School of Historical and Philosophical Studies - Theses
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ItemThe provision of hospital care in country Victoria 1840's to 1940s( 1999)Many hospital histories have been written whose authors have usually made exaggerated claims about the significance of individual hospitals. This narrow approach fails to take into account the influences of ideological and economic changes such as the rise of the Labour movement between 1890 and 1915, the erosion of the charitable ideal, the secularisation of Australian society and the increased acceptance of certain welfare provisions as a right rather than a privilege. This results in some misconceptions and a blinkered view of hospital development. A comparative analysis of how country hospitals were administered during this early founding period is important because it reveals that prior to 1862, three categories of hospitals were established, namely, working men's hospitals, custodial or hospital/benevolent institutions and semi-voluntary hospitals. All were controlled by hospital committees dominated by lay community leaders. Country hospitals provided an important focus for small communities with hospital committees defending their independence and resisting attempts by central authorities to wrest administrative control from them. The control exerted by an increasingly centralist State government over hospitals in country Victoria (heavily influenced by the medical profession), hindered their development to a greater degree than those in metropolitan areas. The mechanisms for achieving this were the enforcement of the Appropriation Acts from 1862 and the rigid implementation of the 1923 Hospital and Charities Act. Both of these kept hospitals tied to the voluntary/philanthropic model (or semi-voluntary model because charities received significant funding from the state) until the 1930s thereby delaying the establishment of more viable community hospitals. After the early 1930s, a transition from charities to community hospitals occurred. A major source of their concern was the already inequitable levels of funding compared to metropolitan hospitals. This inequity meant that Hospital Committees spent much time raising funds through enlisting subscribers, fund-raising and soliciting bequests. Their first collective action was the formation of the Country Hospitals Association in 1918. The number of charitable hospitals in country Victoria grew rapidly from fourteen in 1859 to thirty-four in 1891 and sixty-one in 1923. In that year there were also 476 private hospitals, which prior to the 1890s were little more than nursing homes. Whilst the Charities Board sought to control the spread of public hospitals, hospitals established by the Bush Nursing Association proliferated outside their control, leading to conflict between the Board and the Association. Funding for public hospitals dropped significantly between the 1890s and 1930s. At the same time there was an increase in the demand for beds in public hospitals by the lower middle classes who found private hospital costs prohibitive and wanted the higher standard of care provided in public hospital facilities. An increased dependence on medical technology led to an urgent need for the upgrading of Victorian country hospitals' technologically obsolete equipment. Additionally, Victorian hospitals were heavily influenced by North American views on efficiency and standardisation. Finally, the impetus to improve hospitals came in the 1930s when unemployment relief funds and a gambling tax levy subsidised new hospital facilities.