Competing/conflicts of interest: No stated conflict of interest.
Australasian ophthalmology: trans-Tasman ties
Article first published online: 6 DEC 2011
© 2011 The Authors. Clinical and Experimental Ophthalmology © 2011 Royal Australian and New Zealand College of Ophthalmologists
Clinical & Experimental Ophthalmology
Volume 40, Issue 1, pages 108–114, January/February 2012
How to Cite
Hadden, O. B. and Kaufman, D. V. (2012), Australasian ophthalmology: trans-Tasman ties. Clinical & Experimental Ophthalmology, 40: 108–114. doi: 10.1111/j.1442-9071.2011.02715.x
Funding sources: No stated funding sources.
- Issue published online: 5 FEB 2012
- Article first published online: 6 DEC 2011
- Accepted manuscript online: 17 OCT 2011 08:46AM EST
- Received 24 April 2011; accepted 4 October 2011.
- Australasian ophthalmology
Links between Australian and New Zealand ophthalmology began with peripatetic surgeons who worked in both countries. Links continued with the Intercolonial Medical Congresses which began in 1887. Ophthalmologists from both countries were involved in the founding of the Royal Australian College of Surgeons in 1927. There were combined meetings of the Ophthalmological Societies of Australia and New Zealand from 1962. Common training and qualification programs evolved. The culmination of ties occurred in 1997 when the Ophthalmological Society of New Zealand merged with the Royal Australian College of Ophthalmologists to form the Royal Australian and New Zealand College of Ophthalmologists.
This paper explores the developing liaisons between Australian and New Zealand ophthalmology from the 19th to the 21st century, which culminated in the founding of the Royal Australian and New Zealand College of Ophthalmologists (RANZCO).
Links between Australian and New Zealand ophthalmology began with the itinerant surgeons Dr B Schwarzbach and Dr John Wilkins, both of whom moved between the two countries. Dr Schwarzbach, a German, was working in Wellington when he reported the first 11 cases of eye surgery performed under cocaine as local anaesthetic the year after Carl Koller in Vienna had discovered the local anaesthetic properties of cocaine in 1884.1 Dr John Wilkins (Fig. 1) first began practising in Williamstown, Victoria, in 1850.2 In 1871, he established a self-supporting infirmary for the throat, chest, eye and ear, probably in competition with the fledgling precursor of the Royal Victorian Eye and Ear Hospital, founded by Gray and Bowen.3,4 While in Melbourne, Wilkins published 22 papers in the Australian Medical Journal, eight of which were about ophthalmology and ear, nose and throat. Wilkins clearly had good surgical and writing skills, but he fell foul of the Medical Society of Victoria with his improper advertisement, which appeared several times in The Age in 1875, which read ‘Notice- Mr John Wilkins FRCS Edin, MRCS Eng, 1st M.B. Lond, Hon. Surgeon Alfred Hospital. Surgeon, Infirmary for Diseases of Chest, Throat, Eye, Ear, will attend outdoor practice in surgery and medicine. At home for consultations- 9.00am–12.30pm. Afternoon 2.00 pm–4.00 pm. Evening- 7.00pm–8.00pm. 121 Collins Street East, Melbourne’. The advertisement is well within present-day guidelines. However, at that time, advertisements were considered improper if they included details about qualifications and appointments held. As a result, Wilkins was forced to resign from the Medical Society of Victoria, and he moved to Dunedin, New Zealand, then to Christchurch in 1880, and finally to Auckland. Sir Lindo Ferguson, in a speech to the British Medical Association in 1922, said the following about the scene in New Zealand on his arrival in 1883: ‘I found on arrival that the eye work of the colony was either dealt with as part of general practice or was done peripatetically by a Dr Schwarzbach, a German who later made Sydney his headquarters, and came round New Zealand every year or so after the fashion of an operatic company, making short stays in each centre, and by a Dr Wilkins who had been in Dunedin but who lived in Christchurch when I arrived and came down periodically for a fortnight or three weeks and paid shorter visits to the smaller towns. Soon after my arrival he moved to Auckland and later to San Francisco and his practice was not by any means confined to ophthalmology. From what I saw of the work I should say that Wilkins was a good operator and I have been told that his operating showed what was then referred to as surgical style, but I must confess that the methods of practice of both men filled me with amazement and dismay. Dr Wilkins' preliminary advertisements announcing a three weeks visit in which he could be consulted at his hotel in Dunedin. A few days after I landed he came down but returned to Christchurch next day and since then there has been no peripatetic ophthalmologists in Dunedin though both he and Schwarzbach worked the North Island for a good many years after that time’.
An invaluable account of the early medical and ophthalmic conferences in Australia and New Zealand was contained in the presidential address to the Ophthalmological Society of Australia, given by Dr Darcy Williams in 1947.5 The first medical conference in Australasia was the Intercolonial Medical Congress in Adelaide in 1887. There was no special section on ophthalmology. The second Intercolonial Medical Congress in Melbourne in 1889 was a glittering affair. The governors of the six states of Australia and of New Zealand lent their patronage. There was a special section for diseases of the eye, ear and throat. Papers were presented by ophthalmologists from both countries. The fourth Intercolonial Medical Congress was held in Dunedin in 1896, in which 10 papers on ophthalmology were read by Australians and New Zealanders. Prior to the meeting, Dr Ferdinand Batchelor, obstetrician and gynaecologist, and later Dunedin's professor of midwifery and women's diseases, and president of the congress, and Lindo Ferguson journeyed to Hobart, Melbourne, Adelaide and Sydney to promote interest in the meeting. Dr Darcy Williams in the same presidential address commented that at that time, James W Barrett of Melbourne, John Lockhart Gibson of Brisbane and Lindo Ferguson of Dunedin were the three outstanding figures of Australasian ophthalmology. Lindo Ferguson was president of the eye, ear and throat section of the fifth Intercolonial Congress in Brisbane in 1899. The sixth Congress in Hobart in 1902 was the last Intercolonial Congress. Owing to Australian Federation, there was a change of name, and subsequent meetings were known as Australasian Medical Congresses, and the various governors-general gave their patronage, the first being Lord Hopetoun. The tenth Congress was held in Auckland in 1914 when the president was Arthur Challinor Purchas, ophthalmologist of Auckland. Francis Antill Pockley of Sydney was the president of the ophthalmology section, and George Fenwick of Auckland was the secretary. Conferences were interrupted by the First World War. Later conferences were held under the auspices of the British Medical Association. They were in Brisbane in 1920, Melbourne in 1923, Dunedin in 1927, Sydney in 1929, Hobart in 1934 and Adelaide in 1937.
Sir Lindo Ferguson
The medallion presented by the Ferguson family to the Ophthalmological Society of New Zealand in 1970 to be worn by its president has engraved upon its reverse side ‘Sir Henry Lindo Ferguson, 1878–1948, Australasia's first ophthalmologist’ (Figs 2,3). He was probably not Australasia's first ophthalmologist, nor the first to practise solely ophthalmology, but he was Australasia's first academic ophthalmologist, including being the first professor of ophthalmology. He was also hugely influential in both countries in ophthalmology and in medical education. Lindo Ferguson travelled widely, and his reputation was such that many patients from Australia travelled to New Zealand. As noted earlier, he was involved in the Intercolonial Medical Congresses. One of his first four medical students in 1884 was Louis Barnett, later Sir Louis Barnett, professor of surgery in Dunedin, and later, with Sir Lindo, a founder of the Royal Australian College of Surgeons in 1927. Dr Wyn Beasley, in his book The Mantle of Surgery,6 described in detail the founding of the Royal Australian College of Surgeons. Sir Lindo was one of the party of Australasian surgeons who attended the American College of Surgeons meeting in New York in 1925. Also in the group were Professor John Hunter, Norman Royle and Ralph Worrall, all of Sydney, Sir Hugh Devine of Melbourne, Sir Carrick Robertson of Auckland and Sir James Elliott of Wellington, father of ophthalmologist Sir Randal Elliott. After New York, Sir Hugh Devine of Melbourne visited Will Mayo in Rochester Minnesota, a visit that inspired Devine into action. Negotiations continued during 1926. The Australasian Medical Conference was in Dunedin in 1927. Sir Louis Barnett was the president of the conference, and at that meeting, the founders of the College of Surgeons were invited to offer themselves for election to its council. The founders who attended that congress in Dunedin included four ophthalmologists: Sir Lindo Ferguson of Dunedin, Sir James Barrett and Augustus L Kenny of Melbourne, and Francis Antill Pockley of Sydney (Fig. 4). Fittingly for his influence in both countries, an extensive obituary for Sir Lindo was published in the Transactions of the Ophthalmological Society of Australia in 1948.7
The Ophthalmological Societies
The Ophthalmological Society of Australia was founded in 1938. Its first president was Sir James W. Barrett, and its first congress was in Melbourne in 1939. There was no meeting in 1942 because of the Second World War. Meetings were held every year since, but renamed the Annual Scientific Congress of the Australian College of Ophthalmologists from when the college replaced the Ophthalmological Society of Australia in 1969. The Ophthalmological Society of New Zealand was founded in 1947 and likewise held conferences every year until its merger with the Royal Australian College of Ophthalmologists (RACO) in 1997 to form the RANZCO. There were two joint annual congresses of the Ophthalmological Society of Australia and the Ophthalmological Society of New Zealand. The first was in Surfers Paradise in 1962 and the second in Rotorua, New Zealand, in 1966. The first combined meeting of the Australian College of Ophthalmologists and the Ophthalmological Society of New Zealand was in 1970 in Christchurch. Later conjoint meetings were in Sydney in 1975, Christchurch in 1980 and Sydney in 1984. The Ophthalmological Society of New Zealand hosted the Asia-Pacific Academy of Ophthalmology meeting in Auckland in 1972.
Around 1992, discussions began on amalgamation of the Ophthalmological Society of New Zealand with the RACO. There was strong support from by Associate Professor Ivan Goldberg AM of Sydney, who was the college's censor-in-chief (Fig. 5). An amalgamation committee was formed in 1994, comprising Professor Ian Favilla of Melbourne, Dr Peter Wellings of Wellington and Dr Bruce Hadden of Auckland. The main impetus for amalgamation was that New Zealand fellows did not have the right to vote or to hold office in the college. A few New Zealanders were against amalgamation because of loss of local control and a rise in subscription.
The council of the RACO accepted full amalgamation, which took place on 1 July 1997. The last hurdle was the question as to whether the royal appellation could be retained after the change of name. Advice was that royal patronage would need to be applied for. It was estimated that designing and applying for a new coat of arms might cost around $20 000. The decision was made that the existing coat of arms of the Royal Australian College would be retained but put in the bottom drawer. A new coat of arms, incorporating an emblem of New Zealand, would be designed and used, although it would never be the ‘official’ coat of arms. It was thought that after a time, few would know or care, a prediction that has been borne out. Thus, Dr Harold Coop of Auckland, ophthalmologist and renowned artist, was invited to design a new coat of arms. His design received trans-Tasman acclamation, cost the college nothing and now appears on all college publications. The first congress of the all-embracing RANZCO was in 2001, and the first to be held in New Zealand was in Auckland in 2003.
Training, examination and qualification in ophthalmology
From the earliest days, ophthalmologists did some or all of their training overseas and obtained overseas postgraduate qualifications. In 1933, the University of Melbourne established its diploma in ophthalmology, which was modelled on the Diploma in Ophthalmic Medicine and Surgery set up by the Royal College of Physicians and the Royal College of Surgeons of England in 1920. Sir James Barrett, a leading Melbourne ophthalmologist, was the chancellor of the University of Melbourne at the time. The diploma was especially valuable in the early 1930s, when the Great Depression made overseas travel difficult. Later, the Universities of Sydney and Queensland set up diplomas. Subsequently, the diploma was somewhat of a political football, as has been fully documented by Lowe.8 The last diploma was awarded in 1979. In 1935, the Royal Australasian College of Surgeons (RACS) offered the final fellowship examination in ophthalmology, and this quickly became more prestigious than the diploma. The final fellowship examination of the RACS was first held in New Zealand for New Zealanders in 1970, on which occasion, the examiners were Professor John Parr and Dr Calvin Ring of New Zealand, and Dr Reuben Hertzberg of Sydney. Each year, there were only one or two candidates. This made it difficult for the examiners to ensure even standards and also made the exercise uneconomic for the RACS, and later for the RACO. An additional expense was that to help maintain standards, each year, a New Zealand examiner was invited to attend an examination in Australia. The last final fellowship examination in New Zealand for New Zealanders was held in Hamilton in 1991.
In the late 1950s, Victorian ophthalmologists James Foster and Geoffrey Harley proposed that the Ophthalmological Society of Australia be superseded by the Australian College of Ophthalmologists.9 A strong reason for this move was to give Australians a single qualification in ophthalmology provided by their own college. Also, increasingly, the RACS was not meeting the needs of the increasingly complex and specialized field of ophthalmology. The Australian College of Ophthalmologists was established in May 1969 and gained its Royal Charter in 1977. From 1980, the RACO took over ophthalmic training and examinations.
Up until the 1980s, many from both countries trained at Moorfields Eye Hospital in London. Professor Barrie Jones, a New Zealander, was appointed professor of clinical ophthalmology at Moorfields in 1963. He fostered their training at Moorfields, where many enduring trans-Tasman friendships germinated. 10
From the 1980s, when many took the fellowship before any overseas postgraduate training, difficulties arose for New Zealanders, as they were not eligible to be members of the RACO. This had the potential of leaving New Zealand trainees in limbo, but thankfully, Dr Lindo Ferguson, supported by others, including Dr Roy Holmes of Christchurch, negotiated for New Zealand ophthalmologists to be eligible to take the examination and to become fellows of the RACO. They were known as New Zealand fellows, the difference from their Australian counterparts being that they had no voting rights and were not eligible to hold office in the RACO. Nevertheless, New Zealanders had an internationally recognized qualification, but they had to wait until 1997 to become equal fellows of the college, when full amalgamation occurred and the College was renamed the RANZCO. Since 1991, the final examination has been held twice a year for candidates from both countries, with the examination being held once every 2 years in New Zealand, meaning that once every 2 years, many Australians come to New Zealand to take the examination. The first full examination in New Zealand for candidates from both countries was held in Auckland in 1993, when the chairman of examiners was Dr Alan Hilton of Brisbane. Similarly, a separate New Zealand part one examination was held until 1996. From then until 2002, the part one examination for candidates from both countries rotated around Sydney, Melbourne and Auckland. From 2004, the ophthalmic sciences were incorporated into the vocational training program and examined as modules. New Zealanders have always been included on the part one and part two examination boards, with Philip Polkinghorne and Bruce Hadden serving as the board chairman. The inspection of training centres across the two countries began in 1988, when Dr Kenneth Howsam, first censor-in-chief of the college, visited centres in New Zealand. Inspections were formalized when Dr Frank Taylor of Sydney was appointed the first inspector of training posts in the 1990s. These inspections take place every 3 years and are aimed at ensuring that every department in both countries, which is accredited for vocational training, has adequate expertise and facilities.
Courses and teaching
In 1982, Professor John Parr established the Dunedin annual ophthalmic basic sciences course, which was the most comprehensive and popular course in Australasia for candidates seeking to pass the part one examination of the RANZCO. It was a 4-week residential course, and each year Australian students outnumbered New Zealanders. With his research interests in the basic sciences, and in particular ocular physiology, Professor Parr was well placed to teach those attempting the ophthalmic basic sciences examination. Associate Professor Gordon Sanderson, an academic optometrist, joined the Dunedin department in 1972 and contributed tremendously to the teaching of optics. Anatomy was more than adequately catered for by the Otago Medical School Department of Anatomy headed at the time by Professor WE (Bill) Adams.
Credit must be given to pathologists who assisted in teaching at the course and in examining. In particular, Dr George Hitchcock OBE, DFC (1922–2010) contributed very generously not only to ophthalmic pathology but also to pathology for all surgeons. His contributions were acknowledged by being granted not only honorary membership of the Ophthalmological Society of New Zealand but more prestigiously, honorary fellowship of the RACS (Fig. 6).
In 2006, The College established annual awards for excellent teachers called The College Award for Excellence in Training. Ten or eleven awards are made each year, from 200 to 300 trainers throughout Australasia, based on nominations by trainees. They are presented by the college president or censor-in-chief at the college's annual conferences. A 2-week residential course in Dunedin for part two candidates from both countries was started in 1998, overseen by Tony Molteno and Gordon Sanderson. Later, the Dunedin basic science course was also taught through the University of Sydney, organized by Professor Frank Billson.
The 21st century
The past 11 years have seen the college being fully integrated across the two countries. In 2002, the college elected New Zealanders as president and as director of Continuing Professional Development. The college board has bilateral representation. Strong academic links have developed, with joint academic appointments. Professor Helen Danesh-Meyer was made an honorary professor at the University of Melbourne for her collaborative research in glaucoma. Professor Gerard Sutton of the University of Sydney is an honorary associate professor at the University of Auckland. He heads a postgraduate course at the University of Sydney in refractive surgery, attracting ophthalmologists from both countries. Professor Charles McGhee has built up the Department of Ophthalmology at the University of Auckland. He has been editor-in-chief of the college's journal, Clinical and Experimental Ophthalmology, and has been the chairman of the college's Scientific Congress Program Committee. The Fred Hollows Foundation is active in Australia and New Zealand, serving ophthalmology in developing countries.
These strengthening liaisons have been of mutual benefit, developing education and exchange, which bodes well for ophthalmic care in our Asia-Pacific region and for our place in world ophthalmology. This is already evidenced by the increasingly high ranking of our college journal, Clinical and Experimental Ophthalmology.
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