The early honorary era of surgery from 1953–1975

John Thomson was one of the first surgeons to work at the newly built Footscray and District Hospital.

He arrived in 1955 when the suburb was bristling with civic pride about two of its main public institutions – its new 205-bed hospital and the Footscray Football Club, which had triumphed the previous year over its richer, more highly fancied rivals to win its first premiership.

Footscray was the first large acute care general hospital to be established beyond Melbourne’s city’s centre and its inner suburbs.

Mr Thomson, born and raised in Brisbane’s working class suburb of Kangaroo Point, immediately felt at home. “The patients were great people, very down to earth. I came from a poor family and I worked my way up. I knew what it meant to suffer and to try hard.”

At the hospital he joined a small team of general and specialist surgeons working in unpaid, honorary positions. Each had a rostered day for operating on patients.

There were no specialist surgical departments. Instead all of the surgeons, including those with specialist expertise, were expected to deal with most of the surgical patients who came through the hospital’s doors, from people needing a simple procedure to those requiring complex emergency surgery.

“It was pretty primitive,” Mr Thomson said. “There was no running water on the top floor of outpatients so we had two trays of water to wash our hands in. There was a lack of instruments so we had to improvise and brought some of our own.”

Almost all surgeons in Australia worked in unpaid honorary positions at public hospitals until 1975 when the Whitlam government’s radical overhaul of the health system enabled public hospitals to directly employ surgeons.

Under the pre-1975 honorary system surgeons earned their incomes from treating private patients at private and public hospitals. Some were also employed by Melbourne or Monash University to do clinical work and teach medical students at one of the large city-based public teaching hospitals.

Honorary positions at public hospitals were highly prized by surgeons, despite the absence of payment for their services. The appointments gave surgeons access to general practitioners, enabling each surgeon to establish a pipeline of private patient referrals from GPs.

Most surgeons had honorary jobs at several hospitals.

“As honorary surgeons we had an understanding with the hospital’s staff and management to give service and to help people,” Mr Thomson said. “It was a gentleman’s arrangement to do a job between professionals and professional administrators. That meant we took short cuts. . .We’d say, ‘Look I’ve got such and such could you help me out?’…. There was endless cooperation.”

Mr Thomson operated once a week at Footscray and was also called out several times each week to treat emergency cases.

“I’d travel out to Footscray by car. It was quite a hairy trip because there were new road signs, new road developments all the way. But parking was wonderful in the ‘50s because there was nobody there.

“The theatre lists were very long, much longer than the surgery lists at the Royal Melbourne where I worked, because the need was greater. It was a very poor district and people often suffered and put up with things.

“You felt the need, you felt it all over you. The amount of sickness that wasn’t being provided for was just incredible. I remember one woman had a huge tumour growing in her throat and she could hardly breathe. It was too far for her to go into Melbourne so I debulked the tumour. It was the best way to deal with it and give her life.”

Kendall Francis was another young recruit to Footscray’s surgical team. He also came from a working class family and had spent part of his childhood living in Eleanor Street, opposite the site of the future hospital.

Before his 1956 appointment to Footscray Hospital, Mr Francis served in Korea with the Australian Army’s Medical Corp.

“Footscray was considered by many of the chaps at that time as a stepping stone to get experience in surgery,” he said. “It was a great training ground because of the amount of work. We did the whole spectrum of abdominal surgery, neck and limb - mainly workplace accidents and trauma.”

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The new hospital at Eleanor Street catered for general medical and surgical patients and maternity patients. It had a children’s ward and a premature baby nursery. Its ancillary services included Casualty and Outpatients Departments, Pharmacy, Pathology, X-Ray, Physiotherapy and Almoner Departments.

Swamped by demand

Three years after the hospital’s grand opening its board and administrators began to raise concerns about what would become a perennial problem. The hospital didn’t have enough resources to cope with the west’s growing population and the high levels of illness and injury emerging from the area’s factories and working class districts.

Medical Superintendent Dr W (Lee) Farrer wrote in the hospital’s 1956 annual report that the hospital’s greatest difficulty was its inability to meet the demands for surgical beds.

“A high proportion of our surgical beds is occupied by cases arising from industrial or traffic accidents, and some of these cases, particularly those involving head injuries and major fractures, require prolonged inpatient treatment,” Dr Farrer wrote.

By the mid 1950s more than half a century of unchecked heavy industrial development in the inner west had led to high levels of pollution, according to Associate Professor Lack’s History of Footscray.

Footscray’s “residential areas were ringed by vast chemical, meat and building materials factories. The public health implications were rarely considered,” Associate Professor Lack wrote. “By 1966 for example, the sulphur dioxide fallout in Footscray, as measured by a gauge on top of the Town Hall, was the worst in Victoria.”

In the late ‘50s, patient numbers were rising so fast that an average of 50 expectant mothers per month, or 600 per year, were forced to seek admission to other hospitals. In 1956 the small team of surgeons performed a record number of theatre operations – 3,352.

Dr Patricia Wilson, the hospital’s first Director of Anaesthetics, and the honorary medical staff, urged the hospital board to provide a third operating theatre, an extra anaesthetic room and a surgical recovery room – essential requirements for a modern hospital. The board’s president, Roy Parsons, started lobbying the Hospitals and Charities Board for more funding.

He called for better government planning to overcome the hospital’s predicament. “If this general hospital is to provide hospitalisation for the rapid development in the western suburbs area, consideration must be given at an early date to the question of the necessary extensions required to keep pace with the increasing population,” wrote Mr Parsons, who served as Footscray Hospital’s president from 1953-1972. His dedication to the hospital later earned him an OBE from Queen Elizabeth.

By 1959 patient numbers had reached record levels. The hospital’s salaried medical staff included the medical superintendent, radiologist, pathologist, director of anaesthesia, sessional anaesthetists, a senior surgical registrar, senior resident medical officers, an obstetrics registrar and junior resident medical officers.

The small team of honorary surgeons performed 3,747 operations in the hospital’s two operating theatres during 1959 – a record number. They settled into a routine of self-reliance and making do with modest resources – elements that would characterise the hospital for years to come.

A surgeon’s day

Vernon Marshall’s routine at Footscray was typical of a general surgeon’s workload. Friday was his rostered day for surgery. He would drive to the hospital from his Ivanhoe home, arrive at 7.45am and start operating at 8am.

“We covered all the emergency admissions and did the surgical wards,” said Mr Marshall, who joined the hospital in 1963. “We did gastro intestinal surgery, urology, trauma and thoracic surgery because we didn’t have the capacity for all of those things to be covered all of the time.

“I’d start on the morning operating list - patients from the waiting list needing surgery for such things as cancer or a hernia repair.

“If an emergency came in during the morning I’d whip down to the emergency department and put them on the end of my list. Then I’d do outpatients in the afternoon. If an emergency patient came in on a Friday night I’d operate on them on Saturday morning. If someone needed further surgery I would fit it in during the week.”

In that era the road between Geelong and Melbourne was a dangerous two-lane country road. About half of Mr Marshall’s patients were road accident victims, many of them injured in crashes on the Geelong Road.

“The road toll was terrible on the road going down to Geelong. We spent a lot of our time peeling people off windscreens.”

Many other patients were injured in workplace accidents in the factories dotted throughout the streets of Footscray, Yarraville and other nearby suburbs.

“It was common for patients to have severe burns from working in molten metal industries,’ said Mr Marshall, who later became Professor of Surgery at Monash University.

“I remember one patient who had dreadful chemical burns from falling into a vat of boiling caustic soda. He had burns to one third of his body but we managed to help him and he survived.”

The surgical team’s growing expertise with burns patients was tested in January 1969 when a bushfire at Lara swept across the Geelong Road killing 17 people. Most of those killed in the flames were motorists. The badly burned survivors were rushed to Footscray Hospital.

“Many of those people had got out of their cars when the fire engulfed them and had run to escape,” Mr Marshall said. “But they received very nasty burns from the bubbling bitumen and were in hospital for months.”

A brilliant band of pioneer surgeons

Mr Marshall’s older brother Bob had previously worked at Footscray before taking up a senior role in surgery at Prince Henry’s Hospital.

The Marshall brothers were members of the small band of honorary surgeons at Footscray in the 50s and 60s – including the obstetrician George Thoms, plastic surgeons John Hueston and Bob Thompson, Kendall Francis and John Thomson and others – whose clinical brilliance, camaraderie and commitment to Footscray propelled surgery’s development.

They set the tone and ethos of the surgical team and had an enormous influence on generations of Footscray’s interns, residents and young surgeons. Joseph Epstein was one of the younger residents and surgeons taught by the older close-knit group of surgeons.

“I remember Kendall Francis and George Thoms used to argue about whether the first operation at Footscray Hospital in the early 50s was a surgical operation or a gynaecological operation,” Mr Epstein said.

“The surgeons at Footscray were enormously influential on me as a young man. It was my first exposure as a young man to human behaviour at a professional level and I found it fascinating.

“I came into contact with people like Kendall Francis, Vernon Marshall and John Thomson who were confident in their own professional ability and had confidence in their own interpretation of the world. They were very able, not only technically, but personally.

“They were outstanding people, who were gifted with a self confidence that enabled them to get by despite restrictions on resources.

“The thing I remember most about John Thomson was when we were talking in the tea room of the surgeons’ lounge at Footscray and someone described so and so as “the best in Melbourne”.

“John Thomson got stuck into this person saying: ‘How on earth do you know he’s the best in Melbourne and secondly what does that mean? If someone’s the second best, you shouldn’t go to them?’”

“John Hueston went on to be the senior plastic surgeon at Royal Melbourne. Bob Thompson wrote a textbook and influenced generations of people, including me, to develop their techniques. He was a beautiful surgeon. I still remember everything he taught me.”

Dual careers: test cricketer and surgeon

George Thoms, one of Footscray’s pioneer surgeons, was a trailblazer in medicine and sport. Born in Footscray in 1927 and educated at Williamstown High School, he is the only obstetrician and gynaecologist to have been an Australian test cricketer.

Mr Thoms played one Test match for Australia in 1952 in the fifth Test against the West Indies at the Sydney Cricket Ground.

Writing in The Wisden Cricketer, in 2003, the year that Mr Thoms died, Ken Piesse paid tribute to the Footscray surgeon’s achievements:

Not only was George Thoms a member of Australia’s one-Test club, he is the only Test cricketer to have been a gynaecologist. An eminent surgeon who introduced the concept of laser surgery to Australia in the mid-70s, Thoms quit representative cricket prematurely, at 27, for fear of sustaining a hand injury, which would have finished his career as a surgeon.

Good enough to make three centuries and average 35 at first-class level in a formidable era for fast bowlers, he scored 16 and 28 on debut for Australia on a green Sydney wicket alongside fellow rookies Richie Benaud and Colin McDonald against the West Indies in the fifth Test of the 1951-52 summer.

“My strengths were more with defence, to keep them out early or as (his Victorian captain) Lindsay Hassett would say, ‘see you at lunch or see you after the new ball,’” Thoms said in a recent interview. Thoms was awarded an Order of Australia Medal in 1996.

George Thoms’ medical career was just as remarkable as his sporting prowess. As a young man he won the FJ Brown Medal, awarded by the Australasian College of Obstetricians and Gynaecologists for the most outstanding graduate in the specialty.

Barry King, a former colleague of Mr Thoms, remembers that he took longer than usual to finish his medical degree at Melbourne University because he was “always playing cricket”. Mr Thoms opened the batting with Colin McDonald for the University Cricket Club. The pair also played first class cricket for Victoria, partnered as opening batsmen.

In 1962 Mr Thoms joined Footscray Hospital’s surgical team as an obstetrician and gynaecologist. His surgical colleagues considered him to be one of the most brilliant and likable surgeons they ever worked with.

John Mathew was a general physician at Footscray Hospital for 30 years. He was a friend of Mr Thoms and saw him play in the 1952 test match. “George was famous and rightly so. But he was a fairly modest fellow and he never went around saying, ‘George Thoms, one test for Australia’.

“He had a string of degrees but his main business was delivering babies. I think he delivered virtually everyone in sight and he was very dedicated to his home suburb. He did a lot for the western suburbs.”

Unlike most surgeons of his era, Mr Thoms chose to live in Footscray rather than Melbourne’s leafy eastern suburbs. He served on Footscray Hospital’s board for almost 30 years and was a member of Footscray Rotary Club and a council member of the Footscray Institute of Technology.

Like many of the hospital’s board members and staff, he was a staunch supporter of Footscray Football Club, where his older brother Jim played 120 games as a rover for the club between 1937 and 1946.

In 1976 Mr Thoms’ interest in new technologies led Footscray Hospital to become the first in Australia to install and demonstrate a Laser Surgery Unit. Mr Thoms had previously visited the unit’s co-inventor, Professor Isaac Kaplan, in Tel Aviv in Israel. Inspired by the potential of the laser unit, Mr Thoms organised for it to be installed at Footscray. Professor Kaplan then visited Footscray Hospital and worked with the hospital’s surgeons completing several successful operations using the new technology.

Mr Thoms retired as the hospital’s senior obstetrician and gynaecologist in 1992, the same year that his close friend and colleague, Kendall Francis retired as a senior surgeon at the hospital. The hospital bestowed the title of Consultant Emeritus on both men in recognition of their services to Western Hospital.

When Mr Thoms died, aged 76, on 29 August 2003, Cricket Australia’s chairman Bob Merriman released a statement on behalf of the organisation.

“George was a great man with a glorious sense of humour, who always gave his full support and effort to his university, club and national side,” Mr Merriman said. “He was an excellent all-round sportsman, not just on the cricketing field, but he ultimately chose to put his profession ahead of his cricketing career.”

Workloads worsen

The heavy workloads shouldered by George Thoms and his fellow surgeons grew steadily worse during the 60s.

By 1968 the 274-bed hospital was almost full, with a bed occupancy rate in the adult wards continuously hovering at 95 per cent of capacity. Patient numbers in the casualty department were rising rapidly, mainly because more people were being injured in traffic and industrial accidents.

The 1968 annual report shows that casualty staff treated 1, 322 traffic accident victims and 1,661 people injured in industrial accidents during the year. Overall the hospital treated 64,341 people in its outpatients department, 4,232 people had surgery and 2,330 babies were born.

President Parsons and Medical Superintendent Lawson wrote about the dire bed shortages in that year’s annual report. “Because of the high bed occupancy many patients who require admission to hospital have to be turned away and cared for elsewhere or in their own homes,” Superintendent Lawson said. “This causes considerable distress to both patients and staff, as many of these patients, although not suffering from life threatening conditions, do require hospital attention.”

He said shortages in the midwifery division were especially bad, with patient demand for beds outstripping supply by about 2:1.

“When the Premier, Sir Henry Bolte, opened the new Casualty Department, he referred to the rapid development of the western suburbs and indicated that we would ultimately become a Teaching Hospital, and the Chairman of the Hospitals and Charities Commission referred to the growth in this area and felt we would need to provide for additional beds up to 450-500,” President Parsons said.