Nursing services in the Rockhampton district_ 1911 – 1957

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					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.




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




                                                     x
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 region 1




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.



                                                                                11
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.

12
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 Webster 3 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 over-
crowding 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, Gregory 9 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. Selby 16 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 Hellier 20 and Strachan 21 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-Miller 22

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, Bell 28 records the

government tried to reduce its financial contribution to the Brisbane Hospital

from 1849. As Trembath and Hellier 29 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-Wilkinson 39 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. Welsh 40

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. Durdin 45 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. Selby 46 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 Maggs 49 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

Maggs 53 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, Cushing 54 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, McPherson 55

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. Rafferty 56 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 Baly 57 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. McDonald 65 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 Macintyre 66 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 Murphy 67 and Ross Fitzgerald 68 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. Patrick 69 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
Bell 70 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 racial 74 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 Spearritt 76 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 Willis 78

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 Conlon 80 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 Reeke 81 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?



                                                                                31
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 Cushing 89 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 Marwick 90 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, Patmore 94 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. Simonton 97 cites Davis’ 1976 view regarding the

tendency to record women’s activities ‘wrenched’ from their historical context.

Lake 98 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 Tosh 102 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 MacRaild 107 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. McMinn 5 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, McMinn 6

and Alomes and Jones 7 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 McQueen 13 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 Grundy 17 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, McQueen 20 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 McQueen 22 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, Tsokhas 28 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, Dickey 30 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 Queensland 34

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 Thornton 35 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, Hawkins 36 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.

52
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 Murphy 38 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 Selby 41 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.



Patrick 56 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. Jordon 57 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.



Knight 60 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. Costar 61 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, Gregory 63 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



Gregory 69 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. Daniel 70 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. Strachan 71 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 1923 81 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. Selby 82 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

7.



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 Thorton 93 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. Russell 97 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’s 99 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 Gregory 106

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

Hellier 108 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 nurses 114

                       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 six 9 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 1923 18

 Hospital or Organization               ATNA registers 19                   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

1923 20 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
                                 23
were mostly unregistered.             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. Strachan 29

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 Hellier 30 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’s 38 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 Mortimer 46 and Martyr 47 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 Summers 49 and those provided by

others such as Durdin 50 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 Greene 52 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 Hellier 53 , Durdin 54 and Schultz 55 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 Whiting 62

have identified a similar situation in the UK and Lane-Miller 63 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 Cosgrove 88 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 –
1955 98

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 – 1958 110

         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



Selby 3 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 1905 5 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
          18
school,        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 - 1949 20

        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. 1930 24




                      This figure is not available online.
                      Please consult the hardcopy thesis
                      available from the QUT Library




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 staff 27




                     This figure is not available online.
                     Please consult the hardcopy thesis
                     available from the QUT Library




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 Bulletin 48 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 Hospital 51




                          This figure is not available online.
                          Please consult the hardcopy thesis
                          available from the QUT Library




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, Selby 56 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 Selby 60 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, 2002 67




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 1939 72

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
McCalman 77 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



Selby 79 and Summers 80 indicate the majority of nurses who undertook

maternity work during the first part of the twentieth century did so without

formal training.     Indeed, Selby 81 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’s 85 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 Strachan 92 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.
92
   Strachan, 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
            99
Forsdick;        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,

Cosgrove 107 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.

Selby 111 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

Smith 112 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

1922 115 and 1927 116 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. Martyr 118 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 – 1940 127

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.



Selby 141 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, Williamson 145 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

Martell 151 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, Martyr 152 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. Reiger 153 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 Francis 1 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 Godden 4 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 Hyslop 7 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. Prochaska 8 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 Francis 11 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, Solomon 13 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.                        Thane 19

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, Godden 21 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 Lewis 25 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,

Taylor 27 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 -
1931 36

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 Bradley 40 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 Hospital 43




                      This figure is not available online.
                      Please consult the hardcopy thesis
                      available from the QUT Library




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. Hermann 45

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. Trotman 53 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 – 1928 56

Year            Born            Deaths          Stillborn 57        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 -
1931 66

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. Selby 68 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 - 1922 72

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 Hospital 74




                     This figure is not available online.
                     Please consult the hardcopy thesis
                     available from the QUT Library




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. Trotman 77 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 Voss 78 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. 1913 92




                           This figure is not available online.
                           Please consult the hardcopy thesis
                           available from the QUT Library




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.
1937 109




                               This figure is not available online.
                               Please consult the hardcopy thesis
                               available from the QUT Library




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. 1937 110




                 This figure is not available online.
                 Please consult the hardcopy thesis
                 available from the QUT Library




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.
117
    Salvation 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. 1919 123




                              This figure is not available online.
                              Please consult the hardcopy thesis
                              available from the QUT Library




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 – 1934 131

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
- 1958 134

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 Wall 136 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 on-

going 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 Stevens 147 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.

Selby 148 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 built 150 . 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 Stewart 153

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. Brodie 155 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 Wall 156 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.

Prochaska 157 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 on-

going viability of these services by providing the workforce at a minimal cost.



Conclusion



Deane 161 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 Hellier 4 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. Selby 5 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,

Selby 7 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.
11
   Carment 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 –
1926 13

       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. 1928 14

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 1949 19

       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 Killion 23 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 –
1927 42

       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 1947 49 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, 1922 68

     •   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, 1930 69




                                 This figure is not available online.
                                 Please consult the hardcopy thesis
                                 available from the QUT Library




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, 1919 74




                                   This figure is not available online.
                                   Please consult the hardcopy thesis
                                   available from the QUT Library




73
     The Capricornian, 13 September 1919, p. 46.
74
     Folder A/4721, QSA, Brisbane.

236
Figure 6.4 Westwood Sanatorium, 1919 75




                       This figure is not available online.
                       Please consult the hardcopy thesis
                       available from the QUT Library




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 Sanatorium 80

             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 – 1941 85

              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 - 1949 103

 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 1930s 108 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 - 1954 126

                 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 – 1930 130

       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

Mendelsohn 154 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

trainees 159 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,

Keleher 3 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’s 4 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

Smith 6 explores the infant welfare movement in Victoria, New South Wales

and to a lesser extent South Australia and Queensland. Crawford 7 looks at

Gowie Centres in Western Australia during the 1940s and O’Hara 8 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 Queensland 9 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 Lewis 13 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 Roe 16 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 rate 19 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 Cameron 24 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. Cumpston 28 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 Davis 33 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. Selby 35

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 Brennan 36 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.                          Selby 38

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. Cilento 41

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 officer 48 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 Olssen 61 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’s 67 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 2002 78




Figure 7.2 Standard floor plan of Maternal and Child Welfare Centres, c.
1922 79




                         This figure is not available online.
                         Please consult the hardcopy thesis
                         available from the QUT Library




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 – 1924 83

       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 Bashford 107 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,

Kelsey 108 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 Kelsey 111 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. Grant 114 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, Beddie 117 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    Wilson 125 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’Hara 129 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 Selby 139 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. Lewis 143 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’. Bashford 144 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,

Selby 145 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 - 1938 153

      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 visits 154

      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              Selby 158 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           ~225 2
          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 Berrill 3 *, 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 Neil 4 , 330 Campbell St            Gray
          Mrs M Burns, 130 Denham St                    Miss Eliz
          Miss Mary Jones 5 *, 10 West St               Mitchell
          Mrs Anna Eckle 6 *, 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                              Hardy 7
          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       Hetherington 8
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               1598 10
           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 city 1




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.


                                                                         331
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Cosgrove, B.            Yeppoon, Central Queensland 1867 – 1939:
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Selby, W.        Motherhood in Labor’s Queensland, 1915 – 1957.
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                 ‘Women’s’ Hospital Rockhampton’, unpublished paper,
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