; extension of antenatal, kindergarten and crèche services; initiation of prison farms and improvements in Aboriginal and Torres Strait

Islander conditions.54 While he advocated decentralisation and the importance of local government,55 in regards to health services Hanlon implemented a number of centrally controlled initiatives.

Patrick56 suggests the Hospital Act 1936, overseen by Hanlon, set the pattern for hospital administration for many years and hence became an enduring legacy of Hanlon’s initiatives. This Act, and the Medical Services Act 1939 significantly eroded the power of the medical profession regarding the management of hospitals. Jordon57 points out the Labor government of the

1930s did not trust medical practitioners and resisted bowing to the medical profession’s interests in promoting the general practitioner. While Jordon asserts this stemmed from the anti-intellectualism associated with the Labor

52 Gregory, op. cit., p. 71. 53 Knight, op. cit., p. 441. 54 Ibid. 55 Cumpston, J.H.L., Health of the People. A Study in Federalism, Canberra, Roebuck Society Publications, 1978, p. 80. 56 Patrick, op. cit., pp. 76-77. 57 Jordon, P.K., ‘Health and social welfare’, in Murphy, D.J., Joyce, R.B., Hughes, C.A. (eds), Labor in Power. The Labor Party in Government in Queensland 1915 – 1957, St Lucia, University of Queensland Press, 1980, pp. 315-316.

56 Party, Hanlon no doubt saw the control of doctors as efficient administration.

He is quoted as stating in 1944:

All the mistakes we had to correct were due to medical

control. The doctor is not trained in business management

or any function of the hospital other than treating the

sick.58

Interestingly, Hanlon seems to have had a different view of nurses and actively promoted Sister Kenny’s work with poliomyelitis victims late in the 1930s.59

Indeed, the controversy surrounding Kenny, generated by the medical profession, further illustrates the conflict between Hanlon and the doctors of the time.

Knight60 notes that as Premier, Hanlon increasingly moved away from Labor’s ideals of dealing with strikes through arbitration and conciliation and implemented significant legislation that dealt more harshly with unions. This move away from the close ties previously held with the trade unions was exacerbated when Vincent Gair became Premier in 1952 upon Hanlon’s death.

As a result, a number of crises led to the gradual disintegration of the Party from 1955 to its eventual collapse in 1957. Costar61 suggests the demise of the

58 MacPhail, J., ‘Women, Aborigines and health in Queensland 1939 – 80: some preliminary thoughts’, Australia 1939 – 88, no. 2, 1980, p.61. 59 For more information regarding Sister Kenny’s work see Wilson, J., Through Kenny’s Eyes: An Exploration of Sister Kenny’s Views about Nursing, Townsville, The Townsville Regional Group, James Cook University Royal College of Nursing, 1995; Alexander, W., Sister Elizabeth Kenny: Maverick Heroine of the Polio Treatment Controversy, Rockhampton, Central Queensland University Press, 2002. 60 Knight, op. cit., pp. 449-456. 61 Costar, op. cit.,, p. 471.

57 Labor party in Queensland stemmed from rising power struggles between Gair, who had never held office in a trade union, and the Australian Workers Union, who had previously had a good relationship with the parliamentary organization. The result, of course, was that the Labor Party in Queensland was doomed to political wilderness for the next 36 years, after having an unprecedented time of government. However, many of the initiatives enacted during the time, especially in relation to health services, were long enduring.

Legislative effects on nursing services in Rockhampton

The Labor Party was a working man’s party. It evolved from the trade union movement and valued protection of male jobs. It is not surprising then, that nurses, as women in a traditional female occupation, were not targeted in the policies of this government. However, throughout the first half of the twentieth century in Queensland, a number of pieces of legislation were enacted that did relate to nurses, albeit often indirectly. Some of these Acts had profound and long-term effects. The final part of this chapter will outline these specific pieces of legislation and consider the overall changes in nursing services resulting from each Act. The effects on both trained and untrained nurses will be explored, as the initial act to be considered made the distinction between the two groups. Many of these pieces of legislation relating to nursing services reflect the nationalistic and reformist ideals discussed earlier. In particular, it is evident there was a strong emphasis on the expansion of a healthy, white population throughout this period.

58 The Health Act Amendment Act 1911

The Health Act Amendment Act 1911 was a broad ranging piece of legislation that dealt with issues ranging from excluding children with infectious diseases from school to registering private hospitals and the registration of nurses. Food and drug regulations were also included.62 Although introduced prior to Labor winning government in its own right, this legislation contained a number of elements valued by Labor, and indeed, some aspects contained in this legislation relating to private hospitals were not enforced until Labor came into power. The reformist ideals subscribed to by the Labor Party towards regulation and control, rather than outright ownership are clearly evident in this legislation.

Initially nurses were to be incorporated under the control of the Medical Board as part of this legislation. However, Gregory63 notes the QATNA became aware of the proposal in sufficient time to alter the bill such that a separate

Nurses’ Registration Board was established. State registration was valued by the QATNA as a means of decreasing the competition within the private duty market in favour of trained nurses. However, because the QATNA was not intimately involved in the formulation of the legislation, this aspect was not realised in this Act. Indeed, the only restriction placed on untrained nurses by this legislation was that they could not own or work in certain hospitals.64 The

Act took into account untrained but experienced nurses through the provision of a grandfather clause, thus allowing experienced nurses to register. This was

62 Gregory, op. cit., p. 51. 63 Ibid., p. 49. 64 Strachan, op. cit., p. 79.

59 one of the first pieces of nurse registration legislation in the world, and the first in Australia.65 Other States followed: South Australia in 1920,66 Victoria in

1923,67 and New South Wales in 1924.68

Gregory69 suggests the motivation for the government in introducing nurse registration stemmed from concern regarding infant and maternal mortality rates and the desire to move midwifery into the hands of trained professionals, thereby increasing the number of white babies to populate the nation. The inclusion of conditions and the need to register lying-in hospitals as part of this legislation supports this notion. Daniel70 asserts that the ultimate effect on nurses of nurse registration legislation in Australia was that control of nursing and its affairs was wrested from nursing organizations and placed into the hands of governments, particularly the Ministers of Health. This led to the exploitation of nurses, as they staffed, cheaply, the public hospitals run by

State health departments. Although the nurse registration provisions in

Queensland were about control of private hospitals, this element of favouring public hospitals is also evident.

The effect of nurse registration legislation at a local level is explored in

Chapter 3, which identifies a significant drop in the number of private duty

65 Gregory, op. cit., p. 51. 66 White, D., A New Beginning: Nurse Training and Registration Policy 1920 – 1938. The Role of the Nurse Registration Board of South Australia, Adelaide, Nurses’ Board of South Australia, 1993. 67 Burchill, E., Australian Nurses since Nightingale 1860 – 1990, Melbourne, Spectrum Publications, 1992, p. 44. 68 Castle, J., ‘The development of professional nursing in New South Wales, Australia’, in Maggs, C. (ed), Nursing History: The State of the Art, Kent, Croom Helm, 1987, p. 11. 69 Gregory, op. cit., p. 49. 70 Daniel, A., Medicine and the State. Professional Autonomy and Public Accountability, Sydney, Allen & Unwin, 1990, pp. 73-74.

60 nurses advertising in the Post Office Directories, most of whom were untrained. This is interesting as the legislation did not prohibit these women from working as private duty nurses and thus raises the question of how well the legislation was understood by untrained private duty nurses. The QATNA would not have embarked on a public campaign to clarify this matter, as it wanted to minimise the legitimacy of these untrained nurses in the first place.

The untrained private duty nurses did not belong to an association and probably operated in relative isolation from one another. Hence their understanding of the legislation may have been minimal. Therefore, although the legislation did not specifically address the issue of competition from untrained nurses on the private duty market, as desired by the QATNA, the effect may have been similar.

In regards to hospitals, untrained nurses who were not registered could not own and operate a private hospital, however, they could work in private hospitals as employees. For example, small hospitals such as Yeppoon Hospital and the

Albert Private Hospital in Mount Morgan were not large enough to qualify as training hospitals and relied on untrained nurses as nurses’ aides to meet the fundamental nursing needs of the patients. As such, the legislation should have only affected untrained nurses who did not qualify for registration and wanted to operate a private hospital. How many this pertained to is unknown.

Other legislation was introduced over the following 36 years which affected the registration of nurses. In 1928, the Nurses’ and Masseurs’ Registration Act was introduced. This legislation brought the Nurses’ Registration Board under

61 its own Act, and also provided for the registration of the increasing number of child welfare nurses. Strachan71 points out this Act was again a government initiative, taking the QATNA by surprise. Indeed, the QATNA minutes indicate attention was only drawn to this legislative change after a member read about it in the newspaper.72 A number of subsequent amendments to this

Act were introduced, although they had minor effects. The 1938 amendment prohibited unregistered nurses from wearing veils.73 This would appear to be the only occasion on which the QATNA initiated any action that resulted in legislative changes.74 The whole issue reflects the continuing concern regarding untrained nurses in the metropolitan area. In Rockhampton, this amendment had limited impact on private duty nurses as there were so few untrained nurses in the market by this stage. However, untrained nurses were employed in a variety of institutions and there may have been concern regarding the public identifying these as trained nurses. The issue of distinguishing the trained nurse from the untrained in terms of physical appearance was certainly one of considerable concern for the QANTA, as the discussions regarding the wearing of badges indicates.75 Indeed, the initiation of this action by the QATNA seems to relate to its failure to prohibit untrained nurses from calling themselves ‘nurse’.76 The 1948 amendment allowed nurses under the age of 21 years to register.77 This was probably in response to the nursing shortage experienced at the end of WWII and the desire to have

71 Strachan, op. cit., p. 83. 72 QATNA minutes, The Australasian Nurses’ Journal, vol. 27, no. 10, 1929, p. 267. 73 Patrick, op. cit., p. 72. 74 QATNA minutes, The Australasian Nurses’ Journal, vol. 36, no. 6, 1938, p. 128. 75 This issue came up repeatedly in QATNA minutes. For example, members were reminded of the importance of wearing the designated badge and cap to distinguish them from untrained nurses and to ‘protect the profession’. QATNA minutes, The Australasian Nurses’ Journal, vol. 31, no. 6, 1933, p. 167. 76 QATNA minutes, The Australasian Nurses’ Journal, vol. 29, no. 11, 1931, p. 215. 77 Patrick, op. cit., p. 72.

62 nurses registered as promptly as possible. However, the QATNA was of the opinion that commencing nurse training under the age of eighteen years was deleterious to girls.78

The second significant aspect for nurses of the Health Act Amendment Act

1911 was the registration of private hospitals. The Act stipulated doctors or registered nurses only could operate private hospitals. The desire to control private hospitals needs to be viewed in the context of national and international concern over maternal and infant mortality in the pre WWI era. The Federal government was concerned enough to pay over £4 for every live birth, via the passage of the Maternity Allowance Act in 1912.79 Similar private hospital legislation was passed in 1908 in New South Wales, also in response to the high infant mortality rates and the belief untrained midwives were responsible.80 As such, the 1911 legislation allowed the government some control over the quality of lying-in hospitals. Furthermore, it allowed governments to more readily monitor quantities such as the number of births and beds provided by facilities. Such measurement was symptomatic of

‘scientific management’ ideals of the time. The statistics thus gathered, were certainly used in later years by the Labor government as it moved to provide

State run maternity beds and later general hospitals.

The fact that this legislation included provisions for the registration of lying-in hospitals suggests these hospitals were relatively common and were perceived as a contributing factor in the maternal and infant mortality rates. Although

78 QATNA minutes, The Australasian Nurses’ Journal, vol. 42, no. 3, 1944, p. 31. 79 Cumpston, op. cit., p. 52. 80 Strachan, op. cit., p. 71.

63 only small numbers of private hospitals can be identified in Rockhampton from sources such as the Post Office Directories, some private duty nurses may have been taking patients into their own homes. Indeed, the fact that so many untrained nurses registered their homes as lying-in hospitals in Rockhampton within a few years of 1916 would suggest they had been practicing for some time – at least three years prior to 1912 when they qualified for registration and knew the legislation would require them to be registered with the Queensland

Nurses’ Registration Board (QNRB) in order to operate a lying-in hospital. As such, this indicates the practice of untrained nurses taking patients into their own homes prior to 1912 was relatively prevalent, if not well documented. It is unlikely, therefore, that the introduction of the Maternity Allowance by the

Federal government in 1912 had any significant impact on the number of lying-in hospitals available in the community, although it may have sustained a number and/or prompted some nurses to officially register their homes. The perceived failure of the Maternity Allowance by 192381 would suggest no major shifts in midwifery practice had occurred in the decade after the allowance was introduced. Furthermore, the introduction of the Maternity Act

1922 in Queensland also suggests the government felt the 1911 nurse registration legislation did not go far enough in eliminating undesirable midwives.

81 Cumpston, op. cit., p. 52.

64 Maternity Act 1922

The Maternity Act 1922 was the second piece of legislation that had a significant impact on nursing services, although again, it was not one that was immediately noticeable. The main aspect of this legislation was the active provision of State-funded maternity wards and hospitals, and maternal and child welfare clinics. Selby82 suggests this Act aimed to provide ‘better’ maternity and child health services to women, especially those in rural communities, and hence to ultimately increase the prosperity of the white population of Queensland. The schemes were funded by the Golden Casket lottery,83 which allowed the government to rapidly increase the number of facilities throughout the State such that by 1947 there were 196 maternity hospitals (1285 beds) and 181 maternal and child welfare clinics provided by the State government.84 Furthermore, the maternal and child welfare services were free of charge to mothers.85 Impressive maternity hospitals, such as the

Lady Goodwin Hospital in Rockhampton, were erected in association with base hospitals. This corresponded to a shift in the location of childbirth from the community into State funded hospitals, although the provision of public maternity hospitals was not the only factor in this transition.

82 Selby, W., ‘Raising an interrogatory eyebrow. Women’s responses to the infant welfare movement in Queensland 1918 – 1939’, in Reeke, G. (ed), On the Edge. Women’s Experiences of Queensland, St Lucia, University of Queensland Press, 1994, pp. 83-84. 83 Bell, op. cit., p. 43. 84 Report to Senior Commonwealth Medical Officer, 13 May 1947, folder A/31677, QSA, Brisbane. 85 Fitzgerald and Thornton, op. cit., p. 110.

65 Regardless of the reasons for the transfer, this feature effectively shifted childbirth out of the control of nurses into the hands of medical practitioners.86

Where midwives in the community were mostly responsible for overseeing the birth, either in the patient’s home or in a lying-in hospital, doctors became the director of procedures in a larger hospital. The midwife became an obstetric nurse – one who merely assisted the doctor in childbirth. Whether this shift had the desired effect on maternal and infant mortality rates is debatable, as many of the doctors prior to 1930 had little experience or training in obstetrics, and little patience with natural processes.87 Indeed, some USA figures suggest the medical embrace of midwifery had profoundly negative consequences in the 1920s and 1930s.88 Furthermore, the countries with the lowest levels of pregnancy related deaths in the 1920s had the highest levels of community midwife involvement.89

The Maternity Act 1922 also restricted the range of patients seen by maternity nurses, such that maternity cases only were attended. This probably contributed to the transition towards double certificates for nurses, whereby nurses needed to have a general certificate before undertaking midwifery training. Interestingly, the QATNA minutes do not mention the Maternity Act

1922 at all. However, they needed to deal with some of the reverberations of the Act. For example, as maternity wards and hospitals were being built, the

86 Selby, op. cit., 1992a, p. 143. 87 Dawley, K., ‘Ideology and self-interest. Nursing, medicine and the elimination of the midwife’, Nursing History Review, vol. 9, 2001, p. 105; Boyd, J.J., ‘Maternal mortality and morbidity. Causes and prevention’, The Australasian Nurses’ Journal, vol. 28, no. 3, 1930, p. 68. 88 For example, in 1921 doctors were responsible for 62% of all births, and 84% of all birth related deaths. Dawley, op. cit., p. 102. 89 Ibid, p. 101.

66 matrons and trained staff were being asked to upgrade their qualifications. One matron of a country hospital sought the assistance of the QATNA as she thought she was too old to be accepted into obstetric training, although she was being requested by her hospital committee to undertake this training.90 The

QATNA subsequently organised for her to attend the Lady Bowen Hospital, although it is unclear who paid for her training or if she had to forfeit wages as was common practice for obstetric training at this time.

Finally, the Maternity Act 1922 was instrumental in the construction of maternal and child welfare centres throughout Queensland. Unlike other States, the Queensland government was solely responsible for maternal and child welfare services and even eschewed volunteer contributions.91 While other pieces of legislation imposed nationalist ideals upon nurses through regulation, the Maternity Act used nurses specifically to fulfil its objectives of increasing the number of white children reaching adulthood. As such, nurses became agents of the State, the means to the end. They undertook this role as part of their surveillance and health promotion activities as will be explored in Chapter

These early years of the Queensland Labor government, therefore, saw the introduction and enforcement of legislation that had considerable long-term effects on the provision of nursing services, especially those dealing with midwifery. This resulted in an emphasis of the trained nurse over her untrained counterpart, while at the same time restricting the trained nurse to

90 QATNA minutes, The Australasian Nurses’ Journal, vol. 21, no. 11, 1923, p. 522. 91 Mein Smith, op. cit.

67 greater institutional control. While the Labor government was involved in long-running disputes with the medical profession over issues of medical autonomy,92 these early pieces of legislation also promoted the control of nurses by doctors as they became institutionalised. While the social democratic ideals of the Labor Party can be seen in the regulation of the private hospital market legislation, a much stronger nationalist ideal is evident in the Maternity

Act 1922, with the government gaining complete control over maternal and child welfare services and an increasing stake in maternity services. This desire for greater control over hospital services is demonstrated in the development of the Hospital Acts.

The Hospitals Act 1923

The Hospitals Act 1923 was the first of a series that promoted government control of hospitals. The State government had been financing many hospitals and institutions since their inception, as is revealed in Chapters 5 and 6. It did not, however, exercise any control over how the hospitals were managed. As such, Fitzgerald and Thorton93 suggest a spirit of administering efficiency rather than reforming zeal drove this Act. Hospitals were under no obligation to join the scheme. However, in reality, few could resist the temptation of guaranteed funding of 60 percent of their operating costs.94 In return, the hospital needed to form a board, consisting of three government representatives, three local government representatives, and three members

92 Jordon, op. cit., pp. 315-316. 93 Fitzgerald and Thornton, op. cit., p. 109. 94 Bell, op. cit., p. 44; Fitzgerald and Thornton, op. cit., p. 109.

68 elected by direct vote.95 This legislation, in effect, stabilised funding for the hospitals, and allowed services to be expanded. Indeed, hospitals would not have been able to expand services in response to medical technological advancements and societal demands without this stability of income, although it could be argued such demands may not have been as great without the increasing size of hospitals.

Similar governmental tightening of hospital management and accountability can be found in other States. For example, The Public Hospital Act 1929 –

1959 in New South Wales regulated government subsidies.96 Furthermore, the increasing demand being made on public hospitals was also experienced in other States. Russell97 outlines the daily average occupancy in New South

Wales rose by approximately 45 percent from 1939 to 1961, while there was a threefold increase in the number of nurses employed for the same period. As such, this period demonstrates the avid appetite for hospital nurses within the public hospital system. Similar increases in hospital use and the subsequent employment of nurses are noted in this thesis, although the transition was earlier.

In Rockhampton, the Women’s Hospital and Children’s Hospital were brought under the control of the Rockhampton Hospital Board and eventually all three were amalgamated on the same site. Smaller centres in the district, such as the

Yeppoon Hospital were also incorporated under the Board. Where there had

95 Bell, op. cit., pp. 43-44. 96 Russell, R.L., From Nightingale to Now. Nurse Education in Australia, Sydney, W.B. Saunders/Bailliere Tindall, 1990, p. 50. 97 Ibid.

69 previously been considerable community ‘ownership’ through committees, representation from the community was severely restricted on the new Board.

As such, the face of hospital services altered significantly in Rockhampton in the seven years following the Hospitals Act 1923.

For the Rockhampton Hospital, this meant the daily average occupancy rate effectively doubled from 1925 to 1944 (70.85 to 142.63 respectively), while the population expanded only marginally from 30,000 (1926) to just under

35,000 (1949).98 As will be discussed in Chapter 6, during this same time the level of nursing within the hospital increased significantly and the ratio of nurse to patients decreased from 1:3.37 in 1907 to 1:1.67 in 1944, although the proportion of trained nurses to trainees remained the same. This supports

Daniel’s99 argument that the rise of modern public hospitals was closely intertwined with the emergence of nursing as a highly skilled occupation.

However, this also led to nursing being strongly, almost exclusively, identified with hospitals, to the detriment of other aspects of nursing.

The quest for greater administrative efficiency continued with the Hospitals

Act 1936 that extended the government’s control over hospitals by replacing the honorary system with full time medical officers;100 and increasing the level of control over the boards.101 This Act also abolished any remaining vestiges of the voluntary system and laid the foundations for further control, fulfilled in the Hospitals Act 1944. This final Act allowed the State to gain complete

98 POD 1926, p. 435; 1949, p. 342. 99 Daniel, op. cit., p. 68. 100 Bell, op. cit., p. 47. 101 Fitzgerald and Thornton, op. cit., pp. 113-114.

70 control of the public hospital system.102 Subsequently, with the aid of the hospital bed subsidy from the Federal government in 1946, the State was able to offer ‘free’ hospital treatment to Queenslanders.103

The impact of these Acts on nurses is variable. Rockhampton Hospital became a large organization with over 200 beds. As a base hospital, its services were comprehensive, providing a wide range of learning opportunities for trainees and trained nurses alike. Furthermore, the government was willing to support trainees via capital investment and outward manifestations of success, such as graduation ceremonies.104 The Rockhampton Hospital nurses’ quarters, which still stand today, were built in 1954 to accommodate 169 nurses. Swimming pools were subsidised by the State for the nurses’ quarters.105 These improvements in the living conditions of nurses reflect the government’s concern to maintain the staffing of its hospitals. However, as Gregory106 points out, the concern only related to the quantity of nurses and little attention was paid to their intellectual development. The curriculum remained unaltered from 1907 to the 1950s,107 reflecting the anti-intellectualism of both successive

Labor governments and the nursing profession during this time.

Throughout these years of significant changes to hospital administration, nothing is mentioned in the QATNA minutes. It would appear the association did not concern itself with such administrative issues, nor did it appear to have

102 Bell, op. cit., p. 48. 103 Fitzgerald and Thornton, op. cit., p. 115. 104 Gregory, op. cit., p. 108. 105 Ibid, pp. 99-100. 106 Ibid, p. 108. 107 Ibid.

71 reflected on the effects of these changes on nursing. It is possible this apparent lack of concern related to the QATNA executive committee members coming from large public hospitals in Brisbane which may not have been as effected by the legislative changes as regional areas. Furthermore, since regional branches of the QATNA were not established until after 1944, non-metropolitan views were rarely voiced in this forum.

Discussion

The above legislative changes were often prompted by concern for the welfare of the State’s citizens, although there was an underlying theme of national security. The government increasingly gained control of private and public hospitals, provided maternal and child welfare services, including midwifery and instigated additional services such as tuberculosis sanatoria and school nursing. The impact on nursing services was widespread. The main outcome identified was the overall shifting of nurses into institutions. Both trained and untrained nurses were affected, although for different reasons.

Details regarding how individual pieces of legislation effected nursing services will be revealed throughout this thesis. However, it is pertinent to point out three issues here. Firstly, the legislative changes decreased the opportunities of untrained private duty nurses. This did not result in the demise of untrained nurses. Rather, untrained nurses found employment in a variety of institutions, many of which were government funded, such as Westwood Sanatorium.

However, these changed employment options for untrained nurses meant the

72 former, older nurses who were often married and had dependents were excluded, as only those who could ‘live-in’ were eligible for these positions.

As such, untrained nurses were not seen by the government, on the whole, as problematic, except when working independently. This group continued to play an important role in the provision of nursing services throughout the twentieth century, which should be recognised more in the history of nursing literature.

The second overall effect of these legislative changes was the gradual erosion of autonomy for trained nurses as they moved from being independent practitioners to being employed by large organizations. While not all trained nurses went into private duty nursing prior to WWI, the opportunities to do so dramatically decreased at the end of this time, as public hospitals and public services such as maternal and child welfare grew. These institutions required trained nurses and trained nurses were attracted to them. The effect was that the nurses came under the control of an employer and their practices were regulated as such. Furthermore, for many who worked in teaching hospitals, their nursing practice was reduced to one of supervision and administration, with little hands-on work. The latter was the responsibility of trainees.

Why trained nurses became increasingly attracted to hospitals is not clear.

However, it is likely a number of factors contributed to the move, including protection of practice issues and better working conditions. As will be explored in Chapter 3, the private duty nursing market was initially the main avenue of employment for nurses. However, these nurses frequently found

73 their services undermined by untrained nurses, and in earlier years, trainees.

Hospitals, especially training hospitals, on the other hand, offered some protection of practice. That is, the training the nurses had completed was recognised and status was accorded to them on this basis. Trembath and

Hellier108 suggest the trained private duty nurse prior to WW1 was perceived to have held greater status within the nursing profession. However, despite years of trained nurses advocating their practice was different to that of untrained nurses, many doctors and the general public did not make any distinction as is evidenced by the continuing numbers of untrained private duty nurses in the 1920s. Therefore, some trained nurses may have found the protection of practice associated with hospitals more attractive, where a hierarchical system based on training was entrenched.

The third issue to be highlighted here relates to the introduction of industrial awards for hospital nurses. The QATNA was forced to become an industrial union in 1921 after a rival organization, the Queensland Nurses’ Association, was formed and applied for an award to control conditions and wages.109 The first nurses’ award was implemented in 1921. It applied only to hospital nurses after the QATNA asked for private duty nurses to be excluded.110 Hospitals with less than six daily-occupied beds were also exempt. The award provided minimum wages for trainees and trained nurses, ensured board and lodging was free as well as the provision of uniforms, making this condition consistent throughout the State. Hours were decreased to 112 per fortnight, inclusive of

108 Trembath, R., Hellier, D., All Care and Responsibility. A History of Nursing in Victoria 1950 – 1935, Victoria, The Florence Nightingale Committee, Australia, Victoria Branch, 1987, p. 74. 109 Strachan, op. cit., p. 102. 110 The Australasian Nurses’ Journal, vol. 19, no. 7, p. 218.

74 meals, and overtime was to be paid at time and a half. Each nurse was entitled to four weeks holiday per year. Breakages of equipment such as thermometers were no longer to be paid for by staff members. The award also deemed one trained nurse should be employed for every eight trainees.111 As will be explored in Chapter 3, the QATNA was unable to procure any conditions of employment for private duty nurses, as the domestic sphere these nurses worked within was deemed inappropriate to the imposition of awards. The provision of a nurses’ award in Queensland from the early 1920s promoted consistency of employment within various hospitals, a provision that was not realised in New South Wales until 1937.112 As such, this may have increased the attraction towards hospitals of nurses in Queensland at an earlier stage compared to their southern counterparts.

As a result of nurses’ awards applying to hospitals only, the wages and conditions for hospital nurses improved markedly compared to private duty nurses. Table 2.2 summarises the wages and conditions of private duty nurses and hospital nurses after the first nurses’ award was introduced in 1921. This table clearly demonstrates the wages and conditions for hospital nurses compared more than favourably with those of private duty nurses. In contrast, wages and conditions in New South Wales reflected the lack of an award with hospital nurses working up to twelve hour shifts, six days a week, for less remuneration than their Queensland colleagues.113

111 Nurses’ Award 1921, The Australasian Nurses’ Journal, vol. 19, no. 7, 1921, pp. 219-222. 112 Russell, op. cit., p. 28. 113 Ibid; Raxworthy, D., ‘The changing face of nursing: nurse training in Sydney 1935 – 85’, in Shields, J. (ed), All Our Labours, Kensington, Sydney University Press, 1992, p. 159.

75 Table 2.2 Wages and conditions of private duty and hospital nurses114

Trained private duty Hospital staff nurse nurse Wages £3.3 per week £2.31 – 3.08 per week Hours 24 hours a day, 7 days a 112 hours per fortnight, week while on case continuity of employment Irregular employment Paid sick leave No paid leave (holiday or 4 weeks annual paid sick leave) holidays Accommodation/ Provided own Accommodation, meals and meals accommodation laundry provided Made own meals Did own laundry Isolation All physical work undertaken Most physical work by self undertaken by trainees or assistants in nursing Work value Continually fighting to have Hierarchical system – status work distinguished from accorded by training untrained nurses

In addition to industrial changes, nursing began to specialise in general nursing, obstetric and mental nursing, as outlined in the registration legislation of 1911 and enforced with the Maternity Act 1922. This meant nurses were restricted to a particular field of nursing, generally associated with a hospital.

Furthermore, the training of nurses in these hospitals reinforced the compliance of nursing and its subservience to medicine. As such, even when working in relative isolation, such as maternal and child welfare or school nursing, there was little autonomy or independence and the nurses adhered to the guidelines provided for them by their medical directors. In these circumstances they were not to treat any problems identified, but rather to refer the patients to the appropriate doctor. As such, while new fields of nursing opened up for trained nurses, there was a concomitant decrease in control over their own practice.

That this was not perceived as problematic by the QATNA reflects the make

114 Nurses’ Award 1921, The Australasian Nurses’ Journal, vol. 19, no. 7, 1921, pp. 219-222. Private duty nurses wages and conditions compiled from Chapter 3.

76 up of the Executive Council of that body and the acceptance by nurses that they should be under the control of medicine. However, the consequences of this increased reliance upon medicine is reflected in the concern expressed by some of the more isolated members of the QATNA regarding their legal status in attending patients without the presence of a doctor. One matron of a country hospital wrote in 1928 wanting to know how she should fare legally as she was delivering babies in the absence of a doctor who could not always be contacted.115 In comparison, untrained nurses undertook all the aspects of the delivery as part of their normal practice.

Although it is evident these trends occurred, it is not easy to determine the causes for these developments. The legislative changes would appear to have instigated some of the developments such as restricting untrained nurses.

However, the causal relationship between nursing and increased institutionalisation remains unclear. That is, while the legislation promoted the relationship, it is unlikely to have been solely responsible. Finally, it should be noted that in all cases, the effects of each piece of legislation on nursing services was not instantaneous upon enactment, and indeed, the changes only became evident after a number of years. As a result, it is difficult to isolate the specific effects of each legislative change, and it needs to be acknowledged that other factors, such as medical advances, and societal perceptions and changes, are also likely to have been influential, both in the formulation of legislation and its eventual effect.

115 QATNA minutes, The Australasian Nurses’ Journal, vol. 26, no. 7, 1928, p. 186.

77 Conclusion

This chapter has considered the effect of legislation on the evolution of nursing services in Queensland from pre WWI to the 1950s. As the Labor Party was in government for most of this time, it was pertinent to review the ideals of this

Party and how these may have influenced legislative changes. The Labor government pursued interventionist policies reflecting its nationalistic and democratic socialist ideals. These ideals can be seen in its actions and legislation, especially in relation to health. For example, the government provided some services such as Westwood Sanatorium, maternal and child welfare services and Eventide. Furthermore, the government moved to control those services that were wholly private and gained complete control over those it funded, that is public hospitals.

Nurses formed the bulk of health service provision at the turn of the twentieth century, as they still do. As such, it is not unreasonable to expect these interventions to have had direct or indirect effects on nursing services.

Overall, two main effects have been identified: the gradual shift of untrained nurses from private duty nursing into institutions; and the similar institutionalisation of trained nurses, accompanied by a loss of autonomy. It has been suggested that while some of these evolutionary changes can be traced to particular pieces of legislation, determining the true effect is not possible due to the length of time associated with the changes and the likely interplay between the legislation and other broader factors. These political and broader factors will be explored in more detail throughout the rest of the thesis

78 as each nursing service is examined. What is clear, however, is that nurses were at all times pawns in any developments that occurred. That is, they responded to the changes and adapted to the various circumstances, but nurses were never instrumental in instigating the changes.

79 Chapter 3

Private duty nursing: the loss of independence

One must endure the drudgery to obtain the reward –

that is, the certificate, a parchment which leads us to

liberty, the golden sum of 3 guineas weekly which

may be earned as a private nurse.1

At the turn of the twentieth century, private duty nursing was depicted as the ultimate goal of a trained nurse, both internationally and in Australia. This avenue of nursing has been portrayed as the main source of income for a significant number of nurses and was considered to be superior in terms of professional status and financial rewards to hospital nursing.2 However, the reality of working as a private duty nurse has rarely been explored, probably because few records are available. Indeed, when it has been considered within the history of nursing literature, most have focused on trained nurses in metropolitan centres. This chapter redresses this deficit by including untrained nurses. Therefore, this examination of private duty nursing in the

1 Letter to Editor, The Australasian Nurses’ Journal, vol. 5, no. 4, April 1907, p. 119. 2 Trembath, R., Hellier, D., All Care and Responsibility. A History of Nursing in Victoria 1850 – 1934, Victoria, The Florence Nightingale Committee, Australia, Victoria Branch, 1987, pp. 74, 155; Dickenson, M., An Unsentimental Union. The New South Wales Nurses’ Association 1931 – 1992, Sydney, Hale & Iremonger, 1993, p. 23.

80 Rockhampton region from 1901 to 1954 challenges some previously held concepts of private duty nursing in Australia.

In order to more fully appreciate the issues relating to changes pertaining to private duty nursing, it is worthwhile recalling from the previous chapter the importance of nationalism within Australian society at the turn of the twentieth century. The notion of ‘populate or perish’ should not be underestimated as a prevailing doctrine. Coinciding with this doctrine was the rise of professional nursing in Australia and elsewhere in the Western world. While these two developments were not directly related, it is argued in this chapter the professional nursing groups such as the Australasian Trained Nurses’

Association (ATNA) tried to capitalise on such a doctrine to promote their own profession at the expense of untrained nurses. How successful such promotion was is questionable, as it would appear both the government and the communities where untrained nurses resided, did not necessarily subscribe to the same view.

Private duty nursing is likely to have existed in Rockhampton since the early days of settlement. Therefore, it is necessary to consider this avenue of nursing from at least the turn of the twentieth century in order to determine what changes occurred as a result of nurse registration. Few records exist detailing private duty nurses in the Rockhampton area. The Post Office Directories provide some insights, although they do not identify all possibilities.

Therefore, a range of sources have been used throughout this chapter.

Although some of the early nurses may have undertaken private duty nursing

81 as well as taking patients into their own homes, known as cottage hospitals, 3 this chapter will focus as much as possible on private duty nursing as it occurred in the patient’s home. Cottage hospitals will be explored in more detail in Chapter 4.

Private duty nurses in the Rockhampton district

In 1901, ten women in Rockhampton and three in Mount Morgan may be identified in the Post Office Directories as private duty nurses.4 Yeppoon and

Emu Park were very small communities at this time and did not list any private duty nurses until later. Yeppoon had a small number (one or two) from 1924 to 1949.5 However, Emu Park only appears to have had one private duty nurse, Miss Bessie Hardy, for a brief time in 1917/18.6 Mount Morgan listed one or two nurses for most of the period under review, despite a significant reduction in the population of this town by the 1930s.7 In the few years leading to 1911/12, Rockhampton had ten private duty nurses within its

3 Sometimes these cottage hospitals were called ‘nursing homes’ or ‘lying-in hospitals’. All terms represent patients being attended to in the nurses’ homes, which usually accommodated between 2 – 4. For further details see Chapter 4 or Selby, W. Motherhood in Labor’s Queensland, 1915 – 1957. Unpublished PhD thesis, Griffith University, 1992, p. 102. 4 POD 1901, pp. 424-430; 454-490. See Appendix A for a summary of private duty nurses in the Rockhampton region, 1901 – 1949. A map of Rockhampton has been provided in Appendix C to assist in visualising the locations of these homes. 5 For most of the period under review, there were up to two nurses in Yeppoon, however, from 1927 – 1931, Nurses Austin, Bianchi and Pettit also worked in this town. POD 1924/25, p. 534; 1925/26, p. 541; 1926, p. 543; 1927/28, pp. 554-555; 1928/29, p. 560; 1929/30, p. 566; 1931, pp. 585-586; 1931/32, p. 583; 1935, p. 623; 1936, p. 644; 1937, p. 675; 1938, p. 701; 1939, p. 671; 1940, p. 684; 1941, 387; 1942, p. 370; 1944, p. 357; 1946, p. 368; 1949, p. 416. 6 POD, 1917/18, p. 230. 7 POD, 1901, pp. 424-430; 1908, p. 374; 1909/10, p. 232; 1910/11, p. 234; 1912/13, pp. 253- 255; 1913/14, pp. 257-258; 1914/15, p. 276; 1915/16, p. 284; 1917/18, p. 320; 1922/23, p. 356; 1923/24, p. 369; 1924/25, pp. 387-388; 1925/26, pp. 393-394; 1926, p. 404; 1927/28, p. 416; 1928/29, pp. 418-419; 1929/30, p. 426; 1931, pp. 440-441; 1931/32, p. 440; 1935, p. 474; 1936, pp. 488-489; 1937, p. 511; 1938, p. 529; 1939, pp. 500-501; 1940, p. 488; 1941, p. 292; 1942, p. 279; 1944, p. 272; 1946, p. 252.

82 population of approximately 20 000.8 By 1912/13, this number had dropped significantly to six9 and continued to decline such that by 1925 Mrs Mary

Giles is the only nurse identified.10 However, Nurse (Mrs Sarah) Brady also began working as a private duty nurse after 1930,11 along with a number of nurses who had been operating lying-in hospitals prior to 1930.12 Nurse Brady is not listed after 1938 leaving only two until 1941. After 1941, the directory changed format, listing businesses rather than households, in a manner similar to the Yellow Pages of modern directories. No separate listing for nurses was included under the new organization of the directory. However, private duty nurses continued to operate in Rockhampton as they were represented on the committee of the Rockhampton Branch of the Queensland Australasian

Trained Nurses’ Association (QATNA), which functioned from 1944 to 1954, firstly by Miss Bourke (1944 to 1945), then Miss Greene (1946) and then by

Mrs Kenny after 1947.13 Unfortunately these records do not indicate how many nurses were working as private duty nurses. Given the decline noted in numbers prior to 1941, the number is likely to have been very small.

8 POD, 1911/12, pp. 266-284. 9 This figure may be lower, as Miss Mary Jones and Mrs Anna Eckel are included although they later registered their homes as lying-in hospitals. Whether they were operating as such in 1912/13 is impossible to tell. Miss Jane Berrill is noted as operating a private hospital and has not been included in this figure. POD, 1912/13, pp. 274-289. 10 POD, 1925, p. 428; 1926, p. 438; 1927/28, p. 450; 1928/29, p. 454; 1929/30, p. 462; 1930/31, p. 478; 1931/32, p. 476; 1933, p. 473; 1934, p. 499; 1935, p. 512. 11 Advertisement: ‘Nurse Brady is prepared to take outside cases in midwifery nursing. Address 196 Murray St, off Denham St, Phone 1525’. Morning Bulletin, 3 February, 1930, p. 8. 12 Nurses Wye, Gaffney, McGuirk, Hoare and Jones are listed in PODs as ‘nurse’ in addition to Mrs Mary Giles. POD 1929/30, pp. 462-475; 1930/31, pp. 478-491; 1931/32, pp. 477-490; 1933, pp. 474-487; 1934, pp. 500-509; 1935, pp. 512-522; 1936, pp. 531-544; 1937, pp. 557- 567; 1938, pp. 576-587; 1939, pp. 576-592; 1940, pp. 532-549. 13 Minutes of the Rockhampton Branch of the QATNA, 1944 – 1954, ACHHAM, Rockhampton.

83 These figures suggest private duty nursing was not the most significant nursing group numerically in the Rockhampton region, even prior to 1930, which has been postulated as the critical time for this group.14 Indeed, the most significant drop in numbers occurred around 1912 coinciding with the introduction of nurse registration in Queensland. Nor can the drop be accounted for by private duty nurses taking up lying-in hospitals as their main avenue of income. In 1912, only two nurses operated private, nurse-run hospitals – Miss Jane Berrill, who had previously nursed privately;15 and Jessie

Christmas, who operated a private hospital for less than twelve months, but who did not undertake private duty nursing in Rockhampton.16 Some of the nurses may have taken cases into their own homes. For example, Nurse Eckel is listed consistently in the Post Office Directories as ‘nurse’ from 1901 to

1923, although she was operating a lying-in hospital from at least 1920.17

This impression that private duty nurses were not the major group of nurses is reinforced when numbers employed by hospitals and other institutions are compared with those nurses working for themselves. The 1923 ATNA register of nurses lists all the members of that year, including their addresses. This source provides some insight into the employment of nurses, as it was customary for all hospital-employed nurses to live at the hospital in which they were working. Table 3.1 outlines 23 trained nursing staff were employed in hospitals or other organizations in Rockhampton. It should be noted, however,

14 Trembath and Hellier, op. cit., p. 155; Dickenson, op. cit., p. 23. 15 POD 1911/12, p. 282. 16 Ibid., p. 280. 17 Nurse Eckel registered with the Rockhampton City Council in 1920 when the North Rockhampton Borough came under the jurisdiction of the RCC. McDonald, L., Rockhampton. A History of City and District, St. Lucia, University of Queensland Press, 1981, p. 141.

84 that this figure would have been exceeded in actual numbers employed as not all trained nurses joined the ATNA. For example, no nurses are listed for

Tannachy or Leinster Hospitals, although these hospitals employed trained staff. Furthermore, two nurses were employed at the Maternal and Child

Welfare Clinic, and one each at the Salvation Army Maternity Hospital; Lock

Hospital (for venereal diseases); Reception House for the Insane; and the Gaol, who are not accounted for in the ATNA records, although some of these latter nurses may not have been trained.

Table 3.1 Numbers of ATNA members employed by hospitals or other organizations in 192318

Hospital or Organization ATNA registers19 Total

Hillcrest Hospital 3 general, 1 midwifery 4 Mater Misericordiae Hospital 2 general 2 General Hospital 7 general 7 Women’s Hospital 1 general, 2 midwifery 3 Children’s Hospital 2 general, 2 midwifery 4 Doctor’s surgeries 3 general 3 TOTAL 23

In comparison, seventeen nurses ran lying-in hospitals in Rockhampton in

192320 and a further three worked as private duty nurses, making a total of only twenty as self-employed. Some private duty nurses may be unaccounted for as seventeen nurses were listed in the 1923 register with Post Office boxes, private addresses or no address at all. However, these cannot be assumed to have been private duty nurses as many of these would appear to be family

18 Australasian Trained Nurses’ Association, Register of Members 1923, Sydney, Eagle Press, 1923. 19 ATNA registers were divided into three categories: general, midwifery and mental, reflecting the certificates held by the members. Members could be registered in more than one category. 20 See Chapter 4.

85 addresses. For example, Marianne Dowling is listed at Upper Dawson Road in

1923; however, she was Matron of the Yeppoon Hospital from 1922 to 1939.21

By 1930, self-employed nurses (private duty nurses and those running lying-in hospitals) numbered only twelve and by 1938 this number was reduced to just five. As such, these figures demonstrate that while self-employed nurses constituted a significant proportion of the nurses in Rockhampton in the early

1920s, private duty nurses made up only a small percentage of this group.

Of the ten private duty nurses listed in 1911/12 in Rockhampton, only six applied for registration with the Queensland Nurses’ Registration Board

(QNRB), four of whom went on to apply for registration for lying-in hospitals with the Rockhampton City Council in 1916. The majority of those who registered did so under the category 154C2(3) indicating they had not completed a recognised training certificate.22 Most of the private duty nurses in Rockhampton identified in this thesis do not appear to have registered at all, although some of them may have done so under their maiden names.

Similarly, those private duty nurses working at Mount Morgan and Yeppoon were mostly unregistered. 23 As such, the majority of nurses undertaking private duty nursing in the Rockhampton region during the early part of the

21 Ryan papers: Hospitals 1955, folder C362.11, RDHS, Rockhampton. Elsie Crudginton, Ida Kent, Gertrude Elliott and Annie Thomas list addresses that would appear to be family addresses according to the POD 1923, pp. 390, 387, 399, 298 respectively. 22 Miss Mary Jones registered under category 154C1 as she had completed twelve months training at the Women’s Hospital, Rockhampton in 1905 (Register of Maternity Nurses 1912 – 1925, QNRB, folder A/73218, QSA, Brisbane; ATNA Register of Members 1923, op. cit.); Miss E. Dickson is not in the Register, however, Ella Dixon (possibly the same person), Post Office Rockhampton, is registered under category 154B1 in the Register of General Nurses 1912 - 1925 (completed recognised training). All others were registered under category 154C2(3). 23 The exceptions were Mrs Jessie B. Hetherington, registered under category 154C2, after completing 12 months training at Lady Bowen Hospital, Brisbane; and Bessie Hardie, registered under 154B4 suggesting no formal training. ATNA, Register of Members 1923, op. cit., Register of Maternity Nurses 1912 - 1925, QNRB, folder A/73218, QSA, Brisbane; Register of General Nurses 1912 – 1925, QNRB, folder A/73216, QSA, Brisbane.

86 twentieth century were not ‘trained’ nurses. This supports Selby’s assertion that around 70 percent of practising midwives in Queensland in 1913/14 were untrained.24 Although there was provision in the legislation for nurses who had not completed the desired training to become registered, those working as private duty nurses were under no obligation to do so. Untrained private duty nurses continued to take cases for a number of years.25

In addition to their training status, there are a number of other aspects common to the earlier private duty nurses. In 1901, all of the listed private duty nurses in Rockhampton were married. In 1910/11, all but two were married, and indeed, the few who continued to work as private duty nurses into the 1920s and 1930s were married. What their family status was is impossible to tell, although the Post Office Directories suggest at least some of these nurses lived with their husbands.26 In an era when marriage was usually followed by the birth of a number of children, it is also unlikely the majority of these women were without family responsibilities.27 Another common feature was most of these nurses had been residing and working in the Rockhampton community for a number of years. Mrs Pollard nursed for at least eleven years; Mrs Burns

24 Selby, op. cit., p. 96. 25 Reports of untrained, unregistered private duty nurses continued to filter to the QATNA for many years after registration was introduced. For example, QATNA Minutes, The Australasian Nurses’ Journal, vol. 28, no. 4, 1930, p. 109. 26 Mrs Emma (J.M.) Willis and Mr John Willis lived at 11 Caroline Street (POD 1901, p. 462 – 1904, p. 448). Mrs Willis recommenced nursing in 1907, however, she appears to have lived alone after this time (POD 1907, p. 398). Mrs Wm. J. Mallory and Wm. J. Mallory lived at 84 Campbell Street (POD 1903, p. 430; 1904, p. 446; 1905, p. 438; 1906, p. 372; 1907, p.389; 1908, p. 406; 1909/20, p. 254; 1910/11, p. 258; 1911/12, p. 270). 27 For further exploration of women’s role within marriage see: Cass, B., ‘Population policies and family policies: State construction of domestic life’, in Baldock, C.V., Cass, B., (eds), Women, Social Welfare and the State in Australia, Sydney, Allen & Unwin, 1983, pp. 164-185; Holmes, K., ‘Spinsters indispensable: feminists, single women and the critique of marriage, 1890 – 1920’, Australian Historical Studies, no. 110, 1998, pp. 68-90; Lake, M., ‘Marriage as bondage: the anomaly of the citizen wife’, Australian Historical Studies, no. 112, 1999, pp. 116-129.

87 worked for at least twelve; Mrs Willis nursed privately for at least seventeen years before running a lying-in hospital from 1917 to 1921; Mrs Flenady nursed for at least 21 years; while Mrs Eckel nursed privately for at least twenty years prior to registering her lying-in hospital from 1920 to 1928.

Hence, these women were long-term residents of the communities in which they worked and reinforces Summers’ view of these women as married, older and local residents of their communities.28 Furthermore, the longevity of their practice suggests these nurses were respected and competent nurses within those communities.

Discussion

Few authors within the history of nursing literature have considered private duty nursing. Of these, most have focused on trained nurses. Strachan29 identifies how taxing private duty nursing was and that private duty nurses offered nurses some control over their work. Although her focus is on the wages of these nurses and the role professional organizations played in setting wages and conditions. Untrained nurses are rarely considered. However, as this thesis illustrates, the training status of the nurses is an important factor in the analysis of private duty nursing in regional Queensland. Although untrained nurses were not unique to the Rockhampton district, by focusing on a particular region, these nurses are brought to the foreground in a manner that is rarely evident in the literature. In particular, this chapter will consider the

28 Summers, A., ‘Sairey Gamp: generating fact from fiction’, Nursing Inquiry, vol. 4, 1997, p. 14. 29 Strachan, G., Labour of Love. The History of the Nurses’ Association in Queensland 1860 – 1950, St Leonards, Allen & Unwin, 1996.

88 relationship between trained and untrained private duty nurses; how training status affected the nature of the work undertaken by each group, including the remuneration associated with their work; the relationship private duty nurses had with doctors and whether this relationship was effected by the training status of the nurse.

Trained versus untrained private duty nurses

Trembath and Hellier30 assert that private duty nursing in Australia was severely affected by the economic Depression of the 1930s and did not recover.

A similar drop in private duty nursing was also experienced in the United

States of America. Geister reported in 1926 that a New York study found 30 to

50 percent of private duty nurses were planning to seek other avenues of nursing.31 However, these studies only considered trained private duty nurses.

While the total number of self-employed nurses in Rockhampton dropped considerably after 1926, all of those who stopped nursing ran lying-in hospitals. When lying-in hospital proprietors are removed from the analysis

(factors contributing to the closure of lying-in hospitals are discussed in

Chapter 4), Rockhampton did not see a drop in private duty nursing during the

Depression years at all. Indeed a small number of private duty nurses consistently operated in Rockhampton from 1923 to the early 1940s.

Similarly, there was no drop in numbers working as private duty nurses in

Mount Morgan or Yeppoon during the Depression. In fact, there was an increase in the number of nurses operating in Yeppoon between 1927 and

30 Trembath and Hellier, op. cit., p. 155. 31 Geister, J., ‘Heresay and facts of private duty’, The Australasian Nurses’ Journal, vol. 24, no. 12, 1926, p. 557.

89 1931.32 This raises a number of questions including whether previous researchers have adequately differentiated between private duty nurses and those running cottage hospitals or whether private duty nurses working in regional areas of Australia experienced a different reality to those working in metropolitan centres. It is argued here that Rockhampton did not reflect this downward trend because of the latter explanation, with the prime factor being the number of untrained private duty nurses working in this region.

On the other hand, this thesis has identified a significant decline in the number of private duty nurses in 1912, which in Rockhampton dropped by 40 percent.

It is proposed this was related to the introduction of nurse registration legislation by the Queensland Government as part of the Health Act

Amendment Act of 1911.33 One of the aims of registration was to regulate against the practice of untrained nurses in relation to midwifery and hence address one of the perceived factors contributing to the maternal and infant mortality rates. The legislation stipulated only trained nurses could hold positions of authority, such as Matron, and that only registered nurses (and medical practitioners) could be the proprietors of private hospitals. However, the legislation did not prohibit untrained nurses from working as private duty nurses, provided they only undertook cases in the patient’s home,34 nor were they required to register with the Queensland Nurses’ Registration Board

(QNRB). As such, while the introduction of nurse registration legislation coincided with a drop in numbers of private duty nurses, it is not clear why this was so. Possible factors could be a lack of understanding by untrained

32 POD 1927/28, pp. 554-555; 1928/29, p. 560; 1929/30, p. 566; 1931, pp. 585-586. 33 Health Act Amendment Act of 1911, Government Gazette, vol. XCVII, no. 176, p. 1794. 34 Strachan, op. cit., p. 80.

90 practitioners regarding the legislation or a perception that this avenue of nursing was closing as more trained nurses appeared.

Attempts to sketch the portrait of private duty nurses in Rockhampton are fraught with difficulties because of the lack of empirical data available and the variations in training status among the women who undertook this work. The impression of older women taking on nursing as a means of income is readily found in Victorian novels. Indeed, the image of Sairey Gamp from Charles

Dickens’ Martin Chuzzlewit, was used for much of the nineteenth century to promote the need for modern trained nursing.35 Earles also notes older women of eighteenth century London tended to take on nursing as an occupation when

‘declining eyesight and arthritic fingers prevented them from maintaining themselves “by the needle”’.36 Summers’ research into the midwives of the late nineteenth and early twentieth century in South Australia depicts independent practitioners within a local community, who had not completed any formal training but had gained experience and knowledge from either local doctors and/or other women.37 Supporting Robertson’s38 earlier portrait of untrained nurses, Summers found these women were generally middle aged or elderly married women, who took on midwifery and nursing as the means to support their families.39 Martyr outlines the view of Dr Joseph Arratta that North

Queensland midwives had significant knowledge and efficiency, although they

35 Summers, op. cit., p. 15. 36 Earle, P., ‘The female labour market in London in the late seventeenth and eighteenth centuries’, in Sharpe, P. (ed), Women’s Work: The English Experience 1650 – 1914, London, Arnold, 1998, p. 136. 37 Summers, op. cit., p. 14. 38 Robertson, B., ‘Old traditions and new technologies: an oral history of childbirth in South Australia from 1900 – 1940’, Oral History of Australia Journal, no. 14, 1992. 39 Summers, op. cit., p. 14.

91 were untrained.40 Thus, nursing had long been considered as a viable employment option for older women who had gained skills and knowledge through looking after family members. It is likely this was the path taken by many of the private duty nurses of the Rockhampton region.

The untrained status of the majority of private duty nurses in Rockhampton prior to WW2 may explain in part why this group was not adversely affected by the Depression. It is also likely to be a factor in their invisibility in the literature. Robertson found older, married, mostly untrained nurses did not advertise their services and only appear in conventional records when they drew the attention of the authorities, making it difficult to gain a full appreciation of the extent of their work or influence.41 Their presence in

Rockhampton is not likely to have been unique to this part of Queensland, which was an area of considerable political and economic significance during the early twentieth century, although further research is required to establish the training status of private duty nurses in other regions of Queensland.

However, this region also contained trained private duty nurses who were more likely to have been younger, single and without dependants.

The tension between trained and untrained private duty nurses at the beginning of the twentieth century was based on issues of professionalism and pragmatics as each vied for a limited market. Throughout this chapter a number of factors contributing to this tension will become apparent. These include the recognition of training as a distinguishing feature; the availability and type of

40 Martyr, op. cit., p. 225. 41 Robertson, op. cit., p. 63.

92 work undertaken by each group; the level of remuneration and conditions of work; and the impact of increased hospitalisation upon private duty nursing.

That untrained nurses were seen as a threat to the emerging group of trained nurses is clear from Letters to the Editor in The Australasian Nurses’ Journal, the official journal of the ATNA. In particular, there would appear to have been a considerable campaign from within the nursing profession to discredit untrained private duty nurses and to unequivocally associate them with the high maternal and infant mortality rates of the early twentieth century. Given the societal concern regarding the need to populate the country in order to protect its shores against an Asian invasion, such views would appear to have been politically motivated, at least in part. It is likely professional nurses drew upon such nationalist concerns to promote their own cause of shoring up legislative and public support to limit the practice of nursing to trained nurses only. For example, in 1907, a matron of a country hospital outlined two births overseen by ‘Gamps’ (untrained nurses) where the placenta had not been completely expelled and the women became acutely ill.42 The Editor’s reply stated there was ‘no law defining what was meant by a midwife, and so there

[was] nothing to prevent anyone accepting fees to act in this capacity’.43

Another 1907 letter refers to a country town where a number of ‘Gamps’ resided who were considered to be incompetent.44

As a result of professional, trained nurses wishing to distance themselves from their untrained counterparts, the QATNA advocated a number of actions.

42 Letter to Editor, The Australasian Nurses’ Journal, vol. 5, no. 10, 1907, p. 313. 43 Ibid. 44 Letter to Editor, The Australasian Nurses’ Journal, vol. 5, no. 12, 1907, pp. 380-381.

93 These included exclusivity of the title ‘nurse’ and a variety of distinguishing additions to their uniform, such as badges, although few of these actions were supported by legislation. As such, the issue of promoting the trained nurse at the expense of the untrained nurse was left to professional nurses themselves.

They invariably did this by associating untrained nurses with incompetence and poor patient outcomes. Indeed, letters to the ATNA outlining the

‘problem’ of untrained nurses continued into the 1930s. However, it needs to be remembered those trained nurses writing to the ATNA had a vested interest in propagating the image of untrained nurses as incompetent and a danger to the community. Indeed, Summers,45 Mortimer46 and Martyr47 suggest the image of untrained nurses as incompetent may not be historically correct.

The government’s response to queries raised regarding the competence of untrained private duty nurses is also not entirely transparent. On one hand, private duty nurses were restricted from operating a lying-in hospital, but only if unregistered. On the other hand, they were free to continue to operate as long as it was within the confines of a patient’s home. This does not indicate the government was overtly concerned regarding the practice of these women.

Furthermore, many doctors and the wider community also supported untrained nurses, as will become evident later in this chapter.

45 Summers, op, cit.; Summers, A., ‘A different start: midwifery in South Australia 1836 – 1920’, International History of Nursing Journal, vol. 5, no. 3, 2000, pp. 51-57. 46 Mortimer, B., ‘Independent women: domiciliary nurses in mid-nineteenth century Edinburgh’, in Rafferty, A., Robinson, J., Elkan, R. (eds), Nursing History and the Politics of Welfare, London, Routledge, 1997, pp. 133-149. 47 Martyr, P., Paradise of Quacks. An Alternative History of Medicine in Australia, Sydney, Macleay Press, 2002.

94 Interestingly, it would appear the majority of the complaints received by the

ATNA related to ‘country’ areas.48 Therein may be the key to the different images of private duty nursing presented by Summers49 and those provided by others such as Durdin50 and Trembath and Hellier:51 the latter tend to locate their work in metropolitan situations, whereas Summers considers a broader cohort. Where previous studies only considered trained nurses, Summers takes into account untrained nurses who also provided private duty nursing. How prevalent untrained private duty nurses were in metropolitan areas is uncertain.

The evidence presented here suggests that in regional areas of Australia at least, private duty nursing was largely carried out by untrained, experienced nurses who were mostly ineligible for, or disinterested in, membership of organizations such as the ATNA.

Whether rivalries existed between trained and untrained private duty nurses in

Rockhampton is unknown. There is no mention of such issues in the minutes of the Rockhampton branch of the QATNA after it was established in 1944.

However, by this stage there may not have been any untrained private duty nurses remaining in Rockhampton. Despite this, a closer look at one of the nurses who undertook private duty nursing in Rockhampton during the 1940s illustrates both similarities and differences between untrained and trained private duty nurses. Sarah Maud Greene52 was born 1886 and commenced her

48 QATNA Minutes, The Australasian Nurses’ Journal, vol. 26, no. 6, 1928, p. 154; QATNA Minutes, The Australasian Nurses’ Journal, vol. 29, no. 1, 1931, p. 8. 49 Summers, 1997, op. cit. 50 Durdin, J., They Became Nurses: A History of Nursing in South Australia 1836 – 1980, Sydney, Allen & Unwin, 1991. 51 Trembath and Hellier, op. cit. 52 Obituary clipping: Sarah Maud Greene, ACHHAM, Rockhampton. The original source of this information is unknown.

95 training at the Rockhampton Hospital in 1907. Upon completion in 1910,

Greene worked in a variety of small hospitals, mostly as Matron, and undertook some private duty nursing in Brisbane and Sydney, including running her own private hospital in Brisbane for two years with a friend. She eventually became Matron of the Women’s Hospital in Rockhampton in 1929 and then Matron of the Rockhampton Hospital from 1930 to 1944. It would appear Greene then undertook private duty nursing in Rockhampton at the age of 58, as she was the representative for private duty nurses for the

Rockhampton Branch of the QATNA. How long she did this is unknown.

When she was 64 years old, she became Matron of the Barcaldine Hospital for

7 years, and then Matron of the Augethella Hospital before retiring at the age of 78 years. This overview of Greene’s career suggests several things. Firstly, trained nurses moved fairly fluidly between private duty nursing and hospital nursing. Such fluidity would not have been possible for untrained nurses who were restricted to working within the homes of patients. Secondly, private duty nursing was still considered a suitable option for an older nurse, reinforcing the association of this avenue with older nurses, whether trained or otherwise.

Working as a private duty nurse

As the private duty nurses of the Rockhampton region prior to the 1930s were mostly untrained, their experience of working as private duty nurses is likely to have differed from that of trained nurses living in metropolitan areas. For

96 example, Trembath and Hellier53, Durdin54 and Schultz55 suggest private duty nurses generally entered a nurses’ home where they lived between cases. These homes were run by Matrons and acted as agencies allocating cases to the nurses. Where the nurse lived constitutes a major difference between metropolitan and regional private duty nurses. No nurses’ home existed in

Rockhampton. Indeed, as the majority of the nurses were married or widowed, with possible families to support and attend to, such an arrangement was not appropriate.

The lack of a central point for doctors and patients to contact nurses raises the question of how this was accomplished. While some nurses appear to have used the newspaper to advertise their availability,56 it is likely word-of-mouth or the use of Post Office Directories were the main avenues. In smaller towns such as Mount Morgan and Yeppoon, word-of-mouth may not have been necessary, as everyone would have ‘known’ where the ‘nurse’ lived.57 As such, the problem of contacting available private duty nurses was probably mostly restricted to metropolitan areas.58

53 Trembath and Hellier, op. cit., pp. 89-90. 54 Durdin, op. cit., p. 44. 55 Schultz, B., A Tapestry of Service. The Evolution of Nursing in Australia, Volume 1. Foundation to Federation 1788 – 1900, Melbourne, Churchill Livingstone, 1991, p. 141. 56 Advertisement: ‘Nurse Brady is prepared to take outside cases in midwifery nursing. Address 196 Murray St, off Denham St, Phone 1525’, Morning Bulletin, 3 February, 1930, p. 8. 57 Cryle, D., Mullins, S., Cosgrove, B., ‘Voices from the Mount: work cultures and social segregation in a Central Queensland mining town’, Oral History Association of Australia Journal, no. 15, 1993, pp. 11-21. In this article, the authors note how ‘everyone knew one another’ (p. 17) in Mount Morgan. 58 The Director of Labour in Queensland, Frank Walsh, proposed a central nurses’ Registration Bureau in 1927 where private duty nurses could be contacted. Walsh noted several Nurses’ Homes in Brisbane, but complained nurses were living with relatives or residing in general boarding establishments because of a lack of room at Nurses’ Homes, making them difficult to contact. QATNA Minutes, The Australasian Nurses’ Journal, vol. 25, no. 3, 1927, pp. 84-85.

97 The issue of contacting a private duty nurse was a contentious one for many years in Australia and centred on the competition associated with private duty nursing. Gregory notes that shortly after the Hospital for Sick Children and the

Brisbane Hospital began issuing certificates for training in 1886 and 1888 respectively, the Queensland Medical Society established an unofficial register of trained nurses who were available for private duty nursing.59 Maintenance of a central register was seen as one of the main avenues of protecting the employment of trained private duty nurses, although ironically when the

QNRB was established in 1912, untrained nurses could still work as private duty nurses.60 However, it was not just untrained nurses who competed on the private duty nursing market. Hospitals also were known to vie for the private dollar by sending out trainees and trained staff during quieter times on the wards.61 This practice seems to have been widespread as Hunt and Whiting62 have identified a similar situation in the UK and Lane-Miller63 in the USA.

Despite the development of registers and central points of contact, this did not prohibit some doctors from recommending untrained nurses with whom they had built a rapport over the years. A Letter to the Editor in The Australasian

Nurses’ Journal in 1920 suggested some doctors were not showing loyalty to trained nurses and extended their patronage to the untrained.64 This further

59 Gregory, H., A Tradition of Care. The History of Nursing at the Royal Brisbane Hospital. Brisbane, Boolarong Publications, 1988, p. 38. 60 Strachan, op. cit., p. 80. 61 QATNA Minutes, The Australasian Nurses’ Journal, vol. 6, no. 11, 1908, p. 403. Similar situations are noted by Durdin, op. cit., p. 42; Trembath and Hellier, op. cit., p. 33; Gregory, op. cit., p. 32. 62 Hunt, J., Whiting, M., ‘A re-examination of the history of children’s community nursing’, Paediatric Nursing, vol. 11, no. 4, 1999, p. 34. 63 Lane-Miller, E., ‘From home to hospital: changing work settings of Arkansas nurses, 1910 – 1954’, Journal of Nursing History, vol. 3, no. 2, 1988, p. 39. 64 Letter to Editor, The Australasian Nurses’ Journal, vol. 18, no. 2, 1920, p. 54.

98 supports the view that the untrained nurse was not always synonymous with the unskilled or incompetent.

The relationship private duty nurses had with doctors is interesting and has not been explored to any great extent in the literature. Hallett suggests that eighteenth century doctors in the UK were suspicious of the influence private duty nurses had with the patient, for while, ‘the physician may have a monopoly of the giving of medical advice, … the nurse has the power to implement or ignore his instructions’.65 Indeed, the value of the nurse obeying

‘to the letter’ the instructions of the doctor is clearly illustrated in Charlotte

Bronte’s Shirley, when the surgeon replies to intimations his preferred nurse may be a drunkard. ‘Pooh! my dear sir, they are all so … But Horsfall has this virtue, drunk or sober, she always remembers to obey me’.66

Martyr also observes some of the ‘new’ trained nurses of the late nineteenth century in Australia were also accused by doctors of not being ‘overburdened by scruples’ in regards to doctors’ orders.67 Such concerns suggest two conflicting issues. Firstly, private duty nursing provided the opportunity for nurses to exercise considerable control within their practice of nursing; and secondly, doctors were often more concerned with the obedience of the nurse than perhaps her trained status (or indeed, her sobriety). As obedience was greatly emphasised in nurse training by the early twentieth century, it could be expected such concerns for doctors abated when more trained private duty

65 Hallett, C., ‘Puerperal fever as a source of conflict between midwives and medical men in eighteenth- and early nineteenth-century Britain’, Breaking New Ground – Women Researchers in a Regional Community Conference, February 2003, Bundaberg. 66 Bronte, C., Shirley, Hertfordshire, Wordsworth Classics, 1993, p. 421. 67 Martyr, op. cit., p. 166.

99 nurses entered the market. Given the success of those untrained private duty nurses in the Rockhampton region, it is likely these nurses were well regarded by the doctors of the time and were probably diligent in carrying out their requirements. As such, although private duty nurses in Rockhampton had the opportunity to exercise considerable autonomy in their practice, they would appear to have conformed with doctors’ orders. This suggests the difference between untrained and trained nurses may not have been significant in the eyes of many doctors.

It is likely private duty nurses in Rockhampton undertook both nursing and midwifery cases, although no evidence has been found that details the work undertaken by these women. Of those who registered with the QNRB, most did so under the midwifery category. For those who went on to operate lying-in hospitals, this would have been necessary. Thus midwifery may have been the mainstay of most private duty nursing employment. Summers remarks both doctors and nurses in South Australia openly acknowledged the difference between midwifery and nursing as separate professions during the early part of the twentieth century.68 However, such distinction between nursing and midwifery was not always evident in the early twentieth century literature or by the nurses themselves. For example, in a Letter to the Editor in The

Australasian Nurses’ Journal in 1907, a private duty nurse outlined a situation in Perth where a medical man was giving three months of lectures in midwifery to women who were then calling themselves ‘trained nurses’.69 Hallett also found a lack of distinction between nursing and midwifery in the UK prior to

68 Summers, A., ‘The lost voice of midwifery. Midwives, nurses and the Nurses’ Registration Act of South Australia’, Collegian, vol. 5, no. 3, 1998, p. 18. 69 Letter to Editor, The Australasian Nurses’ Journal, vol. 5, no. 4, 1907, p. 119.

100 the twentieth century.70 Indeed, the QATNA often referred to ‘midwifery nurses’ in the early twentieth century.71 As such, no attempt has been made here to distinguish between nursing and midwifery. Indeed, the conditions of work were likely to have been similar regardless of the type of case being attended.

Private duty nursing has been depicted as isolated, irregular and strenuous work during the early twentieth century.72 Geister, writing about private duty nursing in the USA in 1926, noted it had not changed much in the previous fifty years with one nurse being in constant attendance and arose from a time when women’s services were inexpensive.73 This linking of private duty nursing with women’s services in general illustrates the acceptance of many private duty nurses of performing domestic duties in addition to their nursing ones. A 1907 letter to the Editor in The Australasian Nurses’ Journal stated the private duty nurse was expected to cook and wash not only for the patient but also for the whole family.74 Anderson also advocated the practice whereby a successful private duty nurse would not be afraid to lower herself to do domestic duties.75

The willingness of trained nurses to undertake these ‘non-nursing’ aspects of private duty nursing appears to have decreased by the 1930s, with the support of the ATNA. In 1926, the QATNA replied to an enquiry about domestic

70 Hallett, op. cit. 71 For example, The Australasian Nurses’ Journal, vol. 4, no. 6, 1906, p. 198. 72 Geister, op. cit., p. 558. 73 Ibid., p. 557. 74 Letter to Editor, The Australasian Nurses’ Journal, vol. 5, no. 4, 1907, p. 119. 75 Anderson, G.M., ‘Helps to success in private duty’, The Australasian Nurses’ Journal, vol. 7, no. 4, 1909, p. 136.

101 duties indicating there were no set duties for private duty nurses and that each case was governed by circumstances.76 By 1932, the QATNA’s reply to a similar enquiry advised that while the nurse adapts herself to circumstances, domestic duties were not her responsibility except for looking after the comfort of her patient.77 However, Saunders and Spearritt suggest untrained private duty nurses continued to be willing to take on domestic duties, with this being the main distinction between the work undertaken by trained and untrained private duty nurses.78 Despite this difference, the nature of the nursing work probably consisted of fundamental nursing duties, with fewer instances of acute nursing as more patients entered hospitals for surgery and other procedures.

The need for the private duty nurse to ‘adapt’ to her circumstances required considerable personal resources. Those private duty nurses who lived at the patient’s home needed to possess tact, self-denial, sympathy, patience, humour, orderliness, punctuation and a strong constitution.79 One nurse complained in

1922 that ‘some folk think they own the nurse body and soul, when she is in their employ; and they think sleep, fresh air and comfort are quite out of the question, and often the food is not at all interesting’.80 The situation was similar in the USA with Geister noting in 1926 that while society valued a well

76 QATNA Minutes, The Australasian Nurses’ Journal, vol. 24, no. 12, 1926, p. 555. 77 QATNA Minutes, The Australasian Nurses’ Journal, vol. 30, no. 4, 1932, p. 74. 78 Saunders, K., Spearritt, K., ‘Hazardous beginnings: childbirth practices in frontier tropical Australia’, Queensland Review, vol. 3, no. 2, 1996, p. 11. 79 ‘Some hints to private duty nurses by one of them’, The Australasian Nurses’ Journal, vol. 6, no. 4, 1908, pp. 137-138; Rose, E., ‘Private duty nursing’, The Australasian Nurses’ Journal, vol. 17, no. 3, 1919, pp. 96, 98. 80 Letter to Editor, The Australasian Nurses’ Journal, vol. 19, no. 7, 1922, p. 271.

102 balanced life of work, play, love and worship, such standards were not extended to private duty nurses.81

While most early twentieth century private duty nurses lived with the patient during their employment, other options were available. As early as 1914, the

ATNA recommended fees for private duty nurses for a twelve-hour shift,82 although this was not without its difficulties. Ruth Dunnett found twelve-hour shifts problematic as they were usually from 7am to 7pm, leaving no time for shopping, preparing meals and for doing the laundry.83 ‘Hourly’ nursing was also introduced as early as 1909.84 Hourly nursing consisted of visiting the patient for a short period of time to undertake whatever procedures were necessary. The patient was then charged only for the time the nurse was in attendance. District nursing had been operating on a visiting basis since its inception in Australia so the concept was not new, but it had not been applied to private duty nursing. By the 1920s, hourly nursing was gaining popularity in the USA, aided by societal changes whereby hospitals were becoming more prevalent and popular; houses were becoming smaller (and built without servants quarters) and less isolated as more people had access to telephones, cars and good roads.85 Furthermore, private duty nursing, as it had traditionally been practiced, was being questioned as too costly and a waste of nursing skills.86 Geister calculated the hourly rate of a private duty nurse in the USA as 49 cents and pointed out unskilled labourers received 50 cents per

81 Geister, op. cit., p. 558. 82 Strachan, op. cit., p. 144. 83 Letter to Editor, The Australasian Nurses’ Journal, vol. 41, no. 1, 1943, p. 10. 84 ‘Hourly nursing’, The Australasian Nurses’ Journal, vol. 7, no. 10, 1909, pp. 345-346. 85 Geister, op. cit., p. 557. 86 Ibid., pp. 559-560.

103 hour. Peter’s more recent analysis of private duty nursing during the twentieth century also highlights how one nurse attending one patient at any one time was a waste of nursing skill and money, and that ‘visiting’ nursing and hospitalisation were promoted as providing better care for all.87

What mode of nursing private duty nurses in Rockhampton adopted is unknown. However, as they were mostly married and possibly had families of their own, they were likely to have visited rather than lived with their patients.

Cryle, Mullins and Cosgrove88 recount early twentieth century midwives in

Mount Morgan attended patients twice daily in the patients’ homes. Thus, the mode of service delivery may be another feature that distinguished regional private duty nurses from their metropolitan counterparts.

Throughout the 1940s and 1950s in Australia, the working conditions of trained private duty nurses became more of an issue with the ATNA. Although the QATNA had attempted to establish an award for private duty nurses in

1922, Mr Justice McCawley ruled such an award was inappropriate as it was considered an invasion of the home.89 However, the New South Wales ATNA resolved in 1940 that private duty nurses were entitled to 24 hours leave every fourteen days in addition to the two hours off each day while engaged on chronic cases.90 The QATNA stipulated in 1944 that private duty nurses were entitled to 30 minutes for each meal, which was to be taken outside the

87 Peter, E., ‘The history of nursing in the home: revealing the significance of place and the expression of moral agency’, Nursing Inquiry, vol. 9, no. 2, 2002, p. 69. 88 Cryle, Mullins, Cosgrove, op. cit., p. 15. 89 QATNA AGM Minutes, The Australasian Nurses’ Journal, vol. 21, no. 8, 1923, pp. 369- 371. 90 New South Wales ATNA Minutes, The Australasian Nurses’ Journal, vol. 38, no. 8, 1940, p. 142.

104 patient’s room.91 By 1948 the QATNA was advocating private duty nurses only work ten hours consecutively and that they have one and a half days off per week.92 These latter stipulations coincided with more private duty nurses taking on hospital cases for a limited shift, known as ‘specialling’ which will be discussed in more detail later in this chapter.

After the 1940s, the untrained private duty nurses seem to disappear completely from the records accessed for this research. Paradoxically, it would appear trained nurses were simultaneously becoming attracted to hospitals and less interested in private duty nursing. In 1937, an article appeared in The

Australasian Nurses’ Journal suggesting a declining interest of registered nurses in ‘chronic cases’ as they were seen as a waste of nursing skill and money.93 The author outlined a scheme by the Essex County Council of training assistants in nursing to go into private practice to take on these cases.

Indeed, as Edwards has noted, untrained nurses continued to exist in the UK and formed the backbone of aged care nursing for much of the twentieth century, both within institutions and in the community setting.94 While untrained nurses may not have worked as private duty nurses in the

Rockhampton region after WWII, untrained nurses continued to find work in various institutions such as Westwood Sanatorium (see Chapter 6) and in some private hospitals (see Chapter 5). Thus, the options for untrained nurses

91 QATNA Minutes, The Australasian Nurses’ Journal, vol. 42, no. 10, 1944, p. 120. 92 QATNA Minutes, The Australasian Nurses’ Journal, vol. 46, no. 4, 1948, p. 81. 93 ‘Training assistants in nursing’, The Australasian Nurses’ Journal, vol. 35, no. 4, 1937, p. 84. 94 Edwards, M., ‘The nurses’ aide: past and future necessity’, Journal of Advanced Nursing, vol. 26, 1997, p. 243.

105 narrowed, leading to a loss in control regarding where these nurses could work and whom they could attend.

Paying for a private duty nurse

The issue of patients paying for the services of a private duty nurse seems to have been the main concern regarding private duty nursing for professional organizations such as the ATNA. Strachan’s analysis of the QATNA highlights the lack of action by this organization in raising recommended fees for this group of nurses. This is not surprising given the history of nursing and the delicate claims for professionalism of nurses founded upon ideals of philanthropy and vocation.95 Indeed, Godden claims Nightingale discouraged

‘her’ nurses from undertaking lucrative and congenial private duty nursing.96

However, the reality was that private duty nurses depended on patient fees as their sole source of income. Whether this avenue was a lucrative one is debatable. Some nurses may have gained significant financial rewards, although as the previous section suggests, this was likely to have been at considerable cost to their health and wellbeing. It was not unusual for private duty nurses to ‘burn out’ after ten years of practice.97

95 For further exploration of the professionalisation of nursing see: Woods, C., ‘From individual dedication to social activism: historical development of nursing professionalism’, in Maggs, C. (ed), Nursing History: The State of the Art, Kent, Croom Helm, 1987, pp. 153-175; Hughes, L., ‘Professionalising domesticity: a synthesis of selected nursing historiography’, Advanced Nursing Science, vol. 12, no. 4, 1990, pp. 25-31; Strachan, G., ‘Sacred office. Trade or profession? The dilemma of nurses’ involvement in industrial activities in Queensland 1900 – 1950’, in Frances, R., Scates, B. (eds), Women, Work and the Labour Movement in Australia and Aotearoa/NZ, Sydney, Australian Society for the Study of Labour History, 1991, pp. 147-171; Godden, J., ‘For the benefit of mankind: Nightingale’s legacy and hours of work in Australian nursing 1868 – 1939’, in Rafferty, A., Robinson, J., Elkan, R. (ed), Nursing History and the Politics of Welfare, London, Routledge, 1997, pp. 177-191. 96 Godden, op. cit., p. 185. 97 Strachan, 1996, op. cit., p. 137.

106

Table 3.2 outlines the recommended fees set by the QATNA from 1905 to

1955. This table illustrates the categories of work undertaken by private duty nurses: ordinary, influenza, midwifery and ‘other’ in 1905. These categories became more explicit in 1929 and included medical/surgical, infectious, mental, alcoholic, venereal and obstetric. The table also demonstrates the shift towards visiting and working limited shifts as discussed earlier. Specialling was initially for twelve-hour shifts, however, by 1951 this was reduced to nine hours. Although living with the patient may have been seen as ‘wasteful’, other factors also influenced this trend, including a nursing shortage experienced during and after WW2 and the relative cost for the patient. Daily visits at five shillings per day in 1946 was considerably less than the £4.4 required for a private duty nurse to live in the home.

107 Table 3.2 QATNA recommended fees for private duty nurses 1905 – 195598

Year Recommended scale of fees 1905 Ordinary, influenza, midwifery £2.2 per week; other cases £3.3 per week 1914 £3.3 per week; £1.1 per 24 hours; 10s.6p per 12 hours; 5 shilling laundry allowance for infectious cases 1929 Medical/surgical, infectious, mental, alcoholic, venereal £4.4 per week; obstetric £4.4 (10 – 12 days + confinement); £1.10 confinement only; £1.10 per 24 hours; £1.1 per 12 hours; 10s.6d per extra patient in same house 1931 £3.3 per week; obstetric £4 (10 days + confinement) 1942 £4.4 per week 1946 Visiting nurses: 5s for first visit, 3s subsequent visits same day + travelling costs 1949 Flat rate 25s per day if living out, 20s per day if accommodated 1950 Visiting nurses: 7s for first visit, 3s.6d subsequent visits Special nurses: £1.5 one case, 13s.2d from each for 2 cases, 9s.9d for 3 cases Private duty nurses: £2 per day for 2 patients, £2.15 for 3 patients (inclusive of living out allowance and fares) 1951 Medical, surgical, obstetric, infectious £1.12.6 per 9 hour shift; £1.12.6 confinement only Visiting nurses: 10s for first visit, 5s subsequent visits 1955 Medical, surgical, obstetric £2.5; infectious (notifiable) £2.10 Visiting nurses: 15s single visit; £1.1 for 2 visits per day; 18s for 2 consecutive hours, £1.2.6 for 3 hours, £1.10 for 4 hours

While these fees provide some guidance as to the income of private duty nurses, some private duty nurses charged more than the recommended fee.99

Although there was no legal obligation for private duty nurses to follow the recommended schedules, higher fees were actively discouraged by the ATNA in order not to damage the reputation of the nursing profession.100 It was, however, quite acceptable for private duty nurses to charge fees less than the

98 Strachan, 1996, op. cit., p. 139, 144; ‘Scale of fees for private nurses in Queensland’, The Australasian Nurses’ Journal, vol. 27, no. 8, 1929, p. 230; QATNA Minutes, The Australasian Nurses’ Journal, vol. 29, no. 12, 1931, p. 245; QATNA AGM Minutes, The Australasian Nurses’ Journal, vol. 40, no. 8, 1942, p. 121; QATNA Minutes, The Australasian Nurses’ Journal, vol. 44, no. 8, 1946, p. 127; QATNA Minutes, The Australasian Nurses’ Journal, vol. 47, no. 10, 1949, p. 204; QATNA Minutes, The Australasian Nurses’ Journal, vol. 48, no. 5, 1950, p. 75; QATNA Minutes, The Australasian Nurses’ Journal, vol. 48, no. 4, 1950, p. 60; QATNA Report, The Australasian Nurses’ Journal, vol. 49, no. 10, 1951, p. 167; QATNA Minutes, The Australasian Nurses’ Journal, vol. 53, no. 4, 1955, p. 87. 99 QATNA Minutes, The Australasian Nurses’ Journal, vol. 24, no. 7, 1926, p. 316. The letter outlined in these minutes asked if there had been a raise in fees as some nurses in Queensland were charging 4 guineas for obstetric cases. The reply indicated 3 guineas was the current recommended fee. 100 ‘Private nursing and the public’, The Australasian Nurses’ Journal, vol. 54, no. 2, 1956, pp. 31, 48.

108 recommended fee if the patient’s circumstances were such the nurse thought this was appropriate.101 One nurse estimated the maximum income a private duty nurse could earn in 1922 was £218.8 per year;102 however it is likely few achieved this sum. Furthermore, untrained private duty nurses habitually charged less than the recommended fee, as this was a frequent cause of complaint from trained nurses who saw untrained nurses as undercutting the market.103 As the majority of private duty nurses in the Rockhampton region were untrained prior to the 1940s, it is probable the fees being charged were less than those recommended by the QATNA. In addition, untrained private duty nurses in Rockhampton visited rather than lived with the patient, thereby incurring less expense for the patient, but also limiting their own income.

While the QATNA did not include ‘visiting’ rates in its recommended fee structure until 1946, an enquiry in 1926 regarding appropriate fees for visiting indicates some private duty nurses were using this mode of service. The reply identified district nurses in ‘other places’ were charging five shillings for the first visit and two shillings six pence for subsequent visits each day.104 Similar amounts were set in 1946 when this avenue of visiting patients was incorporated into the schedule of fees. Although Table 3.2 indicates private duty nurses had gained a significant increase in wages between 1926 and 1946, this is more likely to reflect the low level of remuneration private duty nurses

101 Letter to Editor, The Australasian Nurses’ Journal, vol. 18, no. 1, 1920, p. 20. The letter asked nurses not to accept 4 guineas as recommended fee as it was detrimental to country people. The Editor’s reply points out it was not compulsory for nurses to charge full fee. 102 Letter to Editor, The Australasian Nurses’ Journal, vol. 20, no. 8, 1922, p. 311. 103 Letter to Editor, The Australasian Nurses’ Journal, vol. 20, no. 1, 1922, p. 230 104 QATNA Minutes, The Australasian Nurses’ Journal, vol. 24, no. 9, 1926, p. 420.

109 had received for most of the period 1914 to 1942.105 In comparison, trained nurses in hospitals were only receiving a marginally increased wage in the

1940s compared to their 1921 award.106 As such, the similarity between the

1926 and 1946 visiting fees appears to be consistent with other nursing wages.

Regardless of the recommended fees, nurses needed to charge fees that were affordable for their patients. A 1922 letter to the Editor in The Australasian

Nurses’ Journal suggested most people received an annual income of £200 –

500, but that the cost of living was high and this prohibited them from employing a private duty nurse.107 Although not stipulated, this letter appears to have been written by a nurse in a large city, possibly Sydney, as she refers to

‘all the registered homes’ being full of unemployed nurses. Dickenson documents the fee for a private duty nurse in New South Wales in 1920 was

£4.4 compared to the average award wage of £4.9.8.108 However, she also points out nurses’ hours were unlimited, work was spasmodic and often for only 30 to 35 weeks per year. Dickenson also reports private duty nurses frequently charged less than the recommended fee. In Queensland, the basic wage was not stipulated prior to 1921, although it was generally accepted that

£3.17 was a reasonable ‘living wage’.109 Table 3.3 summarizes the male basic wage the Southern Division of Queensland, which included Rockhampton, from 1921 to 1958. This table provides a useful guide to the income of

Rockhampton families. What is evident from these figures is that the average

105 Strachan, 1996, op. cit., pp. 149-150. 106 ‘The Queensland Nurses’ Award’, The Australasian Nurses’ Journal, vol. 19, no. 7, 1921, p. 220; ‘Nurses’ Award’, The Australasian Nurses’ Journal, vol. 36, no. 5, 1938, pp. 101-102. 107 Letter to Editor, The Australasian Nurses’ Journal, vol. 20, no. 6, 1922, p. 230. 108 Dickenson, op. cit., p. 24. 109 Solomon, S.E., Queensland Year Book 1965, Canberra, Commonwealth Bureau of Census and Statistics, 1965, p. 381.

110 worker would not have been able to afford the services of a live-in private duty nurse charging £3.3 per week.

Table 3.3 Basic male wage for Brisbane 1921 – 1958110

Year Basic wage (£.s.d) Year Basic wage (£.s.d) 1921 4.5.0 1947 5.9.0 1922 4.0.0 1948 5.19.0 1925 4.5.0 1949 6.9.0 1930 3.17.0 1950 7.14.0 1931 3.14.0 1951 9.5.0 1937 3.18.0 1952 10.16.0 1938 4.1.0 1953 11.2.0 1939 4.4.0 1954 11.5.0 1941 4.9.0 1955 11.9.0 1942 4.14.0 1956 12.1.0 1943 4.17.0 1957 12.1.0 1946 5.5.0 1958 12.6.0

Overall, the fees outlined above and the likely incomes of the majority of

Rockhampton district residents would support the notion that in this region private duty nursing would not have been in high demand (hence the low numbers); that private duty nurses probably did not charge the recommended

QATNA fee; and that they visited rather than lived with the patient. This is consistent with the majority coming from untrained backgrounds. Until the

1940s then, these factors may explain why the few who did offer private duty nursing in the Rockhampton region were able to continue to do so throughout the Depression years and beyond. That is, they were in a better position to meet the needs of the ‘market’.

110 Ibid., p. 382.

111

Private duty nurses: the ready reserve

While untrained nurses were in a better position to gain employment as private duty nurses because of their lower fees, they were excluded from the changes occurring within the nursing market itself. In particular, throughout the early part of the twentieth century, an increasing number of patients sought nursing services from within hospitals. Only trained nurses could take advantage of this trend and they became a reserve work force for hospitals and other health institutions.

Although hospitalisation was being touted as a more effective means of delivering nursing services as discussed earlier, an over supply of private duty nurses in some USA countries also prompted hospitals to consider short term employment of private duty nurses.111 However, the transition towards hospitalisation was not always seen in a positive light. One private duty nurse suggested patients going to private hospitals for treatment were likely to pay more (£5.5 per week compared to £4.4 for a private duty nurse) and be attended by a series of probationers, rather than have the individualized attention of a trained nurse.112

The employment of a private duty nurse for a short period in a hospital has had a long history in Australia. Durdin reports the Wakefield Street Private

Hospital in Adelaide during the late nineteenth and early twentieth centuries

111 Lane Miller, op. cit., p. 43. 112 Letter to Editor, The Australasian Nurses’ Journal, vol. 10, no. 8, 1922, p. 311.

112 employed private duty nurses at a reduced salary and allowed them to stay at the hospital while building their networks and awaiting private cases.113 A

1907 letter to the Editor in The Australasian Nurses’ Journal described a private duty nurse going to a private hospital for one to three nights for ‘big operations’, to ‘tid[y] over the most critical period’.114 However, the writer complained against this practice because it interfered with employment on larger cases and ultimately decreased her income.

Attending to the needs of the patient for a short time in a hospital was evident in Rockhampton until the 1970s.115 Specialling juxtaposed hospital and private duty nursing. Baas laments the loss of control in nursing practice when nurses moved from private duty nursing to hospital employment.116 However, specialling allowed the trained nurse to retain some independence. This was acquired via a number of arrangements. Firstly, the nurse lived in her own home, and wore her own uniform.117 Secondly, the nurse usually relied on being contacted by the Matron of a hospital for work, although some nurses’ clubs and medical practitioners may also have been used.118 This latter arrangement allowed the nurse some influence over which cases to take, although obviously if she offended any particular Matron she may have experienced a reduced level of work. In this way, the Matron became the

113 Durdin, op. cit., p. 77. 114 Letter to Editor, The Australasian Nurses’ Journal, vol. 5, no. 7, 1907, p. 219. 115 Madsen, W., ‘Private duty nursing: the last days in Central Queensland’, Collegian, vol. 11, no. 3, 2004, pp. 34-38. 116 Baas, L.S., ‘An analysis of the writings of Janet Geister and Mary Roberts regarding the problems of private duty nursing’, Journal of Professional Nursing, vol. 8, no. 3, 1992, p. 182. 117 ‘A day in the life of a special nurse’, The Australasian Nurses’ Journal, vol. 50, no. 4, 1952, pp. 70-71. 118 Ibid.

113 patient’s agent when engaging a special nurse, although the patient remained directly responsible for payment of the nurse’s fee.119

One of the advantages associated with specialling was the opportunity for private duty nurses to became acquainted with new nursing skills and knowledge. As early as 1919, specialling was seen as advantageous because it had more regulated hours than living in the patient’s home; reduced responsibility, as the nurse could readily consult with others; and allowed the private duty nurse to get an update on the latest skills and knowledge.120

Indeed, The Children’s Hospital of Great Ormand Street, London, formalized a policy in 1922 to bring private duty nurses onto the wards when not engaged,

‘in order to keep their knowledge up-to-date’.121 Likewise in Brisbane in

1929, the QATNA had negotiated with the Brisbane Hospital and the Mater

Misericordiae Public Hospital for its members to spend a day on the wards in order to keep themselves up-to-date.122 This concern with up-dating skills and knowledge of private duty nurses raises several issues. Firstly, it was recognized by the 1920s that nursing in hospitals was changing and as a result differed to that being practiced by private duty nurses. Secondly, private duty nurses who specialled in Queensland would have been trained nurses because untrained nurses could not work in hospitals. Therefore, specialling may have been used as an avenue not only to up-date trained nurses, but to further distinguish them from their untrained competition. In this scenario, untrained private duty nurses would have found their practice restricted to those cases

119 QATNA Minutes, The Australasian Nurses’ Journal, vol. 39, no. 9, 1941, p. 166. 120 Rose, op. cit., p. 100. 121 Hunt and Whiting, op. cit., p. 35. 122 QATNA Minutes, The Australasian Nurses’ Journal, vol. 27, no. 12, 1929, p. 338.

114 requiring fundamental nursing (meeting hygiene and feeding needs) that could be readily managed in the patient’s home. As explored earlier, this type of nursing was losing its appeal to trained nurses by the 1930s. Furthermore, as medical and surgical management evolved and became increasingly located in hospitals after WWI,123 it is logical hospital administrators looked to (and perhaps encouraged) specialling, where the patient paid for his/her own nurses, to minimize rising staffing costs associated with increased hospital usage.

In addition to private duty nurses being employed by the patient for a number of shifts, private duty nurses were also employed to ‘take over’ from hospital staff for limited periods of time. For example, a member of the QATNA enquired in 1925 what fee she should charge when being engaged to temporarily take charge of the maternity section of a public hospital. The reply indicated no extra charge could be applied and that £3.3 per week was the current rate.124 This reply is interesting, as the responsibilities associated with running a ward would seem to be greater than those associated with attending one patient. However, in the 1920s an experienced Sister of a public hospital in

Queensland would not have received much more than £3 per week.125

Finally, private duty nurses were used as reserve staff for other institutions such as the Maternal and Child Welfare Clinics.126 In Rockhampton during the

1919 Spanish Influenza epidemic, Dr Voss, who organized an immunization

123 Ives, W., Mendelsohn, R., ‘Hospitals and the State: the Thomas Report’, The Australian Quarterly, vol. 12, no. 3, 1940, pp. 49-59. 124 QATNA Minutes, The Australasian Nurses’ Journal, vol. 23, no. 6, 1925, p. 263. 125 ‘The Queensland Nurses’ Award’, The Australasian Nurses’ Journal, vol. 19, no. 7, 1921, p. 220. In this award, a Sister received £120 – 160 per annum. 126 Memo from Public Service Commissioner Department, 25 July 1929, noting ‘temporary’ nurses paid private duty nursing rates, folder A/31678, QSA, Brisbane.

115 clinic, reported to the Town Clerk of the Rockhampton City Council that, ‘the nurse gave two hours each day’ and ‘spent the rest of her time working at the

Rockhampton Hospital’.127 While Dr Voss does not stipulate the nurse was a private duty nurse, he did imply she was working as a special. Furthermore, he wrote, ‘It is certainly a very good thing to have a nurse available if required’, suggesting the nurse concerned was not employed by a hospital on a permanent basis. This indicates trained private duty nurses were undertaking special, short-term assignments before 1920.

Conclusion

This chapter has outlined private duty nursing in the Rockhampton region from

1901 to 1954. While the relevance of these results may be limited to this particular area, this chapter suggests the experience and patterns of private duty nursing in a regional Queensland district may have been different to those of metropolitan areas, with the key difference relating to the training status of these women. However, further research is necessary to confirm or challenge these notions.

As a result of the higher proportion of untrained private duty nurses in

Rockhampton, the pattern of employment and availability of private duty nurses appears to be different to that outlined in the literature for metropolitan centres, with untrained private duty nurses in Rockhampton visiting rather than living with the patient. A significant drop in numbers of private duty nurses

127 Dr Voss to Town Clerk, 24 April 1919, Rockhampton City Council Correspondence, Folder Ta – Z, Special Collection, RCCML, Rockhampton.

116 was evident in Rockhampton around 1912, the year nurse registration was introduced in Queensland, and only a small number of private duty nurses continued to operate in this region until the 1950s. It has been suggested the untrained status of the majority of private duty nurses for much of this time contributed to the ongoing viability of this group during the difficult years of the Depression, as they were able to meet the needs of the market. This chapter has also highlighted the differentiations made between untrained and trained private duty nurses throughout the first half of the twentieth century. From a situation where the work between the two groups was only distinguished by the greater level of domestic duty undertaken by the untrained nurses, trained private duty nurses increasingly found work opportunities in hospitals, specialling and as replacements for hospital and institutional nursing staff.

Furthermore, the concept of up-skilling further defined the trained private duty nurse from the untrained. However, while the distinction between the trained and untrained private duty nurses has been made throughout the chapter, it has been noted that professional nurses primarily made such a distinction. Many doctors, the community at large, and in many instances, the government, were not as quick to distinguish between the trained and the untrained. This must have been a source of frustration for professional nursing bodies that consistently associated untrained nurses with threats to public health and safety.

Overall, this chapter has not painted a homogenous image of a private duty nurse in the Rockhampton region. While many private duty nurses were untrained, married and likely to have had families, some were single and

117 trained and more readily fitted into the ‘mould’ of the modern twentieth century nurse. Some were long-term residents in the communities they worked, others were not. However, this group met the nursing needs of their communities by providing an alternative nursing service to that of hospitalisation. Furthermore, while they would have worked in association with the patient’s doctor, they had considerable opportunity to control their practice, which was not evident in hospital nursing. As such, as private duty nursing became less prevalent and more nurses moved into hospital employment, they forfeited many of those aspects of independence: who they nursed, where they nursed, how they nursed, and what they charged for their services. These issues are further explored in the following chapter in regards to private hospitals and in Chapter 6 which deals with public hospitals.

118 Chapter 4

Nurses and private hospitals: owners, managers,

workers

The provisions relating to private hospitals were designed to

improve the conditions of private hospitals and to make

them safer, particularly for maternity cases, and not

withstanding that these provisions have been law for nearly

20 years there is a section of opinion which declares that the

day of the private hospital is gone.1

Prior to the introduction of the ‘free’ hospital system in Queensland in 1946, patients expected to pay for any health services received. This situation allowed more entrepreneurial-minded health providers to establish their own hospitals. These hospitals varied considerably in size, the services provided, and the conditions under which they operated. It was these variations that prompted the introduction of the regulations of private hospitals in the Health

Act Amendment Act of 1911. This chapter will focus on those hospitals run privately in the Rockhampton region during the first half of the twentieth century. It will consider both nurse-owned and doctor-owned hospitals.

1 Internal memo, anonymous author, circa 1931, relating to Health Act Amendment 1931 section dealing with lying-in hospitals. A/31738, QSA, Brisbane.

119 However, much of the chapter relates to maternity services, as the majority of nurse-owned hospitals only accepted maternity cases. This chapter explores who these nurses were and extends the argument presented in Chapter 3 that the majority of these early nurses running their own businesses were not trained nurses. As such, the hospitals they operated remained small and were limited to the working life of the proprietor, although collectively they constituted a significant avenue of nursing services prior to 1930. Those factors contributing to the eventual demise of nurse-owned private hospitals will also be explored. In particular, the age of the proprietor, the personal and financial cost of running a lying-in hospital, and the increasing attraction towards larger hospitals have been identified as influential, as well as changes in legislation. The initial part of the chapter, however, briefly overviews the doctor-owned private hospitals and the roles nurses played in the success of these facilities. Although not all doctor-owned hospitals in Rockhampton outlived their original owners, it is postulated doctor-owned hospitals were able to operate differently to nurse-owned hospitals, and therefore their ongoing survival was more assured. Overall, this chapter highlights the anonymous author’s sentiment cited above, but suggests the statement should be more specific. That is, ‘the day of the nurse-owned hospital is gone’.

Throughout this chapter a range of terminology has been used. The term

‘private hospital’ was defined in 1911 as ‘any house, apartment, or premises which is used or intended to be used for the reception, care, and treatment of sick persons or of women for the purposes of their lying-in or confinement, and

120 which is not a hospital subject to The Hospitals Act 1847 – 1891’.2 While this term was generally applied to doctor-owned facilities, other terms were frequently associated with nurse-owned facilities. Specifically, ‘cottage hospitals’ and ‘lying-in hospitals’ generally referred to the smaller operation of the nurse living in her own home and having provision for maternity cases.

‘Maternity hospitals’ sometimes referred to these facilities, although the term also included larger, often charity-run hospitals such as the Women’s Hospital and the Salvation Army Maternity Hospital discussed in Chapter 5. Finally,

‘nursing home’ was frequently the term used to describe nurse-owned (usually lying-in) hospitals in publications such as the Post Office Directories.

Whenever possible, the term that best describes the operations within the hospital will be used throughout the chapter.

Doctor-owned private hospitals

Selby3 proposes private hospitals increased in popularity in the 1920s and

1930s as lying-in hospitals run by untrained midwives declined. Examination of the private hospitals in the Rockhampton region generally supports this, although the transition in Rockhampton was probably more towards the mid to late 1930s. Lying-in hospitals were still popular until 1930 and Rockhampton did not experience a significant rise in private hospital bed numbers after the early 1920s. During the first half of the twentieth century, Rockhampton had a total of four private hospitals operated by doctors, although not all were run simultaneously. In addition, the Mater Misericordiae Hospital commenced

2 The Health Act Amendment Act of 1911, Government Gazette, 31 December 1911, p. 1790. 3 Selby, W. Motherhood in Labor’s Queensland, 1915 – 1957. Unpublished PhD thesis, Griffith University, 1992, p. 104.

121 services as a private hospital in 1915. This hospital will be discussed in the next chapter, as it was operated by a church organization.

In 1904, Dr Steward operated a hospital in the Athelstone Range and employed

Mrs A Marwedal as the Matron.4 Little is known of this hospital. No matron is mentioned in the Post Office Directories after 19055 and the hospital does not appear to have existed after 1908.6 This doctor-owned hospital appears to have been the exception to the rule, with the other three, Hillcrest, Leinster and

Tannachy, providing the private hospital services for many years in

Rockhampton.

Dr F H Vivian Voss commenced the first significant doctor-owned hospital in

Rockhampton. This hospital opened on the corner of Archer Street and Kent

Lane in the early 1890s, accommodated four patients and was staffed solely by

Sisters Nellie and Alice Brooks.7 In 1899, the hospital commenced operations as Hillcrest in its current location in Talford Street.8 Dr Daniel P O’Brien opened his first private hospital in Rockhampton in 1908 in Quay Street. This hospital, Avenleigh, was originally the home of Fred Morgan, one of the founders of Mount Morgan Mines.9 This building continued as Dr O’Brian’s surgery after 1912 when he established Leinster on the corner of Agnes and

Ward Streets.10 The third hospital to be considered here was operated by Dr

4 POD 1904, p. 442. 5 POD 1905, p. 434. 6 POD 1906, p. 368; 1908, p. 402. 7 Ryan Papers, folder C362.11, RDHS, Rockhampton. 8 ‘A century of quality health care’, Capricorn Local News, 14 April 1999, p. 14. 9 Hayes, T.B., Wright, B.D., Mater Misericordiae Hospital Rockhampton, 1915 – 1990, Rockhampton, Youth Services Press, 1990, p. 13. 10 The exact year O’Brien established Leinster is unknown.

122 Norman C Talbot, who commenced his medical practice in Rockhampton in

1919 and purchased the stately former home of William Paterson in Quay

Street for the purposes of his hospital, Tannachy, in 1922.11 Initially the hospital contained just four beds.12 In 1923 the practice was joined by Dr

Wooster.13

As such, all of these private hospitals began with a small number of beds based in relatively large residences. They each employed nurses to undertake the work, although in the initial stages these nurses were not necessarily formally trained. For example, Sister Alice Brooks worked with Dr Voss from the inception of Hillcrest until at least the 1920s.14 Brooks was admitted to the

ATNA on 20 April 1900 under Rule xxi.15 However, all these hospitals grew sufficiently in the ensuing years such that they met the criteria for nurse training, although their bed numbers seem to have stabilized once they had gained a sufficient size to qualify for four-year nurse training. In 1939

Hillcrest had 27 general and four maternity beds;16 and Tannachy had 49 general and 9 maternity beds in 1955.17 Therefore, as indicated earlier, these private hospital beds do not seem to have increased significantly as a result of nurse-operated hospitals closing. However, the issue of reaching a sufficient

11 Ryan Papers, folder 362.11, RDHS, Rockhampton; Town Clerk, Rockhampton to Dr AA Parry, MOH, 9 March 1922, RCC Correspondence folder H – L, RCCML, Special Collections, Rockhampton. 12 Hermann, E.A., ‘Tannachy Hospital’, unpublished paper 1959, Tannachy Hospital file, ACHHAM Museum, Rockhampton. 13 Ryan Papers, folder 362.11, RDHS, Rockhampton. 14 Women’s Hospital Committee Minutes, 11 January 1922, outlining their indebtedness to Nurse Brooks who cleaned and washed instruments used in operations, thereby saving the hospital the need to employ an extra nurse. 15 Australasian Trained Nurses’ Association Register of Members 1923, Sydney, Eagle Press, 1923. Rule xxi allowed experienced nurses to join the association. 16 Report: Department of Health and Home Affairs, ‘Private Hospitals of Queensland’, 11 January 1939, folder A/38347, QSA, Brisbane. 17 Ryan Papers, folder 362.11, RDHS, Rockhampton.

123 size to be a nurse training facility was a key difference between doctor- controlled hospitals and those operated by nurses, as outlined in this chapter.

As training hospitals, these institutions needed to employ a small number of trained staff, with the bulk of the work undertaken by trainee nurses. This had two main advantages: wages could be kept to a minimum; and trained staff could be readily replaced by graduating students. Indeed, all of these hospitals appear to have adhered to a pattern of employing their own graduates.

Hillcrest was the first private hospital to qualify for nursing training in

Rockhampton. In 1908 it was granted recognition by the Queensland branch of the Australasian Trained Nurses Association (QATNA) as a five-year training school, 18 indicating it had a daily occupancy of less than 20 beds.19 The number of nurses graduating each year from Hillcrest usually ranged from one to two, although five graduated in 1920. It is not clear when Hillcrest became a four-year training hospital, however, the isolated increase in graduates in

1920 outlined in Table 4.1 would suggest it was around the immediate post war period.

18 QATNA Minutes, The Australasian Nurses’ Journal, vol. 6, no. 5, 1908, p. 157; vol. 6, no. 6, 1908, p. 184. 19 The Nurses and Masseurs Registration Act of 1928, Government Gazette, 15 July 1929, p. 124. This Act adopted the ATNA guidelines for training schools. Strachan, G., Labour of Love. The History of the Nurses’ Association of Queensland 1860 – 1950, St Leonards, Allen & Unwin, 1996, p. 48.

124 Table 4.1 Nurse graduates of Hillcrest Private Hospital 1914 - 194920

Year Total Year Total 1914 1 1927 1 1915 1 1929 1 1917 1 1932 2 1918 1 1933 1 1920 5 1934 1 1921 2 1937 1 1922 1 1938 2 1923 1 1939 3 1924 1 1945 2 1925 2 1948 1 1926 1 1949 1

In 1920, Dr O’Brien applied for registration of Leinster as a nurse training school. This was approved by the QATNA as a five-year training school.21 In

1928, the Matron of Leinster informed the QATNA the hospital had been recognised as a four-year nurse training school by the Queensland Nurses’

Registration Board (QNRB) since 1927.22 However, those nurses who graduated from Leinster and became members of the ATNA from 1921 completed four years of training,23 making the period of training of this hospital unclear. As with Hillcrest Hospital, the number of nurses graduating from Leinster was small. A photograph of the staff circa 1930, shows four registered staff (long veils) and seven trainees (see Figure 4.1).

20 Compiled from General Nurses’ Register, 1912 - 1925, QSA A/73216; Midwifery Nurses’ Register, 1912 – 1925, QSA A/73218; General Nurses’ Training Register 1915 – 1925, B3072; ATNA membership as recorded in The Australasian Nurses’ Journal, 1906 – 1949, QNU. 21 QATNA Minutes, The Australasian Nurses’ Journal, vol. 18, no. 11, 1920, pp. 362-363. 22 QATNA Minutes, The Australasian Nurses’ Journal, vol. 26, no. 11, 1928, p. 297. 23 New Members , The Australasian Nurses’ Journal: Murial Hairs (graduated 1922), vol. 20, no. 8, 1922, p. xiv; Kathleen Callaghan (g. 1921), vol. 20, no. 10, 1922, p. xvii; Elsie Conaghan (g. 1924), vol. 23, no. 1, 1925, p. 51; Mary McAuliffe (g. 1924), vol. 23, no. 4, 1925, p. 207; Mary Bauman (g. 1925), vol. 26, no. 6, 1928, p. 165; Irene Cunningham (g. 1927), vol. 26, no. 10, 1928, p. 282; Ester Duckham (g. 1931), vol. 36, no. 3, 1938, p. 68; Mary Haworth (g. 1934), vol. 39, no. 7, 1941, p. 143.

125 Figure 4.1 Leinster Hospital staff, c. 193024

It is not clear when Tannachy commenced as a nurse training hospital.

However, Jessie Fullerton graduated from Tannachy after four years general training in October 1929,25 suggesting the hospital had reached the required daily bed occupancy rate by the mid 1920s. A photograph of the staff, circa

1940 (see Figure 4.2), shows nine trainees and one registered nurse, Matron and Dr Wooster. The two nurses in different coloured uniforms were maternity nurses. At least four registered nurses were employed at this time, aside from the Matron: Sisters Abbott, Reid, Hill and Anderson.26

24 Courtesy of ACCHAM, Rockhampton. 25 New Members, The Australasian Nurses’ Journal, vol. 35, no. 5, 1937, p. 109. 26 New Members, The Australasian Nurses’ Journal: Debbie Reid (graduated Tannachy 1933), vol. 39, no. 3, 1941, p. 62; Elsie Abbott (g. Tannachy 1940), vol. 42, no. 8, 1944, p. 101.

126 Figure 4.2 Tannachy Hospital staff27

The pattern whereby graduates were frequently re-employed by their training hospital as trained nurses becomes evident when examining who worked in these hospitals. For example, Elizabeth Palfrey graduated from Hillcrest in

November 1922 after undertaking four years of training.28 Palfrey, who later became Matron of Hillcrest, had completed twelve months training in midwifery at the Women’s Hospital prior to commencing her general training.

This pattern was associated with a number of advantages including familiarity with the hospitals’ procedures and culture and an increased sense of loyalty towards that particular hospital. For example, in 1950, Dr Talbot retired and

Dr Wooster died, and Tannachy was forced to close for a short period.29 A consortium of shareholders was only able to reopen the hospital in 1951 with

27 Courtesy of Jill Cowrie. Jill is one of the maternity nurses, seated on the right in the photograph. 28 New Members, The Australasian Nurses’ Journal, vol. 21, no. 3, 1923, p. 155. 29 Obituary, Dr Talbot, Medical Journal of Australia, 30 March 1968, p. 564; Obituary, Dr Wooster, Morning Bulletin, 6 June 1950, p. 3.

127 the help of nursing staff who had been associated with the hospital for many years: Sisters Sylvia Anderson, Elizabeth Urquhart, Matron Godden, and

Acting Matron Edna Triffet, many of whom had completed their training at

Tannachy.30

The above example also demonstrates the importance of the proprietor to the on-going success of the hospital. As each of the proprietors of these hospitals reached retirement or died, the hospital faced a period of uncertainty in regards to its future. For Hillcrest this did not emerge until the early 1950s because Dr

Voss’ son, Dr Paul Voss and his wife, Dr Harriet Voss took over the management of the hospital in 1929.31 However, in 1951 the hospital was placed on the market because of the death of both these doctors.32 The St

Andrew’s Presbyterian Church bought the hospital in 1952 and it continued to operate as a training hospital until the mid 1970s.33 In 1938, Dr O’Brien sold his medical practice to Dr V Lynch who does not appear to have continued with the hospital, Leinster.34 O’Brien died around 1940, leaving Leinster to the Sisters of Mercy who established a home for the aged, Bethany, as per his will.35 Tannachy remained under the control of the consortium until 1961 when it was acquired by the Anglican Diocese of Rockhampton and was renamed St John’s Hospital.36

30 Ryan Papers, folder 362.11, RDHS, Rockhampton. 31 Ibid. 32 Hillcrest folder, ACHHAM, Rockhampton. 33 McDonald, L., A Ministry of Caring, Rockhampton, St Andrew’s Presbyterian Welfare Administration Board, 1992, p. 54. 34 Sister of Mercy Archives, folder 327.10, Rockhampton. 35 Ibid; ‘Bethany, home for old people’, Morning Bulletin, 26 August 1955, p. 25. 36 Tannachy folder, ACHHAM, Rockhampton.

128 This brief overview of doctor-owned hospitals reveals a number of common factors. Each hospital began with a small number of beds, however, soon expanded to meet the requirements for nurse training. In this way, trainee nurses undertook the work and were overseen by a small number of trained staff, thus keeping costs to a minimum. Furthermore, the trained nurses were frequently graduates of the hospital and therefore familiar with hospital procedures and peculiarities. As nurses in training hospitals, the roles and responsibilities were not dissimilar to those in larger public training hospitals.

These will be explored in more detail in Chapter 6. Finally, doctors were the ones who recommended the hospital treatment of patients and thus were able to direct patients into their own hospitals. These factors placed doctor-owned hospitals at a distinct advantage over nurse-owned facilities, which are explored for the remainder of the chapter.

Nurse-owned private hospitals

Private hospital proprietorship for nurses was not unusual at the turn of the twentieth century. The successful Wakefield Street Private Hospital in

Adelaide was mentioned in the previous chapter. This was established by

Alice Tibbits in 1888 and went on to become a nurse training hospital.37

Smaller hospitals, however, were more the norm. A 1919 letter to the Editor in

The Australasian Nurses’ Journal,38 noted a trained nurse had three options available: private duty nursing (‘racking and precarious’); hospital matronship

(‘few well paying positions’); and hospital proprietorship which was identified

37 Durdin, J., They Became Nurses: A History of Nursing in South Australia, Sydney, Allen & Unwin, 1991, p. 27. 38 Letter to the Editor, The Australasian Nurses’ Journal, vol. 17, no. 5, 1919, p. 150.

129 as the ‘best reward’ for the nurse with skill, business ability and capital. This nurse also advocated public hospitals accepting private patients were ‘unfair competition’.

Three private hospitals have been identified as nurse-owned and operated in the Rockhampton district, although very little is known about any of them. In

1911/12, two private hospitals commenced in Rockhampton: one in Oxford

Street, operated by Jessie T Christmas,39 and the other on the corner of Archer and Talford Streets, operated by Miss Mary Jane Berrill.40 No further information has been located regarding Jessie T Christmas and it would appear her hospital was short-lived as it was not identified in subsequent Post Office

Directories. Miss Berrill had been operating, presumably as a private duty nurse, from 112 Fitzroy Street, from 1906.41 However, she had been nursing for some time prior to this. The 1923 Australasian Trained Nurses’

Association (ATNA) Register of Members records Mary Jane Berrill had been admitted to the ATNA under Rule xxi in 1904, indicating she was considered to be an experienced, yet untrained nurse.42 As she was only listed under the

General Register (and not also listed in the Maternity Register), it is presumed at that stage of her career Berrill was working as a general nurse: attending medical, surgical and infectious cases. In 1906, Berrill completed her midwifery certificate at the Women’s Hospital in Rockhampton,43 and began a long association with the Rockhampton community as a maternity nurse.

39 POD 1911/12, p. 280. 40 Ibid., p. 282. 41 POD 1906, p. 378. 42 Australasian Trained Nurses’ Association, Register of Members 1923, Sydney, Eagle Press, 1923. 43 Ibid.

130

In 1916, when lying-in hospitals were required to register with the

Rockhampton City Council, Berrill registered Strath-Avon, her private hospital, as accepting maternity cases only.44 However, it is unclear if other cases were also accepted prior to 1916. The early Post Office Directory entries list Berrill’s residence as ‘private hospital’,45 although later entries identify this residence as ‘nursing home’,46 suggesting she was only accepting maternity cases by 1914. Further discussion of Berrill is included later in the chapter dealing with lying-in hospitals.

The third nurse identified as owning and operating a private hospital is Sarah

Molloy, who owned the Albert Private Hospital in East Street, Extended,

Mount Morgan. It is not entirely clear when Molloy began operating this hospital. The Mount Morgan Historical Museum suggests it was from around

1911 and indeed, Molloy registered with the Queensland Nurses’ Registration

Board (QNRB) from Mount Morgan on 11 December 1912.47 However, an advertisement in the Morning Bulletin48 indicates the Albert Private Hospital was not taken over by Molloy until 1917. An undated photograph shows

Molloy employed three nurses (Howard, Reid, and G Evans) and two domestics (See Figure 4.3). In 1920, the Albert Private Hospital is noted as

44 Town Clerk, RCC to M. Berrill, 13 September 1916, granting permission to register home as a lying-in hospital, RCC Correspondence, folder Aa – Cz, RCCML, Special Collections, Rockhampton. 45 POD 1911/12, p. 282; 1912/13, p. 287; 1913/14, p. 291. 46 For example, POD 1914/15, p. 198; 1937, p. 553. 47 Sarah Molloy registered under category 154C2(3), Register of Maternity Nurses, 1912 – 1925, QNRB, folder A/73218, QSA, Brisbane. 48 Morning Bulletin, 2 July 1917, p. 4.

131 providing accommodation for seven maternity cases.49 Total accommodation was 14 beds,50 suggesting general cases were provided for, although Molloy was registered as a maternity nurse only.

Figure 4.3 Albert Hospital51

In 1924 the government agreed to purchase the Albert Private Hospital and move it to the Mount Morgan Hospital premises for their maternity ward as the need for maternity accommodation was becoming urgent.52 The sale did not proceed at that time. Although the government did eventually purchase the

49 Town Clerk, Mt Morgan to Under Secretary, Home Secretary’s Office, 10 December 1920, folder A/4730, QSA, Brisbane. 50 ‘Precis of Official Record’, 22 March 1929, Home Secretary, folder A/29542, QSA, Brisbane. 51 Courtesy of Mount Morgan Historical Society. 52 ‘Precis of Official Record’, 22 March 1929, Home Secretary, folder A/29542, QSA, Brisbane.

132 building,53 it does not appear to have been moved to the Mount Morgan

Hospital site as originally planned. From 1927, Mrs Sarah Brady began operating a lying-in hospital in Rockhampton,54 and as noted in Chapter 3, also worked as a private duty nurse from 1930, undertaking maternity cases only.

The loss of the Albert Private Hospital to the residents of Mount Morgan had a significant effect on the availability of midwifery services in the town. By the end of 1925, a couple of influential citizens wrote to the Home Secretary,

James Stopford, asking the government to provide some relief, either through provision of maternity services or by increasing the ‘Baby Bonus’, as a number of expectant mothers could not afford the £9.9.0 fee for maternity services.55

Although these letters do not indicate who was charging such an amount for maternity services, it was probably the Mount Morgan Hospital as few other options were available in Mount Morgan at the time.

Lying-in hospitals

From the mid nineteenth until the early twentieth century, pregnant women had a range of possible choices regarding their confinement. These included the employment of a live-in private duty nurse with or without a personal physician to oversee the process; employing a private duty nurse on a visiting basis; or using a private or public hospital. Finally, many women relied on the

53 Folder A/29542, QSA, Brisbane. 54 Town Clerk, RCC to Nurse Brady, 4 October 1927, indicating application for lying-in hospital approved, RCC Correspondence, folder Bo – City Engineer, RCCML, Special Collections, Rockhampton. 55 Court House to James Stopford, 30 November 1925; James Clark to James Stopford, 30 November 1925, folder A/29542, QSA, Brisbane.

133 services of family and neighbours to assist them with their labour and postpartum period. Public and charity hospitals were generally avoided by most, other than the poor and those without choice. They were strongly associated with poverty and death. Indeed, Selby56 postulates that prior to the introduction of maternity hospitals funded by the government, most women would have used the services of the community-based midwives, either in a lying-in hospital or in their own homes.

As with private duty nurses, these nurses were self-employed and thus locating data regarding their activities poses difficulties. However, Queensland nurses were required to register their homes as lying-in hospitals with the local authority from 1916,57 creating a fragile and fragmented paper trail. The process required reminder letters and letters of acceptance to be sent to the proprietors, and memoranda to be sent from the Town Clerk to the Medical

Officer requesting the premises be inspected yearly. Thus the resultant records provide glimpses into the services provided and some insight as to the nurses’ identities. These records also suggest possible factors impacting on the decline of such facilities. Unfortunately, the Rockhampton City Council correspondence records have been lost after 1930. However, the Post Office

Directories, although not as rich as the correspondence records, provide further information. From the surviving records, it is possible to identify twenty-six nurses who ran lying-in hospitals at varying times in Rockhampton between

1916 and 1930. Other sources indicate lying-in hospitals were also operational in other towns at times. While these will be mentioned throughout the chapter,

56 Selby, op. cit., p. 204. 57 The requirement outlined in the Health Act Amendment Act 1911 was not enforced until 1916.

134 the focus will be on those in Rockhampton city, as this is where there was a concentration of lying-in hospitals, allowing a more concise analysis.

Appendix B contains details of individual lying-in hospitals in Rockhampton.

In order to register a home as a lying-in hospital, the nurse was required to submit a ground plan of the premises to the Rockhampton City Council, including the drainage of the property.58 They were also required to indicate the number of cases they were intending to take.59 Selby60 asserts most lying- in hospitals were only able to cater for one or two patients. Indeed, Mrs J

Edwards, Mrs Hughes James and Mrs Bruce James who operated lying-in hospitals in Mount Morgan in 1920 could only take a maximum of two cases each.61 However, a number of lying-in hospitals could cater for more. For example, Nurse Berrill informed the Rockhampton City Council in 1923 of three patients who were currently residing in her lying-in hospital.62 Nurse

McGuirk wrote to the Town Clerk in 1924 stating, ‘The maximum cases intended to be accommodated in my premises is four’.63 Nurse Costello’s lying-in hospital also had accommodation for four.64 In Yeppoon, a five bed

58 Selby, op. cit., p. 102; Town Clerk, RCC to Nurse Clark, 20 November 1919, RCC Correspondence, folder Aa – City Engineering; Town Clerk, RCC to Nurse McGuirk, 25 July 1930, RCC Correspondence, folder Farmland Rates – Medical Officer of Health; Town Clerk, RCC to Nurse Wye, 19 March 1922, RCC Correspondence, folder W – Z; Town Clerk, RCC to Nurse Wye, 8 May 1925, RCC Correspondence, folder Treasury – XYZ, RCCML, Special Collections, Rockhampton. 59 Selby, op. cit., p. 102. 60 Selby, W., ‘Maternity hospitals and baby clinics. A twentieth century Australian frontier’, in Pearn, J., Cobcroft, M. (eds), Fevers and Frontiers, Brisbane, Amphion Press, 1990, pp. 197- 212. 61 Town Clerk, Mt Morgan to Undersecretary, Home Office 10 December 1920, folder A/4730, QSA, Brisbane. 62 Nurse Berrill to Council Chambers, 8 January 1923, RCC Correspondence, folder Aa – Ca, RCCML, Special Collections, Rockhampton. 63 Nurse McGuirk to Town Clerk, Rockhampton, 9 September 1924, RCC Correspondence, folder Li – Pa, RCCML, Special Collections, Rockhampton. 64 ‘Private Hospitals in Queensland’, report, 23 March 1938, Department of Health and Home Affairs, folder A/38347, QSA, Brisbane.

135 maternity hospital was operational in 1938.65 The overall availability of lying- in hospital beds in Rockhampton in 1920 was 60.66 At this time, there were sixteen lying-in hospitals registered, giving an average of 3.75 beds per hospital. Figure 4.4 provides an example of the type of residential home used as a lying-in hospital in Rockhampton.

Figure 4.4 Nurse Costello’s lying-in hospital, 200267

It is not possible to determine the in-patient numbers for each of these premises although collectively, lying-in hospitals provided the main avenue of maternity service in Rockhampton during the early 1920s. Indeed, Rockhampton had significantly more lying-in hospitals than any other regional town in 1920, while Brisbane had around 80.68 This large proportion of lying-in hospitals

65 Ibid. 66 Town Clerk, Rockhampton to Undersecretary Home Office, 11 December 1920, folder A/4730, QSA, Brisbane. 67 Author’s collection. 68 Report extract, ‘Private Hospitals in Queensland, year ending 1920’, sent from Home Secretary’s Office to W. Biggs Solicitor, 13 September 1921, in reply to request by Miss M.

136 may have reflected the city’s population size or a preference within

Rockhampton for this form of maternity service. As will become apparent throughout this chapter, the women of Rockhampton do seem to have supported lying-in hospitals until the 1930s. In addition to the 60 beds located in lying-in hospitals, nine beds were available in private hospitals (doctor owned) and 24 were available at the Women’s Hospital. Therefore, lying-in hospitals provided almost 65 per cent of available maternity beds in the city in

1920. Nurse Forsdick (formally Nurse Young) kept a record of all the births she had attended in Rockhampton from 25 April 1884 to 26 January 1928 – a total of 879, including six sets of twins.69 This figure suggests Nurse Forsdick attended an average of almost twenty births a year. By 1939, only one lying-in hospital remained in Rockhampton. Nurse Costello delivered 49 babies that year, representing 13.8 percent of all private deliveries.70 Table 4.2 provides details of maternity cases within the private sector for 1939. In comparison, in

1938, the public maternity hospital, the Lady Goodwin, saw 167 private births

(10 available beds) and 302 births in its public ward.71 Thus, more babies

(over 60 per cent) continued to be delivered privately than publicly by the end of the 1930s, although the proportion being delivered by independent midwives had significantly reduced.

Dowling, St Helen’s Private Hospital who wished to start a Private Hospital association, folder A/31607, QSA, Brisbane. 69 ‘Fifty years practice as a nurse, Mrs Forsdick’, interviewer unknown, circa 1950s, folder Y- 13-1224, RCCML, Special Collections, Rockhampton. 70 Internal Department of Health and Home Affairs report outlining numbers of private maternity cases, 1 January 1939 – 21 December 1939, folder A/38347, QSA, Brisbane. 71 Memoranda: Department of Health and Home Affairs, 19 June 1940; Letter: Undersecretary Department of Health and Home Affairs to Secretary of Rockhampton Hospital Board, 26 August 1938, folder A/29559, QSA, Brisbane.

137 Table 4.2 Private deliveries in Rockhampton 193972

Hospital Number of beds Births (percentage) Tannachy 7 110 (30.9%) Bethesda 6 109 (30.6%) Lucina (Nurse Costello) 3 49 (13.8%) Mater 22 88 (24.7%)

While most nurses operated independently, a couple of lying-in hospitals had two or more nurses living on the premises. For example, Mary Jane Berrill was the proprietor of Strath-Avon, but had assistance from a relative, Elizabeth

Berrill, particularly after 1926. Furthermore, the QNRB records demonstrate other nurses (Nurses Beale, Molloy and McInroy) also used the Berrill’s address at various times.73 What relationship existed between these other nurses and the Berrills and whether these nurses assisted with the lying-in cases at Strath-Avon is unclear. Between 1921 and 1924, Nurse Jane Aitken, who had run her own lying-in hospital from 1916 to 1919 before doing her obstetric training at the Women’s Hospital in Rockhampton,74 joined with

Nurse Alison Bruce in her home, Bannockburn, to operate a lying-in hospital.

This particular home was somewhat unique because it was located on the then outskirts of Rockhampton, in a prestigious area, whereas most of the others were located within a few streets of the central business district. Finally,

Nurses Margaret Ellen Jones and Mary Anne Jones both list 10 West Street as their address in the QNRB records, although it would appear Mary Anne was the main proprietor.

72 Internal Department of Health and Home Affairs report outlining numbers of private maternity cases, 1 January 1939 – 21 December 1939, folder A/38347, QSA, Brisbane. 73 Register of Midwifery Nurses 1912 - 1925, QNRB, folder A/73218, QSA, Brisbane. 74 Australasian Trained Nurses’ Association Register of Members 1923, Sydney, Eagle Press, 1923.

138 The above figures would suggest there was considerable demand for lying-in hospitals in Rockhampton until 1930. While some nurses only offered their services for a very short period of time, such as Nurse Gairdner, who operated her lying-in hospital, Lisberg, from January to September 1923, many maintained their homes for extensive periods of time. Table 4.3 illustrates the steady rise in the number of lying-in hospitals from 1916 to 1920, which was followed by a decline after 1924.

When data contained in Figure 4.3 is combined with information from other sources, it is clear many of the nurses operated lying-in hospitals in

Rockhampton for considerable periods of time. For example, Nurse Berrill operated Strath-Avon for twenty-five years and Nurse Costello operated

Lucina for eighteen years. Indeed, from 1916 to 1930, eight of the nurses operated their hospitals for more than ten years, with a further eight operating for more than five years; the average being 7.92 years. These figures would therefore support Summers’75 research that shows that in some large country towns in South Australia, ten or more community midwives were practicing in the 1920s.

75 Summers, A., ‘A different start: midwifery in South Australia 1836 – 1920’, International History of Nursing Journal, vol. 5, no. 3, 2000, p. 54.

139

Table 4.3 Lying-in hospitals in Rockhampton 1916 - 1930

Proprietor 19 19 19 19 19 19 19 19 19 19 19 19 19 19 19 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 Aitken Berrills Gaffney Forsdick Muller Pollard Preece Smith, E Wye Jones Lawson Miller Willis Curran Clarke Holland Smith, B Eckel Hoare Bruce O’Malley Costello Gairdner McGiurk Brady TOTAL 9 13 12 15 16 17 16 17 17 13 13 11 11 10 10

140 Discussion

As outlined in the previous chapters, there was an increased level of concern regarding the high maternal and infant mortality rates from the end of the nineteenth century in Australia. This concern was not unique to Australia and most Western societies began to focus political and social attention on this problem. However, in Australia this concern was intimately associated with the fear of Asian invasion and therefore, there was a sense of urgency regarding increasing the white population. Such sentiments were particularly acute in Queensland due to its proximity to Asia and its very sparsely populated northern districts. Consequently, in Australia, there were a number of inquiries and legislative changes, as well as the mobilisation of charity groups establishing services for the care and education of mothers regarding their own health and that of their families. By the early twentieth century, considerable advice was being offered to mothers through maternal and child welfare agencies and various media regarding home hygiene and sanitation, nutrition, ventilation and domestic health in general.76 As such, a number of hitherto private aspects of women’s lives, such as childbirth, began to attract the attention of the public. In particular, the place of birthing came to be scrutinised and postulated as a cause of the high mortality figures, with the main source of contention being nurse-run lying-in hospitals.

76 Many of these aspects will be explored in further detail in Chapter 7. Examples of literature outlining this increasing focus on domestic health and sanitation include: Reiger, K., ‘Women’s labour redefined. Child-bearing and rearing advice in Australia, 1880 – 1930s’, in Bevege, M., James, M., Shute, C. (eds), Worth Her Salt. Women at Work in Australia, Sydney, Hale & Iremonger, 1982, pp. 72-83; Bashford, A., Purity and Pollution. Gender, Embodiment and Victorian Medicine, London, MacMillan Press, 2000; Brennan, S., ‘Nursing and motherhood constructions: implications for practice’, Nursing Inquiry, vol. 15, 1998, pp. 11- 17; Davis, A., ‘Infant mortality and child saving: the campaign of women’s organizations in Western Australia 1900 – 1922’, in Hetherington, P. (ed), Childhood and Society in Western Australia, Perth, University of Western Australia Press, 1988, pp. 161-173.

141

McCalman77 cites the review of all Victorian maternity hospitals undertaken during the mid 1920s by Dr Marshall Allan, who identified around a third of

Melbourne’s obstetric hospitals as being in a ‘poor’ or ‘bad’ condition, some of which were run by untrained nurses. However, before a generalisation can be made regarding the safety of lying-in hospitals and particularly those run by untrained nurses, there needs to be closer examination of this issue. This exploration of lying-in hospitals in Rockhampton reveals a number of paradoxes in regards to these matters. Firstly, the Health Act Amendment Act

1911 introduced measures to control unregulated nurses running lying-in hospitals. These included the necessity to become registered with the QNRB in order to be a proprietor of a hospital and a range of conditions these hospitals had to meet, especially in regards to re-opening after an incidence of puerperal fever. It could be expected these measures would restrict the number of lying-in hospitals. However, in Rockhampton, this number increased over the ensuing decade, most of which were run by women who had not undergone any formal training.

The second paradox was that while untrained practitioners were generally perceived as responsible for the high maternal and infant mortality rates, no evidence has been uncovered in this research to indicate this was the case.

None of the lying-in hospitals operating in Rockhampton, whether run by trained or untrained nurses, were reported for transmitting infections, nor were they refused re-registration by the medical officers. Indeed, Marshall Allan’s

77 McCalman, J., Sex and Suffering. Women’s Health and a Women’s Hospital, Melbourne, Melbourne University Press, 1998, p. 165.

142 report on the Victorian situation in 1928 pointed the finger very decisively at unnecessary medical intervention as the prime cause of maternal mortality.78

Nevertheless, the report recommended the exclusion of untrained nurses from maternity work.

The third paradox relates to the overall effect of state intervention into maternity services during the first half of the twentieth century. It is evident the government promoted public maternity services within Queensland from

1922 with an increase of maternity hospitals. It is also evident changes occurred in regards to the availability of lying-in hospitals throughout this period. However, as lying-in hospitals declined in Rockhampton, it was not the public wards that took up the shortfall, but rather the private services, either private hospitals or the private ward of the public hospital.

These paradoxes will be explored in this chapter by considering first, the women who ran lying-in hospitals; and second by analysing those factors that contributed to the demise of this avenue of maternity service. Overall, the evolution of lying-in hospitals was influenced by broad social and medical factors, as well as government intervention. Furthermore, the interplay of these factors needs to be considered within a regional context, as the location of

Rockhampton may have been influential as well.

78 Marshall Allan, R., Report on Maternal Mortality and Morbidity in the State of Victoria, Australia, Melbourne, University of Melbourne, 1928, p. 21.

143

Nurses and lying-in hospitals

Selby79 and Summers80 indicate the majority of nurses who undertook maternity work during the first part of the twentieth century did so without formal training. Indeed, Selby81 observes approximately 70 per cent of practicing midwives in Queensland in 1913 to 1914 were untrained and that by

1923, untrained practitioners still accounted for 38 per cent of Queensland’s midwives. A similar percentage of untrained nurses existed in other States such as Victoria.82 Examination of the training status of Rockhampton women running lying-in hospitals reveals even higher percentages of untrained nurses: only six (23 per cent) had undergone midwifery training.83 The majority of the nurses, when registered with the QNRB, came under various categories within the Register of Midwifery Nurses, indicating they had not undergone any formal training or had not sat a qualifying exam. Only one of the nurses’ names appears in the Register of General Nurses, that of Nurse

O’Malley, who registered in 1912 under category 154E (discretion of the

Minister).84 As such, the maximum level of formal training of any of the nurses was twelve months at a maternity hospital. This higher proportion of untrained nurses continued: 60 percent of lying-in hospital proprietors in

Rockhampton in 1930 were run by untrained nurses. This prevalence of

79 Selby, op. cit., 1992, p. 96. 80 Summers, op. cit. 81 Selby, op. cit., 1992, p. 96. 82 Marshall Allan, op. cit., p. 19. 83 Most certificates were undertaken from the Women’s Hospital in Rockhampton: Nurse Jones 1905; Nurse Berrill 1906; Nurse Costello 1918; Nurse Bruce 1920; Nurse Aitken 1921. Nurse McGuirk trained at the Lady Chelmsford Hospital in Bundaberg in 1923. Register of Midwifery Nurses, QNRB, A/73218, QSA, Brisbane. 84 The Health Act Amendment Act of 1911, Government Gazette, 31 December 1911, p. 1796.

144 untrained midwives is interesting and undermines to some extent Saunders and

Spearritt’s85 suggestion the need to register maternity homes after 1912 saw the elimination of the unqualified midwife. This thesis would suggest such an elimination did not take place until after 1930 and then not in response to just the registration legislation. This higher percentage of untrained nurses in

Rockhampton may also reflect a regional difference. For while the overall numbers of untrained midwives decreased in the State as indicated by Selby, this was not a uniform phenomenon.

Of those who did their training, most attended the Women’s Hospital. This hospital, like other midwifery training hospitals across Australia, charged a premium of ten guineas for twelve months training and paid no wages.86 This is consistent with other midwifery training hospitals in other States. For example, the Queens Hospital in Adelaide in 1902 required general nurses to pay a premium of eight guineas for six months training, and a higher premium for those undertaking twelve months.87 In some New South Wales hospitals in

1928, students paid £50 for obstetric training of one year, lived without wages and had to supply their own uniforms.88 The Women’s Hospital provided midwifery training with some general nursing as part of the 12-month certificate. This latter aspect was valued by the hospital’s committee who acknowledged nurses, especially those who ‘went bush’, needed a broad

85 Saunders, K., Spearritt, K., ‘Hazardous beginnings: childbirth practices in frontier tropical Australia’, Queensland Review, vol. 3, no. 2, 1996, p. 10. 86 Women’s Hospital Committee Minutes, 9 August 1922; 25 August 1922, ACHHAM, Rockhampton. 87 Durdin, op. cit., 1991, p. 75. 88 Letter to Editor, The Australasian Nurses’ Journal, vol. 26, no. 1, 1928, p. 22.

145 experience.89 As such, a certificate from the Women’s Hospital provided almost ideal preparation for women wishing to run lying-in hospitals: it was shorter than general training, and focused on midwifery, although not exclusively. The difficulties for the nurse associated with this training was being able to pay the premium upon commencement and live without an income for twelve months, although it is likely the hospital provided food and sleeping quarters. As the Women’s Hospital does not appear to have experienced recruitment shortages, the nurses met these conditions either via an independent income, or from personal savings.

The ability of nurses to fund their own training raises questions of the socio- economic status of these women. The letters examined for this research that were written by nurses, suggest a wide educational background. Nurse Clarke, an untrained nurse, would appear to have had limited education if the sentence structure of her correspondence is any guide. For example, her letter dated 11

January 1922 reads:

I pay my registration of my nursing home and it is almost

impossible for Doctor or patient to get in or out if there

were a couple of loads of screenings it would be a slight

improvement to it hoping you will do a little to it.90

Whereas, Nurse Costello’s (a trained nurse) letter would suggest more extensive education:

89 Women’s Hospital Committee Minutes, 21 September 1922, ACHHAM, Rockhampton. 90 Nurse Clarke to Town Clerk, Rockhampton, 11 January 1922, RCC Correspondence folder Aa – Cl, RCCML, Special Collections, Rockhampton.

146

I beg to draw your attention to the boggy state of the road

near the footpath opposite my nursing home. It is

dangerous for cars to approach near the footpath and

thereby is very inconvenient for patients coming and

going. I would deem it a favour if you would give it your

early attention.91

Such disparity regarding educational background would have been common, with Strachan92 observing that in 1911 most girls left school upon completion of primary school (aged twelve) and only 20 per cent continuing until the age of fifteen years. Furthermore, primary school education was considered to be the minimal education required for women to apply for nursing at a training school in 1906.93 For nurses admitted to the QNRB under the grandfather clause, there is a high possibility of them having less education. For example,

Nurse Forsdick worked in an English brickyard at the age of ten and was unable to read or write until, presumably, later in life.94

Similarly, there was likely to have been considerable variation in regards to economic status among the nurses. Correspondence with the Rockhampton

City Council and valuation records reveal a number of the nurses owned the homes from which they operated. Indeed, Nurse Forsdick owned several

91 Nurse Costello to Works Committee, Rockhampton City Council, 24 July 1924, RCC Correspondence folder City Engineer – Dz, RCCML, Special Collections, Rockhampton. 92Strachan, op. cit., p. 45. 93 Ibid. 94 ‘Fifty years practice as a nurse, Mrs Forsdick’, interviewer unknown, circa 1950, RCCML, Special Collections, Rockhampton. Mrs Forsdick was literate from at least 1916, as she corresponded with the Rockhampton City Council after that date.

147 properties she appears to have rented out. Home ownership in itself is not conclusive of the particular economic status of a person, depending on how the property came to be purchased/acquired and the level of outstanding mortgage.

Yet this does suggest some of the nurses came from wealthier families or that lying-in hospitals provided a reasonable income for these women. However, as will be discussed later in the chapter, ownership may have had some bearing on the decision to discontinue operation after 1925.

As with private duty nurses discussed in the precious chapter, many of these women, especially untrained nurses, were older, married women with family responsibilities. Indeed, a similar profile of the community midwife is found in other locations such as Sheffield, England.95 Of those working in

Rockhampton until 1930, at least fifteen were married, although little evidence was found as to their family status. For example, Mrs Holland had a son old enough to call upon the Town Clerk on her behalf in 1923;96 and a Mr F

Holland of the same address wrote to the Town Clerk in 1927 looking for work, although it is unclear what relationship he had with Nurse Holland.97

The Post Office Directories suggest many of the nurses did not live alone.

Nurse Clarke lived with John H. Clarke;98 Nurse Forsdick lived with Horace

Forsdick; 99 Nurse Hoare lived with Frederick Hoare;100 Nurse Muller lived

95 McIntosh, T., ‘An abortionist city: maternal mortality, abortion, and birth control in Sheffield, 1920 – 1940’, Medical History, vol. 44, 2000, pp. 77-96. 96 Town Clerk, Rockhampton to Nurse M. Holland, 14 February 1923, RCC Correspondence folder Government Printer – La, RCCML, Special Collections, Rockhampton. 97 Mr F. Holland to Town Clerk, Rockhampton, 20 February 1927, RCC Correspondence folder Fi – I, RCCML, Special Collections, Rockhampton. NB the Post Office Directories only list Mr Fredrick Holland for 27 Kent Street, suggesting he was Nurse Holland’s husband. POD 1923/24, p. 409. 98 POD 1923/24, p. 408. 99 Ibid., p. 410. 100 POD 1922/23, p. 417.

148 with Wm. J. Muller;101 and Nurse Beasely Smith lived with Joe F. Smith.102

It is presumed these gentlemen were the nurses’ husbands. Furthermore, some of the nurses may have had older members of their family living with them.

For example, Nurse Berrill had Mrs Jane Berrill, possibly her mother, living with her in 1911/12.103

The profile of the nurses also provides some insight into why these nurses operated lying-in hospitals. For some it would have been a necessity with few employment options available. However, for a number of these women, to do so was their choice, rather than being forced to take this avenue through unforeseen circumstances. That is, lying-in hospitals were sufficiently attractive, either financially or professionally, to have been a chosen career option. The suggestion of choice is strengthened when one considers the applications made to the Women’s Hospital Committee for vacancies for trained staff (of which there were several between 1921 and 1925). While this committee had a preference for employing its own trainees, none of the trained nurses operating lying-in hospitals applied for these positions. It may have been necessary for some of the nurses to operate lying-in hospitals as a result of family obligations and the need for an income. However, this thesis suggests this may not have been the sole reason for all nurses opting for this type of employment.

Mortimer reports lying-in cases in the UK during the nineteenth century required the nurse to reside with the mother just before the birth and for a

101 POD 1923/24, p. 405. 102 Ibid., p. 402. 103 POD 1911/12, p. 276.

149 month afterwards, attending both mother and child as well as undertaking some domestic tasks.104 By the late 1920s in Queensland, the usual time associated for attending a lying-in case included the delivery and 10 to 12 days postpartum,105 during which time the mother was required to remain in bed.

Therefore, operating a lying-in hospital required the nurse to be available at all times while the patient was admitted as stipulated in The Health Act

Amendment Act of 1911.106 Those lying-in hospitals with more than two nurses would have found this easier than those operating alone. Any family living on the premises would also have assisted with household duties, and some may have even assisted with attending the patient. For example,

Cosgrove107 outlines a lying-in hospital in Mount Morgan where the young daughter of the midwife did the shopping for the patients. In addition, some of the nurses may have helped each other. For example, Nurse Wye took over

Nurse Pollard’s lying-in hospital for at least a couple of years from 1919.

This discussion of the nurses who operated lying-in hospitals in Rockhampton provides an overall impression of women with varied socio-economic backgrounds and educational experience, using their own homes to gain an income, either through choice or through necessity. They did this by either working alone or with the aid of another nurse or family member. In order to operate a lying-in hospital after 1911, they needed to register with the QNRB and conform to standards of operation. However, rather than restricting the

104 Mortimer, B., ‘Independent women: domiciliary nurses in min-nineteenth century Edinburgh’, in Rafferty, A., Robertson, J., Elkan, R. (eds), Nursing History and the Politics of Welfare, London, Routledge, 1997, p. 138. 105 QATNA Minutes, The Australasian Nurses’ Journal, vol. 27, no. 5, 1929, p. 121. 106 Selby, op. cit., 1992, p. 102. 107 Cosgrove, B. Mount Morgan: images and realities. Dynamics and decline of a mining town. Unpublished PhD thesis, Central Queensland University, 2001, p. 276.

150 number of women who undertook this type of work, as would be expected after the introduction of regulations, Rockhampton witnessed a rise in the number of lying-in hospitals over the next decade, the majority of which were run by untrained nurses.

There were a number of factors contributing to this anomaly. The Queensland legislation regulating lying-in hospitals coincided with the Maternity

Allowance offered by the Commonwealth Government. The ultimate aim of the Baby Bonus was to encourage the birth and survival of more white babies being born. It was believed the bonus would allow women to ‘purchase’ safer maternity options. This may have been an incentive for some women to establish lying-in hospitals.108 However, in Queensland, women had to be registered with the QNRB before they could embark on such scheme, and in order to register they needed to have at least three years nursing experience or a midwifery certificate. Hence the Baby Bonus only privileged those women who were already operating as midwives in 1911 and does not adequately explain the rise of lying-in hospitals because gaining registration after this date required both time and money. Furthermore, the nurses who ran lying-in hospitals in Rockhampton had a long association with the community as maternity nurses, both prior to the introduction of the maternity allowance and afterwards (18 of the 26 nurses who ran lying-in hospitals in Rockhampton registered as midwifery nurses in 1912). As such, while the Baby Bonus allowed women to fund their confinements more readily, they appear to have continued to choose lying-in hospitals, most of which were operated by

108 Reiger, K.M., The Disenchantment of the Home. Modernizing the Australian Family 1880 – 1940, Melbourne, Oxford University Press, 1985, p. 94.

151 untrained nurses. This was probably not the ‘safer option’ envisaged by the

Commonwealth government and, indeed, by 1923 serious doubts were being raised as to the scheme’s success.109 Therefore, neither the Queensland government’s legislative regulations nor the Commonwealth’s initiative reduced the prevalence of untrained midwives operating lying-in hospitals in

Rockhampton, and possibly other regional towns.

The apparent lack of effectiveness of these state interventions in decreasing the prevalence of untrained midwives raises the question of competence. The general perception was that these nurses, especially those who were untrained, were responsible for the high infant and maternal mortality rates. This issue is best explored by considering the relationship these nurses had with the doctors in the community.

Midwives and doctors

Summers indicates midwives in South Australia liaised closely with the patient’s doctor,110 although does not specify if the doctor attended each birth.

Selby111 alleges private maternity hospitals owned and operated by trained nurses, usually had a doctor attend the birth, while smaller lying-in hospitals were normally associated with the midwife only attending. However, Mein

Smith112 points out 48 percent of births in Queensland in 1913 were attended

109 Cumpston, J.H.L., The Health of the People. A Study in Federalism, Canberra, Roebuck Society Publications, 1978, p. 52. 110 Summers, op. cit., p. 54. 111 Selby, op. cit., 1992, p. 103. 112 Mein Smith, P., Mothers and King Baby. Infant Survival and Welfare in an Imperial World: Australia 1880 – 1950, Hampshire, MacMillan Press, 1997, p. 200.

152 by a doctor; a figure that rose to 85 percent by 1935. While no evidence has been uncovered regarding doctor attendance of the births, the correspondence files of the Rockhampton City Council contain numerous letters from nurses complaining about the state of the footpaths and streets, particularly after rain, which prevented doctors, ambulance and patients from accessing their residences. Thus they provide circumstantial evidence suggesting the nurses were at least keen to maintain a good relationship with the local doctors, and that doctors were regular visitors of lying-in hospitals. For example, Nurse

Berrill complained to the Rockhampton City Council regarding the smell emanating from an open drain near her ‘nursing home’ which was a disturbance ‘to medical men who visit daily as well as the patients’.113 Nurse

Clarke noted in 1920, ‘the doctor had to call out in the street to know how his patient was [as he was] unable to get in [after] that late rain’.114 Wet weather caused on-going problems for Nurse Clarke who complained to the Council in

1922115 and 1927116 about the difficulty doctors had in accessing her nursing home. Nurses Bruce and Aitken also had difficulties with a neighbour fencing part of his property and blocking the ‘usual’ route to their hospital, ‘our home

[is] almost inaccessible with doctors and Ambulance calling day and night it is most dangerous and all are complaining’.117

113 Nurse M.J. Berrill to Town Clerk, Rockhampton City Council, 13 March 1916, RCC Correspondence folder Aa – Cz, RCCML, Special Collections, Rockhampton. 114 Nurse Clarke to Town Clerk, Rockhampton City Council, 9 February 1920, RCC Correspondence folder Aa – City Engineer, RCCML, Special Collections, Rockhampton. 115 Nurse Clarke to Town Clerk, Rockhampton City Council, 11 January 1922, RCC Correspondence folder Aa – Cl, RCCML, Special Collections, Rockhampton. 116 Nurse Clarke to Town Clerk, Rockhampton City Council, 15 August 1927, RCC Correspondence folder B0 – City Engineer, RCCML, Special Collections, Rockhampton. 117 Nurse Bruce to Town Clerk, Rockhampton City Council, 16 May 1922, RCC Correspondence folder Aa – Cl, RCCML, Special Collections, Rockhampton.

153 This seemingly close relationship with doctors as shown by the nurses in

Rockhampton did not always exist. Martyr118 proposes the relationship between doctors and midwives during the latter part of the nineteenth century was strained. A number of factors contributed to this situation. However, most seem to relate to the allocation of blame for adverse outcomes and the protection of each group’s reputation. Midwives were reluctant to call upon a doctor, fearing reprisals for their incompetence. This often resulted in the doctor arriving too late to save either mother or child.119 On the other hand, the medical profession often denounced lying-in hospitals as ‘abortion shops’120 although the sole responsibility attributed to midwives for abortions is debatable, with many doctors also being implicated in such illegal practices.121

The main point of contention between doctors and midwives related to puerperal fever. While puerperal fever was not the most prevalent cause of maternal mortality,122 it was seen as preventable and a reflection on the skill of the midwife or doctor. Hallett’s123 research regarding puerperal fever dates the dispute between the two groups to well before the eighteenth century in

England. It is, therefore, not surprising to see puerperal fever being used as grounds for condemnation in the twentieth century. By the early 1900s, the

118 Martyr, P., Paradise of Quacks. An Alternative History of Medicine in Australia, Sydney, Macleay Press, 2002, p. 96. 119 McCalman, op. cit., p. 165. 120 Martyr, op. cit., p. 136. 121 Ibid, p. 191. 122 Eclampsia caused more than two times as many deaths as puerperal fever. However, preventative measures for eclampsia were not routinely implemented until after the 1930s. McCalman, op. cit., p. 162. 123 Hallett, C., ‘Puerperal fever as a source of conflict between midwives and medical men in the eighteenth- and early-nineteen-century Britain’, Breaking New Ground: Women Researchers in a Regional Community Conference, February 2003, Bundaberg.

154 medical profession was expressing concern about trained midwives undertaking independent cases, suggesting they were a danger to the community.124 However, questions were being raised early in the twentieth century as to the safety of the medical profession’s involvement in midwifery, as the rate of puerperal fever increased as more doctors became involved (see

Table 4.4). In 1920 Dr J S Purdy addressed the National Council of Women, stating puerperal fever accounted for a third of maternity related deaths in New

South Wales.125 Furthermore, Purdy identified this rate as almost double that of England, where there was a high rate of home births. He recommended stricter aseptic practices for midwives and doctors; the extension of institutional accommodation for midwifery; and clearer guidelines for midwives calling upon doctors during in-home births. By 1930, Dr J J Boyd advocated for a higher rate of home births by appropriately trained midwives because of the clear evidence that trauma associated with the unnecessary hurrying of deliveries by doctors through the use of forceps was the most important cause of death from sepsis.126

Table 4.4 Puerperal fever rates for Queensland 1901 – 1940127

Year 1901 1909/10 1919/20 1930 1940

Rate 20 18 34.4 42.2 34.8

124 Martyr, op. cit., p. 165. 125 Dr J.S. Purdy, ‘Maternal mortality’, The Australasian Nurses’ Journal, vol. 18, no. 12, 1920, p. 404. 126 Dr J.J. Boyd, ‘Maternal mortality and morbidity. Causes and prevention’, The Australasian Nurses’ Journal, vol. 28, no. 3, 1930, pp. 65-97; vol. 28, no. 4, pp. 95-97. 127 Notification rates per 1 million population. Wilson, R., Official Yearbook of the Commonwealth of Australia 1944 and 1945, Canberra, Commonwealth Bureau of Census and Statistics, 1947, pp. 75, 453.

155

This increasing level of medical intervention may account for the rise of reported puerperal fever cases noted in Queensland and other Australian States.

According to McCalman,128 such unnecessary intervention was mostly confined to uninformed private doctors working in the community rather than those working in larger hospitals. However, this explanation is too simplistic and does not adequately account for the geographical distribution of puerperal mortality which Marshall Allan found to be greater in Melbourne (where the large hospitals were located) than in country towns or the rest of the State of

Victoria from 1918 to 1927.129 Marshall Allan also noted 90 percent of deliveries were attended by a doctor, with the proportion being higher in country areas.

Concern about the prevalence of puerperal fever was one of the underlying reasons for the introduction and enforcement of the 1911 legislation. This has been associated with the Labor government’s desire to ‘raise’ the standards of lying-in hospitals and reduce the maternal mortality rates. The legislation outlined that in cases of puerperal fever or sepsis, the hospital was to be closed.

It was not allowed to be reopened until all inner walls, partitions and ceilings were repainted, repapered or lime washed, every room disinfected and a certificate of proof forwarded within twenty-four hours to the local authority and subsequently to the Commissioner of Public Health.130 In order to comply with such guidelines, considerable cost was incurred, especially for single operators, and this may have forced a number of permanent closures.

128 McCalman, op. cit., p. 146. 129 Marshall Allan, op. cit., p. 13. 130 Selby, op. cit., 1992, p. 102.

156

Despite these requirements, no correspondence has been found either between the Rockhampton City Council and the Medical Officer or between the Council and the Department of Public Health relating to puerperal fever in any of the lying-in hospitals in Rockhampton, nor has any evidence been located indicating these hospitals were forced to close by the medical authorities. This suggests these lying-in hospitals were not significant sources of puerperal fever. It is unlikely nurses could have ‘hidden’ any cases because of the seriousness of the condition and the requirement of doctors to notify the appropriate authorities of infectious diseases. Furthermore, the number of reported cases of puerperal fever continued in Queensland after 1930, despite the closure of most lying-in hospitals.131 Thus, while puerperal fever continued to claim a small number of women’s lives in Queensland until the

1950s, this thesis questions the generalisations regarding the incompetence of midwives running lying-in hospitals, trained or otherwise. This is based on the high prevalence of untrained midwives operating lying-in hospitals in

Rockhampton and the lack of evidence to suggest any of these nurses were responsible for a case of puerperal fever. Therefore, while the incompetence of untrained midwives was posed as the ultimate reason for State intervention to amend the problem of maternal and infant mortality, this thesis supports

Selby’s assertion lying-in hospitals owned and operated by midwives were not the cause of the problem.132

131 Solomon, S.E., Statistics of the State of Queensland for the Year 1954-55, Brisbane, Government Printer, 1955, p. 75. 132 Selby, op. cit., 1992, p. 102.

157 Unscrupulous providers of maternity services undoubtedly existed. The numbers of puerperal fever in Queensland verify this. What is at issue is the assumption during the early twentieth century that untrained midwives running lying-in hospitals and such unscrupulous providers were one and the same.

The data presented in this thesis in relation to Rockhampton does not support this. Some untrained midwives would have been responsible for infecting their patients as were some educated doctors. Finally, the situation in Rockhampton highlights that midwifery within lying-in hospitals was not undertaken in isolation of doctors and that the two groups worked cooperatively, regardless of who actually delivered the baby.

Closing a lying-in hospital

The final paradox identified in this chapter relates to the effect the rise of government maternity hospitals had on lying-in hospitals. Although there was a decline in the number of lying-in hospitals after the Rockhampton Hospital

Board was established, and indeed, a significant number of lying-in hospitals closed after the Lady Goodwin Hospital opened in Rockhampton in 1930, the relevance of these events is not clear. Examination of the reasons for closure of lying-in hospitals in Rockhampton suggest a number of factors may have contributed, including the age of the nurses, ill health, financial constraints as well as the attraction of larger hospitals.

By the mid 1920s, some of the nurses in Rockhampton are likely to have been quite elderly when they stopped taking in cases. For example, Nurse Forsdick

158 worked in Rockhampton for 44 years suggesting she was well into her 60s before retiring in 1928. The Post Office Directories indicate Nurse Eckel nursed from at least 1901 before retiring in 1928 (27 years) and Nurse Berrill worked for at least 33 years, 25 of which she ran a lying-in hospital. Indeed the closure of Berrill’s lying-in hospital was probably related to the death of

Elizabeth Berrill in September 1937.133 Jane Berrill died in 1945.134 As each of them retired, however, there were no younger nurses to take on this type of work. Younger trained nurses were looking at other avenues of nursing work such as Maternal and Child Welfare or hospital work. Furthermore, the Health

Act Amendment Act of 1911 prohibited unregistered nurses from taking on establishments such as lying-in hospitals, while other legislation gradually closed the avenue for untrained nurses to register. Thus the number of nurses available to replace retiring proprietors was significantly restricted as a result of these legislative interventions. Therefore, the eventual effect of these legislative changes was to force untrained nurses out of maternity work, as argued by Saunders and Spearritt.135 However, it took over twenty years to accomplish this, and did so in conjunction with other factors, including the eventual retirement of untrained nurses.

While the majority of nurses who closed their lying-in hospitals during the period under review did so without a specified reason, two nurses notified the

Town Clerk of Rockhampton City Council their intending closures were the result of deteriorating health. Nurse Holland closed her home in 1926: ‘Just a line to let you know I am giving up my nursing home on account of bad

133 RCCML, Special Collections Index, Rockhampton. 134 Ibid. 135 Saunders and Spearritt, op. cit., p. 10.

159 health’.136 Nurse Beasley Smith also closed her home in 1926: ‘I am sending you notice I am closing my nursing home as my health is completely broken up and my doctors have strictly forbidden nursing’.137

It is interesting both these nurses who cited ill health closed their homes in the same year, as a further four nursing homes closed between 1925 and 1926.

The sudden drop in the number of lying-in hospitals at this time may have been influenced by a number of factors, not the least being a sudden increase in water rates being applied to lying-in hospitals in Rockhampton. How widely this increase was advertised is unclear, as Nurse Costello queried her water rates of £12 in 1925 as being significantly higher than previous years.138 The reply indicated a change had occurred in the criteria for charging water rates, with lying-in hospitals being charged a higher rate than normal residences.139

The rationale underlying this increase is unclear. Further research is required to determine if the increase was limited to the Rockhampton local authority or if similar changes occurred in other areas. Given the yearly income of these nurses may have been as low as £70 (20 cases at 3 guineas each), such an increase would have been problematic. Nurse Beasley Smith seems to have found this increase in water rates a significant burden. In September 1926 she informed the Rockhampton City Council she had removed the bottom storey of

136 Nurse Holland to Town Clerk, Rockhampton, 14 October 1926, RCC Correspondence folder Medical Officer of Health – Ji, RCCML, Special Collections, Rockhampton. 137 Nurse Beasley Smith to Town Clerk, Rockhampton, 5 November 1926, RCC Correspondence folder Rc – Specifications, RCCML, Special Collections, Rockhampton. 138 Nurse Costello to Town Clerk, Rockhampton, 3 February 1925, RCC Correspondence folder City Engineer – Dz, RCCML, Special Collections, Rockhampton. 139 Town Clerk, Rockhampton to Nurse Costello, 10 February 1925, RCC Correspondence folder City Engineer – Dz, RCCML, Special Collections, Rockhampton.

160 her two storeyed house and asked for a reduction in her water rates.140

However, as she closed her home in November of that year, this move may have had little effect on the eventual outcome. One can speculate this added financial burden contributed to Nurse Beasley Smith’s ill health either through the psychological stress associated with ‘making ends meet’, or by her taking on extra cases leading to physical exhaustion. Of the six nurses who closed between 1925 and 1926, at least four owned their homes, suggesting the water rates increase may have been a factor in decisions to close.

Selby141 asserts it was the financial burdens associated with the Health Act

Amendment Act of 1911 upon lying-in hospitals which deferred implementing the legislation by many local authorities. The 1911 Act outlined an annual fee of £2 be charged to the lying-in hospitals. Private hospitals were charged £5.

These fees covered the administration and inspection costs. The Medical

Officer of the Rockhampton City Council was paid £1.10 for inspecting a private hospital and £0.10.6 for a lying-in hospital.142 The correspondence to the nurses throughout the years under review found no increase in this fee.

However, the registration appears to have been linked to the premises rather than the nurse. For example, Nurse Brady registered two houses within twelve months and was required to pay two fees.143 Nurse Wye also paid two registration fees within three months when she moved premises after

140 Nurse Beasley Smith to Town Clerk, Rockhampton, 13 September 1926, RCC Correspondence folder Rc – Specifications, RCCML, Special Collections, Rockhampton. 141 Selby, op. cit., 1992, p. 101. 142 Report: Dr A.A. Parry to Mayor of Rockhampton, 23 December 1918, RCC Correspondence folder Fi – Ky, RCCML, Special Collections, Rockhampton. 143 Town Clerk, Rockhampton to Nurse Brady, 4 October 1927, RCC Correspondence folder Bo – City Engineer; Town Clerk, Rockhampton to Nurse Brady, 30 March 1928, RCC Correspondence folder Botanic Gardens Trust – City Engineer, RCCML, Special Collections, Rockhampton.

161 purchasing her home.144 It is thus unlikely the introduction of the fee in 1916 caused any lying-in hospitals to close in Rockhampton and not register. It would also appear the introduction of this fee did not adversely affect the financial viability of lying-in hospitals in any significant way. However, the fee may have been a factor in delaying registering with the Council by some nurses. Furthermore, the registration fee, in combination with the QATNA’s reluctance to increase fees charged to patients, may have detracted from these nurses becoming as wealthy as some of their New South Wales counterparts.

For example, Williamson145 outlines the financial shrewdness of Nurse Kirk who operated a lying-in hospital in Kempsey between 1900 and 1930.

While these factors contributed to the closure of a number of lying-in hospitals prior to 1930, the opening of a public maternity hospital, Lady Goodwin

Hospital, in that year may have had some impact, although to what extent is unclear. By 1938, only one lying-in hospital existed in Rockhampton.

However, there was not a concomitant rise in the number of publicly funded births: over 60 percent of births were still undertaken privately, albeit in larger hospitals rather than lying-in hospitals. While this appears to contrast significantly with figures cited overall for Queensland where in 1945/46, 67.2 percent of all babies were born in a public hospital,146 this does not take into account the high percentage of private patients within the public hospital. In

144 Town Clerk, Rockhampton to Nurse Wye, 6 February 1925, RCC Correspondence folder Treasury – XYZ; Town Clerk, Rockhampton to Nurse Wye, 9 May 1925, RCC Correspondence folder Treasury – XYZ, RCCML, Special Collections, Rockhampton. 145 Williamson, N., ‘She walked … with great purpose. Mary Kirkpatrick and the history of midwifery in New South Wales’, in Bevege, M., James, M., Shute, C. (eds), Worth Her Salt. Women at Work in Australia, Sydney, Hale & Iremonger, 1982, p. 14. 146 Report: Acting government statistician, Mr Clark, Department of Health and Home Affairs, 2 July 1947, folder A/31677, QSA, Brisbane.

162 the late 1930s, these accounted for around 35 percent of all births at the Lady

Goodwin Hospital.147 Thus, as the lying-hospitals closed, private patients sought other private services, including those of the Lady Goodwin Hospital.

It is widely accepted that throughout the first part of the twentieth century the general public in Western societies increasingly sought out hospitals rather than community based services. This was particularly so with maternity cases.

In the UK, where up to 75 per cent of births were conducted by midwives in a home setting at the turn of the century,148 this figure was reduced to 50 per cent by 1948.149 Why women were attracted to hospitals for birthing is subject to speculation. However, Robertson’s oral history research in South Australia suggests three factors contributed: acceptance of the medical profession’s argument that hospital birthing was safer; pain control; and cost.150

Martell151 confirms these factors within the USA and adds the dislocation of the extended family and an increase in urbanisation as further factors. While there is some doubt regarding the argument doctors (in hospitals) provided a safer service, Martyr152 has found the medical profession was very adept at using the media, particularly in the 1930s, to promote their image as the sole authoritative voice of healing and birthing. This may account for some of the

147 Memorandum: Department of Health and Home Affairs, 19 June 1940, folder A/29559, QSA, Brisbane. 148 Dawley, K., ‘Ideology and self-interest. Nursing, medicine and the elimination of the midwife’, Nursing History Review, vol. 9, 2001, p. 101. 149 Webster, C., ‘The early NHS and the crisis of public health nursing’, International History of Nursing Journal, vol. 5, no. 2, 2000, p. 4. 150 Roberston, B., ‘Old traditions and new technologies: an oral history of childbirth in South Australia from 1900 – 1940’, Oral History of Australia Journal, no. 14, 1992, pp. 66-67. 151 Martell, L., ‘The hospital and the postpartum experience: a historical analysis’, Journal of Obstetrics, Gynaecology and Neonatal Nursing, vol. 29, no. 1, 2000, pp. 65-72. 152 Martyr, op. cit., p. 260.

163 attraction of hospitals. Reiger153 also notes child birth had been increasingly

‘medicalised’ after WWI, but found the issue does not seem to have been publicly debated. Rather, there was a general sense of acceptance by the public towards hospitalisation. Integral to this increasing hospitalisation was the lure of a pain free birth,154 although anaesthetics were not without dangers.155

Finally, as Mein Smith points out, mothers were attracted to hospitals as they were clean, pleasant spaces where the woman was waited on for a fortnight.156

Interestingly, the cost of childbirth does not appear to have been a significant factor in Rockhampton. The Women’s Hospital was the public hospital in

Rockhampton prior to the opening of the Lady Goodwin. This hospital only charged one guinea per week until 1925, although after it was incorporated into the Rockhampton Hospital Board a higher fee may have been implemented. A circular sent to the hospital boards in Queensland in 1927 indicated public hospitals were for those who could not afford alternative medical or nursing services, although there was no objection to private and intermediate wards.157

This circular also stipulated the maximum fee for maternity patients in public wards was seven guineas for two weeks. Hence the Women’s Hospital, and later the Lady Goodwin Hospital, probably charged between £0 – 3.8 per week for public patients and more for private and intermediate accommodation. A lying-in hospital charged around £3 for ten days. Therefore, prior to 1925, the

Women’s Hospital was the cheapest option for childbirth. However, the public supported lying-in hospitals in preference to the Women’s Hospital. This was

153 Reiger, op. cit., 1985, p. 95. 154 Ibid., pp. 99-100. 155 Saunders and Spearritt, op. cit., p. 11; Mein Smith, op. cit., p. 201. 156 Mein Smith, op. cit., p. 202. 157 Circular: Home Secretary’s Office, 23 June 1927, folder A/31608, QSA, Brisbane.

164 related to several factors. Firstly, Trotman, the secretary of the Women’s

Hospital until 1925, outlined there were no private wards at the Women’s

Hospital and that those who could pay for such services were encouraged to go elsewhere.158 This may have maintained the image of public hospitals as associated with poorer sections of the community. Secondly, the Women’s

Hospital was not without its problems. As discussed in Chapter 5, the

Women’s Hospital had a relatively high infant mortality rate and its students had difficulties in passing exams. As such, the Women’s Hospital may not have had a robust reputation in the community of Rockhampton, and hence women looked more favourably at lying-in hospitals.

Conclusion

This chapter has explored nursing within the private hospitals of the

Rockhampton region during the first half of the twentieth century and reveals a number of differences between nurse-owned and doctor-owned hospitals.

These include the size of the hospitals and the ability of doctor-owned facilities to become nurse-training hospitals that employed trained nurses to oversee its operations. In addition, the doctor-run hospitals were not restricted to maternity cases only, as were all of the nurse-run hospitals, with the possible exception of Albert Hospital in Mount Morgan. To use business terms, general hospitals were the expanding market. Medical and surgical techniques were

158 Trotman, M., Re Women’s Hospital, paper presented to the Women’s Electoral League, May 1922, Women’s Hospital folder, ACHHAM, Rockhampton.

165 rapidly improving from the 1930s, whereas family sizes were decreasing.159

These factors contributed to a more stable business. They were able to keep costs to a minimum by employing (cheap) trainee nurses to do the bulk of the work; they could replace staff easily, often from their own graduates; and they had tighter control over the supply of income (patients).

In contrast, the nurse-owned hospitals, particularly lying-in hospitals, were being squeezed out of the market. This was the result of a number of factors, one of which being State intervention in maternity services. This occurred through the government gradually restricting who could operate a lying-in hospital. However, the relationship between the interventions by the State and the viability of lying-in hospitals was complex and contained a number of paradoxes. These included the increase in lying-in hospital numbers after the regulations were introduced, especially by untrained nurses who were seen as the cause of high maternal and infant mortality rates; the lack of evidence to support the perception untrained nurses were incompetent; and the stability in the percentage of private births after the provision of a new public maternity hospital in Rockhampton. Furthermore, this chapter has outlined a number of other factors that also affected lying-in hospitals over which the government had less control. These include the age of the nurse proprietors, their health, and local factors such as increased water rates. However, it is likely broader social and medical factors such as the general attraction towards larger hospitals for pain relief during childbirth constituted one of the most significant factors. The interplay between government intervention and nursing services is

159 The birth rate in Queensland fell steadily from 30.1 in 1913 to a low of 18.1 in 1933. Solomon, S.E., Queensland Year Book 1957, Canberra, Commonwealth Bureau of Census and Statistics, 1957, p. 56.

166 explored further in the following chapters, firstly in regards to charity services before considering services completely run by the State government in

Chapters 6 and 7.

167 Chapter 5

For the love of God: churches and charities

Nursing has had a long association with self-sacrifice. Modern nursing arose in the nineteenth century during a time of increasing philanthropy, when wealthier members of society recognised the hardships of the poor and infirm and began acting to alleviate these. As a result, charities were established. In addition, the message of ‘help thy neighbour’ was promoted from church pulpits. Women, in particular, took up the mantle of beneficence, giving their time and energies to fund-raising, visiting the poor and sick, doling out food and provisions to the needy. It was from within this context that nursing came to be seen as a calling or vocation for women with middle class backgrounds.

As such, churches and charities provided some of the earliest avenues of welfare involving nurses throughout the Western world; an involvement that continued into the twentieth century.

This chapter focuses on those nursing services in the Rockhampton district that were established and managed by church and charity groups. It outlines the foundations of welfare provision within Rockhampton’s nursing services as opposed to those offered privately and those completely controlled by the government. What emerges from this chapter is the significant role of women in providing nursing services and meeting the needs of the community. As

168 such, it identifies and explores a number of social factors that influenced the success or otherwise of a number of nursing avenues. Such factors include the role of philanthropy as the foundation of the services, along with notions of

‘deserving’ and ‘undeserving’ poor. Furthermore, this chapter brings into focus the vocational aspects of nursing, although postulates that not all nurses who worked within charitable facilities did so as the result of a ‘higher calling’.

While welfare services, such as orphanages, may have employed a nurse, often an untrained nurse, in the role of matron, these have been excluded from this analysis as nursing was not the primary function of these institutions. The services explored here include the Benevolent Society which established the

Children’s Hospital and the Women’s Hospital; the Salvation Army Maternity

Hospital; and the Sisters of Mercy’s Mater Misericordiae Hospital. The Emu

Park Convalescent Home will also be briefly examined as it was run by the

Women’s Hospital Committee.

Prior to examining each of the services in the Rockhampton district, it is pertinent to briefly review nineteenth century philanthropy, as it was from within this ethos that services began. In addition, it is worthwhile noting the important role of Christian churches, both Protestant and Catholic, in propagating this ethos, in providing the structures and in some cases, allowing the services to develop. While the government increasingly became involved in provision of health services during the early twentieth century, it was the churches that were primarily responsible for the establishment of the services examined here. Unfortunately, this involvement also had the effect of

169 moralising the relief provided. As Francis1 points out, the nineteenth century was an era where industry and productivity were seen as ordained by God, and idleness as sinful, so the poor were often viewed as being responsible for their own plight. This resulted in distinctions being made about who should receive charity and charitable acts being served up with a liberal amount of evangelism so the poor could be redeemed.

The term philanthropy can have a variety of meanings, from simply being an action that promotes the wellbeing of others,2 to one that has a much stronger motivation. Louisa Twining, a late nineteenth century English philanthropist, saw charity work as fervent, unselfish love, a gift of money, time, skill and experience offered from a belief in God.3 Indeed, this latter definition provides significant insight into the actions of many nineteenth and twentieth century philanthropists. However, as Godden4 points out, the motivation may not have been purely altruistic, as religion provided the main avenue for many middle and upper class women to escape the confines of the home. Hence, the

‘rewards’ associated with philanthropic activities may not have all been for the hereafter for many women who would have otherwise had very limited social spheres.5

1 Francis, K., ‘Service to the poor: the foundations of community nursing in England, Ireland and New South Wales’, International Journal of Nursing Practice, vol. 7, 2001, pp.170-171. 2 Deane, T., ‘Late nineteenth century philanthropy. The case of Louisa Twining’, in Digby, A., Stewart, J. (eds), Gender, Health and Welfare, London, Routledge, 1996, p. 124. 3 Ibid, p. 125. 4 Godden, J., ‘Portrait of a lady. A decade in the life of Helen Fell (1849 – 1935)’, in Bevege, M., James, M., Shute, C. (eds), Worth Her Salt. Women at Work in Australia, Sydney, Hale & Iremonger, 1982, p. 40. 5 Similar sentiments are expressed by Prochaska, F.K., Women and Philanthropy in Nineteenth Century England, Oxford, Clarendon Press, 1980, p. 71.

170 The types of charity activities undertaken by women both in England and

Australia were similar. They included collecting for the Bible Society, visiting the sick, raising funds, reforming prisons, advocating for child and maternal welfare, establishing services such as kindergartens and Bush Nursing services, and supporting housing and sanitary reform.6 Although Hyslop7 estimates 40 percent of those active in charities in Australia were women around the turn of the twentieth century, they tended to concentrate their efforts on ‘traditional’ feminine domains such as nursing and child and maternal welfare. As such,

Hyslop argues women were both objects and agents of charity. This chapter expands on Hyslop’s concept of women being agents of charity and distinguishes between those women whose involvement was removed from the

‘objects’ or recipients of charity, and those whose hands actually nursed the patients. Prochaska8 alludes to such a distinction by outlining the practice of the British gentry sending their domestic servants to do the visiting of the poor.

While not all the services considered in this chapter followed the same pattern, such practices did occur and have implications for the underlying philosophy of philanthropy and the incentives of the individual players.

Despite these variations, each of the case studies presented here demonstrate a number of similarities: the services were managed and staffed by women, offering services that mostly focused on the needs of women; they arose from ideals of philanthropy and were closely associated with Christianity, including the view souls could be saved through acts of nursing; and they were mostly

6 Godden, op. cit., pp. 40, 44; Hyslop, A., ‘Agents and objects. Women and social reform in Melbourne 1900 – 1914’, in Bevege, M., James, M., Shute, C. (eds), Worth Her Salt. Women Workers in Australia, Sydney, Hale & Iremonger, 1982, pp. 234-240. 7 Hyslop, op. cit., p. 230. 8 Prochaska, op. cit.

171 financially viable institutions because of successful fundraising efforts and tight controls on costs. Nurses were intimately involved in each of these factors. As women willing to submit to self-sacrifice, they were the hands doing the work and the means to the end, although they themselves have often remained invisible.9 Indeed, the nurses working in these facilities in

Rockhampton are more ethereal than those working in private duty nursing and lying-in hospitals where few records exist. A few names have been uncovered, but little is known of these other than training status. For those untrained nurses, even less is apparent. Their roles and responsibilities can be assumed to be similar to most nurses working in hospitals and public institutions (as explored in the next chapter). However, these may have been exceeded due to the nature of the service in which they were involved. For some, nursing was a calling, a fulfilment of religious vows and commitments; for others, work within the institution allowed them to gain further experience and a certificate in nursing before embarking on other paths.

The Benevolent Society in Rockhampton

The Benevolent Society of New South Wales is notable as one of the first charity groups in the new colony. Originally called the ‘New South Wales

Society for Promoting Christian Knowledge and Benevolence’, it commenced in 1813 and became known by the shorter version of its name by 1818.10 The aim of the Society was to relieve the poor, distressed, aged and infirm,

9 Sheehan, M., ‘Envisioning the nurse’, Visions Conference, Newcastle, July 2004. 10 Schultz, B., A Tapestry of Service. The Evolution of Nursing in Australia, Volume 1. Foundation to Federation 1788 – 1900, Melbourne, Churchill Livingstone, 1991, p. 13.

172 although Francis11 points out the Society’s underlying objective was to teach

Protestantism and attend the deserving poor. The first destitute asylum was built in 1821 and the Benevolent Society managed this asylum, unchecked, until the 1850s.12 This is one of the first examples of the government using charity groups for the management of aged and destitute adults; a tendency that continued into the twentieth century. In 1957, Solomon13 identified twenty benevolent asylums in Queensland, four of which were State institutions while the other sixteen were operated by religious denominations or private groups, only some of which received government aid.

In Rockhampton, the Benevolent Society was established in 1866 and received a government grant of a block of land on the Athelstane Range in 1872.14 By

1879, the Society had erected an asylum that was used for sick and old people, sick children, convalescence and maternity cases.15 A child minding service was briefly added in 1881.16 The Society continued to expand throughout the

1880s and established the Children’s Hospital and the Women’s Hospital, both of which were later taken over by separate committees. The separation of the

Children’s and Women’s Hospitals allowed the Benevolent Society to concentrate its energies on the needs of the elderly and outdoor relief. For

11 Francis, op. cit., p. 173. 12 Stevens, J., ‘The ennursement of old age in New South Wales: a history of nursing and the care of older people between white settlement and Federation’, Collegian, vol. 10, no. 2, 2003, p. 20; Schultz, op. cit., p. 14. 13 Solomon, S.E., Queensland Year Book 1957, Canberra, Commonwealth Bureau of Census and Statistics, 1957, p. 116. 14 ‘Home for Aged and Infirm’, unpublished paper, author unidentified, presented to Rockhampton District Historical Society, circa 1945, folder C362.8, RDHS, Rockhampton; Hermann, A.E., The Development of Rockhampton and District, Rockhampton, Central Queensland Family History Association, 2002, p. 92. 15 Power, W., ‘117 years of caring. The Rockhampton Benevolent Society’, paper presented to Rockhampton District Historical Society, September 1983, folder C362.8, RDHS, Rockhampton. 16 Ibid.

173 example, in 1914, four self-contained cottages for the elderly were officially opened.17

The Rockhampton Benevolent Society reflected a number of nineteenth century philanthropic ideals and realities but was not always consistent with

British models. Firstly, it had a strong emphasis on the elderly. According to

Stevens,18 the New South Wales Benevolent Society Asylum housed 140 people by 1830, 70 percent of whom were 60 years and older. Such concern for the elderly was not always evident in British philanthropy. Thane19 suggests the involvement of women in charity activities in nineteenth century

Britain tended to focus concern towards the young, especially child and maternal welfare. More in common with British tradition was the tendency to make moral judgments regarding who should receive assistance. One of the earliest rules of the Society was that relief should not be provided to mothers of illegitimate children, except in ‘urgent cases’ when the committee was satisfied as to the ‘good conduct of the mother’.20 In describing the philanthropic work of Helen Fells in Sydney during the late nineteenth century, Godden21 also identifies the need for those seeking relief to be ‘deserving’. Finally, the overwhelming majority of the committee members in Rockhampton were women. Although a men’s committee was established in 1867 to advise and

17 Griffin, H., ‘Rockhampton Benevolent Society 1866 – 1916: a successful philanthropic venture’, paper presented to Rockhampton District Historical Society, September 1994, folder C362.8, RDHS, Rockhampton. 18 Stevens, op. cit., p. 20. 19 Thane, P., ‘Gender, welfare and old age in Britain, 1870s – 1940s’, in Digby, A., Stewart, J. (eds), Gender, Health and Welfare, London, Routledge, 1996, p. 195. 20 McDonald, L., Rockhampton Benevolent Society, 1866 – 1991. A Brief History, Rockhampton, Rockhampton Benevolent Society, 1991. 21 Godden, op. cit., p. 42.

174 raise money,22 the position of president of the Benevolent Society from 1866 to 1975 was undertaken by women.23 Indeed, in an overview of the

Benevolent Society in 1955, the Morning Bulletin pointed out that the entire work of the Benevolent Society in Rockhampton, with few exceptions, had always rested on a group of married women.24 Again, this would appear to be in conflict with some British charities, where Lewis25 notes a gender division until WWI, with women doing the visiting and social work, while men ran the committee. Prochaska,26 however, clearly points to the increasing role of women in committees throughout the nineteenth century in Britain. Indeed,

Taylor27 indicates the Women’s Hospital in Castlegate, Nottingham, was run by its women’s committee from 1875, although indicates this was an unusual situation in Britain at that time.

The Benevolent Society in Rockhampton employed a matron to attend to the daily management of the asylum, many of whom served for lengthy periods of time.28 Other staff appears to have been minimal, including nurses. In

1939/40, the Society received a total of £589 for the financial year (none of it from the State government) and only paid out £109 in wages.29 Given a staff

22 McDonald, op. cit. 23 Benevolent Society Archives, Rockhampton. 24 Morning Bulletin, 26 August 1955, p. 16. 25 Lewis, J., ‘Gender and welfare in late nineteenth and early twentieth centuries’, in Digby, A., Stewart, J. (eds), Gender, Health and Welfare. London, Routledge, 1996, p. 223. 26 Proshaska, op. cit., pp. 21-46. 27 Taylor, J., ‘The Ladies committee of the Women’s Hospital, Castlegate, Nottingham 1880 – 1900’, International History of Nursing Journal, vol. 2, no. 4, 1997, pp. 38-47. 28 Mrs Mundy and Mrs McKnight were matrons for 18 and 28 years, respectively. Morning Bulletin, 26 August 1955, p. 16. 29 Clark, C., Statistics of the State of Queensland for the year 1939-40. Brisbane, Government Printer, 1940, p. 35G.

175 nurse was paid £109 – 114 per annum from 1938,30 it is unlikely other nurses were employed. Indeed, only minimal wages were provided to the matron.

Children’s Hospital

The Children’s Hospital in Rockhampton was established in 1884 in the former

Female Lock Hospital in the grounds of the Port Curtis and Leichhardt District

Hospital,31 and transferred to the Benevolent Society Committee in March

1885.32 In 1889, a new building was opened for the Children’s Hospital on the corner of Agnes and Denham Streets which eventually accommodated 62 patients in five wards.33 By 1890, the Benevolent Society placed the management of the Children’s Hospital under a separate committee.34

Not a great deal is known about the Children’s Hospital in Rockhampton beyond these rudimentary facts. Nurses were trained at the Children’s

Hospital, although it is not clear when training commenced. Margaret Halpin and Louisa Parnell appear to have graduated after four years of training in

1904,35 so training had commenced by at least the late 1890s. The number of

30 ‘Nurses’ Award Queensland’, The Australasian Nurses’ Journal, vol. 36, no. 5, 1938, pp. 101-102. 31 This hospital became the Rockhampton Hospital in 1896, and it although changed its name a number of times throughout the twentieth century, will be referred to as the Rockhampton Hospital throughout this thesis. 32 Extract, Annual Report 1885, folder Children’s Hospital, ACHHAM, Rockhampton. 33 McDonald, L., Rockhampton. A History of City and District. St Lucia, University of Queensland Press, 1981, p. 362. NB Government records would suggest the Children’s Hospital commenced in 1892 and had 48 beds in 1917 (Home Secretary’s Office to Secretary Department of Public Health, Sydney 18 July 1917, folder A/31605, QSA, Brisbane). It is not clear why discrepancies exist regarding dates or bed numbers. 34 Hermann, op. cit., p. 91. 35 ATNA New Members, The Australasian Nurses’ Journal, vol. 4, no. 6, 1906, pp. 209-210. NB Louise Sarah Parnell appears to have trained for five years from November 1899 to November 1904. This extra time may have been related to problems passing exams or to working in the hospital until old enough to commence her training or graduate.

176 trainees graduating from the hospital was quite small: one or two per year, and some years none. Table 5.1 outlines the number of nurses who graduated 1904 to 1931. The larger number noted for 1925 (four graduates) is likely to be related to some nurses taking more than four years to complete.

Table 5.1 Graduates from Children’s Hospital, Rockhampton 1904 - 193136

Year Number Year Number Year Number Year Number 1904 4 1916 1 1922 2 1926 2 1911 1 1919 1 1923 1 1927 2 1912 1 1920 2 1924 1 1929 2 1914 2 1921 1 1925 4 1931 1

The hospital had a small number of registered nurses on staff aside from the matron. A photograph depicting the staff of the hospital in 1919 shows eleven nursing staff in addition to the matron.37 However, it is unclear from this photograph how many of these staff may have been trained. The 1923 ATNA register noted three members as living at the Rockhampton Children’s

Hospital: Maud Freeman (who graduated from Brisbane Children’s Hospital in 1915); Jessie Neil (who graduated from Mackay Hospital in 1920); and

Laura Nesbitt (who graduated from the Women’s Hospital in 1919). The latter would appear to have been the matron at this time.38 It is interesting to note the range of institutions from which these nurses originated. This suggests the

Children’s Hospital Committee did not have a preference for their own trainees when appointing staff as discussed in the previous chapter. This may have been related to the mobility of graduates. The 1923 ATNA register suggests

36 Compiled from ATNA and QNRB records. 37 ‘A most useful institution’, The Capricornian, 23 August 1919, between pages 24 and 25. 38 ATNA, Register of Members 1923, Sydney, Eagle Press, 1923; ‘A most useful institution’, The Capricornian, 23 August 1919, p. 25.

177 very few Children’s Hospital graduates continued to live in Rockhampton and were scattered from Cardwell to Sydney.39

The role of the nurse was all-encompassing in children’s hospitals and wards during the first half of the twentieth century. As Bradley40 points out, parents had very restricted roles in caring for their children once admitted to hospital.

Some British hospitals, as late as 1949, permitted parents a single 30 minute visit per week.41 At the Children’s Hospital in Rockhampton, parents were able to come on Wednesday and Sunday afternoons, although it is not clear for how long.42 The effect this possibly had on the children can be discerned from the saddened looks on their faces (see Figure 5.1). Unfortunately, no evidence has been located outlining the effect of this policy on the staff: how they controlled the children (playing was not encouraged during these early years), or how they attended to other necessary treatments, feeding and hygiene regimes. As such, the practice of nursing children in Australian hospitals during the first half of the twentieth century would benefit from further research.

39 ATNA, Register of Members 1923, Sydney, Eagle Press, 1923. 40 Bradley, S., ‘Suffer the little children. The influence of nurses and parents in the evolution of open visiting in children’s wards’, International History of Nursing Journal, vol. 6, no. 2, 2001, p. 45. 41 Ibid. 42 Children’s Hospital folder, ACHHAM, Rockhampton.

178 Figure 5.1 Inpatient of Children’s Hospital43

Funding for the hospital came from a variety of sources, including arrangements with local authorities. These were established in 1915 with the

Rockhampton City Council and surrounding shires such that the hospital would treat children between the ages of twelve months and twelve years for infectious diseases, except bubonic and oriental plague, smallpox and cholera.

Each of the local authorities then paid the hospital between 12 and 42 shillings per week, depending on the agreement,44 for hospitalisation of any child from that jurisdiction. It was fortunate such agreements were in place prior to the

Spanish Influenza epidemic in 1919. The State government provided occasional (or more regular) grants, as was common practice. Hermann45 details that in 1885 a bazaar raised £503 which the government matched pound

43 Children’s Hospital folder, ACHHAM, Rockhampton. 44 Agreements signed with Rockhampton City Council, 26 August 1915; Livingstone Shire Council 4 May 1915; Duaringa Shire 14 March 1916. Children’s Hospital folder, ACHHAM, Rockhampton. 45 Hermann, op. cit., p. 90.

179 for pound, hence providing the initial deposit for the Children’s Hospital.

Furthermore, the hospital was looking for government money to provide or supplement funds for a new operating theatre and to enlarge the nurses’ quarters in 1919.46

Women’s Hospital

The origins of the Women’s Hospital began in 1885 when a maternity ward was opened as part of the Benevolent Asylum.47 In 1891, a separate building was erected on the grounds of the asylum and named the Lady Norman

Hospital after the wife of the then Governor, who took an interest in maternity causes.48 Dr F H V Voss was appointed honorary medical officer at this time and continued to serve the hospital until 1925 at no expense to the committee or patients.49 In 1895, the Benevolent Society handed over the management of the hospital, free of debt, to a separate committee. This committee was comprised of prominent Rockhampton women from its inception until its demise in 1925. 50 In 1917, the hospital had 45 beds,51 although was able to accommodate 60 patients by 1922.52

46 ‘A most useful institution’, The Capricornian, 23 August 1919, p. 25. 47 Power, op. cit. 48 McDonald, op. cit., 1981, p. 362. It is not certain when the Lady Norman Hospital name was replaced with Women’s Hospital. 49 Ibid; Morning Bulletin, 20 February 1988, p. 13. 50 Morning Bulletin, 26 August 1955, p. 16. 51 Home Secretary to Secretary of Department of Public Health, 18 July 1917, folder A/31605, QSA, Brisbane. NB this source notes Women’s Hospital was established in 1899. As with Children’s Hospital, it is not clear how discrepancies arose, possibly relating to commencement as training hospitals. 52 Trotman, M., ‘Re Women’s Hospital, Rockhampton’, paper presented to Women’s Electoral League, 1922, Women’s Hospital folder, ACHHAM, Rockhampton.

180 Significantly, more information is available regarding the Women’s Hospital than the Children’s Hospital, as some records of committee meetings (1921 to

1925) have been preserved. Furthermore, as maternity hospitals had become a political issue in the 1920s, a number of government records are also available.

While this data is only relevant to the Women’s Hospital, some of the operating issues and committee structures revealed in these records may well have been similar to those of the Children’s Hospital.

As noted in Chapter 4, the Women’s Hospital played a significant role in delivering maternity and other female related medical/surgical services to the

Rockhampton district. Trotman53 wrote in 1922 that in the previous 26 years, the Women’s Hospital had accommodated 6379 adult patients; 2709 being maternity cases. Trotman also pointed out the hospital had a death rate of 2.4 percent. During these years a total of 1407 male and 1302 female births had taken place. Of these, 4 percent had died shortly after birth, mostly due to prematurity, and there were 5.4 percent stillbirths. These figures were considered by Trotman to be commendable, although it is difficult to make comparisons as most infant mortality rates are based on death under twelve months of age.54 Death relating to prematurity in Queensland from 1901 to

1947 hovered around 10 – 14 per 1000 live births.55 Given Trotman’s figures of 108 deaths relating to prematurity from a total of 2709 births, this equates to

38.9 deaths per 1000 live births, a significantly higher level than the State average. Table 5.2 outlines the infant mortality of the Women’s Hospital after it was taken over by the Rockhampton Hospital Board in 1925. While it would

53 Ibid. 54 See Appendix D: table outlining the infant mortality rates for Australia 1901 – 1950. 55 Problems of Prematurity, Brisbane, Department of Health and Home Affairs, 1948.

181 appear there was a significant drop in death relating to prematurity as a result of this change in management, the total number of deaths remained similar.

The differing statistics probably relate to variations in classifications of deaths.

That is, the death was classified as stillborn rather than relating to prematurity.

Table 5.2 Infant deaths, Women’s Hospital 1925 – 192856

Year Born Deaths Stillborn57 Total deaths (prematurity) (% deaths of total births) 1925/26 219 10 8 18 (8.2) 1926/27 216 3 12 15 (6.9) 1927/28 211 2 14 16 (7.6)

Staffing

The staffing of the Women’s Hospital included a matron, a small number of trained staff and an ever-changing line up of student nurses. Just when training began at the Women’s Hospital is unclear, although the ATNA records indicate two graduates of twelve months from 1906 (Louise Parnell and Minnie

Roberts).58 Until the 1920s, the Women’s Hospital only offered twelve-month training schedules regardless of previous nursing experience. For example,

Louise Parnell had completed her four years general training at the Children’s

Hospital in 1904, prior to commencing her twelve months midwifery training.59 The hospital graduated a small number of midwifery nurses each year, up to seven. However, the large number of general cases, seen at the

Women’s Hospital prompted concern by the Queensland Nurses’ Registration

56 Based on figures provided in letter: Rockhampton Hospital Board to Assistant Under Secretary Home Office, 3 September 1928, folder A/4730, QSA, Brisbane. 57 Number of still born are included in the total births figure. 58 ATNA New Members, The Australasian Nurses’ Journal, vol. 4, no. 6, 1906, p. 310. 59 ATNA, Register of Members 1923, Sydney, Eagle Press, 1923.

182 Board (QNRB) as to the effectiveness of the training in midwifery at the

Women’s Hospital as a significant number of trainees had difficulty in passing the exams set by the QNRB.60 As a result of these concerns, and the passing of the Maternity Act of 1922, the Women’s Hospital had to limit its trainees to attending maternity work only after 1922, although it regretted ‘dispensing’ with the extra training previously given.61 This was seen as a valuable asset to those nurses who went on and worked as independent midwives, as discussed in the previous chapter.

While the Women’s Hospital committee defended its inclusion of ‘extra curricula’ activities, it should be noted a large percentage of those seeking midwifery training prior to the 1920s did not have any previous nursing training.62 A six-month training scheme for general nurses was introduced around 1923.63 As such, Rockhampton trained nurses may have gone elsewhere for their maternity training. For example, Sarah Costello completed her general training at the Rockhampton Hospital in 1919 and went to the Lady

Chelmsford Hospital in Bundaberg in 1922 for her six months maternity training.64 Acquiring a ‘double certificate’ was not common before the early

1920s. Indeed, of the 107 Rockhampton related names on the QNRB Register of Midwifery Nurses 1912 to 1925, only 21 (19 percent) had also completed general certificates. Three of these completed the midwifery certificate from

60 Memoranda: QNRB to Home Office, 31 May 1923, notes of the 6 candidates from Women’s Hospital, 3 failed, 2 passed (both of whom had sat previously and failed), and the final nurse was given a pass conceded, having achieved 61%, although the pass mark was 65%, folder A/5075, QSA, Brisbane. 61 Trotman, M. to Secretary QNRB, 8 November 1922, folder A/5075, QSA, Brisbane. 62 Trotman, M. to Secretary QNRB, 21 September 1922, folder A/5075, QSA, Brisbane. 63 Janet Baron appears to be the first to complete 6 months training at the Women’s Hospital. ATNA New Members, The Australasian Nurses’ Journal, vol. 23, no. 4, 1925, p. 207. 64 ATNA New Members, The Australasian Nurses’ Journal, vol. 20, no. 2, 1922, p. xi.

183 the Women’s Hospital prior to their general training. After the introduction of the Maternity Act 1922, a greater percentage of trained nurses completed their midwifery training. For example, in 1922, 93 (27.9 percent) of the 333 obstetric nurses registered with the QATNA also had general certificates. By

1936, 90 percent of those nurses with obstetric training had completed general certificates.65 This trend is reflected in the graduates of the Women’s Hospital as outlined in Table 5.3.

Table 5.3 Women’s Hospital graduates and length of training 1918 - 193166

Year 12 months 6 months Year 12 months 6 months 1918 8 - 1925 3 1 1919 5 - 1926 2 3 1920 7 - 1927 - 4 1921 2 - 1928 - 3 1922 7 - 1929 2 1 1923 4 - 1930 - 3 1924 2 2 1931 1 6

The permanent nursing staff at the Women’s Hospital in 1922 consisted of the matron; two other trained nurses, one of whom attended medical and surgical cases only; and two assistant nurses.67 Whether the staffing arrangements altered as a result of the removal of trainees from general cases is unclear.

However, this must have had a significant impact on the workloads of these permanent staff, as the proportion of general cases far outweighed the

65 QATNA Annual General Meeting minutes, The Australasian Nurses’ Journal, vol. 20, no. 7, 1922, p. 257; QATNA Annual General Meeting minutes, The Australasian Nurses’ Journal, vol. 34, no. 9, 1936, pp. 179-180. 66 Based on ATNA New Member records, as recorded in The Australasian Nurses’ Journal, 1918 – 1931. 67 Trotman, M. to QNRB, 4 August 1922, folder A/5075, QSA, Brisbane.

184 maternity ones. Selby68 suggests the regulations regarding maternity cases were often broken in country hospitals. A letter from Trotman to the QNRB stated pupil nurses were strictly engaged in maternity after 1922, however it does not stipulate the same for permanent staff.69 Table 5.4 illustrates the large percentage of general cases admitted to the hospital and supports the concerns raised by the QNRB. This large proportion also suggests the Women’s

Hospital was the main hospital used by women in Rockhampton. Possible factors contributing to this may have been familiarity from having their babies at the Women’s Hospital and the relatively cheap rates. The fee charged by the

Women’s Hospital was one guinea (30 shillings) per week for board, lodging, nursing, medical attendance and medicines,70 whereas it was recommended public hospitals, such as the Rockhampton Hospital, charge nine shillings per day,71 (63 shillings a week), more than twice the rate of the Women’s Hospital.

Table 5.4 Patients admitted to Women’s Hospital 1918 - 192272

Year Midwifery Midwifery General cases General daily cases daily average average 1918 172 6.6 488 31.47 1919 176 6.7 476 32.2 1920 173 6.6 489 29.91 1921 200 7.7 522 33.14 1922 270 8.4 537 36.5

In addition to general adult cases, the Women’s Hospital also admitted a number of infant cases because the Children’s Hospital did not cater for infants

68 Selby, W., Motherhood in Labor’s Queensland, 1915 – 1957. Unpublished PhD thesis, Griffith University, 1992, pp. 118-120. 69 Trotman, M. to QNRB, 4 August 1922, folder A/5075, QSA, Brisbane. 70 Women’s Hospital Annual Report 1923, p. 7, folder Women’s Hospital, ACHHAM, Rockhampton. 71 Circular: Home Secretary’s Office, 23 June 1927, folder A/31608, QSA, Brisbane. 72 Memoranda: QNRB to Home Secretary, 31 May 1923, folder A/5075, QSA, Brisbane.

185 less than twelve months. Although the numbers were not large, up to four per month,73 these patients must have also extended the breadth of work undertaken by the nursing staff.

One other factor likely to have impacted on the ability of the staff to meet their duties was the layout of the hospital. As can be seen on the floor plan of the hospital (see Figure 5.2), there were significant distances between the children’s ward and some of the other wards. Provided the maternity cases were close to the labour ward, this would have meant those staff responsible for other cases needed to cover significant distances in a shift.

73 For example: Women’s Hospital committee minutes 10 March 1921; Women’s Hospital Annual Report 1923, Women’s Hospital folder, ACHHAM, Rockhampton.

186 Figure 5.2 Floor plan of Women’s Hospital74

74 Women’s Hospital folder, ACHHAM, Rockhampton.

187 Management of Women’s Hospital

The Women’s Hospital was managed by a small committee of women who appear to have been very diligent and successful in their endeavours. The 1923

Annual Report indicates funding was obtained from a variety of sources: subscriptions and donations (£424.7.4); net proceeds from entertainments

(£392.4.11); Walter and Eliza Hall Trust Fund (£200.0.0); patient fees

(£1067.1.10); Home Secretary’s Department (£2281.10.6); Golden Casket grant (£750.0.0); entrance fees from student nurses (£42.0.0). Furthermore, the savings the committee held in two bank accounts paid over £30 per year in interest.75 As this list of receipts illustrates, while the committee contributed to the income of the hospital through fund raising efforts, the government provided the bulk of the hospital’s income. When and how this reliance came about is unclear; however, by the 1920s, the Women’s Hospital, along with the

Rockhampton Hospital and the Children’s Hospital were considered to be

‘public’ institutions. The Town Clerk of the Rockhampton City Council wrote to the Department of Public Health in 1922 clearly indicating the Council had

‘always’ treated these hospitals as non-private hospitals, as they were

‘supported by public subscriptions and subsidy … by the government’.76 Such reliance on the government would have been necessary in order for the hospital to meet the needs of its clientele. Trotman77 explained the hospital catered for women from a wide range of socio-economic backgrounds, but particularly sought to provide for less advantaged women: soldier’s wives were attended

75 1923 Annual Report, Woman’s Hospital, ACHHAM, Rockhampton. 76 Town Clerk, Rockhampton City Council to Secretary, Department of Public Health, 25 August 1922, RCC Correspondence, folder H – L, RCCML, Special Collections, Rockhampton. 77 Trotman, op. cit.

188 free of charge, as were women whose husbands were out of work, or who had large and young families. Furthermore, the Women’s Hospital Committee was responsible for running the Emu Park Convalescent Home which had been established in 1912 by Dr Voss78 and was used:

for the purpose of recruiting the health of mother and

child. Also for unmarried mothers who were encouraged

to stay at this Home with their infants, nursing them till

they were six or nine months old. The Home has also

provided for the last ten years for delicate and homeless

children who are kept from a couple of days old till they

are of an age and able to walk and strong enough to be

boarded out or sent to orphanages.79

Although the Benevolent Society was quite stern towards unmarried mothers at its inception, the Women’s Hospital Committee appears to have had a more generous attitude by the 1920s. Why this change in attitude occurred is unknown, although it possibly reflects a softening within the broader society regarding issues of sex,80 and a disassociation between circumstances and moral judgement.81

78 Morning Bulletin, 26 August 1955, p. 15. 79 Trotman, op. cit. 80 While illegitimate births were not condoned, there is evidence issues of sexuality were being explored in society by the 1920s. See Reiger, K.M., The Disenchantment of the Home. Modernising the Australian Family 1880 – 1940, Melbourne, Oxford University Press, 1985; Holmes, K., ‘Spinsters indispensable: feminists, single women and the critique of marriage, 1890 – 1920’, Australian Historical Studies, no. 110, 1998, pp. 68-90. 81 Digby, A., Steward, J., ‘Welfare in context’, in Digby, A., Steward, J. (eds), Gender, Health and Welfare, London, Routledge, 1996, p. 3.

189 From 1922, the government took an increasing interest in the Women’s

Hospital. The Home Secretary visited the hospital in early 1922 and was reportedly ‘greatly impressed’.82 Subsequent correspondence gave the committee the impression the government was planning to use the Women’s

Hospital as part of its maternity hospital scheme.83 As a result, the committee were quite unprepared for the announcement the Women’s Hospital was to be amalgamated with the Children’s and Rockhampton Hospitals.84 The last meeting of the Women’s Hospital committee was held 8 October 1925, where it was noted Mrs Kenna had been nominated as a representative on the

Rockhampton Hospital Board. Regardless of their disappointment at the closing of the Women’s Hospital, it would appear the committee was powerless to resist the change imposed by the government.

Although the Rockhampton Hospital Board took control of the Women’s

Hospital in 1925, it was not until 1930 that the new maternity ward at the

Rockhampton Hospital was ready. In the interim, the Women’s Hospital continued to accept maternity patients and to act as a maternity training school, although general cases were no longer accepted.85 In 1930, patients and equipment were transferred over to the new Lady Goodwin Maternity Hospital on the Rockhampton Hospital site. By 1932, the Rockhampton Hospital Board

82 Women’s Hospital minutes, 16 February 1922, Women’s Hospital folder, ACHHAM, Rockhampton. 83 Women’s Hospital minutes, 9 August 1923, Women’s Hospital folder, ACHHAM, Rockhampton. 84 Women’s Hospital minutes, 15 January 1925, Women’s Hospital folder, ACHHAM, Rockhampton. 85 Chuter, C.E., Assistant Under Secretary Home Office to Director, Division of Tropical Medicine, 4 September 1929, indicated Women’s Hospital had 30 beds, 1 medical officer, 10 nursing staff and that only maternity cases were accepted. Folder A/4730, QSA, Brisbane.

190 had disposed of the land and buildings to reduce its government debt.86

Although the Benevolent Society requested the return of the land upon which the Women’s Hospital was built, it does not appear this was granted.87

Salvation Army Maternity Home

Since the Women’s Hospital was considered by the Rockhampton City Council to be a public institution, there was no requirement to register the Women’s

Hospital as a private hospital. However, the council viewed facilities such as the Salvation Army Maternity Hospital in a very different manner. In 1907, an acre of land was purchased in Talford Street (between Albert and Cambridge

Streets) by the Salvation Army. Upon this land was built a rescue home, called

‘Glenties’.88 The matron was Ensign Lily Gilbert.89 In 1916, the home had accommodation for 30 adults and fifteen infants, and provided work for four

Salvation Army Officers and four employees (see Figure 5.3).90 It is likely a range of needs were met by the home from its inception. Indeed, a number of sources indicate the home provided for ‘destitute, wronged and neglected girls’ until the adoption of their babies could be arranged; ‘incorrigible’ girls; invalid pensioners; and foster babies.91

86 Secretary of Rockhampton Hospital Board to Home Secretary, 20 September 1932, Women’s Hospital folder, ACHHAM, Rockhampton. 87 Home Secretary to Secretary of Benevolent Society, 8 May 1928, folder A/29556, QSA, Brisbane. 88 Hermann, op. cit., p. 91. 89 List of matrons for Glenties as provided by the Salvation Army Heritage Centre, Sydney. 90 Ibid. 91 ‘Salvation Army’s social work. Hospital and Home on the Range’, op. cit.; The War Cry, 23 July 1938, p. 6.

191 Figure 5.3 Salvation Army Rescue Home, Glenties, c. 191392

In 1917 the matron, Catherine Evaneline Walz, applied to the Rockhampton

City Council for registration of the Salvation Army Home as a lying-in hospital.93 However, approval was not provided until Adjunct Elizabeth

Gibson was appointed as matron in February 1918, and re-applied in April.94

Why the original application was not accepted is unknown, although it may have related to the management of the various patients within the home. The

1918 application stated the home consisted of two distinct sections: a private hospital and a section where other services were conducted.95

Whether the Salvation Army was compelled or decided voluntarily to apply for registration as a private lying-in hospital is unclear. Taking in paying patients

92 Salvation Army Maternity Hospital folder, ACHHAM, Rockhampton. 93 CE Walz to Town Clerk, Rockhampton City Council, 28 March 1917, RCC Correspondence F0 – Kn, RCCML, Special Collections, Rockhampton. 94 Salvation Army Heritage Centre; Town Clerk, Rockhampton City Council, to Matron Gibson, 13 April 1918, RCC Correspondence Fi – Ky. 95 Folder 361.7, RDHS, Rockhampton.

192 may have been seen as a way of raising funds in order to supplement the management of other charity work. This lead to the perception the hospital was profiteering rather than acting in a benevolent manner. In 1921, the

Salvation Army applied to the Rockhampton City Council for exemption of rates for the Maternity Hospital, noting such exemption had been granted for its children’s home opened the year before. However, this request was refused.96 In further correspondence, the Salvation Army Financial Secretary from Sydney outlined how the home took in ‘unfortunate girls’, without payment.97 However, the Town Clerk considered the hospital was being run

‘for profit’.98 In 1925, the Salvation Army again asked for relief from rates, this time due to the massive rise in water rates noted in Chapter 4. The

Salvation Army Maternity Hospital rates almost quadrupled from £5.7.0 for

1924 to £21.1.0 for 1925.99 Again, the request was rejected. Financial assistance from the Rockhampton City Council was requested in 1929. The request states the Council was ‘aware of the work we are doing reclaiming and helping many back to lives of purity and honesty’.100 Yet, again assistance was denied, as it was in 1930, when the work of the hospital was outlined as follows:

96 Town Clerk, Rockhampton City Council to Brigadier R Garbutt, Salvation Army, Rockhampton, 8 April 1921, RCC Correspondence Q – Sy, RCCML, Special Collections, Rockhampton; The Way Cry, 31 January 1920, p. 2, notes the opening of the children’s home, ‘Weeroona’, in Rockhampton. 97 Financial Secretary, Salvation Army, Sydney to Town Clerk, Rockhampton City Council, 7 June 1931, RCC Correspondence A – Sy, RCCML, Special Collections, Rockhampton. 98 Town Clerk, Rockhampton City Council to Town Clerk, Brisbane, 20 June 1921, RCC Correspondence Am – City Engineer, RCCML, Special Collections, Rockhampton. 99 Financial Secretary, Salvation Army, Sydney to Town Clerk, Rockhampton City Council, 17 February 1925, RCC Correspondence Saint – Tramway, RCCML, Special Collections, Rockhampton. 100 Commanding Officer, Salvation Army, Sydney to Town Clerk, Rockhampton City Council, 26 August, 1929, RCC Correspondence R’ton Agriculture – State Archives, RCCML, Special Collections, Rockhampton.

193 The facts represented to the Council are as follows:

Although we are registered as a Private Nursing Home, only

a small proportion of our accommodation is devoted to that

purpose, namely two beds. The remainder, 23, are used for

charitable purposes. Our maternity hospitals are primarily

intended to deal with the unmarried mother and her infant.

… in all that we helped last year only seven were private

patients [in Rockhampton].101

It seems incredible the Rockhampton City Council would not have been aware of the work being undertaken by the Salvation Army Maternity Hospital and would require such explicit explanation. However, these refusals to offer financial assistance by the Rockhampton City Council suggest moral judgements were still made regarding who was deserving of charity within some sectors of society. A further possible explanation for the lack of assistance may have been based on denominational differences. There was a large Roman Catholic community within Rockhampton at this time. Indeed, nearly half the schools in Rockhampton were Roman Catholic,102 although the percentage of Catholics on the Rockhampton City Council is unknown. As such, it is possible religious differences may have contributed to the moral judgements being made.

101 Lieut-Colonel Women’s Social Secretary, Salvation Army, Sydney to Town Clerk, Rockhampton City Council, 17 June 1930, RCC Correspondence RA – Sc, RCCML, Special Collections, Rockhampton. Reply denying request, 22 July 1930. 102 POD 1942, p. 328.

194 The Salvation Army appears to have gained more sympathy from the State government. In 1937, it granted the Salvation Army Maternity Hospital in

Rockhampton £2100 for renovations and repairs to the home and to provide for a new six-bed hospital on the grounds adjacent to the home.103 The government, for its part, accepted the majority of the hospital’s work related to the care and attention of girls aged 15 to 23 years of age. These girls were taken into the hospital three months prior to confinement and remained there for six weeks afterwards. After this time, the matron found work for the girls.

The payment received for these girls was the Maternity Bonus of £4.10.0 only.

Furthermore, the hospital tended to the infants until ‘suitable arrangements’

(adoption) could be made.104

In 1938, a new separate maternity hospital, called Bethesda Mother’s Hospital, was opened by the Salvation Army. It offered ten private maternity beds and was distinctly separate from the unmarried mothers section. Each private patient was to be attended by her own doctor.105 Judging from the floor plans of the original maternity hospital (Figure 5.4) and those of Bethesda (Figure

5.5), it is evident the new facility would have been simpler to manage as a private hospital, in terms of infection control and general ward management.

Bethesda was registered as a Class B hospital, that is maternity work only.106

The success of this venture is noted in the 1939/40 statistics gathered by the government which indicated a daily average of 6.35 at a cost of £0.13.3 per

103 Lieut-Commissioner, Salvation Army, Sydney to Minister Health and Home Affairs, 16 December 1937, folder A/31687, QSA, Brisbane. 104 Memoranda: Department of Health and Home Affairs, 3 December 1937, folder A/31687, QSA, Brisbane. 105 The War Cry, 23 July 1938, p. 6. 106 Report: List of private hospitals in Queensland, Department of Health and Home Affairs, 1938/39, folder A/31807, QSA, Brisbane.

195 patient per day. One medical officer was employed, along with three nurses and three ‘other’ (female) staff.107 Furthermore, the Salvation Army reported an income of £1610 for the year, none of which came from the government, and an expenditure of £1540, leaving a small profit.108 Bethesda, of course, could not be considered as a charity activity in itself. Rather, it supported charity work.

Figure 5.4 Floor plan of original Salvation Army Maternity Hospital, c. 1937109

107 Clark, op. cit., p. 23G. 108 Ibid, p. 27G. 109 Folder A/31687, QSA, Brisbane.

196 Figure 5.5 Floor plan of Bethesda, c. 1937110

110 Folder A/31687, QSA, Brisbane.

197 By 1951, Bethesda was the only private hospital in Rockhampton where the licensee was a registered nurse.111 However, the financial viability of this venture appears to have waned by the mid 1950s. In 1954/55, Bethesda continued to offer ten beds and employed one medical officer, four registered nurses and two ‘other’ (female) staff. However, the daily average occupancy was only 2.6 at a cost of £5.14.6 per patient per day.112 Of the total income of

£4103, government aid accounted for £655, with an expenditure of £5507.113

The following year the situation became worse. Although a similar number of patients were seen, the cost of running the hospital had risen to £7.5.7 per patient per day. This left a deficit of £2808 for the year.114 The maternity hospital closed operations by 1957 and the facility became known as Glenties

Rescue Home, which was run by five Salvation Army officers and three employees.115

Nursing at the Salvation Army Maternity Hospital

For many years, a single registered nurse, the matron, provided the nursing at the Salvation Army Maternity Hospital, although she may have had assistance from untrained aides, such as domestic help. The matron needed to find a relief registered nurse and be granted permission from the Rockhampton City

111 QNRB to Director General, Health and Medical Services, 1 September 1951, folder A/38347, QSA, Brisbane. NB the Mater Misericordiae Hospital was registered under MJ Ryan in 1953 (Registrar, QNRB to Secretary, Department Health and Home Affairs, 18 December 1953, folder A/38347, QSA, Brisbane). However, it is unclear who this person may have been as it was not the Matron at the time. Other documents simply state the proprietor of the Mater as ‘Sisters of Mercy’ (Registrar, QNRB to Acting Secretary, Department Public Affairs, 11 January 1939, folder A/38347, QSA, Brisbane). 112 Solomon, S.E., Statistics of the State of Queensland for the Year 1954 – 55, Brisbane, Government Printer, 1955, p. 23G. 113 Ibid, p. 28G. 114 Solomon, 1957, op. cit., pp. 112-113. 115 Salvation Army Heritage Centre, Sydney.

198 Council medical officer before being able to leave the premises.116 All the matrons, and possibly the other nurses, were members of the Salvation Army.

As such they were subject to being transferred within the eastern coast territory of the Salvation Army’s social work, including New South Wales and

Queensland.117 These transfers were normally directed by the Women’s Social

Secretary in Sydney. As members of the Salvation Army, the nurses were provided with a small allowance in addition to their board and lodging. The allowance was dependent on rank, years of service, and marital status.118 In this way the Salvation Army Maternity Hospital was able to keep wages to a minimum. In 1939, the hospital employed three nursing staff, one doctor and three other female staff; with total wages expenditure was only £501 for the year.119 However, it is not clear what position or proportion of these workers were Salvation Army officers or employed from within the community. Nor do the figures indicate if the nurses, aside from the matron, were trained nurses or nursing assistants.

Mater Misericordiae Hospital

The final facility to be considered in this chapter is the Mater Misericordiae

Hospital which opened in Rockhampton in 1915 by the Sisters of Mercy. The hospital was housed in ‘Kenmore Mansion’, a grand residence built in 1894

116 Nurse Aitken and Nurse Clarke, who ran lying-in hospitals each relieved the matron at various times. Matron Gibson to Town Clerk, Rockhampton, 10 April 1922, RCC Correspondence folder Q – S; Dr H Brown to Town Clerk, Rockhampton, 19 July 1929, RCC Correspondence folder Fi – I, RCCML Special Collections, Rockhampton. 117Salvation Army Heritage Centre, Sydney. 118 Ibid. 119 Clark, op. cit., pp. 23G, 35G.

199 originally to house the Governor of the proposed Central Queensland State.120

Indeed, the building was (and is) so impressive, most reports of the Mater seem to focus more on the building than the services it contained (see Figure 5.6).

The nuns paid £1250 for the purchase of the building and four acres, less than a third of the going value.121 The hospital was to be run as a private enterprise, available to all patients regardless of denomination:

Patients will have the right to call in the services of any

doctor they wish, while the Sisters will undertake the

nursing. The Matron will be Miss Adelaide Wilson, a

highly trained and capable nurse. She will have the

assistance of a competent staff.122

Figure 5.6 Mater Misericordiae Hospital, c. 1919123

120 Hayes, T.P., Wright, B.D., Mater Misericordiae Hospital Rockhampton, 1915 – 1990, Rockhampton, Youth Services Press, 1990, p. 4. 121 Morning Bulletin, 6 November 1915, p. 4. 122 Ibid. 123 Hayes and Wright, op. cit., p. 59.

200 The nuns did not keep meticulous records regarding the hospital during the early years of operation, unlike some of the Catholic hospitals of the USA.124

Furthermore, it took a while before issues regarding registration of the hospital with the local authority were finalised. While Adelaide Wilson was appointed initially as the matron, Wilson was not a member of the Sisterhood, nor were any of the Sisters trained nurses.125 Sister M Alphonsos Owens (possibly the

Mother Superior) applied for registration of the Mater Hospital initially in

1915,126 even though other Rockhampton City Council records indicate the hospital was registered in the name of Sister M Berchmans Forrest of the

Convent High School in 1917.127 It does not appear Sister Forrest was a registered nurse, nor did she live on the hospital premises. Why the

Rockhampton City Council ‘overlooked’ these irregularities is a matter of conjecture. In addition, while changes of matron occurred during the first couple of years,128 the Rockhampton City Council does not appear to have been notified of these changes similar to those outlined in relation to the

Salvation Army Maternity Hospital. By 1917, however, Sister Mary Mercy

(Mary Boyan) took up the position of Matron and registration issues were settled.129 Thereafter, a member of the sisterhood filled the position.

124 Nelson, S., Say Little, Do Much. Nurses, Nuns, and Hospitals in the Nineteenth Century, Philadelphia, University of Pennsylvania Press, 2001. 125 Sister Mary Mercy was the only trained nurse of the congregation and she was occupied at the time with St Joseph’s Orphanage at Neerkol, some 15kms away. It should be noted that while Hayes and Wright have provided the ‘official’ history of the Mater Hospital at Rockhampton, it is not clear what sources were used, nor does the information contained in this publication always correspond with other primary source material. 126 Town Clerk, Rockhampton City Council to City Engineer, 23 December 1915, RCC Correspondence Aa – Co, RCCML, Special Collections, Rockhampton. 127 Town Clerk, Rockhampton City Council to Department of Public Health, 13 April 1917, RCC Correspondence Fo – Kn, RCCML, Special Collections, Rockhampton. 128 Hayes and Wright, op. cit., p. 6. 129 It is likely Sister Mary Boyan did not expect to use her nursing qualifications as matron of a hospital. Although she completed her general nurse training at the Brisbane Hospital in 1909, she did not register with the QNRB until 17 January 1917. ATNA Register of Members 1923, op. cit.; QNRB Register of General Nurses, folder A/73216, QSA, Brisbane.

201 The Mater was a nurse training hospital from its inception, with Sister Mary

Borromeo registering with the QNRB in February 1920 after completing four years of training at the Mater. There are only scattered records regarding nurse training at the Mater Hospital prior to 1942, indicating a small number graduated during the early years. Consistent with other Catholic hospitals, 130 early graduates initially came from within the Order, and were gradually outnumbered by lay nurses. Table 5.5 outlines this change in graduates. It is not known what percentage of the permanent staff, that is trained nurses, were nuns, although it is likely this decreased throughout the period under review, as fewer nuns trained at the hospital.

Table 5.5 Graduates from Mater Hospital 1920 – 1934131

Year Sisters Lay Year Sisters Lay nurses nurses 1920 1 2 1930 - 2 1921 1 - 1932 - 1 1925 4 2 1934 - 1

From 1942 to 1958, the Sisters kept more consistent records of trainees. These records reveal not only the small numbers of trainees who graduated each year, but the fluctuating, and often low level of retention among trainee nurses.

Table 5.6 illustrates the percentage of trainees who completed their general certificates for this period. As this table demonstrates, retention rates ranged from 16.7 – 80 percent, with the average for the period being 47 percent. Such a high drop out was not unusual among nurse trainees under the system of

130 Nelson, op. cit. 131 Compiled from QNRB and ATNA new members records.

202 hospital training for much of the twentieth century. Nor was the problem restricted to Australia. Indeed, the Wood Report on retention and recruitment of British nurses in 1948 found an overall ‘wastage’ rate of 38 percent.132 The

Mater’s wastage rate of 53 percent is significantly higher than that cited for the

British study, although compares similarly to New South Wales’ wastage rate in the 1960s.133 Due to the size of the hospital and the small number of graduates, these rates cannot be directly compared. What they do indicate, however, is that the system of nurse training at this time had a significant problem retaining nurses in the various programs.

Table 5.6 Graduates and retention rates of trainees, Mater Hospital 1942 - 1958134

Year Year Retention Year Year Retention commenced completed (percentage) commenced competed (percentage) 1942 1946 1/2 (50%) 1951 1955 2/5 (40%) 1943 1947 1/2 (50%) 1952 1956 3/7 (43%) 1944 1948 1/5 (20%) 1953 1957 5/10 (50%) 1945 1949 4/9 (44.4%) 1954 1958 3/10 (33%) 1946 1950 1/6 (16.7%) 1955 1959 2/4 (50%) 1947 1951 3/6 (50%) 1956 1960 8/10 (80%) 1948 1952 3/4 (75%) 1957 1961 5/9 (56%) 1949 1953 3/6 (50%) 1958 1962 5/7 (71%) 1950 1954 2/8 (25%)

132 Wood, R. (Chairman), The Report of the Working Party on the Retention and Training of Nurses, London, His Majesty’s Stationary Office, 1947. For a fuller discussion regarding conditions of nurse training, and the subsequent wastage rates in Rockhampton, see Madsen, W., Nursing, nurses and their work in Rockhampton, 1930 – 1950. Unpublished Master of Health Science thesis, Central Queensland University, 1998. Other Australian contexts are discussed in: Gregory, H., A Tradition of Care. The History of Nursing at the Royal Brisbane Hospital, Brisbane, Boolarong Publications, 1988; Durdin, J., They Became Nurses: A History of Nursing in South Australia, Sydney, Allen & Unwin, 1991; Russell, R.L., From Nightingale to Now. Nurse Education in Australia, Sydney, W.B. Saunders/Bailliers Tindall, 1990. The quintessential British text is Maggs, C., The Origins of General Nursing, London, Croom Helm, 1983. 133 Russell, op. cit., p. 57. 134 Compiled from records of trainees, Mater Misericordiae Hospital Archives, Rockhampton.

203 As with other Catholic hospitals of Australia and the USA, the Mater Hospital in Rockhampton was not established for charity purposes.135 That is, the poor were not the main focus of the service. Rather it was always run as a business.

Mann Wall136 has found Catholic run hospitals in the USA were managed as businesses with the profits being channelled back into the hospital for expansion of services. To reconcile the apparent anomalies between running a hospital as a business rather than a charity, Mann Wall suggests the nuns’ concept of charity was one of unselfish giving to those in need and that it did not matter whether the recipient paid for the services or not. As the nuns did not personally profit by their actions, the service could be seen as tending to the sick and opening opportunities for conversion to Catholicism, and was therefore consistent with their vows.137 In 1917, the Mater Hospital advertised its fees as £2.2 per week, ‘payable in advance’.138 This mirrors the rate and conditions set by Hillcrest Private Hospital.139

Although the Mater Hospital was regarded as a private hospital, it did not operate in the same manner as other private hospitals. For example, it initially relied on ‘unpaid’ workers, that is nuns, as the main workforce. Furthermore, the Mater received government grants. The government contributed £2000 towards the new Mater Maternity Hospital which opened in 1940.140 No evidence of government money being granted for improvements to other

135 Nelson, op. cit. 136 Mann Wall, B., ‘The pin striped habit. Balancing charity and business in Catholic hospitals, 1865 – 1915’, Nursing Research, vol. 51, no. 1, 2002, p. 51. 137 Ibid, p. 52. 138 Morning Bulletin, 2 July 1917, p. 4. 139 Morning Bulletin, 3 July 1917, p. 4. 140 Sister Mary Raphael to Minister Health and Home Affairs, 30 January 1940, folder A/31819, QSA, Brisbane.

204 private hospitals has been located. The other significant difference was the

Mater would have sought patronage from a wide range of doctors from within the city, similar to nurse-run private lying-in hospitals. As such, the Mater

Hospital cannot be readily classified: it was a private hospital accepting paying patients, but had other characteristics similar to charity facilities, such as staff who were paid low or no wages, and the possibility of accepting non- paying patients.

As mentioned in the previous chapter, Leinster Hospital, which was adjacent to the Mater Hospital, was bequeathed to the Sisters of Mercy in 1939 and became a centre for aged care, Bethany. Although it began with only seven male patients, it grew to contain 38 male and 22 female patients in 1950,141 and up to 72 (47 men and 25 women) in 1954.142 Sister M Assisium (Margaret

Whelan), who had trained at the Mater Hospital, Rockhampton, began working as the only registered nurse at Bethany in 1941 and was assisted by untrained staff for a number of years.143 Indeed, staffing was probably kept to a minimum as the more able male patients helped in the garden, while the female patients assisted with housework, needlework and those more physically dependent.144

141 Sisters of Mercy Archives, folder 327.10, Rockhampton. 142 Morning Bulletin, 26 August 1955, p. 25. 143 Sisters of Mercy Archives, folder 327.10, Rockhampton. 144 Morning Bulletin, 26 August 1955, p. 25.

205 Discussion

The outline provided above of each of the church and charity organisations highlights a number of similarities between the various facilities. These include the focus on traditional feminine concerns such as tending to the elderly, women and children; the role of women in the establishment and ongoing management of the facilities; the importance of philanthropy and the church; and the importance of controlling costs, especially through the use of trainee nurses. However, closer examination of these services, particularly in relation to the nurses themselves, shows a number of anomalies. These include the discrepancy between the motives underlying the provision of some services and the actuality of doing so.

One of the most striking similarities between the services examined in this chapter is the focus on women and children. Indeed, all the services catered for these groups: The Children’s Hospital for children with medical/surgical needs; the Women’s Hospital for maternity and other female adult medical/surgical complaints, as well as sick infants; the Salvation Army

Maternity Hospital for maternity and various children’s needs; and the Mater

Misericordiae Hospital for maternity cases after 1940. As recounted earlier, many late nineteenth century charities in Britain controlled by women had a particular interest in these ‘traditional’ feminine areas. Hence, it is not surprising these services in Rockhampton were also concerned with these needs. However, the needs of the elderly were also addressed by some of the services in Rockhampton, if not to the same extent as the younger age group.

206 The Salvation Army Maternity Hospital emerged from Glenties which catered for a wide range of needs, including the elderly, and was reabsorbed into this work when the maternity hospital was no longer viable. Furthermore, the

Sisters of Mercy branched into aged care after 1940 with the opening of

Bethany. Finally, it needs to be remembered the Benevolent Society continued to cater for aged persons throughout the period under review. However, unlike the services offered to the younger women and children, those meeting the needs of the elderly used few nurses, relying instead on able-bodied patients and unidentifiable ‘employees’, possibly nursing assistants. This is not unlike the situation in many of the poor houses of nineteenth century Britain, where the in-mates attended each other.145 Indeed, the system was adopted in the convict era in Australia.146 Stevens147 purports trained nursing was recognised as important in the management of aged persons from 1877; however, the view to employ trained nurses in aged care institutions was not supported at that time by charities. This thesis would suggest charities maintained a minimalist approach with respect to trained nurses well into the twentieth century.

In relation to maternity services, the role of the midwife in these church and charity groups is not entirely clear, as with the private lying-in hospitals.

Selby148 asserts maternity hospitals run by philanthropic women or church groups usually employed a midwife who delivered the babies, unless the labour

145 Norton, D., The Age of Old Age, London, Scutari Press, 1990, p. 7. 146 Pearson, A., Taylor, B., ‘Gender and nursing in colonial Victoria, 1840 – 1870’, International History of Nursing Journal, vol. 2, no. 1, 1996, pp. 25-45; Cushing, A., ‘Perspectives on male and female care giving in Victoria, 1850 – 1890’, in Bryder, L., Dow, D.A. (eds), New Countries and Old Medicine. Proceedings of an International Conference on the History of Medicine and Health, Auckland, Auckland Medical Historical Society, 1995, pp. 263-293. 147 Stevens, op. cit., p. 23. 148 Selby, op. cit., p. 105.

207 deviated from ‘normal’ when an honorary doctor was called in. The honorary system was certainly utilised in facilities such as the Women’s Hospital, where

Dr Voss was noted to be available 24 hours a day, seven days a week.149

However, the records do not indicate if Dr Voss attended each birth or was available ‘if needed’. Given the demands on Dr Voss’ time (running a surgery and private hospital of his own as well as being a government medical officer), it is likely he did not attend each birth. It is unlikely the midwives at the Mater

Hospital delivered the babies without the presence of the patient’s attending doctor, as this was a private hospital. At the Salvation Army Maternity

Hospital, their own doctors would also have attended paying patients, while the midwife probably attended the unmarried mothers. It is not clear if an honorary system operated at the Salvation Army Maternity Hospital. The records from 1939/40 indicate a medical officer worked at the hospital after

Bethesda was built150. What arrangements were in place prior to this is not known at this stage.

The influence of nineteenth century philanthropy is evident in many aspects of the services, all of which evolved from these ideals: the Benevolent Society began in the early nineteenth century; the Salvation Army has nineteenth century roots in Australia and Britain; the Sisters of Mercy left their cloistered existence in the nineteenth century to serve the sick and the poor.151 One of the defining features of nineteenth century philanthropy was the discernment made regarding the ‘deserving’ and the ‘undeserving’ poor. While this

149 Trotman, op. cit. 150 Clarke, op. cit., p. 23G. 151 Francis, op. cit., p. 172.

208 distinction was often made on moral grounds, Prochaska152 argues much of the issue was related to the pragmatic reality of insufficient funds available to charities to meet all needs. It has been suggested here some of this moral distinction was erased by the early decades of the twentieth century, as the

Women’s Hospital does not appear to have withheld services based on the marital status of the expectant mother seeking help. Digby and Stewart153 claim a change of thinking regarding welfare was evident from the late nineteenth century in Britain, whereby unemployment, poor housing and poverty could not be explained by individual moral shortcomings. However, the taint of immorality, especially relating to unmarried mothers, seems to have lingered, if not within the services themselves, then within the community.

There can be few other explanations as to why the Salvation Army Maternity

Hospital was repeatedly refused rates assistance from the Rockhampton City

Council, when other charities and services received subsidies. The Salvation

Army Maternity Hospital primarily dealt with unmarried mothers, the

‘undeserving’.

Prochaska’s observation regarding the pragmatic realities of running a charity when the needs were great and the supply limited, raises the issue of how committees and groups managed to provide charity services. This chapter has outlined a number of means including fundraising, donations and government grants. However, the less transparent avenue of using profits gained from a paying service for charity purposes has also been illustrated in regards to

Bethesda and the Mater Hospital. The Women’s Hospital actively discouraged

152 Prochaska, op. cit., p. 117. 153 Digby and Stewart, op. cit., p. 3.

209 patients who could afford to pay for private services,154 although it expected those who could pay the nominal fee of one guinea per week, to do so. As such, these paying patients contributed to the overall financial stability of the facility allowing it to cater for those who could not pay. However, Bethesda and the Mater Hospital went one step further, by competing openly within the private hospital market, although any profits gained were channelled back into the respective organizations. Brodie155 proposes many charities in the USA during the early twentieth century began to operate in this way and moved away from the traditional charity model. This was prompted by a number of factors including the changing patterns of private donations and the move towards the operation of nursing services as businesses in order to secure ongoing financial support from within the community.

Philanthropic groups providing nursing services to the wealthy does at first seem an anomaly if one considers charity work in isolation. However, when considered in the context of Christian outreach, such activities make more sense. Mann Wall156 makes the point that the primary aim of Catholic hospitals was to provide an avenue for conversion to Catholicism through the nursing services provided. Although a small number of non-paying patients were accepted, providing charity was more an aside function.

The role of the Christian church was fundamental to many of the facilities and organising committees. The Mater Hospital and the Salvation Army Maternity

154 Trotman, op. cit. 155 Brodie, B., ‘From charity to business: community health nursing, 1900 – 1926’, Nursing Connections, vol. 7, no. 1, 1994, pp. 35-43. 156 Mann Wall, op. cit., p. 56.

210 Hospital were owned and operated by church organisations. As such, they provided an outlet to proselytise and meet their social obligations. The

Benevolent Society was not overtly associated with one particular church, however, it is likely the members of the various committees were regular attendants of Protestant churches as a fundamental aim of the Benevolent

Society was to teach Protestantism as part of its charity function, as indicated earlier in the chapter. As such, it would appear all the services outlined in this chapter linked the provision of nursing services with Christian outreach.

Prochaska157 demonstrates a close relationship between philanthropic activities and church commitment throughout the nineteenth century in Britain. Similar associations have been made in relation to the Australian context.158 However, these do not adequately consider the distinction between those managing a charity and those providing the services. Nor is there sufficient consideration of some of the ulterior motives of nurses involved in these services.

It is important to recognise that while members of the managing committees, such as the Women’s Hospital committee, may have been committed to

Christian outreach through their involvement in fund-raising and decision- making regarding the hospital, these women did not provide the nursing to the patients themselves. In the cases presented here, nursing was the primary function of these services. The nurses themselves, however, were not a homogenous group, nor can it be assumed they were involved in these services for the same reasons as the management committees. This chapter outlines a

157 Prochaska, op. cit. 158 Aspects of the philanthropic/Christian relationship in Australia can be found in the literature. For example, Hyslop, op, cit.; Nelson, op. cit. However, this research has not located any Australian research comparable to Prochaska’s British work.

211 wide range of nursing groups, from assistants in nursing to matrons; yet it is clear not all of these nurses were uniformly motivated regarding their involvement in these church and charity run services. For some nurses, such as the Sisters of Mercy and the officers of the Salvation Army, nursing provided opportunities to fulfil their religious commitments and they may have used these opportunities to ‘spread the word’. Others, however, had specific reasons for their involvement, such as the nurse trainees at the Women’s and

Children’s Hospitals and the Mater Hospital. In these cases, the motivation was the attainment of a nursing qualification. The high attrition rate associated with this training also suggests these women were not strongly committed to a vocation, although the reasons for leaving training were numerous.159 For these nurses, the role of propagating any religious ideals was not appropriate, nor likely to be expected.

Despite these variations in motivation regarding their involvement in these facilities, all nurses were affected one way or another by ideals of nineteenth century philanthropy and vocation. In particular, they willingly worked in these facilities regardless of the pay and living conditions, which allowed the management committees to keep running costs of these hospitals to a minimum. Trainees of the Women’s Hospital paid for the privilege of working for twelve months in exchange for board and lodging (and a certificate); the

Salvation Army Maternity Hospital was staffed by officers of its corps, who were paid a small allowance rather than a wage; and the Mater Hospital had relied heavily on its Sisterhood to undertake the nursing upon opening the

159 Maggs, op. cit.

212 hospital, although this was increasingly transferred to lay trainee nurses, who were paid meagre wages. Furthermore, there was a tendency to use assistants in nursing whenever possible, as opposed to a more highly paid registered nurse. Finally, some facilities contained costs by using the patients themselves.

Nurses displayed characteristics of self-sacrifice in ways other than acceptance of low wages. For example, the 1923 Annual Report of the Women’s Hospital indicates the staff handed over to the committee £40 initially collected towards a piano, but considered more important for the running of the hospital.160 In addition, a sense of self-sacrifice would have been necessary to tolerate the poor standards of nurses’ quarters provided by these facilities. For example, the floor plans of the original Salvation Army Maternity Hospital indicate the nurses slept on the verandah. As such, nurses actively contributed to the ongoing viability of these services by providing the workforce at a minimal cost.

Conclusion

Deane161 argues the traditional role of philanthropy changed during the early part of the twentieth century with charity services having less reliance on volunteers, greater government involvement and a stronger business outlook.

This trend is also evident in the services examined in this chapter. The

Women’s and Children’s Hospitals were completely taken over by the government resulting in the demise of the voluntary management committees.

160 Women’s Hospital Annual Report, 1923, p. 6, Women’s Hospital folder, ACHHA, Rockhampton. 161 Deane, op. cit., p. 138.

213 The Mater Hospital increasingly used laywomen to provide the hands-on nursing and hence decreased the association between proselytising and service provision. Even the Salvation Army Maternity Hospital temporarily competed on the private hospital market as a means of raising funds. In addition, the use of trainee nurses to provide the bulk of the nursing in some services further strengthens this concept of increasing professionalism. A number of these aspects, especially relating to government involvement will be taken up in the next chapter.

This chapter has examined the evolution of church and charity based nursing services and has identified a number of similarities. Firstly, these services had a large number of women involved in the management and provision of nursing services. Secondly, the focus of the services was upon the needs of the aged, women and children. These two factors are consistent with Hyslop’s view that women involved in charity services focussed on traditional feminine domains. The third common factor is that all the services originated from nineteenth century philanthropic ideals of serving less fortunate members of society because of a sense of Christian duty to address the physical and spiritual needs of the poor. Nursing provided an avenue of accomplishing this desire. However, it is at this point divergences are evident. For some of the nurses involved in these services, nursing allowed them to fulfil their religious commitments. These nurses included the Sisters of Mercy and the Salvation

Army officers. For others, working as a nurse within these services was more about gaining a nursing qualification rather than an expression of religious fervour. This is significant because as much of the ‘legend’ of nursing is

214 focused on this concept of vocationalism as the basis of professional nursing – of nursing for the ‘love of it’. This thesis proposes this was only true for some nurses. Despite these differences in motivation, the conditions these nurses worked under were similar and included a number of elements of self-sacrifice consistent with vocational ideals. Thus, nurses contributed to the financial viability of these services. Finally, regardless of the reasons for their involvement, these women acted as agents of charity because theirs were the hands doing the work.

215 Chapter 6

Opening Pandora’s box: nursing and the rise of public

institutions in the Rockhampton district

(P)ublic hospitals, born of humanitarian motives, and

intended mainly to serve the poor, now minister, with

State aid, to a section of the community which is, in a

great majority of cases, neither destitute nor poor.1

Government-supported hospitals have been a reality in Australia since the arrival of the First Fleet. Throughout the nineteenth century, governments provided grants to hospitals that were managed by independent committees.

These allowed those who were not able to afford private avenues of either a private hospital or hiring a private duty nurse, to access some level of health service. However, during the early twentieth century, public hospitals and other institutions came to be seen as an available resource for the broader community. As discussed in Chapter 2, the nationalisation of hospitals was a dearly held ideal of the Labor Party in Queensland from 1905. This chapter looks at the flowering of that ideal and considers the effects of increased governmental activity within public hospitals on the nurses who worked in those institutions. Some of these issues have already been identified in the

1 Australian Medical Association memorandum, September 1941, as cited in Cumpston, J.H.L., The Health of the People. A Study of Federalism, Canberra, Roebuck Society Publications, 1978, p. 94.

216 previous chapter in regards to the Women’s and Children’s Hospitals. This chapter will expand on these and incorporate the other public health institutions in the Rockhampton region. What emerges is that despite the increased level of government activity and the rise of public hospitals as the bastion of professionalising nurses, untrained nurses continued to play a significant role in the delivery of health services.

The hospitals and institutions explored here represent the range of institutions evident within the wider Australian society during the early twentieth century: from voluntary hospitals (Mount Morgan Hospital), to publicly instigated and funded facilities such as Westwood Sanatorium. In between, there were a range of hospitals initially run by community-minded citizens who relied on a range of income sources, although primarily government funded, which were

‘taken over’ by the government. These include the Yeppoon Hospital and the

Rockhampton Hospital, which incorporated the Children’s Hospital and the

Women’s Hospital in 1925 as discussed in the previous chapter. Nurses constituted the bulk of employees in all these institutions. As such, their roles and responsibilities were affected by the day-to-day management of these facilities as well as by the changing demands made upon the facilities by the community. This chapter will explore the various roles of nurses within public institutions as these changing demands evolved. Before examining each of the institutions in turn, I will expand on the relationship between voluntary and government contributions to welfare services, as alluded to in the previous chapter.

217 Welfare provision in Western countries consists of three segments: family, voluntary and statutory. Throughout the twentieth century, the contribution of family has remained relatively unchanged, while the balance between the voluntary and the statutory sectors has altered, with a decreasing level of charity activity.2 In Australia, the level of government funding has always been high due to the nature of white settlement in this country. Indeed, the

1862 Victorian Commission found 75 percent of building and maintenance costs of hospitals were born by the government.3 However, the hospitals were still considered to be ‘voluntary’ institutions – both by the public and by the hospital committees who ran them. As Trembath and Hellier4 point out, the paradox of this situation was that while the State provided the majority of funds, it had little involvement in the running of the hospitals; its interference being seen as a threat to private benevolence. Hence, the façade of the voluntary system remained until the early twentieth century. That is, hospitals were run by committees of volunteers and perceived to be supported financially from within the community through fund raising and subscriptions.

A similar situation was evident in Queensland. Selby5 reports that Charles

Chuter, the Chief Clerk of the Home Office, who took over management of the

Brisbane and South Coast Hospital Board’s finances in 1917 and became

Chairman in 1924, was in the unique position of being involved in the public service as well as in the management of a hospital. This situation was forced

2 Lewis, J., ‘Gender and welfare in late nineteenth and early twentieth centuries’, in Digby, A., Steward, J. (eds), Gender, Health and Welfare, London, Routledge, 1996, p. 213. 3 Trembath, R., Hellier, D., All Care and Responsibility. A History of Nursing in Victoria 1850 – 1934, Victoria, The Florence Nightingale Committee, Australia, Victoria Branch, 1987, p. 10. 4 Ibid., p. 11. 5 Selby, W., ‘Motherhood and the Golden Casket: an odd couple’, Journal of the Royal Historical Society of Queensland, vol. 14, 1992, p. 408.

218 upon the government, as the voluntary system in the south east of the State had collapsed leaving the government with little choice but to step in.6 As such,

Selby7 suggests it was probably Chuter who was responsible for much of the development of Labor’s hospital and health policies during the 1920s and particularly the appropriation of the Golden Casket fund for hospital and health services. The government may have been forced into this situation through financial necessity; however, these moves were consistent with Labor’s policies regarding health reform and the push to improve the health of the white population as discussed in Chapter 2.

Despite the inevitability of increased government involvement, the suspicion of government interference remained until at least the 1940s in many States. Ives and Mendelsohn, commenting on the contemporary New South Wales Thomas

Report in 1940, warned that ‘hospital taxation is the death-knell of the voluntary contribution system, and probably, too, of the charitable gift or bequest’.8 What is evident throughout this chapter is the Queensland government’s role, both in providing finances and administrative support, significantly increased throughout the period studied. However, the case studies outlined below illustrate considerable consistency in many aspects of nursing throughout this period. Indeed, most changes related to industrial conditions rather than direct government intervention. While some changes regarding the roles and responsibilities of the matrons and trained nurses

6 Gillespie, J., ‘Medical markets in Australian medical politics, 1920 – 45’, Labour History, no. 54, 1988, p. 39. 7 Selby, op. cit., p. 408. 8 Ives, W., Mendelsohn, R., ‘Hospitals and the State: the Thomas Report’, The Australian Quarterly, vol. 12, no. 3, 1940, p. 51.

219 resulted from government action, the work of the trainee remained the same.

These roles and responsibilities will be explored later in the chapter.

Rockhampton Hospital

In the same year Rockhampton was proclaimed as a town, the first hospital opened in a small building near the river.9 As this initial site was prone to flooding, the hospital was eventually established in 1869 on the Athelstane

Range.10 Although promised funding, the procrastination of the government forced the hospital committee to act independently to initiate the new hospital.11 Between 1906 and 1911, the daily occupancy for the hospital was

50.6 and rose to 74.5 for the year 1912/13 after a number of capital works were completed, including additions to the wards. Table 6.1 outlines the daily occupancy rates over the years 1915 to 1926. This table illustrates the relative stability in patient numbers over this period, although there seems to have been an unexplained increase in numbers during the early 1920s. Interestingly,

1919, the year of the Spanish Influenza, was not the year with the highest through-put, although the occupancy rate of 99.8 for July of that year, the peak of the influenza, highlights how the resources at the hospital were strained,

9 McDonald, L., Rockhampton. A History of City and District, St Lucia, University of Queensland Press, 1981, p. 19; Carment, D., Killion, F., The Story of Rockhampton Hospital and Those Other Institutions Administered by the Rockhampton Hospital Board, 1868 – 1980, Rockhampton, Rockhampton Hospitals Board and Queensland Department of Health, 1980, p. 2. 10 Hospital and Medical Services. Ryan Papers: Hospitals, 1955, folder C362.11, RDHS, Rockhampton. 11Carment and Killion op. cit., p. 3.

220 especially since the majority of the nursing staff were affected by the infection.12

Table 6.1 Average daily occupancy for Rockhampton Hospital 1915 – 192613

Year Daily Occupancy Year Daily Occupancy 1915 63.85 1921 87.56 1916 64.42 1922 83.55 1917 73.71 1923 87.64 1918 82.06 1924 72.4 1919 81.69 1925 70.85 1920 83.2 1926 75.59

In 1925, the Rockhampton Hospital Board was constituted and assumed control of the Rockhampton Hospital, Children’s and Women’s Hospitals. The

Board was responsible for the largest geographical district in Queensland, some 20 074 square miles. It contained the second highest number of beds within its district, 251, providing a relatively high proportion of beds per head of population. Table 6.2 compares various districts throughout Queensland.

12 Rockhampton Hospital Medical Superintendent’s Report, July 1919, ACHHAM, Rockhampton. 13 Compiled from Rockhampton Hospital Medical Superintendent’s Reports, 1915 – 1926, ACHHAM, Rockhampton.

221 Table 6.2 Hospital districts in Queensland, c. 192814

Hospital District Area (square Population Number of No. of beds per miles) beds 1000 population Brisbane 2229 306 248 688 2.24 Bundaberg 3450.5 23 242 188 8.1 Cairns 682.25 15 000 106 7 Maryborough 3311.25 22 568 136 6 Mackay 5578 20 050 82 4 Gympie 1642 24 451 58 2.4 Rockhampton 20 074 44 370 251 5.6 Toowoomba 5041.5 58 227 166 2.85 Townsville 3571 39 800 153 3.8

Although the bulk of beds within the Rockhampton Hospital were for ‘public’ patients, the Rockhampton Hospital did provide for a small number of private patients from 1916, allowing both the medical superintendent and other doctors in the town to use these facilities for paying patients.15 When the Lady

Goodwin was opened in 1930, private maternity rooms were also available.

The Medical Superintendent noted in 1932 that 40 private maternity cases had been attended in 1931, while 166 maternity patients were admitted to the public wards.16

The use of the services offered by the Rockhampton Hospital continued to grow. A hospital inspection in 1949 documented the allocation of beds within the Rockhampton Hospital (see Table 6.3), indicating there were 172 beds throughout the hospital, although in 1944 the bed number had been reported as

14 Memorandum: Department of Home Affairs, circa 1928, folder A/31612, QSA, Brisbane. 15 Rockhampton Hospital Medical Superintendent’s Report, November 1916, ACHHAM, Rockhampton. 16 Report: Medical Superintendent to Rockhampton Hospital Board, 14 January 1932, folder A/29556, QSA, Brisbane.

222 high as 230.17 The obvious omission in services provided by the Rockhampton

Hospital throughout the period under review is that of psychiatric services.

Indeed, these were not established in Rockhampton until 1962.18 Patients with mental health problems were held briefly in a cell in the Rockhampton

Hospital before being transferred to one of the psychiatric institutions around

Brisbane.

Table 6.3 Allocation of beds at the Rockhampton Hospital 194919

Ward Beds Male Surgical 24 beds + 6 on verandah Male Medical 24 beds + 8 on verandah Female 13 medical/surgical beds (9 on enclosed verandah, 4 on open verandah). Old women’s ward of 10 beds Children’s 17 beds + 11 on verandah Private 12 patient rooms Nurses’ Sick Bay 4 beds Isolation 10 beds Maternity 1 x 12 bed public ward, 1 x 6 bed public ward, isolation ward of 3 beds, one observation ward, nursery, premature babies ward, 12 private rooms.

17 Report: Department Health and Home Affairs regarding nursing and domestic staff in Queensland public hospitals, 30 June 1944, folder A/31807, QSA, Brisbane. 18 Carment and Killion, op. cit., p. 19. 19 Report: Hospital Inspector to Department of Health and Home Affairs, 16 November 1949, folder A/25960, QSA, Brisbane. NB This table accounts for 172 beds not the reported 230 beds. The miscalculation of beds continued in 1955 when the Morning Bulletin claimed 230 beds were available, although the breakdown added up to only 200. Morning Bulletin, 26 August 1955, p. 14.

223 Prior to the establishment of the Rockhampton Hospital Board, the

Rockhampton Hospital was managed by a (male) committee of Rockhampton citizens. Carment and Killion document the success of the fund raising measures of ‘the ladies’, particularly an annual fete.20 Hence, it would appear the Rockhampton Hospital committee conformed to traditional norms of benevolent roles and activities. Furthermore, the hospital’s work in the 1890s met the needs of ‘very large numbers of deserving sick poor’,21 implying the hospital’s charity work also conformed to notions of who should receive such services, as discussed in Chapter 5. It is not intended here to outline the fluctuating relationship the committee had with the government over funding.

This has been adequately documented by Carment and Killion, who indicate the government seems to have made annual endowments to the hospital well before the turn of the twentieth century and that funding was often problematic and came from a variety of sources.

The Rockhampton Hospital Board met for the first time on the 27 November

1925 and was established in accordance with the Hospitals Act of 1923 which provided a more stable income for hospitals.22 Under this agreement, the board’s finances came first from the contributors, with the shortfall being made up of 60 percent from the State government and 40 percent from the local authorities. Interestingly, Carment and Killion23 suggest the Rockhampton

Hospital Committee instigated the board because they realised they could not

20 Carment and Killion, op. cit., p. 6. 21 Ibid, p. 5. 22 Patrick, R., A History of Health and Medicine in Queensland 1824 – 1960, St Lucia, University of Queensland Press, 1987, pp. 75-76. 23 Carment and Killion, op. cit., p. 9.

224 continue to independently fund their activities, although do not mention consultation with other hospitals, as mentioned in the previous chapter.

Fees continued to be charged by the institutions under control of the board, although these accounted for little in comparison to the contribution of the government. In 1926/27, £3 457.4.0 (14.5%) was collected by the board, while the contribution of the State and local governments amounted to £20 297.12.4

(85.5%).24 In 1944, the State government assumed all financial responsibility.25 This coincided with an increased demand for services by the public.26 According to Strachan,27 the number of patients being treated in public hospitals in Queensland increased ten percent by the late 1940s after

‘free’ treatment was introduced, while nursing staff decreased by six percent as a result of post war shortages.

Nursing at the Rockhampton Hospital

Nurse training was instigated at the Rockhampton Hospital from an early stage.

Mary Jane Hood completed her three year general training at the Rockhampton

Hospital in March 1888, some eight months before the first graduates from the

(Royal) Brisbane Hospital. By April of that year, Hood was appointed as

Matron, a position she held until 1906.28 The hospital became affiliated with the Australasian Trained Nurses’ Association (ATNA) in 1901 and offered a

24 Ibid, p. 11. 25 Patrick, op. cit., p. 77. 26 Carment and Killion, op. cit., p. 15. 27 Strachan, G., Labour of Love. The History of the Nurses’ Association in Queensland 1860 – 1950, St Leonards, Allen & Unwin, 1996, p. 196. 28 Morning Bulletin, 4 March 1989, p. 12.

225 three-year training program. This increased to four years in the early 1920s, although reverted temporarily to three years in response to nursing shortages at the end of WWII.

As was common practice for most of the twentieth century in nurse training hospitals, the bulk of the nursing staff consisted of trainees.29 In 1907, 12 of the 15 nurses employed at the Rockhampton Hospital were trainees (4:1 ratio).30 By 1922, the number of trainees stood at 32.31 This number rose in

1941 to 63, overseen by 14 trained staff.32 This ratio of 4.5 trainees to each trained staff is only slightly higher than that noted in 1907 and is not dissimilar to ratios noted in British voluntary hospitals of 2.1 to 4.7 trainees for every trained nurse.33 This proportion of trainees to staff, however, was criticised in

1942 by a British nurse, who recommended a ratio closer to 2:1 as being more conducive to the trainee being able to adequately attend other requirements of training such as lectures and study in addition to the time spent working on the wards.34 Of equal importance to the trainee’s experience was the proportion of patients to nursing staff. In 1944 there were 87 nursing staff employed at the

Rockhampton Hospital to manage a daily average occupancy of 142.63 (1.67 patients per nursing staff).35 This shows a significant improvement in the

29 Pavey, A., ‘Post-war reconstruction of schools of nursing’, The Australasian Nurses’ Journal, vol. 40, no. 5, 1942, p. 75. 30 Kelley, Y., ‘Rockhampton nurses’, Recreating Queensland Nurses, Queensland Nursing History Conference, August 1994, Brisbane. 31 Rockhampton Hospital Medical Superintendent Report, December 1922, ACHHAM, Rockhampton. 32 Report: Department of Health and Home Affairs, 9 December 1941, folder A/31807, QSA, Brisbane. 33 Maggs, C., The Origins of General Nursing, London, Croom Helm, 1983, p. 104. 34 Pavey, op. cit., p. 76. 35 Report: Department of Health and Home Affairs, 30 June 1944, folder A/31807, QSA, Brisbane.

226 staff/patient ratio over the first four decades of the twentieth century. In 1907, there were 3.37 patients per nursing staff at the Rockhampton Hospital. 36

The Medical Superintendent’s monthly reports to the hospital committee between 1916 and 1927 show the nursing staff was in a constant state of flux.37

Each month one or two nurses were appointed as trainees or resigned. Trained staff also changed fairly regularly. Although the reasons for departures were not often provided, ill health and marriage seem to have predominated. For example:

On her return from holidays, Nurse Tait gave one month’s

notice on account of her having been married during her

vacation. Under the circumstances, I dispensed with the

usual month’s notice and Nurse Tait did not resume duty.38

This entry raises a number of issues. Firstly, it illustrates the importance of the

Medical Superintendent in relation to nursing staff. Although Nightingale advocated a system of nursing that promoted independence of the matron and nursing staff, this was often not realised. Whether there was any consultation between the doctor and the matron in regards to Nurse Tait’s resignation is not known. Secondly, the immediacy of Nurse Tait’s dismissal based on her marital status suggests two things: that staffing could be easily adjusted to account for Nurse Tait’s unplanned absence; and that married nurses were not

36 Kelley, op. cit. 37 Rockhampton Hospital Medical Superintendent Reports, 1 September 1916 – September 1927, ACHHAM, Rockhampton. 38 Ibid, July 1917.

227 tolerated under any circumstances. This reluctance to consider married nurses continued for most of the century. Indeed, only an extreme shortage of nurses in 1946 forced the hospital to accept, on a temporary basis, part time married nurses.39 Other research suggests it was not until the mid 1970s before this nursing resource was used by the Rockhampton Hospital on a regular basis.40

Thus, nursing reflected the social norms that discouraged married women from the workforce.

Nurses were accepted to commence their training throughout the year after completing three months probation. This allowed the hospital to quickly adjust staff to meet demands by employing new trainees with no nursing experience.

For example, the ‘trial’ of providing private wards in 1917 was deemed a success in November, requiring extra nursing staff, who commenced the following month.41 Table 6.4 illustrates this constant movement of staff in and out of the hospital between 1916 and 1927 as described by the Medical

Superintendent reports. As can also be seen from this table, the number of nurses graduating from the hospital fluctuated considerably, further demonstrating the high level of attrition from nurse training programs as discussed in the previous chapter. By the 1940s, around ten nurses graduated each year from the Rockhampton Hospital.

39 Undersecretary, Department Public Health to Undersecretary, Department of Health and Home Affairs, 5 November 1946, folder A/25960, QSA, Brisbane. This letter indicates there were only 2 midwifery trainees instead of the usual 12. 40 Madsen, W., ‘Private duty nursing: the last days in central Queensland’, Collegian, vol. 11, no. 3, 2004, pp. 34-38. 41 Rockhampton Hospital Medical Superintendent Reports, 1 November 1917; 15 December 1917, ACHHAM, Rockhampton.

228

Table 6.4 Movement of nursing staff at Rockhampton Hospital 1916 – 192742

Year Commenced Resigned Graduated 1916 1 - 6 1917 3 1 - 1918 4 4 2 1919 - 2 - 1920 7 3 2 1921 16 4 7 1922 8 1 4 1923 11 3 1 1924 1 2 - 1925 3 1 2 1926 13 3 - 1927 11 5 2

In 1925, the nursing staff were brought under the new Nurses’ Award.43 This necessitated the increase of up to two nursing staff as a result of the limited hours (44 hours per week) to be worked by nurses.44 Prior to the first nurses’ award in 1921, trainees were expected to work twelve-hour shifts with a single afternoon off per month.45 The first nurses’ award stipulated nurses could work more than 112 hours per fortnight, inclusive of meals and could work no more than 10.5 hours consecutively.46 This allowed nurses three days off per fortnight. While public hospital nurses were gaining better working conditions, those in private hospitals during the same time were often still working under archaic systems. One New South Wales nurse reported private

42 Compiled from Rockhampton Hospital Medical Superintendent Reports, 1 September 1916 – September 1927, ACHHAM, Rockhampton. NB This table uses figures included in the reports, however, it is recognized the figures do not balance. That is, the number of resignations and graduations do not tally with the number of commencements. 43 Rockhampton Hospital Medical Superintendent Reports, August 1925, ACHHAM, Rockhampton. 44 Ibid., Strachan, op. cit., p. 118. 45 Obituary Maud Green, source unknown, ACHHAM, Rockhampton. 46 ‘Queensland Nurses’ Award’, The Australasian Nurses’ Journal, vol. 19, no. 7, 1921, p. 220.

229 hospitals in 1919 still expected nurses to have four hours off per week during which lectures were to be attended, and only one day off per month.47

However, the reduced hours were only temporary and were increased to 96 hours per fortnight in 1930 as a result of the Depression.48 Nurses in

Queensland public hospitals again achieved a 44-hour week in 194749 and in

1955 nurses were provided with a ten-minute ‘rest-pause’ (morning or afternoon tea) during a shift.50

Yeppoon Hospital

The Yeppoon Hospital began as a result of a gift from another township,

Mount Chalmers, also in the Rockhampton district. In 1912, £1200 had been raised within the town of Mount Chalmers for the purposes of a hospital.

Unfortunately, a week prior to the planned opening of the hospital, the gold mine, the main industry of the town, closed. Hence the hospital was never used by this township.51 In 1917, it was decided by the Mount Chalmers committee to donate the hospital and the remainder of the funds (£300) to the

Rockhampton Committee, on the condition the building was located at

Yeppoon as a convalescent home.52 The Yeppoon Convalescent Home opened in July 1917, on 1.5 acres donated by the Livingstone Shire Council,53 and consisted of two wards, an operating room, dispensary, matron and nurses’

47 Letter to Editor, The Australasian Nurses’ Journal, vol. 17, no. 2, 1919, p. 51. 48 QATNA minutes, The Australasian Nurses’ Journal, vol. 28, no. 12, 1930, p. 318. 49 QATNA Annual General Meeting minutes, The Australasian Nurses’ Journal, vol. 45, no. 12, 1947, p. 295. 50 Carment and Killion, op. cit., p. 18. 51 The Central Queensland Herald, 3 November 1932, p. 54. 52 Ibid. 53 The Morning Bulletin, 6 July 1917, p. 10.

230 quarters, kitchen and two bathrooms.54 Nurse Lucy was appointed Matron and her husband worked as a wards man.55

In 1922, the Rockhampton Hospital Committee decided to close the Yeppoon

Convalescent Home because it had incurred significant debt.56 The Yeppoon residents objected and convinced the Rockhampton Hospital Committee to hand over the building to a local committee in exchange for the £800 owing.

This condition was met in a few weeks, with £270 coming from town residents and the remainder from the government.57 This was a remarkable achievement for such a small community.58 The facility was then renamed the Yeppoon

District Hospital. The rules of the hospital indicate its objective was to provide medical and surgical aid to indoor and outdoor paying and non-paying patients and that the institution was to be supported by voluntary contributions

(subscriptions), patient fees and where possible, government aid.59 When the committee learned the Yeppoon Hospital was to be incorporated into the

Rockhampton Hospital Board in 1925, they had a credit of £1203 on their accounts. Thus, as a voluntary hospital, the Yeppoon Hospital was quite successful. These funds were quickly spent on improvements to the hospital, such that only £30.1.1 was handed over to the Rockhampton Hospital

Committee when it assumed control a few months later.60

54 The Morning Bulletin, 9 July 1917, p. 9. 55 Hospital and Medical Services. Ryan Papers: Hospitals, 1955, folder C362.11, RDHS, Rockhampton. 56 The Central Queensland Herald, 3 November 1932, p. 54. 57 Ibid. 58 The population of Yeppoon in 1911 was 639, and in 1933 was only 1598. Cosgrove, B., Yeppoon, Central Queensland 1867 – 1939: Establishment and growth of a seaside holiday resort. Unpublished Masters of Letters thesis, University of New England, 1984, pp. 57, 87 respectively. 59 The Central Queensland Herald, 3 November 1932, p. 54. 60 Ibid.

231

Prior to 1922, Rockhampton Hospital trainee nurses were sent to Yeppoon to assist on a rotational basis.61 However, under the Yeppoon Hospital

Committee, the nursing staff consisted of the matron and one other trained nurse.62 The role of the matron was quite extensive and included not only overseeing the nursing of patients, but also quite significant administrative functions as was normal for matrons of this time.63 Figure 6.1 outlines these responsibilities. Furthermore, as a small hospital, the Nurses’ Awards did not apply and the staff continued to work unregulated hours.64 In 1930, a private ward of five rooms was erected and the public wards were expanded from four beds to eight beds each (see Figure 6.2). This meant the hospital could cater for sixteen general public patients, five private patients and six maternity cases.65 Staff also increased and consisted of the doctor, matron, one sister, five assistants in nursing and a small number of auxiliary staff (cook, laundress, yards man). The staffing and bed numbers appear to have remained fairly constant throughout the period under review after this date. By the early

1940s, one matron, one sister and six assistants in nursing were employed, and the domestic staff had increased to five, while the daily average occupancy was

61 Rockhampton Hospital Medical Superintendent reports, for example, November 1917: Nurse Mitchell went to Yeppoon; January 1918, Nurse Haines returned from Yeppoon, Nurse Reaney at Yeppoon, ACHHAM, Rockhampton. 62 ATNA Register of Members 1923, Sydney, Eagle Press, 1923 notes C.R. McKechnie at Yeppoon Hospital in addition to Matron Dowling. POD 1923/24, p. 510 notes Matron Dowling and Sister Bowker at Yeppoon Hospital. 63 For example see Harloe, L., ‘Matron McCarroll of Cairns Base Hospital during World War 2’, Queensland Nurses – at War and on the Home Front, 1939 – 1945, Queensland Nursing History Conference, August 1995, Brisbane. 64 Strachan, op. cit., p. 107. 65 Secretary, Rockhampton Hospital Board to Undersecretary, Home Office, 19 August 1929, folder A/4740, QSA, Brisbane.

232 around 10.66 In 1949, the hospital had 28 beds (10 male public, 8 female public, 5 private, 3 public maternity, 2 private maternity).67

Figure 6.1 Responsibilities of Matron, Yeppoon Hospital, 192268

• The Matron shall be a trained, certificated, qualified nurse holding a QNRB or ATNA certificate and shall be directly under the control of the Medical Officer • She shall have responsibility for the discipline of staff • She shall see that all such articles as can be made or mended on the premises are so made and mended • She shall be responsible for the cleanliness of the hospital, including the operating room and all appliances and instruments therein • Unless she has obtained permission from the Medical Officer, she shall not be absent from the town of Yeppoon for more than three hours • She shall have charge of properties, provisions kept in stock and shall examine all goods and provisions as they are delivered by the supplier to see if they are suitable. She shall refuse to take delivery of and return to the supplier articles of inferior quality. She shall check all bills for provision delivered and initial same when correct and pass them to the secretary without delay • In case of extreme danger or the death of a patient, she shall use every endeavour to inform the relatives and friends of the patient, also a Minister of Religion if required by the patient • She shall obtain from the patients their wishes as to class of ward they require and shall in return submit to patients the fullest of particulars of their liabilities for treatment therein • She shall issue to all private and paying patients a final account prior to their discharge • She may receive any donations to the institution and also accept payment for treatment, she shall issue a receipt and account for all such money’s to the secretary • She shall advise the secretary of all donations received in money or kind in order that he may suitably acknowledge same • The Matron shall give the committee one months notice of her intention to resign her position and accept similar notice from them.

66 Report: General training of nurses in Queensland, Department of Health and Home Affairs, 9 December 1941, folder A/31807, QSA; Report: Department of Health and Home Affairs, 30 June 1944, folder A/31807, QSA, Brisbane. 67 Report: Inspector of Hospitals, Department of Health and Home Affairs, 30 September 1949, folder A/29560, QSA, Brisbane. 68 Kelley, Y., ‘The Yeppoon Hospital’, unpublished paper, 1998, Yeppoon Hospital folder, ACCHAM.

233 Figure 6.2 Floor plan of Yeppoon Hospital, 193069

69 Folder A/29556, QSA, Brisbane.

234 Westwood Sanatorium

On 6 September 1919, a large crowd of 2000 gathered at the site of the

Westwood Sanatorium, some 30 miles (50 kms) west of Rockhampton, for the official opening of the facility.70 The instigation of the sanatorium is generally related to the visitation of the Westwood site by members of parliament when they attended the Labor in Politics convention in Rockhampton in 1917.71 A group travelled out to Westwood, which was connected to Rockhampton by rail, and noted the temperature was significantly cooler than Rockhampton. At this time, patients requiring admission to sanatoria were waiting for up to six months before being accepted. In particular, the problem of miner’s phthisis was prevalent in nearby Mount Morgan. However, the idea of establishing a sanatorium in the Rockhampton district can be dated to 1911 when Dr Fred

Woolrake, a Health Officer for the Department of Public Health, undertook an inspection of a number of potential sites, including ‘Canomie’ at Tanby (near

Emu Park), as well as Westwood.72 Woolrake considered ‘Canomie’ too close to the ocean for the treatment of consumptives and therefore recommended the

Westwood site. Why nothing was acted upon until 1917 is not clear, although it is possible the First World War interrupted plans.

70 The Capricornian, 13 September 1919, p. 46. 71 For example, Hock, I., ‘Medical care at Westwood’, unpublished paper, folder C362.11, RDHS, Rockhampton; Hospital and Medical Services. Ryan Papers: Hospitals, 1955, folder C362.11, RDHS, Rockhampton. 72 Dr Fred Woolrake to Commissioner Public Health, 24 November 1911, folder A/4741, QSA, Brisbane.

235 The sanatorium cost the government £20 000 to erect and was declared ‘one of the finest institutions of the kind in the Commonwealth’.73 Ten buildings in all were erected for the facility, laid out according to Figure 6.3. These separate buildings were mostly joined by covered walkways. Early photographs show the site as devoid of any vegetation, thereby necessitating covered areas (See

Figure 6.4).

Figure 6.3 Plan of Westwood premises, 191974

73 The Capricornian, 13 September 1919, p. 46. 74 Folder A/4721, QSA, Brisbane.

236 Figure 6.4 Westwood Sanatorium, 191975

The sanatorium accommodated 64 patients. Preference was given to patients with miner’s phthisis and consumptive cases, while other chronic cases such as paralysis were also considered.76 Although distinction was made between phthisis and consumption at this time, these were various terms for tuberculosis infections. By the 1930s these terms ceased to be used. There was no cure for tuberculosis until the introduction of antibiotics in the late 1940s, although cases detected early, often by X-ray,77 were considered curable. The mainstay of treatment was prescribed rest, that is, rest taken at stipulated hours; fresh air; sunshine and good food. Indeed, even when more active medical intervention was possible in the 1930s and 1940s, such as artificial pneumothorax

(collapsing a lung), rest continued to be prescribed.78

75 Folder A/4720, QSA, Brisbane. 76 The Capricornian, 6 September 1919, p. 31. 77 Roche, H., ‘Tuberculosis’, The Australasian Nurses’ Journal, vol. 51, no. 3, 1953, p. 48; Hughes, J., ‘Pulmonary tuberculosis’, The Australasian Nurses’ Journal, vol. 35, no. 4, 1937, p. 75. 78 Hughes, J., ‘A broadcast of tuberculosis’, The Australasian Nurses’ Journal, vol. 35, no. 12, 1937, p. 254.

237 An instruction booklet for patients at Westwood Sanatorium, circa 1945, indicates patients were graded from one to ten, according to the amount of activity allowed.79 Grade one was complete bed rest. Grade two allowed toilet and bathroom privileges. A grade three patient could sit out of bed for 30 minutes a day. Each grade allowed a slight increase in activity until grade ten when the patient could be up from 6.30 am to 9 pm except for rest periods.

Table 6.5 outlines these rest periods. Rest periods meant the patient could not talk, or engage in any activity that required sitting up.

Table 6.5 Prescribed rest periods at Westwood Sanatorium80

After breakfast 8.15am – 9.00am Before lunch 11.00am – 12.00noon After lunch 12.45pm – 3.30pm Before tea 4.30pm – 5.00pm After tea 5.45pm – 6.30pm

Patient numbers seem to have been relatively stable for most of the early years of the sanatorium, although the facility rarely ran to full capacity despite a number of reported bed shortages for tuberculosis cases.81 This was because the structure of the facility allowed equal numbers of beds for men and women.

However, men consistently outnumbered women (See Table 6.6). The close proximity of Mount Morgan and the prevalence of consumption associated with mining would have contributed to this imbalance because tuberculosis as a disease was not gender specific. Hainsworth suggested more men died from tuberculosis than women after the age of 25 years, while more women were

79 Instructions for Patients and Visitors, Westwood Sanatorium, ACHHAM, Rockhampton. 80 Ibid. 81 For example, Dr Blackburn to Undersecretary, Department Health and Home Affairs, 15 January 1938, folder A/4720, QSA, Brisbane.

238 more affected before this age.82 In 1940, Dr Blackburn, the medical superintendent, reported a waiting list of 26 male patients who could not be accommodated, despite an overall availability of beds.83 It would have been inconceivable to have had men in the female ward. Eventually the problem was resolved with increased accommodation for tuberculosis patients in the south east of Queensland, leaving only 19 patients at Westwood in 1945.84

Table 6.6 Inpatients of Westwood Sanatorium 1923 – 194185

Year Males Females 1923 32 15 1926 30 19 1929 32 13 1930 38 12 1933 39 18 1934 39 17 1938 63 27 1940 47 19 1941 42 17

At this point, the government decided to transfer the management of the facility to the Rockhampton Hospital Board, which undertook significant improvements and repairs to the aging buildings costing £37 000.86 The facility still treated some tuberculosis cases; although it is likely the majority were ‘incurable cases’ of diverse origin.87 The Federal and State governments’

82 Hainsworth, M., Modern Professional Nursing, Volume 4, London, The Caxton Publishing Co., 1949, p. 421. 83 Dr Blackburn to Undersecretary, Department of Health and Home Affairs, 15 January 1938, folder A/4721, QSA, Brisbane. 84 Hock, op. cit. 85 Compiled from Medical Superintendent reports, 1926 – 1941, Westwood file, Centre for the History of Remote and Rural Nursing, Central Queensland University, Rockhampton; Home Department to Minister of Railways, 12 February 1923, folder A/4721, QSA, Brisbane. 86 Report: Department of Health and Home Affairs, circa 1945, folder A/4721, QSA, Brisbane. 87 Ibid.

239 tuberculosis prevention programs and more effective chemotherapy treatment for this disease saw a dramatic decrease in the number of tuberculosis cases by the mid 1950s. In 1955, it was decided to convert the Westwood institution to an aged persons’ home, with a capacity of 120 beds.88 The facility ceased operations in 1984 and the buildings were demolished in 1992.89

Although Westwood was initially outfitted with modern facilities such as a septic system and a lighting plant, it would appear the staff and patients frequently lived with less-than-desirable conditions. By the early 1930s, the

Medical Superintendent was regularly complaining to the Home Department regarding overcrowding; patients sleeping on verandahs, protected by shabby blinds; and a lack of adequate heating facilities, including hot water and bedpan sterilizing provisions.90 The Visiting Justice found complaints regarding the lighting were justifiable because it was impossible to read at night.91 In 1937, one ward with 28 male patients had no hot water and unserviceable lavatories.92 It is little wonder the Rockhampton Hospital Board needed to spend such a large sum of money in order to make the facility usable when it assumed responsibility. In 1946, staff quarters were attended to, upgrades were made to the engine room, boiler house and laundry; alternating current electricity and sewage were installed and the water supply was improved. Other improvements were made to recreation and therapy buildings

88 The Morning Bulletin, 10 February 1958, p. 9. 89 Hock, op. cit. 90 Ibid. 91 Visiting Justice to Undersecretary, Home Office, 22 April 1930, folder A/4721, QSA, Brisbane. 92 Dr Blackburn to Undersecretary, Department of Health and Home Affairs, 7 October 1937, folder A/4720, QSA, Brisbane.

240 and the administration building, which contained the dispensary, laboratory, X- ray rooms, minor operating theatre and a medical records room.93

Nursing at Westwood

Matron Clare Axelson was engaged to oversee the establishment of Westwood

Sanatorium from February 1919.94 Axelson had previously worked almost twenty years continuously at the Diamantina Hospital for Chronic Diseases in

Brisbane, where she had also trained and had left as Acting Matron.95 It is likely Axelson was greatly influenced by Florence Chatfield, who had been

Lady Superintendent (Matron) since the opening of the Diamantina in 1900 and held very traditional views regarding nursing.96 In particular, Chatfield believed it was beneficial for both nurses and the patients for nurses to work long hours.97 It was also expected Axelson would continue to draw on her association with Chatfield during the early years of managing Westwood

Sanatorium.98

At the time of opening the Westwood Sanatorium, the majority of the staff were to be drawn from the Rockhampton region,99 as Westwood was a very small community. In particular, returned soldiers were encouraged to apply for positions of male attendants.100 The pattern of employing a small number of

93 Hock, op. cit. 94 Westwood Sanatorium file, ACHHAM, Rockhampton. 95 Ibid. 96 Gregory, H., A Tradition of Care. The History of Nursing at the Royal Brisbane Hospital, Brisbane, Boolarong Publications, 1988, p. 46; Strachan, op. cit., pp. 126-127. 97 Strachan, op. cit., p. 127. 98 The Capricornian, 6 September 1919, p. 32. 99 Ibid. 100 Ibid.

241 trained nurses and higher numbers of male and female nursing assistants continued throughout the period under review, although staffing was more prevalent after the Rockhampton Hospital Board assumed management (see

Table 6.7). Obtaining and retaining nursing staff at Westwood Sanatorium seems to have been a problem for most of the period under review. The turnover of staff was consistently high. For example, in just six months in

1936, 30 nursing staff changed,101 while in 1955 it was reported 54 nurses had been replaced in the preceding two and a half years.102 Factors contributing to this high turnover include geographical isolation, living and working conditions, and less than amiable relations among the staff, with most reports citing ‘bad conditions’ at Westwood as the cause of the low retention of staff.

Table 6.7 Staffing at Westwood Sanatorium 1932 - 1949103

Year Trained nurses Assistants in nursing Other staff 1932 3 4 2 1936 2 5 3 1937 2 9 N/A 1941 14 N/A 1949 14 19 49

When exploring what ‘bad conditions’ may have meant, it is necessary to consider the geographical location of the Westwood Sanatorium. Although only 50 kilometres from Rockhampton, railway services were not readily available. In an effort to counter this isolation, the Rockhampton Hospital

Board advertised the following conditions of employment:

101 Hock, op. cit. 102 Report: Rockhampton Hospital Board, February 1955, Westwood Sanatorium folder, ACHHAM, Rockhampton. 103 Compiled from Edna Besch (nee Weber) memoirs, ACHHAM, Rockhampton; Hock, op. cit.; Report: Department Health and Home Affairs, 9 December 1941, folder A/31807, QSA,

242

Conditions of appointment include refund of first class rail

or ‘plane fare after six months service, an arrangement

whereby one week may be spent in Rockhampton or

Yeppoon on pay with quarters and board provided after

every five weeks of duty; six weeks annual leave. Other

conditions as per Nurses’ Award for the State of

Queensland.104

Although the lure of a week at the beach every six weeks may have seemed attractive, it disguises the lack of facilities available for nurses when they were not actually working. Time off duty must have seemed immeasurable with only work mates and patients for company and little outside relief.

Furthermore, the work itself took its toll on nurses. Edna Besch, who worked at the sanatorium from 1930 to 1932, found the work to be depressing, as so little could be done for the patients in terms of curative treatment, while the psychological effect of chronic disease were not readily recognised by nursing staff until the 1950s. 105 With few outside attractions, the nature of the work at the Sanatorium became more significant.

Aside from the isolation of the facility, it has already been identified that some of the working conditions were appalling. How nurses dealt with bed restricted patients in dimly lit, cold wards, with no hot water or sterilizing facilities can

Brisbane; Report: Department Health and Home Affairs, circa 1949, folder A/4721, QSA, Brisbane. 104 The Australasian Nurses’ Journal, vol. 44, no. 1, 1946, p. 26. 105 Edna Besch (nee Weber) memoirs, ACHHAM, Rockhampton; Roche, op. cit., p. 48.

243 only be imagined. The lengthy distances between wards must have also meant nurses were walking significant distances during a shift. In addition, the nurses quarters were little better. In 1919, the nurses’ quarters consisted of a large building containing seven bedrooms, each equipped with two or three beds.106

By 1937, one of these rooms had been partitioned off into four ‘bedrooms’, all sharing the same light.107

These conditions would have placed significant strain on the relationships between the nurses. In addition, the Westwood staff also had a long-term

‘bully’ among its staff. Sister Sadie Spressor worked at the sanatorium from at least the mid 1930s108 and held the position of assistant matron for much of the time, until at least 1949.109 Sister Spressor was accused of causing other

‘lower’ staff to resign including nursing and administration staff. Even the

Medical Superintendent, Dr Blackburn, threatened to resign as a result of her actions.110 Blackburn suggested Matron Axelson allowed Spressor, ‘too much latitude’. Such an unsettling element among a small staff in an isolated location would not have helped staff retention.

106 The Capricornian, 6 September 1919, p. 32. 107 Geo A. Sloan and Co, Electrical Engineers to Supervising Mechanical Engineer, Department of Health and Home Affairs, 9 April 1937, folder A/4721, QSA, Brisbane. 108 The Morning Bulletin, 8 December 1936, p. 9. 109 Sister Spressor to Department of Health and Home Affairs, 4 December 1949, folder A/31726, QSA, Brisbane. 110 Dr Blackburn to Undersecretary, Department Health and Home Affairs, 29 September 1938, folder A/31726, QSA, Brisbane.

244 Mount Morgan Hospital

Mount Morgan township was established as a result of the commencement of gold mining of the mountain of the same name from 1882.111 By 1890, the

Mount Morgan Hospital was officially opened, primarily for the treatment of male patients.112 Although the mining company profited quite handsomely from the mine, little of this money was channelled back into the community.

Indeed, the hospital was primarily funded by public subscriptions and not by the mining company.113 An annual subscription of fifteen shillings allowed one indoor and one outdoor patient to be treated.114 The hospital also sought government grants as was the custom of most voluntary hospitals. Although the mining company contributed little to the hospital, the fate of the hospital depended on the company. In 1927, the company closed down permanently.

As a consequence of people leaving the town and the unemployment status of those who remained, the hospital ran into significant financial difficulty and the government assumed management.115 Interestingly, the government did not put the Mount Morgan Hospital under the control of the Rockhampton

Hospital Board and continued to classify the Mount Morgan hospital as a

‘voluntary’ hospital until at least 1944,116 although it maintained a close interest in the financial and administration status of the hospital.

111 McDonald, op. cit., p. 295. 112 Cosgrove, B., Mount Morgan: images and realities. Unpublished PhD thesis, Central Queensland University, 2001, p. 86. 113 Ibid. 114 Ibid. Cosgrove also notes the miners were not well paid and worked an 8 hour shift for 7s.6d in 1898 (p. 76), while rent was 4 – 10 shillings per week (p. 64). 115 Assistant Undersecretary, Home Office to General Manager, Mount Morgan Gold Mining Company, cc to Secretary Walter and Eliza Hall Trust, 26 February 1927, folder A/29542, QSA, Brisbane. 116 Report: Nursing and domestic Staff in public hospitals, 30 June 1944, folder A/31807, QSA, Brisbane.

245 As a result of the financial difficulties faced by the Mount Morgan Hospital committee, the government insisted on a number of reforms including the appointment of a new committee,117 although acknowledged the permanency of these arrangements ‘depended on the developments which took place in

Mount Morgan’.118 Mining operations recommenced in 1929;119 however, the difficulties for the hospital committee continued. In 1931, the income for the hospital was £9421 while expenditure was £9437, leaving an overall deficit of

£996.120 However, the government also appreciated the efforts of cost cutting made by the committee and in particular, the staff. A 1933 report stated, ‘The matron exercises a close supervision over all provisions, bedding, linen etc, while the staff has been considerably reduced over the last two years’.121 In

1933, it was expected the recent rainfall would produce a good cotton crop in the area and hence allow increased community contributions to the hospital.122

Indeed, the government was well aware of the difficulties facing small, rural, voluntary hospitals which were dependent on the fluctuating incomes of primary producers. One memorandum provides the example of Aramac

Hospital, where voluntary subscriptions yielded £343 in 1929/30 and £1047 in

1932/33.123 In 1944, the voluntary system was abolished in Queensland and a board replaced the Mount Morgan Hospital Committee, although the hospital was the only responsibility of this hospital board, unlike the many hospitals

117 Press release: Home Office, February 1927, folder A/29542, QSA, Brisbane; Rockhampton Evening News, 8 March 1927, p. 8. 118 Ibid. 119 McDonald, op. cit., p. 321. 120 Report: Financial position of Mount Morgan Hospital, Department of Home Affairs, 30 June 1931, folder A/26874, QSA, Brisbane. 121 Report: Financial position of Mount Morgan Hospital, Department of Home Affairs, 1932/33, folder A/26874, QSA, Brisbane. 122 Ibid. 123 Memorandum: Home Secretary’s Office, 22 March 1933, folder A/26874, QSA, Brisbane.

246 and facilities overseen by other boards, for example the Rockhampton Hospital

Board.

Throughout the years under review, the hospital offered the main avenue of health service to the Mount Morgan community and provided a significant number of trained nurses. It is not clear how many beds the hospital contained during the earlier part of the century when the population of Mount Morgan was 12 000 (around 1919).124 However, as the nurse training program was only three years from around WWI to the mid 1920s,125 the daily occupancy must have been greater than 40. Table 6.8 outlines the occupancy of the

Mount Morgan Hospital which reflects the fluctuations of the population throughout this time.

Table 6.8 Occupancy of Mount Morgan Hospital 1926 - 1954126

Year Daily average 1926/27 40.6 1928/29 29.7 1939/40 56 1941 45 1954 37.8

124 Mount Morgan Museum notes the Spanish Influenza epidemic in May – June 1919, saw the high school used as an isolation hospital, and that 12 000 residents were left in the care of one doctor after the other two were affected by the disease. 125 Australasian Trained Nurses Association, new members, The Australasian Nurses’ Journal, 1920 – 1925. 126 Compiled from Report: Home Secretary’s Office, 30 June 1931, folder A/26874, QSA, Brisbane; Clark, C., Statistics of the State of Queensland for the year 1939-40, Brisbane, Government Printer, 1940, pp. 15G-23G; Report: General Training Nurses, Department of Health and Home Affairs, folder A/31807, QSA, Brisbane; Solomon, S.E., Statistics of the State of Queensland for the Year 1954-55, Brisbane, Government Printer, 1955, pp. 12G-21G.

247 Nursing at Mount Morgan Hospital

Nurse training began at the Mount Morgan Hospital in 1900 and ceased in

1972.127 The hospital produced a considerable number of nurses in its early years. For example in 1906, five nurses passed their third year exams.128

Indeed, prior to the mid 1920s, Mount Morgan Hospital probably rivalled the

Rockhampton Hospital in terms of graduate nurses. For example in 1915, four graduates were noted in the Queensland Nurses’ Registration Board (QNRB) records, while six were noted in 1918 and 1923.129 However, as the daily average decreased and the hospital experienced financial concerns, slightly fewer trainees completed the four year training program each year. As with other nurse training hospitals, the bulk of the workforce consisted of trainees.

This is demonstrated in Table 6.9 which outlines the nursing staff for the period 1926 to 1930.

Table 6.9 Nursing staff of Mount Morgan Hospital 1926 – 1930130

Position 1926/27 1927/28 1928/29 1929/30 Matron 1 1 1 1 Sisters 3 2 3 3 1st year trainee 7 5 6 6 2nd year trainee 3 6 5 6 3rd year trainee 7 3 6 2 4th year trainee 2 7 2 5 Total trainees 19 21 19 19

127 Mount Morgan Museum. 128 The Australasian Nurses’ Journal, vol. 4, no. 2, 1906, p. 58. 129 QNRB General Training register, folder B/3072, QSA, Brisbane. 130 Report: Home Secretary’s Office, 30 June 1931, folder A/26874, QSA, Brisbane.

248 Interestingly, this table also demonstrates a considerable retention of trainees during this period. Although there is a drop from five to two trainees between the second years in 1928/29 to third years in 1929/30, other years and intakes were fairly consistent. Indeed, from the first year intake in 1926/27 of seven students, five reached their fourth year. This may well have been related to the uncertain financial future of the town, as well as the economic depression affecting the rest of the country, whereby jobs were not readily given up. By

1938 the staff consisted of the matron, three sisters and sixteen trainees. In

1941, the hospital employed six trained nurses and seventeen trainees, although two assistants in nursing were also employed.131

The number of trainees seems to have remained fairly constant at around sixteen to seventeen from the mid 1930s. While this number is slightly lower than that noted in the late 1920s, it is significant trainee nurses were retained when the hospital experienced financial difficulties. Indeed, it was the ‘other’ staff who were dispensed with from 1926 to 1930: the number of maids dropped from five in 1926 to none in 1929/30. The services of the seamstress were also dispensed with after 1928.132 It would have been easy to justify these staffing changes. Maids could not undertake nursing duties, but it was readily acceptable, indeed traditional, for nurse trainees to clean wards.

Furthermore, maids’ wages were £72 per annum, whereas a student nurse’s wage ranged from £36 - 75, depending on year of training.133 As such, the use of trainee nursing staff and the Matron’s close supervision of expenditure,

131 Report: General Training Nurses, Department of Health and Home Affairs, 9 December 1941, folder A/31807, QSA, Brisbane. 132 Ibid. 133 Ibid.

249 helped to significantly contain costs of the hospital from a high of £0.17.9 per patient per day in 1928/29 to £0.10.6 in 1933.134 By 1939/40, the cost was only £0.9.4, which was one of the most economical in the State.135 Only St

Vincent’s Hospital in Toowoomba ran slightly more efficiently, whereas most hospitals managed under hospital boards were significantly more costly. For example, at the Rockhampton Hospital, the cost per patient per day was

£0.11.8, while Yeppoon Hospital was £0.14.8. In comparison, the (Royal)

Brisbane Hospital ran at £0.13.10, while small hospitals such as Many Peaks

Hospital cost £1.19.10 per patient per day to manage.136 In 1955, under the

Mount Morgan Hospital Board, the hospital continued to operate with one of the lowest cost bases in the State - £2.19.7 per patient per day.137 Only

Aboriginal settlements were operated more cheaply (Woorabinda £1.18.4;

Palm Island £0.17.4; Yarrabah £0.19.9), reflecting the lack of resources allocated to non-white health services by the government.

The reliance on trainee nursing staff also requires us to consider the effect on those staff. In 1926/27 there were 4.75 trainees to each trained nurse, a slightly higher rate than that noted at the Rockhampton Hospital, while the (Royal)

Brisbane Hospital had a rate of 5:1.138 However, due to the small numbers involved, it did not take much alteration in staffing to significantly distort this ratio. The following year, Mount Morgan Hospital lost one of its trained nurses, leaving only three registered nurses to oversee 21 student nurses, a ratio

134 Reports: Home Secretary’s Office, 30 June 1931, and 1932/33, folder A/26874, QSA, Brisbane. 135 Clark, op. cit., p. 23G. 136 Ibid. 137 Solomon, op. cit., p. 21G. 138 Gregory, op. cit., p. 63.

250 of 7:1. This must have impacted on the level of supervision and training these nurses received, even in a system that relied heavily on other trainees for teaching purposes.139 The strict control of resources would also have impacted on the work of student nurses – from the amount of extra ward cleaning required to cost saving measures such as packaging dressing materials.140

Other public institutions in the Rockhampton district

In addition to those institutions explored above, there were four other publicly funded institutions in the Rockhampton district: Eventide Nursing Home,

Woorabinda Hospital, Ogmore Hospital and the Lock Hospital. Little is known of these facilities but are mentioned briefly here as nurses were involved in each of these services. Eventide Nursing Home commenced in

Rockhampton in 1949, specifically for the provision of aged care nursing. All nursing staff lived on site and in 1950 consisted of a matron, two sisters and nine (apparently female) attendants.141 Woorabinda Hospital served the

Aboriginal population of the Woorabinda reserve, some 170 kms west of

Rockhampton. In 1951, the hospital was placed under the control of the

Rockhampton Hospital Board. The hospital had 36 beds and was staffed by a matron, two sisters and an unidentified number of nursing assistants drawn from within the community.142 General and maternity cases were taken at this

139 Madsen, W., ‘Learning to be a nurse: the culture of training, 1930 – 1950’, Transformations, vol. 1, no. 1, 2000, URL: http://www.ahs.cqu.edu/transformations/journal/articles1/text.htm 140 Madsen, W., ‘Keeping the lid on infection: infection control practices of a regional Queensland hospital, 1930 – 1950’, Nursing Inquiry, vol. 7, 2000, pp. 81-90. 141 Acting Manager, Eventide to Undersecretary, Department of Health and Home Affairs, 4 April 1950, folder A/31726, QSA, Brisbane. 142 Carment and Killion, op. cit., pp. 28-29.

251 hospital, as well as children. As indicated earlier in this chapter, the cost per patient per day was relatively low at the Woorabinda Hospital, reflecting the low wages likely to have been paid to the Indigenous nursing assistants.

Ogmore Hospital is an example of a multifunctional cottage hospital, considered by the Queensland government as early as 1923. These accommodated up to two patients and were staffed by a single registered nurse.

The functions of these hospitals included ‘bush’ nursing, antenatal and baby- clinic nursing, as well as first aid.143 The Ogmore Hospital opened in 1949 and was intended as a first aid station prior to transport to the Rockhampton

Hospital.144 While it is unknown if Ogmore Hospital was established as part of the earlier scheme, it is likely to have served similar functions.

Lock hospitals were established in the United Kingdom from the mid eighteenth century for the treatment of venereal disease.145 The Lock Hospital opened in Rockhampton in 1869.146 The Post Office Directory of 1901 notes the Lock Hospital was situated on North Street, between Victoria Parade and

Campbell Street.147 The matron at this time was Mrs Little, who held the position until 1916.148 Mrs Mulroney then took the position until at least

143 Report: Home Secretary’s Office, circa 1922/23 regarding maternal and child welfare services in Queensland, folder A/4730, QSA, Brisbane. 144 Hospital and Medical Services. Ryan Papers: Hospitals, 1955, folder C362.11, RDHS, Rockhampton. 145 Prochaska, F.K., Women and Philanthropy in Nineteenth Century England, Oxford, Clarendon Press, 1980, p. 188. 146 Barclay, E., ‘Queensland Contagious Diseases Act, 1868. The act for the encouragement of vice and some nineteenth century attempts to repeal it. Part 1’, Queensland Heritage, vol. 2, no. 10, 1974, p. 31. 147 POD 1901, p. 465. 148 Ibid; POD1915/16, p. 320.

252 1920.149 Neither of these women appear to have been trained nurses and did not register with the QNRB. The Lock Hospital in Rockhampton was used for the detention and treatment of prostitutes in the Rockhampton region for a period of one month before being transferred to a Magdalene Home in

Brisbane.150 In 1927 the hospital was closed. It would appear, however, that much of the furniture and linen was removed to the Rockhampton Hospital without the permission of the Commissioner of Public Health,151 providing an example of the fluidity of public property. That is, employees working in a separate public institution perceived they had a right to access such equipment.

Discussion

In 1927 a circular from the Home Secretary’s Office read as follows:

The Hospitals Act 1923 defines public hospital to mean a

hospital or institution which affords medical and nursing

services to the sick, infirm, or disabled persons and

accommodation for first aid or sick persons, or is engaged

in ambulance work, or makes provision for motherhood

and child welfare, and which is established primarily for

persons who are unable to provide such services for

themselves. The public hospital is therefore not provided

for well-to-do persons, or persons who are able to pay for

149 PODs, 1916/17, p. 358; 1919/20, p. 379. 150 Cosgrove, 2000, op. cit., p. 297. 151 Commissioner, Public Health to Undersecretary, Home Department, 19 April 1927, folder A/29556, QSA, Brisbane.

253 their medical attention, but there is no objection to private

or intermediate wards being provided as part of the public

hospital, in fact the practice of providing intermediate

hospital or wards in association with the public hospital is

generally recognized and encouraged.152

This circular suggests the government approached increased involvement in public hospitals somewhat reluctantly, with the provision of services for the poor primarily in mind. However, the Labor party had dreamed of a providing hospital services well prior to WW1. It is likely the cautionary tone of the circular related to the reality of providing free hospital treatment for

Queenslanders still being a number of years away. Furthermore, as Hanlon noted in 1941, the realization of a ‘nationalized’ hospital service was always going to take many years to implement as it required a ‘revolutionary approach to organisation’ regarding hospital personnel.153 Hanlon also estimated twelve to fifteen beds per 1000 population would be required for ‘nationalization’, double the number then available.

Regardless of government readiness for increased control of hospitals, Ives and

Mendelsohn154 indicate other changes were probably influencing State involvement. In particular, the expanding function of hospitals coincided with

‘more elaborate and expensive methods of treatment’ becoming available and

152 Circular: Home Secretary’s Office, 23 June 1927, folder A/31608, QSA, Brisbane. 153 Hanlon, E.M., Speech to Labor in Politics Convention, 17 February 1941, folder A/27273, QSA, Brisbane. 154 Ives and Mendelsohn, op. cit., p. 50.

254 people were becoming ‘hospital minded’.155 The long established tradition of governments propping up the hospital system set the precedent for

‘nationalization’ of hospitals, while increased public demand of hospital services propelled the ideal into reality. Public hospitals were no longer charitable places for the poor. Rather, they were gaining a reputation as the location of health service provision, a situation that did not escape the notice of the government. Indeed, Hanlon’s speech in 1941 emphasized that not all health service provision needed to be undertaken in hospitals, ‘with much in the home requiring organisation of visiting medical, nursing and other services’.156 The initial vision of ‘nationalization’ of hospitals did not foresee the medical and social changes that were to take place from the 1930s.

This chapter has outlined the increase in government control of a range of public institutions in the Rockhampton district. However, it also provides insight into some of the difficulties facing a government with ‘big’ ideals and

‘small’ budgets. This is particularly demonstrated by the lack of ongoing maintenance provided to Westwood Sanatorium. How these institutions met the changing demands impacted on the roles and responsibilities of the various nursing staff employed. This final part of the chapter will consider the nursing services provided by these public institutions within this context of moving towards nationalization of hospital services. Consistent with the celebratory nature of much of the history of nursing literature, a small number of prominent matrons have been identified personally, usually in association with

155 Ibid. 156 Hanlon, op. cit.

255 a particular (metropolitan) institution.157 However, the role and responsibilities of the matron and indeed those of the trained nurse have rarely been historically analysed, unlike the role and responsibilities of the trainee nurse.158 This is especially true for regional areas. Therefore, the roles and responsibilities of the various groups of nurses - trained, trainees, and nursing assistants, will be explored. Although some changes are evident as a result of increased government involvement, this section suggests many aspects of nursing services remained the same, while nationalization of hospital services proceeded around them. Furthermore, the size and function of the institutions examined emerges as an important feature in the variations identified.

Matrons

The matron of a public institution played a key role in the provision and administration of services. However, the role seems to have been quite pliable and depended on the facility the matron oversaw. For example, the matron of a large teaching hospital such as the Rockhampton Hospital provided lectures to trainees159 and took on more of a supervisory role such as conducting regular

157 For example Williams, J.A., Goodman, R.D., Jane Bell, OBE, 1873 – 1959, Melbourne, The Royal Melbourne Hospital Graduate Nurses’ Association, 1988. 158 Maggs has outlined the roles of general nurses in England, 1880 – 1914, although primarily focuses on trainees as these formed the bulk of the nursing workforce of these hospitals. Maggs, op. cit. 159 For example, Matron Christmas, 1907 lectures on general nursing; Matron Clarke, 1922 lectures (ACHHAM, Rockhampton); Matron Green 1935 lectures (Centre for the History of Remote and Rural Nursing, Central Queensland University); Matron Fraser 1945 lectures (Joan Kidd personal memorabilia). For an analysis of these lecture notes see Madsen, W., ‘The good nurse: a historical analysis of early twentieth century nursing lectures’, in Madsen, W., Schlotzer, A. (eds), Smashing the Glass Ceiling: Women Researchers in A Regional Community, Women in Research Conference papers, Centre for Social Science Research, Central Queensland University, 2000, pp. 83-88.

256 rounds of the hospital and providing reports.160 Matrons of smaller hospitals undertook more hands-on nursing duties. The matrons of the Yeppoon

Hospital and Westwood Sanatorium had few trained nursing staff to call upon and probably undertook all the more complex nursing of the patients in addition to other administrative duties. Furthermore, matrons of smaller hospitals may have been called upon to undertake a number of auxiliary medical functions. For example, the matron of the Mount Morgan Hospital regularly undertook the role of anaesthetist prior to the 1930s. Indeed, a photograph, circa 1920, at the Mount Morgan Hospital illustrates Matron

Aland administering the anaesthetic during an operation.161 One matron of a

Queensland country hospital enquired if she was entitled to extra payment for such expanded duties. The reply from the Queensland branch of the

Australasian Trained Nurses’ Association (QATNA) suggested she was not because anaesthetics administration was accepted as normal practice in these circumstances.162 However, by 1933, the QATNA was becoming less supportive of nurses administering anaesthetics:

No nurses are specifically trained to be qualified

anaesthetists in Queensland. It is recognized that under

certain circumstances it is necessary for a nurse to

administer an anaesthetic when no second doctor is

160 QATNA AGM minutes, 15 August 1930, The Australasian Nurses’ Journal, vol. 28, no. 8, 1930, p. 222, notes matrons of training schools needed to provide reports to the QATNA as well as the QNRB. 161 Mount Morgan Museum. 162 QATNA minutes, The Australasian Nurses’ Journal, vol. 29, no. 7, 1931, p. 137.

257 available, and only under these circumstances can the

Council of the ATNA approve of such action.163

Similarly, matrons were often called upon to dispense medications. The

Pharmacy Board took this matter up with the QATNA in 1935, objecting to trained nurses of country hospitals (normally matrons) dispensing medicines, that is filling doctors’ prescriptions. The QATNA’s reply indicated trained nurses should not do any dispensing, ‘except as a matter of urgency, and where no qualified pharmacist is available’.164 Whether the matrons of smaller hospitals in the Rockhampton region dispensed medications is unknown, although it is likely they did on occasions. By 1953 this practice was being actively discouraged by the QATNA who advised it was not legal for nurses to dispense medications in hospitals as they were not trained to do so and that it was within their right to refuse to accept this responsibility.165 By this stage it was probably not necessary for nurses in the Rockhampton district to dispense medications, although as research into the practice of rural and remote nurses illustrates, necessity continued to fuel the continuation of such practices throughout the twentieth century.166

When not actually undertaking nursing activities, matrons had considerable administrative responsibilities. As the rules of the Yeppoon Hospital illustrate, the matron needed to check and control provisions (presumably not only items

163 QATNA minutes, The Australasian Nurses’ Journal, vol. 31, no. 4, 1933, p. 76. 164 QATNA minutes, The Australasian Nurses’ Journal, vol. 33, no. 5, 1935, p. 98. 165 QATNA minutes, The Australasian Nurses’ Journal, vol. 51, no. 3, 1953, p. 60. 166 Klotz, J. Role and function of remote area nurses at Birdsville 1923 – 1953, Unpublished PhD thesis, Central Queensland University, 2001; Klotz, J., ‘Nursing in isolation’, The Queensland Nurse, vol. 2, no. 3, 1983, pp. 14-15.

258 such as medicine and linen, but also food) and she issued accounts and receipts. Furthermore, the matron was responsible for overseeing domestic staff as well as nursing staff. This aspect of the matron’s role was occasionally usurped by some hospital committees. However, the QATNA was adamant that ‘domestic staff [were] always under the control of the Matron’.167 Indeed, there was no ‘time off’ for these matrons. The Yeppoon Hospital matron needed the permission of the medical superintendent in order to be away from the hospital for more than three hours. As such, long hours were likely to have been expected of these matrons. Matron Axelson’s long association with

Florence Chatfield would have assured she was well adapted to working the long hours necessary at the Westwood Sanatorium.

This examination of the role of the matrons of these facilities illustrates much depended on the skills and diligence of this person. Hospital committees looked to the matron to cut costs and indeed, the government recognized the success of these measures at the Mount Morgan Hospital. Matrons filled in the

‘holes’ when other staff were not available, including administrative, nursing and medical roles, and probably formed the axis for the entire operation of the institution, large or small.

167 QATNA minutes, The Australasian Nurses’ Journal, vol. 23, no. 7, 1925, p. 31. These minutes outlined a letter from a former matron of Adavale Hospital indicating she had resigned owing to the hospital committee refusing to recognise her authority over domestic staff. The QATNA resolved to communicate with the hospital committee pointing out the matron’s responsibility.

259 Trained nurses

Trained nurses could be employed in public hospitals as staff nurses or sisters.

The position of sister usually incorporated more responsibility such as being in charge of a ward. In earlier years, these positions were seen as an interim measure with private duty nursing, hospital matronship or private hospital proprietorship as the main goals for trained nurses.168 However, as hospitals came to be the mainstay of health service provision and options such as private duty nursing declined, more nurses completed their nursing careers as sisters in hospitals. Furthermore, although private duty was possible within public hospitals as discussed in Chapter 3, the practice of using hospital trainees to meet the nursing needs in private wards, such as those at the Rockhampton

Hospital, undermined this opportunity for trained nurses. However, with the often poor living arrangements associated with public facilities, such as

Westwood Sanatorium, the increased opportunities for public hospital work were not always accompanied by more attractive conditions. Indeed, it was not until 1955 the QATNA really agitated for better conditions for trained nurses, and this was probably brought about by the post WWII nursing shortages.

These specifications are interesting in that they provide insight into the working and living arrangements of many trained nursing staff prior to this.

Specifically they include: adhering to a 40 hour working week; eight hour consecutive shifts; a room of their own in the nurses’ quarters; and extra money for additional certificates whether the knowledge was used or not.169

168 Letter to Editor, The Australasian Nurses’ Journal, vol. 17, no. 5, 1919, p. 50. 169 QATNA minutes, The Australasian Nurses’ Journal, vol. 53, no. 8, 1955, p. 181.

260 Despite the less than ideal conditions associated with many hospitals, the position of ‘sister’ within hospitals was valued highly. Indeed, a lengthy

QATNA debate regarding nursing promotion within hospitals raises some interesting issues. The debate revolved around ‘whether experience gained in other hospitals should count’ when filling a vacant sister position, or whether all staff should move up in rank and a junior staff nurse be appointed.170 While no resolution was made, the discussion highlights the rivalry between hospitals, the concept of loyalty within a hospital, and the widespread practice of appointing staff from within their own ranks, as alluded to in Chapter 4.

As with the position of matron, the role of the trained nurse depended on the institution she was working within. For those working in large nurse training hospitals, much of their time was absorbed in administration and supervisory duties. Indeed, a 1953 UK study estimated 50 percent of the ward sister’s time was spent doing non-nursing duties.171 These included stock-taking and other administrative tasks. Although teaching trainees was supposedly a major component of their job, the study found only five minutes each day was actually spent doing so. The high proportion of trainees per trained staff outlined in this chapter, confirms the sisters of these hospitals would have had difficulties meeting these obligations.

The Hospitals Act 1936 stipulated one trained nurse for every three beds.172

However, the figures presented in this chapter suggest none of the public

170 QATNA minutes, The Australasian Nurses’ Journal, vol. 46, no. 10, 1948, p. 215. 171 ‘Job analysis on nursing’, The Australasian Nurses’ Journal, vol. 51, no. 5, 1953, pp. 112- 115. 172 Selby, op. cit., p. 134.

261 institutions in the Rockhampton district came close to this standard. Mount

Morgan Hospital had around 7.5 beds per trained staff in 1941, while at the

Rockhampton Hospital each trained nurse oversaw 8.3 beds. The situation was a little better statistically at Yeppoon Hospital, where each trained nurse oversaw 5.27 beds, although as there were only two trained nurses at the hospital, it is evident their workload was significant. Westwood Sanatorium had the worst ratio, with 23 to 35 beds per trained staff nurse, depending on whether there were two or three nurses available. After 1922, only midwives could attend maternity cases and only those with general certificates could attend general patients.173 While larger centres could meet this condition, smaller centres such as the Yeppoon Hospital, needed each trained staff member to have both certificates. Furthermore, the restrictions associated with maternity and general patients would have been impossible to comply with in these smaller hospitals. As such, the government was devising the rules for nursing in public hospitals but not providing resources for these to be met.

Trainee nurses

Trainee nurses experienced some significant changes throughout the period under review, although many aspects of nurse training remained the same. For example, at the Rockhampton Hospital the trained nurse: trainee ratio improved by the 1950s, although the bulk of nursing work continued to be undertaken by trainee nurses. A British study in 1953 estimated trainees

173 Ibid.

262 carried out 74 percent of the nursing work.174 It is likely a similar proportion was undertaken by Australian trainees. The work of junior student nurses focused on cleaning (wards and patients). As the student progressed in her training, she took on more complex nursing procedures. This fundamental framework persisted throughout the period under review. The main changes for trainees throughout the first half of the twentieth century related to the number of years training and industrial conditions and wages.

As noted in Chapter 2, nurse-training programs were dependent on the average bed occupancy of the hospital. It was believed that smaller hospitals could still provide competent nurses, but over a longer period of time to enable the trainee to experience the necessary range of cases seen in a larger hospital. However, larger hospitals also sought longer periods of training. The (Royal) Brisbane

Hospital added a fourth year of training as early as 1910,175 although it was not until the early to mid 1920s that the Rockhampton Hospital and the Mount

Morgan Hospital extended the length of training to four years. The QNRB did not stipulate training periods, other than the minimum time. Indeed, the

Nurses’ and Masseurs’ Registration Act of 1928 continued to stipulate a minimum of three years training provided the hospital had a daily occupancy of greater than 40 beds.176 This may have influenced the training time at the

Mount Morgan Hospital where the daily occupancy was only 36.9 in

1927/28.177

174 ‘Job analysis on nursing’, op. cit. 175 Gregory, op. cit., p. 51. 176 Nurses’ and Masseurs’ Registration Act of 1928, Government Gazette, 15 July 1929, p. 124. 177 Report: Home Secretary’s Office, 30 June 1931, folder A/26874, QSA, Brisbane.

263 The Rockhampton Hospital increased its nurse-training period for other reasons, although these reasons are not clear. One possible factor was a desire to increase more experienced nursing staff but at trainee wages. As discussed earlier, the tendency had been to increase staff by employing probationers at the inexperienced end of the spectrum. Another possible factor could be the introduction of the Nurses’ Award in 1921 which limited the number of hours worked by trainees. It may have been deemed necessary to lengthen the period of training to compensate for the decreased time experienced on the wards per day. It appears the Rockhampton Hospital extended its nurse-training period during the early 1920s, although exactly when is unclear. It was first recommended by the Medical Superintendent to the Rockhampton Hospital committee in August 1920, and therefore prior to the introduction of the

Nurses’ Award. The hospital had been experiencing a period of increased usage in the months beforehand, with daily occupancy averages per month of

80.4, 88.8, 86.2, 74.4, 82.6, 88, 88.3 respectively since February.178 The

Medical Superintendent’s report recommended increasing the nursing staff from 20 to 22 as well as extending the length of training. As such, the recommendation was in response to a sustained demand on nursing services.

However, the introduction of the Nurses’ Award the following year may have finalized the decision if it had not been taken already.

The brief reduction in nurse training after 1942 was in response to nursing shortages experienced during WWII. The QNRB delivered an edict at the end of 1942: ‘The period of training and study (in Queensland) shall be three

178 Rockhampton Hospital Medical Superintendents reports, February 1920 – August 1920,

264 years, if such general and private hospital is recognized by the Board and has an average of not less than 40 beds occupied daily’ until the termination of the war.179 Training time was extended to four years at the Rockhampton Hospital soon after cessation of hostilities. Hence, the length of training undertaken by nurses in Queensland during the first half of the twentieth century was governed by factors other than the learning needs of the students.

The working conditions of trainee nurses did alter quite dramatically throughout the first half of the twentieth century. In particular, the length of time spent working was reduced significantly and the level of remuneration increased.180 Furthermore, the level of domestic duties undertaken by trainee nurses was being questioned by the mid 1950s.181 Ward cleaning had been a prominent feature of nurse training since the end of the nineteenth century.

Although maids were occasionally employed, trainees were still called upon to undertake this task when domestic help was not available, as illustrated by the cost cutting measures at the Mount Morgan Hospital around 1930. Thus, the level of ward cleaning incorporated into nurse training varied depending on the hospital’s financial status. However, it is evident that even in times of prosperity, as in the 1950s, trainee nurses continued to save money for hospitals by undertaking domestic tasks.

ACHHAM, Rockhampton. 179 QATNA minutes, The Australasian Nurses’ Journal, vol. 41, no. 2, 1943, p. 23. 180 For further information of trainee nurses wages and conditions in Queensland see Strachan, op. cit. 181 QATNA minutes, The Australasian Nurses Journal, vol. 54, no. 6, 1956, p. 146.

265 While certain conditions improved for nurse trainees, it is unlikely they did so as a direct result of government intervention. Rather, the stability of funding provided by the government from the mid 1920s, allowed hospital administrations to incorporate the changes outlined in the various Nurses’

Awards more easily than if the hospitals had continued under the previous voluntary system. The lagging of private hospitals in providing similar wages and conditions supports the necessity of government backing before nurse training conditions could be significantly improved.

Assistants in nursing

Assistants in nursing (AINs), like the untrained, experienced nurses earlier in the century, are not well documented within the history of nursing literature.182

However, as this chapter illustrates, AINs were very much a feature within public institutions from at least the 1920s. They were employed at Westwood

Sanatorium from its inception and were noted at the Yeppoon Hospital and later at the Mount Morgan Hospital. Furthermore, Eventide and Woorabinda

Hospital also employed AINs to undertake the bulk of the nursing. It would appear, therefore, that while untrained nurses of the late nineteenth century and early twentieth century were able to work privately as nurses, they were increasingly incorporated into non-training hospitals and facilities as the twentieth century progressed. Indeed, they were precluded from working in

182 One of the few exceptions is Edwards, M., ‘The nurses’ aide: past and future necessity’, Journal of Advanced Nursing, vol. 26, 1997, pp. 237-245.

266 training hospitals,183 although Mount Morgan Hospital had two on its staff in the early 1940s.

The role and duties of the AIN were not well defined and depended on the institution and the matron. In 1928, the QATNA stated these employees had no defined duties and that the matron had the power to detail what activities they undertook.184 On the whole, the QATNA did not wish to acknowledge the role of AINs, probably because most of the QATNA council came from large metropolitan nurse training hospitals where there were no AINs. In 1943, the QATNA council was confronted, however, with the reality of many smaller, regional Queensland hospitals, when the Bundaberg Hospital Board asked if ‘experienced’ nurses could be appointed as acting staff nurses at the

Gin Gin and Lady Chelmsford Hospitals.185 The reply was that this would be in breach of the Nurses’ and Masseurs’ Act. However, this situation illustrates how reliant some hospitals were on such staff.

By the mid 1940s, the QATNA seems to have grudgingly accepted the presence of AINs, although in 1944 it opposed registration of AINs, stating,

‘[S]uch registration was regarded as a retrograde step and not in the best interests of the public or the nursing profession’.186 Such views reflect the earlier antagonism shown towards untrained nurses as discussed in Chapters 3 and 4. In 1947, it was again proposed AINs should be registered, as they were

‘to a great extent’ staffing institutions such as homes for the chronically sick,

183 QATNA minutes, The Australasian Nurses’ Journal, vol. 46, no. 3, 1948, p. 53. 184 QATNA minutes, The Australasian Nurses’ Journal, vol. 26, no. 5, 1928, p. 124. 185 QATNA minutes, 10 March 1943, Queensland Nurses’ Union, Brisbane. 186 QATNA minutes, The Australasian Nurses’ Journal, vol. 42, no. 7, 1944, p. 83.

267 non-training hospitals, sanatoria, private hospitals, convalescent and rest homes.187 From the figures presented in this chapter, in the Rockhampton district AINs made up approximately 23 percent of all nursing staff in public institutions during the 1940s. Yet, their role was still not defined other than working under the direct supervision of a trained nurse, although it was acknowledged this posed difficulties for matrons of small country hospitals where AINs constituted the bulk of the staff. Indeed, the QATNA arbitrated for AINs, but did not recognise them and in fact seem to have diverted the responsibility of AINs control and training to the QNRB.188

So what did AINs do? To a large extent it would appear AINs undertook those fundamental nursing duties such as hygiene measures, feeding patients, and probably ward cleaning – duties that were undertaken by equally unprepared staff in larger hospitals, that is, trainee nurses. Just how complex the procedures were that these nurses carried out probably varied considerably, with smaller hospitals allocating more responsibility to these nurses as illustrated by the Gin Gin example above, whereby the experienced nurse was considered as capable as a trained nurse.

187 ‘Proposed registration of Assistants in Nursing’, The Australasian Nurses’ Journal, vol. 45, no. 10, 1947, p. 242. 188 QATNA minutes, The Australasian Nurses’ Journal, vol. 48, no. 10, 1950, p. 167.

268 Conclusion

This chapter has provided an overview of the publicly funded institutions in the

Rockhampton district. It has examined the evolution of each of these services in terms of administration, patient numbers and nursing staff. This examination has allowed the various roles of each of the types of nurses to be explored. In particular, the pivotal role of the matron has been highlighted, as has the reliance on non-trained staff – either trainee nurses or assistants in nursing. As such, the interaction between various groups of nurses within institutions has revealed that despite the prominence of large public hospitals as the breeding grounds for trained nurses and hence the professionalization of nurses, untrained nurses continued to exist in significant numbers.

Furthermore, their levels of responsibility in some institutions raises questions of the exclusivity of training as the only means of gaining nursing skill and knowledge.

Overall, the chapter has illustrated that while government intervention increased in institutional health facilities, the impact on nursing services within these facilities was mostly limited to improvements in working conditions and wages. The divisions of who carried out particular duties remained within each facility. Furthermore, it has been demonstrated that facilities depended on the stringent use of resources by nursing staff as well as the use of ‘expanded’ nursing duties to meet the needs of the facility – be they administrative, economic or patient needs. Finally, this chapter has acknowledged the increasing demand placed on many of these facilities as they became more

269 popular with the public. This increase in demand came not from the ‘deserving poor’ within the community, but from the general public at large, regardless of financial status. The public facility had irretrievably progressed from its charitable foundations to one of public health necessity. This aspect of increased government concern regarding the health and welfare of the community is further explored in the following chapter which focuses on community based services.

270 Chapter 7

Public health nursing: promoting growth of the (white)

nation

The only cure for want of knowledge is education, and this

can only be given by those themselves who have been

rightly trained.1

From the mid-nineteenth century, Western societies became increasingly proactive towards the prevention of communicable diseases. Generally termed

‘sanitary reform’, this movement generated a range of health initiatives.2

While its influence has been widely recognised within hospitals, especially in relation to hygiene measures associated with ‘modern nursing’, less attention has been played to community services arising from this movement. Indeed,

Keleher3 laments the invisibility of Australian public health nursing within the literature. The history of public health nursing is not completely absent, but it is rarely contained in main stream nursing literature. Wendy Selby’s4 work on motherhood documents a number of aspects of maternal and child welfare nursing in Queensland from 1915 to 1957, and will be drawn upon extensively

1 Assistant undersecretary, R.S. Mackay, Home Department, to Subeditor The Morning Bulletin, 13 April 1927, folder A/31685, QSA, Brisbane. 2 For fuller exploration of nineteenth sanitary reform, see Bashford, A., Purity and Pollution. Gender, Embodiment and Victorian Medicine, London, MacMillan Press, 2000. 3 Keleher, H., ‘Public health nursing in Australia – historically invisible’, International History of Nursing Journal, vol. 7, no. 3, 2003, p. 50. 4 Selby, W. Motherhood in Labor’s Queensland, 1915 – 1957. Unpublished PhD thesis, Griffith University, 1992.

271 in this chapter. Maternal and child welfare nursing is also considered by

Reiger,5 although she focuses more on the Victorian context; while Mein

Smith6 explores the infant welfare movement in Victoria, New South Wales and to a lesser extent South Australia and Queensland. Crawford7 looks at

Gowie Centres in Western Australia during the 1940s and O’Hara8 briefly reviews school nursing in Western Australia during the interwar years.

However, there are many aspects of public health nursing that are not explored from a historical perspective. This chapter hopes to redress this lacuna to some extent by considering the two aspects of public health nursing evident in the

Rockhampton district: maternal and child welfare and school nursing. Firstly, however, it is pertinent to review the issues relating to public health initiatives.

It should be noted that while industrial nursing is also normally considered as part of public health nursing, no evidence has been uncovered of industrial nursing occurring in the Rockhampton district. It is likely this aspect of public health nursing was not well developed in Queensland9 and as Rockhampton had little in the way of manufacturing, other than the meat works, opportunities would not have been great.

Early twentieth century public health activities can be broadly categorised into three areas: infrastructure, prevention, and monitoring. Of these, nursing was

5 Reiger, K.M., The Disenchantment of the Home. Modernizing the Australian Family 1880 – 1940, Melbourne, Oxford University Press, 1985. 6 Mein Smith, P., Mothers and King Baby. Infant Survival and Welfare in an Imperial World: Australia 1880 – 1950, Hampshire, MacMillan Press, 1997. 7 Crawford, P., ‘Early childhood in Perth, 1940 – 1945: from the records of the Lady Gowie Child Centre’, in Hetherington, P. (ed), Childhood and Society in Western Australia, Perth, University of Western Australia Press, 1988, pp. 187-207. 8 O’Hara, M.A., ‘Child health in the interwar years, 1920 – 1939’, in Hetherington, P. (ed), Childhood and Society in Western Australia, Perth, University of Western Australia Press, 1988, pp. 174-186. 9 QATNA Annual General Meeting minutes, The Australasian Nurses’ Journal, vol. 34, no. 9, 1934, p. 182. These minutes note industrial nursing was not popular in Queensland.

272 only evident in the latter two. Infrastructure initiatives included sewage systems, garbage disposal, reticulated water and ensuring the safe supply of products such as milk.10 These activities were mostly the responsibility of the local authority. Preventative activities included the control of vermin (for example rats and mice), immunisation programs, and education of the public regarding health matters. Mothers were of particular concern as the bearers of future generations as discussed throughout this thesis. Nurses were more involved in these latter activities through maternal and child welfare centres.

Finally, considerable effort was directed towards monitoring and surveying children in regard to ‘normal’ development, with interventions foreshadowed should irregularities arise. Such measures were particularly relevant to school nurses. While school nurses were involved in education as well, much of their energy was devoted to surveillance.

A consistent point of contention regarding public health initiatives throughout the twentieth century relates to the relative effectiveness of these programs.

While there is no doubt certain indicators, such as infant mortality, clearly demonstrated improvements had been gained, it is unclear what factors influenced these. Proponents of schemes such as maternal and child welfare centres were quick to claim credit for improvements, but they often overlooked the gains and likely contributions of other initiatives, especially infrastructure and environment conditions. Furthermore, these claims do not adequately account for temporal and geographic mismatches between the instigation of

10 Lewis, M., ‘Milk, mothers and infant welfare’, in Roe, J. (ed), Twentieth Century Sydney. Studies in Urban and Social History, Sydney, Hale & Iremonger, 1980, p. 194.

273 services and the improvements.11 As early as the 1930s, some British voices were questioning whether the general improvements in living standards may not have been more influential than infant welfare centres.12 Lewis13 also suggests infrastructure initiatives were the main factor in decreasing infant mortality in Australia during the early part of the twentieth century. Indeed,

Taylor, Lewis and Powles’14 analysis of infectious diseases in Australia between 1907 and 1990 found a 50 percent reduction prior to WWII and the introduction of antibiotics. They suggest socio-economic factors affecting food, education and housing as well as infrastructure initiatives were responsible for these gains in public health. It is not intended here to evaluate the merits of either side of the debate as this has been adequately explored by

Mein Smith.15 However, this chapter will often refer to the ‘achievements’ of public health nursing services, as advocated by the press and government. It is therefore worthwhile acknowledging from the outset the difficulty in verifying the claims and recognising that other factors are likely to have been influential, to a greater or lesser extent, in delivering these outcomes. This chapter will briefly explore the evolution of public health nursing in Australia before looking more specifically at maternal and child welfare and school nursing within the Rockhampton district.

11 Mein Smith, op. cit., p. 135. 12 Peretz, E., ‘Infant welfare in inter-war Oxford’, International History of Nursing Journal, vol. 1, no. 1, 1995, pp. 5-6. 13 Lewis, op. cit., p. 194. 14 Taylor, R., Lewis, M., Powles, J., ‘The Australian mortality decline: cause-specific mortality 1907 – 1990’, Australian and New Zealand Journal of Public Health, vol. 22, no. 1, 1998, p. 41. 15 Mein Smith, op. cit.

274 Public health nursing in Australia

As already stated, there were a number of interplaying factors at the turn of the twentieth century that influenced the evolution of public health nursing in

Australia. Firstly Roe16 notes the bulk of the poor in the late nineteenth century were women and children: impoverished wives, widows, deserted wives, ‘magdalenes’, and young girls ‘exposed to moral danger by colonial circumstances’. As discussed in Chapter 5, this led to the rise of a number of women-led charities for women. Secondly, the health of young people was seriously brought into question after the large number of working class men were rejected from the army upon trying to enlist for the Boer War – 30 percent were rejected in Britain,17 while 36 percent were rejected from the

Australian military for WWI.18 Thirdly, there was an increasing awareness of the ‘need’ to populate the continent with white people. This was linked with the realities of a decreasing birth rate, a high infant mortality rate19 and the perceived threat of invasion from China and Japan.20 These factors led to the promotion of women’s health and the health and growth of the children produced by women. As will be illustrated in this chapter, most aspects of women’s domestic lives were targeted in the public campaigns that were established, and in Queensland, these campaigns were primarily the activities of the government.

16 Roe, J., ‘The end is where we start from: women and welfare since 1901’, in Baldock, C.V., Cass, B. (eds), Women, Social Welfare and the State in Australia, Sydney, Allen & Unwin, 1983, p. 2. 17 Davis, A., ‘Infant mortality and child saving: the campaign for women’s organization in Western Australia 1900 – 1922’, in Hetherington, P. (ed), Childhood and Society in Western Australia, Perth, University of Western Australia Press, 1988, p. 161. 18 Mein Smith, op. cit., p. 78. 19 Ibid. 20 McQueen, H., A New Britannia, Melbourne, Penguin Books, 1986, p. 71.

275

In 1903, the New South Wales Commission on the Decline of the Birth Rate highlighted a number of issues: that illegitimate infant deaths were caused by abortion, infanticide, baby farming, and defective management by benevolent institutions; and that legitimate infant deaths were related to inadequate hospital care, impurity of milk and dairy foods, and ignorance of domestic hygiene.21 In addition, the Commission advocated tighter controls on contraception devices in an attempt to counter the ‘selfish’ birth control practices of the middle and upper classes. In this context, motherhood was promoted as a service to the community and safety of the nation. It was believed women needed to be encouraged to become mothers and educated in methods of infant care and basic household tasks in order to increase the number of white children reaching adulthood.

As with many community needs of the late nineteenth century, these were initially met by charity groups and tended to encompass the nursing of patients in their own homes as well as public health initiatives. The Melbourne District

Nursing Society was formed in 1885 as a charitable organisation, and was influenced by the social welfare work in the UK.22 The initial work focused on looking after disadvantaged people in their own homes.23 Cameron24 notes this service soon expanded to include broader health objectives: public

21 Davis, op. cit., p. 161; Mein Smith, op. cit. 22 Burchill, E., Australian Nurses Since Nightingale 1860 – 1990, Richmond, Spectrum Publications, 1992, p. 55; Wilson, J., ‘Bush Nightingales. A view of the nurses’ role in the Australian cottage hospital industry’, in Pearn, J. (ed), Health, History and Horizons, Brisbane, Amphion Press, 1992, p. 34. 23 Cameron, R.J., Year Book Australia 1985, Canberra, Australian Bureau of Statistics, 1985, p. 202. 24 Ibid, p. 204.

276 lectures on hygiene (1894); baby welfare clinics (1917); antenatal education

(1931) and advice on family planning and birth control (1934). The Church of

England also promoted motherhood through its Mothers’ Union groups which commenced in Sydney in 1901 and Brisbane in 1904.25 These also began district nursing associations to assist the poor, sick and needy.26 The Victorian

Bush Nursing Association was a community-based nursing service established in 1910 by Lady Rachel Dudley, wife of the Governor-General of Australia.

However, this service operated on a ‘user-pays’ rather than charity basis.27

By the early twentieth century, governments at various levels were beginning to take up the public health aspects of these services. Cumpston28 suggests the opening of the first infant welfare service in the world in Sydney in 1904 illustrated a ‘widening horizon of accepted public responsibility’. In Adelaide, the City Council employed a nurse from 1899 to educate the public regarding effective isolation of infectious diseases and disinfection.29 These duties were expanded in 1909 to include visiting mothers with young infants.30 This council also established a School of Mothers to promote maternal mental, physical and moral development, which later began clinics to weigh babies.31

Some States, such as Western Australia, preferred to keep State intervention to a minimum and therefore promoted the coordination and encouragement of

25 Willis, S., ‘Homes are divine workshops’, in Windshuttle, E. (ed), Women, Class and History. Feminist Perspective on Australia 1788 – 1978, Melbourne, Fontana Books, 1980, p. 179; Wilson, op. cit., p. 34; Selby, op. cit., p. 97. 26 Cameron, op. cit., p. 206. 27 Burchill, op. cit., p. 76. 28 Cumpston, J.H.L., The Health of the People. A Study in Federalism, Canberra, Boebuck Society Publications, 1978, p. 16. 29 Durdin, J., They Became Nurses: A History of Nursing in South Australia, Sydney, Allen & Unwin, 1991, p. 71. 30 Ibid, p. 72. 31 Ibid, p. 73.

277 philanthropic agencies in activities such as infant welfare.32 As Davis33 points out, this led to a proliferation of middle-class views regarding motherhood and child care, with the State government producing propaganda that was increasingly patronising towards mothers and thus less helpful.

Throughout most of the early twentieth century, voluntary groups and most

State governments maintained some sort of relationship, while both worked towards the betterment of public health. However, it was within the domestic realm that nurses played a predominant role. Ironically, while earlier voluntary organisations, mostly run by married women, were responsible for ‘educating’ mothers, this task was increasingly taken over by unmarried women who had neither had children nor been responsible for managing a household.34

However, they had been ‘rightly trained’ and they were promoted as a necessary means of reforming the domestic space in much the same way as trained nurses had been associated with the reformation of hospitals. Selby35 has explored this issue of younger, trained nurses providing information to mothers and suggests maternal and child welfare nurses were encouraged to look older and more matronly in order that their advice might be more seriously considered. While Brennan36 indicates these nurses were promoted to this role because of their skills in ‘scientific’ cleanliness, she argues other factors may also have been influential: they were women, trained to obey and constituted relatively cheap labour.

32 O’Hara, op. cit., p. 178. 33 Davis, op. cit., pp. 166-167. 34 Brennan, S., ‘Nursing and motherhood constructions: implications for practice’, Nursing Inquiry, vol. 15, 1998, p. 12. 35 Selby, op. cit., p. 269. 36 Brennan, op. cit., p. 12.

278

Maternal and child welfare in Queensland

The first government funded maternal and child welfare centres in Queensland were in Brisbane from 1918: Fortitude Valley, Wooloongabba, Spring Hill and

West End.37 After the passage of the Maternity Act 1922, maternal and child welfare centres expanded rapidly throughout the State, with one of the first non-metropolitan centres being opened in Rockhampton in 1923. Selby38 points out that unlike other States where infant welfare services were provided by voluntary groups and governments, the Queensland government discouraged voluntary assistance, believing the State could provide the best social services. It did so by appointing a Director of Maternal and Child

Welfare Services, who worked within the Home Department, later the

Department of Health and Home Affairs. All maternal and child welfare nurses in Queensland, therefore, were employed by the State government. It should be recognised, however, that the Mothercraft Association in

Queensland, a voluntary organisation with which Dr Phyllis Cilento was intimately involved, seems to have had a close relationship with the government.39 Other organisations concerned with maternal and child welfare

37 Murphy, H.C., ‘History of the Maternal and Child Welfare Service, Queensland’, Queensland Health, vol. 1, no. 4, 1963, p. 21. 38 Selby, op. cit., p. 221. 39 Dr (later Lady) Cilento was the wife of Ralph Cilento, the Director of Health and Medical Services from 1934. In Phyllis Cilento’s memoirs of the Mothercraft Association, it is difficult to differentiate between the responsibilities of the government and those of the voluntary organization, although the latter does not figure in many of the government’s records. Cilento, P.D., ‘Mothercraft in Queensland. A story of progress and achievement’, Royal Historical Society of Queensland Journal, vol. 8, no. 2, 1966-1967, pp. 317-341.

279 in Queensland include the Crèche and Kindergarten Association, and the

Playground Association, each of which may have used trained nurses.40

The early maternal and child welfare centres, while focussed on providing services to mothers of young children, did not do so exclusively. Cilento41 recalled visiting the Fortitude Valley Baby Clinic in 1922 to find an adult case of burns being dressed, but no babies in the clinic. Indeed, Ellen Barron, the

Queensland nurse who was selected to go to New Zealand for maternal and child welfare nurse training, noted in her report to the Home Secretary that

New Zealand clinics did not undertake surgical dressings or provide medicines to clients – adult or otherwise. However, she suggested, ‘to discontinue this branch of our work would be to curtail the usefulness of our Brisbane clinics’.42 Despite the recognition from some that this was a useful adjunct to maternal and child welfare work, the practice was halted in 1926 by Chuter, who claimed the nurses were too ‘liberal’.43 What this term refers to is unclear. It may be that some within the medical profession saw nurses working relatively independently in these situations as a potential threat to the medical profession’s autonomy and monopoly. Indeed, there was a perceptible level of tension throughout the 1920s and 1930s regarding the relationship between nurses involved in preventative work and doctors.44

40 Axelson, I.M., ‘Child welfare in Queensland’, The Australasian Nurses’ Journal, vol. 34, no. 4, 1936, p. 73. 41 Cilento, op. cit., p. 325. 42 Ellen Barron to Home Secretary, 17 May 1923, folder A/31678, QSA, Brisbane. 43 Selby, op. cit., p. 229. 44 Robbins outlines a further example of this tension in relation to tuberculosis prevention in the USA. Robbins points out public health nurses were drawn from the elite ranks of nursing and often had superior knowledge and skills to doctors as well as coming from privileged social backgrounds. Robbins, J.M., ‘Barren of results? The tuberculosis nurses’ debate, 1908 – 1914’, Nursing History Review, vol. 9, 2001, pp. 35-50.

280 As a result, the government was explicit in insisting that nurses involved in maternal and child welfare work under a medical officer. For example, in announcing plans to build a maternal and child welfare clinic in Rockhampton,

Chuter specified, ‘the work will be in charge of an honorary medical officer, assisted by two qualified nurses’.45 However, as late as 1939, the suspicion that nurses could not be trusted to work alone continued, with the Director

General stating, ‘Nurses also do not react well unless under the control of a medical man or woman… women need definite discipline and they will only accept it readily from a man or woman who is a medical practitioner of strong personality’.46 However, Dr Mathewson, the then Director of Maternal and

Child Welfare Services, spoke out in defence of the service and its nurses:

It is the experience of our welfare nurses that in a great

many cases mothers look to them rather than to their

doctors for the understanding of their problems and feel

that the nurses have time and patience to devote to them.

This has been definitely stated by many mothers who

develop a very good trust in the nurse who has helped

them with their children. The Maternal and Child Welfare

Service is essentially a nursing service and its aim is

prevention. To have doctors attending the welfare service

too frequently would be to alter the whole character of the

service.47

45 The Morning Bulletin, 18 October 1922, p. 10. 46 Report: Ralph Cilento, 4 October 1939, folder A/31677, QSA, Brisbane. 47 Dr Mathewson to Undersecretary, Health and Home Affairs, 8 March 1940, folder A/31677, QSA, Brisbane.

281

Nurses were provided with guidelines as to when to refer a child on to a medical practitioner – that is in any cases of sickness. With the removal of many of the dressing products and medicines from the centres after 1926, they had little option but to restrict their practice to preventative activities.

However, it is interesting to speculate on what the evolution of nursing services within the community might have been if the practice of attending other needs had continued.

It should be noted that in New Zealand, Plunket nurses had no responsibility to report to a medical officer48 and indeed, it was the nurses who attempted to differentiate their responsibilities from those of doctors. Plunket nurses had generally agreed by 1910 that a doctor need only be called in for cases of

‘serious illness’,49 which did not include simple diarrhoea, indigestion or colic

– conditions generally seen as the result of improper management.50 However, the Plunket Society was careful not to deviate from its objectives and restricted the number of training centres to just one in order to increase uniformity of training and practice.51 As such, they maintained the scope of their practice to those areas initially outlined, as identified later in this chapter.

Without these extra duties, the role of the maternal and child welfare nurses came to be focused on teaching women the importance of breastfeeding and

48 Bryder, L., ‘The Plunket nurse as a New Zealand icon’, UK Centre for History of Nursing, 2002, URL: http://www.qmuc.ac.uk/hn/history/seminars02.html Accessed 9 December 2002. 49 Ibid. 50 Pines, S., ‘Mothercraft’, The Australasian Nurses’ Journal, vol. 22, no. 11, 1924, p. 560. 51 Hosking, Mrs, ‘Child welfare in New Zealand’, The Australasian Nurses’ Journal, vol. 23, no.5, 1925, p. 228.

282 household hygiene.52 The movement in Queensland was based on the model devised by Dr Truby King of New Zealand. As indicated earlier, Ellen Barron went to the Dunedin school to gain training in maternal and child welfare nursing before returning to Brisbane to set up a similar school in 1924.53 It is worthwhile reviewing King’s philosophies here as King influenced child- rearing practices in parts of Australia and other Western countries, such as

Britain,54 for much of the early twentieth century.

Truby King and maternal and child welfare

Dr Truby King was the medical superintendent of a large mental institution at

Seacliff, New Zealand.55 Part of his responsibility as superintendent was to rear young animals on the large farm associated with the institution.56 King was strongly influenced by notions of control and discipline and postulated that the lack thereof damaged health and morality.57 He believed child rearing, like animal husbandry, should be viewed as a professional enterprise, based on managerial know-how and scientific method.58 As such he was obsessed with the discipline of the clock as the basis of sound health and character. These factors impelled King to ask women in Dunedin to form a society in 1907 to help mothers care for their babies. The group was called the Society for

52 Brennan, op. cit., p. 13. 53 Queensland training included two intakes per year, of four months duration. Murphy, op. cit., p. 21. 54 Bryder, op. cit. notes the world wide influence of King and the Plunket Society, however, Mein Smith op. cit. disputes the universal appeal of King in Australia, 55 Hosking, op. cit., p. 224; Olssen, E., ‘Truby King and the Plunket Society. An analysis of a prescriptive ideology’, The New Zealand Journal of History, vol. 15, no. 9, 1981, pp. 11-12. 56 Hosking, op. cit., p. 224. 57 Olssen, op. cit., pp. 6-7. 58 Ibid., p. 10.

283 Promoting the Health of Women and Children,59 but soon became known as the Plunket Society, as Lady Plunket, wife of the Governor-General, became the first patron. The objectives of the Plunket Society included the following:

1. To promote the sacredness of body and duty of health through

motherhood, by advocating and promoting breastfeeding;

2. To disseminate through the society, lectures, nurses and newspapers,

accurate knowledge regarding the health of women and children;

3. To train and employ qualified nurses regarding the wellbeing of

women, nursing infants and children.60

However, as Olssen61 points out, King’s underlying philosophy was much broader than the health and wellbeing of mothers and children. He linked the care of babies to the health of the family and ultimately to the health of the nation and British Empire. He was also a committed eugenicist.62 As such,

King’s views reflected broader societal concerns regarding nationalism and promotion of white races, while providing society and governments with a practical means of working towards these goals. In a climate where fewer middle and upper class women were having children, with a large infant mortality rate, King’s ideals were appealing:

If women in general were rendered fit for maternity, if

instrumental deliveries were obviated as far as possible, if

59 Ibid., p. 8. 60 Hosking, op. cit., p. 226. 61 Olssen, op. cit., p. 4. 62 Mein Smith, op. cit., p. 90.

284 infants were nourished by their mothers, and boys and

girls were given a rational education, the main supplies of

population of our asylums, hospitals, benevolent

institutions, gaols and slums would be cut off at the

sources: further improvement would take place in the

physical, mental and moral condition of the whole

community.63

The system of child rearing associated with the Plunket Society was based on regularity and self discipline. From the first days of life, babies were to be regulated in regards to their bathing, eating and sleeping, even their bowel movements. King believed, ‘Mothers must not allow ten o’clock in the morning to pass without getting baby’s bowels to move’.64 Toilet training commenced at six weeks of age. Feeding was to be fourth hourly during the day and nothing provided at night.65 Finally, mothers were instructed not to rock, tickle or play with their babies so as not to promote self indulgence.66

What effect this advice had on mothers is debatable. Selby’s67 research suggests many mothers, although regular attendants at maternal and child welfare clinics, did not actually practice the advice they were given. Indeed, many women sought advice from other sources: grandmothers, mothers, local untrained midwives, but did not reveal these:

63 King, as cited in Olssen, ibid., p. 6. 64 Ibid., p. 14. 65 Ibid. 66 Ibid., p. 15. 67 Selby, op. cit.

285 You never told the clinic sister – you wouldn’t dare. You

only went there to get baby weighed and meet people.68

This view is supported by Mein Smith who advocates mothers used their own discretion regarding child-rearing advice.69 However, the philosophies of King and the Plunket Society regarding child rearing is easily discernible in the propaganda emanating from the Queensland government until the 1950s.

Maternal and child welfare in Rockhampton

On the 27th October 1923, the Home Secretary, James Stopford, in the presence of Mrs Stopford, his daughter, Mr and Mrs Charles Chuter, Miss Barron, and a large crowd of Rockhampton residents, officially opened the Rockhampton

Maternal and Child Welfare Centre in Fitzroy Street. Stopford’s speech on that occasion strongly reflected nationalistic ideals, including King’s philosophies, and is worth citing as length:

The work in connection with the baby clinic and the

maternity work that we are starting for the sake of the

mothers and future citizens of this great state… We have

one of the purest races existent, and a pure white

Australian population, drawn from the old portions of the

British Empire. Hence we are not faced with the racial

problems of other countries, and I think that, if we are

68 Experience of Blair Athol mother, cited in Martyr, P., Paradise of Quacks. An Alternative History of Medicine in Australia, Sydney, Macleay Press, 2002, p. 225. 69 Mein Smith, op. cit., p. 172.

286 wise in our generation, we will endeavour to keep our race

as pure and healthy as it is today (Applause). One of the

problems of the war is the fact that, to be successful, to

win through as a nation, we must realise that the day for

thinking individually on health matters is gone. – We must

look upon them from a community standpoint and think

that the health of the nation depends on the health of the

child. We must look gravely at the problem where the

difficulty exists, and that is in the infant life of the

community. Here in Queensland, with our climatic

conditions, we are threatened with many grave

problems.70

Stopford clearly linked the provision of maternal and child welfare services with the promotion of the white race in Queensland and highlighted some of the Labor government’s anxieties as discussed in Chapter 2: protection of the white (British) population through immigration restriction and defence services; and the effect of the hot, tropical conditions on white people. The use of nurses to meet this agenda will be discussed later in the chapter.

The clinic was built according to the standard plan for maternal and child welfare centres throughout the state. Figures 7.1 and 7.2 illustrate this building. Two staff were appointed to work in the clinic: Flora MacDonald,

70 The Morning Bulletin, 29 October 1923, p. 10.

287 Nurse in Charge, and Anne Copley.71 It was standard practice for two nurses to be placed in most centres, although some smaller regional areas started with only one.72 A cleaner was employed on a daily basis to allow the nurses to focus on clinical work.73 Dr Buchanan attended the clinic in an honorary capacity.74 The work consisted of indoor work (attending those who came to the clinic) and outdoor work (visiting new mothers to encourage clinic attendance). In 1933, visits to Yeppoon, Gladstone and Mount Morgan necessitated an extra staff member at the Rockhampton centre.75 Visits to

Mount Larcom were added later.76 Nurses transferred regularly between centres throughout Queensland. As a result, these retrospective maternal and child welfare nurses tend to be faceless – an array of names, with little sense of identity, although Miss Ruby Brown remained at the Rockhampton centre from

1926 to at least 1946.77

71 Submission for Government Gazette, 29 September 1923, folder A/31678, QSA, Brisbane. 72 Undersecretary, Home Department to Secretary Public Service Commission, 14 July 1923, folder A/31678, QSA, Brisbane. 73 Undersecretary, Public Service Commission to Undersecretary, Home Department, 4 October 1923, noting cleaner at Rockhampton employed two hours per day, folder A/31678, QSA, Brisbane. 74 The Morning Bulletin, 29 October, 1923, p. 10. 75 Dr J. Turner to Assistant Undersecretary, Home Department, 1 November 1933, folder A/31674, QSA, Brisbane. 76 Miss Bardsley to Undersecretary, Department of Health and Home Affairs, 21 December 1938, folder A/31674, QSA, Brisbane. 77 Submission for Government Gazette, 27 November 1926, folder A/31673; Miss R. Brown to Director of Maternal and Child Welfare Division, 14 March 1946, folder A/31685, QSA, Brisbane.

288 Figure 7.1 Maternal and Child Welfare Centre Rockhampton 200278

Figure 7.2 Standard floor plan of Maternal and Child Welfare Centres, c. 192279

78 Author’s own collection. 79 Folder A/31685, QSA, Brisbane.

289

Throughout 1924, the nurses were increasingly accepted and used within the

Rockhampton community. Table 7.1 outlines the monthly attendance at the clinic from October 1923 to June 1924. The outdoor visits reflect a similar rise in number. By 1933, attendance was often in excess of 700 per month,80 and over 1000 by 1938.81 Attendance was often affected by weather. For example, Miss Brown’s report to Miss Bardsley, Superintendent of Nurses, noted figures were down for March 1938 due to ‘excessively hot and wet weather’.82

Table 7.1 Attendance at Maternal and Child Welfare Centre, Rockhampton 1923 – 192483

Month Number Month Number October 1923 94 March 241 November 173 April 246 December 165 May 301 January 1924 213 June 238 February 238

The role of the maternal and child welfare clinic sister was to be purely preventative. According to Dr Jefferis Turner, the Director of the clinics in

Queensland until 1937, the clinic nurses were double certificated (general and/or maternal and child welfare certificates), and the chief work was not to treat sick babies, but to keep babies and young children well. Nurses were to weigh all babies, encourage breast feeding (check the mothers’ technique, amount of milk taken by the infant, express milk to increase amount), or teach

80 Report from Miss Barron 8 December 1933, folder A/31673, QSA, Brisbane. 81 Miss Bardsley to Undersecretary Department of Health and Home Affairs, 21 December 1938, folder A/31674, QSA, Brisbane. 82 Miss Brown to Miss Bardsley 27 April 1938, folder A/31674, QSA, Brisbane. 83 Reports from Miss Barron 8 August 1924, folder A/31679, QSA, Brisbane.

290 the preparation of bottle feeds and to advise on diets. ‘If sick in any way, they advise the mothers to get medical advice without delay’.84

Although the reports from the Rockhampton Maternal and Child Welfare

Clinic were often limited to figures of attendance, occasional glimpses of the work of these nurses can be found. These accounts, however, would appear to document the ‘unusual’ rather than the normal practice of these nurses, which must be assumed to be in accordance with Turner’s outline. In 1933, a number of sets of twins and one set of triplets were noted to attend the clinic, along with a small number of premature infants.85 Premature twins were also noted in 1935:

‘Feeding cases include premature twins and a backward

infant. All are improving. Several counts of mothers have

written for feeding, weaning or antenatal advice’.86

As such, the clinic mostly dealt with normal infants and uncomplicated developmental issues and a majority of the nurses’ work was of a preventative nature. On the other hand, under the control of Dr Buchanan, children from poor families were sometimes treated for medical conditions, ‘not strictly related to preventative or feeding difficulties’.87 However, the presence of premature infants in these clinics allowed the maternal and child welfare

84 Dr Turner lecture in Rockhampton, as reported in The Morning Bulletin, 17 August 1926, p. 13. 85 Miss Barron to Undersecretary, Home Department, 8 December 1933, folder A/31673, QSA, Brisbane. 86 Miss Barron to Undersecretary, Home Department, 15 March 1935, folder A/31674, QSA, Brisbane. 87 Miss MacDonald to Miss Chatfield, 25 March 1924, folder A/31679, QSA, Brisbane.

291 service to take a broad view of ‘prevention’, especially in relation to feeding.

In 1925, a premature infant was admitted into residence at the Fortitude Valley

Maternal and Child Welfare Clinic.88 Prior to this, all clients of the centre had visited only. Although nurses slept at the centre in order for this admission to occur, the clinics were not designed for this purpose. Indeed, the standard plan of regional maternal and child welfare centres (see Figure 7.2) had provision for the nurses to ‘live on site’, but nowhere for them to cater for in-patients.

Furthermore, regular staffing did not permit this to occur in regional centres where each nurse had specific duties (indoor or outdoor) to perform each day.

However, Dr Turner did not believe children’s hospitals to be suitable places for premature infants and argued that, although ‘feeble’ and susceptible to infection, they should not be classed as ‘sick’.89 It was suggested maternal and child welfare nurses were trained to deal with these cases and that admission of such cases at a maternal and child welfare training school would benefit both the infants and training nurses.90 From this point forward, the Division of

Maternal and Child Welfare began to move towards the provision of mothercraft homes in addition to the clinics.

Mothercraft homes providing for the in-patient treatment of premature infants and those with feeding difficulties were set up in a number of States in

Australia, as well as in New Zealand. The Tresillian Centre in Sydney accepted babies as residents upon opening in 1921.91 Hobart had a dedicated

88 Murphy, op. cit., p. 24. 89 Miss Barron to Assistant Undersecretary, Home Department, 9 June 1925, folder A/31672, QSA, Brisbane. 90 Ibid. 91 ‘Training school for infant welfare. First under the Karitane System in Australia’, The Australasian Nurses’ Journal, vol. 19, no. 10, 1921, p. 349.

292 mothercraft home in 1925.92 However, it was not until 1941 that a dedicated mothercraft was opened in Queensland.93 A home was opened in

Rockhampton in 1952 in Corbery Street, where up to three mothers with breast feeding problems, including mastitis, were admitted, along with premature infants and small children with a range of feeding problems, such as failure-to- thrive. The home catered for between twelve and fifteen children.94 This home was also used to train child welfare assistants, who completed twelve months of training to allow them to work within the homes of ‘normal’ infants.

However, many went directly into general nurse training upon completion of this certificate.95

The Queensland Minister for Health and Home Affairs opened the Corbery

Street home and used the opportunity to espouse the success of the government’s maternal and child welfare programs whereby the infant mortality rate was only 25.7 per 1000 live births in 1951.96 Remnants of

King’s philosophies can also be detected as the Minister outlined the government’s belief in the health of the community: ‘We will be leading young Queenslanders on the path to good health and happiness’.97 This statement reinforces Mein Smith’s suggestion that training undertaken by young girls at Mothercraft homes was promoted as an ideal preparation for

92 ‘Mothercraft home at Hobart’, The Australasian Nurses’ Journal, vol. 23, no. 11, 1925, p. 526. 93 Murphy, op. cit., p. 24. 94 Madsen, W., ‘Babies in residence: child welfare assistants at the Rockhampton Maternal and Child Welfare Centre, Corbery Street’, Breaking New Ground: Women Researchers in a Regional Community Conference, February 2003, Bundaberg. 95 Ibid. 96 The Morning Bulletin, 22 September 1952, p. 6. 97 Ibid.

293 motherhood.98 The home was managed by a matron, who had a small number of trained staff, although the bulk of the work was undertaken by trainees.99

Two intakes of around eight students were accepted each year, with most trainees being sixteen to seventeen years of age.100 Unusually for this time period, the trainees did not live on the premises, but boarded out, as the home, the former residence of Dr Doris Skying, was not large enough to accommodate all staff.101

The management of the Corbery Street home seems to have been in accordance with similar mothercraft homes. How the work in these homes came to be classified as preventative is intriguing, as actual problems clearly existed. The homes were established to deal with mothers with lactation difficulties and babies with dietetic disturbances.102 Although some of these problems would now be considered ‘medical’ issues, they were often then seen as relating to deviations from good habits. For example, vomiting was perceived as the result of overfeeding, feeding irregularly, at night or overfeeding with artificial food.103 Hence, strict adherence to a feeding regime was thought to correct this problem. Similarly, premature babies could be viewed as the result of maternal deviation from ‘proper’ antenatal preparation. The Plunket Society clearly linked the health and discipline of the mother to that of the unborn child. This included eating nutritious food, breathing fresh air (window open at all times), and exercising with vigour, including a two hour walk whatever

98 Mein Smith, op. cit. 99 Madsen, op. cit. 100 Ibid. 101 Ibid. 102 ‘Mothercraft home at Hobart’, op. cit., p. 526. 103 Axelson, op. cit., p. 74.

294 the weather. It was believed failure to adhere to this regime was likely to result in pain, fatigue, morning sickness, unhappiness and even miscarriage.104 As such, the mothercraft homes appear to have dealt with problems arising from the perception of mothers not obeying the preventative measures advocated by the staff at maternal and child welfare clinics. The interpretation of this work as ‘preventative’ seems, then, to have been related to the problems being perceived as preventable; and therefore correctable through adherence to regimes.

School nursing

In Queensland, the aim of the maternal and child welfare service was to supervise the care, feeding and management of the expectant and nursing mother and the child up to the age or five of six years, when the school health service took over this latter responsibility.105 While some cities began Gowie

Centres to increase the level of supervision and monitoring of preschool children,106 there does not appear to have been a Gowie Centre in

Rockhampton. Hooker and Bashford107 suggest the introduction of school nursing arose from the early twentieth century increase in medicalisation of childhood and schooling, especially the desire for constructing physical and mental ‘norms’ of development, such as age-height ratios. Indeed, this goal of measuring children’s growth against a ‘standard’ was a feature of school

104 Olssen, op. cit., p. 13. 105 Maternal and Child Welfare Certificate, Superintendent’s lectures 1959, Lecture 1, author’s collection. 106 Crawford, op. cit., p. 188. 107 Hooker, C., Bashford, A., ‘Diphtheria and Australian public health: bacteriology and its complex applications, c. 1890 – 1930’, Medical History, vol. 46, 2002, pp. 57-58.

295 nursing, Gowie Centres, and maternal and child welfare nursing. However,

Kelsey108 indicates the essential difference between maternal and child welfare nursing and school nursing was that the former focused more on health promotion via education and improving hygiene and nutrition, whereas the latter worked more towards detection of disease rather than prevention.

School nursing was introduced in most Western countries during the early years of the twentieth century, with each country appearing to have developed similar objectives. In the UK, school medical inspection was introduced in

1907, whereby parents were advised of any problems detected but not provided with access to treatment.109 The impetus for government intervention in UK schools – initially with meals for undernourished children in 1906 and then school inspection the following year, related to the poor army recruitments for the Boer War.110 The role of the nurse was to undress and dress the child for medical inspection, although Kelsey111 documents nurses also applied treatments for minor ailments such as simple dressings and first aid and provided standard interventions such as insulin injections.112 However, after

WWII the focus was more directed at detecting and removing lice rather than development of health education.113 Similar activities were noted in USA schools. Grant114 asserts the beginnings of school nursing related to control of

108 Kelsey, A., ‘Health care for all children: the beginnings of school nursing 1904 – 1908’, International History of Nursing Journal, vol. 7, no. 2, 2002(a), p. 6. 109 Lewis, J., ‘Gender and welfare in the late nineteenth and early twentieth centuries’, in Digby, A., Steward, J. (eds), Gender, Health and Welfare, London, Routledge, 1996, p. 217. 110 Kelsey, op. cit., p. 5. 111 Ibid., p. 9. 112 Kelsey, A., ‘Nits, nurses and the war: school nursing before the National Health Service’, International History of Nursing Journal, vol. 7, no. 2, 2002 (b), p. 16. 113 Ibid., p. 18. 114 Grant, A., ‘The nurse in the school health service’, The Journal of School Health, vol. 71, no. 8, 2001, p. 388.

296 infectious diseases in schools such that infected children were excluded from school. However, minor first aid was also conducted by the nurse.115

Furthermore, students detected with medical problems were referred to their family physician, with treatment of significant medical issues being firmly deflected from the school health service.116 Underlying all these reasons for instigating school nursing were the broader issues of increasing the predominantly white population into adulthood and hence improving national defence. Indeed, Beddie117 argues the Commonwealth government’s funding of Gowie Centres related to the increasing wellbeing of children and ultimately the defence of the nation. The aim of these centres was to decrease the level of defects within the population that prohibited volunteers from being accepted into military service.

It is unclear when school nursing began in Queensland. Indeed, the history of school nursing in Australia is significantly lacking in the literature. It would appear to have commenced around 1917.118 The work of the school health services in Queensland was to:

1. Examine all school children 5.5 – 14 years of age every three years;

2. Identify those children with infectious diseases and exclude from

school;

115 Wilson, C.C., ‘Reminiscing on school health’, The Journal of School Health, vol. 71, no. 8, 2001, p. 376. 116 Ibid. 117 Beddie, F., Putting Life into Years. The Commonwealth’s Role in Australia’s Health Since 1901, Canberra, Commonwealth Department of Health and Aged Care, 2001, p. 34. 118 Report circa 1937 outlines school medical and dental inspection was instituted, ‘more than 20 years ago’, folder A/31821, QSA, Brisbane.

297 3. Examine children appearing to be malnourished and investigate food

supplies, clothing and home environment. The State Children’s

Department could be contacted to make children wards of the State if

necessary;

4. Detect any physical defect in children: ear, nose, throat, hearing, sight,

muscular or skeletal deformity, skin, evidence of chronic bacterial or

fungal disease;

5. Immunise against diphtheria if requested;

6. Investigate epidemics;

7. Survey for trachoma;

8. Supply suitable spectacles for children with indigent circumstances

(after 1934);

9. Arrange with local medical officer, treatment of other eye

conditions.119

Much of this work was undertaken by the school nurse, as few medical officers were employed. However, due to the limitations inherent within nursing at the time, nurses were only able to point out deviations and could not provide a definitive diagnosis as this was the prerogative of the doctor. Hence, nurses had to advise parents their child had a ‘disability of the throat’, or ‘disability of the ears’.120 As such, children needed to be directed to their own medical practitioner for diagnosis and treatment.

119 T.L. Williams, Acting Minister, Department of Health and Home Affairs to Mr Larcombe, Minister of Public Inspection, 12 December 1944; Report circa 1937, folder A/31823, QSA, Brisbane. 120 Dr St Vincent Welsh to Charles Chuter, Undersecretary Department of Health and Home Affairs, 18 December 1936, folder A/31826, QSA, Brisbane.

298 The nurses examined children for cleanliness, nutritional and dental defects, and undertook simple hearing and eye tests. They advised on health matters; gave lectures to children regarding health; reported on the ventilation, lighting and general cleanliness of the school and classrooms; gave first aid; assisted with immunisations; swabbed throats; and reported cases of neglect to the State

Children’s Department.121 Reiger,122 who focuses more on Victoria and New

South Wales, suggests school nursing in Australia became focused on the psychological progress of the child and identifying ‘mental defects’. However, this is not evident in the documents accessed for this thesis, which suggest that in Queensland, the focus remained on physical aspects. As such, the role of the school nurse in Queensland was similar to that in other Western countries, with an emphasis on screening and detection of abnormalities. However, there may have been some exceptions, with nurses actively promoting health. For example, in 1946, Sister Hillier made a request to the Department of Health and Home Affairs to supply suitable mugs, sterilising equipment and water heating apparatus to Rockhampton schools, to allow the various school committees to make malted milk drinks for children and hence improve their milk intake.123

In most Western countries, school nursing has always been strongly associated with government intervention, although various government departments were primarily involved. In the UK, school health services were managed by the

Board of Education, although the nurses were responsible to the Ministry of

121 Ibid. 122 Reiger, op. cit., pp. 167-169. 123 Memorandum: Chief Medical Officer to Accountant, Department of Health and Home Affairs, 2 April 1946, folder A/31824, QSA, Brisbane.

299 Health.124 Wilson125 identified jealousy and competition between the departments of health and education in the USA, thwarting the efforts of both.

Most Australian school health services were set up under education departments, with the exception of Western Australia and Queensland.126

However, the relationship between the health and education departments in

Queensland was ‘not always easy’ and reflects some of the jealousies noted in the USA:

If a School Health Service is to function with full

efficiency it must have the active and sympathetic support

of the Educational Authorities, as either is complementary

of the other. There must be no attitude of patronage – no

personal animosities. It is a public service for the benefit

of future generations and if the spirit of sound team work

is kept in view the results will be redound to the lasting

credit of the government, otherwise the present situation

might develop into so much window dressing.127

No doubt the responsibility of the school nurse to report on health related conditions within the schools such as cleanliness and classroom conditions did not augment the relationship between the departments.

124 Kelsey, 2002(b), op. cit., p. 15. 125 Wilson, op. cit., p. 376. 126 O’Hara, op. cit., p. 175; Durdin, op. cit., p. 74. 127 Memorandum: Chief Medical Officer to Director General, Health and Medical Services, 13 September 1945, folder A/31823, QSA, Brisbane.

300 UK estimates of staffing for school nursing services included one nurse for every 2,500 – 3000 children.128 It is unlikely Australian figures approached this. Indeed, O’Hara129 notes that in 1923 the School Medical Inspection

Service in Western Australia consisted of only one medical officer and three nurses for the State. In Queensland, the school health services worked with the

Department of Public Health and would appear to have used local public health medical officers, as there were only two full time and one part time medical officers for the State in 1937.130 At this time, fourteen nursing staff were employed – five in Brisbane and the others scattered throughout the State.131

However, it is unclear how nurses were managed as they were moved around frequently. Whether each nurse was responsible for a particular district, or whether they were all transferred around, is not known. For example, the

Sister Hillier mentioned earlier regarding milk drinks in Rockhampton, appears to have been based in Brisbane.132 Given the number of schools in the immediate Rockhampton district (there were 11 State schools in Rockhampton alone),133 it is evident nurses would have had difficulty in carrying out all their responsibilities, especially in relation to following up on referred cases. It is not surprising then, that the focus of school nurses tended towards screening for deviations as they would have had little time to encompass broader health promotion activities.

128 Kelsey, 2002(b), op. cit., p. 15. 129 O’Hara, op. cit., p. 176. 130 Report circa 1937, folder A/31823, QSA, Brisbane. 131 Ibid. 132 Letters to Sister Hillier in folder A/31824, have a Brisbane address, QSA, Brisbane. 133 POD, 1942, p. 328.

301 Discussion

While the work of maternal and child welfare nurses often differed to that of school nurses, there are a number of similarities that defined the work of both.

Both groups of nurses were employed by the State and therefore perceived as agents of the State. Both groups monitored children against a ‘norm’. They were to refer cases that deviated from the ‘norm’ to medical officers, however, generally worked independently and not under the direct supervision of a medical officer. They educated the public (mostly mothers) about nutrition, hygiene and household matters, although they had not experienced these issues for themselves. Finally, many were constantly moved around to different communities within the State and would not have formed strong connections within the communities. Although these nurses were ‘rightly trained’, these factors must have conditioned the impact the nurses had within a particular community, and hence the effectiveness of the public health programs they advocated. The final part of this chapter will explore each of these factors.

Agents of the State

In order to fully appreciate the introduction and formulation of public health nursing as outlined in this chapter, it is necessary to consider the social and political context of early twentieth century Queensland. This thesis has highlighted issues of concern relating to decreasing birth rates, high maternal and infant mortality rates, military rejections based on physical defects, and sustaining a white Australia. The public health initiatives outlined here were

302 specifically designed to promote the population of white people – both numerically and in physical health. The aim was to prevent children from contracting diseases and the resultant disabilities thereby reaching adulthood in a healthier state to further defend or populate the country. In this respect, nurses working in Queensland maternal and child health clinics or school medical services were actively promoting the agenda of the State. They were therefore agents of the State because they were the means by which many of the State’s white Australia policies were implemented at a domestic level.

State intervention into private lives used the precedent set by philanthropic women through their visitation of homes and providing advice.134 Maternal and child welfare nurses drew on this precedent when their work was divided into indoor and outdoor services, with the latter going to the homes of newborn babies. At first, the nurses had to rely on rather informal methods of identifying homes, such as seeing nappies on the washing line.135 However, after 1932, the nurses were notified of births in their areas within three days of their occurrence.136 The admittance of ‘experts’, in this case nurses, into homes was an increasing phenomenon during the early twentieth century.137

While there, nurses could observe a range of factors: the general cleanliness of the home, especially the kitchen; the mother’s breastfeeding technique; sleeping arrangements; availability of food; and family dynamics – features which would remain unseen if the mother attended the clinic only.

134 Prochaska, F.K., Women and Philanthropy in Nineteenth Century England, Oxford, Clarendon Press, 1980. 135 Selby, W., ‘Raising an interrogatory eyebrow. Women’s responses to the infant welfare movement in Queensland 1918 – 1939’, in Reeke, G. (ed), On The Edge. Women’s Experiences of Queensland, St Lucia, University of Queensland Press, 1994, p. 90. 136 Murphy, op. cit., p. 22. 137 Reiger, op. cit.

303

Similarly, school nurses were expected to follow up cases of ‘neglected’ and malnourished children, which might involve inspecting the child’s lunch and also visiting the home.138 While education of parents was the first form of intervention for both the infant welfare and the school nurses, the school nurses, in particular, were expected to involve the services of the State

Children’s Department if the issues were not resolved. While no evidence has been located regarding maternal and child welfare nurses drawing on the State

Children’s Department resources, it is likely they also had this option.

Holding such authority placed these nurses in a very different position vis-a-vis the other group of nurses who visited homes in the early twentieth century, private duty nurses. Indeed, as Selby139 points out, the maternal and child welfare movement in Queensland actively worked to discredit the latter, along with all other ‘grandmotherly’ advice. However, as outlined in Chapter 3, private duty nurses, especially older, untrained nurses, were not affiliated with any authority, government or otherwise; they were long-term residents in their communities and they were chosen by their patients. As such, they were in positions of trust with mothers, whereas maternal and child welfare and school nurses needed to rely on their image of ‘expert’ to gain admittance to homes.

However, the implied threat of ‘the big stick’ (State Children’s Department) is likely to have also acted in their favour when trying to gain admittance.

138 Mr T.L. Williams, Acting Minster of Health and Home Affairs, to Mr Larcombe, Minister of Public Inspection, 12 December 1944, folder A/31823, QSA, Brisbane. 139 Selby, 1994, op. cit., p. 87.

304 In addition to their positions of authority, maternal and child welfare and school nurses were frequently moved around the State. Even Ruby Brown, who had an unusually long association with Rockhampton, took her turn attending remote towns on the Railway Baby Clinic Service after 1930 when it commenced.140 These duties lasted for around three months at a time.141 As public servants, they were entitled to annual leave and promotions, necessitating transfers. For example, the 1938 maternal and child welfare clinic reports for Rockhampton reveal a number of staff changes: Nurse Stack was replaced temporarily in March while she went of annual leave; Nurse

Kemp commenced in April in Rockhampton, after Nurse Liverseed resigned;

Nurse Moore was transferred to Rockhampton in July and in September Sister

Brown commenced annual leave once Nurse Kemp returned from her break.142

It is evident, therefore, that a mother attending the maternal and child welfare clinic on a monthly basis may well have found a different clinic sister each time. In these circumstances, it would have been difficult for the nurses to build a trusting relationship with the mothers and families, although as mentioned earlier, this was perceived as the basis of the success of the service.

As such, they again had to rely on their ‘expert’ status to lend weight to their advice.

The seemingly ready acceptance of ‘experts’ by these mothers relates to a couple of issues. Lewis143 suggests mothers were willing to take on advice from maternal and child welfare nurses because they were products of

140 Murphy, op. cit., p. 23. 141 Personal and News Items, The Australasian Nurses’ Journal, vol. 29, no. 4, 1931, p. 89. 142 Compiled from monthly reports from Miss Bardsley, folder A/31674, QSA, Brisbane. 143 Lewis, 1980, op. cit., p. 206.

305 compulsory education – they were, ‘used to being taught and to looking to experts for information’. Bashford144 proposes the new reductionist view of biomedicine at the turn of the twentieth century led to doctors (and nurses), being seen as the ‘experts’ on daily personal and social life. That is, professionals whose status was based on scientific premises increasingly replaced the clergy as the external authority on how families and individuals conducted themselves. While there may be some credence in these views,

Selby145 points out that these perspectives do not adequately consider the level of acceptance of the information provided by the ‘experts’, which she estimates was variable at best; a view supported by Mein Smith.146 Nonetheless, without the benefit of developing long-term relationships with the communities in which they worked, these nurses had little option but to rely on their public images.

Role of the nurse

Considerable energy went into measuring infant’s and children’s physical growth during the early twentieth century. Indeed, determining the normal growth and nutritional needs and patterns was one of the primary objectives of the Gowie Centres.147 Babies were measured and weighed by maternal and child welfare nurses, who used charts to plot the growth of the child and to compare this with the ‘normal’ development of a baby.148 School nurses

144 Bashford, A., ‘Domestic scientists: modernity, gender and the negotiation of science in Australian nursing, 1880 – 1910’, Journal of Women’s History, vol. 12, no. 2, 2000, p. 131. 145 Selby, 1994, op. cit. 146 Mein Smith, op. cit., p. 172. 147 Crawford, op. cit., p. 188. 148 Selby, 1994, op. cit., p. 80.

306 continued this practice of measuring and comparing to ‘norms’. Such an obsession with measuring and plotting the physical growth of children served a couple of purposes. Firstly, it reinforced the image of scientific ‘expert’.

Weights and heights were one of the few objective tools readily available to nurses to determine if the child was progressing ‘normally’. Secondly, children falling outside these ‘norms’ could be easily identified and therefore more closely observed. An ‘underweight’ infant could trigger greater scrutiny of the mother’s feeding practices, although there was little association made between the rigid fourth hourly feeding regimes advocated by maternal and child welfare nurses and an ‘underweight’ baby.149 Similarly, the underweight school child had his/her lunch inspected by the school nurse to see if the child was being adequately nourished. It is unclear, however, if provisions, other than education of the mother, were made for those families whose socioeconomic circumstances were a major factor in determining the weight of their children. Furthermore, not providing for the treatment of these

‘abnormalities’ significantly undermined the purpose of detection in the first place, especially in instances of straitened means.

By being able to measure against a ‘norm’, nurses were also provided with clearer guidelines as to when to refer the child to a medical officer. Medical officers were associated with both maternal and child welfare centres and school nursing. However, the medical officers did not have the same relationship with the nurses in these services as in the hospital system. Within a hospital, nurses were expected to carry out the doctors’ orders as part of the

149 Selby outlines a mother’s recollections of her skinny baby whom she tried to feed only fourth hourly, but who was always crying, Selby, 1994, op. cit., p. 80.

307 curative function of hospitals. However, the public health nurses were generally dealing with healthy subjects for whom no curative interventions were necessary. The nurses formed the initial point of contact with the public, and indeed, this was usually the main avenue. It was the nurse who decided if a client needed to be referred to a doctor – either the client’s own general practitioner or to the medical officer associated with the service. This was a reversal of the usual power relationship between doctors and nurses at the time.

It is little wonder some doctors were uncomfortable with this situation, as expressed by the Director General of Medical Services in relation to maternal and child welfare nurses.

While these nurses were not under the direct supervision of medical officers, their activities and advice were controlled in other ways. The Director of

Maternal and Child Welfare services used the media in particular, to flood the public with information regarding ‘proper’ child rearing practices. Dr Jefferis

Turner made tours throughout Queensland, giving public lectures which were reproduced in local newspapers. For example, in his 1926 tour, Turner noted the infant mortality rate was more than 60 per 1000 live births:

which is lower than it once was, but, it is still far too high,

and for every infant that dies, several are sick, and there is

much unnecessary expense, pain, and unhappiness. When

we enquire into the cause of all this unnecessary sickness

308 and death we find in nearly every instance that it is due to

the same cause – lack of knowledge.150

He went on to outline the main errors of thinking: healthy mothers unable to suckle their own child; giving infants castor oil, condensed milk and dummies dipped in honey; diets of mothers disagreeing with infants. The maternal and child welfare service also provided written advice from a central location. The

Queensland Mother’s Book was widely distributed to mothers throughout the

State.151 This was supplemented with a correspondence section of the division, established in 1941, to reach mothers who were geographically isolated.152

Such widespread provision of information coming from a central source is likely to have discouraged maternal and child welfare nurses from providing contrary information. Furthermore, like the system in New Zealand, all training of maternal and child welfare nurses was conducted from the one location in Brisbane, where students were provided with type-written lecture notes. There was also a widespread dispersal of this training into other health facilities in the community. Table 7.2 outlines the movement of nurses who had undertaken maternal and child welfare training. As illustrated by this table, relatively few actually worked in Baby Clinics. This would also have encouraged consistency between the advice given by the nurses and that coming from within the division. Finally, these nurses had completed at least two formal certificates that stressed the importance of obedience. This reduced the likelihood of these nurses acting independent of their role descriptions and responsibilities.

150 The Morning Bulletin, 17 August 1926, p. 13. 151 Selby, 1994, op. cit., p. 91. 152 Murphy, op. cit., p. 26.

309

Table 7.2 Subsequent movement of maternal and child welfare trainees 1925 - 1938153

Position Number Percentage of total Married 90 18.48 State public service 87 17.87 Staff of public hospital 83 17.04 Private duty nursing 75 15.4 Unknown 72 14.79 Private hospitals 39 8.01 Overseas 11 2.26 Deceased 8 1.64 Living privately 6 1.23 Miscellaneous 8 1.64

School nurses, on the other hand, do not appear to have had the same level of training or control. However, as there were so few of them across the state –

14 in total in 1937, as opposed to 65 in maternal and child welfare centres, supervision of their activities may have been possible via other means.

However, further research into this aspect of nursing is necessary in order to determine how this may have operated.

One of the defining features of these public health nurses was the isolation in which they practiced. One school nurse probably attended all the

Rockhampton schools. Although there were more maternal and child welfare nurses – three in Rockhampton after 1929, each had her own activities to conduct in isolation to the others. One attended clients at the clinic, one visited clients in their homes, and one conducted the branch visits which took all day.

Table 7.3 outlines the proposed schedule for branch visits in the Rockhampton

153 Report: Department Health and Home Affairs, 9 December 1941, folder A/31807, QSA, Brisbane.

310 area. As can be seen, little time was left for assisting or working with the other staff of the centre.

Table 7.3 Proposed schedule for branch visits154

Gladstone Leave Rockhampton 7.15am Monday, return 3.15 Tuesday Yeppoon Leave Rockhampton 9.15 am Wednesday, return 7.50pm Mount Leave Rockhampton 7.50am Friday, return 6.35pm Morgan

Each nurse was therefore responsible for all aspects of her work – preparation, implementation and documenting. Again, this would have been in stark contrast with the hospital environment these nurses had experienced. As a result, it is not surprising the maternal and child welfare nurses were keen to join the activities of the Queensland Australasian Trained Nurses’

Association’s (QATNA) Rockhampton branch when it commenced in 1944.155

While the maternal and child welfare nurses had each other to socialise with after hours, and the QATNA activities, nothing is known, at this stage, of the after hours of the school nurse – where she lived/stayed when in Rockhampton, or how she stayed in touch with other nurses.

The final aspect regarding the role of the public health nurse relates to the education provided to their clients, in particular mothers. The propaganda emanating from the Maternal and Child Welfare division clearly claimed that

154 Trains were used for all branch transports, folder A/31685, QSA, Brisbane. 155 A representative of the Baby Clinic was noted on the committee from 1945 – 1951, when the committee representatives were identified. The association ceased functioning in 1954. Rockhampton QATNA minutes, ACHHAM, Rockhampton.

311 the benefits of education provided to mothers had a direct bearing on lowering the infant mortality rate:

Each day the Register-General furnishes the clinic with a list

of births in the District. The nurse calls at the home and

advises the mother as to the care of herself and baby and

encourages her to bring her infant to the clinic as soon as

possible in order that its progress can be noted and any

wrong treatment can be rectified… The beneficial result

since the clinic services were established in 1918 cannot be

better illustrated than by quoting the infant mortality figures

over five year periods:

Years 1913 – 1917 63.2 per 1000

1918 – 1922 59.5 per 1000

1923 – 1927 51.1 per 1000

1928 – 1932 41.7 per 1000

For 1932 the figures were 40.2 per 1000.156

Clearly the clinic sister was responsible for advising the ‘proper’ management of an infant and for ensuring the mother did not listen to ‘wrong treatments’.

This advice was based on the regimes advocated by Truby King and the

Plunket Society, although Mein Smith infers some adaptation occurred in

Queensland because of State involvement.157 Selby158 has appraised the

156 Press release or speech, Home Department, 16 January 1934, folder A/31674, QSA, Brisbane. 157 Mein Smith, op. cit., p. 131. 158 Selby, 1994, op. cit.

312 advice provided by maternal and child welfare nurses as to the effect on the mothers. She suggests many women did not take any notice of the nurses’ advice unless, ‘it coincided with their family’s own opinion’.159 As such, despite the consistency of information coming from the division and the clinic of maternal and child welfare, the overall effect of this information on the child-rearing practices of mothers remains debatable, and therefore further fuels the argument that ‘other’ factors were influential in the declining infant mortality rate.

It is likely the advice of school nurses was also disregarded in many instances.

Furthermore, this issue of rejecting the advice of the ‘experts’ raises questions as to whether referrals to medical officers were also heeded. The advice that a child had a ‘disability of the throat’ may not have led to the family attending a general practitioner. Indeed, if the family was experiencing financial hardships, there is a good chance this advice was not acted upon. However, this aspect too would benefit from further research before definite conclusions can be drawn.

Conclusion

This chapter has examined the beginnings of public health nursing in

Queensland, and in Rockhampton particularly. It has noted public health nursing evolved as the result of a range of factors at the beginning of the twentieth century. In particular, concern regarding the declining birth rate, a

159 Ibid., p. 89.

313 high infant mortality rate and the health of citizens to defend the nation led to a focus on educating women in their domestic and child-rearing responsibilities.

Maternal and child welfare nursing and school nursing services were the two avenues of public health nursing evident in Rockhampton prior to 1957. This examination of these services has suggested considerable uniformity within these services across the State of Queensland, due to their control by the State government. The maternal and child welfare clinics were built to a standard plan, the staff were trained according to the same doctrine, and all were employed by the government. As such, Queensland did not witness the rivalries between various factions associated with the different philanthropic groups evident in other States.160 Maternal and child welfare nursing and school nursing, therefore, represented a significant portion of the public health expenditure of the State government.

A recurring theme throughout this chapter has been that of promoting public health nurses as ‘experts’ in domestic hygiene and child rearing. This status was gained through the training these nurses undertook, and it was believed this grounding in scientific methods gave them the authority to direct the domestic practices of the ‘uneducated’ public. In addition, the measuring and surveillance activities of these nurses reinforced their image of scientific expert. However, it has also been suggested in this chapter that the public may not have held these nurses in universal awe. Indeed, the very nature of their work and who they were was likely to have contributed to a lack of zeal towards the practices they advocated. As such, this chapter supports notions

160 Reiger, op. cit., pp. 128-152.

314 that while maternal and child welfare nursing and school nursing programs may have benefited a number of families within the communities in which they served, their overall contribution to gains in public health must be questioned.

However, as highlighted throughout this chapter, the history of public health nursing in Australia has been significantly under-researched and would benefit from greater attention before any definite conclusions can be drawn.

315 Conclusion

This thesis has examined the entire gamut of nursing services as they existed in the Rockhampton region during the first half of the twentieth century. Some dealt with the sick, others focused on the healthy. Some were located in large buildings, others were found in family homes. Some were offered privately, while others were incorporated into welfare provisions involving charities and governments. As each service was analysed, change was apparent. In particular, there was a transition within society that placed greater importance on the community and nation rather than the individual. This can be seen in the overall move towards institutionalisation of nursing that affected both trained and untrained nurses. Coinciding with this was the gradual erosion of what little independence nurses had at the beginning of the century as institutions and government controlled their practice. These trends were apparent throughout Australia as in other Western countries.1 The nursing services in the Rockhampton region did not run counter to the trust of nursing services elsewhere. Those aspects challenged by this thesis, rather, rest in the details of some of the services themselves, and to some extent the timing of the changes noted elsewhere. Such differences related to either the influence of the Queensland government’s policies or local influences within the

1 For example, see: Baly, M.E., Nursing and Social Change, 3rd Edition, London, Routledge, 1995; McPherson, K., Bedside Matters. The Transformation of Canadian Nursing 1900 – 1990, Toronto, Oxford University Press, 1996; Melosh, B., The Physician’s Hand. Work Culture and Conflict in American Nursing, Philadelphia, Temple University Press, 1992.

316 Rockhampton district itself, thus confirming the importance of context as outlined in Chapter 1.

Throughout this thesis three overall issues have emerged. Firstly, the continuing high level of untrained nurses identified within this thesis challenges notions of professional status based on statutory regulation.

Secondly, nurses decreased their scope of practice as they became institutionalised and lost independence. Finally, nurses demonstrated a high level of self-sacrifice regardless of the type of work they undertook, whether it was offered privately, through charities or governments; however, profit and status also mattered. Each of these will be apparent in this summation, hence highlighting the significance of this thesis.

The most important contribution this thesis makes to the historical understanding of nursing is its consideration of untrained nurses. These nurses predominated in those services offered privately: private duty nursing and lying-in hospitals as outlined in Chapters 3 and 4. However, they were also the main source of staff for a variety of institutions such as Westwood Sanatorium,

Eventide, Bethesda and Bethany; institutions that were not nurse-training hospitals. Although untrained nurses constituted a sizeable proportion of nursing services, trained nurses viewed them with suspicion and took every opportunity to distinguish between the two groups. Statutory regulations as contained in the Health Act Amendment Act 1911 only partly protected the status of trained nurses. In addition, the lack of regulation did not prohibit some untrained nurses from acquiring a high level of skill or knowledge under

317 certain circumstances. As such, this thesis challenges some of the tenets used by past professional nurses to protect their practice: the exclusivity of training and the effectiveness of statutory regulation. With the continuing levels of unregulated nurses within today’s ever-changing health environments, consideration of what constitutes the boundaries of professional nursing is essential.

The second issue relates to the increased level of institutionalisation experienced by nurses, both trained and untrained, throughout the first half of the twentieth century. Private duty nursing and lying-in hospitals gradually decreased as a result of economic and social changes. In particular, advances in medical science and technology emphasised the hospital over home-based nursing. Political interventions also contributed to this transition through increased State control of finances and administration as discussed in Chapters

5 and 6. Welfare increasingly became the domain of the government as opposed to the voluntary sector. In addition, in Queensland, community-based nursing services such as maternal and child welfare and school nursing were also institutionalised and controlled as outlined in Chapter 7. Overall, this led to a decrease in independence within nursing. Nurses no longer controlled who they nursed and when. Although it can be argued nurses never controlled how they nursed, this thesis has outlined a reduction in the scope of practice within nursing. However, not all of these restrictions were the result of direct statutory control. Government intervention in the form of the Maternity Act 1922 saw trainees of the Women’s Hospital restricted to maternity work only. Trained nurses in small hospitals such as the Yeppoon Hospital and Mount Morgan

318 Hospital gave up activities such as administering anaesthetics and dispensing medications as a result of the professional nursing body gradually recommending restrictions in response to pressure from other professional organizations. Maternal and child welfare nurses stopped providing first aid because the government removed the supplies needed to do so. As such, this thesis provides further evidence that a range of factors influenced issues of scope of practice in relation to nursing and that nursing practice was controlled through a variety of mechanisms: obeying doctors’ instructions, abiding by statutory regulations, working within the physical and social structures of institutions. Such factors continue to resonate within contemporary nursing. It is therefore, worthwhile considering the foundations of these factors.

Thirdly, this thesis confirms the high level of self-sacrifice associated with nursing: low or no wages, less-than-ideal working and living conditions and unrestricted hours. These were evident in both the private as well as the public sector. However, the debates regarding professional status outlined in Chapter

3; the agitation regarding recommended fees and award wages noted in

Chapters 3 and 6; and the emphasis placed on status based on expertise identified in Chapter 7, challenge notions of vocation as the underlying motivation for nursing. As discussed in Chapter 5, nurses were willing to forgo significant comforts, but their motivations for doing so were not always the same. This thesis clearly identifies the lack of homogeneity among nurses and reminds us to be wary of making assumptions regarding nurses both in the past and present.

319 In conclusion, the introduction of trained nursing at the end of the nineteenth century is often portrayed as a ‘coming of the light’. This thesis examines this concept by considering the early part of the twentieth century – the transition of nursing from primarily an untrained domain to one where trained nurses predominated. By exploring this transition in detail as it occurred in one geographical location, various aspects emerge that have implications for nursing as a whole. These include the struggle to distinguish between trained and untrained nurses, including debunking the myth untrained nurses were a significant threat to the well being of society. The issue of vocationalism as a foundation of professionalism is also exposed whereby only some nurses were motivated by philanthropy, others accepted the harsh conditions as a means to an end. The premise that training provided a basis for professionalisation of nursing is also challenged as illustrated by the increase in skills and knowledge attained by untrained nurses, and the perceived need by governments and doctors to implement external controls of the practice of trained nurses when working in relative isolation. Thus, this thesis has coloured in a small section of the ‘tapestry of service’; but in doing so, has pulled a number of threads that have formed the foundations of professional nursing in Australia. Only through a closer analysis of these issues will a clearer picture of nursing emerge.

320 Appendix A: Private Duty Nurses, 1901 – 1949 (Post Office Directories)1

Year Rockhampton (including North Mt Morgan Yeppoon Emu Park Rockhampton) 1901 Mrs M Westray, 25 Archer St Mrs A Balchin Nil listed Nil listed Mrs Jane Jones, 97 Bolsover St Mrs Leighton Mrs Emma Willis*, 11 Caroline St (+ John) Mrs Poole Mrs Neil, Cambridge St (Cnr Denham) Mrs Pollard, 114 Denham St Mrs MA Holt, 173 Denham St Mrs Coker, 60 Fitzroy St Mrs M Allen, 274 West St Mrs Anna Eckle*, N R’ton Mrs Mary Flenady, N R’ton 1902 Mrs E Mallory, 88 Albert St (+ Mr William) Mrs A Balchin (+ Nil listed Nil listed Mrs Jane Jones, 97 Bolsover St (+ Charles E Henry) Crocker) Mrs Ellen Westray, Cambridge (Cnr Archer Park Railway) Mrs Emma Willis*, 11 Caroline St (+ Mr John Willis) Mrs Pollard, 114 Denham St Mrs MA Holt, 173 Denison St Mrs M Allen, 274 West St Mrs Anna Eckel*, Rose St, N R’ton Mrs Mary Flenady 1903 Mrs E Mallory, 88 Albert St (+ William) Mrs A Balchin Nil listed Nil listed Mrs Ellen Westray, Cambridge (Cnr Archer Park Railway) Mrs Emma Willis*, 11 Caroline St (+ John) Mrs AM Strewd, 216 Denison Lane Mrs MA Holt, 173 Denison St Mrs Anna Eckel*, Rose St, N. R’ton Mrs Mary Flenady, N. R’ton 1904 Mrs E Pollard, 129 Bolsover St Mrs A Balchin, Nil listed Nil listed Mrs Ellen Westray, Cambridge St (Cnr Dee River (+ Archer Park Railway) Henry) Mrs Wm J Mallory, Cnr Campbell & North St (+ Wm J) Mrs G Neil, 274 Campbell St Mrs Emma Willis*, 11 Caroline St (+ John) Mrs Louise Buderus, 191 Denison St (+ Mrs C Adams) Mrs Quinlon, 158 George St Miss E Smith, Lion Creek Rd, West R’ton Mrs Anna Eckel*, Rose St, N. R’ton Mrs Mary Flenady, Musgrave St, N. R’ton

1 Names in brackets indicate another person living at the same address. * indicates nurse registered with the Rockhampton City Council as operating a lying-in hospital. It is unclear if these nurses were operating as such prior to registering in 1916, hence have been included here as private duty nurses unless evidence indicates otherwise.

321 1905 Mrs E Pollard, 129 Bolsover St Mrs A Balchin, Nil listed Nil listed Mrs Ellen Westray, Cambridge St (Cnr Dee River (+ Archer Park Railway) Henry) Mrs Wm J Mallory, 84 Campbell St (+ Wm J) Mrs G Neil, 274 Campbell St Mrs Quinlan, 158 George St Miss E Smith, Lion Creek Rd, West R’ton Mrs Anna Eckel*, Rose St, N. R’ton Mrs Mary Flenady, Musgrave St, N. R’ton 1906 Mrs E Pollard, 129 Bolsover St Mrs A Balchin, Nil listed Nil listed Mrs Wm J Mallory, 84 Campbell St (+ Wm Dee River (+ J) Henry) Mrs Neil, 204 Denison St - Berrill*, 112 Fitzroy St (Cnr Campbell Lane) Mrs L Buderus, 156 Kent St Miss E Smith, Lion Creek Rd, West R’ton Mrs Anna Eckel*, Rose St, N. R’ton Mrs Mary Flenady, Musgrave St, N. R’ton 1907 Mrs E Pollard, 129 Bolsover St Mrs A Balchin, Nil listed Nil listed Mrs Wm J Mallory, 84 Campbell St (+ Wm Dee River (+ J) Henry) Mrs J M Willis*, 11 Caroline St Mrs M Burns, Cnr Denham & Campbell Lane Mrs Neil, 204 Denison St Miss Dickson, 87 Derby St Jane Berrill*, 112 Fitzroy St Mrs Anna Eckel*, Rose St N. R’ton Mrs Mary Flenady, Musgrave St 1908 Mrs Wm Jones, 33 Archer St Mrs A Balchin, Nil listed Nil listed Mrs Wm J Mallory, 84 Campbell St (+ Wm Dee River (+ J) Henry) Mrs J M Willis*, 11 Caroline St Mrs M Burns, Cnr Denham & Campbell Lane Mrs Neil, 204 Denison St Miss Dickson, 87 Derby St Jane Berrill*, 112 Fitzroy St Mrs Anna Eckel*, Rose St, N. R’ton Mrs Mary Flenady, Musgrave St, N. R’ton 1909/10 Mrs Wm Jones, 33 Archer St Mrs A Balchin, Nil listed Nil listed Mrs Wm J Mallory, 84 Campbell St (+ Wm Dee River (+ J) Henry) Mrs J M Willis*, 11 Caroline St Mrs M Burns, Cnr Denham & Campbell Lane Miss Dickson, 87 Derby St Mrs A Bannon, 300 East St Jane Berrill*, 112 Fitzroy St Mrs Anna Eckel*, Rose St, N. R’ton Mrs Mary Flenady, Musgrave St, N. R’ton

322 1910/11 Population 20 000 Mrs A Balchin, Population Nil listed Mrs Jane Pollard, 246 Alma Street Dee River ~2252 Mrs Wm J Mallory, 84 Campbell St (+ Wm Nil listed J) Mrs J.M Willis*, 11 Caroline St Mrs M Burns, 130 Denham St Miss E Dickson, Cnr Derby & Kent St Mrs A Bannon, 300 East St Mrs Kate Gaffney*, Stanley St (between Gladstone & Canning) Miss Mary Jones*, 10 West St Mrs Anna Eckel*, Rose St, N. R’ton Mrs Mary Flanady, Musgrave St, N. R’ton 1911/12 Mrs Jane Pollard,246 Alma St Nil listed Nil listed Nil listed Mrs Wm J Mallory, 84 Campbell St (+ Wm J) Mrs M Burns, 130 Denham St Miss E Dickson, Cnr Derby & Kent St Mrs Emily Neil, Cnr East Lane & Cambridge St Mrs A Bannon, 300 East St Miss Jane Berrill3*, 112 Fitzroy (+ Mrs Jane Berrill) NB also noted to have Nursing home @ Cnr Talford and Archer St Miss Mary Jones*, 10 West St Mrs Anna Eckel*, Rose St, N. R’ton Mrs Mary Flenady, Musgrave St, N. R’ton 1912/13 Mrs Jane Pollard, 246 Alma St Miss Florence Nil listed Nil listed Mrs Emily Neil4, 330 Campbell St Gray Mrs M Burns, 130 Denham St Miss Eliz Miss Mary Jones5*, 10 West St Mitchell Mrs Anna Eckle6*, Rose St N. R’ton Miss Eileen Mrs Mary Flenady, Musgrave St, N.’Rton Perrier 1913/14 Mrs Jane Pollard, 246 Alma St Miss Florence Nil listed Nil listed Mrs Emily Neil, 330 Campbell St Gray Mrs M Burns, 130 Denham St Miss Eliz Miss Mary Jones*, 10 West St Mitchell Mrs Anna Eckel, Rose St, N. R’ton Miss Eileen Mrs Mary Flenady, Rose St, N. R’ton Perrier 1914/15 Mrs Emily Neil, 330 Campbell St Miss Florence Nil listed Nil listed Mrs M Burns, 130 Denham St Gray Miss Mary Jones*, 10 West St Miss Eliz Mitchell

2 Cosgrove, B. Yeppoon, Central Queensland 1867 – 1939: establishment and growth of a seaside holiday resort. Master of Letters thesis, University of New England, 1984, p. 47. 3 Miss Mary Jane Berrill, ‘Strath-Avon’, Archer Street, Rockhampton, registered with Queensland Midwifery Register 4 December 1912 under Category 154C1, folder A/73218, QSA, Brisbane. 4 Mrs Emily Neil, 330 Campbell Street, Rockhampton, registered with Queensland Midwifery Register 11 December 1912 under Category 1542C(3), folder A/73218, QSA, Brisbane. 5 Miss Mary Anne Jones, 10 West Street, Rockhampton, registered with Queensland Midwifery Register 4 December 1912 under Category 154C1, folder A/73218, QSA, Brisbane. 6 Mrs Anna Eckel, Rose Street, North Rockhampton, registered with Queensland Midwifery Register 11 November 1912 under Category 154C2(3), folder A/73218, QSA, Brisbane.

323 1917/18 Mrs Mary Giles, 225 Campbell St Miss Elis Nil listed Miss Bessie Mrs Emily Neil, 330 Campbell St Mitchell Hardy7 Mrs M Burns, 130 Denham St Mrs Anna Eckel*, Rose St, N. R’ton Mrs Mary Flenady, Musgrave St, N. R’ton 1919/20 Mrs Mary Giles, 225 Campbell St Nil listed Nil listed Nil listed Mrs Emily Neil, 330 Campbell St Mrs M Burns, 130 Denham St Mrs Anna Eckel, Rose St, N. R’ton Mrs Mary Flenady, Musgrave St, N. R’ton 1920/21 Mrs Mary Giles, 225 Campbell St Nil listed Nil listed Nil listed Mrs Emily Neil, 330 Campbell St Mrs M Burns, 130 Denham St Mrs Mary Flenady, Musgrave St, N. R’ton 1922/23 Population 24 3000 Gwen Evans Nil listed Nil listed Mrs Mary Giles, 225 Campbell St Mrs Emily Neil, 330 Campbell St Mrs M Burns, 130 Denham St 1923/24 Mrs Mary Giles, 225 Campbell St Gwen Evans Nil listed Nil listed 1924/25 Mrs Mary Giles, 225 Campbell St Gwen Evans Mrs Nil listed Lucy Hopwood Hetherington8 1925/26 Mrs Mary Giles, 225 Campbell St Gwen Evans Mrs Nil listed Lucy Hopwood Hetherington N Olsen 1926 Population 30 000 Gwen Evans Mrs Nil listed Mrs Mary Giles, 225 Campbell St Lucy Hopwood Hetherington N Olsen

1927/28 Mrs Mary Giles, 225 Campbell St Gwen Evans Mrs Nil listed Lucy Hopwood Hetherington N Olsen E Austin E Bianchi T Pettit 1928/29 Mrs Mary Giles, 225 Campbell St Gwen Evans Mrs Nil listed Lucy Hopwood Hetherington N Olsen E Austin E Bianchi T Pettit 1929/30 Mrs Mary Giles, 225 Campbell St Gwen Evans Mrs Nil listed Lucy Hopwood Hetherington N Olsen E Austin T Pettit

7 Miss Elizabeth Hardy, Hillcrest Hospital, Rockhampton, registered with Queensland General Nurses Register 23 December 1912 under Category 154B4, folder A/73216, QSA, Brisbane. 8 Mrs Jessie Hetherington, ‘Acadia’, Murray Street, Rockhampton, registered with Queensland Midwifery Register 11 October 1915 under Category 154C2, folder A/73218, QSA, Brisbane.

324 1930/31 Mrs Mary Giles, 225 Campbell St Gwen Evans Mrs Nil listed Mrs Florence Wye*9, 2 Cathedral St Lucy Hopwood Hetheringgon Mrs Catherine Gaffney*, 87 Derby St N Olsen Mrs M McGuirk*, 89 George St E Austin Mrs Edith Hoare*, 9 Rose St, N. R’ton T Pettit Miss Mary Jones*, 10 West St 1931/32 Mrs Mary Giles, 225 Campbell St Gwen Evans Mrs Nil listed Mrs Florence Wye*, 2 Cathedral St Lucy Hopwood Hetherington Mrs Catherine Gaffney*, 87 Derby St N Olsen Mrs M McGuirk*, 89 George St Mrs Edith Hoare*, 9 Rose St, N. R’ton Miss Mary Jones*, 10 West St 1933 Mrs Mary Giles, 225 Campbell St Gwen Evans Mrs Nil listed Mrs Florence Wye*, 2 Cathedral St Lucy Hopwood Hetherington Mrs Catherine Gaffney*, 87 Derby St N Olsen Mrs M McGuirk*, 89 George St Mrs Edith Hoare*, 9 Rose St, N. R’ton Miss Mary Jones*, 10 West St 1934 Mrs Mary Giles, 225 Campbell St Gwen Evans Mrs Nil listed Mrs Florence Wye*, 2 Cathedral St Lucy Hopwood Hetherington Mrs M McGuirk*, 211 George St N Olsen Mrs Edith Hoare*, 9 Linnett (formally Rose) St, N. R’ton Nurse Brady*, 194 Murray St 1935 Mrs Mary Giles, 225 Campbell St Gwen Evans Population Nil listed Mrs Florence Wye*, 2 Cathedral St Lucy C 159810 Mrs M McGuirk*, 211 George St Hopwood Mrs Nurse Brady*, 194 Murray St Hetherington N Olsen 1936 Mrs Mary Giles, 225 Campbell St Gwen Evans Mrs Nil listed Mrs M McGuirk*, 211 George Street Lucy C Hetherington Nurse Brady*, 194 Murray Street Hopwood N Olsen 1937 Mrs Mary Giles, 225 Campbell St Gwen Evans Mrs Nil listed Mrs M McGuirk*, 211 George St Lucy C Hetherington Nurse Brady*, 194 Murray St Hopwood N Olsen 1938 Mrs Mary Giles, 225 Campbell St Gwen Evans Mrs Nil listed Mrs M McGuirk*, 211 George St Lucy Hopwood Hetherington Nurse Brady*, 194 Murray St Olsen 1939 Mrs Mary Giles, 225 Campbell St Gwen Evans Mrs Nil listed Mrs M McGuirk*, 211 George St Lucy Hopwood Hetherington N Olsen 1940 Mrs Mary Giles, 225 Campbell St Gwen Evans Mrs Nil listed Mrs M McGuirk*, 221 George St Lucy Hopwood Hetherington N Olsen 1941 Directory changed – no listing for nurses (Population very H Brimstone (+ Nil listed small) W Brimstone) Gwen Evans Lucy Hopwood

9 * indicates nurses who had registered lying-in hospital with Rockhampton City Council in 1930 (when records cease). Unclear if lying-in hospital still in existence after 1930 as POD often listed as ‘nurse’ prior to 1930. 10 Cosgrove, op. cit., p. 87.

325 1942 Gwen Evans H Brimstone (+ Nil listed Lucy Hopwood W) 1944 Lucy Hopwood H Brimstone (+ Nil listed W) 1946 Lucy Hopwood H Brimstone (+ Nil listed W) 1949 H Brimstone (+ Nil listed W)

326 Appendix B: Nurses and their lying in hospitals in Rockhampton

Last date Post R’ton Estimate Nurse QNRB Address Reg. R’ton Lying Lying-in years date in nursing 1923 Mt Aitken, Mrs Jane 1912 ‘Balgay’ 1916 1919 Morgan Min 11 154C2(3) 123 Stanley Street Obstetric + 1921 training Women’s Bruce, Miss Alison 1925 Longreach 1920 ‘Bannockburn’ 1921 1924 changed Private Hospital Min 17 Women’s King Street*1 address 1937 ‘Kingston’ Gympie (1904 Berrill, Miss Mary ATNA xxi ‘Strath-Avon’ 1916 1937 Min 33 1906 Cnr Archer & (Eliz d. 1937 Women’s) Talford Streets* MJ d. 1945) 1912 154C1 (1911 Brady, Mrs Sarah Albert 7 McDonald Street 1927 1928 (nee Molloy, Hospital) Albert Hospital, Mt 1912 Morgan) 154C2(3) 1930 advertised ‘Bralock’ 1928 1930 taking ‘outside Min 26 196 Murray Street cases’ 1937 POD

Clarke, Mrs Rhoda 1912 ‘Aura’ 1919 1930 Min 18 Ann 154C2(3) 51 George Street, Nil further btwn Cambridge and data Albert Streets

Costello, Miss (B) (1918 ‘Lucina’ 1923 1941 (not by Min 23 Henrietta Women’s) 152 Talford Street, 1946) 1922 btwn Denham and 206 Fitzroy Streets

Curren, Rose Ann 1912 131 Denison Street* 1919 1920 (May) Min 8 154C2(3) (Nov) Notified, no reason

Eckel, Mrs Anna (1901 ‘Glecoma’ 1920 1928 Min 27 POD) Rose Street, North renewal Nil further 1912 Rockhampton data 154C2(3)

Forsdick, Mrs (1884 ‘Cranham Cottage’ 1916 as 1926 1928 last Min 44 Alice Selina arrived 130 Murray Street Young Notified, no delivery (formally Mrs Aus) 138 Murray Street 1917 reason Young) 1912 from 1924 number 154C2(3) adj.*

1 * indicates nurse owned home.

327

Gaffney, Mrs 1912 ‘Derrinlough’ 1916 1930 Min 18 Catherine (Kate) 154C2(3) 87 Derby Street* No further data

Gairdner, ML 1922 ‘Lisbeg’ 1923 1923 (Sept.) 1 206 Crn Separation & (Jan) Notified, no Gladstone Streets* reason

Holland, Mrs Mary 1912 27 Kent Street* 1919 1926 Min 14 154C2(3) Notified, ill health

Hoare, Mrs Edith 1912 ‘Fairview’ 1920 1930 Min 18 154C2(3) Rose & Brown renewal No further Streets* data

Jones, Miss Mary (1905 ‘Stoneyhurst’ 1917 1930 Min 25 Anne POD) 10 West Street No further (Women’s data 1905) 1912 154C1

Laird, Ellen Mary 1912 Murray and 1917 ? not 154C2(3) Gladstone Streets applicati successful on

Lawson, Mrs Ann 1912 96 George Street 1918 1921 Min 9 S. 154C2(3) renewal reminder

Miller, Mrs Mary 1917 94 Albert Street* 1917 1918 1 154E reminder

Muller, Mrs 1912 ‘Zilzie’ 1916 1930 Min 18 Margaret Jane 154C2(3) 119 Denison Street No further 95 Denison Street data from 1924 number adj.*

1923 Listed as ‘nurse’ McGiurrk, Mrs exam ‘Taronga’ 1924 1930 in POD until Min 17 Mary (Lady 89 George Street 1940 when Chelsmford records change. ) Nil further data 1912 O’Malley, Matron General ‘Innesfail’ 1922 1924 1939 Min 27 Ethel Lucy 154E 207 Kent Street application ‘Stuartholme’, 1917 175 Kent Street from renewed. No Jandowal Midwifery 1924 number adj. further 154E correspond.

Pollard, Miss Mary 1916 ‘Bidgood House’ 1916 1922 Min 6 Elizabeth 154E 249 Campbell Street (1919- application 1922 run renewed. No by Nurse further data

328 Wye)

Preece, Mrs Harriet 1912 293 Murray Street 1916 1926 not Min 14 154C2(3) renewing (MOH)

Smith, Miss 1912 131 Bolsover Street 1916 1917 Min 5 Elizabeth 154C2(3) reminder

Smith, MA Beasley 1919 ‘Canterbury’ 1919 1921 granted 206 185 Campbell Street*

‘Glenolive’ 1924 1926 7 102 Denison Street* Notified, ill health

Willis, Mrs Emma (1901 1 George Street 1918 1921 Min 20 POD) reminder 1912 154C2(3)

Wye, Mrs Florence 1912 ‘Richmond’ 1916 1918 Emily 154C2(3) Denham Street reminder

‘Bidgood House’ 1919 1920 249 Campbell Street (late application Pollard) granted. No corresp. 1921

Oxford Street 1922 1925 (May)

‘Richmond House’* 1925 1930 Min 18 2 Cathedral Street (May) No further data

329 Appendix C: Map of Rockhampton city1

1 PDC Directories 2002.

330 Appendix D: Infant mortality rates, Australia, 1901 – 1945 (Rates per 1000 live births)1

Year NSW Vic. Qld SA WA Tas Aust 1901-5 64 61 62 56 88 56 63 1906- 46 47 40 42 59 54 47 10 1911- 39 39 35 38 42 38 39 15 1916- 33 34 33 32 32 32 33 20 1921- 28 30 24 26 32 29 28 25 1926- 25 23 20 20 24 20 23 30 1931- 14 15 12 12 16 14 14 35 1936- 14 12 11 11 17 12 13 40 1941- 12 10 10 12 13 12 11 45

1 Commonwealth Year Book 1951, as cited in Mein Smith, P., Mothers and King Baby. Infant Survival and Welfare in an Imperial World: Australia 1880 – 1950, Hampshire, MacMillan Press, 1997, p. 20.

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