British Journal of Ophthalmology, 1982, 66, 617-621

Sydney Eye HospitalLENNOX PRICE

From Sydney Eye Hospital, Sir John Young Crescent, Woolloomooloo 2011, New South Wales, Australia

SUMMARY This year, 1982, marks the centenary of the Sydney Eye Hospital, originally theophthalmic department of the old Sydney Infirmary, which was founded with the settlement of theColony in 1788. Established in 1882, the hospital was transferred to its present site 60 years ago, andit still provides ward accommodation. After alternating periods of stagnation and progress the newhospital (stage 1) was completed in 1974, with modern clinic and research facilities. It is now thelargest eye hospital in the southern hemisphere and is a first-class referral centre with an annualattendance of 75000. The Department of Ophthalmology, University of Sydney, is based at thehospital, providing undergraduate instruction and a comprehensive postgraduate trainingprogramme for Australian ophthalmologists and others in more distant continents.

This year the Sydney Eye Hospital celebrates itscentenary. The early history of the hospital is closelylinked to that of its parent institution, the old SydneyInfirmary, which was founded by Governor Philip,who set foot on the shores of Sydney Cove on 26January 1788, and proceeded to establish a convictsettlement 'in the reign of his most sacred majestyGeorge the Third' (Fig. 1).By 1796 the Sydney Infirmary was housed in a

series of one-storeyed buildings surrounded by roughpicket fences (Fig. 2), and it so remained until 1816,during the governorship of Lachlan Macquarie, whena move was made to a new site in Macquarie Street. In1877 the buildings on that site were demolished andreplaced by the present Sydney Hospital, which wasofficially opened in 1894.

First eye department

In 1877 the Board of the Sydney Infirmary decided toestablish a separate ophthalmic department, andthis concept was realised in 1882 when the ophthalmicbranch of the hospital was opened in Moorciff on theharbour foreshore close to the original site (Fig. 3).This was but 2 years after the foundation of theOphthalmological Society of the United Kingdom bySir William Bowman. The first eye department wasmost successful, 'being a great boon to the poorafflicted with diseases of the eye . . . its goodreputation has attracted patients from all parts of

Correspondence to Dr L. Price.617

New South Wales and even neighbouring colonies'(Sydney Hospital Annual Report, 1877). Forty yearslater (1922) the population of Sydney had increasedto over three-quarters of a million. The originalbuildings of the Eye Hospital had becomedilapidated, and the board determined that it shouldbe moved to a fresh site a short distance acrossparkland adjoining the main hospital.The building selected was a solid 4-storeyed stone

edifice (built in 1885) with a colourful history. Beingat first a coffee palace, then a private hotel, it isbelieved it later achieved notoriety as a 'house of

this BuildingHis ExceIIenEy

LACHLANKMACQUARJE ESeQ</Gorno Chief

ArsW SOUTH WALZZ:

MOST SACRED MAJESTYGEORGE: III

Fig. 1 Inscription on thefoundation stone ofthe oldSydney Hospital.

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Lennox Price

Fig. 2 Thefirst Sydney Hospital,1796.

ill-fame.' The building was altered and converted toan ophthalmic hospital in 1922 (Fig. 4). It has thusremained practically unchanged for 60 years,providing ward accommodation in conditions whichcan at best be described as substandard. Despite thisthe medical and nursing staffs have continued to giveloyal service at a first-class level.

In its first 40 years the clinical practice of thehospital underwent considerable changes. In 1890patients suffering from trachoma represented 37% ofthe total, dropping to only 7% in 1930. During the

same period the figures for cataract increased from14% to 36% of the total. It is interesting to note thatat the turn of the century operations for trachoma andits sequelae were 17% of the total number ofoperations as compared with only 2% for Britishhospitals in the same era.' The trachoma patientswould remain in the hospital for months on end, andsome were actually employed there while undergoingtreatment. Forty-five years ago (1937), when thewriter was the sole registrar, cases of active trachomawere treated by anaesthetising the tarsal plates with

1....S.,5;S C T; *}. As.s.'_F F ,s....t.z.*7knt -v . ; .... . #,_M S.>.. ..L2L s%ijiCt9; 3,. <,.Fig 3 Sydney Eye Hospital

(Moorcliffl, 1882.

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sternation when a patient was admitted needingurgent surgery. The night porter solved the problemby whispering to the surgeon, 'SisterM has gone out,

"'4 Sir, and has taken the key with her, but if the matter isreally urgent you can find it under her pillow.'

In a more serious vein, it is of historical interest torecord that the fine nursing tradition of SydneyHospital and Sydney Eye Hospital dates from 1869,when the first matron (Miss Lucy Osbum) and 5nurses trained by Florence Nightingale arrived fromSt Thomas's Hospital, London. The nurses were sub-sequently in residence in the Nightingale Wing (thefirst nursing school in Australia) constructed to adesign approved by the lady herself (Fig. 5).

Unique identity

Thus the Sydney Eye Hospital, perhaps through itsgeographical location, but certainly through thequality of its services, developed a unique identityand role in the eyes of the community and the medicalprofession. In 1922, the first year on the site, 3000attendances were registered at the casualty depart-

¢12i4

ment. This figure had doubled by the year 1930, withcontinuing increases to 75 000 in 1981. The presentfigure has to be seen in the context of a city populationof only 31/2 millions, and a State population of 5

The 40 years from 1933 to 1962 saw worldwideFig. 4 Sydney Eye Hospital, 1922. epoch-making advances in ophthalmology. Towards

the end of this period the Sydney Hospital board andthe consultant staff of the Eye Hospital realised that itwas essential to expand their hospital and to follow

solid cocaine and crushing the follicles with roller-forceps, followed by rubbing with a blue-stone stickor silver-nitrate pencil. This treatment, barbarous asit may sound, appeared effectively to prevent some ofthe blinding complications of the disease. Patients vsuffering from acute iritis and congestive glaucomahad their pain partially relieved by live leechesapplied to the outer orbital margins. The leecheswould bite, suck blood until engorged, and thenrelease their hold, leaving a gory field in their wake. Aside effect was the lucrative trade plied by small boyswho would arrive at the hospital clutching jars ofleeches caught in the neighbouring swamp-land.As with all old institutions there have been many

anecdotes relating to some of the colourful person-alities who served the hospital in bygone days. Onesuch person was a matron of yesteryear (Sister M),iknown unofficially as 'Auntie'. Being something of amartinet she managed the wards and theatre almostsingle-handed with the assistance of a small numberof trainee nurses from the main hospital. Going off _duty, it was her custom to leave the theatre securely _locked, but one evening there was considerable con- Fig. 5 Sydney Hospital Nightingale Wing, circa 1900.

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Fig. 6 Sydney Eye Hospital,1974.

the pattern of overseas countries by the establishmentof special units requiring both sophisticated equip-ment and expertise.

Accordingly in 1963, owing to the initiative andtenacity of the senior surgeon (and his successor) apublic meeting was held in the Sydney Town Hallpresided over by the lord mayor and in the presenceof the governor, following which a public appeal waslaunched with a magnificent response. A frustratingdelay ensued for several years while factionswrangled over the most suitable location for the newhospital. Finally in 1970 the State Governmentgenerously stepped in and made a matching grant.This, together with monies for the housing of theuniversity department, was sufficient to allow stage 1of the new hospital to be started on the existing site,but the building did not include the renewal ofinpatient facilities. The stage 1 came to reality in1974, when new building consisted of 3 storeys and aservice basement (Fig. 6). The ground floor containsthe administrative offices and 12 consulting rooms forcasualty and the general clinics, together withfacilities for minor surgery, a pharmacy, an opticaldispensary, and orthoptic department. On the firstfloor special clinics are located, with equipment for allsophisticated procedures. Teaching facilities on thisfloor include a lecture hall (seating 90), fully equippedfor projection, and a seminar room with closed-circuittelevision. On the same floor the University ofSydney's Department of Clinical Ophthalmology andEye Health is located together with a well-stockedlibrary staffed by a trained librarian. On the secondfloor is the theatre block, laser, anaesthetic, andrecovery rooms, pathology and research laboratories,electron microscope, and eye-bank service. The thirdfloor has a fully equipped animal laboratory.

Stage II is to comprise a 14-storey tower block, and

it is envisaged that when this is built it will providenew ward accommodation and expand the facilitiesfor special clinics and the university department.With this objective the Sydney Eye HospitalFoundation has been formed and an appeal launched.The Health Commission report on planning for the

development of ophthalmic services in the State ofNew South Wales indicated that more than half of thecomplicated eye surgery in the State was carried outat the Sydney Eye Hospital, including two-thirds ofthe retinal detachment surgery and two-thirds of thecorneal surgery. Special clinics have developed fordiabetic retinopathy, retinal dystrophy, retinal andvitreoretinal surgery, cornea, orbit, and plasticsurgery, uveitis, neuro-ophthalmology, and lowvision. The hospital has the additional rotation ofgeneral resident medical officers assisting in the careof inpatients together with appointments to the staffof specialists in endocrinology, neurology, andimmunology.The Eye Hospital is a centre for training of nurses

for the ophthalmic nurses diploma, and is involved inprogrammes of preventive eye care and rehabilitationof the visually disabled.

Teaching and research

It is one of the teaching hospitals of the University ofSydney, and in 1964 a chair in clinical ophthalmologyand eye health was endowed by a magnificentbenefaction from an anonymous donor in thecommercial community. The department was at firstadministered by part-time directors (members of theconsultant staff), who rendered important service toundergraduate and postgraduate teaching in additionto excellent contributions to clinical ophthalmology.A full-time foundation professor was appointed in

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Sydney Eye Hospital

1977. The university department is responsible forproviding undergraduate instruction at all theteaching hospitals within the University of Sydney,and it co-ordinates registrar training in ophthal-mology in association with the Registrar TrainingCommittee of Sydney Eye Hospital. Currently 19registrars are co-ordinated in a programme thatinvolves rotation to other hospitals, both teachingand peripheral. In addition the rotations includecentres as far flung as Darwin and Alice Springs in theNorthern Territory.The department also has a programme of basic

research supported by national funding and continuesto establish close ties with other areas in Sydneyconcerned with basic research in vision.The staff of the University Department is closely

integrated with the staff of the Sydney Eye Hospital.The university has access to the research laboratoriesand all other hospital facilities. In return the universitydepartment is available to the staff of the hospitalboth for research and for patient management,including the special investigation techniques ofclinical photography, fluorescein angiography,electrophysiology, and ultrasonography.The University of Sydney favoured the physical

location of the Department of Ophthalmology atSydney Eye Hospital because of the unique clinicalload which formed an appropriate base for such adepartment, and this decision has set the seal on the

hospital as a major teaching centre. Being the largesteye hospital in the southern hemisphere it serves thewhole of New South Wales, receiving complicatedcases from other institutions and practising ophthal-mologists. It has become a State resource, animportant focal point for the continuing education ofophthalmologists in New South Wales, and is arecognised training centre for young ophthalmolo-gists from all Australian states and from othercountries including India, Africa, South-east Asia,America, and Britain.The history of the first century of Sydney Eye

Hospital thus parallels that ofother similar institutions-a gradual growth, sometimes painfully slow, yetwith a progressive onward march. It is hoped that theachievements of the past will inspire those who nowlabour as they advance to meet the exciting challengesof the future.

The author is grateful to Professor F. A. Billson, Professor ofOphthalmology, the University of Sydney, for advice concerning theactivities of his department. Thanks are also due to the staff of thedepartment for valuable assistance with the manuscript andillustrations.

Photographs by courtesy of the Board of Sydney Hospital.

Reference

1 Gillis S, Deane-Butcher W, Donaldson EJ. Sydney Eye Hospital-the wider view. Aust J Ophthalmol 1976; 4: 116-21.

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