150 Years of Medicine

One professor and four anatomy students. So began New Zealand’s first medical school. Next year it will celebrate its 150th anniversary.

Until the 1870s, every registered doctor in New Zealand was trained overseas, mostly in Britain. That gradually changed following the establishment of the University of Otago in 1869 (the country’s first university) and the opening of the first medical school in 1875 (just the third medical school in Australasia, after Sydney and Melbourne).

A sole professor, of anatomy and physiology, Dr Millen Coughtrey, recruited from Britain, was the only full-time staff member, and he only lasted a couple of years before going into private practice in Dunedin.

Although four students had enrolled in anatomy in 1875, it was not until the following year that Coughtrey could make a more serious attempt at teaching prospective doctors. This was after a medical preliminary examination was in place and a law passed permitting the legal dissection of human bodies.

Just two students – Saul Solomon and Charles Low – passed the preliminary exam, but Solomon soon switched to law, reducing the Medical School to one professor, one student, one classroom and one cadaver.

The medical classes commenced in the University’s original building in Dunedin’s Princes Street (on the site of John Wickliffe House) but shifted in 1878 to what is now the Geology Building. 

Medical School buildings then gravitated towards the Great King Street block opposite the Dunedin Public Hospital, starting in 1917 with the Scott Building, followed by the Lindo Ferguson Building (1927), Hercus Building (1948), Sayers Building (1972) and Adams Building (1973): named after the first five deans.

For the first decade, medical students undertook a two-year course in Dunedin, and completed their Bachelor of Medicine and Bachelor of Surgery (MB ChB) degrees overseas, usually at the University of Edinburgh. It effectively restricted medical school entry to those who could afford to travel and study abroad.

From 1885, medical students were able to complete the required four years of study at Otago (extended to five years in 1894), and the first fully-Otago trained doctor, Dr Ledingham Christie, graduated in 1887. Even after a complete course became available at Otago, some students continued to transfer to Edinburgh to finish their undergraduate years. 

The comparatively low number of medical students at Otago did not deter the undergraduates from forming their own students’ association in 1888, two years before the establishment of the Otago University Students’ Association. 

In 1891, Dr John Scott was appointed as the inaugural dean, after the Medical School formed an official faculty of all hospital and medical staff who lectured to medical students. Scott was another young British import who succeeded Coughtrey in 1877 and continued as the professor of anatomy and physiology until 1914.

For the first 16 years, the Otago Medical School was an exclusively blokey place, initially in part at least because Edinburgh refused to accept female medical students. Dr Emily Siedeberg (McKinnon) was the first woman admitted to the Otago Medical School, in 1891, two years before women were allowed to vote. Siedeberg was joined the following year by Dr Margaret Cruickshank, who became the first New Zealand woman to register as a medical practitioner.

Other notable firsts include the first Māori medical students, Te Rangihīroa (Sir Peter Buck) (Ngāti Mutunga) and Dr Tūtere Wī Repa (Te Whānau-ā-Apanui, Ngāti Porou), who entered the Medical School in 1899 as the first in a succession of pupils from Te Aute College in Hawkes Bay. Te Rangihīroa was not just the Medical School’s but also the University’s first Māori graduate. Wī Repa graduated four years after him. 

From the 1920s, the Medical School slowly became more cosmopolitan. The first non-European woman and the first person of Chinese descent to study medicine at Otago, Dr Kathleen Pih (Chang), enrolled in 1921 and graduated in 1929.

The Medical School also began to assume responsibility for training doctors from other countries, particularly from the South Pacific. Dr Tom Dovi (Ratu Dovi Madraiwiwi) from Fiji entered the Medical School in 1929 as the University’s first Pacific Islands student.

Eminent Pacific leaders who have since studied medicine at Otago include Sir Tom Davis, who was the first Cook Islands-born medical graduate and served as the country’s chief medical officer and prime minister. Another Pacific medical student, Sir Ratu Kamisese Mara, led Fiji to independence and served as its first prime minister.

The arrival of full fee-paying students from the 1980s from Malaysia and then from other countries in Asia and in the Middle East further broadened the student ethnic demographic.

While teaching was at the heart of the Medical School, the distinguished research tradition dates back to Coughtrey’s successor, Scott. From his arrival in 1877, his research papers began to be published in the prestigious British Journal of Anatomy and Physiology.

In 1926, the Medical School introduced a Bachelor of Medical Science (BMedSc) degree that involved students taking a year out to complete a supervised research project in one of the medical sciences. This was extended in 1945 into a Master of Medical Science (MMedSc) degree as a part of a focus on medical research following the Second World War.

Arguably the Medical School’s highest-profile staff member has been Sir Jack Eccles, after whom the research support facility – the Eccles Building – is named. Born and educated in Australia, Eccles was the professor of physiology at Otago from 1944 to 1951. Along with physicist, Jack Coombs, and physiology lecturer, Dr Laurie Brock, Eccles made a breakthrough discovery in brain research that would ultimately lead to his sharing the Nobel Prize in physiology or medicine back in Australia in 1963.

More recently, the Medical School’s public profile has been greatly enhanced by media-go-to experts such as professors Philippa Howden-Chapman (housing), Janet Hoek (smoking), Chris Jackson (cancer), and Michael Baker (epidemiology).

Beyond the University, outstanding graduates who have made significant contributions to medicine and health include nutritionist, Dr Muriel Bell (1922); plastic surgeon, Sir Archibald McIndoe (1924); heart surgeon, Sir Brian Barratt-Boyes (1946); and ophthalmologist, Professor Fred Hollows (1956).

The Otago Medical School was very much of Dunedin for nearly 40 years, during the early period of which it was the largest and wealthiest city in New Zealand. The School tentatively made its first move beyond its traditional Dunedin base in 1924.

Forty medical students in Dunedin failed their final examination the previous year and needed to gain more clinical experience before they resat the exam. As there was no room for them in Dunedin Hospital, Christchurch Hospital offered to host them, and so they headed north.

This heralded a more permanent presence in Christchurch, Wellington, and Auckland, prompted by the Medical School phasing in a new programme involving a sixth year of entirely clinical work, and the further strain this placed on Dunedin Hospital. The Medical School started sending some of the final-year class to Christchurch in 1926, and to Wellington and Auckland in 1927.

These arrangements were formalised in 1938 with the establishment of branch medical faculties in the three northern centres.

The Auckland Branch Faculty closed in 1972, following the opening of the country’s second medical school at Auckland University in 1968 and the end of the Otago Medical School’s 92-year monopoly on medical training.

Christchurch and Wellington meanwhile became full clinical schools in the 1970s. All medical students continued to spend their first three years studying in Dunedin; some were then allocated to Christchurch and Wellington for their final three years of training. 

The two northern clinical schools then evolved into schools of medicine in the 1980s and the University of Otago, Christchurch; and University of Otago, Wellington in 2007. Their roles have greatly expanded from the training of doctors to also embrace a broad range of mainly post-graduate health science qualifications and research, reflecting a similar evolution in Dunedin.

Such was the gap between graduates and demand for doctors that anyone who qualified gained entry to the Medical School for its first 65 years. In 1941, the intake was limited for the first time: set at 100 students entering the second-year class, mainly because of wartime staff and accommodation shortages. This was soon increased to 120 and has gradually grown to the current cap of 302 set by the Government.

Policies for selection and admission changed during the second half of the Medical School’s history. What was called a preferential system, first introduced in 1951, offered priority entry to two Māori and two Pacific Island students.

The latest incarnation, aimed at ensuring a health workforce that represents the society it seeks to serve, has seen significant increases in the numbers of medical students with Māori and Pacific, low socio-economic, refugee and rural backgrounds.

This is reinforced by the Medical School’s education programmes, which “emphasise equitable health outcomes and a commitment to Te Tiriti o Waitangi,” and support “the health of Pacific communities through leading research programmes and the training of Pacific health professionals.”

The Medical School’s acting dean, Professor Tim Wilkinson, says he is really proud of the work in developing curricula in Māori and Pacific health, and other major developments over the past few decades.

“We’ve strengthened exposure to medicine in the community. The rural immersion programme has been shown to increase interest in people practising rurally, plus our students get some rural experience.”

Students get more exposure to clinical contexts and to learning clinical skills at an earlier stage in the curriculum.

“We remain strong in our research at all levels, all the while being mindful of how that is applicable to helping people with everyday health problems,” Wilkinson says.

Another major change has been the dramatic shift in the gender balance in the Medical School, including the flagship MB ChB degree, which has gone from exclusively male to more than half the students being female: just over 57 percent this year, while six students identified as gender diverse.

This has been accompanied by a substantial shift in attitudes towards female students. Siedeberg was initially asked to absent herself from two anatomy classes on the grounds of decorum.

Looking ahead to the 150th anniversary, the Otago Medical School has much to commemorate, including having graduated a total of 14,357 MB ChB students since 1887, with a further 1,510 current students working hard to join them.

As Emerita Professor Dorothy Page wrote in her history of the Medical School: “The Otago Medical School is proud of its graduates, as they are of the school. Many have pursued remarkable careers, achieving at the highest level in widely different fields, in New Zealand and overseas, as medical academics, specialist researchers, surgeons and physicians, humanitarian activists, war heroes, political leaders or general practitioners playing a vital role in their various communities.”

The 150th anniversary is being celebrated in Dunedin over an extended King’s Birthday weekend next year (29 May to 2 June).

The organisers say the chosen theme of ko tōku kainga waewae (my place of standing) “is inspired by the concept of homecoming and of reconnecting with a place of great personal meaning and significance”.

“The Otago Medical School has been a place of standing for all of us. It has enabled unique opportunities for learning and personal growth, and become the point from which we have launched our research and clinical careers.”

Packed into the long weekend will be informal and formal welcomes, class and decade get-togethers, presentation sessions, a celebration dinner, a church service, a great debate and a “humerus 150 medical review”.

Coughtrey and his four anatomy students could scarcely have imagined that they were the genesis of a Medical School that, nearly 150 years on, would comprise approximately 3,700 students, across three cities, studying medicine and health sciences at such a comparative level of complexity and cleverness.

Mind you, what would we make of the Otago Medical School 150 years from now, let alone the role of the doctor, the demography of the patients, and the nature of health care delivery in the year 2175?

kōrero by Ian Dougherty