Zeehan Hospital, about 1900 (Tasmaniana Library, SLT)
Hospitals in Van Diemen's Land were rudimentary: patients were treated by untrained staff in makeshift accommodation, and supplies of provisions, medicine and bedding were inadequate or defective. Home care by relatives or a hired nurse was preferable, and it was assumed that hospitals catered for the poor. By 1831 there were large government hospitals at Hobart (1804–, major building 1820), New Norfolk (1827–), Launceston (1808–) and Port Arthur (by 1831), and nine country towns had smaller 'hospitals', usually small huts, or single rooms attached to the gaol, used to save transporting local convicts to the larger centres. Most closed when the convict system ended.
Private hospitals opened during the 1840s. Established by Dr Bedford for private patients and the industrious poor in Hobart, St Mary's was a sixty-bed hospital which opened in 1841 through subscription, and closed in 1860 when it could not pay its way. Similarly, Launceston's Dr Pugh established St John's Hospital in 1845, but inadequate donations forced its closure in 1851, and St Paul's Hospital in Stanley lasted about twelve years from 1846. To attract paying customers, conditions were better in private hospitals – for example, ether was first used for an operation in St John's in the late 1840s, ahead of the convict medical services. Tasmania's first regional hospital established through local effort opened at Campbell Town in 1855.
From the 1870s onwards, the establishment of trained, scientific nursing, and the development of antiseptics and anaesthetics, which improved operations, and medicine generally, meant that hospital care improved greatly, and patients were more likely to recover from serious illness in hospital than at home. As public confidence in hospitals grew, many more were established. The Hobart and Launceston general hospitals developed considerably, not catering merely for the poor but for the general public. Designed to protect Her Majesty's naval forces from venereal disease while visiting ports, Contagious Diseases Hospitals were opened at the Cascades in 1879 and in Launceston in 1886 for the treatment of prostitutes. Mining towns were quick to establish hospitals, with the first at Mt Bischoff, aided by local mining companies, in 1881, followed by Beaconsfield (1890), Zeehan (1891), Strahan (1893) and Queenstown (1895). Cottage hospitals at New Norfolk (1889) and Hamilton (1896) were short-lived, but the 1889 Devon hospital (now the Mersey Community Hospital) was more successful. With scant attention paid to sanitation, city and mining hospitals were often overstrained by severe outbreaks of infectious illness such as typhoid, diphtheria and diarrhoea, but as public health improved these diseases declined.
From 1900 onwards more country hospitals were set up, twelve by 1914. Trained nurses were employed at many of the new types of hospital such as the Consumptives' Sanatorium at New Town, established in 1906 (later known as the Tasmanian Chest Hospital). The Queen Victoria hospital in Launceston (1897), and Hobart's Queen Alexandra Hospital (1908), both set up by committees of women for female patients, employed trained staff and provided training, as did the Hobart (1899) and Launceston (1900) Homeopathic Hospitals. Many trained nurses opened their own small hospitals, sometimes just rooms in a private house. These mainly cared for maternity cases, but some also provided general care. Two sisters ran a small hospital which later became the Ulverstone General Hospital, and in Hobart, three of these private hospitals were accredited for training nurses: Stowell, Highbury and St Helen's. As well as avoiding any social stigma attached to public facilities, some private hospitals offered advantages in skilled nursing and equipment.
From 1918 hospitals had to be registered, which meant providing required levels of facilities and trained staff. Many small hospitals could not compete, and closed. Larger hospitals improved their standards and several new ones were established, often by churches. The homeopathic hospitals were taken over by the Anglican church as St John's, Hobart (1931) and St Luke's, Launceston (1951), and Launceston's St Margaret's Hospital, a small private institution established in 1912, was taken over in 1944 by the Sisters of Charity and renamed St Vincent's. New were the Repatriation General Hospital, Hobart, after the First World War; Spencer Hospital at Wynyard (1940); and Calvary Hospital, established in Hobart by a Catholic religious nursing order, the Little Company of Mary, in 1940.
The further development of medical treatment and equipment from the 1950s accelerated the closure of small hospitals. In the private sector, Calvary has taken over St John's, St Luke's and St Vincent's, and a new private hospital, Hobart Private, run by the national company Healthscope, has taken over St Helen's. Healthscope also runs the North-West Private Hospital at Burnie. These are the major private hospitals in Tasmania. In the public sphere, centralisation of public services continued despite strong criticism from local communities. In 2004, Tasmania's hospital system consists of a mix of public and private services. The Department of Health and Human Services funds four major hospitals (Royal Hobart, Launceston General, Burnie's North West Regional and the Mersey General), twenty rural hospitals and multi-purpose service centres, and one palliative care centre. The hospital system faces significant challenges: a rapidly ageing population and the cost of providing services (without economies of scale) to a dispersed population.
Further reading: J Brown, “Poverty is not a crime”, Hobart, 1972; A Alexander, 'The public role of women in Tasmania, 1803–1914', PhD thesis, UT, 1989; Expert Advisory Group, The Tasmanian hospital system, Hobart, 2004; B Kelly, A background to the history of nursing in Tasmania, [Hobart, 1977]; W Rimmer, Portrait of a hospital, Hobart, 1981.