I was appointed to the Austin Hospital in July 1967 at the age of 32, following the appointment of Professor Howard Eddey in February of that year. Until 1968, we constituted the University Department of Surgery. The first six months were quite hectic. A course for the incoming students (who started in October 1967) had to be planned. Lectures had to be arranged. Teaching rounds had to be scheduled. This was all in addition to the routine clinical work. Surgical teaching was done by Professor Eddey and me.
On the medical side, Professor Austin Doyle, Dr Bernard Sweet (who was in the same year as me as an undergraduate) and Dr Bill Louis arranged the medical lectures and ward rounds. At the Austin, pathology and microbiology were taught on the hospital campus, unlike the older teaching hospitals where these subjects were taught on the University of Melbourne campus. This meant that integrated teaching in these subjects was facilitated. I did joint sessions with the pathology staff and the microbiology staff. In particular, I did joint ward rounds with the senior lecturer in microbiology. This meant that the practical use of antibiotics on surgical patients was taught at the bedside. This was new to the University of Melbourne.
There was universal enthusiasm from all the new appointees and from the first student group. I think that all staff members recognised an incredible opportunity. The students did also. We were all pioneers. We did not have to follow the age-old traditions of the hospitals whence we came. We had worked overseas and seen the best in the world. We could do our own thing and we did. We did not aim to be as good as the Royal Melbourne Hospital or St Vincent’s Hospital. We aimed to be better. Apart from the two professors the new clinical staff were all in their thirties. We transformed the hospital from “The Austin Hospital for Cancer and the Incurables” into a leading teaching hospital in Australia, which lead the world in several areas. The research output in those early years was incredible, largely due to the efforts of Austin Doyle (Professor of Medicine). Austin Doyle supported me personally as much as he did those in his own Department. My rabbits (on a high cholesterol diet) were housed in a tiny green corrugated tin shed behind a new two-storey brick building which had just been built for the University.
There was no vascular surgeon at the Austin when I was appointed and I was the only one for the next five years. In retrospect, being the sole vascular surgeon for five years gave me an unparalleled opportunity to develop vascular surgery at the Austin in the way I wished. There were no ICU units in Australia at that time although I had seen several in the USA. We had an excellent nurse in charge of our 3KZ block ward, Barbara Carson (she later became Matron of the Austin). I arranged with Sister Carson that a four bed section of the ward be set aside for vascular patients returning to the ward from the operating theatre. I thought that this was very important for my aneurysm patients in particular. The nursing staff in this section developed considerable expertise looking after these patients When Robin Smallwood was appointed Director of Anaesthesia in 1969 he soon set up an ICU adjacent to the operating theatres. My ward ICU became redundant, but I like to think that I started the ICU at the Austin.
I started a separate Vascular Surgery Outpatient clinic in 1970 and a Vascular Surgery Unit when Neil Johnson and Brian Buxton were appointed to the hospital in 1973. Our unit became one of the leading units in Australia. I had been taught in the Professorial unit at St Bartholomew’s Hospital in London, the importance of audit. I kept an audit of all my patients, public and private, throughout my surgical career. This enabled the publication of many papers. I employed a secretary to the vascular unit (at my own expense for several years) to ensure an accurate audit. Eventually, the hospital paid for the secretary.
During my extended visit to the USA in early 1967, I met several surgeons who were “Fellows in Vascular Surgery” in the units to which they were attached Some of these fellows were paid others, others were not. They were full time and the training they received was first class. In Australia there were no positions specifically for vascular surgery training, experience in vascular surgery was part of general surgery training. We were the first in Australia to have a Fellow in vascular surgery. This was highly successful and eventually, this training was adopted throughout Australia, based on the model at the Austin.
We were the first to have a vascular laboratory attached to a vascular surgery unit in Australia. The initial laboratory was a former infant feeding preparation room adjacent to our ward in the 3KZ block. This facility was, of course, expanded with the building of the Harold Stokes block and again later with the Austin/Mercy redevelopment. In the late 1980’s the Medicare fee schedule was to be expanded, a team came from Canberra to inspect our facilities, our staff and our costings as we were the leading Vascular Laboratory in the country. The work in our laboratory led to the publication of many papers. I was the first in the world to use ultrasound to interrogate varicose veins. Several of our fellows worked on this theme and of course, our laboratory did also.
An anecdote I well remember was as follows: In 1979, at an overseas meeting, I heard a presentation about OPG’s (an oculoplethysmograph to measure delay in flow in the carotid artery for detection of carotid artery stenosis). I visited Wesley Moore in Tucson Arizona USA to see how this machine was used. I was most impressed. I purchased the machine with my own money. After return to the Austin, I applied to management for reimbursement of the cost ($8600). This was a lot of money in 1979. After a lot of haggling, the hospital agreed to reimburse me. But they clearly stated, “Never do that again”, However, I had my machine.
My colleagues at the Austin had similar ambitions. When John Dawborn was appointed to the Austin in September 1967, he established a home dialysis program (the first in Australia). As the only vascular surgeon in the hospital, I did all the renal access surgery and so developed a close liaison with the renal unit. This liaison has continued since. When I was on my own, I developed a close liaison with the radiology department. This grew as the volume and complexity of vascular surgery advanced. I think that the liaison between the Radiology department and the vascular unit at the Austin became the best in Melbourne. A similar liaison was developed with the neurology unit. The stroke unit was the first such unit in Australia. Peter Bladin and I both became recognised internationally for our work on stroke patients. Such liaison between physicians and surgeons did not occur at the hospitals we had come from, and I think that this medical-surgical interaction was of great importance to the development of the Austin Hospital. This was seen later in the development of the liver transplant program.
A further anecdote I can remember was this: One morning we had completed the ward round of our patients in the 3KZ block. We were proceeding along the walkway on the first floor towards the main hospital. I looked down and saw two men dressed in black with balaclavas over their heads waving sawn-off shotguns around. They did not spot us as we were on a higher level. I quietly and quickly ushered everyone back into the ward. The NAB branch was in a solitary building immediately adjacent to the east end of the 3KZ block. It was being robbed. The ward clerk promptly phoned the police. She said, “The bank’s being robbed”. When she hung up we realised she had not told the bank, which bank. She was too excited. I do not know whether or not the culprits were caught. I had to take the bank manager to the operating theatre and stitch up a large gaping wound on his bald head, where he had been struck by one of the robbers.
Professor John Royle
(Class of 1957)