CELEBRATING MEDICINE IN THE KAROO

A Medical Humanities Literary Festival, scheduled for the 10th anniversary of the Richmond Booktown Book Fair in October 2016, will celebrate medicine in the Karoo. The event follows on the opening of South Africa’s first Museum of Optometry and Ophthalmology at this year’s event. The new museum was established to salute the work of Albert Gaston Eugen Fick, the developer of the contact lens. Way back in the late 1880s several people began speculating on the possibility of applying a lens or shell directly on to the eye to correct visual disorders. A variety of impractical and sometimes bizarre optical devices were suggested then, Fick, who once practised as a medical doctor in Richmond, made and wore the world’s first practical contact lens. By that time, he was back in Germany, but his basic research had been done on rabbits while he was in the Karoo.

FATHER OF ORTHOPAEDICS LIVED IN RICHMOND

Richmond’s history includes another world-famous medical man whom many hail as the father of modern orthopaedics. He was Albert (sometimes referred to as Emil), the son of Richmond’s general practitioner, Maurice Hoffa. He followed his father into medicine and then went on to play a pivotal role in the world of orthopaedics. His name is associated with a condition known as “Hoffa’s Syndrome or Hoffa’s fat pad disease”. It is characterized by the enlargement of the fat pad of the knee and aggravated by exercise. The condition consists of fractures to the distal femur caused by high energy trauma and presents as chronic knee pain beneath the patella. It is difficult to diagnose and, as it can often not be seen on X-rays, presents great challenges to orthopaedic surgeons.

A BONES AND JOINT MAN

Albert attended Richmond’s little local school, run by Irish schoolmistress Helena Gilstain, whose husband claimed to have stolen a kiss from Juana María de los Dolores de León, the beautiful Spanish wife of Sir Harry Smith. After completing his schooling, he went to Germany to study medicine at the Univerities of Marburg and Freiburg. Julius Wolff (known for Wolff’s Law) was one of his lecturers and a man whom he greatly admired. Hoffa’s doctoral thesis dealt with nephritis saturnina. In 1886 he opened a private clinic for orthopaedics, physiotherapy and massage. In 1895 he became an associate professor at the Wurzburg University and in 1902 succeeded Julius Wolff at the Uniersity of Berlin. Hoffa is also remembered for introducing an operation for congenital hip dislocations and the development of Hoffa’s system of massage therapy. He describes this in his textbook on basic massage where he advocates that massage should not last for any longer than 15 minutes. Hoffa’s textbook of orthopaedics, published in 1891, brought him world recognition. This work is still in use and so are many of his other writings on fracture, dislocation and massage. In 1892 he founded the journal Zeitschrift fur orthopädische Chirurgie. Legend has it that Hoffa met Fick at the University of Wurzburg and, in 1879 persuaded him to go to Richmond. Hoffa felt the crisp Karoo air would help cure Fick’s wife’s tuberculosis. He also mentioned that they would feel quite at home in this village because it had a large German speaking community. They came and for a while and were happy in this village. Then Fick returned to Germany to finalise his research.

Meet the Medical Men of the Great Karoo
SOME WERE TRUSTED ‘BOSSIEDOKTERS’

Over the years the Karoo has seen many medical pioneers. Some were trusted, respected “bossiedokters” (herbalists), who had no medical degrees. They used veld plants and “boererate” (farmer’s cures), lotions, potions and powders, mostly from their trusted little boxes of Lennon’s remedies and their success rate was impressive. One of these men lived and practiced at Klaarstroom, almost at the entrance to Meiringspoort. People came from far and wide to consult him. Judge Juta was among his patients. Then there were the highly-educated sons of the Karoo who qualified at leading European medical universities and returned to serve far flung hinterland communities. Some did groundbreaking work and discovered rare conditions, named in their honour, and this allowed them to step onto the world stage in unusual spheres of medicine.

THE KING OF HEARTS

Professor Christiaan Neethling Barnard, the son of a Beaufort West mission parson was perhaps the most famous of the Karoo medical men. He rocketed to world fame when he transplanted the world’s first human heart on December 3, 1967. His brother, Marius, who rose from the same humble beginnings to become a highly respected doctor and esteemed politician, was a member of the transplant team, that day. Many more sons of Beaufort West made medical history. One was Daniel Pieter de Villiers, fondly known as “DP”. Born in 1900, DP spent a carefree boyhood in old Beaufort West. He then studied medicine at the Universities of Cape Town and Liverpool in England, where he was greatly influenced by Blair Bell, a highly respected, internationally acclaimed professor of obstetrics and gynacaeology. Their meeting developed into a lifelong friendship and set DP on a career path where he was to become widely known. He was one of the first doctors in South Africa to start as private hospital. He also played important roles in agriculture and in the preservation of the country’s cultural heritage.

MOVED FROM MEDICINE TO LAW

John George Fraser, (Later Sir), was the eldest son of Beaufort West’s Dutch Reformed Church minister, Reverend Colin McKenzie Fraser and his second wife, Maria Elizabeth Sieberhagen. John qualified as a doctor at Kings College, in Aberdeen, Scotland in 1861. He returned to the Karoo and practised medicine for a short time. He then worked as a locum for Richmond’s Dr Maurice Hoffa. He served as a member of the Phillipolis Commando before moving to the Bloemfontein in 1871, switching to law and taking up an appointment as private secretary to President John Brand. He was a member of the Volksraad. He was knighted for his services to the Free State in 1905. He also served on the first Union Parliament in 1910. He married Dorothea Ortlepp and they had 11 children.

AN EXPERT ON FLOPPY BABIES

Another Beaufort Wester who distinguished himself in medicine was Victor Dubowitz whose father was a much loved, highly respected village shopkeeper. Victor, a pioneer in pediatric neurology, made meaningful clinical and research contributions in the fields of neonatal neurology and neuromuscular disorders in children. In 1965 he described a rare and difficult to diagnose, genetic disorder characterised by a small, round, triangular shaped face with a pointed, receding chin, a broad, wide-tipped nose, and wide-set eyes with drooping eyelids. It was named Dubowitz Syndrome in his honour. Victor and his wife, Lilly (nee Sebok) co-authored a book, The Floppy Infant, which is today still considered a classic throughout the world. His cousin Nathan Finkelstein, known as Mr Pharmacy was honoured for his meaningful role in the South African Pharmaceutical industry, and granted the freedom of his home town, Beaufort West, in May 2009. Nathan’s lifelong friend, Eugene Weinberg, also a Beaufort Wester, became one of South Africa’s leading paediatric allergists and head of the Department of Paediatrics at the Red Cross Children’s Hospital in Cape Town.

FLED FOR HIS LIFE

One son of Beaufort West, who qualified as a doctor, ended up fleeing for his life. He was Cecil Alport, and his father, a cousin of Sir John Charles Molteno, was a general dealer in old Beaufort West. Cecil also had a disease named in his honour. He pioneered a cure for a nephritis, a kidney complaint, which was later named Alport’s Disease. Cecil worked for some time in England and also on the Rand, then while working in Egypt in the early 1900s, he wrote an expose on the horrors and atrocities of the medical system in that country and, as a consequence, had to flee barely escaping with his life. More recently, Dr Cyril Karabus’s detention in Dubai for months captivated world attention. Karabus, MBChB, Town (also FRCP, FRCPE) the former Professor of Paediatrics, at the University of Cape and later head of the Oncology and Haemotology Unit of Red Cross Children’s Hospital in the Mother City, came from a very well-known Beaufort West family.

HEART MAN FROM HANOVER

Lionel Henry Opie, who hails from Hanover in the heart of the Great Karoo, hit the world headlines when he received South Africa’s highest Presidential award “in recognition of his national and international contributions to cardiology”. When accepting The Order of Mapungubwe in silver in 2006 he said three men inspired him to achieve in this field – they were Lister, Flemming and Professor Chris Barnard. Opie was only 12 when Fleming, received the Nobel Prize, yet he vowed he would pursue a similar career. A great admiration for Barnard led him to research the heart and in the end his research represented a breakthrough in the understanding of the causes of heart attacks and the use of medication for heart disease. Opie, who is considered one of the world’s foremost scholars of heart disease, has written hundreds of articles and books on his research. Two books were translated into Chinese. One is a standard reference on the treatment of heart disease.

SOME VISITORS ALSO HAVE TALES TO TELL

Sagas of several “visiting” doctors are also interwoven into the chronicles of the Karoo. Among them is William Gill who came to practice in Somerset East, but later turned his attention to botany and an Eastern Cape college was later named in his honour. Much meaningful work was done at the Imperial Yeomanry Hospital at Deelfontein, a short distance from Richmond, during the Anglo-Boer war. Among the medical men who served there and who received top honours at various stages of medical history were Dr John Hall-Edwards, a pioneer in the field of X-rays; Dr John Brian Christopherson, was nominated for the Nobel Prize in 1918 after discovering that an ancient poison, antimony, could be used to treat bilharzias; dentist, Frederick Newland-Pedley, the only specialist in this field to serve during the Anglo-Boer War, gave his name to a special porcelain crown. Dr Howard Tooth, who also briefly served at the IYH, was honoured with two colleagues for research, on a hereditary progressive neuropathic muscular atrophy that affects nerves that stimulate movement (the motor nerves) of the legs and feet. This is known as Charcot-Marie-Tooth disease. Donald Munro, a RAMC doctor was invalided to the IYH as a patient and later seconded to the staff. He fell in love with a local girl, Emily Adams, and stayed to practice in Steynsburg.

A FIRST IN PHYSIOTHERAPY

Service at the IYH at Deelfontein changed the life Florence Barraclough ‘Barrie” Lambert. As a nurse she was so impressed with the work done at the hospital that she went on to study medicine and qualify as doctor in 1906. Born, on August 13, 1871, the daughter of a solicitor, she was educated in France and trained as a nurse in London. Petite, energetic, intelligent and friendly, she was a ball of fire and enthusiasm with a keen sense of humour. With her friend Elizabeth Patteson she turned her attention to the physical medicine (physiotherapy) and studied in Stockholm. She did great work in this field. She achieved an almost unique distinction for a woman in those days and served as a major in the RAMC during WWI. After the war she moved in civic and political circles doing groundbreaking work in social reform. Party criticism never ruffled her.

CAME FROM A LONG LINE OF DOCTORS

Surgeon Dresser Lance Corporal Charles Bernard Sells, No 15309, died of typhoid at the Imperial Yeomanry Hospital, at Deelfontein, on January 22, 1901. He was 26 years old and one of six staff members to die in service at that hospital. Senior Surgeon, Alfred Downing Fripp, said Sells’s death was a “severe loss” to the surgical team. Charles came from a long line of doctors – his father, Charles John, and grandfather, Thomas Jenner Sells served the Guildford community for years. His great grandfather, William, a practitioner of physics and surgery, was born in Kingston and did meaningful work among the slaves in Jamacia before moving to America and later to St Luke’s Hospital in London. Born in 1874 Charles grew up in Guildford and attended Malvern College before going on to study medicine at Guys Hospital in London. At the outbreak of the Anglo-Boer War he enlisted as a trooper in the 31st Imperial Yeomanry Company and came to South Africa. Shortly after his arrival he was invalided to the IYH at Deelfontein, suffering from typhoid fever. When he recovered, he was attached to the IYH staff. Sadly, his typhoid re-occurred and killed him. He is remembered on the Old Malvernian Roll of Honour and on the central memorial in the Deelfontein graveyard where a marble cross marks his grave. His brother, Lionel, a medical officer, also contracted typhoid during the SA war. He became gravely ill and almost died, but fortunately recovered and went on to become an expert in the use of X-rays. Their brother, Hugh Lancelot, trained at Edinburgh University and served as a major in the RAMC during WWI. He later became deputy medical officer of the East Indian Railways. Their sisters, Violet and Sybil, were artists.

NO THOUGHT OF REWARD

Charles’s father, Charles John, was proud of his sons and their service to medicine. He personally served as medical officer at many hospitals and medical committees. He served at the workhouse from 1876 to 1922 and was praised for giving 46 years of service to medicine “without thought of reward”. He was appointed president of the East and West Surrey branches of the British Medical Association and the Sells Ward at St. Luke’s Hospital, in London, was named in his honour. On qualifying in 1867, he went into practice with his father (Thomas), at their home in Guildford High Street and, like his father he became a borough magistrate and mayor of Guildford. He married Emily Schofield in 1873 and, in time presided over a huge household comprising himself, his wife, eight (later 12) children (three of whom died in infancy), Emily’s mother, her sister, Helen, a medical assistant, a governess, a cook, a housemaid, a parlour maid, a nurse, under nurse, nursemaid and a groom. When Emily died in 1897 Charles married Edith Willoughby Darvel.

POWERFUL POISON BULB TRANSPORTS THE DEAD

“The advancement of human consciousness can be mapped by the quest to access the landscapes of the spirit and the life hereafter,” writes Heather Dugmore “This drive has replayed itself out over the millennia – from the ancient Egyptians to the Khoi and San of Southern Africa. Both mummified their dead with sacred embalming extracts to keep them intact for the life hereafter. The best local example is a 2 000-year-old Khoisan mummy that was discovered in a cave in the Baviaanskloof Mountains of the Eastern Cape, not far from Shamwari. The mummy was embalmed with the scales of the Boophone bulb, a member of the March lily family. The Khoisan people believe this bulb had the power to transport the dead through the doorway of the spirit to the life hereafter. The plant is revered and feared by the Khoisan for this reason. They regard it as enormously powerful. Khoisan herbalists who traditionally share their knowledge of healing plants will not discuss the powers of the Boophone. They will not even go near the bulb when they see it growing in the wild.” Professor Ben-Erik van Wyk, believes the plant might well have been used in traditional Khoisan trance rituals. “It is highly poisonous and the line between a trance and fatal dose is extremely fine,” he says. “Absolute precision is required.”

We all look for happiness, but without knowing where to find it: like drunkards who look for their house, knowing dimly that they have one – Voltaire