Professor Abdela’al Abdalla Osman, the previous President of the Sudan Association of Surgeons, a pioneering Sudanese Plastic Surgeon and one of the Fathers of surgical and medical education in Sudan, has spent much of his life-time studying History and Islam, and has gone a long way towards interpreting many features of human anatomy, physiology, behaviour and pathology within the lines and words of the Quraan.His writings and quotations on the history of the development of the Sudan and its tribes, and the development of Islam in Sudan go hand-in-hand with his narration of the Development of the Surgical Services in Sudan.His article on the “Milestones in the History of Surgical Practice in the Sudan” which we present here in three sections or eras (the same three periods he has give
Milestones in the History of Surgical Practice in the Sudan
By Abdel A`Al Abdella Osman Introduction Our knowledge of the pattern of medicine that was practiced in Sudan in the early 19th century is small. Broadly speaking, internal diseases were treated with herbs and magico-religious methods, while surgical diseases were mainly treated with cautery, scarifications, various forms of dressings and manipulation with or without modified splinting. Modern medicine was introduced in the beginning of the 20th century by the Anglo-Egyptian army that conquered the Sudan in 1898. It gradually passed through several phases before progressing to its present standard. The few doctors who first came to Sudan were army doctors, manning a small medical service whose main object were to look after the health of the troops. Gradually, this small service grew, extending its service to civilians and so not only more army doctors had to be recruited but also civilian doctors were asked to join. The backbones were British doctors in the senior post and Syrian doctors in the junior posts. By 1955, they were all replaced by Sudanese doctors. These pioneers had to work under difficult conditions and quite often had to do additional work unrelated to their training. As a result of their experiences and cumulative hard work over the years, they made a slow but steady progress.        This paper is meant to give a broad outline of the events through which modern surgery in the Sudan passed; to acknowledge the debt we owe to those pioneers who paved the way for our present medical service and medical training; and to remind our young doctors that medical history, like that of all arts and sciences, is continuous. The past form basis for the present and the present for the future. For convenience, this paper is divided into three periods: *        1898-1924: The establishment of medical and health services. *        1924-1949: The training of Sudanese doctors and medical auxiliary staff. *        1949-1972: The development of specialized surgery and the promotion of para-surgical auxiliary functions. Part 1: 1898-1924: The establishment of medical and health services During this period, the history of surgery cannot be separated from general medicine. The first concern of Medical Corps of the British-Egyptian army was to look after the health of their own troops. The doctors were either British, holding the rank of Major and above, or Syrians (lieutenants and captains). After reopening of Sudan, their second concern was to look after cleanliness and sanitation in the large towns in the North in order to protect themselves and citizens from outbreaks of cholera, small pox, malaria, etc. and in 1898, the total revenue collected in Sudan amounted to 35,000 pounds only. With such an insignificant budget to start with, for such a large country, the only source of supply for new officials was against commissioned ranks in the Egyptian army (Squires, 1958). In 1900, small civil hospitals were opened in Khartoum, Omdurman, Berber, Dongola, Halfa, Suakin and Kassala. The first three British civilian doctors arrived in Sudan early in 1901, and were given the rank of temporary Bimbashi (Major). They were: Dr. E. A. Gates, O.B.E, who work for one year at Omdurman and Kassala before going back to Britain; Dr. Webb Jones, who was stationed at Halfa and then left to Alexandria to become a surgeon there; Dr. E.S. Crispin, who graduated in 1898 and volunteered as a civil surgeon in South Africa during the Boer War. When his contract ended, he accepted the offer of the Principle Medical Officer of the Egyptian Army. He arrived in Cairo in February 1890. In 1902, he was sent to Southern Sudan to deal with health problems in that area.        Simultaneously, a similar offer was made by doctor Theodore Dyke Ackland, FRCS, Medical Adviser to the Governor General, to Mr. J.B. Christopherson, FRCS who accepted it. Dr. Ackland, who was a physician, had worked in Egypt since 1880 and came to be close friend of Sir Reginald Wingate. He was for a short time the Principle Medical Officer of health of the Egyptian Army. In 1900 he was appointed Medical Adviser to the Sirdar and the Governor General and was asked to select Medical Personnel for the Sudan Government. Both Dr. Crispin and Mr. Christopherson joined the Sudan Government service for 2 years, during which they led very distinguished careers. Their names were deeply engraved as founders of the medical services in Sudan (Squires, 1958). Mr. J. B. Christopherson, CBE, FRCS, FRCP: He was the fourth civilian doctor and the first qualified surgeon to join the service. His career and that of other pioneer surgeons who worked with him or followed him will be described in some details. Mr. Christopherson graduated from St. Bartholomew’s hospital and all his service in Sudan was in Khartoum.        In 1904 the Governor General decided to establish a civil medical service for the country, to be called the Medical Department. Mr. Christopherson was appointed as the first Director of the department. Dr. Crispin protested and offered his resignation. However, he was appointed to the newly created post of Medical officer, Port Sudan when the present harbour was being constructed. During Mr. Christopherson`s directorship(1904-1908), the Medical Department was extended as follows: the authorized British cadre of civilian doctors was raised to six; Syrian civil doctors appointed in the Medical Department increased to more than thirty; three modern-type planed hospitals were built in Khartoum, Port Sudan and Atbara. They contained three classes of beds. The first and second classes were assigned to government officials: British, Egyptian and Sudanese. The hospital contained wards for the women. Operating theatres were included and two British sisters, Miss Pye Moore and Miss Jones joined the services. In 1908, Mr. Christopherson was appointed as a Director of Khartoum and Omdurman Hospitals and so gave his time to clinical work. Colonel Mathias, who was the Principle Medical Officer of the Egyptian Army, succeeded him as Director Medical Officer of the Medical Department and Dr. Crispin was appointed as Assistant Director. Also Mr. Christopherson was devoted to clinical surgery; he was in fact working as a general purpose doctor in addition to surgery and administration. In 1908, he reported the first case of relapsing fever in Sudan. The spirochete was detected by a Syrian Medical Officer in a routine examination of blood of a patient coming to Khartoum from a village 50 miles north. Mr. Christopherson confirmed the diagnosis. In 1914, he was assigned to temporary duty with the Red Cross Hospital in Serbia during World War I, and was taken as prisoner of war by the Austrians but had an early release because of Slatin Pasha`s intervention in Vienna. After the war, he accomplished the most significant contribution to medicine made by a member of the Sudan Medical Service. On 15th of July 1919, he published in the Journal of Tropical Medicine and Hygiene the successful treatment of seventy cases of schistosomiasis with intravenous potassium antimony tartrate. He also injected the same drug through the dorsal vein of the penis, in an attempt to get maximum concentration of the same drug around the worm in the perivesical plexus of veins (I. El Maghrabi, personal communication). For this great discovery, he received the C.B.E and was elected Fellow of the Royal College of Physician of England while he was still abroad. This latter honour was similarly bestowed on the late professor Kirk, Director of the Stack Medical Research laboratory and first professor of pathology in Kitchener School of Medicine. In 1922, Mr. Christopherson retired on a pension and was succeeded by Dr. Hodson, MRCP, as a Director of Khartoum and Omdurman hospitals. Dr. Hodson was the fifth civilian doctor and arrived in Sudan in 1903. He studied in Oxford and graduated at St. Thomas`s hospital. He worked in Kaser Ini for a while. He obtained his MRCP in 1908 when at Atbara. In 1921, he opened the Medical Assistants School. In 1924, he replaced Dr. Ackland as Medical Representative, Sudan Government in London (Squires, 1958).        Mr. N.E. Waterfield, CMG, FRCS: like Mr. Christopherson, Mr. Waterfield was a graduate of Bartholomew`s hospital. He obtained the fellowship and joined the Medical Service in 1905. Thus he was the sixth civilian doctor to arrive in Sudan and the second qualified surgeon after Christopherson. He had no settled post for a time, but was mainly at Khartoum. In 1908 he was transferred to Port Sudan to replace Dr. Crispin, there he spent the full tour of his service before retiring to Britain. Mr. O.F.H. Atkey, CMG, FRCS: he was a graduate of King`s College Hospital, London. He spent his resident surgical post in the Royal Free Hospital and like Mr. Waterfield obtained his FRSC before coming to Sudan in 1907. He was the seventh qualified surgeon to join the Medical Service. For some years, he acted as leave relief in summer and was given special duties during winter. In 1919 he was entrusted with the medical supervision of Blue Nile Province with Headquarters at Wad Madani. In 1922 he succeeded Dr. Crispin as Director of Medical Service, till 1933 when he was succeeded by Dr.(later Sir) Eric Pridie. During the eleven years of his directorship, Mr. Atkey had a very distinguished career. The Medical service was greatly expanded and even more important was his contribution in collecting funds for Kitchener`s School of Medicine. His name will always be remembered in connection with the School. Besides this Dr. Atkey was a great horseman and air pilot in spite of the trouble with his visual accommodation, which used to give him a difficult time when he was landing with his small air craft (I. ElMaghrabi, personal communication). Mr. G. R. Footner, FRCS: a graduate of St Thomas’s Hospital, spent his surgical residentship at Derby before obtaining his fellowship. He was the fourth qualified surgeon to join the Sudan Medical Service. He arrived in 1909 and spent his early years of service as medical officer in charge of the personnel working the railway extension to El Obeid and Kassala. In 1919, when Sudan Medical Service took the Gezira and Upper Nile Provinces from the military, Mr. Footner was posted as Medical Inspector in Malakal. To be able to get about in the province, he asked Dr. Crispin, the Director of the Medical Service, to provide him with a hospital ship. DR. Crispin made use of an old steamer, called Atbara, taken by the government from the Sudan Development and Exploration Company. The steamer was refitted to contain the dispensary and examination room on the lower deck leaving the upper deck for an operating room, an eight-bed room for in-patients and Mr. Footner’s accommodation. The experiment proved to be practical and successful.        When there was an overflow of patients extra accommodation was provided on a barge tied to the side of the steamer. The ship was named Lady Baker by Dr. Crispin with the approval of Sir Lee Stack. About 1880, Sir Samuel Baker was sent to Southern Sudan to stop slave trade. His wife, Austrian by birth, was the first European lady to carry out medical work in tropical Africa. Sir S. Baker was related to Dr. Crispin by marriage; and also a direct relative of R.E.T Baily, governor of Kassala Province. About 1931, a new Lady Baker was specially designed for the purpose and still exists (Squires,1958). While on duty Mr. Footner followed an injured lion into the Upper Nile jungles. He sustained penetrating wounds in his knee from the lion. Mr. Atkey was able to save Footner`s limb; but he lived with a stiffened knee for the rest of his life. Before the accident Mr. Footner was a keen cricketeer and tennis player. In 1924, with the emergence of Kitchener’s School of Medicine, Mr. Footner was the first to fill the newly created post of Senior Surgeon and Lecturer in Surgery. Mr. Footner used to visit Omdurman Hospital three time per week to look after the surgical problems. Before completion of the White Nile Bridge in 1927, Mr.Footner used to cross in a ferry to Mawrada where the theater attendant stood waiting for him to accompany him to the hospital. (Ismail Ahmed, Personal communication). Mr. Footner retired in 1929, and was succeeded by Mr. Grantham Hill. He died in 1943 of carcinoma of the small intestine, a very rare condition. Mr. Grantham Hill, FRCS: Mr. Grantham Hill is a graduate of Cambridge who worked in the London Hospital for some time. He arrived in Sudan at the end of 1920, and in 1922 was posted in Madani in place of Mr. Atkey who became the Director of the Medical Department. In 1928 Mr. Hill obtained the Edinburgh Fellowship. He was afterwards transferred to Khartoum to succeed Mr. Footner as Senior Surgeon and Lecturer of Surgery in the Kitchener School of Medicine. In 1930, he was also Director of Khartoum Civil Hospital. He retained these posts up to 1933 when he retired to settle as surgeon Beccles, England. He was fond of sailing (Dr. H. ElNagar, personal communication). Summary During the period 1898-1924, surgical practice did not develop into separate specialty due to the preponderance of the medical and public health problems of the country. Thus the qualified surgeons in the country were functioning as general duty doctors. Of course they still had to deal with the surgical and obstetrical problems that crossed their way. With the same understanding, the medical assistants, who were primarily trained as auxiliary medical staff to help in the fields of public health and internal medicine, were also taught to deal with minor surgical procedures. They opened abscesses, excised lumps, performed circumcisions and gave general inhalational anaesthesia (mask and ether). Sometimes the very experienced medical assistants were allowed to deal with hernias and amputation (A. Bayoumi, personal communication). 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). Part 3: 1949-1972:                                                                                                   The development of specialized surgery and the promotion of para-surgical auxiliary functions The main features of this period were: Postgraduate training of Sudanese doctors in general surgery and in sub-specializations such as orthopaedics, E.N.T., plastic …etc., and their acquiring of specialist posts in the Ministry of Health and University of Khartoum, and the promotion and expansion of Surgical Auxiliary Services. Postgraduate Training in Surgery.        The later years of the last period witnessed the dawn of postgraduate training for the Sudanese doctors. Before the Second World War, doctors were sent to the United Kingdom for short postgraduate courses; but following the war, proper postgraduate training was started. For example, in the years 1946-53, thirty seven doctors were in the United Kingdom. The candidates were given the opportunity to acquire higher qualifications in the various branches of medicine. This was the natural outcome of the increase in the number of Sudanese doctors, the high degree of efficiency and self-confidence they had shown, their desire to gain more knowledge, and of course the increasing consciousness of the public about the need for specialist services. For convenience, the development of postgraduate training of surgery will be discussed in various sub-headings according to their chronological order. Pioneer Sudanese Surgeons.        In 1948, Dr. Abdel Hamid Bayoumi was sent to the United Kingdom to acquire the fellowship in surgery. The candidate has to do both parts of the fellowship abroad. This system was not a success for two main reasons: candidates were selected many years after graduation, hence it was difficult to pass the Primary Fellowship Examination; and they were not sponsored by a teaching centre that may facilitate their training.        From 1948 to 1960 only three Sudanese doctors obtained the fellowship this hard way. They were Mr. Bayoumi, Mr. Bakheit M. Omer and Mr. I.M. el-Moghrabi. Abdel Hamid Bayoumi, F.R.C.S.: He graduated from the Kitchener School of Medicine in 1934 (6th batch of Sudanese doctors to qualify). Having completed his internship, he served as Medical Officer in many stations, particularly Torit where he spent five years. In 1947 he was selected surgical registrar to Khartoum Civil Hospital, and in 1948 he left for the United Kingdom to attempt the fellowship. It was a real burden to be the guinea-pig for such a challenging mission. It seemed as if all eyes in the Sudan were on Bayoumi and his colleagues (to register their success or failure). In 1949 he passed the Edinburgh and Glasgow fellowships, thus proving that he was worthy of the responsibility.        He came back home and was posted surgeon at Omdurman Civil Hospital in place of Mr. Bartholomew who was promoted Senior Surgeon, Khartoum Civil Hospital. Four years later Mr. Bayoumi was the first Sudanese to become Senior Surgeon and lecturer after the death of Mr. Bartholomew.        Mr. Fleming, M.S., F.R.C.S.E., who was appointed lecturer in anatomy and Assistant to the Senior Surgeon in 1951, returned to the United Kingdom on the Sudanization of the latter post by Mr. Bayoumi.        Mr. Bayoumi held the Senior Surgeon post for twelve years, retiring in 1966, to be succeeded by Mr. Ibrahim el-Moghrabi. Collaborating with the Professors of Surgery in the University on the one hand and the Ministry of Health Authorities on the other meant that surgery was promoted both in quantity and quality during Bayoumi’s tenure. He was elected president of the Sudan Association of Surgeons several times during the eight years since its formation.        Ibrahim M. el-Moghrabi, D.Chur., D.Orthop., F.R.C.S.: He graduated from the Kitchener School of Medicine in 1935. Having completed his internship he continued to work in Khartoum Hospital with the intention of becoming a surgeon; but he left the Sudan for Cairo to pursue his surgical training where he passed the D.Chur. and D.Orthop. He then left for England on his own initiative where he had further training in surgery and obtained the English fellowship in 1952.        He returned to Sudan and was posted Surgeon at Wad Medani Hospital in 1953. In 1965 he was transferred to Khartoum to become the Senior Surgeon after Mr. Bayoumi. He retired in 1968, and was succeeded by Mr. Ahmed Abdel Aziz.        During his stay at Medani, surgery was greatly developed in that hospital, so much so that the Royal College of Surgeons recognized a post of surgical registrar for the purpose of the F.R.C.S. examination. Mr. Moghrabi’s reputation came from his research work on mycetoma which was of great contribution to Prof. J.B. Lynch in obtaining his Hunterian Professorship and Dr. El Sheikh Mahgoub in his thesis for Ph.D. on mycology. Full-Time Surgical Staff of the Medical School        About the year 1952, it was decided by the University of Khartoum to create professorial posts in the various departments of the School.        Prof. B. Hickey: He was the first to fill the chair in the Department of Surgery. He was assisted by one or two lecturers or senior lecturers. The professor and his assistants were allocated surgical beds for which they were fully responsible. Later, posts for anaesthesia were created within the Department of Surgery.        Mr. P.R. Slade, F.R.C.S., was the first full-time senior lecturer appointed with the professor; he was succeeded by Mr. Mynors.        The Senior Surgeon and his fellow surgeons on the Ministry side-in both Khartoum and Omdurman Civil Hospitals-continued their contribution to the teaching of students. With the promotion of Mr. Bayoumi to Senior Surgeon in 1954, the Omdurman surgical post was filled by a German doctor. The latter did not prove a success and was soon replaced by Mr. Barst, F.R.C.S., who successfully filled the post till his retirement in 1963. Mr. Barst had worked for over ten years in the Sudan; first at Port-Sudan and then at Juba when he got his F.R.C.S.        Not all British doctors who were surgeons or later became surgeons, are mentioned in this article. An example of the former was Mr. O. Grattan, F.R.C.S., who worked in Khartoum and Port-Sudan before going to East Africa in the mid-forties. In addition, mention should be made of Mr. Husband and Mr. Owens. The latter is now a urological surgeon in St. Mary’s Hospital, London.        Prof. Julian Taylor, C.B.E., M.S., F.R.C.S.: he was a graduate of University College Medical School and spent his career in University College Hospital. He obtained the English fellowship in 1914 and was consulting surgeon to the Eighty-five Field Ambulance in France and Macedonia during the First World War. In 1920 he obtained M.S., London. In University College Hospital he was at first a consulting surgeon but later became the Senior Surgeon. He also served in the Malayan Command (Singapore) during the Second World War. He was also a Member of Council-Royal College of Surgeons-and before retirement he was Vice-President to the College (Who’s Who 1972). Sailing was his favourite recreation.        Mr. Taylor was the visiting examiner to the Kitchener School of Medicine in 1953. On his retirement from University College Hospital, Mr. Taylor succeeded Prof. Hickey in 1956. The history of the making of Sudanese surgeons was accelerated by the appointment of Professor Taylor to Khartoum University. No professor had been made in the making of surgeons since Mr. Moghrabi passed the F.R.C.S. in 1952. All Sudanese candidates sent to the United Kingdom to get that qualification failed in their mission. One of Professor Taylor’s main concerns was to solve this problem. He tackled it from various angles.        For those who were already selected surgical registrars, he insisted that they should work for two years in the basic medical sciences and undergo a test before being allowed to proceed to the United Kingdom. They (Dr. Osman Awadalla, Dr. Ahmed H. Adam, Dr. Abdalla Saad, Dr. El-Nazeer Fadl el-Mula), being relatively young graduates, thought the plan to be unnecessary. However, they all successfully passed the primary and final F.R.C.S. examination in the United Kingdom.        Secondly, Professor Taylor decided to send new graduates for the F.R.C.S. mission. From among the 1956 graduates who finished their housemanship in April 1958, he focused on three, namely Dr. Haddad Omer, Dr. Nasr el-Din Ahmed, and Dr. A. Abdel Aziz. Dr. Haddad’s first desire was to become an obstetrician and so he preferred Prof. Daly’s offer. Dr. Nasr el-Din who was Medical Officer El Dueim-immediately after his internship-was taken by Professor Dean Smith for the Department of Physiology. Thus Dr. Ahmed Abdel Aziz accepted Professor Taylor’s offer to be the guinea pig. However, the 1959 guinea-pig was better fed than the 1948 one. So he succeeded in his mission and obtained his F.R.C.S. in 1961.        The third intervention by Professor Taylor to solve the problem was to ease the way to the fellowship for all competent applicants. Being a Vice-President of the Royal College of Surgeons before coming to Sudan, it was a comparatively easy job for him to convince the College to hold a Primary F.R.C.S. examination in Khartoum each year. The first examination was held in 1960, and every year up to now Khartoum Centre has been running with a very high percentage of pass rates. The candidates are given training courses in the basic medical sciences at the Basic Science Department of the University. At first the candidates were few in number. They were surgical registrars of the Ministry of Health-averaging four-plus one or two private candidates. This did not satisfy Professor Taylor, and so in 1961 he wrote to the Vice-Chancellor of Khartoum University asking the University to select its own research assistants to qualify as surgeons and lecturers. By so doing, the process of Sudanization was started in the Department of Surgery. The author of this paper, Dr. Ali Kambal and Dr. Atabani were the first Sudanese to join the Department as research assistants in surgery. The number of candidates sitting for the examination in the last few years was from 14-18; mostly on their own initiative. The total number of those passing the Primary F.R.C.S. in Khartoum Centre amounted to about 60 Sudanese and a few others from neighbouring African countries.        Through his great influence in England, Professor Taylor was able to provide accommodation for those who passed the Primary in certain big London hospitals with good teaching facilities. Thus most of them got through the Final F.R.C.S. examination within one year. It is very evident that Sudan owes a great deal in the making of its surgeons to Professor Julian Taylor. Following a heart attack in Khartoum, the Professor died on his way to London. He was a great loss to this country and to the surgical profession.        With the appointment of Professor Taylor to Khartoum University, specialized surgery found its way to Sudan. The Professor himself had experience in neurosurgery. Mr. McGowen, F.R.C.S., who joined the Department of Surgery in 1956 was a Chest Surgeon. Mr. J. Jacques, F.R.C.S., succeeded Mr. McGowen in 1959 as Lecturer and Chest Surgeon. He was very devoted to his work and extremely helpful to his younger Sudanese colleagues. Mr. Jacques died suddenly in London of subarachnoid haemorrhage in the summer of 1962. Mr. D. Crockett, F.R.C.S., was the first Plastic Surgeon appointed as Lecturer in 1959. He stayed for 5 years during which time he was promoted to Senior Lecturer. He was able to establish plastic surgery as a recognised specialty in Khartoum Civil Hospital; and to convince the author and Mr. Kamal Bushra to pursue this line of specialization. Mr. Crockett left the Sudan in April 1964 for Bradford as a Consultant Plastic Surgeon to the Royal Infirmary.        Prof. M.F. Nicholls, K.B.E., M.A., M.Chir., F.R.C.S.: He studied at Clare College, Cambridge, and then St. George’s Hospital, London. He served as a soldier in the First World War. After graduation he ascended the ladder of appointments from house-officer, surgical registrar, resident assistant surgeon to full surgeon (1939) in St. George’s Hospital. During the Second World War, he was Brigadier to the R.A.M.C. He became Dean of the Medical School, St. George’s Hospital, and was a Member and later Chairman, Court of Examiners Royal College of Surgeons. Before retirement he was President Section of Urology, Royal Society of Medicine (Who’s Who 1972). Fishing was his favourite recreation. He arrived in Khartoum at the end of 1961 in place of late Professor Taylor. Professor Nicholls’ mission was not an easy one. Besides the teaching and administrative functions of the department-with the doubling of students intake-he had to maintain and improve the standards reached by Professor Taylor, particularly in the field of making of surgeons. The latter was kept very well as shown by the record of Khartoum Centre for the Primary Fellowship. By his good and friendly relations with Dr. Daniel-British Council Representative-Professor Nicholls was able to induce the Council to offer a number of scholarships for Sudanese medicals-in Ministry and University-to study in England. Thus if we know that the Primary F.R.C.S. examining team comes against the fees paid by the candidates, it becomes clear that the process of the making of surgeons in the Sudan has been very economical and of course very efficient.        Professor Nicholls, being a urological surgeon himself, introduced this specialty to three of our colleagues now working in Khartoum Civil Hospital. In addition a Department of Orthopaedics was initiated for the first time in Khartoum Civil Hospital during his tenure: according to an agreement between the Nuffield Orthopaedic Hospital Oxford, Ministry of Health and University of Khartoum. The agreement catered for the training of Sudanese surgeons in orthopaedics at Oxford, and for sending a senior lecturer from the Nuffield to run the department and teach the students in Khartoum. Five orthopaedic surgeons have come to Khartoum over a period of about 8 years from 1962 to 1970. The first was Mr. O’Conner (now professor of orthopaedics in Oxford regional hospitals) who started the process running in the first two years. He was succeeded by Mr. Denman, Mr. Eckerzli, Mr. Neeser and finally Mr. J.S. Ferguson. Five Sudanese orthopaedic surgeons were thus trained in Oxford according to this agreement.        Both Mr. Jacques and Mr. Crockett worked with Professor Nicholls during the initial two years followed by Mr. C. Davidson, F.R.C.S., who worked as senior lecturer from 1964 to 1966. Mr. Davidson replaced Mr. Crockett and maintained plastic surgery besides general surgery and teaching of students. After 1966 British staff in the department were reduced to the Professor and the Orthopaedic Surgeon. In 1967 the headship of the department was taken over by Professor Bakheit M. Omer, yet Professor Nicholls willingly continued to cooperate with all the Sudanese Staff in the department till his sudden death of a heart attack on Monday 25th August 1969. In the morning of that day he was at Khartoum Airport to see the Daniells off to Cairo on their way home. In the same plane the coffin of an Egyptian Professor of Engineering who died in Khartoum was being carried. Professor Nicholls told his wife at the Airport that if he died in the Sudan, he would not mind being buried in Khartoum. So his wish was fulfilled. Professor Nicholls was knighted on 9th July, 1969 by Queen Elizabeth II for his long, devoted service in war and in peace. A compelling coincidence to the death of Sir Marriot must be told at this junction. On Monday evenings there was always a clinico-pathological conference for 5th year students run by two members of staff, a surgeon and a pathologist. On the day of Sir Marriot’s death, it was his turn and Dr. Sayed Dawoud’s to conduct the lesson. “Sir Marriot after having lunch set the alarm clock at twenty minutes to five”, said his wife. Dr. Sayed Dawoud is a man of strict punctuality. When it was a few minutes past five and the Professor had not arrived for the class, Dr. Sayed Dawoud said to the students “The khawaga must have died”. Truly the Professor was dead. Professor Bakheit M. Omer, F.R.C.S.: In 1928, he left the Sudan at secondary school level-with others-after the political uprisings following the death of Sir Lee Stack in 1924. They were welcomed in Cairo and granted scholarships to complete their education. Having successfully finished his secondary school course, he left for Scotland and qualified in Edinburgh University. He returned home and served his internship in Khartoum after which he was posted in Nyala. He was dissatisfied with the very small salary given to Sudanese in comparison to British doctors. He left the Sudan for Egypt and afterwards for England to train as a surgeon. Having passed the English fellowship in 1951, he returned home again and app