Whārangi 1: Biography
Grabham, George Wallington
Doctor, health administrator
I tuhia tēnei haurongo e K. A. Simpson, ā, i tāngia tuatahitia ki Ngā Tāngata Taumata Rau Ko te wāhanga, 1993, and updated in March, 2006.
George Wallington Grabham was born in Rochford, Essex, England, on 1 September 1836, the son of John Grabham, a surgeon, and his wife, Sarah Fry. George and three brothers all studied medicine at St Thomas's Hospital, London. Grabham qualified MRCS in 1857, LSA in 1858, MD from the University of London in 1867 and MRCP in 1882.
In 1859 Grabham was medical officer at Bradford Infirmary, Yorkshire. While at Bradford, on 3 June 1863, he married Mary Elizabeth Illingworth. About 1870 George Grabham became medical superintendent of the Earlswood Idiot Asylum at Redhill, Surrey. In 1882 he was appointed inspector of hospitals and inspector of lunatic asylums in New Zealand. His predecessor, the fiery Frederick Skae, had held the position for only 15 months before dying prematurely in 1881. During his time in office Skae had strongly criticised the administration of New Zealand's asylums and turned his words into deeds by vigorously cutting expenditure and staff numbers.
From the time of his arrival in New Zealand to the end of April 1883 Grabham travelled 4,158 miles by ship, coach and train, visiting all 38 hospitals and eight asylums in the colony. He began his tour in November at Dunedin, inspecting its asylum and the temporary asylum at Seacliff. Reaching Wellington in late November, he inspected the hospital and asylum there, then travelled to Picton, Blenheim and Nelson, returning to the capital and later visiting hospitals at Masterton and Greytown.
In January 1883 Grabham made a more extensive trip to the South Island, beginning at Christchurch and continuing south to Ashburton, Timaru, Oamaru and the numerous hospitals connected with the goldfield towns in Otago and the West Coast. This trip lasted over a month. Grabham scrutinised each institution thoroughly, noting minute details such as the stuffing of mattresses and pillows, and the presence of reading matter, pictures and flowers. He examined provisions for fire fighting, water supply, sewerage, laundry, ventilation and visits by clergy. He sampled the patients' food and talked to each patient privately about their treatment. Cleanliness and absence of unpleasant smells were important: he described Blenheim Hospital as 'infested with bugs', while the scullery at Christchurch Hospital was 'undermined by rats'.
In March Grabham turned his attention north, visiting Gisborne, Auckland, Coromandel, Thames, Rotorua, Napier, Palmerston North, Wanganui, Patea and New Plymouth, completing the trip with a visit to Nelson Asylum on 26 April. His report on asylums was dated 4 May and that on hospitals 7 June 1883. Both are surprisingly concise, given the wealth of information he had gathered during his travels. Larger hospitals received more extensive coverage, and were visited more than once.
Like Skae, Grabham was critical of deficiencies perceived in the running of hospitals: there were too many and their distribution was inefficient; funding, usually a combination of subscription and payment for inpatient treatment, was irregularly collected; and bookkeeping was substandard. The excessive amounts spent on alcoholic beverages and other extravagances were queried. He mentioned numerous examples of patients who were not proper subjects for hospital treatment and who would be more suitably accommodated in a workhouse or refuge, as was the case in England. At Timaru he found one patient who had occupied a hospital bed for 18 years.
From April 1884 to April 1885 Grabham travelled even more extensively, covering 6,452 miles and all the hospitals and asylums of the colony, again beginning at Dunedin. In July and August he inspected institutions at Wanganui, Patea, New Plymouth and Auckland, returning through Rotorua, Gisborne and Napier. In November he visited Masterton and Greytown, and later that month commenced a tour of the South Island at Dunedin, finishing at Picton on 1 January 1885. In February he returned to Gisborne, Coromandel, Auckland, Thames and Rotorua and in April visited Christchurch, Akaroa, Ashburton, Waimate and Naseby. His inspections were as exacting as before: he reported that the laundress at Christchurch Hospital required four ounces of brandy daily. He made 72 visits in all, inspecting some hospitals three times. Despite the recommendations of his 1883 report there were still 38 hospitals in 1884, some half empty and some, like Auckland, overcrowded. In March 1885 Grabham published a memorandum on hospital maintenance and management, recommending that six hospitals be abolished immediately and consideration be given to closing some or all of a further seven.
Between his journeys of inspection Grabham was domiciled in Wellington, writing reports and preparing legislation. His second report on hospitals, dated 1 June 1885, showed that some progress had been made. However, expenditure had increased by nearly £4,000 and income from annual subscriptions and maintenance money (paid by patients or their relatives) had fallen. Some hospitals were under-utilised, and existed principally to induce doctors to practise in an area where they would not have been able to make a living without a hospital appointment.
Grabham was author of the Hospitals and Charitable Institutions Act 1885. The model he adopted was a system used in Ontario, Canada, whereby locally elected hospital and charitable-aid boards were to administer hospitals, and a government subsidy supplemented charges levied on the local bodies. Twenty-eight districts were established under the act, some of them (for example Patea, Inangahua and Tuapeka) representing very small population bases. Patients continued to be charged maintenance fees, later abolished by the Social Security Act 1938. Accurate, audited accounts were required to be kept. The system of local hospital boards established by the act was to remain largely unchanged until the formation of area health boards over 100 years later.
With the legislation passed, Grabham resigned and returned to England in 1886, without seeing the new system in operation. He was perhaps irritated that the government had not acted on his recommendations to close small, unnecessary hospitals and create larger, more cost-effective districts.
Mary Grabham died on 24 July 1892 at Bradford, Yorkshire and in 1894 he married Constance Ethel Joseph Crane; she died on 31 May 1904. Their son, also called George Wallington, was born on 29 November 1895. George Grabham practised medicine at Bradford, then moved to Witham, Essex, where he died on 23 July 1912.