Since the earliest days New Zealand seems to have had an attraction for medical men. The planned Wakefield settlements made provision for the inclusion of doctors among their settlers, and the flow of emigration brought into the country a number of medical men from time to time. As early as 1838 Dr Joseph Crocome settled at Waikouaiti, and worked among the scattered whaling stations and settlements along the Otago coast until his death in 1878. The gold rush of the sixties attracted many medical men, certain of whom devoted their first energies to the search for gold, some later returning to the practice of medicine. Before the discovery of gold in Otago there were five doctors practising in Dunedin; by 1862 there were 13, and in 1864 twenty-nine practitioners were attending to the needs of the rapidly growing town.
Medical practice in the early days – particularly in country districts – was an exhausting and strenuous calling. Patients were scattered over a wide area, and because of poor roads the country doctor could travel only on horseback or on foot. Writing of one such practitioner who settled at Tuapeka among the gold miners, Fulton refers to “the miles he had to travel by night and by day; the tedious ascent of precipitous mountains on horseback or on foot; the rivers to be forded, or if in spate to be swum across; the journeys in brightest sunshine or in blinding snow storms; the nights he had to camp with no place to lay his head, or in shepherds' huts or small shanties, awaiting the arrival of the long looked for son and heir; these were but a few of the trials that Ebenezar Halley had to face”.
Dr John Wait, who practised during the sixties in Oamaru and the country around and beyond it, “for many years led a very hard and strenuous life, riding long journeys into the back-blocks to attend patients, swimming rivers, and often, when he lost the track, camping in the tussocks until daylight. One of his long journeys necessitated his riding to Lake Ohau about 150 miles from Oamaru. The latter part of his journey he rode through snow piloted by a back-block shepherd… On his return to Oamaru he had to go immediately to Hampden. When he got home again he found some friends waiting to have a game of whist. He therefore sat down and played most of the night although he had been in the saddle for several days and nights”.
If life in the early days was hard for the average colonist, it was doubly so for the country doctor who conscientiously did his duty and answered every call. This country has good reason to be grateful to such men. By 1868 the Medical Register contained the names of 133 medical practitioners to serve a population of about 228,000. Specialism had not developed, and the absence of antiseptics and anaesthetics prevented all but the most urgent surgery. During the eighties, however, medicine, and particularly surgery, made great advances. Louis Pasteur had established the bacterial origin of infection, and Lister had supplemented this by the introduction of antiseptics, while anaesthesia was coming into general use. By 1885 the leading surgeons in Dunedin did not hesitate to open the abdominal cavity when necessary, and in 1891 Dr F. C. Batchelor published Notes on 100 Cases of Abdominal Surgery – a remarkable achievement at that time.
Further great advances in medical science were made after the First World War, and this hastened the development of specialism. It also led to an increase in the number and size of hospitals, and a demand for more medical men. This need was amply supplied both by an increased output from the Otago Medical School, and also by the continual arrival of highly qualified doctors from overseas; indeed, there can be few countries that have been so well provided with adequate numbers of well-trained and competent medical practitioners. The numbers of registered medical practitioners in New Zealand in proportion to the population at different periods are as follow:
|Medical Practitioners Registered|
|Year||Names on Register||Population|
*Excluding those registered with addresses outside New Zealand.
The Medical Register includes the names of many practitioners who have left the country, either permanently or temporarily, and many others who have retired, or for other reason are not practising their profession. A survey of the distribution in New Zealand, during 1963, of the active members of the profession produced the following figures:
Public Hospitals: Whole time, 576; part time, 637. Department of Health – Mental and other hospitals: Whole time, 75; part time, 40. Others: Whole time, 72; part time, 36. In Private Practice: 1,738.
Of the doctors in private practice in 1965, 432 were specialists and 1,287 were general practitioners, of whom 152 had some specialist interest.
The ratio of doctors in private practice to population was one active private practitioner to 1,478 population, and one general practitioner per 1,974 population. These are overall figures, but there is a greater concentration of private practitioners in urban than in rural areas, and some urban areas are better supplied than others.
Registration and Discipline
The first legislation for the registration of medical practitioners throughout the whole country was the Medical Practitioners Act of 1867, although previously, both in the Wellington and in the Otago Provinces, Ordinances had been passed setting up, in each case, a Medical Board to undertake the registration of doctors within the province. The Otago Ordinance even made provision for the deregistration of any medical man deemed by the Board to be “guilty of disreputable or infamous conduct in any professional respect”. The Act of 1867 also set up a Medical Board which was empowered to compile a Register and to purge it as necessary. The Board had power also to remove a name from the Register if the practitioner concerned was found guilty of any crime or misdemeanour, or was deemed to be guilty of discreditable or infamous conduct in any professional respect. This Act was unpopular with the profession on account of the composition of the Medical Board, which included the Director of Geological Survey, the Comptroller of Public Accounts, the Secretary for Crown Lands, and the Auditor-General. Consequently in 1869 a new Act was passed and the Medical Board abolished. Under the Act of 1869 the registration of medical men was undertaken by the Registrar-General. He had power to remove a name from the Register in the event of false registration, or after conviction of felony or misdemeanour, but the Act made no provision for removal for discreditable or infamous conduct in any professional respect.
No substantial amendment to these provisions was made until 1914, in which year a new Act provided for a Medical Board of seven medical practitioners including the Inspector-General of Hospitals (in effect the Chief Health Officer). In addition to the powers formerly held by the Registrar-General, the Board, in any case of grave misconduct in any professional respect, could apply to the Supreme Court for the removal of the name of the practitioner concerned. In 1924 the Medical Board became the Medical Council, and the Director-General of Health continued to be an ex officio member as well as becoming Registrar. The Council was also empowered, after due inquiry, to fine a medical practitioner an amount not exceeding £50, or to suspend him from practice for a period of 12 months. With minor amendments the system of registration has remained the same up to the present time.
With the introduction of health benefits, under the Social Security Act 1938, it was deemed necessary to provide further disciplinary powers to deal with irregularities in respect of claims for remuneration from the Social Security Fund. This led to the setting up of District Disciplinary Committees controlled by a Central Disciplinary Committee which has the power to censure or to fine any practitioner if a complaint, made against him by the Minister of Health, is found, after due inquiry, to be substantiated. All the members of these committees are themselves medical practitioners. This system of disciplinary procedure is controlled entirely by the New Zealand Branch of the British Medical Association, except that the Minister may appoint one member of the Central Disciplinary Committee. The Medical Practitioners' Disciplinary Committee also has a lesser jurisdiction over offences termed “professional misconduct” and breaches of contract between bursars and the Department of Health.
It will be seen that, for offences concerned with a practitioner's practice of his profession, all disciplinary powers are exercised by the profession itself.
Medical Training – The Otago Medical School
For the first 50 years or so of settlement, the New Zealand population relied entirely on doctors who had been trained overseas. Today the majority of medical practitioners in this country have received their basic medical training in New Zealand.
The University of Otago was established by 1870, and in 1875 the embryo medical school was in existence. This was a very ambitious project for so small a community, and many difficulties arose before the school was firmly established. It was proposed at first to provide only the first two years of a medical course, students having to complete their studies and obtain their medical qualifications at some other school of medicine. Even this modest undertaking met with difficulties, as for a time most of the medical authorities overseas hesitated to recognise this preliminary training. It was not long, however, before the required recognition was granted by the University of Edinburgh, and it became the custom for New Zealand medical students to study for two years at Dunedin, and to complete their course with a further two years' study at Edinburgh. From 1885 onwards it became possible to complete the whole medical course in Dunedin, and the first student to do so was William Ledingham Christie who qualified in 1887. The first woman to complete the medical course at Dunedin was Emily Siedeberg, later Dr Emily Siedeberg McKinnon, who entered the school in 1891. She later specialised in obstetrics and was medical superintendent of the Dunedin St. Helens Hospital for 33 years.
Round the turn of the century the Medical School went through a difficult period. The University was in serious financial straits, and the Council had no choice but to reduce the salaries of the teaching staff, while money was lacking for necessary extensions and improvements, both as regards buildings and equipment, and for the appointment of an adequate staff. It was impossible to keep the school and the hospital up to date, and there was a serious falling off in the number of students. After 1905 the University's finances improved, and during the years leading up to the outbreak of the First World War conditions at the Medical School showed a slow but steady improvement. The salary cuts were restored, additional appointments were made, and new departments were established. By 1912 the number of students was 120, and it was coming to be realised both by the Government and by the general public that the Otago Medical School was a national institution and one worthy of support. During this period Dr (later Sir Louis E.) Barnett, Professor of Surgery, on returning from a visit to America, was able to say: “Our Medical School, with all its limitations and imperfections, compares favourably with the American Schools”.
With the outbreak of war in 1914 intending medical students could no longer study overseas, and the demands of the services for medical officers added a further stimulus to the training of doctors in this country. Between the years 1914 and 1919 the annual entries of students increased from 30 to 90, and the total numbers of students from 155 to 340. The existing buildings were quite inadequate for these numbers, and during the war years the first of the Medical School buildings adjacent to the hospital was erected, and served to accommodate the Pathology Department and the newly created Bacteriology Department. A portion of the cost of this building was met by public subscription.
With the end of the war the numbers of students continued to increase. Many returned servicemen sought to enrol, and the majority of medical students now wished to train in New Zealand rather than overseas as had previously been a common alternative. An additional building became necessary, as well as increases in staff and equipment. The Government was unsympathetic, and having its own financial difficulties was not disposed to be generous. However the Medical Faculty, ably led by the Dean, Dr (later, Sir Lindo) Ferguson, and supported by the Chancellor, maintained such pressure on the Government that successive grants were reluctantly made, and the building proceeded with, to be finally completed in 1927. This provided adequate accommodation for the Anatomy and Physiology Departments. During the twenties the medical course was extended to six years and, later, in 1937, arrangements were made for sixth-year students to undergo clinical training at one or other of the four metropolitan hospitals, thus taking advantage of the large amount of clinical material available in the other three major centres.
By 1923 there were 870 doctors in active practice in New Zealand, and 297 of these were Otago graduates. In point of size the Medical School was one of the most important in the British Commonwealth, and Otago graduates had proved that they could more than hold their own in securing and holding appointments in Great Britain and elsewhere. Undoubtedly the wisdom of the school's founders, and the exertions and devotion of its teaching staff during the early years of struggle, had been amply justified. About this time the need for better training in obstetrics became evident, and this required the establishment of a chair of obstetrics and gynaecology, and the provision of an up-to-date maternity hospital with facilities for the adequate training of medical students. The Government agreed to provide the cost of the new hospital, and the New Zealand Obstetrical and Gynaecological Society, stimulated by their energetic secretary, Dr Doris Gordon, succeeded in raising by public subscription the money necessary to endow the new chair. The new Professor of Obstetrics and Gynaecology, Dr J. B. (later, Sir Bernard) Dawson was appointed in 1931, but the Queen Mary Maternity Hospital, to take 28 patients, and with living accommodation for six students, was not opened until February 1938.
After the post-war rush of students, the numbers became stabilised at a slightly lower level for some years, but the introduction of health benefits under the Social Security Act, from 1941 onwards, increased both the need and the opportunities for medical practitioners, and the numbers increased once more. After the end of the Second World War, in 1945, it was found necessary to limit the yearly intake of students to 120, and to establish a system of priorities for admission to the school. This intake ensures a yearly output of approximately 100 doctors.
The quality of a medical school is greatly influenced by the calibre of its Dean, and in this respect the Otago Medical School has been very fortunate. Over a long period of 68 years the position has been held successively by three men only, and each played a significant part in building up and maintaining a high standard of efficiency. Dr J. H. Scott was Dean from 1890 to 1914, Dr (later, Sir Lindo) Ferguson from 1914 to 1937, and Dr C. E. (later, Sir Charles) Hercus from 1937 to 1958. The present Dean is Dr E. G. Sayers, C.M.G., F.R.C.P. (LONDON). Both Sir Charles and Dr Sayers are Dunedin graduates.
Besides the basic medical degree, the Medical School provides instruction and conducts examinations for the following degrees and diplomas:
|Degrees:||Doctor of Medicine:||M.D.|
|Master of Surgery:||Ch.M.|
|Bachelor of Medical Science:||B.Med.Sc.|
|Master of Medical Science:||M.Med.Sc.|
|Diplomas:||Diploma in Public Health:||D.P.H.|
|Diploma in Microbiology:||Dip.Micr.|
|Diploma in Diagnostic Radiology:||Dip.D.R.|
Post-graduate Medical Education
In addition to the facilities provided at the Medical School, Postgraduate Committees based on the larger hospitals have been active for a number of years in providing facilities for post-graduate instruction in different branches of medicine and surgery. For some time these committees worked independently, but recently they agreed to bring about closer integration by forming the New Zealand Post-graduate Medical Federation Incorporated. The objects of the Federation are the encouragement, advancement, and integration of all aspects of post-graduate medical education in New Zealand.
At present the Federation includes eight Post-graduate Committees based respectively on the Otago Medical School, Auckland University, and the hospitals at Hamilton, Napier, Palmerston North, Wellington, Christchurch, and Invercargill.
Post-graduate education has varying functions and methods:
Training of Young Specialists: To assist in the further study of the basic medical sciences weekly viva-tutorials are held from March to the end of July at both Dunedin and Auckland, and in August a month's concentrated course is held at the Medical School in preparation for the various primary examinations for higher qualifications.
Courses of General Interest: All Post-graduate Committees, at least annually, hold up to a two-week course for medical men in their area. The subjects of these courses, over a five-year period, will cover many aspects of medicine, surgery, and obstetrics.
General Practitioner Training: Each Post-graduate Committee holds short courses for general practitioners lasting for a weekend, or for several spaced afternoons during one month. This enables practitioners to benefit from additional study without interference with their ordinary work.
Post-graduate courses benefit greatly from the stimulus provided by the visits of eminent professional men from other countries, such as are provided by the Sims Visiting Professorships, the Sims-Black Professorship, and the Pfizer Lecturer. In addition, most committees bring visitors from abroad to strengthen their courses.
The aim of post-graduate education is to assist young men to study for higher qualifications without being obliged to leave New Zealand, and to offer all medical men the opportunity to continue their medical education throughout their professional lives.
The first recorded attempt to form a medical association was made in Dunedin in 1873 by Dr T. M. Hocken. It aroused little interest, however, and lapsed after a few months. In 1876 Dr Coughtrey, the first Professor of Anatomy in the University of Otago, succeeded in forming an Otago Medical Association, which two years later changed its name to The New Zealand Medical Association. Its influence, however, does not seem to have extended beyond Otago. In 1879 an attempt was made by the profession to have set up a General Medical Council which would appoint medical boards in the various provincial districts to undertake the registration of medical practitioners, to adjudicate on all matters relating to medical ethics, and to consider matters of public importance requiring professional consideration. Provincial district associations were also envisaged. A Bill along these lines was introduced in the Legislative Council and passed, but was rejected by the House of Representatives.
During the eighties local medical associations were established in Auckland, Wellington, and Christchurch, and in 1887 a New Zealand Medical Association came into being, the first meeting being held at the Dunedin Hospital on 12 April 1887. At a later meeting held in Wellington a Code of Medical Ethics was adopted. In 1896 the New Zealand Medical Association became the New Zealand branch of the British Medical Association, and has continued as such up to the present time. To enable it to hold its own property the branch, in 1927, was registered as a limited liability company.
In addition to the British Medical Association there are smaller societies and associations formed by groups of medical men having a common interest. Some of these are peculiar to New Zealand, while some have originated overseas, and have branches in this country. The aim of these societies and associations is to foster an interest in some section of medical practice, and to bring about and maintain a high standard. These groups may be classified according to their different characteristics:
The Royal Australasian College of Physicians and the Royal Australasian College of Surgeons each has a New Zealand Committee, and in each case membership is obtained by examination. Fellowship of the Royal Australasian College of Physicians is obtained by election, and of the Royal Australasian College of Surgeons by examination.
The Royal College of Obstetricians and Gynaecologists has a Regional Council in New Zealand. It grants a diploma by examination, and membership also is granted by examination. Fellowship is awarded only by election.
The College of Radiologists of Australasia is derived from an earlier body – The Australian and New Zealand Association of Radiologists. The college has a New Zealand Committee, and conducts examinations for diplomas and certificates. Membership is obtained only by election.
The College of General Practitioners of the United Kingdom has a New Zealand Council, and four faculties in New Zealand – in Auckland, Wellington, Canterbury, and Otago. Any registered medical practitioner may become an associate if he undertakes to continue approved post-graduate study, and to uphold and promote the aims of the college. To obtain membership a practitioner must be qualified for seven years (with five years in general practice), and must be sponsored by two members of the college. He must submit evidence concerning practice, experience, and academic achievements. If required, he must submit to interview by the Board of Censors.
The Australia and New Zealand College of Psychiatrists has a New Zealand Committee. Membership is granted by election, and requires at least five years' specialised practice in psychiatry and approved postgraduate qualifications.
There are also a number of specialist and other societies which are peculiar to New Zealand, and which are affiliated with the New Zealand branch of the British Medical Association. The aim of some is primarily to foster some branch of medical or surgical practice, while others provide the opportunity for consultation and association between groups of practitioners having a common interest. They fall into several groups:
Specialist societies. Membership of these is obtained only by election, and indicates recognition of competence in the specialty:
The Ophthalmological Society of New Zealand;
The Oto-laryngological Society of New Zealand;
The New Zealand Dermatological Society;
The New Zealand Orthopaedic Association;
The New Zealand Society of Pathologists.
Specialist societies open to any registered medical practitioner:
The New Zealand Obstetrical and Gynaecological Society;
The Paediatric Society of New Zealand;
The New Zealand Society of Anaesthetists;
The New Zealand Rheumatism Association;
The Neurological Association of New Zealand.
Associations of hospital officers:
The Psychiatric Medical Officers' Association;
The Medical Superintendents' Association of New Zealand;
The New Zealand Association of Part-time Hospital Staff;
The Whole-time Senior Medical Officers' Association of New Zealand.
Other societies open to any registered medical practitioner:
The General Practitioners' Society;
The Association of Medicine in Sport.
There are four medical libraries under the charge of full-time librarians, and five smaller libraries:
Otago Medical School Library: This is the largest of the medical libraries, and has about 50,000 volumes, and receives about 700 current periodicals. It has two branch libraries concerned with anatomy and physiology.
Department of Health Library: This library, with its branch libraries distributed throughout the country, contains about 35,000 volumes. It specialises in the literature of preventive medicine and public health, and receives about 500 current periodicals.
The Marion Davis Memorial Library: This library was established in 1961, in Auckland, through the generosity of Sir Ernest Davisa who built, equipped, and endowed it in memory of his wife. The previously existing Auckland Hospital Medical Library has been integrated with this library, which subscribes to some 500 periodicals. There are about 5,000 modern textbooks and 11,500 volumes of journals.
The Canterbury Medical Library has some 14,000 volumes and 350 periodical subscriptions.
Smaller medical libraries, not in charge of full-time librarians, have been established at the Wellington, Palmerston North, Cook, and Masterton and many other hospitals, and at the headquarters of the New Zealand branch of the British Medical Association.
A New Zealand Medical Journal was first published in September 1887, shortly after the formation of the New Zealand Medical Association, and was edited by Dr D. Colquhoun, the first professor of medicine at the Otago Medical School. It ceased publication in October 1896 when it was amalgamated with the Australasian Medical Gazette.
In August 1900 the present New Zealand Medical Journal commenced publication, the editor being Dr J. M. Mason who shortly after became Chief Health Officer. For many years the Journal appeared six times a year, but since January 1960 it has been published monthly. Other editors, in succession, have been Dr J. W. Fell, Sir James Elliott, Dr S. D. Rhind, and the present editor, Dr J. O. Mercer.
Annals of University of Otago Medical School, Carmalt-Jones, D. W. (1945); Medical Practice in Otago and Southland in the Early Days, Fulton, R. V. (1922); Handbook of B.M.A. (New Zealand Branch (1947–60); The Otago Medical School Under the First Three Deans, Hercus, C. E., and Bell, F. G. (1964).