Balmain Cottage Hospital opened on 10 August 1885 and was located behind the present Court House on Darling Street. It consisted of four beds and treated 39 patients that first year.
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Balmain Cottage Hospital was the first metropolitan suburban Hospital in New South Wales. In the late 1800s Balmain became a hive of industry with engineering, chemical, glass, soap and canning factories, works and stores lining the foreshores. These industries led to increased risks and accidents. The distance from city hospitals and the dangers and difficulties of transport led to 'public agitation' for a Cottage Hospital to treat the accidents.
Although the Second World War was largely fought far from Australian shores, attacks on Northern Australia and a submarine attack on Sydney Harbour in 1942 lead Australians to believe a Japanese invasion was imminent. Hospitals prepared by taking air raid precautions. Balmain Hospital built large brick and concrete barriers outside the hospital and strengthened some wards with additional timber scaffolding and support beams.
In 1951 Balmain Hospital opened its first Maternity Unit with 25 beds in the John Beasley Ward. This was extended to 39 beds in 1960 with the opening of the Harold Simpson Wing. The first baby was born in January 1951, and the last in November 1980. A total of 16,781 babies were born over the 29 years of operation, peaking in 1979/1980 with 750 births that year. Although the maternity unit transferred to the King George V Memorial Hospital for Mothers and Babies at RPA Hospital, antenatal outpatient clinics continued at Balmain for many years.