In 1895 Grace Neill – a tall, red-headed, cigarette-smoking nurse – became New Zealand’s first female senior public servant.

A year later Emily Siederberg became New Zealand’s first female medical graduate and went on to challenge Plunket founder Dr Truby King’s claim that higher education would impair the health of the nation’s future mothers.

Again in 1896 Sibylla Maude left her job as matron of Christchurch Hospital to found the cycling district nursing association that still bears her name.

Within a few years of each other that same decade, Margaret Cruikshank, the country’s first female GP, and Hester Maclean, who became the country’s first chief nurse and army ‘matron-in-chief’, both graduated.

The 1890s was a heady decade for women – as the Victorian era came to a close the fairer sex were also ready to prove that not only were they worthy of the vote but could also cut their own paths in the health professions.

Other pioneers had gone before them, with in 1881 Elizabeth Robinson becoming the country’s first female registered pharmacist and Margaret Caro becoming the country’s first female registered dentist. Pioneers to follow were Ākenehi Hei the country’s first female Māori registered nurse (1908) and Rina Moore, the first female Māori doctor (1949).

Health Central looks at the story of some of these women – starting with the feisty public servant whose legacy includes laying the foundation for New Zealand’s nursing, midwifery and maternity systems.

Grace Neill: “nondescript combatant against drink, poverty, factory owners and the medical profession”

Grace Neill in 1895 took on the rather daunting title of deputy inspector of lunatic asylums, hospitals, licensed houses and charitable institutions.

The only woman working in Wellington’s Government Buildings at the time, she was requested to enter the buildings either before or after the men employed there.

But that didn’t mean she was submissive – the strong-willed reformer later boasted that no public official could treat her as “putty” and delighted to “twist and twiddle Minister and Premiers” to make them think they were having their own way.

Born into the Scottish gentry in 1846, the young Grace Campbell did not defy her father when forbidden to study medicine and instead trained as a nurse in London, but was later shunned by her family for marrying a doctor considered below her. After training as a midwife, she and her husband and their only child emigrated to Queensland for her husband’s health. After she was widowed, the single parent helped found a trade union for women that led to a state appointment on a Royal Commission on Labour Conditions and an invitation soon after to cross the Tasman.

And so began her career in the New Zealand public service – most of it in her deputy inspector role, with a brief to deal with the ‘numerous and delicate’ questions affecting women in the areas of health and welfare.

Much of her job involved working with stressed and stretched local hospital and charitable aid boards. But a major focus also became nursing reform and she is most famous as the instigator of what is said to be the world’s first national registration act for nurses, which was passed in 1901. Her own name was first on the register and she also set in place the nursing curriculum, set up the state final exam and designed the registered nurse medal.

In 1904 she followed this up with the Midwives Act 1904, but this involved also establishing a series of state maternity hospitals – known as the St Helen’s Hospitals, after the birthplace of Premier Richard (Dick) Seddon – where registered midwives could be trained. The hospitals were to be “for mothers, managed by women and doctored by women” with no male medical students allowed. The self-described “nondescript combatant against drink, poverty, factory owners and the medical profession” later said her two most successful achievements were raising her son and “making the pains and risks of child bearing less” for hundreds of women who birthed in St Helen’s Hospitals.

Emily Siederberg: fighting ‘the wrongs of womankind as she would fight for the life of a patient’

Unlike Grace Neill, it was Emily Siederberg’s father who told her from a young age that she must train as a doctor.

She was born in Central Otago in 1873 where her German father and Irish Quaker mother had been drawn by the gold rush. The family later moved to Dunedin where her she and her father ticked off the barriers for her becoming in 1891 the country’s first female student enrolled in the University of Otago Medical School.

Apart from a “trifling occasion when a few pieces [of flesh] from a dissecting table” came her way, she later did not recall any major issues with being the sole female medical student, but was grateful when fellow Otago Girls’ High student Margaret Cruikshank joined her the following year.

Siederberg graduated in 1896 to become the country’s first female medical graduate and worked as a locum for one month at Seacliff Lunatic Asylum before heading overseas for further study in obstetrics, gynaecology and children’s diseases in Dublin and Berlin.

On her return in 1898, she registered as a medical practitioner in Dunedin, where she continued to practise for 30 years.

Siederberg’s career was to be influenced by the work of Grace Neill when in 1905 she became the medical officer and later superintendent of Dunedin’s St Helen’s Hospital. She took an active role in the training of midwives and with the matron battled against sometimes strong opposition from medical colleagues to the female-led, midwifery model hospital.

She was also active in welfare work and women’s organisations was said to have fought ‘the wrongs of womankind as she would fight for the life of a patient’, including championing education for women alongside her St Helen’s Hospital counterpart in Wellington, Dr Agnes Bennett. The pair in 1909 combined forces to challenge the views of Plunket founder Dr Truby King and other senior medical school staff, who opposed women’s higher education in the belief that the stress would be detrimental to the health of the nation’s future mothers.

Sibylla (Nurse) Maude: “The most cruel thing you can do is take away a family’s self-respect”

Sibylla Maude’s transition from controversial Christchurch Hospital matron to the much loved founder of Nurse Maude district nursing began with a decision in 1896 that she would rather nurse then lead.

Born to an influential Canterbury family, she travelled to England in the late 1880s to train as a nurse in London and returned to be appointed matron of Christchurch Hospital in 1893. She attempted to improve conditions in the conditions and training of nurses at the hospital but was ahead of her time and her reforms were not welcomed by the hospital board. A commission set up in 1895 cleared her of mismanagement but she decided to resign in 1896 and later that year began what was to become New Zealand’s first district nursing service.

With a long-held wish to bring nursing relief to the poor, old and infirm unable to afford hospital, she gained funding to initially offer her one-woman service by foot, then horse and cart to people in need around the city. She was finally joined by an assistant in 1902 and as the infant district nursing association grew the nurses were given a fleet of bicycles and – fuelled by bacon sandwiches – cycled around Christchurch tending to their patients.

In 1918 the registered charity took the name of the Nurse Maude Association for District Nursing and later that same year Nurse Maude was put in charge of a central bureau to co-ordinate the care of victims of the Black November influenza pandemic.

She is described as having an uncompromising and direct approach but combined with real compassion and empathy for those most in need of her care. She was often heard to say “The most cruel thing you can do is take away a family’s self-respect”. When she died in 1935 the people of Christchurch lined the streets for her funeral.

Margaret Cruikshank: “The beloved physician, faithful unto death”

The country’s first female GP is most remembered for her selfless service to the Waimate community during the great influenza pandemic of 1918 that robbed her of her own life.

Margaret Cruikshank’s path to medical school was not an easy one with her mother becoming terminally ill when she was about 10 years old, prompting her and her twin sister Christina – who were the eldest of seven children – to stay home alternate days from school to help out at home leading up to their mother’s death.

But they were bright girls and after attending the local Palmerston District High School went on to Otago Girls’ High, where they were joint Dux. Both went on to university but Cruikshank chose to follow her friend Emily Siedeberg into medical school and graduated a year after her in 1897. Soon after she took up the position as an assistant to a Waimate GP and became the first New Zealand trained woman to register as a doctor and work as a GP. (The first female doctor to register in New Zealand was the controversial overseas-trained doctor Eliza Frikart.)

Cruikshank became a partner in the practice where she practiced and lived for the rest of her life but did not stop studying and gained a Doctor of Medicine in 1903 and spent 1913 gaining further postgraduate qualifications in Edinburgh and Dublin. With the start of World War I she took on the full practice as her partner headed away to war along with Red Cross work and sharing the role as local hospital superintendent.

By the time the influenza epidemic hit, she was already strained by overwork but kept pushing on to care for flu-struck patients around the district – including stepping beyond medical care to at times feed babies and milk cows. Then the weary, selfless doctor caught the flu herself and succumbed to pneumonia on November 28, 1918. A statue was erected of her in the town carved with the words: “The beloved physician, faithful unto death”.

Hester Maclean, Matron-in-Chief of the New Zealand Army Nursing Service in WWI. From www.nzhistory.net.nz.

Hester Maclean: “A nurse must be a woman, working not in the first place for the sake of money-making, but for the good of her fellow creatures…”

Hester Maclean spent her 20s enjoying Sydney society life until a change in family circumstances saw her start her nursing training aged 30.

She may have started her career late but once started she was a formidable force and when she stepped into Grace Neill’s shoes in 1906 as New Zealand’s new assistant inspector of hospitals she quickly made her mark on New Zealand nursing.

One of Maclean’s first moves was to found the country’s first nursing journal Kai Tiaki in 1908 and then to amalgamate the regional nursing associations into the professional-standards focused New Zealand Trained Nurses Association in 1909 – the forerunner of today’s New Zealand Nurses Organisation – of which she was the founding president.

In 1911 she was given the titular title of Matron-in-Chief of an army nursing reserve yet to exist. So when World War I broke out a few years later she kept lobbying the Government to turn the reserve into a reality because was she was aware of hundreds of New Zealand nurses keen to “share to some extent in the dangers and hardships of the troops”. She wore them down and in April 1915 she joined the first 50 official New Zealand Army Nursing Service (NZANS) nurses in setting sail for Europe in their picturesque coats of grey and scarlet and accompanied them when they were redirected to Egypt to care for the wounded arriving from Gallipoli. She reluctantly returned to her home duties in 1916 but her actions allowed around 600-plus New Zealand nurses to serve during the war.

In 1920 MacLean was the country’s first official ‘chief nurse’ for the new Department of Health as well as the registrar of nurses and the owner and editor of the country’s nursing journal. She oversaw the development of Plunket, tuberculosis, school and backblocks district nursing, independent midwifery, the Māori health nursing service and nursing training for Māori women.

She also set a culture of expecting professional standards for nursing but regarding nursing as foremost a vocation as a “nurse must be a woman, working not in the first place for the sake of money-making, but for the good of her fellow creatures…”. MacLean campaigned for nurses’ superannuation and merit pay and increased salaries for senior staff, but fought against the eight-hour day, arguing that nurses must be allowed to work the hours that met the needs of their patients.

She retired in 1923 and although she sold Kai Tiaki to what is now NZNO, she continued to be its editor until her death in 1935.

OTHER NEW ZEALAND FEMALE HEALTH PIONEERS

Akenehi Hei: first female Māori registered nurse

Akenehi Hei (sometimes called Agnes) was born in 1887 or 1878 to a Te Whakatohea and Te Whanau-a-Apanui family at Te Kaha, Bay of Plenty, and went on to attend St Joseph’s Māori Girls’ College in Napier.

In 1901 Hei, encouraged by her Te Aute graduate brother, began a basic nursing skills programme offered by the Government at Napier Hospital intended to make her and others an “efficient preacher of the gospel of health” for when they returned to their villages as a “good, useful wife and mother”.

In 1905 the scheme was extended to offer full nurse training and the still-unmarried Hei qualified as a registered nurse in mid-1908. She quickly completed her midwifery training in the same year at St Helen’s Hospital in Christchurch in readiness to be part of a 1907 Public Health Department scheme to employ Māori district nurses (working in public hospitals was not envisaged or encouraged for the first Māori nurses.)

But by late 1908 there were still no government funds allocated to pay for Māori district nurses and it wasn’t until June 1909 that she was offered a two-month post nursing in a Northland typhoid epidemic. After that it took several more months until she was finally offered another post in New Plymouth.

Hei reported her greatest difficulty was balancing the demands of her Pākehā training with the traditions of her people. “Great discretion must be used not to offend the patient’s beliefs,’ she wrote, ‘and at the same time uphold one’s own mission”.

Tragically, she succumbed to typhoid in late 1910 after returning home to nurse family members who were ill with typhoid.

Her biography in Te Ara – The Encyclopedia of New Zealand states she not only had to deal with institutional racism – her postings were seen as a test case “to see how these Māori nurses act” – but also with little support from a department which was concerned with minimising costs and was not fully committed to Māori health work.

Elizabeth Robinson: first female registered pharmacist

Elizabeth Robinson began her career assisting her husband Richard in his Cashel St pharmacy which they lived above with their children. When he died in 1871, she continued to run the business and in 1881 was the first woman registered under the new Pharmacy Act 1880, which had set up a registration system to protect the public from ‘amateurs’ and ‘witchdoctors’.

 Margaret Caro: first female registered dentist

Young Nelson woman Margaret Caro’s journey to becoming New Zealand’s first registered female dentist started with her marrying in 1864, at the age of 16, a Polish man, James Caro, who had trained in Berlin and Melbourne as a physician. The pair worked in isolated mining and farming communities across the South Island, where she learnt to sew up wounds, set bones and administer dental treatment, and became a mother of three sons.

In 1881 she became the first woman to be listed on the Dentists Register of New Zealand and was the only woman to attend the inaugural conference of the New Zealand Dental Association in 1890. The family settled in Napier, where Caro ran her own dental practice until 1909.

Rina Moore: first female Māori registered doctor

Born Rina Winifred Rohipa, of Ngati Kahungunu, Rangitane, and Te Whanau-a-Apanui iwi, her parents installed in her a strong work ethic and ensured she and her siblings had the best educational opportunities available to them.

Moore began studying medicine at Otago University in 1941

She married in 1944, and the couple welcomed their first child the following year. Despite their daughter’s birth, Moore continued her studies, graduating in 1949 to become the first female Māori doctor.

Her first post-graduation job was an assistant medical officer at Ngawhatu Mental Hospital, Nelson.

Her biography in the Dictionary of New Zealand states: “Her interest in psychiatry began during a class visit to Seacliffe Mental Hospital where she instinctively reached out to a patient who had committed murder.

“Her ability to recognise the essential humanity in each person, and to connect with it, particularly if the person was in trouble, was central to her work. She had great compassion for the sick and handicapped, and a special gift for helping those who were unable to help themselves.”

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