The First Fleet, as it later came to be known, arrived on Australia's East Coast in 1788. It comprised eleven ships bearing around 1400 people, half of whom were convicts. Between 1788 and 1868, when the last convict ship docked in Fremantle, over a hundred medical men are known to have arrived as transportees¹. With no standardization of medical qualification in the early nineteenth century, many would have been unqualified. Of those who came during this period three men, well known to each other in Sydney, are recognized for their medical abilities and as founding fathers of several respected institutions which developed as the settlement turned from a gaol into a colony. Many of those transported were not criminals in the true sense, but found themselves crossing the oceans as a result of some youthful, impetuous statement or action².

William Redfern, who has been called the father of Australian medicine, arrived as a convict in 1801 and was given an absolute pardon three years later. D'Arcy Wentworth barely escaped conviction, and was forced to embark for Australia in 1790 aboard the Neptune, one of the three ships of the notorious Second Fleet, in which just under a third of the voyagers died during the journey³. William Bland arrived as a convict in 1814 and was pardoned a year later. All three were well known to Lachlan Macquarie, the longserving Governor who held office from 1810 until 1821⁴. Macquarie, born on the Isle of Mull, governed as a paternalistic autocratic laird and brought discipline and some order to the chaos he found in New South Wales. His predecessor, William Bligh, already known for his bravery after the mutiny on HMS Bounty, had attempted to control the import of large quantities of rum, traded by the New South Wales Corps. Furious with Bligh, members of the ‘Rum Corps’, as they were known, arrested him, and wielded considerable power until the arrival of Macquarie. The new Governor was not popular with those who had come as free men, among whom was the arrogant pastoralist John Macarthur. They were known as the ‘exclusives’ while ex-convicts, however successful they became, never lost the stigma of being ‘emancipists’. The latter were considered beyond hope by many, but Macquarie felt they might have talents which could be of great use to the colony⁵. He employed the ex-convict Francis Greenway, a former pupil of Nash, to design distinguished buildings in the growing town of Sydney, and he chose Redfern as his family doctor.

William Redfern, from a Trowbridge family, was born in 1778, and may have received some surgical training in Edinburgh. He did not collect his diploma after passing the examination of the Company of Surgeons. Joining the Navy in 1797 he was appointed assistant surgeon on HMS Standard. He encouraged the sailors to present a united front at the Mutiny of the Nore and, as a result, was sentenced to death with 59 others⁶. On account of his youth, the sentence was commuted to life imprisonment and he was transported in 1801 aboard Minerva to the penal colony at Norfolk Island. He impressed the Governor with his medical skills, was pardoned in 1803 and in 1808 became assistant surgeon at the Dawes Point Convict Hospital in Sydney. To prove his abilities he agreed to appear before three of the colony's doctors, and so became the first Australian medical graduate⁵.

He spent his mornings in the hospital and saw private patients in the afternoons. His knowledge and skills soon won him a high reputation, though his manner could be brusque, especially when reference was made to his emancipist status. Even John Macarthur, the most powerful exclusive, entrusted his family to Redfern's care⁷. In 1813 Lachlan Macquarie declared, ‘I consider Mr Redfern as a professional man a very great acquisition to the Colony’. A year later he asked Redfern to examine convict health—an invitation that further enhanced the doctor's reputation. While the health of those who came with the First Fleet had been surprisingly good, this was not the case with subsequent voyages. Convicts were housed on board in appallingly cramped conditions, and dysentery, scurvy, typhus, typhoid and venereal disease were rife. Those who survived the voyage often remained too weak to make a useful contribution to the growing colony⁸. In 1814 the General Hewit, the Three Bees and the Surrey arrived with a terrible record of illness. On the Surrey 50 people had died of preventable disease, including the captain. Redfern's report Medical Aspects of Convict Transportation, published in 1814, was a model of its kind, impressing the authorities in England, and laying the foundations of public health in Australia. He covered five main topics—fresh air, clothing, diet, cleanliness and medical health. He recommended that, instead of men chosen by the shipowner, well-trained naval surgeons should be appointed, who could also act as government agents to oversee conditions on board. With implementation of his ideas, deaths were reduced by three-quarters³.

Macquarie was appalled at the Dawes Point Hospital, which he described as in a ‘ruinous state and very unfit for the reception of the sick’⁶. Without reference to the Colonial Office he financed the building of a new hospital by making the contractors sole importers of 45 000 (later 60 000) gallons of spirits for three years. This also allowed the Governor to exert some control over the importation of rum. Illegally imported spirit, which was used as barter in the colony, had caused great concern to the British Government, which had asked Macquarie to attempt some regularization of imports. After many delays the new building finally opened in May 1817⁸ and became known as the Rum Hospital⁹. Redfern, as its medical officer, lived in one of the detached staff wings, while the colony's Principal Surgeon, D'Arcy Wentworth, lived in the other. The Rum Hospital was replaced by Sydney Hospital in 1894.

Bitterly disappointed not to be chosen to replace D'Arcy Wentworth in 1818, Redfern decided to relinquish medicine and turn his attention to farming. He introduced merino sheep from Madeira in 1824, and was to play a leading part in the growth of Australia's wool industry⁵. He also brought back vines and was the first in a long line of distinguished medical vignerons. He was a founder and director of the Bank of New South Wales and, as a spokesman for less fortunate emancipists on a trip to Britain, he achieved the granting of equal rights. With the eventual end of transportation the term emancipist ceased to be used. Redfern died in Edinburgh in 1833, where he was supervising the education of his young son William.

D'Arcy Wentworth was born in Northern Ireland, son of an unsuccessful barrister with aristocratic connections. Service with the Irish Volunteers, whose young men came from very different social backgrounds, instilled liberal views which he held throughout later life⁷. While pursuing medical studies in London he mingled with members of high society and was soon living beyond his means. Attempts at highway robbery resulted in three charges, on two of which he was found not guilty. On the third he was acquitted for lack of evidence, though the victim, a distinguished man, claimed to recognize him. He was advised to leave the country and go to Botany Bay as assistant surgeon on a convict fleet. After four years working in Norfolk Island, where his skills were recognized, he took a post in Sydney. Putting his youthful exuberance behind him, he inspired increasing respect, particularly after the arrival of Lachlan Macquarie who appointed him Chief of Police and Treasurer of the Police Fund, describing him as ‘a man on whose rectitude of conduct and zealous attention to his duties I could safely rely’¹⁰.

In 1809 Wentworth was appointed Principal Surgeon, a post he held for nine years. As one of the contractors of the Rum Hospital, and through other business deals, he acquired very considerable wealth, though he was probably one of many entrepreneurs in the fast-growing town¹. With William Redfern he was a founder of the Bank of New South Wales and became one of its largest original shareholders. Despite his success D'Arcy Wentworth always retained his humanity and, remembering his own past, gave constant support to emancipists, thus incurring criticism from the exclusives.

Little is known of D'Arcy Wentworth's medicine apart from a necropsy he conducted in 1813 on a man who had been attacked by two drunk young officers. Wentworth recorded no visible marks on the body and, in view of this, was surprised at the violence of the attack, though others claimed to have seen similar cases. He found ‘a very considerable effusion of blood in both lobes of the lungs’. Death was attributed to ‘spasm of the heart occasioned by violent agitation’, and Wentworth was commended for his careful and detailed evidence¹¹. D'Arcy Wentworth died at his property ‘Homebush’ in 1827, leaving 22 000 acres of land to his family. He had served thirty-seven years as a government official, but his eldest son William Charles made an even greater contribution. A brilliant lawyer, he was one of the architects of self-government, the first Legislative Council being established in 1843. By the early 1830s free colonists had been putting pressure on Britain for some form of representative government. WC Wentworth led the emancipist party known as Botany Bay Whigs while John Macarthur headed the exclusives or Botany Bay Tories. In 1835 a public meeting was held and established the Australian Patriotic Association. This worked towards the constitution which was finally granted by Britain after the end of transportation on the East Coast.

William Bland, born in London in 1789, son of a distinguished obstetrician, passed the examination of the College of Surgeons in 1809. He joined the Royal Navy where his high principles and impetuous character soon led him into trouble. On HMS Hesper bound for India, he was challenged to a duel after throwing a glass of water at a very unpopular purser who, Bland felt, had unfairly criticized another officer. Bland pleaded with the purser not to pursue the challenge but was forced to a confrontation with pistols, as a result of which Case, the purser, was wounded in the abdomen and died shortly afterwards. The Recorder of Bombay recommended mercy, and Bland was sentenced to seven years' transportation¹².

Bland arrived in Sydney in 1814 and was freed almost immediately by Governor Macquarie, who knew of the urgent need for qualified doctors. Bland worked as medical officer of the Castle Hill Asylum, and, on receiving his absolute pardon a year later, was examined in accordance with the regulations in force for all doctors wishing to work in the colony. The three examiners, D'Arcy Wentworth, William Redfern and Major West, considered him better qualified than any of them² Bland turned down an official appointment in favour of private practice. At the time Sydney's young men amused themselves writing scurrilous verse about leading figures. Bland, who was critical of Macquarie's autocratic governorship, wrote some anonymous lines in 1818 on Macquarie's habit of attaching his name to geographical features and monuments. Bland was arrested, charged and spent a year in goal. He emerged considerably matured and decided to devote the rest of his life to helping the oppressed and improving the colony. Bland was involved with WC Wentworth and others in the foundation of the Australian Patriotic Association, becoming its secretary. In 1839 he published the first paper putting forward the colony's right to self-rule¹². He and Wentworth, who had deep respect for each other, were both elected to the first Legislative Council.

Since he enjoyed a good income as a private doctor Bland gave his time to several philanthropic institutions. For forty years he was honorary surgeon to the Benevolent Asylum, Australia's first free hospital for the sick poor. Bland's work there attracted international recognition when, in 1832, he operated on a patient with an aneurysm of the innominate artery. This was one of the first such operations in the world, and took place twenty years before anaesthesia was introduced to Australia. The patient lived for 18 days after surgery, and later that year Bland's detailed description of the case and the aneurysm needle he invented was published in The Lancet¹³. His other surgical procedures included cataract operations, removal of tumours and amputations. Unlike many surgeons at the time, Bland was known to resort to the knife only when he felt there was no other option.

William Bland, an eloquent speaker and writer, included subjects as varied as ‘Dislocations’, ‘Sanitary Reform’ and ‘Bites of Venomous snakes in Australia’ among his published work. He was very involved with the foundation of the Sydney Dispensary in 1826 and worked there for the next twenty years. The Dispensary provided the poor with treatment at home or as outpatients, and carried out Australia's first vaccination programme on over 400 children. Bland was aware of the importance of education to the future success of the colony. In 1830 Sydney College, which later became the grammar school, was founded with William Bland as president. He was also a generous benefactor to the Sydney Mechanics School of Arts founded three years later. In February 1859 the Australian Medical Association held its first meeting with Bland as its enthusiastic president¹⁴. Despite having 87 Fellows it lasted only eleven years, and the present AMA grew out of a second attempt by the British Medical Association.

A man of great energy and originality of thought, Bland was responsible for some remarkable inventions. There had been much concern about spontaneous combustion in the holds of ships carrying wool. He suggested flooding the hold with carbon dioxide gas, and a working model was on show at the 1851 Great Exhibition in London. His method was successfully used in several coal mines in Britain¹¹. Another invention was his ‘atmotic ship’—a balloon inflated by hydrogen gas ‘for the navigation of the atmosphere’. He foresaw developments in aeronautics including reduction of travel times and exploration of some of the world's remotest regions. William Bland died at the age of 79 in 1868; he saw patients to the last and eventually succumbed to the influenza he was treating in others. The skills, humanity and public service of this great patriot were recognized by a state funeral.

William Redfern, D'Arcy Wentworth and William Bland are representative of a group who arrived despised and disadvantaged in an alien land. In spite of their handicaps they not only succeeded in proving themselves to be upright and reliable citizens of their adopted country but also contributed enormously to its development. Though always sensitive to personal insults regarding their past, they gained great respect as the colony became established and achieved self-government. The exuberance that led to their transportation, once tempered, helped lay the foundations of one of the six colonies that became the Commonwealth of Australia a hundred years ago.