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Two hundred years ago, Sydney was little more than a convict camp in desperate need of infrastructure, supplies and a hospital. The long journey from Great Britain across the Atlantic and the Indian Ocean in damp, unhygienic conditions of 18th-century convict ships left prisoners in poor health. Many arrived suffering from infectious diseases or other illnesses such as dysentery, smallpox, scurvy, and typhoid. One convict out of ten died during the voyage itself.

The situation in the colony was no better. There were no permanent buildings, only tents and temporary structures, one of which housed a basic and inadequately equipped hospital. Food was scarce and efforts at agriculture was met with failures. Not only prisoners, but officers themselves often went to bed hungry.

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