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Whatsapp A young girl receives a typhoid inoculation in 1943.

Australia's early settlements were for many years immune to foreign infectious diseases by virtue of the fact that most sufferers had either died or recovered by the time they arrived. But gradually Europe's diseases—smallpox, scarlet fever, measles and diphtheria—all made it to the mainland, resulting in wave upon wave of panic-inducing outbreaks, as Professor Clem Boughton writes.

On the 25th of May 1881, the child of Mr Chong, a Chinese immigrant living at 223 Lower George St Sydney was found to be suffering from smallpox. Smallpox had been a scourge for centuries and the cause of many thousands of deaths and much disability. From Lower George St, the contagion spread to other streets in the city and inner suburbs. The public reaction was predictable—one of virtual panic.

Smallpox was a quarantinable disease. Sufferers had to be isolated from the community until they were no longer infectious and contacts who might have been infected also had to be isolated in case they developed the disease. This was done initially at the North Head Quarantine Station that was designed to accommodate passengers and crew from overseas ships carrying cases with quarantinable diseases. Obviously this station should not be filled with land based patients, as a ship could arrive at any time with a quarantinable disease aboard, so a couple of old hulks were also pressed into use until more satisfactory arrangements could be made. In addition, the Station was remote from the city and at that time, not near any hospital facilities.

When finally Australia was discovered by Europe, such diseases as measles, diphtheria, poliomyelitis and whooping cough did not enter this country for some time. Because of the long time needed to sail from England and Europe, often longer than the incubation periods of these diseases, such infections usually died out when all those on board who were susceptible had been infected.

This was the occasion for the establishment of the Board of Health in NSW, and it was appointed specifically to deal with this frightening emergency. And so 500 acres of land located well out of town, nine miles in fact, at a place called Little Bay down near La Perouse, were allocated for the establishment of an emergency quarantine hospital to handle the problem. This was remote sandy scrubby country to which only unmade roads and tracks gave access.

The initial accommodation consisted of a series of bell tents hastily erected on a flat area of grassy ground adjoining the beach of Little Bay, and the first patients were admitted in wet and windy weather in September 1881. However, Constable Houlahan, who was put in charge, did a great job in making admissions to the settlement welcome.

In the meantime, construction of more substantial accommodation along the cliffs facing the Pacific Ocean proceeded apace. Because of the urgency of the situation, the quickest construction methods were used and this meant building with wood and corrugated iron—not designed for long life in the salty air of the seashore. Still, the crisis had been met to everyone's satisfaction.

The epidemic continued until February 1882 and during the nine months it lasted, there were a known 157 cases, most of whom were treated at the Coast Hospital as the new hospital came to be known. Its name was changed to the Prince Henry Hospital in 1934. Forty of these smallpox cases died, a case fatality rate of 25%. These victims were buried in a hospital cemetery some distance south of the newly constructed wards.

Smallpox was introduced into Sydney from time to time on ships bringing the virus from infected overseas ports, and periodically the place was reopened to accommodate such cases. After 1884 it was decided to use the Coast as a convalescent centre for patients from the city hospitals to free up their beds. And then the reasonable suggestion was made to make it the infectious diseases hospital for Sydney, a decision welcomed by the city hospitals as a highly transmissible infectious disease inadvertently admitted could result in the closure of one or more of their wards for several weeks..

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Whatsapp Prince Henry Hospital, formerly The Coast Hospital, La Perouse, Sydney.

The story of the Coast Hospital is related to the intriguing history of infectious diseases in this country. The Australian continent separated from the great south Gondwanaland Continent about 70 million years ago, and migrated northwards. Because of its extreme geographical isolation from the rest of the world for many millions of years, most of the communicable diseases that evolved in the major populated centres of Europe were not to be found among Australian indigenes.

When finally Australia was discovered by Europe, such diseases as measles, diphtheria, poliomyelitis and whooping cough did not enter this country for some time. Because of the long time needed to sail from England and Europe, often longer than the incubation periods of these diseases, such infections usually died out when all those on board who were susceptible, had been infected. Also while the sizes of communities in Australia were small, when infectious diseases like measles were introduced, they died out because there were not enough susceptibles to keep them going.

Measles (morbilli) probably made its first appearance in Australia in October 1834 among the passengers of the ship David Scott which sailed direct from London to Sydney; this resulted in an outbreak of the disease in Sydney. Another outbreak started in 1850 in Victoria as a result of importation of the infection on the ship Persian from England, and reached NSW in 1853.

Scarlet fever was first recognised in NSW between 1840 and 1850 and was noted then to cause high death rates among indigenes. Towards the end of the 19th century it was quite virulent, causing many deaths and much disability. Penicillin could have quickly controlled the infection, but of course was not available until the late 1940s.

Whooping cough appeared in NSW in March 1828 having arrived on the ship Morley which carried convicts from England. It swept uncontrollably through the colony, causing many deaths including the son of Governor Darling. There were explosive outbreaks from 1858, with 80% of deaths occurring in babies in the first two years of life. Death rates among indigenes were again very high.

Diphtheria was first recorded in Victoria in October 1858, to which state most English immigrants went. The disease was prevalent in England in June 1858. It took a heavy toll of children until the introduction of vaccine in the late 1920s.

By the time the Coast Hospital had been established in 1881, these diseases had become endemic in Sydney.

Poliomyelitis (infantile paralysis) was first recorded in sporadic form in 1887 when cases were reported on the Clarence River NSW and in Port Lincoln SA, and thereafter in sporadic outbreaks until the early 1900’s when it became endemic. Parents’ greatest fears were that their children could become paralysed for life, or die from asphyxia. It was not until 1963 that it could be controlled by the injectable Salk and then the oral Sabin polio vaccine.

Smallpox made a re-appearance in 1913 among workers in a clothing factory in Chalmers St Sydney; this time it was variola minor, a less virulent form of smallpox called alastrim. It was apparently brought into Australia by the ship SS Zealandia from Vancouver. The disease spread through Sydney and to a number of country towns including Taree, Stroud, Moree, Walgett and Yass and continued until 1919, being responsible for some 2400 cases in total, but no deaths.

Smallpox was declared in 1980 by WHO to be globally eradicated by means of Jennerian vaccination—one of mankind’s greatest achievements.

The history of the Prince Henry Hospital in Sydney Listen to Professor Clement Boughton's talk about the work of the Prince Henry Hospital with infectious diseases, like Smallpox (pictured), at Ockham's Razor.

The numbers of cases of scarlet fever, measles, diphtheria and whooping cough admitted to the Coast Hospital from the community, increased each year, until in the 1920s there were up to 2000 admissions of some of these diseases in a year. In Australia as a whole, in the decade 1926 to 1935 there were 4074 deaths from diphtheria alone, when the total population was only 6.6 million. The vaccine was introduced during that decade and numbers of cases and deaths steadily declined, until in the decade from 1986 to 1995 there were none. In the decade 1946 to 1955, polio caused 1013 deaths. After the vaccines became available, the number of cases declined to zero by 1985.

At the Coast in the early years prior to immunisation there were no ways of effectively protecting staff members from these illnesses, and many succumbed. They were very brave people. One can visit the museum at the Prince Henry Hospital site at Little Bay recounting its history. It is open on Sundays between 10am and 4pm in Ward 1.

This hospital had many tumultuous years ahead, which included, in addition to the infectious diseases of childhood, bubonic plague, cholera, leprosy, sexually transmissible infections, poliomyelitis and influenza epidemics, and the vicissitudes of politics.

One message comes through very loud and clear: that is, without adequate immunisation of our communities, we can never fully protect our people, and especially our children, from these terrible vaccine preventable infectious diseases. Mistaken prejudice is still undermining full effectiveness of our immunisation programs, with the risk that these diseases could reappear here, as is now happening in the UK, USA and Europe. We must not let this happen.

Professor Clement Boughton is from the University of New South Wales and worked at the Prince Henry Hospital for many years. Find out more at Ockham's Razor.

