Saturday, October 5, 2013

Part 4 - The clinical teachers, Some milestones in the history of the Colombo Medical School - Some remarkable Clinical Teachers of the early 1960s. Part 4 The Clinical Teachers.

The Clinical teachers
In the ward classes called the 'Pre-clinicals' in our 2nd MB and in the appointments called 'Clerking' in the later years, where the students spent two months with a Consultant in each major specialty  the inputs were remarkable. Each one of these Consultants was a 'character'. What fun we had learning about life and medicine from them. They were some of the ideals we built on. They were quite 'distant' with us as they belonged to a different generation but the dedication and love they had for their work stood out. Hardly any of them were mercenary and they did not have the vulgar habit of flaunting their riches.
I list below a few of the names which stand out and will expand on the experiences we had as students.

The Clinical teachers -The Surgeons.

Dr. Clifford Misso - Consultant Surgeon
Clifford Joseph Ledulx Misso, L.M.S. (Ceylon), Civil Medical
Department, born 14th March 1909, married in St. Mary's Ohurch,
Bambalapitiya, 14th September 1936, Verna Edith May Misso
(vide X X X I I I . 1, supra). He had by her :—

1 Louis Hilarie Ledulx, born 12th September 1937.
I did my first surgical clerking of two months with Dr. Misso. He was soft spoken and mild mannered. He would arrive in a white satin drill suit and a sober tie. There was no drama of his entry into his ward. On our clerking groups first post casualty rounds he stopped next to a patient with a fractured patella. He asked the medical students ‘What is the problem with this patient?’ I was the first to answer and said ‘He has a fractured patella’. His next question was ‘How did you diagnose it?’ With the rash foolishness of youth I replied ‘I can see it on the Xray’. The next comment that Dr. Misso made ‘Very clever’ made me hide my head in shame.  My answer should have given the history of the accident and the subsequent series of inspection, palpation and specific tests in that order before coming to the Xray. That was his gentle way of teaching.
His surgical technique was meticulous. The morbidity and mortality in his ward was minimal.
At the end of his days work he would be tie-less and he would carry the folded coat over the back of one shoulder grabbing the collar of his coat by one hand. He would wend his way to the parking lot where his ‘Jubilee Hillman Minx’ would be parked.
I have seen this car parked often near the Maradana railway bridge. I later came to know that one of his hobbies was identifying the make and model of railway engines.




Photos of steam engines taken by Dr.CJL Misso

He lived in retirement in Australia and died in 2013 aged over ninety years.

Dr. P.R. Anthonis - Consultant Surgeon
'Romiel was born in Bambalapitiya in 1911, the second child of a family of sixteen children. His father, Margris Anthonis Appuhamy (baptised as Michael, although never following the Christian faith), was a carpenter who, after the birth of his third child found employment at the carpentry workshop at Brown’s, later rising to be the supervisor for the handsome salary of fifty cents per day. His mother, Egelthina Perera, was from Kotikawatte, and was the daughter of a well known Ayurvedic physician, popularly known as Juse Vedamahattaya.' - http://www.infolanka.com/org/srilanka/people/76.htm
Dr. P.R.Anthonis LMS 1936, FRCS 1947, recalls the 1930s, “ I became a medical student in 1930, undergoing  the ‘rag’ upstairs at the Mahamodiya Hotel in Pettah in the usual manner in the usual garb, with the usual discomfiture.  Alcohol was forced down me by ‘senior’ Gerry Muller”.
He continues, “For old people, fracture femur often meant death, death from pneumonia and pressure sores. Plenty of splints and slings were used on fracture patients. In the  Convalescence Hospital at Ragama, I was the first honorary House Officer, with one Apothecary to assist.. Most of the wards had galvanized ‘takarang’ roofs. One ward was reserved for orthopaedic patients under treatment from Colombo. In Colombo many wards down Regent St. were for private patients and only the chief surgeon had the right to private surgical patients there. Generals surgeons tackled all problems.”  His salary was Rs. 250/ per month. (A teacher would receive about Rs.30/ at the time)
Two physiotherapists served the whole hospital.
All nursing care was by European sisters under a mother superior until the 1950s.     


The O.T. ‘D’ was the major operating theatre with the new theatre complex A, B, C, commissioned from the late forties.   
From - History Sri Lanka Orthopaedic Association by Dr. JKS Weerasekara, Orthopaedic Surgeon -http://srilankaoa.m.webs.com/site/mobile?dm_path=%2Fhistory.htm&fw_sig_premium=0&fw_sig_permission_level=0&fw_sig_social=1&fw_sig_url=http://srilankaoa.webs.com/&fw_sig_is_admin=0&fw_sig_permissions=none&fw_sig_api_key=522b0eedffc137c934fc7268582d53a1&fw_sig_access_token=9d5fe0d7466254c7cdd497c79a17570c0db5c3ae&fw_sig_time=1381073361003&fw_sig_session_key=e3fefc617bb54134add039324e851e6279b18ef34c4efdbba5bfe2c418f8ee9d-62248066&fw_sig=6974edfb21d73742a9bd3d8eee35b869&fw_sig_tier=0&fw_sig_site=62248066&fb_sig_network=fw#0301 

'Antho' as he was known by generations of medical students was a household word for prowess in surgery in Sri Lanka from the 1950s till his death in 2012.
He had been a medical officer attached to the Government Hospital, Avissawella. He had operated successfully on a young female patient for appendicitis  He was subsequently invited for dinner by the wealthy father of the patient to their mansion at Kithulgala, a few miles off from Avissawella. The younger sister of the patient - Ruby - caught the eye of the young 'Antho'. They were subsequently married at a gala wedding. 'The bridegroom made his entrance to the ceremony riding an elephant. The entire 'Siv-paa balaya' (the four modes of carriage) was present at the sumptuous reception' - this was related by a very old resident from Kithulgala.


http://www.island.lk/2010/01/03/features9.html


Dr. Noel Bartholomews - Consultant Surgeon
Dr.Bartholomews was DMA at Avissawella Hospital in the 1940s (War years). He had become very friendly with a gentleman farmer of the area by the name Sadiris Appuhamy. Sediris had a son and two daughters. The son Somasiri is resident now at Avissaweela. Somasiri  worked in the Municipality here he is now retired) and told me the following stories.
Sadiris had become very attached to Dr.Bartholomews and his wife. He used to take rice pounded from paddy from his first harvest to Dr. Bartholomews.  When Dr Bartholomews went on transfer to Badulla, Sadiris had collected the best fruits of the season like Rambuttan, Mangoostein, Mangoes etc by train to Badulla. The Kelani Valley narrow gauge train transported the fruits as parcel to Colombo Fort and from there it went by the Badulla train to be collected by Dr.Bartholomews at Badulla. Below is a Photostat copy of a letter sent by Nora Bartholomews to Sadiris.


                Travelling from one province to another apparently needed a permit from the authorities during war time. That explains the last part of the letter and shows how ‘Batho’ was prepared to stick his neck out for Sadiris.
                In later years after Dr.Bartholomews went to the UK and came back with his FRCS, he was posted Surgeon at the GH Colombo. Sadiris used to visit ‘Batho’. Batho would take Sadiris round his garden and get advice on horticulture from Sadiris. Sadiris had received an earlier model of a Singer sewing machine which worked without a shuttle, as a present from Batho. He had also gifted Sadiris a ‘Rudge’ bicycle which the proud Sadiris road all the way from Colombo to Avissawella.
                At one point ‘Batho’ had asked sadiris whether he would be willing to give his son Somasiri for adoption by him. Since Somasiri was Sadiris’s only son the latter had politely declined the offer. Somasiri told me jokingly that if he had been adopted by ‘Batho’ that he would have been the owner of the house now occupied by the College of Surgeons.
                Later when Somasiri applied for jobs ‘ Batho’ had given him letters of recommendation. 
                I came across an old lady who showed me a mastectomy scar for a Ca Breast done by ‘Batho’ long ago. She described to me how ‘Batho’ had done the clinical examination on her prior to the surgery. It was a classic text-book description of how to examine a breast.
                Dr. Burhan told me how ‘Batho’ presented an Abdomino-Perineal resection in a youngish female. At the end of the presentation he showed a biopsy report of the specimen which identified the pathology as Chrohn’s disease. Such was the integrity of ‘Batho’ that he presented and admitted his mistake. He showed to emphasize the importance of biopsy prior to this type of surgery.

'...Mallika Home was adjudged the 'Best Home in the Western Province' by the National Secretariat for Elders in 2003. Renovated in 2004 with the assistance of a generous bequest from the Nora & Noel Bartholomeusz Fund, the original building still retains it's old world charm'.

 http://mallikahomes.org/elders.shtml


A comment on my book ‘The Cry of the Devil Bird’ by Dr. Miachael Abheyaratne, who was SHO to ‘Batho’.
Dear Philip,
Thank you for so promptly sending me your new book.I read it through at one sitting and was fascinated.I was of course some years your senior though I did have contact  with Kappagoda and Karaliadde and Dayasiri. My career track followed very much on yours and I had the great pleasure of working with Dr Bartholomeusz both as interne and as SHO. I was happy to hear that you cleaned out the floor cases section and replaced it with an HDU. I was also very impressed with your teaching methods; I am sure the great man would have been very appreciative  of one of his sucessors.
Best regards
Michael Abeyaratne.(25/7/2010)

Part of a letter from Ms.Anne Ranasinghe commenting on my first book ‘Remembered Vignettes’:-

 Noel Crusz: In a Sri Lankan hospital in Colombo some years ago, I was setting up my camera and lights to film a major surgical operation. It was for a brilliant Fellow of the Royal College of Surgeons, London. His name was Noel Bartholomews.
'Sorry', he said, as he walked late into the theatre, 'I was on dialysis at home.' Through the years he had lost normal kidney functions. Now he was to begin a five hour operation on the jaw of a young man.

Click on each of the web-links below:-

http://www.rootsweb.ancestry.com/~lkawgw/gen1037.html



Dr. DF de S Gunawardena - Consultant Surgeon
'DFDS' as he was affectionately known was always dressed in white satin drill suit and tie of sober colors. He drove a Mercedes Benz and his male ward was on the ground floor (Ward No 1 of the 1960s). His female ward was ward 5 and was managed by a Sister who was a stickler for cleanliness. I was his intern in 1960. There was a Senior House Officer Dr. Malik Vitharana who had completed his Primary FRCS and there was myself the only intern. 'DFDS' was soft-spoken due to some problem in his larynx after a surgery it was rumored. The students who had to get close to him to hear what he commented that they went to do his surgical appointment to learn 'The secrets of surgery'. On a New Year day the medical students doing his 'clerking' had entered the Operating Theater late. DFDS had said something to them looking from behind the surgical mask he was wearing inside the theater  The students thought that he was wishing them a happy new year and replied 'Wish you the same Sir'. A louder reply by DFDS was much clearer this time. It was 'You are late, get out'. It was a sad beginning for a New Year for the students. DFDS had a son who was in our medical batch of the 1960 entrants.

Dr. Drogo Austin Consultant Surgeon

GENEALOGY OF THE FAMILY OF AUSTIN
, OF CEYLON
(Compiled by Mr. F. H. de Vos in. 1914; revised by
Mr.-D, V- AUsndorffin 1958).
I
Nathaniel Austin of the 3rd Ceylon Regiment, Deputy Assistant
Commissary General, Galle, born 26th March 1785, died at Galle, 7th
June 1853, married in St. Peter's Church, Fort, Colombo, 80th July 1807,
Sophia Frederica Wilhelmina Calesky, born 6th February 1794, died 1862,
daughter of Friedrich Wilhelm Calesky of Grandzee (Branderburg) and
Elizabeth Rodriguez, widow of Jan Harmensz of Amsterdam. (D.B.U.
Journal, Vol. XXXVII, page 68). He had by her—
1 William, who follows under II.
2 Nathaniel Adrian, who follows under I I I,
3 George, born 11th December 1811, baptised at St. Peter's
Church, Fort, Colombo, 25th December 1811.
I I
William Austin, born 12th May 1808, baptised atNigel Drogo Cameron, horn 2nd April .1946. ;V':0;;


Lester Drogo Cameron Austin, L.M.S.' (Ceylon), F.R.C.S., (Eng.),
|pvil Medical Department, born 17th. October 1910, married in the Dutch
Reformed Church, Bambalapitiya, 6th.June 1935, Alice Eleanor Loos, ■
pmi 18th September 1912, daughter of Guy ;Errol Loos, District Engi-
IIJ^V Public 'Works Department, and Eleanor Lucretia de Hoedt.
^•B.Tj, Journal, Vol. XXXIX, page. 117)1 ' H e had by her—
1. Carole Myrna born 18.3.1937. Married on 19.2.1955 Naomal Sucil Dias
born 17.2.1934, son of Cecil Dias and Monica de Soysa.
2. Jeanette Ethel born 30.3.1941. Married on 4.4.1959 at St. Andrews
Scots Kirk, Colombo, George Arthur Richard Arndt born 22.10.1929
son of Dr. George Herbert Arndt and Verena Laura Corrinne Ephraums
3. Nigel Drogo Cameron born 2.4.1946 Married on 15.12.1971 Dawn
Shalini Chanmugam .

Dr.Austin, was a stickler for discipline and protocol. Ward rounds would start in time. The Surgeon would lead, the ward Sister would follow and the house officers in order of protocol. Woe to the person who stepped out of line. On one occasion while waiting for the lift to take everyone to the ward upstairs, a medical student jumped the gun and walked in preceding everyone waiting. Dr. Austin grabbed the miscreant by the collar and while chucking him outside the lift exclaimed ‘Senioris prioris’. Dr. Mark Amarasinghe who trained with him told me that if he made a false move while assisting at surgical operations he would get a rap on the knuckles. Dr. Austin had an ‘Austin Gypsy’ and a caravan to go on his jungle trips. Later he bought an orange colored ‘Peaugeot 404’. Dr Singaratnam related to me how after a trip to Chilaw Hospital for a Clinical meeting Dr.Austin found himself locked out of his car with the key inside. Dr. Singaratnam used his old ‘Morris Minor’ key and opened it to a grateful Dr. Austin.

There is a ‘Drogo Austin Gold Medal for Orthopaedics’ awarded at the Medical Faculty Colombo. 

Diversions of a Diplomat – Philip Crowe -


The following are some references to Dr. Austin in the above book.
..’One chooses carefully companions for a trip like this, 
for the success of the venture as a whole could easily be 
wrecked by the fears or tempers of any one member of the 
expedition. My original plan was to take ten men with 
me, in addition to the crew and cook, but three of those 
invited had to drop out. The following seven made the 
journey : James Espy, Counsellor of the American Em- 
bassy and a good man to have along any time for any pur- 
pose ; Paul Deraniyagala, Director of the Ceylon National 
Museums and a well-known authority on the Island's fauna 
and flora ; Dr. Drogo Austin, leading surgeon of Colombo ; 
Colonel Christie Jayawardana, Camp Chief of the Ceylon 
Boy Scouts and A.D.C. to Her Majesty the Queen ; Mr. 
Charles Cruickshank, United Kingdom Trade Commis- 
sioner in Ceylon and my companion on a journey to the 
little-known Maldive Islands ; T. L. Green, Professor of 
Education at the University of Ceylon ; and Dr. Chandra 
Gooneratne, Director of Films for the United States 
Information Service in Ceylon…’ 

…’Soon after we passed the hawk eagle, Drogo Austin, 
who was sitting next to me in the adjoining canoe, gave a 
shout to the effect that he had dropped the telephoto lens 
of his camera overboard. The river at that point was 
narrow and fast but fortunately only about waist deep. 
Tom Green had the presence of mind to note where the 
lens had dropped. He intimated that this quick reaction 
was due to his early poaching experiences in England when, 
occasionally, he had to dump his shotgun overboard. The 
canoes were stopped and, while two boatmen held them 
against the current, the rest of us plunged in and, forming 
a line, waded over the area. Christie, the last one to join 
the line and the most dubious about its success, promptly 
found the lens. Trust the Boy Scouts to make the miracle 
rescue of the year !’ 

…’Drogo and Christie 
were busy shooting pigeons for supper and Chandra and 
Tom were supervising the pitching of our tents for the 
night. The elephant party, therefore, consisted of Charlie, 
armed with a Leica camera, Paul with a pair of binoculars, 
Jim with a shotgun and me with the -405 Winchester.’
 
 
…’Aided and abetted by Drogo, John produced a 
savoury mess consisting of chop suey, fried Bombay onions, 
fried bacon, shredded cabbage, boiled rice, two tins of 
mushroom soup, one tin of tomato soup and pre-cooked 
bully beef.’
 
…’Dr. Drogo Austin, a leading surgeon of Colombo and 
owner of a pack of beagles himself, also showed up with 
his family for the day's sport, and by the time the stars 
were beginning to pale, we left the plantation and headed 
for a big stretch of jungle about ten miles away.’ 
 
Dr. K G Jayasekara Consultant Surgeon
Dr. Jayasekara was technically superb as a surgeon. He had an unbroken success with 5 porto-caval anastomosis for portal hypertension in the early 1960. A Resident Surgeon who acted for him while he was away on leave did a similar case and the patient died post-operative. Dr. Jayasekara was livid at the break of his record in his unit.

Dr. Niles Consultant Surgeon
Dr.Niles was another person who used to talk with flamboyance. He was talking about the progress of an aneurysm of the ascending aorta in a ward class for medical students. He narrated:-
“ The aneurysm of the ascending aorta starts getting bigger. It presses on all the surrounding structures. It causes pressure necrosis and erodes through them. Thus it erodes through the body of the sternum. It will erode through the skin in front of this area. It will also erode through the “Hentley Gold Label” shirt that the, patient is wearing. Then the patient will collapse and die.” Hentley Gold label” was the acme of middle class read- made shirts in Ceyon, in the early 1960’s.
                Once when doing a ward round he addressed a patient and asked what was wrong with him. The patient answered “Moothra wala seeni thiyanawa”- (There is sugar in my urine). He gave the necessary instructions and went to the next patient. He repeated the question to him. The answer was “Moothra wala piti thiyanawa”.-(There is flour in my urine i.e. his urine was turbid). Like a flash Niles told both patients –“Umbala denna ekathuwela, bakeriak dapalla” -  (Both of you get together and open a bakery). The understanding being that both can produce the flour and sugar needed as raw materials for the bakery.

I remember an incident while clerking with Dr. Niles. He always presented himself well dressed in starched cream colored suites, and was well spoken. During one of his morning rounds, with my colleagues and I trailing behind him, he went up to the patient listed for Hernia operation the following day and explained to him the surgical process. He explained that the surgery involved would include ‘’kappanawa’’ , ‘’pallanawa’’(cutting). ‘’thallanawa’’ (pounding), much to the flabbergasted patient’s horror. Needless to say the following morning he found that the patient was missing from his bed, as obviously he had bolted.
Regards

Sadiq


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