Elie Matar
Sydney, Australia

When His Royal Highness Prince Alfred, Duke of Edinburgh and second son of Queen Victoria, landed on the shores of Sydney on January 21, 1868, he was received with thunderous ovation from the thousands gathered to witness the arrival of the first member of the Royal family to Australia. In light of such a warm reception, none would have predicted that this momentous visit would soon be marred by the first attempted political assassination on Australian soil.

Royal Prince Alfred Hospital (RPAH) is one of the busiest and foremost tertiary teaching hospitals in New South Wales, Australia. It accommodates over one thousand inpatient beds within a large multi-storied complex of buildings nestled in the heart of Sydney’s bustling inner west¹. In spite of the more modern architectural additions, the entrance to the main hospital survives as it was when the hospital opened in 1882.

On entering the colonial-façade of the main building, one encounters a short passageway flanked by dark-timber veneer benches, aged stained glass windows, and antiquated busts before giving way to the bright and spacious lobby that marks the transition to the more modern extension of the hospital. The passageway serves as a relic of a rich and colourful history – of a hospital born at the intersection between a nineteenth century scandal and period of major change in medicine. This revolutionary period saw the development of the germ theory advanced by Pasteur, Koch, and Lister and an increased emphasis on sanitation as pioneered by Florence Nightingale, the founder of modern nursing care².

In the mid-nineteenth century the state of health care in the young and expanding colony of New South Wales (NSW) was in a dire state. The wards in the only hospital in Sydney at the time (the Sydney Infirmary) were overcrowded and infested with vermin while sewage lay about the yard in the open³. Because of such conditions, it was not uncommon for nursing and medical staff to contract various illnesses, as one observer noted:

The colonial fever always takes a dysenteric type…haemorrhage, purging and stringing are indeed terrible…many deaths. There is no water, no sink, no taps belonging to this ward. All the slops are emptied into a pail…carried through the length (middle of the ward) …to a ward containing one seat for 50 people. Is it to be wondered that the nurses have fever?⁴

Other hospitals at the time were not much better, which were only staffed by a lay married couple who acted as matron-cook and ward-yardman.

During this time in Europe the work of Florence Nightingale in the Crimea in 1855 in reducing the death rate of wounded soldiers by promoting improved sanitation had become widely publicized. Four years after her return to England, her first school for nurses was established in St Thomas’ hospital, London in 1862. Subsequently she became recognized as an authority in modern hospital organisation, administration, and nursing. This led the visionary Mr Alfred Roberts, a London-trained surgeon working at the Sydney Infirmary, to ask Miss Nightingale to send trained nurses to Australia and advise how to improve the infrastructure of the hospitals³. After several exchanges, the first trained nurses from the Nightingale School of St Thomas’ in London disembarked in Sydney on March 5, 1868 – the same year (incidentally) of the visit of the first Royal family member to Australia, Prince Alfred³.

By this time, Prince Alfred had been in Sydney for less than two months and had spent his time attending numerous formal social events. On March 12, 1868, the Prince was attending a formal picnic in aid of the ‘Sailor’s home’ in the harbour-side suburb of Clontarf. In the afternoon, as he emerged from the luncheon tent to survey the landscape, he was ambushed and shot in the lower back by Henry James O’Farrell – an Irish anti-monarchist and self-proclaimed ‘Fenian’⁵. As the Prince fell to the ground, the assailant was swiftly overcome by nearby attendants who managed to divert a second shot into the foot of an unfortunate bystander⁶ (Fig 1). An excerpt from the diary of Mrs Barker, wife of the Bishop of Sydney at the time, aptly captures the reaction of the crowd:

… the scene was … so instantaneous and stunning that people seemed to lose their senses … rushing about in all directions … men as well as women fainting. The culprit has the narrowest escape of being torn to pieces.⁷

The Prince was taken to Government House in HMS Morpeth and attended by Dr Watson, surgeon of HMS Challenger. An urgent request was sent for two of the newly arrived Nightingale nurses to attend to the Prince. Fortunately he survived, and two days later the bullet was successfully extracted without anaesthesia by Dr Young of HMS Galatea⁸ (the gold probe used in this procedure is still on display today in the RPA Museum).

The sentiment amongst the citizens of Sydney was a mixture of indignation, shock, and deep embarrassment6. Several public meetings were held in the wake of the incident. Within one week of the wounding the people had resolved that the most appropriate memorial of gratitude for the Prince’s recovery was to be ‘an institution for the care of the sick and the training of nurses’ – the ‘Prince Alfred Memorial Hospital’³. The proposal was received with much enthusiasm by numerous beneficiaries. Leading the petition was Mr Alfred Roberts, who saw this as an opportunity to build a first-class hospital in the colonies based on the Nightingale design. Eventually, after some deliberation, the University of Sydney Senate granted 400 acres of land from the Grose Farm estate for the building of the hospital⁹. Thus Royal Prince Alfred Hospital was to become the first clinical post of the new medical school of the University as well as the first school for training nurses.

After the land rights were granted by the University in 1873, Mr Roberts set upon optimizing the design of the proposed hospital. As part of his extensive research, he set sail across the world to gather information about prominent hospitals in India, Egypt, Italy, Austria, Prague, Germany, England, and the United States³. He also called frequently on Miss Nightingale to comment and advise on the design of the new hospital.

The foundation stone was finally laid on April 24, 1876, eight years after the attempted assassination of the Prince. This foundation stone which exists to this day contains a Latin inscription which translates:

To God all powerful, all merciful – who, when Alfred Duke of Edinburgh, in the midst of festivals and rejoicings, with which the citizens of Sydney welcomed him, was dangerously wounded by a fanatic, preserved him for his Mother, the Queen, and for all Britons – the people of New South Wales relieved from the grief and reproach of so terrible an act, dedicated this refuge of the sick and seat of medicine, in the year of human redemption, 1876 …¹⁰

Royal Prince Alfred Hospital officially opened on September 25, 1882 with 146 beds. In its inaugural year over one thousand patients at RPAH⁸. From these modest beginnings, the hospital has continued to grow to meet the demands of the population and now represents the largest tertiary referral hospital in central Sydney, accommodating almost 60’000 inpatients and over 455,000 outpatient visits every year¹.

It is only fitting that a hospital born in the spirit of innovation and leadership should continue in this tradition today. Indeed, RPAH has consistently been at the forefront of medical knowledge and advancement, having achieved numerous ‘firsts’, among these the first open heart surgery in NSW, the first aortic valve replacement, the first coronary angiography in NSW, the first major haemophilia centre, and even the first triage nurses in Australia. RPAH also houses the largest melanoma unit in the world, a national liver transplant unit, and the largest lung cancer service in NSW¹¹.

Its traditional ties with the University have also entrenched a strong academic culture within RPAH which currently holds more research bodies than any other public hospital in Australia¹¹. Among the rewards of the research has been the development of new therapies such as the invention of the CPAP (Continuous Positive Airway Pressure) machine for the treatment of sleep apnoea¹². Keeping with the tradition, this last year has seen the opening of the new multi-million dollar Charles Perkins centre, dedicated to reducing the burden of cardiovascular disease, obesity, and diabetes through research and education¹³.

Uniquely, the hospital has also enjoyed some mainstream celebrity as the subject of the prime-time documentary series titled ‘RPA’ comprising twelve seasons spanning seventeen years between 1995 and 2012. The hour long episodes showcased the medical journeys of various patients and often contained footage of operations.  RPA was consistently nominated for the national television industry awards in the categories of ‘Most Popular Reality Program’ and ‘Most Outstanding Factual Series’, winning the award on two occasions¹⁴.

From the outset RPAH has continually evolved to meet the various medical and social challenges of the modern era. The evolution has taken many different forms, from the release of medical staff to assist in the war efforts in 1914 to the opening of a new centralized seventy-three-bed mental health facility to deal with the local burden of mental illnesses in 2014. Yet whatever new challenges (and buildings) the future may bring, the ‘people’s hospital’ will continue its tradition of serving the community through innovation and excellence – a tradition that lives not in the architecture, museum or marble busts of an often-overlooked passageway but rather in the dedicated efforts of the volunteers, nurses, porters, allied health, receptionists, pharmacists, administrators, and physicians that is Royal Prince Albert Hospital.

References

1. RPA Executive Staff. Royal Prince Alfred Hospital Strategic Plan 2013-2018. Sydney Local Health District: RPA. http://www.slhd.nsw.gov.au/pdfs/RPA_StrategicPlan.pdf. Published November 2012. Accessed January 4, 2015.
2. Ellis, H. Florence Nightingale: creator of modern nursing and public health pioneer. J Perioper Pract. 2008; 18(9): 406.
3. Doherty, MK. The Life and Times of Royal Prince Alfred Hospital, Sydney, Australia. Sydney: NSW College of Nursing; 1996.
4. Correspondence Miss Lucy Osburn to Miss F. Nightingale, held in Vaughan Nash Collection, British Museum, 1868.
5. Lyons, M. O’Farrell, Henry James (1833–1868). In Australian Dictionary of Biography. Canberra: Australian National University. 1974.
6. Unlisted Author. Attempt to Assassinate H.R.H. Prince Alfred at Clontarf. The Sydney Morning Herald. Mar 13, 1868: 5.
7. Diaries, Mrs Fredrick Barker, held in the Royal Archives, Windsor Castle.
8. Croll, H. History of Royal Prince Alfred Hospital. Media Releases. http://www.sswahs.nsw.gov.au/mediacentre/mediareleases/Archives/2003/mr030224b.htm. Published Feb 24, 2003. Accessed Jan 5, 2015.
9. Prince Alfred Memorial Hospital. Acts of Parliament. April 3, 1873.
10. Unlisted Author. Prince Alfred Hospital. The Sydney Morning Herald. Apr 25, 1876: 6.
11. RPAH Staff. About RPAH. Sydney Local Health District, Royal Prince Alfred Hospital. http://www.sswahs.nsw.gov.au/rpa/about_us.html. Published 2013. Accessed Jan 10, 2015.
12. Kirby, T. Colin Sullivan: inventive pioneer of sleep medicine. Lancet.  2011; 377(9776): 1485.
13. Our Approach: The Charles Perkins Centre. The University of Sydney. http://sydney.edu.au/perkins/about/our-approach.shtml. Published 2014. Retrieved 12 Jan, 2015.
14. Logie Timeline. TV week Logie Awards. http://www.tvweeklogieawards.com.au/logie-history. Published 2015. Retrieved Jan 10, 2015.