539573 research-article2014

APY0010.1177/1039856214539573Australasian PsychiatryWhite

Australasian

Psychiatry

History

Sir John Macpherson, the first but sometimes overlooked Professor of Psychiatry at the University of Sydney

Australasian Psychiatry 2014, Vol 22(4) 378­–382 © The Royal Australian and New Zealand College of Psychiatrists 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1039856214539573 apy.sagepub.com

Richard T White  Honorary Associate, Discipline of Psychiatry, Central Medical School, University of Sydney, Camperdown, NSW, Australia

Abstract Objective: To chronicle the creation of the Chair of Psychiatry at the University of Sydney, and the career and legacy, in New South Wales, of the first incumbent, Professor Sir John Macpherson CB MD FRCPE. Conclusions: The creation of the Chair, Macpherson’s appointment, and his contributions to psychiatry in Sydney during the 52 months of his tenure, are well documented in contemporaneous sources and demonstrate that he was a very worthy Foundation Professor of Psychiatry at the University of Sydney. There are several possible reasons why Macpherson has been overlooked, including an erroneous statement in The World History of Psychiatry (1975) that William Siegfried Dawson, his successor from 1927 to 1952, was the first Professor of Psychiatry. Keywords:  Professor Sir John Macpherson, University of Sydney, history of psychiatry, general hospital psychiatry, Royal Prince Alfred Hospital

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here is a mistake in The World History Psychiatry (1975), where one reads “The first professor of psychiatry, W.S. Dawson, of Aids to Psychiatry fame, was appointed to Sydney in 1922…”.1 The same error appears in a 1999 paper on the history of Australian psychiatry prior to 1960.2 Macpherson is not mentioned in The Australian Dictionary of Biography (2012).3 In the official history of the University of Sydney, Australia’s First (1991), Macpherson occupies less than one line – as the predecessor of W.S. Dawson in the Chair of Psychiatry.4 As an exception to this trend, there is an informative two-paragraph summary of Macpherson in The Centenary Book of the University of Sydney Faculty of Medicine (1984),5 and he receives brief mention with correct attribution in Managing Madness (1988).6 The extent of this under-recognition of Macpherson indicates a need to set the record straight. This article examines the creation of the Chair of Psychiatry at the University of Sydney and the related appointment processes, gives an account of Macpherson’s career and achievements in the United Kingdom, and of his contributions in New South Wales (NSW), examines factors that that may have led to those contributions being overlooked and concludes with the author’s appraisal of Macpherson’s worth as the Foundation Chair of Psychiatry at the University of Sydney.

Creation of the first Chair of Psychiatry at the University of Sydney The University of Sydney was founded in 1850,7 and its fourth Faculty, Medicine, established in 1856.7 However, entry of the first undergraduate medical students, in 1883,8 only became feasible after the admission of patients to the Royal Prince Alfred Hospital (RPAH) in 1882.9 Sources agree that the impetus for the creation of a Chair of Psychiatry was provided by Dr Eric Sinclair, the second Inspector-General of Mental Hospitals (1898– 1925).5,10,11 On 2 September 1918 the Senate of the University of Sydney received a request from the Minister for Public Health, perhaps at the instigation of Dr Sinclair, for the creation of a Chair of Psychiatry.12 The Senate considered the matter on several occasions and sought the opinion of the Faculty of Medicine regarding

Corresponding author: Dr Richard T White, Honorary Associate, Discipline of Psychiatry, Central Medical School, University of Sydney, 34 The Avenue, Camperdown, NSW 2041, Australia. Email: [email protected]

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the need for a Chair of Psychiatry. The Senate then resolved to create the Chair and approved Conditions of Appointment on 2 May 1921,13 with advertisement for applicants to take place in Australia and in the UK.13 The Chair was to be funded jointly by the University and the State of New South Wales. The appointee should have “interest in clinical rather than pathological work”.13 He would have certain clinical responsibilities required by that State and would have access to all mental hospitals. His clinical duties would be under the control of the Inspector-General of Mental Hospitals (Dr Eric Sinclair being the incumbent), and he would have appointments at Broughton Hall Special Hospital in Rozelle and at RPAH in Camperdown. The appointment to the Chair was potentially for 7 years, beginning on 1 March 1922, with eligibility for reappointment.13

Selection and appointment processes On 5 September 1921 the Senate set up an appointments committee that included Professors D.A. Welsh and A.E. Mills, Dr Eric Sinclair and seven others.14 Another committee was set up in London to assist with British applications. Applications were received from the UK and from Australia but, on 5 December 1921, the Senate accepted the recommendation of the selection committee that none of the applicants had sufficient qualifications or experience.15 The Senate then authorised the London committee to “consult privately with certain (sic) who might be considered to have the necessary qualifications and professional experience” and that the appointment would be formalised by the Agent General in London.15 In the Centenary Book, Editors Webb and Young state that there is a “mystery” regarding the appointment of Macpherson, rather than a younger man, and that his appointment “may have been” recommended by two of the Faculty’s three first, and most influential Professors, D.A. Welsh and J.T. Wilson, the latter now at Cambridge and a member of the UK selection committee. Webb and Young also suggest that Welsh may have professionally known Macpherson when completing his residency in Scotland.16 Macpherson arrived in Sydney on 29 July 1922 accompanied by his wife and two daughters. His likeness in the 1920s is shown in Figure 1. When disembarking, he is quoted in the media: “it was rather a sudden appointment” and “I had just retired from the Commissionership of Lunacy in Scotland when I was offered the Chair of Psychiatry at your University for a term of three years.”17 The Senate later extended Macpherson’s appointment by 18 months.18

Who was Macpherson and what had he achieved in the United Kingdom? Born in Inverness-shire, the son of a clergyman, Macpherson graduated MB CM from Edinburgh University in 1882, and was appointed assistant physician at the

Figure 1.  Professor Sir John Macpherson: a photograph from the Student Year Book of the Faculty of Medicine of 1925 Royal Edinburgh Asylum. In 1889 he became medical superintendent of the Stirling District Asylum at Larbert, where he oversaw architectural renovations. While at Larbert he lectured in mental diseases at the Royal College School of Medicine, Edinburgh. In 1896, Edinburgh University awarded a gold medal for his MD thesis. In 1899 his textbook “Mental Affections: an Introduction to the Study of Insanity”19 was published. In the same year he was appointed Commissioner of Lunacy for Scotland, a post he held until 1921. He became President of the Royal Medico-Psychological Association in 1910. Beyond his immediate duties, Macpherson assisted on many Boards and contributed to the framing of the Mental Deficiency and Lunacy (Scotland) Amendment Act (1913). “During the War he was president of a s pecial medical board that dealt with cases of neurasthenia, shell-shock, insanity, epilepsy and other nervous disorders.”20 In recognition of his many services and achievements, he was bestowed Companionship of the Order of the Bath.21

Macpherson arrives in Sydney In 1922 Sydney was the largest city and port in Australasia, with a population nearing a million. Several mental asylums, overseen by the Inspector-General of Mental Hospitals, Dr Eric Sinclair, served the State of NSW. There were also several small private hospitals. Close to Sydney, Broughton Hall had recently (1921) opened as a 130-bed voluntary Special Hospital for mental disorders.

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Education: postgraduate, undergraduate and professional groups On Wednesday 5 March 1923, 7 months after Macpherson’s arrival, the Senate ratified a Diploma of Psychological Medicine and its related by-laws.22 We may never know the contribution of other parties to the gestation of the Diploma, but Macpherson certainly had the major role in its implementation and in its credibility. The University Calendar for 1923 outlines an advanced course for a Diploma of Psychiatry and courses for undergraduate students.23 Since 1886, a series of examiners and lecturers had provided undergraduate education in psychiatry. Macpherson took over undergraduate lectures and conducted Saturday morning demonstrations at Broughton Hall Special Hospital and the adjacent Callan Park Mental Hospital.5 His appearance and manner were described in the Student Year Book for 1925: “The firm intensity of his manner and the piercing scrutiny of his gaze gave to his lectures an atmosphere that was distinctive and unique.”5 During his four and a half years in Sydney, it is reported in medical journals that Macpherson attended, and contributed to eight scientific meetings, at four of which he presented papers. Three of these were published, in full, in the Medical Journal of Australia.24–26 At two of those eight meetings he spoke about “mental defectives” – a group to whom he had devoted much attention in Scotland. One such meeting, in Melbourne, was the inaugural Australasian Medical Congress (1923).27 On another occasion Macpherson presented six cases of hysteria.28 Macpherson’s other topics included manicdepressive illness, anxiety, neurasthenia and the psychiatric (outpatient) clinic. On the creation of the Section of Neurology and Psychiatry of the British Medical Association for New South Wales on 5 June 1924, Macpherson was elected its first Chairman.29

Clinical service innovations In February 1923 the Daily Telegraph reported Macpherson inaugurating a special “educative clinic” for “early mental cases” at the RPAH, “the first of its kind to be established within the grounds of a general hospital in Australia.”30 The goals of this clinic, said Macpherson, were threefold: To provide skilled medical advice to persons suffering from the early symptoms of mental and functional nervous diseases… The education of the medical profession in the essential features of mental diseases… The closer linking of psychiatry with general medicine and the breaking down of the artificial barrier…30 The clinic seems to have been very popular. By 1928 the annual outpatient throughput numbered 731, and by 1935 it had reached 2231.31 Macpherson deserves credit

for establishing the clinic and for its success. However, his clinical engagement in the yet-to-be-created outpatient services at RPAH was specified in the Suggested Conditions of Appointment to the Chair.13 Macpherson also acquired six beds in the medical wards at RPAH for the management of “incipient mental diseases”.31 These beds were retained by the Psychiatry Department until 1937 – and probably until the opening of the Psychiatry and Neurosurgery Pavilion in 1938.31 Macpherson’s effectiveness in as an advocate for general hospital psychiatry must have been greatly enhanced by the establishment of the outpatient and inpatient services at RPAH. Sir John Macpherson and Sir Harold Dew provided expert advice to the architect who designed the celebrated Psychiatry and Neurosurgery Pavilion, which was opened in 1938.32 This pavilion was proclaimed the first purpose-built psychiatry inpatient facility in the grounds of a general hospital in the British Empire.33

Public psychiatry in New South Wales On 30 April 1923 Macpherson gave expert advice to the NSW Royal Commission on Lunacy Law and Administration on a wide range of issues.34 At the outset he stated that the law lagged behind advances in clinical psychiatry and that less restrictive legal procedures were needed, so that citizens with psychiatric problems could gain access to expert psychiatric attention much as they would to surgical or medical consultation.34 He then proposed the creation of psychiatric outpatient and inpatient facilities in general hospitals throughout NSW. He also emphasised the need for better care and education for the “feeble minded” and “mentally deficient”. In response to questions regarding the euthanasia and sterilisation, Macpherson opined that medical panels would not countenance the former or public opinion the latter. He advocated the creation of villa accommodation for some classes of patients instead of their placement in monolithic asylums. He twice commented on the dire effects of overcrowding in mental hospitals. Regarding the successful system of boarding out of asylum patients in Scotland, Macpherson said that he was not confident that the system would work well in New South Wales.34 It appears that the Commissioners were impressed by Macpherson’s testimony.35 In their final Report they advised amendments to the Lunacy Act 1876 that were consistent with the advice they had received from Macpherson.36

Macpherson’s psychiatric philosophy and values Macpherson’s psychiatric philosophy and values are on display in his evidence before the 1923 Lunacy Commission,34 in the various lectures that he gave in NSW24–26 and, especially, in the Maudsley Lecture that

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Throughout his tenure, he promotes general hospital psychiatry, ease of psychiatric assessment and admis•  sion and the care of the intellectually disabled. •  •  •  •  •  •  •  • 

Introduces postgraduate Diploma of Psychological Medicine (1923) Establishes educative outpatient clinic at RPAH (1923) Establishes six beds at RPAH for early mental cases (date uncertain) Advises NSW Royal Commission on Lunacy (1923) Chairs new Section of Neurology and Psychiatry of the BMA (1925) Delivers eight lectures to medical audiences Publishes three papers on clinical and theoretical issues Assists design of innovative inpatient unit at RPAH (post 1926)

Figure 2.  Macpherson’s documented contributions in NSW he delivered in 1928.37 Probably the highest mark of respect by his colleagues, for a British psychiatrist, is the invitation to deliver the annual Maudsley Lecture. The title of Macpherson’s address was “The New Psychiatry and the Influences which are forming it”.37 Macpherson strongly favoured a medical-organic explanation for the origins of major mental disorders but believed that the psycho-pathological mechanism of dissociation led to the varieties of clinical disturbance. He expressed great admiration for the clinical psychiatry of Emil Kraepelin, and predicted that its fundamentals would endure. He was also impressed by the theories of Pierre Janet relating to dissociation, but was critical of those of Sigmund Freud. Macpherson’s hostility to Freudian ideas was harmonious with that of most Australian psychiatrists practicing during the 1920s.38 Macpherson also expressed admiration for the theories of Ivan Pavlov. He made no mention of Adolph Meyer, whose ideas would soon gain importance, especially in the USA. The middle section of the Maudsley Lecture is of particular interest because Macpherson praised the administrative-legal nexus in NSW whereby general hospitals could admit and manage psychiatric patients with minimal legal restraint and administrative complexity. He said “In the same State it has recently been arranged that every large general hospital should make provision for the accommodation and treatment of patients suffering from mental and nervous disorders.”37 During his Lecture, Macpherson expressed enthusiasm for these arrangements but did not claim, or imply, any personal credit.

book Aids to Psychiatry41 ran to eight editions, and was internationally popular with medical students. Dawson’s pluralistic approach to psychiatry is very evident in this textbook41 and differs in significant ways from the approach of Macpherson. Dawson had worked with, and been influenced by, Adolph Meyer in Baltimore. By 1952, in some academic departments, especially in the USA, Meyer’s views regarding the nature of mental illness were now tending to eclipse those of Kraepelin. Dr Eric Cunningham Dax arrived in Australia from Britain in 1953 to head the Victorian Mental Health Authority. Dax would have been very familiar with Dawson’s importance and long tenure. It probably did not occur to Dax that Dawson had a predecessor in the Chair. It was Dax who recorded, mistakenly, in the The World History Psychiatry (1975)1 that Dawson was the first Professor of Psychiatry. Other factors of probable relevance to the overlooking of Macpherson are the relatively short duration of his tenure and the fact that he had no biographer. By 1952, few of Macpherson’s former colleagues in Sydney would have been professionally active, yet all of the profession knew the name, and importance, of W.S. Dawson – who was still the only clinical professor of psychiatry in Australasia.41

Concluding appraisal of Macpherson

Why has Macpherson so often been overlooked?

Macpherson was selected for the Chair of Psychiatry at the University of Sydney because he possessed superb qualifications and experience in psychiatry. His record in the UK, his Presidency of the Medico-Psychological Association and his knighthood put him at the pinnacle of the profession.

Macpherson occupied the Chair for four and a half years and left Australia, late in 1926, to retire in Somerset. He had been a member of the appointments committee that unanimously recommended William Siegfried Dawson as his successor.39 Dawson occupied the Chair, excluding an interval between 1933 and 1936, until his retirement in 1952.40 In 1946 Dawson became the first President of the Australasian Association of Psychiatrists. His text-

During the 52 months of his tenure, Macpherson proved to be a powerful advocate for general hospital psychiatry. His main contributions in NSW are outlined in Figure 2. Enlightened compassion was evident in all of his reported statements and in his writings. By any standard, these contributions recommend him as a very worthy Foundation Professor of Psychiatry at the University of Sydney. 381

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Acknowledgements For their advice and other assistance I thank the following: Ken Kirkby, Peter Morse, Michael Robertson, Stephen Rosenman, Peter Shea, Sid Williams, the Archivists at the Royal Prince Alfred Hospital (Katherine Hellier) and at the University of Sydney (Nyree Morrison) together with the staff of the Susman Library. However, I am totally responsible for any omissions or errors in this paper.

17. Psychiatry: Sir John Macpherson Arrives: New University Chair. Sydney Morning Herald, 30 July 1922, p.8 18. Minutes of the Senate. Archives of the University of Sydney. 1925, p.431. 19. Macpherson J. Mental Affections: an Introduction to the Study of Insanity. London: Macmillan and Company, 1899. 20. Appointed to Chair. Chair of Psychiatry. Calendar of the University of Sydney. 1923, p.779.

Disclosure The author reports no conflict of interest. The author alone is responsible for the content and writing of the paper.

21. Obituary John Macpherson. Lancet 5 September 1942. p.297.

References

23. Calendar of the University of Sydney. 1923, p.45. Psychiatry. p.779

1. Dax EC. Australia and New Zealand. In: Howell JG (ed) The World History of Psychiatry. London: Balliere Tindall, 1975, p.781

24. Macpherson J. Neurasthenia, hysteria and epilepsy. Med J Aust 1924; 9: 201-203.

2. Kirkby KC. History of psychiatry in Australia, pre-1960. History of Psychiatry 1999; 10(38): 191–204. 3. The Australian Dictionary of Biography. Australian National University, 2012. 4. Turney C, Bygott U and Chippendale P. Australia’s First. A History of the University of Sydney, Vol 1, 1850–1939. Sydney: University of Sydney in association with Hale & Iremonger, Sydney University Press, 1991. 5. Greenberg PH and Beumont PJV. The clinical disciplines: psychiatry. In: Young AY, Sefton AJ and Webb N (eds) The Centenary Book of the University of Sydney Faculty of Medicine. Sydney: Sydney University Press, 1984, pp.390-391. 6. Lewis M. Managing Madness. Canberra: AGPS Australian Government Publishing Service. 1988, p.104 7. Young JA and Webb N. Prologue: the foundation of the faculty. In: Young JA, Sefton AJ and Webb N (eds) The Centenary Book of the University of Sydney Faculty of Medicine. Sydney: Sydney University Press, 1984, pp.1-2. 8. Young AY. Second act: the medical school 1882-1889. In: Young JA, Sefton AJ and Webb N (eds) The Centenary Book of the University of Sydney Faculty of Medicine. Sydney: Sydney University Press, 1984, p.137.

22. Minutes of the Senate. Archives of the University of Sydney. 22 February 1923, pp.334-335.

25. Macpherson J. The relation of neurasthenia and anxiety neurosis to the manic-depressive syndrome. Med J Aust 1925; 618-624. 26. Macpherson J. The psychiatric clinic. Med J Aust 1926; 174-178. 27. Inaugural Meeting: Australian Medical Congress (British Medical Association). Med J Aust 1923: 642-643. 28. British Medical Association News. Scientific Meeting of the NSW Branch of the British Medical Association. Med J Aust 1926: 392. 29. Report on a Meeting of Members of the British Medical Association. Med J Aust 1924: 155. 30. Early Mental Cases. Educative Clinic. “First of its Kind”. Daily Telegraph, 20 February 1923, p.5. 31. Something about the Psychiatry Department. Royal Prince Alfred Hospital Gazette, 16 July 1957, p.10. 32. Maddox K. Schlink of Prince Alfred. Sydney: Royal Prince Alfred Hospital, 1978: p.146. 33. Buildings. Royal Prince Alfred Hospital Annual Report. 1938, p.19. 34. Proceedings, Monday 30 April 1923. Witness Sir John Macpherson. Royal Commission on Lunacy Law and Administration, pp.195-203.

9. Child D. Royal Prince Alfred Hospital. In: Young JA, Sefton AJ and Webb N (eds) The Centenary Book of the University of Sydney Faculty of Medicine. Sydney: Sydney University Press, 1984, p.436

35. Shea P. Defining Madness. Institute of Criminology Monograph Series. Hawkins Press, 1999, footnote 68.

10. Great Alienist: Dr Eric Sinclair: Sudden Death. 25 May 1925. Sydney Morning Herald, p.14

36. Proposed Amendment to the Lunacy Act. Report of the Royal Commission on Lunacy Law and Administration. 1923, p.8.

11. Garton S. Dr Eric Sinclair (1860-1925). The Australian Dictionary of Biography Vol 11. Melbourne: Melbourne University Press, 1988. 12. Minutes of the Senate. Archives of the University of Sydney. 2 September 1918, p.99

37. Macpherson J. The new psychiatry and the influences which are forming it. Ninth Maudsley Lecture. J Ment Sci 1928; 74: 386.

13. Minutes of the Senate. Archives of the University of Sydney. 2 May 1921, pp.41-42

38. Lewis M. Managing Madness. Canberra: AGPS Australian Government Publishing Service, 1988, p.52.

14. Minutes of the Senate. Archives of the University of Sydney. 5 September 1921, p.85

39. Minutes of the Senate. Archives of the University of Sydney. June 30 1926, p.244.

15. Minutes of Senate. Archives of the University of Sydney. 5 December 1921, p.121

40. Roxanas M. William Dawson: a pioneering Australasian psychiatrist. Australas Psychiatry 2013; 21: 8-12.

16. Webb N and Young JA. The medical school in the 1920s. In: Young JA, Sefton AJ and Webb N (eds) The Centenary Book of the University of Sydney Faculty of Medicine. Sydney: Sydney University Press, 1984, pp.214-215.

41. Dawson WS. Aids to Psychiatry. London: Balliere, Tindall and Cox. Students aid series. 8 editions.

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Sir John Macpherson, the first but sometimes overlooked Professor of Psychiatry at the University of Sydney.

To chronicle the creation of the Chair of Psychiatry at the University of Sydney, and the career and legacy, in New South Wales, of the first incumben...
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