Milestones in the History of Surgical Practice in the Sudan


By Abdel A`Al Abdella Osman


Part 2: 1924-1949 The Period of training Sudanese Doctors and medical auxiliary staff.


The main features of this period were: the creation of Kitchener's School of Medicine for the training of Sudanese doctors: the establishment of a specialist cadre made necessary for teaching purposes in the medical school; and the dawn of postgraduate training of Sudanese doctors.
Kitchener's School of Medicine


Lord Kitchener was appointed High commissioner in Egypt after completion of his mission in Sudan. It was during his last visit to Sudan in 1914 that Lord Kitchener suggested the establishment of a medical school for the training of Sudanese doctors with the purpose to replace the expatriates. His death towards the end of the First World War created great public enthusiasm to fulfil his wish. In December 1916, the subscription list was opened and the collection of funds mounted quickly, especially during Mr. Atkey's directorship which started in October 1922. On the 29th of February 1924, Sir Lee Stack formally opened the Kitchener's School of Medicine. That was Stack's Last public act in Sudan before his assassination in Cairo in November 1924 (Squires, 1958).


The Kitchener School of medicine was probably the first medical school with syllabus established in north tropical Africa. The students were trained to be general-purpose doctors. It was Mr. Atkey's opinion, from the start, that the school should have some contact with the general world of medicine. For that reason, he established the principle that competent assessors should be present to view the carrying of professional examinations and should be given the opportunity to express their criticism and advice after an inspection of the various departments of the school. Among those reporting were Presidents of the Royal Colleges of Physicians of Edinburgh and London: and Presidents of the Royal Colleges of Surgeons of England and also Presidents of Royal College of Obstetricians and Gynaecologists.


To start with, the length of period of study was four years. In 1934, it was increased to five years. In 1939, it was further increased to six years, two of which is to be spent in School of Science. In 1940, the School of Science period was reduced to one and half years, leaving four and half years for medicine. In 1946, the course of School of Science was reduced to one year and medicine left with five years as it is today.


In 1946, the School obtained full recognition by the London Colleges. In 1948, it was recognized by the Council of Royal College of Physicians of Edinburgh. In 1949, the Royal College of Surgeons of Edinburgh recognized the posts of surgical registrar at Khartoum and Omdurman Civil Hospitals for the purpose of FRCS examination. It was interesting to note that Dr. Abdel Hamid Bayoumi, the first Sudanese to become a surgeon, was sent to England in 1948 and obtained his fellowship in 1949. In 1963, the Royal College of Surgeons recognized the surgical registrar post at Wad Madani Hospital for the same purpose: and 1972 a similar post was also recognized for Omdurman Military Hospital.


In 1952, the School became a Faculty of the University of Khartoum with full-time staff. The student intake was half a dozen at the start, increasing gradually to one dozen in 1951. After joining the University of Khartoum, the student intake to the faculty jumped to 30, 60, 120, and 180 and now is 300. In spite of this increase, many students went to study abroad.
Establishment of the Specialist Cadre


Before 1924, all doctors functioned as general-purpose doctors irrespective of any specialty they might have. They were given various titles of Medical Officer, Medical Inspector or Director according to administrative status. However, no qualified surgeon was given a status lower than Medical Inspector. All surgeons who joined the services during the 1898-1924 period obtained their fellowship before arrival in Sudan with exception of Mr. Hill.


At one time, namely around 1912, the Medical Services consisted of seven British doctors who were all specialists: four FRCS and three MRCP. Dr. Squires described it as the most highly qualified service in the world. In practice, the backbone of the service was always a Syrian Medical Officer until the late thirties when they were gradually replaced by the Sudanese doctors. In all small hospitals at Sawakin, Halfa, Merowi, Dongola, and Dueim and in many of the big ones, the Syrian Medical Officers were invaluable especially during First World War. Ismail Ahmed, theatre attendant, has witnessed that two Syrian Medical Officers working in Omdurman Civil Hospital about the mid-twenties, namely Dr. Yousif Muzhir and Dr. Ridda Khusat, performed a mastectomy to El Sayed Taha's daughter (Grand mother of Dr. AbdeIMoneim Abd EIGhaffar and aunt to Mr. Ahmed Nageeb) at home. Ismail prepared the instruments and towels: put them inside a wooden box which he carried on a donkey (no ambulance service) to El Sayed Taha's house next to the late Sayed Khalil's home. Ismail must have "SERVED" a richly supplied (operating) table because the lady enjoyed, thereafter, a long healthy life.


In 1924, the first specialist appointment was made. Mr. Footner was appointed Senior Surgeon and lecturer in surgery and Dr. Squires Senior Physician and lecturer of Medicine. In 1928 Mr. Hill succeeded Mr. Footner as Senior Surgeon and lecturer and in 1933 Mr. Mayne followed him. With the death of Sir Lee Sack in 1924, the Egyptian troops were sent back to Cairo. The Sudan Defense Force was formed and its medical corps initially consisted of British and Syrian doctors. British additions to Medical Department (re-named Sudan Medical Service in 1925) tremendously increased. For example in 1925-1929 twenty-five doctors joined the service (some for very short periods), amongst them famous surgeons such as L. O'Shaughnessy, F.S. Mayne, and E.W.T. Morris, and in 1932 among five new recruits was F. Bartholomew (Squires, 1958)


Luarance 0 Shaughnessy, FRSC: He was born in Durham and his medical training was in Newcastle. He was hard working, preserving and extremely intelligent. He passed the final FRCS at twenty-three, one year before the time when he could receive the qualification. His two great loves were surgery and the Territorial Army.


He arrived in Sudan in 1924 and was sent to Sennar to look after the personnel engaged in building the Dam. In 1929, he was sent to take charge of Omdurman Civil Hospital, which before that date was under the care of Mr. Footner.


During his short stay in Omdurman. Mr. O'Shaughnessy showed profound proof of his talents. As a surgeon, he could do any operation indicated. Uncle Ismail, theatre attendant in Omdurman Hospital since 1924, served him doing thyroidectomy under local anaesthesia, cholecystectomy, gastrectomy and even uretro-colic anastomosis for ectopia vesicae. In the field of experimental surgery, he performed 200 phrenic nerve avulsions and lobectomies and was probably the first one to do sympathectomy for blindness (I.M. EIMaghrabi, personal communication).


Besides his surgery, he used to teach physics, chemistry, botany, zoology and gynaecology. In his leisure time, he used to learn German, thus preparing himself for the study of thoracic surgery under the famed Professor Sauerbruch of Berlin. He retired in 1931, and made use of gratuity for that purpose. Collaborating with Professor Sauerburch he was able to produce an early textbook on Thoracic Surgery in England.


When back home he took thoracic work at Maidstone Sanatorium. Assisted by Lord Dawson, he was put in charge of the Heart unit at Lambeth hospital. The outbreak of the Second World War offered him the chances of enjoying his loves. He was experimenting on pathways of the spinal cord and shock. He was of the opinion that chest surgery should be done at the field hospital and not at the base. His death in France before Calais 1940 was a great loss to the surgical profession.


F.S. Mayne, FRCS: He graduated from Queens University, Belfast. Having obtained Edinburgh Fellowship, he was (1929) posted to Sennar in place of O'Shaughnessy who was transferred to Omdurman. Two years later (1931), he also replaced O'Shaughnessy on his retirement. In 1933, he succeeded Grantham Hill in Khartoum as a Senior Surgeon and lecturer but not as Director of the Hospital, the most senior in the hospital always held the later post. The surgeons who held the post of Director were Christopherson to start with, and then G. Hill and lastly A. Bayoumi near his retirement. Mr. Mayne kept the twin posts until 1944 when he was forced to retire after a gallant struggle with ill health. Thus, he had considerable surgical experiences.


E.W.T. Morris, FRCS: He was a graduate of St. Thomas Hospital. On joining service he was posted (in 1929) at Source Yogu. Before that time, all doctors in southern Sudan were military. While in Source Yogu Dr. Morris acquired his fellowship. He worked for a short period in Wau (1939), El Fashir (1936) and then at Madani in 1938 (Dr. Ali Badri, personal communication).


In 1944, he left Wad Madani to succeed Mr. Mayne in the twin post of Senior Surgeon and lecturer up to 1949 when he retired. Back home, Mr. Morris preferred to be a teacher in anatomy at St. Thomas Hospital Medical School. He came to Khartoum for a couple of years as a professor of anatomy during 1966-68. Mr. Morris is still acting and enjoying good health he was a keen polo player.


F Bartholomew, FRCS: He joined the service in 1932. Also he was stationed at Port Sudan, he was also functioning as a relief doctor. In 1939, while in Merowi he obtained his Edinburgh Fellowship. His longest stay was in Omdurman 1937- 1949. During his directorship, the hospital developed greatly under his inspiration.


Mr. Bartholomew was conceptious and devoted to his profession and the strain of the war took its toll on him. In 1949 he succeeded Mr. Morris as Senior Surgeon and a lecturer in the Medical School. In 1952, his health broke down and he was taken to London, were he died of obscure cardiac condition (probably due to dissecting aneurysm of the aorta).


Dr. A. Bayoumi, who replaced Mr. Bartholomew in 1949, also succeeded him in the capacity of Senior Surgeon and Lecturer in 1953.
Dawn of Postgraduate Training


Before the Second World War, Sudanese Doctors were sent to England to acquire postgraduate experiences. There was no idea at first of these doctor taking diploma or courses for higher qualification; and the length of their stay approved was only three months. Dr. Ali Badri and Dr. Hussein Ahmed Hussein were the first to go in 1937 (personal communication).


The first batch of Sudanese doctors graduated in 1928, when they were badly needed to replace foreign doctors in the service, particularly after 1931, when the price of cotton dropped very low in the outside market. All military doctors were withdrawn and Syrian medical officers in civil service dispensed with. The last Syrian doctor left the Sudan in 1939. Under these circumstances there was no chance for sending doctors for higher specialization in surgery. It is of interest at this juncture to note that the first Sudanese graduate to perform planned non-barber surgical operation in Khartoum Civil Hospital was Dr. Ali Badri. According to Khartoum Hospital Operation Registry it was excision of madura in a fourteen-year-old patient named Ali Khider done under chloroform on the third of May 1928. Four days later, Dr. Ali Badri performed Syme's amputation for the same disease in 21-year-old Osman Ali Elawad. Dr. Ali Badri vividly remembered his first experience in surgery. It is engraved in his memory, because it reminded him of the final qualifying examination in surgery. Mr. Robert Dolby, MS, FRSC, professor of clinical surgery Cairo was the examiner for the first batch of graduates. He asked Ali Badri to demonstrate Syme's amputation on the foot of cadaver provided; when he saw his performance. Mr. Dolby looked at the performance, he said "Is this a surgical operation or a camel bite?". Such a comment was rather demoralizing for a pioneer student about to graduate! "This comment was spinning into my ears when I did the Syme's after qualification" said Ali Badri. It made him give up surgery, but he enjoyed giving anaesthesia for other surgeons from 1933 to 1937.


The late Dr. Ali Kheir was the first Sudanese reported in the operation registry of Khartoum to perform a hernia operation under spinal, and cataract extraction under cocaine on the sixth of June 1938