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How Melbourne's former infectious diseases hospital helped prepare us for COVID-19

The Fairfield Infectious Diseases Hospital's fleet of ambulances in the 1930s. (Fever Hospital: A History of Fairfield Infectious Diseases Hospital)

Open fireplaces, soft leather couches, rickety old stairs and peacock-populated grounds that swept down to the banks of the Yarra River.

Clinical researcher Suzanne Crowe AO has fond memories from her time as a medical student in Australia's last dedicated infectious diseases hospital.

"There were ducks running around, you'd have scones with jam served in the sitting room for your morning tea," she said.

The Fairfield Infectious Diseases Hospital's history stretches back to the early years of colonisation, as Victoria struggled to maintain basic sanitation amid a gold rush-fuelled population boom.

In Melbourne, a lack of proper sewerage infrastructure enabled the easy spread of communicable diseases across the entire population.

This grim cartoon from 1869 highlights the pall infectious diseases had cast over the city. (Melbourne Punch)

Historian William Anderson wrote that dysentery, syphilis and smallpox, measles, scarlet fever, whooping cough and diphtheria were prevalent across Melbourne, and young children were among the most vulnerable.

Large families were common as parents factored in the very real possibility that several children would not survive to adulthood.

For Aboriginal communities, the toll of infectious diseases introduced during Australia's colonisation had already been immense.

A queen's edict crowdfunds a hospital

But by the late 19th century, a more sophisticated understanding of infectious diseases was emerging, and the need for a dedicated "fever hospital" in Melbourne came into focus.

Anderson, who authored a detailed book on the hospital's history, wrote that the opportunity to raise funds for the hospital presented itself as Queen Victoria celebrated 60 years on the throne in 1897.

The Queen had decreed that any funds raised to celebrate her Diamond Jubilee should be used "towards the amelioration of the sick and suffering of the community".

Queen Victoria's Jubilee presented an ideal opportunity to raise cash for the much-needed hospital. (Fever Hospital: A History of Fairfield Infectious Diseases Hospital)

Victoria's political leaders seized on the opportunity to launch a campaign for Melbourne's fever hospital, including concerts and even a poem which aimed to tug on the heart (and purse) strings of the community.

The poem ended with lines that underscored the traumatic toll infectious diseases were wreaking on the community's youngest:

"Babies distraught and delirious with pain,

Asking in whispers, for just a cool pillow,

Asking for help — shall they ask in vain?"

The fundraiser was a huge success, raising 16,000 pounds and enabling the opening in 1904 of the Queen's Memorial Infectious Diseases Hospital at Fairfield, in Melbourne's north-east.

The committee running the hospital later decided to put a portrait of the queen in the administrative block of the building, so the late monarch could keep a watchful eye on operations.

The hospital was located near the Yarra Bend Asylum for the Insane, on a sloping hill beside the river. (Supplied: State Library of Victoria)

In the next few years, the hospital had plenty to keep it busy, as waves of scarlet fever and diphtheria brought an influx of patients.

But it wasn't without controversies and funding continued to be a struggle.

In an early signal of those tensions, the admission of a young patient who later died was delayed while the hospital and a Northcote town clerk argued over who would pay the treatment costs.

The hospital soon procured its first ambulance to support patients in urgent need of its services. (Fever Hospital: A History of Fairfield Infectious Diseases Hospital)

A generation of polio survivors endure well-meaning but 'sinister' treatments

But in the decades that followed, the hospital began to build its expertise and reputation as a centre of excellence for the treatment of infectious diseases, including the influenza outbreak after World War I.

That was followed by the polio epidemic, which the hospital prepared to combat with a supply of "iron lung" ventilators from London.

The disease, which can present as a flu, is devastating for a small number of patients, and hit children especially hard.

People are worst affected when the virus reaches the nervous system, paralysing muscles including the diaphragm or limbs.

These children with polio were being treated on a hospital verandah due to overcrowding during the 1937 epidemic. (Fever Hospital: A History of Fairfield Infectious Diseases Hospital)

There's a familiar ring to a note around this time from the hospital's medical superintendent, F.V. Scholes, where he described the pressures of the epidemic.

"Not only were the majority of the older and more experienced nurses required for the Poliomyelitis wards, in which, particularly in the respirator wards, a large staff had to be maintained, but very careful nursing and isolation measures were necessary in the Diphtheria and Scarlet Fever wards to prevent infection there," he wrote.

"Finally, several hundred patients were admitted as suspected cases of Poliomyelitis, found actually to be suffering from a wide variety of diseases, and for many months, all the isolation accommodation in the hospital was taken up."

Over decades, the hospital built a strong reputation as a centre of excellence for clinical infectious diseases care. (Fever Hospital: A History of Fairfield Infectious Diseases Hospital)

Polio would continue to pose a challenge to humanity worldwide for decades to come.

Vaccines were produced in Australia from the 1950s onwards, but it wasn't until 2000 that the Western Pacific region, including Australia, was declared polio-free.

Former nurse Robyn Abrahams was three when she was infected amid one of the community's "roaring epidemics".

The 71-year-old recalls being taken into a "big white ambulance with four men in white coats" who drove her to Fairfield Infectious Diseases Hospital, where she remained for many months in isolation.

"I can remember my mother as they shoved me in the back of the ambulance, was screaming 'I love you, I love you, I love you'," Ms Abrahams said.

Iron lungs were used to help inflate the lungs of children whose breathing muscles had been harmed by polio. (ABC News)

She also remembers the stigma that came with the disease, which is spread through faeces and mucous like most gastrointestinal viruses.

"There was a lot of blame, it was said to be 'dirty people' got it, and things like that," she said.

The fear and top-down, authoritative culture that pervaded medical institutions at the time also looms large in her memory.

The hospital was largely known as 'Fairfield Hospital', and in the 50s its title referencing Queen Victoria dropped out of use. (Fever Hospital: A History of Fairfield Infectious Diseases Hospital)

She was told she was in an iron lung for a while, and she can recall hearing the "whoosh, bang, whoosh, bang" of the machines working throughout the hospital.

But her main memories are of seeing her visiting parents through glass and nurses in long white dresses who administered fairly "sinister" treatments that focused on getting the patient moving, but took little account of their psychological health.

"Best as they knew at the time, Fairfield and other places did the very best job they could," she reflected.

A happier memory is the tranquillity of the gardens surrounding her ward, which she and other children with polio were wheeled out to enjoy from the balcony.

"It wasn't fenced, lots of lovely flowers, it was pretty and it smelt good, whereas the hospital smelled of carbolic soap, some disgusting, horrible disinfectant they used to scrub us with all the time," she said.

Roaming peacocks brought an exotic touch to the sprawling gardens around the hospital. (Supplied: Phil Carswell)

Despite the traumatic illness which lingers to this day in the form of post-polio syndrome, Ms Abrahams went on to become a nurse and regards herself has having enjoyed a "wondrous life".

She and other senior polio survivors, many of whom are campaigning for inclusion in the NDIS, are keen to see Fairfield maintained with a museum or educational centre added to the site to ensure their story is not lost.

"The important thing is to not forget so we don't repeat history, we understand that what was possibly done with the best intent at the time is in fact very wrong, and mustn't be repeated," she said.

A WWII hero takes the helm as matron

As the hospital marched into the late 1960s, its profile was further boosted with the recruitment of the legendary World War II nurse Vivian Bullwinkel AO as its new Matron.

Vivian Bullwinkel rose to the rank of lieutenant colonel during her army service. (Supplied: Australian War Memorial)

Ms Bullwinkel was a household name across Australia, as the sole survivor of the Banka Island massacre in 1942, when Japanese soldiers shot the survivors of a shipwreck south of Singapore.

As Anderson notes in his historical account, "the hospital counted itself extremely fortunate to have obtained the services of such an outstanding new Matron".

Nurses who trained and worked alongside her still speak of her "incredible leadership" and the care she gave not only to patients but colleagues, with an apparently prodigious memory for each nurse she worked with.

"If only our world was full of Vivian Bullwinkels, what a wonderful place it would be," one former colleague said.

Her widely respected 16-year tenure was later honoured with the establishment of the Vivian Bullwinkel School of Nursing.

Vivian Bullwinkel (left) had her contribution to the hospital recognised with the dedication of a new nursing ward in 1978. (Fever Hospital: A History of Fairfield Infectious Diseases Hospital)

The high standards of clinical care and virology expertise at the hospital were now attracting international attention, which escalated as the construction of several laboratories added more research capability.

In 1963, the hospital was designated a World Health Organization (WHO) Influenza Centre.

A year later, the international body recognised Fairfield's laboratory as the Oceanic Regions Reference Centre for Enteroviruses and Respiratory Viruses.

An epidemiologist visiting from Glasgow referred to the hospital in a letter as "one of the most important world centres for the study of communicable disease".

That expertise was about to be tested.

An epidemic arrives with uncomfortable parallels to COVID-19

A lull between infectious diseases epidemics came to an end in the 80s, as predominantly gay men began to present to their doctors with swollen lymph glands and other symptoms that didn't quite line up to any existing illness.

As researchers around the globe began to join the dots on HIV and the deadly acquired immunodeficiency syndrome (AIDS) it caused, Fairfield hospital's Suzanne Crowe found herself plunged into an epidemic that would occupy much of her working life for years to come.

"We didn't even know that it was a virus," she said.

"The term HIV hadn't been coined at that stage."

The staff at the Fairfield Infectious Diseases Hospital including Ian Gust (left) and Suzanne Crowe (second from left) were at the forefront of efforts to combat Australia's HIV epidemic. (Supplied: Burnet Institute)

Professor Crowe was part of the team that set up the Fairfield hospital's HIV clinic, where they were startled to find 25 per cent of people presenting were testing positive to the virus.

She said it was a challenging time as she and two female colleagues, Anne Mijch and Jan Watson, worked to build a safe space for their patients, who faced "rampant" homophobia in the community.

"When we didn't have treatment, initially, we had empathy, and we would try and make our patients feel comfortable," she said.

Professor Crowe said the team prided itself on a culture of non-judgemental care, which stood in contrast to some other hospitals during the early, panicked chapters of the epidemic.

"For example, at one of Melbourne's major public hospitals, their food was left outside their door and the cleaners didn't want to go in and clean," she said.

It was a painful time, too, as Professor Crowe regularly attended funerals for the young, funny patients she had come to know so well.

David Menadue was also there.

"So many of my friends were dying," he said.

"And I even had flatmates that were dying and I was looking after while I was nursing my own sick body, it wasn't a very nice time at all."

David Menadue OAM has advocated for the rights of HIV-positive people for decades. (Supplied: David Menadue)

Mr Menadue was in his 30s when he was battling the illness and said the team at Fairfield Infectious Diseases Hospital, including Professor Crowe, had "saved my life several times".

He said the caring, loving environment at the hospital was rare at the time.

"The fact that we had so little stigma as HIV-positive patients meant when I was in hospital, it really aided my healing," he said.

By the late 80s, the hospital was planning a second and then a third ward to house the growing number of AIDS patients.

In a time of crisis, the hospital played a national role, with its legendary medical virologist Ian Gust (who had already helped develop vaccines against Hepatitis A) establishing the National HIV Reference Laboratory.

It was around this time that virologist Gilda Tachedjian graduated from university and began work at the hospital, keen to use her skills to tackle the HIV epidemic.

While therapeutic care was welcomed, what was crucially needed was treatment.

Gilda Tachedjian (right) now heads the Burnet Institute's Retroviral Biology and Antivirals Group. (Supplied: Burnet Institute)

Professor Tachedjian said the work was intellectually exciting, as she spent hours "desperately trying to find a drug that will inhibit the virus growing in the test tube".

"[The hospital] was a really fascinating environment to work in ... because you had the clinicians working hand in hand with the basic researchers," she said.

It was also profoundly sobering, as she saw many young men around her who were extremely sick with the virus.

"And there was nothing much that we could do for these individuals, because there were no drugs at the time," she said.

"We've come a long way over the last 40 years. HIV was a death sentence then."

The controversial closure of an icon, fought until the very end

But as infectious diseases epidemics ebbed and flowed, so too did the hospital's usefulness in the eyes of the governments who funded it.

In the 1920s and 30s, when epidemics of diphtheria, scarlet fever, measles, whooping cough and meningitis were common threats, the hospital had bed occupancy of 500 or more per month.

By 1990 the average rate was just 73, most of whom were AIDS patients.

Reports on the hospital highlighted empty wards "waiting for the epidemic — which didn't occur", although the hospital's management of the day felt this was ill-informed criticism, Anderson wrote.

The hospital found passionate advocates in its current and former patients. (Fever Hospital: A History of Fairfield Infectious Diseases Hospital)

Hospital staff were concerned that what had become renowned as the "Fairfield culture of care" at the hospital would be lost if the hospital was dissolved and amalgamated into the broader hospital network.

When the serving Labor government health minister Maureen Lyster announced Fairfield's closure in 1991, it sparked an outcry.

Health unions and staff joined forces to launch a campaign to save the hospital, and managed to push the Labor government back into a position of deliberation on the centre's future.

A mass rally of more than 1,000 patients, staff and supporters marched to Parliament House.

One of the hospital's longest-residing patients, polio survivor Joan Gillespie, shared her experience of contracting polio aged 22, and still requiring ventilation for 14 hours a day.

She said she supported the hospital remaining open because "it has kept me alive all these years".

The impassioned displays of support kept the hospital's doors open for a while, but couldn't delay its eventual closure. (Fever Hospital: A History of Fairfield Infectious Diseases Hospital)

The emotional defence of the hospital managed to stay its closure for a time, but not forever.

After a few more years of controversy and angst over the hospital's future, including prominent advocacy for its retention from AIDS support groups, the hospital was closed in 1996 by the Liberal-National Kennett government, in a process Professor Crowe recalled as "rather clumsy".

"Instead of transferring [the hospital's expertise] in total to one of the hospitals, the expertise was carved up into pieces and so the collective impact was lost, no doubt about that," she said.

"It doesn't mean to say that hasn't been rebuilt, because it has, and infectious diseases is now incredibly strong across Melbourne again.

Much of the research capability from the hospital lives on in the Burnet Institute, where Professor Crowe continued her HIV research.

Australia has benefited from the expertise honed at Fairfield

Years later, as Victoria weathered its second year of the COVID-19 pandemic, the state government pushed ahead with plans to build a $650 million Institute of Infectious Disease in Parkville.

The opposition, too, made its own pledge to fund a new infectious disease response centre and more specialist nurses.

Professor Crowe said while there had certainly been reflections over the years about the times the Fairfield Infectious Diseases Hospital would have come in handy had it not been disbanded, she believed the new institute being built would be "fabulous".

"I think the government is right to do this, and COVID, it seems, has provided the impetus for this to happen," she said.

Leading Australian virology experts Suzanne Crowe and Sharon Lewin are among the alumnae from Fairfield Infectious Diseases Hospital. (Supplied)

While the Fairfield hospital may be no more, Professor Tachedjian said Australia had benefited from the investment in a generation of virology experts who passed through its doors.

"That investment has paid off in spades, because it's now relevant to tackling the virus SARS-CoV-2," Professor Tachedjian said.

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