KAMALIKA PIERIS

 The History of surgery in Sri Lanka published by the College of Surgeons of Sri Lanka contains surgical information which will be greatly valued by the surgeons. But the book also contains information which will appeal to those interested in the history of medicine.

 The book is a gold mine of medical biography. The biographies are presented    in three clusters, 1860-1910, 1911-1948 and 1949-1975. These biographies are neat and well written.  The biographies focus on the professional career of the surgeon, not his personal life. They record the hospitals the surgeon worked in, appointments held and contributions made to surgery. Anecdotes and reminiscences from fellow surgeons, seamlessly woven together by the Editor, make these biographies come alive. Each biography has a pleasing photograph beside it.

The development of general surgery in Sri Lanka during this period is shown through the biographies in these three clusters. This is a clever double use of the biographies. We learn that it was R.L.Spittel who had introduced masks and gloves for the surgeons. Nicholas Attygalle was the first to train his assistants and registrars to conduct operations directly under his supervision. They went on to do major operations on their own.

The emphasis on biographies does not end with these three clusters. Biographies are woven into   the rest of the book. The sections on surgical specialties carry biographical information on each surgeon who worked in that specialty, in the early days and now. The section on provincial and teaching hospitals provide at least a mention of each of the surgeons who had worked there, at one time or another.

 In the section on undergraduate training, there is a detailed description for each university teacher, the date of joining the department, his academic achievements, including prizes and awards. There is a detailed description of the overseas training, special techniques learned are listed. The surgeon’s career in the state health service prior to joining the university is given. Many of the services introduced to the hospitals by the university departments of surgery are presented through biographies of the surgeons who worked there and are working there today, a clever strategy.

The tone in all these biographies is very generous. One surgeon was described as he is a popular trainer of postgraduate surgical trainees and a mentor to many of the unit’s younger surgeons.

In addition to these capsule biographies, the book makes special mention of one family which produced three generations of surgeons, the Jaffna Tamil family of surgeons, starting with W.T. Paul. WT Paul had trained in medicine under Samuel Greene in Jaffna. His son was S.C Paul, an outstanding surgeon of his time. He was First Surgeon in General Hospital, Colombo in 1908. S.C. Paul had got rid of all surgical instruments with wooden handles and replaced them with metal instruments which could be sterilized. There is a photograph of SC Paul’s his home, Rao Mahal in Ward Place built in 1901.

 SC Paul produced two sons, who were   outstanding surgeons, Milroy Paul and ATS Paul.  A T S Paul was a pioneer in cardiac surgery in Sri Lanka . Milroy Paul (1900-1989) was a brilliant and versatile surgeon. This book devotes several pages to him. He won many awards in London when he went there to study. He was the first Professor of Surgery at Ceylon Medical College, a position he held until his retirement. Milroy Paul had over 80 publications in prestigious peer reviewed journals.  He was the first Ceylonese to deliver the prestigious Hunterian Oration at the Royal College of Surgeons, London.  He was invited to do so three times. 

There were no pediatric surgeons at the time and Milroy Paul generously ran a pediatric surgical ward at Lady Ridgway Hospital Colombo, in addition to his work at General Hospital. He was on call for emergency surgery at Lady Ridgway Hospital, twice a week.  He had done post mortems on all fatal cases, much can be learnt from these, he said.

 Dr P.R.Anthonis (1911-2009) is given a whole chapter, the only surgeon to be recognized in this manner. It is also the only chapter with personal information, such as origins, education,   and marriage. Anthonis did not come from an affluent family. His father was a carpenter.  Father rose to be the supervisor of the carpentry workshop at Browns for the salary of fifty cents per day. Father had only a little English but was a voracious reader in Sinhala and composed refined poetry.

The Anthonis family lived in Bambalapitiya, in Colombo. Anthonis had learnt his first letters at the Dharmasalawa, later known as Vajiraramaya.  At that time Vajira Road was a narrow, gravel road with thick jungle all round. My brother, sister and I would walk barefoot to school. I wore a white sarong, he recalled. The family kept a cow. ‘We used to wake up at 4.30 am to feed the cow, he said. 

Anthonis has practiced as a surgeon for a record period of 70 years and had performed over a hundred thousand operations. He had kept a record of all his cases, in bound volumes listed by year. The account ends with the operation on Prime Minister SWRD Bandaranaike after he was shot in 1959. There was general agreement at the time that Anthonis had performed the operation very satisfactorily, though ‘the patient died’.

One of the striking features of this book, is the enormous number of photographs included in it .It is most unusual for a work of this type to have so many photographs of such clarity and good quality.

 The majority of the photographs are photos of surgeons.  They are part of the biographical slant in the book .But they are also cleverly used to function as lists. Instead of an inanimate list of names we have photographs of all the doctors who had worked in a specific hospital. A clever device.

For instance, there are two pages of photos of the surgeons of the   National Hospital, Colombo, those who are currently working there and those who were there in the past.  There are similar pages of photos for surgeons who had worked in the other hospital in Colombo District, at Kalubowila, Colombo North and Kelaniya.  There are similar photo galleries for the other provinces too.

The book also has many photographs of surgical equipment and surgical operations, which will be interest to the surgeons. There is a photo of the first Surgical Intensive Care unit at the General Hospital Colombo in 1968.  This was probably a significant advance.  There are some photographs of interest to the layman. My favorite is the lovely colour photograph of the  General Hospital, Colombo, in 1914, taken from a   postcard. It has a very ornate front.  A photo of the ‘kadamandiya’ where Karapitiya hospital was built is an unexpected inclusion in the book. (Continued)