The Turtle and the Caduceus: How Pacific Politics and Modern Medicine Shaped the Medical School in Fiji, 1885-2010

By Professor David Brewster AM

The Turtle and the Caduceus are metaphors for the impact of Western medicine (the Caduceus) upon a traditional Pacific island culture (the Turtle), through the history of a school which started training native medical practitioners 125 years ago. David Brewster, the former Dean of Fiji School of Medicine, tells the fascinating tale of how a devastating measles epidemic and pro-indigenous benign colonialism led the foundation of this unique school. Then, Rockefeller philanthropy helped to transform it into a regional institution with an excellent reputation. However, its evolution into a modern university medical school was hampered by local politics and internal dissensions related to ethnic strife between the indigenous and Indian populations of Fiji, which also resulted in four military coups with economic stagnation and migration of medical graduates. This cautionary tale has important lessons for the relatively neglected disciplines of Pacific island history and medicine.

• Language: English
• Publisher: Xlibris US
• Release date: Jan 11, 2010
• ISBN: 9781450022637

Professor David Brewster AM

David Brewster is an academic paediatrician with extensive experience in the Pacific Islands, Africa and the Caribbean as well as Australia, New Zealand and Canada (see Figure 1). This book comes out of his experience as Dean of Fiji School of Medicine from 2005-8. He has also published widely in the biomedical literature on childhood malnutrition, diarrhoeal disease and malaria. He is currently based at the University of Botswana.

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ABBREVIATIONS

FIGURES

TABLES

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Fig. 1: Author’s Postings for Education and Work Positions

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Fig. 2: Map of the Pacific Islands with numbers of doctors per 100,000 population

Introduction

The Tale

Once upon a time, in a distant group of islands in the Pacific Ocean, there was a King named Cakobau who decided to cede his kingdom to the British Queen Victoria, in order to circumvent a debt and a rival chief. As part of the celebrations, he went on a voyage to Sydney, where he and his party contracted measles. Upon his return home, measles was transmitted to the islands resulting in the death of over a quarter of his subjects.

The new Scottish Governor of the colony, named Gordon, wanted to protect the natives from further depopulation and the destructive effects of plantation labour, so he imported indentured labourers from India to work on the sugar cane plantations. His Chief Medical Officer, another Scot by the name of MacGregor, was also concerned about the welfare of the native population as well as the severe shortage of colonial medical officers, so he commenced a School to train native practitioners. Thus began the medical school in Fiji in 1885.

But many of the Indian indentured labourers and their offspring remained in the colony, increasing in numbers until they outnumbered the native population. The dénouement of these political events greatly affected the medical school.

This book tells the tale of the School, as we must learn from the past or we are doomed to repeat past mistakes. It also examines the background to the story, such as:

1) an apparently benign form of British colonialism favouring native Fijians

2) the population changes: on the one hand, the decline in Fijians from epidemics and malaise; on the other hand, the demographic rise in Indians due to high fertility and an inclination to remain in Fiji after completing their labour contract

3) the resulting ethnic tension

4) the impact of new developments in medicine and medical education on the School

5) the importance of philanthropy and foreign aid, and above all

6) the political, economic and migration developments following from the four coups d’état between 1987 and 2006.

Fiji and the School are still struggling from the consequences of these momentous events.

The Western tradition of biomedical science (the caduceus) was introduced into traditional Pacific Island cultures (the turtle), and the native practitioners who graduated from the School were the intermediaries. It was not an easy role, and some fell by the wayside. But the battle was ultimately won, and the School was strengthened and regionalised by Rockefeller philanthropy in the 1920s. Finally, however, in the transition to a modern university medical school, the School faltered and lost its way due to political events beyond its control. Only time will tell whether it can rise from the ashes to triumph over ‘an uncertain future’ and assume once again the role it had occupied for a hundred years.

This book has been written for the general reader with an interest in Pacific Islands politics, history, health and medical education. It is not a dry academic history—as it is not based on a systematic search of all primary sources, and is not written by an academic historian. Nor is it a conventional institutional history—as it does not just aim to celebrate the School’s accomplishments, indeed is often critical of some aspects of its history, and is also very selective of the interesting parts of the story. Nevertheless, it is a work of academic scholarship which tells an interesting tale, a ‘narrative’, as historians prefer to call it, from which lessons can be drawn. I agree with the distinguished medical historian, John Burnham, that within the realm of scholarship, medical history . . . [is] the most fascinating subject of all.1 It is also generally acknowledged that there has been a relative neglect of historical scholarship of the Pacific Islands.

Medical Historians

It is not uncommon for an older medical practitioner, like myself, to develop an interest in medical history. Indeed, the story is told of a discussion between an aging doctor and a historian, in which the medical practitioner tells the historian that he plans to become a medical historian on his retirement, to which the historian replies that he is going to become a neurosurgeon. The doctor did not see the joke and pointed out the need for proper training, which was, of course, the historian’s point that many doctors write about the past without any training in academic history. Indeed, much of clinician history has been dismissed as bad history.

Although I have no pretensions as an academic historian, one of the advantages of McMaster University, where I studied medicine, was that it allowed humanities students into medicine without the need for having studied sciences as an undergraduate. Thus, I studied history and the history of philosophy for 10 semesters at 3 universities prior to commencing medicine. I have also read widely in history, the social sciences and public health since 2005 for this book.

To cite Burnham again: another special character of medical historians of the twentieth century . . . [is] the openness of physicians, who for so long monopolized interest in the subject of the history of medicine, to other scholars who began to come into the field.1 It is in the spirit of this tradition in which this book is written. But it would be a mistake to assume that medical history is only the concern of historians. It is certainly true that their interest in the subject and rigour in consulting primary sources has contributed greatly to the field. Nevertheless, there is more than ever the need for an insider’s medical interpretation and perspective on medicine’s past, which takes into account work in other disciplines and the political background of events.

In my reading in medical history, I discovered that there were quite different traditions of writing between medical practitioners as amateur historians and medical historians. The former tend to tell the story of:

disease discoveries, diagnosis, and treatment from the perspective of medical practice and science, but insulated from wider cultural influences. By contrast, academic historians view history as a contextual enterprise . . . Historians of medicine study institutions, classification systems, and the social and cultural values that physicians, patients, and their families bring to the clinical encounter.2

In the USA, there are even distinct professional organisations for the two groups, with doctors belonging to the exclusive American Osler Society and medical historians to the American Association of the History of Medicine. They even use footnotes and references differently with doctors tending to use Reference Manager to give the sources of information whereas historians are more likely to rely on Endnote with extensive footnotes to accompany the text. Whereas medical practitioners as historians have tended to tell stories of conquering diseases, medical historians and sociologists have focussed more on the professionalization of medicine and medicalization of society, including many critics of these trends. There is even a recent collection of ‘clinician-historian’ stories of how history had an impact on clinical activities.3 In this book, however, we focus more on the impact of political developments and the history of medicine upon an institution. We also lament the detrimental effects of ‘Politics’—as opposed to state regulation of the profession—on a medical institution; its politicization as part of partisan agendas and military coups.

In his Lancet paper, Kushner throws down the challenge to create a collaborative environment to bring these two strands together.2 He calls for an educational effort, on one hand, to expose academic historians to patient care and medical science, and on the other hand, to provide doctor ‘historians’ with the training to appreciate the extent to which medical practice and research take place within a broad social context, which must be understood and critiqued, even deconstructed. I have attempted to follow this advice, by telling the story of the medical school in Fiji in its historical and cultural context. Ten of the 15 chapters cover the political and medical education background to events at the School. The title is analogous to a La Fontaine fable; here is a tale, which I have tried to tell it in an interesting and accessible way for the general reader.

The Book’s Thesis

The thesis of the book is that the first hundred years of the medical school in Suva (1885-1987, to be exact) were its glorious days, and its downfall was intimately linked to the political instability of the military coups, which were in turn largely dictated by the unique mixture of Polynesian and Melanesian cultures in Fiji and by the majority of inhabitants of Fiji being of Indian descent at independence in 1970. But there were other key factors in the decline, such as its failure to become part of the regional university, the dominance within the school of Fijian nationalists and an old boys’ network and the exponential rise in student numbers (Figs 31-2 & 49) without the administrative competence and structures to cope with them. So rather than a story of conquering diseases or the professionalization of medicine, this book is about how medical education and its institutions were affected by the political context—the politicization of medical education.

This is certainly not unique to Fiji, as Australia saw much the same during the Howard era in an attempt to get more rural doctors for the National Party’s election campaign against the onslaughts of Pauline Hansen (e.g. University Departments of Rural Health, rural clinical schools, massive increases in medical school places, bonded scholarships, rural placements, etc.). Medical deans now have more of a political than educational or medical role in their institutions. The moral of the story is that we need to fight the encroaching politicization of our medical institutions, so they can get on with the important business of training future doctors—a role too important to be left entirely to politicians, or to professors either for that matter.

The first Professor of Pacific History, James W Davidson, observed in 1953 that:

The writing of valid history requires not merely technical training but also mature understanding of the human mind. The historian has to understand the ways of thought and action of a whole society; and to gain this understanding he cannot go to the actors themselves but has to rely on the desiccated residue which they left behind—a pile of documents . . . The historian’s training comes as much from an understanding of men as from an understanding of books.4 (p99)

The danger of the contemporary participant history favoured by Davidson, in his book Samoa mo Samoa, is the loss of objectivity, detachment and critical distance which is required for history.5 As Dean of the Fiji School of Medicine from 2005-7, the author was a brief participant in the story, and the last chapter tells his version of events. In one sense, this book is an attempt to understand those years with the benefit of hindsight and in a larger historical perspective. I have tried to tell this personal story with reasoned fairness, as a cautionary tale from which there are lessons of general interest to medical education, institutional management and the Pacific Islands. The past can teach us a lot about what is going on in the present, and this is a story which I felt compelled to tell.

The Caduceus Symbol

The title of this book is taken from the two symbols on the School insignias of both Central Medical School (Fig 5) and Fiji School of Medicine (front cover), in which the caduceus stands for medicine and the turtle represents the Pacific Islands. The title was chosen to symbolise the result of the introduction of Western medicine (the caduceus) into traditional Pacific island societies (the turtle). It was likely to have been the American, Dr Sylvester Lambert of the Rockefeller Foundation, who chose the caduceus symbol (staff of Hermes in Fig 3) for the insignia of the new Central Medical School in 1928, presumably following the US Army Medical Corps.

The caduceus is a symbol of Greco-Roman origin, but there is an interesting twist which is relevant to our story. The School chose to use the double serpent entwined staff with wings from the Greek messenger Hermes (or his Roman counterpart Mercury), which it superimposed on the shell of a turtle to represent the Pacific islands. However, the correct Greco-Roman symbol for medicine is the rod of Asklepios (or Roman Aesculapius or Asclepius), which has a single snake and rough hewn staff without wings (Fig 4). Asklepios was the mythical son of Apollo and was trained in the arts of healing by Chiron, the centaur. Asklepios is mentioned in both Homer’s Iliad and the Hippocratic oath. The Asklepian cult built hundreds of health-related temples during the Roman Empire, where healing was practiced by the magical intervention of the gods during sleep. This heathen symbol of healing was suppressed by Christianity from about the 6th century, when the urine flask became the favoured medical symbol.

The reintroduction of the staff of Asclepius as the symbol of medicine commenced after the Protestant reformation in northern Europe. It was used by the US Army Medical Department as early as 1818, but the influential US Army Medical Corps adopted the caduceus as a medical symbol in 1902. Although this was later claimed to be a symbol of non-combatants in war, it is clear that it was used in ignorance of its Greco-Roman origins. It was not used as the staff of Hermes but copied from a London publisher, John Churchill, who used it as a printers mark on scientific books, with the twin serpents signifying the bond between medicine and literature. Churchill understood the distinction in staffs, as he still used the Asklepian staff as a specific symbol of medicine on his medical publications. The staff of Hermes was perhaps an unfortunate choice of symbol for medicine as Hermes was the god of thieves, games, travellers, merchants and commerce.6,7

Perhaps Lambert’s use of this insignia was anticipating the commercial nature of medicine as it would develop in America and elsewhere. Many medical organisations use the correct Asklepian staff as their symbol, but still refer to it as the caduceus (or la caducée in French). However, the use of the incorrect insignia, at least from a Greco-Roman perspective, is widespread. With the name change of Central Medical School to Fiji School of Medicine in 1961, the logo was changed with the caduceus and turtle depicted separately, but the erroneous symbol for medicine was retained.

The Turtle (Pacific Islands)

The setting for this story is Fiji and the Pacific Islands, symbolised by the turtle on the School’s insignia. For those unfamiliar with the region, we will attempt very briefly to set the scene. The Figure 2 map illustrates the vast array of islands over a larger area than any continent, but the population of the region is small at 9.2 million (including 6.2 million in PNG). The islands were populated by at least two distinct waves of migrations: the first some 50,000 years ago brought settlers on foot to the New Guinea region who now speak some 800 languages; the second wave only arrived some 3,500 years ago as Austronesian speakers and voyageurs by canoe to the smaller distant islands of Polynesia and Micronesia. One can hardly exaggerate the diversity and variability of the populations in the region. The Pacific Islands have often been portrayed as ‘paradise’, which is a highly misleading myth—nor was the region inhabited by either ‘noble savages’ or ‘savage brutes’, although there was cannibalism in the past. But such stereotypes are unhelpful.

The region is also experiencing rapid social change with globalisation, one aspect of which is epidemic levels of obesity with most of the adult morbidity and mortality due to non-communicable diseases (over 70%). Issues of land tenure are also central concerns of Pacific islander’s lives, as are increasingly global warming for the coral atolls and HIV/AIDS for PNG. The experience of colonialism, philanthropy, foreign aid and migration will be dealt with in the book. Finally, the issue of political unrest and instability have emerged in recent decades, and its impact on the regional medical school in Fiji is the subject of this book.

Fig. 5: Insignia of Central Medical School

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Acknowledgments

The author would like to thank the following people for their kind assistance: Niraj Swami of Fiji School of Medicine, Graeme Maguire of James Cook University, Brian Cameron of McMaster University and Ian Lewis of Tasmania.

Fig. 6: Map of Fiji.8

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Table 1: Medical Graduates by Titles and Duration of Course

Part I

THE SUVA MEDICAL SCHOOL, 1885-1928

Chapter 1

A Medical School for Natives

Suva Medical School, 1885-1902

In 1885, a medical school for native Fijian boys was initiated at the Colonial Hospital in Suva by the Chief Medical Officer (CMO) of the colony, Dr William MacGregor. The background to this initiative included factors such as:

1. the devastating measles epidemic in 1875,

2. the fear of smallpox and cholera among indentured labourers aboard the first ship from India in 1879,

3. the acute shortage and high cost of European medical officers, and undoubtedly

4. the favourable but patronising attitude of the British Colonial administration of Sir Arthur Gordon towards the native Fijian population.

Each of these factors will be explored over the next few chapters.

One of MacGregor’s chief concerns as CMO was the chronic shortage of colonial medical officers in Fiji. In 1876, he instituted an initiative to train Wesleyan mission teachers as medical assistants, intending personally to supervise their purely practical course at Levuka Hospital in Fiji’s capital at that time. Although aware of the limitations of such a rudimentary apprenticeship, he felt it would be adequate for training them to treat common diseases such as dysentery, bronchitis, worms, wounds, burns, and skin and eye infections. He urged all Christian missions in the Pacific Islands to have every missionary and teacher, white or coloured, man or woman, put through a course of medical instruction that would enable them to alleviate and mitigate the maladies that now menace the different races of the islanders.9 The Methodist, Wesleyan and Catholic Christian Missions had already begun training natives as assistant missionaries, ministers or catechists by the 1850s, so MacGregor had a model which could be equally applied to health in order to save lives as well as ‘saving souls’.10

Prior to Fiji becoming a British colony in 1874, the major health threat to the settler population in the capital, Levuka, was environmental—as in Europe at the time.

Anyone going through Levuka cannot fail to be struck with the filthiness and unwholesomeness of the place . . . Drains flushed with filthy refuse, . . . the effluvium of refuse from shambles which come floating down Totoga creek, the stinking refuse which is thrown out onto the beach . . . 11 (p231)

Although there were four doctors in practice in Levuka, they could do little to improve the health of settlers under such appalling sanitary conditions—which were arguably worse than for the indigenous population in their villages. The outcome of European settlement depended primarily on the price of cotton, security of land tenure, and the availability of cheap labour. The outbreak of the American Civil War in 1860 was followed by a steady rise in the price of cotton, attracting European adventurers from the Australian and New Zealand (NZ) frontier, who were looking to make a quick fortune and believed in their racial superiority. By 1871, their ranks had swelled to a population of 2,560, and they expected to be favoured by the new British colonial administration for which they had agitated.11 Their hopes would soon be frustrated both by the pro-Fijian attitude of the colonial administration and by the fall in the price of cotton with the ending of the American civil war.

When the first ship of Indian labourers was found to have cholera and smallpox cases on board, the colonial administration imposed a three month quarantine. It heeded the lesson from the previous quarantine failure in the devastating 1875 measles epidemic (chapter 2), so prevented smallpox and cholera from affecting the population of Fiji. But such a long quarantine period was expensive and difficult to enforce, so the colonial administration looked to vaccination as better protection against smallpox. European vaccinators were costly, so MacGregor trained a team of young natives boys in vaccination technique. While working in Fijian villages, these vaccinators developed an interest in the illnesses affecting communities, and their reports disclosed the considerable burden of disease in the native population. Moreover, even after the measles epidemic, the native population continued to decline further, which greatly concerned the colonial administration. MacGregor proposed an expansion of the vaccination training program for natives so they could be trained to assist in healing the sick and arresting the spread of disease, similar to what he had suggested for missionaries previously.12 This was one of the incentives for the initiative which led ultimately to the Suva Medical School, as it was later called.

The first official proposal by MacGregor to train natives was in 1879, following an outbreak of dysentery (bloody diarrhoea) at Kadavu in which over 60 people died without medical care. In getting approval for the proposal, MacGregor had to contend with considerable scepticism among colonial authorities and colonists about the inherent intelligence of the ‘savage’ and his ability to understand modern medical concepts. On the whole, Europeans at the time had little doubt that they were a biologically superior species, with little awareness of the importance of what are now recognised as social determinants of health—the non-medical context of disease, such as good nutrition and living conditions as the explanation for better European health status. Sir Charles Mitchell, who was Governor from 1877-88, expressed a common European perspective of the time that medical training would upset the equilibrium of the native’s mind due to rapid promotion over other natives leading to ‘the slothful life of petty chiefs’. He stressed the need for natives to be kept ‘in due subjection to their chiefs’.

Nevertheless, an initial trial of medical training of natives started in 1884 when a few Fijians, mostly sons of chiefs, were given practical instruction on vaccination techniques and simple medical procedures at the new Colonial Hospital in Suva, the new capital of the colony. The training was carried out by MacGregor as CMO with the intention of them assisting European medical officers in providing basic health services to the indigenous population. Meanwhile, MacGregor persevered in his lobbying endeavours for a formal training programme, until funds were eventually officially approved by Governor Des Voeux.12

The official proposal to Fiji’s Legislative Council in December 1883 explained the proposal in the following terms:

It not infrequently happens that sickness of an epidemic form breaks out in a remote part of the Colony or at a spot which, while geographically near, is in consequence of the infrequency or difficulty of communication virtually remote and that tens and scores of natives are swept off before any confirmation can reach the seat of Government. Dr. McGregor proposes to form a class of students, carefully selected from among the most intelligent of the Fijian people, who, after completing a course of practical instruction in the hospital, including nursing, may be sent out to assist in healing the sick and arresting the progress of disease in those parts of the Colony These students will also be taught to vaccinate and it is probable that those among them who evince any aptitude or inclination for it may be taught to dispense the simpler form of medicines.13 (p3)

Thus, following the successful initial trial, the Suva medical school project began in 1885 with a small group of young men who were given three years of instruction in the rudiments of human anatomy and physiology, and clinical experience in medicine and surgery at the Colonial hospital under the supervision of the CMO and Matron. Even in Europe at the time, medicine was an apprenticeship and did not involve any teaching of basic sciences, which in any case were rather rudimentary at the time (chapter 4). Incompetent or otherwise unacceptable candidates were eliminated from the class during the first year. After three years of satisfactory performance, students were granted the status of native practitioner.

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Fig. 7: Class of 1885.13

The first group of 10 students began the course in 1885, and three years later, three of the trainees had passed the oral examination in medicine and surgery, with six more the following year. This was the same year as the first University of Sydney medical school graduation for the MB ChM degree.14

In June 1888, the Native Practitioners Ordinance gave native practitioners legal status upon condition that they had been medical students at a public hospital for three years and passed an examination in medicine and surgery.

They were then granted a certificate as a Native Practitioner, which gave them the right to practice medicine and surgery in a district specified by the CMO, where they would be provided with a house and a garden. Although the CMO was their official chief, they still had to obey their native superiors, but their services as Native Practitioners were to take precedence over normal village duties. The salary was at least £5 a year from the province, and £2 10s a year from the Colony with the proviso that they were not allowed to demand any fees for their services, although they were allowed to accept gifts offered to them.13 Thus, the cost of native practitioners (including training costs) was still only a fraction of the minimum salary of colonial medical officers (£350/year).

Although it was MacGregor who inaugurated the scheme, the credit for ensuring its success goes to his successor as CMO, Dr Glanville Corney, who was in charge of the Suva Medical School for its first graduation in 1888. He had studied at St. Thomas’s Hospital and received the diploma of MRCS in 1874 without ever attending university, as was common at the time in England. According to David Hoodless, the first full-time Tutor of the School, it is:

doubtful if any European official has ever been better known and more beloved by the Fijians than Dr Corney, and under his direction the training of Native Medical Practitioners (NMPs) developed steadily.13

Along with Sir Basil Thomson, Corney investigated the causes of the population decrease in Fiji (chapter 2). He also collected implements of traditional healers for the museum of the Royal College of Surgeons of England,15 and wrote an English vocabulary of medical terms for the students with the assistance of Miss May Anderson, who was Matron from 1896 to 1919. Her knowledge of the Fijian language and customs was a great asset, and her authority over the students was remarkable, given Fijian males reluctance to be supervised by a woman at the time, yet she was obeyed ‘like the CMO himself’.13 In 1908, Corney retired after 31 years in Fiji and 20 years as CMO.

It is worth quoting at length from MacGregor’s description of the establishment of the School, as he looked back 37 years later:

In 1885 the Government of Fiji invited the chiefs to send forward eight or ten young men of proved intelligence, and of good character and family, with a view to them being given a course of instruction in the rudiments of human anatomy and physiology, supplemented by suitable teaching in the wards of the Colonial Hospital, with practice of minor surgery and domestic medicine. The proposal met with a willing response, almost every province contributing at least one student; and these were housed near the Colonial Hospital, where they received technical and disciplinary training from the medical officers and the matron during a term of three years each. Particular attention was paid to such ailments as pneumonia, bronchitis, dysentery, conjunctivitis, and other diseases to which the natives are specially prone, and to the methods for arresting bleeding. General sanitation, both public and individual, and prophylaxis were, of course, included.

In course of time the most promising and careful of these students became useful adjuncts to the labours of the District Medical Officers; and even in parts of the islands out of reach of the latter. As a measure of their ability and precision it may be mentioned that three became in rotation dispensers and anaesthetists at the Hospital, and one of these served with unvarying success for more than a dozen years. Before very long their number reached fifty. Incompetent and otherwise undesirable candidates were generally detected and eliminated from the class long before entering upon a third year of study; but, when the sounder ones had completed the full term, they were subjected to a stiffish examination, written, oral, and practical, and those that passed satisfactorily were awarded a Certificate to that effect. They were then appointed to a provincial post, at first under the supervision of a European Medical Officer, but by degrees their usefulness was availed of, as I have said, for the benefit of the native population of remote islands where no European medical officer was ordinarily within reach, and after some natural hesitation and an occasional rebuff on the part of a biased and ignorant people, they became greatly appreciated, and no province deemed itself properly equipped without one or more of them, so that the total number of these Native Practitioners, as they were officially called, has been maintained, and remains at present at more than fifty, year after year.9 (pp81-2)

Native practitioners were meant to function like medical assistants to the native population, but their remote site and the shortage of doctors gave them considerable independence and a high degree of responsibility for the health of their communities, including often the dispensaries and district hospitals that opened between 1889 and 1904. Although supervision by European Medical Officers did not always happen as planned, the communal system in Fiji meant that any native practitioner who neglected his duties or mismanaged his cases would soon come to the notice of the chief and be reported to the Native Commissioner in Suva.13 Many of them became skilled at treating diseases and carrying out simple surgical procedures, so they soon acquired a good reputation. Of course, some racist settlers attributed their surgical skills to familiarity with human anatomy from cannibalism so they could continue to deny their capacity to assimilate European education.12

William MacGregor

MacGregor served in the British Colonial Service for a total of 42 years. He was the son of an impoverished Scottish crofter, so it was a truly remarkable achievement not only to complete medical school but to end up a knighted colonial governor. He completed his medical training in Aberdeen and Glasgow in 1872, and immediately joined the Colonial Medical Service, first in Seychelles and then in Mauritius.

The story is told that, while completing his medical degree in Scotland, MacGregor survived on half a crown a week with a diet of porridge for breakfast, two fresh herrings or a kipper for lunch and another bowl of porridge for his supper. He was a bright and diligent student, winning the Gold Medal of the University at graduation. When only three years out of medical school, he was appointed Chief Medical Officer (CMO) in Fiji, serving in that role from 1875 to 1888. MacGregor had more general intellectual interests apart from medicine: he was an autodidact, a multilingual scholar, and a student of the classics. But there was another side to this lonely dour Scot, according to his biographer, RB Joyce.16 His correspondence reveals that he was often embittered and frustrated, feeling overlooked for promotion, convinced that his salary was inadequate and that he had been unfairly treated by the Colonial Office.

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Fig. 8: Sir William MacGregor

After founding of the School, MacGregor went on to have a distinguished career in the region as Governor of Papua and later of Queensland. It is interesting to consider the appraisals of MacGregor by some of his contemporaries to convey both the nature of the man and the elegant writing of the time. Ronald Ross, who proved that malaria was transmitted by mosquitoes in 1897, formed a close acquaintance with MacGregor during his time as Governor of Nigeria, and wrote perceptively of him as:

Wise, grave, but humorous, bearded, thick-set, with wrinkled forehead and a high and somewhat conical bald head, his low voice and kindly manner filled all with trust in him. He drank no wine and did not smoke, but was no fanatic in these respects, and kept a hospitable table. Every night he read from his Greek Testament, and was also skilled in French and Italian, and knew something of many barbarous tongues. He was a mathematician, a practised surveyor, a lapidary, and a master of many arts, but always proud of his medical upbringing and of his nationality. Simply dignified, he did not allow his dignity to obscure his personality, and he had no trace of that meanest and