KENNETH FITZPATRICK RUSSELL, 1911–1987

The Kenneth F. Russell memorial lecture honours the life of a manwho was many things: a surgeon, a soldier, an anatomist, ateacher and, most relevantly, a great medical historian, arguably thegreatest that Australia has yet produced. His career has beenwell recorded by his friend Peter Burke.1

Kenneth Russell was the son of a Melbourne dental surgeon whoserved in World War I in the Australian facial injuries team at theQueen’s Hospital at Sidcup, commanded by H. S. Newland, one ofthe founders of the Royal Australasian College of Surgeons(RACS).2 The team worked in collaboration with Harold Gillies theNew Zealand-born creator of modern maxillofacial reconstructivesurgery.

Russell studied medicine at the University of Melbourne andgraduated in 1935. He intended to be a surgeon, probably aplastic surgeon, for he had neat hands (J. F. Russell, pers.comm. 1999). But World War II intervened and took him as a regimental medical officer to the siege of Tobruk. There he had todeal with an epidemic of dysentery: the new wonder drug sulph-aguanidine helped to save the garrison from the inconveniences ofslit trenches awash with liquid faeces.3 He later served in NewGuinea, where he contracted a devastating fever and, later,recurring hepatitis. He was invalided out but his recovery wasslow, and he found that he had to choose between a surgicalcareer and something less strenuous. He chose anatomy, which wasa longstanding interest, and this choice made possible hisremarkable career as a medical historian and bibliographer. He wasappointed senior lecturer in anatomy in his own university in1947, and rose in the academic hierarchy over the next 20 years,achieving in 1969 the exceptional appointments of personalchairs both in anatomy and in medical history.

Russell wrote many excellent historical books and papers,especially on the history of anatomy.4 In 1977 his history of the Mel-bourne medical school appeared, and no one who is interested inAustralian medical education can ignore this well-plannedaccount of the history of Australia’s first university medicalschool.5 Two years later the RACS published Russell’s catalogue ofthe historical books in the Gordon Craig library.6 This lists some 800books and other items, astonishing in its range of subjects and in thequality of the books left by Leslie Cowlishaw. Russell’s cata-logue is a splendid guide to a great library, meticulous in the bibliographic details, excellently introduced and, in some 470cases, provided with useful brief notes on the book or the author.These notes are a study in themselves: they show an amazingrange of knowledge and are sometimes startling. Thus, one five-linebiographical sketch ends with the useful warning that few today willhave the patience to read the book. In another the note tells us thatthe supposed author was a convicted pickpocket.

PAGET ON HARVEY

Among the books listed in Russell’s catalogue is James Paget’sRecords of Harvey, being extracts from hospital records relating toWilliam Harvey’s work at St Bartholomew’s Hospital (Barts) inLondon.7 The book was published by John Churchill in 1846and it was written when Paget was Warden of the medicalcollege at Barts, a position which he held from 1843 until heresigned 7 years later, profoundly relieved that he no longer had tolive at close quarters with medical students.8 It is one of thesmallest books that bear Leslie Cowlishaw’s bookplate because itconsists of only 37 pages, or 44 if one includes the preliminaries.

This book recalls Russell’s own interest in William Harvey,whose anatomical lectures he helped to translate and to edit.9 It isof interest in the light of Paget’s later importance in the history ofthe Melbourne medical school, and in British medical educationgenerally. Small as it is, this book has much to tell us about theEnglish roots of medical education in Australia and NewZealand.

Aust. N.Z. J. Surg. (2000) 70, 843–850

SURGICAL HISTORY

ENGLISH ROOTS OF MEDICAL EDUCATION IN AUSTRALASIA:KENNETH F. RUSSELL MEMORIAL LECTURE

DONALD SIMPSON

Road Accident Research Unit, University of Adelaide, South Australia, Australia

Some individuals have a heightened perception of history. K. F. Russell was one of these gifted people, and he wrote many books andpapers on historical subjects. Two are classics: his history of the Melbourne medical school and his catalogue of the historical booksin the library of the Royal Australasian College of Surgeons. Among the books catalogued by Russell is a small work by James Pagetentitled Records of Harvey: In Extracts from the Journals of the Royal Hospital of St Bartholomew. This book recalls Paget’s careeras a teacher and reformer in medical education during the second half of the 19th century, and also his role in drafting a model cur-riculum for Australia’s first university medical school, in Melbourne. Medical education in Melbourne and Adelaide was largely mouldedby Paget and other leading London teachers. Cambridge was also influential in Adelaide. Scottish influences were stronger inDunedin and Sydney. In the two decades before World War I, many graduates from these new medical schools went to Britain for post-graduate experience. They were assisted by British educational institutions inspired by the contemporary ideology of imperialism.

Key words: Archibald Watson, Edward Stirling, James Paget, Kenneth Russell, medical education, William Harvey.

Correspondence: D. Simpson, 7A Undelcarra Road, Burnside, SA 5066,Australia.

Accepted for publication 11 August 2000.

WILLIAM HARVEY (1578–1657)

The William Harvey who appears in Paget’s book is not thebrilliant experimental scientist who discovered the circulation of theblood and also made major contributions in embryology. Nor is itHarvey the medical teacher, who styled himself professor ofanatomy and surgery and lectured to surgeons.10 It is WilliamHarvey the physician, and the very tough medical administrator(Fig. 1). Harvey was appointed physician in charge of StBartholomew’s Hospital in 1609, and held this position until1643, when he was dismissed on political grounds by the revolu-tionary government of England.11 He was a leading figure in theRoyal College of Physicians of London (RCP), being made aFellow in 1607, and he had a most exalted view of his status andhis duties as a physician, although not more so than otherFellows of his College.

In Harvey’s time Barts was a 100-bed charity hospital withone salaried physician, three regular surgeons, an apothecaryand several specialists, including an expert in lithotomy. In1633, when Harvey was going on long leave, he drafted a set ofhospital rules to guide his deputy in his absence. There are 16 of these rules and Paget reprinted them with annotations, some of them politely critical. Harvey’s hospital rules, which Pagetrightly called peremptory, set out what Harvey saw as the relationsof the physician to the other health professionals, to use a term thatsums up the members of the hospital staff quite accurately;although it is not how they would have described their roles.

Harvey’s view of the role of the hospital surgeons appears inseveral clauses and most vigorously in clauses 8 and 9.7 Clause 8enjoined ‘That the chirurgions in all difficult cases, or whereinward phisick may be necessary, shall consult with the Dor’[i.e. Harvey or his deputy]. Clause 10 reiterated that the sur-geons are not entitled to prescribe or administer internal medicineswithout the physician’s approval.

Clause 9 restricted the surgeon’s right to operate on his ownjudgement. Harvey demanded ‘That no chirurgion or his man[assistant] doe trepan the head, peirce the body, dismember or doeany greate oper’con [operation]…but with th’ app’bacon [appro-bation] and by the direccon [direction] of the Dor’. There is aqualifying addition, ‘when conveniently it may be hadd’ which mayhave given the surgeon some latitude to operate in emergencieswhen the physician was not available.

Less attention is given to the place of the apothecary and how tokeep him in it. But there is a clause that demanded that theapothecary as well as the matron and sisters should attend on thephysician so that they knew what he wanted to be done. Thiswas probably in the interests of the patients because Harvey’shandwriting was appalling even by contemporary standards.12

There is plenty of evidence, however, to show that Harvey and theother fellows of the RCP were resolute in trying to repress theapothecaries, who were already trying to practise as physicians.

These rules give a vivid picture of the medical hierarchy inthe 17th century, in England and indeed elsewhere in westernEurope. In theory it was pyramidal. On the top of the pyramid werethe physicians, knowing all about health and disease, sociallyexalted, and often absent because they were inclined to give priorityto their richer patients. In Harvey’s case these included KingCharles I and his family. The basis of the physician’s superioritywas his education. The physicians were all university graduates;Harvey had studied at Cambridge and had taken his doctorate ofmedicine in Padua at a time when that great university was in thevan of medical progress. Physicians claimed, and the law confirmedthe claim, to know all about surgery, and in Harvey’s case with

some reason; his writings show much common sense knowledge oftrephining, for example. There were not very many licensedphysicians, even in London with its population of 200 000 or so.When Harvey was admitted to the RCP there were only 30Fellows, and apparently no more than a dozen candidates andlicentiates; according to Webster the total in 1614 was only 41.13

There were other unlicensed physicians practising in London;even so, it was a very small elite profession.

The base of the pyramid was much larger. Under the physicianswere two wholly separate corporate bodies: the surgeons and theapothecaries. The surgeons were craftsmen, trained as appren-tices and with no pretentions to learning; although in fact some ofthem were well read in the literature of the day, and they couldlearn from Harvey’s public lecture–demonstrations in anatomy, firstdelivered in 1616. The apothecaries were tradesmen, alsotrained as apprentices, and learned enough to understand thephysician’s Latin prescriptions. It was their business to supplydrugs.

Among the Barts’ surgeons to whom Harvey dictated was JohnWoodall, one of the most famous surgeons of the day. Woodallcould not rival Harvey’s learning, being trained by an unknownbarber–surgeon, but he was vastly experienced in war and peacewhen he was appointed surgeon to Barts in 1616. Woodall was theauthor of that splendid book The Surgion’s Mate.14 He musthave been a fine surgeon; he claimed that he had ‘taken off and

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Fig. 1. William Harvey, supposedly aged 72; by an unknownartist. By courtesy of the Royal College of Physicians of London.

holpen to take off more than one hundred of legges and armes,besides very many hands’, without a single death from bloodloss and a mortality of only 20%.11 He was also a seriousstudent of pharmacology and wrote about chemical therapy,with some wise comments on the dangers of overdosage. But for allhis skill and knowledge Harvey was determined that Woodalland his fellow surgeons would operate only under physicianlysupervision, and could prescribe drugs only for external application.

The surgeons protested to parliament against the monopoly of theRCP but without success. In reality Harvey’s rules were probablyunenforceable, at least outside Barts Hospital, and the career ofRichard Wiseman 30 years later does not suggest surgical sub-servience to physicians.15 Nevertheless, the educational basis of thetripartite hierarchy did remain for the next 200 years: physiciansremained university graduates, surgeons and apothecaries con-tinued to learn their trades as apprentices. When Australia was col-onized most of the first medical practitioners were surgeonseducated in this way.

JAMES PAGET (1814–1899) AND HIS MEDICALWORLD

James Paget (Fig. 2) began his surgical career as an apprentice; hehad been apprenticed to a Mr Charles Costerton, a surgeon inhis home town of Yarmouth, for the term of 5 years.8 Pagethimself thought this was time well spent. He learned the ele-ments of surgery and how to run a general practice. He alsolearned how to dispense drugs because general practice nowincluded the work of the apothecary. Apothecaries were by thistime well established in medical practice. By a House of Lordsdecision in 1704 apothecaries had been allowed to practise medi-cine, and by a parliamentary act of 1815 their Society had beenauthorized to examine students of medicine, although notsurgery, and to confer a licence to practise medicine. Many of the apothecaries practised surgery and were often calledsurgeon–apothecaries or general practitioners, a term that wascoming into use in Paget’s time. After his apprenticeship inYarmouth Paget went to London and studied in Barts medicalschool. He became a member of the Royal College of Surgeons(RCS) by examination in 1836.

In 1846, when Paget published his picture of the world ofWilliam Harvey, his own world was changing rapidly and a newmedical pyramid was taking shape. At the apex was an elite of con-sultants, but this elite now included surgeons as well as physicians.As in Harvey’s time the RCP remained socially and to someextent intellectually dominant, and physicians were still universitygraduates. Paget’s own brother George was a fellow of the RCP: hehad gone to Cambridge when the Paget family had been richenough to send him to Harvey’s college Gonville and Caius.There he had done very well and eventually became Regius Pro-fessor of Medicine and a great figure in the reform of medical edu-cation.

The status of the physician remained high when comparedwith the general practitioners, as is beautifully shown in Trol-lope’s novel Dr Thorne. In the city of Barchester the chiefphysician is Dr Fillgrave, who gave advice for a gentlemanlyguinea. Dr Fillgrave is contrasted with his enemy Dr Thorne, ageneral practitioner in a nearby village who charged much less, andwas so vulgar as to make his medicines himself, giving powders forrural bowels and ointments for agricultural itches.16 But also at theapex of the pyramid was an elite of surgical specialists. TheRCS had been established in 1800 on a frankly elitist basis; it was

ruled by a self-perpetuating oligarchy of London surgeons andclaimed the right to examine all general practitioners whowished to practise surgery (Fig. 3). The lower strata of themedical pyramid strongly resented this and they had the noisysupport of The Lancetand its editor Thomas Wakley. Thecollege oligarchs fought a dogged and skilful battle against theforces of medical democracy and, in 1843, the RCS legitimized itsantidemocratic ideals by creating a fellowship, the FRCS, forthe surgical aristocracy.17 As usually happens when a newmedical diploma is launched, the first 600 Fellows were chosen bynomination and their successors by examination. James Pagetwas one of the first to be nominated, and also one of theyoungest, being only 29 years old.

The general practitioners resented this coup; The Lancetfrothed with fury. But it was a step forward towards unifyingmedical education. The education of the safe general practi-tioner clearly required teaching in surgery, and the strengthenedRCS regulated this. The Society of Apothecaries regulatedteaching in general medicine and ideally every English generalpractitioner held both the membership of the College of Sur-geons (MRCS) and the apothecaries’ licence (LSA), although inreality many held only one of these diplomas. Eventually the

MEDICAL EDUCATION IN AUSTRALASIA 845

Fig. 2. James Paget, aged 49. Lithograph by T. H. Maguire. By cour-tesy of the Wellcome Library, London.

RCP abandoned its policy of superb isolation in medical educationand, after 1861, this College offered its own diploma, the LRCP.Still later the two colleges offered both diplomas as a conjoint qualification.

PAGET AND MEDICAL EDUCATION

James Paget was a great surgical pathologist and he lives on in theeponyms that still carry his name: Paget’s disease of bone(osteitis deformans) and Paget’s precancerous disease of thenipple. He was also a great medical teacher. In his years asWarden of Barts medical college he taught physiology, whichthen included histology, and, with one of his students, WilliamKirkes, he co-authored a textbook of physiology.18 A copy ofthe 1848 edition of this book is in the RACS library. It went intomany editions and later appeared as a recommended textbook in themedical schools of Adelaide, Sydney and Dunedin. In his timePaget was unusual in demonstrating physiology with livinganimals, including frogs and turtles. Paget was deeply interested instudents and in how they should be helped. It is true that hecomplained of their noise and tendency to drink too much; itshould be remembered that his students were contemporaries ofDickens’ Bob Sawyer. He took a warm interest in their careers,however, and in 1869 he published a career analysis of 1226students whom he had taught, with a follow up of more than 10years. These make fascinating reading. Paget noted that one of hisex-students was idle, dissolute, extravagant, vulgar and stupid,and was eventually hanged for murder.8 More happily, hereported on another who was well-meaning but weak-minded;he married a prostitute who saved his career and made him arespectable general practitioner. It is clear that he loved under-graduate teaching, and he had high but realistic standards which hemaintained in his later career as an examiner, as President of theEnglish college, and as Vice Chancellor of London Universityfrom 1883 until 1895.

MEDICAL EDUCATION IN THE AUSTRALASIANCOLONIES

Since Australia and New Zealand were settled by Britishcolonists it was natural that the members of their medical work-forces were mostly the products of British medical schools. In 1788the First Fleet brought 11 medical men to New South Wales. Allwere surgeons and it is likely that most of them had been edu-cated by some form of apprenticeship, although one (ThomasJamison) had studied at the University of Dublin and another(Denis Considen) later took a doctorate of medicine in Edin-burgh.19 In later years a few surgical apprentices were trained inNew South Wales and Van Diemen’s Land.

Later colonies such as New Zealand, Victoria and South Aus-tralia recruited their medical practitioners from the world inwhich Paget worked, although not from its upper echelons.Understandably, the London medical elite saw no reason tomigrate to the end of the world, except a few who thought they hadtuberculosis and who emigrated in the delusion that Australiaand New Zealand were exceptionally healthy for sufferers ofconsumption. In 19th century South Australia the bulk of thecolonial medical workforce held English qualifications. In 1861there were 120 medical practitioners on the register: nearly 60% ofthem held English medical qualifications (Table 1). In almost allcases these were the basic diplomas given by the RCS, and onlyone medical practitioner held a Cambridge degree. There were alsograduates of Scottish and German universities: their contribu-tion was important but they were not numerous. I do not have datafor the other Australasian colonies of the time, but it seemslikely that their medical workforces were similar.

In 1852 a notable medical migrant came to Melbourne, and hewas to change the face of medical practice in Australasia. This wasAnthony Brownless, founder of the University of Melbournemedical school, the first in Australasia, and the exemplar of latermedical schools. Brownless held the qualifications of a surgeonapothecary, the MRCS and LSA, to which he had added a doctorate

846 SIMPSON

Fig. 3. The Royal College ofSurgeons, ca 1814. From a printin the author’s collection.

of medicine from St Andrews, acquired in 1847. That ancientScottish university was then in low water; it had no medicalschool and, to get his doctorate, Brownless had only to pass anexamination with a pleasantly low failure rate, and to hand over£25.3.0.20 The St Andrews doctorate gave physicianly status and nodoubt meant a good grasp of academic medicine, although 40years earlier it had been obtainable by correspondence without thenuisance of actually going to St Andrews.

In 1855 Brownless became a member of the council of thenewly formed University of Melbourne. Almost at once he cam-paigned to establish a university medical school. As a student atBarts he had known James Paget when Paget was a demons-trator in morbid anatomy. When the desirability of a universitymedical school in Melbourne was accepted, Brownless arranged forPaget to be consulted on the course structure. Paget’s reply outlined

matriculation requirements and a complete 4-year course,including preclinical requirements and hospital practice in medi-cine, surgery and midwifery. It is by the standards of the day a veryenlightened programme, with some flexibility, and makesmention of microscopic pathology at a time when this was avery new field of study.

Brownless had his own ideas about medical teaching but itseems likely that Paget’s thoughts were very influential whenthe Melbourne medical curriculum took shape. Brownless wentbeyond Paget, and beyond British precedents, in insisting on a 5-year programme. Russell and other historians have seen thisas a commitment to excellence and this is doubtless true. ButBrownless also seems to have been concerned about the classicaleducation of the students before their entrance into the course: inhis curriculum much of the first year was spent in Greek andLatin, while there was for some years no requirement forbiology.

Paget performed another service for the new colonial medicalschool. Together with Richard Owen the anatomist he selectedMelbourne’s first professor of anatomy, physiology and pathology.Their choice was George Britton Halford (1824–1910). He was aLondon-educated medical teacher with a distinguished record incardiac research, and it proved to be a most successful appointment(Fig. 4). Thus, Paget’s choice set the Melbourne medical course offwith excellent teaching in the basic sciences, and it was not his faultthat clinical teaching was for a long time less satisfactory.5

These were not Paget’s last services to colonial medical educa-tion. In 1881 the problems of recognition of medical degreeswere reviewed by a British Royal Commission. It was a veryhigh-powered committee, even by the standards of a Gladstoneadministration. The members included a lord, a bishop, theMaster of the Rolls, John Simon the apostle of state-controlledmedicine, William Turner the great Edinburgh anatomist andThomas Henry Huxley, no less. The commission considered the

MEDICAL EDUCATION IN AUSTRALASIA 847

Table 1. Analysis of initial medical qualification(s) recorded onthe South Australian medical register, 1861

Nation Qualifications n %

England MRCS + LSA 24 20MRCS only 35 29.2LSA only 10 8.3University degree (Cambridge) 1 0.9

Scotland Surgical diplomas 17 14.2University degrees 10 8.3

Ireland Diplomas 4 3.3Germany University degrees 15 12.5Other France, US, uncertain 4 3.3

Total 120 100

Qualifications acquired in later life are excluded.MRCS, Member of the Royal College of Surgeons; LSA, Licence of the

Society of Apothecaries.

Fig. 4. G. B. Halford, first pro-fessor of anatomy and physiol-ogy in Melbourne, with students,demonstrator and porter, in 1864.By courtesy of the University ofMelbourne.

eligibility of colonial medical schools for registration and Paget wascalled to give evidence. By then he was a grand old man, abaronet and a Fellow of the Royal Society. Paget gave evidence onthe quality of teaching in Canada and in the universities of Calcutta,Madras, Bombay and Melbourne, and spoke warmly in favour ofaccepting their medical degrees with no further examination. Of theMelbourne degree, he said that a Melbourne graduate wouldhave ‘passed through the same education and through examinationsin all essentials the same as in England’.21 The chief objection toPaget’s view came from his brother George the physician: hewas afraid to give automatic registration to graduates of colonialuniversities from fear that this might admit the products of morethan 100 medical schools in the USA, some of which hadextremely low standards and which gave courses of only 3 yearsduration. This objection was eventually overcome, however, andafter 1893 the medical degrees given by the chief colonial uni-versities were recognized in Great Britain.

By this time Melbourne was not the only medical school inAustralasia. The University of Otago opened a medical schoolin 1877. It was to have a great future but got off to a slow start, andat first served chiefly as a preclinical school for Edinburgh. Thefirst students wholly educated in Dunedin graduated in 1887.The University of Sydney, after a long delay, opened a medicalschool in 1883, and Adelaide did so in 1885 (Table 2).

These Australasian medical schools were all universitybased, and in this they resembled the Scottish universitymedical schools. It is therefore often said that they weredesigned on the Scottish model, in contrast to the Englishmodel of hospital-based medical schools accredited by thegreat corporations, the royal colleges and the Society ofApothecaries. This is, up to a point, undeniable. But some historians have gone further, and have argued that there was inAustralasia an extension of a Scottish educational philosophy. In her excellent biography of J. T. Wilson the Sydney ana-tomist, Morison has argued that Edinburgh medical teachingwas scientific and in the best sense academic, honouringresearch and organized on a democratic basis. In contrast, she sawEnglish medical education as empirical, provincial and aristo-cratic.22 One can dispute these generalizations, but if there areScottish roots in Australasian medical teaching it is reasonable to look for them in Dunedin and Sydney. In both these greatmedical schools the first full-time professors, and they wereboth very able men, were Edinburgh graduates (John HallidayScott (1851–1914) and Thomas Anderson Stuart (1856–1920).Both were strong Scottish influences on their respectivemedical schools and Anderson Stuart recruited numerous otherScotsmen:23 when academic jobs came up, many were calledbut Macs were chosen.

But this was not so in Melbourne. Both Brownless andHalford were Englishmen, educated in London hospital-basedmedical schools: Brownless at Barts and Halford at St George’s.Certainly, they both held doctorates from the University of StAndrews, but this was not a teaching school until many years

later and it cannot be said that these Scottish degrees meantScottish influence. Of the other early teachers who seem to havebeen influential in Melbourne, Edward Barker (the first lecturer insurgery) and J.E. Neild (the first lecturer in forensic medicine) wereboth educated in London, at University College, the most avantgarde of the London medical schools in the 19th century.Several other early Melbourne medical teachers held Dublindegrees. Certainly, there were Scottish-educated members ofwhat would have been the inaugural faculty of medicine if the autocratic Brownless had allowed such a democratic body to beformed; it was not established until 1876.5 But I do not find anyreason to believe that they were especially influential. I believe thatthe Melbourne school began under English auspices, althoughbefore long it developed its own characteristics.

Adelaide was the last and smallest of the Australasianmedical schools to be established during the 19th century. Onemight expect to find strong Scottish influences here since SouthAustralia had many Scottish colonists, and one of the mostinfluential, Sir Thomas Elder, was the chief financial support of thenew medical school. In fact, the evidence suggests strongly that theAdelaide medical school has its roots in London and Cam-bridge. The chief founder and first professor of physiology,Edward Stirling, studied physiology in Cambridge. There hewould have known Paget’s brother George the physician,although it is likely that his principal mentors were MichaelFoster the physiologist and George Humphry the surgeon–anatomist. George Paget, Humphry, and Foster formed a bril-liant triumvirate who had opened what has been seen as thegolden age of Cambridge medical teaching, and Stirling hadbeen there when the golden age dawned. After Cambridge, Stirlingstudied clinical medicine in London, took his English surgicalfellowship and for a while taught physiology in St George’shospital, where he held a staff appointment as assistant surgeon.Stirling gave the Adelaide medical school leadership until his death in 1919, more by force of character and devotion than by any official position. His influence was profound and it was certainly along lines that were established by his own education in Cambridge and London.

Archibald Watson was Adelaide’s first professor of anatomyand he taught until 1919 when Stirling, as one of his last servicesto Adelaide’s medical school, persuaded Watson to resign. He wassucceeded by Frederick Wood Jones. Much has been writtenabout Watson, and rightly: he was not only a vivid and bizarre personality but also a very fine teacher and influential in thedevelopment of Australian surgery. Watson’s intellectual back-ground was unusual. He graduated in Germany, at Göttingen,took a second doctorate in Paris, and studied in London atCharing Cross Hospital; he also taught anatomy in Cooke’sprivate medical school. I have concluded that Watson’s teachingwas eclectic, but probably most governed by his London experi-ence, and directed towards safe surgery rather than to medicalscience.

Watson had done well in Göttingen; he had had a full training inmicroscopic studies, and his professor Wilhelm Krause thoughthighly of him. But there is little to suggest that he was an exponentof German scientific medicine. Indeed, German influences donot seem to have been very strong in any of the Australasian19th century medical schools. Both in Adelaide and Sydneythere were individuals who had studied in German or Austrian uni-versity medical schools but there is nothing to suggest that theseschools had the profound influence in Australasia that they had inthe USA, where a revolution in medical education was initiated in

848 SIMPSON

Table 2. The first medical schools in Australia and New Zealand

University Opening of medical school First graduates

Melbourne 1862 1867Otago 1877 1887Sydney 1883 1888Adelaide 1885 1889

the Johns Hopkins University in Baltimore, along explicitlyGerman lines.

Stirling and Watson were both clinically minded, but therewere other clinical leaders in what was a surprisingly democraticmedical faculty. Three of these were London graduates withEnglish surgical fellowships. Only one of Adelaide’s earlyleaders was Scottish educated: William Gardner. He had in factstudied at Melbourne, left the course in midstream and com-pleted his education in Glasgow.

POSTGRADUATE MEDICAL EDUCATION

The strength of the English connection becomes more evidentwhen postgraduate education is considered. A large number ofgraduates from the Australasian medical schools went overseas forfurther education, and often to take postgraduate degrees. Of205 Adelaide students who graduated before World War I, morethan 40 are known to have gone overseas for further study. So didmany graduates from Melbourne, Dunedin and Sydney. Manytook higher qualifications; 17 of the Adelaide graduates tooksurgical fellowships: 10 in London and seven in Edinburgh. TheLondon Hospital seems to have had special magnetism forSouth Australian postgraduate students; H. S. Newland wentthere in 1897 and found it as I did in 1950: physically shabby andintellectually splendid, with a wealth of clinical material and a con-stellation of brilliant teachers.

James Paget died in 1899 and thus lived to see the decade of ideological imperialism, the decade of jingoism. One of themanifestations of the 1890s was awareness of the need for post-graduate education, and a number of important postgraduateinstitutions were established in London during and soon afterthis decade (Table 3). Some of these had overt imperial implica-tions, notably the Rhodes scholarships and the London Schoolof Hygiene and Tropical Medicine, opened when Joseph Cham-berlain was colonial secretary. These institutions strengthenedthe Anglo-Australasian connection in medical education andhelped to overcome limitations in Australian medical teaching.England benefited reciprocally from the stimulus of postgraduateteaching; most obviously, the Rhodes scholarships helped tomake Oxford a great medical teaching centre.

CONCLUSIONS

William Harvey established English leadership in experimentalmedical science in his day. He also did his best to perpetuate thetriple hierarchy of medical practice, which did much to delaythe development of a single medical profession based on asingle system of education. James Paget inherited the tripartite hier-archy; he and his contemporaries modernized and transformed itinto a unified medical profession which was transplanted to theAustralasian colonies, where it has merged with other European andAmerican medical systems to become what we know today.

In stressing the English contribution in medical education in the19th century I do not denigrate the importance of other influ-ences. The importance of Scottish medical education is wellknown; Edinburgh was very influential, most obviously inDunedin and Sydney. Dublin contributed some fine teachers,especially in Melbourne, and was an important postgraduatecentre in obstetrics. Germany and Austria were leaders in 19thcentury medical science and there is evidence that they influ-enced many individuals, especially in Sydney and Adelaide. But Ibelieve that, overall, London and Cambridge were paramount inestablishing modern medical education in Melbourne and Adelaide,and influential everywhere in Australasia. This was in part due tothe concentration of numbers and wealth in southern England.London, the megalopolis, had enormous teaching resources,with some 5000 beds available for undergraduate teaching, not tomention the many specialist hospitals and the many medicalpublishers. But there was also a dominance of quality. Theperiod 1860–1885 can today be seen as the zenith of Englishclinical medicine: it was the age of Joseph Lister, HughlingsJackson and the young Victor Horsley, and it is not surprising thatthe new Australasian medical schools took much of their inspira-tion from London.

ACKNOWLEDGEMENTS

I am indebted to Mrs Jean Fogo Russell and to her daughterMiss Mary Fogo Russell for much help in respect to the career ofKenneth Fitzpatrick Russell. I thank Mr Barry Grieger forpreparing the illustrations appearing in this paper.

Some of the material presented in this paper is embodied in athesis to be submitted for the degree of Doctor of Medicine at theUniversity of Adelaide.

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Gordon Craig Library. Aust. N.Z. J. Surg.1997; 67: 501–7.2. Butler AG (ed.) The Australian Army Medical Services in the

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Medicine and Pathology. History of the Second World War.London: Her Majesty’s Stationery Office, 1952; 195–221.

4. Russell MF. An Annotated Bibliography of Kenneth FitzpatrickRussell. Melbourne: Mary Fogo Russell, 1997.

5. Russell KF. The Melbourne Medical School 1862–1962. Mel-bourne: Melbourne University Press, 1977.

6. Russell KF. Catalogue of the Historical Books in the Library of theRoyal Australasian College of Surgeons. Melbourne: Queens-berry Hill Press, 1979.

7. Paget J. Records of Harvey in Extracts from the Journals of theRoyal Hospital of St Bartholomew. London: Churchill, 1846.

8. Roberts S. Sir James Paget. The Rise of Clinical Surgery.London: Royal Society of Medicine, 1989.

9. O’Malley CD, Poynter FNL, Russell KP (eds)William Harvey:Lectures on the Whole of Anatomy. An Annotated Translationof Prelectiones Anatomiae Universalis. Los Angeles: Univer-sity of California Press, 1961.

10. Whitteridge G. The Anatomical Lectures of William Harvey.Edinburgh: Livingstone, 1964.

11. Keynes G. The Life of William Harvey. Oxford: ClarendonPress, 1966.

12. Dick OL (ed.) Aubrey’s Brief Lives.London: Secker &Warburg, 1950.

13. Webster C. The Great Instauration. Science, Medicine andReform. 1626–1660. London: Duckworth, 1975.

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Table 3. Postgraduate teaching centres established in Englandbefore World War I

West London Hospital Postgraduate College, 1896Lister Institute, 1903London School of Tropical Medicine, 1899Hutchinson’s Medical Graduates College and Polyclinic, 1900University of Oxford: The Rhodes scholarships, 1903

14. Woodall J. The Surgion’s Mate. 1617. Facsimile: In: Kirkup J (ed.)Bath: Kingsmead, 1978.

15. Simpson D. Trauma surgery during the military revolution: Thecareer of Richard Wiseman. Aust. N.Z. J. Surg.1999; 69: 291–6.

16. Trollope A. Dr Thorne. London: Zodiac Press, 1962.17. Cope Z. The Royal College of Surgeons of England. A History.

London: Blond, 1959.18. Kirkes WS. Hand-book of Physiology. London: Taylor, Walton

and Moberly, 1848.19. Pearn J. Gentlemen of the faculty: A synopsis of the First Fleet

surgeons. Med. J. Aust.1988; 149: 639–43.

20. Blair JSG. History of Medicine in the University of St Andrews.Edinburgh: Scottish Academic Press, 1987.

21. Report of the Royal Commissioners Appointed to Inquire into theMedical Acts with Minutes of Evidence Appendices and Index.London: Her Majesty’s Stationery Office, 1997.

22. Morison P. J T Wilson and the Fraternity of Duckmaloi.Amster-dam: Rodopi, 1997.

23. Webb N, Young JA. Anderson Stuart and the Medical School. In:Young JA, Sefton AJ, Webb N (eds) Centenary Book of theUniversity Faculty of Medicine. Sydney: Sydney UniversityPress, 1984; Ch. 4.

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