By the turn of the 20th century the role and public image of the hospital was changing. A number of developments made hospitals less unpleasant for patients.
The discovery of anaesthesia in the 1840s made patients more willing to undergo operations and reduced the risk of dying of shock during surgery. However, anaesthesia did not dramatically improve the prognosis for the patient. Hospitals were still often unhygienic, which caused a high rate of post-operative infections.
From the 1860s antisepsis (use of antiseptic substances such as carbolic acid) and asepsis (exclusion of bacteria and viruses) were used during operations. Sterile hospital environments made operations safer for patients.
Laboratory and diagnostic facilities such as X-rays were not available in most New Zealand hospitals until well into the 20th century. Nevertheless, by the late 19th century scientific developments meant that more people were willing to enter hospitals.
The first medical school in New Zealand opened in Dunedin in 1875. Initially, the course was limited and students had to study overseas to qualify. The first student to complete a full course at Dunedin graduated in 1887. New Zealand’s second medical school (Auckland) did not open until 1968.
As in Britain, hospitals were integral to medical education. This altered their function – no longer solely places of refuge, they became the site of scientific training and research. Under the influence of the medical profession, hospitals increasingly admitted only cases which were deemed curable. Complaints about ‘incurables’ occupying beds around the turn of the century made it clear who was prioritised in hospital care.
Nursing has often been described in highly moral, almost religious terms. In 1910 Matron Thurston of Christchurch Hospital called it ‘the noblest profession … Self must be put aside; jealousy and disloyalty unknown. Instead of looking on each other as individuals setting forth on our task alone, let us remember we are members of the same family … and the training school our mother, ready to go forth, armed only with high ideals, banded together for the good and comfort of the sufferers; loyal to the traditions of nursing as shown us by the self-sacrificing life of Florence Nightingale.’1
Nursing training and registration
The nursing reform movement led by Florence Nightingale, which originated in Britain in the 1860s, was significant in the transformation of hospitals. This produced a new style of nurse who was efficient, obedient, clean, hard-working and sober. Nursing leaders (matrons) were posted around the British Empire and took ideas about cleanliness and discipline within hospitals with them. Auckland Hospital appointed its first matron in 1865, but it was not until 1883 that the first Nightingale-trained matron, Annie Crisp, transformed the hospital environment.
Nursing was feminised – the trained male nurses who had previously dominated hospitals now mainly worked in mental hospitals. However, the orderlies who performed physical tasks such as moving patients around remained mostly male. To encourage respectable young women to become nurses, supervised nurses’ homes were set up on hospital premises.
The Nurses Registration Act 1901 was the first legislation covering nursing training and registration in the world. This act formalised the hospital-based nature of nurse training through a system of apprenticeship, involving three years of training and a state examination. From the 1970s nurses were trained in tertiary institutions rather than in hospitals.
Donating blood in the 1920s was not for the faint-hearted. A donor recalled his experience when he first gave blood in Auckland in 1925: ‘The needle used to draw blood seemed like a 2 ½ [inch] nail and about as blunt … Often the blood was taken in an operating theatre where a local anaesthetic was sometimes used and the patient [being operated on] lay beside you.’2
Medical science advanced significantly in the 20th century and hospitals were central to these developments. The discovery of blood types in 1901 made blood transfusion safer and helped prevent death from haemorrhage following surgery and childbirth. Techniques were devised between the world wars to store blood products. Blood banks were established, which increased the number of operations that could be performed.
New drugs to fight infections discovered in the 1920s reduced deaths in childbirth. Penicillin was developed during the Second World War and other antibiotics followed. Surgery expanded in the post-war period to include organ transplantation, such as kidney transplants and later heart transplants. These procedures were assisted by the discovery of immunosuppressant drugs (which prevent organ and tissue rejection) from the 1960s. Specialist units such as coronary care, intensive care and neonatal special care units were established in major hospitals.