Royal Perth Hospital: Heritage Precinct

The Royal Perth Hospital Heritage Precinct is home to the first purpose built hospital in Western Australia, opened as the Colonial Hospital in 1855 and continuing to function as a busy public and teaching hospital today.   The heritage buildings includes the original Colonial Hospital (1855), Administration Building (1894), Kirkman House (1909), the Old Kitchen (1909), Outpatients’ Extension (1923), the Cancer Clinic (1930) as well as the Moreton Bay Fig Tree on Murray Street (c.1900) and the associated gardens within the precinct.  The buildings which range from 1855 through to the 1930s show the many changes over time in attitudes to patient care, nursing and other medical professions and practices, types of diseases and injuries/accidents, technology and treatment, as well as architectural design of public/health buildings being associated with a number of significant State Government Architects, including James Austin, Richard Roach Jewell, George Temple Poole, Hillson Beasley, William B Hardwick, A.E.’Paddy’ Clare, John Tait. 

From the beginning of the Swan River Colony, temporary hospitals were set up – mostly in poorly adapted buildings – but opened and closed at frequent intervals until finally in the 1850s Governor Hutt committed to building Western Australia’s first proper hospital.   The location of the hospital was not randomly selected.  At the time, most of the poorer people of Perth lived in this north-east area of the city and so it was readily accessible to them.  It was also located on an elevated position so theoretically good for fresh air and drainage.  Plans for the new Colonial Hospital (which today is the (north-west portion of ‘N’ Block) were drawn up in 1852 by James Austin, the Superintendent of Public Works, but completed by his successor Richard Roach Jewell in 1853.  It was a two storey pavilion plan surrounded by verandahs based on the traditional compartmented ward plan which put small groups of patients in separate confined spaces.  

There were delays with the construction of the hospital for several reasons.  Although there was convict labour they were initially put to building roads and bridges rather than buildings.  The gold rush in the Eastern States in the 1850s also drew a lot of men away from WA leaving a shortage of labour here. The situation was only relieved once convicts were deployed on the construction of public buildings and the hospital was finally completed in 1855.  Owing to the status of hospitals at the time, there was no formal opening ceremony.   

The development and expansion of the Colonial Hospital was very much determined by external events, advances and impacts, and the first few decades saw the hospital buildings and facilities change and grow to accommodate new methods of medical practice and patient care.  One major change was to do with operating procedures.  Originally operations were performed in the wards which could be quite distressing for the other patients in the ward.  By the 1870s separate operating theatres were introduced and a purpose-built operating ward was added to the hospital in the 1880s.  

By the 1890s, as WA progressed, needs of the hospital changed even more to reflect social, political and economic factors such as changes in Government and legislation, the growth of the mining and timber industry, population increases, the outbreak and aftermath of wars, as well as the introduction of the motor vehicle.  Significant changes to the management, administration and size of the Colonial Hospital were also introduced in the mid-1890s, which was not before time as the hospital was by now constantly being described as insanitary and ill-arranged with insufficient medical staff and disorganised nursing staff.  This was a bad reflection of the Government at a time when the health of a community was considered next in importance to the condition of its morals, and a public hospital the principle monument of the State’s charity.  Complaints were also common of the overbearing stench emanating from the Morgue, especially when bodies had reached a certain level of decay and the hospital windows had to be closed.  

In 1895, the Hospital Act was introduced which established that public hospitals would be maintained by Government funding and additional revenue provided through public subscription.  The hospital was renamed Perth Public Hospital as a way of changing the perception of the hospital from being considered a lower-class government institution to a hospital that catered for those who were not in a position to afford private hospital care, therefore attract more public sympathy and in turn more philanthropic donations and support.  Around the same time, a nursing certification program was introduced which was the start of nursing becoming more professional.   

The Gold Boom which began in the 1890s not only meant a huge population growth but also greater numbers of mining-related injuries as well as a surge in alcoholism and morphine addiction and the issues that came with that.  Buildings such as the Administration Building and Nurses Quarters (Kirkman House) are both connected to this period, and their fine architectural designs reflected the arrival of talented and skilled architects to the State such as Poole and Beasley.  Other buildings â€“ although not in the heritage precinct – were also constructed in this period that signalled not only growing patient numbers but universal changes in response to the care of patients.  The new surgical wing (the original Block A) built in 1898 aligned with the principles of the ‘Nightingale Ward’, named after the famous nurse Florence Nightingale, moving away from the small compartment plan to more large open and airy spaces with bathrooms provided on each floor.  This not only improved ventilation and sanitary conditions but also the supervision of patients by the ward nurses.   

The next major event was the First World War, which saw the return of injured servicemen as well as contagious (and often deadly) diseases – such as the Spanish Flu, and also a rise in mental health issues.  In 1923, in the wake of the return of vast numbers of soldiers, a new wing was added called the Soldiers’ Ward which was made possible with funding from the Commonwealth Government. 

The 1920s-30s saw many more additions and new buildings to the hospital complex.  In 1926, the original Colonial Hospital building was extended to create a new outpatients department.  Also in 1926, the nurses’ building was extended to cater for the increased nursing staff.  During the 1920s the hospital also had mounting community pressure placed upon it to provide facilities for the treatment of cancer, and an appeal to the public for donations enabled the building of the Cancer Clinic (‘P’ Block) in 1930. 

By the 1930s, however, Perth Hospital was once again under scrutiny and considered a last resort for people unable to afford anything else especially those from the county areas where there wasn’t a hospital.  As proposals for further additions were rejected and Government kept cutting its budget, the hospital was only able to take the most urgent cases and had to cope with deteriorating and out-of-date facilities.  Finally in 1939, work began on the construction of a new multi-storey building, located on the site of the original Block A (which had been demolished).  The new state-of-the-art building was completed by 1942.  Fittingly, the hospital changed its name to â€œRoyal Perth Hospital” – the Royal connection putting the hospital in line with the other big hospital in the Eastern States and with the hope of elevating its community profile.  During the second half of the twentieth century, a number of buildings underwent alterations, often to adapt the building for other hospital functions, especially in its role as a teaching hospital.  The Old Kitchen was converted for use as a nurses’ lecture hall, and by the 1970s, with nurses no longer needing to be accommodated at the hospital, Kirkman House was remodelled into offices. 

Royal Perth Hospital Precinct Conservation Plan, Considine and Griffiths Architects 1995